Search

Introduction: Ferric derisomaltose is the newest available parenteral iron formulation. Studies have demonstrated a good safety profile with improved tolerability compared to alternative parenteral iron formulations. To date there have been no reported acute, life-threatening cardiac events associated with ferric derisomaltose.Case Report: An 86-year-old male who had previously tolerated routine iron infusions received a first dose of ferric derisomaltose at an outpatient infusion clinic. Six minutes into the infusion the patient became unresponsive with no palpable pulse. Return of spontaneous circulation was achieved after two minutes of chest compressions. Electrocardiogram showed complete heart block requiring transcutaneous pacing and vasopressor administration. The patient was transferred to the emergency department for stabilization and then admitted to the cardiac intensive care unit. During admission, the patient received a dual-chamber, permanent pacemaker without complication and was ultimately discharged.Conclusion: It may be reasonable to consider parenteral iron as a toxicological etiology for patients presenting with complete heart block temporally associated with parenteral iron administration, particularly in patients with underlying conduction abnormalities.

Background The critical care literature has seen an increase in the development and validation of tools using artificial intelligence for early detection of patient events or disease onset in the intensive care unit (ICU). The hemodynamic stability index (HSI) was found to have an AUC of 0.82 in predicting the need for hemodynamic intervention in the ICU. Future studies using this tool may benefit from targeting those outcomes that are more relevant to clinicians and most achievable. Methods A three-round Delphi study was conducted with a panel of 10 critical care physicians and three nurses in the United States to identify outcomes that may be most relevant and achievable with the HSI when evaluated for use in the ICU. To achieve criteria for relevance, at least 65% of panelists had to rate an outcome as a 4 or 5 on a 5-point scale. Results Nineteen of 24 outcomes that may be associated with the HSI achieved consensus for relevance. The Kemeny-Young approach was used to develop a matrix depicting the distribution of outcomes considering both relevance and achievability. Reduces time spent in hemodynamic instability and reduces times to recognition of hemodynamic instability were the highest-ranking outcomes considering both relevance and achievability. Conclusion This Delphi study was a feasible method to identify relevant outcomes that may be associated with an appropriate predictive analytic tool in the ICU. These findings can provide insight to researchers looking to study such tools to impact outcomes relevant to critical care practitioners. Future studies should test these tools in the ICU that target the most clinically relevant and achievable outcomes, such as time spent hemodynamically unstable or time until actionable nursing assessment or treatment.

BACKGROUND: This is Part 2 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy (EL) using an Enhanced Recovery After Surgery (ERAS) approach. This paper addresses intra- and postoperative aspects of care. METHODS: Experts in aspects of management of high-risk and emergency general surgical patients were invited to contribute by the International ERAS® Society. PubMed, Cochrane, Embase, and Medline database searches were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized clinical trials, systematic reviews, meta-analyses, and large cohort studies and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on elective patients when appropriate. A modified Delphi method was used to validate final recommendations. Some ERAS® components covered in other guideline papers are outlined only briefly, with the bulk of the text focusing on key areas pertaining specifically to EL. RESULTS: Twenty-three components of intraoperative and postoperative care were defined. Consensus was reached after three rounds of a modified Delphi Process. CONCLUSIONS: These guidelines are based on best available evidence for an ERAS® approach to patients undergoing EL. These guidelines are not exhaustive but pull together evidence on important components of care for this high-risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies.

BACKGROUND: This is Part 3 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy using an enhanced recovery after surgery (ERAS) approach. This paper addresses organizational aspects of care. METHODS: Experts in management of the high-risk and emergency general surgical patient were invited to contribute by the International ERAS® Society. PubMed, Cochrane, Embase, and MEDLINE database searches were performed for ERAS elements and relevant specific topics. Studies were selected with particular attention to randomized clinical trials, systematic reviews, meta-analyses and large cohort studies, and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation system. Recommendations were made on the best level of evidence, or extrapolation from studies on elective patients when appropriate. A modified Delphi method was used to validate final recommendations. RESULTS: Components of organizational aspects of care were considered. Consensus was reached after three rounds of a modified Delphi process. CONCLUSIONS: These guidelines are based on best current available evidence for organizational aspects of an ERAS® approach to patients undergoing emergency laparotomy and include discussion of less common aspects of care for the surgical patient, including end-of-life issues. These guidelines are not exhaustive but pull together evidence on important components of care for this high-risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies.

Abstract The pine marten (Martes martes) occupies the northernmost extent of its distribution in Norway, where microtine rodents are an important food item. The relationship between microtine rodent abundance and pine marten population dynamics is not well understood. In this paper, we examined this relationship and tested if environmental factors (e.g. snow depth, elevation, mature spruce forest density and agricultural land density) modulate pine marten population dynamics. We calculated pine marten abundance indices using data collected from 593 unique snow transects surveyed between 2003 and 2014 in Hedmark, Norway. We employed a Partial Rate Correlation Function to identify potential cyclicity in pine marten populations. We did not observe any cyclical patterns in pine marten populations within our short time series. Instead, their population appeared to be directly density‐dependent. Although the population growth rate of pine marten tended to increase with increasing elevation, it was not affected by individual variables including a microtine rodent abundance index and snow depth. However, the annual growth rate of pine marten populations was positively affected by the interaction between the microtine rodent abundance index and increasing elevation. Pine marten abundance increased with microtine rodent abundance, elevation, snow depth and density of mature spruce forest, but decreased with increasing agricultural land density. Pine martens are opportunistic diet generalists that can switch between prey and cache food for later consumption. They are also strongly territorial with delayed implantation and are slow to respond to environmental changes due to their relatively low reproductive potential. These life‐history traits may mitigate the effects of fluctuating microtine rodent abundance on pine marten reproduction and survival. Nevertheless, our findings suggest that microtine rodents still serve as important prey which can influence the population dynamics of pine martens in higher elevation habitats where alternative prey may be less available.

Research suggests that elementary school is a crucial period for sparking students' long-term interest in science and consideration of a STEM career. Teachers influence students' dispositions towards science; therefore, it is important to consider elementary teachers' identity development, a preservice teacher's own voice and self-image, with science as a factor in science education. This longitudinal, qualitative study examines the experiences that served as barriers or supports to elementary Master of Teaching preservice teachers' science teacher identity development. Six preservice teachers were interviewed at the beginning of their graduate teacher education programs and again during their first year of teaching. Our findings indicate that identity development of future elementary teachers begins during their own elementary school experiences as a student and spans through their teaching practicums. Barriers to science identity development included prior elementary science experiences/lack of interest, science content and coursework requirements, practicum experiences, and socioeconomic status. Supports that bolster elementary teacher identity for instructing science included hands-on/inquiry-based science coursework, prior experience in schools and working with children, positive practicum experiences, and support from family and friends. This research indicates that in order to develop more rigorous elementary science teacher preparation programs, in regard to instruction and self-efficacy, educators and public policymakers will need to provide a series of supports for future science teachers ranging from their initial elementary school experiences through their practicum placements.