RESUMEN
AIM: To report the clinical outcomes of thoracoscopic left atrial appendage occlusion (LAAO) with the AtriClip PRO2 device (Atricure Inc, Mason, OH, USA). Stroke risk reduction with LAAO in patients with atrial fibrillation is now well-established. Many surgical and percutaneous techniques have been used, with varying rates of success. The percutaneous devices have had issues with procedural complications and peridevice flow. Thoracoscopic AtriClip offers an epicardial linear closure of the appendage at its ostium. This study sought to evaluate its safety and efficacy in achieving complete LAA closure. METHOD: This is a prospective series of thoracoscopic AtriClip PRO2 as a standalone procedure or a thoracoscopic AtriClip deployed as an adjunct to minimal access cardiac and thoracic surgery. Study ethical approval was granted by the hospital Human Research Ethics Committee. RESULTS: In total, 144 thoracoscopic AtriClip procedures were conducted by a single surgeon from 2017 to 2022, 56 standalone and 88 concomitant. There was no mortality or major morbidities. A 100% success in complete LAA closure was observed, with 87% complete follow-up imaging. For patients that underwent standalone AtriClip after cessation of anticoagulation, no thromboembolic phenomena were seen in the 180 patient-years of follow-up. CONCLUSIONS: This study demonstrates that thoracoscopic placement of AtriClip is safe and effective in achieving consistent and complete LAAO. Future randomised trials will be useful to compare outcomes with percutaneous devices.
RESUMEN
BACKGROUND: Increasingly, mental health nurses are expected to base their clinical practice on evidence based knowledge and many of the practice traditions that have passed between generations of nurses must now be examined within this scientific context. Since 2000, there has been an increasing debate on what is best practice for the administration of intramuscular injections particularly in relation to site selection, needle size and technique. Weight gain associated with second generation long acting antipsychotics influences the site and needle size for effective medication delivery. AIM: To determine intramuscular injecting practice choices made by nurses working in the mental health setting in 2006 compared to those made by a similar group of nurses in 2012. METHODS: A descriptive cross sectional study conducted across two time points: 2006 (93 participants) and 2012 (245 participants) utilising the same questionnaire designed to measure nurses' intramuscular injecting practice choices. RESULTS: Data were analysed using SPSS version 20 package. Six statistically significant practice changes were recorded related to needle size, site selection and the use of the Z-tracking technique. A continued higher usage of the dorsogluteal site was also reported in 2012 contrary to the recommendations in the current research for the ventrogluteal site. CONCLUSION: Whilst some practice changes occurred, translation of research into evidenced based practice is challenging and definitive best practice in the administration of intramuscular injections remains unclear. Education and randomised controlled trials are needed to provide the evidence to ensure the delivery of safe and effective intramuscular injecting practice.