Color-Changing Device to Improve Adherence to Foley Catheter Replacement Protocols and Reduce Urinary Tract Infection Frequency

Background: Foley catheter-associated UTI’s (CAUTI’s) represent a driving cause of cystitis, bacteremia and sepsis in the hospital setting. Accordingly, the CDC has identified prolonged indwelling time as the foremost risk factor for CAUTI’s. However, the fundamental design of the Foley has remained unchanged for over eighty years. Hospital-specific protocols do currently exist for the removal of infection-prone catheters; however, in practice it remains commonplace for catheters to be ignored, increasing the risk of life-threatening infection. Our design process addressed this by creating a color-changing alarm device that would alert providers when a catheter has been left in beyond protocol, is at risk for infection, and should be assessed for removal. Methods: In-depth interviewing with the goal of collecting end-user feedback was conducted during our design process. Working with an infectious disease case manager, two physicians (urology and EM), and the CAUTI nursing chair, we targeted two primary aspects of CAUTI use: procedures currently used to determine infection risk of indwelling catheters, and potential strategies for alerting and preventing CAUTI’s. “Design Thinking” framework allowed us to incorporate stakeholder feedback, iterate ideas for, and prototype our color-changing alarm device. Results: Interviews suggest that despite current protocols, providers continue to leave catheters indwelling beyond suggested time limits. End-user feedback also indicated an urgent need for an innovative strategy to assist in the recognition of infection-prone catheters and to limit CAUTI’s. Conclusions: Currently, the color-indicator alarm system is within the prototyping phase of the iterative design process. We will incorporate end-user expert feedback (such as the five-to-eight day “critical window” suggested by our experts for catheter assessment and removal) into the product design. Future hospital trials will test whether the device improves the recognition of infectionprone catheters, effectively notifies providers of catheters left indwelling, and decreases the incidence of CAUTI’s

Can Opioids be Eliminated After Arthroscopic Meniscus Surgery? A Prospective Randomized Controlled Trial

Purpose: To compare a multimodal nonopioid pain protocol to traditional opioid medication in controlling postoperative pain following arthroscopic meniscal surgery. Methods: Ninety-nine patients undergoing primary meniscectomy or meniscal repair were assessed for participation. A prospective randomized control trial was performed in accordance with the Consolidated Standards of Reporting Trials 2010 (CONSORT) statement. The two arms of the study included a multimodal non-opioid analgesic protocol and a standard opioid regimen with a primary outcome of postoperative pain level (visual analog scale) for 10 days. Secondary outcomes included patient reported outcomes, complications and patient satisfaction. Randomization was achieved using a random number generator. Patients were not blinded. Data collection was done by a blinded observer. Results: A total of 61 patients were analyzed with 30 randomized to the opioid regimen, and 31 randomized to the non-opioid regimen. Patients receiving the nonopioid regimen demonstrated non-inferior VAS scores compared to patients who received opioid pain medication (p\u3e0.05) No significant differences were found in preoperative (opioid: 58.9 ± 7.0; nonopioid: 58.2 ± 5.5, p = 0.724) nor postoperative (opioid: 59.8 ± 6.5; nonopioid: 54.9 ± 7.1, p = 0.064) PROMIS-Pain Interference Short Form scores. No difference was found in recorded side effects between both groups: constipation, nausea, diarrhea, upset stomach, and drowsiness (p \u3c 0.05). Conclusion: This study found that multimodal nonopioid pain protocol provided equivalent pain control and patient outcomes following primary meniscus surgery while having an equivalent side effect profile. All patients reported satisfaction with their pain management without requiring emergency opioid analgesia

Biodiversity in a changing climate: a synthesis of current and projected trends in the US

This paper provides a synthesis of the recent literature describing how global biodiversity is being affected by climate change and is projected to respond in the future. Current studies reinforce earlier findings of major climate-change-related impacts on biological systems and document new, more subtle after-effects. For example, many species are shifting their distributions and phenologies at faster rates than were recorded just a few years ago; however, responses are not uniform across species. Shifts have been idiosyncratic and in some cases counterintuitive, promoting new community compositions and altering biotic interactions. Although genetic diversity enhances species\u27 potential to respond to variable conditions, climate change may outpace intrinsic adaptive capacities and increase the relative vulnerabilities of many organisms. Developing effective adaptation strategies for biodiversity conservation will not only require flexible decision-making and management approaches that account for uncertainties in climate projections and ecological responses but will also necessitate coordinated monitoring efforts

Best Practices for Perinatal Care during COVID-19

Many hospitals and health systems are altering practice in response to the COVID-19 pandemic. This presentation will highlight best practices that can be implemented to keep moms and babies safe during the antepartum, intrapartum and postpartum stages of pregnancy. Presentation: 59:3

A Medical student, Pharmacy student and a Nurse resident walk into a room

Learning Objectives Participants will: 1. Describe how an innovative interprofessional education project was designed and implemented in an academic clinical setting. 2. Demonstrate how simulation was employed to achieve specific Core Competencies of Interprofessional Collaborative Practice a. The Purpose of our project was to develop, implement and evaluate an interprofessional simulation program to assist medical students, pharmacy students and nursing residents in achieving the competencies required for interprofessional practice (IP). b. Background: Working as a part of an interprofessional team is an essential skill for healthcare providers. As such it has become a core competency among trainees in many professional fields. Despite this need, there is little that currently exists in the clinical curriculum for students to participate in deliberately. c. Description of Intervention or Program: An IP educational curriculum was built consisting of an online module describing each profession’s education requirements and elements of effective team function. Three simulation exercises were developed with an embedded issue requiring team approach to address the patient’s concern. The Interprofessional Collaborative Competency Attainment survey (ICCAS) was issued pre and post program for quantitative data. Additionally a focus group was held post project for qualitative data. All participants were asked to attend all education and simulation sessions. d. Preliminary Results: Focus group comments include,” It was interesting to see different thought processes”. “We didn’t know (at first) what we were all capable of”. Initial ICCA results indicate that respondents perceive their IP abilities improved by participating in the project. Participants reported overall that they enjoyed the program and thought it should be continued. e. Relevance to interprofessional education or practice: The results indicate that by participating in the project, these emerging professionals learned about another health care team members’ scope of practice, role and capabilities to managing patient problems. f. Recommendations for future investigation and/or incorporation into education and/or practice settings: The importance of continued opportunities for emerging professionals to work together deliberately in the clinical setting will improve their outlook on team work in future interactions with other professionals. Scenarios need to be well focused and provide good opportunity for each involved discipline to contribute meaningfully. Individuals must be matched well in terms of experience or at least self-efficacy

Hitting boundaries: Contract type, playing experience, non-cognitive skills, and sport anxiety in elite women cricketers

This paper examined the psychological impact of contextual influences (i.e., contract type and playing experience) on sport anxiety in elite women cricketers participating in The Hundred. A sample of 71 elite female cricketers playing during the 2021–2022 season took part. Forty-nine of the sample (69%) held professional contracts, and 22 (31%) had yet to sign a professional contract. Participants provided details about their contract type and playing experience and completed self-report measures assessing sport anxiety, mental toughness, and general self-efficacy. Since mental toughness and self-efficacy are non-cognitive constructs, which buffer competitive trait anxiety, analysis controlled for these variables. Multivariate analyses of covariance examined sport anxiety scores among participants in relation to Hundred matches played (either 0, 1–10, or more than 10) and contract type (whether participants had a professional contract in place or not). Subfactors of Worry, Somatic, and Confusion assessed sports anxiety. No significant main effects existed. However, alongside a significant interaction, a covariate mental toughness effect occurred. Examination of the interaction revealed Worry scores were lower in cricketers who were yet to play a Hundred match who had not received a professional contract. Furthermore, Worry and Somatic scores were higher in cricketers that had played more than 10 Hundred matches and had not received a professional contract. These findings have important implications for the development of elite women cricketers. Particularly, they highlight the need to differentially support players through their career progression

Quality of life among symptomatic compared to PSA-detected prostate cancer survivors - results from a UK wide patient-reported outcomes study

Background: Quality of life among prostate cancer survivors varies by socio-demographic factors and treatment type received; however, less in known about differences in functional outcomes by method of presentation. We investigate differences in reported urinary, bowel, sexual and hormone-related problems between symptomatic and PSA-detected prostate cancer survivors. Methods: A UK wide cross-sectional postal survey of prostate cancer survivors conducted 18-42 months post-diagnosis. Questions were included on presentation method and treatment. Functional outcome was determined using the EPIC-26 questionnaire. Reported outcomes were compared for symptomatic and PSA-detected survivors using ANOVA and multivariable log-linear regression. Results: Thirty-five thousand eight hundred twenty-three men responded (response rate: 60.8%). Of these, 31.3% reported presenting via PSA test and 59.7% symptomatically. In multivariable analysis, symptomatic men reported more difficulty with urinary incontinence (Adjusted mean ratio (AMR): 0.96, 95% CI: 0.96-0.97), urinary irritation (AMR: 0.95, 95% CI: 0.95-0.96), bowel function (AMR: 0.97, 95% CI: 0.97-0.98), sexual function (AMR: 0.90, 95% CI: 0.88-0.92), and vitality/hormonal function (AMR: 0.96, 95% CI: 0.96-0.96) than PSA-detected men. Differences were consistent across respondents of differing age, stage, Gleason score and treatment type. Conclusion: Prostate cancer survivors presenting symptomatically report poorer functional outcomes than PSA-detected survivors. Differences were not explained by socio-demographic or clinical factors. Clinicians should be aware that men presenting with symptoms are more likely to report functional difficulties after prostate cancer treatment and may need additional aftercare if these difficulties persist. Method of presentation should be considered as a covariate in patient-reported outcome studies of prostate cancer

Bench-to-bedside review : targeting antioxidants to mitochondria in sepsis

Peer reviewedPublisher PD