scholarly journals Neuromuscular block monitoring by smartphone application (i-TOF© system): an observational pilot study

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Lorenzo Schiavoni ◽  
Giuseppe Pascarella ◽  
Stefania Grande ◽  
Felice Eugenio Agrò
Keyword(s):  
Pilot Study ◽  
General Anesthesia ◽  
Neuromuscular Block ◽  
Good Clinical Practice ◽  
Smartphone Application ◽  
Comparable Efficacy ◽  
Time Intervals ◽  
Mean Values ◽  
Residual Curarization ◽  
Deep Neuromuscular Block

Abstract Neuromuscular block monitoring is recommended by international guidelines to improve myorelaxation during surgery and reduce the risk of postoperative residual curarization. We conducted a pilot study to verify the efficacy of i-TOF, a wireless neuromuscular monitoring device connectable to a smartphone, comparing it with TOF WATCH SX. We enrolled 53 patients who underwent general anesthesia. For each patient, we recorded by both devices, in different time intervals, train-of-four (TOF) count/ratio after induction to general anesthesia (TI0–TI3) and during recovery (TR0–TR3). Moreover, post-tetanic count (PTC) was evaluated during deep neuromuscular block (TP0–TP2). We noticed no significant differences between the devices in recorded mean values of TOF ratio, TOF count, and PTC analyzed at time intervals for every phase of general anesthesia, although the i-TOF tends to an underestimation compared to TOF WATCH SX. For each patient, data sessions were successfully recorded by a smartphone. This aspect could be relevant for clinicians in order to have a stored proof of good clinical practice to be added on anesthesiologist records. By our results, i-TOF demonstrates a comparable efficacy to TOF WATCH SX, suggesting that it could be a proven alternative to standard devices for neuromuscular block monitoring. Further studies are needed to confirm our findings.

scholarly journals Bioequivalence Pilot Study of Two Multivitamin Formulations in Healthy Adults

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1846-1846
Author(s):  
Carol Wagner ◽  
Judy Shary ◽  
Myla Ebeling ◽  
Amy Wahlquist ◽  
Paul Nietert
Keyword(s):  
Pilot Study ◽  
Time Course ◽  
Phase 1 ◽  
Geometric Mean ◽  
Area Under The Curve ◽  
Healthy Adults ◽  
Time Intervals ◽  
Mean Values ◽  
Funding Sources ◽  
To Receive

Abstract Objectives Bioequivalence of vitamins (vit) E, B12 and folate in a single oral dose multivitamin (MVI) gummies vs. tablets Methods This crossover clinical trial involved healthy adults randomized to either gummy or tablet MVI containing vitE, B12 and folate as a single dose in Phase 1 with serial blood samples obtained to measure vitE, B12 and folate at baseline 0, 0.5-, 1-, 2-, 4-, 6-, 8-, 9-, 10-, 24-, and 48-hrs followed by a 2-wk washout period. In Phase 2, participants then crossed over to receive MVI in the form not previously given, with blood sampling at same timepoints. Time course of absorption of gummy vs. tablet form was compared: Cmax and Area Under the Curve (AUC) calculated for each subject for vitamins at specific time intervals based on known t½. Data analyzed using SAS 9.4 (Cary, NC). Results Six healthy subjects completed the study. For vitE, there were no differences in AUC geometric mean ratios (GMR), log AUC GMR, or Cmax compared as GMR, log GMR or for Tmax GMR for gummy vs. tablet. For vitB12, no statistical differences on any of metrics with Cmax and Tmax GMR similar between gummy vs. tablet. For folate, there were significant differences in time course of absorption: folate absorption peaked earlier in gummy group (Tmax 1.59 hrs) vs. tablet group (Tmax 4.08 hrs), shifting mean values in the gummy group to earlier timepoints, with higher mean values at mid timepoints in tablet group. Shorter Tmax in gummy group suggested a difference in bioavailability in that preparation when compared to tablet. For folate, geometric and log AUC GMR, incremental AUC ratios, and Cmax measures showed no statistically significant differences in the gummy vs. tablet groups. Conclusions Overall, under the conditions of this pilot study, both gummy and tablet showed similar absorption of vitamins E and B12. The time course of absorption of folate differed significantly between gummy vs. tablet formulation, with more rapid absorption with the gummy form. Cmax for gummy vs. tablet were similar for the 3 vitamins. A definitive study is planned with a larger sample size powered to verify these preliminary results. Funding Sources Church & Dwight Co., Inc.

scholarly journals Sugammadex in antagonism of neuromuscular block in anesthesia: a clinical and economic profile

2009 ◽  
Vol 10 (3) ◽  
pp. 103-114
Author(s):  
Viola Sacchi ◽  
Sergio Iannazzo ◽  
Francesco Giunta
Keyword(s):  
Impact Analysis ◽  
Neuromuscular Block ◽  
Dose Range ◽  
Cost Savings ◽  
Neuromuscular Blocking ◽  
Phase Iii ◽  
Pivotal Phase ◽  
Residual Curarization ◽  
Deep Neuromuscular Block ◽  
Anaesthesia Care

Sugammadex is a modified cyclodextrin which acts by encapsulating and inactivating the neuromuscular blocking agents (NMBAs) rocuronium and vecuronium, used to induce relaxation of skeletal muscles during surgery and to facilitate endotracheal intubation. The procedure of reversal of the block at the end of surgery can influence the time to discharge from the operating room and post-operative residual curarization (PORC) incidence, which is related to an increased rate of adverse respiratory events in the post-anaesthesia care unit. Cholinesterase inhibitors are frequently used to reverse neuromuscular block, but their use is associated with potential cardiovascular and respiratory side-effects. The recommended dose-range for sugammadex is 2-16 mg/kg, depending on the level of block: the dose is approximately 2 mg/kg for reversal of moderate blockade, 4 mg/kg for deep blockade and 16 mg/kg for the immediate reversal of a neuromuscular blockade as early as 3 minutes after 1-1.2 mg/kg of rocuronium. Four pivotal, phase III trials studied sugammadex in routine reversal of moderate, deep neuromuscular block and in the immediate reversal of rocuronium-induced block. In all the cases the drug demonstrated of being significantly more efficient than other reversal strategies, providing a faster reversal than the most used anticholinesterase comparator neostigmine. Sugammadex also appeared to have an acceptable safety profile. Acquisition cost of sugammadex is greater than that of neostigmine, but cost-savings related to the reduced theatre time and to the reduced incidence of PORC episodes can offset it. A Budget Impact analysis in the perspective of the hospital has been conducted for the Italian setting resulting in a total cost-save of 7,420 € for one year of activity. In conclusion, sugammadex appears to be a valuable innovation in anesthesiology. This drug represents a safe and effective alternative to anticholinesterase agents.

scholarly journals The influence of moderate or deep neuromuscular block status on anesthetic depth monitoring system during total intravenous anesthesia using propofol and remifentanil: A randomized trial

2021 ◽  
Vol 104 (2) ◽  
pp. 003685042110106
Author(s):  
Hyo-Seok Na ◽  
Dae-Jin Lim ◽  
Bon-Wook Koo ◽  
Ah-Young Oh ◽  
Pyung-Bok Lee
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Anesthesia ◽  
Total Dose ◽  
Neuromuscular Block ◽  
Total Intravenous Anesthesia ◽  
Intravenous Anesthesia ◽  
Anesthetic Depth ◽  
Time Points ◽  
Group Assignment ◽  
Deep Neuromuscular Block

The neuromuscular block state may affect the electroencephalogram-derived index representing the anesthetic depth. We applied an Anesthetic Depth Monitoring for Sedation (ADMS) to patients undergoing laparoscopic cholecystectomy under total intravenous anesthesia, and evaluated the requirement of propofol according to the different neuromuscular block state. Adult patients scheduled to undergo laparoscopic cholecystectomy were enrolled and randomly assigned to either the moderate (MB) or deep neuromuscular block (DB) group. The UniCon sensor of ADMS was applied to monitor anesthetic depth and the unicon value was maintained between 40 and 50 during the operation. According to the group assignment, intraoperative rocuronium was administered to maintain proper neuromuscular block state, moderate or deep block state. The unicon value, electromyography (EMG) index, and total dose of propofol and rocuronium were analyzed. At similar anesthetic depth, less propofol was used in the DB group compared to the MB group (6.19 ± 1.36 in the MB mg/kg/h group vs 4.93 ± 3.02 mg/kg/h in the DM group, p = 0.042). As expected, more rocuronium were used in the DB group than in the MB group (0.8 ± 0.2 mg/kg in the MB group vs 1.2 ± 0.2 mg/kg in the DB group, p = 0.023) and the EMG indices were lower in the DB group than in the MB group, at several time points as follows: at starting operation ( p < 0.001); at 15 ( p = 0.019), 45 ( p = 0.011), and 60 min ( p < 0.001) after the initiation of the operation; at the end of operation ( p = 0.003); and at 5 min after the administration of sugammadex ( p < 0.001). At similar anesthetic depth, patients under the deep neuromuscular block state required less propofol with lower intraoperative EMG indices compared to those under the moderate neuromuscular block state during general anesthesia.

Digital Dietitian—Pilot Study of a Novel Smartphone Application

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 767-P ◽  
Author(s):  
CHRISTIAN C. FARFAN ◽  
CEARA AXELROD ◽  
DONNA L. FRASE ◽  
ANDREW MACKENZIE ◽  
GAL HAROUSH ◽  
...  
Keyword(s):  
Pilot Study ◽  
Smartphone Application

scholarly journals Digitalizing multidisciplinary pulmonary rehabilitation in COPD with a smartphone application: an international observational pilot study

2018 ◽  
Vol Volume 13 ◽  
pp. 3831-3836 ◽  
Author(s):  
Frank Rassouli ◽  
David Boutellier ◽  
Jonas Duss ◽  
Stephan Huber ◽  
Martin H. Brutsche
Keyword(s):  
Pilot Study ◽  
Pulmonary Rehabilitation ◽  
Smartphone Application

scholarly journals Association Between Osteoarticular Scores and Acute Phase Reactant Levels in Rheumatoid Arthritis

2009 ◽  
Vol 28 (2) ◽  
pp. 116-121 ◽  
Author(s):  
Irena Kafeđiska ◽  
Dejan Spasovski ◽  
Todor Gruev ◽  
Mane Grličkov ◽  
Kočo Cakalaroski ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Acute Phase ◽  
Acute Phase Reactant ◽  
Control Group ◽  
Time Intervals ◽  
Acute Phase Reactants ◽  
Mean Values ◽  
Cell Counts ◽  
Phase Reactant ◽  
The Mean

Association Between Osteoarticular Scores and Acute Phase Reactant Levels in Rheumatoid Arthritis The aim of this prospective control study was a quantitative evaluation of the activity of rheumatoid arthritis (RA) in certain time intervals, using articular indexes (set of 28 sensitive and 28 swollen joints), laboratory parameters (Hb, Hct, Er, Le and Plt) and acute phase reactants (ESR, RF, CRP); to determine which of the acute phase reactants is the most useful biochemical marker for the evaluation of disease activity in RA; to quantify the therapeutical and laboratory differences in certain time intervals in the group with and without immunomodulatory therapy with Methotrexate. Sixty patients with RA were included, 27 of who were treated with non-steroid antiinflammatory drugs (NSAIDs) and Methotrexate (MTX). The control group consisted of 33 patients treated only with NSAIDs because of irregular controls. In the first group of patients the disease activity was estimated at four time intervals, and in the control group of patients at three time intervals following the scores of the articular indexes, blood cell counts, ESR and CRP in every patient. In the first group of patients decreased activity of RA was found upon every following control with a consecutive decrease in mean values of the scores of articular indexes with statistically significant differences at the four time intervals. Considering laboratory parameters, there were statistically significant differences in the mean values of Hb, Er, Plt, ESR, (p=0.0462, p=0.0076, p= 0.0058, p= 0.0003). Mean values of CRP did not show statistically significant differences, but the number of patients who were CRP negative increased (there were great standard deviations). In the group of patients treated only with NSAIDs, there were statistically significant differences in the mean values of the scores of articular indexes with an increse at every following control (in favour of progression of the disease). There were no statistically significant differences considering blood cell counts, ESR and CRP (in favour of permanently active disease). In conclusion, CRP is the most useful marker for the prospective follow-up of patients with RA.

scholarly journals A Novel Educational Smartphone Application for Cognitively Healthy Seniors: A Pilot Study

2021 ◽  
Vol 18 (12) ◽  
pp. 6601
Author(s):  
Blanka Klimova ◽  
Lukas Sanda
Keyword(s):  
Pilot Study ◽  
Mobile Application ◽  
Empirical Studies ◽  
Well Being ◽  
Smartphone Application ◽  
Assessment Tools ◽  
Pedagogical Practice ◽  
Older Individuals ◽  
Individual Needs ◽  
Instructional Manual

Modern technologies surround people every day, including seniors. The aim of this pilot study was to create a maximally user-friendly mobile application in order to meet older users’ individual needs. The research sample consisted of 13 older individuals at the age of 55+ years with a mean age of 67 years, living in the Czech Republic. The key assessment tools of this pilot study were the developed application and usability testing. The findings confirmed that the newly developed mobile application for teaching English met the needs of cognitively healthy seniors, and was acceptable and feasible. In addition, it indicated what technical (e.g., visual interface or easy navigation) and pedagogical (e.g., an instructional manual or adjusting to seniors’ learning pace or clear instructions) aspects should be strictly followed when designing such an educational smartphone application. In addition, the authors of this pilot study provide several implications for pedagogical practice. Further research should include more empirical studies aimed at the exploration of educational mobile applications for older generation groups with respect to meeting their individual needs in order to enhance their overall well-being. However, such studies are, nowadays, very rare.

scholarly journals Retinomotor movements in the Antarctic fish Trematomus newnesi Boulenger submitted to different environmental light conditions

2007 ◽  
Vol 24 (2) ◽  
pp. 457-462 ◽  
Author(s):  
Lucélia Donatti ◽  
Edith Fanta
Keyword(s):  
Pigment Epithelium ◽  
Antarctic Fish ◽  
Constant Darkness ◽  
Time Intervals ◽  
Mean Values ◽  
Environmental Light ◽  
The Mean ◽  
The Difference ◽  
The One ◽  
The Antarctic

The Antarctic fish Trematomus newnesi (Boulenger, 1902) occurs from benthic to pelagic habitats, in seasonally and daily varied photic conditions that induce retinomotor movements. Fish were experimentally kept under constant darkness or light, and 12Light/12Dark for seven days. The retinomotor movement of the pigment epithelium was established through the pigment index, while that of the cones was calculated as the length of the myoid. The retinomotor movement of the pigment epithelium in T.newnesi,revealed that the adaptation to constant light occurred in the one hour of exposure, remaining constant for the next seven days. However, the adaptation to constant darkness, was slower. The difference between the mean values of the pigment indices in the time intervals of sampling was significant in the first hours of the experiment, and only after six hours they were not significant any more. The myoid of cones became elongated in darkness and contracted in light. In the experiments where T.newnesiwas exposed initially to 12 hours light followed by 12 hours darkness 12 was evidenced that the speed and intensity of the retinomotor movements was higher when darkness changed into light, than when light changed into darkness.

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