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The Benefits of Heat Application and Range of Motion vs. Ice Therapy
Get PDFPICOT Question: In patients with musculoskeletal injuries, is heat application and gentle range of motion more or less effective than standard icing and immobilization methods in regard to the healing process, prognosis and positive patient outcomes?https://knowledgeconnection.mainehealth.org/nurseresidency/1067/thumbnail.jp
Nurse and CNA Communication/Delegation
Get PDFDoes having RN and CNA quality communication/delegation opposed to lack of/poor communication improve staff performance, satisfaction and patient outcomes?https://knowledgeconnection.mainehealth.org/nurseresidency/1081/thumbnail.jp
An Evaluation of Peripheral Nerve Stimulation When Monitoring ICU Patients Requiring Chemical Paralysis
Get PDFIn ICU patients receiving infusions of vecuronium or cisatracurium, is a clinical assessment-based titration model compared to a train-of-four titration model more effective when monitoring paralysis?https://knowledgeconnection.mainehealth.org/nurseresidency/1079/thumbnail.jp
Mental Health in Emergency Nursing
Get PDFIn emergency nursing, how does the early provision of mental health care and interventions compared to lack of such care impact the occurrence of early burnout?https://knowledgeconnection.mainehealth.org/nurseresidency/1087/thumbnail.jp
Early vs. Delayed Ambulation: Impact on Postoperative Patient Outcomes During Hospitalization
Get PDFIn post-op patients, how does early mobilization compared to delayed mobilization affect patient outcomes within hospital time?https://knowledgeconnection.mainehealth.org/nurseresidency/1100/thumbnail.jp
Unsafe Sleep Practices
Get PDFIn newborns does enhanced verbal and visual education given to their parents/guardians related to unsafe sleep practices help to lower the incidence of unsafe sleep reported on our unit?https://knowledgeconnection.mainehealth.org/nurseresidency/1116/thumbnail.jp
Association of diuretic requirement and right heart failure post-LVAD implantation
No full textBACKGROUND: Diuretic responsiveness is associated with heart failure disease progression. Among patients with advanced heart failure, we hypothesized that decreased diuretic responsiveness and higher diuretic requirement are correlates of progressive right ventricular dysfunction and may help to risk stratify patients undergoing left ventricular assist device (LVAD) evaluation. METHODS: We performed a single-center, retrospective analysis of 147 patients undergoing LVAD implantation between 2014 and 2018. The primary outcome was early right heart failure (RHF) or death during the index hospital stay. Patients were stratified by tertiles of preoperative 24-hour diuretic dose within 72 hours of surgery. RESULTS: The incidence of early RHF was higher in the highest-dose group (66.0%) compared to the medium- (41.3%) and low-dose groups (23.5%) (p \u3c 0.001). Each 40 mg increase in intravenous furosemide dose was associated with a 6% increase in the risk of RHF, after adjusting for other known risk factors. The median ICU length of stay was 2 days longer for patients in the highest compared to low-dose group (7 vs 5 days, p = 0.02). Mortality within 14 days post-op was numerically higher although not significantly different between the highest-dose group and the low-dose group (12.0% vs 5.9%, p = 0.55). Six-month survival across diuretic dose tertiles was also not statistically different (p = 0.40). CONCLUSIONS: We concluded that higher preoperative diuretic dose is associated with risk of early RHF following LVAD surgery. These data furthermore support the role of progressive right ventricular dysfunction on the development of cardiorenal disease and diuretic resistance
Ethical considerations in shoulder arthroplasty in patients who are obese
No full textObesity and osteoarthritis are two of the most common conditions in the United States and often co-occur. Obese patients with osteoarthritis are at increased risk for complications when undergoing total shoulder arthroplasty (TSA). The ethical consideration relevant to the decision to perform TSA in obese and morbidly obese patients who may benefit from surgery is not well understood. We performed an ethical analysis for patients undergoing TSA who are obese by analyzing the 4 core bioethical principles, beneficence, nonmaleficence, autonomy, and justice. To provide the most benefit to patients, counseling patients on weight loss before surgery should be attempted including bariatric surgery or weight loss medication in select patients. To respect the ethical principles of beneficence and nonmaleficence, the surgeon must carefully weigh the potential for debilitating progression of disease, pain, and the psychological toll of osteoarthritis against the concern that obese patients may have a higher risk of complications. Respecting patient autonomy requires a rigorous, standardized consent process, which is informed by an understanding of common cognitive biases that affect patient understanding and minimization of perverse incentives that make it more difficult for the surgeon to spend adequate time and resources counseling the patient. Improving incentives for hospitals and physician alike to treat patients with obesity and other comorbidities will provide most just care while minimizing long-term harmful effects to the patient, surgeon, and health-care system
Deletion of FNDC5/irisin modifies murine osteocyte function in a sex-specific manner
No full textIrisin, released from exercised muscle, has been shown to have beneficial effects on numerous tissues but its effects on bone are unclear. We found significant sex and genotype differences in bone from wildtype (WT) mice compared to mice lacking Fndc5 (knockout [KO]), with and without calcium deficiency. Despite their bone being indistinguishable from WT females, KO female mice were partially protected from osteocytic osteolysis and osteoclastic bone resorption when allowed to lactate or when placed on a low-calcium diet. Male KO mice have more but weaker bone compared to WT males, and when challenged with a low-calcium diet lost more bone than WT males. To begin to understand responsible molecular mechanisms, osteocyte transcriptomics was performed. Osteocytes from WT females had greater expression of genes associated with osteocytic osteolysis and osteoclastic bone resorption compared to WT males which had greater expression of genes associated with steroid and fatty acid metabolism. Few differences were observed between female KO and WT osteocytes, but with a low-calcium diet, the KO females had lower expression of genes responsible for osteocytic osteolysis and osteoclastic resorption than the WT females. Male KO osteocytes had lower expression of genes associated with steroid and fatty acid metabolism, but higher expression of genes associated with bone resorption compared to male WT. In conclusion, irisin plays a critical role in the development of the male but not the female skeleton and protects male but not female bone from calcium deficiency. We propose irisin ensures the survival of offspring by targeting the osteocyte to provide calcium in lactating females, a novel function for this myokine
Closing the Gap: Using the ECHO Model to Improve Access to Hereditary Colorectal Cancer Risk Assessment and Genetic Counseling in the Rural Setting
Get PDFBackground: There is underutilization of colorectal (CRC)-related cancer genetic counseling services nationally, especially in underserved regions. Novel models of cancer genetic care in rural states like Maine are needed to narrow the practice gap, reflected in an improvement in the percentage of individuals meeting genetic testing guidelines referred for cancer genetic counseling. Goal To lower the CRC c