Baylor Scott and White Research Institute

Wasek, B., E. Arning and T. Bottiglieri (2018). “The use of microwave irradiation for quantitative analysis of neurotransmitters in the mouse brain.” J Neurosci Methods 307: 188-193.

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BACKGROUND: Assessing neurotransmitter metabolism in the brain is essential in studying the effects of drugs, dietary modification and characterizing transgenic mouse models of human neurodegenerative diseases. Regional brain concentrations of parent neurotransmitters and related metabolites are informative and provide a snap shot of the steady-state levels. The choice in method of sacrificing mice may differ from one laboratory to another, and the technique in removal of brain may have limitations depending on speed in which tissue can be dissected and frozen to prevent post-mortem changes. NEW METHODS: In order to better assess neurotransmitter metabolism in an effective and standardized manner we evaluated microwave irradiation as a method of sacrificing mice. Mice were sacrificed by CO2 asphyxiation followed by cervical dislocation or microwave irradiation at 4 Kw for 1.1s. Brain tissue was harvested into five regions and stored at -80 degrees C until analysis by either LC-MS/MS for acetylcholine, choline and GABA, or HPLC-EC for dopamine, serotonin and norepinephrine and related metabolites. RESULTS: The results of our study showed considerable differences in the levels of neurotransmitters between the two methods of sacrifice. Overall, the concentrations of neurotransmitters were higher in mice sacrificed by microwave irradiation, except for GABA, which was lower. COMPARISON WITH EXISTING METHOD(S): Previous microwave irradiation studies employed presently outdated equipment and neurotransmitter analysis methods, and were not as comprehensive. CONCLUSIONS: The combination of microwave irradiation with LC-MS/MS and HPLC-EC detection allows accurate and sensitive measurement of several neurotransmitter systems in discrete mouse brain regions.

Reynolds, M., S. Driver, M. Bennett, S. Patel, E. Rainey and A. M. Warren (2018). “Examining the relationship between obesity and mental health outcomes among individuals admitted to a level I trauma centre.” Clin Obes Jul 31. [Epub ahead of print].

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The increased incidence of obesity in the general population translates into clinicians caring for an increased number of trauma patients with obesity. Previous research has documented the unique anatomical and physiological challenges that clinicians face when caring for trauma patients with obesity; however, little is known about psychological challenges that trauma patients with obesity may also experience in the months following injury. The aim of this study is to determine the relationship between obesity and (i) mental health, (ii) demographic and injury-related variables and (iii) quality-of-life outcomes among trauma patients between hospitalization and 3-months post-injury. This is a prospective, longitudinal study conducted between March 2012 and May 2014 at a single, level I trauma centre in the southwest United States. Inclusion criteria for this convenience sample consisted of patients who were admitted to the trauma or orthopaedic trauma service >/=24 h, medically stable, spoke English or Spanish and >/=18 years of age. In total, 455 eligible patients were consented and enrolled; 343 (70.87%) completed 3-month follow-up. The objective of this study is to investigate the relationship between obesity and mental health among trauma patients in the months following injury. Demographic and injury-related data were also collected; patients’ height and weight were used to determine body mass index. Health outcomes were assessed during initial hospitalization and at 3-month follow-up and included depression, post-traumatic stress symptoms, pain and return to work. Prior to data collection, it was hypothesized that obesity would have a negative effect on mental health outcomes among patients 3 months post-injury. The final sample consisted of 343 participants; average age was 46.4 +/- 17.3 years; majority male (n = 213, 63%) and Caucasian (n = 231, 69%). Patients with obesity had higher odds of screening positive for depression (odds ratio [OR] = 2.36, P = 0.02) and overweight patients had lower odds of returning to work (OR = 0.31, P = 0.01) 3 months post-injury compared to patients of normal weight (65% vs. 40%). No other significant differences were found. Results of the current study are novel in that they identify psychological challenges that overweight and trauma patients with obesity may experience. These results demonstrate the need for mental health professionals to be involved in follow-up care to extending in the months following injury.

Ramsey, J., S. Driver, C. Swank, M. Bennett and R. Dubiel (2018). “Physical activity intensity of patient’s with traumatic brain injury during inpatient rehabilitation.” Brain Inj Jul 23. [Epub ahead of print]: 1-7.

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OBJECTIVE: Use actigraphy to (1) describe the intensity of physical activity completed by patients with traumatic brain injury (TBI) during inpatient rehabilitation, and (2) examine the association between physical activity intensity and demographic, injury, and programmatic characteristics. DESIGN: Observational. METHOD: Fifty individuals with TBI undergoing inpatient rehabilitation wore accelerometers for an average of 8.7 +/- 1.8 days to capture physical activity intensity that was summarized using activity counts (ACs). Intensity of activity was described for categories of the participant’s day including physical and occupational therapy, non-active therapy, recreation, and sleep. Descriptive statistics, Pearson’s correlations, and general linear regression were computed. RESULTS: Participants average physical activity intensity was considered “inactive” during physical (M = 242.7.7 +/- 105.2 AC/min) and occupational therapy (M = 244 +/- 105), non-active therapy (M = 142.2 +/- 74.1), and recreation (M = 112.8 +/- 59.5), and “sedentary” during sleep (M = 26.7 +/- 14.8). Significant positive associations were identified between physical activity intensity and categories of the participant’s day suggesting that participants who complete more intense activity in therapy also complete more intense activity during non-active therapy and recreation time. General linear regression indicated that age significantly predicted physical activity intensity. CONCLUSIONS: Findings demonstrate that patients with TBI undergoing inpatient rehabilitation are largely inactive or sedentary. Strategies to promote a safe increase in physical activity intensity are required if cardiovascular conditioning is to be improved during inpatient rehabilitation.

Douglas Lawson, T., K. M. Tecson, C. N. Shaver, S. A. Barnes and S. Kavli (2018). “The impact of informal leader nurses on patient satisfaction.” J Nurs Manag Jul 11. [Epub ahead of print].

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BACKGROUND: The relationship between informal leaders, i.e., highly competent individuals who have influence over peers without holding formal leadership positions, and organisational outcomes has not been adequately assessed in health care. AIMS: We evaluated the relationships between informal leaders and experience, job satisfaction and patient satisfaction, among hospital nurses. METHODS: Floor nurses in non-leadership positions participated in an online survey and rated colleagues’ leadership behaviours. Nurses identified as informal leaders took an additional survey to determine their leadership styles via the Multifactor Leadership Questionnaire(TM) . Six months of patient satisfaction data were linked to the nursing units. RESULTS: A total of 3,456 (91%) nurses received peer ratings and 628 (18%) were identified as informal leaders. Informal leaders had more experience (13.2 +/- 10.9 vs. 8.4 +/- 9.7 years, p < 0.001) and higher job satisfaction than their counterparts (4.8 +/- 1.2 vs. 4.5 +/- 1.1, p = 0.007). Neither the proportion of informal leaders on a unit nor leadership style was associated with patient satisfaction (p = 0.53, 0.46, respectively). CONCLUSION: While significant relationships were not detected between patient satisfaction and styles/proportion of informal leaders, we found that informal leaders had more years of experience and higher job satisfaction. More work is needed to understand the informal leaders' roles in achieving organisational outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse informal leaders are unique resources and health care organisations should utilise them for optimal outcomes.

Mullins, B. P., C. J. Kramer, B. J. Bartel, J. S. Catlin and R. E. Gilder (2018). “Comparison of the Nephrotoxicity of Vancomycin in Combination With Cefepime, Meropenem, or Piperacillin/Tazobactam: A Prospective, Multicenter Study.” Ann Pharmacother 52(7): 639-644.

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BACKGROUND: Patients often receive broad-spectrum antibiotics for nosocomial infections commonly with activity against Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus. Previous retrospective and/or single-center studies have suggested that the combination of vancomycin and piperacillin/tazobactam might be associated with an increased risk of acute kidney injury. OBJECTIVES: To compare the incidence of nephrotoxicity in patients receiving intravenous vancomycin in combination with cefepime, meropenem, or piperacillin/tazobactam. METHODS: This was a prospective, multicenter observational study of patients receiving vancomycin in combination with piperacillin/tazobactam versus cefepime or meropenem. Adult patients 18 years of age or older who were hospitalized and received 72 or more hours of intravenous vancomycin and 72 hours or more of cefepime, meropenem, or piperacillin/tazobactam were eligible. Patient and medication characteristics were examined for the 242 patients included. RESULTS: The incidence of acute kidney injury for patients treated with vancomycin and piperacillin/tazobactam was significantly higher than for those treated with vancomycin and cefepime or meropenem, 29.8% versus 8.8%, respectively, P < 0.001. Binary logistic regression demonstrated that patients receiving vancomycin and piperacillin/tazobactam were 6.7 times more likely to develop acute kidney injury compared with the other cohort. CONCLUSIONS: The combination of vancomycin with piperacillin/tazobactam significantly increases the risk of acute kidney injury compared with other broad-spectrum antibiotic combinations. Clinicians should be vigilant when employing this regimen.