scholarly journals Comparison of the Clinical Use of Macintosh and Miller Laryngoscopes for Orotracheal Intubation by Second-Month Nurse Students in Anesthesiology

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Somchai Amornyotin ◽  
Ungkab Prakanrattana ◽  
Phongthara Vichitvejpaisal ◽  
Thantima Vallisut ◽  
Neunghathai Kunanont ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Primary Outcome ◽  
Orotracheal Intubation ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Primary Outcome Variable ◽  
Safe Technique ◽  
The Mean ◽  
Nurse Students ◽  
Mean Heart Rate

Aim. The aim of this study is to compare the clinical feasibility of Macintosh and Miller laryngoscopes for tracheal intubation in non-experienced users in anesthetized patients.Patients and Methods. 119 patients were randomized into the Macintosh group (59) and the Miller group (60). The primary outcome variable was successful tracheal intubation. The secondary outcome variables were number of insertion attempt, intubation time needed, total time to intubation, hemodynamic change and complications.Results. All patients were successfully intubated using the Macintosh, whereas 13 patients (21.6%) were failed with the Miller (). The Macintosh significantly reduced the mean total time to intubation (). There were significant differences in the mean blood pressure at 2 minutes after laryngoscope insertion, immediately, and 2 minutes after tracheal intubation and in the mean heart rate at the laryngoscope insertion, immediately, and at 2 minutes after tracheal intubation between the two groups. Overall complications in both were not significantly different.Conclusion. Orotracheal intubation using the Macintosh is an effective and safe technique in non-experienced hands with significantly increased success rate as well as decreased mean total time to intubation as compare to the Miller. However, these intubations only apply to selected patients deemed to have normal airways.

Fractures in the Pediatric Emergency Department: Are We Considering Abuse?

2018 ◽  
Vol 57 (10) ◽  
pp. 1161-1167 ◽  
Author(s):  
Lindsay R. Lavin ◽  
Cody H. Penrod ◽  
Cristina M. Estrada ◽  
Donald H. Arnold ◽  
Benjamin R. Saville ◽  
...  
Keyword(s):  
Emergency Department ◽  
Primary Outcome ◽  
Pediatric Emergency ◽  
Primary Objective ◽  
Predictor Variables ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Pediatric Emergency Department ◽  
Emergency Physicians ◽  
Primary Outcome Variable

Approximately one fourths of infant fractures are due to abuse. Recognition of abuse is important to avoid further morbidity/mortality. There is limited knowledge regarding how frequently pediatric emergency department clinicians consider abuse in infants with fractures. Our primary objective was to estimate the percentage of infants with fractures for whom abuse was considered, and to examine characteristics associated with abuse consideration. We performed a retrospective review of infants <1 year of age presenting to a pediatric emergency department. Our primary outcome variable was consideration of abuse. Our secondary outcome measures were identification of predictor variables associated with consideration of abuse. We identified 509 infants meeting study criteria. Pediatric emergency physicians considered abuse in approximately two thirds of infants with fractures. Consideration was more likely to occur in younger infants, in the presence of no history or unwitnessed injury mechanism, when evaluated by male physicians, and emergency department encounters from 12 am to 6 am.

scholarly journals Bronchodilator Response to Salbutamol Delivered by Metered Dose Inhaler with Spacer and Dry Powder Inhaler in Acute Asthma In Children: A Comparative Study

2014 ◽  
Vol 38 (2) ◽  
pp. 68-73
Author(s):  
Md Saifuddin Khaled ◽  
Firoza Akter ◽  
Khadija Rahman ◽  
Mohammad Shahid Ullah ◽  
Md Hamidur Rahman
Keyword(s):  
Primary Outcome ◽  
Acute Asthma ◽  
Dry Powder Inhaler ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Dose Inhaler ◽  
Primary Outcome Variable ◽  
Bronchodilator Response ◽  
Before And After ◽  
Metered Dose

Background: Salbutamol inhalation is the mainstay of treatment for acute exacerbation of asthma. A number of delivery systems for asthma medication have been developed for children, each having its own advantages and disadvantages. This study was done to compare the bronchodilator effect of salbutamol inhalation delivered through metered dose inhaler (MDI) with spacer and dry powder inhaler (DPI) in children presenting with mild and moderate acute asthma. Methodology: Children of 6 to 15 years of age with mild or moderate acute exacerbation of asthma were assessed primarily and randomly distributed into two groups having equal number of patients and received 400micro-gram of salbutamol delivered by either MDI with spacer or DPI device. The primary outcome variable was peak expiratory flow rate (PEFR) and secondary outcome variables were percent predicted PEFR, heart rate, respiratory rate, oxygen saturation, wheezing and accessory muscle scores. Changes in primary and secondary outcome variables, before and after drug intervention were recorded and subjected to statistical tests for significance. Separate analyses were done for mild and moderate asthma patients. Results: The changes in primary outcome variable (PEFR) in both groups before and after intervention was 179.19 ± 33.27 vs. 197.52 ± 57.01 liters/min and 184.81 ± 59.65 vs. 202.83 ± 64.76 liters/min respectively, which was statistically highly significant (P= 0.001). Similar significant changes were also observed in case of secondary outcome variables. Conclusion: Bronchodilator response to salbutamol in mild or moderate acute asthma in children is similar when equal amount of drug is delivered either through an MDI with spacer or a DPI DOI: http://dx.doi.org/10.3329/bjch.v38i2.21138 Bangladesh J Child Health 2014; VOL 38 (2) : 62-67

scholarly journals BRONCHIOLITIS;

2012 ◽  
Vol 20 (01) ◽  
pp. 089-094
Author(s):  
SHAKIL AHMAD ◽  
SADIDA AAMIR ◽  
KHURRAM NAWAZ
Keyword(s):  
Primary Outcome ◽  
Symptomatic Relief ◽  
University Hospital ◽  
Outpatient Department ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Interventional Study ◽  
Primary Outcome Variable ◽  
Normal Feeding ◽  
Independent University

Objectives: To determine the efficacy of oral salbutamol administration for symptomatic relief in children less than twoyears of age with acute mild bronchiolitis. Study Design: Interventional study. Place and duration of study: Outpatient department ofDepartment of Pediatrics, independent university hospital, Faisalabad, Pakistan, from October 2010 to March 2011. Methodology: 160children less than two years of age diagnosed clinically as acute mild bronchiolitis with comparable baseline parameters (age, weight,duration of present illness) were included in the study. They were randomly placed in two groups, Salbutamol Group (SG) (n=80)Placebo Group (PG) (n=80) and were followed daily for first 3 days, then on day 5 and day 7 in outpatient department. Oral salbutamolwas administered (0.1 mg/kg/dose) three times daily for 7 days or till complete resolution of illness, whichever came earlier. Time forresolution of illness (ROI) was primary outcome variable whereas time for resolution of cough, coryza, breathlessness, wheeze,achievement of normal feeding and sleep patterns and salbutamol adverse effects were secondary outcome variables. Results: Meanduration of resolution of illness (ROI) was similar in both groups. (6.1±0.75) days in the salbutamol group and (6.0±0.80) days inplacebo group (p=0.53). There was no significant resolution time difference of secondary outcome variables between the two studygroups. Cough (SG 4.1"0.70, PG 4.1"0.68, P=0.68) Coryza (SG 4.3"0.59, PG 4.2"0.62, P=0.14) Wheeze and Breathlessness (SG3.8"0.60, PG 3.8"0.63, p=0.24) Sleep (SG 4.5"0.40, PG 4.4"0.55, p=0.19) Feeding (SG 4.3"0.59, PG 4.2"0.62, P= 0.14). Salbutamoladverse effects (tremors, irritability) were observed in 13 (16.25%) children in salbutamol group. Conclusions: Oral salbutamoladministration is not superior to placebo in providing symptomatic relief in children with acute mild bronchiolitis.

DRAIN VERSUS NO DRAIN AFTER LAPAROSCOPIC CHOLECYSTECTOMY-A COMPARATIVE STUDY.

2021 ◽  
pp. 82-83
Author(s):  
Neelesh Bansal ◽  
Simran Simran ◽  
Debarshi Jana
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Comparative Study ◽  
Primary Outcome ◽  
Outcome Variable ◽  
Medical Sciences ◽  
Research Committee ◽  
Primary Outcome Variable ◽  
Drain Group ◽  
Calculate Sample Size ◽  
Site Pain

INTRODUCTION Gallstones are the most common conditions encountered in surgical OPD. The prevalence rose with age, except in women of 40-49 years, so that at 60-69 years, 22.4% of women and 11.5% of men had gall stones or had undergone cholecystectomy. With the help of this study, best treatment option for cholecystectomy patient (whether to insert drain or not), was ensured in terms of post lap cholecystectomy collections of bile or blood, drain site pain. The study was provide knowledge whether drain insertion was benecial or harmful to patient. MATERIALS AND METHODS This comparative study was presented to the surgery OPD and emergency department with cholelithiasis within a period of 1 year from the approval of Research committee and Ethics Committee, Adesh institute of medical sciences and research, Bathinda. The primary outcome variable used to calculate sample size is amount of collection on post-operative day 3(Quantitative Variable) in both groups. Total 100 patients were present in this study. RESULT In this present study VAS median grade in patients with drain was G4 (48%), followed by G3(47%) then G2(5%). VAS median grade in without drain group was G2 (48%), followed by G3(31%) and G1(16%). CONCLUSION There is no signicant difference as far as post operative wound infection in laparoscopic Cholecystectomy with drain or without drain. Therefore in patients undergoing laparoscopic cholecystectomy keeping drain can be avoided as it does not provide any additional benet.

A phase III trial of intramuscular recombinant interferon beta as treatment for exacerbating-remitting multiple sclerosis: design and conduct of study and baseline characteristics of patients

1995 ◽  
Vol 1 (2) ◽  
pp. 118-135 ◽  
Author(s):  
LD Jacobs ◽  
DL Cookfair ◽  
RA Rudick ◽  
RM Herndon ◽  
J R Richert ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Interferon Beta ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Phase Iii ◽  
Secondary Outcome ◽  
Recombinant Interferon ◽  
Study Population ◽  
The Mean ◽  
Baseline Characteristics

The design and conduct of a randomized, double-blinded, placebo-controlled, multicenter, phase III study of recombinant interferon beta-1a (IFN-β-1a) as treatment for exacerbating-remitting MS are described, as are baseline characteristics of the study population. The purpose of the study was to determine if 6.0 × 106 IU (30 μg) of IFN-β-1a, administered by weekly intramuscular (i.m.) injections, was effective in delaying the onset of sustained disability. The primary outcome measure was time to onset of treatment failure, defined as a worsening on the Kurtzke Expanded Disability Status Scale (EDSS) of greater than or equal to 1.0 point compared with baseline, persisting for at least 6 months. An intent-to-treat design was used. The primary outcome measure was analyzed using the Mantel-Cox log-rank statistic and Kaplan-Meier survival curves. Secondary outcomes included quantitative measures of upper and lower extremity function, neuropsychological test performance, functional and quality of life assessments and several measures derived from annual brain MRI studies. Entry criteria included prestudy exacerbation rates of at least 0.67 per year and EDSS scores of 1.0–3.5. A total of 301 MS patients were randomly assigned to receive weekly i.m. injections of IFN-β-1a or placebo. The average age of the study population at entry was 37 years; 92% were Caucasian and 73% were women. The mean prestudy disease duration was 6.5 years, mean prestudy exacerbation rate was 1.2 per year and the mean EDSS score was 2.3. The randomization yielded well-balanced treatment arms. Various aspects of the study are discussed, including: (1) the decision to focus study design on sustained disability; (2) the rationale for the treatment regimen; (3) measures taken to assure the reliability of the primary outcome measure; and (4) a description of the secondary outcome measures.

Abstract 133: White Matter Hyperintensity and Cardiovascular Disease Outcomes: A Secondary Analysis of the SPRINT MIND Trial

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Tanya Turan ◽  
Sharon Yeatts ◽  
Rebecca Gottesman ◽  
Shyam Prabhakaran ◽  
...  
Keyword(s):  
White Matter ◽  
Primary Outcome ◽  
Stroke Risk ◽  
Secondary Analysis ◽  
White Matter Hyperintensity ◽  
Secondary Outcome ◽  
Cox Models ◽  
Disease Outcomes ◽  
Hazard Ratios ◽  
The Mean

Background: The Systolic Blood Pressure Intervention Trial (SPRINT) randomized patients to a goal SBP <120 mm Hg vs. <140 mm Hg . A subset of patients enrolled in SPRINT MIND, which performed a baseline MRI and measured white matter hyperintensity volume (WMHv). We evaluated the association between WMHv and cardiovascular events. Methods: The primary outcome was a composite of stroke, MI, ACS, decompensated CHF, or CVD death. The secondary outcome was stroke. The WMHv was divided into quartiles. We fit Cox models to the outcomes and report adjusted hazard ratios for the quartiles of WMHv, and stratified by SPRINT treatment arm. Results: Among 719 included patients, the mean WMHv in the quartiles was 0.34, 1.09, 2.61, and 10.8 mL. The primary outcome occurred in 51/719 (7.1%) and the secondary outcome in 10/719 (1.4%). The WMHv was associated with both outcomes (Table 1, Figure 1). After stratifying by treatment arm, we found the association persisted in the standard, but not intensive, treatment arm (Table 2). However, the interaction term between WMHv and treatment arm was not significant. Conclusions: We observed that degree of WMH was associated with CVD and stroke risk in SPRINT MIND. The risk may be attenuated in patients randomized to intensive BP lowering. Trials are needed to determine if intensive BP lowering can prospectively reduce the high cardiovascular risk in patients with WMH.

P–328 Dienogest significantly decreases the size of the cyst and alters Anti-Müllerian Hormone concentration in patients with endometrioma

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
E Karataş ◽  
B E Temiz ◽  
S Mumusoglu ◽  
H Yarali ◽  
G Bozdag
Keyword(s):  
Primary Outcome ◽  
Statistical Significance ◽  
Mean Difference ◽  
Secondary Outcome ◽  
Control Group ◽  
Significant Drop ◽  
Mean Size ◽  
The Mean ◽  
Respective Figure

Abstract Study question Does utilization of dienogest make any impact on the size of cyst and Anti-Müllerian Hormone (AMH) concentration in patients with endometrioma throughout 12-months? Summary answer Although dienogest makes a gradual reduction in the size of endometrioma cyst throughout 12-months, a significant drop in AMH serum concentration was also noticed. What is known already According to recent studies, pre-operative serum AMH levels might be illusively increased with parallel to the size of endometrioma which will be a misleading factor while deciding to operate the patient via cystectomy. Although dienogest is one of the medical options that might be commenced in patients with endometrioma cyst, there is limited data about its effect on the size of the endometrioma and hence serum AMH concentration throughout 12 months of follow up. Study design, size, duration The current observational cohort study was conducted among patients with endometrioma those treated with dienogest from January 2017 to January 2020. The primary outcome was alteration in diameter of endometrioma cyst at 6th and 12th months of treatment. Secondary outcome was alteration in serum AMH concentration in the same period. Of 104 patients treated with dienogest, 44 patients were excluded due to being treated with any type of surgical intervention during follow up period. Participants/materials, setting, methods A total of 60 patients were recruited for the final analysis. Of them, primary symptom was dysmenorrhea, chronic pelvic pain and menstrual irregularity in 16 (26.7%), 25 (41.7%) and 8 (13.3%) patients, respectively. Eighteen patients (30%) were asymptomatic. As 21 patients had bi-lateral endometrioma, size of the leading cyst was considered to be analyzed for the primary outcome measure. Paired-t test was used for comparison of numerical values and p ≤ 0.05 was taken as statistical significance. Main results and the role of chance The mean age was 31.5±8.0 years. In the time point when dienogest was started, the mean size of the endometrioma was 46.3±17.4 mm. The mean serum AMH concentration was 3.6±2.4 ng/ml. After 6 months of treatment, the mean size of the endometrioma decreased to 38.6±14.0 mm which corresponds to a mean difference of 7.8 mm (95% CI: 3.0 to 12.6; p: 0.003). The respective figure for AMH was 3.3±2.7 ng/ml which corresponds to a mean difference of 0.3 ng/ml (95% CI: –0.2 to 0.8; p: 0.23) at 6 months. After 12 months of treatment, the mean size of the endometrioma was 37.5±15.7 mm which corresponds to a mean difference of 8.9 mm (95% CI: 2.9 to 14.9; p: 0.005) at the end of 12 months. The respective figure for AMH was 2.7±1.9 ng/ml which corresponds to a mean difference of 0.9 ng/ml (95% CI: 0.1 to 1.7; p: 0.045) at the end of 12 months. The mean diameter of endometrioma and AMH concentration did not differ throughout the time period between 6th and 12th months of the treatment. Limitations, reasons for caution Although herein we present the largest data that depicts the alteration of endometrioma cyst and AMH concentration with the application of dienogest, the lack of control group is a limitation that avoids to perform any comparison. Wider implications of the findings: A shrinkage after commencement of treatment suggest that dienogest might present improvement in patients with endometrioma with respect to radiological findings, but further studies are required whether a decline in AMH concentration after 12 months refers to a genuine decrease in ovarian reserve or resolution of misleading high pre-treatment levels. Trial registration number not available

End-Tidal CO2 as a Predictor of Survival in Out-of-Hospital Cardiac Arrest

2011 ◽  
Vol 26 (3) ◽  
pp. 148-150 ◽  
Author(s):  
Marc Eckstein ◽  
Lorien Hatch ◽  
Jennifer Malleck ◽  
Christian McClung ◽  
Sean O. Henderson
Keyword(s):  
Cardiac Arrest ◽  
Los Angeles ◽  
Spontaneous Circulation ◽  
Outcome Variable ◽  
Primary Outcome Variable ◽  
Return Of Spontaneous Circulation ◽  
Bystander Cardiopulmonary Resuscitation ◽  
The Mean ◽  
End Tidal ◽  
Hospital Cardiac Arrest

AbstractObjective: The objective of this study was to evaluate initial end-tidal CO2 (EtCO2) as a predictor of survival in out-of-hospital cardiac arrest.Methods: This was a retrospective study of all adult, non-traumatic, out-of-hospital, cardiac arrests during 2006 and 2007 in Los Angeles, California. The primary outcome variable was attaining return of spontaneous circulation (ROSC) in the field. All demographic information was reviewed and logistic regression analysis was performed to determine which variables of the cardiac arrest were significantly associated with ROSC.Results: There were 3,121 cardiac arrests included in the study, of which 1,689 (54.4%) were witnessed, and 516 (16.9%) were primary ventricular fibrillation (VF). The mean initial EtCO2 was 18.7 (95%CI = 18.2–19.3) for all patients. Return of spontaneous circulation was achieved in 695 patients (22.4%) for which the mean initial EtCO2 was 27.6 (95%CI = 26.3–29.0). For patients who failed to achieve ROSC, the mean EtCO2 was 16.0 (95%CI = 15.5–16.5). The following variables were significantly associated with achieving ROSC: witnessed arrest (OR = 1.51; 95%CI = 1.07–2.12); initial EtCO2 >10 (OR = 4.79; 95%CI = 3.10–4.42); and EtCO2 dropping <25% during the resuscitation (OR = 2.82; 95%CI = 2.01–3.97).The combination of male gender, lack of bystander cardiopulmonary resuscitation, unwitnessed collapse, non-vfib arrest, initial EtCO2 ≤10 and EtCO2 falling > 25% was 97% predictive of failure to achieve ROSC.Conclusions: An initial EtCO2 >10 and the absence of a falling EtCO2 >25% from baseline were significantly associated with achieving ROSC in out-of-hospital cardiac arrest. These additional variables should be incorporated in termination of resuscitation algorithms in the prehospital setting.

scholarly journals A Sternum-Disk Distance Method to Identify the Skin Level for Approaching a Surgical Segment without Fluoroscopy Guidance during Anterior Cervical Discectomy And Fusion

2017 ◽  
Vol 11 (1) ◽  
pp. 50-56
Author(s):  
Gun Woo Lee ◽  
Myun-Whan Ahn ◽  
Ji-Hoon Shin ◽  
Jae Woo Park ◽  
Jae-Hyung Uh ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Kappa Coefficient ◽  
Anterior Cervical Discectomy ◽  
Secondary Outcome ◽  
Distance Method ◽  
Cervical Discectomy ◽  
Observer Reliability ◽  
The Mean

<sec><title>Study Design</title><p>A retrospective review of prospectively collected data.</p></sec><sec><title>Purpose</title><p>To introduce the sternum-disk distance (SDD) method for approaching the exact surgical level without C-arm guidance during anterior cervical discectomy and fusion (ACDF) surgery and to evaluate its accuracy and reliability.</p></sec><sec><title>Overview of Literature</title><p>Although spine surgeons have tried to optimize methods for identifying the skin level for accessing the operative disk level without C-arm guidance during ACDF, success has rarely been reported.</p></sec><sec><title>Methods</title><p>In total, 103 patients who underwent single-level ACDF surgery with the SDD method were enrolled. The primary outcome measure was the accuracy of the SDD method. The secondary outcome measures were the mean SDD value at each cervical level from the cranial margin of the sternum in the neutral and extension positions of the cervical spine and the inter- and intra-observer reliability of the SDD outcome determined using repeated measurements by three orthopedic spine surgeons.</p></sec><sec><title>Results</title><p>The SDD accuracy (primary outcome measure) was indicated in 99% of the patients (102/103). The mean SDD values in the neutral-position magnetic resonance imaging (MRI) were 108.8 mm at C3–C4, 85.3 mm at C4–C5, 64.4 mm at C5–C6, 44.3 mm at C6–C7, and 24.1 mm at C7–T1; and those in the extension-position MRI were 112.9 mm at C3–C4, 88.7 mm at C4–C5, 67.3 mm at C5–C6, 46.5 mm at C6–C7, and 24.3 mm at C7–T1. The Cohen kappa coefficient value for intra-observer reliability was 0.88 (excellent reliability), and the Fleiss kappa coefficient value for inter-observer reliability as reported by three surgeons was 0.89 (excellent reliability).</p></sec><sec><title>Conclusions</title><p>Based on the results of the present study, we recommend performing ACDF surgery using the SDD method to determine the skin level for approaching the surgical cervical segment without fluoroscopic guidance.</p></sec>

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