Support Guidelines Research Articles

Overconfidence effects and learning motivation refreshing BLS: An observational questionnaire study

Aim of the studyRegular refresher skill courses are necessary to maintain competence in basic life support. The utilization of these training programs strongly depends on the motivation to learn. Learning motivation may be affected by overconfidence and clinical tribalism, as they both imply a higher competence compared to others, and therefore, a lower demand for training. This study aimed to assess how overconfidence in basic life support competencies affects learning motivation. MethodsWe conducted a cross-sectional, observational, multicenter, anonymous online questionnaire survey using validated psychometric tests for healthcare professionals in Germany. Further, we tested participants’ knowledge and attitude regarding international basic life support guidelines. The study was conducted between March and April 2022, and healthcare providers from 22 German emergency medical services and hospitals at all levels were assessed. ResultsOf 2,000 healthcare professionals assessed, 407 completed the assessment (response rate, 20.4%). We confirmed the presence of overconfidence and clinical tribalism (identity differentiation between social groups) among the 407 physicians, nurses, and emergency medical service providers who completed the survey. Three different learning-motivation groups emerged from cluster analysis: “experts” (confident and motivated), “recruitables” (overconfident and motivated), and “unawares” (overconfident and unmotivated). The three groups were present in all professional groups, independent of the frequency of exposure to cardiac arrest and educational level. ConclusionsThese findings showed the presence of overconfidence effects and different learning motivation types in individuals learning basic life support, even in instructors.

Evidence-Based Guidelines for Labor Support that Promote Vaginal Birth.

Dr. Samantha L. Bernstein is Assistant Professor at the MGH Institute of Health Professions in Boston, MA and an MCN Editorial Board Member. Dr. Bernstein can be reached via email at [email protected] The author declares no conflicts of interest.

Effect of Supportive Educational Guidelines about Hydatidiform Mole on Women's Knowledge, Satisfaction, Compliance with Treatment and Follow up

Effect of Supportive Educational Guidelines about Hydatidiform Mole on Women's Knowledge, Satisfaction, Compliance with Treatment and Follow up

Strategies to adapt and update the existing residential building stock of Lezha region in the post Covid-19 pandemic era

Towards sustainable solutions for post pandemic city is analyzed the city of Lezha - as case Since its beginning, the Covid-19 pandemic changed most of the aspects of human life and, specifically, has resulted in a disruptive transformation of the social interactions. As it is well known, the largest part of the built spaces has been shaped to ensure these interactions and, as consequence, sanitary prevention measures (minimum interpersonal distance of one meter and half to keep in public spaces or the attendance of school from home, working from home) have been having a disruptive impact on the spaces inhabited by humans until now. Narrowing down the field to the built environment, at the scale of the residential buildings, this article investigates how, in the of region of Lezha (Albania), both in the pandemic and post-pandemic scenario, the reconfiguration of the home spaces can play a significant role in protecting residents from the disease. In this context, the two main key aspects of the houses analyzed in the article are essential to face those transformations of built environment due to the pandemic: the spatial transformation in terms of size, adaptability, and flexibility of the layout of the dwellings and the improvement of environmental quality and comfort of the dwellings. Starting from data available from the Census 2011 for the region of Lezha, the spatial, constructive and environmental features of the most representative existing building types have been analyzed, identifying the ones that have to be improved. From the data collected by this analysis, general design support guidelines to adapt and update the existing residential Lezha region building stock to the new living needs imposed by Covid-19 pandemic have been developed, addressed mainly to local authorities and building users.

The psychological support for women who underwent a stillbirth during their pregnancy: the quality of midwifery care.

This review aims to investigate the role of midwifery care in perinatal death. Specifically, it aims to investigate the type and implications in the clinical practice of psychological and psychiatric support interventions for women/couples. A scoping review was conducted following the PRISMA methodology. For this purpose, the following databases were queried: PubMed, APA PsycInfo, CINAHL Plus with Full Text, and ERIC, considering only studies published in the 2002-2022 time frame. 14 studies were found to be eligible by the literature review. These researches were divided into 3 macro-topics representing the most crucial factors in influencing the quality of care: the healthcare setting, the experience and training of caregivers, and the experience of parents. The healthcare figure who experiences such a tragic event most closely is the midwife. The health and geographic context in which care is provided - understood to be low-medium-high resources - have a fundamental impact on the quality of midwifery care and caregiver satisfaction. The training was found to be incomplete, and midwives' experiences revealed how they felt unprepared. Parents' experiences indicate the need for multidisciplinary care, better communicability, and follow-up including psychological/psychiatric support for mothers who are increasingly alone in coping with bereavement. To date, there are no guidelines for psychological support for this specific event in the literature. Birth-death management should be a structured part of professional courses so that new generations of midwives can improve the quality of care for affected families. Future research should focus on how to improve communication processes, and hospital centers should adopt protocols adapted to the needs of parents, including a midwifery-led model policy based on psychological support for the mothers/couples involved, as well as increase follow-ups.

Following up on mild cognitive impairment: A memory service case study

Mild Cognitive Impairment is a diagnosis of uncertainty. Although some people with MCI may go on to receive a dementia diagnosis, others do not. In the absence of national guidelines for MCI assessment and support, there is considerable variation in practice. In this paper we provide a description of the approach taken by one Memory Service to recalling people given an MCI diagnosis, including consumer feedback.

NRS‑2002 scale impact on nutritional status screening of patients with acute cerebrovascular accident

Evaluation of the nutritional status at an early stage of hospitalization in patients with acute cerebrovascular insufficiency (CVA) is important for providing timely nutritional support. According to the Russian clinical guidelines for nutritional support of patients with stroke, the NRS‑2002 scale is essential to assessment the nutritional status. However, due to the obesity, about 30 % of patients do not entered into the general category of patients with CVA to get the standard examination.Aim. To analyze the NRS‑2002 scale effectiveness in patients with acute cerebrovascular accident, taking into account the somatic and visceral protein pools.Materials and methods. In the case of the prospective study the 140 patients with CVA were hospitalized in the primary vascular department of the City Clinical Hospital n. a. V. V. Vinogradov (Moscow, Russia), and were screened by the simplified malnutrition scoring system and the NRS‑2002 scale.Results. The research reveals: A low risk of malnutrition in 34,3 % of all cases and 72,7 % in patients under 70 years; the high BMI – Me‑26,6 (24,2–30,8) kg/m²; the protein deficiency in 140 (25.7 %) of patients with normal somatic protein pool and in 66 (28.8 %) of patients under 70 years.Conclusions. Detecting the risk of malnutrition with the NRS‑2002 scale in the early stage after hospitalization is not always informative due to the overweight and the age less than 70 years. The visceral protein pool analysis should be performed in all patients, independently of the NRS‑2002 scale and the somatic protein pool results.

Multiple Arterial Graft Use in Coronary Artery Bypass Surgery: Surgeon Perspective vs Practice

BackgroundDespite supportive evidence and guidelines, the use of multiple arterial grafts (MAGs) in coronary artery bypass grafting remains low. We sought to determine surgeon perception of personal MAG use and compare this with actual MAG use. MethodsWe conducted a statewide surgeon survey of MAG use, presence of a hospital MAG protocol, and barriers for MAG use, with a response rate of 78% (n = 25). Surgeon survey responses were compared with actual Society of Thoracic Surgeons patient data from January 1, 2017, to December 31, 2020 using χ2 or Fisher’s exact tests. ResultsOf 5299 patients who had first-time, nonemergent, isolated coronary artery bypass grafting (≥2 grafts) by responding surgeons, 16% received MAG (n = 825). MAG use in patients whose surgeons self-designated as “routine” MAG users was 21% vs 7% for “nonroutine” users. Surgeons with a hospital protocol for MAG use utilized MAG more often (18% vs 14%, P = .001). Surgeons who were unconvinced by the data on the benefits of MAGs used MAGs in 11% vs 22% in surgeons who were convinced. MAG use increased over time, particularly from before to after the survey (13.1% vs 30.5%, P < .001). ConclusionsAlthough MAG use increased over time, barriers to routine use remain. In surgeons who reported routine use, only 21% of their patients received MAGs. Hospital protocols, education, and increased awareness may reduce barriers to use and encourage evidence-based clinical practice.

Development of mental health and psychosocial support (MHPSS) guidelines for deaf and hard of hearing children in the Gaza Strip.

Deaf and hard of hearing children in the Gaza Strip may be at risk of mental health conditions and psychological distress, as a result of social exclusion and limited accessible communication. This article presents the process and research methods used to develop guidelines for schools in the Gaza Strip on mental health and psychosocial support for deaf and hard of hearing children. The process was guided by the GIN-McMaster guideline development checklist across four steps: (1) priority settings; (2) searching for evidence; (3) developing recommendations; (4) evaluation. Priority setting was spearheaded by local and international researchers, and a local steering committee comprised of deaf and hard of hearing representatives, school administration and staff, mental health specialists, family members and government officials. In searching for evidence, and in order to generate evidence-based recommendations for the guidelines, we utilised a scoping review of global mental health support for deaf and hard of hearing children and qualitative research with deaf and hard of hearing children and adults, families and teachers. Two pilot studies were conducted in mainstream and specialist educational settings as way of evaluation. The scoping review and qualitative research identified various content for the guidelines, including the importance of information on disability and deafness, promoting social inclusion and self-esteem, and accessible learning environments. The pilot studies demonstrated feasibility and acceptability among teachers and deaf and hard of hearing children, although teachers need sufficient support and resources to implement. Now finalised, the guidelines are being distributed to schools in the Gaza Strip to support the mental health and wellbeing of deaf and hard of hearing children.

Complete fracture-dislocation of the cervical spine without permanent neurological sequelae: case report

Background: Cervical spine injuries occur in up to 3% of all trauma patients. Fracture-dislocation of the lower cervical spine is typically present with severe spinal cord injury in which the body of one vertebra rests fully anterior to the next body. With this kind of injury, there are very few examples where there is no permanent neurological deficit, and those that do exist are extremely rare. Case Presentation: A 19-year-old Saudi male patient was presented by ambulance to the emergency department. He was a front-seat passenger in a vehicle involved in a road accident. The patient was unconscious, Glasgow Coma Scale (GCS) (8/15), and quadriparetic. He was intubated and put on a mechanical ventilator and vasopressor support for persistent hypotension. American Spinal Injury Association impairment scale was a grade A. Initial management and resuscitation was done according to Advanced trauma life support (ATLS) guidelines: cervical collar application, logrolling, analgesic therapy, vitals normalized, and general condition stabilized. Skull traction was performed on admission. The patient underwent anterior cervical open reduction + C6/7 pedicle screw, and lateral mass screw internal fixation was performed. Conclusion: We report a rare case of complete fracture dislocation of C5/C6 listhesis with bilateral facet lock, with C7 fracture, C7/T1 listhesis, and bilateral facet lock. The patient presented with quadriparesis and was successfully treated with posterior reduction and fusion. The mechanism of injury, which was thought to be flexion and compression, was deduced by the patient&amp;apos;s history and the results of physical and neuroimaging examinations.

Izazovi korporativnog restrukturiranja javnih preduzeća u Republici Srbiji

This paper deals with restructuring of public enterprises in Serbia, focusing on the identification of challenges, as well as the analysis of all the key aspects relevant to the process of the restructuring. It points out the importance of theoretical perspectives and the state with its institutional framework in providing support and restructuring guidelines. Financial challenges and social aspects are also highlighted, as well as employee protection measures. It also deals with the influence of politics, economy and human capital on the process itself. The purpose of this paper is to provide a comprehensive insight into the challenges, implications, and both theoretical and practical sides to restructuring of public enterprises. The goal is to understand the complexity and specific details of the restructuring, while identifying all the key factors of the process-success and obstacles. A detailed study of relevant literature, research papers, articles and regulations had been conducted prior to writing this paper. Applicable restructuring theoretical models and concepts were also examined. After analysis and research, it was noticed that the restructuring of public enterprises in Serbia faces different challenges, such as: political interference, lack of financial resources, structure inflexibility, and resistance to change. The state and institutions play an important role in the process of restructuring. We emphasized the importance of adequate employee protection during restructuring and provided guidelines for achieving social justice. The results provide a starting point for further research, including those regarding specific sectors, implementing new technologies and some innovative approaches to restructuring.

Cardiac Surgery Unit Advanced Life Support Training: A 10-Year Retrospective Study Examining Patient Mortality Outcomes After Implementation.

Although the body of knowledge related to Cardiac Surgery Unit Advanced Life Support (CSU-ALS) guideline has grown over the last 10 years, there is no existing literature examining the impact of this training on patient mortality outcomes. This article describes one institution's experience related to patient mortality outcomes following a rigorous training program following the CSU-ALS guideline. Because of the small numbers associated with cardiac arrests after cardiac surgery (0.7%-8%), statistical significance was not a goal. A quasi-experimental design was used to compare mortality outcomes before and after CSU-ALS training. One hundred percent of the staff were trained in the initial year, and 85% to 90% of the staff maintained competency in the following years. The author used 10 years of retrospective data to compare mortality rates 4 years before and 6 years after the intervention. The retrospective data showed a decrease in the percentage of failure-to-rescue rate in the intervention group (control 16% vs intervention 2%). Fisher exact testing implies that the observed frequencies were not significantly different from the expected frequencies (P = .072 and P = .135). Because of the small sample size, statistical significance could not be established. This institution experienced an extremely positive track record in outcomes despite its inability to prove a statistically significant correlation to the CSU-ALS training. The overall observed and self-reported confidence level of the staff during the study period was outside the project scope but deserves mention and further research.

Revised Trauma Score, Injury Severity Score, New Injury Severity Score and Trauma Revised Injury Severity Score among Trauma Patients in a Tertiary Care Hospital: A Comparative Study

Introduction: Injury severity scoring can provide objective correlations with resource utilisation, such as length of stay and treatment costs, and inform clinical decisions regarding managing injuries of specific severity. The ability to predict survival after trauma is perhaps the most fundamental use of injury severity scoring. Aim: To compare the efficacy of the Injury Severity Score (ISS), Revised Trauma Score (RTS), New Injury Severity Score (NISS), and Trauma Revised Injury Severity Score (TRISS) in the prediction of mortality in trauma patients. Materials and Methods: In this comparative prospective observational study conducted in the Department of General Surgery, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India from April 2021 to September 2022 in 400 trauma patients who were clinically assessed and managed per the latest Advanced Trauma Life Support (ATLS) guidelines (10th edition). After the stabilisation of the patient, RTS, ISS, NISS and TRISS was obtained from the trauma chart, imaging studies and intraoperative findings. Statistical analysis was done using the statistical software Statistical Package for the Social Sciences (SPSS) version 16.0. Results: Most trauma patients showed more blunt injuries 284 (71.0%) than penetrating injuries 116 (29.0%). The major trauma region was external 161 (40.3%), followed by extremity 124 (31.0%). The mortality rate in this study was 17 (4.3%). The cut-off points for predicting mortality in trauma patients in ISS, RTS, NISS and TRISS systems were 22, 6.8, 28.5, 87.95 with sensitivity of 94.12%, 88.24%, 88.24%, 100.00% and specificity of 94.78%, 94.52%, 92.95%, 95.56%, respectively. Conclusion: According to the current study’s findings, TRISS was a more accurate prognosticator among trauma patients.

중도중복장애 학생을 위한 특수교사 직무역량 척도 개발을 위한 기초 연구

This study was conducted to improve the quality of education in special education in accordance with the trend of using the basis for job competency as part of improving the expertise of teachers in the school. Due to the recent increase in the proportion of students with severe and multiple disabilities, special teachers have had difficulties in keeping up; this is because the definition of students with severe and multiple disabilities is ambiguous, and the necessary support for them has not been clearly identified. Institutional support for students with severe and multiple disabilities is improved, but schools still have not established specific guidelines for education and support, and opinions on medical support are still divided. Therefore, the purpose of this study is to develop a special teacher job competency scale necessary for the education of students with severe and multiple disabilities. To this, through the Delphi survey, the domains, factors, and items of the special teacher competency scale for students with severe and multiple disabilities were examined. As a result of the study, five domains, 31 factors, and 90 items were finally derived as a special teacher competency scale for students with severe and multiple disabilities. This study is meaningful in that it presented specific education and support guides for special teachers in the education of students with severe and multiple disabilities and became basic data for enhancing the professionalism and quality of education for special teachers.

Relationship between cardiac ultrasound findings during cardiopulmonary resuscitation with the outcome of patients

Objective: Cardiopulmonary arrest is a devastating outcome of some clinical situations and requires strict implementation of cardiopulmonary resuscitation (CPR) protocols. Since ultrasound is one of the recommended tools to determine the presence of cardiac movements and may be a predictor of the outcome, this study examined the relationship between echocardiographic findings during CPR with patients’ outcomes. Methods: This cross-sectional prospective observational study was conducted on patients with cardio-respiratory arrest in the emergency department of Shariaty hospital during 2019. sampling method was random. Echocardiography was done at the patient’s bedside during the CPR process in accordance with the last advanced cardiac life support (ACLS) guidelines, on two points, after the end of the second and 10th minutes from the start of CPR. The echocardiography findings (cardiac movement vs standstill) were recorded, and patient outcomes were followed. Thirty-two patients enrolled in this study with a mean age of 56.9±15.3 years. Chi-square and Mann-Whitney U tests were used to calculate the association between heart contractions during resuscitation and the outcomes via SPSS V.22. Fisher’s exact test and Kruskal-Wallis test were used to evaluate the relationship between heart rhythm in the second and tenth minutes with the outcomes of CPR. Results: The presence of cardiac movement in the 10th minute of CPR, in contrast to the findings of the second minute, had a significant correlation with the success rate of CPR and outcomes (P&lt;0.05). Moreover, patients with ventricular tachycardia (VT)/ventricular fibrillation (VF) cardiac rhythm had a better resuscitation rate, 24-hour survival rate, and better outcome than patients with other cardiac rhythms and asystole (P&lt;0.05). Conclusion: Echocardiographic findings in the 10th minute of the CPR process can be used as a prognostic factor for cardiac arrest.

Real-World Use of Granulocyte-Colony Stimulating Factor in Patients with Breast Cancer from Alberta, Canada.

There are limited published data in the Canadian healthcare system on the use of granulocyte colony-stimulating factor (G-CSF) among patients with breast cancer. This study characterized real-world G-CSF use during the period surrounding the introduction of filgrastim biosimilar. Electronic medical records were reviewed retrospectively for patients with breast cancer who received moderately or highly myelosuppressive (neo)adjuvant chemotherapy from 2008 to 2019 in Alberta, Canada. Trends in G-CSF usage were plotted to elucidate temporal variations and multivariable regression models were constructed to identify clinical factors associated with G-CSF use. We included 6662 patients in our analyses. G-CSF was used in 57.1% of patients during their treatment trajectory. Among the 3801 patients who were treated with G-CSF, the majority received pegfilgrastim only (91.5%; n = 3477) versus filgrastim only (5.7%; n = 217). G-CSF use increased linearly more than two-fold over the 11-year study period. Predictors of G-CSF use included younger age, south zone of residence, higher neighborhood education, inferior disease stage, highly neutropenic risk chemotherapy, and more recent chemotherapy initiation. Despite increasing G-CSF usage over time, an appreciable proportion of patients for whom G-CSF prophylaxis is recommended did not receive it. G-CSF use could be further optimized to align with supportive care clinical guidelines and reduce the impact of neutropenia and its associated complications.

Review of ESPEN-2021 Practice Guidelines for Cancer Patients: Part 1

This study discusses the 2021 ESPEN Practical Guidelines for Nutritional Support in Oncology. The updated version of the 2021 ESPEN practice guidelines differs slightly from the 2017 version and contains flowcharts to facilitate the use of the guidelines in clinical practice, which is also relevant for domestic healthcare. ESPEN-2021 Clinical Guidelines, which offer practical solutions in all areas of oncology, are of particular interest to both oncologists and allied specialists working in oncology. The first part of the review discusses general recommendations for nutritional support for patients with cancer and the possibility of their use in our country: screening of nutritional status at the initial visit, indications for prescribing additional nutrition, benefits of one or another type of nutritional support in various situations, norms for providing macronutrients, vitamins, and minerals, and need for physical activity. This practical guide forms an algorithm of actions to ensure optimal nutrition for patients with cancer. The general principles of nutritional therapy for all patients with cancer are based on timely screening for nutritional deficiencies and adherence to appropriate nutritional support of patients, which can be achieved by modifying the diet or prescribing additional nutrition, mainly enteral nutrition.

A Clinical Audit to Assess the Adherence of the Code Blue Team to Advanced Cardiac Life Support Protocol and its Effect on the Patient Outcome in a Tertiary Care Hospital in Kochi, Kerala

Introduction: Cardiopulmonary resuscitation is a sequence of techniques that combines chest compression with artificial ventilation to manually maintain the circulation to preserve intact brain function. The aim is to maintain circulation and breathing in a person who is in cardiac arrest until emergency aid arrives. Effective teamwork by Code Blue team raises chances of a successful outcome. The advanced cardiac life support (ACLS) guidelines were developed by the American Heart Association using the comprehensive review of resuscitation literature performed by the International Liaison Committee on Resuscitation. Aim: To assess adherence of Code Blue team to ACLS protocol, to assess outcome of resuscitation, and to compare outcome between those where ACLS guidelines were followed and those not followed. Patients and Methods: A clinical audit was done between 2014 and 2015 at Lourdes Hospital, Kochi, on inpatients aged between 30 and 80 years, with witnessed cardiac arrests/respiratory arrest. Pregnant and unwilling patients were excluded. Results: The common arrest rhythm was pulseless electrical activity, followed by asystole. ACLS protocol was followed in 58.7%. The most common deviation was usage of inappropriate drugs. Return of spontaneous circulation (ROSC) was attained in 53.3%, of which 28.5% were discharged (P

Correlation between in vitro toxicity of pesticides and in vivo risk guidelines in support of complex operating site risk management: A meta-analysis.

In vitro cell systems can support hazard characterization and identify mechanisms involved in toxicity; however, using in vitro data for risk assessment still is challenging. As part of an effort to develop approaches for a complex operating site used for biocide packaging and distribution, we evaluated in vitro assays that could be used in a site management format. Across 66 studies, 108 pesticides were assessed on ten human-derived cell types at four endpoints. In vitro IC50s were compared to in vivo guidelines, NOEL/NOAELs, and ADIs using Spearman correlation and linear regression models. While human neuroblastoma cells (SH-SY5Y) were the most sensitive, HepG2 was the most used cell line in evaluating the toxicity of pesticides. Amongst the ten human cell lines, the IC50s derived from SH-SY5Y cells, using MTT-24 & 48h (the most used assay) correlated (rho=0.56-0.79; p<0.05) with ADIs and NOEL/NOAELs. Although in vitro cell systems have some limitations, the correlation between in vitro data derived from SH-SY5Y cells and in vivo safety guidelines can provide site investigators with a tool to survey and prioritize areas and media of concern at complex operating sites impacted by pesticide mixtures.

Red Blood Cell Transfusion in Patients With Placenta Accreta Spectrum: A Systematic Review and Meta-analysis.

To evaluate red blood cell use during delivery in patients with placenta accreta spectrum. We searched MEDLINE, EMBASE, CINAHL, Cochrane Central, ClinicalTrials.gov, and Scopus for clinical trials and observational studies published between 2000 and 2021 in countries with developed economies. Abstracts (n=4,275) and full-text studies (n=599) were identified and reviewed by two independent reviewers. Data on transfused red blood cells were included from studies reporting means and SDs, medians with interquartile ranges, or individual patient data. The primary outcome was the weighted mean number of units of red blood cells transfused per patient. Between-study heterogeneity was assessed with an I2 statistic. Secondary analyses included red blood cell usage by placenta accreta subtype. Of the 599 full-text studies identified, 20 met criteria for inclusion in the systematic review, comprising 1,091 cases of placenta accreta spectrum. The number of units of red blood cells transfused was inconsistently described across studies, with five studies (25.0%) reporting means, 11 (55.0%) reporting medians, and four (20.0%) reporting individual patient data. The weighted mean number of units transfused was 5.19 (95% CI 4.12-6.26) per patient. Heterogeneity was high across studies (I2=91%). In a sensitivity analysis of five studies reporting mean data, the mean number of units transfused was 6.61 (95% CI 4.73-8.48; n=220 patients). Further quantification of units transfused by placenta accreta subtype was limited due to methodologic inconsistencies between studies and small cohort sizes. Based on the upper limit of the CI in our main analysis and the high study heterogeneity, we recommend that a minimum of 6 units of red blood cells be available before delivery for patients with placenta accreta spectrum. These findings may inform future guidelines for predelivery blood ordering and transfusion support. PROSPERO, CRD42021240993.