Evaluating Learner Perceptions of Use of Simulations for New nurses – A Collaboration Between the UT SON and the Methodist Hospital

The purpose of this evaluation project was to describe the integration of simulation into a nursing internship program and to help prepare new graduate nurses for patient care. Additionally, learning styles and perceptions of active learning, collaboration among peers, ways of learning, expectation of simulation, satisfaction, self-confidence, and design of simulation were examined. [See PDF for complete abstract

Nurse Practitioner Opioid Prescribing and Educational Requirements in Canada and the Unites States: A Narrative Review

Introduction/Background: Canada and the U.S had the highest level of opioid consumption per capita worldwide in 2015 (Pasricha et al., 2018). Nurse Practitioners (NPs) are authorized to prescribe opioids in both Canada and the U.S.Purpose: This narrative review aims to examine the differences in NP opioid-related educational requirements and prescribing patterns between the U.S. and Canada. Methods: A narrative review was used to synthesize findings from literature obtained through computerized databases, authoritative texts, and hand searches. Discussion: As of 2010, NPs in Canada and the U.S. must hold a master\u27s degree. American NPs must obtain a Drug Enforcement Administration(DEA) license to prescribe opioids; the Canadian government authorized NPs to prescribe opioids in 2012, with varying provincial licensure requirements. New American national guidelines for prescribing opioids for chronic pain were released by the Centers for Disease Control (CDC) and Prevention in 2016; McMaster University in Canada followed and published ‘The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain.’. In contrast to Canada, NP opioid prescribing in the U.S. is monitored though the DEA drug monitoring program, and NPs complete a national survey every 5 years regarding all prescribing practices. Canada lacks emergency department (ED) specific opioid prescribing guidelines whereas 24 American states have implemented them. Implications for Future Research: Canadian NP opioid prescribing is under-researched. Further research is needed to provide a more adequate comparison with American data. Additionally, research regarding ED specific guidelines could provide valuable information to guide prescribers in this rapidly changing, high-stress environment

The Effects of Interprofessional Pediatric End-of-Life Simulation on Communication and Role Understanding in Health Professions Students: A Pharmacy Perspective

Purpose: The purpose of this study is to analyze the impact of an interprofessional pediatric end-of life simulation for medical students, nursing students, pharmacy students, and public health students. Background: Simulation allows healthcare professionals to work and learn side by side as they do in actual patient-care situations. Previous studies have confirmed the effectiveness of high-fidelity simulation in improving nursing students’ and medical students’ knowledge and communication skills (Alinier et al., 2006). Thoughtfully designed educational programs can help students of health professions develop interprofessional competencies and capacities, including values and ethics, roles and responsibilities, interprofessional communication, and teamwork (Interprofessional Education Collaborative Expert Panel, 2011). Intervention: The pediatric end-of-life simulations will include two high fidelity simulations and discussions. An experimental design will be used in which all students will participate in the two simulations. Pre and posttest data will be collected using the TeamSTEPPS® 2.0 Team Performance Observation Tool, The TeamSTEPPS® 2.0 Teamwork Attitudes Questionnaire (T-TAQ), and The TeamSTEPPS® 2.0 Teamwork Perceptions Questionnaire (T-TPQ). The control group will consist of students in the same disciplines that receive standard lecture content. These participants will also complete the survey instruments. Relevance to Interprofessional Education: The improvement in attitudes toward interprofessional teamwork and role clarity will also transition into practice. Students will have a better understanding of the importance of collaboration in order to assure quality patient care. Recommendations: If findings indicate that, regardless of profession, there is significant improvement in clinical knowledge which can be transpired into practice as well as an improvement in attitudes toward interprofessional teamwork and role clarity a curriculum change that includes these types of simulations is recommended. This curriculum change should then be investigated. Measurable Learning Objectives: 1) Define methods of evaluating program and patient outcomes in assessing the effectiveness of interprofessional education and collaborative practice endeavors 2) Employ technology and social media to advance interprofessional education and collaborative practic

Stochasticity of flow through microcirculation as a regulator of oxygen delivery

<p>Abstract</p> <p>Objective</p> <p>Observations of microcirculation reveal that the blood flow is subject to interruptions and resumptions. Accepting that blood randomly stops and resumes, one can show that the randomness could be a powerful means to match oxygen delivery with oxygen demand.</p> <p>Method</p> <p>The ability of the randomness to regulate oxygen delivery is based on two suppositions: (a) the probability for flow to stop does not depend on the time of uninterrupted flow, thus the number of interruptions of flow follows a Poisson distribution; (b) the probability to resume the flow does not depend on the time for flow being interrupted; meaning that time spent by erythrocytes at rest follows an exponential distribution. Thus the distribution of the time to pass an organ is a compound Poisson distribution. The Laplace transform of the given distribution gives the fraction of oxygen that passes the organ.</p> <p>Result</p> <p>Oxygen delivery to the tissues directly depends on characteristics of the irregularity of the flow through microcirculation.</p> <p>Conclusion</p> <p>By variation of vasomotion activity it is possible to change delivery of oxygen to a tissue by up to 8 times.</p

Neuromuscular Blockade with Rocuronium Bromide Increases the Tolerance of Acute Normovolemic Anemia in Anesthetized Pigs

Background: The patient's individual anemia tolerance is pivotal when blood transfusions become necessary, but are not feasible for some reason. To date, the effects of neuromuscular blockade (NMB) on anemia tolerance have not been investigated. Methods: 14 anesthetized and mechanically ventilated pigs were randomly assigned to the Roc group (3.78 mg/kg rocuronium bromide followed by continuous infusion of 1 mg/kg/min, n = 7) or to the Sal group (administration of the corresponding volume of normal saline, n = 7). Subsequently, acute normovolemic anemia was induced by simultaneous exchange of whole blood for a 6% hydroxyethyl starch solution (130/0.4) until a sudden decrease of total body O-2 consumption (VO2) indicated a critical limitation of O-2 transport capacity. The Hb concentration quantified at this time point (Hb(crit)) was the primary end-point of the protocol. Secondary endpoints were parameters of hemodynamics, O-2 transport and tissue oxygenation. Results: Hb(crit) was significantly lower in the Roc group (2.4 +/- 0.5 vs. 3.2 +/- 0.7 g/dl) reflecting increased anemia tolerance. NMB with rocuronium bromide reduced skeletal muscular VO2 and total body O-2 extraction rate. As the cardiac index increased simultaneously, total body VO2 only decreased marginally in the Roc group (change of VO2 relative to baseline -1.7 +/- 0.8 vs. 3.2 +/- 1.9% in the Sal group, p < 0.05). Conclusion: Deep NMB with rocuronium bromide increases the tolerance of acute normovolemic anemia. The underlying mechanism most likely involves a reduction of skeletal muscular VO2. During acellular treatment of an acute blood loss, NMB might play an adjuvant role in situations where profound stages of normovolemic anemia have to be tolerated (e.g. bridging an unexpected blood loss until blood products become available for transfusion). Copyright (C) 2011 S. Karger AG, Base

Hyperspectral Computed Tomographic Imaging Spectroscopy of Vascular Oxygen Gradients in the Rabbit Retina In Vivo

Diagnosis of retinal vascular diseases depends on ophthalmoscopic findings that most often occur after severe visual loss (as in vein occlusions) or chronic changes that are irreversible (as in diabetic retinopathy). Despite recent advances, diagnostic imaging currently reveals very little about the vascular function and local oxygen delivery. One potentially useful measure of vascular function is measurement of hemoglobin oxygen content. In this paper, we demonstrate a novel method of accurately, rapidly and easily measuring oxygen saturation within retinal vessels using in vivo imaging spectroscopy. This method uses a commercially available fundus camera coupled to two-dimensional diffracting optics that scatter the incident light onto a focal plane array in a calibrated pattern. Computed tomographic algorithms are used to reconstruct the diffracted spectral patterns into wavelength components of the original image. In this paper the spectral components of oxy- and deoxyhemoglobin are analyzed from the vessels within the image. Up to 76 spectral measurements can be made in only a few milliseconds and used to quantify the oxygen saturation within the retinal vessels over a 10–15 degree field. The method described here can acquire 10-fold more spectral data in much less time than conventional oximetry systems (while utilizing the commonly accepted fundus camera platform). Application of this method to animal models of retinal vascular disease and clinical subjects will provide useful and novel information about retinal vascular disease and physiology

Insufficient evidence for pathogenicity of SNCA His50Gln (H50Q) in Parkinson's disease

SNCA missense mutations are a rare cause of autosomal dominant Parkinson's disease (PD). To date, 6 missense mutations in SNCA have been nominated as causal. Here, we assess the frequency of these 6 mutations in public population databases and PD case-control data sets to determine their true pathogenicity. We found that 1 of the 6 reported SNCA mutations, His50Gln, was consistently identified in large population databases, and no enrichment was evident in PD cases compared to controls. These results suggest that His50Gln is probably not a pathogenic variant. This information is important to provide counseling for His50Gln carriers and has implications for the interpretation of His50Gln α-synuclein functional investigations

β-Adrenoreceptor Stimulation Mediates Reconsolidation of Social Reward-Related Memories

In recent years, the notion that consolidated memories become transiently unstable after retrieval and require reconsolidation to persist for later use has received strong experimental support. To date, the majority of studies on reconsolidation have focused on memories of negative emotions, while the dynamics of positive memories have been less well studied. Social play, the most characteristic social behavior displayed by young mammals, is important for social and cognitive development. It has strong rewarding properties, illustrated by the fact that it can induce conditioned place preference (CPP). In order to understand the dynamics of positive social memories, we evaluated the effect of propranolol, a β-adrenoreceptor antagonist known to influence a variety of memory processes, on acquisition, consolidation, retrieval and reconsolidation of social play-induced CPP in adolescent rats.Systemic treatment with propranolol, immediately before or after a CPP test (i.e. retrieval session), attenuated CPP 24 h later. Following extinction, CPP could be reinstated in saline--but not in propranolol-treated rats, indicating that propranolol treatment had persistently disrupted the CPP memory trace. Propranolol did not affect social play-induced CPP in the absence of memory retrieval or when administered 1 h or 6 h after retrieval. Furthermore, propranolol did not affect acquisition, consolidation or retrieval of social play-induced CPP.We conclude that β-adrenergic neurotransmission selectively mediates the reconsolidation, but not other processes involved in the storage and stability of social reward-related memories in adolescent rats. These data support the notion that consolidation and reconsolidation of social reward-related memories in adolescent rats rely on distinct neural mechanisms

Spatial Analyses of Benthic Habitats to Define Coral Reef Ecosystem Regions and Potential Biogeographic Boundaries along a Latitudinal Gradient

Marine organism diversity typically attenuates latitudinally from tropical to colder climate regimes. Since the distribution of many marine species relates to certain habitats and depth regimes, mapping data provide valuable information in the absence of detailed ecological data that can be used to identify and spatially quantify smaller scale (10 s km) coral reef ecosystem regions and potential physical biogeographic barriers. This study focused on the southeast Florida coast due to a recognized, but understudied, tropical to subtropical biogeographic gradient. GIS spatial analyses were conducted on recent, accurate, shallow-water (0–30 m) benthic habitat maps to identify and quantify specific regions along the coast that were statistically distinct in the number and amount of major benthic habitat types. Habitat type and width were measured for 209 evenly-spaced cross-shelf transects. Evaluation of groupings from a cluster analysis at 75% similarity yielded five distinct regions. The number of benthic habitats and their area, width, distance from shore, distance from each other, and LIDAR depths were calculated in GIS and examined to determine regional statistical differences. The number of benthic habitats decreased with increasing latitude from 9 in the south to 4 in the north and many of the habitat metrics statistically differed between regions. Three potential biogeographic barriers were found at the Boca, Hillsboro, and Biscayne boundaries, where specific shallow-water habitats were absent further north; Middle Reef, Inner Reef, and oceanic seagrass beds respectively. The Bahamas Fault Zone boundary was also noted where changes in coastal morphologies occurred that could relate to subtle ecological changes. The analyses defined regions on a smaller scale more appropriate to regional management decisions, hence strengthening marine conservation planning with an objective, scientific foundation for decision making. They provide a framework for similar regional analyses elsewhere