University of Nebraska Medical Center
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Examining Change in Burnout and Empathy Among Physician Assistant Students During the Clinical and Didactic Years
Get PDFFew studies investigate how burnout affects physician assistant\u27s student empathy. This study aimed to determine the degree of burnout and empathy in didactic PA students as compared to burnout and empathy in their clinical year.
Methods: One cohort of PA students at a Midwestern university were surveyed twice during their education. Once during didactic and once during the clinical year. Two surveys were used to assess burnout and empathy.
Results: Our findings showed moderate to high levels of emotional exhaustion and depersonalization at the end of the didactic phase and significant improvement in lack of personal achievement and emotional exhaustion at the end of their clinical year. Our study revealed no significant relationship between empathy and burnout at either time point.
Conclusion: Understanding how burnout and empathy change as healthcare students transition into practice is critical. This understanding can aid in comprehension of these issues in healthcare education and curricular design
Comparative Study of Coronary Heart Disease Incidence in Smokers vs. Non Smokers: A Longitudinal Cohort Analysis from the Framingham Heart Study
Get PDFObjective: To evaluate the association between smoking and coronary heart disease (CHD) incidence while adjusting for potential confounding factors, including age, education level, systolic blood pressure, BMI, serum cholesterol, and diabetes, using data from the Framingham Heart Study.
Methods: A cohort of 4,434 participants aged 32–70 years, free of CHD at baseline, was analyzed. Smoking status (current vs. non-current smokers) was the primary exposure, and CHD incidence was the outcome. Adjustments were made for confounders using multivariable logistic regression models. Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.
Results: CHD was diagnosed in 27.96% of participants. After adjustment, smoking was significantly associated with 40% increased odds of CHD (aOR=1.40, 95% CI: 1.211.62, p\u3c 0.0001). Other significant predictors included age, BMI, systolic blood pressure, serum cholesterol, diabetes, and education level (p\u3c 0.05).
Conclusions: In conclusion, we observed a significant association between smoking and CHD, emphasizing the need for targeted public health interventions to reduce smoking and reduce CHD risk
Implementation of an Algorithm to Reduce Wait Times for College-Aged Women Presenting with UTI Symptoms
Get PDFUrinary tract infections, UTIs, are among the most common reasons college-aged women seek medical care. The selected University clinic has a difficult time triaging walk-in UTI patients promptly. Long patient wait times have a negative effect on patient and employee satisfaction scores. An algorithm was created to assist the University clinic in triaging walk-in UTI patients using guidelines from the American Academy of Family Physicians updated with the most current clinical practice recommendations. The algorithm includes the utilization of a point-of-care urine analyzer which provides urinalysis results in 120 seconds. With the algorithm and point-of-care urine analyzer, the student health clinic can improve wait times for patients seeking treatment for UTIs. Improving the diagnosis and treatment process for the large number of female patients seeking medical care for UTI symptoms will facilitate patient and provider satisfaction. Validation of reliable methods that accurately diagnose UTIs without overuse of valuable clinic time and resources is necessary.
This study is a retrospective observational study on wait times and the effectiveness of diagnosing patients using the proposed algorithm. Data were collected over two three-month periods, each separated by a year pre- and post-intervention, and a total of 220 charts were collected. The study took place at a university campus student health center in the front range area of Colorado. Inclusion criteria for participants in the quality improvement project included college-aged women who were assigned female gender at birth and are aged 18 years and older who walk into the health clinic, presenting with UTI symptoms of dysuria, frequency, and/or urgency. Exclusion criteria included pregnant women, those assigned male gender at birth, and participants with scheduled appointments.
The study results showed that implementing the algorithm to reduce patient wait times was not statistically significant. The mean wait time for patients pre-intervention was 70.44 minutes, while the post-intervention cohort had an average wait time of 68.04 minutes. This reduction was not statistically significant. However, the algorithm did not have a negative effect on the effectiveness of diagnosing female patients with UTIs based on return follow-up visits.
This study did not prove that the algorithm helped reduce patient wait times. In future studies, barriers impacting patient wait times must be identified and managed. Future studies to identify when POC urinalysis testing is appropriate, how POC testing affects patient wait times, and the effectiveness of diagnosing UTIs with POC testing versus laboratory-run urinalysis could all help to make this research study more effective in reducing patient wait times in future attempts. Implications of this study could translate to other ambulatory healthcare settings in helping these clinics assess where their barriers lie in reducing patient wait times and how they can manage these barriers
Early Life Exposure to Deltamethrin Impairs Synaptic Function by Altering the Brain-Derived Extracellular Vesicle Proteome
Get PDFPyrethroid pesticides have been associated with neurodevelopmental disorders including attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). While behavioral effects of pyrethroid exposure have been previously reported, the underlying mechanisms remain unclear. Here, we hypothesized that exposure to deltamethrin (DM), a widely used pyrethroid pesticide known for its neurotoxicity during early developmental stages, induces brain dysfunction through alterations in brain-derived extracellular vesicle (BDEV) signaling. Using a well-established rodent model of early life DM exposure within the recommended no observable effect level, we isolated BDEVs from postnatal 30-day-old vehicle-exposed (control) and DM-exposed mice using a differential sucrose density gradient. Following ZetaView nanoparticle tracking and electron microscopy characterization, quantitative mass spectrometry-based proteomics revealed 89 differentially expressed proteins (DEPs) in BDEVs from DM exposed animals compared to control BDEVs. Bioinformatic analysis identified convergence of DEPs on pathways associated with mitochondrial function and synaptic plasticity. PKH67-green conjugated BDEVs derived from either control or DM-exposed mice were bilaterally injected intracerebroventricularly into naive adult mice, and the brain distribution of labeled BDEVs was verified prior to extracellular field recording experiments. Strikingly, long-term potentiation (LTP) at CA3-CA1 hippocampal synapses, a functional correlate of learning and memory, was intact in control BDEVs but absent in naive mice receiving BDEVs from DM exposed mice. Notably, exogenously delivering LRRTM1, one of the DEPs found in DM BDEVs, disrupts synaptic transmission in CA1 neurons consistent with impaired LTP. Thus, differentially regulated signaling in BDEVs represents a novel mechanism of DM neurotoxicity
Metabolism Shapes Immune Responses to Staphylococcus aureus.
Get PDFBACKGROUND: Staphylococcus aureus (S. aureus) is a common cause of hospital- and community-acquired infections that can result in various clinical manifestations ranging from mild to severe disease. The bacterium utilizes different combinations of virulence factors and biofilm formation to establish a successful infection, and the emergence of methicillin- and vancomycin-resistant strains introduces additional challenges for infection management and treatment.
SUMMARY: Metabolic programming of immune cells regulates the balance of energy requirements for activation and dictates pro- versus anti-inflammatory function. Recent investigations into metabolic adaptations of leukocytes and S. aureus during infection indicate that metabolic crosstalk plays a crucial role in pathogenesis. Furthermore, S. aureus can modify its metabolic profile to fit an array of niches for commensal or invasive growth.
KEY MESSAGES: Here we focus on the current understanding of immunometabolism during S. aureus infection and explore how metabolic crosstalk between the host and S. aureus influences disease outcome. We also discuss how key metabolic pathways influence leukocyte responses to other bacterial pathogens when information for S. aureus is not available. A better understanding of how S. aureus and leukocytes adapt their metabolic profiles in distinct tissue niches may reveal novel therapeutic targets to prevent or control invasive infections
Heart Failure Zone Tool: A Quality Improvement Project
Get PDFPurpose
Heart failure is the leading cause of hospital admissions among adults over 65 years old and lack of patient knowledge regarding the self-management of heart failure is a key factor in rising readmission rates. This project enhances inpatient heart failure education using a laminated heart failure zone tool handout to guide heart failure education. The intent was to increase patients’ confidence regarding heart failure self-management and positively impact patients’ knowledge regarding the management of heart failure.
Materials and Methods
The process included identifying hospitalized patients who had been flagged as a heart failure core measure or had been identified by the heart failure coordinators as needing heart failure education. The DNP research team analyzed two main outcomes: patient confidence in self-managing heart failure and patient knowledge about heart failure. Patients completed two pre-test assessments to evaluate their baseline heart failure knowledge and confidence in self-managing heart failure. The Nebraska Medicine Confidence Survey (NMCS) was used to assess their confidence while knowledge was tested using the Patient Knowledge Questionnaire (PKQ). Specialized education was provided, emphasizing the heart failure zone tool to help patients identify commonly reported symptoms and steps for managing those symptoms. After receiving the specialized education, patients completed a post-test to reassess any changes to their heart failure knowledge and confidence. The intent was that the specialized heart failure education would increase patients’ reported confidence in managing heart failure and patients’ knowledge about heart failure.
Results
The process included identifying hospitalized patients who had been flagged as a heart failure core measure or had been identified by the heart failure coordinators as needing heart failure education. The DNP research team analyzed two main outcomes: patient confidence in self-managing heart failure and patient knowledge about heart failure. Patients completed two pre-test assessments to evaluate their baseline heart failure knowledge and confidence in self-managing heart failure. The Nebraska Medicine Confidence Survey (NMCS) was used to assess their confidence while knowledge was tested using the Patient Knowledge Questionnaire (PKQ). Specialized education was provided, emphasizing the heart failure zone tool to help patients identify commonly reported symptoms and steps for managing those symptoms. After receiving the specialized education, patients completed a post-test to reassess any changes to their heart failure knowledge and confidence. The intent was that the specialized heart failure education would increase patients’ reported confidence in managing heart failure and patients’ knowledge about heart failure.
Conclusions
The findings suggest clinical significance because the education provided positively impacted patients’ self-management confidence and heart failure knowledge. The heart failure zone tool clearly indicates which symptoms require contacting their physician for further guidance and “red flag” symptoms that require contacting emergency services. The outcomes of this DNP project suggest that utilizing the heart failure zone tool will be advantageous for improving patients’ health
Impact of Sepsis Education for Emergency Department Staff: A Quality Improvement Project
Get PDFBackground: Sepsis continues to be a critical issue worldwide. New sepsis guidelines instituted by the Centers of Medicare and Medicaid Services (CMS) list evidence-based standards to comply with regarding care for sepsis patients. To help a new acute care facility meet compliance, a sepsis educational program has been developed to assess staff knowledge and confidence in caring for these patients.
Methods: This quality improvement (QI) project was developed using a pre-post study design to assess the impact of implementing a sepsis educational program for emergency department staff at this new acute care institution. A sepsis educational program was derived from CMS’s sepsis protocol SEP-1 Core Measures. The protocol calls for a series of evidence-based interventions to be completed within three and six hours.
Results:Post intervention data show that after completing the sepsis education program 69.3% of staff felt they were very confident or extremely confident in their care of sepsis patients. Familiarity with sepsis had a statically significant increase t (22) = 10.35, p
Conclusions: Data show the participants gained familiarity and confidence from the sepsis education program. Knowledge improvement was significant after the standard of care guidelines education. Having staff trained in these interventions will not only increase compliance but, most importantly, improve patient outcomes
Physical Activity and Knee Health Outcomes After Anterior Cruciate Ligament Reconstruction
Get PDFAnterior cruciate ligament reconstructions (ACLR) have increased in incidence worldwide. After ACLR, individuals are at higher risk for developing early onset knee osteoarthritis. Individuals after ACLR also participate in less physical activity (PA), contributing to an increased risk for early onset knee osteoarthritis and poor overall health outcomes.
The two goals of this work were to 1) determine the relationship between PA and knee health outcomes 18 months after ACLR and 2) determine the feasibility and acceptability of a PA intervention early after ACLR that considered participant thoughts and feelings.
Findings for the first goal suggest that there is no association between change in daily steps from six to 18 months after ACLR and structural or symptomatic signs of early onset knee osteoarthritis. However, there was an association with decreased morning sedentary time from six to 18 months after ACLR and improved symptoms related to knee health.
For the second goal, individuals were enrolled in a 12-week personalized progressive PA program within eight weeks of ACLR. The PA intervention was found to be safe, with good adherence to wearing a wrist-worn activity monitor and attending virtual visits demonstrated. However, individuals demonstrated difficultly reaching targeted PA levels. Qualitative analysis of post-intervention semi-structured interviews identified participant level theme (experience with sport, flexibility in schedule, and response to goals) that contributed to success in achieving PA targets, as well as programmatic themes (provide accountability and feedback, promote activity early, and measure all PA) to include in a future program to promote successful achievement of PA targets.
The results of my work add significant contributions to our knowledge about PA after ACLR. Although daily step counts were not associated with knee health outcomes 18 months after ACLR, decreasing sedentary time from six to 18 months was associated with better knee function. Beyond its impact on knee health, promoting PA after ACLR will likely also benefit overall health and wellness. My work establishing the feasibility of a PA program early after ACLR provides the foundation for further development and testing a PA intervention to promote recovery of healthy PA participation in individuals after ACLR
Factors Associated with Sedentary Behavior and Physical Activity During Hospitalization for Hematopoietic Stem Cell Transplantation
No full textPurpose: Physical activity may decrease inactivity-related complications associated with hematopoietic stem cell transplantation (HSCT). Factors associated with objectively measured sedentary behavior and physical activity during HSCT have not been studied adequately. This study aimed to describe the clinical and personal factors associated with sedentary behavior and physical activity starting with the day of hematopoietic stem cell transplantation, for 10 days during hospitalization, and the first 7 days after discharge.
Methods: This longitudinal, observational study measured sedentary behavior and physical activity with accelerometers on HSCT days 0-4 (T1), days 5-9 (T2), and the first 7 days after hospital discharge (T3). Clinical factors (demographics, HSCT type, time to engraftment, length of hospitalization) and personal factors (exercise self-efficacy, physical and mental health, and symptom severity and interference) were assessed at T1, T2, and T3. Physical activity and clinical and personal factors were described and evaluated for change over time (Friedman test), differences in physical activity between clinical and personal factors (Mann-Whitney U and Kruskal-Wallis tests), and associations with clinical and personal factors (Spearman correlations).
Results: Participants’ (n=26, 57% male, median age 55 years [40-65.3]) accelerometer data revealed participants were sedentary ³87% of the time with no change over time. The sample’s median metabolic equivalent values corresponded to lying, sitting, or standing from T1-T3. Light and moderate-vigorous physical activity and median number of steps decreased significantly as symptom severity and interference increased from T1 to T2. Patient-reported exercise self-efficacy was moderate to high at all time points and was correlated with an increased number of steps at T2 (r=.57, p=.05) and increased light physical activity (r=.55, p=.05) and number of steps (r=.61, p=.01) at T3.
Conclusion: Accelerometers recorded low minutes of light and moderate-to-vigorous physical activity per day, with metabolic equivalent levels corresponding with sedentary activities, despite reporting moderate to high exercise self-efficacy. Symptom severity and interference were associated with lower levels of physical activity in patients hospitalized for HSCT. Oncology nurses can educate patients hospitalized for HSCT on the benefits of reducing sedentary time, increasing physical activity, and managing symptoms during hospitalization and early recovery
Evaluating the Association of Influenza Vaccination on Long-Term COVID-19 Symptoms in U.S. Adults
Get PDFObjective. To evaluate the association of influenza vaccination in the past 12 months with Long COVID effects and clinical and sociodemographic factors.
Methods. Cross-sectional study with data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), covering 415,132 non-institutionalized U.S. adults with a confirmed COVID-19 diagnosis and influenza vaccination reported within the last 12 months. Logistic regression was conducted between influenza vaccination (exposure) and Long COVID (outcome), controlling for demographic variables, pre-existing health conditions, and socioeconomic status.
Results. Of 120,603 participants, 21.89% reported Long COVID symptoms and 42.04% had received an influenza vaccine. Findings indicate a statistically significant 13% reduction (95% CI: 1.06 - 1.20) of Long COVID among influenza-vaccinated individuals, adjusting for confounders such as healthcare access, socioeconomic and demographic factors, and chronic health conditions. Individuals with chronic health conditions, women, minority racial/ethnic groups, and adults aged 45 to 64 were more likely to report Long COVID symptoms.
Conclusions. Our study suggests that influenza vaccination may reduce Long COVID symptoms, maintaining statistical significance. Further research is needed to confirm these associations and explore strategies for addressing Long COVID challenges