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From Witch Hunts to Autoantibodies: Overcoming Psychogenic Stigma to Uncover the Molecular Cause of Autoimmunity
Get PDFDue to the frequency of misdiagnosis of autoimmune diseases and their disproportionate incidence in women, my thesis explores historical misconceptions about autoimmune conditions which could have lingered in society to impede their diagnoses today. Antiphospholipid Antibody Syndrome (APS) and Anti-NMDA Receptor Encephalitis (ANRE) are the conditions I focused on, as both diseases can cause complex neurologic symptoms such as hallucinations and memory loss, which in combination with the fact that they are disproportionately suffered by women, have caused physicians in the past to misdiagnose patients as either hysteric or demonically possessed. I explore antiphospholipid antibody syndrome and anti-NMDA receptor encephalitis’s etiologic transitions from psychogenic to their correct physiologic explanations. I then apply this research to another, more poorly understood condition, fibromyalgia, a disorder that is currently classified as “psychogenic,” yet is hypothesized to be autoimmune. It still isn’t well understood, partly due to the fact that patients still face the stigma of hysteria when seeking a diagnosis. The purpose of this thesis is to combine biological and historical perspectives of medicine to explore the dangerous implications of labeling diseases as psychogenic, as this term often is merely a resurrection of the gender-biased concept of hysteria that impedes the diagnosis process on a daily basis. The dismissal of these conditions’ true etiology illuminates the resurgence of hysteria as an acceptable medical diagnosis, revealing the urgency to emphasize the molecular forces underlying previously misunderstood diseases of anti-phospholipid antibody syndrome and anti-NMDA receptor encephalitis
Step Model for Managing Chronic, Non-Malignant Pain in Primary Care
Get PDFOftentimes, primary care providers lack the knowledge, confidence, and time to monitor chronic pain patients closely resulting in possible inappropriate prescribing of opioids. Purpose: The project aim was to improve primary care provider knowledge and confidence in managing chronic pain patients in the primary care setting using a step model that was developed based on the Centers for Disease Control (CDC) guidelines as well as online education modules produced by the CDC. Methods: The project design was a quantitative pretest-posttest design. The primary outcome was to provide training on the CDC guidelines for prescribing opioids for chronic pain as well as implementation of a step model for primary care providers increasing their knowledge and confidence in management of chronic, non-malignant (CNMP) pain patients. Outcomes and Results: There were seven questions on the pre- and posttest that were analyzed using Wilcoxon Signed Ranks Test. Of the seven questions, five were statistically significant. The project data showed that the education module and step model increased knowledge and confidence in managing CNMP and prescribing opioid medication for this population (n=7). It also demonstrated a lack of education related to management of CNMP and opioid medications highlighting the need for increased education on chronic pain management and opioid therapy for physicians in the sample population as evidenced by statistically significant improvement between the pretest and posttest scores
Implementing Educational Courses on Social Media Within Prisons to Decrease Unemployment Rates Among Ex-Prisoners and Reduce Recidivism in the United States
Get PDFThis paper focuses on whether or not it would be beneficial to implement educational courses on social media within prisons in order to prepare prisoners for release, improve post-release unemployment rates, and improve recidivism rates in the United States. Since the early 1990s, technology has grown to a point where it has become a part of everyone’s daily life, which includes social media platforms (Greenstein, 2012). While society has adapted to these advancements, prisoners who have been removed from society for many years are unable to achieve the same levels of social media comprehension, which can cause disparity between their skill levels and preparedness for release. If society has an expectation for ex-prisoners to assimilate seamlessly, it would be beneficial if prisons aided prisoners by keeping them updated in the necessary skills needed to be successful post-release. This paper will discuss background information and past research to provide in-depth knowledge on social media, social media advancements, current prison programs, studies that have looked into social media within prisons, and statistics on the success rate of securing employment opportunities through social media. The analysis of past research will support whether or not implementing educational courses on social media within prisons can be beneficial in improving unemployment rates among ex-prisoners, which could improve recidivism rates long term due to the inter-connectivity between the two
Comparison of Neonates’ Positions in SnuggleUp™ Wraps Prior to and Following Education
Get PDFExecutive Summary
Problem
According to the Synactive Theory of Newborn Behavioral Organization and Development, the adaption of preterm infant to the NICU environment is determined by his/her ability to change their behavior in response to a stimulus, to achieve a self-regulated balance, and to maintain the energy required to sustain life (Als, 1986). When positioning is not done well, it can cause damage due to immaturity that can generate body alignment complications. Preterm infants do not have the muscle tone to move themselves out of an uncomfortable position. Therefore, the NICU team is responsible for the preterm infant’s alignment, posture and movement (Santos et al., 2017).
Purpose
There has been a multitude of studies investigating and discussing the benefits of developmental positioning on infants’ stability. The purpose of this study was to investigate if quality and consistency of infants’ positions in SnuggleUp™ wraps improved following education.
Evidence-based practice is constantly evolving in the NICU and has become the foundation for patient-centered care; NNPs and RNs should be working together to improve patient outcomes, (Smith et al, 2009). At the end of the day, when providing patient care, it is not what was done or how it was done, but did we make a difference? (Assi, 2015).
Goals
The goal of this study is to improve the quality and consistency of developmental positioning in infants born 25 0/7 weeks to 34 6/7. This will be achieved by evaluating the use of the positioning aid, the SnuggleUp™ wrap, develop proper education, educate the staff and re-evaluate the use of the SnuggleUp™ wraps.
Objectives
The objective of this Quality Improvement Project (QI) was to improve the quality and consistency of developmental positioning utilizing the SnuggleUp™ wrap following education via the present form of education used in the unit, the Occupational Competency Index (OCI).
Plan
Pre-education and post-education were both collected in 4 week periods in a total of 7 data collection sessions; two of these data collection sessions occurred on weekend days. Observations were made up to 3 times per 12 hour shift on each baby. Education and training on both the use of this product and proper developmental positioning was provided to the nursing staff for one month via the Occupational Competency Index, the unit’s current preferred mode of education. Staff was also provided with 4 baby dolls positioned in SnuggleUp™ wraps per manufacturer guidelines to facilitate tactile learning.
Outcomes
Though the data showed that there was not statistically significant change in position prior to and following education, there was data that showed that there was an improvement in positioning infants correctly, with the correct size of SnuggleUp™ with no extra blanket for infants who are 33 – 34 6/7 weeks gestation at birth. There were also correlations between the increased gestational age at collection and the decrease in use of extra blankets in the SnuggleUp™ Wraps
The Impact of an Online Educational Course on Vascular Nurses’ Knowledge, Self-Confidence and Competence
Get PDFIn the United States, approximately 8 to 10% of patients admitted to an acute care facility receive venous access. Nurses that specialize in vascular access place approximately 3 million peripherally inserted central catheter (PICC) lines annually. There is a lack of standard minimum requirements for educating PICC nurses, especially on insertion techniques and maintenance. The goal of the project was to enhance the preparation of nurses who place PICC lines in different healthcare settings in order to improve quality metrics such as CLABSI, UE DVT, and LOS, with a subsequent decrease in cost of care. A pilot study that utilized a quasi-experimental, one-group pre-posttest design with a convenience sample was performed using an online educational PICC course and certification process as the independent variable. The dependent variable, improved vascular access nurse’s knowledge, competence and self-confidence, was measured by a pre-post intervention test and self-efficacy assessment. Collected data were analyzed to determine if a correlation existed between the intervention and dependent variables. The pretest and posttest results were statistically significant (t = -6.069, p = .000), indicating that the participants had improved knowledge/competence post intervention. Results of the pre-post self-efficacy assessment showed that the nurses felt more confident following the program (t = - 2.591, p = .011). The primary investigator of this study recommends future implementation of a formal standardized orientation program, as well as a standardized validation/certification process for all vascular access nurses
Effectiveness of physical therapy treatment in addition to usual podiatry management of plantar heel pain: A randomized clinical trial
No full textBackground: Many patients will seek care from a podiatrist for plantar heel pain (PHP), while few of these patients will also be seen by a physical therapist. Physical therapists can provide treatment that is not a part of routine podiatric care for PHP and may provide additional improvement. Therefore, the purpose of this study was to examine the effects of interdisciplinary care for PHP that incorporated physical therapy treatment after initiating podiatric treatment. Methods: Eligible individuals with PHP that presented to a podiatrist were randomized to receive usual podiatric care (uPOD) or usual podiatric care plus physical therapy treatment (uPOD+PT). The primary outcome was change in foot and ankle ability measure (FAAM) at 6-months. Secondary outcomes included change in numeric pain rating scale (NPRS), patient-reported success, and 6-week and 1-year endpoints. Patient-reported success was defined as the top two global rating of change scale rankings. Primary analysis was intention-to-treat (ITT) using analysis by covariance adjusted to baseline scores, and a secondary per-protocol (PP) analysis was performed analyzing only those who completed treatment. Results: Ninety-five individuals participated and were included in the ITT analysis, and 79 were included in the PP analysis. For the primary outcome of FAAM change from baseline to 6-months, both groups improved significantly (uPOD+PT: 26.8 [95% CI 21.6, 31.9]; uPOD: (20 [15.6, 24.4]), but there was no between-group difference (4.3 [-1, 9.6]). For secondary outcomes, the uPOD+PT group demonstrated greater improvement in NPRS at 6 weeks (0.9 [0.3, 1.4]) and 1 year (1.5 [0.6, 2.5]) in the ITT analysis. In the PP analysis, the uPOD+PT group demonstrated greater improvement in FAAM at 6 months (7.7 [2.1, 13.3]) and 1 year (5.5 [0.1, 10.8]), NPRS at 6 weeks (0.9 [0.2, 1.6]), 6 months (1.3 [0.6, 2.1]) and 1 year (1.3 [0.6, 2.1]), and in patient-reported success (relative risk [95% CI]) at 6 weeks (2.8 [1.1, 7.1]), 6 months (1.5 [1.1, 2.1]), and 1 year (1.5 [1.1, 1.9]). Conclusions: There was no significant benefit of uPOD+PT in the primary outcome of FAAM change at 6 months. Secondary outcomes and PP analysis indicated additional benefit of uPOD+PT, mostly observed in individuals who completed treatment
In search of microbial indicator taxa: shifts in stream bacterial communities along an urbanization gradient
No full textA majority of environmental studies describe microbiomes at coarse scales of taxonomic resolution (bacterial community, phylum), ignoring key ecological knowledge gained from finer-scales and microbial indicator taxa. Here, we characterized the distribution of 940 bacterial taxa from 41 streams along an urbanization gradient (0%–83% developed watershed area) in the Raleigh-Durham area of North Carolina (USA). Using statistical approaches derived from macro-organismal ecology, we found that more bacterial taxa were classified as intolerant than as tolerant to increasing watershed urbanization (143 vs 48 OTUs), and we identified a threshold of 12.1% developed watershed area beyond which the majority of intolerant taxa were lost from streams. Two bacterial families strongly decreased with urbanization: Acidobacteriaceae (Acidobacteria) and Xanthobacteraceae (Alphaproteobacteria). Tolerant taxa were broadly distributed throughout the bacterial phylogeny, with members of the Comamonadaceae family (Betaproteobacteria) presenting the highest number of tolerant taxa. Shifts in microbial community structure were strongly correlated with a stream biotic index, based on macroinvertebrate composition, suggesting that microbial assemblages could be used to establish biotic criteria for monitoring aquatic ecosystems. In addition, our study shows that classic methods in community ecology can be applied to microbiome datasets to identify reliable microbial indicator taxa and determine the environmental constraints on individual taxa distributions along environmental gradients
Integrating evidence-based reading practices into middle-school content instruction: exploring a facet of sustainability
No full textReading comprehension models are being implemented in content-area settings to boost reading achievement. Yet, little research explores how such models are incorporated into teachers’ daily instructional practice. The authors used extended observations and interviews to examine the integration of Collaborative Strategic Reading (CSR), an evidence-based reading comprehension model, into the instructional practices of 15 middle school science, social studies, and language arts teachers. Findings indicated that high-integration teachers embedded CSR lessons into their curriculum and reinforced CSR strategy use throughout the week. These teachers also felt supported in their efforts by colleagues and school administrators. There is much to be learned from the ways in which teachers engage in the art of integrating new methods into their teaching
The effect of manual therapy on gastrocnemius muscle stiffness in healthy individuals
No full textStudy Design: Randomized clinical trial. Background: Muscle stiffness is a potential complication after injury and has been shown to be a risk factor for injury in healthy individuals. Objectives: The primary purpose of this study was to assess the short-term effects of manual therapy (MT) on muscle stiffness of the gastrocnemius in both a relaxed and contracted state. The secondary purpose was to assess the reliability of a novel clinical tool (MyotonPRO) to measure muscle stiffness in the gastrocnemius in both a passive and contracted state. Methods: Eighty-four consecutive healthy individuals were randomized to receive Manual Therapy (MT group) directed at the right-side ankle and foot or no treatment (CONTROL group). Muscle stiffness of the gastrocnemius was assessed bilaterally in all participants at baseline and then immediately after intervention in a relaxed and contracted state. Group (MT vs. CONTROL) by side (ipsilateral vs. contralateral) by time (pre vs. post) effects were compared through a 3-way interaction utilizing mixed model ANOVA. Reliability of the MyotonPRO was assessed with two-way mixed model intraclass correlation coefficients. Results: There was a significant 3-way interaction for muscle stiffness of the gastrocnemius in a relaxed state (p \u3c.01), but not contracted state (p =.54). All conditions had increased resting muscle stiffness from pre to post measures except for the ipsilateral limb of the MT group. There was not a significant interaction for muscle stiffness in a contracted state. Reliability estimates (ICC) for muscle stiffness measures ranged between.898 and.986. Conclusion: The change in muscle stiffness of the gastrocnemius in a relaxed state depended upon whether individuals received MT. Muscle stiffness measures were highly reliable based on single measurements. Level of evidence: Therapy, level 2