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Scholarship & History
The UMB Digital Archive is a service of the Health Sciences and Human Services Library (HS/HSL) that collects, preserves, and distributes the academic works of the University of Maryland, Baltimore. It is a place that digitally captures the historical record of the campus.
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Standardized Preoperative Tooth Documentation to Reduce Risk of Peri-Anesthetic Dental InjuryProblem & Purpose: Literature confirms that peri-anesthetic dental injury (PDI) is one of the most common negative anesthesia-related events and a frequent topic in anesthesia-related litigation. There are over 30 reported PDIs per year at an academic level II trauma center In the mid-Atlantic United States. This quality improvement project aims to improve dental assessment and documentation to mitigate the risk of PDI at the project site. The population is adult inpatients receiving anesthesia, excluding obstetrics. Methods: The project lead (PL) and the site’s Chief Anesthesiologist selected a standardized numeric dental diagram. It was inserted into the physical examination section of the existing electronic pre-anesthesia evaluation (PAE). PAEs are completed preoperatively by anesthesia providers for all inpatients receiving anesthesia. Tooth numbers in the diagram are a reference for providers to accurately document dental damage. About 45 anesthesia providers were educated on access and use of the diagram. Real-time one-on-one demonstrations were provided. Step-by-step visual and written instructions were placed in anesthesia offices. The PL reviewed charts weekly to monitor compliance with numeric documentation of pre-existing dental damage. Results: The PL reviewed 659 charts. There were 461 charts excluded due to teeth within normal limits, presence of an endotracheal tube before surgery, edentulousness, lack of electronic PAE, lack of dental documentation in the PAE, inability to assess the mouth, and surgery on a weekend or holiday. The remaining 198 charts were included. Average compliance with using tooth numbers to document pre-existing dental damage was 47% during the 14-week implementation period. There have been at least two reported PDIs during those 14 weeks. Both PAEs revealed incomplete dental documentation. Conclusion: Evidence suggests a standardized numeric diagram can improve compliance with dental documentation. Literature states that thorough preoperative dental assessment and documentation can result in the anesthetist modifying airway instrumentation techniques to reduce PDI risk and lead to PDI-related litigation results in favor of the anesthesia department.
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Quality Improvement Project to Increase Meaning and Joy at Work and Reduce Nursing TurnoverProblem and Purpose: Nationwide, nursing turnover is 23%. Chronic fatigue, low meaning and joy at work are high contributors. On a 30 bed Medical Surgical (MSU) the turnover rate was 30%. The purpose of this quality improvement (QI) project was to assist nurses to identify and eliminate barriers to achieving meaning and joy at work with a goal of reducing turnover. Methods: Project launched with the Meaning and Joy at Work Questionnaire (MJWQ) presurvey (two supplemental questions about Intent to Leave), followed by focus groups, action plans and a post intervention MJWQ. Turnover was measured monthly. Results: Of the 45 eligible nurses on MSU, 38% completed the pre-survey. The highest percentage of nurses completing the survey indicated no intent to leave their position, 47.1% or the profession in the next year, 94.1%. Many of the MJW questions scored positively, with most staff reporting they agree or strongly agree. Resulting interventions included staff recognition, coordination with departments to ensure supply delivery, and launching a Disruptive Behavior Policy. Post-Survey: Of the 45 eligible nurses, 17.8% completed the post-survey. Scores decreased in areas of feeling respected and meaning for the work, all other questions improved. The Intent to Leave data showed a 28% increase in staff indicating they did not intend to leave, a total of 75.1%. A slight increase in staff reporting they would leave the profession within the next year, from 5.9% pre to 12.5% post intervention. Turnover decreased over several months to 26.94%, and then 23.35%. Conclusions: Reasons nurses find meaning and joy at work are a sense of purpose and being present for patients. Teamwork, support and adequate staffing drive a sense of purpose. Facilitated focus groups provide nurses with an opportunity to explore perceptions of meaning, joy at work and to identify barriers. Barriers include staffing, resources, communication recognition, and disruptive behavior by patients and families. Staff and leadership interventions that address barriers are an effective tool to improve meaning, joy and reduce turnover.
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Extracellular vesicles in sepsis plasma mediate neuronal inflammation in the brain through miRNAs and innate immune signalingBackground Neuroinflammation reportedly plays a critical role in the pathogenesis of sepsis-associated encephalopathy (SAE). We previously reported that circulating plasma extracellular vesicles (EVs) from septic mice are proinflammatory. In the current study, we tested the role of sepsis plasma EVs in neuroinflammation. Methods To track EVs in cells and tissues, HEK293T cell-derived EVs were labeled with the fluorescent dye PKH26. Cecal ligation and puncture (CLP) was conducted to model polymicrobial sepsis in mice. Plasma EVs were isolated by ultracentrifugation and their role in promoting neuronal inflammation was tested following intracerebroventricular (ICV) injection. miRNA inhibitors (anti-miR-146a, -122, -34a, and -145a) were applied to determine the effects of EV cargo miRNAs in the brain. A cytokine array was performed to profile microglia-released protein mediators. TLR7- or MyD88-knockout (KO) mice were utilized to determine the underlying mechanism of EVs-mediated neuroinflammation. Results We observed the uptake of fluorescent PKH26-EVs inside the cell bodies of both microglia and neurons. Sepsis plasma EVs led to a dose-dependent cytokine release in cultured microglia, which was partially attenuated by miRNA inhibitors against the target miRNAs and in TLR7-KO cells. When administered via the ICV, sepsis plasma EVs resulted in a marked increase in the accumulation of innate immune cells, including monocyte and neutrophil and cytokine gene expression, in the brain. Although sepsis plasma EVs had no direct effect on cytokine production or neuronal injury in vitro, the conditioned media (CM) of microglia treated with sepsis plasma EVs induced neuronal cell death as evidenced by increased caspase-3 cleavage and Annexin-V staining. Cytokine arrays and bioinformatics analysis of the microglial CM revealed multiple cytokines/chemokines and other factors functionally linked to leukocyte chemotaxis and migration, TLR signaling, and neuronal death. Moreover, sepsis plasma EV-induced brain inflammation in vivo was significantly dependent on MyD88. Conclusions Circulating plasma EVs in septic mice cause a microglial proinflammatory response in vitro and a brain innate immune response in vivo, some of which are in part mediated by TLR7 in vitro and MyD88 signaling in vivo. These findings highlight the importance of circulating EVs in brain inflammation during sepsis.
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Suicide in Healthcare: Awareness and Prevention"I cry and no one cares" INTRODUCTION It is important for healthcare organizations to prioritize suicide prevention and provide support for their staff to address this critical issue. However, even when that support exists, medical professionals are in a unique position to not seek out or accept mental health help. Stigma for seeking help is real, and getting confidential care is a valid concern.
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The Business case for Mental Health Initiatives in the WorkplaceThe impact of poor mental health at work Mental health is not a problem that is unique to the U.S. Globally, nearly 4 in 10 adults aged 15 or over either endure significant depression and anxiety themselves or have a close friend or family member who suffers from it. The serious increase of global unhappiness, in turn, reveals a steadily rising percentage of people over the last 10 years who report significant amounts of anger, stress, worry, sadness and physical pain the day before, reaching a new high in 2021
