Focused transoesophageal TOE (fTOE): A new accreditation pathway
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ABSTRACT:
SUBMITTER: Rubino A
PROVIDER: S-EPMC10572472 | biostudies-literature | 2023 Jun
REPOSITORIES: biostudies-literature
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Project description:Echocardiography is increasingly used in the management of the critically ill patient as a non-invasive diagnostic and monitoring tool. Whilst in few countries specialized national training schemes for intensive care unit (ICU) echocardiography have been developed, specific guidelines for ICU physicians wishing to incorporate echocardiography into their clinical practice are lacking. Further, existing echocardiography accreditation does not reflect the requirements of the ICU practitioner. The WINFOCUS (World Interactive Network Focused On Critical UltraSound) ECHO-ICU Group drew up a document aimed at providing guidance to individual physicians, trainers and the relevant societies of the requirements for the development of skills in echocardiography in the ICU setting. The document is based on recommendations published by the Royal College of Radiologists, British Society of Echocardiography, European Association of Echocardiography and American Society of Echocardiography, together with international input from established practitioners of ICU echocardiography. The recommendations contained in this document are concerned with theoretical basis of ultrasonography, the practical aspects of building an ICU-based echocardiography service as well as the key components of standard adult TTE and TEE studies to be performed on the ICU. Specific issues regarding echocardiography in different ICU clinical scenarios are then described. Obtaining competence in ICU echocardiography may be achieved in different ways - either through completion of an appropriate fellowship/training scheme, or, where not available, via a staged approach designed to train the practitioner to a level at which they can achieve accreditation. Here, peri-resuscitation focused echocardiography represents the entry level--obtainable through established courses followed by mentored practice. Next, a competence-based modular training programme is proposed: theoretical elements delivered through blended-learning and practical elements acquired in parallel through proctored practice. These all linked with existing national/international echocardiography courses. When completed, it is anticipated that the practitioner will have performed the prerequisite number of studies, and achieved the competency to undertake accreditation (leading to Level 2 competence) via a recognized National or European examination and provide the appropriate required evidence of competency (logbook). Thus, even where appropriate fellowships are not available, with support from the relevant echocardiography bodies, training and subsequently accreditation in ICU echocardiography becomes achievable within the existing framework of current critical care and cardiological practice, and is adaptable to each countrie's needs.
| S-EPMC2586628 | biostudies-literature
Project description:During typical human walking, the metatarsophalangeal joints undergo extension/flexion, which we term toe joint articulation. This toe joint articulation impacts locomotor performance, as evidenced by prior studies on prostheses, footwear, sports and humanoid robots. However, a knowledge gap exists in our understanding of how individual toe properties (e.g. shape, joint stiffness) affect bipedal locomotion. To address this gap, we designed and built a pair of adjustable foot prostheses that enabled us to independently vary different toe properties, across a broad range of physiological and non-physiological values. We then characterized the effects of varying toe joint stiffness across a range of different ankle joint stiffness conditions, and the effects of varying toe shape on walking biomechanics. Ten able-bodied individuals walked on a treadmill with prostheses mounted bilaterally underneath simulator boots (which immobilized their biological ankles). We collected motion capture and ground reaction force data, then computed joint kinematics and kinetics, and center-of-mass (COM) power and work. To our surprise, we found that varying toe joint stiffness affected COM Push-off dynamics during walking as much as, or in some cases even more than, varying ankle joint stiffness. Increasing toe joint stiffness increased COM Push-off work by up to 48% (6 J), and prosthetic anklefoot Push-off work by up to 181% (12 J). In contrast, large changes in toe shape had little effect on gait. This study brings attention to the toes, an aspect of prosthetic and robotic foot design that is often overlooked or overshadowed by design of the ankle. Optimizing toe joint stiffness in assistive and robotic devices (e.g. prostheses, exoskeletons, robot feet) may provide a complementary means of enhancing Push-off or other aspects of locomotor performance, in conjunction with the more conventional approach of augmenting ankle dynamics. Future studies are needed to isolate the effects of additional toe properties (e.g. toe length).
| S-EPMC8777388 | biostudies-literature
Project description:Limiting global warming to 2 °C requires urgent action on land-based mitigation. This study evaluates the biogeochemical and biogeophysical implications of two alternative land-based mitigation scenarios that aim to achieve the same radiative forcing. One scenario is primarily driven by bioenergy expansion (SSP226Lu-BIOCROP), while the other involves re/afforestation (SSP126Lu-REFOREST). We find that overall, SSP126Lu-REFOREST is a more efficient strategy for removing CO2 from the atmosphere by 2100, resulting in a net carbon sink of 242 ~ 483 PgC with smaller uncertainties compared to SSP226Lu-BIOCROP, which exhibits a wider range of -78 ~ 621 PgC. However, SSP126Lu-REFOREST leads to a relatively warmer planetary climate than SSP226Lu-BIOCROP, and this relative warming can be intensified in certain re/afforested regions where local climates are not favorable for tree growth. Despite the cooling effect on a global scale, SSP226Lu-BIOCROP reshuffles regional warming hotspots, amplifying summer temperatures in vulnerable tropical regions such as Central Africa and Southeast Asia. Our findings highlight the need for strategic land use planning to identify suitable regions for re/afforestation and bioenergy expansion, thereby improving the likelihood of achieving the intended climate mitigation outcomes.
| S-EPMC10873610 | biostudies-literature
Project description:BackgroundThe Ankle Brachial Index is a useful clinical test for establishing blood supply to the foot. However, there are limitations to this method when conducted on people with diabetes. As an alternative to the Ankle Brachial Index, measuring Toe Systolic Pressures and the Toe Brachial Index have been recommended to assess the arterial blood supply to the foot. This study aimed to determine the intra and inter-rater reliability of the measurement of Toe Systolic Pressure and the Toe Brachial Index in patients with diabetes using a manual measurement system.MethodsThis was a repeated measures, reliability study. Three raters measured Toe Systolic Pressure and the Toe Brachial Index in thirty participants with diabetes. Measurement sessions occurred on two occasions, one week apart, using a manual photoplethysmography unit (Hadeco Smartdop 45) and a standardised measurement protocol.ResultsThe mean intra-class correlation for intra-rater reliability for toe systolic pressures was 0.87 (95% LOA: -25.97 to 26.06 mmHg) and the mean intra-class correlation for Toe Brachial Indices was 0.75 (95% LOA: -0.22 to 0.28). The intra-class correlation for inter-rater reliability was 0.88 for toe systolic pressures (95% LOA: -22.91 to 29.17.mmHg) and 0.77 for Toe Brachial Indices (95% LOA: -0.21 to 0.22).ConclusionDespite the reasonable intra-class correlation results, the range of error (95% LOA) was broad. This raises questions regarding the reliability of using a manual sphygmomanometer and PPG for the Toe Systolic Pressure and Toe Brachial Indice.
| S-EPMC3020155 | biostudies-literature
Project description: Not available
| S-EPMC6778693 | biostudies-literature
Project description:BackgroundTransoesophageal echocardiography (TOE) is a safe and useful tool. In our case, we are presenting a rare case of a patient with aortic dissection during TOE procedure.Case summaryA 79-year-old woman was referred to our hospital for recurrent paroxysmal atrial fibrillation (AF) with palpitation. Pre-procedural cardiac computed tomography (CT) showed slight dilated ascending aorta (maximum diameter: 40 mm). We decided to perform catheter ablation (CA) for AF, and recommended TOE before the CA because she had a CHADS2 score of 4. On the day before the CA, TOE was performed. Her physical examinations at the time of TOE procedure were unremarkable. At 3 min after probe insertion, there was no abnormal finding of the ascending aorta. At 5 min after the insertion, TOE showed ascending aortic dissection without pericardial effusion. After waking, she had severe back pain and underwent a contrast-enhanced CT. Computed tomography demonstrated Stanford type A aortic dissection extending from the aortic root to the bifurcation of common iliac arteries, and tight stenosis in the right coronary artery (maximum diameter; 49 mm). The patient underwent a replacement of the ascending aorta, and a coronary artery bypass graft surgery for the right coronary artery.DiscussionTransoesophageal echocardiography would have to be performed under sufficient sedation with continuous blood pressure monitoring in patients who have risk factors of aortic dissection. The risk-benefit of TOE must be considered before a decision is made. Depending on the situation, another modality instead of TOE might be required.
| S-EPMC7891243 | biostudies-literature
Project description:The great toe hemipulp flap transfer is a viable reconstructive method for finger pulp defect. However, early functional recovery of the donor foot is essential for returning to daily life activities, and functional and aesthetic restoration of the donor site remains challenging. We present a case in which the great toe hemipulp flap donor site was reconstructed with pedicled partial second toe pulp flap transfer, aiming for early recovery of the donor foot and aesthetically and functionally satisfactory donor-site reconstruction. A 62-year-old man underwent left little finger-pulp crush amputation in Tamai zone 2 and received free great toe hemipulp flap transfer. For the defect following flap harvest, the partial second toe pulp flap was elevated and transferred. The donor site of the partial second toe pulp flap was primarily closed. The postoperative course was uneventful, and the patient started walking on postoperative day 2. Postoperatively, the sensory recovery of the transferred flap was excellent, and the reconstructed great toe was functionally and aesthetically satisfactory. The pedicled partial second toe pulp flap transfer may be a viable alternative for the coverage of great toe hemipulp flap donor site.
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Project description:Hospital accreditation is an established quality improvement intervention. Despite a growing body of research, the evidence of effect remains contested. This umbrella review synthesizes reviews that examine the impacts of hospital accreditation with regard to health-care quality, highlighting research trends and knowledge gaps. Terms specific to the population: 'hospital' and the intervention: 'accreditation' were used to search seven databases: CINAHL (via EBSCOhost), Embase, Medline (via EBSCOhost), PubMed, Scopus, the Cochrane Database of Systematic Reviews, and the Joanna Briggs Institute (JBI) EBP Database (via Ovid). 2545 references were exported to endnote. After completing a systematic screening process and chain-referencing, 33 reviews were included. Following quality assessment and data extraction, key findings were thematically grouped into the seven health-care quality dimensions. Hospital accreditation has a range of associations with health system and organizational outcomes. Effectiveness, efficiency, patient-centredness, and safety were the most researched quality dimensions. Access, equity, and timeliness were examined in only three reviews. Barriers to robust original studies were reported to have impeded conclusive evidence. The body of research was largely atheoretical, incapable of precisely explaining how or why hospital accreditation may actually influence quality improvement. The impact of hospital accreditation remains poorly understood. Future research should control for all possible variables. Research and accreditation program development should integrate concepts of implementation and behavioural science to investigate the mechanisms through which hospital accreditation may enable quality improvement.
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Project description:We describe a phenomenon of "kinaesthetic extensor plantar response" in advanced pyramidal dysfunction, an interesting observation noted in a patient with dorsal myelopathy. A 44-year-old woman presented with one-year history of gradually progressive weakness and stiffness of both lower limbs along with urge incontinence of urine. Examination showed spontaneous elicitation of extensor plantar response while assessing the tone by rolling method as well as on noxious stimulation of the thigh. Magnetic resonance imaging (MRI) of the dorsal spine and digital subtraction angiography showed the presence of spinal dural arteriovenous fistula causing myelopathy. This case exemplifies the fact that in advanced pyramidal dysfunction, not only the receptive field of Babinski reflex may extend to the leg or thigh, but may also integrate with other modalities of stimulation, such as the rolling movement. The possible underlying pathophysiology of such a phenomenon is discussed.
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Project description:Recent identifications of associations between novel variants in inflammation-related genes and several common diseases emphasize the need for systematic evaluations of these genes in disease susceptibility. Considering that many genes are involved in the complex inflammation responses and many genetic variants in these genes have the potential to alter the functions and expression of these genes, we assembled a list of key inflammation-related genes to facilitate the identification of genetic associations of diseases with an inflammation-related etiology. We first reviewed various phases of inflammation responses, including the development of immune cells, sensing of danger, influx of cells to sites of insult, activation and functional responses of immune and non-immune cells, and resolution of the immune response. Assisted by the Ingenuity Pathway Analysis, we then identified 17 functional sub-pathways that are involved in one or multiple phases. This organization would greatly increase the chance of detecting gene-gene interactions by hierarchical clustering of genes with their functional closeness in a pathway. Finally, as an example application, we have developed tagging single nucleotide polymorphism (tSNP) arrays for populations of European and African descent to capture all the common variants of these key inflammation-related genes. Assays of these tSNPs have been designed and assembled into two Affymetrix ParAllele customized chips, one each for European (12,011 SNPs) and African (21,542 SNPs) populations. These tSNPs have greater coverage for these inflammation-related genes compared to the existing genome-wide arrays, particularly in the African population. These tSNP arrays can facilitate systematic evaluation of inflammation pathways in disease susceptibility. For additional applications, other genotyping platforms could also be employed. For existing genome-wide association data, this list of key inflammation-related genes and associated subpathways can facilitate comprehensive inflammation pathway- focused association analyses.
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