Search

Background: Currently, no generally accepted curriculum for operating room nurses (OR nurses) working with robotic-assisted surgery (RAS) exists. OR nurses working with RAS require different competencies than regular OR nurses, e.g. knowledge of the robotic system and equipment and specific emergency undocking procedures. The objective of this study was to identify learning goals for a curriculum for OR nurses working with RAS and to investigate which learning methods should be used. Methods: A three-round Delphi approach, with an additional survey, was used in this study. Four OR nurses from every department in gynecology, urology, and surgical gastroenterology doing RAS in Denmark were invited to participate. Results: The response rates were 93%, 81%, and 79%, respectively, in the three rounds of the Delphi survey and 68% in the additional survey. After the processing of data, a list of 57 learning goals, sorted under 11 domains, was produced. 41 learning goals were rated Relevant, Very relevant, or Essential spread over 10 of the 11 domains. The top 3 learning goals rated as Essential: Identify the most common injuries related to patient positioning during robotic-assisted surgery and know how to avoid them, Connect, calibrate and handle the scope, Perform an emergency undocking procedure. The panel rated Supervised training during surgery on patients as the most relevant learning method, followed by Dry lab and Team training. Conclusions: The learning goals identified in this study, can be used as the basis for a curriculum for OR nurses working with RAS. During the processing, it became clear that there is a need to further investigate issues such as communication challenges, awareness of emergency procedures, and differences in the skills required depending on the role of the RAS nurse.

BACKGROUND: Therapeutic hypothermia (TH) is a promising treatment of stroke, but limited data are available regarding the safety and effectiveness of cooling methodology. We investigated the safety of TH and compared the cooling capacity of two widely used cooling strategies - endovascular and surface cooling. METHODS: COOLAID Oresund is a bicentre randomized trial in Copenhagen (Denmark) and Malmö (Sweden). Patients were randomized to either TH (33°C for 24 h) in a general intensive care unit (ICU) or standardized stroke unit care (control). Cooling was induced by a surface or endovascular-based strategy. RESULTS: Thirty-one patients were randomized. Seven were cooled using endovascular and 10 using surface-based cooling methods and 14 patients received standard care (controls). 14 (45%) patients received thrombolysis. Pneumonia was recorded in 6 (35%) TH patients and in 1 (7%) control. 4 TH patients and 1 control developed massive infarction. 1 TH patient and 2 control suffered asymptomatic haemorrhagic transformation. Mortality was comparable with 2 (12%) in the TH group and 1 (7%) among controls. Mean (SD) duration of hospital stay was 25.0 days (24, 9) in TH and 22.5 days (20.6) in control patients (P = 0.767). Mean (SD) induction period (cooling onset to target temperature) was 126.3 min (80.6) with endovascular cooling and 196.3 min (76.3) with surface cooling (P = 0.025). CONCLUSIONS: Therapeutic hypothermia with general anaesthesia is feasible in stroke patients. We noticed increased rates of pneumonia, while the length of hospital stay remained comparable. The endovascular cooling strategy provides a faster induction period than surface cooling.

BACKGROUND: Therapeutic hypothermia (TH) is a promising treatment of stroke, but limited data are available regarding the safety and effectiveness of cooling methodology. We investigated the safety of TH and compared the cooling capacity of two widely used cooling strategies - endovascular and surface cooling. METHODS: COOLAID Oresund is a bicentre randomized trial in Copenhagen (Denmark) and Malmö (Sweden). Patients were randomized to either TH (33°C for 24 h) in a general intensive care unit (ICU) or standardized stroke unit care (control). Cooling was induced by a surface or endovascular-based strategy. RESULTS: Thirty-one patients were randomized. Seven were cooled using endovascular and 10 using surface-based cooling methods and 14 patients received standard care (controls). 14 (45%) patients received thrombolysis. Pneumonia was recorded in 6 (35%) TH patients and in 1 (7%) control. 4 TH patients and 1 control developed massive infarction. 1 TH patient and 2 control suffered asymptomatic haemorrhagic transformation. Mortality was comparable with 2 (12%) in the TH group and 1 (7%) among controls. Mean (SD) duration of hospital stay was 25.0 days (24, 9) in TH and 22.5 days (20.6) in control patients (P = 0.767). Mean (SD) induction period (cooling onset to target temperature) was 126.3 min (80.6) with endovascular cooling and 196.3 min (76.3) with surface cooling (P = 0.025). CONCLUSIONS: Therapeutic hypothermia with general anaesthesia is feasible in stroke patients. We noticed increased rates of pneumonia, while the length of hospital stay remained comparable. The endovascular cooling strategy provides a faster induction period than surface cooling.