Prevention of workplace violence in ED nursing using the implementation of an educational program and a new reporting tool
Published on: 7th January, 2022
The Emergency Department (ED) is a place that regularly deals with acute scenarios and people that are generally sensitive in nature. In a fast-paced environment such as this, people can be emotionally charged and react in different ways. Unfortunately, nurses in the ED tend to be most affected. Literature shows that workplace violence incidents that occur tend to involve ED nurses. Furthermore, ED nurses are more inclined to have an attitude that makes them think that any acts of transgression are “part of the job” and incidents usually go underreported. Moreover, reporting tools are usually difficult to use and tend to be a barrier to reporting workplace violence. In this evidence-based project, ED nurses will participate in an educational prevention program that will help equip them with the knowledge and awareness that is needed to decrease the incidence of workplace violence. Furthermore, a new, easy-to-use reporting tool will be implemented for ED staff. An implementation of an easier reporting tool and an education prevention program on the incidence of workplace violence will help reduce the number of future incidents of workplace violence. The purpose of this evidence-based project is to create a “zero tolerance” workplace culture for ED nurses that ultimately decreases the incidence of workplace violence. Based on research, an educational program and new reporting tool will be implemented at an urban community hospital in Westchester. Included is a purpose statement, and operational and conceptual definition, PICO questions, and an evidence-based practice protocol for workplace violence.
Nasal cytology in patients with previous SARS-CoV-2 infection: occurrence of atypical lymphocytes
Published on: 31st May, 2023
SARS-CoV-2 is a new pandemic infection that affects at the beginning the upper respiratory system, and, successively, all the organisms, due to cytokine storm, with serious consequences that can reach death. The aim of this work was the observation of the nasal mucosa of enrolled 60 patients, resulting negative for two weeks to the molecular swab for SARS-CoV-2, versus the control group. Rhino-fibroscopy and nasal cytology of nasal mucosa were performed for both the investigated groups. The observation of the samples showed the occurrence of plasmablastic lymphocytes and Downey II lymphocytes type. The former type of lymphocytes was prevalent against the second one, probably because of an immunological “scar”. The rhino-fibroscopy showed a “pseudo ischemia of nasal submucosa” at pre and pericranial levels, not occurred in the control group.The occurrence of atypical lymphocytes in the nasal smear was analog to that observed in the blood peripheral smear, probably caused by mechanisms of local immune reaction and dysregulation like those observed in other virus infections. Our findings suggest that the nasal mucosa study through the nasal cytology, can represent an important predictive tool of the SARS-CoV-2 infection.
A new theory on the shape of the universe and the origin of the time
Published on: 25th January, 2022
In this article, we have made a theoretical research, at the limit of the scientific reflection, to respond to the following query: what is the origin of the time? To find the response to this question, we adopted an attractive method. First, we have considered the light physical characteristics (speed, energy...) as the invariants. On this basis, we characterized all other physical systems by referring to the light. By this scheme, we showed that the calculation of the absolute physical characteristics of any system comes compulsory by the light viewpoint. That method avoids the use of mathematical transformations like Lorentz transformation; which is used in relativity to make invariant the equations by the change of the system of reference. Second, we made other hypothesis to find a law characterizing the interactions between matter and antimatter. Third, we used these interactions to quantify the time. The central query of this research led us to the shape of the universe and its volume. Finally, we found that the universe is a conical shape.
Haemodynamic, Biochemical and Respiratory Implications of total Bronchoalveolar Lavage in Pulmonary Alveolar Proteinosis
Published on: 17th June, 2023
Introduction: Total bronchoalveolar lavage (BAL) continues to be the treatment of choice for alveolar proteinosis (AP), facilitating the removal of lipoprotein material. The purpose of this article is to evaluate the impact of haemodynamic, biochemical, and respiratory parameters, as well as the complications and evolution of patients undergoing this procedure. Methods: Retrospective, observational, and descriptive study of BAL. The technique was performed in the Intensive Care Unit. Blood gases, blood pressure, central venous pressure, body temperature, and fluid balance were analyzed. Results: Including eight patients, thirty-eight BAL were performed from 2008 to 2021. The mean instillation of saline at each session was 13.464 ± 4.002 ml per lung. No significant changes were observed before and after BAL in heart rate and blood pressure. Mean central venous pressure increased by 2.59 cm H20. The pO2 initial was 126 mmHg with a final mean of 69.7 mmHg, with statistical significance. The pCO2, HCO3 and pH parameters remained stable. Complications were observed during fifteen of the thirty-eight BAL (nine with arterial hypotension, three with glottic oedema, one acute pulmonary oedema, one pneumothorax, and one cardiorespiratory arrest). In terms of evolution, one case had a clinical-radiological resolution, one case of exits, one required lung transplantation, and the remaining five remained stable. Conclusion: This study demonstrates that the procedure, is well tolerated haemodynamically and that the biochemical alterations to which the patient is subjected are not compromised. With few complications and good results in delaying the progression of AP.
To estimate the levels of gingival crevicular fluid YKL-40 in patients with chronic periodontitis and rheumatoid arthritis with chronic periodontitis - a clinico-biochemical study
Published on: 25th March, 2022
OCLC Number/Unique Identifier: 9470199605
Background and objectives: YKL-40, a C-reactive protein belongs to the positive acute-phase protein. It is also known as Human chitinase-3-like protein 1(HCI3L1) and is closely related to both acute and chronic inflammation. The present study aimed to detect and estimate the levels of YKL-40 in gingival crevicular fluid (GCF) in patients with healthy periodontium, chronic periodontitis, and rheumatoid arthritis with chronic periodontitis. Materials and methods: Forty-five patients in the age range of 25-55years were included in the study. Patients were divided into three groups: Group I-15 Periodontal healthy patients, Group II-15 Chronic Periodontitis patients, and Group III-15 Rheumatoid arthritis with chronic periodontitis patients. Clinical parameters recorded were Plaque index, Gingival index, Gingival bleeding index, probing depth, and Relative attachment level. GCF samples were analyzed using ELISA. p - value < 0.05 was considered statistically significant. Results: The highest mean YKL-40 concentration in GCF was observed in rheumatoid arthritis with Chronic periodontitis. The mean concentration of YKL-40 in GCF showed a three to four folds increase in its levels when compared to healthy controls (p < 0.001). Contrary, GCF YKL-40 levels between Group II and Group III were not significant.Conclusion: With the increase in severity of periodontal destruction from healthy periodontium to chronic periodontitis, there was a substantial increase in the concentration of YKL-40 in GCF. Correlation of GCF YKL-40 with clinical parameters demonstrated increased severity of the diseases increased its levels
Multifrecuency bioimpedance phase angle as a tool to predict maturation failure of native fistulae for hemodialysis
Published on: 21st July, 2021
OCLC Number/Unique Identifier: 9198828640
Background and objectives: An arteriovenous fistula is considered to be an ideal vascular access for patients receiving hemodialysis, its main limitation is its high failure rate to achieve maturation and long-term functionality loss. Multiple strategies have attempted to identify patients at risk. Bioelectrical impedance has shown to be a valuable resource in the determination of the hydration status, and the measurement of the phase angle through this method has demonstrated to be a good indicator of the nutritional state and its related as a general marker of survival. The objective of this study is to analyze the role of plasma albumin and phase angle measured through bioelectrical impedance as tools useful for predicting failure of arteriovenous fistulas.
Materials and methods: prospective observational study, including 104 patients with chronic kidney disease receiving hemodialysis who underwent a native arteriovenous fistula during a period of 24 months. Analyzing its clinical characteristics, laboratory and phase angle through electrical bioimpedance, both univariate and multivariate analysis was performed both with logistic regression, furthermore calculation of coordinates and ROC curve to establish a better cut-off point.
Results: of the variables that were analyzed only the phase angle measurement showed statistical significance OR 2.61 (1.6 – 4.4) p - value 0.001 for predicting arteriovenous fistula failure. In female patients with a phase angle value of 3.25 had a 90% sensibility and 53% specificity for male patients a value of 3.58 showed a sensibility of 84% and a specificity of 52% with ROC curve of 0.78.
Conclusion: phase angle through bioimpedance is a useful parameter, helpful in predicting failure of native arteriovenous fistula, it is also an important tool for identifying patients at risk, in early stages prior to the construction of a vascular access.
Pneumopericardium: A Rare Complication of Antireflux Surgery
Published on: 23rd August, 2023
Pneumopericardium is a rare clinical entity, occurring in the setting of thoracic trauma, malignancies, or mechanical ventilation. Very few cases report pneumopericardium as a complication of gastrointestinal tract surgery. Signs and symptoms may be frustrating, ranging from asymptomatic to chest pain, sepsis, hemodynamic instability, pericarditis, or even cardiac tamponade. Clinical pathognomonic signs of pneumopericardium include pericardial metallic tinkling friction rub and mill wheel murmur. Diagnostic work-up includes electrocardiogram, chest radiography, and, computed tomography imaging. A gastro pericardial fistula should be considered a rare differential diagnosis for acute chest pain in patients with a history of gastroesophageal surgery. Rapid recognition and treatment avoid life-threatening complications. The successful outcome of gastro pericardial fistula treatment depends on both emergency and definitive surgical management. The survival rate with conservative management is poor.We present the case of a 78-year-old patient suffering from pneumopericardium and pericardial infusion, due to a fibrotic fistula between the Nissen’s valve, occurring 10 years after redo antireflux surgery. Treatment included broad-spectrum antibiotics, and emergency surgery for pericardial drainage, biopsy of the valve’s defect, suture, and omentoplasty.
Short-term responses to high-dose inhaled corticosteroid treatment in patients with chronic obstructive pulmonary disease with a fractional nitric oxide concentration over 35 parts per billion: A single-centre pre–post study
Published on: 6th October, 2020
OCLC Number/Unique Identifier: 8686101260
Introduction: There is currently no strategy for identifying chronic obstructive pulmonary disease (COPD) patients whose pulmonary function could benefit from inhaled corticosteroids. We investigated whether a 28-day regime of inhaled corticosteroids improved pulmonary function test results among COPD patients with a fractional exhaled nitric oxide concentration > 35 parts per billion.
Methods: This single-centre one-arm pre–post trial included COPD patients with a fractional exhaled nitric oxide concentration > 35 parts per billion treated at our institution from September 2018 to August 2019. Patients were administered budesonide (200 μg, 8 puffs daily) for 28 days. The primary outcome measure was the difference between the forced expiratory volume in 1 s (FEV1) at baseline and after 28 days of inhaled corticosteroid treatment. Secondary outcomes included differences in COPD Assessment Test scores, %FEV1, and that between the percent forced vital capacity (%FVC) at baseline and after 28 days of treatment.
Results: Twenty patients completed the 28-day inhaled corticosteroid regime. The mean difference in FEV1 between day 1 and day 28 was 340 mL (95% confidence interval: −100 to 770 mL; p = 0.122). The mean differences in secondary outcomes were: %FVC, −0.16% (95% confidence interval [CI]: −2.84 to 2.53%; p = 0.905); %FEV1, 1.63% (95%CI: −4.56 to 7.81%; p = 0.589); COPD Assessment Test score, −2.50 (95%CI: −5.72 to 0.72; p = 0.121).
Conclusion: The 28-day course of inhaled corticosteroids yielded no significant difference in FEV1 for COPD patients with a fractional exhaled nitric oxide concentration > 35 parts per billion.
Trial registration: University Hospital Medical Information Network Center, UMIN000034005. Registered 3 September 2018.
https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000038557
Associated indicator factors among inappropriate malfunctions’ development for the 9-month-old-baby
Published on: 10th September, 2021
OCLC Number/Unique Identifier: 9252205593
To investigate the associated an inappropriate development of the 9-month-old-baby with the Matched Case-Control Study on five categories and three factors including predisposing, contributing, and complementary through the babies’ malfunction development with the Analysis Research Method was analyzed. The babies’ developing crisis was enhanced as the guidelines for promoting healthy babies’ development via the DSPM in the future of Thailand. Creative the Interview Factor Questionnaire analyzed the 130-child caregivers’ parenting matching 65-pairs-case-control group into 5 parts: the Predisposing Factor Questionnaire, the Positive Interview Form; the Baby-Self-Efficacy Form; the Inappropriate Contributing Interview Form; the Inappropriate Development Interview Form for assessing the motor skills, self-efficacy, predisposing, contributing, and complementary factors of the 9-month-old-baby, respectively. Highest, Middle, and Lowest means levels are indicated. The child caregivers’ are presenting responses, overall on the Predisposing Factor Questionnaire on five categories’ motor skills, and the Inappropriate Development Interview Form showed off at the Middle Levels. The Positive Interview Form, the Baby-Self-Efficacy Form, and the Inappropriate Contributing Interview Form comprised at the Highest Levels for the predisposing, self-efficacy, and contributing factors for developing the 9-month-old-baby, respectively. To help professionals assess the factors affecting a child’s development into environmental factors, biological factors, interpersonal relationships, and early environments and experiences that identified in contributing to growth, brain, emotional, social developments at early childhood are the GM, FM, RL, EL, and PS motor skills practices with the DSPM for Thai’s children are also more likely to have health problems all child ages with the knowledge and skills.
Detection of extended-spectrum betalactamase and carbapenemase-producing Enterobacteriaceae in Tunisia
Published on: 15th March, 2023
The emergence of dramatic urinary tract infections (UTIs) caused by the members of the Enterobacteriales is an important public health problem in the community as well as in Tunisian hospitals. This study aims to investigate the prevalence of extended-spectrum β-lactamase (ESBL) and carbapenemase-producing uropathogenic isolates of Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae). Based on decreased susceptibility to β-lactams antibiotics and analyzed for the presence of ESBL and carbapenemase genes by Real Time- polymerase chain reaction (RT-PCR), 56 uropathogenic isolates of E. coli (n = 36) and K. pneumoniae (n = 20) were confirmed positive for ESBLs. The CTX-M-type β-lactamases were mostly detected in E. coli isolates (21 strains, 58.33% [95% CI 38.09% - 72.06%]) followed by blaSHV-like (18 strains, 50% [95% CI 32.92% - 67.07%]), blaTEM-like and blaCMY-2-like simultaneously (15 strains, 41.67% [95% CI 25.51% - 59.24%]). Furthermore, the RT-PCR system on the K. pneumoniae strains demonstrated that blaSHV-12-like was the most predominant (16 strains, 80% [95% CI 56.33% - 94.26%]) followed by blaTEM-like (14 strains, 70% [95% CI 45.72% - 88.10%]), blaCTX-M belonging to groups 9 and 1 (11 strains, 55% [95% CI 31.52% - 76.94%]) and finally blaCMY-2-like (10 strains, 50% [95% CI 27.19% - 72.80%]). In addition, E. coli and K. pneumoniae strains harbored a carbapenemase gene blaOXA-48-like with 22.2% [95% CI 10.11% - 39.15%]; 20% [95% CI 12.83% - 43.66%], respectively.Our results confirm the need to monitor the resistance to extended-spectrum β-lactams and to carbapenems among enterobacteria in Tunisia.
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