Air leak syndrome in animals: definition and pathogenesis.

Air leak syndrome (ALS) is described in human medicine as a constellation of clinical disorders including pneumomediastinum, pneumopericardium, pulmonary interstitial emphysema, pneumothorax, pneumoperitoneum, pneumoretroperitoneum and subcutaneous emphysema. The pathogenesis of ALS depends on the anatomy of the mediastinum and its associations with thoracic, abdominal and cervical connective tissues, as well as a physical phenomenon referred to as the Macklin effect. Various animal species develop diverse combinations of these lesions, although ALS has not been recognized in animals. However, this term aids pathologists in addressing this disease compilation. The aim of this retrospective study is to illustrate examples of ALS in animals by arbitrarily selecting 13 cases in dogs, cats, pinnipeds, sea otters and harbour porpoises. ALS can be classified into three groups based on aetiology: iatrogenic, secondary or spontaneous. Iatrogenic ALS was diagnosed in two cats with tracheal laceration following endotracheal intubation. Secondary ALS was identified in two dogs, one with acute respiratory distress syndrome and the other due to grass awn migration. Secondary ALS in pinnipeds was diagnosed following severe pulmonary parasitism, uraemic pneumonia and oesophageal perforation. The other marine mammals developed ALS following trauma. Spontaneous ALS was also diagnosed in one cat and one dog without any apparent predisposing causes.

Clinical, imaging, and pathologic features in cases of neurologic disease in 3 psittacine birds.

We used magnetic resonance imaging (MRI) to evaluate the CNS, and confirmed CNS lesions histologically, in 3 psittacine birds with neurologic signs. One bird was recumbent as a result of non-ambulatory paraparesis, and 2 birds were ataxic with impaired proprioception. In all 3 cases, imaging was performed, and infectious diseases were excluded in cases 1 and 2. In case 1, a large mass arose from the left lung; in case 2, a multinodular coelomic mass encompassed the left caudal pulmonary area to the left cranial renal pole; and in case 3, a diffuse hyperintensity affected the lumbar spinal cord. In the first 2 cases, masses invaded the vertebral canal, causing spinal cord compression. All 3 birds were euthanized given the poor prognosis, and postmortem examinations were performed. The final diagnoses were pulmonary adenocarcinoma in cases 1 and 2, and granulomatous and lymphocytic leptomeningitis caused by Mycobacterium genavense in case 3. MRI enabled visualization of the lesions in the affected area of the CNS, and MRI findings were confirmed by histopathology.

Development and Validation of a Questionnaire of the Perioperative Nursing Competencies in Patient Safety.

(1) Background: This research presents the CUCEQS© (Spanish acronym for Questionnaire of Perioperative Nursing Safety Competencies), which evaluates the perception of perioperative nurses about their competencies related to surgical patient safety. The aim of the present study was to design, validate, and analyze the psychometric properties of the CUCEQS©. (2) Methods: We devised an instrumental, quantitative, and descriptive study divided into two phases: in the first, the questionnaire was designed through a Delphi method developed by perioperative nurses and experts in patient safety. In the second, the reliability, validity, and internal structure of the tool were evaluated. (3) Results: In the first phase, the items kept were those that obtained a mean equal to or higher than four out of five in the expert consensus, and a Content Validity Index higher than 0.78. In the second phase, at the global level, a Stratified Cronbach's Alpha of 0.992 was obtained, and for each competency, Cronbach's Alpha values between 0.81 and 0.97 were found. A first-order confirmatory factor analysis of the 17 subscales (RMSEA 0.028, (IC 90% = 0.026-0.029) and its observed measures was performed for the 164 items, as well as a second-order analysis of the four competencies (RMSEA = 0.034, (IC90% = 0.033-0.035). (4) Conclusions: The questionnaire is a valid tool for measuring the perceived level of competency by the perioperative nurses in surgical patient safety. This is the first questionnaire developed for this purpose, and the results obtained will facilitate the identification of areas to be improved by health professionals in patient safety.

Self-Learning Methodology in Simulated Environments (MAES©) as a Learning Tool in Perioperative Nursing. An Evidence-Based Practice Model for Acquiring Clinical Safety Competencies.

BACKGROUND: The self-learning Methodology in Simulated Environments (Spanish acronym: MAES©, (Murcia, Spain) is a type of self-directed and collaborative training in health sciences. The objective of the present study was to compare the level of competence of postgraduate surgical nursing students in the clinical safety of surgical patients, after training with the MAES© methodology versus traditional theoretical-practical workshops, at different points in time (post-intervention, after three months, six months post-intervention, and at the end of the clinical training period, specifically nine months post-intervention). METHODS: We conducted a prospective study with an experimental group of surgical nursing postgraduate students who participated in MAES© high-fidelity simulation sessions, and a control group of postgraduate nursing students who attended traditional theoretical-practical sessions at two universities in Catalonia (Spain). The levels of competence were compared between the two groups and at different time points of the study. RESULTS: The score was higher and statistically significantly different in the experimental group for all the competencies, with a large effect size at every measurement point previously mentioned. CONCLUSIONS: The postgraduate nurses were the most competent in the clinical safety of surgical patients when they trained with the MAES© methodology than when they learned through traditional theoretical-practical workshops. The learning of surgical safety competencies was more stable and superior in the experimental group who trained with MAES©, as compared to the control group.

Perioperative nurses' experiences in relation to surgical patient safety: A qualitative study.

Surgical patient safety remains a concern worldwide as, despite World Health Organization recommendations and implementation of its Surgical Safety Checklist, adverse events continue to occur. The aim of this qualitative study was to explore the views and experiences of perioperative nurses regarding the factors that impact surgical patient safety. Data were collected through five focus groups involving a total of 50 perioperative nurses recruited from four public hospitals in Spain. Content analysis of the focus groups yielded four main themes: personal qualities of the perioperative nurse, the surgical environment, safety culture, and perioperative nursing care plans. One of the main findings concerned barriers to the exercise of leadership by nurses, especially regarding completion of the Surgical Safety Checklist. Some of the key factors that impacted the ability of perioperative nurses to fulfil their duties and ensure patient safety were the stress associated with working in the operating room, time pressures, and ineffective communication in the multidisciplinary team. Targeting these aspects through training initiatives could contribute to the professional development of perioperative nurses and reduce the incidence of adverse events by enhancing the surgical safety culture.

Causes of cetacean stranding and death on the Catalonian coast (western Mediterranean Sea), 2012-2019.

The causes of cetacean stranding and death along the Catalan coast between 2012 and 2019 were systematically investigated. Necropsies and detailed pathological investigations were performed on 89 well-preserved stranded cetaceans, including 72 striped dolphins Stenella coeruleoalba, 9 Risso's dolphins Grampus griseus, 5 bottlenose dolphins Tursiops truncatus, 1 common dolphin Delphinus delphis, 1 Cuvier's beaked whale Ziphius cavirostris and 1 fin whale Balaenoptera physalus. The cause of death was determined for 89.9% of the stranded cetaceans. Fisheries interaction was the most frequent cause of death in striped dolphins (27.8%) and bottlenose dolphins (60%). Cetacean morbillivirus (CeMV) was detected on the Catalan coast from 2016 to 2017, causing systemic disease and death in 8 of the 72 (11.1%) striped dolphins. Chronic CeMV infection of the central nervous system was observed from 2018-2019 in a further 5 striped dolphins. Thus, acute and chronic CeMV disease caused mortality in 18% of striped dolphins and 14.6% of all 89 cetaceans. Brucella ceti was isolated in 6 striped dolphins and 1 bottlenose dolphin with typical brucellosis lesions and in 1 striped dolphin with systemic CeMV. Sinusitis due to severe infestation by the nematode parasite Crassicauda grampicola caused the death of 4 out of 6 adult Risso's dolphins. Maternal separation, in some cases complicated with septicemia, was a frequent cause of death in 13 of 14 calves. Other less common causes of death were encephalomalacia of unknown origin, septicemia, peritonitis due to gastric perforation by parasites and hepatitis caused by Sarcocystis spp.