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Screening of Crude Microalgal Extracts for Antimicrobial Activity
Get PDFMicrobial biofilm associated infections are a significant threat to patients with medical devices and are partially responsible for the increased resistance seen in nosocomial infections. The biofilm chemical and physical properties restrict access of chemotherapeutic agents. Therefore, there is a need to enhance the antimicrobial effects of current chemotherapeutic agents. Microalgae live in competitive environments that include film-forming, opportunistic pathogens S. maltophilia and C. albicans. Extracts from 5 diverse species of microalgae were screened for antimicrobial enhancing effects against established biofilms with two different extraction solvents, 3:1 hexanes and isopropyl (HIPA) and 2-methyltetrahydrofuran (2-MTHF).
Three species, B. braunii, C. danica, and N. oculata showed statistically significant reduction in cell viability of S. maltophilia in an established biofilm (pN. oculata [M], showed enhancing effects of ceftriaxone against S. maltophilia in an established biofilm. Furthermore, B. braunii, C. danica, and N. oculata extracts showed a statistically significant reduction in cell viability of C. albicans in combination with fluconazole (p = 0.003, p = 0.002, and p = 0.021, respectively). Based on our findings, additional research should focus on the organic components of N. oculata, B. braunii, C. danica that contribute to reduced microbial cell viability in established biofilms. Furthermore, data suggests that 2-MTHF is a viable solvent for future extraction processes
Understanding Employee Engagement: A Mixed-Methods Study
Get PDFFor over 4 decades businesses around the world have been conducting employee satisfaction surveys at regular intervals and this surfaced a strong positive relationship between employee satisfaction, customer satisfaction, and overall company performance. In recent years however, academics and researchers have reopened the debate on whether employee or job satisfaction metrics are in fact reliable indicators of productivity, suggesting that employee engagement has a far stronger correlation to productivity. This study addresses two interrelated problems that are associated with a practice that is common in working environments all over the world. According to literature, it is generally accepted that (a) quantitative measurement of employee engagement yields reliable results and that (b) reliable conclusions about employee productivity can be drawn from it. The objective of this study is to examine whether this notion is accurate and to assess whether qualitative research adds meaningful insights to an employee engagement study. These research questions are answered by means of a study based on an explanatory sequential mixed-methods research design. Qualitative and quantitative primary research is conducted among employees at a large financial services company based in the United States and the target sample is characterized by homogeneity across age, tenure, rank, ethnicity and gender, with a normally distributed spread across these variables. The results are compared to a generalized secondary data set containing raw survey data from employee engagement studies conducted across countries and industries. The study reveals that conducting interviews in addition to the structured surveys produces significant deep insights, varying from subtle nuances to distinctly different and even conflicting outcomes, which the quantitative research did not capture on its own. The preliminary results indicate that the current quantitative instrument as well as its delivery method are no longer adequate to measure employee engagement in modern day working environments
Program Evaluation of an APRN-Led Home-Based Psychiatric Care (HBPC) Program for Vulnerable Geriatric Patients
Get PDFBackground: Mental illness remains under-treated in older adults, especially those that are home-bound. In response to access to care gaps, an innovative advanced practice registered nurse led Home-Based Psychiatric Care program was developed as an adjunct to an established home-based counseling agency. The program involves the research supported provision of home-based psychiatric evaluations and medication management by the agency’s PMHNP. Purpose/Objectives: To evaluate the HBPC Program’s effectiveness at increasing access to timely and effective psychopharmacological treatment and management as evidenced by: (a) an increased percentage of referred patients who are being managed by the agency’s PMHNP, (b) a decrease in wait times for psychiatric evaluation, and (c) improvement in Global Clinical Impression-Improvement scale (CGI-I) and Efficacy Index (CGI-E) scores. Intervention: A retrospective program evaluation of the first 3 months (February to April 2019) of the HBPC Program was conducted via the analysis of remotely mined data, collected from the agency\u27s internally shared quality improvement database. Results: At the 12-week mark, 60% of referred patients were being managed by the agency\u27s PMHNP, 13% had been assessed within 10 days, and 33.3% had achieved a CGI-I score of ≤ 3 and an Efficacy Index score of ≥ 1.5. Implications: The initial results are inconclusive, yet promising. If improved outcomes are realized over time, the HBPC program is anticipated to improve this agency\u27s ability to provide psychiatric care to vulnerable home-bound geriatric patients, by serving as an essential bridge that connects the elderly with effective psychopharmacologic interventions
Using the ADAM Questionnaire in Primary Care to Identify Hypoandrogenism in Males Aged 40 Years or Older
Get PDFTestosterone replacement therapy (TRT) has been shown to improve the symptoms of metabolic syndrome by reducing Hemoglobin A1C, belly fat, cholesterol, and blood pressure (Cunningham, 2015). The ultimate goal for testosterone-deficient patients is to have an improved quality of life by starting TRT. This quality improvement project was conducted at a small primary care clinic in South Texas. The project was started by screening 84 male patients ≥ 40 years of age using the Androgen Deficiency in Aging Males (ADAM) questionnaire. The ADAM questionnaire was considered positive for anyone who answered “yes” to 3 or more questions or “yes” to questions 1 or 7 (Morley et al., 2000). Out of the 84 patients screened by the ADAM questionnaire, 57 screened positive for low testosterone. Only 23 of those 57 patients agreed a confirmatory testosterone blood test; 20 of those 23 had low testosterone blood levels. Any patient who had an abnormally low testosterone level was given the option to start TRT. Eleven of the 20 patients included in the project accepted TRT. After 6 to 8 weeks of testosterone replacement therapy, patients were given the ADAM questionnaire again to assess if improved scores had occurred. After starting TRT, only 1 of the 11 participants had an unchanged ADAM score although it was noted his testosterone levels were still subtherapeutic. Ten of the 11 participants who received TRT had improved ADAM scores at the end of the project window. The ADAM questionnaire has a sensitivity of 88-97%, so poor ADAM scores were highly linked to low total testosterone levels (Morley et al., 2000; Lunenfield et al., 2015)
Implementation of ACE Inhibitor Regimen in Patients With Type 2 Diabetes Mellitus
Get PDFThe incidence of type 2 diabetes has increased dramatically and is associated with many problems, including chronic kidney disease. The purpose of this quality improvement project was to implement two evidence-based guidelines that may detect chronic kidney disease and slow its progression in patients with type 2 diabetes by implementing angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy according to evidence-based guidelines from the American Diabetes Association. Patients with type diabetes were screened for microalbuminuria and eGFR of \u3c 60 mL/min/1.73 m2. Based on lab results, the provider recommended either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker to patients with as appropriate. The primary aim of this project was to achieve 80% implementation of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for patients with type 2 diabetes who met criteria. Second, seventy to 90 percent of early progression to chronic kidney disease among those with type 2 diabetes was to be identified via blood and urine testing. One hundred and sixty-three patients with type 2 diabetes were seen during the implementation phase and screened, and one hundred and thirty-two patients who needed an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker were placed on one or the other. Thirteen patients were on an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker prior to project implementation. Introducing an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker as recommended for many patients with type 2 diabetes may slow the progression of chronic kidney disease and improve quality of life
A Grounded Theory Study of Senior Leader Experiences and Perceptions of Unplanned Turnover
Get PDFThis study focused on the persistent problem facing organizational leaders of voluntary turnover of professional staffs. The problem of turnover in general has been studied for decades from the perspective of those who left the organization. What is lacking in the body of research is an understanding, from the perspective of senior management, of why professionals abruptly leave the organization (Waldman, Carter, & Hom, 2015). The purpose of this exploratory qualitative research is to examine the phenomenon of sometimes abrupt, voluntary turnover of professionals in organizations from the perspective of organizational leaders. A more contemporary, less objective evolution of traditional grounded theory, constructivist grounded theory, was utilized which still retains the emergent, iterative process of traditional grounded theory but instead allows for and promotes the inclusion of the researcher’s point of view (Charmaz, 2014). Interview and transcription data were analyzed using open coding, focused coding, memoing, constant comparative analysis, and theoretical sampling. The proposed grounded theory that emerged from the responses of leader participants is described as a repeating cycle of leader experiences associated with the unplanned loss of a valuable employee. This cycle of leader experience (sequence) is composed of major phases of Trust, Shock, and Regret. Simultaneous to the Trust-Shock-Regret cycle are situational conditions related to the unplanned loss: high leader communication, ‘warning signs’, and management disconnect. This study adds a new dimension to our understanding about the role of leaders in unplanned turnover, from the context of experienced, senior-level organizational leaders of professional employees.
This study focused on the persistent problem facing organizational leaders of voluntary turnover of professional staffs. The problem of turnover in general has been studied for decades from the perspective of those who left the organization. What is lacking in the body of research is an understanding, from the perspective of senior management, of why professionals abruptly leave the organization (Waldman, Carter, & Hom, 2015). The purpose of this exploratory qualitative research is to examine the phenomenon of sometimes abrupt, voluntary turnover of professionals in organizations from the perspective of organizational leaders. A more contemporary, less objective evolution of traditional grounded theory, constructivist grounded theory, was utilized which still retains the emergent, iterative process of traditional grounded theory but instead allows for and promotes the inclusion of the researcher’s point of view (Charmaz, 2014). Interview and transcription data were analyzed using open coding, focused coding, memoing, constant comparative analysis, and theoretical sampling. The proposed grounded theory that emerged from the responses of leader participants is described as a repeating cycle of leader experiences associated with the unplanned loss of a valuable employee. This cycle of leader experience (sequence) is composed of major phases of Trust, Shock, and Regret. Simultaneous to the Trust-Shock-Regret cycle are situational conditions related to the unplanned loss: high leader communication, ‘warning signs’, and management disconnect. This study adds a new dimension to our understanding about the role of leaders in unplanned turnover, from the context of experienced, senior-level organizational leaders of professional employees
Improving Provider Adherence to Guidelines and Screening for Adult Depression in Primary Care
Get PDFThe purpose of this QI project was to improve provider adherence to the Institute for Clinical Systems Improvement (ICSI) Guidelines for Adult Depression in Primary Care to enhance the screening, diagnosis, treatment, and management of adult major depressive disorder (MDD). MDD is a widespread, disabling, and treatable psychiatric disorder that is primarily treated and managed by primary care providers (PCPs). Untreated depression is prone to become chronic and can lead to pain, suffering, disability, increased morbidity and mortality, and premature death, with serious repercussions for the individual and society. Universal and routine screening in primary care for depression in adults, in combination with adequate systems of support, is recommended by ICSI guidelines and has been found to be a cornerstone in the management of MDD. Despite this, depression remains underrecognized, underdiagnosed, and undertreated in primary care. The project objectives aimed at aligning the clinic with ICSI’s guidelines to increase screening for depression, routine assessment for the severity of symptoms, referrals to behavioral health specialists (BHS), and minimize suicide risk. An MDD protocol was developed and all adult patients were universally and routinely screened for depression using PHQ-2 and/or PHQ-9 over an 8-week period. Project interventions were successful at initiating change toward improving provider adherence to ICSI guidelines. Screening rates for depression, routine assessment rate for the severity of symptoms, provider adherence rate to the suicide protocol, and the referral rate to a BHS increased from pre-intervention to post-interventio
Medication Management in a Primary Care Practice
Get PDFImproving medication management has become the 3rd National Patient Safety Goal. Medication errors cost $42 billion annually. A 5-month quality improvement project was conducted in a primary care clinic located in a south Texas metropolitan city to address medication reconciliation problems. The project improved medication management by implementing 7 tools to decrease preventable medication errors: One Source Medication List, staff knowledge pre- and post-tests, visual signs and staff badges, staff templates, Beers Criteria pocket guide, patient brochure, and a quality improvement tracking form. There were two objectives: 1. Staff would improve medication reconciliation documentation by 50%. 2. For patients 65 years of age and older, potential contraindicated medications review using the Beers Criteria medication list to reduce adverse drug events, drug interactions, and allergies would increase by 50%. Objective 1 was not met, achieving only 30%, and Objective 2 reached only 29%, indicating that medication reconciliation continues to be a challenge in that clinic. The implications for practice are for doctorally-prepared nurse practitioners to lead the improvement of medication management by implementing robust medication reconciliation processes, to increase the knowledge and motivation of the staff, and to advocate for a more current medical record software. Therefore, nurse practitioners can help increase patient safety and the outcomes of prescribing practices by providers whose clinical decisions must rely on accurate medication information
Implementing the Patient-Centered Care Paradigm in an Academic Research Environment
Get PDFResearch Focus. The healthcare landscape is transitioning from a provider-centered care model toward greater emphasis on patient-centered care (PCC). The shift to PCC reflects efforts to increase the quality of healthcare and the care experience. The current state of research within healthcare remains focused on how to provide high-quality and sound research that will bring new equipment, procedures, and verify strategies that may benefit healthcare globally. However, changes in the healthcare atmosphere bring a new perspective to research. How is the paradigm shift to patient-centered care implemented in an academic research environment? Does this holistic mindset fully cross into the spectrum of research and fit its existing criteria? The aim of this study is to describe the implementation of PCC within an academic research environment.
Research Methods. A focused ethnographic case study (qualitative) design was selected for this study based on the researcher’s background and experience. The purpose of the study was to discover how implementation of PCC, as defined by the Institute of Medicine and the Agency for Healthcare Research and Quality, integrates within the current healthcare research settings, and to uncover implementation successes and failures. This study utilized interview questions, observations, and a survey to collect and analyze data. Data were collected in two phases, interview questions and survey, and observations were documented throughout the process. These data described the implementation of PCC in an academic research setting through the eyes of six participants, and the success and challenges in meeting the standards expected by the Agency for Healthcare Research and the Institute of Medicine, who developed the survey utilized in this project.
Research Results/Findings. Emergent themes indicate that the structure of PCC falls well short of full realization within this clinic with alignment of PCC being by “essence” not structure. Due to the misalignment of PCC within the research realm the effect is then only measured as an emotional overlay that is normally seen at the end of the clinic assessments.
Conclusions from Research. One implication from the study includes the realization that there has been little to nothing done on the complete implementation package of PCC in an academic research setting. Current attempts to promote the conversation of implementing PCC are currently on the agenda for some researchers within the setting; however, there is confusion about how to begin. Synthesis of the findings suggest that although the clinical group is willing to delve deep into the paradigm to ensure that the care and effects are in tune with PCC, delivery limitations restrict improvement in customer service and appreciation. The current reality is that the implementation of PCC is used as a quality improvement experiment that calls for the clinics to blindly paw at the concept with little guidance on how to properly incorporate the paradigm. There are three recommendations that may help build a strong foundation for setting PCC within the academic research setting: 1. development of measurement tools, 2. experiments to demonstrate what works for implementing PCC in the academic research setting, and 3. implementation guidance for other academic research systems to utilize what is learned from recommendation 2. Projects similar to this would allow for the collective voices of the academic research setting to be heard and would validate the creation of a self-assessment tool that would be system specific. This tool can then be provided on a grand scale to the university setting, initiating the researchers’ vision of complete saturation of PCC into the environment
Biotransformation of Natural Antioxidants Osajin and Pomiferin by Cunninghamella Elegans (ATCC® 9245TM)
Get PDFOsajin and pomiferin, prenylated isoflavones extracted from the fruit of the osage orange tree (Maclura pomifera) have been reported as antioxidant compounds. The purpose of this study is to analyze the metabolization of osajin and pomiferin by the fungi Cunninghamella elegans (ATCC 9245) and supporting strains Umbelopsis ramanniana and Aspergillus fumigatus fresnius.
HPLC analysis of the extracts showed new, more polar compounds were formed, evidenced by peaks at lower retention times for each strain of fungi. To further investigate the metabolites produced, HPLC-guided chromatographic purification will be performed, and the pure metabolites will be analyzed through nuclear magnetic resonance and mass spectrometry