Summary Background Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in people with chronic refractory epilepsy. Very rarely, SUDEP occurs in epilepsy monitoring units, ...providing highly informative data for its still elusive pathophysiology. The MORTEMUS study expanded these data through comprehensive evaluation of cardiorespiratory arrests encountered in epilepsy monitoring units worldwide. Methods Between Jan 1, 2008, and Dec 29, 2009, we did a systematic retrospective survey of epilepsy monitoring units located in Europe, Israel, Australia, and New Zealand, to retrieve data for all cardiorespiratory arrests recorded in these units and estimate their incidence. Epilepsy monitoring units from other regions were invited to report similar cases to further explore the mechanisms. An expert panel reviewed data, including video electroencephalogram (VEEG) and electrocardiogram material at the time of cardiorespiratory arrests whenever available. Findings 147 (92%) of 160 units responded to the survey. 29 cardiorespiratory arrests, including 16 SUDEP (14 at night), nine near SUDEP, and four deaths from other causes, were reported. Cardiorespiratory data, available for ten cases of SUDEP, showed a consistent and previously unrecognised pattern whereby rapid breathing (18–50 breaths per min) developed after secondary generalised tonic-clonic seizure, followed within 3 min by transient or terminal cardiorespiratory dysfunction. Where transient, this dysfunction later recurred with terminal apnoea occurring within 11 min of the end of the seizure, followed by cardiac arrest. SUDEP incidence in adult epilepsy monitoring units was 5·1 (95% CI 2·6–9·2) per 1000 patient-years, with a risk of 1·2 (0·6–2·1) per 10 000 VEEG monitorings, probably aggravated by suboptimum supervision and possibly by antiepileptic drug withdrawal. Interpretation SUDEP in epilepsy monitoring units primarily follows an early postictal, centrally mediated, severe alteration of respiratory and cardiac function induced by generalised tonic-clonic seizure, leading to immediate death or a short period of partly restored cardiorespiratory function followed by terminal apnoea then cardiac arrest. Improved supervision is warranted in epilepsy monitoring units, in particular during night time. Funding Commission of European Affairs of the International League Against Epilepsy.
From its beginning in December 2019, the coronavirus disease 2019 outbreak has spread globally from Wuhan and is now declared a pandemic by the World Health Organization. The sheer scale and severity ...of this pandemic is unprecedented in the modern era. Although primarily a respiratory tract infection transmitted by direct contact and droplets, during aerosol‐generating procedures, there is a possibility of airborne transmission. In addition, emerging evidence suggests possible fecal–oral spread of the virus. Clinical departments that perform endoscopy are faced with daunting challenges during this pandemic. To date, multiple position statements and guidelines have been issued by various professional organizations to recommend practices in endoscopic procedures. This article aims to summarize and discuss available evidence for these practices, to provide guidance for endoscopy to enhance patient safety, avoid nosocomial outbreaks, protect healthcare personnel, and ensure rational use of personal protective equipment. Responses adapted to national recommendations and local infection control guidelines and tailored to the availability of medical resources are imminently needed to fight the coronavirus disease 2019 pandemic.
The hematologist´s perspective. What to offer from the nutrition units González García, Esther; Sánchez-Migallón Montull, José Manuel
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral,
2024-May-23, 20240523, Letnik:
41, Številka:
Spec No2
Journal Article
Healthcare-associated infection is a global threat in healthcare which increases the emergence of multiple drug-resistant microbial infections. Hence, continuous surveillance data is required before ...or after patient discharge from health institutions though such data is scarce in developing countries. Similarly, ongoing infection surveillance data are not available in Ethiopia. However, various primary studies conducted in the country showed different magnitude and determinants of healthcare-associated infection from 1983 to 2017. Therefore, this systematic review and meta-analysis aimed to estimate the national pooled prevalence and determinants of healthcare-associated infection in Ethiopia.
We searched PubMed, Science Direct, Google Scholar, and grey literature deposited at Addis Ababa University online repository. The quality of studies was checked using Joanna Brigg's Institute quality assessment scale. Then, the funnel plot and Egger's regression test were used to assess publication bias. The pooled prevalence of healthcare-associated infection was estimated using a weighted-inverse random-effects model meta-analysis. Finally, the subgroup analysis was done to resolve the cause of statistical heterogeneity.
A total of 19 studies that satisfy the quality assessment criteria were considered in the final meta-analysis. The pooled prevalence of healthcare-associated infection in Ethiopia as estimated from 18 studies was 16.96% (95% CI: 14.10%-19.82%). In the subgroup analysis, the highest prevalence of healthcare-associated infection was in the intensive care unit 25.8% (95% CI: 3.55%-40.06%) followed by pediatrics ward 24.16% (95% CI: 12.76%-35.57%), surgical ward 23.78% (95% CI: 18.87%-29.69%) and obstetrics ward 22.25% (95% CI: 19.71%-24.80%). The pooled effect of two or more studies in this meta-analysis also showed that patients who had surgical procedures (AOR = 3.37; 95% CI: 1.85-4.89) and underlying non-communicable disease (AOR = 2.81; 95% CI: 1.39-4.22) were at increased risk of healthcare-associated infection.
The nationwide prevalence of healthcare-associated infection has remained a problem of public health importance in Ethiopia. The highest prevalence was observed in intensive care units followed by the pediatric ward, surgical ward and obstetrics ward. Thus, policymakers and program officers should give due emphasis on healthcare-associated infection preventive strategies at all levels. Essentially, the existing infection prevention and control practices in Ethiopia should be strengthened with special emphasis for patients admitted to intensive care units. Moreover, patients who had surgical procedures and underlying non-communicable diseases should be given more due attention.
The outbreak of the coronavirus disease 2019 (COVID-19) and its rapid global spread have created unprecedented challenges to health care systems. Significant and sustained efforts have focused on ...mobilization of personal protective equipment, intensive care beds, and medical equipment, while substantially less attention has focused on preserving the psychological health of the medical workforce tasked with addressing the challenges of the pandemic. And yet, similar to battlefield conditions, health care workers are being confronted with ongoing uncertainty about resources, capacities, and risks; as well as exposure to suffering, death, and threats to their own safety. These conditions are engendering high levels of fear and anxiety in the short term, and place individuals at risk for persistent stress exposure syndromes, subclinical mental health symptoms, and professional burnout in the long term. Given the potentially wide-ranging mental health impact of COVID-19, protecting health care workers from adverse psychological effects of the pandemic is critical. Therefore, we present an overview of the potential psychological stress responses to the COVID-19 crisis in medical providers and describe preemptive resilience-promoting strategies at the organizational and personal level. We then describe a rapidly deployable Psychological Resilience Intervention founded on a peer support model (Battle Buddies) developed by the United States Army. This intervention-the product of a multidisciplinary collaboration between the Departments of Anesthesiology and Psychiatry & Behavioral Sciences at the University of Minnesota Medical Center-also incorporates evidence-informed "stress inoculation" methods developed for managing psychological stress exposure in providers deployed to disasters. Our multilevel, resource-efficient, and scalable approach places 2 key tools directly in the hands of providers: (1) a peer support Battle Buddy; and (2) a designated mental health consultant who can facilitate training in stress inoculation methods, provide additional support, or coordinate referral for external professional consultation. In parallel, we have instituted a voluntary research data-collection component that will enable us to evaluate the intervention's effectiveness while also identifying the most salient resilience factors for future iterations. It is our hope that these elements will provide guidance to other organizations seeking to protect the well-being of their medical workforce during the pandemic. Given the remarkable adaptability of human beings, we believe that, by promoting resilience, our diverse health care workforce can emerge from this monumental challenge with new skills, closer relationships, and greater confidence in the power of community.
There is interest in emergency medical admissions, the outcomes of major reconfigurations and the development of systems and processes for Acute Medicine. We report on the long-term outcomes of an ...Acute Medical Admissions Unit, using a database of emergency admissions to St James' Hospital, Dublin, from 2002 to 2012.
All emergency admissions (67,971 episodes in 37,828 patients) were tracked and in-hospital mortality, length of stay and emergency 'wait' numbers and times summarized. We examined outcomes using generalized estimating equations, an extension of generalized linear models that permitted adjustment for correlated observations (readmissions). Margins statistics used adjusted predictions to test for interactions of key predictors while controlling for other variables using computations of the average marginal effect.
By episode, the in-hospital mortality averaged 5.8% (95% CI 5.6-5.9%); the relative risk reduction (RRR) was 35.0% between 2002 and 2012, from 7.0% to 4.6% (P = 0.001), with a number needed to treat (NNT) of 40.7. By unique patient the in-hospital mortality averaged 10.3% (95% CI 10.0-10.6%) with a RRR of 60.0% from 14.5% to 5.7% (P = 0.001), with an NNT of 11.4. Emergency Department 'wait' numbers decreased by 43%. The main mortality outcome predictors were Illness Severity, Charlson Comorbidity, Manchester Triage Category, O2 saturation, blood culture results, transfusion requirement and a primary respiratory or neurological diagnosis; the model had a high AUROC of 0.88 (95% CI 0.87, 0.88).
Institution reform can result in substantial outcome and process measure benefits, improving care delivery to emergency medical admissions.
A point-prevalence survey that was conducted in the United States in 2011 showed that 4% of hospitalized patients had a health care-associated infection. We repeated the survey in 2015 to assess ...changes in the prevalence of health care-associated infections during a period of national attention to the prevention of such infections.
At Emerging Infections Program sites in 10 states, we recruited up to 25 hospitals in each site area, prioritizing hospitals that had participated in the 2011 survey. Each hospital selected 1 day on which a random sample of patients was identified for assessment. Trained staff reviewed medical records using the 2011 definitions of health care-associated infections. We compared the percentages of patients with health care-associated infections and performed multivariable log-binomial regression modeling to evaluate the association of survey year with the risk of health care-associated infections.
In 2015, a total of 12,299 patients in 199 hospitals were surveyed, as compared with 11,282 patients in 183 hospitals in 2011. Fewer patients had health care-associated infections in 2015 (394 patients 3.2%; 95% confidence interval {CI}, 2.9 to 3.5) than in 2011 (452 4.0%; 95% CI, 3.7 to 4.4) (P<0.001), largely owing to reductions in the prevalence of surgical-site and urinary tract infections. Pneumonia, gastrointestinal infections (most of which were due to Clostridium difficile now Clostridioides difficile), and surgical-site infections were the most common health care-associated infections. Patients' risk of having a health care-associated infection was 16% lower in 2015 than in 2011 (risk ratio, 0.84; 95% CI, 0.74 to 0.95; P=0.005), after adjustment for age, presence of devices, days from admission to survey, and status of being in a large hospital.
The prevalence of health care-associated infections was lower in 2015 than in 2011. To continue to make progress in the prevention of such infections, prevention strategies against C. difficile infection and pneumonia should be augmented. (Funded by the Centers for Disease Control and Prevention.).
The epidemic of coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China and has now spread worldwide. In the affected countries, physicians and nurses are under heavy workload ...conditions and are at high risk of infection.
The aim of this study was to compare the frequency of burnout between physicians and nurses on the frontline (FL) wards and those working in usual wards (UWs).
A survey with a total of 49 questions was administered to 220 medical staff members from the COVID-19 FL and UWs, with a ratio of 1:1. General information, such as age, gender, marriage status, and the Maslach Burnout Inventory—medical personnel, were gathered and compared.
The group working on the FLs had a lower frequency of burnout (13% vs. 39%; P < 0.0001) and were less worried about being infected compared with the UW group.
Compared with medical staff working on their UWs for uninfected patients, medical staff working on the COVID-19 FL ward had a lower frequency of burnout. These results suggest that in the face of the COVID-19 crisis, both FL ward and UW staff should be considered when policies and procedures to support the well-being of health care workers are devised.
Faecal microbiota transplantation (FMT) is an important therapeutic option for
infection. Promising findings suggest that FMT may play a role also in the management of other disorders associated with ...the alteration of gut microbiota. Although the health community is assessing FMT with renewed interest and patients are becoming more aware, there are technical and logistical issues in establishing such a non-standardised treatment into the clinical practice with safety and proper governance. In view of this, an evidence-based recommendation is needed to drive the practical implementation of FMT. In this European Consensus Conference, 28 experts from 10 countries collaborated, in separate working groups and through an evidence-based process, to provide statements on the following key issues: FMT indications; donor selection; preparation of faecal material; clinical management and faecal delivery and basic requirements for implementing an FMT centre. Statements developed by each working group were evaluated and voted by all members, first through an electronic Delphi process, and then in a plenary consensus conference. The recommendations were released according to best available evidence, in order to act as guidance for physicians who plan to implement FMT, aiming at supporting the broad availability of the procedure, discussing other issues relevant to FMT and promoting future clinical research in the area of gut microbiota manipulation. This consensus report strongly recommends the implementation of FMT centres for the treatment of
infection as well as traces the guidelines of technicality, regulatory, administrative and laboratory requirements.
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