Abbreviated Perioperative Fasting Management for Elective Fresh Fracture Surgery: Guideline Adherence Analysis

BackgroundLong-term fasting for elective surgery has been proven unnecessary based on established guidelines. Instead, preoperative carbohydrate loading 2 hours before surgery and recommencing oral nutrition intake as soon as possible after surgery is recommended. This study was performed to analyze the compliance with and effect of abbreviated perioperative fasting management in patients undergoing surgical repair of fresh fractures based on current guidelines.MethodsPatients with fresh fractures were consecutively enrolled from May 2019 to July 2019 at our hospital. A carbohydrate-enriched beverage was recommended up to 2 hours before surgery for all surgical patients except those with contraindications. Postoperatively, oral clear liquids were allowed once the patients had regained full consciousness, and solid food was allowed 1 to 2 hours later according to the patients’ willingness. The perioperative fasting time was recorded and the patients’ subjective comfort with respect to thirst and hunger was assessed using an interview-assisted questionnaire.ResultsIn total, 306 patients were enrolled in this study. The compliance rate of preoperative carbohydrate loading was 71.6%, and 93.5% of patients began ingestion of oral liquids within 2 hours after surgery. The median (interquartile range) preoperative fasting time for liquids and solids was 8 (5.2–12.9) and 19 (15.7–22) hours, respectively. The median postoperative fasting time for liquids and solids was 1 (0.5–1.9) and 2.8 (2.2–3.5) hours, respectively. A total of 70.3% and 74.2% of patients reported no thirst or hunger during the perioperative period. Logistic regression analysis showed that the preoperative fasting time for liquids was an independent risk factor for perioperative hunger. No adverse events such as aspiration pneumonia or gastroesophageal reflux were observed.ConclusionsIn this study of a real clinical practice setting, abbreviated perioperative fasting management was carried out with high compliance in patients with fresh fractures. The preoperative fasting time should be further shortened to further improve patients’ subjective comfort.

The Application of Islamic Spiritual Methods in Nursing Program Curriculum at UIN Syarif Hidayatullah Jakarta and UIN Alauddin Makasar

<p class="abstrak">This research focuses on describing the implementation of Islamic spiritual care of the clinical nursing students at the State Islamic University (UIN). The implementation of Islamic spiritual care has not been done well by nurses. Clinical nursing students are the forerunners of nurses, but no one has examined the description of the application of Islamic spiritual care carried out by clinical nursing students in State Islamic University (UIN). This research method was descriptive quantitative. Samples were students of the clinical nursing students of UIN Jakarta and UIN Alauddin Makassar, 40 respondents. The results showed that most respondents applied Islamic spiritual care well (52.5%). The most well-implemented component is instilling optimism for healing that comes from God (60%). Students need to improve their self-competence in Islamic religious knowledge to become more competent in providing Islamic care to patients. The head of the clinical nursing program needs to emphasize efforts to increase Islamic spiritual competence in the clinical practice setting of learning guidelines through the guidance process and learning achievement targets.</p><p><em>Penelitian ini berfokus untuk mengetahui penerapan perawatan spiritual Islam mahasiswa Ners di Universitas Islam Negeri (UIN). Penerapan asuhan keperawatan secara holistik khususnya dalam aspek spiritual karena masih sangat minim </em><em>dilakukan oleh perawat di tatanan pelayanan keperawatan.</em><em> Mahasiswa merupakan cikal bakal perawat dan peneliti belum menemukan penelitian tentang penerapan perawatan Islam oleh mahasiswa Ners di lingkungan UIN.</em><em> </em><em>Metode yang digunakan yaitu deskriptif kuantitatif. Sampel yang digunakan yaitu mahasiswa Ners UIN Jakarta dan UIN Makassar masing-masing 40 responden. Hasil menunjukkan sebagian responden menerapkan perawatan spiritual Islam dengan baik (52,5%). Komponen yang paling banyak diterapkan dengan baik yaitu menanamkan optimisme kesembuhan yang datang dari Allah (60%). Mahasiswa perlu meningkatkan kompetensi diri dalam ilmu agama islam sehingga menjadi lebih kompeten dalam mebrikan perawatah islam kepada paeien, program studi Ners perlu lebih menekankan pada upaya peningkatan kompetensi spiritual islam pada tatanan praktik klini pedoman pembelajaran, melalui proses bimbingan maupu target capaian pembelajaran.</em></p>

Promoting Communication and Socialisation in Music Therapy for Children with Cerebral Palsy

<p>This research was conducted as an exploratory case study as identified by Yin (2009) using primarily qualitative data gathered from a clinical practice setting with young children. The primary aim was to find out how music therapy could promote communication and socialisation for children with cerebral palsy at an Early Intervention Conductive Education Centre. This case study research involved two indepth cases of children diagnosed with Cerebral Palsy at different levels of severity at aged four to five years old. It documents individual music therapy sessions over a three month period. Assessments of the two children’s communication and socialisation skills were made using the Assessment, Evaluation, and Programming System for Infants and Children (AEPS) to provide a comparison before and after the intervention. Staff perceptions about the nature of the children’s communication and socialisation in music therapy were sought using a short and informal interview with two staff members at the Centre. These three data sources were triangulated in the analysis and the findings are discussed individually. Each child showed diverse observable improvement in communication and socialisation based on perspectives of staff members interviewed, on clinical notes and on the AEPS evaluations. It is hoped that this mixed methods study could lead towards a more specific quantitative inquiry in the future about the effectiveness of music therapy for children with cerebral palsy.</p>

Promoting Communication and Socialisation in Music Therapy for Children with Cerebral Palsy

<p>This research was conducted as an exploratory case study as identified by Yin (2009) using primarily qualitative data gathered from a clinical practice setting with young children. The primary aim was to find out how music therapy could promote communication and socialisation for children with cerebral palsy at an Early Intervention Conductive Education Centre. This case study research involved two indepth cases of children diagnosed with Cerebral Palsy at different levels of severity at aged four to five years old. It documents individual music therapy sessions over a three month period. Assessments of the two children’s communication and socialisation skills were made using the Assessment, Evaluation, and Programming System for Infants and Children (AEPS) to provide a comparison before and after the intervention. Staff perceptions about the nature of the children’s communication and socialisation in music therapy were sought using a short and informal interview with two staff members at the Centre. These three data sources were triangulated in the analysis and the findings are discussed individually. Each child showed diverse observable improvement in communication and socialisation based on perspectives of staff members interviewed, on clinical notes and on the AEPS evaluations. It is hoped that this mixed methods study could lead towards a more specific quantitative inquiry in the future about the effectiveness of music therapy for children with cerebral palsy.</p>

Venetoclax, Actinomycin D and Low Dose Cytarabine for Relapsed or Refractory Acute Myeloid Leukemia in Clinical Practice Setting

Background Venetoclax based therapies have produced varying results in the relapsed or refractory acute myeloid leukemia (R/R AML) setting. Highest response rates were demonstrated after Venetoclax in combination with high dose chemotherapy. However, this approach is feasible mainly in fit, younger patients. Herein, we present a lower intensity combination therapy consisting of Venetoclax, low dose Cytarabine and Actinomycin D (ACTIVE) in patients with R/R AML administered in real-life clinical practice setting. Methods We performed an observational, retrospective, single centre study. The patients were at least 18 years of age and had R/R AML. All patients provided informed consent for treatment as well as data collection. Venetoclax ramp-up was administered over either 3 or 5 days until the daily dose of 600mg/d was reached. The ACTIVE regimen consisted of Venetoclax 600mg/d p/o on days 1-28, Cytarabine 20mg/m 2 s/c on days 1-10, Actinomycin D 12.5 µg/kg i/v on days 1, 2 and 3 (on days 1 and 2 for patients ≥65 years). Strong/moderate CYP3A inhibitors/inducers or Venetoclax dose reductions were not allowed. Indications for stopping Venetoclax before Day 28 were life threatening infectious complications or faster hematological recovery with the addition of G-CSF in responders. A second ACTIVE cycle was administered in non-responders without evidence of progressive disease after Cycle 1 or in responders with positive minimal residual disease (MRD). We evaluated baseline characteristics, composite CR (CRc = CR + CRi + CRp), overall response (ORR = CRc + MLFS), MRD negativity rates, overall survival (OS), relapse-free survival (RFS), event-free survival (EFS), Grade 3-5 non-hematological toxicities and Day 30 and Day 60 mortality rates. Results Fifty R/R AML patients were treated with ACTIVE and 56% (28/50) were male. The median age was 65 years (20-84). The median Eastern Cooperative Oncology Group (ECOG) status was 1 (0-3) and 40% (20/50) had ECOG status of 2 or 3. Secondary AML was confirmed in 48% (24/50) of cases. Adverse cytogenetics were identified in 28% (14/50) of patients whereas 60% (30/50) were stratified to adverse risk group in accordance with ELN 2017 guidelines. The most common gene mutations were IDH1/2 30% (15/50), FLT3 28% (14/50), ASXL1 22% (11/50), NPM1 14% (7/50), N/KRAS 12% (6/50) and RUNX1 12% (6/50). The median number of prior therapies was 2 (1-5). Intensive chemotherapy was administered in 80% (40/50) of whom 38% (15/40) had primary refractory disease and 48% (19/40) had previously received Fludarabine + Cytarabine + Idarubicin (FLAG-Ida) or Cytarabine + Mitoxantrone (HAM). Eight percent (4/50) had had prior Venetoclax exposure. Thirty-six percent (18/50) had relapsed after allogeneic stem cell transplantation (alloSCT) with a median time of 7.4 months (1.6-37.3) from transplant to relapse. One cycle of ACTIVE therapy was administered in 76% (38/50) of cases, whereas 24% (12/50) received 2 cycles. The median number of Venetoclax 600mg/d days per cycle was 18 (8-28). Additional FLT3/RAS/BCR-ABL1 inhibitors Gilteritinib, Trametinib or Dasatinib were administered in 12% (6/50). Forty-nine patients were evaluable for response and one patient died of sepsis before response evaluation (Table 1). The ORR was 73% (36/49) and the CRc rate was 67% (31/46). MRD negativity was confirmed in 61% (19/31) of CRc patients. Sixteen patients had undergone additional early bone marrow evaluations. Blast count reduction to &lt;5% was observed in 50% (8/16) after Venetoclax ramp-up and in 88% (14/16) on Day 4. Half of the ACTIVE responders (18/36) continued maintenance therapy with Venetoclax + low dose Cytarabine and optional DLI, whereas 36% (13/36) proceeded to either first or second alloSCT. After 16.4 months of median follow-up, the median OS, RFS and EFS were 13.1, 7.2 and 4.5 months, respectively (Figure 1A). Median OS was not reached in MRD negative patients (Figure 1B). In multivariable Cox regression analysis, adverse cytogenetics (HR 3.48, 95% CI 1.39 -8.55) and primary refractory disease (HR 2.54, 95% CI 1.05-6.12) were associated with worse OS. The most common grade 3-5 non-hematological adverse events were febrile neutropenia (54%, 27/50) and bacteremia/sepsis (34%, 17/50). Day 30 and Day 60 mortality rates were 8% (4/50) and 16% (8/50), respectively. Conclusions ACTIVE was effective and well tolerated in this unselected prognostically unfavourable older R/R AML patient population. Figure 1 Figure 1. Disclosures Zucenka: Jannsen: Honoraria, Other: Travel-expenses; Takeda: Other: Travel Expenses; Novartis: Honoraria, Other: Travel Expenses; Pfizer: Honoraria, Other: Travel Expenses; Astellas: Honoraria; Abbvie: Honoraria, Other: Travel Expenses. Maneikis: Abbvie: Honoraria. Pileckytė: Abbvie: Honoraria, Other: Travel Expenses. Griškevičius: Abbvie: Other: Travel Expenses. OffLabel Disclosure: Venetoclax has been used off-label for the treatment of R/R AML

Health Maintenance Consensus for Adults With Inflammatory Bowel Disease

Background With the management of inflammatory bowel disease (IBD) becoming increasingly complex, incorporating preventive care health maintenance measures can be challenging. The aim of developing these updated recommendations is to provide more specific details to facilitate their use into a busy clinical practice setting. Method Fifteen statements were formulated with recommendations regarding the target, timing, and frequency of the health maintenance interventions in patients with IBD. We used a modified Delphi method and a literature review to establish a consensus among the panel of experts. The appropriateness of each health maintenance statement was rated on a scale of 1 to 5 (1–2 as inappropriate, and 4–5 as appropriate) by each panelist. Interventions were considered appropriate, and statements were accepted if ≥80% of the panelists agreed with a score ≥4. Results The panel approved 15 health maintenance recommendations for adults with IBD based on the current literature and expert opinion. These recommendations include explicit details regarding specific screening tools, timing of screening, and vaccinations for adults with IBD. Conclusions Patients with IBD are at an increased risk for infections, malignancies, and other comorbidities. Given the complexity of caring for patients with IBD, this focused list of recommendations can be easily incorporated in to clinical care to help eliminate the gap in preventative care for patients with IBD.

Brain Atrophy and Physical and Cognitive Disability in Multiple Sclerosis

Introduction: brain atrophy is associated with physical disability in multiple sclerosis (MS), but there is a great variability between different studies and methodologies, and its use is still limited to research projects. Objective: to analyze the relationship between several volumetric measurements and physical disability and cognitive functioning in MS patients in a clinical practice setting. Material and methods: cross-sectional study. 41 patinets (31 relapsing-remitting MS, 6 secondary-progressive MS and 4 primary-progressive MS). Whole brain volume (WBV), Gray Matter Volume (GMV) and T2 lesion load (T2L) were obtained using Icometrix ® software. Physical disability was measured with the Expanded Disability Status Scale (EDSS), and cognitive status was evaluated with the Brief Repeatble Battery of neuropsychological tests (BRB-N). The relationship between brain volumes and EDSS was analyzed through lineal multivariate regression. The association between volumetry measurements and the number of affected cognitive domains was studied with negative binomial regression. Results: GMV was associated with age (b=-1.7; p=0,014) and with EDSS (b= -7.55; p=0.013). T2L was associated with EDSS (b= 2.29; p=0.032). The number of affected cognitive domains was associated with clinical phenotype, worse in primary progressive MS (PPMS). There was not correlations between cognitive impairment and cerebral volumes. Conclusions: Brain atrophy measurement is feasible in clinical practice setting, and it is helpful in monitoring the EDSS progression. Primary progressive phenotype is associated with greater risk of cognitive dysfunction.