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"Murphy, Glenn"
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Why is snot green? : and other extremely important questions (and answers)
Sure, a lot of kids want to grow up to be astronauts, but according to scientist Glenn Murphy, even MORE kids want to know what happens to astronaut farts. (Short answer: Not good things!) And they want to know: Why don't all fish die from lightning storms? Why haven't we all been sucked into a black hole? Do animals talk? Told in a back-and-forth conversational style, \"Why is Snot Green?\" presents science just the way kids want to learn it--with lots of laughter.
Book
Comparison of the TetraGraph and TOFscan for monitoring recovery from neuromuscular blockade in the Post Anesthesia Care Unit
Comparison of the TetraGraph (TG) and TOFscan (TS) for monitoring recovery from neuromuscular blockade in the Post Anesthesia Care Unit (PACU).
Randomized, multicenter trial.
PACU in three tertiary care hospitals.
120 patients (40 per site) receiving neuromuscular blockade during elective surgery.
Patients were enrolled preoperatively and intraoperative neuromuscular blockade management was at the discretion of the anesthesiologist. Upon arrival to the PACU, patients were randomized to have either TG or TS placed on their dominant hand. The alternate device (TS or TG) was placed on the non-dominant hand. Following simultaneous ulnar nerve stimulation on each arm, the response of the adductor pollicis was measured.
Train-of-four ratios (TOFRs) were obtained upon arrival to the PACU (t = 0), after 5 min (t = + 5) and after +10 min (t = + 10).
There was there was no significant difference in the mean TOFRs obtained with the TG and TS at t = 0 (0.97 ± 0.18 vs 0.94 ± 0.13, P = 0.06, respectively) and t = + 5 (0.96 ± 0.20 vs 0.95 ± 0.12, P = 0.29, respectively). At (t = + 10), there was a statistically significant difference in mean TOFRs obtained with the TG and TS, (0.99 ± 0.14 vs 0.94 ± 0.12, P < 0.001, respectively). The bias between devices at t = 0 was estimated to be 0.03 (95% CI, −0.29 to 0.35, P = 0.26); at t = + 5 min, it was estimated to be 0.02 (95% CI, −0.36 to 0.40, P = 0.54); and at t = +10 min, it was estimated to be 0.05 (95% CI, −0.25 to 0.36, P = 0.77).
TS and TG provide interchangeable quantitative measurements once the TOF ratio has returned to a value of 0.90 or greater in the PACU.
•Comparison of new technologies.•Comparison of AMG & EMG.•NMB management strategies impact patient safety.
Journal Article
Inventions
A brief history of mankind's greatest inventions, from the first firemaking implements to the internet.
Book
Extracranial contamination in the INVOS 5100C versus the FORE-SIGHT ELITE cerebral oximeter: a prospective observational crossover study in volunteers
Purpose
Previous studies have found that most cerebral oximeters are subject to inaccuracies secondary to extracranial contamination of the cerebral oximetric signals. We hypothesized that the more advanced second-generation FORE-SIGHT ELITE cerebral oximeter would be significantly less affected by extracranial tissue hypoxemia than the more widely used first-generation INVOS™ 5100C monitor.
Methods
Twenty healthy volunteers aged 18-45 yr had the INVOS and FORE-SIGHT probes placed on their forehead in a random sequence while in the supine position. A pneumatic head cuff was then placed around each volunteer’s head just below both the oximeter and a concomitantly placed scalp forehead pulse oximeter probe. The subjects’ scalp cerebral oxygen saturation (SctO
2
) values were measured and compared using the two different devices in sequence, both before and after scalp tissue ischemia was induced by the pneumatic cuff.
Results
Extracranial ischemia resulted in a significant reduction in SctO
2
values from baseline in both devices. The INVOS 5100C recorded a median [interquartile range] decrease in SctO
2
from baseline at five minutes of 15.1% [12.6 - 17.6], while that recorded by the FORESIGHT ELITE device was 8.6% [4.0 -12.3] at five minutes (median difference, 7.9%; 99% confidence interval, 1.9 to 16.5;
P
= 0.002).
Conclusion
Updated technological algorithms employed in the FORE-SIGHT ELITE cerebral oximeter may be responsible for less extracranial contamination than was observed in the previous-generation INVOS 5100C device. The impact that this extracranial contamination may have on the clinical use of these devices remains to be determined.
Journal Article
How loud can you burp? : more extremely important questions (and answers!)
How loud can your average middle-grader burp? Parents, librarians, and innocent bystanders are about to find out. This follow-up to the equally alluring Why is Snot Green? tackles more of life's burning questions, many submitted by real-life ten-year-olds. Could we use animal poop to make electricity? What's the world's deadliest disease? Why is your mother turning green? Part silly, part serious, and a big part scatological, How Loud Can You Burp? is destined for greatness and grossness.
Book
Procedural Timeout Compliance Is Improved With Real-Time Clinical Decision Support
PURPOSEThe goal of this study was to assess compliance with a presurgical safety checklist before and after the institution of a surgical flight board displaying a surgical safety checklist with embedded real-time clinical decision support (CDS). We hypothesized that the institution of a surgical flight board with embedded real-time data support would improve compliance with the presurgical safety checklist.
METHODSIn this prospective, observational trial, surgeon-led procedural timeout compliance for 300 procedures was studied. In phase I (PI), procedural timeouts were performed using a simple paper checklist. In phase II (PII), an electronic surgical flight board with an embedded safety checklist was installed in each operating room, but the timeout procedure consisted of the same paper process as in PI. In phase III (PIII), the flight board safety checklist was used. Ten procedures each from 10 surgeons were evaluated in each phase. Compliance was scored on a 12-point scale with each point representing a different item on the checklist.
RESULTSTimeout compliance in PI ranged from 4.5 to 8.6 and 8.75 to 12 in PIII. All 10 surgeons demonstrated statistically improved compliance from PI to PIII. Compliance was significantly improved in 8 of 12 safety check items. Decreased compliance was not seen with any checklist item. Of the items with CDS, compliance with procedure consent and special safety precautions improved from PI to PIII, as did compliance with display of essential imaging, critical events or concerns, and number of procedures (i.e., >1 surgeon performing procedures).
CONCLUSIONSUsing the electronic medical record with real-time CDS improves compliance with presurgical safety checklists.
Journal Article
أشياء تخيفك وتجعلك تمسك ببنطالك
ما من مخاوف معينة مثل الحيوانات المتوحشة أو الكوارث الطبيعية أو يشعر العديد منا يوما الغرق أو الظلام أو الأشباح أو الموت وغيرها العديد من المخاوف، وقد تتطور هذه المخاوف إلى رهاب يلازمنا سنين عديدة ويعيق حياتنا الطبيعية. يتحدث هثل هذا الكتاب عن أغلب هذه المخاوف وأصولها وكيفية التعامل معها ويذكر أغلب أسبابها النفسية والعلمية وحقائقها وطرق التعامل معها ومعالجتها بأسلوب هذه المخاوف مبينا مباشر لا يخلو من حس الدعابة. لقد نال هذا الكتاب جائزة أفضل كتاب للوقائع العلمية عام 2007 وجائزة أفضل كتاب علمي لليافعين عام 200.
BOOK
Documentation and Treatment of Intraoperative Hypotension: Electronic Anesthesia Records versus Paper Anesthesia Records
In this study, we examined anesthetic records before and after the implementation of an electronic anesthetic record documentation (AIMS) in a single surgical population. The purpose of this study was to identify any inconsistencies in anesthetic care based on handwritten documentation (paper) or AIMS. We hypothesized that the type of anesthetic record (paper or AIMS) would lead to differences in the documentation and management of hypotension. Consecutive patients who underwent esophageal surgery between 2009 and 2014 by a single surgeon were eligible for the study. Patients were grouped in to ‘paper’ or ‘AIMS’ based on the type of anesthetic record identified in the chart. Pertinent patient identifiers were removed and data collated after collection. Predetermined preoperative and intraoperative data variables were reviewed. Consecutive esophageal surgery patients (
N
= 189) between 2009 and 2014 were evaluated. 92 patients had an anesthetic record documented on paper and 97 using AIMS. The median number of unique blood pressure recordings was lower in the AIMS group (median (Q1,Q3) AIMS 30.0 (24.0, 39.0) vs. Paper 35.0 (28.5, 43.5),
p
< 0.01). However, the median number of hypotensive events (HTEs) was higher in the AIMS group (median (Q1,Q3) 8.0 (4.0, 18.0) vs. 4.0 (1.0, 10.5),
p
< 0.001), and the percentage of HTEs per blood pressure recording was higher in the AIMS group (30.4 ((Q1, Q3) (9.5, 60.9)% vs. 12.5 (2.4, 27.5)%),
p
< 0.01). Multivariable regression analysis identified independent predictors of HTEs. The incidence of HTEs was found to increase with AIMS (IRR = 1.88,
p
< 0.01). Preoperative systolic blood pressure, increased blood loss, and phenylephrine. A phenylephrine infusion was negatively associated with hypotensive events (IRR = 0.99,
p
= 0.03). We noted an increased incidence of HTEs associated with the institution of an AIMS. Despite this increase, no change in medical therapy for hypotension was seen. AIMS did not appear to have an effect on the management of intraoperative hypotension in this patient population.
Journal Article
Cerebral desaturation events in the intensive care unit following cardiac surgery
Patients may be at high risk for hemodynamic instability in the early postoperative period, with subsequent poor cerebral perfusion and the development of postoperative cerebral oxygen desaturation events (CDEs). Intraoperative CDEs have been associated with postoperative adverse events. However, none of these studies examined the incidence of early postoperative cerebral desaturations. This study was designed to identify the incidence of CDEs (defined as a decrease in SctO2 to less than 60% for at least 60 seconds) in the immediate postoperative period following cardiac surgery.
Fifty-three moderate to high-risk patients undergoing elective cardiac surgery were enrolled in this observational study. Cerebral oximeter monitors were placed on all patients prior to induction of anesthesia and remained in place for 6 hours or until the patients were extubated postoperatively, whichever occurred first. Data were recorded from the cerebral oximeter, physiologic monitor and ventilator during the study period. Data were analyzed to identify the incidence of early postoperative CDEs, as well as association with subsequent clinical events.
The incidence of early postoperative CDEs was 53%. Sixty-four percent of these CDEs lasted for more than 1 hour. Patients with postoperative CDEs were more likely to have had intraoperative CDEs (P< 0.0001). Five out of 28 patients who experienced CDEs in the intensive care unit died while none of the patients without postoperative CDEs died (P = .053).
A high incidence of CDEs (53%) was found in the early post-cardiac surgery period. Larger studies are needed to determine whether postoperative CDEs are correlated with various physiologic events or are associated with adverse patient outcomes.
Journal Article
Constructing a Blueprint for a Professional Development Module on Interventions for Bullying and Self-Advocacy for Nursing Faculty
Bullying remains a persistent issue among nursing faculty. Nursing faculty often claim they do not have the communication skills or the confidence to address bullying behaviors and to advocate for themselves. Instead, they often avoid the perpetrators or accept bullying as part of the nursing education environment. One possible solution involves creating a professional development module for nursing faculty. My Delphi study led to the creation of a blueprint for a professional development module on interventions for bullying and self-advocacy for nursing faculty. Over the three rounds of online questionnaires, an expert panel of nursing faculty suggested content areas, recommended instructional approaches, and rated their essentialness for inclusion in the module. Between rounds, I analyzed the open-ended questions using qualitative content analysis and the closed-ended questions using descriptive statistics. In all, there were 40 content areas and 6 instructional approaches that reached the consensus level of 70%. The final blueprint displayed the essential content areas and instructional approaches that reached consensus in priority order, using the mean ratings from the expert panelists. By targeting nursing faculty with a professional development module, the cycle of bullying can be interrupted. Nursing faculty can practice and develop confidence in their self-advocacy skills. Nursing faculty can show their students how to stand up for themselves as they teach them the skills, further reinforcing their learning while developing the next generation of nurses.
Dissertation