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To Preserve the Historic Lore for Which St. Louis is Famous : The St. Louis Historic Markers Program and the Construction of Community Historical Memory
No full textThe Historic Markers project was implemented in the mid 20th century in St. Louis, Missouri to mark sites of historic significance. This article studies the program to analyze how historical memory is created in a community, and how history is constructed by those in power, often to convey a positive view of the past
Utilizing Simulation to Implement Cognitive Aids in The Operating Room
Get PDFBackground: Operating room crises require prompt, efficient action to avoid detrimental outcomes. Research shows that crisis checklists or other cognitive aids assist anesthesia providers in taking prompt action while improving efficiency by decreasing treatment steps missed during critical events.
Objectives: The purpose of this project was to evaluate the effectiveness of incorporating cardiac arrest and malignant hyperthermia crisis checklists into the operating room using high-fidelity simulation-based education.
Methods: Researchers implemented the Stanford Emergency Manual Cognitive Aids for cardiac arrest and malignant hyperthermia to anesthesia staff at a community hospital in southern Illinois with 18 participants. Implementation consisted of an education session followed by crisis event simulation in two operating rooms with high-fidelity models and monitoring equipment. A post-simulation survey was completed by participants regarding their perceptions of crisis checklists and their future value.
Results: All respondents (N=16) reported increased preparedness to manage or assist a patient having a perioperative cardiac arrest and malignant hyperthermia crisis event after implementation of the crisis checklists. All respondents suggest implementing the crisis checklists into their daily practice.
Conclusions: The respondents’ positive responses display the implementation of operating room crisis checklists’ value and how they assist anesthesia providers in high-stress situations.
Keywords: Crisis Checklists, Cognitive Aids, Simulation-Based Educatio
Stability Analysis of a More General Class of Systems with Delay-Dependent Coefficients
Get PDFThis paper presents a systematic method to analyse the stability of systems with single delay in which the coefficient polynomials of the characteristic equation depend on the delay. Such systems often arise in, for example, life science and engineering systems. A method to analyze such systems was presented by Beretta and Kuang in a 2002 paper, but with some very restrictive assumptions. This work extends their results to the general case with the exception of some degenerate cases. It is found that a much richer behavior is possible when the restrictive assumptions are removed. The interval of interest for the delay is partitioned into subintervals so that the magnitude condition generates a fixed number of frequencies as functions of the delay within each subinterval. The crossing conditions are expressed in a general form, and a simplified derivation for the first-order derivative criterion is obtained. Illustrative examples are also presented
Implementation of a Medication Near-Miss Reporting System
Get PDFFaculty from a state university nurse anesthesia program requested a system to track medication near-miss events among their students. After a literature review, and in collaboration with faculty stakeholders, an electronic medication near-miss reporting system was developed and activated. A Likert scale evaluation survey was designed and reviewed by experts. This medication near-miss survey was auto-populated for all students who utilized the system. Students were happy with the anonymity, ease of use, and time it took to report the near-miss. Faculty stakeholders were given an open-ended question survey and results indicated faculty were pleased with the data they received. After some revisions, the faculty plan to continue to utilize the system for all errors, not only those meeting a “near-miss” definition. Results from this project will allow changes to be made in the curriculum to better address medication errors. The most impactful finding was the importance of debriefing after a near-miss event. Faculty plan to ensure that students are a part of a debriefing after medication near-miss events and errors, since many students found it beneficial. The reporting system also provided details about the drugs and situations that were most frequently part of the near-miss events
Implementation of a High-Fidelity Simulation Day for Student Registered Nurse Anesthetists: Program Development and Evaluation Project
Get PDFStudent registered nurse anesthetists (SRNAs) often rotate to many clinical settings for clinical practicum experiences. Each clinical site has unique operating room layouts, anesthesia cart organization, anesthesia machines, and protocols. Orientation to new settings is time-intensive, and lack of familiarity can interfere with learning and detract from the overall clinical experience. This project involves the development and implementation of a simulation “boot-camp” specifically designed to better prepare SRNAs to adapt more readily to clinical settings. Objectives for this project include reviewing the current evidence-based literature to determine the role of simulation-based learning in nurse anesthesia training, creating simulations in collaboration with the clinical site, developing a simulation “boot-camp” for SRNAs, and evaluating outcomes. The project was conducted at a large level 1 trauma center in central Illinois which also includes on its premises one of the largest simulation and healthcare engineering centers in the world. The purpose of this project was to expose students to the setup, resources, and protocols used on premises through the use of high-fidelity simulated crisis scenarios. The facility hopes to use this project as a template for designing orientation simulation scenarios for incoming staff and students from several disciplines
Implementing Routine HIV Testing and Prevention in a Primary Care Setting
Get PDFEvidenced-based research has identified that routine HIV testing and education is pivotal in identifying new infections, providing access to treatment, and decreasing the rates of transmission. In 2006, the CDC implemented new guidelines recommending that all persons aged 13-64 years be tested yearly for HIV regardless of risk factors. Despite these recommendations, the CDC estimated that less than 37% of people were tested in 2017 and in the years prior. In this project, a protocol for routine testing and education was developed and implemented in a private Southern Illinois primary care practice. Providers and staff were educated on HIV and routine HIV testing, and they were, then, surveyed regarding their perceptions on HIV, HIV testing, and barriers to offering testing. Overall, providers agreed that HIV testing is important, but they felt that time constraints and cost prevent them from regularly offering HIV testing during routine visits. Evaluation follow up 6 months post-implementation revealed that rates of routine HIV testing at this clinic increased from 0.9% to 1.7%. Further follow up would be needed to evaluate long-term impact of this protocol. Expanding this project to other practices may be helpful in improving overall HIV health outcomes
Snapchat and Civic Engagement among College Students
Get PDFDuring the 2016 presidential election cycle, Clinton and Trump used Snapchat as one part of their overall voter outreach and engagement efforts. This portion of their campaign strategy was disproportionately targeted toward younger voters, since those between 18 and 25 comprise a vast portion of Snapchat’s user base. Did their efforts, those of political parties, or those of interest groups on Snapchat produce higher levels of civic engagement among college students? We utilize a survey that we conducted from a college campus in the Midwest in October 2016 to answer this question. Using a series of matching analyses, we discover that those students who sent pictures or videos about interest groups, candidates for office, or political parties on Snapchat were more civically and politically active than otherwise similar students who had not participated in these activities
Depression Screening in the Primary Care Setting
Get PDFRecent data reveals that approximately 17.3 million adults in the US population experience an episode of depression each year. Unidentified and untreated depression has many consequences leading to a poor quality of life, direct and indirect healthcare cost-related increases, and an increase in medical comorbidities. The U.S. Preventative Services Task Force recommends that all adults be screened for depression. The PHQ-2 and PHQ-9 are the most widely accepted screening tools in the preliminary detection of depression. The purpose of this project was to educate health care professionals regarding depression and the implementation of a new depression screening protocol: A positive PHQ-2, would trigger the immediate administration of the PHQ-9, possibly leading to prompt intervention. The population used in this study were adults aged 18-99, medically underserved, and predominantly African American. Data collected to evaluate the protocol included: rates of administering the PHQ-2 and PHQ-9 prior to and after an educational in-service, the number of patients identified with depression with comparison of the clinic’s previous and new depression screening protocol, and the clinic’s reimbursement after proper coding for these screenings. There was a 33% increase in the PHQ-2 screening (n=145); 100% of patients (n=22) with positive PHQ-9 screening for depression were immediately treated or referred for treatment. The results of this project demonstrate that the clinic members accepted and implemented this new protocol, more effectively identifying patients with depression, promptly referring for treatment, and billing for services
Implementation of Crisis Checklists in the Operating Room
Get PDFBackground: Operating room crises require prompt, efficient action to avoid detrimental outcomes. Research shows that crisis checklists or other cognitive aids assist anesthesia providers in taking prompt action while improving efficiency by decreasing treatment steps missed during critical events.
Objectives: The purpose of this project was to evaluate the effectiveness of incorporating cardiac arrest and malignant hyperthermia crisis checklists into the operating room using high-fidelity simulation-based education.
Methods: Researchers implemented the Stanford Emergency Manual Cognitive Aids for cardiac arrest and malignant hyperthermia to anesthesia staff at a community hospital in southern Illinois with 18 participants. Implementation consisted of an education session followed by crisis event simulation in two operating rooms with high-fidelity models and monitoring equipment. A post-simulation survey was completed by participants regarding their perceptions of crisis checklists and their future value.
Results: All respondents (N=16) reported increased preparedness to manage or assist a patient having a perioperative cardiac arrest and malignant hyperthermia crisis event after implementation of the crisis checklists. All respondents suggest implementing the crisis checklists into their daily practice.
Conclusions: The respondents’ positive responses display the implementation of operating room crisis checklists’ value and how they assist anesthesia providers in high-stress situations
The Implementation of a Behavioral Intervention Program in Obese Elderly Patients
Get PDFAbstract
The prevalence of obesity is increasing in American and patients are living longer. Research suggests that behavioral lifestyle interventions help optimize elderly patient’s health and improve their quality of life. A successful behavioral weight loss program had been in place in one clinic within a large healthcare organization. The need at another metropolitan Midwest location seemed even greater due to having a patient population consisting of elderly, demographics, obesity trends, and high rates of obesity linked morbidities such a diabetes, hypertension, and heart disease. Thirteen elderly obese patients with ages ranging from 65-75 years old were enrolled in an eight-week behavioral intervention program. Each week participants were led in discussion about pedometer usage, goal setting and progress, journal review, food choices for the week and exercise regimen. Patients lost between 1-8 lbs. and 38% of them completed the entire program. Only 46% of participants, initially enrolled completed at least half of the program instead of the intended goal of 75%. A longer program length of twelve weeks, better recruitment of participants and offering several times for sessions are recommended for future program success