bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors for Bleeding Complications after Percutaneous Dilatational Tracheostomy: A Ten-year Institutional Analysis
Authors: Pilarczyk K. , Haake N. , Dudasova M. , Huschens B. , Wendt D. , Demircioglu E. , Jakob H. , Dusse F. 
Published: January 2019

Summary Bleeding complications after percutaneous dilatational tracheostomy (PDT) are infrequent but may have a tremendous impact on a patient's further clinical course. Therefore, it seems necessary to perform risk stratification for patients scheduled for PDT. We retrospectively reviewed the records of 1001 patients (46% male, mean age 68.1 years) undergoing PDT (using the Ciaglia Blue Rhino® technique with direct bronchoscopic guidance) in our cardiothoracic ICU between January 2003 and February 2013. Patients were stratified into two groups: patients suffering acute moderate, severe, or major bleeding (Group A) and patients who had no or only mild bleeding (Group B). In the majority of patients, no or only mild bleeding during PDT occurred (none: 425 [42.5%], mild: 488 [48.8%]). In 84 patients (8.4%), bleeding was classified as moderate. Three patients suffered from severe bleeding; only one major bleed with need for emergency surgery occured. Patients in Group A had a significantly higher Simplified Acute Physiology Score on the day of PDT ( P=0.042), higher prevalence of renal replacement therapy on the day of PDT ( P=0.026), higher incidence of coagulopathy ( P=0.043), lower platelet counts ( P=0.037), lower fibrinogen levels ( P=0.012), higher proportion of PDTs performed by residents ( P=0.034) and higher difficulty grading of PDT ( P=0.001). Using logistic regression analyses, difficult PDT, less experienced operator, Simplified Acute Physiology Score >40 and low fibrinogen levels were independent predictors of clinically significant bleeding after PDT.
Acute Kidney Injury following Liver Transplantation: A Systematic Review of Published Predictive Models
Authors: Caragata R. , Wyssusek K. H. , Kruger P. 
Published: January 2019

Summary Acute kidney injury (AKI) is a frequent postoperative complication amongst liver transplant recipients and is associated with increased morbidity and mortality. This systematic review analysed the existing predictive models, in order to solidify current understanding. Articles were selected for inclusion if they described the primary development of a clinical prediction model (either an algorithm or risk score) to predict AKI post liver transplantation. The database search yielded a total of seven studies describing the primary development of a prediction model or risk score for the development of AKI following liver transplantation. The models span thirteen years of clinical research and highlight a gradual change in the definitions of AKI, emphasising the need to employ standardised definitions for subsequent studies. Collectively, the models identify a diverse range of predictive factors with several common trends. They emphasise the impact of preoperative renal dysfunction, liver disease severity and aetiology, metabolic risk factors as well as intraoperative variables including measures of haemodynamic instability and graft quality. Although several of the models address postoperative parameters, their utility in predictive modelling seems to be of questionable relevance. The common risk factors identified within this systematic review provide a minimum list of variables, which future studies should address. Research in this area would benefit from prospective, multisite studies with larger cohorts as well as the subsequent internal and external validation of predictive models. Ultimately, the ability to identify patients at high risk of post-transplant AKI may enable early intervention and perhaps prevention.
Spontaneous Ventilation Using Target-Controlled Propofol Infusion for Microlaryngoscopy in Adults: A Retrospective Audit
Authors: Booth A. W. G. , Vidhani K. 
Published: January 2019

Summary We conducted a retrospective audit of 285 adult elective microlaryngoscopy cases in our institution over a three-and-a-half year period. Conventional anaesthesia with intubation and mechanical ventilation was the most common technique, used in 71% of cases. Tubeless spontaneous ventilation during total intravenous anaesthesia with a target-controlled infusion of propofol (SVTCI) was the most common alternative. Spontaneous ventilation with target-controlled infusion was used for 79 (27.7%) anaesthetic inductions and was continued through the maintenance phase for 60 patients (21.1%). Jet and intermittent ventilation were both used infrequently (1% each). The most common SVTCI technique since 2013 involved adjusting the target-controlled infusion rate during induction using a formula we developed based on intermittently increasing the target rate, such that the predicted plasma concentration minus the predicted effect site concentration was maintained at 1 μg/ml. We found that this method maintained ventilation during induction more reliably than other SVTCI strategies, and was associated with fewer complications than other spontaneous ventilation techniques or mechanical ventilation: it was associated with only one (3.1%) failed induction and one (3.9%) episode of apnoea. Jet ventilation was associated with the most severe complications, including two cases of barotrauma.
Anaesthesia for Aboriginal Australians
Authors: Howe P. W. , Condon J. R. , Goodchild C. S. 
Published: January 2019

This prospective study was designed to describe problems that arise when Aboriginal people undergo anaesthesia, in order to develop guidelines for anaesthetists who are not accustomed to treating Aboriginal people. Data were collected on 1122 consecutive different individuals undergoing anaesthesia at Royal Darwin Hospital, 24.5% of whom described themselves as Aboriginal. Aboriginal patients were in a poorer physiological state than were non-Aboriginal patients. The prevalence of diabetes mellitus, renal disease and rheumatic heart disease reported in Aboriginal patients was very high. Communication difficulties were more commonly reported in Aboriginal patients; the most common difficulty was apparent shyness or fear, rather than actual language difficulty. The results suggest that the treatment of Aboriginal people involves diagnosis and management of diverse pre-operative medical problems, and that better management may be achieved by learning simple cultural strategies and by adding Aboriginal interpreters and health workers to the anaesthetic team.
The Effect of Intraoperative Ventilation Strategies on Perioperative Atelectasis
Authors: Clarke J. P. , Schuitemaker M. N. , Sleigh J. W. 
Published: January 2019

Several methods of ventilation have previously been shown to reduce intraoperative atelectasis and alveolar to arterial oxygen gradient (A-a DO2) in healthy patients. This study was designed to show firstly the relative intra-operative benefit and secondly if any method had an effect on atelectasis postoperatively. Using a factorial design we randomized 24 patients to each of the four ventilatory interventions (manual inflations, large tidal volumes, PEEP, and pressure control inverse ratio ventilation (IRV)). The A-a DO2 was used as the measure of atelectasis and data collected intra- and postoperatively for 24 hours. The mean pre-induction A-a DO2 was 80 mmHg. This study demonstrated that PEEP and IRV were most effective in reducing intraoperative A-a DO2 (P<0.05 ANCOVA). Using more than one intervention did not improve the A-a DO2. No method had any effect on postoperative A-a DO2.
A Comparison of Three Fluid-Vasopressor Regimens Used to Prevent Hypotension during Subarachnoid Anaesthesia in the Elderly
Authors: Yap J. C. M. , Critchley L. A. H. , Yu S. C. , Calcroft R. M. , Derrick J. L. 
Published: January 2019

We aimed to compare the efficacy of fluid preloading with two recently recommended fluid-vasopressor regimens for maintaining blood pressure during subarachnoid anaesthesia in the elderly. Sixty elderly patients requiring surgery for traumatic hip fractures received subarachnoid anaesthesia using 0.05 ml/kg of 0.5% heavy bupivacaine. Hypotension, i.e. systolic arterial pressure <75% of baseline, was prevented or treated by: A—normal saline 16 ml/kg plus intravenous ephedrine boluses (0.1 mg/kg); B—normal saline 8 ml/kg plus intramuscular depot ephedrine (0.5 mg/kg); or C—Haemaccel 8 ml/kg plus metaraminol infusion. Systolic arterial pressure and heart rate were recorded using custom-written computer software (Monitor, version 1.0). Systolic arterial pressure decreased in all groups after five minutes (P<0.001). Decreases were greatest in group A (P<0.05). Heart rate increased by 7% group A and decreased by 9% in group C (P<0.05). During the first hour, hypotension was present for 47%, 25% and 20% of the time in groups A, B and C respectively and overcorrection of systolic arterial pressure occurred in 19% of the time in group C. We conclude that treatment A was inadequate in preventing hypotension. Treatments B and C were more effective but were associated with an increased heart rate and overcorrection of systolic arterial pressure respectively.
Obstetricians’ Knowledge and Attitudes toward Epidural Analgesia in Labour
Authors: Vandendriesen N. M. , Lim W. , Paech M. J. , Michaels C. 
Published: January 2019

A survey of all registered obstetrician/gynaecologists in Western Australia (n = 79) was conducted to obtain information regarding their level of knowledge about epidural analgesia (EA) in labour and its complications, their sources of information about EA, and their opinions regarding its role in labour and effect on progress of labour. Response rate was 68%. Most respondents had only received lectures about EA after specialist training and 20% did not achieve an adequate knowledge score. Those of less than five years’ experience achieved significantly better scores. Over a third did not favour EA in labour until active labour was established, though 90% would recommend it by late first stage in those with a potentially complicated delivery. For women with cardiac or significant medical disease aggravated by labour, 18% would wait until the late first or second stage before suggesting EA. Seventy-seven per cent believed EA prolonged the second stage of labour, though opinion varied regarding EA effects on the duration and progress of first and third stages. Up to thirty minutes delay before epidural placement is acceptable to 87%. This survey suggests that there is both a demand and a need for greater education about EA in labour, particularly with respect to EA side-effects, complications and effects on labour, in the subgroup of obstetricians who have been in obstetric practice more than five years.
Disconnect Alarm Failure in Detection of Common Gas Outlet Disconnection
Authors: French R. A. , Kennedy R. R. 
Published: January 2019

This laboratory study was prompted by two paediatric cases where low pressure alarms and capnography failed to detect common gas outlet disconnection when using a T-piece pump ventilator. A carbon dioxide producing model lung was ventilated using the Clare ventilator (a T-piece pump type ventilator) via an Ayres T-piece. The T-piece used has 3 mm diameter fresh gas tubing. Common gas outlet disconnects were carried out using varying fresh gas flows and ventilatory patterns. At fresh gas flows of less than 8 l/min, the low pressure alarm of the Clare ventilator failed to sound following common gas outlet disconnection. Oxygraphy showed a rapid rise in inspired oxygen. End-tidal CG2 rose, whilst inspired CO2 remained at zero. This experiment demonstrates that the Clare ventilator's low pressure alarm detects common gas outlet disconnection poorly when used with an Ayres T-piece with narrow fresh gas tubing. Graphical representation of airway oxygen content has merit as an alerting monitor for common gas outlet disconnection.
Nasopharyngeal Electrode Recording of Somatosensory Evoked Potentials as an Indicator in Brain Death
Authors: Roncucci P. , Lepori P. , Mok M. S. , Bayat A. , Logi F. , Marino A. 
Published: January 2019

Median nerve somatosensory evoked potentials were recorded in 28 comatose patients, eight of whom were progressing from coma to eventual brain death and in 11 brain dead patients using electrodes over the scalp, neck and nasopharynx (nasopharyngeal electrode). This recording technique was used to assess the different derivation of brainstem P14 wave activity. It showed that in the midfrontal scalp to the nasopharynx derivation a clear P14 was present in all comatose patients. This component disappeared during the passage from coma to brain death. In a separate group, simultaneous direct recordings in the vicinity of the dorsal column nuclei and with a nasopharyngeal electrode were made in five patients undergoing neurosurgical procedures at the craniocervical junction with the same somatosensory evoked potential monitor. We found that the P14 recorded with the nasopharyngeal electrode in the neurosurgical patients corresponded in latency and morphology with the P14 recorded directly on the surface of the craniocervical junction and more specifically in the vicinity of the nucleus cuneatus. The nasopharyngeal electrode provides non-invasive access to the ventral brainstem at the medullo-pontine level and the disappearance of the P14 shows a clear sign of involvement of the craniocervical junction in brain dead patients. Our study showed that with a simple montage the nasopharyngeal electrode is an effective non-invasive monitor for brainstem activity and can be used as an early diagnostic indicator of brainstem death.
Epidural Analgesia Reduces the Release of Amino Acids from Peripheral Tissues in the Ebb Phase of the Metabolic Response to Major Upper Abdominal Surgery
Authors: Barratt S. M. , Smith R. C. , Kee A. J. , Carlsson A. R. , Mather L. E. , Cousins M. J. 
Published: January 2019

The purpose of this prospective cohort study was to compare metabolic effects of epidural or patient controlled analgesia (PCA) in patients undergoing major upper abdominal surgery. Seventeen patients undergoing major upper abdominal surgery were included: 10 received perioperative epidural analgesia (Group I) and the remainder received morphine via a PCA device for postoperative analgesia (Group II). A number of measures compared between one day preoperatively (day 1) and day 2 postoperatively included femoral arterial and venous blood concentrations of glucose, lactate, pyruvate and amino acids. In addition, the relevant flux values were measured from the products of the respective arteriovenous substrate concentration differences and calf blood flow. The efflux of lactate from peripheral tissues was greater in Group II than in Group I (P<0.01): glucose and pyruvate efflux did not differ between groups. There was no difference between groups in mean individual and total flux of amino acids on day -1. However increased efflux between day -1 and day 2 was found for alanine, valine, isoleucine, leucine, phenylalanine, lysine, arginine in both groups, and for serine, glycine, tyrosine and histidine in Group II (P<0.05). The efflux of glycine, methionine, amino benzoic acid, alanine, and lysine was less in Group I than Group II on day 2 (P<0.05). There was a significant difference in the total amino acid flux on day 2 (Group I = -1.2 μmol.(100 ml tissue)-1.min-1 cf Group II = -2.5 μmol.(100 ml tissue)-1.min-1; P = 0.04). In conclusion, perioperative epidural analgesia was associated with a reduced postoperative amino acid efflux two days following major upper abdominal surgery.
Chomping at the Bit: A Descriptive Report on Pediatric Clenbuterol Ingestion
Authors: Woolum Jordan , Mancuso Nicholas , Rutter Philip W. , Baum Regan A. , Akpunonu Peter 
Published: January 2019

Introduction: Clenbuterol hydrochloride is a selective beta-2 adrenergic agonist with uses in both humans and animals. Ingestions occurring within the United States are generally due to incidental ingestion of a veterinary product, use as a cutting agent for illicit substances, or illegal use for performance-enhancing purposes. Case Report: A four-and-a-half year-old male presented approximately two-and-a-half hours after an accidental ingestion of an unknown quantity of clenbuterol. Initial laboratory results and electrocardiogram were remarkable for hyperglycemia, hypokalemia, and hypophosphatemia, with an electrocardiogram demonstrating sinus tachycardia. Heart rate ranged from 126 to 147 beats per minute while other vitals remained within normal limits. The patient was observed for 24 hours and discharged with normalized vital signs, laboratory results, and electrocardiogram. Discussion: Clenbuterol hydrochloride is a beta-agonist with high potency, extended half-life, and bioavailability of 70% to 80%. Tachycardia occurs due to beta-1 receptor stimulation, as well as a homeostatic reflex to peripheral vasodilation. Hyperglycemia is not uncommon in exposures and intracellular shifting of potassium causes hypokalemia. Treatment is primarily supportive in nature, with hemodynamic management representing the primary focus of initial triage.
A study on modified accelerated diagnostic protocol to safely discharge low-risk chest pain patients in emergency department
Authors: Yean Kok Siew , Abd. Wahab Mahathar Bin , Zakaria Mohd Idzwan Bin 
Published: January 2019

Background: Evaluation of chest pain patients in emergency departments to distinguish between high-risk patients who require admission and low-risk patients who can be managed as outpatients is a challenging task. Objective: The aim of this study was to evaluate the efficacy of Observation Ward Short Stay Evaluation Service for Chest Pain Protocol to identify and safely discharge low-risk patients with low incidence of major adverse cardiac events within 30 days. Methods: This was a single center prospective observational study, conducted from 1 March 2016 to 31 August 2016 at the Emergency and Trauma Department, Hospital Kuala Lumpur, Kuala Lumpur. Observation Ward Short Stay Evaluation Service for Chest Pain Protocol was used to evaluate patients presented with chest pain or angina equivalents. The components involved Thrombolysis in Myocardial Infarction (TIMI) score, serial electrocardiograms, high-sensitivity cardiac troponin T, and exercise treadmill test. Low-risk patients were patients with TIMI < 2, normal serial electrocardiogram, high-sensitivity cardiac troponin T ≤ 14 ng/L, and negative exercise treadmill test. If anyone of the components was not fulfilled patients were considered as high risk, and they were either admitted or referred to clinic for further intervention. Low-risk patients were allowed for discharged. All patients were followed-up in 30 days for any incidence of major adverse cardiac events. Results: Totally, 174 patients were studied. Observation Ward Short Stay Evaluation Service for Chest Pain Protocol managed to discharge 102 (58.6%) patients, and 84 (82.4%) of them underwent exercise treadmill test. About 46 (54.8%) patients had negative exercise treadmill test, whereas 38 (45.2%) patients had either positive or inconclusive exercise treadmill test, and they were referred to physician clinic for further cardiac assessment. None of the patients with negative exercise treadmill test developed major adverse cardiac events in 30 days. The sensitivity and the negative predictive value (NPV) of Observation Ward Short Stay Evaluation Service for Chest Pain Protocol were both 100%. Conclusion: Observation Ward Short Stay Evaluation Service for Chest Pain Protocol can be applied in emergency departments to identify and safely discharge patients with low risk of major adverse cardiac events in 30 days.
Talking about Race: Overcoming Fear in the Process of Change
Authors: Palmer Emily Lilja , Louis Karen Seashore 
Published: January 2019

Purpose We investigated the way in which structured, multiyear conversations about race and institutional racism occurred in suburban secondary schools with changing racial demographics. Research Framework The study draws on interpretive research traditions, in that we assume that how teachers understand race and racism will influence how they work with colleagues and students. As such, the research examines to what extent talking about race and learning about institutional racism affects educators’ mental models and their classroom practices. Method Secondary schools in three districts that had participated in ongoing professional development related to racial equity were selected. Grounded theory methods were used for data collection, coding, and analysis of interviews with teachers and administrators. Findings This study revealed that principal leadership affected teachers’ engagement in this work. When this occurred, teachers made meaningful changes in classroom practices and their school communities. The primary findings of the study are: (1) fear of being considered racist was a barrier for White teachers and administrators that impeded collective focus on racial achievement gaps; (2) principals’ deep personal engagement over a period of several years encouraged a process of confronting and mitigating this fear, and helped teachers engage with the implications of race for school and classroom practices. Significance Discomfort, a critical element in confronting racial inequities in schools, requires school leaders, particularly principals, to authentically participate and engage in order to foster teacher change.
Stress be not Proud: The Myth of Burnout
Authors: Demoulin Donald F. 
Published: January 2019

Virtually every form of media has reports concerning teacher burnout in education. Many of these reports have been directed towards a relationship between teacher burnout and a declining educational status in this country. However, the question of concern should be, “Is the term burnout being appropriately used or being systematically abused when describing teacher productivity?” The following study is a culmination of a seven-year investigation concerning the impact of stress on self efficacy and personal productivity. From information received from the Career Awareness Index and the Instrument Summary Assessment Program, analysis indicates that the term burnout may be an inappropriate descriptor of low to moderate levels of self efficacy and personal productivity. Hence, professional development activities may be incorrectly designed having little or no affect in enhancing self efficacy manners. Therefore, it is imperative that professional development activities be specifically designed to match individual needs and interests in order for positive effects to occur.