Effect of Midazolam in Addition to Propofol and Opiate Sedation on the Quality of Recovery After Colonoscopy: A Randomized Clinical Trial.

BACKGROUND: There is a concern that midazolam, when used as a component of sedation for colonoscopy, may impair cognition and prolong recovery. We aimed to identify whether midazolam produced short- and longer-term effects on multiple dimensions of recovery including cognition. METHODS: A 2-center double-blinded, placebo-controlled, parallel-group, randomized, phase IV study with a 1:1 allocation ratio was conducted in adults ≥18 years of age undergoing elective outpatient colonoscopy, with sufficient English language proficiency to complete the Postoperative Quality of Recovery Scale (PostopQRS). Participants were administered either midazolam (0.04 mg·kg) or an equivalent volume of 0.9% saline before sedation with propofol with or without an opiate. The primary outcome was incidence of recovery in the cognitive domain of the PostopQRS on day 3 after colonoscopy, which was analyzed using a χ test. Secondary outcomes included recovery in other domains of the PostopQRS over time, time to eye-opening, and hospital stay, and patient and endoscopist satisfaction. All hypotheses were defined before recruitment. RESULTS: During September 2015 to June 2018, 406 patients were allocated to either midazolam (n = 201) or placebo (n = 205), with one withdrawn before allocation. There was no significant difference in recovery in the cognitive domain of the PostopQRS on day 3 after colonoscopy (midazolam 86.8% vs placebo 88.7%, odds ratio, 0.838; 95% confidence interval [CI], 0.42-1.683; P= .625). Furthermore, there was no difference in recovery over time in the cognitive domain of the PostopQRS (P = .534). Overall recovery of the PostopQRS increased over time but was not different between groups. Furthermore, there were no differences between groups for nociceptive, emotive, activities-of-daily-living domains of the PostopQRS. Patient and endoscopist satisfaction were high and not different. There were no differences in time to eye-opening (midazolam 9.4 ± 12.8 minutes vs placebo 7.3 ± 0.7 minutes; P = .055), or time to hospital discharge (midazolam 103.4 ± 1.4 minutes vs placebo 98.4 ± 37.0 minutes; P = .516). CONCLUSIONS: The addition of midazolam 0.04 mg·kg as adjunct to propofol and opiate sedation for elective colonoscopy did not show evidence of any significant differences in recovery in the cognitive domain of the PostopQRS, overall quality of recovery as measured by the PostopQRS, or emergence and hospital discharge times. The use of midazolam should be determined by the anesthesiologist.

Standardizing Nurse Leader Safety Rounds to Promote Highly Reliable Care.

BACKGROUND: Despite decades of intensive resource allocation to eliminate preventable harm and increase high reliability in the hospital, the prevalence of serious harm remains consistent. LOCAL PROBLEM: A hospital reduced targeted preventable harms using audit and feedback (A&F) but failed to globally reduce harm or increase proactive awareness. Nurse leaders lacked a defined process for identifying errors, mitigating risk, and teaching systems thinking to influence resiliency among teams. METHODS: Nurse leaders underwent A&F of daily safety rounds. Adherence data on frequency, high-quality, and high-reliability organizational (HRO) leader practice standards and precursor incident reporting rates were trended. RESULTS: Rounding practice adherence increased for the following defined standards: frequency (63%-79%); high quality (50%-90%); and HRO leadership (0%-67%). Precursor incident reporting rates increased 25%. CONCLUSIONS: A&F reinforced quality and accountability for daily safety rounds. HRO theory-guided feedback offered an innovative way to translate HRO influence into nurse leader practice.

Advocating for People With Disabilities Through Inclusion in Nursing Education.

Providing staff with nursing education that reflects care of people with disabilities is vital to promote equitable care. Professional development specialists can design educational tools that address diversity, equity, and inclusion objectives that include care of this minority. Nursing staff who are educated to apply these concepts can improve health outcomes for this patient population. [J Contin Educ Nurs. 2024;55(1):10-12.].

From the bottom up: the roots of social neuroscience at risk of running dry?

A second-person neuroscience, as an emerging area of neuroscience and the behavioral sciences, cannot afford to avoid a bottom-up, subcortical, and conative-affective perspective. An example with canid social play and a modern motivational behavioral neursocience will illustrate our point.

Age-related changes to electroencephalographic markers of visuomotor error processing and learning in prism adaptation.

Aging is associated with changes in cognitive function, including declines in learning, memory, and executive function. Prism adaptation (PA) is a useful paradigm to measure changes in explicit and implicit mechanisms of visuo-motor learning with age, but the neural correlates are not well understood. In the present study, we used PA to investigate visuo-motor learning and error processing in older adults. Twenty older adults (56-85 yrs) and 20 younger adults (18-33 yrs) underwent a goal-oriented reaching task while wearing prism goggles as continuous EEG was recorded to examine neural correlates of error detection. We examined behavioural measures of PA, as well as ERP components previously found associated with the early and late phases of adaptation to visual distortion caused by the prism goggles. Our results indicate important age-related behavioural and neurophysiological differences. Older adults reached more slowly than younger adults but showed the same accuracy throughout the prism exposure. Older adults also displayed larger aftereffects, indicating preserved visuomotor adaptation. EEG results indicated similar initial error processing in older and younger adults, as measured by the feedback error related negativity (FRN). As seen previously in young adults, the P3a and P3b declined over the prism exposure phase in both groups. Older adults displayed reduced P3a amplitude compared to the younger group in the early phase of adaptation, however, suggesting reduced attentional orienting. Finally, the older group exhibited a greater P3b amplitude compared to the younger group in the later phases of adaptation, potentially a marker of enhanced context updating underlying spatial realignment, leading to their larger aftereffect. Implications for age-related learning differences and clinical applications are discussed.

Using a Simulation to Increase Awareness of the Impact of Poverty on Health Care.

A poverty simulation can increase participants' knowledge of the impact of poverty on patients' health care choices. Professional development specialists can develop poverty simulations for their health care organizations. Planning and delivering a successful simulation requires preparation beforehand to logistically implement a simulation that has a positive, meaningful impact. [J Contin Educ Nurs. 2022;53(2):57-58.].

Roadmap to Wellness: Exploring Live Customized Music at the Bedside for Hospitalized Children.

BACKGROUND: Randomized trials on clinical outcomes of music are conflicting, with few performed in the postoperative pediatric population. We aimed to determine if there was a benefit of a live, customized bedside music delivery program (MyMusicRx®) for children hospitalized after pediatric surgery. We present our perspective on the utility of music medicine, review others' work in this area, and discuss future directions. METHODS: All admitted postsurgical patients aged between 5 and 18 years were considered. One live, customized music session was delivered by a MyMusicRx® music specialist to intervention participants, and compared with matched controls who did not receive music intervention. Pain, cumulative analgesia dosage, and vital signs within 12 h after unit arrival were compared between groups. RESULTS: Thirty-two participants (16 intervention, 16 controls; 8:8 females:males per group) were enrolled. No differences in age, surgery length, or duration of music intervention were found between groups. No differences in pain scores (p = 0.73), heart rate (p = 0.82), respirations (p = 84), narcotic (p = 0.92) or non-narcotic medication usage (p = 0.88, 0.86, 0.95; ibuprofen, acetaminophen, and ketorolac, respectively), or time to first narcotic dose (p = 0.64) were found. CONCLUSION: A single music intervention in the acute postoperative period did not appear to be adequate to augment traditional methods of pain and hemodynamic control. Prior studies have similar outcome measures but conflicting results. We did not evaluate psychological well-being, patient engagement, or family perception in this pilot study. Future directions include developing and validating a tool that explores the observable impact of music medicine on children's emotions and behaviors.

En bloc resection of a C-1 lateral mass osteosarcoma: technical note.

Osteosarcoma is an aggressive primary bone tumor. It is currently treated with multimodality therapy including en bloc resection, which has been demonstrated to confer a survival benefit over intralesional resection. The authors present the case of an 8-year-old girl with a C-1 lateral mass osteosarcoma, which was treated with a 4-stage en bloc resection and spinal reconstruction. While technically complex, the feasibility of en bloc resection for spinal osteosarcoma should be explored in the pediatric population.