Acute Kidney Injury and Lower Extremity Orthopedic Surgery: A Targeted Education on AKI Risk Factors

BACKGROUND: Total knee and total hip replacement surgery is highly effective for relieving pain and improving functionality. Though effective, the surgery is not without risk. Acute kidney injury (AKI) can develop following joint replacement surgery and has been shown to increase morbidity, mortality, hospital costs, and length of stay. There are several risk factors associated with the development of AKI – some of which are modifiable. METHODS: This quality improvement project implements an educational module with the goal of educating staff on the risk factors for developing AKI and evidence-based recommendations surrounding perioperative management for total joint arthroplasty (TJA). Using Johns Hopkins Nursing Evidence-Based Practice Model, a three-step process called PET: practice question, evidence, and translation will be used to implement a pre-test, educational video, and post-test. INTERVENTION: Anesthesia providers will be given a pre-test to assess their current knowledge of factors affecting the development of AKI. Immediately following this test, the educational video will be viewed. After watching, a post-test will be administered to the providers to assess if there is an increase in knowledge. RESULTS: 53 anesthesia providers took this module. The mean pre-test score before the education video was 6.64 points out of the maximum score of 10 points. The mean post-test score after watching the education video was 9.08 points out of 10 points. After conducting a paired two sample t-test the resulting p-value was \u3c 0.00, therefore statistically significant. CONCLUSIONS: The educational video increased knowledge of risk factors for the development of AKI and evidence-based recommendations

Political transition and emergent forest-conservation issues in Myanmar.

Political and economic transitions have had substantial impacts on forest conservation. Where transitions are underway or anticipated, historical precedent and methods for systematically assessing future trends should be used to anticipate likely threats to forest conservation and design appropriate and prescient policy measures to counteract them. Myanmar is transitioning from an authoritarian, centralized state with a highly regulated economy to a more decentralized and economically liberal democracy and is working to end a long-running civil war. With these transitions in mind, we used a horizon-scanning approach to assess the 40 emerging issues most affecting Myanmar's forests, including internal conflict, land-tenure insecurity, large-scale agricultural development, demise of state timber enterprises, shortfalls in government revenue and capacity, and opening of new deforestation frontiers with new roads, mines, and hydroelectric dams. Averting these threats will require, for example, overhauling governance models, building capacity, improving infrastructure- and energy-project planning, and reforming land-tenure and environmental-protection laws. Although challenges to conservation in Myanmar are daunting, the political transition offers an opportunity for conservationists and researchers to help shape a future that enhances Myanmar's social, economic, and environmental potential while learning and applying lessons from other countries. Our approach and results are relevant to other countries undergoing similar transitions

Political transition and emergent forest-conservation issues in Myanmar.

Political and economic transitions have had substantial impacts on forest conservation. Where transitions are underway or anticipated, historical precedent and methods for systematically assessing future trends should be used to anticipate likely threats to forest conservation and design appropriate and prescient policy measures to counteract them. Myanmar is transitioning from an authoritarian, centralized state with a highly regulated economy to a more decentralized and economically liberal democracy and is working to end a long-running civil war. With these transitions in mind, we used a horizon-scanning approach to assess the 40 emerging issues most affecting Myanmar's forests, including internal conflict, land-tenure insecurity, large-scale agricultural development, demise of state timber enterprises, shortfalls in government revenue and capacity, and opening of new deforestation frontiers with new roads, mines, and hydroelectric dams. Averting these threats will require, for example, overhauling governance models, building capacity, improving infrastructure- and energy-project planning, and reforming land-tenure and environmental-protection laws. Although challenges to conservation in Myanmar are daunting, the political transition offers an opportunity for conservationists and researchers to help shape a future that enhances Myanmar's social, economic, and environmental potential while learning and applying lessons from other countries. Our approach and results are relevant to other countries undergoing similar transitions