scholarly journals P139: Procedural sedation by advanced care paramedics for emergency GI endoscopy

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S124-S124
Author(s):  
H. Wiemer ◽  
M.B. Butler ◽  
P. Froese ◽  
D. Farina ◽  
A. Lapierre ◽  
...  
Keyword(s):  
Propensity Scores ◽  
Medication Use ◽  
Upper Airway ◽  
Massive Bleeding ◽  
Procedural Sedation ◽  
Orthopedic Procedures ◽  
Airway Intervention ◽  
Vasopressor Agent ◽  
Increased Risk ◽  
To Receive

Introduction: Acute upper gastrointestinal (UGI) bleeding is a relatively common emergency resulting in death in 6 to 8% of cases. UGI endoscopy is the intervention of choice which requires procedural sedation and analgesia (PSA). The Halifax Infirmary emergency department (ED) performs 1000 PSAs annually, performed by advanced care paramedics (ACPs). This has been shown safe for other indications for PSA, such as orthopedic procedures. Considering that UGI endoscopy involves upper airway manipulation, and patients are at an increased risk of massive bleeding, this procedure would be expected to be more complex and have an increased risk of adverse events (AEs). This study aims to compare PSA for UGI endoscopy performed by ACPs to that for orthopedic procedures for AEs, airway intervention and medication use. Methods: This study is a retrospective review of an ACP-performed ED PSA quality control database. A dataset was built matching 64 UGI endoscopy PSAs to 192 orthopedic PSAs by propensity scores calculated using age, gender and ASA classification. Outcomes assessed were hypotension (SBP < 100, or 15% decrease from baseline), hypoxia (SaO2 < 90), apnea (> 30sec), vomiting, arrhythmias and death in the ED. The need for airway intervention and medication use was assessed. Results: The UGI endoscopy group was 4.60 times more likely to suffer hypotension than the orthopedic group (OR=4.6, CI:2.2-9.6), and a fifth as likely to require airway repositioning (OR=0.2, CI:0.1-0.5). One endoscopy patient required endotracheal intubation. No patient died in either group. Compared to the orthopedic group, the UGI endoscopy group was one-third as likely to receive fentanyl (OR=0.3, CI:0.2-0.6). When fentanyl was administered, endoscopy patients received an average 26.7 mcg less than orthopedic patients. The endoscopy group was 15.4 times more likely to receive ketamine (OR=15.4, CI:4.7-66.5), and received 34.4 mg less on average. Four endoscopy patients received phenylephrine compared to none in the orthopedic group. There were no other differences. Conclusion: ED PSA for UGI endoscopy appears to differ significantly from that performed for orthopedic procedures. It was associated with more frequent hypotension and increased use of ketamine as a sedative. Patients undergoing UGI endoscopy were less likely to receive fentanyl and require airway repositioning. Only patients in the endoscopy group required intubation or a vasopressor agent.

Procedural sedation by advanced care paramedics for emergency gastrointestinal endoscopy

CJEM ◽  
2018 ◽  
Vol 21 (2) ◽  
pp. 235-242
Author(s):  
Hana M. Wiemer ◽  
Michael B. Butler ◽  
Patrick C. Froese ◽  
Allan Lapierre ◽  
Chris Carriere ◽  
...  
Keyword(s):  
Adverse Events ◽  
Propensity Scores ◽  
Medication Use ◽  
Preliminary Evidence ◽  
Procedural Sedation ◽  
Orthopedic Procedures ◽  
Data Set ◽  
Airway Intervention ◽  
American Society ◽  
Orthopedic Patients

AbstractObjectivesAt the QEII Health Sciences Centre Emergency Department (ED) in Halifax, Nova Scotia, advanced care paramedics (ACPs) perform procedural sedation and analgesia (PSA) for many indications, including orthopedic procedures. We have begun using ACPs as sedationists for emergent upper gastrointestinal (UGI) endoscopy. This study compares ACP-performed ED PSA for UGI endoscopy and orthopedic procedures in terms of adverse events, airway intervention, vasopressor requirement, and PSA medication use.MethodsA data set was built from an ED PSA quality control database matching 61 UGI endoscopy PSAs to 183 orthopedic PSAs by propensity scores calculated using age, gender, and the American Society of Anesthesiologists (ASA) classification. Outcomes assessed were hypotension (systolic BP<100 mm Hg or a 15% decrease from baseline), hypoxia (SaO2<90%), apnea (>30 sec), vomiting, arrhythmias, death, airway intervention, vasopressor requirement, and PSA medication use.ResultsUGI endoscopy patients experienced hypotension more frequently than orthopedic patients (OR=4.11, CI: 2.05-8.22) and required airway repositioning less often (OR=0.24, CI: 0.10-0.59). They received ketamine more frequently (OR=15.7, CI: 4.75-67.7) and fentanyl less often (OR=0.30, CI: 0.15-0.63) than orthopedic patients. Four endoscopy patients received phenylephrine, and one required intubation. No patient died in either group.ConclusionsIn ACP-led sedation for UGI endoscopy and orthopedic procedures, adverse events were rare with the notable exception of hypotension, which was more frequent in the endoscopy group. Only endoscopy patients required vasopressor treatment and intubation. We provide preliminary evidence that ACPs can manage ED PSA for emergent UGI endoscopy, although priorities must shift from pain control to hemodynamic optimization.

Markers of Hypercoagulability in Patients with Hemophilia B Given Repeated, Large Doses of Factor IX Concentrates during and after Surgery

1994 ◽  
Vol 71 (06) ◽  
pp. 737-740 ◽  
Author(s):  
E Santagostino ◽  
P M Mannucci ◽  
A Gringeri ◽  
G Tagariello ◽  
F Baudo ◽  
...  
Keyword(s):  
High Risk ◽  
Ex Vivo ◽  
Factor Ix ◽  
Hemophilia B ◽  
Coagulation System ◽  
Prolonged Treatment ◽  
Orthopedic Procedures ◽  
Factor X ◽  
Prothrombin Complex Concentrates ◽  
Increased Risk

SummaryPurer factor IX (FIX) concentrates have been produced for the treatment of hemophilia B in the attempt to reduce the risk of thrombotic complications associated with the use of prothrombin complex concentrates. To evaluate ex vivo whether or not FIX concentrates activate the coagulation system in conditions associated with a high risk for thrombosis, we measured markers of hypercoagulability in 10 patients with hemophilia B who underwent surgery, mainly orthopedic procedures, covered by multiple concentrate infusions (40-80 U/kg/day). Postinfusion plasma levels of prothrombin fragment 1+2 and factor X activation peptide did not differ significantly from the presurgical levels, neither before nor after each concentrate dose. Therefore, it appears that prolonged treatment of patients with hemophilia B undergoing high risk surgical procedures with high doses of FIX concentrate does not cause systemic activation of coagulation. This suggests that purified FIX concentrates are preferable to prothrombin complex concentrates for conditions associated with an increased risk of thrombosis.

CLINICAL CHALLENGES FOR ANESTHESIOLOGIST FACING PATIENT WITH ACROMEGALY. CASE REPORT

2020 ◽  
Vol 30 (3) ◽  
pp. 56-59
Author(s):  
Jūratė Gudaitytė ◽  
Justina Jermolajevaitė ◽  
Martynas Judickas
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
General Population ◽  
Metabolic Disorders ◽  
Upper Airway ◽  
Cardiovascular Complications ◽  
Case Presentation ◽  
Increased Risk ◽  
Fluid Regulation ◽  
Class Iv

Background and objectives: Acromegaly is endocri­nal disorder which results in changes involving ge­neral appearance as well as upper airway abnorma­lities, cardiovascular and metabolic disorders which can aggravate the anesthesia and can lead to compli­cations. We aim to discuss the challenges for anesthe­siologist that occurs facing patient with acromegaly and are necessary to investigate before performing any kind of intervention. Case Presentation: 79 years old male patient presen­ted the hospital with recently diagnosed acromegaly for rectal prolapse surgery. From anamnesis he had NYHAIII with cardiomyopathy, atrial fibrillation and arterial hypertension, also multiple old compressive fractures Th10 – L5. He was graded with Mallam­pati score IV and ASA class IV. The complemen­tary examinations were made to assess the possible complications. In induction of general anesthesia the intubation was performed using fibro- bronchoscope and anesthesia went without complications except hypotension which was managed. After surgery the patient was leaded to the postoperative room for furt­her monitoring. Discussion and Conclusion: Acromegalic patients have an increased risk of difficulty during anesthe­sia compared to general population due to difficult intubation, cardiovascular complications , OSA , alte­ration in intraoperative glucose intolerance and fluid regulation. Therefore profound investigation and as­sessment are necessary to predict and prepare for possible difficulties in the surgery room.

scholarly journals The DWQ-EMR Embedded Tool to Enhance the Family Physician-Caregiver Connection: A Pilot Case Study

Geriatrics ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 29
Author(s):  
Kristina Marie Kokorelias ◽  
Einat Danieli ◽  
Sheila Dunn ◽  
Sid Feldman ◽  
David Patrick Ryan ◽  
...  
Keyword(s):  
Family Caregivers ◽  
Best Practice ◽  
Data Gathering ◽  
Family Physicians ◽  
Efficient Manner ◽  
Efficient Access ◽  
Increased Risk ◽  
Starting Point ◽  
To Receive

The number of family caregivers to individuals with dementia is increasing. Family physicians are often the first point of access to the health care system for individuals with dementia and their caregivers. Caregivers are at an increased risk of developing negative physical, cognitive and affective health problems themselves. Caregivers also describe having unmet needs to help them sustain care in the community. Family physicians are in a unique position to help support caregivers and individuals with dementia, but often struggle with keeping up with best practice dementia service knowledge. The Dementia Wellness Questionnaire was designed to serve as a starting point for discussions between caregivers and family physicians by empowering caregivers to communicate their needs and concerns and to enhance family physicians’ access to specific dementia support information. The DWQ aims to alert physicians of caregiver and patient needs. This pilot study aimed to explore the experiences of physicians and caregivers of people using the Questionnaire in two family medicine clinics in Ontario, Canada. Interviews with physicians and caregivers collected data on their experiences using the DWQ following a 10-month data gathering period. Data was analyzed using content analysis. Results indicated that family physicians may have an improved efficacy in managing dementia by having dementia care case specific guidelines integrated within electronic medical records. By having time-efficient access to tailored supports, family physicians can better address the needs of the caregiver–patient dyad and help support family caregivers in their caregiving role. Caregivers expressed that the Questionnaire helped them remember concerns to bring up with physicians, in order to receive help in a more efficient manner.

Out of the Picture: Latinx and White Male Youths’ Facial Features Predict Their Juvenile Justice System Processing Outcomes

2021 ◽  
pp. 001112872199934
Author(s):  
Jacqueline M. Chen ◽  
Adam D. Fine ◽  
Jasmine B. Norman ◽  
Paul J. Frick ◽  
Elizabeth Cauffman
Keyword(s):  
Criminal Justice ◽  
Juvenile Justice ◽  
Justice System ◽  
Juvenile Justice System ◽  
White Male ◽  
Facial Features ◽  
Legal Decisions ◽  
Increased Risk ◽  
First Time ◽  
To Receive

Adults’ facial characteristics predict whether and how severely they are sentenced in the adult criminal justice system. We investigate whether characteristics of White and Latinx male youths’ faces predict the severity of their processing in the juvenile justice system. Among a sample of first-time offenders, despite no differences in the severity of their offenses, youth who were perceived by naïve observers as more dominant, less trustworthy, less healthy, and having darker skin were more likely to receive harsher sanctions. Thus, extralegal factors like appearance may bias legal decisions that place some youth at increased risk for more restrictive sanctioning. Our findings highlight the need for structured approaches to juvenile processing decisions that take youths’ appearance out of the picture.

Somatic symptoms are sensitive in predicting interstitial cystitis/bladder pain syndrome

2017 ◽  
Vol 52 (1) ◽  
pp. 48-61 ◽  
Author(s):  
I-Chun Chen ◽  
MingHuei Lee ◽  
Shang-Liang Wu ◽  
Hsuan-Hung Lin ◽  
Kun-Min Chang ◽  
...  
Keyword(s):  
Interstitial Cystitis ◽  
Propensity Scores ◽  
Somatic Symptoms ◽  
Pain Syndrome ◽  
International Classification Of Diseases ◽  
Bladder Pain Syndrome ◽  
Incidence Density ◽  
Bladder Pain ◽  
Increased Risk ◽  
Reimbursement Database

Objectives Somatic symptoms are somatic complaints accompanied by disproportionate thoughts, feelings, and behaviors related to such symptoms. The study investigated five International Classification of Diseases, Ninth Revision, Clinical Modification diagnoses hallmarked by somatic symptoms. The study hypothesized an increased risk of interstitial cystitis/bladder pain syndrome in patients with somatic symptoms. Methods The raw data were obtained from a nationwide health insurance reimbursement database over a 12-year period from 2002 to 2013. The study followed a somatic symptoms cohort ( n = 34,393) and non-somatic symptoms cohort ( n = 637,999) for interstitial cystitis/bladder pain syndrome. Both cohorts were stratified into three subgroups based on propensity scores calculated by sex, age, and 17 comorbidities of interstitial cystitis/bladder pain syndrome. Results The incidence density of interstitial cystitis/bladder pain syndrome between the somatic symptoms cohort and non-somatic symptoms cohort was significantly different in the three subgroups (relative ratio [95% confidence interval], 2.14 [1.01, 4.53], 1.52 [1.47, 1.57], and 1.59 [1.28, 1.98], respectively). The adjusted hazard ratio for interstitial cystitis/bladder pain syndrome was significantly greater in the female-dominant and older age subgroups—subgroup 2 and subgroup 3 (adjusted hazard ratios, 1.47 [1.07, 2.01] and 1.72 [1.38, 2.16], respectively). Conclusion The longitudinal investigation identified a subsequent risk of interstitial cystitis/bladder pain syndrome in patients with somatic symptoms. Somatic symptoms might be linked to biological pathways that might increase the risk of interstitial cystitis/bladder pain syndrome, much like more traditional psychosocial factors.

scholarly journals Meaningful Use of an Electronic Personal Health Record (ePHR) among Pediatric Cancer Survivors

2017 ◽  
Vol 26 (01) ◽  
pp. 250-264 ◽  
Author(s):  
Rebecca S Williamson ◽  
Brooke O Cherven ◽  
Jordan Gilleland Marchak ◽  
Paula Edwards ◽  
Michael Palgon ◽  
...  
Keyword(s):  
Young Adult ◽  
Personal Health Record ◽  
Adult Survivors ◽  
Personal Health ◽  
Adult Care ◽  
Adolescent Cancer ◽  
Increased Risk ◽  
Electronic Personal Health Records ◽  
Young Adult Survivors ◽  
To Receive

Summary Background and Objectivs: Survivors of pediatric and adolescent cancer are at an increased risk of chronic and debilitating health conditions and require life-long specialized care. Stand-alone electronic personal health records (ePHRs) may aid their self-management. This analysis characterizes young adult survivors and parents who meaningfully use an ePHR, Cancer SurvivorLinkTM, designed for survivors of pediatric and adolescent cancer. Methods: This was a retrospective observational study of patients seen at a pediatric survivor clinic for annual survivor care. Young adult survivors and/or parent proxies for survivors <18 years old who completed ePHR registration prior to their appointment or within 90 days were classified as registrants. Registrants who uploaded or downloaded a document and/or shared their record were classified as meaningful users. Results: Overall, 23.7% (148/624) of survivors/parents registered and 38% of registrants used SurvivorLink meaningfully. Young adult registrants who transferred to adult care during the study period were more likely to be meaningful users (aOR: 2.6 (95% CI: 1.1, 6.1)) and used the ePHR twice as frequently as those who continued to receive care in our institution’s pediatric survivor clinic. Among survivors who continued to receive care at our institution, being a registrant was associated with having an annual follow-up visit (aOR: 2.6 (95% CI: 1.2, 5.8)). Conclusions: While ePHRs may not be utilized by all survivors, SurvivorLink is a resource for a subset and may serve as an important bridge for patients who transfer their care. Using SurvivorLink was also associated with receiving recommended annual survivor care.

Attention to diet, exercise, and weight in the oncology clinic: Results of a national patient survey.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10549-10549
Author(s):  
Jennifer A. Ligibel ◽  
Lori J. Pierce ◽  
Catherine M. Bender ◽  
Tracy E Crane ◽  
Christina Marie Dieli-Conwright ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Online Survey ◽  
Early Stage ◽  
Cancer Type ◽  
Breast Cancer Patients ◽  
Related Factors ◽  
Increased Risk ◽  
Diet And Exercise ◽  
To Receive

10549 Background: Obesity and related factors are increasingly associated with increased risk of developing and dying from cancer. The American Society of Clinical Oncology (ASCO) conducted a survey of cancer patients to assess their experience in receiving recommendations and referrals related to weight, diet and exercise as a part of their cancer care. Methods: An online survey was distributed to potential participants between March and June 2020 via ASCO channels and patient advocacy organizations, with an estimated reach of over 25,000 individuals. Eligibility criteria included being 18 years, living in the US, and having been diagnosed with cancer. Logistic regression was used to determine factors associated with recommendation and referral patterns. Results: In total, 2419 individuals responded to the survey. Most respondents were female (75.5%), 61.8% had an early-stage malignancy, 38.2% had advanced disease, and 49.0% were currently receiving treatment. Breast cancer was the most common cancer type (36.0%). Average BMI was 25.8 kg/m2. The majority of respondents consumed £2 servings of fruits and vegetables per day (50.9%) and exercised £2 times per week (50.4%). Exercise was addressed at most or some oncology visits in 57.5% of respondents, diet in 50.7%, and weight in 28.4%. Referrals were less common: 14.9% of respondents were referred to an exercise program, 25.6% to a dietitian and 4.5% to a weight management program. In multiple regression analyses, racial and ethnicity minority respondents were more likely to receive advice about diet (Odds Ratio [OR] 1.92, 95% CI 1.56-2.38) and weight (OR 1.64, 95% CI 1.23-2.17) compared to non-Hispanic whites, individuals diagnosed with cancer in the past 5 yrs (vs > 5 yrs) were more likely to receive advice about exercise (OR 1.48, 95% CI 1.23-1.79), and breast cancer patients were more likely to receive advice about exercise (OR 1.37, 95% CI 1.11-1.68) and weight (OR 1.46, 95% CI 1.03-2.07) than other cancer patients. Overall, 74% of survey respondents had changed their diet or exercise after cancer diagnosis. Respondents reporting that their oncologist spoke to them about increasing exercise or eating healthier foods were more likely to report a change in behavior than those whose oncologists did not (exercise: 79.6% vs 69.0%, P < 0.001; diet 81.1% vs 71.4%, P < 0.001). Respondents whose oncologist had spoken to them about exercise were more likely to exercise > 2 times per week compared to respondents whose oncologists did not address exercise (53.5% vs 44.1%, P < 0.001). Conclusions: In a national survey of oncology patients, slightly more than half of respondents reported attention to diet and exercise during oncology visits. Provider recommendations for diet and exercise were associated with positive changes in these behaviors. Additional attention to diet and exercise as part of oncology visits is needed to help support healthy lifestyle change in cancer patients.

scholarly journals Lopinavir/Ritonavir and Darunavir/Cobicistat in Hospitalized COVID-19 Patients: Findings From the Multicenter Italian CORIST Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Augusto Di Castelnuovo ◽  
Simona Costanzo ◽  
Andrea Antinori ◽  
Nausicaa Berselli ◽  
Lorenzo Blandi ◽  
...  
Keyword(s):  
Observational Study ◽  
Propensity Scores ◽  
Proportional Hazards ◽  
Real Life ◽  
Cox Proportional Hazards ◽  
Event Analysis ◽  
Multicenter Observational Study ◽  
Protein Levels ◽  
Cox Proportional Hazards Models ◽  
Increased Risk

Background: Protease inhibitors have been considered as possible therapeutic agents for COVID-19 patients.Objectives: To describe the association between lopinavir/ritonavir (LPV/r) or darunavir/cobicistat (DRV/c) use and in-hospital mortality in COVID-19 patients.Study Design: Multicenter observational study of COVID-19 patients admitted in 33 Italian hospitals. Medications, preexisting conditions, clinical measures, and outcomes were extracted from medical records. Patients were retrospectively divided in three groups, according to use of LPV/r, DRV/c or none of them. Primary outcome in a time-to event analysis was death. We used Cox proportional-hazards models with inverse probability of treatment weighting by multinomial propensity scores.Results: Out of 3,451 patients, 33.3% LPV/r and 13.9% received DRV/c. Patients receiving LPV/r or DRV/c were more likely younger, men, had higher C-reactive protein levels while less likely had hypertension, cardiovascular, pulmonary or kidney disease. After adjustment for propensity scores, LPV/r use was not associated with mortality (HR = 0.94, 95% CI 0.78 to 1.13), whereas treatment with DRV/c was associated with a higher death risk (HR = 1.89, 1.53 to 2.34, E-value = 2.43). This increased risk was more marked in women, in elderly, in patients with higher severity of COVID-19 and in patients receiving other COVID-19 drugs.Conclusions: In a large cohort of Italian patients hospitalized for COVID-19 in a real-life setting, the use of LPV/r treatment did not change death rate, while DRV/c was associated with increased mortality. Within the limits of an observational study, these data do not support the use of LPV/r or DRV/c in COVID-19 patients.

Understanding Language Features in Loneliness Forum Posts that Elicit Comments (Preprint)

2021 ◽  
Author(s):  
Anietie Andy
Keyword(s):  
Language Processing ◽  
Latent Dirichlet Allocation ◽  
Well Being ◽  
Time Of Day ◽  
Online Forums ◽  
Cohen’S D ◽  
Increased Risk ◽  
Social Media Platforms ◽  
Cohen's D ◽  
To Receive

BACKGROUND Loneliness is a threat to the well-being of individuals and in older adults is associated with increased risk of early mortality. Studies have shown that some individuals seek support around loneliness on online forums/social media platforms. A common challenge in online forums is that some posts do not receive comments. In some non-health related forums, posts not receiving comments may not be a serious concern, however, in an online health forum such as those focused on discussions around loneliness, posts not receiving comments could translate to individuals seeking support around loneliness not receiving adequate support. OBJECTIVE The aim of this work is to analyze posts published on an active online forum focused on discussions around loneliness (loneliness forum) to determine the language features associated with posts that elicit comments from members of the forum. METHODS For the analysis in this work, 15,012 posts published on an online loneliness forum by 9,956 users were analyzed. Of these posts, 6,450 received five or more comments, 13,221 received one or more comments, and 1,791 received no comments. Using the natural language processing method, latent dirichlet allocation (LDA) and a psycholinguistic dictionary, Linguistics Inquiry and Word Count (LIWC), the language features expressed in posts that elicit comments from members of the forum were determined. RESULTS The findings from this work show that posts related to topics themes on relationships (Cohen’s D = 0.319) and the use of negation words (Cohen’s D = 0.149) tend to receive one or more comments. Also, posts associated with LIWC categories on first person singular pronouns (Cohen’s D = 0.264) tend to elicit one or more comments. Posts on topic themes related to spending time around holidays/birthdays/year/time of day or week (Cohen’s D = 0.79) and affection relative to relationships (Cohen’s D = 0.102) tend to receive five or more comments. CONCLUSIONS This work identifies language features expressed in loneliness forum posts that elicit comments. The findings from this work can provide members of online loneliness forums tips on how to write posts that potentially elicit comments from members of the forum.

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