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Chelly S, Jaziri S, Ammar A, Ezzi O, Douss N, Saffar S, Tritar M, Njah M, Mahjoub M. Safety and efficiency of COVID-19 vaccine in North Africa. Hum Vaccin Immunother 2024; 20:2306703. [PMID: 38304972 PMCID: PMC10841012 DOI: 10.1080/21645515.2024.2306703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
Background In the absence of a specific treatment for COVID-19, preventive measures have been implemented to control this pandemic and vaccination is one of them. However, it is crucial to verify the safety and efficiency of every vaccine. The aim was to determinate the predictive factors of side effects and reinfection after COVID-19 vaccine. Methods A cross-sectional study was conducted in February 2022 among Tunisians infected with COVID-19 between March 2020 and February 2022, using an online self-administered questionnaire. We conducted univariate and multivariate analyses using binary stepwise logistic regression. Results A total of 1541 was selected from 1911 individuals. Comorbidities affected a quarter of the population (22.3%). Before the initial infection, 39.3% had received full vaccination, and 8.7% had received partial vaccination. By February 2022, the majority (82.9%) had received at least two vaccine doses. The reinfection rate was 30.6%. All vaccines prior to the first infection was identified as a protective factor against reinfection. Inactivated virus vaccinations were less likely to induce adverse effects. Conclusion ach vaccine has its own set of advantages and disadvantages: mRNA-based vaccines had a higher incidence of side effects but all vaccines provided better protection against reinfection.
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Affiliation(s)
- Souhir Chelly
- Faculty of Medicine of Sousse, Infection Prevention and Control Department, Farhat Hached University Hospital, University of Sousse, Sousse, Tunisia
| | - Shayma Jaziri
- Faculty of Medicine of Sousse, Infection Prevention and Control Department, Farhat Hached University Hospital, University of Sousse, Sousse, Tunisia
| | - Asma Ammar
- Faculty of Medicine of Sousse, Infection Prevention and Control Department, Farhat Hached University Hospital, University of Sousse, Sousse, Tunisia
| | - Olfa Ezzi
- Faculty of Medicine of Sousse, Infection Prevention and Control Department, Farhat Hached University Hospital, University of Sousse, Sousse, Tunisia
| | - Nour Douss
- Faculty of Medicine of Sousse, Infection Prevention and Control Department, Farhat Hached University Hospital, University of Sousse, Sousse, Tunisia
| | - Sonia Saffar
- Faculty of Medicine of Sousse, Infection Prevention and Control Department, Farhat Hached University Hospital, University of Sousse, Sousse, Tunisia
| | - Marouen Tritar
- Faculty of Medicine of Sousse, Infection Prevention and Control Department, Farhat Hached University Hospital, University of Sousse, Sousse, Tunisia
| | - Mansour Njah
- Faculty of Medicine of Sousse, Infection Prevention and Control Department, Farhat Hached University Hospital, University of Sousse, Sousse, Tunisia
| | - Mohamed Mahjoub
- Faculty of Medicine of Sousse, Infection Prevention and Control Department, Farhat Hached University Hospital, University of Sousse, Sousse, Tunisia
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Kumar P, Singh A, Sharma J, Parshad S, Johar S, Kaur K. Assessment of ultrasound guided erector spinae plane block for early post-operative analgesia for modified radical mastectomy: a prospective, randomized, controlled study. Med Gas Res 2024; 14:201-205. [PMID: 39073328 DOI: 10.4103/mgr.mgr_74_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/23/2024] [Indexed: 07/30/2024] Open
Abstract
Erector spinae plane block is a recently introduced block with a wide range of indications. The aim of the present study was to assess the efficacy and safety of ultrasound-guided erector spinae plane block on early post-operative pain relief in patients undergoing modified radical mastectomy. We conducted a prospective, randomized, controlled study in a tertiary care institute. Sixty-five patients were enrolled. Final analysis was performed on 58 patients randomized into two groups. Ultrasound-guided erector spinae plane block with 25 mL of 0.25% bupivacaine was given using a 18 gauge needle. No block was given in the other group. All patients received general anesthesia. Primary outcome measure was 24-hour analgesic consumption. Secondary outcome measures included intra-operative fentanyl consumption, time to first analgesic request, Visual Analog Scale score, nausea score, sedation score, wound quality and patient satisfaction score. Post-operative additional analgesics and intra-operative fentanyl were significantly reduced in patients receiving erector spinae plane block. Time to rescue analgesia was significantly delayed. Visual Analog Scale score was significantly lower at all time intervals. Post-operative nausea at various time intervals was also less. Patient satisfaction score was also noted on a 5-point scale and there was a statistical significant difference. We concluded that erector spinae plane block is a safe technique and provides good analgesia in breast surgery.
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Affiliation(s)
- Prashant Kumar
- Department of Anaesthesiology and Critical Care, Pt. B D Sharma PGIMS, Rohtak, India
| | - Anu Singh
- Department of Anaesthesiology and Critical Care, Pt. B D Sharma PGIMS, Rohtak, India
| | - Jyoti Sharma
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, India
| | | | - Sanjay Johar
- Department of Anaesthesiology and Critical Care, Pt. B D Sharma PGIMS, Rohtak, India
| | - Kiranpreet Kaur
- Department of Anaesthesiology and Critical Care, Pt. B D Sharma PGIMS, Rohtak, India
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Elmati PR, Jagirdhar GSK, Surani S. Cardiac implications in myasthenia gravis. World J Clin Cases 2024; 12:5863-5867. [DOI: 10.12998/wjcc.v12.i26.5863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/03/2024] [Accepted: 06/14/2024] [Indexed: 07/19/2024] Open
Abstract
This editorial aimed to consolidate the current evidence in literature on the association between myasthenia gravis (MG) and cardiac involvement, focusing on the impact of thymoma, antistriational antibodies, and late-onset MG. Additionally, the study aimed to explore the influence of genetic differences among populations on the association with cardiac disease. We conducted a review of existing literature in PubMed and Google Scholar to find relevant studies on cardiac involvement in MG. We created search criteria using a combination of free text words, including MG, antistriational antibodies, thymectomy, cardiomyopathy, myocarditis, arrhythmias, autonomic dysfunction. Relevant articles published in English language were analyzed and incorporated. The findings indicate a strong association between thymoma, myasthenic crisis, antistriational antibodies, and late-onset MG with cardiac involvement. The study also revealed that genetic differences among populations influence the risk of cardiac disease and electrocardiography (ECG) abnormalities in MG patients. Autonomic dysfunctions altered cardiac autonomic response and increased susceptibility to arrhythmias and sudden cardiac death in MG patients. The study supports the significance of thymoma, antistriational antibodies, and late-onset MG as key factors associated with cardiac involvement in MG patients. It emphasizes the importance of ECG as the initial test in managing MG patients, particularly in the perioperative period, to identify and genetic testing if needed to address their cardiac risk effectively.
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Affiliation(s)
- Praveen Reddy Elmati
- Department of Anesthesiology, Saint Clair Hospital, Dover, NJ 07801, United States
| | | | - Salim Surani
- Department of Medicine and Pharmacology, Texas A&M University, College Station, TX 77843, United States
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Higgins S, Dlamini S, Hattingh M, Rambharose S, Theron E, Stassen W. Views and perceptions of advanced life support practitioners on initiating, withholding and terminating resuscitation in out-of-hospital cardiac arrest in the Emergency Medical Services of South Africa. Resusc Plus 2024; 19:100709. [PMID: 39104446 PMCID: PMC11298628 DOI: 10.1016/j.resplu.2024.100709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 08/07/2024] Open
Abstract
Introduction This study aimed to explore the views and perceptions of Advanced Life Support (ALS) practitioners in two South African provinces on initiating, withholding, and terminating resuscitation in OHCA. Methodology Semi-structured one-on-one interviews were conducted with operational ALS practitioners working within the prehospital setting in the Western Cape and Free State provinces. Recorded interviews were transcribed and subjected to inductive-dominant, manifest content analysis. After familiarisation with the data, meaning units were condensed, codes were applied and collated into categories that were then assessed, reviewed, and refined repeatedly. Results A total of 18 ALS providers were interviewed. Five main categories were developed from the data analysis: 1) assessment of prognosis, 2) internal factors affecting decision-making, 3) external factors affecting decision-making, 4) system challenges, and 5) ideas for improvement. Factors influencing the assessment of prognosis were history, clinical presentation, and response to resuscitation. Internal factors affecting decision-making were driven by emotion and contemplation. External factors affecting decision-making included family, safety, and disposition. System challenges relating to bystander response and resources were identified. Ideas for improvement in training and support were brought forward. Conclusion Many factors influence OHCA decision-making in the Western Cape and Free State provinces, and numerous system challenges have been identified. The findings of this study can be used as a frame of reference for prehospital emergency care personnel and contribute to the development of context-specific guidelines.
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Affiliation(s)
- S. Higgins
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - S. Dlamini
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - M. Hattingh
- School of Nursing, University of the Free State, Bloemfontein, South Africa
| | - S. Rambharose
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - E. Theron
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - W. Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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Bodnar RJ. Endogenous opiates and behavior: 2023. Peptides 2024; 179:171268. [PMID: 38943841 DOI: 10.1016/j.peptides.2024.171268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/01/2024]
Abstract
This paper is the forty-sixth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2023 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug and alcohol abuse (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Psychology Doctoral Sub-Program, Queens College and the Graduate Center, City University of New York, USA.
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Liu Y, Yin S, Lu G, Du Y. The intersection of the nervous system and breast cancer. Cancer Lett 2024; 598:217132. [PMID: 39059572 DOI: 10.1016/j.canlet.2024.217132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/15/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
Breast cancer (BC) represents a paradigm of heterogeneity, manifesting as a spectrum of molecular subtypes with divergent clinical trajectories. It is fundamentally characterized by the aberrant proliferation of malignant cells within breast tissue, a process modulated by a myriad of factors that govern its progression. Recent endeavors outline the interplay between BC and the nervous system, illuminate the complex symbiosis between neural structures and neoplastic cells, and elucidate nerve dependence as a cornerstone of BC progression. This includes the neural modulations on immune response, neurovascular formation, and multisystem interactions. Such insights have unveiled the critical impact of neural elements on tumor dynamics and patient prognosis. This revelation beckons a deeper exploration into the neuro-oncological interface, potentially unlocking novel therapeutic vistas. This review endeavors to delineate the intricate mechanisms between the nervous system and BC, aiming to accentuate the implications and therapeutic strategies of this intersection for tumor evolution and the formulation of innovative therapeutic approaches.
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Affiliation(s)
- Yutong Liu
- Department of Breast Surgery, General Surgery Center, The First Hospital of Jilin University, No.71Xinmin Street, Changchun, Jilin, China
| | - Shiqi Yin
- Anhui University of Science and Technology Affiliated Fengxian Hospital, 6600 Nanfeng Road, Shanghai, China
| | - Guanyu Lu
- Cancer Center, The First Hospital of Jilin University, No.71Xinmin Street, Changchun, Jilin, China
| | - Ye Du
- Department of Breast Surgery, General Surgery Center, The First Hospital of Jilin University, No.71Xinmin Street, Changchun, Jilin, China.
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Karamchandani K, Nasa P, Jarzebowski M, Brewster DJ, De Jong A, Bauer PR, Berkow L, Brown CA, Cabrini L, Casey J, Cook T, Divatia JV, Duggan LV, Ellard L, Ergan B, Jonsson Fagerlund M, Gatward J, Greif R, Higgs A, Jaber S, Janz D, Joffe AM, Jung B, Kovacs G, Kwizera A, Laffey JG, Lascarrou JB, Law JA, Marshall S, McGrath BA, Mosier JM, Perin D, Roca O, Rollé A, Russotto V, Sakles JC, Shrestha GS, Smischney NJ, Sorbello M, Tung A, Jabaley CS, Myatra SN. Tracheal intubation in critically ill adults with a physiologically difficult airway. An international Delphi study. Intensive Care Med 2024:10.1007/s00134-024-07578-2. [PMID: 39162823 DOI: 10.1007/s00134-024-07578-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/28/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE Our study aimed to provide consensus and expert clinical practice statements related to airway management in critically ill adults with a physiologically difficult airway (PDA). METHODS An international Steering Committee involving seven intensivists and one Delphi methodology expert was convened by the Society of Critical Care Anaesthesiologists (SOCCA) Physiologically Difficult Airway Task Force. The committee selected an international panel of 35 expert clinician-researchers with expertise in airway management in critically ill adults. A Delphi process based on an iterative approach was used to obtain the final consensus statements. RESULTS The Delphi process included seven survey rounds. A stable consensus was achieved for 53 (87%) out of 61 statements. The experts agreed that in addition to pathophysiological conditions, physiological alterations associated with pregnancy and obesity also constitute a physiologically difficult airway. They suggested having an intubation team consisting of at least three healthcare providers including two airway operators, implementing an appropriately designed checklist, and optimizing hemodynamics prior to tracheal intubation. Similarly, the experts agreed on the head elevated laryngoscopic position, routine use of videolaryngoscopy during the first attempt, preoxygenation with non-invasive ventilation, careful mask ventilation during the apneic phase, and attention to cardiorespiratory status for post-intubation care. CONCLUSION Using a Delphi method, agreement among a panel of international experts was reached for 53 statements providing guidance to clinicians worldwide on safe tracheal intubation practices in patients with a physiologically difficult airway to help improve patient outcomes. Well-designed studies are needed to assess the effects of these practice statements and address the remaining uncertainties.
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Affiliation(s)
- Kunal Karamchandani
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Prashant Nasa
- Critical Care Medicine, NMC Specialty Hospital, Al Nahda, Dubai, UAE
- Internal Medicine, College of Medicine and Health Sciences, Al Ain, Abu Dhabi, UAE
| | - Mary Jarzebowski
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, Henry Ford Health, Detroit, MI, USA
| | - David J Brewster
- Intensive Care Unit, Cabrini Hospital, Melbourne, Australia
- School of Translational Medicine, Monash University, Melbourne, Australia
| | - Audrey De Jong
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, Phymedexp, Université de Montpellier, Inserm, CNRS, CHRU de Montpellier, Montpellier, France
| | - Philippe R Bauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Lauren Berkow
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Calvin A Brown
- Department of Emergency Medicine, Lahey Hospital and Medical Center, UMass Chan - Lahey School of Medicine, Burlington, MA, USA
| | - Luca Cabrini
- Department of Biotechnology and Life Sciences, Insubria University, Ospedale di Circolo, Varese, Italy
| | - Jonathan Casey
- Division of Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tim Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Jigeeshu Vasishtha Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Laura V Duggan
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada
| | - Louise Ellard
- Department of Critical Care, University of Melbourne, Department of Anaesthesia, Austin Health, Victoria, Australia
| | - Begum Ergan
- Division of Critical Care Medicine, Department of Pulmonary and Critical Care, Dokuz Eylul University, Izmir, Turkey
| | - Malin Jonsson Fagerlund
- Department of Perioperative Medicine and Intensive Care, Department of Physiology and Pharmacology, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Jonathan Gatward
- Intensive Care Unit, Royal North Shore Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Robert Greif
- University of Bern, Bern, Switzerland
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Andy Higgs
- Department of Critical Care Medicine, Warrington Teaching Hospitals, Cheshire, UK
| | - Samir Jaber
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, Phymedexp, Université de Montpellier, Inserm, CNRS, CHRU de Montpellier, Montpellier, France
| | - David Janz
- Section of Pulmonary and Critical Care Medicine, Tulane School of Medicine, University Medical Center New Orleans, LSU School of Medicine of New Orleans, New Orleans, LA, USA
| | - Aaron M Joffe
- Department of Anesthesiology, Creighton University School of Medicine, Valleywise Health Medical Center, Phoenix, AZ, USA
| | - Boris Jung
- Medical Intensive Care Unit, INSERM PhyMedexp, Montpellier University, Montpellier, France
| | - George Kovacs
- Departments of Emergency Medicine, Anaesthesia, Medical Neurosciences & Continuing Professional Development and Medical Education, Charles V. Keating Emergency and Trauma Centre, Dalhousie University, Halifax, NS, Canada
| | - Arthur Kwizera
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Mulago Hospital Complex, Kampala, Uganda
| | - John G Laffey
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospital, Saolta Hospital Group, Galway, Ireland
- Anaesthesia and Intensive Care Medicine, School of Medicine, University of Galway, Galway, Ireland
| | - Jean-Baptiste Lascarrou
- Nantes Université, CHU Nantes, Movement - Interactions - Performance, MIP, Médecine Intensive Réanimation, UR 4334, 44000, Nantes, France
| | - J Adam Law
- Department of Anesthesia, Pain Management and Perioperative Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Stuart Marshall
- Department of Critical Care, University of Melbourne, Melbourne, Australia
- Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia
| | - Brendan A McGrath
- Anaesthesia and Intensive Care Medicine, Manchester University Hospital, NHS Foundation Trust, Manchester, UK
| | - Jarrod M Mosier
- Department of Emergency Medicine, Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep, University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Oriol Roca
- Servei de Medicina Intensiva, Institut de Recerca Part Taulí (I3PT-CERCA), Parc Taulí Hospital Universitari, Sabadell, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Ciber Enfermedades Respiratorias (Ciberes), Instituto de Salud Carlos III, Madrid, Spain
| | - Amélie Rollé
- Anesthesia and Intensive Care, University Hospital of La Guadeloupe, University of Les Antilles, Abymes, France
| | - Vincenzo Russotto
- Anesthesia and Intensive Care, University Hospital San Luigi Gonzaga, Orbassano (TO), University of Turin, Turin, Italy
| | - John C Sakles
- Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Gentle S Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Nathan J Smischney
- Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Massimiliano Sorbello
- UOC Anesthesia and Intensive Care PO Giovanni Paolo II, Ragusa, Italy
- Anaesthesia and Intensive Care, Kore University, Enna, Italy
| | - Avery Tung
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA
| | - Craig S Jabaley
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
- Emory Critical Care Center, Atlanta, GA, USA
| | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Thiruvenkitasamy N, Manimozhi S. Perioperative anaesthetic management of an elderly high-risk male with cardiac ochronosis undergoing aortic valve replacement with coronary artery bypass graft: A case report. J Perioper Pract 2024:17504589241268633. [PMID: 39133167 DOI: 10.1177/17504589241268633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Alkaptonuria is a rare autosomal recessive congenital disorder of metabolism that affects 1 in 250,000 live births. It manifests as ochronosis and degenerative arthritis due to the accumulation of homogentistic acid in cartilage and heart valves along with precipitation of renal, salivary, pancreatic and gall bladder calculi. It is noted to cause cardiac valve stenosis and regurgitation secondary to calcification leading to cardiac failure in 10% of patients. Through this report, we present a successful perioperative anaesthetic management of a 74-year-old man with cardiac ochronosis, who underwent an aortic valve replacement with coronary artery bypass graft surgery at our centre.
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Affiliation(s)
- Nareshkumar Thiruvenkitasamy
- National University Hospital Singapore, Singapore
- Department of Cardiac Anaesthesiology, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
| | - Siddharth Manimozhi
- Department of Cardiac Anaesthesiology, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
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9
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Maraş G, Kalaycı H, Ceyhan Ö. Comparison of predictive models in postoperative nausea and vomiting in patients undergoing breast cancer surgery. Support Care Cancer 2024; 32:578. [PMID: 39112678 PMCID: PMC11306303 DOI: 10.1007/s00520-024-08781-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Post-operative nausea and vomiting remain an unresolved concern in Türkiye and some parts of the world, impacting the quality of the patient's recovery process and diminishing overall satisfaction. OBJECTIVE This study was conducted as a descriptive investigation to compare the incidence of nausea and vomiting following breast cancer surgery with the nausea and vomiting risk scores proposed by Apfel and Koivuranta. METHODS This study was conducted with 100 patients admitted to the General Surgery service of a university hospital between 31 August 2019 and 31 May 2021 for breast cancer surgery. The patient information form developed by the researchers, Apfel Nausea and Vomiting Risk Score, and Koivuranta Nausea and Vomiting Risk Score were used as data collection tools. RESULTS It was identified that 61% of the patients experienced nausea and vomiting within the initial 24 h following surgery. A significant correlation was found between age, post-operative opioid use, motion sickness or history of PONV, and nausea and vomiting (p < 0,05). The sensitivity of the Apfel score obtained was 80%, the specificity was 46%, and the AUC value was 0.686. The sensitivity of the Koivuranta score was 80%, the specificity was 35%, and the AUC value was 0.675 (p < 0.05). CONCLUSION It has been observed that patients experience high rates of nausea and vomiting after breast cancer surgery and that the Apfel and Koivuranta Risk Scores are equally applicable in predicting post-operative nausea and vomiting.
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Affiliation(s)
- Gülseren Maraş
- Erciyes University, Faculty of Health Sciences, Surgery Nursing, Kayseri, Türkiye.
| | - Halil Kalaycı
- Erciyes University, Faculty of Health Sciences, Surgery Nursing, Kayseri, Türkiye
| | - Özlem Ceyhan
- Erciyes University, Faculty of Health Sciences, Internal Medicine Nursing, Kayseri, Türkiye
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Patel S, Bhatt A, Mehta S, Ramakrishnan AS. Two-stage cytoreductive surgery for 'extensive' pseudomyxoma peritonei: A legitimate alternative or salvage strategy? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108593. [PMID: 39121632 DOI: 10.1016/j.ejso.2024.108593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 08/06/2024] [Accepted: 08/06/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND AND AIM Two-stage cytoreductive surgery (CRS) has been proposed as an alternative to one-stage surgery in patients who have 'extensive' pseudomyxoma peritonei (PMP) and/or are unfit for very extensive surgery, to reduce morbidity. We review current evidence on two-stage CRS focusing on patient selection, interval between procedures, extent of surgery, use of HIPEC, perioperative and oncological outcomes. METHODS This is a narrative review. A literature search on PubMed and Embase was performed using keywords- 'Two-stage cytoreductive surgery', 'pseudomyxoma peritonei', 'high-volume PMP', 'huge PMP', 'cytoreductive surgery', 'HIPEC', 'staged surgery' and 'extensive pseudomyxoma peritonei'. RESULTS Five studies reported outcomes in a total of 114 patients. The indications for two-stage CRS were: in two studies, patients undergoing an incomplete cytoreduction due to undue surgical risk were reevaluated for a second surgery during routine surveillance; severe comorbidities in one; extensive disease with PCI>28 in another and in one, only HIPEC was performed as a second procedure due to intraoperative hemodynamic instability (the two-stage procedure was performed in interest of patient's safety). Major morbidity ranged from 0 to 37.5 % (first-stage) and 25%-38.9 % (second-stage). Short term follow-up demonstrated equivalent short-term oncological outcomes compared to historical data. Long term follow-up and quality-of-life data were not available. CONCLUSIONS The published studies showed different interpretations and applications of the two-stage CRS concept. The reported morbidity was similar to that after single-stage CRS for extensive PMP. Though short-term survival outcomes are acceptable, long-term follow-up is needed. Planned two-stage CRS should currently be reserved for highly selected clinical situations.
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Affiliation(s)
- Swapnil Patel
- Dept of Surgical Oncology, MPMMCC & HBCH, Tata Memorial Centre, Varanasi, India
| | - Aditi Bhatt
- Dept of Surgical Oncology, KD Hospital, Ahmedabad, India.
| | - Sanket Mehta
- Dept of Surgical Oncology, Specialty Surgical Oncology, Mumbai, India
| | - A S Ramakrishnan
- Dept. of Surgical Oncology, Cancer Institute, WIA, Chennai, India
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Benlidayi IC, Gupta L. CAse-BAsed REview sTandards (CABARET): Considerations for Authors, Reviewers, and Editors. J Korean Med Sci 2024; 39:e225. [PMID: 39106889 PMCID: PMC11301009 DOI: 10.3346/jkms.2024.39.e225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 06/27/2024] [Indexed: 08/09/2024] Open
Abstract
The publication landscape for case reports has undergone a significant shift, with many high-impact journals deprioritizing or ceasing their publication altogether. This trend has led to the emergence of case-based reviews as an alternative to traditional case reports. Several factors drive this shift. Case-based reviews offer a more comprehensive synthesis of the literature compared to single case reports. They employ systematic search methodologies, reducing the risk of excluding relevant data, and providing robust evidence. From a publisher's perspective, case-based reviews have a greater potential for citation. While recommendations exist for writing traditional case reports, such as the CAse REports (CARE) guidelines, there is a lack of published recommendations for composing case-based reviews. This review aims to address this gap by providing guidance on drafting high-quality case-based reviews.
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Affiliation(s)
- Ilke Coskun Benlidayi
- Department of Physical Medicine and Rehabilitation, Cukurova University Faculty of Medicine, Adana, Türkiye.
| | - Latika Gupta
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
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Guzzetti L, Inversini D, Bacuzzi A. Anaesthesia for thyroid and parathyroid surgery. BJA Educ 2024; 24:270-276. [PMID: 39099753 PMCID: PMC11293567 DOI: 10.1016/j.bjae.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 03/08/2024] [Accepted: 04/23/2024] [Indexed: 08/06/2024] Open
Affiliation(s)
- L. Guzzetti
- University Hospital Varese ASST Settelaghi, Varese, Italy
| | - D. Inversini
- University Hospital Varese ASST Settelaghi, Varese, Italy
| | - A. Bacuzzi
- University Hospital Varese ASST Settelaghi, Varese, Italy
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Sekarsari D, Handoyono QF, Amal MY, Maharani MAP, Hendriarto A. Pediatric paraparesis: Radiological challenges in multidrug-resistant tuberculous spondylitis based on experience in Indonesia. Radiol Case Rep 2024; 19:3287-3293. [PMID: 38812598 PMCID: PMC11133498 DOI: 10.1016/j.radcr.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 05/31/2024] Open
Abstract
Multidrug-resistant tuberculous spondylitis is a global health issue, especially in developing nations, and non-specific symptoms lead to delay in identification, treatment, and potential disability in children. Radiology plays a crucial role in diagnosing tuberculous spondylitis, which in turn might lead to effective treatment, prevention of disability and improved patient outcomes. Our case involved a 20-month-old malnourished child presented with paraparesis, revealing a history of contact with parental multidrug-resistant tuberculosis. Multimodality radiological examinations, including conventional radiography, CT, and MRI revealed extensive disease of the spine with disc involvement, large paravertebral abscess, and kyphotic deformity which produced neurological deficits, necessitating both anti-tuberculosis regimen and surgical intervention. Radiological examinations have a pivotal role in diagnosing, evaluating and guiding timely management of multidrug-resistant tuberculous spondylitis. Prompt diagnosis of the condition is crucial in order to prevent potentially severe complications, which contribute significantly to morbidity. Our case demonstrated the importance of radiology in diagnosing extensive spine involvement of the disease causing neurological deficits. Furthermore, radiology also helps in managing tuberculous spondylitis to prevent future disability in a child patient of a developing country. This case highlights the crucial significance of radiological imaging in the diagnosis and management of pediatric tuberculous spondylitis in impoverished nations. The patient's complex medical history highlights the socioeconomic factors contributing to tuberculosis burden. Early and comprehensive radiological assessment, together with collaboration between radiologists and clinicians, is vital for timely intervention and improved outcomes in pediatric tuberculous spondylitis cases to prevent the impact of this debilitating disease on children.
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Affiliation(s)
- Damayanti Sekarsari
- Division of Pediatric Radiology, Department of Radiology, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No. 4, Senen, Central Jakarta, DKI Jakarta
| | - Quinta Febryani Handoyono
- Department of Radiology, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No. 4, Senen, Central Jakarta, DKI Jakarta
| | - Mohamad Yanuar Amal
- Division of Pediatric Radiology, Department of Radiology, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No. 4, Senen, Central Jakarta, DKI Jakarta
| | - Maria Angela Putri Maharani
- Department of Anatomic Pathology, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No. 4, Senen, Central Jakarta, DKI Jakarta
| | - Andra Hendriarto
- Department of Orthopedics and Traumatology, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No. 4, Senen, Central Jakarta, DKI Jakarta
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14
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Grasner JT, Bray JE, Nolan JP, Iwami T, Ong MEH, Finn J, McNally B, Nehme Z, Sasson C, Tijssen J, Lim SL, Tjelmeland I, Wnent J, Dicker B, Nishiyama C, Doherty Z, Welsford M, Perkins GD. Cardiac arrest and cardiopulmonary resuscitation outcome reports: 2024 update of the Utstein Out-of-Hospital Cardiac Arrest Registry template. Resuscitation 2024; 201:110288. [PMID: 39045606 DOI: 10.1016/j.resuscitation.2024.110288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
The Utstein Out-of-Hospital Cardiac Arrest Resuscitation Registry Template, introduced in 1991 and updated in 2004 and 2015, standardizes data collection to enable research, evaluation, and comparisons of systems of care. The impetus for the current update stemmed from significant advances in the field and insights from registry development and regional comparisons. This 2024 update involved representatives of the International Liaison Committee on Resuscitation and used a modified Delphi process. Every 2015 Utstein data element was reviewed for relevance, priority (core or supplemental), and improvement. New variables were proposed and refined. All changes were voted on for inclusion. The 2015 domains-system, dispatch, patient, process, and outcomes-were retained. Further clarity is provided for the definitions of out-of-hospital cardiac arrest attended resuscitation and attempted resuscitation. Changes reflect advancements in dispatch, early response systems, and resuscitation care, as well as the importance of prehospital outcomes. Time intervals such as emergency medical service response time now emphasize precise reporting of the times used. New flowcharts aid the reporting of system effectiveness for patients with an attempted resuscitation and system efficacy for the Utstein comparator group. Recognizing the varying capacities of emergency systems globally, the writing group provided a minimal dataset for settings with developing emergency medical systems. Supplementary variables are considered useful for research purposes. These revisions aim to elevate data collection and reporting transparency by registries and researchers and to advance international comparisons and collaborations. The overarching objective remains the improvement of outcomes for patients with out-of-hospital cardiac arrest.
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Jyoti, Kwak S, Ham S, Hwang Y, Kang S, Kim J. Analysis of the effect of inert gas on alveolar/venous blood partial pressure by using the operator splitting method. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3839. [PMID: 38885939 DOI: 10.1002/cnm.3839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 05/24/2024] [Accepted: 05/31/2024] [Indexed: 06/20/2024]
Abstract
This study aims to investigate how inert gas affects the partial pressure of alveolar and venous blood using a fast and accurate operator splitting method (OSM). Unlike previous complex methods, such as the finite element method (FEM), OSM effectively separates governing equations into smaller sub-problems, facilitating a better understanding of inert gas transport and exchange between blood capillaries and surrounding tissue. The governing equations were discretized with a fully implicit finite difference method (FDM), which enables the use of larger time steps. The model employed partial differential equations, considering convection-diffusion in blood and only diffusion in tissue. The study explores the impact of initial arterial pressure, breathing frequency, blood flow velocity, solubility, and diffusivity on the partial pressure of inert gas in blood and tissue. Additionally, the effects of anesthetic inert gas and oxygen on venous blood partial pressure were analyzed. Simulation results demonstrate that the high solubility and diffusivity of anesthetic inert gas lead to its prolonged presence in blood and tissue, resulting in lower partial pressure in venous blood. These findings enhance our understanding of inert gas interaction with alveolar/venous blood, with potential implications for medical diagnostics and therapies.
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Affiliation(s)
- Jyoti
- The Institute of Basic Science, Korea University, Seoul, Republic of Korea
| | - Soobin Kwak
- Department of Mathematics, Korea University, Seoul, Republic of Korea
| | - Seokjun Ham
- Department of Mathematics, Korea University, Seoul, Republic of Korea
| | - Youngjin Hwang
- Department of Mathematics, Korea University, Seoul, Republic of Korea
| | - Seungyoon Kang
- Department of Mathematics, Korea University, Seoul, Republic of Korea
| | - Junseok Kim
- Department of Mathematics, Korea University, Seoul, Republic of Korea
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Kumar A, Gupta A, Gupta N, Bhargava T, Kumar V. In reply: Comparing approaches to the difficult airway. Can J Anaesth 2024; 71:1181-1182. [PMID: 38902574 DOI: 10.1007/s12630-024-02784-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/01/2024] [Accepted: 05/09/2024] [Indexed: 06/22/2024] Open
Affiliation(s)
| | - Anju Gupta
- Department of Anesthesia, Pain Medicine, and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Vinod Kumar
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
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17
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Natale P, Mooi PK, Palmer SC, Cross NB, Cooper TE, Webster AC, Masson P, Craig JC, Strippoli GF. Antihypertensive treatment for kidney transplant recipients. Cochrane Database Syst Rev 2024; 7:CD003598. [PMID: 39082471 PMCID: PMC11290053 DOI: 10.1002/14651858.cd003598.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
BACKGROUND The comparative effects of specific blood pressure (BP) lowering treatments on patient-important outcomes following kidney transplantation are uncertain. Our 2009 Cochrane review found that calcium channel blockers (CCBs) improved graft function and prevented graft loss, while the evidence for other BP-lowering treatments was limited. This is an update of the 2009 Cochrane review. OBJECTIVES To compare the benefits and harms of different classes and combinations of antihypertensive drugs in kidney transplant recipients. SEARCH METHODS We contacted the Information Specialist and searched the Cochrane Kidney and Transplant Register of Studies up to 3 July 2024 using search terms relevant to this review. Studies in the Register were identified through searches of CENTRAL, MEDLINE, EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs evaluating any BP-lowering agent in recipients of a functioning kidney transplant for at least two weeks were eligible. DATA COLLECTION AND ANALYSIS Two authors independently assessed the risks of bias and extracted data. Treatment estimates were summarised using the random-effects model and expressed as relative risk (RR) or mean difference (MD) with 95% confidence intervals (CI). Evidence certainty was assessed using Grades of Recommendation, Assessment, Development and Evaluation (GRADE) processes. The primary outcomes included all-cause death, graft loss, and kidney function. MAIN RESULTS Ninety-seven studies (8706 participants) were included. One study evaluated treatment in children. The overall risk of bias was unclear to high across all domains. Compared to placebo or standard care alone, CCBs probably reduce all-cause death (23 studies, 3327 participants: RR 0.83, 95% CI 0.72 to 0.95; I2 = 0%; moderate certainty evidence) and graft loss (24 studies, 3577 participants: RR 0.84, 95% CI 0.75 to 0.95; I2 = 0%; moderate certainty evidence). CCBs may make little or no difference to estimated glomerular filtration rate (eGFR) (11 studies, 2250 participants: MD 1.89 mL/min/1.73 m2, 95% CI -0.70 to 4.48; I2 = 48%; low certainty evidence) and acute rejection (13 studies, 906 participants: RR 10.8, 95% CI 0.85 to 1.35; I2 = 0%; moderate certainty evidence). CCBs may reduce systolic BP (SBP) (3 studies, 329 participants: MD -5.83 mm Hg, 95% CI -10.24 to -1.42; I2 = 13%; low certainty evidence) and diastolic BP (DBP) (3 studies, 329 participants: MD -3.98 mm Hg, 95% CI -5.98 to -1.99; I2 = 0%; low certainty evidence). CCBs have uncertain effects on proteinuria. Compared to placebo or standard care alone, angiotensin-converting-enzyme inhibitors (ACEi) may make little or no difference to all-cause death (7 studies, 702 participants: RR 1.13, 95% CI 0.58 to 2.21; I2 = 0%; low certainty evidence), graft loss (6 studies, 718 participants: RR 0.75, 95% CI 0.49 to 1.13; I2 = 0%; low certainty evidence), eGFR (4 studies, 509 participants: MD -2.46 mL/min/1.73 m2, 95% CI -7.66 to 2.73; I2 = 64%; low certainty evidence) and acute rejection (4 studies, 388 participants: RR 1.75, 95% CI 0.76 to 4.04; I2 = 0%; low certainty evidence). ACEi may reduce proteinuria (5 studies, 441 participants: MD -0.33 g/24 hours, 95% CI -0.64 to -0.01; I2 = 67%; low certainty evidence) but had uncertain effects on SBP and DBP. Compared to placebo or standard care alone, angiotensin receptor blockers (ARB) may make little or no difference to all-cause death (6 studies, 1041 participants: RR 0.69, 95% CI 0.36 to 1.31; I2 = 0%; low certainty evidence), eGRF (5 studies, 300 participants: MD -1.91 mL/min/1.73 m2, 95% CI -6.20 to 2.38; I2 = 57%; low certainty evidence), and acute rejection (4 studies, 323 participants: RR 1.00, 95% CI 0.44 to 2.29; I2 = 0%; low certainty evidence). ARBs may reduce graft loss (6 studies, 892 participants: RR 0.35, 95% CI 0.15 to 0.84; I2 = 0%; low certainty evidence), SBP (10 studies, 1239 participants: MD -3.73 mm Hg, 95% CI -7.02 to -0.44; I2 = 63%; moderate certainty evidence) and DBP (9 studies, 1086 participants: MD -2.75 mm Hg, 95% CI -4.32 to -1.18; I2 = 47%; moderate certainty evidence), but has uncertain effects on proteinuria. The effects of CCBs, ACEi or ARB compared to placebo or standard care alone on cardiovascular outcomes (including fatal or nonfatal myocardial infarction, fatal or nonfatal stroke) or other adverse events were uncertain. The comparative effects of ACEi plus ARB dual therapy, alpha-blockers, and mineralocorticoid receptor antagonists compared to placebo or standard care alone were rarely evaluated. Head-to-head comparisons of ACEi, ARB or thiazide versus CCB, ACEi versus ARB, CCB or ACEi versus alpha- or beta-blockers, or ACEi plus CCB dual therapy versus ACEi or CCB monotherapy were scarce. No studies reported outcome data for cancer or life participation. AUTHORS' CONCLUSIONS For kidney transplant recipients, the use of CCB therapy to reduce BP probably reduces death and graft loss compared to placebo or standard care alone, while ARB may reduce graft loss. The effects of ACEi and ARB compared to placebo or standard care on other patient-centred outcomes were uncertain. The effects of dual therapy, alpha-blockers, and mineralocorticoid receptor antagonists compared to placebo or standard care alone and the comparative effects of different treatments were uncertain.
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Affiliation(s)
- Patrizia Natale
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy
| | - Pamela Kl Mooi
- Department of Nephrology, Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Nicholas B Cross
- Department of Nephrology, Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand
- New Zealand Clinical Research, 3/264 Antigua St, Christchurch, New Zealand
| | - Tess E Cooper
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Angela C Webster
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Westmead Applied Research Centre, The University of Sydney at Westmead, Westmead, Australia
- Department of Transplant and Renal Medicine, Westmead Hospital, Westmead, Australia
| | - Philip Masson
- Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Jonathan C Craig
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Giovanni Fm Strippoli
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
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Punzo G, Nachira D, Calabrese G, Cambise C, Congedo MT, Vita ML, Meacci E, Margaritora S. Safety and efficacy of surgically performed continuous superficial serratus anterior plane block in uniportal video-assisted thoracic surgery. J Minim Access Surg 2024:01413045-990000000-00076. [PMID: 39095997 DOI: 10.4103/jmas.jmas_345_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 06/03/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION The 'surgically performed' continuous superficial serratus anterior plane block (continuous s-SAPB) was never described before in uniportal video-assisted thoracic surgery (uniportal VATS) surgery. The aim of the study was to evaluate the safety and efficacy of the technique. PATIENTS AND METHODS Between March 2022 and April 2023, 50 patients, undergone uniportal VATS surgery at our thoracic surgery department, were scheduled for a surgically performed continuous s-SAPB as post-operative analgesia protocol. RESULTS The mean execution time for the block was 3.92 ± 2.56 min. Ten patients (20%) required morphine for a visual analogue scale (VAS) score >4 immediately after surgery. The recorded VAS score at chest tube removal was 1.87 ± 1.41, whereas 2 h after the manoeuvre was 0.42 ± 0.72. No complication related to block insertion was recorded. The onset of chronic pain was observed in a total of 2 patients (4%). CONCLUSIONS The surgically performed continuous s-SAPB in uniportal VATS seems to be safe and easy to perform, and it provides a satisfactory analgesic effect.
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Affiliation(s)
- Giovanni Punzo
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giuseppe Calabrese
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Chiara Cambise
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Maria Teresa Congedo
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Elisa Meacci
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
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Omindo WW, Ping W, Qiu R, Zheng S, Sun Q, Qian Y, Zhang R, Zhang N, Zhou B. Efficacy of ultrasound-guided second serratus anterior plane block on postoperative quality of recovery and analgesia after video-assisted thoracic surgery: a randomized, triple-blind, placebo-controlled study. J Thorac Dis 2024; 16:4195-4207. [PMID: 39144345 PMCID: PMC11320292 DOI: 10.21037/jtd-23-982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 05/17/2024] [Indexed: 08/16/2024]
Abstract
Background Despite widespread application of minimally invasive video-assisted thoracic surgery (VATS), postoperative pain following this procedure is still a constant clinical challenge. Serratus anterior plane (SAP) block is one of the regional analgesic techniques with promising outcomes. However, due to the limited duration of action, optimal analgesia is often not achieved with a single injection. We tested whether in patients who have been subjected to routine SAP block under preoperative anesthesia, the addition of a second SAP block 24 hours after surgery, improves quality of recovery, lowers postoperative opioid consumption, and reduces the prevalence of chronic pain. Methods The present study is a single institutional, prospective, randomized, triple-blinded, placebo-controlled study. Ninety patients undergoing VATS from January 2022 to April 2022 were randomized at 1:1 ratio to receive ultrasound-guided second SAP block with 15 mL 0.375% ropivacaine (SAP block group) or 15 mL normal saline (control group) 24 hours after both groups received routine SAP block with 15 mL 0.375% ropivacaine. The primary outcome was quality of patient recovery, measured using 40-item quality of recovery questionnaire (QoR-40) at postoperative day 2 (POD 2). Secondary outcomes included: postoperative pain scores at rest, postoperative opioid consumptions, number of times that patient controlled analgesia (PCA) pump button was pressed, perioperative complications and adverse effects, prevalence of chronic pain at 2nd and 3rd month postoperatively, and length of hospital stay (LOS). Results A total of 83 patients completed the study: 43 patients in SAP block group and 40 patients in the control group. The global QoR-40 scores on POD 2 and POD 3 were significantly higher among SAP block group patients (180.07±11.34, 182.09±8.20) compared with the control group (172.18±6.15, 177.50±6.94) (P=0.01, P=0.008) respectively. Postoperative pain scores, opioid consumptions and incidence of postoperative nausea and vomiting were significantly lower among patients in SAP block group versus control group. There were no statistically significant differences in perioperative complications and LOS between the two groups. The prevalence of chronic pain at the 2nd and 3rd month postoperatively for patients in SAP block group and control group was 16.3%, 14%, and 32.5%, 27.5% respectively. Conclusions In patients undergoing VATS, application of ultrasound-guided second SAP block 24 hours after surgery improved postoperative quality of life, reduced opioid consumption and related side effects, and lowered the prevalence of chronic pain.
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Affiliation(s)
- Willis Wasonga Omindo
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Ping
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruixing Qiu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shubin Zheng
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qihang Sun
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Qian
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruijie Zhang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ni Zhang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Biyun Zhou
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Boulton AJ, Smith E, Yasin A, Moreton J, Mendonca C. Tracheal tube introducer-associated airway trauma: a systematic review. Anaesthesia 2024. [PMID: 39073144 DOI: 10.1111/anae.16379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Tracheal tube introducers are recommended in airway management guidelines and are used increasingly as videolaryngoscopy becomes more widespread. This systematic review aimed to summarise the published literature concerning tracheal tube introducer-associated airway trauma. METHODS PubMed, EMBASE and CINAHL databases were searched using pre-determined criteria. Two authors independently assessed search results and performed data extraction and risk of bias assessments. RESULTS We included 16 randomised controlled trials and five observational studies involving 10,797 patients. There was heterogeneity in patient characteristics, airway manipulation, and airway trauma definition and measurement. One study investigated hyperangulated videolaryngoscopy. The standard stylet was the most commonly reported introducer, followed by bougie and stylets with additional features such as video or lighted tip. Airway trauma resulted in low harm and most frequently involved injuries to the upper airway, followed by laryngeal and tracheobronchial injuries. Eighteen studies were comparative and reported a reduction in airway trauma incidence when an introducer was used, with the exception of the standard stylet. Median (IQR [range]) pooled incidence of airway trauma associated with standard stylets was 13.1% (4.2-31.4 [0.5-79.2])% and with bougies was 5.4% (0.4-49.9 [0.0-68.0])%. The risk of bias of included studies was variable and many randomised trials were found to be at high risk due to non-robust measurement of the outcome. CONCLUSIONS Stylets might be associated with an increased risk of airway trauma compared with other devices or when no stylet was used, though the quality of evidence is modest. However, other introducers appear to be safe and reduce the risk of airway trauma.
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Affiliation(s)
- Adam J Boulton
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Edward Smith
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ambreen Yasin
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Joseph Moreton
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Cyprian Mendonca
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Yeramosu T, Krivicich LM, Puzzitiello RN, Guenthner G, Salzler MJ. Concomitant Procedures, Black Race, Male Sex, and General Anesthesia Show Fair Predictive Value for Prolonged Rotator Cuff Repair Operative Time: Analysis of the NSQIP Database Using Machine Learning. Arthroscopy 2024:S0749-8063(24)00516-4. [PMID: 39069020 DOI: 10.1016/j.arthro.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE The purpose of this study is to develop machine learning models using the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database to predict prolonged operative time (POT) for rotator cuff repair (RCR). Furthermore, this study aims to use the trained machine learning (ML) models, cross-referenced with traditional multivariate logistic regression (MLR), to determine the key perioperative variables that may predict POT for RCR. METHODS Data were obtained from a large, national database (NSQIP) from 2021. Patients with unilateral RCR procedures were included. Demographic, preoperative, and operative variables were analyzed. A multivariable logistic regression (MLR) model and various other machine learning techniques, including random forest (RF) and artificial neural network (ANN), were compared using area under the curve (AUC), calibration, Brier score, and decision curve analysis. Feature importance was identified from the overall best-performing model. RESULTS A total of 6,690 patients met inclusion criteria. The random forest (RF) ML model had the highest AUC upon internal validation (0.706) and the lowest Brier score (0.15), outperforming the other models. The RF model also demonstrated strong performance upon assessment of the calibration curves (Slope = 0.86, Intercept = 0.08) and decision curve analysis. The model identified concomitant procedure, specifically labral repair and biceps tenodesis, as the most important variable for determining POT, followed by age <30 years, Black or African American race, male sex, and general anesthesia. CONCLUSIONS Despite the advanced machine learning models used in this study, the NSQIP dataset was only able to fairly predict POT following RCR. The RF model identified concomitant procedures, specifically labral repair and biceps tenodesis, as the most important variables for determining POT. Additionally, demographic factors such as age <30 years, Black race, and general anesthesia were significant predictors. While male sex was identified as important in the RF model, the MLR model indicated that its predictive value is primarily in conjunction with specific procedures like biceps tenodesis and subacromial decompression.
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Affiliation(s)
- Teja Yeramosu
- Virginia Commonwealth University School of Medicine, Richmond, VA, U.S.A
| | - Laura M Krivicich
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Richard N Puzzitiello
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Guy Guenthner
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Matthew J Salzler
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A.
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Habte MF, Tegegne BA, Alemayehu TY. Anesthetics drug wastage and preventive strategies: Systematic review. PLoS One 2024; 19:e0306933. [PMID: 39018322 PMCID: PMC11253927 DOI: 10.1371/journal.pone.0306933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/25/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Surgical Patients and hospitals are now facing financial strain due to direct anesthetic demand as a result of the development of new anesthetic drugs, equipment, and techniques. Up to 15% of a hospital's pharmacy budget is currently allocated to anesthetic drug expenses. Drug wastage during anesthesia practice is a widespread hidden source of healthcare waste that leads to anesthetic drug shortages as well as poor operating room efficiency. On the other hand, despite the fact that it is preventable in the vast majority of cases, it is well described that drug wastage is routinely observed, including in developing countries where the consequences significantly affect both hospitals and patients. METHODS This review aims to review the prevalence of anesthetic drug waste across the world and systematically formulate and describe preventive strategies. Relevant publications were identified using systematic searches on databases including Google Scholar, Medline (PubMed), the Cochrane Library, and Embase. In addition, papers were detected and then selected through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria guidelines and the inclusion and exclusion criteria. Using the predetermined terms and dates from the searching databases, a total of 504 articles were identified. Based on the screening criteria, 16 papers were considered eligible and included in the final review. In addition, the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis was used for evaluating the quality of selected articles. This study is registered on PROSPERO, number CRD42024497044. RESULTS Of the sixteen publications from eleven different nations that were considered suitable for inclusion, only two of them addressed the waste of inhalational anesthetics. In more than half of eligible articles, propofol was the frequently wasted drug that contributed to increased financial loss through drug waste. The first most significant factor contributing to the waste of intravenous and inhalational anesthetics was the disposal of multidrug vials following their use for a single patient and high fresh gas flow, respectively. CONCLUSION Anesthetic medication waste is a common occurrence worldwide, despite the fact that it is expensive and has a significant negative impact on operating room efficiency. Because the majority of drug waste is avoidable, preventive measures may lower drug waste and improve patient and hospital efficiency.
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23
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Lu Y, Yuan H, Li Y, Liu Y, Li R, Diao Y, Chen J, Jia L, Dong X, Xue H, Zhang X. Effects of nutritional interventions on cognitive function in adult cancer survivors: A systematic review. J Clin Nurs 2024. [PMID: 39021041 DOI: 10.1111/jocn.17371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 06/11/2024] [Accepted: 07/04/2024] [Indexed: 07/20/2024]
Abstract
AIM To evaluate the effectiveness and safety of nutritional interventions (i.e. nutritional support, dietary patterns and dietary supplements) on cognitive function in cancer survivors. DESIGN Systematic review. METHODS A systematic and comprehensive search of PubMed, Web of Science, the Cochrane Library, Embase, and CINAHL was conducted from the inception until March 10, 2023. The last search was conducted on December 10, 2023. REPORTING METHOD PRISMA. RESULTS A total of 59 randomized controlled trials were included for analysis. Nutritional support, dietary patterns and dietary supplements improved cognitive function in cancer survivors with no apparent safety concerns. The anti-inflammatory diet, the fasting-mimicking diet and the web-based diet significantly improved cognitive function. Whereas the ketogenic diet or dietary advice to consume more soluble dietary fibres and less insoluble dietary fibres and lactose could not. There was evidence from dietary supplements to support the beneficial effects of polyunsaturated fatty acid supplements, traditional herbal medicines and other supplements. CONCLUSIONS Nutritional interventions have great promise for improving cognitive function in adult cancer survivors. Further validation of the nutritional interventions supported in this study in other survivors and exploration of more effective nutritional interventions are needed. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE This work can support the construction of nutritional support interventions and dietary guidance programs to prevent cancer-related cognitive decline. IMPACT This work filled a gap in preventive strategies for cancer-related cognitive decline from a nutritional perspective. Nutritional support, dietary patterns, and dietary supplements can prevent cancer-related cognitive decline without serious safety concerns. This work highlighted nutritional interventions that have the potential to improve cognitive function in cancer survivors, benefiting the further construction of evidence-based nutritional intervention programs. PROTOCOL REGISTRATION PROSPERO. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Yao Lu
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Hua Yuan
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Yan Li
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, People's Republic of China
| | - YingLin Liu
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Rui Li
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Yue Diao
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, People's Republic of China
| | - JiaLu Chen
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, People's Republic of China
| | - LuYao Jia
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, People's Republic of China
| | - XueQi Dong
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, People's Republic of China
| | - Hui Xue
- Department of Histology and Embryology, College of Basic Medical Sciences, Jilin University, Changchun, People's Republic of China
| | - XiuYing Zhang
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, People's Republic of China
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24
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Sękowska A, Czyżewski K, Jaremek K, Zalas-Więcek P, Zając-Spychała O, Wachowiak J, Szmydki-Baran A, Hutnik Ł, Gietka A, Gryniewicz-Kwiatkowska O, Dembowska-Bagińska B, Semczuk K, Dzierżanowska-Fangrat K, Czogała W, Balwierz W, Żak I, Tomaszewska R, Szczepański T, Bień E, Irga-Jaworska N, Machnik K, Urbańska-Rakus J, Pająk S, Płonowski M, Krawczuk-Rybak M, Królak A, Ociepa T, Urasiński T, Wawryków P, Peregud-Pogorzelski J, Brzeski T, Mycko K, Mańko-Glińska H, Badowska W, Urbanek-Dądela A, Karolczyk G, Stolpa W, Skowron-Kandzia K, Mizia-Malarz A, Pierlejewski F, Młynarski W, Musiał J, Chaber R, Zawitkowska J, Zaucha-Prażmo A, Drabko K, Goździk J, Frączkiewicz J, Salamonowicz-Bodzioch M, Kałwak K, Styczyński J. Infections with Klebsiella pneumoniae in Children Undergoing Anticancer Therapy or Hematopoietic Cell Transplantation: A Multicenter Nationwide Study. J Clin Med 2024; 13:4078. [PMID: 39064118 PMCID: PMC11277684 DOI: 10.3390/jcm13144078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/25/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Background:Klebsiella pneumoniae is a nosocomial pathogen that causes severe infections in immunocompromised patients. The aim of the study was to conduct a microbiological and clinical analysis of K. pneumoniae infections in children with malignancies or undergoing hematopoietic cell transplantation in Poland. Methods: We conducted a retrospective, multicenter study including children and adolescents under 19 years old treated between 2012 and 2021. We analyzed patients' characteristics, microbiological data, and the outcomes of antibiotic therapy. Results: A total of 9121 newly diagnosed children were treated for malignancy and 1697 pediatric patients underwent hematopoietic cell transplantation. K. pneumoniae infections were diagnosed in 527 patients. Their overall incidence was 4.86% in pediatric hematology and oncology patients and 4.95% in patients who underwent hematopoietic cell transplantation. The incidence of infection was higher in patients with acute leukemia than with solid tumors (7.8% vs. 4.1%; OR = 2.0; 95% CI = 1.6-2.4; p < 0.0001). The most frequent source of infection was in the urinary tract at 55.2%. More than 57% of K. pneumoniae strains were extended-spectrum β-lactamase-positive and almost 34% were multidrug-resistant. Infections with K. pneumoniae contributed to death in 3.22% of patients. Conclusions: K. pneumoniae is one of the most critical pathogens in children suffering from malignancies or undergoing hematopoietic cell transplantation. The incidence of multidrug-resistant K. pneumoniae strains is increasing and contributing to poor clinical outcome.
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Affiliation(s)
- Alicja Sękowska
- Microbiology Department, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland;
| | - Krzysztof Czyżewski
- Department of Pediatrics, Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland; (K.C.); (K.J.); (J.S.)
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, 61-701 Poznan, Poland; (O.Z.-S.); (J.W.)
| | - Kamila Jaremek
- Department of Pediatrics, Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland; (K.C.); (K.J.); (J.S.)
| | - Patrycja Zalas-Więcek
- Microbiology Department, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland;
| | - Olga Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, 61-701 Poznan, Poland; (O.Z.-S.); (J.W.)
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, 61-701 Poznan, Poland; (O.Z.-S.); (J.W.)
| | - Anna Szmydki-Baran
- Department of Oncology, Pediatric Hematology, Clinical Transplantation and Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.S.-B.); (Ł.H.)
| | - Łukasz Hutnik
- Department of Oncology, Pediatric Hematology, Clinical Transplantation and Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.S.-B.); (Ł.H.)
| | - Agnieszka Gietka
- Department of Oncology, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (A.G.); (O.G.-K.); (B.D.-B.)
| | - Olga Gryniewicz-Kwiatkowska
- Department of Oncology, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (A.G.); (O.G.-K.); (B.D.-B.)
| | - Bożenna Dembowska-Bagińska
- Department of Oncology, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (A.G.); (O.G.-K.); (B.D.-B.)
| | - Katarzyna Semczuk
- Department of Clinical Microbiology and Immunology, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (K.S.); (K.D.-F.)
| | - Katarzyna Dzierżanowska-Fangrat
- Department of Clinical Microbiology and Immunology, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (K.S.); (K.D.-F.)
| | - Wojciech Czogała
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 31-008 Krakow, Poland; (W.C.); (W.B.)
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 31-008 Krakow, Poland; (W.C.); (W.B.)
| | - Iwona Żak
- Department of Microbiology, University Children’s Hospital, 30-663 Krakow, Poland;
| | - Renata Tomaszewska
- Department of Pediatric Hematology and Oncology, Silesian Medical University, 41-808 Zabrze, Poland; (R.T.); (T.S.)
| | - Tomasz Szczepański
- Department of Pediatric Hematology and Oncology, Silesian Medical University, 41-808 Zabrze, Poland; (R.T.); (T.S.)
| | - Ewa Bień
- Department of Pediatrics, Hematology and Oncology, Medical University, 80-210 Gdansk, Poland; (E.B.); (N.I.-J.)
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University, 80-210 Gdansk, Poland; (E.B.); (N.I.-J.)
| | - Katarzyna Machnik
- Division of Pediatric Hematology and Oncology, Chorzow City Hospital, 41-500 Chorzow, Poland; (K.M.); (J.U.-R.); (S.P.)
| | - Justyna Urbańska-Rakus
- Division of Pediatric Hematology and Oncology, Chorzow City Hospital, 41-500 Chorzow, Poland; (K.M.); (J.U.-R.); (S.P.)
| | - Sonia Pająk
- Division of Pediatric Hematology and Oncology, Chorzow City Hospital, 41-500 Chorzow, Poland; (K.M.); (J.U.-R.); (S.P.)
| | - Marcin Płonowski
- Department of Pediatric Oncology and Hematology, Medical University, 15-089 Bialystok, Poland; (M.P.); (M.K.-R.)
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University, 15-089 Bialystok, Poland; (M.P.); (M.K.-R.)
| | - Aleksandra Królak
- Department of Pediatrics, Pediatric Hematooncology and Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland; (A.K.); (T.O.); (T.U.)
| | - Tomasz Ociepa
- Department of Pediatrics, Pediatric Hematooncology and Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland; (A.K.); (T.O.); (T.U.)
| | - Tomasz Urasiński
- Department of Pediatrics, Pediatric Hematooncology and Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland; (A.K.); (T.O.); (T.U.)
| | - Paweł Wawryków
- Department of Pediatrics, Pediatric Oncology and Immunology, Pomeranian Medical University, 70-204 Szczecin, Poland; (P.W.); (J.P.-P.)
| | - Jarosław Peregud-Pogorzelski
- Department of Pediatrics, Pediatric Oncology and Immunology, Pomeranian Medical University, 70-204 Szczecin, Poland; (P.W.); (J.P.-P.)
| | - Tomasz Brzeski
- Department of Clinical Pediatrics University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland; (T.B.); (K.M.); (H.M.-G.); (W.B.)
- Clinical Divison of Pediatric Oncology and Hematology, Regional Specialised Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Katarzyna Mycko
- Department of Clinical Pediatrics University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland; (T.B.); (K.M.); (H.M.-G.); (W.B.)
- Clinical Divison of Pediatric Oncology and Hematology, Regional Specialised Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Hanna Mańko-Glińska
- Department of Clinical Pediatrics University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland; (T.B.); (K.M.); (H.M.-G.); (W.B.)
- Clinical Divison of Pediatric Oncology and Hematology, Regional Specialised Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Wanda Badowska
- Department of Clinical Pediatrics University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland; (T.B.); (K.M.); (H.M.-G.); (W.B.)
- Clinical Divison of Pediatric Oncology and Hematology, Regional Specialised Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland
| | - Agnieszka Urbanek-Dądela
- Division of Pediatric Hematology and Oncology, Children Hospital, 25-736 Kielce, Poland; (A.U.-D.); (G.K.)
| | - Grażyna Karolczyk
- Division of Pediatric Hematology and Oncology, Children Hospital, 25-736 Kielce, Poland; (A.U.-D.); (G.K.)
| | - Weronika Stolpa
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, 40-055 Katowice, Poland; (W.S.); (K.S.-K.); (A.M.-M.)
| | - Katarzyna Skowron-Kandzia
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, 40-055 Katowice, Poland; (W.S.); (K.S.-K.); (A.M.-M.)
| | - Agnieszka Mizia-Malarz
- Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, 40-055 Katowice, Poland; (W.S.); (K.S.-K.); (A.M.-M.)
| | - Filip Pierlejewski
- Department of Pediatrics, Hematology and Oncology, Medical University, 90-419 Lodz, Poland; (F.P.); (W.M.)
| | - Wojciech Młynarski
- Department of Pediatrics, Hematology and Oncology, Medical University, 90-419 Lodz, Poland; (F.P.); (W.M.)
| | - Jakub Musiał
- Department of Pediatric Oncohematology, Medical Faculty University of Rzeszow, Clinical Provincial Hospital No. 2, 35-301 Rzeszow, Poland; (J.M.); (R.C.)
| | - Radosław Chaber
- Department of Pediatric Oncohematology, Medical Faculty University of Rzeszow, Clinical Provincial Hospital No. 2, 35-301 Rzeszow, Poland; (J.M.); (R.C.)
| | - Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-059 Lublin, Poland; (J.Z.); (A.Z.-P.); (K.D.)
| | - Agnieszka Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-059 Lublin, Poland; (J.Z.); (A.Z.-P.); (K.D.)
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-059 Lublin, Poland; (J.Z.); (A.Z.-P.); (K.D.)
| | - Jolanta Goździk
- Stem Cell Transplant Center, University Children’s Hospital, Department of Clinical Immunology and Transplantology, Jagiellonian University Collegium Medicum, 31-008 Krakow, Poland;
| | - Jowita Frączkiewicz
- Department of Pediatric Hematology, Oncology and BMT, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.F.); (M.S.-B.); (K.K.)
| | - Małgorzata Salamonowicz-Bodzioch
- Department of Pediatric Hematology, Oncology and BMT, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.F.); (M.S.-B.); (K.K.)
| | - Krzysztof Kałwak
- Department of Pediatric Hematology, Oncology and BMT, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.F.); (M.S.-B.); (K.K.)
| | - Jan Styczyński
- Department of Pediatrics, Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland; (K.C.); (K.J.); (J.S.)
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Schnaubelt S, Veigl C, Snijders E, Abelairas Gómez C, Neymayer M, Anderson N, Nabecker S, Greif R. Tailored Basic Life Support Training for Specific Layperson Populations-A Scoping Review. J Clin Med 2024; 13:4032. [PMID: 39064072 PMCID: PMC11277549 DOI: 10.3390/jcm13144032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Basic life support (BLS) is a life-saving link in the out-of-hospital cardiac arrest chain of survival. Most members of the public are capable of providing BLS but are more likely to do so confidently and effectively if they undertake BLS training. Lay members of the public comprise diverse and specific populations and may benefit from tailored BLS training. Data on this topic are scarce, and it is completely unknown if there are any benefits arising from tailored courses or for whom course adaptations should be developed. Methods: The primary objective of this scoping review was to identify and describe differences in patient, clinical, and educational outcomes when comparing tailored versus standard BLS courses for specific layperson populations. This review was undertaken as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation. Results: A primary search identified 1307 studies and after title, abstract, and full-text screening, we included eight publications reporting on tailored courses for specific populations. There were no studies reporting direct comparisons between tailored and standardized training. Seven (88%) studies investigated courses tailored for individuals with a disability, and only one study covered another specific population group (refugees). Overall, the quality of evidence was low as the studies did not compare tailored vs. non-tailored approaches or consisted of observational or pre-post-designed investigations. Conclusions: Tailored BLS education for specific populations is likely feasible and can include such groups into the pool of potential bystander resuscitation providers. Research into comparing tailored vs. standard courses, their cost-to-benefit ratio, how to best adapt courses, and how to involve members of the respective communities should be conducted. Additionally, tailored courses for first responders with and without a duty to respond could be explored.
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Affiliation(s)
- Sebastian Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
- PULS—Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Department of Emergency Medicine, Antwerp University Hospital, 2650 Edegem, Belgium
- Emergency Medical Service Vienna, 1030 Vienna, Austria
| | - Christoph Veigl
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
- PULS—Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
| | - Erwin Snijders
- Department of Emergency Medicine, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Cristian Abelairas Gómez
- Faculty of Education Sciences and CLINURSID Research Group, Universidade de Santiago de Compostela, 15705 Santiago de Compostela, Spain
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela—CHUS, 15706 Santiago de Compostela, Spain
| | - Marco Neymayer
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
- PULS—Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
| | - Natalie Anderson
- Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Sabine Nabecker
- Department of Anesthesiology and Pain Management, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Robert Greif
- Faculty of Medicine, University of Bern, 3012 Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, 1020 Vienna, Austria
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26
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Didier C, Faucher S, Sarra Ferrer M, Lapouge M, Junot S, Jourdan G. Postoperative opioid-free analgesia in dogs undergoing tibial plateau leveling osteotomy: a feasibility study. Front Vet Sci 2024; 11:1394366. [PMID: 39036794 PMCID: PMC11257878 DOI: 10.3389/fvets.2024.1394366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/19/2024] [Indexed: 07/23/2024] Open
Abstract
Objectives This study was designed to prospectively evaluate the feasibility of an opioid-free anesthesia protocol and describe the quality of recovery and management of postoperative analgesia in dogs after a tibial plateau leveling osteotomy (TPLO). Methods In total, 20 dogs presented for TPLO were included. After premedication with intravenous (IV) medetomidine (0.005-0.007 mg/kg) and midazolam (0.2 mg/kg), the dogs were anesthetized using ketamine (2 mg/kg) and propofol and maintained with isoflurane and ketamine CRI (0.6 mg/kg/h). Sciatic and femoral nerve blocks were performed with bupivacaine 0.5% (0.087 +/- 0.01 and 0.09 +/- 0.02 mL/kg, respectively). Meloxicam (0.2 mg/kg IV) was administered intraoperatively, after osteotomy. Fentanyl (0.002 mg/kg IV) was administered intraoperatively, as rescue analgesia in the case of sustained increase in cardiorespiratory variables. Two pain scores (French 4A-VET and Glasgow short form) were performed at conscious sternal recumbency and 2, 4, 6, 8, 12, and 20 h after extubation and compared to baseline using a Friedman test followed by a Nemenyi post-hoc test. The time taken for the first food intake and urination was reported. Results Intraoperative opioid-free anesthesia was feasible in 11 dogs, whereas 9 dogs received fentanyl once during arthrotomy. No opioid postoperative rescue analgesia was required. Food intake occurred within 6 h, and all dogs were discharged after 24 h without any complication. Conclusion Total opioid-free postoperative analgesia was achieved in all dogs, with adequate recoveries. Although opioid-free anesthesia was feasible in 55% of the population, a single dose of fentanyl was necessary in 45% of the dogs during arthrotomy.
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Affiliation(s)
- Caroline Didier
- Department of Clinical Sciences, National Veterinary School of Toulouse, University of Toulouse, Toulouse, France
| | - Sarah Faucher
- Department of Clinical Sciences, National Veterinary School of Toulouse, University of Toulouse, Toulouse, France
| | - Marti Sarra Ferrer
- Department of Clinical Sciences, National Veterinary School of Toulouse, University of Toulouse, Toulouse, France
| | | | - Stéphane Junot
- Department of Veterinary Anesthesia and Analgesia, Université de Lyon, VetAgro Sup, Marcy l’Etoile, France
| | - Géraldine Jourdan
- Department of Clinical Sciences, National Veterinary School of Toulouse, University of Toulouse, Toulouse, France
- RESTORE Research Center, University of Toulouse, INSERM, CNRS, EFS, ENVT, Toulouse, France
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Kumari N, Dubey PK, Singh S. Comparison of intranasal dexmedetomidine and ketamine for paediatric premedication: A randomized study. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024:S2341-1929(24)00121-5. [PMID: 38972353 DOI: 10.1016/j.redare.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION AND OBJECTIVES Paediatric patients are given premedication in order to decrease preoperative anxiety, allow smooth induction, and prevent postoperative psychological insult and behavioural changes. A child friendly method of administration is desirable. We compared intranasal administration of dexmedetomidine and ketamine in the operating room environment, to evaluate the Faces, Legs, Activity, Cry and Consolability (FLACC) score at the time of establishing intravenous access for induction of general anaesthesia. METHODS This prospective, double-blind, randomized controlled trial was conducted at a tertiary care center. One hundred patients, 2-10 years of age, ASA physical status 1 & 2, scheduled for general anaesthesia were enrolled. Patient's presedation behaviour was assessed by the modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF). Patients in Group D received Dexmedetomidine 1 mcg/kg intranasally, and patients in Group K received Ketamine 5 mg/kg intranasally. After 45 min, patients were transferred to the operating table where intravenous cannulation was carried out and the response to needle insertion was assessed by FLACC scale. Vital signs, including the pulse-oximetry, heart rate and respiratory rate were monitored. Side effects such as nausea, vomiting, and agitation were also recorded. RESULTS A significantly higher FLACC score was seen in Group D as compared to Group K (p = 0.001). The mean heart rate between two groups was found to be significantly (p = 0.001) lower in Group D compared to Group K. However, the proportion of adverse events was 8% in patients who received ketamine. CONCLUSIONS Intranasal ketamine in a dose of 5 mg/kg is clinically more effective as premedication in children aged 2-10 years in comparison with intranasal dexmedetomidine in a dose of 1 mcg/kg.
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Affiliation(s)
- N Kumari
- Department of Anaesthesiology, Indira Gandhi Institute of Medical Sciences, Patna, India
| | - P K Dubey
- Department of Anaesthesiology, Indira Gandhi Institute of Medical Sciences, Patna, India.
| | - S Singh
- Department of Anaesthesiology, Indira Gandhi Institute of Medical Sciences, Patna, India
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Cablay KJ, Arney LA, Peterman NJ, Yu-Shan AA, Smith GL, Kazemi A, Joseph JA, Tuttle JR. Total Intravenous Anesthesia with Propofol Reduces Discharge Times Compared with Inhaled General Anesthesia in Shoulder Arthroscopy: A Randomized Controlled Trial. J Bone Joint Surg Am 2024; 106:1154-1161. [PMID: 38598609 DOI: 10.2106/jbjs.23.00954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
BACKGROUND Shoulder arthroscopy is commonly performed at ambulatory surgical centers (ASCs) with use of an interscalene block and inhaled general anesthesia (IGA). However, an alternative option known as total intravenous anesthesia with propofol (TIVA-P) has shown promising results in reducing recovery time for other surgeries. The objective of this study was to assess whether there is a clinically meaningful difference in post-anesthesia care unit phase-I (PACU-I) time following shoulder arthroscopy between patients receiving an interscalene block with IGA and those receiving an interscalene block with TIVA-P. METHODS Patients who underwent shoulder arthroscopy performed by a single surgeon at the ASC of our institution between 2020 and 2023 were enrolled. Enrollment was conducted in blocks, with up to 3 planned interim analyses. After 2 blocks, enrollment was halted because the study arms demonstrated a significant difference in the primary outcome measure, PACU-I time. A total of 96 patients were randomized into the TIVA-P and IGA groups; after patient withdrawals, the groups comprised 42 and 40 patients, respectively. Patients underwent shoulder arthroscopy with use of the anesthesia method corresponding to their assigned group. Pain, satisfaction, antiemetic use, perioperative interventions, surgical time, PACU-II time, postoperative care time, and total time until discharge were recorded and were analyzed with use of chi-square and Mann-Whitney U tests with a significance cutoff of 0.0167 to account for the interim analyses. RESULTS Across groups, 81.7% of patients were non-Hispanic White and 58.5% were male. Significant differences were observed between the TIVA-P and IGA groups with respect to median PACU-I time (0.0 minutes [interquartile range (IQR), 0.0 to 6.0 minutes] versus 25.5 minutes [IQR, 20.5 to 32.5 minutes]; p < 0.001) and median total time until discharge (135.5 minutes [IQR, 118.5 to 156.8 minutes] versus 148.5 minutes [IQR, 133.8 to 168.8 minutes]; p = 0.0104). The TIVA-P group had a 9.1% quicker discharge time, primarily as a result of bypassing PACU-I (66.7% of patients) and spending 25.5 fewer minutes there overall. The TIVA-P group also had a lower rate of antiemetic use than the IGA group (59.5% versus 92.5% of patients; p = 0.0013). No significant differences were detected between the TIVA-P and IGA groups in terms of median pain improvement (1.0 [IQR, 0.0 to 2.0] versus 1.0 [IQR, 0.0 to 2.0]; p = 0.6734), perioperative interventions (78.6% versus 77.5% of patients, p = 1.0000), or median patient satisfaction (4.0 [IQR, 4.0 to 4.0] versus 4.0 [IQR, 3.8 to 4.0]; p = 0.4148). CONCLUSIONS TIVA-P showed potential to improve both PACU-I time and the total time until discharge while reducing antiemetic use without impacting pain or satisfaction. TIVA-P thus warrants consideration by orthopaedic surgeons for use in shoulder arthroscopy performed at ASCs. LEVEL OF EVIDENCE Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kory J Cablay
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Lucas A Arney
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Nicholas J Peterman
- Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, Virginia
| | - Andrea A Yu-Shan
- Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, Virginia
| | - George L Smith
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Ali Kazemi
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Julie A Joseph
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - John R Tuttle
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
- Musculoskeletal Education and Research Center, Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, Virginia
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Nabata KJ, Rai S, Zhao D, MacNeill AJ, Hamilton TD. Negative Pressure Wound Therapy to Reduce Surgical Site Infections after CRS/HIPEC. Ann Surg Oncol 2024; 31:4735-4740. [PMID: 38653941 DOI: 10.1245/s10434-024-15283-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/27/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Surgical site infections (SSIs) are a common cause of morbidity after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancy. Negative pressure wound therapy (NPWT) has been proposed as a method to reduce the rates of SSIs; however, there is paucity in the literature on the efficacy in this population. The goal of this study was to determine whether routine use of NPWT in patients undergoing CRS/HIPEC could reduce the risk of developing SSI. METHODS We performed a retrospective before-after study to assess the rates of SSI with NPWT compared with a standard postoperative surgical dressing (SSD) in all patients undergoing CRS/HIPEC from November 2013 to December 2021 at a single tertiary care center. The primary outcome was rate of SSI. A multivariate logistic regression analysis was performed to evaluate for risk factors for SSI. RESULTS A total of 178 patients were treated with CRS/HIPEC over the study period. Seventy patients had placement of SSD, and 108 patients had placement of NPWT. Rates of SSI were 11.4% (8/70) and 5.6% (6/108) in the two groups, respectively (p = 0.16). On multivariate analysis, patients treated with NPWT had a significantly lower risk of developing an SSI (OR 0.24 [0.06, 0.92], p = 0.037). Patients living >50 km from the hospital had significantly higher risk of developing SSI (OR 2.03 [1.09, 3.78], p = 0.026). CONCLUSIONS These results suggest that routine use of NPWT can reduce the risk of developing an SSI in patients undergoing CRS/HIPEC for peritoneal malignancy.
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Affiliation(s)
- Kylie J Nabata
- Department of Surgery, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Vancouver, BC, Canada
| | - Sabrina Rai
- Department of Surgery, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Vancouver, BC, Canada
| | - Darren Zhao
- Department of Surgery, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Vancouver, BC, Canada
| | - Andrea J MacNeill
- Department of Surgery, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Vancouver, BC, Canada
| | - Trevor D Hamilton
- Department of Surgery, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Vancouver, BC, Canada.
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Kim JG, Kang CH, Sheen JJ, Song Y, Rhim JK. A Case of Severe Delayed Vasospasm after Clipping Surgery for an Unruptured Intracranial Aneurysm. Neurointervention 2024; 19:123-128. [PMID: 38871004 PMCID: PMC11222685 DOI: 10.5469/neuroint.2024.00150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/25/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024] Open
Abstract
Delayed ischemic stroke associated with intractable vasospasm after clipping of unruptured intracranial aneurysms (UIAs) has been rarely reported. We report a patient with delayed ischemic stroke associated with intractable vasospasm following UIA clipping. A middle-aged female underwent surgery for unruptured middle cerebral artery bifurcation aneurysms. The patient tolerated the neurosurgical procedure well. Seven days postoperatively, the headache was unbearable; a postcraniotomy headache persisted and abruptly presented with global aphasia and right-sided hemiplegia after a nap. Emergency digital subtraction angiography showed severe luminal narrowing with segmental vasoconstriction, consistent with severe vasospasm. The patient's neurological deficit improved after chemical angioplasty. Neurosurgeons should pay close attention to this treatable/preventive entity after neurological deterioration following UIA clipping, even in patients without subarachnoid hemorrhage.
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Affiliation(s)
- Joong-Goo Kim
- Jeju National University School of Medicine, Jeju, Korea
- Department of Neurology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Chul-Hoo Kang
- Jeju National University School of Medicine, Jeju, Korea
- Department of Neurology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Jae Jon Sheen
- Department of Neurosurgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Yunsun Song
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Kook Rhim
- Department of Neurosurgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
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Grillo-Marín C, Antón-Rodríguez C, Prieto L, Ortega-Pérez G, González-Moreno S. Nephrotoxicity Associated with Cytoreductive Surgery Combined with Cisplatin-Based Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignant Disease: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3793. [PMID: 38999359 PMCID: PMC11242517 DOI: 10.3390/jcm13133793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/14/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Cisplatin is employed in hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS) for peritoneal surface malignancies (PSMs). The main concern regarding intraperitoneal cisplatin administration is nephrotoxicity. Numerous reports in this context are available. Our objective was to conduct a systematic review and meta-analysis to assess cisplatin-based HIPEC-related nephrotoxicity (CHRN). Methods: A systematic literature review on CHRN after CRS for the treatment of PSMs was performed. The literature search was carried out using Medline, Cochrane, and Embase. The last day of the search was 23 October 2023. PRISMA guidelines were used. A meta-analysis was then conducted. The main endpoint was the incidence of acute and chronic renal impairment after CHRN. Secondary endpoints included the potential impact of several clinical variables on the primary endpoint and a critical appraisal of the different renal impairment scales employed. Results: Our study included 26 articles with a total sample of 1473 patients. The incidence of acute kidney injury (AKI) was 18.6% (95% CI: 13.6-25%, range of true effects 3-59%). For chronic kidney disease, it was 7% (95% CI: 3-15.3%, range of true effects 1-53%). The variables that statistically influenced these results were the scale used to measure renal insufficiency, the use of nephroprotective agents, and the presence of pre-existing renal disease. Conclusions: The reported incidence of renal impairment following cisplatin-based HIPEC is highly variable. The incidence of renal failure obtained in this meta-analysis should be used as a reference for subsequent reports on this topic. Further prospective studies are warranted to establish optimal and standardized management.
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Affiliation(s)
- Cristián Grillo-Marín
- Department of General Surgery, Hospital Universitario Puerta de Hierro, Calle Joaquín Rodrigo 1, 28222 Majadahonda, Spain;
- Unidad de Apoyo a la Investigación, Facultad de Medicina, Universidad Francisco de Vitoria M-515, km 1, 800, 28223 Pozuelo de Alarcón, Spain; (C.A.-R.); (L.P.)
- MD Anderson Cancer Center, Madrid Spain Foundation, Calle Arturo Soria 270, 28033 Madrid, Spain
| | - Cristina Antón-Rodríguez
- Unidad de Apoyo a la Investigación, Facultad de Medicina, Universidad Francisco de Vitoria M-515, km 1, 800, 28223 Pozuelo de Alarcón, Spain; (C.A.-R.); (L.P.)
| | - Lola Prieto
- Unidad de Apoyo a la Investigación, Facultad de Medicina, Universidad Francisco de Vitoria M-515, km 1, 800, 28223 Pozuelo de Alarcón, Spain; (C.A.-R.); (L.P.)
| | - Gloria Ortega-Pérez
- Department of Surgical Oncology, Peritoneal Surface Oncology Program, MD Anderson Cancer Center, Calle Arturo Soria 270, 28033 Madrid, Spain;
| | - Santiago González-Moreno
- Department of Surgical Oncology, Peritoneal Surface Oncology Program, MD Anderson Cancer Center, Calle Arturo Soria 270, 28033 Madrid, Spain;
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Ximenes Braz B, Cavalcante Meneses G, Bezerra da Silva Junior G, Costa Martins AM, de Souza Mourão Feitosa AF, Cavalcante Lima Chagas G, De Francesco Daher E. Risk factors for mortality in coronavirus disease 2019 patients with silent hypoxemia. Rev Clin Esp 2024:S2254-8874(24)00089-4. [PMID: 38945525 DOI: 10.1016/j.rceng.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/02/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE To describe the predictors of mortality in hospitalized patients with severe acute respiratory syndrome (SARS) due to COVID-19 presenting with silent hypoxemia. MATERIAL AND METHODS Retrospective cohort study of hospitalized patients with SARS due to COVID-19 and silent hypoxemia at admission, in Brazil, from January to June 2021. The primary outcome of interest was in-hospital death. Multivariable logistic regression analysis was performed. RESULTS Of 46,102 patients, the mean age was 59 ± 16 years, and 41.6% were female. During hospitalization, 13,149 patients died. Compared to survivors, non-survivors were older (mean age, 66 vs. 56 years; P < 0.001), less frequently female (43.6% vs. 40.9%; P < 0.001), and more likely to have comorbidities (74.3% vs. 56.8%; P < 0.001). Non-survivors had higher needs for invasive mechanical ventilation (42.4% vs. 6.6%; P < 0.001) and intensive care unit admission (56.9% vs. 20%; P < 0.001) compared to survivors. In the multivariable regression analysis, advanced age (OR 1.04; 95%CI 1.037-1.04), presence of comorbidities (OR 1.54; 95%CI 1.47-1.62), cough (OR 0.74; 95%CI 0.71-0.79), respiratory distress (OR 1.32; 95%CI 1.26-1.38), and need for non-invasive respiratory support (OR 0.37; 95%CI 0.35-0.40) remained independently associated with death. CONCLUSIONS Advanced age, presence of comorbidities, and respiratory distress were independent risk factors for mortality, while cough and requirement for non-invasive respiratory support were independent protective factors against mortality in hospitalized patients due to SARS due to COVID-19 with silent hypoxemia at presentation.
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Affiliation(s)
- Beatriz Ximenes Braz
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Internal Medicine Department, University of Miami, Miami, FL, United States
| | - Gdayllon Cavalcante Meneses
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Geraldo Bezerra da Silva Junior
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, CE, Brazil; Post-Graduation Program in Collective Health, Health Sciences Center, University of Fortaleza - UNIFOR, Fortaleza, CE, Brazil
| | - Alice Maria Costa Martins
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, CE, Brazil
| | | | - Gabriel Cavalcante Lima Chagas
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
| | - Elizabeth De Francesco Daher
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
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Dong X, Zhang L, Wang Z, Zheng ZJ. Implementation of basic life support education for the lay public in China: barriers, enablers, and possible solutions. Front Public Health 2024; 12:1390819. [PMID: 38993705 PMCID: PMC11236690 DOI: 10.3389/fpubh.2024.1390819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/14/2024] [Indexed: 07/13/2024] Open
Abstract
Background Education for the lay public in basic life support (BLS) is critical for increasing bystander cardiopulmonary resuscitation (CPR) rates and improving survival from out-of-hospital cardiac arrest (OHCA). Despite years of implementation, the BLS training rate in China has remained modest. The aim of this study was to investigate the factors influencing the implementation of BLS training programs in emergency medical service (EMS) centers in China and to identify specific barriers and enablers. Methods Qualitative interviews were conducted with key informants from 40 EMS centers in Chinese cities. The participants included 11 directors/deputy directors, 24 training department leaders, and 5 senior trainers. The interview guide was based on the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Thematic content analysis was used to identify themes and patterns across the interviews. Results We identified 16 factors influencing the implementation of BLS training programs encompassing the outer content, inner context, innovation and bridging factors. Some factors acted as either barriers or enablers at different EPIS stages. The main implementation barriers included limited external leadership, insufficient government investment, low public awareness, a shortage of trainers, an absence of incentives, an absence of authoritative courses and guidelines, a lack of qualification to issue certificates, limited academic involvement, and insufficient publicity. The main enablers were found to be supportive government leaders, strong public demand, adequate resources, program champions, available high-quality courses of high fitness within the local context, the involvement of diverse institutions, and effective publicity and promotion. Conclusion Our findings emphasize the diversity of stakeholders, the complexity of implementation, and the need for localization and co-construction when conducting BLS training for lay public in city EMS centers. Improvements can be made at the national level, city level, and EMS institutional level to boost priority and awareness, promote legislation and policies, raise sustainable resources, and enhance the technology of BLS courses.
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Affiliation(s)
- Xuejie Dong
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Lin Zhang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Zongbin Wang
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Zhi-jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
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Irigoyen-Camacho ME, Velazquez-Alva MC, Zepeda-Zepeda MA, Lazarevich I, Castano-Seiquer A, Flores-Fraile J. Physical Performance, Body Composition, and Oral Health in Community-Residing Older Adults: A Cross-Sectional Study. Geriatrics (Basel) 2024; 9:89. [PMID: 39051253 PMCID: PMC11270300 DOI: 10.3390/geriatrics9040089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/23/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Physical activity is essential for healthy aging. This study aimed to identify an association between physical performance, body fat percentage (%BF), and the perception of oral health-related quality of life (OHRQoL) in independent older adults. METHOD A group of active older adults was selected from a government-sponsored reunion center in Mexico City. OHRQoL was assessed using the General Oral Health Index (GOHAI), and nutritional status was assessed using the Mini Nutritional Assessment (MNA) tool. A short physical performance battery (SPPB) was applied, and, for body composition, DXA (dual X-ray absorptiometry) was conducted. Data were analyzed using logistic regression models, and marginal probabilities were obtained. RESULTS This study involved 366 participants; their mean age was 73.9 (±6.2) years, and 24.9% had type 2 diabetes mellitus (T2DM). OHRQoL information revealed that pain or discomfort in the oral cavity was perceived by 63.9% of the older adults during the previous three months. The SPPB score was low in 159 (43.44%) participants. The logistic regression model revealed that age (OR = 1.13, p < 0.001), T2DM (OR = 2.10, p = 0.009), the risk of malnutrition/malnutrition (OR = 1.76, p = 0.047), high %BF (OR = 1.09, <0.001), and poor OHRQoL (OR = 1.96, p = 0.009) were associated with deteriorated physical performance. CONCLUSION OHRQoL self-perception, excess body fat, and nutritional status impacted physical performance. Aging well requires a comprehensive approach.
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Affiliation(s)
- Maria Esther Irigoyen-Camacho
- Health Care Department, Metropolitan Autonomous University, Calzada del Hueso 1100, Col. Villa Quietud, Mexico City 04960, Mexico; (M.A.Z.-Z.); (I.L.)
| | - Maria Consuelo Velazquez-Alva
- Health Care Department, Metropolitan Autonomous University, Calzada del Hueso 1100, Col. Villa Quietud, Mexico City 04960, Mexico; (M.A.Z.-Z.); (I.L.)
| | - Marco Antonio Zepeda-Zepeda
- Health Care Department, Metropolitan Autonomous University, Calzada del Hueso 1100, Col. Villa Quietud, Mexico City 04960, Mexico; (M.A.Z.-Z.); (I.L.)
| | - Irina Lazarevich
- Health Care Department, Metropolitan Autonomous University, Calzada del Hueso 1100, Col. Villa Quietud, Mexico City 04960, Mexico; (M.A.Z.-Z.); (I.L.)
| | | | - Javier Flores-Fraile
- Department of Surgery, Faculty of Medicine, University of Salamanca, C. Alfonso X el Sabio, s.n., 37008 Salamanca, Spain;
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Shelke A, Priya P, Mishra S, Chauhan R, Murti K, Ravichandiran V, Dhingra S. Investigation of antimicrobial susceptibility patterns, risk factors and their impact on mortality in cancer patients at a tertiary care cancer hospital- A prospective study. Ann Clin Microbiol Antimicrob 2024; 23:59. [PMID: 38926734 PMCID: PMC11210011 DOI: 10.1186/s12941-024-00703-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/06/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Cancer patients are vulnerable to infections due to immunosuppression caused by cancer itself and its treatment. The emergence of antimicrobial-resistant bacteria further complicates the treatment of infections and increases the mortality and hospital stays. This study aimed to investigate the microbial spectrum, antimicrobial resistance patterns, risk factors, and their impact on clinical outcomes in these patients. METHODS A prospective study was conducted at a tertiary care cancer hospital in Patna, Bihar, India, which included cancer patients aged 18 years and older with positive microbial cultures. RESULTS This study analysed 440 patients, 53% (234) of whom were females, with an average age of 49.27 (± 14.73) years. A total of 541 isolates were identified, among which 48.01% (242) were multidrug resistant (MDR), 29.76% (150) were extensively drug resistant (XDR), and 19.84% (112) were sensitive. This study revealed that patients who underwent surgery, chemotherapy, were hospitalized, had a history of antibiotic exposure, and had severe neutropenia were more susceptible to MDR and XDR infections. The average hospital stays were 16.90 (± 10.23), 18.30 (± 11.14), and 22.83 (± 13.22) days for patients with sensitive, MDR, and XDR infections, respectively. The study also revealed overall 30-day mortality rate of 31.81% (140), whereas the MDR and XDR group exhibited 38.92% and 50.29% rates of 30-day mortality respectively (P < 0.001). Possible risk factors identified that could lead to mortality, were cancer recurrence, sepsis, chemotherapy, indwelling invasive devices such as foley catheter, Central venous catheter and ryles tube, MASCC score (< 21) and pneumonia. CONCLUSIONS This study emphasizes the necessity for personalized interventions among cancer patients, such as identifying patients at risk of infection, judicious antibiotic use, infection control measures, and the implementation of antimicrobial stewardship programs to reduce the rate of antimicrobial-resistant infection and associated mortality and hospital length of stay.
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Affiliation(s)
- Akshay Shelke
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER) Hajipur, Dist. Vaishali, Bihar, India
| | - Pallavi Priya
- Department of Microbiology, Mahavir Cancer Sansthan and Research Centre (MCSRC), Patna, Bihar, India
| | - Shiwani Mishra
- Department of Microbiology, Mahavir Cancer Sansthan and Research Centre (MCSRC), Patna, Bihar, India
| | - Richa Chauhan
- Department of Radiotherapy, Mahavir Cancer Sansthan and Research Centre (MCSRC), Patna, Bihar, India
| | - Krishna Murti
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER) Hajipur, Dist. Vaishali, Bihar, India
| | - V Ravichandiran
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER) Hajipur, Dist. Vaishali, Bihar, India
| | - Sameer Dhingra
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER) Hajipur, Dist. Vaishali, Bihar, India.
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Hernández-Zambrano SM, Carrillo-Algarra AJ, Manotas-Solano OE, Ibáñez-Gamboa SE, Mejia-Mendez LM, Martínez-Montoya OH, Fernández-Alcántara M, Hueso-Montoro C. Interprofessional interventions and factors that improve end-of-life care in intensive care units: An integratory review. ENFERMERIA INTENSIVA 2024:S2529-9840(23)00069-1. [PMID: 38910066 DOI: 10.1016/j.enfie.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/24/2023] [Indexed: 06/25/2024]
Abstract
INTRODUCTION The changes in health dynamics, caused by the SARS-COVD-2 pandemic and its consequences, generated a greater need to integrate palliative care in the ICU to promote a dignified death. OBJECTIVE Identify interprofessional interventions and factors that improve the care of patients at the end of life. METHODOLOGY Integrative review, including experimental, quasi-experimental, observational, analytical, and descriptive studies with correlation of variables, published from 2010 to 2021, identified in COCHRANE, CINAHL, CUIDEN, LILACS, SCIELO, Dialnet, PsychInfo, PubMed, PROQUES, PSYCHOLOGY, JOURNALS, SCIENCEDIRECT, with MeSH/DECS terms: "Critical Care", "IntensiveCare" "Life support care", "Palliative care", "Life Quality", "Right to die". 36,271 were identified, after excluding duplicate title, abstract, year of publication, design, theme, methodological quality, objectives, and content, 31 studies were found. RESULTS It included 31 articles, 16.7% experimental, 3.3% quasi-experimental, 80% observational, analytical, and descriptive with correlation of variables, 38% published in the United States, 38%, and 19% in Brazil. The pooled sample was 24,779 participants. 32.2% of the studies had level of evidence 1 recommendation (c), and 25.8% level of evidence 2 recommendation (c). This paper synthesises evidence to promote Interprofessional Collaborative Practice in the ICU, improve end-of-life care, and interventions to achieve established therapeutic goals, implement effective care policies, plans, and programmes for critically ill patients and their families; factors that affect palliative care and improve with training and continuing education for health personnel. CONCLUSION There are interventions to manage physical and emotional symptoms, training strategies and emotional support aimed at health personnel and family members to improve the quality of death and reduce stays in the ICU. The interdisciplinary team requires training on palliative and end-of-life care to improve care.
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Affiliation(s)
- S M Hernández-Zambrano
- Grupo Perspectivas del Cuidado, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia.
| | - A J Carrillo-Algarra
- Grupo Perspectivas del Cuidado, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - O E Manotas-Solano
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - S E Ibáñez-Gamboa
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - L M Mejia-Mendez
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - O H Martínez-Montoya
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | | | - C Hueso-Montoro
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Jaén, Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Jaén, Spain
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Ding H, Wang C, Ghorbani H, Yang S, Stepanyan H, Zhang G, Zhou N, Wang W. The impact of magnesium on shivering incidence in cardiac surgery patients: A systematic review. Heliyon 2024; 10:e32127. [PMID: 38873687 PMCID: PMC11170178 DOI: 10.1016/j.heliyon.2024.e32127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/15/2024] Open
Abstract
Background and objective This scientific review involves a sequential analysis of randomized trial research focused on the incidence of shivering in patients undergoing cardiac surgery. The study conducted a comprehensive search of different databases, up to the end of 2020. Only randomized trials comparing magnesium administration with either placebo or no treatment in patients expected to experience shivering were included. The primary objective was to evaluate shivering occurrence, distinguishing between patients receiving general anesthesia and those not. Secondary outcomes included serum magnesium concentrations, intubation time, post-anesthesia care unit stay, hospitalization duration, and side effects. Data collection included patient demographics and various factors related to magnesium administration. Material and methods This scientific review analyzed 64 clinical trials meeting inclusion criteria, encompassing a total of 4303 patients. Magnesium was administered via different routes, primarily intravenous, epidural, and intraperitoneal, and compared against placebo or control. Data included demographics, magnesium dosage, administration method, and outcomes. Heterogeneity was assessed using the I2 statistic. Some studies were excluded due to unavailability of data or non-responsiveness from authors. Result and discussion: Out of 2546 initially identified articles, 64 trials were selected for analysis. IV magnesium effectively reduced shivering, with epidural and intraperitoneal routes showing even greater efficacy. IV magnesium demonstrated cost-effectiveness and a favorable safety profile, not increasing adverse effects. The exact dose-response relationship of magnesium remains unclear. The results also indicated no significant impact on sedation, extubation time, or gastrointestinal distress. However, further research is needed to determine the optimal magnesium dose and to explore its potential effects on blood pressure and heart rate, particularly regarding pruritus prevention. Conclusion This study highlights the efficacy of intravenous (IV) magnesium in preventing shivering after cardiac surgery. Both epidural and intraperitoneal routes have shown promising results. The safety profile of magnesium administration appears favorable, as it reduces the incidence of shivering without significantly increasing costs. However, further investigation is required to establish the ideal magnesium dosage and explore its potential effects on blood pressure, heart rate, and pruritus prevention, especially in various patient groups.
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Affiliation(s)
- Haiyang Ding
- Department of Anesthesia, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China
- Department of Anesthesia, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China
| | - Chuanguang Wang
- Department of Anesthesia, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China
- Department of Anesthesia, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China
| | - Hamzeh Ghorbani
- Faculty of General Medicine, University of Traditional Medicine of Armenia (UTMA), 38a Marshal Babajanyan St., Yerevan, 0040, Armenia
| | - Sufang Yang
- Department of Anesthesia, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China
- Department of Anesthesia, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China
| | - Harutyun Stepanyan
- Faculty of General Medicine, University of Traditional Medicine of Armenia (UTMA), 38a Marshal Babajanyan St., Yerevan, 0040, Armenia
| | - Guodao Zhang
- Department of Digital Media Technology, Hangzhou Dianzi University, Hangzhou, 310018, China
| | - Nan Zhou
- Department of Anesthesia, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China
- Department of Anesthesia, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China
| | - Wu Wang
- Department of Anesthesia, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang 323000, China
- Department of Anesthesia, Lishui Municipal Central Hospital, Lishui, Zhejiang 323000, China
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Wijekoon A, Gamage Dona D, Jayawardana S, Beane A. Quality of Life, Physical Activity Participation, and Perceptions of Physical Rehabilitation Among Community-Reintegrated Veterans With Lower Limb Amputation in Sri Lanka: Convergent Parallel Mixed Methods Study. JMIR Rehabil Assist Technol 2024; 11:e52811. [PMID: 38869933 PMCID: PMC11211708 DOI: 10.2196/52811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/22/2023] [Accepted: 03/19/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Lower limb amputation (LLA) impacts physical activity (PA) participation and quality of life (QoL). To minimize the effects of these challenges, LLA survivors need to have opportunities to engage in appropriately tailored rehabilitation throughout their lives. However, in Sri Lanka, where a 3-decade civil war resulted in trauma-related LLA among young male soldiers, access to rehabilitation was limited to the immediate postinjury period. Developing rehabilitation interventions for these veterans requires an understanding of their current health status and rehabilitation perceptions. OBJECTIVE This study was conducted to evaluate the QoL and PA participation of veterans with LLA and explore perceptions of factors influencing their PA participation and expectations for a future community-based physical rehabilitation (CBPR) intervention. METHODS This mixed methods study combined a comparative cross-sectional quantitative survey with qualitative semistructured interviews in 5 districts of Sri Lanka. QoL and PA participation were assessed among community-reintegrated veterans with LLA (n=85) and compared with a matched able-bodied cohort (control; n=85) using Mann-Whitney U and Chi-square tests. PA was assessed in terms of metabolic equivalent of task (MET) minutes per week and was computed for walking, moderate-intensity, and vigorous-intensity activities. PA was classified as sufficiently active, low, or sedentary. The design of interview questions was guided by the Theoretical Domains Framework and followed a phenomenological approach. Interviews were conducted with 25 veterans and were analyzed thematically, and the perceptions regarding PA participation and CBPR were codified using the Consolidated Framework for Implementation Research (CFIR). RESULTS Based on the quantitative survey findings, scores for both physical (P<.001) and psychological (P<.001) well-being and participation in walking (P=.004) and vigorous-intensity activities (P<.001) were significantly lower among veterans than among controls. A "sedentary" classification was made for 43% (34/79) of veterans and 12% (10/82) of controls. Veterans mostly engaged in moderate-intensity PA inside the house (49/79, 62%) and in the yard (30/79, 38%). Qualitative interviews revealed that barriers to PA exist at individual (eg, comorbidity burden), primary care (eg, absence of community rehabilitation services), and policy levels (eg, limited resources) and facilitators exist primarily at societal (eg, inclusive community) and individual levels (eg, preinjury activity baseline and positive attitudes toward exercise). Expectations regarding CBPR included individualized rehabilitation parameters; functional exercises; and involvement of peers, amputee societies, and community health care providers. The nonresponse rate for interviews was 7% (2/27). CONCLUSIONS The findings of reduced PA participation, poor QoL, and physical and psychological impairments among relatively young veterans reveal the long-term impacts of living with LLA in the absence of long-term rehabilitation. Policy-level changes need to be implemented along with behavior-change strategies to promote PA participation and minimize physical inactivity-induced health issues. Veterans' perceptions regarding future CBPR programs were positive and centered on holistic, individualized, and peer-led activities.
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Affiliation(s)
- Ashan Wijekoon
- National Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
- Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Department of Health and Care Professions, Faculty of Health and Wellbeing, University of Winchester, Winchester, United Kingdom
| | - Dilanthi Gamage Dona
- National Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
| | - Subashini Jayawardana
- Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Abigail Beane
- National Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Scotland, United Kingdom
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Liu Y, Zhang X, Zhang F, Song W. Bronchial artery chemoembolization in the treatment of refractory central lung cancer with atelectasis. Front Oncol 2024; 14:1343324. [PMID: 38933450 PMCID: PMC11199781 DOI: 10.3389/fonc.2024.1343324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
Objective This study aims to explore the clinical application of bronchial artery chemoembolization (BACE) in managing refractory central lung cancer with atelectasis. Methods The retrospective case series includes patients diagnosed with refractory central lung cancer and atelectasis who underwent BACE treatment at Yueyang Integrated Traditional Chinese and Western Medicine Hospital, affiliated with Shanghai University of Traditional Chinese Medicine, from January 2012 to December 2021. Results All 30 patients with lung cancer successfully underwent BACE procedures. Their ages ranged from 62 to 88 years, with an average age of 67.53. The treatment interval was 21 days, and the treatment cycle ranged from 2 to 12 times, averaging 4.13 times. During the BACE procedures, the Karnofsky Performance Status (KPS) score after 2 to 3 BACE cycles showed a significant improvement (82.0 ± 10.1 vs 68.3 ± 14.0, P < 0.001) than that of before BACE. Only nutritional support and symptomatic treatment were performed after BACE, and no major hemoptysis were observed. During follow-up, 23 cases resulted in mortality, while seven survived. The median progression-free survival (PFS) and overall survival (OS) were 7.0 (95% CI: 4.6-9.4) and 10.0 (95% CI: 6.2-13.8) months, respectively, with 1-, 2-, and 3-year survival rates of 84.0%, 53.5%, and 11.3%, respectively. Eight cases exhibited bronchial recanalization and relief of atelectasis. According to the RECIST scale, there were 4 cases of complete response (CR), 16 cases of partial response (PR), 9 cases of stable disease (SD), and 1 case of progressive disease (PD). No serious adverse events were reported. Conclusion BACE might be a safe intervention for refractory central lung cancer accompanied by atelectasis. The procedure exhibits satisfactory outcomes in tumor control, atelectasis relief, and enhancement of quality of life, warranting further investigation.
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Affiliation(s)
- Yujin Liu
- Department of Interventional Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiumei Zhang
- Nursing department, Tongji University Affiliated Shanghai Fourth People’s Hospital, Shanghai, China
| | - Fenxiang Zhang
- Department of Interventional Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weixiang Song
- Department of Interventional Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Kengne MF, Mbaveng AT, Karimo O, Dadjo BST, Tsobeng OD, Marbou WJT, Kuete V. Frequency of Fecal Carriage of ESBL Resistance Genes in Multidrug-Resistant Pseudomonas aeruginosa Isolates from Cancer Patients at Laquintinie Hospital, Douala, Littoral Region, Cameroon. Int J Microbiol 2024; 2024:7685878. [PMID: 38962396 PMCID: PMC11222006 DOI: 10.1155/2024/7685878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 07/05/2024] Open
Abstract
Background. Opportunistic infections are the second cause of death among cancer patients. This study aimed at determining the antimicrobial profile and the prevalence of extended-spectrum beta-lactamase (ESBL)-gene carriage of Pseudomonas aeruginosa isolates among cancer patients at the Douala Laquintinie Hospital, Littoral Region of Cameroon. Between October 2021 and March 2023, 507 study participants were recruited among whom 307 (60.55%) were cancer patients, compared to 200 (39.45%) noncancer patients. Fifty-eight P. aeruginosa isolates were isolated from fecal samples of forty-five cancer patients and thirteen noncancer patients using Cetrimide agar. The antimicrobial resistance profile of the isolates was determined using the Kirby-Bauer disk diffusion method. The polymerase chain reaction was used to detect the presence of extended-spectrum beta-lactamase genes among P. aeruginosa isolates. P. aeruginosa showed significant resistance rates in cancer patients compared to noncancer patients to imipenem, cefotaxime, and ceftazidime, piperacillin-tazobactam, ticarcillin-clavulanic acid, and ciprofloxacin. The multidrug resistance (MDR) rate was significantly (p < 0.05) higher in cancer patients than in noncancer patients. The frequency of beta-lactamase genes in the 58 ESBL-producing P. aeruginosa isolates was determined as 72.41% for bla TEM, 37.93% for bla OXA, 74.14% for blaCTX-M, and 44.83% for bla SHV genes. The study revealed an alarmingly high prevalence of fecal carriage of ESBL-producing P. aeruginosa with a high rate of MDR among cancer patients. It indicates that regular monitoring and surveillance of ESBL-producing P. aeruginosa among cancer patients are needed to improve the management of patients.
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Affiliation(s)
- Michael F. Kengne
- Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Armelle T. Mbaveng
- Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Ousenu Karimo
- Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Ballue S. T. Dadjo
- Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Ornella D. Tsobeng
- Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Wiliane J. T. Marbou
- Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Victor Kuete
- Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
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Werner K, Stassen W, Theron E, Wallis LA, Lin TK. Patient Preferences for Out-of-Hospital Cardiac Arrest Care in South Africa: A Discrete Choice Experiment. Value Health Reg Issues 2024; 43:101006. [PMID: 38857557 DOI: 10.1016/j.vhri.2024.101006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 03/27/2024] [Accepted: 05/01/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE This study examined the trade-offs low-resource setting community members were willing to make in regard to out-of-hospital cardiac arrest care using a discrete choice experiment survey. METHODS We administered a discrete choice experiment survey to a sample of community members 18 years or older across South Africa between April and May 2022. Participants were presented with 18 paired choice tasks comprised of 5 attributes (distance to closest adequate facility, provider of care, response time, chances of survival, and transport cost) and a range of 3 to 5 levels. We used mixed logit models to evaluate respondents' preferences for selected attributes. RESULTS Analyses were based on 2228 responses and 40 104 choice tasks. Patients valued care with the shortest response time, delivered by the highest qualified individuals, which placed them within the shortest distance of an adequate facility, gave them the highest chance of survival, and costed the least. In addition, patients preferred care delivered by their family members over care delivered by the lay public. The highest mean willingness-to-pay for increased survival is 11 699 South African rand (ZAR), followed by distance to health facility (8108 ZAR), and response time (5678 ZAR), and the lowest for increasing specialization of provider (1287 ZAR). CONCLUSIONS In low-resource settings, it may align with patients' preference to include targeted resuscitation training for family members of individuals with high-risk for cardiac arrest as a part of out-of-hospital cardiac arrest intervention strategies.
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Affiliation(s)
- Kalin Werner
- Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA; Division of Emergency Medicine, University of Cape Town, Western Cape, Cape Town, South Africa.
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Elzarie Theron
- Division of Emergency Medicine, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Lee A Wallis
- Division of Emergency Medicine, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Tracy K Lin
- Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
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Zhang Y, He K, Chen L, Ji K, Zhang Z, Wang W. Role of scalp nerve block in improving the quality of rehabilitation in patients after meningioma resection: A randomized controlled clinical trial. Medicine (Baltimore) 2024; 103:e38324. [PMID: 38847715 PMCID: PMC11155575 DOI: 10.1097/md.0000000000038324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/01/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND In this study, we analyzed whether scalp nerve block with ropivacaine can improve the quality of rehabilitation in patients after meningioma resection. METHODS We included 150 patients who were undergoing craniotomy in our hospital and categorized them into 2 groups - observation group (patients received an additional regional scalp nerve block anesthesia) and control group (patients underwent intravenous general anesthesia for surgery), using the random number table method approach (75 patients in each group). The main indicator of the study was the Karnofsky Performance Scale scores of patients at 3 days postoperatively, and the secondary indicator was the anesthesia satisfaction scores of patients after awakening from anesthesia. The application value of different anesthesia modes was studied and compared in the 2 groups. RESULTS Patients in the observation group showed better anesthesia effects than those in the control group, with significantly higher Karnofsky Performance Scale scores at 3 days postoperatively (75.02 vs 66.43, P < .05) and anesthesia satisfaction scores. Compared with patients in the control group, patients in the observation group had lower pain degrees at different times after the surgery, markedly lower dose of propofol and remifentanil for anesthesia, and lower incidence of adverse reactions and postoperative complications. In addition, the satisfaction score of the patients and their families for the treatment was higher and the results of all the indicators were better in the observation group than in the control group, with statistically significant differences (P < .05). CONCLUSION Scalp nerve block with ropivacaine significantly improves the quality of short-term postoperative rehabilitation in patients undergoing elective craniotomy for meningioma resection. This is presumably related to the improvements in intraoperative hemodynamics, relief from postoperative pain, and reduction in postoperative nausea and vomiting.
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Affiliation(s)
- Yongguo Zhang
- Department of Anesthesiology, People’s Hospital of Qiannan, Qiannan, China
- Department of Neurosurgery, People’s Hospital of Qiannan, Qiannan, China
| | - Kai He
- Department of Anesthesiology, People’s Hospital of Qiannan, Qiannan, China
- Department of Neurosurgery, People’s Hospital of Qiannan, Qiannan, China
| | - Lvlv Chen
- Department of Anesthesiology, People’s Hospital of Qiannan, Qiannan, China
- Department of Neurosurgery, People’s Hospital of Qiannan, Qiannan, China
| | - Kuiquan Ji
- Department of Anesthesiology, People’s Hospital of Qiannan, Qiannan, China
- Department of Neurosurgery, People’s Hospital of Qiannan, Qiannan, China
| | - Zhongwei Zhang
- Department of Anesthesiology, People’s Hospital of Qiannan, Qiannan, China
- Department of Neurosurgery, People’s Hospital of Qiannan, Qiannan, China
| | - Weijun Wang
- Department of Anesthesiology, People’s Hospital of Qiannan, Qiannan, China
- Department of Neurosurgery, People’s Hospital of Qiannan, Qiannan, China
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Ose G, Evansa I, Ivanovs N, Zlobina N, Vanags I. Life-Threatening Tracheal Diverticulum Rupture Following Laparoscopic Cholecystectomy: A Rare Case Report. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943639. [PMID: 38840414 PMCID: PMC11165929 DOI: 10.12659/ajcr.943639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/16/2024] [Accepted: 03/27/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND We present an exceptional case of asystole and tracheal diverticulum rupture as a result of cardiopulmonary resuscitation (CPR) immediately following laparoscopic cholecystectomy performed at Riga 1st Hospital. Tracheal rupture after tracheal intubation is a severe but very rare complication that can be fatal. We present an incidental finding of the tracheal diverticulum and its rupture during CPR. CASE REPORT A 71-year-old woman (American Society of Anesthesiologists class II, body mass index 28.58) underwent a planned laparoscopic cholecystectomy. Preoperative chest X-ray showed no abnormalities. Endotracheal intubation was performed, with the first attempt with a 7-mm inner diameter cuffed endotracheal tube without an introducer. Five minutes after rapid desufflation of the pneumoperitoneum, severe bradycardia and hypotension occurred, followed by asystole. CPR was performed for a total of 2 min, until spontaneous circulation returned. Twenty hours after surgery, subcutaneous emphysema appeared on the chest. Computed tomography scan of the chest revealed subcutaneous neck emphysema, bilateral pneumothorax, extensive pneumomediastinitis, and a pocket-like, air-filled tissue defect measuring 10×32 mm in the distal third of the trachea, with suspected rupture. Two hours after the diagnosis was established, the emergent surgery was performed. The patient was completely recovered after 15 days. CONCLUSIONS Our case illustrates that tracheal diverticula is sometimes diagnosed by accident and too late, which then can lead to life-threatening situations. Tracheal rupture can be made not only by mechanical piercing by an endotracheal tube but also during interventions, such as CPR. Rapid desufflation of the pneumoperitoneum can lead to asystole, induced by the Bezold-Jarisch reflex.
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Affiliation(s)
- Gundega Ose
- Faculty of Medicine, Riga Stradins University, Riga, Latvia
- Department of Anesthesiology and Intensive Care, Riga Stradins University, Riga, Latvia
| | - Irina Evansa
- Department of Anesthesiology and Intensive Care, Riga Stradins University, Riga, Latvia
- Department of Anesthesiology, Intensive Care and Pain, Riga 1 Hospital, Riga, Latvia
| | - Nikita Ivanovs
- Department of Anesthesiology, Intensive Care and Pain, Riga 1 Hospital, Riga, Latvia
| | - Natalija Zlobina
- Department of Anesthesiology, Intensive Care and Pain, Riga 1 Hospital, Riga, Latvia
| | - Indulis Vanags
- Department of Anesthesiology and Intensive Care, Riga Stradins University, Riga, Latvia
- Clinic of Anesthesiology and Reanimatology, Paul Stradins Clinical University Hospital, Riga, Latvia
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Kothapalli S, Anandaswamy TC, Patil S, Anne N, Muthalgiri CM, Niranjan A. Ultrasound evaluation of gastric residual volume in fasting end-stage renal failure patients. J Clin Anesth 2024; 94:111414. [PMID: 38377764 DOI: 10.1016/j.jclinane.2024.111414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/22/2023] [Accepted: 02/09/2024] [Indexed: 02/22/2024]
Abstract
STUDY OBJECTIVE To evaluate the gastric contents and gastric residual volume in patient with end-stage renal failure by gastric ultrasound. DESIGN Prospective observational study. SETTING Tertiary care teaching hospital. PATIENTS Adults of either gender with BMI < 40 kg/m2 with end-stage renal failure scheduled to undergo arteriovenous graft or fistula. INTERVENTIONS & MEASUREMENTS The cross-sectional area of the gastric antrum was measured by gastric ultrasound with patient in both supine and right lateral decubitus positions. The volume of the gastric contents were calculated using suitable validated formula. In addition, the nature of the gastric contents was also determined by gastric ultrasound. MAIN RESULTS The incidence of delayed gastric emptying was found to be 57.7% in the population studied despite following the prescribed preoperative standard fasting guidelines. CONCLUSIONS There is a high incidence of delayed gastric emptying in patients with end-stage renal failure presenting for surgery which may predispose them to risk of pulmonary aspiration perioperatively.
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Affiliation(s)
- Sushma Kothapalli
- Department of Anaesthesiology, MS Ramaiah Medical College, Bangalore 560054, India
| | - Tejesh C Anandaswamy
- Department of Anaesthesiology, MS Ramaiah Medical College, Bangalore 560054, India.
| | - Sahana Patil
- Department of Anaesthesiology, Navodaya Medical College, Raichur 584101, India
| | - Namita Anne
- Department of Anaesthesiology, MS Ramaiah Medical College, Bangalore 560054, India
| | - Chaitra M Muthalgiri
- Department of Anaesthesiology, MS Ramaiah Medical College, Bangalore 560054, India
| | - Akshita Niranjan
- Department of Anaesthesiology, MS Ramaiah Medical College, Bangalore 560054, India
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Badheeb AM, Musallam SH, Alyami AY, Almakrami AH, Al-Swedan AD, Ahmed F, Badheeb M, Aedh AI, Obied HY, Seada IA, Alyami NH, Elhadi M, Aman AA, Alkarak S, Haridi HK. Cancer Care During the COVID-19 Pandemic: A Retrospective Study From a Najran Oncology Center. Cureus 2024; 16:e63252. [PMID: 39070488 PMCID: PMC11281966 DOI: 10.7759/cureus.63252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Background The COVID-19 pandemic significantly impacted healthcare systems globally, with cancer patients representing a particularly vulnerable group. This study aims to evaluate the influence of COVID-19 on cancer, focusing on infection rates, types of care, therapy adjustments, and factors associated with COVID-19 infection. Materials and methods This single-center retrospective analysis included adult cancer patients who underwent anticancer therapy at King Khalid Hospital in Najran, Saudi Arabia, from December 20, 2020, to January 23, 2022. Data on patient and cancer characteristics, COVID-19 specifics, treatment delays, outcomes, and factors associated with COVID-19 were collected and analyzed. Results A total of 257 chemotherapy recipients were interviewed. The mean age was 52.6 ± 14.4 years, with 44 (17.1%) over 65 years old. Females comprised 160 (62.3%) of the patients. The most common malignancies were gastrointestinal (71, 27.6%), breast (70, 27.2%), and hematological (50, 19.5%). Metastasis was present in 116 patients (45.1%). Common comorbidities included diabetes (68, 26.5%) and hypertension (55, 21.4%). Most patients (226, 87.9%) were vaccinated against COVID-19. COVID-19 tested positive in 22 patients (8.6%), with a lower infection rate in vaccinated patients (7 vs. 15, p < 0.001). Most cases were mild (18, 81.8%), with fever (19, 7.4%) and cough and fatigue (17, 6.6%) being the most common symptoms. The median time to resume treatment post-infection was 30 days. Factors associated with higher infection rates included diabetes (OR: 4.73, 95% CI: 1.94-12.03, p = 0.001), coronary artery disease (OR: 4.13, 95% CI: 1.07-13.30, p = 0.049), chronic lung disease (OR: 15.58, 95% CI: 5.37-45.79, p < 0.001), chronic liver disease (OR: 7.64, 95% CI: 2.38-22.98, p < 0.001), and multiple comorbidities (OR: 2.04, 95% CI: 1.46-2.90, p < 0.001), cancer patients who received chemotherapy (OR: 1.02, 95% CI: 0.12-12.79, p = 0.027), and immunotherapy (OR: 3.37, 95% CI:1.27-8.43, p = 0.012). Conclusion The incidence of COVID-19 in cancer patients is proportional to the prevalence in the general population of similar geographic areas. Diabetes, coronary artery disease, chronic lung disease, chronic liver disease, receiving chemotherapy or immunotherapy, and multiple comorbidities were associated with higher COVID-19 infection rates.
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Affiliation(s)
- Ahmed M Badheeb
- Oncology, King Khalid Hospital - Oncology Center, Najran, SAU
- Oncology, Hadhramout University, Mukalla, YEM
| | | | | | | | | | | | - Mohamed Badheeb
- Internal Medicine, Bridgeport Hospital, Yale New Haven Health, Bridgeport, USA
| | | | - Hamoud Y Obied
- Surgery, Najran University, Najran, SAU
- Cardiac Surgery, King Khalid Hospital, Najran, SAU
| | - Islam A Seada
- Cardiothoracic Surgery, King Khalid Hospital, Najran, SAU
| | - Nasher H Alyami
- Laboratory Medicine, Hematology Unit, Najran General Hospital, Najran, SAU
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Kuttan KA, Padala SRAN, Vinay AP, Aravind K, Kiran M. Anesthetic management of a large mandibular odontogenic myxoma in a child - a case report. J Dent Anesth Pain Med 2024; 24:213-217. [PMID: 38840650 PMCID: PMC11148415 DOI: 10.17245/jdapm.2024.24.3.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024] Open
Abstract
Numerous neoplastic lesions can arise in the orofacial region in the pediatric populations. Odontogenic tumors typically affect the mandible more than the maxilla. Airway management can be challenging in pediatric oral tumors because of the distorted anatomy and physiological variations. Conventional awake fiberoptic intubation is not always possible owing to limited cooperation from the pediatric populations. Herein, we report the case of a 1-year-old child with odontogenic myxoma of the mandible and an anticipated difficult airway. Given the expected difficulties in the airway, video laryngoscope-assisted orotracheal intubation under general anesthesia with maintenance of spontaneous breathing was scheduled. Proper planning and thorough examinations are vital for successful airway management in pediatric patients.
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Affiliation(s)
| | | | - Anagha P Vinay
- Department of Anesthesiology, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Kuruba Aravind
- Department of Anesthesiology, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Molli Kiran
- Department of Anesthesiology, All India Institute of Medical Sciences (AIIMS), Bhopal, India
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Shah R, Loo CE, Hanna NM, Hughes S, Mafra A, Fink H, McFerran E, Garcia M, Acharya S, Langselius O, Frick C, Niyigaba J, Lasebikan N, Steinberg J, Sullivan R, Bray F, Ilbawi AM, Ginsburg O, Chiam K, Cylus J, Caruana M, David M, Hui H, Canfell K, Soerjomataram I. Global review of COVID-19 mitigation strategies and their impact on cancer service disruptions. J Cancer Policy 2024; 41:100486. [PMID: 38830535 DOI: 10.1016/j.jcpo.2024.100486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/15/2024] [Accepted: 05/24/2024] [Indexed: 06/05/2024]
Abstract
During the COVID-19 pandemic, countries adopted mitigation strategies to reduce disruptions to cancer services. We reviewed their implementation across health system functions and their impact on cancer diagnosis and care during the pandemic. A systematic search was performed using terms related to cancer and COVID-19. Included studies reported on individuals with cancer or cancer care services, focusing on strategies/programs aimed to reduce delays and disruptions. Extracted data were grouped into four functions (governance, financing, service delivery, and resource generation) and sub-functions of the health system performance assessment framework. We included 30 studies from 16 countries involving 192,233 patients with cancer. Multiple mitigation approaches were implemented, predominantly affecting sub-functions of service delivery to control COVID-19 infection via the suspension of non-urgent cancer care, modified treatment guidelines, and increased telemedicine use in routine cancer care delivery. Resource generation was mainly ensured through adequate workforce supply. However, less emphasis on monitoring or assessing the effectiveness and financing of these strategies was observed. Seventeen studies suggested improved service uptake after mitigation implementation, yet the resulting impact on cancer diagnosis and care has not been established. This review emphasizes the importance of developing effective mitigation strategies across all health system (sub)functions to minimize cancer care service disruptions during crises. Deficiencies were observed in health service delivery (to ensure equity), governance (to monitor and evaluate the implementation of mitigation strategies), and financing. In the wake of future emergencies, implementation research studies that include pre-prepared protocols will be essential to assess mitigation impact across cancer care services.
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Affiliation(s)
- Richa Shah
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.
| | - Ching Ee Loo
- Centre for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | | | - Suzanne Hughes
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Allini Mafra
- Cancer Epidemiology and Prevention Team, Public Health Expertise, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Hanna Fink
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Montse Garcia
- Cancer Screening Unit, Institut Català d'Oncologia (ICO), Early Detection of Cancer Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | | | - Oliver Langselius
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Clara Frick
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Jean Niyigaba
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Julia Steinberg
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Richard Sullivan
- King's College London, Institute of Cancer Policy, Guy's Hospital, London, UK
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - André Michel Ilbawi
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | | | - Karen Chiam
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Jonathan Cylus
- WHO Barcelona Office for Health Systems Financing, World Health Organization Regional Office for Europe, Barcelona, Spain; London School of Hygiene and Tropical Medicine Faculty of Public Health, London, UK
| | - Michael Caruana
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Michael David
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia; School of Medicine & Dentistry, Griffith University, Gold Coast, Australia
| | - Harriet Hui
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
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Bozzetti F. The role of the nutrition in malnourished cancer patients: Revisiting an old dilemma. Clin Nutr 2024; 43:1320-1328. [PMID: 38669764 DOI: 10.1016/j.clnu.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/10/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND & AIMS GLIM definition of malnutrition is recognised all over the world and, when is referring to cancer, it specifies that weight or muscle loss are associated with an inflammatory status. However, the real-world practice shows that GLIM definition cannot encompass all the wide and heterogenous clinical presentations of cancer patients with malnutrition, which involves many other drivers beyond inflammation. Moreover, placing an excessive emphasis on the inflammation can overshadow, in the clinical practice, the role of the nutritional support in malnourished cancer patients. The aim of this paper is not to criticize the rationale of the GLIM definition of cancer cachexia, but to show the complexity and heterogeneity of malnutrition of cancer patients and reasons why nutritional support should deserve such a better consideration among the oncologists. METHODS Literature pertinent to pathophysiology of malnutrition of cancer patients is scrutinised and reasons for the frequent underuse of nutritional support are critically analysed. RESULTS The appraisal of the literature shows that there are various pathophysiological patterns of malnutrition among cancer patients and inflammatory markers are not universally present in weight-losing cancer patients. Inflammation alone does not account for weight loss in all cancer patients and factors other than inflammation can drive hypophagia and weight loss, and hypophagia appears to be a primary catalyst for weight loss. Furthermore, malnutrition may be the consequence of the presence of several Nutrition Impact Symptoms or of the oncologic therapy. The nutritional support may fail to show benefits in malnourished cancer patients because the golden standard to validate a therapy relies on RCT, but it is ethically impossible to have an unfed control group of malnourished patients. Furthermore, nutritional interventions often fell short of the optimal standards, adherence to treatment plans was often poor, nutritional support was mainly reserved for very advanced patients and the primary endpoints of the studies on nutritional support were sometimes unrealistic. CONCLUSION There is a gap between the suggestion of the guidelines which advocate the use of nutritional support to improve the compliance of patients facing intensive oncologic treatments or to prevent an early demise when patients enter a chronic phase of slow nutritional deterioration, and the poor use of nutrition in the real-world practice. This requires a higher level of awareness of the oncologists concerning the reasons for the lacking evidence of efficacy of the nutritional support and an understanding of its potential contribute to improve the outcome of the patients. Finally, this paper calls for a change of the oncologist's approach to the cancer patient, from only focusing on the cure of the tumour to taking care of the patient as a whole.
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Brown LR, Sousa MS, Yule MS, Baracos VE, McMillan DC, Arends J, Balstad TR, Bye A, Dajani O, Dolan RD, Fallon MT, Greil C, Hjermstad MJ, Jakobsen G, Maddocks M, McDonald J, Ottestad IO, Phillips I, Sayers J, Simpson MR, Vagnildhaug OM, Solheim TS, Laird BJ, Skipworth RJ. Body weight and composition endpoints in cancer cachexia clinical trials: Systematic Review 4 of the cachexia endpoints series. J Cachexia Sarcopenia Muscle 2024; 15:816-852. [PMID: 38738581 PMCID: PMC11154800 DOI: 10.1002/jcsm.13478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/12/2024] [Accepted: 03/16/2024] [Indexed: 05/14/2024] Open
Abstract
Significant variation exists in the outcomes used in cancer cachexia trials, including measures of body composition, which are often selected as primary or secondary endpoints. To date, there has been no review of the most commonly selected measures or their potential sensitivity to detect changes resulting from the interventions being examined. The aim of this systematic review is to assess the frequency and diversity of body composition measures that have been used in cancer cachexia trials. MEDLINE, Embase and Cochrane Library databases were systematically searched between January 1990 and June 2021. Eligible trials examined adults (≥18 years) who had received an intervention aiming to treat or attenuate the effects of cancer cachexia for >14 days. Trials were also of a prospective controlled design and included body weight or at least one anthropometric, bioelectrical or radiological endpoint pertaining to body composition, irrespective of the modality of intervention (e.g., pharmacological, nutritional, physical exercise and behavioural) or comparator. Trials with a sample size of <40 patients were excluded. Data extraction used Covidence software, and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. This review was prospectively registered (PROSPERO: CRD42022276710). A total of 84 clinical trials, comprising 13 016 patients, were eligible for inclusion. Non-small-cell lung cancer and pancreatic cancer were studied most frequently. The majority of trial interventions were pharmacological (52%) or nutritional (34%) in nature. The most frequently reported endpoints were assessments of body weight (68 trials, n = 11 561) followed by bioimpedance analysis (BIA)-based estimates (23 trials, n = 3140). Sixteen trials (n = 3052) included dual-energy X-ray absorptiometry (DEXA)-based endpoints, and computed tomography (CT) body composition was included in eight trials (n = 841). Discrepancies were evident when comparing the efficacy of interventions using BIA-based estimates of lean tissue mass against radiological assessment modalities. Body weight, BIA and DEXA-based endpoints have been most frequently used in cancer cachexia trials. Although the optimal endpoints cannot be determined from this review, body weight, alongside measurements from radiological body composition analysis, would seem appropriate. The choice of radiological modality is likely to be dependent on the trial setting, population and intervention in question. CT and magnetic resonance imaging, which have the ability to accurately discriminate tissue types, are likely to be more sensitive and provide greater detail. Endpoints are of particular importance when aligned with the intervention's mechanism of action and/or intended patient benefit.
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Affiliation(s)
- Leo R. Brown
- Clinical SurgeryThe University of Edinburgh, Royal Infirmary of EdinburghEdinburghUK
| | - Mariana S. Sousa
- Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation (IMPACCT)University of Technology SydneySydneyAustralia
| | - Michael S. Yule
- Clinical SurgeryThe University of Edinburgh, Royal Infirmary of EdinburghEdinburghUK
- Institute of Genetics and CancerThe University of Edinburgh, Western General HospitalEdinburghUK
- St Columba's Hospice CareEdinburghUK
| | | | - Donald C. McMillan
- Academic Unit of SurgeryUniversity of Glasgow, Glasgow Royal InfirmaryGlasgowUK
| | - Jann Arends
- Department of Medicine I, Medical Centre—University of Freiburg Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Trude R. Balstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Clinical Medicine, Clinical Nutrition Research GroupUiT The Arctic University of NorwayTromsøNorway
| | - Asta Bye
- Department of OncologyOslo University HospitalOsloNorway
- Department of Nursing and Health Promotion, Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
| | - Olav Dajani
- Department of OncologyOslo University HospitalOsloNorway
| | - Ross D. Dolan
- Academic Unit of SurgeryUniversity of Glasgow, Glasgow Royal InfirmaryGlasgowUK
| | - Marie T. Fallon
- Institute of Genetics and CancerThe University of Edinburgh, Western General HospitalEdinburghUK
- St Columba's Hospice CareEdinburghUK
| | - Christine Greil
- Department of Medicine I, Medical Centre—University of Freiburg Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | | | - Gunnhild Jakobsen
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Cancer ClinicSt. Olav's Hospital, Trondheim University HospitalTrondheimNorway
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
| | - James McDonald
- Institute of Genetics and CancerThe University of Edinburgh, Western General HospitalEdinburghUK
- St Columba's Hospice CareEdinburghUK
| | - Inger O. Ottestad
- Department of Nutrition, Institute of Basic Medical SciencesUniversity of OsloOsloNorway
- The Clinical Nutrition Outpatient Clinic, Section of Clinical Nutrition, Department of Clinical Service, Division of Cancer MedicineOslo University HospitalOsloNorway
| | - Iain Phillips
- Edinburgh Cancer CentreWestern General HospitalEdinburghUK
| | - Judith Sayers
- Clinical SurgeryThe University of Edinburgh, Royal Infirmary of EdinburghEdinburghUK
- Institute of Genetics and CancerThe University of Edinburgh, Western General HospitalEdinburghUK
- St Columba's Hospice CareEdinburghUK
| | - Melanie R. Simpson
- Department of Nursing and Health Promotion, Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
| | - Ola M. Vagnildhaug
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Tora S. Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Barry J.A. Laird
- Institute of Genetics and CancerThe University of Edinburgh, Western General HospitalEdinburghUK
- St Columba's Hospice CareEdinburghUK
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Cheemalapati S, R D, S R S, Karthik M V S K, D N. Culture of Cultures: A Small Step Towards Augmenting Diagnostic Stewardship. Cureus 2024; 16:e63451. [PMID: 39077235 PMCID: PMC11285012 DOI: 10.7759/cureus.63451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2024] [Indexed: 07/31/2024] Open
Abstract
Laboratories with a well-established diagnostic stewardship program for culture and the antimicrobial susceptibility test (C-AST) play a key role in guiding clinicians to institute specific targeted therapy. Blood culture is one of the most critical investigations performed at a microbiology laboratory. Therefore, it is particularly important to develop a robust diagnostic stewardship model for the blood culture laboratory division. Aiming at this hypothesis, this hospital-based clinical audit carried out within the Department of General Medicine, centered on the critical domain of antimicrobial stewardship (AMSP). The audit's primary objective was to systematically evaluate prevailing practices and pinpoint areas necessitating refinement in the administration of antimicrobial agents. Employing a meticulous approach involving exhaustive data scrutiny and feedback mechanisms, the audit unearthed strategic opportunities to optimize prescription patterns, curtail unwarranted antimicrobial utilization, and fortify adherence to established guidelines. The subsequent execution of targeted interventions, encompassing educational initiatives and routine performance feedback, culminated in a noteworthy enhancement of antimicrobial prescribing practices. These outcomes unequivocally underscore the efficacy of the audit in cultivating a milieu of judicious antimicrobial utilization, thereby augmenting patient care and mitigating antibiotic resistance within the department.
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Affiliation(s)
| | - Deepashree R
- Department of Microbiology, JSS Medical College and Hospital, Mysore, IND
| | - Sujatha S R
- Department of Microbiology, JSS Medical College and Hospital, Mysore, IND
| | | | - Narayanappa D
- Department of Paediatrics, JSS Medical College and Hospital, Mysore, IND
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