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Does Preoperative Incentive Spirometry Use Reduce the Incidence of Postoperative Pulmonary Complications After CABG Surgery: A Systematic Review
Full text linkCoronary artery bypass graft (CABG) surgeries are often associated with postoperative pulmonary complications such as atelectasis. This complication can lead to increased length of stay, morbidity, and mortality. There is substantial information about the impact of incentive spirometry postoperatively; however, the use of incentive spirometry preoperatively is understudied. This systematic review aims to determine if preoperative incentive spirometry use reduces the incidence of postoperative pulmonary complications after CABG surgery such as atelectasis, pleural effusions, pneumonia, and pulmonary embolism. Inclusion criteria included randomized controlled trials with the inclusion criteria of patients 18 years of age or older undergoing a CABG procedure, and preoperative use of incentive spirometry. Five studies met criteria and were included in this systematic review utilizing PRISMA guidelines and CASP tools. Descriptive data were collected from each study and a cross study analysis was conducted to compare all studies and assess the outcomes studied. Results of this systematic review demonstrate that preoperative teaching and appropriate use of incentive spirometry may reduce the incidence of postoperative pulmonary complications and length of stay. Implications of this study demonstrate the potential impact of the clinical nurse specialist (CNS) on preoperative evaluation and education of CABG patients to reduce postoperative pulmonary complications. Education regarding the preoperative use of incentive spirometry should be added to preoperative testing to decrease the incidence of pulmonary complications
Phenobarbital vs Lorazepam: A Comparison of Alcohol Withdrawal Syndrome Treatments
Full text linkThe wide use of alcohol and its consequent problems in our society have contributed to an estimated 1.2 million hospital admissions, 85,000 deaths, and a cost above $250 billion to our health care system every year. Benzodiazepines such as lorazepam have long been the preferred choice of treatment for alcohol withdrawal symptoms (AWS) in the hospital setting. However, alternative treatments like phenobarbital could possibly improve outcomes in terms of efficacy and safety. A systematic review was conducted to compare and synthesize the current evidence as it relates to the effectiveness of phenobarbital and lorazepam in decreasing AWS and total hospital length of stay. Results showed no significant advantage or disadvantage using either medication independently or in combination on decreasing AWS symptoms or length of stay but more research is needed. Advanced Practice Nurse Practitioners (APRNs) contribute to high quality evidence-based research where additional information can examine and propose changes to practice guidelines
Addressing Housing Insecurity: Policy Analysis of Managed Care Organizations and Healthcare Providers
Full text linkAn average of 4,000 Rhode Islanders experience homelessness and housing insecurity each year. A policy analysis of screening tools for Social Determinants of Health (SDOH) was conducted for Neighborhood Health Plan of Rhode Island (NHPRI), Inland Empire Health Plan, The Veteran Health Administration (VHA), The Medicaid Medical Directors Network (MMDN), Executive Office of Health and Human Services (EOHHS), RI Office of Housing and Community Development, U.S. Department of Housing and Urban Development, Keiser Permanent School of Medicine Health Systems Science, Canadian Observatory on Homelessness, and primary care offices in Indianapolis, Florida, and Indiana. The analysis revealed ineffective screening when addressing SDOH, specifically housing insecurity and homelessness. Ineffective SDOH screening within managed care organizations (MCOs) and by healthcare providers contributed to health instability. The average cost to Rhode Island taxpayers for emergency room visits for persons experiencing homelessness is $18,000 a year. A literature review of key evidence demonstrated that a standardized SDOH assessment screening tool is needed to determine the appropriate plan of care and treatment such as the Vulnerability Assessment Tool (VAT). A policy update for proper assessment and screening of SDOH is needed by local MCOs and healthcare providers to address the rising costs of healthcare and the increased needs of high-risk populations. Recommendations to adopt a similar version of the VAT as part of the health plan assessment is a possible solution towards increasing health equity
Everyday Life History of the Soviet Laborer, 1920s-1930s
Full text linkThis thesis provides a comprehensive view of the daily lives of the Soviet Proletariat in the 1920s and 1930s. Both negative and positive outcomes of the policies implemented during this period are discussed regarding the growth and experiences of the working class. The discipline of everyday life history is explored and applied to this socioeconomic group. Work, education, home life, family structure, gender roles, and standard of living are the main subsets of daily life examined in this thesis. The research presented here concludes that the Soviet Communist Party considered itself an urban vanguard creating a proletarian serving state and would maintain this narrative regardless of its contradictory policies. Due to difficult living conditions, the proletariat was an incredibly resourceful and enduring population that valued its culture and traditions
How Does Weight Influence the Timing of Puberty Onset in Female Adolescents?
Full text linkBackground: The early onset of puberty poses threats to a child\u27s social, emotional, and physical well-being including an increase in the risk of developing chronic conditions. Studies have shown an increased incidence of type 2 diabetes, cardiovascular disease, and breast and endometrial cancers for adults who experienced menarche earlier than their peers (Villamor & Jansen, 2016). Data has shown most females of higher weight have experienced menarche at younger ages than those of lesser weight.
Purpose/Specific Aims: The purpose of this systematic review was to investigate the influence of weight, on the timing of puberty onset in adolescent females.
Methods: A systematic review was conducted for articles comparing the onset of menarche and weight in females using EBSCOHost, Google Scholar, and CINAHL Plus. Inclusion criteria included female participants, menarche as the determining factor for onset of puberty, written in English in the last ten years, early onset puberty, and obesity, overweight, or elevated BMI as an influencing factor. Only articles using the onset of menarche as the determining factor for the onset of puberty were included.
Results: The initial search yielded 35 studies; four met the inclusion criteria for this review. No randomized control studies met inclusion criteria. Commonalities between studies included a higher incidence of earlier menses in females with higher amounts of adipose tissue, higher BMIs, increased dietary fat, and/or higher prepubescent weights. Limitations of this study include, but are not limited to, recall bias for age of menses, age of menses often reported in whole years rather than exact age, and limited sample size.
Conclusion: Results of this study show an association between increased prepubescent weight in females and earlier onset of menarche. Considering these findings, efforts should be made to decrease the prevalence of childhood obesity and the risk of early menarche
Monitored Anesthesia Care Versus Moderate Sedation in the Endoscopy Setting: A Retrospective Chart Review
Full text linkSedation is a state of depression in the level of consciousness that is medically induced allowing for decreased consciousness, reduction in sensation, and relaxation. Two methods of sedation administered in the acute care setting of an endoscopy unit are moderate sedation and monitored anesthesia care (MAC). When it comes to recovery from sedation and eligibility to reach discharge criteria whether one method of sedation is superior to the other or if both are comparable is a topic of more research. A retrospective chart review of a hospital��s endoscopy unit was conducted to determine if one method of sedation over the other leads to a prompter recovery and discharge time. This retrospective chart review also examined age, gender, and type of endoscopic procedure and if any of those variables had a relationship to discharge time. Results from this project concluded that in nearly all categories, discharge time was slightly sooner for moderate sedation cases compared to MAC cases. Endoscopy departments should in turn consider the importance of recovery from sedation and minimizing discharge time and its effect on the health care system and providing quality patient care. Implications for advanced nursing practice include research and education on sedation induction and recovery process in the endoscopy suite to support patient quality care, safety, cost effectiveness, and department efficiency
Police Violence Against Women of Color: All Girls of Color Need Safety
Full text linkThis study examined police violence against Black women and other women of color. The intersectionality theory was used to discover how Black women are victims of police brutality. The research question is how Black women can resist police violence to show they are not invisible. Semi-structured interviews were used to examine Black women’s perspective of police violence against their population by interviewing women of color who are college students. The findings show women of color were likely unfamiliar with the term intersectionality and its impact on police violence against Black women. Furthermore, women of color are aware that police violence can happen to Black women and other women of color but have little specific knowledge of cases of Black women who have experienced police abuse. They also described their own experiences of police bias that have affected their lives. Study provides limitations as well as suggestions for future research
Seesawing: An Evaluation of the Educational Aspirations and Attainments of College-aged BIWOC
Full text linkThere are disparities in achievement for Black, Indigenous, and Women of Color (BIWOC) both during college as well as beyond completion due to insufficient preparation before matriculation. Researchers have attributed this struggle of aligning attainment and aspiration to financial constraints, culture shock, and overcoming an academic and social learning curve. However, many institutions have naively created programming and scholarship to aid these barriers, yet retention and graduation rates for BIWOC students are still lower than their white counterparts. These gaps that are characterized by race and ethnicity are persistent, leading institutions to wonder how effective their support systems are. This thesis study explores the voices of college- aged BIWOC. It aims to educate universities on dismantling their group stereotypes of BIWOC to adopt a more communal climate for students that treats BIWOC as individuals rather than homogeneously. The goal of this study is to support BIWOC students by educating universities on the importance of intentional programming that includes being transparent about disparities and why the programming exists altogether. This thesis uses reflexivity and qualitative interviews with a sample of 15 BIWOC who had attended one or more college classes, who are currently between the ages of 18 to 35, and who have lived in Rhode Island at some point in their life to better understand the experience of BIWOC. Among the sample size, an eclectic mix of colleges were represented including community colleges, public universities, Historically Black Universities, Hispanic Serving Institutions, Predominately White Institutions, and other private institutions. Zoom interviews were held from December 2022-February 2023. They were recorded, transcribed, and coded inductively and then the researcher analyzed the codes, noting seven overarching themes: Educational Seesawing, Ignorance Fatigue, Heightened Awareness of Disparities, Drive/Focus/Disposition, Family Influence, Literacy, and Self- Limitation
The Power of Sound: The Positive Effects of Music for Students with Autism
Full text linkSound is a powerful force that can change the lives of many people. Individuals with Autism may struggle in different areas including various forms of communication, social skills, behavioral difficulties, and more. Vocal and/or instrumental sounds (music) can make a significant difference in how individuals on the spectrum make sense of the world and deal with their challenges. Music is an essential tool, an important educational element for students with autism, that must be provided as part of their education so that they may have better opportunities to blossom to their full potential. The power of sound is explored through interviews, case studies, and more
Effectiveness of De-Escalation Strategies on Psychiatric Patients in the Acute Care Setting
Full text linkThe use of restraints has been a controversial topic for decades in the healthcare field. Due to the fast paced and challenging environment in the acute care setting, there is frequent use of restraints when health care providers are faced with aggressive and threatening patient behavior. A review of the literature found that restraints can have many harmful physical and emotional effects. Several non-invasive alternatives as well as various de-escalation techniques to decrease restraint use have been proposed. The purpose of the systematic review was to identify the effectiveness of de-escalation strategies used to de-escalate aggressive behavior in adults over the age of eighteen with a previous psychiatric diagnosis in acute care settings. The Tidal Model is the conceptual framework serving as a guide for the research plan. A systematic review of randomized control trials was conducted to address interventions to prevent or de-escalate aggressive behavior in order to prevent the use of restraints and seclusion in acute psychiatric patients. The four studies analyzed in the systematic review demonstrated that non-invasive de-escalation techniques have been shown to decrease the incidence of aggressive behavior, seclusion, coercion and physical restraints. Recommendations for future practice include the need for further research and education as well as a standardized policy across the nation regarding the use of restraints in the acute care setting