Parturient satisfaction with labour epidural and factors affecting satisfaction scores: experiences from a tertiary centre in Southern India

Background: Labour analgesia though widely practised is still not routinely administered to all parturients in India. We conducted this historical observational cross-sectional study to assess parturient knowledge and factors affecting satisfaction in those who received epidural labour analgesia; aiming at improving the services.Methods: All parturients requesting epidural labour analgesia have the catheter sited and the drug administered as per institutional protocols. A feedback form is given to these parturients, postnatally. The form consists of questions regarding her knowledge of and experience with labour analgesia, including her satisfaction score on a scale of 0 to 10. Author collected these forms and analyzed them along with information from the labour epidural register and the discharge summary.Results: The mean satisfaction score was 7.1 (SD- 2.28). 46 parturients (31.08%) had ‘low satisfaction’ (<7 score) and 102 parturients (68.9%) had ‘high satisfaction’ (≥7 score). The timing of initiation of epidural analgesia within the parturients expectations and adequate analgesia were two factors that were found to affect satisfaction scores, with statistically significant values (p=0.002 and p=0.006 respectively). Those with a very short or very long duration of labour analgesia, were more likely to give less satisfaction scores (p=0.023 and p=0.002). Only 30% of parturients had heard of labour analgesia in the past.Conclusions: In this setting good analgesia and receiving it on time are of utmost importance in those receiving epidural labor analgesia, emphasising the need for adequate analgesia and prompt initiation of the same

Comparing Banana Leaf Dressing and Vaseline Gauze Dressing for Split-Thickness Skin Graft Donor Sites in a Ugandan Hospital

Introduction: This study compared the effectiveness of banana leaf dressing (BLD) with the commonly used Vaseline gauze dressing (VGD) on split-thickness skin graft (SSG) donor sites. VGD is not completely nonadherent and is associated with pain on removal. BLD is smooth, non-adherent, pain-free and available. Methods: In this prospective study, consecutive patients were dressed with either BLD or VGD. Ease of applying and removing the dressings was scored. Pain scores were taken on postoperative days 3, 5, 7, 9 and 10. On day 10, the dressing was changed, epithelialization recorded and a swab taken for microbial culture. Average cost of each dressing was calculated. Results: There was no significant difference between postoperative pain scores with either dressing (p=0.992). BLD patients had less pain on&nbsp; dressing change (p=0.006). Both dressings were easy to apply; BLD was easier to remove (p=0.000). Wounds with BLD re-epithelialized faster (p=0.0158). 40% of wounds grew no organism on microbial culture, 25% grew Staphylococcus aureus and 35% grew unusual organisms (p=0.482). VGD was 4 times more expensive than BLD (p=0.000). Conclusion: Banana leaf dressing is effective and highly recommended for dressing SSG donor sites.Keywords: Split-thickness skin graft, Donor sites, Banana leaf dressing, Vaseline gauze dressin

Nociceptin attenuates the escalation of oxycodone self-administration by normalizing CeA-GABA transmission in highly addicted rats.

Approximately 25% of patients who are prescribed opioids for chronic pain misuse them, and 5 to 10% develop an opioid use disorder. Although the neurobiological target of opioids is well known, the molecular mechanisms that are responsible for the development of addiction-like behaviors in some but not all individuals are poorly known. To address this issue, we used a unique outbred rat population (heterogeneous stock) that better models the behavioral and genetic diversity that is found in humans. We characterized individual differences in addiction-like behaviors using an addiction index that incorporates the key criteria of opioid use disorder: escalated intake, highly motivated responding, and hyperalgesia. Using in vitro electrophysiological recordings in the central nucleus of the amygdala (CeA), we found that rats with high addiction-like behaviors (HA) exhibited a significant increase in γ-aminobutyric acid (GABA) transmission compared with rats with low addiction-like behaviors (LA) and naive rats. The superfusion of CeA slices with nociceptin/orphanin FQ peptide (N/OFQ; 500 nM), an endogenous opioid-like peptide, normalized GABA transmission in HA rats. Intra-CeA levels of N/OFQ were lower in HA rats than in LA rats. Intra-CeA infusions of N/OFQ (1 μg per site) reversed the escalation of oxycodone self-administration in HA rats but not in LA rats. These results demonstrate that the downregulation of N/OFQ levels in the CeA may be responsible for hyper-GABAergic tone in the CeA that is observed in individuals who develop addiction-like behaviors. Based on these results, we hypothesize that small molecules that target the N/OFQ system might be useful for the treatment of opioid use disorder

Brainstorm Radiation Systems Inc

Many different designs have been created to immobilize patients for radiation therapy of the head and neck. Options exist which result in varying degrees of patient comfort, radiation attenuation, and limitation of movement. While one requirement can be met effectively, it is difficult to design a system which adequately meets all requirements for radiation therapy. Brainstorm Radiation Systems aims to address all of these variables and transform the patient and technician experience during radiation treatment. The requirements for our head and neck immobilization design were to immobilize the patient within 3mm of movement for at least 30 minutes, and must be repeatable over the course of several weeks. The device must limit attenuation of the radiation and be comfortable for the patient. Our team worked to address these issues, and together, went through storming, norming, and performing as a group. We learned to communicate our ideas and goals effectively and efficiently through conflict resolution and teamwork. And through visits with radiation oncologist experts, brainstorming, designing, 3D modeling, and construction of prototypes, we were able to design a system of components which accomplishes our goals. Our system, which includes a bite-block, holds the patient in place and is unaffected by weight or facial change of the patient. Our design is easily integrated with Bionix’s line of products and will create a better experience for both the patient and the technicians

Drawing Waters: Creative visual enquiries through riverscapes

Drawing Waters is a series of participatory walks and visual fieldwork exercises developed and executed by the authors, to facilitate engagement with river landscapes. Through walking and drawing together, these events aim to develop discursive tools for the discovery and communication of cultural, political and socio-economic place narratives, identifying this as a key area for development in design research. Importance is placed on ‘thinking through making’ and examining the value of experiential approaches in place research. Using two case studies, outcomes are documented through material captured via physical and digital data resulting in a visual and textual cross section of different river locations. A practical methodology is identified that can be applied to a wide range of research environments and key areas of impact are outlined, including heritage, pedagogy, public engagement, land use and policy making

How a Mandated Space Change by the Library\u27s Parent Organization Resulted in Unexpected Benefits to Multiple Intra-Library Systems

In 2008, Himmelfarb Health Sciences Library was mandated to relocate its 70,000-volume bound journal collection. This poster narrates the planning and execution of this project which resulted in unexpected benefits to the library

Implementing a Mandated Space Change: The Unexpected Benefits to Library Systems

In September 2008, the Himmelfarb Health Sciences Library received a mandate to convert the second floor to quiet study space. The conversion involved the removal of the 70,000-volume bound journal collection. This poster presentation illustrates the steps taken to complete the collection relocation and describes the unexpected, beneficial results of this space change

Running Out of Library Space: Sharing Remote Storage to Increase Cost-Savings and Conserve Space

A cooperative project between two urban academic medical libraries, the Himmelfarb Health Sciences Library (George Washington University Medical Center) and the Dahlgren Medical Library (Georgetown Medical Center), was designed to relocate all pre-1980 bound journal volumes to a remote-storage facility. This poster explores the goals, process, and results, both financially and physically, of the collaborative initiative

Village Baseline Study: Site Analysis Report for Usambara – Lushoto, Tanzania (TZ0105)

The village baseline study of Kwang’wenda village in the CCAFS benchmark Lushoto site, Tanzania took place from April 27 to 29, 2011. Focus group discussions were conducted separately for men and women. Population growth and agriculture intensification have led to encroachment onto the forest areas, reduction in riparian vegetation, cultivation along the riverbank, and soil fertility depletion on the farmland. The overall area under farming has increased but individual farms have become smaller and production per unit area has reduced due to land subdivision. The community’s vision of the future includes the conservation and expansion of the forest area by planting more trees and enforcing restrictions on illegal logging. It also calls for promoting agroforestry systems in the farmlands and allowing riverine vegetation to mature, in order to ensure clean waters in the rivers. The discussion groups identified 32 organisations, and 60% of them were involved in food security assistance, prioritizing food availability. Radio is the most significant source of information on agriculture in the village. Men were better informed about and interacted with groups that operated beyond the locality, while women were more aware of and engaged in groups that operated within the community but had limited operational capacity

Public Housing Transformation and Crime: Making the Case for Responsible Relocation

The research in this article examines the effect on crime rates of public housing transformation in Atlanta and Chicago, focusing on the neighborhoods receiving households relocated with housing vouchers. Modeling the complex relationship between voucher holder locations and crime, using quarterly data, our analysis found that crime rates fell substantially in neighborhoods with public housing demolition, whereas destination neighborhoods experienced a much lesser effect than popular accounts imply. Nevertheless, on average, negative effects emerge for some neighborhoods with modest or high densities of relocated households compared with conditions in areas without relocated households. Overall, we estimate small net decreases citywide in violent crime over study periods during which crime declined significantly. These findings suggest a need for thoughtful relocation strategies that support both assisted residents and receiving communities