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1172 research outputs found
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Using EHR Reminders to Control Hypertension
Full text linkPurpose/Background
Hypertension is a significant risk factor for cardiovascular and kidney diseases but is often under-diagnosed and poorly managed. Electronic Health Records (EHR) can help by providing automated reminders to recheck elevated blood pressure (BP) readings, ensuring accurate measurements, and guiding clinical interventions. This study aims to determine if EHR-based reminders improve BP control in adult patients aged 21 and older, focusing on hypertension diagnosis accuracy and timely management.
Methods
After a literature review, the study took place in a primary care clinic and only included patients with an existing diagnosis of hypertension. Thirty patients were included in the study. Personal identifying factors were redacted, and they were assigned numeric numbers. The following data was obtained and analyzed: the highest and lowest in-office BPs, the number of times BP was re-checked if over 140/90, and the percentage of BPs ≤140/90 or ≥140/90.
Results
Among all research participants (n=30), 14 had BPs ≤140/90 while 16 had BPs ≥140/90. Out of the 16 participants with elevated BPs, 9 had rechecks, with 5 having BPs ≤140/90. 5 did not get BP rechecks. The percentage of BPs ≤140/90 was 46.67%, and ≥140/90 was 53.3%. Results of the study indicate rechecking in-office BPs can be beneficial in reducing the number of high readings, potentially minimizing unnecessary diagnoses of hypertension.
Implications for Nursing Practice
Re-checking BPs in-office helps reduce the likelihood of false high readings caused by anxiety or temporary factors, ensuring more accurate diagnoses. This approach can prevent unnecessary hypertension diagnoses and reduce the over treatment of patients. It also promotes individualized care, allowing clinicians to confirm elevated readings before initiating treatment, which leads to better patient outcomes and reduces healthcare costs
Evaluating the Effectiveness of a Non-Pharmacological Sleep Bundle for the Prevention of Delirium in Geriatric Patients in the Intensive Care Unit: A Scoping Review
Full text linkPurpose/Background
Delirium is an acute disorder yielding cognitive deficits, such as disruption in attention and awareness. It impacts approximately 50% of individuals over the age of 65 who are admitted to the hospital and is prevalent with patients in the intensive care unit (ICU). ICU delirium is associated with adverse outcomes, including higher morbidity, prolonged hospital stays, and chronic neurocognitive deficits. Research demonstrates that implementation of a non-pharmacological sleep bundle can reduce the overall occurrence of delirium. The purpose of this scoping review is to examine the efficacy of a non-pharmacological sleep bundle on the incidence of ICU delirium in geriatric patients.
Methods
Between August 2022 and November 2024, a scoping literature review was conducted using the following keywords: ICU delirium in geriatric patients and non-pharmacological sleep aids for ICU delirium. The four primary outcomes for analysis were implementation of age-appropriate treatments (IAAT), incidence of delirium associated with non-pharmacological sleep interventions (IDNST), ICU sleep quality (ICUSQ), and length of stay in the ICU (ICULOS). 12 articles were chosen for inclusion in this review based on quality and relevance to the topic.
Results
This review shows that non-pharmacological sleep bundles can decrease the incidence of ICU delirium and create a marginal improvement in sleep quality in the ICU. There was not enough relevant research to show if non-pharmacological sleep bundles can decrease ICU length of stay or whether these bundles have any specific impact on the geriatric population.
Implications for Nursing Practice
Implementing a non-pharmacological sleep bundle in the ICU for geriatric patients above the age of 65 is associated with a lower incidence of ICU delirium. Further research is needed to examine the effectiveness of non-pharmacological sleep bundles on the quality of sleep in the ICU and the length of stay in the ICU, specifically in geriatric populations
Scoping Review of Algorithms for Electronic Fetal Monitoring
Full text linkPurpose/Background
The purpose of this scoping review is to review the use of an algorithm in evaluating continuous external fetal heart rate (FHR) monitoring in labor as opposed to clinician judgment for improved fetal outcomes, including earlier recognition of abnormal tracings (Clark et al., 2017). FHR monitoring was created to evaluate for fetal hypoxia in labor and has become standard practice (Gyllencreutz et al., 2018). One of the goals of the use of cardiotocography is to decrease hypoxia-induced fetal metabolic acidemia and neurologic injury. There are multiple options for individual or computer-based algorithms in evaluating FHR to reduce fetal acidemia rates. A scoping review was used to synthesize the data and review the potential implications.
Methods
The information sources for this scoping review included PubMed at UTHSC, as well as CINAHL and Google Scholar from October 2023 until November 2024. After narrowing the criteria applied, the articles were reviewed to consider relevance and application.
Results
The use of standardized algorithms increased the identification of abnormal FHR patterns while identifying fetal hypoxia-induced fetal metabolic acidemia. However, it did not show any association with improved fetal outcomes, namely the identification of low APGAR score or rates of Cerebral Palsy. The use of the algorithm increased interrater reliability and resulted in decreased time from the abnormality visualized to the delivery time.
Implications for Nursing Practice
FHR is a key assessment tool used nationwide in hospital labor and delivery units with a need for further investigation into which specific algorithm to use and further of how to improve outcomes. There is a nationwide initiative to decrease the rates of primary cesarean section delivery with a needed risk-benefit analysis of expedited delivery and outcomes. The use of a standard algorithm in the evaluation of electronic fetal monitoring shows potential for finding a solution to adverse neonatal outcomes
Central-line dressing protocols: The effectiveness of a standardized dressing change protocol in reducing central-line associated bloodstream infections (CLABSI) in critically ill patients requiring central lines
Full text linkPurpose/Background
In the Intensive Care Units (ICU), central lines are an essential way of life. However, central lines have risks such as central line-associated bloodstream infections (CLABSI), which increase hospital stays and mortality. CLABSI significantly impacts patient outcomes in critical care, increases mortality and morbidity, increases medical costs, increases hospital-acquired infections, and reduces hospital reimbursements. Typically, antimicrobial dressing has been associated with decreased mortality and improved CLABSI rates. The scoping review will evaluate the literature and examine the effectiveness of various antimicrobial dressing strategies on CLABSI rates. This study aims to synthesize these findings to develop improved CLABSI prevention protocols in ICUs, ultimately enhancing patient outcomes.
Methods
Following PRISMA guidelines, a literature review was performed from August 2022 through December 1, 2024, synthesizing research published within the last five years. Articles were selected based on their relevance. Individual searches of Clinical Key, Elsevier, Cochrane, NCBI, CDC, LBM, and Washington Medical Therapeutics were completed using the following keywords: “adult patients hospitalized with CLABSI,” “dressing change protocol,” “no protocol,” “affect the incidence of CLABSI,” “in the intensive care unit,” “central line infection,” dressing changes,” “dressing change protocol,” and “CHG.” Out of eighteen potentially appropriate articles, a rapid critical appraisal and in-depth discussion of these articles yielded a final section of 8 articles. The goal was to note that proper CVAD dressing changes reduce CLABSI rates.
Results
Building on Paquet et al. (2019), who transitioned from CHG-impregnated dressings to dry dressings without increasing CLABSI rates, we emphasize the need for a structured dressing change protocol. Webster et al. (2017) found no significant difference in CLABSI rates between CHG and PHMB dressings, attributed to their existing dressing bundle.
Research by Pook et al. (2022) suggests CHG locking solutions are more effective than standard methods for reducing bacterial growth. Mitchell et al. (2020) demonstrated the benefits of sutured central lines with CHG discs and integrated securement devices. Wei et al. (2021) reported a 68% decline in CLABSI due to comprehensive protocols, while Hunger et al. (2020) and Reynolds et al. (2021) emphasized the importance of adherence to established protocols for reducing rates. Conversely, Yu et al. (2019) found that CHG dressings did not significantly decrease CLABSI rates despite less frequent dressing changes.
Implications for Nursing Practice
This scoping review underscores the importance of standardized central line dressing change protocols in reducing CLABSI rates and improving patient outcomes in ICU settings. Nurses and nursing staff are pivotal in implementing and adhering to these protocols. The findings suggest that continued refinement and compliance with dressing change protocols, particularly CHG dressings, should be prioritized to enhance patient safety, reduce infection- related complications, and shorten hospital stays. Future research should focus on the optimal design and long-term outcomes of various dressing change protocols to further inform best practices in ICU settings
Enhancing Schizophrenia Treatment Outcomes: Integrating CBT with Medication Therapy to Reduce Hospital Readmission
Full text linkPurpose/Background Schizophrenia is a chronic mental illness that disrupts cognition, emotion, and social functioning, imposing significant personal and societal burdens. While antipsychotic medications are effective in alleviating psychotic symptoms, they are often associated with side effects, poor adherence, and relapse risk. Cognitive behavioral therapy (CBT) has shown promise as an adjunct to medication, addressing persistent symptoms and improving outcomes. This scoping review examines the integration of CBT with medication therapy to reduce hospital readmissions and improve quality of life for adult patients hospitalized with schizophrenia.
Methods A systematic search of databases, including PubMed, PsycINFO, Embase, and Cochrane Library, was conducted alongside the University of Tennessee Health Science Center online Library. Peer-reviewed studies examining CBT in combination with medication therapy versus medication alone were included. Eligible studies utilized quantitative or mixed-method designs, including RCTs, cohort studies, and systematic reviews, focusing on hospital readmission rates, symptom severity, quality of life, and treatment adherence. Ten studies met the criteria, with outcome data measured using scales such as the Positive and Negative Syndrome Scale (PANSS), Personal and Social Performance Scale (PSPS), and Goal Attainment Scale (GAS).
Results The review included 5 systematic reviews, 4 RCTs, and 1 literature review. Findings demonstrated that CBT significantly improves positive and negative symptoms of schizophrenia, reduces hospital readmission rates, and enhances quality of life. These outcomes highlight the utility of CBT as an effective adjunct to medication therapy.
Implications for Nursing Practice Nurses play a vital role in integrating CBT with medication management to enhance patient outcomes. By advocating for evidence-based practices, educating patients and families, and supporting treatment adherence, nurses can foster holistic care strategies that reduce hospital readmissions, improve symptom management, and enhance quality of life for patients with schizophrenia
Evaluation of Depression Screening Tools for Utilization in Adolescents: A Scoping Review
Full text linkPurpose/Background
Anxiety and depression are prevalent mood disorders among the adolescent population with significant impacts on academic performance, social interactions, and mental well-being. With depression rates continuing to rise and suicide among the leading causes of death in adolescents, there is an urgent need for effective screening and intervention. While depression screening is recommended in the primary care setting, many adolescents do not have regular access to healthcare, complicating early identification and treatment. The purpose of this scoping review is to compare the effectiveness of two depression screening tools, the Patient Health Questionnaire (PHQ-9) and the Beck Depression Inventory (BDI), to identify the most effective tool for depression screening specifically in the adolescent population.
Methods
This scoping review synthesized evidence on the efficacy of depression screening tools in adolescents aged 14-18, focusing on the PHQ-9 and Beck Depression Inventory (BDI). A systematic search was conducted across multiple databases between 2021 and 2024, yielding ten relevant studies. These studies assessed the validity, reliability, and effectiveness of the PHQ-9 and BDI in detecting depression in adolescents, primarily in public school settings, and examined the impact of these screenings on referral rates for mental health care.
Results
Both the PHQ-9 and BDI were found to be valid and reliable tools for screening adolescent depression. The PHQ-9 was particularly favored due to its brevity, accessibility, and alignment with DSM criteria, making it highly suitable for universal screening in school and primary care settings. The BDI, while comprehensive, was more appropriate for situations requiring a detailed assessment of depression severity.
Implications for Nursing Practice
Research suggests that universal screenings for depression in public schools is an ideal setting for identifying adolescents who may require mental health services. The studies that were reviewed present the importance of screening adolescents for depression to improve their overall quality of life. The implementation of routine screenings can fulfill an essential role in early identification and intervention, leading to improved outcomes for adolescents with depression. Screening programs must include a referral process to ensure that adolescents who screen positive are connected to mental health professionals and services. Both the PHQ-9 and BDI are considered sufficient for screening. However, Advanced Practice Registered Nurses should remain aware of current research and evidence-based practice, as well as advocate for further research that includes the available screening tools to determine their effectiveness and reliability
Efficacy of Aprepitant and Ondansetron in Managing Postoperative Nausea and Vomiting in Perioperative Obese Patients
Full text linkPurpose/Background
Postoperative nausea and vomiting (PONV) is a common adverse event that occurs during the recovery period following anesthesia. PONV has been reported to affect nearly 80% of patients, leading to prolonged hospitalization, increases in cost of care, patient dissatisfaction, dehydration, electrolyte imbalances, acute kidney injury, and pulmonary aspiration. Certain risk factors, including obese patients, female gender, and nonsmoker status, increase the risk of PONV. Traditionally, for all patients going under anesthesia, a prophylactic antiemetic regimen is administered; however, since obese and other high-risk patients are at increased risk of experiencing PONV despite traditional regimens, anesthesia providers should administer multiple medications to help ensure PONV is avoided. Aprepitant, a Neurokinin-1 antagonist, is an effective adjunct in the prevention and treatment of PONV. This scoping review aims to compare the effectiveness of Aprepitant compared to other conventional antiemetics, such as Ondansetron, in treating and preventing PONV in high-risk patients undergoing laparoscopic surgery.
Methods
The synthesis of this scoping review was conducted in September 2023 to March 2024 with a systematic database search to identify articles that met the eligibility criteria. A total of 25 eligible articles were included, and a synthesis table was created to organize the relative qualitative and quantitative data. From these, ten articles were selected for further evaluation through Rapid Critical Appraisal (RCA). Lastly, the ten articles were further reviewed to find whether Aprepitant alone versus in combination with Ondansetron worked better in managing post-operative nausea and vomiting in perioperative obese patients.
Results
The studies generally support the prediction of aprepitant’s effectiveness in reducing post-operative nausea and vomiting, especially in the obese population. The most consistent outcome amongst the ten selected articles showed a significant decrease in PONV with the combination of aprepitant and ondansetron. Data indicated a reduction in nausea, vomiting, and use of rescue medications with aprepitant use alone. One trial showed that the combination delayed PONV but was not more effective than using Ondansetron alone. Another study found that aprepitant was more effective in the long-term recovery period than Ondansetron. While not all studies support the use of combination anti-emetic therapy, the majority supports using aprepitant in the obese population for further PONV prevention.
Implications for Nursing Practice
A summary of the evidence supports the use of aprepitant in reducing postoperative nausea and vomiting in the obese population. The purpose of this scoping review was to condense evidence to support the use of aprepitant in decreasing postoperative nausea and vomiting, reducing hospital stay, and reducing adverse patient outcomes in the bariatric population. Current research indicates that integrating aprepitant for preventing PONV using a multimodal antiemetic approach is rapidly becoming the standard of care
Activation of the P2XR7 Channel by Non-Nucleotide Agonists
Full text linkP2X receptors (P2XRs) are a family of ionotropic purinergic receptors composed of seven subtypes (P2XR1–P2XR7). These trimeric, ligand-gated, non-selective cation channels are activated by adenosine triphosphate (ATP). While all P2X receptors respond to ATP, they exhibit significant variability in sensitivity, desensitization kinetics, and roles in cellular signaling. Among them, P2XR7 is unique due to its low ATP sensitivity, requiring approximately 1 mM ATP for half-maximal activation. This suggests that P2XR7 activation may necessitate alternative activation mechanisms or proximity to an ATP source, as observed in inflammatory microenvironments where P2XR7 plays a well-established role in inducing non-infectious inflammation. ATP, a damage-associated molecular pattern (DAMP), faces challenges in reaching the high extracellular concentrations required for P2XR7 activation due to rapid enzymatic degradation by ATPases. This raises questions about how P2XR7 achieves functional activation in such conditions. To address this gap, we investigate whether P2XR7 activation can be influenced by other extracellular molecules that accumulate in damaged microenvironments. Specifically, we focus on circulating histones and antimicrobial peptides (AMPs), such as LL-37, which are known DAMPs that increase at inflammatory sites following cell damage and innate immune cell activation. Extracellular histones have been shown to induce Ca²⁺ influx and propidium iodide (PI) uptake in endothelial cells, suggesting the involvement of a non-selective cation channel, although the exact mechanism remains unclear. Similarly, LL-37 has been implicated in mediating P2XR7-dependent Ca²⁺ influx and dye uptake in innate immune cells, but direct functional assays to confirm its interaction with P2XR7 are lacking. Our core hypothesis proposes that, in addition to ATP, P2XR7 can be activated by non-nucleotide agonists—such as circulating histone proteins and LL-37 peptides—through direct interaction with the receptor\u27s extracellular domain. To test these hypotheses, we expressed the receptors of interest in Xenopus oocytes and employed two-electrode voltage clamp techniques to measure evoked currents in response to ATP, BzATP, histones, and LL-37. Our findings identify histones and LL-37 as novel agonists for P2XR7. We demonstrate that histones also activate P2XR1 and P2XR5 channels. Through combining current recording and site-directed mutagenesis, we identified five potential histone-binding sites on P2XR7, whose mutations significantly reduced histone sensitivity while preserving ATP responsiveness. Notably, P2XR7 activation by non-ATP agonists was not inhibited by highly selective allosteric inhibitors, highlighting a unique mechanism of activation. These findings may elucidate the previously unknown molecular mechanism behind histone-induced Ca²⁺ influx and PI uptake in endothelial cells, providing evidence for a direct interaction between LL-37 and P2XR7. Understanding how P2XR7 is activated by non-nucleotide agonists, such as histones and AMPs, opens new avenues for developing selective antagonists to regulate its function in various pathological conditions. Currently, no selective P2XR7 antagonists are available on the market. Additionally, the existing selective inhibitors only block ATP-mediated activation of the channel, without affecting the activation induced by non-ATP agonists, as demonstrated here
SARS-CoV-2 Variants of Concern: Biological Implications of Immunogenicity and Comorbidity
No full textWhen coronavirus disease 2019 (COVID-19) emerged in human populations in late 2019, there was nothing known about the virus, SARS-CoV-2, besides that it had a high degree of similarity to severe acute respiratory syndrome coronavirus (SARS-CoV) and middle east respiratory syndrome coronavirus (MERS-CoV). The prior published research on these viruses set a strong foundation for the research approaches needed to quickly stand-up medical countermeasures for treatment of COVID-19. However, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) soon revealed a high propensity to evolve new variants that could engage host cell receptors with greater affinity and escape host immunity. With each wave of new variants of concern (VOC), scientists unveiled new mutations that granted each virus the ability to reinfect and cause disease, resulting in nearly three years of global COVID-19 infection and hospitalization that continues to this day. The pandemic created an urgent and immediate need for the development of a wide variety of in vivo and in vitro models of SARS-CoV-2 which could define the unique phenotypes of each variant so that medical countermeasures could be developed. Hence my thesis, conducted during the peak of the pandemic and after focused on two main scientific contributions toward characterizing SARS-CoV-2 in vitro and in vivo. My first research efforts sought to understand the immunity and protection conferred by challenge with an early stain of SARS-CoV-2 called Washington (or WA1) based on its origin to the later variant of concern (VOC), Alpha and Delta in a lethal mouse model. The transgenic mouse model was genetically modified to express the primary receptor for SARS-CoV-2, angiotensin-converting enzyme 2 (ACE2). As the infection of the K18 hACE2 mouse model with SARS-CoV-2 results in lethality, a dose needed to be chosen that the mouse survives in order to examine protection conferred by an initial infection. The mice that survived the SARS-CoV-2 WA1 infection were challenged three weeks later with lethal doses of SARS-CoV-2 WA1, Alpha or Delta strains. In contrast to mice that were infected and then reinfected with WA1, mice that were infected with WA1 and then infected with Alpha or Delta lost weight. In contrast the mice infected, and reinfected with WA1, continued to gain weight. Breakthrough infection was observed in the Alpha and Delta infected mice. Viral transcripts were detected by ribonucleic acid sequencing (RNA-Seq) and reverse transcription quantitative polymerase chain reaction (RT-qPCR) in the nasal turbinates, but not in the lungs one day after reinfection. No virus was detected in any of the WA1 infected-reinfected groups suggesting protection from the first low dose (nonlethal) infection. RNASeq identified nonsynonymous amino acid changes in the viral genomes recovered from several infected mice and from one recovered from a challenged mouse. These studies provide supportive evidence that SARS-CoV-2 variants could be generated within host using the host response as selection pressure. Another dynamic that became apparent early in the pandemic was that individuals with certain comorbidities such as diabetes and heart disease were especially prone to severe COVID-19 outcomes. Diabetes was among the top represented condition of hospitalized COVID-19 patients. Not only did diabetes put an individual at an enhanced risk of developing severe symptoms with COVID-19, but COVID-19 was associated with raising an individual’s risk of developing new-onset diabetes. There is strong evidence that SARS-CoV-2 could promote diabetes through its ability to dysregulate host metabolism. Since diabetes mellitus is a disease of maligned host metabolism, I concluded that to study these mechanisms in vitro would have an impact on the field. To address the gap of available in vitro models to study SARS-CoV-2 infection, I focused the second half of my thesis on developing an in vitro transwell culture model of differentiated lung cells and using the model to characterize the effect of high glucose on viral infection and replication. I chose A549 cells, an adenocarcinoma cell line sourced from human lung tissue, since there was ample literature that described the effect of high glucose on the cell line. In my model, the cells are differentiated in low or high glucose for 21 days at an air-liquid interface. I then infected these cells at 21 dpi and evaluated the susceptibility of these cells to SARS-CoV-2 infection. High glucose supplementation did not increase the level of virus load as compared to low glucose cells. Delta infected samples had the greatest amount in recoverable infectious virus compared to the WA1 or JN.1 infected samples. Additionally, preliminary analysis of immunofluorescent stained samples reveals ACE2 and SARS-CoV-2 colocalize in the infected wells, with ACE2 not detectable above the limit of detection elsewhere. Remarkably, the model has robust infection despite a low level of ACE2. Preliminary data shows that infection and ACE2 are expressed in the same regions. A second receptor of SARS-CoV-2, transmembrane serine protease 2 (TMPRSS2) is also expressed in the differentiated, transwell A549 model. The study highlights differentiated A549 cells as a promising tool to reveal phenotypic differences between SARS-CoV-2 variants and its potential to study the effects of high glucose on viral infection and replication. In summary, my research contributed to the development of in vitro and in vivo models to study the biology of SARS-CoV-2. There remains a significant lack of insight into the mechanisms by which COVID-19 is more severe in diabetics and how COVID-19 may promote new-onset diabetes. Although case fatality rates have fallen since the height of the pandemic, COVID-19 cases continue. Hence it remains a high priority to remain vigilant in development of therapeutics that effectively combat the threat of breakthrough infection by genotypically and phenotypically different strains of SARS-CoV-2 that may continue to evolve