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Navigating Epstein-Barr Virus (EBV) and Post-Transplant Lymphoproliferative Disorder (PTLD) in Pediatric Liver Transplantation: Current Knowledge and Strategies for Treatment and Surveillance
Get PDFEpstein-Barr virus (EBV) is strongly associated with the development of post-transplant lymphoproliferative disorder (PTLD) in pediatric liver transplant recipients. PTLD is one of the most common malignancies following liver transplantation and is associated with significant morbidity and mortality. Factors such as EBV-serostatus mismatch and prolonged or high levels of immunosuppression impact a patient\u27s risk of developing PTLD. While pre-transplant EBV serological screening and post-transplant monitoring of EBV-DNA levels are strongly recommended, universal guidelines for its prevention and management are lacking. Due to a lack of robust prospective studies, current clinical practices vary widely. The treatment of PTLD typically involves reducing immunosuppression and using targeted therapies such as rituximab, or chemotherapy for refractory cases. This review aims to address our current understanding of EBV\u27s relationship with PTLD, evaluate the available treatment modalities, and highlight evolving strategies for using EBV as a biomarker for PTLD screening and prevention
Worldwide Prevalence of Chagas Cardiomyopathy-An Analysis From the Global Burden of Disease Dataset
No full textPurpose: The worldwide prevalence of Chagas Cardiomyopathy (CCM) as well as the trends in the prevalence of CCM over time have not been well characterized.
Methods: An analysis of the Global Burden of Disease (GBD) data from 1990 to 2019 was conducted to assess the burden of CCM. This study focused on determining the prevalence of CCM, along with its age-standardized prevalence rate (ASR) per 1,00,000 people, considering various patient demographics and geographical regions as defined in the GBD. Additionally, the study examined the temporal trends over this 30-year period by calculating the estimated annual percentage change (EAPC) in CCM prevalence for the global population and specific subgroups.
Results: Worldwide, the GBD reported 220,166 individuals with CCM in 1990 and 2,83,236 individuals in 2019, with a decline in the ASR from 5.23 (3.34-7.47) to 3.42 (2.2-4.91) per 1,00,000 individuals during that period. In 2019, the prevalence was highest in individuals over age 70 and in males compared to females. Among available geographic classifications in 2019, Latin American regions had the highest rates (ASR of 39.49-61.15/1,00,000), while high income North American and Western European regions had the lowest rates (ASRs of 0.67 and 0.34/1,00,000, respectively). Between 1990 and 2019, the worldwide prevalence of CCM per 1,00,000 decreased (EAPC of -0.35, -0.37 to -0.32), with similar trends among most regions and subgroups.
Conclusion: This analysis of the GBD data reveals both global and country-specific patterns in the prevalence and trends of CCM. Notably, CCM shows the highest prevalence in Latin American countries, although it\u27s also significantly present in regions beyond Latin America. Notably, the global age-standardized rate of CCM is on the decline, suggesting improvements in healthcare strategies or lifestyle changes across the world
LibKey Nomad
Get PDFWhat is LibKey Nomad? LibKey Nomad is a browser extension to use with Chrome, Firefox, and Edge that helps connect you to journal articles through our library subscriptions or open access resources. Simply install the plugin and choose the Texas Medical Center Library as your library. LibKey Nomad browser extension gives you fast, one-click access to scholarly articles
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Get PDFhe TMC Library will be closed Friday, July 4 in observance of Independence Day. Regular hours resume Saturday, July 5
Ethics-Driven Cannulation Protocol of ECMO Candidates
No full textPurpose:
This project sought to improve patient and staff outcomes through the implementation of an ethics-driven protocol of patients considered for and placed on extracorporeal membrane oxygenation (ECMO) in a Cardiovascular Intensive Care Unit (CVICU). The aim was to improve 30-day post-cannulation survival outcomes, reduce pain, improve quality of life, and reduce inappropriate cannulations.
Background:
Patients in the CVICU suffering from cardiac or pulmonary failure may require ECMO support. However, ECMO utilization is associated with significant risks, especially in cases of poor prognosis or multiple comorbidities. Before protocol implementation, facility decisions were clinician-dependent, rather than standardized. This protocol aimed to bring structure and consistency to clinical decision-making and improve outcomes.
Methodology:
The protocol was developed based on literature and evidence-based practice, implemented, reinforced and refined through the use of 3 distinct PDSA (Plan-Do-Study-Act) cycles focusing on development, education, and data collection. Data was collected on measures pre- and post- implementation. Outcomes included protocol adherence, pain scores, quality-of-life data, 30-day survival rates, and staff certification rates.
Results:
Patient pain scores in verbal, awake patients increased, but resolved with medication administration. Quality-of-life scores improved after protocol implementation. Venovenous survival rates rose from 61.5% to 76.9%, and Venoarterial from 55.2% to 57.5%. Protocol adherence and nurse ECMO certification rates improved.
Implications:
Protocol implementation helped structure and streamline decision-making, improved patient outcomes, and increased staff satisfaction. Ongoing evaluation of how the protocol is utilized on the unit may help support long-term sustainability, strengthen communication, and bring greater consistency to unit practice
Abstract Prevention of Hospital-Acquired Pressure Injuries in Older Adults in Acute Care Settings
No full textINTRODUCTION:
Hospital-acquired pressure injuries (HAPIs) are a significant risk for older people in acute care, leading to increased morbidity,
Healthcare costs and fragility in senior patients result in higher HAPI rates. This quality improvement (QI) project aimed to reduce HAPI incidence by 40% within four months, utilizing evidence-based nursing interventions tailored to this vulnerable population.
METHODOLOGY:
The project followed the Plan-Do-Study-Act (PDSA) methodology, implementing staff training, periodical skin assessments, and repositioning schedules. Data were collected monthly using skin evaluation checklists and HAPI incidence reports from 30 patient days, and chi-square tests and control charts were used to examine the results. Staff turnover and anomalies in the early paperwork were among the limitations. Interventions included standardized practices, pressure-relieving cushions, and interdisciplinary teamwork, with problems such as increasing staff workload addressed by further training and automated reminders.
RESULTS:
The project achieved an 88% reduction in HAPI incidence, exceeding the 40% target. High levels of staff involvement and interdisciplinary interaction were essential. Integrating protocols into standard treatment and providing continual staff education helped to ensure sustainability.
IMPLICATIONS FOR PRACTICE:
Evidence-based therapies can effectively reduce HAPIs, improve patient safety, and reduce costs. Unexpected outcomes included increased patient-provider trust. To ensure long-term impact, future efforts should focus on expanding protocols to other units and resolving staff attrition
Modeling Renal Anomalies Associated with Li-Fraumeni Patients: A Novel Role for p53 in Kidney Development
No full textLi-Fraumeni syndrome (LFS) is a heritable disorder caused by germline mutations in the TP53 gene that result in an increased risk of cancer. The TP53 tumor suppressor gene regulates cell division and prevents the accumulation of cells that may become cancerous. LFS patients are susceptible to various types of cancers, including osteosarcoma, soft tissue sarcoma, acute leukemia, and adrenal cortical tumors, as well as breast and brain cancer. Additionally, these patients have an increased risk of developing kidney, stomach, colon, pancreas, esophagus, lung, and gonadal germ cell cancers. Prior studies indicate that p53 is involved in kidney development. However, there is no confirmed link between Li-Fraumeni TP53 patient mutations and kidney abnormalities. Nevertheless, collaborative data indicate these patients have an increased prevalence of urogenital anomalies (36%) as compared with the general population (10%) [1]. Considering individuals with LFS are predisposed to cancer due to mutations in TP53, and they have a higher occurrence of congenital anomalies of the kidney and urinary tract, our goal is to determine whether germline disruption of p53 contributes to kidney developmental anomalies. Here, we establish a foundation for future analysis of the molecular mechanism(s) by which p53 influences kidney development. Additionally, we show that kidney-targeted p53 manipulation profoundly disrupts the development of multiple nephron segments in Xenopus embryos. Future studies will further explore the role of p53 in nephron development by modeling the effects of Li-Fraumeni patient-derived mutations in the developing kidney
Nurse-Led Medication Reconciliation Protocol in the Adult Outpatient Mental Health Setting
No full textThis scholarly project implemented a medication reconciliation protocol within the adult outpatient mental health clinic setting. The protocol aimed to increase the medication reconciliation rate from 55% to 60% within three months by May 2025, as well as improve the perception of medication reconciliation among nursing staff. The project was implemented within an outpatient mental health clinic, part of a local community mental health center in Austin, Texas. Patients often see multiple healthcare providers, leading to risks of polypharmacy. This can lead to adverse reactions, medication interactions, and hospitalizations. A flowsheet protocol was created to help guide nursing staff on the process of medication reconciliation. Changes to the protocol during the implementation period were guided by the Plan Do Study Act method. Likert scale questionnaires were distributed before, during, and after the implementation to assess nursing staff’s perception of the medication reconciliation process and effectiveness of the protocol tool. Three nursing staff participated; however, staff turnover limited the ability to have an adequate sample size. A 10% increase in medication reconciliation rate was seen compared to baseline rate of 55% and the post-implementation rate of 65%. Post-implementation questionnaires showed that nursing staff believed the protocol to be easy to interpret, improved the reconciliation process, and fits into their workflow. Barriers to medication reconciliation included workflow compatibility and implementation climate factors, such as staff turnover. It is recommended to extend the use of the protocol to other outpatient mental health clinics and integrate it into the electronic health record system
Heart Failure and Home Health Care Referral Utilization
No full textHeart Failure and Home Health Care Referral Utilization
Purpose
The purpose was to increase provider awareness of the benefits of home health care (HHC) referrals for heart failure patients. It aimed to increase HHC referral utilization intention to maintain compliance with the American Heart Association’s (AHA) recommendation for early follow-up within seven days post-discharge.
Background
Heart failure is a major cause of readmissions in older adults. HHC has been shown to reduce readmissions and improve outcomes post-discharge. HHC referrals remain underused despite its benefits, due to limited provider awareness. This project addressed the gap at a Southeast Texas suburban hospital through an intervention promoting HHC referrals as part of evidence-based, patient-centered care.
Methodology
Guided by the Theory of Planned Behavior, a strategically placed visual prompt of a flyer was implemented in nine key provider areas to promote consideration of HHC referrals. A voluntary QR-code-linked survey assessed providers’ knowledge and intent to refer. Descriptive statistics and thematic analysis were used to evaluate quantitative and qualitative responses. Limitations included time constraints and staff turnover.
Results
Although survey responses were limited to five doctors (n= 5), they showed an increase in provider awareness and intent from 60 percent to 100 percent after intervention. The themes found were awareness through visibility, reinforcement of guidelines, motivation to act, and perceived feasibility.
Implications
Low-cost informational flyers can effectively influence provider awareness and behavior. Future initiatives can incorporate ways to expand impact, increase response rates, and integrate HHC referrals into routine discharge planning