Obesity and Anesthesia Management

The prevalence of obesity is rapidly increasing throughout the world. Correspondingly, anesthetic procedures in obese patients are also increasing due to both treatment of obesity and other surgical problems of obese patients. Anesthesia-related complications are also seen in obese patients than in normal-weighted population. The importance of anesthetic applications in obese patients originates from physiological and pharmacokinetic alterations. Inhalation of these patients via mask or intubation during general anesthesia may be difficult or even impossible. Determination of extubation time after awakening from anesthesia is also a critical decision. Sleep apnea syndrome and postoperative atelectasis are more common in obese patients than in normal-weighted population. Another vital complication that should be emphasized is thromboembolism, whose incidence and severity may be decreased by pharmacological and functional preventive modalities. This patient population has elevated risk of perioperative mortality and morbidity. Prior to any elective surgical procedure, an obese patient should be thoroughly evaluated to check medical conditions that may increase perioperative mortality risk. Since anesthesiologists will gradually encounter more obese patients, they need a better comprehending of the difficulties of obesity during anesthetic procedures and taking more preventive measures for their patients to avoid complications, or rendering them less traumatic, if any

Exploring Teacher’s Professional Identity in Relationship to Leadership: A Latent Profile Analysis

As a result of the COVID-19 outbreak, which has affected the whole world, teacher leadership has gained more significance. Teacher leadership is a multidimensional concept. While some teachers exercise leadership only at the classroom level, others exercise leadership at a macro level. This level of leadership enactment is directly related to how teachers construct their professional identity in relation to leadership. This study aims to explore the leadership-related professional identities of teachers who came to the fore, especially during the COVID-19 pandemic period by using latent profile analysis. The data were collected from a sample of 710 teachers. Teachers completed the Teacher Leadership Behavior Scale, which measures teacher leadership behaviors at four levels: classroom, parental, micro-level, and macro-level. Participants also completed the Rosenberg self-esteem scale, the teacher self-efficacy scale, the openness to authority scale, and the job satisfaction scale. As a result of latent profile analysis, three distinct profiles of teacher leadership identity emerged: those who exercise leadership at a minimum level, an intermediate level, and a maximum level across all four levels of teacher leadership. These profiles were labeled as “restricted professionality”, “intermediate professionality”, and “extended professionality”, drawing upon Hoyle’s conceptualization of teacher professional identity. These findings suggest that teachers construct their identities differently regarding teacher leadership. It is essential for school leaders to first explore the different levels of professional identity and tailor their professional development activities accordingly

A comparison of three different needles used for spinal anesthesia in terms of squamous epithelial cell transport risk

Background and objectives: To investigate the differences in the number of squamous epithelial cells carried to the spinal canal by three different types of spinal needle tip of the same size. Methods: Patients were allocated into three groups (Group I, Group II, Group III). Spinal anesthesia was administered to Group I (n = 50) using a 25G Quincke needle, to Group II (n = 50) using a 25G pencil point spinal needle, and to Group III (n = 50) using a non-cutting atraumatic needle with special bending. The first and third drops of cerebral spinal fluid (CSF) samples were taken from each patient and each drop was placed on a slide for cytological examination. Nucleated and non-nucleated squamous epithelial cells on the smear preparations were counted. Results: There was statistically significant difference between the groups in respect to the number of squamous epithelial cells in the first drop (p  0.05 for each group). Conclusions: In this study of different needle tips, it was seen that with atraumatic needle with special bending a significantly smaller number of cells were transported when compared to the Quincke tip needles, and with pencil point needles. Resumo: Justificativa e objetivo: Investigar as diferenças no número de células epiteliais escamosas transportadas para o canal medular por três tipos diferentes de pontas de agulhas espinhais do mesmo tamanho. Métodos: Os pacientes foram alocados em três grupos (Grupo I, Grupo II, Grupo III). Raquianestesia foi administrada aos pacientes do Grupo I (n = 50) com agulha Quincke de 25G, do Grupo II (n = 50) com agulha espinhal ponta de lápis de 25G e do Grupo III (n = 50) com agulha atraumática não cortante de curvatura especial. A primeira e terceira gotas de líquido cefalorraquidiano (LCR) foram colhidas de cada paciente para amostra e cada gota foi colocada em lâmina para exame citológico. As células epiteliais escamosas nucleadas e não nucleadas sobre as lâminas de esfregaço foram contadas. Resultados: Houve diferença estatisticamente significativa entre os grupos em relação ao número de células epiteliais escamosas na primeira gota (p  0,05, para cada grupo). Conclusões: Neste estudo de pontas de agulha diferentes, verificamos que com a agulha atraumática de curvatura especial o número de células transportadas foi significativamente menor, em comparação com as agulhas Quincke e ponta de lápis. Keywords: Spinal anesthesia, Cerebrospinal fluid, Spinal needles, Epithelial cells, Palavras-chave: Raquianestesia, Líquido cefalorraquidiano, Agulhas espinhais, Células epiteliai

Bacterial colonization due to increased nurse workload in an intensive care unit

INTRODUCTION: The rates of multiresistant bacteria colonization or infection (MRB+) development in intensive care units are very high. The aim of this study was to determine the possible association between the risk of development of nosocomial infections and increased daily nurse workload due to understaffing in intensive care unit. METHODS: We included 168 patients. Intensity of workload and applied procedures to patients were scored with the Project de Recherch&#233; en Nursing and the Omega scores, respectively. The criteria used for infections were those defined by the Centers for Disease Control. RESULTS: Of the 168 patients, 91 (54.2%) were female and 77 (45.8%) were male patients. The mean age of female and male was 64.9 &#177; 6.2 years and 63.1 &#177; 11.9 years, respectively. The mean duration of hospitalization in intensive care unit was 18.4 &#177; 6.1 days. Multiresistant bacteria were isolated from cultures of 39 (23.2%) patients. The development of MRB+ infection was correlated with length of stay, Omega 1, Omega 2, Omega 3, Total Omega, daily PRN, and Total PRN (p < 0.05). There was no correlation between development of MRB+ infection with gender, age and APACHE-II scores (p > 0.05). CONCLUSION: The risk of nosocomial infection development in an intensive care unit is directly correlated with increased nurse workload, applied intervention, and length of stay. Understaffing in the intensive care unit is an important health problem that especially affects care-needing patients. Nosocomial infection development has laid a heavy burden on the economy of many countries. To control nosocomial infection development in the intensive care unit, nurse workload, staffing level, and working conditions must be arranged