Improving Patient Experience and Education by Leveraging Technology

It is estimated that 65% of the population are visual learners. With that in mind, a team of cardiac nurses in a large academic tertiary hospital developed a quality improvement project to hopefully improve patient engagement as well the patients’ perception that the nurses explained things in a manner that they could understand. Baseline patient survey scores for the question, “Nurses Explained Things In A Way That I Understand”, were under the 75thpercentile for a period of 9 months. A root cause analysis was conducted and it demonstrated numerous reasons for this score. Several countermeasures were instituted to include the use of I Pads for patient education. In conjunction with the hospital IT specialists, cardiac educational materials were developed and videos chosen for I Pad use. A daily KPI was established to track progress of their i Pad usage goal. Follow-up survey results demonstrated significant improvement post I Pad implementation to the question “Nurses Explained Things In A Way That I Understand”. Next steps include further education of nursing staff on educating patients in the use of I Pads as well as adding other cardiovascular educational materials

Hypertensive pressure mechanosensing alone triggers lipid droplet accumulation and transdifferentiation of vascular smooth muscle cells to foam cells

Arterial Vascular smooth muscle cells (VSMCs) play a central role in the onset and progression of atherosclerosis. Upon exposure to pathological stimuli, they can take on alternative phenotypes that, among others, have been described as macrophage like, or foam cells. VSMC foam cells make up >50% of all arterial foam cells and have been suggested to retain an even higher proportion of the cell stored lipid droplets, further leading to apoptosis, secondary necrosis, and an inflammatory response. However, the mechanism of VSMC foam cell formation is still unclear. Here, it is identified that mechanical stimulation through hypertensive pressure alone is sufficient for the phenotypic switch. Hyperspectral stimulated Raman scattering imaging demonstrates rapid lipid droplet formation and changes to lipid metabolism and changes are confirmed in ABCA1, KLF4, LDLR, and CD68 expression, cell proliferation, and migration. Further, a mechanosignaling route is identified involving Piezo1, phospholipid, and arachidonic acid signaling, as well as epigenetic regulation, whereby CUT&Tag epigenomic analysis confirms changes in the cells (lipid) metabolism and atherosclerotic pathways. Overall, the results show for the first time that VSMC foam cell formation can be triggered by mechanical stimulation alone, suggesting modulation of mechanosignaling can be harnessed as potential therapeutic strategy

Capturing residents' values for urban green space: mapping, analysis and guidance for practice

Planning for green space is guided by standards and guidelines but there is currently little understanding of the variety of values people assign to green spaces or their determinants. Land use planners need to know what values are associated with different landscape characteristics and how value elicitation techniques can inform decisions. We designed a Public Participation GIS (PPGIS) study and surveyed residents of four urbanising suburbs in the Lower Hunter region of NSW, Australia. Participants assigned dots on maps to indicate places they associated with a typology of values (specific attributes or functions considered important) and negative qualities related to green spaces. The marker points were digitised and aggregated according to discrete park polygons for statistical analysis. People assigned a variety of values to green spaces (such as aesthetic value or social interaction value), which were related to landscape characteristics. Some variables (e.g. distance to water) were statistically associated with multiple open space values. Distance from place of residence however did not strongly influence value assignment after landscape configuration was accounted for. Value compatibility analysis revealed that some values co-occurred in park polygons more than others (e.g. nature value and health/therapeutic value). Results highlight the potential for PPGIS techniques to inform green space planning through the spatial representation of complex human-nature relationships. However, a number of potential pitfalls and challenges should be addressed. These include the non-random spatial arrangement of landscape features that can skew interpretation of results and the need to communicate clearly about theory that explains observed patterns

CORK study in cystic fibrosis: sustained improvements in ultra-low-dose chest CT scores after CFTR modulation with ivacaftor

Background: Ivacaftor produces significant clinical benefit in patients with cystic fibrosis (CF) with the G551D mutation. Prevalence of this mutation at the Cork CF Centre is 23%. This study assessed the impact of CFTR modulation on multiple modalities of patient assessment. Methods: Thirty-three patients with the G551D mutation were assessed at baseline and prospectively every 3 months for 1 year after initiation of ivacaftor. Change in ultra-low-dose chest CT scans, blood inflammatory mediators, and the sputum microbiome were assessed. Results: Significant improvements in FEV1, BMI, and sweat chloride levels were observed post-ivacaftor treatment. Improvement in ultra-low-dose CT imaging scores were observed after treatment, with significant mean reductions in total Bhalla score (P < .01), peribronchial thickening (P = .035), and extent of mucous plugging (P < .001). Reductions in circulating inflammatory markers, including interleukin (IL)-1β, IL-6, and IL-8 were demonstrated. There was a 30% reduction in the relative abundance of Pseudomonas species and an increase in the relative abundance of bacteria associated with more stable community structures. Posttreatment community richness increased significantly (P = .03). Conclusions: Early and sustained improvements on ultra-low-dose CT scores suggest it may be a useful method of evaluating treatment response. It paralleled improvement in symptoms, circulating inflammatory markers, and changes in the lung microbiota

The nuclear lamina in health and disease

The nuclear lamina (NL) is a structural component of the nuclear envelope and makes extensive contacts with integral nuclear membrane proteins and chromatin. These interactions are critical for many cellular processes, such as nuclear positioning, perception of mechanical stimuli from the cell surface, nuclear stability, 3-dimensional organization of chromatin and regulation of chromatin-binding proteins, including transcription factors. The NL is present in all nucleated metazoan cells but its composition and interactome differ between tissues. Most likely, this contributes to the broad spectrum of disease manifestations in humans with mutations in NL-related genes, ranging from muscle dystrophies to neurological disorders, lipodystrophies and progeria syndromes. We review here exciting novel insight into NL function at the cellular level, in particular in chromatin organization and mechanosensation. We also present recent observations on the relation between the NL and metabolism and the special relevance of the NL in muscle tissues. Finally, we discuss new therapeutic approaches to treat NL-related diseases