Browsing by Author "Mulkey, Malissa A."

Now showing 1 - 6 of 6
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    Impact of risk for severe COVID-19 illness on physical activity during the pandemic
    (Elsevier, 2023) Wierenga, Kelly L.; Perkins, Susan M.; Forster, Anna K.; Alwine, Jennifer; Ofner, Susan; Mulkey, Malissa A.; Danaher Hacker, Eileen; Pressler, Susan J.; Moore, Scott Emory; School of Nursing
    Background: Precautions to mitigate spread of COVID-19 such as the closing of exercise facilities impacted physical activity behaviors. Varied risks for severe COVID-19 may have influenced participation in regular physical activity to maintain precautions. Objective: Describe differences in the amount and intensity of physical activity between adults at high versus low risk for severe COVID-19 illness during the pandemic. We hypothesized that over 13 months, 1) high-risk adults would have greater odds of inactivity than low-risk adults, and 2) when active, high-risk adults would have lower metabolic equivalent of task minutes (MET-min) than low-risk adults. Methods: This longitudinal observational cohort study surveyed U.S. adults' demographics, health history, and physical activity beginning March 2020 using REDCap. Using self-report, health history was assessed with a modified Charlson Comorbidity Index and physical activity with the International Physical Activity Questionnaire. Repeated physical activity measurements were conducted in June, July, October, and December of 2020, and in April of 2021. Two models, a logistic model evaluating physical inactivity (hypothesis 1) and a gamma model evaluating total MET-min for physically active individuals (hypothesis 2), were used. Models were controlled for age, gender, and race. Results: The final sample consisted of 640 participants (mean age 42.7 ± 15.7, 78% women, 90% white), with n = 175 categorized as high-risk and n = 465 as low-risk. The odds of inactivity for the high-risk adults were 2.8 to 4.1 times as high than for low-risk adults at baseline and 13 months. Active high-risk adults had lower MET-min levels than low-risk adults in March (28%, p = 0.001), June (29%, p = 0.002), and July of 2020 (30%, p = 0.005) only. Conclusions: Adults at high risk of severe COVID-19 illness were disproportionately more likely to be physically inactive and exhibit lower MET-min levels than adults at low risk during the early months of the COVID-19 pandemic.
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    Increasing the Effectiveness of Targeted Temperature Management
    (American Association of Critical-Care Nurses, 2021) Moreda, Melissa; Beacham, Pamela S.; Reese, Angela; Mulkey, Malissa A.; School of Nursing
    Topic: Targeted temperature management and therapeutic hypothermia are essential components of the multimodal approach to caring for compromised patients after cardiac arrest and severe traumatic brain injury. Clinical relevance: The continuously evolving science necessitates summation of individual facets and concepts to enhance knowledge and application for optimally delivering care. Targeted temperature management is a complex therapy that requires fine-tuning the most effective interventions to maintain high-quality targeted temperature management and maximize patient outcomes. Purpose: To describe the underlying pathophysiology of fever and the importance of manipulating water temperature and of preventing and treating shivering during that process. Content covered: This article discusses nursing considerations regarding the care of patients requiring targeted temperature management that are necessary to improve patient outcomes.
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    Minimizing Post–Intensive Care Syndrome to Improve Outcomes for Intensive Care Unit Survivors
    (American Association of Critical-Care Nurses, 2022) Mulkey, Malissa A.; Beacham, Pamela; McCormick, Megan A.; Everhart, D. Erik; Khan, Babar; Medicine, School of Medicine
    Topic: Post-intensive care syndrome is a collection of symptoms that more than half of patients who survive a critical illness, and their family caregivers, experience after the illness. Those symptoms include weakness/ fatigue, sleep disturbances/insomnia, cognitive dysfunction, posttraumatic stress disorder, other mental health conditions, and a lack of effective coping strategies. Clinical relevance: To minimize the risk of a patient developing post-intensive care syndrome, intensive care unit nurses must adopt practices that reduce the severity of disability and optimize patient outcomes. They must also advocate for patients who need additional expert care. Purpose: To describe interventions that critical care nurses can implement to minimize a patient's risk for post-intensive care syndrome. Content covered: This article describes patients who have a high risk of developing post-intensive care syndrome and interventions that are within nurses' purview.
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    Rapid Hand-held Continuous EEG has the Potential to Detect Delirium in Older Adults
    (Wolters Kluwer, 2022) Mulkey, Malissa A.; Gantt, Laura T.; Hardin, Sonya R.; Munro, Cindy L.; Everhart, D. Erik; Kim, Sunghan; Schoeman, Alexander M.; Roberson, Donna W.; McAuliffe, Maura; Olson, DaiWai M.; School of Nursing
    Background: Delirium-related biochemical derangements lead to electrical changes that can be detected in electroencephalographic (EEG) patterns followed by behavioral signs and symptoms. Studies using limited lead EEG show a large difference between patients with and without delirium while discriminating delirium from other causes. Handheld rapid EEG devices may be capable of detecting delirium before symptom onset, thus providing an objective physiological method to detect delirium when it is most amenable to interventions. Objective: The aim of this study was to explore the potential for rapid EEG to detect waveform pattern changes consistent with delirium status. Methods: This prospective exploratory pilot study used a correlational design and mixed models to explore the relationships between handheld portable EEG data and delirium status. Results: While being under powered minimized opportunities to detect statistical differences in EEG-derived ratios using spectral density analysis, sleep-to-wake ratios tended to be higher in patients with delirium. Conclusions: Limited lead EEG may be useful in predicting adverse outcomes and risk for delirium in older critically ill patients. Although this population is at the highest risk for mortality, delirium is not easily identified by current clinical assessments. Therefore, further investigation of limited lead EEG for delirium detection is warranted.
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    Relationship between Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Prescribing and Delirium in the ICU-A Secondary Analysis
    (Wiley, 2023) Mulkey, Malissa A.; Khan, Sikandar; Perkins, Anthony; Gao, Sujuan; Wang, Sophia; Campbell, Noll; Khan, Babar; Medicine, School of Medicine
    Background: Studies suggest Angiotensin-Converting Enzyme inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) may slow the decline of memory function in individuals with mild to moderate Alzheimer's disease by regulating migroglial activation and oxidative stress within the brain's reticular activating system. Therefore, we evaluated the relationship between delirium prevalence and being prescribed ACEI and ARB in participants admitted to the intensive care units (ICU). Methods: A secondary analysis of data from two parallel pragmatic randomized controlled trials was performed. ACEI and ARB exposure was defined as being prescribed an ACEI or an ARB within six months prior to the ICU admission. The primary endpoint was the first positive delirium assessment based on Confusion Assessment Method for the ICU (CAM-ICU) for up to thirty days. Results: A total of 4791 patients admitted to the medical, surgical, and progressive ICU and screened for eligibility for the parent studies between February 2009 and January 2015 from two level 1 trauma and one safety net hospital in a large urban academic health system were included. Delirium rates in the ICU were not significantly different among participants with no exposure to ACEI/ARB (12.6%), or exposure to ACEI (14.4%), ARB (11.8%), or ACEI and ARB in combination (15.4%) in six months prior to the ICU admission. Exposure to ACEI (OR = 0.97[0.77, 1.22]), ARB (OR = 0.70 [0.47, 1.05]), or both (OR = 0.97 [0.33, 2.89]) in six months prior to ICU admission was not significantly associated with odds of delirium during the ICU admission after adjusting for age, gender, race, co-morbidities, and insurance status. Conclusions: While the impact of ACEI and ARB exposure prior to the ICU admission was not associated with the prevalence of delirium in this study, further research is needed to fully understand the impact of antihypertensive medications on delirium.
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    Understanding Disorders of Consciousness: Opportunities for Critical Care Nurses
    (American Association of Critical Care Nurses, 2021) Mulkey, Malissa A.; School of Nursing
    Background: Disorders of consciousness are powerful predictors of outcomes including mortality among critically ill patients. Encephalopathy, delirium, and coma are disorders of consciousness frequently encountered by critical care nurses but often classified incorrectly. Objective: To provide a greater understanding of disorders of consciousness and to provide standardized assessments and nursing interventions for these disorders. Methods: A literature search was conducted by using the terms consciousness, mental status, awareness, arousal, wakefulness, assessment, disorders of consciousness, delirium, encephalopathy, coma, vegetative state, and minimal consciousness. Articles were published in the past 10 years in CINAHL and PubMed. Articles were excluded if they were not in English or directly related to caring for patients with a disorder of consciousness. The remaining 142 articles were evaluated for inclusion; 81 articles received full review. Results: A disorder of consciousness signifies that the threshold for compensation has been surpassed with potentially irreversible damage. Altered thalamocortical interactions and reduced cortical activity impair communication networks across the various parts of the brain, causing a disturbance in consciousness. Discussion: The cue-response theory is a model that describes the process and impact of nursing care on recovery from acute brain injury. Appropriate standardized assessments and interventions must be used to manage altered levels of consciousness in critically ill patients. Conclusions: Paying close attention to neurological changes and monitoring them with standardized assessments are critical to implementing early measures to prevent complications.