Evaluating Nurse Use and Satisfaction with Video-Based Discharge Education for Adults with Heart Failure

Background Heart failure (HF) readmission rates are high and influenced by self-care practices and self-efficacy for managing chronic disease. Using digital education via tablet can help improve the discharge education process and may increase self-care knowledge. Objective The purpose of the study is to assess the current discharge processes implemented for HF patients in cardiovascular units at a Midwestern academic medical center. Methods Participants for this two-phase study were recruited from two inpatient cardiovascular units within a 700-bed, Midwestern academic medical center. Phase one used a pre-post quasiexperimental design to evaluate a discharge educational intervention using the teach-back method in changing HF knowledge, measured with the Atlanta Heart Failure Knowledge Test (AHFKT), and self-efficacy, measured with the Self-Efficacy for Managing Chronic Diseases 6-item scale (SEMCD-6). Due to our limited sample size, a related-samples Wilcoxon signed rank test was used to analyze changes in scores from pre-test to post-test for HF knowledge and self-efficacy. Phase two used a descriptive survey to evaluate RN use and satisfaction with video-based HF education (HF Emmi™) and bedside tablets for discharge education. The 15-item survey included eight multiple choice questions, a 5-point Likert scale ranging from 0 to 4, and six open-ended questions. Descriptive statistics were reported for Emmi™ video satisfaction and responses to the open-ended questions were aggregated and analyzed for the presence of common threads. Results Between September 2022 and November 2022, four participants enrolled and completed the initial intervention for phase one. Two were later lost to follow-up. Data analysis demonstrated that AHFKT scores and SEMCD-6 scores were not significantly different from pre-intervention to 30-days post discharge (p = 0.18). From November 2022 and the end of December 2022, 24 nurses enrolled and completed phase two. Nurses reported mean satisfaction of the HF Emmi™ video and beside tables at 2.33 (SD = 0.92). Common threads in open-ended survey responses demonstrated difficulty accessing the HF Emmi™ video and lack of knowledge regarding the HF Emmi™ video. Conclusions HF knowledge and self-efficacy for chronic disease management scores did not demonstrate statistical significance from pre-intervention to 30-days post discharge. Nurse surveys indicated a neutral response for use and satisfaction of the HF Emmi™ video. Findings from phase one indicate future studies are necessary to evaluate the impact of the teach-back method and digital discharge education in adults with HF. Findings from phase two indicate a need for further nurse training on the use of tablets for digital discharge education and methods for implementation to workflow. Keywords: heart failure, teach-back, video educatio

Promoting Adherence to Best Practice Related to Urine Reflex to Culture Testing

Over a two week period, the infection control nurse, from a trauma designated facility located in norther California, planned a practice improvement project in collaboration with the laboratory microsystem to educate referring physicians and increase adherence to the Centers for Disease Control (CDC) protocol, which delineates recommended best practices related to urine reflex to culture testing. Urinalysis (UA) is a test that triggers a reflex urine culture when pyuria is present. Frequent urine culturing without the presence of pyuria can cause unnecessary treatment with antimicrobials. From January 2017 to December 2017, 10% of UAs from 200 urine samples from asymptomatic patients yielded the presence of a microorganism, necessitating antimicrobial treatment. A single center study applied a best practice and used a reflex urine culture protocol that prompted the laboratory staff to perform a UA followed by a urine culture if pyuria (WBC \u3e10/HPF) was present. Currently, the facility’s laboratory uses WBC \u3e5/HPF as a criterion. To gain physician support over a 2-week period, 25 physicians were educated using a flowchart that defines the new clinical and pyuria criteria (Appendix A). The long-term goal is to ensure that the number of urine cultures triggered by the new pyuria value aligns with Urinary Tract Infection (UTI) symptomatology, which consequently reduce unnecessary antimicrobial treatment. The project resulted in referring physicians’ engagement and adoption of the CDC protocol and agreement to monitor the number of reflex urine tests prospectively and analyze patterns that triggered treatment with antimicrobials of asymptomatic patients over a six month period

Minimal flavour violation extensions of the seesaw

We analyze the most natural formulations of the minimal lepton flavour violation hypothesis compatible with a type-I seesaw structure with three heavy singlet neutrinos N, and satisfying the requirement of being predictive, in the sense that all LFV effects can be expressed in terms of low energy observables. We find a new interesting realization based on the flavour group $SU(3)_e\times SU(3)_{\ell+N}$ (being $e$ and $\ell$ respectively the SU(2) singlet and doublet leptons). An intriguing feature of this realization is that, in the normal hierarchy scenario for neutrino masses, it allows for sizeable enhancements of $\mu \to e$ transitions with respect to LFV processes involving the $\tau$ lepton. We also discuss how the symmetries of the type-I seesaw allow for a strong suppression of the N mass scale with respect to the scale of lepton number breaking, without implying a similar suppression for possible mechanisms of N productionComment: 14 pages, 6 figure

The Impact of Flavour Changing Neutral Gauge Bosons on B->X_s gamma

The branching ratio of the rare decay B->X_s gamma provides potentially strong constraints on models beyond the Standard Model. Considering a general scenario with new heavy neutral gauge bosons, present in particular in Z' and gauge flavour models, we point out two new contributions to the B->X_s gamma decay. The first one originates from one-loop diagrams mediated by gauge bosons and heavy exotic quarks with electric charge -1/3. The second contribution stems from the QCD mixing of neutral current-current operators generated by heavy neutral gauge bosons and the dipole operators responsible for the B->X_s gamma decay. The latter mixing is calculated here for the first time. We discuss general sum rules which have to be satisfied in any model of this type. We emphasise that the neutral gauge bosons in question could also significantly affect other fermion radiative decays as well as non-leptonic two-body B decays, epsilon'/epsilon, anomalous (g-2)_mu and electric dipole moments.Comment: 31 pages, 5 figures; version published on JHEP; added magic QCD numbers for flavour-violating Z gauge boson contribution to B -> X_s gamm

Exogenous Glucose Administration Impairs Glucose Tolerance and Pancreatic Insulin Secretion during Acute Sepsis in Non-Diabetic Mice

Objectives:The development of hyperglycemia and the use of early parenteral feeding are associated with poor outcomes in critically ill patients. We therefore examined the impact of exogenous glucose administration on the integrated metabolic function of endotoxemic mice using our recently developed frequently sampled intravenous glucose tolerance test (FSIVGTT). We next extended our findings using a cecal ligation and puncture (CLP) sepsis model administered early parenteral glucose support.Methods:Male C57BL/6J mice, 8-12 weeks, were instrumented with chronic indwelling arterial and venous catheters. Endotoxemia was initiated with intra-arterial lipopolysaccharide (LPS; 1 mg/kg) in the presence of saline or glucose infusion (100 μL/hr), and an FSIVGTT was performed after five hours. In a second experiment, catheterized mice underwent CLP and the impact of early parenteral glucose administration on glucose homeostasis and mortality was assessed over 24 hrs.Measurements:And MAIN RESULTS: Administration of LPS alone did not impair metabolic function, whereas glucose administration alone induced an insulin sensitive state. In contrast, LPS and glucose combined caused marked glucose intolerance and insulin resistance and significantly impaired pancreatic insulin secretion. Similarly, CLP mice receiving parenteral glucose developed fulminant hyperglycemia within 18 hrs (all > 600 mg/dl) associated with increased systemic cytokine release and 40% mortality, whereas CLP alone (85 ± 2 mg/dL) or sham mice receiving parenteral glucose (113 ± 3 mg/dL) all survived and were not hyperglycemic. Despite profound hyperglycemia, plasma insulin in the CLP glucose-infused mice (3.7 ± 1.2 ng/ml) was not higher than sham glucose infused mice (2.1 ± 0.3 ng/ml).Conclusions:The combination of parenteral glucose support and the systemic inflammatory response in the acute phase of sepsis induces profound insulin resistance and impairs compensatory pancreatic insulin secretion, leading to the development of fulminant hyperglycemia. © 2013 Watanabe et al

Neutrino Masses at LHC: Minimal Lepton Flavour Violation in Type-III See-saw

We study the signatures of minimal lepton flavour violation in a simple Type-III see - saw model in which the flavour scale is given by the new fermion triplet mass and it can be naturally light enough to be produced at the LHC. In this model the flavour structure of the lepton number conserving couplings of the triplet fermions to the Standard Model leptons can be reconstructed from the neutrino mass matrix and the smallness of the neutrino mass is associated with a tiny violation of total lepton number. Characteristic signatures of this model include suppressed lepton number violation decays of the triplet fermions, absence of displaced vertices in their decays and predictable lepton flavour composition of the states produced in their decays. We study the observability of these signals in the processes pp\rightarrow 3\ell + 2j +\Sla{E_T} and $pp\rightarrow 2\ell + 4j$ with $\ell =e$ or $\mu$ taking into account the present low energy data on neutrino physics and the corresponding Standard Model backgrounds. Our results indicate that the new fermionic states can be observed for masses up to 500 GeV depending on the CP violating Majorana phase for an integrated luminosity of 30 fb$^{-1}$. Moreover, the flavour of the final state leptons in the above processes can shed light on the neutrino mass ordering.Comment: 31 pages, 11 Figures, matches published versio

Radiative Corrections to Light Neutrino Masses in Low Scale Type I Seesaw Scenarios and Neutrinoless Double Beta Decay

We perform a detailed analysis of the one-loop corrections to the light neutrino mass matrix within low scale type I seesaw extensions of the Standard Model and their implications in experimental searches for neutrinoless double beta decay. We show that a sizable contribution to the effective Majorana neutrino mass from the exchange of heavy Majorana neutrinos is always possible, provided one requires a fine-tuned cancellation between the tree-level and one-loop contribution to the light neutrino masses. We quantify the level of fine-tuning as a function of the seesaw parameters and introduce a generalisation of the Casas-Ibarra parametrization of the neutrino Yukawa matrix, which easily allows to include the one-loop corrections to the light neutrino masses. \ua9 2015, The Author(s)

Probing the Type I Seesaw Mechanism with Displaced Vertices at the LHC

The observation of Higgs decays into heavy neutrinos would be strong evidence for new physics associated to neutrino masses. In this work we propose a search for such decays within the Type I seesaw model in the few-GeV mass range via displaced vertices. Using 300 fb−1 of integrated luminosity, at 13 TeV, we explore the region of parameter space where such decays are measurable. We show that, after imposing pseudorapidity cuts, there still exists a region where the number of events is larger than O(10). We also find that conventional triggers can greatly limit the sensitivity of our signal, so we display several relevant kinematical distributions which might aid in the optimization of a dedicated trigger selection

A method of determining where to target surveillance efforts in heterogeneous epidemiological systems

The spread of pathogens into new environments poses a considerable threat to human, animal, and plant health, and by extension, human and animal wellbeing, ecosystem function, and agricultural productivity, worldwide. Early detection through effective surveillance is a key strategy to reduce the risk of their establishment. Whilst it is well established that statistical and economic considerations are of vital importance when planning surveillance efforts, it is also important to consider epidemiological characteristics of the pathogen in question—including heterogeneities within the epidemiological system itself. One of the most pronounced realisations of this heterogeneity is seen in the case of vector-borne pathogens, which spread between ‘hosts’ and ‘vectors’—with each group possessing distinct epidemiological characteristics. As a result, an important question when planning surveillance for emerging vector-borne pathogens is where to place sampling resources in order to detect the pathogen as early as possible. We answer this question by developing a statistical function which describes the probability distributions of the prevalences of infection at first detection in both hosts and vectors. We also show how this method can be adapted in order to maximise the probability of early detection of an emerging pathogen within imposed sample size and/or cost constraints, and demonstrate its application using two simple models of vector-borne citrus pathogens. Under the assumption of a linear cost function, we find that sampling costs are generally minimised when either hosts or vectors, but not both, are sampled

Genetic association study of QT interval highlights role for calcium signaling pathways in myocardial repolarization.

The QT interval, an electrocardiographic measure reflecting myocardial repolarization, is a heritable trait. QT prolongation is a risk factor for ventricular arrhythmias and sudden cardiac death (SCD) and could indicate the presence of the potentially lethal mendelian long-QT syndrome (LQTS). Using a genome-wide association and replication study in up to 100,000 individuals, we identified 35 common variant loci associated with QT interval that collectively explain ∼8-10% of QT-interval variation and highlight the importance of calcium regulation in myocardial repolarization. Rare variant analysis of 6 new QT interval-associated loci in 298 unrelated probands with LQTS identified coding variants not found in controls but of uncertain causality and therefore requiring validation. Several newly identified loci encode proteins that physically interact with other recognized repolarization proteins. Our integration of common variant association, expression and orthogonal protein-protein interaction screens provides new insights into cardiac electrophysiology and identifies new candidate genes for ventricular arrhythmias, LQTS and SCD