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Feasibility and Effectiveness of a Prehabilitation Program Prior to Breast Cancer Surgery: A Critically Appraised Topic
Get PDFThe purpose of our project is to determine the feasibility and effectiveness of a prehabilitation (prehab) program for patients undergoing breast cancer surgery as compared to only receiving post-surgical rehabilitation. Our clinical mentor has recently obtained certification as a lymphedema specialist and is assisting with the opening of an outpatient mastectomy clinic through the Methodist University systems. Through our research process, we critically appraised two Level II articles, two Level III articles, and one Level IV article. Positive outcomes related to the feasibility were identified, however there is limited significant evidence supporting the effectiveness of the intervention. We recommend using the intervention with caution and monitoring based on the preliminary nature of the current evidence. Further studies should be conducted to determine the effectiveness of the intervention
Muscular Dystrophy and Quality of Life: A Critically Appraised Topic
Get PDFMuscular dystrophy causes progressive muscle disease that affects both children and their families. This poster describes a critical appraisal and synthesis of the literature describing factors affecting quality of life for children with MD. Identification of these factors can help professionals educate and support individuals and their families
ETD Formatting and Reviewing: Hot Topics and Questions
Get PDFOne of the most important products from university graduate programs is highly qualified professionals. Ultimately, student success is one measure of a university’s academic quality. But another measure of academic quality is the institution’s online continuous display of ETDs. This display is a public picture of content and style representing the students and their university. Thus, ETD administrators are tasked not only with the format reviews but also the continuous improvements in all aspects of the ETD workflow to ensure the integrity of their institutions’ public-facing ETDs.
To facilitate the plenary discussion about ETD formatting and reviewing for differentsized institutions at the USETDA Conference, each chapter of this manuscript, except for one, provides a brief ETD administrator sketch of their university ETD formatting and review process that produces varying numbers of ETDs per year. The additional chapter, provided by the Overleaf panelist, describes how the Overleaf free tool-set can support the ETD formatting and review process.
This information along with a Q & C survey (Questions and Comments) is available to all USETDA conference registrants prior to the conference for their questions and comments. Asking questions or providing as many comments as possible prior to the panel discussion will help to make this program a successful event.
We invite you to consider the following questions and thoughts as you review the information:
• Is ETD capacity tied to ETD process management, or is it only tied to the human financial support of these programs?
• Does your university consider its ETD formatting and review process to be an asset or a liability?
• How is your ETD program organized?
• How well is your review process working?
• Do you have enough support relative to reviews and reviewers to produce high quality and reader functional digital manuscripts?
• How do the campus-wide stakeholders coordinate their efforts to assist students and faculty with ETD creation, formatting, and review?
• Does your university invest in innovative ETDs?
• Is the quantity of ETDs produced inversely proportional to quality?
• What criteria should we consider in efforts to improve styles (formatting) and reader functions?
• What role should ETD administrators play in improving the universities’ ETD products?
Collecting ETD formatting and reviewing information allows administrators and institutional ETD stakeholders to examine different university methods, and question, comment, or make suggestions. By actively participating in this panel discussion, we hope you will be better equipped to provide constructive advice with documented examples to your own stakeholders and for your own ETD programs.
This manuscript will be expanded after the 2022 USETDA conference to integrate gaps brought up during the plenary discussion. Subsequently, each of the initial chapters in this manuscript will be finalized as the first version of this e-book to recognize the original authors’ contributions. It is our intention that this e-book will be presented as an open project. After the first version has been published, we invite ETD administrators and universities to participate in this project by submitting a chapter about their own practices. This e-book will be constantly evolving as contributions are accepted and authors’ updates are provided annually
OTULIN\u27s Novel Regulatory Mechanisms in Genotoxic and Inflammatory NF-kB Signaling
Get PDFTriple negative breast cancer (TNBC) is aggressive but cannot be treated with hormone therapy or molecular therapy due to the lack of a target. Chemotherapy is a systemic treatment that works by attacking rapidly growing cells, which is initially more effective for TNBC patients than those individuals with the hormone receptor-positive breast cancer. However, patients with TNBC tend to develop resistance to chemo drugs, called chemoresistance. After years of effort, the signaling pathways involved in TNBC chemoresistance are gradually revealed, including the nuclear factor-kappa B (NF-kB) pathway. Transcription factor NF-kB is widely involved in cancer development and progression, and its overactivation renders chemoresistance to TNBC and induces aberrant inflammation. Therefore, targeting NF-kB becomes a feasible strategy to overcome chemoresistance. Ubiquitination is an essential post-translational modification during which ubiquitin chains are assembled on a substrate protein, leading to various cellular processes, such as endocytosis, membrane trafficking, DNA repair, signal transduction, and protein degradation. The outcome of one ubiquitinated protein is dependent on its ubiquitin linkage and the context. Our previous study has shown that the linear ubiquitin chains assembled by the linear ubiquitin chain assembly complex (LUBAC) solidly facilitate NF-kB signaling transduction upon genotoxic stress. OTU deubiquitinase with linear linkage specificity (OTULIN) is known to cleave linear ubiquitin chains exclusively. The purpose of this dissertation is to investigate whether OTULIN can counteract LUBAC-mediated NF
Screening for Social Determinants of Health to Improve Care in Pediatric Patients with Recurrent Urinary Tract Infections: A Scoping Review
Get PDFPurpose: To describe what is known about how SDoH screening impacts adherence to treatment in pediatric patients with recurrent UTIs
A Scoping Review: Trauma Informed Care for Justice Involved Youth to Decrease Recidivism
Get PDFPurpose The purpose of this scoping review was to address trauma-informed care, juvenile justice systems, and recidivism rates. The literature review conducted identified key research and analysis of effective trauma-informed treatment methodologies, referrals, and accessibility of care for justice-involved youth, and the rate change of recidivism related to trauma-informed treatment and interventions.
Background The high rates of recidivism in the juvenile court systems matched with the increased prevalence of psychological trauma in justice-involved youth represent the need for implementing trauma informed care. The scoping review analyzed the research implementing the intervention of trauma informed care to determine if it resulted in justice involved youth more likely to have a higher success rate of regulating trauma symptoms and behaviors, thereby decreasing recidivism rates.
Methods The scoping review was conducted following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) reporting guidelines for scoping review. A computerized database search of PubMed, Social Science Research Network (SSRN), and Scopus was performed. Scientific articles, approved by an international peer review board and published in medical, social science, or nursing journals were included.
Results The findings of the scoping review analyzed trauma-informed approaches and effective justice interventions in the juvenile justice system’s impact on reducing recidivism. Common trends included the ongoing need to establish standardized assessments of trauma, improve trauma-informed programs, and development of trauma interventions system-wide.
Implications for Nursing Practice Nursing serves as a trauma informed intervention for justice involved youth to reduce recidivism rates. Creating awareness of trauma informed care through nursing education provides current and future healthcare workers the education and tools to effectively reduce recidivism in justice-involved youth. The goal of utilizing nursing’s unique role in this patient population is to implement trauma informed care and prevent additional trauma experiences
Dexmedetomidine to Reduce PONV
Get PDFPurpose/Background Postoperative nausea and vomiting (PONV) contribute to patient dissatisfaction, discomfort, adverse outcomes, and increased healthcare costs. Despite current protocols that aim to reduce PONV by prevention/antiemetic administration, PONV continues to be a common manifestation in many postoperative patients (Elvir-Lazo et al., 2020). This scoping review aimed to analyze available research on the efficacy of dexmedetomidine to reduce perioperative opioid requirements and PONV.
Methods Synthesis of this scoping review began with a systematic approach to search databases and identify eligibility criteria articles. Of the 21 articles that met criteria, a synthesis table was formed to visualize the qualitative (smoking status, surgery type, medical history, etc.) and quantitative (sex, age, American Society of Anesthesiology (ASA) status, etc.) data points of interest. Ten articles were then selected for review via Rapid Critical Appraisal (RCA). Finally, each article’s comparison of two study groups (patients receiving dexmedetomidine without opioids and those who did not) were analyzed to find a direct correlation between dexmedetomidine administration and a decrease in PONV.
Results For 100% of studies analyzed, dexmedetomidine reduced the incidence and severity of PONV. 90% of studies showed decreased perioperative opioid requirements. The method of dexmedetomidine administration was the most potent predictor of undesirable hemodynamic changes, highlighting the need for further research on appropriate dosing of dexmedetomidine when using it in an opioid-sparing manner to reduce PONV.
Implications for Nursing Practice The evidence found highlights the efficacy of using dexmedetomidine to reduce perioperative opioid usage and PONV. Nevertheless, the practice of using two classes of antiemetics to prevent PONV remains the standard in anesthetic practice, making some providers hesitant to attempt using dexmedetomidine for this purpose. Providers should be educated on the findings of this scoping review, and further studies aiming to identify the efficacy of using dexmedetomidine should be conducted
Comparing the Effectiveness of Perioperative Ketorolac to Opioids: A Scoping Review
Get PDFAbstract Purpose/Background Opioids are commonly administered in the perioperative period to manage surgical pain. However, the ongoing opioid epidemic in the United States makes it necessary to evaluate other modalities of pain management that do not cause respiratory depression, nausea, vomiting and addiction. Ketorolac is a nonsteroidal anti-inflammatory drug that can manage pain safely and effectively. This scoping review examines the available literature on the effectiveness and feasibility of using ketorolac to minimize perioperative opioid use.
Methods A comprehensive literature review was performed between October 2020 and September 2021 utilizing five scholarly databases: GoogleScholar ™, PubMed, Ovid, Cochrane Library, and the University of Tennessee Health Science Center (UTHSC) library databases. The key terms searched were “narcotics,” “opioids,” “intraoperative,” “ketorolac,” and “Toradol.” 28 articles met the initial inclusion criteria and were subjected to a rapid critical appraisal by each team member. Fifteen articles were included in the final review and the results of the literature were organized in a synthesis table.
Findings The literature surveyed in this scoping review suggests that perioperative ketorolac administration reduces postoperative opioid consumption and postoperative pain scores in adult patients undergoing a variety of surgical procedures. Furthermore, perioperative ketorolac administration significantly reduced the incidence of PONV and was not associated with any significant adverse effects or negative postoperative outcomes in adult surgical patients. Finally, the authors identified significant heterogeneity in the current data, which limited their ability to provide specific guidance for practice.
Interpretations The scoping review authors suggest that further, more robust, and homogenous studies should be performed regarding the efficacy and safety of ketorolac in the perioperative period. In general, intraoperative ketorolac administration provided sufficient, opioid-sparing analgesia without the adverse effects of narcotics. Ketorolac is a valuable adjunct in a multimodal perioperative analgesia regiment. Anesthesia providers should strongly consider utilizing ketorolac as an alternative to perioperative opioids to improve postoperative patient outcomes and combat the opioid epidemic in America
Esmolol Compared to Fentanyl on Hemodynamic Effects: A Scoping Review
Get PDFPurpose The purpose of this DNP project is to compare the efficacy of esmolol to fentanyl in attenuation the hemodynamic response associated with direct laryngoscopy.
Specific Aims Compare the effects of esmolol to fentanyl on patient heart rate during laryngoscopy. Compare the effects of esmolol to fentanyl on patient mean arterial pressure during laryngoscopy
Implementation of Enhanced Recovery After Surgery (ERAS) Guidelines: A Comprehensive Interdisciplinary Approach
Get PDFPurpose/Background Enhance Recovery After Surgery (ERAS) protocols are multimodal transdisciplinary care guidelines that can improve clinical outcomes and cost savings. Although surgical practices currently vary significantly among healthcare institutions, perioperative outcomes and safety appear to improve with ERAS pathways. This scoping review evaluates patient outcomes and satisfaction in adult patients during their first week postoperatively while utilizing ERAS pathways.
Methods This scoping review includes a variety of peer-reviewed and published academic journals within the last five years to guarantee the information surveyed is current. Even though this scoping review focuses on the interdisciplinary method to executing ERAS pathways, studies demonstrating alternate approaches were included to ratify evidence-based interventions. Databases utilized for this review include EBSCO, CINAHL, Pubmed, and Medline. The literature search resulted in 2,222 articles meeting initial criteria but was narrowed down based on level of evidence, citation, methodology, sample/setting, data analysis, description, results/findings, and evaluation of practice worth.
Results Although many outcomes were examined throughout the literature, postoperative complications, patient outcomes, LOS, and potential savings were most common. Additionally, the RCTs included in this scoping review encompassed many measured results. Nearly all of the published ERAS trials and studies analyzed demonstrated a reduction in LOS and postoperative complications with the use of ERAS interventions when compared to traditional postoperative surgery guidelines.
Implications for Nursing Practice Overwhelming evidence supports the implementation of standardized, evidence-based ERAS pathways to decrease surgical costs and improve surgical outcomes. However, variations in the capabilities of different healthcare systems currently limit the implantation of every possible ERAS intervention. Implications for nursing practice emphasize further implication and participation of standardized ERAS guidelines for surgical patients during all phases of their perioperative journey