Critical Care Commons^™

Point Of Care Ultrasound (Pocus) For Advanced Practice Providers (Apps), Crystal S. Rogers

DNP Projects

Background: Advanced practice providers (APPs) routinely lack the skillset to perform Point of Care Ultrasound (POCUS) because currently, there is not a standardized curriculum within scholarly programs (Santos et al., 2018) and/or inadequate hospital training to perform these competencies (Huang et al., 2021). The absence of a standard curriculum has limited the ability of APPs to practice with full scope, provide care that is comparable to physician partners in the acute care setting, and deliver highest quality of patient care. Implementing standard education to train APPs for POCUS addresses this identified gap.

Purpose: The purpose of this project was to …

The Effects Of Social Support On Recovery Outcomes Of Hip Fracture Patients, Preshecca Ragavan

Williams Honors College, Honors Research Projects

This literature review, completed under the guidance of Ms. Anuja Sarode-Paciorek from Summa Health - Akron, will investigate the effects of social support on the recovery outcomes of hip fracture patients. As part of this literature review, I will collect and analyze several scientific journal articles previously published on this topic to gain an overview of what prior knowledge clinical researchers have already gathered about this topic. As part of the analyses, each article will be thoroughly read and briefly summarized. Then, these summaries will be used to compile a list of a few strengths and a list of a …

An Interesting Case Of Hypothyroidism In The Critical Care Setting, Lance Mwangi, Ladi Larry

Gulf Coast Division GME Research Symposium 2024

No abstract provided.

Impact Of Tiered Implementation Of Clinical Decision Support System For Acute Kidney Injury And Nephrotoxin Exposure In Cardiac Surgery Patients, Christopher M. Justice Ii

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Nephrotoxin exposure may worsen kidney injury and impair kidney recovery if continued in patients with acute kidney injury (AKI).

Objective: To determine if tiered implementation of a clinical decision support system (CDSS) would reduce nephrotoxin use in cardiac surgery patients with AKI.

Methods: We assessed patients admitted to the cardiac surgery intensive care unit at a tertiary care center from January 2020 to December 2021, and August 2022 to September 2023. A passive electronic AKI alert was activated in Jul 2020, followed by an electronic nephrotoxin alert in March 2023. In this alert, active nephrotoxic medication orders resulted in …

Improving Nutritional Delivery To Pediatric Patients On Continuous Renal Replacement Therapy, Jennifer Ruiz-Boada, Sarah Brunner, Tara Benton, Vimal Chadha

Presentations

INTRODUCTION: Continuous renal replacement therapy (CRRT) is used in critically ill children with acute renal failure. CRRT can lead to malnutrition by removing essential proteins and micronutrients. Malnutrition is associated with worse outcomes, including increased length of stay and mortality. CRRT guidelines suggest the importance of early nutrition and ensuring high protein intake. After evaluating our CRRT patients, we found sub-optimal adherence to the guidelines. This Quality Improvement project aimed to increase the percentage of patients achieving 75% of their goal protein and caloric intake by day 5 of CRRT initiation by 15% by August 2023. METHODS: A multidisciplinary group …

Improving Knowledge, Confidence, And Competency Among Icu Nurses Concerning The Benefits Of Using The Uk Ventilator Separation Protocol, Brittany Monroe

DNP Projects

Background: The trauma intensive care unit (ICU) at University of Kentucky (UK) Healthcare uses a ventilator separation protocol which provides specific guidelines on the successful weaning of patients from mechanical ventilation. However, many of the nurses are not aware of this protocol as formal education is not included in their orientation or training. This lack of knowledge can lead to risks such as increased patient morbidity, mortality, ICU length of stay, and healthcare-related costs. Research shows that using structured mechanical ventilator weaning tools in the ICU can shorten the duration of mechanical ventilation, which in turn, lowers these associated risks. …

Stroke Survivors’ Telemedicine Experiences During The Covid-19 Pandemic: A Phenomenological Investigation, Barbara Kimmel, Annette Walder, Anette Ovalle, Chethan P Venkatasubba Rao, Sean I Savitz, Mark Goldberg, Steven Warach, Salvador Cruz-Flores, Daiwai M Olson, Jane A Anderson

Faculty, Staff and Student Publications

PURPOSE: This study aimed to describe stroke survivors' experiences receiving telemedicine visits at the Lone Star Stroke Consortium during the COVID-19 pandemic.

MATERIALS AND METHODS: A qualitative descriptive phenomenological design was applied to gather patients' telemedicine experiences through in-depth interviews, using a study guide. Audio-recorded interviews were conducted via ZOOM and transcribed verbatim. Two independent reviewers used the Giorgi descriptive method to analyze the data and search for the essence of stroke survivors' follow-up telemedicine experiences during the COVID-19 pandemic.

RESULTS: Fifteen underserved patients were recruited: mean age, 51.8 (15.7), and 9 (60%) females. Three themes emerged: (1) vivid memory …

Editorial: Emerging Anti-Cancer Compounds And Immunomodulators For Pancreatic Cancer Treatment, Kathleen E Delgiorno, Stephen Safe, Jennifer M Bailey-Lundberg

Faculty, Staff and Student Publications

No abstract provided.

Impact Of Covid Status And Blood Group On Complications In Patients In Hemorrhagic Shock, Jason Bradley Brill, Krislynn M Mueck, Madeline E Cotton, Brian Tang, Mariela Sandoval, Lillian S Kao, Bryan A Cotton

Faculty, Staff and Student Publications

OBJECTIVE: Among critically injured patients of various blood groups, we sought to compare survival and complication rates between COVID-19-positive and COVID-19-negative cohorts.

BACKGROUND: SARS-CoV-2 infections have been shown to cause endothelial injury and dysfunctional coagulation. We hypothesized that, among patients with trauma in hemorrhagic shock, COVID-19-positive status would be associated with increased mortality and inpatient complications. As a secondary hypothesis, we suspected group O patients with COVID-19 would experience fewer complications than non-group O patients with COVID-19.

METHODS: We evaluated all trauma patients admitted 4/2020-7/2020. Patients 16 years or older were included if they presented in hemorrhagic shock and received …

Hypoxia-Adenosine Axis As Therapeutic Targets For Acute Respiratory Distress Syndrome, Katherine Figarella, Jieun Kim, Wei Ruan, Tingting Mills, Holger Klaus Eltzschig, Xiaoyi Yuan

Faculty, Staff and Student Publications

The human respiratory and circulatory systems collaborate intricately to ensure oxygen delivery to all cells, which is vital for ATP production and maintaining physiological functions and structures. During limited oxygen availability, hypoxia-inducible factors (HIFs) are stabilized and play a fundamental role in maintaining cellular processes for hypoxia adaptation. First discovered during investigations of erythropoietin production regulation, HIFs influence physiological and pathological processes, including development, inflammation, wound healing, and cancer. HIFs promote extracellular adenosine signaling by enhancing adenosine generation and receptor signaling, representing an endogenous feedback mechanism that curbs excessive inflammation, supports injury resolution, and enhances hypoxia tolerance. This is especially …

In Sickness And In Health-Type I Interferon And The Brain, Wei Cao

Faculty, Staff and Student Publications

Type I interferons (IFN-I) represent a group of pleiotropic cytokines renowned for their antiviral activity and immune regulatory functions. A multitude of studies have unveiled a critical role of IFN-I in the brain, influencing various neurological processes and diseases. In this mini-review, I highlight recent findings on IFN-I's effects on brain aging, Alzheimer's disease (AD) progression, and central nervous system (CNS) homeostasis. The multifaceted influence of IFN-I on brain health and disease sheds light on the complex interplay between immune responses and neurological processes. Of particular interest is the cGAS-STING-IFN-I axis, which extensively participates in brain aging and various forms …

The Toxicology Investigators Consortium Case Registry-The 2021 Annual Report, Rachel R Tindall, Jennifer M Bailey-Lundberg, Yanna Cao, Tien C Ko

Faculty, Staff and Student Publications

The transforming growth factor (TGF)-β superfamily has important physiologic roles and is dysregulated in many pathologic processes, including pancreatic cancer. Pancreatic cancer is one of the most lethal cancer diagnoses, and current therapies are largely ineffective due to tumor resistance and late-stage diagnosis with poor prognosis. Recent efforts are focused on the potential of immunotherapies in improving therapeutic results for patients with pancreatic cancer, among which TGF-β has been identified as a promising target. This review focuses on the role of TGF-β in the diseased pancreas and pancreatic cancer. It also aims to summarize the current status of therapies targeting …

Survivorship, Outcomes, And Risk Factors For Conversion To Total Hip Arthroplasty After Revision Hip Arthroscopic Surgery In Obese Patients: Results At A Minimum 5-Year Follow-Up, Peng Li, Jie Luo, Zilong Zheng, Lu Meng, Anqi Zhang, Wei Cao, Xiaomei Gong

Faculty, Staff and Student Publications

OBJECTIVE: A high number of Non-Small Cell Lung Cancer (NSCLC) patients with brain metastasis who have not had surgery often have a negative outlook. Radiotherapy remains a most common and effective method. Nomograms were developed to forecast the cancer-specific survival (CSS) and overall survival (OS) in NSCLC individuals with nonoperative brain metastases who underwent radiotherapy.

METHODS: Information was gathered from the Surveillance, Epidemiology, and End Results (SEER) database about patients diagnosed with NSCLC who had brain metastases not suitable for surgery. Nomograms were created and tested using multivariate Cox regression models to forecast CSS and OS at intervals of 1, …

Peripheral Nerve Stimulation After Total Knee Arthroplasty And Non-Operable Patella Fracture, Peter D Vu, Farah Gul, Christopher L Robinson, Grant H Chen, Jamal Hasoon

Faculty, Staff and Student Publications

Chronic knee pain, affecting over 25% of adults in the United States, has surged by 65% over the past two decades leading to rising functional deficits, mobility problems, and a diminished quality of life. While conservative management with pharmacologic and minimally invasive injections are pursued early in the disease process, total knee arthroplasty for refractory osteoarthritis of the knee is often considered. This procedure usually improves pain and functionality within the first three months. However, a significant portion of patients often suffer from postoperative pain that can become chronic and debilitating. We detail the case of a patient with a …

Chronic Adolescent Stress Alters Gr-Fkbp5 Interactions In The Hippocampus Of Adult Female Rats, Sydney Rowson, Mandakh Bekhbat, Sean Kelly, Molly M Hyer, Samya Dyer, David Weinshenker, Gretchen Neigh

Faculty, Staff and Student Publications

Chronic stress exposure during development can have lasting behavioral consequences that differ in males and females. More specifically, increased depressive behaviors in females, but not males, are observed in both humans and rodent models of chronic stress. Despite these known stress-induced outcomes, the molecular consequences of chronic adolescent stress in the adult brain are less clear. The stress hormone corticosterone activates the glucocorticoid receptor, and activity of the receptor is regulated through interactions with co-chaperones-such as the immunophilin FK506 binding proteins 5 (FKBP5). Previously, it has been reported that the adult stress response is modified by a history of chronic …

Invasion Of Superbugs: Cockroach-Driven Outbreak Of Multidrug-Resistant Enterobacter In An Icu, Jennifer Hanrahan, Nicholas Schouten, Steven H. Fyffe, Annette Jencson, Stephanie Stroever

Department of Medicine Faculty Publications

Objective: To describe factors in an outbreak of multidrug-resistant Enterobacter cloacae (MRE) in an intensive care unit (ICU) over a 20-month period including the likely contribution of cockroaches to the outbreak.

Design: This is a retrospective descriptive study.

Setting: ICU in an urban hospital.

Patients: All patients admitted to the ICU during the 20-month outbreak period were included in the study.

Interventions: Infection prevention interventions included contact isolation, hand hygiene, dedicated patient equipment, environmental cultures, and pest control.

Results: 25 patients were identified as being colonized or infected with MRE. Relatedness of the outbreak strain and strains found in cockroaches …

Effects Of Covid-19 On Sleep Services Use And Its Recovery, Amin Ramezani, Amir Sharafkhaneh, Ahmed S Bahammam, Samuel T Kuna, Javad Razjouyan

Faculty, Staff and Students Publications

PURPOSE: The COVID-19 pandemic affected the utilization of various healthcare services differentially. Sleep testing services utilization (STU), including Home Sleep Apnea Testing (HSAT) and Polysomnography (PSG), were uniquely affected. We assessed the effects of the pandemic on STU and its recovery using the Veterans Health Administration (VHA) data.

PATIENTS AND METHODS: A retrospective cohort study from the VHA between 01/2019 and 10/2023 of veterans with age ≥ 50. We extracted STU data using Current Procedural Terminology codes for five periods based on STU and vaccination status: pre-pandemic (Pre-Pan), pandemic sleep test moratorium (Pan-Mor), and pandemic pre-vaccination (Pan-Pre-Vax), vaccination (Pan-Vax), and …

Diagnostic Value Of Soluble Urokinase-Type Plasminogen Activator Receptor In Patients With Acute Coronary Syndrome: A Systematic Review And Meta-Analysis, Michal Pruc, Iwona Jannasz, Damian Swieczkowski, Grzegorz Procyk, Aleksandra Gasecka, Zubaid Rafique, Francesco Chirico, Nicola Luigi Bragazzi, Milosz J Jaguszewski, Jaroslaw Wysocki, Lukasz Szarpak

Faculty, Staff and Students Publications

BACKGROUND: In contemporary clinical practice, there is an increasing need for new clinically relevant biomarkers potentially optimizing management strategies in patients with suspected acute coronary syndrome (ACS). This study aimed to determine the diagnostic utility of soluble urokinase-type plasminogen activator receptor (suPAR) levels in individuals with suspected ACS.

METHODS: A literature search was performed in Web of Science, PubMed, Scopus, and the Cochrane Central Register of Controlled Trials databases, for studies comparing suPAR levels among patients with and without ACS groups. The methodological quality of the included papers was assessed using the Newcastle-Ottawa Scale (NOS). A fixed-effects model was used …

Etiology Of Hospital Mortality In Children Living In Low- And Middle-Income Countries: A Systematic Review And Meta-Analysis, Teresa B Kortz, Rishi P Mediratta, Audrey M Smith, Katie R Nielsen, Asya Agulnik, Stephanie Gordon Rivera, Hailey Reeves, Nicole F O'Brien, Jan Hau Lee, Qalab Abbas, Jonah E Attebery, Tigist Bacha, Emaan G Bhutta, Carter J Biewen, Jhon Camacho-Cruz, Alvaro Coronado Muñoz, Mary L Dealmeida, Larko Domeryo Owusu, Yudy Fonseca, Shubhada Hooli, Hunter Wynkoop, Mara Leimanis-Laurens, Deogratius Nicholaus Mally, Amanda M Mccarthy, Andrew Mutekanga, Carol Pineda, Kenneth E Remy, Sara C Sanders, Erica Tabor, Adriana Teixeira Rodrigues, Justin Qi Yuee Wang, Niranjan Kissoon, Yemisi Takwoingi, Matthew O Wiens, Adnan Bhutta

Faculty, Staff and Students Publications

In 2019, 80% of the 7.4 million global child deaths occurred in low- and middle-income countries (LMICs). Global and regional estimates of cause of hospital death and admission in LMIC children are needed to guide global and local priority setting and resource allocation but are currently lacking. The study objective was to estimate global and regional prevalence for common causes of pediatric hospital mortality and admission in LMICs. We performed a systematic review and meta-analysis to identify LMIC observational studies published January 1, 2005-February 26, 2021. Eligible studies included: a general pediatric admission population, a cause of admission or death, …

Nurse-Led Interprofessional Pressure Injury Prevention In The Medical Intensive Care Unit, Chelsea Lannoo

Articles, Abstracts, and Reports

Background:

The patient population in Medical Intensive care units (MICU) have the highest risk of developing pressure injuries. These pressure injuries can be attributed from medical devices such as Endotracheal tubes, nasogastric tubes, chest tubes etc. Diligent care and assessment of skin is crucial upon admission. Aggressive measures need to be implemented early through prevention protocols, the Air-tap turning system, appropriate bed education, placement of foams/Z-flex boots on arrival to unit. Appropriate staff education will help ensure policies are being initiated early on and decrease hospital acquired pressure injuries.

Purpose:

The Medical Intensive Care Unit (MICU) has seen a gradual …