R22. Oliceridine’s role in pain management: a qualitative literature review

Corresponding author (Pharmacy Practice): Hallie Austin, [email protected]://egrove.olemiss.edu/pharm_annual_posters/1021/thumbnail.jp

Evaluating the Utility of Diagnostic Workups for Biliary Atresia in Neonates with Cholestatic Jaundice Following Prolonged TPN

Introduction: Parenteral nutrition associated cholestasis (PNAC) develops in 40-60% of premature infants following TPN for 2-4+ weeks. The incidence of biliary atresia is low and there is a 60-day, post-term window for corrective surgery. There is limited data on both the natural history of PNAC in premature infants following prolonged TPN, as well as the utility of diagnostic tools investigating biliary atresia in these patients. Methods: A retrospective chart review using EMR data from the Intensive Care Nursey was performed with the following criteria: premature babies diagnosed with cholestasis, born at \u3c1500 grams, and received TPN for 14 days. Ultimately 61 babies met criteria and data was collected and pooled to produce descriptive statistics and graphs describing laboratory trends. Results: Median gestational age was 26 [IQR 25, 28] weeks, birth weight was 732 [650, 930] grams and 60% (36/60) were male. After being on TPN for a median of 51 [38, 73] days and developing cholestasis, 12/61 (19.7%) babies underwent hepatobiliary scintigraphy, three of which also underwent repeat scans, 29/61 (47.5%) received GI consults and 32/61 (52.5%) underwent abdominal ultrasounds. No babies were diagnosed with biliary atresia. Graphical depiction of laboratory trends demonstrates an initial spike in direct bilirubin after TPN cessation, followed by a gradual decline 3-4 weeks later. Discussion: Despite many diagnostic procedures and consults, PNAC was the only observed diagnosis at discharge for this cohort of babies. Based on the laboratory trends, delaying the investigation of elevated bilirubin until 3-4 weeks after ceasing TPN might prevent unnecessary diagnostics and improve resource allocation

Information Provision and the Carceral State: Race and Reference beyond the Idea of the Underserved

This article addresses an approach to library services for people who are incarcerated that meets the situated information needs and desires of people within jails and prisons. By creating a flow of information between LIS students and individuals who are incarcerated through a Reference by Mail program, resources available to incarcerated people are increased while students engage in a humanizing and self-reflexive project, with the understanding that the regulation of information within jails and prisons has lasting effects for the life chances of incarcerated people

Ultrasound-Guided Intravenous Access as a First-Line Approach by Nurses: A Quality Improvement Project

Background: Up to 9% of patients admitted to EDs (Emergency Departments) have difficult intravenous insertion access issues (DIVA). This creates delays in patient care that includes interruptions for physicians providing medical emergency care. Often the utilization of RNs to perform US (ultrasound) IV insertions is limited related to lack of training and supportive policies. Local Problem: The site for this project was an ED Level 1 Trauma Center associated with a large teaching hospital located in the southeastern U.S. Prior to the implementation of the process improvement project, there was no formal education of RNs in the use of US for difficult insertion IVs, resulting in patient care delays and physician interruptions for IV starts. The purpose of this project was to reduce patient care delays related to patients with difficult IV insertions with the aim to train RNs to perform ultrasound-guided IV insertions. Methods: The Model for Improvement was utilized as a guide for this project. Using the PDSA (plan, do, study, act), which included a review of the literature for best practice, the RN education and ultrasound protocol was developed. Pre- and post-implementation DIVA patients\u27 baseline door-to-IV start and door-to-blood collection times were measured. Interventions: US educational sessions were developed and taught to 15 RNs in the ED. Results: ED increased the number of US proficient RNs to 24. Physician IV starts decreased by 12%. There were no significant differences between pre and post-intervention time to IV (p=0.552) or time to blood draw (p=0.081). Conclusions: The project increased RN availability for US-guided access and reduced physician interruptions. Post-intervention door-to-IV and door-to-blood draw times were not significantly different, possibly relating to ED volume during the time of the project. The project site will continue the RN US education program

Analysis of Betta splendens erythrophore responses to Bacillus cereus cultured in different media

Biological agents and their products commonly cause foodborne illnesses. In the United States it is estimated that there are over 76 million cases of foodborne illnesses each year, resulting in an economic loss of approximately $40 billion. These high figures demonstrate the need for bioassays that display a rapid and accurate response to biologically active agents such as the products produced by pathogenic bacteria. Current detection techniques consist of selective enrichment plating, which requires culturing time, or molecular probing techniques, that detect the presence of an agent, but not its actual biological toxicity. A rapid assay that detects biologically active agents would provide a superior method of pathogen detection and could act as a warning of environmental contamination. One pathogen of concern, Bacillus cereus, is ubiquitous in the environment and most notably known for causing food poisoning. This research describes a chromatophore-based biosensor from Betta splendens (Siamese fighting fish), which can detect B. cereus at levels at or below the infectious dose needed to cause food poisoning. Chromatophores are pigmented cells found in cold-blooded animals that react physiologically to biologically active agents by altering their optical density. The red-pigmented chromatophores, or erythrophores, were used to determine the response limit to B. cereus, and the response patterns to B. cereus grown in different media. This research found the lower limit of detection of B. splendens erythrophores for B. cereus cultured in Luria Bertani broth to be 104 viable B. cereus cells per milliliter. This sensitivity is equivalent to that expected of the sensitivity pertinent to food safety standards. Erythrophore responses to B. cereus cultured in Brain Heart Infusion broth supplemented with glucose support the hypothesis that culturing in this fashion results in maximally expressed enterotoxins. These results establish Brain Heart Infusion broth supplemented with glucose as the preferred medium for use in B. cereus gene expression analyses that assess enterotoxin regulation and function.Keywords: Biosensor, Erythrophore, Chromatophore, Bacillus cereus, Foodborne illness, Betta splenden

Vessel Reactivity and Blood Flow in Rats Exposed to Neonatal Supplemental Oxygen

Premature babies make up 12.8% of live births per year. Because their lungs are poorly developed, supplemental oxygen is a necessary treatment. Recent studies in our laboratory, in a rat model of prematurity, show that aortic pulse wave velocities were higher in rats exposed to neonatal supplemental oxygen. This is an indicator of significant aortic stiffening. This study aims to determine if supplemental oxygen also affects the downstream vasculature reactivity. We hypothesized that exposure to supplemental oxygen during the neonatal period will decrease vessel reactivity and we will observe smaller changes in blood flow with hypoxic and carbon dioxide challenges. Twelve month old rats exposed to 80% and 21% oxygen for eight days during the neonatal period were ventilated with hypoxic (12% O2), hypercapnic (5% CO2), and room air conditions. Each exposure lasted 10 minutes and followed with different 10 µm neutron-activated BioPAL microspheres injections into the left ventricle. The microspheres were allowed to circulate for 300-400 cardiac cycles. Microspheres lodged in the tissues were used to quantify changes in visceral blood flow. 80% O2 exposed rats showed a decreased baseline cardiac output to tissues compared to controls. In hypoxic and carbon dioxide conditions, 80% O2 exposed rats showed decreased changes in blood flow to tissues compared to controls, but results were not significant. Some tissues showed decreased blood flows when the rats were exposed to hypoxia and carbon dioxide challenges suggesting some vasoconstrictive effects had also occurred

Informing NHS policy in 'digital-first primary care': a rapid evidence synthesis

Background In ‘digital-first primary care’ models of health-care delivery, a patient’s first point of contact with a general practitioner or other health professional is through a digital channel, rather than a face-to-face consultation. Patients are able to access advice and treatment remotely from their home or workplace via a number of different technologies. Objectives This rapid responsive evidence synthesis was undertaken to inform NHS England policy in ‘digital-first primary care’. It was conducted in two stages: (1) scoping the published evidence and (2) addressing a refined set of questions produced by NHS England from the evidence retrieved during the scoping stage. Data sources Searches were conducted of five electronic databases (MEDLINE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, the Health Technology Assessment database and PROSPERO were searched in July 2018) and relevant research/policy and government websites, as well as the National Institute for Health Research Health Service and Delivery Research programme database of ongoing and completed projects. No date or geographical limitations were applied. Review methods After examining the initial scoping material, NHS England provided a list of questions relating to the potential effects of digital modes and models of engagement, and the contracting and integration of these models into primary care. Systematic reviews and evidence syntheses, including evidence on the use of digital (online) modes and models of engagement between patients and primary care, were examined more closely, as was ongoing research and any incidentally identified primary studies focused on the use of digital (online) modes and models of engagement. All records were screened by two reviewers, with disagreements resolved by consensus or consulting a third reviewer. Results Evidence suggests that uptake of existing digital modes of engagement is currently low. Patients who use digital alternatives to face-to-face consultations are likely to be younger, female and have higher income and education levels. There is some evidence that online triage tools can divert demand away from primary care, but results vary between interventions and outcome measures. A number of potential barriers exist to using digital alternatives to face-to-face consultations, including inadequate NHS technology and staff concerns about workload and confidentiality. There are currently insufficient empirical data to either substantiate or allay such concerns. Very little evidence exists on outcomes related to quality of care, service delivery, benefits or harms for patients, or on financial costs/cost-effectiveness. No studies examining how to contract and commission alternatives to face-to-face consultations were identified. Limitations The quality of the included reviews was variable. Poor reporting of methodology and a lack of adequate study details were common issues. Much of the evidence focused on exploring stakeholder views rather than on objective measurement of potential impacts. The current evidence synthesis is based on a rapid scoping exercise and cannot provide the breadth or depth of insight that might have been achieved with a full systematic review. Conclusions Rapid scoping of the literature suggests that there is little high-quality evidence relating to ‘digital-first primary care’ as defined by NHS England. The broader evidence on alternatives to face-to-face consultation addresses certain policy-maker concerns, such as the possible impact of new technologies on workload and workforce, inequalities, local implementation and integration with existing services. However, although this evidence gives an insight into the views and experiences of health professionals in relation to such concerns, quantitative empirical data are lacking

Effects of Neonatal Supplemental Oxygen and High Fat Diet on Weight Gain, Ventricular Hypertrophy and Contractility

Premature birth represents about 13% of live births each year. Since lungs of these infants are underdeveloped, they receive supplemental oxygen right after birth, but little is known about its effects on the development of normal physiological responses and whether it impacts long-term cardio-metabolic function. Based on previous studies from our lab that showed increased pulse wave velocity in 12 month old rats exposed to neonatal supplemental oxygen, we hypothesized that neonatal exposure to supplemental oxygen causes cardiac hypertrophy and decreased left ventricular contractility. We also hypothesized that these effects to supplemental oxygen would be enhanced by 10 weeks on a high fat diet. To test the hypothesis, we used our rat model of 80% and 21% O2 exposed rats to FlO2=0.80 and 0.21 respectively, for 8 days post-birth. Two months after birth, these 80% and 21% rats were randomly assigned to either a high fat diet (60% of calories from animal fat) or low fat diet (CON) for 10 weeks during which their weights and caloric consumption were monitored. After 10 weeks, a Miller conductance catheter was inserted into the left ventricle to obtain pressure-volume loops and end-systolic pressure volume relationship, which was used to evaluate contractility. 80% rats exposed to CON diet showed higher cumulative weight gain than 21% rats on the same diet. No significant difference was observed between the weights of the left ventricles due to exposure to supplemental oxygen or high fat diet. Neonatal supplemental oxygen exposure decreased contractility whereas the combination of high fat diet and supplemental oxygen exposure reversed this effect. These data suggest that neonatal exposure to supplemental oxygen promotes weight gain and decreased ventricular contractility

Neonatal Supplemental Oxygen Exposure Promotes the Development of Metabolic Disease in Adult Rats

Premature infants frequently require supplemental oxygen to sustain life, but little is known about how supplemental oxygen administered during the critical developmental window after birth increases the risk of age-related disease, including obesity and diabetes. We hypothesized that neonatal rats exposed to supplemental oxygen (OXY) would have impaired glucose tolerance and that they would develop a diabetes phenotype earlier than controls (CON), when offered a high fat diet. We used an established rat model of neonatal oxygen exposure (80% O2 for 8-14 days) and glucose tolerance was evaluated 14 days and 12 months post-natally. To evaluate glucose tolerance, baseline blood glucose was measured after an overnight fast, followed by an intraperitoneal injection of concentrated glucose. Blood glucose was then measured 15, 30, 60 and 120 minutes post-injection. In a second experiment, two month old OXY and CON rats were randomly assigned to an animal-based fat diet (60% of calories from fat), or standard, low fat diet for ten weeks. At the beginning of the study and each subsequent week, glucose tolerance was measured. At 14 days and 12 months, OXY rats had higher blood glucose at 15 and 30 minutes compared to CON rats. OXY rats fed a high fat diet developed frank glucose intolerance after 4 weeks. Ten weeks of high fat diet had minimal effect on glucose tolerance in CON rats. Taken together, these data suggest that supplemental oxygen during the neonatal period may predispose the premature infant to the development of metabolic disease later in life