Search

Right ventricular (RV) dysfunction in cardiac surgery can lead to RV failure, which is associated with increased morbidity and mortality. Abnormal RV function can be identified using RV pressure monitoring. The primary objective of the study is to determine the proportion of patients with abnormal RV early to end-diastole diastolic pressure gradient (RVDPG) and abnormal RV end-diastolic pressure (RVEDP) before initiation and after cardiopulmonary bypass (CPB) separation. The secondary objective is to evaluate if RVDPG before CPB initiation is associated with difficult and complex separation from CPB, RV dysfunction, and failure at the end of cardiac surgery. Prospective study. Tertiary care cardiac institute. Cardiac surgical patients. Cardiac surgery. Automated electronic quantification of RVDPG and RVEDP were obtained. Hemodynamic measurements were correlated with cardiac and extracardiac parameters from transesophageal echocardiography and postoperative complications. Abnormal RVDPG was present in 80% of the patients (n = 105) at baseline, with a mean RVEDP of 14.2 ± 3.9 mmHg. Patients experienced an RVDPG > 4 mmHg for a median duration of 50.2% of the intraoperative period before CPB initiation and 60.6% after CPB separation. A total of 46 (43.8%) patients had difficult/complex separation from CPB, 18 (38.3%) patients had RV dysfunction, and 8 (17%) had RV failure. Abnormal RVDPG before CPB was not associated with postoperative outcome. Elevated RVDPG and RVEDP are common in cardiac surgery. RVDPG and RVEDP before CPB initiation are not associated with RV dysfunction and failure but can be used to diagnose them. [ABSTRACT FROM AUTHOR]

Interview and questionnaire studies have identified barriers and challenges to preventing surgical site infections (SSIs) by focusing on compliance with recommendations and care bundles using interviews, questionnaires and expert panels. This study proposes a more comprehensive investigation by using observations of clinical practice plus interviews which will enable a wider focus. To comprehensively identify the factors which affect SSI prevention using cardiac surgery as an exemplar. The study consisted of 130 h of observed clinical practice followed by individual semi-structured interviews with 16 surgeons, anaesthetists, theatre staff, and nurses at four cardiac centres in England. Data were analysed thematically. The factors were complex and existed at the level of the intervention, the individual, the team, the organization, and even the wider society. Factors included: the attributes of the intervention; the relationship between evidence, personal beliefs, and perceived risk; power and hierarchy; leadership and culture; resources; infrastructure; supplies; organization and planning; patient engagement and power; hospital administration; workforce shortages; COVID-19 pandemic; 'Brexit'; and the war in Ukraine. This is one of the first studies to provide a comprehensive overview of the factors affecting SSI prevention. The factors are complex and need to be fully understood when trying to reduce SSIs. A strong evidence base was insufficient to ensure implementation of an intervention. [ABSTRACT FROM AUTHOR]

Surgical site infection (SSI) following cardiac surgery poses a significant challenge for healthcare providers. Despite advances in surgical techniques and infection control measures, SSI remains a leading cause of morbidity and mortality, in addition to being a significant economic burden on healthcare services. Current literature suggests there is a reproducible difference in the incidence of SSI following cardiac surgery between sexes. We aim to assess the sex-specific predictive risk factors for sternal SSI following coronary artery bypass grafting (CABG) in addition to identifying any differences in the causative organisms between groups. Adult patients undergoing isolated CABG between January 2012 and December 2022 in one UK hospital organization were included. In this 10-year, retrospective observational study, a total of 10,208 patients met the inclusion criteria. Pre-operative risk factors were identified using univariate analysis. To assess dependence between sex and organism or Gram stain, a Pearson Chi-squared test with Yates correction for continuity was performed. In total there were 8457 males of which 181 developed a sternal SSI (2.14%) and 1751 females, 128 of whom had a sternal SSI (7.31%). Male patients were found to be significantly more likely to develop an SSI secondary to a Gram-positive organism, whereas female patients were more likely to have a Gram-negative causative organism (P <0.00001). Staphylococcus was statistically more likely to be the causative organism genus in male patients. Pseudomonas aeruginosa was found to be twice as common in the female cohort compared with the male group. In our study, we found a statistically significant difference in the causative organisms and Gram stain for post-CABG sternal SSIs between males and females. Male patients predominately have Gram-positive associated SSIs, whereas female SSI pathogens are more likely to be Gram negative. The preoperative risk profiles of both cohorts are similar, including being an insulin-dependent diabetic and triple vessel coronary artery disease. Given these findings, it prompts the question, should we be tailoring our SSI treatment strategies according to sex and associated risk profiles? [ABSTRACT FROM AUTHOR]

Surgical site infection (SSI) surveillance aims to facilitate a reduction in SSIs through identifying infection rates, benchmarking, triggering clinical review and instituting infection control measures. Participation in surveillance is, however, variable suggesting opportunities to improve wider adoption. To gain an in-depth understanding of the barriers and facilitators for SSI surveillance in a high-income European setting. Key informant interviews with 16 surveillance staff, infection prevention staff, nurses and surgeons from nine cardiac hospitals in England. Data were analysed thematically. SSI surveillance was reported to be resource intensive. Barriers to surveillance included challenges associated with data collection: data being located in numerous places, multiple SSI data reporting schemes, difficulty in finding denominator data, lack of interface between computerized systems, 'labour intensive' or 'antiquated' methods to collect data (e.g., using postal systems for patient questionnaires). Additional reported concerns included: relevance of definitions, perceived variability in data reporting, lack of surgeon engagement, unsupportive managers, low priority of SSIs among staff, and a 'blame culture' around high SSI rates. Facilitators were increased resources, better use of digital technologies (e.g., remote digital wound monitoring), integrating surveillance within routine clinical work, having champions, mandating surveillance, ensuring a closer relationship between surveillance and improved patient outcomes, increasing the focus on post-discharge surveillance, and integration with primary care data. Using novel interviews with 'front-line' staff, identified opportunities for improving participation in SSI surveillance. Translating these findings into action will increase surveillance activity and bring patient safety benefits to a larger pool of surgical patients. [ABSTRACT FROM AUTHOR]

Lower extremity venous insufficiency is a chronic medical condition resulting from primary valvular incompetence or, less commonly, prior deep venous thrombosis or extrinsic venous obstruction. Lower extremity chronic venous disease has a high prevalence with a related socioeconomic burden. In the United States, over 11 million males and 22 million females 40 to 80 years of age have varicose veins, with over 2 million adults having advanced chronic venous disease. The high cost to the health care system is related to the recurrent nature of venous ulcerative disease, with total treatment costs estimated >$2.5 billion per year in the United States, with at least 20,556 individuals with newly diagnosed venous ulcers yearly. Various diagnostic and treatment strategies are in place for lower extremity chronic venous disease and are discussed in this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

• A large proportion of residents of LTC homes in Ontario were prescribed long-term opioid therapy. • Very few residents had opioids deprescribed long-term. • Residents who had opioid deprescribed were younger, had high comorbidity, and were co-prescribed benzodiazepines and gabapentinoids. Residents of long-term care (LTC) homes have potentially painful conditions and are prescribed opioids to manage their pain, despite the risks associated with the use of these high-risk medications. Therefore, the overall aim of this study was to describe the associations between resident and facility characteristics of residents prescribed long-term opioid therapy and those who remained on opioids or had opioids deprescribed. We conducted a retrospective cohort study utilizing health administrative databases housed within ICES. Our cohort included 26,592 of 121,564 LTC residents (21.9%) of Ontario LTC homes who were prescribed long-term opioid therapy at cohort inception. Of these residents, 4,299 (16.2%) residents had opioids deprescribed during the follow-up period. Opioid deprescribing was associated with younger age, high comorbidity, and co-prescription with benzodiazepines and gabapentinoids. Our findings suggest that there is variation in the characteristics of residents who continued long-term opioid therapy and those who subsequently had opioids deprescribed, and these characteristics need to be considered as part of individualized pain management plans of care. [ABSTRACT FROM AUTHOR]

Surgical site infections (SSIs) can have a significant impact on patients, their families and healthcare providers. With shortening inpatient periods, the post-discharge element of surveillance is becoming increasingly important. Proactive surveillance, including digital wound images using patient smartphones, may be an efficient alternative to traditional methods for collecting post-discharge surveillance (PDS). To determine success in patient enrolment and engagement including reasons for non-response, the time for clinicians to respond to patients, SSI rates, and carbon emissions when conducting PDS using patient smartphones. An evaluation was undertaken for a one-month period (June 2022) in two adult cardiac surgery services which routinely used patient smartphones for PDS, using the secure Islacare (Isla) system. The initial patient response rate for Isla was 87.3%, and the majority of patients (73%) remained engaged throughout the 30-day period. There was no significant difference in age, gender, operation type or distance to hospital between Isla responders or non-responders, or if the hospital provided a photo at discharge or not. Patients using Isla had a shorter post-discharge stay (P = 0.03), although this was not attributed to the platform. Patients not owning a smartphone and a technical issue were the main barriers to participation. Overall, nine SSIs were recorded, eight through the Isla surveillance and one through a hospital transfer readmission. The carbon emission associated with the SSI ranged from 5 to 2615 kg CO2e. In a real-world setting, using patient smartphones is an effective method to collect PDS, including wound images. [ABSTRACT FROM AUTHOR]

Background/Purpose: Organ and tissue donation coordinators (OTDCs) are usually registered nurses with an intensive care background who work in highly specialized and complex environments that can lead them to experience work-related issues, such as burnout and compassion fatigue. To help tackle these issues, organ donation organizations need to take preventive measures to improve coordinators’ work-related well-being. Therefore, the purpose of this study was to explore the perceptions of coordinators following participation in a workshop aimed at improving team cohesion, communication strategies, and work-related well-being. Methods/Procedures: We conducted individual descriptive qualitative interviews using a semi-structured interview guide with coordinators in an organ donation organization in Canada. The data were analyzed using an inductive thematic analysis process. Results: Seven coordinators participated in the study. Most participants reported improvements in inclusiveness and cohesiveness among their team after the workshop. Some coordinators reported apprehension about role-playing, but found it to be a valuable aspect of the intervention. Participants reported a positive experience and indicated they would participate in future workshops. Still, coordinators mentioned that future interventions should have an additional focus on the donation work and how to become a better communicator. Discussion: The findings from this study brought new insight into the coordinators’ team dynamics and their experience in a workshop intervention. The expertise and experience of the facilitators, role-playing, group interaction, and feedback were perceived as valuable components of the workshop. Conclusion: OTDCs in this study perceived positive impacts on their team cohesiveness, communication skills, and work-related well-being following the workshop initiative. The findings from this study highlight that workshop interventions can be effective in fostering work-related well-being among OTDCs. [ABSTRACT FROM AUTHOR]

Copyright of Frontières is the property of Universite du Quebec a Montreal, Revue Frontieres and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Minority patients such as Blacks, Hispanics, and Native Americans are disproportionately impacted by critical limb ischemia and amputation due to multiple factors such as socioeconomic status, type or lack of insurance, lack of access to health care, capacity and expertise of local hospitals, prevalence of diabetes, and unconscious bias. The Society of Interventional Radiology Foundation recognizes that it is imperative to close the disparity gaps and funded a Research Consensus Panel to prioritize a research agenda. The following research priorities were ultimately prioritized: (a) randomized controlled trial with peripheral arterial disease screening of at-risk patients with oversampling of high-risk racial groups, (b) prospective trial with the introduction of an intervention to alter a social determinant of health, and (c) a prospective trial with the implementation of an algorithm that requires criteria be met prior to an amputation. This article presents the proceedings and recommendations from the panel. [ABSTRACT FROM AUTHOR]

Ship ballast residual sediments are an important vector of introduction for non-indigenous species. We evaluated the proportion of residual sediments and associated organisms released during de-ballasting operations of a commercial bulk carrier and estimated a total residual sediment accumulation of ∼13 t, with accumulations of up to 20 cm in some tank areas that had accumulated over 11 years. We observed interior hull-fouling (anemones, hydrozoans, and bryozoans) and high abundances of viable invertebrate resting stages and dinoflagellate cysts in sediments. Although we determined that <1 % of residual sediments and associated resting stages were resuspended and released into the environment during individual de-ballasting events, this represents a substantial inoculum of 21 × 107 viable dinoflagellate cysts and 7.5 × 105 invertebrate resting stages with many taxa being nonindigenous, cryptogenic, or toxic/harmful species. The methods used and results will help estimate propagule pressure associated with this pathway and will be relevant for residual sediments and nonindigenous species management. • Detailed residual sediment accumulation was mapped in ship ballast tanks. • High residual sediment accumulation (up to 20 cm and 11-year-old) was found. • Residual sediments and associated fauna (<1 %) are released during de-ballasting operations. • High quantity of viable dinoflagellate cysts and invertebrate resting stages are released. • Better propagule pressure estimates are relevant for ship ballast sediment and NIS management. [ABSTRACT FROM AUTHOR]

Aim: To understand the experiences and perceptions of burnout and compassion fatigue among Organ and Tissue Donation Coordinators (OTDCs) in Canada. Methods: A series of virtual focus group discussions were held with OTDCs from across Canada to discuss burnout and compassion fatigue as part of a national research project in collaboration with Canadian Blood Services, the organ donation and transplantation community, and experts in the field. Results: Eleven participants, including Canadian OTDCs and experts in the area of burnout, compassion fatigue and organ donation, participated in the discussion. OTDCs agreed that the high pressure and demands of their role challenge their workplace wellbeing and mental health. As a result, some of the OTDCs have recognized signs and symptoms of burnout and compassion fatigue throughout their career. Although OTDCs support each other and develop their own personal coping and protective strategies, there is a continued need to develop specific strategies to help mitigate work-related issues and increase retention of experienced OTDCs in Canada. Conclusion: The highly demanding role of OTDCs in Canada have challenged their mental health and work-related wellbeing, leaving them more susceptible to experiencing issues such as burnout and compassion fatigue. Future research is needed to investigate the levels of work-related issues among OTDCs, as well as to develop specific interventions to help support the work-related wellbeing and mental health of these professionals. [ABSTRACT FROM AUTHOR]

• General overview of vascular malformations and their treatments. • Descriptions of interventional radiology procedures used to treat malformations. • Discussion of medications commonly used for treatment. [ABSTRACT FROM AUTHOR]

[Display omitted] [ABSTRACT FROM AUTHOR]

Key Summary Points: Aim: To describe the objectives and expected impact of an international consortium (iKASCADE) whose purpose is to improve drug safety for older adults by addressing prescribing cascades through a sex and gender lens. Findings: The consortium proposes to (a) develop an inventory of clinically relevant prescribing cascades; (b) provide a detailed understanding of sex-specific prescribing cascades in hospital, long-term care, and community settings; (c) foster a greater understanding of similarities or differences regarding prescribing cascades internationally; (d) and provide a nascent understanding of the ways in which gender dimensions may influence the development or treatment of prescribing cascades. Message: It is critically important to examine sex and gender within geriatric pharmacology to better inform recommendations and treatment decisions tailored for older women and men. Purpose: To describe the objectives, methods and expected impact of an international consortium (iKASCADE) whose purpose is to improve drug safety for older adults by addressing prescribing cascades through a sex and gender lens. Methods: To create a comprehensive, internationally relevant inventory of prescribing cascades affecting older adults, the consortium has created a modified Delphi procedure where international experts in prescribing and managing pharmacotherapy for older adults will rank a list of prescribing cascades as to their clinical importance. We will use administrative and clinical data on older adults to evaluate the frequency of prescribing cascades by sex internationally, in the hospital, long-term care and community settings. Finally, we will use semi-structured interviews and realistic, country-specific vignettes, each incorporating a prescribing cascade with identified sex differences, to explore how socially constructed gender roles contribute to the experience, presentation and management of prescribing cascades. Results: The consortium will synthesize the quantitative and qualitative results to produce a position paper and products—aimed at knowledge users within and outside of academia—designed to elevate the importance of integrating a gender dimension in the identification and prevention of prescribing cascades. Conclusion: Findings will improve our understanding of how adverse drug events are different between older women and men and inform the development and dissemination of tailored knowledge translation products to reduce the frequency and impact of prescribing cascades. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: The Association of Program Directors in Radiology (APDR) surveys its membership annually on hot topics and new developments in radiology residency training. Here we report the results of that annual survey.Materials and Methods: A web-based survey was posed to the APDR membership in the Fall of 2018. Members were asked 43 questions on program staffing, resident education resources/funding, impact of the integrated-Interventional Radiology residency program on Diagnostic Radiology program resources, resident interest in imaging informatics, Accreditation Council for Graduate Medical Education requirements on resident practice habits data reporting, institutional reliance on residents for clinical coverage, teaching format in the post-oral board era, resident conference attendance, confidentiality of the Match rank list, Early Specialization in Interventional Radiology pathway recruitment and selection, Diagnostic Radiology and Interventional Radiology program relationships, independent resident call, pediatric radiology training, diversity and unconscious bias training, and social media in radiology education.Results: Responses were collected electronically, results were tallied using Qualtrics software, and qualitative responses were tabulated or summarized as comments. There were 86 respondents with a response rate of 31.3%.Conclusion: Survey result highlights include perceived resident interest in imaging informatics with the vast majority of residency programs offering an informatics curriculum; the provision of resident practice habits data by nearly all residency programs despite lack of clarity surrounding this Accreditation Council for Graduate Medical Education requirement; continued use of case-taking in the post-oral boards era; frequent disclosure of the Match rank list to departmental and hospital administration; low penetration of unconscious bias training in academic radiology; and finally, the successful integration of interventional and diagnostic radiology training programs. [ABSTRACT FROM AUTHOR]

Diverticulosis remains the commonest cause for acute lower gastrointestinal tract bleeding (GIB). Conservative management is initially sufficient for most patients, followed by elective diagnostic tests. However, if acute lower GIB persists, it can be investigated with colonoscopy, CT angiography (CTA), or red blood cell (RBC) scan. Colonoscopy can identify the site and cause of bleeding and provide effective treatment. CTA is a noninvasive diagnostic tool that is better tolerated by patients, can identify actively bleeding site or a potential bleeding lesion in vast majority of patients. RBC scan can identify intermittent bleeding, and with single-photon emission computed tomography, can more accurately localize it to a small segment of bowel. If patients are hemodynamically unstable, CTA and transcatheter arteriography/embolization can be performed. Colonoscopy can also be considered in these patients if rapid bowel preparation is feasible. Transcatheter arteriography has a low rate of major complications; however, targeted transcatheter embolization is only feasible if extravasation is seen, which is more likely in hemodynamically unstable patients. If bleeding site has been previously localized but the intervention by colonoscopy and transcatheter embolization have failed to achieve hemostasis, surgery may be required. Among patients with obscure (nonlocalized) recurrent bleeding, capsule endoscopy and CT enterography can be considered to identify culprit mucosal lesion(s). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Digitalization is a primary driver of sustainable development. We investigate the impact of digitalization on the carbon footprints of the (national) government sector, households, enterprises, non-governmental organizations, and imported carbon footprints. We use panel data analysis to study the link between digitalization and sustainable economic growth by monitoring digital carbon footprint patterns. Our study results show that digitalization has a positive and statistically significant impact on sustainability development measured by the sustainable development goals (SDG). Furthermore, our results support the hypothesis that advancing total factor productivity, referring to green total factor productivity, is critical for meeting SDGs. Notably, we determine that the ecological footprint across sectors and countries is diverging, or at best, slowly converging at a pace that is not even close to that required to meet the 2030 SDGs. Therefore, policymakers and practitioners must strategically revise sustainability policies to ensure industrial and economic transition and adaptability to climate change and advance economic green growth and sustainable development. • Digitalization drives sustainable development. • Green productivity key for SDGs. • Sectoral, country footprint divergence • Policymakers must revise sustainability policies. • Digital carbon footprint impacts SDGs. [ABSTRACT FROM AUTHOR]