Effects of Incorporating Patient Acuity into the RN Assignment Process

As the largest sector of healthcare, nurses are the primary providers of patient care. By 2025, it is estimated that there will be a shortage of over 250,000 registered nurses (RNs) (American Association of Colleges of Nursing, 2011). Factors contributing to the nursing shortage include increased complexity of patients and decreased staffing that leads to decreased job satisfaction (Fox & Abrahamson, 2009). Over half of neonatal intensive care nurses reported missing at least one nursing task per shift when staffing was inadequate or patient acuity was high (TubbsCooley, Pickler, Younger, & Mark, 2015). The purpose of this evidence-based practice (EBP) project was to evaluate the effects of incorporating patient acuity into nursing assignments on nursing satisfaction and workload measures over a 3-month period. Kanter’s (1996) theory of structural empowerment and the Iowa model (2015) were used to guide the project on two medical units at a large pediatric hospital. Assignments for RNs were made by charge nurses who considered total patient acuity and each nurse’s proficiency level when making assignments. Nurses were surveyed using the Nurse Workload Satisfaction Questionnaire (NWSQ) pre- and post-implementation. In addition, two workload measures – pain reassessment within 30 minutes and medication given within 1 hour of scheduled time – were monitored throughout the study. Using paired t-tests, NWSQ scores showed a statistically significant increase in overall RN satisfaction. The mean pre-intervention NWSQ scores (M = 35.14, SD = 8.245) were compared to the mean post intervention NWSQ scores (M = 29.23, SD = 6.195, t = 2.833, p = .014). Other statistically significant improvements were found in the relational portion of the NWSQ, which gauges colleague relationships. There were no changes in the success rate of the two workload measures. Findings from this project support the incorporation of patient acuity into the nursing assignment process

Effects of Incorporating Patient Acuity into the RN Assignment Process

As the largest sector of healthcare, nurses are the primary providers of patient care. By 2025, it is estimated that there will be a shortage of over 250,000 registered nurses (RNs) (American Association of Colleges of Nursing, 2011). Factors contributing to the nursing shortage include increased complexity of patients and decreased staffing that leads to decreased job satisfaction (Fox & Abrahamson, 2009). Over half of neonatal intensive care nurses reported missing at least one nursing task per shift when staffing was inadequate or patient acuity was high (TubbsCooley, Pickler, Younger, & Mark, 2015). The purpose of this evidence-based practice (EBP) project was to evaluate the effects of incorporating patient acuity into nursing assignments on nursing satisfaction and workload measures over a 3-month period. Kanter’s (1996) theory of structural empowerment and the Iowa model (2015) were used to guide the project on two medical units at a large pediatric hospital. Assignments for RNs were made by charge nurses who considered total patient acuity and each nurse’s proficiency level when making assignments. Nurses were surveyed using the Nurse Workload Satisfaction Questionnaire (NWSQ) pre- and post-implementation. In addition, two workload measures – pain reassessment within 30 minutes and medication given within 1 hour of scheduled time – were monitored throughout the study. Using paired t-tests, NWSQ scores showed a statistically significant increase in overall RN satisfaction. The mean pre-intervention NWSQ scores (M = 35.14, SD = 8.245) were compared to the mean post intervention NWSQ scores (M = 29.23, SD = 6.195, t = 2.833, p = .014). Other statistically significant improvements were found in the relational portion of the NWSQ, which gauges colleague relationships. There were no changes in the success rate of the two workload measures. Findings from this project support the incorporation of patient acuity into the nursing assignment process

Ionic Liquids to Replace Hydrazine

A method for developing safe, easy-to-handle propellants has been developed based upon ionic liquids (ILs) or their eutectic mixtures. An IL is a binary combination of a typically organic cation and anion, which generally produces an ionic salt with a melting point below 100 deg C. Many ILs have melting points near, or even below, room temperature (room temperature ionic liquids, RTILs). More importantly, a number of ILs have a positive enthalpy of formation. This means the thermal energy released during decomposition reactions makes energetic ILs ideal for use as propellants. In this specific work, to date, a baseline set of energetic ILs has been identified, synthesized, and characterized. Many of the ILs in this set have excellent performance potential in their own right. In all, ten ILs were characterized for their enthalpy of formation, density, melting point, glass transition point (if applicable), and decomposition temperature. Enthalpy of formation was measured using a microcalorimeter designed specifically to test milligram amounts of energetic materials. Of the ten ILs characterized, five offer higher Isp performance than hydrazine, ranging between 10 and 113 seconds higher than the state-of-the-art propellant. To achieve this level of performance, the energetic cations 4- amino-l,2,4-triazolium and 3-amino-1,2,4-triazolium were paired with various anions in the nitrate, dicyanamide, chloride, and 3-nitro-l,2,4-triazole families. Protonation, alkylation, and butylation synthesis routes were used for creation of the different salts

Population Pharmacokinetic Modeling of Total and Free Ceftriaxone in Critically Ill Children and Young Adults and Monte Carlo Simulations Support Twice Daily Dosing for Target Attainment

Critical illness, including sepsis, causes significant pathophysiologic changes that alter the pharmacokinetics (PK) of antibiotics. Ceftriaxone is one of the most prescribed antibiotics in patients admitted to the pediatric intensive care unit (PICU). We sought to develop population PK models of both total ceftriaxone and free ceftriaxone in children admitted to a single-center PICU using a scavenged opportunistic sampling approach. We tested if the presence of sepsis and phase of illness (before or after 48 h of antibiotic treatment) altered ceftriaxone PK parameters. We performed Monte Carlo simulations to evaluate whether dosing regimens commonly used in PICUs in the United States (50 mg/kg of body weight every 12 h versus 24 h) resulted in adequate antimicrobial coverage. We found that a two-compartment model best described both total and free ceftriaxone concentrations. For free concentrations, the population clearance value is 6.54 L/h/70 kg, central volume is 25.4 L/70 kg, and peripheral volume is 19.6 L/70 kg. For both models, we found that allometric weight scaling, postmenstrual age, creatinine clearance, and daily highest temperature had significant effects on clearance. The presence of sepsis or phase of illness did not have a significant effect on clearance or volume of distribution. Monte Carlo simulations demonstrated that to achieve free concentrations above 1 mu g/ml for 100% of the dosing intervals, a dosing regimen of 50 mg/kg every 12 h is recommended for most patients. A continuous infusion could be considered if the target is to maintain free concentrations four times above the MICs (4 mu g/ml)

Pharmacokinetic parameters over time during sepsis and the association of target attainment and outcomes in critically ill children and young adults receiving ceftriaxone

Introduction: Early sepsis results in pharmacokinetic (PK) changes due to physiologic alterations. PK changes can lead to suboptimal drug target attainment, risking inadequate coverage from antibiotics like ceftriaxone. Little is known about how ceftriaxone PK and target attainment quantitatively change over time in patients with sepsis or the association between target attainment and outcomes in critically ill children and young adults. Methods: A retrospective analysis of a prospective study was conducted in a single-center pediatric intensive care unit. Septic patients given at least one ceftriaxone dose (commonly as 50 mg/kg every 12 h) and who had blood obtained in both the first 48 h of therapy (early) and afterwards (late) were included. Normalized clearance and central volume were estimated and compared in both sepsis phases. We evaluated target attainment, defined as concentrations above 1× or 4× the minimum inhibitory concentration (MIC) for 100% of dosing intervals, and investigated the association between target attainment and clinical outcomes. Results: Fifty-five septic patients (median age: 7.5 years) were included. Normalized clearance and central volume were similar in both phases (6.18 ± 1.48 L/h/70 kg early vs. 6.10 ± 1.61 L/h/70 kg late, p = 0.60; 26.6 [IQR 22.3, 31.3] L/70 kg early vs. 24.5 [IQR 22.0, 29.4] L/70 kg late, p = 0.18). Individual percent differences in normalized clearance and central volume between sepsis phases ranged from −39% to 276% and −51% to 212% (reference, late sepsis), respectively. Fewer patients attained the 1× MIC target in late sepsis (82% late vs. 96% early, p = 0.013), which was associated with transition to once daily dosing, typically done due to transfer from the pediatric intensive care unit (PICU) to a lower acuity unit. Failure to attain either target in late sepsis was associated with antibiotic broadening. Conclusion: Ceftriaxone PK parameters were similar between early and late sepsis, but there were large individual differences. Fewer patients attained MIC targets in late sepsis and all who did not attain the less stringent target received once daily dosing during this period. The failure to attain targets in late sepsis was associated with antibiotic broadening and could be an area for antibiotic stewardship intervention

TX - Taller de Tesis - AR304 - 202100

Descripción: En este curso se desarrollará el pre anteproyecto arquitectónico basado en un tema específico seleccionado en los cursos de Investigación y Lineamientos para el proyecto profesional. En la primera etapa se establecen los criterios básicos de diseño de un pre anteproyecto arquitectónico sustentado a partir de las condiciones: conceptuales, programáticas y de usuario, aspectos medio ambientales, urbano y paisajistas. En la segunda etapa se desarrolla un anteproyecto arquitectónico incluyendo además los criterios de las especialidades de estructuras, instalaciones eléctricas y sanitarias, y sistemas de evacuación. Propósito: El curso tiene como propósito la aprobación del anteproyecto con el cual el estudiante puede iniciar su Proyecto 1de Titulación Profesional. Busca contribuir al desarrollo de las competencias generales: Comunicación Escrita, Comunicación Oral, Pensamiento Crítico, Razonamiento Cuantitativo, Manejo de la Información, Ciudadanía, Pensamiento Innovador y en las competencias específicas de la carrera: Pensamiento Crítico y Representación, Desarrollo de prácticas, habilidades técnicas y conocimiento, Soluciones arquitectónicas integrada y Práctica profesional, todas en el nivel 3. Tiene como requisitos AR248 Gestión Inmobiliaria y HU61 inglés 5 y AR271 Lineamientos para el Proyecto Profesional y AR272 Seminario de Urbanismo y AR250 TIX - Taller de Ejercicio Profesional y aprobación por el director de la Carrera

Cognitive performance and mood in patients on the waiting list for liver transplantation and their relation to the model for end-stage liver disease Desempenho cognitivo e humor em pacientes em lista de espera de transplante de fígado e suas relações com modelo para doença hepática e fase terminal

OBJECTIVE: To investigate the links between depression and cognitive functioning in patients with Hepatitis C and other chronic liver diseases with and without the use of alcohol on the waiting list for liver transplantation and their associations with the MELD classification. METHOD: 40 patients were evaluated on a waiting list for liver transplant by a battery of neuropsychological tests, depression scales and interview at the Liver Transplant Service, of the Hospital das Clínicas University of São Paulo Medical School. RESULTS: After splitting the sample according to the education, the results showed statistical significance in the comparisons between groups of MELD > 15 and <15 in the following functions: estimated IQ, visual-spatial delayed recall and recognition as part of episodic memory and short term memory. CONCLUSION: These findings, usually found in hepatic encephalopathy, corroborated with the literature and emphasized the need to investigate in more detail the cognitive functions of these patients in order to facilitate the adoption of different conducts.<br>OBJETIVO: Investigar as relações entre depressão e funcionamento cognitivo em pacientes portadores de hepatite C e demais doenças hepáticas crônicas com e sem uso de álcool em fila de espera para transplante hepático e suas relações com a classificação MELD. MÉTODO: Foram avaliados 40 pacientes em lista de espera para transplante hepático por bateria de testes neuropsicológicos, escalas de depressão e entrevista no Serviço de Transplante do Fígado do HC-FMUSP. RESULTADOS: Após divisão da amostra por escolaridade os resultados mostraram significância estatística nas comparações entre grupos de MELD > 15 e <15 nas funções: QI estimado, memória episódica de evocação tardia e de reconhecimento visuo-espacial e memória de curto prazo. CONCLUSÃO: As dificuldades encontradas, comuns ao quadro de encefalopatia hepática, corroboram a literatura pesquisada e enfatizam a necessidade de se investigar de maneira mais detalhada o funcionamento cognitivo destes pacientes, uma vez que diferentes condutas podem ser adotadas

TX - Taller de Tesis - AR304 - 202101

Descripción: En este curso se desarrollará, mediante una propuesta arquitectónica, un proyecto escogido por el estudiante, en el que pueda acreditar que está en capacidad de hacer frente a los principales aspectos comprendidos en el desarrollo de un proyecto arquitectónico. En la primera etapa se establecen los criterios básicos de diseño de un pre-anteproyecto arquitectónico sustentado a partir de las condiciones: conceptuales, programáticas y de usuario, aspectos medio ambientales, urbano y paisajistas. En la segunda etapa se desarrolla un anteproyecto arquitectónico incluyendo además los criterios de las especialidades de estructuras, instalaciones eléctricas y sanitarias, y sistemas de evacuación. Propósito: El curso tiene como propósito la aprobación del anteproyecto con el cual el estudiante puede iniciar su Proyecto de Titulación Profesional. Busca contribuir al desarrollo de las competencias generales UPC: Comunicación Escrita, Comunicación Oral, Pensamiento Crítico, Razonamiento Cuantitativo, Manejo de la Información, Ciudadanía, Pensamiento Innovador y de las competencias específicas de la carrera: Diseño Fundamentado (que corresponde a los criterios NAAB PC2, PC3,PC5, PC8, SC5), Cultura Arquitectónica (que corresponde a los criterios NAAB1 PC4), Técnica y Construcción (que corresponde a los criterios NAAB1 SC1, SC4,SC6) y Gestión Profesional (que corresponde a los criterios NAAB1 PC6, SC2), todas en el nivel 3. Tiene como requisitos AR248 Gestión Inmobiliaria y HU61 inglés 5 y AR271 Lineamientos para el Proyecto Profesional y AR272 Seminario de Urbanismo y AR250 TIX - Taller de Ejercicio Profesional y aprobación por el director de la Carrera