ABSTRACT
The low intrinsic growth capacity of neurons and an injury-induced inhibitory milieu are major contributors to the failure of sensory and motor functional recovery following spinal cord injury. Heat shock transcription factor 1 (HSF1), a master regulator of the heat shock response, plays neurogenetic and neuroprotective roles in the damaged or diseased central nervous system. However, the underlying mechanism has not been fully elucidated. In the present study, we used a gecko model of spontaneous nerve regeneration to investigate the potential roles of gecko HSF1 (gHSF1) in the regulation of neurite outgrowth and inflammatory inhibition of macrophages following spinal cord injury. gHSF1 expression in neurons and microglia at the lesion site increased dramatically immediately after tail amputation. gHSF1 overexpression in gecko primary neurons significantly promoted axonal growth by suppressing the expression of suppressor of cytokine signaling-3, and facilitated neuronal survival via activation of the mitogen-activated extracellular signal-regulated kinase/extracellular regulated protein kinases and phosphatidylinositol 3-kinase/protein kinase B pathways. Furthermore, gHSF1 efficiently inhibited the macrophage-mediated inflammatory response by inactivating IkappaB-alpha/NF-kappaB signaling. Our findings show that HSF1 plays dual roles in promoting axonal regrowth and inhibiting leukocyte inflammation, and provide new avenues of investigation for promoting spinal cord injury repair in mammals.
ABSTRACT
BACKGROUND: Nasogastric (NG) tubes are used for providing nutrition to patients who have difficulties swallowing. However, the difficult process of repeatedly inserting NG tubes may lead to gastric erosions. PURPOSE: The rehabilitation ward in this study had an NG tube slippage rate of 2.26% in 2012, significantly higher than the same rate in 2011. A proposal was developed to design better techniques for nurses to perform NG tube insertions in order to decrease the rate of NG tube slippage. RESOLUTION: The following were identified as the major causes of NG tube slippage: (1) caretaker is unfamiliar with NG tube care instructions, (2) caretaker disengages NG tube constraints, and (3) improper rotation of patients or carelessness when turning patients. Therefore, the following solutions were proposed: (1) establish an NG tube safety standard operating procedure, (2) publish bilingual (English and Bahasa Indonesia) pamphlets providing instructions on the correct method of securing and placing the NG tubes, (3) make bilingual (English and Bahasa Indonesia) instructional videos showing the correct method for securing and placing the NG tubes, (4) fabricate a novel tube constraint tool (the constraint ball) that is easy to use, (5) install creative bedside NG tube warning signs, and (6) reinforce the importance of NG tube constraint and placement among caretakers. RESULTS: The NG tube slippage rate was reduced from 2.26% to 0.77%, and was maintained at 0.75% during the follow-up period. The caretaker assessment further showed 100% understanding of the implemented NG tube safety procedures. CONCLUSION: This proposal was established using literature research, problem identification, and creative problem solving to achieve an effective reduction in NG tube slippage as well as to enhance nursing quality.
Subject(s)
Intubation, Gastrointestinal/adverse effects , Humans , Incidence , Rehabilitation CentersABSTRACT
BACKGROUND & PROBLEMS: Foreign health aides are the main providers of care for the elderly and the physically disabled in Taiwan. Correct care skills improve patient safety. In 2010, the incidence of mistakes among foreign health aides in our hospital unit was 58% for nasogastric tube care and 57% for tracheostomy tube care. A survey of foreign health aides and nurses in the unit identified the main causes of these mistakes as: communication difficulties, inaccurate instructions given to patients, and a lack of standard operating procedures given to the foreign health aides. PURPOSE: This project was designed to reduce the rates of improper nasogastric tube care and improper tracheostomy tube care to 20%, respectively. METHODS: This project implemented several appropriate measures. We produced patient instruction hand-outs in Bahasa Indonesia, established a dedicated file holder for Bahasa Indonesian tube care reference information, produced Bahasa Indonesian tube-care-related posters, produced a short film about tube care in Bahasa Indonesian, and established a standardized operating procedure for tube care in our unit. RESULTS: Between December 15th and 31st, 2011, we audited the performance of a total of 32 foreign health aides for proper execution of nasogastric tube care (21 aides) and of proper execution of tracheostomy tube care (11 aides). Patients with concurrent nasogastric and tracheostomy tubes were inspected separately for each care group. The incidence of improper care decreased from 58% to 18% nasogastric intubation and 57% to 18% for tracheostomy intubation. CONCLUSIONS: This project decreased significantly the incidence of improper tube care by the foreign health aides in our unit. Furthermore, the foreign health aides improved their tube nursing care skills. Therefore, this project improved the quality of patient care.
