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Efficacy of Distraction Therapy in Reducing Needlestick Pain in Pediatrics: A Scoping Review
Get PDFPurpose/Background
Pediatric pain management is often overlooked due to time constraints and lack of resources or education on interventions used, such as distraction or pharmacological therapy. Lack of pain management leads to patient and caregiver distress, as well as an increased number of attempts to perform the procedure. This scoping review evaluates the efficacy of distraction therapy compared to nonopioid pharmacological interventions for acute needlestick pain in children ages 6 to 12 years; patient and caregiver levels of distress were also evaluated in most studies.
Methods
The UTHSC (University of Tennessee Health Science Center) Library database was searched for full-text articles published in the last 5 years. Terms used included “pediatric needlestick pain”, “pain management”, “distraction and acute pain”, “lumbar puncture”, and “venipuncture”. 37 articles resulted, 25 underwent rapid critical appraisal for quality of evidence which resulted in 10 articles being selected based on ages 6 to 12 years, pain scale, intervention, and relevance to our PICOT question.
Results
Of our 10 articles, 6 articles demonstrated reduced pain when using distraction techniques. 7 articles showed decreased anxiety, fear, and distress. 5 articles stated increased parental and patient satisfaction. 2 articles reported decreased staff distress. However, only 3 articles demonstrated a statistically significant reduction in pain scores.
Implications for Nursing Practice
Although few of our articles showed statistical significance in pain reduction, most of our articles report lower pain scores with interventions used. Separating pain and anxiety in the pediatric population is difficult, therefore any reduction in pain scores should be seen as significant and interventions should be implemented appropriately
Screening for Social Determinants of Health in Children with Attention-Deficit/Hyperactivity Disorder
Get PDFPurpose/Background
Increased social determinants of health (SDoH) are associated with poorer health outcomes and decreased treatment compliance. Addressing SDoH can be associated with increased treatment compliance, although currently there is no standard for completing SDoH screening. The WE CARE screening tool is a validated screen that asks about 6 SDoH and whether the family is interested in assistance if the screen is positive. The purpose of this project was to implement the use of the WE CARE screening tool for patients with attention deficit hyperactivity disorder (ADHD) at follow-up visits.
Methods
From October 17, 2022 through November 22, 2022, charts were reviewed for patients scheduled with the participating nurse practitioner and physicians who met inclusion criteria. The WE CARE screening tool was administered and reviewed by the provider, then a referral to social work could be initiated if needed.
Results
Following chart review, 23 patients met eligibility criteria, and of these 12 (52%) completed a WE CARE form. Needs were identified on 2 of the completed forms (17 %), and no referrals were made to social work.
Implications for Nursing Practice
During the implementation period of this quality improvement project, only about half of eligible families had a screening form completed, either because the parent refused or because the physician or nurse practitioner forgot to give the form to the family. Based on the results of this initial implementation phase, more information is needed from the participating healthcare providers about whether they did not feel comfortable using the screen, thought the screen was helpful, or if there were other factors impacting the rate of form completion. It may also be helpful to try to use this screening tool with new patients first instead of follow-ups. The results of the current project do not yet support a change in practice by implementing this tool
Enhanced Recovery After Surgery (ERAS) for Cardiothoracic Surgery
Get PDFBackground/Purpose
Enhanced Recovery After Surgery (ERAS) protocols are multi-disciplinary approaches that optimize recovery and reduce surgical outcome variability. This scoping review compares surgical outcomes associated with traditional perioperative care to outcomes associated with an ERAS protocol for patients undergoing cardiothoracic surgery.
Methods
A literature review evaluating traditional perioperative care versus ERAS protocols in cardiothoracic surgical patients was performed to set inclusion and exclusion criteria based on current peer-reviewed journal articles for qualitative data. Group members selected 14 articles based on inclusion criteria and relevance to the PICOT question for review and placed findings in a synthesis table. Findings included compliance rate to protocol, length of stay (LOS), pain control, perioperative education, and complication rates. Control groups involved patients undergoing similar procedures from the same facilities utilizing traditional perioperative care compared to those enrolled in an ERAS protocol at 1 month, 3 months, and 6 months postoperative.
Results
Of the included studies (N=14), the most significant outcome from the evidence collection is a decreased LOS with the ERAS protocol (N=13). Postoperative complication rates decreased in 57% of the articles (N=8) and hospitalization costs decreased in half of the articles (N=7) when using ERAS protocols. Hospital readmission rates were either maintained (N=12) or decreased (N=2). These trends indicate that ERAS protocols are associated with improved patient outcomes and decreased hospitalization costs.
Implications for Nursing Practice
This scoping review shows that ERAS protocols consistently produce positive surgical outcomes. Because ERAS protocols consolidate evidence-based practices known to improve surgical outcomes, they comprise a straightforward plan for hospitals to implement that will effectively improve surgical outcomes for patients. Utilizing ERAS protocols from the pre-admission to post-discharge phases of care should be standard practice for appropriate patient groups
PKPD-Model Based Preclinical Characterization of the Activity of Spectinamide 1599 Against Mycobacterial Subpopulations. and the Identification of Potential Partners for Combination Therapy
Get PDFTuberculosis is one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent prior to COVID19. Mycobacterium tuberculosis (Mtb) is the causative agent of TB. The interaction between Mtb and the immune system leads to development of diverse environmental niches and physiology within the lung of the TB patients. Mtb is thought to adapt and thrive in such an environment by transforming to different phenotypic variants. Such variants are difficult to kill and are thought to prolong TB pharmacotherapy. Spectinamide 1599 is a synthetic modification of spectinomycin that has demonstrated excellent preclinical drug like properties such as excellent in vivo efficacy, strong efficacy against clinical MDR isolates, lack of cross resistance, long post antibiotic effect, and low toxicity potential. It also has a favorable pharmacokinetic profile and is primarily eliminated in the urine and thus has a low propensity for drug-drug interaction with other partner drugs. In addition, spectinamide 1599 has shown good lung penetration, good accumulation within lungs of mice over multiple doses, and high uptake into macrophages. In the first set of studies, we characterized the activity of spectinamide 1599 against log, acid and hypoxic phenotypic variants of Mtb using various in vitro approaches involving static and dynamic drug concentrations over time. We used minimum inhibitory concentration (MIC) and dose response studies to characterize the activity of spectinamide 1599 against log, acid, and hypoxic phenotypic variants. We found that, spectinamide 1599 has an MIC of 0.78 µg/mL against log phase bacteria and 6.25 µg/mL against acid phase bacteria. We then used the hollow fiber infection model (HFIM) as a dynamic pharmacokinetic (PK) and pharmacodynamics (PD) model system to evaluate the activity of spectinamide 1599 against log and acid phase bacteria. Our results show that spectinamide 1599 exhibits a potent dose-dependent bactericidal effect against log phase bacteria, but has limited effect against acid phase bacteria. We built a PK/PD model to characterize the activity of spectinamide 1599 against log and acid phase bacteria through estimated parameters. In the next set of studies, we attempted to integrate available preclinical data through a meta-analysis PK/PD model-based approach to quantitatively screen and characterize ternary drug combinations containing spectinamide 1599 in BALB/c mouse models of TB. The metanalysis process involved building models to describe natural growth of mycobacteria in the lungs of mice, the PK/PD effect of single and binary anti-TB drug regimens on growth of mycobacteria over time. The natural growth, single and pairwise drug model parameters were then used to predict bacterial kill for ternary drug combinations containing spectinamide 1599 using the Isserelis theorem. Once we achieved reasonable prediction of ternary drug combinations containing spectinamide 1599, we simulated bacterial kill of other ternary drug combination regimens to screen and rank combinations and create a framework to prioritize which combinations should be explored first in mouse models of TB. Altogether, the results of the above studies can be used as a roadmap or guide the optimization of spectinamide 1599’s dosing regimen in the preclinical development phase
The Effects of Exosomal Derived TSG-6 on Microglia Activation
Get PDFFollowing a traumatic brain injury, microglia become overactive for long periods and display pathologic behavior. We have shown that concentrated conditioned media from adipose tissue-derived mesenchymal stem cells (MSC-CCM) can suppress microglial activation. In this pilot study, we evaluated the efficacy of exosomes containing TNF-stimulated gene 6 (TSG6) derived from MSC-CCM on decreasing microglial activation in vitro via phagocytic activity and pro-inflammatory microglial gene expression
The Effectiveness of Increasing Frequency of Central-Line Dressing Changes and Monitoring on CLABSI Rates: A Scoping Review
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Purpose/Background
Central lines provide many benefits to critically ill patients; however, there are additional risks with them, including central line-associated bloodstream infections (CLABSIs). CLABSIs place patients at increased risk for morbidity and mortality, longer length of stay, and higher medical costs. Studies evaluating various methods of reducing CLABSIs have been performed. This scoping review was completed to determine the effectiveness of frequent central-line dressing changes and increased monitoring on the incidence of central-line associated blood stream infections in adults with central-lines.
Methods
An extensive database search through the University of Tennessee Health Science Center (UTHSC) Online Library was performed between September of 2019 and November of 2022. EBSCO/CINAHL, PubMed, Cochrane, and Scopus databases were utilized, using key terms: monitoring, CLABSI, dressing changes, central line, infection, bundle care, and central venous catheter. Of the 2,341 articles resulted, 15 articles were chosen based on relevance, results, and quality of the articles. Tables were created to identify levels of evidence and evidence outcomes.
Results
Out of the fifteen articles selected, eight reported a decrease in CLABSI rates. Many facilities reduced their CLABSI rate while lowering frequency of CVC dressing changes. Increased CVC bundle compliance, CVC surveillance, improved documentation, and use of checklists contribute to these reduced rates, but confound the results.
Implications for Nursing Practice
The articles revealed that the utilization of CVC surveillance decreased CLABSI rates. It is unclear how the frequency of CVC dressing changes affects CLABSI rate. Most studies failed to mention dressing changes, and when mentioned, the frequency of dressing changes was reduced with continued reduction in CLABSI rate. Further studies isolating these variables is recommended
Extubation and Weaning: Implementing a Standard Weaning Protocol
Get PDFPurpose The purpose of this project is to determine if implementation of a standardized weaning protocol on mechanically ventilated patients affects reintubation rates and decreases adverse outcomes
Theory Lecture, Penn State, Pittsburgh
No full textLecture on theory given at Penn State University, Pittsburgh, undated
Modulation of Cerebral Artery Smooth Muscle BK Channel Function by Neurosteroids
Get PDFVoltage-gated and Ca2+ activated K+ channels of large conductance (BK) channels are essential for many key physiological processes, such as controlling the contraction of smooth muscle, including cerebrovascular smooth muscle. Importantly, BK channels are made up of a homotetramer of α subunits which associate with accessory β subunits. These β subunits alter the activity of the channel; this modulation is subunit-specific. Moreover, these accessory subunits have tissue-specific expression, such that the β1 subunit is highly expressed within cerebrovascular smooth muscle and greatly increases the open probability of BK channels. Increased BK channel open probability is linked to increased dilation of cerebral arterial smooth muscle. The tissue specificity and functional effects of the β1 subunit offer a unique opportunity for the identification of pharmacological activators to be developed with few off-target effects. While many steroids have been implicated to have vasoactive effects, including but not limited to, pregnenolone and progesterone, these effects have been mainly attributed to the actions produced by the activation of traditional steroid receptors. Importantly, both pregnenolone and progesterone are currently under investigation for clinical applications, including substance- and alcohol-use disorders, and treatments for ischemic-related brain injury, respectively. Additionally, cholesterol maintains clinical importance as the western diet maintains high levels of cholesterol which are known to increase the risk of heart disease and stroke through maladaptive vasoactive effects. Since the precursor to, and the neurosteroids all produce vasoactive effects, it is important to identify the molecular mediators modulating these effects. This body of work examines the cerebrovascular effects of and determines the mechanisms of action by which the neurosteroids pregnenolone, progesterone, and the precursor cholesterol, modulate the BK channel activity while investigating pre-clinical implications for the K+ channel activators. Through functional, biochemical, and molecular analysis we are able to determine: 1. the physiological implications of; 2. the subunit-specificity for; 3. binding site(s) of; and 4. the gating parameters affected by, the direct binding of neurosteroids to the BK channel complex
Early Manual Lymphatic Drainage with Secondary Edema
Get PDFImplementation of an early manual lymphatic drainage program on post-op head/neck patients to decrease secondary edema