Early and late complications of bariatric operation.

Weight loss surgery is one of the fastest growing segments of the surgical discipline. As with all medical procedures, postoperative complications will occur. Acute care surgeons need to be familiar with the common problems and their management. Although general surgical principles generally apply, diagnoses specific to the various bariatric operations must be considered. There are anatomic considerations which alter management priorities and options for these patients in many instances. These problems present both early or late in the postoperative course. Bariatric operations, in many instances, result in permanent alteration of a patient\u27s anatomy, which can lead to complications at any time during the course of a patient\u27s life. Acute care surgeons diagnosing surgical emergencies in postbariatric operation patients must be familiar with the type of surgery performed, as well as the common postbariatric surgical emergencies. In addition, surgeons must not overlook the common causes of an acute surgical abdomen-acute appendicitis, acute diverticulitis, acute pancreatitis, and gallstone disease-for these are still among the most common etiologies of abdominal pathology in these patients

No Really, We Can Help with This: Librarians Facilitating Research Assignment Design

Premises: Students need scaffolded, authentic opportunities to practice and develop research skills. Interdisciplinary faculty collaboration on assignment redesign facilitates peer feedback that isn\u27t usually available. Bringing librarians to the assignment design table establishes stronger connections with and among teaching faculty and promotes deeper learning opportunities for students. Key principles: Reflect on where students get stuck. Make the implicit explicit. Scaffold the research process. Offer formative assessment and opportunities for peer learning. Consider authentic, renewable, or public-facing end products

Current outcomes of blunt open pelvic fractures: how modern advances in trauma care may decrease mortality.

Background:Open pelvic fracture, caused by a blunt mechanism, is an uncommon injury with a high mortality rate. In 2008, evidence-based algorithm for managing pelvic fractures in unstable patients was published by the Western Trauma Association (WTA). The use of massive transfusion protocols has become widespread as has the availability and use of pelvic angiography. The purpose of this study was to evaluate the outcome of open pelvic fractures in association with related advances in trauma care. Methods:A retrospective review was performed, at an American College of Surgeon verified level I trauma center, of patients with blunt open pelvic fractures from January 2010 to April 2016. The WTA algorithm, including massive transfusion protocol, and pelvic angiography were uniformly used. Data collected included injury severity score, demographic data, transfusion requirements, use of pelvic angiography, length of stay, and disposition. Data were compared with a similar study from 2005. Results:During the study period, 1505 patients with pelvic fractures were analyzed; 87 (6%) patients had open pelvic fractures. Of these, 25 were from blunt mechanisms and made up the study population. Patients in both studies had similar injury severity scores, ages, Glasgow Coma Scale, and gender distributions. Use of angiography was higher (44% vs. 16%; P=0.011) and mortality was lower (16% vs. 45%; P=0.014) than in the 2005 study. Conclusions:Changes in trauma care for patients with open blunt pelvic fracture include the use of an evidence-based algorithm, massive transfusion protocols and increased use of angioembolization. Mortality for open pelvic fractures has decreased with these advances. Level of evidence:Level IV

Macroeconomic trends and practice models impacting acute care surgery

Acute care surgery (ACS) diagnoses are responsible for approximately a quarter of the costs of inpatient care in the US government, and individuals will be responsible for a larger share of the costs of this healthcare as the population ages. ACS as a specialty thus has the opportunity to meet a significant healthcare need, and by optimizing care delivery models do so in a way that improves both quality and value. ACS practice models that have maintained or added emergency general surgery (EGS) and even elective surgery have realized more operative case volume and surgeon satisfaction. However, vulnerabilities exist in the ACS model. Payer mix in a practice varies by geography and distribution of EGS, trauma, critical care, and elective surgery. Critical care codes constitute approximately 25% of all billing by acute care surgeons, so even small changes in reimbursement in critical care can have significant impact on professional revenue. Staffing an ACS practice can be challenging depending on reimbursement and due to uneven geographic distribution of available surgeons. Empowered by an understanding of economics, using team-oriented leadership inherent to trauma surgeons, and in partnership with healthcare organizations and regulatory bodies, ACS surgeons are positioned to significantly influence the future of healthcare in the USA

The Effects of the Transition from Pre-nursing to Nursing on Mental Health

Mental health is an ever-growing crisis among adolescents and young adults, with suicide as second leading cause of death and the number of those negatively affected continually on the rise. Transitions are one of the major stressors prevalent among these age groups, placing individuals at risk for mental health deficits. This quantitative voluntary response comparative study assesses the transitional mental health of pre-nursing students and students in the nursing program at East Tennessee State University. Emailed to all with a declared major of pre-nursing or nursing, this study measured mental health using evidenced based assessment tools. The PHQ-9 for depression and the GAD-7 for anxiety, along with additional demographic information and mental health service usage questions, was sent to and completed by participants. A total of n = 173 responses were received. Of these responses n = 99 or 57.2 percent were nursing students, a participation rate of 9.6 percent, and n = 74 or 42.8 percent were pre-nursing students. The research revealed that depression and anxiety scores were above the cutoff for moderate depression and anxiety in both groups, as well as identified a deficit in availability of mental health resources, with over 10 percent of students unable to access counseling or psychiatric services. Contraindicatory to literature, which predicted improving mental health in the progression through university studies, this study reveals a variable and even worsening trajectory of mental health as students transition into the nursing program and progressed through college

Pain Management and Comfort in Robotic Laparoscopic Prostatectomy Patients

Prostate cancer is the second most common cancer in American men with about 1 in 7 men being diagnosed during his lifetime. Robotic surgery has been increasing since its inception over 10 years ago and these procedures continue to grow and diversify. A focus on pain control, reducing invasiveness and promoting early discharge is a benefit and goal with use of Robotic Procedures. Pain assessment and management has become a priority to many stakeholders including medical caregivers, patients, health care organizations and credentialing agencies. Although pain is reduced in minimally invasive surgery, there is a gap in the literature describing pain and comfort management. A variety of pharmacologic agents have been used to treat pain and improve comfort in this population. Pain control modalities and treatments in this research focus specifically on pharmacologic modalities. Two groups were formed to differentiate use of opioids in Group A and opioids plus alpha 2 agonist in Group B. After a standard of care for each patient, pain and comfort levels were measured and medical records were reviewed. Participants were placed into Group A or B depending upon their medications received. The null hypothesis of this research is that there will be no difference between two standard anesthesia protocols with regard to pain and comfort in the perioperative setting and decreased pain will not be associated with increased comfort. Data collection ceased upon completion of both groups and statistical analysis revealed no significant difference between Group A and Group B.Dr.N.P., Nursing Practice -- Drexel University, 201

Making an Impact Statewide to Benefit 21st-Century School Leadership

How can institutions of higher education, local education agencies, and departments of education partner to build capacity for 21st-Century school leadership? The model (IMPACT V) we describe utilizes a systems-wide partnership approach to cultivate shared leadership within influenced middle and high schools statewide to leverage technology as a catalyst for school reform. The model supports online cohort-based graduate programming, leadership coaching, ongoing professional development, and technical assistance across the state of North Carolina. This professional commentary describes theory related to the coordinated school–university partnership context. Also discussed are practicalities regarding how this approach prepares practicing school leaders more innovatively for the challenges of 21st-Century leadership

Transformational and Transformative Leadership in a Research-Informed Leadership Preparation Program

This article describes IMPACT V, a grant-funded preparation partnership among a community of institutions, and then considers whether such a partnership is a viable way to cultivate transformational and transformative sensibilities in building leaders. Methods included content analysis of baseline and summative student artifacts. Findings suggest that the program promoted elements of transformational leadership, as well as transformative leadership focused on liberation, democracy, equity, and justice. The program promoted school change and cultivated leadership and personal growth but suffered from unevenness in the program partnerships. Implications for leadership preparation are considered