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Cureus May 2024Suboptimal teamwork in the operating room (OR) is a contributing factor in a significant proportion of preventable complications for surgical patients. Specifying... (Review)
Review
Suboptimal teamwork in the operating room (OR) is a contributing factor in a significant proportion of preventable complications for surgical patients. Specifying behaviour is fundamental to closing evidence-practice gaps in healthcare. Current teamwork interventions, however, have yet to be synthesized in this way. This scoping review aimed to identify actionable strategies for use during surgery by mapping the existing literature according to the Action, Actor, Context, Target, Time (AACTT) framework. The databases MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), Cochrane, Scopus, and PsycINFO were searched from inception to April 5, 2022. Screening and data extraction were conducted in duplicate by pairs of independent reviewers. The search identified 9,289 references after the removal of duplicates. Across 249 studies deemed eligible for inclusion, eight types of teamwork interventions could be mapped according to the AACTT framework: bundle/checklists, protocols, audit and feedback, clinical practice guidelines, environmental change, cognitive aid, education, and other), yet many were ambiguous regarding the actors and actions involved. The 101 included protocol interventions appeared to be among the most actionable for the OR based on the clear specification of ACCTT elements, and their effectiveness should be evaluated and compared in future work.
PubMed: 38883070
DOI: 10.7759/cureus.60522 -
Heliyon Jun 2024To develop and evaluate a nomogram prediction model for recurrence of acute ischemic stroke (AIS) within one year.
OBJECTIVE
To develop and evaluate a nomogram prediction model for recurrence of acute ischemic stroke (AIS) within one year.
METHOD
Patients with AIS treated at the second affiliated hospital of Xuzhou Medical University from August 2017 to July 2019 were enrolled. Clinical data such as demographic data, risk factors, laboratory tests, TOAST etiological types, MRI features, and treatment methods were collected. Cox regression analysis was done to determine the parameters for entering the nomogram model. The performance of the model was estimated by receiver operating characteristic curves, decision curve analysis, calibration curves, and C-index.
RESULT
A total of 645 patients were enrolled in this study. Side of hemisphere (SOH, Bilateral, HR = 0.35, 95 % CI = 0.15-0.84, p = 0.018), homocysteine (HCY, HR = 1.38, 95 % CI = 1.29-1.47, p < 0.001), c-reactive protein (CRP, HR = 1.04, 95 % CI = 1.01-1.07, p = 0.013) and stroke severity (SS, HR = 3.66, 95 % CI = 2.04-6.57, p < 0.001) were independent risk factors. The C-index of the nomogram model was 0.872 (se = 0.016). The area under the receiver operating characteristic (ROC)curve at one-year recurrence was 0.900. Calibration curve, decision curve analysis showed good performance of the nomogram. The cutoff value for low or high risk of recurrence score was 1.73.
CONCLUSION
The nomogram model for stroke recurrence within one year developed in this study performed well. This useful tool can be used in clinical practice to provide important guidance to healthcare professionals.
PubMed: 38882377
DOI: 10.1016/j.heliyon.2024.e32176 -
Journal of Clinical Anesthesia Jun 2024Spinal anesthesia often causes hypotension, with consequent risk to the fetus. The use of vasopressor agents has been highly recommended for the prevention of spinal...
Norepinephrine or phenylephrine for the prevention of post-spinal hypotension after caesarean section: A double-blinded, randomized, controlled study of fetal heart rate and fetal cardiac output.
STUDY OBJECTIVE
Spinal anesthesia often causes hypotension, with consequent risk to the fetus. The use of vasopressor agents has been highly recommended for the prevention of spinal anesthesia-induced hypotension during caesarean delivery. Many studies have shown that norepinephrine can provide more stable maternal hemodynamics than phenylephrine. We therefore tested the hypothesis that norepinephrine preserves fetal circulation better than phenylephrine when used to treat maternal hypotension consequent to spinal anesthesia.
DESIGN
Prospective, randomized, double-blinded study.
SETTING
Operating room.
PATIENTS
We recruited 223 parturients with uncomplicated singleton pregnancies who were scheduled for elective caesarean section under combined spinal-epidural anesthesia.
INTERVENTIONS
The patients received prophylactic intravenous infusion of either 0.08 μg/kg/min norepinephrine or 0.5 μg/kg/min phenylephrine for prevention of spinal anesthesia-induced hypotension.
MEASUREMENTS
Changes in fetal heart rate and fetal cardiac output before and after spinal anesthesia were measured using noninvasive Doppler ultrasound.
MAIN RESULTS
90 subjects who received norepinephrine infusion and 93 subjects who received phenylephrine infusion were ultimately analyzed in the present study. The effects of norepinephrine and phenylephrine on the change of fetal heart rate and fetal cardiac output at 3 and 6 min after spinal block were similar. Although there was a statistically significant decrease in fetal cardiac output at 6 min after subarachnoid block initiation in both the norepinephrine group (mean difference 0.02 L/min; 95% CI, 0-0.04 L/min; P = 0.03) and the phenylephrine group (mean difference 0.02 L/min; 95% CI, 0-0.04 L/min; P = 0.02), it remained within the normal range.
CONCLUSIONS
Prophylactic infusion of comparable doses of phenylephrine or norepinephrine has similar effects on fetal heart rate and cardiac output changes after spinal anesthesia. Neither phenylephrine nor norepinephrine has meaningful detrimental effects on fetal circulation or neonatal outcomes.
PubMed: 38880002
DOI: 10.1016/j.jclinane.2024.111533 -
BMC Public Health Jun 2024Sleep disturbance is the most common concern of patients with schizophrenia and can lead to a poor prognosis, a low survival rate and aggressive behaviour, posing a...
OBJECTIVE
Sleep disturbance is the most common concern of patients with schizophrenia and can lead to a poor prognosis, a low survival rate and aggressive behaviour, posing a significant threat to social security and stability. The aim of this study was to explore the mediating role of depression in the relationship between sleep disturbance and aggressive behaviour in people with schizophrenia living in the community, as well as the regulatory role of family intimacy and adaptability. These findings, in turn, may provide a theoretical basis and constructive suggestions for addressing the physical and mental health problems of these patients.
METHOD
From September 2020 to August 2021, a convenience sampling method was used to select schizophrenia patients from the community attending follow-up appointments at the Fourth People's Hospital of Pengzhou City, China. The researchers conducted a survey in the form of a star questionnaire. The survey included questions about general demographic data and disease-related questionnaires: the Pittsburgh Sleep Quality Index (PSQI), the revised Chinese version of the Modified Over Aggression Scale (MOAS), the Self-Rating Depression Scale (SDS), and the Family Adaptability and Cohesion Scale, Second Edition. FACES-II and SPSS 21.0 were used to organize and analyse the data.
RESULTS
A total of 818 schizophrenia patients living in the community participated in the survey, and 785 valid questionnaires were ultimately collected, for a response rate of 95.97%. The results of multivariate analysis indicated that sex, number of psychiatric medications used, outpatient follow-up, history of hospitalization for mental disorders and sleep disturbances were factors influencing aggressive behaviour. Depression played a partial mediating role between sleep disturbance and aggressive behaviour, and the indirect effect size was 0.043 (57.33% of the total). In addition to sleep disturbance, family intimacy (β=-0.009, P < 0.01) and adaptability (β=-0.145, P < 0.001) can significantly predict depression.
CONCLUSION
The findings indicate that sleep disturbance in schizophrenia patients in the community is a risk factor for aggressive behaviour, and depression plays a partial mediating role in the relationship among sleep disturbance, aggressive behaviour and family intimacy. In addition, adaptability plays a regulatory role in the relationship between depression and sleep disturbance.
Topics: Humans; Female; Male; Aggression; Schizophrenia; Sleep Wake Disorders; Adult; China; Middle Aged; Independent Living; Surveys and Questionnaires; Depression; Young Adult; Schizophrenic Psychology
PubMed: 38879495
DOI: 10.1186/s12889-024-19090-9 -
International Journal of Surgery Case... Jul 2024Craniocerebral wounds are potentially serious and life-threatening injuries. These are real medical and surgical emergencies. The authors report a case of craniocerebral...
INTRODUCTION AND IMPORTANCE
Craniocerebral wounds are potentially serious and life-threatening injuries. These are real medical and surgical emergencies. The authors report a case of craniocerebral injury in a child with extensive craniotomy and its management in a hospital with limited resources in Togo.
CASE REPORT
He was a young 11-year-old schoolboy who presented with an extensive craniocerebral injury with craniotomy after a road traffic accident. On admission, he had no focal neurological deficits or other signs related to an intracranial expansive process. After preoperative reanimation, antibiotic therapy and anti-tetanus serovaccination, he was taken to the operating room by general surgeons. He underwent lavage, suture of the dura mater, placement of the bone flap and suture of the scalp wound. The postoperative course was simple.
CLINICAL DISCUSSION
Cranioencephalic trauma is one of the main causes of pediatric mortality in developing countries. Cranio-cerebral wounds are a therapeutic emergency because of the risk of infection, which remains the main concern. Treatment consists of a medical component followed by a surgical component. Reanimation remains an essential component of medical treatment.
CONCLUSION
Craniocerebral wounds are serious injuries. It requires rapid and appropriate medical and surgical management to avoid complications, particularly infection.
PubMed: 38878734
DOI: 10.1016/j.ijscr.2024.109883 -
BMC Women's Health Jun 2024Breast cancer patients undergoing chemotherapy via peripherally inserted central catheter often experience serious behavioral and psychological challenges, with...
Uncertainty affects cancer-related fatigue among breast cancer women undergoing peripherally inserted central catheter chemotherapy: the chain mediating role of psychological resilience and self-care.
BACKGROUND
Breast cancer patients undergoing chemotherapy via peripherally inserted central catheter often experience serious behavioral and psychological challenges, with uncertainty and cancer-related fatigue being prevalent issues that profoundly impact prognosis. Therefore, this study aimed to investigate the relationship between uncertainty and cancer-related fatigue by employing a chain mediation model to examine the potential mediating roles of psychological resilience and self-care.
METHODS
A cross-sectional study was conducted with 223 breast cancer patients receiving peripherally inserted central catheter chemotherapy at two tertiary affiliated hospitals of China Medical University in Liaoning, China, from February 2021 to December 2022. Participants completed self-reported questionnaires to assess uncertainty, psychological resilience, self-care, and cancer-related fatigue. The collected data were subsequently analyzed using Pearson's correlation analysis, hierarchical regression analysis, and mediation analysis.
RESULTS
Uncertainty exhibited a significant positive correlation with cancer-related fatigue (p < 0.01) and a negative correlation with psychological resilience (p < 0.01) and self-care (p < 0.01). Uncertainty was found to impact cancer-related fatigue through three pathways: psychological resilience mediated the relationship between uncertainty and cancer-related fatigue (mediating effect = 0.240, 95% confidence interval: 0.188 to 0.298, effect ratio = 53.22%); self-care also mediated this relationship (mediating effect = 0.080, 95% confidence interval: 0.044 to 0.121, effect ratio = 17.74%); furthermore, there was a significant joint mediating effect of psychological resilience and self-care on the association between uncertainty and cancer-related fatigue (mediating effect = 0.042, 95% confidence interval: 0.021 to 0.068, effect ratio o = 9.31%).
CONCLUSION
The findings of this study revealed that uncertainty not only directly influenced cancer-related fatigue, but also operated through the mediating effect of psychological resilience, self-care, and sequential mediation of psychological resilience and self-care. Interventions tailored for breast cancer patients receiving peripherally inserted central catheter chemotherapy should target these factors to help alleviate uncertainty, enhance psychological resilience, and improve self-care practices, thereby ameliorating cancer-related fatigue.
Topics: Humans; Female; Breast Neoplasms; Fatigue; Uncertainty; Resilience, Psychological; Middle Aged; Self Care; Cross-Sectional Studies; Adult; China; Surveys and Questionnaires; Catheterization, Peripheral; Aged; Antineoplastic Agents
PubMed: 38877474
DOI: 10.1186/s12905-024-03187-9 -
Scientific Reports Jun 2024Indoor inspection robots operating in occupied buildings need to minimize disturbance to occupants and access high areas of a room and cramped spaces obstructed by...
Indoor inspection robots operating in occupied buildings need to minimize disturbance to occupants and access high areas of a room and cramped spaces obstructed by obstacles for higher inspection coverage. However, existing indoor inspection robots are still unable to meet these requirements. This paper aims to explore the feasibility of applying wall-climbing robots to address these requirements. To this end, we propose a small-sized wall-climbing robot prototype that can move on common indoor surfaces. We extend the proposed prototype to support thermographic inspection by integrating thermal imaging technology into it. Experiment results show that the proposed robot prototype can reach more wall and floor areas for inspection than previously developed indoor inspection robots. It has also been demonstrated that the reduced size and the wall-climbing ability allow the robot to largely avoid human activity areas, thereby reducing disturbance to occupants. This study represents the first attempt to introduce wall-climbing robots into the indoor inspection domain and provides the initial validation of their advantages over existing indoor inspection robots regarding improving inspection coverage and minimizing disturbance to occupants. The findings in this study can provide valuable insights for the future design, selection and application of robotic systems for indoor inspection tasks.
PubMed: 38877208
DOI: 10.1038/s41598-024-64642-z -
Cognitive aid and performance for simulated umbilical venous catheter placement: A randomized trial.Archives de Pediatrie : Organe Officiel... Jul 2024Neonatal resuscitation may require urgent umbilical venous catheter (UVC) placement. Complications can be observed with umbilical venous catheterization, especially in a... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Neonatal resuscitation may require urgent umbilical venous catheter (UVC) placement. Complications can be observed with umbilical venous catheterization, especially in a stressful context. Inspired by the aeronautic environment, medical routine checklists, also called "cognitive aids," secure the equipment and environment for the patients once they are admitted to the operating room. We hypothesized that reading a cognitive aid for UVC placement in the delivery room during neonatal resuscitation simulation scenarios can (a) improve the performance in reducing catheterization duration and (b) can limit complications.
METHODS
This was a prospective single-center randomized study. A total of 23 dyads for a simulation scenario were included: 12 in the control group and 11 in the cognitive aid group. In the cognitive aid group, the cognitive aid was read by the same facilitator for every scenario.
RESULTS
No significant difference concerning the duration of the procedure was identified between the cognitive aid and control groups: 412 s [342; 420] vs. 374 s [338;402], respectively (p = 0.781). Nevertheless, there were significantly fewer deviations from hygiene guidelines and improved prevention of air embolism in the cognitive aid group compared with the control group.
CONCLUSION
The UVC insertion time was similar between the control and cognitive aid groups. Moreover, cognitive aid can limit infectious complications or air embolism by allowing caregivers to follow UVC placement standards.
Topics: Humans; Prospective Studies; Umbilical Veins; Infant, Newborn; Female; Male; Catheterization, Peripheral; Simulation Training; Resuscitation; Adult; Checklist
PubMed: 38876930
DOI: 10.1016/j.arcped.2024.03.001 -
JMIR AI Sep 2023Accurate projections of procedural case durations are complex but critical to the planning of perioperative staffing, operating room resources, and patient...
BACKGROUND
Accurate projections of procedural case durations are complex but critical to the planning of perioperative staffing, operating room resources, and patient communication. Nonlinear prediction models using machine learning methods may provide opportunities for hospitals to improve upon current estimates of procedure duration.
OBJECTIVE
The aim of this study was to determine whether a machine learning algorithm scalable across multiple centers could make estimations of case duration within a tolerance limit because there are substantial resources required for operating room functioning that relate to case duration.
METHODS
Deep learning, gradient boosting, and ensemble machine learning models were generated using perioperative data available at 3 distinct time points: the time of scheduling, the time of patient arrival to the operating or procedure room (primary model), and the time of surgical incision or procedure start. The primary outcome was procedure duration, defined by the time between the arrival and the departure of the patient from the procedure room. Model performance was assessed by mean absolute error (MAE), the proportion of predictions falling within 20% of the actual duration, and other standard metrics. Performance was compared with a baseline method of historical means within a linear regression model. Model features driving predictions were assessed using Shapley additive explanations values and permutation feature importance.
RESULTS
A total of 1,177,893 procedures from 13 academic and private hospitals between 2016 and 2019 were used. Across all procedures, the median procedure duration was 94 (IQR 50-167) minutes. In estimating the procedure duration, the gradient boosting machine was the best-performing model, demonstrating an MAE of 34 (SD 47) minutes, with 46% of the predictions falling within 20% of the actual duration in the test data set. This represented a statistically and clinically significant improvement in predictions compared with a baseline linear regression model (MAE 43 min; P<.001; 39% of the predictions falling within 20% of the actual duration). The most important features in model training were historical procedure duration by surgeon, the word "free" within the procedure text, and the time of day.
CONCLUSIONS
Nonlinear models using machine learning techniques may be used to generate high-performing, automatable, explainable, and scalable prediction models for procedure duration.
PubMed: 38875567
DOI: 10.2196/44909 -
Medicine Jun 2024Ultrasound (US) can guide and confirm percutaneous release of the achilles tendon in the clubfoot. However, this technique may not always be available; therefore,... (Observational Study)
Observational Study
Reproducibility of pop sensation, Thompson sign in achillotomy, and final Pirani score to predict clubfoot relapse: Achillotomy clinical signs and Pirani predictive ability.
Ultrasound (US) can guide and confirm percutaneous release of the achilles tendon in the clubfoot. However, this technique may not always be available; therefore, surgeons' reported feelings of tendon release ("click" or "pop") and the Thompson sign could demonstrate that they are sensitive and reliable for confirming complete tendon release. The purpose of this study was to compare the reproducibility of clinical maneuvers that aim to detect the reported "click" or "pop" sensation by the surgeon and the Thompson sign after surgical release in percutaneous achilles tenotomy compare with US in patients with clubfoot. A cross-sectional reproducibility study of consecutive patients with idiopathic clubfoot was conducted. All the patients were scheduled to undergo tenotomy in the operating room using the standard percutaneous achilles tenotomy technique under sedation. The surgeon's reported surgical sensation ("click" or "pop") and Thompson signs were compared to the US assessment of the cut. The final Pirani score was used to predict recurrence risk and was correlated with the number of plaster casts and age. Forty-five feet were affected in 30 patients. Eighteen (60%) men. Age range: 1 to 60 months. The sensation of "click" or "pop" was recorded in 38 patients, and complete release was confirmed by US in 37 patients, for a sensitivity (Se) of 0.95 and specificity (Sp) of 0.63. Thompson signs were positive in 33 and 36 patients at 2 evaluations, with Se values of 0.87 and 0.92 and Sp values of 0.88 and 0.75, respectively. The Pirani final score, a predictor of recurrence risk, had an area under the curve of 0.80 (95% CI = 0.63-0.97; P = .005), Se = 0.78, and Sp = 0.56, with a cutoff point of 2.75. The feeling of achilles tendon release and Thompson sign had high sensitivity, prevalence, accuracy, and posttest probability. The confirmation of tendon release based on clinical signs could prevent the use of US.
Topics: Humans; Clubfoot; Male; Female; Recurrence; Achilles Tendon; Cross-Sectional Studies; Infant; Tenotomy; Reproducibility of Results; Child, Preschool; Ultrasonography; Predictive Value of Tests
PubMed: 38875390
DOI: 10.1097/MD.0000000000038377