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Improving Patient Education on Spinal Anesthesia: An Assessment of a Patient Educational Program
Get PDFAbstract
Spinal Anesthesia (SA) is a common type of anesthesia that is frequently used for surgeries of the lower abdomen, lower extremities, and perineal area. Spinal anesthesia offers fewer side effects and risks than General Anesthesia (GA). Patients usually recover their senses much faster with SA (MedlinePlus, 2017). Some patients often refuse SA due to fears and misconceptions. These misconceptions are related to a lack of education and resources available to patients. It is crucial that anesthesia providers learn to adequately educate patients preoperatively on the use of SA. Anesthesia providers in a community hospital in southern Illinois educated patients preoperatively about the use of SA with a pamphlet and video created by the author. Anesthesia providers who utilized the educational video and pamphlet were given a survey after one month. A total of eight anesthesia providers completed the survey. Five were CRNAs (62%) and three were anesthesiologists (37%). All the participants agreed that the material was at an appropriate reading level for patients and that the method was effective. The majority (62%) of participants found the materials to neither increase nor decrease the time of pre-anesthetic interviewing. A multimodal approach for preoperative education in SA can improve patient knowledge
Fabrication and Thermal Characterization of Composite Cu-CNT Micropillars for Capillary-driven Phase-Change Cooling Devices
Get PDFThis paper presents the fabrication, testing, and modeling of an array of composite copper-carbon nanotubes (Cu-CNT) micropillars as a wick structure for potential application in passive phase-change cooling systems. This novel wick structure has a larger spacing at the base of the micropillars to provide a higher liquid permeability and mushroom-like structures on the top surface of the micropillars with a smaller spacing to provide a greater capillary pressure. The composite Cu-CNT micropillars were fabricated by an electrochemical deposition method on a patterned copper template. Cauliflower-like nanostructures were then grown on the top surface of the micropillars using chronoamperometry technique to improve the capillary pressure and thermal performance of the wick structure. After successful fabrication of the micropillars, a series of tests were conducted to quantify the thermal performance of the wick structures. The results demonstrate superior thermal and corrosion performances for composite Cu-CNT micropillars compared to those of copper micropillars. Additionally, a thermal resistance network analysis was conducted to model the thermal performance of the fabricated mushroom-shaped micropillar array. Model predictions were compared with the experimental results and good agreement was observed
Why won\u27t this heal?: Actinomyces and wounds
Get PDFWhy Won’t This heal? Actinomyces and Wounds
Christina Wagener, MSN, Steve Kalish, MD, Mary Lee Barron, PhD, APRN, FNP-BC, FAANP
An incidental finding of Actinomyces europaeus in a refractory healing abscess presents an opportunity to close a knowledge and treatment gap. After finding Actinomyces species in multiple patients within a twenty-month period in an independent hospital in Chicago, IL, the probability exists that Actinomyces is becoming more prevalent in subcutaneous wounds. Chronic, non-healing wounds cause multiple negative consequences including financial, psychological and physical losses and possibly death.
Actinomyces is a Gram-positive, filamentous, non-acid-fast and anaerobic-to-microaerophilic bacteria first identified in 1997 and found in the oropharynx and reproductive track of females (White & Woolley, 2018). Typical wound cultures miss Actinomyces bacterium because it is a rare finding outside usual habitat, time to grow, and wound cultures do not traditionally include anaerobic testing (Kononen & Wade, 2015). Treatment guidelines from the Centers of Disease Control for subcutaneous abscesses include incision, drainage and culturing; protocols do not include testing for Actinomyces (CDC, 2007). Treatment protocols for Actinomyces are unique because of the use of long-term penicillin (Barberis et al., 2017; CDC, 2007; Sharkawy & Chow, 2018).
An educational quality improvement project on the identification, risk factors, testing and treatment for Actinomyces species was presented to clinicians in an independent hospital. Pre- and post-education survey results, frequency of requests for Actinomyces testing, and positive results were collected. Pre- and post-educational intervention surveys were evaluated using a paired T-Test. Frequency of cultures as well as positive culture results were used to evaluate the utilization of the testing as well as the occurrence of the bacteria. A statistically significant educational outcome showed an increase in knowledge, awareness, and identification of the appropriate testing and treatment protocols for refractory wounds. Since October 2017, 17 specimens were cultured for Actinomyces; 41% (n=7) were positive. Actinomyces species may be prevalent in refractory wounds. Additional multi-site studies as well as updating the treatment algorithm related to subcutaneous wounds/abscesses should be considered
Hepatitis C Virus Screening and Treatment
Get PDFHepatitis C Virus (HCV) is classified as a contagious liver disease that can be either acute or chronic, and the illness ranges in severity from mild to lifelong. It is estimated that 2.7 million people in the United States (US) have HCV, but only half are diagnosed. The CDC recommends testing by birth-cohort, focusing on adults born between 1945 and 1965. Three main objectives for this project included implementation of a clinical decision support system (CDSS) for providers, increasing HCV screening by providing education to the support staff in primary care clinics of a local hospital which would increase the consults, and sharing resource information with patients diagnosed with HCV about the clinic and available treatments. While a CDSS was not established, in-services by clinic educators regarding HCV and screening were conducted. Education about HCV and the hospital-based HCV clinic were shared with local health departments and the Red Cross. Regarding the hospital-based HCV clinic utilization, there was a 48% increase in patients referred following implementatio
Ethical Considerations in Short Term Global Health Experiences
Get PDFAcademically sponsored, short-term experiences in global health care (STEGH) have increased in popularity and accessibility among students originating from high-income countries (HIC) and enrolled in medical and health care programs. The populations served have socioeconomic, cultural, and/or geographic barriers to healthcare. Establishment of goals, clarity of expectations, and ethical awareness of services being provided are essential to achieve mutually agreeable outcomes for all involved. The project was designed to increase the knowledge of undergraduate nursing students scheduled to embark on a short term experience in global health. Module development and dissemination of evidence regarding the ethics of care and cultural humility was followed by a two-fold interactive, evaluation of undergraduate nursing students and on-site stakeholders. The evaluation was incorporated into a routine debriefing conducted prior to departure from the STEGH location. Survey findings indicated that undergraduate nursing students perceived personal growth, the acquisition of new knowledge, and clinical relevance to the population served
Improving Acute Pain Management: Development of an Adult Dexmedetomidine Infusion Protocol
Get PDFStudies have revealed over 80% of surgical patients experience acute postoperative pain: 75% of patients describe pain levels as moderate, severe, or extreme (Chou et al., 2016). Opioids continue to be the mainstay of most postoperative analgesia regimens (Tan, Law, & Gan, 2015). While effective for the treatment of severe pain, opioid use also prolongs length of hospital stay and places patients at greater risk for higher adjusted mean costs due to dose-related side effects. Multimodal analgesia is a concept that continues to gain momentum to improve perioperative analgesia while reducing the incidence of opioid-related adverse events (Buvanendran & Kroin, 2009). Evidence-based research has indicated the use of dexmedetomidine in the perioperative setting as a successful adjunct to a multimodal pain management regimen (Chou et al., 2016; Tan et al., 2015). This project aimed to provide education for a tertiary care center in central Illinois concerning the use of a dexmedetomidine infusion protocol as part of a multimodal pain management regimen, particularly for opioid-tolerant patients. The results of the project suggested the anesthesia providers at the facility increased their knowledge pertaining to the use of the dexmedetomidine and supported the implementation of a dexmedetomidine infusion protocol
Enhancing IANA Member Communication & Engagement
Get PDFThe National Provider Identifier (NPI) Registry data identifies CRNAs as the sole providers of anesthesia for 29% of counties in the state of Illinois (“Illinois CRNA Map,” n.d.). These CRNAs, therefore, should play an important role in advocating for access to high quality care. While IANA is a vigorous advocate with regards to patient access to high quality, affordable health care (Bickel, 2017), the long-term patient advocacy capabilities of IANA are at risk due to a declining trend in membership numbers (Farina et al., 2016; Flores, 2014; “Keeping Pace,” n.d.; Yohn, 2016). Traditional forms of communication utilized by IANA, such as letters and email, are not engaging recent CRNA graduates as effectively as in the past (A. Griffin, personal communication, October 11, 2017). This project attempted to enhance Illinois CRNA and SRNA communication and engagement through increased frequency and variety of content on state-level CRNA social media platforms that reside on Facebook, Twitter, and state organization IANA website. Examples of content areas included professional advocacy, anesthesia practice, CRNA education, professionalism, patient/public education, member engagement, and entertainment. Analysis of web metrics detailed significantly improved member communication and engagement
Utilizing Team-Based Care to Improve Rural Cardiovascular Care
Get PDFCardiovascular morbidity and mortality are significantly higher among individuals living in rural areas compared to urban and suburban settings. Some contributing factors include financial limitations, education level, and limited access to cardiovascular specialty healthcare. Using a team-based cardiovascular care approach in rural communities, including both nurse practitioners and physicians, could help improve access to cardiovascular health services. The purpose of this project was to conduct a focus group interview to evaluate a team-based care approach to cardiovascular services implemented in a rural clinic located in a medically underserved area. Based on the results of the focus group interview, an evidence based strategic plan was developed. Nine health care providers participated in the focus group. The participants noted that with the team-based approach, there has been an increase in the number of cardiology patients that are able to receive care. They expressed that support from clinic administrators influenced the noted success. Their main concerns were now focused on the implementation of a standardized chest pain protocol, increasing and retaining specialized staff, and acquiring equipment for more cardiovascular procedures. Future projects focusing on evaluating the perceptions that patients receiving cardiovascular care have about this model are essential
Clinical Guideline Based Interventions to Increase Smoking Cessation Success in Primary Care
Get PDFCurrent evidence indicates that providers play an integral role and are most successful in improving cigarette smoking cessation rates through a combination of counseling, patient follow up, and pharmacotherapy. In order to address high smoking rates among patients at a primary care clinic in an urban community, the Five A’s model for smoking cessation (Ask, Advise, Assess, Assist, and Arrange) was initiated. During clinic visits, patients were asked about their smoking status. For those who stated they smoked cigarettes, further evaluation was conducted using the Fagerstrom Test for Nicotine Dependence and the patient’s willingness to quit was assessed. Five of the ten patients assessed were willing to attempt smoking cessation. In collaboration with the primary care provider, the protocol was initiated on these patients and follow up phone calls were conducted over two months. During the time frame, one of the five patients was successful with smoking cessation. An educational session about the protocol was conducted for the staff at the clinic. The staff noted they had adequate resources, support, and time to implement the protocol. Future projects are needed including larger sample sizes and longer time frame of implementation to evaluate long term impact
Assessing Palliative Care Needs in Residents with Alzheimer\u27s
Get PDFCurrent evidence indicates a lack of assessment protocols focusing on palliative care needs for patients with Alzheimer’s disease. This gap in practice supported the need to implement an evidence-based assessment protocol for early identification of palliative care needs in patients with Alzheimer’s disease residing in a long-term care facility. The protocol included using the patient’s Global Deterioration Scale (GDS) score to determine the patient’s palliative care needs according to the Dementia Progression Prioritization of Goals model. If the score indicated moderate to severe Alzheimer’s disease, then their goal was maximization of comfort, indicating a need to begin palliative care plans.
A total of 36 residents in the long-term care facility selected for this project were assessed. Based on the protocol, 17 residents needed a palliative care consult. Following implementation of the protocol, hospice care was initiated on four residents and palliative care plans were initiated on another four residents. An educational session about the protocol was conducted to the staff. Upon evaluation of the protocol, staff identified the protocol easy to understand, feasible for daily use, and beneficial to practice. Further follow up is needed to evaluate the long-term impact of this project