Do Digital Handover Checklists Influence the Clinical Outcome Parameters of Intensive Care Unit Patients? A Randomized Controlled Pilot Study

Background: Clinical handovers have been identified as high-risk situations for medical treatment errors. It has been shown that handover checklists lead to a reduced rate of medical errors and mortality. However, the influence of handover checklists on essential patient outcomes such as prevalence of sepsis, mortality, and length of hospitalization has not yet been investigated in a randomized controlled trial (RCT).Objectives: The aim of the present pilot study was to estimate the effect of two different handover checklists on the 48 h sepsis-related organ failure assessment (SOFA) score and the feasibility of a respective clinical RCT.Methods: Outcome parameters and feasibility were investigated implementing and comparing an intervention with a control checklist.Design: Single center two-armed cluster randomized prospective crossover pilot study.Setting: The study took place over three 1-month periods in an intensive care unit (ICU) setting at the University Hospital Aachen.Patients/Participants: Data from 1,882 patients on seven ICU wards were assessed, of which 1,038 were included in the analysis.Intervention: A digital standardized handover checklist (ISBAR3) was compared to a control checklist (VICUR).Main Outcome Measures: Primary outcome was the 2nd 24 h time window sepsis-related organ failure assessment (SOFA) score. Secondary outcomes were SOFA scores on the 3rd and 5th 24 h time window, mortality, reuptake, and length of stay; handover duration, degree of satisfaction, and compliance as feasibility-related outcomes.Results: Different sepsis scores were observed only for the 1st 24 h time window after admission to the ICU, with higher values for ISBAR3. With respect to the patient-centered outcomes, both checklists achieved similar results. Average handover duration was shorter for VICUR, whereas satisfaction and compliance were higher for ISBAR3. However, overall compliance was low (25.4% for ISBAR3 and 15.8% for VICUR).Conclusions: Based on the results, a stratified randomization procedure is recommended for following RCTs, in which medical treatment errors should also be investigated as an additional variable. The use of control checklists is discouraged due to lower acceptance and compliance among healthcare practitioners. Measures should be undertaken to increase compliance with the use of checklists. Clinical outcome parameters should be carefully selected.Trial Registration:ClinicalTrials.gov, Identifier [NCT03117088]. Registered April 14, 2017.

The Swinging Flashlight Test – Flawed Execution and Interpretation in Ophthalmological Routine

Background The swinging flashlight test is a standard diagnostic procedure to detect relative afferent pupillary defects. The advantages of the test lie within its objectivity and minimal effort. However, its value depends on its correct execution and interpretation. This questionnaire-based survey investigates whether this is given among German speaking ophthalmologists. Methods A multiple-choice questionnaire with 14 questions on the use of the swinging flashlight test was designed. It was presented to German speaking ophthalmology specialists (primary data) and orthoptists (secondary data) on specialist conferences or by telephone interviews. Results 249 ophthalmologists and 76 orthoptists participated in the survey. Only 2% of ophthalmologists answered all 14 questions correctly. On average 66% (range 29 – 100%) of the questions were answered correctly by the ophthalmologists. The question with the lowest result had a rate of 19%, the question with the highest result was correctly answered by 95%. The orthoptists achieved similar results. Conclusion The rate of correct answers appears disturbingly low. The swinging flashlight test being a basic tool and an obligatory test in a number of guidelines should rather be performed nearly error-free. In light of the high error rates, misdiagnoses and treatment errors must be feared. Better training seems necessary.

TREATMENT OF BRAFV600E POSITIVE ANAPLASTIC THYROID CARCINOMA: CASE REPORT

Anaplastic thyroid cancer is one of the most aggressive and fatal human carcinomas. A significant experience in using various kinase inhibitors for anaplastic thyroid cancer therapy has been accumulated worldwide. The most encouraging results were obtained after using a combination of b-Raf and MEK kinase inhibitors (vemurafenib/dabrafenib and trametinib/cobimetinib, respectively) for the treatment of the unresectable BRAFV600E-positive anaplastic thyroid cancer. This drug combination makes it possible to perform surgery followed by chemoradiotherapy and other targeted therapies. Here we report a clinical case of anaplastic thyroid cancer in a 69-year-old woman, who was treated with neoadjuvant targeted therapy. The treatment was carried out on the basis of three medical institutions: the National Medical Research Radiological Centre (Moscow), the N.I. Pirogov Clinic of Advanced Medical Technologies (St. Petersburg) and the Endocrinology Research Center (Moscow). Since there is still no universal protocol for treating ATC patients, and only palliative therapy is used in most cases, we emphasized on diagnostic and treatment errors of this disease. Special attention was paid to the importance of using molecular diagnostics and modern medical imaging technologies.

role of telehealth services in the treatment of rare disease: analysis of 1 year of work on the example of anal cancer

Objective: to assess the potential need for telehealth consultations in regions for the treatment of patients diagnosed with anal cancer and to analyze the most common treatment errors. Materials and methods. We analyzed telehealth consultations provided for 3 Federal districts between April 2019 and April 2020. The following parameters were evaluated: the ratio between the predicted need for telehealth consultations and the real number of requests, the number of medical errors in patients who had already undergone first and / or subsequent treatment stages (according to relevant clinical guidelines). Results. Fifteen telehealth consultations were provided during this year: 13 of them (86.7 %) for disease progression or complications and 2 of them (13.3 %) to determine the initial treatment strategy. Treatment errors were registered in 11 out of 13 cases (84.6 %). The predicted need based on the population size was 565 consultations per year; the predicted need based on the real number of patients visited cancer clinics was 81 consultations. Conclusions. We found many significant errors in treatment regimens of patients with squamous cell anal carcinoma. Wider use of telehealth consultations with Federal centers will ensure the correct choice of the initial treatment strategy.

Detection of Additives with the Help of Discrete Geometrical Invariants

In this paper, we propose a general mathematical method for the detection of electrochemical additives in a given solute with the help of discrete geometrical invariants (DGI). This idea is based on the generalization of Pythagor’s theorem that can be proved for two random sets located in the two-dimensional (2D) plane. This statement follows from the previous ideas proposed by Babenko, who essentially modernized the well-known theorem and propagated it on a wide class of “right” discrete sets with different symmetry. However, attentive analysis of these results shows that there is a possibility for their further generalization. For practical purposes, it is important to have discrete and deterministic curve(s) with the limited number of parameters that enables comparing two random sets of any nature if their quantitative description expressed in terms of the “best-fit” model is absent. Under the best-fit model, we imply the microscopic model that enables describing the measured data in terms of the minimal set of the fitting parameters. We propose at least two invariants: (a) the curve of the second order that coincides with the classical ellipse oriented at an arbitrary direction relative to the X- and Y-axes, and (b) the curve of the fourth order that has eight quantitative parameters and includes the cross-combination of the integer moments. In this paper, the DGIs of both types were used. These curves are made useful for the solution of a key problem in electrochemistry, i.e., the detection of small concentrations of d-tryptophan (6.54 ÷ 38.7) 10−5 mol·L−1 in a given solute (phosphate buffer solution (Na2HPO4 + KH2PO4) with pH = 6.86) that was activated by electrodes of two types—Pt (platinum) and C (carbon). The DGI method is free from treatment errors and model suppositions; therefore, it can be applied for the detection of small additives in a given solute and a further description can be attained with the help of a monotone/calibration curve expressed by means of parameters associated with the DGI.