scholarly journals Premedication practices for tracheal intubation in neonates transported by French medical transport teams: a prospective observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e034052 ◽  
Author(s):  
Ricardo Carbajal ◽  
Noella Lode ◽  
Azzedine Ayachi ◽  
Ourida Chouakri ◽  
Véronique Henry-Larzul ◽  
...  
Keyword(s):  
Adverse Events ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Drug Regimen ◽  
Muscle Rigidity ◽  
Neonatal Transport ◽  
Registration Number ◽  
Medical Transport ◽  
The Mean ◽  
Paris Region

ObjectivesPremedication practices for neonatal tracheal intubations have not yet been described for neonatal transport teams. Our objective is to describe the use of sedation/analgesia (SA) for tracheal intubations and to assess its tolerance in neonates transported by medical transport teams in France.SettingThis prospective observational study was part of the EPIPPAIN 2 project and collected around-the-clock data on SA practices in neonates intubated by all five paediatric medical transport teams of the Paris region during a 2-month period. Intubations were classified as emergent, semiemergent and non-emergent. Sedation level and conditions of intubation were assessed with the Tonus, Reactivity, Awareness and Conditions of intubation to Help in Endotracheal intubation Assessment (TRACHEA score). The scores range from 0 to 10 representing an increasing ladder from adequate to inadequate sedation, and from excellent to very poor conditions of intubation.Participants40 neonates intubated in 28 different centres.ResultsThe mean (SD) age was 34.9 (3.9) weeks, and 62.5% were intubated in the delivery room. 30/40 (75%) of intubations were performed with the use of SA. In 18/30 (60.0%) intubations performed with SA, the drug regimen was the association of sufentanil and midazolam. Atropine was given in 19/40 intubations. From the 16, 21 and 3 intubations classified as emergent, semiemergent and non-emergent, respectively, 8 (50%), 19 (90.5%) and 3 (100%) were performed with SA premedication. 79.3% of intubations performed with SA had TRACHEA scores of 3 or less. 22/40 (55%) infants had at least one of the following adverse events: muscle rigidity, bradycardia below 100/min, desaturation below 80% and nose or pharynx–larynx bleeding. 7/24 (29.2%) of those who had only one attempt presented at least one of these adverse events compared with 15/16 (93.8%) of those who needed two or more attempts (p<0.001).ConclusionSA premedication is largely feasible for tracheal intubations performed in neonates transported by medical transport teams including intubations judged as emergent or semiemergent.Trial registration numberNCT01346813; Results.

Incidence of Sinusoidal Obstruction Syndrome Following Mylotarg (Gemtuzumab Ozogamicin, GO): a Prospective Observational Study in Routine Clinical Practice.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 956-956
Author(s):  
Marti n S Tallman ◽  
George B McDonald ◽  
Laurie D DeLeve ◽  
Eliot Obi-Tabot ◽  
Carl Kollmer ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Weight Gain ◽  
Adverse Events ◽  
Observational Study ◽  
Special Interest ◽  
Prospective Observational Study ◽  
Routine Clinical Practice ◽  
Sinusoidal Obstruction Syndrome ◽  
Prior Chemotherapy ◽  
The Mean

Abstract Objectives: GO is a conjugate of calicheamicin and a monoclonal antibody that targets CD33+ myeloblasts in acute myeloid leukemia (AML). After GO administration, ascites, weight gain, elevated aminotransferase enzymes, and jaundice (Sinusoidal Obstruction Syndrome, SOS, formerly known as VOD) have been reported. After approval by the FDA for relapsed AML in 2000 and its introduction into routine clinical practice, the incidence of SOS after GO infusion has been the subject of debate. The objectives of this study were to estimate the incidence rate of SOS after GO infusion in routine clinical practice, identify risk factors associated with the development of SOS, describe the incidence rates of serious adverse events (SAEs) and nonserious adverse events of special interest (ESIs). Methods: This study was a prospective observational study that enrolled consenting patients who were to receive GO for AML, with assessments at baseline, weekly x6 after the 1st dose of GO or 4 weeks after the last dose (whichever was later), and at 6 months. There were no exclusion criteria. Two hepatologists (GBM, LDD) reviewed cases with liver abnormalities and classified patients as either SOS, liver disease unlikely to be SOS, or no SOS. A diagnosis of SOS was based on 2 of the following 3 criteria: elevated bilirubin (>34 mmol/L or 2 mg/dL), increase in liver size or right upper quadrant liver pain, weight gain (>2.5% after GO infusion), along with exclusion of other liver diseases with this presentation. The study was conducted according to the Declaration of Helsinki and its amendments. Results: 512 patients were enrolled at 54 U.S. centers and 482 were analyzed. The study population consisted predominantly of men (59%); the mean age was 61.5 years; 73% had an ECOG performance status of 0 or 1 at baseline. 18% had received prior hematopoietic cell transplant (HCT), 4% had prior graft versus host disease (GVHD), 11% prior irradiation, 40% reported alcohol intake, and 19% were smokers. Most patients had received prior chemotherapy (87%). AML in first relapse was the indication for GO in 44%. Most patients received chemotherapy concomitantly with GO, most common were cytarabine (16%) and hydroxycarbamide (14%). The mean number of GO infusions per patient was 1.5 and the mean dose of GO per infusion was 7.8 mg/m2. The incidence of SOS was 8.9% (43/482; 95% confidence interval [CI]: 6.5% to 11.8%), with 19 cases classified as severe, 15 moderate, and 9 mild. Of 43 patients with SOS, 33 died within 6 months; of these, 20 died of AML progression. By multivariate analysis, only prior HCT was significantly related to development of moderate/severe SOS (odds ratio 2.2, CI 1.01–4.99). There was no evidence to suggest that age, blast count, body weight, GO dosing, prior chemotherapy, concomitant chemotherapy, or use of acetaminophen were related to development of SOS. 68% of patients died within 6 months. Progression of AML was the primary cause of death (73% of deaths); 7% were due to cardiovascular causes, 7% were due to infection, 6% were due to multiorgan failure, and 7% were due to other causes. SAEs occurred in 85% of patients; most (81%) due to other reasons, including AML, febrile neutropenia, pyrexia, and sepsis. Of the special interest categories, most SAEs were due to hepatic events (10%). 73% of patients experienced ESIs (both serious and nonserious); most ESIs were infusion-related events (46%) and 44% were hepatic events. Conclusions: GO can be safely administered in routine clinical practice with an overall 8.9% risk of SOS and with most cases moderate to severe. The only risk factor identified was prior HCT. Development of SOS following GO cannot be predicted in the majority of cases. Most ESIs were infusion-related events and most SAEs of the special interest categories were due to hepatic events.

scholarly journals What are the barriers to the completion of a home-based rehabilitation programme for patients awaiting surgery for lung cancer: a prospective observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041907
Author(s):  
Heloise Catho ◽  
Sebastien Guigard ◽  
Anne-Claire Toffart ◽  
Gil Frey ◽  
Thibaut Chollier ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Living Alone ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Factors Associated ◽  
Home Based ◽  
Registration Number

ObjectivesHome-based rehabilitation programmes (H-RPs) could facilitate the implementation of pulmonary rehabilitation prior to resection for non-small cell lung cancer (NSCLC), but their feasibility has not been evaluated. The aim of this study was to identify determinants of non-completion of an H-RP and the factors associated with medical events occurring 30 days after hospital discharge.DesignA prospective observational study.InterventionAll patients with confirmed or suspected NSCLC were enrolled in a four-component H-RP prior to surgery: (i) smoking cessation, (ii) nutritional support, (iii) physiotherapy (at least one session/week) and (iv) home cycle-ergometry (at least three times/week).OutcomesThe H-RP was defined as ‘completed’ if the four components were performed before surgery.ResultsOut of 50 patients included, 42 underwent surgery (80% men; median age: 69 (IQR 25%–75%; 60–74) years; 64% Chronic Obstructive Pulmonary Disease (COPD); 29% type 2 diabetes). Twenty patients (48%) completed 100% of the programme. The median (IQR) duration of the H-RP was 32 (19; 46) days. Multivariate analysis showed polypharmacy (n=24) OR=12.2 (95% CI 2.0 to 74.2), living alone (n=8) (single vs couple) OR=21.5 (95% CI 1.4 to >100) and a long delay before starting the H-RP (n=18) OR=6.24 (95% CI 1.1 to 36.6) were independently associated with a risk of non-completion. In univariate analyses, factors associated with medical events at 30 days were H-RP non-completion, diabetes, polypharmacy, social precariousness and female sex.ConclusionFacing multiple comorbidities, living alone and a long delay before starting the rehabilitation increase the risk of not completing preoperative H-RP.Trial registration numberNCT03530059.

scholarly journals Anaesthesia and Perioperative Care in Remote Health Camps- Patients’ Concerns

2010 ◽  
Vol 49 (179) ◽  
Author(s):  
Balkrishna Bhattarai ◽  
A Ghimire ◽  
BK Baral ◽  
A Shrestha ◽  
Y Dhungana
Keyword(s):  
Observational Study ◽  
Perioperative Care ◽  
Local Anaesthesia ◽  
Prospective Observational Study ◽  
Main Concern ◽  
Surgical Experience ◽  
Female Ratio ◽  
Male Female Ratio ◽  
The Mean ◽  
Remote Health

INTRODUCTION:Identifying patients' concerns and expectations regarding anaesthesia and perioperative care in mobile surgical camps is relevant for the camp workers. This prospective observational study was conducted to assess knowledge, concerns, and expectations about anaesthesia and perioperative care in patients undergoing surgery in mobile surgical camps in remote mountainous districts of Eastern Nepal.METHODS:A questionnaire with seven items related to anaesthesia and perioperative care was used for interviewing 80 individuals of age > or = 12 years, 20 from each camp at Solukhumbu, Sankhuwasabha, Khotang and Bhojpur districts.RESULTS:Data of two patients were lost leaving only 78 individuals for analysis. The mean age of the subjects was 30.5 (+/- 14.6) years with the male: female ratio of 43: 35. Fifty-eight (74.4%) patients had some gross idea about the modality of administration of anaesthetics. Twenty-six (33.3%) individuals preferred GA over local anaesthesia, whereas 22 (28.2%) were happy either way if there was no pain. Pain was the main concern for 73.1% of the patients. Of the 25 patients expressing fear of GA, death or not being able to wake up anymore was the main concern for 60.0%. Increasing age was associated with lower fear of GA (p < 0.05). Surgical experience was distressing for 17 (21.8%) patients. The overall experience of the anaesthesia and surgery was worse than expected for 25.6% of the patients.CONCLUSIONS:Patients presenting to these health camps have limited knowledge regarding anaesthesia and perioperative care but have valid concerns and expectations in respect of their safety, comfort and outcome.

scholarly journals Role of JIGSAW method of teaching in improving clinical diagnosis among final year medical students – A prospective observational study

2021 ◽  
Vol 12 (12) ◽  
pp. 44-49
Author(s):  
Appandraj S ◽  
Sivagamasundari V ◽  
Varatharajan Sakthivadivel
Keyword(s):  
Observational Study ◽  
Test Score ◽  
Prospective Observational Study ◽  
Coronary Syndrome ◽  
Post Test ◽  
Jigsaw Method ◽  
The Mean ◽  
The Difference ◽  
Didactic Lecture ◽  
Teaching Learning

Background: The Jigsaw method is a form of cooperative learning, in which students are actively involved in the teaching-learning process that improves the long-term retention of acquired knowledge. Aims and Objectives: The objective of this study was to assess the knowledge acquired by students using the Jigsaw learning method in Internal Medicine. Materials and Methods: A prospective observational study was conducted with 100 students. The acute coronary syndrome was taken for 1 h as a didactic lecture, and a pre-test was conducted. The students were divided into five groups and were put for the intervention “Jigsaw.” The pre- and post-test were conducted, and feedback was collected from the students. Paired t-test was used to perform analysis of pre- and post-test. Feedback evaluation was done by a 5-point Liker scale. P<0.05 was considered statistically significant, and the data were analyzed using CoGuide software. Results: The mean pre-test score was 8.44 ± 2.33 ranged (3–14) and the mean post-test score was 11.03 ± 2.07 (ranged 6–15). The difference of 2.39 (95% CI: 2.19–2.59) increase in marks post-test after the Jigsaw method was statistically significant (P<0.001). The satisfaction level was 50–55% on the Likert scale based on the questionnaire given. There was a significant improvement in the post-test scores of the students after Jigsaw. Conclusion: The Jigsaw method improved knowledge in the short-term by engaging students in group work and motivation to learn. Overall response based on the questionnaire about the Jigsaw method was positive.

scholarly journals Incisional Hernia Repair in Contaminated Surgical fields (I.H.R.C.S.) study using biological prostheses in emergency surgery setting with contaminated hernias: a multicenter prospective observational study

2016 ◽  
Author(s):  
Belinda De Simone ◽  
Fausto Catena ◽  
Antonio Biondi ◽  
Gianluca Baiocchi ◽  
Fabio Campanile ◽  
...  
Keyword(s):  
Observational Study ◽  
Incisional Hernia ◽  
Prospective Observational Study ◽  
Wound Complication ◽  
Hernia Recurrence ◽  
Mesh Placement ◽  
Asa Score ◽  
Surgical Field ◽  
The Mean ◽  
Biological Prostheses

There are still difficulties to find appropriate indication for prosthetic implant in hernia surgery in contaminated surgical fields. Biologic prosthetic materials have been developed and proposed for the clinical use in contaminated surgical fields with interesting outcomes. The aim of this study is to analyze data from nine Italian Emergency Surgery Units concerning patients consecutively admitted with diagnosis of strangulated incisional hernia (IH), submitted to surgery in emergency and treated with biological prostheses. This is a prospective observational study. Subjects submitted to singlestaged IH repair in a contaminated surgical field, with the use of biologic mesh, were prospectively studied over a 1-year time period. All patients enrolled in this study were submitted to bowel/intestinal resection at the same operative time for perforation. Primary end points of our study were wound complication and hernia recurrence. Seventy-one patients were enrolled (F=21, M=50); the mean age was 69.2±11.1 standard deviation (SD) years and the mean American Society of Anesthesiologist (ASA) score was 3.1±0.8 SD. Twenty-one patients (29.57%) had a wound complication, associated with high ASA score, diabetes, smoking, chronic immunosuppression, number of previous hernia repairs, dirty surgical field, sublay extra peritoneal mesh placement and no anterior fascia closure. After a mean follow up time of 27.2 months, hernia recurrence occurred in 19 patients (26.76%). Predictors of hernia recurrence included wound complications, high ASA score, diabetes, chronic immunosuppression, dirty surgical field and sublay extra peritoneal mesh placement. Use of biological prostheses in contaminated fields is safe with favorable medium term recurrence rate (26.76% in our experience). Surgical technique performed is important to decrease hernia recurrence rate.

scholarly journals How do palliative care doctors recognise imminently dying patients? A judgement analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e024996 ◽  
Author(s):  
Nicola White ◽  
Priscilla Harries ◽  
Adam JL Harris ◽  
Victoria Vickerstaff ◽  
Philip Lodge ◽  
...  
Keyword(s):  
Palliative Care ◽  
Observational Study ◽  
Phase I ◽  
Phase Ii ◽  
Prospective Observational Study ◽  
Clinical Signs ◽  
Brier Score ◽  
Prognostic Test ◽  
Probability Of Death ◽  
The Mean

ObjectivesTo identify a group of palliative care doctors who perform well on a prognostic test and to understand how they make their survival predictions.DesignProspective observational study and two cross-sectional online studies.SettingPhase I: an online prognostic test, developed from a prospective observational study of patients referred to palliative care. Phase II: an online judgement task consisting of 50 hypothetical vignettes.ParticipantsAll members of the Association of Palliative Medicine (APM) were eligible (n=~1100). 99 doctors completed the prognostic test and were included in the phase I analysis. The top 20% were invited to participate in phase II; 14/19 doctors completed the judgement task and were included in the phase II analysis.MeasuresPhase I: participants were asked to give a probability of death within 72 hours (0%–100%) for all 20 cases. Accuracy on the prognostic test was measured with the Brier score which was used to identify the ‘expert’ group (scale range: 0 (expert)–1 (non-expert)). Phase II: participants gave a probability of death within 72 hours (0%–100%). A mixed model regression analysis was completed using the percentage estimate as the outcome and the patient information included in the vignettes as the predictors.ResultsThe mean Brier score of all participants was 0.237 (95% CI 0.235 to 0.239). The mean Brier score of the ‘experts’ was 0.184 (95% CI 0.176 to 0.192). Six of the seven prognostic variables included in the hypothetical vignettes were significantly associated with clinician predictions of death. The Palliative Performance Score was identified as being the most influential in the doctors’ prognostic decision making (β=0.48, p<0.001).ConclusionsThis study identified six clinical signs and symptoms which influenced the judgement policies of palliative care doctors. These results may be used to teach novice doctors how to improve their prognostic skills.

scholarly journals Should home-based ovulation predictor kits be offered as an additional approach for fertility management for women and couples desiring pregnancy? A systematic review and meta-analysis

2019 ◽  
Vol 4 (2) ◽  
pp. e001403 ◽  
Author(s):  
Ping Teresa Yeh ◽  
Caitlin E Kennedy ◽  
Sheryl Van der Poel ◽  
Thabo Matsaseng ◽  
Laura Bernard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Observational Study ◽  
Pregnancy Rate ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Time To Pregnancy ◽  
Fertility Management ◽  
Home Based ◽  
Registration Number

IntroductionTo inform the WHO Guideline on self-care interventions, we conducted a systematic review of the impact of ovulation predictor kits (OPKs) on time-to-pregnancy, pregnancy, live birth, stress/anxiety, social harms/adverse events and values/preferences.MethodsIncluded studies had to compare women desiring pregnancy who managed their fertility with and without OPKs, measure an outcome of interest and be published in a peer-reviewed journal. We searched for studies on PubMed, CINAHL, LILACS and EMBASE through November 2018. We assessed risk of bias assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for observational studies, and conducted meta-analysis using random effects models to generate pooled estimates of relative risk (RR).ResultsFour studies (three RCTs and one observational study) including 1487 participants, all in high-income countries, were included. Quality of evidence was low. Two RCTs found no difference in time-to-pregnancy. All studies reported pregnancy rate, with mixed results: one RCT from the 1990s among couples with unexplained or male-factor infertility found no difference in clinical pregnancy rate (RR: 1.09, 95% CI 0.51 to 2.32); two more recent RCTs found higher self-reported pregnancy rates among OPK users (pooled RR: 1.40, 95% CI 1.08 to 1.80). A small observational study found higher rates of pregnancy with lab testing versus OPKs among women using donor insemination services. One RCT found no increase in stress/anxiety after two menstrual cycles using OPKs, besides a decline in positive affect. No studies measured live birth or social harms/adverse events. Six studies presented end-users’ values/preferences, with almost all women reporting feeling satisfied, comfortable and confident using OPKs.ConclusionA small evidence base, from high-income countries and with high risk of bias, suggests that home-based use of OPKs may improve fertility management when attempting to become pregnant with no meaningful increase in stress/anxiety and with high user acceptability.Systematic review registration numberPROSPERO registration number CRD42019119402.

scholarly journals Anemia Control in Kidney Transplant Recipients Using Once-Monthly Continuous Erythropoietin Receptor Activator: A Prospective, Observational Study

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Klemens Budde ◽  
Thomas Rath ◽  
Volker Kliem
Keyword(s):  
Adverse Events ◽  
Observational Study ◽  
Kidney Transplant ◽  
Prospective Observational Study ◽  
Erythropoietin Receptor ◽  
Study Entry ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Receptor Activator ◽  
Continuous Erythropoietin Receptor Activator

In a multicenter, prospective, observational study of 279 kidney transplant recipients with anemia, the efficacy and safety of once-monthly continuous erythropoietin receptor activator (C.E.R.A.) were assessed to a maximum of 15 months. The main efficacy variable was the proportion of patients achieving a hemoglobin level of 11-12 g/dL at each of visits between months 7 and 9. At study entry, 224 patients (80.3%) were receiving erythropoiesis stimulating agent (ESA) therapy including darbepoetin alfa (98), epoetin beta (61), and C.E.R.A. (45). The mean (SD) time between C.E.R.A. applications was 34.0 (11.9) days. Among 193 patients for whom efficacy data were available, mean (SD) hemoglobin was 11.1 (0.99) g/dL at study entry, 11.5 (1.1) g/dL at month 7, 11.6 (1.3) g/dL at month 9, and 11.4 (1.1) g/dL at month 15. During months 7–9, 20.7% of patients had all hemoglobin values within the range 11-12 g/dL and 64.8% were within 10–13 g/dL. Seven patients (2.5%) discontinued C.E.R.A. due to adverse events or serious adverse events. In this observational trial under real-life conditions, once-monthly C.E.R.A. therapy achieved stable hemoglobin levels in stable kidney transplant recipients with good tolerability, and with no requirement for any dose change in 43% of patients.

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