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Implementation of Synchronous and Asynchronous CAR-T Education For Emergency Room and Intensive Care Unit Nurses in Non-Oncology Units
Get PDFBackground: Chimeric antigen receptor T cell (CAR-T) therapy is a novel and promising cancer treatment for hematologic malignancies. This treatment is highly regulated by the Food and Drug Administration (FDA) and The Foundation for the Accreditation of Cellular Therapy (FACT) because of the known toxicities associated with treatment.
Local problem: In 2022, FACT published guidelines requiring formal education for both oncology and non-oncology nurses who care for these patients, including emergency room and intensive care unit nurses.
Methods: This quality improvement project provided education to emergency room and intensive care unit care nurses who are caring for CAR-T cell therapy patients using synchronous and asynchronous education sessions.
Interventions: This quality improvement project focused on providing education to emergency room and intensive care unit nurses caring for CAR-T cell therapy patients outside of the oncology unit regarding documentation and identification of Cytokine Release Syndrome (CRS) and Immune Effector Cell Associated Neurotoxicity Syndrome (ICANS), grading of toxicities, and subsequent triage, and appropriate interventions according to clinical guidelines published by the American Society for Transplantation and Cellular Therapy.
Results: In total, 141 staff from the medical intensive care unit and emergency room completed the education and post-survey. Pre and post intervention survey results showed an increase in learner knowledge and skill in CAR-T cell therapy, CRS, and ICANS. There was not a substantial difference between learner outcomes when synchronous and asynchronous learning was compared. Continuing education opportunities were identified from the post data survey.
Conclusion: Both synchronous and asynchronous education are an effective means of proving education. However, when given the option, more learners chose to participate in synchronous education rather than asynchronous. Both methods should be offered to learners in the future and embedded into unit orientation
Online Diabetes Program Improving Nurses\u27 Competency in School-Age Diabetes Care
Get PDFBackground: Diabetes affects over 280,000 children under 20 in the US, requiring specialized knowledge and skills for management. In a large urban school district with 54,000 students, 159 have diabetes, cared for by 158 school nurses. These nurses often struggle with the complexities of diabetes care and lack standardized training, leading to potential suboptimal care. An online diabetes education program was implemented to improve their competency, knowledge and skills, and confidence in managing diabetes in school-age children.
Methods: An asynchronous online competency-based diabetes education program to improve nurses’ competency to care for school-age children with diabetes was implemented in an urban public school district to address several issues, including a lack of standardized training, familiarity with diabetes equipment, and access to up-to-date resources.
Intervention: The intervention took place in three phases: pre-implementation, implementation, and post-implementation. The pre-implementation phase included developing the education program and surveys and pre-testing (pilot) the program to seven school nurses. Implementation involved inviting 144 school nurses to participate and complete the program. The post-implementation phase included data analysis and synthesis.
Results: Stakeholders convened to develop the education program and surveys. Seven school nurses participated in the pilot program, deeming it 100% feasible and clear. Sixty percent (n=87) of school nurses participated in the program and 49 completed the entire program including the pre-test, watching the education video, post-test, and post-program satisfaction survey. Participants had a 7 % increase in knowledge, a 10% increase in skill self-assessment, and an 18% increase in confidence after engaging in the program. Additionally, 98% of participants reported satisfaction with the program.
Conclusions: Implementation of the locally tailored asynchronous online diabetes education program was effective in increasing nurses’ competency, knowledge and skills, and confidence to care for school-age children with diabetes. The program has the potential of being sustained, standardized, and mandated for all district school nurses as part of their orientation and training. Furthermore, the diabetes education program may serve as a valuable resource for the district to develop educational programs about other chronic conditions. Future research should explore the impact of the diabetes education program on students\u27 diabetes care
Implementation of a Standardized Acute Care Plan for Complex Care Medicine Service Patients: A Quality Improvement Initiative
Get PDFAbstract
BACKGROUND: Care transition plans, locally called Acute Care Plans (ACPs), are created specifically for super utilizers of the Complex Care Medicine Service (CCMS) and are a target for improvement. The purpose of this project was to improve care for CCMS patients by developing, implementing, and evaluating a standardized CCMS ACP. A multidisciplinary approach was chosen to facilitate the transitions of care process during an admission or discharge from the hospital.
LOCAL PROBLEM: The purpose of the ACP is to get a quick summary of how to treat a patient when they come to the hospital. The ACPs are unstructured, content is greatly variable, and updates lack ownership.
METHODS: The intervention for this quality improvement initiative includes the following: to standardize the ACP for CCMS patients; to educate CCMS providers on transitions of care and what to include in the standardized ACP; huddles with the Emergency Department (ED) providers to evaluate the implementation process; and huddles with CCMS providers to identify barriers and successes evident from the ACP improvement process. The intervention was evaluated after twelve weeks by comparing the number of CCMS patients that have a standardized ACP in place at the time of discharge compared to the start of the Quality Improvement project.
RESULTS: The results of the standardization of the CCMS ACPs were favorable. At the start of this QI project there were 40 CCMS patients that had an ACP in the EMR. At the completion of this QI project there were 65 CCMS patients that have a standardized ACP in the EMR. This project demonstrated that by standardizing the ACPs, the care of the CCMS patients improved.
CONCLUSIONS: This project demonstrated that by standardizing the ACPs, providers perceived that their care of CCMS patients improved. At the close of the project, all ACPs at issue had a standardized plan of care
Latino Political Leadership in Massachusetts (2023)
Get PDFLatinos and Latinas comprise an increasing share of eligible voters in the Commonwealth of Massachusetts, yet their political leadership at all levels of government is less than proportionate to Latino populations across the state. 82 Latinos and Latinas hold seats in local elected governing bodies and offices and in the Massachusetts Legislature. However, significant leadership gaps persist at the state level and in the state’s congressional delegation. In addition, leadership gaps at the local level remain a reality in most Latino communities across the state.
Currently, more Latinas than Latinos serve in local offices (city council and school committee), while more Latinos than Latinas serve in the legislature.
Lawrence, Chelsea, Holyoke, Springfield, and Lynn are the cities with the highest concentration of Latinos in their communities. However, only Lawrence and Chelsea have a relatively high rate of Latino and Latino leadership, each reaching 60% of elected officials. Brockton and Holyoke follow with near-proportional Latino political representation compared to their share of Latino residents
Referendum Metrics: the numbers game, Chapter Five from Perils and Prospects of a United Ireland
Get PDFThis article is an extract from Perils and Prospects of a United Ireland, published by Lilliput Press, Dublin, Ireland in March 2023. The book draws on extensive interviews with ninety-seven senior politicians across the ethno-national divide, a range of academics and political commentators, and religious leaders.
The context for the chapter is the Belfast/Good Friday Agreement (B/GFA), which ended thirty years of violent conflict between Irish republicans, mostly Catholic, who wanted Northern Ireland to become reunified with the rest of Ireland, and unionists, mostly Protestants supported by British security forces, who wanted to maintain the union of Northern Ireland and Great Britain.
The agreement (April 10, 1998) has three components. Strand I outlines a power sharing arrangement for the internal government of Northern Ireland; Strand II, a North South Ministerial Council to reflect relations between Northern Ireland and the Republic of Ireland (ROI); and Strand III, a British-Irish Intergovernmental Conference to mediate relations between the UK and ROI. The agreement also provides an electoral formula that will be used to determine whether Northern Ireland wishes to stay in the UK or become part of a reunified Ireland, should it appear that that is the wish of majority.
The article concludes that all the metrics that a Secretary of State for Northern Ireland might draw on to gauge support for a united Ireland have several shortcomings. At the present time none indicates a majority voting would choose to leave the UK and become part of an all-Ireland state
Seeing Race as We Are: Avoiding, Arguing, Aspiring
Get PDFRacial conflict in the United States pushes people to positions of argument or avoidance, more or less intensely and for varying lengths of time, depending on external events like the murder of George Floyd. Neither stance produces the conversations required to seek common ground and compromise around racial issues. Argument alone deepens divisions and avoidance leaves them to metastasize in the social body. In an attempt to go beneath these two positions, this article first explains the role and form of interpretation in all conflict and dispute resolution and how it is shaped. Then it examines the concepts and strategies on race of seven identifiable groups. For example, whereas individualists reject identity politics and collective guilt for past wrongs and stress personal responsibility, pragmatists eschew ideologies on race, focusing instead on what they affirm. The article makes a deep critique of the antiracist assertion that those who fail to embrace its ideology are, by definition, racists. Finally the author discusses possible ways forward that reject dogmatic, either/or strategies in favor of a hermeneutical approach to matters of race including both sacred values and material interests
The Impact of Historical Trauma, Self-Compassion, and Resistance Against Racism among African Americans
Get PDFFor African Americans, historical trauma is described as collective psychological, emotional and cognitive distress, producing an intergenerational impact through repeated experiences of oppression that both stems from slavery and continues into the present day through patterned experiences of racism (Williams-Washington & Mills, 2018). The current study explored the association between historical racial trauma, resistance and empowerment against racism, self-compassion, and internalized racism, and symptoms of depression in a sample of 100 African American adults. Due to low internal reliability of the measure, self-compassion in the context of historical trauma could not be examined. The study included exploration of simple correlations, main effects, moderation, and moderated mediation models to better understand the relations among the remaining variables. Results revealed that internalized racism, impact of historical trauma, and resistance against racism were all significantly, positively associated with depression symptoms. Historical racial trauma significantly predicted both internalized racism and resistance against racism. Further, resistance against racism significantly moderated the relation between the impact of historical racial trauma and internalized racism, as well as the relation between the impact of historical racial trauma and symptoms of depression, with higher levels of resistance associated with stronger relations among the other variables. Results also revealed that internalized racism partially mediated the relation between impact of historical racial trauma and symptoms of depression and that the mediation effect was stronger among those higher in resistance against racism. The study findings demonstrate the importance of determining how resistance and advocacy can be more thoughtfully approached, given their impact on mental health symptoms. The findings also indicate the significant emotional harm associated with the impact of historical trauma in the United States and the urgent need to address collective trauma with communal interventions
How Does China View the Modern Asian Regional System?
No full textWith China’s rise, international relations (IR) scholars are in need of an intellectual framework to understand Chinese policymakers’ worldview, particularly their vision for a modern Asian regional system. Accordingly, this thesis examines the relevance of several prominent themes in contemporary Chinese IR scholarship to Chinese policy elites’ strategic thinking through a careful textual study of Chinese officials’ speeches. This discursive analysis reveals that although Chinese leaders have mainly used mainstream Western IR theories to explain their worldview in Asia, they also appear to be making a transition from the predominant application of mainstream Western IR theories to the localization of their own IR concepts applied to Chinese foreign policy making. In particular, Chinese officials have increasingly applied the concepts of relationality, morality, and world-ness in their diplomatic statements. This analysis sheds light on common misperceptions of Western scholars, and particularly US policymakers, about China. These misconceptions interfere with an understanding of China’s worldview, and as a result they also lead to problematic policy recommendations for US policymakers and Asian states
Margaret Cross Norton in Context: Norton’s Portrayal in American Archival Theory, the Social Conditions of Her Time and the Evolution of Presidential Libraries in the United States
No full textMargaret Cross Norton became the inaugural archivist for the State of Illinois in 1922 and served in that role for thirty-five years. As such, she founded one of the first American state archives established in the early twentieth century to remedy the neglect of government documents that had prevailed since our nation’s founding. Norton became a leading national figure in this effort to protect public records as a result of her prolific writing and wide-ranging work to develop the public archives profession in the United States.
More recently, Norton has been characterized in the archival literature as the leader of a movement among American public archivists to break away from their private sector counterparts and reject historical scholarship as an appropriate professional focus. This thesis re-examines that portrayal of Norton, considering the import of her writing and professional activities in two distinct contexts: the social conditions of her day and contemporary developments in the curation of presidential records. Thus contextualized, Norton appears not as an adversary of historical scholarship but rather as a prescient and effective advocate for protecting American public records
Design of a Low-Cost Sensor to Ensure Integrity of Seaweed Aquaculture Operations
No full textSeaweed aquaculture is a fast-growing industry, both in the United States and worldwide. In a typical operation, a grower operates an offshore plot which consists of a grid-like pattern of submerged “long line ropes. Kelp is seeded onto these ropes and grows downward, nurtured by the flow of water and nutrients that passes over it. If this structure of underwater ropes is compromised, either by floating debris or an animal entanglement, it can cause significant economic damage to the operation. There is also growing concern towards protecting marine mammals from becoming entangled and injured in aquaculture systems. Due to the nature of seaweed farming, an aquaculturist might only visit their plot every two - three weeks. This intermittent schedule of visits contributes to the need of a near real-time monitoring system. This thesis describes the design and fabrication of a sensor system to monitor the physical integrity of the underwater ropes used in seaweed and other aquaculture operations, so that growers can be remotely notified and rapidly respond to incidents occurring on their offshore plots. The final sensor design integrates a reusable weak link , a piezoelectric sound projector, a hydrophone, and LoRa radio communication technology. As tension is added to the rope by an entanglement or other stress event, the modified weak link activates, generating an acoustic frequency which is picked up by a hydrophone monitoring buoy and transmitted to shore. This sensor can be added to an existing long line rope without needing to cut the rope, and the break-link can be scaled to fail at different tension forces. Preliminary testing shows the acoustic range to be at minimum 60 feet from node to monitoring buoy