Postprocedural Care Research Articles

Modified Frailty Index (mFI-5) as a prognostic tool of mortality, complications, and readmissions in patients undergoing hepatic ablation for hepatocellular carcinoma.

610 Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer deaths, often diagnosed late, limiting curative options. Transarterial chemoembolization, Y-90 radioablation, radiofrequency ablation, and thermoablation are commonly used for downstaging, transplant bridging, and palliation in unresectable HCC. Frailty, linked to postoperative complications, has not been studied in hepatic ablation patients. This study evaluates the predictive value of the modified frailty index (mFI-5) for mortality, readmissions, complications, redo procedures, and discharges. Methods: We utilized the National Surgical Quality Improvement Program (NSQIP) database from 2015 to 2019, querying cases of hepatic ablation for CPT codes: 47370 (closed hepatic ablation, single site) and 47380 (open hepatic ablation, single site). Selected cases were analyzed for frailty using the mFI-5 criteria. A multivariate analysis was performed using mFI-5 frailty scores, stratified into non-frail (0), pre-frail (1), frail (2), and severely frail (3+). The outcomes analyzed included mortality, discharge to a destination other than home, major complications, minor complications, readmission, and reoperation. Results: We identified 1921 patients as: 737 non-frail, 701 pre-frail, 442 frail and 41 severely frail. The rates of readmission (5.4%), reoperation (1.4%), major (5.3%) and minor (3.5%) complications were low. Eight patients died following hepatic ablation, and 79 patients were discharged to a destination other than home. In multivariate analysis, most outcomes were not significantly associated with increasing frailty. However, discharge to a destination other than home was significantly more likely in patients with higher frailty scores. In frail patients, the odds ratio (OR) was 2.325 (95% CI 1.228–4.402), and in severely frail patients, this increased to 8.720 (95% CI 3.389–22.435). Conclusions: Hepatic ablation is generally well tolerated with low complication rates; however, frailty significantly influences postoperative outcomes. Frail and severely frail patients are more likely to be discharged to care facilities rather than returning home, suggesting that even in the absence of major complications, these patients require a higher level of post-procedural care. This underscores the need for tailored discharge planning and resource allocation based on patient frailty.

Temporal profiling of M-TEER-related complications.

Transcatheter edge-to-edge repair of the mitral valve (M-TEER) is known for its low complication rates. However, the optimal level and duration of post-procedural care remain unclear. This study aimed to identify the specific timeframe of post-procedural complications following M-TEER. We conducted a retrospective analysis of 865 patients who underwent M-TEER at the University Hospital Düsseldorf between August 2010 and August 2023. Our analysis focused on a comprehensive examination of all acute post-procedural complications (1-100h), considering the time point of occurrence or diagnosis. The complication analysed included cardiogenic shock, pericardial tamponade, stroke, cardiac arrhythmias, bleeding, acute kidney injury, myocardial infarction, peripheral vascular ischaemia and in-hospital mortality. The median age was 80 (74, 84) years, and the EuroScore II was high (6.5 [4.0, 12.0] %). Functional mitral regurgitation (MR) was more common than degenerative or mixed MR (69% vs. 20%. respectively; 11%). Technical success rate was 97.2%. Overall, acute post-procedural complications occurred in 87 patients (10.1%). Most complications (75.9%) occurred within the first 4h post-procedure. 12.6% of the complications occurred during the period between 4 and 24h post-procedure, and 11.5% of the complications happened between 24 and 100h post-procedure. Life-threatening complications were observed only within the first 4h post-procedure. The majority of post-procedural complications after M-TEER occur within the first 4h, with pericardial tamponade and major bleeding occurring only during this period. These findings provide valuable insight for physicians in determining the optimal surveillance and monitoring duration after M-TEER within clinical settings.

Management of Vascular Complications from Button Battery Ingestions.

To propose a gastrointestinal bleeding management algorithm that incorporates an endoscopic and imaging scoring system and specifies management of vascular complication from button battery ingestion. Button batteries (BB) are found in many electronic devices and ingestions are associated with serious complications especially in cases of unwitnessed ingestions, prolonged impaction, and in children less than 5years of age. Gastrointestinal bleeding from BB related vascular injury is rare but often rapidly fatal, with a mortality rate as high as 81%. There are no evidence-based guidelines for managing vascular complications from button battery ingestions. This paper proposes a management algorithm that 1) incorporates both an endoscopic and imaging scoring system to guide initial, post procedure, and discharge care and 2) specifies management of button battery related vascular bleeding. The endoscopic score is a modified Zargar classification with added categories for suspected aneurysm and tracheoesophageal fistula. Surgical and endovascular interventions for vascular injury are also reviewed. Until evidence-based guidelines can be developed, hospitals should have a multidisciplinary protocol based on institutional expertise to rapidly manage BB related vascular injury. Prevention of BB related injury offers the best hope of preventing serious complications and should include increasing public awareness and improving safety standards by working with industry and government.

IMPACT OF OFF-HOURS PRESENTATION ON DOOR-TO-BALLOON TIME AND CLINICAL OUTCOMES IN PATIENTS REFERRED FOR PRIMARY PERCUTANEOUS CORONARY INTERVENTION

Timely intervention is crucial in managing ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Due to staffing and logistical constraints, off-hours presentations may impact door-to-balloon (D2B) time and clinical outcomes. Objectives: To assess the impact of off-hours presentation on door-to-balloon time and clinical outcomes in patients referred for primary percutaneous coronary intervention. Methods: After receiving approval from the Ethical Committee of the Department of Cardiology, Armed Forces Institute of Cardiology, and NIHD, 92 patients meeting inclusion criteria were enrolled, with written informed consent obtained. Participants underwent a detailed history review and physical examination. The study divided participants into off-hours and regular-hours groups based on their hospital arrival times. The main focus was on the timing of presentation, linked to outcomes like door-to-balloon (D2B) time, mortality, and complications such as cardiogenic shock and heart failure. Data on demographics, clinical characteristics, and PCI details were carefully collected using standardized forms by trained personnel. Results: The off-hours group had a mean age of 58.8 years, with 76.1% male, while the regular hour’s group had a mean age of 54.7 years and 69.6% male. Hypertension was present in 37% of the off-hours group and 41.3% of the regular-hour group. Smokers comprised 67.4% of the off-hours group and 45.7% of the regular-hours group. The off-hours group had a mean door-to-balloon time of 89.96 minutes, compared to 83.46 minutes for the regular hour group. Mortality was 4.3% in the off-hours group and 8.7% in the regular-hour group. The Cardiogenic shock occurred in 6.5% of the off-hours group versus 10.9% in the regular-hour group. Multivariable regression showed that off-hours presentation increased D2B time by 12.6 minutes. Logistic regression revealed no significant differences in mortality, shock, or heart failure between the two groups. Both groups had similar angiography findings, with most lesions in the LAD. Conclusion: Off-hours presentations result in longer D2B times for STEMI patients, mainly due to staffing and logistical challenges. However, the off-hours group had lower mortality and cardiogenic shock rates, likely influenced by disease severity and post-procedural care. Although no significant outcome differences were observed, there was a trend toward more adverse events. These findings highlight the importance of improving off-hours care, optimizing pre-hospital processes, and promoting public health initiatives.

The Plaque Puzzle How Dentists, Lab Technicians, and Nurses Are Tackling the Oral-Systemic Disease Mysteries

Oral health is not an isolated aspect of well-being but an essential component of overall health. A growing body of evidence highlights the significant impact of oral diseases, particularly periodontal infections, on systemic conditions such as cardiovascular disease, diabetes, respiratory illnesses, and neurodegenerative disorders. The "oral-systemic link" underscores the need for a multidisciplinary approach in identifying, managing, and preventing diseases that originate in the oral cavity but influence the entire body. General dentists, laboratory technicians, nursing technicians, and phlebotomists each play a distinct yet interconnected role in tackling these oral-systemic disease mysteries. Dentists serve as the frontline professionals in diagnosing and treating conditions like periodontitis, which contribute to systemic inflammation. Laboratory technicians analyze microbial profiles, biochemical markers, and inflammatory mediators to provide diagnostic insights. Nursing technicians assist in patient education, treatment adherence, and post-procedural care, ensuring that patients receive proper oral hygiene guidance to reduce systemic risks. Phlebotomists contribute by collecting and processing blood samples that help track inflammatory markers and correlate oral infections with systemic diseases. This review highlights the collaborative effort among these professionals in advancing research, refining diagnostic methods, and improving patient outcomes. By understanding the complexities of oral-systemic interactions, healthcare providers can develop more comprehensive strategies to prevent and manage diseases that affect both the oral cavity and the entire body.

Percutaneous coronary intervention (PCI) in patients of rheumatoid arthritis(RA): A systematic review and meta-analysis.

The present study aims to investigate the outcomes of Percutaneous coronary intervention (PCI) in patients with Rheumatoid arthritis (RA). A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to 15th September 2023. All statistical analyses were conducted using Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported in the odds ratio (OR) and the corresponding 95% confidence interval (CI). Eight observational studies were selected to conduct the analysis. A statistically significant increase in major adverse cardiovascular event (MACE) was seen in RA patients after undergoing PCI as compared to the control group (OR=1.18 (1.16, 1.21); p<0.00001; I2=0%). There was no significant difference found in the long-term revascularization outcome between the RA and non-RA patients (OR=1.18 (0.81, 1.71); p=0.39; I2=93%). Survival rates of all-cause mortality in the long-term outcome were statistically insignificant among the two groups (OR=1.21 (0.84, 1.74); p=0.31; I2=99%). Percutaneous coronary intervention is an important intervention to reduce morbidity and mortality but special precautions and attention should be made when it comes to patients with RA. Different precautions such as close monitoring for medication interaction, and tailored post-procedural care are essential in reducing morbidity and mortality.

The impact of diabetes on aesthetic procedures

Diabetes may have an impact on aesthetic medicine, influencing both the safety and efficacy of various aesthetic procedures. Key aspects of the impact of diabetes on aesthetic medicine are summarized. Individuals with diabetes often experience dry skin, acondition known as xerosis, which may affect the overall texture and appearance of the skin. Diabetes can compromise the immune system, making individuals more susceptible to skin infections. Aesthetic procedures involve the introduction of foreign substances, and compromised skin integrity may heighten the risk of infection. This underscores the importance of strict hygiene and postprocedure care to minimize the risk of complications. Delayed wound healing can be asignificant concern in aesthetic procedures where incisions, injections, or other manipulations are made, as impaired healing may affect the final outcome and increase the risk of complications. Collagen metabolism, affecting the elasticity and structural integrity of the skin, may influence the long-term results of procedures such as dermal fillers, where collagen plays acrucial role in maintaining skin volume and firmness. Diabetes is linked to vascular complications, including poor blood circulation, which may have implications for procedures like laser treatments or other interventions that rely on adequate blood supply for optimal results.

One in six patients exhibit changes in reperfusion on 10-minute repeat cerebral angiography during mechanical thrombectomy for stroke

BackgroundPost-recanalization target vessel re-occlusion (TVR) following endovascular thrombectomy (EVT) is a known complication of the procedure, and it is associated with worse long-term functional outcomes. The incidence and factors that...

Whole lung and sequential bronchoscopic lavage for pulmonary alveolar proteinosis.

Pulmonary alveolar proteinosis (PAP) is a diffuse lung disease that results from the accumulation of lipoproteinaceous material in the alveoli due to abnormal surfactant homeostasis. Since its introduction in the 1960s, whole lung lavage (WLL) has been the primary treatment for PAP. This review focuses on WLL, including its technique modifications, and sequential bronchoscopic lavage. Autoimmune PAP, which accounts for the majority of cases, occurs when antigranulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies lead to the deficiency of bioavailable GM-CSF. At present, there are no international guidelines or consensus statements for PAP treatment. Traditionally, therapeutic decisions are made based on the severity and type of PAP. Despite emerging data on GM-CSF-based therapies, WLL remains a central component in the therapeutic strategy for PAP. Although the technique of WLL has evolved over time, there is still no universally adopted, standardized protocol. However, key periprocedural aspects - such as preprocedural planning, patient evaluation, anesthetic technique, lavage protocol, and postprocedural care - remain essential to ensuring the safety and success of WLL.

Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis.

With technological advances in endoscopic ultrasonography, endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) was introduced as a treatment option for acute cholecystitis. Recently, new studies have emerged, suggesting that EUS-GBD has a lower adverse event rate and reintervention rate, when compared to percutaneous drainage and endoscopic transpapillary gallbladder drainage. There is growing interest in the different technical aspects of EUS-GBD, such as the puncture approach, choice of stents, and long-term management. There are also cohorts on performing EUS-GBD in potential surgical candidates. This review article gathers the latest evidence on EUS-GBD, including its indications, procedural techniques, choice of equipment, outcomes, postprocedural care, and the controversial extended indications.

The Impact of Socioeconomic Factors on 90-day Postoperative Readmissions and Cost in Shoulder Arthroplasty Patients

Understanding the impact of Social Drivers of Health (SDOH) on shoulder arthroplasty is pivotal for the development of equitable value-based payment models that enhance the quality of patient care. This investigation aims to understand the influence of Area Deprivation Index (ADI) on hospital admissions, readmissions, and associated costs post-shoulder arthroplasty. We conducted an analysis using US Medicare claims data from 2019 to 2021, identifying patients who received shoulder arthroplasty in either an inpatient or outpatient setting using Current Procedural Terminology (CPT) codes. Our primary outcomes were 90-day unplanned readmissions and post-procedure 90-day care costs. The ADI was our primary exposure variable, calculated at the census block level. Our analysis adjusted for multiple factors using a stepwise modeling approach including patient demographics, 29 Elixhauser comorbid conditions, Medicaid-dual eligibility, and end-stage renal disease status using logistic regression models. A total of 145,435 patients were included in our study. The average age of patients in our cohort was 74.5 years old, with 59.5% being female. Patients in the high ADI group had a higher readmission rate than the lowest ADI group (8.5% vs. 6.0%, p<0.001).When controlling for confounding factors, there was an indepdentent association between high ADI and readmission (OR: 1.28 [95% CI 1.12, 1.46]). Overall, we saw a dose-dependent relationship between ADI and readmission, with the association growing stronger as ADI increased. Conversely, we found a negative association with ADI and high-costs. (High ADI Group OR: 0.80 [95% CI 0.70, 0.91]). Patients in the high SES group had higher healthcare contact days during the 90-day follow-up period, with a median of 16 visits (IQR 8, 23), compared to 13 visits (IQR 6, 22) in the middle SES group and 10 visits (IQR 5, 20) in the low SES group (p<0.001). Socioeconomic disparities significantly influence the outcomes of primary shoulder arthroplasty, as indicated by higher readmission rates for low SES patients. Notably, our analysis shows a strong, independent association between ADI and readmission. Moreover, patients with higher SES incurred greater costs within a 90-day period potentially due to increased resource utilization.

Vascular complications in TAVI procedures: assessment, management, and outcomes-a retrospective study

ObjectiveTranscatheter Aortic Valve Implantation (TAVI) has emerged as a pivotal therapeutic modality for aortic stenosis, predominantly in the elderly population. Despite its clinical success, the incidence and implications of vascular complications during TAVI remain a subject of critical concern. MethodsA retrospective analysis was conducted on 140 patients who experienced vascular complications during TAVI procedures from a total cohort of 1343 cases. Patient demographics, clinical profiles, and procedural characteristics were scrupulously examined. Vascular complications, both intraoperative and postoperative, were identified through various diagnostic modalities. Statistical analyses were employed to discern associations and significance levels. Comparative assessments with international literature were performed to gain broader insights. ResultsThe study unveiled an overall incidence of vascular complications at approximately 10.44%. Coronary Artery Disease (CAD)-p-value (0.013), choice of valve type-p-value (0.016), and access point-p-value (0.027) demonstrated significant correlations with these complications. Complication incidences in TAVI procedures included pseudoaneurysms (4.76%), arteriovenous fistulas (1.49%), hematomas (0.37%), dissections (2.24%), arterial perforations (0.15%), stenosis/occlusion (0.37%), and closure device failures (1.94%). Over 70% of complications at the valve entry point result from dissections and closure device failures, while the pigtail entry point is predominantly linked to over 70% of pseudoaneurysms. Extended hospitalization (7.84 ± SD 3.14) was observed for patients experiencing vascular complications, underlining the importance of vigilant postprocedural care. ConclusionThis study provides comprehensive insights into vascular complications during TAVI procedures, shedding light on their incidence, risk factors, clinical presentations, diagnostic methodologies, and management strategies.

Large-Bore Mechanical Thrombectomy Versus Catheter-Directed Thrombolysis in the Management of Intermediate-Risk Pulmonary Embolism: Primary Results of the PEERLESS Randomized Controlled Trial.

There are a lack of randomized controlled trial data comparing outcomes of different catheter-based interventions for intermediate-risk pulmonary embolism. PEERLESS is a prospective, multicenter, randomized controlled trial that enrolled 550 patients with intermediate-risk pulmonary embolism with right ventricular dilatation and additional clinical risk factors randomized 1:1 to treatment with large-bore mechanical thrombectomy (LBMT) or catheter-directed thrombolysis (CDT). The primary end point was a hierarchal win ratio composite of the following (assessed at the sooner of hospital discharge or 7 days after the procedure): (1) all-cause mortality, (2) intracranial hemorrhage, (3) major bleeding, (4) clinical deterioration and/or escalation to bailout, and (5) postprocedural intensive care unit admission and length of stay. Assessments at the 24-hour visit included respiratory rate, modified Medical Research Council dyspnea score, New York Heart Association classification, right ventricle/left ventricle ratio reduction, and right ventricular function. End points through 30 days included total hospital stay, all-cause readmission, and all-cause mortality. The primary end point occurred significantly less frequently with LBMT compared with CDT (win ratio, 5.01 [95% CI, 3.68-6.97]; P<0.001). There were significantly fewer episodes of clinical deterioration and/or bailout (1.8% versus 5.4%; P=0.04) with LBMT compared with CDT and less postprocedural intensive care unit use (P<0.001), including admissions (41.6% versus 98.6%) and stays >24 hours (19.3% versus 64.5%). There were no significant differences in mortality, intracranial hemorrhage, or major bleeding between strategies or in a secondary win ratio end point including the first 4 components (win ratio, 1.34 [95% CI, 0.78-2.35]; P=0.30). At the 24-hour visit, respiratory rate was lower for patients treated with LBMT (18.3±3.3 versus 20.1±5.1; P<0.001), and fewer had moderate to severe modified Medical Research Council dyspnea scores (13.5% versus 26.4%; P<0.001), New York Heart Association classifications (16.3% versus 27.4%; P=0.002), and right ventricular dysfunction (42.1% versus 57.9%; P=0.004). Right ventricle/left ventricle ratio reduction was similar (0.32±0.24 versus 0.30±0.26; P=0.55). Patients treated with LBMT had shorter total hospital stays (4.5±2.8 overnights versus 5.3±3.9 overnights; P=0.002) and fewer all-cause readmissions (3.2% versus 7.9%; P=0.03), whereas 30-day mortality was similar (0.4% versus 0.8%; P=0.62). PEERLESS met its primary end point in favor of LBMT compared with CDT in treatment of intermediate-risk pulmonary embolism. LBMT had lower rates of clinical deterioration and/or bailout and postprocedural intensive care unit use compared with CDT, with no difference in mortality or bleeding. URL: https://www.clinicaltrials.gov; Unique identifier: NCT05111613.

Same-day discharge after atrial fibrillation ablation: is it equally safe?

Abstract Introduction Same-day discharge after atrial fibrillation (AF) ablation represents a paradigm shift in post-procedure care. This approach allows patients (pts) to return home on the same day after their ablation, promoting comfort and reducing hospitalization duration. Purpose To evaluate safety of same-day discharge in pts submitted to either pulsed field ablation (PFA) or cryoablation (CA). Methods Single-center retrospective study of AF pts submitted to ablation with either PFA or CA from May 2019 to November 2023. Ablation strategy consisted in pulmonary vein isolation complemented with ablation of the cavo-tricuspid isthmus in pts with history of atrial flutter. Pts were considered eligible to same-day discharge if an observation period of at least 6h was assured after the procedure. Safety was defined as 30-day major or minor complications. Chi-square tests were used for the comparison of continuous variables. Results We included 152 pts, 60 were submitted to PFA and 92 to CA, 56.6% males, median age 66±14 years, mean CHA2DS2-VASc score 2.45±1.4. Paroxysmal AF, short and long-standing persistent AF were present in 67%, 16% and 15% of pts respectively. Previous stroke was present in 8.7% of pts and 27 pts had history of heart failure. Acute success rate was 99.3%, concomitant cavo-tricuspid isthmus ablation was performed in 20% of pts, and mean procedure time was 107.5±74 min. Same-day discharge was initially considered in 70% of pts, however of these, 12 pts remained under further observation due to acute complications. No major or minor acute complications were reported in pts with same-day discharge. There were no significant differences in 30 days complications between groups. At 30 days no major complications were reported in pts with same-day discharge. One pts in which same-day discharge was halted died 4 days after ablation from hemorrhagic shock. Regarding minor complications at 30 days, 4 minor femoral hematoma were reported, 2 in each group. Conclusion In our population, same-day discharge proved to be a safe strategy if careful pts selection is assured. This practice enhances overall pt experience, marking a significant paradigm shift in AF management.

PHYSICAL CONCEPTS OF CEREBRAL ANGIOGRAPHY AND CEREBRAL ANEURYSM EMBOlIZATION AND NURSING ASSISTANCE TO PATIENTS IN THE HEMODYNAMICS LABORATORY

This paper evaluates common nursing practices related to patients undergoing cerebral angiography and embolization of cerebral aneurysms as described in the specialized literature, addressing the importance of nursing team involvement in the care of patients undergoing these hemodynamic procedures. The text outlines various aspects of nursing assistance from patient admission to discharge in the hemodynamics unit. The methodology includes a literature review highlighting care protocols, recommended practices, and specific interventions aimed at minimizing complications and promoting patient safety. Issues such as the systematization of nursing care, vital sign monitoring, pain management, infection prevention, and guidance on post-procedure care are discussed. The results indicate that well-structured, evidence-based nursing assistance significantly contributes to patient recovery and reduction of adverse events. The article emphasizes the need for further studies related to this topic, as well as the fundamental role of this category within the multidisciplinary team for faster recovery and prevention of post-intervention complications.

Technological advancements in endoscopy and their impact on gastrointestinal nursing

Technological advancements in endoscopy have significantly transformed the landscape of gastrointestinal (GI) nursing. This article explores the latest innovations in endoscopic techniques, such as high-resolution imaging, endoscopic ultrasound and therapeutic procedures. It examines the implications of these advancements for GI nursing practice, focusing on the roles and responsibilities of nurses in pre-procedural, intra-procedural and post-procedural care. The importance of continuous education and specialised training for GI nurses is also discussed. Recommendations are provided to enhance nursing practices in endoscopy settings, ensuring optimal patient care and safety.

Investigating clinical decision-making in bleeding complications among nursing students: A longitudinal mixed-methods study

AimTo describe undergraduate nursing students’ clinical decision-making in post-procedural bleeding scenarios and explore the changes from the first to the final year of their program. BackgroundBleeding is a common complication following invasive procedures and its effective management requires nurses to develop strong clinical decision-making competencies. Although nursing education programs typically address bleeding complications, there is a gap in understanding how nursing students make clinical decisions regarding these scenarios. Additionally, little is known about how their approach to bleeding management evolves over the course of their education. DesignLongitudinal mixed-methods study based on the Recognition-Primed Decision Model. MethodsA total of 59 undergraduate students recorded their responses to two clinical decision-making vignettes depicting patients with signs of bleeding post-hip surgery (first year) and cardiac catheterization (final year). Their responses were analyzed using content analysis. The resulting categories capture the cues students noticed, the goals they aimed to achieve, the actions they proposed and their expectations for how the bleeding situations might unfold. Code frequencies showing the most variation between the first and final years were analyzed to explore changes in students’ clinical decision-making. ResultsNearly all students focused on two primary categories: ‘Bleeding’ and ‘Instability and Shock.’ Fewer students addressed six secondary categories: ‘Stress and Concern,’ ‘Pain,’ ‘Lifestyle and Social History,’ ‘Wound Infection,’ ‘Arrhythmia,’ and ‘Generalities in Surgery.’ Students often concentrated on actions to manage bleeding without further assessing its causes. Changes from the first to the final year included a more focused assessment of instability and shifts in preferred actions. ConclusionsThis study reveals that nursing students often prioritize immediate actions to stop bleeding while sometimes overlooking the assessment of underlying causes or broader care goals. It suggests that concept-based learning and reflection on long-term outcomes could improve clinical decision-making in post-procedural care.

A Novel Hybrid Injectable for Soft-tissue Augmentation: Analysis of Data and Practical Experience

Background: HA/CaHa (HArmonyCa, Allergan Aesthetics, an AbbVie Company) is a hybrid injectable filler developed for aesthetic purposes that contains calcium hydroxyapatite microspheres suspended in a hyaluronic acid gel. This review describes preclinical and clinical data, recommendations for use based on the primary author’s clinical experience, and case studies that illustrate implementation of product use recommendations and patient outcomes. Methods: Preclinical data on the lift capacity and tissue integration of the HA/CaHa hybrid injectable and clinical data on its safety, efficacy, and real-world use were extracted from poster presentations, published literature, manufacturer instructions for use, and proprietary data files. Case studies were presented based on clinical experience. Results: The HA component of HA/CaHa provides an immediate and noticeable filling and lifting effect, whereas CaHa microspheres result in neocollagenesis. In preclinical studies, HA/CaHa demonstrated higher lift capacity (P &lt; 0.05) and faster tissue integration than a CaHa filler and led to collagen I gene and protein expression. Clinical studies showed clinical safety and effectiveness with high patient satisfaction. The most common adverse event was injection-site response. Clinician recommendations for achieving desired aesthetic results while minimizing or preventing adverse events are reviewed, including patient selection and assessment, treatment approaches based on face shape, injection technique, and postprocedure care. Conclusion: The novel hybrid injectable consisting of HA with incorporated CaHa microspheres in a single marketed product may help achieve aesthetic goals by immediately restoring volume and potentially improving skin architecture and soft-tissue quality over time.

Survival of a young male patient with catastrophic acute left main coronary artery occlusion and cardiogenic shock

ABSTRACT Total occlusion of the left main coronary artery (LMCA) is a rare but highly lethal event in acute coronary syndrome. It can lead to extensive myocardial infarction and hemodynamic instability. Despite advancements in percutaneous coronary intervention (PCI), mortality remains high. A 35-year-old male presented with chest pain, dyspnea, and hemodynamic instability. Diagnostic workup revealed LMCA thrombotic occlusion with extensive myocardial involvement and cardiogenic shock (CS). Prompt intervention, including thrombus aspiration, angioplasty, and hemodynamic support with intra-aortic balloon pump and venoarterial extracorporeal membrane oxygenation, was initiated. The patient’s condition gradually improved with comprehensive management, including pharmacotherapy and intensive care support. LMCA occlusion presents challenges due to its extensive myocardial distribution and high mortality rates, particularly when complicated by CS. PCI combined with circulatory support is crucial for restoring perfusion and improving outcomes. Achieving optimal flow and providing postprocedural care significantly impact patient prognosis. Rapid diagnosis and intervention are critical in LMCA occlusion with CS. A multidisciplinary approach incorporating advanced circulatory support and timely revascularization are the keys in improving patient outcomes. Comprehensive postprocedural care is essential for ensuring successful recovery and survival.

Impact of a Multidisciplinary Service Line and Program for Transcatheter Device Closure of the Neonatal Ductus Arteriosus.

Outline a quality initiative establishing an institutional service line for neonatal transcatheter device closure of the patent ductus arteriosus (TDC-PDA). A retrospective descriptive observational study surrounds programmatic approach to TDC-PDA in premature neonates with process measure spanning education, implementation, referral, and post-procedural care. Metrics tracked pre- and post-program creation with statistical analyses performed. Neonatal TDC-PDA referrals increased exponentially since program inception (n = 13 in year prior; n = 42year 1; n = 74year 2), especially in patients weighing less than 1.3kg (12.5%; 55%; 50%), and were associated with an increased procedural success rate (81%; 95%; 99%). Procedural checklist creation decreased procedural "out of isolette" time (median 93min; 59; 52), and procedural-related complication or clinical sequelae (19%; 12%; 4%). A multidisciplinary service line and program dedicated to neonatal TDC-PDA can result in a significant increase in referrals as well as procedural efficacy and safety for this medically fragile population.