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Elements of a successful quality improvement initiative.

: Analyze the elements of a successful quality improvement initiative.
o Explain evidence-based and best-practice solutions to improve patient safety focusing on medication administration and reducing costs.
• Competency 2: Analyze factors that lead to patient safety risks.
o Explain factors leading to a specific patient-safety risk focusing on medication administration.
• Competency 4: Explain the nurse’s role in coordinating care to enhance quality and reduce costs.
o Explain how nurses can help coordinate care to increase patient safety with medication administration and reduce costs.
o Identify stakeholders with whom nurses would need to coordinate to drive quality and safety enhancements with medication administration.

Sample Solution

eurofilament mRNAs are selectively reduced in diabetic rats and alterations on post-translational modification of NF proteins have been detected. A reduction of myelinated fiber size is correlated with axonal NFs loss in peripheral nerves of STZ-induced diabetic rats (25, 26), and mRNAs levels encoding for NF-L and NF-H are reduced in the same animal model of diabetes (7). Moreover, changes on the expression of several NF-associated protein kinases isoforms may also contribute to diabetes-induced changes (4). Several protein kinases regulate NF phosphorylation status, being NFs hyperphosphorylation a hallmark of several neurodegenerative diseases. Abnormal NF phosphorylation has been described in sensory neurons of animal models of type 1 diabetes (27). Moreover, in the spinal cord of diabetic rats there is increased phosphorylation of NF-H, (28). Additionally, changes on the activity of Cdk5 and GSK-3β kinases have been described to alter the phosphorylation status of NFs in an animal model of type 1 diabetes. Specifically, in dorsal root ganglion neuronsincreased phosphorylation of GSK-3β correlated linearly with increased phosphorylation of NF-H, while decreasing activity of Cdk5 is associated with reduced phosphorylation of NF-M, which may result in progressive deficits of axonal function (29). Microfilaments Microfilaments (or actin filaments) are the thinnest filaments of the cytoskeleton, having 6 nm in diameter, providing both stability and dynamics to neurons. In neurons, actin filaments are packed into networks and stabilized by interacting proteins (22). Microfilaments play a role in spine formation and spine volume stabilization (30), with the dynamics of actin leading to the formation of new synapses as well as increased cell communication. The actin cytoskeleton controls several cellular processes. In animal models of diabetes there is an impairment of slow axonal transport of cytoskeletal elements like tubulin and NF proteins (slow component a), and polypeptides such as actin (slow component b) (31-33). Actin undergoes glycation in the brain of STZ-induced diabetic rats and the appearance of glycated actin is prevented by administration of insulin (9, 34). More recently, it was investigated if the receptor for advanced glycation end-product (RAGE) is involved in axonal transport impairment via interaction with its cytoplasmic domain binding partner mDia1, which is involved in actin structure modifications. Slow axonal transport in the peripheral nerves is indeed affected by diabetes, but in a RAGE-independent manner (35). Moreover, mDia1 axonal transport is impaired, suggesting that diabetes-induced changes affecting actin binding proteins are early events in the course of the pathology (35), and forward the hypothesis that mDia1 axonal transport impairment might be correlated with the extent of actin glycation (34).
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