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Lee MC, Bartuska A, Chen J, Kim RK, Jaradeh S, Mihm F. Stellate ganglion block catheter for paroxysmal sympathetic hyperactivity: calming the 'neuro-storm'. Reg Anesth Pain Med 2023; 48:522-525. [PMID: 37230754 DOI: 10.1136/rapm-2023-104399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Paroxysmal sympathetic hyperactivity (PSH) is an autonomic disorder affecting patients with severe acquired brain injury characterized by intermittent sympathetic discharges with limited therapeutic options. We hypothesized that the PSH pathophysiology could be interrupted via stellate ganglion blockade (SGB). CASE PRESENTATION A patient with PSH after midbrain hemorrhage followed by hydrocephalus obtained near-complete resolution of sympathetic events for 140 days after SGB. CONCLUSION SGB is a promising therapy for PSH, overcoming the limitations of systemic medications and may serve to recalibrate aberrant autonomic states.
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Affiliation(s)
- Man-Cheung Lee
- Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Andrew Bartuska
- Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jeffrey Chen
- Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Richard K Kim
- Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Safwan Jaradeh
- Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Fred Mihm
- Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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Abahuje E, Bartuska A, Dias RD, Muneza E, Sibomana I, Williams W, Koch R, Robertson JM, Ntakiyiruta G, Evans F, Riviello R, Yule S. Learning NOTSS While Tying Knots: Integrating the Nontechnical Skills for Surgeons Course With Technical Surgical Skills Training, A Mixed Methods Study. Ann Surg Open 2022; 3:e133. [PMID: 37600100 PMCID: PMC10431258 DOI: 10.1097/as9.0000000000000133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The aims of this study were to describe the process of integrating 2 established training programs, Nontechnical skills for surgeons, and a traditional essential surgical skills course and to measure the impact of this integrated course on the behaviors of interprofessional surgical teams in Rwandan district hospitals. Background Surgical errors and resulting adverse events are due to variability in both technical and nontechnical surgical skills. Providing technical and nontechnical skills training to the perioperative team may enhance the learning of both of these skills and promote safe intraoperative patient care. Methods A quality improvement framework guided the process of integrating essential surgical skills and nontechnical skills into a single training program for surgical teams. The resulting 2-day training program was delivered to 68-person teams from 17 hospitals. Nontechnical skills for surgeons was taught through didactics and in the operating room, where preoperative briefing, intraoperative interactions, and postoperative debriefing were used as essential and nontechnical skills teaching moments. Postcourse surveys, follow-up interviews, focus groups, and direct observation of participants in the operating room were conducted to assess how participants implemented the knowledge and skills from the training into practice. Results Ninety-seven percent of the participants reported that they were satisfied with the course. Follow-up participant interviews and focus groups reported that the course helped them to improve their preoperative planning, intraoperative communication, decision-making, and postoperative debriefing. Conclusions It is possible to implement an integrated essential surgical skills and nontechnical skills training course. Integrating nontechnical skills into essential surgical skills courses may enhance learning of these skills.
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Affiliation(s)
- Egide Abahuje
- From the Surgical Outcome and Quality Improvement Center, Department of Surgical Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL
- MGH Institute of Health Professions, Boston, MA
- Department of Surgery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Roger D. Dias
- Harvard Medical School, Boston, MA
- Department of Emergency Medicine, Brigham and Women’s Hospital, STRATUS Center for Medical Simulation, Boston, MA
| | - Eugène Muneza
- Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | | | - Wendy Williams
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA
| | - Rachel Koch
- Department of Surgery, School of Medicine, Vanderbilt University, Nashville, TN
| | | | | | - Faye Evans
- Critical Care and Pain Medicine, Boston Children Hospital, Department of Anesthesia, Boston, MA
| | - Robert Riviello
- Harvard Medical School, Boston, MA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA
- Department of Surgery, School of Medicine, Vanderbilt University, Nashville, TN
| | - Steven Yule
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA
- Department of Surgery, University of Edinburg, Edinburg, Scotland
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Abahuje E, Bartuska A, Koch R, Youngson G, Ntakiyiruta G, Williams W, Dias RD, Rosu C, Yule S, Riviello R. Understanding Barriers and Facilitators to Behavior Change After Implementation of an Interdisciplinary Surgical Non-Technical Skills Training Program in Rwanda. J Surg Educ 2021; 78:1618-1628. [PMID: 33516750 DOI: 10.1016/j.jsurg.2021.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Nontechnical skills, such as situation awareness, decision making, leadership, communication, and teamwork play a crucial role on the quality of care and patient safety in the operating room (OR). In our previous work, we developed an interdisciplinary training program, based on the NOTSS (Non-Technical Skills for Surgeons) taxonomy. The aim of this study was to understand the challenges faced by Rwandan surgical providers, who had undergone NOTSS training, to apply these nontechnical skills during subsequent operative surgery. SETTING DESIGN A sequential exploratory mixed method study design was used to assess how participants who took the NOTSS in Rwanda applied nontechnical skills in surgical care delivery. The qualitative phase of this study deployed a constructivist grounded theory approach. Findings from the qualitative phase were used to build a quantitative survey tool that explored themes that emerged from the first phase. PARTICIPANTS Participants were nurses and resident from the departments of Surgery, Anesthesia, Obstetric, and Gynecology, from the University of Rwanda who attended the NOTSS course in March 2018. RESULTS A total of 25 participants and 49 participants were respectively enrolled in the qualitative phase and quantitative phase. Participants noted that nontechnical skills implementation in clinical practice was facilitated by working with other personnel also trained in NOTSS, anticipation, and preparation ahead of the time; while lack of interdisciplinary communication, hierarchy, work overload, and an inconsistently changing environment compromised nontechnical skills implementation. Nontechnical skills were useful both inside and outside the operating. Participants reported that nontechnical skills implementation resulted in improved team dynamics, safer patient care, and empowerment. CONCLUSION Surgical care providers who took the NOTSS course subsequently implemented nontechnical skills both inside and outside of the OR. Human and system-based factors affected the implementation of nontechnical skills in the clinical setting.
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Affiliation(s)
- Egide Abahuje
- Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; University of Rwanda, College of Medicine and Health Sciences, Kigali-Rwanda; MGH Institute of Health Professions, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Andrew Bartuska
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Rachel Koch
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - George Youngson
- Royal College of Surgeons of Edinburgh, Edinburgh, Scotland- United Kingdom
| | | | - Wendy Williams
- Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Roger D Dias
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Claudia Rosu
- MGH Institute of Health Professions, Boston, Massachusetts
| | - Steven Yule
- Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland-United Kingdom
| | - Robert Riviello
- Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; University of Rwanda, College of Medicine and Health Sciences, Kigali-Rwanda; Department of Surgery, Harvard Medical School, Boston, Massachusetts
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Akama-Garren EH, Shah SA, Zinzuwadia AN, Bartuska A, Hashimoto M, Chu JT, Kruse GR, Cohen MJ. Outcomes of a Student-Led Telemedicine Clinic in Response to COVID-19. J Ambul Care Manage 2021; 44:197-206. [PMID: 34016847 PMCID: PMC8148224 DOI: 10.1097/jac.0000000000000380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In response to the coronavirus disease-2019 (COVID-19) pandemic, we developed and launched a student-led telemedicine program in Chelsea. From April to November 2020, over 200 student volunteers contacted over 1000 patients to assess COVID-19 symptoms, provide counseling, and triage patients. Through a retrospective cohort study, we determined that student triage decision was associated with patient outcomes, including hospitalization status, COVID-19 test administration, and COVID-19 test result. These results quantify the outcomes of a student-led telemedicine clinic to combat the ongoing pandemic and may serve as a model for implementation of similar clinics to alleviate mounting health care system burden.
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Affiliation(s)
| | | | | | | | | | - Jacqueline T Chu
- Harvard Medical School, Boston, MA 02115
- Massachusetts General Hospital, Boston, MA 02115
| | - Gina R Kruse
- Harvard Medical School, Boston, MA 02115
- Massachusetts General Hospital, Boston, MA 02115
| | - Marya J Cohen
- Harvard Medical School, Boston, MA 02115
- Massachusetts General Hospital, Boston, MA 02115
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Ejikeme T, de Castro GC, Ripple K, Chen Y, Giamberardino C, Bartuska A, Smilnak G, Marius C, Boua JV, Chongsathidkiet P, Hodges S, Pagadala P, Verbick LZ, McCabe AR, Lad SP. Evaluation of neurapheresis therapy in vitro: a novel approach for the treatment of leptomeningeal metastases. Neurooncol Adv 2020; 2:vdaa052. [PMID: 32642705 PMCID: PMC7236387 DOI: 10.1093/noajnl/vdaa052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Leptomeningeal metastases (LM), late-stage cancer when malignant cells migrate to the subarachnoid space (SAS), have an extremely poor prognosis. Current treatment regimens fall short in effectively reducing SAS tumor burden. Neurapheresis therapy is a novel approach employing filtration and enhanced circulation of the cerebrospinal fluid (CSF). Here, we examine the in vitro use of neurapheresis therapy as a novel, adjunctive treatment option for LM by filtering cells and augmenting the distribution of drugs that may have the potential to enhance the current clinical approach. Methods Clinically relevant concentrations of VX2 carcinoma cells were suspended in artificial CSF. The neurapheresis system’s ability to clear VX2 carcinoma cells was tested with and without the chemotherapeutic presence (methotrexate [MTX]). The VX2 cell concentration following each filtration cycle and the number of cycles required to reach the limit of detection were calculated. The ability of neurapheresis therapy to circulate, distribute, and maintain therapeutic levels of MTX was assessed using a cranial–spinal model of the SAS. The distribution of a 6 mg dose was monitored for 48 h. An MTX-specific ELISA measured drug concentration at ventricular, cervical, and lumbar sites in the model over time. Results In vitro filtration of VX2 cancer cells with neurapheresis therapy alone resulted in a 2.3-log reduction in cancer cell concentration in 7.5 h and a 2.4-log reduction in live-cancer cell concentration in 7.5 h when used with MTX. Cranial–spinal model experiments demonstrated the ability of neurapheresis therapy to enhance the circulation of MTX in CSF along the neuraxis. Conclusion Neurapheresis has the potential to act as an adjunct therapy for LM patients and significantly improve the standard of care.
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Affiliation(s)
- Tiffany Ejikeme
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - George C de Castro
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Katelyn Ripple
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Yutong Chen
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Charles Giamberardino
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrew Bartuska
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Gordon Smilnak
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Choiselle Marius
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jane-Valeriane Boua
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Sarah Hodges
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Promila Pagadala
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | | | | | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
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McCrone J, Bartuska A, Martin H, Parsons D. Editorial. Environ Monit Assess 1989; 12:1-2. [PMID: 24249053 DOI: 10.1007/bf00396723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- J McCrone
- USDA Forest Service Environment-Canada USDI National Park Service, Clemson University, Canada
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