Anesthesia Alarm Fatigue Policy Recommendations: The Path of Development

Healthcare workers are inundated with alarms every minute, yet 80-95% of these alarms do not result in provider intervention. False alarms cause a “cry-wolf” phenomenon among providers resulting in cognitive stress and workflow interruptions. A cross-sectional design was used to examine the perceptions of alarm fatigue and alarm management of Certified Registered Nurse Anesthetists (CRNAs), Student Registered Nurse Anesthetists (SRNAs) and Anesthesiologists. This Likert-scale questionnaire was sent to approximately 150 anesthesia providers at NorthShore University HealthSystem (NSUHS) through an online survey. Data analysis revealed anesthesia trainees and providers with less total years in practice and less clinical experience exhibit statistically significant (p=0.011), higher levels (10.60%) of alarm fatigue and associated provider distress. A p value of 0.007 indicated students appreciate significantly higher levels (11.76%) of alarm fatigue than their CRNA colleagues. In conjunction with survey responses, a survey development table based on evidence and current endorsements in the literature was used to guide proposed policy recommendations for the anesthesia department at NSUHS. Future work involves adoption and implementation of the policy and evaluation to determine if it improved provider workflow, their alarm fatigue experience or patient safety

Visbestandopnames op enkele wateren in het bekken van de Zeeschelde (2009): meting nulsituatie in het kader van de monitoring van het Sigmaplan

INBO researchers surveyed fish assemblages in several future flood control areas along the Zeeschelde estuary (Fig. 1, Table 1). Two survey periods were performed at 11 sites (117 surveys in toal). Fish assembvlages were assessed using electric fishing and fyke netting. Physical and chemical recordings showed that the 25% of the sites had a too low oxygen concentration. Some sites had no fish.In total 25 fish species were recorded. In the text fish results are explained for each area. In genral bitterling, stone moroko, Prucian carp, three-spined stickleback, roach and pumpkinseed dominate in numbers. The results indicate the presence of a diverse fish assemblage of mainly eurytopic and limnophilic species in some sites

Respiratie bij vogels: een functioneel-anatomische benadering

The mechanism of avian respiration is still controversial. It is fundamentally different from respiration in mammals. Although during in-and expiration a continuous caudocranial airflow is present within the tertiary bronchi and the air capillaries of the avian lung, the air flow within the entire respiratory system is still equivocal. Several patterns explaining the air flow during in-and expiration have been proposed during the past century. Moreover, various anatomical structures and aerodynamic mechanisms have recently been described in an attempt to explain the proposed mechanisms of respiration. This manuscript gives an overview of the anatomy of the avian respiratory system and the hypotheses concerning the physiology of avian respiration

A reference list of fish species for a heavily modified estuary and its tributaries: the River Schelde

The river Schelde is a basin that has seen an enormous anthropogenic impact over the last millenium. This report lists all freshwater and brackish water fish species currently recorded for the Schelde river

Following up patients with depression after hospital discharge: a mixed methods approach

<p>Abstract</p> <p>Background</p> <p>A medication information intervention was delivered to patients with a major depressive episode prior to psychiatric hospital discharge.</p> <p>Methods</p> <p>The objective of this study was to explore how patients evolved after hospital discharge and to identify factors influencing this evolution. Using a quasi-experimental longitudinal design, the quantitative analysis measured clinical (using the Hospital Anxiety and Depression Scale, the somatic dimension of the Symptom Checklist 90 and recording the number of readmissions) and humanistic (using the Quality of Life Enjoyment and Satisfaction Questionnaire) outcomes of patients via telephone contacts up to one year following discharge. The qualitative analysis was based on the researcher diary, consisting of reports on the telephone outcome assessment of patients with major depression (n = 99). All reports were analyzed using the thematic framework approach.</p> <p>Results</p> <p>The change in the participants' health status was as diverse as it was at hospital discharge. Participants reported on remissions; changes in mood; relapses; and re-admissions (one third of patients). Quantitative data on group level showed low anxiety, depression and somatic scores over time. Three groups of contributing factors were identified: process, individual and environmental factors. Process factors included self caring process, medical care after discharge, resumption of work and managing daily life. Individual factors were symptom control, medication and personality. Environmental factors were material and social environment. Each of them could ameliorate, deteriorate or be neutral to the patient's health state. A mix of factors was observed in individual patients.</p> <p>Conclusions</p> <p>After hospital discharge, participants with a major depressive episode evolved in many different ways. Process, individual and environmental factors may influence the participant's health status following hospital discharge. Each of the factors could be positive, neutral or negative for the patient.</p