Conectar
While paediatric cardiac arrest is a rare event, consequences for the patients are significant with a considerable risk of morbidity, disability and mortality. The risk of cardiac arrest is substantially increased in children with congenital heart disease. Nevertheless, there is a lack of data concerning this population. To close this knowledge gap, this multicentre, prospective, open registry aims to implement a standardised structure for data collection and follow-up of paediatric cardiac arrests associated with heart diseases in Germany.
All paediatric patients who experience a cardiac arrest and receive at least 2 minutes of cardiopulmonary resuscitation are invited to participate in this registry. The dataset comprises demographical, clinical, resuscitation and outcome data, collected in accordance with the Utstein guidelines. Neurological assessments, cognitive and motor tests are conducted at fixed intervals. Additionally, patient-reported outcome measures will be surveyed. Primary outcomes are survival to discharge and neurodevelopmental outcome after discharge and 2 years. The data are pseudonymised prior to submission to an online REDCap database, which is centrally hosted on a server located in Leipzig, Germany.
This study follows the Declaration of Helsinki and received ethical approval from the Ethics Committee in Leipzig. Registry results will allow us to understand the epidemiology, guideline adherence, risk factors and will be presented at conferences and submitted to a peer-reviewed journal for publication.
by Ian C. Murphy, Kelly Bryan, Muriel Burk, Rong Jiang, Francesca Cunningham, Sarah Providence, Elizabeth Rightnour, Sarah Zavala, Kathleen Morneau, Trisha Exline, Stacey Rice, Travis Schmitt, Kelly Drumright, Jennifer Lee, BreAnna Davids, Tram Guilbeault, Brooke Klenosky, Ann-Marie Sutherland, Abbie Rosen, Lauren Ratliff, Kenneth Bukowski, Margaret A. Pisani, Andrew Franck, Mark Wong, Preston Witcher, Kathleen M. Akgün
OBJECTIVESEarly data suggested higher sedative requirements for ventilated COVID+ patients, deviating from established guidelines. We assessed the relationship between sedative use and outcomes in mechanically ventilated Veterans during the COVID-19 pandemic.
DesignRetrospective Medication Use Evaluation
SettingNational Sample of 13 Distinct VA Medical Center Intensive Care Units
PatientsCritically ill Veteran patients requiring mechanically ventilation for ≥2 days
InterventionsNone.
Measurements and main resultsThe proportion of patients receiving fentanyl, midazolam and propofol was higher during COVID years. Compared with pre-COVID, median fentanyl dose was higher during Years 1 and 2 (1575mcg [(IQR) 1000–1650] vs. 1900 [1250–3000] vs. 1910 [1150–3500]). Adjuvant antipsychotics use was relatively low but tended to increase over time (pre = 10.5% vs. Year 1 = 12.3% vs. Year 2 = 14.1%). Most patients started on antipsychotics in the ICU were continued on the drug after extubation. Mortality was higher during COVID years (pre = 26.9% vs. 1 = 36.8% and 2 = 35.9%). In stratified analyses by COVID status years 1–2 (n = 79, 27%), a higher proportion of COVID+ patients received fentanyl (96% vs. 84%) and propofol (90% vs. 77%) and at higher doses (fentanyl = 1650mcg vs. 2688mcg median cumulative dose; propofol maximum infusion rate = 30 mc/kg/min (20–50) vs. 40 (25–50)). Sedative doses were similar to pre-COVID among non-COVID patients. Anti-psychotics were more frequently continued post extubation among COVID+ (34.6% vs. non-COVID+=14.9%). COVID+ patients were also less likely to have awakening and breathing trials at 48 hours after intubation (18% vs. 46%).
ConclusionsSedative use and dosing increased during the first two years of COVID compared to pre-COVID, especially for COVID+ patients. The sustained elevated levels of fentanyl use in Year 2 suggests possible ‘therapeutic creep’ away from guideline-concordant practices for COVID+ patients. Antipsychotic prescription during intubation and following extubation was also more common among COVID + . These findings could inform development and implementation of safer sedation practices across VA ICUs during respiratory pandemics.
The objective of this study is to assess the extent to which palliative care content is integrated into occupational therapy education in Germany. In addition, the study will examine trainees’ and students’ knowledge, experiences and attitudes towards palliative care.
A cross-sectional quantitative survey study using a structured online questionnaire.
Institutions and universities across Germany that offer training in occupational therapy.
A total of 451 subjects completed the survey (89.4% female). Of these, 91.4% were trainees at vocational schools, while 8.6% were university students. The inclusion criteria stipulated that subjects must be enrolled in an occupational therapy programme in Germany at the time of data collection.
Not applicable.
The primary outcomes of the study were knowledge, educational experience and attitudes towards palliative care among occupational therapy trainees and students. Secondary outcomes encompassed practical experience with palliative care patients and expressed interest in further training.
A total of 451 occupational therapy trainees and students participated in the survey. The majority of participants (89.4%) were female and in training (91.4%). Although 90.8% had no previous medical training, 69.2% could define palliative care and 92.6% were familiar with the concept of a hospice. However, 68.1% of respondents reported that they had not received any teaching on palliative care as part of their occupational therapy training. A strong interest in further education in this area was expressed by 95.1%. Only 23.9% had practical experience with palliative clients, mainly in nursing homes.
A substantial discrepancy exists between the recognised importance of palliative care and its representation in occupational therapy education. The findings underline the necessity for a more robust and methodical incorporation of palliative care into occupational therapy curricula. This integration is crucial to ensure that trainees and students are adequately equipped with the theoretical knowledge and practical skills necessary to provide support to seriously ill and dying patients.
DRKS00033464.
There is an urgent need to better understand how information from circulating tumour DNA (ctDNA) can be integrated into routine care for patients with advanced solid cancer.
The implementation of liquid biopsies in routine care of patients with advanced solid cancer trial (LIQPLAT) is a single-centre, single-arm trial investigating the implementation of ctDNA in the routine care of patients with advanced solid cancer. We present a mixed-methods process evaluation embedded in the LIQPLAT trial, following Medical Research Council guidance and the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. We show a logic model, which details the causal chain and related assumptions from recruiting patients into the trial to the goal of improving quality of life and survival. Data collection is longitudinal and includes: semistructured interviews with healthcare professionals (pathologists, biologists, oncologists; planned n=20) and patients (planned n=15) to identify implementation barriers and facilitators; recordings of molecular tumour board meetings to analyse clinical decision-making; the 23-item Normalisation MeAsure Development survey for healthcare professionals (planned n=20) at four time points. Quantitative data from hospital records will be used to assess implementation outcomes like patient acceptance rates and ctDNA workflow success. Qualitative data will undergo thematic and content analysis, and quantitative data will be analysed using a Bayesian framework.
The LIQPLAT trial was approved by the regional ethics committee of Northwestern and Central Switzerland (BASEC 2024-00358). The qualitative aspects of the process evaluation were exempted from ethics review according to the Swiss Human Research Act. We follow guidelines for data security, confidentiality and information governance. Results will be submitted for publication in peer-reviewed journals and discussed at conferences.
NCT06367751, SNCTP000005844.
Background
There is a dearth of research inclusive of African American adults living with obstructive sleep apnea (OSA) despite differences in symptom presentations compared to non-Hispanic White patient populations. Less is known regarding the potential effect of comorbidities, including hypertension, on commonly reported symptoms, such as fatigue, and their association with inflammatory biomarkers.
Objective
This longitudinal pilot study aimed to characterize fatigue symptom presentations among African American adults newly diagnosed with OSA and discern peripheral blood analytes linked to symptoms while accounting for co-occurring hypertension.
Methods
African American adults newly diagnosed with OSA with and without co-occurring hypertension were approached by study staff and recruited following their diagnostic visit with sleep medicine clinicians at two health systems and followed over 6 months after commencing continuous positive airway pressure treatment. Patient-Reported Outcomes Measurement Information System Fatigue surveys and plasma were collected every 3 months from 29 participants. Mixed-effects models examined changes in fatigue symptom presentations over time while accounting for plasma-based analytes and hypertension status.
Results
Despite higher fatigue symptom severity upon diagnosis, participants with co-occurring hypertension reported greater improvements in fatigue scores after commencing continuous positive airway pressure treatment for up to 6 months than those without hypertension. Inverse correlations were observed between fatigue scores, C-reactive protein, matrix metalloproteinase-8, and osteoprotegerin analyte levels among participants with/without hypertension. Across all participants, changes in interleukin-6 were associated with changes in fatigue scores in the first 3 months after diagnosis.
Discussion
Findings indicate that hypertension is linked to increased fatigue upon diagnosis of OSA in this sample of African American adults. Fatigue in persons with hypertension improved after treatment in this sample. These hypothesis-generating findings can inform future interventional studies aimed at improving fatigue among persons with OSA while leveraging markers linked to fatigue symptom severity as potential objective markers of improvements. Further research on the role of inflammatory markers, such as IL-6, on fatigue symptom presentations is warranted in persons with OSA. 
FreshRSS