Citations

Purpose of review Medication administration errors represent a significant yet preventable cause of patient harm in the peripartum period. Implementation of best practices contained in this manuscript can significantly reduce medication errors and associated patient harm. Recent findings Cases of medication errors involving unintended intrathecal administration of tranexamic acid highlight the need to improve medication safety in peripartum patients and obstetric anesthesia. Summary In obstetric anesthesia, medication errors can include wrong medication, dose, route, time, patient, or infusion setting. These errors are often underreported, have the potential to be catastrophic, and most can be prevented. Implementation of various types of best practice cost effective mitigation strategies include recommendations to improve drug labeling, optimize storage, determine correct medication prior to administration, use non-Luer epidural and intravenous connection ports, follow patient monitoring guidelines, use smart pumps and protocols for all infusions, disseminate medication safety educational material, and optimize staffing models. Vigilance in patient care and implementation of improved patient safety measures are urgently needed to decrease harm to mothers and newborns worldwide.

In the Spring of 2020, the United States of America (USA) deployed COVID-19 convalescent plasma (CCP) to treat hospitalized patients. Over 500,000 patients were treated with CCP during the first year of the pandemic. In this study, we estimated the number of actual inpatient lives saved by CCP treatment in the United States of America based on CCP weekly use, weekly national mortality data, and CCP mortality reduction data from meta-analyses of randomized controlled trials and real-world data. We also estimate the potential number of lives saved if CCP had been deployed for 100% of hospitalized patients or used in 15 to 75% of outpatients. Depending on the assumptions modeled in stratified analyses, we estimated that CCP saved between 16,476 and 66,296 lives. The CCP ideal use might have saved as many as 234,869 lives and prevented 1,136,133 hospitalizations. CCP deployment was a successful strategy for ameliorating the impact of the COVID-19 pandemic in the USA. This experience has important implications for convalescent plasma use in future infectious disease emergencies.

Abstract This phase 2 trial assessed high-dose IV ascorbic acid in TET2 mutant clonal cytopenia. Eight of 10 patients were eligible for response assessment, with no responses at week 20 by International Working Group Myelodysplasia Syndromes/Neoplasms criteria. This trial was registered at www.clinicaltrials.gov as #NCT03418038.

Abstract Objective This study aimed to conduct a scoping review of machine learning (ML) techniques in outpatient parenteral antimicrobial therapy (OPAT) for predicting adverse outcomes and to evaluate their validation, implementation and potential barriers to adoption. Materials and methods This scoping review included studies applying ML algorithms to adult OPAT patients, covering techniques from logistic regression to neural networks. Outcomes considered were medication intolerance, toxicity, catheter complications, hospital readmission and patient deterioration. A comprehensive search was conducted across databases including Cochrane Central, Cochrane Reviews, Embase, Ovid MEDLINE and Scopus, from 1 January 2000 to 1 January 2024. Results Thirty-two studies met the inclusion criteria, with the majority being single-centre experiences primarily from North America. Most studies focused on developing new ML models to predict outcomes such as hospital readmissions and medication-related complications. However, there was very little reporting on the performance characteristics of these models, such as specificity, sensitivity and C-statistics. There was a lack of multi-centre or cross-centre validation, limiting generalizability. Few studies advanced beyond traditional logistic regression models, and integration into clinical practice remains limited. Discussion ML shows promise for enhancing OPAT outcomes by predicting adverse events and enabling pre-emptive interventions. Despite this potential, significant gaps exist in development, validation and practical implementation. Barriers include the need for representative data sets and broadly applicable, validated models. Conclusion Future research should address these barriers to fully leverage ML’s potential in optimizing OPAT care and patient safety. Models must deliver timely, accurate and actionable insights to improve adverse event prediction and prevention in OPAT settings.

In the ever-evolving healthcare landscape, hospitals routinely grapple with daily disruptions and unforeseen events affecting resources and capacity. This paper explores the implementation and impact of the Rochester Hospital Operations Command Center (RHOCC) as a strategic response to challenges faced by the Mayo Clinic Hospital campuses in Rochester. The RHOCC, developed with an expedited timeline in response to capacity issues, exacerbated by COVID-19, serves as a centralised hub for real-time monitoring, coordination and decision-making related to patient flow. The process of establishing the command centre involved role identification, skill set determination, location of important personnel in an organised central space and vendor selection to develop the necessary infrastructure. Dashboards were developed to provide real-time actionable insights into external transfers, surgical and other planned admissions, emergency department status, patient throughput and discharges. These dashboards include colour-coded keys highlighting thresholds related to patient flow metrics and are used to facilitate daily huddles and enhance transparency and data-driven decision-making among hospital stakeholders. The outcomes of implementing the RHOCC include improved efficiency and collaboration, as well as a significantly enhanced ability to proactively respond to factors affecting census. The development of a command centre — driven by leadership endorsement and a commitment to continuous improvement — emerges as a transformative strategy in healthcare innovation. The RHOCC’s approach of building capability, fostering inclusion and articulating a vision of providing superior care while driving impactful improvements, positions it as a leading force in creating operational efficiencies to define healthcare delivery.

Vascular access is an indispensable component of haemodialysis therapy for end-stage kidney disease patients. The arteriovenous fistula (AVF) is most common, but importantly, two-year failure rates are greater than fifty percent. AVF failure can occur due to a lack of suitable vascular remodelling, and inappropriate inflammation preventing maturation, or alternatively neointimal hyperplasia and vascular stenosis preventing long-term use. A comprehensive mechanistic understanding of these processes is still lacking, but recent studies highlight an essential role for inflammation from uraemia and the AVF itself. Inflammation affects each cell in the cascade of AVF failure, the endothelium, the infiltrating immune cells, and the vascular smooth muscle cells. This review examines the role of inflammation in each cell step by step and the influence on AVF failure. Inflammation resulting in AVF failure occurs initially via changes in endothelial cell activation, permeability, and vasoprotective chemokine secretion. Resultingly, immune cells can extravasate into the subendothelial space to release inflammatory cytokines and cause other deleterious changes to the microenvironment. Finally, all these changes modify vascular smooth muscle cell function, resulting in excessive and unchecked hyperplasia and proliferation, eventually leading to stenosis and the failure of the AVF. Finally, the emerging therapeutic options based off these findings are discussed, including mesenchymal stem cells, small-molecule inhibitors, and far-infrared therapies. Recent years have clearly demonstrated a vital role for inflammation in deciding the fate of the AVF, and future works must be centred on this to develop therapies for a hitherto unacceptably underserved patient population.

Background: The highly arrhythmogenic nature of cardiac sarcoidosis (CS) leads to high morbidity and mortality, the rates of which may be higher in COVID-19 patients. This study aimed to evaluate the outcomes of CS patients admitted to hospitals with COVID-19. Methods: The study utilised the 2020–2021 National Inpatient Sample database, examining primary COVID-19 cases in adults aged older than or equal to 18 years. Those with CS were identified using ICD-10 code “D86.85” and compared with and without propensity matching (1:10) to those without CS for baseline characteristics and primary outcomes of acute kidney injury (AKI), use of mechanical ventilation, cardiac arrest and mortality. Results: In total, 2 543 912 COVID-19 cases were identified. Before propensity matching, CS patients were more likely to be younger (58.0 vs. 64.0 years, P<0.01), male (64.0% vs. 52.6%, P=0.011), of Black ethnicity (60.0% vs. 15.9%, P<0.01), exhibit higher Charlson Comorbidity Index (CCI) scores (3.00 vs. 1.00, P<0.01) and had a higher incidence of in-hospital cardiac arrest (aOR 2.649, 95% CI 1.366–5.134, P=0.004). After propensity matching (CS, N=95; non-CS, N=875), those with CS were at a statistically significant reduced risk of AKI (aOR 0.484, P=0.01); however, the outcomes of death, cardiac arrest, mechanical ventilation, length of stay (LOS) and healthcare costs did not reach significance. Conclusion: In a propensity-matched cohort admitted with COVID-19, CS patients had a reduced risk of AKI, but comparable LOS, rates of cardiac arrest, mechanical ventilator use, and mortality. Future research is warranted to develop evidence-based guidelines for managing COVID-19 in patients with CS.

Abstract Objective Menopause symptoms affect quality of life and financial well-being but are often unaddressed in primary care clinics. Therefore, we evaluated the extent of menopause symptom documentation in electronic health records (EHRs) by primary health care professionals. Methods We retrospectively reviewed adult women who reported moderate or higher vasomotor symptoms on a Mayo Clinic survey conducted from March 1, 2021, through June 30, 2021. We then assessed adequacy of menopause symptom documentation in the EHRs of these women who had primary care visits during the survey period. We reviewed the percentage of documented vasomotor symptoms from May 1, 2019, through May 1, 2021. Results In the Mayo Clinic Health System—Northwest Wisconsin Region, 229 women self-reported moderate or higher vasomotor symptoms in the Mayo Clinic survey. Although only 23% of these women had vasomotor symptoms listed in the EHR clinical problem lists, 60% of these women had vasomotor symptoms documented in their clinic notes from the primary care visit. Approximately 6% of women reported hormone therapy use for management of menopause symptoms, and nearly 15% reported use of nonhormone prescription therapies for vasomotor symptoms. Conclusions A greater proportion of women in our study had EHR documentation of bothersome menopause symptoms than those reported in other studies, but vasomotor symptoms remain generally untreated. We need better methods for identifying midlife women with bothersome menopause symptoms in primary care clinics so that appropriate treatment options, including hormone therapy, can be discussed and offered.