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In Adults with Difficult Intubations, What Is a Gold Standard Method for Success?
Get PDFThe objective of this thesis is to analyze existing literature and guidelines for difficult intubations and provide clinical recommendations. This paper is a retrospective analysis of human trials focusing on preparation, medication, and tools in the field of emergency airway management. Techniques will be described and discussed. A large portion of intubations are described as difficult and have the potential to fail. Articles retrieved from databases PubMed, Medline, and PLOS ONE and the search engine Google Scholar were reviewed. Websites for the institutions of the American Society of Anesthesiologists and Difficult Airway Society were used in guidance. Currently, many guidelines exist for difficult intubation, and traditional bedside prediction has proven to be unreliable. Techniques such as preprocedural checklists, preoxygenation, proper positioning benefit all intubations. In addition, practicing the failed intubation protocol including a standardized tracheotomy procedure is recommended. The paralytic rocuronium may be superior to succinylcholine in critically ill or those likely to have difficult airways. Technologies such as video laryngoscope, supraglottic airway devices, and bougie-first intubation should be included in training and implemented in practice. The obese population may have specific changes to technique to reduce the risk of complications. Finally, cricoid pressure is theoretically beneficial but practically challenging to replicate and recommendations will be given regarding its implementation
Hypertrophic Cardiomyopathy and ICD Therapy
No full textBackground: Hypertrophic cardiomyopathy (HCM) is a genetic cardiac disease associated with high population prevalence and the potential for sudden cardiac death (SCD). Treating the disease is difficult, with symptom management, surgery, implantable cardioverter- defibrillator (ICD) therapy, and heart transplantation as the main options. This literature review outlines the history of the disease, the role genetics play in diagnosis and future treatment, and screening for families and athletes. A description of HCM with and without obstruction is provided. Additionally, a summary of the current risk stratification guidelines and an overview of treatment and ICD therapy is included.
Methods: This paper is a systematic review of 22 articles; it seeks to analyze ICD therapy recommendations for patient selection and timing based on the current risk stratification models; pointing out strengths and weaknesses. Key terms include hypertrophic cardiomyopathy , ICD therapy , sudden cardiac death , risk stratification guidelines , and athlete screening .
Results: Analysis of current data identifies flaws in the current risk stratification guidelines. These include lack of research surrounding comorbid conditions and their impact on ICD therapy, lack of knowledge surrounding which risk factors are most predictive for SCD, and the role potential risk factors play in assessment. Included is a thorough comparison of the United States and European guidelines, and areas for future research. In addition, novel treatments are outlined. Conclusion: The current guidelines are ill-suited for clinical use, and a new algorithm is necessary to determine optimal timing for ICD therapy and to correctly identify qualifying patients
Nicotine Exposure During Pregnancy and Risk of Behavioral Disorders in Offspring
Get PDFBackground: Smoking during pregnancy has been linked to various health outcomes in offspring. The relationship between nicotine (smoke) exposure during pregnancy and behavioral disorders, such as attention deficit hyperactivity disorder (ADHD), has been studied for years yielding mixed results. These studies have varied in quality of design and methods, alluding to varied association conclusions. The purpose of this summative review is to determine the association between prenatal nicotine exposure and risk of developing behavioral disorders, such as ADHD.
Methods: A systematic search using Lindell Library and PubMed was used to find peer- reviewed studies on the topics of maternal nicotine exposure during pregnancy, and smoking during pregnancy and behavioral disorders in offspring. Specific areas of interest included maternal smoking during pregnancy and ADHD, nicotine exposure during pregnancy and effects on offspring, and ADHD.
Results: Several large sample studies indicate there is a correlation between nicotine exposure in utero and ADHD in offspring. However, a few smaller, single population or regional studies fail to confirm the relationship. This indicates more research needs to be conducted.
Conclusions: More research needs to be done on the topic, particularly prospectively, while addressing confounding variables. More recent research using various forms of nicotine exposure, such as vaping or e-cigarette use, needs to be done using a large-scale study in various populations to examine the possible associated risks. Smoking during pregnancy is still not recommended, in any form, because of the known poor health outcomes for mother and baby, and possible associated risks of behavioral disorders
RL: Finding Realness, Meaning, and Belonging in Our Digital Lives
No full textIt\u27s easy and reflexive to view our online presence as fake, to see the internet as a space we enter when we aren\u27t living our real, offline lives. Yet so much of who we are and what we do now happens online, making it hard to know which parts of our lives are real.
IRL, Chris Stedman\u27s personal and searing exploration of authenticity in the digital age, shines a light on how age-old notions of realness--who we are and where we fit in the world--can be freshly understood in our increasingly online lives. Stedman offers a different way of seeing the supposed split between our online and offline selves: the internet and social media are new tools for understanding and expressing ourselves, and the not-always-graceful ways we use these tools can reveal new insights into far older human behaviors and desires.
IRL invites readers to consider how we use the internet to fulfill the essential human need to feel real--a need many of us once met in institutions, but now seek to do on our own, online--as well as the ways we edit or curate ourselves for digital audiences. The digital search for meaning and belonging presents challenges, Stedman suggests, but also myriad opportunities to become more fully human. In the end, he makes a bold case for embracing realness in all of its uncertainty, online and off, even when it feels risky.https://idun.augsburg.edu/monographs/1076/thumbnail.jp
Interhemispheric Comparisons of Large Nighttime Magnetic Perturbation Events Relevant to GICs
Get PDFNearly all studies of impulsive magnetic perturbation events (MPEs) with large magnetic field variability (dB/dt) that can produce dangerous geomagnetically induced currents (GICs) have used data from the Northern Hemisphere. Here we present details of four large‐amplitude MPE events (|ΔBx| \u3e 900 nT and |dB/dt| \u3e 10 nT/s in at least one component) observed between 2015 and 2018 in conjugate high‐latitude regions (65–80° corrected geomagnetic latitude), using magnetometer data from (1) Pangnirtung and Iqaluit in eastern Arctic Canada and the magnetically conjugate South Pole Station in Antarctica and (2) the Greenland West Coast Chain and two magnetically conjugate chains in Antarctica, AAL‐PIP and BAS LPM. From one to three different isolated MPEs localized in corrected geomagnetic latitude were observed during three premidnight events; many were simultaneous within 3 min in both hemispheres. Their conjugate latitudinal amplitude profiles, however, matched qualitatively at best. During an extended postmidnight interval, which we associate with an interval of omega bands, multiple highly localized MPEs occurred independently in time at each station in both hemispheres. These nighttime MPEs occurred under a wide range of geomagnetic conditions, but common to each was a negative interplanetary magnetic field Bz that exhibited at least a modest increase at or near the time of the event. A comparison of perturbation amplitudes to modeled ionospheric conductances in conjugate hemispheres clearly favored a current generator model over a voltage generator model for three of the four events; neither model provided a good fit for the premidnight event that occurred near vernal equinox
A Pilot Study of Mindfulness-Based Music Therapy in an Intensive Outpatient Program for Adults with Co-Occurring Mental Health and Substance Use Disorders
Get PDFThis pilot study was designed to explore the use of mindfulness-based music therapy in an intensive outpatient program for adults with co-occurring mental health and substance use disorders. All participants completed the Brief Serenity Scale (Kreitzer et al., 2009) as a pre-test prior to their participation in this study. Participants took part in four monthly 50-minute mindfulness-based music therapy groups. At designated points throughout each music therapy session (including the beginning, end, and after each specific experience), the participants marked on a Likert scale where their thoughts were, in relation to the past, present, and future. Post-test measures of the Brief Serenity Scale (Kreitzer et al., 2009) were completed after the participants’ final study session. Descriptive statistics were used to identify trends in data from the Likert scales, and results indicated that the highest number of participants in each session felt present after the musical introductions. Differences between pre- and post-test scores were calculated using inferential statistics. The statistical analysis of the overall pre- and post-test scores showed no significant differences in the mean scores, although the mean score was higher for the post-test than the pre-test. Pre- and post-test scores for the individual questions showed a significant difference for four responses. These responses are all connected with the serenity factor of inner haven (Kreitzer et al., 2009)
Assuring Cultural Competence in the Nurse Caring for the Transgender Patient
No full textThe wellbeing of the transgender population is a healthcare priority. Transgender people have a gender identity that does not align with the sex assigned at birth. This population struggles to find healthcare with providers who are knowledgeable in transgender needs. This population also experiences high rates of discrimination in society as well as in health care settings, which negatively affects their health and wellbeing. Transgender individuals seek care for common acute medical needs as well as for gender affirming cares such as hormone therapy or surgical procedures to cope with their diagnosis of gender dysphoria. There is a great need educate nurses. This project is to develop education related to the transgender population and as a patient. The education will be presented verbally and guided by a power point presentation. At the close of the presentation, 10 minutes will be allowed for question and dialogue to address any content not covered. Madeleine Leiningers nursing theory guided the development of the education content to be presented to nurses working in an ambulatory clinic setting. A pre and post assessment survey will be given to the nurses in attendance to evaluate learning and levels of comfort interacting with a transgender patient. Nurses and other health care providers must develop the knowledge and skills required to care for the transgender patient in order to promote health and wellbeing. This includes knowledge about transgender lifeways and language, along with the ability to care for their specific medical needs. Nurses are in a unique position to shift the paradigm and to increase awareness of culture care of the transgender population
Electropenetography Reveals Altered Aphid Feeding Behavior Correlated with Differential Gene Expression in Wild Barley Hosts
No full textAphids are phloem-feeding insects that substantially reduce crop yields around the world. Current pest-management approaches threaten to undermine ecological balance, rely heavily on expensive chemical inputs, and select for resistant insect biotypes. This study investigated differential fitness of the bird-cherry oat aphid (Rhopalosiphum padi) on three accessions of Hordeum vulgare ssp. spontaneum, the wild progenitor of cultivated barley. Data from the electrical penetration graph (EPG) technique suggest that aphids presented with WBDC 053 as a host spent significantly less time ingesting phloem sap than those infesting WBDC 117, WBDC 336, or the commercial barley line ‘Morex’ (Mx) – indicating the presence of a phloem-based resistance in WBDC 053. The plant genes SOD, LOX, and HSP70 were selected as representatives of key metabolic pathways involved in plant defense responses, namely those in the production of jasmonate. Altered regulation of these genes during aphid feeding in the various barley accessions was assessed via quantitative RT-PCR. Differential gene expression between accessions is correlated with EPG and reproductive data. This characterization of pest resistance in three wild barley accessions demonstrates the utility of crop wild relatives as sources of novel genetic variation for plant improvement.https://idun.augsburg.edu/zyzzogeton/1022/thumbnail.jp
Implementing Health Coaching Principles Into the Role of a Family Nurse Practitioner
No full textA spinal cord injury is a serious and complex disease that causes significant disability with profound consequences. In 2016, 282,000 individuals were living with a spinal cord injury, and over 42,000 of those were veterans. Veterans with a spinal cord injury often experience health disparity due to the limited resources and support to help them achieve optimal health. To address the health disparity of veterans with a spinal cord injury, family nurse practitioners at the Veterans Affair Hospital must identify ways to promote health and prevent disease among veterans with a spinal cord injury. Health coaching, a practice that has shown to support patients in primary care to identify their health goals, strength, and barriers, helps to facilitate behavioral changes in a structured and supportive partnership between a health coach and patients. Implementing the evidence-based practice of health coaching in primary care will support family nurse practitioners in guiding veterans to improve self-efficacy and positive patient health outcomes that are congruent with a veteran’s values, beliefs, and culture. The foundation of health coaching practice is guided by health coaching principles and Jean Watson’s theory of Transpersonal Care and Caring Moment during each coaching occasion. Using the health coaching principles and Watson’s theory of Transpersonal Care and Caring Moment, a health and wellness model of practice was created to guide family nurse practitioners in helping veterans with a spinal cord injury regain control of their health and living a high quality of life as they define it
Education for Health Care Providers: Medical Cannabis
Get PDFHealth care providers are consistently unaware of the implications, efficacy, and resources correlated with medical cannabis and cannabidiol. Thus, patients are uninformed about medical cannabis as a treatment option for their qualifying conditions. Informative educational sessions present a method to facilitate specialty knowledge development regarding medical cannabis and cannabidiol. In this scholarly project, six nurse practitioners and two allied staff members, attended a PowerPoint presentation followed by an open discussion regarding cannabinoids. Examination of post-presentation survey results indicated that felt more informed about the physiology and efficacy of cannabidiol, more aware of the resources for them, and had increased comfort speaking and informing their patients about cannabidiol after the educational session. These results indicate that health care providers’ increased knowledge and awareness about medical cannabis and cannabidiol translates into increased comfort recommending cannabidiol in their patient’s treatment plan. Future implications include continued education to health care providers in different demographics, to expand awareness of medical cannabis and cannabidiol and their associated implications to wellness