Service-learning outreach to attract high school students to degrees and careers in agricultural sciences.

Given projected deficits and a lack of diversity, there is a critical need to recruit and develop the next generation of the agricultural workforce. The objectives of our study were to evaluate if AgCamp, a one day workshop focused on agriculture delivered through a college student-led service-learning platform: (1) increased high school students' knowledge of agriculture, (2) changed their interests in pursuing degrees and careers in agriculture, and (3) increased their comfort and confidence in communicating with others in agriculture. We hosted high school students at AgCamp and provided them with instruction in animal science, horticulture, and agricultural mechanics. Pre- and post-test survey instruments were developed and distributed at the beginning and end of AgCamp. Data were analyzed with SPSS 26.0 using paired sample t-tests. As a result of attending this outreach initiative, high school students (n = 26) reported having more knowledge of horticulture (P < 0.01) and agricultural mechanics (P < 0.01), but not animal science (P = 0.12), likely due to greater incoming knowledge of this sub-discipline, as reflected on the pre-test value. High school participants were also more interested in pursuing a college degree (P = 0.04) and career (P < 0.01) in agriculture and became more confident approaching other high school students (P < 0.01), college students (P < 0.01), and college faculty (P = 0.01) involved in agriculture. Ultimately, participating in AgCamp stimulated high school students' knowledge and interest in pursuing agricultural degrees and careers, indicating there is value in offering youth outreach as short-term programming to attract students to agriculture.

Perioperative pain management: an update for obstetrician-gynecologists.

The opioid epidemic in the United States is unprecedented and continues to worsen. Many opioid abusers obtain their pills through legitimate prescriptions, directly or indirectly, from a medical provider. While practitioners have a responsibility to treat pain, it is now becoming clear that aggressive opioid prescription practices contribute to an epidemic of abuse. The medical community has to balance the unintended consequences of opioid misuse and abuse with the need to provide adequate pain control. Additionally, providers are being held accountable by the legal system and professional organizations for their prescribing practices. Responsible use of opioids is paramount and pain control does not supersede safety. Effective and safe pain management requires that providers perform risk assessments, understand medication risks, avoid excessive reliance on opioids, and adequately monitor and educate patients. Obstetricians and gynecologists are uniquely positioned to influence pain management practices as primary care providers and surgeons who regularly manage both acute and chronic pain conditions. Therefore, the objective of this publication was to familiarize obstetricians and gynecologists with contemporary concepts in pain management and summarize recent guidelines in a manner that is applicable to our specialty. We focus on perioperative pain management, which is the time period immediately before, during, and after surgery. Topics reviewed include proper risk assessment to evaluate a patient's potential for poor pain control or development of chronic pain or misuse of opioids; multimodal pain management with nonpharmacological, nonopioid alternatives, safe opioid-use strategies; education and documentation; and special considerations for women, veterans, and lactation concerns.

Non-opioid pain management in benign minimally invasive hysterectomy: A systematic review.

BACKGROUND: Less postoperative pain typically is associated with a minimally invasive hysterectomy compared with a laparotomy approach; however, poor pain control can still be an issue. Multiple guidelines exist for managing postoperative pain, yet most are not specialty-specific and are based on procedures that bear little relevance to a minimally invasive hysterectomy. OBJECTIVE: The purpose of this study was to determine whether there is enough quality evidence within the benign gynecology literature to make non-opioid pain control recommendations for women who undergo a benign minimally invasive hysterectomy. STUDY APPRAISAL AND SYNTHESIS METHODS: We queried PubMed, ClinicalTrials.gov, and Cochrane databases using MeSH terms: "postoperative pain," "perioperative pain," "postoperative analgesia," "pain management," "pain control," "minimally invasive gynecologic surgery," and "hysterectomy." A manual examination of references from identified studies was also performed. All PubMed published studies that involved minimally invasive hysterectomies through November 9, 2016, were included. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were restricted to benign minimally invasive hysterectomies evaluating non-opioid pharmacologic therapies. Primary outcomes included amount of postoperative analgesics consumed and postoperative pain scores. Two reviewers independently completed an in-depth evaluation of each study for characteristics and results using an established database, according to inclusion/exclusion criteria. A risk assessment was performed, and a quality rating was assigned with the use of the Cochrane Collaboration's Grades of Recommendation, Assessment, Development and Evaluation approach. RESULTS: Initially 1155 studies were identified, and 24 studies met all inclusion criteria. Based on limited data of varying quality, intravenous acetaminophen, anticonvulsants and dexamethasone demonstrate opioid-sparing benefits; ketorolac shows mixed results in laparoscopic hysterectomies. Paracervical blocks provide pain-reducing benefits in vaginal hysterectomies. CONCLUSIONS: Convincing conclusions are difficult to draw because of the heterogeneous and contradictory nature of the literature. There is a clear need for more high-quality research that will evaluate each medication type for posthysterectomy pain control.

Wound Infiltration With Extended-Release Versus Short-Acting Bupivacaine Before Laparoscopic Hysterectomy: A Randomized Controlled Trial.

STUDY OBJECTIVE: To evaluate if preincision infiltration with extended-release liposomal bupivacaine provides improved overall pain relief compared with 0.25% bupivacaine after laparoscopic or robotic-assisted hysterectomy. DESIGN: A single-center double-masked randomized controlled trial (Canadian Task Force Classification I). SETTING: A tertiary-care community hospital. PATIENTS: Patients recruited from July 2015 through January 2016. Sixty-four patients were randomized, and 59 were analyzed for the primary outcome. INTERVENTIONS: Women scheduled to undergo multiport laparoscopic or robotic-assisted total hysterectomy for benign indications were randomized to receive preincision infiltration with undiluted liposomal bupivacaine or 0.25% bupivacaine. MEASUREMENTS AND MAIN RESULTS: The primary outcome was overall average pain intensity by numeric rating scale (0-10) using the Brief Pain Inventory (BPI) via telephone survey on postoperative day (POD) 3. A sample size of 28 per group (N = 56) was planned to detect a 30% change in pain scores. Secondary outcomes were overall average and worst numeric pain scores on PODs 1, 2, and 14; pain scores in hospital; BPI pain interference scores; and total opioid use. There were no demographic differences between the 2 groups. For the primary outcome, we found a decrease in the average (p = .02) pain scores on POD 3 in the liposomal bupivacaine group. We also found a decrease in worst pain scores on POD 2 (p = .03) and POD 3 (p = .01). There were no differences in pain scores while in the hospital or on POD 1 or POD 14. There were no differences in BPI pain interference scores, opioid use, or reported adverse effects. CONCLUSION: For laparoscopic and robotic-assisted multiport hysterectomies, there is evidence of decreased average postoperative pain with liposomal bupivacaine compared with 0.25% bupivacaine for port-site analgesia on POD 3, but no difference in opioid use or measures of functioning.