St. Helena Hospital

Introdução: A cirurgia robótica constitui uma das principais inovações tecnológicas na área cirúrgica contemporânea, integrando sistemas computadorizados de alta precisão que ampliam a destreza do cirurgião, proporcionam visão tridimensional ampliada e favorecem movimentos mais seguros, com menor trauma tecidual e recuperação mais rápida do paciente. Sua incorporação em diferentes especialidades tem exigido reorganização dos processos de trabalho, capacitação específica e adaptação das equipes de enfermagem às novas demandas tecnológicas no contexto perioperatório. Objetivo: Compreender as percepções da equipe de enfermagem sobre a implementação da cirurgia robótica em um hospital privado de Joinville (SC). Método: Estudo qualitativo, realizado por meio de entrevistas com profissionais de enfermagem atuantes na cirurgia robótica em centro cirúrgico. Resultados: A introdução da tecnologia foi inicialmente associada a sentimentos de incerteza e receio, especialmente relacionados ao manuseio dos equipamentos, devido à sua complexidade e alto valor tecnológico. Com a realização de treinamentos e a prática assistida, observou-se a substituição desses sentimentos por confiança, domínio técnico e familiaridade com o sistema. Os participantes destacaram benefícios como maior precisão cirúrgica, recuperação mais rápida dos pacientes, redução de erros e melhor organização do trabalho em equipe. A capacitação profissional foi identificada como fator essencial para o sucesso da implementação, evidenciando a importância da educação permanente e do suporte institucional. Conclusão: A cirurgia robótica representa um avanço significativo para a enfermagem perioperatória, promovendo qualificação técnica, valorização profissional e maior segurança do paciente, apesar dos desafios iniciais de adaptação.

Objetivos: avaliar a reprodutibilidade intra- e inter-observador de 3 classificações das fraturas do maléolo posterior (FMP) e analisar a relação da escolha do tratamento e a abordagem cirúrgica com as classificações. Métodos: Imagens de TC do tornozelo de 50 pacientes foram avaliados por 10 observadores, sendo 4 especialistas em pé e tornozelo e 6 ortopedistas, com um intervalo de duas semanas entre as avaliações. Os avaliadores classificaram as FMP de acordo com as classificações de Mason, Haraguchi e Bartoníček/Rammelt, e julgaram se as fraturas eram de tratamento conservador ou cirúrgico (neste caso, por qual a via de acesso tratariam). Para a concordância intra-observador foi utilizado o Alfa de Cronbach e para a avaliação inter-observador, o Teste de Kappa. A correlação da tomada de decisão e via de acesso foram analisadas utilizando o Teste do Qui-Quadrado (Q²). Resultados: A reprodutibilidade intra-observador em toda a amostra variou de 0.53 a 0.95 (0.78 +- 0.12) para a classificação de Haraguchi, de 0.47 a 0.95 (0.74 +- 0.17) para Mason, e de 0.53 a 0.94 (0.72 +- 0.12) para Bartoníček/Rammelt, representando uma concordância adequada para as três classificações. Para os especialistas, a média para as classificações de Haraguchi, Mason e Bartoníček/Rammelt foram 0.86, 0.84 e 0.75, representando uma classificação boa, boa e adequada, respectivamente. Para o grupo de não especialistas, essa média resultou em 0.72, 0.68 e 0.70, representando uma classificação adequada, média e adequada, respectivamente. A reprodutibilidade inter-observador foi considerada razoável para Haraguchi (0.38) e moderado para Mason (0.42) e Bartoníček/Rammelt (0.43). Ao analisarmos a tomada de decisão e a via de acesso, todas as classificações demonstraram tamanho de efeito grande (V>0.50). Conclusão: As classificações de Haraguchi, Mason e Bartoníček/Rammelt para as FMP tiveram uma reprodutibilidade intra-observador considerada adequada. A reprodutibilidade inter-observador foi considerada razoável ou moderada. Todas as três classificações demonstraram efeitos considerados grandes para decisão entre não-operar ou operar e a decisão sobre a via de acesso, sendo a classificação de Bartoníček/Rammelt a que apresentou os valores mais elevados. Palavras-chave: Classificação; Fraturas do Tornozelo; Reprodutibilidade do Resultado. Nível de evidência IV, Estudos terapêuticos, Série de casos.

Background/Objectives: Surgical ablation for atrial fibrillation (AF) during cardiac surgery decreases perioperative morbidity and mortality and improves long-term patient outcomes. Because of these benefits, it has been designated a Class I surgical society recommendation. As surgical ablation techniques have evolved, so too have ablation tools such as radiofrequency and cryothermal devices. In this study, we evaluated real-world evidence (RWE) of concomitant surgical ablation featuring an epicardial left atrial encircling lesion created by a novel bipolar radiofrequency clamp. Methods: Thirteen centers in the observational Tracking Results of Ablation to Combat AF (TRAC-AF) Registry (NCT05111015) contributed data used in this analysis. Included patients had AF and received the epicardial encircling lesion during cardiac surgery. Additional ablation and follow-up were per institutional standard of care. Freedom from AF/atrial tachycardia (AT)/atrial flutter (AFL) and survival were evaluated using the Kaplan-Meier method. Safety was evaluated within 30 days of the procedure. Results: Among 327 patients, 70% were male with a median age of 69 years. Sixty-nine percent had paroxysmal AF. Median left atrial diameter was 4.1 cm, and CHA2DS2-VASc score was 3. Isolated coronary artery bypass graft and aortic valve surgery were performed in 51% and 11% of patients, respectively. One- and two-year survival rates were 95.3% (95% CI, 91.7-97.3%) and 88.1% (95% CI, 81.5-92.5%). Through 12- and 24-months freedom from AF/AT/AFL was 87.4% (95% CI, 81.3-91.6%) and 79.9% (95% CI 72.0-85.8%). Mortality within 30 days of the index procedure was 1.5%. No serious adverse events were related to the epicardial cardiac ablation procedure or device. Conclusions: RWE from the TRAC-AF Registry demonstrates surgical ablation including an epicardial left atrial encircling lesion made by a novel bipolar RF clamp was safe and resulted in favorable long-term rhythm outcomes.

BackgroundIn the UK, an estimate of the prevalence of frailty in over 65yrs in the community is 10.7%. Undertaking a Clinical Frailty Score (CFS) may help predict their mortality. NHS frailty toolkit advocates that patients with moderate/severe frailty (CFS 6+) should have access to Advance Care Planning (ACP). ACP provides advantages to both the system and patients. Reducing acute hospital admissions and potentially reducing NHS costs, possibly saving between 16–49% (£399 - £1450) comparing hospital to community EoL care.MethodNorth East Essex Alliance commissioned an integrated frailty team and Hospice palliative care project. To engage patients in hospital with a CFS of 6+, complete a Comprehensive Geriatric Assessment (CGA) and offer a home visit to discuss ACP using our EPaCCS (Electronic Palliative Care Coordination System) My Care Choices Register (MCCR). Mainly focusing on an Core20+ postcode area.ResultsOver a year 121 people were identified with 64 participated in engagement. 61.6% of which had a CGA completed. Due to engagement 48 new ACP via MCCR were created and 50 new ReSPECT forms completed. Reviews undertaken at 3 and 6 months revealed that 29 patients had died, 15 within their Preferred Place of Death (PPD), 7 hadn’t recorded a PPD, 3 patients had a PPD recorded however their situation had changed and were in care home but their PPD wasn’t updated. The cost per patient was between £200.14 - £233.52, meaning a potential saving of £165.48 to £1216.48 per community death.ConclusionCase studies collected highlighted the need for more pro-active ACP discussions in many patients, being openly offered the opportunity to discuss ACP had been welcomed and successful in a good number of people. This could also lead to a reduction in acute admissions at the EoL and cost saving to the NHS.

Background: Quality-of-life (OQL) is recognized as a proven benefit of atrial fibrillation (AF) ablation. The DEEP trial (NCT02393885) showed safety (6.7%) and efficacy (71.8%) of an epicardial-endocardial hybrid ablation (HA) approach with left atrial appendage exclusion (LAAE) for non-paroxysmal AF; results were consistent with two randomized trials comparing HA+LAAE to catheter ablation (CA). Limited data exist on QOL after HA+LAAE. Goal: To evaluate QOL changes from baseline to 12-months post-HA+LAAE in the DEEP trial. Methods: DEEP is a 17-site prospective, international, single arm trial. Key eligibility: adults with non-paroxysmal AF, left atrial diameter ≤5.5cm, failed class I/III anti-arrhythmic drugs, and ≤2 prior failed CA. Stage 1 was thoracoscopic radiofrequency epicardial ablation to isolate the pulmonary veins and left atrial posterior wall, and LAAE. Stage 2 was endocardial mapping and touchup ablation. QOL was measured via the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire at baseline and 12-months post-HA+LAAE. AFEQT yields scores from 0 to 100 (0 as complete disability and 100 as no disability) and includes an overall and four subscale scores. A 5-point AFEQT change is clinically important. Mean differences with 95% CIs were calculated; p-values are from paired t-tests. Results: Of 85 patients, 82 completed both baseline and 12-month AFEQT. The mean change in overall score was 30.1 ± 19.8 (95% CI: 25.8-34.5; median 29.5, min, max: -15.4, 78.2; p<0.0001) (Figure). The greatest improvement was in the Treatment Satisfaction subscale with a mean score of 53.2 ± 29.9 (95% CI: 46.6-59.7; median 58.3, min, max: 0.0, 100.0; p<0.0001), followed by Treatment Concern, Daily Activities, and Symptoms subscale scores. All mean improvements from baseline exceeded a clinically meaningful 5-point change. Conclusion: In the DEEP trial, HA+LAAE resulted in patient-reported QOL improvements at 12-months post-procedure.

Native Americans (Indigenous Americans) have high rates of serious illness in the United States. Informal caregivers are heavily relied on in caring for patients in low-resource settings. The needs of caregivers residing on reservations are sorely underreported. Therefore, our objective was to examine relationships between facilitators (communal mastery, cultural identity, and spirituality) and barriers (depression, anxiety, stress, and burden) with supportive care needs among adult informal caregivers in 1 reservation-based community. A cross-sectional survey was distributed in July and August 2022 as part of a larger multimethod, community-based participatory research study. We used descriptive statistics and linear regression models to examine relationships against the primary outcome, the Supportive Care Needs Assessment Tool for Indigenous People. Overall, 127 participants were included; most were female (n = 92, 72.4%), were between 30 and 49 years (n = 57, 44.9%), and had 6 months or less of caregiving experience (n = 41, 32.5%). Higher depression, anxiety, stress, and burden were significantly associated with higher Supportive Care Needs Assessment Tool for Indigenous People scores. Overall, mental health is a significant barrier that may indicate greater supportive care needs among informal caregivers, although further work is needed to differentiate symptoms and their impact on caregiving from a cultural perspective.