Length of Stay for Laparoscopic Cholecystectomy

Background: Hospitals seek to maximize efficiency in stabilizing and discharging post-operative patients. The post-operative length of stay (LOS) for laparoscopic cholecystectomy surgeries in the short stay unit of a community hospital in the Portland area varies significantly with an average LOS of 170 minutes. Purpose: The purpose of this study was to isolate factors associated with decreased post-operative LOS for laparoscopic cholecystectomy surgeries to identify procedural changes that would help meet the goal of an average 120 minutes LOS. Methods: EPIC charts of 41 patients who received a laparoscopic cholecystectomy since July 1st 2014 were reviewed for data on specific factors of perioperative care. A literature review was also conducted to gather information on evidence based standards of care. Results: Data showed no differences in post-operative LOS for laparoscopic cholecystectomy patients based on gender, use of a nerve block, or pre-operative Xanax administration. Patients with the shortest LOS, under 120 minutes, received an average of three different antiemetics. Evidence based literature recommends using a combination of antiemetics during surgery to prevent post-operative nausea and vomiting (PONV). Discussion/Recommendation: PONV is a leading factor contributing to increased length of stay. The results of this study, along with evidence-based literature, suggests that a combination of at least three antiemetics during surgery can decrease PONV and thus decrease post-operative LOS for laparoscopic cholecystectomies

A Magical Week in Galway

Postcard from Alexis Sayer, during the Linfield College Semester Abroad Program at the National University of Ireland, Galwa

Effect of a National Nutrition Communications Campaign on Stunting Awareness and Promotion of Exclusive Breastfeeding Behavior among Rural Indonesian Mothers

Background: Stunting affects 37% of Indonesian children and has lifelong consequences for the affected child. Childhood stunting can be prevented by promoting exclusive breastfeeding (EBF) and helping mothers overcome barriers to EBF. This study aimed to examine the effect of a National Nutrition Communications Campaign (NNCC) on stunting awareness and promotion of exclusive breast­feeding behavior among rural Indonesian mothers.Subjects and Method: Data came from interviews and a cross-sectional survey of 1,740 mothers with children under the age of 2 in three Indonesian districts, from November 2015 to March 2018. Measures included exposure to two different NNCC interventions: multi-media messages (media) and interpersonal communication strategies (IPC) and associations with stunting knowledge, breast­feeding knowledge, and breastfeeding perceptions/intentions. The data were analyzed by a multiple logistic regression.Results: Exposure to NNCC was positively associated with knowledge toward EBF (OR= 1.56; 95% CI= 1.10 to 2.19; p= 0.043), awareness of the importance of nutrition during the first 1000 days of life (OR= 1.90; 95% CI= 1.43 to 2.52; p<0.001), and having heard of stunting (OR= 1.93; 95% CI= 1.41 to 2.63; p<0.001). Exposure to IPC was positively associated with knowledge toward EBF (OR=1.78, CI95% 1.37 to 2.30, p<0.001), awareness of the importance of nutrition during the first 1000 days of life (OR= 3.02; 95% CI= 2.40 to 3.80; p<0.001), knowledge of EBF benefit to prevent stunting (OR= 3.05; CI 95%= 2.33 to 3.98; p<0.001), and having heard of stunting (OR= 3.15; CI 95%= 2.49 to 3.98; p<0.001). Exposure to IPC was a significant predictor of an intention to engage in EBF (p <0.050).Conclusion: These findings point to practical recommendations for national level social and behavior change communication efforts. Future campaigns should aim to be inclusive of: 1) mass media (tele­vision, radio, billboards, and social media) to promote health as these efforts provide for wide exposure while maintaining impact; and 2) IPC (face-to-face communications, classes, and support groups) as these efforts increase knowledge and impact on behavior, beliefs and intentions.Keywords: stunting, exclusive breastfeeding, communications campaignCorrespondence: Ryan Moffat. Brigham Young University, Provo, UT, USA. Email: [email protected]. Mobile: (801)792-9800.Journal of Maternal and Child Health (2021), 06(05): 612-625https://doi.org/10.26911/thejmch.2021.06.05.11

Oxygen targets and 6-month outcome after out of hospital cardiac arrest: a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial

International audienceAbstract Background Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO 2 ) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO 2 with patients’ outcome. Methods Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO 2  300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. Results 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93–1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95–1.06). The time exposure, i.e., the area under the curve (PaO 2 -AUC), for hyperoxemia was significantly associated with mortality ( p = 0.003). Conclusions In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. Trial registration : clinicaltrials.gov NCT02908308 , Registered September 20, 2016

Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial

International audienc