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Risk Management of Aggressive Behaviors in Mental Health Units for Adolescents: a Scoping Review
Publication . Ferreira, A; Maravilha, A; Fluttert, F; Rosa, A; Sousa, L; Tomás, J; Sá, L
Introduction: Research on aggressive behaviors (ABs) in adolescent mental healthcare settings remains limited and underexplored. Such behaviors significantly affect staff, patients, and the therapeutic environment, necessitating nursing interventions for effective risk management to reduce their adverse impact on safety and quality of care. Objective: This review aimed to map the existing evidence on nursing interventions for the risk management of AB in adolescent mental health units. Methods: A search strategy was used to identify relevant studies in databases, respecting the Participant/Concept/Context (PCC) question formulation structure. This review covers studies describing nursing risk management strategies for adolescents (10 to 19 years old) with aggression problems and admitted to mental healthcare units. Results: From the 499 records initially identified, 9 articles met the inclusion criteria and were selected for review, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) and its associated flow diagram. The nursing interventions identified for managing AB in adolescent healthcare settings included risk assessment tools, targeted risk management strategies, evidence-based interventions but also various forms of coercive measures. Conclusions: This review integrates current knowledge on nursing interventions for the risk management of AB in adolescent mental health units. The focus of these interventions is prevention, by early intervention strategies but also intervention programs with improved outcomes for the patient, staff and therapeutic milieu, promoting less coercive interventions and increased care quality and safety.
Right Ventricular Myocardial Work: Proof-of-Concept for the Assessment of Pressure-Strain Loops of Patients With Pre-Capillary Pulmonary Hypertension.
Publication . Lacerda Teixeira, Bárbara; Albuquerque, Francisco; Santos, Raquel; Ferreira, André; Carvalheiro, Ricardo; Reis, João; Morais, Luis Almeida; Mano, Tânia; Rio, Pedro; Timóteo, Ana Teresa; Cruz Ferreira, Rui; Galrinho, Ana
Background: Right ventricular myocardial work (RVMW) assessed by transthoracic echocardiography allows to study the right ventricular (RV) function using RV pressure-strain loops. The assessment of these novel indexes of RVMW has not yet been exten sively studied, namely in pre-capillary pulmonary hypertension (PH) population.
Objectives: to evaluate the relationship between RVMW and invasive indices of right heart catheterization (RHC) in a cohort of patients with group I and group IV PH and to compare with a control group without PH.
Methods: A prospective registry of pre-capillary PH patients was used and compared with a control group without PH. In both groups, patients underwent same day RHC and echocardiographic assessment. Dedicated software for left ventricle myocardial work was used for the RV. RV global work index (RVGWI) was calculated as the area of the RV pressure-strain loops. From RVGWI, RV global constructive work (RVGCW), RV global wasted work (RVGWW), and RV global work efficiency (RVGWE) were estimated.
Results: 25 pts were included: 17 pts with PH were compared with 8 pts without PH. RVGWI, RVGCW and RVGWW were significantly higher in PH patients than in controls (p < 0,05), while RVGWE was significantly lower (p < 0,05). Significant correlations were found between mean pulmonary artery pressure, cardiac index, venous oxygen saturation, NT-proBNP and RVGCW, RVGWW and RVGWE; between pulmonary vascular resistance, cardiac output, right ventricular stroke work and RVGWI, RVGCW, RVGWW and RVGWE; between stroke volume and RVGWW and RVGWE; between pulmonary artery pulsatility index and RVGWI, RVGCW and RVGWW; between RA pressure and RVGWE.
Conclusions: Patients with pre-capillary PH present significantly higher RVGWI, RVGCW and RVGWW and lower RVGWE than patients without PH. Echocardiographic RVMW-derived indexes show significant correlation with invasive measurements and NT-proBNP. Larger studies are needed to assess the prognostic value of these novel indexes.
Implementing Digital Respiratory Technologies for People With Respiratory Conditions: a Protocol for a Scoping Review.
Publication . Hui, Chi Yan; Condon, Kathleena; Kolekar, Shailesh; Roberts, Nicola; Sreter, Katherina Bernadette; Simons, Sami O; Figueiredo, Carlos; McKeough, Zoe; Salim, Hani; Gawlik-Lipinski, Aleksandra; Gonsard, Apolline; Önal Aral, Ayşe; Vanoverschelde, Anna; Armstrong, Matthew; Kohlbrenner, Dario; Paixão, Cátia; Stafler, Patrick; Papadopoulou, Efthymia; Rabe, Adrian Paul; Mohammad, Milan; Bouloukaki, Izolde; Quach, Shirley; Chaabouni, Malek; Kaltsakas, Georgios; Loveys, Kate; Reier-Nilsen, Tonje; Sunjaya, Anthony Paulo; Robinson, Paul; Pinnock, Hilary; Chan, Amy Hai Yan
The value of 'data-enabled', digital healthcare is evolving rapidly, as demonstrated in the COVID-19 pandemic, and its successful implementation remains complex and challenging. Harmonisation (within/between healthcare systems) of infrastructure and implementation strategies has the potential to promote safe, equitable and accessible digital healthcare, but guidance for implementation is lacking. Using respiratory technologies as an example, our scoping review process will capture and review the published research between 12th December 2013 to 12th December 2023. Following standard methodology (Arksey and O'Malley), we will search for studies published in ten databases: MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library, Web of Science, Scopus, IEEE Xplore, CABI Global Health, and WHO Medicus. Our search strategy will use the terms: digital health, respiratory conditions, and implementation. Using Covidence, screening of abstracts and full texts will be undertaken by two independent reviewers, with conflicts resolved by a third reviewer. Data will be extracted into a pilot-tested data extraction table for charting, summarising and reporting the results. We will conduct stakeholder meetings throughout to discuss the themes emerging from implementation studies and support interpretation of findings in the light of their experience within their own networks and organisations. The findings will inform the future work within the ERS CONNECT clinical research collaboration and contribute to policy statements to promote a harmonised framework for digital transformation of respiratory healthcare.
The Impact of Atrial Voltage and Conduction Velocity Phenotypes on Atrial Fibrillation Recurrence.
Publication . Silva Cunha, Pedro; Laranjo, Sérgio; Monteiro, Sofia; Portugal, Guilherme; Guerra, Cátia; Rocha, António Condeixa; Pereira, Mariana; Cruz Ferreira, R; Heijman, Jordi; Oliveira, Mário Martins
Introduction: Low atrial voltage and slow conduction velocity (CV) have been associated with atrial fibrillation (AF); however, their interaction and relative importance as early disease markers remain incompletely understood. We aimed to elucidate the relationship between atrial voltage and CV using high-density electroanatomic (HDE) maps of patients with AF.
Methods: HDE maps obtained during sinus rhythm in 52 patients with AF and five healthy controls were analysed. Atrial voltage and CV maps were generated, and their correlations were assessed. Subgroup analyses were performed based on clinically relevant factors such as AF type, CV, and voltage levels. Finally, cluster analysis was conducted to identify distinct phenotypes within the population, reflecting different patterns of conduction and voltage.
Results: A moderate positive correlation was found between the mean atrial voltage and CV (r = 0.570). Subgroup analysis revealed differences in voltage (p = 0.0044) but not in global CV (p = 0.42), with no significant differences between AF types. Three distinct phenotypes emerged: normal voltage/normal CV, normal voltage/low CV, and low voltage/low CV, with distinct recurrence rates, suggesting different disease progression paths. Slower atrial CV was identified as a significant predictor of arrhythmia recurrence at 12 and 24 months after AF ablation, surpassing the predictive potential of atrial voltage.
Conclusion: Atrial voltage and CV analyses revealed distinct phenotypes. Lower atrial CV emerged as a significant predictor of AF recurrence, exceeding the predictive significance of atrial voltage. These findings emphasise the importance of considering CV and voltage in managing AF and offer potential insights for personalised strategies.
Iatrogenic Intramural Esophageal Hematoma During EUS-B-FNA Procedure.
Publication . Rodrigues, João Oliveira; Matos, Paulo; Rodrigues, Luís Vaz; de Santis, Michele; Barradas, Lourdes
Background: Esophageal ultrasound with bronchoscope fine needle aspiration (EUS-B-FNA) is a valuable tool for the diagnosis and staging of lung cancer, complementing endobronchial lung ultrasound (EBUS). While generally considered safe, there is a notable lack of comprehensive knowledge within the interventional pulmonology community regarding potential complications.
Case presentation: We present a case involving a 66-year-old male with squamous cell lung carcinoma undergoing mediastinal staging. A systematic mediastinal assessment through EBUS confirmed the presence of enlarged lymph nodes at 4 L with limited access to puncture. Complementary EUS-B widened the visualization and access to station 4 L and after excluding nearby vessels, a single puncture was performed. Unexpectedly, an iatrogenic esophageal hematoma was promptly noted at the puncture site. The procedure was immediately interrupted, and subsequent workup confirmed the hematoma without active bleeding. Conservative management, including upper endoscopy and clip sealing, resulted in the patient's asymptomatic recovery.
Conclusion: This case underscores the importance of recognizing and managing complications associated with EUS-B-FNA, emphasizing the need for heightened awareness and education in the interventional pulmonology community. Despite being infrequently discussed in medical literature, EUS-B-FNA can give rise to both immediate and delayed complications, warranting increased vigilance during its practice.