How Long is too Long?

Background: The United States is experiencing a nationwide shortage of nurses. Emergency departments (EDs) are at the forefront of this crisis which is contributing to long wait times for patients. Existing literature shows a strong correlation between increased wait times and patients leaving without being seen (LWBS). This likely increases the incidence of adverse events (AE). Studies examining the impact of nursing coverage on the incidence of AE have been conducted primarily in inpatient settings. Our study aims to assess the relationship between nursing coverage and incidence of LWBS/AE in the ED. Methods: This is a retrospective cohort study from January 2019 to December 2023. The eligible participant population is adults presenting to Detroit Receiving Hospital (DRH), Harper University Hospital (HUH), or Sinai Grace Hospital (SGH) EDs and then LWBS. Data will be collected from the respective EMR databases, Detroit Medical Center nursing office (DMCNO), and Data to Intelligence. Results: Data from the DMCNO will be used to calculate the total number of nursing hours worked divided by the total number of patients in the ED in a given 24-hours. A logistic regression analysis will determine how variations in nurse staffing correlate with the incidence of LWBS/AE. Discussion: We hypothesize that the emergency nursing shortage will lead to an increase in the incidence of both LWBS and AE. Based on data obtained from this pilot study, we hope to compile a data registry from EDs nationwide to gain a better understanding of how alterations in nursing coverage impacts LWBS/AE

A REVIEW ON COMMON HAZARDS OF STEROIDS USE IN HYPERTENSION

Since hypertension raises the risk of cardiovascular disease and other consequences, it must be considered when deciding on a patient's course of treatment. Hypertension is the most dangerous adverse effect of corticosteroid use. Corticosteroid treatments, generally known as steroids or anti-inflammatory pharmaceuticals, are used to treat a variety of diseases. They differ from anabolic steroids, which some people often use illicitly to gain muscular mass. Despite being essential in the care of many inflammatory and immunologic illnesses, systemic corticosteroids carry a number of hazards. Osteoporosis, adrenal suppression, hyperglycemia, dyslipidemia, cardiovascular disease, Cushing's syndrome, psychiatric disorders, and immunosuppression are some of the more severe adverse effects of systemic corticosteroid therapy, particularly when taken in high dosages for lengthy periods of time. Using the most recent data as well as the authors' clinical expertise, this extensive study discusses these adverse occurrences and offers helpful advice for their prevention and management

A COMPREHENSIVE REVIEW ON PRONIOSOMES: A NEW CONCEPT IN OCULAR DRUG DELIVERY

The concept of novel drug delivery with the comparison of modern and conventional delivery system. The Ocular is the most challenging organ to deliver drugs after the brain and conventional delivery systems currently available in the arsenal have severe limitations thus there is a strong demand for an improved ocular delivery system and a suitable opinion is a novel drug delivery system. Noisome and liposome are dominant vesicular carriers in ocular drug delivery, as both systems improve the bioavailability of drugs and are well tolerated in ocular; however, both delivery systems have critical drawbacks of physicochemical stability during storage, lacking contain in dispersion and fusion of nanoparticles. The gel form is formulated by the coacervation phase’s parathion method. The material utilized for the formulation of proniosomes are non-ionic surfactant, cholesterol, carrier and alcohol are well tolerable and nontoxic in the ocular. The benefits offered to ocular drug delivery are prolonged retention time of formulation on the ocular surface, enhance ocular penetration to deliver effective therapeutic dosage, improve bioavailability of hydrophobic, lipophilic and herbal drugs, biocompatible, biodegradable, nontoxic and stable stored in pro-vesicle state. Hereby article will review proniosomes drug delivery from the perspective of ophthalmic delivery, discussing proniosomes as an ocular carrier, materials and methods their effect on ocular drug delivery and depth explanation of recent studies of proniosome in the ocular. Proniosomes are one of the sterile drug delivery systems that have seen a tremendous increase in popularity and are heavily utilized in cancer therapy. Researchers and academicians generally agree that incorporating the medicine into niosomes will improve its ability to target tissues where it is needed. Proniosomes created by academics and researchers. Niosomes that are produced from protostomes are a promising medication delivery system. They are well known for avoiding several issues related to aqueous noisome dispersion as well as issues with physical stability such aggregation, fusion, and leakage. They make transportation, distribution, storage, and dosage even more convenient. Proniosomes not only present a promising medication delivery method but also have the potential to speed up the skin barrier's repair

An overview of biological macromolecule crystallization.

The elucidation of the three dimensional structure of biological macromolecules has provided an important contribution to our current understanding of many basic mechanisms involved in life processes. This enormous impact largely results from the ability of X-ray crystallography to provide accurate structural details at atomic resolution that are a prerequisite for a deeper insight on the way in which bio-macromolecules interact with each other to build up supramolecular nano-machines capable of performing specialized biological functions. With the advent of high-energy synchrotron sources and the development of sophisticated software to solve X-ray and neutron crystal structures of large molecules, the crystallization step has become even more the bottleneck of a successful structure determination. This review introduces the general aspects of protein crystallization, summarizes conventional and innovative crystallization methods and focuses on the new strategies utilized to improve the success rate of experiments and increase crystal diffraction quality