Patient Care Protocols Research Articles

Expert assessment of the suitability of treatment and diagnostic measures in providing emergency care to patients with acute coronary syndrome

It is known that it is possible to affect the extent of myocardial damage and, as a result, mortality only in the first hours of its development. Therapeutic tactics in ACS with elevation of the ST segment involves the restoration of coronary blood flow, the main method is the reperfusion of the coronary artery by systemic thrombolysis or PCI in a specialized hospital. The effectiveness of treatment is inversely related to the time spent.
 The aim of the study was to examine the opinion of specialists on the feasibility of implementing the items of the protocol of emergency medical care for patients with ACS at the place of call.
 Materials and methods. During the study the method of expert evaluations, which consisted of gathering information by interviewing experts and summarizing the individual opinions of experts into a general concept was used. The experts were 48 emergency physicians. The method of expert evaluation included the following stages: development of the questionnaire; survey of experts; summary of examination materials; calculation of statistical indicators; interpretation of the obtained results and formulation of conclusions.
 Results. In order to assess the actions of the emergency team, depending on the need to conduct them for diagnosis and emergency care for patients with ACS at the scene, we calculated the feasibility indexes for each item of the protocol. In the future, we divided the treatment and diagnostic measures for ACS with ST segment elevation according to the level of expediency at the scene into four groups (n): n1 – high level, n2 – sufficient level and n3 – low level and n4 – very low level. According to the results of the ranking, the scope of measures to be implemented by the head of the emergency team at the ACS with elevation of the ST segment on arrival on call, as well as measures that, according to interviewed experts, are not required at this stage and can be carried out during transportation of the patient to a specialized hospital.
 Conclusions. Based on the results of the calculation of feasibility indices and subsequent ranking of treatment and diagnostic measures for the relevant groups (n1, n2, n3, n4) from 37 items of the study, to assist patients with ACS with ST segment elevation at the scene, it is recommended to perform 16

Impact of the COVID-19 Pandemic on Nephrology Fellow Training and Well-Being in the United States: A National Survey.

The coronavirus disease 2019 (COVID-19) pandemic's effects on nephrology fellows' educational experiences, preparedness for practice, and emotional wellbeing are unknown. We recruited current adult and pediatric fellows and 2020 graduates of nephrology training programs in the United States to participate in a survey measuring COVID-19's effects on their training experiences and wellbeing. Of 1005 nephrology fellows-in-training and recent graduates, 425 participated (response rate 42%). Telehealth was widely adopted (90% for some or all outpatient nephrology consults), as was remote learning (76% of conferences were exclusively online). Most respondents (64%) did not have in-person consults on COVID-19 inpatients; these patients were managed by telehealth visits (27%), by in-person visits with the attending faculty without fellows (29%), or by another approach (9%). A majority of fellows (84%) and graduates (82%) said their training programs successfully sustained their education during the pandemic, and most fellows (86%) and graduates (90%) perceived themselves as prepared for unsupervised practice. Although 42% indicated the pandemic had negatively affected their overall quality of life and 33% reported a poorer work-life balance, only 15% of 412 respondents who completed the Resident Well-Being Index met its distress threshold. Risk for distress was increased among respondents who perceived the pandemic had impaired their knowledge base (odds ratio [OR], 3.04; 95% confidence interval [CI], 2.00 to 4.77) or negatively affected their quality of life (OR, 3.47; 95% CI, 2.29 to 5.46) or work-life balance (OR, 3.16; 95% CI, 2.18 to 4.71). Despite major shifts in education modalities and patient care protocols precipitated by the COVID-19 pandemic, participants perceived their education and preparation for practice to be minimally affected.

The effects of implementation of a stepwise algorithmic protocol for nutrition care process in gastro-intestinal surgical children in Pediatric Intensive Care Unit (PICU).

Malnutrition is known as one of the major health problems among critically ill children; optimum nutrition support is considered as a therapeutic strategy to improve clinical outcomes and minimize the length of Pediatric Intensive Care Unit (PICU) staying as well as its costs. Implementation of an algorithmic protocol can result in the upgrade of the quality of nutrition support system in PICU. In this study, we developed a stepwise algorithmic nutrition care protocol for PICU patients in two phases as follows: a critical review of past literature and an expert discussion panel. The final structured protocol includes three following steps for the nutrition care process: 1) Initial nutrition screening and assessment, 2) Nutritional intervention and 3) Nutritional monitoring. Pre and post-implementation audits were carried out in a 23 bed medical/surgical PICU in a children's hospital affiliated to Mashhad University of Medical Sciences over two 4-week periods to evaluate the impact of the algorithm implementation. The post-implementation audit was performed by passing 12 weeks from the protocol implementation. Critically ill children aged between 1month and 10 years, and PICU length of stay>24h who were in post gastrointestinal surgery state, were enrolled. Totally, 34 eligible critically ill gastrointestinal surgical children in post-implementation audit were compared with 30 patients with similar eligibility criteria in the pre-implementation audit. Notably, there were no significant differences in gender, median age, length of PICU stay, and mechanical ventilation requirement in the two audits. The comparison of our pre and post-implementation audits showed a significant increase in the proportion of energy delivery goal achievement following performing our intervention (56.7%, and 85.3%, for pre and post-implementation audits, respectively; p-value=0.01).Additionally, time of achieving energy and protein goals were significantly decreased (5.5 vs. 3 days; p-value=0.008 and 4 vs 3 days; p-value=0.002, for energy and protein delivery goal achievements, respectively). The implementation of the algorithm have significantly improved the adequacy ratio of energy delivery and also decreased the time to achieve the goal in energy and protein intake among critically ill children in post-gastrointestinal state. In this regard, further prospective studies are needed for continuing the evaluation of the algorithm implementation outcomes in critically ill children with different surgical and internal underlying diseases.

Mechanical ventilator test protocol for care of patients with COVID-19 in porcine model

As a result of the SARS-CoV-2 pandemic, health systems globally have seen a dramatic increase in the occupancy of intensive care units, with mechanical ventilators being a resource in high demand in the care of these patients. This article proposes a protocol for testing low-cost mechanical ventilators in pig models, as part of the development of locally manufactured biomedical equipment that can support the health crisis caused by the pandemic. The protocol addresses aspects that include the pre-test phase, anesthetic and airway management, laboratory monitoring, recovery and monitoring of the animal. This document presents to the academic community a validation protocol of a mechanical ventilator prototype in a pig specimen that can be a reference for its application and revalidation by other groups interested in the development of local and low-cost technologies.

Survey of the Opinion of Dentists and Dental Technicians on the Impact of the State of Emergency Related to the Coronavirus Disease 2019 Epidemic in Bulgaria on their Practice

BACKGROUND: In their practice, health-care professionals are at increased risk of coronavirus disease 2019 (COVID-19) infection, which is particularly high for dentists, hygienists, dental assistants, and dental technicians due to close contact with patients and exposure to biological fluids and aerosol/droplets during dental procedures. AIM: The purpose of this study is to survey the opinion of dentists and dental technicians about the impact of the state of emergency in Bulgaria related to the COVID-19 epidemic on their practices. MATERIALS AND METHODS: A specially developed web-based survey conducted among 49 dentists and dental technicians was used. The results were processed with SPSS v. 18 at significance level of p < 0.05. RESULTS: A group of 49 dentists and dental technicians were included in the survey. Оf them (20.41 ± 5.76) reported that they did not work at all during the state of emergency. Relatively, a large number of dentists (81.82 ± 8.22) respond that they have completely changed their patient care protocols. The result is similar for dental technicians (77.77 ± 8.00). More than half of the dentists (59.09 ± 10.48) respond that they specifically disinfect the dental impressions, and of the dental technicians (29.63 ± 8.78) say that they insist on this. All of the respondents share that they use special protective equipment in their practices. CONCLUSION: Although significant progress has been made in controlling COVID-19 and dental clinics and practices are gradually resuming routine patient care, the prevention and control of severe acute respiratory syndrome coronavirus 2 transmission during dental procedures remains a serious challenge.

Reducing Cardiac Telemetry Nuisance Alarms Through Evidence-Based Interventions.

Cardiac telemetry nuisance alarms due to leads off and poor signal increase staff workflow interruptions, decrease staff trust in technology, and can compromise patient safety. Interventions were directed at reducing nuisance alarms on a 32-bed, non-intensive care - a cardiac telemetry unit. A nursing staff education module with evidence-based practices for reducing nuisance alarms, a daily care protocol for patients on cardiac telemetry monitoring, and daily audits of protocol adherence were implemented. Staff pre- and posttest comparisons on their knowledge relating to nuisance alarms and the evidence-based protocol demonstrated a significant mean increase of 3.02 (95% CI, 2.55-3.48). Daily audits for 7 weeks demonstrated an average of 58.46% staff adherence. Telemetry technician call volume reduction was 16% postimplementation, while nuisance alarms were not reduced significantly. This rapid-cycle, quality improvement process resulted in minimal reduction in nuisance alarms but improved staff awareness of the issue and reduced workflow interruptions.

The Impact of the Aging Population on Surgical Diseases

The portion of the population comprised by those aged 65 years and older is the fastest growing age group. With the aging of Americans, so goes the age of a surgeon’s patients. It is also well established that with aging, the incidence of various diseases also increases. Thus, more surgical care will be consumed by the elderly. The cost of care however will be greater for geriatric patients when compared to younger patients due to the greater incidence of comorbidities in the elderly. The surgical community will need to develop new protocols for the perioperative care of these frail patients in order to provide safe care with acceptable morbidity and mortality rates. Over the past 5 years, there have been notable changes in the surgical management of geriatric patients. Increased evidence in several surgical specialties supports that minimally invasive techniques for traditional open procedures improve outcomes. Additional knowledge regarding the effect of aging on organ function has led to improved stratification and preoperative preparation of patients prior to surgery. An example of this is the establishment of specific triage criteria for geriatric trauma patients. These changes have resulted in reduced morbidity and mortality rates. The elderly form a large portion of surgical patients, and this portion will continue to grow as life expectancy improves. Surgeons must adapt to this changing environment to provide optimal care to geriatric patients.

Nonalcoholic fatty liver disease as a metabolic disease in humans: A literature review.

AimsTo conduct a systematic literature review to identify recent epidemiological, biomarker, genetic and clinical evidence that expands our understanding of nonalcoholic fatty liver disease (NAFLD) as a metabolic disorder.Materials and MethodsWe performed a literature search using PubMed to identify trials, observational studies and meta‐analyses published in the past 5 years.ResultsA total of 95 publications met prespecified inclusion criteria and reported on the interplay between NAFLD/nonalcoholic steatohepatitis (NASH) and metabolic dysfunction, in terms of disease burden and/or epidemiology (n = 10), pathophysiology, risk factors and associated conditions (n = 29), diagnosis and biomarkers (n = 34), and treatment approaches (n = 22). There is a growing body of evidence on the links between NAFLD/NASH pathogenesis and mechanisms of metabolic dysfunction, through liver lipid accumulation, insulin resistance, inflammation, apoptosis, and fibrogenic remodelling within the liver. The frequent co‐occurrence of NAFLD with obesity, metabolic syndrome and type 2 diabetes supports this premise. Therapeutic approaches originally envisaged for type 2 diabetes or obesity (such as glucagon‐like peptide‐1 receptor agonists, sodium‐glucose co‐transporter‐2 inhibitors, insulin sensitizers and bariatric surgery) have shown promising signs of benefit for patients with NAFLD/NASH.ConclusionsGiven the complex interplay between NAFLD and metabolic dysfunction, there is an urgent need for multidisciplinary collaboration and established protocols for care of patients with NAFLD that are individualized and ideally support reduction of overall metabolic risk as well as treatment for NASH.

Results of Care Redesign for Joint Arthroplasty in the BPCI Program in an Independent Physician-Owned Orthopedic Group.

BackgroundThe Bundled Payment for Care Improvement initiative is a program designed by Center for Medicare and Medicaid Services in an attempt to increase the value of care delivered to Medicare recipients by rewarding providers who can deliver more cost-efficient, high-value care. This article reports the results of a coordinated care redesign program in an independent, medium-sized private-practice orthopedic group.MethodsA committee of stakeholders worked to redesign care protocols for patients receiving upper and lower joint replacement procedures. These protocols included preoperative, intraoperative, and postoperative care. Baseline metrics for post-acute care and readmissions were compared to the same metrics after initiating care redesign.ResultsIncidence of discharge to inpatient facilities decreased as did length of stay at these facilities. Home health utilization and readmission rates were lowered. Average cost of the 90-day episodes decreased to a statistically significant degree.ConclusionsThese initial results indicate that coordinated care redesign in the private practice setting can yield higher value care with decreased utilization of high-cost care, particularly in the post-acute period.

Application of the Modified Barrow Oral Care Protocol in Patients Receiving Mechanical Ventilation

Application of the Modified Barrow Oral Care Protocol in Patients Receiving Mechanical Ventilation

Review of Variability in Rehabilitation Protocols after Lateral Ankle Ligament Surgery

Ankle sprains are one of the most common athletic injuries. If a patient fails to improve through conservative management, surgery is an option to restore ankle stability. The purpose of this study is to analyze and assess the variability across different rehabilitation protocols for care of lateral ankle ligament repair, reconstruction, and suture tape augmentation surgical patients. Using a web-based search for published rehabilitation protocols after lateral ankle ligament repair, reconstruction, and suture tape augmentation, a total of 26 protocols were found. Inclusion criteria was protocols for post-operative care after an ankle ligament surgery (repair, reconstruction, or suture tape augmentation). Protocols for multi-ligament surgeries and non-operative care were excluded. A scoring rubric was created to analyze different inclusion, exclusion, and timing of protocols such as weightbearing, range of motion (ROM), immobilization with brace, single leg exercises, return to running, and return to sport (RTS). Protocols inclusion of different recommendations was recorded along with the time frame that activities were suggested in each protocol. 26 protocols were analyzed. There was variability across rehab protocols for lateral ankle ligament surgical patients especially in the type of immobilizing brace, time to partial and full weigh bearing, time to plantar flexion, dorsiflexion, eversion and inversion movements of the ankle and return to single leg exercise and running. For repair and reconstruction, none of these categories had greater than 60% agreement between protocols. The most consistent aspects of protocols were the post-operative restricted ROM and non-weight bearing status, where 100% of Repair, Internal Brace, and unspecific protocols and 86% of reconstruction protocols all recommended no ROM immediately post operatively and 86% repair and 78% reconstruction recommended no weight bearing immediately after surgery either. 66% of suture tape augmentation protocols allowed full weight bearing immediately post operatively. Suture tape augmentation protocols generally allowed rehabilitation to occur on a quicker timeline with full weight bearing by week 4-6 and full ROM by week 8-10 in the majority of protocols. RTS was especially consistent in repair protocols, but varied more in reconstruction. ROM was highly variable across protocols and did not always match up with supporting literature for early mobilization of the ankle. RTS mostly correlated between protocols and the literature. Weight bearing was consistent between most protocols but requires further research to determine what the best practice is for patient outcomes. Overall, there was a lack of published protocols and enough variability that the need for standardization of rehabilitation protocols was shown.

Postoperative care of cardiac surgery patients: A protocolized approach towards enhanced recovery versus the conventional approach

ABSTRACT Background Patients post-cardiac surgery face multiple challenges, but poorly controlled pain and atelectasis remain major issues that can prolong their recovery journey. The aim of this study was to compare two protocols of postoperative care in cardiac surgery: An enhanced recovery program consisting of high flow nasal oxygen therapy together with pectointercostal block, versus conventional postoperative care. Patients and Methods Fifty adult participants above the age of 18, of either sex scheduled for cardiac surgery who required the utilization of cardiopulmonary bypass and median sternotomy approach, were included in the study. The participants were divided into ERAS Care group, where they received ultrasound-guided pectointercostal fascial plane block with subcutaneous local anaesthesia infiltration around the mediastinal drains and were extubated onto high flow nasal oxygen therapy (HFNO), and a Conventional (CONV) care group, where participants received fentanyl IV bolus dose followed by fentanyl IV infusion that was continued till the end of day zero and were extubated onto 6 L/min simple facemask. Results Participants in the ERAS group had shorter ICU stay, lower numeric pain rating scale scores, less need for rescue analgesia, better oxygenation and lung aeration scores, better patient satisfaction, and less late pulmonary complications on discharge radiological screening. However, gastrointestinal complications and hospital stay were compared in both groups. Conclusion ERAS care protocol in cardiac surgery patients led to shorter ICU ventilation periods, shorter ICU stay, better patient satisfaction and pain control, better oxygenation and lung aeration and less atelectasis on discharge radiology.

95. CAUTI and CLABSI in Hospitalized COVID-19 Patients

BackgroundPatients hospitalized for suspected or confirmed COVID-19 often require high levels of support, including supplemental oxygen or ventilation, intravenous fluids and pressors, prone positioning, and strict input/output monitoring. Increased utilization of invasive devices such as indwelling urinary catheters and central venous catheters may be needed in this population. Staff minimize contact time with COVID-19 patients. We hypothesized higher rates of device infection in patients with COVID-19.Table 1 MethodsThis is a retrospective cohort study at a 555-bed safety net hospital. 4 units (125 beds) primarily cared for patients with confirmed infection. Other units did not accept patients until COVID status was deemed negative, except Labor & Delivery and a designated mixed unit. Indwelling urinary catheter and central venous catheter (CVC) device days are tracked in all inpatient areas. CLABSI and CAUTI surveillance is performed using NHSN definitions. The first hospitalized COVID-19 case at our hospital occurred late March 2020. April - May 2020 was considered the initial pandemic phase for our institution. Device utilization for the 6 months prior (October 2019 – March 2020) was compared to initial pandemic phase. Device infection rates were also compared. Within the initial pandemic phase, utilization and infection rates were stratified by COVID-19 vs non-COVID-19 areas.ResultsMedian indwelling urinary catheter usage increased during the initial pandemic period by 36% (998 to 1355 catheter days, p=0.13); CVC usage increased 25% (997 to 1246 CVC days, p=0.13). Hospital-wide, median CAUTI rates remained constant (2.9 and 2.7 infections/1000 catheter days, p=1.00). CLABSI rates increased significantly (0.0 and 1.6 infections/1000 CVC days, p=0.008). CAUTI rates were 83% higher, and CLABSI rates were 65% higher in COVID-19 areas compared to non-COVID-19 areas (Table 1). Urine culture and blood culture ordering were 69% higher and 73% higher in COVID-19 areas, respectively.ConclusionUtilization of both indwelling urinary catheters and CVC increased during the initial phase of the pandemic. Hospitalized COVID-19 patients appear to be at higher risk of both CAUTI and CLABSI. Patient care protocols, device utilization and culture ordering all require further investigation.Disclosures All Authors: No reported disclosures

Effect of immediate pain management on oxygenation level among early extubation patients post heart surgery

Pain is the most severe in patients after open thoracic surgery. Patients undergoing surgery report slightly higher pain intensity than other surgery types. The aim of the study: is to evaluate the effect of immediate pain management on oxygenation levels among early extubated patients post-heart surgery. Subjects and Methods:Quasi-experimental design; a sample of 60 patients (male and female)divided equally into two groups; study group (n=30) and control group (n=30). Setting: cardiothoracic ICU and cardiothoracic department at the cardiothoracic hospital that belongs to Minia University Hospitals, Egypt. Tools: Three tools: I: Socio-demographic and medical Assessment, II: oxygenation level assessment and III: Numeric Pain Scale. Results: Mean age of study and control groups were (38.4±5.4) & (37.2±4.8) year respectively. (40%) from the study group suffered a myocardial infarction and did coronary angioplasty, (43.3%) of the control suffered coronary artery stenosis (33.3%) among them did coronary angioplasty. Related to the pain scale there was a significant difference between study and control groups at p-value <0.05. Also regarding oxygenation level which presented by a significant difference between both groups about breathing sound and arterial blood gases test at 1st, 3rd and 7th day of the study, presented by p-value <0.05. Conclusion: This study concluded that pain management has a positive effect on a patient's oxygenation level which was presented in improving patients breathing sound and arterial blood gases which reflected on the patient's outcomes post-cardiac surgery. Recommendations: All cardiac surgery patients should receive pain management strategies before their operations and the pain management strategies should be included in the protocol of care for cardiothoracic patients.

A snapshot of COVID-19 infection in patients with solid tumors.

Coronavirus disease 2019 (COVID‐19) pandemic is affecting a high percentage of the population at an unprecedented rate. Cancer patients comprise a subgroup especially vulnerable to this infection. Herein, we present a prospective analysis of epidemiological, clinical, radiological and laboratory data of consecutive adult cancer patients seen in the Clínico San Carlos University Hospital (Madrid, Spain), and admitted to hospital and tested for COVID‐19 between 21 February 2020 and 8 May 2020 due to clinical suspicion of infection. Data from 73 patients with confirmed COVID‐19 and active solid tumors or diagnosed within the previous 5 years were analyzed. The most frequent malignancy was lung cancer (19%) and 54 patients (74%) were on active cancer treatment. Most common findings on presentation included cough (55%), fever (52%) and dyspnea (45%), and 32 (44%) patients showed oxygen saturation levels below 95%. Radiologically, 54 (73%) patients presented an abnormal pattern, the most frequent being infiltrates (64%). 18 (24.7%) patients died in hospital and 55 (75.3%) were discharged with clinical resolution of the event. Multivariable logistic regression adjusted for age and tumor stage showed higher odds of in‐hospital death associated with a history of cardiovascular disease, hospitalization in the previous 30 days, and several features on admission including dyspnea, higher qSOFA score, higher C‐reactive protein levels and an abnormal neutrophil count. We present prospective, real‐world evidence that can help articulate cancer care protocols for patients infected with SARS‐CoV‐2, with special focus on features on admission that can stratify patients with a higher risk of death from COVID‐19.

Atendimento odontológico a pacientes em fase de pré-transplante hepático: proposta de protocolo

O número de pacientes que aguardam o transplante hepático tem aumentado mundialmente. Sua avaliação e tratamento odontológicos são recomendados antes do transplante hepático, com o objetivo de eliminar focos de infecções bucais, evitando complicações orais e infecções generalizadas após a terapia imunossupressora.Para isso, uma padronização de condutas clínicas odontológicas deve ser empregada para uniformização dos tipos de tratamento para determinados diagnósticos. O objetivo deste estudo é propor um protocolo de atendimento odontológico a pacientes candidatos a transplante hepático. Os procedimentos odontológicos realizados no projeto de extensão “Assistência Odontológica a Pacientes Transplantados de Fígado” demonstraram que podem ser realizados com segurança, desde que as devidas alterações da condição sistêmica sejam avaliadas, observando exames como coagulograma e realizando a escolha da correta medicação e trabalhando em conjunto com a equipe multidisciplinar irão garantir uma melhor qualidade de vida para os pacientes.

NURS-11. MARIJUANA, HEMP, AND THE CHILD WITH CANCER: PATIENT, PARENT, AND CLINICIAN EDUCATION

Many pediatric oncology patients report medical marijuana (MMJ) and hemp-based CBD use. Eleven states and Washington, DC have legalized marijuana for recreational use for adults greater than 21. Medical marijuana is legalized in 33 states. Additionally, due to the bipartisan Farm Bill passed in December of 2018, hemp is federally legal. Marijuana has medical legalization in 23 countries worldwide. Clinical trials in adults have examined MMJ for cancer-related symptoms. New research is emerging on MMJ in anticancer therapy, MMJ receptors on tumor cells, and the potential role for MMJ as an immunomodulator. Few pediatric oncology studies have evaluated MMJ. We describe the initial findings of a prospective observational study of MMJ on the quality of life (QOL) in pediatric brain tumor patients. Specific aims included (1) MMJ’s association with symptoms (nausea, anxiety, pain, fatigue, and cognitive problems) and (2) MMJ’s impact on family dynamics. The legality of hemp plus the increasing use of MMJ raises concerns with pharmacological interactions with CBD and the medications routinely administered to children with cancer. Nurses are the frontline for discussions with patients about MMJ and must be aware of the emerging field of MMJ in pediatric cancer. Additionally, nurses can influence patient care protocols and processes for alternative therapy administration enabling an open dialogue between providers, parents, and patients regarding treatments, symptoms, adverse effects, and drug interactions. Education about how to have conversations about important facets to cover and consider is crucial to patient safety and increased quality of life.

Unlocking of the Orthopedic Department in the Largest Tertiary Referral Hospital of Iran: Our Experience during Coronavirus Disease 2019 Pandemic

Background: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the largest global healthcare crisis of the last century since its emergence in December 2019. As more of the condition’s chronicity became evident and the government policies changed, the unlocking of the orthopedic wards seemed necessary. In this study, we decided to share our experience regarding the unlocking of our orthopedic ward in the largest tertiary referral hospital of Iran and to explain its negative and positive consequences.&#x0D; Methods: This observational study was done in Imam Khomeini Hospital Complex, Tehran, Iran, from April to August 2020. We extracted the data regarding the number of elective/trauma operations, emergency patients, and morning report sessions attendance from our registry database. The data were analyzed and plotted using Microsoft Excel 365.&#x0D; Results: The mean weekly number of orthopedic operations decreased from 50 for elective and 30 for trauma operations in January 2020 to almost zero for both in late March and early April 2020 [the first coronavirus disease 2019 (COVID-19) peak]. Following the department unlocking, the mean weekly elective and trauma operations returned to 50 and 20 by mid-June, respectively. The mean weekly orthopedic emergency visits followed the same order with decrease from 50 to almost zero in late March and increase to 70 in mid-June. However, by the beginning of the second wave, it decreased to almost 38 in early July and further to 28 in late July by the end of the second wave.&#x0D; Conclusion: The unlocking of the orthopedic department in a tertiary referral hospital during the COVID-19 pandemic is possible, provided that there is a set of protocols for patient care in the ward, emergency room (ER), operating room (OR), and clinic during the pandemic.

Validation of a Novel 'Supportive Oral Care Protocol' (SOCP), a Model for Care in Head and Neck Cancer Patients at Tertiary Cancer Centre in India.

India has a huge burden of head and neck cancer and specifically oral cancer. Supportive oral care is not a standard of care in our population and is often neglected. Currently, there are no specific guidelines for such care in India which could be followed. The aim of this study is to validate a novel institutional supportive oral care protocol (SOCP) for head and neck cancer patients. This protocol is specific to our population developed for head and neck/dental oncology experts working in cancer centres to provide comprehensive care. This is a cross-sectional validity study. Fifteen dental oncology experts working in cancer centres/hospitals across India and six oncology experts from our centre were enrolled. All experts provided their inputs on 41 points of the SOCP. The data was analysed for item validity, content validity index and inter-rater agreement. The statistical analyses used were kappa measure for inter-rater agreement and content validity index for item-wise agreement. Out of 861 responses from all the reviewers, 91% agreed, 8.4% agreed with modification and 0.6% disagreed. The content validity index and agreement between reviewers ranged from 0.9 to 1 for kappa measure. The SOCP of our institution was shown to be a valid protocol. SOCP addresses oral and dental supportive care and rehabilitation as part of overall comprehensive care for head and neck cancer patients in our population.

Stereotactic EEG Practices: A Survey of United States Tertiary Referral Epilepsy Centers.

Stereotactic EEG (SEEG) is being increasingly used in the intracranial evaluation of refractory epilepsy in the United States. In this study, the authors describe current practice of SEEG among National Association of Epilepsy Centers tertiary referral (level IV) centers. Using the Survey Monkey platform, a survey was sent to all National Association of Epilepsy Centers level IV center directors. Of 192 centers polled, 104 directors completed the survey (54% response rate). Ninety-two percent currently perform SEEG. Of these, 55% of institutions reported that greater than 75% of their invasive electrode cases used SEEG. Stereotactic EEG was commonly used over subdural electrodes in cases of suspected mesial temporal lobe epilepsy (87%), nonlesional frontal lobe epilepsy (79%), insular epilepsy (100%), and individuals with prior epilepsy surgery (74%). Most centers (72%) used single-lead electrocardiogram monitoring concurrently with SEEG, but less than half used continuous pulse oximetry (47%) and only a few used respiratory belts (3%). Other significant intercenter technical variabilities included electrode nomenclature and choice of reference electrode. Patient care protocols varied among centers in patient-to-nurse ratio and allowed patient activity. Half of all centers had personnel who had prior experience in SEEG (50.5%); 20% of centers had adopted SEEG without any formal training. Stereotactic EEG has become the principal method for intracranial EEG monitoring in the majority of epilepsy surgery centers in the United States. Most report similar indications for use of SEEG, though significant variability exists in the utilization of concurrent cardiopulmonary monitoring as well as several technical and patient care practices. There is significant variability in level of background training in SEEG among practitioners. The study highlights the need for consensus statements and guidelines to benchmark SEEG practice and develop uniform standards in the United States.