Interdisciplinary collaborative eye examinations to protect preterm infant neurodevelopment: a quality improvement project

Introduction Infants born <31 weeks gestational age with birth weight ≤ 1,500 grams receive routine eye examinations to screen for Retinopathy of Prematurity (ROP) while in the Neonatal Intensive Care Unit (NICU) to help prevent vision threatening complications; however, preterm infants’ sensory systems are underdeveloped, and repeated exposure to painful stimuli is associated with worse developmental outcomes.Methods An interdisciplinary NICU team designed a collaborative eye exam model (CEEM) incorporating best practice recommendations for infant pain control during exams. Pain scores and vital signs were recorded before, during, and after exams. Two sets of mixed-effects regression models with a random intercept on infants were established to investigate relationships between the intervention, birth gestational age (BGA), postmenstrual age (PMA), and outcomes associated with painful stimuli. Survey feedback was elicited from NICU stakeholders about the CEEM. Results Thirty standard of care (SC) and 35 CEEM exams of 37 infants were included in final analysis. In infants of the same BGA, the number of desaturation events was significantly reduced in the CEEM group (p = 0.003) and became 1.53 times smaller with each additional week of BGA (p = 0.009). Probability of heart rate recovery within 15 min lowered significantly in the CEEM group (p = 0.04). In SC or CEEM or between infants of the same PMA, no differences were observed for bradycardia, heart rate range, chance of heart rate recovery, or pain scores. Increases in tachycardia (p < 0.001) events and desaturations p = 0.006 were discovered in the CEEM group. When considering interaction effects, the CEEM appeared to reduce the number of desaturations to a greater degree for infants at earliest BGAs with attenuation of this effect with greater BGA. Regarding PMA, bradycardia and tachycardia events were reduced for infants across PMAs in the CEEM, but the effect for tachycardia improves with age, while the effect for bradycardia diminishes with age. Stakeholders agreed that the infant’s eye exam experience and the staff experience was “very much” improved by the CEEM. Discussion Despite variable findings in selected outcome measures, the CEEM was positively viewed by staff. Infants may benefit from the CEEM differently based on BGA and PMA

Interdisciplinary collaborative eye examinations to protect preterm infant neurodevelopment: a quality improvement project

IntroductionInfants born <31 weeks gestational age with birth weight ≤ 1,500 grams receive routine eye examinations to screen for Retinopathy of Prematurity (ROP) while in the Neonatal Intensive Care Unit (NICU) to help prevent vision threatening complications; however, preterm infants’ sensory systems are underdeveloped, and repeated exposure to painful stimuli is associated with worse developmental outcomes.MethodsAn interdisciplinary NICU team designed a collaborative eye exam model (CEEM) incorporating best practice recommendations for infant pain control during exams. Pain scores and vital signs were recorded before, during, and after exams. Two sets of mixed-effects regression models with a random intercept on infants were established to investigate relationships between the intervention, birth gestational age (BGA), postmenstrual age (PMA), and outcomes associated with painful stimuli. Survey feedback was elicited from NICU stakeholders about the CEEM.ResultsThirty standard of care (SC) and 35 CEEM exams of 37 infants were included in final analysis. In infants of the same BGA, the number of desaturation events was significantly reduced in the CEEM group (p = 0.003) and became 1.53 times smaller with each additional week of BGA (p = 0.009). Probability of heart rate recovery within 15 min lowered significantly in the CEEM group (p = 0.04). In SC or CEEM or between infants of the same PMA, no differences were observed for bradycardia, heart rate range, chance of heart rate recovery, or pain scores. Increases in tachycardia (p < 0.001) events and desaturations p = 0.006 were discovered in the CEEM group. When considering interaction effects, the CEEM appeared to reduce the number of desaturations to a greater degree for infants at earliest BGAs with attenuation of this effect with greater BGA. Regarding PMA, bradycardia and tachycardia events were reduced for infants across PMAs in the CEEM, but the effect for tachycardia improves with age, while the effect for bradycardia diminishes with age. Stakeholders agreed that the infant’s eye exam experience and the staff experience was “very much” improved by the CEEM.DiscussionDespite variable findings in selected outcome measures, the CEEM was positively viewed by staff. Infants may benefit from the CEEM differently based on BGA and PMA

ESURS: Die Komponente des WIREMAN zur Uebersetzung von Retrievalsprachen

SIGLEAvailable from TIB Hannover: RO5070(1990,3) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Proteomic analysis of the membrane skeleton of Tetrahymena thermophila

The membrane skeleton of the Tetrahymena is likely to determine many aspects of the cell surface structure of this ciliated protozoan. The availability of the genomic sequence of Tetrahymena thermophila has facilitated a proteomic analysis of the non-microtubular portion of the cortical cytoskeleton of Tetrahymena thermophila. Potassium iodide-Triton X-100 insoluble residues of these cells retain the cell surface organization of this ciliate, while being depleted in microtubular proteins. Proteins in these membrane skeletal residues have been subsequently fractionated into distinct sets by means of selective extraction and precipitation steps. We have initiated a proteomic analysis of one group of membrane skeletal proteins: the set containing epiplasmin C and associated proteins. Bands containing each of the specific proteins were excised from preparative SDS-polyacrylamide gels. These proteins were reduced, alkylated and digested in-gel with trypsin with the resulting enzymatic peptide fragments analyzed by LC-MS using electrospray ionization. The observed peptide molecular weights were used to search a database of predicted Tetrahymena proteins in order to identify the protein in the original gel band. Further confirmation was obtained by sequencing several enzymatically-derived peptides in the mass spectrometer. Two major components of these structures were identified – epiplasmin C and epiplasmin A – both of which are predicted to be coiled coil proteins. The other major protein to be identified was TCBP-25, an EF-hand containing calcium-binding protein. Several other minor proteins were identified, including epiplasmin B protein, another coiled coil protein. Intriguingly, among the minor proteins present in these preparations were proteins predicted to be related to lipid or protein kinases. Another minor protein was found to be related to a centromeric calcium-binding protein. These minor proteins suggest the possibility of the linkage of these cytoskeletal proteins to cellular signaling processes. We are currently working to analyze protein-protein interactions within the membrane skeleton by means of non-denaturing gel electrophoresis of protein complexes, as well as far-Western blotting experiments