OBJECTIVES

The current study aimed to evaluate the impact of an interprofessional simulation-based training program on providers' perception, knowledge, and confidence in proning of pregnant patients with Acute Respiratory Distress Syndrome due to COVID -19 or other causes.

METHODS

A total of 124 healthcare workers who took part in the management of patients in COVID wards and ICUs participated in the study. The simulation workshop was conducted on May 2022 and the participants were divided into interprofessional teams. Standardized patients and mannequins were used to simulate patients with ARDS. Standardized checklists for proning were used. The participants were debriefed after. The participants completed pre- and post-simulation questionnaires.

RESULTS

After the simulation workshop, the participants’ perception on the benefit of prone position in the ventilation of patients with ARDS, level of confidence in handling proning of pregnant patients, comfort in speaking to patient and next of kin regarding prone ventilation, and knowledge on proning significantly improved. Subgroup analysis
showed statistically significant improvements in knowledge scores among registered nurses, resident physicians, and participants with varying degrees of experience managing COVID-19 patients and proning pregnant patients. Majority of participants deemed it was easy to turn patients in the prone position using the supportive pillow as well as expressed confidence in doing the procedure.

CONCLUSION

Interprofessional simulation-based training of healthcare workers improved providers' knowledge and confidence in proning pregnant patients. Simulation based training also improved the comfort of the healthcare professional in advising the patient and next of kin on the benefits of proning.
Human ; World Health Organization ; Respiratory Insufficiency ; Handling (psychology) ; Occupational Groups ; Knowledge

Background/Aims: The integration of artificial intelligence (AI)-powered image analysis and mucosal exposure devices, such as distal attachment caps, has been demonstrated to significantly improve the adenoma detection rate (ADR) during colonoscopy. This study aimed to compare AI-assisted colonoscopy (AIC) with cap-assisted colonoscopy (CAC). Methods: This retrospective propensity score-matched cohort study was performed at a tertiary care hospital between January 2022 and May 2022. Data were extracted from the electronic health record system and colonoscopy video recordings. Adult patients aged 40 years who underwent screening or surveillance colonoscopies were included. The primary outcome was the ADR, whereas the secondary outcome was the polyp detection rate (PDR). Results: A 1:1 propensity score-matched analysis was performed, resulting in 49 well-matched patient pairs. One patient from each pair was assigned to the CAC group, whereas the other was assigned to the AIC group. No significant difference in ADR was observed between the CAC and AIC groups (47% vs. 51%, p=0.69). Similarly, PDR did not significantly differ between the two groups (80% vs. 71%, p=0.35). Conclusions Both CAC and AIC have the potential to increase ADR and PDR. However, neither modality offers a significant advantage.

We report the first documented case of facial-stapedial synkinesis (FSS) secondary to Ramsay Hunt syndrome (RHS) by describing the clinical manifestations and definitive surgical treatment outcome of this rare condition. A 35-year-old female presented with initial symptoms of severe right-sided facial weakness, otalgia, hyperacusis, ear fullness, and erythematous vesicles in the external auditory canal and tympanic membrane, suggestive of RHS. She later developed an intermittent “quivering” or “buzzing” sensation in her right ear initiated by facial movements such as closing her eyes and smiling. We performed magnetic resonance imaging of the brain and serial audiometric testing, and administered pharmacological treatment, including prednisone and famciclovir, for the initial infection, followed by stapedial tendon tenotomy for the definitive management of FSS. This case provides valuable clinical insights as the first reported instance of FSS secondary to RHS. RHS causes a more severe facial paralysis with lower rates of complete recovery, with an increased risk of aberrant facial nerve regeneration. FSS should be considered in patients presenting with persistent auditory symptoms after facial paralysis. Stapedial tendon tenotomy is an effective treatment option for patients with severe refractory symptoms.

Background: The role of pulsed-field ablation (PFA) in convergent procedure for atrial fibrillation (AF)/atrial tachycardia remains unclear.Case presentation: We describe a case of a patient who developed pulmonary vein (PV)-left atrium macroreentrant tachycardia following the epicardial portion of convergent procedure for AF and subsequently underwent successful endocardial ablation using a pentaspline PFA system. Conclusions The application of PFA successfully terminated the tachycardia and eliminated the PV potentials, thereby completing the convergent ablation procedure.

Background: Small studies suggest that variations in plasma potassium (p-K) levels may affect cardiac contractile function. A substudy to the recently published POTCAST trial demonstrated short-term improvements in myocardial function in patients randomized to potassium-increasing treatment. However, the long-term effects of increasing p-K on cardiac function remain unclear. This study aimed to investigate whether treatment that increases p-K improves diastolic and systolic myocardial function as assessed by echocardiography during long-term follow-up in a Danish implantable cardioverter-defibrillator (ICD) cohort. Methods: The POTCAST trial randomized patients with an ICD (1:1) to either usual therapy (control group) or treatment with oral potassium supplements and/or mineralocorticoid receptor antagonists (high-normal potassium group). In this substudy, consecutive patients from both arms of the POTCAST trial were included. Echocardiography was performed at baseline and repeated after > 6 months for the current study to compare changes in left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global constructive work (GCW), and diastolic parameters (E, e’, and E/e’) between the high-normal potassium and control groups. Results: A total of 289 patients (mean age, 58 ± 13.4 years; 77.5% male) were included in the study. The median follow-up time between baseline and follow-up echocardiography was 729 days (interquartile range, 511–986 days).From baseline to follow-up the high-normal potassium group had an increase in mean difference in p-K of 0.22 mmol/L (95% confidence interval [CI], –0.31 to –0.13; P < 0.001) compared to the control group. In the high-normal potassium group e’lat increased by 0.77 cm/sec (95% CI, 0.12–1.40; P = 0.020), and E/e’lat decreased by –1.15 (95% CI, –2.1 to –0.25; P = 0.013) on average compared to the control group. No significant differences were observed in changes in other diastolic parameters. For systolic function, no significant differences were found between groups in terms of change in LVEF (–0.6%; 95% CI, –2.17 to 1.02; P = 0.475), GLS (–0.26%; 95% CI, –0.8 to 0.4; P = 0.472), or GCW (–3.99 mmHg; 95% CI, –89.5 to 81.6; P = 0.927). Conclusions In contrast to previous short-term findings, when myocardial function was assessed by echocardiography, long-term potassium-increasing treatment led to only minor improvements in diastolic function in a contemporary Danish ICD cohort.

The surface electrocardiogram (ECG) can provide many clues to a patient’s underlying medical condition or tendency for arrhythmogenesis. An 80-year-old man with severe aortic stenosis and an implantable cardioverter-defibrillator (ICD) for advanced heart block presented with burping, chest discomfort and intermittent pounding sensations. His ECG showed atrial fibrillation with intermittent ventricular pacing at 60 bpm characterized by irregularly irregular rhythm, absent P waves, narrow intrinsic QRS complexes alternating with wide-paced beats (left bundle branch block [LBBB] morphology, superior axis) and visible pacing spikes. Device interrogation revealed ventricular tachycardia (VT) storm with multiple appropriate ICD shocks explaining his pounding sensations. This report highlights two key teaching points: recognizing atrial fibrillation during ventricular pacing—a frequently missed diagnosis affecting nearly half of patients with pacemakers—and managing VT storm to reduce shock burden. After device reprogramming and antiarrhythmic adjustment, the patient became asymptomatic.

Human ; Male ; Aged: 65-79 Yrs Old ; Thorax ; Teaching ; Tachycardia, Ventricular ; Electrocardiography ; Atrial Fibrillation ; Bundle-branch Block ; Constriction, Pathologic

Background: Our genomic understanding of lymphomas, a heterogeneous group of neoplasms, has grown exponentially. The latest World Health Organization (WHO) and International Consensus classifications reflect the importance of genetic assessment in the diagnosis and prognostication of and therapeutic decision making in lymphoid neoplasms. To address this clinical need for routinely available and timely testing, we aimed to validate the Ion AmpliSeq Liverpool Lymphoid Network Panel (IALLNP; Thermo Fisher Scientific, Waltham, MA, USA). Methods: We clinically validated the IALLNP on the Ion Torrent Genexus Sequencer (Thermo Fisher Scientific). The panel detects single-nucleotide variants (SNVs) and insertions/deletions (indels) in 60 clinically relevant genes. The validation set included a commercial control and 54 DNA samples covering the spectrum of clinically aggressive and indolent lymphomas. Results: After optimizing for poor coverage regions, recurrent artifacts, and false-negative calls, the panel showed good performance in terms of depth of coverage, on-target reads, and uniformity. Its sensitivity for SNVs and indels at a lower limit of detection of 5% variant allele frequency (VAF) was 100%. Specificity in variant-negative samples was 100%, and the mean per-sample number of false-positive variants—which were easily identifiable and excluded upon interrogation of raw data—was 0.4. The panel demonstrated 92.8% reproducibility; however, all nonreproducible variants fell below the 5% VAF analytical threshold. Conclusions The IALLNP is an accurate and reproducible next-generation sequencing panel that delivers genetic results for lymphoid neoplasms in a clinically meaningful timeframe.

Objective: To assess maladaptive beliefs about low back pain (LBP), valid and reliable measurement tools are required. Although some tools exist to assess them, the Low Back Pain-related Beliefs Screening Tool (LBP-BST) was developed in order to explore all different categories of misbeliefs in individuals chronic low back pain (CLBP). This study aimed to evaluate the main psychometric properties of both the short and long versions of the revised LBPBSTv2. Methods: A total of 108 patients with CLBP completed the LBP-BSTv2 to assess its potential floor/ceiling effects, internal consistency, and construct validity. The latter was evaluated by comparing scores with the Back Beliefs Questionnaire (BBQ). Test-retest reliability was assessed in 47 of the participants one week later. Results: No floor or ceiling effects were observed. The short and long versions of the LBPBSTv2 showed strong construct validity, with significant correlations with BBQ scores. Internal consistency was acceptable to good (Cronbach’s alpha: 0.77–0.84), and test-retest reliability was high (intraclass correlation coefficient: 0.76–0.81). Conclusion The LBP-BSTv2 is a valid and reliable tool for assessing maladaptive beliefs in patients with CLBP. Its integration into clinical practice could help healthcare professionals identify and address unhelpful beliefs that may hinder rehabilitation. Further research is needed to confirm its usefulness in tracking changes over time and guiding individualized interventions and to study other psychometric properties such as responsiveness.

Background/Aims: The Leuven Postprandial Distress Scale (LPDS) is a validated patient reported outcome (PRO) measure for functional dyspepsia (FD)/postprandial distress syndrome (PDS) patients according to Rome III criteria. However, meal-related nausea or epigastric pain, part of PDS in Rome IV, were not addressed in this construct. Also, focus groups identified fatigue as a frequently reported complaint for which the European Medicines Agency requested further analysis. Our aim is to validate the LPDS in FD/PDS as defined by Rome IV criteria and to optimize the model by assessing the value of adding extra items to this questionnaire. Methods: The questionnaire was validated in 3 different Rome IV FD/PDS patient cohorts recruited for controlled clinical trials. Additional questions in the diary regarding symptom relationship to meal and fatigue were evaluated. Anchor scores were the patient assessment of gastrointestinal symptom severity index, Short-form Nepean dyspepsia index, the overall treatment evaluation and overall symptom severity questionnaires. Results: The LPDS Construct validity was confirmed for Rome IV-defined PDS. Psychometric analysis did not support inclusion of fatigue, nausea, meal-related or meal-unrelated, and meal-related epigastric pain, due to low loading or poor model fit. Conclusions The LPDS questionnaire showed good reliability and responsiveness, and can be confidently used as a validated tool in Rome IV PDS populations. Data did not support adding accessory symptoms to the construct, due to low loading or poor model fit.