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Ketamine Infusion Protocol & Patient Education Pamphlet for Complex Regional Pain Syndrome
Get PDFComplex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy (RSD) and causalgia, is a debilitating neurological disease accounting for 1.2% of all chronic pain conditions, with eighty percent being severely disabled (Zhao et al., 2018). Altered pain pathways in CRPS patients result in resistance to traditional methods of analgesia, contributing to poor quality of life and unanticipated hospitalizations. Multiple meta-analysis studies suggest ketamine infusions effectively lower chronic pain scores in CRPS patients. Despite the evidence, a lack of standardized ketamine infusion protocols creates a barrier to provider implementation. This Doctor of Nursing Anesthesia project aimed to develop a ketamine infusion protocol and patient education pamphlet for CRPS providers in a Midwest Hospital. Project implementation consisted of an educational presentation and pamphlet with a post-education survey completed anonymously by anesthesia providers and recovery room nurses. Analysis of survey responses indicated that the project successfully improved provider knowledge and comfort in managing ketamine infusions. The protocol is a potentially impactful clinical resource for pain management in the CRPS population
Promoting the Incorporation of Regional Anesthesia to Improve Pain Management for Lower Extremity Surgeries
Get PDFOpioid addiction in the United States is a healthcare crisis and continues to increase yearly. Multimodal pain management is a priority intervention that needs to be implemented to manage pain with less intra and postoperative opioid use. Peripheral nerve blocks are one alternative that can be used to decrease opioid use and assist in controlling pain for foot and ankle surgeries. This project aims to educate, develop, and create a protocol for popliteal nerve blocks at Hillsboro Area Hospital in Hillsboro, Illinois. As a result, the long-term goal is to reduce opioid administration and improve pain control. An educational PowerPoint presentation was provided for the surgical perioperative personnel and anesthesia providers in July 2023. Pre- and post-presentation surveys were distributed to evaluate knowledge gained from the educational presentation. It was noted that there was a significant improvement between the pretest and posttest scores, indicating an increased understanding of the benefits of popliteal nerve blocks and the resultant reduction of opioid use and improved pain control. The results positively impacted the implementation of a popliteal block protocol and provided education for its use. Utilization of the popliteal block protocol could potentially reduce opioid administration for pain control of patients undergoing foot and ankle surgeries. As a result, it improves patient satisfaction, reduces the length of hospital stays, and reduces patient and institutional costs
Diversity, Equity, & Inclusion in Nurse Anesthesia: Bridging the Gap
Get PDFThe nurse anesthetist plays a crucial role in the healthcare system. Through intensive training, they provide safe and effective anesthesia care to patients across various healthcare settings. Currently, the nurse anesthesia field lacks diversity, with underrepresentation of minority groups such as Black, Hispanic, and Indigenous individuals. The United States Census revealed that there are more than 325 million residents. Yet only 10.9% of nurse anesthetists are of diverse racial backgrounds. This lack of diversity limits the cultural perspectives and experiences brought to patient care and perpetuates disparities in healthcare outcomes. An increase in diversity can improve care for individuals and groups by increasing their awareness of the community’s health needs, their ability to provide personalized care, and their capacity to continuously learn to serve everyone in their community. Addressing this issue is essential for creating a more inclusive and representative workforce that can better meet the needs of diverse patient populations. By increasing awareness in the nurse anesthesia field, we can encourage dialogue, advocacy, and action to promote diversity and equity. Some strategies to raise awareness within the nurse anesthesia field are targeted outreach programs to underrepresented communities, collaboration with diversity-focused organizations, and promoting diversity and inclusion initiatives within educational and professional settings. Broadening awareness of the need for diversity in anesthesia practice can improve the overall delivery of healthcare to all ethnicities
Iron Deficiency Screening Implementation for Patients with Heart Failure Reduced Ejection Fraction
Get PDFHeart failure with reduced ejection fraction (HFrEF) significantly impacts patients’ quality of life. Similarly, iron deficiency (ID) anemia decreases the patient’s oxygen levels and functional ability due to fewer red blood cells and less oxygen binding capacity. Patients with heart failure frequently have a commonly overlooked comorbidity of ID anemia, which impacts almost 50% of the ambulatory patient population. Patients with HFrEF and ID anemia have decreased exercise capacity, increased fatigue, reduced oxygenation due to low hemoglobin, and increased hospital readmissions. The end goal of this implementation project was to increase the number of times providers screened for ID anemia in HFrEF patients and consideration of iron infusion when needed. Within two large suburban cardiology clinics, 15 patients with HFrEF were screened for ID anemia. The providers did not capture all patients screened at these facilities due to time constraints. A pre-and post-implementation survey was given to providers at the two clinics. Results from the survey found that most providers knew that screening HFrEF patients for ID anemia was necessary yet overlooked. Providers noted that they did not have a standard process for evaluating it. Providers’ feedback suggested that the screening tool, while useful and easy to use, some changes are needed to make it a part of routine practice. Other concerns included the feasibility of screening due to provider time constraints and the cost burden of iron infusions to patients
EMR Templates for Age-Appropriate Well-Child Pediatric Visits
Get PDFThe world of pediatric medicine is continually evolving. The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) regularly update guidelines to have the most current information available to providers and their patients. The overwhelming majority of primary care offices have transitioned to electronic medical records (EMRs) for charting purposes. Templates included in EMRs ease the workflow and documentation process for providers. In the primary care setting, templates include essential information discussed at well-child visits, such as developmental milestones, vaccination schedules, and anticipatory guidance. The project’s purpose was to update the age-specific well-child templates at a private suburban Midwest primary care office to ensure patients and their families receive the best quality care. After the updated templates were implemented, a chart review was completed to compare the accuracy and completeness of provider documentation on the new templates compared to the previous templates. The updated templates were found to have more patient education and anticipatory guidance documented in each visit. A questionnaire was also given to the providers for feedback about usability and provider satisfaction. Overall, the providers were satisfied with the updated templates and information included, but agreed there were limitations to being unable to upload the new templates to the EMR. The templates overall provided the patients and families with the most recent age-specific information
Establishing Community Connections for a Mobile Health Clinic
Get PDFWithin the United States, there are many healthcare disparities. The supply and demand for mobile health have increased since the start of the COVID-19 pandemic. This project\u27s purpose was to improve and develop partnerships between communities and a new mobile health clinic with the intention of increasing healthcare services availability. The new mobile health clinic is an extension of a well-established university brick-and-mortar clinic. A survey was sent to county housing authority residents to determine community healthcare needs for various services including preventative and acute care services. Residents filling out the survey provided information about the targeted patient population and what patients\u27 needs are within that community. Residents were provided with information regarding the mobile health clinic and services that could be offered. The intention of the mobile health unit is to decrease disparities for the patients, who may not have access to regular health care, and for those who may feel more comfortable with health care services being provided within their community. The connections with community partnerships have substantial positive impacts on communities within the United States. Based on surveys, services that are desired include: diabetes care, management of hypertension, depression, allergies, headaches, anemia, anxiety, arthritis, bladder infections, kidney disease, sleep disorders, low energy, poor circulation, gout, alcohol consumption, water retention, skin disorders, high cholesterol, menopausal, Alzheimer\u27s, osteoporosis, smoking, acne, ADHD, COPD, lupus, thyroid management, heartburn, and calcium deficiency
Ca2+ binding shifts dimeric dual oxidase\u27s truncated EF-hand domain to monomer
Get PDFHydrogen peroxide, produced by Dual Oxidase (Duox), is essential for thyroid hormone synthesis. Duox activation involves Ca2+ binding to its EF-hand Domain (EFD), which contains two EF-hands (EFs). In this study, we characterized a truncated EFD using spectrometry, calorimetry, electrophoretic mobility, and gel filtration to obtain its Ca2+ binding thermodynamic and kinetics, as well as to assess the associated conformational changes. Our results revealed that its 2nd EF-hand (EF2) exhibits a strong exothermic Ca2+ binding (Ka = 107 M−1) while EF1 shows a weaker binding (Ka = 105 M−1), resulting in the burial of its negatively charged residues. The Ca2+ binding to EFD results in a stable structure with a melting temperature shifting from 67 to 99 °C and induces a structural transition from a dimeric to monomeric form. EF2 appears to play a role in dimer formation in its apo form, while the hydrophobic exposure of Ca2+-bound-EF1 is crucial for dimer formation in its holo form. The result is consistent with structures obtained from Cryo-EM, indicating that a stable structure of EFD with hydrophobic patches upon Ca2+ binding is vital for its Duox\u27s domain-domain interaction for electron transfer
Nurse Anesthesiology Education for Regulators
Get PDFGovernmental and regulatory entities like the state board of nursing have an active role in regulating all nursing fields, including anesthesiology. The lack of a required nurse anesthesiology representative on the board presents a potential knowledge gap related to anesthesiology practice. Board members and staff must make decisions related to nurse anesthesiology that may cause anxiety due to its complexity. The lack of education in this area allows one to make wrong decisions or spend extended time looking for the correct information. The main objective of this project was to provide an educational module on nurse anesthesiology practice to the state board of nursing commissioners and staff. Pre and Post-test surrounding a lecture on the basics of nurse anesthesiology history, practice, and billing models and their effect on safety and access, attendees were given a questionnaire to assess knowledge regarding nurse anesthesiology practice. The literature suggests that nurse anesthesiology is a complex and unique area in the broad spectrum of nursing. The different providers, their educational pathways, backgrounds, scope of practice, and legislature restrictions make it quite difficult for leaders in regulatory bodies like the Nursing Care Quality Assurance Commission to understand, which could impact decision-making. The graded percentage for the pre-test was 34%, while the post-test was 79%. Based on these results, there is a strong indication that members of a regulatory body, like the Board of Nursing, should implement a continuous educational module in nurse anesthesiology to better serve the public. Some participants were in a virtual setting and, therefore, unable to answer both parts of the evaluation. Some participants expressed minimal knowledge and interest in the assessment and lecture
p450 APO in Membrane Trajectory 1
No full textThe Cytochrome P450 (CYP) enzymes metabolize a variety of drugs, which may potentially lead to toxicity or reduced efficacy when drugs are co-administered. These drug-drug interactions are often manifested by CYP3A4, the most prevalent of all CYP isozymes. We carried out multiple MD simulations employing CAVER to quantify the channels, and Hidden Markov Models (HMM) to characterize the behavior of the gating residues. We discuss channel properties, bottleneck residues with respect to their likelihood to deem the respective channel ingress or egress, gating residues regarding their open or closed states, and channel location relative to the membrane. Channels do not display coordinated motion and randomly transition between different conformations. Gateway residues also behave in a random fashion. Our findings shed light on the equilibrium behavior of the gating residues and channels in the apo state
Structural Effects on the Temperature Dependence of Hydride Kinetic Isotope Effects of the NADH/NAD+ Model Reactions in Acetonitrile: Charge-Transfer Complex Tightness Is a Key
No full textIt has recently frequently been found that the kinetic isotope effect (KIE) is independent of temperature (T) in H-tunneling reactions in enzymes but becomes dependent on T in their mutants. Many enzymologists found that the trend is related to different donor-acceptor distances (DADs) at tunneling-ready states (TRSs), which could be sampled by protein dynamics. That is, a more rigid system of densely populated short DADs gives rise to a weaker T dependence of KIEs. Theoreticians have attempted to develop H-tunneling theories to explain the observations, but none have been universally accepted. It is reasonable to assume that the DAD sampling concept, if it exists, applies to the H-transfer reactions in solution, as well. In this work, we designed NADH/NAD+ model reactions to investigate their structural effects on the T dependence of hydride KIEs in acetonitrile. Hammett correlations together with N-CH3/CD3 secondary KIEs were used to provide the electronic structure of the TRSs and thus the rigidity of their charge-transfer complexation vibrations. In all three pairs of reactions, a weaker T dependence of KIEs always corresponds to a steeper Hammett slope on the substituted hydride acceptors. It was found that a tighter/rigid charge-transfer complexation system corresponds with a weaker T dependence of KIEs, consistent with the observations in enzymes