IMPACT OF AN EDUCATIONAL INTERVENTION ON PROVIDER PERSPECTIVES ABOUT THE USE OF PHENOBARBITAL IN THE MANAGEMENT OF ALCOHOL WITHDRAWAL SYNDROME

Twaddell, Kimberly. Impact of an educational intervention on provider perspectives about the use of phenobarbital in the management of alcohol withdrawal syndrome. Published Doctor of Nursing Practice scholarly research project, University of Northern Colorado, 2023. Alcohol withdrawal syndrome (AWS) is a clinical diagnosis that occurs when an individual who regularly consumes alcohol either reduces or stops consumption. Complications of AWS include admission to the intensive care unit, prolonged hospitalization, and increased risk of infection and mortality. These complications might lead to poor patient outcomes and increased healthcare costs. Currently, the standard of care in managing this inpatient population includes supportive and pharmacological interventions with sedatives such as benzodiazepines. However, recent research found that a long-acting barbiturate, phenobarbital demonstrated superiority in reducing both hospital length of stay and progression of AWS symptoms when compared to benzodiazepines. Healthcare providers, such as advanced practice providers and physicians, are responsible for prescribing medications to manage AWS. However, without education about the recent research findings of phenobarbital, healthcare providers might be underutilizing phenobarbital in the management of this serious condition. The purpose of this Doctor of Nursing Practice scholarly project was to evaluate if an evidence-based educational intervention delivered to advanced practice providers and physicians at a level one trauma center would influence their knowledge, attitudes, and intention to use an existing phenobarbital order set for the management of AWS among the adult inpatient population. As guided by the knowledge attitude practice model, this study had a pre-posttest design with a virtually delivered iii educational intervention based upon an integrated literature review that discussed the safety of phenobarbital and its superiority in the management of AWS among the inpatient population. The impact of the intervention was measured using a modified version of the Continuing Professional Development Reaction questionnaire

Molecular Interactions between MUC1 Epithelial Mucin, β-Catenin, and CagA Proteins

Interleukin (IL)-8-driven neutrophil infiltration of the gastric mucosa is pathognomonic of persistent Helicobacter pylori infection. Our prior study showed that ectopic over-expression of MUC1 in human AGS gastric epithelial cells reduced H. pylori-stimulated IL-8 production compared with cells expressing MUC1 endogenously. Conversely, Muc1 knockout (Muc1−/−) mice displayed an increased level of transcripts encoding the keratinocyte chemoattractant (KC), the murine equivalent of human IL-8, in gastric mucosa compared with Muc1+/+ mice during experimental H. pylori infection. The current study tested the hypothesis that a decreased IL-8 level observed following MUC1 over-expression is mediated through the ability of MUC1 to associate with β-catenin, thereby inhibiting H. pylori-induced β-catenin nuclear translocation. Increased neutrophil infiltration of the gastric mucosa of H. pylori-infected Muc1−/− mice was observed compared with Muc1+/+ wild type littermates, thus defining the functional consequences of increased KC expression in the Muc1-null animals. Protein co-immunoprecipitation (co-IP) studies using lysates of untreated or H. pylori-treated AGS cells demonstrated that (a) MUC1 formed a co-IP complex with β-catenin and CagA, (b) MUC1 over-expression reduced CagA/β-catenin co-IP, and (c) in the absence of MUC1 over-expression, H. pylori infection increased the nuclear level of β-catenin, (d) whereas MUC1 over-expression decreased bacteria-driven β-catenin nuclear localization. These results suggest that manipulation of MUC1 expression in gastric epithelia may be an effective therapeutic strategy to inhibit H. pylori-dependent IL-8 production, neutrophil infiltration, and stomach inflammation

Parent education needs of infants with complex life-threatening illnesses

Infant morbidity and mortality continues to be a significant problem in the U. S. Preterm birth and/or low birth weight and congenital anomalies are primary causes of infant morbidity and mortality. Analysis of an existing study was done on data from a prospective longitudinal, case based, mixed-methods research study to examine learning needs of parents in the Neonatal Intensive Care Unit (NICU) whose infants were born with complex cardiac anomalies or born extremely premature. The principles of Knowles' Theory of Adult Learning were used to frame the study and findings. Systematic review of the parent and provider interview transcripts from six cases and nurse-kept Interdisciplinary Patient and Family Education Records was conducted to determine parent education needs and provider given information during and after the infant's hospitalization. Findings revealed the theme of parents wanting to answer the question, `What is going on with my baby's care?' while information given by providers was classified under the theme `Whose Team are you on?' Resources utilized to find information by parents were explained by the theme, `Help me Learn'. Contextual variables of parents were also noted to impact learning needs of parents depending on whether the infant was hospitalized or discharged from the hospital and were grouped into themes of `Issues Before the Infant's Birth' and `Adjustment to Everyday Life'. Providers need to be aware of the learning needs of parents, potential factors that may influence this learning, and to consider these needs when giving infant care

Emphysematous Gastritis in a Transplant Recipient With Clostridium ventriculi Infection.

Clostridium ventriculi is a rare infection in poorly controlled diabetic patients with a history of gastroparesis. We present the first documented case in a transplant recipient, who underwent a simultaneous liver kidney transplant. Computed tomography showed emphysematous gastritis, endoscopy revealed gastric necrosis, and microscopy confirmed the diagnosis. Operative intervention was high risk, given the previous liver transplant. Antibiotics and proton pump inhibitor treatment with repeat endoscopy at 4 days showed resolution of gastric necrosis and elimination of microscopic evidence of infection. Combination antibiotic and proton pump inhibitor therapy may be an effective treatment for this rare, life-threatening infection

Thoracic Ultrasound: What Non-radiologists Need to Know

PURPOSE OF REVIEW: The aim of this review is to provide the theoretical and practical knowledge essential for non-radiologists to develop the skills necessary to apply thoracic ultrasound as an extension of clinical assessment and intervention. RECENT FINDINGS: Issues relating to training and competence are discussed and a library of thoracic ultrasound videos is provided to illustrate artefacts, pleural, parenchymal and pneumothorax pathology as well as important pitfalls to consider. Novel and future diagnostic applications of thoracic ultrasound in the setting of acute cardiorespiratory pathology including consolidation, acute interstitial syndromes and pulmonary embolism are explored. SUMMARY: Thoracic ultrasound requires an understanding of imaging artefact specific to lung and pleura and a working knowledge of machine knobology for image optimisation and interpretation. Ultrasound is a valuable tool for the practicing chest clinician providing diagnostic information for the assessment of pleural and parenchymal disease and increased safety and cost effectiveness of thoracic interventions. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13665-017-0164-1) contains supplementary material, which is available to authorized users

Exploring Pedestrian Counting Procedures

DTFH61-13-D-00016Clear and comprehensive information about pedestrian travel patterns is critical to multimodal transportation planning, programming, and management. This report covers existing guidance and best practices to recommend strategies for accurate, timely, and feasible measurement of pedestrian travel. Recommendations include: 1) expand the use of multi-day/multi-week counts to reduce estimation error rates, and rotate counts around the network; 2) validate equipment at installation and regularly thereafter; 3) tailor quality checks appropriate for low volume versus high volume locations; 4) compute bias compensation factors (e.g., occlusion adjustment factors) to account for limitations related to equipment and locations; and 5) conduct both short-duration and continuous counts to fully consider temporal and spatial aspects of pedestrian traffic patterns

Are all melanomas the same? Spitzoid melanoma is a distinct subtype of melanoma.

Background: Although the majority of melanomas demonstrate high rates of mutations in B-RAF or N-RAS that result in constitutive activation of the mitogen-activated protein kinase-signaling pathway, emerging data suggest molecular differences among melanoma subtypes. In this study, the authors evaluated the contribution of B-RAF and N-RAS mutations to the pathogenesis of Spitzoid melanomas. Methods: In total, 33 Spitzoid melanomas were analyzed for clinical and pathologic characteristics as well as for hot-spot mutations in the B-RAF and N-RAS genes. In the majority of patients (28 of 33 melanomas), the tumors were confined to the skin with no evidence of metastasis (average follow-up, 32.5 mos). There were five metastasizing melanomas (5 of 33 tumors) with regional or systemic spread. Results: Of 33 Spitzoid melanomas, only 1 showed the V600E mutation in the B-RAF gene (1 of 33 tumors; 3%). It was noteworthy that none of the metastatic Spitzoid melanomas (0 of 5 tumors; 0%), of which 2 resulted in fatal outcomes, demonstrated mutations in B-RAF or N-RAS. Conclusions: In contrast to the majority of cutaneous melanomas, activating hot-spot mutations in B-RAF or N-RAS were not involved in the pathogenesis of Spitzoid melanoma. These data suggested that Spitzoid melanoma is a distinct form of melanoma with unknown genes and/or signaling pathways involved in its development.VoRSUNY DownstatePathologyN/