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Intraoperative Reminder for Low-Flow Anesthesia
No full textAnesthetic gases, such as sevoflurane, are highly effective in providing amnesia but are greenhouse gases that contribute to climate change. Anesthesia providers can utilize low fresh gas flow (FGF) rates of 1 liter per minute (L/min) to decrease the amount of gas released into the environment while maintaining safe and effective care. This quality improvement project aimed to decrease the anesthesia department’s total amount of sevoflurane administered. The secondary aims of this project were to increase the number of cases that utilized FGF rates of 1 L/min or less and calculate the cost savings from the change in practice. An intraoperative reminder was implemented, and the department website was updated to encourage providers to reduce FGF rates after induction. Chart reviews were completed for 3-weeks before and after implementation to collect the total milliliters of sevoflurane used. After the implementation of the reminder, there was no decrease in the milliliters of sevoflurane used over 3-weeks. However, there was a 7% increase of cases that used low-flow. There was also a reduction in the total departmental FGF rate between the pre- to post-implementation period from 3.7 to 3.0 L/min. The use of an intraoperative reminder supporting low-flow anesthesia was not an effective tool to decrease the amount milliliters of sevoflurane used. There were numerous variables that could have contributed to the increase in sevoflurane used including the inability to implement a clinical decision support tool, difference in demographic data between samples, new anesthesia students, and sample size. Keywords: low-flow anesthesia, intraoperative reminder, carbon emissions, sevofluran
Bioavailability of calcium and calcium content in plant-based milk substitutes and Cow's milk: a systematic review
No full textResearch question: Do plant-based milk alternatives have a lower calcium bioavailability than cow's milk? Aim: To present a whole picture of calcium digestibility and examine the factors that may affect bioavailability and absorption of calcium in plant based and cow's milk. Background: For the best bone health, individuals use consume an ample amount of calcium, Dairy milk has long been seen by Americans as the basis of a balanced diet. Milk has long been acknowledged by federal nutrition policy, and USDA as a high-quality staple source of protein and calcium. With the raise of popularity in non- dairy milk the nutritional value and bioavailability of calcium has ensued further questioning and examination when compared to cow's milk. Methods: A systematic review investigating dietary calcium bioavailability and calcium content in plant-based milk alternatives in comparison to bovine milk. Results: The results revealed that regular cow's milk has more consistent bioavailability of calcium when compared to nondairy plant- based milk. Moreover, studies divulged that soy milk, plant-based milk alternatives had a lower calcium bioavailability than cow's milk. Conclusion: Despite the fact, the research around the bioavailability of the micronutrient calcium is troubling, it is imperative to cogitate a consumer's overall dietary habits, other plant sources, enrichment, and nutritional value. According to studies, plant-based milks (PBM) such as soy, have comparable calcium bioavailability to cow's milk (CM). Furthermore, lower calcium bioavailability is frequently addressed in plant-based milks through fortification or fermentation to boost their absorption in the body. When equated to cow's milk, some fortified nondairy plant- based alternatives exhibited a similar bioavailability of calcium. Keywords: Plant-based milk (PBM), cow milk (CM), Non-dairy substitutes (NDS), Tricalcium phosphate (TCP)-, calcium carbonate (CC), milk, calcium (Ca), absorption bioavailable
Pancreatectomy: Does Magnitude of Operation Impact Quality of Life?
No full textData regarding quality of life (QoL) following radical pancreatectomy are lacking. This prospective longitudinal project included adult patients (age ≥ 18 years) who underwent pancreatectomy from 1/12/2022 to 1/5/2023. Patient reported outcomes were evaluated using a validated linear analog self-assessment QoL questionnaire and a customized questionnaire to evaluate gastrointestinal (GI) symptoms. Patients (N = 71) were stratified into “standard” and “radical” resection groups (n = 58, n = 13). Thirty- and 60-day follow-up was completed by 89% and 68%, respectively. Overall QoL was higher in standard resections at 30 days (M 7.16, SD 1.88 vs M 5.85, SD 1.82, p = .03) and 60 days (M 7.82, SD 1.39 standard vs M 6.8, SD 2.49 radical, p = .241). The standard cohort reported lower surgery related complaints (32% vs 70%, p = .18) while the radical resection cohort were more likely to report they would not consider undergoing surgery again (8% standard vs 43% radical; p = .05). The radical resection cohort were more likely to report GI symptoms (100% vs 53%, p = .006) and 40% reported ≥ 4 bowel movements at 60-days (p = .01). Of all pancreatectomy cases, 35% developed New-onset diabetes mellitus and 37% reported pancreatic enzyme replacement therapy initiation. Standard questions allowed for identification and optimization of exocrine insufficiency. The customized questionnaire should be implemented in routine practice as a clinical decision-making tool and targeted quality improvement initiatives aimed at improving QoL and GI symptoms in high-risk patients should be considered
Finding Homeschooling Resources
No full textThe problem this project addresses is the lack of knowledge when it comes to homeschooling resources. Specifically finding peer-reviewed, close to non-bias textbooks and online resources at affordable prices. I find this to be an issue because not many people realize these sources are out there, and not just religious sources, but relatively nonbias/neutral
Multicultural Training in Counseling: Working with Children and Adult Children of Undocumented Immigrants
No full textThe purpose of this study was to determine if a summative program evaluation on the impacts of mental health concerns and social justice issues of children of undocumented immigrants would be helpful for counselors-in-training. Therefore, a presentation was created with the following content: laws in the United States, sanctuary states, cities, and counties, social justice issues, multicultural concerns and challenges, mental health concerns, implications for clinical practice, provider resources, client resources, and a case study. The presentation was presented to a convenience sample that consisted of students enrolled in the Master of Science in Mental Health Counseling program (n = 15) at a midwestern university. It was hypothesized that a summative program evaluation on understanding needs or concerns of children and adult children when their parents are undocumented immigrants would be helpful for counselors-in-training. The findings suggested that a program discussing the needs and concerns of children and adult whose parents are undocumented immigrants was helpful for counselors-in-training (n = 15, mean = 4.13)
Systemic Racism in the US HealthCare System
No full textSystemic racism is pervasive in the healthcare system : Long lasting ethnic/racial disparities in health care such as access to opportunities to prevent injuries, disease, and violence. The BIPOC (Blacks, Indigenous, and people of color) experience racial injustices in health care. These communities have unmet medical needs due to cost, lack of health insurance, and limited access to primary care (Caraballo et al., 2020)
Nutrition Counseling on College Student in Correlation with Iron Levels
No full textThe significance of academic success during a person's collegiate career is multifactorial, but heavily dependent on the mental and physical health of the individual. Cognitive performance can be linked to the physicality of one's body. Low iron status affects cognitive performance, potentially impacting a student's full potential for academic success. The purpose of this study is to provide more insight on the impact of how using nutritional counseling and educational methods affect outcomes of collegiate participants regarding iron level status. The study performed was over the course of a 4-week randomized controlled trial on college students. Using the random sampling method, a total of 15 participants were included in this study of nutrition counseling and education based on the results of their hemoglobin levels. The results provided evidence that nutrition counseling and education project a positive effect on iron status in individuals; however, further research should include a large trial of participants with similar characteristics and limitations to investigate the potential of how nutrition counseling affects different populations and cultures over an extended period
Are Instagram Influencers in the US and Canada a Reliable Source of Information on Nutrition and Weight Loss?
No full textSocial media has become a prevalent source of information on nutrition and weight management. However, the credibility of this information is often questionable, as anyone can post content regardless of their qualifications or expertise. The purpose of this study was to investigate whether Instagram influencers in the US and Canada were reliable sources of information on nutrition and weight loss. The research hypotheses stated that most influencers posting about nutrition and weight loss on Instagram are not qualified. To answer the research question, the study used nutrition- and weight-related keywords to search for Instagram influencers using the website influence.co. LinkedIn was used to verify the influencers' credentials and qualifications. A total of 70 influencers were found. Thirty-eight social media influencers were included in the study and 32 were excluded. The study found that only a small percentage (13.16%, n=5) had nutrition-related education, while the majority (57.89%, n=22) had non-nutrition-related education. A small proportion (10.53%, n=4) had some nutrition-related education. Out of the 5 influences that have nutrition-related education, only two influences had registered dietitian credentials. The study's results indicated that Instagram influencers are not a reliable source of information on weight loss and nutrition. The study suggested developing new strategies to regulate health information on social media. These measures can protect the public from harmful messages and help identify trustworthy sources of information on social media
Opioid-sparing Anesthesia During Laparoscopic Bariatric Surgery
No full textA retrospective quality improvement project on patients who underwent bariatric surgery was conducted within four Midwestern hospitals. This project compared clinically significant post-operative nausea and vomiting, post-operative pain control, and post-operative respiratory support in patients who had opioid-sparing versus non-opioid-sparing anesthesia. The non-opioid-sparing group received a median intraoperative opioid dose of 60 mg of morphine equivalents while the opioid-sparing group received a median intraoperative opioid dose of 0 mg of morphine equivalents. In the opioid-sparing group, 24.4% of patients had PONV compared to 37.2% of patients in the non-opioid-sparing group (OR = 0.65, 95% CI [0.38, 1.12], p = .123). Maximum post-operative pain scores were unaffected by opioid-sparing anesthesia (OR = 1.03, 95% CI [0.67, 1.58], p = .882). Post-operative opioid requirements were also unaffected by opioid-sparing anesthesia (OR = 0.91, 95% CI [0.63, 1.32], p = .613). Opioid-sparing anesthesia was associated with a reduced length of hospital stay (OR = 0.64, 95% CI [0.41, 1.00], p = .052). No statistically significant relationship was found between opioid-sparing anesthesia and length of stay in the post-anesthesia care unit nor time to ambulation. It can be concluded that receiving opioid-sparing anesthesia during bariatric surgeries can decrease the risk of post-operative nausea and vomiting without compromising post-operative pain control. Keywords: bariatric surgery, opioid-sparing, anesthesia, nausea, vomiting, pai
Job Embeddedness in Acute Care Gen Y Nurses
No full textNurse retention is vital in improving patient outcomes and maintaining the financial health of an organization. Generation Y employees will soon encompass the largest portion of the United States work force, therefore gaining insight into their motivations and experiences is warranted. Exploring Gen Y nurses through the lens of job embeddedness can help to understand why nurses stay rather than why they leave. The purpose of this study was to identify components of job embeddedness (fit, links, and sacrifice) that may influence Generation Y acute care nurses’ intention to stay. Semi-structured interviews were conducted to explore nine Generation Y registered nurses’ experiences in this qualitative study utilizing naturalistic inquiry. Three main themes emerged: fit, links, and sacrifice. Also identified in all nine participants were four subthemes: environment, work-life balance, community, and teamwork. Unexpected findings were open discussion of wages amongst staff and negative experiences with technology in the workplace. Findings indicated that components of job embeddedness were identified. Using identified components of job embeddedness can help leadership develop strategies to retain staff which can improve patient outcomes and staff satisfaction