Development and Implementation of an Acute Kidney Injury Remote Patient Monitoring Program: Research Letter.

Acute kidney injury (AKI) survivors have a dynamic posthospital course which warrants close monitoring. Remote patient monitoring (RPM) could be used to improve quality and efficiency of AKI survivor care. Objective: The objective of this report was to describe the development and preliminary feasibility of an AKI RPM program launched in October 2021. Setting: Academic medical center. Patients: Patients enrolled in the AKI RPM program were those who experienced AKI during a hospitalization and underwent nephrology consultation. Measurements/Methods: At enrollment, patients were provided with home monitoring technology and underwent weekly laboratory assessments. Nurses evaluated the data daily and adhered to prespecified protocols for management and escalation of care if needed. Results: Twenty patients were enrolled in AKI RPM in the first 5 months. Median duration of program participation was 36 (31, 40) days. Eight patients (40%) experienced an unplanned readmission, or an emergency department visit, half (N = 4) of which were attributed to AKI and related circumstances. Of the 9 postgraduation survey respondents, all were satisfied with the RPM program and 89% would recommend RPM to other patients with similar health conditions. Limitations: Acute kidney injury RPM was made possible by the existing infrastructure in our integrated health system and the robust resources available in the Mayo Clinic Center for Digital Health. Such infrastructure may not be universally available which could limit scale and generalizability of such a program. Conclusions: Remote patient monitoring can offer a unique opportunity to bridge the care transition from hospital to home and increase access to quality care for the AKI survivors.

Les survivants d'un épisode d'insuffisance rénale aiguë (IRA) ont un parcours post-hospitalier dynamique qui justifie une surveillance étroite. La télésurveillance des patients (TSP) pourrait être employée pour améliorer la qualité et l'efficacité des soins pour les survivants de l'IRA. Objectif: L'objectif de ce rapport était de décrire le développement et la faisabilité préliminaire d'un programme de TSP-IRA (télésurveillance des patients atteints d'IRA) en octobre 2021. Cadre: Centre médical universitaire. Sujets: Les patients inscrits au programme de TSP-IRA étaient des patients qui avaient vécu un épisode d'IRA lors d'une hospitalisation et obtenu une consultation en néphrologie. Mesures et méthodologie: Au moment de l'inclusion, les patients ont reçu un dispositif de surveillance à domicile et se sont soumis à des évaluations de laboratoire hebdomadaires. Les infirmières ont évalué les données quotidiennement et ont respecté des protocoles prédéfinis pour la gestion et l'escalade des soins si nécessaire. Résultats: Vingt patients ont été inclus dans le programme de TSP-IRA au cours des cinq premiers mois. La durée médiane de participation au programme était de 36 (31, 40) jours. Huit patients (40%) ont dû être réadmis de façon non planifiée ou ont dû faire une visite aux urgences; pour la moitié d'entre eux (N = 4) en raison de l'IRA et de circonstances connexes. Parmi les neuf répondants qui ont répondu au sondage à la complétion du programme, tous se sont dits satisfaits du programme de TSP et 89% le recommanderaient à d'autres patients ayant des problèmes de santé similaires. Limites: Le programme de TSP-IRA a été rendu possible grâce à l'infrastructure existante dans notre système de santé intégré et aux ressources robustes disponibles au Mayo Clinic Center for Digital Health. Une telle infrastructure n'est peut-être pas universellement disponible, ce qui pourrait limiter l'ampleur et la généralisabilité d'un tel programme. Conclusion: La TSP peut offrir une occasion unique de faciliter la transition des soins entre l'hôpital et le domicile et d'accroître l'accès à des soins de qualité pour les survivants d'un épisode d'IRA.

Initiating Virtual Nursing in General Inpatient Care.

ABSTRACT: With increased demands for inpatient care and limited nursing resources, bedside RNs at one health care system were challenged to find experienced nurse colleagues to provide mentorship when they needed assistance in executing best practices. A virtual RN (ViRN) role was created to support bedside RNs and patients on designated general care inpatient units. The ViRN provided real-time virtual clinical guidance to bedside RNs and actively surveilled patients. Bedside RNs were surveyed by email to gauge the utility and their perceptions of integrating ViRNs into the nursing care team. RNs reported that they valued the consistent availability of having the ViRNs' expert nursing knowledge and virtual assistance with nursing tasks.

Transversus Abdominis Plane Block Reduces Intraoperative Opioid Consumption in Patients Undergoing Periacetabular Osteotomy.

BACKGROUND: Administering intraoperative analgesia in patients undergoing periacetabular osteotomy (PAO) is challenging due to both the relevant surgical approach and osteotomies, which are associated with pain. The aim of this study was to assess the effect of the transversus abdominis plane block (TAPb) on intraoperative opioid consumption and circulation parameters in PAO patients. PATIENTS AND METHODS: We conducted a two-group randomized-controlled trial involving 42 consecutive patients undergoing PAO for symptomatic developmental dysplasia of the hip (DDH) in our department. Patients assigned to the study group received an ultrasound-guided TAPb with 0.75% ropivacaine before the beginning of the surgery and after general anesthesia induction. Patients assigned to the control group did not receive a TAPb. General anesthesia was conducted according to a defined study protocol. The primary endpoint of the study was the intraoperative opioid consumption, measured in morphine equivalent dose (MED). Secondary endpoints were the assessment of intraoperative heart rate, mean arterial pressure (MAP), need for hypotension treatment, and length of hospital stay (LOHS). A total of 41 patients (n = 21 TAPb group, n = 20 control group) completed the study; of these, 33 were women (88.5%) and 8 were men (19.5%). The mean age at the time of surgery was 28 years (18-43, SD ± 7.4). All operations were performed by a single high-volume surgeon and all TAPb procedures were performed by a single experienced senior anesthesiologist. RESULTS: We observed a significantly lower intraoperative opioid consumption in the TAPb group compared to the control group (930 vs. 1186 MED per kg bodyweight; p = 0.016). No significant differences were observed in the secondary outcome parameters. We observed no perioperative complications. CONCLUSION: Ultrasound-guided TAPb significantly reduces intraoperative opioid consumption in patients undergoing PAO.

Leadership Strategies, An Interdisciplinary Team, and Ongoing Nurse Feedback: Ingredients For a Successful BCMA Project.

Barcode medication administration (BCMA) implementation represents a change in a complex process requiring significant modifications in the work of nurses. Nurses' voices are critical for successfully implementing BCMA technology to support this change in nursing practice. Feedback from nurses who administered medications was critical to selecting and refining a BCMA system that supported their practice needs. Feedback regarding implementation status was critical for keeping key stakeholders across the institution informed of the progress and initial impact of the implementation. Nursing leadership engagement throughout the process supported the successful adoption of new workflow processes and technology.

Potential-dependent surface-enhanced resonance Raman spectroscopy at nanostructured TiO2 : a case study on cytochrome b5.

Nanostructured titanium dioxide (TiO2 ) electrodes, prepared by anodization of titanium, are employed to probe the electron-transfer process of cytochrome b5 (cyt b5 ) by surface-enhanced resonance Raman (SERR) spectroscopy. Concomitant with the increased nanoscopic surface roughness of TiO2 , achieved by raising the anodization voltage from 10 to 20 V, the enhancement factor increases from 2.4 to 8.6, which is rationalized by calculations of the electric field enhancement. Cyt b5 is immobilized on TiO2 under preservation of its native structure but it displays a non-ideal redox behavior due to the limited conductivity of the electrode material. The electron-transfer efficiency which depends on the crystalline phase of TiO2 has to be improved by appropriate doping for applications in bioelectrochemistry.

Time- and momentum-resolved phonon-induced relaxation dynamics in carbon nanotubes.

Applying the density matrix formalism, we obtain microscopic access to the time- and momentum-resolved carrier relaxation dynamics driven by acoustic and optical phonons in semiconducting carbon nanotubes. Our calculations predict two clearly distinguishable relaxation times: the ultrafast component in the femtosecond range is ascribed to the scattering with optical phonons, while the slower component on a time scale of a few picoseconds stems from acoustic phonons. Investigating a number of different nanotubes sheds light on the diameter and chirality dependence of the phonon-induced carrier relaxation dynamics. The difference in the carrier-phonon coupling elements and in the dispersion relation for optical and acoustic phonons explains the significant variation in the efficiency of the corresponding relaxation channels.

Induced surface enhancement in coral Pt island films attached to nanostructured Ag electrodes.

Coral Pt islands films are deposited via electrochemical reduction on silica-coated nanostructured Ag electrodes. From these devices surface-enhanced (resonance) Raman [SE(R)R] signals of molecules exclusively attached to Pt are obtained with intensity up to 50% of the value determined for Ag. SE(R)R spectroscopic investigations are carried out with different probe molecules, silica-coating thicknesses, and excitation lines. Additionally, field enhancement calculations on Ag-SiO(2)-Pt support geometries are performed to elucidate the influence of the Pt island film nanostructure on the observed Raman intensities. It is concluded that the nonperfect coating of the Pt island film promotes the efficiency of the induced Pt SER activity. Comparison with similar measurements on Ag-SiO(2)-Au electrodes further suggests that the chemical nature of the deposited metal island film plays a minor role for the SE(R)R intensity.

Ultrafast relaxation dynamics via acoustic phonons in carbon nanotubes.

Carbon nanotubes as one-dimensional nanostructures are ideal model systems to study relaxation channels of excited charged carriers. The understanding of the ultrafast scattering processes is the key for exploiting the huge application potential that nanotubes offer, e.g., for light-emitting and detecting nanoscale electronic devices. In a joint study of two-color pump-probe experiments and microscopic calculations based on the density matrix formalism, we extract, both experimentally and theoretically, a picosecond carrier relaxation dynamics, and ascribe it to the intraband scattering of excited carriers with acoustic phonons. The calculated picosecond relaxation times show a decrease for smaller tube diameters. The best agreement between experiment and theory is obtained for the (8,7) nanotubes with the largest investigated diameter and chiral angle for which the applied zone-folded tight-binding wave functions are a good approximation.

Fatty acid profile of sunshine bass: I. Profile change is affected by initial composition and differs among tissues.

Fatty acid (FA) composition of fillet tissue can be tailored by transitioning fish from alternative lipid-based, low long-chain polyunsaturated fatty acid (LC-PUFA) grow-out feeds to high LC-PUFA "finishing" feeds. To address whether grow-out feed composition influences the responsiveness of fillet tissue to finishing, sunshine bass (SB, Morone chrysops x M. saxatilis) were reared to a submarketable size on grow-out feeds containing fish oil (FO) or a 50:50 blend of FO and coconut (CO), grapeseed (GO), linseed (LO), or poultry (PO) oil. For the final 8 weeks of the trial, fish were either maintained on assigned grow-out feeds or finished with the 100% FO feed. Production performance was unaffected by dietary lipid source, but fillet FA profile generally conformed to nutritional history. Regardless of grow-out regimen, finishing had a significant restorative effect on fillet FA composition; however, complete restoration of control levels of 20:5n-3, 22:6n-3, total LC-PUFA and n-3:n-6 FA ratio was achieved only among fish fed the CO-based grow-out feed. Saturated fatty acids (SFA) appear to be preferential catabolic substrates, whereas medium-chain and long-chain PUFA are selectively deposited in tissues. Provision of SFA in grow-out feeds appears to optimize selective FA metabolism and restoration of beneficial fillet FA profile during finishing.

Fatty Acid Profile of Sunshine Bass: II. Profile Change Differs Among Fillet Lipid Classes.

Fatty acid (FA) profile of fish tissue mirrors dietary FA profile and changes in a time-dependent manner following a change in dietary FA composition. To determine whether FA profile change varies among lipid classes, we evaluated the FA composition of fillet cholesteryl esters (CE), phospholipids (PL), and triacylglycerols (TAG) of sunshine bass (SB, Morone chrysops x M. saxatilis) raised on feeds containing fish oil or 50:50 blend of fish oil and coconut, grapeseed, linseed, or poultry oil, with or without implementation of a finishing period (100% FO feed) prior to harvest. Each lipid class was associated with a generalized FA signature, irrespective of nutritional history: fillet PL was comprised largely of saturated FA (SFA), long-chain polyunsaturated FA (LC-PUFA), and total n-3 FA; fillet TAG was higher in MC-PUFA and total n-6 FA; and fillet CE was highest in monounsaturated FA (MUFA). Neutral lipids reflected dietary composition in a near-direct fashion; conversely, PL showed evidence of selectivity for MC- and LC-PUFA. Shorter-chain SFA were not strongly reflected within any lipid fraction, even when dietary availability was high, suggesting catabolism of these FA. FA metabolism in SB is apparently characterized by a division between saturated and unsaturated FA, whereby LC-PUFA are preferentially incorporated into tissues and SFA are preferentially oxidized for energy production. We demonstrated provision of SFA in grow-out feeds for SB, instead MC-PUFA which compete for tissue deposition, meets energy demands and allows for maximum inclusion of LC-PUFA within fillet lipids.

Modification of fillet composition and evidence of differential fatty acid turnover in sunshine bass Morone chrysops x M. saxatilis following change in dietary lipid source.

Marine oil-based finishing diets have been used to restore fillet FA profile in several "medium-fat" fleshed aquaculture species, and a simple dilution model describing FA turnover has been established to predict and tailor final fillet composition. We evaluated finishing diet efficacy and suitability of the dilution model to describe patterns of FA change in a lean-fleshed model, sunshine bass. Two practical diets (45% crude protein, 15% crude lipid) were formulated, respectively containing corn oil (CO) or menhaden oil (MO) as the primary lipid sources. Sunshine bass (age 1 [approximately 14 mo], 347 +/- 8.6 g, mean individual weight +/- SEM) were stocked in a recirculating system and fed the diets according to different feeding regimens during the final 28 wk of the production cycle. Control groups were fed the CO or the MO feeds exclusively; whereas, the remaining treatment groups were transitioned from the CO diet to the MO diet at 4-, 8-, or 12-wk intervals. Upon completion of the feeding trial, fish were harvested, and production performance and fillet composition were assessed. Replacing MO with CO as the primary lipid source in sunshine bass diets yielded fillets with distinctly different FA profiles; however, finishing with a MO-based diet offered significant compensation for CO-associated reductions in fillet long-chain highly unsaturated FA (LC-HUFA). Although complete restoration was not observed, we achieved significant augmentation of endogenous n-3 FA within 4 wk of feeding the MO diet, and observed a significant increase in LC-HUFA and a beneficial shift in n-3:n-6 FA ratio after 8 weeks. Simple dilution accurately predicted tissue composition for most FA; however, deviations from the model were noted, suggesting selective retention of n-3, PUFA, and LC-HUFA and preferential catabolism of saturates. We conclude marine oil-based finishing diets can rapidly augment beneficial FA levels in sunshine bass fillets; however, simple dilution models do not fully describe selective FA metabolism observed for this lean-fleshed fish.