13468 research outputs found
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Urinetown: The Musical
No full texthttps://digitalcommons.otterbein.edu/production_2025_2026/1000/thumbnail.jp
The Trojan Women
No full texthttps://digitalcommons.otterbein.edu/theatre_dance_gallery/5889/thumbnail.jp
The Trojan Women
No full texthttps://digitalcommons.otterbein.edu/theatre_dance_gallery/5886/thumbnail.jp
Final Scholarly Project: Evidence-based Practice Guidelines for the Perioperative Management of Blood Glucose Levels in the Cardiac Surgery Patient
Full text linkCardiovascular disease is the leading cause of mortality worldwide, necessitating a high demand for cardiac surgery. A unique stressor for cardiac surgery is an increased surgical stress response involving hyperglycemia. Perioperative hyperglycemia contributes to adverse postoperative outcomes following cardiac surgery. Current evidence examines blood glucose control and its effect on adverse postoperative outcomes, including sternal wound infections, acute kidney injury, prolonged mechanical ventilation, and an increased length of stay in the intensive care unit. Despite the link between hyperglycemia and poor postoperative outcomes, most facilities lack standardized guidelines for the perioperative management of blood glucose levels in cardiac surgery patients. This project aims to have anesthesia providers implement blood glucose management guidelines in adult cardiac surgery patients during the perioperative setting. The Johns Hopkins Evidence-based Practice model guided the project through initial research, planning, implementation, and dissemination. A literature synthesis and analysis were conducted to synthesize current evidence supporting the development of guidelines to decrease adverse postoperative outcomes after cardiac surgery. The project team educated critical stakeholders, including anesthesia providers, and implemented blood glucose management guidelines based on current evidence. Outcomes following the implementation of the blood glucose guidelines will be compared to pre-implementation outcomes. The project team will analyze the post-implementation outcomes, including sternal wound infections, acute kidney injury, prolonged mechanical ventilation, and an increased length of stay in the intensive care unit, for improvements to assess whether the guidelines can be disseminated, or adjustments are needed
Using the Bispectral Index Monitor to Decrease the Incidence of Unintended Intraoperative Awareness in the High-Risk Population
Full text linkUnintended intraoperative awareness is a traumatizing complication of general anesthesia. This negative outcome affects 0.1-0.2% of all patients undergoing general anesthesia. Patients at higher risk for this experience include those undergoing emergency surgery, traumas, cesarian sections, those on cardiopulmonary bypass, those with substance use disorder, and those undergoing total-intravenous anesthesia (TIVA). This high-risk population is affected by unintended intraoperative awareness 1% of the time. The bispectral index (BIS) monitor has been proposed as a tool to decrease the incidence of unintended intraoperative awareness. There are several large, randomized controlled trials that demonstrate that using a BIS monitor decreases the incidence of intraoperative awareness, but it is not a tool that is utilized for every anesthetic. This project aims to evaluate if using a BIS monitor for all high-risk patients will decrease the incidence of unintended intraoperative awareness in a large, central Ohio medical center. This project will include 100 high-risk, adult patients receiving general anesthesia at this medical center. Data will be collected by the project leader using the Modified Brice Interview as the measuring tool. The data collected will be reviewed by a team of three anesthesia experts and interpreted by a statistician for accuracy. The two possible outcomes of this project are: the patient experienced intraoperative awareness and the patient did not experience intraoperative awareness. The results of this project will be calculated to a percentage and compared to the national average of 1% to determine if the use of the BIS monitor decreases the incidence of intraoperative awareness in the high-risk patient population
Patient Satisfaction with Telehealth to Access Psychiatric Health Services in Rural Outpatient Psychiatric Health Settings: A Project Proposal
Full text linkAbstract
Telehealth competencies of the National Organization of Nurse Practitioner Faculties for Advanced Practice Registered Nurses (APRN) are fundamental in psychiatric health management. This project examined patient satisfaction with telehealth services through surveys and interviews, focusing on factors such as quality of care and provider-patient relationships, comparing satisfaction levels between in-person visits and telehealth services while evaluating how telehealth impacts overall service utilization.
Methodology: The project applied a mixed-methods approach. In structured interviews and surveys, patients were surveyed on satisfaction scores based on convenience, usability, provider-patient communication, and perceived care effectiveness. A comparative analysis was done between telehealth and traditional in-person visits to determine the differences in patient preferences and experiences.
Results: Findings indicate that most patients in rural outpatient psychiatric settings value telehealth for its convenience and ease of access, highlighting its potential to improve service utilization and satisfaction in underserved areas.
Discussion: A comparative analysis of the use of telehealth to access psychiatric health services revealed the levels of patient satisfaction. Telehealth provides greater access to care, particularly in rural and underserved areas, reducing travel costs and wait times.
Conclusion: The project concluded that telehealth services undeniably hold enormous potential for improving patient satisfaction in rural areas. Telehealth services bridge geographical gaps, offering flexibility and convenience while overcoming logistical barriers.
Keywords: telehealth services, patient satisfaction, psychiatric health, rural outpatient settings in northern New Jersey, access to care, mental health outcomes, service utilization
The Effects of Pond Algal Deterrents on the Growth and Development of Gray Treefrogs, Hyla Versicolor
Full text linkHarmful algal blooms, often exacerbated by nutrient pollution, pose significant threats to aquatic ecosystems (Hallegraeff 2003). Two commonly used treatments for mitigating algae growth in ponds are copper sulfate and Aquashade. However, both treatments have potential ecological consequences, particularly for sensitive amphibian species. This study explores the effects of copper sulfate and Aquashade on the gray treefrog (Hyla versicolor) from egg to juvenile froglet. Specifically, we investigated the impacts of algae treatments on light, temperature, and Hyla versicolor survivorship, growth, and time to metamorphosis. Copper sulfate significantly reduced egg and early hatchling survivorship and produced froglets with smaller snout-vent lengths (SVLs). Unexpectedly, there was a trend in larvae treated with Aquashade metamorphosing faster into froglets with larger SVLs. As anticipated, increased food availability positively influenced froglet growth, with larvae that received supplemental food metamorphosing into froglets with larger SVLs. Aquashade mesocosms had significantly cooler temperatures than control and copper sulfate mesocosms and exhibited a trend in lower light levels. In a 10-week indoor feeding and growth experiment, we observed a behavior similar to compensatory growth as froglets reared without supplemental food retained mass better than froglets reared with supplemental food. This study reveals the complex relationship of algae treatments on gray treefrogs, offering valuable insights to better pond management practices
Implementation of Guidelines for Preprocedural Ultrasound in Neuraxial Placement for Obstetric Patients with Scoliosis
Full text linkNeuraxial anesthesia including epidural, spinal, and combined spinal-epidural, is used with 65% of parturients in the United States for the management of pain and discomfort. Conventional landmark palpation has been the mainstay technique for neuraxial anesthesia, but unfamiliar spinal anatomy can lead to incomplete blockade or an increased incidence of complications. Scoliosis causes lateral curvature and rotation of the spine leading to arthritis and soft tissue changes that can present obscure anatomical landmarks, cause difficulty in needle passage, and result in inadequacy of local anesthetic efficacy. The literature illustrates that preprocedural ultrasound is recommended for needle placement in parturients with difficult spinal anatomy and those with moderate to severe scoliosis. Despite the preprocedural ultrasound benefits of enhanced imaging of structures, and needle depth estimation and direction, in the United States, only 22% of obstetric units incorporated preprocedural ultrasound for neuraxial anesthesia. The model used for the DNP (Doctorate in Nursing Practice) project is the practice, evidence, and translation (PET) section of the John Hopkins Evidence-Based Practice Model (JHEBP) for healthcare professionals. This project’s main objective is the implementation of evidence-based practice (EBP) guidelines for the facilitation of neuraxial anesthesia in parturients who present with scoliosis with preprocedural ultrasound or conventional landmark palpation. If implemented, the project can aid in first-pass success, allow for needle redirection accuracy, and decrease procedural time while also decreasing complications of incomplete blockade, vascular puncture, and post-dural puncture headache. Additional project objectives include an algorithmic approach to decision-making for neuraxial anesthesia based on patient characteristics, a comprehensive plan to implement the EBP guidelines, and a method to monitor, measure, and evaluate guidelines
Analysis of Clinical Outcomes and Cost Effectiveness of Neuromuscular Blocking Drug Reversal in Patients Classified as Obese
Full text linkObesity predisposes patients to heightened risks of adverse outcomes following surgery, including residual neuromuscular blockade and postoperative complications. The administration of non-depolarizing neuromuscular agents (NMBAs) is fundamental for muscle relaxation and optimal surgical conditions. However, the subsequent reversal of these blockers with agents like sugammadex or neostigmine is crucial to mitigate these risks. While sugammadex is recognized as a clinically superior choice due to its rapid and more complete reversal, its extensive use is often limited by cost, presenting challenges in obese patients who already face increased susceptibility to complications. This project evaluates the cost-effectiveness of sugammadex versus neostigmine in obese patients undergoing general anesthesia. Employing the PET process of the Johns Hopkins Nursing Evidence-Based Practice (EBP) Model, the project develops evidence-based recommendations. By conducting evidence review and analyzing literature on clinical and economic outcomes, including postoperative complications and costs, anesthesia providers will receive guidance in optimizing patient care and resource utilization
Clinical Guidelines for the Perioperative Management of Patients with Aortic Stenosis Undergoing Noncardiac Surgery
Full text linkAortic stenosis (AS) is a common valvular disorder that causes left ventricular (LV) outflow obstruction. The prevalence of AS may increase with the aging population and the widespread availability of diagnostic capabilities like echocardiography. With the increasing patient population diagnosed with AS, the chance of encountering these patients during noncardiac surgery (NCS) increases. Performance of anesthesia is challenging in patients with AS due to the pathophysiological consequences of AS and the hemodynamic changes associated with anesthesia. The patient with AS presenting for NCS is at an increased risk of perioperative major adverse cardiac events (MACEs). This project aimed to determine the most up-to-date evidence for the perioperative management of patients with AS undergoing NCS. A literature search was conducted through the EBSCO Discovery Service and Google Scholar to find current evidence. The current evidence was used to create clinical guidelines for the pre and intraoperative management of patients with AS undergoing NCS using the Bayesian approach. The practice question, evidence, translation (PET), part of the Johns Hopkins Evidence-Based Practice Model (JHEBPM), was used as the literature review’s framework. An implementation plan to disseminate the guidelines into practice was formed and discussed. The outcome the project team aims to study is the incidence of MACEs in patients with AS undergoing NCS after the implementation of clinical guidelines.
Keywords: aortic stenosis, noncardiac surgery, major adverse cardiac event, preoperative evaluation, intraoperative managemen