Reducing Indwelling Urinary Catheter Days: Improving Interdisciplinary Communication in a Surgical Intensive Care Unit

Problem Urinary catheter nurse-driven removal protocols (UCNDRPs) are evidence-based algorithms that promote the timely removal of indwelling urinary catheters (IUCs) and prevent catheter-associated urinary tract infections (CAUTIs). Communication barriers hinder consistent implementation of the UCNDRP, resulting in delayed IUC removal and increased risk of CAUTIs. Context This quality improvement project was conducted in a 16-bed surgical intensive care unit (SICU) in an academic medical center in the San Francisco metropolitan area. Interventions Urinary catheter reminder posters displaying the duration of IUC days were placed at the bedside to prompt interdisciplinary communication about IUC indication and removal. An email detailing the project’s background was sent to nurses and physicians by the unit director. One-on-one conversations describing the use of the posters were conducted with bedside nurses. Stickers with an image of an IUC accompanied by the question “Why am I here?” were distributed as light-hearted conversation starters to initiate discussion about IUCs. Measures Interdisciplinary rounds were observed pre- and post-implementation to determine the number of rounds in which the care team discussed IUC indication or removal. The catheter utilization ratio was compared between the pre- and post-intervention periods. Results The frequency of interdisciplinary rounds discussing IUC indication or removal increased by 7% from 23% to 30%. The catheter utilization ratio decreased by 20% from 0.61 in April 2023 to an average of 0.50 from April 1-21, 2024. Conclusion These findings suggest that promoting interdisciplinary communication through visual cues enhances communication and reduces IUC utilization. Further evaluation is needed to ascertain sustainability and long-term impact

A comparison of continuous and bi-level positive airway pressure non-invasive ventilation in patients with acute cardiogenic pulmonary oedema: a meta-analysis

INTRODUCTION: We conducted the present study to investigate the potential beneficial and adverse effects of continuous positive airway pressure (CPAP) compared with bi-level positive airway pressure (BiPAP) noninvasive ventilation in patients with cardiogenic pulmonary oedema. METHOD: We included randomized controlled studies comparing CPAP and BiPAP treatment in patients with cardiogenic pulmonary oedema from the Cochrane Controlled Trials Register (2005 issue 3), and EMBASE and MEDLINE databases (1966 to 1 December 2005), without language restriction. Two reviewers reviewed the quality of the studies and independently performed data extraction. RESULTS: Seven randomized controlled studies, including a total of 290 patients with cardiogenic pulmonary oedema, were considered. The hospital mortality (relative risk [RR] 0.76, 95% confidence interval [CI] 0.32–1.78; P = 0.52; I(2 )= 0%) and risk for requiring invasive ventilation (RR 0.80, 95% CI 0.33–1.94; P = 0.62; I(2 )= 0%) were not significantly different between patients treated with CPAP and those treated with BiPAP. Stratifying studies that used either fixed or titrated pressure during BiPAP treatment and studies involving patients with or without hypercapnia did not change the results. The duration of noninvasive ventilation required until the pulmonary oedema resolved (weighted mean difference [WMD] in hours = 3.65, 95% CI -12.12 to +19.43; P = 0.65, I(2 )= 0%) and length of hospital stay (WMD in days = -0.04, 95% CI -2.57 to +2.48; P = 0.97, I(2 )= 0%) were also not significantly different between the two groups. Based on the limited data available, there was an insignificant trend toward an increase in new onset acute myocardial infarction in patients treated with BiPAP (RR 2.10, 95% CI 0.91–4.84; P = 0.08; I(2 )= 25.3%). CONCLUSION: BiPAP does not offer any significant clinical benefits over CPAP in patients with acute cardiogenic pulmonary oedema. Until a large randomized controlled trial shows significant clinical benefit and cost-effectiveness of BiPAP versus CPAP in patients with acute cardiogenic pulmonary oedema, the choice of modality will depend mainly on the equipment available

Thermal studies on chromium(II) salts: part 2

The thermal behavior of Cr(pn)3Br2·2H2O, Cr(pn)3Cl2·2H2O, Cr(pn)3SO4, Cr(dien)2Br2, Cr(dien)2Cl2, Cr(dien)Cl2 and Cr(dien)Br2 was investigated using TG and DSC under nitrogen atmosphere. The thermograms are interpreted and the enthalpies of dissociation are calculated where possible

Seafood Contamination after the BP Gulf Oil Spill and Risks to Vulnerable Populations: A Critique of the FDA Risk Assessment

Background: The BP oil spill of 2010 resulted in contamination of one of the most productive fisheries in the United States by polycyclic aromatic hydrocarbons (PAHs). PAHs, which can accumulate in seafood, are known carcinogens and developmental toxicants. In response to the oil spill, the U.S. Food and Drug Administration (FDA) developed risk criteria and established thresholds for allowable levels [levels of concern (LOCs)] of PAH contaminants in Gulf Coast seafood

Expanding Qualitative Research Interviewing Strategies: Zoom Video Communications

The proliferation of new video conferencing tools offers unique data generation opportunities for qualitative researchers. While in-person interviews were the mainstay of data generation in qualitative studies, video conferencing programs, such as Zoom Video Communications Inc. (Zoom), provide researchers with a cost-effective and convenient alternative to in-person interviews. The uses and advantages of face-to-face interviewing are well documented; however, utilizing video conferencing as a method of data generation has not been well examined. The purpose of this paper is to examine the specific attributes of Zoom that contribute to high quality and in-depth qualitative interviews when in person interviewing is not feasible. While video conferencing was developed to facilitate long-distance or international communication, enhance collaborations and reduce travel costs for business these same features can be extended to qualitative research interviews. Overall, participants reported that Zoom video conferencing was a positive experience. They identified strengths of this approach such as: (1) convenience and ease of use, (2) enhanced personal interface to discuss personal topics (e.g., parenting), (3) accessibility (i.e., phone, tablet, and computer), (4) time-saving with no travel requirements to participate in the research and therefore more time available for their family. Video conferencing software economically supports research aimed at large numbers of participants and diverse and geographically dispersed populations

Scaffolding Discourse in Asynchronous Learning Networks

Discourse, a form of collaborative learning, is fundamentally a communications process. This in-progress study adapts Clark and Brennan’s grounding in communications principles to investigate how to “scaffold” asynchronous discourse. Scaffolding is defined as providing support for the learner at his or her level until the support is no longer needed. This paper presents early results from an experimental study measuring learning effectiveness. In the experiment, content and process scaffolding are manipulated based on pedagogic principles. A major contribution of the study is building and testing a technologymediated, discourse-centered, teaching and learning model called the Asynchronous Learning Networks Cognitive Discourse Model (ALNCDM). As discourse is one of the most widely used online methods of teaching and learning, the results of the study are expected to add to the body of knowledge on how to structure asynchronous online discourse assignments for more effective student learning

Genomic degradation of a young Y chromosome in Drosophila miranda

Background: Y chromosomes are derived from ordinary autosomes and degenerate because of a lack of recombination. Well-studied Y chromosomes only have few of their original genes left and contain little information about their evolutionary origin. Here, we take advantage of the recently formed neo-Y chromosome of Drosophila miranda to study the processes involved in Y degeneration on a genomic scale. Results: We obtained sequence information from 14 homologous bacterial artificial chromosome (BAC) clones from the neo-X and neo-Y chromosome of D. miranda, encompassing over 2.5 Mb of neo-sex-linked DNA. A large fraction of neo-Y DNA is composed of repetitive and transposable-element-derived DNA (20% of total DNA) relative to their homologous neo-X linked regions (1%). The overlapping regions of the neo-sex linked BAC clones contain 118 gene pairs, half of which are pseudogenized on the neo-Y. Pseudogenes evolve significantly faster on the neo-Y than functional genes, and both functional and non-functional genes show higher rates of protein evolution on the neo-Y relative to their neo-X homologs. No heterogeneity in levels of degeneration was detected among the regions investigated. Functional genes on the neo-Y are under stronger evolutionary constraint on the neo-X, but genes were found to degenerate randomly on the neo-Y with regards to their function or sex-biased expression patterns. Conclusion: Patterns of genome evolution in D. miranda demonstrate that degeneration of a recently formed Y chromosome can proceed very rapidly, by both an accumulation of repetitive DNA and degeneration of protein-coding genes. Our data support a random model of Y inactivation, with little heterogeneity in degeneration among genomic regions, or between functional classes of genes or genes with sex-biased expression patternsThis research is funded by NIH Grant GM076007 and a Sloan Fellowship to DB. BAC library construction was funded by a Wellcome Trust grant to P Keightley and B Charlesworth. P Andolfatto provided funds for the sequence of two BAC clonesS

Food and Nutrition Extension Programs: Next Generation Impact Evaluation

Grassroots stakeholder input results in relevant and timely Extension programs, but presents a challenge for performance measurement using common indicators. A balanced approach to program evaluation and reporting that is adequately valid and reliable while honoring the Extension culture of service is most likely to be successful. This article reviews recent advances in evaluation methodology of food and nutrition programs. It further describes how this evidence base informs the current set of national Extension program outcomes and indicators. Evaluation work is an essential step in documenting the public value of Extension programs

Recognition of specific sialoglycan structures by oral streptococci impacts the severity of endocardial infection.

Streptococcus gordonii and Streptococcus sanguinis are primary colonizers of the tooth surface. Although generally non-pathogenic in the oral environment, they are a frequent cause of infective endocarditis. Both streptococcal species express a serine-rich repeat surface adhesin that mediates attachment to sialylated glycans on mucin-like glycoproteins, but the specific sialoglycan structures recognized can vary from strain to strain. Previous studies have shown that sialoglycan binding is clearly important for aortic valve infections caused by some S. gordonii, but this process did not contribute to the virulence of a strain of S. sanguinis. However, these streptococci can bind to different subsets of sialoglycan structures. Here we generated isogenic strains of S. gordonii that differ only in the type and range of sialoglycan structures to which they adhere and examined whether this rendered them more or less virulent in a rat model of endocarditis. The findings indicate that the recognition of specific sialoglycans can either enhance or diminish pathogenicity. Binding to sialyllactosamine reduces the initial colonization of mechanically-damaged aortic valves, whereas binding to the closely-related trisaccharide sialyl T-antigen promotes higher bacterial densities in valve tissue 72 hours later. A surprising finding was that the initial attachment of streptococci to aortic valves was inversely proportional to the affinity of each strain for platelets, suggesting that binding to platelets circulating in the blood may divert bacteria away from the endocardial surface. Importantly, we found that human and rat platelet GPIbα (the major receptor for S. gordonii and S. sanguinis on platelets) display similar O-glycan structures, comprised mainly of a di-sialylated core 2 hexasaccharide, although the rat GPIbα has a more heterogenous composition of modified sialic acids. The combined results suggest that streptococcal interaction with a minor O-glycan on GPIbα may be more important than the over-all affinity for GPIbα for pathogenic effects

The pathogenesis of cingulate atrophy in behavioral variant frontotemporal dementia and Alzheimer’s disease

BACKGROUND: Early atrophy of the cingulate cortex is a feature of both behavioral variant frontotemporal dementia (bvFTD) and Alzheimer’s disease (AD), with degeneration of the anterior cingulate region increasingly recognized as a strong predictor of bvFTD. The total number of neurons in this region, rather than the density of neurons, is associated with mood disturbance in other dementias, although there are no data on the extent and magnitude of neuronal loss in patients with bvFTD. While the density of small populations of neurons in this region has been assessed, it is unlikely that the degree of atrophy of the cingulate cortex seen in bvFTD can be explained by the loss of these subpopulations. This suggests that there is more generalized degeneration of neurons in this region in bvFTD. The present study assesses total neuronal number, as well as characteristic pathologies, in the anterior and posterior cingulate cortices of pathologically confirmed bvFTD (N = 11) and AD (N = 9) patients compared with age-matched controls (N = 14). The bvFTD cohort comprised 5 cases with tau pathology (Pick’s disease), and 6 with TDP-43 pathology. RESULTS: At postmortem, atrophy was detected in the anterior and posterior cingulate cortices of bvFTD cases, but only in the posterior cingulate cortex of AD cases. As predicted, there was a significant reduction in both the density and total number of neurons in the anterior but not the posterior cingulate cortex of bvFTD cases with the opposite observed for the AD cases. Importantly, neuronal loss in the anterior cingulate cortex was only observed in cases with tau pathology. CONCLUSIONS: This study confirms significant neuronal loss in the posterior but not anterior cingulate cortex in AD, and demonstrates that significant neuron loss in bvFTD occurs only in the anterior cingulate cortex but only in cases with tau pathology compared with cases with TDP pathology. We propose that significant neurodegeneration in the anterior cingulate cortex may be useful in differentiating the pathological subtypes in vivo