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Post-COVID, it was evident that there were severe signs of burnout and a mass exodus from nursing. It is imperative that nurse leaders focus on strategies to engage and recognize the values and opinions of the staff. From multiple appreciative inquiries (AIs), leadership was able to solicit meaningful projects that would directly affect the staff. Historically, it is known that the relationship between perianesthesia and the medical surgical (med-surg) floors can be tense and at times collaboration is low. The AIs produced an innovative idea that came from the perianesthesia staff nurses who had recently transitioned from the floor. Their overarching goal was to bridge the gap between both specialties and forge a professional relationship that consisted of mutual understanding, bidirectional communication, and increased patient/staff satisfaction. Goals of this project were to enhance the relationship between units, to create an environment of mutual understanding, respect, trust, and to improve nurse/patient satisfaction. In theory, if staff and patients are satisfied, increased patient experience and outcomes would subsequently increase. Three mutual goals were identified between the two departments: a better understanding of daily operations, clarification of assumptions surrounding workflow, and assistance with patient progression. Following the National Database of Nursing Quality Indicators results, leadership conducted multiple AIs or listening sessions, to formulate meaningful action plans. There was a reoccurring theme of teamwork, communication and respect. The idea of forming a workgroup between perianesthesia and med-surg was introduced. Staff and leadership outlined the framework of what this workgroup would accomplish. Quarterly meetings were established, structured shadowing sessions were carried out, and pre/post surveys were collected to provide feedback from the shadowing experience. Through the quarterly meetings both perianesthesia and med-surg staff were able to bring forward pain points, top of minds, and actively participate in the resolution of quality improvement initiatives. Ideas such as daily huddles, continuous text communication, and real time feedback were initiatives introduced by the staff. Pre/post surveys, quarterly meetings, and bidirectional communication allowed leadership to obtain real time feedback from the staff nurses. The ago old acceptance of perianesthesia against the inpatient team can no longer be accepted. Leadership should strive to forge a psychologically safe environment that elevates and engages the staff. Holding frequent AIs allowed the team to gauge what was important to these staff members. Bridging this gap empowered the nurses with knowledge, collaboration opportunities, and allowed for innovative strategies to improve patient and staff experience. [ABSTRACT FROM AUTHOR]

The expression of the genes for serum albumin and several other plasma proteins is decreased in animals consuming inadequate amounts of dietary protein. To define the specificity of this phenomenon, we examined the effect of dietary protein restriction on the abundance of the mRNA for nine genes in rat liver. The results of this and previous studies indicate that genes in liver can be divided into two classes based on their response to protein restriction. Group I genes (albumin, transthyretin, carbamyl phosphate synthetase-I, class I alcohol dehydrogenase, insulin-like growth factor-I) exhibit decreased expression in response to protein restriction. In contrast, the expression of group II genes (hypoxanthine-guanine phosphoribosyl transferase, ubiquitin, H-ferritin, insulin-like growth factor binding proteins-1, -2 and -4) is either unchanged or increased in response to protein restriction. To investigate the molecular mechanism(s) leading to the decreased level of albumin and transthyretin mRNA in protein-restricted animals, the effect of protein restriction on the abundance of albumin and transthyretin nuclear transcripts was examined. The results demonstrated that protein restriction specifically decreased the abundance of albumin and transthyretin nuclear transcripts, indicating that the reduction in mRNA levels is caused at least partly by a decrease in gene transcription.

Objectives/Hypothesis: Assess the safety and efficacy of combined antegrade and retrograde esophageal dilation (CARD) for complete esophageal stenosis following head and neck cancer (HNC) treatment. Review HNC dysphagia management. Study Design: Retrospective review of all patients undergoing CARD following HNC treatment between May 2001 and September 2008. Methods: Forty-five patients were identified for review. Parameters assessed included: ability to obtain intraoperative esophageal patency, complications, number of dilations required, diet, and gastric tube (GT) status. Factors associated with dilation failure were analyzed. Results: Intraoperative esophageal patency was obtained in 91% of patients. Median number of all dilations per patient was three. Median number of CARDs per patient was one. Resumption of oral intake occurred in 36/45 (80%). Diet results included: regular or soft diet 32/45 (71%), GT removal 27/45 (60%), and GT dependence with nothing by mouth 9/45 (20%). Laryngeal and pharyngeal stenosis, radionecrosis, tracheotomy dependence, and elongated stenosis were associated with dilation failure. Complications occurred in 18/63 (29%) CARD procedures: eight pneumomediastinum, seven GT site problems, two esophageal perforations, and one pharyngeal infection. All complications resolved spontaneously or with minimal interventions. Conclusions: CARD was safe and effective. Intraoperative patency was achieved in 91% of patients. Eighty percent resumed oral intake. The majority of patients had their GTs removed and resumed a soft or regular diet. Dilation failure was associated with laryngeal, pharyngeal, and excessively long esophageal stenosis, often resulting from radionecrosis. Complications were minor. CARD should be considered before relegating patients with complete esophageal stenosis to chronic GT dependence or subjecting them to laryngopharyngo esophagectomy. Laryngoscope, 2010 [ABSTRACT FROM AUTHOR]

Objective: To update a 15-year-old study of 800 postlinguistically deaf adult patients showing how duration of severe to profound hearing loss, age at cochlear implantation (CI), age at onset of severe to profound hearing loss, etiology and CI experience affected CI outcome., Study Design: Retrospective multicenter study., Methods: Data from 2251 adult patients implanted since 2003 in 15 international centers were collected and speech scores in quiet were converted to percentile ranks to remove differences between centers., Results: The negative effect of long duration of severe to profound hearing loss was less important in the new data than in 1996; the effects of age at CI and age at onset of severe to profound hearing loss were delayed until older ages; etiology had a smaller effect, and the effect of CI experience was greater with a steeper learning curve. Patients with longer durations of severe to profound hearing loss were less likely to improve with CI experience than patients with shorter duration of severe to profound hearing loss., Conclusions: The factors that were relevant in 1996 were still relevant in 2011, although their relative importance had changed. Relaxed patient selection criteria, improved clinical management of hearing loss, modifications of surgical practice, and improved devices may explain the differences., (Copyright © 2012 S. Karger AG, Basel.)