Utilization of base deficit and reliability of base deficit as a surrogate for serum lactate in the peri-operative setting

<p>Abstract</p> <p>Background</p> <p>Base deficit (BD) is commonly used in the operating room (OR) as an endpoint of resuscitation. BD is used as a surrogate marker for the accumulation of lactic acid(Lac). However, the BD can be affected by large amounts of saline.</p> <p>Methods</p> <p>We conducted a survey of anesthesiologists regarding the use of BD. We also studied the reliability of BD to determine the presence of hyperlactatemia (HL). Patients undergoing general anesthesia were eligible for enrollment if they were receiving an arterial line as part of their routine care. If an arterial blood gas was drawn by the operative team as part of the routine care, the remainder of the unused blood was also used to measure Lac.</p> <p>Results</p> <p><it>Survey</it>: 73 staff anesthesiologists were surveyed. Over 70% of respondents used BD as an endpoint of resuscitation.</p> <p><it>Base Deficit Study</it>: 35 patients were enrolled resulting in 88 arterial blood gases with corresponding Lac. Mean age was 61.4 ± 14.3 years, 43% were male. Mean pH was 7.39 ± 0.05, the mean bicarbonate was 23.0 ± 2.3 meq/L, the mean BD 1.34 ± 2.3, and the mean Lac was 1.58 ± 0.71 mmol/L. Mean ASA risk score was 3.16 ± 0.71. ROC area under the curve for base deficit to detect HL was 0.58.</p> <p>Conclusion</p> <p>BD can often mislead the clinician as to the actual Lac. Lac can now be measured in the OR in real time. Therefore, if clinicians in the operative setting want to know the Lac, it should be measured directly.</p

A self-determination perspective of strengths use at work: Examining its determinant and performance implications

We investigate the role of strengths use in the workplace by drawing on self-determination theory (SDT) to propose that strengths use at work can yield performance benefits in terms of task performance and discretionary helping, and that the social context, in the form of leader autonomy support, can promote employees’ strengths use. Further, consistent with an interactional psychology perspective, we contend that the relationship between autonomy support and strengths use will be stronger among individuals with strong independent self-construal. We tested the model using matched data from 194 employees and their supervisors and found evidence for the relevance of strengths use at work, even after accounting for the role of intrinsic motivation. In addition to providing practical implications on developing employee strengths use and how to do so, this study advances theory and research on workplace strength use, SDT, and positive organizational behavior

‘More willing to carry on in the face of adversity’: how beginner teachers facing challenging circumstances experience positive psychology coaching. An interpretative phenomenological analysis

Positive psychology coaching (PPC) is defined as activating positive psychology (PP) in an applied and systematic way through coaching (Passmore, J., & Oades, P. (2014). Positive psychology coaching – A model for coaching practice. The Coaching Psychologist, 10(2), 68–70). Currently studies looking at how PPC is experienced by coachees are limited. While there has been some early success cited in using a PPC approach in professional development in education with adults (Zwart, R. C., Korthagen, F. A. J., & Attema-Noordewier, S. (2014). A strength-based approach to teacher professional development. Professional Development in Education, 41(3), 579–596. https://doi.org/10.1080/19415257.2014.919341) it is not yet known how teachers experience PPC. The purpose of this paper was to gain an understanding of how PPC is experienced by beginner teachers undergoing challenging circumstances. This initial explorative study adopted a qualitative approach using Interpretative Phenomenological Analysis (IPA) (Smith, J., Flowers, P., & Larkin, M. (2009). Interpretative phenomenological analysis: Theory, method and research. Sage). Four superordinate themes emerged: ‘perfectly normal to feel this way’; making sense and ‘joining the dots’; increased positive emotion; and, time to think ‘in an easy-going environment’. Further studies of the application of PPC in educational settings are needed

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Proceedings of a roundtable event ‘Is communicating the concept of nutrient density important?’

International audienceThe British Nutrition Foundation held a 1‐day roundtable event to gather views from a wide range of stakeholders on the relevance and importance of the concept of nutrient density in supporting and motivating people to make healthier dietary choices. The opportunities and barriers associated with the use of this concept were also explored. The roundtable involved experts from research, public health nutrition, dietetics, retail and nutrition science communication, and this report describes the main themes emerging from the discussions. High obesity prevalence rates indicate that, on average, we are consuming too many calories relative to energy requirements; yet, the quality of our diets, with respect to certain vitamins and minerals and fibre, seems to be falling somewhat short of recommendations. Addressing this issue may require a more holistic approach than the current focus on restricting single nutrients prevalent in public health messaging internationally. Most members of the roundtable felt that communicating the concept of nutrient density may help in encouraging healthier food choices and dietary patterns that are higher in nutritional quality. However, while nutrient profiling has been used to guide front‐of‐pack labelling and in restricting the advertising of less healthy foods to children, there is a lack of consensus on the precise definition of a ‘nutrient dense’ food or which nutrients should be used as markers of the ‘healthiness’ of foods/drinks, and the term seems to be poorly understood by consumers and health professionals alike. Therefore, further work is required if tools around this concept are to be developed to try and successfully promote behaviour change