11210 research outputs found
Sort by
Purple Squirrels Find Nut: Best Fit Culture Reduces Turnover
No full textPurple Squirrels Find Nut: Best Fit Culture Reduces Turnover Purpose: Clinical nurses at a small community hospital sought to decrease the organization-level nurse turnover rate. Relevance: Nationally, the nurse turnover rate is 18.4%, with an average cost of 3.9 to 3.2 million annually. By celebrating nursing excellence, focusing on nurse well-being, supporting nurses through peer support, and hiring-for-fit, nurses helped create a positive culture where they want to stay and build their careers. Conclusion: Clinical nurses can lead transformative initiatives in recruitment and retention. Advocacy and collaboration between clinical nurses and nurse leaders are crucial in recognizing nursing excellence, prioritizing well-being, and tackling the national nursing turnover issue
Leadless versus transvenous single-chamber ventricular pacemakers: Real-world evidence from aveir VR coverage with evidence development study
No full textBackground: Aveir VR, a helix-fixation leadless pacemaker (LP), was US Food and Drug Administration (FDA)-approved in 2022. The performance of this novel LP has not been evaluated against transvenous single chamber ventricular pacemakers (TV-VVI) in a real-world setting. This observational coverage with evidence development study of Aveir VR implants (Aveir coverage with evidence development) evaluates complications and outcomes among Medicare beneficiaries implanted with Aveir VR immediately after FDA approval compared with those implanted with TV-VVI.
Methods: Medicare fee-for-service and Abbott device registration data were used to identify de novo Aveir VR LP (implanted 6/2022-6/2024) or TV-VVI (all manufacturers, implanted 1/2021-6/2024). Outcomes evaluated included 30-day and 12-month complications, reinterventions, and mortality rates, adjusted for demographics, comorbidities, and hospital encounter characteristics.
Results: Among 2425 Aveir VR LP and 21 335 TV-VVI patients included in this analysis, Aveir VR patients had significantly fewer acute device-related complications (1.4% versus 2.8%, P=0.002). Overall acute complications were similar between Aveir VR (6.5%) and TV-VVI (6.8%), P=0.69. Cardiac effusion/perforation rates were also similar between Aveir VR (0.4%) and TV-VVI (0.3%), P=0.45. Aveir VR had a 30% lower overall 12-month complication rate compared with TV-VVI (4.1% versus 5.7%, P=0.02), including a 47% lower device-related complication rate (2.8% versus 5.2%, P=0.0002). There were 61% fewer 12-month reinterventions with Aveir VR compared with TV-VVI (1.2% versus 3.2%, PP=0.02).
Conclusions: This real-world evidence study, conducted immediately after commercialization of Aveir VR, demonstrates that safety of helix-fixation LPs is better than traditional TV-VVI pacemakers
I would like an epidural, and oh, by the way, I\u27m allergic to local anesthesia!
No full textIntroduction: Allergies to local anesthetics (LAs) are rare [1] but can present significant challenges in patient management, particularly for laboring patients seeking neuraxial analgesia. While there is limited cross-reactivity between amide and ester LAs, significant cross-reactivity can occur within the same class, especially among ester LAs. This case illustrates a safe approach to testing and administering LAs in a patient with an allergy to an unknown LA. Case Presentation: This case involves a 20-year-old female, G1P0 at 40 weeks and 0 days gestation, with a medical history of gestational hypertension and obesity (BMI 36), who was admitted to the labor and delivery department requesting labor analgesia. During the pre-procedure evaluation, the patient disclosed that she had recently undergone two deep dental cleanings where LAs were administered. Approximately 1–2 hours after receiving LAs on both occasions, she developed full-body hives, which improved after taking diphenhydramine. The patient was unsure which LA was used and had never received LAs before her recent dental procedures. She had not undergone formal allergy testing following these reactions. Given this history, the anesthesia team consulted an allergist, who recommended performing a scratch skin test with commonly used anesthetic agents, including 1% lidocaine, 3% 2-chloroprocaine, 0.5% ropivacaine, and 0.25% bupivacaine. All tests were negative except for lidocaine, which caused localized erythema, swelling, and pruritus. This reaction was interpreted as a true allergy to lidocaine. The allergist then advised performing intradermal testing with the LAs that had negative scratch test results, all of which were non-reactive. Based on these findings, the allergist and anesthesia team determined that it was safe to administer LAs neuraxially, except for lidocaine. The patient subsequently required a cesarean delivery due to failed induction of labor. The anesthesia team opted for a single spinal shot with 1.4 mL of 0.75% hyperbaric bupivacaine, along with 15 mcg of fentanyl and 150 mcg of morphine. Additionally, 3 mL of 0.25% bupivacaine was used to numb the skin at the injection site. No pre-medications were given, and ERAC protocol was followed. The spinal block provided excellent analgesia, with no signs of an allergic reaction during or after the procedure. Conclusion: Ideally, patients with a similar history should undergo formal allergy testing outpatient before presenting for delivery. However, anesthesiologists may encounter situations like the one described, which present unique challenges and considerations. This case demonstrates a safe approach to identifying and managing patients with a suspected allergy to an unknown LA. It suggests that LAs can be safely administered neuraxially following negative scratch and intradermal skin tests [2]. 1. Bhole, M. V. et al. (2012) British Journal of Anaesthesia 108:903-911 2. Arya, V.et al.(2021) J Dent Anesth Pain Med 21(6):583-58
A rare case of mycoplasma pneumonaie infection: Cold-aglutinin autoimmune hemolytic anemia causing pulmonary embolism
No full textDeglutition syncope: Transient AV block with swallowing in an otherwise normal conduction system
No full textTeleHelp Ukraine\u27s telemedicine services amidst conflict in Ukraine: Increasing access & reducing mental health stigma
No full textUpdate on the saccular endovascular aneurysm lattice system interventional pivotal trial (SEAL(TM) IT): Abstract 493
No full textTCT-257 From Progress To Plateau: Regional Inequities In ST-elevation Myocardial Infarction With Cardiogenic Shock Mortality Across 15 Years Of Us Practice
No full textFaculty decision making in ad hoc entrustment of pediatric critical care fellows: A national case-based survey
No full textPhenomenon: Ad hoc entrustment decisions reflect a clinical supervisor\u27s estimation of the amount of supervision a trainee needs to successfully complete a task in the moment. These decisions have important consequences for patient safety, trainee learning, and preparation for independent practice. Determinants of these decisions have previously been described but have not been well described for acute care contexts such as critical care and emergency medicine. The ad hoc entrustment of trainees caring for vulnerable patient populations is a high-stakes decision that may differ from other contexts. Critically ill patients and children are vulnerable patient populations, making the ad hoc entrustment of a pediatric critical care medicine (PCCM) fellow a particularly high-stakes decision. This study sought to characterize how ad hoc entrustment decisions are made for PCCM fellows through faculty ratings of vignettes. The authors investigated how acuity, relationship, training level, and task interact to influence ad hoc entrustment decisions.
Approach: A survey containing 16 vignettes that varied by four traits (acuity, relationship, training level, and task) was distributed to U.S. faculty of pediatric critical care fellowships in 2020. Respondents determined an entrustment level for each case and provided demographic data. Entrustment ratings were dichotomized by high entrustment versus low entrustment (direct supervision or observation only). The authors used logistic regression to evaluate the individual and interactive effects of the four traits on dichotomized entrustment ratings.
Findings: One hundred seventy-eight respondents from 30 institutions completed the survey (44% institutional response rate). Acuity, relationship, and task all significantly influenced the entrustment level selected but did not interact. Faculty most frequently selected direct supervision as the entrustment level for vignettes, including for 24% of vignettes describing fellows in their final year of training. Faculty rated the majority of vignettes (61%) as low entrustment. There was no relationship between faculty or institutional demographics and the entrustment level selected.
Insights: As has been found in summative entrustment for pediatrics, internal medicine, and surgery trainees, PCCM fellows often rated at or below the direct supervision level of ad hoc entrustment. This may relate to declining opportunities to practice procedures, a culture of low trust propensity among the specialty, and/or variation in interpretation of entrustment scales
Preconception chlamydia trachomatis seropositivity and fecundability, live birth, and adverse pregnancy outcomes
No full textObjective: To study the impact of preconception Chlamydia trachomatis seropositivity on fecundability, live birth, and pregnancy loss and to assess the effect of low-dose aspirin therapy (81 mg/day) on live birth and pregnancy loss.
Design: Preconception cohort study conducted using data and specimens from the Effects of Aspirin in Gestation and Reproduction study-a randomized placebo-controlled trial.
Subjects: A total of 1,228 individuals with proven fecundity and a history of 1-2 pregnancy losses.
Exposure: Preconception C. trachomatis seropositivity determined using an enzyme-linked immunoabsorbent assay-based synthetic peptide assay at baseline.
Main outcome measures: Time-to pregnancy (fecundability) was defined as number of menstrual cycles to beta human chorionic gonadrotropin-detected pregnancy; live birth status was determined from medical record abstraction; pregnancy loss was defined as any loss post positive beta human chorionic gonadrotropin test.
Results: After adjusting for confounders (baseline demographic and reproductive history variables), C. trachomatis seropositivity (n = 134/1228, 11%) was associated with a reduced live birth likelihood (relative risk [RR]: 0.77, 95% confidence interval [CI]: 0.59, 0.99) and an increased risk of pregnancy loss (RR: 1.16, 95% CI: 1.04, 1.29), but was not associated with fecundability (fecundability odds ratio: 0.92, 95% CI: 0.71, 1.20). Among a subset of C. trachomatis seropositive individuals with chronic inflammation indicated by increased C-reactive protein levels ≥1.95 but ≤10 mg/L (n = 50/134, 37.3%), low-dose aspirin therapy improved live birth rates (RR: 1.68, 95% CI: 0.96, 2.92) and reduced the risk of pregnancy loss (RR: 0.83, 95% CI: 0.65, 1.10). However, the sample size reduced precision.
Conclusion: Prior exposure to C. trachomatis among women with a history of pregnancy loss may impact risk of pregnancy loss. Our results indicate the need for future studies exploring mechanisms by which C. trachomatis may influence long-term reproductive function, because this may identify treatments to improve outcomes among those with a history of infection