bluuebunny/crossref_metadata_2025 huggingface dataset:
The Australian Incident Monitoring Study in Intensive Care: AIMS-ICU. the Development and Evaluation of an Incident Reporting System in Intensive Care
Authors: Beckmann U. , West L. F. , Groombridge G. J. , Baldwin I. , Hart G. K. , Clayton D. G. , Webb R. K. , Runciman W. B. ,   Intensive Care Units participating in the AIMS-ICU project
Published: January 2019

Intensive care units are complex, dynamic patient management environments. Incidents and accidents can be caused by human error, by problems inherent in complex systems, or by a combination of these. Study objectives were to develop and evaluate an incident reporting system. A report form was designed eliciting a description of the incident, contextual information and contributing factors. Staff group sessions using open-ended questions, observations in the workplace and a review of earlier narratives were used to develop the report form. Three intensive care units participated in a two-month evaluation study. Feedback questionnaires were used to assess staff attitudes and understanding, project design and organization. These demonstrated a positive attitude and good understanding by more than 90% participants. Errors in communication, technique, problem recognition and charting were the predisposing factors most commonly chosen in the 128 incidents reported. It was concluded that incident monitoring may be a suitable technique for improving patient safety in intensive care.
Continuous Measurement of Arterial Blood Gas Status during Total Hip Replacement: A Prospective Study
Authors: Venkatesh B. , Pigott D. W. , Fernandez A. , Hendry S. P.
Published: January 2019

The arterial blood gas chemistry was measured continuously in ten patients during primary cemented total hip replacement in order to define more precisely the patterns of changes in blood gases during various stages of the operation. All ten patients demonstrated significant drops in PaO2 after femoral cement implantation and nine of the ten after acetabular cement implanation. The mean drop in PaO2 following acetabular cement expressed as mean ± SD was 18±8 mmHg (16±6%) (P<0.05) and femoral cement application was 25±11 mmHg (23±9%) (P<0.05). For changes in PaO2 there were corresponding drops in SpO2 in all patients with the femoral cement and in eight patients with the acetabular cement. The mean drop in SpO2 following the application of acetabular and femoral cements respectively were 1.7±1.5% and 3±2.45%. No changes in blood PaO2 were observed during dislocation of the hip joint or reaming of acetabulum and femur. In vitro studies revealed no effect of the liquid monomer or the cured cement on the performance of the Clark electrode of the sensor. We suggest that significant drops in PaO2 occur with both acetabular and femoral cement implantation and that the derangements in blood PaO2 last longer than detected by pulse oximetry following cement implantation.
Staged Abdominal Repair in Critical Illness
Authors: Torrie J. , Hill A. A. , Streat S.
Published: January 2019

Marlex mesh interposition as part of staged abdominal repair (M-STAR) was used on 68 occasions to reduce pressure during abdominal closure (46), facilitate multiple laparotomies (15), both indications (4) or defect repair (3), in 66 critical care admissions (median \APACHE-II=21). Physiological data before and after M-STAR performed for intra-abdominal pressure were retrospectively available on 33/36 ventilated occasions. Compliance improved (median Vt/[Paw-PEEP] 22.6 vs 30.3 ml/cm H2O, P<0.0001), but efficiency of oxygenation (median PaO2/FiO2 136 vs 175 mmHg) and ventilation (median VE/PaCO2 243 vs 289 ml/min/mmHg) were unchanged. Heart rate fell (median 130 to 110, P=0.01), blood pressure and inotrope dose did not change. Urine flow increased (median 60 to 110 ml/h, P=0.007) but there was no clear trend in six-hourly serum creatinine. Seven bowel fistulae and three dehiscences occurred. Thirty-five patients survived critical care after 2–7 (median 2) M-STAR related operations and 3–63 (median 20) days. Thirty-one hospital survivors used 19–158 (median 47) hospital days; one patient was still in hospital at 39 months. Five patients died 1–55 months after hospital discharge. At follow-up 1–39 (median 7.5) months after critical care there were two fistulae, five stitch sinuses and five incisional hernias in the 27 survivors. M-STAR facilitates critical care and repeat laparotomy with acceptable surgical sequelae.
An Outbreak of Hepatitis A in an Intensive Care Unit
Authors: Hanna J. N. , Loewenthal M. R. , Negel P. , Wenck D. J.
Published: January 2019

We describe an outbreak of hepatitis A that occurred in an Intensive Care Unit (ICU) in a regional hospital in North Queensland. Seven people were infected including two patients, two close contacts of the index patient and three ICU nursing staff. The index case was admitted with an overdose and multiple trauma; he was not suspected to be incubating hepatitis A. The outbreak was initiated as a result of inadequate precautions taken whilst handling the index patient's bile. Problems identified upon reviewing the outbreak were inadequate terminal cleaning of equipment, food consumption in the ICU and inadequate handwashing practices. Implementation and maintenance of standard infection control practices is vital if further outbreaks of hospital-acquired hepatitis A and other enteric infections are to be avoided. We also suggest that the inactivated hepatitis A vaccine be considered for ICU staff.
Audit of Unbooked Paediatric Post-Anaesthesia Admissions to Intensive Care
Authors: Downey G. B. , O'Connell A. J.
Published: January 2019

We performed an audit of booked and unbooked admissions to a paediatric intensive care unit (PICU) after anaesthesia over a 19 month period in order to determine whether unbooked admissions were predictable, or whether there were any preventable anaesthetic factors responsible for PICU admission, and to evaluate the necessity of PICU admission in all study patients. Data was collected from the PICU database and from the medical records, especially the anaesthesia records, of unbooked admissions. There were 640 admissions to the PICU from the operating theatres, with 35 (5%) unbooked. Of the unbooked admissions, 71% were considered predictable and 20% had preventable features. There was an appropriate use of intensive care resources by these unbooked patients, with 77% having PICU-specific therapies (compared with 88% of booked cases). This quality assurance tool was relatively easy to perform, however it has numerous limitations hampering future routine use.
Sensitivity and Specificity of the Hemochron, Hemotec and APTT for the Detection of Low Concentrations of Heparin
Authors: Weightman W. M. , Clapin A. O. G. , Michalopoulis N. , Gibbs N. M.
Published: January 2019

This study compared two bedside methods recommended for the detection of low concentrations of heparin and the activated partial thromboplastin time (APTT), with reference to a laboratory measure of heparin concentration. Patients undergoing cardiopulmonary bypass had blood drawn at four stages when low levels of heparin could be expected. At each stage four tests were performed: whole blood clotting time using a Hemochron analyser with a Saline-Rinsed test cartridge, whole blood clotting time using a Hemotec analyser with a High Range Heparinase test cartridge, APTT, and heparin concentration by polybrene neutralization. Thirty patients were studied. The sensitivity of the Saline-Rinsed Hemochron, Hemotec High Range Heparinase, and APTT in detecting concentrations of heparin less than 1 U/ml was 38%, 40% and 97%, respectively, while specificities were 87%, 90%, and 30%, respectively. Neither the Saline Rinsed Hemochron, nor the Hemotec Heparinase cartridge reliably detected concentrations of heparin less than 1 U/ml.
Analgesia following Thoracotomy: A Survey of Australian Practice
Authors: Cook T. M. , Riley R. H.
Published: January 2019

This survey examines pain management after thoracotomy in Australian hospitals. Questionnaires were sent to senior thoracic anaesthetists at 27 hospitals (16 public and 11 private) with thoracic surgical units. Twenty-six anaesthetists replied and 24 responses were included in the analyses. Seventy-two percent of respondents were from hospitals with acute pain services (APS), and in 94% of these hospitals patients are reportedly visited by the APS. The most frequently used analgesic modalities are epidural analgesia, intravenous patient-controlled analgesia (IVPCA), and nurse-controlled intravenous opioid infusions. Over half of the anaesthetists reported using local anaesthetic intercostal nerve block, non-steroidal anti-inflammatory drugs (NSAIDs), or paracetamol. Combinations of analgesic techniques were cited frequently. Respondents reported that cryoanalgesia, interpleural blockade, paravertebral blockade, subarachnoid infusions, ketamine, and transcutaneous electrical nerve stimulation are used infrequently. Anaesthetists from public hospitals reported using epidural analgesia, IVPCA and NSAIDs more frequently than those from private hospitals. When epidural analgesia is used, most respondents place the catheter in the mid-thoracic region (91%), use a regimen of opioids plus local anaesthetic (96%), use a constant infusion technique (100%), and continue analgesia for up to three days (83%). Over half of the respondents reported that post-thoracotomy patients are nursed in a high-dependency area. Seventy-nine percent of respondents selected epidural analgesia as the best available analgesia technique, whereas 21% consider IVPCA to be the best. Only 75% of respondents reported that the type of analgesia they consider best is also the type which they use most frequently ‡ .
Inhaled Aerosolized Prostacyclin and Nitric Oxide as Selective Pulmonary Vasodilators in ARDS—A Pilot Study
Authors: Van Heerden P. V. , Blythe D. , Webb S. A. R.
Published: January 2019

Nitric oxide 10 ppm and inhaled aerosolized prostacyclin 50 ng/kg/min were compared as selective pulmonary vasodilators in five patients with hypoxaemia secondary to acute respiratory distress syndrome. Neither agent resulted in systemic haemodynamic changes, indicating true pulmonary selectivity. Inhaled aerolized prostacyclin improved oxygenation to a degree comparable to nitric oxide, as measured by the arterial alveolar oxygen partial pressure gradient and shunt fraction.
Acute Renal Failure in Cardiac Surgical Patients, Potentiated by Gentamicin and Calcium
Authors: Schneider M. , Valentine S. , Clarke G. M. , Newman M. A. J. , Peacock J.
Published: January 2019

A retrospective study in coronary artery bypass graft patients was undertaken to assess the effect of gentamicin and a bypass prime with a high calcium on the incidence of renal failure. Patients who received both Haemaccel (polygeline, Hoechst Marion Roussel) (calcium concentration 6.25 mmol/l) in the bypass prime and gentamicin perioperatively had a higher incidence of renal failure compared with those who received only Haemaccel (P=0.005), only gentamicin (P=0.002) or neither (P=0.0001). We suggest that the combination be avoided in this group of patients.
Association between Oxygen Delivery and Consumption in Patients Undergoing Cardiac Surgery. is There Supply Dependence?
Authors: Myles P. S. , Mcrae R. , Ryder I. , Hunt J. O. , Buckland M. R.
Published: January 2019

We studied the relationship between oxygen delivery (DO2) and consumption (VO2) in twenty patients undergoing cardiac surgery, in order to determine if VO2 was dependent on DO2 (pathological oxygen supply dependence). We measured VO2 from expired gas analysis (VO2G) and compared this to that calculated using the reverse Fick method (VO2F). Both VO2G and VO2F increased after cardiopulmonary bypass (P<0.001), without change in DO2 (i.e. oxygen extraction ratio increased). There was a significant relationship between changes in DO2 and VO2F, both before bypass (r=0.74, P < 0.001) and after bypass (r=0.69, P < 0.001), while changes in DO2 and VO2G had no such relationship (pre-bypass: r=0.38, P=0.094; post-bypass: r=0.10, P=0.68). There was poor agreement between VO2F and VO2G perioperatively. We could not demonstrate supply dependence in elective cardiac surgical patients.
The Efficacy, Applicability and Side-Effects of Postoperative Intravenous Patient-Controlled Morphine Analgesia: An Audit of 1233 Chinese Patients
Authors: Tsui S. L. , Tong W. N. , Irwin M. , Ng K. F. J. , Lo J. R. , Chan W. S.
Published: January 2019

We analyzed data from 1233 Chinese patients of a wide age range who received patient-controlled analgesia (PCA) intravenous morphine for postoperative pain relief during the period from January 1992 to May 1995. The analgesic regimen was standardized as follows: PCA bolus 1 to 1.5 mg; lock-out interval 5 minutes; one-hour maximum dose 0.075 to 0.1 mg.kg–1 and background infusion 0 or 0.5 mg.h–1. Most patients underwent major surgery that was broadly subclassified according to the anatomical area involved. The median verbal numerical rating scales of pain (0 to 10) at rest and while coughing for the first, second and third 24 hours were 3.0/5.0, 1.5/4.0 and 0/3.0 respectively and the corresponding demand to delivery ratios were 2.8±2.9, 2.6±2.4 and 2.4±2.6. The overall morphine consumptions in 1004 of these Chinese patients were 27.5±16.8, 178±16.1 and 18.1±21.0 μg.kg-1.h–1 during the first 16, 17 to 41 and 42 to 66 postoperative hours respectively. These figures were the same as for Caucasian patients man-aged in the same institution. Morphine consumption was significantly higher following thoracic, upper abdominal and spinal surgery. Also it was higher in patients younger than 65 years, males, cigarette smokers and those with ASA physical status I or II. The commonest side-effects were nausea (34.5%) and vomiting (18.2%). Bradypnoea and oxygen desaturation occurred in 0.5% and 1.6% respectively. All cases were promptly detected and managed with no adverse outcomes. Most patients were satisfied (76.7% ranked “good”) with their postoperative analgesia. The commonest reasons for dissatisfaction were inadequate pain relief, nausea and reluctance to self-control analgesic administration. It is concluded that PCA with intravenous morphine is effective and safe as a routine postoperative technique for Chinese surgical patients.
A Comparison of Intramuscular Ketorolac with Indomethacin Suppositories in the Treatment of Pain after Oral Surgery
Authors: Turner G. A. , Anson N. , Williamson R.
Published: January 2019

The analgesic effects of 30 mg of intramuscular ketorolac were compared with those of rectal indomethacin in 100 mg and 200 mg doses in 66 patients in a single-blinded trial. Pain scores and the incidence of nausea and vomiting were assessed at 30, 60 and 120 minutes postoperatively, at discharge (4 hours) and on the evening of surgery. Area under the curve of pain scores versus time for pain at 30, 60 and 120 minutes postoperatively was significantly lower in the ketorolac group compared to indomethacin 100 mg and 200 mg groups. There were no significant differences in the pain scores at discharge or at home on the evening of surgery. At 60 minutes post-operatively there was significantly more nausea and vomiting in the indomethacin 200 mg group; at all other time-points there was no significant difference between the groups with regard to nausea and vomiting. The power of the study to determine the significance of side-effects between the groups was low.
Analgesic Efficacy of Paracetamol in Children Using Tonsillectomy as a Pain Model
Authors: Anderson B. , Kanagasundarum S. , Woollard G.
Published: January 2019

The analgesic efficacy of paracetamol was assessed in a prospective, randomized, double-blinded study of 100 children undergoing tonsillectomy with or without adenoidectomy. Fifty children were given paracetamol elixir 40 mg/kg 40 minutes preoperatively (Group A); the remaining 50 children were given an oral placebo 40 minutes pre-operatively and paracetamol suppositories 40 mg/kg after induction of anaesthesia (Group B). Paracetamol was the only analgesic given and was given either orally or rectally in order to produce high variations in plasma paracetamol concentrations postoperatively. At 30 minutes after the end of surgery a pain score (0–10) was obtained and a venous blood sample was taken for serum paracetamol concentration analysis.

Children given paracetamol elixir had a higher mean paracetamol concentration (0.15 [SD 0.06] mmol/l vs 0.05 [SD 0.03] mmol/l, P < 0.001) and a lower median pain score (5 vs 7, P < 0.02) than those who were given suppositories. The use of rescue morphine was higher (10 vs 23, P < 0.001) in the latter group. The incidence of nausea and vomiting was the same in both groups (20%) during the 24 hour postoperative period. Plasma paracetamol concentrations of 0.066–0.132 mmol/l are known to reduce temperature; plasma paracetamol concentrations which provide analgesia are unknown. Children with plasma paracetamol concentrations above 0.07 mmol/l had superior analgesia to those with concentrations below this level (P < 0.05).
Response Times to Visual and Auditory Alarms during Anaesthesia
Authors: Morris R. W. , Montano S. R.
Published: January 2019

Objective

To measure and compare the response times to audibly or visually presented alarms in the operating theatre.

Methods

The time taken by anaesthetists to cancel randomly generated visual and audible false alarms was measured during maintenance of routine anaesthesia. Alarms were generated and times recorded by a laptop computer on the anaesthetic machine. The visual signal was a 15mm diameter red light positioned next to the physiological monitor mounted on top of the machine. The audible alarm was a Sonalert® buzzer of the type incorporated into many medical devices.

Results

Nineteen anaesthetists provided a total of seventy-two hours of data (887 alarm events). The response times to visual alarms was significantly longer than to audible alarms (P=0.001 Mann Whitney U test).

Conclusions

The ability of anaesthetists to appreciate changes in patient physiology may be limited by delays in noticing information presented by monitors. The rapid response to the vast majority of alarms indicates a high level of vigilance among the anaesthetists studied. However, this study suggests that it is safer to rely on audible rather than visual alarms when time-critical information such as oxygenation, heart beat and ventilator disconnection is concerned. Visual alarms would appear to be more appropriate for conveying less urgent information.
Urgent Non-Emergency Surgery and Death Attributable to Anaesthetic Factors
Authors: Horan B. F. , Warden J. C.
Published: January 2019

The Special Committee Investigating Deaths Under Anaesthesia in New South Wales classified 1503 deaths which occurred in the years 1984 to 1990 during, within 24 hours of, or as a result of anaesthesia. One hundred and seventy-two (11.4%) of these were attributed definitely, probably or jointly to factors under the anaesthetists’ control. One hundred and forty-four (9.6%) of the 1503 deaths classified occurred in patients undergoing urgent non-emergency operations of which 45 (31.3%) were attributed to anaesthetic factors.

A specialist anaesthetist either gave the anaesthetic or was present for part or all of it in 35 of these 45 cases. In 22 the hospital was a metropolitan teaching hospital. General anaesthesia was employed in 31 cases and major regional block (10 spinals and 4 epidurals) in the others. The commonest type of surgery was orthopaedic (26 cases), particularly for fractured neck of femur (20 cases). There were no deaths attributed to anaesthetic factors in cases of this degree of urgency in patients less than 16 years old.

The factors under the anaesthetists’ control most often identified as contributing to death were inadequate preparation for anaesthesia and surgery (18 cases, 12 of which were jointly attributed to the surgeon); inappropriate choice or application of technique (17); inadequate postoperative care (12 cases); and overdose (11 cases).

If improved outcomes are to be achieved for patients having operations of this degree of urgency, greater attention must be paid to these aspects of their anaesthetic management.
A Prospective Clinical Comparison of Two Intravenous Polyurethane Cannulae
Authors: Russell W. J. , Micik S. , Gourd S. , Mackay H. , Wright S.
Published: January 2019

Tissue irritation, as evidenced by phlebitis, associated with Optiva™ (Johnson & Johnson Medical) and Insyte™ (Becton Dickinson) polyurethane cannulae was studied. The integrity of the cannulae on removal, the incidence of infection at the cannula site and the factors which influence phlebitis were also examined.

One thousand and eight patients had a polyurethane cannula placed for induction of anaesthesia for cardiac surgery. After surgery, the cannula was examined every 24 hours. If evidence of phlebitis occurred, the cannula was removed and sent for culture. All remaining cannulae were removed at 72 hours and the site examined daily for a further three days.

There were 503 Optiva™ and 505 Insyte™ cannulae studied. The distributions between the two cannulae with respect to patient characteristics, gauge of cannula, number of attempts and difficulty of insertion, cannula site and anaesthetist inserting were similar. The early removal rate for both groups was 47%.

Overall phlebitis rate with Optiva™ was 31% and Insyte™ 33%. This difference is not statistically significant. The cumulative phlebitis rate increased with time but did not differ between the two types of cannulae.

Minor tip distortion or shaft kinking of the cannulae occurred in 16.2% of Optiva™ and 23.5% of Insyte™. This difference is statistically significant and may relate to the slightly more acute taper at the Optiva™ cannula tip. Both cannulae were similar in clinical performance.
Acute Weakness Syndromes in Critically Ill Patients—A Reappraisal
Authors: Nates J. L. , Cooper D. J. , Day B. , Tuxen D. V.
Published: January 2019

Over the last twenty years, increasing numbers of critically ill, mechanically ventilated patients who develop acute profound muscle weakness have been described. These acute weakness syndromes have not been well understood and they have been given many names including: acute steroid myopathy, acute quadriplegic myopathy, the floppy person syndrome, critical illness polyneuropathy, critical illness polyneuromyopathy, and prolonged neurogenic weakness. Many of these “syndromes” either overlap or represent the same disease process in different patients. Many have been incompletely diagnosed.

During this review it became evident that the acute weakness syndromes currently recognized in critically ill patients could be categorized into four major groups: myopathy, neuromuscular junction abnormalites, neuropathy and polyneuromyopathy. Each had different possible aetiologies.

“Myopathy” includes acute necrotizing myopathy and disuse atrophy. Neuromuscular junction abnormalities are subdivided into myasthenia-like syndromes and prolonged neuromuscular blockade. Neuropathies are divided into critical illness polyneuropathy and acute motor neuropathy. The anterior horn cell injury in Hopkins syndrome should also be considered in this group. Polyneuromyopathies include various combinations of neuropathy and myopathy in the same patients.
Relationship of Muscle Strength to Potassium Concentration in a Hypokalaemic Infant
Authors: Reid A. W. , Anderson B. J. , Futter M. E. , Holford N. H. G.
Published: January 2019

A nine-month infant, weighing 9.8 kg, presented with hypotonia secondary to acute hypokalaemia (1.0 mmol/l). Muscle strength improved as the serum potassium was increased. Muscle strength was assessed by the pressure generated inside a saline-filled endotracheal tube cuff during a grasp reflex. Potassium concentration and hand grip strength were related using a sigmoidal Emax model. Zero effect was assumed when the potassium concentration was zero. The Emax, EC50 and Hill coefficient values were determined by non-linear regression using the MKMODEL program. Parameter estimates (SE) were EC50 1.79 (0.15) mmol/l, Hill coefficient 3.79 (0.92), Emax 114.4 (8.9) mmHg.
Assumptions and Practice in Clinical Medical Ethics
Authors: Baker A. B.
Published: January 2019

An orderly scheme of action is proposed to allow for the practical solution of clinical ethical problems. This scheme depends on understanding and discussion, between patient and doctor, of the ethical assumptions involved in any dilemma. Instead of the more usual ethical principles, arguments are presented for six basic ethical assumptions (and their associated corollaries) in favour of Life, Autonomy, Beneficence, Equity, Truth, and Law. Because these assumptions are dependent on the different personal viewpoints of the people involved and not immutable principles, such ethical assumptions are able to be set in different hierachical orders on different occasions permitting in most cases a particular solution specific for that dilemma.
The Cardiovascular, Coagulation and Haematological Effects of Tiger Snake (Notechis scutatus) Prothrombin Activator and Investigation of Release of Vasoactive Substances
Authors: Tibballs J.
Published: January 2019

The cardiovascular, coagulation and haematological effects of prothrombin activator from Tiger Snake (Notechis scutatus) venom were investigated in anaesthetized mechanically ventilated dogs. Infusion caused dose-related systemic hypotension, marked decreases in cardiac output and stroke volume, marked increases in pulmonary artery pressure, pulmonary artery occlusion pressure and pulmonary vascular resistance. Effects occurred within several minutes but abated over 30 to 40 minutes. Evidence of procoagulation included prolongation of prothrombin and partial thromboplastin times and depletion of serum fibrinogen. Thrombocytopenia and leucopenia occurred. All effects were prevented by prior administration of heparin but none by inhaled nitric oxide. Oesophageal echocardiography during infusion identified thrombi within the heart, right ventricular dilatation and dyskinesia. Electrocardiography suggested myocardial ischaemia. Pulmonary thromboemboli were identified histologically post mortem. Cardiovascular effects of the activator were not due to a variety of endogenous substances as indicated by use of antagonists to platelet activating factor and thromboxane A2, indomethacin, dexamethasone, serotonin, ketanserin, histamine, promethazine and ondansetron. Tiger Snake prothrombin activator causes bilateral ventricular failure by thrombotic obstruction of the pulmonary vasculature and possibly by coronary ischaemia.
Heart Rate Variability following Cardiac Surgery Fails to Predict Short-Term Cardiovascular Instability
Authors: McHugh G. J. , Sleigh J. W. , Bo H. , Henderson J. D.
Published: January 2019

The heart rate variability of 40 patients has been examined by spectral analysis following cardiac surgery. The heart rate variability was measured upon patient arrival in ICU in both a resting supine position, and following passive straight-leg raising. After 12 hours in ICU, the patients were classified as having been cardiovascularly stable or unstable according to a specially devised inventory. Their heart rale variability data was then examined to seek any predictor of instability.

Passive straight-leg raising induced a decrease in spectral power across all of the component frequency bands. The LF/HF ratio rose with passive straight-leg raising, but failed to reach significance. None of these changes were sustained. There was no significant difference in heart rate variability patterns between the stable and unstable groups, and so no predictor was identified. Initial clinical assessment was also studied, and it too provided no reliable prediction of short-term cardiovascular instability.
The Effects of Short Intravenous Infusions of Thiopentone on Myocardial Function, Blood Flow and Oxygen Consumption in Sheep
Authors: Huang Y. F. , Upton R. N. , Gray E. C. , Grant C. , Zheng D. , Ludbrook G. L.
Published: January 2019

The cardiovascular effects of slow (over two minutes) intravenous infusions of thiopentone 750 mg in conscious instrumented sheep breathing 100% oxygen were examined for 30 minutes following the start of the infusion.

The maximum rate of rise of left ventricular pressure (an index of myocardial contractility) decreased significantly from 1 to 10 minutes, to a minimum of 45% of baseline. Heart rate increased by up to 33% above baseline from 0.5 min onwards. Both mean arterial pressure and cardiac output were decreased from between 1 and 7 min. Left ventricular minute work was transiently decreased, but left coronary blood flow and myocardial oxygen consumption showed little or no change from baseline.

We conclude that in vivo, thiopentone administered at a relatively slow rate caused large reductions in myocardial contractility, and therefore cardiac reserve, in the absence of significant changes in myocardial blood flow or oxygen consumption.
A Safe Technique to Monitor Pulmonary Artery Pressure during and after Paediatric Cardiac Surgery
Authors: Muralidhar K. , Dixit M. D. , Shetty D. P.
Published: January 2019

Pulmonary hypertensive crises (PHC) are a recognized cause of sudden clinical deterioration and death after the surgical correction of congenital heart disease. In this study, pulmonary artery pressure was monitored in 84 children (at high risk to develop PHC) aged nine days to five years (mean 1.4 years) using monitoring lines inserted percutaneously through the right internal jugular vein (IJV). Success rate of placement of the catheter tip in the pulmonary artery (PA) in the pre-incision period was not high (7%) but all catheter-tips were successfully placed in the PA by the surgeon before right atrial closure prior to separation from cardiopulmonary bypass. Complications related to the technique were transient ventricular/atrial arrhythmias (78.5%) during insertion and slipping or coiling (20%) of the catheter in the right ventricle. Complications relating to the IJV puncture included carotid arterial puncture1 and pneumothorax1. No other complications were encountered. Monitoring lines inserted percutaneously and guided into the pulmonary artery during surgery provide a safe and practical way of monitoring pulmonary artery in infants and children at risk of postoperative pulmonary hypertensive crises.
A Comparison of Sevoflurane with Halothane for Paediatric Day Case Surgery
Authors: Walker S. M. , Haugen R. D. , Richards A.
Published: January 2019

A phase III, open label, randomized study was conducted in 50 patients comparing halothane and sevoflurane for paediatric day case surgery. A graded inhalational induction resulted in only slightly more rapid induction with sevoflurane (3.34±0.92 versus 3.85±1.02 minutes; P>0.05). In children receiving sevoflurane, systolic blood pressure decreased to a lesser extent during induction (14.3±19.2 versus 26.9±10.9 percent decrease from resting values; P<0.01) and heart rate was maintained. Respiratory events (coughing, breath-holding, bronchospasm, laryngospasm) were more common during induction with halothane, and excitement more common in children receiving sevoflurane. Emergence times were significantly more rapid in children who had received sevoflurane (21.4±10.9 versus 33.1 ±13.7 minutes; P<0.01). Objective pain/discomfort scores were higher in patients receiving sevoflurane at 10, 20, 30 and 40 minutes after arrival in the recovery room, and the incidence of excitement during emergence was higher in this group. It is concluded that sevoflurane is well tolerated for inhalational induction and has an improved cardiovascular profile compared to halothane. Emergence was significantly more rapid following sevoflurane.
Intrathecal Pethidine: An Alternative Anaesthetic for Transurethral Resection of Prostate?
Authors: Sia A. T. H. , Chow M. Y. H. , Koay C. K. , Chong J. L.
Published: January 2019

We aimed to determine the usefulness of intrathecal pethidine as the sole anaesthetic for transurethral resection of prostate (TURP) while comparing the incidence of hypotension with intrathecal bupivacaine.

A double-binded randomized prospective trial was conducted involving 40 patients for TURP. The patients were divided equally into two groups; group A received 2 ml 0.5% bupivacaine intrathecally and group B received 40 mg pethidine intrathecally. Changes in blood pressure and heart rate were measured over the first 30 minutes. The highest sensory block and the time to reach it were documented. The degree of motor blockade was also recorded.

There was no significant difference in the incidence of hypotension. The pethidine group had significantly greater reduction in heart rate, a lower degree of motor block, shorter period before requests for postoperative analgesia but a higher incidence of sedation, nausea and vomiting.

Intrathecal pethidine did not offer any advantage over intrathecal bupivacaine for TURP.
Occupational Stress in Anaesthesia
Authors: Kam P. C. A.
Published: January 2019

Anaesthetists, like most in the medical profession, often deny that they may be suffering from work-related stress. This article explores the sources and effects of occupational stress with suggestions for dealing with the stresses of our specialty.
Superwarfarin (Brodifacoum) Poisoning
Authors: Corke P. J.
Published: January 2019

A case of self-ingestion of brodifacoum that resulted in spontaneous intra-abdominal haemorrhage, circulatory shock, rhabdomyolysis and acute renal failure is reported. Current knowledge and management of superwarfarin poisoning are discussed.
Identifying Factors Associated With Severe Intellectual Disabilities in Teenagers With Cerebral Palsy Using a Predictive Learning Model
Authors: Bertoncelli Carlo M. , Altamura Paola , Vieira Edgar Ramos , Bertoncelli Domenico , Thummler Susanne , Solla Federico
Published: January 2019

Background:

Intellectual disability and impaired adaptive functioning are common in children with cerebral palsy, but there is a lack of studies assessing these issues in teenagers with cerebral palsy. Therefore, the aim of this study was to develop and test a predictive machine learning model to identify factors associated with intellectual disability in teenagers with cerebral palsy.

Methods:

This was a multicenter controlled cohort study of 91 teenagers with cerebral palsy (53 males, 38 females; mean age ± SD = 17 ± 1 y; range: 12-18 y). Data on etiology, diagnosis, spasticity, epilepsy, clinical history, communication abilities, behaviors, motor skills, eating, and drinking abilities were collected between 2005 and 2015. Intellectual disability was classified as “mild,” “moderate,” “severe,” or “profound” based on adaptive functioning, and according to the DSM-5 after 2013 and DSM-IV before 2013, the Wechsler Intelligence Scale for Children for patients up to ages 16 years, 11 months, and the Wechsler Adult Intelligence Scale for patients ages 17-18. Statistical analysis included Fisher’s exact test and multiple logistic regressions to identify factors associated with intellectual disability. A predictive machine learning model was developed to identify factors associated with having profound intellectual disability. The guidelines of the “Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis Statement” were followed.

Results:

Poor manual abilities ( P ≤ .001), gross motor function ( P ≤ .001), and type of epilepsy (intractable: P = .04; well controlled: P = .01) were significantly associated with profound intellectual disability. The average model accuracy, specificity, and sensitivity was 78%.

Conclusion:

Poor motor skills and epilepsy were associated with profound intellectual disability. The machine learning prediction model was able to adequately identify high likelihood of severe intellectual disability in teenagers with cerebral palsy.
Evaluation of biocompatibility and immunogenicity of micro/nanofiber materials based on tilapia skin collagen
Authors: Li Dongsheng , Gao Yonglin , Wang Yunzhi , Yang Xiaoping , He Chuanglong , Zhu Meifang , Zhang Shumin , Mo Xiumei
Published: January 2019

Type I collagen, used as a raw material, plays a pivotal role in the development of medical devices and tissue engineering. Due to the risk of zoonotic transmission and religious constraints for mammalian collagen, fish collagen gains increased attention and is widely seen as an alternative. In this study, two collagen micro/nanofiber materials, self-assembled collagen nanofiber and electrospun collagen nanofiber, were prepared by tilapia skin collagen and their biocompatibility and immunogenicity was thoroughly investigated. The result revealed that the state of tilapia skin collagen in self-assembled collagen nanofiber and electrospun collagen nanofiber was different. The circular dichroism spectrum indicated that collagen in self-assembled collagen nanofiber retained the triple helical structure of the native collagen, while collagen in electrospun collagen nanofiber was denatured into gelatin. Nevertheless, the evaluation according to ISO10993, including tests of cytotoxicity, hemolysis, skin sensitization, acute systemic toxicity, mouse immunization and lymphocyte proliferation, demonstrated good biocompatibility and low immunogenicity for both self-assembled and electrospun collagen nanofiber materials. Overall, the present study highlighted that type I collagen from tilapia skin would be a promising biomaterial for the development of regenerate medical products.
The Sustainability of a Workplace Wellness Program That Incorporates Gamification Principles: Participant Engagement and Health Benefits After 2 Years
Authors: Lowensteyn Ilka , Berberian Violette , Berger Claudie , Da Costa Deborah , Joseph Lawrence , Grover Steven A.
Published: January 2019

Purpose:

To evaluate the results of a workplace wellness program that incorporates gamification principles.

Design:

In this prospective cohort study, the participation rate and observed health outcomes were evaluated after approximately 2 years.

Setting and participants:

All permanent employees (n = 775) of a national company located in Canada were eligible to participate.

Intervention:

The wellness program included web-based challenges (team or individual) incorporating gamification strategies to improve exercise, nutrition, weight reduction, and mental health management behaviors.

Measures and analysis:

The primary outcomes were employee participation rates. The secondary pre-specified outcomes were the sustained benefits of the program on physical and mental health measures.

Results:

Participation rates in the health screenings were 78% (baseline), 54% (year 1), and 56% (year 2). Participation in the 4 team web-based challenges ranged from 33% to 68% with 76% to 86% of participants tracking their activity on at least half of the days. After 2 years, there were significant clinical improvements in systolic blood pressure (−1.3mm Hg), total cholesterol/high-density lipoprotein (HDL) ratio (−0.14), glycated haemoglobin (HbA1c; −0.1%), weekly physical activity (+264 Metabolic Equivalents [METs]), perceived stress score (−17%), insomnia severity index (−16%), general fatigue (−10%), and reductions in the cardiovascular age gap (−0.3 years). Greater benefits occurred among employees at higher risk.

Conclusions:

Workplace wellness programs that evolve over time and focus primarily on fun and competitive challenges may support long-term participation, behavior change, and sustained improvements in clinical outcomes.
Auto-ignition of single n-heptane droplets in low-temperature and high-pressure air using Lagrangian–Eulerian approach
Authors: Kazemi Fard Ahmad , Khaleghi Hassan , Ebrahimi Reza
Published: January 2019

The objective of this research is to investigate the evaporating, mixing, and auto-ignition processes of isolated fuel droplets using Lagrangian–Eulerian numerical approach. By using Peng–Robinson equation for the phase-equilibrium, the gas solubility at the droplet surface is considered at high-pressure ambient gases. Using perfectly stirred reactor combustion model and a low-temperature detailed mechanism for the n-heptane, the auto-ignition of the premixed fuel vapor–air mixture is verified at a constant pressure. Then, the auto-ignition of a fuel droplet with 60 µm diameter is studied at various low air temperatures. The analysis indicated that the results are strongly mesh dependent in this approach. Therefore, in order to predict the correct values of auto-ignition delay time and maximum gas temperature, the computational mesh size should be chosen in a specific range of cell sizes. Also, the auto-ignition of different size fuel droplets is studied at the air initial temperature of 800 K. It was observed that for accurate results, the computational mesh size should be chosen around seven to eight times the diameter of initial fuel droplets.
Phenothiazines Enhance the Hypothermic Preservation of Liver Grafts: A Pilot in Vitro Study
Authors: Li Fengwu , Yang Zhiying , Stone Christopher , Ding Jamie Y. , Previch Lauren , Shen Jiamei , Ji Yu , Geng Xiaokun , Ding Yuchuan
Published: January 2019

In vitro liver conservation is an issue of ongoing critical importance in graft transplantation. In this study, we investigated the possibility of augmenting the standard pre-transplant liver conservation protocol (University of Wisconsin (UW) cold solution) with the phenothiazines chlorpromazine and promethazine. Livers from male Sprague-Dawley rats were preserved either in UW solution alone, or in UW solution plus either 2.4, 3.6, or 4.8 mg chlorpromazine and promethazine (C+P, 1:1). The extent of liver injury following preservation was determined by alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities, the ratio of AST/ALT, morphological changes as assessed by hematoxylin-eosin staining, apoptotic cell death as determined by ELISA, and by expression of the apoptotic regulatory proteins BAX and Bcl-2. Levels of glucose (GLU) and lactate dehydrogenase (LDH) in the preservation liquid were determined at 3, 12, and 24 h after incubation to assess glucose metabolism. Oxidative stress was assessed by levels of superoxide dismutase (SOD), reactive oxygen species (ROS), and malondialdehyde (MDA), and inflammatory cytokine expression was evaluated with Western blotting. C+P augmentation induced significant reductions in ALT and AST activities; the AST/ALT ratio; as well as in cellular swelling, vacuolar degeneration, apoptosis, and BAX expression. These changes were associated with lowered levels of GLU and LDH; decreased expression of SOD, MDA, ROS, TNF-α, and IL-1β; and increased expression of Bcl-2. We conclude that C+P augments hypothermic preservation of liver tissue by protecting hepatocytes from ischemia-induced oxidative stress and metabolic dysfunction. This result provides a basis for improvement of the current preservation strategy, and thus for the development of a more effective graft conservation method.
Development, validity and reliability testing the Swedish Ethical Climate Questionnaire
Authors: Grönlund Catarina Fischer , Söderberg Anna , Dahlqvist Vera , Andersson Lars , Isaksson Ulf
Published: January 2019

Background:

An ethical climate has been described as a working climate embracing shared perceptions about morally correct behaviour concerning ethical issues. Various ethical climate questionnaires have been developed and validated for different contexts, but no questionnaire has been found concerning the ethical climate from an inter-professional perspective in a healthcare context. The Swedish Ethical Climate Questionnaire, based on Habermas’ four requirements for a democratic dialogue, attempts to assess and measure the ethical climate at various inter-professional workplaces. This study aimed to present the construction of and to test the psychometric properties of the Swedish Ethical Climate Questionnaire.

Method:

An expert group of six researchers, skilled in ethics, evaluated the content validity. The questionnaire was tested among 355 healthcare workers at three hospitals in Sweden. A parallel analysis (PA), an exploratory factor analysis and confirmatory factor analysis were performed.

Ethical considerations:

The participants included in the psychometric analysis were informed about the study, asked to participate in person and informed that they could withdraw at any time without giving any reason. They were also assured of confidentiality in the reporting of the results.

Findings:

The parallel analysis (PA) recommended one factor as a solution. The initial exploratory factor analysis with a four-factor solution showed low concordance with a four-factor model. Cronbach’s alpha varied from 0.75 to 0.82; however, since two factors only consisted of one item, alpha could not be reported. Cronbach’s alpha for the entire scale showed good homogeneity (α = 0.86). A confirmatory factory analysis was carried out based on the four requirements and showed a goodness-of-fit after deleting two items. After deletion of these items, Cronbach’s alpha was 0.82.

Discussion:

Based on the exploratory factor analysis, we suggest that the scale should be treated as a one-factor model. The result indicates that the instrument is unidimensional and assesses ethical climate as a whole.

Conclusion:

After testing the Swedish Ethical Climate Questionnaire, we found support for the validity and reliability of the instrument. We found the 10-item version of Swedish Ethical Climate Questionnaire satisfactory. However, we found no support for measuring different dimensions and, therefore, this instrument should be seen as assessing ethical climate as of whole.
Sanitation Interventions in India: Gender Myopia and Implications for Gender Equality
Authors: Koonan Sujith
Published: January 2019

In India, sanitation interventions have been, by and large, myopic to the gender dimensions of sanitation and hygiene. As a result, women’s sanitation and hygiene needs and vulnerabilities have not received adequate attention. While the legal and policy framework related to sanitation highlights some of the concerns of women, implementation at the local level has almost completely neglected them, raising serious concerns from a gender equality point of view. Using a gender perspective, this article takes a critical look at the existing legal and policy framework in India pertaining to sanitation.
Child Work and Schooling in Rural India: What Do Time Use Data Say about Trade-offs and Drivers of Human Capital Investment?
Authors: Narayanan Sudha , Dhanaraj Sowmya
Published: January 2019

This study examines time use data for 1,244 children in the age group 6–12 years in 274 villages in eight states in rural north India to understand the trade-offs between time spent in school, time spent at work, time spent on home study and leisure. Using a Seemingly Unrelated Regressions Model, we find that there seems to be no trade-off between time spent at school and at work, whereas leisure time and home study appear to be compromised for the sake of work. Only a few variables influence allocation of time to different activities across the board.
Land Transportation Link Between Indian Subcontinent and Europe Is a Strategic Necessity
Authors: Tsereteli Mamuka
Published: January 2019

This article is a brief overview of the land transportation link between Europe and the Indian subcontinent via Central Asia and the South Caucasus and Turkey. An emerging need for greater continental transit in Eurasia has been stressed upon apart from dealing with China’s strategy for connectivity, prospects for the ‘Southern Corridor’, and that continental transportation should be part of the strategic calculation of the governments and private sectors of India, Pakistan and Bangladesh.