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BMC Medical Education Jun 2024Clinical teaching during encounters with real patients lies at the heart of medical education. Mixed reality (MR) using a Microsoft HoloLens 2 (HL2) offers the potential... (Observational Study)
Observational Study
BACKGROUND
Clinical teaching during encounters with real patients lies at the heart of medical education. Mixed reality (MR) using a Microsoft HoloLens 2 (HL2) offers the potential to address several challenges: including enabling remote learning; decreasing infection control risks; facilitating greater access to medical specialties; and enhancing learning by vertical integration of basic principles to clinical application. We aimed to assess the feasibility and usability of MR using the HL2 for teaching in a busy, tertiary referral university hospital.
METHODS
This prospective observational study examined the use of the HL2 to facilitate a live two-way broadcast of a clinician-patient encounter, to remotely situated third and fourth year medical students. System Usability Scale (SUS) Scores were elicited from participating medical students, clinician, and technician. Feedback was also elicited from participating patients. A modified Evaluation of Technology-Enhanced Learning Materials: Learner Perceptions Questionnaire (mETELM) was completed by medical students and patients.
RESULTS
This was a mixed methods prospective, observational study, undertaken in the Day of Surgery Assessment Unit. Forty-seven medical students participated. The mean SUS score for medical students was 71.4 (SD 15.4), clinician (SUS = 75) and technician (SUS = 70) indicating good usability. The mETELM Questionnaire using a 7-point Likert Scale demonstrated MR was perceived to be more beneficial than a PowerPoint presentation (Median = 7, Range 6-7). Opinion amongst the student cohort was divided as to whether the MR tutorial was as beneficial for learning as a live patient encounter would have been (Median = 5, Range 3-6). Students were positive about the prospect of incorporating of MR in future tutorials (Median = 7, Range 5-7). The patients' mETELM results indicate the HL2 did not affect communication with the clinician (Median = 7, Range 7-7). The MR tutorial was preferred to a format based on small group teaching at the bedside (Median = 6, Range 4-7).
CONCLUSIONS
Our study findings indicate that MR teaching using the HL2 demonstrates good usability characteristics for providing education to medical students at least in a clinical setting and under conditions similar to those of our study. Also, it is feasible to deliver to remotely located students, although certain practical constraints apply including Wi-Fi and audio quality.
Topics: Humans; Feasibility Studies; Prospective Studies; Students, Medical; Female; Male; Self Report; Education, Medical, Undergraduate; Adult; Young Adult; Augmented Reality; Education, Distance; Surveys and Questionnaires
PubMed: 38937764
DOI: 10.1186/s12909-024-05591-z -
BMC Geriatrics Jun 2024No study has compared 30-day and 90-day adverse postoperative outcomes between old-age patients with and those without sarcopenia.
PURPOSE
No study has compared 30-day and 90-day adverse postoperative outcomes between old-age patients with and those without sarcopenia.
PATIENTS AND METHODS
We categorize elderly patients receiving major surgery into two groups according to the presence or absence of preoperative sarcopenia that were matched at a 1:4 ratio through propensity score matching (PSM). We analyzed 30-day or 90-day adverse postoperative outcomes and mortality in patients with and without sarcopenia receiving major surgery.
RESULTS
Multivariate logistic regression analyses revealed that the patients with preoperative sarcopenia were at significantly higher risk of 30-day postoperative mortality (adjusted odds ratio [aOR]. = 1.25; 95% confidence interval [CI]. = 1.03-1.52) and 30-day major complications such as postoperative pneumonia (aOR = 1.15; 95% CI = 1.00-1.40), postoperative bleeding (aOR = 2.18; 95% CI = 1.04-4.57), septicemia (aOR = 1.31; 95% CI = 1.03-1.66), and overall complications (aOR = 1.13; 95% CI = 1.00-1.46). In addition, surgical patients with sarcopenia were at significantly higher risk of 90-day postoperative mortality (aOR = 1.50; 95% CI = 1.29-1.74) and 90-day major complications such as pneumonia (aOR = 1.27; 95% CI = 1.10-1.47), postoperative bleeding (aOR = 1.90; 95% CI = 1.04-3.48), septicemia (aOR = 1.52; 95% CI = 1.28-1.82), and overall complications (aOR = 1.24; 95% CI = 1.08-1.42).
CONCLUSIONS
Sarcopenia is an independent risk factor for 30-day and 90-day adverse postoperative outcomes such as pneumonia, postoperative bleeding, and septicemia and increases 30-day and 90-day postoperative mortality among patients receiving major surgery. No study has compared 30-day and 90-day adverse postoperative outcomes between patients with and those without sarcopenia. We conducted a propensity score?matched (PSM) population-based cohort study to investigate the adverse postoperative outcomes and mortality in patients undergoing major elective surgery with preoperative sarcopenia versus those without preoperative sarcopenia. We demonstrated that sarcopenia is an independent risk factor for 30-day and 90-day adverse postoperative outcomes, such as postoperative pneumonia, bleeding, septicemia, and mortality after major surgery. Therefore, surgeons and anesthesiologists should attempt to correct preoperative sarcopenia, swallowing function, and respiratory muscle training before elective surgery to reduce postoperative complications that contribute to the decrease in surgical mortality.
Topics: Humans; Sarcopenia; Male; Aged; Female; Postoperative Complications; Aged, 80 and over; Propensity Score; Retrospective Studies; Risk Factors
PubMed: 38937671
DOI: 10.1186/s12877-024-05066-2 -
Journal of Perianesthesia Nursing :... Jun 2024To summarize the evidence on perioperative nausea and vomiting management in adult patients worldwide. (Review)
Review
PURPOSE
To summarize the evidence on perioperative nausea and vomiting management in adult patients worldwide.
DESIGN
This is a summary of the best evidence on postoperative nausea and vomiting in adults.
METHODS
Databases such as British Medical Journal Best Practice, Cochrane Library, Joanna Briggs Institute, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, National Guideline Clearing House, Guidelines International Network, American Society of Anesthesiologists (ASA), Association of periOperative Registered Nurses (AORN), Registered Nurses Association of Ontario, PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Yimaitong Clinical Guidelines, China Anesthesia Official website, SinoMed, China National Knowledge Infrastructure, Wanfang, and VIP were searched to collect the relevant guidelines for clinical decision-making, best practices, systematic review, evidence summary, and expert consensus about perioperative nausea and vomiting management. The retrieval time was from the establishment of the database to January 2022. Two authors independently evaluated the quality of the included literature and extracted and summarized the evidence that met the quality criteria.
FINDINGS
A total of 22 studies, including 1 best practice, 2 clinical decision-making articles, 7 evidence summaries, 1 clinical guideline, 9 systematic reviews, and 2 expert consensuses, were included. The summary of 37 pieces of evidence from 7 aspects: risk factors, assessment methods, multimodal prevention strategy, health education, nondrug intervention, drug prevention, postoperative analgesia management strategy, and organization management.
CONCLUSIONS
The health care team should select the best evidence according to the characteristics of the department and clinical practice, scientifically manage perioperative nausea and vomiting of patients, reduce the incidence and severity of nausea and vomiting, and promote the accelerated rehabilitation of patients.
PubMed: 38935008
DOI: 10.1016/j.jopan.2024.01.027 -
Turk Gogus Kalp Damar Cerrahisi Dergisi Apr 2024This second harvest of the Congenital Heart Surgery Database intended to compare current results with international databases.
BACKGROUND
This second harvest of the Congenital Heart Surgery Database intended to compare current results with international databases.
METHODS
This retrospective study examined a total of 4007 congenital heart surgery procedures from 15 centers in the Congenital Heart Surgery Database between January 2018 and January 2023. International diagnostic and procedural codes were used for data entry. STAT (Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery) mortality scores and categories were used for comparison of the data. Surgical priority status was modified from American Society of Anesthesiologist guidelines. Centers that sent more than 5 cases to the database were included to the study.
RESULTS
Cardiopulmonary bypass and cardioplegic arrest were performed in 2,983 (74.4%) procedures. General risk factors were present in 22.6% of the patients, such as genetic anomaly, syndrome, or prematurity. Overall, 18.9% of the patients had preoperative risk factors (e.g., mechanical ventilation, renal failure, and sepsis). Of the procedures, 610 (15.2%) were performed on neonates, 1,450 (36.2%) on infants, 1,803 (45%) on children, and 144 (3.6%) on adults. The operative timing was elective in 56.5% of the patients, 34.4% were urgent, 8% were emergent, and 1.1% were rescue procedures. Extracorporeal membrane oxygenation support was used in 163 (4%) patients, with a 34.3% survival rate. Overall mortality in this series was 6.7% (n=271). Risk for mortality was higher in patients with general risk factors, such as prematurity, low birth weight neonates, and heterotaxy syndrome. Mortality for patients with preoperative mechanical ventilation was 17.5%. Pulmonary hypertension and preoperative circulatory shock had 11.6% and 10% mortality rates, respectively. Mortality for patients who had no preoperative risk factor was 3.9%. Neonates had the highest mortality rate (20.5%). Intensive care unit and hospital stay time for neonates (median of 17.8 days and 24.8 days, respectively) were also higher than the other age groups. Infants had 6.2% mortality. Hospital mortality was 2.8% for children and 3.5% for adults. Mortality rate was 2.8% for elective cases. Observed mortality rates were higher than expected in the fourth and fifth categories of the STAT system (observed, 14.8% and 51.9%; expected, 9.9% and 23.1%; respectively).
CONCLUSION
For the first time, outcomes of congenital heart surgery in Türkiye could be compared to the current world experience with this multicenter database study. Increased mortality rate of neonatal and complex heart operations could be delineated as areas that need improvement. The Congenital Heart Surgery Database has great potential for quality improvement of congenital heart surgery in Türkiye. In the long term, participation of more centers in the database may allow more accurate risk adjustment.
PubMed: 38933312
DOI: 10.5606/tgkdc.dergisi.2024.25758 -
Acta Anaesthesiologica Scandinavica Jun 2024Cocaine may be applied to decongest the nasal mucosa before nasotracheal intubation, but patients risk a criminal offence if cocaine is detected when patients drive a...
BACKGROUND
Cocaine may be applied to decongest the nasal mucosa before nasotracheal intubation, but patients risk a criminal offence if cocaine is detected when patients drive a car shortly after surgery. We aimed to evaluate whether benzoylecgonine levels in saliva exceeded the cut-off point 24 h after administration in patients undergoing nasotracheal intubation and whether cocaine would be detectable above the Danish legal fixed limit in blood samples 1 and 24 h after surgery.
METHODS
We conducted a prospective study following approval from the local research ethics committee and the national medicine agency. Written informed consent was obtained from all patients. We included patients scheduled for surgery under general anaesthesia with nasotracheal intubation. They received 80 mg cocaine as a nasal spray 5 min before induction and nasotracheal intubation. The primary outcome was a dichotomous assessment of benzoylecgonine levels in saliva samples measured 24 h after administration of nasal cocaine with a cut-off limit of 200 ng/mL. Secondary outcomes were dichotomous assessments of cocaine in whole blood samples measured 1 and 24 h after administration of nasal cocaine with a cut-off limit of 0.01 mg/kg.
RESULTS
Overall, 70 patients had valid saliva samples and 75 had valid blood samples 24 h after cocaine administration. Benzoylecgonine in saliva was traceable above the cut-off in 9/70 patients (13%; CI: 6% to 23%), and cocaine in blood was detected above the cut-off in 2/75 patients (3%; CI: 0.3% to 9%).
CONCLUSION
We found benzoylecgonine traceable in saliva in 13% of patients and cocaine traceable in blood in 3% of patients 24 h after administration of 80 mg nasal cocaine. Patients should be informed when receiving cocaine and advised not to drive for at least 24 h.
PubMed: 38932490
DOI: 10.1111/aas.14475 -
Antibiotics (Basel, Switzerland) May 2024Interactions between drugs are a common problem in Intensive Care Unit patients, as they mainly have a critical condition that often demands the administration of... (Review)
Review
Interactions between drugs are a common problem in Intensive Care Unit patients, as they mainly have a critical condition that often demands the administration of multiple drugs simultaneously. Antibiotics are among the most frequently used medications, as infectious diseases are often observed in ICU patients. In this review, the most important antibiotic-drug interactions, based on the pharmacokinetic and pharmacodynamic mechanisms, were gathered together and described. In particular, some of the most important interactions with main groups of antibacterial drugs were observed in patients simultaneously prescribed oral anticoagulants, NSAIDs, loop diuretics, and valproic acid. As a result, the activity of drugs can be increased or decreased, as dosage modification might be necessary. It should be noted that these crucial interactions can help predict and avoid negative consequences, leading to better patient recovery. Moreover, since there are other factors, such as fluid therapy or albumins, which may also modify the effectiveness of antibacterial therapy, it is important for anaesthesiologists to be aware of them.
PubMed: 38927170
DOI: 10.3390/antibiotics13060503 -
The Tohoku Journal of Experimental... Jun 2024
PubMed: 38925951
DOI: 10.1620/tjem.2024.J051 -
Injury Jun 2024An emergent front of neck airway (FONA) is needed when a 'can't intubate, can't oxygenate' crisis occurs. A FONA may also in specific cases be the primary choice of...
INTRODUCTION
An emergent front of neck airway (FONA) is needed when a 'can't intubate, can't oxygenate' crisis occurs. A FONA may also in specific cases be the primary choice of airway management. Two techniques exist for FONA, with literature favouring the surgical technique over the percutaneous. The reported need for a prehospital FONA is fortunately rare as the mortality has been shown to be high. Due to the low incidence, literature on FONA is limited with regards to different settings, techniques and operators. As a foundation for future research and improvement of patient care, we aim to describe the frequency, indications, technique, success, and outcomes of FONA in the Finnish helicopter emergency medical services (HEMS).
MATERIALS AND METHODS
This retrospective descriptive study reviews FONA performed at the Finnish HEMS during 1.1.2012 to 8.9.2019. The Finnish HEMS consists of six units, staffed mainly by anaesthesiologists. Clinical data was gathered from a national HEMS database and trough chart reviews. Data on mortality was obtained from a population registry. Only descriptive statistics were performed.
RESULTS
A total of 22 FONA were performed during the study period, 7 were primary and 14 performed after failure to intubate (missing data regarding indication for one attempt). This equals a 0.13 % (14/10,813) need for a rescue FONA and a rate of 0.20 % (22/10,813) FONA out of all advanced airway management. All but one FONA was performed using a surgical approach (20/21, 95 %, missing data = 1) and all were successful (22/22, 100 %). Indications were mainly cardiac arrest (10/22, 45 %) and trauma (6/22, 27 %), and the most common reason for a need for a secondary FONA was obstruction of airway by food or fluids (7/14, 50 %). On-scene mortality was 36 % (8/22) and 30-day mortality 90 % (19/21, missing data = 1).
CONCLUSION
The need for FONA is scarce in a HEMS system with experienced airway providers. Even though the procedure is successfully performed, the mortality is markedly high.
PubMed: 38924838
DOI: 10.1016/j.injury.2024.111689 -
Diseases of the Colon and Rectum Jun 2024The double-stapled technique is the most common method of colorectal anastomosis in minimally invasive surgery. Several modifications to the conventional technique have...
BACKGROUND
The double-stapled technique is the most common method of colorectal anastomosis in minimally invasive surgery. Several modifications to the conventional technique have been described aiming to reduce the intersection between the stapled lines, as the resulting lateral dog-ears are considered as possible risk factors for anastomotic leakage.
OBJECTIVE
The purpose of this study was to analyze the outcomes of patients receiving conventional versus modified stapled colorectal anastomosis following minimally invasive surgery.
DATA SOURCES
A systematic review was undertaken of the published literature. PubMed/MEDLINE, Web of Science, and EMBASE databases were screened up to July 2023.
STUDY SELECTION
Relevant articles were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles reporting on the outcomes of patients with modified stapled colorectal reconstruction as compared to the conventional method of double-stapled anastomosis were included.
INTERVENTIONS
Conventional double-stapling colorectal anastomosis and modified techniques with reduced intersection between the stapled lines were compared.
MAIN OUTCOME MEASURES
The rate of anastomotic leak was the primary endpoint of interest. Perioperative details including postoperative morbidity were also appraised.
RESULTS
There were 2537 patients from 12 studies included for data extraction, with no significant differences on age, body mass index and proportion of high American Society of Anesthesiologists Score between patients who had conventional versus modified techniques of reconstructions. The risk of anastomotic leak was 62% lower for the modified procedure compared to the conventional procedure (odds ratio = 0.38 [95% CI: 0.26, 0.56]. The incidences of overall postoperative morbidity (odds ratio = 0.57 [95% CI: 0.45, 0.73] and major morbidity (odds ratio = 0.48 [95% CI: 0.32, 0.72] following were significantly lower than following conventional double-stapled anastomosis.
LIMITATIONS
The retrospective nature of most included studies is a main limitation, essentially due to the lack of randomization, and the risk of selection and detection bias.
CONCLUSIONS
The available evidence supports the modification of the conventional double-stapled technique with elimination of one of both dog-ears as it is associated with lower incidence of anastomotic-related morbidity.
PubMed: 38924002
DOI: 10.1097/DCR.0000000000003382 -
Japanese Journal of Radiology Jun 2024To evaluate the safety of propofol sedation administered by interventional radiologists during radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC).
PURPOSE
To evaluate the safety of propofol sedation administered by interventional radiologists during radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC).
MATERIALS AND METHODS
Propofol sedation was administered by interventional radiologists in 72 patients (85 procedures, 93 tumors) during RFA for HCC between August 2018 and December 2020. Interventional radiologists equipped with adequate knowledge and skills in sedation and respiratory management were responsible for sedation. Sedation was carefully assessed based on vital signs, including end-tidal carbon dioxide, consciousness status, and bispectral index. The primary endpoint was the incidence of sedation-related complications, which were evaluated separately as respiratory and cardiovascular complications. Secondary endpoints were technical success rate, ablation-related complications, and local tumor control rate. Technical success was defined as completion of ablation in the planned area. Complications were evaluated using the Clavien-Dindo classification. Sedation-related complications, technical success rate, and ablation-related complications were evaluated on a procedure basis, and local tumor control was evaluated on a tumor basis.
RESULTS
Respiratory and cardiovascular complications were observed in eight (8/85, 9.4%) and two (2/85, 2.4%) patients, respectively. Four patients required the jaw thrust maneuver due to glossoptosis, whereas a decrease in oxygen saturation to < 90% was recorded in the other four patients. However, these were temporary, and none required manual ventilation or endotracheal intubation. Bradycardia (< 50 bpm) was detected in two patients; one recovered immediately without treatment, whereas the other rapidly improved after atropine sulfate administration. No severe hypotension (< 80 mmHg) was observed. The technical success rate was 100% (85/85). Grade 3 ablation-related complications were identified in three patients (3/85, 3.5%). The local tumor control rate was 95.7% (89/93).
CONCLUSION
Propofol sedation can be safely administered by interventional radiologists during RFA for HCC. Although it requires special safety considerations, it may be a sedation option during hepatic RFA.
PubMed: 38922567
DOI: 10.1007/s11604-024-01615-2