Increasing Providers Awareness of Waste Anesthetic Gases Exposure in the Post-Anesthetic Care Unit: An Educational Module

This quality improvement project aims to increase the providers\u27 knowledge based on the current literature, the potential dangers of WAGs exposure, and ways providers can reduce exposure levels. Background: The OR\u27s concentration, effects, and reduction strategies are well addressed. Nevertheless, studies that address the exposure of WAGs in perioperative providers in the PACU are limited. Methods: An in-depth inquiry was conducted using CINAHL, PubMed, and MEDLINE, to withdraw studies from 2014 to 2021 related to the PICOT question, of which 8 articles were appraised. Then, an invitation of CRNAs solely to partake in a pre-test survey, followed by the educational module implementation and a post-test survey. Statistical analysis was applied to assess the impact of the educational intervention. Results: There was a 60% increase in knowledge for the organization responsible for setting exposure limits to WAGs, also a 20% to 30% increase in the participant\u27s ability to distinguish between the short- and long-term effects of WAGs exposure. Seventy percent of participants identified at-risk providers to WAG exposure. Finally, all participants knew that chronic WAGs had been linked to short- and long-term effects. Discussion: There was increased knowledge regarding WAG exposure, adverse effects, and practices that reduce its exposure. Considering the limitations of the project and little research focused on mitigating WAGs exposure in the PACU, further research is needed. Limitations include the sample size of 10 participants and the virtual delivery of the educational module

Toward evidence-based teaching: evaluating the effectiveness of two teaching strategies in an associate degree nursing program

The need for evidence based teaching has become an important ideology for nurse educators who are frequently encouraged to expand their teaching strategies based on recent advances in technology and student learning styles. Traditional lecture is often preferred by students, yet the literature encourages case study methodology for the development of critical thinking. A pilot study was conducted comparing learning outcomes using two different teaching strategies: lecture and case study instruction. Recommendations for using case study as a teaching methodology are offered

Circulating endothelial cell-derived extracellular vesicles mediate the acute phase response and sickness behaviour associated with CNS inflammation.

Brain injury elicits a systemic acute-phase response (APR), which is responsible for co-ordinating the peripheral immunological response to injury. To date, the mechanisms responsible for signalling the presence of injury or disease to selectively activate responses in distant organs were unclear. Circulating endogenous extracellular vesicles (EVs) are increased after brain injury and have the potential to carry targeted injury signals around the body. Here, we examined the potential of EVs, isolated from rats after focal inflammatory brain lesions using IL-1β, to activate a systemic APR in recipient naïve rats, as well as the behavioural consequences of EV transfer. Focal brain lesions increased EV release, and, following isolation and transfer, the EVs were sequestered by the liver where they initiated an APR. Transfer of blood-borne EVs from brain-injured animals was also enough to suppress exploratory behaviours in recipient naïve animals. EVs derived from brain endothelial cell cultures treated with IL-1β also activated an APR and altered behaviour in recipient animals. These experiments reveal that inflammation-induced circulating EVs derived from endothelial cells are able to initiate the APR to brain injury and are sufficient to generate the associated sickness behaviours, and are the first demonstration that EVs are capable of modifying behavioural responses

Lavender Aromatherapy Compared to Midazolam For Quality Improvement Of Preoperative Anxiety In Elderly Surgical Patients: An Educational Module

Impact: Investigation into the anxiolytic effects of lavender aromatherapy across several patient populations, application types, and outcome measures establish that lavender oil relieves anxiety, reduces mental stress, provides sedation, and promotes good sleep. Background: Studies have investigated the link between age and the occurrence of undesired responses to premedication with agents of the benzodiazepine drug class. This link is explained by age-related pathophysiologic changes that occur as a function of aging. Despite numerous knowledge-based concerns, benzodiazepines prevail among the top psychotropic medications prescribed in elderly patients aged between 65 and 80 years. Objective: This quality improvement project aims to enhance anesthesia providers\u27 knowledge, beliefs, and attitude regarding the value of aromatherapy with lavender oil as an affordable, safe, and effective alternative to midazolam administration for preoperative anxiolysis in elderly surgical patients. Methods: An extensive literature search was conducted to synthesize studies relevant to the PICO question and create an evidence-based educational module for virtual presentation. An anonymous online platform was used to distribute the project’s intervention and survey components to a sample of anesthesia providers working at a South Florida level-1 trauma center and to record and statistically analyze data. Results: Collectively, the evidence-based literature presented by this project positively impacts the perioperative care of older adults, as it demonstrates lavender aromatherapy as a beneficial alternative to midazolam administration for improved management of preoperative anxiety in elderly surgical patients. Discussion: Analysis of the pre-and post-survey results reveals that this quality improvement project met the objective of expanding anesthesia providers’ knowledge and understanding of the use of lavender oil aromatherapy to optimize preoperative anxiety and care outcomes in elderly surgical patients. As a result, they will be more competent and effective in helping elderly patient populations achieve relief from anxiety before surgery and improved perioperative care outcomes. The small sample size, short project duration, and online delivery platform were limitations of this project

Potentiality in Biology

We take the potentialities that are studied in the biological sciences (e.g., totipotency) to be an important subtype of biological dispositions. The goal of this paper is twofold: first, we want to provide a detailed understanding of what biological dispositions are. We claim that two features are essential for dispositions in biology: the importance of the manifestation process and the diversity of conditions that need to be satisfied for the disposition to be manifest. Second, we demonstrate that the concept of a disposition (or potentiality) is a very useful tool for the analysis of the explanatory practice in the biological sciences. On the one hand it allows an in-depth analysis of the nature and diversity of the conditions under which biological systems display specific behaviors. On the other hand the concept of a disposition may serve a unificatory role in the philosophy of the natural sciences since it captures not only the explanatory practice of biology, but of all natural sciences. Towards the end we will briefly come back to the notion of a potentiality in biology

Designing theoretically-informed implementation interventions

Clinical and health services research is continually producing new findings that may contribute to effective and efficient patient care. However, the transfer of research findings into practice is unpredictable and can be a slow and haphazard process. Ideally, the choice of implementation strategies would be based upon evidence from randomised controlled trials or systematic reviews of a given implementation strategy. Unfortunately, reviews of implementation strategies consistently report effectiveness some, but not all of the time; possible causes of this variation are seldom reported or measured by the investigators in the original studies. Thus, any attempts to extrapolate from study settings to the real world are hampered by a lack of understanding of the effects of key elements of individuals, interventions, and the settings in which they were trialled. The explicit use of theory offers a way of addressing these issues and has a number of advantages, such as providing: a generalisable framework within which to represent the dimensions that implementation studies address, a process by which to inform the development and delivery of interventions, a guide when evaluating, and a way to allow for an exploration of potential causal mechanisms. However, the use of theory in designing implementation interventions is methodologically challenging for a number of reasons, including choosing between theories and faithfully translating theoretical constructs into interventions. The explicit use of theory offers potential advantages in terms of facilitating a better understanding of the generalisability and replicability of implementation interventions. However, this is a relatively unexplored methodological area

Magnetar outbursts: an observational review

Transient outbursts from magnetars have shown to be a key property of their emission, and one of the main way to discover new sources of this class. From the discovery of the first transient event around 2003, we now count about a dozen of outbursts, which increased the number of these strongly magnetic neutron stars by a third in six years. Magnetar outbursts might involve their multi-band emission resulting in an increased activity from radio to hard X-ray, usually with a soft X-ray flux increasing by a factor of 10-1000 with respect to the quiescent level. A connected X-ray spectral evolution is also often observed, with a spectral softening during the outburst decay. The flux decay times vary a lot from source to source, ranging from a few weeks to several years, as also the decay law which can be exponential-like, a power-law or even multiple power-laws can be required to model the flux decrease. We review here on the latest observational results on the multi-band emission of magnetars, and summarize one by one all the transient events which could be studied to date from these sources.Comment: 34 pages, 6 figures. Chapter of the Springer Book ASSP 7395 "High-energy emission from pulsars and their systems", proceeding of the Sant Cugat Forum on Astrophysics (12-16 April 2010). Review updated to January 201

Integrating Palliative Care Into the Care of Neurocritically Ill Patients: A Report From the Improving Palliative Care in the ICU Project Advisory Board and the Center to Advance Palliative Care.

OBJECTIVES: To describe unique features of neurocritical illness that are relevant to provision of high-quality palliative care; to discuss key prognostic aids and their limitations for neurocritical illnesses; to review challenges and strategies for establishing realistic goals of care for patients in the neuro-ICU; and to describe elements of best practice concerning symptom management, limitation of life support, and organ donation for the neurocritically ill. DATA SOURCES: A search of PubMed and MEDLINE was conducted from inception through January 2015 for all English-language articles using the term palliative care, supportive care, end-of-life care, withdrawal of life-sustaining therapy, limitation of life support, prognosis, or goals of care together with neurocritical care, neurointensive care, neurological, stroke, subarachnoid hemorrhage, intracerebral hemorrhage, or brain injury. DATA EXTRACTION AND SYNTHESIS: We reviewed the existing literature on delivery of palliative care in the neurointensive care unit setting, focusing on challenges and strategies for establishing realistic and appropriate goals of care, symptom management, organ donation, and other considerations related to use and limitation of life-sustaining therapies for neurocritically ill patients. Based on review of these articles and the experiences of our interdisciplinary/interprofessional expert advisory board, this report was prepared to guide critical care staff, palliative care specialists, and others who practice in this setting. CONCLUSIONS: Most neurocritically ill patients and their families face the sudden onset of devastating cognitive and functional changes that challenge clinicians to provide patient-centered palliative care within a complex and often uncertain prognostic environment. Application of palliative care principles concerning symptom relief, goal setting, and family emotional support will provide clinicians a framework to address decision making at a time of crisis that enhances patient/family autonomy and clinician professionalism