IntroductionWhite matter hyperintensities (WMH) is a risk factor of cognitive impairment and Alzheimer’s disease (AD). Arterial stiffening is associated with increased arterial pressure and cerebral blood flow (CBF) pulsatility which may lead to WMH pathogenesis. However, the relations among WMH, arterial stiffness, and pulsatile change in arterial pressure and CBF remain unclear. Therefore, this study investigated the associations among WMH volume, carotid arterial stiffness, carotid arterial pressure, and CBF pulsatility in patients with amnestic mild cognitive impairment (MCI), a prodromal stage of AD.MethodsFifty‐four amnestic MCI patients and twenty‐four cognitively normal subjects (CN) underwent measurements of WMH volume using T2‐weighted‐fluid‐attenuated inversion recovery imaging. Carotid β‐stiffness index and arterial pressure at the common carotid artery (CCA) were measured using ultrasound and applanation tonometry. CBF pulsatility index (PI) was measured from the middle cerebral artery using transcranial Doppler.ResultsWMH volume, PI, carotid β‐stiffness index, carotid systolic blood pressure (cSBP) and pulse pressure (cPP) did not differ between groups. Greater WMH volume was correlated with higher CBF PI in both groups (MCI: r=0.373, NC: r=0.463, p<0.05), whereas it was correlated positively with carotid β‐stiffness index, cSBP, and cPP only in the MCI group (MCI: r=0.499, r=0.432, r=0.468, all p<0.01). In multiple linear regression analysis, cSBP was an independent determinant of WMH (β=0.293, p=0.005) with adjustment for age, sex, body mass index, and MCI status.ConclusionThese findings collectively suggest that carotid arterial stiffness, carotid SBP, and pulse pressure may play an important role in WMH pathogenesis in MCI.Support or Funding InformationThis work was funded by the National Institutes of Health ((R01AG033106, R01HL102457, P30AG012300)

2019-06-01·American Journal of Infection Control

CAUTIon With Our Patients: The Development and Implementation of a CAUTI Tracer Program

作者: Kristina Hobbs ; Prinu Gabriel

BACKGROUND The most common hospital acquired infection is catheter associated urinary tract infection (CAUTI). Approximately 75% of urinary tract infections acquired in the hospital are associated with urinary catheters. CAUTI increases the length of stay by two days and incurs unnecessary costs to the patient. Our nosocomial CAUTI SIR (Standardized infection ratio) in 2017 was 1.161 which is above the Center for Medicare and Medicaid services Hospital Value- Based Purchasing (CMS VBP) benchmark of 0.822. The purpose of this project is to reduce nosocomial CAUTI SIR and to increase catheter bundle compliance. METHODS We utilized a multidisciplinary approach partnering with our corporate Infection Preventionist. We performed a gap analysis using the Targeted Assessment for Prevention (TAP) report to identify our units with opportunities for improvement. We built a CAUTI tracer tool that can be utilized to measure compliance of catheter care and a report can be generated for analysis. A tip sheet was developed and education was provided on all of the bundle components including alternatives for external urinary devices. For sustainment we engaged senior leadership and the units identified with opportunities were required to perform daily catheter care audits until CAUTI free for four months. RESULTS After the process changes were initiated in quarter 1 2018, the hospital acquired CAUTI SIR started to show a steady decline. The 2018 quality year January through September CAUTI SIR is at 0.883 which is a 28% reduction from 2017. With the implementation of the tracer tool, bundle compliance was observed to increase from 80% to 95%. CONCLUSIONS Initiation of the education tip sheet and the CAUTI tracer tool were successful interventions in reducing hospital acquired CAUTI's. Support from both corporate and entity leadership has proven to be effective towards deployment, reduction and sustainment.

100 项与 Texas Health Resources 相关的药物交易

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100 项与 Texas Health Resources 相关的转化医学

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