Optimal Management During Systemic Lupus Erythematosus Cesarean Section: An Educational Module

Abstract Importance: Systemic lupus erythematosus (SLE) is a lifelong multisystem autoimmune disorder characterized by the presence of autoantibodies that are directed against nuclear antigens. The disease is the most common type of lupus that has a heterogeneous presentation, and an affinity for the female gender with a peak onset in normative childbearing years. It becomes important for anesthesia providers to understand the potential complications that they may encounter during the obstetric management of this population, during cesarean sections. Recommendations that address the disease’s heterogeneous presentation and effect on the parturient organ systems provide a template for anesthesia providers during the perioperative management of the obstetric SLE patient. Objective: This quality improvement (QI) project aims to improve healthcare provider knowledge regarding the clinical implications of SLE, during the obstetric management for a cesarean section, to reduce morbidity and mortality for mother and newborn. Setting: A 716-bed acute care hospital in Broward County, Florida, which has a large obstetric population requiring anesthetic services. Anesthesia providers at this facility will be educated on the maternal-fetal dyad that can present during the management of the SLE mother during a cesarian section. Methods: A pretest survey will be administered to assess anesthesia providers’ knowledge, attitudes, and behaviors regarding the management of the SLE parturient during a cesarian section. An educational module will then be provided. Finally, a posttest survey containing the same questions as the pretest will be administered to participants. Results: Following the educational intervention, there was an increase in knowledge scores and stronger attitudes and beliefs regarding the role of anesthesia providers in the management of the SLE parturient during a cesarean section. Furthermore, most participants reported that they were highly likely to implement this into their clinical practice. Conclusion: An educational module can enhance anesthesia provider knowledge and increase the likelihood of improved outcomes for mother and neonate, during the anesthetic management of an SLE parturient during a cesarean section

Decreased Odds for Vasospasm Treatment in Patients with Aneurysmal Subarachnoid Hemorrhage after Transitioning from Neurosurgery Led Care to a Neurology Led Multidisciplinary Approach.

Introduction: The limited research on the management of aneurysmal subarachnoid hemorrhages (aSAHs) has not assessed the efficacy of neurology-led care. Our objective was to describe aSAH patients\u27 outcomes after transitioning from a neurosurgery-led intensive care unit (ICU) to a neurology-led multidisciplinary care neurocritical care unit (NCCU). The study hypothesis was that the neurology-led multidisciplinary care would improve patient outcomes. Methods: This was a retrospective cohort study. We included patients (≥ 18) with aSAHs from 1/16 to 8/16 (pregroup) and from 3/17 to 11/17 (postgroup). The pregroup care was led by a neurosurgeon. The postgroup care included a neurologist, a pulmonary intensivist, a neurocritical care clinical nurse specialist, a neurosurgeon, and euvolemia protocol. The primary outcome was trips to interventional radiology (IR) for vasospasm treatment. Univariate analyses and multivariable ordinal logistic regression were used. Results: There were 99 patients included: 50 in the pregroup and 49 in the postgroup. On average, postgroup patients were 7 years older than the pregroup ( Conclusions: In aSAH patients, the neurology-led multidisciplinary care in the NCCU decreased the odds of repeated procedures for vasospasm treatment. Neurology-led multidisciplinary care could be more cost-effective than the neurosurgical-led care

Increased Blood Pressure Variability Is Associated with Worse Neurologic Outcome in Acute Anterior Circulation Ischemic Stroke

Background. Although research suggests that blood pressure variability (BPV) is detrimental in the weeks to months after acute ischemic stroke, it has not been adequately studied in the acute setting. Methods. We reviewed acute ischemic stroke patients from 2007 to 2014 with anterior circulation stroke. Mean blood pressure and three BPV indices (standard deviation, coefficient of variation, and successive variation) for the intervals 0–24, 0–72, and 0–120 hours after admission were correlated with follow-up modified Rankin Scale (mRS) in ordinal logistic regression models. The correlation between BPV and mRS was further analyzed by terciles of clinically informative stratifications. Results. Two hundred and fifteen patients met inclusion criteria. At all time intervals, increased systolic BPV was associated with higher mRS, but the relationship was not significant for diastolic BPV or mean blood pressure. This association was strongest in patients with proximal stroke parent artery vessel occlusion and lower mean blood pressure. Conclusion. Increased early systolic BPV is associated with worse neurologic outcome after ischemic stroke. This association is strongest in patients with lower mean blood pressure and proximal vessel occlusion, often despite endovascular or thrombolytic therapy. This hypothesis-generating dataset suggests potential benefit for interventions aimed at reducing BPV in this patient population

The Lantern Vol. 62, No. 2, Summer 1995

• In the Season of Grief • Subtleties • Crazehaze • Blacksmith • I Feel Your Weight • L\u27Amour Manque • Sense of You • Greed • Gender (Rolled) • Soliloquy of a Punter • Nightmares • God is a Frisbee • Cleansing • Flat • Chemistry of Mind • Louderback • Ritual • Rebuilding Mother • Scott Lomba • The Acting Bug • Untitled • The Seek • Gluttony • Great South Bay • Archangel • Suburban Zeus • Vespers • At Change of A-Dress • The Hierarchy of Coolness • The Apology • I Know it is Evening There • Pridehttps://digitalcommons.ursinus.edu/lantern/1146/thumbnail.jp

Double Trouble: Two Transits of the Super-Earth GJ 1132 b Observed with JWST NIRSpec G395H

The search for rocky planet atmospheres with JWST has focused on planets transiting M dwarfs. Such planets have favorable planet-to-star size ratios, enhancing the amplitude of atmospheric features. Since the expected signal strength of atmospheric features is similar to the single-transit performance of JWST, multiple observations are required to confirm any detection. Here, we present two transit observations of the rocky planet GJ 1132 b with JWST NIRSpec G395H, covering 2.8-5.2 $\mu$m. Previous HST WFC3 observations of GJ 1132 b were inconclusive, with evidence reported for either an atmosphere or a featureless spectrum based on analyses of the same dataset. Our JWST data exhibit substantial differences between the two visits. One transit is consistent with either a H$_2$O-dominated atmosphere containing ~1% CH$_4$ and trace N$_2$O ($\chi^{2}_{\nu}$ = 1.13) or stellar contamination from unocculted starspots ($\chi^{2}_{\nu}$ = 1.36). However, the second transit is consistent with a featureless spectrum. Neither visit is consistent with a previous report of HCN. Atmospheric variability is unlikely to explain the scale of the observed differences between the visits. Similarly, our out-of-transit stellar spectra show no evidence of changing stellar inhomogeneity between the two visits - observed 8 days apart, only 6.5% of the stellar rotation rate. We further find no evidence of differing instrumental systematic effects between visits. The most plausible explanation is an unlucky random noise draw leading to two significantly discrepant transmission spectra. Our results highlight the importance of multi-visit repeatability with JWST prior to claiming atmospheric detections for these small, enigmatic planets.Comment: 22 pages, 10 figures, 2 tables. Accepted for publication in ApJ Letters. Co-First Authors. Bonus materials and spectral data: https://doi.org/10.5281/zenodo.1000208