Implementation Of New Protocol Research Articles

Renal and Genitourinary Ultrasound Evaluation in Emergency and Critical Care: An Overview.

Renal and genitourinary ultrasound are fundamental resources employed by emergency and critical care healthcare providers to make prompt diagnoses and perform ultrasound-guided procedures. At the bedside, ultrasound can aid in the diagnosis of relevant pathologies, such as post-renal obstruction or kidney stones, and life-threatening conditions such as aortic dissection or hemoperitoneum. A narrative overview was performed, providing an updated review of renal and genitourinary ultrasound for emergency and critical care healthcare providers, emphasizing its advantages and the latest advances in the field. A thorough summary that can be utilized as a guide for emergency and critical care healthcare providers is presented. The daily hemodynamic management of critically ill patients involves the implementation of new protocols, such as VexUS or the evaluation of the renal resistance index. The role of ultrasound in managing acute nephropathy and genitourinary issues is increasingly crucial given its bedside availability, thus this imaging modality not only facilitates the initiation of therapeutic interventions but also provides swift prognostic insights that are vital to provide tailored patient care. As further advances in ultrasound will arise, it is important for healthcare providers to foster the use of these technologies capable of improving patient outcomes.

939. Barriers and facilitators in the implementation of ASP in Mexico and the impact of COVID-19

Abstract Background Hospital antimicrobial stewardship programs (ASP) involve a continuous effort by health institutions to monitor and optimize the use of antimicrobials. In this study, we aimed to explore barriers and opportunities in the implementation of ASP perceived by personnel of Mexican hospitals, as well as their views on the impact of COVID-19 in ASP activities. Methods An online survey was applied to a purposive sample of 40 hospitals that perform regular antimicrobial stewardship activities in Mexico, during the last trimester of 2021. Results A total of 40 hospitals (62.5% public and 37.5% private) in 13 states in Mexico responded to the survey. Regarding the perception of barriers, they identified the overload of activities (73%), hospital reconversion due to COVID-19 (65%), the scarcity of human resources, and resistance of personnel to new procedures (63% each). The main perceived facilitators were the support by hospital authorities (60%) and the commitment by the ASP team and health professionals in the implementation of ASP (48%). Only 15% of hospitals reported that support by health authorities or other hospitals were factors favoring implementation. The main reported changes due to COVID-19 were: temporary suspension of ASP activities (60%); greater workload due to increased prescription of antimicrobials (33%); involvement in interventions (such as education and guidelines) directed to improve antimicrobial use in COVID-19 patients (18%), as well as implementation of new protocols in pharmacy (44%) and microbiology laboratory (51%). 18% reported no changes in ASP. Conclusion Implementation of ASP in Mexican Hospitals could be strengthened by the inclusion of sufficient human resources with protected time for ASP activities, the active involvement of hospital authorities, as well as encouraging the training and leadership of ASP teams. The impact of COVID-19 was two-way: the stagnation of the program in some hospitals, as well as the active participation in the response to the emergency, in other hospitals. Disclosures Anahí Dreser, PhD, MSD: Grant/Research Support.

Mimicking effects of auditory verbal hallucinations on language production at the level of words, sentences and stories.

Schizophrenia is characterised foremost by hallucinations, delusions and disorganised speech. Deficits in the internal speech monitor may contribute to the development of auditory-verbal hallucinations. This study investigates potential effects in the opposite direction: could the presence of auditory-verbal hallucinations have an effect on speech production? To this end, a recent mimicking/simulation approach was adopted for 40 healthy participants who perceived either white noise or hallucination-like speech recordings during different language production tasks with increasing demands: picture naming, verbal fluency with and without category switch, sentence production, and discourse. In line with reports about real schizophrenia cases in the literature, mimicking auditory-verbal hallucinations affected verbal fluency (switch condition) and sentence production (duration) in a different way than mere noise. These effects were not correlated, suggesting that hallucinations may even affect different levels of linguistic complexity in different ways. Anyway, in both cases (mimicked), auditory hallucination appear to contribute to the emergence of disordered speech. The mimicking/simulation paradigm may in future help to identify and disentangle the various factors contributing to disorganised speech in schizophrenia. They may also support the development and implementation of new protocols, e.g., in speech and language therapy in persons with schizophrenia in order to improve their communication skills despite the presence of auditory-verbal hallucinations.

Pneumonia Associated with Mechanical Ventilation: Management and Preventive Aspects

Introduction: Ventilator-associated pneumonia (VAP) constitutes a real iatrogenic health problem, which can lead to a higher rate of hospital admission days associated with the morbidity and mortality that it could cause. Objective: To study and learn about the different preventive measures used to reduce the incidence of VAP, as well as to study the microorganisms that most frequently cause VAP. To determine the nursing staff’s knowledge of this phenomenon and the social and health care costs derived from the disease. Methodology: The bibliographic search of the existing literature was carried out between November 2021 and June 2022. In order to gather all the necessary information, different databases were searched. For this purpose, a search strategy was developed using keywords included in “DeCS” and “MeSH” and using boolean operators such as “AND and OR”, and all articles meeting the chosen inclusion criteria were included. Results: After applying the article selection criteria and assessing the quality of the methodology, a total of 33 articles were finally included for systematic review. The results show the usefulness of various preventive measures against the micro-organisms that most frequently cause this type of pneumonia, as well as the true cost associated with this pathology and the still insufficient knowledge of healthcare personnel about it. Conclusion: Although many advances have reduced the incidence and mortality of this pathology, further research, training of healthcare personnel and implementation of new protocols are still required.

Optimization of the exposure parameters in digital mammography for diverse glandularities using the contrast-detail metric

PurposeThis investigation aims to study the optimization in digital mammography, considering a diverse percentage of breast glandularity using the contrast-detail metric. MethodsThe Figure of Merit (FOM), defined as the ratio of the square of the Inverted Image Quality Figure (IQFINV) by the Mean Glandular Dose (MGD), was used. A Monte Carlo simulation study was carried out to calculate the Normalized Glandular Dose (DgN). A contrast detail analysis employing the test object Contrast-Detail Mammography Phantom (CDMAM, type 3.4) was performed in the Hologic digital mammography system-model Selenia located in the Research Center in Radiation Sciences and Technologies (CPqCTR) facilities (Brazil). It employed the CIRS phantom with 20 %, 30 %, 50 % of glandularity, and 6.0 cm in thickness. ResultsIt was obtained new acquisition parameters for all glandularities that achieved a decrease in the MGD up to ∼ 50 %, maintaining the same image quality. The study was validated using the CIRS, TORMAM, and ACR phantoms through the contrast-to-noise ratio (CNR), the signal-to-noise ratio (SNR), and the MGD values obtained with the optimized parameters and the four AEC modes, which are the optimization proposed by the manufacturer. ConclusionsIn this work, a new procedure was proposed that estimated the IQFINV value using the equivalence criterion between the CIRS phantom and the CDMAM test object with their respective PMMA plates. Based on the optimization carried out in this investigation, the AEC parameters, considering diverse glandularities, could be improved. This achievement permits the implementation of new protocols that optimize the ratio between the image's quality and the breast dose with 6.0 cm in thickness and 20 %, 30 %, and 50 % glandularity using contrast-detail metric.

THE RISE OF FAMILY VIOLENCE AND PARENTING STRESS DURING THE COVID-19 PANDEMI: FAMILY SCIENCE PROPOSED SOLUTIONS AND DIRECTION

The rise of family-oriented misconduct is rising during the pandemic situation due to multiple problems related to economy, social and even many other physical embodiments in the element of living. In the theory of living substances, internal parental, external resources and parental perceptions towards all of the stressors element will impact how families cooperate with all of these burdens that they face, which may impact the possibility of child abuse, physical and mentally. This paper will uncover all of the available stressors that happen as a consequence of COVID-19 pandemic using the family stress theory at the family and society level, and then further elaborates how these elements are associated with family violence via parents perceptions and coping strategies. This research will also elaborate with the possible future obstacles that families may face during the implementation of new protocols, strict market revenue, and many other possible social barriers and obstacles ahead within the possible future change and development of society conditions. Keywords: Covid-19, family stress theory, child abuse risk, perception

Impact of COVID-19 on incidence and treatment of intracranial aneurysms in Poland: a national study.

The COVID-19 pandemic greatly disrupted the national healthcare system in Poland, resulting in the implementation of new protocols allowing only patients with severe diagnoses to receive immediate treatment. Given that an intracranial aneurysm (IA) is regarded as one of the most severe diagnoses, we planned to assess whether the current protocol has successfully provided the standard treatment for IAs. Data on all IA cases treated from 2015 to 2020 was extracted from the JGP (a homogeneous group of patients) catalogue provided by the National Health Index of Poland (NFZ, Narodowy Fundusz Zdrowia). Poisson regression was used to determine the significance of the change in hospital admissions, and differences between proportions were analysed using the "N-1" Chi-squared test. A total of 21,801 IA patients treated during 2015-2020 were included in this study. The overall number of hospitalisations due to IAs fell in the open surgery group, but not in the endovascular cohort. Mortality rates following IA treatment increased significantly by 21% in 2020 compared to preceding years. The demographics changed as well; the patients were significantly younger during the pandemic. Our findings show that the current strategy for optimal care for patients diagnosed with IAs in Poland during the pandemic is failing to maintain high quality treatment. New methods to improve the current plan should be implemented to address future crises.

Reproduction of Ooencyrtus submetallicus (Hymenoptera: Encyrtidae) and Trissolcus sp. aff. urichi (Hymenoptera: Scelionidae) in Eggs of Nezara viridula (Hemiptera: Pentatomidae) of Different Ages

The study of the interaction between parasitoid and host, especially the age of these organisms, is an important step towards the implementation of biological control programs. Therefore, we investigated the performance of Ooencyrtus submetallicus (Hymenoptera: Encyrtidae) and Trissolcus sp. aff. urichi (Hymenoptera: Scelionidae) parasitizing eggs of Nezara viridula (Hemiptera: Pentatomidae), considering different ages of the parasitoids and the host. We performed four laboratory bioassays: two using females of O. submetallicus and Trissolcus sp. aff. urichi at 24, 48, 72, 96, 120, or 144 hours of age exposed to parasitism in N. viridula eggs (24 h) and two trials with N. viridula eggs at 24, 48, 72, 96, 120, or 144 hours exposed to the parasitism of O. submetallicus and Trissolcus sp. aff. urichi (24 h). We evaluated the percentage of parasitism and emergence, life cycle length, progeny, sex ratio, and the longevity of the parasitoids. The parasitism of O. submetallicus in N. viridula eggs was influenced by the age of the parasitoid, 120 hours being the minimum to obtain better parasitism. From this age on, there is interference in the longevity of the progeny. Trisolcus sp. aff. urichi, at all ages, parasitized N. viridula eggs relatively well, but with almost no emergence of the parasitized eggs. Females of O. submetallicus parasitized and developed in eggs of N. viridula of all ages. Females of Trissolcus sp. aff. urichi parasitized their host, but there was barely any emergence. These pieces of information regarding the breeding methodology contribute to the implementation of new protocols for the multiplication of these parasitoids in the laboratory, and later, their release in the field.

An Evaluation of Hemoglobin A1c Monitoring at a Student-Run Free Clinic in Kansas City, Missouri

Background: The hemoglobin A1c is critical for monitoring and managing type II diabetes and providing clinicians with a framework for a treatment plan. Our study analyzes compliance to the American Diabetes Association (ADA) standards of appropriate A1c monitoring and encourages other clinics to monitor the same information within their own clinics.
 Methods: A retrospective chart review was conducted on all patients who visited the Sojourner Health Clinic between January 2017 and November 2019. All patients who had met the criteria for A1c screening based on recommendations from the ADA were included in the study, as well as patients who were charted as diabetic or pre-diabetic. A total of 88 patients met the criteria for this study. Data collected included patient documentation as diabetic or pre-diabetic and patients’ three most recent A1c values with corresponding dates. Based on this data, these patients were categorized as diabetic, pre-diabetic, or non-diabetic, and were evaluated on whether their A1c was monitored at appropriate intervals.
 Results: A total of 21.6% of patients were monitored appropriately for their diabetic status determined by their A1c values. Only 18.2% of diabetic patients were accurately monitored. Patients with an unknown diabetic status had the lowest rate of appropriate monitoring.
 Conclusions: Most patients at the Sojourner Health Clinic are not properly monitored for diabetes using the clinic's modified A1c monitoring guidelines. The clinic can make several improvements to strengthen adherence to these guidelines with the implementation of new protocols for better A1c monitoring. Further studies should be made to assess the efficacy of these changes.

Neurosurgery perception of Enhanced Recovery After Surgery (ERAS) protocols

Enhanced Recovery After Surgery (ERAS) protocols are widespread in several fields, particularly general surgery, and attempt to deliver surgical care at a lower cost while also improving patient outcomes. However, few institutions have implemented ERAS protocols in neurosurgery. As such, a survey of neurosurgeons on the current state of ERAS in neurosurgery was conducted to provide insight on scaling the practice nationally. A 15-question survey was designed to assess the implementation of andsatisfaction with ERAS protocols at individual institutions. A total of 39 responses were collected from 38 unique institutions. 58.9%(N = 23) reported implementation of neurosurgical ERAS protocols. 52.1% (N = 12) of the responses were neurosurgeons at academic institutions withneurosurgical residency programs. Most neurosurgeons used ERAS protocolsfor spine cases (N = 23), with only 17.3% (N = 4) employing ERAS protocolsfor cranial cases. 69.5% (N = 16) of survey participants reported that thedesign and implementation of ERAS was a multidisciplinary effort acrossmany departments, including neurosurgery, anesthesia, and pharmacy.Decreased costs and intensive care unit (ICU) admission were reported tobe unanticipated benefits of ERAS implementation. Unanticipated challenges to implementation of new protocols included difficulties withelectronic medical record (EMR) integration, agreement of protocoldetails amongst stakeholders, uniform implementation of protocols by allneurosurgeons, and lack of adaptability by multidisciplinary staff. Meandepartment satisfaction with ERAS protocol implementation was 4.00 +/− 0.81 (N = 22) on a 5-point Likert scale.

Greasing the wheels: The impact of COVID-19 on US physician attitudes and practices regarding medication abortion

ObjectiveTo explore US provider perspectives about self-sourced medication abortion and how their attitudes and clinic practices changed in the context of the COVID-19 pandemic. Study DesignWe conducted a multi-method study of survey and interview data. We performed 40 baseline interviews and surveys in spring 2019 and 36 follow-up surveys and ten interviews one year later. We compared pre- and post-Likert scale responses of provider views on the importance of different aspects of standard medication abortion assessment and evaluation (e.g., related to ultrasounds and blood-typing). We performed content analysis of the follow-up interviews using deductive-inductive analysis. ResultsSurvey results revealed that clinics substantially changed their medication abortion protocols in response to COVID-19, with more than half increasing their gestational age limits and introducing telemedicine for follow-up of a medication abortion. Interview analysis suggested that physicians were more supportive of self-sourced medication abortion in response to changing clinic protocols that decreased in-clinic assessment and evaluation for medication abortion, and as a result of physicians' altered assessments of risk in the context of COVID-19. Having evidence already in place that supported these practice changes made the implementation of new protocols more efficient, while working in a state with restrictive abortion policies thwarted the flexibility of clinics to adapt to changes in standards of care. ConclusionThis exploratory study reveals that the COVID-19 pandemic has altered clinical assessment of risk and has shifted practice towards a less medicalized model. Further work to facilitate person-centered abortion information and care can build on initial modifications in response to the pandemic. ImplicationsCOVID-19 has shifted clinician perception of risk and has catalyzed a change in clinical protocols for medication abortion. However, state laws and policies that regulate medication abortion limit physician ability to respond to changes in risk assessment.

Determinants of Missed Games Following Concussions in the National Football League

Concussions in the National Football League (NFL) are a rising topic of concern and debate. With the implementation of new protocols, NFL players are required to be removed from play and must follow specific processes before full return to play after sustaining a concussion. While concussion severity is the primary determinant of time-off, it is possible that other factors associated with player value influence time-off as well. The purpose of this study is to examine determinants of NFL games missed after a concussion. NFL concussion data from 2012 to 2015 were used in conjunction with player salary, position, previous concussions, average plays per game, and season during which the concussion occurred. Results indicate that quarterbacks and players who sustained multiple concussions missed more games, while players involved in more plays per game miss less games, providing evidence that player health and value are determinants of time-off after a concussion. Additionally, the number of games missed has increased each year, which could be the result of NFL efforts to increase safety and increased media attention.

Implementation of new protocol for pain management following cardiac surgery

Aims: We assessed the implementation and effectiveness of an updated protocol designed to improve pain management in cardiac surgery patients. The new updated protocol was recommended systemic pain assessment every four hours unless patients were unstable, using the numerical rating score (NRS) after the endotracheal extubation. Our secondary aim was to analyze the factors predicting patients’ postoperative pain to guide development of future pain management protocols. Methods: Fifty patients undergoing cardiac surgery with median sternotomy were evaluated in this audit. Perioperative details and details regarding analgesic administration were collected. High-risk patients were classified as ones with a history of substance misuse, chronic pain, and preoperative opioid use. Pain was measured at rest, on coughing and on moving, for the first three postoperative days (POD), using 11-point NRS (0–10). Pain was considered “unacceptable” if it was NRS ≥4 at rest, and NRS ≥8 on activity. A univariate and multivariate mixed model linear regression was used to investigate factors that may contribute to pain following cardiac surgery. Results: On POD1 38% of patients reported unacceptable pain at rest, and 27% reported unacceptable pain on coughing or moving. There was limited implementation of the new protocol, thus we cannot comment on the effectiveness of the updated protocol. Multivariate analysis demonstrated an overall significant interaction effect between postoperative day and risk (p = 0.032). It was found that high-risk patients reported pain to be greater than pain reported by low-risk patients on POD3 (2.14, CI −0.32 to 4.26, p = 0.054). Use of preoperative gabapentin did not affect pain at rest nor pain on coughing or moving (p > 0.5). Conclusion: The new pain protocol was not followed in the majority of patient cases. Preoperatively, only 25 (56%) patients received gabapentin. No patients received patient-controlled analgesia (PCA) postoperatively. Seven (15%) patients identified as high risk received no differential pharmacological management contrary to the updated protocol. It is believed that e-mail is not sufficient to implement a new protocol such as this, thus resulting in protocol implementation failure. However, it was found that postoperative pain differed between high-and low-risk patients, especially at rest. This indicates that risk assessment and individualized pain protocols are important to optimize postoperative pain management following cardiac surgery. We have discussed the efforts required to improve future protocol implementation and pain management across disciplines.

Antenatal corticosteroids and incidence of neonatal respiratory distress after elective caesarean section in late preterm and term neonates

IntroductionBirth by elective caesarean section in late preterm and early term newborn increases the risk of respiratory distress. Administration of antenatal corticosteroids in these cases could reduce the respiratory distress and its severity. ObjectivesTo determine the influence of antenatal corticosteroids use in elective caesarean sections in the respiratory distress of the newborn from 35+0 to 38+6 weeks of gestational age. Patients and methodsRetrospective analytical study of caesarean sections from 35+0 to 38+6 gestational age was conducted in a tertiary hospital from January 2013 to April 2017. Data were collected from medical records of pregnant women and newborns after an implementation of new protocol of betamethasone administration to these elective caesarean sections. Analysis was performed on 2 newborn subgroups: preterm newborn (PTN) 35–36 gestational age and term (TN) 37–38 weeks. ResultsA total of 208 elective caesarean sections were performed in the study period. Corticosteroids were administered in 97 (46.6%) of cases. The percentage of respiratory distress was higher in the group of preterm newborn compared to term newborn (29% vs. 8.8%, P<.001) and in term newborn higher at a lower gestational age. Between treated with corticosteroids or not, no significant differences were found in the treated and non-treated in the development of respiratory distress (PTN 30 vs. 30%, TN 9.1 vs. 6.9%, P=.6). ConclusionsNo statistically significant differences were found in this study in favour of the administration of an antenatal dose of betamethasone in the reduction of respiratory distress in the elective caesarean sections from 35+0 to 38+6 gestational age. The delay in the indication of elective caesarean sections, whenever possible, could help reduce the incidence of newborn respiratory distress.

Теоретичні засади та застосування блокчейн-технологій: імплементація нових протоколів консенсусу та краудсорсінг обчислень

Теоретичні засади та застосування блокчейн-технологій: імплементація нових протоколів консенсусу та краудсорсінг обчислень

Compliance with screening for and recommended management of maternal group B streptococcus carriage in pregnancy.

Universal screening of pregnant women at 35-37weeks gestation is recommended for detection of anogenital group B streptococcus carriage. Intrapartum chemoprophylaxis is prescribed to carriers to prevent transmission to babies, reducing early-onset neonatal group B streptococcal sepsis. To review compliance with, and the effects of education on group B streptococcus screening and intrapartum chemoprophylaxis practices at The Royal Women's Hospital, Melbourne, Australia. A retrospective audit of women delivering in February 2016 and February-March 2017 was conducted. In February 2017, updated early-onset group B streptococcal disease prevention guidelines were released and promoted with targeted education of clinical staff. Compliance was considered appropriate if practices followed up-to-date local protocols. Screening rate for group B streptococcus was 84.4% (599/710) and carriage rate 19.5% (109/558), while intrapartum antibiotic prophylaxis was optimal in 83% of those labouring greater than four hours (39/47). There was no significant difference in compliance between 2016 and 2017. Of 113 women with unknown group B streptococcal status at delivery, only five of 33 (15%) with clinical risk factors for early-onset neonatal disease received intrapartum prophylaxis. Compliance remained stable, with no change during or after implementation of new protocols. Compliance with protocols was low for cases with unknown group B streptococcal status at delivery but with the presence of one or more clinical risk factors for early-onset group B streptococcal sepsis.

Every ENT anesthesia fellowship needs a simulation-based education program

Every ENT anesthesia fellowship needs a simulation-based education program

The impact of "Option B" on HIV transmission from mother to child in Rwanda: An interrupted time series analysis.

BackgroundNearly a quarter of a million children have acquired HIV, prompting the implementation of new protocols—Option B and B+—for treating HIV+ pregnant women. While efficacy has been demonstrated in randomized trials, there is limited real-world evidence on the impact of these changes. Using longitudinal, routinely collected data we assessed the impact of the adoption of WHO Option B in Rwanda on mother to infant transmission.MethodsWe used interrupted time series analysis to evaluate the impact of Option B on mother-to-child HIV transmission in Rwanda. Our primary outcome was the proportion of HIV tests in infants with positive results at six weeks of age. We included data for 20 months before and 22 months after the 2010 policy change.ResultsOf the 15,830 HIV tests conducted during our study period, 392 tested positive. We found a significant decrease in both the level (-2.08 positive tests per 100 tests conducted, 95% CI: -2.71 to -1.45, p < 0.001) and trend (-0.11 positive tests per 100 tests conducted per month, 95% CI: -0.16 to -0.07, p < 0.001) of test positivity. This represents an estimated 297 fewer children born without HIV in the post-policy period or a 46% reduction in HIV transmission from mother to child.ConclusionsThe adoption of Option B in Rwanda contributed to an immediate decrease in the rate of HIV transmission from mother to child. This suggests other countries may benefit from adopting these WHO guidelines.

A nurse-driven protocol for oral rehydration therapy in mildly dehydrated pediatric patients

A nurse-driven protocol for oral rehydration therapy in mildly dehydrated pediatric patients

Postmortem coronary CT angiography

In the past few decades, the medical autopsy rate has markedly decreased owing to several factors such as the family’s refusal to provide consent, complexity of a time-consuming procedure, and fear of litigation in case of a missed diagnosis. On the other hand, CT and MR scans have increased the accuracy of diagnostic procedures and reduced the need for autopsy. However, medical autopsy remains of interest in the case of unexplained sudden death. Recently, postmortem computed tomography (CT) has emerged as an appealing alternative and compared favourably with conventional autopsy [1]. However, because of blood flow cessation, confirmation of diagnosis based on vascular opacification remains difficult. Recent advances in forensic medicine have prompted implementation of new protocols and use of a modified heart lung machine which temporarily restores blood flow and allows diagnosis of vascular pathologies. However, this requires surgical cannulation of the femoral vessels and might be difficult to implement on a routine basis [2, 3].