The World Health Organization surgical safety checklist (WHO SSC) provides a standardized framework for preoperative safety procedures. However, studies have revealed substantial variation in adherence, with items being skipped or misunderstood and nurses likely to be less involved than other operating room (OR) professional groups. We introduce a 16-item team timeout checklist (TTOC) that clarifies and adds safety-critical items to the existing WHO before skin incision timeout and is led by nurses to improve information exchange, closed-loop communication, and encouraging participation of all professional groups. Using a prospective pre-post interventional design, we live-coded all team communication during on-site observations in the OR focusing on the pre-incision phase. Surgical teams were first observed during a pre-intervention period without the TTOC checklist and subsequently during a post-intervention period after implementation of the TTOC checklist. The TTOC was evaluated on four communication outcomes critical for patient safety: information exchange of checklist items, measured as the percentage of the 16 items that were verbally communicated among team members (eg, team introduction, surgical site, allergies), participation rates of different professional groups, frequency of explicit coordination behaviors (eg, instruction, information request, speaking up) and the frequency of closed-loop communication sequences, defined as information request followed by information upon request within 30 seconds. A total of 155 teams were observed, including 78 teams in the pre-intervention phase without TTOC use and 77 teams in the post-intervention phase using the TTOC, resulting in 13,127 coded communication events. The median information exchange increased from 62.5% (interquartile range [IQR] 50-68.8) in the pre-intervention phase to 100% (IQR 100-100) in the post-intervention phase (P < .001). For 15 of all 16 subitems, the odds of exchanging information were significantly higher after TTOC implementation than before TTOC implementation (odds ratios range 10.8-1896, all 95% confidence intervals [CIs] excluded 1). Participation rates increased for circulating nurses, scrub nurses, surgical residents, and anesthesia (all P < .05) but not for lead surgeons. Mean (standard deviation [SD]) closed-loop communication patterns per operation were more frequent with (20.4 [10.7]) than without the TTOC (16.4, [7.24]), P = .004. In our study, the nurse-led TTOC significantly improved the exchange of safety-critical items during the pre-incision phase, facilitated closed-loop communication, and empowered the participation of various professional groups. These findings suggest integrating the TTOC with the WHO SSC before-incision protocol may have important advantages.
In 2022, the Basic Healthcare Services (BHS) primary care physiotherapy program was embedded at three rural primary clinics in southern Rajasthan. The intent was to address critical rehabilitation needs in underserved rural communities, strengthen primary care teams, and improve functional outcomes. The aim of the paper is to share systematic insights from our practice on the burden of musculoskeletal, neurological, and respiratory conditions in a rural, underserved population, while also documenting the role and outcomes of community-based physiotherapy. BHS operates in deeply underserved tribal regions of southern Rajasthan through a network of rural primary care centers (AMRIT Clinics). Within this model, physiotherapy services are designed to emphasize accessibility, continuity, and collaboration, with care provided across clinic, community, and home settings. To systematically document service delivery and outcomes, a prospective clinical registry was maintained from July 2022 to July 2024 in two phases across three rural clinics-Manpur, Ghated, and Bedawal. Service delivery challenges were analyzed using the three-delays framework, which considers barriers in recognizing the need for care, reaching care, and receiving adequate care. This approach highlights both obstacles to rehabilitation access and the solutions emerging from a community-anchored physiotherapy model. Between June 2024 and July 2025, over 1000 physiotherapy encounters were documented. The program served a diverse age range from children under 10 years to elders over 70, with the majority being working-age adults between 20 and 50 years (45%) and older adults >50 years (50%). Patients predominantly presented with musculoskeletal disorders (~70%), followed by respiratory sequelae such as post-tuberculosis lung disease and chronic obstructive pulmonary disease (~15%), and neurological impairments (~10%). Autoimmune conditions, particularly rheumatoid arthritis, were most prevalent among women aged 20-50 years. Seventy six percent of patients were new and 24% were follow-up visits. Occupational analysis indicated that 32% of patients were unemployed and reported disability or functional limitations. The program employed a holistic, low-cost approach integrating pain relief, mobility enhancement, and progressive strengthening tailored to individual needs. Evidence-based interventions-including hot packs, strengthening exercises, breathing routines, and functional rehabilitation-were the most common modalities used. Analysis of 2 years of registry data from a rural physiotherapy program offers a snapshot of the clinical scope, utilization patterns, and major syndromes encountered in primary care. Three key insights emerge: physiotherapy functions as a core component rather than an ancillary service, clinical data serve as a powerful learning and improvement tool, and the physiotherapist's role must remain flexible and context-sensitive. A matrix of key individual and interprofessional competencies emerged for members of the primary care teams. For health systems and practitioners aiming to replicate or scale such models, we recommend investing in integrated primary care teams, ensuring continuity of care, and developing adaptive systems responsive to local realities.
This short report aims to bring evidence from modern psychometric methods (item response theory; IRT) to bear on a general team measure (Teamwork Questionnaire; FAT) adopted specifically for interprofessional education (IPE). The FAT was administered to n = 160 mixed-health‑profession participants in a post-IPE questionnaire. IRT analyses examine the following three aspects of the FAT: 1) scale dimensionality, 2) subscale reliability, and 3) item bias. Firstly, findings support FAT overall reliability but fail to support subscale reliabilities. Secondly, findings indicate a strong, general factor underlying the FAT that supports unidimensional interpretations. Thirdly, item bias assessment indicated insubstantial differences across student and facilitator groups, supporting the retention of all FAT items in future IPE administrations. Taken together, we find sufficient evidence to support the FAT's application within an IPE context, and future research should aim to inspect its responsivity (change) over time.
Artificial intelligence (AI)-based clinical decision support systems (CDSSs) are increasingly used to support clinicians by providing evidence-based treatment recommendations for multidisciplinary team (MDT) meetings. This systematic review mapped the current landscape of AI-based CDSSs in surgical oncology decision-making and synthesized evidence on their performance and factors influencing effectiveness. Cochrane, Ovid MEDLINE, and Embase were searched on February 3, 2025. Studies evaluating AI-based CDSSs for therapeutic decision-making in surgical oncology were included. Methodological quality was assessed using the Critical Appraisal Skills Programme Diagnostic Study Checklist, and data were synthesized narratively. Fifty-nine studies, encompassing 23,158 patients, were included. CDSSs were classified into five categories: decision tree-based systems, knowledge representation-based systems, Watson for Oncology (WfO), large language models, and other AI-based systems. Concordance with MDT or guideline-based recommendations ranged from 23.2% to 99%. Decision tree- and knowledge-based systems generally demonstrated higher concordance and improved guideline adherence, while WfO performance varied substantially by region and treatment accessibility. Three key themes related to implementation challenges emerged: technical limitations, socioeconomic and healthcare system constraints, and patient- and tumour-specific factors. Reported benefits included improved adherence of MDT decisions to clinical guidelines, enhanced identification of patients eligible for clinical trial enrolment, support for less experienced clinicians, and facilitation of triage for routine cases. AI-based CDSSs show promise in supporting MDT decision-making but remain constrained by challenges related to system maintenance, variability in clinical protocols, therapeutic availability, and patient heterogeneity. Larger prospective studies are needed to evaluate the real-world integration, clinical impact, and patient outcomes of AI-based CDSSs within MDT workflows. https://www.crd.york.ac.uk/PROSPERO/view/CRD42025639227, identifer: CRD42025639227.
to understand multidisciplinary team' experiences in the everyday lifeworld of older residents of Therapeutic Residential Services in a city in the countryside of São Paulo state. qualitative research based on Alfred Schutz's theoretical-methodological framework, conducted through phenomenological interviews with 19 professionals. Analysis revealed three categories that highlight the motivations for care actions. professionals' experiences in caring for older adults in a Therapeutic Residential Service are motivated by the bond formed, by biographical aspects, and by existence of challenges faced, such as inherent limitations of care. There is also a search for greater autonomy and for valuing residents' uniqueness in daily actions. observing the experiences that constitute the daily lives of professionals caring for older residents allowed us to recognize their unique and collective needs, and understand the challenges linked to the deinstitutionalization process, in which the Individual Therapeutic Project can guide care actions. comprender las experiencias del equipo multidisciplinario en el entorno cotidiano de ancianos residentes de Servicios Residenciales Terapéuticos en una ciudad del interior del estado de São Paulo. investigación cualitativa basada en el marco teórico-metodológico de Alfred Schutz, realizada mediante entrevistas fenomenológicas a 19 profesionales. El análisis reveló tres categorías que destacan las motivaciones para acciones de cuidado. las experiencias de los profesionales en el cuidado de ancianos en el Servicio Residencial Terapéutico están motivadas por el vínculo afectivo, aspectos biográficos y desafíos experimentados, como las limitaciones propias de la atención. Asimismo, se observa una búsqueda de mayor autonomía y valoración de la singularidad de los residentes en las actividades cotidianas. la observación de las experiencias que conforman la vida de los profesionales al cuidar a residentes ancianos nos permitió reconocer necesidades individuales y colectivas, así como comprender los desafíos vinculados al proceso de desinstitucionalización, en el que el Proyecto Terapéutico Individual puede orientar las acciones de cuidado.
Between March 15 and April 5, 2025, an outbreak of Candidozyma auris, a multidrug-resistant fungal pathogen, was detected in the intensive care unit of a tertiary care center in Thiruvananthapuram, India. Five patients were affected-three with bloodstream infections and two with asymptomatic colonization. Interventions included patient screening, cohorting, enhanced hand hygiene, environmental cleaning, and disinfection of shared equipment. C. auris was identified using MALDI-TOF, but antifungal susceptibility testing could not be performed. The probable index case was a colonized patient with prolonged fluconazole exposure. Lapses in hand hygiene were the likely mode of transmission; environmental cultures were negative. No new cases occurred two months after implementation of infection control measures. The outbreak highlights the need for early species-level identification of non-albicans Candida, improved laboratory capacity, regular staff training, and strict infection control practices. It underscores the importance of preparedness and rapid response to fungal threats in critical care settings. Zwischen dem 15. März und dem 5. April 2025 wurde in der Intensivstation eines tertiären Versorgungszentrums in Thiruvananthapuram ein Ausbruch von Candidozyma (C.) auris festgestellt. Fünf Patienten waren betroffen, drei mit Blutstrominfektionen und zwei mit asymptomatischer Besiedlung. Zu den Maßnahmen gehörten Patienten-Screening, Kohortierung, verstärkte Händehygiene und desinfizierende Flächenreinigung einschließlich benutzter Medizinprodukte. C. auris wurde mittels MALDI-TOF identifiziert; eine Antimykotika-Empfindlichkeitsprüfung konnte aufgrund fehlender standardisierter Protokolle nicht durchgeführt werden. Der wahrscheinliche Indexfall war ein kolonizierter Patient mit längerer Fluconazol-Exposition. Die Übertragung erfolgte wahrscheinlich durch mangelnde Händehygiene, weil Umgebungsuntersuchungen negativ waren. Zwei Monate nach Einführung der Infektionskontrollmaßnahmen traten keine neuen Fälle auf. Der Ausbruch unterstreicht die Notwendigkeit einer frühzeitigen Identifizierung von Nicht-Albicans-Candida auf Artenebene, verbesserter Laborkapazitäten, regelmäßiger Mitarbeiterschulungen und strenger Infektionskontrollmaßnahmen.
Introduction:Navarra´s healthcare model is based on coordination between healthcare levels and the integration of diverse healthcare professionals across them. The objectives of this study were describe the design, implementation, and evaluation a communication channel between Primary Care (PC) teams and Community Pharmacies (CP) within each Basic Health Zone in Navarra, integrated into the electronic prescription system. Materials and Methods: A channel was designed to enable interaction between CP and PC professionals through the electronic prescription. A procedure was developed, outlining responsibilities, notification protocols and the distinction between urgent and non-urgent incidents. For the evaluation, a satisfaction survey was distributed to all participants. Results: The system was progressively expanded since 2021, reaching 95% of PC teams and 100% of CPs in 2024. Satisfaction surveys revealed a high appraisal of the channel, particularly among CPs, highlighting its utility, improvements in work organization and optimization of resolution times. Conclusion: The implementation of an appropriate communication channel between PC teams and CPs is essential for enhancing patient care. This channel has improved the quality of interprofessional collaboration, acting as a catalyst for alignment and trust between HC and CP professionals. Introducción: El modelo sanitario de Navarra se apoya en la coordinación entre niveles asistenciales y la integración de los diferentes profesionales sanitarios en los distintos niveles.Los objetivos del trabajo fueron describir el diseño, implementación y evaluación de un canal de comunicación entre los equipos de AP y las farmacias comunitarias (FC) de cada zona básica de salud (ZBS) de Navarra a través de la receta electrónica.Material y métodos: Se diseñó un canal de comunicación que, a través de la receta electrónica, lograba la comunicación entre los farmacéuticos comunitarios y los profesionales de los CS.Se elaboró un procedimiento normalizado de trabajo en el que se indicaban las responsabilidades, cómo realizar las notificaciones y la diferencia entre incidencias urgentes y no urgentes.Para la evaluación, se envió una encuesta de satisfacción a todos los profesionales implicados.Resultados: El sistema se extendió progresivamente hasta alcanzar en 2024 al 95 % de los equipos de AP y al 100 % de las FC de Navarra.Las encuestas de satisfacción mostraron una elevada valoración del canal, especialmente por parte de los profesionales de las FC, destacando su utilidad, la mejora en la organización del trabajo y la optimización del tiempo de resolución.Conclusiones: La puesta en marcha de un canal de comunicación adecuado entre los equipos de AP y las FC es fundamental y permite mejorar la atención a nuestros pacientes. Este canal de comunicación ha permitido mejorar la calidad de la colaboración interprofesional, siendo un punto de acercamiento y confianza entre los profesionales del CS y de la FC.
Educational programmes aimed at nurturing person-centred leadership are requested to advance the implementation of person-centred care, however there is a scarcity of evaluations. This study aimed to explore health and social care leaders' experiences of changes in leadership practices following participation in an educational programme on person-centred leadership. A qualitative exploratory research approach, with individual interviews analysed using conventional content analysis, including an interpretative step linking categories to an overarching theme using three leadership concepts. Health and social care services in Sweden. Thirteen leaders were purposefully selected according to sampling criteria. The programme did, according to the participants, contribute to the development of person-centred leadership practices by enhancing self-leadership, team leadership, and workforce development aligned with person-centred principles. Three categories unfolded this process: Live as you learn, Strive for equal relations, and Enable co-creation, which were further detailed into nine sub-categories. The results were influenced by various preconditions for continuous learning. The findings emphasise the necessity of establishing preconditions promoting person-centred leadership (e.g., continuous support from other leaders, time to coach teams and establishing empowering working methods) for continuous development during and after the educational programme. When these preconditions were met, the programme was experienced to effectively influence self-leadership, enhance team leadership, and promote workforce development in line with person-centred principles. It is crucial to integrate practical assignments into workplace settings, address daily challenges, and involve leaders, employees, patients, and their relatives early on. This approach supports the continuous development of leadership practices and ensures the sustainable transformation of health and social care practices towards person-centred care. The programme's theoretical foundation was considered applicable in supporting leadership development, but more research is needed to evaluate the impact and effect of person-centred leadership programmes over time from leaders', employees', and patients' perspectives.
Failure to Rescue (FTR) refers to patient death following a complication despite opportunities for timely recognition and intervention. Residents are particularly vulnerable during FTR events because they provide frontline care while training within hierarchical systems. Although FTR is widely used as a quality indicator, its impact on residents remains underexplored. This study examined residents' emotional responses, coping strategies, and the influence of supervisory behavior and institutional culture on recovery and learning. We conducted a qualitative interview study following constructivist grounded theory (CGT). Semi-structured interviews were performed with residents from multiple Swiss hospitals between October 2022 and May 2023. Interviews explored emotional experiences related to FTR events, coping mechanisms, supervisory interactions, and perceptions of institutional culture. Data was analyzed iteratively using constant comparison, memo writing, and reflexive team discussions. Fifteen residents (4 males, 11 females), primarily from surgery and internal medicine, participated. Mean age was 30.6 years, with an average of 2.6 years of residency experience. Four interrelated themes emerged: (1) temporal layering of emotional responses, from shock to insecurity and rumination; (2) problem- and emotion-focused coping strategies, including vigilance, peer support, and counseling; (3) supervisory responses, where guidance, debrief, or silence shaped emotional outcomes; and (4) institutional error culture, which influenced expectations around coping and responsibility. Participants described self-doubt, avoidance, and hypervigilance that evolved into either constructive learning or prolonged distress depending on team and organizational support. FTR events can leave emotional and professional effects on residents. Supportive leadership, structured debriefings, and accessible psychological support facilitated recovery and learning, whereas silence and blame intensified distress and avoidance. These findings informed a model of contextually mediated recovery in which supervisors serve as key interpreters of failure, while institutional culture facilitates or constrains this role. Coping with FTR is a collective responsibility embedded within team and institutional culture.
to understand the support network of breastfeeding mothers with children born in two teaching hospitals, its effectiveness in the postpartum period, and its impact on breastfeeding. a prospective cohort study was conducted in two public hospitals accredited to the Baby-Friendly Hospital Initiative. For analysis, the Statistical Package for the Social Sciences software was used. of 304 postpartum women, 295 (97.04%) mentioned support from the hospital's health team, and 283 (93.09%) reported having a support network in the postpartum period. Support network became effective in the first month postpartum (p=0.0001), favoring daytime rest (p=0.0005) and having a positive relationship with exclusive breastfeeding in the sixth month (p=0.0424). most women considered the healthcare team as a source of support for breastfeeding and mentioned that they would have a support network after discharge, which materialized with a positive outcome for breastfeeding. comprender la red de apoyo de las madres lactantes con hijos nacidos en dos hospitales universitarios, su efectividad en el período posparto y su impacto en la lactancia materna. Estudio de cohorte prospectivo realizado en dos hospitales públicos acreditados por la Iniciativa Hospital Amigo del Niño. Para el análisis se utilizó el software Statistical Package for the Social Sciences. de 304 mujeres en el posparto, 295 (97,04%) mencionaron haber recibido apoyo del equipo de salud del hospital y 283 (93,09%) indicaron contar con una red de apoyo durante el período posparto. La red de apoyo resultó efectiva durante el primer mes posparto (p=0,0001), favoreciendo el descanso diurno (p=0,0005) y mostrando una relación positiva con la lactancia materna exclusiva al sexto mes (p=0,0424). la mayoría de las mujeres consideraron al equipo de atención médica como una fuente de apoyo para la lactancia materna y mencionaron que contarían con una red de apoyo tras el alta, lo cual se tradujo en un resultado positivo para la lactancia.
Professional psychological help can significantly improve outcomes for women with perinatal depression (PND), yet many delay or avoid seeking it. Spouses significantly influence women's help-seeking decisions. However, comprehensive reviews synthesizing factors affecting both women's and their spouses' intentions, particularly regarding spousal support, remain lacking. This scoping review synthesises current evidence on the factors influencing the psychological help-seeking intentions of women with PND and their spouses. This scoping review adhered to the framework by Arksey and O'Malley and followed the reporting guidelines specified in the PRISMA-ScR checklist. A systematic search was performed in May 2025, across five databases: CINAHL, Web of Science, PubMed, Embase, and PsycINFO. To capture a multi-method evidence base, qualitative, quantitative, and mixed-method studies were included. Study methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). 35 studies met the criteria, forming a multi-method evidence pool (13 qualitative, 19 quantitative, 3 mixed) spanning 16 countries, mainly in North America, Europe, and Asia. Participants were primarily perinatal women, with fewer involving spouses and couples. Five key factors were found to influence the intention of women with PND and their spouses to seek professional psychological help, including: (1) demographic factors; (2) knowledge factors (knowledge of PND and psychotherapy); (3) attitude factors (perspectives on PND screening, psychotherapy, and the responsibilities of the obstetric team); (4) social psychological factors (three types of stigma, and self-efficacy); and (5) psychological service provider-related factors. For women with PND and their spouses, intentions to seek professional help are shaped by a complex interplay of knowledge, attitudes, social-psychological factors, and the accessibility and competence of service providers. Future interventions should prioritize comprehensive mental health education, obstetric team training, and standardized medical procedures. Theory-driven longitudinal research is needed to disentangle causal mechanisms and test multi-component interventions targeting these determinants.
Swedish healthcare staff are obliged to immediately report suspected child maltreatment (CM) to child protection services (CPS), but often fail this duty. The use of screening instruments in EDs increases detection of adults with risk factors for CM. Such instruments have previously not been available in Sweden. The aim of the present study was to pilot test a Swedish version of the Dutch 'child-check' instrument, and evaluate a retrospective case series. Our study was performed in an ED at Skåne University Hospital. The original Dutch instrument was translated with adaptation to national medico-legal context; face validity was obtained by a multidisciplinary expert panel, and it was piloted by a multiprofessional ED team. Following implementation, retrospective data was collected 2021-2022 from registries at the hospital ED and one municipal CPS. The screening instrument identified 295 adult care-seekers with risk factors for CM. Subsequent reports of concern included 131 children, among which 62 (47%) were not known to CPS. Our study suggests that the Swedish version of the instrument, 'child-check adult', could play an important role for ED personnel in identifying adults with risk factors for CM. We therefore aim to implement it in all Swedish regions.
To evaluate the efficacy, safety, and clinical outcomes of percutaneous treatment in pediatric patients with World Health Organization (WHO) CE1 and CE3a hepatic hydatid cysts. A total of 98 pediatric patients with WHO CE1 or CE3a hepatic hydatid cysts who underwent treatment using the Standard Catheterization Technique (S-CAT) between March 1, 2020 and March 31, 2026 were retrospectively evaluated. Demographic characteristics, cyst features (type, size, and location), pre- and post-treatment cyst volumes, major and minor complications, presence of cystobiliary fistula (CBF), catheter removal time, length of hospital stay, re-collection, and treatment-related interventions were recorded. Patients were categorized according to the presence of cystobiliary fistula and cyst size (giant vs. non-giant) for comparative analysis. Among the 98 children included in the study, 51 (52.0%) were female, and the mean age was 12.8 ± 4.5 years (range, 4-18 years). Most cysts were located in the right hepatic lobe (85.7%, n = 84) and classified as CE1 (87.8%, n = 86). Cystobiliary fistula was detected in 19 patients (19.4%), and seven patients (7.2%) required papillotomy and common bile duct stenting due to persistent fistula. Spontaneous fistula closure time was 13.2 ± 3.85 days. Central cyst location was significantly more frequent in patients with fistula (68.4% vs. 27.8%, p < 0.001). Patients with CBF had longer hospital stay (4.6 ± 1.9 vs. 2.8 ± 2.2 days, p < 0.001) and longer catheterization duration (17.2 ± 6.5 vs. 3.9 ± 2.7 days, p < 0.001). Initial cyst volume was also higher in patients with fistula (309 ± 137 vs. 235 ± 108 cm³, p = 0.04). In multivariable logistic regression analysis, central cyst location and giant cyst status (> 10 cm) were identified as independent predictors of cystobiliary fistula, with approximately 4.5-fold and 8.5-fold increased risks, respectively. Giant cysts were present in 35 patients (35.7%). Compared with non-giant cysts, giant cysts had longer hospital stay (5.7 ± 3.6 vs. 3.1 ± 2.1 days, p < 0.001), longer catheterization duration (13.1 ± 8.8 vs. 5.3 ± 6.4 days, p < 0.001), and higher fistula rates (37.1% vs. 9.5%, p = 0.001). Mean follow-up was 17.9 ± 10.7 months (range, 12-48 months), and mean cyst volume reduction was 86.9%. Re-collection occurred in 5 patients (5.1%), and anaphylaxis in 6 patients (6.1%). Percutaneous treatment of pediatric hepatic hydatid cysts appears to be a safe and effective treatment modality, resulting in substantial cyst volume reduction and favorable clinical outcomes during follow-up. However, giant cysts and central cyst location are independently associated with higher risk of cystobiliary fistula and prolonged hospitalization and catheterization duration. Due to the risk of anaphylaxis, procedures should be performed under general anesthesia with appropriate equipment and an experienced multidisciplinary team.
BACKGROUND Awake craniotomy is a neurosurgical approach used for resecting brain tumors in eloquent areas, where real-time neurological monitoring is critical to preserving function. Selecting the appropriate anesthesia approach is essential when preoperative language deficits or patient anxiety may limit intraoperative participation. While motor mapping is an established component of awake craniotomy, the use of a speech-language pathologist for real-time intraoperative monitoring remains underutilized. CASE REPORT A 31-year-old woman presented with a 1-year history of seizures, headaches, and progressive speech disturbances. Imaging revealed a left-sided supratentorial hemorrhagic brain tumor measuring 4.1×3.8×3.6 cm located near language centers. Given the proximity to the eloquent cortex and the patient's significant preoperative speech and memory deficits, a sleep-awake-sleep (SAS) anesthesia technique was chosen for awake craniotomy with intraoperative speech mapping. Uniquely, a speech-language pathologist (SLP) was integrated into the surgical team to conduct real-time assessments of language function. After induction with propofol and remifentanil, the patient was awakened during resection for real-time speech testing, allowing maximal tumor removal without compromising language function. She was then re-sedated for surgical closure. Postoperatively, there were no new deficits, speech remained at baseline, and magnetic resonance imaging (MRI) confirmed gross total resection. CONCLUSIONS This case report highlights the importance of individualized anesthesia planning and the under-recognized role of intraoperative SLP integration in awake craniotomy, which offers a more responsive approach to functional preservation than standard practice alone. For select patients, the SAS method provides a balance between patient comfort, surgical access, and preservation of neurological function.
to develop a sustainable and innovative business model in enterostomal therapy integrating digital health technologies. a methodological study of technological development. "Amazon Care - Digital Enterostomal Therapy" is a conceptual prototype in a portfolio, based on theoretical frameworks and the research team's practical experience, and can be adapted to different social contexts. Strengths - provision of specialized services and the use of digital technologies; weaknesses - dependence on technological infrastructure and the need for continuous training of professionals; opportunities - expansion of services to other specialties and strategic partnerships; threats - competition from telehealthcare services and regulatory challenges. the business model can support nurses' practice through access to specialized care in rural and remote areas of the Amazon. desarrollar un modelo de negocio sostenible e innovador para la estomaterapia que integre tecnologías de salud digital. estudio metodológico del desarrollo tecnológico. “Amazon Care - Estomaterapia Digital” es un prototipo conceptual integrado en un portafolio, basado en referencias teóricas y la experiencia práctica del equipo de investigación, y adaptable a diferentes contextos sociales. Fortalezas: prestación de servicios especializados y uso de tecnologías digitales; debilidades: dependencia de la infraestructura tecnológica y necesidad de capacitación continua del personal; oportunidades: expansión de los servicios a otras especialidades y alianzas estratégicas; amenazas: competencia de los servicios de telesalud y desafíos regulatorios. el modelo de negocio puede apoyar la práctica de la enfermería mediante el acceso a atención especializada en zonas rurales y remotas de la Amazonía.
Haemophilia A is an X-linked bleeding disorder resulting from factor VIII deficiency. While surgical management requires the correction of factor VIII levels by the administration of factor VIII concentrate, antiplatelet therapy after lower-risk cardiac surgery/procedures (such as transcatheter aortic valve implantation-TAVI) is not yet standardized. This report describes the management of a patient with moderate haemophilia A undergoing TAVI for severe aortic stenosis. A 76-year-old man with untreated haemophilia A was admitted with traumatic bleeding. After initial stabilization, he developed acute heart failure due to newly discovered severe aortic stenosis. TAVI procedure was performed by transfemoral access according to multidisciplinary team-discussion; a bio-prosthetic valve was successfully implanted. We outline the peri-procedural haemostatic management, which included factor VIII replacement therapy to achieve guideline-recommended activity levels, followed by progressive dose reduction. In view of the high bleeding risk and absence of significant coronary artery disease, antiplatelet therapy was limited to a short course. The procedure was successful, with no bleeding complications. In our patient, replacement therapy with rFVIII was initiated with a target FVIII activity between 80 and 100 IU/dL. During the procedure, unfractionated heparin was administered to achieve an ACT target 29 of 200 s. Post-operatively, FVIII replacement therapy was maintained above 60 IU/dL for the first 30-72 h, followed by 40-50 IU/dL from day 4 to day 7. Subsequently, it was decided to continue low-dose FVIII replacement for 32 additional 7 days. This strategy led to a successful management of both cardiological and hematological aspects. Although evidence is limited to case reports, TAVI appears to be feasible and safe in patients with haemophilia A. Maintaining high factor VIII activity levels and minimizing antithrombotic exposure through multidisciplinary evaluation can effectively reduce haemorrhagic risk. Our case, in line with previous reports, resulted in no bleeding complications.
The Global Committee of the World Congress on Vascular Access (WoCoVA) launched a cross-sectional descriptive survey between February and April 2024 to evaluate healthcare workers' knowledge and routine practices regarding intravenous (IV) catheter management on a global scale. The primary objective was to capture real-world, day-to-day practices rather than institutional or national guideline compliance. The aim was to provide an updated global perspective and identify areas for targeted education and guideline dissemination by WoCoVA. An anonymous online questionnaire was distributed to health professionals registered in the WoCoVA mailing list. The questionnaire comprised sections on catheter dressing and infection prevention (30 questions), catheter patency (22 questions), and locking practices (8 questions). 251 responses were analysed, from 44 countries. IV team nurses, anaesthetists, intensive care unit professionals and specialists in oncology were the more represented specialties. The skin is disinfected by scrubbing in 65% of responses, with considerable variability in the procedure; 98% use a transparent semi-permeable dressing. To disinfect needle-free connectors alcohol 70% (53%) or chlorhexidine 2% in alcohol 70% (50%) are the first choice; scrubbing is used by 73% of respondents. For management of catheter patency, 43% apply a high force on the plunger to flush. When they use a 10 ml syringe, 79% flush 10 short volumes of 1 ml saline interrupted by brief pauses. Various solutions are used for catheter locking. Clarification is needed regarding definitions of loss of patency, flushing, rinsing, and locking. Further analysis is required to correlate locking practices with frequency of use. Despite a general alignment with evidence-based standards in certain areas, variation persists in practices such as disinfection methods, flushing techniques, and locking strategies. There is a pressing need for evidence-based recommendations approved by an international committee, and reflection on the best way to spread best practices.
This study implemented a multidisciplinary team (MDT) palliative care and assessed its impact on symptom burden and health-related quality of life (HRQoL) among patients with advanced-stage cancer at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. This non-randomized pre-post quasi-experimental study (without a concurrent control group) enrolled 192 adult patients with cancer. The intervention was the introduction of MDT palliative care delivered by palliative-care-trained healthcare professionals. Outcomes were assessed before and after MDT implementation using the African Palliative Outcome Scale (APCA POS), EQ-5D-5L (Ethiopian value set) with EQ-VAS, and EORTC QLQ-C15-PAL. Within-patient changes were evaluated in the matched alive cohort (n=167) using paired-sample t-tests, with effect sizes quantified using Cohen's d. Factors associated with changes in HRQoL were examined using ANCOVA-of-change linear regression. All APCA POS domains, except social/communication, improved significantly, and the overall patient score decreased by 3.71 points (Cohen's d = -0.662, p<0.001). The EQ-5D-5L utility index score increased by 0. 0.286 (Cohen's d=0.668, p<0.001). The EORTC global HRQoL increased by 14.62 points (Cohen's d = 0.909, p<0.001), exceeding the conventional 10-point minimal clinically important difference. In the multivariable model, each one-level reduction in patient-rated pain severity was associated with a 4.22-point gain in HRQoL (p<0.001), and approximately 31.2% of marginal HRQoL improvement was associated with concurrent pain reduction. Patients with a poor performance status (ECOG 2-4) showed greater HRQoL improvement than those with a better performance status (β = 2.81, p=0.031). MDT palliative care was associated with clinically meaningful improvements in symptom burden and HRQoL, with the largest gains observed in patients with the greatest symptom burden at baseline. To maximize the population-level impact, ensuring the integration of MDT palliative care into Ethiopia's national cancer and palliative care strategies is recommended.
Intraoperative (IOCA) and perioperative cardiac arrest (POCA) in pediatric patients represents a rare but catastrophic event with significant implications for morbidity and mortality. Despite advances in anesthetic techniques, monitoring technology, and resuscitation protocols, the incidence of IOCA and POCA in children has remained relatively stable over the past two decades. In the pediatric noncardiac surgery population, the incidence ranges from approximately 3 to 22 per 10 000 cases. Key risk factors include young age, particularly neonates and infants, high American Society of Anesthesiologists (ASA) physical status classification, emergency surgery, the presence of congenital heart disease (CHD), and pulmonary hypertension. Respiratory events remain the leading cause of anesthesia-related cardiac arrest, with cardiovascular causes carrying a higher mortality. Prevention strategies emphasize preoperative risk stratification, team communication, and preparedness. Management requires rapid recognition, high-quality cardiopulmonary resuscitation, and consideration of extracorporeal cardiopulmonary resuscitation (ECPR) in refractory cases. This review synthesizes current evidence regarding the epidemiology, risk factors, mechanisms, and provides clinicians with management strategies for pediatric IOCA and POCA.
Hepatic mesenchymal hamartoma (HMH) is a rare benign paediatric liver tumour. We present an 8-month-old female infant referred with a 2-month history of progressive abdominal distension and poor oral intake. Contrast-enhanced computed tomography identified a massive heterogeneous right hepatic mass measuring 10.7 × 14 × 15.4 cm, extending to the pelvis, crossing the midline, and abutting major vascular structures. Ultrasound-guided Tru-cut biopsy confirmed HMH. Following multidisciplinary team (MDT) discussion, open right hepatectomy was performed achieving complete tumour excision with clear surgical margins of 7 mm. Histopathology confirmed a benign biphasic mesenchymal-biliary proliferation without atypia or malignant transformation. The patient had an uneventful postoperative recovery with preserved liver function. Radiological follow-up at 4 months demonstrated a clear operative bed with no residual or recurrent disease. This case highlights the diagnostic and surgical challenges of giant HMH and the critical role of an MDT approach in achieving curative resection.