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Using quality improvement methods to increase use of pain prevention strategies for childhood vaccination

World Journal of Clinical Pediatrics 2017年第1期6卷 81-88页

作者： Jennifer Verrill Schurman Amanda D Deacy Rebecca J Johnson jolynn parker Kristi Williams Dustin Wallace Mark Connelly Lynn Anson Kevin Mroczka Division of Developmental and Behavioral Sciences Children's Mercy Primary Care Clinic Children’s Mercy Division of General Academic Pediatrics Children’s Mercy Comprehensive Pain Management Children’s Mercy Department of Pediatrics Children’s Mercy

AIM To increase evidence-based pain prevention strategy use during routine vaccinations in a pediatric primary care clinic using quality improvement *** Specific intervention strategies(i.e.,comfort positioning,nonnutritive sucking and sucrose analgesia,distraction) were identified,selected and introduced in three waves,using a Plan-Do-Study-Act ***-wide change was measured from baseline to post-intervention by:(1) percent of vaccination visits during which an evidence-based pain prevention strategy was reported as being used; and(2) caregiver satisfaction ratings following the ***,self-reported staff and caregiver attitudes and beliefs about pain prevention were measured at baseline and 1-year post-intervention to assess for possible long-term cultural *** Significant improvements were noted *** of at least one pain prevention strategy was documented at 99% of patient visits and 94% of caregivers were satisfied or very satisfied with the pain prevention care ***/caregivers reported greater satisfaction with the specific pain prevention strategy used [t(143) = 2.50,P ≤ 0.05],as well as greater agreement that the pain prevention strategies used helped their children's pain [t(180) = 2.17,P ≤ 0.05] and that they would be willing to use the same strategy again in the future [t(179) = 3.26,P ≤ 0.001] as compared to *** and caregivers also demonstrated a shift in attitudes from baseline to 1-year ***,staff reported greater agreement that the pain felt from vaccinations can result in harmful effects [2.47 vs 3.10; t(70) =-2.11,P ≤ 0.05],less agreement that pain from vaccinations is "just part of the process" [3.94 vs 3.23; t(70) = 2.61,P ≤ 0.05],and less agreement that parents expect their children to experience pain during vaccinations [4.81 vs 4.38; t(69) = 2.24,P ≤ 0.05].Parents/caregivers reported more favorable attitudes about pain prevention st

关键词： Pediatrics Quality improvement Distraction Pain management Immunization Vaccination Sucrose analgesia Pain prevention Non-nutritive sucking Comfort positioning Primary care

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The Artificial Disc Nucleus and Other Strategies for Replacement of the Nucleus Pulposus:Past,Present and Future Designs for an Emerging Surgical Solution

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Engineered Regeneration 2024年第2期5卷 269-281页

作者： Greg Sacks Vincent DeStefano Claire parker Ryan Lebens Harry Mushlin Renaissance School of Medicine at Stony Brook University Stony BrookNYUSA

Nucleus Pulposus(NP)Replacement is a developing surgical methodology for the treatment of pathology related to degeneration of intervertebral discs(IVDs).This article provides necessary context regarding the patholo-gies treated with this technology,the biomechanical structure and function of the IVD,and the procedures this technology aims to ***,it provides an overview and discussion of commercial and experimental preformed and in situ curing prosthesis designs reported in the scientific literature and summarizes the results of biomechanical and clinical studies evaluating their *** and updated information on the most recent research into NP replacement with novel hydrogel and tissue engineering(TE)strategies is *** of the NP allows for potential improvement in the treatment of degenerative spinal pathologies through minimally invasive surgical techniques.

关键词： Nucleus Pulposus Intradiscal Prosthesis Hydrogel Artificial Disc Implant Spine Surgery

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General practice trainee,supervisor and educator perspectives on the transitions in postgraduate training:a scoping review

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Family Medicine and Community Health 2024年第4期12卷 17-28页

作者： Michael Tran Joel Rhee Wendy Hu parker Magin Boaz Shulruf Discipline of General Practice School of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia School of Medicine Western Sydney UniversitySydneyNew South WalesAustralia Discipline of General Practice School of Medicine and Public HealthThe University of NewcastleNewcastleNew South WalesAustralia Office of Medical Education University of New South WalesSydneyNew South WalesAustralia

Transitions are a period and a process,through which there is a longitudinal adaptation in response to changing circumstances in clinical practice and *** the experience of the transition in medical student learning and in hospital-based specialty training programmes are well described and researched,the experience of the transition in community-based postgraduate general practitioner(GP)training has not been described *** We aimed to identify,and categorise,the formative experiences of transitions in GP training and their impacts on personal and professional *** We adopted Levac et al’s scoping review *** 1543 retrieved records,76 were selected for data *** on a combined model of the socioecological and multiple and multi-dimensional theories of transitions,data relating to the experiences of transitions were organised into contextual themes:being physical,psychosocial,organisational culture and *** criteria Empirical studies focused on general practice trainees or training,that discussed the transitions experienced in general practice training and that were published in English were *** sources PubMed,MEDLINE and Web of Science databases were searched in January 2024 with no date limits for empirical studies on the transition experiences of GP into,and through,*** Our findings describe context-dependent formative experiences which advance,or impede,learning and *** is a significant modulator of the factors contributing to more negative experiences,with some initially adverse experiences becoming more *** of the inflection point that represents a shift from initially adverse to more positive experiences of transitions may help moderate expectations for learning and performance at different stages of *** Challenges in training can either advance development and contribute positively to pr

关键词： finding initially programme

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In Vivo Improvements in Facial Appearance and in Vitro Changes in Gene Expression Using a Topical Formulation Designed to Repair Environmentally Induced DNA Damage

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Journal of Cosmetics, Dermatological Sciences and Applications 2024年第2期14卷 141-173页

作者： Amaryllis Aganahi Richard parker Yohei Tanaka RATIONALE Kyneton Australia Clinica Tanaka Plastic Reconstructive Surgery and Anti-aging Center Matsumoto Japan

Background: While sunscreen has been accepted as a mainline defence against photodamage from ultraviolet, visible light and near-infrared radiation, there appears to be a lack of research into photorepair. The concept of protecting the skin during the day and repairing cellular damage at night is intuitive, yet specific strategies revolving around combinations of proven reparative active ingredients remain unelucidated. Purpose: To investigate the efficacy of a solar repair Formulation following ultraviolet and environmental exposure in order to improve overall skin health and appearance through three hypotheses: The Formulation increases expression of DNA repair mechanisms markers;The Formulation enhances overall skin appearance through reducing signs of inflammation, elevating hydration, reinforcing skin firmness and amplifying radiance;In-Vivo efficacy test results are aligned with measured gene expression changes. Methods: The Formulation (#6NIC1.V1.1-1) was tested for: In-vitro LDH cytotoxicity activity, In-vitro qPCR gene expression with and without ultraviolet exposure on a reconstructed 3-dimensional skin model, and In-Vivo efficacy study on a panel of 22 participants objectively and subjectively. Results: Skin radiance, firmness, hydration, redness, and inflammation are significantly improved after In-Vivo skin exposure to the Formulation and environmental challenges such as ultraviolet radiation. These outcomes were confirmed by in-vitro genetic testing on a reconstructed human skin model. Conclusion: The studies allowed us to identify and group results in four main skin functions that were significantly enhanced following the application of the Formulation: firmness, hydration, radiance and soothing.

关键词： Photoprotection Photorepair DNA Repair Anti-Photoaging Gene Expression Antioxidant Rejuvenation

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Breakdown of a Commonly Practiced Technique in Quantum Mechanics

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Journal of Applied Mathematics and Physics 2024年第5期12卷 1919-1929页

作者： Pirooz Mohazzabi William D. parker Peter Kveton Department of Mathematics and Physics University of Wisconsin-Parkside Kenosha USA

The dynamically shifted oscillator is investigated quantum mechanically, both analytically and numerically. It is shown that the commonly used method of solving the Schrödinger equation using power series results in i... 详细信息

关键词： Dynamic Shift Oscillator Quantum Schrödinger Solution

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Artificial light at night(ALAN) pollution alters bat lunar chronobiology:insights from broad-scale long-term acoustic monitoring

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Ecological Processes 2024年第1期13卷 176-187页

作者： Han Li Pauline Allen Saige Boris Samantha Lagrama Jade Lyons Christina Mills Pauline Moussi Casey Nichols Carter Tacosik Mc Kenzie Tsaousis Nyzaya Livingston Wilson John F.Grider Kevin A.parker Matina C.Kalcounis-Rueppell Department of Biology University of Nebraska Omaha Department of Biology University of North Carolina Greensboro Colorado Parks and Wild-life parker Ecology LLC Department of Biological Sciences University of Alberta

Background The timing of behavior and habitat use of nocturnal animals can be influenced by the lunar cycle in nature. The prevalence of artificial light at night(ALAN) has been recognized as a source of environmental pol-lution. The interaction between ALAN and the lunar cycle on bat behavior is important for understanding anthro-pogenic effects on bats. We utilized a decade(2012–2022) of acoustic monitoring data collected in North Carolina, United States, to investigate the relationship between bat activity, lunar cycle, and light pollution. We examined whether the amount of lunar illumination affected species-specific nightly activity and whether hourly bat activity patterns varied between nights with different moon phases. We further investigated if the relationship between bat activity and the lunar cycle might be altered by light *** We found that seven bat species showed activity variation across nights in relation to the amount of moon illumination when ALAN was absent. In general, bats were less active on full moon nights compared to new moon nights. Light pollution interacted with the bat–lunar relationship in five of the seven species, masking the effect of the lunar cycle. We identified delayed bat activity patterns on nights with a full or waxing moon in seven species, and light pollution altered that pattern in four species. Overall, ALAN was associated with decreased bat activity inde-pendent of lunar cycle *** Our study demonstrated that at a broad spatial scale, ALAN negatively affected many North American temperate bat species and altered their lunar chronobiology. As light pollution is spreading to historically dark areas and habitats, ALAN might couple with other threats, such as the white-nose syndrome or climate change, to cause cascading damage in the environment that depends on ecosystem services such as pest control provided by bats. We argue that further research and conservation actions are needed to mitigate

关键词： Artificial light at night ALAN Bats Chiroptera Chronobiology Light pollution Lunar cycle Moonlight

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Patients’experiences with‘sludge’(administrative burden)in the cancer screening process and its relationship with screening completion,experience and health system distrust

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Family Medicine and Community Health 2024年第S2期12卷 8-17页

作者： Michelle S Rockwell Brianna Chang Vivian Zagarese Jamie K Turner Ally Southworth YingXing Wu Paul Yeaton Li Li Jeffrey S Stein Sarah H parker John W Epling Department of Family and Community Medicine Virginia Tech Carilion School of MedicineRoanokeVirginiaUSA Department of Family and Community Medicine Carilion ClinicRoanokeVirginiaUSA Virginia Tech Carilion School of Medicine RoanokeVirginiaUSA Department of Health Systems and Implementation Science Virginia Tech Carilion School of MedicineRoanokeVirginiaUSA Graduate Program in Translational Biology Medicineand HealthVirginia TechRoanokeVirginiaUSA Health Analytics Research Team Carilion ClinicRoanokeVirginiaUSA Division of Gastroenterology Department of Internal MedicineCarilion ClinicRoanokeVirginiaUSA Department of Family Medicine University of Virginia School of MedicineCharlottesvilleVirginiaUSA Center for Health Behaviors Research Fralin Biomedical Research Institute at VTCRoanokeVirginiaUSA

Objective‘Sludge’refers to administrative burdens or frictions that preclude people from getting what they want or need(eg,duplicative forms,complicated instructions,long waiting times).This mixed methods study evaluated patients’perceptions of sludge in the colorectal cancer(CRC)screening process and some impacts of this *** We employed an exploratory sequential mixed methods study design that comprised patient interviews and a patient *** interviews informed final survey revisions and captured contextual data about patients’experiences with *** transcripts were inductively and deductively analysed to identify overarching *** survey quantified sludge,delayed or forgone screenings,screening experience(Net Promoter Score)and health system distrust(Health System Distrust Scale).We usedχ2 or t-tests for univariable comparisons and logistic or linear regressions to evaluate the association between cumulative sludge score and delayed or forgone screenings,screening experience and health system *** were integrated for *** Southeastern United *** Patients who were 45–75 years of age,at average risk for CRC and had either completed or been referred for CRC screening(colonoscopy or stool-based test)within the previous 12 *** 22 interview participants and 255 survey participants completed the study.38(15%)survey participants rated their screening experience as poor(Net Promoter Score=0–7 out of 10).The mean(SD)Health System Distrust Scale score was 22.4(6.3)out of 45 possible points(higher score=greater distrust).Perceptions of sludge in the CRC screening process varied,with long waiting times and burdensome communication being the most common sources(58%and 35%of participants,respectively).Sludge was positively associated with delayed or forgone screenings(OR=1.42,95%CI 1.28,1.57,p<0.001),poor screening experience(OR=1.15,95%CI 1.04,1.28,p=0.009)and health system distrust(β=0.47,p

关键词： sludge screening burden

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有说服力的讲故事艺术（英文）

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英语画刊(高中版) 2024年第24期 3-5页

作者： Kelly D.parker

沟通专家凯利·D·帕克说：“讲故事是最强大的营销和领导工具之一。”在这个演讲中，她解释了故事如何让各种提案更令人难忘，并展示了如何讲述一个引人注目的故事，以连接、说服和推动有意义的行动。

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Understanding wound healing in obesity

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World Journal of Experimental Medicine 2024年第1期14卷 22-32页

作者： Asha Cotterell Michelle Griffin Mauricio A Downer Jennifer B parker Derrick Wan Michael T Longaker Division of Plastic and Reconstructive Surgery Stanford UniversityPalo AltoCA 94301United States Stanford University School of Medicine Stanford University School of MedicinePalo AltoCA 94301United States Department of Surgery Stanford University School of MedicineHagey Laboratory for Pediatric Regenerative MedicinePalo AltoCA 94301United States

Obesity has become more prevalent in the global *** is associated with the development of several diseases including diabetes mellitus,coronary heart disease,and metabolic *** are a multitude of factors impacted by obesity that may contribute to poor wound healing *** millions worldwide classified as obese,it is imperative to understand wound healing in these *** advances in the understanding of wound healing in both healthy and diabetic populations,much is unknown about wound healing in obese *** review examines the impact of obesity on wound healing and several animal models that may be used to broaden our understanding in this *** a growing portion of the population identifies as obese,understanding the underlying mechanisms and how to overcome poor wound healing is of the utmost importance.

关键词： Obesity Wound healing Adipokines Tissue fibrosis Diabetes Preclinical animal models Hypertrophic skin scarring Wound tension Metabolic syndrome

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Proximate analyses,in vitro antioxidant activity and GC-MS analyses of fermented Pentaclethra macrophylla seeds

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Life Research 2024年第3期7卷 2-8页

作者： Ikechukwu Okoro parker Joshua Innocent Okagu Christian Amah Nnamani Ikenna Nene Chiaka-Onyemeze Emeka Anaduaka David Obasi Prince Okoroh Daniel Orieke Victor Ogugua Department of Medical Biochemistry College of Health SciencesDavid Umahi Federal University of Health SciencesUburuNigeria Department of Biochemistry University of NigeriaNsukkaNigeria Department of Biochemistry State University of Medical and Applied SciencesIgbo-EnoNigeria Department of Medical Laboratory Sciences State University of Medical and Applied SciencesIgbo-EnoNigeria

The present study assessed the proximate composition,in vitro antioxidant activity and GC-MS analyses of fermented Pentaclethra macrophylla seeds extract(FPMSE).The in vitro antioxidant activity was assessed using 2,2-diphenyl-1-picrylhydrazl(DPPH)while Gas Chromatography-Mass Spectrophotometry(GC-MS)technique was used to identify the volatile compounds in *** revealed a dose dependent percentage inhibition of the extract on DPPH *** composition of FPMSE constitutes respectively;ash(0.33±0.12%),protein(2.19±0.08%),fats and oil(80.60±0.00%),carbohydrate(16.88±0.00%)while moisture and fibre were not ***,the pulverised sample constitute respectively;ash(1.27±0.58%),protein(10.51±0.60%),moisture(8.27±0.12%),fats and oil(32.33±0.12%),fibre(7.27±0.12%)and carbohydrate(40.35±0.00%).GC-MS analyses revealed fourteen(14)fatty acids including Octadecanoic acid(1.95%),Benzyloxymethylimine(43.89%),2-Allylpent-4-enoic acid benzyl ester(26.25%),Hexadecanoic acid,methyl ester(1.09%),Oleic Acid(0.25%),9,12-Octadecadienoic acid,methyl ester(Omega-6-fatty acid)(1.52%).The bioactive compounds identified in FPMSE could contribute to the pharmacological properties of *** seeds and hence,could be of considerable interest for the development of new drugs.

关键词： Pentaclethra macrophylla in vitro antioxidant GC-MS fatty acids

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