Use of Non-Technical Skills Training & Video Simulation to Improve Knowledge Among Nurse Anesthesia Trainees

Background: The transition from didactic component to clinical practice is challenging for nurse anesthesia trainees. When faced with an airway crisis, successful management involves non-technical skills, which include recognition, decision-making, and prioritization. Limited data is available on the efficacy of instructional video on enhancing non-technical skills during airway crisis management among nurse anesthesia trainees. Purpose: The purpose of this study was to examine the efficacy of instructional video simulation on enhancing the nurse anesthesia trainee’s knowledge of recognition, decisionmaking, and prioritization during bronchospasm and laryngospasm airway crises. Methods: A quasi-experimental pre-test and post-test design was used to investigate the effect of an instructional video simulating the proper non-technical skills of recognition, decision-making, and prioritization. Results: A convenience sample of 27 second and third year nurse anesthesia trainees were recruited. A Wilcoxon Signed Ranks Test demonstrated that the median post-test scores were statistically higher that the median pre-test scores between pre and post-instructional video [Z= 4.473; p=0.000 (2-tailed)] with adequate pre and post-test Kuder-Richardson-20 (KR-20) scores (0.533, 0.686). Specifically, post-test median prioritization scores for bronchospasm and laryngospasm were statistically higher than median pre-test scores [t=-5.366; p=0.000 (2-tailed)]; [t=-8.588; p=0.000 (2-tailed)]. Conclusion: The findings demonstrate the effectiveness of instructional video simulation on non-technical skills, specifically prioritization, during airway crises such as bronchospasm and laryngospasm for nurse anesthesia trainees. According to the results, utilizing a pre-test/post-test NON-­‐TECHNICAL SKILLS VIDEO SIMULATION 4 design and instructional video simulation improved non-technical skills knowledge among nurse anesthesia trainees

Three different phonological approaches moving one child towards intelligible speech

Includes bibliographical references.For my Capstone, I will research, contrast, and then apply three different phonological approaches to therapy to the same four year old female with unintelligible speech. The three different phonological approaches are multiple oppositions, phonemic categories development, and construct of complexity. Each phonological approach has different targets to therapy but all have the same ultimate goal of intelligible speech. Multiple oppositions use multiple sound pairs to help the child reduce homonomy and integrate their knowledge of sound sets. Facilitating underlying phonemic category uses complete emersion of phonemic sounds though training and assessments in hope that the mass quantity of input will aid in the correction of the child's phonological disorder. Construct of complexity uses complex target clusters in therapy in hopes that the complexity of the targets will allow the mastery of simpler tasks.B.S. (Bachelor of Science

The mediated myth of rock and roll

This study deconstructs the cultural myth (Barthes, 1957) of rock and roll as constructed by television and film (forms) and negotiated through musicians' experiences and personal understandings (concepts). It does so through textual analyses of five films and eight televisual forms and forty-one in-depth interviews with a maximum variation sample of rock and roll musicians to examine how individuals negotiated concepts about the rock and roll myth. The myth of rock and roll is simultaneously simple and complex, discussed openly and mired in code, and contains both surface level and deep structures. It is at once a rejection of American capitalism through its insistence on the existence "pure" rock and roll outside of industry while being the very embodiment of it through its meritocratic and agentic views of rock and roll success, where the best product sells the most records. The myth of rock and roll contains promises of openness and equality to "anyone" who wishes to "do it" while disguising "averageness" as white, male, and heterosexual. As with the function of all myths, each of these dualistic statements contains a degree of truth to allow its circulation throughout culture (Dyer, 1982). However, musicians negotiate what constitutes "truth" through the lens of the myth throughout the various stages of their careers. Additionally, the cultural forms and individual concepts of rock and roll are not inherently good or bad, or true or false, rather, they serve different cultural and individual functions, which this study critically examines

Adjuvant therapy with antidepressants for the management of inflammatory bowel disease

BACKGROUND: Symptoms of anxiety and depression are common in inflammatory bowel disease (IBD). Antidepressants are taken by approximately 30% of people with IBD. However, there are no current guidelines on treating co-morbid anxiety and depression in people with IBD with antidepressants, nor are there clear data on the role of antidepressants in managing physical symptoms of IBD. OBJECTIVES: The objectives were to assess the efficacy and safety of antidepressants for treating anxiety and depression in IBD, and to assess the effects of antidepressants on quality of life (QoL) and managing disease activity in IBD. SEARCH METHODS: We searched MEDLINE; Embase, CINAHL, PsycINFO, CENTRAL, and the Cochrane IBD Group Specialized Register from inception to 23 August 2018. Reference lists, trials registers, conference proceedings and grey literature were also searched. SELECTION CRITERIA: Randomised controlled trials (RCTs) and observational studies comparing any type of antidepressant to placebo, no treatment or an active therapy for IBD were included. DATA COLLECTION AND ANALYSIS: Two authors independently screened search results, extracted data and assessed bias using the Cochrane risk of bias tool. We used the Newcastle-Ottawa Scale to assess quality of observational studies. GRADE was used to evaluate the certainty of the evidence supporting the outcomes. Primary outcomes included anxiety and depression. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS) or the Hamilton Anxiety Rating Scale (HARS). Depression was assessed using HADS or the Beck Depression Inventory. Secondary outcomes included adverse events (AEs), serious AEs, withdrawal due to AEs, quality of life (QoL), clinical remission, relapse, pain, hospital admissions, surgery, and need for steroid treatment. QoL was assessed using the WHO-QOL-BREF questionnaire. We calculated the risk ratio (RR) and corresponding 95% confidence intervals (CI) for dichotomous outcomes. For continuous outcomes, we calculated the mean difference (MD) with 95% CI. A fixed-effect model was used for analysis. MAIN RESULTS: We included four studies (188 participants). Two studies were double-blind RCTs, one was a non-randomised controlled trial, and one was an observational retrospective case-matched study. The age of participants ranged from 27 to 37.8 years. In three studies participants had quiescent IBD and in one study participants had active or quiescent IBD. Participants in one study had co-morbid anxiety or depression. One study used duloxetine (60 mg daily), one study used fluoxetine (20 mg daily), one study used tianeptine (36 mg daily), and one study used various antidepressants in clinical ranges. Three studies had placebo controls and one study had a no treatment control group. One RCT was rated as low risk of bias and the other was rated as high risk of bias (incomplete outcome data). The non-randomised controlled trial was rated as high risk of bias (random sequence generation, allocation concealment, blinding). The observational study was rated as high methodological quality, but is still considered to be at high risk of bias given its observational design.The effect of antidepressants on anxiety and depression is uncertain. At 12 weeks, the mean anxiety score in antidepressant participants was 6.11 + 3 compared to 8.5 + 3.45 in placebo participants (MD -2.39, 95% -4.30 to -0.48, 44 participants, low certainty evidence). At 12 months, the mean anxiety score in antidepressant participants was 3.8 + 2.5 compared to 4.2 + 4.9 in placebo participants (MD -0.40, 95% -3.47 to 2.67, 26 participants; low certainty evidence). At 12 weeks, the mean depression score in antidepressant participants was 7.47 + 2.42 compared to 10.5 + 3.57 in placebo participants (MD -3.03, 95% CI -4.83 to -1.23, 44 participants; low certainty evidence). At 12 months, the mean depression score in antidepressant participants was 2.9 + 2.8 compared to 3.1 + 3.4 in placebo participants (MD -0.20, 95% -2.62 to 2.22, 26 participants; low certainty evidence).The effect of antidepressants on AEs is uncertain. Fifty-seven per cent (8/14) of antidepressant participants group reported AEs versus 25% (3/12) of placebo participants (RR 2.29, 95% CI 0.78 to 6.73, low certainty evidence). Commonly reported AEs include nausea, headache, dizziness, drowsiness, sexual problems, insomnia, fatigue, low mood/anxiety, dry mouth, muscle spasms and hot flushes. None of the included studies reported any serious AEs. None of the included studies reported on pain.One study (44 participants) reported on QoL at 12 weeks and another study (26 participants) reported on QoL at 12 months. Physical, Psychological, Social and Environmental QoL were improved at 12 weeks compared to placebo (all low certainty evidence). There were no group differences in QoL at 12 months (all low certainty evidence). The effect of antidepressants on maintenance of clinical remission and endoscopic relapse is uncertain. At 12 months, 64% (9/14) of participants in the antidepressant group maintained clinical remission compared to 67% (8/12) of placebo participants (RR 0.96, 95% CI 0.55 to 1.69; low certainty evidence). At 12 months, none (0/30) of participants in the antidepressant group had endoscopic relapse compared to 10% (3/30) of placebo participants (RR 0.14, 95% CI 0.01 to 2.65; very low certainty evidence). AUTHORS' CONCLUSIONS: The results for the outcomes assessed in this review are uncertain and no firm conclusions regarding the efficacy and safety of antidepressants in IBD can be drawn. Future studies should employ RCT designs, with a longer follow-up and develop solutions to address attrition. Inclusion of objective markers of disease activity is strongly recommended as is testing antidepressants from different classes, as at present it is unclear if any antidepressant (or class thereof) has differential efficacy

Systematic review with meta-analysis: the impact of a depressive state on disease course in adult inflammatory bowel disease

Background Despite a higher prevalence of psychosocial morbidity in Inflammatory Bowel Disease (IBD), the association between depressive state and disease course in IBD is poorly understood. Aim To investigate the impact of depressive state on disease course in IBD. Methods We conducted a systematic review in MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews and PsychINFO for prospective studies evaluating the impact of baseline depressive state on subsequent disease course in adult IBD. Results Eleven studies matched our entry criteria, representing 3194 patients with IBD. Three reported on patients with ulcerative colitis (UC), four included patients with Crohn's disease (CD) exclusively, and four studies included both UC and CD. Five studies reported an association between depressive state and disease course. None of the UC‐specific studies found any association. In three of four CD‐specific studies, a relationship between depressive state and worsening disease course was found. In four of five studies including patients in remission at baseline, no association between depressive state and disease course was found. Pooled analysis of IBD studies with patients in clinical remission at baseline identified no association between depressive state and disease course (HR 1.04, 95%CI: 0.97‐1.12). Conclusion There is limited evidence to support an association between depressive state and subsequent deterioration in disease course in IBD, but what data that exist are more supportive of an association with CD than UC. Baseline disease activity may be an important factor in this relationship. Further studies are needed to understand the relationship between mental health and outcomes in IBD

Physical activity habits, limitations and predictors in people with inflammatory bowel disease: a large cross-sectional online survey

Background: Limited evidence suggests that physical activity has beneficial effects in people with inflammatory bowel disease (IBD). This study aimed to determine the physical activity habits of adults with IBD, the limitations to physical activity they experience because of their disease, and the extent to which their physical activity is affected by various demographic, clinical, and psychological factors. Methods: Data were collected on 859 adult participants (52% with Crohn's disease, 75% women) through an online survey conducted between May and June 2016. Measures included physical activity (International Physical Activity Questionnaire), psychological symptoms (Hospital Anxiety and Depression Scale), fatigue (subitems of IBD fatigue scale), exercise perceptions (Exercise Benefits/Barriers Scale), and disease activity. Regression analyses were used to identify predictors of physical activity. Results: Only 17% of respondents were categorized as "high active." Self-reported physical activity levels decreased, and fatigue and psychological scores increased, with increasing disease activity. Walking was the most common activity performed (57% of respondents) and running/jogging the most commonly avoided (34%). Many participants (n = 677) reported that IBD limited their physical activity, for reasons including abdominal/joint pain (70%), fatigue/tiredness (69%), disease flare-up (63%), and increased toilet urgency (61%). Physical activity was independently associated with depression, disease activity, and perceived barriers to exercise in people with Crohn's disease, and depression and age in people with ulcerative or indeterminate colitis (all P <= 0.038). Conclusions: This survey highlights several important factors that should be considered by designers of future physical activity interventions for people with IBD

Symptoms of Depression and Anxiety Are Independently Associated With Clinical Recurrence of Inflammatory Bowel Disease.

BACKGROUND & AIMS: We examined the relationship between symptoms of depression and anxiety and clinical recurrence of inflammatory bowel disease (IBD) in a large patient cohort. We considered the progression of depression and anxiety over time. METHODS: We collected clinical and treatment data on 2007 adult participants in an IBD study (56% with Crohn's disease [CD], 48% male) performed in Switzerland from 2006 through 2015. Depression and anxiety symptoms were quantified by using the Hospital Anxiety and Depression Scale. The relationship between depression and anxiety scores and clinical recurrence was analyzed by using survival-time techniques. RESULTS: We found a significant association between symptoms of depression and clinical recurrence over time (for all patients with IBD, P = .000001; for subjects with CD, P = .0007; for subjects with ulcerative colitis, P = .005). There was also a significant relationship between symptoms of anxiety and clinical recurrence over time in all subjects with IBD (P = .0014) and in subjects with CD (P = .031) but not ulcerative colitis (P = .066). CONCLUSIONS: In an analysis of a large cohort of subjects with IBD, we found a significant association between symptoms of depression or anxiety and clinical recurrence. Patients with IBD should therefore be screened for clinically relevant levels of depression and anxiety and referred to psychologists or psychiatrists for further evaluation and treatment