University of Nebraska Medical Center
University of Nebraska Medical Center Research: DigitalCommons@UNMCNot a member yet
10909 research outputs found
Sort by
Development of Adult Multidisciplinary Tracheostomy Rounding Teams: Prevalence, Template for Starting, and Analysis for Diffusion of Innovation
Full text linkEducational Objective: At the conclusion of this presentation, the participants should be able to (a) Describe the prevalence of adult tracheostomy teams in the Middle Section; (b) Outline the impact of dedicated tracheostomy rounding teams; (c) Craft strategies for multidisciplinary rounding team including the necessary personnel; (d) Identify accelerants and barriers to incorporation of the team at their institution or community. Objectives: Multidisciplinary tracheostomy rounding teams have been found to decrease days to speech and decannulation and decrease adverse events. The need of such teams and the characteristics that increase or inhibit the tracheostomy rounding team\u27s implementation rates have not been well described. This quality improvement study and intervention aimed to (a) characterize the prevalence of inpatient teams dedicated to adult tracheostomy patients in the Middle Section; (b) describe strategies to develop a dedicated tracheostomy rounding team; (c) discuss plans to optimize Diffusion of the innovation based on Rodgers’ 1962 text that will increase adoption at other Middle Section institutions. Study Design: This prospective and retrospective quality improvement study both quantitatively and qualitatively analyzed the need, development, and implementation of a multidisciplinary tracheostomy rounding team at two Middle Section institutions. Methods: Inquiries were sent to academic departments throughout the programs in the Middle Section of the Triological Society regarding the presence of a dedicated adult team. Two institutions simultaneously formed tracheostomy teams with different strategies. Results: Only one of the academic departments that responded had a dedicated tracheostomy rounding team for adults. Analyzing the process of our tracheostomy team development, we share strategies to enhance the diffusion process, while recognizing that the time constraints and compensation of the stakeholders involved could be barriers moving forward. Conclusion: Overall, despite literature demonstrating that tracheostomy rounding teams lead to improved patient care and better navigation of the healthcare system by patients and their families, this type of multidisciplinary intervention is underutilized at many programs. Characterizing the development of a tracheostomy rounding team and creating a collaborative network for feedback and implementation help is necessary for its continued momentum and effectiveness.https://digitalcommons.unmc.edu/com_otolayrn_pres/1000/thumbnail.jp
Postnatal Growth Assessment of the Very-Low-Birth-Weight Preterm Infant
Full text linkPreterm birth represents a nutritional emergency and a sudden dissociation of the maternal-placental-fetal unit that regulates metabolic and endocrine physiology. Growth demonstrates health and is a signal of physiological well-being. Growth is expensive for a critically ill infant and possible only after other homeostasis energy demands are met. Despite an expert-stated goal that preterm infants should grow at a similar rate to their gestational age-matched fetal counterparts, this is not the reality for many preterm infants. Other investigators have proposed new metrics for growth quality in the neonatal intensive care unit. This review discusses growth assessment and standards in very-low-birth-weight infants and attempts to address the knowledge gap of which growth metrics are the most important to monitor
Persistent Barriers to Implementation of Long-Acting Injectable Antiretroviral Therapy
Full text linkhttps://digitalcommons.unmc.edu/emet_posters/1039/thumbnail.jp
Temporal Trends and Patterns for Early- and Late-Onset Adult Liver Cancer Incidence Vary by Race/Ethnicity, Subsite, and Histologic Type in the United States from 2000 to 2019
Full text linkPURPOSE: To examine incidence trends and patterns for early- and late-onset liver cancer.
METHODS: Liver and intrahepatic bile duct (IBD) cancers diagnosed between 2000 and 2019 were acquired from 22 SEER registries. Variables included early-onset (20-49) vs. late-onset (50+), anatomic subsite, histologic type (hepatocellular carcinoma [HCC] and IBD cholangiocarcinoma [ICC]), sex, and race/ethnicity. Age-standardized incidence rates were calculated using SEER*Stat. Jointpoint regression analysis was employed to estimate the annual percent change (APC) and the average APC (AAPC) with pairwise comparisons for trend by sex and by race/ethnicity stratified by age and subsite.
RESULTS: Liver cancer incidence decreased among early-onset (AAPC [95% CI] - 2.39 [- 2.74, - 2.07]) but increased among late-onset patients (2.85 [2.71, 3.01]), primarily driven by HCC (3.60 [3.50, 3.71]). IBD incidence increased for both ages with ICC incidence annually increasing 7.92% (6.84, 9.26) for early-onset and 6.32% (5.46, 8.86) for late-onset patients. Early-onset liver cancer displayed comparable trends across racial/ethnic groups; however, late-onset liver cancer showed more variation, particularly among American Indian/Alaska Native/Asian Pacific Islander (AI/AN/API) populations, which experienced a significant decrease in incidence, thereby narrowing the gap with other racial/ethnic groups. For IBD, an identical pattern of early-onset IBD among non-Hispanic Blacks (NHBs) compared to Hispanics was showed with coincidence test p = 0.1522, and a parallel pattern was observed among late-onset patients for both sexes (p = 0.5087).
CONCLUSION: Late-onset HCC continues to rise, except for NHB and AI/AN/API, where incidence rates have started to decrease over the past 4-5 years. Early and late-onset ICC incidence continues to increase across all racial/ethnic groups
Descriptive Analysis of Student Diagnostic and Documentation Skill Development in a Low Fidelity Simulation in Psychiatric Nurse Practitioner Education
Full text linkIntroduction: Nursing educators face challenges in helping registered nurses prepare to be psychiatric nurse practitioners. Nursing educators must consider the variation of students’ skill sets, experience levels, and the shortage of preceptors. Simulations can help overcome limited clinical sites and standardize skill acquisition. High-fidelity simulations can be helpful but are labor-intensive and expensive. Low-fidelity simulations are adaptable to fit the learning needs of psychiatric nurse practitioner students but little research has evaluated these simulations.
Objective: This paper evaluates a series of low-fidelity interventions used to help students learn diagnostic criteria, treatment decisions, and documentation.
Methods: A retrospective descriptive analysis was performed on the results of all students in five cohorts in a psychiatric nurse practitioner course (n=68) on 45 low-fidelity online simulations over five years during the course on advanced psychiatric nursing of adults. Diagnostic notes were graded on four criteria by a psychologist or a psychiatric nurse practitioner. A representative sample of grades on eight notes were analyzed for this manuscript. Survey responses from the students in one cohort were obtained to evaluate their confidence levels and perceptions of simulation utility and responses were analyzed using descriptive and qualitative methods.
Results: The overall mean of description, detail, completeness, and professionalism increased from 7.6 (out of 10) to 9 over the semester with statistically significant improvements in all four areas. The strongest correlation was between detail and completeness and the weakest correlation was between professionalism and description. Students reported that they found significant value in the low-fidelity simulation exercises.
Conclusion: This analysis demonstrates one of the first efforts to analyze low-fidelity simulations for psychiatric nurse practitioner students. The data indicate these simulations can help students improve their confidence and skills in several areas
FORTIFY-med: Fostering Ongoing Research Training In First-Year Medical Students
Full text linkPhysicians are valuable contributors to the biomedical research process with unique perspectives that enhance the translatability of research to patient care. The benefit of physicians in biomedical research is further realized in the expansion of team science, which has reshaped the landscape of translational research and elevated the ability of PhD scientists to work with human populations and samples. Despite these merits, recent studies have demonstrated falling levels of research engagement amongst physicians, which has significant implications for the future of biomedical discovery and evidence-based medicine. To address this issue, we developed the FORTIFY-Med initiative, a pilot project designed to introduce first-year medical students at UNMC to biomedical research through an interactive e-learning module. This module, incorporated into the first-year medical curriculum, exposes students to a broad array of research methodologies, emphasizing the importance of aligning research experiences with individual interests. The primary objective of this study is to evaluate whether early exposure to personalized biomedical research content enhances medical students’ attitudes, participation, and satisfaction with research experiences. Specific aims include: 1) assessing the impact of early exposure on students’ perceptions of biomedical research and 2) measuring its influence on extracurricular interest and participation in research activities. The module’s efficacy is evaluated through pre- and post-module surveys, longitudinal tracking of research engagement, and focus groups. Our central hypothesis is that introducing interest-oriented biomedical research concepts early in medical training will foster positive attitudes and greater involvement in meaningful research activities. Our approach aims to mitigate the current trend of short-term, high output volume-focused projects while inspiring sustained research engagement. Although early in the implementation phase, we aim for this pilot project to serve as a model for medical programs seeking to enhance research education and foster generations of healthcare professionals committed to advancing translational research and improving patient care
AI and OT: Preparing Future-ready Practitioners
Full text linkAim of the project: To assess current state of artificial intelligence (AI) within occupational therapy (OT) practice, education, and research To support the departmental AI readiness of the University of Nebraska’s Medical Center’s OT program To create a student resource empowering integration of ethical and beneficial use of generative AI technologies in the curriculum
Data collection: Researchers are pursuing several avenues of data collection including conducting a scoping review, and semi-structured interviews and surveys with faculty, administrative staff, and students. Analysis will include qualitative and quantitative findings compiled into a needs assessment report.
Student resource: Topics covered in the student resource include an introduction to the fundamental of AI, a description of the current state of AI within OT, tutorials on use of UNMC approved AI tools with examples specific to OT curriculum, prompt engineering, ethical concerns about the use of AI and how to be an informed user, and will connect students to resources and point people within the broader UNMC community to further their understanding of the technology.
Additional resources: The project includes the creation of learning activities for different courses within the curriculum that encourages student use of AI technology with accompanying rubrics to assist faculty in incorporating the technology into their courses
Gazing in the Mirror: Reflecting on Student Perspectives in Work-Integrated Learning in Healthcare Education
Full text linkAbstract: Student engagement is typically woven into the curriculum of healthcare education through hands-on experiences, lectures, discussions, active learning, and lab components. This engagement is critical to developing student confidence, efficacy, and esteem in important skills that will serve them as they enter their profession. In our doctoral program, we are allowed additional engagement opportunities, including belonging to a research project with professionals. Upon reflection, our experience on an interprofessional research team has helped to translate our classroom knowledge to research and professional practice skills.
Plain-Language Summary: This paper is a reflection on the value of adding work skills beyond common fieldwork placements. We recommend schools give students an opportunity to try research skills as part of a working team
Development of Self-Assembled Polymeric Polyplexes for MicroRNA Delivery: Toward Treatment of Alcohol-Associated Liver Disease
Full text linkSelf-assembled polymeric polyplexes have the potential to serve as an RNA interference (RNAi) delivery platform for the combined inhibition of CXCR4 and miR-155 in the treatment of alcohol-associated liver disease (AALD). A central challenge in RNA delivery is balancing the extracellular stability of polyplexes, cellular uptake, and intracellular release of RNA cargo. We developed polymeric polyplexes using the CXCR4-antagonist polymer PAMD, designed to target CXCR4 on activated hepatic stellate cells (HSCs) and deliver therapeutic miRNA to activated Kupffer cells (KCs) in fibrotic liver. We improved the polyplexes by cholesterol modification of PAMD and by PEGylation of PAMD-Ch. The cholesterol modification of PAMD reduced the hydrodynamic size of the polyplexes and improved their colloidal stability through hydrophobic core compaction, facilitating passage through liver sinusoidal fenestrae. This modification also partially neutralized the surface charge of the polyplexes, reducing their cytotoxicity and improving the stability in heparin and plasma. Furthermore, cholesterol modification increased the hydrophobicity of the polyplexes, resulting in enhanced cellular uptake in macrophages. PEGylation of PAMD-Ch further improved polyplex resistance to heparin and blood plasma (especially at moderate PEG content) through charge neutralization and the introduction of stealth properties. Our formulated polyplexes achieved high RNA transfection efficiency in vitro. Overall, this makes the novel PEG-PAMD-Ch/miR a promising miRNA delivery platform for AALD therapy
Novel Drug Delivery Platforms for Small Molecule and miRNA-Based Therapies in Acute Myeloid Leukemia
No full textAcute myeloid leukemia (AML) is an aggressive and heterogeneous hematologic malignancy that largely affects older adults (≥ 60 years). Despite available treatment options, many AML patients experience drug resistance and non-responsiveness, leading to relapses and a dismal 5-year survival rate. Therefore, novel therapies are urgently required.
MicroRNA (miRNA)-based treatments remain an untapped strategy in AML. Using patient-derived specimens, we found increased inflammatory cytokines, including interleukin-6 (IL-6) in the serum of older adults with AML, and decreased miR-497-5p in CD34+ leukemic blasts. Target prediction revealed that miR-497-5p could directly target mitogen-activated protein kinase-1 (MAP2K1) mRNA to indirectly target cytokines and the JAK/STAT signaling pathway through the p38-MAPK signaling pathway, potentially inhibiting leukemic growth and overcoming chemoresistance from venetoclax. To improve miRNA delivery and minimize off-target effects, which represent key barriers to clinical translation, we developed liposomes for co-delivery of miR-497-5p and venetoclax. We decorated our liposomes with a peptide targeting C-type lectin-like molecule-1 (CLL1), which is present on 92% of leukemia blasts while being absent in normal hematopoietic cells. This targeted approach demonstrated high efficacy in inhibiting AML growth in mice with minimal toxicity, as well as reduced exposure to chemoresistance. Our findings suggested that anti-CLL1-decorated, miR-497-5p, and venetoclax-loaded liposomes represent a promising novel miRNA-based therapeutic, which should be investigated further as a strategy to reduce venetoclax resistance in AML.
In addition, mutations in the tumor suppressor gene TP53 are strongly associated with poor outcomes, making treatment especially challenging for these patients. Thus, we developed a new BRD4/PI3K dual-inhibitor, MDP5, to combine with azacitidine (AZA), as a novel treatment strategy for AML. As AZA and MDP5 demonstrated synergistic inhibitory effects in both TP53 wide-type and TP53-mutant AML cells, we further sought to improve delivery efficacy by developing a novel AZA-conjugated polymer, m-PEG[113]-p-[Asp-BLA]-p-[Asp-AZA]-p-g[Asp-DA], which self-assembles into nanoparticles for the co-delivery of AZA and MDP5. Our results showed that the AZA and MDP5-containing nanoparticles significantly enhanced antileukemic efficacy with limited system toxicity. To further improve targeting accuracy and minimize off-target effects, we also modified the nanoparticles with CLL1-targeted peptide. The targeted nanoparticle system effectively suppressed AML progression with minimal toxicity, particularly in TP53-mutant models. This approach holds strong potential to improve outcomes in AML patients, especially those who are unresponsive to standard therapies