Problem Statement: Obese adults having laparoscopic surgery are at increased risk for postoperative pulmonary complications (PPCs) due to the alteration in pulmonary physiology caused by their body habitus, the use of Trendelenburg position, and the abdominal insufflation required for this surgical approach. Current literature recommends utilizing lung-protective ventilation (LPV) strategies to reduce the incidence of PPCs, but anesthesia provider implementation of LPV strategies is inconsistent. The purpose of this quality improvement project was to explore anesthesia providers’ knowledge and utilization of lung-protective positive end-expiratory pressure (PEEP) strategies in obese patients undergoing laparoscopic surgery.
Methods: The descriptive design aimed to investigate anesthesia providers’ knowledge and use of LPV PEEP strategies in obese patients (BMI > 30kg/m²) undergoing laparoscopic surgery via an anonymous, quantitative electronic survey consisting of 24 Likert-scale questions. A convenience sampling of certified registered nurse anesthetists (CRNAs) and anesthesiologists (MDAs) was used. The survey was disseminated via e-mail and available by QR code. Data was stratified by role/education, age and years of experience to evaluate for trends.
Results: Fifty-two providers completed the survey. There were significant differences in likelihood to incorporate LPV PEEP strategies across groups.
Conclusions: Anesthesia provider utilization of LPV PEEP strategies remains inconsistent. Education regarding utilization of evidence-based LPV PEEP strategies in obese patients undergoing laparoscopic surgery is warranted.
Keywords: postoperative pulmonary complications, lung-protective ventilation, positive end-expiratory pressure
Corneal abrasions (CA) are one of the most common anesthesia-related adverse events. There is limited evidence about the effect of virtual education on providers’ knowledge regarding CA prevention. The purpose of this project was to assess if a web-based educational module effectively improved anesthesia providers’ awareness of evidence-based preventative measures of CA. This project had a quasi-experimental, pretest-posttest design. All participants completed a questionnaire regarding the knowledge on CA prevention before and after the educational module. A student T-test was used to compare the differences in pre- and post-education knowledge scores. Among 25 participants, 12.0% were anesthesiologists and 88.0% were certified registered nurse anesthetists. There was a significant pretest-posttest difference on the total knowledge score (6.88 ± 1.59 vs. 8.29 ± 1.31, p < .001). Overall, the average number of correct answers increased from 6.88 (SD = 1.59) to 8.29 (SD = 1.31), t = 4.22, p<.001. The web-based educational module effectively enhanced anesthesia providers’ knowledge in preventing surgical induced CA. The finding may add evidence when developing guidelines and standardizing provider education in CA prevention.
JOANI FRANCESCHI. Enhancing the Anesthesia Providers’ Awareness of Resources, Policies, & Procedures Surrounding Patients with Language Communication Barriers.
(Under the direction of DR. LUFEI YOUNG)
Background: Patients who have limited proficiency in English (LEP) face significant communication challenges in perioperative settings. These obstacles range from difficulties in understanding anesthesia-related information to obtaining informed consent. These language-based barriers result in a decreased quality of care, lower patient satisfaction, and a heightened risk of adverse healthcare outcomes.
Purpose: The goal of this study is to determine if a web-based educational program can enhance anesthesia providers' knowledge of available resources, policies, and procedures for LEP patients.
Methods: We conducted a quasi-experimental study with a pre- /post-test design. The study was conducted in a surgical center located in the southeastern region of the United States. A digital survey was given before and after the online education intervention. The effect of web-based education was examined by comparing the differences of the pre-and post-education survey scores.
Results: In this study, 40 participants were predominantly female (65%), including 87.5% CRNAs and 12.5% anesthesiologists. A significant improvement in knowledge was observed in the post-education survey score. The average number of correct answers increased from 3.78 (SD = 1.61) to 5.89 (SD = 0.84), t = 8.69, p < .001. Demographic factors did not significantly impact question accuracy at the pretest or posttest. These findings underscore the educational program's effectiveness in enhancing anesthesia providers' knowledge across diverse professional and demographic groups.
Conclusion: The web-based educational program significantly improved anesthesia providers' knowledge of resources, policies, and procedures for LEP patients.
Keywords: Limited English Proficiency (LEP), Anesthesia Providers, Web-Based Learning
The purpose of this quality improvement (QI) project was to identify trends in the intraoperative dosing of dexamethasone in type II diabetic patients undergoing orthopedic procedures at a community hospital to determine impact of dosage level on postoperative glycemic response compared to preoperative levels and HgbA1C levels.
Dexamethasone is a corticosteroid and despite its many documented benefits when administered perioperatively to surgical patients, it is often withheld in the type II diabetic population out of concern for effects on postoperative glycemic control. For this QI project, charts of type II diabetics receiving dexamethasone undergoing orthopedic procedures were reviewed. Data inclusion criteria were type II diabetics, procedures <4 hours, patients with a HbA1C reading 6.5-8.9%, patients who are non-pregnant, patients with an ASA classification of I, II, or III, & those not taking steroidal medications.
Dexamethasone dosage had a significant effect on the change of blood glucose levels, (t = 4.16, p < .001), with a higher dose leading to a greater increase in blood glucose (BG). There was a positive correlation between postoperative BG and both surgery length and age, meaning that the longer the surgery and the older the patient the higher the postop BG. Change in BG postoperatively had a negative correlation with HgbA1C, meaning that patients with a lower HgbA1C preoperatively had a greater increase in BG postoperatively. There was no significant increase in BG in doses of 0, 4, or 8 mg; but there was a significant increase in BG with a dexamethasone dose of 10 mg.
Results of the charts reviews found that small doses of dexamethasone did not increase postoperative BG significantly in type II diabetics. Larger doses of 10 mg had a significant increase in BG readings. Project results suggest further study and improvement interventions in dexamethasone dosing in diabetics.
Background: Patients with limited English proficiency (LEP) are facing significant communication challenges in peri-operative settings, spanning from understanding anesthesia-related information to obtaining informed consent. These language-based obstacles lead to decreased quality of care, lower patient satisfaction, and a heightened risk of adverse healthcare outcomes. The purpose of this study is to investigate if a web-based educational program can increase the anesthesia providers’ awareness of resources, policies, and procedures available for LEP patients. Methods: This quantitative, quasi-experimental project uses a pretest-posttest design sampling from a full-service community hospital in the Southeastern region of United States. Results: Twenty-five individuals participated in this study. There was significant pretest-posttest difference on question : question 1 (χ2(1) = 5.98, p = .015) (federal law); question 2 (language service resources) (χ2(1) = 13.30, p < .001); question 4 (language service procedure) (χ2(1) = 11.80, p < .001); question 5 (policy location) (χ2(1) = 11.70, p < .001); question 6 (resource location) (χ2(1) = 7.29, p = .007); question 7 (resource location) (χ2(1) = 24.10, p < .001). The average number of correct answers increased from 3.19 ± 1.48 to 5.80 ± 0.50 (t = 6.53, p < .001). Conclusion: The result of this data is evidence that utilization of a brief educational module can greatly impact anesthesia providers’ awareness of resources, policies, and procedures for language services for patients with language communication barriers. Future projects should aim to highlight the significance of obtaining informed consent via a certified interpreter in lieu of ad hoc interpretation.
Background: Patients with limited English proficiency (LEP) are facing significant communication challenges in peri-operative settings, spanning from understanding anesthesia-related information to obtaining informed consent. These language-based obstacles lead to decreased quality of care, lower patient satisfaction, and a heightened risk of adverse healthcare outcomes. The purpose of this study is to investigate if a web-based educational program can increase the anesthesia providers’ awareness of resources, policies, and procedures available for LEP patients. Methods: This quantitative, quasi-experimental project uses a pretest-posttest design sampling from a level II healthcare facility in Charlotte, NC. Results: Twenty-six individuals participated in this study. There was significant pretest-posttest difference on question 2 (language service resources) (χ2(1) = 7.24, p = .007); question 4 (language service procedure) (χ2(1) = 16.50, p < .001); question 5 (policy location) (χ2(1) = 10.00, p = .002); and question 7 (resource location) (χ2(1) = 28.40, p < .001). The average number of correct answers significantly increased from 3.77 ± 1.34 to 6.15 ± 0.46 (t = 8.58, p < .001). Conclusion: The result of this data serves as evidence that a short, simple education module can profoundly impact the anesthesia provider’s understanding of resources and policies surrounding language communication barriers. Future projects should emphasize the importance of bilingual teammates avoiding obtaining pre-operative consent without the presence of a certified interpreter.
ALYSSA RENAYE OLIVERI. A Radiation Safety Education Intervention for Certified Registered Nurse Anesthetists. (Under the Direction of DR. STEPHANIE WOODS, PH.D., RN)
CRNAs provide anesthesia for surgeries that utilize ionizing radiation daily and must possess the knowledge to protect themselves from the negative biological sequelae that can be caused by ionizing radiation exposure. CRNAs must remain compliant with the Occupational Safety and Health Administration’s (OSHA) ionizing radiation standards, and not exceed an annual whole body dose equivalent of 1.25 rem per quarter, or 5 rem per year (OSHA, n.d.). By increasing awareness of the risks of occupational exposure to ionizing radiation in the anesthesia setting, safer radiation precautions and practices can be promoted to aid in minimizing workplace exposure. The PICO question for the quality improvement (QI) project is, “In Certified Registered Nurse Anesthetists, does a radiation safety online educational intervention improve knowledge of radiation safety measures?” For the implementation of this project, an online education intervention was distributed to 157 CRNAs at a Level I trauma center. The intervention contained a pre-test consisting of four demographic and 11 knowledge-based questions, a narrated radiation safety infographic, and a post-test consisting of the same knowledge-based questions as the pre-test. Data analysis revealed that the educational infographic enhanced CRNAs knowledge of radiation safety. Moreover, CRNAs demonstrated the most improvement in their knowledge of potential health hazards of occupational exposure to ionizing radiation. The QI project recommends a strong emphasis on increasing distance away from the radiation source, custom fit lead, acknowledgement of ionizing radiation use during the surgical time-out, and for CRNAs to be sent their quarterly dosimeter reports.
Pesticide use has reached alarming levels globally, causing potential risks to human health and the environment. With its high population densities and rapid development, California emerges as one of the country's leading users of pesticides in the country. Recognized point and non-point pathways for pesticides entering surface water include mixed indoor and outdoor applications and treated municipal wastewater effluent, indicating that conventional wastewater treatment plants (WWTPs) treatment processes are inefficient at removing pesticides from effluents. Recent studies have assessed the fate of pesticides in surface water with a limited understanding of watershed characteristics. This project aimed to quantify WWTP discharges, a lesser-known source of pesticide loads, and investigate the potential environmental benefits of their removal. To evaluate WWTP pesticide concentrations, we developed a geospatial model with municipal WWTP discharges, streamflow characteristics, and pesticide loading data to estimate pesticide concentrations within wastewater receiving streams. Next, we set a multimetric Pesticide Vulnerability Index (PVI) to identify the most vulnerable California watersheds to wastewater-derived pesticide loading. Finally, we investigated the environmental benefits of incorporating advanced WWTP processes for pesticide residue removal from treated effluent before surface water discharge using estimated WWTP life-cycle costs. This work presents an integrated assessment of pesticides in surface water to support source control and mitigation efforts. It highlighted the significance and effects of municipal WWTP pesticide loading in California’s urban waterways. In addition, completing this project provided insight into the environmental and economic costs associated with municipal wastewater-derived pesticide mitigation.
Recent advancements in deep learning have significantly propelled the field of computer vision, especially in 3D human model recovery from monocular images. This work is centered on developing efficient deep learning models for digitizing human subjects, thereby laying a solid foundation for various subsequent applications. 3D human mesh estimation from monocular images often requires complex deep learning models. In addressing this, we propose a hybrid approach combining deep learning models with analytical inverse kinematics to precisely estimate 3D pose and shape.
Our precise 3D pose estimations facilitate three high-impact downstream applications. Firstly, we aim to create a real-time biomechanics analysis system that provides low-cost, real-time, and accurate estimations of kinematic sequences for managing joint human health-performance. Herein, our system integrates mobile modular 3D pose estimation with model-based inverse kinematics optimization seamlessly. The next downstream task entails skeleton-based human action recognition (HAR), with extensive applications in smart homes, cities, and retail. By rendering 3D pose sequences as RGB images and utilizing conventional CNN architectures alongside various data augmentation schemes, we have achieved results comparable to sophisticated Graph Neural Network models. Lastly, in scenarios where visual cues are scarce yet human monitoring is essential, radar-based sensing offers a non-intrusive solution for tracking human movements and vital signs. Given the paucity of extensive radar datasets, we introduce a "virtual radar" framework in our third downstream task. This framework, driven by 3D pose and physics-informed principles, generates synthetic radar data, presenting a novel avenue towards a nuanced understanding of human behavior through privacy-preserving radar-based methodologies.
Personalized Learning Instruction (PLI) is the practice of personalizing instructional practices, scaffolding, and assessing the schoolwork of each individual student based on their specific learning needs and the standards of the curricular content. It involves student choice and interest within a flexible structure. Currently, most of the research that has been conducted on PLI has focused on math instruction, older secondary students (grades 9-12), and relatively small samples of students. Little research has been conducted to determine if and what impacts PLI may or may not have on English Language Arts achievement. Nor has much emphasis been placed on middle schoolers, where routines and patterns for future success in secondary school are established. The purpose of this study was to understand middle school principals’ perceptions of (1) Personalized Learning Instruction (PLI), (2) the effects of Personalized Learning Instruction on middle grades English Language Arts achievement, and (3) the impact of COVID-19 on the implementation of Personalized Learning Instruction in their schools. This qualitative case study involved in-depth interviews of four middle school principals who had experience with the implementation of PLI in their schools. Four themes emerged from these case studies and are expressed through thematic sentences; (1) Principals perceive a positive impact on student achievement through Personalized Learning Instruction, largely through increased engagement with reading in English Language Arts classes, (2) A misalignment exists between using PLI strategies and current instructional practices, (3) Staffing issues, inexperience, and vacancies have pushed instructional leaders away from Personalized Learning Instruction, and (4) Personalized Learning Instruction is not a priority post-COVID-19.
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