Educating Anesthesia Personnel on STOP-BANG to Predict Difficult Airway

Impact Statement: The purpose of this study is to educate the anesthesia team on the incidence of a difficult airway in patients with obstructive sleep apnea (OSA) and the STOP-BANG Questionnaire to predict this complication. Background: Characterized by cessation of breathing during sleep due to collapse of the upper airway, patients with OSA possess a high risk of a difficult airway during anesthesia induction. During periods of constriction, the pharynx becomes obstructed, leading to adverse reactions such as desaturation, blood gas instabilities, abrupt arousal from sleep, and daytime fatigue. A needs assessment revealed that the STOP-Bang Questionnaire, the most validated screening tool for OSA, is not incorporated by anesthesia providers in clinical practice. Method: Anesthesia personnel within the Broward Health system were asked to anonymously participate in an educational module, sent via email provided by the institution. Over the course of one month, anesthesia personnel completed an informed consent and prompted to complete a pre-evaluation examination on pathophysiology and assessment of OSA. Participants were then forwarded to a 13-minute educational video surrounding OSA, the STOP-BANG Questionnaire, and its relevancy in detecting difficult airways. When complete, the participants were asked to answer the same questions on the post-evaluation examination in effort to determine any increase in knowledge and participants willingness to change practice. Information is collected through an anonymous website, Qualtrics. Results: There was an average improvement score of 50%, demonstrating the receptiveness of the educational module. More importantly, the likeliness of utilizing the STOP-Bang Questionnaire tool during their preoperative assessment increased from 67% more likely during the pre-test, to 100% more likely in the post-test. Discussion: In the concluding assessment for participating anesthesia providers, an overwhelming amount contributors demonstrated not only an increase in knowledge, but a greater willingness to incorporate the STOP-BANG Questionnaire into the daily anesthesia patient assessment. Limitations within this quality improvement study include a small sample size was very small, only reaching six anesthesia providers, as well as holding the same pre-and post-evaluation examination questions. The STOP-BANG questionnaire can aid in alerting anesthesia providers of a potential OSA diagnosis and assist the provider in preparing for possible interventions. Potential anesthetic considerations for diagnosed or suspected OSA include minimal sedation, preparation for difficult mask ventilation and airway with glidescope and fiberoptic tools, pre-oxygenation with the head of the bed elevated, use of continuous positive airway pressure (CPAP), and cautious use of opioids

Physiological models of body composition and human obesity

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Transcranial direct current stimulation combined with upper limb functional training in children with spastic, hemiparetic cerebral palsy: study protocol for a randomized controlled trial

The aim of the proposed study is to perform a comparative analysis of functional training effects for the paretic upper limb with and without transcranial direct current stimulation over the primary motor cortex in children with spastic hemiparetic cerebral palsy

E-commerce ethics and its impact on buyer repurchase intentions and loyalty: an empirical study of small and medium Egyptian businesses

The theoretical understanding of e-commerce has received much attention over the years; however, relatively little focus has been directed towards e-commerce ethics, especially the SMEs B2B e-commerce aspect. Therefore, the purpose of this paper is to develop and empirically test a framework that explains the impact of SMEs B2B e-commerce ethics on buyer repurchase intentions and loyalty. Using SEM to analyse the data collected from a sample of SME e-commerce firms in Egypt, the results indicate that buyers’ perceptions of supplier ethics construct is composed of six dimensions (security, non-deception, fulfilment/reliability, service recovery, shared value, and communication) and strongly predictive of online buyer repurchase intentions and loyalty. Furthermore, our results also show that reliability/fulfilment and non-deception are the most effective relationship-building dimensions. In addition, relationship quality has a positive effect on buyer repurchase intentions and loyalty. The results offer important implications for B2B e-commerce and are likely to stimulate further research in the area of relationship marketing

Association of Chromosome 9p21 with Subsequent Coronary Heart Disease events:A GENIUS-CHD study of individual participant data

BACKGROUND:Genetic variation at chromosome 9p21 is a recognized risk factor for coronary heart disease (CHD). However, its effect on disease progression and subsequent events is unclear, raising questions about its value for stratification of residual risk. METHODS:A variant at chromosome 9p21 (rs1333049) was tested for association with subsequent events during follow-up in 103,357 Europeans with established CHD at baseline from the GENIUS-CHD Consortium (73.1% male, mean age 62.9 years). The primary outcome, subsequent CHD death or myocardial infarction (CHD death/MI), occurred in 13,040 of the 93,115 participants with available outcome data. Effect estimates were compared to case/control risk obtained from CARDIoGRAMPlusC4D including 47,222 CHD cases and 122,264 controls free of CHD. RESULTS:Meta-analyses revealed no significant association between chromosome 9p21 and the primary outcome of CHD death/MI among those with established CHD at baseline (GENIUS-CHD OR 1.02; 95% CI 0.99-1.05). This contrasted with a strong association in CARDIoGRAMPlusC4D OR 1.20; 95% CI 1.18-1.22; p for interaction Conclusions: In contrast to studies comparing individuals with CHD to disease free controls, we found no clear association between genetic variation at chromosome 9p21 and risk of subsequent acute CHD events when all individuals had CHD at baseline. However, the association with subsequent revascularization may support the postulated mechanism of chromosome 9p21 for promoting atheroma development