Increasing Pulmonary Artery Catheter Education Among CCU Nurses: A Quality Improvement Project

Executive Summary Title: Increasing Pulmonary Artery Catheter Education Among CCU Nurses: A Quality Improvement Project Background and Significance: Among the patient population in the Cardiac Care Unit (CCU) at a large academic medical center in Seattle, pulmonary artery (PA) catheters are commonplace. PA catheters are invasive central venous access devices with the ability to measure hemodynamic parameters that reveal information about the functionality and cardiac output of the heart. Should values obtained from PA catheters be incorrectly measured, serious complications could arise. Appropriate management of this device requires specialized expertise which is usually limited to cardiac critical care and surgical settings. Problem and Purpose Statement: Multiple studies report mismanagement of PA catheters and incorrect measurement of the values derived from them in the absence of a specialized education program. Sufficient evidence supports the effectiveness of content-specific training for improvement of PA catheter knowledge. The CCU at this healthcare facility does not have a routine ongoing education program specifically dedicated to PA catheter management after the initial onboarding educational process for nurses. The primary aim of this program is to determine whether knowledge increases among CCU nurses who participate in a PA catheter training program. A secondary aim of the project is to evaluate the effectiveness of the developed PA catheter training program itself. Methods: A PA catheter educational training program and an identical pretest and posttest were developed from published or validated resources and test questions. Concepts covered in the module includes expected standards of care, a brief overview of the basics of PA catheter management, the process of measuring hemodynamic values, and the mechanics of measuring end-expiration and its significance. Test questions for the pre- and posttest that demonstrated knowledge of the aforementioned topics were chosen. Ten CCU charge nurses participated in the pretest, intervention, and posttest. Tests were scored and compared to assess change in knowledge. Descriptive statistics of the paired data were calculated and analyzed quantitatively for change. Results/Outcomes: Significant improvement was recognized after participants engaged in the educational program. The mean test score increased, answer variability decreased, and a p-value of 0.01 resulted demonstrating statistical significance. This effectively demonstrates that CCU nurse knowledge of PA catheters and their management improved. Inaccurate measurement of hemodynamic values obtained from a PA catheter is associated with increased mortality in critically ill patients (Claure-Del Granado & Mehta, 2016). Sustainability: Promoting sustainability, this program will be used to educate nurse ‘super-users’. Since the implementation of the project, interdisciplinary interest has been expressed. Further aims are to educate a wider array of health professionals including physicians, advanced practice nurses, and physician assistants. In addition to the efficacy of the intervention, this educational program is inherently valuable within this healthcare facility due to the lack of published and scholarly resources dedicated to PA catheters. Implications: Increased PA catheter knowledge among project participants indicates not only that the program content itself was efficacious at educating nurses; it also demonstrates that the educational program will likely be successful at educating other interdisciplinary staff in the CCU as well. The results also imply patients will receive safer and more effective care, thus improving patient care outcomes

Arteriolar neuropathology in cerebral microvascular disease

\ua9 2022 The Authors. Neuropathology and Applied Neurobiology published by John Wiley & Sons Ltd on behalf of British Neuropathological Society. Cerebral microvascular disease (MVD) is an important cause of vascular cognitive impairment. MVD is heterogeneous in aetiology, ranging from universal ageing to the sporadic (hypertension, sporadic cerebral amyloid angiopathy [CAA] and chronic kidney disease) and the genetic (e.g., familial CAA, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy [CADASIL] and cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy [CARASIL]). The brain parenchymal consequences of MVD predominantly consist of lacunar infarcts (lacunes), microinfarcts, white matter disease of ageing and microhaemorrhages. MVD is characterised by substantial arteriolar neuropathology involving ubiquitous vascular smooth muscle cell (SMC) abnormalities. Cerebral MVD is characterised by a wide variety of arteriolar injuries but only a limited number of parenchymal manifestations. We reason that the cerebral arteriole plays a dominant role in the pathogenesis of each type of MVD. Perturbations in signalling and function (i.e., changes in proliferation, apoptosis, phenotypic switch and migration of SMC) are prominent in the pathogenesis of cerebral MVD, making ‘cerebral angiomyopathy’ an appropriate term to describe the spectrum of pathologic abnormalities. The evidence suggests that the cerebral arteriole acts as both source and mediator of parenchymal injury in MVD

Endothelin-1 Predicts Hemodynamically Assessed Pulmonary Arterial Hypertension in HIV Infection.

BackgroundHIV infection is an independent risk factor for PAH, but the underlying pathogenesis remains unclear. ET-1 is a robust vasoconstrictor and key mediator of pulmonary vascular homeostasis. Higher levels of ET-1 predict disease severity and mortality in other forms of PAH, and endothelin receptor antagonists are central to treatment, including in HIV-associated PAH. The direct relationship between ET-1 and PAH in HIV-infected individuals is not well described.MethodsWe measured ET-1 and estimated pulmonary artery systolic pressure (PASP) with transthoracic echocardiography (TTE) in 106 HIV-infected individuals. Participants with a PASP ≥ 30 mmHg (n = 65) underwent right heart catheterization (RHC) to definitively diagnose PAH. We conducted multivariable analysis to identify factors associated with PAH.ResultsAmong 106 HIV-infected participants, 80% were male, the median age was 52 years and 77% were on antiretroviral therapy. ET-1 was significantly associated with higher values of PASP [14% per 0.1 pg/mL increase in ET-1, p = 0.05] and PASP ≥ 30 mmHg [PR (prevalence ratio) = 1.24, p = 0.012] on TTE after multivariable adjustment for PAH risk factors. Similarly, among the 65 individuals who underwent RHC, ET-1 was significantly associated with higher values of mean pulmonary artery pressure and PAH (34%, p = 0.003 and PR = 2.43, p = 0.032, respectively) in the multivariable analyses.ConclusionsHigher levels of ET-1 are independently associated with HIV-associated PAH as hemodynamically assessed by RHC. Our findings suggest that excessive ET-1 production in the setting of HIV infection impairs pulmonary endothelial function and contributes to the development of PAH

Consistency of Published Results on the Pathogen Batrachochytrium dendrobatidis in Madagascar: Formal Comment on Kolby et al. Rapid Response to Evaluate the Presence of Amphibian Chytrid Fungus (Batrachochytrium dendrobatidis) and Ranavirus in Wild Amphibian Populations in Madagascar

判型：B5，平成4年１１月30日[目次]バブル消えて思うこと新任教官紹介及び挨拶一番古い新しい大学維管束植物の遺伝子発現機構の解析のための基礎的研究留学感想トピックス学生サークル紹介学生部だより保健管理センターだより卒業生だよりへルン文

Observer-Based State Feedback for Enhanced Insulin Control of Type ‘I’ Diabetic Patients

During the past few decades, biomedical modeling techniques have been applied to improve performance of a wide variety of medical systems that require monitoring and control. Diabetes is one of the most important medical problems. This paper focuses on designing a state feedback controller with observer to improve the performance of the insulin control for type ‘I’ diabetic patients. The dynamic model of glucose levels in diabetic patients is a nonlinear model. The system is a typical fourth-order single-input-single-output state space model. Using a linear time invariant controller based on an operating condition is a common method to simplify control design. On the other hand, adaptive control can potentially improve system performance. But it increases control complexity and may create further stability issues. This paper investigates patient models and presents a simplified control scheme using observer-based feedback controllers. By comparing different control schemes, it shows that a properly designed state feedback controller with observer can eliminate the adaptation strategy that the Proportional-Integral-Derivative (PID) controllers need to improve the control performance. Control strategies are simulated and their performance is evaluated in MATLAB and Simulink

Gene expression drives the evolution of dominance.

Dominance is a fundamental concept in molecular genetics and has implications for understanding patterns of genetic variation, evolution, and complex traits. However, despite its importance, the degree of dominance in natural populations is poorly quantified. Here, we leverage multiple mating systems in natural populations of Arabidopsis to co-estimate the distribution of fitness effects and dominance coefficients of new amino acid changing mutations. We find that more deleterious mutations are more likely to be recessive than less deleterious mutations. Further, this pattern holds across gene categories, but varies with the connectivity and expression patterns of genes. Our work argues that dominance arises as a consequence of the functional importance of genes and their optimal expression levels