The sepsis syndrome is the systemic response of the body to infection. It develops from the earliest stage, Systemic Inflammatory Response Syndrome sepsis, to severe sepsis, septic shock and multi-organ dysfunction syndrome. The incidence of sepsis is growing and globally accounts for one in ten admissions to Intensive Care Units. The mortality rate for severe sepsis ranges from 25% to 67%. People with cancer are ten times more likely to develop sepsis and having developed it have a higher mortality rate. Early recognition and treatment of sepsis has been demonstrated to improve outcomes. This study sought to improve early recognition of sepsis in cancer patients receiving acute treatment. Nurses and patient assessment were the focus of this study. The design was a prospective multi-method observational study with two interventions: a teaching session for 177 nurses; the introduction of a bedside test - Procalcitonin (PCT-Q), an immunological marker of sepsis. PCT has been shown to be a reliable marker of sepsis. The PCT-Q, has been used since the late 1990s but never by ward nurses. Methods used were: qualitative interviews of ten nurses and a questionnaire survey of 177 nurses pre and post intervention; and a patient database with the PCT-Q test being used 416 times in 320 patients to diagnose sepsis. The study showed that nurses and patients recognise the early changes of deterioration before their observations change. Nurses recognise these changes because they know their patients well. Nurses' knowledge improved in several areas during the study and they used PCT-Q appropriately, diagnosing sepsis at an early stage in 66% of cases. Ordinal multi-regression analysis demonstrated that PCT was more reliable than CRP and, used together with a low WBC and high lactate, accurately predicts sepsis.

Natural killer (NK) cells are a small subset of CD3-negative non-T, non-B lymphocytes that display spontaneous cytotoxic activity against a variety of normal, virus-infected, or tumor target cells without previous sensitization and with no requirement for expression of polymorphic MHC determinants on target cells. By using multicolor EPICS Elite Flow Cytometer (Coulter Corporation) and a panel of fluorochrome-conjugated Coulter Clone monoclonal antibodies (CD16-FITC, CD56-RD1, CD3-ECD and CD8-APC) , the present studies were carried out to monitor and measure the peripheral blood NK cells in seven cancer patients during chemotherapy and stem cell harvests. Flow cytometric (FCM) analysis revealed that NK cells were increased during ch'emotherapy, however as expected in many cancer or AIDS patients the immunophenotypic results did correlate poorly with the functional data obtained by 4-hour chromium-51 release cytotoxicity assay. In addition, the present studies provide direct evidence that FCM analysis can be used as a useful tool for rapid identification and purification of NK cells from cancer patients for further clinical study/application.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / The purpose of this research was to assess the quality of the inpatient, health education diabetes program as it relates to primary Spanish speaking patients. Complications from diabetes account for huge personal and financial costs. There is substantial evidence supporting the use of targeted diabetes education to reduce complications but we need to know if our education interventions are valid. In order to accomplish this by auditing the knowledge of a sample of inpatient diabetics before and after receiving the standard MMC Spanish language diabetes education interventions via Spanish language pre and post surveys (standardized by the previously validated SKILLD survey). Demographic and clinical data were analyzed and all significant data (p value <0.05) were considered for their importance. The data demonstrated that in all 10 items on the survey, overall patients were able to demonstrate significant improvement in survey scores. Additionally, comparisons of demographic data demonstrated that being less than 50 years old was associated with improved survey scores. This indicates overall benefit of the training program as well as possible insight into need for more aggressive training for patients greater than 50 years in age.

Class of 2014 Abstract / Specific Aims: The purpose of this study is to assess whether baseline rates of metabolic monitoring of scheduled atypical antipsychotics are sustained as a result of a pharmacist intervention. Methods: This study was a retrospective chart review assessing rates of metabolic monitoring two months after a pharmacist intervention that utilized a pharmacist-physician metabolic monitoring recommendation form was discontinued. Patients ages 18 years or older with orders for a scheduled atypical antipsychotic were included. Patients with orders for first-generation antipsychotics or who have orders for as needed atypical antipsychotics were excluded. Main Results: Data from the two month post intervention period was compared to those obtained during the pharmacist intervention. For the monitoring of hemoglobin A1c and fasting lipid panels, which improved during the pharmacist intervention, there was a non-statistically significant trend towards decreased monitoring. For hemoglobin A1c, the rates of monitoring decreased from 21.59% to 12.32% (p = 0.09). For fasting lipid panels, monitoring decreased from 39.77% to 28.99% (p = 0.125). Conclusion: A pharmacist intervention utilizing a recommendation form was effective in sustaining the improvement of baseline metabolic monitoring of personal history of diabetes and cardiovascular disease and monitoring of hemoglobin A1c and lipid panels. However, a trend towards decreased monitoring was observed in both the percentage of hemoglobin A1c and lipid panels ordered. Thus, continuing pharmacist intervention may be necessary in order to ensure that baseline metabolic monitoring for atypical antipsychotics occurs.

Class of 2015 Abstract / Objectives: Argatroban is the current drug of choice for type II heparin induced thrombocytopenia. Primarily metabolized by the liver, this direct thrombin inhibitor has a volume of distribution of approximately 174 mLs per kg. While few studies suggested no differences in coagulation parameters or clinical outcomes between obese and non-obese populations receiving argatroban, a recent case report revealed elevated anticoagulation parameters for 20 days post argatroban discontinuation in a morbidly obese female. The purpose of this study is to assess anticoagulation parameters in obese and non-obese patients in an intensive care unit (ICU) setting who received argatroban treatment during their stay. Methods: This is a retrospective, observational, single-centered study. Participants of the study must be adults, at least 18 years of age. Patient must be an inpatient and have received argatroban for either suspected or confirmed heparin-induced thrombocytopenia (HIT). All patients in the study were screened for the above criteria between November 2008 and September 2013. Patients admitted to the cardiac ICU were excluded from the study. Main anticoagulation parameters post discontinuation evaluated were daily international normalized ratio (INR) and activated partial thromboplastin time (aPTT), while safety outcomes included major, minor and non-bleed events. All data were analyzed with STATA 13 with P less than 0.05 being considered as statistically significant. Results: The study included a total of 51 patients, 37 were non-obese with body mass index (BMI) less than 30 kg per m2 (73 percent), and 14 were obese with BMI greater or equal to 30 kg per m2 (27 percent). Among basic demographic data, no differences were found between age, sex, race, height and SOFA scores at baseline between the two groups, BMI less than 30 kg per m2 and BMI greater or equal to 30 kg per m2. (P equals 0.7, 0.21, 1.0, 0.41, 0.51 respectively). However, as expected, weight was the only characteristic that was different at baseline (P less than 0.01). Primary outcome of time of INR to normalization post argatroban administration (2.73 seconds plus or minus 0.27 seconds) as well as safety outcomes including major, minor, and non-bleed adverse events (P equals 0.61) were statistically non-significant between the two groups. Conclusions: In this retrospective, observational, single centered study, no differences were identified between non-obese and obese groups in terms of argatroban administration, primary anticoagulation parameters, and safety outcomes. The length of time required for coagulation parameters to normalize after discontinuation of argatroban therapy for HIT does not appear to be influenced by BMI. Large, multicenter, and random controlled trials are needed to evaluate obesity on pharmacokinetic parameters and clinical outcomes of argatroban.

Les nouvelles technologies de l’information rendent l’accès au savoir possible, des forum et des réseaux sociaux permettent aux malades de s’organiser, le monde associatif se structure, et dans cette dynamique, des patients sont considérés des experts de leur maladie chronique. Toutefois, la nature de leur expertise reste floue et polémique et appelle à être caractérisée. Pour caractériser ce phénomène, nous avons utilisé comme cadre conceptuel le socioconstructivisme et l’individualisme méthodologique. A partir d’une première grille d’analyse issue d’une recension des écrits sur les notions d’expert et d’expertise, il a été procédé à des entretiens avec 12 patients reconnus socialement comme ayant une pratique d’expert ainsi qu’à des entretiens avec des professionnels de santé qui les côtoient en différentes circonstances. La première grille d’analyse ayant permis d’identifier les domaines à explorer, nous avons procédé à l’analyse qualitative et compréhensive des récits de vie des patients et mis en évidence leur motivation, éthique, déontologie, rapport au savoir, modalités d’apprentissages, savoirs, actions, compétences, traits de personnalité, et leur rapport aux soins et à leurs soignants. Deux types de patients-experts émergent qui se consacrent soit aux problématiques biomédicales, soit à l’accompagnement social et au système de soins. Ces deux types de patients-experts ont en commun d’être des acteurs sociaux passionnés et altruistes, qui poursuivent l’objectif d’améliorer la prise en charge de la maladie et/ou sa prévention, qui déploient à cet effet des compétences interculturelles, émotionnelles et de l’autonomie, et qui assurent des rôles d’interface, de porte-voix et d’éclaireurs. Ces acteurs motivés, qui participent à identifier des problématiques de santé et à les élucider, intéressent la santé publique dans la mesure où nos résultats interrogent le type de fonctions qu’ils pourraient occuper dans le système de santé et la forme que pourrait prendre la valorisation de leurs actions. / New information technology provides access to knowledge; thanks to forums and social networks, patients can organize, constructing a community in which some patients are considered experts in their chronic disease. The nature of that expertise is unclear and controversial, however, and demands characterizations. To characterize this phenomenon we employed social constructivism and methodological individualism as a conceptual framework. Using an initial analysis grid taken from a literature review on the concepts of expert and expertise, we interviewed twelve patients socially acknowledged as having expert experience, as well as health professionals with whom they have contact in a variety of circumstances.

Class of 2013 Abstract / Specific Aims: The purpose of the project was to determine if implementation of a detailed pharmacist recommendation form written for providers, could be an effective tool to reduce the use of antipsychotics in the psychiatric nursing home patients with dementia by 15%. Methods: The project was conducted by a pharmacy student and a consultant pharmacist at a single psychiatric nursing home. Thirty recommendations were written to the nursing home providers. The prescribers made comments on the forms and returned them to investigators for analysis. Active orders were compared pre and post pharmacy recommendations. Main Results: Of the 30 interventions, the prescriber addressed 26 (87%) recommendations and agreed to 15 (58%) of them. Nine recommendations involved either a GDR, discontinuation of a medication, or switching to a non-pharmacological method. Six of the nine (66%) recommendations led to the prescriber reducing the dose or discontinuing the medication. Overall, six out of 30 (20%) interventions resulted in a successful reduction of the use of antipsychotics. Conclusion: This project showed that when the prescribers see a more detailed pharmacist written recommendation regarding the therapy, they are more likely to respond with an explanation. However, even though the overall reduction was 20%, black box warnings did not seem to be a deterrent for prescribing in this psychiatric nursing home. Antipsychotics are heavily relied on to control behaviors associated with dementia.

Class of 2013 Abstract / Specific Aims: To further explore the relationship between patient’s diabetes knowledge and pharmacist intervention in patient care related to diabetes management. Study participants included diabetic patients being seen at the El Rio Health Clinic East campus. Subjects were patients being seen only by their primary care providers for diabetes management as well as patients being managed by a clinical pharmacist in addition to their primary care provider. Methods: Questionnaires were administered to eligible patients at the time of their clinic visit. Knowledge was assessed in various areas of diabetes management including diet, exercise, blood glucose management, overall diabetes control, and insulin therapy where applicable. HbA1C was self-reported as a secondary measure. Main Results: Questionnaires were completed by a total of 78 subjects. The pharmacist group included 48 subjects (mean age = 54; SD = 11.9; 60% Caucasian; 65% female) and the non-pharmacist group included 30 subjects (mean age = 52; SD = 9.5; 66% Caucasian; 57% female). Overall, there was no statistically significant difference in diabetes knowledge (p = 0.17) between the two groups. Conclusion: Survey data from this study, although limited and not adequately powered, showed no statistically significant difference in diabetes knowledge between the pharmacist group and non-pharmacist group.

Magister Curationis - MCur / Background and Research Problem: It is well-known that nurses around the world are exposed to various forms of violence at their workplaces. In psychiatric facilities, many of these incidents are perpetrated by patients against nurses. There is a perception that the current legislation and regulations in the country do not adequately protect psychiatric nurses (health care workers in general) against workplace violence. The preliminary literature suggested that most quantitative studies on workplace violence in psychiatric facilities have concentrated on secondary and tertiary psychiatric hospitals looking at the prevalence, the association between demographic factors and violence behaviour, nurses‟ therapeutic responses, and the impacts on the quality of care. Studies on workplace violence in a psychiatric facility for adults with intellectual disability in the country are limited. Secondly, it appeared from the preliminary literature review that similar studies have not looked at this phenomenon from the individual resilience perspective.Therefore, this study will seek to determine the factors associated with the psychological response of nurses‟ victims of inpatient violence in a psychiatric facility for adults with intellectual disability in Cape Town.Aim: To determine factors associated with the psychological response of nurses‟ victims of in-patient violence in a psychiatric facility for adults with intellectual disability in Cape Town.Objectives: To describe the (1) individual resilience of nurses working at a psychiatricfacility for adults with intellectual disability; (2) psychological response of nurses‟ victims of in-patients‟ violence at a psychiatric facility for adults with intellectual disability; and (3) association between the individual resilience characteristics and the psychological responses of nurses victims of in-patients‟ violence in a psychiatric facility for adults with intellectual disability.Methodology: Descriptive-exploratory design using a quantitative approach was used.All categories of nurses (professional nurse, enrolled nurse and enrolled nursing assistance) working at the psychiatric facility for adults with intellectual disability were eligible for the study. Convenient sampling was conducted to select 127 participants who met the inclusion criteria. Self-administered questionnaire was used to collect data. Data was analysed using the SAS V9.3 computer programme. Ethical clearance was obtained from University as well as approval from the management of the psychiatric facility prior to approaching the study participants. Results: The results of the study showed high level of resilience among nurses on Assessment of Resilience Scale (82.9%, n=104); nurses psychological responses to violence were equally distributed between avoidance (mean =4.65 and SD=1.36), intrusion (mean= 4.55 and SD=1.50), hyper arousal (mean=4.46 and SD=1.60) resulting in total mean of 13.67 (SD=4.14) on the revised Impact of Event Scale (IES-R). Measure of association between resilience and the impact of violence on the psychological wellbeing of nurses showed that nurses with high resilience score (82.9%, n=104) fitted the symptoms of PTSD on the IES-R. Spearman Rank correlations (r) analysis showed the total scores of IES-R (r=0.04, p=0.68), avoidance (r=0.01, p= 0.34), intrusion (r=0.08,p=0.34), and hyper-arousal (r= -0.002, p=0.97). Further research looking at the nurses‟ reliance and their responses using resilience theory is needed.

No description available.