Debrief in Emergency Departments to Improve Compassion Fatigue and Promote Resiliency

The purpose of this case study was to describe compassion fatigue using one nurse\u27s experience as an example and to present the process of Personal Reflective Debrief as an intervention to prevent compassion fatigue in emergency department (ED) nurses. Debriefing after adverse outcomes using a structured model has been used in health care as a nonthreatening and relatively low-cost way to discuss unanticipated outcomes, identify opportunities for improvement, and heal as a group. There are many methods of debrief tailored to specific timing around events, specific populations of health care workers, and amount of time for debriefing. Debrief with personal and group reflection will help develop insights that nurses may need to understand their own emotions and experiences, as well as to develop knowledge that can be used in subsequent situations. Regular engagement in a proactive scheduled Personal Reflective Debrief has been identified as a method of promoting resiliency in an environment where the realities of emergency nursing make compassion fatigue an imminent concern. Nurses working in the ED normally experience some level of stress because of high acuity patients and high patient volume; yet, repeated exposure puts them at risk for developing compassion fatigue. The Personal Reflective Debrief is one way emergency nurses can alleviate some of this caring-related stress and thereby become more resilient. Increasing nurses\u27 resilience to workplace stress can counter compassion fatigue. The key is to provide planned, proactive resources to positively improve resiliency

Impact of an addiction medicine consult service on patients admitted to the hospital with injection drug use-associated infective endocarditis

Background: The addition of an addiction medicine consult service has been shown to improve mortality and decrease hospital costs but its impact on the proportion of patients discharged against medical advice (DAMA) and in-hospital initiation of medication for opioid use disorder (MOUD) has not been examined. Methods: A retrospective before-after cohort study was performed at an urban, academic medical center between January 1, 2015 and November 1, 2019. We included adult patients with infective endocarditis and injection drug use determined by admitting diagnosis ICD-9 or ICD-10 codes or documentation within the history section of electronic health recordEHR. Our institution implemented a formal addiction medicine consult service on July 1, 2018. We determined the proportion of patients DAMA and the proportion of patients started on MOUD among patients in the pre-intervention (i.e. hospitalized before July 1, 2018) and intervention (i.e. hospitalized July 1, 2018 or after) groups. Results: A total of 171 patients among hospitalized patients with injection drug use-associated infective endocarditis were included with 119 patients in the pre-intervention group and 52 patients in the intervention group. There was no statistically significant difference in patients DAMA [19% vs 15%, absolute risk difference 4.6% (95% confidence interval -8.6% to 17.7%)] between the intervention and pre-intervention groups. However, there was an increase in the proportion of inpatient MOUD initiation in the intervention group compared to the pre-intervention group [56% vs 21%, absolute risk difference 35% (95% confidence interval 19% to 50%)]. Conclusions: The initiation of an addiction medicine consult service was associated with a higher proportion of MOUD initiation but there was no statistically significant association with the proportion of patients DAMA

Understanding the Antiproliferative Activity of Plant Extracts

Many plants possess medicinal properties. Some, such as the Pacific yew, have yielded chemotherapeutic drugs (taxanes). Scientists report that other extracts such as the leaves of Calendula officinalis (marigold), Vinca rosea (periwinkle), Viscum cruciatum (mistletoe), and Rosmarinus officinalis (rosemary) have anti-tumor activity. In most cases, the chemical components responsible for antiproliferative activity have not been identified and it is unclear if any individual components are as effective in isolation as they are in the context of the whole extract. Furthermore, in most cases, there are no data indicating whether these extracts have synergistic effects or cause negative reactions when used with other drugs. We are using HeLa (adenocarcinoma), RAW 264.7 (leukemia), HepG2 (hepatoma), MDA-MB-231 (adenocarcinoma), and human foreskin fibroblasts (HFF, non-tumorigenic) to test the antiproliferative activity of several plant extracts. We identified five extracts, grapeseed, guava, yew, juniper berry, and Vinca, that slow the growth of all five cell lines in a dose-dependent manner. We are using a variety of methods to understand the mechanism by which these extracts are blocking cell growth

Gravitational waves: search results, data analysis and parameter estimation

The Amaldi 10 Parallel Session C2 on gravitational wave (GW) search results, data analysis and parameter estimation included three lively sessions of lectures by 13 presenters, and 34 posters. The talks and posters covered a huge range of material, including results and analysis techniques for ground-based GW detectors, targeting anticipated signals from different astrophysical sources: compact binary inspiral, merger and ringdown; GW bursts from intermediate mass binary black hole mergers, cosmic string cusps, core-collapse supernovae, and other unmodeled sources; continuous waves from spinning neutron stars; and a stochastic GW background. There was considerable emphasis on Bayesian techniques for estimating the parameters of coalescing compact binary systems from the gravitational waveforms extracted from the data from the advanced detector network. This included methods to distinguish deviations of the signals from what is expected in the context of General Relativity

Analysis of autonomic outcomes in APOLLO, a phase III trial of the RNAi therapeutic patisiran in patients with hereditary transthyretin-mediated amyloidosis

Hereditary transthyretin-mediated (hATTR) amyloidosis is a progressive, debilitating disease often resulting in early-onset, life-impacting autonomic dysfunction. The effect of the RNAi therapeutic, patisiran, on autonomic neuropathy manifestations in patients with hATTR amyloidosis with polyneuropathy in the phase III APOLLO study is reported. Patients received patisiran 0.3 mg/kg intravenously (n = 148) or placebo (n = 77) once every 3 weeks for 18 months. Patisiran halted or reversed polyneuropathy and improved quality of life from baseline in the majority of patients. At baseline, patients in APOLLO had notable autonomic impairment, as demonstrated by the Composite Autonomic Symptom Score-31 (COMPASS-31) questionnaire and Norfolk Quality of Life-Diabetic Neuropathy (Norfolk QOL-DN) questionnaire autonomic neuropathy domain. At 18 months, patisiran improved autonomic neuropathy symptoms compared with placebo [COMPASS-31, least squares (LS) mean difference, - 7.5; 95% CI: - 11.9, - 3.2; Norfolk QOL-DN autonomic neuropathy domain, LS mean difference, - 1.1; - 1.8, - 0.5], nutritional status (modified body mass index, LS mean difference, 115.7; - 82.4, 149.0), and vasomotor function (postural blood pressure, LS mean difference, - 0.3; - 0.5, - 0.1). Patisiran treatment also led to improvement from baseline at 18 months for COMPASS-31 (LS mean change from baseline, - 5.3; 95% CI: - 7.9, - 2.7) and individual domains, orthostatic intolerance (- 4.6; - 6.3, - 2.9) and gastrointestinal symptoms (- 0.8; - 1.5, - 0.2). Rapid worsening of all study measures was observed with placebo, while patisiran treatment resulted in stable or improved scores compared with baseline. Patisiran demonstrates benefit across a range of burdensome autonomic neuropathy manifestations that deteriorate rapidly without early and continued treatment.The study was funded by Alnylam Pharmaceuticals, Inc. Medical writing services provided by Kristen Brown (PhD) of Adelphi Communications Ltd, Macclesfeld, UK were funded by Alnylam Pharmaceuticals, Inc. in accordance with Good Publication Practice (GPP3) guidelines. We would like to thank Anastasia McManus (Alnylam Pharmaceuticals, Inc.) for her assistance during preparation of this manuscript.info:eu-repo/semantics/publishedVersio

Imitation of β-lactam binding enables broad-spectrum metallo-β-lactamase inhibitors

Carbapenems are vital antibiotics, but their efficacy is increasingly compromised by metallo-beta-lactamases (MBLs). Here we report the discovery and optimization of potent broad-spectrum MBL inhibitors. A high-throughput screen for NDM-1 inhibitors identified indole-2-carboxylates (InCs) as potential beta-lactamase stable beta-lactam mimics. Subsequent structure-activity relationship studies revealed InCs as a new class of potent MBL inhibitor, active against all MBL classes of major clinical relevance. Crystallographic studies revealed a binding mode of the InCs to MBLs that, in some regards, mimics that predicted for intact carbapenems, including with respect to maintenance of the Zn(II)-bound hydroxyl, and in other regards mimics binding observed in MBL-carbapenem product complexes. InCs restore carbapenem activity against multiple drug-resistant Gram-negative bacteria and have a low frequency of resistance. InCs also have a good in vivo safety profile, and when combined with meropenem show a strong in vivo efficacy in peritonitis and thigh mouse infection models.Peer reviewe

Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016

The UN’s Sustainable Development Goals (SDGs) are grounded in the global ambition of “leaving no one behind”. Understanding today’s gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990–2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030