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Recommendations for Emergency Robotic Thoracic Conversions and Intraoperative Resuscitation: A Modified Delphi Consensus Study
No full textBACKGROUND: The purpose of this consensus is to determine essential principles and acceptable variations in emergency conversion events in robotic thoracic operations. METHODS: A modified Delphi study was performed with 21 expert robotic thoracic surgeons. A pilot round was conducted with 5 experts to test feasibility. Two rounds were conducted between July 2024 - September 2024 with 33 statements rated on 5-point Likert scales. Statements included content across 3 domains: 1. Preoperative preparation, 2. Emergency undocking and resuscitation in the lateral position, and 3. Debriefing. A consensus report was provided to panelists after round 1 and a focus group was held. Content was adjusted between rounds based on feedback from round 1 and the focus group. Consensus was defined as agreement ≥70%. RESULTS: The response rate was 100%. Consensus was achieved for all preoperative preparation and debriefing statements. 16/19 statements regarding undocking and resuscitation achieved consensus, 3 statements (9.1%) in this domain were found to have insufficient agreement at 66.7%. Essential principles that achieved consensus included: conversion indications, calling for help, initial tamponade with robotic instruments, conversion via a partial undocking protocol, uninterrupted visualization, and team communication, amongst others. CONCLUSIONS: The consensus achieved can inform protocols for emergency robotic conversion events in thoracic surgery. The points of disagreement highlight acceptable surgeon- and institution-specific variations
Variable Toxicity by β-Blocker Class in Intentional Overdoses Reported To U.S. Poison Centers
No full textCeftriaxone to prevent early-onset pneumonia in comatose patients after out-of-hospital cardiac arrest: a pilot randomized controlled trial and resistome assessment (PROTECT).
No full textBACKGROUND: Antibiotic prophylaxis after out-of-hospital cardiac arrest (OHCA) reduces early-onset pneumonia, but has uncertain impact on mortality and non-infectious outcomes, with ongoing concerns about the subsequent development of antibiotic resistance.
RESEARCH QUESTION: Does prophylactic ceftriaxone reduce the incidence of early-onset pneumonia without increasing the acquisition of antibiotic resistance genes after OHCA?
STUDY DESIGN: and Methods: Comatose survivors of OHCA treated with targeted temperature management without a clinical diagnosis of pneumonia at admission were randomized to ceftriaxone 2 gm or matching placebo every 12 hours for three days. The primary outcome was early-onset pneumonia occurring ≤4 days after intubation confirmed by blinded adjudicators. Abundance of antibiotic resistance genes recovered from rectal swabs before-and-after study drug administration were analyzed with metagenomic sequencing.
RESULTS: 411 subjects were screened, 53 (13%) were randomized, and one subject withdrew, leaving 26 in each group in the final analysis. Early-onset pneumonia was diagnosed in 10 (38%) subjects receiving ceftriaxone and 18 (69%) subjects receiving placebo (RR 0.57, 95% CI 0.21-1.001; p=0.05). Open-label antibiotics were administered to 14 (54%) subjects receiving ceftriaxone and 22 (85%) receiving placebo (RR 0.64, 95%CI 0.43-0.94), most of which were broad-spectrum (93% and 100%, respectively). After adjusting for differences in abundance of antibiotic resistance genes prior to study drug administration, subjects randomized to ceftriaxone acquired significantly fewer antibiotic resistance genes to frequently used antibiotics in the ICU compared to those randomized to placebo (IRR 0.30, 95% CI 0.13-0.70). Serious adverse drug effects were not reported in either treatment group.
INTERPRETATION: This trial was inconclusive regarding the impact of ceftriaxone prophylaxis to reduce the incidence of EOP after OHCA but ceftriaxone was associated with less frequent administration of open-label antibiotics, and reduced acquisition of ARGs to frequently used antibiotics in the ICU.
CLINICAL TRIAL REGISTRATION: National Library of Medicine at www.
CLINICALTRIALS: gov (NCT04999592)
The critical role of clinical placement professionals in academic-practice partnerships for nurse education.
No full textClinical Placement Professionals (CPPs) are instrumental in seamlessly connecting academic learning with practical clinical experiences in nursing education. This paper describes the role, responsibilities, challenges, and recommendations for the CPP profession and explores how the utilization of CPPs across academic disciplines varies significantly, with diverse titles, team structures, and fundamental duties among schools of nursing and healthcare systems. As nursing program enrollments surge and clinical placements remain scarce, the value and standardization of the CPP role become paramount in increasing the number of adequately prepared nurses nationwide. CPPs encounter unique challenges, including managing complex partnerships, navigating technological advancements, and addressing growing demand for clinical placements while facing limited professional development opportunities. The establishment of a nationwide organization aimed at enhancing the clinical placement profession could provide an arena for CPPs to strategically innovate, standardize practices, advocate for resources, and network with peers, ultimately supporting their critical work and contributing to the overall improvement of nursing education and preparation of a skilled nursing workforce
Tips and Tricks on Principal Care Management Coding and Billing.
No full textPrincipal care management codes offer orthopaedic surgeons an opportunity to seek reimbursement when managing comorbid conditions in patients planning to undergo total joint arthroplasty. This article provides key tips and tricks for effectively utilizing principal care management codes (CPT 99424 to 99427), focusing on correct documentation, time management, billing compliance, as well as practice model examples. By following these best practices, total joint arthroplasty surgeons can receive proper compensation for preoperative optimization of comorbid conditions when preparing their patients for surgery
Reducing Delirium in Older Adults: The Role of Quiet Hours During Hospitalization
No full textIn older adults how does the implementation of quiet hours compared to no quiet hours affect the incidence of delirium as measured by positive cam score during hospitalization?https://knowledgeconnection.mainehealth.org/nurseresidency/1138/thumbnail.jp
November 19th, 2025: Draping the Star Quilt: Lessons Learned from an American Indian Palliative Care (PC) Community Health Worker Program
No full texthttps://knowledgeconnection.mainehealth.org/medicine_gr/1052/thumbnail.jp
Preoperative Patient Education as a Tool for Reducing Postoperative Opioid Use Following Primary Total Hip Arthroplasty: One Institution\u27s Experience
No full textBACKGROUND: Minimizing postoperative opioids remaining after total hip arthroplasty (THA) is important for patient outcomes and community safety. The purpose of this study was to investigate whether completion of one preoperative patient education class prior to THA was associated with reduced opioid consumption at 2 weeks postoperatively. Secondary goals included evaluating whether satisfaction scores and postoperative healthcare utilization were impacted by class attendance, and whether demographic characteristics varied between groups that may highlight care disparities for our practice to address. METHODS: Patients undergoing primary THA between January 2022 and December 2024 at a single large academic institution were retrospectively evaluated for inclusion, identifying 372 patients who completed the education class and 30 patients who did not. All patients received a multimodal perioperative pain management protocol standardized at our institution. RESULTS: The number of morphine milligram equivalents (MMEs) consumed in the 2 weeks following THA was significantly lower among the class completion group (84.60 vs 127.30 MMEs; P = .04). On multivariable analysis, patients who attended the preoperative education class consumed 41.57 fewer MMEs compared to those who do not attend (95% confidence interval: -75.87 to -7.27; P = .018). No differences in complications, 2-week refill requests, emergency department visits, or readmission were noted. Functional outcome and satisfaction scores were high among both groups. CONCLUSIONS: THA patients who completed an education class preoperatively consumed significantly fewer prescribed opioids as measured at the 2-week mark following surgery compared to those who did receive education. Our results support the role of patient education in reducing opioid use following arthroplasty
It\u27s Still Much More Than the Pill: Keeping up with Contraception for Young People in 2025
No full textCME available for 1 year after presentation
CME Text Code: 97046
In order to claim CME credit, please complete an evaluation in CloudCME for each presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1087/thumbnail.jp
November 12th, 2025: Updates in Atrial Fibrillation: Pearls for Management
No full texthttps://knowledgeconnection.mainehealth.org/medicine_gr/1053/thumbnail.jp