Notes

Monitoring the security involving COVID-19 vaccines while pregnant in america.
ciated.
Ruptured anterior communicating artery (ACoA) aneurysms can be challenging to treat via an endovascular procedure. This study analyzed retreatment rates and neurological outcomes associated with ruptured ACoA aneurysms treated via endovascular coiling.

All patients with a ruptured ACoA aneurysm treated with endovascular coiling from 2003 to 2019 were retrospectively analyzed at a single center. Two comparisons were performed no retreatment versus retreatment and coil embolization versus balloon-assisted coil embolization. Outcomes included retreatment and neurological outcome assessed via modified Rankin Scale (mRS).

During the study period, 186 patients with ruptured ACoA aneurysms underwent coil embolization. Treatment included standard coil embolization (68.3%, n=127), balloon-assisted coiling (28.5%, n=53), and stent-assisted embolization (2.7%, n=5). Angiographic outcomes were as follows class I, 65.1% (n=121); class II, 28.5% (n=53); and class III, 6.5% (n=12). There were no aneurysm reruptures afred retreatment.
The underlying etiology of intracranial non-occlusive intraluminal thrombus (iNOT) remains unknown. This study aimed to investigate whether the presence of iNOT can indicate the underlying etiology of large vessel occlusion (LVO) in patients undergoing endovascular therapy (EVT).

Among patients who underwent EVT at three comprehensive stroke centers, we included those with intracranial LVO in the anterior circulation. The presence of iNOT was determined by pretreatment DSA. We investigated the association between iNOT and intracranial atherosclerotic stenosis (ICAS) related LVO.

Of 546 patients, 44 (8.1%) had iNOT. Patients with iNOT were younger, had less hypertension, atrial fibrillation, and a history of antiplatelet use. In addition, the involvement of the M1 segment of the middle cerebral artery (MCA) was more frequent. However, they had a lower National Institutes of Health Stroke Scale (NIHSS) score on admission and longer onset to recanalization time compared with patients with no iNOT. In a logistic regression model adjusting for age, sex, atrial fibrillation, smoking, prior antiplatelet and anticoagulant use, intravenous tissue plasminogen activator, NIHSS on admission, number of technical trials, intraprocedural re-occlusion, and the location of LVO (p<0.10 in the univariate analysis), the presence of iNOT was significantly associated with ICAS related LVO (adjusted OR 3.04; 95% CI 1.33 to 6.90; p=0.007).

The presence of iNOT may reflect an underlying ICAS related LVO in patients undergoing EVT.
The presence of iNOT may reflect an underlying ICAS related LVO in patients undergoing EVT.
Unruptured intracranial aneurysms (UIAs) are considered to be a relative contraindication for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). However, there is currently limited data on the risk of UIA rupture following IVT. Our objective was to assess whether IVT for AIS can lead to a UIA rupture and intracranial hemorrhages (ICHs) in patients with unruptured UIAs.

Prospective cohort study of consecutive patients treated in a comprehensive stroke center between 2005 and 2019. We assessed radiology reports and records at the Finnish Care Register for Health Care to identify patients with UIAs among all AIS patients treated with IVT at the center. We analyzed patient angiograms for aneurysm characteristics and other brain imaging studies for ICHs after IVT. The main outcome was in-hospital ICHs attributable to an UIA rupture after IVT. Secondary outcomes were in-hospital symptomatic ICHs (ECASS-2 criteria, i.e., NIH Stroke Scale score increase of ≥4 points) and any in-hospital ICHs.

A totaAIS patients with saccular UIAs, including larges UIAs (≥10 mm). Anticoagulation after AIS in patients with large fusiform posterior circulation UIAs may increase the risk of aneurysm rupture.
Estimate the prevalence/incidence/number of major lower extremity amputations (MLEAs) in the UK; identify sources of routinely collected electronic health data used; assess time trends and regional variation; and identify reasons for variation in reported incidence/prevalence of MLEA.

Systematic review and narrative synthesis.

Medline, Embase, EMcare, CINAHL, The Cochrane Library, AMED, Scopus and grey literature sources searched from 1 January 2009 to 1 August 2021.

Reports that provided population-based statistics, used routinely collected electronic health data, gave a measure of MLEA in adults in the general population or those with diabetes in the UK or constituent countries were included.

Data extraction and quality assessment using the Joanna Briggs Institute Critical Appraisal Instruments were performed by two reviewers independently. Due to considerable differences in study populations and methodology, data pooling was not possible; data were tabulated and narratively synthesised, and studyential to use primary care data in MLEA epidemiology.

PROSPERO CRD42020165592.
PROSPERO CRD42020165592.
Rapid sequence induction of anaesthesia is indicated in patients with an increased risk of pulmonary aspiration. The main objective of the technique is to reduce the critical time period between loss of airway protective reflexes and rapid inflation of the cuff of the endotracheal tube to minimise the chance of aspiration of gastric contents. The COVID-19 pandemic has reinforced the importance of first-pass intubation success to ensure patient and healthcare worker safety. The aim of this study is to compare the first-pass intubation success rate (FPS) using the videolaryngoscopy compared with conventional direct laryngoscopy in surgical patients with a high risk of pulmonary aspiration.

The LARA trial is a multicentre, patient-blinded, randomised controlled trial. Consecutive patients requiring tracheal intubation are randomly allocated to either the McGrath MAC videolaryngoscope or direct laryngoscopy using the Macintosh laryngoscope. The expected rate of FPS is 92% in the McGrath group and 82% in the Macintosh group. Each group must include a total of 500 patients to achieve 90% power for detecting a difference at the 5% significance level. Successful intubation with the FPS is the primary endpoint. The secondary endpoints are the time to intubation, the number of intubation attempts, the necessity of airway management alternatives, the visualisation of the glottis using the Cormack and Lehane Score and the Percentage Of Glottic Opening Score and definite adverse events.

The project is approved by the local ethics committee of the Medical Association of the Rhineland Palatine state (registration number 2020-15502) and medical ethics committee of the University of Freiburg (registration number 21-1303). The results of this study will be made available in form of manuscripts for publication and presentations at national and international meetings.

NCT04794764.
NCT04794764.
There is a high burden of adverse events and poor outcomes in fragile, conflict-affected and vulnerable (FCV) settings. To improve outcomes, there is a need to better identify which interventions can improve patient safety in these settings, as well as to develop strategies to optimise their implementation.

This study intends to generate a consensus on the most relevant patient safety interventions from experts with experience on FCV settings, including frontline clinicians and managers/administrators, non-governmental organisations, policymakers and researchers.

The study uses an online Delphi research approach (eDelphi). Participants will include experts from a range of backgrounds, including those working in a variety of FCV settings. Participants will be established contacts known to the research team or recruited via snowball sampling, and will be asked to identify and rank the importance of a variety of patient safety interventions. Consensus will be defined as >70% of participants agreeing/strongly agreeing or disagreeing/strongly disagreeing with a statement. Data analysis will be completed in Microsoft Excel and NVivo. The primary outcome of the study will be a list of the most relevant and applicable patient safety interventions for FCV settings.

The study has received approval from Imperial College London Ethics Committee (reference number 20IC665). Anonymous results will be made available to the public, academic organisations and policymakers.
The study has received approval from Imperial College London Ethics Committee (reference number 20IC665). LSelenoMethionine Anonymous results will be made available to the public, academic organisations and policymakers.
Patients with multiple myeloma (MM) experience significant delays in diagnosis due to non-specific symptomatology. link2 The aim of this study was to characterise the frequency and timing of clinical features in the primary care setting prior to MM diagnosis.

Population-based cohort study.

Electronic health records data of approximately 17 million patients (2006-2016) within the UK Clinical Practice Research Datalink.

Patients aged ≥18 years with newly diagnosed MM (NDMM), no history of solid tumours and ≥2 years registration in a primary care practice prior to MM diagnosis.

Clinical features and symptoms including bone pain, skeletal-related events (SREs), investigation and confirmation of MM diagnostic CRAB criteria (hyperCalcaemia, Renal impairment, Anaemia, Bone lesions) during the 2 years prior to MM diagnosis; time between symptom manifestation and/or relevant investigation and diagnosis of MM.

Among 2646 patients with NDMM, 47.5% had a bone pain record during the 2-year period prior to MM diagnos7 months prior to MM diagnosis. link3 Investigations to evaluate all CRAB criteria, including targeted imaging, were underused. Early recognition of myeloma clinical features and optimised use of investigations in primary care may potentially expedite MM diagnosis.
To capture the extent and nature of intellectual disability nursing publications in Ireland.

Scoping review using Arksey and O'Malley approach.

Six databases (PsycINFO, CINAHL, Medline, Academic Search Complete, Scopus, Embase) were searched along with a web-based search of the eight academic institutions delivering intellectual disability nurse education in Ireland for publications indexed from the earliest available date to the 31 December 2020.

Publications by an academic, practitioner or student working in intellectual disability practice or education in Ireland relating to intellectual disability nursing, care or education.

Data pertaining to type of paper/design, authors (academic/professional/student), year, collaboration (national/international), topic/content area and title were extracted from each paper. Data were analysed by two authors using Colorafi and Evans content analysis steps where data was tabulated, and a narrative synthesis undertaken.

The reporting of the review is in line wanagement.
This review highlights the extent and nature of intellectual disability publications by academic, practitioner or student working in intellectual disability nursing in Ireland together with opportunities for future growth and development. From the findings it is apparent that there is an ongoing need for intellectual disability nurses to define their role across the full trajectory of health provision and to make visible their role in person-family centred support, inclusion, and contributions in health education, health promotion and health management.
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