BACKGROUND AND OBJECTIVES

Heart Failure (HF) remains a major health concern worldwide. In the Philippine General Hospital (PGH), HF is consistently a top cause of mortality and readmissions among adults. The American College of Cardiology (ACC) and European Society of Cardiology (ESC) published guidelines for interventions that improve quality of life and survival, but they are underused and untested for local acceptability. Hospitals overseas used order sets created from these guidelines, which resulted in a considerable decrease in in-hospital mortality and healthcare costs. We aimed to develop an order set for adult patients with acute heart failure (AHF) admitted to the PGH Emergency Department (ED) to improve care outcomes.

This study utilized a mixed methods approach to create the AHF order set. ESC and ACC HF guidelines were appraised using the AGREE II tool. Class I interventions for AHF were included in the initial order set. Through focused group discussions (FGD), clinicians and other care team members involved in the management of AHF patients at PGH ED modified and validated the order set. Stakeholders were asked to use online Delphi and FGD to get a consensus on how to amend, approve, and carry out the order given.

Upon review of HF guidelines, 29 recommendations on patient monitoring, initial diagnostic, and therapeutic interventions were adopted in the order set. Orders on subspecialty referrals and ED disposition were introduced. The AHF patient was operationally defined in the setting of PGH ED. The clinical orders fit the PGH context, ensuring evidence-based, cost-effective, and accessible care responsiveness to patients’ needs and suitable for local practice. Workflow changes due to COVID-19 were considered. Potential barriers to implementation were identified and addressed. The final order set was adopted for implementation through stakeholder consensus.

The PGH developed and adopted its own AHF order set that is locally applicable and can potentially optimize outcomes of care.

BACKGROUND

The capability of nurse educators to teach and practice quality improvement (QI) is crucial in assisting students in their transition to becoming professionals. Understanding the strengths and limitations of nurse educators on QI can be a logical start to determine if they can keep up with the expectations.

This paper aimed to determine the nurse educators' knowledge, preparation, application, and participation in QI, as well as the differences when grouped according to years of teaching and BSN degree completion.

A descriptive correlational design was utilized involving nurse educators from six nursing schools in Baguio City, Philippines. Only full-time nurse educators with official teaching load during the data gathering, regardless of academic background and position, were eligible. Faculty members who were on leave were excluded. A self-made tool (CVI 0.90, Cronbach's alpha 0.90) was used to gather data. Unpaired t-tests and ANOVA were used to determine the significant differences in the scores. Multiple regression was utilized to compute the relationship between knowledge, preparation, and participation in applying QI.

104 nurse educators responded. Results show that they are knowledgeable (x̄= 15.82; SD = 0.11), somewhat prepared (x̄= 2.93; SD = 0.08), and participated reasonably well (x̄= 2.77; SD = 0.11) on QI. Higher scores were given to the application of QI in the nursing courses (x̄= 2.44; SD = 0.08) and teaching-learning strategies (x̄= 0.83; SD = 0.07), compared with its application in improving Self as educators (x̄= 2.30; SD = 0.11), and improving student's learning outcomes (x̄= 2.13; SD = 0.11). Scores of nurse educators with more than ten years of teaching experience significantly differed in the extent of knowledge, application in teaching-learning strategies, and application of QI tools to improve Self and participation compared to those with less teaching experience. The scores did not significantly vary when grouped according to BSN degree completion. A positive relationship was observed between preparation and the application of QI tools to improve Self (p = 0.00). Data also showed a positive relationship between participation with application in nursing courses (p = 0.00), application of QI tools to improve Self (p = 0.00), and student learning outcomes. (p = 0.00).

The results of this study are encouraging and show the potential of nurse educators to apply quality improvement in the nursing curriculum. The adept use of technological tools in producing QI projects can augment the strength of nurse educators in meeting patient-centered care. Teaching experience can contribute to a better grasp of the concepts and maximum integration of quality improvement in nursing students' learning. Identifying, mobilizing, and supporting QI champions to spearhead the mentoring of new faculty members on QI may be a viable strategy to sustain a culture that values quality improvement. It further calls for the attention of educational institutions to develop policies to inform nurse educators in applying QI concepts.

Background and Objectives: Heart Failure (HF) remains a major health concern worldwide. In the Philippine General Hospital (PGH), HF is consistently a top cause of mortality and readmissions among adults. The American College of Cardiology (ACC) and European Society of Cardiology (ESC) published guidelines for interventions that improve quality of life and survival, but they are underused and untested for local acceptability. Hospitals overseas used order sets created from these guidelines, which resulted in a considerable decrease in in-hospital mortality and healthcare costs. We aimed to develop an order set for adult patients with acute heart failure (AHF) admitted to the PGH Emergency Department (ED) to improve care outcomes. Methods: This study utilized a mixed methods approach to create the AHF order set. ESC and ACC HF guidelines were appraised using the AGREE II tool. Class I interventions for AHF were included in the initial order set. Through focused group discussions (FGD), clinicians and other care team members involved in the management of AHF patients at PGH ED modified and validated the order set. Stakeholders were asked to use online Delphi and FGD to get a consensus on how to amend, approve, and carry out the order given. Results: Upon review of HF guidelines, 29 recommendations on patient monitoring, initial diagnostic, and therapeutic interventions were adopted in the order set. Orders on subspecialty referrals and ED disposition were introduced. The AHF patient was operationally defined in the setting of PGH ED. The clinical orders fit the PGH context, ensuring evidence-based, cost-effective, and accessible care responsiveness to patients’ needs and suitable for local practice. Workflow changes due to COVID-19 were considered. Potential barriers to implementation were identified and addressed. The final order set was adopted for implementation through stakeholder consensus. Conclusion The PGH developed and adopted its own AHF order set that is locally applicable and can potentially optimize outcomes of care.
Quality Improvement ; Critical Pathways

Infant, Newborn ; Humans ; Quality Improvement ; Intensive Care Units, Neonatal

Conducting and writing quality improvement studies is a skill that every family and community physician should learn and apply in their practice. As family and community physicians it is one of our responsibilities to provide quality health care to our patients.1 Simply put, “quality” is doing the right thing right the first time and doing it better the next. Similar to the doctor-patient interaction in a typical consult, where the physician’s objective is to learn as much as possible about the patient’s signs and symptoms and medical history in order to make the right diagnosis and thus render the right treatment. The physician strives to do all this on the first visit and hopes to keep up-to-date on the condition so that when another patient presents with the same condition, he or she will receive better and more current care.

The "new engineering" concept requires that in addition to laying a solid professional foundation, engineering colleges and universities in China should also pay attention to improving the humanistic quality and developing a professional ethics education in training the engineering and technical talents. One important way is to carry out the engineering ethics education. By referring to the mature case-teaching ideas around the world and combining the practical experience accumulated in recent years, this paper focuses on the curriculum development and teaching reform of engineering ethics for students studying biological and medical engineering, from the perspectives of case selection and teaching method innovation. It also introduces some typical case studies, and summarizes the teaching effect analyzed from questionnaire.
Humans ; Curriculum ; Engineering/education* ; Students ; Ethics, Professional ; Biology/education*

5-aminovalanoic acid (5AVA) can be used as the precursor of new plastics nylon 5 and nylon 56, and is a promising platform compound for the synthesis of polyimides. At present, the biosynthesis of 5-aminovalanoic acid generally is of low yield, complex synthesis process and high cost, which hampers large-scale industrial production. In order to achieve efficient biosynthesis of 5AVA, we developed a new pathway mediated by 2-keto-6-aminohexanoate. By combinatory expression of L-lysine α-oxidase from Scomber japonicus, α-ketoacid decarcarboxylase from Lactococcus lactis and aldehyde dehydrogenase from Escherichia coli, the synthesis of 5AVA from L-lysine in Escherichia coli was achieved. Under the initial conditions of glucose concentration of 55 g/L and lysine hydrochloride of 40 g/L, the final consumption of 158 g/L glucose and 144 g/L lysine hydrochloride, feeding batch fermentation to produce 57.52 g/L of 5AVA, and the molar yield is 0.62 mol/mol. The new 5AVA biosynthetic pathway does not require ethanol and H₂O₂, and achieved a higher production efficiency as compared to the previously reported Bio-Chem hybrid pathway mediated by 2-keto-6-aminohexanoate.
Nylons ; Lysine/metabolism* ; Hydrogen Peroxide/metabolism* ; Metabolic Engineering ; Plastics/metabolism* ; Fermentation ; Escherichia coli/metabolism* ; Aminocaproates/metabolism*

Plastics are one of the most important polymers with huge global demand. However, the downsides of this polymer are that it is difficult to degrade, which causes huge pollution. The environmental-friendly bio-degradable plastics therefore could be an alternative and eventually fulfill the ever-growing demand from every aspect of the society. One of the building blocks of bio-degradable plastics is dicarboxylic acids, which have excellent biodegradability and numerous industrial applications. More importantly, dicarboxylic acid can be biologically synthesized. Herein, this review discusses the recent advance on the biosynthesis routes and metabolic engineering strategies of some of the typical dicarboxylic acids, in hope that it will help to provide inspiration to further efforts on the biosynthesis of dicarboxylic acids.
Biodegradable Plastics ; Dicarboxylic Acids ; Polymers/metabolism* ; Biodegradation, Environmental ; Metabolic Engineering

Engineering efficient enzymes or microbial cell factories should help to establish green bio-manufacturing process for chemical overproduction. The rapid advances and development in synthetic biology, systems biology and enzymatic engineering accerleate the establishing feasbile bioprocess for chemical biosynthesis, including expanding the chemical kingdom and improving the productivity. To consolidate the latest advances in chemical biosynthesis and promote green bio-manufaturing, we organized a special issue on chemical bioproduction that including review or original research papers about enzymatic biosynthesis, cell factory, one-carbon based biorefinery and feasible strategies. These papers comprehensively discussed the latest advaces, the challenges as well as the possible solutions in chemical biomanufacturing.
Synthetic Biology ; Carbon ; Metabolic Engineering

Tetraacetyl phytosphingosine (TAPS) is an excellent raw material for natural skin care products. Its deacetylation leads to the production of phytosphingosine, which can be further used for synthesizing the moisturizing skin care product ceramide. For this reason, TAPS is widely used in the skin care oriented cosmetics industry. The unconventional yeast Wickerhamomyces ciferrii is the only known microorganism that can naturally secrete TAPS, and it has become the host for the industrial production of TAPS. This review firstly introduces the discovery, functions of TAPS, and the metabolic pathway for TAPS biosynthesis is further introduced. Subsequently, the strategies for increasing the TAPS yield of W. ciferrii, including haploid screening, mutagenesis breeding and metabolic engineering, are summarized. In addition, the prospects of TAPS biomanufacturing by W. ciferrii are discussed in light of the current progresses, challenges, and trends in this field. Finally, guidelines for engineering W. ciferrii cell factory using synthetic biology tools for TAPS production are also presented.
Sphingosine ; Ceramides ; Metabolic Engineering ; Synthetic Biology