Uses of Immersive Virtual Reality Distraction as an adjunct to anesthesia to decrease levels of pain in patients experiencing acute procedural pain: An Evidence-Based Educational Module

Abstract Background: Virtual reality (VR) is a relatively new technology that has garnered medical researchers\u27 attention. VR is a computer-generated depiction of an immersive environment that can be viewed through a headset.1 This multi-sensory immersion provided by VR hypothetically distracts the patient from pain and can reduce pain levels in patients experiencing pain. Objectives: The purpose of this study is to improve anesthesia provider knowledge on the value of virtual reality and its effects as a distraction to reduce pain levels. A literature review including primary research studies addresses the PICO question: Can immersive virtual reality be used as an adjunct to anesthesia in patients ages 10 through 70 who are experiencing acute procedural pain compared to a pharmacological approach? The literature review is used to provide the educational framework to improve provider knowledge. The overall objective is to increase awareness to improve healthcare outcomes for patients experiencing acute pain Methodology: The primary methodology of the proposed project is to administer an online educational intervention to providers focusing on the benefits of the use of virtual reality as a distraction to reduce pain levels in patients experiencing pain. Pre- and post-assessment surveys will be used to measure the improvement of provider knowledge before and after the intervention. Results: 11,198 studies were identified, nine randomized control studies were included in the review. All nine studies were at high risk of bias in at least one domain. A total of 483 patients experiencing pain participated in the nine studies. Of the ten studies examined, eight of them showed a statically significant decrease in pain level reported than the standard of care. One study showed no difference. The results of the QI project showed there was a gain in knowledge between pre-and post-test assessments. In every question, participants correctly picked the correct answer post-intervention. After participating in the educational module, participants showed increased interest and knowledge in immersive virtual reality. Conclusion: The data in this review suggests that VR may have a place in treating patients experiencing acute pain. The studies presented were heterogeneous. Further research is required to validate findings, establish optimal populations, settings, and determine the cost-efficacy of immersive virtual reality in the treatment of acute pain

Does laser therapy improve pain or pinch strength for thumb carpometacarpal joint osteoarthritis as an isolated treatment? A randomized controlled trial.

Objective: Osteoarthritis (OA) is a chronic and prevalent joint disorder that greatly impacts quality of life and has a high economic burden on health resources. Although a number of conservative therapies have proven to be effective for the management of hand OA, only modest treatment effects were reported for most individual interventions. The aim of the proposed study is to assess the effect of laser therapy on pain and pinch strength in subjects with thumb carpometacarpal osteoarthritis (CMC OA) Materials and Methods: 43 patients, (mean ± SD age: 71 ±12 years; 57% female) with the diagnosis of CMC joint OA grade 1-2 were randomized to the control (n=21) or experimental (n=23) groups. The primary outcome measures were pain intensity [Visual Analogue Scale (VAS)], and the secondary outcome measure was key pinch strength (dynamometer). The experimental group received laser therapy and control group received a placebo treatment. All outcome measures were collected at baseline, immediately following the intervention at 4 weeks, and at 12 weeks following the intervention. Results: The experimental group evidenced a 2-point improvement VAS pain score following the treatment. There was a gain of 0.7 kg of pinch strength in the experimental group following the treatment. The effects of both pinch strength gains and pain reduction diminished by the 12 week follow up. Conclusions: High intensity laser therapy effectively decreases pain intensity when used as a isolated treatment for early CMC OA, but the effect of treatment decreases after 3 months.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

An Educational Intervention on Occupational Radiation Exposure and Risk of Cataract Development

Background: Anesthesia providers are increasingly practicing under radiography and fluoroscopically guided procedures in surgical suites without the conventional tools present in standard operating rooms. During these cases, physicians, nurses, and anesthesia providers are inadvertently exposed to radiation. Radiation has inherent risks; studies have demonstrated exposure to low levels of medical radiation can increase the risk of several types of cancer, bone marrow suppression, infertility, birth deformities, and cataracts. Unlike the standard procedure for surgeons and interventionalists, who routinely use leaded glasses or ceiling-mounted lead shields to protect the eyes, there are currently no similar protections for anesthesia providers, who may be unintentionally leaving themselves exposed and at higher risk for radiation-induced cataracts. Objectives: The purpose of this quality improvement (QI) project is to improve anesthesia knowledge of radiation hazards within the workplace and steps to mitigate risk. The QI project aims to educate anesthetists about radiation-induced cataracts and protective measures. Methods: The primary methodology of the proposed quality improvement project is to administer an educational intervention to anesthesia providers which discusses occupational radiation exposure and cataract development. Pre-assessment and post-assessment surveys will be used to measure the effectiveness of the educational intervention. Results: Overall, there was an improvement in anesthesia provider knowledge following the educational intervention. Participants also answered they would “most likely” consider using additional PPE and leaded glasses to limit occupational exposure compared to “somewhat likely” before the educational intervention

Improving Knowledge of Parents in Dietary Management for Children with Diabetes and Hyperlipidemia: A Quality Improvement Project

Abstract: There is evidence that the number of cases of hyperlipidemia and diabetes in children is increasing along with the prevalence of childhood obesity in low- and high-income countries. Several factors may influence the dietary management of chronic conditions in children and adolescents, including the perceptions and beliefs of parents and caregivers about the conditions and their role in treating them. Shifting the focus of obesity, hyperlipidemia, and diabetes prevention interventions to the early education of parents has the potential to change children’s dietary habits significantly and decrease their risk of suffering from these chronic conditions. Ab important goal of this Quality Improvement project was to initiate an educational program that addresses community dietary management and the prevention of chronic conditions such as hyperlipidemia and diabetes. METHODS: The parents of pediatric patients diagnosed with hyperlipidemia and diabetes were administered as a pre- and post-test the Revised General Nutrition Knowledge Questionnaire (GNKQ), which consists of four domains of nutrition knowledge: dietary recommendations (DR), sources of nutrients in food (SON), knowledge of healthy food choices (HFC), and diet, disease, and weight management (DDWM). The scores were tabulated for each section to obtain a total score (T0 and T1). RESULTS: The total and individual section scores for the pre-test (T0 = 60%) and post-test (T1= 69.55%) for the GNKQ. The mean overall GNKQ score including the pre- and post-test values for the parent participants was 57.00 (± 8.85), representing 64.77%. CONCLUSION: The results indicated improvement in the participating parents’ overall nutritional knowledge after the implementation of nutritional education in this Quality Improvement project. These sections measured knowledge of the groups of food selection and the suggested serving sizes, sources of nutrients in food, and the correlation between diet and disease

Generation and analysis of an Eucalyptus globulus cDNA library constructed from seedlings subjected to low temperature conditions

Indexación: ScieloEucalyptus globulus is the most important commercial temperate hardwood in the world because of its wood properties and due to its characteristics for biofuel production. However, only a very low number of expressed sequence tags (ESTs) are publicly available for this tree species. We constructed a cDNA from E. globulus seedlings subjected to low temperature and sequenced 9,913 randomly selected clones, generating 8,737 curated ESTs. The assembly produced 1,062 contigs and 3,879 singletons forming a Eucalyptus unigene set. Based on BLASTX analysis, 89.3% of the contigs and 88.5% of the singletons had significant similarity to known genes in the non-redundant database of GenBank. The Eucalyptus unigene set generated is a valuable public resource that provides an initial model for genes and regulatory pathways involved in cell wall biosynthesis at low temperature.Financial support: This work was partially funded by Universidad Andrés Bello (DI Proyect: 04-05/1) and MIFAB (Proyect: P04-071-F) and by the Microsoft Joint Research Program

Advantages of Intravenous Administration of Remimazolam Over Midazolam in Inflammatory Bowel Disease Patients Undergoing Endoscopic Procedures: An Educational Module

Background: Inflammatory bowel disease (IBD) patients experience more pain and discomfort during colonoscopy due to the nature of the disease. They are often young, highly anxious before the procedure, and have undergone many previous colonoscopies, which are known risk factors for intolerance to the procedure. Currently, the sedative drugs used with these procedures are primarily propofol and midazolam. Midazolam possesses a prolonged half-life, necessitating a lengthier recovery period from anesthesia for patients. In this patient population, the utilization of a new drug called remimazolam as an alternative can lead to improved outcomes. Methods: A thorough search of research was performed utilizing PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar to distinguish research studies published within the past ten years that have assessed the efficacy of remimazolam to midazolam and/or another anesthetic agent in similar populations. Using the literature review, an educational module was presented to educate providers on the use of remimazolam. Results: The educational module resulted in a boost in providers\u27 knowledge and attitudes concerning remimazolam, leading to its increased utilization for IBD patients undergoing endoscopic procedures

An Educational Intervention on the Clinical Utility of Point-Of-Care Ultrasound (POCUS) in the Timely Detection of Perioperative Thromboembolic Complications in COVID-19 Patients Undergoing Noncardiac Surgery

Background: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a rare but most likely fatal perioperative complication associated with increased patient morbidity and mortality. COVID-19-positive patients with VTE who present for surgery are predominantly asymptomatic and do not meet the conventional definition and traditional diagnostic criteria. This presents a challenge in identifying VTE in this patient population without proper surveillance and monitoring. Objectives: The purpose of this study is to improve anesthesia providers’ knowledge of the value of POCUS modality in preventing perioperative VTE in patients with COVID-19 undergoing noncardiac surgical procedures and improve recognition of associated risk factors that predispose patients to the development of VTE. Investigators used CINAHL, MEDLINE, and EMBASE databases to answer the PICO (i.e., population, intervention, comparison, outcome) question: “In the adult patients with COVID-19 (P), does the use of the POCUS modality as an adjunct to preoperative screening for DVT (I), compared to its non-use (C), improve the early identification of perioperative VTE ( O)? The literature review provides the educational framework to improve provider knowledge. The overall objective of the project is to increase the quality of healthcare delivery to improve healthcare outcomes for patients with COVID-19 undergoing noncardiac surgery. Methodology: The primary methodology of the proposed project is to administer an online educational intervention to providers which focuses on the benefits of perioperative POCUS utilization in the early identification of VTEs. Pre- and post-assessment surveys will be used to measure the improvement of provider knowledge before and after the intervention. Results: Overall, there was an improvement in provider knowledge following the education intervention. Additionally, the likelihood of utilizing the perioperative POCUS modality increased among anesthesia providers. Conclusion: The perioperative incorporation of the POCUS modality has been shown to accurately assess the presence of DVT. The educational intervention provided effectively improved anesthesia provider knowledge on the value of POCUS modality in preventing perioperative VTE in patients with COVID-19 undergoing noncardiac surgical procedures and improving recognition of associated risk factors that predispose patients to the development of these events. Increasing awareness of the high incidence of thromboembolic events in patients with COVID-19 and the role of POCUS in their early detection can reduce mortality and improve postoperative outcomes

An Educational Intervention on the Role of Perioperative Troponin Monitoring in Adult Patients Undergoing Noncardiac Surgery

Background: Myocardial injury after noncardiac surgery is considered a common perioperative complication associated with increased morbidity and mortality following surgery. Patients who sustain MINS are predominantly asymptomatic and do not meet the conventional definition and diagnostic criteria for myocardial infarction (MI). This presents a challenge in identifying patients with MINS without proper surveillance and monitoring in place. Objectives: The purpose of this study is to improve anesthesia provider knowledge on the value of perioperative troponin monitoring in identifying myocardial injury after noncardiac surgery. A literature review including primary research studies addresses the PICO question: “In patients older than 45 years of age with cardiovascular risk factors, does routine perioperative troponin monitoring vs. monitoring traditional subjective symptoms indicative of postoperative myocardial ischemia improve identification of myocardial injury after noncardiac surgery?” The literature review is used to provide the educational framework to improve provider knowledge. The overall objective is to increase awareness with the intention of improving healthcare outcomes for surgical patients. Methodology: The primary methodology of the proposed project is to administer an online educational intervention to providers which focuses on the benefits of perioperative troponin monitoring in the early identification of MINS. Pre- and post-assessment surveys will be used to measure improvement of provider knowledge before and after the intervention. Results: Overall, there was an improvement in provider knowledge following the education intervention. Additionally, the likelihood of utilizing perioperative troponin monitoring increased among providers. Conclusions: Currently, troponin monitoring is not standard practice in high-risk patients undergoing major noncardiac surgery. The educational intervention provided was effective in improving anesthesia provider knowledge of MINS and the likelihood of utilizing perioperative troponin monitoring. Increasing awareness of myocardial injury after noncardiac surgery and the role of serial troponin monitoring can reduce mortality and improve postoperative outcomes

Uses of Immersive Virtual Reality Distraction as an adjunct to anesthesia to decrease levels of pain in patients experiencing acute procedural pain: An Evidence-Based Educational Module

Background: Virtual reality (VR) is a relatively new technology that has garnered medical researchers\u27 attention. VR is a computer-generated depiction of an immersive environment that can be viewed through a headset.1 This multi-sensory immersion provided by VR hypothetically distracts the patient from pain and can reduce pain levels in patients experiencing pain. Objectives: The purpose of this study is to improve anesthesia provider knowledge on the value of virtual reality and its effects as a distraction to reduce pain levels. A literature review including primary research studies addresses the PICO question: Can immersive virtual reality be used as an adjunct to anesthesia in patients ages 10 through 70 who are experiencing acute procedural pain compared to a pharmacological approach? The literature review is used to provide the educational framework to improve provider knowledge. The overall objective is to increase awareness to improve healthcare outcomes for patients experiencing acute pain Methodology: The primary methodology of the proposed project is to administer an online educational intervention to providers focusing on the benefits of the use of virtual reality as a distraction to reduce pain levels in patients experiencing pain. Pre- and post-assessment surveys will be used to measure the improvement of provider knowledge before and after the intervention. Results: 11,198 studies were identified, nine randomized control studies were included in the review. All nine studies were at high risk of bias in at least one domain. A total of 483 patients experiencing pain participated in the nine studies. Of the ten studies examined, eight of them showed a statically significant decrease in pain level reported than the standard of care. One study showed no difference. The results of the QI project showed there was a gain in knowledge between pre-and post-test assessments. In every question, participants correctly picked the correct answer post-intervention. After participating in the educational module, participants showed increased interest and knowledge in immersive virtual reality. Conclusion: The data in this review suggests that VR may have a place in treating patients experiencing acute pain. The studies presented were heterogeneous. Further research is required to validate findings, establish optimal populations, settings, and determine the cost-efficacy of immersive virtual reality in the treatment of acute pain

Contrastación de un modelo de ciberconsumo

El consumo de productos y servicios en Internet se ha estudiado a partir de dos hipótesis, según las cuales los usuarios compran productos o contratan servicios en la medida en que la información se percibe como útil o riesgosa. Por consiguiente, la utilidad percibida supone que los protocolos de in - formación digitales tienen mayores beneficios que costos, o bien, en comparación con otros modos de comercio, Internet resulta más compatible con estilos de vida implicados en dispositivos electrónicos. Sin embargo, la percepción de riesgo es un factor que no solo inhibe las transferencias electrónicas, sino que además hace más selectiva la búsqueda y compra de bienes de consumo o la contratación de servi - cios. Precisamente, el objetivo del presente trabajo fue establecer las dimensiones de la selectividad en torno al consumo electrónico. Para tal fin, se realizó una selección no probabilística de 188 internautas a los que se aplicó un cuestionario de ciberconsumo, el cual obtuvo una consistencia interna adecuada. A partir de un modelo estructural, se estimó la validez reflectiva de cuatro indicadores del consumo en Internet. Los resultados se discuten a partir del estado actual del conocimiento