Outpatient Laparoscopic Cholecystectomy

Outpatient Laparoscopic Cholecystectomy was attempted in 98 patients selected from 266 patients presenting for elective cholecystectomy (37%). Two patients required admission following conversion to “open” Cholecystectomy, one patient was admitted for observation because of a technically difficult Laparoscopic Cholecystectomy and 16 patients were admitted because of refractory nausea and vomiting in the early post-operative period. Seventy-nine patients (81%) were able to be discharged home within 4 to 6 hours of surgery, with only one patient requiring readmission to hospital because of the onset of nausea and vomiting. There were no post-operative complications attributable to the outpatient experience. We believe this approach to elective gallbladder pathology can be safely accomplished in selected patients and will be increasingly utilized in the future.     

Nutrition Management in Women with Gestational Diabetes Mellitus: A Review by ADA's Diabetes Care and Education Dietetic Practice Group

Gestational diabetes mellitus (GDM) is the most common medical disorder complicating pregnancy that requires the services of a registered dietitian. Despite three international workshops on GDM, many questions remain regarding its epidemiology, pathophysiology, screening, diagnosis, and management. Registered dietitians encounter these controversial issues when working with women referred for GDM education and counseling. Nutrition intervention remains the cornerstone of therapy. The purpose of this article is not to provide practice guidelines but to review the literature and current practices in research centers across the United States. Registered dietitians are in a position to individualize nutrition care to each woman's needs and to participate in the decision-making process of nutrition management. J Am Diet Assoc. 1995; 95:460–467.     

Accuracy of Equations to Predict Basal Metabolic Rate in Older Women

Objective To assess the accuracy of several published equations for predicting basal metabolic rate (BMR) in older women.

Design BMR was assessed in 116 healthy, older white women, aged 60 to 82 years, on three successive mornings by indirect calorimetry. Body composition was determined by dual energy X-ray absorptiometry or hydrostatic weighing. The measured BMRs were compared with values obtained from eight published prediction equations that used solely, or in various combinations, measures of height, weight, fat-free mass, age, and menopausal status.

Statistical analyses performed The root mean squared prediction error (RMSPE) was used to determine how accurately predicted BMR matched actual BMR for each subject. In addition, regression analysis was used to evaluate accuracy of predicted BMR vs directly measured BMR.

Results Predicted mean BMR determined using all eight equations was significantly correlated to measured BMR (P=.0001), accounting for 30% to 52% of the variance of measured BMR. When analyzed by RMSPE, however, the equations of Owen et al (1986), Fredrix et al (1990), and Harris-Benedict (1919) predicted actual BMR for each subject within an average of 116 kcal/day, and the equation of Cunningham (1980) resulted in the largest prediction error at 208 kcal/day.

Applications/conclusions The regression equations of Owen et al (1986), which used body weight, Fredrix et al (1990), which used body weight and age, and Harris-Benedict (1919), which used age, weight, and height as variables, were most accurate in predicting BMR in our sample of healthy older women. J Am Diet Assoc. 1995; 95:1387-1392.     

Culturally Sensitive Prenatal Care for Southeast Asians

OBJECTIVE: To evaluate the success of the Southeast Asian Health Project in terms of client satisfaction with the prenatal care and other services. To obtain additional data about Southeast Asian women's health practices regarding childbearing. DESIGN: Survey through questionnaires administered as interviews. SETTING: In clients' homes or via telephone. PARTICIPANTS: 119 women from SEAHP's case files of recently delivered clients. MEASUREMENTS AND MAIN RESULTS: Interviews were conducted by four community workers fluent in Cambodian or Lao. The majority of women were satisfied with SEAHP, particularly the interpretation and education in native languages. Women were also satisfied with SEAHP, encouraging others to seek care. CONCLUSIONS: SEAHP appears to meet prenatal care needs of Southeast Asian women in Long Beach, California. More objective outcome data await analyses, but the program's approach may ensure access to and use of health services.     

Concept Mapping: An Effective Instructional Strategy for Diet Therapy

Concept mapping is an instructional strategy that requires learners to identify, graphically display, and link key concepts in instructional reading material. Although proven effective in numerous disciplines as a means to promote critical thinking and self-directed learning, concept mapping has not been tested in diet therapy. The objective of this study was to implement concept mapping as a small-group, cooperative learning strategy in an upper-division diet therapy course and to evaluate student attitudes about the effect of concept mapping on knowledge, self-directed learning, problem-solving, and collaborative skills. Students in the first semester (n=27) initially learned course material by lecture (4 weeks) followed by an integrated mapping/lecture format (12 weeks); the second semester (n=25) used an integrated mapping lecture format for the full 16 weeks. At the end of both semesters, students completed a 10-item original survey questionnaire. Responses for first (n=25) and second (n=21) semesters were analyzed independently. Results indicated that a majority of students thought participation in concept mapping enhanced knowledge of diet therapy principles (n=19 of 25; 18 of 21), self-directed learning (n=14 of 25; 18 of 21), critical thinking (n=21 of 25; 14 of 21), problem-solving (n=22 of 25; 16 of 21), and collaboration (n=24 of 25; 20 of 21) skills. When noncooperation of teammates was a factor, concept mapping was viewed as more frustrating and time consuming than lecture. This study demonstrated concept mapping as an effective learning strategy for diet therapy; it improves students’ ability to engage in self-directed learning, critical thinking, collaboration, and creative problem solving. Results suggest that concept mapping is most effective when accompanied with comprehensive training, coordinated lectures, instructor guidance, and long-term practice. J Am Diet Assoc. 1995; 95:908–911.     

Exercise and older adults

The benefits of regular physical activity in older persons are numerous and well established. Regular physical activity in older adults is associated with an overall improvement in health, functional capacity, quality of life, and independence. Many questions arise for healthcare providers regarding an older person’s ability and motivation to be physically active. The healthcare provider has a unique opportunity to assess the older client’s incentives, preferences, and abilities for physical activities, as well as to prescribe a safe, appropriate, and enjoyable exercise plan. The exercise precription can be simple yet thorough enough to ensure benefits in an older person’s health and functional capacity.     

When Is a Bispectral Index of 60 Too Low?: Rational Processed Electroencephalographic Targets Are Dependent on the Sedative-Opioid Ratio

Background: Opioids are commonly used in conjunction with sedative drugs to provide anesthesia. Previous studies have shown that opioids reduce the clinical requirements of sedatives needed to provide adequate anesthesia. Processed electroencephalographic parameters, such as the Bispectral Index (BIS; Aspect Medical Systems, Newton, MA) and Auditory Evoked Potential Index (AAI; Alaris Medical Systems, San Diego, CA), can be used intraoperatively to assess the depth of sedation. The aim of this study was to characterize how the addition of opioids sufficient to change the clinical level of sedation influenced the BIS and AAI.

Methods: Twenty-four adult volunteers received a target-controlled infusion of remifentanil (0-15 ng/ml) and inhaled sevoflurane (0-6 vol%) at various target concentration pairs. After reaching pseudo-steady state drug levels, the modified Observer's Assessment of Alertness/Sedation score, BIS, and AAI were measured at each target concentration pair. Response surface pharmacodynamic interaction models were built using the pooled data for each pharmacodynamic endpoint.

Results: Response surface models adequately characterized all pharmacodynamic endpoints. Despite the fact that sevoflurane-remifentanil interactions were strongly synergistic for clinical sedation, BIS and AAI were minimally affected by the addition of remifentanil to sevoflurane anesthetics.