Faculty Bibliography

BACKGROUND:Fostering a culture of inquiry within an academic health system can be both challenging and rewarding. Having a strategic approach can help navigate these complexities. PURPOSE/OBJECTIVE:The aim of this program evaluation is to describe the steps taken to develop, implement, and sustain a nursing science fellowship (NSF) in an academic health system. METHODS:Grounded by a nursing strategic map, the NSF was established under the leadership of a steering committee. Key components of the NSF, including eligibility guidelines, curriculum development, outcome measurements, and faculty and mentor selection, were created over a three-month period. The first cohort of fellows began the 13-month program in January 2023. Fellows attended monthly lectures and were provided with individualized mentorship to advance either an evidence-based practice (EBP) or research project. Prior to beginning the curriculum, fellows were given a research/EBP textbook. A survey to determine their confidence in nursing science skills both before and after the program was administered to all fellows. RESULTS:Of the 11 inaugural fellows, eight completed the program. Four fellows conducted research studies, and four completed EBP projects. The results were disseminated through national presentations, posters, and peer-reviewed publications. Evaluations demonstrated significant improvements in the fellows' confidence in all measured nursing science skills and topics, with notable increases in navigating institutional review board submissions (148.54%), utilizing theoretical frameworks (86.92%), and critically appraising evidence (68.07%). A second cohort began the NSF program in September 2024, and a third will begin in 2026. CONCLUSION/CONCLUSIONS:The NSF helped to sustain a culture of inquiry within the academic health system. This program highlights the critical role of strategic planning and stakeholder engagement in advancing a culture of inquiry. The NSF fosters professional curiosity and aligns with the tenets of the American Nurses Credentialing Center Magnet model by advancing nursing science. As health care evolves, programs like the NSF are essential for cultivating sustainable nursing research and EBP practices that drive professional growth and innovation and can lead to enhanced patient care.

OBJECTIVES/OBJECTIVE:To determine the relationships between the number and class of xerogenic medications on whole stimulated salivary flow rates and oral health-related quality of life (OH-QOL) measures in patients who received high-dose external beam radiation therapy (RT) for head and neck cancer (HNC). STUDY DESIGN/METHODS:Complete medication lists were generated using patient electronic health records from every attended study visit for 146 HNC patients. Whole stimulated salivary flow was measured before RT, and 6 and 18-months after RT. Ten single-item questions and two composite scales of swallowing problems and senses problems (taste and smell) were assessed at baseline and at 6-month intervals up to 24 months after RT. Linear mixed-effects models examined associations between the total number and class of medications and stimulated salivary flow and OH-QOL. RESULTS:There was no detected association between the total number of medications and stimulated salivary flow (p-value = .18). Only antidepressant usage was significantly associated with stimulated salivary flow (P = .006). Number of medications, narcotic analgesic, and antidepressant usage were significantly associated with a clinically meaningful decrease in OH-QOL. CONCLUSION/CONCLUSIONS:Antidepressants were associated with reduced stimulated salivary flow, but no cumulative negative effect on whole stimulated salivary flow was identified. Polypharmacy was associated with worse OH-QOL.

OBJECTIVE:To review currently available devices on pressure injury (PI) early detection, summarize challenges and opportunities to clinical implementation, and propose evaluation standards for device categories. DATA SOURCES/METHODS:PubMed and US Food and Drug Administration (FDA) databases. STUDY SELECTION/METHODS:Published in English from peer-reviewed journals with full text available. Excluded if opinion statements, lack of empirical data, or unrelated to project's objective. DATA EXTRACTION/METHODS:For both clinical device and research equipment: measurement mechanisms, measurement types, outcome/output, FDA classification, and indications for use. Addition data were extracted for clinical devices: instruction for use, end user, order requirement, and billable code. DATA SYNTHESIS/RESULTS:The 4 clinical devices are ultrasound, long-wave infrared thermography, subepidermal moisture assessment, and nearinfrared spectroscopy. The 3 research devices are laser Doppler flowmetry, laser speckle contrast imaging, and colorimetry. CONCLUSIONS:The measurement mechanisms of all devices are unique and different from each other. One commonality is that they could measure the nonvisual signs of PI (eg, inflammation, edema, ischemia, and hypoxia) except colorimeter. Some clinical devices are promising to assist with early identification of PIs, especially in individuals with dark skin tones. Currently, there is no reimbursement available for early detection of PI. Current evidence did not support replacing the standard skin assessment of visual inspection and palpation with the devices reviewed, rather using validated devices to augment the current practice standard. This is especially recommended for individuals identified as high risk for a PI on admission to a facility.

BACKGROUND/UNASSIGNED:Prepectoral direct-to-implant (DTI) breast reconstruction has gained popularity for reducing postoperative pain, animation deformity, and the number of surgical procedures. However, the limited vascularized tissue overlying the implant presents challenges. This study evaluated mean 18-month outcomes in prepectoral DTI patients using a poly-4-hydroxybutyrate (P4HB) wrap designed to optimize reconstructive results. METHODS/UNASSIGNED:We retrospectively reviewed all consecutive patients who underwent prepectoral DTI breast reconstruction with our P4HB-implant construct. Data were collected via chart review. RESULTS/UNASSIGNED:. The mean (± SD) follow-up time was 18.1 (± 5.1) months. Thirty (30 of 50, 60%) patients did not require further procedures beyond the index operation. No patients had implant malposition/dystopia. Of patients requiring a subsequent operation, the majority (12 of 20, 60%) of operations were for aesthetic optimization. Eight (8 of 87, 9.2%) breasts required a subsequent operation due to complications with 4 (4 of 87, 4.6%) of these breasts requiring removal of the construct. Increased BMI and age were found to significantly decrease the odds of rippling (odds ratios 0.73 and 0.89, respectively), and increased BMI was also found to significantly increase the odds of major complications (odds ratio 1.21). CONCLUSIONS/UNASSIGNED:This is the first study reporting mean 18-month P4HB outcomes in prepectoral DTI breast reconstruction at full hydrolysis. Most patients did not require revisional procedures during the follow-up period, and reoperations were primarily for aesthetic concerns. These findings suggest that P4HB is an effective adjunct for implant stabilization in breast reconstruction.

BACKGROUND:The gracilis flap is a versatile muscle flap that can be utilized as a muscle only or myocutaneous flap for soft tissue coverage, as well as for reconstruction of facial animation or extremity function. Few studies have compared donor site complications of free and pedicled gracilis flaps, including the effect of skin paddle harvest on donor site morbidity. METHODS:We performed a retrospective review of patients who underwent a free or pedicled gracilis flap at our institution from 2013-2023. Gracilis flaps were categorized as: pedicled gracilis muscle flaps used for vaginectomy in gender reaffirming surgery, free gracilis muscle flaps, and free gracilis myocutaneous flaps. Outcome variables were duration of drain placement and complications including seroma, hematoma, infection, dehiscence, and persistent numbness. RESULTS:We identified 128 gracilis flaps including 19 free myocutaneous flaps, 35 free muscle flaps, and 74 pedicled muscle flaps. Free myocutaneous flaps required longer drain placement as compared to free muscle flaps or pedicled flaps (13.6 vs 8.4 vs 7.4 days, respectively, p=0.002). Free myocutaneous flaps displayed a higher complication rate (36.8%) as compared to pedicled muscle flaps (10.8%), or free muscle flaps (11.4%, p=0.020). After adjusting for age, BMI, and ASA status, free myocutaneous flaps demonstrated higher odds of major donor site complication as compared to pedicled muscle flaps (OR 1.23, p<0.001), while free muscle flaps were not associated with increased odds of major complication (OR 1.08, p=0.117). Of the documented complications, the most common were surgical site infection (36.8%), hematoma (21.1%) and seroma (21.1%). CONCLUSION/CONCLUSIONS:The inclusion of a skin paddle during gracilis flap harvest is associated with increased duration of drain placement and donor site complications including surgical site infection, hematoma, and seroma. These factors should be carefully considered in the context of patients' reconstructive needs and other risk factors.

Presurgical lip, alveolus, and nose approximation (PLANA) is a novel form of presurgical infant orthopedics (PSIO) designed without an intraoral molding plate. While early studies on PLANA have demonstrated improvements in nasolabial morphology, its impact on infant feeding and weight gain has not been assessed. A single-institution, retrospective review of all patients with cleft lip and palate (CL±P) treated with PLANA over a 1-year period was therefore performed. Weight values at baseline and at surgery were compared with World Health Organization (WHO) Child Growth Standards, and weight-for-age z-scores (WAZ) as well as changes in weight-for-age z-scores (WAZ) were obtained. A cohort of patients who underwent PSIO with NasoAlveolar Molding (NAM) was evaluated as a reference group. The PLANA (n=19) and NAM (n=25) groups were comparable in age (15.63 versus 21.16 d, P=0.2), weight (3.38 versus 3.50 kg, P=0.2), and WAZ (-0.80 versus -0.94, P=0.8) at baseline, and in age (103.11 versus 113.04 d, P=0.06), weight (5.82 versus 5.68 kg, P=0.3), and WAZ (-0.92 versus -1.47, P=0.2) at surgery. Both groups had similar weight gain (2.44 versus 2.18 kg, P=0.1) and WAZ (-0.12 versus -0.53, P=0.2). The PLANA group exhibited statistically significant greater daily weight gain (0.028 versus 0.024 kg/d, P=0.04). None of the patients experienced surgical delays due to insufficient weight gain. PLANA did not interfere with presurgical weight gain in infants with CL±P.

Several biologic and synthetic adjuncts have been employed to reduce ptosis and improve cosmesis in breast surgery. Poly-4-hydroxybutyrate (P4HB), a fully absorbable polymer, continues to increase in use. This study sought to identify uses of P4HB in both reconstructive and aesthetic breast surgery and synthesize the available data on its outcomes and efficacy. A literature search was performed from inception to May 2024 following PRISMA in PubMed (MEDLINE), EMBASE, and Cochrane databases. Two independent reviewers screened the studies for eligibility. Bibliographies and citing references from selected articles from Scopus (Elsevier) were also reviewed. The search identified 372 studies, with 16 articles included. All prospective and retrospective case series utilizing P4HB reported high rates of patient satisfaction and scaffold incorporation as well as low complication rates including recurrent ptosis, implant malposition, and capsular contracture. One retrospective cohort study reported significantly higher rates of capsular contracture with use of P4HB sling in dual-plane, two-stage breast reconstruction. No other studies reported significantly higher rates of capsular contracture with P4HB and no other significant differences in complication rates were noted. Two animal studies exploring the use of P4HB in nipple reconstruction reported that P4HB promoted the growth of fibrovascular tissue with higher rates of nipple projection with respect to control. This study supports P4HB as a safe and efficacious adjunct in a variety of indications. Large-scale, randomized trials between P4HB and other types of soft-tissue support are needed to further delineate the above trends.

Although many internalized G protein-coupled receptors (GPCRs) continue to signal, the mechanisms and outcomes of intracellular GPCR signaling are uncertain due to the challenges of measuring organelle-specific signals and of selectively antagonizing receptors in intracellular compartments. Herein, genetically encoded biosensors targeted to the plasma membrane and early endosomes were used to analyze compartmentalized signaling of protease-activated receptor 2 (PAR₂); the propensity of nanoparticles (NPs) to accumulate in endosomes was leveraged to preferentially antagonize intracellular PAR₂ signaling of pain. PAR₂ agonists evoked sustained activation of PAR₂, Gαq, and β-arrestin-1 in early endosomes and activated extracellular signal regulated kinase (ERK) in the cytosol and nucleus, measured with targeted biosensors. Fluorescent dendrimer and core-shell polymeric NPs accumulated in endosomes of HEK293T cells, colonic epithelial cells, and nociceptors, detected by confocal microscopy. NPs efficiently encapsulated and slowly released AZ3451, a negative allosteric PAR₂ modulator. NP-encapsulated AZ3451, but not unencapsulated AZ3451, rapidly and completely reversed PAR₂, Gαq, and β-arrestin-1 activation in early endosomes and ERK activation in the cytosol and nucleus. When administered into the mouse colon lumen, fluorescent dendrimer NPs accumulated in endosomes of colonocytes and polymeric NPs accumulated in neurons, sites of PAR₂ expression. Both NP formulations of AZ3451, but not unencapsulated AZ3451, caused long-lasting analgesia and normalized aberrant behavior in preclinical models of inflammatory bowel disease. These results provide evidence that PAR₂ endosomal signaling mediates pain and that nanomedicines that antagonize PAR₂ in endosomes effectively relieve pain. NP-mediated delivery may improve the efficacy of other GPCR antagonists for treatment of diverse diseases.

Protease-activated receptor 2 (PAR₂) is a central regulator of intestinal barrier function, inflammation, and pain. Upregulated intestinal proteolysis and PAR₂ signaling are implicated in inflammatory bowel diseases (IBDs) and irritable bowel syndrome (IBS), conditions often associated with gut microbiome alterations. To identify potential bacterial regulators of PAR₂ activity, we developed a functional assay for PAR₂ processing to screen a library of diverse gut microbes. We identify multiple bacteria that secrete proteases capable of cleaving host PAR₂. Using chemoproteomic profiling with a covalent irreversible inhibitor, we uncovered a previously uncharacterized Bacteroides fragilis serine protease 1 (Bfp1) and show that it cleaves and activates PAR₂ in multicellular and murine models. PAR₂ cleavage by Bfp1 disrupts the intestinal barrier, sensitizes nociceptors, and triggers colonic inflammation and abdominal pain. Collectively, our findings uncover Bfp1-mediated PAR₂ processing as an axis of host-commensal interaction in the gut that has the potential to be targeted for therapeutic intervention in IBD or IBS.