Articles: cations.
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Anesthesia and analgesia · Dec 2024
Observational StudyPoor Concordance Between Intensive Care Unit Patients' and Family Members' Patient Dignity Inventory Scores Despite Communication of Dignity-Related Distress.
Promptly assessing and treating the distress of intensive care unit (ICU) patients may improve long-term psychological outcomes. One holistic approach to reduce patient distress is through dignity-centered care, traditionally used in palliative care. The 25-item Patient Dignity Inventory has construct validity and reliability for measuring dignity-related distress among ICU patients. Because family members often serve as ICU patients' surrogates and play an integral role in patients' dignity, we examined whether family members reliably recognized ICU patients' sources of distress. ⋯ Although ICU patients often report sharing sources of distress with their loved ones, family members cannot accurately or reliably assess the extent to which patients experience psychosocial, existential, and symptom-related distress during critical illness. Treatments of distress should not be delayed by the absence of family members.
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Acute kidney injury (AKI) affects 20% to 30% of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). This review synthesizes clinical evidence indicating that CPB-induced hemolysis plays a pivotal role in the development of AKI. ⋯ Current clinical data support the potential efficacy of these treatments. Our analysis concludes that sufficient proof of concept exists to further develop and test these targeted therapies for preventing hemoglobin-induced AKI in patients undergoing CPB.
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This study investigates the predictive values of the Risk Analysis Index (RAI), the modified 5-item Frailty Index (mFI-5), and advanced age for predicting 30-day extended length of stay (LOS), 30-day complications, and readmissions in patients undergoing posterior spinal fusion (PSF) for adult spinal deformity (ASD). ⋯ This study suggests that the utility of RAI and mFI-5 in predicting extended LOS patients undergoing PSF for ASD. RAI was found to be superior to mFI-5 for predicting 30-day readmissions, while mF-5 was greater for 30-day complications. These findings highlight the need for future studies to identify optimal methods in incorporating frailty assessments into preoperative surgical planning and patient discussions.
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Case Reports
MALIGNANT TRANSFORMATION OF PREVIOULSY RADIATED VESTIBULAR SCHWANNOMA: 2D operative video.
Malignant transformation of vestibular schwannomas (VSs), though rare,1 demands a comprehensive, multidisciplinary treatment approach to optimize patient outcomes.2 We present a rare case of malignant transformation in a VS after radiation treatment in a 58-year-old woman (Video 1). Initially diagnosed with a right cerebellopontine angle VS, the patient underwent CyberKnife (Accuray, Madison, Wisconsin, USA) treatment 16 years ago, receiving 18 Gy across 3 fractions. Despite initial stability, the patient experienced progressive hearing loss, ultimately requiring a bone-anchored hearing aid implant. ⋯ This case underscores the importance of vigilant monitoring for patients with VS, particularly patients with rapid symptom progression and tumor growth, highlighting the crucial role of adjuvant radiotherapy in treatment regimens. This study received institutional review board approval. The patient provided informed consent for the use of their image and information.
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Anesthesia and analgesia · Dec 2024
An Evaluation of the Transfer of Skills and Knowledge from Two World Federation of Societies of Anaesthesiologists Fellowship Programs.
Subspecialist training is an important part of developing human resources for health and for some learners, may require taking place in another, higher-resourced country. Despite effective learning of skills and knowledge in a different, more highly resourced context, transfer of these skills and knowledge back to a more poorly resourced context can be a challenge. We aimed to evaluate the transfer of skills and knowledge in 2 World Federation of Societies of Anaesthesiologists (WFSA) fellowship programs. ⋯ Our study found that the 2 fellowship programs had variable success in the transfer of learned skills and knowledge back to the fellows' "home" institutions. Contextual differences between the fellowship institution and the home institution were the main source of barriers to transfer, and fellows from different countries had diverse needs. Supporting the transfer of knowledge and skills should be an explicit goal of these fellowship programs, and as such, should be considered in the recruitment of fellows, curriculum development, and in how the success of a fellowship is evaluated. Curricula should not just focus on medical knowledge and skills, but also skills in leading change and in education.