Multidisciplinary Care Approach Research Articles

A Critical Reappraisal of Haloperidol for Delirium Management in the Intensive Care Unit: Perspective from Psychiatry

Delirium is a complex neuropsychiatric syndrome with multifactorial pathophysiology, encompassing a wide range of neuropsychiatric symptoms, and its management remains a significant challenge in critical care. Although often managed with antipsychotics, like haloperidol, current research has predominantly focused on dopamine dysregulation as the primary driver of delirium, overlooking its broader neuroanatomical and neurochemical underpinnings. This has led to a majority of research focusing on haloperidol as a treatment for intensive care unit (ICU) delirium. Our review critically evaluates the role of haloperidol in ICU delirium management, particularly in light of recent large-scale randomized controlled trials (RCTs) that have primarily focused on delirium-free days and mortality as the primary endpoints. These studies highlight an limited understanding of the true nature of delirium treatment, which requires a broader, neuropsychiatric approach. We argue that future research should shift focus to neuropsychiatric symptoms such as agitation and psychosis and explore the clinical and functional benefits of reducing these distressing symptoms. Additionally, the stratification of delirium by subtypes and etiology, the enhancement of detection tools, and the adoption of multi-intervention and multi-disciplinary care approaches should be prioritized. Despite the methodological flaws in these studies, the findings support the safety of haloperidol in the ICU setting, with minimal risk of adverse events, particularly cardiac and neuropsychiatric. Moving forward, delirium research must integrate modern neuroscientific understanding and adopt more multi-disciplinary input and nuanced, patient-centered approaches to truly advance clinical care and outcomes.

Managing Retinitis Pigmentosa: A Literature Review of Current Non-Surgical Approaches

Retinitis pigmentosa (RP) is a heterogeneous group of inherited retinal diseases characterized by the progressive loss of photoreceptor function, visual impairment, and, ultimately, blindness. While gene therapy has emerged as a promising therapy, it is currently available only for the RPE65 gene mutation, leaving many patients without targeted genetic treatments. Non-surgical interventions may help in managing the progression of RP and improving patients’ quality of life. Visual training and rehabilitation, maximizing residual vision, have shown potential in improving mobility and patients’ ability to perform daily activities. Visual aids enhance visual function. Moreover, photo-protection demonstrated effectiveness in mitigating light-induced damage and improving visual comfort. Alternative therapies (i.e., electrostimulation, acupuncture, and ozone therapy) are being explored to preserve retinal function and reduce disease progression. Pharmacological interventions supported by nutritional and psychological counseling play a role in slowing retinal degeneration while managing the emotional burden of progressive vision loss. Although for these interventions, further validation is required, their potential benefits make them valuable additions to care for RP patients. The integration of these interventions into a multidisciplinary care approach—including ophthalmologists, orthoptist, dietitians, and psychologists—is essential for providing comprehensive, personalized care to RP patients while awaiting more widespread gene therapy solutions.

Comprehensive Clinical and Genetic Characterization of Kabuki Syndrome: A Case Series Study.

Kabuki syndrome is a rare congenital disorder characterized by a distinctive combination of craniofacial features, developmental anomalies, and intellectual disabilities. This study aims to provide a comprehensive exploration of Kabuki syndrome through a meticulous case series analysis focusing on its clinical features and genetic underpinnings. A cohort of 9 Kabuki syndrome patients was identified through a retrospective examination of medical records spanning from 1996 to 2022. These patients underwent various clinical assessments, radiologic investigations, neuropsychological evaluations, and targeted genetic analyses, specifically focusing on the KMT2D and KDM6A genes.The median age of diagnosis was approximately 4.7 years, with a male-to-female ratio of 6:3. Prominent clinical characteristics included distinctive facial features such as arched eyebrows, elongated eyelashes, ear abnormalities, fingertip pads, nasolabial anomalies, and oral alterations. Ophthalmologic and otologic manifestations were notable, alongside a spectrum of cardiovascular, gastrointestinal, and endocrine aberrations. The prevalence of neuropsychological disorders highlighted the cognitive and behavioral challenges experienced by Kabuki syndrome patients. Genetic investigations confirmed the involvement of variants in the KMT2D and KDM6A genes in the pathogenesis of Kabuki syndrome. In conclusion, this study emphasizes the importance of precise diagnosis, the adoption of a multidisciplinary care approach, and the tailored interventions for individuals affected by Kabuki syndrome. Furthermore, it underscores the need for continued research efforts to unravel the genetic intricacies and molecular mechanisms underlying this enigmatic syndrome.

Predictive Factors of Short Inpatient Stay Following Total Knee Replacement.

Enhanced Recovery after Surgery (ERAS) protocols adopt a multidisciplinary approach in perioperative care to reduce Length of Stay (LOS). This study aims to identify predictive factors resulting in short-stay following TKR with an ERAS programme. Retrospective analysis was performed on a consecutive series of patients who underwent unilateral TKR by a single surgeon in a tertiary institution between August 2019 and December 2021. Patient demographics, comorbidities and length of stay were collected using Electronic Medical Records. Short-stay was defined as LOS within 1day or less, while standard-stay was defined as LOS exceeding 2days or more. Statistical analysis was performed using R version 4.3.1. Logistic regression was performed for multivariate analysis. Ninety-nine patients were included in the study, comprising 45 short-stay patients and 54 standard-stay patients. Short-stay patients were significantly younger (mean 66.1, 95% CI [64.5, 67.7], p=0.0212) than standard-stay patients (mean 69.2, 95% CI [67.1, 71.2]). There was a significantly lower mean BMI among short-stay patients (26.98, 95% CI [25.52, 28.45], p=0.021) than among standard-stay patients (29.31, 95% CI [27.96, 30.66]). A significantly higher proportion of short-stay patients (84.4%, 95% CI [73.4, 95.5], p=0.00132) were premorbid community ambulant without aids than standard-stay patients (51.9%, 95% CI [38.1, 65.6]). There was no significant difference in sex, race, smoking, American Society of Anaesthesiologists score and Charlson Comorbidity Index (p>0.05). Multivariate logistic regression revealed the following significant factors: Age<75 (p=0.0293), BMI<25 (p=0.00688), and premorbid community ambulant without aids (p=0.0402). In conclusion, predictive factors for short-stay after TKR include age<75, BMI<25 and being premorbid community ambulant without aids.

Longitudinal analysis of blood pressure control and influencing factors among 32 701 primary care hypertensive patients with or without diabetes: a prospective cohort study in Jianye District, China.

We aimed to explore the variation in blood pressure (BP) control in primary care hypertensive patients with or without diabetes, and investigate potential factors associated with inadequate BP control during follow-up. Primary care hypertensive patients with and without diabetes were recruited in 2020 from Jianye District of Nanjing and prospectively followed up until 2023. Effective BP control was measured in terms of consistent normal readings of systolic BP <140mmHg and of diastolic BP <90mmHg based on the most recent assessment during the follow-up period. We used the negative binomial model with total person-years as an offset to evaluate whether the study population would achieve BP control after the 3-y follow-up period in terms of rate ratio (RR) and 95% CI. We further conducted subgroup analysis based on the absence or presence of clinically confirmed diabetes and BP stability at baseline. Of a total of 32 701 patients with hypertension, compared with those without comorbid diabetes and stable BP at baseline, patients with comorbid diabetes and unstable BP at baseline were less likely to have effective BP control at follow-up (adjusted RR=2.01, 95% CI 1.89 to 2.15). We observed an elevated risk of ineffective BP control at follow-up in those aged 60-70 y (1.69; 95% CI 1.56 to 1.83) or ≥70 y (1.73; 95% CI 1.59 to 1.88), females (1.09; 95% CI 1.03 to 1.16), those with a higher waist-to-height ratio (1.25; 95% CI 1.17 to 1.34), overweight/obese in terms of body mass index (1.16; 95% CI 1.09 to 1.23) or regularly consuming alcohol (1.26; 95% CI 1.16 to 1.37). Higher educational attainment indicated a reduced risk of ineffective BP control at follow-up (0.68; 95% CI 0.63 to 0.75). Achieving effective BP control remains a persistent challenge, especially for patients with comorbid hypertension and diabetes. In the absence of any novel strategies for hypertension care, the existing multidisciplinary care approaches could be repurposed and integrated for effective management of the aforementioned comorbid conditions in primary care settings.

A Cross-Sectional Study on the Quality of Life of Adults With Sickle Cell Disease Followed-Up in Outpatient Clinics: A Single-Center Experience.

Background Sickle cell disease (SCD) is a genetic blood disorder characterized by abnormal hemoglobin S, leading to red blood cell deformities, chronic hemolysis, and frequent vaso-occlusive crises (VOC). While advancements in medical care have improved survival rates, adults with SCD continue to face substantial challenges in their quality of life (QoL) due to chronic pain, recurrent VOCs, and various complications. This study aimed to evaluate the health-related quality of life (HRQoL) in adult patients aged 14 years and above with SCD and identify key factors influencing patient outcomes using the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me). Methods A cross-sectional study was conducted at the Prince Sultan Oncology Center, King Salman Northwest Armed Forces Hospital, Tabuk, Saudi Arabia, between December 2019 and May 2020. The study population comprised adult SCD patients attending outpatient clinics. The QoL was assessed using the ASCQ-Me Short Form, which evaluates five domains: emotional impact, social functioning, pain impact, sleep impact, and stiffness impact. Additionally, a nine-item SCD Medical History Checklist was used to evaluate complications and treatments. Data were collected through structured one-on-one interviews. Scores were transformed into T-scores (mean = 50, standard deviation (SD) = ±10) based on standardized guidelines. Inferential analysis was conducted to compare QoL domains between groups stratified by VOC frequency and severity using the Mann-Whitney U test, with a significance threshold of p ≤ 0.05. Results A total of 53 adult SCD patients were surveyed, with the majority aged 25-34 years (50%). Gender distribution was nearly equal, with 50.9% male participants. The prevalence of complications was notable, with 31% reporting chronic pain, 26% reporting gallstones, and 9% reporting avascular necrosis. Laboratory findings revealed a mean hemoglobin level of 8.63 g/dL (SD: 1.59) and an average fetal hemoglobin (HbF) level of 10.59% (SD: 5.64). The frequency of VOCs varied, with 30% of patients reporting no VOC in the past year, while 57% experienced two to three VOCs. Patients with higher VOC frequency (≥4 per year) reported significantly lower scores across all QoL domains except stiffness (p < 0.05). Higher VOC severity was associated with poorer sleep quality and social functioning (p < 0.05). Pain severity was also a critical determinant, with more than 55% of patients rating their last pain episode as severe or extreme. Conclusion The study highlights the significant burden of pain and VOCs on the quality of life in adult SCD patients. Frequent VOCs and chronic complications such as avascular necrosis and gallstones were major contributors to reduced HRQoL. Findings emphasize the need for comprehensive, multidisciplinary care approaches targeting pain management, psychological support, and functional independence. The ASCQ-Me tool proved valuable for identifying specific domains of impairment and guiding patient-centered interventions. Future research should focus on longitudinal studies to explore the efficacy of tailored interventions and address the ongoing challenges faced by this vulnerable population.

Developing a Core Outcome Set for Netherton Syndrome: An International Multi-Stakeholder e-Delphi Consensus Study

Introduction: Netherton syndrome (NS; OMIM#256500) is a rare and severe disorder of epidermal maturation and keratinization caused by pathogenic variants in the serine protease inhibitor Kazal type 5 (SPINK5), leading to severe skin barrier impairment. Although effective treatment is crucial for NS patients, there is a lack of knowledge on what the best treatment options are for these patients. Large heterogeneity in reported outcomes and measurement instruments hinders accurate comparison of treatment results across studies and the development of a treatment guideline. Therefore, we aimed to develop a core outcome set (COS) for NS that can be used in clinical care and research. Methods: This study was performed in accordance with the recommendations of the Core Outcome Measures in Effectiveness Trials (COMET) initiative. After identification of outcomes through a literature search and classification based on the International Classification of Functioning and taxonomies published by the COMET initiative, discussion groups were organized at the 2nd International Netherton Congress 2022 to finalize the provisional outcome list. Through a 2-round e-Delphi, 41 stakeholders (patients and family members, professionals, and representatives of industry) from 14 countries rated the importance of the outcomes using a 9-point Likert scale. An online consensus meeting attended by 14 stakeholders finalized the COS. Results: The COS for NS comprised 21 outcomes in 10 domains. These included four “skin” outcomes, two “sensation” outcomes, two “side-effects of treatment” outcomes, one “vitality” outcome, one “emotional functioning” outcome, two “physical development” outcomes, two “nutrition” outcomes, two “infections” outcomes, two “allergies” outcomes, and three “assessment results” outcomes. Conclusion: In this study, consensus was reached on 21 outcomes to be included in the COS for NS. The selection of outcomes in the COS underlines that NS not only affects the skin but is a disease requiring a broad multidisciplinary approach in clinical care and research. International implementation of this COS will lead to more uniform reporting, thereby enabling comparison of study results, which may facilitate future treatment guideline development. The next step is to further conceptually define the outcomes and reach consensus on how to measure these.

Empowerment and interprofessional collaboration in health promotion centre Murska Sobota

Abstract Background Health promotion centres (HPCs) were introduced in Slovenian primary health care centres to provide interventions against risk factors for noncommunicable diseases (NCDs). HPCs integrate a multidisciplinary and community-based primary care approach to the prevention of NCDs and provide free lifestyle intervention programmes. This study aims to explore the perspectives of health care professionals on promoting health of local community members, as well as their perceptions of interprofessional collaboration in HPCs. Methods Two group discussions were conducted with a total of 11 health care professionals at the HPC Murska Sobota. Data collection was accompanied by a dual role interpreter in accordance with the principles of cross-language qualitative research. The data was transcribed, semantically translated and thematically analysed. Results Health care professionals emphasize the importance of health-related empowerment of individuals for the success of health promotion activities and therefore for the improvement of individuals’ quality of life. This is based on shared decision-making, self-management and educational measures in a combination of population- and individual-based approaches. The need for efficient interprofessional communication, characterized by a flat hierarchy, is stressed. Structured cooperation with other health care facilities, as well as close collaboration with communities and local media, are described as crucial for reaching all individuals and promoting health equity. Conclusions Interprofessional collaboration, health-related empowerment of individuals and collaboration with local communities are fundamental for the success of health promotion activities, achieving health equity and preventing NCDs. Understanding how these activities are implemented from the health care professionals’ perspective can help other health facilities developing and improving local health promotion strategies. Key messages • Slovenian health care professionals see interprofessional collaboration as fundamental for the implementation of health-promotion strategies. • Health-related empowerment of individuals and collaboration with local communities play an important role in achieving health equity in health promotion activities.

A IMPORTÂNCIA DO ACOMPANHAMENTO ODONTOLÓGICO DURANTE O PRÉ NATAL

The study addresses the hormonal and physiological changes during pregnancy that directly affect the oral health of the pregnant woman and can have an impact on the baby. The objective of the work is to highlight the importance of prenatal dental care, addressing the most prevalent oral diseases in pregnant women, the impacts of these conditions on fetal development, the necessary care in the clinical management of pregnant women, and the importance of a multidisciplinary approach in care. The methodology was based on an integrative literature review, using databases such as PubMed, Scielo, and Google Scholar, with descriptors in Portuguese and English. Studies published between 2009 and 2024 that discuss dental interventions in pregnant women and the relevance of prenatal dental care were included. The results indicate that gingivitis and periodontitis are common conditions during pregnancy, potentially leading to complications such as premature birth and low birth weight. Proper dental care, carried out in a multidisciplinary manner, contributes to the prevention of these problems and improves the well-being of both the pregnant woman and the baby.

From diagnosis to postoperative challenges: a comprehensive case report on 2q37 deletion syndrome with CHD.

Chromosomal 2q37 deletion syndrome, marked by developmental delays, distinctive facial features, and a spectrum of congenital anomalies, presents significant challenges in the cardiac management of affected individuals. This paper details the case of an 8-month-old male with 2q37 deletion syndrome, manifesting atrial and ventricular septal defects, patent ductus arteriosus, and right ventricular outflow tract stenosis, leading to a demanding postoperative course. Despite an initially stable post-surgery phase, the onset of junctional ectopic tachycardia necessitated prolonged veno-arterial extracorporeal membrane oxygenation support, highlighting the syndrome's potential for intricate postoperative courses. The complexities encountered in this case, including extended renal replacement therapy and delayed thoracic closure, underscore the syndrome's multisystem impact and the critical need for tailored, multidisciplinary care approaches. This report contributes to the growing body of knowledge on the cardiac implications of 2q37 deletion syndrome, emphasising the importance of individualised surgical strategies and the ongoing exploration of genotype-phenotype correlations in this rare genetic disorder.

Pituitary Dıseases and Care in Pregnancy

The pituitary gland causes very serious effects on the body thanks to the hormones it secretes. The main pituitary diseases are prolactinoma, acromegaly, lymphocytic hypophysitis, pituitary insufficiency (hypopituitarism), Cushing's syndrome and Sheehan's syndrome. Since pregnancy is rare in these diseases, the diagnosis is usually made in the pre-pregnancy period. A definitive diagnosis is made by means of disease-specific diagnostic tests accompanied by symptoms and findings seen in the pre-pregnancy period. Anatomical and physiological changes in the pituitary gland during pregnancy cause difficulties in the diagnosis of pituitary diseases. For this reason, the care to be given in pituitary diseases should be carried out effectively from the pre-pregnancy period. These diseases cause serious complications for both mother and foetus and require a multidisciplinary care approach. Midwives and other health professionals, who have a major role in the multidisciplinary team providing care, should be familiar with the symptoms, diagnosis and treatment methods of pituitary diseases and an individualised care management specific to the disease should be carried out.

AN UPDATE ON DIAGNOSIS AND MANAGEMENT OF THROMBOEMBOLISM IN PREGNANCY

Thromboembolism during pregnancy poses a significant challenge in maternal healthcare, substantially contributing to maternal morbidity and mortality worldwide. Understanding its diagnosis and management is crucial for improving maternal and fetal outcomes. Objective: To evaluate the diagnosis and management of thromboembolism in pregnant women. Methods: A retrospective cohort study was conducted at Lady Reading Hospital, Peshawar, from July 2022 to July 2024. The study included 175 pregnant females diagnosed with venous thromboembolism (VTE) during their pregnancy. Data were collected on patient demographics, trimester of diagnosis, type of thromboembolism (deep vein thrombosis [DVT] or pulmonary embolism [PE]), treatment modalities, and outcomes. Patients were treated with either low molecular weight heparin (LMWH) or unfractionated heparin (UFH). Descriptive statistics were used to analyze the data, with results presented as percentages and means with standard deviations. Results: The mean age of the participants was 32.01 ± 2.35 years. Thromboembolism was most commonly diagnosed in the third trimester (65%), followed by the second trimester (25%) and the first trimester (10%). DVT was observed in 74% of patients, while PE occurred in 26%. Among the 160 patients treated with LMWH, 3% (5 patients) experienced a recurrence of VTE. Of the 15 patients who received UFH, 5% (8 patients) had significant bleeding complications. Overall maternal outcomes included a 3% recurrence rate of VTE and a 5% rate of significant bleeding complications. No maternal mortality was reported. Conclusion: Early diagnosis and timely management of thromboembolism in pregnancy, mainly through the use of low molecular weight heparin and a multidisciplinary care approach, significantly improve maternal and fetal outcomes. LMWH was associated with fewer complications compared to UFH, highlighting its effectiveness and safety in treating pregnant women with VTE.

Exploration of Management Strategies for Type 2 Diabetes among Wounded Patients: A Review

The management of type 2 diabetes mellitus (T2DM) in patients with wounds posed a complex challenge, requiring a multifaceted approach to optimize glycemic control and improve healing outcomes. T2DM impaired the body’s natural healing processes, increasing the risk of chronic wounds, particularly diabetic foot ulcers (DFUs), which can lead to severe complications such as infections and amputations. This review explored various management strategies tailored for wounded patients with T2DM, including the importance of maintaining optimal glycemic levels, dietary interventions, pharmacological treatments, and multidisciplinary care approaches. The review was conducted by synthesizing current research findings, clinical studies, and systematic reviews on glycemic control, dietary interventions, pharmacological treatments, and multidisciplinary approaches in managing wounds among patients with T2DM. Key findings indicate that tight glycemic control, particularly with target hemoglobin A1c (HbA1c) levels between 7.0% and 8.0%, enhances wound healing, while overly aggressive management may have adverse effects. Nutritional strategies like Mediterranean and low-carbohydrate diets improve insulin sensitivity and reduce inflammation, while pharmacological treatments like metformin, GLP-1 receptor agonists, and SGLT-2 inhibitors improve glycemic control and overall health outcomes. A multidisciplinary team (MDT) approach is highlighted as a critical factor in improving patient care, with evidence showing significant reductions in HbA1c levels among patients treated by MDTs. Future research should focus on standardizing protocols, leveraging emerging technologies, and assessing the long-term effects of integrated management strategies on wound healing and quality of life. Keywords: Type 2 Diabetes Management, Glycemic Control, Wound Healing, Dietary Interventions, Multidisciplinary Care.

Modernizing Endocarditis Treatment Through a Multidisciplinary Team Approach

Fostering a multidisciplinary team approach in cardiovascular care to manage valve disease and heart failure is not a new concept; however, it is underused in the setting of infective endocarditis (IE). IE is one of the deadliest medical conditions largely due to a delay in diagnosis and treatment as a result of the time used to individually coordinate care between multiple specialties. Research shows a multidisciplinary endocarditis team decreases mortality rates by decreasing the time between admission and initiating treatment. Patients with IE secondary to intravenous substance abuse pose complex challenges to developing an effective, comprehensive, multidisciplinary endocarditis team.

Successful Treatment of Pulmonary Embolism Causing Cardiac Arrests with Reteplase during Neurosurgery: A Case Report

Pulmonary embolism can cause cardiac arrest. Fibrinolytic therapy and surgical embolectomy can be used to manage it. This case report presents the clinical course of a patient who experienced intraoperative cardiac arrest resulting from massive pulmonary embolism. The patient encountered three instances of cardiac arrest requiring 35 minutes of cardiopulmonary resuscitation. Subsequent treatment involved the administration of reteplase, a thrombolytic agent. Following resuscitation, the patient developed multiple organ dysfunction in the intensive care unit, necessitating the use of diverse medications. Successful resolution of organ dysfunction led to the patient's transfer to the neurosurgery department. This case highlights the complexities involved in managing pulmonary embolism-induced cardiac arrest and subsequent multiorgan dysfunction, emphasizing the significance of a multidisciplinary approach in the comprehensive care and treatment of these patients.

Evaluating Family Coping Mechanisms in Pediatric Seizure Disorders: From Emergency Room to Long-Term Follow-Up.

Pediatric seizure disorders profoundly impact family dynamics, often escalating stress and impairing coping mechanisms. This study aimed to longitudinally assess the impact of pediatric seizures on family stress and coping, evaluating the efficacy of multidisciplinary follow-up care in enhancing psychological resilience and adaptation. A longitudinal study design was implemented, enrolling children aged 1-18 who presented with a first seizure and received a neurologist's diagnosis at the Emergency Clinical Hospital for Children "Louis Turcanu," Timisoara, Romania. Validated questionnaires, including the Parenting Stress Index (PSI), Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS-10), and Parental Concerns Questionnaire (PCQ), were employed at baseline, 6, and 12 months. Statistical analysis utilized ANOVA and t-tests to evaluate changes in stress and coping outcomes. The study involved 68 families, with significant reductions in stress and anxiety reported over the follow-up period. Initial PSI scores showed high stress levels across various domains: Emotional Stress (59.47) decreased to 50.63 at one year; Parent-Child Communication Difficulties started at 66.03 ± 20.15 and reduced to 56.92 ± 18.74; and Total Family Stress decreased from 65.55 to 55.97. The HADS scores indicated initial anxiety and depression at 8.2 ± 3.1 and 7.1 ± 2.8, respectively, with reductions to 6.8 and 5.9 by the end of the year. The overall HADS score showed a decrease from 15.4 to 12.8. PCQ results mirrored these findings, with Total Score dropping from 9.7 to 7.7. PSS-10 scores declined from 13.5 to 11.3, with a significant reduction in the positive sub-score. The proactive, multidisciplinary care approach significantly reduced stress and enhanced coping mechanisms in families dealing with pediatric seizures. The decreases in stress, anxiety, and depression scores highlight the potential for integrated care models to improve long-term outcomes in these families. These findings support the continued development of targeted interventions to aid in the management of chronic pediatric conditions.

Effectiveness of a delirium risk assessment and multidisciplinary care approach in reducing delirium incidence among surgical intensive care unit patients: A retrospective pre-post intervention study

BackgroundDelirium is a common complication in intensive care unit (ICU) patients. It can lead to various adverse events. In this study, we investigated the effectiveness of combining the use of the PREdiction of DELIRium (PRE-DELIRIC) model for delirium risk assessment and the use of a multicomponent care bundle for delirium assessment, prevention, and care in terms of reductions in the incidence of delirium among surgical ICU patients. MethodsThis retrospective study included surgical ICU patients who had received PRE-DELIRIC-guided SMART/SmART care (SMART care: SmART bundle plus multidisciplinary team; SmART care: Sleep/sweet sense of home (creating a comforting and restful environment for patients), Assessment (regular and thorough evaluation of patient needs and conditions), Release (revised endotracheal tube care/removal, restraint device care, and immobility reduction for patient comfort), and Time (reorientation of time to optimize patient care schedules) in our hospital between May 2022 and March 2023 (intervention group) and individuals who had received usual care between January 2021 and April 2022 (historical control group). The SmART intervention involves providing care in the following domains: sleep/sweet sense of home, assessment, release, and time. Patients with a PRE-DELIRIC score of >30% received SMART care, which includes multidisciplinary (physicians, pharmacists, respiratory therapists, and physiotherapists) care in addition to SmART care. For the control group, usual care was provided following the guidelines for the prevention and management of pain, agitation, delirium, immobility, and sleep disruption. The primary outcome was delirium incidence during ICU stay, which was assessed using the Intensive Care Delirium Screening Checklist. The secondary outcomes were the duration of ICU stay, rate of unplanned self-extubation, and status of ICU discharge. ResultsThe intervention and control groups comprised 184 and 197 patients, respectively; their mean ages were 63.7 ± 18.4 years and 62.4 ± 19.5 years, respectively. The incidence of delirium was significantly lower (p = 0.001) in the intervention group (22.3%) than in the control group (47.7%). ConclusionOur findings suggest that the PRE-DELIRIC-guided SMART/SmART care intervention is effective in preventing and managing delirium among surgical ICU patients.

Increased Risk of End-Stage Kidney Disease in Patients with Chronic Kidney Disease and Heart Failure with Reduced Ejection Fraction

Plain Language SummaryChronic kidney disease (CKD) and heart failure (HF) are two conditions that are common, often coexist and cause higher rates of mortality. However, the effect of HF on the incidence of end-stage kidney disease (ESKD) is not well studied. This observational study aimed to understand the association between a specific type of HF, HF with reduced ejection fraction (HFrEF), and the incidence of ESKD. Our study showed that the presence of HFrEF in an individual with CKD was associated with a higher risk of ESKD. These findings were consistent after correcting for other related factors such as age, diabetes, and urinary protein by using two methods of propensity matching. These findings highlight the importance of using appropriate measures such as a multidisciplinary health care approach and utilising protective medications to delay the progression of CKD.

Body Dysmorphic Disorder in Aesthetic and Reconstructive Plastic Surgery-A Systematic Review and Meta-Analysis.

(1) Background: Body dysmorphic disorder (BDD) presents significant challenges in aesthetic and reconstructive plastic surgery, impacting patient outcomes and well-being. Understanding its prevalence and associated factors is crucial for effective patient care. (2) Methods: A systematic review of national and international databases on body dysmorphic disorder, plastic surgery, cosmetic surgery, reconstructive surgery, and prevalence yielded 999 studies between 1878 and April 2024. Inclusion criteria focused on studies reporting prevalence while excluding those with small sample sizes (<20 participants), unclear diagnostic criteria for BDD, and non-English accessibility. (3) Results: A meta-analysis using a random effects model was conducted on 65 studies involving 17,107 patients to estimate the prevalence of BDD. The overall estimated prevalence of BDD was 18.6%; 10,776 (62.9%) were females, with a mean age of 35.5 ± 11.7 years. Subgroup meta-analysis found significant variability in effect sizes across countries and types of specialty, of which Brazil showed the highest proportion and dermatology exhibited the smallest. Meta-regression analysis found no significant relationship between the year of publication and prevalence rates. (4) Conclusions: Our findings update the current literature on BDD prevalence in aesthetic and reconstructive plastic surgery. We emphasize the importance of proactive screening and multidisciplinary care approaches to address the complex challenges posed by patients with BDD. Further research is needed to explore evolving trends in BDD prevalence and factors influencing its expression across different cultural contexts.

Examining characteristics of those who receive pedorthic services: A clinical audit.

Diabetes-related foot complications, including neuropathic plantar forefoot ulcers, are a significant contributor to morbidity and increased healthcare costs. This retrospective clinical audit examines the characteristics of people accessing pedorthics services who are at risk of neuropathic plantar forefoot ulcer (re)occurrence and the pathways and funding models used to access these services. A clinical record audit was conducted on all patients accessing a pedorthics service who had diabetes and neuropathy with a history of plantar forefoot ulceration. The data included demographics, diabetes and neuropathy duration, main forefoot pathology and other comorbidity, footwear and insole interventions, and health fund access status. A total of 70 patient records were accessed, and relevant data was extracted. The mean age of participants was 64.69 (standard deviation (SD) 11.78) years; 61% were male and 39% female. Duration of diabetes ranged from one to 35 years, with a mean of 14.09 years (SD 6.58). The mean duration of neuropathy was 8.56 (SD 4.16) years. The most common forefoot conditions were bony prominences at 71% (n = 50), rigid flat foot and limited joint mobility (53%, n = 37), and hallux abductovalgus at 47% (n = 33). All participants had hyperkeratosis; 34% (n = 24) had forefoot amputation, and around 34% (n = 24) had a history of digital amputation. Various publicly funded packages and private health insurance were accessed. This study investigates the sociodemographic and medical profiles of individuals with diabetes-related foot complexities prone to neuropathic plantar forefoot ulcers. It is the first to examine patients receiving pedorthic services, informing practitioner surveys and preventive care strategies. Understanding patient characteristics aids in optimising multidisciplinary care and reducing ulcer incidence. Further studies are warranted to explore the field to establish an effective multidisciplinary care approach between medical professionals, podiatrists and pedorthists to optimise patient outcomes.