Patient Bedside Research Articles

Importance of IP-10 as a biomarker of host immune response: Critical perspective as a target for biosensing

While the exploration into biomolecules for diagnostic and prognostic devices continues to develop, many molecules continue to be examined for individual diseases or treatments. Consequently, it can be difficult to fully understand the scope of one individual molecule’s current and potential clinical utilization. The scope of this study aimed to assess the potential of Interferon Gamma-induced Protein 10 (IP-10) as a biomarker in a wide variety of diseases, both as a main and supplemental indicator of disease infection and progression. IP-10 is a chemokine secreted in response to IFN-γ playing a major role in the activation and regulation of inflammatory and immune responses within the body. Currently, IP-10 has displayed potential application in diseases such as COVID-19, tuberculosis, sepsis, Kawasaki disease, cancer, and many more. Molecular assays developed for the detection of IP-10 take longer testing time, sophisticated instrument utilization, and need more sample volumes. These cannot be utilized for bedside patient monitoring during the illness state of the patient. Biosensing tools are alternative methods used at clinical sites due to their rapid results. Though many types of sensing mechanisms established for the detection of disease biomarkers such as optical, piezoelectric sensors, and electrochemical biosensors are far beyond the other sensing methods due to their ease of mechanism, rapid results, and portable nature. IP-10 has been a promising biomarker in different diseases, evaluation of IP-10 levels at different time points of treatments is necessary. To achieve this, current conventional methods cannot be used and thus a portable device that provides rapid results is in demand. Such point-of-care (POC) device development for IP-10 analysis is very crucial in the current scenario. Beyond this, the clarification of its physiological role in healthy and infected individuals could allow for more proper utilization in clinical diagnoses, prognoses, treatment monitoring, and more. Overall, this study was developed to summarize the associations currently created between levels of IP-10 and other biomolecules and diseases.

Relationship between Nurses’ Attitudes and Satisfaction with Bedside Shift Reports and Patient Safety Culture

Background: A thoroughly standardized nurse bedside shift report, including effective communication, may improve nurses’ satisfaction and patients’ safety. However, a few studies were found that measure the relationships between nurses’ attitudes and satisfaction with bedside shift reports and patient safety outcomes.Purpose: This study aimed to measure nurses’ attitudes and satisfaction with bedside shift reports and their relationships with patient safety culture.Methods: A cross-sectional and descriptive study was conducted between May to August 2021 among 90 bedside nurses conveniently recruited from a public hospital in Lebanon. The Bedside Handover Report Staff Nurses’ Satisfaction Survey and the Survey on Patient Safety (SOPS) were used to collect data. Data were analyzed using descriptive statistics such as mean and standard deviation and inferential statistics, i.e., Pearson correlation coefficient.Results: The results showed that satisfaction scores were high in all the questions in the bedside shift reporting. The participants showed relatively positive attitudes towards bedside shift reports where all the statements recorded above-average mean values. The highest-ranking statement “bedside shift report is completed in a reasonable time” was recorded with a mean value of 3.35 (SD=0.87), while the lowest-ranking statement was “bedside shift report is relatively stress-free” with a mean value of 2.03 (SD=0.86). There were significant relationships between nurses’ satisfaction with shift reports and some patient safety culture composites, such as between nurses’ satisfaction with bedside shift reports and communication about errors and reporting of patient safety events (p<0.05) and between nurses’ attitudes toward bedside shift reports and communication about errors (p<0.001)Conclusion: Implementation of the bedside shift report improves nurses’ levels of satisfaction, enhances positive attitudes toward work, and enhances patients' safety. Nursing leaders should encourage nurses to implement bedside handover reports in their hospitals.

Simple and Easily Interpretable Flap Monitoring Method Using a Commercial Pulse Oximeter and a Widely Used Bedside Patient Monitor.

Background Various methods for monitoring after free flap surgery have been reported in the literature. Among them, pulse oximetry shows a sensitive reaction to vascular issues, and it is easy to interpret visually. However, previous reports used special equipment that was less commonly used and difficult to generalize. In this study, we used a commercial pulse oximeter and a widely used bedside patient monitor to monitor transplanted free tissue and lower extremities of healthy subjects with impaired circulation. Methods A reflectance pulse oximeter sensor was attached on the flap after free tissue transplantation. The sensor was connected to a bedside patient monitor, and the flap oxygen saturation (SpO2) levels and arterial waveforms were continuously monitored. Additionally, blood circulation disorder was induced in the lower limbs of healthy volunteers using pressure cuff inflation on the thigh, and the waveform and SpO2 levels on the pulse oximeter attached to the lower leg were monitored. Results Twenty-two patients were included in this study. No postoperative vascular issues were observed in any case. Pulse oximeters showed normal rhythmic wavelengths, and the flap SpO2 level ranged approximately >90%. The pulse oximeter waveform rapidly disappeared during arterial occlusion in the thigh pressure cuff inflation test, and the waveform flattened and the SpO2 level decreased slightly during venous congestion. Conclusion Flap monitoring using a commercially available pulse oximeter and a bedside patient monitor is a versatile, easy-to-interpret, and useful method. Changes in waveform and SpO2 levels appear during arterial and venous circulation disorders, and these changes can be differentiated.

Clinical and pedagogical school of Semen Semenovich Zimnitsky

The clinical and pedagogical school of Semyon Semyonovich Zimnitsky is described in close connection with the evolution of his academic status, changes in clinical bases and the social structure of society at the beginning of the 20th century. S. S. Zimnitsky took part in the creation of the Clinical Institute, opened the department of infectious diseases, founded the department of propaedeutics of internal diseases at Kazan State University. The outstanding talent of the lecturer and deep knowledge of clinical material won the love of affection and junior doctors. S. S. Zimnitsky creates methods for teaching therapy at the patient bedside in practical classes and in a lecture course, has an active professional position and is fighting with unreconstructed university professors.

Nurses' perceptions of point of care testing in critical care: A cross-sectional survey.

Nurses working in critical care (intensive or high dependency care units) perform a multitude of tasks including point-of-care testing (POCT), where diagnostic tests are performed at or near a patient's bedside. POCT can speed up clinical decision-making, but errors can occur at any point in the pre-analytical phase. To investigate nurses' perceptions of current POCT practice in critical care pre and post the COVID-19 pandemic. An online cross-sectional survey of critical care nurses undertaken 2019-2021. Nurses across Europe were invited to participate during a conference and via communication from professional organizations. A total of 158 critical care nurses responded to the survey. All respondents who stated their location reported being residents of the UK. Alongside challenges related to training and competence, frequency of sampling and sampling volumes were key concerns, seen to be associated with increased blood wastage and nursing workload, potentially increasing the potential for error, and leading to poorer patient and staff outcomes. Results from this study highlight the impact of POCT on nurses' workload, patient care provision and staff wellbeing. Alongside exploring feasible and effective training models, innovative roles, which provide technical support, including undertaking POCT could enable nurses more time to provide care to patients and families. Any future changes in workforce allocation must, however, be fully evaluated from the perspective of both patient and staff outcomes.

The Benefits of a Transdisciplinary Trach Team in Inpatient Rehabilitation

<h3>Research Objectives</h3> Investigation of benefits of a transdisciplinary trach team in an inpatient rehabilitation environment via exploratory research design focusing on knowledge translation and enhanced patient experience. <h3>Design</h3> Following establishment of a transdisciplinary trach team, including representatives from nursing, respiratory care and speech therapy, we developed a qualitative study to track outcomes. Targeted diet progression via IDDSI and trach size/type, speaking valve trials, capping trials and decannulation. <h3>Setting</h3> Inpatient rehabilitation hospital. <h3>Participants</h3> Patients admitted with tracheostomy. <h3>Interventions</h3> Holding twice weekly walking rounds, at patient bedside. Discussions during rounds resulting in changes to patient status are reflected on in room signage as well as charted in the medical record. <h3>Main Outcome Measures</h3> The apriori hypothesis of this study was the transdisciplinary trach team leads to increased communication between team members and therefore fewer days to diet upgrade and decannulation. A team member tracks number of days each patient remains with a trach, use of speaking valve, and diet progression. The IDDSI scale has strong consensual validity as a measure of the patient's diet texture. <h3>Results</h3> For this qualitative study, data for first 12 weeks showed: Participation in average of 3.5 rounds 7 patients (60%) admitted on diets below "regular" diet of IDDSI 7/0 progressed to IDDSI 5/0 or higher 10 patients progressed to decannulation (80%) <h3>Conclusions</h3> The role of the transdisciplinary trach team is cited as beneficial to the tracheostomized patient's outcomes especially considering the potential for these patients to have complex needs . In this qualitative study, a common theme among the population was advancement of diet and progression toward decannulation. This information was gathered through analysis of data documented in patients' medical record and tracked via spreadsheet. The data support the hypothesis that a trach team enhances patient outcomes. Considerations for further qualitative investigation include use of PROMs to explore experience of all stakeholders regarding in-person rounds and interviews to determine the individual's perceptions of the team rounds. Additionally utilizing analysis software to manage our data could only enhance the analysis of our data. <h3>Author(s) Disclosures</h3> None.

Basic notions of lung ultrasound in neonatology.

Lung ultrasound (LU) has gained ground in the diagnosis of most respiratory conditions present since birth. It is highly sensitive to variations in air content and pulmonary fluids and functions as a true densitometer of the lung parenchyma with a sensitivity superior to that of radiological studies. A LU is a non-invasive, fast and easy tool that can be used at the patient's bedside and, unlike conventional radiology, does not pose risks of radiation. In addition, a LU provides real-time dynamic information in a variety of neonatal settings and, like heart and brain examinations, can be performed by the neonatologist. The objective of this article is to describe the main artifacts and images that can be found in the neonatal LU, as well as the different aeration patterns, and to highlight their usefulness in the study of the most frequent respiratory disorders of neonates.

Translating the Coma Recovery Scale-Revised into Clinical Practice Using Person-Centered Measurement Principles

<h3>Research Objectives</h3> To co-create a Recovery Ruler, that visualizes Coma Recovery Scale-Revised (CRS-R) assessment results, reflecting person-centered measurement principles (co-created, patient-driven, holistic, transparent, comprehensible and timely). We examined pre-implementation factors (usability, acceptability, appropriateness, and feasibility) to determine whether the Recovery Ruler was ready for usability testing. <h3>Design</h3> Concurrent mixed methods using two design groups and four surveys. <h3>Setting</h3> N/A. <h3>Participants</h3> 6 family care partners (FCP) and 8 rehabilitation practitioners (RP) who have experience caring for a person with disorders of consciousness following a brain injury. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> System Usability Scale (SUS), Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM). <h3>Results</h3> An initial prototype of a Recovery Ruler visualized the CRS-R keyform from Rasch analysis. Content analysis identified Recovery Ruler elements that could be added, removed, or changed. During design group 1, participants added a descriptive text box to incorporate the patient's preferences (patient driven), suggested the Recovery Ruler be laminated to place at the patient's bedside (transparent), and changed words to clarify concepts (comprehensible). These changes were reflected in a revised Recovery Ruler during Design Group 2. There was a significant increase between the SUS scores from the revised Recovery Ruler shown during Design Group 2 (M=83.3, SD=11.9) and initial Recovery Ruler prototype shown in Design Group 1 (M= 77.9, SD=13.3) indicating improved usability; t(11) 1.84, p=0.045. The Wilcoxon singed rank test suggested that results from Design Group 2 on the AIM and IAM were statistically significantly higher than the results on these scales from Design Group 1 indicating improved acceptability and appropriateness. The FIM did not show a statistically significant difference between scores from each design group, but the median and mean were consistently > 4 (agree) on the average scale score indicating good feasibility. <h3>Conclusions</h3> Complex information from a Rasch co-calibration was embedded into the Recovery Ruler that reflects person-centered measurement principles. FCPs and RPs determined the Recovery Ruler is usable, acceptable, appropriate, and feasible, ultimately ready for usability testing. <h3>Author(s) Disclosures</h3> N/A.

Basic notions of lung ultrasound in neonatology.

Lung ultrasound (LU) has gained ground in the diagnosis of most respiratory conditions present since birth. It is highly sensitive to variations in air content and pulmonary fluids and functions as a true densitometer of the lung parenchyma with a sensitivity superior to that of radiological studies. A LU is a non-invasive, fast and easy tool that can be used at the patient's bedside and, unlike conventional radiology, does not pose risks of radiation. In addition, a LU provides real-time dynamic information in a variety of neonatal settings and, like heart and brain examinations, can be performed by the neonatologist. The objective of this article is to describe the main artifacts and images that can be found in the neonatal LU, as well as the different aeration patterns, and to highlight their usefulness in the study of the most frequent respiratory disorders of neonates.

Abdominal Ultrasound Education for Gastroenterology Residents and Fellows

Ultrasound (US) is an essential diagnostic tool in almost every medical area. Therefore, abdominal US education for internal medicine residents was mandated by the Korean Association of Internal Medicine. However, US education for physicians has been conducted only in some university hospitals that directly perform abdominal US examinations in internal medicine, or some education is provided with the help of radiologists. US technology continues to become increasingly widespread, portable, and miniaturized. Furthermore, point-of-care US, i.e., US executed at the patient's bedside to obtain real-time objective information with diagnostic and clinical monitoring purposes or to guide invasive procedures, has been incorporated in many specialties. Despite the increasing role of US, there is no systemized abdominal US education program. Therefore, the authors are trying to develop a structured abdominal US education program through cooperation with related US organizations.

An automated bedside measure for monitoring neonatal cortical activity: a supervised deep learning-based electroencephalogram classifier with external cohort validation

Electroencephalogram (EEG) monitoring is recommended as routine in newborn neurocritical care to facilitate early therapeutic decisions and outcome predictions. EEG's larger-scale implementation is, however, hindered by the shortage of expertise needed for the interpretation of spontaneous cortical activity, the EEG background. We developed an automated algorithm that transforms EEG recordings to quantified interpretations of EEG background and provides simple intuitive visualisations in patient monitors. In this method-development and proof-of-concept study, we collected visually classified EEGs from infants recovering from birth asphyxia or stroke. We used unsupervised learning methods to explore latent EEG characteristics, which guided the supervised training of a deep learning-based classifier. We assessed the classifier performance using cross-validation and an external validation dataset. We constructed a novel measure of cortical function, brain state of the newborn (BSN), from the novel EEG background classifier and a previously published sleep-state classifier. We estimated clinical utility of the BSN by identification of two key items in newborn brain monitoring, the onset of continuous cortical activity and sleep-wake cycling, compared with the visual interpretation of the raw EEG signal and the amplitude-integrated (aEEG) trend. We collected 2561 h of EEG from 39 infants (gestational age 35·0-42·1 weeks; postnatal age 0-7 days). The external validation dataset included 105 h of EEG from 31 full-term infants. The overall accuracy of the EEG background classifier was 92% in the whole cohort (95% CI 91-96; range 85-100 for individual infants). BSN trend values were closely related to the onset of continuous EEG activity or sleep-wake cycling, and BSN levels showed robust difference between aEEG categories. The temporal evolution of the BSN trends showed early diverging trajectories in infants with severely abnormal outcomes. The BSN trend can be implemented in bedside patient monitors as an EEG interpretation that is intuitive, transparent, and clinically explainable. A quantitative trend measure of brain function might harmonise practices across medical centres, enable wider use of brain monitoring in neurocritical care, and might facilitate clinical intervention trials. European Training Networks Funding Scheme, the Academy of Finland, Finnish Pediatric Foundation (Lastentautiensäätiö), Aivosäätiö, Sigrid Juselius Foundation, HUS Children's Hospital, HUS Diagnostic Center, National Health and Medical Research Council of Australia.

Locating the Emergency Centers on High-risk Roads Leading to Bojnurd using Analytical Hierarchy Process-Fuzzy Method (FAHP)

Introduction: According to the report of the World Health Organization represent-ative in Iran and expressing regret over the increasing and cautionary trend of injuries and deaths due to traffic accidents, road casualties in this country have been increasing since 2017, and they are among the five most important causes of death in Iran. Therefore, the present study aimed to locate the emergency stations on the roads leading to Bojnurd, North Khorasan Province, Iran, in order to reduce injuries and deaths and provide timely services to the injured and accident victims. Method: This applied research used a positivism philosophy, library documents, specialized references, previous studies, field research, observations, and interviews. Based on experts' opinions, 10 locating factors were selected for weighting using multi-criteria decision-making methods (FAHP). Afterward, a fine-grained zoning map was provided in GIS utilizing FUZZY logic. Results: Physical, demographic, social, and geographic data were used in this study to locate the emergency stations on the roads of this province. The results revealed four desirable locations for the construction of emergency statins on the roads leading to Bojnurd. Conclusion: The selection of the correct place to construct emergency stations plays a significant role in reducing the time for the emergency vehicle to reach the patient's bedside. Therefore, the location and placement of emergency centers and the arrangement of these services on the road, as well as the optimal distribution of these centers have a significant impact on the type of performance and quality of service

Development and evaluation of a new assistive device for low back load reduction in caregivers: an experimental study

Low back pain among healthcare professionals is associated with the manual handling of patients. Some bed features for turning and repositioning have been developed; however, the load during patient care remains heavy. We developed a device to reduce low back load in caregivers during patient bedside care and evaluated it objectively and subjectively from a caregiver’s perspective using a randomised crossover study. Overall, 28 clinical nurses and care workers were randomly assigned to two interventional groups: administering care with (Device method) and without (Manual method) the device in an experimental room. We measured the caregiver’s trunk flexion angle using inertial measurement units and video recording during care and then defined a trunk flexion angle of > 45° as the threshold; the variables were analysed using linear mixed models. Subsequently, participants responded to a survey regarding the usability of the device. Trunk flexion time and percentage of time were 26.5 s (95% confidence interval: 14.1 s, 38.9 s) (p < 0.001) and 23.0% (95% confidence interval: 16.4%, 29.6%) (p < 0.001) lower, respectively, in the Device group than in the Manual group. Furthermore, caregivers evaluated the care they could administer with the device as being better than that associated with manual care.

Abstract 14205: WAVES - The Lucile Packard Children's Hospital Open-Access Pediatric Physiological Waveforms Dataset

Introduction: Research repositories of adult physiological waveform (PW) data facilitate clinical and methodological advances. Models trained on adult data do not generalize well to pediatric groups. No large, open repository of pediatric PW data is available for research. Methods: PW and vital sign data were downloaded from bedside patient monitoring systems at an academic pediatric hospital from 06/2008-01/2017, de-identified, cleaned, organized, and stored on a research platform managed by Stanford University. Algorithms to process data for deep learning applications were designed, validated, and uploaded to the research platform. Results: WAVES is a single-institution dataset comprising 9 years of high-frequency PW data. WAVES consists of 10.6 million hours of 1 to 20 concurrent types of high-frequency PWs (Table 1). Approximately 1.5 million PW samples were collected over 50,364 unique hospital encounters across various specialized and general units (Table 2). Initial work demonstrated the suitability of the data for training deep learning models by accurately detecting hypotension with data only from electrocardiogram, plethysmography, and respiration waveforms. Conclusions: WAVES is currently the largest pediatric-focused PW dataset available for open-access research and the second largest repository of correlated multi-channel PW data. The WAVES database can enable improvements in pediatric clinical care through machine learning research on PWs from a variety of hospitalized pediatric patients and could facilitate the development of methodological and clinical innovation in the field of pediatric care.

Evaluation of timeliness and models of transporting critically ill children for intensive care: the DEPICT mixed-methods study

Background Centralisation of paediatric intensive care has increased the need for specialist critical care transport teams to transfer sick children from general hospitals to tertiary centres. National audit data show variation in how quickly transport teams reach the patient’s bedside and in the models of care provided during transport; however, the impact of this variation on clinical outcomes and the experience of patients, families and clinicians is unknown. Objectives We aimed to understand if and how clinical outcomes and experience of children transported for intensive care are affected by timeliness of access to a transport team and different models of transport care. Methods We used a mixed-methods approach with a convergent triangulation study design. There were four study workstreams: a retrospective analysis of linked national clinical audit data (2014–16) (workstream A), a prospective questionnaire study to collect experience data from parents of transported children and qualitative analysis of interviews with patients, families and clinicians (workstream B), health economic evaluation of paediatric transport services (workstream C) and mathematical modelling evaluating the potential impact of alternative service configurations (workstream D). Results Transport data from over 9000 children were analysed in workstream A. Transport teams reached the patient bedside within 3 hours of accepting the referral in &gt; 85% of transports, and there was no apparent association between time to bedside and 30-day mortality. Similarly, the grade of the transport team leader or stabilisation approach did not appear to affect mortality. Patient-related critical incidents were associated with higher mortality (adjusted odds ratio 3.07, 95% confidence interval 1.48 to 6.35). In workstream B, 2133 parents completed experience questionnaires pertaining to 2084 unique transports of 1998 children. Interviews were conducted with 30 parents and 48 staff. Regardless of the actual time to bedside, parent satisfaction was higher when parents were kept informed about the team’s arrival time and when their expectation matched the actual arrival time. Satisfaction was lower when parents were unsure who the team leader was or when they were not told who the team leader was. Staff confidence, rather than seniority, and the choice for parents to travel with their child in the ambulance were identified as key factors associated with a positive experience. The health economic evaluation found that team composition was variable between transport teams, but not significantly associated with cost and outcome measures. Modelling showed marginal benefit in changing current transport team locations, some benefit in reallocating existing teams and suggested where additional transport teams could be allocated in winter to cope with the expected surge in demand. Limitations Our analysis plans were limited by the impact of the pandemic. Unmeasured confounding may have affected workstream A findings. Conclusions There is no evidence that reducing the current 3-hour time-to-bedside target for transport teams will improve patient outcomes, although timeliness is an important consideration for parents and staff. Improving communication during transport and providing parents the choice to travel in the ambulance with their child are two key service changes to enhance patient/family experience. Future work More research is needed to develop suitable risk-adjustment tools for paediatric transport and to validate the short patient-related experience measure developed in this study. Trial registration This trial is registered as ClinicalTrials.gov NCT03520192. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 34. See the NIHR Journals Library website for further project information.

Hemostasis from Bench to Bedside: The History of Three Successful Stories of Translational Medicine.

Looking at the history of hemostasis, one can easily conclude that most of the achievements we see today have been done through the ingenuity and dedication of scientists, who devoted their efforts to translate the basic concepts behind their hypotheses from the laboratory to the patient bedside. I am personally excited by three of these stories. This article aims to review the history on the development of D-dimer, heparin, and coagulometers, which have been chosen as paradigmatic examples of diagnostic testing, drugs, and measuring devices, respectively. They should be considered among the most successful histories of translational medicine.

Moving forward with point-of-care ultrasound: An (early) educational effort can (also) strengthen research

The growing availability of portable ultrasound equipment, associated with the rapidity of execution and the perceived benefit on diagnostic accuracy and time-to-diagnosis, has led to an exponential increase in the use of Point-of-Care Ultrasound (POCUS) in everyday practice. However, given the complexity of the impact of the rapid introduction of such a revolution at the patient's bedside, one cannot avoid highlighting which steps are still needed to formally establish the role of POCUS in patient management.

Comparison of CRUSADE and ORBIT bleeding risk scores in prediction of mayor bleeding in pacients with acute coronary syndrome

Abstract Introduction Mayor bleeding is the most important complication of antithrombotic treatment in acute coronary syndrome (ACS) and is even associated with higher mortality. The CRUSADE scrore has been developed to predict mayor bleeding in ACS and is one of the most used. however, it has a moderate predictive capacity and is relatively complex to calculate at the patient's bedside. On the other hand, different bleeding risk scores have been developed for atrial fibrillation witch have also been evaluated for ACS, for example HAS-BLED. Recently, the NICE guidelines suggest using the Orbit Bleeding score (ORBIT) to assess the risk of bleeding in atrial fibrillation due to its greater predictive capacity. Its usefulness in the context of ACS has been little studied. Purpose The aim of the study is to evaluate the usefulness of the ORBIT to predict major bleeding in patients with ACS compared to the CRUSADE Methods A obserbational retrsopective study was performed. Patients with diagnostico ACS in two coronary units of Argentina were included. All of them, received antocoagulation as a antithrombitic treatment. The CRUSADE and ORBIT scores were calculated with the clinical data on admission. The primary point of major bleeding, defined as a BARC classification 3 or 5, was analyzed. Multivariate analysis was performed by logistic regression. To establish the discrimination capacity of the scores, the area under the ROC curve (AUC) was evaluated and the comparison between the curves was carried out using the chi-square area homogeneity test. Results A total of 880 patients were included (68% with non-ST elevation ACS and 32% with ST elevation), the mean of age was 68±11 years and 35% were women. As antithrombotic treatment, 100% received aspirin, 96.3% received P2Y12 receptor inhibitors, 100% received anticoagulation with enoxaparin, and 9.5% received fibrinolytics. The primary end point of major bleeding occurred in 3.4% (n=30). In univariate analysis both CRUSADE and ORBIT were predictors of mayor bleeding, but in multivariate analysis only ORBIT was independent predictor of mayor bleeding. (ORBIT OR: 2.46 (95% CI 1,61 to 3,97), P&amp;lt;0.001. The table shows the univariate and multivariate analysis. The AUC of CRUSADE was 0.68 (95% CI 0.57–0.80) and the ORBIT was 0.80 (95% CI 0.72–0.90). The ORBIT score presented a higher AUC than the CRUSADE (p=0.03). See Figure 1. Conclusion The Orbit score was an independent predictor of major bleeding in patients with ACS, presenting a better predictive capacity than the CRUSADE. Funding Acknowledgement Type of funding sources: None.

PoCUS in nephrology: a new tool to improve our diagnostic skills.

Point-of-Care Ultrasonography (PoCUS) aims to include a fifth pillar (insonation) in the classical physical examination in order to obtain images to answer specific questions by the clinician at the patient's bedside, allowing rapid identification of structural or functional abnormalities, enabling more accurate volume assessment and supporting diagnosis, as well as guiding procedures. In recent years, PoCUS has started becoming a valuable tool in day-to-day clinical practice, adopted by healthcare professionals from various medical specialties, never replacing physical examination but improving patient and medical care and experience. Renal patients represent a wide range of diseases, which lends PoCUS a special role as a valuable tool in different scenarios, not only for volume-related information but also for the assessment of a wide range of acute and chronic conditions, enhancing the sensitivity of conventional physical examination in nephrology. PoCUS in the hands of a nephrologist is a precision medicine tool.

Needle Arthroscopy for Bacterial Arthritis of a Native Joint: Surgical Technique for the Shoulder, Elbow, Wrist, Knee, and Ankle Under Local Anesthesia

Suspected bacterial arthritis of a native joint requires urgent management to control potential life-threatening sepsis and limit cartilage damage. Diagnosing bacterial arthritis is often challenging and relies on diagnostic tests with low accuracy. A high threshold for surgery poses a risk of undertreatment, whereas a low threshold for surgery could lead to overtreatment with unnecessary invasive and costly procedures. Surgical lavage through arthroscopy or arthrotomy is generally considered standard treatment. Nowadays, needle arthroscopy provides an alternative and potentially less-invasive approach that can safely lower the surgical threshold. Needle arthroscopy can be performed directly upon presentation at the patient's bedside, as it is well tolerated under local anesthesia. Therefore, this Technical Note presents a stepwise guideline for performing standardized needle arthroscopic lavage in patients with (suspected) bacterial arthritis of the shoulder, elbow, wrist, knee, and ankle.