3511 research outputs found
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Application of Ultrasound for Difficult Vascular Access in Obstetric Patients
No full textThis project aimed to create a three-tiered educational program to introduce the benefits of ultrasound application for peripheral IV placement in obstetrical patients. The main goals of this project were to increase successful first-attempt IV placement in obstetric patients who may be difficult to obtain IV access on. The first tier of education consisted of presenting findings from the literature review as an educational PowerPoint to all project stakeholders. The second tier of education included stakeholders practicing using the ultrasound for PIV placement on mannequin arms. The third tier, which is still on going, included implementation of the first two tiers by practicing PIV placement on patients while being supervised by an approved colleague.A five-point Likert scale was utilized to assess the use of ultrasound for PIV placement after the educational presentation. After the educational in-service, 54.5% of participants felt confident, and 27.2% felt extremely confident in incorporating ultrasound use for PIVs in normal everyday use. 54.5% felt confident and 36.4% felt extremely confident they could correctly perform the steps of PIV placement via ultrasound. Implementing an educational training program for ultrasound use during PIV placement will give participants more confidence in their ability to incorporate ultrasound use into everyday practice for PIV placement. The successful completion of the educational in-service will lead participants to increase first-attempt success for PIV placement. These newly acquired abilities would lead to cost reduction in supply usage, greater patient satisfaction due to decreased needle sticks and timeliness of care by providers
Methadone
Get PDFThis study investigates the efficacy of intravenous methadone as an alternative to traditional opioids for postoperative pain management following major surgeries. A comprehensive literature review, including randomized controlled trials, meta-analysis, and retrospective studies, was conducted. The findings highlight methadone’s effectiveness in reducing postoperative pain, with advantages over conventional opioids in various surgical scenarios. However, its use necessitates caution due to several potential risks. Methadone’s dual role as an opioid agonist and NMDA antagonist makes it effective in preventing the transition from acute to chronic postoperative pain, positioning it as a valuable tool in chronic pain management. Its cost-effectiveness further enhances its sustainability for long-term pain management strategies. The study concludes with the development of a methadone protocol for a major hospital in central Illinois, aimed at improving the anesthesia staff’s understanding and application of methadone. The project’s findings were presented to hospital staff, with evaluations indicating significant knowledge enhancement and a willingness to incorporate methadone into anesthetic plans. This research underscores the potential of methadone in transforming postoperative pain management, emphasizing the need for ongoing research to refine dosing guidelines and broaden its application across diverse surgical procedures
Implementation of Prenatal and Postpartum Depression Screening for a Telehealth Company
Get PDFAbstract
Depression is a leading mental health disorder. Depression occurring during the perinatal and postpartum periods has become highly prevalent throughout the world, impacting 5-10% of women during (van de Loo et al., 2018) and 9-23.5% postpartum (Bauman et al., 2020). Proper diagnosis and treatment of perinatal and postpartum depression (PPD) is crucial, as depression can lead to poor outcomes including relationship complications and negatively affect child development (Slomain, 2019). The implementation of screening tools can help identify women at risk based on their signs and symptoms of PPD (Bauman et al., 2020). The primary goal of this project was to implement a standardized tool at a telehealth company for all providers to use to screen for perinatal and PPD and to provide further education to these providers regarding PPD. Pre and post-intervention questionnaires were utilized to assess the change in providers\u27 knowledge and attitudes regarding PPD following an educational session on PPD. Prior to the educational sessions, 36% of participants felt strongly comfortable in addressing mental health concerns with this population, and 73% felt strongly comfortable in the post-survey. Additionally, there was an improvement in identifying signs and symptoms of depression, as well as increased comfortability with treating this patient population. Education on PPD and the introduction of evidence-based screening guidelines provide valuable tools for providers to use when caring for populations impacted by postpartum depression. The implementation of a postpartum depression screening tool can help providers deliver high-quality and holistic care to both new and expecting mothers
Structured invariant subspace and decomposition of systems with time delays and uncertainties
Get PDFThis article discusses invariant subspaces of a matrix with a given partition structure. The existence of a nontrivial structured invariant subspace is equivalent to the possibility of decomposing the associated system with multiple feedback blocks such that the feedback operators are subject to a given constraint. The formulation is especially useful in the stability analysis of time-delay systems using the Lyapunov-Krasovskii functional approach where computational efficiency is essential in order to achieve accuracy for large scale systems. The set of all structured invariant subspaces are obtained (thus all possible decompositions are obtained as a result) for the coupled differential-difference equations associated with the differential-difference equations of retarded and neutral types, as well as systems with a time-varying delay. It was shown that the known ad hoc methods of reducing the dimensions of delay channels can be considered as special cases of decomposition where one subsystem has trivial dynamics. The reduction of computational cost is demonstrated by a numerical example. For the general case, a recursive procedure is developed to obtain the set of all structured invariant subspaces. Based on this procedure, a method is presented to obtain a nontrivial structured invariant subspace that considers computational efficiency and increased possibility of terminating in a finite number of steps
Qualitative vs. Quantitative Train of Four
Get PDFThe growing body of evidence linking residual neuromuscular blockade (NMB) to postoperative complications has underscored the need to integrate quantitative neuromuscular monitoring techniques into anesthesia practice. This study, conducted at a tertiary care center in southern Illinois, investigates the gap between current clinical practices and the latest evidence advocating for objective monitoring. The study utilized a non-experimental pretest-posttest design to evaluate an educational intervention\u27s effectiveness in increasing anesthesia providers\u27 knowledge of quantitative neuromuscular monitoring techniques and enhancing their awareness of the incidence and clinical implications of postoperative residual neuromuscular blockade. Analysis of the pretest and post-test responses revealed significant improvements in providers\u27 knowledge, particularly in understanding the prevalence of residual neuromuscular blockade and the clinical relevance of the TOFR (Train-of-Four Ratio). However, gaps remained in participants\u27 understanding of subjective assessment methods and factors affecting the accuracy of quantitative monitoring. Nonetheless, these findings highlight the critical role of educational interventions in advancing neuromuscular monitoring practices. Future initiatives should address economic and technical barriers to implementation and incorporate ongoing educational efforts to promote long-term practice change
Shivering in Postpartum Women: Development of a Perioperative Protocol for Women Undergoing Cesarean Section
Get PDFIn obstetric patients undergoing a cesarean section, a spinal anesthetic is the most common form of anesthesia (Hannallah, 2016). An intrathecal (or spinal) block is not benign. Postpartum shivering is a potential risk with any neuraxial procedure, with an incidence of 40-80% specifically following a spinal anesthetic (Feng et al., 2021). Patients who experience shivering are at a greater risk for postoperative complications, impaired mother-newborn bonding, and decreased patient satisfaction. Both nonpharmacological and pharmacological treatment options exist for prevention and treatment of postpartum shivering. The objective of this project was to introduce a standardized, evidence-based protocol to decrease the incidence of shivering and untoward sequela in patients undergoing a cesarean section with spinal anesthesia. A comprehensive review of the literature was performed to identify contributing factors, prevention of, and treatment for postpartum shivering. The project study design utilized a non-experimental pre- and post-evaluation method completed by 29 obstetric nurses and anesthesia providers. Following the educational PowerPoint presentation, the post-evaluation survey was utilized to assess participant comprehension. Overall, participants improved their knowledge as evidenced by the rate of correct responses. The implementation of the postpartum shivering protocol was directed at improving patient outcomes and enhancing provider knowledge; further research is needed to follow-up on patient outcomes
A Behavioral Intervention Checklist to Reduce Re-Hospitalizations in Residents with Mental Illness
Get PDFSkilled nursing facilities are an essential component of the continuum of care and, with the rapidly aging population, represent an increasing cost to the healthcare system. The policies beginning in the 1960s promoting the deinstitutionalization of mental health institutions have resulted in increasing numbers of individuals with serious mental illnesses now residing in skilled nursing facilities. The complex needs of individuals with mental illness have been associated with an even greater cost of care, deficient quality, and safety concerns. This quality improvement project analyzed the impact of an evidenced-based, structured behavioral intervention checklist on rehospitalization rates in individuals with mental illness residing in a skilled nursing facility. The checklist was designed to allow nurses to use an algorithmic methodology to deescalate the manifestations of mental illness to prevent rehospitalization. Staff were provided with education on the management of residents with mental illness and the use of the checklist throughout the process. Data was collected pre- and post-implementation of the checklist to measure 90-day rehospitalization rates with a secondary measure reviewing lost census days to hospitalizations. The checklist showed limited improvement in 90-day rehospitalization rates (p \u3c 0.04). Lost census days to hospitalization showed a more robust improvement (p \u3c 0.01). While more research would appear warranted, the implications of these findings suggest that checklists or algorithms may be a viable care improvement tool in complex care environments such as skilled nursing facilities
Identifying and Improving Developmental Delays in Children Within Central America
Get PDFRoughly 40% of children living in low-income countries worldwide are at an increased risk of not reaching developmental milestones. Many of these children are at risk due to lack of resources, quality healthcare, and proper developmental screenings. Short-term medical mission trips (STMMs) aim to improve the health of those residing in developing countries. However, although the U.S. does carry out many STMMs to developing countries within Central America to help improve health outcomes, pediatric developmental screenings are often not a part of routine health visits during these STMMs. This may be due to providers having a general lack of experience with pediatric patients or a lack of knowledge about cultural childrearing practices, pediatric norms, and resources available that promote development in the host country. This quality improvement project was based on evidence-based practices and aimed to use an online educational module to increase providers’ knowledge on pediatric developmental milestones in children ages 1-3 years, as well as screen children on a STMM in Guatemala for developmental delays and provide intervention to those children who are shown to be delayed. Results from pre- and post-surveys within the educational module suggest an increase in knowledge of developmental milestones post-education. Results from a qualitative survey conducted on the last day of the STMM suggest that although the screening tool provided was difficult to use due to low health literacy levels in the patient population, interventions provided to the parents and children were positive
Recommendations for Sugammadex Administration in Standard and Special Populations
Get PDFThe purpose of this project was to collect evidence-based information regarding sugammadex administration in both standard and selected special populations. Special populations included renal failure, breastfeeding, pregnancy, and pediatrics. The objectives of the project were to collect and present current research to the host facility, define barriers to the use of sugammadex, and assess the participants’ knowledge of sugammadex use in special populations. A guideline for sugammdex administration was created and presented to the host facility through a poster presentation and quick reference guide. A voluntary post-implementation survey was implemented, and the results were recorded, analyzed, and displayed in the final dissemination. Results showed an overall increase in provider knowledge in the use of sugammadex in special populations, improved confidence in use of medication, and found the quick reference guide to be user friendly. The small sample size and use of a convenience sample limited the ability to generalize the results to the larger population. Additional long-term research is still required for the use of sugammadex in special populations. However, current evidence shows sugammadex to be superior for prevention of postoperative pulmonary complications in standard populations. Sugammadex is a useful drug in clinical anesthesia practice requiring additional education for providers to ensure best practice