Tag: nevin manimala

Dent Med Probl. 2025 Mar 28. doi: 10.17219/dmp/167467. Online ahead of print.

ABSTRACT

BACKGROUND: Chitosan prepared with acetic acid is commonly used as an endodontic irrigant. However, the chitosan solution prepared with distilled water has not been evaluated for endodontic usage.

OBJECTIVES: The present study aimed to compare the effects of ethylenediaminetetraacetic acid (EDTA), fumaric acid, and the chitosan solutions prepared with distilled water (C-DW) and acetic acid (C-AA) on dentin microhardness and dentinal tubule penetration.

MATERIAL AND METHODS: Eighty maxillary central incisors were endodontically instrumented and randomly divided into 2 main groups (n = 40) for the evaluation of dentin microhardness and tubular penetration, with 4 subgroups in each main group (n = 10) according to the final irrigation solutions used (EDTA, fumaric acid, C-DW, and C-AA). The C-AA solution was prepared by diluting medium-molecularweight chitosan in acetic acid. The C-DW solution was prepared with distilled water and chitosan ammonium salts, which were synthesized using trichloroacetic acid and low-molecular-weight chitosan. After irrigation, the roots were sectioned horizontally 2 mm (the apical third) and 5 mm (the middle third) from the apex. The microhardness measurements were taken at depths of 500 μm and 1,000 μm from the canal lumen. The sections were examined for tubular penetration using confocal laser scanning microscopy. The data was analyzed using the analysis of variance (ANOVA), with a significance level set at p < 0.05.

RESULTS: The microhardness values were statistically similar at either depth for each third (p > 0.05), except for the 1,000-μm depth in the apical third, where the use of the C-AA solution resulted in lower microhardness as compared to fumaric acid (p < 0.05). No significant differences were observed in tubular penetration with regard to each third (p > 0.05).

CONCLUSIONS: All solutions showed a similar penetration ability in each third. At the 1,000-μm depth in the apical third, the fumaric acid solution provided a higher microhardness value than the C-AA solution.

PMID:40152894 | DOI:10.17219/dmp/167467

JAMA Health Forum. 2025 Mar 7;6(3):e250159. doi: 10.1001/jamahealthforum.2025.0159.

ABSTRACT

IMPORTANCE: Recently, there has been an emergence of veteran Medicare Advantage affinity plans (VMAPs) marketing to veterans, including those dually covered by the Veterans Health Administration (VHA). To date, limited evidence exists characterizing what benefits VMAPs offer and their veteran enrollees.

OBJECTIVE: To examine plan-level differences between VMAPs and other Medicare Advantage (MA) plans and characteristics of their veteran enrollees.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study compared the plan benefit design, supplemental benefit offerings, and veteran enrollee characteristics of all VMAP and other MA plan enrollees in 2022 using standardized mean differences (SMDs). VMAPs were identified based on military-associated words in their plan name and further validated through a web-based search. Data were analyzed from April 2023 to August 2024.

EXPOSURE: VMAP designation.

MAIN OUTCOMES AND MEASURES: Plan-level characteristics, supplemental benefits, and veteran enrollee characteristics.

RESULTS: The sample included 188 VMAPs with 179 449 veteran enrollees and 3442 other MA plans with 954 581 veteran enrollees. A total of 1 088 938 (96.0%) were male, 3558 (0.3%) were American Indian or Alaska Native, 8845 (0.8%) were Asian or Pacific Islander, 162 934 (14.4%) were Black, 61 264 (5.4%) were Hispanic, and 876 234 (77.3%) were White; the mean (SD) age was 75.9 (8.6) years. Most VMAPs were administered by for-profit insurers (173 [92.0%]; SMD, 0.42), including Aetna (46 [24.9%]), Humana (36 [19.5%]), and United HealthCare (49 [26.5%]). Compared with veterans in other MA plans, veterans in VMAPs were slightly younger (mean [SD] age, 73.7 [8.0] years vs 76.3 [8.7] years; SMD, 0.31), more likely to be Black (34 837 [19.4%] vs 128 097 [13.4%]; SMD, 0.18), and more likely to have zero cost sharing for VHA services (ie, priority group 1) (62 056 [34.6%] vs 195 688 [20.5%]; SMD, 0.40). VMAPs were more likely than other MA plans to offer $0 plan premiums (186 [98.9%] vs 2064 [60.0%]; SMD, 1.10), and Medicare Part B premium reductions (140 [74.5%] vs 298 [8.7%]; SMD, 1.80), averaging $33 more in cash back benefits. Only 1 VMAP offered Medicare Part D coverage compared with most other MA plans (1 [0.5%] vs 3293 [95.7%]; SMD, 6.23). VMAPs were more likely than other MA plans to provide comprehensive dental coverage (179 [95.2%] vs 3006 [87.3%]; SMD, 0.28), hearing aids (184 [97.9%] vs 3012 [87.5%]; SMD, 0.40), eyewear (188 [100%] vs 3620 [94.7%]; SMD, 0.33), over-the-counter drug coverage (179 [95.2%] vs 2831 [82.2%]; SMD, 0.42), and meal benefits (151 [80.3%] vs 2348 [68.2%]; SMD, 0.28).

CONCLUSIONS AND RELEVANCE: This study found that MA insurers-specifically VMAPs-engaged in targeted marketing to veterans, offering $0 premiums, cash back benefits, and supplemental benefits. However, nearly all VMAPs excluded Medicare Part D, likely designed to attract veteran enrollees who use VHA care, making them low-cost enrollees to the plan. Since the VHA cannot bill plans for Medicare-covered services, VMAPs may be increasing wasteful federal spending.

PMID:40152874 | DOI:10.1001/jamahealthforum.2025.0159

JAMA Health Forum. 2025 Mar 7;6(3):e250273. doi: 10.1001/jamahealthforum.2025.0273.

ABSTRACT

IMPORTANCE: Acculturation among Hispanic/Latino populations, defined as adaptation to US lifestyle and culture, is often assumed to lead to adverse health outcomes that will reduce the immigrant health advantage.

OBJECTIVE: To evaluate the risks for incident diabetes and hypertension by levels of acculturation and educational attainment.

DESIGN, SETTING, AND PARTICIPANTS: This study used data from the Hispanic Community Health Study/Study of Latinos, a population-based cohort study of men and women aged 18 to 74 years who identified as Central American, Cuban, Dominican, Mexican, Puerto Rican, or South American living in 4 urban locales in the US. Visit 1 spanned March 2008 to June 2011; visit 2 spanned October 2014 to December 2017.

MAIN OUTCOMES AND MEASURES: Multivariable logistic regression was used to evaluate the association between language acculturation level defined by the Short Acculturation Scale for Hispanics (SASH) and educational attainment (less than high school graduate vs more than high school) and incident diabetes and hypertension by heritage group.

RESULTS: Of 11 623 adult participants, 1207 (10.4%) were of Central American heritage, 1645 (14.2%) of Cuban heritage, 1021 (8.8%) of Dominican heritage, 11 623 (41.3%) of Mexican heritage, 1801 (15.5%) of Puerto Rican heritage, and 795 (6.8%) of South American heritage. The mean (SE) age of all participants was 43.1 (0.3) years, and 7345 (56.3%) were female. A total of 8697 (71.4%) were born outside the US, 4358 (32.5%) had less than a high school education, and 7475 (58.3%) were less acculturated (SASH score less than 2). Incident rates of diabetes (total cohort, 14.6% [95% CI, 13.6%-15.6%]) and hypertension (total cohort, 20.4% [95% CI, 19.0%-21.9%]) varied across heritages; Mexican individuals (17.2% [95% CI, 15.5%-19.0%]) had the highest diabetes incidence and Dominican individuals the highest hypertension incidence (27.1% [95% CI, 22.7%-31.4%]). Persons with more educational attainment were at lower risk for diabetes and hypertension independent of acculturation, and more acculturated participants had a lower risk for incident diabetes. Less acculturated with lower socioeconomic status (SES) were more likely to have incident diabetes (weighted predicted probability [WPP], 0.17 [95% CI, 0.14-0.19]), and more acculturated with lower SES had the highest predicted probability of hypertension (WPP, 0.19 [95% CI, 0.15-0.23]). More acculturated with higher SES were at lower risk of diabetes (WPP, 0.11 [95% CI, 0.09-0.13]) and had a lower predicted probability of hypertension (WPP, 0.10 [95% CI, 0.08-0.12]).

CONCLUSIONS AND RELEVANCE: In this cohort study, the association of acculturation with health outcomes is not unidirectional and interacts with educational attainment in determining incident diabetes and hypertension. The Hispanic and Latino paradox, in which immigrants have a health advantage, is influenced by more factors than acculturation and may persist with higher educational attainment. These observations may inform prevention and treatment strategies associated with cardiometabolic health in Hispanic/Latino populations.

PMID:40152873 | DOI:10.1001/jamahealthforum.2025.0273

J Laparoendosc Adv Surg Tech A. 2025 Mar 28. doi: 10.1089/lap.2025.0003. Online ahead of print.

ABSTRACT

Purpose: Minimally invasive surgery is the standard approach for colorectal cancers and requires an abdominal incision for specimen removal. Natural orifice specimen extraction (NOSE) may improve outcomes, reducing trauma, and speeding postoperative recovery. This study compares both techniques regarding postoperative complications, operative outcomes, and recurrence. Methods: We searched PubMed, Scopus, and Cochrane Central Register of Clinical Trials for studies published up to November 2024. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using a random-effects model, and heterogeneity was assessed with I² statistics. Statistical analyses were conducted using R Software version 4.4.1 (R Foundation for Statistical Computing). Results: Four randomized controlled trials involving 439 patients with colorectal cancer were included, with 212 (48.2%) undergoing NOSE and 227 (51.7%) undergoing conventional laparoscopic specimen extraction. NOSE significantly reduced postoperative pain (visual analog scale score: mean difference [MD] -1.8; 95% confidence interval [CI] -2.5 to -1.1; P = .01), time to pass flatus (MD -0.8; 95% CI -1.1 to -0.6; P < .01), and surgical site infection rates (OR 0.15; 95% CI 0.03-0.69; P = .015) but was associated with a longer operative time (MD 11.1 minutes; 95% CI 1.5-20.6; P = .02). No significant differences were observed between the groups in bowel leaks, lymph nodes harvested, intraoperative blood loss, hospital stay duration, or local recurrence rates. Conclusion: NOSE was associated with reduced postoperative pain, faster time to pass flatus, and lower infection rates but required longer operative time than conventional laparoscopic specimen extraction. Other outcomes, including complications, operative characteristics, and recurrence, showed no significant differences between the techniques.

PMID:40152871 | DOI:10.1089/lap.2025.0003

JAMA Netw Open. 2025 Mar 3;8(3):e252290. doi: 10.1001/jamanetworkopen.2025.2290.

ABSTRACT

IMPORTANCE: Washington, District of Colombia (DC), has the largest gap in life expectancy between Black and White populations among major US cities.

OBJECTIVE: To investigate mortality, key modifiable cardiovascular disease (CVD) risk factors, and temporal trends for non-Hispanic Black and non-Hispanic White populations in Washington, DC, from 2000 to 2020.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database for mortality and the Behavioral Risk Factor Surveillance System for the prevalence of risk factors (obesity, hypertension, diabetes, smoking, and hypercholesterolemia) among Black and White populations in Washington, DC, from 2000 to 2020. All analyses were conducted in January 2024.

MAIN OUTCOMES AND MEASURES: All-cause and cause-specific, age-adjusted mortality rates per 100 000 person-years, prevalence of risk factors, and corresponding rate ratios (RRs) and 95% CIs comparing Black individuals to White individuals were assessed. Average annual percentage change (AAPC) was examined using joinpoint regression.

RESULTS: Among 102 710 deaths in Washington, DC (51 712 among males [50.3%], 26 100 among individuals aged ≥85 years [25.4%]; 82 308 among Black [80.1%] and 20 402 among White [19.9%] individuals), CVD (33 254 deaths [32.4%]) and cancer (22 677 deaths [22.1%]) accounted for more than half of deaths. All-cause mortality declined between 2000 and 2012 (AAPC, -2.6%; 95% CI, -4.5% to -1.9%), stagnated between 2012 and 2018, and increased between 2018 and 2020 (AAPC, 10.9%; 95% CI. 3.8% to 15.1%). CVD mortality declined between 2000 and 2011 (AAPC, -3.1%; 95% CI, -4.3% to -2.4%) and plateaued thereafter in the Black population, contrasting with the monotonic decline in the White population from 2000 to 2020 (AAPC, -4.7%; 95% CI, -5.3% to -4.1%), for a magnification of disparities from 2000 (RR, 1.5; 95% CI, 1.4 to 1.7) to 2020 (RR, 2.9; 95% CI, 2.5 to 3.3). Cancer mortality decreased from 2000 to 2020 but with a greater magnitude in the White (AAPC, -3.4%; 95% CI, -3.9% to -2.9%) than Black (AAPC, -1.8%; 95% CI, -2.2% to -1.4%) population (RR for 2000, 1.6; 95% CI, 1.4 to 1.8 and RR for 2020, 2.1; 95% CI, 1.8 to 2.4). Risk factors were consistently more prevalent in the Black than White population (eg, hypertension: RR, 2.2; 95% CI, 1.8 to 2.7 in 2001 and 2.3; 95% CI, 1.9-2.6 in 2019). Disparities as assessed by RRs increased for smoking (AAPC, 4.3%; 95% CI, 3.8% to 5.6%), decreased for obesity (AAPC, -1.2%; 95% CI, -1.9% to -0.4%), and remained constant for diabetes, hypercholesterolemia, and hypertension.

CONCLUSIONS AND RELEVANCE: In this study, all-cause, age-adjusted mortality was higher in the Black than White population, racial disparities worsened for CVD and cancer, and CVD risk factors were more prevalent in the Black population, underscoring the urgent need for precision public health interventions tailored toward high-risk populations.

PMID:40152862 | DOI:10.1001/jamanetworkopen.2025.2290

JAMA Netw Open. 2025 Mar 3;8(3):e252371. doi: 10.1001/jamanetworkopen.2025.2371.

ABSTRACT

IMPORTANCE: For deaths preceded by nonfirearm force by law enforcement officers, mortality classification has potential implications for public accountability and epidemiologic surveillance.

OBJECTIVE: To characterize the proportion of in-custody deaths for which cause and manner of death reflected the use of nonfirearm force by police officers and to assess factors associated with mortality classification.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined national data from the Associated Press’s Lethal Restraint database. The analysis included deaths that occurred in 2012 to 2021 following the use of nonfirearm force by state or local police officers and that did not occur in prisons or jails.

EXPOSURES: Death investigation system (medical examiner, coroner, or sheriff-coroner), racial and ethnic bias, and county political context (percentage of Republican presidential votes).

MAIN OUTCOMES AND MEASURES: Manner of death classification (homicide vs accident, undetermined, natural, suicide, and any manner), mention of force-related injuries or conditions in the cause-of-death statement (yes vs no), and mention of any force in the cause-of-death statement (yes vs no) were assessed using logistic regression models.

RESULTS: A total of 940 decedents (mean [SD] age, 39 [11] years; 909 men [97.0%]; 297 identified as Black [32.4%], 179 as Hispanic or Latinx [19.6%], 401 as White [43.9%], and 37 as other [4.0%] race and ethnicity) were included. Of the 940 deaths, 268 (28.5%) were classified as homicide, and 155 (16.5%) were mentioned as a force-related injury or condition and 400 (42.6%) as any force in the cause-of-death statement. In contrast, 695 cause-of-death statements (73.9%) mentioned drugs. Unadjusted results showed that homicide classification increased from 25.0% (66 of 264 deaths) during 2012-2014 to 32.2% (123 of 382 deaths) during 2018-2021. Models estimating adjusted prevalence differences showed that compared with medical examiner jurisdictions, coroners (-0.19; 95% CI, -0.31 to -0.06) and sheriff-coroners (-0.17; 95% CI, -0.28 to -0.05) were less likely to classify deaths as homicides. Model results also showed that classifications for incidents occurring in counties with the lowest percentage of Republican voters were the most likely to reflect force across all 3 manner and cause outcomes (0.17 [95% CI, 0.05-0.28] for homicide, 0.22 [95% CI, 0.06-0.38] for any mention of force, and 0.14 [95% CI, 0.023-0.26] for force-related injuries or conditions).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of deaths following use of nonfirearm force by police officers, nonhomicide classifications and cause-of-death statements making no mention of force were widespread. These findings suggest that inconsistent classification of the cause and manner of deaths that follow nonfirearm force by police officers is an issue of public safety and health with profound social implications.

PMID:40152860 | DOI:10.1001/jamanetworkopen.2025.2371

JAMA Netw Open. 2025 Mar 3;8(3):e252380. doi: 10.1001/jamanetworkopen.2025.2380.

ABSTRACT

IMPORTANCE: Despite constituting 8% of the US population, people who speak languages other than English (LOE) are consistently underrepresented in health-focused research. To make research more inclusive and generalizable, it is crucial to better understand researcher perspectives on barriers to inclusion of participants using LOE and solutions to promote language justice.

OBJECTIVE: To assess researcher perspectives on barriers to and best practices for inclusion of participants using LOE and to generate strategies to make research more inclusive.

DESIGN, SETTING, AND PARTICIPANTS: This exploratory cross-sectional survey study used an anonymous digital Qualtrics survey distributed between March 1 and June 30, 2023. The study was conducted among principal investigators (PIs) and research coordinators at the University of Pittsburgh, Pennsylvania. Any PIs or research coordinators who conducted human participant research in the past 5 years were eligible to participate. A convenience sample, using department emails, research electronic mailing lists, a recruitment repository, and word of mouth, was recruited.

MAIN OUTCOMES AND MEASURES: Survey questions, drafted with input from community partners, assessed researcher demographics, experience working with participants using LOE, barriers to inclusion, and recommendations to increase research inclusivity. All variables were analyzed using descriptive statistics to calculate means, SDs, and frequencies.

RESULTS: There were 339 respondents who completed the survey (260 cisgender females or women [76.7%]). Of these respondents, 127 (37.5%) were PIs and 212 (62.5%) were research coordinators. In terms of race and ethnicity, 8.8% were Asian; 3.8% were Black, African, or African American; 2.4% were Hispanic, Latino, Latina, Latine, or Latinx; 0.9% were Middle Eastern or North African; 70.5% were White; 6.5% were of other race or ethnicity or were multiracial; 2.7% preferred not to say; and 4.4% had missing data. Most respondents primarily conducted clinical research (239 [70.5%]), and 170 (50.1%) worked with participants using LOE in the prior 5 years. In 188 reported cases in which inclusion occurred, 78 respondents (41.5%) did not proactively include participants using LOE but instead reactively included interested participants after studies had begun. Respondents listed lack of training, time and scheduling challenges around interpreter services, and budget constraints as barriers to inclusion. Recommendations to improve inclusion were made by 272 respondents (80.2%), 265 (78.2%) of whom suggested access to low-cost interpreters and translators, 249 (73.5%) of whom suggested training, and 272 (80.2%) of whom suggested availability of validated measures in different languages.

CONCLUSIONS AND RELEVANCE: In this survey study of health PIs and research coordinators affiliated with 1 academic institution, respondents faced multiple barriers to including participants who use LOE in their studies. Because a lack of language representation may compromise the quality and applicability of research, purposeful individual and institutional investments are needed to overcome these barriers.

PMID:40152859 | DOI:10.1001/jamanetworkopen.2025.2380

JAMA Netw Open. 2025 Mar 3;8(3):e252404. doi: 10.1001/jamanetworkopen.2025.2404.

ABSTRACT

IMPORTANCE: Examining how discrimination is associated with mental health across different demographic groups can guide efforts to improve mental well-being.

OBJECTIVES: To analyze associations between discrimination and mental health and explore how these associations may vary by race and ethnicity and sex.

DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional data of 29 522 adults weighted to represent a population of 258 237 552 US adults from the 2023 US National Health Interview Survey were analyzed.

EXPOSURES: Exposure to discrimination was measured using the Everyday Discrimination Scale, which assesses frequency of being treated with less courtesy, receiving poor service, being treated as not smart, being feared, and experiencing harassment. A summative scale and a nominal variable (none, low, and high) measured degree and levels of discrimination exposure.

MAIN OUTCOMES AND MEASURES: Outcomes included depression (measured with the Patient Health Questionnaire-2 scale) and anxiety (measured with the Generalized Anxiety Disorder-2 scale), with scores of 3 or greater indicating positive screening results for each scale. Multinomial logistic regression analyses examined associations of interest and tests of interaction explored effect modification by race and ethnicity and sex.

RESULTS: Among a sample of 29 522 adults weighted to represent a population of 258 237 552 US adults (mean age, 48.1 years [95% CI, 47.8-48.4 years]; 51.1% female; 17.5% Hispanic or Latino, 2.5% multiracial or other, 6.2% non-Hispanic Asian, 11.6% non-Hispanic or non-Latino Black, and 62.2% non-Hispanic or non-Latino White), each unit increase in exposure to discrimination was associated with increased odds of positive screening results for depression (odds ratio [OR], 1.15 [95% CI, 1.12-1.17]), anxiety (OR, 1.14 [95% CI, 1.12-1.16]), and both depression and anxiety (OR, 1.19 [95% CI, 1.16-1.21]). Compared with no exposure to discrimination, low and high exposure to discrimination were associated with increased odds of positive screening results for depression (low exposure: OR, 2.20 [95% CI, 1.77-2.72]; high exposure: OR, 5.39 [95% CI, 3.61-8.04]), anxiety (low exposure: OR, 1.97 [95% CI, 1.66-2.33]; high exposure: OR, 4.98 [95% CI, 3.59-6.91]), and both depression and anxiety (low exposure: OR, 2.60 [95% CI, 2.13-3.18]; high exposure: OR, 8.84 [95% CI, 6.44-12.14]). Associations between discrimination and positive screening results for depression alone (F4,607 = 3.35; P = .01) and between discrimination and positive screening results for both depression and anxiety (F4,607 = 2.80; P = .03) varied by race and ethnicity. Associations of interest did not differ by sex.

CONCLUSIONS AND RELEVANCE: Findings of this cross-sectional study suggest an association between discrimination and mental health across US adults, emphasizing the need for further evaluation and increased awareness of how these associations may vary across different demographic groups.

PMID:40152858 | DOI:10.1001/jamanetworkopen.2025.2404

Environ Health Perspect. 2025 Mar 28. doi: 10.1289/EHP15465. Online ahead of print.

ABSTRACT

BACKGROUND: Innovation in mass spectrometry-based methods to both quantify and perform discovery has blurred the lines between targeted and untargeted assays of biospecimens. Continuous data-concentrations or intensity values generated from both methods-can be used in statistical analysis to determine associations with health outcomes, but concentration values are needed to compare measurements from one study to another, to inform policy making decisions, and to develop clinically relevant thresholds. As a single solution for discovery and quantitation, new hybrid-type assays derive concentration values for chemicals or metabolites, but with varying degrees of uncertainty that may be greater than traditional quantitative assays. There is no current single standard to guide reporting bioassay concentrations or their uncertainty in concentration values from hybrid assays. Even when measures are robust, obtained with high scientific rigor, and provide valuable data towards risk assessment, unknown uncertainty can lead to bias in interpretation of reported data or omission of reported data that doesn’t meet the strict criteria for absolute quantitation.

OBJECTIVE: The objective of this commentary is to articulate a scheme that enables investigators across bioanalytical fields to easily report analyte measurement assurance on the same scale from quantitative, untargeted, or hybrid assays that include a range of concentration confidences.

DISCUSSION: We propose a simple scheme to report concentrations for targeted and untargeted analytes. Level 1 is a confirmed concentration following established tolerances in a fully quantitative assay while Level 5 is a tentative intensity from a typical untargeted assay. This framework enables easy communication of uncertainty in concentration measurements to aid cross-validation, meta-analysis, and extrapolation across studies. It will facilitate interpretation while supporting analytical advancement and allow clear and concise measurement reporting across a broad range of confidences. https://doi.org/10.1289/EHP15465.

PMID:40152856 | DOI:10.1289/EHP15465

J Perianesth Nurs. 2025 Mar 27:S1089-9472(24)00533-1. doi: 10.1016/j.jopan.2024.11.006. Online ahead of print.

ABSTRACT

PURPOSE: To reduce pain scores with intravenous (IV) insertion by 50% over 2 months among children in the ambulatory surgery center within a pediatric academic hospital.

DESIGN: Evidence-based quality improvement project.

METHODS: The project was implemented on a pediatric ambulatory surgery unit within a large, urban pediatric academic hospital. Interventions included implementing an evidence-based needleless anesthetic (J-Tip) with 1% buffered lidocaine. The team collected baseline data based on the standard unit practice before implementation. Our primary outcome was the mean pain scores during IV insertions for children receiving a peripheral IV for ambulatory surgery, and our secondary outcomes were pain scores with the application of the anesthetics and the number of IV attempts. This was carried out through practice changes implemented in Plan-Do-Study-Act (PDSA) cycles.

FINDINGS: Mean pain scores decreased by 72%. This was a statistically significant improvement (P < .05) from baseline (x̄ = 5.3) to post intervention (x̄ = 1.5). We found a slight decrease in IV attempts in the intervention group, from 1.47 to 1.35.

CONCLUSIONS: This quality improvement project significantly enhanced the quality of care for pediatric patients in the ambulatory surgery unit by effectively decreasing pain associated with IV insertions. By implementing evidence-based strategies such as needleless anesthetic devices, perianesthesia nurses can minimize pain and create a less intimidating environment for pediatric patients.

PMID:40152851 | DOI:10.1016/j.jopan.2024.11.006