ORCID Profile
0000-0003-2864-0045
Current Organisation
The Chinese University of Hong Kong Faculty of Medicine
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Publisher: Elsevier BV
Date: 11-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2006
DOI: 10.1097/00000542-200610000-00012
Abstract: The purpose of this study was to determine an optimum dose of alfentanil, coadministered with 2.5 mg/kg propofol, when inserting a classic laryngeal mask airway. Seventy-five adult ethnic Chinese patients with an American Society of Anesthesiologists physiologic status classification I or II and requiring anesthesia for minor surgery with a laryngeal mask were recruited. They were randomly assigned to five dosage groups: placebo or 5, 10, 15, or 20 microg/kg. The study drug plus propofol were administered, and 90 s later, insertion conditions were assessed using a six-category score. The duration of apnea was recorded. A probit analysis was performed and used to estimate the ED50 and ED95 with 95% confidence intervals for each assessment. Twenty-five male and 50 female patients, aged 18-59 yr, were studied. The five groups were similar. Laryngeal mask insertion was successful in all but one alfentanil patient. Duration of apnea increased with increasing dosage of alfentanil to over 5 min (P & 0.001). Dose-responses could not be predicted for categories of resistance to mouth opening and to insertion. For the other four categories, swallowing, gagging, movement, and laryngospasm, ED50 and ED95 with confidence intervals for alfentanil could be determined. The optimum dose for alfentanil, when coadministered with 2.5 mg/kg propofol, was 10 microg/kg.
Publisher: Wiley
Date: 26-09-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-1998
DOI: 10.1097/00000539-199809000-00005
Abstract: In a prospective, randomized, single-blind trial, we assessed the effectiveness of a preoperative video as a source of additional patient information before ambulatory surgery. One hundred twenty-seven patients were allocated to either treatment (video) or control (nonvideo) groups. Of the 127, 17 (13%) patients correctly answered all process, risk, and misconception statements using a questionnaire. Overall, the video group was 2-16 times more likely to recall all knowledge questions correctly than the nonvideo group after adjusting for previous general anesthesia experience, state (how one feels at the moment), and trait (how one generally feels) anxiety levels (relative risk 6.36, 95% confidence interval 2.01-15.82). The predictors of correct risk knowledge were those who had a video intervention (relative risk 7.12, 95% confidence interval 3.70 to 10.07) and low trait anxiety scores (relative risk 5.88, 95% confidence interval 1.69 to 25.00). A video could be an important additional component of the preoperative interview, but anesthesiologists will still need to provide patient-specific information. This study randomly allocated adults to see a video about anesthesia before scheduled ambulatory surgery. The video group had better recall of information. The video was a useful adjunct to routine preoperative consultations.
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1053/J.JVCA.2011.01.003
Abstract: To develop a valid statistical method of showing acceptable cardiac output (CO) trending ability when new CO monitors are compared to a reference standard, such as thermodilution, using polar coordinates. Developing a new statistical analytic method using historic data. University Hospital Anesthesia and Intensive Care Department. Data taken from previously published CO validation studies. Cartesian data were reanalyzed, being uplifted using Data Thief 3.0 software (datathief.org/). Polar plots were constructed from this data. Central zone data (<0.5 L/min or 95%-90%) from 5 articles supported trending, and polar data from these studies concurred with the authors' pilot criteria. Favorable comments on trending also were found in 8 of 15 articles in which radial limits were less than ±32°. Good calibration was associated with a mean polar angle of less than ±5°. Polar plots can be used to show the trending ability of CO monitors in comparative validation studies. They overcome the deficiencies of concordance analysis, which uses the direction of change as a statistic and ignores the magnitude of change in CO.
Publisher: Oxford University Press (OUP)
Date: 20-03-2013
DOI: 10.1093/NTR/NTT039
Abstract: Smoking is a preventable cause of perioperative complications. An accurate and rapid classification of smoking status is essential as up to 35% of smokers deny smoking before surgery. We compared the diagnostic performance of a preoperative urinary cotinine immunoassay test strip (NicAlert®) as an add-on test to patient's self-reported smoking status. Four hundred and sixty-five patients undergoing major elective surgery self-reported their smoking history and provided a s le for measuring urinary cotinine concentration by liquid chromatography tandem mass spectrometry (reference standard) and NicAlert®. Using the "either test positive" rule, the gain in diagnostic performance for NicAlert® add-on test was assessed using relative positive and negative likelihood ratios (LRs) and area under the receiver operating characteristic curve (AUROC) with 95% CIs. Of the 60 patients with a positive reference standard (adjusted cotinine ≥ 50 ng/ml), 10 (16.7%) denied current cigarette smoking. The NicAlert® add-on test had better test performance measures (sensitivity = 95.0%, specificity = 94.8%) than self-reported smoking history alone (sensitivity = 83.3%, specificity = 95.0%). The relative positive and negative LRs were 1.09 (95% CI = 0.95-1.24) and 0.30 (95% CI = 0.12-0.78), respectively. The AUROC for the NicAlert® add-on test (0.90 95% CI = 0.84-0.96) was significantly higher than for the self-reported smoking history alone (0.78 95% CI = 0.69-0.88) (p = .006). The NicAlert® add-on test strategy had excellent diagnostic test performance for identifying current smokers who are expected to have a high risk of perioperative complications.
Publisher: Elsevier BV
Date: 08-2021
Publisher: SAGE Publications
Date: 10-1995
DOI: 10.1177/0310057X9502300511
Abstract: A Perioperative Service has recently been introduced at Liverpool Hospital, a 460-bed university teaching hospital. This provides a co-ordinated system for managing all elective surgical patients from the time an admission is booked until hospital discharge. This paper describes the patient assessment, structure and staff requirements, benefits of and problems encountered with this service. The patient's preoperative preparation occurs before hospital admission. Where possible, patients are admitted on the day of procedure, either as a day-only patient, or a day-of-surgery patient. Patients are initially admitted to a specifically designed Perioperative Unit, adjacent to the Operating Theatre Suite. Patients do not enter the surgical wards until after their operation. Planning of the hospital discharge process commences at the time of booking for operation. Introduction of the Perioperative Service was staged process commencing in mid-1992. The hospital admits approximately 6,400 elective surgery cases each year. From July 1992 to December 1994, day-only patients were approximately 45% of these cases. Day-of-surgery admission patients increased from 6% to 35% of all cases over the same period. Appproximately 22% of elective surgical cases were seen in the Perioperative Clinic. As the Perioerative Service became fully operational, the average length of stay for elective surgical procedures fell. There has been a reduction in the areas of cancellations due to unavailablity of beds, inappropriate preparation of patients, and non-attendance of patients for booked procedures. Patient acceptance is high. The existence of a perioperative system facilitates the planning and management of elective surgery with maximum quality and efficiency.
Publisher: Springer Science and Business Media LLC
Date: 11-1994
DOI: 10.1007/BF01705728
Publisher: Wiley
Date: 11-09-2017
DOI: 10.1111/ANAE.14018
Abstract: We included 34 trials with 3742 participants, identified through 6 database and supplementary searches (to May 2017): 29 were randomised 4 were quasi-randomised and 1 was cluster-randomised. Disparate measurements and outcomes precluded meta-analyses. Blinding was attempted in only 6 out of 34 (18%) trials. A multimedia format, alone or in combination with text or verbal formats, was studied in 20/34 (59%) trials: pre-operative anxiety was unaffected in 10 out of 14 trials and reduced by the multimedia format in three postoperative anxiety was unaffected in four out of five trials in which formats were compared. Multimedia formats increased knowledge more than text, which in turn increased knowledge more than verbal formats. Other outcomes were unaffected by information format. The timing of information did not affect pre-operative anxiety, postoperative pain or length of stay. In conclusion, the effects of pre-operative information on peri-operative anxiety and other outcomes were affected little by format or timing.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2010
Publisher: Wiley
Date: 03-01-2013
DOI: 10.1111/ANAE.12115
Abstract: Describing the relationship between magnitude of response, probability of response, dose and time is difficult using traditional two-dimensional dose-response curves. We devised a novel way of presentation in four dimensions. Data from a previous study of epidural bupivacaine and ropivacaine given for labour analgesia were re-analysed. For a range of response magnitudes (5-95% reduction in pain score), estimates of doses associated with probabilities of response 0.05-0.95 were calculated using probit analysis. Three dimensional surface plots were constructed with axes x = magnitude of response, y = probability of response and z = log(dose) at intervals for 30 min. Arithmetic interpolation was used to assemble an animation depicting temporal changes in relationship between variables (fourth dimension). Response-probability-dose curves in three and four dimensions were constructed and presented for both drugs. We believe that this model is more aligned with the logic of clinical dose selection compared with traditional two-dimensional curves.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2015
Publisher: SAGE Publications
Date: 06-2010
Abstract: The STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) were published in five journals in 2001 and 2002. These guidelines, in the form of a checklist and explanations for use by authors and journal editors, were designed to improve reporting of acupuncture trials, particularly the interventions, thereby facilitating their interpretation and replication. Subsequent reviews of the application and impact of STRICTA have highlighted the value of STRICTA as well as scope for improvements and revision. To manage the revision process a collaboration between the STRICTA Group, the CONSORT Group and the Chinese Cochrane Centre was developed in 2008. An expert panel with 47 participants was convened that provided electronic feedback on a revised draft of the checklist. At a subsequent face-to-face meeting in Freiburg, a group of 21 participants further revised the STRICTA checklist and planned dissemination. The new STRICTA checklist, which is an official extension of CONSORT, includes 6 items and 17 subitems. These set out reporting guidelines for the acupuncture rationale, the details of needling, the treatment regimen, other components of treatment, the practitioner background and the control or comparator interventions. In addition, and as part of this revision process, the explanations for each item have been elaborated, and ex les of good reporting for each item are provided. In addition, the word ‘controlled’ in STRICTA is replaced by ‘clinical’, to indicate that STRICTA is applicable to a broad range of clinical evaluation designs, including uncontrolled outcome studies and case reports. It is intended that the revised STRICTA checklist, in conjunction with both the main CONSORT statement and extension for non-pharmacological treatment, will raise the quality of reporting of clinical trials of acupuncture.
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.JCRC.2019.07.009
Abstract: To assess the psychometric properties of the Chinese version of the 23-item Patient Satisfaction in the Intensive Care Unit (PS-ICU-23) and 24-item Family Satisfaction in the Intensive Care Unit (FS-ICU-24) questionnaires. Patients (n = 243) discharged from an intensive care unit (ICU) in Hong Kong and family members (n = 237) completed the translated questionnaires. We used confirmatory factor analysis to assess the construct validity and measurement equivalence across groups (gender, mechanical ventilation, casemix, length of stay in ICU), coefficient alpha for internal consistency (reliability) and concordance correlation coefficient (ρ A three-factor model provided a better fit than the two-factor model for both PS-ICU-23 and FS-ICU-24 questionnaires. Factorial equivalence was present across groups in both questionnaires. Internal consistency was adequate for PS-ICU-23 (coefficient alpha overall domain 0.85 care subscale, 0.83 information subscale, 0.90 decision-making process subscale, 0.67) and for FS-ICU-24 (coefficient alpha overall scale 0.86 care subscale, 0.84 information subscale, 0.89 decision-making process subscale, 0.65). Overall ICU satisfaction agreement was moderate (0.40). Both Chinese PS-ICU-23 and FS-ICU-24 questionnaires have sound psychometric properties but family satisfaction may not be a good proxy for patient satisfaction in ICU.
Publisher: Oxford University Press
Date: 12-1997
Publisher: Springer Science and Business Media LLC
Date: 02-05-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2005
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.JHIN.2018.10.007
Abstract: Whereas high-flow nasal cannula use is gaining prevalence, its high gas flow raises concerns about aerosolization of infectious particles and spread of infection. This randomized controlled crossover non-inferiority trial (N = 20) evaluated the degree of environmental contamination by viable bacteria associated with the use of high-flow nasal cannula compared with conventional oxygen mask for critically ill patients with Gram-negative pneumonia. The results show that high-flow nasal cannula use was not associated with increased air or contact surface contamination by either Gram-negative bacteria or total bacteria, suggesting that additional infection control measures are not required.
Publisher: Mary Ann Liebert Inc
Date: 10-2010
Abstract: The Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) were published in five journals in 2001 and 2002. These guidelines, in the form of a checklist and explanations for use by authors and journal editors, were designed to improve reporting of acupuncture trials, particularly the interventions, thereby facilitating their interpretation and replication. Subsequent reviews of the application and impact of STRICTA have highlighted the value of STRICTA as well as scope for improvements and revision. To manage the revision process a collaboration between the STRICTA Group, the CONSORT Group, and the Chinese Cochrane Centre was developed in 2008. An expert panel with 47 participants was convened that provided electronic feedback on a revised draft of the checklist. At a subsequent face-to-face meeting in Freiburg, a group of 21 participants further revised the STRICTA checklist and planned dissemination. The new STRICTA checklist, which is an official extension of CONSORT, includes six items and 17 sub-items. These set out reporting guidelines for the acupuncture rationale, the details of needling, the treatment regimen, other components of treatment, the practitioner background, and the control or comparator interventions. In addition, and as part of this revision process, the explanations for each item have been elaborated, and ex les of good reporting for each item are provided. In addition, the word "controlled" in STRICTA is replaced by "clinical," to indicate that STRICTA is applicable to a broad range of clinical evaluation designs, including uncontrolled outcome studies and case reports. It is intended that the revised STRICTA, in conjunction with both the main CONSORT Statement and extension for nonpharmacologic treatment, will raise the quality of reporting of clinical trials of acupuncture.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2002
Publisher: Research Square Platform LLC
Date: 18-05-2023
DOI: 10.21203/RS.3.RS-2926027/V1
Abstract: Background Frailty is associated with worse outcomes and higher healthcare costs. The long waiting time for surgery is a potential “teachable” moment. We examined the feasibility and safety of a pilot prehabilitation program on high-risk frail patients undergoing major elective surgery. Methods A single-centre, retrospective pilot study (Dec 2020-Nov 2021) on a one-stop prehabilitation program (structured exercise training, nutritional counselling/therapy and psychological support) in collaboration with geriatricians and allied health professionals. At least 4 weeks before surgery, patients at high risk of frailty or malnutrition, or undergoing major hepatectomy, esophagectomy, pancreaticoduodenectomy or radical cystectomy were referred for prehabilitation (2–3 sessions/week). The primary outcomes were the feasibility and safety of prehabilitation. The secondary outcomes were changes in functional, emotional, and nutritional status, and days alive and at home within 30 days after surgery (DAH 30 ) associated with prehabilitation. Results Over a 12-month period, 72 out of 111 patients (64.9%) from the Perioperative Medicine Clinic were eligible for prehabilitation, of which 54 (75%) were recruited. Mean (standard deviation) age was 71.9 (6.9) years. The adherence rate to three-weeks of prehabilitation was high in 52 (96.3%) participants. Prehabilitation improved exercise capacity (P = 0.08), enhanced some functional mobility measures (P = 0.02), and increased nutritional energy (P = 0.04) and protein intakes (P 0.01). However, prehabilitation-related changes in muscle strength, cognitive function and emotional resilience were minimal. The median (interquatile range) DAH 30 was 19 (14–23) days. No adverse events were reported Conclusions This outpatient based, one-stop multidisciplinary prehabilitation program was feasible, safe, and improved several measures of patient’s physiological reserve and functional capacity. Clinical trial registration ID: NCT05668221
Publisher: Wiley
Date: 04-2004
Publisher: Wiley
Date: 06-1998
DOI: 10.1046/J.1365-2044.1998.00395.X
Abstract: To examine the risk factors of early postoperative emergencies that required an intensive care team intervention, a matched nested case-control study (34 cases and 126 controls) was conducted. Over a 17-month period, the incidence of early postoperative emergencies occurring within 48 h of surgery was 0.21% (95% confidence intervals (CI): 0.14%-0.30%). The intensive care team treated two cardiac arrests and three respiratory arrests. The major physiological changes which led to ward staff summoning an intensive care team were hypotension (13 cases) and a decreased level of consciousness (nine cases). Significant associations with early postoperative emergencies were high ASA (> or = IV) physical status grades (odds ratio: 4.51, 95% CI: 1.24-16.40) and surgery performed outside normal working hours (odds ratio: 4.40, 95% CI: 1.41-13.69). High-risk patients may benefit from a visit by a postoperative care team during the early postoperative period but this requires further evaluation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-1996
DOI: 10.1097/00003246-199604000-00012
Abstract: To evaluate the training of clinical staff in the use of interhospital transfer guidelines and to examine the underlying decision-making behavior in organizing patient transfers between hospitals. Prospective assessment of clinical scenarios, given before (time 1), immediately after (time 2), and 3 months after (time 3) a program informing clinical staff about the use of interhospital transfer guidelines. Three emergency departments and one intensive care unit at three hospitals and a medical retrieval service in Sydney, Australia. Physicians, nurses, and a paramedic working in critical care areas and at a medical retrieval service. A questionnaire containing clinical scenarios was administered to clinical staff. There was a significant difference in mean scores for selecting the appropriate escort levels across time (F2,78 = 24.2 p < .01) and for participant's experience with interhospital transfer (F2,39 = 4.63 p = .02). Significant improvement in mean scores occurred between time 1 (7.55 +/- 1.84 and time 2 (9.48 +/- 1.47) (t41 = -6.21 p < .01). The improvement in selecting appropriate escorts was maintained at time 3 (mean score 9.86 +/- 2.01). The error rate for inappropriate assignment of low levels of escorts decreased from 35% (time 1) to 10% (time 2) and 14% (time 3). Using conjoint analysis, there were large variations in the decision-making behaviour between each time period. The relative importance of each factor in influencing the decision to organize an escort at time 3 were as follows: treatment (43%) physiology (29%) patient age (24%) and diagnosis (4%). The decision-making model observed at time 3 had a high predictive value (87%) as compared with the model at time 1 (48%). Clinical staff can make informed and appropriate decisions by using standardized guidelines when organizing interhospital transfers.
Publisher: Wiley
Date: 03-2023
DOI: 10.1111/ANAE.15990
Publisher: American Thoracic Society
Date: 11-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2003
Publisher: John Wiley & Sons, Ltd
Date: 19-07-2006
Publisher: SAGE Publications
Date: 12-1997
DOI: 10.1177/0310057X9702500613
Abstract: The provision of good analgesia can be influenced by ethnic differences in how pain is expressed, the attitudes of patients and health professionals towards pain management and pharmacological differences in the responses to opioids. It is difficult to generalize results so that they are applicable to any ethnic group as a whole. There is also the question of how best to categorize ethnic Asians who have been in Australasia for several generations. Much of the pharmacogenetic work has focused on the metabolism of codeine, morphine and pethidine, and there are some differences between Chinese and Caucasians. Asians may receive less analgesia because they are more likely to experience, or are less tolerant of the adverse effects of opioids. Despite this, ethnic factors are probably only a small contributor to the inter-in idual variation in opioid requirements. Unlike earlier studies, recent larger studies using patient-controlled analgesia have shown similar opioid usage between Asians and Caucasians in the postoperative period. An in idualized pain management program is essential for any patient, whatever his or her ethnic origin. The use of patient-controlled analgesia will minimize some of the problems that may occur because of poor communication between the patient and the healthcare staff. Nevertheless, in a multicultural society like Australia's, health professionals should be conscious of the many factors that may influence the effects of prescribed treatment to manage pain in different ethnic groups.
Publisher: Elsevier BV
Date: 09-2006
DOI: 10.1016/J.JCLINEPI.2006.02.003
Abstract: To assess the effect of publication bias and country effect on the results and conclusion of a systematic review of wrist P6 acupoint stimulation for the prevention of postoperative nausea and vomiting. Reanalysis of a systematic review of 26 randomized trials comparing P6 acupoint stimulation with sham published in the Cochrane Database of Systematic Reviews using the Copas' sensitivity approach. If it is assumed that all studies that have ever been carried out are included, or that those selected for review are truly representative of all such studies, then the estimated relative risk (RR) for nausea was 0.71 (95% CI: 0.58 to 0.88, P<.01) and for vomiting was 0.70 (95% CI: 0.56 to 0.88, P<.01) after adjusting for country effect. For nausea, adjustment for publication bias suggests that the risk has been overestimated. If around 33% of studies have been unpublished, the RR of nausea (0.92, 95% CI: 0.80 to 1.06, P=.25) is no longer significant. For vomiting, however, there is no strong evidence of publication bias. The number of unpublished studies required to substantially overturn the above significant result is implausibly large. Publication bias affects the published estimate of postoperative nausea, not vomiting.
Publisher: Wiley
Date: 10-1999
DOI: 10.1046/J.1440-1622.1999.01688.X
Abstract: The authors hypothesized that the addition of critical care physicians to the flight crew of paramedic helicopter services would decrease mortality in blunt trauma, and that this would be due to the greater procedural capability and clinical judgement of the physician. Retrospective comparison was undertaken of patients flown directly from the accident scene over a 28-month period by the paramedic-staffed Westpac Hunter region helicopter to John Hunter Hospital, and the physician-staffed NRMA CareFlight helicopter to Westmead or Nepean Hospitals. Inclusion criteria were blunt trauma and an Injury Severity Score of > 10. Mortality was compared by trauma score-injury severity score (TRISS) methodology. There were 140 patients in the paramedic treatment group and 67 in the physician group. There were no significant differences between the groups in age, mechanism of injury, distance transported, response, scene or transport times. Physicians intubated a greater proportion of patients (51 vs 10% P < 0.001) including all patients with a Glasgow Coma Score of < 9. Physicians gave significantly greater volumes of fluids to hypotensive patients (median: 5035 vs 1475 mL: P < 0.001) and performed thoracic decompressions on a larger proportion of patients (12 vs 1% P < 0.01). The Z statistic for the physician treatment group was 2.72 (P < 0.01 ) compared with -1.16 (P = 0.25) in the paramedic group. The adjusted W statistic was 13.44 (95% CI: 7.80-19.08) suggesting that there would be between eight and 19 extra survivors per 100 patients treated in the physician group compared with the paramedic group. Physicians perform a greater number of procedures at accident scenes without increasing scene time. This results in significantly lower mortality. Critical care physicians should be added to paramedic helicopter services for scene response to blunt trauma.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2003
Publisher: Informa UK Limited
Date: 2007
DOI: 10.1080/01421590701287897
Abstract: A four-hour integrated teaching session on clinical decision analysis has been developed and introduced as part of the Life Long Learning Skills course for medical students at The Chinese University of Hong Kong. The feasibility and effectiveness of teaching the principles and practice of clinical decision analysis to final-year undergraduate medical students was evaluated. One hundred and thirty-two students were randomly assigned to medical (intervention) and surgical rotations (control) and were assessed two weeks before and three weeks following a teaching session. The students' performance was assessed in response to 10 A-type multiple choice question items that incorporated various clinical scenarios requiring decision making and interpreting cost-effectiveness ratios and sensitivity analysis graphs. More students in the intervention group improved their overall performance scores compared with those in the control group (23.4% vs. 7.4% 16.1% difference 95% confidence interval [CI], 3.8-28.5% p = 0.01). Improvements were in interpretation of decision making (22.2% difference 95% CI, 10.1-34.4% p < 0.001). No improvements were seen for calculating cost-effectiveness ratios or interpreting sensitivity analysis graphs. The overall educational intervention was well received by students and effective in improving students' clinical decision analysis skills under simulated conditions.
Publisher: Elsevier BV
Date: 03-2013
Publisher: Oxford University Press (OUP)
Date: 03-2007
DOI: 10.1673/031.007.1301
Publisher: Elsevier BV
Date: 12-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2018
Publisher: Wiley
Date: 2003
Publisher: Royal Society of Chemistry (RSC)
Date: 2010
DOI: 10.1039/B911429G
Abstract: The speciation of phosphorus in Tamar estuary sediment has been determined at eight stations from Gunnislake (riverine end-member) to Torpoint (marine end-member) using the SEDEX (sedimentary extraction) sequential extraction scheme. The seasonal variability of total phosphorus and each of the five fractions is discussed. Total phosphorus, in the range 26-51 micromol g(-1), was stored in the relatively labile fractions, particularly in the iron oxide fraction. The well oxygenated waters of the macrotidal Tamar estuary ensure that the surface sediment layer remains oxic, providing an effective barrier that retains dissolved reactive phosphorus (DRP) within the sedimentary iron oxide fraction and prevents phosphorus migration from the sediment to the water column. The exchangeable and organic phosphorus sedimentary pools, although small, are therefore the main potential sources of phosphorus release to the water column. In particular, this study shows that exchangeable phosphorus and dissolved organic phosphorus (DOP) in the pore water are intimately linked. Finally, the distribution of phosphorus in the estuary is strongly influenced by particle morphology, with most of the sedimentary phosphorus forms exhibiting significant positive correlations with the percent of each grain size.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2016
Publisher: Springer Science and Business Media LLC
Date: 17-07-2008
Publisher: Elsevier BV
Date: 12-1994
DOI: 10.1016/S1036-7314(94)70698-6
Abstract: Registered Nurses (RN's) caring for the critically ill, require a wide range of specialised skills and knowledge. Assessing knowledge of RN's within Intensive Care Units (ICU's) is imperative if we are to ensure that patients are afforded quality care. The aim of this study was to evaluate existing knowledge of the RN's working in the ICU of a major teaching hospital using the Basic Knowledge Assessment Tool (BKAT). Overall mean test scores of 78% were encouraging. Knowledge gaps were evident in gastrointestinal and endocrine disorders. Significantly higher scores were obtained by RN's trained in the hospital based system (p = 0.02) and those possessing ICU qualifications (p = 0.01). There were no differences in scores according to age and length of ICU experience. Registered nurses scored badly in a number of questions, which highlighted some problems in the terminology used in the BKAT.
Publisher: Springer Science and Business Media LLC
Date: 03-01-2008
Publisher: Springer Science and Business Media LLC
Date: 05-01-2008
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2005
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2006
DOI: 10.1213/01.ANE.0000217211.12232.55
Abstract: The original and modified Mall ati tests are commonly used to predict the difficult airway, but there is controversy regarding their accuracy. We searched MEDLINE and other databases for prospective studies of patients undergoing general anesthesia in which the results of a preoperative Mall ati test were compared with the subsequent rate of difficult airway (difficult laryngoscopy, difficult intubation, or difficult ventilation as reference tests). Forty-two studies enrolling 34,513 patients were included. The definitions of the reference tests varied widely. For predicting difficult laryngoscopy, both versions of the Mall ati test had good accuracy (area under the summary receiver operating characteristic (sROC) curve = 0.89 +/- 0.05 and 0.78 +/- 0.05, respectively). For predicting difficult intubation, the modified Mall ati test had good accuracy (area under the sROC curve = 0.83 +/- 0.03) whereas the original Mall ati test was poor (area under the sROC curve = 0.58 +/- 0.12). The Mall ati tests were poor at identifying difficult mask ventilation. Publication bias was not detected. Used alone, the Mall ati tests have limited accuracy for predicting the difficult airway and thus are not useful screening tests.
Publisher: Oxford University Press (OUP)
Date: 02-1993
Abstract: Enterohaemorrhagic Escherichia coli (EHEC) comprise a group of intestinal pathogens responsible for a range of illnesses, including kidney failure and neurological compromise. EHEC produce critical virulence factors, Shiga toxin (Stx) 1 or 2, and the synthesis of Stx2 is associated with worse disease manifestations. Infected patients only receive supportive treatment because some conventional antibiotics enable toxin production. Shiga toxin 2 genes (stx2) are carried in λ-like bacteriophages (stx2-phages) inserted into the EHEC genome as prophages. Factors that cause DNA damage induce the lytic cycle of stx2-phages, leading to Stx2 production. The phage Q protein is critical for transcription antitermination of stx2 and phage lytic genes. This study reports that deficiency of two endoribonucleases (RNases), E and G, significantly delayed cell lysis and impaired production of both Stx2 and stx2-phages, unlike deficiency of either enzyme alone. Moreover, scarcity of both enzymes reduced the concentrations of Q and stx2 transcripts and slowed cell growth.
Publisher: SAGE Publications
Date: 12-1999
DOI: 10.1177/0310057X9902700603
Abstract: The aim of this systematic review was to assess the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on postoperative renal function. Eight randomized placebo-controlled double-blinded trials (n=345) were identified from searches of MEDLINE, EMBASE and the Cochrane Controlled Trials Register databases. The summary effect size and 95% confidence intervals (95%CI) were calculated by a weighted mean difference analysis using a random-effects model. The NSAIDs (diclofenac, ketorolac, indomethacin, ibuprofen) were used for up to three days after surgery. There were no reported cases of postoperative renal failure requiring dialysis. NSAIDs reduced creatinine clearance by 22 ml.min −1 (95%CI: 7 to 37), sodium output by 54 mmol.day −1 (95%CI: 5 to 103) and potassium output by 38 mmol.day −1 (95%CI: 19 to 56) on Day 1 but not on Day 2. Serum creatinine increased on Day 2 by 15μmol.l −1 (95%CI: 2 to 28). Urine volume did not change significantly at any time. There was therefore a clinically unimportant transient reduction in renal function. NSAIDs should not be withheld from patients with normal preoperative renal function because of concerns about postoperative renal impairment.
Publisher: Elsevier BV
Date: 2009
DOI: 10.1093/BJA/AEN343
Abstract: The pulmonary artery catheter is invasive and may cause serious complications. A safe method of cardiac output (CO) measurement is needed. We have assessed the accuracy and reliability of a recently marketed self-calibrating arterial pulse contour CO monitoring system (FloTrac/Vigileo) in end-stage liver failure patients undergoing liver transplant. The pattern of alterations known as cirrhotic cardiomyopathy, and the transplant procedure itself, provided an evaluation under varying clinical conditions. The cardiac index was measured simultaneously by thermodilution (CI(TD): mean of four readings) using a pulmonary artery catheter and pulse contour analysis (CI(V): mean value computed by the FloTrac/Vigileo over the same time period). Readings were made at 10 time-points during liver transplant surgery (T1-T5) and on the intensive care unit (T6-T10). CI(V) was computed using the latest Vigileo software version 01.10. A total of 290 paired readings from 29 patients were collected. Mean (SD) CI(TD) was 5.2 (1.3) and CI(V) was 3.9 (0.9) litre min(-1) m(-2), with a corrected for repeated measures bias between readings of 1.3 (0.2) litre min(-1) m(-2) and 95% limits of agreement of -1.5 (0.2) to 4.1 (0.3) litre min(-1) m(-2). The percentage error (2SD(Bias)/meanCI(TD)) was 54%, which exceeded a 30% limit of acceptance. Low peripheral resistance and increasing bias were related (r=0.69 P<0.001). The Vigileo system failed to reliably trend CI data, with a concordance compared with thermodilution below an acceptable level (at best 68% of sequential readings). In cirrhotic patients with hyperdynamic circulation, the Vigileo system showed a degree of error and unreliability higher than that considered acceptable for clinical purposes.
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.INJURY.2016.05.038
Abstract: Prehospital transfusion of packed red blood cells (PRBC) may be life saving for hypovolaemic trauma patients. PRBCs should preferably be warmed prior to administration but practical prehospital devices have only recently become available. The effectiveness of purpose designed prehospital warmers compared with previously used improvised methods of warming has not previously been described. Expired units of PRBCs were randomly assigned to a warming method in a bench study. Warming methods were exposure to body heat of an investigator, leaving the blood in direct sunlight on a dark material, wrapping the giving set around gel heat pads or a commercial fluid warmer (Belmont Buddy Lite). Methods were compared with control units that were run through the fluid circuit with no active warming strategy. The mean temperature was similar for all methods on removal from the fridge (4.5°C). The mean temperatures (degrees centigrade) for all methods were higher than the control group at the end of the circuit (all P≤0.001). For each method the mean (95% CI) temperature at the end of the circuit was body heat 17.2 (16.4-18.0), exposure to sunlight 20.2 (19.4-21.0), gel heat pads 18.8 (18.0-19.6), Buddy Lite 35.2 (34.5-36.0) and control group 14.7 (13.9-15.5). All of the warming methods significantly warmed the blood but only the Buddy Lite reliably warmed the blood to a near normal physiological level. Improvised warming methods therefore cannot be recommended.
Publisher: Elsevier BV
Date: 02-2022
Publisher: JMIR Publications Inc.
Date: 05-07-2016
DOI: 10.2196/JMIR.5378
Publisher: Elsevier BV
Date: 07-2001
DOI: 10.1016/S0020-1383(01)00013-4
Abstract: To determine whether prehospital critical care teams (CCT) would result in improved functional outcomes for road trauma related severe head injury in the Australian setting, when compared with standard advanced life support measures provided by paramedics. Retrospective review of 250 patients treated by paramedics and 46 patients treated by CCT transported directly from the accident scene, with a prehospital Glasgow coma scale (GCS)< or =8. CCT-treated patients had longer median prehospital times (113 versus 45 min, P<0.001), and a higher prehospital intubation rate (100% versus 36%, P or =4.45 (odds ratio [OR] 2.31, 95% CI: 1.15-4.65), lower injury severity score (OR 1.04, 95% CI: 1.02-1.06), age< or =25 years (OR 1.76, 95% CI: 1.13-2.75), absence of an acute subdural haematoma (OR 3.36, 95% CI: 1.89-5.95) and prehospital treatment by a CCT (OR 2.70, 95% CI: 1.48-4.95) independently predicted better outcome. The range of advanced interventions provided by the CCT were associated with improved functional outcome. Further studies are required to determine the in idual factors responsible.
Publisher: Springer Science and Business Media LLC
Date: 10-1996
Abstract: This study evaluated the potential association between increased intraabdominal pressure (IAP) and abnormally low gastric intramucosal pH (pHi) ( /= 20 mmHg and a pHi of </= 7.32 were considered abnormal. The development of the following complications were also documented: hypotension [mean aortic pressure (MAP) < 80 mmHg], abdominal sepsis, renal impairment, and death. The median APACHE II score was 16 (range 5-34). Twenty-two patients had upper gastrointestinal (GI) surgery, 27 lower GI surgery, and 24 aortic surgery 44 of these patients underwent emergency surgery. Abnormal pHi (</= 7.32) occurred in 36 patients while on the intensive care unit. Compared to patients with normal pHi, abnormal pHi patients were 11.3 times (3.2-43.5) [odds ratio +/- 95% CI] more likely to have an increased IAP. Abnormal pHi was significantly associated with hypotension (chi2 = 6.8 = 0.009), sepsis (chi2 = 3.7 = 0.06), renal impairment (chi2 = 28.3 = 0. 0000001), relaparotomy (chi2 = 4.1 = 0.04), and death (chi2 = 9. 7 = 0.002). This study demonstrated a significant clinical association between increased IAP and abnormal pHi. An abnormally low pHi was associated with poor outcome.
Publisher: Oxford University Press (OUP)
Date: 22-12-2011
DOI: 10.1002/BJS.7732
Abstract: Observational studies on injured patients requiring massive transfusion have found a survival advantage associated with use of equivalent number of units of fresh frozen plasma (FFP) and packed red blood cells (RBCs) compared with use of FFP based on conventional guidelines. However, a survivorship bias might have favoured the higher use of FFP because patients who died early never had the chance to receive sufficient FFP to match the number of RBC units transfused. A Markov model using trauma data from local hospitals was constructed and various FFP transfusion scenarios were applied in Monte Carlo simulations in which the relative risk of death associated with exposure to high FFP transfusion was set at 1·00, so that the FFP : RBC ratio had no influence on mortality outcome. Simulation results showed that the relative risk associated with exposure to high FFP transfusion was less than 1·00 (0·33–0·56 based on programmed delays in achieving an FFP : RBC ratio of 1 : 1–2), thus demonstrating a survivorship bias in favour of FFP : RBC equal to or more than 1 : 1–2 in certain observational trauma studies. This bias was directly proportional to the delay in achieving a FFP : RBC ratio of 1 : 1–2 during resuscitation. Some observational studies comparing low and high FFP administration in injured patients requiring massive transfusion probably involve survivorship bias that inflates or creates a survival advantage in favour of a higher FFP : RBC ratio.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2003
Publisher: Springer Science and Business Media LLC
Date: 09-1997
DOI: 10.1007/BF03011966
Abstract: The aim of this study was to assess the clinical and oncological outcome of a selected group of stage IV rectal cancer patients managed by the watch-and-wait approach following a (near-)complete response of the primary rectal tumour after radiotherapy. Patients registered in the Dutch watch-and-wait registry since 2004 were selected when diagnosed with synchronous stage IV rectal cancer. Data on patient characteristics, treatment details, follow-up and survival were collected. The 2-year local regrowth rate, organ-preservation rate, colostomy-free rate, metastatic progression-free rate and 2- and 5-year overall survival were analysed. After a median follow-up period of 35 months, local regrowth was observed in 17 patients (40.5%). Nine patients underwent subsequent total mesorectal excision, resulting in a permanent colostomy in four patients. The 2-year local regrowth rate was 39.9%, the 2-year organ-preservation rate was 77.1%, the 2-year colostomy-free rate was 88.1%, and the 2-year metastatic progression-free rate was 46.7%. The 2- and 5-year overall survival rates were 92.0% and 67.5%. The watch-and-wait approach can be considered as an alternative to total mesorectal excision in a selected group of stage IV rectal cancer patients with a (near-)complete response following pelvic radiotherapy. Despite a relatively high regrowth rate, total mesorectal excision and a permanent colostomy can be avoided in the majority of these patients.
Publisher: Wiley
Date: 04-11-2019
DOI: 10.1111/ANAE.14836
Publisher: Public Library of Science (PLoS)
Date: 08-06-2010
Publisher: Springer Science and Business Media LLC
Date: 03-10-2014
Publisher: British Institute of Radiology
Date: 06-2012
DOI: 10.1259/BJR/30878012
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.JEMERMED.2017.05.006
Abstract: The current evaluation of patients with chest pain presenting to an emergency department (ED) with suspected acute coronary syndrome (ACS) is a lengthy process involving serial measurements of troponin. We aimed to validate the diagnostic accuracy of a Thrombolysis in Myocardial Infarction (TIMI) score with single high-sensitive cardiac troponin T (hs-cTnT) for early rule out of 30-day major adverse cardiac events (MACE), and to compare the TIMI score with combinations of heart-type fatty acid binding protein (H-FABP) and a modified HEART (history, electrocardiogram, age, risk factors, troponin) score. We recruited 602 consecutive adult patients with chest pain and suspected ACS in the ED. Each patient had TIMI and HEART scores, and a point-of-care H-FABP test. MACE occurred in 42 (7.0%) patients within 30 days. A low risk for 30-day MACE was identified by a modified TIMI score of 0 in 65 (11%) patients, and by a HEART score ≤ 2 in 96 (16%) patients. No MACE occurred in these groups, giving both scores a sensitivity of 100% (95% confidence interval [CI] 91.6-100%), and specificity of 11.6% (95% CI 9.2-14.5%) and 17.1% (95% CI 14.2-20.5%), respectively. Use of combined TIMI and HEART scores improved the specificity further to 22.0% (95% CI 18.7-25.6%) without lowering sensitivity. Early H-FABP measurement > 7 μg/L had a sensitivity of 41.5% (95% CI 27.8-56.6%) and a specificity of 91.1% (95% CI 88.4-93.2%) for predicting 30-day MACE. A modified TIMI score of 0 or a HEART score of ≤ 2, incorporating a single hs-cTnT level, will identify patients with low risk of 30-day MACE for early discharge within 2 h of ED arrival.
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.PHRS.2016.12.028
Abstract: Although pharmacokinetic (PK) data for prolonged sedative and analgesic agents in intensive care unit (ICU) has been described, the number of publications in this important area appear relatively few, and PK data presented is not comprehensive. Known pathophysiological changes in critically ill patients result in altered drug PK when compared with non-critically ill patients. ClinPK Statement was recently developed to promote consistent reporting in PK studies, however, its applicability to ICU specific PK studies is unclear. In this systematic review, we assessed the overall ClinPK Statement compliance rate, determined the factors affecting compliance rate, graded the level of PK evidence and assessed the applicability of the ClinPK Statement to future ICU PK studies. Of the 33 included studies (n=2016), 22 (67%) were low evidence quality descriptive studies (Level 4). Included studies had a median compliance rate of 80% (IQR 66% to 86%) against the ClinPK Statement. Overall pooled compliance rate (78%, 95% CI 73% to 83%) was stable across time (P=0.38), with higher compliance rates found in studies fitting three compartments models (88%, P<0.01), two compartments models (83%, P<0.01) and one compartment models (77%, P=0.17) than studies fitting noncompartmental or unspecified models (69%) (P<0.01). Data unique to the interpretation of PK data in critically ill patients, such as illness severity (48%), organ dysfunction (36%) and renal replacement therapy use (32%), were infrequently reported. Discrepancy between the general compliance rate with ClinPK Statement and the under-reporting of ICU specific parameters suggests that the applicability of the ClinPK Statement to ICU PK studies may be limited in its current form.
Publisher: BMJ
Date: 10-2020
DOI: 10.1136/BMJOPEN-2020-040469
Abstract: This study assessed the feasibility and preliminary efficacy of a 2-hour compression-only cardiopulmonary resuscitation and automated external defibrillator (CO-CPRAED) course in secondary school students. Prospective pre-post feasibility study. 128 students (12–15 years old) without prior basic life support (BLS) training at four secondary schools in Hong Kong. All students were followed up at 3 months after training. Emergency medicine-trained nurse and physicians taught the 2-hour CO-CPRAED course using the American Heart Association ‘CPR in School Training Kit’ programme. Students were trained in groups up to 40 students/session, with an instructor to student ratio not exceeding 1:10. To practise hands-on compressions, the manikin to student ratio was 1:1. For a simulated cardiac arrest, the manikin and AED to student ratio was 1:10. CPR and AED knowledge, attitude statements towards bystander CPR and AED, quality of BLS performance skills during training and at 3 months. Some students (46%) knew how deep to push on an adult chest when doing CO-CPR before training. The course was associated with an increase in knowledge score (pretraining 55%, post-training 93% adjusted mean difference (MD) 38%, 95% CI 33% to 43% p .001). Most students (68%) thought that CPR education in senior secondary school was essential before training. The students had a very positive attitude towards CPR no change in the mean (SD) attitude score out of 30 over time (pretraining 27.2 (2.5), post-training 27.6 (2.7) adjusted MD 0.5, 95% CI −0.1 to 1.0 p=0.132). Most students were competent in performing BLS immediately after training (77%) and at 3 months (83%) (adjusted MD 6%, 95% CI −4% to 15% p=0.268). The results demonstrate the feasibility of scaling up the number of secondary schools trained in a brief CO-CPRAED course within the local school curriculum.
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.JPBA.2019.07.025
Abstract: Dexmedetomidine (DMTD), an α
Publisher: Springer Science and Business Media LLC
Date: 06-2002
DOI: 10.1007/BF03017387
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2010
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.CLINTHERA.2018.07.021
Abstract: The pharmacokinetic (PK) parameters of many drugs are altered as a consequence of the pathophysiological changes associated with critical illness. The critically ill population presents challenges when titrating infusions of sedatives and analgesics to maintain optimal sedation and pain levels. This systematic review examined the PK data in critically ill adult patients with prolonged infusions (>24 hours) of commonly used sedatives and analgesics to highlight possible altered PK parameters compared with noncritically ill patients. A literature search of PK studies was performed by using MEDLINE (1946-December 2017) and EMBASE (1910-December 2017) we identified further studies by citation tracking (Web of Science) and checked references of retrieved studies and review articles. All studies were included that were published in English, Chinese, or German conducted in critically ill adult patients receiving lorazepam, midazolam, propofol, dexmedetomidine, sufentanil, alfentanil, remifentanil, morphine, or fentanyl infusion for ≥24 hours and reported PK parameters. When appropriate, we conducted a meta-analysis on volume of distribution at steady state (V Thirty-three randomized controlled trials and prospective cohort studies were identified involving 1803 adult critically ill patients with 35 drug treatment arms: fifteen midazolam (n = 906) studies, three dexmedetomidine (n = 561), nine propofol (n = 165), four lorazepam (n = 86), one morphine (n = 20), two remifentanil (n = 55), and one sufentanil (n = 10). Each study showed large variations in V These findings show a marked difference in many PK parameters from those reported for noncritically ill patients. Initiatives to improve the delivery of prolonged sedatives and analgesic infusions should be informed by PK parameters (Vd
Publisher: Wiley
Date: 07-05-2019
DOI: 10.1111/ANAE.14680
Abstract: Pre-hospital transfusion of blood products is a vital component of many advanced pre-hospital systems. Portable fluid warmers may be utilised to help prevent hypothermia, but the limits defined by manufacturers often do not reflect their clinical use. The primary aim of this randomised in-vitro study was to assess the warming performance of four portable blood warming devices (Thermal Angel, Hypotherm X LG, °M Warmer, Buddy Lite) against control at different clinically-relevant flow rates. The secondary aim was to assess haemolysis rates between devices at different flow rates. We assessed each of the four devices and the control, at flow rates of 50 ml.min
Publisher: Oxford University Press (OUP)
Date: 09-03-2020
DOI: 10.1093/CID/CIAA224
Abstract: The optimal dosing of antibiotics in critically ill patients receiving renal replacement therapy (RRT) remains unclear. In this study, we describe the variability in RRT techniques and antibiotic dosing in critically ill patients receiving RRT and relate observed trough antibiotic concentrations to optimal targets. We performed a prospective, observational, multinational, pharmacokinetic study in 29 intensive care units from 14 countries. We collected demographic, clinical, and RRT data. We measured trough antibiotic concentrations of meropenem, piperacillin-tazobactam, and vancomycin and related them to high- and low-target trough concentrations. We studied 381 patients and obtained 508 trough antibiotic concentrations. There was wide variability (4–8-fold) in antibiotic dosing regimens, RRT prescription, and estimated endogenous renal function. The overall median estimated total renal clearance (eTRCL) was 50 mL/minute (interquartile range [IQR], 35–65) and higher eTRCL was associated with lower trough concentrations for all antibiotics (P & .05). The median (IQR) trough concentration for meropenem was 12.1 mg/L (7.9–18.8), piperacillin was 78.6 mg/L (49.5–127.3), tazobactam was 9.5 mg/L (6.3–14.2), and vancomycin was 14.3 mg/L (11.6–21.8). Trough concentrations failed to meet optimal higher limits in 26%, 36%, and 72% and optimal lower limits in 4%, 4%, and 55% of patients for meropenem, piperacillin, and vancomycin, respectively. In critically ill patients treated with RRT, antibiotic dosing regimens, RRT prescription, and eTRCL varied markedly and resulted in highly variable antibiotic concentrations that failed to meet therapeutic targets in many patients.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2009
DOI: 10.1213/ANE.0B013E31818F8907
Abstract: Since thromboelastography (TEG) can detect hypercoagulable states, it is a potentially useful test for predicting postoperative thromboembolic complications. Therefore, we performed a systematic review of the literature to evaluate the accuracy of TEG in predicting postoperative thromboembolic events. PUBMED and EMBASE electronic databases were searched by two independent investigators to identify prospective studies involving adult patients undergoing operative procedures in which a TEG test was performed perioperatively and outcomes were measured by reference standards. The quality of included studies was assessed and measures of diagnostic test accuracy were estimated for each included study. Ten studies (with a total of 1056 patients) were included in this analysis however, only five reported measures of TEG test accuracy. The overall quality of the studies and level of diagnostic evaluation of the studies were highly variable, from poor to good. As there were variations in the definition of hypercoagulability, TEG methodology and patient characteristics, reference standards used and outcomes measured, a meta-analysis was not undertaken. The sensitivity and specificity ranged from 0% to 100% and 62% to 92%, respectively. The diagnostic odds ratio ranged from 1.5 to 27.7 area under the curve ranged from 0.57 to 0.91. Of the TEG variables, maximum litude seems to be the best parameter to identify hypercoagulable states and to predict thromboembolic events. The predictive accuracy of TEG for postoperative thromboembolic events is highly variable. To determine if the TEG is a clinically useful screening test in high-risk surgical populations, more prospective studies are needed.
Publisher: John Wiley & Sons, Ltd
Date: 17-10-2012
Publisher: SAGE Publications
Date: 2010
DOI: 10.1177/0310057X1003800111
Abstract: The study objective was to show that fentanyl given five minutes prior to induction improved insertion conditions for the Classic Laryngeal Mask Airway. Previous work had shown fentanyl at 90 seconds to be unpredictable. A probit analysis design was used in which success I failure rates of different doses of fentanyl were measured and dose-response curves drawn from which the ED 50 and ED 95 with 95% confidence intervals were determined. Adult Chinese patients with American Society of Anesthesiologists physical status classification I or II and requiring anaesthesia for minor surgery with a laryngeal mask were recruited. They were randomly assigned to one of six dosage groups: 0.25, 0.5, 1.0, 1.5, 2.0 and 3.0 μg.kg -1 . Fentanyl was given prior to propofol 2.5 mg.kg -1 , and insertion was assessed 90 seconds later using six categories of patient response. Ninety-six patients, aged 18 to 63 years, were studied. The six dosage groups were similar. As the fentanyl dose increased, fewer patients responded to insertion (P .01). Dose-responses could be predicted for all categories, except resistance to insertion and laryngospasm. Probit analysis predicted an ED 50 of 0.5 μg.kg -1 and ED 95 of 7.5 pg.kg -1 for ideal insertion conditions (i.e. no swallowing, gagging, body movement or laryngospasm). Commonly used fentanyl doses of 1 to 2 μg.kg -1 only prevented patients responding to insertion in 70 to 80% of cases. When using propofol 2.5 mg.kg -1 , administering fentanyl five minutes before laryngeal mask insertion does not provide ideal insertion conditions in 95% of cases unless excessively large doses are used. An ideal dose of fentanyl that produces optimum insertion conditions could not be determined.
Publisher: Wiley
Date: 12-09-2016
Publisher: BMJ
Date: 06-2016
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.IJCARD.2016.05.057
Abstract: Chest pain patients commonly present to emergency departments (ED), and require either hospital admission and/or lengthy diagnostic protocols to rule-out myocardial infarction. We aimed to identify the best combination of add-on tests to high-sensitivity cardiac troponin (hs-cTnT) for predicting 30-day major adverse cardiac events (MACE) in adult chest pain patients presenting to an ED with suspected acute coronary syndrome. This prospective observational study was conducted in the ED of a tertiary university hospital in Hong Kong, recruiting adult patients with chest pain of less than 24h duration, suspected with acute coronary syndrome (ACS), and had no history of coronary artery bypass grafting or stent insertion. Patients underwent triage assessment, electrocardiography, blood s ling for laboratory hs-cTnT, and Thrombolysis in Myocardial Infarction (TIMI) and HEART score assessment. The primary outcome was the number of patients with 30-day MACE. 602 consecutive patients were recruited and completed 30-day follow-up. A 30-day MACE occurred in 42 (7.0%) patients. Out of 12 possible models for stratifying patients at risk of 30-day MACE within 2h of ED arrival, a combination of electrocardiography (ECG) and one-time hs-cTnT (model 5) provided the simplest and most accurate model. A risk score of 0 to 5 was derived from raw coefficients of model 5. The risk score provided excellent calibration (P=0.91) and discrimination (AUC 0.87, 95% CI: 0.82 to 0.93). Appropriate early risk-stratification of patients with chest pain and possible ACS using a combination of ECG and one-time hs-cTnT may improve efficiency of care.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2004
Publisher: Elsevier BV
Date: 12-2001
Publisher: Springer Science and Business Media LLC
Date: 2012
Publisher: Wiley
Date: 06-03-2019
DOI: 10.1111/ANAE.14608
Abstract: Although bedside screening tests are routinely used to identify people at high risk of having a difficult airway, their clinical utility is unclear. We estimated the diagnostic accuracy of commonly used bedside examination tests for assessing the airway in adult patients without apparent anatomical abnormalities scheduled to undergo general anaesthesia. We searched for studies that reported our pre-specified bedside index screening tests against a reference standard, published in any language, from date of inception to 16 December 2016, in seven bibliographic databases. We included 133 studies (127 cohort type and 6 case-control) involving 844,206 participants. Overall, their methodological quality (according to QUADAS-2, a standard tool for assessing quality of diagnostic accuracy studies) was moderate to high. Our pre-specified tests were: the Mall ati test (6 studies) modified Mall ati test (105 studies) Wilson risk score (6 studies) thyromental distance (52 studies) sternomental distance (18 studies) mouth opening test (34 studies) and the upper lip bite test (30 studies). Difficult facemask ventilation, difficult laryngoscopy, difficult intubation and failed intubation were the reference standards in seven, 92, 50 and two studies, respectively. Across all reference standards, we found all index tests had relatively low sensitivities, with high variability, but specificities were consistently and markedly higher than sensitivities. For difficult laryngoscopy, the sensitivity and specificity (95%CI) of the upper lip bite test were 0.67 (0.45-0.83) and 0.92 (0.86-0.95), respectively upper lip bite test sensitivity (95%CI) was significantly higher than that for the mouth opening test (0.22, 0.13-0.33 p < 0.001). For difficult tracheal intubation, the modified Mall ati test had a significantly higher sensitivity (95%CI) at 0.51 (0.40-0.61) compared with mouth opening (0.27, 0.16-0.41 p < 0.001) and thyromental distance (0.24, 0.12-0.43 p < 0.001). Although the upper lip bite test showed the most favourable diagnostic test accuracy properties, none of the common bedside screening tests is well suited for detecting unanticipated difficult airways, as many of them are missed.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2016
Publisher: Wiley
Date: 15-05-2018
Publisher: Emerald
Date: 06-02-2017
DOI: 10.1108/IJSI-09-2015-0037
Abstract: The purpose of this paper is to describe the results of a combined numerical and experimental study into the ability of supersonic particle deposition (SPD) to restore the load carrying capacity of rib stiffened wing planks with simulated stress corrosion cracking (SCC). In this context the experimental results reveal that SCC can result in a dramatic reduction in the load carrying capacity of the structure and catastrophic failure via cracking that tears the length of the structure through buckling. A combined numerical and experimental study then reveals how this reduction, in the load carrying capacity can be overcome by using SPD. This paper is the first to show that SPD can be used to restore the load carrying capacity of rib stiffened structures with SCC. It also shows that SPD repairs can be designed to have only a minimal effect on the local stiffness and hence on the load path. However, care should be taken to ensure that the design is such that premature failure of the SPD does not occur. This is the first paper to show that a thin layer of SPD deposited 7,075 aluminium alloy powder on either side of the SCC-simulated stiffener has the potential to restore the load carrying capability of a rib stiffened structure. As such it represents an important first step into establishing the potential for SPD to restore the buckling strength of rib stiffened wing panels containing SCC.
Publisher: John Wiley & Sons, Ltd
Date: 15-04-2009
Publisher: Wiley
Date: 02-11-2015
Publisher: Elsevier BV
Date: 06-1994
DOI: 10.1016/0964-3397(94)90007-8
Abstract: At Liverpool Hospital in 1989, mortality from cardiopulmonary arrest was 71% in the general wards, and 64% in the Emergency department. In an attempt to identify and treat seriously ill patients before they progressed to cardiac arrest, a medical emergency team (MET) was established. The MET replaced the existing cardiac arrest team and comprised a nurse from the intensive care unit (ICU), a resuscitation registrar (an anaesthetics trainee), a medical registrar and a senior registrar from the ICU. The resuscitation registrar was the team leader. The calling criteria for the MET were based on predetermined physiological variables, abnormal laboratory results, and specific conditions or if nursing or medical staff were concerned by the patient's condition. A study was conducted 2 years following implementation of the MET system, to determine registered nurses' (RNs) opinions, knowledge and use of the system. A questionnaire distributed to 141 nurses rostered on the chosen study date revealed a positive attitude the MET, although there was a low awareness regarding the availability of the MET information booklet. 53% of nurses had called the MET in the last 3 months all would call the team again in the same circumstances. The correct response in three of four hypothetical situations presented was to call the MET. The number of correct responses varied between scenarios from 17-73%. Hypotension did not appear to alert nurses to summon emergency assistance. Some nurses, despite the presence of severe deterioration and patient distress, called the resident rather than the MET.(ABSTRACT TRUNCATED AT 250 WORDS)
Publisher: BMJ
Date: 10-07-2014
Publisher: Elsevier BV
Date: 10-2020
Publisher: Elsevier BV
Date: 06-2001
Abstract: The objective was to evaluate the effectiveness of low-dose, long-term antibiotics for the prevention of symptomatic urinary tract infection (UTI) in children. This was a systematic review of randomized controlled trials with a random effects model meta-analysis. Five trials involving 463 children were performed. Three trials (n = 392) evaluated the effectiveness of long treatment courses of antibiotics (2 to 6 months) for children with acute UTI to prevent subsequent, off-treatment infection. Only 2 trials (n = 71) evaluated the effectiveness of long-term, low-dose antibiotics to prevent on-treatment UTI. Very few of the children enrolled in the trials were boys, had abnormal renal tracts, or were infants. The trial quality was poor, with a lack of blinding, and unstated UTI definitions were almost universal. Long-term antibiotic administration reduced the risk of UTI with treatment (relative risk 0.31, 95% confidence limits 0.10 to 1.00), but there was significant heterogeneity (Q = 13.45, P <.01), and there was no sustained benefit once antibiotics had ceased (relative risk 0.79, 0.61 to 1.02). Methodologic and applicability problems with published trials mean that there is considerable uncertainty about whether long-term, low-dose antibiotic administration prevents UTI in children. Well-designed, randomized, placebo-controlled trials are still required to evaluate this commonly used intervention.
Publisher: SAGE Publications
Date: 12-1996
Publisher: Informa UK Limited
Date: 21-12-2018
Publisher: BMJ
Date: 12-2021
DOI: 10.1136/BMJOPEN-2021-052462
Abstract: Determine 90-day mortality of mechanically ventilated ward patients outside the intensive care unit (ICU) and its association with organisational factors. Multicentre prospective observational study of mechanically ventilated ward patients. Modified Poisson regression was used to assess association between nurse to patient ratio (NPR) and 90-day mortality, adjusted for designated medical team, Society of Critical Care Medicine (SCCM) triage priority and centre effect. NPR was ided into low (1:9.6 to 1:10), medium (1:6 to 1:8) and high (1:2.6). Sensitivity analysis was conducted for pneumonia with or without acute respiratory distress syndrome (ARDS) to assess magnitude of association. 7 acute public hospitals in Hong Kong. All 485 mechanically ventilated patients in wards from participating hospitals between 18 January 2016 and 17 April 2016 were recruited. Three hundred patients were included after excluding patients with limitation of therapy within 24 hours of intubation. 90-day mortality, Mortality Prediction Model III Standardised mortality ratio (MPMIII 0 SMR). 201 patients died within 90 days after intubation (67.0%, 95% CI 61.5% to 72.1%), with MPMIII 0 SMR 1.88, 95% CI 1.63 to 2.17. Compared with high NPR, medium and low NPRs were associated with higher risk of 90-day mortality (adjusted relative risk (RR adj ) 1.84, 95% CI 1.70 to 1.99 and 1.64, 95% CI 1.47 to 1.83, respectively). For 114 patients with pneumonia with or without ARDS, low to medium NPR, too sick to benefit from ICU (SCCM priority 4b), no ICU consultation and designated medical team were associated with risk of 90-day mortality (RR adj 1.49, 95% CI 1.40 to 1.58 RR adj 1.60, 95% CI 1.49 to 1.72 RR adj 1.34, 95% CI 1.27 to 1.40 RR adj 0.85, 95% CI 0.78 to 0.93, respectively). The 90-day mortality rates of mechanically ventilated ward patients were high. NPR was an independent predictor of survival for mechanically ventilated ward patients.
Publisher: Elsevier BV
Date: 06-2006
DOI: 10.1016/J.BPA.2005.10.009
Abstract: Acupuncture and related techniques are increasingly practised in anaesthesia. This paper reviews the current evidence and applicability of acupuncture and related techniques for anaesthetic procedures and postoperative nausea and vomiting. Recent evidence suggests that manual acupuncture is effective for reducing preoperative anxiety and for postoperative pain relief. Current available data do not support the use of acupuncture as an adjunct to the general anaesthetic in the intraoperative setting. There are extensive and good quality data to support the use of P6 acupoint stimulation techniques for preventing postoperative nausea and vomiting in combination with or as an alternative to conventional anti-emetics. The use of acupuncture for labour pain management appears promising but requires further research. Patient selection, acupoint selection, needling techniques, and mode of acupuncture need to be considered when applying acupuncture and related techniques in the perioperative setting. There are guidelines for the conduct and reporting of acupuncture research, and these should be followed to improve the quality of studies.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2021
Publisher: Springer Science and Business Media LLC
Date: 12-07-2016
Publisher: Elsevier BV
Date: 06-2003
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2003
DOI: 10.1097/00003246-200301000-00047
Abstract: To identify a consensus of opinion regarding the content of an intensive care core syllabus for undergraduate medical students and factors that may limit its teaching. Cross-sectional postal survey containing 35 items ranging from department structure to curriculum content and factors that limit the teaching of intensive care. English-speaking medical schools (n = 210) listed in the 1986 World Health Organization Directory. Of 122 (58%) returned questionnaires, a 45% return was achieved from the United States and 86% from non-U.S. countries. Most respondents (84%) considered teaching undergraduate intensive care to be essential however, teaching intensive care was compulsory in only 31% of schools. Many schools (43%) reported recent changes to their intensive care curriculum. Most respondents (60%) thought that intensive care specialists should teach and that each student required a median (interquartile range) of 20 (10-80) hrs of teacher contact time. Resuscitation skills were taught in 98% of schools. In comparison, 63% of schools had no intensive care syllabus. More than 90% of respondents thought that the intensive care syllabus should include the following: cardiopulmonary resuscitation, assessment and management of the acutely ill patient management of respiratory, circulatory, and multiple organ system failure (including systemic inflammatory response syndrome and sepsis) management of the unconscious patient early postoperative care and communication skills and ethics as they relate to end-of-life issues. Factors that limited intensive care teaching were lack of staff, funding, and time dedicated to teaching and excessive clinical workload. Student performance in intensive care was assessed by 66% of schools, but only 28% used a written or oral examination. By surveying a wide range of medical schools internationally, we have been able to define an undergraduate intensive care syllabus that could be delivered in 20 hrs or 1 wk of dedicated teaching time. Factors that impede the provision of undergraduate intensive care teaching are a lack of staff, funding, and dedicated teaching time.
Publisher: BMJ
Date: 03-10-2019
DOI: 10.1136/EMERMED-2019-208421
Abstract: Paediatric intubation is a high-risk procedure for ground emergency medical services (GEMS). Physician-staffed helicopter EMS (PS-HEMS) may bring additional skills, drugs and equipment to the scene including advanced airway management beyond the scope of GEMS even in urban areas with short transport times. This study aimed to evaluate prehospital paediatric intubation performed by a PS-HEMS when dispatched to assist GEMS in a large urban area and examine how often PS-HEMS provided airway intervention that was not or could not be provided by GEMS. We performed a retrospective observational study from July 2011 to December 2016 of a PS-HEMS in a large urban area (Sydney, Australia), which responds in parallel to GEMS. GEMS intubate without adjuvant neuromuscular blockade, whereas the PS-HEMS use neuromuscular blockade and anaesthetic agents. We examined endotracheal intubation success rate, first-look success rate and complications for the PS-HEMS and contrasted this with the advanced airway interventions provided by GEMS prior to PS-HEMS arrival. Overall intubation success rate was 62/62 (100%) and first-look success was 59/62 (95%) in the PS-HEMS-treated group, whereas the overall success rate was 2/7 (29%) for the GEMS group. Peri-intubation hypoxia was documented in 5/65 (8%) of the PS-HEMS intubation attempts but no other complications were reported. However, 3/7 (43%) of the attempted intubations by GEMS were oesophageal intubations, two of which were unrecognised. PS-HEMS have high success with low complication rates in paediatric prehospital intubation. Even in urban areas with rapid GEMS response, PS-HEMS activated in parallel can provide safe and timely advanced prehospital airway management for seriously ill and injured children beyond the scope of GEMS practice. Review of GEMS airway management protocols and the PS-HEMS case identification and dispatch system in Sydney is warranted.
Publisher: Elsevier BV
Date: 11-2001
Abstract: We sought to retrospectively measure the accuracy of multiple-casualty incident (MCI) triage algorithms and their component physiologic variables in predicting adult patients with critical injury. We performed a retrospective review of 1,144 consecutive adult patients transported by ambulance and admitted to 2 trauma centers. Association between first-recorded out-of-hospital physiologic variables and a resource-based definition of severe injury appropriate to the MCI context was determined. The association between severe injury and Triage Sieve, Simple Triage and Rapid Treatment, modified Simple Triage and Rapid Treatment, and CareFlight Triage was determined in the patient population. Of the physiologic variables, the Motor Component of the Glasgow Coma Scale had the strongest association with severe injury, followed by systolic blood pressure. The differences between CareFlight Triage, Simple Triage and Rapid Treatment, and modified Simple Triage and Rapid Treatment were not dramatic, with sensitivities of 82% (95% confidence interval [CI] 75% to 88%), 85% (95% CI 78% to 90%), and 84% (95% CI 76% to 89%), respectively, and specificities of 96% (95% CI 94% to 97%), 86% (95% CI 84% to 88%), and 91% (95% CI 89% to 93%), respectively. Both forms of Triage Sieve were significantly poorer predictors of severe injury. Of the physiologic variables used in the triage algorithms, the Motor Component of the Glasgow Coma Scale and systolic blood pressure had the strongest association with severe injury. CareFlight Triage, Simple Triage and Rapid Treatment, and modified Simple Triage and Rapid Treatment had similar sensitivities in predicting critical injury in designated trauma patients, but CareFlight Triage had better specificity. Because patients in a true mass casualty situation may not be completely comparable with designated trauma patients transported to emergency departments in routine circumstances, the best triage instrument in this study may not be the best in an actual MCI. These findings must be validated prospectively before their accuracy can be confirmed.
Publisher: Oxford University Press (OUP)
Date: 11-1992
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.HEALTHPOL.2011.05.009
Abstract: There has been a recent widespread international 'paradigm shift' to new Perioperative Systems for surgical patient care. These new systems are based on a multidisciplinary team providing an integrated process of care from the time a decision is made that a patient should have an operation until the patient has recovered from surgery. The objectives of this review were to outline the rationale for new Perioperative Systems, synthesize the evidence supporting these new systems and consider the current state of Perioperative Systems and its future development. A systematic review of studies that focus on preoperative management practices to improve patient preparation for surgery and anaesthesia, with restriction to study designs with the highest levels of evidence for the synthesis of evidence. Perioperative Systems are regarded as the standard model of care in Australia, New Zealand, North America and increasingly in Europe. The benefits of Perioperative Systems include: increased surgical volume and flow (20-35%), shorter preoperative length of stay (-0.2 to -1.3 days), fewer cancellations of surgery (absolute reduction 1-8%), relative reduction in the number (23-55%) and cost (40-59%) of preoperative investigations and a lower risk of wound infection (relative risk 0.30, 95% CI 0.12-0.78) compared to the traditional system. The mean reduction in the total cost per patient associated with a Perioperative System was 8-18%. Future developments include offering health promotion activities in the weeks before surgery to improve long term patient outcomes after surgery. There is evidence of quality benefits for patients, clinicians and health administrators associated with new Perioperative Systems. Despite this, these systems are yet to be fully developed in many jurisdictions.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2003
DOI: 10.1097/00000539-200301000-00005
Abstract: The prothrombin time (PT) is useful for identifying coagulation factor deficits after cardiopulmonary bypass (CPB). However, long processing times and the need for fresh frozen plasma (FFP) to be thawed cause delays in factor replacement. We hypothesized that, by treating with heparinase, blood s led toward the end of CPB can provide PT results that help to determine the requirement for FFP after CPB. Laboratory delays can be eliminated with point-of-care monitors. We studied 158 adults undergoing nonemergent cardiac surgery. Blood taken before separation from CPB was mixed with heparinase, and PT was measured in the laboratory with a HemoTec timer. Agreements between these results and laboratory measurements of blood taken after systemic protamine were compared by using Bland and Altman plots with the threshold of +/-1.0 s. We found that the laboratory PT measurements during CPB versus after CPB were compara-ble, but the limits of agreement exceeded these thresholds. Similarly, there was unsatisfactory agreement between the HemoTec and laboratory PT results measured before, during, and after CPB. For each PT measured during CPB, the corresponding confidence interval for the postprotamine PT was calculated. During CPB, a laboratory PT of or =18 s suggests a > or =83% or > or =93% probability of not requiring or potentially requiring, respectively, FFP after CPB. We conclude that the majority of PT measurements obtained from blood taken before weaning from CPB and treated in vitro with heparinase was associated with a high probability of whether or not FFP would be needed after CPB. Coagulation dysfunction after cardiopulmonary bypass may contribute to bleeding. Obtaining coagulation tests and fresh frozen plasma requires time and delays treatment in patients who need fresh frozen plasma. We have devised a technique to provide early estimation of postbypass coagulation status.
Publisher: Wiley
Date: 02-2008
DOI: 10.1046/J.1365-2044.2003.02888.X
Abstract: We have investigated the factors predicting umbilical arterial pH (UA pH) and standard base excess (UA BE) in 337 consecutive elective Caesarean sections performed under spinal anaesthesia. Multiple linear regression analysis was performed with UA pH and UA BE as the dependent factors. We found that the significant factors predicting UA pH were: use of ephedrine, uterine incision-to-delivery time, maximum decrease in systolic arterial pressure and the interaction between ephedrine use and duration of hypotension (adjusted R2 = 0.39, F15,321 = 15.4, p < 0.0001). The significant factors predicting UA BE were: use of ephedrine and the interaction between ephedrine use and duration of hypotension (adjusted R2 = 0.52, F15,321 = 25.0, p < 0.0001). We conclude that, in order to minimise the risk of fetal acidosis, ephedrine should not be used before delivery, uterine incision-to-delivery time should be as short as possible, and alpha-agonists such as metaraminol or phenylephrine should be used to minimise both the magnitude and duration of hypotension.
Publisher: Springer Science and Business Media LLC
Date: 15-04-2020
DOI: 10.1186/S13054-020-02865-Y
Abstract: Clinical team composition for prehospital paediatric intubation may affect success and complication rates. We performed a systematic review and meta-analysis to determine the success and complication rates by type of clinical team. We searched MEDLINE, EMBASE, and CINAHL for interventional and observational studies describing prehospital intubation attempts in children with overall success, first-pass success, and complication rates. Eligible studies, data extraction, and assessment of risk of bias were assessed independently by two reviewers. We performed a random-effects meta-analysis of proportions. Forty studies (1989 to 2019) described three types of clinical teams: non-physician teams with no relaxants (22 studies, n = 7602), non-physician teams with relaxants (12 studies, n = 2185), and physician teams with relaxants (12 studies, n = 1780). Twenty-two ( n = 3747) and 18 ( n = 7820) studies were at low and moderate risk of bias, respectively. Non-physician teams without relaxants had lower overall intubation success rate (72%, 95% CI 67–76%) than non-physician teams with relaxants (95%, 95% CI 93–98%) and physician teams (99%, 95% CI 97–100%). Physician teams had higher first-pass success rate (91%, 95% CI 86–95%) than non-physicians with (75%, 95% CI 69–81%) and without (55%, 95% CI 48–63%) relaxants. Overall airway complication rate was lower in physician teams (10%, 95% CI 3–22%) than non-physicians with (30%, 95% CI 23–38%) and without (39%, 95% CI 28–51%) relaxants. Physician teams had higher rates of intubation success and lower rates of overall airway complications than other team types. Physician prehospital teams should be utilised wherever practicable for critically ill children requiring prehospital intubation.
Publisher: SAGE Publications
Date: 10-1994
DOI: 10.1177/0310057X9402200510
Abstract: Effective utilization of an anaesthetic clinic depends on appropriate referral of high-risk surgical patients. The decision-making behaviour of anaesthetists and nurses was examined to identify factors that influence the referral of patients to an outpatient anaesthetic clinic. Eleven consultant anaesthetists, seven anaesthetic trainees and sixteen nurses working in anaesthetic areas estimated the likelihood that they would refer patients for each of the 30 scenarios presented. The relative importance of each factor influencing the decision to refer as determined by the 34 participants were: type of procedure (22%), co-morbidities (18%), fitness (13%), history of anaesthetic problems (12%), medications (11%), age (10%), obesity (8%) and anxiety (6%). Indicative risk factors identified were aged 65 years or over, unable to climb more than two flights of stairs, presence of significant medical problems, gross obesity, history of anaesthetic problems, taking regular medications, scheduled for major surgery and expressed anxiety about the anaesthetic. There were large variations in the decision-making behaviour among health professional groups.
Publisher: Wiley
Date: 18-04-2007
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2002
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
Publisher: BMJ
Date: 09-2022
DOI: 10.1136/BMJOPEN-2022-063583
Abstract: Multimodal prehabilitation, an emerging field within the Perioperative Medicine specialty, requires close multidisciplinary team coordination. The goal is to optimise the patient’s health status in the 4–8 weeks before elective surgery to withstand surgical stress. Most patients are unfamiliar with the concept of prehabilitation but are interested in participating in such a programme after explanation. The objective of this randomised controlled trial is to evaluate the effect of prehabilitation (patient education video and multimodal prehabilitation) on the preoperative patient-centred coordinated care experience. One hundred patients undergoing major elective surgery (cardiac, colorectal, hepatobiliary-pancreatic and urology) will be recruited into a two-group, parallel, superiority, single-blinded randomised controlled trial. Patients will be randomised to receive either preoperative patient education comprising of a video and prehabilitation programme with standard care (intervention) or standard care (control). The primary outcome measure will be the quality of preoperative patient care experience using the 11-item Chinese version of the Person-Centred Coordinated Care Experience Questionnaire (P3CEQ) before surgery. Secondary outcomes will include the change in Hospital Anxiety and Depression Scale (HADS) score from trial enrolment to before surgery, Quality of Recovery Score (QoR-15) on third day after surgery and Days Alive and At Home within 30 days after surgery (DAH 30 ). Intention-to-treat and per-protocol analyses will be performed. The Joint CUHK-NTEC Clinical Research Ethics Committee approved the study protocol (CREC Ref. No. 2021.518-T). The findings will be presented at scientific meetings, in peer-reviewed journals and to study participants. ChiCTR2100053637.
Publisher: Springer Science and Business Media LLC
Date: 27-06-2012
Publisher: BMJ
Date: 2014
Publisher: Springer Science and Business Media LLC
Date: 12-12-2023
Publisher: Springer Science and Business Media LLC
Date: 20-05-2008
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-1998
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2006
DOI: 10.1097/00000542-200609000-00007
Abstract: The use of traditional Chinese herbal medicines (TCHMs) among the presurgical population is widespread, but their impact on perioperative patient care is unclear. The authors estimated the incidence and risk of TCHM-related perioperative events. In a Hong Kong cohort study, 601 patients undergoing major elective surgery were asked about their Western medicine and TCHM use in the 2 weeks before surgery. Unanticipated perioperative events were noted by attending anesthesiologists, blinded to patients' use of specific TCHMs. Modified Poisson regression models were used to obtain the relative risk of combined endpoints of perioperative events associated with TCHM use. Of the 601 patients, 483 patients (80%) took self-prescribed TCHM, and 47 (8%) took TCHM by prescription (with or without self-prescribed TCHM) in the 2 weeks before surgery. The crude incidences of any combined endpoints of preoperative, intraoperative, and postoperative events were 23% (95% confidence interval, 19-26%), 74% (95% confidence interval, 71-78%), and 63% (95% confidence interval, 59-66%), respectively. Compared with nonusers, patients who took TCHM by prescription were more likely to have a preoperative event (adjusted relative risk, 2.21 95% confidence interval, 1.14-4.29). The authors present four case reports to highlight the effect of TCHM by prescription on prolonged activated partial thromboplastin time and hypokalemia in the preoperative period. In contrast, there was no significant association between the use of any type of TCHM and the occurrence of either intraoperative or postoperative events. The use of TCHM by prescription near the time of surgery should be discouraged because of the increased risk of adverse events in the preoperative period.
Publisher: SAGE Publications
Date: 10-2004
DOI: 10.1345/APH.1E098
Abstract: To describe a patient with massive intraoperative bleeding after oral consumption of Aloe vera tablets. A 35-year-old woman lost 5 L of blood during surgery as a result of a possible herb—drug interaction between Aloe vera and sevoflurane. Aloe vera is a common herb used for antiinflammatory and antiarthritic activity, as well as antibacterial, hypoglycemic, and lipid-lowering effects. Compounds contained within Aloe vera can cause a reduction in prostaglandin synthesis, which may inhibit secondary aggregation of platelets. Sevoflurane inhibits thromboxane A 2 formation by suppression of cyclooxygenase activity, impairs platelet aggregation, and prolongs bleeding. Although the vascularity and size of the hemangioma were the most important factors for the massive intraoperative blood loss, concomitant use of sevoflurane and Aloe vera played a contributory role. An objective causality assessment revealed that this adverse event was possible as a result of the sevoflurane and Aloe vera interaction. There is a potential herb—drug interaction between Aloe vera and sevoflurane based on the antiplatelet effects of these 2 agents. Herbal medications with antiplatelet potential should be discontinued before anesthesia and surgery.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2015
Publisher: Springer Science and Business Media LLC
Date: 26-07-2023
Publisher: BMJ
Date: 22-04-2020
DOI: 10.1136/BMJQS-2019-010667
Abstract: Preoperative education may help participants to psychologically prepare themselves for surgery, but the outcomes of such preparation have rarely been assessed in patients requiring postoperative care in the intensive care unit (ICU) as well as in family members. To assess the effect of a preoperative multifaceted education intervention on patient and family satisfaction levels in the ICU and measures of perioperative patients’ anxiety and depression. Single-centre, two-armed, parallel, superiority, randomised controlled trial. Healthcare professionals in ICU and outcome assessor were blinded to treatment allocation. 100 elective coronary artery bypass grafting±valve surgery patients and their family members. Preoperative education comprising of a video and ICU tour in addition to standard care (treatment), versus standard care (control). Patient and family satisfaction levels with ICU using validated PS-ICU23 and FS-ICU24 questionnaires (0–100), respectively change in perioperative anxiety and depression scores between 1 day presurgery and 3 days postsurgery. Among 100 (50 treatment, 50 control) patients and 98 (49 treatment, 49 control) family members, 94 (48 treatment, 46 control) patients and 94 (47 treatment, 47 control) family members completed the trial. Preoperative education was associated with higher overall patient (mean difference (MD) 6.7, 95% CI 0.2 to 13.2) and family (MD 10.0, 95% CI 3.8 to 16.3) satisfaction scores. There was a weak association between preoperative education and a reduction in patient’s anxiety scores over time (MD −1.7, 95% CI −3.5 to 0.0). However, there was no evidence of a treatment effect on patient’s depression scores over time (MD −0.6, 95% CI −2.3 to 1.2). Providing comprehensive preoperative information about ICU to elective cardiac surgical patients improved patient and family satisfaction levels and may decrease patients’ anxiety levels. ChiCTR-IOR-15006971.
Publisher: Springer Science and Business Media LLC
Date: 06-12-2007
Publisher: SAGE Publications
Date: 04-1995
DOI: 10.1177/0310057X9502300210
Abstract: The concept of a Medical Emergency Team was developed in order to rapidly identify and manage seriously ill patients at risk of cardiopulmonary arrest and other high-risk conditions. The aim of this study was to describe the utilization and outcome of Medical Emergency Team interventions over a one-year period at a teaching hospital in South Western Sydney. Data was collected prospectively using a standardized form. Cardiopulmonary resuscitation occurred in 148/522 (28%) calls. Alerting the team using the specific condition criteria occurred in 253/522 (48%) calls and on physiological athological abnormality criteria in 121/522 (23%) calls. Survival rate to hospital discharge following cardiopulmonary arrest was low (29%), compared with other medical emergencies (76%).
Publisher: Wiley
Date: 06-12-2006
Publisher: AMPCo
Date: 03-1994
Publisher: Springer Science and Business Media LLC
Date: 27-02-2009
Publisher: John Wiley & Sons, Ltd
Date: 19-12-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2007
Publisher: Elsevier BV
Date: 11-2003
DOI: 10.1016/S0020-1383(02)00395-9
Abstract: To determine the association between mortality and the level of prehospital care in severely injured blunt trauma patients with or without severe head injury. Retrospective review of 2010 severe blunt trauma patients (injury severity score (ISS) >15) with or without severe head injury in a tiered trauma system involving ambulance officers (basic life support (BLS) and advanced life support (ALS)) and physicians, and a Level 1 trauma centre. After adjusting for age, type of head injury, glasgow coma scale score (GCS), systolic blood pressure, ISS and prehospital time, intensive care unit (ICU) admission modified the association between level of prehospital care and mortality. In those patients without ICU admission, patients in the paramedic and physician-staffed emergency services group were more likely to die than patients in the BLS ambulance group (odds ratio (OR) 2.18, 95% confidence intervals (CI): 1.05-4.55 4.27, 95% CI: 1.46-12.45, respectively). Among patients who survived to ICU treatment, however, there was no association between level of prehospital care and risk of mortality. Presence or absence of a head injury did not modify the risk of mortality. The level of prehospital care was associated with the risk of mortality. This was modified by whether the patient survived long enough to be admitted to the ICU.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2002
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2005
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2018
Publisher: BMJ
Date: 07-2023
DOI: 10.1136/BMJOPEN-2022-069528
Abstract: Protein malnutrition is associated with higher risks of postoperative complications, mortality, prolonged postoperative stays in hospital, slower physical and mental recovery after surgery and lower subsequent health-related quality of life. To reduce the risk of postoperative morbidity and mortality, nutritional prehabilitation programmes have been developed recently to build up patient’s nutritional reserve to withstand the stress of surgery. The intervention involves nutritional screening and counselling, and increasing dietary protein intake in protein-malnourished patients in the several weeks before surgery. However, there are few well-conducted preoperative studies to examine the effect of increasing dietary protein intake on the quality of recovery of malnourished patients after elective cardiac surgery. This randomised controlled trial of malnourished patients undergoing major elective cardiac surgery will compare the quality of postoperative recovery in patients with or without nutritional prehabilitation. One hundred and thirty-two patients will be randomised to receive nutritional prehabilitation (target-adjusted whey protein powder supplementation and an in idualised 1 hour session/week counselling by a dietician 1 month before operation date) or standard care (no nutritional prehabilitation). Primary outcomes will be the quality of recovery after surgery (15-item Quality of Recovery) on the third postoperative day. Secondary outcomes will include days (alive and) at home within 30 days, changes in the WHO Disability Assessment Schedule 2.0, changes in health-related quality of life (EQ-5D) and Cardiac Postoperative Morbidity Survey. An outcomes assessor will be blinded to the treatment allocation. Appropriate univariate analyses, generalised estimating equations and multiple regressions will be performed for intention-to-treat and per-protocol analyses. The Joint CUHK-NTEC Clinical Research Ethics Committee approved the study protocol (CREC Ref. No.: 2021.703 T). The findings will be presented at scientific meetings, peer-reviewed journals and to study participants. ChiCTR2200057463.
Publisher: Springer Science and Business Media LLC
Date: 07-09-2020
DOI: 10.1186/S12879-020-05330-X
Abstract: Currently there are only two population studies on sepsis incidence in Asia. The burden of sepsis in Hong Kong is unknown. We developed a sepsis surveillance method to estimate sepsis incidence from a population electronic health record (EHR) in Hong Kong using objective clinical data. The study objective was to assess our method’s performance in identifying sepsis using a retrospective cohort. We compared its accuracy to administrative sepsis surveillance methods such as Angus’ and Martin’s methods. In this single centre retrospective study we applied our sepsis surveillance method on adult patients admitted to a tertiary hospital in Hong Kong. Two clinicians independently reviewed the clinical notes to determine which patients had sepsis. Performance was assessed by sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) of Angus’, Martin’s and our surveillance methods using clinical review as “gold standard.” Between January 1 and February 28, 2018, our sepsis surveillance method identified 1352 adult patients hospitalised with suspected infection. We found that 38.9% (95%CI 36.3–41.5) of these patients had sepsis. Using a 490 patient validation cohort, two clinicians had good agreement with weighted kappa of 0.75 (95% CI 0.69–0.81) before coming to consensus on diagnosis of uncomplicated infection or sepsis for all patients. Our method had sensitivity 0.93 (95%CI 0.89–0.96), specificity 0.86 (95%CI 0.82–0.90) and an AUC 0.90 (95%CI 0.87–0.92) when validated against clinician review. In contrast, Angus’ and Martin’s methods had AUCs 0.56 (95%CI 0.53–0.58) and 0.56 (95%CI 0.52–0.59), respectively. A sepsis surveillance method based on objective data from a population EHR in Hong Kong was more accurate than administrative methods. It may be used to estimate sepsis population incidence and outcomes in Hong Kong. This study was retrospectively registered at clinicaltrials.gov on October 3, 2019 ( NCT04114214 ).
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2015
DOI: 10.1097/ALN.0000000000000589
Abstract: Adaptive support ventilation can speed weaning after coronary artery surgery compared with protocolized weaning using other modes. There are no data to support this mode of weaning after cardiac valvular surgery. Furthermore, control group weaning times have been long, suggesting that the results may reflect control group protocols that delay weaning rather than a real advantage of adaptive support ventilation. Randomized (computer-generated sequence and sealed opaque envelopes), parallel-arm, unblinded trial of adaptive support ventilation versus physician-directed weaning after adult fast-track cardiac valvular surgery. The primary outcome was duration of mechanical ventilation. Patients aged 18 to 80 yr without significant renal, liver, or lung disease or severe impairment of left ventricular function undergoing uncomplicated elective valve surgery were eligible. Care was standardized, except postoperative ventilation. In the adaptive support ventilation group, target minute ventilation and inspired oxygen concentration were adjusted according to blood gases. A spontaneous breathing trial was carried out when the total inspiratory pressure of 15 cm H2O or less with positive end-expiratory pressure of 5 cm H2O. In the control group, the duty physician made all ventilatory decisions. Median duration of ventilation was statistically significantly shorter (P = 0.013) in the adaptive support ventilation group (205 [141 to 295] min, n = 30) than that in controls (342 [214 to 491] min, n = 31). Manual ventilator changes and alarms were less common in the adaptive support ventilation group, and arterial blood gas estimations were more common. Adaptive support ventilation reduces ventilation time by more than 2 h in patients who have undergone fast-track cardiac valvular surgery while reducing the number of manual ventilator changes and alarms.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 1997
DOI: 10.1097/00000542-199701000-00034
Abstract: Introduction The role of complete revascularization (CR) vs target vessel revascularization (TVR) in non-ST-elevation myocardial infarction (NSTEMI) in patients without cardiogenic shock is still not established. In this study, we compared outcomes at one and six months among patients with NSTEMI with multivessel disease (MVD) undergoing CR vs TVR. Methods It was a prospective, observational study carried out among 60 NSTEMI patients with MVD (30 undergoing TVR and 30 CR) from October 2018 to November 2019. They were assessed at one and six months for primary and secondary outcomes. Results The mean age of the patients was 56.13 ± 9.23 years and both the groups were well matched with respect to age, gender, risk factors, and comorbidities. In the majority of patients, the target vessel was left anterior descending (LAD) followed by right coronary artery (RCA) and left circumflex (LCX) in both groups. The primary outcomes of death from any cause, non-fatal myocardial infarction, and the need for revascularization of the ischemia-driven vessel showed no significant difference at one and six months follow-up between the CR and TVR groups. However, the secondary outcomes of heart failure hospitalizations and angina episodes were significantly more in the TVR group than CR group at one month (6 vs 1, P=0.044), (8 vs 2, P=0.038) and six months (8 vs 2, P=0.038), (9 vs 2, P=0.02), respectively. Conclusion CR was associated with no difference in death from all-cause or future revascularization but significantly lesser secondary outcomes of heart failure hospitalizations and angina episodes as compared to TVR in NSTEMI without cardiogenic shock.
Publisher: Elsevier BV
Date: 03-2003
Abstract: To evaluate, by systematic review, the efficacy of heliox on respiratory mechanics and outcomes in patients with acute asthma. The search strategy included searching electronic databases (MEDLINE, EMBASE, and The Cochrane Library) and the references of relevant articles. Study quality was assessed based on allocation concealment. Randomized controlled trials (RCTs) comparing heliox to an air-oxygen mixture (airO(2)) as an adjunct treatment in patients with acute asthmatic attacks were analyzed. For the qualitative portion of the analysis, all reports of the use of heliox in patients with acute asthma were included. Four RCTs (n = 278) were found to have a common respiratory parameter (peak expiratory flow rate as a percentage of predicted) suitable for meta-analysis. Within the 92% confidence interval (CI), there was a small benefit with the use of heliox compared to airO(2) (weighted mean difference, + 3% 95% CI, - 2 to + 8%). There was also a slight improvement in the dyspnea index (weighted mean difference, 0.60 95% CI, 0.04 to 1.16) with the use of heliox over airO(2). Overall, five RCTs, one nonrandomized unblinded parallel trial, one retrospective case-matched control trial, three case series, and one case report had results in favor of heliox one RCT and one case series showed no improvement with heliox one RCT showed a possible detrimental effect with heliox and 1 small RCT was inconclusive. Most investigators did not prevent entrainment of room air during heliox use or compensate for the lower nebulizing efficiency of heliox. Based on surrogate markers, heliox may offer mild-to-moderate benefits in patients with acute asthma within the first hour of use, but its advantages become less apparent beyond 1 h, as most conventionally treated patients improve to similar levels, with or without it. The effect of heliox may be more pronounced in more severe cases. There are insufficient data on whether heliox can avert tracheal intubation, or change intensive care and hospital admission rates and duration, or mortality.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 28-10-2022
Publisher: Springer Science and Business Media LLC
Date: 26-01-2017
Publisher: Wiley
Date: 29-03-2016
Abstract: Simultaneous electrophoretic concentration and separation (SECS) was used as a simple and environmental friendly s le preparation strategy for herbicides in beer s les. An electric field was used to facilitate the separation and concentration of the analytes based on their charge from a 20 mL s le of diluted beer into two separate 20 μL aliquots of an acceptor electrolyte housed inside a micropipette. The anionic organophosphonate and cationic quaternary ammonium herbicides were concentrated in the anodic and cathodic pipette, respectively. Under optimized conditions, SECS was completed in 30 min at an applied voltage of 150 V, which provided analyte concentration factors of up to 90. After s le preparation, the SECS concentrate of cationic and anionic herbicides was analyzed by stacking CE with UV detection and also by LC-MS, respectively. The method detection limit for the diluted and undiluted s le was as low as 3 and 15 ng/mL, respectively. The method was linear over two orders of concentration with repeatability and intermediate precision of better than 5.8 and 7.0%RSD, respectively. Accuracy values were between 91.0-115.1%.
Publisher: Elsevier BV
Date: 12-2023
Publisher: SAGE Publications
Date: 08-2005
DOI: 10.1177/0310057X0503300414
Abstract: We have surveyed, by means of a questionnaire, the preoperative use of traditional Chinese medicines in 259 adult Chinese patients admitted to a Hong Kong teaching hospital. The spectrum and use of herbal remedies differed from that reported by Western sources. Of those patients surveyed 90% used Chinese herbs on a regular daily basis in traditional soups and teas while 44% had consulted a traditional Chinese medicine practitioner in the last twelve months prior to admission, but mainly for health promotion (59%) and minor ailments (30%). Only 25% sought advice for their current illness and 13% were taking regular traditional Chinese medicines prior to admission. The ingredients were difficult to identify. Patients with cancer were more likely to use ling zhi (odds ratio 5.4). Female patients with reproductive problems were more likely to visit a traditional Chinese medical practitioner (odds ratio 2.6) and use ginseng (odds ratio 5.1). The anaesthetic implications of preoperative traditional Chinese medicine in keeping with Hong Kong practices need to be investigated, and appropriate anaesthetic guidelines should be developed.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.ARTH.2016.02.052
Abstract: Hypovitaminosis D is associated with adverse surgical outcomes. We quantified the environmental, demographic, and modifiable determinants of serum 25-hydroxyvitamin D (25-OHD) concentration and assessed the potential impact of a preoperative screening questionnaire for moderate-to-severe hypovitaminosis D (25-OHD <30 nmol/L). In a retrospective cohort study of 227 Chinese patients (69 males and 158 females) undergoing 261 joint arthroplasty, we collected information on recent sun exposure, dietary vitamin D intake, vitamin D supplementation, and Western Ontario and McMaster Universities osteoarthritis index using a questionnaire and measured a fasting 25-OHD concentration using a liquid chromatography-tandem mass spectrometry before surgery. The multiple regression model on the determinants of 25-OHD concentration described 14% of the total variance, with the greatest relative contribution from ambient ultraviolet radiation (42%). A 4-item screening test for moderate-to-severe hypovitaminosis D had acceptable discrimination (area under receiver operating characteristic curve = 0.76, 95% CI, 0.65-0.87), good calibration (Hosmer-Lemeshow goodness-of-fit P = .93). Decision curve analysis showed that the screening test can potentially reduce unnecessary 25-OHD testing by 390 per 1000 patients at a threshold probability of 10%. The screening test appears moderately useful in avoiding a substantial number of unnecessary 25-OHD testing in a setting where the prevalence of moderate-to-severe hypovitaminosis D is less than 10%.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2007
Publisher: Anticancer Research USA Inc.
Date: 03-10-2017
DOI: 10.21873/ANTICANRES.12024
Abstract: This 5-year prospective follow-up of women randomized to general anesthesia (GA) with or without a thoracic paravertebral block (TPVB) examined the risk of local recurrence, metastasis and mortality after breast cancer surgery. A total of 180 patients undergoing modified radical mastectomy were randomized to one of three study groups: standardized GA only GA with a single-injection TPVB (s-TPVB) and placebo paravertebral infusion after surgery for 72-h and GA plus with continuous TPVB (c-TPVB) for 72-h postoperatively. Cox proportional models were used to assess the effect of TPVB on long-term outcomes. Equivalence testing was used to help interpret the results. The incidence [95% confidence interval (CI)] of cancer recurrence, metastatic spread and all-cause mortality was 2.3% (0.7-5.4%), 7.9% (4.6-12.6%) and 6.8% (3.6-11.2%), respectively. Four women had cancer recurrence and had metastatic spread. Compared to the GA-only group, the risk of metastatic spread was not different from that of GA with s-TPVB [hazard ratio (HR)=1.11, 95% CI=0.32-3.83) nor from that with GA plus c-TPVB (HR=0.79, 95% CI=0.21-2.96) (p=0.88). Compared to the GA-only group, the risk of mortality was similarly not different from that of the two other groups (HR=2.57, 95% CI=0.66-9.92 and HR=0.66, 95% CI=0.11-3.97, respectively, p=0.15). Although the original study was underpowered to properly address long-term outcomes, the results of this analysis suggest that TPVB, administered whether as a single-injection or continuous infusion during the perioperative period, had little to no appreciable effect on local recurrence, metastasis or mortality after breast cancer surgery.
Publisher: Wiley
Date: 14-09-2000
Publisher: Springer Science and Business Media LLC
Date: 09-2001
Abstract: To evaluate factors associated with decisions to refuse ICU admission and to assess the outcome of refused patients. Prospective, descriptive evaluation in a multi-disciplinary intensive care unit, university referral hospital. All adult emergency referrals over a 7-month period. The number of beds available at the time of referral, the patient's age, gender, diagnosis, mortality probability model score and hospital survival were documented. The outcome of the referral and the reason for refusal were recorded. Of 624 patients 388 were admitted and 236 (38%) refused. Reasons for refusal were triage (n=104), futility (n=82) and inappropriate referral (too well n=50). The standardised mortality ratio (SMR) for refused and admitted groups was 1.24 (95% CI 1.05-1.46) and 0.93 (0.78-1.09) respectively. The SMR ratio (refused SMR/admitted SMR) was highest in the middle range of illness (1.95, 1.19-3.20). Inappropriate referrals had a better than expected outcome despite refusal, with a SMR ratio of 0.39 (0.11-0.99). Excluding inappropriate referrals, multivariate analysis demonstrated that refusal was associated with older age, diagnostic group and severity of illness. Triage decisions were associated with a diagnosis of sepsis, and futility decisions with greater severity of illness and recent cardiac arrest. Refusal of admission to our ICU is common. Excess mortality of patients refused is most marked in the middle range of severity of illness. Age, diagnostic group, and severity of illness are important in decision making. Strategies should be developed to create admission criteria that would identify patients in the middle range of severity of illness who should benefit most from ICU care.
Publisher: Mary Ann Liebert Inc
Date: 09-2010
Publisher: Oxford University Press (OUP)
Date: 16-03-2010
DOI: 10.1002/BJS.6960
Abstract: This study investigated the relationship of American Society of Anesthesiologists Physical Status (ASA-PS) grade and degree of surgical insult to long-term postoperative survival. National death records to June 2007 were matched against records of patients undergoing elective surgery between January 1997 and December 2001. Stratified survival analysis was performed to allow baseline hazard functions to vary among four patient groups (15–64 years with no malignancy, at least 65 years with no malignancy, 15–64 years with malignancy and at least 65 years with malignancy). Of 8134 patients, 6185 (76·0 per cent) were alive after a median follow-up of 7·1 (range 0–10·5) years. The overall mortality rate was 3·62 (95 per cent confidence interval (c.i.) 3·46 to 3·78) per 100 person-years. The 10-year probability of survival was significantly higher in ASA-PS I or II for minor or intermediate surgery (90·7 (89·1 to 92·1) per cent) than in ASA-PS I or II for major or complex major surgery (79·6 (77·5 to 81·6) per cent), ASA-PS III or IV for minor or intermediate surgery (41·2 (36·2 to 46·7) per cent) and ASA-PS III or IV for major or complex major surgery (44·6 (41·4 to 47·7) per cent) (P & 0·001). Priority of admission modified survival probabilities. Adjusted survival probabilities were lowest in the elderly with malignancy. ASA-PS grade has a more significant and persistent effect on long-term survival than degree of surgical insult.
Publisher: Mary Ann Liebert Inc
Date: 12-2010
Publisher: Wiley
Date: 24-02-2013
Publisher: BMJ
Date: 03-2002
Abstract: Omission of a confidence interval (CI) associated with the risk of a serious complication can lead to inaccurate interpretation of risk data. The calculation of a CI for a risk or a single proportion typically uses the familiar Gaussian (normal) approximation. However, when the risk is small, "exact" methods or other special techniques should be used to avoid overshooting (risks that include values outside of [0,1]) and zero width interval degeneration. Computer programs and simple equations are available to construct CIs reasonably accurately. In the special case in which the complication has not occurred, the risk estimated with 95% confidence is no worse than 3/n, where n is the number of trials.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-1999
DOI: 10.1097/00000539-199906000-00031
Abstract: We assessed the efficacy of nonpharmacologic techniques to prevent postoperative nausea and vomiting (PONV) by systematic review. These studies included acupuncture, electroacupuncture, transcutaneous electrical nerve stimulation, acupoint stimulation, and acupressure. Of the 24 randomized trials retrieved by a search of articles indexed on the MEDLINE and EMBASE databases (1980-1997), 19 were eligible for meta-analysis. The primary outcomes were the incidence of nausea, vomiting, or both 0-6 h (early efficacy) or 0-48 h (late efficacy) after surgery. The pooled relative risk (RR) and numbers needed to treat (NNT) were calculated. In children, no benefit was found. Some results in adults were significant. Nonpharmacologic techniques were similar to antiemetics in preventing early vomiting (RR = 0.89 [95% confidence interval 0.47-1.67] NNT = 63 [10-infinity]) and late vomiting (RR = 0.80 [0.35-1.81] NNT = 25 [5-infinity]) in adults. Nonpharmacologic techniques were better than placebo at preventing early nausea (RR = 0.34 [0.20-0.58] NNT = 4 [3-6]) and early vomiting in adults (RR = 0.47 [0.34-0.64] NNT = 5 [4-8]). Nonpharmacologic techniques were similar to placebo in preventing late vomiting in adults (RR = 0.81 [0.46-1.42] NNT = 14 [6-infinity]). Using nonpharmacologic techniques, 20%-25% of adults will not have early PONV compared with placebo. It may be an alternative to receiving no treatment or first-line antiemetics. This systematic review showed that nonpharmacologic techniques were equivalent to commonly used antiemetic drugs in preventing vomiting after surgery. Nonpharmacologic techniques were more effective than placebo in preventing nausea and vomiting within 6 h of surgery in adults, but there was no benefit in children.
Publisher: John Wiley & Sons, Ltd
Date: 23-10-2001
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2014
DOI: 10.1097/ALN.0000000000000118
Abstract: Lipophilic opioids and local anesthetics are often given intrathecally in combination for labor analgesia. However, the nature of the pharmacologic interaction between these drugs has not been clearly elucidated in humans. Three hundred nulliparous women randomly received 1 of 30 different combinations of fentanyl and bupivacaine intrathecally using a combined spinal-epidural technique for analgesia in the first stage of labor. Visual analogue scale pain scores were recorded for 30 min. Response was defined by percentage decrease in pain score from baseline at 15 and 30 min. Dose–response curves for in idual drugs were fitted to a hyperbolic dose–response model using nonlinear regression. The nature of the drug interaction was determined using dose equivalence methodology to compare observed effects of drug combinations with effects predicted by additivity. The derived dose–response models for in idual drugs (doses in micrograms) at 15 min were: Effect = 100 × dose / (13.82 + dose) for fentanyl, and Effect = 100 × dose / (1,590 + dose) for bupivacaine. Combinations of fentanyl and bupivacaine produced greater effects than those predicted by additivity at 15 min (P & 0.001) and 30 min (P = 0.015) (mean differences, 9.1 [95% CI, 4.1–14.1] and 6.4 [95% CI, 1.2–11.5] units of the normalized response, respectively), indicating a synergistic interaction. The pharmacologic interaction between intrathecal fentanyl and bupivacaine is synergistic. Characterization and quantification of this interaction provide a theoretical basis and support for the clinical practice of combining intrathecal opioids and local anesthetics.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 27-08-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2008
Publisher: Wiley
Date: 31-03-2020
DOI: 10.1111/ANAE.15057
Publisher: Oxford University Press (OUP)
Date: 19-08-2023
DOI: 10.1093/CID/CIAD491
Abstract: Sepsis surveillance using electronic health record (EHR)-based data may provide more accurate epidemiologic estimates than administrative data, but experience with this approach to estimate population-level sepsis burden is lacking. This was a retrospective cohort study including all adults admitted to publicly-funded hospitals in Hong Kong between 2009-2018. Sepsis was defined as clinical evidence of presumed infection (clinical cultures and treatment with antibiotics) and concurrent acute organ dysfunction (≥2 point increase in baseline SOFA score). Trends in incidence, mortality, and case fatality risk (CFR) were modelled by exponential regression. Performance of the EHR-based definition was compared with 4 administrative definitions using 500 medical record reviews. Among 13,550,168 hospital episodes during the study period, 485,057 (3.6%) had sepsis by EHR-based criteria with 21.5% CFR. In 2018, age- and sex-adjusted standardized sepsis incidence was 759 per 100,000 (relative +2.9%/year [95%CI 2.0, 3.8%] between 2009-2018) and standardized sepsis mortality was 156 per 100,000 (relative +1.9%/year [95%CI 0.9,2.9%]). Despite decreasing CFR (relative -0.5%/year [95%CI -1.0, -0.1%]), sepsis accounted for an increasing proportion of all deaths (relative +3.9%/year [95%CI 2.9, 4.9%]). Medical record reviews demonstrated that the EHR-based definition more accurately identified sepsis than administrative definitions (AUC 0.91 vs 0.52–0.55, p & 0.001). An objective EHR-based surveillance definition demonstrated an increase in population-level standardized sepsis incidence and mortality in Hong Kong between 2009-2018 and was much more accurate than administrative definitions. These findings demonstrate the feasibility and advantages of an EHR-based approach for widescale sepsis surveillance.
Publisher: Springer Science and Business Media LLC
Date: 25-01-2011
DOI: 10.1007/S00134-010-2124-X
Abstract: Critical care doctors are frequently faced with clinical problems that have important ethical and moral dimensions. While Western attitudes and practice are well documented, little is known of the attitudes or practice of Chinese critical care doctors. An anonymous, written, structured questionnaire survey was translated from previously reported ethical surveys used in Europe and Hong Kong. A snowball method was used to identify 534 potential participants from 21 regions in China. A total of 315 (59%) valid responses were analysed. Most respondents (66%) reported that admission to an intensive care unit (ICU) was commonly limited by bed availability, but most (63%) would admit patients with a poor prognosis to ICU. Only 19% of respondents gave complete information to patients and family, with most providing in idually adjusted information, based on prognosis and the recipient's educational level. Only 28% disclosed all details of an iatrogenic incident, despite 62% stating that they should. The use of do not resuscitate orders or limitation of life-sustaining therapy in terminally ill patients reported as uncommon and according to comparable reports, both are more common practice in Hong Kong or Europe. In contrast to European practices, doctors were more acquiescent to families in decision-making at the end of life. A number of differences in ethical attitudes and related behaviour between Chinese, Hong Kong and European ICU doctors were documented. A likely explanation is differing cultural background, and doctors should be aware of likely expectations when treating patients from a different culture.
Publisher: Wiley
Date: 23-07-2020
DOI: 10.1111/AAS.13444
Abstract: Noninvasive monitoring of cerebral physiology could potentially guide pre-hospital management of patients with traumatic injuries. Near-infrared spectroscopy (NIRS) is one such modality but the consistency of monitoring performance remains unclear. This study assessed the proportion of successful signal collection during pre-hospital care. As part of a prospective observational study, an independent study observer placed three sensors for a Nonin 7610 NIRS device two on the forehead and one on the forearm. NIRS records were analysed for time of adequate monitoring signal in each sensor (>70% of total pre-hospital time). We also compared pre-hospital scene and transport times for patients with or without NIRS monitoring. Sixty-three patients with monitoring sensors applied were compared to 255 patients where no study observer was on board and 97 without NIRS monitoring for various reasons within the same time period. The proportion of pre-hospital time with successful monitoring (>70%) was 71.4% (45 of 63) for all three sensors, with at least two sensors functional in 90.4% (57 of 63). The median (interquartile range) scene time was 19 (11-23) minutes in patients with NIRS monitoring compared to 18 (11-27) minutes without NIRS monitoring (P = .570). There was no difference in the median (interquartile range) total pre-hospital time between patients with or without monitoring sensors (72 [59-89] versus 72 [59-80] minutes P = .605). In this pre-hospital observational feasibility study with dedicated personnel an acceptable proportion of measurement time was achieved in over 90% of monitored subjects. Addition of NIRS monitoring did not alter pre-hospital scene or transport times in this research setting.
Publisher: Public Library of Science (PLoS)
Date: 30-06-2022
DOI: 10.1371/JOURNAL.PONE.0270640
Abstract: Patients with colorectal cancer have a high risk of iron deficiency anaemia (IDA) due to chronic tumour induced blood loss, a reduced dietary iron intake from poor nutrition or gastrointestinal malabsorption. This pilot, double blinded, randomised controlled trial (RCT) examined the effect and feasibility of using preoperative iron isomaltoside for treating iron deficiency anaemia. Forty eligible adults with IDA were randomised to receive either intravenous iron isomaltoside (20 mg.kg -1 up to 1000 mg over 30 minutes) or usual preoperative care (control) three weeks before scheduled colorectal surgery. The primary outcomes were perioperative changes in haemoglobin and ferritin concentrations. The recruitment rate was 78% of all eligible referred patients (1.9 patients/month). The haemoglobin and ferritin concentrations were higher in the iron isomaltoside group than the control group over the perioperative period (group*time interaction P = 0.042 and P 0.001 respectively). Mean haemoglobin change from baseline to before surgery was higher in the iron isomaltoside group (7.8, 95% CI: 3.2 to 12.3 g.l -1 ) than the control group (1.7, 95% CI: -1.9 to 5.3 g.l -1 ) [mean difference 6.1, 95% CI: 0.3 to 11.8 g.l -1 P = 0.040]. The ferritin change from baseline to before surgery between groups was large in favour of the iron isomaltoside group (mean difference 296.9, 95% CI: 200.6 to 393.2 μg.l -1 P 0.001]. There were no differences between groups in packed red blood cell transfusions needed, surgical complications, quality of recovery and days (alive and) at home within 30 days after surgery. Iron isomaltoside therapy was safe and had a minimal effect on perioperative changes in haemoglobin concentration. Given the slow recruitment and new evidence emerging during the conduct of this study, conducting a multi-centre RCT based on the current pilot trial protocol is unlikely to be feasible. ClinicalTrials.gov NCT03565354 .
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1093/BJA/AEW476
Abstract: Numerous risk prediction models are available for predicting delirium after cardiac surgery, but few have been directly compared with one another or been validated in an independent data set. We conducted a systematic review to identify validated risk prediction models of delirium (using the Confusion Assessment Method-Intensive Care Unit tool) after cardiac surgery and assessed the transportability of the risk prediction models on a prospective cohort of 600 consecutive patients undergoing cardiac surgery at a university hospital in Hong Kong from July 2013 to July 2015. The discrimination (c-statistic), calibration (GiViTI calibration belt), and clinical usefulness (decision curve analysis) of the risk prediction models were examined in a stepwise manner. Three published high-quality intensive care unit delirium risk prediction models (n=5939) were identified: Katznelson, the original PRE-DELIRIC, and the international recalibrated PRE-DELIRIC model. Delirium occurred in 83 patients (13.8%, 95% CI: 11.2-16.9%). After updating the intercept and regression coefficients in the Katznelson model, there was fair discrimination (0.62, 95% CI: 0.58-0.66) and good calibration. As the original PRE-DELIRIC model was already validated externally and recalibrated in six countries, we performed a logistic calibration on the recalibrated model and found acceptable discrimination (0.75, 95% CI: 0.72-0.79) and good calibration. Decision curve analysis demonstrated that the recalibrated PRE-DELIRIC risk model was marginally more clinically useful than the Katznelson model. Current models predict delirium risk in the intensive care unit after cardiac surgery with only fair to moderate accuracy and are insufficient for routine clinical use.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.JTCVS.2017.08.139
Abstract: The purpose of the study was to evaluate the association between motor subtypes of postoperative delirium in the intensive care unit and fast-track failure (a composite outcome of prolonged stay in the intensive care unit >48 hours, intensive care unit readmission, and 30-day mortality) after cardiac surgery. This was a secondary analysis of a prospective cohort study of 600 consecutive adults undergoing cardiac surgery at a university hospital in Hong Kong (July 2013 to July 2015). The motor subtypes of delirium were classified using the Richmond Agitation Sedation Score and Confusion Assessment Method intensive care unit assessments performed by trained bedside nurses. A generalized estimating equation was used to estimate a common relative risk of fast-track failure associated with motor subtypes. The incidences of hypoactive, hyperactive, and mixed motor subtypes were 4.3% (n = 26), 4.0% (n = 24), and 5.5% (n = 33), respectively. Fast-track failure occurred in 88 patients (14.7%). There was an association between delirium (all subtypes) and fast-track failure (P = .048) hyperactive delirium (relative risk, 1.95 95% confidence interval, 0.96-3.94) hypoactive delirium (relative risk, 2.79 95% confidence interval, 1.34-5.84) and mixed delirium (relative risk, 2.55 95% confidence interval, 1.11-5.88). Hypoactive and mixed subtypes were associated with prolonged intensive care unit stay (both P = .001). Patients with pure hypoactive delirium had a similar risk of developing fast-track failure as other motor subtypes. Differentiation of motor subtypes is unlikely to be clinically important for prognostication of fast-track failure. However, because delirium is associated with poor outcomes, potential treatment strategies should address all subtypes equally.
Location: Hong Kong
Start Date: 2006
End Date: 2009
Funder: Research Grants Council, University Grants Committee
View Funded ActivityStart Date: 2007
End Date: 2010
Funder: Research Grants Council, University Grants Committee
View Funded ActivityStart Date: 2001
End Date: 2003
Funder: Research Grants Council, University Grants Committee
View Funded ActivityStart Date: 2002
End Date: 2005
Funder: Research Grants Council, University Grants Committee
View Funded ActivityStart Date: 2011
End Date: 2014
Funder: Research Grants Council, University Grants Committee
View Funded ActivityStart Date: 2013
End Date: 2016
Funder: Research Grants Council, University Grants Committee
View Funded ActivityStart Date: 2010
End Date: 2012
Funder: Food and Health Bureau
View Funded ActivityStart Date: 2010
End Date: 2012
Funder: Research Grants Council, University Grants Committee
View Funded ActivityStart Date: 2019
End Date: 2022
Funder: Chinese University of Hong Kong
View Funded ActivityStart Date: 2015
End Date: 2017
Funder: Research Grants Council, University Grants Committee
View Funded ActivityStart Date: 2022
End Date: 2025
Funder: Research Grants Council, University Grants Committee
View Funded ActivityStart Date: 2011
End Date: 2013
Funder: Food and Health Bureau
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