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The Influence of Depression on Pain in the Postoperative Setting: A Systematic Review
Get PDFOver 5% of Americans over the age of 12 reported depression between 2005–2006, and it remains the second leading cause of death in the adolescent and the early adulthood population. The estimated worldwide impact of depression affects approximately 300 million people (World Health Organization [WHO], 2017). Few research studies analyzed the correlation of depression and postoperative pain. The impact of depression on physiological wellbeing, and evidence from various studies suggest a correlation between psychological illnesses such as depression and the physiological manifestations of pain. This systematic review will consider Randomized Controlled Trials (RCT’s), however in the absence of RCT’s, a Quasi-experimental design, and Prospective cohort studies, will be included. Inclusion criteria for the systematic review consists of: adults ≥ 18 years of age with self-reported depression, subjects who have mild, moderate, or severe postoperative pain, subjects who received anesthesia or analgesia, and who underwent ambulatory surgery. Six of the nine studies reported higher postoperative pain levels among participants who had increased preoperative depression, and three out nine studies reported a negative correlation. Overall limitations in this review include the inability to obtain the highest level of evidence such as RCT’s. Due to lack of available RCT studies, cohort studies provided the primary basis of information for which this study relied. Cohort studies do not provide the highest level of evidence, and therefore an increased level of heterogenicity within this study was apparent
Haloperidol and Postoperative Nausea and Vomiting: A Systematic Review
Get PDFPostoperative nausea and vomiting (PONV) is a complication that affects up to 30% of the patients undergoing general surgery. This complication can be dangerous for patients, increase recovery time and decrease patient satisfaction scores. There are many different medications that have been used to prophylactically treat PONV including haloperidol. A systematic review was conducted to determine the efficacy of haloperidol as an antiemetic. Databases were searched and inclusion and exclusion criteria were applied to finalize the articles included. The PRISMA framework was used to guide the review and a total of five studies were critically analyzed. Two data collection tables were created for each article, one that illustrated the design of the study and one that illustrated the results. The CASP checklist was utilized to critically appraise each article. Finally, a cross study analysis was conducted to compare the studies. Haloperidol was studied alone and in combination with other antiemetic medications. Overall, these studies showed a decrease in PONV in patients medicated with haloperidol. Using haloperidol prophylactically, especially when utilized with multiple medications, decreased episodes of vomiting and levels of nausea. Haloperidol can be a useful and safe medication that anesthesia providers may utilize to prevent PONV. Further research is needed to study the impact on general surgery procedures and with larger samples
The Independent Man, Hope, Rhode Island State House
No full textThe “Independent Man” was first proposed to be a statue of Roger Williams at the annual meeting of the Rhode Island Historical Society in 1895. The statue, to be placed atop the proposed new State House, was designed by George T. Brewster for $3,000, who called the statue “Hope” and changed the design to fit the Renaissance Revival architecture of the building. Though now embraced as a unique symbol of the state, the statue was the subject of heated debate over the aesthetic and subject. However, a statement issued by the Capitol Commissioners declaring that the statue symbolized, authority, dignity, independence, and power, put the debate to rest and it has been known as The Independent Man since. Since 1900, it has only moved once, in 1975, for repair and a new coat of gold leaf. This photograph was taken in 1980.https://digitalcommons.ric.edu/ri_architecture/1005/thumbnail.jp
Eye on Ethics: Arm\u27s Length Transactions-Conflicts of Interest in Social Work
No full textHistorically, social workers have focused on conflicts of interest that can arise in their face-to-face relationships with clients. Now, however, given the prevalence of online social media and social networking sites, social workers should be especially mindful of newer forms of conflicts of interest that may require arm\u27s length relationships. In the digital age, social workers may be approached for professional services by someone with whom they have had a longstanding Facebook relationship. Or, social workers may receive an online request to be a Facebook friend from a current or former client. In these instances, social workers must be alert to potential conflicts of interest
Commencement Program 2018
Get PDFThis commencement program is for baccalaureate and advanced degrees.https://digitalcommons.ric.edu/commencement_programs/1130/thumbnail.jp
The Effectiveness of Bispectral Index Monitoring on Intraoperative Awareness in Adult Surgical Patients Undergoing General Anesthesia
Get PDFIntraoperative awareness (IA), or the unexpected and explicit recall by patients of events that occurred intraoperatively, is a rare but serious event. Incidences of IA have been associated with extreme anxiety, physiologic stress, and the development of post-traumatic stress disorder. Anesthesia has debated the efficacy of brain monitoring devices, such as the Bispectral (BIS) index monitor, to reduce the incidence of IA. By analyzing EEG waves, these monitors can be used to alert the anesthesia provider when the patient may not be sufficiently anesthetized. An integrative review was conducted to evaluate the current evidence on the use of BIS monitoring in reducing IA. The review was comprised of 10 articles which were randomized control trials, prospective studies, literature reviews, and a practice advisory. Articles were critically appraised and a cross analysis comparing similarities and differences was conducted. In the articles reviewed, similarities existed regarding IA patient risk factors and prevention strategies. Anesthesia providers must conduct a thorough preoperative assessment to determine if a patient may be high risk for experiencing IA. Risk factors included: type of surgery, history of IA, opiate or alcohol use, and significant co-morbidities. Prevention strategies included: pre-medicating patients with an amnestic such as a benzodiazepine and discussing the possibility of IA with high-risk patients. Findings of this review indicated BIS monitoring may serve as a useful adjunct monitoring tool but should not be utilized as a primary source in determining a patient’s anesthetic. Evidence does not support BIS monitoring as a means of preventing IA
Music Therapy for Preoperative Anxiety in Surgical Patients: An Integrative Review
Get PDFThis integrative review compared the use of music interventions on the effects of preoperative anxiety in surgical patients. Preoperative anxiety can have detrimental effects such as increased blood pressure, increased heart rate, increased cortisol levels, increased infection risk, and delayed wound healing. Anesthetic complications include autonomic fluctuations, increased anesthetic requirements, tightening of the jaw, and possible coughing on induction of anesthesia. A search was completed using electronic databases including CINAHL, PubMed, and Medline. The PRISMA flowchart was utilized to identify research that was included and excluded in the review, with a final total of 10 studies. Studies were critically appraised using Polit and Beck’s analysis tables and illustrated in individual tables identifying key aspects of the study. Outcomes included anxiety levels, vital signs, patient satisfaction including positive and negative emotions, length of procedure, and amount of medications used intraoperatively. Findings showed an overall decrease in anxiety levels when patients were exposed to some type of music intervention. Music interventions, including both live and prerecorded music, have been shown to have a positive impact on anxiety levels. Overall, this integrative review supported the use of music interventions as a safe, low-cost technique to help ease anxiety of patients awaiting surgery
Efficacy of Alveolar Recruitment Maneuvers in the Adult Obese Patient Undergoing General Anesthesia: A Systematic Review of the Literature
Get PDFThere are many pathophysiologic health effects associated with obesity, and the effects on normal respiratory physiology can be profound. The presence of increased adipose tissue can limit a patient’s functional residual capacity, reduce end expiratory lung volumes, and increase small airway closure. When exposed to general anesthesia with mechanical ventilation these physiologic changes can increase atelectasis development and increase the likelihood of ventilation-perfusion mismatching. Alveolar recruitment maneuvers are brief applications of positive airway pressure that are employed to recruit alveoli that have already collapsed and prevent new atelectasis formation. The purpose of this systematic review was to determine if the use of alveolar recruitment maneuvers are a safe and effective treatment strategy for managing the adult obese patient requiring general anesthesia with mechanical ventilation. The theoretical framework that guided this systematic review was the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Randomized control trials that utilized alveolar recruitment maneuvers in adult obese patients were reviewed and appraised for inclusion in this systematic review. It was determined that alveolar recruitment maneuvers are a safe and effective strategy for minimizing atelectasis development in the adult obese patient undergoing general anesthesia. Alveolar recruitment maneuvers were associated with an improved intraoperative oxygenation, a decreased alveolar-arterial oxygen concentration gradient, and improved lung compliance. Furthermore, alveolar recruitment maneuver use demonstrated a decrease in atelectasis development measured via computed tomography and radiograph imaging. Application of these maneuvers in the obese patient during the perioperative period can improve ventilation-perfusion matching and decrease respiratory complications associated with atelectasis development
Modelling Medieval Hands: Practical OCR for Caroline Minuscule
Get PDFThis article presents the results of a series of experiments with open-source neural network OCR software on a total of 88 medieval manuscripts ranging from the ninth through thirteenth centuries.[5] Our scope in these experiments focused mainly on manuscripts written in Caroline minuscule, as well as a handful of test cases toward the end of our date range written in what may be called “Late Caroline” and “Early Gothic” scripts (termed “transitional” when taken together).[6] In the following, we discuss the possibilities and challenges of using OCR on medieval manuscripts, neural network technology and its use in OCR software, the process and results of our experiments, and how these results offer a baseline for future research. Our results show potential for contributing to not only text recognition as such but also other areas of bibliography like paleographical analysis. In all of this, we want to emphasize the use of open-source software and sharing of data for decentralized, large-scale OCR with manuscripts in order to open up new collaborative avenues for innovation in the digital humanities and medieval studies
Prosthesis: From Grammar to Medicine in the Earliest History of the World
Get PDFThis article provides an examination of the earliest history of the term prosthesis in English, re-evaluating other such histories with previously unrecognized archival material from early printed books. These sources include sixteenth- and seventeenth-century early printed books such as handbooks of grammar, English dictionaries, British Latin dictionaries, and medical treatises on surgery. Such an investigation reveals both a more nuanced trajectory of the early history of the word in English and fuller context for a shift in meaning from usages in the study of grammar and rhetoric to the study of medicine and surgery. This narrative, then, speaks to the growth of medical knowledge and discourse in the sixteenth and seventeenth centuries, as well as concepts about disability that remain part of disability studies even in the present field