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Ataxia with oculomotor apraxia type 2 is a rare autosomal recessive cerebellar ataxia caused by senataxin gene mutations, with minimal published data on anaesthetic management. We report the peri-operative care of a 46-year-old woman with genetically confirmed ataxia with oculomotor apraxia type 2 undergoing laparoscopic cholecystectomy under general anaesthesia. Key challenges included uncertain sensitivity to neuromuscular blocking agents and the potential for respiratory weakness and bulbar dysfunction. Non-technical challenges arose from incomplete recognition and communication of the condition pre-operatively. Anaesthetic strategy prioritised titratable, reversible agents and careful intra-operative monitoring. Rocuronium was administered in reduced dose with quantitative neuromuscular monitoring and fully reversed with sugammadex prior to tracheal extubation. Propofol, sevoflurane and remifentanil target-controlled infusion were used to ensure haemodynamic stability and minimise cumulative opioid exposure. The patient recovered uneventfully with no residual weakness or respiratory impairment. To our knowledge, this is the first published description of general anaesthesia for laparoscopic surgery in a patient with ataxia with oculomotor apraxia type 2. It demonstrates that anaesthesia can be safely delivered to patients with this condition with careful pre-operative planning.
Severe sepsis presents a critical healthcare challenge where rapid pathogen identification is vital for timely intervention. Current diagnostic methods, however, remain inadequate, often delaying targeted treatment. Using readily available printed circuit board (PCB) electrodes, we address this need by developing a low-cost electrochemical DNA biosensor for rapid detection of Streptococcus pneumoniae using the lytA gene as a biomarker. Through systematic evaluation of commercial and custom PCB designs (P1-P4), gold-plated PCB P4 was found as the optimal platform, demonstrating sensitive detection of lytA sequences (20 bp at 4.50 pM limit of detection in buffer) and clinically relevant 235 bp polymerase chain reaction (PCR) amplicons in 100% human serum (1.0-100 pM) within 15 min at room temperature using electrochemical impedance spectroscopy. The performance of the biosensor originates from the optimized electrode geometry, surface properties, and robust self-assembled monolayer functionalization, enabling specific recognition of bacterial DNA without sample pretreatment. This work establishes PCB-based biosensors as a promising solution for point-of-care sepsis diagnostics, offering significant advantages in speed, cost, and operational simplicity compared to conventional methods.
OBJECTIVE:To identify patient-centered approaches to pressure injury (PI) prevention and management for adults in acute care settings, including the strategies used and their effectiveness. DATA SOURCES:A comprehensive search strategy was developed using the JBI Participants, Concept, and Context framework. The authors searched EMBASE, CINAHL, MEDLINE, Scopus, Cochrane Library, ProQuest, the James Lind Alliance, Healthcare Excellence Canada, and PI-specific organizations for English-language publications from the past 10 years. STUDY SELECTION:The search identified 3055 articles, and 1422 duplicates were removed. Studies were excluded if they did not focus on patient-centered PI prevention and management, did not occur in acute care settings, or did not include data that could be extracted. Following abstract and full-text screening, 21 studies were included in this review. DATA EXTRACTION:Two independent reviewers extracted data on study design, interventions, and outcomes, and quality (using the Mixed Methods Appraisal Tool). DATA SYNTHESIS:The included studies reported 4 main PI prevention strategies: care bundles, educational interventions, technological interventions, or tools to assess or reduce PI risk. Quantitative findings consistently showed reduced PI incidence with patient-centered interventions. Qualitative studies emphasized the importance of knowledge, communication, and collaboration in enhancing patient involvement. Barriers to engagement included pain, cognitive impairment, and health care provider time constraints. The methodological quality of the included studies varied, with limitations due to a lack of blinding and incomplete outcome data. CONCLUSIONS:Patient-centered approaches can effectively reduce PI incidence in acute care. Future interventions should incorporate consistent education, tailored care plans, and effective communication to enhance patient engagement and improve PI prevention and management.
Introduction of the statutory process of independent medical scrutiny in England and Wales, provides an excellent opportunity to identify shortfalls, concerns and helps us to learn from deaths. The system adopted by Wales (in contrast to England) guarantees fully independent scrutiny as recommended by the confidential enquiries into deaths. Evidence shows that a significant proportion of deaths has been referred to the care providers for a clinical review and to improve patient care. However, the system has created so many steps in the death certification process it leads to delays in issuing death certificates causing distress and anguish to the bereaved families. A multipronged approach to streamline the death certification process should include: education and training of doctors, a prompt, proportionate and pragmatic scrutiny by MEs, a review of the criteria for referral to coroners, implementation of digital MCCD and an overhaul of the list of causes of death.
