The Impact of Nursing Skill Competency on Patient Outcomes: A Quality Improvement Project

45 out of 50 facilities that implemented continued education saw improved patient outcomes. This presentation focuses on the importance of nurse participation in continued professional development programs because it is a shortcoming that we noticed in clinical practice.https://scholarworks.moreheadstate.edu/celebration_posters_2023/1010/thumbnail.jp

PITTSBURGH’S RACIAL DEMOGRAPHICS: DIFFERENCES AND DISPARITIES

Pittsburgh’s Racial Demographics: Differences and Disparities provides indicators of quality of life by race and ethnicity in the Pittsburgh region. Data are provided for four groups (Whites, African Americans, Asians, and Hispanics) and for four geographic areas (city of Pittsburgh, Allegheny County, Pittsburgh Metropolitan Statistical Area, and the U.S.). The most recent data available for the Pittsburgh area and the nation were used in this report. In some instances, however, only data from the 2000 census were available to make comparisons. It is also the case that data were not available on all of our topic areas in the same years. It is our hope to update this report every three years, particularly if the American Community Survey (which is designed to replace the decennial census) produces regular, reliable data by race for cities, counties, and regions

The Cool Accretion Disk in ESO 243-49 HLX-1: Further Evidence of an Intermediate Mass Black Hole

With an inferred bolometric luminosity exceeding 10^42 erg/s, HLX-1 in ESO 243-49 is the most luminous of ultraluminous X-ray sources and provides one of the strongest cases for the existence of intermediate mass black holes. We obtain good fits to disk-dominated observations of the source with BHSPEC, a fully relativistic black hole accretion disk spectral model. Due to degeneracies in the model arising from the lack of independent constraints on inclination and black hole spin, there is a factor of 100 uncertainty in the best-fit black hole mass M. Nevertheless, spectral fitting of XMM-Newton observations provides robust lower and upper limits with 3000 Msun < M < 3 x 10^5 Msun, at 90% confidence, placing HLX-1 firmly in the intermediate-mass regime. The lower bound on M is entirely determined by matching the shape and peak energy of the thermal component in the spectrum. This bound is consistent with (but independent of) arguments based solely on the Eddington limit. Joint spectral modelling of the XMM-Newton data with more luminous Swift and Chandra observations increases the lower bound to 6000 Msun, but this tighter constraint is not independent of the Eddington limit. The upper bound on M is sensitive to the maximum allowed inclination i, and is reduced to M < 10^5 Msun if we limit i < 75 deg.Comment: 10 pages, 7 figures, accepted for publication in Ap

Broad activation of the ubiquitin-proteasome system by Parkin is critical for mitophagy

Parkin, an E3 ubiquitin ligase implicated in Parkinson's disease, promotes degradation of dysfunctional mitochondria by autophagy. Using proteomic and cellular approaches, we show that upon translocation to mitochondria, Parkin activates the ubiquitin–proteasome system (UPS) for widespread degradation of outer membrane proteins. This is evidenced by an increase in K48-linked polyubiquitin on mitochondria, recruitment of the 26S proteasome and rapid degradation of multiple outer membrane proteins. The degradation of proteins by the UPS occurs independently of the autophagy pathway, and inhibition of the 26S proteasome completely abrogates Parkin-mediated mitophagy in HeLa, SH-SY5Y and mouse cells. Although the mitofusins Mfn1 and Mfn2 are rapid degradation targets of Parkin, we find that degradation of additional targets is essential for mitophagy. These results indicate that remodeling of the mitochondrial outer membrane proteome is important for mitophagy, and reveal a causal link between the UPS and autophagy, the major pathways for degradation of intracellular substrates

Management of Worsening Heart Failure With Reduced Ejection Fraction:<i>JACC </i>Focus Seminar 3/3

Despite worsening heart failure (HF) being extremely common, expensive, and associated with substantial risk of death, there remain no dedicated clinical practice guidelines for the specific management of these patients. The lack of a management guideline is despite a rapidly evolving evidence-base, as a number of recent clinical trials have demonstrated multiple therapies to be safe and efficacious in this high-risk population. Herein, we propose a framework for treating worsening HF with reduced ejection fraction with the sense of urgency it deserves. This includes treating congestion; managing precipitants; and establishing a foundation of rapid-sequence, simultaneous, and/or in-hospital initiation of quadruple medical therapy for HF with reduced ejection fraction, with the top priority being at least low doses of all 4 medications. Moreover, to maximally reduce residual clinical risk, we further propose consideration of upfront simultaneous use of vericiguat (ie, quintuple medical therapy) and administration of intravenous iron for those who are iron deficient.</p

Older patients' attitudes towards and experiences of patient-physician end-of-life communication: a secondary analysis of interviews from British, Dutch and Belgian patients

<p>Abstract</p> <p>Background</p> <p>Older patients often experience sub-standard communication in the palliative phase of illness. Due to the importance of good communication in patient-centred end-of-life care, it is essential to understand the factors which influence older patients’ communication with physicians. This study examines older patients’ attitudes towards, and experiences of, patient-physician end-of-life (EoL) communication in three European countries.</p> <p>Methods</p> <p>A secondary analysis of interviews from British, Dutch and Belgian patients over the age of 60 with a progressive terminal illness was conducted. Cross-cutting themes were identified using a thematic approach.</p> <p>Results</p> <p>Themes from 30 interviews (Male n = 20, Median age 78.5) included: confidence and trust; disclosure and awareness; and participation in decision-making. Confidence and trust were reinforced by physicians’ availability, time and genuine attention and hindered by misdiagnoses and poor communication style. Most participants preferred full disclosure, though some remained deliberately ill-informed to avoid distress. Patients expressed a variety of preferences for and experiences of involvement in medical EoL decision-making and a few complained that information was only provided about the physician's preferred treatment.</p> <p>Conclusions</p> <p>A variety of experiences and attitudes regarding disclosure and participation in decision-making were reported from each country, suggesting that communication preferences are highly individual. It is important that physicians are sensitive to this diversity and avoid stereotyping. In regard to communication style, physicians are advised to provide clear explanations, avoid jargon, and continually check understanding. Both the ‘informed’ and the ‘shared’ patient-physician decision-making models assume patients make rational choices based on a clear understanding of treatment options. This idealized situation was often not reflected in patients’ experiences.</p