published_or_final_version / abstract / toc / Medicine / Master / Doctor of Medicine

This qualitative descriptive study described the prodromal symptoms of older individuals, age 65 and above, experiencing acute coronary syndrome (ACS). Review of the literature establishes that older adults experiencing precursor symptoms of ACS are a high-risk group, one that experiences disparities in hospital emergency departments (EDs) and decreased ACS survival. Identification of early symptoms predictive of ACS may influence a patient's willingness to seek medical treatment and necessitate early, accurate diagnosis and treatment. The purpose of this study was to describe older individual's prodromal symptoms patterns and symptom experiences including perceptions, interpretations, and treatment seeking decisions. This study compared and contrasted symptom patterns of ACS among groups of older adult participants, age 65+ based upon age, gender, and other demographic characteristics (previous myocardial infarction, race, ethnicity, regular exercise, insurance, and comorbidity). Three specific aims were addressed in this study. Specific Aim 1 Explore the prodromal symptom patterns as perceived by the older individual encountering ACS. Specific Aim 2 Explore the older individual's interpretation of the prodromal symptom patterns encountering ACS. Specific Aim 3 Explore the treatment decision making processes used by older individuals when experiencing and interpreting prodromal symptom patterns in ACS. Participants included patients newly diagnosed with ACS and ≥ 65 years of age. For the qualitative description, participants (n=20) were recruited and a chart audit was conducted. Demographic information and data were obtained from the admitting ED history and physical, and discharge summary. Additionally, face-to-face semi-structured interviews were conducted with each participant. Content and matrix analyses were used to address the study aims. Research findings from this study elucidated early symptom indicators of myocardial ischemia/infarction (MI), which may be used for screening or developing ACS assessment guidelines specific to geriatric patients.

Background: In the current policy environment hospital readmissions are receiving considerable attention due to a provision in the Affordable Care Act (2010), that penalize hospitals through reduced payments for excess readmissions (the hospital readmissions reduction program (HRRP)). This program primarily holds hospitals accountable, although a multitude of factors not directly in control of hospitals can be contributory to readmissions. Of these, whether or not patients are discharged to an appropriate post-discharge care setting can be one contributory factor, and, this study evaluated the association between post-discharge care setting and hospital revisits. Methods: A retrospective analysis of the 2008 Medicare Current Beneficiary Survey (MCBS) was conducted. Three post-discharge care settings were evaluated: 1) routine discharge to home; 2) home with home healthcare; and 3) skilled nursing facility. Two outcomes were assessed: 1) 30-day all-cause hospital readmissions; and 2) 30-day all-cause hospital revisits (combination of inpatient admissions and emergency department visits). Analyses were carried out among patients with hospitalizations for any reason, as well as among a subgroup that were hospitalized for one of seven priority conditions identified in the HRRP. Weighted logistic regression analyses that incorporated information on the complex survey design were conducted. Results: Of the MCBS sample representing 46,048,125 Medicare beneficiaries (unweighted N=11,723), 4.9 percent (N= 2,293,629; unweighted N=670) contributed at least one index hospitalization to the analysis. Among hospitalization for any reason, 30-day all-cause hospital readmissions and revisits was 12.3 percent and 17.8 percent, respectively. The subgroup consisted of 31.8 percent of hospitalizations for any reason (N=730,174; unweighted N=216). Readmissions and revisits in the subgroup were 17.8 percent, and 24.5 percent, respectively. Post-discharge care setting was not significantly associated with either readmissions (P=0.966) or revisits (P=0.728) for hospitalizations for any reason. Findings for the subgroup were similar with no significant association between post-discharge care setting with either readmissions (P=0.850) or revisits (P=0.483). Conclusion: Absence of a difference in readmissions and revisits by post-discharge care setting suggests that the choice of discharge status might be appropriate following an inpatient admission. However, further research with larger sample sizes for conditions in the subgroup both together and separately is recommended.

The Slit family of secreted proteins act as axonal repellents during embryogenesis. Slit2 via its receptor, Roundabout-1, also inhibits chemotaxis of multiple leukocyte subsets. Using static and microfluidic shear assays, we found that Slit2 inhibited multiple steps required to recruit circulating neutrophils. Slit2 blocked capture and firm adhesion of human neutrophils to and transmigration across inflamed primary vascular endothelial cells. To determine the response of Slit2 in renal ischemia reperfsuion injury, Slit2 was administered prior to bilateral renal pedicle clamping in mice. This led to significant decreases in both renal tubular necrosis score and neutrophil infiltration. Administration of Slit2 also prevented elevation of plasma creatinine following injury in a dose-dependent manner. Furthermore, administration of Slit2 did not increase hepatic bacterial load in mice infected with L.monocytogenes infection. Collectively, these data demonstrate Slit2 as an exciting therapeutic molecule to combat renal ischemia reperfusion injury without compromising protective host innate immune functions.

The Slit family of secreted proteins act as axonal repellents during embryogenesis. Slit2 via its receptor, Roundabout-1, also inhibits chemotaxis of multiple leukocyte subsets. Using static and microfluidic shear assays, we found that Slit2 inhibited multiple steps required to recruit circulating neutrophils. Slit2 blocked capture and firm adhesion of human neutrophils to and transmigration across inflamed primary vascular endothelial cells. To determine the response of Slit2 in renal ischemia reperfsuion injury, Slit2 was administered prior to bilateral renal pedicle clamping in mice. This led to significant decreases in both renal tubular necrosis score and neutrophil infiltration. Administration of Slit2 also prevented elevation of plasma creatinine following injury in a dose-dependent manner. Furthermore, administration of Slit2 did not increase hepatic bacterial load in mice infected with L.monocytogenes infection. Collectively, these data demonstrate Slit2 as an exciting therapeutic molecule to combat renal ischemia reperfusion injury without compromising protective host innate immune functions.

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Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous environmental contaminants. There are numerous studies reporting developmental cardiac toxicity in multiple fish species due to PAH exposure. However, there are relatively few instances where the effects of acute PAH exposure in adult fish have been characterized. Furthermore, the majority of experiments comparing PAH toxicity with exposure route in adult fish focus on CYP1A gene expression or enzyme activity, while there is a lack of information about the possible pathophysiological effects. Therefore, the overall objective of this thesis was to characterize the sublethal effects of benzo[a]pyrene (BaP), a prototypical PAH, on adult zebrafish (Danio rerio) cardiorespiratory function and fitness following acute exposure by two different routes. In the first experiment, adult zebrafish were intraperitoneally (i.p.) injected twice (one injection/24 hr) with increasing concentrations of BaP (0.1, 10, and 1000 μg/kg) and compared to corresponding dimethylsulfoxide (DMSO) controls. In a second set of experiments, adult zebrafish were aqueously exposed to BaP (static, renewal at 24 hr; 16.2 and 162 μg/L) and compared to DMSO controls. Following 48 hr exposure, one group of fish (n=10/treatment group) were subjected to swimming performance tests to assess critical swimming speed (Ucrit), oxygen consumption rate (MO2), cost of transport (COT), standard metabolic rate (SMR), active metabolic rate (AMR), and factorial aerobic scope (F-AS). Another group of fish (n=12/treatment group) were subjected to echocardiography following 48 hr BaP exposure to evaluate cardiac function. Following echocardiography analysis, samples were collected for parent compound (BaP) body burden and CYP1A mRNA induction analysis. 48 hr BaP injection resulted in significant sublethal effects on adult zebrafish cardiorespiratory function. Oxygen consumption (MO2) was increased at three swimming speeds in injected BaP groups compared to control. In contrast, aqueously BaP-exposed fish showed increased MO2 only at the single lowest swim speed. COT was also similarly increased for both exposure routes. SMR was elevated with both exposure routes, while AMR remained unchanged. This resulted in a significant decrease in F-AS for all treatment groups compared to corresponding controls with both exposure routes. Cardiac function was significantly affected by both routes of BaP exposure. Ventricular heart rate was significantly decreased in BaP-exposed fish, both injected and aqueously-exposed. However, stroke volume was decreased only in fish aqueously exposed to BaP, which resulted in significantly reduced cardiac output with that exposure route. In contrast, the ratio of atrial to ventricular heart rate (AV ratio) was increased only in fish i.p. injected with BaP, indicating the possibility of cardiac arrhythmias occurring. Analysis of BaP body burdens in fish tissue allowed for identification of an overlapping dose group between exposure routes, through which comparisons of cardiotoxicity were then made. This comparison revealed slight differences in cardiotoxicity between exposure routes. BaP-injected fish suffered from more severe bradycardia than aqueously exposed fish. Furthermore, cytochrome P4501A (CYP1A) mRNA levels in liver and heart tissue showed more significant increases in injected fish, while skeletal muscle CYP1A was increased only following aqueous exposure. In conclusion, acute BaP exposure caused metabolic alterations and impaired cardiorespiratory function in adult zebrafish regardless of exposure route. Interestingly, the primary mechanism behind these effects appeared to differ slightly with exposure route. These results suggest that acute BaP exposure may have negative effects on adult fish survivability in the environment. Overall, this work provides valuable insight into the pathophysiogical consequences of acute PAH exposure in adult stage fish.

SANTRAUKA Slaugytojams tenka svarbus vaidmuo, slaugant alkoholį vartojančius pacientus, tačiau apie tai dar yra skirta mažai mokslinių publikacijų, informacijos. Darbo tikslas. Išanalizuoti slaugos procesą ūmių alkoholinių psichozių skyriuje. Tyrimas buvo atliekamas Respublikinėje Vilniaus psichiatrijos ligoninės (RVPL) ūmių alkoholinių psichozių (ŪAP) ir kituose psichiatrijos skyriuose 2007 metais. Planas. Iš viso apklausta abiejų lyčių įvairaus amžiaus 278 respondentai, besigydantys RVPL ŪAP ir kituose psichiatrijos skyriuose. Jie buvo suskirstyti į 2 grupes, priklausomai nuo skyriaus kuriame gydėsi. Buvo pildomos anoniminės anketos. Rezultatai. ŪAPS ir kitų skyrių slaugytojos, pakankamai kvalifikuotai teikia pacientams psichologinę pagalbą. 95,2 proc. respondentų pasitiki savo slaugytoja, ji padeda jiems spręsti iškilusias sveikatos problemas 89,3 proc., 60,6 proc. respondentų jaučiasi suprasti ir 76,8 proc. respondentų kreipiasi į slaugytoją, kai juos pradeda varginti nerimas ar baimė. Svarbiausios ŪAPS slaugytojos savybės, yra pagarba pacientui 63,0 proc. bei 58,7 proc. profesionalumas, o kitų skyrių pacientams - slaugytojos užuojauta 68,3 proc. ir profesionalumas 57,5 proc. ŪAPS respondentai, kad ir pasitiki, dažniau 33,0 proc. išsako savo poreikius slaugytojai nei kitų skyrių respondentai 19,2 proc. bei nuoširdžiai bendradarbiauja su slaugytoja 93,5 proc. nei kitų skyrių respondentai 89,2proc. Tačiau ŪAPS respondentai dažniau 23,9 proc. jaučiasi nesuprasti slaugytojų... [toliau žr. visą tekstą] / SUMMARY Nurses take important part in nursing of patients, who have alcohol addiction, but there is lack of scientific publications and information about it. The objective of thesis is to traverse nursing process in sudden alcoholic psychosis department. The research was made in sudden alcoholic psychosis and other psychiatric departments of Republican Vilnius Psychiatric Hospital in year 2007. Design. There were interwied 278 different age and gender respondents, who were hospitalised in sudden alcoholic psychosis and other psychiatric departments of RVPL. They were divided into two groups, according from department. Anonymous questionnaires were filled. Results. Nurses from sudden alcoholic psychosis and other departments ensure professional psychological help. 95,2 proc. of respondents trust in nurse, she helps to deal with health problems 89,3 proc., 60,6 proc - feel understood and 76,8 proc. – ask for help of nurses, when anxiety and fear trouble them. The most important features of nurses are respect for patient 63,0 proc. and professional work 58,7 proc., while in other departments – compassion 68,3 proc. and professional work 57,5 proc.. In sudden alcoholic psychosis department respondents despite the fact that they trust in nurses, more often 33.0 proc. tell about their needs to them than respondents from other departments 19.2 proc. and collaborate accordingly 93.5 and 89.2 proc. However in sudden alcoholic psychosis department respondents more often 23.9 proc. feel... [to full text]

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