Rasha S. Farag

Background: Chronic wound healing is a major surgical problem in clinical practice that affects patient’s quality of life. Studies have shown multiple different products to enhance and accelerate this process. Objectives: A locally available topical gel, Zymalge gel ^® , is a combination of hyaluronic acid, alginate, antimicrobial enzymes, and moisturizing agents for use in wound dressings. This study evaluates healing clinical outcomes and safety associated with its use in promoting wound healing. Methods: This is a retrospective single-arm cohort study of patients with chronic, surgical, or burn wounds that presented to a plastic surgery clinic in Damietta, Egypt. We included 50 patients who used Zymalge gel ^® for their wound dressings. Results: The median patients age (first quartile (Q1), third quartile (Q3)) was 50 (37, 56.25) years. 56% of participants had a history of chronic medical illness, and 48% were smokers. Wound types were 22% surgical, 22% chronic, and 12% were burn wounds. Median (Q1, Q3) wound sizes were 20 (9.75, 36.25) cm². Complete healing outcomes were observed in 62% of patients with no need for grafts or flaps, where 38% were ready to graft wounds with healthy granulation tissue. There were no reported local or systemic adverse effects associated with the use of the gel. Larger wound size was significantly associated with delayed healing (Hazard Ratio = 0.97, 95% Confidence Interval: 0.95–0.99, P = 0.002). Conclusions: Based on the available data, we conclude that Zymalge gel® was associated with favorable wound-healing outcomes and a good safety profile across chronic, surgical, or burn wounds, particularly for complex or slow-healing wounds encountered in tertiary outpatient settings. Further multicenter, double-blind, randomized controlled trials are required to compare it with other local wound care treatments and assess its efficacy.

Introduction: Burnout, a pervasive phenomenon among healthcare providers, has been linked to both clinicians’ and patient safety. This study aimed to assess the association between burnout and patient safety. Methods: This cross-sectional study was conducted at Al Nahda General Hospital in Saudi Arabia from 2023 to 2024. A total of 399 healthcare providers (HCPs) completed an online survey. Burnout was measured using the Copenhagen Burnout Inventory (CBI). The primary outcomes were evaluating the prevalence of burnout among HCPs and measuring its association with Patient Safety Management Activities (PSMA). The secondary outcome was to identify potential risk factors affecting PSMA practice. Results: Of the study group, 64.4% of HCPs aged 30 to 45 years, 61.2% were physicians, and 50.1% had over 10 years of experience. The prevalence of burnout among participants was 41%. HCPs under 30 years old exhibited a significantly lower prevalence of burnout compared to those aged 30–45 years (Prevalence ratio (PR) = 0.63, 95% CI: 0.46–0.86, P = 0.003). Work schedule played a significant role, with night-shift workers showing a higher burnout prevalence compared to those on morning shifts (PR = 1.38, 95% CI: 1.09–1.74, P = 0.007). Respondents experiencing burnout showed a significantly higher likelihood of being suboptimal in complying with infection control guidelines (Odds ratio (OR) = 3.78, 95% CI: 1.04–13.69, P = 0.04) and were less likely to be familiar with standard precautions for preventing the spread of infections (OR = 0.30, 95% CI: 0.11–0.82, P = 0.02) compared to those who were not experiencing burnout. HCPs burnout was significantly associated with higher moderate patient involvement in decision-making (OR = 9.69, 95% CI: 2.53–37.10, P = 0.001), speaking up about patient safety concerns within teams and departments (OR = 3.62, 95% CI: 1.18–11.07, P = 0.02), and documentation and record-keeping (OR = 5.17, 95% CI: 1.22–21.81, P = 0.03). Healthcare setting and depression were significant risk factors associated with reduced PSMA. Conclusions: HCPs burnout was prevalent among middle-aged staff (aged 30–45 years) and night shift workers. It is potentially associated with patient safety practices, including lapses in infection control, patient involvement, safe communication, and record documentation. Further research is required to include multiple centers and multi-pronged interventions to mitigate burnout and improve patient safety.

Background: Limited evidence exists on the additive risk of bradycardia in children with respiratory syncytial virus (RSV) bronchiolitis receiving dexmedetomidine (DMED). We aim to study the association between RSV bronchiolitis and bradycardia during DMED administration. Methods: This retrospective cohort study included 273 children under 2 years old admitted to the intensive care units at Boston Children’s Hospital with severe bronchiolitis and sedated with DMED from 2009 to 2022. Children were classified as RSV or non-RSV based on confirmed laboratory results. The primary outcome was a composite measure of clinically significant bradycardia, defined as either a heart rate 2 ₁ =3.6, p=0.04) or admitted before the COVID-19 pandemic (OR: 2.94 vs 0.51; Χ ² ₁ =4.7, p=0.03). The RSV cohort experienced a significantly greater heart rate reduction after DMED initiation (−8.07 bpm; 95% CI: −13.71 to –2.43; p = 0.005). Conclusions: Children with RSV bronchiolitis experienced greater heart rate reduction after DMED initiation, with a higher likelihood of clinically significant bradycardia if IMV is in use at DMED initiation or if admitted before the COVID-19 pandemic. Caution is warranted when treating RSV bronchiolitis patients with DMED.

Background: Emergence agitation is a complex syndrome of altered consciousness after emergence from anesthesia. It can result in injury to patients and staff and is associated with other postoperative complications. Sevoflurane has been associated with emergence agitation, potentially due to low tissue solubility and therefore speed of emergence. Prior meta‐analyses comparing emergence agitation incidence between sevoflurane and isoflurane anesthetics did not demonstrate a statistically significant difference. Given the publication of additional relevant studies not included in prior meta‐analyses as well as improved diagnosis of emergence agitation, we aim to perform an updated, comprehensive meta‐analysis comparing emergence agitation incidence between sevoflurane and isoflurane anesthetics in children.Methods: We conducted an updated systematic review and meta‐analysis of clinical trials comparing sevoflurane to isoflurane in children I² = 40.01%, p < .001)). Time to extubation, awakening times, and postanesthetic care unit duration were not significantly different. The protective effect of isoflurane compared to sevoflurane remained significant in subgroups of patients who received premedication or intraoperative systemic analgesics (risk ratios: (0.48 [0.28–0.82]; I² = 60.78%, p = .01), (0.52 [0.37–0.75]; I² = 0.00%, p < .001), respectively).Conclusion: The risk of emergence agitation in children after maintenance anesthesia with sevoflurane is significantly greater than with isoflurane; we did not find evidence of prolonged emergence or postanesthetic length of stay. When possible, isoflurane should be considered for maintenance anesthesia over sevoflurane in patients at high risk of emergence agitation.