This document discusses the history and evolution of vasopressor use for treating maternal hypotension during spinal anesthesia for cesarean section. It describes how ephedrine was originally used but was found to be associated with worse fetal outcomes compared to phenylephrine or metaraminol. Phenylephrine then emerged as the preferred vasopressor due to studies showing it improved fetal acid-base status. Recent research has focused on optimizing phenylephrine administration, comparing continuous infusions to bolus doses and investigating optimal infusion rates and regimens. However, the ideal method to both control blood pressure and minimize side effects like hypertension is still unclear.
My talk in April 2015 Malaysia on Best Practices and Resuscitation Workflow. The new 2015 resuscitation guidelines is expected to be released in Oct 2015.
dual antiplatelet in stroke meta analysisGovind Madhaw
This journal club presentation summarizes a meta-analysis of 18 randomized controlled trials with 15,515 patients comparing dual antiplatelet therapy to mono antiplatelet therapy for secondary stroke prevention in patients with acute ischemic stroke or transient ischemic attack. The meta-analysis found dual antiplatelet therapy significantly reduced the risk of stroke recurrence and composite vascular events compared to monotherapy, without significantly increasing the risk of major bleeding. Sensitivity analyses restricting to double-blind studies showed similar results. The presentation provides details on the search methods, inclusion/exclusion criteria, data extraction, outcomes analyzed, and results of the meta-analysis.
This study analyzed bleeding events among 5,170 patients from the CHANCE trial who received dual antiplatelet therapy (clopidogrel plus aspirin) or aspirin alone for minor stroke or transient ischemic attack. A total of 101 bleeding events occurred, with no significant difference in rates between the treatment groups. However, patients with minor strokes had a higher risk of bleeding than those with transient ischemic attacks. Being elderly, male, and having a history of aspirin or proton pump inhibitor use were associated with greater bleeding risk, while higher body mass index was protective against bleeding.
1) The study investigated whether adherence to lipid-lowering medications predicts initial adherence to CPAP therapy for obstructive sleep apnea.
2) The study found that higher adherence to lipid-lowering medications, as measured by medication refill rates in the previous year, closely predicted higher rates of at least 4 hours per night of CPAP use in the first week of therapy.
3) Demographic and clinical factors like age, race, apnea severity, and obesity did not predict initial CPAP adherence, but adherence to lipid medications did, suggesting a "healthy user bias" may confound studies linking poor CPAP adherence to health outcomes.
This document provides updates on several topics in pediatrics from the past 6 months, as determined by editors and authors to be particularly notable. It includes:
1) Updated recommendations for the diagnosis and treatment of head lice from the American Academy of Pediatrics.
2) A warning from the FDA about potential health risks of over-the-counter homeopathic treatments for asthma.
3) Evidence that head circumference standards may vary between countries/ethnic groups, and local standards may be preferable to WHO standards in some cases.
Identifying Significant Antipsychotic-Related Side Effects in Patients on a Community Psychiatric Rehabilitation Unit-A Feasibility Study of The Glasgow Antipsychotic Side-Effect Scale (GASS) by Ahmed Saeed Yahya* in crimson publishers: Journal of Physical Medicine and Rehabilitation
Antipsychotic side-effects are common and are an important determinant of non-adherence and consequent relapse. Most rating scales for the identification of these are lengthy and complicated. This report reviews the medical literature on the Glasgow antipsychotic side-effect scale (GASS)-a brief and validated rating scale to measure the unwanted effects of antipsychotics. We administered the GASS to fourteen in-patients in a United Kingdom-based Community Psychiatric Rehabilitation Unit. The objective was to establish the utility of the GASS in this setting and to make recommendations on how this tool could be used in clinical practice to improve adherence to antipsychotic medication.
https://crimsonpublishers.com/epmr/fulltext/EPMR.000529.php
For more Open access journals in Crimson Publishers
Please click on: https://crimsonpublishers.com/
For more articles in Examines in Physical Medicine & Rehabilitation
Please click on: https://crimsonpublishers.com/epmr/
Journal Club - EMS - "Effect of adrenaline on survival in out-of-hospital car...Farooq Khan
Summary and Critical Appraisal of:
Jacobs et al,"Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial" Resuscitation 82 (2011) 1138– 1143
The DANISH trial investigated whether implanting an ICD in patients with non-ischemic heart failure reduced mortality. Over 67 months of follow-up:
1) ICD implantation did not provide an overall survival benefit compared to usual care.
2) The risk of sudden cardiac death was halved with an ICD.
3) Younger patients and those receiving CRT may benefit more from an ICD.
4) ICDs were associated with device-related complications but reduced inappropriate shocks compared to earlier studies. The trial adds to understanding ICD benefits in non-ischemic heart failure.
My talk in April 2015 Malaysia on Best Practices and Resuscitation Workflow. The new 2015 resuscitation guidelines is expected to be released in Oct 2015.
dual antiplatelet in stroke meta analysisGovind Madhaw
This journal club presentation summarizes a meta-analysis of 18 randomized controlled trials with 15,515 patients comparing dual antiplatelet therapy to mono antiplatelet therapy for secondary stroke prevention in patients with acute ischemic stroke or transient ischemic attack. The meta-analysis found dual antiplatelet therapy significantly reduced the risk of stroke recurrence and composite vascular events compared to monotherapy, without significantly increasing the risk of major bleeding. Sensitivity analyses restricting to double-blind studies showed similar results. The presentation provides details on the search methods, inclusion/exclusion criteria, data extraction, outcomes analyzed, and results of the meta-analysis.
This study analyzed bleeding events among 5,170 patients from the CHANCE trial who received dual antiplatelet therapy (clopidogrel plus aspirin) or aspirin alone for minor stroke or transient ischemic attack. A total of 101 bleeding events occurred, with no significant difference in rates between the treatment groups. However, patients with minor strokes had a higher risk of bleeding than those with transient ischemic attacks. Being elderly, male, and having a history of aspirin or proton pump inhibitor use were associated with greater bleeding risk, while higher body mass index was protective against bleeding.
1) The study investigated whether adherence to lipid-lowering medications predicts initial adherence to CPAP therapy for obstructive sleep apnea.
2) The study found that higher adherence to lipid-lowering medications, as measured by medication refill rates in the previous year, closely predicted higher rates of at least 4 hours per night of CPAP use in the first week of therapy.
3) Demographic and clinical factors like age, race, apnea severity, and obesity did not predict initial CPAP adherence, but adherence to lipid medications did, suggesting a "healthy user bias" may confound studies linking poor CPAP adherence to health outcomes.
This document provides updates on several topics in pediatrics from the past 6 months, as determined by editors and authors to be particularly notable. It includes:
1) Updated recommendations for the diagnosis and treatment of head lice from the American Academy of Pediatrics.
2) A warning from the FDA about potential health risks of over-the-counter homeopathic treatments for asthma.
3) Evidence that head circumference standards may vary between countries/ethnic groups, and local standards may be preferable to WHO standards in some cases.
Identifying Significant Antipsychotic-Related Side Effects in Patients on a Community Psychiatric Rehabilitation Unit-A Feasibility Study of The Glasgow Antipsychotic Side-Effect Scale (GASS) by Ahmed Saeed Yahya* in crimson publishers: Journal of Physical Medicine and Rehabilitation
Antipsychotic side-effects are common and are an important determinant of non-adherence and consequent relapse. Most rating scales for the identification of these are lengthy and complicated. This report reviews the medical literature on the Glasgow antipsychotic side-effect scale (GASS)-a brief and validated rating scale to measure the unwanted effects of antipsychotics. We administered the GASS to fourteen in-patients in a United Kingdom-based Community Psychiatric Rehabilitation Unit. The objective was to establish the utility of the GASS in this setting and to make recommendations on how this tool could be used in clinical practice to improve adherence to antipsychotic medication.
https://crimsonpublishers.com/epmr/fulltext/EPMR.000529.php
For more Open access journals in Crimson Publishers
Please click on: https://crimsonpublishers.com/
For more articles in Examines in Physical Medicine & Rehabilitation
Please click on: https://crimsonpublishers.com/epmr/
Journal Club - EMS - "Effect of adrenaline on survival in out-of-hospital car...Farooq Khan
Summary and Critical Appraisal of:
Jacobs et al,"Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial" Resuscitation 82 (2011) 1138– 1143
The DANISH trial investigated whether implanting an ICD in patients with non-ischemic heart failure reduced mortality. Over 67 months of follow-up:
1) ICD implantation did not provide an overall survival benefit compared to usual care.
2) The risk of sudden cardiac death was halved with an ICD.
3) Younger patients and those receiving CRT may benefit more from an ICD.
4) ICDs were associated with device-related complications but reduced inappropriate shocks compared to earlier studies. The trial adds to understanding ICD benefits in non-ischemic heart failure.
This study aimed to determine if introducing a high-sensitivity cardiac troponin I (hs-cTnI) assay would improve clinical outcomes for patients with suspected acute coronary syndrome. The study was a stepped-wedge, cluster-randomized controlled trial across 10 hospitals in Scotland. It found that the hs-cTnI assay reclassified 17% of patients with myocardial injury or infarction not identified by the standard assay. However, among reclassified patients, the incidence of subsequent heart attack or cardiovascular death within 1 year was not significantly different after implementing the new assay. The findings question whether the diagnostic threshold for heart attack should be based on the 99th percentile from a normal population.
This randomized controlled trial compared the effectiveness and safety of minimal stimulation IVF (mini-IVF) to conventional IVF. 564 women were randomly assigned to either mini-IVF using oral clomiphene and gonadotropins followed by a freeze-all policy, or conventional IVF using high dose gonadotropins and fresh double embryo transfer. The primary outcome was cumulative live birth rate within 6 months, and secondary outcomes included pregnancy rates, ovarian hyperstimulation syndrome, and multiple pregnancy rates. Results showed mini-IVF resulted in comparable live birth rates but significantly lower risks of ovarian hyperstimulation syndrome and multiple pregnancies compared to conventional IVF.
This study evaluated the effects of prehospital continuous positive airway pressure (CPAP) on physiologic measures in 109 patients with acute dyspnea. CPAP improved respiratory rates in 46.4% of patients with an initial rate over 25 breaths per minute. Oxygen saturation improved to over 95% in 34.2% of patients with an initial saturation under 90%. End-tidal carbon dioxide levels improved to under 40 mmHg in 38.9% of patients with initial levels over 40 mmHg. Intubation was required for 11% of patients. The study found that prehospital CPAP resulted in similar levels of improvement in oxygenation and ventilation parameters as seen in previous studies.
We wrote this brief paper to help you to better understand the calculation of sample size. In clinical research, our goal is to make an inference regarding something about a population by studying a sample of that population. This sample has to be representative of the target population, and the number of participants must be appropriate. It should be large enough that the probability of finding differences between groups by mere chance is low and that of detecting true, clinically significant differences is high. Let me know if you have any questions.
This meta-analysis examined 15 clinical trials involving 916 participants to test the hypothesis that eicosapentaenoic acid (EPA) is the effective component in omega-3 polyunsaturated fatty acid (PUFA) supplementation for treating major depressive episodes. The analysis found that supplements containing at least 60% EPA were effective at reducing depression symptoms, while supplements containing less than 60% EPA were ineffective. Exploratory analyses suggested EPA was effective in a dose-dependent manner when the EPA dose exceeded the docosahexaenoic acid (DHA) dose between 200-2200 mg of EPA. The findings provide evidence that EPA, rather than DHA, is likely the active component in PUFA supplementation for treating depression.
This document summarizes two studies that raised questions about the risks and benefits of testosterone therapy:
1. A retrospective study found that male veterans with low testosterone who received testosterone therapy had a higher risk of heart attack, stroke, or death compared to those not receiving therapy, even after adjusting for potential confounding factors.
2. A randomized trial found that adding testosterone to optimized sildenafil therapy for erectile dysfunction provided no additional improvement in erectile function compared to sildenafil alone.
Together these studies highlight the need for more research on the long-term risks and benefits of testosterone therapy, as current understanding is limited despite its increasing use.
This systematic review and meta-analysis evaluated the efficacy of oral corticosteroids for acute wheezing episodes in asthmatic preschoolers. The analysis included 11 randomized controlled trials involving oral corticosteroid treatment compared to placebo. The results showed no significant differences overall between corticosteroids and placebo for hospital admissions, need for additional corticosteroid treatment, or unscheduled visits. However, corticosteroids may reduce hospital admissions and additional corticosteroid need for more severe cases presenting to the emergency department or requiring hospitalization. The evidence was deemed inadequate to form clinical recommendations due to limitations in the studies.
The good news in resuscitation is that there have not been any new advances that mandate a change in practice since the 2016 ANZCOR Guidelines. The bad news is that despite our best intent, the ever-increasing research appears unable to demonstrate improved outcomes with any particular approach. Two of the most exciting areas (eCPR and post-resuscitation care) are being covered in detail at separate talks at this meeting. This presentation will focus on updating the audience on the more continuous approach to evidence evaluation, and the key recent publications that have made us at least re-evaluate our practices in BLS (including ventilation), ALS (including anti-arrhythmics) and peri-resuscitation care.
Clinical trials are studies that compare the effectiveness of two or more treatments. They are important for determining if a new treatment is better than no treatment, an old treatment, or a placebo. Key features of clinical trials include randomization of patients, use of controls, appropriate sample size, blinded assessment, and intention-to-treat analysis. Proper design and conduct of clinical trials can limit bias, but biased interpretation of results remains a risk.
This document summarizes a study that compared two different phenylephrine (PE) infusion rates for preventing hypotension during spinal anesthesia for elective cesarean sections. The study randomized 117 patients to receive either a PE infusion of 50 mcg/min (Group 50) or 100 mcg/min (Group 100). The results found that a PE rate of 50 mcg/min was as effective as 100 mcg/min at maintaining blood pressure within normal ranges. Group 50 also had significantly less maternal bradycardia (1.8% vs 17.4%) compared to Group 100. Neonatal outcomes were similar between the two groups, including Apgar scores, umbilical cord blood gases, and acid-
The document discusses different treatment options for Graves' disease, including antithyroid drugs, radioactive iodine (RAI), and surgery. [1] It finds that while antithyroid drugs and RAI have similar long-term efficacy, RAI is more cost-effective. [2] Carbimazole is preferred over propylthiouracil as it has a more favorable side effect profile and can be taken once daily. [3] Dose titration and block-and-replace regimens have similar efficacy and side effects, though dose titration requires fewer blood tests.
The document summarizes two studies related to airway management during cardiac arrest. The first study by Andersen et al examined whether tracheal intubation during adult in-hospital cardiac arrest is associated with survival to hospital discharge. It found that intubation was associated with lower rates of survival to discharge, return of spontaneous circulation, and favorable functional outcome. The second study by Villafranca et al surveyed healthcare professionals and found high reported rates of exposure to rude or disruptive behaviors in the operating room, which has been shown to negatively impact team performance.
Is early use of combination therapy the solution 35 minute slide setSoM
1) Combination antihypertensive therapy is more effective at controlling blood pressure and reducing cardiovascular events than monotherapy. Studies show combination therapy lowers blood pressure more than doubling the dose of a single drug.
2) The use of single pill combinations can improve medication adherence compared to free drug combinations. This is due to reducing pill burden and side effects. Improved adherence is associated with better blood pressure control and reduced cardiovascular outcomes.
3) Guidelines now recommend initiating treatment of hypertension with two drugs from different classes in a single pill combination, especially for patients with higher risk or uncontrolled blood pressure on monotherapy. Starting with low doses of multiple agents can provide rapid and effective blood pressure reduction.
This systematic review analyzed data from four randomized controlled trials (HIT 1-4) and one additional study to determine the effect of the drug nimodipine on outcomes in patients with traumatic subarachnoid hemorrhage. The review included a total of 1074 patients and found that the occurrence of poor outcome, defined as death, vegetative state or severe disability, was similar between patients treated with nimodipine (39%) and those treated with placebo (40%). Mortality rates also did not differ between the nimodipine group (26%) and placebo group (27%). These results contradict an earlier Cochrane review that reported nimodipine improved outcomes in this patient group.
The document discusses a presentation on the best medical papers of 2015. It summarizes 5 influential papers, including studies on preoperative sedation with lorazepam, supplemental oxygen therapy for normoxic STEMI patients, and the efficacy of chlorhexidine-alcohol versus iodine-alcohol for preventing catheter-related infections.
Murley Meghan Thesis Female Heart Rate Variability - A Pilot Reliability StudyMeghan Murley
This pilot study evaluated the reliability of assessing heart rate variability (HRV) in females. Intra-class correlation values for time domain HRV measures ranged from 0.68-0.98, showing good reliability. Frequency domain measures were less reliable, ranging from 0.68-0.86. Editing ECG data had little impact on HRV measures. Heart rate was significantly lower and stroke volume significantly higher in the supine position compared to sitting. The study demonstrated adequate reliability for measuring HRV to inform a larger study.
Current Issues In Emergency Medicine - A Selected UpdateChew Keng Sheng
This document summarizes several topics in emergency medicine, including:
1) Sensitivity, specificity, positive predictive value, and negative predictive value and how they relate to diagnostic testing.
2) The use of B-type natriuretic peptide (BNP) testing to diagnose acute decompensated heart failure and guidelines on BNP level interpretation.
3) Studies evaluating the use of non-invasive ventilation with continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) to treat acute cardiogenic pulmonary edema.
Nejm journal watch practice changing articles 2014Jaime dehais
This document provides a compilation of summaries of the latest practice-changing articles from NEJM Journal Watch. It includes summaries of articles on topics such as delayed or no antibiotic prescriptions for respiratory infections, physical therapy being beneficial for knee osteoarthritis, low-dose steroids being better than high-dose for COPD exacerbations, a diagnostic algorithm for upper-extremity deep vein thrombosis, evidence that meniscal tears may not require surgery, improvements in mental health with smoking cessation, doubts cast on flu drugs by meta-analyses, the 2014 recommended childhood immunization schedule, sentinel lymph node biopsies for thin melanomas, age-specific d-dimer cutoffs for pulmonary embolism, evidence that FOD
This document provides guidelines for managing acute asthma exacerbations in children aged 0-18 years in emergency department and inpatient settings. It recommends obtaining a brief focused history and physical exam including onset of symptoms, medications, risk factors and triggers. It recommends monitoring response to therapy including clinical exam, asthma score, oxygen saturation and lung function. Initial treatment should include supplemental oxygen if saturation is below 91% and inhaled short-acting beta-2 agonists such as albuterol every 10-20 minutes for a total of 3 doses. The guidelines provide recommendations on inhaler device selection, adjunctive therapies and criteria for admission or discharge.
Consider the following hypothet-ical scenario and results .docxdonnajames55
C
onsider the following hypothet-
ical scenario and results that are
formatted in evidence-based
practice (EBP) language such as those
that you might see in the Cochrane
Collaboration,1 a primary resource for
evidence-based systematic reviews.
Scenario: How effective is a daily
dose of 500 mg of vitamin C in
the prevention of ulcers on the heels of
bedridden elderly clients? Results: With
an NNT of 5, vitamin C is effective (OR,
0.10; 95% CI, 0.05-0.20).
If there are some abbreviations
or values in this situation that are un-
familiar to you, you will find explana-
tions and examples in this article that
will help you in reading, interpreting,
and understanding them as you use
evidence-based literature for your best
practices. Nurses always rise to the
occasion to learn the latest research
information that may improve patient
care and outcomes.
An obstacle to involvement in EBP
is lack of skill in understanding the
‘‘bottom line’’ of systematic reviews
and accompanying risk-related num-
bers.
2-4
Content and research experts
conduct systematic reviews using strict
criteria for inclusion of primary re-
search studies and statistical analysis.
5
The Cochrane Collaboration is a major
resource for more than 1,000 system-
atic reviews of randomized clinical
trials for the effects of healthcare inter-
ventions created through collaboration
of more than 50 worldwide review and
methods teams.6
The systematic review teams basi-
cally seek the response to 1 question:
how many people have a bad outcome
in the experimental group compared
with the control group? Bad outcomes
refer to the undesirable outcomes in a
study, such as development of a heel
ulcer. Noteworthy in EBP statistics is
the simplicity of using a head count
rather than group averages. Even when
individual study results are not statisti-
cally significant, if the experimental
group has fewer bad outcomes than the
control group, the nurse or other pro-
vider might want to apply the results
anyway. Seven terms and their abbre-
viations and formulas are common in
the reported results,7,8 as summarized
in Table 1. In this article, hypothetical
examples and their derivations de-
scribe these 7 terms. At the end, you
can derive these values for a clinical
scenario toward a better understanding
when teaching these terms to others.
Absolute Risk Reduction
Absolute risk reduction (ARR) is the
absolute arithmetic difference (abso-
lute means that one ignores plus and
minus signs) in percentages of bad
outcomes between the experimental
and control groups. Absolute risk reduc-
tion means that more people in the
control group than in the experimen-
tal group develop a bad outcome. To
calculate the ARR, you need to know
just 2 things: the experimental event
rate (EER), or the percentage of the
bad outcome in the experimental group;
and the control group event rate (CER),
or the percentage of the bad outcome in
the control group. Let us look at an ex-
ample: 13% of patients with diabetes
receiv.
This study evaluated the effectiveness of low-fractional concentration continuous positive airway pressure (CPAP) in the prehospital setting. 340 patients with respiratory distress were treated with CPAP providing a fixed oxygen concentration of 28-30%. Improvements were seen in respiratory rate and oxygen saturation levels. CPAP was discontinued for 16.5% of patients, mostly due to anxiety or requiring intubation. 71.5% of patients' conditions were improved with CPAP treatment based on paramedic assessment. The results suggest CPAP with a low fixed oxygen concentration is effective for commonly encountered respiratory emergencies in the prehospital setting.
This study aimed to determine if introducing a high-sensitivity cardiac troponin I (hs-cTnI) assay would improve clinical outcomes for patients with suspected acute coronary syndrome. The study was a stepped-wedge, cluster-randomized controlled trial across 10 hospitals in Scotland. It found that the hs-cTnI assay reclassified 17% of patients with myocardial injury or infarction not identified by the standard assay. However, among reclassified patients, the incidence of subsequent heart attack or cardiovascular death within 1 year was not significantly different after implementing the new assay. The findings question whether the diagnostic threshold for heart attack should be based on the 99th percentile from a normal population.
This randomized controlled trial compared the effectiveness and safety of minimal stimulation IVF (mini-IVF) to conventional IVF. 564 women were randomly assigned to either mini-IVF using oral clomiphene and gonadotropins followed by a freeze-all policy, or conventional IVF using high dose gonadotropins and fresh double embryo transfer. The primary outcome was cumulative live birth rate within 6 months, and secondary outcomes included pregnancy rates, ovarian hyperstimulation syndrome, and multiple pregnancy rates. Results showed mini-IVF resulted in comparable live birth rates but significantly lower risks of ovarian hyperstimulation syndrome and multiple pregnancies compared to conventional IVF.
This study evaluated the effects of prehospital continuous positive airway pressure (CPAP) on physiologic measures in 109 patients with acute dyspnea. CPAP improved respiratory rates in 46.4% of patients with an initial rate over 25 breaths per minute. Oxygen saturation improved to over 95% in 34.2% of patients with an initial saturation under 90%. End-tidal carbon dioxide levels improved to under 40 mmHg in 38.9% of patients with initial levels over 40 mmHg. Intubation was required for 11% of patients. The study found that prehospital CPAP resulted in similar levels of improvement in oxygenation and ventilation parameters as seen in previous studies.
We wrote this brief paper to help you to better understand the calculation of sample size. In clinical research, our goal is to make an inference regarding something about a population by studying a sample of that population. This sample has to be representative of the target population, and the number of participants must be appropriate. It should be large enough that the probability of finding differences between groups by mere chance is low and that of detecting true, clinically significant differences is high. Let me know if you have any questions.
This meta-analysis examined 15 clinical trials involving 916 participants to test the hypothesis that eicosapentaenoic acid (EPA) is the effective component in omega-3 polyunsaturated fatty acid (PUFA) supplementation for treating major depressive episodes. The analysis found that supplements containing at least 60% EPA were effective at reducing depression symptoms, while supplements containing less than 60% EPA were ineffective. Exploratory analyses suggested EPA was effective in a dose-dependent manner when the EPA dose exceeded the docosahexaenoic acid (DHA) dose between 200-2200 mg of EPA. The findings provide evidence that EPA, rather than DHA, is likely the active component in PUFA supplementation for treating depression.
This document summarizes two studies that raised questions about the risks and benefits of testosterone therapy:
1. A retrospective study found that male veterans with low testosterone who received testosterone therapy had a higher risk of heart attack, stroke, or death compared to those not receiving therapy, even after adjusting for potential confounding factors.
2. A randomized trial found that adding testosterone to optimized sildenafil therapy for erectile dysfunction provided no additional improvement in erectile function compared to sildenafil alone.
Together these studies highlight the need for more research on the long-term risks and benefits of testosterone therapy, as current understanding is limited despite its increasing use.
This systematic review and meta-analysis evaluated the efficacy of oral corticosteroids for acute wheezing episodes in asthmatic preschoolers. The analysis included 11 randomized controlled trials involving oral corticosteroid treatment compared to placebo. The results showed no significant differences overall between corticosteroids and placebo for hospital admissions, need for additional corticosteroid treatment, or unscheduled visits. However, corticosteroids may reduce hospital admissions and additional corticosteroid need for more severe cases presenting to the emergency department or requiring hospitalization. The evidence was deemed inadequate to form clinical recommendations due to limitations in the studies.
The good news in resuscitation is that there have not been any new advances that mandate a change in practice since the 2016 ANZCOR Guidelines. The bad news is that despite our best intent, the ever-increasing research appears unable to demonstrate improved outcomes with any particular approach. Two of the most exciting areas (eCPR and post-resuscitation care) are being covered in detail at separate talks at this meeting. This presentation will focus on updating the audience on the more continuous approach to evidence evaluation, and the key recent publications that have made us at least re-evaluate our practices in BLS (including ventilation), ALS (including anti-arrhythmics) and peri-resuscitation care.
Clinical trials are studies that compare the effectiveness of two or more treatments. They are important for determining if a new treatment is better than no treatment, an old treatment, or a placebo. Key features of clinical trials include randomization of patients, use of controls, appropriate sample size, blinded assessment, and intention-to-treat analysis. Proper design and conduct of clinical trials can limit bias, but biased interpretation of results remains a risk.
This document summarizes a study that compared two different phenylephrine (PE) infusion rates for preventing hypotension during spinal anesthesia for elective cesarean sections. The study randomized 117 patients to receive either a PE infusion of 50 mcg/min (Group 50) or 100 mcg/min (Group 100). The results found that a PE rate of 50 mcg/min was as effective as 100 mcg/min at maintaining blood pressure within normal ranges. Group 50 also had significantly less maternal bradycardia (1.8% vs 17.4%) compared to Group 100. Neonatal outcomes were similar between the two groups, including Apgar scores, umbilical cord blood gases, and acid-
The document discusses different treatment options for Graves' disease, including antithyroid drugs, radioactive iodine (RAI), and surgery. [1] It finds that while antithyroid drugs and RAI have similar long-term efficacy, RAI is more cost-effective. [2] Carbimazole is preferred over propylthiouracil as it has a more favorable side effect profile and can be taken once daily. [3] Dose titration and block-and-replace regimens have similar efficacy and side effects, though dose titration requires fewer blood tests.
The document summarizes two studies related to airway management during cardiac arrest. The first study by Andersen et al examined whether tracheal intubation during adult in-hospital cardiac arrest is associated with survival to hospital discharge. It found that intubation was associated with lower rates of survival to discharge, return of spontaneous circulation, and favorable functional outcome. The second study by Villafranca et al surveyed healthcare professionals and found high reported rates of exposure to rude or disruptive behaviors in the operating room, which has been shown to negatively impact team performance.
Is early use of combination therapy the solution 35 minute slide setSoM
1) Combination antihypertensive therapy is more effective at controlling blood pressure and reducing cardiovascular events than monotherapy. Studies show combination therapy lowers blood pressure more than doubling the dose of a single drug.
2) The use of single pill combinations can improve medication adherence compared to free drug combinations. This is due to reducing pill burden and side effects. Improved adherence is associated with better blood pressure control and reduced cardiovascular outcomes.
3) Guidelines now recommend initiating treatment of hypertension with two drugs from different classes in a single pill combination, especially for patients with higher risk or uncontrolled blood pressure on monotherapy. Starting with low doses of multiple agents can provide rapid and effective blood pressure reduction.
This systematic review analyzed data from four randomized controlled trials (HIT 1-4) and one additional study to determine the effect of the drug nimodipine on outcomes in patients with traumatic subarachnoid hemorrhage. The review included a total of 1074 patients and found that the occurrence of poor outcome, defined as death, vegetative state or severe disability, was similar between patients treated with nimodipine (39%) and those treated with placebo (40%). Mortality rates also did not differ between the nimodipine group (26%) and placebo group (27%). These results contradict an earlier Cochrane review that reported nimodipine improved outcomes in this patient group.
The document discusses a presentation on the best medical papers of 2015. It summarizes 5 influential papers, including studies on preoperative sedation with lorazepam, supplemental oxygen therapy for normoxic STEMI patients, and the efficacy of chlorhexidine-alcohol versus iodine-alcohol for preventing catheter-related infections.
Murley Meghan Thesis Female Heart Rate Variability - A Pilot Reliability StudyMeghan Murley
This pilot study evaluated the reliability of assessing heart rate variability (HRV) in females. Intra-class correlation values for time domain HRV measures ranged from 0.68-0.98, showing good reliability. Frequency domain measures were less reliable, ranging from 0.68-0.86. Editing ECG data had little impact on HRV measures. Heart rate was significantly lower and stroke volume significantly higher in the supine position compared to sitting. The study demonstrated adequate reliability for measuring HRV to inform a larger study.
Current Issues In Emergency Medicine - A Selected UpdateChew Keng Sheng
This document summarizes several topics in emergency medicine, including:
1) Sensitivity, specificity, positive predictive value, and negative predictive value and how they relate to diagnostic testing.
2) The use of B-type natriuretic peptide (BNP) testing to diagnose acute decompensated heart failure and guidelines on BNP level interpretation.
3) Studies evaluating the use of non-invasive ventilation with continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) to treat acute cardiogenic pulmonary edema.
Nejm journal watch practice changing articles 2014Jaime dehais
This document provides a compilation of summaries of the latest practice-changing articles from NEJM Journal Watch. It includes summaries of articles on topics such as delayed or no antibiotic prescriptions for respiratory infections, physical therapy being beneficial for knee osteoarthritis, low-dose steroids being better than high-dose for COPD exacerbations, a diagnostic algorithm for upper-extremity deep vein thrombosis, evidence that meniscal tears may not require surgery, improvements in mental health with smoking cessation, doubts cast on flu drugs by meta-analyses, the 2014 recommended childhood immunization schedule, sentinel lymph node biopsies for thin melanomas, age-specific d-dimer cutoffs for pulmonary embolism, evidence that FOD
This document provides guidelines for managing acute asthma exacerbations in children aged 0-18 years in emergency department and inpatient settings. It recommends obtaining a brief focused history and physical exam including onset of symptoms, medications, risk factors and triggers. It recommends monitoring response to therapy including clinical exam, asthma score, oxygen saturation and lung function. Initial treatment should include supplemental oxygen if saturation is below 91% and inhaled short-acting beta-2 agonists such as albuterol every 10-20 minutes for a total of 3 doses. The guidelines provide recommendations on inhaler device selection, adjunctive therapies and criteria for admission or discharge.
Consider the following hypothet-ical scenario and results .docxdonnajames55
C
onsider the following hypothet-
ical scenario and results that are
formatted in evidence-based
practice (EBP) language such as those
that you might see in the Cochrane
Collaboration,1 a primary resource for
evidence-based systematic reviews.
Scenario: How effective is a daily
dose of 500 mg of vitamin C in
the prevention of ulcers on the heels of
bedridden elderly clients? Results: With
an NNT of 5, vitamin C is effective (OR,
0.10; 95% CI, 0.05-0.20).
If there are some abbreviations
or values in this situation that are un-
familiar to you, you will find explana-
tions and examples in this article that
will help you in reading, interpreting,
and understanding them as you use
evidence-based literature for your best
practices. Nurses always rise to the
occasion to learn the latest research
information that may improve patient
care and outcomes.
An obstacle to involvement in EBP
is lack of skill in understanding the
‘‘bottom line’’ of systematic reviews
and accompanying risk-related num-
bers.
2-4
Content and research experts
conduct systematic reviews using strict
criteria for inclusion of primary re-
search studies and statistical analysis.
5
The Cochrane Collaboration is a major
resource for more than 1,000 system-
atic reviews of randomized clinical
trials for the effects of healthcare inter-
ventions created through collaboration
of more than 50 worldwide review and
methods teams.6
The systematic review teams basi-
cally seek the response to 1 question:
how many people have a bad outcome
in the experimental group compared
with the control group? Bad outcomes
refer to the undesirable outcomes in a
study, such as development of a heel
ulcer. Noteworthy in EBP statistics is
the simplicity of using a head count
rather than group averages. Even when
individual study results are not statisti-
cally significant, if the experimental
group has fewer bad outcomes than the
control group, the nurse or other pro-
vider might want to apply the results
anyway. Seven terms and their abbre-
viations and formulas are common in
the reported results,7,8 as summarized
in Table 1. In this article, hypothetical
examples and their derivations de-
scribe these 7 terms. At the end, you
can derive these values for a clinical
scenario toward a better understanding
when teaching these terms to others.
Absolute Risk Reduction
Absolute risk reduction (ARR) is the
absolute arithmetic difference (abso-
lute means that one ignores plus and
minus signs) in percentages of bad
outcomes between the experimental
and control groups. Absolute risk reduc-
tion means that more people in the
control group than in the experimen-
tal group develop a bad outcome. To
calculate the ARR, you need to know
just 2 things: the experimental event
rate (EER), or the percentage of the
bad outcome in the experimental group;
and the control group event rate (CER),
or the percentage of the bad outcome in
the control group. Let us look at an ex-
ample: 13% of patients with diabetes
receiv.
This study evaluated the effectiveness of low-fractional concentration continuous positive airway pressure (CPAP) in the prehospital setting. 340 patients with respiratory distress were treated with CPAP providing a fixed oxygen concentration of 28-30%. Improvements were seen in respiratory rate and oxygen saturation levels. CPAP was discontinued for 16.5% of patients, mostly due to anxiety or requiring intubation. 71.5% of patients' conditions were improved with CPAP treatment based on paramedic assessment. The results suggest CPAP with a low fixed oxygen concentration is effective for commonly encountered respiratory emergencies in the prehospital setting.
1) The document discusses issues with relying solely on statistical significance (p-values) to determine clinical significance. While p-values indicate if results could be due to chance, they do not provide information on the size of the treatment effect or its clinical meaningfulness.
2) Effect sizes and confidence intervals provide a measure of the magnitude of the treatment effect but do not necessarily indicate clinical significance on their own.
3) The document argues that clinical significance should be determined based on external standards from patients and clinicians regarding what would constitute a meaningful improvement, rather than solely on statistical measures.
Nursing Research JanuaryFebruary 2010 Vol 59, No 1, 18–25.docxcherishwinsland
Nursing Research � January/February 2010 � Vol 59, No 1, 18–25
Effectiveness of an Aspiration
Risk-Reduction Protocol
Norma A. Metheny 4 Jami Davis-Jackson 4 Barbara J. Stewart
b Background: Aspiration of gastric contents is a serious prob-
lem in critically ill, mechanically ventilated patients receiving
tube feedings.
b Objectives: The purpose of this study was to evaluate the
effectiveness of a three-pronged intervention to reduce as-
piration risk in a group of critically ill, mechanically ventilated
patients receiving tube feedings.
b Methods: A two-group quasi-experimental design was used
to compare outcomes of a usual care group (December
2002YSeptember 2004) with those of an Aspiration Risk-
Reduction Protocol (ARRP) group (January 2007YApril
2008). The incidence of aspiration and pneumonia was
compared between the usual care group (n = 329) and the
ARRP group (n = 145). The ARRP had three components:
maintaining head-of-bed elevation at 30- or higher, unless
contraindicated; inserting feeding tubes into distal small
bowel, when indicated; and using an algorithmic approach
for high gastric residual volumes.
b Results: Two of the three ARRP components were imple-
mented successfully. Almost 90% of the ARRP group had
mean head-of-bed elevations of 30- or higher as compared to
38% in the usual care group. Almost three fourths of the ARRP
group had feeding tubes placed in the small bowel as com-
pared with less than 50% in the usual care group. Only three
patients met the criteria for the high gastric residual volume
algorithm. Aspiration was much lower in the ARRP group than
that in the usual care group (39% vs. 88%, respectively).
Similarly, pneumonia was much lower in the ARRP group than
that in the usual care group (19% vs. 48%, respectively).
b Discussion: Findings from this study suggest that a combi-
nation of a head-of-bed position elevated to at least 30- and
use of a small-bowel feeding site can reduce the incidence
of aspiration and aspiration-related pneumonia dramatically
in critically ill, tube-fed patients.
b Key Words: enteral nutrition & preventive measures & respiratory
aspiration
Frequent aspiration of gastric contents predisposes tube-fed patients to pneumonia, especially those who are
critically ill and mechanically ventilated. Airway protection
from regurgitated gastric contents often is impaired in these
patients by underlying illness, sedation, or both. A number of
interventions have been proposed to minimize aspiration. For
example, a research-based guideline issued by the Centers for
Disease Control and Prevention recommends a head-of-bed
position elevated to at least 30- to reduce risk for aspiration-
related pneumonia (Tablan et al., 2004). Further, a fre-
quently cited study of aspiration in mechanically ventilated
patients found that aspiration was significantly more likely
when patients were supine; however, it also occurred when
they were semirecumbent (Torres et al., 1992). .
This randomized controlled trial compared the efficacy of low-dose aspirin alone versus low-dose aspirin plus low molecular weight heparin in preventing pregnancy loss in women with antiphospholipid syndrome and recurrent miscarriage. 98 women were randomized to receive either low-dose aspirin alone (Group A) or low-dose aspirin plus low molecular weight heparin (Group B). The live birth rate was 72% for Group A and 78% for Group B, with no significant difference between the groups. Adding low molecular weight heparin to low-dose aspirin did not significantly improve pregnancy outcomes for women with antiphospholipid syndrome.
What is the Association between COPD and HRQoL in Manchester in 2011? Helen Beaumont-Kellner
This study examined the association between Chronic Obstructive Pulmonary Disease (COPD) and health-related quality of life in Manchester, UK in 2011. The study found that COPD patients reported lower health-related quality of life scores compared to a control group without chronic conditions. COPD patients were also more likely to be current or former smokers and less likely to have received education after age 16. However, the study had some limitations due to its small sample size and inability to account for all confounding variables like age.
A Comprehensive Review of Studies Related to Chinese Herbal Medicine suzi smith
A Comprehensive Review of Studies Related to Chinese Herbal Medicine and Traditional Chinese Medicine (TCM) in Conjunction with Assisted Reproductive Technology (ART), IVF, and IUI for Male and Female Infertility
The document summarizes research on treatments for idiopathic pulmonary fibrosis (IPF). It describes IPF as a fatal lung disease characterized by lung scarring. Two drugs are discussed: pirfenidone and nintedanib. Regarding pirfenidone, the document outlines clinical trials that demonstrated its ability to reduce lung function decline in IPF patients. For nintedanib, two replicate trials found it significantly reduced the rate of lung function decline compared to placebo and reduced the risk of acute exacerbations, though it commonly caused diarrhea. Both drugs represent new treatment options for slowing the progression of IPF.
Questioning the Use of Epinephrine to Treat Cardiac ArrestEmergency Live
"The role of epinephrine drug therapy during cardiac arrest:A properly evaluation of this traditional therapy seems necessary"
Clifton W. Callaway, MD, PhD on JAMA, dec 2012
This document provides a drug class update and new drug evaluation for asthma and COPD maintenance medications. It summarizes evidence from guidelines and studies published since the previous review. For asthma, evidence supports current preferred treatments and the use of ICS/LABA as controller and quick relief therapy. Adding LAMA to ICS may reduce exacerbations in uncontrolled asthma. New evidence for COPD is consistent with guidelines. Limited data found revefenacin increases lung function versus placebo but safety is similar to other LAMAs. No changes to preferred treatments or prior authorization criteria are recommended.
This study assessed the relationship between non-compliance to antihypertensive treatment and the development of stroke using a case-control design. The study found that non-compliance to medication, diet, exercise, alcohol restrictions and smoking increased the odds of developing stroke among hypertensive patients. Overall, the study concluded that non-compliance to an antihypertensive management regimen significantly increased the risk of stroke.
The document discusses evidence-based medicine (EBM), which involves using the best current evidence from clinical research in medical decision making. It provides definitions of EBM and outlines its benefits, such as better patient outcomes and generalizable information. However, some criticisms of EBM are that it can promote a "cookbook" approach and ignore patient values. The key steps in EBM are formulating a clear clinical question, searching for evidence, appraising the evidence, and applying it to patients. Questions are structured using PICO (patient/problem, intervention, comparison, outcome). While EBM aims to use high-quality evidence, the document notes that for many treatments, there is little or poor quality evidence to guide decisions.
This study evaluated whether continuing dual antiplatelet therapy (DAPT) beyond one year after drug-eluting stent placement reduces adverse events. It was a large randomized controlled trial comparing aspirin + thienopyridine to aspirin + placebo in patients who had completed one year of standard DAPT. Continuing thienopyridine therapy until 30 months reduced stent thrombosis and major adverse cardiovascular events, but increased moderate or severe bleeding risks compared to placebo. The study provides evidence that prolonging DAPT to 30 months may benefit patients who complete one year of standard therapy without adverse events.
This document discusses evidence-based medicine and its advantages. It explains that evidence-based medicine involves integrating the best available medical research with clinical expertise and patient values and preferences. This is superior to past practices of relying solely on physician experience and judgment. Evidence-based medicine can help improve quality and safety, more quickly incorporate research findings into practice, and potentially reduce healthcare costs.
This study examined the relationship between nebulizer treatments administered by respiratory therapy (RT) students and changes in their lung function over one year, as measured by monthly spirometry tests. The study found a significant correlation between higher numbers of nebulizer treatments and greater declines in the students' FEF75 and FEF25-75 scores. However, the small sample size and short study duration limit the ability to draw broad conclusions about long-term effects. Larger and longer studies are needed to further investigate the potential impacts of repeated nebulizer treatments on RT lung health.
Works Cited Milne, Anne C., Alison Avenell, and Jan Potter. Meta-.docxkeilenettie
Works Cited
Milne, Anne C., Alison Avenell, and Jan Potter. "Meta-Analysis: Protein and Energy Supplementation in Older People."
Annals of Internal Medicine
144.1 (2006): 37-48.
ProQuest.
Web. 1 Oct. 2014.
Meta-Analysis: Protein and Energy Supplementation in Older People Anne C. Milne, MSc; Alison Avenell, MD; and Jan Potter, MBChB Background: Protein and energy undernutrition is common in older people, and further deterioration may occur during illness. Purpose: To assess whether oral protein and energy supplementa tion improves clinical and
nutritional outcomes for older people in the hospital, in an institution, or in the community. Data Sources: Cochrane Central Register of Controlled Trials (CEN TRAL), MEDLINE, EMBASE,
HealthStar, CINAHL, BIOSIS, and CAB abstracts. The authors included English- and non-English-language studies and hand-searched journals, contacted manufacturers, and sought information from trialists. The date of the most recent search of CENTRAL and MEDLINE is June 2005. Study Selection: Randomized and quasi-randomized controlled tri als of oral protein and energy
supplementation compared with placebo or control treatment in older people. Data Extraction: Two reviewers independently assessed trials for inclusion, extracted data, and assessed trial quality. Differences were resolved by consensus. Data Synthesis: Fifty-five trials were included (n = 9187 randomly tions (Peto odds ratio, 0.72 [95% Cl, 0.53 to 0.97]) and reduced mortality (Peto odds ratio, 0.66 [CI, 0.49 to 0.90]) for those un dernourished at baseline. Few studies reported evidence that suggested any change in mortality, morbidity, or function for those given supplements at home. Ten trials reported gastrointestinal disturbances, such as nausea, vomiting, and diarrhea, with oral supplements. Limitations: The quality of most studies, as reported, was poor, particularly for concealment of allocation and blinding of outcome assessors. Many studies were too small or the follow-up time was too short to detect a statistically significant change in clinical out come. The clinical results are dominated by 1 very large recent trial in patients with stroke. Although this was a high-quality trial, few participants were undernourished at baseline. Conclusions: Oral nutritional supplements can improve nutritional status and seem to reduce mortality and complications for under nourished elderly patients in the hospital. Current evidence does not support routine supplementation for older people at home or for well-nourished older patients in any setting. assigned participants). For patients in short-term care hospitals who were given oral supplements, evidence suggested fewer complica-Ann Intern Med. 2006:144:37-48. For author affiliations, see end of text.
www.annals.OIJ
ndernutrition among older people is a continuing source of concern (1, 2). Older people have longer periods of illness and longer hospital stays (3), and data show tha.
This study performed a cost-effectiveness analysis comparing a low-cost bubble CPAP device to nasal oxygen therapy for treating neonatal respiratory distress in Malawi. The bubble CPAP was found to be more effective, providing 6.78 additional life years on average compared to nasal oxygen. However, it was also more costly at $57.78 per patient versus $29.29 for nasal oxygen. The incremental cost-effectiveness ratio for bubble CPAP was $4.20 per additional life year gained. Subgroup analyses found bubble CPAP to be highly cost-effective for neonates with very low birth weights, respiratory distress syndrome, or sepsis. The study concluded that bubble CPAP represents a cost-effective strategy for ventil
Nocebo hyperalgesia partial reinforcement and extinction Paul Coelho, MD
This study investigated whether partial reinforcement (PRF) can induce nocebo hyperalgesia, and whether nocebo hyperalgesia extinguishes after conditioning. 135 participants received electrocutaneous stimulation and were told a device could increase pain sensitivity. Those in the continuous reinforcement (CRF) group always felt increased pain with the device, while the PRF group felt it 62.5% of the time. Both CRF and PRF induced nocebo hyperalgesia, but it was weaker under PRF. Nocebo hyperalgesia failed to extinguish for either group. This suggests PRF may reduce nocebo hyperalgesia intensity in clinical settings, and that once established, no
Association of Hypertension and Pulmonary Functions-Association between cardiac dysfunction and abnormal pulmonary function has remained controversial since long. The objective of this study is to find out the association of hypertension and its severity on pulmonary functions. Study was conducted on 30 hypertensive (study group) and 30 non hypertensive (control group) subjects identified from Medical OPD of SMS Hospital, Jaipur. Pulmonary functions were assessed of both hypertensive (study group) and non hypertensive (control group) subjects by Medspiror). Among pulmonary function tests, difference in means of FVC, FEV1 PEFR, FEF25-75%, MVV and FVC/ FEV1 were found less with significant difference in cases group with predominantly restrictive type of effects are observed. Female’s shows lower values than male hypertensive subjects. Furthermore, FVC, FEV1, PEFR, FEF25-75%, MVV, FVC/ FEV1 were not found to be associated with severity of illness. An inverse relation is found between hypertension and pulmonary functions predominantly restrictive type of pattern. While non significant effects are observed with severity of illness.
Les NVPO sont un événement fréquent en post-anesthésie puisqu'ils touchent environ un tiers des patients. Les différents scores et prophylaxies utilisées bien que souvent efficaces ne closent pas le chapitre de leur prévention. La gabapentine, antivonvusilvant, a montré par ailleurs son effet analgésique en post-opératoire.
Plus récemment, la gabapentine a montré un effet anti-émétique lorsqu'elle était administrée en prévention dans la chimiothérapie du cancer du sein.
Cette étude est une méta-analyse des essais randomisés de la gabapentine en prévention des NVPO. Elle conclut à son efficacité, efficacité d'autant plus marquée que le propofol n'est pas utilisé comme agent d'induction et/ou d'entretien.
Le degré de relâchement musculaire en chirurgie coelioscopique de la vésicule biliaire fait partie du quotidien des discussions entre anesthésistes et chirurgiens au bloc opératoire. Au fond tous sont convaincus de l'efficacité du curare : le chirurgien qui le demande et l'anesthésiste qui pense lui à sa décurarisation.
Cette étude teste curarisation profonde versus curarisation de routine dans la chirurgie coelioscopique de la vésicule biliaire. Avec comme première question "est-ce qu'une curarisation profonde permet de travaillert avec une pression abdominable moindre?", pression dont on sait qu'elle est pourvoyeuse de douleur post-opératoire.
La réponse est que le degré de curarisation participe de façon marginale au confort du chirurgien... et ne permet pas plus fréquemment de travailler à pression abdominale basse.
This document summarizes a study that evaluated the World Health Organization Disability Assessment Schedule 2.0 (WHODAS) as a tool for measuring postoperative disability. The study assessed WHODAS in 510 surgical patients across multiple timepoints. Results showed WHODAS demonstrated good criterion and convergent validity when compared to other measures of quality of recovery, physical functioning, quality of life and pain. WHODAS also showed excellent internal consistency and responsiveness over time. The study concludes WHODAS is a clinically valid, reliable and responsive tool for measuring postoperative disability in diverse surgical populations.
Thiruvenkatarajan et al-2015-anaesthesiasamirsharshar
Cranial nerve injuries are a rare but serious complication of supraglottic airway device use. The review identified 56 cases of cranial nerve injuries reported in the literature. Lingual nerve injury was most common (22 patients), followed by recurrent laryngeal nerve injury (17 patients). Recurrent laryngeal nerve injury can cause hoarseness, dysphagia, and in severe bilateral cases, respiratory distress requiring intubation or tracheostomy. Contributing factors to injury included inappropriate device size, overinflated cuffs, patient positioning, and surgical duration. Most injuries resolved with conservative treatment, but some patients had persisting voice impairment or required surgical intervention.
This study analyzed data from the Danish Anaesthesia Database to evaluate the diagnostic accuracy of anesthesiologists' predictions of difficult airway management. The study included 188,064 patients who underwent tracheal intubation or mask ventilation. For tracheal intubation, 93% of difficult intubations were unanticipated by anesthesiologists. When a difficult intubation was anticipated, it was correct only 25% of the time. Similarly, 94% of difficult mask ventilations were unanticipated, and when anticipated, it was correct 22% of the time. The results suggest anesthesiologists' predictions of difficult airway management have low sensitivity and positive predictive value, but remain an important part of preparation
The document summarizes a study that investigated whether adding hyaluronidase to ropivacaine reduces the time to achieve complete sensory block after axillary brachial plexus block. Patients were randomly assigned to receive ropivacaine with or without hyaluronidase. The study found that the group receiving ropivacaine with hyaluronidase had a significantly shorter mean time to achieve complete sensory block, sensory block onset time, and time to reach surgical anesthesia compared to the control group receiving ropivacaine alone. Addition of hyaluronidase to ropivacaine resulted in faster blockade times for axillary brachial plexus blocks.
The document summarizes research on the impact of autonomic dysfunction on peri-operative cardiovascular complications. It finds that cardiovascular autonomic neuropathy is common in diabetic patients and can lead to haemodynamic instability during anesthesia due to the interplay between the neuropathy and anesthesia's effects on autonomic function. Depending on the type of anesthesia used, autonomic neuropathy can affect peri-operative haemodynamics and postoperative recovery in surgical patients. Pre-operative testing of autonomic function may help reduce cardiovascular complications by identifying patients at risk.
Wijeysundera et al-2015-anesthesia_&_analgesiasamirsharshar
- The study found that patients managed by high-performing anesthesiologists experienced rates of postoperative death or major complications that were 45% lower than rates among patients managed by low-performing anesthesiologists.
- This confirms an implicit understanding among anesthesiologists that individual skill and performance varies, and that choice of anesthesiologist can impact patient outcomes, especially during complex high-risk procedures.
- Further research is needed to identify factors that explain variations in performance, such as procedure volume, and to leverage variations to identify best perioperative practices.
This document summarizes a study that tested the effectiveness of a brief smoking cessation intervention for surgical patients. The intervention included brief counseling, smoking cessation brochures, free nicotine patches, and referral to a quitline. It significantly increased smoking abstinence before and after surgery compared to standard care. The results suggest that even relatively simple interventions can help many surgical patients quit smoking long-term.
Terrando et al-2015-anesthesia_&_analgesiasamirsharshar
This article summarizes discussions from a workshop on perioperative neurotoxicity in the elderly. The workshop included presentations on:
1) Preclinical evidence that surgery and anesthesia can cause neuroinflammation and cognitive impairment in rodent models, especially in vulnerable populations like the elderly.
2) Emerging human biomarkers like CSF tau levels that show potential to objectively measure postoperative neuronal injury and predict cognitive outcomes.
3) Preliminary clinical studies finding associations between postoperative cytokines, blood-brain barrier disruption, and delirium; however, interventions like glucocorticoids have not proven effective yet.
4) The need for standardized nomenclature and consideration of preexisting patient vulnerabilities in clinical studies to help resolve
1) A study showed that the choice of anesthesiologist affects outcomes in cardiac surgery, with patients of low-performing anesthesiologists having twice the rate of death or complications compared to patients of high-performing anesthesiologists.
2) While some view anesthesiologists as interchangeable, the results demonstrate that individual anesthesiologists can significantly impact outcomes.
3) Additional studies discussed in the document examine how better understanding differences in provider performance and standardizing best practices can help improve outcomes for all patients.
This document summarizes factors that determine the need for sedation during regional anesthesia. It discusses how sedation is routinely used during regional anesthesia but may not always be necessary and can have adverse effects, especially in older or higher risk patients. It suggests that alternatives to sedation like hypnosis, music, or conversation may provide adequate comfort for many patients during procedures when regional anesthesia is used. More research is still needed but moving away from routinely asking "do you want to be asleep?" and only using sedation when truly indicated could help reduce risks.
This randomized controlled trial evaluated the effectiveness of a perioperative smoking cessation intervention on long-term smoking abstinence rates. The intervention involved brief counseling, smoking cessation materials, referral to a quitline, and nicotine replacement therapy. At the 1-year follow-up, smoking cessation was reported in 25% of patients who received the intervention compared to 8% of control patients. Lower nicotine dependence at baseline and receiving the intervention were predictive of long-term smoking cessation. The study demonstrates that a minimally intensive perioperative smoking cessation intervention can significantly increase smoking abstinence rates not just short-term but also at 1 year postoperatively.
To meet the need for qualified anesthetists during the Civil War and latter 19th century, American surgeons recruited nurses to practice anesthesia. This collaboration was successful and led surgeons to work more formally with nurses at the Mayo Clinic in Minnesota. During this time period, nurses like Alice Magaw and Florence Henderson refined the safe administration of ether at hospitals. Their work improved safety and enabled surgeons like those at the Mayo Clinic to perform more complex surgeries. Other notable surgeon-nurse collaborations included George Crile working with Agatha Hodgins to introduce nitrous oxide/oxygen anesthesia, and William Halsted working closely with Margaret Boise. As surgery advanced, collaboration between surgeons and nurse anesthetists became routine and necessary to
Kancir et al-2015-anesthesia_&_analgesiasamirsharshar
This randomized controlled trial investigated the effect of hydroxyethyl starch (HES) on renal function in patients undergoing radical prostatectomy. Forty patients received either 6% HES 130/0.4 or saline during surgery. Urine and blood samples were collected before, during, and after surgery to measure markers of renal function like urinary neutrophil gelatinase-associated lipocalin (u-NGAL), creatinine clearance, and urine output. While blood loss was higher in the HES group, the study found no significant differences in the measured markers of renal function between the HES and saline groups. This suggests that 6% HES 130/0.4 did not negatively impact renal function in patients with normal preoperative
This editorial discusses the limitations of predicting difficult airways. It summarizes a large study that found the vast majority of difficult intubations were unanticipated. It argues that the "difficult airway" does not truly exist, as there are over a million possible combinations of patient, provider, equipment and circumstances that could impact airway management success. Current prediction models and documentation methods are unreliable. The complexity of airway management means accurately anticipating problems is very difficult. The editorial concludes that focusing on standardized documentation and emphasizing skills and preparedness over prediction may be a better approach.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.