Grande Ronde Hospital

ABSTRACT Restoration of floodplain habitats is one of the most common approaches to restoring ecological processes, ecosystem services, increasing floodplain capacity, and improving habitat for endangered salmon and trout. Restoring floodplains at a reach or valley segment scale to an anastomosing or other multi‐thread channel patterns, often called “Stage 0” or valley bottom restoration, has become common in the United States. However, additional information is needed to ensure these projects are successful, implemented in the right locations, and not the latest watershed restoration technique applied inappropriately. Using lessons learned from floodplain restoration in the Grande Ronde River Basin in Oregon, we outline key considerations for planning, designing, and implementing valley bottom restoration projects. We first crosswalk the stages of channel evolution in the stream evolution model, commonly used for valley bottom restoration, with channel types in popular stream classification schemes, and then identify natural anastomosing and meandering channels in the Grande Ronde Basin to assist with designing valley bottom restoration projects. Next, we discuss how to determine whether a reach or valley segment is appropriate for valley bottom restoration, including examining the current, historic, and potential for a site to support anastomosing or other channel types. We then discuss considerations for project design and implementation including: goals, hydraulic modeling, habitat suitability modeling, and other tools to develop and evaluate design alternatives. Valley bottom restoration projects present unique challenges for monitoring, and we close with guidelines for monitoring that rely on remote sensing to map the entire valley bottom before and after restoration and that are linked directly to project objectives. This article is categorized under: Water and Life > Nature of Freshwater Ecosystems

Bowel obstruction is a common complication that can affect patients due to different factors, including after a history of gastric bypass surgery. This review was conducted by searching the literature using both PubMed and Google Scholar for articles relating to bowel obstructions. Fifty-six articles were found after applying inclusion and exclusion criteria. Based on the literature search, there are many causes of bowel obstruction, the most common of which include internal hernias, adhesions, and intussusception. Regarding management strategies, surgery is usually the definitive treatment method, but other studies favor a non-surgical approach depending on the specific case. Bowel obstruction is a significant complication that can occur post gastric bypass surgery. This review sheds light on various causes of bowel obstruction, including the possible treatment options, prevention of bowel obstruction that could be achieved by implementing different surgical techniques, the importance of postoperative monitoring, and timely intervention.

Deep vein thrombosis (DVT) is a critical complication and concern in hospitalized patients due to its significant morbidity and mortality. Given the complex and multifaceted pathophysiology surrounding DVT formation, patients who have had surgical interventions faced acute or chronic trauma and prolonged immobility are at substantially high risk. Identifying these risk factors early is essential for early intervention and prophylaxis. Current standard-of-care prophylaxis for DVT includes pharmacological agents such as anticoagulants, and recently, there has been an increase in the use of mechanical medical devices such as sequential compression devices (SCDs). Pharmacological prophylaxis, while shown to be effective in some patients, carries certain risks of complications such as bleeding. SCDs offer a safer and more effective approach for these patients. SCDs function by artificially replicating the "pumping mechanism" present in the soleus muscle to enhance venous return and reduce stasis. Various types of SCDs, namely intermittent pneumatic compression and graduated compression stockings, have demonstrated clinical efficacy when used as an adjunctive intervention with anticoagulant medications. This narrative review explores the pathophysiology, risk factors, and prophylactic measures for DVT, focusing on the use of SCDs as a non-pharmacological intervention. Through synthesizing evidence from various studies obtained from PubMed, MEDLINE, and Cochrane Library and evaluating the benefits and limitations of SCD use, this review highlights the need for tailored prophylactic strategies, considering patient-specific risk factors and preferences.

Studies have shown that documentation burden experienced by clinicians may lead to less direct patient care, increased errors, and job dissatisfaction. Implementing effective strategies within health care systems to mitigate documentation burden can result in improved clinician satisfaction and more time spent with patients. However, there is a gap in the literature regarding evidence-based interventions to reduce documentation burden. The objective of this review was to identify and comprehensively summarize the state of the science related to documentation burden reduction efforts. Following Joanna Briggs Institute Manual for Evidence Synthesis and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we conducted a comprehensive search of multiple databases, including PubMed, Medline, Embase, CINAHL Complete, Scopus, and Web of Science. Additionally, we searched gray literature and used Google Scholar to ensure a thorough review. Two reviewers independently screened titles and abstracts, followed by full-text review, with a third reviewer resolving any discrepancies. Data extraction was performed and a table of evidence was created. A total of 34 articles were included in the review, published between 2016 and 2022, with a majority focusing on the United States. The efforts described can be categorized into medical scribes, workflow improvements, educational interventions, user-driven approaches, technology-based solutions, combination approaches, and other strategies. The outcomes of these efforts often resulted in improvements in documentation time, workflow efficiency, provider satisfaction, and patient interactions. This scoping review provides a comprehensive summary of health system documentation burden reduction efforts. The positive outcomes reported in the literature emphasize the potential effectiveness of these efforts. However, more research is needed to identify universally applicable best practices, and considerations should be given to the transfer of burden among members of the health care team, quality of education, clinician involvement, and evaluation methods.

Over the last two decades, the medical community witnessed an outstanding and accelerated development on minimally invasive therapies. The definition of what constitutes large bore access is subject to discussion, however within the field it is generally accepted to reflect a catheter diameter exceeding 8-French. We sought in this review to explore the evolution, characteristics and vascular compatibility of the current commercially available devices, analyze the devices along with access site-specific complications rates and finally review the present methods for percutaneous vascular closure.