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Journal of Advanced Nursing Jun 2024The aim was to explore how representatives from the different professions in the surgical team experience roles, responsibilities and challenges in positioning the...
AIMS
The aim was to explore how representatives from the different professions in the surgical team experience roles, responsibilities and challenges in positioning the surgical patient.
BACKGROUND
Appropriate patient positioning on the operating table during surgery is vital for optimal anatomical exposure, access to essential equipment, patient comfort and to minimize the risk of injuries. Patient positioning has been described as a shared responsibility of the entire surgical team. The research on roles and responsibilities in patient positioning during surgery is sparse.
DESIGN
The study had a qualitative design, including 16 individual, semi-structured interviews, conducted in November and December 2023.
METHODS
Participants included surgeons (n = 4), anaesthetists (n = 4), operating room nurses (n = 4) and nurse anaesthetists (n = 4) in a hospital in Southeastern Norway. The data were analysed using Braun and Clarke's six-step Reflexive Thematic Analysis.
RESULTS
Three main themes with subthemes were identified, namely (1) A teamwork approach, with subthemes (a) facilitating surgery and (b) health professionals' roles and responsibilities. (2) A patient safety issue, with subthemes (a) risk patients and (b) procedural challenges. (3) Absence of a systematic approach, with subthemes (a) various approach to second time-out and (b) documentation and feedback issues.
CONCLUSION
Appropriate and safe positioning during surgery is a common responsibility of all members of the surgical team. Despite the common assumption that surgeons hold the primary responsibility, the operating room nurses seemed to hold the hands-on responsibility. Different health professionals emphasized different risk patients, risk procedures and perceived challenges. This suggests a connection between the specific focus of distinct professional domains, their tasks and expertise within the surgical context.
IMPACT
There is a lack of clear guidelines outlining roles and the distribution of responsibility in patient positioning, which may be a safety concern. A need for reviewing responsibilities and defining roles is identified. Systematic follow-up of documentation of post-operative observation and documentation of skin status and the "second time-out" procedure is crucial to establish measures rooted in guidelines supported by both professional and administrative management. This dual commitment may ensure a comprehensive strategy for systematic follow-up, fostering a culture of continuous improvement.
PATIENT CONTRIBUTION
Not applicable.
PubMed: 38888365
DOI: 10.1111/jan.16278 -
Journal of Neuro-oncology Jun 2024Postoperative bowel and bladder dysfunction (BBD) poses a significant risk following surgery of the sacral spinal segments and sacral nerve roots, particularly in...
PURPOSE
Postoperative bowel and bladder dysfunction (BBD) poses a significant risk following surgery of the sacral spinal segments and sacral nerve roots, particularly in neuro-oncology cases. The need for more reliable neuromonitoring techniques to enhance the safety of spine surgery is evident.
METHODS
We conducted a case series comprising 60 procedures involving 56 patients, spanning from September 2022 to January 2024. We assessed the diagnostic accuracy of sacral reflexes (bulbocavernosus and external urethral sphincter reflexes) and compared them with transcranial motor evoked potentials (TCMEP) incorporating anal sphincter (AS) and external urethral sphincter (EUS) recordings, as well as spontaneous electromyography (s-EMG) with AS and EUS recordings.
RESULTS
Sacral reflexes demonstrated a specificity of 100% in predicting postoperative BBD, with a sensitivity of 73.33%. While sensitivity slightly decreased to 64.71% at the 1-month follow-up, it remained consistently high overall. TCMEP with AS/EUS recordings did not identify any instances of postoperative BBD, whereas s-EMG with AS/EUS recordings showed a sensitivity of 14.29% and a specificity of 97.14%.
CONCLUSION
Sacral reflex monitoring emerges as a robust adjunct to routine neuromonitoring, offering surgeons valuable predictive insights to potentially mitigate the occurrence of postoperative BBD.
PubMed: 38884662
DOI: 10.1007/s11060-024-04742-y -
Journal of Clinical Neurophysiology :... Jun 2024Transcutaneous electrical stimulation is used to stimulate the dorsal roots of the cauda equina. Multiple elicited responses recorded in the lower extremity muscles are...
INTRODUCTION
Transcutaneous electrical stimulation is used to stimulate the dorsal roots of the cauda equina. Multiple elicited responses recorded in the lower extremity muscles are called posterior root muscle reflexes (PRMRs). Normal PRMR values in the muscles of healthy lower extremities have yet to be determined.
METHODS
Thirty subjects without known lumbosacral spinal root illness were included in this study. Subsequently, they were subjected to transcutaneous electrical stimulation of the cauda equina. Posterior root muscle reflex was recorded in the four muscle groups of both lower extremities. We elicited multiple PRMR and examined their characteristics in order to establish normal electrophysiological parameter values.
RESULTS
Posterior root muscle reflex was successfully elicited in the tibialis anterior (96.7%), gastrocnemius (100%), quadriceps femoris (93.3%), and hamstring (96.7%). No statistically significant differences were found in the intensity of stimulation, latencies, or area under the PRMR between the right and left leg muscles. The area under PRMR varied significantly among the participants. Higher body weight and abdominal girth showed a significant positive correlation with stimulation intensity for eliciting PRMR, and a significant negative correlation with the area under PRMR. Older age showed a significant negative correlation with the success of eliciting PRMR and the area under the PRMR.
CONCLUSIONS
Posterior root muscle reflex is a noninvasive and successful method for eliciting selective reflex responses of cauda equina posterior roots. Obtained values could be used in future studies to evaluate the utility of this methodology in clinical practice. This methodology could improve testing of the proximal lumbosacral nervous system functional integrity.
PubMed: 38857374
DOI: 10.1097/WNP.0000000000001088 -
International Journal of Nanomedicine 2024, a dual-purpose food and medicine, displays limited efficacy in alcohol detoxification and liver protection, with previous research primarily focused on puerarin in its...
PURPOSE
, a dual-purpose food and medicine, displays limited efficacy in alcohol detoxification and liver protection, with previous research primarily focused on puerarin in its dried roots. In this study, we investigated the potential effects and mechanisms of fresh root-derived exosome-like nanovesicles (P-ELNs) for mitigating alcoholic intoxication, promoting alcohol metabolism effects and protecting the liver in C57BL/6J mice.
METHODS
We isolated P-ELNs from fresh root using differential centrifugation and characterized them via transmission electron microscopy, nanoscale particle sizing, ζ potential analysis, and biochemical assays. In Acute Alcoholism (AAI) mice pre-treated with P-ELNs, we evaluated their effects on the timing and duration of the loss of the righting reflex (LORR), liver alcohol metabolism enzymes activity, liver and serum alcohol content, and ferroptosis-related markers.
RESULTS
P-ELNs, enriched in proteins, lipids, and small RNAs, exhibited an ideal size (150.7 ± 82.8 nm) and negative surface charge (-31 mV). Pre-treatment with 10 mg/(kg.bw) P-ELNs in both male and female mice significantly prolonged ebriety time, shortened sobriety time, enhanced acetaldehyde dehydrogenase (ALDH) activity while concurrently inhibited alcohol dehydrogenase (ADH) activity, and reduced alcohol content in the liver and serum. Notably, P-ELNs demonstrated more efficacy compared to P-ELNs supernatant fluid (abundant puerarin content), suggesting alternative active components beyond puerarin. Additionally, P-ELNs prevented ferroptosis by inhibiting the reduction of glutathione peroxidase 4 (GPX4) and reduced glutathione (GSH), and suppressing acyl-CoA synthetase long-chain family member 4 (ACSL4) elevation, thereby mitigating pathological liver lipid accumulation.
CONCLUSION
P-ELNs exhibit distinct exosomal characteristics and effectively alleviate alcoholic intoxication, improve alcohol metabolism, suppress ferroptosis, and protect the liver from alcoholic injury. Consequently, P-ELNs hold promise as a therapeutic agent for detoxification, sobriety promotion, and prevention of alcoholic liver injury.
Topics: Animals; Pueraria; Mice, Inbred C57BL; Exosomes; Mice; Male; Alcoholic Intoxication; Plant Roots; Liver; Ethanol; Plant Extracts; Alcoholism; Isoflavones
PubMed: 38828197
DOI: 10.2147/IJN.S462602 -
Children (Basel, Switzerland) May 2024Cough is a common presenting symptom for patients in a primary care setting and significantly impacts a patient's quality of life. Cough involves a complex reflex arc... (Review)
Review
Cough is a common presenting symptom for patients in a primary care setting and significantly impacts a patient's quality of life. Cough involves a complex reflex arc beginning with the stimulation of sensory nerves that function as cough receptors that stimulate the cough center in the brain. This "cough center" functions to receive these impulses and produce a cough by activating efferent nervous pathways to the diaphragm and laryngeal, thoracic, and abdominal musculature. Drugs that suppress the neural activity of cough are non-specific as those treatments are not directed toward pathogenic causes such as inflammation and oxidative stress. Moreover, they block a reflex called the watchdog of the lung and have a defense mechanism. Acute respiratory infections of the upper and lower airways most commonly cause acute cough. In contrast, the most common causes of chronic cough are upper airway cough syndrome, asthma, and gastroesophageal reflux disease, all associated with an inflammatory reaction at the level of the cough receptors. The use of natural compounds or herbal drugs such as carob syrup, dry blackcurrant extract, dry extract of caraway fruit, dry extract of ginger rhizome, dry extract of marshmallow root, and dry extract of ivy leaves, to name a few, not only have anti-inflammatory and antioxidant activity, but also act as antimicrobials, bronchial muscle relaxants, and increase gastric motility and empty. For these reasons, these natural substances are widely used to control cough at its deep roots (i.e., contrasting its causes and not inhibiting the arch reflex). With this approach, the lung watchdog is not put to sleep, as with peripheral or central inhibition of the cough reflex, and by contrasting the causes, we may control cough that viruses use at self-advantage to increase transmission.
PubMed: 38790578
DOI: 10.3390/children11050584 -
Journal of Aging and Physical Activity May 2024Randomized controlled trials that deliver physical activity interventions have demonstrated benefits for older adults across numerous health outcomes. However, too...
BACKGROUND/OBJECTIVES
Randomized controlled trials that deliver physical activity interventions have demonstrated benefits for older adults across numerous health outcomes. However, too little attention has been directed to ensuring that such trials are measuring patient-relevant outcomes. To support outcome selection for future trials, the objective of this study was to understand what outcomes related to their physical activity participation older adults find important.
METHODS
We conducted 12 semistructured interviews with adults aged 65 years and older and analyzed interview transcripts with a reflexive thematic analysis.
RESULTS
Older adults desired diverse outcomes from their physical activity participation, ranging from generic (e.g., quality of life) to specific (e.g., leg strength). Relevant outcomes were classified under five themes: physical, clinical, social, psychological, and overarching, each with respective subthemes.
CONCLUSIONS
The outcomes that older adults found important were plentiful and rooted in a desire to improve their quality of life. Some of the outcome themes have been reported frequently in past trials (e.g., physical), but others have not (e.g., social). Future researchers should be aware of, and responsive to, the priorities of older adults when designing trials and defining outcomes. Significance/Implications: This study will help to improve outcome selection for future trials of physical activity with older adults. In alignment with a patient-oriented research philosophy, this study will also ground future outcome selection in the priorities of older adults.
PubMed: 38753312
DOI: 10.1123/japa.2023-0290 -
Frontiers in Sociology 2024Veganism is a movement that avoids consuming animal products. This lifestyle is commonly represented as elitist despite the broad range of people who follow it. Using...
INTRODUCTION
Veganism is a movement that avoids consuming animal products. This lifestyle is commonly represented as elitist despite the broad range of people who follow it. Using Bourdieu's taste theory, this study analyzes how personal culinary tastes of different social classes generate favorable (or unfavorable) dispositions to adopting veganism.
METHODS
We analyzed 73 biographical interviews with 40 young vegans in three different waves.
RESULTS
The findings reveal that all social classes exhibit favorable dispositions towards veganism. In upper-class individuals, dispositions to embrace healthy and exotic food facilitate the adoption of new flavors and reflexivity in eating practices. Conversely, lower-class individuals have traditional meatless culinary practices rooted in their restricted budget, facilitating the transition to a plant-based diet.
DISCUSSION
These results demonstrate the relevance of social class in understanding the diversity of vegan practices, and they contribute to breaking stereotypes around this movement.
PubMed: 38690292
DOI: 10.3389/fsoc.2024.1356457 -
Bioresources and Bioprocessing Nov 2023Ottonia anisum (O. anisum), belonging to the family Piperaceae, is renowned for its medicinal properties. The plant is rich in alkaloids, terpenoids and flavonoids with...
Ottonia anisum (O. anisum), belonging to the family Piperaceae, is renowned for its medicinal properties. The plant is rich in alkaloids, terpenoids and flavonoids with recorded bioactivities. The stems, roots, and leaves, of the O. anisum have been extensively used in the folk medicine. Therefore, the present study was conducted to examine the pharmacological activities of O. anisum root extract. Methanolic root extract of O. anisum was assessed for local anesthetic, analgesic, anti-inflammatory and HCl-induced acute lung injury activities in animal models. Local anesthetic activity assessed in frog and guinea pigs through foot withdrawal reflex and intradermal wheal method, respectively, revealed the dose-dependent onset time of anesthesia response. In the case of HCl-induced ALI, the mice group orally administered with O. anisum extract were assessed for bronchoalveolar lavage fluid (BLF) contents, oxidative stress, and proinflammatory molecules. The analysis revealed the reduction in inflammatory molecules, neutrophils, and oxidative stress in the extract treated mice group. In addition, the redox homeostasis, reduced GSH and the catalase activity was found to be restored in the treated groups. Intriguingly, the genes associated with the NFkB expression was found to be downregulated in O. anisum extract treated groups. Moreover, the extract unveiled the significant analgesic and anti-inflammatory activities. Overall, the findings emphasize the clinical applicability of O. anisum extract in the treatment of ALI as well as the potential usage in local anesthetic, analgesic, and anti-inflammatory agents during the treatments.
PubMed: 38647807
DOI: 10.1186/s40643-023-00706-8 -
Journal of Spine Surgery (Hong Kong) Mar 2024Cervical spondylotic myelopathy (CSM) is defined as compression of the spinal cord in the neck, resulting in problems with fine motor skills, hand numbness, pain or... (Review)
Review
Cervical spondylotic myelopathy (CSM) is defined as compression of the spinal cord in the neck, resulting in problems with fine motor skills, hand numbness, pain or stiffness of the neck, and difficulty walking due to loss of balance. Brachial plexus (BP) neuropathies arise due to compression to any distal branches arising from C5-T1, whereas cervical radiculopathy involves compression at the nerve root in the neck. Such conditions can present with variable degrees of musculoskeletal pain, weakness, sensory changes, and reflex changes. The pronounced convergence in symptomatic manifestation within these conditions can pose a formidable challenge to clinicians, particularly in primary care. Thus, the primary objective of this paper is to enhance clarity and distinction among these pathological conditions. This objective is pursued through comprehensive delineation of the dermatomal and myotomal distributions characteristic of each condition. Furthermore, a meticulous examination is undertaken to elucidate physical indicators and maneuvers that exhibit a notably high sensitivity in detecting these conditions. Accurate diagnosis and treatment of each nerve pathology is important as long-term spinal cord compression and its roots may result in permanent disability and severely impact one's quality of life. As such, this systematic review serves as a guide that aids clinicians in differentiating the aforementioned conditions based on anatomy, physical exam findings, and imaging studies. Furthermore, this study aims to outline common peripheral nerve neuropathies in the upper extremities and ways to mitigate these pathologies using the least to most invasive treatment modalities.
PubMed: 38567008
DOI: 10.21037/jss-23-39 -
Health Communication Apr 2024In the United States, the messages Black women receive about vaginal hygiene are often rooted in misogynoir. As a result, Black women across multiple generations may...
In the United States, the messages Black women receive about vaginal hygiene are often rooted in misogynoir. As a result, Black women across multiple generations may engage in extensive vaginal hygiene practices that are harmful to their health as a means of decreasing the potential for dehumanization or confirming racist stereotypes. The purpose of the current qualitative study is to explore the messages four generations of Black women ( = 12) received about genital hygiene and grooming and the sociocultural factors that influence these messages. Reflexive thematic analysis was used to analyze the semi-structured interview data. The following themes were identified: (1) a culture of silence, (2) knowledge acquisition, (3) pressure to maintain Black cleanliness standards, and (4) gendered racist messaging. Subthemes emerged within the knowledge acquisition theme, including learning through word-of-mouth, observation, deduction, trial and error, and direct messaging. Overall, themes and subthemes were consistent across generations; however, some differences were discussed. Participants highlighted the importance of intergenerational conversations in promoting safe vaginal hygiene practices. Recommendations for sexuality educators and healthcare professionals are discussed.
PubMed: 38557391
DOI: 10.1080/10410236.2024.2335057