Chest drain removal

'Out of sync': a qualitative investigation of patients' experiences of atrial fibrillation and perceptions of weight management

OBJECTIVES

To explore ways to enhance the design of risk factor management and weight-loss services for people with overweight/obesity and atrial fibrillation (AF).

BACKGROUND

AF is the most common cardiac arrhythmia, with serious consequences for health and quality of life. Some evidence indicates weight reduction in people with AF and overweight/obesity may improve symptoms. This population may require additional support with weight management due to factors associated with ageing and health.

DESIGN

Qualitative investigation based on semi-structured interviews.

METHODS

12 adult participants (4 female, 8 male) with diagnosed AF and a current or previous body mass index >27 kg/m² were recruited at a large tertiary cardiac referral centre in southern England between September 2020 and January 2021. Participants completed quality of life and AF symptom questionnaires using Think-Aloud technique and semi-structured interviews relating to their weight management experiences, needs and preferences. Interviews were audio recorded and analysed thematically using the Capability, Opportunity and Motivation-Behaviour model as a theoretical framework.

RESULTS

Three main themes were identified. Being out of rhythm explores the psychological and physical impact of AF on weight management; doing the right thing discusses participants' weight management experiences and broaching the subject explores participants' perspectives on weight management conversations with clinicians.

CONCLUSIONS

There was dissatisfaction with the weight management advice received from healthcare professionals including cardiologists. Participants wanted open, non-judgemental discussion of cardiac health implications of overweight/obesity supported by referral to weight management services. Improved communication including research findings regarding the benefits of weight loss as a factor in AF management might increase motivation to adhere to weight-loss advice in this population.

Existing barriers and recommendations of real-world data standardisation for clinical research in China: a qualitative study

OBJECTIVE

To investigate the existing barriers and recommendations of real-world data (RWD) standardisation for clinical research through a qualitative study on different stakeholders.

DESIGN

This qualitative study involved five types of stakeholders based on five interview outlines. The data analysis was performed using the constructivist grounded theory analysis process.

SETTING

Eight hospitals, four hospital system vendors, three big data companies, six medical products companies and four regulatory institutions were included.

PARTICIPANTS

In total, 62 participants from 25 institutions were interviewed through purposive sampling.

RESULTS

The findings showed that the lack of clinical applicability in existing terminology standards, lack of generalisability in existing research databases, and lack of transparency in existing data standardisation process were the barriers of data standardisation of RWD for clinical research. Enhancing terminology standards by incorporating locally used clinical terminology, reducing burden in the usage of terminology standards, improving generalisability of RWD for research by using clinical data models, and improving traceability to source data for transparency might be feasible suggestions for solving the current problems.

CONCLUSIONS

Efficient and reliable data standardisation of RWD for clinical research can help generate better evidence used to support regulatory evaluation of medical products. This research suggested enhancing terminology standards by incorporating locally used clinical terminology, reducing burden in the usage of terminology standards, improving generalisability of RWD for research by using clinical data models, and improving traceability to source data for transparency to guide efforts in data standardisation in the future.

Air leaks: Stapling affects porcine lungs biomechanics

During thoracic operations, surgical staplers resect cancerous tumors and seal the spared lung. However, post-operative air leaks are undesirable clinical consequences: staple legs wound lung tissue. Subsequent to this trauma, air leaks from lung tissue into the pleural space. This affects the lung's physiology and patients' recovery. The objective is to biomechanically and visually characterize porcine lung tissue with and without staples in order to gain knowledge on air leakage following pulmonary resection. Therefore, a syringe pump filled with air inflates and deflates eleven porcine lungs cyclically without exceeding 10 cmH₂O of pressure. Cameras capture stereo-images of the deformed lung surface at regular intervals while a microcontroller simultaneously records the alveolar pressure and the volume of air pumped. The raw images are then used to compute tri-dimensional displacements and strains with the Digital Image Correlation method (DIC). Air bubbles originated at staple holes of inner row from exposed porcine lung tissue due to torn pleural on costal surface. Compared during inflation, left upper or lower lobe resections have similar compliance (slope of the pressure vs volume curve), which are 9% lower than healthy lung compliance. However, lower lobes statistically burst at lower pressures than upper lobes (p-value<0.046) in ex vivo conditions confirming previous clinical in vivo studies. In parallel, the lung deformed mostly in the vicinity of staple holes and presented maximum shear strain near the observed leak location. To conclude, a novel technique DIC provided concrete evidence of the post-operative air leaks biomechanics. Further studies could investigate causal relationships between the mechanical parameters and the development of an air leak.

Gap between real-world data and clinical research within hospitals in China: a qualitative study

OBJECTIVE

To investigate the gap between real-world data and clinical research initiated by doctors in China, explore the potential reasons for this gap and collect different stakeholders' suggestions.

DESIGN

This qualitative study involved three types of hospital personnel based on three interview outlines. The data analysis was performed using the constructivist grounded theory analysis process.

SETTING

Six tertiary hospitals (three general hospitals and three specialised hospitals) in Beijing, China, were included.

PARTICIPANTS

In total, 42 doctors from 12 departments, 5 information technology managers and 4 clinical managers were interviewed through stratified purposive sampling.

RESULTS

Electronic medical record data cannot be directly downloaded into clinical research files, which is a major problem in China. The lack of data interoperability, unstructured electronic medical record data and concerns regarding data security create a gap between real-world data and research data. Updating hospital information systems, promoting data standards and establishing an independent clinical research platform may be feasible suggestions for solving the current problems.

CONCLUSIONS

Determining the causes of gaps and targeted solutions could contribute to the development of clinical research in China. This research suggests that updating the hospital information system, promoting data standards and establishing a clinical research platform could promote the use of real-world data in the future.

The Impact of Using Ice on Quality of Pain Associated with Chest Drain Removal in Postcardiac Surgery Patients: An Evidence-Based Care

Background:

Patients undergoing cardiothoracic surgery require the placement of at least one chest drain. Chest Drain Removal (CDR) has been considered to be a painful event in patient’s postoperative recuperation.

Objective:

This study aimed to evaluate the impact of using ice on quality of pain associated with CDR in adult patients undergoing cardiac surgery

Materials and Methods:

This randomized, observer-blind, crossover trial was done on 51 post-cardiac surgery patients who had two chest drains in the Mashhad Heart Center in Iran. The patients were assigned to ice, placebo, and control groups. Ice and placebo bags were used over the region around the chest drains for 20 minutes prior to CDR. The quality of pain was assessedviaShort-Form McGill Pain Questionnaire (SF-MPQ) before and after CRT. The data were analyzed through the SPSS software using ANOVA, Kruskal-Wallis, and Chi-square tests.

Results:

The study findings revealed that the three groups were not significantly different regarding pain quality before CDR (p=0.24). However, the ice bag group (4.6±4.4) was significantly different from the placebo (8.1±6.9) and control groups (7.1±5.3) concerning the pain quality score immediately after CDR (p<0.05). The results of chi-square test also showed that the three groups were significantly different regarding “hot-burning” (p=0.009). However, no significant differences were observed with regard to other items of SF-MPQ.

Conclusion:

The results indicated that ice bag application could be used as an effective, safe, and inexpensive non-pharmacological intervention to reduce patients’ pain and increase their comfort during CDR.