Improving Colonoscopy Preparation Quality: A Quality Improvement Project

Abstract Background High-quality bowel preparations are essential for colonoscopies. Helping patients enhance prep quality can help increase the early detection of colorectal cancer, improving patient outcomes. A quality improvement (QI) project was introduced to increase the bowel prep quality at a Veterans Health Administration ambulatory surgery center. Methods Bowel prep quality descriptors were collected from a chart audit collected for the year 2021 to establish a baseline. In addition, the patients were queried regarding their perceptions on how easy the instructions were to follow. Interventions New prep instructions were created with feedback from the clinic gastroenterology registered nurses. The new instructions were then implemented to see whether there was an impact on the patient’s perception of the ease of the instructions and the bowel prep quality rating by the gastroenterologist. Post-intervention data were collected after the implementation of the new instructions. Results The prep quality rated by the gastroenterologist improved from 72.8% to 77.7% rated as good, remained relatively unchanged for the fair quality rating, and improved from 4.4% to 0% rated as poor. For the Likert scale that patients were surveyed with pre-and post-intervention, with 1 being very easy and 5 being very hard, the mean answer went from 1.99 pre-intervention (SD=1.17, range 1-5) to 2.06 post-intervention (SD=1.18, range=1-5). Conclusion Overall, implementation of the new instructions did impact the prep quality, however not the patient’s perception regarding the ease of the instructions. There are many suggested next steps for the facility to take to continue with this quality improvement project including a longer intervention phase to collect more data, and continue getting feedback on how to improve the instructions from patients

A log analysis study of 10 years of ebook consumption in academic library collections

Even though libraries have been offering eBooks for more than a decade, very little is known about eBook access and consumption in academic library collections. This paper addresses this gap with a log analysis study of eBook access at the library of the University of Waikato. This in-depth analysis covers a period spanning 10 years of eBook use at this university. We draw conclusions about the use of eBooks at this institution and compare the results with other published studies of eBook usage at tertiary institutes

CV17021

This report provides the main results and findings of the twelfth annual underwater television survey on the ‘Smalls grounds’ ICES assessment area; Functional Unit 22. The survey was multi-disciplinary in nature collecting UWTV, CTD and other ecosystem data. A total of 40 UWTV stations were surveyed successfully (good quality video footage) carried out over an isometric grid at 4.5nmi or 8.3km intervals. The precision, with a CV of 5%, was well below the upper limit of 20% recommended by SGNEPS 2012. The 2017 abundance estimate was 16% higher than in 2016 and at 1600 million is above the new MSY Btrigger (990 million). Using the 2017 estimate of abundance and updated stock data implies catch of 4,332 tonnes and landings of 3,784 tonnes in 2018 when MSY approach is applied (assuming that discard rates and fishery selection patterns do not change from the average of 2014–2016). Only one species of sea-pen Virgilaria mirabilis was recorded as present at the stations surveyed. Trawl marks were observed at 59% of the stations surveyed. Ten beam trawl tows were carried out providing important data on the benthic communities and size structure of the Nephrops population

CV18017

This report provides the results of the sixth underwater television on the ‘Porcupine Bank Nephrops grounds’ ICES assessment area; Functional Unit 16. The survey was multi-disciplinary in nature collecting UWTV, CTD and other ecosystem data. In total 69 UWTV stations were successfully completed in a randomised 6 nautical mile isometric grid covering the full spatial extent of the stock. The mean burrow density observed in 2018, adjusted for edge effect, was 0.16 burrows/m². The final krigged abundance estimate was 1117 million burrows with a relative standard error of 4% and an estimated stock area of 7,130 km2. The 2018 abundance estimate was 31% higher than in 2017. Using the 2018 estimate of abundance and updated stock data implies catch of 2,645 tonnes and landings of 2,645 tonnes in 2019 when MSY approach is applied (assuming that all catch is landed). The three species of sea-pen; Virgularia mirabilis, Funiculina quadrangularis and Pennatula phosphorea, were all observed during the survey. The deepwater sea-pen Kophobelemnon stelliferum was also observed and its presence/absence mapped from the available time-series. Trawl marks were also observed on 33% of the stations surveyed

'To live and die [for] Dixie': Irish civilians and the Confederate States of America

Around 20,000 Irishmen served in the Confederate army in the Civil War. As a result, they left behind, in various Southern towns and cities, large numbers of friends, family, and community leaders. As with native-born Confederates, Irish civilian support was crucial to Irish participation in the Confederate military effort. Also, Irish civilians served in various supporting roles: in factories and hospitals, on railroads and diplomatic missions, and as boosters for the cause. They also, however, suffered in bombardments, sieges, and the blockade. Usually poorer than their native neighbours, they could not afford to become 'refugees' and move away from the centres of conflict. This essay, based on research from manuscript collections, contemporary newspapers, British Consular records, and Federal military records, will examine the role of Irish civilians in the Confederacy, and assess the role this activity had on their integration into Southern communities. It will also look at Irish civilians in the defeat of the Confederacy, particularly when they came under Union occupation. Initial research shows that Irish civilians were not as upset as other whites in the South about Union victory. They welcomed a return to normalcy, and often 'collaborated' with Union authorities. Also, Irish desertion rates in the Confederate army were particularly high, and I will attempt to gauge whether Irish civilians played a role in this. All of the research in this paper will thus be put in the context of the Drew Gilpin Faust/Gary Gallagher debate on the influence of the Confederate homefront on military performance. By studying the Irish civilian experience one can assess how strong the Confederate national experiment was. Was it a nation without a nationalism

Unsubstantiated Conclusions: A Scoping Review on Generational Differences of Leadership in Academic Libraries

The academic library profession is experiencing a large turnover in leadership. To date, information on differences in the generational expectations about how to lead is scarce and the research is contradictory. This article presents a scoping review of the literature on generational expectations of academic library leaders. Based on predefined eligibility criteria, the authors searched twelve bibliographic databases and performed a broad web search. 5,435 articles were located and considered for inclusion, however, only four eligible articles were identified and included for analysis. There is little empirical evidence that generational differences are evident in the academic library setting or in individual leadership expectations. There is a lack of original research on generational differences in leadership in libraries, however, anecdotal and opinion literature is drawing attention to this topic in ways that cannot be validated

Assessing the quality of primary care referrals to surgery of patients with diabetes in the East of England: A multi-centre cross-sectional cohort study

Aim: Peri-operative hyperglycaemia is associated with an increased incidence of adverse outcomes. Communication between primary and secondary care is paramount to minimise these harms. National guidance in the UK recommends that the glycated haemoglobin (HbA1c) should be measured within 3 months prior to surgery and that the concentration should be less that 69 mmol/mol (8.5%). In addition, national guidance outlines the minimum dataset that should be included in any letter at the time of referral to the surgeons. Currently, it is unclear how well this process is being carried out. This study investigated the quality of information being handed over during the referral from primary care to surgical outpatients within the East of England. Methods: Primary care referrals to nine different NHS hospital Trusts were gathered over a 1-week period. All age groups were included from 11 different surgical specialties. Referral letters were analysed using a standardised data collection tool based on the national guidelines. Results: A total of 1919 referrals were received, of whom 169 (8.8%) had previously diagnosed diabetes mellitus (DM). However, of these, 38 made no mention of DM in the referral letter but were on glucose-lowering agents. Only 13 (7.7%) referrals for patients with DM contained a recent HbA1c, and 20 (11.8%) contained no documentation of glucose-lowering medication. Conclusion: This study has shown that the quality of referral letters to surgical specialties for patients with DM in the East of England remain inadequate. There is a clear need for improving the quality of clinical data contained within referral letters from primary care. In addition, we have shown that the rate of referral for surgery for people with diabetes is almost 50% higher than the background population with diabetes

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability