EMLA Cream is an Effective Topical Anesthetic for Bronchoscopy

BACKGROUND:EMLA cream (AstraZeneca Inc, Canada) (1:1 eutectic mixture of lidocaine 2.5% and prilocaine 2.5%) has traditionally been used for topical anesthesia of the skin. Recent reports of EMLA's use for anesthesia of the oral mucosa suggest an application in topical anesthesia for bronchoscopy.OBJECTIVES:To evaluate the amount of local anesthetic administered during bronchoscopy; to assess the time required to obtain topical anesthesia; to assess the quality of the topical anesthesia as described by bronchoscopists; and to document any complications.METHODS:Fifty-seven unpremedicated patients had 4 mL of EMLA cream applied to the posterior third of their tongues on arrival in the bronchoscopy suite. Liquid lidocaine was applied through the bronchoscope for laryngeal anesthesia.RESULTS:The mean time from the application of EMLA cream to insertion of the bronchoscope was 5.10±0.48 min. Fifty-six patients (98.2%) required no supplemental anesthesia. Bronchoscopy conditions were described as 'excellent' in 55 cases (96.5%) and 'good' in the remaining two cases (3.5%).CONCLUSIONS:EMLA is an effective alternative for oropharyngeal topical anesthesia that is well-tolerated by patients.

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The impact of angling experience on the efficiency of float fishing using different hook types

Fisheries & Aquatic Life ◽

10.2478/aopf-2019-0005 ◽

2019 ◽

Vol 27 (1) ◽

pp. 41-46

Author(s):

Tomasz K. Czarkowski ◽

Andrzej Kapusta

Keyword(s):

The Mean ◽

Catch Rates ◽

Time Required ◽

The Impact ◽

Mean Time

Abstract The aim of the study was to compare the catch efficiency of novice and experienced anglers float fishing with different hook types. The mortality of fish that were caught and released was determined based on the experience of the angler and the type of hook used. The mean catch rates of the experienced angler was 46.7 fish per hour, while that of the novice angler was 33.7 fish per hour. The landing efficiency of fish using hooks with micro-barbs was higher than that with barbless hooks. Angling experience had a significant impact on the mean time required to unhook caught fish and also on the mortality of the fish released. The lowest mortality was noted in fish caught by experienced anglers fishing with barbless hooks. The results of the study suggest that angling experience does not have a great impact on parameters characterizing the quality of angling catches. The efficiency of float fishing performed by novice and experienced anglers was similar. Differences were noted in the time required to unhook the fish and in the mortality of the fish released.

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A Randomized Controlled Trial Comparing Er:YAG Laser and Rotary Bur in the Excavation of Caries - Patients' Experiences and the Quality of Composite Restoration

The Open Dentistry Journal ◽

10.2174/1874210601812010443 ◽

2018 ◽

Vol 12 (1) ◽

pp. 443-454 ◽

Cited By ~ 4

Author(s):

Roxana Sarmadi ◽

Elin Viktoria Andersson ◽

Peter Lingström ◽

Pia Gabre

Keyword(s):

Er:Yag Laser ◽

Controlled Trial ◽

Laser Technique ◽

Laser Method ◽

The Mean ◽

Time Required ◽

Mean Time ◽

Caries Lesions ◽

Single Blind

Objective: The aim of this study was to evaluate patients´ experiences of two excavation methods, Er:YAG laser and rotary bur and time required by the methods as well as objective assessments of quality and durability of restorations over a two-year period. Methods: A prospective, single-blind, randomized and controlled investigation was performed. Patients aged 15 to 40 years with at least two primary caries lesions, which had been radiographically assessed as of the same size, were recruited. In each patient, one cavity was excavated using rotary bur and one using Er:YAG laser technique. The time required for excavations and, where applicable, local anaesthesia, was measured during the treatments. Patient experiences were measured using questionnaires. The quality and durability of restorations were assessed over a two-year period in accordance with modified Ryges criteria and radiographs. Twenty-five patients (mean age 22.6 years) participated in the study. In total, 56 cavities were included of which 28 were treated with Er:YAG laser and 28 were treated with a rotary bur. Results: The patients associated the laser method with less discomfort. The mean time for excavation by laser was three times longer than by rotary bur (13.2 min vs. 4.3 min, P<0.0001). Over a two-year period, no statistically significant differences with regard to quality or durability could be seen between the restorations associated with the methods. Conclusion: The Er:YAG laser technique was more time-consuming than the rotary bur. Despite this, the laser technique caused less discomfort and was preferred as an excavation method by patients.

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Time required to move cash through slot machines

Journal of Money Laundering Control ◽

10.1108/jmlc-09-2017-0049 ◽

2018 ◽

Vol 21 (3) ◽

pp. 376-384 ◽

Cited By ~ 1

Author(s):

Karen Kelly ◽

Carl James Schwarz ◽

Ricardo Gomez ◽

Kim Marsh

Keyword(s):

British Columbia ◽

Slot Machines ◽

Content Type ◽

The Public ◽

Average Value ◽

The Mean ◽

Time Required ◽

Rest Breaks ◽

Mean Time ◽

Practical Implications

Purpose The purpose of this paper is to present an empirical study on the time needed to load and disburse cash using bill validators on slot machines and stand-alone cash dispensers in casinos in British Columbia under a Ticket In Ticket Out (TITO) system. Design/methodology/approach Testing took place over two days, using 18 machines. The results were extrapolated to estimate the approximate time required to process $1,000,000 with different average bill amounts in the cash mix and three different bill validator machines in common use. The average value per bill using the cash mix used by the public in the casino was $33.11 [standard error (SE) $2.11]. Findings The mean time/accepted note ranged from 4.12 to 9.65 s, depending on bill validator type. This implies that the time needed to load $1,000,000 onto credit slips using bill validators on slot machines ranges from 35 to 81 h, excluding rest breaks and other breaks. The time needed to redeem $1,000,000 is estimated to be 3 h. Practical/implications The implications of these finding for illicit actors to successfully launder large amounts of cash are discussed. Given the time needed to physically handle the cash, and other control systems currently in use in casinos in British Columbia, processing large amounts of cash using bill validators on slot machines would require a highly organized team that would find it difficult to elude detection. Originality/value The trial results provide a baseline estimate to be used going forward when investigating or proposing money laundering methodologies that include slot machines.

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Treatment of hyperthyroidism with a small single daily dose of methimazole

Acta Endocrinologica ◽

10.1530/acta.0.1190139 ◽

1988 ◽

Vol 119 (1) ◽

pp. 139-144 ◽

Cited By ~ 22

Author(s):

Yasuo Mashio ◽

Mutsuo Beniko ◽

Akemi Ikota ◽

Hiroaki Mizumoto ◽

Haruhiko Kunita

Keyword(s):

Divided Dose ◽

Dose Regimen ◽

Single Daily Dose ◽

Once Daily ◽

Daily Dose ◽

The Mean ◽

Time Required ◽

Daily Dose Regimen ◽

Mean Time ◽

Immunoglobulin Levels

Abstract. A prospective randomized trial with the conventional divided doses (10 mg 3 times daily, N = 29) and a small single daily dose (15 mg once daily, N = 25) of methimazole for the treatment of Graves' hyperthyroidism was performed. Within 8 weeks, almost 80% of the patients in both groups became euthyroid. The mean time required to achieve the euthyroid state was 6.0 ± 2.8 and 6.0 ± 3.8 weeks, respectively. TSH binding inhibitor immunoglobulin was found in about 90% of the patients in both groups before methimazole treatment. However, a gradual fall of its levels was observed in nearly all patients after treatment. There was no difference in the mean levels of TSH binding inhibitor immunoglobulin between the two groups during therapy. We conclude that the single daily dose regimen of 15 mg of methimazole will control Graves' hyperthyroidism in most patients, and TSH binding inhibitor immunoglobulin levels decrease in this regimen in the same way as with the conventional divided dose regimen (10 mg 3 times daily).

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Antithrombotic properties of hemofilter coated with polymer having a hydrophilic blood-contacting layer

The International Journal of Artificial Organs ◽

10.1177/0391398818815480 ◽

2018 ◽

Vol 42 (2) ◽

pp. 88-94 ◽

Cited By ~ 1

Author(s):

Masashi Tagaya ◽

Kazunobu Hara ◽

Shunsuke Takahashi ◽

Saki Nagoshi ◽

Hiroki Handa ◽

...

Keyword(s):

Extracorporeal Circulation ◽

Polymer Coating ◽

Coating Agent ◽

Biocompatible Polymer ◽

Time Points ◽

Antithrombin Activity ◽

Antithrombotic Effects ◽

The Mean ◽

Time Required ◽

Mean Time

Objective: Extracorporeal circulation devices are coated with a biocompatible polymer coating agent (BPCA) that has a hydrophilic blood-contacting layer, but hemofilters are not. We aimed to investigate the antithrombotic properties of a BPCA-coated hemofilter. Methods: Four experiments using BPCA-coated circuits and non-coated hemofilters and four experiments using BPCA-coated circuits and BPCA-coated hemofilters were performed with whole human blood and compared by measuring the circuit pressure every 5 min, antithrombin activity every 40 min, and thrombin–antithrombin complex every 40 min, for a total of 240 min of recirculation. Results: The mean time required for the pressure at the inlet of the hemofilter to increase sharply was longer in BPCA-coated than in non-coated hemofilters (66 ± 11 min vs 25 ± 9 min, p < 0.01). The mean antithrombin activity value at 200 and 240 min of recirculation was significantly higher in the experiments with BPCA-coated versus non-coated hemofilters (43.3 ± 2.87 vs 33.3 ± 5.74, p = 0.04; 42.8 ± 3.59 vs 31.0 ± 5.35, p = 0.01, respectively); the antithrombin activity values at the other time points were not significantly different. Furthermore, all thrombin–antithrombin complex values in experiments with the BPCA-coated hemofilters achieved overrange at 80 min of recirculation, whereas those with the non-coated hemofilter achieved overrange at 40 min. Conclusion: This study suggests that BPCA-coated hemofilters can inhibit antithrombin consumption, contributing to antithrombotic effects in extracorporeal circulation circuits.

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Quality of febrile neutropenia management in a regional cancer center emergency department.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.104 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 104-104

Author(s):

Priyanka Kapil ◽

Katherine Enright

Keyword(s):

Emergency Department ◽

Febrile Neutropenia ◽

Antibiotic Therapy ◽

Cancer Site ◽

Cancer Center ◽

Time To Initiation ◽

The Mean ◽

The Impact ◽

Mean Time

104 Background: ASCO's current guidelines for febrile neutropenia (FN) management support antibiotic administration within one hour of presentation to the emergency department (ED). Prompt initiation of antibiotic therapy is vital to decrease the likelihood of adverse outcomes. Many studies, however, have reported significant delays in antibiotic initiation with mean wait times far exceeding ASCO's guidelines. We aimed to assess the quality of FN management at a regional cancer centre ED. Methods: Patients undergoing chemotherapy who visited the ED at the Peel Regional Cancer Center in Ontario, Canada between 04/12 - 03/13 were identified using electronic medical records. Patients were excluded if there was no record of chemotherapy delivery within 30 days prior to ED visit. ICD-10 codes and chart data were used to identify patients who had presented for either fever or infection. The primary outcome measures were three major quality of health indicators; time to assessment by a physician, Canadian Triage and Acuity Scale (CTAS) score, and time to initiation of intravenous antibiotics. Results: In total 239 records were included in the analysis. CTAS score was concordant with recommendation for FN (level 1-2) in 85% of patients and did not vary based on primary cancer site (p = 0.17). The mean time to physician assessment was 97.2 min and the mean time to initiation of IV antibiotics was 194.7 min. Overall, 14.6% of patients received their first dose of antibiotic therapy within the recommended 1 hour window. Conclusions: Our audit identified a large margin for improvement in the time to initiation of antibiotic therapy for chemotherapy patients with suspected FN. Prompt recognition and initiation of standardized treatment pathways for FN in the ED may improve the time to initiation of antibiotic therapy. In an attempt to address this gap in quality we have developed and distributed a standardized wallet-sized fever card to all patients receiving cytotoxic chemotherapy within our regional cancer program. This card contains information pertaining to the current chemotherapy treatment and recommended ED treatment protocols for FN. An evaluation of the impact of these cards is ongoing.

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Timing should no Longer be an Obstacle to Oocyte Cryopreservation in Patients with Cancer

Tumori Journal ◽

10.5301/tj.5000586 ◽

2016 ◽

Vol 103 (2) ◽

pp. 182-186 ◽

Cited By ~ 2

Author(s):

Giorgia Mangili ◽

Enrico Papaleo ◽

Cristina Sigismondi ◽

Rossella Masciangelo ◽

Veronica Sarais ◽

...

Keyword(s):

Malignant Tumors ◽

Oocyte Cryopreservation ◽

Relevant Issue ◽

Patients With Cancer ◽

Number Of Patients ◽

Anticancer Treatment ◽

The Mean ◽

Time Required ◽

Second Period ◽

Mean Time

Purpose Anticancer treatment-related infertility is preventable with oocyte cryopreservation, but this is often not considered a relevant issue, due to lack of knowledge and time. The aim of this study is to prove that adequate organization of an Oncofertility Unit and the use of new protocols for controlled ovarian stimulation (COS) can reduce the time required by the procedure, encouraging consultants and patients to preserve fertility before gonadotoxic treatments. Methods A total of 125 patients diagnosed with malignant tumors were referred to the Oncofertility Unit of San Raffaele Hospital: 52 patients between April 2011 and October 2013 and 73 patients between October 2013 and November 2015. The 2 periods differ in office organization and type of COS protocol used. Results Between the 2 periods, a reduction in the mean number of days required from first counseling to the initiation (6.45 ± 1.058 vs 1.61 ± 0.228) and the end of the COS (17.83 ± 1.227 vs 13.70 ± 0.393) was observed (p<0.0001). No differences exist in the groups between the mean time required to complete COS (11.38 ± 0.360 vs 12.17 ± 0.309; p = 0.11) and mean number of frozen oocytes (8.458 ± 1.060 vs 10.30 ± 0.919; p = 0.22). Furthermore, in the second period, the number of patients who accepted fertility preservation increased (46.15% vs 64.38%; p<0.05). Conclusions Renewed organization of the Oncofertility Unit and the newest random-start COS protocol allowed us to shorten the time for oocyte cryopreservation and start anticancer treatment on time.

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1700 Using Intra-Operative Imaging as A Tool to Provide Peer Review, Scoring, Feedback and Education for Hand and Wrist Trauma Cases - A Quality Improvement Project

British Journal of Surgery ◽

10.1093/bjs/znab259.923 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Smith ◽

A Thompson ◽

P Stanier ◽

J Rooker ◽

I Lowdon

Keyword(s):

Final Report ◽

X Rays ◽

Improvement Project ◽

X Ray ◽

Constructive Feedback ◽

Wrist Trauma ◽

Specific Feedback ◽

The Mean ◽

Mean Time

Abstract Aim To improve the efficiency of intraoperative hand trauma x-ray review, introduce a scoring system for quality of fixation achieved and use this as an education and feedback tool for trainees. Method A large QI project in 2019 demonstrated that intra-operative images taken using the mini C-arm were not being reviewed. In March 2020 the first QI cycle introduced an Access database to ensure that as cases were removed from the trauma board, they were added to a review list. Each x-ray was also scored in the trauma meeting (good, acceptable, poor) to assess the radiographic quality of fixation. The second QI cycle identified the named surgeon for each case, allowing surgeon specific feedback. Finally, we trained all qualified users of the mini C-arm to upload their own images after each case, reducing the mean time to upload. Results This QI project has improved the review rate of mini C-arm images from 30% to 100% and every x-ray is scored. The mean time to review images has reduced from 4 days to less than 24 hours. All trainees can access their scores for imaged hand and wrist trauma and receive written constructive feedback. Conclusions This project ensures appropriate and prompt review of all hand and wrist trauma cases allowing early identification of any concerns. All x-rays are scored, and this process acts as an educational prompt in the trauma meeting. A final report can be printed for each trainee which can be uploaded to their portfolio to document their surgical progress.

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Tectal gliomas: assessment of malignant progression, clinical management, and quality of life in a supposedly benign neoplasm

Neurosurgical FOCUS ◽

10.3171/2018.3.focus1850 ◽

2018 ◽

Vol 44 (6) ◽

pp. E15 ◽

Cited By ~ 4

Author(s):

Malte Mohme ◽

Friederike S. Fritzsche ◽

Klaus C. Mende ◽

Jakob Matschke ◽

Ulrike Löbel ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Course ◽

Case Series ◽

Diffuse Astrocytoma ◽

The Mean ◽

Mean Time ◽

Tectal Glioma ◽

Astrocytoma Grade

OBJECTIVETectal gliomas constitute a rare and inhomogeneous group of lesions with an uncertain clinical course. Because these supposedly benign tumors are frequently followed up by observation over many years, the authors undertook this analysis of their own case series in an effort to demonstrate that the clinical course is highly variable and that there is a potential for a progressive biology.METHODSClinical data analysis of 23 cases of tectal glioma (involving 9 children and 14 adults) was performed retrospectively. Radiographic data were analyzed longitudinally and MR images were evaluated for tumor volume, contrast enhancement, and growth progression. Quality of life was assessed using the EORTC BN20 and C30 questionnaires during follow-up in a subgroup of patients.RESULTSThe patients’ mean age at diagnosis was 29.2 years. The main presenting symptom at diagnosis was hydrocephalus (80%). Six patients were treated by primary tumor resection (26.1%), 3 patients underwent biopsy followed by resection (13.1%), and 3 patients underwent biopsy only (13.1%). For additional treatment of hydrocephalus, 14 patients (60.9%) received shunts and/or endoscopic third ventriculostomy. Radiographic tumor progression was observed in 47.9% of the 23 cases. The mean time between diagnosis and growth progression was 51.5 months, and the mean time to contrast enhancement was 69.7 months. Histopathological analysis was obtained in 12 cases (52.2%), resulting in 5 cases of high-grade glioma (3 cases of glioblastoma multiforme [GBM], grade IV, and 2 of anaplastic astrocytoma, grade III), 5 cases of pilocytic astrocytoma, 1 diffuse astrocytoma, and 1 ganglioglioma. Malignant progression was observed in 2 cases, with 1 case progressing from a diffuse astrocytoma (grade II) to a GBM (grade IV) within a period of 13 years. Quality-of-life measurements demonstrated distinct functional deficits compared to a healthy sample as well as glioma control cohorts.CONCLUSIONSAnalysis of this case series shows that a major subpopulation of tectal gliomas show progression and malignant transformation in children as well as in adolescents. These tumors therefore cannot be considered inert lesions and require histological confirmation and close follow-up. Quality-of-life questionnaires show that tectal glioma patients might benefit from special psychological support in emotional, social, and cognitive functionality.

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Evaluation of Youtube Video Content About Developmental Dysplasia of the Hip

10.21203/rs.3.rs-25308/v2 ◽

2020 ◽

Author(s):

Ahmet Oztermeli ◽

Nazım Karahan

Keyword(s):

Peer Review Process ◽

International Health ◽

Poor Quality ◽

Developmental Dysplasia ◽

Global Quality ◽

Youtube Videos ◽

The Mean ◽

Mean Time ◽

Dysplasia Of The Hip

Abstract Background: The purpose of this study is to investigate the quality and reliability of YouTube videos regarding developmental dysplasia of the hip (DDH).YouTube is one of the most popular websites used as a source of information, but the variety in authorship and lack of a peer-review process are problems.Methods: The search string “developmental dysplasia of the hip” was inputted to the YouTube search engine, and the first 52 videos returned as a response were assessed. The Video Power Index (VPI) (like ratio*view ratio/100) was used to assess the popularity of the videos. Global Quality Score (GQS) and developmental dysplasia of the hip scores (DDHS) were used to evaluate the quality and educational quality of the videos, and The Journal of the American Medical Association Score (JAMAS) was used to evaluate the accuracy of the source of information.Results: According to our research, the mean duration time of the videos was 526 s (SD: 813), and the average view count of the videos was 34,644. The mean time since upload was 1907 days (SD: 1137). On average, the videos received 10.9 comments, 210.3 likes, and 6.8 dislikes. The mean like ratio and VPI were 92.9 (SD: 19.57) and 25.8 (SD: 53.43), respectively. The mean JAMAS, GQS, and DDHS of all videos evaluated were 1.37 (SD: 0.7), 2.46 (SD: 1.09), and 4.63 (SD: 5.00), respectively. The DDHS and GQS were positively correlated (p:0.001 r: 65.8%). The GQS and the DDHS were higher in the academic group than in the commercial group (p:0.01). (p:0.037).Conclusions: The videos regarding DDH on YouTube generally had poor quality. As a result, to maintain an optimal parent–physician or patient–physician relationship, we suggest that international health societies make their own educational videos for parents, patients, and fellow physicians.

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