Care Guidelines Research Articles

Spirituality in Patients With Cancer: A Synthesis of a Program of Research.

Spiritual care is a key domain of quality palliative care as defined by national palliative care guidelines. The aim of this project was to synthesize data and research experience by the authors over 30years related to spirituality in patients with cancer. The research objectives for this analysis were to: Describe spirituality in patients with cancer. Determine the outcomes of palliative care interventions on spirituality and related variables in patients with cancer in these studies conducted by the authors. Summarize methodological issues in conducting research related to spirituality in oncology patients. A synthesis of 15 prior studies conducted by the authors was completed and also compared to current literature regarding spirituality in cancer and other serious illness. Findings demonstrate the broad scope of spirituality, key spiritual concerns in cancer and methodological approaches to assessing spirituality. Spirituality is a major concern for patients, yet limited training has been provided for clinicians who deliver this care. Additional studies are needed to advance this important aspect of palliative care.

Implementing a Quality Improvement Initiative to Screen for Dementia in a Down Syndrome Specialty Clinic.

Using quality improvement methods, we aimed to implement a protocol to assess for dementia among adults with Down syndrome (DS). To track implementation, interval retrospective chart review of patients with DS with visits to the Massachusetts General Hospital DS Program (MGH DSP) was conducted quarterly. The impact of a newly implemented protocol created and informed by clinical experts in the MGH DSP including laboratory tests, imaging, referrals, and screening tools for dementia and mental health concerns, was analyzed using statistical process control charts. From December 2021 to December 2022, the MGH DSP developed and implemented a new clinical protocol to screen for dementia in 44 adults with DS, ages 40 and above, at a total of 48 visits. We found high rates of completion of two screening surveys (85% and 81%, respectively) and an 84% adherence to our overall protocol elements by clinical staff. Among those with dementia-like symptoms, medical evaluation was collected and summarized. We show that it is possible to successfully implement a new protocol, including the use of a dementia screener, in line with published evidence-based care guidelines for adults with DS. We present our protocol as one successful approach focused on pre-visit screening for symptoms of dementia and mental health concerns and evaluating for co-occurring medical conditions in adults with DS.

Barriers and facilitators for strengthening primary health systems for person-centred multimorbid care in low-income and middle-income countries: a scoping review

ObjectiveTo understand barriers and facilitators for strengthening health systems for person-centred care of people with multiple long-term conditions-multimorbidity (MLTC-M) at the primary healthcare (PHC) level in low-income and middle-income countries...

Neurological Monitoring and Management for Adult Extracorporeal Membrane Oxygenation Patients: Extracorporeal Life Support Organization Consensus Guidelines.

Critical care of patients on extracorporeal membrane oxygenation (ECMO) with acute brain injury (ABI) is notable for a lack of high-quality clinical evidence. Here, we offer guidelines for neurological care (neurological monitoring and management) of adults during and after ECMO support. These guidelines are based on clinical practice consensus recommendations and scientific statements. We convened an international multidisciplinary consensus panel including 30 clinician-scientists with expertise in ECMO from all chapters of the Extracorporeal Life Support Organization (ELSO). We used a modified Delphi process with three rounds of voting and asked panelists to assess the recommendation levels. We identified five key clinical areas needing guidance: (1) neurological monitoring, (2) post-cannulation early physiological targets and ABI, (3) neurological therapy including medical and surgical intervention, (4) neurological prognostication, and (5) neurological follow-up and outcomes. The consensus produced 30 statements and recommendations regarding key clinical areas. We identified several knowledge gaps to shape future research efforts. The impact of ABI on morbidity and mortality in ECMO patients is significant. Particularly, early detection and timely intervention are crucial for improving outcomes. These consensus recommendations and scientific statements serve to guide the neurological monitoring and prevention of ABI, and management strategy of ECMO-associated ABI.

Prevention of Pathogenesis of Infection in Postpartum Women Through Postpartum Care Culture

Cultural beliefs and practices significantly influence postpartum care, affecting maternal health outcomes both positively and negatively. In developing countries, around 70% of postpartum mothers lack adequate care and often only seek medical attention in severe cases, contributing to elevated maternal mortality rates during the postpartum period. This study investigates how cultural practices impact postpartum care and the incidence of postpartum infection pathogenesis. Using a cross-sectional study design, the research analyzed data from 141 participants with chi-square tests. Results reveal a significant relationship between postpartum care culture and infection incidence, with a p-value of 0.000. Participants were primarily aged 20-35 years (61%), had high school education (68.80%), and were non-working (72.30%). These factors suggest that education and employment status may affect postpartum care practices. A majority of respondents exhibited positive care practices, with 51.10% reporting good care and no postpartum infections. The findings highlight the necessity for developing culturally sensitive postpartum care guidelines to reduce infection risks and enhance maternal health outcomes by incorporating local cultural values into care practices.

A Dutch paediatric palliative care guideline: a systematic review and recommendations on advance care planning and shared decision-making

BackgroundIn paediatric palliative care, children with life-threatening and life-limiting conditions, their families, and their health care professionals often face difficult decisions about treatment, goals of care, and delivery of care. Advance care planning and shared decision-making are strategies that can improve quality of care by discussing goals and preferences on future care. In this paper, we provide recommendations that aim to optimise advance care planning and shared decision-making in paediatric palliative care in the Netherlands.MethodsA multidisciplinary guideline panel of 20 experts in paediatric palliative care and nine (bereaved) parents was established to develop recommendations on advance care planning and shared decision-making. We performed systematic literature searches to identify quantitative and qualitative evidence and used the GRADE (CERQual) methodology for appraisal of evidence. Recommendations were formulated based on quantitative and qualitative evidence, clinical expertise, and patient and family experiences.ResultsWe identified 4 RCTs that reported on the effect of advance care planning interventions in paediatric palliative care and 33 qualitative studies on barriers and facilitators to advance care planning and shared decision-making. We formulated 28 strong recommendations in close collaboration with a multidisciplinary guideline panel that provide guidance to offer advance care planning and shared decision-making, involve children and their family, and communicate information about care and treatment.ConclusionThe identified evidence and recommendations support the use of advance care planning and shared decision-making in paediatric palliative care. However, we found several knowledge gaps that should be addressed. As advance care planning and shared decision-making require specific skills and can be time-consuming, we emphasise the importance of education, adequate staffing and sufficient funding to improve integration in clinical practice. We do believe that our recommendations can be used as a starting point to develop recommendations in other countries. However, country-specific factors should be very carefully considered before applying any recommendations in other countries.

Maternal and perinatal outcomes of live births after uterus transplantation: A systematic review.

Uterus transplantation (UTx) is a treatment for absolute uterine factor infertility. The results of pregnancies of this complex infertility treatment should be established. The aim of the study was to systematically review maternal and neonatal outcomes in the pregnancies of women who have undergone UTx. The population of this review were women that have undergone UTx and delivered child(ren). Cesarean delivery after UTx were planned to be compared with studies reporting maternal mortality/morbidity and perinatal mortality/morbidity after delivery by elective cesarean section without UTx. Systematic literature searches were performed utilizing Medline, Embase, the Cochrane Library, Cinahl, PsycInfo, Web of Science, and clinicaltrials.gov for studies written in English language and published between January 1, 2010, and November 08, 2023. No study design limitation was applied. If no comparative studies were identified, we planned to report the outcomes from the case reports and case series. Included studies were assessed for risk of bias using a checklist for case series. The study protocol was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (registration number: INPLASY202310052). Twenty-four articles were identified, containing data on 40 unique live births. Multiple publications including same cases were identified and clearly indicated. No comparative studies were identified. The certainty of evidence was very low, as all studies were either case reports (n = 15) or case series (n = 9). All deliveries were by cesarean section and 47.5% of them resulted in emergency cesarean sections. Out of the 21 elective cesarean sections, 52.4% were performed before 37 weeks' gestation. Historical comparison to population data on pregnancies delivered by cesarean section found a markedly increased risk for both the mother and child following cesarean section for UTx. Risks for placenta previa and preterm birth were notably high after UTx; however, some of the later may reflect the results of provider-initiated births. The maternal and perinatal outcomes of 40 live births post-UTx indicate that these pregnancies may be at high risk of maternal and perinatal complications. Aiming to delay elective cesarean section beyond 37 weeks' gestation could potentially reduce some of these risks. Registration of maternal and perinatal outcomes after UTx through quality registries are essential and obstetrical care guidelines for these women should be established.

Medical students' knowledge on palliative care - a survey of teaching in Finland.

Most studies on palliative medicine (PM) undergraduate education have focused on contents and organizational issues but not the outcome. Students' learning outcomes should be studied to improve teaching in medical schools. A questionnaire about perceived PM education and attitudes on palliative care (PC) was sent to 543 last year students in all five Finnish medical schools in 2018-2019. In total, 175 (32 %) responses were received from four universities. The students evaluated both the quantity and quality of their PM teaching, implementation of European Association for Palliative Care (EAPC) guidelines and their satisfaction to the training. There were two palliative case scenarios, and the students were asked to find the best treatment option. In addition, students´ attitudes towards end-of-life (EOL) care issues were examined. In the Finnish universities, PM education was available mainly integrated with oncology, geriatrics, and general medicine. A total of two universities also offered a specific PM course. In average, 50-70% of the EAPC curriculum was covered by lectures, small-group teaching, seminars, and bedside teaching with significant differences between faculties. Only 30-60 % of students were satisfied with the education received. The highest rankings were given in the universities with a special PM course. Students from these universities expressed less anxiety in facing EOL issues. In Finland, the coverage of EAPC curriculum is satisfactory, but the PM education is mainly given integrated with other specialties. The dedicated course on PM was associated with increased perceived knowledge and satisfaction of PM education. However, PM training was not associated with students' attitudes on PC.

Intrapartum Care: Updated Summary of NICE Guidance

(BMJ. 2024;384:p2885. doi: 10.1136/bmj.p2885) In 2021, there were around 650,000 births in England and Wales, mostly from straightforward pregnancies without complications. The care and advice regarding the place of birth, pain relief, and labor management significantly affect women’s overall birth experiences and health outcomes. The National Institute for Health and Care Excellence (NICE) issued intrapartum care guidelines in 2014 that were then updated in 2017. This article summarizes new and updated recommendations in 2023, highlighting those based on new evidence and emphasizes shared decision-making between women and health care professionals. These guidelines apply to all pregnant or postpartum individuals, regardless of gender identity. Recommendations are derived from systematic reviews and cost-effectiveness considerations, using GRADE criteria to assess evidence certainty.

Mission and Future Plans for the ADPKD Centers of Excellence Program.

The Autosomal Dominant Polycystic Kidney Disease (ADPKD) Centers of Excellence Program, launched by the Polycystic Kidney Disease Foundation in 2022, aims to bridge the gap in specialized care for individuals with ADPKD. This program seeks to enhance the availability of specialized clinicians and simplify the process for patients seeking expert care. It is founded on three pillars: improving care for all individuals with ADPKD, educating and empowering the community, and advancing PKD research. The program draws inspiration from successful models in other diseases, such as cystic fibrosis and muscular dystrophy, which have demonstrated the effectiveness of standardized care centers in improving patient outcomes. Patient and clinician stakeholder interviews have identified key areas where a national program could make a significant impact, including the need for a core care team with defined referral processes, mentorship and shared care models, patient navigation services, and education around expert consensus and care guidelines. The program introduces two designations: "Center of Excellence" and "Partner Clinic" to accommodate diverse care settings and enhance patient access to specialists. The Partner Clinic designation ensures that patients in smaller community practices have access to specialized care through mentorship and guidance from experts at Centers of Excellence. The program also emphasizes the importance of specialized services, especially in underserved communities experiencing health disparities, to manage the complexities of ADPKD care. Patient focus groups have highlighted the need for care navigation services, centralized sources of knowledge, and access to local care. The program aims to address these needs by providing a structured framework for care coordination, enhancing patient self-advocacy, and improving overall outcomes for individuals with ADPKD.

Factors influencing job performance of nurses in COVID-19 care: a study in Egypt.

Coronavirus disease (COVID-19) is an illness that has critical effects on public health and overall circumstances across the world. The performance of nurses represents the vital actions in providing care for COVID-19 patients. The aim of this study was to assess job performance and associated nurses, patients, and environmental-related factors among nurses providing care to COVID-19 patients in Egypt through the following: assessing the nurses' knowledge regarding care of COVID-19 patients; assessing the nurses' practice regarding care of COVID-19 patients; assessing different factors that affect different types of nurses' job performance; and assessing the factors associated with the job performance of nurses providing care to COVID-19 patients.Design A descriptive exploratory study was used to meet the aim of the study.Setting The study was conducted at Ain Shams University COVID-19 Hospital.Study subjects A convenient sample of all 52 available nurses working at Ain Shams University COVID-19 Hospital. Data collection tools: The data was collected using a self-administered questionnaire. It consisted of the following: A. Self-administered nurses' questionnaire: Part I: Demographic characteristics of nurses. Part II: Nurses knowledge assessment. Part III: Factors associated with nurses' job performance. B. Narses's practice observational checklist. Results: The mean age (mean ± SD) of the study population was 40.59 ± 6.90. As regards their years of experience working as nurses, only 32.7% of them have more than ten years of experience. In relation to the total satisfactory level of knowledge about coronavirus, the study reveals that 55.8% of the nurses have unsatisfactory knowledge regarding coronavirus, There is a highly significant relationship between level of practice and years of experience (p-value < 0.001**), while there is a significant relationship between level of practice and educational level and attending the training courses about caring for COVID-19 patients (P-value 0.033*, P-value 0.025*), respectively.Conclusion The study concluded that most of the studied nurses had unsatisfactory knowledge, and more than half had incompetent practice scores about nursing care practices for patients with COVID-19. There was a positive linear correlation between the nurses' knowledge and practice. The factors affecting their performance in caring for patients with COVID-19, lack of cooperation between nurses and patients, lack of supplies and equipment during care were the most frequently reported factors, as were an unequal nurse-patient ratio, many nursing tasks, and a lack of patients' knowledge.Recommendation The study recommends the importance of promoting the nursing care guidelines as a standard procedure in ICUs, and the nursing care guideline educational program for patients with COVID-19 should be scheduled regularly for nurses. Providing the hospitals with supplies to avoid the shortage's effect on nurses' performance.

Oral Health Complications of SCUBA Diving

OBJECTIVE This review aims to assess the specific oral health complications associated with SCUBA diving, including barodontalgia, barosinusitis, and temporomandibular joint (TMJ) disorders, and to examine the dental implications of hyperbaric oxygen therapy (HBOT) used in decompression sickness treatment. Additionally, this review identifies gaps in the literature and suggests areas for further research to improve dental care guidelines for divers. MATERIALS AND METHODS A systematic literature search was conducted using PubMed and Scopus databases from 2004 to 2024, focusing on terms such as "barodontalgia," "dental barotrauma," and "diving dentistry." From 77 initial articles, 25 studies were selected based on relevance to pressure-induced oral complications, diving-related barotrauma, and dental management for SCUBA divers. RESULTS The review identifies barodontalgia as a prevalent issue, commonly triggered by untreated caries or defective restorations, with symptoms intensified by pressure changes. TMJ disorders, linked to prolonged clenching on diving mouthpieces, and sinus-related barotrauma also emerged as significant concerns. Preventive measures, including regular dental checkups, use of resin-based cements, and customized mouthpieces, are recommended to reduce risks. Furthermore, the review highlights a need for larger, controlled studies across diverse diver populations to validate current recommendations and develop accessible guidelines, especially for recreational divers who may lack access to specialized dental care.

A novel way to integrate economic information into clinical practice guidelines

BackgroundClinical guidelines are widely used to support clinical decision making, so they could also provide economic information about medical interventions to promote cost-conscious health care. We developed a new way to integrate economic information into the Finnish Current Care Guidelines.MethodsOur development team consisted of clinical guideline specialists and health economists. We first looked at integration of economic information in clinical guidelines of other countries. Our key principle was that economic information should be integrated only to mutually exclusive medical interventions where the extensive choice of one the options will yield a significant cost differences on the national level. For the comparative effectiveness information of the interventions, we primarily looked for network meta-analyses. We then combined the effectiveness information presented as number needed to treat with prices or costs for the interventions and present the result as a cost per responder, which reflects both effectiveness and price or costs.ResultsWe introduce a process to integrate and present the economic information of the selected interventions in tables in the Current Care Guidelines.ConclusionsOur novel way to integrate economic information into the Current Care Guidelines is an effort to support cost-conscious clinical decision making to promote cost-effective health care in Finland. This process is general and could be used in clinical guidelines in other countries as well.

A Systemic Review on Phytochemicals and Novel Approaches for the Management of Hepatic Cancer

Introduction: Hepatic cancer, an aggressive tumour that often develops along with cirrhosis and chronic liver disease like infections with the hepatitis B and hepatitis C viruses, while nonalcoholic steatohepatitis, is linked to metabolic syndrome or diabetes mellitus. It is the third most prevalent cause of cancer-related mortality globally and ranks fifth in cancer incidence. According to GLOBOCON, the prevalence is expected to rise by 55.0% and the fatalities by 56.4% in the near future. Objective: The present review offered natural plant-based substances and compounds having curative effects on liver cancer, along with novel drug delivery systems and nanocarrier-based therapies. Methods: The literature has been taken from PubMed, Google Scholar, SciFinder, Springer Nature, Bentham Science, PLOS one, or other internet sites. Result: Treatment for heterogeneous malignancy is multidimensional, and care guidelines differ depending on the specialty and location. Several nutritional herbal remedies and their active phytoconstituents may have an abundance of impacts on the management of liver cancer, including preventing the growth and spread of tumor cells, shielding the body from liver carcinogens, boosting the effects of chemotherapy and immunomodulating the body. Conclusion: The treatment of liver cancer involves multidisciplinary and multimodel therapy. The literature is a compilation of extract, compounds, and novel approaches like nanoparticles, microsphere, liposomes, niosomes, phytosomes and microparticles. These approaches not only manage cancer but also boost the immunity of the individuals.

Balancing Post-Vasectomy Adequate Sperm Clearance with Patient Compliance: Time to Rethink?

Background/Objectives: The American Urological Association (AUA) vasectomy guidelines’ current recommendation to obtain the first post-vasectomy semen analysis (PVSA) from 8 weeks to 16 weeks post-vasectomy is based predominantly on azoospermia rates. However, non-compliance with semen analysis after vasectomy is a known problem in this patient population. An approach that optimizes clearance and compliance is essential when adopting appropriate post-vasectomy care guidelines, specifically the scheduling of the first PVSA. We aimed to conduct a systematic review and meta-analysis of studies assessing compliance and clearance to determine the optimal time of first PVSA. Methods: Databases (MEDLINE, EMBASE, POPLINE) were searched for studies that contained the following: rate of azoospermia and rare nonmotile sperm (RNMS), compliance, recanalization, persistent RNMS, pregnancies, and incidence of repeat vasectomy. Results: A total of 28 studies were included in this review. The patient compliance was 47–100% and trended downward with increasing time to first PVSA. There was a positive trend in azoospermia rate as post-vasectomy time increased, but this plateaued at 8 weeks. Compliance and post-vasectomy semen analysis clearance (PVSAC) converged at 5.7 weeks, with rates of 74.5% and 74.6%, respectively. A proportion of 1.5% of patients exhibited persistent RNMS. Recanalization events had an incidence rate of 1.5%. Repeat vasectomies were performed in 1.6% of patients. Conclusions: Based on our study optimizing post-vasectomy semen clearance with follow-up compliance, we recommend initial PVSA between 6 to 18 weeks post-vasectomy, as this offers improved compliance over current AUA guidelines which recommend PVSA at 8 to 16 weeks and allows for the identification of instances of “subclinical recanalization” that may be missed at later time points.

Study protocol of the ALMA-CKD trial; an electronic triggering decision-support system to improve the detection, recognition, and management of patients with chronic kidney disease in primary care

BackgroundChronic kidney disease (CKD) is a global health problem affected by under-recognition and under-treatment in primary care settings. Electronic clinical decision support (CDS) triggering systems have the potential to improve detection and management of people with CKD by assisting clinicians in adhering to guideline recommendations. We aimed to test whether an electronic CDS triggering system would improve the detection, recognition, and management of patients with CKD in primary care.Method/DesignThis is a pragmatic cluster-randomized controlled trial where 66 primary healthcare centers from the Stockholm Region, Sweden were randomized 1:1 to receive either a new expanded CDS-triggering system offering kidney-specific advice or to continue with their current CDS-triggering system. The expanded CDS system reminds and provides practical facilitators of the processes of CKD screening, recognition with a diagnosis, management and referral to specialist care. The trial duration is 24 months and it is embedded into the Stockholm CREAtinine measurements (SCREAM) project, a repository of healthcare data from the region, which minimizes disturbances with healthcare praxis due to the trial and makes it fully pragmatic. The primary outcomes are the number of eligible patients screened for creatinine and albuminuria once annually and the re-testing of these labs within 6 months in patients with abnormal eGFR or albuminuria. Secondary outcomes are the proportions of issued clinical diagnoses among those fulfilling criteria, proportions of patients with significant albuminuria receiving prescribed nephroprotective medications, proportions of accepted referrals to nephrologist care among those fulfilling criteria and proportion of referrals for ultrasound of the kidneys.DiscussionPrior pragmatic trials of CDS-systems in CKD has shown an improvement in quality indicators primarily in patients already diagnosed with CKD. This study expands this evidence by focusing on the process of screening, identification, monitoring and diagnostic work-up.ConclusionThis pragmatic trial will assess the value of CDS for improved adherence to CKD guidelines in primary care. Clinicaltrials.gov registration: NCT06386172, submitted 2024-04-23.

Tumor seeding across specialties: a systematic review.

Understanding shared characteristics underlying reported tumor seeding episodes can reveal when tumor seeding is most likely to occur and guide clinical decision making. Our goal was to systematically review tumor seeding across specialties and determine what types of instrumentation and primary tumor histology are associated with tumor seeding. A systematic review was conducted using PubMed and Web of Science, per PRISMA guidelines. Publications ranged from 1965 to 2022, and studies with five or more reports of seeding were included. Papers were sorted by specialty and assigned a PRISMA Level of Evidence, and data analysis was conducted based on whether each paper supported the clinical significance of seeding. 7,165 papers were screened with 156 papers included for analysis. Overall, there were 8,161 cases of tumors seeding across specialties with the majority from general surgery, gastroenterology, and urology. Laparoscopy (n=1,561) and needle biopsy (n=3,448) were most frequently implicated, and carcinomas (n=5,778) and adenocarcinomas (n=1,090) were the most common primary tumor types. Upon review of the most updated (2023) versions of the NCCN and NICE guidelines across all cancer types, there were identified gaps in the coverage of tumor seeding within these guidelines, with tumor seeding being entirely absent from certain guidelines and partially absent from others. Given the high cumulative reports of seeding and the deadly and disseminated nature of secondary disease, it is important to consider seeding risk when manipulating tumors and to modify current cancer care guidelines (NCCN/NICE) to ensure that they appropriately address seeding risk.

2024 American Heart Association and American Academy of Pediatrics Focused Update on Special Circumstances: Resuscitation Following Drowning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Drowning is the third leading cause of death from unintentional injury worldwide, accounting for 7% of all injury-related deaths. In the United States, drowning is the leading cause of death in children 1 to 4 years of age and second leading cause of death due to unintentional injury in those aged 5 to 14 years. Drowning generally progresses from initial respiratory arrest due to submersion-related hypoxia to cardiac arrest; thus, it can be challenging to distinguish respiratory arrest from cardiac arrest because pulses are difficult to accurately palpate within the recommended 10-second window. Therefore, resuscitation from cardiac arrest due to this specific circumstance must focus on restoring breathing as much as it does circulation. Resuscitation from drowning may begin with in-water rescue breathing when safely provided by rescuers trained in the technique and should continue with chest compressions, in keeping with basic life support guidelines, once the drowned individual and the rescuer are in a safe environment (eg, dry land, boat). This focused update incorporates systematic reviews from 2021 to 2023 performed by the International Liaison Committee on Resuscitation related to the resuscitation of drowning. These clinical guidelines are the product of a committee of experts representing the American Academy of Pediatrics and the American Heart Association. The writing group reviewed the recent International Liaison Committee on Resuscitation systematic reviews, including updated literature searches, prior guidelines related to resuscitation from cardiac arrest following drowning, and other drowning-related publications from the American Academy of Pediatrics and the American Heart Association. The writing group used these reviews to update its recommendations aimed at resuscitation from cardiac arrest following drowning in children.

2024 American Heart Association and American Academy of Pediatrics Focused Update on Special Circumstances: Resuscitation Following Drowning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Drowning is the third leading cause of death from unintentional injury worldwide, accounting for 7% of all injury-related deaths. The World Health Organization estimates that there are ≈236 000 deaths due to drowning worldwide each year. Significant efforts have focused on creating systems to prevent drowning, but an average of 4000 fatal and 8000 nonfatal drownings still occur annually in the United States-likely an underestimate. Drowning generally progresses from initial respiratory arrest due to submersion-related hypoxia to cardiac arrest; thus, it can be challenging to distinguish respiratory arrest from cardiac arrest because pulses are difficult to accurately palpate within the recommended 10-second window. Therefore, resuscitation from cardiac arrest attributable to this specific circumstance must focus on restoring breathing as much as it does circulation. Resuscitation from drowning may begin with in-water rescue breathing when safely provided by rescuers trained in the technique and should continue with chest compressions, in keeping with basic life support guidelines, once the drowned individual and the rescuer are in a safe environment (eg, dry land, a boat). This focused update incorporates systematic reviews from 2021 to 2023 performed by the International Liaison Committee on Resuscitation related to the resuscitation of drowning. These clinical guidelines are the product of a committee of experts representing the American Heart Association and the American Academy of Pediatrics. The writing group reviewed the recent International Liaison Committee on Resuscitation systematic reviews, including updated literature searches, prior guidelines related to resuscitation from cardiac arrest following drowning, and other drowning-related publications from the American Heart Association and American Academy of Pediatrics. The writing group used these reviews to update its recommendations aimed at resuscitation of cardiac arrest following drowning in adults and children.

Digital Education for Health Care Providers: An Advanced Cardiac Life Support Resource

Advanced cardiovascular life support (ACLS) refers to a set of urgent treatment guidelines for cardiac emergencies to improve patient outcomes. Strong evidence supports online interactive content in facilitating student learning and engagement. This project introduces an innovative approach to ACLS education, namely a digital ACLS simulation to promote medical resident learning of relevant protocols. No similar resource was found in existing literature, supporting the potential merit of creating this tool for medical education. A scoping review was conducted on current ACLS guidelines to inform interactive content creation with MEDLINE [PubMED] and Web of Science. From this review, a decision tree based on validated care guidelines was derived, guiding digital application development. An online prototype was constructed in HTML, JavaScript, and CSS frameworks. The creation allows users to input cardiovascular emergency patient information and output relevant care instructions based on American Heart Association guidelines. Evidence-based descriptions were provided for each decision, referencing credible external resources for further learning. This interactive application may enhance ACLS protocol learning. Next steps include simulation testing with medical residents to establish whether statistically significant benefits are observed. Long term, this project may inform the development and revision of similar digital resources to enhance medical education delivery.