abstract: Greater than half of older adults who are admitted to an acute care setting experience delirium with an estimated cost between four to twenty billion dollars annually in the United States. As a strategy to address the gap between research and practice, this feasibility study used the Roy Adaptation Model to provide a theoretical perspective for intervention design and evaluation, with a focus on modifying contextual stimuli in a Trauma Intensive Care and a Trauma Orthopedic Unit setting. The study sample included older hospitalized patients in a Trauma Intensive Care and a Trauma Orthopedic setting where there is a greater incidence for delirium. Study participants included two groups, with one group assigned to receive either a music intervention or usual care. The music intervention included pre-recorded music, delivered using an iPod player with soft headsets, with music self-selected from a collection of music compositions with musical elements of slow tempo and simple repetitive rhythm that influence delirium prevention. For the proposed study a music intervention dose included intervention delivery for 60 minutes, twice a day, over a three day period following admission. Physiologic variables measured included systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate, which were electronically monitored every four hours for the study. The Confusion Assessment Method was used as a screening tool to identify delirium in the admitted patients. Specific aims of this feasibility study were to (a) examine the feasibility of a music intervention designed to prevent delirium among older adults, and (b) evaluate the effects of a music intervention designed to prevent delirium among older adults. Findings indicate there was a significant music group by time interaction effect which suggests that change over time was different for the music and usual care group. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2015

Migraines are recurrent debilitating headaches that predominately afflict young women. The pathophysiology of migraines is still not well understood but is related to neurovascular dysfunction. Meningeal blood vessel dilation, extravasation of pro-inflammatory cytokines and activation of trigeminal afferent neurons promote migraine generation. Serotonin (5-HT) is an endogenous vasoactive peptide with diverse physiology. In meningeal blood vessels, serotonin causes vasoconstriction, however in coronary arteries, serotonin causes both vasodilation and vasoconstriction. In diseased coronary arteries, with impaired endothelial function, vasoconstriction predominates. Selective meningeal blood vessel serotonin agonists, termed ‘triptans’, have become the therapy of choice for migraine headaches. However, due to their constrictive effects on the coronary vasculature, triptans are not recommend in patients with known coronary artery disease, patients with greater than one coronary artery risk factor or patients with atherosclerotic cardiovascular disease risk (ASCVD) greater than ten percent. Triptan associated chest pain is a well-known phenomenon. Age, hypertension, dyspepsia, and Raynauds phenomenon are associated with triptan associated chest pain. Hypertension is the strongest risk factor for triptan associated chest pain in males. Although triptan associated chest pain is assumed to be cardiovascular due to its constrictive effect on the coronary vasculature, only a few cases of myocardial infarction, with documented ST elevation and/or troponin elevation, have been reported. Herein we report the case of a male patient with inferolateral ST elevation myocardial infarction, within minutes of receiving subcutaneous sumatriptan for migraine headache. The patient had a normal echocardiogram and electrocardiogram prior to sumatriptan use, and a normal cardiac catheterization afterwards.

Symptomatic sinus bradycardia, due to either sick sinus syndrome or vagotonia, can be familial, affecting several members of a family. We report an 18-year-old male patient with palpitations and limited exercise capacity who was noted to have severe sinus bradycardia. His resting heart rate was 40/min, with normal PR and corrected QT intervals, and sinus pauses up to 6 seconds during sleep. Exercise treadmill test and pharmacologic autonomic blockade during electrophysiologic studies abolished the bradycardia, suggestive of vagotonia rather than intrinsic sinus node dysfunction. This patient's father and a female cousin had a similar clinical history but associated with syncope and severe sinus bradycardia. The mode of transmission appeared to be autosomal dominant. All three have permanent demand pacemakers implanted and are asymptomatic.

Flatworms, or planarian, have a high potential for regeneration and have been used as a model to investigate regeneration and stem cell biology for over a century. Chemicals, temperature, and seasonal factors can influence planarian regeneration. Caffeine and ethanol are two widely used drugs and their effect on flatworm regeneration was evaluated in this experiment. Non-toxic levels of caffeine, a stimulant, and ethanol, a depressant, were determined. The tails of the flatworms were removed and the regeneration stage was analyzed every 3 days for 15 days to see the effect of these drugs alone and in combination on regeneration. For day 3 and day 6, there was a significant difference between the ethanol treatment and the other treatments (positive control, caffeine treatment, and combined treatment). The ethanol treatment showed a delay in the initiation of regeneration but caught up to the other treatments by day 15.

Erythromycin is a macrolide antibiotic that inhibits not only mRNA translation but also 50S ribosomal subunit assembly in bacterial cells. An important mechanism of erythromycin resistance is the methylation of 23S rRNA by erm methyl transferase enzymes. We are interested in investigating the true substrate for methylation because it is known from our work and the work of others that fully assembled 50S subunits are not substrates for methylation. We have published a model for 50S ribosomal subunit formation where, the precursor particle that accumulates in erythromycin treated cells is a target for methyl transferase activity. Current studies are aimed at investigating the role of the precursor particle as substrate for ermE methyltransferase activity and the competition between this enzyme and erythromycin for the 50S precursor particle. Slot-blot hybridization experiments have identified the presence of 23S rRNA in the 50S precursor region. Quantitation of the 23S rRNA in these blots also revealed that the percentage of the precursor increased as the concentration of erythromycin was increased in the growth media. Ribosomal proteins of S. aureus were studied by two-dimensional gel electrophoresis. Protein content of the 50S precursor particle was analyzed by MALDI-TOF. These studies have identified 16 50S ribosomal proteins in the precursor region. Methyltransferase assays showed that 50S precursor particle was a substrate for ermE methyltransferase. Importantly, RNA that is already assembled into 50S subunits was not a substrate for the enzyme. Inhibition curves showed that macrolide, lincosamide, and streptogramin B (MLSB) drugs bound to the precursor particle with similar affinity and inhibited the ermE methyltransferase activity. Competition experiments suggested that the enzyme can displace erythromycin from the 50S precursor particle and that erm methyltransferase has a lower association constant for the precursor particle compared to that of the erythromycin. This suggests that higher concentrations of erythromycin are needed to combat erm induced resistance. These studies shed light on the interaction of ermE methyltransferase and erythromycin in the clinically important pathogen S. aureus.

Amphetamine (AMPH) and its derivatives embody a remarkable breadth of pharmacology. These molecules exert their effects, both therapeutic and pathological, at the human monoamine transporters, which tune synaptic dynamics by evacuating monoamine neuromodulators from the synapse subsequent to neuronal impulses. These transporters are electrogenic, and the transporter-mediated current can be correlated to a surrogate measure of the change in membrane voltage: Ca++ currents from co-transfected L-type Ca++ channels. The present work makes use of this assay, with which it is possible to derive pharmacodynamic metrics from both substrates and inhibitors. This work presents data on a heretofore-unstudied class of amphetamine analogs: the enantiomers of N-Me 4-Me AMPH and N-Et 4-Me AMPH. Remarkably, while both enantiomers of the N-Me version of this compound function as substrates at hDAT, both enantiomers of the N-Et version are inhibitors. This switch does not occur at hNET, where all enantiomers of both N-Me and N-Et 4-Me AMPH function as substrates. Further, (S)-N-Et 4-Me AMPH is a substrate at dDAT. EC50 and IC50 values for all drugs at both transporters are presented. I present the results of super-resolution microscopic co-localization studies on the plasmalemmal spatial relation of the human dopamine transporter and voltage gated calcium channel, L-type 1.2 (CaV1.2). I discuss future aims toward a unified understanding of the mechanisms of monoamine transporter function, with an emphasis on what amphetamine can illuminate in this regard.

The prescription rate of antipsychotics in patients with dementia varies between 20% and 50% for the common and troubling neuropsychiatric symptoms experienced by patients with dementia. The use of these antipsychotic medications has been linked with increased risk of morbidity and mortality due to associated Parkinsonism, over sedation, gait disturbances, cognitive decline, and cardiovascular adverse events. The purpose of this project was to assess whether development of an evidence-based clinical practice guideline (CPG) for a long-term care facility would increase awareness about issues that govern the safe use of antipsychotic medications. The conceptual framework for the project was Watson's model of caring. The Fineout-Overholt tool was used to rank and score information retrieved following an extensive literature review. An expert panel made up of 2 medical doctors and 4 nurse practitioners had 100% agreement that objectives were clear; content was relevant and easy to understand; the CPG was well-organized and easy to follow; and knowledge learned would be used in practice. From 66.6% to 83.3% agreed that the CGP led to an improved understanding of dementia, neuropsychiatric symptoms, medication adverse events, and nonpharmacologic interventions. The expert panel agreed to launch the CPG upon implementation of an educational program for frontline nursing staff and a behavioral log to track occurrence and frequency of behaviors and the use of nonpharmacologic interventions and their effectiveness in managing behaviors. Safe implementation of this CPG might be adapted to other long-term facilities to optimize dementia care, which would bring about a positive social change.

No description available.

The purpose of this study was to conduct an integrated review of the literature examining the use of non-pharmacologic pain management strategies in premature neonates and to explore the relationship between health outcomes and time to discharge from the neonatal intensive care unit (NICU). Non-pharmacologic pain management strategies include human touch, facilitated tucking, non-nutritive sucking, and kangaroo care. A systematic review of the literature was conducted from multiple online databases. Peer reviewed, English-language articles containing the keywords ‘pain management’, ‘neonatal intensive care unit’, and ‘non-pharmacologic’ were included for synthesis. Exclusion criteria included articles with a focus on infants not admitted to the NICU and infants with a gestational age greater than 37 weeks. Results revealed positive outcomes when alternative pain-relieving methods, rather than drug therapy, were used in the NICU. A majority of articles suggest facilitated tucking is very successful in lowering a preterm infant’s pain. However, facilitated tucking alone was significantly less effective in relieving procedural pain compared to facilitated tucking in combination with oral sucrose administration. Kangaroo care and gentle human touch also proved to reduce physiologic and behavioral signs of pain in neonates. The literature reveled an overall positive outcome when non-pharmacologic pain interventions are used in the NICU, with some behavioral interventions showing better efficacy than others at relieving neonatal pain. None of the reviewed articles explored the relationship between reduced length of stay and parameters assessing health outcomes based on pain control in neonates. The literature indicated nurses play a significant role in the use of pain-relieving methods in neonatal populations. Implications for future research that focuses on successful behavioral based pain management strategies that assists in refining neonatal pain relief would be of great benefit to improving health outcomes related to infant survival after discharge from the NICU.

Bakgrund: Förlossningssmärta är en av de mest intensiva formerna av smärta. Det finns både farmakologiska och icke farmakologiska metoder för att lindra förlossningssmärta. En icke farmakologisk smärtlindringsmetod är sterilvatteninjektioner. Sterilt vatten injiceras intrakutant eller subkutant. Smärtlindrande effekten kommer snabbt, oftast inom 10 min och kan sitta kvar i upp till två timmar. Enda bieffekt injektionerna ger är en brännande känsla när det sterila vattnet injiceras. Syfte: Att analysera betydelsen av den smärta som uppstår vid behandling med sterilvatteninjektioner. Metod: Kvalitativ metod i enlighet med hybridmodellen har använts. Hybridmodellen är uppdelad i tre faser. I den första, teoretiska fasen, gjordes artikelsökningar. I den andra, empiriska fasen, intervjuades åtta kvinnor och fyra barnmorskor. I den tredje fasen sker en sammanfattande analys. Resultat: Sticksmärtan har betydelse i kvinnans val att använda sterilvatteninjektioner. När barnmorskorna informerar kvinnorna om sterilvatteninjektioner får de information om att de kommer uppleva en smärta i samband med injektionen. Efter erhållen sterilvatteninjektion uttrycker kvinnorna att det gjorde ont att få injektionerna. Konklusion: Smärta uppkommer när kvinnor erhåller sterilvatteninjektioner. När barnmorskan upplyser om sterilvatteninjektionernas effekt vill kvinnorna ändå testa. De kvinnor som erhöll en god smärtlindring av injektionerna kände att smärtan var överkomlig och kunde då rekommendera metoden till andra. / Background: Labor pain is one of the most intensive forms of pain. Sterile water injected intradermal or subcutaneously is a non-pharmacological pain-relief method. The analgesic effect comes quickly and can remain for up to two hours. The only side-effect is a burning pain during injection. Aim: To analyze the importance of the pain that occurs during treatment with sterile water injections. Method: A qualitative method in accordance with the hybrid model has been used. The hybrid model is divided into three phases. In the first, theoretical phase, search of scientific articles was made. In the second, empirical phase, interviews were conducted with eight women and four midwives. In the third phase a summary analysis takes place. Results: Injection pain is of importance in the woman's choice of the use of sterile water injections. Midwives inform women of sterile water injections, they informed that they will experience a pain associated with the injection. After the women received sterile water injection they expressed that it hurts to get the injection. Conclusion: Pain arises when obtaining sterile water injections. Women who received a good pain relief from the injections felt that the pain was affordable and could then recommend the method to others.