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Appropriateness of Vascular Access Device Selection
Get PDFCentral venous access devices (CVADs) are associated with serious complications, including central line associated bloodstream infection (CLABSI), that place patients at risk for poor outcomes and are costly for hospital systems. Research suggests great variability of CVAD use in hospitals including overuse and inappropriate use of these devices which places patients at unnecessary risk for complications. Each unique patient situation involves multiple characteristics that adds complexity to their hospitalization. Clinicians make decisions regarding line selection often during emergent situations without the appropriate level of evidence to support this decision, which results in inconsistencies and variations in the use of CVADs. Vascular access nurses, specialized clinicians who place and maintain vascular access devices (VADs) in hospitalized patients, are often involved in decision making regarding VAD use. Providing these specialized clinicians with the latest evidence-based decision support tools and the knowledge needed to interpret this information to determine the most appropriate VAD for an individual patient may impact VAD utilization. Empowering vascular access nurses to appropriately evaluate and decide if a patient meets the criteria for CVAD insertion prior to placement could prevent unnecessary exposure to potentially dangerous and costly complications. The proposed project objectives include introducing an evidence-based guideline for use by the vascular access team to support VAD selection for hospitalized adult patients at a large academic medical center. Decision support guidelines are composed of evidence-based recommendations from Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) resources. The algorithms to be implemented address various complex patient scenarios that challenge clinicians when choosing the most appropriate VAD. Project goals include improving appropriateness of VAD selection through recommendations from vascular access nurses using MAGIC resources as evidence-based guidelines in clinical decision making. Achieving these goals may result in a decrease in inpatient CVAD use and a reduction in serious complications associated with CVADs. Objectives are aimed at improving the quality of patient care by using the latest evidence for vascular access recommendations. Improved quality of care can reduce health care costs by preventing serious and life-threatening complications that prolong the hospital length of stay and require additional unnecessary therapies and hospital readmissions
Am I Going to Glow in the Dark?\u27 An Analysis of the Overutilization of Diagnostic Medical Imaging
Get PDFIt is the goal of this paper to raise awareness of the danger of overutilization of diagnostic medical imaging and present possible solutions to reduce the current number of imaging exams performed
Ambulatory Oncology Nurses\u27 and Nurse Practitioners\u27 Self Perception of Competence in Cancer Survivorship Care
Get PDFThe advances in cancer research with medical treatments and early detection practices have improved the survival of cancer patients as they are living longer and the rate of cancer survivors are increasing steadily. Cancer survivors may experience residual side effects from cancer or its treatment. These side effects may be disabling acutely or long-term causing physical and psychological effects that can negatively affect quality of life. There is a need for extended follow-up care for cancer survivors beyond solely just receiving treatment for cancer. Nurses and nurse practitioners can make a huge impact on the quality of life for cancer survivors by providing education, symptom management, promoting healthy lifestyles, preventative care, emotional support, and cancer surveillance. Research has shown that knowledge and competence in cancer survivorship care exist. The purpose of this project was to examine oncology nurses and nurse practitioner’s self-perception of competence in cancer survivorship care. A survey questionnaire “Caring for patients living with and beyond cancer competency tool” was administered to nurses and nurse practitioners at the outpatient oncology institute. The survey measured self-perception of competence in the areas of clinical practice, symptom management, care coordination, and proactive management. Twenty-nine participants (n=29), twenty-five nurses and four nurse practitioners completed the survey. Results indicated self-perception of knowledge deficits in certain areas of cancer survivorship care. The findings support the need for continuing education and training to give nurses and nurse practitioners the knowledge and skills to care for a growing population of cancer survivors
But I Don\u27t Use a Textbook: Open Educational Resources for All
Get PDFPresentation (slide, PDF format) about open educational resources
A Systematic Review Examining the Efficacy of Epidural Analgesia on Mortality in Older Adult Patients with Rib Fractures
Get PDFRib fractures are a common consequence of blunt force trauma, producing pain and potentially leading to complications such as pneumonia, atelectasis, respiratory failure, and death. Due to physiological changes related to aging, older adults aged 65 and over are at increased risk for developing such complications. Aggressive treatment of pain has been recognized as paramount in preventing such consequences. While there are multiple modalities to treat pain related to rib fractures, epidural analgesia has frequently been recognized as an effective means of preventing pulmonary complications and decreasing mortality in an opioid sparing technique. However, it remains unclear if this therapy would serve as a definitive treatment in the population of older adults. The purpose of this systematic review was to determine the effect of epidural analgesia on decreasing mortality in the older adult patient population. Literature and pertinent randomized controlled trials were searched for inclusion within this review. Six trials were included within this review utilizing the PRISMA checklist and CASP tool to extract and critically appraise data. Cross study analysis was then utilized to determine overarching themes within the data. This systematic review did not find any statistically significant data to suggest that mortality is decreased in older adults by utilizing epidural analgesia after thoracic trauma. Further research is necessary utilizing prospective data focusing on this particular patient population in order to better determine the effectiveness of this treatment
The World Will Never Know What We Did To Them : The Western Press Coverage of the Romanov Family Murder
Get PDFOn July 17, 1918, three hundred years of monarchy had ended in Russia with the brutal murder/execution of ex-Tsar Nicholas II and his entire family. In the midst of this, the Russian Revolution had been in full swing and Lenin rose to power. He also intended to keep this power and would do so by any means necessary. While keeping the Romanovs under house arrest, Lenin and the Bolsheviks pondered for months about what to do with the former royal family. He concluded that they could not be kept alive because of the possibility that one member could be reinstated as the monarch. However, Nicholas had been the individual to blame for Russia\u27s descent and the world would be shocked to discover that Lenin had murdered innocent women and children to keep his power. Therefore, it was imperative that Lenin and the Bolesheviks mislead the West, specially their reporters who had been the main sources of information coming from Russia. This paper analyzes the effect that this deception had on the press and the stories that it generated. Many of these fabrications could not be verified because of the lack of physical evidence and the overall suppression of speech regarding the monarchy. It was not until the fall of the Soviet Union and subsequent DNA analysis of the remains when the true fate of the Romanovs emerged
Social Value Creation and Social Innovation by Human Service Professionals: Evidence from Missouri, USA
Get PDFOwing to the contextual challenges, human service professionals (HSP) are creating social value (SV) for diverse vulnerable population groups through social innovation. This qualitative exploratory study investigates the nature of SV created by 14 HSPs, representing a diverse range of human service organizations (HSOs), and examines ‘why’ and ‘how’ they innovate. In addition, the study examines HSPs’ current understanding and practices related to social entrepreneurship (SE). The study findings highlight that increased accountability and new funding opportunities challenged HSPs to innovate. HSPs created SV by addressing new unmet needs, developing new collaborations, and employing alternative marketing strategies, thereby ensuring the financial sustainability of their programs and organizations, and promoting social and economic justice. Different understandings of SE were voiced based on the educational backgrounds of HSPs. Without formal training in SE, HSPs trained in social work appeared to use various components of the SE process, though in a haphazard fashion compared to those with a non-social work academic training. We suggest that the graduate curriculum across various disciplines should formally include principles and behaviors related to social innovation and entrepreneurship. Finally, more research is needed to understand and describe how HSPs create SV in HSOs
Nurses\u27 Perceptions of the Barriers to Using Nonpharmacological Methods to Relieve Patients\u27 Pain in the Acute Care Setting
Get PDFManaging patients’ pain is a challenge that many caregivers face as they balance adequate pain management with minimal drug side effects. Nonpharmacological pain management techniques exist that literature has shown to be effective. Although caregivers may be aware that nonpharmacological pain relief options exist, pharmacological pain management still remains the primary, and often the sole form of pain intervention. The purpose of this project was to identify nurses’ perceptions of barriers to using nonpharmacological methods to manage their patients’ pain in the inpatient hospital setting. A modified survey was created using the Nurses’ Perceived Obstacles to Pain Assessment and Management Practices questionnaire by Coker et al (2010). The modified survey included 19 questions that were relevant to nonpharmacological pain management of an adult patient in the hospital setting. The participants’ years of nursing experience was also collected with this tool. A total of 19 nurses that work in the Intensive Care Unit of Newport Hospital, a 129-bed community hospital in Newport, RI were surveyed. The results of the survey showed that over half of all respondents perceived they had inadequate time to educate their patients on the use of nonpharmacological pain management and that their institution did not have clear policies or guidelines of best practices regarding nonpharmacological pain management. Over 45% of all respondents found a lack of system support and education and patient attitude to be barriers. This project identified that both nurses and patients would benefit from further guidance by the institution with the use of guidelines and policies to enhance their knowledge, confidence, efficiency, and skills to manage their patients’ pain with nonpharmacological options
Improving the Delivery of Enteral Nutrition in the Neurocritical Care Unit Through the Implementation of a Volume-Base Feeding Protocol
Get PDFNeurocritical care patients receiving rate-based enteral nutrition (RBEN) consistently received less than their full prescription of enteral nutrition (EN) volume due to interruptions in feeding. This study investigated the impact of the implementation of a volume-based feeding protocol (VBEN) on the percentage of prescribed volume of EN delivered over the course of patients’ neurocritical care unit (NCCU) length of stay. Aim: The aim of this study was to better meet the nutritional needs of adult neurocritical care patients receiving nutrition through the enteral route. Methods: A retrospective pre and postimplementation chart review was conducted on adult patients with age 18 or greater and less than 90 years with a neurological-related injury or disease process who had EN initiated and delivered for three or more days during their stay in NCCU. Results: Despite no significant differences in characteristics or gastrointestinal complications between the groups, there was a significant increase in the percentage of prescribed EN volume delivered over the course of NCCU stay of 23.15% percentage points in the VBEN group (M = 95.3%, SD 4.92) as compared to the RBEN group (M = 72.15%, SD 10.55, t(27, n=40) = 8.89,
Homology Modeling of the Squalus Acanthias AHR1 To Locate Structural Determinants of Function
Get PDFThe aryl hydrocarbon receptor (AHR) is a ligand-activated transcription factor that mediates a toxic response to many environmental contaminants. Cartilaginous fishes, due to gene duplication events, express 4 distinct AHR genes. Squalus acanthias AHR1 (SaAHR1) does not bind to typical AHR agonists, including dioxin-like chemicals (DLCs), whereas SaAHR2 binds to DLCs and subsequently upregulates genes containing dioxin responsive elements. Three-dimensional homology models were created based upon both human HIF1α and human HIF2α structural templates. These models yielded different secondary structural characteristics, most notably in the length of the β-strand on the C-terminal end of the ligand binding domain, which is centrally located in the antiparallel β-sheet that makes up a large portion of the ligand binding cavity. Residue A375 is located in a possible hinge area on this β-strand, and the mutation A375C would change this alanine residue in the nonbinding SaAHR1 to its analog in the DLC-binding SaAHR2, which may increase SaAHR1’s binding affinity to DLCs. The SaAHR1 also has a novel diproline motif comprising residues 379 and 380, located on the same β- strand as residue 375. This motif is not known to be found in any other AHR isoforms. Reversion of the diproline motif to proline-leucine, its analogous residues in SaAHR2, did not restore PCB 126 induced activation of a luciferase reporter gene. Epifluorescence microscopy using a heterologous expression system and an eGFP-SaAHR1 DNA construct revealed a nuclear localization unique to this isoform. Further characterization of this non-binding receptor could help to determine species-specific sensitivities to AHR agonists, especially in animals that are unavailable for direct experimentation (i.e.: endangered species)