Incidence of Connected Consciousness after Tracheal Intubation

2017 ◽  
Vol 126 (2) ◽  
pp. 214-222 ◽  
Author(s):  
Robert D. Sanders ◽  
Amy Gaskell ◽  
Aeyal Raz ◽  
Joel Winders ◽  
Ana Stevanovic ◽  
...  
Keyword(s):  
Routine Practice ◽  
Verbal Command ◽  
Logistic Regression Models ◽  
Wide Range ◽  
Bivariate Logistic Regression ◽  
Anesthesia Monitoring ◽  
Univariate Statistics ◽  
Explicit Recall ◽  
Forearm Technique ◽  
International Multicenter

Abstract Background The isolated forearm technique allows assessment of consciousness of the external world (connected consciousness) through a verbal command to move the hand (of a tourniquet-isolated arm) during intended general anesthesia. Previous isolated forearm technique data suggest that the incidence of connected consciousness may approach 37% after a noxious stimulus. The authors conducted an international, multicenter, pragmatic study to establish the incidence of isolated forearm technique responsiveness after intubation in routine practice. Methods Two hundred sixty adult patients were recruited at six sites into a prospective cohort study of the isolated forearm technique after intubation. Demographic, anesthetic, and intubation data, plus postoperative questionnaires, were collected. Univariate statistics, followed by bivariate logistic regression models for age plus variable, were conducted. Results The incidence of isolated forearm technique responsiveness after intubation was 4.6% (12/260); 5 of 12 responders reported pain through a second hand squeeze. Responders were younger than nonresponders (39 ± 17 vs. 51 ± 16 yr old; P = 0.01) with more frequent signs of sympathetic activation (50% vs. 2.4%; P = 0.03). No participant had explicit recall of intraoperative events when questioned after surgery (n = 253). Across groups, depth of anesthesia monitoring values showed a wide range; however, values were higher for responders before (54 ± 20 vs. 42 ± 14; P = 0.02) and after (52 ± 16 vs. 43 ± 16; P = 0.02) intubation. In patients not receiving total intravenous anesthesia, exposure to volatile anesthetics before intubation reduced the odds of responding (odds ratio, 0.2 [0.1 to 0.8]; P = 0.02) after adjustment for age. Conclusions Intraoperative connected consciousness occurred frequently, although the rate is up to 10-times lower than anticipated. This should be considered a conservative estimate of intraoperative connected consciousness.

DSM-5 alcohol use disorder features among treatment-seeking older adults

2018 ◽  
Vol 64 (4) ◽  
pp. 185-196 ◽  
Author(s):  
Silke Behrendt ◽  
Barbara Braun ◽  
Randi Bilberg ◽  
Gerhard Bühringer ◽  
Michael Bogenschutz ◽  
...  
Keyword(s):  
Older Adults ◽  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
The Elderly ◽  
Treatment Seeking ◽  
Controlled Clinical Trial ◽  
Dsm 5 ◽  
Wide Range ◽  
And Gender ◽  
International Multicenter

Abstract. Background: The number of older adults with alcohol use disorder (AUD) is expected to rise. Adapted treatments for this group are lacking and information on AUD features in treatment seeking older adults is scarce. The international multicenter randomized-controlled clinical trial “ELDERLY-Study” with few exclusion criteria was conducted to investigate two outpatient AUD-treatments for adults aged 60+ with DSM-5 AUD. Aims: To add to 1) basic methodological information on the ELDERLY-Study by providing information on AUD features in ELDERLY-participants taking into account country and gender, and 2) knowledge on AUD features in older adults seeking outpatient treatment. Methods: baseline data from the German and Danish ELDERLY-sites (n=544) were used. AUD diagnoses were obtained with the Mini International Neuropsychiatric Interview, alcohol use information with Form 90. Results: Lost control, desired control, mental/physical problem, and craving were the most prevalent (> 70 %) AUD-symptoms. 54.9 % reported severe DSM-5 AUD (moderate: 28.2 %, mild: 16.9 %). Mean daily alcohol use was 6.3 drinks at 12 grams ethanol each. 93.9 % reported binging. More intense alcohol use was associated with greater AUD-severity and male gender. Country effects showed for alcohol use and AUD-severity. Conclusion: European ELDERLY-participants presented typical dependence symptoms, a wide range of severity, and intense alcohol use. This may underline the clinical significance of AUD in treatment-seeking seniors.

scholarly journals A Systematic Review and Qualitative Synthesis Resulting in a Typology of Elementary Classroom Movement Integration Interventions

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Spyridoula Vazou ◽  
Collin A. Webster ◽  
Gregory Stewart ◽  
Priscila Candal ◽  
Cate A. Egan ◽  
...  
Keyword(s):  
Physical Activity ◽  
Teacher Collaboration ◽  
A Priori ◽  
Real Life ◽  
Dose Intensity ◽  
Routine Practice ◽  
Qualitative Synthesis ◽  
Wide Range ◽  
Meta Analyses ◽  
Movement Integration

Abstract Background/Objective Movement integration (MI) involves infusing physical activity into normal classroom time. A wide range of MI interventions have succeeded in increasing children’s participation in physical activity. However, no previous research has attempted to unpack the various MI intervention approaches. Therefore, this study aimed to systematically review, qualitatively analyze, and develop a typology of MI interventions conducted in primary/elementary school settings. Subjects/Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify published MI interventions. Irrelevant records were removed first by title, then by abstract, and finally by full texts of articles, resulting in 72 studies being retained for qualitative analysis. A deductive approach, using previous MI research as an a priori analytic framework, alongside inductive techniques were used to analyze the data. Results Four types of MI interventions were identified and labeled based on their design: student-driven, teacher-driven, researcher-teacher collaboration, and researcher-driven. Each type was further refined based on the MI strategies (movement breaks, active lessons, other: opening activity, transitions, reward, awareness), the level of intrapersonal and institutional support (training, resources), and the delivery (dose, intensity, type, fidelity). Nearly half of the interventions were researcher-driven, which may undermine the sustainability of MI as a routine practice by teachers in schools. An imbalance is evident on the MI strategies, with transitions, opening and awareness activities, and rewards being limitedly studied. Delivery should be further examined with a strong focus on reporting fidelity. Conclusions There are distinct approaches that are most often employed to promote the use of MI and these approaches may often lack a minimum standard for reporting MI intervention details. This typology may be useful to effectively translate the evidence into practice in real-life settings to better understand and study MI interventions.

scholarly journals Patterns of use, effectiveness and safety of gadolinium contrast agents: a European prospective cross-sectional multicentre observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jarl Åsbjørn Jakobsen ◽  
Carlo Cosimo Quattrocchi ◽  
Frank H. H. Müller ◽  
Olivier Outteryck ◽  
Andrés Alcázar ◽  
...  
Keyword(s):  
Image Quality ◽  
Observational Study ◽  
Contrast Agents ◽  
Marketing Authorisation ◽  
Safety Data ◽  
Radiological Diagnosis ◽  
Routine Practice ◽  
Diagnostic Confidence ◽  
Cross Sectional ◽  
Wide Range

Abstract Background The EU gadolinium-based contrast agents (GBCA) market has changed in recent years due to the European Medicines Agency decision to suspend the marketing authorisation of linear GBCA and the marketing authorisation of new generic macrocyclic GBCA. The study aims to understand the patterns of (GBCA) use, and to study the effectiveness and safety of GBCA in routine practice across Europe. Methods Prospective, cross-sectional, multicentre, observational study in patients undergoing contrast-enhanced magnetic resonance. Reported usage patterns included indication, referral and examination details. Assessment of effectiveness included changes in radiological diagnosis, diagnostic confidence and image quality. Safety data were collected by spontaneous patient adverse event (AE) reporting. Results 2118 patients were included from 8 centres across 5 European countries between December 2018 and November 2019. Clariscan, Dotarem (gadoteric acid), Gadovist (gadobutrol) and ProHance (gadoteridol) were utilised in 1513 (71.4%), 356 (16.8%), 237 (11.2%) and 12 (0.6%) patients, respectively. Most were performed in CNS-related indications (46.2%). Mean GBCA doses were 0.10 mmol/kg body weight, except for Gadovist (mean 0.12 mmol/kg). GBCA use increased confidence in diagnosis in 96.2% of examinations and resulted in a change in radiological diagnosis in 73.9% of patients. Image quality was considered excellent or good in 96.1% of patients and across all GBCA. Four patients reported AEs (0.19%), with only 1 (0.05%) considered serious. Conclusions This European study confirmed that GBCAs are used appropriately in Europe for a wide range of indications. The study demonstrated a significant increase in diagnostic confidence after GBCA use and confirmed the good safety profile of GBCAs, with comparable results for all agents used.

scholarly journals Validation of an HPLC–MS/MS Method for the Determination of Plasma Ticagrelor and Its Active Metabolite Useful for Research and Clinical Practice

Molecules ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 278
Author(s):  
Jennifer Lagoutte-Renosi ◽  
Bernard Royer ◽  
Vahideh Rabani ◽  
Siamak Davani
Keyword(s):  
Active Metabolite ◽  
Plasma Concentrations ◽  
Antiplatelet Agent ◽  
High Plasma ◽  
Therapeutic Drug ◽  
Routine Practice ◽  
Daily Routine ◽  
Limit Of Quantification ◽  
Wide Range

Ticagrelor is an antiplatelet agent which is extensively metabolized in an active metabolite: AR-C124910XX. Ticagrelor antagonizes P2Y12 receptors, but recently, this effect on the central nervous system has been linked to the development of dyspnea. Ticagrelor-related dyspnea has been linked to persistently high plasma concentrations of ticagrelor. Therefore, there is a need to develop a simple, rapid, and sensitive method for simultaneous determination of ticagrelor and its active metabolite in human plasma to further investigate the link between concentrations of ticagrelor, its active metabolite, and side effects in routine practice. We present here a new method of quantifying both molecules, suitable for routine practice, validated according to the latest Food and Drug Administration (FDA) guidelines, with a good accuracy and precision (<15% respectively), except for the lower limit of quantification (<20%). We further describe its successful application to plasma samples for a population pharmacokinetics study. The simplicity and rapidity, the wide range of the calibration curve (2–5000 µg/L for ticagrelor and its metabolite), and high throughput make a broad spectrum of applications possible for our method, which can easily be implemented for research, or in daily routine practice such as therapeutic drug monitoring to prevent overdosage and occurrence of adverse events in patients.

scholarly journals Experience with the use of microbiological analyzer BactoSCREEN in a routine practice of clinical microbiology laboratory

2020 ◽  
pp. 221-230
Author(s):  
Svetlana A. Gordeeva ◽  
A.Yu. Zolotarev ◽  
M.G. Movsisyan ◽  
A.V. Rozinko
Keyword(s):  
Species Identification ◽  
Clinical Microbiology ◽  
Objective Assessment ◽  
Maldi Ms ◽  
Routine Practice ◽  
Clinical Microbiology Laboratory ◽  
Full Time ◽  
Microbiology Laboratory ◽  
Staff Time ◽  
Wide Range

Objective. Assessment of bacterial identification effectiveness in clinical microbiology laboratory using the MALDI-MS based system BactoSCREEN. Materials and Methods. Bacteriological testing was done by the cultivation on Сolumbia agar with 5% of sheep blood (at 37°C for 24 hours). Colonies for identification were selected based on their growth pattern, type of hemolysis, morphology and consistency. The species identification was done by the MALDI-MS using the microbiology analyzer BactoSCREEN. Apart from MALDI-MS, we used morphology and biochemical methods for species identification when necessary. Serological tests were used for serovar and biovar identifications. Results. A total of 85945 bacterial identifications was performed in 2018. When compared to 2017, the throughput of the laboratory increased ten times. A total of 23252 isolates were obtained in the previously mentioned period. A single identification took 2.98–13.22 minutes including time for supporting procedures, whereas the staff time for one identification itself constituted an average of 1.55 minutes. When compared to manual methods, introduction of mass-spectrometry allowed us to achieve 3.5-fold decrease of the staff time in the average. Therefore, annual labor saving in terms of staffing corresponds to 11 full-time positions. Conclusions. In view of high throughput, analysis speed, simplicity and low cost of sample preparation, MALDI-MS identification fits well into the practice of clinical microbiology laboratory, especially when large-scale screening studies of bacterial cultures are required. The use of MALDI-MS is likely to be most promising when carrying out microbiological monitoring that is traditionally associated with large number of samples and wide range of microorganisms detected.

Abstract 37: ASPECTS and Stratified Outcomes After Endovascular Therapy in the Trevo Retriever Registry: Benefit in Low ASPECTS

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
David S Liebeskind ◽  
Graham W Woolf ◽  
Bin Xiang ◽  
Ryan Shields ◽  
Erol Veznedaroglu ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Large Scale ◽  
Arterial Occlusion ◽  
Routine Practice ◽  
Anterior Circulation ◽  
Endovascular Thrombectomy ◽  
Large Scale Data ◽  
Wide Range ◽  
Therapy Studies ◽  
Occlusion Effect

Background: Most endovascular stroke therapy studies and subsequent guidelines restrict intervention based on ASPECTS. A wide range of ASPECTS scores may be encountered in practice and individual patient benefit may be realized even at low ASPECTS. We examined large-scale data on outcomes after endovascular therapy, stratified by baseline ASPECTS in the Trevo Retriever Registry. Methods: The independent Imaging Core Lab of the Trevo Retriever Registry prospectively determines ASPECTS on baseline imaging acquired immediately prior to endovascular thrombectomy. ASPECTS scores and regional involvement were analyzed with respect to site of arterial occlusion, effect of time from symptom onset, co-morbidities and clinical outcomes, based on ASPECTS strata. Results: Baseline ASPECTS data was reviewed by the Imaging Core Lab in 426 subjects with anterior circulation stroke enrolled in the Trevo Retriever Registry, as of July 2016. Mean age was 68.8 ± 13.7 yrs, with 20.9% > 80 years old. Baseline NIHSS was median 15.0 (10.0, 19.0). Onset to CT was median 3.8 (1.5, 9.0) hrs, with median ASPECTS of 8.0 (7.0, 9.0), ranging from 3-10. Baseline ASPECTS 0-7 occurred in 118/426 (27.7%) subjects, including 39.0% of ICA, 27.1% M1 and 16.9% M2/3 arterial occlusions at angiography. Baseline clinical variables predicting ASPECTS included age and NIHSS, whereas the ASPECTS score was mildly associated with final TICI2C reperfusion (r=0.24, p<0.001). Subsequent symptomatic ICH was 1.7% with baseline ASPECTS 0-7 versus 2.0% with ASPECTS 8-10. The distribution of mRS at 90 days based on individual ASPECTS strata from 10 to 3 revealed a trend to worse outcomes with lower ASPECTS, yet good outcomes (mRS 0-2) were 60.7% (ASPECTS 10), 55.3% (9), 60.2% (8), 54.9% (7), 55.1% (3-6). Conclusions: Discrete ASPECTS strata may influence outcomes of endovascular therapy conducted in routine practice around the world, yet individuals with low ASPECTS may still achieve reasonable outcomes.

scholarly journals Two-year clinical and economic burden, risk and outcomes following application of software-assisted hexapod ring fixation systems

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
J. Spence Reid ◽  
Mollie Vanderkarr ◽  
Bidusee Ray ◽  
Abhishek Chitnis ◽  
Chantal E. Holy ◽  
...  
Keyword(s):  
Consumer Price Index ◽  
Deformity Correction ◽  
Deep Infection ◽  
Healthcare Resource Utilization ◽  
Congenital Deformity ◽  
Significant Heterogeneity ◽  
Logistic Regression Models ◽  
Congenital Deformities ◽  
Wide Range ◽  
Orthopedic Care

Abstract Background Multiplanar external fixation systems that employ software-assisted deformity correction consist of rings connected by angled struts, defined as hexapod ring fixators (HRF). Costs and outcomes associated with the application of HRFs are not well documented. This study was designed to provide a nationwide baseline understanding of the clinical presentation, risks, outcomes and payer costs, and healthcare resource utilization (HCU) of patients requiring application of an HRF, from the day of, and up to 2 years, post-application. Methods Patients with HRF application (“index”) between 2007 and 2019 within the IBM Marketscan® Commercial Claims database were identified and categorized based on diagnosis: acquired deformity, arthropathy, congenital deformity, deep infection, nonunion, fracture, and other post-operative fracture sequelae. Demographics, comorbidities at index, complications post-index, HCU, and payments were analyzed. Payments were estimated using a generalized linear model and were adjusted for inflation to the 2020 consumer price index. Rates of deep infection and amputation were estimated up to 2 years post-index using Poisson regressions, and risk factors for each were estimated using logistic regression models. Results Six hundred ninety-five patients were included in our study (including 219 fractures, 168 congenital deformities, 68 deep infections, 103 acquired deformities). Comorbidities at index were significantly different across groups: less than 2% pediatrics vs 18% adults had 3 or more comorbidities, < 1% pediatric vs 29% adults had diabetes. Index payments ranged from $39,250–$75,350, with 12-months post-index payments ranging from $14,350 to $43,108. The duration of the HRF application ranged from 96 days to 174 days. Amputation was observed in patients with deep infection (8.9, 95% confidence interval (CI): 3.2–23.9%), nonunion (5.0, 95%CI: 1.6–15.4%) or fracture (2.7, 95%CI: 0.9–7.6%) at index. Complicated diabetes was the main predictor for deep infection (odds ratio (OR): 5.14, 95%CI: 2.50–10.54) and amputation (OR: 5.26, 95%CI: 1.79–15.51). Conclusions Findings from this longitudinal analysis demonstrate the significant heterogeneity in patients treated with HRF, and the wide range in treatment intensity, payments, and outcomes. Risks for deep infection and amputation were primarily linked to the presence of complicated diabetes at the time of HRF application, suggesting a need for careful management of comorbid chronic conditions in patients requiring HRF for orthopedic care.

scholarly journals Remifentanil Modifies the Relation of Electroencephalographic Spectral Changes and Clinical Endpoints in Propofol Anesthesia

2008 ◽  
Vol 109 (2) ◽  
pp. 198-205 ◽  
Author(s):  
Jukka Kortelainen ◽  
Miika Koskinen ◽  
Seppo Mustola ◽  
Tapio Seppänen
Keyword(s):  
Spectral Characteristics ◽  
High Dose ◽  
Verbal Command ◽  
Clinical Endpoints ◽  
Spectral Changes ◽  
Significant Difference ◽  
Anesthesia Monitoring ◽  
Patient Groups ◽  
Mutual Relations ◽  
Dose Patient

Background Depth-of-anesthesia monitoring with the electroencephalogram has become widely used in anesthesia practice. Generally, the methods presented are based on the spectral changes of the electroencephalogram. In this study, the authors evaluate the influence of remifentanil on the relation of timely occurrence of clinical endpoints and the spectral behavior of the electroencephalogram. Methods Twenty-seven patients scheduled to undergo a surgical procedure were randomly assigned to three groups. Patients blindly received equal volumes of saline or remifentanil (7.5 or 30 microg.kg.h) 1 min before induction of anesthesia with infusion of propofol (30 mg.kg.h). The occurrence of loss of counting, loss of obeying verbal command, and loss of reaction to tetanic stimulation was assessed. The electroencephalogram was recorded from electrode Fz referenced to the common average, and an iterative algorithm was applied to solve the underlying frequency progression pattern. The positions of the clinical endpoints on the pattern were analyzed. Results The administration of remifentanil during induction of anesthesia with propofol led to an earlier occurrence of the clinical endpoints on the frequency progression pattern. A significant difference (P &lt; 0.05) was observed between the saline and high-dose patient groups in all three endpoints. The effect of remifentanil was proportional to the infusion rate. Conclusions The infusion of remifentanil during propofol anesthesia significantly modifies the mutual relations of the electroencephalographic spectral characteristics and the endpoints in a predictable and quantifiable manner. This finding suggests that the electroencephalographic phenomena and the endpoints may not be identical but rather to some extent separate manifestations of hypnotic drug effect.

scholarly journals Does healthcare inequity reflect variations in peoples’ abilities to access healthcare? Results from a multi-jurisdictional interventional study in two high-income countries

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Jeannie Haggerty ◽  
Jean-Frederic Levesque ◽  
Mark Harris ◽  
Catherine Scott ◽  
Simone Dahrouge ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Primary Healthcare ◽  
Social Vulnerability ◽  
Regression Models ◽  
Social Systems ◽  
Social Characteristics ◽  
Linear Regression Models ◽  
Logistic Regression Models ◽  
Wide Range ◽  
Social Vulnerabilities

Abstract Background Primary healthcare services must respond to the healthcare-seeking needs of persons with a wide range of personal and social characteristics. In this study, examined whether socially vulnerable persons exhibit lower abilities to access healthcare. First, we examined how personal and social characteristics are associated with the abilities to access healthcare described in the patient-centered accessibility framework and with the likelihood of reporting problematic access. We then examined whether higher abilities to access healthcare are protective against problematic access. Finally, we explored whether social vulnerabilities predict problematic access after accounting for abilities to access healthcare. Methods This is an exploratory analysis of pooled data collected in the Innovative Models Promoting Access-To-Care Transformation (IMPACT) study, a Canadian-Australian research program that aimed to improve access to primary healthcare for vulnerable populations. This specific analysis is based on 284 participants in four study regions who completed a baseline access survey. Hierarchical linear regression models were used to explore the effects of personal or social characteristics on the abilities to access care; logistic regression models, to determine the increased or decreased likelihood of problematic access. Results The likelihood of problematic access varies by personal and social characteristics. Those reporting at least two social vulnerabilities are more likely to experience all indicators of problematic access except hospitalizations. Perceived financial status and accumulated vulnerabilities were also associated with lower abilities to access care. Higher scores on abilities to access healthcare are protective against most indicators of problematic access except hospitalizations. Logistic regression models showed that ability to access is more predictive of problematic access than social vulnerability. Conclusions We showed that those at higher risk of social vulnerability are more likely to report problematic access and also have low scores on ability to seek, reach, pay, and engage with healthcare. Equity-oriented healthcare interventions should pay particular attention to enhancing people’s abilities to access care in addition to modifying organizational processes and structures that reinforce social systems of discrimination or exclusion.

Welfare Attitudes and Expressions of (Trans)national Solidarity

2019 ◽  
Vol 63 (4) ◽  
pp. 492-505
Author(s):  
Anna Kurowska ◽  
Olga Eisele ◽  
Johannes M. Kiess
Keyword(s):  
Welfare State ◽  
The European Union ◽  
Logistic Regression Models ◽  
Explanatory Variables ◽  
Eu Countries ◽  
Wide Range ◽  
Welfare Attitudes ◽  
Eu Project ◽  
National Solidarity ◽  
The Welfare State

The article explores the extent to which Europeans’ welfare attitudes explain (trans)national solidarity behavior. We set our analyses against the backdrop of the broader debate of welfare state consequences: Does a strong welfare state that is considered to take care of those in need diminish or strengthen citizens’ motivations to become engaged in helping others? We distinguish individuals’ solidarity behavior toward others within the welfare state, that is, citizens within one’s country, and outside the welfare state community of the respondents’ particular country. We further distinguish different others outside the welfare state, that is, between refugees, taking the refugee crisis in the European Union (EU) as a prime example, and citizens living in other countries—in EU countries and non-EU countries. As far as the main explanatory variables are concerned, we derive from the concept of “multidimensional welfare attitudes” and focus on five crucial dimensions of these attitudes, that is, welfare goals, range, degree, redistribution, and outcome. We draw on data collected within the EU project TransSOL and calculate a set of multilevel logistic regression models controlling for a wide range of individual (sociodemographic, economic, and political) variables. Overall, we observe that a “crowding in” effect, that is, higher support of the welfare state, goes in line with solidarity activity toward others including both “outsiders” and “insiders” of the national community.

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