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Emerging approaches in the management of intracranial hemorrhage: ARISE II consensus recommendations
No full textDespite advances in the fundamental understanding of the pathophysiology of intracranial hemorrhage (ICH), many issues related to ICH management remain understudied with discrepancies in management. Given the high disease severity and prevalence, consensus recommendations are urgently needed to guide further research and management strategies. Thus, a group of clinical experts, industry leaders, and government representatives was assembled to examine emerging approaches in ICH management and their future impact on patient care. The timing of intervention within 24 hours and the role of minimally invasive evacuation, particularly for basal ganglia hemorrhage locations, were identified as key research focuses to guide future trial design. Mobile stroke units and artificial intelligence (AI) are promising technologies that streamline preoperative and triaging workflows and improve time to intervention. Efforts to further develop surgical technologies will be crucial to improve ICH visualization and evacuation. Further research, industry collaboration, and investment are needed to advance treatment frontiers and catalyze ICH research
Stomach cancer elective surgery morbidity and mortality at 90-Day (Hold Study): A prospective, international collaborative cohort study
No full textBackground: Data on multinational 90-day mortality and morbidity rates after surgery for gastric cancer is limited in the literature. This study aimed to understand the 90-day mortality and morbidity outcomes among patients undergoing elective gastric cancer surgery, as in the GASTRODATA Registry, and to identify associated risk factors.
Methods: We conducted an international prospective study on patients aged ≥ 18 years undergoing elective surgery for gastric cancer with curative intent from January 4 to September 30, 2022. Known metastatic disease, concurrent secondary cancers, gastrointestinal stromal tumour (GIST) and Siewert type I/II oesophagogastric junction malignancies were excluded. Univariate and multivariate logistic regression were used to identify variables associated with the 90-day outcome.
Results: 380 collaborators from 47 countries submitted data on 1538 patients. Median age was 65 years (IQR: 19-94), and 58.5% were males. 90-day morbidity and mortality rates were 38.2% (n = 587) and 2.9% (n = 45), respectively. Pre-operative higher Charlson Comorbidity Index, higher ASA score, pre-operative weight loss \u3e 10%, positive specimen margin, and post-operative pathological IV staging (p value \u3c 0.05) were significantly associated with clinically relevant complications and mortality.
Conclusion: Elective gastric cancer surgery has a 90-day morbidity of 38.2% and a 90-day mortality of 2.9% globally. This study provided the most comprehensive international 90-day prospective data to date regarding gastric cancer surgery. Several factors associated with higher morbidity were identified, highlighting the importance of a unified language on surgical morbidity, prehabilitation, and ongoing audits to enhance patient outcomes
Competency-based simulation training for procedural skills: A systematic review and meta-analysis
No full textWe conducted a systematic review of competency-based simulation education for medical procedural skills, encompassing a diverse range of healthcare domains and professions. Meta-analysis showed competency-based simulation is more effective than noncompetency-based simulation for skill outcomes (large effect). Outcomes are favorable, but small, for behaviors in practice and patient effects. Specific instructional design features examining different simulators and different types and sources of feedback were common themes identified among studies though no instructional design features were found to have significant impact on skill acquisition. This review also identified significant gaps in research including a lack of standardized terminology and reporting methods as well as a limited number of studies assessing the impact on behaviors in practice and patient effects. This study contributes to the ongoing evidence to support competency-based simulation training and highlights the need for further research to enhance the efficacy and efficiency of training of healthcare professionals
Use and outcomes of the medical hybrid procedure for stage 1 palliation in infants with hypoplastic left heart syndrome and variants
No full textBackground: Staged palliation of hypoplastic left heart syndrome and variants begins with the Norwood or hybrid procedure. Hybrid palliation is used in a minority of cases and often reserved for high-risk patients. Stented hybrid (SH) comprises bilateral pulmonary artery bands and ductal stenting, and medical hybrid (MH) comprises bilateral pulmonary artery bands and prostaglandins. MH use and outcomes have not been well described. We sought to compare MH, SH, and surgical stage 1 (SS1) using a national database.
Methods: Patients from the National Pediatric Cardiology Quality Improvement Collaborative database born between 2016 and 2021 were categorized by initial intervention: MH, SH, or SS1. Statistical comparisons and Kaplan-Meier analysis were performed.
Results: This study included 2423 patients from 65 centers: 277 (11%) MH, 133 (5%) SH, and 2013 (83%) SS1. MH had lowest birth weight and gestational age, most noncardiac anomalies, and most preoperative risk factors. Most centers had minority MH, though use ranged from 0% to 82% at centers with ≥10 patients. Transplant-free 1-year survival was MH 56%, SH 66%, and SS1 81% (P\u3c0.0001). Using multivariable logistic regression, predictors of MH versus SS1 were lower birth weight, lower gestational age, genetic syndrome, noncardiac anomaly, and ≥4/12 preoperative risk factors. Predictors of MH versus SH were hypoplastic left heart syndrome and ≥4/12 preoperative risk factors. Cox proportional hazards regression showed MH had higher adjusted risk of 1-year mortality/transplant compared with SS1 (hazard ratio [HR], 1.86 [95% CI, 1.44-2.39]) and no difference compared with SH (HR, 1.20 [95% CI, 0.84-1.70]).
Conclusions: Survival after MH is similar to SH and worse than SS1. This may be due to patient risk factors not controlled for in this study
Incidence of mortality and predictors among patients with shock managed in the emergency room of a tertiary hospital in Ethiopia
No full textIntroduction: Shock is a common emergency condition which can lead to organ failure and death if not diagnosed and managed timely. Despite its huge global impact, data is scarce in resource-limited settings, including Ethiopia, which hinders the provision of quality care for improved outcomes. Hence, this study aimed to determine the incidence of death and predictors among adult patients with shock managed at the Emergency Department of St. Paul\u27s Hospital Millennium Medical College in Ethiopia.
Methods: A retrospective chart review study was conducted among eligible patients managed at the hospital between October 1, 2021 and May 20, 2022. Mortality was estimated with incidence density using person day (PD) of observation. To identify predictors of mortality, a generalized linear model using poisson regression model with robust standard errors fitted, where adjusted relative risk (ARR) with 95 % CI was used to interpret results.
Result: During the study period, a total of 196 patients were identified for assessment, of which 18 with incomplete records were excluded, resulting in 178 eligible patients for inclusion. The majority of participants were 40 or older (69.7 %) and female (51.1 %), presenting with symptoms lasting less than one week (68.5 %) and had at least one comorbid illness (70.8 %). The incidence of death was 16.5 deaths per 100 PD (95 % CI = 13.1 to 20.9). While triage to orange was associated with a decreased risk of death, high shock index, septic shock diagnosis, vasopressor use, and organ failure were associated with increased risk of death.
Conclusion: The incidence of mortality among shock patients was found to be considerable. To optimize patient care and improve outcomes, it is important to remain vigilant in the proper triage and early diagnosis of shock using more sensitive tools for prompt identification of high-risk cases, as well as to provide timely, prioritized and effective interventions
In response to comment on Effectiveness of peripheral nerve stimulation in managing chronic pain: A systematic review and meta-analysis of randomized controlled trials
No full textGuardians of the Skin: Preventing Pressure Injuries on a Stroke Unit
No full textOur nurses saw a rise in hospital-acquired pressure injuries in the stroke unit. NDNQI data showed we performed below the national mean in three out of four quarters. This project\u27s aim was to identify gaps and create innovative solutions led by nurses, to reduce pressure injuries by 20%. Several factors contributed to the rise in pressure injuries, including length of stay, increase in acutely ill stroke patients due to bed designation, nutritional barriers, and mobility limitations. Post-covid, our unit experienced turnover, which resulted in new nurses being unaware of strategies used to prevent pressure injuries. Using the “5 Why” root cause analysis, we created a bundle for patients with a Braden score of 18 or less. This included a preventative foam dressing, a turn clock on the door for Q2 hour turns, a foam turning wedge, and a 2-person skin assessment each shift to prioritize integumentary assessment and accountability. The 2-person skin assessment was a new and innovative component for the team. We educated staff during huddles and monitored progress in the areas of turn compliance, 2-person skin assessment, and total pressure injuries. A daily compliance report was created to discuss successes and opportunities with the staff. Our turn compliance increased from a baseline of 30% to 54%, and our 2-person skin assessments increased from 0% to 49%. As a result, our pressure injuries decreased from 10 to 6 between 2023 and 2024, representing a 40% reduction. By comparing the annual costs of foam dressings and wedges to the expenses of treating pressure injuries, we achieved cost savings of $73,426 this year! This innovative approach to pressure injury reduction has shown impressive results, addressing turn effectiveness, visual management, accountability, and prioritization. As the project advances, stakeholders can extend the implementation of the bundle to additional units, ensuring widespread success
Immersive Age Friendly Care: Taking CBT to the Next Level
No full textBackground/Introduction:
A 162-bed acute care Midwest hospital serves the largest population of patients aged 65 and older in the state. The unique healthcare needs of older adults benefit from evidence-based, individualized care commonly known as the “4Ms: What Matters, Medication, Mentation, and Mobility.
Objective:
Develop an innovative, hands-on educational program using simulation to increase nurses’ knowledge and skill in caring for older adult patients.
Method:
The program utilized unfolding simulation sessions as its primary method of education. These sessions focused on the 4 Ms with each aspect addressed individually and in combination. Teammates were asked to address an unsafe environment and disoriented patient by implementing knowledge of age-friendly principles. An interactive discussion and symptom matching activity reinforced delirium versus dementia. The use of simulation allowed nurses to engage in realistic, scenario-based learning, improving their ability to handle complex cases of elderly patient care. Additionally, nurses verified their competency in completing the Comprehensive Mobility Evaluation Tool (CMET) as the mobility focus. A robust debrief summarizing all 4 Ms of Age Friendly Care was completed.
Findings:
Pre- and post-education assessments revealed substantial gains in knowledge with 100% of nurses able to identify the 4 Ms of Age Friendly Care after completing the simulation. Additionally, 85% of nurses, up from 7% pre-simulation, could correctly recognize the symptoms of delirium, demonstrating the simulation\u27s effectiveness in improving clinical recognition.
Implications for Practice:
The innovative use of simulation for Age-Friendly care significantly enhanced the knowledge and skills of the nursing team. Sustainability efforts are ongoing to reinforce Age Friendly Care principles through Epic documentation audits and daily discussions during multi-disciplinary rounds. This approach has proven successful in bridging the gap between theoretical knowledge and practical application - ultimately enhancing patient care