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Medical Cannabis: Alternative to Opioids for the Treatment of Chronic Pain
Get PDFThere is a growing body of evidence to suggest that cannabinoids (CBD) are beneficial for a range of clinical conditions, including chronic pain, sleep disorders, osteoarthritis inflammation, anxiety, depression, and enhanced quality of life. For patients with chronic pain and arthritis inflammation, traditionally pain-relieving medications, including opioids, have been prescribed for pain relief but with increased risks of addiction and adverse effects with poor outcomes. Medical cannabis use is an emerging treatment alternative to prescription opioids and as an adjunctive to diminish the use of opioids addiction. This project objectively reviews the works of literature on the challenges of proposing a prescribed treatment plan with the use of cannabinol products compared to the standard of care prescribing anti-inflammatory medication and opioids drugs. This project explores the most recent developments, from the preclinical trials to the most advanced clinical trials, and the patients\u27 perspectives. A strong recommendation is to implement study findings and educate the healthcare provider, worker, and stakeholders to develop a proactive public health approach that builds power in prevention measures. Also, to encourage the healthcare arena to maintain evidence-based skilled knowledge in pain management of non-opioid alternatives. Thereby, it\u27s recommended to continue to monitor current practice outcomes and the literature for further studies on medical cannabis use as an alternative or adjunctive to prescription opioids
How COVID-19 CHANGED NEW NURSE ORIENTATION
Get PDFUniversities were no longer able to do in person learning for nursing students. Nursing students were being taught vital skills like inserting an IV catheter via online simulation. The number of hours nursing students had to participate in clinical hours at the hospital was diminished due to the hospitals not allowing in nursing students. This created a huge educational deficit in nursing students. The nursing students who graduated during the COVID-19 pandemic are arguably less skilled than their predecessors before them. To fill this educational gap, additional training and orientation time must be provided to allow for fully competent new graduate hires. Allowing more preparation for new graduates will reduce errors thus reducing hospital costs
Bedside Nurse Shift Length: Evidence-Based Intervention on Nursing Burnout
Get PDFWith the aging baby boomer population, employee burnout, and lack of quality medical training, the United States is facing one of the most detrimental nursing shortages in history. Before the COVID-19 pandemic, the United States Health and Human Services projected the demand for nurses to be much higher than the actual number of employed registered nurses through 2030. Since 2016 the nursing population was widely composed of nurses between 25 to 34 years old. After the global pandemic hit, the number of nurses in that age group declined by 5.2 percent, and nurses aged 35 to 44 have reduced by 7.4 percent (Haines, 2022). During a period when the need for nurses is at an all-time high, many are leaving the bedside for other less stressful careers.
When examining the nursing crisis topic, many factors must be considered, one of the most important being decreasing staff burnout, thus maintaining quality trained nurses. Everhart et al. found that retaining nursing staff decreased overall financial costs for the hospital and decreased adverse events, length of stays, and improved care processes (2013).
One of the issues leading to nursing burnout is believed to be the 12-hour shift work. A recent review showed that nurses who worked 12-hour shifts developed more chronic fatigue, cognitive anxiety, sleep disturbance, and emotional exhaustion than those who worked 8-hour shifts (Banakhar, 2017). In a recent survey, nurses working longer than ten hours were more likely to experience burnout and job dissatisfaction and showed intention to quit their jobs (Stimpfel, Sloane & Aiken, 2012). With this information, it is essential to assess how to decrease nursing burnout and retain quality nurses at the bedside. This change project discusses the following research question: In the acute setting, do nurses (P) working 8-hour shifts (I), compared to nurses working 12-hour shifts(C), have less burnout (O) over three months (T)?
During this project, we will take a deeper look into the effects of the 8-hour shift versus the 12-hour shift, the nursing retention, and thus, overall patient care
Reducing Suicide Reattempts with a Telephone Follow Up Program
Get PDFSuicide is one of the leading causes of death in the United States. Most people can say they know at least one person who has committed suicide or has considered suicide. The number of deaths continues to rise, and they aren’t stopping anytime soon. Many of these patients visit emergency rooms around the country seeking help for their depression and suicidal ideation. Some are brought into the emergency department following a suicide attempt and their visit only predicts another one happening in the near future. Some hospitals around the globe has tried to stop this recurrence of suicide reattempts by putting a telephone follow up program into action. Patients are called in monthly time increments for one year to follow up on their care and see how they are doing. These studies have showed a decrease in the number of suicide reattempts and hospital recidivism. This is just one of the ways to help in this global issue. This paper discusses a benchmark project that can be incorporated in a hospital emergency department. The hope is to implement a project like this in my facility in the near future
Nurse Efficiency & Ultrasound Guided Intravenous Access: Evidence based intervention Benchmark
Get PDFGaining IV access is this first step into accurate, timely diagnosis and interventions of patients. Nurses are typically the first medical professional a patient sees. If the nurse can establish IV access as early as possible this will lead to faster interventions faster diagnostic results and better management for patients and ultimately better patient outcomes. Ultrasound guided IV can increase first attempt success rates leading to decreased painful IV insertions by multiple nurses. This would increase patient satisfactions scores leading to higher re-imbursement
Meeting the Needs of Gen Z Nurses to Improve Nurse Retention
Get PDFThis benchmark project explores the unique learning styles and generational characteristics of Generation Z nurses (those born between 1995 - 2012). The need exists for a change in traditional orientation and onboarding processes to meet the needs of Gen Z nurses. Gen Y and Gen Z nurses are expected to make up 50% of the workforce by 2024. Retention of these nurses is critical to a hospital organization as it is an effective strategy in dealing with the nursing shortage. Specific strategies for engaging the gen Z nurses include incorporating more digital platforms in the orientation and onboarding process, face to face orientation consisting of interactive small group sessions, and assigning a mentor to each new nurse. This new process will lead to improved retention of a stable nursing team, cost savings for the organization, and improved patient satisfaction
DIFFERENTIAL EXPRESSION OF PHOTOSYNTHETIC GENES IN CRYPTOPHYTE ALGAE (HEMISELMIS CRYPTOCHROMATICA CCMP 1181)
Get PDFCryptophytes are a group of freshwater algae that have acquired photosynthesis through secondary endosymbiosis with a red alga and an unknown eukaryote heterotroph. Cryptophytes possess photosynthetic pigment-protein structures called phycobiliproteins (PBPs). Cryptophyte phycobiliproteins are composed of α and β-protein subunits and four chromophores (bilins). There are nine classes of cryptophyte PBPs that absorb different wavelengths of light based on the type of bilins covalently bound to the protein subunits. Three cryptophyte PBPs are phycoerythrins that give the algae a red appearance and six are phycocyanins that give the algae a blue to green appearance. Hemiselmis cryptochromatica (CCMP 1181) is a strain of cryptophyte algae that has demonstrated the ability to shift its PBP maximum absorption peak under different light conditions suggesting its PBP absorption is a plastic phenotype. This unique characteristic is what brought our attention to this strain. The research questions addressed here are, (1) Do changes in gene expression of photosynthetic genes stabilize after the acclimation period (four weeks) in green- or red-light environments? And (2) Do the β-subunit, CPES, PebA, and PebB genes play a role in H. cryptochromatica’s (CCMP 1181) ability to shift its PBP maximum peak wavelength absorption under different light environments? To address these questions, gene expression was examined using RNA-seq data and RT-qPCR. Cultures of H. cryptochromatica (CCMP 1181) were grown under green-light and red-light environments for –six to eight weeks to determine how gene expression of photosynthetic related genes is altered in these environments. For question one, we found that gene expression does not change after the four weeks acclimation period in the red-light environment up to six weeks, but in the green-light environment, we found that significant changes in gene expression occur at eight weeks for three of the four genes. For question two, we found that the β-subunit and PebB do not play a role in this phenotypic plasticity response. However, CPES and PebA may be partially responsible for the shift of its maximum wavelength absorption peak to 625nm under red-light. Both of these genes were upregulated in the red-light environment. PebA is the oxidoreductase responsible for producing the bilin DBV and CPES is an S/U type lyase that can only bind DBV and PEB bilins to the β-subunit. This suggests that an increase in DBV production and attachment to the β-subunit is likely needed for the shift in absorption under red-light. Furthermore, this leads us to think that another bilin is responsible for the dominant peak at 569nm under green-light that is currently unknown. These data indicate that the oxidoreductase that produces this unknown bilin needs to be determined, as well as the lyase that binds the bilin. Therefore, an in-depth RNA-seq experiment and characterization of the bilins of H. cryptochromatica (CCMP 1181) in different light environments will be necessary to fully understand phenotypic plasticity in cryptophytes
Integration of in Vitro and in Vivo Models to Predict Cellular and Tissue Dosimetry of Nanomaterials Using Physiologically Based Pharmacokinetic Modeling
Get PDFNanomaterials (NMs) have been increasingly used in a number of areas, including consumer products and nanomedicine. Target tissue dosimetry is important in the evaluation of safety, efficacy, and potential toxicity of NMs. Current evaluation of NM efficacy and safety involves the time-consuming collection of pharmacokinetic and toxicity data in animals and is usually completed one material at a time. This traditional approach no longer meets the demand of the explosive growth of NM-based products. There is an emerging need to develop methods that can help design safe and effective NMs in an efficient manner. In this review article, we critically evaluate existing studies on in vivo pharmacokinetic properties, in vitro cellular uptake and release and kinetic modeling, and whole-body physiologically based pharmacokinetic (PBPK) modeling studies of different NMs. Methods on how to simulate in vitro cellular uptake and release kinetics and how to extrapolate cellular and tissue dosimetry of NMs from in vitro to in vivo via PBPK modeling are discussed. We also share our perspectives on the current challenges and future directions of in vivo pharmacokinetic studies, in vitro cellular uptake and kinetic modeling, and whole-body PBPK modeling studies for NMs. Finally, we propose a nanomaterial in vitro to in vivo extrapolation via physiologically based pharmacokinetic modeling (Nano-IVIVE-PBPK) framework for high-throughput screening of target cellular and tissue dosimetry as well as potential toxicity of different NMs in order to meet the demand of efficient evaluation of the safety, efficacy, and potential toxicity of a rapidly increasing number of NM-based products
A study into Proton Exchange Membrane Fuel Cell power and voltage prediction using Artificial Neural Network
Get PDFPolymer Electrolyte Membrane fuel cell (PEMFC) uses hydrogen as fuel to generate electricity and by-product water at relatively low operating temperatures, which is environmentally friendly. Since PEMFC performance characteristics are inherently nonlinear and related, predicting the best performance for the different operating conditions is essential to improve the system\u27s efficiency. Thus, modeling using artificial neural networks (ANN) to predict its performance can significantly improve the capabilities of handling multi-variable nonlinear performance of the PEMFC. This paper predicts the electrical performance of a PEMFC stack under various operating conditions. The four input terms for the 5 W PEMFC include anode and cathode pressures and flow rates. The model performances are based on ANN using two different learning algorithms to estimate the stack voltage and power. The models have shown consistently to be comparable to the experimental data. All models with at least five hidden neurons have coefficients of determination of 0.95 or higher. Meanwhile, the PEMFC voltage and power models have mean squared errors of less than 1 × 10--3 V and 1 × 10--3 W, respectively. Therefore, the model results demonstrate the potential use of ANN into the implementation of such models to predict the steady state behavior of the PEMFC system (not limited to polarization curves) for different operating conditions and help in the optimization process for achieving the best performance of the system
Dehumidification performance of a variable speed heat pump and a single speed heat pump with and without dehumidification capabilities in a warm and humid climate
Get PDFConventional air conditioning systems in houses respond to thermal loads by means of controlling dry-bulb temperature through the thermostat. As part of the process to control temperature, dehumidification is also provided. However, as houses are becoming more efficient, supplemental dehumidification is often necessary for homes located in hot and humid climates to control relative humidity intentionally. This study compared the dehumidification performance of a residential air conditioning system working in three operations modes to emulate three different systems: a system with a variable speed mode, a single-speed system with an enhanced dehumidification mode, and a single-speed system operating in a traditional or normal cooling mode. With operation mode changes achieved through software, this study constituted a novelty in the topic of humidity control by using a single machine, with the same exact physical set-up to directly compare the dehumidification performance of three types of systems. Two types of days were of interest in the study, hot and humid days (summer season) and mild and humid days (Fall shoulder season). After assessment of the dehumidification performance, the variable speed mode was able to maintain relative humidity between 50% to 52% on summer days. In the single-speed with enhanced dehumidification, a slightly less effective humidity control was achieved on summer days with the mode keeping the relative humidity between 53% to 55%. In the normal cooling mode, which resembles a conventional system, the humidity levels were controlled between 55% to 60%. In the shoulder season, the variable speed and enhanced dehumidification modes maintained the relative humidity between 55% to 58% and 53% to 56% respectively. In the shoulder season, the normal cooling mode kept the indoor relative humidity near or above 60%. In terms of dehumidification efficiency expressed as a function of the amount of water condensate per unit of energy, the variable speed was determined to be more efficient than the other modes