bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transthoracic Right Atrial Cannulation for Total Parenteral Nutrition — Case Report
Authors: Hayden L. , Stewart G. Ramsey , Johnson D. C. , Fisher M. McD. 
Published: January 2019

A man with severe peripheral vascular disease and requiring total parenteral nutrition because of short bowel syndrome was referred because a central venous catheter could not be inserted by conventional techniques. A right thoracotomy was performed and a Hickman catheter inserted via the right atrial appendage into the right atrium. This catheter was used for a total of seven months for total parenteral nutrition. For the last two months of this time, the patient was maintained at home on a Home Parenteral Nutrition Programme. After four months of total parenteral nutrition the patient developed recurrent fevers and the catheter was found to have migrated from the right atrium into the pulmonary artery. The catheter was resited under x-ray control and used for a further three months until the recurrence of fever and dyspnoea heralded the onset of septic pulmonary emboli resulting in his death.
A Rational Approach to Crossmatching Blood for Elective Surgery
Authors: Dodds Anthony J. , Pun Anthony , Isbister James P. , Ting Amy , Klarkowski Derryck , Concannon Alan J. , Biggs James C. 
Published: January 2019

A group-and-screen system was introduced for selected surgical procedures to improve the cost-effectiveness of the hospital blood transfusion service. The mean crossmatch-transfusion ratio for eleven procedures was 11.1 but fell to 3.3 after the change. The overall crossmatch-transfusion ratio in the hospital improved from 2.7 to 2.2 (p <0.001) and blood wastage by expiry fell from 12% to 5% (p <0.02). The mean age of blood being transfused also improved slightly from 12.3 days to 10.4 days (p <0.001). No problems have arisen from the group-and-screen system to date. It has led to improvement in the efficiency and cost-effectiveness of the hospital blood bank and resulted in fresher blood being transfused.
The Spread of Caudal Analgesia in Children: A Mathematical Model
Authors: Busoni P. , Andreuccetti T. 
Published: January 2019

A mathematical model correlating the spread of analgesia to the dose of local anaesthetic and to age or body weight was found analysing the data of 763 caudal blocks in children from age one day to twelve years. Two graphs have been plotted: (1) spread of analgesia, dose, age and (2) spread of analgesia, dose, weight. Both age and weight can be used as predictors to determine the desired level of analgesia, but weight is more useful in very young patients while age is a better guide in older children.
The ‘New’ Relaxants. A Review of the Clinical Pharmacology of Atracurium and Vecuronium
Authors: Torda T. A. 
Published: January 2019

Atracurium and vecuronium are reviewed with reference to the following aspects: Development and chemistry Pharmacology Potency and dosage Onset and duration of action Non-neuromuscular effects Cardiovascular Central nervous system Histamine release and allergic responses Fate in the body Pharmacokinetics Factors which affect response to atracurium and vecuronium Anaesthetic agents Suxamethonium Age Clinical aspects Intubation Cardiac disease and cardiac surgery Renal disease Liver disease Obstetric anaesthesia Anaesthesia for ophthalmic and neurosurgery Intercurrent disease states Outpatient surgery Reversal of neuromuscular block Conclusion
Oxygen Saturation during Transfer from Operating Room to Recovery after Anaesthesia
Authors: Blair I. , Holland R. , Lau W. , McCarthy N. , Chiah T. S. , Ledwidge D. 
Published: January 2019

Transcutaneous oxygen saturation of haemoglobin was measured in 101 patients en route from the operating room to the recovery room. Twenty-nine became significantly hypoxaemic during the journey. The incidence of hypoxaemia was not found to relate to age, weight, duration or type of surgery, type of anaesthesia or pre-existing disease. Duration of the interval between cessation of oxygen in the operating room and arrival in recovery room was the only significant finding in patients who became hypoxaemic.
A Survey of Epidural Analgesia Practice in Western Australian Obstetric Units
Authors: Paech M. J. , Godkin R. 
Published: January 2019

A survey of epidural practices in all obstetric units in this state was conducted to obtain information regarding epidural analgesia services, epidural conduct and management, management of complications and staff education. The survey revealed a diversity of practice and in some instances standards of care. While reflecting the regionalisation of services in this geographically vast state, the problems identified appear universal and are likely to be relevant on a broader and national scale. Practices are discussed and recommendations made with respect to improvement of management and continuing education.
Single versus Double Occlusive Dressing Technique to Minimize Infusion Thrombophlebitis: Vialon® and Teflon® Cannulae Reassessed
Authors: Myles P. S. , Buckland M. R. , Burnett W. J. 
Published: January 2019

Infusion thrombophlebitis is the commonest complication of intravenous cannulation. This study was undertaken to prospectively evaluate a double-occlusive dressing technique and a new cannula, bismuth oxide-Teflon® (Critikon Inc., Aust.), comparing it to Vialon® (Deseret Medical Inc., Utah, USA). The study group of two hundred patients had a 16 gauge intravenous cannula inserted in theatre using a standard technique. The incidence of thrombophlebitis was determined on a daily basis. Cannula tips were sent for culture on removal. Vialon® was found to be superior to Teflon® after day 1. Although a double-occlusive dressing technique increased the duration of cannulation (50.9 vs. 41.9 hours, P < 0.05), there was no difference in the incidence of thrombophlebitis. Neither cannula material nor dressing technique had an influence on the results of cannula tip culture (6% incidence). There was no evidence of bacteraemia in any case.
Alveolar Oxygenation and Mouth-to-Mask Ventilation: Effects of Oxygen Insufflation
Authors: Stahl J. M. , Cutfield G. R. , Harrison G. A. 
Published: January 2019

The effect on alveolar oxygen fraction (FAO2) of insufflating oxygen under a mask (or through an inflow nipple provided in the mask) during simulated mouth-to-mask ventilation was investigated using a lung model. A variety of commercially produced masks were evaluated. Two patterns of artificial ventilation were applied: 1. 500 ml tidal volume at 20 breaths per minute, and 2. 900 ml tidal volume at 12 breaths per minute. The ventilating gas mixture was oxygen 16% in nitrous oxide, and oxygen was insufflated at flow rates of 2, 4, 6, 8, 10, 12 or 14 litres per minute. The rate of rise of FAO2 and the equilibrium FAO2 attained were greatest at high oxygen inflow rates. The relationship between oxygen flow and FAO2 was not linear however, and an oxygen flow rate of 10 l/min was adequate to generate FAO2‘s around 50% with either ventilatory pattern. The equilibrium FAO2 achieved was greater with smaller tidal volumes and with larger mask deadspace. We also found that several breaths were required for equilibration of FAO2 during each trial, supporting recommendations that several breaths should be given on commencement of artificial ventilation during cardiopulmonary resuscitation.
Intensive Care Unit Resource Utilisation
Authors: Buist M. 
Published: January 2019

The cost-effectiveness of the Intensive Care Unit after three decades of development has yet to be demonstrated. Accurate ICU resource allocation is limited by our inability to measure cost-effectiveness. Measurement tools have been developed and refined that will give a prediction of in-hospital mortality of groups of critically ill patients. However, these measures will not predict with certainty individual patient outcomes, and take no account of quality of life. Methodology to examine long-term outcome and quality of life after intensive care is still in its infancy. Measurement of ICU cost is limited by a lack of cost-accounting models that not only reflect true cost but that are clinically applicable.
Survey: National Audit of Anaesthesia for Major Abdominal Surgery
Authors: Rigg J. R. , Collins K. , Jamrozik K. 
Published: January 2019

A postal survey was conducted of all hospitals in Australia known to have a department of anaesthesia and an intensive care or high dependency unit. Each hospital was asked to report the anaesthetic and postoperative analgesic techniques used for the last ten cases of four common major surgical procedures—aorto-femoral bypass, repair of an abdominal aortic aneurysm, hemicolectomy and anterior resection of the rectum. Half of 76 hospitals sent a survey form completed and returned it. Responding hospitals were larger, on average, than non-responding ones, but otherwise typical of them in terms of university affiliation and metropolitan versus rural location. For each of the four procedures studied, the proportion of cases in which epidural block was used intra- or postoperatively varied from 0% to 100%. Depending on the procedure, between 65% and 85% of hospitals used epidural block sometimes, with between 10% and 90% of patients in these hospitals being managed with this technique. There is wide variation in the use of epidural block, intra- and postoperatively, in Australia, variation that is unlikely to be explained by systematic differences between institutions in the patients seen or their suitability for one or other technique. This pattern of practice mirrors the lack of agreement about the proper place for epidural techniques evident in the recent literature. There is a widespread belief among clinicians that this is a question of great importance. Accordingly, we believe that anaesthetists and surgeons share an ethical responsibility to enter suitable patients in an appropriately designed randomized controlled trial in order to resolve this question.
Tracheostomy in a Neuro-Intensive Care Setting: Indications and Timing
Authors: Koh W. Y. , Lew T. W. K. , Chin N. M. , Wong M. F. M. 
Published: January 2019

A retrospective review was made of 49 survivors who were mechanically ventilated for more than 48 hours in the neurosurgical ICU. Thirty-two patients (Gp I) were successfully extubated, 9 patients (Gp II) underwent tracheostomy after one or more failed extubations, and 8 patients (Gp III) underwent elective tracheostomy. Glasgow Coma Scale (GCS) scores at extubation were 11.3±2.8 (mean (SD) for Gp I vs 7.8±2.7 for Gp II (P= n.s.) and at elective tracheostomy (Gp III) was 5.4±2.3. Incidence of ventilator-associated pneumonia were 35% in Gp I vs 100% of patients in Gp II and III (P<0.05). Reasons for reintubation in 7 of 9 patients (Gp II) were upper airway obstruction and tenacious tracheal secretions while 14 of 17 patients were weaned off the ventilator within 48 hours of tracheostomy. The length of stay in ICU was 16.8±7.1 days in Gp II vs 11.7±2.9 days in Gp III (P<0.05). In our study, elective tracheostomy for selected patients with poor GCS scores and nosocomial pneumonia has resulted in shortened ICU length of stay and rapid weaning from ventilatory support.
Undernutrition in Children—Effect on Vecuronium Induced Neuromuscular Blockade
Authors: Jain A. K. , Hussain S. , Ahuja S. 
Published: January 2019

Sixty children aged one to 12 years requiring anaesthesia including a muscle relaxant were assessed for their nutritional status based on simple anthropometric and biochemical parameters. They were allocated to one of four groups: normal nutrition, mild, moderate or severe malnutrition. The neuromuscular effects of vecuronium bromide 0.1 mg/kg were studied by recording evoked responses to train of four (TOF) nerve stimulation using an accelerograph. In the above nutritional groups, time to onset of 25% depression of T1 was 0.8, 1.4, 1.3 and 2.1 minutes respectively. Maximal depression of TOF response was seen at 2.2, 3.2, 3.7 and 8.4 minutes. The duration of action of the initial dose was 26.5, 24.0, 17.7 and 13.3 minutes and the mean duration of action of top-up doses was 16.2, 14.9, 11.2 and 8.9 minutes respectively. Reversal time with neostigmine 0.05 mg/kg was not significantly different in the four groups. These results demonstrate a statistically significant delay in onset and shortening of the duration of action of vecuronium in the undernourished groups compared with the normal nutrition group when vecuronium is administered to children on a milligram per kilogram basis.
Dental emergencies at sea: A study in the French maritime TeleMedical Assistance Service
Authors: Binaisse Pierre , Dehours Emilie , Bodéré Céline , Chevalier Valérie , Le Fur Bonnabesse Anaïs 
Published: January 2019

Introduction The aim of the study was to assess the frequency, features and management of dental emergencies at sea in France. Methods A descriptive study was carried out by retrospectively examining medical records of patients who were assisted by the French maritime TeleMedical Assistance Service (TMAS) from 2012 to 2016. Data were ranked in different categories: socio-demographic data, diagnosis, prescription, and monitoring or treatment prescribed. Results The TMAS recorded 9122 medical files for all medical emergencies. Among these medical records 135 concerned oral diseases. The main causes for dental emergencies are dental abscess (51.8%), tooth decay (33.3%), and dental fracture (8.9%). Even where teledentistry is validated for remote screening and oral lesion diagnosis, management of dental emergencies mostly requires a dental procedure. On board, without special equipment and/or specifically trained healthcare workers, this management often results in the prescription of medication. Discussion The International Medical Guide for Ships published by the World Health Organization could be updated to suit the latest recommendations of dental emergency management. This could facilitate the addition of a medical act to dental management, resulting in more effective treatment. Furthermore, simple and specific equipment could be added to the medical supplies.
Continuous Subcutaneous Insulin Infusion Initiation Is Associated With Blood Pressure Reduction in Adults With Type 1 Diabetes
Authors: Markakis Konstantinos , Alam Tayiba , Jinadev Pushpa , Chapman Alyson , Urwin Andrea , Thabit Hood , Boulton Andrew J. M. , Rutter Martin K. , Leelarathna Lalantha 
Published: January 2019

Background: In type 1 diabetes (T1D) continuous subcutaneous insulin infusion (CSII) use has been associated with lower risks for mortality and diabetes-related complications when compared to multiple daily injections. There are limited data on the effect of CSII on blood pressure (BP). We aimed to evaluate the relationship between CSII initiation and BP changes. Methods: We performed a retrospective, single-center, observational study including all adults with T1D who initiated CSII between 2001 and 2014. Mean systolic BP levels were calculated from values obtained up to 15 months before and up 15 months after CSII initiation. Results: We studied 436 adults (46% male; mean [95% CI] age: 45 [36, 54] years, duration of diabetes: 20.3 [19.1, 21.5] years). CSII was associated with the following changes (post minus pre CSII levels) in mean (95% CI) SBP and DBP levels, respectively: whole cohort (N = 436): −2 (−1, −3), P < .001 and −2 (−1, −2), P < .001; those taking stable antihypertensive medication (n = 118): −4 (−6, −2), P < .001 and −2 (−3, −1), P < .001; antihypertensive treatment-naïve patients (n = 279): −1 (−2, 0), P = .147 and −1 (−2, 0), P = .002. In multivariate regression analysis including age, sex, diabetes duration, pre-CSII BP, HbA1c and weight changes, only pre-CSII BP showed an independent association with BP drop in all patients’ groups. Once adjusted for pre-CSII BP there was no significant difference between those on antihypertensive drugs and antihypertensive treatment-naïve individuals. Conclusions: We showed BP reduction in association with CSII therapy particularly in those on antihypertensive medication. These original findings may partly explain the cardiovascular and mortality benefits associated with CSII therapy.
The Effect of Total Knee Arthroplasty on Physical Activity and Body Mass Index: An Analysis of the Osteoarthritis Initiative Cohort
Authors: Rezzadeh Kevin , Behery Omar A. , Kester Benjamin S. , Long William J. , Schwarzkopf Ran 
Published: January 2019

Introduction: Preliminary analysis of accelerometry measurements has shown physical activity may not increase significantly after total knee arthroplasty (TKA). This study evaluates the effect of TKA on physical activity accelerometry measurements and body mass index (BMI). Methods: Using the multicenter Osteoarthritis Initiative (OAI) database, a cohort of patients with physical activity level accelerometry measurements and BMI before and after TKA was identified. Physical activity levels and BMI were acquired at pre-TKA and post-TKA accelerometry visits 2 years apart. Survey scores pertaining to knee functionality and quality of life were also analyzed before and after knee surgery. Each patient included in the study had a unilateral TKA completed between these 2 accelerometry visits. Accelerometry measurements, BMI of the patients, and survey scores relating to knee functionality and pain relief from before and after TKA were compared using paired samples t tests. Results: Twenty-three patients from the OAI database were identified for the paired analysis. They were evaluated at a mean postoperative follow-up of 15 months. There were no statistically significant differences between the post-TKA group and pre-TKA group for the accelerometry variables and BMI, though patients experienced a significant improvement in knee function and pain relief measures included in this analysis. Discussion: Although TKA can successfully restore function and relieve pain, there remains no good evidence that neither physical activity nor BMI improve postoperatively. Conclusion: No significant differences in physical activity and BMI were observed after TKA in this study.
Low Rates of Survival Seen in Orthopedic Patients Receiving In-Hospital Cardiopulmonary Resuscitation
Authors: Fletcher James W. A. , Smith Adam , Walsh Katherine , Riddick Andrew 
Published: January 2019

Introduction: Despite awareness of overall poor survival rates following cardiopulmonary resuscitation (CPR), some orthopedic patients with significant comorbidities continue to have inappropriate resuscitation plans. Furthermore, in certain injury groups such as patients with hip fractures, survival outcome data are very limited; current discussions regarding resuscitation plans may be inaccurate. This study assesses survival in orthopedic patients following CPR, to inform decision-making between physicians, surgeons, and patients. Methods: A dual center, retrospective cohort study was performed analyzing all orthopedic admissions that received CPR over a 25-month period, with a minimum of 1 year follow-up. National Cardiac Arrest Audit data, “mortality and morbidity” meeting records, National Hip Fracture Databases, and electronic notes were analyzed. Survival duration was measured, alongside reason for admission, location CPR occurred, and initial rhythm encountered. Results: Thirty-two patients received CPR over the 25-month period (median age: 83; range: 30-96). Three (9%) of 32 patients survived to discharge. Only 1 of the 26 patients older than 65 years survived to discharge. Fifteen (47%) of 32 had hip fractures, where 4 (27%) of 15 of this group survived 24 hours; none survived to discharge. When recorded, 22 (92%) of 24 initially had a nonshockable rhythm. Discussion: Cardiopulmonary resuscitation was conceptualized as a treatment for reversible cardiopulmonary causes. When used in trauma and orthopedic patients, especially older and/or hip fracture patients, it seldom led to hospital discharge. Different admission practices such as “front door” orthogeriatric reviews may explain the contrast in usage of CPR between the hospitals. Conclusion: Survival rates following CPR were very low, with it proving specifically ineffective in hip fracture patients. Although every decision about resuscitation should be patient centered and individualized, this study will allow clinicians to be more realistic about outcomes from CPR, particularly in the hip fracture group.
PERFIL NEUROPSICOLÓGICO TÍPICO E ATÍPICO NA DEMÊNCIA DE ALZHEIMER: DIFICULDADES DIAGNÓSTICAS EM TRÊS ESTUDOS DE CASO
Authors: Martorelli Pinho Marina , Norte Carlos Eduardo , Nogueira da Gama Chaves Daniel , Charchat-Fichman Helenice 
Published: January 2019

Resumo: A Demência de Alzheimer (DA) é tipicamente caracterizada por déficits precoces na memória episódica, seguidos de déficits em outras funções cognitivas. Entretanto, estudos recentes mostram que déficits precoces em outras funções cognitivas podem estar presentes, configurando um tipo não-amnéstico na DA, denominada DA atípica. Dessa forma, esse estudo tem o objetivo de analisar a heterogeneidade neuropsicológica descrevendo três estudos de casos de demência de Alzheimer. Método: o trabalho consiste na análise de três casos de DA. Uma avaliação neuropsicológica extensa foi realizada em todos eles. Resultados e discussão: os resultados desses estudos de caso mostram dois perfis cognitivos distintos – um típico e um atípico. Compreender essa heterogeneidade cognitiva na DA é necessária para diagnósticos precoces, e consequentes, terapias mais específicas e personalizadas para esses pacientes.Palavras-chave: Doença de Alzheimer. Neuropsicologia. Demência. Diagnóstico.Abstract: Alzheimer's Dementia (AD) is typically characterized by early deficits in episodic memory, followed by deficits in other cognitive functions. However, recent studies show that early deficits in other cognitive functions may be present, configuring a non-amnestic type in AD, which were referred to as “atypical”. Thus, this study aims to present the neuropsychological heterogeneity describing three case studies of Alzheimer's disease. Method: this study consists of the analysis of 3 cases of AD and extensive neuropsychological evaluation was performed in the analyzed cases. Results and Discussion: the results of this case study show two distinct cognitive profiles - one typical and one atypical. Understanding this cognitive heterogeneity in AD is necessary for early diagnosis, and consequent, more specific and customized therapies for these patients.Keywords: Alzheimer's disease. Neuropsychology. Dementia. Diagnosis