Medical Specialties Commons^™

Influence Of Telephone Preoperative Evaluations On Patient Medication Compliance On Day Of Surgery, Emmanuel Magsino, Michael Jung, Olga Suarez Md

Graduate Research Posters

Patient compliance with medication instructions on day of surgery (DOS) is an important part of the preoperative assessment, as failure to comply with these may lead to serious perioperative consequences. Prior studies have shown that compliance increases with multimodal interventions. However due to the recent COVID-19 pandemic, many in-person visits transitioned to telephone visits and providers had to rely on patients to follow solely verbal instructions.

To determine medication compliance, this study compared the medication instructions provided by the VCU Preoperative Assessment Communication and Education Clinic, per chart review, with each patient’s own report of which medications they took on …

Using The Memorial Sloan Kettering Frailty Index To Identify Patients At High Risk For Postoperative Intensive Care Unit Admission, Specialized Advanced Care Unit Admission, And 30-Day Readmission, Timothy J. Donoghue

Theses and Dissertations

Frailty is roughly defined as an accumulation of physiological, emotional, cognitive, and social deficits that impair a person’s response to stressful events. A frailty diagnosis has been associated with poor outcomes following surgical procedures. Cancer surgical patients aged 65 or older represent a vulnerable population susceptible to being frail and the potential associated complications that can accompany frailty. Measuring frailty is an objective risk assessment that identifies increased risk better than age or American Society of Anesthesiologists Physical Status (ASA-PS) score such that frailty can independently predict poor surgical outcomes.

Frailty is not specifically a result of having cancer, disability, …

Evaluating The Clinical Utility Of A Novel Electroencephalography System For Assessing Perioperative Neurocognition In Older Surgical Patients, Lloyd H. Barnwell Iii

Theses and Dissertations

Postoperative delirium (POD) is a public health and research priority (American Society of Anesthesiologists, 2019). POD is a risk factor for long-term neurocognitive decline, and the rate of decline is directly proportional to the severity of POD (Vasunilashorn et al., 2018). Baseline cognitive function is a strong, independent predictor for POD (Culley et al., 2017). The International Perioperative Neurotoxicity Working Group recommends baseline cognitive function be assessed for older patients prior to surgery and anesthesia (Berger, et al., 2018). Perioperative cognitive screening tools trialed in anesthesia are not routinely incorporated into clinical practice related to validity, reliability, or practicality problems …

Reduced Length Of Stay In Major Hepatectomy Surgery After Implementation Of An Enhanced Recovery Pathway In The United States Veteran Population, Yvonne Nguyen Md, Marilyn Mcnulty Np, Leopoldo Fernandez Md, Michael R. Kazior Md

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction

Enhanced recovery after surgery (ERAS) pathways are associated with better postoperative recovery, however, evidence is lacking in major liver surgery, .This study aimed to evaluate the impact of an ERAS pathway in U.S. veterans undergoing major hepatectomy surgery. We hypothesized that the adoption of an ERAS pathway reduces decreased length of stay (LOS).

Methods

After approval from the Hunter Holmes McGuire VA Medical Center IRB, we compared data from consecutive patients undergoing elective open hepatectomy within an ERAS pathway (January 2019-December 2019) to a previous cohort of patients before introduction of ERAS (July 2016-December 2017). One surgeon performed all …

Chronic Post-Surgical Abdominal Pain Treated With Percutaneous Peripheral Nerve Stimulation Of Iliohypogastric And Ilioinguinal Nerves, Harnek Bajaj, Denise Lester

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Chronic pelvic and lower abdominal pain can be a severely debilitating condition that affects between 7% to 24% of the general population (4). The anterior rami of L1 and T12 give contributions to the ilioinguinal and iliohypogastric nerves which provide sensory innervation to the lower abdomen and pubic regions (3). Entrapment or damage of these nerves can occur due to a variety of mechanisms, and common treatment options have included medications (2), nerve blocks (1), and in rare cases, surgical resection of the involved nerve. In this case, a 47 year old morbidly obese female with history of chronic left …

Adaptation And Validation Of The Situation Awareness Global Assessment Technique For Student Registered Nurse Anesthetists, Deniz Dishman

Theses and Dissertations

Anesthesia is a health care specialty fraught with high workload demands, stressful work environments, increased production pressure, work areas with many distractions, an increasing use of advanced technology, and the constant need to prioritize work actions. Effective clinical judgment in this dynamic environment necessitates that the provider demonstrate the ability to project what may occur secondary to actual or potential condition changes. These key elements operationalize situation awareness (SA).

High level SA is an important characteristic for the successful development of student registered nurse anesthetists (SRNAs). With Endsley’s “Theory of Situation Awareness” as the foundation, the goal of this study …

Perceived Impact Of Ambient Operating Room Noise By Certified Registered Nurse Anesthetists, Marianne S. Cosgrove

Theses and Dissertations

It is widely acknowledged that elevated levels of noise are commonplace in the healthcare environment, particularly in high acuity areas such as the operating room (OR). Excessive ambient noise may pose a threat to patient safety by adversely impacting provider performance and interfering with communication among perioperative care team members. With respect to the certified registered nurse anesthetist (CRNA), increased ambient OR noise may engender distractibility, diminish situation awareness and cause untoward health effects, thereby increasing the possibility for the occurrence of error and patient injury.

This research project analytically examines the perceived impact of ambient noise in the operating …

The Relationship Between Central Venous Catheter And Post-Operative Complications In Patients Undergoing Hepatic Resection, David C. O'Connor

Theses and Dissertations

The Relationship Between Central Venous Catheter and Post-operative Complications in Patients Undergoing Hepatic Resection

David C. O’Connor, Ph.D., DNAP, CRNA

A dissertation submitted in partial fulfillment of the requirements for the degree of

Doctor of Philosophy at Virginia Commonwealth University

Virginia Commonwealth University, 2018

Dissertation Chair: Clarence J. Biddle, Ph.D., CRNA

Hepatic resection is indicated for primary and secondary malignancies. Use of a low central venous pressure technique is associated with decreased blood loss in these cases. This technique has evolved; central venous catheters and high dose morphine are no longer used, and patients are extubated earlier. The purpose of …

Predicting Arterial Oxygen Desaturation Events Via Patient Journal And Pulse Oximetry Data In Postoperative Ambulatory Surgery Patients, Charles R. Elam Iv

Theses and Dissertations

Associations between patient and procedural factors on the nature and quality of the immediate in-home recovery from anesthesia following ambulatory orthopedic surgery are unknown. Further, there is a paucity of outcomes research quantitatively categorizing in-home

patient recovery and safety following discharge from same-day orthopedic procedures. Tools are available, however, to shed light on outcomes in this population, and integration of such available measures is critical.

Ambulatory orthopedic surgery is a burgeoning specialty, with growth expected over the foreseeable future. The expected increased patient caseload subsequent to implementation of the Affordable Care Act and aging Baby Boom generation suggests greater morbidity …

Assessing Baseline And Post-Discharge Risk Factors In Subjects With And Without Sleep Apnea Undergoing Endoscopy With Deep Sedation, Mercedes E. Weir

Theses and Dissertations

ABSTRACT

ASSESSING BASELINE AND POST-DISCHARGE RISK FACTORS IN SUBJECTS WITH AND WITHOUT SLEEP APNEA UNDERGOING ENDOSCOPY WITH DEEP SEDATION

Background: Outpatient procedures encompass over 60% of all surgeries in the United States, and the prevalence of obstructive sleep apnea (OSA) remains high among adult surgical ambulatory patients. Ambulatory surgery poses problems for patients with OSA because narcotics and anesthetics used during surgery can complicate the negative effects of OSA, leading to cardiac events, brain hypoxia, and even death. This study was designed to evaluate the prevalence of cardiopulmonary risk factors among post endoscopic patients with diagnosed and undiagnosed sleep apnea. …

Application Of Incident Command Structure To Clinical Trial Management In The Academic Setting: Principles And Lessons Learned, Penny S. Reynolds, Mary J. Michael, Bruce D. Spiess

Anesthesiology Publications

Background

Clinical trial success depends on appropriate management, but practical guidance to trial organisation and planning is lacking. The Incident Command System (ICS) is the ‘gold standard’ management system developed for managing diverse operations in major incident and public health arenas. It enables effective and flexible management through integration of personnel, procedures, resources, and communications within a common hierarchical organisational structure. Conventional ICS organisation consists of five function modules: Command, Planning, Operations, Logistics, and Finance/Administration. Large clinical trials will require a separate Regulatory Administrative arm, and an Information arm, consisting of dedicated data management and information technology staff. We applied …

An Evaluation Of Critical Resources In Nurse Anesthesia Educational Programs, Lois E. Stewart

Theses and Dissertations

Advanced practice nurses fill a vital need in the U.S. by increasing access to needed healthcare. Certified Registered Nurse Anesthetists (CRNAs) are one type of advanced practice nurse with a long history of safe and effective peri-anesthetic care. Nurse anesthetists have a rich tradition of providing anesthetic care for rural and underserved communities, and are a primary provider of anesthesia for active and retired military personnel. CRNAs comprise over one-half of the actively practicing U.S. anesthesia workforce currently, and are able to function in any anesthetic care model. Nurse anesthesia educational programs (NAEPs) are the single source for new graduate …

Sciatic Peripheral Nerve Blockade For Pain Control Following Hamstring Autograft Harvest In Adolescents: A Comparison Of Two Techniques, James Furstein

Theses and Dissertations

Anterior cruciate ligament reconstruction utilizing a hamstring autograft is a surgical technique that has gained popularity among orthopedic surgeons caring for adolescent patients. While utilization of a hamstring autograft is a revered technique, harvest of the hamstring yields significant pain. Sciatic peripheral nerve blockade has proven to reliably provide analgesia at the hamstring donor site. Single-injection sciatic peripheral nerve blockade is considered a basic and effective technique, making its use following anterior cruciate ligament reconstruction standard practice in many institutions. The duration of action of a single-injection sciatic peripheral nerve blockade may fail to outlast the pain arising from the …

Prehospital Use Of Plasma In Traumatic Hemorrhage (The Pupth Trial): Study Protocol For A Randomised Controlled Trial, Penny S. Reynolds, Mary Jane Michael, Emily D. Cochran, Jacob A. Wegelin, Bruce D. Spiess

Anesthesiology Publications

Background

Severe traumatic injury and haemorrhagic shock are frequently associated with disruptions of coagulation function (such as trauma-induced coagulopathy TIC) and activation of inflammatory cascades. These pathologies may be exacerbated by current standard of care resuscitation protocols. Observational studies suggest early administration of plasma to severely-injured haemorrhaging patients may correct TIC, minimise inflammation, and improve survival. The proposed randomised clinical trial will evaluate the clinical effectiveness of pre-hospital plasma administration compared with standard- of-care crystalloid resuscitation in severely-injured patients with major traumatic haemorrhage.

Methods/design

This is a prospective, randomized, open-label, non-blinded trial to determine the effect of pre-hospital administration of …

Perceptions Of Acupuncture And Acupressure By Anesthesia Providers, Amanda Faircloth

Theses and Dissertations

BACKGROUND: Randomized controlled trials show acupuncture and acupressure support anesthesia management by decreasing anxiety, opioid requirements and treating post-operative nausea and vomiting. Acupuncture and acupressure have demonstrated clinical usefulness and received governmental support (NIH, PPACA, WHO, U.S. Military), but have not yet diffused into mainstream anesthesia practice. This study examined US anesthesia providers' perceptions of acupuncture and acupressure.

METHODS: Ninety-six anesthesiology departments stratified by geographic region (Northeast, South, West, and Midwest) and institution type (university medical centers, community hospitals, children’s hospitals, and VA hospitals) were selected for participation in an anonymous, online survey. The target sample was 1,728 providers …

Predictors Of Situation Awareness In Graduate Student Registered Nurse Anesthetists, Suzanne Wright

Theses and Dissertations

ABSTRACT PREDICTORS OF SITUATION AWARENESS IN GRADUATE STUDENT REGISTERED NURSE ANESTHETISTS Suzanne M. Wright, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2009 Major Director: J. James Cotter, Ph.D. Situation awareness (SA) is defined as one’s perception of the elements of the environment, the comprehension of their meaning, and the projection of their status in the near future. Stated more simply, SA is knowing what is going on around you. The concept of SA is well known in the field of aviation which is …

Anesthesia Clinical Performance Outcomes: Does Teaching Methodology Make A Difference?, Nina E. Mclain

Theses and Dissertations

Researchers have studied memory recall of crisis-oriented or emotional events in non-educational settings. However, within the health care field, there has been a limited study of the the concept of recall of crisis oriented or emotional events in& health care education. Crisis-oriented events such as natural disasters, acts of bioterroism, and industrial accidents, have been reported to impact memory. Patient safety is a primary focus in anesthesia education, appropriate crisis management is imperative to quality anesthesia care. Due to the critical nature of anesthesia delivery, there is a strong, constant need to develop methods that will enhance, support, and improve …

Lactate Versus Non-Lactate Metabolic Acidosis: A Retrospective Outcome Evaluation Of Critically Ill Patients, Kyle J. Gunnerson, Melissa Saul, Shui He, John A. Kellum

Anesthesiology Publications

Introduction

Acid–base abnormalities are common in the intensive care unit (ICU). Differences in outcome exist between respiratory and metabolic acidosis in similar pH ranges. Some forms of metabolic acidosis (for example, lactate) seem to have worse outcomes than others (for example, chloride). The relative incidence of each type of disorder is unknown. We therefore designed this study to determine the nature and clinical significance of metabolic acidosis in critically ill patients.

Methods

An observational, cohort study of critically ill patients was performed in a tertiary care hospital. Critically ill patients were selected on the clinical suspicion of the presence of …

The Impact Of An Hematocrit Of 20% During Normothermic Cardiopulmonary Bypass For Elective Low Risk Coronary Artery Bypass Graft Surgery On Oxygen Delivery And Clinical Outcome – A Randomized Controlled Study [Isrctn35655335], Christian Von Heymann, Michael Sander, Achim Foer, Anja Heinemann, Bruce Spiess, Jan Braun, Michael Krämer, Joachim Grosse, Pascal Dohmen, Simon Dushe, Jürgen Halle, Wolfgang F. Konertz, Klaus-Dieter Warnecke, Claudia Spies

Anesthesiology Publications

Introduction

Cardiopulmonary bypass (CPB) induces hemodilutional anemia, which frequently requires the transfusion of blood products. The objective of this study was to evaluate oxygen delivery and consumption and clinical outcome in low risk patients who were allocated to an hematocrit (Hct) of 20% versus 25% during normothermic CPB for elective coronary artery bypass graft (CABG) surgery.

Methods

This study was a prospective, randomized and controlled trial. Patients were subjected to normothermic CPB (35 to 36°C) and were observed until discharge from the intensive care unit (ICU). Outcome measures were calculated whole body oxygen delivery, oxygen consumption and clinical outcome. A …

The Corbett Pain Scale: A Multidimensional Pain Scale For Adult Intensive Care Patients, Gina M. Corbett

Theses and Dissertations

There are no reliable tools that evaluate pain in adult critical care patients who cannot communicate as a result of sedation or illness. This was an observational study in which postoperative cardiothoracic intensive care patients were assessed for pain using both the newly devised Corbett Pain Scale (CPS) and the Numerical Pain Scale (NPS). The CPS was evaluated for content validity, criterion validity, construct validity, test re-test reliability and internal consistency. Thirteen male and seven female patients (n=20) were enrolled and underwent a maximum of five pain assessments each. The mean total scores of the CPS (.740, SD+1.03) and the …

Perceived Deprivation In Active Duty Military Nurse Anesthetists, Julie Ann Pearson

Theses and Dissertations

Problem: There is a shortage of military certified registered nurse anesthetists (CRNAs). The exodus from military service to civilian careers could be a result of relative deprivation (the discrepancy that one perceives between what one has and what one could or should have). Relative deprivation is a perception of unfairness dependent on feelings (subjective data) as well as facts (objective data). Purpose: The purpose of this study was to measure relative deprivation in active duty military nurse anesthetists, to explore variables which correlate with relative deprivation, and to validate or refute the theory of relative deprivation in active duty military …

Adverse Cerebral Outcomes After Coronary Bypass Surgery, Gary W. Roach , M.D., Marc Kanchuger , M.D., Christina Mora Mangano , M.D., Mark Newman , M.D., Nancy Nussmeier , M.D., Richard Wolman , M.D., Anil Aggarwal , M.D., Katherine Marschall , M.D., Steven H. Graham , M.D., Ph.D., Catherine Ley , Ph.D., Gerard Ozanne , M.D., Dennis T. Mangano , Ph.D., M.D., Ahvie Herskowitz , M.D., Vera Katseva , Ph.D, Rita Sears , R.N., M.S.

Anesthesiology Publications

ABSTRACT

Background Acute changes in cerebral function after elective coronary bypass surgery are a difficult clinical problem. We carried out a multicenter study to determine the incidence and predictors of — and the use of resources associated with — perioperative adverse neurologic events, including cerebral injury.

Methods In a prospective study, we evaluated 2108 patients from 24 U.S. institutions for two general categories of neurologic outcome: type I (focal injury, or stupor or coma at discharge) and type II (deterioration in intellectual function, memory deficit, or seizures).

Results Adverse cerebral outcomes occurred in 129 patients (6.1 percent). A total of …

The Effect Of Body Position Changes On Arterial Oxygen Saturation In Obesity As Measured Noninvasively By Pulse Oximetry, Anna Marie Angela Klosterman

Theses and Dissertations

This study utilized a quasi-experimental pretest-posttest design that compared the effect of body position changes on arterial oxygen saturation in obesity as measured noninvasively by pulse oximetry. The null hypothesis, that there would be no difference between oxygen saturation values measured by pulse oximetry with position change from sitting to supine in obese subjects as compared to nonobese subjects, was tested. Fourteen obese, American Society of Anesthesiologist (ASA) physical class status II subjects and 14 nonobese ASA physical class status I subjects were included in the sample population. Thirteen of the obese subjects were further classified as morbidly obese. After …

The Effects Of Needle Play On Pre-School Children's Anxiety Concerning Injections, Michelle Anne Belyea

Theses and Dissertations

The purpose of this study was to determine the effects of needle play in reducing pre-school children's anxiety concerning injections. The Pre-school Observational Scale of Anxiety was used to measure the degree of anxiety experienced by the children. The hypothesis stated that there would be a significant decrease in anxiety of pre-school children who participated in needle play as compared with the anxiety scores of pre-school children who did not participate in needle play.The sample consisted of 20 pre-school children who were receiving routine health care and injections for immunizations or PPDs (purified protein derivative) at a county health department …