Venous Thromboembolism Prevention in Rehabilitation: a Review and Practice Suggestions.

ABSTRACT: Venous thromboembolism (VTE) is a frequent complication of acute hospital care, and this extends to in-patient rehabilitation. The timely use of appropriate thromboprophylaxis in patients who are at risk is a strong, evidence-based patient safety priority that has reduced clinically important VTE, associated mortality and costs of care. While there has been extensive research on optimal approaches to VTE prophylaxis in acute care, there is a paucity of high-quality evidence specific to patients in the rehabilitation setting, and there are no clinical practice guidelines that make recommendations for (or against) thromboprophylaxis across the broad spectrum of rehabilitation patients. Herein, we provide an evidence-informed review of the topic with practice suggestions. We conducted a series of literature searches to assess the risks of VTE and its prevention related to in-patient rehabilitation as well as in major rehabilitation subgroups. Mobilization alone does not eliminate the risk of VTE after another thrombotic insult. Low molecular weight heparins (LMWHs) and direct oral anticoagulants (DOACs) are the principal current modalities of thromboprophylaxis. Based on the literature, we make suggestions for VTE prevention and include an approach for consideration by rehabilitation units that can be aligned with local practice.

A body-brain circuit that regulates body inflammatory responses.

The body-brain axis is emerging as a principal conductor of organismal physiology. It senses and controls organ function1,2, metabolism3 and nutritional state4-6. Here we show that a peripheral immune insult strongly activates the body-brain axis to regulate immune responses. We demonstrate that pro-inflammatory and anti-inflammatory cytokines communicate with distinct populations of vagal neurons to inform the brain of an emerging inflammatory response. In turn, the brain tightly modulates the course of the peripheral immune response. Genetic silencing of this body-brain circuit produced unregulated and out-of-control inflammatory responses. By contrast, activating, rather than silencing, this circuit affords neural control of immune responses. We used single-cell RNA sequencing, combined with functional imaging, to identify the circuit components of this neuroimmune axis, and showed that its selective manipulation can effectively suppress the pro-inflammatory response while enhancing an anti-inflammatory state. The brain-evoked transformation of the course of an immune response offers new possibilities in the modulation of a wide range of immune disorders, from autoimmune diseases to cytokine storm and shock.

Prompting Paramedics: The Effect of Simulation on Paramedics' Identification of Learning Objectives.

INTRODUCTION: Simulation has emerged as a useful educational tool for the continued training of paramedics. Practicing paramedics are thought to learn through reflecting on their own actions in practice, and it is hoped that simulation could spur similar reflection, which could then lead to practice change. Despite this, there is limited data on how these practitioners use simulated experiences to set learning objectives. This study aimed to explore how simulation training affects self-identification of learning objectives in emergency medical services (EMS) providers (a.k.a. paramedics). METHODS: Paramedics (primary care and advanced care) participated in a 30-minute simulated learning session. All participants filled out pre-post surveys identifying their own learning objectives immediately before and after the simulation. An inductive qualitative analysis of these responses were conducted by two authors (EJ, TC) using an interpretive description approach, yielding a list of key themes commonly found in the learning objectives. Pre-post learning objectives were individually compared by the level of specificity as determined by the authorship team. Simple descriptive statistics were generated to describe the number of times that the paramedics' learning objectives became more or less specific, different, or same. RESULTS: Thirty-five paramedics who completed the simulation and survey were included. Four major themes emerged in the learning objectives: 1) assessment and diagnostic; 2) communication and collaboration; 3) integration of knowledge; and 4) treatment and management. After simulation, the learning objectives became more specific in 6 (17.1%), less specific in 3 (8.6%), different in 22 (62.9%), and remained same in 4 (11.4%). CONCLUSION: Simulation training shows promise in refining perceived learning needs. The results from this study offer insight into paramedics' self-identification of learning objectives and gaps pre-post simulation experiences. Understanding the underlying psychology of paramedics participating in simulation may help educators better understand how to guide reflection and continuous improvement.