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Programmed Intermittent Epidural Bolus Compared to Continuous Epidural Infusion: An Evaluation of Patient Outcomes
No full textA programmed intermittent epidural bolus (PIEB) has started to replace the continuous epidural infusion (CEI) standard. Because an intermittent bolus is delivered at a higher pressure, the medication spreads to more dermatomes, preventing it from accumulating, and delivers analgesia with minor motor blockade. The aim of this study was to determine if PIEB would decrease the number of rescue boluses, reduce the duration of the second stage of labor, and increase patient coping scores compared to CEI. A retrospective chart review was conducted at a Midwestern tertiary medical center over six months. This case-control design had an intervention group receiving intermittent epidural bolus and a control group receiving a continuous epidural infusion. Data extraction of a randomized sample of 60 laboring women with epidurals was obtained, with 30 women in each group. Primary outcomes were the number of rescue boluses, the duration of second stage of labor, and patient coping scores. Comparison results of the two groups was done by t-tests. The intervention group had fewer rescue boluses (p = .03). No statistical difference was shown in the duration of second stage of labor and patient coping percentage. The study showed PIEB decreased the number of rescue boluses, thus reducing nurse anesthetist workforce labor. Furthermore, the duration of second stage of labor and patient coping scores showed no statistical significance between the two groups
Administering Intraoperative Dexmedetomidine During Laparoscopic Cholecystectomy Improves Postoperative Outcomes
No full textOpioids are important in medicine, though their use can lead to multiple negative effects. Additionally, misuse of opioids outside of a medical setting can have detrimental impacts on the economy and population health. By utilizing dexmedetomidine, a non-opioid, alpha-2 agonist, anesthesia providers may be able to decrease overall opioid consumption and postoperative pain scores while also decreasing postoperative nausea and vomiting (PONV) associated with opioids and general anesthesia. In this retrospective study, we looked at one institution's use of dexmedetomidine in laparoscopic cholecystectomies and compared the results to results found in current literature regarding dexmedetomidine. Data were extracted from 76 total patients who underwent laparoscopic cholecystectomy. Patients who were pregnant, took chronic opioids, underwent emergent laparoscopic cholecystectomies, or who had received a cumulative dose of less than 0.2 mcg/kg were excluded. There was an even split of 38 patients in both the intervention group who received dexmedetomidine and the control group who did not. It was found that the intervention group did not experience lower opioid consumption (p = .17) or pain scores (p = .40) but did experience significantly less PONV (p = .03). Furthermore, the intervention group did not experience longer time to extubation (p = .72) or PACU length of stays (p = .69). These findings suggest utilization of dexmedetomidine as an adjunct for patients at high risk for PONV should be considered at this institution
Servant Leadership in Higher Education: Exploring Its Perceived Effect on Job Satisfaction and Employee Engagement on Faculty and Non-Faculty in the United States
No full textThe purpose of the literature review was to determine and compare how the perception of servant leadership effects job satisfaction and employee engagement on both faculty and non-faculty staff in higher education institutions in the United States. Very few studies look at higher education and servant leadership and its role in job satisfaction. Both faculty and staff play an important part in the higher education system. With college enrollment decreasing as well as the effects of the �Great Resignation� and people leaving their careers, it is important, now more than ever, to discover what drives job satisfaction and employee engagement in the higher education sector
Fruit and Vegetable Consumption in College-Aged Students and Associated Barriers
No full textUniversity students experience a variety of life changes during the college years, including an often new-found sense of independence, decision-making, and more. Dietary habits during this time may look significantly different than prior to college. This study aimed to look at fruit and vegetable consumption of university students at Viterbo University in La Crosse, Wisconsin in relation to the United States Department of Agriculture (USDA) dietary recommendations. A total of 61 responses were collected, and 49 were used. Participants were asked a number of questions regarding their average fruit and vegetable consumption, their knowledge of USDA recommendations, how they perceive their intakes, and their barriers to consuming the dietary recommendations. Survey results showed that over 80% of students were not aware of the USDA recommendation for daily fruit and vegetable intake. Additionally, 59% of students reported they do not think they consume enough fruit daily, and 71% reported they do not think they consume enough vegetables daily. The most common barriers reported included cost, access, and preparation knowledge. These results may help in developing future educational materials and providing resources for college-aged students
Picture This: Can Pictogram Medication Labels Increase Medication Adherence?
No full textTo determine whether pictogram medication labels are more effective than text-only labels when given to patients with low health literacy and/or limited English proficiency as it relates to patient medication understanding and use. This should, in turn, improve patient safety, and medication adherence
Early Follow-Up Visits to Reduce Readmission Rates in Congestive Heart Failure Patients
No full textTo determine the effectiveness of early follow-up visits for patients with congestive heart failure (CHF) in hopes to reduce readmission rates within 30 days after discharge
Cardiac Rehabilitation Results in Positive Health Outcomes in Cardiac Patients
No full textTo determine the efficacy of completing a cardiac rehabilitation program for patients with a cardiac history, within the scope of measures for cardiac rehab, to improve health outcomes post hospital discharge
Anesthesia Procedural Guidelines for Neuro-Spine Surgeries
No full textAnesthesia providers are required to create anesthetic plans of care which are tailored to a multitude of specific surgical operations while also incorporating surgeon preferences and individual patient factors. Recent literature suggests that the implementation of an anesthesia procedural guideline for neuro-spine procedures may improve operating room efficiency, patient outcomes, and staff confidence. This quality improvement project developed and implemented an anesthesia guideline and compared retrospective data and post-intervention data to determine if the implementation of the guideline impacted a predetermined list of outcomes. The pre-implementation group consisted of 38 patients while the post-implementation group consisted of 34 patients. Demographic data were collected and analyzed, and no significant differences were identified between the two groups. Outcome data were statistically analyzed using paired, two-tailed t-tests; staff survey data were analyzed using chi-squared tests. Efficiency markers (time from in-room to incision, in-room to turnover, case end to anesthesia end) showed some improvement, but there was no statistical significance in any category (p = .740; p = .841; p = .549). Mean postoperative pain scores did not show any improvement (p = .127). There was a reduction in pain scores in patients who received ketorolac, but it was not statistically significant (p = .449). The staff survey data showed no statistically significant changes in confidence when providing anesthesia for neuro-spine surgeries. This project had multiple limitations including limited anesthesia providers and subjective data. Future studies with larger sample sizes at a larger institution may provide more significant results
The Effect of Vitamin D Supplementation on Cognitive Function: A Systematic Review and Meta-Analysis
No full textVitamin D deficiency has become a public health concern of the world and is seen in many individuals with comorbidities and dementia. The aim of this meta-analysis was to assess the effect of vitamin D supplementation on cognitive function among the general population. PubMed was screened for randomized control trials (RCCTs) and randomized crossover trials on vitamin D supplementation for adult subjects. The measure outcome for this study was executive cognitive function. An Evidence Analysis Worksheet along with the Quality Criteria Checklist (QCC) was used to assess selected studies' bias and quality of study. The effect sizes for interventions in each study were calculated using the standardized mean differences (SMD). A total of six studies and 1664 participants (adults 20 years and older without Dementia or Alzheimer's diagnosis at baseline) were included in this study. All six studies received a positive quality rating based on relevance and validity questions from the QCC. A random effects model was used in the statistical analysis. A dose of vitamin D supplementation of a dose >400 IU/day showed no significant difference on executive function for the Digit Span Score (DSP) (SMD: 0.0, 95% CI: -0.10 to 0.10; p= 0.9362; I2= 0%), the Paired Associate Learning (PAL) (SMD: -.38, 95% CI:-0.81 to 0.05; p=0.0838; I2 = 79.18%), and the Trail Making test (TMT) (SMD: -0.14, 95% CI: -0.39 to 0.11; p = 0.2788; I2 = 0%) compared to the controls. The results failed to show a significant effect of vitamin D supplementation on executive function of cognition compared to a placebo or low dose. Future research should include larger trials with similar demographics and over a longer period