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Impact of next-generation delivery assist catheters and crossing strategy on reperfusion success in aspiration thrombectomy
No full textBackground: In mechanical thrombectomy procedures, physicians are often forced to cross the clot to get more support in tortuous anatomy. Stentriever procedures always require traversing the clot. Novel delivery assist catheters with a tapered distal tip have been developed to aid aspiration catheter delivery. This study compares a novel delivery assist catheter to conventional support strategies in terms of reperfusion and distal embolization. The impact of remaining proximal versus entering the clot is also investigated, as is the impact of incorporating a Superbore 088 catheter.Methods: Soft, medium, and stiff ovine blood clots were used to form ICA/M1 occlusions in an in-vitro thrombectomy model. Two approaches were tested: navigating the aspiration catheter with and without crossing/entering the clot with support devices. Six setups were tested: Millipede88 + Zipline88, Millipede88 + Millipede70 + Zipline70, Millipede70 + Zipline70, SOFIA Plus + 021 Microcatheter, SOFIA Plus + 3MAX, SOFIA Plus + 021 Microcatheter + Stentriever. Each setup was tested nine times totaling 72 tests. Revascularization endpoints were First-Pass-Effect (FPE), final complete revascularization, and distal embolization.Results: Avoiding clot entry was associated with higher FPE rates, improved final revascularization, and fewer distal emboli. Using a 3MAX as a microcatheter and crossing the clot resulted in more distal emboli than a standard 021 microcatheter or stentriever procedure. Millipede88 + Zipline88 configuration achieved the highest FPE (67%) when the clot was not crossed (vs. 56% with clot entry). Both 070 aspiration catheters had the same FPE rate (33%) but using Millipede88 for flow control with Millipede70 improved the FPE rate (44%). Of the conventional techniques, SOFIA Plus + 021 Microcatheter + Stentriever was associated with the highest FPE rate (44%).Conclusions: Remaining proximal to the clot is advantageous. Next-generation delivery catheters, like Zipline, may enhance catheter delivery without increasing embolization risk. Using larger internal catheters, such as 3MAX, leads to higher rates of emboli when crossing the clot.</p
Protocol for developing a core outcome set for medicines safety at transitions of care: a systematic review, qualitative study and Delphi consensus
No full textIntroduction: Medication-related problems at transitions of care are common and can lead to patient harm. Comparing results of studies that look at medication reconciliation and medication safety at transitions of care can be difficult as the outcomes reported in these studies are heterogeneous. Moreover, the outcomes measured often lack the patient's perspective. A core outcome set (COS) is a list of outcomes which should be measured and reported in studies in order to avoid heterogeneity between trials, measure outcomes relevant to stakeholders and ensure all trials report usable information. This study aims to develop a COS for medicines safety at transitions of care, through updating an existing systematic review and evaluating the perspectives of patients, carers and healthcare professionals.Methods: This study is registered with the Core Outcome Measures in Effective Trials (COMET) initiative and the project will be conducted following the COS-STAR (Core Outcome Set-Standards for Reporting) guidelines for the design and reporting of COSs. A four-step process will be followed: (1) updating an existing systematic literature review; (2) semistructured interviews with patients and their caregivers; (3) Delphi survey preparation involving a project steering group to compile a list of potential outcomes; (4) a three-round Delphi consensus exercise involving patients, clinicians and policymakers to refine the final core list of outcomes.Analysis: This will be the first COS for medicines safety at transitions of care and will address an unmet need in providing an essential measurement approach that incorporates patients', carers' and healthcare professionals' views. The findings apply to both quality improvement and research, ensuring the relevance and translation of future research findings.Ethics and dissemination: Ethical approval for the qualitative surveys and Delphi technique has been granted by the Irish College of General Practitioners Research Ethics Committee (Record ID: 2182). The findings of this project will be disseminated through peer-reviewed publications, conference presentations and registration with the COMET Initiative. Members of the Delphi panel will receive summaries of the outputs, and findings will also be shared with the patient and public involvement groups involved in the study through lay summaries. Engagement with professional societies, healthcare organisations and patient groups will ensure that the COS is widely accessible and adopted into future practice.</p
Transitioning from pediatric to adult multiple sclerosis care: challenges, strategies and therapy
No full textMultiple sclerosis (MS) is a chronic autoimmune condition causing damage to the protective covering of nerves in the central nervous system. Pediatric multiple sclerosis is a rare form of the disease that affects 3-5% of individuals with multiple sclerosis. Pediatric Onset Multiple Sclerosis (POMS) has a rather different clinical profile from the more prevalent adult multiple sclerosis. Alongside the classic symptoms of multiple sclerosis, children tend to present with various atypical symptoms that can impact motor milestones, speech development, and cognitive functions. This review aims to explore the pathogenesis, clinical features, diagnosis and progression of Pediatric Onset Multiple Sclerosis into adulthood, address the challenges accompanying this transition and identify strategies and therapies to overcome them. Pediatric multiple sclerosis patients transitioning into adulthood face many challenges, such as difficulty in school and social life, and dealing with uncertainties especially due to changes in healthcare providers from pediatric to adult settings. These challenges can be overcome by an emphasis on a well-structured transition plan, early planning, personalized care, proper counselling of the patient as well as the family and caretakers, a multidisciplinary approach with good communication and coordination between all healthcare personnel a robust support network with a gradual transition rather than an abrupt one. Proper care during the transition period is crucial to enhance patient adherence and deepen the understanding of the disease for both patients and their families. This will empower them to seek timely assistance when needed, reduce loss to follow-up, and ultimately improve overall quality of life.</p
What is the impact of care bundles on the prevalence or incidence of pressure ulcers among at-risk adults in the acute care setting? A systematic review
No full textA pressure ulcer is an injury to the skin and underlying tissues caused by pressure, shear or a combination of the two. In Europe, the mean prevalence rate of pressure ulcers is 10.8%, in Ireland, it is less than 12%. Using systematic review methodology, original research studies written in English were included, employing pre- and post-studies, quality improvement initiatives or projects, randomised controlled trials and experimental studies. Data was extracted using a pre-designed data extraction tool and quality appraisal was undertaken using the Evidence-Based Librarianship (EBL) tool. Where appropriate, a meta-analysis was undertaken using RevMan. The study protocol was pre-registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42023442711). Following the search, 628 records were returned, of which 25 met the inclusion criteria. The studies were conducted in a variety of acute healthcare settings. Of the included studies, 16 presented data on incidence and 12 presented data on prevalence of pressure ulcers post-implementation of a care bundle. A meta-analysis of 10 studies discussing incidence indicates the RR of PU is 0.40 (95% CI: 0.21–0.78; p = 0.007), supporting the use of a care bundle. A meta-analysis of seven studies discussing prevalence indicates the RR of PU is 0.34 (95% CI: 0.21–0.56; p = 0.0001), demonstrating the reduction in the RR of PU development in favour of the care bundle group. A variety of care bundle elements were found in the studies. Although results indicated the use of a care bundle was advantageous in preventing a pressure ulcer in the acute care setting, it was unclear which of these elements were most effective.</p
Paediatric and perinatal deaths by the Office of the Irish State Pathologists: a 5-year retrospective cohort study
No full textIntroduction: The Irish Office of the State Pathologist (OSP) provides a forensic pathology service for cases of criminal, suspicious or unusual deaths as referred by the coroner. This study aims to review the paediatric and perinatal deaths referred to the OSP and compare them to existing standards and data.Methods: A retrospective cohort study was conducted on all paediatric and perinatal cases (Results: 65 cases were identified. Confirmed homicide accounted for the highest proportion of referred cases at 31% (n=20). Sudden infant death syndrome (SIDS) was the key cause under 1 years old (n=10/13). 91% of postmortem reports (2018-2022) met reporting standards. Paediatric and perinatal referrals remained consistent when comparing 2012-2017 to 2018-2022. Areas of inconsistency were in the area of SIDS and the inclusion of anthropometric reference values. PMEs involving forensic pathologists (FPs) and paediatric/perinatal pathologists (PPs) produced variations in reporting.Conclusion: Homicide was the leading cause of referred cases at 31% over 2018-2022 and 29% between 2012-2022. While the OSP provides a high standard service, key areas of improvement include the reporting of SIDS, the anthropometric reference values and the integration of PP and FP reports. Analysis of child mortality data and statistics in Ireland would be improved with the implementation of a single reporting database.</p
Training load and injury surveillance in Leinster SChoolboy RUgby players: the SCRUm cohort study
No full textObjectives: To describe training loads and injury incidences, and explore their relationship in senior schoolboy rugby players in Leinster, Ireland.Methods: Prospective cohort study conducted during the 2019-2020 season. Methods aligned with consensus statements for rugby injury surveillance research. Injuries were coded using the Orchard Sports Injury Classification System (OSICS) version 10.1 and recorded using the World Rugby Injury Surveillance System. Training load measures (session type, duration and rate of perceived exertion) were recorded by the players using The Sports Office smartphone application.Results: In total, 463 participants (mean age 17, (SD=0.9 years)) in 16 schools provided data over 20 weeks. Injury incidence per 1000 player hours was 19.9 (95% CI: 15.2 to 25.6) match injuries and 0.7 (95% CI: 0.4 to 1.0) training injuries. Median injury severity was 22 days (95% CI: 17 to 28) lost for match injuries and 14 days (95% CI: 5 to 41) lost for training injuries. Frequent injury sites included shoulder (n=23, 27%), head (n=22, 26%), wrist/hand (n=9, 11%), ankle (n=8, 10%) and knee (n=5, 6%). Tackle accounted for 49% of injuries. Players' recording of individual training load showed 11.5% compliance. Exposure was calculated as 31 141 training hours and 3063 match hours. Training sessions included conditioning weights (31%), rugby skills: non-contact (28%) and semicontact (24%), with variation in proportion of sessions across schools.Conclusion: Match activity and tackle events accounted for most injuries. Training exposure and type varied widely across schools. Low compliance in recorded individual training load limited analysis of association with injury risk, highlighting the challenge in identifying injury risk factors in an adolescent cohort.</p
Simulating the blood transfusion system in Kenya: modelling methods and exploratory analyses
No full textThe process of collecting blood from donors and making it available for transfusion requires a complex series of operations involving multiple actors and different resources at each step. Ensuring hospitals receive adequate and safe blood for transfusion is a common challenge across low- and middle-income countries, but is rarely addressed from a system level. This paper presents the first use of discrete event simulation to study the blood system in Kenya and to explore the effect of variations and perturbations at different steps of the system on meeting blood demand at patient level. A process map of the Kenyan blood system was developed to capture critical steps from blood donation to transfusion using interviews with blood bank, hospital and laboratory personnel at four public hospitals across three counties in Kenya. The blood system was simulated starting with blood collection, a blood bank where blood is tested and stored before it is issued, a major hospital attached to the blood bank, and several smaller hospitals served by the same blood bank. Values for supply-side parameters were based mainly on expert opinion; demand-side parameters were based on data from blood requisitions made in hospital wards, and dispatch of blood from the hospital laboratory. Illustrative examples demonstrate how the model can be used to explore impacts of changes in blood collection (e.g., prioritising different donor types), blood demand (e.g., differing clinical case mix), and blood distribution (e.g., restocking strategies) on meeting demand at patient level. The model can reveal potential process impediments in the blood system and aid in choosing between alternate strategies or policies for improving blood collection, testing, distribution or use. Such a systems approach allows for interventions at different steps in the blood continuum to be tested on blood availability for different patients presenting at diverse hospitals across the country.</p
The impact of pressure ulcer prevention education on the knowledge, skills and attitudes of health care assistants (HCAs) and pressure ulcer prevalence in long term care settings
No full textBackground: Pressure ulcers (PUs) have a profound negative impact on patients, carers and health care services. PU prevention in long-term care settings (LTC) is a particularly important clinical issue as older adults (>65 years) are at a greater risk of PU development due to the presence of co morbidities and reduced mobility. LTC settings refer to the provision of ongoing care and support in a residential care setting to the resident population of older adults (> 65 years old) (HIQA 2016). Whilst prevalence data for the LTC setting demonstrates inconsistency, it highlights the problem of PUs for the LTC setting. Health care assistants (HCAs) represent the majority of the workforce in LTC settings. As such, within this setting, HCAs play a pivotal role in PU prevention. Studies have provided an insight into the positive effects of PU education on health care professionals’ knowledge and skills and PU incidence. However, the precise impact of PU education for HCAs is under reported. Therefore, this study set out to address this gap. Aim: The overarching aim of this study was to evaluate the impact of PU prevention education for HCAs on their knowledge, skills, and attitudes towards PU prevention. A secondary aim was to evaluate the impact of the PU education programme on PU prevalence in LTC settings.Methods: The time frame for this study was four years and comprised of three phases. The first phase involved undertaking a systematic literature review with the aim to ascertain the efficacy of PU education programmes on HCAs knowledge and skills in PU prevention in addition to PU prevalence/ incidence. The Population Intervention Comparison Outcomes (PICO) framework was used to formulate the research question for the review. The Preferred Reporting Items for Systematic reviews and Meta- Analysis (PRISMA) guidelines were used to display the outcomes of the full search strategy. Fourteen studies formed the basis of the review. The review found a consistent pattern of heterogeneity among included studies in terms of study design, research methodologies and sample sizes. Despite this, the findings demonstrated some insight into the positive impact of PU prevention education on HCA knowledge skills and PU prevalence / incidence in health care settings. The second phase involved tailoring the Shanley Pressure Ulcer Prevention Programme (SPUPP) (Shanley et al. 2022) to ensure it met the learning needs of HCAs. Piloting the SPUPP and the PU Classification system (PUCLAS) (Beeckman et al. 2017a) with a sample of (HCAs n=10) for suitability, including testing of the pre-existing validated tools to include; the Knowledge of Pressure Ulcer Prevention questionnaire (KPUP) (Shanley et al. 2020) and the Attitudes towards PU prevention questionnaire (Moore and Price 2004). Following ethical approval, access to LTC settings was granted and HCAs from both public and private LTC settings were invited to participate in the study.A mixed-methods design was employed for the third phase of the study. This phase involved data collection and the implementation of a PU education intervention to HCAs, with a time frame of eight months for completion of this phase. A quasi-experimental design was employed for the quantitative arm of the study. This phase involved assessment of HCAs’ knowledge skills and attitudes pre-and-post delivery of an education intervention. PU prevalence was also collected at each site pre- and post-intervention. The SPUPP and the PUCLAS programme (modules 3 and 4) were delivered. The combined PU programmes were delivered face-to-face, using multiple teaching strategies. Knowledge scores were analysed over time using a repeated measures mixed-model analysis (unadjusted) and additionally adjusted for age, sex, previous education, length of time employed and public /private LTC facility. Skill scores were analysed over time using a repeated mixed-model analysis. Analysis included time only and additionally adjusting for the other variables; age, sex previous education, public/ private facility and length of time employed. A qualitative descriptive design was employed for the qualitative arm of the study and involved conducting semi-structured interviews with directors of nursing (DON) (n=6), patients (n=7) and HCAs (n=40) post-intervention, with an aim to gain insight into the impact of the education programme from their individual perspectives.Results: Of the 129 HCAs who completed the education intervention 19% (n=24) were male and 81% (n=105) were female. The mean age of participants was 49 years (range 29-60 years, SD: 7). A total of 58% (n=75) of participants were recruited from a public LTC facility, whilst 42% (n=54) were employed at private LTC facilities. Knowledge scores were positively impacted by time; (time 2 v time 1: Mean difference (MD): 3.37; 95% CI: 3.11 to 3.64, p = The mean skill score at (S1) was (0.68 SD: 0.78), and this increased at (S2) (2.8, SD:0.77) and decreased at (S3) (2.23, SD: 0.5), but was still higher compared to (S1)scores. Mean skill scores for female and male participants were similar over the study period. However, a greater increase in skill scores was seen from participants in the private LTC facilities post-intervention (S3) (2.3 SD: 0.46). Skill scores were positively impacted by time; (time 1 v time 2: 2.13; 95% CI 1.97 to 2.28, p = The mean attitude score pre-intervention (A1TS) was: 38, (SD: 3.9; range: 28 – 47).The mean attitude score directly after the intervention (A2TS) was: 40, (SD: 2.5; range32 – 48). The mean attitude score four months post-intervention (A3TS) was: 40, (SD:2.6; range 32- 47). Thus mean attitude scores were positively impacted by the education intervention. Health care assistant behaviours towards PU preventative practice improved post-intervention and included enhanced communication skills in the reporting of skin integrity issues to nurses. Mean PU prevalence pre-intervention was: 7.7%, (SD: 3%; Min 4%, Max 12%) and mean PU prevalence post-intervention was: 4.2%, (SD: 1.9%; Min 2%, Max 7%. The mean difference in prevalence (proportions) across study sites was: 3.9%, (95% Cl 2.5% to 5.4%; p = 0.0004). Four key themes emerged from the DON qualitative interviews: Illuminating the status of the HCA role; PU skills: enablers and barriers; inclusion and catalyst for change. DONs reported positives outcomes from the PU education programme on their respective LTC facilities and on HCAs attitudes towards PU prevention practice. Findings revealed a heightened sense of awareness in HCA responsibilities towards PU prevention, improved collegiality, enhanced teamwork, and overall an empowered HCA workforce. DONs called for regulation of the HCA role to protect educational standards, safe guard practice and strengthen the HCA profile.From the analysis of the data from seven patients five themes emerged; pressure ulcer awareness; patient engagement in pressure ulcer care; repositioning: the patients’ perspective; HCA preventative strategies and evaluation of pressure ulcer prevention care - the patients’ perspective. Findings from the patient interviews affirm the key role of the HCA in PU prevention and highlight the therapeutic relationship between the HCA and the patient in delivering person centred PU care. A total of 40 HCAs participated in cognitive interviews, findings demonstrated that HCAs had some ability to classify early stages of PU development; however, there was ambiguity amongst participants in classifying some of the other stages of PUs. Feedback from the education programme was also obtained from participants. Four key themes emerged and include: enhanced self- efficacy; skin assessments: when and what to report; valuing education and teamwork. Findings revealed how the education programme had a positive impact on HCA attitudes and behaviours towards PU prevention. Conclusion: The educational intervention achieved its aim, with a statistically significant increase knowledge and skills scores attained post-intervention compared to pre-intervention. In addition, HCA attitudes and behaviours towards PU prevention improved. An overall reduction in the prevalence of PU post-intervention was also realised. Whilst the design of the education programme was successful in achieving the overall aims, this study affirms the successful implementation of any education programme is dependent upon organisational leadership. This study has provided valuable data into the impact of a PU education programme on HCAs knowledge skills and attitudes in LTCs settings and has addressed a key gap in the literature.</p
National Audit of Hospital Mortality National Report 2022 and 2023
No full textThis report from the National Audit of Hospital Mortality (NAHM) presents data from 44 acute hospitals, focusing on 6 diagnoses that have a high burden on the Irish health system. Clinical chapters for the 6 diagnoses show crude mortality figures over the 10-year period from 2014 to 2023, standardised mortality ratio (SMR) funnel plots for both 2022 and 2023, and population pyramids showing the volume of deceased cases. The report also presents crude mortality data on all diagnoses for in-hospital discharges nationally. </p
Endothelial protein changes indicative of endometriosis in unexplained infertility, an exploratory study
No full textPrevious research has linked both endothelial protein changes and vitamin D with infertility. This study was undertaken to investigate the association of proteins associated with endothelial function and vitamin D status in the luteal phase at day 21 in a group of non-obese women prior to in vitro fertilization (IVF) with either unexplained infertility (UI) or male factor infertility (MFI). Twenty-five non-obese Caucasian women from a UK academic center with MFI (n = 14) and UI (n = 11) were recruited. Blood was withdrawn at day 21 of the menstrual cycle at the time of mock embryo transfer. Vitamin D parameters were measured by tandem mass spectroscopy. Off-rate Modified Aptamer (SOMA)-scan plasma protein measurement was undertaken for 20 protein markers of endothelial dysfunction. Baseline demographics did not differ between groups and parameters of response following IVF did not differ. Vitamins D2 and D3, and 1,25 Vitamin D3 did not differ between groups. In UI, markers of endothelial activation/dysfunction were investigated; vascular cell adhesion molecule 1 (VCAM-1) decreased and this is associated with endothelial stress; vascular endothelial growth factor (VEGF) decreased and this may suggest impaired endometrial angiogenesis; while intercellular adhesion molecule 1 (ICAM-3) increased (p p < 0.05), suggesting increased vascular development. Endothelial markers of inflammation, coagulation, and endothelial progenitor cells were unchanged. Vitamin D and its metabolites show no relationship to UI, but endothelial activation/dysfunction and vascular integrity changes in VCAM-1, VEGF, sICAM-3, angiopoietin-1, and sTie-2 may contribute to UI, though the mechanisms through which they work require further evaluation; however, these protein changes have been associated with endometriosis, raising the suggestion that subclinical/undiagnosed endometriosis may have contributed to UI in these subjects.</p