After they’ve gone

A new report has been published following a three year investigation into the experiences of bereaved adults with whom organ and tissue donation was discussed

Intravenous versus epidural analgesia to reduce the incidence of gastrointestinal complications after elective pancreatoduodenectomy (the PAKMAN trial, DRKS 00007784): study protocol for a randomized controlled trial

Background: Despite substantial improvements in surgical and anesthesiological practices leading to decreased mortality of less than 5 % at high-volume centers, pancreatic surgery is still associated with high morbidity rates of up to 50 %. Attention is increasingly directed toward the optimization of perioperative management to reduce complications and enhance postoperative recovery. Currently, two different strategies for postoperative pain management after pancreatoduodenectomy are being routinely used: patient-controlled intravenous analgesia and thoracic epidural analgesia. Evidence is lacking to assess which strategy entails fewer postoperative complications. Methods/design: The PAKMAN trial is designed as an adaptive, pragmatic, randomized, controlled, multicenter, open-label, superiority trial with two parallel study groups. A total of 370 patients scheduled for elective pancreatoduodenectomy will be randomized after giving written informed consent, and 278 patients are needed for analysis. Patients with chronic pancreatitis, severe chronic obstructive pulmonary disease (COPD), American Society of Anesthesiologists (ASA) physical status classification ≥ IV, or chronic pain syndrome will be excluded. The group A intervention includes intraoperative general anesthesia and postoperative patient-controlled intravenous analgesia; the group B intervention comprises combined intraoperative general anesthesia and epidural analgesia with postoperative epidural analgesia. The primary endpoint of this trial is a composite of the gastrointestinal complications (delayed gastric emptying, pancreatic fistula, biliary leak, gastrointestinal bleeding, and postoperative ileus) up to postoperative day 30. The aim is to investigate whether the frequency of gastrointestinal complications following pancreatoduodenectomy can be reduced by 15 % using postoperative, patient-controlled intravenous analgesia compared with epidural analgesia. Discussion: Several previous studies investigating the two different strategies for postoperative pain management have mainly focused on their effectiveness in pain control. However, the PAKMAN trial is the first to compare them with regard to their impact on the surgical endpoint “postoperative gastrointestinal complications” after pancreatoduodenectomy. Trial registration: German Clinical Trials Register, DRKS0000778

Closed loop medication administration using mobile nursing information system

Through this long journey of PhD study including a research on ‘Closed Loop Medication Administration Using Mobile Nursing Information System’ and the thesis writing, I obtained a lot of knowledge and experience about research method and writing. I really very appreciate the help of all my supervisors

Interhospital Transfers: Managing Competing Priorities while Ensuring Patient Safety

Interhospital patient transfers (IPTs) are highly complex logistical undertakings, involving a multitude of interdependent procedures, critical steps and a degree of unpredictability. Beginning with interfacility communication and patient acceptance agreement, a cascade of numerous handoffs takes place, ultimately culminating in safe arrival of the patient at the receiving facility. Due to the complexity of the IPT process, significant potential for critical errors and adverse patient safety (PS) outcomes exists. To minimize any associated risks, key PS considerations include checklists, handoffs, vehicle/aircraft safety, distance of travel, crew training, team factors, and many other critical components. Detailed knowledge of factors that may influence the risk of errors or adverse events is critical to optimizing both PS and clinical outcomes

Pulmonary arterial hypertension in repaired congenital heart disease: a multicentre study

This doctoral thesis aims to investigate the demographics, treatment patterns and prognosis of paediatric pulmonary hypertension (PH) and the emerging group of children and adults with PH in the setting of repaired congenital heart disease (CHD). I have conducted three studies, each with a distinct focus. The first is a retrospective, longitudinal study of ten CHD centres across the UK that assesses the clinical characteristics and treatment patterns of adults with a Fontan-type circulation receiving pulmonary vasodilators. I have compared treated patients with a matched cohort of Fontan patients who are not receiving pulmonary vasodilator therapy, complemented by an expert survey to determine current practice and the goals of therapy. In the second study, I created a 20-year national UK registry of paediatric PH and derived estimates of incidence and prevalence for all groups of paediatric PH in different age categories. I determined the natural history of paediatric PH and performed survival analysis. I then focused on patients with CHD and described the changes in demographics, with a substantial increase in patients with previously repaired CHD, who now form the largest PAH-CHD subgroup. The third study focuses on this latter group of repaired PAH-CHD. I highlighted the heterogeneity in terms of severity and onset of PAH. I identified prognostic markers and variables associated with PH resolution and developed a novel risk score for predicting adverse clinical outcomes in this group. This score will form the basis for the risk stratification of this high-risk population, to inform prognostication and guide treatment.Open Acces

Clinical Studies, Big Data, and Artificial Intelligence in Nephrology and Transplantation

In recent years, artificial intelligence has increasingly been playing an essential role in diverse areas in medicine, assisting clinicians in patient management. In nephrology and transplantation, artificial intelligence can be utilized to enhance clinical care, such as through hemodialysis prescriptions and the follow-up of kidney transplant patients. Furthermore, there are rapidly expanding applications and validations of comprehensive, computerized medical records and related databases, including national registries, health insurance, and drug prescriptions. For this Special Issue, we made a call to action to stimulate researchers and clinicians to submit their invaluable works and present, here, a collection of articles covering original clinical research (single- or multi-center), database studies from registries, meta-analyses, and artificial intelligence research in nephrology including acute kidney injury, electrolytes and acid–base, chronic kidney disease, glomerular disease, dialysis, and transplantation that will provide additional knowledge and skills in the field of nephrology and transplantation toward improving patient outcomes

Promoting shared decision-making in the surgical realm:From the surgeons’ preferred treatment for patients to the patients’ preferred treatment for surgery

To improve the quality of healthcare. Equality between doctor and patients is becoming increasingly important. In our modern society, the ethical principle that patients have the right to be better involved in the decision-making process regarding their health issues gets more recognition, while at the same time an increasing number of treatment options has become available. The aim of this thesis was to explore the current level of shared decision-making (SDM) and risk communication in the out-patient clinic, and to improve this level by developing and implementing SDM and risk communication tools. An essential step in the process of SDM, is the communication about the possible treatment options with their pros and cons. Because visual presentation of information may increase patient comprehension, a web-based, publicly available (www.mapping.nu) application that provides graphical representation of numerical benefits and risk of surgical treatment options was developed. Besides the MAPPING app we developed various decision support tools (DSTs). DSTs were developed for four vascular disorders, i.e., patients with an abdominal aortic aneurysm (AAA), carotid artery disease (CAD), intermittent claudication (IC) and varicose veins (VV). The various support tools included patient decision aids, consultation cards, and decision cards. Besides the usual content of DAs, the DAs we developed contain 3D-animations of each of the treatment options to better explain and illustrate what these treatments involve. The patients go through the decision aid prior to the decision-making consultation in order to enter this conversation as well prepared as possible.The OVIDIUS trial showed that the introduction of decision support tools improves the degree of shared decision-making, the knowledge about treatment options and that patients opt less often for invasive treatments. In addition, it was seen that the online decision aid was most effective for patients and that the shared decision-making training was the most effective for clinicians