When Is My Care Team Rounding? A Simple Signage Intervention to Increase Awareness of Rounding Times.

Patient and caregiver awareness of multidisciplinary rounds (MDR) times, and their subsequent involvement in MDR, aids in decreasing adverse health outcomes, reducing average length of stay, and increasing satisfaction. The objective of this study was to increase patient and caregiver awareness of MDR times using signage interventions and to assess the state of rounding processes with patient and caregiver satisfaction pre- and post-intervention. We administered survey questions to assess MDR interaction and awareness regarding MDR times. Patient and caregiver awareness of rounding times increased significantly by 25.87% (P = .0043) post-intervention. Although patients' confidence in the physician remained largely unchanged after the intervention due to high initial confidence levels, MDR satisfaction metrics increased slightly post-intervention. Thus, our signage intervention increased rounding time awareness in the MDR process.

Catheter-Associated Urinary Tract Infection (CAUTI) in the NeuroICU: Identification of Risk Factors and Time-to-CAUTI Using a Case-Control Design.

BACKGROUND/OBJECTIVE: Catheter-associated urinary tract infections (CAUTIs) account for 25% of all hospital-acquired infections. Neuro-critically ill patients are at 2-5 times greater risk of developing CAUTI because of increased use of indwelling urinary catheters due to neurogenic urinary retention. Despite the heightened risk of CAUTI occurrence for the neuro-critically ill, there is little data on specific characteristics of CAUTIs and risk factors among this population. The aim of this study was to identify characteristics and risk factors associated with CAUTI development in the neuro-critical patient population. METHODS: In this retrospective single-center case-control study in a tertiary care dedicated 30-bed neuroICU, approximately 3 controls (exact ratio-3.2) were randomly selected for each CAUTI case between January 1st, 2016 and December 31st, 2018. Demographic, clinical and laboratory data were collected, including prospectively collected data pertaining to urinary and bowel function. Descriptive and multivariate logistic regression analysis was conducted to identify common patient characteristics, CAUTI risk factors and duration from catheterization to developing a CAUTI (Time-to-CAUTI). RESULTS: Of 3045 admissions during the study period, 1045 (34.30%) had a urinary catheter at some point during their admission. Of those, 45 developed a CAUTI, yielding a CAUTI incidence rate of 1.50%, corresponding to 4.49 infections/1000 catheter days. On average, CAUTI patients were older as compared to controls (66.44 years of age vs 58.09 years; p < 0.0001). In addition to old age, other risk factors included female gender (75.60% female vs 24.20% males in case group, p < 0.0001), increased neuroICU length of stay (18.31 in cases vs. 8.05 days in controls, p = 0.0001) and stool incontinence (OR = 3.73, p = 0.0146). CAUTI patients more often carried a primary diagnosis of SAH, and comorbidities of hypertension (HTN), vasospasm and diabetes. Time-to-CAUTI was 6 days on average, with an earlier peak for patients requiring two or more catheter placements. Presence of stool incontinence was significantly associated with CAUTI occurrence. CONCLUSION: Stool incontinence, older age, female sex, longer neuroICU LOS and presence of comorbidities such as HTN and diabetes were associated with CAUTI development in the neuro-critically ill population. Average Time-to-CAUTI after catheter placement was 6 days with earlier occurrence if more frequent catheterizations. Colonization of urinary catheters without infection might contribute to CAUTI diagnosis. Prospective research is needed to determine impact of prevention protocols incorporating these factors.

Lissencephaly-1 dependent axonal retrograde transport of L1-type CAM Neuroglian in the adult drosophila central nervous system.

Here, we established the Drosophila Giant Fiber neurons (GF) as a novel model to study axonal trafficking of L1-type Cell Adhesion Molecules (CAM) Neuroglian (Nrg) in the adult CNS using live imaging. L1-type CAMs are well known for their importance in nervous system development and we previously demonstrated a role for Nrg in GF synapse formation. However, in the adult they have also been implicated in synaptic plasticity and regeneration. In addition, to its canonical role in organizing cytoskeletal elements at the plasma membrane, vertebrate L1CAM has also been shown to regulate transcription indirectly as well as directly via its import to the nucleus. Here, we intend to determine if the sole L1CAM homolog Nrg is retrogradley transported and thus has the potential to relay signals from the synapse to the soma. Live imaging of c-terminally tagged Nrg in the GF revealed that there are at least two populations of retrograde vesicles that differ in speed, and either move with consistent or varying velocity. To determine if endogenous Nrg is retrogradely transported, we inhibited two key regulators, Lissencephaly-1 (Lis1) and Dynactin, of the retrograde motor protein Dynein. Similar to previously described phenotypes for expression of poisonous subunits of Dynactin, we found that developmental knock down of Lis1 disrupted GF synaptic terminal growth and that Nrg vesicles accumulated inside the stunted terminals in both mutant backgrounds. Moreover, post mitotic Lis1 knock down in mature GFs by either RNAi or Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) induced mutations, resulted in normal length terminals with fully functional GF synapses which also exhibited severe accumulation of endogenous Nrg vesicles. Thus, our data suggests that accumulation of Nrg vesicles is due to failure of retrograde transport rather than a failure of terminal development. Together with the finding that post mitotic knock down of Lis1 also disrupted retrograde transport of tagged Nrg vesicles in GF axons, it demonstrates that endogenous Nrg protein is transported from the synapse to the soma in the adult central nervous system in a Lis1-dependent manner.