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The Effect of Obesity on Comorbidities: A Benchmark Study
Get PDFObesity is distinguished by a body mass index (BMI) greater than 30. Tremmel et al. (2017) reports obese individuals are at a greater risk for developing cardiovascular disease, diabetes, and cancer. In 2014, approximately 641 million adults were classified as obese (Zhang et al., 2018). This epidemic has drastically worsened over the last two decades resulting in obesity ranking as the fifth most common cause of death globally (Safaei et al., 2021). Okunogbe et al. (2021) states, slowing the incidence rate of obesity by 5% will save approximately $3.3 billion annually between 2020-2060. The pathophysiology and cause of obesity is multifactorial, therefore, interventions to decrease weight and associated comorbid risk factors and diseases must also be complex.
The purpose of this Benchmark project is to implement an evidence-based multifaceted approach to reduce the incidence of obesity and related comorbidities of patients in an outpatient clinic setting. Literature reveals that a combination of interventions, such as semaglutide injections used as an adjunct to lifestyle changes (diet and exercise), provides superior results in weight loss and reduced comorbid risk factors compared to lifestyle adjustments alone. Noteworthy results for a combination intervention approach compared to a singular intervention include improved weight, waist circumference, lipid panels, blood pressure, glucose and insulin levels, and glycated hemoglobin (HbA1c). The most commonly reported adverse effects of GLP-1 receptor antagonists such as liraglutide or semaglutide include gastrointestinal consequences (Garvey et al., 2020 & Kelly et al., 2020)
Benchmark: Reducing Surgical Plume Output with Smoke Evacuation
Get PDFThis project focuses on addressing the critical issue of surgical smoke exposure in operating rooms through the strategic implementation of smoke evacuation systems. The primary objective is twofold: to prioritize the safety and well-being of healthcare professionals and to ensure that patient care remains uncompromised. It strives to reshape the operating room environment, making surgical plume exposure a thing of the past.
Extensive research forms the core of this project. A comprehensive literature synthesis, including systematic reviews, randomized control trials, prospective and cohort studies, and qualitative research, underscores the occupational safety concerns related to surgical plume exposure. This synthesis strongly advocates for comprehensive education and awareness initiatives aimed at all operating room personnel, from surgeons and anesthesiologists to perioperative nurses and surgical technicians.
To facilitate the transformation of operating rooms into smoke-free environments, the project outlines a systematic implementation plan that actively engages key stakeholders. Surgeons, anesthesiologists, perioperative nurses, and surgical technicians play pivotal roles in advocating for and facilitating the adoption of smoke evacuation systems. Through this collaborative approach, the project aims to ensure that every member of the surgical team is committed to the integration of smoke evacuation systems.
The project\u27s findings undeniably support the implementation of surgical smoke evacuation systems. The financial benefits substantially outweigh the costs, with clear advantages including enhanced well-being for healthcare professionals, improved patient safety, and clearer surgical fields. The recommendations include widespread implementation of smoke evacuation systems, education and awareness initiatives for all personnel, continued stakeholder involvement, and rigorous monitoring to ensure the sustained reduction of surgical plume exposure. In conclusion, this project underscores the compelling case for adopting smoke evacuation systems as a standard in the operating room, thereby enhancing patient care and creating a safer working environment for healthcare professionals
Evidence-based Pain Management with Inclusion of Music Therapy for Post-Surgical Patients: A Benchmark Study
Get PDFImproper pain management in the postsurgical patient can delay proper healing, increase frustration for the patient, and prolong hospital stays (Córcoles-Jiménez et al., 2021). Moderate to severe pain can pose a greater risk for complications such as deep vein thrombosis, pneumonia, and delayed recovery (Kolaczko et al., 2019). Music therapy is an underutilized pain intervention in the PACU environment. Music therapy has been shown to lower pain and anxiety scores in many different clinical settings (Lee et al., 2017). Pain management can radically improve a patient’s outlook and recovery (Luo & Min, 2017). Patients who return to wakefulness and receive pain management in the early postoperative phase of recovery respond positively and are discharged from PACU much faster. Ambulating, nausea control, and overall patient well-being greatly improves with patient pain being tolerable. Multimodal analgesics, alternatives including regional anesthesia, and properly executed nursing interventions such as providing pharmacological pain management as ordered, patient positioning or immobilization, and distraction, can drastically improve patient outcomes (Small & Laycock, 2020). The inclusion of music therapy as a distraction can help provide a holistic, comprehensive approach to pain management for the post-surgical patient
Leadership Style and Nursing Retention
Get PDFNursing is the heart of healthcare, for decades we have been the drivers of innovation and have contributed to so many advancements in the profession. Even with nursing being a sincere passion amongst many nurses, there is an alarming trend of nurses who are faced with burnout (Brusie, C., n.d.). It has been reported that 1 in 5 nurses left their position in one particular health system (Andreyeva et al., 2023). It is also noted that turnover can be costly for organizations (Zuniga et al., 2019). While there are a multitude of reasons nurses could be leaving their companies, one is compelled to examine how specifically leadership styles of nurse managers affect retention. Keeping in mind that not every manager or leader governs the same, evidence shows that their leadership style can have an impact on nursing retention (Abdelhafiz, et al., 2016). Many perceive that the terms leader and manager are interchangeable according to Ellis & Abbott (2013) these words are not always interchangeable. Leaders invoke a sense of commitment from their followers versus managers who are seen as task oriented (Ellis & Abbott, 2013). We have a unique opportunity to build up current and future generations of nurses. When nurses are valued, provided psychological safety and are inspired and motivated the quality-of-care overflows to their patients. While there is not a particular leadership style that is promoted there is a growing body of literature that reinforces transformational leadership helps to retain staff
Effect of Nanoparticle Weight on the Cellular Uptake and Drug Delivery Potential of PLGA Nanoparticles
Get PDFBiodegradable and biocompatible polymeric nanoparticles (NPs) stand out as a key tool for improving drug bioavailability, reducing the inherent toxicity, and targeting the intended site. Most importantly, the ease of polymer synthesis and its derivatization to add functional properties makes them potentially ideal to fulfill the requirements for intended therapeutic applications. Among many polymers, US FDA-approved poly(L-lactic-co-glycolic) acid (PLGA) is a widely used biocompatible and biodegradable co-polymer in drug delivery and in implantable biomaterials. While many studies have been conducted using PLGA NPs as a drug delivery system, less attention has been given to understanding the effect of NP weight on cellular behaviors such as uptake. Here we discuss the synthesis of PLGA NPs with varying NP weights and their colloidal and biological properties. Following nanoprecipitation, we have synthesized PLGA NP sizes ranging from 60 to 100 nm by varying the initial PLGA feed in the system. These NPs were found to be stable for a prolonged period in colloidal conditions. We further studied cellular uptake and found that these NPs are cytocompatible; however, they are differentially uptaken by cancer and immune cells, which are greatly influenced by NPs’ weight. The drug delivery potential of these nanoparticles (NPs) was assessed using doxorubicin (DOX) as a model drug, loaded into the NP core at a concentration of 7.0 ± 0.5 wt % to study its therapeutic effects. The results showed that both concentration and treatment time are crucial factors for exhibiting therapeutic effects, as observed with DOX-NPs exhibiting a higher potency at lower concentrations. The observations revealed that DOX-NPs exhibited a higher cellular uptake of DOX compared to the free-DOX treatment group. This will allow us to reduce the recommended dose to achieve the desired effect, which otherwise required a large dose when treated with free DOX. Considering the significance of PLGA-based nanoparticle drug delivery systems, we anticipate that this study will contribute to the establishment of design considerations and guidelines for the therapeutic applications of nanoparticles
Palliative Care in the Neonatal Population
Get PDFIn more than 90% of cases of neonate deaths, terminal comfort care was provided in a Neonatal Intensive Care Unit (NICU) (Soni et al., 2011). Palliative care teams are increasing, but not enough organizations have embraced the need for better palliative care guidelines. Nor do many organizations know when, how, or if palliative care should even be introduced. These events lead to comfort care measures being underutilized in the NICU for most newborn infants with life-limiting and life-threatening conditions. Neonatal palliative care is discussed more than in years past, but little research has been dedicated to how early palliative care can improve comfort and quality of life while in the inpatient hospital setting. Keywords you will find throughout this benchmark study are neonatal palliative care, neonatal quality of life, palliative care nursing, parental stress in end-of-life decision-making, provider preferences, and perceptions of palliative care
DNP Final Report: Preventing Critical Care Nurse Burnout: An Evidence Based Approach to Raising Awareness
Get PDFBurnout has affected nurses nationally and globally for decades. Burnout in nurses is characterized by emotional exhaustion, depersonalization, and lack of feelings of personal accomplishment. Consequences of burnout include physical and emotional suffering in nurses, poorer patient outcomes, and lost revenue and increased cost in healthcare organizations. Burnout is prevalent in many healthcare settings, but 81% of critical care nurses have reported severe symptoms of burnout, Because of the high risk of burnout in critical care nurses, raising awareness about burnout and its prevention in those nurses was imperative. The following PICOT question guided the search for evidence to support this quality improvement project: in critical care nurses (P), how does an educational program about burnout and its prevention (I), compared to no program (C), affect knowledge of burnout and its prevention (O), following the program (T)? Based on systematic review and appraisal of the evidence, an online approach to increasing knowledge was the teaching strategy recommended to use with nurses in the critical care setting. A 30-minute video with information about burnout and its consequences, management, and prevention was developed and made available online to critical care nurses in a central Texas hospital. In nurses who watched the video, knowledge of burnout and its consequences increased 13.94%, and knowledge of burnout prevention and management increased 31.55%. Nurses who watched the video reported that they were likely to use information from the video in the future and recommend the video to their peers and to new hires
ESTIMATING ROTATOR CUFF INJURY RISK DURING REAR-END VEHICLE COLLISIONS USING OPENSIM
Get PDFAutomobile collisions in the United States lead to a staggering number of fatalities and injuries every year. Rear-end collisions account for over a quarter of all injury-producing collisions and often involve shoulder injuries. There is little, if any, research utilizing modern computational human body models to analyze rotator cuff injury risk during rear-end impacts. The goal of this research is to simulate rear-end impact crash forces using OpenSim and analyze the injury mechanism and risk to the rotator cuff muscles. OpenSim is an open-source software used for biomechanical modeling and simulation that enables the analysis of muscle behaviors that are difficult or invasive to measure in vivo. The upper extremity OpenSim model used in this research represents the 50th percentile male and is used to model the BioRID-II rear impact crash dummy. The simulations utilize inputs from a dynamic seat rating rear-impact test performed by the Insurance Institute for Highway Safety (IIHS), which simulates a 16km/h change in velocity. Two simulations were performed using the same acceleration pulse, one with deactivated muscles and another with fully activated muscles. The results from the deactivated simulation were compared against the published IIHS data and the rotator cuff muscles were analyzed for injury risks. In a deactivated state, the rotator cuff muscles measured near zero forces, stresses, and strains from the impact. The glenohumeral joint does become unstable; however, the resultant forces were well below values experienced during daily living tasks. In a fully activated state, the rotator cuff muscle strains were recorded between 2.5-3.5% and the maximum stress was 1.5MPa. These values are several times lower than the published ultimate stress and strain failure values for rotator cuff tendons. The glenohumeral joint was well stabilized with fully activated muscles. The results indicate that there are insufficient forces to damage healthy rotator cuff muscles for 50th percentile adult males, independent of muscle activation state for crash severities reaching 16.1km/h. Future research can be used to expand these results to various populations
ROLE OF HISTONE DEACETYLASES IN REGULATION OF MACROPHAGE PHAGOCYTOSIS OF MYCOBACTERIUM TUBERCULOSIS
Get PDFTuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), remains a global health emergency. Macrophages are critical in protection against TB by phagocytosis of Mtb. Although histone deacetylases (HDACs), are critical in macrophage differentiations, their roles in macrophage phagocytosis of Mtb remain unexplored. To explore this, I first established human monocyte derived macrophages (MDMs) phagocytosis of red zymosan beads. MDM phagocytosed zymosan beads at 37°C in a dose dependent manner in contrast to suppressed phagocytosis by the MDMs incubated with beads at 4°C or in the presence of cytochalasin D, actin polymerization inhibitor. Incubation of MDMs with 11 zinc-dependent HDAC inhibitors did not suppress MDM phagocytosis of zymosan beads though pan-HDAC inhibitor Trichostatin A showed moderate inhibition effects. MDMs showed time, dose, and actin polymerization dependent phagocytosis of Mtb. Screening 11 zinc-dependent HDACs with their chemical inhibitors, DHOB, targeting HDAC1, and MS-275, targeting HDAC1 & 3, but not RGFP966, targeting HDAC3, suppressed macrophage phagocytosis of Mtb without affecting the cell viability as confirmed with MTT assay, indicating the role of HDAC1 in regulation of macrophage phagocytosis of Mtb. Knockdown (KD) of HDAC1 in human THP1 cell line with CRISPR-Cas9 significantly reduced Mtb phagocytosis compared to HDAC1 intact cells. Therefore, we conclude that HDAC1 is required for macrophage phagocytosis of Mtb
THE ROLE OF MTORC2 IN MESOMESENCHYMAL TRANSITIONING IN HUMAN PLEURAL MESOTHELIAL CELLS
Get PDFPleural fibrosis can occur after empyema or complicated parapneumonic effusion as a result of tissue remodeling and excessive expression and deposition of extracellular matrix proteins. Pleural mesothelial cells transition into mesenchymal cells and acquire a profibrotic phenotype. This pathologic transition occurs through a process termed MesoMT and directly contributes to pleural fibrosis. MesoMT is regulated by diverse signaling pathways, including PI3K/AKT, which lie upstream of mTOR. However, the role of mTOR signaling in MesoMT is unknown. Using several mTOR inhibitors, we showed that inhibition of mTORC1/2 with INK128 and AZD8055 blocked and reversed TGF-β induced MesoMT. Targeted knockdown studies showed that mTORC2/Rictor pathway is indispensable for the Induction of MesoMT. Conversely, mTORC1/Raptor knockdown had no appreciable effect on MesoMT. Our in vivo analyses showed that INK128 treatment could attenuate pleural thickening injury and subsequent pleural fibrosis. Biomarkers of MesoMT, α-SMA and collagen were likewise reduced in INK128 treated mice compared to vehicle-treated mice. These studies suggest that mTORC2 may be an important therapeutic target for the treatment of PF