Clinical debriefing (CD) positively impacts individuals, teams and systems and has been shown to improve patient outcomes and staff wellbeing. Although there is a growing evidence base supporting CD, it has not been routinely adopted by many healthcare organisations. Despite the work environment being an important component of transfer of learning, there has been minimal focus on how it influences implementation and maintenance of CD in practice. The overall aim of this study was to explore the work environment barriers and enablers influencing the transfer of clinical debriefing skills from simulation to clinical practice. Following ethical approval, medical registrars who had participated in a simulation course involving a within-scenario CD were invited to participate in semi-structured interviews. These utilised Burke and Hutchins’ evaluation model as the initial conceptual framework and took place at least two months post-course. Interviews explored participants’ experiences of transferring learning related to CD from simulation to the clinical workplace, and were transcribed verbatim and dual coded using template analysis. Fifteen medical registrars participated in interviews between January and May 2025. The work environment influences from Burke and Hutchins’ evaluation model resonated as important factors affecting adoption of CD. With the addition of subthemes generated inductively from the data, the model provided a framework for identification and articulation of the barriers and enablers to CD in the workplace. The most striking finding was participants’ sense of personal responsibility to engage with CD. In addition, participants identified the requirement for cultural change to enable CD. Work environment influences represent both barriers and enablers of CD in relation to the transfer of learning from simulation to clinical practice. Personal responsibility and workplace culture are important drivers of CD, and attention should be paid to the influence of both constructs in this context. Recommendations for practice, based on our findings, are designed to enable educators and organisations to promote the adoption of CD in their own settings. This will help to bridge the gap and make CD the norm, not the exception.
Congenital hypogonadotropic hypogonadism (CHH) is a rare and genetically heterogeneous disorder characterized by absent or incomplete puberty due to impaired gonadotropin-releasing hormone (GnRH) function. A subset of individuals with CHH also present with developmental anomalies, including midline defects such as cleft lip and/or palate (CLP). This study investigates the genetic overlap between CHH and CLP. A total of 336 individuals diagnosed with CHH were clinically assessed for associated phenotypes, including CLP. High-throughput sequencing was performed using a targeted gene panel encompassing known CHH- and CLP-related genes. Variants were analyzed and classified according to the American College of Medical Genetics and Genomics (ACMG) criteria for pathogenicity. CLP was present in 21 patients with CHH (6%). Pathogenic or likely pathogenic variants in genes associated with both CHH and CLP—such as FGFR1 and CHD7—were identified in eight individuals. Furthermore, 17% of the patients with CHH without CLP harbored deleterious variants in genes implicated in clefting, including DVL3, PLCB4, NIPBL, and EDNRA. Evidence of digenic inheritance involving both CHH- and CLP-related genes was observed in multiple cases. FGFR1 variants were the most frequently detected and were commonly associated with anosmia and additional developmental anomalies. These findings highlight a genetic and phenotypic continuum between CHH and CLP, underscoring the involvement of shared developmental pathways. The high prevalence of FGFR1 variants in patients with CHH and CLP supports its role as a pleiotropic gene. Understanding the overlapping genetic mechanisms may enhance diagnostic precision and inform personalized management strategies for affected individuals.
The origins of general anaesthesia for dentistry are inextricably linked to the dawn of anaesthesia as a specialty, and the availability of the very first inhalational anaesthetic agents. Its delivery, regulation and safety profile have evolved significantly since then, with its practice now conducted solely by trained anaesthetists in a hospital setting. Dental chair anaesthesia and nasal masks have largely been replaced by more modern techniques and equipment, nevertheless, the patients that necessitate these interventions present their own unique challenges. Restricted mostly to adult patients that lack capacity (special care dentistry) and paediatric patients, these two groups can be demanding both clinically and logistically, requiring specialist knowledge and experience in managing patients undergoing 'shared airway' surgery, navigating complex consent and safeguarding processes, and working in tandem with a varied multidisciplinary team. Meticulous planning and organization are key to achieving the best interaction with healthcare services for these patients that often require repeat attendances.
Intravenous thrombolysis is one of the standard treatments of acute ischemic stroke. Over the last decades, alteplase (recombinant tissue type plasminogen activator, rt-PA) has been established as the main thrombolytic agent worldwide. However, the short plasma half-life of rt-PA poses logistical challenges, as it necessitates administration as a 10 % bolus followed by a 90 % infusion over one hour. These logistical difficulties, combined with the search for agents with improved efficacy and safety profiles, have spurred the development of alternative thrombolytic agents. This review summarizes current clinical evidence and emerging research on novel thrombolytic agents in acute ischemic stroke, including tenecteplase, reteplase, desmoteplase, urokinase, staphylokinase, JX10, LT3100, Ancrod, and TS23. Among these agents, tenecteplase has been most extensively studied and is already recommended for selected indications by the European Stroke Organization (ESO) and the American Heart Association and American Stroke Association (AHA/ASA). Other agents are still undergoing early clinical investigation and show different levels of potential in terms of effectiveness, safety, and ease of administration.
Introduction: Evidence regarding the benefit of endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (c-ICA-O) is lacking. We assessed the outcomes and safety of EVT in patients with isolated c-ICA-O. Methods: Retrospective multicenter cohort study of patients with an AIS due to isolated c-ICA-O, within 24-h since last-seen-well. Comparisons were made between EVT and best medical therapy (BMT). The primary outcome was 3-months modified Rankin Scale (mRS) ordinal shift. Secondary outcomes included 3-month favorable outcome (mRS 0–2, or return to pre-stroke mRS), symptomatic intracranial hemorrhage (sICH) and any parenchymal hemorrhage. Outcomes were compared combining inverse probability of treatment weighting with regression models and propensity score matching (PSM) as sensitivity analysis. Results: We analyzed 998 patients (66.2% male, mean age 71.1 ± 13.2 years). 487 (48.8%) patients received EVT and 511 (51.2%) received BMT. Patients receiving EVT had a higher admission NIHSS [13 (7–18) vs 5 (2–13)] compared to BMT. There was no difference between EVT and BMT groups in 3-month mRS shift (adjusted common odds ratio [OR], 1.01 [95% CI 0.76–1.34]) and favorable outcome (adjusted OR [aOR] 1.16 [95% CI 0.84–1.60]). No patient (0%) in the BMT group had sICH versus 1.6% in the EVT group. Parenchymal hemorrhage was numerically higher in EVT patients (2.7% vs 0.6%; aOR 3.85 [95% CI 0.98–15.23]). PSM analysis revealed similar results. Discussion and conclusion: In patients with isolated c-ICA-O, EVT was associated with similar odds of disability and intracranial bleeding compared to BMT. Randomized-controlled clinical trials in patients with isolated c-ICA-O are warranted.
