Effects of Modification of Pain Protocol on Incidence of Post Operative Nausea and Vomiting.

BackgroundA Perioperative Surgical Home (PSH) care model applies a standardized multidisciplinary approach to patient care using evidence-based medicine to modify and improve protocols. Analysis of patient outcome measures, such as postoperative nausea and vomiting (PONV), allows for refinement of existing protocols to improve patient care. We aim to compare the incidence of PONV in patients who underwent primary total joint arthroplasty before and after modification of our PSH pain protocol.MethodsAll total joint replacement PSH (TJR-PSH) patients who underwent primary THA (n=149) or TKA (n=212) in the study period were included. The modified protocol added a single dose of intravenous (IV) ketorolac given in the operating room and oxycodone immediate release orally instead of IV Hydromorphone in the Post Anesthesia Care Unit (PACU). The outcomes were (1) incidence of PONV and (2) average pain score in the PACU. We also examined the effect of primary anesthetic (spinal vs. GA) on these outcomes. The groups were compared using chi-square tests of proportions.ResultsThe incidence of post-operative nausea in the PACU decreased significantly with the modified protocol (27.4% vs. 38.1%, p=0.0442). There was no difference in PONV based on choice of anesthetic or procedure. Average PACU pain scores did not differ significantly between the two protocols.ConclusionSimple modifications to TJR-PSH multimodal pain management protocol, with decrease in IV narcotic use, resulted in a lower incidence of postoperative nausea, without compromising average PACU pain scores. This report demonstrates the need for continuous monitoring of PSH pathways and implementation of revisions as needed

Bankruptcy and Education

(Excerpt) Bankruptcy law interacts with education law in a number of respects. A bankrupt educational institution loses access to student financial aid, and its accreditation status is excluded from the bankruptcy estate. Actions by accreditation agencies against bankrupt educational institutions are not subject to the automatic stay. And absent a showing of undue hardship, student loans are not dischargeable in bankruptcy. The exceptional treatment of educational institutions and their students in bankruptcy reflects a fundamental tension between the goals of bankruptcy law on the one hand and education policy on the other. While bankruptcy law generally seeks to maximize value for creditors and afford a fresh start to individual debtors, it balances these objectives with the goals of education policy, which include assuring educational quality, access, and affordability, as well as protecting the investment of public funds in the educational sector. Whether current law achieves the correct balance or ought to be rethought and reformed was the subject of a symposium that the American Bankruptcy Institute Law Review hosted at St. John\u27s School of Law on October 24, 2014. The event brought together distinguished experts in the fields of bankruptcy and education law, and their contributions are published here in this symposium issue. These papers are especially timely in light of recent news events concerning high profile insolvencies in the higher education sector and pending legislation to reauthorize the Higher Education Act. And they will be of particular interest, given how little attention the intersection between these two subject areas has received until now

Women in Israel: The Struggle for Change & Reform

Author of Women in Politics and Living Without a Constitution: Civil Rights in Israel.https://digitalcommons.fairfield.edu/bennettcenter-posters/1191/thumbnail.jp

Valuation Averaging: A New Procedure for Resolving Valuation Disputes

In this Article, Professor Sharfman addresses the problem of discretionary valuation : that courts resolve valuation disputes arbitrarily and unpredictably, thus harming litigants and society. As a solution, he proposes the enactment of valuation averaging, a new procedure for resolving valuation disputes modeled on the algorithmic valuation processes often agreed to by sophisticated private firms in advance of any dispute. He argues that by replacing the discretion of judges and juries with a mechanical valuation process, valuation averaging would cause litigants to introduce more plausible and conciliatory valuations into evidence and thereby reduce the cost of valuation litigation and increase the chance of settlement. He further argues that imposition of the valuation averaging procedure would not deprive litigants of their constitutional entitlements to due process and the right to trial by jury. Finally, he argues that valuation averaging would improve upon current law and is superior to other proposed alternatives