Scholarly Commons @ Baystate Health
Not a member yet
8474 research outputs found
Sort by
Safety of ultra-permissive anemia within a cardiac surgery patient blood management program
No full textObjectives: There remains a lack of studies assessing the safety of highly restrictive patient blood management in cardiac surgery. Our patient blood management program has been focused on ultra-permissive anemia, tolerating hemoglobin concentrations 6.0 g/dL or more in nonbleeding patients. We reviewed our results following an ultra-permissive anemia strategy regarding blood transfusion rates and the association with major complications after cardiac surgery.
Methods: Consecutive patients undergoing coronary artery bypass grafting managed with ultra-permissive anemia were compared with historical controls, labeled the pre-ultra-permissive anemia group, who were transfused at the discretion of the clinician. A 1:1 propensity score matching was performed, and the groups were compared for blood transfusion rates, major complications, length of stay, and cost.
Results: A total of 1216 patients were analyzed. Patients in the ultra-permissive anemia group received significantly less packed red blood cells and other blood components. The mean intraoperative and postoperative packed red blood cells transfusion rates were significantly lower in the ultra-permissive anemia cohort, 2% and 12% versus 27% and 29% pre-ultra-permissive anemia (P \u3c .001). Postoperative length of stay was reduced for patients with ultra-permissive anemia (6.0 days vs 7.3, P \u3c .001). Early extubation rates were higher for patients with ultra-permissive anemia (78% vs 53%, P \u3c .001). The incidence of stage 1 acute kidney injury was lower for patients with ultra-permissive anemia compared with pre-ultra-permissive anemia (20% vs 26%, P = .049) as were rates of atrial fibrillation (34% vs 41%, P = .013). All other major complications, including mortality, were similar.
Conclusions: Our data suggest that ultra-permissive anemia, tolerating hemoglobin values as low as 6 g/dL, is safe and significantly reduces overall blood use.
Keywords: anemia; coronary bypass surgery; patient blood management
Infectious morbidity associated with early amniotomy during labor induction
No full textObjective: This study\u27s purpose was to determine if an early amniotomy increased the risk of maternal and neonatal infectious morbidity when compared with late amniotomy.
Study design: This was a single-center retrospective cohort study performed between 1/1/2010 and 3/31/2018. It assessed the relationship between eligible term women undergoing labor induction with early amniotomy, defined as artificial rupture of membranes (AROM) performed less than 12 h from start of cervical ripening, compared with women who do not have an early amniotomy. The primary outcome was a composite of chorioamnionitis and/or neonatal sepsis. Secondary outcomes included isolated maternal fever, composite maternal morbidity, cesarean delivery, amnioinfusion, any transfusion, length of labor induction, cord prolapse, NICU admission, and Apgar score.
Results: Among the 1200 patients, the rate of chorioamnionitis or neonatal sepsis was lowest at 0.4 % for patients with early amniotomy \u3c 12 h, increased to 3.5 % in both the interval to AROM 12 to \u3c 18 h and 18 to \u3c 24 h, and further increased to 5.9 % when AROM occurred after 24 h from start of cervical ripening (p = 0). For the secondary outcomes, the rate of cesarean was significantly lower in the early AROM group \u3c 12 h at 13.9 % compared to all other later periods of AROM, with the highest rate in the \u3e24 h group (34.9 %, p = 0). The mean time from amniotomy to delivery was increased across each time interval, lowest at 11.5 in the \u3c 12-hour interval and highest at 44.6 h for the interval with AROM at 24 h and beyond (p = 0). Composite maternal morbidity also increased across each time interval, lowest in the \u3c 12-hour group at 17.6 % and highest in the group that had AROM occur after 24 h at 31.2 % (p = 0). There were no significant differences in neonatal secondary outcomes.
Conclusion: When amniotomy is performed \u3c 12 h after initiation of cervical ripening, there does not appear to be an increased rate of infectious morbidity. When performing amniotomy in a closer time interval to end of cervical ripening, it appears infectious morbidity may be reduced with shorter duration from amniotomy to delivery while decreasing cesarean and maternal morbidity rates.
Keywords: Amniotomy; Delayed; Induction; Infection; Labor; Timing
Evaluating the Impact of a Night Shift Education Resource
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation2025/1026/thumbnail.jp
Identifying Barriers to Robotic Technology Integration in Inpatient Nursing: A PETT Scan Work System Analysis
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation2025/1013/thumbnail.jp
Implementing a Buddy Staffing Model
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation2025/1002/thumbnail.jp
Sodium-Glucose Cotransporter-2 Inhibitors Following Transcatheter Aortic Valve Replacement: A Meta-Analysis
No full textSodium-glucose cotransporter-2 inhibitors (SGLT2is) reduce heart failure (HF)-associated admissions; however, the data on patients with aortic stenosis following transcatheter aortic valve replacement (TAVR) is limited. This systematic review and meta-analysis compares clinical outcomes in patients with and without SGLT2i following TAVR. Major electronic databases were systematically searched through April 2025 for studies evaluating SGLT2i following TAVR. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model. A P value of ≤0.05 was considered statistically significant. Two studies with 1534 patients undergoing TAVR (679: SGLT2i; 855: no SGLT2i) were included. SGLT2i therapy led to a significant reduction in HF hospitalization (RR: 0.56; 95% CI: 0.32-0.99; P = 0.05); however, no differences in all-cause (RR: 0.48; 95% CI: 0.13-1.72; P = 0.26) and cardiovascular mortality (RR: 0.53; 95% CI: 0.19-1.48; P = 0.22) were noted. SGLT2i are associated with a statistically and clinically significant reduction in HF hospitalization; however, no reduction in mortality was observed following TAVR. Further randomized controlled trials are warranted to support future guideline recommendations regarding SGLT2i following TAVR.
Keywords: SGLT2; aortic stenosis; heart failure; sodium-glucose cotransporter inhibitor; transcatheter aortic valve implantation
Temporary Mechanical Circulatory Support in Cardiogenic Shock: Executive Summary of the Joint Consensus Reports of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society
No full textBackground: The identification, triage, and management of cardiogenic shock (CS) is complex and resource-intensive, particularly given the recent surge in the use of temporary mechanical circulatory support (tMCS) devices. This document is an executive summary of a series of consensus statements which guide the bedside clinician regarding the management of tMCS in the setting of CS.
Methods: The PeriOperative Quality Initiative (POQI) and Enhanced Recovery After Surgery (ERAS®) Cardiac Society convened an interdisciplinary, international panel of experts, utilized a structured appraisal of the literature and the modified Delphi method to derive consensus on a series of topics related to both CS and tMCS.
Results: The effort resulted in three manuscripts with guidance related to the diagnosis, escalation/de-escalation and best practices associated with CS and the provision of tMCS. Group consensus was derived around existing clinical questions, summary guidance statements and the quality of the existing evidence.
Conclusions: The POQI/ERAS Cardiac consensus series derived 27 unique statements regarding the care of patients with CS and the provision of tMCS. Key themes emerged, including the need for immediate and systematic assessment of CS severity, early initiation of tMCS, an algorithmic approach to the escalation and de-escalation of tMCS therapies and adoption of high-quality best practices associated with tMCS management
Improving Critical Care Communication with the Serious Illness Conversation Guide at an Academic Medical Center
No full textContext: Professional societies have called for methods to improve serious illness communication training for critical care fellows and faculty. The Serious Illness Conversation Guide (SICG) is a best practice tool for discussing goals of care in an outpatient setting.
Objectives: Suitability of a SICG tailored for the intensive care unit (ICU) setting and impact on communication behaviors critical care clinicians.
Methods: In a 460-bed rural academic medical center, 12 critical care service (CCS) fellows and 8 CCS faculty received a one-day palliative care faculty led SICG training tailored to the ICU context including for early and late goals of care discussions. A prospective pre-post single institution design was utilized. Suitability of an ICU-tailored SICG was assessed by surveying critical care fellows and faculty. Impact of the ICU-tailored SICG training was assessed in CCS fellows by simulated patient encounters at baseline and 4-6 months post-training, and impact in CCS faculty was assessed by self-reported practice change 3 months post-training.
Results: Six of the seven suitability questions were statistically significantly in favor of SICG use in the ICU setting. CCS fellows demonstrated more use of the SICG components at 4-6 months after training compared to baseline (SICG component subscale 5.8 vs 9.3; p = 0.033) . CCS faculty reported implementation of the ICU-tailored SICG into their clinical practice after 3 months.
Conclusion: The ICU-tailored SICG was suitable for the critical care setting, and training led to more comprehensive skills in CCS fellows and self-reported practice change in CCS faculty.
Keywords: Serious Illness Conversation Guide; critical care; medical education; serious illness communication training; simulated encounters