GJ Express: an improvement initiative to decrease sedation and anesthesia for gastrojejunostomy tube exchanges.

Background: Overuse of sedation and anesthesia causes delays in gastrojejunostomy tube (GJ) exchanges, increased risk of complications, unnecessary use of resources, preventable hospital admissions, and an adverse impact on patient and family experience. Our hospital was over-utilizing sedation and anesthesia, and we aimed to decrease this use from 78% to 20% within two years.

Methods: An interdisciplinary quality improvement team comprehensively evaluated current processes for GJ tube exchanges through a retrospective chart review for baseline data with prospective time series analysis after improvement implementation.

Climate variability and environmental stress in the Sudan-Sahel zone of West Africa.

Environmental change in the Sudan-Sahel region of West Africa (SSWA) has been much debated since the droughts of the 1970s. In this article we assess climate variability and environmental stress in the region. Households in Senegal, Mali, Burkina Faso, Niger, and Nigeria were asked about climatic changes and their perceptions were compared across north-south and west-east rainfall gradients.