Guidelines For Care Of Patients Research Articles

Perspectives on drug development for the treatment of chronic myeloid leukemia in pregnant patients and patients who are breastfeeding.

Tyrosine kinase inhibitors (TKI) have improved the outcome and life expectancy of patients with chronic myeloid leukemia (CML). Patients are diagnosed with CML at younger ages, and patients treated for CML may become pregnant or choose to breastfeed. The information available to date on the safety of TKIs during pregnancy and lactation and the optimal management of these patients is largely anecdotal, based on personal or small-group experience, and heterogeneous. A panel of interested parties was convened by US Food and Drug Administration (FDA) to analyze the current data and discuss possible solutions. Possible solutions include prospective data collection, in clinical trials and in routine clinical practice, a more uniform and specific data collection, and greater coordination among involved entities. Since patients with cancer are living longer, frequently receiving therapies for extended periods of time (or for life), data on appropriate management of patients through different reproductive phases of life are needed. It is thus time to change our approach for how to study treatment of cancer (including CML) during pregnancy or breastfeeding to develop evidence-based guidelines for safe and effective patient care.

Evidence-Based Update on Transcatheter Therapies for Pulmonary Embolism.

Pulmonary embolism (PE) remains a leading cause of cardiovascular morbidity and mortality. Multiple new therapies are in development and under study to improve our contemporary care of patients with PE. We review and compare here these novel therapeutics and technologies. Multiple novel therapeutic devices have been developed and are under active study. This work has advanced the care of patients with intermediate and high-risk PE. Novel therapies are improving care of complex PE patients. These have inspired large multicenter international randomized controlled trials that are actively recruiting patients to advance the care of PE. These studies will work towards advancing guidelines for clinical care of patients with PE.

Whispers of Consciousness: The Interplay of Surgery, Internal Medicine, and Anesthesia

Introduction: The interplay between surgery, internal medicine, and anesthesia is fundamental to the comprehensive care of patients, particularly in complex clinical scenarios. Understanding the dynamics of these interactions is crucial for improving patient outcomes and advancing healthcare practices. Objective: To review the existing literature on the collaboration between surgery, internal medicine, and anesthesia, identifying key areas of synergy, challenges, technological impacts, and future directions for research and practice. Methods: An extensive literature search was conducted across multiple databases, including PubMed and Google Scholar, using a combination of keywords related to surgery, internal medicine, anesthesia, patient care, and interdisciplinary collaboration. 22 relevant articles were selected based on predefined inclusion and exclusion criteria, with a focus on those that explored the integration and outcomes of these medical disciplines. Data were synthesized through thematic analysis. Results: The review highlights the significance of interdisciplinary collaboration in optimizing patient care, the role of technological advancements in bridging gaps between disciplines, and the ethical and patient-centered considerations that underpin successful integration. Education and training emerge as critical components for fostering effective collaboration. Conclusions: Effective interdisciplinary collaboration between surgery, internal medicine, and anesthesia is pivotal for enhancing patient outcomes. Future research should focus on addressing identified gaps, particularly in the integration of technology and the development of ethical guidelines for complex patient care.

Latin American Consensus on the Treatment of Head and Neck Cancer.

Head and neck squamous cell carcinoma (HNSCC) is well known as a serious health problem worldwide, especially in low-income countries or those with limited resources, such as most countries in Latin America. International guidelines cannot always be applied to a population from a large region with specific conditions. This study established a Latin American guideline for care of patients with head and neck cancer and presented evidence of HNSCC management considering availability and oncologic benefit. A panel composed of 41 head and neck cancer experts systematically worked according to a modified Delphi process on (1) document compilation of evidence-based answers to different questions contextualized by resource availability and oncologic benefit regarding Latin America (region of limited resources and/or without access to all necessary health care system infrastructure), (2) revision of the answers and the classification of levels of evidence and degrees of recommendations of all recommendations, (3) validation of the consensus through two rounds of online surveys, and (4) manuscript composition. The consensus consists of 12 sections: Head and neck cancer staging, Histopathologic evaluation of head and neck cancer, Head and neck surgery-oral cavity, Clinical oncology-oral cavity, Head and neck surgery-oropharynx, Clinical oncology-oropharynx, Head and neck surgery-larynx, Head and neck surgery-larynx/hypopharynx, Clinical oncology-larynx/hypopharynx, Clinical oncology-recurrent and metastatic head and neck cancer, Head and neck surgery-reconstruction and rehabilitation, and Radiation therapy. The present consensus established 48 recommendations on HNSCC patient care considering the availability of resources and focusing on oncologic benefit. These recommendations could also be used to formulate strategies in other regions like Latin America countries.

Care of patients undergoing withdrawal of life-sustaining treatments: an ICU nurse perspective

BackgroundIntensive care unit (ICU) nurses working in South Korea report experiencing uncertainty about how to care for patients undergoing withdrawal of life-sustaining treatments (WLT). A lack of consensus on care guidelines for patients with WLT contributes to uncertainty, ambiguity, and confusion on how to act appropriately within current law and social and ethical norms. To date, little has been discussed or described about how ICU nurses construct meaning about their roles in caring for dying patients in the context of wider social issues about end-of-life care and how this meaning interacts with the ICU system structure and national law. We aimed to better understand how ICU nurses view themselves professionally and how their perceived roles are enabled and/or limited by the current healthcare system in South Korea and by social and ethical norms.MethodsThis qualitative descriptive study was conducted using in-depth, semi-structured interviews and discourse analysis using Gee’s Tools of Inquiry. Purposive sampling was used to recruit ICU nurses (n = 20) who could provide the most insightful information on caring for patients undergoing WLT in the ICU. The interviews were conducted between December 2021 and February 2022 in three university hospitals in South Korea.ResultsWe identified four categories of discourses: (1) both “left hanging" or feeling abandoned ICU nurses and patients undergoing WLT; (2) socially underdeveloped conversations about death and dying management; (3) attitudes of legal guardians and physicians toward the dying process of patients with WLT; and (4) provision of end-of-life care according to individual nurses’ beliefs in their nursing values.ConclusionICU nurses reported having feelings of ambiguity and confusion about their professional roles and identities in caring for dying patients undergoing WLT. This uncertainty may limit their positive contributions to a dignified dying process. We suggest that one way to move forward is for ICU administrators and physicians to respond more sensitively to ICU nurses’ discourses. Additionally, social policy and healthcare system leaders should focus on issues that enable and limit the dignified end-of-life processes of patients undergoing WLT. Doing so may improve nurses’ understanding of their professional roles and identities as caretakers for dying patients.

Clinical Guidelines for Perioperative Care of Older and Oldest-Old Patients Living with Frailty Undergoing Elective Surgery

The population of older and oldest-old individuals is increasing at a rapid pace, leading to a notable proportion of this age group requiring surgical procedures due to multimorbidity. It is known that, compared with young people, patients over 60 have a whole set of factors, such as decreased physiological functions, the presence of several concomitant diseases, polypharmacy, cognitive dysfunction and specific geriatric syndromes, which may lead to a higher risk of postoperative complications and prolonged recovery. Therefore, an integrated multidisciplinary approach on management is necessary for this group of patients, but the use of such an approach is currently rare. The purpose of this document is to review the literature, summarize current recommendations, and provide a set of expert recommendations to assist practicing geriatricians, surgeons, anesthetists, and allied health professionals.

Perspectives on early insights: pediatric cancer caregiving amidst natural calamities - A call for future preparedness.

Natural disasters cause immense damage and disruption to the environment, human lives, and property, posing a threat to safety and well-being. These disasters annually affect individuals and communities, severely impacting mental health. Research indicates a significant link between catastrophic events and an increased risk of mental disorders, including anxiety, depression, substance use, and post-traumatic stress disorder (PTSD). Individuals with chronic conditions, like cancer patients, are particularly vulnerable post-disaster due to disrupted healthcare services. The recent earthquake in Morocco highlighted the urgent need for continued care, especially for vulnerable populations living in poverty. Soleterre Foundation's interventions focus on supporting young cancer patients and their families, emphasizing psychological support following the earthquake. Effective disaster response needs coordinated efforts, clear roles, communication, and standardized healthcare procedures, especially for vulnerable groups like cancer patients. Education programs for patients and clinicians are vital for disaster preparedness. Communication challenges and lack of medical history further emphasize the need for well-defined disaster preparedness plans and continued care guidelines for cancer patients.

Investigating the perceptions and experiences of Canadian dentists on dental regulatory bodies' communications and guidelines during the COVID-19 pandemic.

Dental regulatory bodies aim to ensure the health and safety of dentists, dental staff patients and the public. An important responsibility during a pandemic is to communicate risk and guidelines for patient care. Limited data exist on the perceptions and experiences of dentists navigating new guidelines for mitigating risk in dental care during the pandemic. The objective of this study was to use a qualitative approach to explore how dentists in Canada experienced and perceived their regulatory bodies' communication about COVID-19 risks and guidelines during the pandemic. Participants were Canadian dentists (N = 644) recruited through the email roster of nine provincial dental associations or regulatory bodies. This qualitative analysis was nested within a prospective longitudinal cohort study in which data were collected using online questionnaires at regular intervals from August 2020 to November 2021. To address the objective reported in this paper, a conventional qualitative content analysis method was applied to responses to three open-ended questions included in the final questionnaire. Participants encountered challenges and frustrations amid the COVID-19 pandemic, grappling with diverse regulations and communications from dental bodies. While some bodies offered helpful guidance, many participants felt the need for improved communication on guidelines. Dentists urged for expedited, clearer and more frequent updates, expressing difficulty in navigating overwhelming information. Negative views emerged on the vague and unclear communication of COVID-19 guidelines, contributing to confusion and frustration among participants. As COVID-19 persists and in planning for future pandemics, these experiential findings will help guide regulatory bodies in providing clear, timely and practical guidelines to protect the health and safety of dentists, dental staff, patients and the public.

Social and Psychological Long-Term Consequences of NMDA Receptor Encephalitis (SAPIENCE) - from patients’ views to patient-centred care

Background and target population: NMDA receptor encephalitis is a rare autoimmune disease with severe neurological and neuropsychiatric symptoms but typically a good functional neurological outcome. Nevertheless, most patients suffer long-term cognitive, psychological, and social impairments that have a significant impact on their well-being and occupational or educational activities-this is of particular concern given the young age of patients (median 21 years). However, because the disease was only recently discovered (2007), these psychosocial effects have not been systematically studied and the resulting impact on patients is not adequately appreciated. The SAPIENCE study is an international scientific project funded by the European Joint Program that aims to characterize the long-term cognitive and psychosocial consequences of this rare disease. The leader of the consortium is Prof. Carsten Finke, Charite Berlin. The Polish team, coordinated by Prof. Donata Kurpas, is responsible for the development of standard protocols, monitoring and training of staff in the study centers where the data are collected, and the corresponding qualitative data analysis.
 Study Design/Methods: Patients will be extensively studied at three European study sites in three consecutive project levels. Stage 1 includes in-depth on-site interviews and focus groups (n=30). Stage 2 develops a semi-structured short-form interview and includes on-site neuropsychological testing (n=150). Stage 3 includes an international online survey of patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs), and disease progression information (n=300). Stages 1-3 will support each other in developing structured interviews, survey questions, and treatment guidelines.
 Results/Outcomes: At Level 1, we will identify themes and narratives that influence patients' quality of life and their experience of coping with the disease. At Level 2, we will identify neuropsychological outcomes in the largest cohort of NMDAR encephalitis patients in the world to date, including executive function, memory, and spatial navigation performance, which have been identified as key areas of impairment. At Level 3, we will examine subjective outcomes and individual predictors of post-acute disease progression.
 Based on Stages 1-3, we will develop international consensus guidelines for post-acute care of NMDARE patients.
 Impact: This project is the first to bridge the gap between standardized assessment and individual patient experience in the long-term follow-up of patients with autoimmune encephalitis. By incorporating the patient perspective into medical decision-making, current and future NMDAR encephalitis patients will benefit from the implementation of the diagnostic and treatment guidelines developed in this project for patient-centered post-acut

Diagnosis Update and Treatment of Depression in Breast Cancer Survivor

Individuals suffering from breast cancer or those who have overcome it may experience symptoms such as despondency, despair, apprehension, and a feeling of void. The aim of this study is to provide a comprehensive overview of the diagnosis and treatment advancements for depression in people who have been diagnosed with and survived breast cancer. The prevalence of depressive symptoms and their association with patients' and survivors' quality of life were assessed using the Patient Health Questionnaire (PHQ-8). Depression has a robust association with quality of life. Several clinical care guidelines for cancer patients with co-morbid distress have highlighted the importance of screening and detection. According to the ASCO guidelines, healthcare facilities should create networks of referral sources or appropriate resources to efficiently handle patients' concerns about screening measures, in addition to doing screenings. The availability of screening or treatment depends directly on the financial resources of the institutions that provide them. Ultimately, due to the continuous advancements in breast cancer treatments, a significant number of individuals who have survived breast cancer will need prompt intervention to manage the long-term consequences of the illness. Survivors of breast cancer nevertheless encounter a significant health hazard in the form of depression, which endures long after the completion of therapy.

Gender-affirming care and endocrine-related cancers.

With the increasing number of transgender and gender diverse (TGD) individuals who are seeking gender-affirming care, there is a clear need for the development and collection of evidence-based data to establish guidelines for patient care. TGD individuals are estimated to represent 0.3 to 4.5% of the world population. Gender-affirming care that includes hormone therapy helps to align the body of a transgender person with their gender identity. Hormone therapy requires monitoring for both safety and efficacy. The extent to which gender-affirming hormone therapy alters cancer risk remains unknown. Because of a lack of comprehensive data collection pertaining to this patient population, endocrine cancer data including incidence and outcomes is limited. Dedicated research is needed to help address the gap in knowledge pertaining to the risk of cancer in the TGD population.

How can healthcare providers involve with families in the care of patients with chronic mental illness? A mixed methods protocol study to adapt the clinical practice guideline.

Chronic mental illnesses have long periods, are recurring, and require continuous care as well as an integrated and collaborative approach to organize the care. The purpose of this article is to summarize the most important steps necessary for adapting a clinical practice guideline for family-centered collaborative care of patients with chronic mental illnesses referring to the medical centers. As the study will be an exploratory mixed methods study, the design will be carried out as a sequential qualitative-quantitative study (QUAL quan), consisting of 3 phases, 9 modules, and 24 sequential steps, which is based on the Guidelines International Network to adapt the guideline manual. In the first phase, the prerequisites for adaptation of the clinical guideline were established. In the second phase, to collect evidence, a qualitative study (semi-structured interview) will be conducted to explore the dimensions and components of the care needs of patients with chronic mental disorders and their families from the perspectives of patients, caregivers, and healthcare providers. Additionally, a literature review to extract relevant clinical guidelines and articles will be done. A panel of experts will screen and evaluate potential clinical guidelines, and a draft guideline will be developed. It is expected that these findings will meet the needs of patients with mental illness and their caregivers by providing integrated care and improving collaborative care within the sociocultural context of Iran.

Abstract 18240: Co-Creating Atrial Fibrillation Patient Education Videos by Combining Diverse Patient Feedback, Clinician Peer Review, and ChatGPT Content Analysis to Enhance Guideline-Directed Care Implementation

Introduction: Strong evidence supports that (1) risk factor modification (RFM), (2) stroke prevention, (3) rhythm and (4) rate control are the four pillars of atrial fibrillation (Afib) management. Critical gaps exist in the clinical implementation of these four pillars. Patients and clinicians have identified lack of patient education as a major contributor to the failure of implementing guidelines in patient care. Methods/Results: We previously identified topics of patient education spanning the four pillars of Afib management via human centered design sessions with diverse patients (n=8, median age 69 (IQR 58-78), 50% women, 25% Black, 13% Asian), and clinicians (n=8). Qualitative analysis of the discussions with patients and clinicians was performed to identify desired topics of patient education. After identification of the key topics, we constructed scripts for patient education in an inclusive and iterative manner including physicians, nurses, and technologists (n=10). We then leveraged OpenAI’s ChatGPT - 3.5 artificial intelligence tool to adjust the reading level of the scripts to a 6 th grade reading level to ensure equitable delivery of education. The scripts were again revised for content accuracy. We then used an animated video creation platform (Vyond, San Mateo, CA) to create twenty videos covering the topics of stroke prevention, lifestyle modification, rhythm, and rate control. The videos will be part of a virtual Afib management intervention to be evaluated in a RCT. Conclusions: We have successfully co-created Afib educational videos using input from diverse patients and clinicians with assistance from the artificial intelligence tool ChatGPT. Patient education materials co-created with diverse patients and clinicians have the potential to promote equity in guideline-directed care delivery. We will evaluate the efficacy of the educational videos as part of a virtual Afib management program in Afib guideline implementation in a RCT.

Therapies for people hospitalized with COVID-19 and alignment with national clinical guidelines in a large hospital, Almaty, Kazakhstan, 2020-2021.

Clinical practice guidelines were continually changing during the COVID-19 pandemic to reflect the best available evidence for a novel virus. In Kazakhstan, the national clinical guidelines for COVID-19 patient care were regularly modified and it was not known if and to what extent these guidelines were being followed in practice. We conducted a sub-analysis of data collected from an observational study among people hospitalized with COVID-19 in a large infectious disease hospital in Almaty in four cross-sections of increased COVID-19 incidence: T1 (1 June-30 August 2020); T2 (1 October-31 December 2020); T3 (1 April-31 May 2021); and T4 (1 July-26 October 2021). Modifications to the national COVID-19 treatment guidelines were identified and clinical data were abstracted from electronic medical records. We assessed frequency of antibiotic, glucocorticoid, anticoagulant, and antiviral administered in each period and determined if these aligned with national clinical guidelines. We used multivariable logistic regression to compare practices across periods. Six modifications were made to national COVID-19 treatment guidelines during this study. Of 1,146 people hospitalized with COVID-19, 14% were in T1, 14% in T2, 22% in T3, and 50% in T4. Anticoagulant treatment was administered to 87% (range: 56%-95%), antibiotic treatment to 60% (range: 58%-64%), glucocorticoid to 55% (range: 43%-64%) and antiviral therapy 15% (range: 7%-22%). Majority of treatments were not aligned with national guidelines, including 98% of anticoagulant use, 95% of antibiotic use, 56% of glucocorticoid use, and 56% of antiviral use. There were no significant changes in practice following changes in guidelines for antibiotic use (64% in T1 to 58% in T2, p = 0.30). There was significant increase in use of anticoagulant (84% in T2 vs. 95% in T3, p < 0.01), glucocorticoid (43% in T2 vs. 64% in T3, p < 0.01), and antiviral treatment (7% in T3 vs. 15% in T4, p < 0.01) after guidelines updates. The majority of treatments administered to people hospitalized with COVID-19 in four periods of high incidence in Almaty were not aligned with updated clinical guidelines. Antibiotic misuse was markedly high throughout. Increased awareness and training on clinical practice guidelines as updates are released may help improve adoption of evidence-based practices.

Study of Knowledge, Attitude and Practice Regarding Adolescent’s Rights to Autonomy and Confidentiality among Physicians Working in Ain Shams University Hospitals

Abstract Background Legally, adolescents are not capable of making medical decisions and considered incompetent because of their age. However, psychological studies found adolescents are capable of making informed choices about involvement in health care and research. Aim This study aimed at assessment of physicians knowledge, attitude and practice regarding sharing of adolescents in medical decision making and their right in confidentiality. Methods An online self -administered structured questionnaire was used for 384 physicians working at Ain Shams University Hospitals during the period from December 2019 to December 2020. Results Most of the participants were knowledgeable of variable ages of legal consent between countries (54.7%) while 46.97% of them know the legal age for consent in Egypt. Most of them were aware that they should obtain consent from the adolescents before their involvement in clinical research (87.7%); their duty to breach the confidentiality of the patient’s medical information if this is necessary to protect him/ her or the surrounding people (85.4%). About 45% of them agreed with the adolescent’s ability to make a sound decision regarding his/her health and 47.1% of them were neutral with the adolescent’s right to refuse the proposed treatment even if this against parents’ decision. Most of them agreed with the adolescent’s right to confidentiality if there is no risk for the patient or the surrounding persons (64.3%). Almost all of them obtain consent from both the adolescent patients and their parents/guardians (either always (69.8%) or sometimes (26.3%,)); and give the adolescent an opportunity to speak in private (either always (43.5%) or sometimes (55.2%)). Conclusion Although of the participants’ positive attitude toward sharing the adolescent patient in medical decisions- making, and their right to confidentiality, their practice showed variable responses. This may be due to deficient knowledge of the laws and absence of definite ethical guidelines for health care of adolescent patients. Recommendation Training of the physicians on judgment and assessment of adolescent patient’s capacity is an important step to ensure their involvement in decision making. Also, it is important to formulate ethical guidelines for management of adolescent patients in our community.

THE RELATIONSHIP BETWEEN THE APACHE II SCORE AND THE NUMBER OF DAYS OF HOSPITALIZATION IN THE INTENSIVE CARE UNIT (ICU) AT HARAPAN INSAN HOSPITAL, SENDAWAR WEST KUTAI

The APACHE II score is a method for determining disease severity and assessing patient mortality in ICU. The result of measuring the patient's condition was obtained in the first 24 hours of admission to the ICU. Scoring is used to estimate prognostic risk factors for patients who can leave the ICU room in recovering or dying conditions. The length of hospitalization for patients in the Intensive Care Unit (ICU) is on average more than 5 days. The purpose of this study was to determine the relationship between the APACHE II score and the range of days in the Intensive Care Unit (ICU) at RSUD Harapan Insan Sendawar West Kutai. The design of this study was cross-sectional. The sampling technique in this study used accidental sampling, and the research samplers were 30 respondents. The test instrument used the APACHE II Observation sheet. The results of the statistical analysis of the bivariate test using Chi-Square obtained a p-value of 0.757, which is greater than the alpha value, it means that there is no relationship between the APACHE II score and the range of days of hospitalization in the Intensive Care Unit (ICU) at Harapan Insan Hospital, Sendawar, West Kutai. The Odds Ratio (OR) value was obtained at 0.786, which means that patients who have an APACHE II score were in a low category, and they have an opportunity of 0.786 times to have a range of days of hospitalization in the category of short hospital days. There is no relationship between the APACHE II score and the range of days of hospitalization in the Intensive Care Unit (ICU) at Harapan Insan Hospital, Sendawar, West Kutai. The suggestions for hospital management to add beds in the ICU and the results of the research are expected to be guidelines for patient care in the ICU by using the APACHE II score and improving services in the ICU

THE DEVELOPMENT OF NURSING CARE MODEL IN PATIENTS WITH TOTAL KNEE REPLACEMENT RECONSTRUCTIVE SURGERY

This research aims to develop a nursing care model for patients undergoing total knee replacement surgery (TKR) using the models Kemmis and McTaggart (1988) as development guidelines. The study has started from April to July 2020 in Operation Department, Loei hospital, Thailand. The purposive sampling method has been selected with participant nurses (n=50). The mixed method design has been used to obtain the new development nursing care model and guidelines for patient care, proper assignment system, and follow-up techniques. The result showed the nurse behavior changed before to after implementing a model in pre-operation, intra-operating, and post-operation stages statistically different at p less than .001 (mean = 4.9 ± 0.1, p&lt;0.001, mean = 1.9 ± 0.1, p&lt;0.001, mean = 2.0 ± 0.0, p&lt;0.001) respectively. The nurse’s satisfaction level after cycle 2 was significantly higher than cycle 1 (mean = 4.2 ± 0.3, p&lt;0.001). The development of the new nursing care model in TKR surgery could lead to changes in the system with gained positive feedback from OR nurses. The nursing leadership, group motivation, and a cooperative nursing team contributed to the successful operation of the new model. This research recommended following this model’s protocols as a routine and further expanding to other departments such as outpatient, inpatient, and continuous care units.

THE DEVELOPMENT OF NURSING CARE MODEL IN PATIENTS WITH TOTAL KNEE REPLACEMENT RECONSTRUCTIVE SURGERY

This research aims to develop a nursing care model for patients undergoing total knee replacement surgery (TKR) using the models Kemmis and McTaggart (1988) as development guidelines. The study has started from April to July 2020 in Operation Department, Loei hospital, Thailand. The purposive sampling method has been selected with participant nurses (n=50). The mixed method design has been used to obtain the new development nursing care model and guidelines for patient care, proper assignment system, and follow-up techniques. The result showed the nurse behavior changed before to after implementing a model in pre-operation, intra-operating, and post-operation stages statistically different at p less than .001 (mean = 4.9 ± 0.1, p&lt;0.001, mean = 1.9 ± 0.1, p&lt;0.001, mean = 2.0 ± 0.0, p&lt;0.001) respectively. The nurse’s satisfaction level after cycle 2 was significantly higher than cycle 1 (mean = 4.2 ± 0.3, p&lt;0.001). The development of the new nursing care model in TKR surgery could lead to changes in the system with gained positive feedback from OR nurses. The nursing leadership, group motivation, and a cooperative nursing team contributed to the successful operation of the new model. This research recommended following this model’s protocols as a routine and further expanding to other departments such as outpatient, inpatient, and continuous care units.

Factors associated with 30-day in-hospital mortality in critically ill adult patients receiving extracorporeal membrane oxygenation: A retrospective cohort study

ObjectiveTo identify factors associated with the 30-day in-hospital mortality rate among adult patients requiring extracorporeal membrane oxygenation (ECMO) in intensive care units. Research MethodologyRetrospective cohort study including 148 patients who underwent ECMO for at least 48 h between March 2010 and August 2021. The patients were divided into survivors and non-survivors based on their 30-day in-hospital survival. We obtained the sociodemographic information and pre- and post-ECMO data from electronic medical records. Kaplan–Meier survival curves and Multivariate Cox proportional hazards regression were used to analyse the data. SettingA tertiary-care university hospital in South Korea. Main Outcome MeasuresThe 30-day in-hospital mortality rate was the principal outcome measure. ResultsThe 30-day in-hospital mortality rate was 49.3% (n = 73). Kaplan–Meier analysis demonstrated that the duration of ECMO support in the 50th percentile of surviving patients was 13 days. Multivariable Cox regression analysis showed that new-onset renal failure, lower mean arterial pressure, and ECMO weaning failure were associated with an increased 30-day in-hospital mortality risk among patients who received ECMO. Subgroup analysis also revealed a significant association between weaning failure and 30-day in-hospital mortality after adjusting for covariates in patients undergoing veno-arterial ECMO. ConclusionClose monitoring of post-ECMO renal function and mean arterial pressure is required to minimize the risk of 30-day in-hospital mortality, especially in adults within the first two weeks of ECMO initiation. Moreover, the success of ECMO weaning should be optimized by collaboration within the ECMO team. Implications for Clinical PracticeCritical care nurses should pay close attention to patients’ response to weaning trials as well as alternations in renal function and mean arterial pressure during ECMO support. Furthermore, developing nursing care guidelines for adult patients receiving ECMO and standardized training programs for nurses in intensive care, are required in Korea.

Ethical Considerations for the Delivery of Obstetric and Gynecologic Care During a Pandemic: ACOG Committee Statement No. 6.

Obstetrician-gynecologists (ob-gyns) are essential to providing high-quality health care, and this duty remains unchanged during pandemics. This Committee Statement discusses ethics related to the provision of obstetric and gynecologic care during a pandemic caused by a highly transmissible pathogen. As health care guidelines related to pandemics are created by institutions, ob-gyns have a responsibility to advocate for obstetric and gynecologic health priorities. Additionally, many clinical practice decisions made to reduce the spread of the infectious agent and maximize physicians' ability to care for those who need help will have ramifications on patient satisfaction, the patient-physician relationship, and equity in health outcomes. Obstetrician-gynecologists are obligated to protect themselves, their patients, and others by using appropriate protective measures (such as personal protective equipment and diagnostic testing) and observing institutional, state, and federal guidelines for the appropriate isolation and care of patients with suspected or confirmed disease.