Diagnostic Screening of Bovine Mastitis Using MALDI-TOF MS Direct-Spotting of Milk and Machine Learning.

Novel strategies for diagnostic screening of animal and herd health are crucial to contain disease outbreaks, maintain animal health, and maximize production efficiency. Mastitis is an inflammation of the mammary gland in dairy cows, often resulting from infection from a microorganism. Mastitis outbreaks result in loss of production, degradation of milk quality, and the need to isolate and treat affected animals. In this work, we evaluate MALDI-TOF mass spectrometry as a diagnostic for the culture-less screening of mastitis state from raw milk samples collected from regional dairies. Since sample preparation requires only minutes per sample using microvolumes of reagents and no cell culture, the technique is promising for rapid sample turnaround and low-cost diagnosis. Machine learning algorithms have been used to detect patterns embedded within MALDI-TOF spectra using a training set of 226 raw milk samples. A separate scoring set of 100 raw milk samples has been used to assess the specificity (spc) and sensitivity (sens) of the approach. Of machine learning models tested, the gradient-boosted tree model gave global optimal results, with the Youden index of J = 0.7, sens = 0.89, and spc = 0.81 achieved for the given set of conditions. Random forest models also performed well, achieving J > 0.63, with sens = 0.83 and spc = 0.81. Naïve Bayes, generalized linear, fast large-margin, and deep learning models failed to produce diagnostic results that were as favorable. We conclude that MALDI-TOF MS combined with machine learning is an alternative diagnostic tool for detection of high somatic cell count (SCC) and subclinical mastitis in dairy herds.

From the Operating Room to the Front Lines: Shared Experiences of Nurse Anesthetists During the Coronavirus Pandemic.

Coronavirus disease 2019 (COVID-19) has resulted in severe health, economic, social, political, and cultural consequences while thrusting Certified Registered Nurse Anesthetists (CRNAs) at the forefront of battling an often invisible enemy. A mixed-methods study was conducted to assess the impact of the COVID-19 pandemic on CRNA practice. The purpose of the qualitative component of the study, a focused ethnography, was to use personal and group interviews to determine the shared experiences of CRNAs who worked during the COVID-19 pandemic. Six themes were identified: (1) CRNAs are part of the solution, (2) doing whatever it takes, (3) CRNAs are valued contributors, (4) removal of barriers promotes positive change, (5) trying times, and (6) expertise revealed. The quantitative component of the study will be discussed in a separate article.

When is it acceptable to allow a terminal patient to die? Pharmacy students' views from a London University.

Accompanied suicide is a controversial topic with varying practice across Europe; therefore, there is very little guidance on how healthcare professionals should be educated on accompanied suicide. This study implemented an anonymous, cross-sectional online survey to discover the perceptions of final-year MPharm students on accompanied suicide and the factors affecting one's views, with the aim of investigating the knowledge, awareness and opinions of pharmacy students regarding accompanied suicide, as well as education to pharmacy students. Surveys were disseminated to final-year pharmacy students at Kingston University between January and March 2019. The survey comprised of three sections: Section A consisting of definitions - to determine knowledge of pharmacy students. Section B including case studies - to understand the opinions of pharmacy students and identify influential patient factors. Section C involving demographics - to discover the influential participant factors. An ethics application was submitted and approved prior to conducting this study. The data yielded a total of 111 responses out of a possible 139 (80% response rate); 77.5% participants were unable to correctly define each term given, with many also agreeing their lack of knowledge affected their views. Overall, most pharmacy students disagreed with accompanied suicide, regardless of the patient factors. Additionally, religious participants were more likely to disagree with the patient request (p < 0.03). Three recommendations were concluded to improve the education of pharmacy students: (1) an approved medical organisation to specifically define terminology, (2) include accompanied suicide in the pharmacy syllabus and (3) include lesser known terminal illnesses on the pharmacy syllabus.

Postpoliomyelitis Syndrome and Reversal With Sugammadex: A Case Report.

Postpolio syndrome (PPS) is a disabling process characterized by progressive muscle weakness and atrophy that typically emerges decades after an initial poliomyelitis infection. Although the exact incidence of PPS is unknown, it is estimated that 25% to 40% of all poliomyelitis survivors are affected. Patients with PPS may have increased sensitivity to numerous anesthetic agents including neuromuscular blocking drugs. A case report of a patient with PPS undergoing general anesthesia for a cystoscopy procedure is presented. Because of a previous general anesthetic using traditional muscle relaxant reversal of neostigmine, which resulted in prolonged paralysis (6-8 hours) and an intensive care unit admission, sugammadex was used in the cystoscopy procedure. Excellent results were achieved. Following extubation, the patient sustained adequate respiratory effort demonstrated by respiratory rate, end-tidal carbon dioxide, and oxygen saturation within normal limits. Sugammadex administration led to a markedly improved outcome for a patient with a disabling muscle-weakening neurologic disorder. Use of this medication may be of value to other anesthesia providers caring for patients with PPS in an operative setting.

It's Never Just a Block: An Analysis of Regional Anesthesia Closed Claims.

Anesthesia care increasingly includes use of regional anesthesia techniques, either as a primary anesthetic or to reduce the patient's postoperative pain. Both neuraxial anesthesia and peripheral nerve blockade have several noteworthy functions. These functions include diminishing sensory sensation to pain and potentially producing a motor blockade, both of which may facilitate the surgical procedure. The desire to reduce reliance on opioid medications, protocols to enhance and accelerate patient recovery from surgery, and patient expectations all contribute to the likelihood that use of regional anesthesia will continue to gain popularity. As such, it is essential to understand whether an association exists between regional anesthesia and adverse outcomes of care. The American Association of Nurse Anesthetists Foundation Closed Claim Research Team searched the most current database of closed claims that involved adverse outcomes when either a peripheral nerve block or a neuraxial block was a component of care in the claims. Although there were only 32 claims in the dataset, a thematic analysis resulted in the identification of 3 themes: errors in cognitive decision making, ineffective communication patterns, and production pressure.

Preventable Closed Claims in the AANA Foundation Closed Malpractice Claims Database.

Medical errors are among the top 3 causes of patient deaths in the United States, with up to 400,000 preventable deaths occurring in hospitalized patients each year. Although improvements have been made in anesthesia patient safety, adverse outcomes continue to occur. This study used thematic analysis to examine anesthesia closed claims that were associated with preventable morbidity and mortality. Investigators determined that 123 closed malpractice claims files from the American Association of Nurse Anesthetists (AANA) Foundation closed claims database involved events that the involved Certified Registered Nurse Anesthetist could have prevented. Factors that were associated with preventable closed claims included communication failures, violations of the AANA Standards for Nurse Anesthesia Practice, and errors in judgment.

A Content and Thematic Analysis of Closed Claims Resulting in Death.

The analyses of malpractice closed claims conducted by the AANA Foundation Closed Claims Research Team are scientific studies of adverse anesthetic events where a Certified Registered Nurse Anesthetist was identified as potentially contributing to the outcome. From July 2013 to March 2014, the AANA Foundation Closed Claims Researchers evaluated 245 closed claims from the CNA Insurance Companies spanning from 2003 to 2012. An adverse event leading to death occurred in 87 of the claims. This article describes the use of content and thematic analysis in the evaluation of these closed claims. The purpose of the study was to establish themes that would provide unique insights into the events leading up to death with a focus on the role anesthesia may or may not have had in the outcome. Major themes identified include: (1) patient factors, (2) provider factors, (3) environmental factors, and (4) team/group factors.

Considerations for Management of Bupivacaine Formulation Shortage Affecting Obstetric Anesthesia Services.

Healthcare facilities across North America are experiencing a shortage of several formulations of bupivacaine affecting analgesia and anesthesia care, particularly for obstetric services. This editorial will discuss evidence-based considerations to address the bupivacaine shortage including interprofessional team engagement for planning, alternative anesthetic and analgesic management strategies for the obstetrical patient, and safe drug preparation. As leaders in healthcare, nurse anesthetists are encouraged to work closely with their anesthesia, pharmacy, obstetric, and facility leadership to develop best alternative solutions during this drug shortage to provide safe analgesic and anesthetic care.

Transfer of Care in Perioperative Settings: A Descriptive Qualitative Study.

Transfer of care is defined as the exchange of information and professional accountability for patient care between individuals. This article describes a qualitative content analysis (N = 19) using a closed-claims database generated by the American Association of Nurse Anesthetists (AANA) Foundation. The purpose of this study was to explore perioperative transfer-of-care events that contributed to professional malpractice claims to identify general themes, antecedents, and consequences to improve clinical practices and guide future research. A brief summary of the 6 themes that emerged in this study is as follows. (1) Patients should be transferred to an appropriate level of care based on their needs. (2) Production pressure leads to normalization of deviance. (3) Clinicians need to conduct their own patient assessments and health record reviews without relying solely on another clinician's report. (4) Interdisciplinary team communication failure is a leading cause of adverse outcomes. (5) Inadequate patient monitoring and physical assessment after the transfer of care is completed is a leading cause of adverse outcomes. (6) Transfer of care should not occur during high-risk patient care events or during periods of patient hemodynamic or respiratory instability.

Thematic Analysis of Obstetric Anesthesia Cases From the AANA Foundation Closed Claims Database.

Maternal morbidity and mortality in the United States continues to be high. Understanding parturient complications and causes of death is critical to determine corrective actions. Analysis of closed malpractice claims evaluates patient care, identifies preventable morbidity and mortality, and offers recommendations for improvement. A review of obstetric anesthesia malpractice claims filed against nurse anesthetists (N = 21), extracted from the American Association of Nurse Anesthetists Foundation Closed Claims database, was completed. The malpractice claims included 18 maternal claims and 3 neonatal claims. The most common adverse maternal outcomes were maternal death (8/18) and nerve injury (4/18). Hemorrhage accounted for the greatest number of maternal deaths (3/8) followed by cardiovascular failure, emboli, and neuraxial opioid overdose. All neonatal claims (3/3) involved hypoxic encephalopathy resulting in 1 neonatal death and 2 cases of neonatal permanent brain injury. The majority of maternal cases were identified as nonemergent (15/18) and involved relatively healthy patients (15 identified as ASA physical status 2). Qualitative analysis of closed claims provides the opportunity to identify patterns of injuries, precipitating events, and interventions to improve care. Themes related to poor outcomes in this study include care delays, failed communication, incomplete documentation, maternal hemorrhage, and lack of provider vigilance.