Optimizing anesthesia techniques in the ambulatory setting

Ambulatory surgery refers to the process of admitting patients, administering anesthesia and surgical care, and discharging patients home following an appropriate level of recovery on the same day. The word ambulatory is derived from the latin word ambulare, which means ''to walk''. This means that patients treated on an ambulatory basis do not require hospitalisation and achieve a level of postoperative 'home readiness' that allows them to go home within hours of procedure completion

Commentary

In September 2017, the Caribbean basin and the state of Florida encountered Hurricane Irma—the most powerful and potentially the most devastating storm to impact the region since recordings began. This category 5 hurricane formed in the southern part of the North Atlantic Ocean and traversed to the Leeward Islands, smashing into Antigua, Barbuda, Saint Martin, and the U.S. Virgin Islands, leaving them in a major state of peril. All the while, the forecasted path of the eye of the storm directly targeted the metropolitan centers of Miami and Fort Lauderdale, the latter the home of Region 9 Headquarters (HQ), Marine Corps Embassy Security Group (MCESG). The hurricane continued on its path, grazing Puerto Rico, the Dominican Republic, and Haiti, fortunately sparing their people major desolation and their infrastructure major damage, but still wreaking havoc on those nations

Differences in the Experience of Caregiving Between Spouse and Adult Child Caregivers in Dementia With Lewy Bodies.

Background and objectivesDementia caregiving has been associated with increased burden, depression, grief, a decreased sense of well-being and quality of life, and a weakening of social support. Little is known about the experience of caregiving in Dementia with Lewy Bodies (DLB). The present study examines differences in the caregiving experience of spouse versus adult child caregivers of individuals with DLB.Research design and methodsIn this cross-sectional analytic study of spouses (n = 255) and adult children (n = 160) caregivers of individuals with DLB, participants completed an online survey of burden, grief, depression, well-being, quality of life, and social support.ResultsAdult child caregivers were more likely to care for women (p < .001) and see the care recipient less often (p < .001) than spouses. Adult child caregivers reported lower quality of life (p < .001) and more caregiver burden (p < .009), but also greater social support (p < .001) than spouses. Between group analyses of caregiver type by disease severity demonstrated that spousal caregivers experience greater grief with advancing disease (p = .005), while adult child caregivers increase social support with advancing disease (p < .001).Discussion and implicationsSpouses and adult children experience DLB caregiving differently. This was explained by the younger age of the adult child caregiver, frequency of contact with the care recipient, and differences in the care recipient's characteristics, frequency of neuropsychiatric symptoms, and disease severity. DLB caregiver support for this population should target psychoeducation for complicated neuropsychiatric symptoms in the care recipient. Screening all DLB caregivers for burden, grief, and depression is suggested to identify those that may benefit most from intervention. Spouses specifically may benefit from interventions that target increasing social support, while adult child caregivers may benefit from interventions aimed at mitigating burden and improving quality of life

Vocalization in Dementia: A Case Report and Review of the Literature

Background: Vocalizations are part of the spectrum of the ‘negative' behavioral and psychological symptoms of dementia (BPSD). We describe a patient with moderate-stage mixed dementia of Alzheimer's disease and cerebrovascular disease and a left orbitofrontal lesion exhibiting vocalization. The use of ‘redirection' has been demonstrated to be an effective nonpharmacological means of controlling BPSD, while reducing caregiver distress. Case Report: A 78-year-old right-handed African-American female presented with complaints of worsening memory and BPSD, causing significant caregiver distress. Throughout the evaluation, she constantly vocalized her son's name and made a continuous grunting noise, correlating with increased anxiety/agitation. We utilized a redirection technique, which achieved the immediate reduction of the vocalization symptoms. Caregiver psychoeducation was provided allowing them to use the redirection technique at home. Conclusions: In patients with dementia exhibiting negative symptoms of BPSD, using nonpharmacologic techniques (i.e. redirection) may be indicated. Psychotropic medications rarely address negative BPSD symptoms, while simultaneously decreasing patient's quality of life. Nonpharmacologic approaches are beneficial as first-line therapy for negative BPSD

"Caring for Insiderness": Phenomenologically informed insights that can guide practice.

Understanding the ‘‘insider’’ perspective has been a pivotal strength of qualitative research. Further than this, within the more applied fields in which the human activity of ‘‘caring’’ takes place, such understanding of ‘‘what it is like’’ for people from within their lifeworlds has also been acknowledged as the foundational starting point in order for ‘‘care’’ to be caring. But we believe that more attention needs to be paid to this foundational generic phenomenon: what it means to understand the ‘‘insiderness’’ of another, but more importantly, how to act on this in caring ways. We call this human phenomenon ‘‘caring for insiderness.’’ Drawing on existing phenomenological studies of marginal caring situations at the limits of caring capability, and through a process of phenomenologically oriented reflection, we interrogated some existential themes implicit in these publications that could lead to deeper insights for both theoretical and applied purposes. The paper provides direction for practices of caring by highlighting some dangers as well as some remedies along this path

Pilot study of the air-Q intubating laryngeal airway in clinical use

The air-Q Intubating Laryngeal Airway (ILA) is a newly introduced extraglottic airway device. In this pilot study, we evaluated its use as a routine airway device during positive pressure ventilation. Ease of endotracheal intubation through the device was also assessed. Fifty-nine ASA I and II patients undergoing elective surgery received an air-Q ILA and an endotracheal tube where indicated. Insertion, ventilation and intubation characteristics were noted, as well as throat morbidity and occurrence of adverse events. An air-Q ILA was successfully inserted in 100% of patients. Mean leak pressure was 19±5 cmH2O. Endotracheal intubation was indicated in 19 patients and successful in 58% on the first attempt and 74% in total. Ten percent of the study patients were noted to have dysphagia. One patient was diagnosed with bilateral lingual nerve injury but made a complete recovery in four weeks. The air-Q ILA is an adequate extraglottic airway device in terms of insertion and ventilation. However, the proposed advantage of ease of endotracheal intubation requires further investigation.</p

Pilot study of the air-Q intubating laryngeal airway in clinical use

The air-Q Intubating Laryngeal Airway (ILA) is a newly introduced extraglottic airway device. In this pilot study, we evaluated its use as a routine airway device during positive pressure ventilation. Ease of endotracheal intubation through the device was also assessed. Fifty-nine ASA I and II patients undergoing elective surgery received an air-Q ILA and an endotracheal tube where indicated. Insertion, ventilation and intubation characteristics were noted, as well as throat morbidity and occurrence of adverse events. An air-Q ILA was successfully inserted in 100% of patients. Mean leak pressure was 19±5 cmH2O. Endotracheal intubation was indicated in 19 patients and successful in 58% on the first attempt and 74% in total. Ten percent of the study patients were noted to have dysphagia. One patient was diagnosed with bilateral lingual nerve injury but made a complete recovery in four weeks. The air-Q ILA is an adequate extraglottic airway device in terms of insertion and ventilation. However, the proposed advantage of ease of endotracheal intubation requires further investigation.</p

Identification of misconceptions in the teaching of biology

peer-reviewedTo date research into how young people acquire accurate higher-order scientific knowledge, and gain an understanding of abstract and challenging concepts in science, has occupied much of the science education literature across countries and across continents. In previous studies, we identified that biology teaching that involves the diagnosis, reduction and elimination of misconceptions can be one effective pedagogic approach, particularly if positioned within a “good enough” model of pedagogic practice1 . In this study, we investigate the use of one diagnostic testing approach to the identification of misconceptions in the teaching of respiration and photosynthesis in a small sample of secondary school students (n=139) and pre-service teachers (n=43) in the Republic of Ireland. Photosynthesis and respiration were chosen as they are prevalent biology topics that students find conceptually challenging. The study used test items to elicit the extent of misconceptions among this cohort – a paper-and-pencil test for students and a survey instrument for pre-service teachers. The findings show unacceptably high level of misconceptions among all pre-service teachers and students and suggest that diagnostic tests of this type can be a useful entry point to a pedagogical cycle for the recognition, reduction and removal of misconceptions. The findings have wider implications than this small scale study and are primarily directed toward new understandings in relation to more effective models of biology teaching and teacher education.PUBLISHEDpeer-reviewe

Inclusive leadership : realizing positive outcomes through belongingness and being valued for uniqueness

We introduce a theoretically-grounded conceptualization of inclusive leadership and present a framework for understanding factors that contribute to and follow from inclusive leadership within work groups. We conceptualize inclusive leadership as a set of positive leader behaviors that facilitate group members perceiving belongingness in the work group while maintaining their uniqueness within the group as they fully contribute to group processes and outcomes. We propose that leader pro-diversity beliefs, humility, and cognitive complexity increase the propensity of inclusive leader behaviors. We identify five categories of inclusive leadership behaviors that facilitate group members' perceptions of inclusion, which in turn lead to member work group identification, psychological empowerment, and behavioral outcomes (creativity, job performance, and reduced turnover) in the pursuit of group goals. This framework provides theoretical grounding for the construct of inclusive leadership while advancing our understanding of how leaders can increase diverse work group effectiveness