scholarly journals Qualitative and quantitative gastric ultrasound assessment in highly skilled regional anesthesiologists

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Rattanaporn Tankul ◽  
Pathom Halilamien ◽  
Suwimon Tangwiwat ◽  
Sukanya Dejarkom ◽  
Pawinee Pangthipampai
Keyword(s):  
Gastric Content ◽  
Intraclass Correlation ◽  
Major Complication ◽  
Area Measurement ◽  
Qualitative Assessment ◽  
Cross Sectional ◽  
Content Category ◽  
Qualitative And Quantitative ◽  
Link Type ◽  
Ultrasound Assessment

Abstract Background Pulmonary aspiration is a major complication in anesthesia, and various studies have shown that gastric sonography can reliably provide valuable information relative to both the qualitative and quantitative aspects of gastric content. This study aimed to determine the accuracy of ultrasound assessment of gastric content compared between two novice anesthesiologist gastric sonographers. Methods This prospective cohort study of two anesthesiologists learning to perform qualitative and quantitative ultrasound assessment of gastric content on healthy volunteers was conducted at Siriraj Hospital (Bangkok, Thailand). This trial was registered with ClinicalTrials.gov (reg. no. NCT04760106). Results Of the 50 enrolled participants, three were excluded due to study protocol violation. Each anesthesiologist performed a qualitative assessment on 47 participants for an overall total of 94 scans. There were 15 males and 32 females (age 42 ± 11.7 years, weight 61.2 ± 13.1 kg, height 160.7 ± 7.3 cm, and BMI 23.6 ± 4.3 kg/m2). The overall success rate for all gastric content categories was approximately 96%. From antral cross-sectional area measurement, as the ingested volume increased, there was a tendency toward increased deviation from the actual ingested volume. Interrater agreement between anesthesiologists was analyzed using intraclass correlation coefficients (ICCs). A larger fluid volume was found to be associated with a lower level of agreement between the two anesthesiologists. The ICCs were 0.706 (95% CI: −0.125 to 0.931), 0.669 (95% CI: −0.254 to 0.920), 0.362 (95% CI: −0.498 to 0.807) for the 100 ml, 200 ml, and 300 ml fluid volumes, respectively. The mean duration to perform an ultrasound examination for each gastric content category and for the entire examination did not differ significantly between anesthesiologists (p > 0.05). Conclusion Our results indicate that qualitative ultrasound assessment of gastric content is highly accurate and can be easily learned. In contrast, quantification of gastric volume by novice gastric sonographers is more complex and requires more training. Trial registration ClinicalTrials.gov no. NCT04760106 Date registered on Feb 11, 2021. Prospectively registered.

scholarly journals Qualitative and quantitative ultrasound assessment of gastric content

2017 ◽  
Vol 63 (2) ◽  
pp. 134-141 ◽  
Author(s):  
Flora Margarida Barra Bisinotto ◽  
Patrícia Luísa Pansani ◽  
Luciano Alves Matias da Silveira ◽  
Aline de Araújo Naves ◽  
Ana Cristina Abdu Peixoto ◽  
...  
Keyword(s):  
Gastric Content ◽  
Gastric Volume ◽  
Gastric Antrum ◽  
Qualitative Assessment ◽  
P Value ◽  
Clear Fluid ◽  
Solid Meal ◽  
Cross Sectional ◽  
Qualitative And Quantitative ◽  
The Difference

Summary Objective: Pulmonary aspiration of the gastric contents is one of the most feared complications in anesthesia. Its prevention depends on preoperative fasting as well as identification of risky patients. A reliable diagnostic tool to assess gastric volume is currently lacking. The aim of this study performed on volunteers was to evaluate the feasibility of ultrasonography to identify qualitative and quantitative gastric content. Method: A standardized gastric scanning protocol was applied on 67 healthy volunteers to assess the gastric antrum in four different situations: fasting, after ingesting clear fluid, milk and a solid meal. A qualitative and quantitative assessment of the gastric content in the antrum was performed by a blinded sonographer. The antrum was considered either as empty, or containing clear or thick fluid, or solids. Total gastric volume was predicted based on a cross-sectional area of the antrum. A p-value less than 0.05 was considered statistically significant. Results: For each type of gastric content, the sonographic characteristics of the antrum and its content were described and illustrated. Sonographic qualitative assessment allowed to distinguish between an empty stomach and one with different kinds of meal. The predicted gastric volume was significantly larger after the consumption of any food source compared to fasting. Conclusion: Bedside sonography can determine the nature of gastric content. It is also possible to estimate the difference between an empty gastric antrum and one that has some food in it. Such information may be useful to estimate the risk of aspiration, particularly in situations when prandial status is unknown or uncertain.

scholarly journals Is T2 mapping reliable in evaluation of native and repair cartilage tissue of the knee?

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Hasan Banitalebi ◽  
Christian Owesen ◽  
Asbjørn Årøen ◽  
Hang Thi Tran ◽  
Tor Åge Myklebust ◽  
...  
Keyword(s):  
T2 Mapping ◽  
Intraclass Correlation ◽  
Cartilage Tissue ◽  
Intraobserver Agreement ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Repair Tissue ◽  
Native Cartilage ◽  
Link Type ◽  
Imaging Plane

Abstract Purpose To evaluate the effect of imaging plane and experience of observers on the reliability of T2 mapping of native and repair cartilage tissue of the knee. Methods Fifteen consecutive patients from two randomised controlled trials (RCTs) were included in this cross-sectional study. Patients with an isolated knee cartilage lesion were randomised to receive either debridement or microfracture (RCT 1) or debridement or autologous chondrocyte implantation (RCT 2). T2 mapping was performed in coronal and sagittal planes two years postoperatively. A musculoskeletal radiologist, a resident of radiology and two orthopaedic surgeons measured the T2 values independently. Intraclass Correlation Coefficient (ICC) with 95% Confidence Intervals was used to calculate the inter- and intraobserver agreement. Results Mean age for the patients was 36.8 ± 11 years, 8 (53%) were men. The overall interobserver agreement varied from poor to good with ICCs in the range of 0.27– 0.76 for native cartilage and 0.00 – 0.90 for repair tissue. The lowest agreement was achieved for evaluations of repair cartilage tissue. The estimated ICCs suggested higher inter- and intraobserver agreement for radiologists. On medial femoral condyles, T2 values were higher for native cartilage on coronal images (p < 0.001) and for repair tissue on sagittal images (p < 0.001). Conclusions The reliability of T2 mapping of articular cartilage is influenced by the imaging plane and the experience of the observers. This influence may be more profound for repair cartilage tissue. This is important to consider when using T2 mapping to measure outcomes after cartilage repair surgery. Trial registration ClinicalTrials.gov, NCT02637505 and NCT02636881, registered December 2015. Level of evidence II, based on prospective data from two RCTs.

Diagnostic accuracy of MRI and ultrasound in chronic immune-mediated neuropathies

Neurology ◽  
2019 ◽  
Vol 94 (1) ◽  
pp. e62-e74 ◽  
Author(s):  
Jos Oudeman ◽  
Filip Eftimov ◽  
Gustav J. Strijkers ◽  
Joppe J. Schneiders ◽  
Stefan D. Roosendaal ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Signal Intensity ◽  
Diffusion Tensor ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Intraclass Correlation ◽  
Quantitative Mri ◽  
Qualitative Assessment ◽  
Motor Neuropathy ◽  
Cross Sectional ◽  
Immune Mediated

ObjectiveTo assess and compare the diagnostic performance of qualitative and (semi-)quantitative MRI and ultrasound for distinguishing chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) from segmental spinal muscular atrophy (sSMA).MethodsPatients with CIDP (n = 13), MMN (n = 10), or sSMA (n = 12) and healthy volunteers (n = 30) were included. MRI of the brachial plexus, using short tau inversion recovery (STIR), nerve-specific T2-weighted (magnetic resonance neurography [MRN]), and diffusion tensor imaging (DTI) sequences, was evaluated. Furthermore, with ultrasound, cross-sectional areas of the nerves were evaluated. Three radiologists blinded for diagnosis qualitatively scored hypertrophy and increased signal intensity (STIR and MRN), and intraobserver and interobserver agreement was assessed. For the (semi-)quantitative modalities, group differences and receiver operator characteristics were calculated.ResultsHypertrophy and increased signal intensity were found in all groups including healthy controls. Intraobserver and interobserver agreements varied considerably (intraclass correlation coefficients 0.00–0.811 and 0.101–0.491, respectively). DTI showed significant differences (p < 0.05) among CIDP, MMN, sSMA, and controls for fractional anisotropy, axial diffusivity, and radial diffusivity in the brachial plexus. Ultrasound showed significant differences in cross-sectional area (p < 0.05) among CIDP, MMN, and sSMA in upper arm and brachial plexus. For distinguishing immune-mediated neuropathies (CIDP and MMN) from sSMA, ultrasound yielded the highest area under the curve (0.870).ConclusionQualitative assessment of hypertrophy and signal hyperintensity on STIR or MRN is of limited value. DTI measures may discriminate among CIDP, MMN, and sSMA. Currently, ultrasound may be the most appropriate diagnostic imaging aid in the clinical setting.

Validity of enthesis ultrasound assessment in spondyloarthropathy

2008 ◽  
Vol 68 (2) ◽  
pp. 169-174 ◽  
Author(s):  
E de Miguel ◽  
T Cobo ◽  
S Muñoz-Fernández ◽  
E Naredo ◽  
J Usón ◽  
...  
Keyword(s):  
Intraclass Correlation ◽  
Power Doppler ◽  
Correlation Coefficients ◽  
Plantar Fascia ◽  
Roc Curves ◽  
Patellar Ligament ◽  
Likelihood Ratios ◽  
Cross Sectional ◽  
Ultrasound Assessment ◽  
Ultrasound Score

Objectives:To develop an ultrasound enthesis score and to assess its validity in the diagnostic classification of the spondyloarthropathies (SpAs).Methods:Twenty-five patients with SpA and 29 healthy controls participated in a blinded, gender-matched, cross-sectional study involving ultrasound assessment. The following entheses were explored bilaterally: proximal plantar fascia, distal Achilles tendon, distal and proximal patellar ligament, distal quadriceps and brachial triceps tendons. The ultrasound score evaluated enthesis thickness, structure, calcifications, erosions, bursae and power Doppler signal. The value of each elemental lesion was calculated using a three-model analysis. Validity was analysed by receiver operating characteristic (ROC) curves. Inter-reader and interexplorer intraclass correlation coefficients (ICCs) were calculated.Results:The logistic regression model overestimated the score of three elemental lesions: calcification (0–3), Doppler (0 or 3) and erosion (0 or 3), while scoring tendon structure, tendon thickness and bursa as 0 or 1. ROC curves established an ultrasound score of ⩾18 as the best cut-off point for differentiation between cases and controls. This cut-off point was exceeded by 5/29 controls (17%) and by 21/25 patients with SpA (84%). The sensitivity, specificity, positive and negative likelihood ratios (LR+, LR−) were 83.3%, 82.8%, 4.8% and 0.2%, respectively. The inter-reader and interexplorer ICCs were 0.60 and 0.86, respectively.Conclusion:The findings suggest that the ultrasound enthesis score could be a valid tool in the diagnosis of SpA.

MANAGEMENT OF BLADDER STONE WITH HOLMIUM-YAG LASER AT KARDINAH HOSPITAL TEGAL

2020 ◽  
Vol 27 (1) ◽  
pp. 1-4
Author(s):  
Fatan Abshari ◽  
Zulfikar Ali
Keyword(s):  
General Hospital ◽  
Laser Energy ◽  
Major Complication ◽  
Mucosal Injury ◽  
Cross Sectional Study ◽  
Stone Size ◽  
Cross Sectional ◽  
Yag Laser ◽  
Bladder Stones ◽  
Large Size

Objective: Transurethral lithotripsy using Holmium-YAG laser has been reported to be beneficial in breaking up bladder stones with large size (>4cm in diameter) with lower risk of mucosal injury and hematuria. The aim of this study is to evaluate the utilization of Holmium-YAG laser for the management of bladder stones at Kardinah General Hospital, Tegal. Material & Methods: This is a cross-sectional study conducted from January 2017 to March 2017. Patient’s demography, which included age, sex, length of surgery, stone size, and laser’s energy count were recorded. Results: We included 120 patients in this study. Mean of patients age in this study was 51.93 years old with age range were 41-85 years old. Most of the patients were male (109 vs 11) with a mean size of stone 25.09 ± 3.04 mm. Length of surgery ranges from 15 to 75 minutes and mean energy of the laser 28.99 ± 19.34 kJ. There was 100% stone’s clearance following surgery with no major complication occurred. Conclusion: Holmium-YAG laser is effective in managing bladder stones at Kardinah General Hospital particularly for large size stones. Length of surgery and energy of laser used depend on the stone size in which bigger stone size is associated with longer surgery time and bigger laser energy needed.

scholarly journals The measurement performance of the EQ-5D-5L versus EQ-5D-3L in patients with hidradenitis suppurativa

2021 ◽  
Author(s):  
Alex Bató ◽  
Valentin Brodszky ◽  
L. Hunor Gergely ◽  
Krisztián Gáspár ◽  
Norbert Wikonkál ◽  
...  
Keyword(s):  
Convergent Validity ◽  
Hidradenitis Suppurativa ◽  
Clinical Care ◽  
Intraclass Correlation ◽  
Life Quality ◽  
Measurement Properties ◽  
Economic Evaluations ◽  
Health State ◽  
Cross Sectional Survey ◽  
Cross Sectional

Abstract Purpose Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects up to 1% of the population in Europe. The EQ-5D is the most commonly used generic instrument for measuring health-related quality of life among HS patients. This study aims to compare the measurement properties of the two adult versions of EQ-5D (EQ-5D-3L and EQ-5D-5L) in patients with HS. Methods We recruited 200 consecutive patients with HS (mean age 37 years, 38% severe or very severe HS) to participate in a multicentre cross-sectional survey. Patients completed the EQ-5D-3L, EQ-5D-5L, Dermatology Life Quality Index (DLQI) and Skindex-16 questionnaires. Results More than twice as many different health state profiles occurred in the EQ-5D-5L compared to the EQ-5D-3L (101 vs. 43). A significant reduction in ceiling effect was found for the mobility, self-care and usual activities dimensions. A good agreement was established between the EQ-5D-3L and EQ-5D-5L with an intraclass correlation coefficient of 0.872 (95% CI 0.830–0.903; p < 0.001) that was confirmed by a Bland-Altman plot. EQ-5D-5L improved both the absolute and relative informativity in all dimensions except for anxiety/depression. EQ-5D-3L and EQ-5D-5L demonstrated similar convergent validity with DLQI and Skindex-16. EQ-5D-5L was able to better discriminate between known groups of patients based on the number of comorbidities and disease severity (HS-Physician's Global Assessment). Conclusion In patients with HS, the EQ-5D-5L outperformed the EQ-5D-3L in feasibility, ceiling effects, informativity and known-groups validity for many important clinical characteristics. We recommend using the EQ-5D-5L in HS patients across various settings, including clinical care, research and economic evaluations.

scholarly journals Lifestyle modifications result in alterations in the gut microbiota in obese children

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ky Young Cho
Keyword(s):  
Gut Microbiota ◽  
Normal Weight ◽  
Rrna Gene ◽  
Weight Changes ◽  
Obese Children ◽  
Lifestyle Modifications ◽  
Cross Sectional ◽  
Fat Loss ◽  
Link Type ◽  
Firmicutes Phylum

Abstract Background The association between the gut microbiota and pediatric obesity was analyzed in a cross-sectional study. A prospective study of obese children was conducted to assess the gut microbial alterations after a weight change. We collected fecal samples from obese children before and after a 2-month weight reduction program that consisted of individual counseling for nutritional education and physical activity, and we performed 16S rRNA gene amplicon sequencing using an Illumina MiSeq platform. Results Thirty-six participants, aged 7 to 18 years, were classified into the fat loss (n = 17) and the fat gain (n = 19) groups according to the change in total body fat (%) after the intervention. The baseline analysis of the gut microbiota in the preintervention stages showed dysbiotic features of both groups compared with those of normal-weight children. In the fat loss group, significantly decreased proportions of Bacteroidetes phylum, Bacteroidia class, Bacteroidales order, Bacteroidaceae family, and Bacteroides genus, along with increased proportions of Firmicutes phylum, Clostridia class, and Clostridiales order, were observed after intervention. The microbial richness was significantly reduced, without a change in beta diversity in the fat loss group. The fat gain group showed significantly deceased proportions of Firmicutes phylum, Clostridia class, Clostridiales order, Lachnospiraceae family, and Eubacterium hallii group genus, without a change in diversity after the intervention. According to the functional metabolic analysis by the Phylogenetic Investigation of Communities by Reconstruction of Unobserved States 2, the “Nitrate Reduction VI” and “Aspartate Superpathway” pathways were predicted to increase significantly in the fat loss group. The cooccurring networks of genera were constructed and showed the different microbes that drove the changes between the pre- and postintervention stages in the fat loss and fat gain groups. Conclusions This study demonstrated that lifestyle modifications can impact the composition, richness, and predicted functional profiles of the gut microbiota in obese children after weight changes. Trial registration ClinicalTrials.govNCT03812497, registration date January 23, 2019, retrospectively registered.

scholarly journals Augmenting the Clinical Data Sources for Enigmatic Diseases: A Cross-Sectional Study of Self-Tracking Data and Clinical Documentation in Endometriosis

2020 ◽  
Vol 11 (05) ◽  
pp. 769-784
Author(s):  
Ipek Ensari ◽  
Adrienne Pichon ◽  
Sharon Lipsky-Gorman ◽  
Suzanne Bakken ◽  
Noémie Elhadad
Keyword(s):  
Additional Data ◽  
Intraclass Correlation ◽  
Management Strategies ◽  
The Self ◽  
Self Management ◽  
Cross Sectional ◽  
Two Samples ◽  
Data Source ◽  
Daily Function ◽  
Over Time

Abstract Background Self-tracking through mobile health technology can augment the electronic health record (EHR) as an additional data source by providing direct patient input. This can be particularly useful in the context of enigmatic diseases and further promote patient engagement. Objectives This study aimed to investigate the additional information that can be gained through direct patient input on poorly understood diseases, beyond what is already documented in the EHR. Methods This was an observational study including two samples with a clinically confirmed endometriosis diagnosis. We analyzed data from 6,925 women with endometriosis using a research app for tracking endometriosis to assess prevalence of self-reported pain problems, between- and within-person variability in pain over time, endometriosis-affected tasks of daily function, and self-management strategies. We analyzed data from 4,389 patients identified through a large metropolitan hospital EHR to compare pain problems with the self-tracking app and to identify unique data elements that can be contributed via patient self-tracking. Results Pelvic pain was the most prevalent problem in the self-tracking sample (57.3%), followed by gastrointestinal-related (55.9%) and lower back (49.2%) pain. Unique problems that were captured by self-tracking included pain in ovaries (43.7%) and uterus (37.2%). Pain experience was highly variable both across and within participants over time. Within-person variation accounted for 58% of the total variance in pain scores, and was large in magnitude, based on the ratio of within- to between-person variability (0.92) and the intraclass correlation (0.42). Work was the most affected daily function task (49%), and there was significant within- and between-person variability in self-management effectiveness. Prevalence rates in the EHR were significantly lower, with abdominal pain being the most prevalent (36.5%). Conclusion For enigmatic diseases, patient self-tracking as an additional data source complementary to EHR can enable learning from the patient to more accurately and comprehensively evaluate patient health history and status.

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