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A Systematic Review Comparing Neostigmine Versus Sugammadex
Get PDFPostoperative residual muscle paralysis can lead to very serious complications, such as hypoxia, airway obstruction, and generalized muscle weakness after surgical procedures. Traditional anesthesia practice has utilized a class of medications called cholinesterase inhibitors to mitigate these complications. Cholinesterase inhibiting agents have the potential to create adverse effects of their own, such as bradycardia, due to the drug class’s indirect mechanism of action. An ideal reversal agent would reverse quickly, and reliably, with minimal adverse effects. Recently, sugammadex, a selective relaxant- binding agent, has been introduced as an alternative reversal agent. The purpose of this systemic review was to compare the administration of sugammadex versus neostigmine and time to re-establish normal muscular function, as evidenced by a train-of-four (TOF) ratio of 0.9. Databases were searched for pertinent randomized control trials and literature regarding the topic of this review. Inclusion and exclusion criteria were utilized to finalize the five studies that were included in this systematic review. The PRISMA checklist and CASP tool was utilized to extract and critically appraise each study. Additionally, a cross study analysis was performed. Overall, sugammadex was found to be a faster and more reliable reversal agent, with mild-to-moderate adverse effects reported, when compared to the anticholinesterase, neostigmine. Consistently and reliably reversing neuromuscular blocking agents and educating other health care professionals about the negative consequences of postoperative residual muscle paralysis, are initiatives that the advance practice nurse, particularly the CRNA, can lead
The Impact of Intrathecal Dexmedetomidine as an Adjuvant to Bupivacaine on Postoperative Pain
Get PDFPostoperative pain is an unpleasant consequence of all surgical procedures. It is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. There are many negative consequences to postoperative pain including delayed recovery, increased healthcare costs, and overall dissatisfaction with care. There are many methods to minimize postoperative pain. Spinal anesthesia has been used for years to improve postoperative pain across a variety of surgical procedures. New research has shown that the use of adjuvant medications with intrathecal bupivacaine greatly improves postoperative pain. One adjuvant medication is dexmedetomidine. The purpose of this systematic review was to determine if the administration of intrathecal dexmedetomidine, as an adjuvant medication to bupivacaine, impacts postoperative pain in adult patients undergoing surgery. A literature review was conducted using the PRISMA flow diagram. Data was then collected from each study and a cross study analysis was conducted. Findings indicated, in all studies, the addition of dexmedetomidine to intrathecal bupivacaine decreased postoperative pain levels. Integration of dexmedetomidine into spinal anesthesia can make an immense difference in postoperative analgesia and recovery, an important consideration for anesthesia providers
Building an in vivo model of Tau aggregation in Saccharomyces cerevisae
Get PDFProtein aggregates, which can result in cellular toxicity, are found in the brains of people afflicted with neurodegenerative diseases. One of the proteins found to aggregate is Tau, a protein that stabilizes microtubules in neuronal cells. Based on its amino acid sequence, Tau is likely to be N-terminally acetylated by the complex NatA, which is responsible for the acetylation of a majority of proteins with this post-translational modification. Mutations in the NatA complex result in a variety of pleiotropic detrimental phenotypes, showing that acetylation is a crucial modification for many proteins. Without the presence of NatA – and therefore without acetylation – Tau may be more prone to aggregation and toxicity. By expressing Tau in yeast strains with and without the presence of NatA, the possible effects of acetylation or lack thereof can be determined by examining protein expression and aggregation within the cells by SDS-PAGE and SDD-AGE. Initial results indicate that Tau aggregates within these yeast cells although the nature and effect of the aggregates is still being determined. This project has allowed for the creation of a system by which Tau aggregates can be examined in vivo
Does Nurse Management Effect Continuous Renal Replacement Downtime?
Get PDFAcute kidney failure (AKI) is common among patients in the intensive care unit (ICU) and can have a mortality rate of up to 70%. Continuous renal replacement therapy (CRRT) provides constant dialysis treatment and is the recommended treatment for hemodynamically unstable AKI patients. Delay in CRRT delivery and interruptions of therapy are associated with negative outcomes such as fluid overload, electrolyte imbalance, acid-base imbalance and death. To reduce CRRT downtime, there has been a trend for the critical care nurse to be autonomous with the set-up, management and\ trouble-shooting of treatment instead of a collaboration between the critical care nurse and dialysis nurse. The purpose of this study was to investigate the difference in CRRT therapy downtime with critical care nurse management compared to collaborative management performed by the critical care nurse and dialysis nurse. This research was guided by Benner’s Novice to Expert Model as it best represents the trajectory for nurses attaining the clinical competence to master total management of CRRT. A retrospective chart review was conducted with a total of 43 downtime incidences managed autonomously by the critical care nurse and a total of 48 CRRT downtime incidences managed by a collaboration between the critical care nurse and dialysis nurse. Results demonstrated that the mean CRRT downtime managed autonomously by the critical care nurse, 7,728.8 seconds was significantly less than the CRRT downtime managed by a collaboration between the critical care nurse and dialysis nurse, 13,915 seconds (p =0.01). Further research is indicated to determine the best nursing management of CRRT to reduce treatment downtime
Registered Nurses\u27 Knowledge of Pneumonia Prevention Implementing Incentive Spirometry in Adult Hospitalized Postoperative Patients: A Quality Improvements
Get PDFIn 2011, the Centers for Disease Control and Prevention (2018) estimated there were 157,500 cases of hospital-acquired pneumonia (HAP). Of those, ventilator associated pneumonia (VAP) had declined with increased efforts aimed at prevention, while nonventilator pneumonia (NV-HAP) did not have such prevention interventions and escalated, with approximately 2300 cases and 5600 respectively reported in one state (Baker & Quinn, 2018). The 2012 Healthcare Cost and Utilization Project National Inpatient Sample reported only 4 million people were at risk for VAP, while approximately 35 million more people were at risk for NV-HAP in the United States. The purpose of this project was to evaluate surgical unit registered nurses’ knowledge related to incentive spirometer (IS) in the prevention of NV-HAP postoperatively. The design of this quality improvement, program development project included a pretest, an evidence-based educational intervention specific to IS and a posttest administered to a small sample of RNs, guided by the Logic Model Framework. The results indicated that RNs’ perspectives on patients’ use of IS can be influenced following an educational session related to IS; however, the results showed a decrease in agreement reflecting the new knowledge of the nurses of the present evidence as it relates to incentive spirometry. These results also supported previous research findings and contribute to a body of knowledge validating nurses’ need for endorsed guidelines on appropriate usage of IS to prevent postoperative pneumonia. The Advanced Practice Nurse has a unique role that can directly impact the prevention of postoperative pneumonia
Risk factors for incident prostate cancer in a cohort of world trade center responders
Get PDFDespite a relatively young average age and no routine screening, prostate cancer is one of the most common cancers in men who worked at the World Trade Center (WTC) following the 9/11/2001 disaster. This study evaluated whether re-experiencing stressful memories of a traumatic event was associated with prostate cancer incidence
Women\u27s Sexual Satisfaction and Overall Well-being: Examining Relationship Satisfaction, Sexual Agency, Sociosexual Orientation and Relationship Status
Get PDFMedical and psychological research has found a strong association between sexual satisfaction and overall well-being. However, few studies have addressed whether the relationship between women’s sexual satisfaction and overall well-being differs for women of different ages. This mixed-method study recruited 347 women aged 18 to 76 and found (1) a positive significant association between age, relationship satisfaction, and sexual satisfaction and overall well-being, and higher levels of sexual satisfaction are associated with higher levels of overall well-being. However, age was unrelated to sexual satisfaction and overall well-being, and; (2) while relationship satisfaction interacted with sexual satisfaction and overall well-being, there was no interaction effect of age. Results also indicated that relationship status was unrelated to women\u27s sexual satisfaction. However, sexual satisfaction was positively associated with overall well-being. Semistructured interviews of eight women (ages 20-52) explored women’s attitudes and behaviors pertaining to sex, sexual satisfaction, and wellness. Findings from this study can inform future health psychology and health education efforts to promote the pursuit of sexual satisfaction as a set of healthy behaviors fundamental to overall well-being for women of all ages
Integration of Early Palliative Care in Oncology Patients: Improving Nursing Knowledge and Confidence
Get PDFPalliative care integrated with standard oncology care in cancer patients has been shown to provide a number of beneficial clinical outcomes. Despite the evidence, the utilization of palliative care in the oncology population continues to be inadequate. The purpose of this program development, quality improvement project was to improve nurses’ knowledge regarding palliative care and the benefits of its early implementation in the oncology population, as well as to improve their confidence regarding palliative care consultations to providers. An educational intervention was designed and a pre and posttest were utilized to determine the effect of the intervention. This program development, quality improvement project demonstrated that the implementation of nursing education regarding palliative care within the oncology population increased nurses’ knowledge in palliative care, specific to the oncology population, as well as confidence in recommending appropriate palliative care consultations to providers
Effects of Prebriefing on APRN Student Self-Confidence in Simulation-Based Learning
Get PDFThe contemporary American Health Care System created a demand for skilled advanced practice registered nurses (APRNs) to meet the health care needs of the U.S. population. It is imperative that graduate nursing programs adequately educate APRN students with the competencies to address these demands. Graduate nursing programs have adopted simulation-based learning to provide safe, cost-effective learning opportunities without the potential for real-world negative outcomes that can arise during hospital-based education. The purpose of this quality improvement project was to provide a tailored, APRN-focused prebriefing activity before simulation-based learning and measure its effects on self-reported student self-confidence scores. This project was conducted using a quantitative post-intervention survey design with a convenience sample of 17 APRN students. The participants were provided a prebriefing intervention by email prior to their interprofessional education (IPE). After the prebriefing intervention, the APRN students participated in four pre-established IPE simulation scenarios. The participants were then asked to complete the National League for Nursing (NLN) Satisfaction and Self-confidence in Learning Scale, a thirteen-statement survey with a 5-point Likert scale measuring self-reported, student satisfaction and self confidence related to their simulation-based learning experiences. Overall, high scores resulted on the post-intervention survey for the two subscales. This project supported the implementation of a structured prebriefing activity before IPE simulation-based learning in graduate nursing education
Tales as old as time: Beauties and their Beasts from History through the Modern Age
No full textThe fairy tale La Belle et La Bête (Beauty and the Beast) has continued to capture the public imagination since its original publication in 1740. This thesis examines the two earliest literary versions of the story, and the two Disney film adaptations, using gender and queer theory to question the stories’ role in reinforcing the gender binary and compulsory heterosexuality