Prevention, Recognition, and Appropriate Referral of Diabetic Foot Ulcers in Long-Term Care

Foot ulceration can lead to several health complications if left untreated, and many of these health complications are preventable with proper screening. Early recognition can prevent or delay the onset of adverse outcomes for patients. There are many different screening tools available. However, there is a lack of a systematic process and consistent training for staff nurses in a long-term care setting regarding diabetic foot assessment, leading to inadequate screening. There were three aims of this project. The first aim was to determine the knowledge and practice needs of staff nurses in conducting diabetic foot ulcer assessment in a long-term care setting. The second aim was to develop and implement an effective education intervention for staff nurses to properly assess diabetic long-term care residents for diabetic foot ulcers. The third aim was to implement a valid and reliable diabetic foot ulcer assessment tool and assessment process for staff nurses in a long-term care setting. This quality improvement project used a pre- and post-implementation design to assess diabetic foot ulcer prevention, recognition, and referral. An assessment form and an instructional tool were introduced during this project. This project took place at a large long-term care and rehabilitation facility in Overland Park, KS. The project occurred as part of diabetic foot assessment on residents’ assigned bath day. The participants of the project included staff nurses working with diabetic patients in the facility. The data were collected using the Inlow’s Simplified 60-Second Diabetic Screen. Descriptive statistics were calculated for all project variables. A paired t-test was used to assess the change in nurses’ knowledge about diabetic foot ulcer assessment and a two-sample t-test was used to determine the change in the percentage of diabetic residents receiving a diabetic foot assessment. Completion of the Pre- and Post-Test Knowledge Questionnaire demonstrated a significant increase in the mean percentage of correct answers (71.4% pre-test to 86.5% post-test). Pre-intervention, documentation of diabetic foot ulcer assessments was missing for 46.4% of residents and incomplete for 53.6%. After the intervention, 100% of the assessments were completed. The rate of diabetic foot assessment referrals significantly increased from 7.1% pre-intervention to 49.2% post-intervention. This project improved nursing knowledge, assessment skills, documentation, and referral mechanisms for residents with diabetes. APRNs play an important role in providing education and raising nursing standards of care as they are well-positioned to be involved in quality improvement initiatives. The results of this project demonstrated improved nurses’ assessment skills, proper documentation and referral process for residents with diabetes who are at risk for developing foot ulcer and its complications. Additionally, nurses’ evaluation of the project yielded favorable feedback regarding future utilization and ease of use of the Simplified 60-Second Diabetic Foot Screen. Hence, this quality improvement project has met its objectives and has demonstrated positive outcomes upon its completion

Jemaah Islamiyah and the threat of chemical and biological terrorism

Over the course of the past decade, the possibility of the use of chemical and biological weapons (CBW) by non-state actors has been a topic of extensive academic and public debate. Originally, this debate concentrated primarily on capabilities, where the ease of acquisition of CBW materials after the breakup of the Soviet Union, as well as more widespread availability of information needed for the production and weaponization of CBW agents, were the sources of major concern. Relatively recently, the debate was brought to a more realistic level through the acknowledgment of technical hurdles associated with the successful delivery of CBW agents, as well as the possible motivational constraints involved in the decision of terrorist groups to use such weapons. Another shift in the debate was represented by the claim that the rise of religious terrorism had eroded these constraints. According to this argument, religious terrorists whose operations have been observed to be responsible for the vast majority of all casualties in terrorist attacks worldwide are believed to be unconstrained by political considerations, as their only constituency is God. Further, the ability of religious terrorists to dehumanize indiscriminately their enemies is strengthened by the perceived divine sanction of their actions

Jemaah Islamiyah and the threat of chemical and biological terrorism

Over the course of the past decade, the possibility of the use of chemical and biological weapons (CBW) by non-state actors has been a topic of extensive academic and public debate. Originally, this debate concentrated primarily on capabilities, where the ease of acquisition of CBW materials after the breakup of the Soviet Union, as well as more widespread availability of information needed for the production and weaponization of CBW agents, were the sources of major concern. Relatively recently, the debate was brought to a more realistic level through the acknowledgment of technical hurdles associated with the successful delivery of CBW agents, as well as the possible motivational constraints involved in the decision of terrorist groups to use such weapons. Another shift in the debate was represented by the claim that the rise of religious terrorism had eroded these constraints. According to this argument, religious terrorists whose operations have been observed to be responsible for the vast majority of all casualties in terrorist attacks worldwide are believed to be unconstrained by political considerations, as their only constituency is God. Further, the ability of religious terrorists to dehumanize indiscriminately their enemies is strengthened by the perceived divine sanction of their actions

Some interesting records of Cladonia species from the Nizina Wielkopolska Lowland (W Poland)

The lichen genus Cladonia comprises several similar species which have hardly been recognized in Western Poland so far. We used thin layer chromatography (TLC) as a simple technique to determine diagnostic lichen substances in morphologically similar Cladonia species. During field studies in Sandr Nowotomyski (western Nizina Wielkopolska Lowland), ten interesting records of Cladonia species were made. Cladonia novochlorophaea is reported for the first time from this region. Our records supplement the knowledge about the distribution of Cladonia species both in the investigated region and in Poland. All the records are compared with existing literature data from regional floristic inventories and distribution maps from Poland

Some aspects of the latent iron deficiency diagnosis in the patients with cardiac pathology

Currently, anemia (AN) is a common chronic disease. According to WHO (2008) 24.8% of the world population is at risk of developing anemia. One of the most important causes of anemia is iron deficiency [5]. Anemia is an independent risk factor for adverse cardiovascular disease (CVD) outcomes [6]. It’s shown that anemia contributes to the manifestation of coronary heart disease (CHD) [3], worsens the prognosis and development of complications in acute myocardial infarction [4], and increases the risk of heart failure progression [2]. In cardiac patients, the leading factors of anemia etiology and pathogenesis are associated chronic diseases (infections, chronic inflammatory diseases, neoplasm, chronic renal failure) (about 58%) and iron deficiency (about 21%) [1]. In the both cases, the diagnosis and correction of iron deficiency are the main factors to combat this disease. The purpose of the study: to analyze the prevalence of indirect signs of latent iron deficiency in patients with CVD. Materials and methods: 100 patients with the most common cardiovascular diseases (stable forms of CHD and Hypertension (AH)) were examined during the planned treatment in the cardiology department of DCCH # 9

Interaction of chemical patterns in coupled layers

We investigate the interaction between reaction-diffusion systems coupled by diffusion. The photosensitive CDIMA (chorine dioxide–iodine–malonic acid) reaction allows us to study experimentally the mutual influence of two layers of Turing patterns coupled via a diffusive interaction. By illuminating each of the layers with different intensities of homogeneous external light, the chemical conditions in each layer can be shifted, allowing us to study the result of diffusive interaction between Turing patterns with different spatial configurations. Our experiments suggest a complex scenario for the interaction between different patterns, strongly dependent on the spatial characteristics of the interacting patterns. Numerical simulations are also reported in full agreement with experimental observationsThis work has been supported by the DGI (Spain) under Project No. FIS2010-21023 and Xunta de Galicia (Spain) under Project Nos. PGIDIT05PXIC20607PN and INCITE07PXI206131ES and by the NSF (USA). D.G.M. acknowledges a Ramon y Cajal Fellowship from the Ministry of Science and Technology of Spain and a Marie Curie International Reintegration Grant from the EU248346-NMSSBLS, as well as financial support from the CSIC-SPAIN (JAE-DOC

Impact of D2O on peptidization of L-Cysteine

An attempt was made to answer the question if spontaneous oscillatory conversion and peptidization of proteinogenic a-amino acids might be essential for living organisms. To this effect, we investigated an impact of heavy water (D2O) on the peptidization of L-Cys. As analytical techniques, we used high-performance liquid chromatography, mass spectrometry, scanning electron microscopy, and turbidimetry. The results obtained demonstrate that heavy water seriously hampers the oscillatory peptidization of L-Cys, apparently due to the presence of the deuterium cation in the reaction medium. A cautious conclusion can be drawn that thorough reflection is needed on possible importance of the oscillatory peptidization of proteinogenic a-amino acids for various different life processes

Impact of D2O on the peptidization of L‑alanine

This is our fifth consecutive study carried out in an order to collect experimental evidence on the impact of heavy water ( D2O) on the spontaneous peptidization of proteinogenic α-amino acids and this time its subject matter is L-alanine (L-Ala). Our four earlier studies have been focused on the two sulfur-containing α-amino acids (i.e., L-cysteine (L-Cys) and L-methionine (L-Met)), and on two structurally related α-amino acids (i.e., L-proline (L-Pro) and L-hydroxyproline (L-Hyp)). It seemed interesting to assess the effect exerted by D2O on L-Ala, the simplest chiral (endogenous and proteinogenic) α-amino acid with as low molar weight, as 89.09 g mol−1 only. As analytical techniques, we used high-performance liquid chromatography with the diode array detection (HPLC–DAD), mass spectrometry (MS), and scanning electron microscopy (SEM). The obtained results make it clear that the impact of heavy water on the dynamics of the spontaneous peptidization of L-Ala is even stronger than with the four other α-amino acids discussed earlier (although in all five cases, heavy water significantly hampers spontaneous oscillatory peptidization). Unlike in the four previous cases, though, the solubility of L-Ala in pure D2O is quite low and it takes twice as much time to dissolve it in D2O than in MeOH + X, 70:30 (v/v). Consequently, the peptidization of L-Ala in heavy water is even more obstructed than it was the case with the other investigated α-amino acids and it results in considerable yields of the L-Ala crystals (most probably at least partially deuterated) at the expense of the L-Ala-derived peptides. Perhaps it might be interesting to add that out of five α-amino acids investigated so far, which can be divided into two groups of endogenous and exogenous species, two endogenous species (L-Cys and L-Pro) undergo spontaneous oscillatory peptidization in an aqueousorganic solvent (i.e., in the absence of D2O) following the circadian rhythm, whereas two exogenous ones (i.e., L-Met and L-Hyp) do not. The third endogenous species (L-Ala) first undergoes two initials oscillations which are damped (not periodic) and the oscillatory changes are on a scale of ca. 10 h (as estimated with use of the Fourier transform approach) and after that, the system reaches a steady state