Multimodal Therapy for Postoperative Pain Management

Multimodal therapy works best to control postoperative pain safely. Multimodal pain treatment involves the use of two or more classes of analgesics to target different pain mechanisms. Why? Data is present that supports that health care systems are still under treating pain in the postoperative patient. Unrelieved pain has harmful effects to multi ple body systems. There is still a need to provide education to providers, nurses and patients to promote best practice in pain management approaches regarding multimodal therapy. Opiate analgesics still remain the most commonly used treatment for pain following surgery. Using this singular analgesic modality could put patients at risk for hypoxemia, as respiratory depression is the most dangerous of opioid side effects (Hartrick, 2004). In addition, patients can still have uncontrolled pain on this single analgesic regimen for pain management. Evidence points to multimodal therapy consisting of rational combination of analgesics with different underlying mechanisms that help to achieve the greatest pain relief. The use of the multimodal approach allows for lower doses of each drug and therefore has the potential to minimize adverse effects. Maximizing pain relief while preventing gaps in analgesia is the goal to prevention of worsening pain. Using drug therapy to target both inflammatory and neuropathic pain in the setting of postoperative pain can prove to be opioid sparing. Multimodal and preemptive therapies to prevent postoperative pain have improved by recent advances in the understanding of how undertreated acute pain can lead to chronic pain. Also, more attention has been placed on the role of local inflammation occurring at the injured tissue site. This inflammatory process increases the sensitivity of nociceptors. This prompted the adding of non-steroidal anti-inflammatory drugs to preventively control postoperative pain. Blocking pain signals by a variety of methods has improved postoperative pain management and the patient benefits from all these measures (Cornwell, 201

Managing community college adjuncts in the 21st century

As community college enrollments swell, two-year institution are choosing to hire part-time faculty so that they can offer more courses without exponentially increasing dollars spent on the salary and benefits required to hire full time faculty members. The growing adjunct population is becoming an essential organizational asset that needs to be carefully managed by the institution. Although the use of adjuncts in the community college market is not new, there is little research to show how institutions manage the adjunct population. This study surveyed one hundred and twenty community college personnel on how their institution manages adjuncts. Respondents were asked a series of questions around orientation programs, professional development programs and mentoring programs. The data collected indicated that although adjunct professors are teaching more courses at the community colleges, most community colleges do not have a full time employee dedicated to the success of the adjunct employee. Additionally, most institutions do not have the necessary programs and services needed to manage, train and provide professional development to this essential population. Most respondents indicated that time and money and resources were the major reason why adjuncts were not well supported at their institution. This study supports the recommendation that institutions need to invest in resources to help support these essential employees. Existing tools and technology at the institution such as learning management systems need to be explored as possible short-term solutions to increase communication with adjuncts until funding for additional resources can be secured. Finally, orientation programs, professional development programs and mentoring programs needs to be expanded to support the growing needs of the adjunct population

Neighbourhood parks in Saskatoon : contributions to perceptions of quality of life

The increase in the academic literature concerning the potential impacts that urban park systems can have over the life course of urban residents is beginning to be recognized by professionals in the fields of community quality of life studies, population health and in health geography. Typically urban spaces within Canada are designed to include a component of open space which can facilitate the recreation needs of residents. Within the City of Saskatoon neighbourhoods have such spaces in the form of neighbourhood parks, which are meant to facilitate passive or active recreation. Parks also provide open spaces of vegetation cover as opposed to the concrete and structural components of the city. Parks are meant to positively contribute to the resident’s lives and to the neighbourhood in which they are located. In community quality of life studies, open spaces, such as parks along with other neighbourhood attributes, are often used to gauge residents’ perceptions of their immediate surroundings. The Saskatoon Quality of Life Project conducted by the Quality of Life Module at the Community-University Institute for Social Research (CUISR) conducted such a study in 2004 in which park spaces were related alongside other neighbourhood features such as transportation and social activities in order to capture resident’s perceptions of their community quality of life. The purpose of this study is to look at how residents of differing socio-economic status (SES) neighbourhoods (one high SES and one low SES) perceive their neighbourhood park spaces and if their perceptions affect their perceived quality of life. In order to capture residents perceptions of their neighbourhood parks, face-to-face interviews were conducted with residents. In addition to the resident interviews, interviews were conducted with key informants’ as well as statistical analysis of secondary data from the 2004 Saskatoon Quality of Life Project was carried out. Results showed residents of different neighbourhood SES status shared common perceptions of their park spaces as well as how neighbourhood parks contributed to their quality of life

Coarse grain modeling of spall failure in molecular crystals: role of intra-molecular degrees of freedom

We use a recently developed thermodynamically accurate mesodynamical method (Strachan and Holian 2005 Phys. Rev. Lett. 94 014301) where groups of atoms are represented by mesoparticles to characterize the shock compression and dynamical failure (spall) of a model molecular crystal. We characterize how the temperature rise caused by the shockwave depends on the specific heat of the degrees of freedom (DoFs) internal to the mesoparticles (Cint) and the strength of the coupling between the internal DoFs and the mesoparticles. We find that the temperature of the shocked material decreases with increasing Cint and decreasing coupling and quantify these effects. Our simulations also show that the threshold for plastic deformation (the Hugoniot elastic limit) depends on the properties of the internal DoFs while the threshold for failure is very insensitive to them. These results have implications on the results of all-atom MD simulations, whose classical nature leads to a significant overestimation of the specific heat of molecular materials

School and Community-Based Childhood Obesity: Implications for Policy and Practice

This introduction to a special issue of the Journal of Prevention and Intervention in the Community on the topic of childhood obesity prevention lays some of the basis for the state of affairs of the childhood obesity epidemic in the United States as of 2012 and the need for and types of existing prevention and intervention efforts underway. At the intersection of public health and community psychology, each of the five articles presents some insights into how prevention and intervention efforts currently underway are fairing and offers some implications for program developers and policy makers to start to turn around the epidemic. Given the key role schools play, successful strategies for engaging schools are presented in the introduction. The authors of this special issue also emphasize the need to involve whole communities in order to attain the intended changes of reductions in overweight and obesity rates and increases in positive health outcomes

Inequalities in pediatric avoidable hospitalizations between Aboriginal and non-Aboriginal children in Australia: a population data linkage study

Background: Australian Aboriginal children experience a disproportionate burden of social and health disadvantage. Avoidable hospitalizations present a potentially modifiable health gap that can be targeted and monitored using population data. This study quantifies inequalities in pediatric avoidable hospitalizations between Australian Aboriginal and non-Aboriginal children. Methods: This statewide population-based cohort study included 1 121 440 children born in New South Wales, Australia, between 1 July 2000 and 31 December 2012, including 35 609 Aboriginal children. Using linked hospital data from 1 July 2000 to 31 December 2013, we identified pediatric avoidable, ambulatory care sensitive and non-avoidable hospitalization rates for Aboriginal and non-Aboriginal children. Absolute and relative inequalities between Aboriginal and non-Aboriginal children were measured as rate differences and rate ratios, respectively. Individual-level covariates included age, sex, low birth weight and/or prematurity, and private health insurance/patient status. Area-level covariates included remoteness of residence and area socioeconomic disadvantage. Results: There were 365 386 potentially avoidable hospitalizations observed over the study period, most commonly for respiratory and infectious conditions; Aboriginal children were admitted more frequently for all conditions. Avoidable hospitalization rates were 90.1/1000 person-years (95 % CI, 88.9–91.4) in Aboriginal children and 44.9/1000 person-years (44.8–45.1) in non-Aboriginal children (age and sex adjusted rate ratio = 1.7 (1.7–1.7)). Rate differences and rate ratios declined with age from 94/1000 person-years and 1.9, respectively, for children aged <2 years to 5/1000 person-years and 1.8, respectively, for ages 12- < 14 years. Findings were similar for the subset of ambulatory care sensitive hospitalizations, but in contrast, non-avoidable hospitalization rates were almost identical in Aboriginal (10.1/1000 person-years, (9.6–10.5)) and non-Aboriginal children (9.6/1000 person-years (9.6–9.7)). Conclusions: We observed substantial inequalities in avoidable hospitalizations between Aboriginal and non-Aboriginal children regardless of where they lived, particularly among young children. Policy measures that reduce inequities in the circumstances in which children grow and develop, and improved access to early intervention in primary care, have potential to narrow this gap

Maximising “community benefits” in public procurement: tensions and trade-offs

Purpose - This study aims to illuminate the challenges involved in implementing Community Benefits (CBs), a sustainable public procurement policy that ensures that there are positive social and economic outcomes for the local community when public money is spent on goods, works and services. Design/methodology/approach - Interviews and focus groups were conducted with public sector buyers and suppliers in Wales with experience in implementing CBs. Resource dependence theory was used to examine the extent to which dependence on resources effects CBs implementation. Findings - Whilst the study confirms that implementation of CBs improves economic and social outcomes, there can also be challenges for public sector organisations and their constituent supply chains. These include tensions between CBs and other policies, differing views between buyers and suppliers, and the unintended consequences of promoting one form of CBs over another. Research and practical limitations/implications – The research found that the Welsh Government influences the buyer-supplier dyad through regulatory and financial power. We elaborate on resource dependency theory by adding four constructs (powerful stakeholders, intra and inter organisational issues, challenges, and enablers) to better understand the flows of power and resources in this research context. Buyer and supplier practitioners may find the factors leading to successful CBs implementation useful, such as ensuring closer communication and liaison at early contract stages. Originality/value - This study addresses the need for research into how public sector organisations and suppliers seek to implement socio-economic sustainability measures, and the lack of research on CBs implementation to date. It is also novel in adopting a dyadic approach and a resource dependency perspective

Post Crisis Evolution of Mortgage Legislation: A Comparative Perspective of Ireland and Spain

There are striking parallels between Ireland and Spain from an economic, social and legal perspective. In a pre-crisis economic context, both experienced significant and sustained house price inflation and mortgage market expansion and, in the subsequent reversal of house price trends, they were amongst those countries which experienced the highest consistent price falls in Europe1 . The bursting of the housing bubble and the ensuing global recession led to a significant increase in national unemployment and exposed an indebtedness crisis amongst mortgage consumers; most notably those who were adversely impacted by increased unemployment and those who contracted in the inflationary pre-crisis context when loan origination was premised less on affordability and sustainability than on assumptions of continued asset price appreciation. In both jurisdictions, the legal framework for residential mortgages, which had been comparatively static in a pre-crisis context, became increasing dynamic as national legislatures and regulators attempted to respond to the deficits exposed by the crisis and the related social issues. This article identifies the evolution of the post crisis national frameworks and identifies the similarities and distinctions in the objective, form, scope and impact of the responsive provisions

Social Services Block Grant: Background and Funding

This report discusses the background and funding information of the Social Services Block Grant (SSBG). Topics include the use of the funds provided by the grant, its funding history, and its proposed repeal