Maximizing Use of Social Media to Improve Member Engagement in a Professional Organization

The North Carolina Association of Nurse Anesthetists recognized concerns surrounding decreased member engagement and communication. Member engagement and communication is the lifeblood of an organization and is directly related to the success of an organization's outcomes and goals. Revamping of social media is a cost-effective method to help increase membership engagement and communication. The purpose of this project was to identify Certified Registered Nurse Anesthestist membership preferences for social media-based communication and engagement through the measurement of activity levels based on Facebook posting content, feature, and time. Therefore, a literature review and retrospective analysis was conducted. Results revealed that posting content of public relations/advocacy, the feature of tagging, and the time of week was influential on audience engagement on the association's Facebook account. The aims of the project were met. Social media allows organizations to employ various features and techniques to increase member engagement and communication. To successfully use social media to engage and communicate with members, organizations will need to continuously analyze and adjust their social media posts.

Considerations for an aging nurse anesthetists workforce

The Certified Registered Nurse Anesthetists (CRNA) workforce is aging. It is estimated that nearly half (49.7%) of the CRNA workforce is age 50 or greater, with those practicing in management positions and as educators having the oldest mean ages. Older CRNAs face workplace challenges that can lead to decreased productivity and overall job satisfaction. Common injuries to older practitioners result from repetitive motion, slips and falls, needle sticks, fatigue, and emotional or mental health related illness. Because of the high acuity environment in which CRNAs practice they are at an elevated risk for these injuries. Creating a healthy and supportive work environment has been shown to improve the retention of aging healthcare workers, and succession planning is essential in preparing for their retirement.

LDI-MS scanner: Laser desorption ionization mass spectrometry-based biosensor standardization

Amperometric biosensors have been widely utilized for the cost-effective and rapid analysis of various bioanalytes, for example glucose. However, a lack of standardization and validation procedures remains a major limitation in biosensor development. Therefore, despite rapid advances in material science driving the development of amperometric biosensors, to date only a few biosensors, detecting a limited range of analytes, are available on the market. It is believed, once this issue is addressed, it can significantly facilitate the next step in the overall concept "go to the market" production and implementation of amprerometric biosensors for a large industrial scale. Herein, we report on the use of laser desorption ionization mass spectrometry (LDI-MS) for the standardization of amperometric biosensors, based upon a complete and non-destructive characterization and validation of layer-by-layer (LbL) biosensors at each fabrication step. We reveal that specific ionization pathways of mediators, polymers and enzymes from the biosensor surface allows for robust quality control during LbL biosensor manufacture. Furthermore, this LDI-MS approach can also be used to monitor, and therefore ensure, the encapsulation of enzymes in one-step nanobiosensors. Specifically, we show that LDI-MS can be used for the rapid chemical profiling of LbL biosensors and one-step synthesized nanobiosensors, as well as to assess their synthesis quality and to monitor for batch-to-batch and intra- and inter-day changes in their function and behavior. Our novel approach will thus contribute to the future development, improved design and fine tuning of both conventional LbL-fabricated amperometric biosensors and one-step designed nanobiosensors.

Predictors for 30-day mortality and complications following radiologically inserted gastrostomies: a single centre, large cohort review

AIM

To measure the 30-day mortality and delayed complication rates following radiologically inserted gastrostomy (RIG) placement and determine the predictive risk factors for 30-day mortality and delayed complications to aide pre-procedure informed consent.

MATERIALS AND METHODS

Retrospective analysis was undertaken of RIG insertions between July 2012 and August 2017 at a single tertiary centre, which included 373 patients (56% male; median age: 65 years, range: 19-92 years). Data were collected from electronic databases on patient demographics, RIG indication, all-cause mortality, complication rates, patient co-morbidities, and biochemical/haematological parameters. Multivariate analysis was performed to identify predictive risk factors for complications and mortality.

RESULTS

The RIG procedural success rate was 97.9%. The overall 30-day mortality rate was 7.8%; associated with pre-procedural haemoglobin <130 g/l in men (p=0.030, odds ratio [OR] 23.38), white cell count >11×10⁹/l (p=0.001, OR 4.18), C-reactive protein >10 mg/l (p=0.003, OR 10.10) and international normalised ratio (INR) >1.2 (p=0.03, OR 4.63). Inpatient RIG referrals were associated with 10% 30-day mortality; compared to 1.1% for outpatients (p=0.028, OR 9.51). The incidence of immediate and delayed complications was 2.4% and 42.1%, respectively. Neuromuscular disease was associated with gastrostomy dislodgement (p=0.0001, OR 4.99) and fracture (p=0.0009, OR 13.45), cerebrovascular disease with gastrostomy dislodgement (p=0.009, OR 2.51), cardiovascular disease with sepsis 30-days post-RIG (p=0.02, OR 2.94), and diabetes mellitus with gastrostomy dislodgement (p=0.0001, OR 29.45), fracture (p=0.027, OR 5.63) and stoma site infections (p=0.0003, OR 7.16).

CONCLUSION

RIG 30-day mortality was significantly associated with inpatient procedures compared to outpatient, and a range of biochemical/haematological parameters that suggest infection pre-intervention. It is advised that the markers of infection and catabolism are investigated pre-intervention, which may reduce mortality and complication rates.

Towards one-step design of tailored enzymatic nanobiosensors

NP-based enzymatic biosensors were prepared by the simultaneous encapsulation of glucose and alcohol oxidases, Nafion and noble metal NPs via co-deposition from a phosphate multiple electrolyte on top of the sensor surface.

Post-mortem CT: is coronary angiography required in the presence of a high coronary artery calcium score?

AIM

To test whether a high coronary artery score predicts that the subsequent post-mortem computed tomography (PMCT) with angiography (PMCTA) will diagnose significant coronary artery disease (CAD); to test the diagnostic impact of assuming there is significant CAD based on a high coronary artery calcium (CAC) score alone; and (3) to test whether the clinical CAC score threshold (400) is the most accurate to make this prediction.

MATERIALS AND METHODS

CAC scoring and PMCTA were performed in cases of adult sudden natural death. Angiography was reviewed to determine if there was sufficient CAD to give as the cause of death. Data were analysed to test whether high calcium score predicts significant CAD.

RESULTS

PMCTA with CAC score was successful in 100/104 PMCT examinations and in 87/100 angiography examinations (87%). Forty-six cases (46%) had a CAC score of >400, the clinical level of severe disease. CAD was given as the cause of death in 31 (67%) of these cases. Angiography was successful in 39 of these cases (84.7%) and showed severe CAD in all but one (97%). Twenty-five (25%) cases were diagnosed with a CAD death without a high CAC score.

CONCLUSION

Although CAC score can neither diagnose nor exclude death due to CAD, the addition of angiography adds little diagnostic information to a high CAC score. If PMCT investigation is to exclude trauma and provide a medical cause of death on the "balance of probabilities", angiography is not required when the calcium score >400. This could reduce the number of patients requiring angiography by almost 50%.

The importance of the STOP- BANG questionnaire as a preoperative assessment tool for the elderly population

Undiagnosed obstructive sleep apnea (OSA) may adversely impact surgical patients and can lead to increased morbidity and mortality during the perioperative period, especially among the geriatric patient population (Chung et al. 2008, 2012, 2014; McDonald et al., 2018; Zietlow et al., 2018; Singh et al., 2012). The setting of this quality improvement project was a preoperative anesthesia and geriatric evaluation clinic housed within a 957-bed tertiary academic affiliated hospital. The sample included 45 patients who met the criteria established for surgery and OSA screening preoperatively. Nine patients (20.0%) were assessed as low risk (Stop-bang [SB] score </=2) for OSA, and 36 patients (80.0%) had a prior diagnosis from an ICD-9/10 code or a SB score >/= 3 indicative of high-risk for OSA. The retrospective utilization of a modified SB screening on charts that did not receive a clinical OSA evaluation (n = 52) detected 23 (44.2%) patients who were considered high-risk for OSA but were not identified prior to surgery. The SB questionnaire is underutilized, and patients' OSA is often unidentified prior to surgery.

Development of methods for the preparation of radiopure 82Se sources for the SuperNEMO neutrinoless double-beta decay experiment

A radiochemical method for producing 82Se sources with an ultra-low level of contamination of natural radionuclides (40K, decay products of 232Th and 238U) has been developed based on cation-exchange chromatographic purification with reverse removal of impurities. It includes chromatographic separation (purification), reduction, conditioning (which includes decantation, centrifugation, washing, grinding, and drying), and 82Se foil production. The conditioning stage, during which highly dispersed elemental selenium is obtained by the reduction of purified selenious acid (H2SeO3) with sulfur dioxide (SO2) represents the crucial step in the preparation of radiopure 82Se samples. The natural selenium (600 g) was first produced in this procedure in order to refine the method. The technique developed was then used to produce 2.5 kg of radiopure enriched selenium (82Se). The produced 82Se samples were wrapped in polyethylene (12 μm thick) and radionuclides present in the sample were analyzed with the BiPo-3 detector. The radiopurity of the plastic materials (chromatographic column material and polypropylene chemical vessels), which were used at all stages, was determined by instrumental neutron activation analysis. The radiopurity of the 82Se foils was checked by measurements with the BiPo-3 spectrometer, which confirmed the high purity of the final product. The measured contamination level for 208Tl was 8–54 μBq/kg, and for 214Bi the detection limit of 600 μBq/kg has been reached.

Sleep safe in clean hands: Improving hand hygiene compliance in the operating room through education and increased access to hand hygiene products

BACKGROUND

Hand hygiene compliance is low among anesthesia providers in the operating room, which places patients at risk of preventable infections. The goal of this project was to improve hand hygiene compliance by educating anesthesia providers on the World Health Organization's 5 indications for hand hygiene, and increasing access to hand hygiene products in the operating room.

METHODS

Observations of hand hygiene in the operating room took place in 3 phases: preimplementation, postimplementation, and 60 days postimplementation.

RESULTS

The results showed significant improvements in compliance for each of the 5 indications for hand hygiene as well as overall compliance. Each of the 3 phases of anesthesia demonstrated significant improvement as well. The results also showed a significant decrease in both glove use and use of the portable hand sanitizer device.

DISCUSSION

Education and monitoring of hand hygiene among anesthesia providers in the operating room can improve hand hygiene compliance.

CONCLUSIONS

Although the use of the portable device declined, further studies could focus on observing single anesthesia providers instead of a preceptor/student combination, and also examine proximity to hand hygiene products in relation to compliance.

Creation of a Low-Cost Simulated Trachea for Deliberate Practice of Cricothyrotomy and Retrograde Wire Use

Simulation is an accepted teaching tool that focuses on active learning and is used to solidify cognitive, motor, critical thinking, and communication skills. This method of experiential learning was introduced and integrated into the distance-based degree completion program for practicing anesthetists at the University for Development Studies (UDS), Tamale, Ghana. Because of scarce resources, a simulated trachea was created for teaching students how to perform a needle cricothyrotomy and use a retrograde wire to secure an airway. Students were oriented to the materials, taught to construct the simulated trachea, and encouraged to consider local, inexpensive resources for equipment substitutions as necessary. Students were guided through the steps of performing a needle cricothyrotomy and retrograde wire intubation using the simulated trachea. Following deliberate practice, the practicing anesthetists were encouraged to instruct fellow anesthesia colleagues on the use of these techniques and create additional simulation equipment that would aid in teaching or refining various skills of Ghanaian anesthetists and training future anesthetists. Appropriate for their initial simulation-based learning, the low-fidelity simulated trachea was a reasonable, low-cost approach that aligned with the established learning objectives. All participants reported satisfaction with and increased confidence levels following the simulation-based learning experience.

Search for Neutrinoless Quadruple-β Decay of ^{150}Nd with the NEMO-3 Detector

We report the results of a first experimental search for lepton number violation by four units in the neutrinoless quadruple-β decay of ^{150}Nd using a total exposure of 0.19 kg yr recorded with the NEMO-3 detector at the Modane Underground Laboratory. We find no evidence of this decay and set lower limits on the half-life in the range T_{1/2}>(1.1-3.2)×10^{21}  yr at the 90% C.L., depending on the model used for the kinematic distributions of the emitted electrons.

Framework for Teaching Psychomotor and Procedural Skills in Nursing

The development of psychomotor and procedural skills requires opportunities for repetitive practice combined with specific, informational feedback from the teacher, another expert, or simulator to correct performance errors. Practice enables learners to refine skills and progress through the phases of motor learning: cognitive, associative, and autonomous. Practice should be spaced over time, can occur in dyads, and can rapidly cycle between practicing and receiving feedback and coaching until skills are mastered. The purpose of this article is to examine psychomotor skill learning in nursing and to suggest strategies for nurse educators in teaching motor and procedural skills in nursing programs, as well as in clinical settings. J Contin Educ Nurs. 2016;47(6):278-282.

The BiPo-3 detector

The BiPo-3 detector is a low radioactive detector dedicated to measuring ultra-low natural contaminations of ²⁰⁸Tl and ²¹⁴Bi in thin materials, initially developed to measure the radiopurity of the double β decay source foils of the SuperNEMO experiment at the μBq/kg level. The BiPo-3 technique consists in installing the foil of interest between two thin ultra-radiopure scintillators coupled to low radioactive photomultipliers. The design and performances of the detector are presented. In this paper, the final results of the ²⁰⁸Tl and ²¹⁴Bi activity measurements of the first enriched ⁸²Se foils are reported for the first time, showing the capability of the detector to reach sensitivities in the range of some μBq/kg.

Evaluating the Implementation of a Preemptive, Multimodal Analgesia Protocol in a Plastic Surgery Office

Many patients undergoing plastic surgery experience significant pain postoperatively. The use of preemptive, multimodal analgesia techniques to reduce postoperative pain has been widely described in the literature. This quality improvement project evaluated the implementation of a preemptive, multimodal analgesia protocol in an office-based plastic surgery facility to decrease postoperative pain, decrease postoperative opioid consumption, decrease postanesthesia care time, and increase patient satisfaction. The project included adult patients undergoing surgical procedures at an outpatient plastic and cosmetic surgery office, and the protocol consisted of oral acetaminophen 1,000 mg and gabapentin 1,200 mg. Using a pre-/postintervention design, data were collected from patient medical records and telephone interviews of patients receiving the standard preoperative analgesia regimen (preintervention group: n = 24) and the evidence-based preemptive, multimodal analgesia protocol (postintervention group: n = 23). Results indicated no significant differences between the pre- and postintervention groups for any of the outcomes measured. However, results showed that patients in both groups experienced moderate to severe pain postoperatively. In addition, adverse side effects such as dizziness and drowsiness were higher in the postintervention group than in the preintervention group. Although this quality improvement project did not meet the goals it set out to achieve for patients undergoing plastic surgery, it did illustrate the substantial presence of pain after surgical procedures. Thus, clinicians need to continue to focus on identifying targeted treatment plans that use multimodal, non-opioid-based strategies to manage and prevent postoperative pain.

The Role of Pharmacogenomics in Anesthesia Pharmacology

The field of pharmacogenomics seeks to identify the impact of genetic variants on drug dosing, response, metabolism, and safety outcomes. The narrow therapeutic indices for anesthesia drugs, variability of patient responses to anesthesia, and the risks associated with surgery make anesthetics and the perioperative period prime targets for pharmacogenetic research. Anesthesia providers strive to optimize anesthesia delivery and patient outcomes and to specifically reduce anesthesia-related risks and negative outcomes. Despite pharmacogenomics emerging from the field of anesthesia, the most significant advances to date in the understanding and application of genetics to pharmacology have occurred outside of anesthesiology. This chapter provides an overview of genetic concepts fundamental to understanding the pharmacogenetics of anesthesia practice and presents the current state of the science with respect to the genetic influence on the response to volatile and intravenous anesthetic agents and opioid receptor agonists commonly used in anesthesia practice. In addition, the chapter delineates U.S. Food and Drug Administration labeling tenets for pharmacogenetics, discusses clinical implications of pharmacogenomics for family members, and highlights the potential for future paradigm shifts in pharmacogenomics of anesthesia practice.

Minimising the impact of errors in the interpretation of CT images for surveillance and evaluation of therapy in cancer

Radiological error is inevitable and usually multifactorial. Error can be secondary to radiologist-specific causes, including cognitive and perceptive errors or ambiguity of report, or system-related causes, including inadequate, misleading, or incorrect clinical information, poor imaging technique, excessive workload, and poor working conditions. In this paper, we discuss a systematic approach to reduce errors in oncological radiology reporting, thus reducing risk to the patient. Rather than attempt to discuss all types of error, we concentrate on the most important and commonly occurring errors that we have encountered over 20 years of practice, based on weekly discrepancy reviews of our practice and independent reviews of clinical and research imaging from other institutions. This review focuses on computed tomography (CT) reporting for staging, surveillance, and response assessment of cancer patients, but the messages apply to all imaging methods.