Use of IV Lidocaine Infusion Postoperatively Within the ERAS Surgical Population.

PURPOSE: The aim of this project was to investigate whether opioid pain scores, postoperative opioid requirements, and postanesthesia care unit (PACU) length of stay were impacted when comparing a 24-hour intravenous lidocaine infusion versus postoperative discontinuation of the lidocaine infusion. DESIGN: A retrospective chart review was used both before and after the discontinuation of postoperative lidocaine infusions for a quality improvement project. METHODS: The project was carried out in the adult surgery PACU setting at a level 1 trauma center between April 2021 and September 2021. The sample included 100 adult patients who fell under surgical specialties that used enhanced recovery after surgery protocol. After approval was obtained, data was collected via an electronic chart review using an evaluation tool created by the project team. FINDINGS: Between the five surgical specialties used for this review, the PACU length of stay variable was reduced only in the gynecology oncology service (P= .041). Additionally, the postoperative opioid requirements were significantly reduced in the surgical oncology service (P = .02). Comparing the groups as a whole, 50 participants who had a 24-hour continuous lidocaine infusion and 50 participants whose lidocaine infusion was discontinued before PACU admission had no statistically significant values with pain scores, postoperative opioid requirements, and PACU length of stay. CONCLUSIONS: Results indicate that a 24-hour lidocaine infusion did not impact this patient population's pain scores, postoperative opioid requirements, or PACU length of stay.

Process and outcomes of patient-centered medical care with Alaska Native people at Southcentral Foundation.

PURPOSE: This study describes key elements of the transition to a patient-centered medical home (PCMH) model at Southcentral Foundation (SCF), a tribally owned and managed primary care system, and evaluates changes in emergency care use for any reason, for asthma, and for unintentional injuries, during and after the transition. METHODS: We conducted a time series analyses of emergency care use from medical record data. We also conducted 45 individual, in-depth interviews with PCMH patients (customer-owners), primary care clinicians, health system employees, and tribal leaders. RESULTS: Emergency care use for all causes was increasing before the PCMH implementation, dropped during and immediately after the implementation, and subsequently leveled off. Emergency care use for adult asthma dropped before, during, and immediately after implementation, subsequently leveling off approximately 5 years after implementation. Emergency care use for unintentional injuries, a comparison variable, showed an increasing trend before and during implementation and decreasing trends after implementation. Interview participants observed improved access to primary care services after the transition to the PCMH tempered by increased staff fatigue. Additional themes of PCMH transformation included the building of relationships for coordinated, team-based care, and the important role of leadership in PCMH implementation. CONCLUSIONS: All reported measures of emergency care use show a decreasing trend after the PCMH implementation. Before the implementation, overall use and use for unintentional injuries had been increasing. The combined quantitative and qualitative results are consistent with decreased emergency care use resulting from a decreased need for emergency care services due to increased availability of primary care services and same-day appointments.

Attitudes toward oocyte donation among medical and nursing students and couples who have recently become parents: A Swedish study.

Aim: The aim of the present study was to investigate attitudes toward oocyte donation and receiving oocytes in relation to gender, demographic variables and other factors that could influence these attitudes, such as anonymity of the donor and financial compensation. Methods: The study population consisted of 595 subjects divided into two groups; one group contained men and women who had recently become parents and the other group consisted of medical and nursing students. All subjects were asked to answer a study-specific questionnaire. Results: The proportions of respondents positive toward oocyte donation were 32% in the student group and 37% in the parental group. Of the respondents in the student group, 87% were positive toward donating organs other than oocytes compared with 78% in the parental group (P < 0.05). In the parental group, the respondents that were positive toward organ donation in general were also more positive toward donating/partner donating and receiving/partner receiving oocytes (P < 0.001 and P < 0.01, respectively). The majority of the respondents stated that their attitudes were not affected by anonymity of the donation, financial compensation or knowing the outcome of the donation. Conclusion: Respondents' attitudes were unaffected by anonymity of the donation, financial compensation and knowing the outcome of the donation. However, the data suggest that respondents who were positive toward organ donation in general were also more positive toward donating/partner donating and receiving/partner receiving oocytes. (Reprod Med Biol 2008; 7: 161-168).

Guideline concordant detection and management of depression among Alaska Native and American Indian people in primary care.

BACKGROUND: A tribal health organization in Alaska implemented a primary care depression screening, detection and management initiative amongst 55,000 Alaska Native/American Indian people (AN/AIs). OBJECTIVES: (a) To describe the proportion of AN/AIs screening positive for depression with depression noted or diagnosed and proportion with guideline concordant management and (b) to assess whether management varied by patient and provider factors. RESEARCH DESIGN: Secondary analysis of electronic and paper medical record information of 400 AN/AIs. MEASURES: Provider variables, patient demographics and patient clinical factors were electronically queried. Manual chart audits assessed depression notation, diagnoses and management within 12 weeks of positive screening. Multilevel ordinal logistic modelling assessed management by patient and provider factors. RESULTS: A depression diagnosis was present in 141 (35%) charts and 151 (38%) had depressive symptoms noted. Detection was higher among AN/AIs with moderate and severe depression (p<0.001). In total, 258 patients (66%) received guideline concordant management, 32 (8%) had some management, and 110 (28%) received no management. Younger patient age and increased provider tenure increased odds of management. CONCLUSIONS: Most AN/AIs screening positive for depression received initial guideline concordant management. Additional outreach to older patients and additional support for providers newer to practices appears warranted.