Características clínicas de reanimações cardiopulmonares intra-hospitalares registradas em prontuário: estudo transversal / Clinical characteristics of in-hospital cardiopulmonary resuscitations recorded in medical records: a cross-sectional study / Características clínicas de las reanimaciones cardiopulmonares intrahospitalarias registradas en las historias clínicas: estudio transversal

Objetivo: identificar características clínicas das paradas cardiopulmonares e reanimações cardiopulmonares ocorridas em ambiente intra-hospitalar. Método: estudo quantitativo, prospectivo e observacional, a partir de informações de prontuários de pacientes submetidos a manobras de reanimação devido à parada cardiopulmonar entre janeiro e dezembro de 2021. Utilizou-se um instrumento baseado nas variáveis do modelo de registro Utstein. Resultados: em 12 meses foram registradas 37 paradas cardiopulmonares. A maioria ocorreu na unidade de terapia intensiva respiratória, com causa clínica mais prevalente hipóxia. 65% dos pacientes foram intubados no atendimento e 57% apresentaram ritmo atividade elétrica sem pulso. A duração da reanimação variou entre menos de cinco a mais de 20 minutos. Como desfecho imediato, 57% sobreviveram. Conclusão: dentre os registros analisados, a maior ocorrência de paradas cardiopulmonares foi na unidade de terapia intensiva respiratória, relacionada à Covid-19. Foram encontrados registros incompletos e ausência de padronização nas condutas.

Objective: identify the clinical characteristics of cardiopulmonary arrests and cardiopulmonary resuscitations in the in-hospital environment. Method: this is a quantitative, prospective and observational study based on information from the medical records of patients who underwent resuscitation maneuvers due to cardiopulmonary arrest between January and December 2021. An instrument based on the variables of the Utstein registration protocol was used. Results: thirty-seven cardiopulmonary arrests were recorded in 12 months. The majority occurred in a respiratory intensive care unit, with hypoxia being the most prevalent clinical cause. Sixty-five percent of the patients were intubated and 57% had pulseless electrical activity. The duration of resuscitation ranged from less than five to more than 20 min. As for the immediate outcome, 57% survived. Conclusion: among the records analyzed, the highest occurrence of cardiopulmonary arrests was in respiratory intensive care units, and they were related to Covid-19. Moreover, incomplete records and a lack of standardization in cardiopulmonary resuscitation procedures were found.

Objetivo: Identificar las características clínicas de paros cardiopulmonares y reanimaciones cardiopulmonares que ocurren en un ambiente hospitalario. Método: estudio cuantitativo, prospectivo y observacional, realizado a partir de información presente en historias clínicas de pacientes sometidos a maniobras de reanimación por paro cardiorrespiratorio entre enero y diciembre de 2021. Se utilizó un instrumento basado en las variables del modelo de registro Utstein. Resultados: en 12 meses se registraron 37 paros cardiopulmonares. La mayoría ocurrió en la unidad de cuidados intensivos respiratorios, la causa clínica más prevalente fue la hipoxia. El 65% de los pacientes fue intubado durante la atención y el 57% presentaba un ritmo de actividad eléctrica sin pulso. La duración de la reanimación varió entre menos de cinco y más de 20 minutos. Como resultado inmediato, el 57% sobrevivió. Conclusión: entre los registros analizados, la mayor cantidad de paros cardiopulmonares se dio en la unidad de cuidados intensivos respiratorios, relacionada con Covid-19. Se encontraron registros incompletos y falta de estandarización en el procedimiento.

Effect of COVID-19 Shelter-In-Place Orders on Visual Outcomes of Ophthalmic Surgical Emergencies.

PURPOSE: To compare the outcomes of ophthalmic surgical emergencies during shelter-in-place (SIP) order with the corresponding period in 2019. METHODS: This retrospective cohort study compared patients presenting to the Bascom Palmer Eye Institute (BPEI) emergency department (ED) who underwent urgent surgery during the SIP period (March 23-May 17, 2020), compared to the same weeks in 2019 (non-SIP). Main outcome measures included symptom-to-ED time, ED-to-surgical decision time, surgical decision-to-operating room (OR) time, ED-to-OR time, and postoperative follow-up time. Secondary outcome measures included travel distance, visual acuity (VA), intraocular pressure (IOP), and number of glaucoma medications. RESULTS: Seventy-six and 148 patients presented with ophthalmic surgical emergencies in the SIP and non-SIP study periods, respectively. Retinal detachment (RD), acute glaucoma, and open globe injury were the most common diagnoses in both periods. Symptom-to-ED and surgical decision-to-OR times were shorter during the SIP period. SIP patients had comparable preoperative VA but worse postoperative VA compared to non-SIP patients. During the SIP period, RD patients experienced postoperative VA reduction rather than improvement (+0.09 vs. -0.23 logMAR, p = 0.03); glaucoma patients were less likely to reach surgical decision within 24 h (OR 0.16 [95% CI 0.03-0.95]); and globe injuries had longer ED-to-surgical decision time and ED-to-OR time compared to the non-SIP period. Other outcomes were similar between both study periods. CONCLUSION: There was reduced volume of ophthalmic surgical emergencies and worse postoperative vision during SIP compared to the non-SIP period, despite shorter symptom-to-ED and surgical decision-to-OR times suggesting minimal delays in seeking or receiving care.

Emergency department utilization among adults with epilepsy: A multi-state cross-sectional analysis, 2010-2019.

OBJECTIVE: We described patterns and trends in ED use among adults with epilepsy in the United States. METHODS: Utilizing inpatient and ED discharge data from seven states, we conducted a cross-sectional analysis to identify adult ED visits diagnosed with epilepsy or seizures from 2010 to 2019. Using ED visit counts and estimates of state-level epilepsy prevalence, we calculated ED visit rates overall and by payer, condition, and year. RESULTS: Our data captured 304,935 ED visits with epilepsy as a primary or secondary diagnosis in 2019. Across the seven states, visit rates ranged between 366 and 726 per 1000 and were higher than rates for adults without epilepsy in all states but one. ED visit rates were highest among Medicare and Medicaid beneficiaries (vs commercial or self-pay). Adults with epilepsy were more likely to be admitted as inpatients. Visits for nervous system disorders were 6.3-8.2 times higher among people with epilepsy, and visits for mental health conditions were 1.2-2.6 times higher. Increases in ED visit rates from 2010 to 2019 among people with epilepsy exceeded increases among adults without by 6.0-27.3 percentage points. CONCLUSION: Adults with epilepsy visit the ED frequently and visit rates have been increasing over time. These results underscore the importance of identifying factors contributing to ED use and designing tailored interventions to improve ambulatory care quality.

Trust Building in Public Health Approaches: The Importance of a "People-Centered" Concept in Crisis Response.

Purpose: To argue for trust-building as a key solution for responding to public health crises in the face of political ambiguity in international health governance. Patients and Methods: This perspective piece reviews fundamental concepts and discusses future directions using secondary data from open-access sources. Results: The promise of learning from Covid-19 and previous public health crises, along with the growing recognition of a 'Health For All Policies' approach, clash with siloed preparations, management, and recovery plans for future emergency crises. Trust is proposed as a possible solution to overcome these limitations. It acts as a binding force that unites individuals within the community, fostering a sense of belonging and participation. Trust-building is viewed as a "People-Centered" approach in Crisis Response, aimed at creating active and resilient communities to foster preparation and readiness, respond to emergent risks, facilitate recovery, and mitigate risks. A remaining question is how to measure and identify the dimensions and determinants of trust in specific circumstances. Some ideas are systematized to highlight the pathway to build trust in public health approaches, including transparency, education, robust and equitable health systems, strengthened social capital, stakeholders' engagement, and health workforce training. Conclusion: Trust in public health approaches can be fostered through consistent delivery of quality care, a clear, shared vision, and values underpinned by ethical standards. It requires a commitment to stakeholder well-being, including staff, and the integration of reliability, integrity, and transparency into policies, strategies, and practices. Exemplary leadership, openness in resource utilization, addressing waste or corruption, and effective communication of these principles are essential.

Successful management of carinal shift in aortic dissection: A case report of innovative airway management strategies.

The case underscores the necessity of adaptable airway management strategies in aortic dissection surgeries complicated by carinal shift. Successful lung isolation was achieved using a single-lumen endotracheal tube after failed attempts with traditional methods and bronchial blockers.

Early Diagnosis and Treatment Outcomes of Fournier Gangrene in a Tertiary Center.

INTRODUCTION: Fournier gangrene is an uncommon urological emergency caused by microbial agents, resulting in necrosis of the genitalia and perineum. This study aims to evaluate the outcomes of early diagnosis and management of Fournier gangrene at KAMC in Riyadh, Saudi Arabia. METHODS: A retrospective cohort study was conducted at KAMC, Saudi Arabia. The study population included all adult patients diagnosed with Fournier gangrene between 2015 and 2022. Data analysis was performed using RStudio (RStudio, Boston, MA). Frequencies and percentages were used to present categorical data, while medians and interquartile ranges were used to express numerical variables. RESULTS: The study included 41 patients with Fournier gangrene, the majority (95.12%) being male with a median age of 60 years. The most prevalent comorbidity was diabetes mellitus (85.37%). Ten patients presented to the hospital with sepsis, two of whom were in shock. Within 90 days of admission, two of them had expired. This resulted in a 20% mortality rate among septic patients. The mean FGSI in patients who had died during hospital stays was approximately two times the mean in surviving patients (8.17 and 4.32, respectively). The most utilized imaging study was a CT scan (70.7%). Most patients had undergone multiple debridements (87.7%). The median number of debridements per patient was three, and the interval between each debridement was three days. The most frequent tissue culture finding was mixed organisms, followed by Escherichia coli. Regarding empiric antibiotics, tazocin was the most used, accounting for 22.0%. The most frequently performed adjunctive procedure was the placement of a suprapubic catheter, accounting for 41.5%. Roughly 43.90% required a blood transfusion. Within 90 days of admission, six patients had died, which makes the mortality rate 14.6%. Four of them had died within 30 days of admission (9.76%). CONCLUSION: Fournier gangrene is a surgical emergency that requires prompt attention and resuscitation, antibiotic therapy, and surgical debridement. The study identified the demographic factors of patients who presented with the disease and provided the incidence, mortality rate, and outcomes of the disease. It also identified specifics of the pharmacological and surgical management and hospital courses.

The Obstetrics and Gynecology Hospitalist: Risk Management Implications.

The concept of a 24/7 in-house obstetrician, serving as an obstetrics and gynecology (Ob/Gyn) hospitalist, provides a safety-net for obstetric and gynecologic events that may need immediate intervention for a successful outcome. The addition of an Ob/Gyn hospitalist role in the perinatal department mitigates loss prevention, a key precept of risk management. Inherent in the role of the Ob/Gyn hospitalist are the important patient safety and risk management principles of layers of back-up, enhanced teamwork and communications, and immediate availability.

Organizing and Operationalizing an Effective Obstetric and Gynecologic Hospitalist Program.

Creating and managing a successful obstetric and gynecologic (OB hospitalist) program requires careful attention to multiple aspects of the program. Appropriate policies and procedures need to be created. The clinical team needs to be selected and trained. Measurement of clinical and operational activity needs to be implemented and transparently shared with the team and the hospital partner. This all should be done with the hospital's goals for the program in mind and recognizing the type of clinical care that the hospital provides for obstetric patients in its community.

Triage Versus Obstetric Emergency Department and Main Emergency Department: Best Practices.

An obstetric emergency department (OBED) allows for timely, standardized and quality care by a clinician for pregnant patients presenting unscheduled to a hospital. Understanding the differences between a traditional labor and delivery triage model and an OBED are important in developing a successful, safe, and quality obstetric program that meets the needs of the community with appropriate resource allocation. The benefits in an OBED of every patient seen in a timely fashion by a clinician, and ultimately the impact on outcomes are noteworthy and should be considered when developing a labor and delivery unit.

The effect of modified team-based learning method on the knowledge and skills of medical emergency personnel: a clinical trial.

Background: Trauma is one of the most important issues and problems considered in most countries in today's modern and industrial society. Since pre-hospital care is the first component of a trauma care system, if done properly, it can reduce the problems associated with long-term disability and death due to trauma. Therefore, the present study was conducted to determine the impact of training based on a modified team-based learning (TBL) method on the skills of medical emergency personnel in managing trauma patients in 2022. Materials and methods: The present study was a two-group clinical before/after study in which 96 technicians were selected using a stratified random sampling method. The sample members were randomly divided into an intervention group and a control group. In the intervention group, skills for dealing with trauma patients were taught through a modified team-based learning method. The results were analyzed using SPSS software version 21. Results: The results of the repeated measures analysis of variance showed a significant difference between the intervention and control groups in learning skills for dealing with trauma patients (P<0.001), which were determined by examining the effect of test repetition and the effect of interaction. The changes in the studied variables in the TBL groups were significantly greater than those in the control group (P<0.001). Conclusion: The results indicate that training based on the modified team-based learning method is effective for the management of trauma patients by medical emergency personnel and improves the readiness of personnel in this field.

Challenges to research implementation during public health emergencies: anecdote of insights and lessons learned during the COVID-19 pandemic in Gujarat, India.

Health emergencies, including pandemics, are not new occurrences; some notable ones occurred in the past. However, the scale of the COVID-19 pandemic is unprecedented. The COVID-19 pandemic exposed the unpreparedness of national health systems in effectively managing health emergencies. During the pandemic, controlling the spread of the virus and hopes of exiting into a post-pandemic era were reliant on research to improve patient care and inform government policies. Nonetheless, research implementation during health emergencies can be challenging in low-resourced settings. This paper presents anecdotes of experiences and offers insight into ways research can be supported during health emergencies. We implemented a longitudinal study to investigate the impact of the COVID-19 pandemic, including SARS-CoV-2 infection, during pregnancy on maternal and child health outcomes. The study utilized hospital databases to recruit women who were infected and with no known SARS-CoV-2 infection during pregnancy. Mother-infant pairs in the infected and uninfected group were then followed longitudinally for 3 years. Observations, including challenges during planning, record retrieval, tracking, recruitment, and follow-up of eligible women, were reported by research staff. The challenges observed were group into three overarching themes: (a) individual factors, (b) health system challenges, and (c) research operational challenges. Some notable observations include misinformation, misconception, mistrust, underdeveloped health record systems, stigma, and hesitance. Early planning, effective communication, and community awareness can help in implementing a successful research project. Additionally, efforts to improve collaboration and co-creation between health practitioners, researchers, and the public may benefit the implementation of research projects during a health emergency.

Emergent robotic surgery conversions: improving operating room team performance through high fidelity simulations.

Background: Although robotic surgery has gained popularity, safety concerns remain due to potential delay in addressing intraoperative hemorrhages since the surgeon is not at the bedside. This study aimed to test whether a training program for emergency robotic undocking protocols improved the performance of thoracic operating room (OR) teams. Methods: An emergency undocking protocol and checklists were created for massive hemorrhage during robotic thoracic surgery. In phase I, two OR teams participated in in-situ simulations of the scenarios in the OR without knowledge of the protocols. In phase II, the protocol and checklists were introduced to four different OR teams by either high-fidelity lab simulation or video-based didactic sessions. The teams' performances were tested with in-situ OR simulations. Performance assessments included the number of missed critical steps, participant-reported feedback, and timeliness of crucial steps. Results: All teams successfully converted from robot-assisted to open, with the attending at bedside within five minutes from the decision to convert, regardless of phase or education type. Phase I (control) teams had an average of 2.55 critical misses per team while the average was 0.25 for phase II teams (P=0.08). There was no significant difference between phases in time required for the surgeon to be at the bedside (average 132.2 seconds, P=0.64). Conclusions: Targeted education can lead to improved team performance. This study shows that high-fidelity simulation and didactic sessions can both be used to effectively teach emergency undocking protocols.

The profile of patients attending to the general emergency department with ocular complaints within the last year: is it a true ocular emergency?

PURPOSE: Ocular emergencies require immediate intervention to prevent rapid vision loss or functional impairment. The aim of this study was to determine the proportion of true ocular emergencies among patients who presented to the general emergency department with ocular complaints and were referred to the Eye Clinic. METHODS: In a retrospective cross-sectional study in a tertiary hospital in Istanbul, patients aged 0-100 years who presented to the general emergency department with ocular complaints between January and December 2022 were included. Inconclusive diagnoses and incomplete records were excluded. Patients were divided into three groups: top eye emergencies (TE), relative eye emergencies (REE), and non-emergency eyes (NEE). RESULTS: Among the 652,224 individuals seeking care, 9,982 (1.5%) were referred to the Eye Emergency Clinic. Of these, 2,788 (27.9%) were female, and 7,194 (72.1%) were male, with ages ranging from 0 to 98 years. TopEye Emergencies (TEE), Relative Eye Emergencies (REE), and Non-Eye Emergencies (NEE) accounted for 13%, 60%, and 27% of the cases, respectively. Common top-eye emergencies (TEE) include chemical injuries, orbital-preseptal cellulitis, and orbital fractures. Relative eye emergencies (REEs) commonly feature corneal foreign bodies, corneal erosion, and conjunctivitis. Nonemulsion eye (NEE) methods involve simple eye redness, trauma without eye involvement, and subconjunctival haemorrhage. CONCLUSIONS: Consistent with the literature, 1.5% of patients presenting to the general emergency department had eye complaints.However, 27% of those referred to the ophthalmological clinic did not have an urgent eye condition. This is partly due to the high proportion of patients presenting to the emergency department with ocular complaints and the lack of knowledge of ophthalmological diseases by emergency physicians, leading to unnecessary referrals to the ophthalmology clinic, resulting in a loss of the workforce and reduced time allocated to patients with true ocular emergencies.

Advances in hybridized nanoarchitectures for improved oro-dental health.

On a global note, oral health plays a critical role in improving the overall human health. In this vein, dental-related issues with dentin exposure often facilitate the risk of developing various oral-related diseases in gums and teeth. Several oral-based ailments include gums-associated (gingivitis or periodontitis), tooth-based (dental caries, root infection, enamel erosion, and edentulous or total tooth loss), as well as miscellaneous diseases in the buccal or oral cavity (bad breath, mouth sores, and oral cancer). Although established conventional treatment modalities have been available to improve oral health, these therapeutic options suffer from several limitations, such as fail to eradicate bacterial biofilms, deprived regeneration of dental pulp cells, and poor remineralization of teeth, resulting in dental emergencies. To this end, the advent of nanotechnology has resulted in the development of various innovative nanoarchitectured composites from diverse sources. This review presents a comprehensive overview of different nanoarchitectured composites for improving overall oral health. Initially, we emphasize various oral-related diseases, providing detailed pathological circumstances and their effects on human health along with deficiencies of the conventional therapeutic modalities. Further, the importance of various nanostructured components is emphasized, highlighting their predominant actions in solving crucial dental issues, such as anti-bacterial, remineralization, and tissue regeneration abilities. In addition to an emphasis on the synthesis of different nanostructures, various nano-therapeutic solutions from diverse sources are discussed, including natural (plant, animal, and marine)-based components and other synthetic (organic- and inorganic-) architectures, as well as their composites for improving oral health. Finally, we summarize the article with an interesting outlook on overcoming the challenges of translating these innovative platforms to clinics.

Testicular Torsion as a Complication Following Preperitoneal Packing for Pelvic Fractures in a Motorcycle Accident: A Case Report.

This case report highlights a rare but significant complication of blunt trauma requiring preperitoneal packing and illustrates the intricate relationship between trauma surgery and urological emergencies. Testicular torsion is an acute urological emergency necessitating prompt surgical intervention to salvage testicular function. While commonly associated with intrinsic factors such as the "bell-clapper" deformity, extrinsic factors such as trauma and postoperative complications can also precipitate this condition. This case underscores the complexity of diagnosing and managing testicular torsion arising after surgical interventions for pelvic fractures, a scenario sparsely documented in medical literature. We present a 27-year-old male who sustained multiple injuries, including a pelvic fracture, from a motorcycle accident and subsequently underwent preperitoneal packing for significant pelvic hemorrhage. Five days post-operation, the patient developed acute right lower quadrant and unilateral testicular pain, leading to the diagnosis of testicular torsion via Doppler ultrasonography. An emergency bilateral orchiopexy was performed, revealing a 180° torsion of the right testis. This case illustrates the need for a heightened awareness of potential genitourinary complications following trauma surgery. The pathophysiological mechanisms possibly include increased intra-abdominal pressure and altered testicular mobility due to surgical interventions. The report emphasizes the importance of multidisciplinary care in trauma settings to ensure comprehensive evaluation and management of patients, including the consideration of urological complications. Testicular torsion following preperitoneal packing for pelvic fractures represents a critical intersection between trauma surgery complications and urological emergencies, necessitating vigilant postoperative care and multidisciplinary collaboration for timely diagnosis and intervention. This case contributes to the broader understanding of postoperative complications, advocating for an integrated approach to patient care in high-energy trauma scenarios.

Hybrid aorto-iliac reconstruction for acute infrarenal aortic occlusion: A case report.

OBJECTIVE: Acute aortic occlusion (AAO), though rare, carries a high morbidity and mortality risk. Rapid recognition and revascularization are crucial for limb and life preservation. We present a case of a hybrid approach using open thrombectomy and endovascular arterial stent grafts in lieu of an open bypass for management of AAO. METHODS: This case describes a 77-year-old man who presented with new-onset lower extremity pain with associated sensory deficits and was found to have acute infrarenal aortic occlusion. Open femoral cutdown for open thrombectomy and distal embolic protection with endovascular balloon occlusion was combined with aortic and bilateral iliac artery stenting. RESULTS: The patient was discharged home on post-operative day 3 with resolution of his presenting symptoms and remains asymptomatic at 1-month follow-up. CONCLUSION: This technique of aorto-iliac reconstruction using stent grafts has previously been described in the setting of chronic aorto-iliac occlusive disease; however, its use has not been previously documented in the setting of acute aortic occlusion. This case illustrates the safety and feasibility of a hybrid approach to AAO, particularly in patients who are physiologically unfit for open revascularization.

Uterine sacrifice in obstetric emergencies case series: Complex cases of fetal distress, labor challenges, and life-saving interventions.

This study highlights the complexities and challenges in managing obstetric emergencies, detailing critical interventions and outcomes in various high-risk cases. A retrospective analysis was conducted on four high-risk obstetric cases, each characterized by distinct complications necessitating immediate medical interventions. The study specifically examined cases involving: Fetal Distress cases where fetal health was compromised, necessitating interventions such as emergency cesarean sections. Complex Labor Dynamics detailed examinations of labor complications such as obstructed labor, precipitate labor, or labor complicated by malpresentation. Early pregnancy complications analysis focused on emergencies arising in the first trimester or early second trimester, including ectopic pregnancies and complications in pregnancies with a history of multiple cesarean sections. Severe postpartum hemorrhage investigations into cases of significant blood loss post-delivery, which required interventions ranging from pharmacological management to surgical procedures like hysterectomy. The first case concerned a 28-year-old primigravida with fetal bradycardia and thick meconium, requiring an emergency cesarean section. Postoperative complications included gestational thrombocytopenia and anemia, necessitating a total abdominal hysterectomy for severe sepsis. The newborn showed good recovery, indicated by Apgar scores. In Case 2, the need for a hysterectomy following complications during the third stage of labor was likely due to the presence of Placenta Accreta Spectrum, specifically placenta accreta or increta. While a retained placenta typically can be managed with less invasive methods, the situation escalates when the placenta is abnormally adherent to, or deeply invasive into, the uterine muscle. This can lead to uncontrollable bleeding, making a hysterectomy necessary and justified as a life-saving measure to control the severe hemorrhage while the histology confirms the diagnosis for the placenta accreta. In the third case, the decision to perform a dilation and curettage over manual vacuum aspiration was influenced by several factors. Given the severity of the patient's hemorrhage and the presence of a suspicious echogenic structure, a dilation and curettage provided a more controlled environment for thorough evacuation and immediate bleeding control. This approach was also supported by the combination technique using both Karman aspiration and a curette, allowing for effective management of complicated cases, particularly in patients with a history of multiple cesareans and potential scar tissue. The fourth case involved a 37-year-old multipara with severe postpartum hemorrhage from uterine atony, treated with surgery and managed for diabetic ketoacidosis, leading to discharge on the fourth day. This underscores the urgency and complexity of managing obstetric emergencies effectively.

Global Perfusion Practice Survey: Readiness of On-Call and Emergency Operation Rooms.

INTRODUCTION: Perfusion safety in cardiac surgery is vital, and this survey explores perfusion practices, perspectives, and challenges related to it. Specifically, it examines the readiness of on-call and emergency operation rooms for perfusion-related procedures during urgent situations. The aim is to identify gaps and enhance perfusion safety protocols, ultimately improving patient care. METHODS: This was a preliminary survey conducted as an initial exploration before committing to a comprehensive study. The sample size was primarily determined based on a one-month time frame. The survey collected data from 236 healthcare professionals, including cardiac surgeons, perfusionists, and anesthetists, using an online platform. Ethical considerations ensured participant anonymity and voluntary participation. The survey comprised multiple-choice and open-ended questions to gather quantitative and qualitative data. RESULTS: The survey found that 53% preferred a dry circuit ready for emergencies, 19.9% preferred primed circuits, and 19.1% chose not to have a ready pump at all. Various reasons influenced these choices, including caseload variations, response times, historical practices, surgeon preferences, and backup perfusionist availability. Infection risk, concerns about error, and team dynamics were additional factors affecting circuit readiness. CONCLUSION: This survey sheds light on current perfusion practices and challenges, emphasizing the importance of standardized protocols in regards to readiness of on-call and emergency operation rooms. It provides valuable insights for advancing perfusion safety and patient care while contributing to the existing literature on the subject.

Factors influencing mental health service delivery during public health emergencies: a scoping review protocol.

Background: Unforeseeable public health emergencies (PHEs) profoundly impact psychological well-being and disrupt mental health care provision in affected regions. To enhance preparedness for future emergencies, it is crucial to understand the effectiveness of mental health services, their underlying mechanisms, the populations they are tailored to, and their appropriateness across distinct emergencies. The aim of this scoping review will be to explore how mental health services have responded to PHEs, focusing on their effectiveness as well as barriers and facilitators to implementation. Methods: Following the five-stage Arksey-O'Malley guidance, as updated further by Westphaln and colleagues, this mixed-methods scoping review will search academic and grey literature. Publications related to mental health interventions and supports delivered during PHEs will be considered for inclusion. The interventions and supports are operationally defined as any adaptations to mental health service provision at the international, national, regional or community level as a consequence of PHEs. The "Four Ss" framework will be utilised to provide structure for the evidence synthesis and inform categorisation of interventions and supports delivered during PHEs. Any research methodology will be considered for inclusion. Two reviewers will independently screen titles, abstracts, and full texts of publications against eligibility criteria. The gathered data will be depicted in accordance with the Four Ss" framework through the utilisation of descriptive/analytical statistics and supplemented by narrative exploration of findings. Conclusions: Considering the diverse research methodologies and the varied applicability of services in different contexts of PHEs, this review will offer insights into the type, effectiveness, and implementation barriers and facilitators of mental health interventions and supports delivered during PHEs. By employing the "Four Ss" framework, the review will guide decision-making bodies in identifying effective and practical aspects of mental health system operations during emergencies.

[How does trauma secondary to unexpected extreme weather affect orthopaedic surgery departments? : An epidemiological study on the Filomena snowstorm]. / Wie wirken sich Traumata infolge unerwarteter Wetterextreme auf orthopädisch-chirurgische Abteilungen aus? : Eine epidemiologische Studie über den Schneesturm Filomena.

INTRODUCTION: Trauma secondary to extreme weather events may heavily impact the normal activity of orthopaedic surgery departments, especially in places not prepared to deal with them. The Filomena snowstorm, which happened in January 2021, was one of the greatest snowstorms ever in Spain. During it, the constant influx of trauma patients caused Orthopaedic Emergencies Department (OED) to collapse. The primary objective of this study was to describe the orthopaedic injuries and changes in fracture's epidemiology observed during this exceptional period. Secondary objectives were to analyse the collected variables in order to minimize the future impact of these unexpected extreme weather events. MATERIAL AND METHODS: A retrospective cohort study between patients that came to the OED during the snowstorm (Filomena group) and those who came on the same period of the previous year (Control group) was made. The following data were collected: age, sex, injury location, injury mechanism, diagnosis, AO/OTA fracture classification, treatment type (conservative vs surgical) and delay of surgical treatment. RESULTS: A total of 1237 patients were included, 655 patients from the Filomena group and 582 from the Control group. One in two patients in the Filomena group sustained a fracture (50.7% vs 23.2%). The most frequent diagnosis on the Filomena group was distal radius fracture (16.2%), which was five times more frequent than in the Control group (3.4%). A significant increment was also observed in the incidence of ankle (21.7%) and proximal humerus (33%) fractures. In the Filomena group, surgically treated fractures increased by 168%, being more severe, as C­type fractures were more prevalent (23% vs 13%). Mean delay to surgery was 6.78 days during the snowstorm. CONCLUSION: Unexpected snowstorms entail an exponential rise in orthopaedic care demand and OED pressures. A significant increment in orthopaedic trauma surgery, up to 168% more, particularly distal radius, proximal humerus and ankle fractures, is to be expected, which will imply elective surgery cancellation, hurting patients and increasing costs.