Implementation of Night Shift Rounding to Improve Nursing Communication and Reduce Days of Intubation in the Intensive Care Setting

Multidisciplinary rounds are the gathering of various health care providers who have a shared interest in a patient’s well-being to discuss the plan of care and the patient’s progress through their hospital stay. This multidisciplinary group of staff can be the providers, the nurse, charge nurse, social worker, pharmacist, dietician, respiratory, chaplaincy, and occupational and physical therapists. On night shift at the project site, this rounding process did not occur, leaving the staff feeling they were not involved in the plan of care. The purpose of this quality improvement evidenced-based project was to create a process change, introduced to the staff and to evaluate the effectiveness of staff education on night shift rounding in reducing intubation. Lewin’s theory of planned change was the model used to introduce this new concept. The practice-focused question was “Will the implementation of night shift rounding focusing on nursing communication impact days of intubation in the intensive care setting?” The intubated intensive care population was sampled before and after project implementation. Data were extracted through EPIC the hospital’s health care software. Ventilator days were averaged in July and August and then in October and November and in December. The data were skewed because of the increased population being admitted related to a COVID-19 diagnosis’ the numbers of ventilator days increased with the spikes in COVID admissions. In December, the ventilator days average was at its lowest. The data is in alignment with the practice focused question, indicating both staff and patients benefit from nightshift rounding. As this process is introduced to other units, the hospital will also benefit, and patient outcomes will improve

Implementation of Night Shift Rounding to Improve Nursing Communication and Reduce Days of Intubation in the Intensive Care Setting

Multidisciplinary rounds are the gathering of various health care providers who have a shared interest in a patient’s well-being to discuss the plan of care and the patient’s progress through their hospital stay. This multidisciplinary group of staff can be the providers, the nurse, charge nurse, social worker, pharmacist, dietician, respiratory, chaplaincy, and occupational and physical therapists. On night shift at the project site, this rounding process did not occur, leaving the staff feeling they were not involved in the plan of care. The purpose of this quality improvement evidenced-based project was to create a process change, introduced to the staff and to evaluate the effectiveness of staff education on night shift rounding in reducing intubation. Lewin’s theory of planned change was the model used to introduce this new concept. The practice-focused question was “Will the implementation of night shift rounding focusing on nursing communication impact days of intubation in the intensive care setting?” The intubated intensive care population was sampled before and after project implementation. Data were extracted through EPIC the hospital’s health care software. Ventilator days were averaged in July and August and then in October and November and in December. The data were skewed because of the increased population being admitted related to a COVID-19 diagnosis’ the numbers of ventilator days increased with the spikes in COVID admissions. In December, the ventilator days average was at its lowest. The data is in alignment with the practice focused question, indicating both staff and patients benefit from nightshift rounding. As this process is introduced to other units, the hospital will also benefit, and patient outcomes will improve

Thermal Tolerances of the Spotted-Wing Drosophila Drosophila suzukii (Diptera: Drosophilidae)

The spotted-wing drosophila (Drosophila suzukii Matsumura) is an invasive species of Asian origin that is now widely distributed in North America and Europe. Because of the female’s serrated ovipositor, eggs are laid in preharvest fruit, causing large economic losses in cultivated berries and stone fruit. Modeling D. suzukii population dynamics and potential distribution will require information on its thermal tolerance. Large summer populations have been found in regions with severe winter conditions, though little is known about responses to prolonged low-temperature exposure. We used controlled chambers to examine D. suzukii fecundity, development rate, and mortality across a range of temperatures encompassing the upper and lower thresholds (5–35°C). Optimal temperatures ( Topt ) were found to be 28.2°C for the development of the egg-to-adult stage, and 22.9°C for reproductive output. No adult eclosion occurred below 8.1°C ( Tlower ) or above 30.9°C ( Tupper ). We also investigated survival outcomes following prolonged (42-d) low-temperature exposure to a simulated cold winter (−5, −3, −1, 1, 3, and 5°C). Adult survival was dependent on temperature, with a mean LT50 of 4.9°C. There were no effects of sex, mating status, geographic strain, and photoperiod preexposure on overwintering survival. Thirty-eight percent of females that were mated prior, but not after, prolonged low-temperature exposure produced viable offspring, suggesting that this species may undergo sperm storage. This study provides data on the thermal tolerances of D. suzukii , which can be used for models of D. suzukii population dynamics, degree-day, and distribution models

Using the Traditional Ex Vivo Whole Blood Model to Discriminate Bacteria by Their Inducible Host Responses

Whole blood models are rapid and versatile for determining immune responses to inflammatory and infectious stimuli, but they have not been used for bacterial discrimination. Staphylococcus aureus, S. epidermidis and Escherichia coli are the most common causes of invasive disease, and rapid testing strategies utilising host responses remain elusive. Currently, immune responses can only discriminate between bacterial ‘domains’ (fungi, bacteria and viruses), and very few studies can use immune responses to discriminate bacteria at the species and strain level. Here, whole blood was used to investigate the relationship between host responses and bacterial strains. Results confirmed unique temporal profiles for the 10 parameters studied: IL-6, MIP-1α, MIP-3α, IL-10, resistin, phagocytosis, S100A8, S100A8/A9, C5a and TF3. Pairwise analysis confirmed that IL-6, resistin, phagocytosis, C5a and S100A8/A9 could be used in a discrimination scheme to identify to the strain level. Linear discriminant analysis (LDA) confirmed that (i) IL-6, MIP-3α and TF3 could predict genera with 95% accuracy; (ii) IL-6, phagocytosis, resistin and TF3 could predict species at 90% accuracy and (iii) phagocytosis, S100A8 and IL-10 predicted strain at 40% accuracy. These data are important because they confirm the proof of concept that host biomarker panels could be used to identify bacterial pathogens

Feasibility study of rehabilitation for cardiac patients aided by an artificial intelligence web-based programme: a randomised controlled trial (RECAP trial)—a study protocol

Introduction: Cardiac rehabilitation (CR) delivered by rehabilitation specialists in a healthcare setting is effective in improving functional capacity and reducing readmission rates after cardiac surgery. It is also associated with a reduction in cardiac mortality and recurrent myocardial infarction. This trial assesses the feasibility of a home-based CR programme delivered using a mobile application (app).Methods: The Rehabilitation through Exercise prescription for Cardiac patients using an Artificial intelligence web-based Programme (RECAP) randomised controlled feasibility trial is a single-centre prospective study, in which patients will be allocated on a 1:1 ratio to a home-based CR programme delivered using a mobile app with accelerometers or standard hospital-based rehabilitation classes. The home-based CR programme will employ artificial intelligence to prescribe exercise goals to the participants on a weekly basis. The trial will recruit 70 patients in total. The primary objectives are to evaluate participant recruitment and dropout rates, assess the feasibility of randomisation, determine acceptability to participants and staff, assess the rates of potential outcome measures and determine hospital resource allocation to inform the design of a larger randomised controlled trial for clinical efficacy and health economic evaluation. Secondary objectives include evaluation of health-related quality of life and 6 minute walk distance.Ethics and dissemination: RECAP trial received a favourable outcome from the Berkshire research ethics committee in September 2022 (IRAS 315483)

The CSF immune response in HIV-1-associated cryptococcal meningitis: macrophage activation, correlates of disease severity and effect of antiretroviral therapy.

Immune modulation may improve outcome in HIV-associated cryptococcal meningitis. Animal studies suggest alternatively activated macrophages are detrimental but human studies are limited. We performed a detailed assessment of the cerebrospinal fluid (CSF) immune response and examined immune correlates of disease severity and poor outcome, and the effects of antiretroviral therapy (ART). We enrolled persons ≥18 years with first episode of HIV-associated cryptococcal meningitis. CSF immune response was assessed using flow cytometry and multiplex cytokine analysis. Principal component analysis was used to examine relationships between immune response, fungal burden, intracranial pressure and mortality, and the effects of recent ART initiation (<12 weeks). CSF was available from 57 persons (median CD4 34/μL). CD206 (alternatively activated macrophage marker) was expressed on 54% CD14+ and 35% CD14- monocyte-macrophages. High fungal burden was not associated with CD206 expression but with a paucity of CD4+, CD8+ and CD4-CD8- T cells and lower IL-6, G-CSF and IL-5 concentrations. High intracranial pressure (≥30cmH2O) was associated with fewer T cells, a higher fungal burden and larger Cryptococcus organisms. Mortality was associated with reduced interferon-gamma concentrations and CD4-CD8- T cells but lost statistical significance when adjusted for multiple comparisons. Recent ART was associated with increased CSF CD4/CD8 ratio and a significantly increased macrophage expression of CD206. Paucity of CSF T cell infiltrate rather than alternative macrophage activation was associated with severe disease in HIV-associated cryptococcosis. ART had a pronounced effect on the immune response at the site of disease

The effect of reduced street lighting on road casualties and crime in England and Wales: controlled interrupted time series analysis.

BACKGROUND: Many local authorities in England and Wales have reduced street lighting at night to save money and reduce carbon emissions. There is no evidence to date on whether these reductions impact on public health. We quantified the effect of 4 street lighting adaptation strategies (switch off, part-night lighting, dimming and white light) on casualties and crime in England and Wales. METHODS: Observational study based on analysis of geographically coded police data on road traffic collisions and crime in 62 local authorities. Conditional Poisson models were used to analyse longitudinal changes in the counts of night-time collisions occurring on affected roads during 2000-2013, and crime within census Middle Super Output Areas during 2010-2013. Effect estimates were adjusted for regional temporal trends in casualties and crime. RESULTS: There was no evidence that any street lighting adaptation strategy was associated with a change in collisions at night. There was significant statistical heterogeneity in the effects on crime estimated at police force level. Overall, there was no evidence for an association between the aggregate count of crime and switch off (RR 0.11; 95% CI 0.01 to 2.75) or part-night lighting (RR 0.96; 95% CI 0.86 to 1.06). There was weak evidence for a reduction in the aggregate count of crime and dimming (RR 0.84; 95% CI 0.70 to 1.02) and white light (RR 0.89; 95% CI 0.77 to 1.03). CONCLUSIONS: This study found little evidence of harmful effects of switch off, part-night lighting, dimming, or changes to white light/LEDs on road collisions or crime in England and Wales

Tetrahydrobiopterin Supplementation Improves Endothelial Function But Does Not Alter Aortic Stiffness in Patients With Rheumatoid Arthritis.

BACKGROUND: Rheumatoid arthritis is a systemic inflammatory condition associated with increased cardiovascular risk that may be due to underlying endothelial dysfunction and subsequent aortic stiffening. We hypothesized that supplementation with tetrahydrobiopterin (BH4) would recouple endothelial nitric oxide synthase and thus improve endothelial function and consequently reduce aortic stiffness. METHODS AND RESULTS: We conducted 2 randomized, double-blinded, placebo-controlled crossover studies examining 2 separate regimens: an acute regimen, with a single dose of BH4 400 mg versus placebo (n=18), and a short-term regimen, composed of a 1-week treatment with BH4 400 mg once daily versus placebo (n=15). Flow-mediated dilatation and aortic pulse wave velocity were studied 4 times, before and after each treatment phase. Acute BH4 supplementation led to an improvement of flow-mediated dilatation, whereas placebo had no effect (mean±SD of effect difference 2.56±4.79%; P=0.03). Similarly, 1-week treatment with BH4 improved endothelial function, but there was no change with placebo (mean±SD of effect difference 3.50±5.05%; P=0.02). There was no change in aortic pulse wave velocity following acute or short-term BH4 supplementation or placebo (mean±SD of effect difference: acute 0.09±0.67 m/s, P=0.6; short-term 0.03±1.46 m/s, P=0.9). CONCLUSION: Both acute and short-term supplementation with oral BH4 improved endothelial function but not aortic stiffness. This result suggests that BH4 supplementation may be beneficial for patients with rheumatoid arthritis by improving endothelial dysfunction and potentially reducing risk of cardiovascular disease. There appears to be no causal relationship between endothelial function and aortic stiffness, suggesting that they occur in parallel, although they may share common risk factors such as inflammation.KMMP and IBW were funded by British Heart Foundation. IBW, JC and NS received funding from the Comprehensive Local Research Network and IBW and JC from the National Institute for Health Research: Cambridge Biomedical Research Centre.This is the final version of the article. It first appeared from Wiley Blackwell via http://dx.doi.org/10.1161/JAHA.115.00276

Flow cytometry to assess CSF fungal burden in cryptococcal meningitis

Fungal burden in the cerebrospinal fluid is an important determinant of mortality in cryptococcal meningitis but its use to aid clinical decision-making is hampered by the time involved to perform quantitative cultures. Here we demonstrate the potential of flow cytometry as a novel and rapid technique to address this