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Video laryngoscopy versus direct laryngoscopy for endotracheal intubation in the emergency department and intensive care unit
Get PDFBackground: Endotracheal intubation is a foundational skill of emergency and critical care clinicians. Direct laryngoscopy (DL) has long been the go-to method of intubation, but difficult airway characteristics can hinder clinicians\u27 ability to intubate on their first attempt. Video laryngoscopy (VL) has been suggested as a tool to improve airway management in patients with problematic airway characteristics. However, current data comparing DL to VL has been predominately observational and has produced inconsistent findings.
Objective: The study\u27s objective was to investigate if there is evidence to suggest that VL results in more first-pass intubation success and reduced complications compared to DL in patients needing emergent intubation.
Methods: A systematic review of EBSCO and PubMed databases was performed, examining for studies that compared VL and DL in the emergency department (ED) and intensive care unit (ICU). Relevant articles were then independently reviewed and filtered against various inclusion and exclusion criteria. The primary outcome was the overall rate of first-pass intubation success, with additional analyses based on clinician experience and type of VL used. The secondary outcome was the incidence of complication rates with either device.
Results: A total of 21,788 intubations were attempted across 12 studies with either DL (n = 12,527) or VL (n = 9,261). Data was presented as [odds ratio (95% confidence intervals); P values]. Overall rate of first-pass intubation was 80% and 75% for the VL and DL groups, respectfully [OR=1.35 (1.26–1.45); P\u3c0.0001]. Compared to DL, VL had higher rates of first-pass success amongst less experienced physicians [80.46% vs. 71.66%; OR=1.63 (1.45–1.83); P\u3c0.0001] and a lower incidence of esophageal intubations [1.27% vs. 6.02%; OR=4.93 (3.63–6.70); P\u3c0.0001]. Amongst various VL devices, the CMAC VL led to more first-pass success when compared to the GVL [83.89% vs. 78.18%; OR=1.46 (1.25–1.69); P\u3c0.0001]. DL was associated with greater first-pass success amongst experienced clinicians when compared to VL [81.88% vs 72.84%; OR=0.59 (0.52–0.68); P\u3c0.0001] and decreased incidence of hypoxemia [12.91% vs. 16.88%; OR=1.37 (1.19–1.57); P\u3c0.0001]. Complications such as airway trauma, hypotension, and aspiration were unchanged between the two groups.
Conclusion: The use of VL in patients undergoing emergent intubation was associated with a greater overall first-pass success rate when compared to DL, while also increasing first-pass success in inexperienced physicians and reducing the incidence of esophageal intubations. However, VL was associated with decreased first-pass success in experienced physicians and a greater incidence of hypoxemia. Further randomized controlled trials must be conducted to investigate the utility of VL over DL in the ED and ICU
Explaining the Failure of US-Russian Relations
No full textThis thesis seeks to address the theoretical underpinnings of failed US-Russian relations in the post-Soviet era. Since the dissolution of the Soviet Union in 1991, each United States President has attempted to reset relations with Russia in hopes of a more positive, cooperative relationship. Significant international events during each of these presidential administrations have hindered progress in US-Russian relations, thus reset attempts have failed. I will be using the work of Russian political scientist Boris Mezhuyev on Civilizational Realism to see if this new approach to international relations theory and US-Russia relations is accurate in explaining state behavior and therefore the reasoning behind such failed reset attempts. I argue that civilizational realism provides a valid explanation of US-Russian relations by acknowledging the civilizational ideologies and values of both Russia and the US that consequently shape national identity, national interest, and therefore foreign policy
An Analysis of the Concept of Hospitality in the United Kingdom’s Immigration Policy
Get PDFThe United Kingdom offers a Syrian Vulnerable Persons Resettlement Scheme for the most vulnerable Syrians fleeing the Civil War. For those who do not meet the requirements, they travel to the UK on their own seeking asylum. The United Kingdom deems itself as welcoming to all immigrants; however, while looking at the Syrian population, it is obvious that those who come via the scheme are offered more support while acclimating, compared to those who migrate on their own. This thesis will look at literature on hospitality in order to understand why the UK is welcoming to some Syrians but not all of them. Hospitality is not only about kindness, openness and welcomeness, but also about politics. The United Kingdom can demonstrate hospitality to one group of Syrians because it then allows them to be inhospitable to the other group. This therefore limits immigration and the amount of refugees and asylum seekers they allow in, ultimately positioning the UK as a host that controls the opening and closing of their border. In order to prove this, news articles from a variety of sources on the topic of how Syrians are treated and their experiences in the UK will be analyzed. These articles look at specific experiences Syrians have had while acclimating to their new lives with the government and everyday people
Addressing Barriers to Mental Health Treatment in American Minority Groups
No full textThis special article examines mental health disparities shared across the largest ethnic and racial minority groups in the United States: Hispanic/Latino-Americans, African-Americans, and Asian-Americans. Additionally, it reviews widely accepted solutions to combating disparities, such as increasing diversity and ethnic concordance, cultural competency, and medical pluralism or cultural partnerships. Results show variable efficacy of ethnic concordance and cultural competency. More investigation must be done towards the benefits of medical pluralism. Overall, it reveals an increased need for focus on minority group care with America’s growing diversity, and further implementation of these solutions at a state and national level to increase effectiveness
Comparison of electroconvulsive therapy and transcranial magnetic stimulation for perinatal depression
Get PDFBackground. Perinatal depression places a burden on families, the healthcare system, and the economy. Currently, treatment includes therapy and medications such as serotonin reuptake inhibitors. However, the use of antidepressant medications during pregnancy places the fetus at risk of birth defects and may pass to the infant during breastfeeding. Moreover, certain patients may have refractory depression that remains uncontrolled on medication. This study discusses the use of transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) during the perinatal period as a potential alternative or supplement to medication.
Objective. This study utilizes existing research articles to make a comparison of ECT and TMS therapy in treating pregnant and postpartum patients diagnosed with major depressive disorder (MDD).Considerations include safety for the mother and baby and improvement in symptoms.
Methods. In 2021, a PRISMA search was performed on several databases. Study populations were limited to pregnant and postpartum patients within one year of delivery. Other inclusion criteria for articles were English language, research study, diagnosis of MDD, TMS or ECT treatment alone or in combination with pharmacotherapy, and use of a quantitative depression scale. Databases included Science Direct, PubMed, EBM Review, and EBSCO Host.
Results. The database search resulted in 1,672 results and 646 discrete articles after removing duplicates. Using the inclusion and exclusion criteria, this was then reduced to 11 articles. In general, depression survey scores were used to determined study outcomes.
Conclusion. Both ECT and TMS studies showed significant improvement in patient depressive symptoms. None of the ECT studies considered long-term outcomes. Of the 3 TMS studies that reviewed long-term effects, 2 reported statistically significant decrease in depression scores at 6 months. There were no serious, adverse maternal or infant events associated with ECT or TMS
The Use of Buprenorphine in the treatment of Opioid Use Disorder (OUD)
Get PDFPer the CDC, there were 91,799 drug overdose deaths, of which 75% of these deaths involved an opioid in 2020. Furthermore, the rate of overdose deaths involving synthetic opioids (excluding methadone) increased 56% from 2019 to 2020. Synthetic opioids like fentanyl and its derivatives are easily producible, very inexpensive, and have extremely high potency. To effectively reduce use of illicit opioids, the underlying addiction disorder must be recognized first to adequately treat the disease. Treatment for opioid addiction is critical due to the high risk of mortality and significant disruption to daily functioning. Medication-assisted treatment couples medication use with counseling/therapy, is the most effective treatment for OUD and is considered first-line. Methadone has long been the medication of choice; however, buprenorphine became an alternative treatment option offering more flexible dosing schedules in the early 21st century
In patients with hepatocellular carcinoma (HCC) (P), is Bevacizumab with Atezolizumab (I) more effective than Sorafenib (C) in long-term clinical prognosis (O)?
Get PDFHepatocellular carcinoma (HCC) is the third leading cause of cancer death globally. China contributes to half of the global incidence of liver cancer, with about 70-85% being HCC. Definitive treatment for this condition would be surgical resection with liver transplant but for obvious reasons, the majority of affected patients are unable to meet the necessary criteria. Sorafenib is a form of chemotherapy that has been the mainstay treatment of HCC since its approval in 2007. More recently, the combination of Bevacizumab and Atezolizumab has shown greater efficacy in the treatment of unresectable HCC. Additionally, this new combination therapy shows favorable results in terms of long-term adverse effects. However, on an economic standpoint, the cost of long-term therapy may hinder its progression towards mainstay treatment
Colonialism and the African States: A Case Study
Get PDFColonialism has influenced the development of states on the African continent. This study examines the extent to which colonialism affects the economic growth and the political democratic development of two former British colonies: Kenya and Nigeria. Two theories, Dependency Theory and Neopatrimonialism Theory, argue that institutions, whether economic or political, established during the colonial period impact modern African states\u27 economic and governmental development. Using pattern matching, I operationalized several variables of study such as economic underdevelopment, functioning democracy, power dynamics, and Settler and Non-settler colonial institutions. The results suggest that government corruption, lack of transparency in elections, poor security forces, and overall economic dependency on the international system impedes Kenya and Nigeria’s economic and political development, indicating that underdevelopment relates to policies implemented during their respective colonial periods
Vulvodynia: Making the Diagnosis and Improving Treatment Outcomes
No full textVulvodynia is an underdiagnosed condition that affects about 25% of women1. Patients report frustration and a lack of knowledge in the medical community regarding their symptoms of vulvar pain. Painful penetration makes performing an internal pelvic exam difficult, and patients may avoid annual gynecological appointments due to fear. It is imperative for providers to understand and implement the correct approach for accurate diagnosis. Once the diagnosis of vulvodynia has been identified, the multimodal treatment plan should be implemented to include pharmacological therapy, referral to physical therapy, and psychotherapy. With continued research and the use of evidence-based practice, the gap in healthcare that exists for women with vulvodynia can be decreased
Online vs. In-Person Work Environment: Is Productivity Really Maintained in the Hybrid Work Model?
Get PDFThroughout the COVID-19 pandemic, the term “hybrid work” has been popularized in an attempt to maintain productivity while maintaining social distancing. Hybrid work is a combination of working partly online at home, and partly in the typical office setting. Its existence predates the pandemic; however, it has increased in usage due to the frequent need to quarantine. Hybrid work has also exceeded the boundaries of traditional work, most notably extending into the education field, affecting students’ learning. Come the tail-end of the pandemic, many institutions have adopted the hybrid work model in attempts to suave people’s concerns about returning, as well as to cater to their convenience and accessibility, all while maintaining productivity. Despite all of the research done in hybrid work throughout the pandemic, there are still many discrepancies as to the maintenance of productivity between both work environments