Impact of Nursing Education on Postoperative Ileus Prevention in a Tertiary Care Facility: A Quality Improvement Project

Postoperative ileus (POI) is a preventable but potentially fatal complication that affects approximately 10% to 30% of patients who undergo major abdominal surgery. Despite the use of Enhanced Recovery After Surgery (ERAS) protocols, tertiary care facilities continue to struggle with this complication affecting not only patient outcomes but also healthcare cost and revenue generation. Although hospitals often offer general education to staff nurses throughout the year, the topics are mainly designed to target national accreditation requirements. This leaves a knowledge gap on specific skills and interventions that could greatly improve health outcomes. To address this issue, a quality improvement project to increase nurse knowledge of POI was implemented in an acute tertiary care facility in the Miami area. A total of 43 registered nurses working in two inpatient step-down units were included in this project. The results were analyzed and a significant increase in mean scores for knowledge and confidence before and after the education intervention were noted. Overall, there was a 34% increase in mean confidence self-assessment score and a 109% increase in knowledge mean scores when compared to baseline. Although a power analysis was not performed, a paired one-tailed t-test was executed to determine statistical significance showing a result of p \u3c 0.0001. The data shows that nurse education is effective at enhancing knowledge and confidence when identifying, preventing, and treating POI. Based on the evidence and the results of this project, future education should be implemented and the material incorporated into onboarding curriculums for surgical units

Universities and Pricing on Higher Education Markets

Markets and prices in higher education. When can we speak of markets, and when markets exist, how are prices set

Interventions, Entrepreneurial Orientation and Macro Environment: Effect on Beneficiary Poverty Reduction by Faith Based Enterprises

This study focuses on joint effect of interventions, entrepreneurial orientation and macro environment on beneficiary poverty reduction (BPR) by Faith based enterprises (FBEs) within the slums of Nairobi, Kenya. In Nairobi, about 60-70% of the people live in slums and conditions are deplorable. Hence, FBEs assist meet the social welfare voids like shelter, water, health services, education and employment. However, there is distorted and incomplete information with divergent views to explain success or failure of joint effects in BPR. Hinged on these gaps, the study objective of joint effect of the variables on BPR is assessed and its hypothesis is tested. The study uses a census approach and data was collected from 72 FBEs using a structured questionnaire. The study uses the descriptive cross-sectional research design and data is analysed using descriptive statistics and hierarchical multiple regression analysis. Study found that joint effect of the variables has a greater effect on BPR than the singular effect of each variable; most people in Nairobi slums live below World Bank poverty threshold of $1.90 per day and FBEs bring disruptions that create wealth enabling people take charge of their own destinies as they escape from poverty. Key hindrances to BPR in the slums of Nairobi include lack of markets, reduced donor funding, basic needs such as food, water, shelter, health services, public schools, latrines for safe hygiene and unemployment. Study adds value to theory as findings show net works trigger the mobilization of resources which explains robust joint effects in BPR. Adds value to human capital theory as findings reveal enterprises can deliver in social value based on relationships and doing things differently by those involved despite their illiteracy and inexperience. The paper concludes findings inform new thinking that authorities and development partners may emulate in building new funding outfits for poverty reduction such as collaborations to mobilize resources, enterprise culture for business approaches, technology for markets, quality products, politics for laws and support. Pentecostalism and Catholicism are the most prevalent in BPR within slums of Nairobi. Future research could use grounded theory approach for more in-depth investigation

Electrocardiographic findings and prognostic values in patients hospitalised with COVID-19 in the World Heart Federation Global Study

BACKGROUND COVID-19 affects the cardiovascular system and ECG abnormalities may be associated with worse prognosis. We evaluated the prognostic value of ECG abnormalities in individuals with COVID-19. METHODS Multicentre cohort study with adults hospitalised with COVID-19 from 40 hospitals across 23 countries. Patients were followed-up from admission until 30 days. ECG were obtained at each participating site and coded according to the Minnesota coding criteria. The primary outcome was defined as death from any cause. Secondary outcomes were admission to the intensive care unit (ICU) and major adverse cardiovascular events (MACE). Multiple logistic regression was used to evaluate the association of ECG abnormalities with the outcomes. RESULTS Among 5313 participants, 2451 had at least one ECG and were included in this analysis. The mean age (SD) was 58.0 (16.1) years, 60.7% were male and 61.1% from lower-income to middle-income countries. The prevalence of major ECG abnormalities was 21.3% (n=521), 447 (18.2%) patients died, 196 (8.0%) had MACE and 1115 (45.5%) were admitted to an ICU. After adjustment, the presence of any major ECG abnormality was associated with a higher risk of death (OR 1.39; 95% CI 1.09 to 1.78) and cardiovascular events (OR 1.81; 95% CI 1.30 to 2.51). Sinus tachycardia (>120 bpm) with an increased risk of death (OR 3.86; 95% CI 1.97 to 7.48), MACE (OR 2.68; 95% CI 1.10 to 5.85) and ICU admission OR 1.99; 95% CI 1.03 to 4.00). Atrial fibrillation, bundle branch block, ischaemic abnormalities and prolonged QT interval did not relate to the outcomes. CONCLUSION Major ECG abnormalities and a heart rate >120 bpm were prognostic markers in adults hospitalised with COVID-19

Socio-economic factors determine maternal and neonatal outcomes in women with peripartum cardiomyopathy:A study of the ESC EORP PPCM registry

Background: Peripartum cardiomyopathy (PPCM) is a global disease with substantial morbidity and mortality. The aim of this study was to analyze to what extent socioeconomic factors were associated with maternal and neonatal outcomes. Methods: In 2011, &gt;100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global PPCM registry, under the auspices of the ESC EORP Programme. We investigated the characteristics and outcomes of women with PPCM and their babies according to individual and country-level sociodemographic factors (Gini index coefficient [GINI index], health expenditure [HE] and human developmental index [HDI]). Results: 739 women from 49 countries (Europe [33%], Africa [29%], Asia-Pacific [15%], Middle East [22%]) were enrolled. Low HDI was associated with greater left ventricular (LV) dilatation at time of diagnosis. However, baseline LV ejection fraction did not differ according to sociodemographic factors. Countries with low HE prescribed guideline-directed heart failure therapy less frequently. Six-month mortality was higher in countries with low HE; and LV non-recovery in those with low HDI, low HE and lower levels of education. Maternal outcome (death, re-hospitalization, or persistent LV dysfunction) was independently associated with income. Neonatal death was significantly more common in countries with low HE and low HDI, but was not influenced by maternal income or education attainment.Conclusions: Maternal and neonatal outcomes depend on country-specific socioeconomic characteristics. Attempts should therefore be made to allocate adequate resources to health and education, to improve maternal and fetal outcomes in PPCM.</p

A Randomized Placebo-Controlled Trial of Varenicline for Smoking Cessation Allowing Flexible Quit Dates

Introduction: Current smoking cessation guidelines recommend setting a quit date prior to starting pharmacotherapy. However, providing flexibility in the date of quitting may be more acceptable to some smokers. The objective of this study was to compare varenicline 1 mg twice daily (b.i.d.) with placebo in subjects using a flexible quit date paradigm after starting medication. Methods: In this double-blind, randomized, placebo-controlled international study, smokers of ≥10 cigarettes/day, aged 18-75 years, and who were motivated to quit were randomized (3:1) to receive varenicline 1 mg b.i.d. or placebo for 12 weeks. Subjects were followed up through Week 24. Subjects were instructed to quit between Days 8 and 35 after starting medication. The primary endpoint was carbon monoxide-confirmed continuous abstinence during Weeks 9-12, and a key secondary endpoint was continuous abstinence during Weeks 9-24. Results: Overall, 493 subjects were randomized to varenicline and 166 to placebo. Continuous abstinence was higher for varenicline than for placebo subjects at the end of treatment (Weeks 9-12: 53.1% vs. 19.3%; odds ratio [OR] 5.9; 95% CI, 3.7-9.4; p < .0001) and through 24 weeks follow-up (Weeks 9-24: 34.7% vs. 12.7%; OR 4.4; 95% CI, 2.6-7.5; p < .0001). Serious adverse events occurred in 1.2% varenicline (none were psychiatric) and 0.6% placebo subjects. Fewer varenicline than placebo subjects reported depression-related adverse events (2.3% vs. 6.7%, respectively). Conclusions: Varenicline 1 mg b.i.d. using a flexible quit date paradigm had similar efficacy and safety compared with previous fixed quit date studies. © The Author 2011. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco

As universidades, a inserção e a aprendizagem profissionais: que lugar para a pedagogia?

A universidade enquanto instituição formadora tem preocupações profissionais desde as suas origens medievais, no sentido em que, entre as suas missões, se inclui a preparação dos alunos para o exercício de atividades profissionais. Contudo, na contemporaneidade este tipo de preocupações têm sido o objeto de uma atenção e preocupação crescentes no quadro das políticas educativas, bem como por parte dos académicos e da sociedade em geral, veiculando frequentemente a ideia de que importa repensar o ensino superior numa lógica de resposta a necessidades (quantitativas e qualitativas) da economia e do mercado de trabalho. O objetivo deste artigo é enriquecer a reflexividade sobre este tipo de posicionamentos e sobre as respectivas implicações no campo da pedagogia universitária. Procura-se, deste modo, identificar tensões e desafios subjacentes aos modos de funcionamento e aos modelos curriculares e pedagógicos das universidades na atualidade, reforçando a importância de favorecer uma perspectiva educativa sobre a pedagogia universitária que não a subordine às supostas necessidades do mercado de trabalho