scholarly journals Emergency Tracheal Intubation in Patients with COVID-19: Experience from a UK Centre

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Ajay Gandhi ◽  
Jagdish Sokhi ◽  
Chris Lockie ◽  
Patrick A. Ward
Keyword(s):  
Tracheal Intubation ◽  
Online Survey ◽  
Case Series ◽  
Standard Operating Procedure ◽  
Education Programme ◽  
Oxygen Desaturation ◽  
Related Factor ◽  
Team Members ◽  
First Pass ◽  
Main Factor

This retrospective observational case series describes a single centre’s preparations and experience of 53 emergency tracheal intubations in patients with COVID-19 respiratory failure. The findings of a contemporaneous online survey exploring technical and nontechnical aspects of airway management, completed by intubation team members, are also presented. Preparations included developing a COVID-19 intubation standard operating procedure and checklist, dedicated airway trolleys, a consultant-led mobile intubation team, and an airway education programme. Tracheal intubation was successful in all patients. Intubation first-pass success rate was 85%, first-line videolaryngoscopy use 79%, oxygen desaturation 49%, and hypotension 21%. Performance was consistent across all clinical areas. The main factor impeding first-pass success was larger diameter tracheal tubes. The majority of intubations was performed by consultant anaesthetists. Nonconsultant intubations demonstrated higher oxygen desaturation rates (75% vs. 45%, p = 0.610 ) and lower first-pass success (0% vs. 92%, p < 0.001 ). Survey respondents (n = 29) reported increased anxiety at the start of the pandemic, with statistically significant reduction as the pandemic progressed (median: 4/5 very high vs. 2/5 low anxiety, p < 0.001 ). Reported procedural/environmental challenges included performing tasks in personal protective equipment (62%), remote-site working (48%), and modification of normal practices (41%)—specifically, the use of larger diameter tracheal tubes (21%). Hypoxaemia was identified by 90% of respondents as the most challenging patient-related factor during intubations. Our findings demonstrate that a consultant-led mobile intubation team can safely perform tracheal intubation in critically ill COVID-19 patients across all clinical areas, aided by thorough preparation and training, despite heightened anxiety levels.

Impact of Physician Training Level on Neonatal Tracheal Intubation Success Rates and Adverse Events: A Report from National Emergency Airway Registry for Neonates (NEAR4NEOS)

Neonatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Lindsay Johnston ◽  
Taylor Sawyer ◽  
Anne Ades ◽  
Ahmed Moussa ◽  
Jeanne Zenge ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Adverse Events ◽  
Multivariable Analysis ◽  
Estimating Equation ◽  
Oxygen Desaturation ◽  
Physician Training ◽  
Training Level ◽  
Success Rates ◽  
Emergency Airway ◽  
Significant Difference

<b><i>Introduction:</i></b> Neonatal tracheal intubation (TI) outcomes have been assessed by role, but training level may impact TI success and safety. Effect of physician training level (PTL) on the first-attempt success, adverse TI-associated events (TIAEs), and oxygen desaturation was assessed. <b><i>Methods:</i></b> Prospective cohort study in 11 international NEAR4NEOS sites between October 2014 and December 2017. Primary TIs performed by pediatric/neonatal physicians were included. Univariable analysis evaluated association between PTL, patient/practice characteristics, and outcomes. Multivariable analysis with generalized estimating equation assessed for independent association between PTL and outcomes (first-attempt success, TIAEs, and oxygen desaturation ≥20%; attending as reference). <b><i>Results:</i></b> Of 2,608 primary TIs, 1,298 were first attempted by pediatric/neonatal physicians. PTL was associated with patient age, weight, comorbidities, TI indication, difficult airway history, premedication, and device. First-attempt success rate differed across PTL (resident 23%, fellow 53%, and attending 60%; <i>p</i> &#x3c; 0.001). There was no statistically significant difference in TIAEs (resident 22%, fellow 20%, and attending 25%; <i>p</i> = 0.34). Desaturation occurred more frequently with residents (60%), compared to fellows and attendings (46 and 53%; <i>p</i> &#x3c; 0.001). In multivariable analysis, adjusted odds ratio of the first-attempt success was 0.18 (95% CI: 0.11–0.30) for residents and 0.80 (95% CI: 0.51–1.24) for fellows. PTL was not independently associated with adjusted odds of TIAEs or severe oxygen desaturation. <b><i>Conclusion:</i></b> Higher PTL was associated with increased first-attempt success but not TIAE/oxygen desaturation. Identifying strategies to decrease adverse events during neonatal TI remains critical.

A Direct Aspiration First Pass Technique in Japanese Real-World Clinical Setting

2018 ◽  
Vol 17 (2) ◽  
pp. 115-122 ◽  
Author(s):  
Junji Uno ◽  
Katsuharu Kameda ◽  
Ryosuke Otsuji ◽  
Nice Ren ◽  
Shintaro Nagaoka ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Real World ◽  
Cerebral Blood Volume ◽  
Mechanical Thrombectomy ◽  
Case Series ◽  
Entire Study ◽  
Stroke Treatment ◽  
Real World Setting ◽  
Hemorrhagic Complications ◽  
First Pass

Abstract BACKGROUND It is debatable whether mechanical thrombectomy has benefits in a real-world setting outside the more rigid and selective clinical trial environment. OBJECTIVE To evaluate clinical outcomes, efficacy, and safety of mechanical thrombectomy in single-center retrospective cohort case series. METHODS We reviewed prospectively collected data from our large-vessel occlusion stroke database to identify patients undergoing mechanical thrombectomy using Penumbra catheters (Penumbra, Almeida, California) as first-line devices. The primary outcomes were the modified Rankin Scale score at 90 d and recanalization rate. The secondary outcomes included the rates of hemorrhagic complications and mortality. RESULTS The entire study population included 298 patients. Thrombolysis in Cerebral Infarction Scale ≥2b was achieved in 86.6% of patients. Fifty-five patients (18.5%) were outside the 6 hr time window and 82 patients (27.5%) were over 80-yr old. The posterior circulation thrombectomy rate was 12.4%. At 90 d from onset, 49.3% of patients had favorable outcomes. The parenchymal hemorrhage type 2 (PH2) and subarachnoid hemorrhage rates were 2.3% and 11.7%, respectively. In multivariate analyses, cerebral blood flow/cerebral blood volume mismatch (odds ratio [OR] = 9.418; 95% confidence interval [CI], 3.680-27.726; P < .0001), onset to recanalization time (OR = 0.995; 95% CI, 0.991-0.998; P = .0003), and hemorrhagic complications including PH2 and subarachnoid hemorrhage (OR = 0.186; 95% CI, 0.070-0.455; P = .0002) were associated with favorable outcomes. CONCLUSION A direct aspiration first pass technique with an adjunctive device demonstrated high recanalization rates in old Japanese patients. Our patient cohort may reflect the application of endovascular techniques in acute ischemic stroke treatment in a real-world setting.

Nutrient-Dense, Plant-Rich (NDPR) Diet in Cancer Survivors: Case Series

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Joel H Fuhrman ◽  
Deana M Ferreri
Keyword(s):  
Quality Of Life ◽  
Cancer Survivors ◽  
Cancer Prevention ◽  
Cancer Diagnosis ◽  
Case Series ◽  
Sufficient Evidence ◽  
Related Factor ◽  
Inhibition Of Proliferation ◽  
Risk Of Recurrence

Adherence to healthy lifestyle behaviors in cancer survivors has the potential to reduce the risk of recurrence and improve quality of life. Although whole diet intervention studies in cancer survivors are scarce, the available evidence supports a plant-based diet, and the World Cancer Research Fund (WCRF) recommends following cancer prevention diet and lifestyle guidelines to reduce the risk of recurrence. There is sufficient evidence to presume that the same phytochemical-rich foods that have been shown to reduce the risk of developing cancer (prevention) are beneficial and lifespan promoting for those who have a diagnosis of cancer. The nutrient-dense, plant-rich (NDPR) diet (also called a Nutritarian diet) is a plant-based diet that places emphasis on foods with evidence backing anti-tumor activity such as inhibition of proliferation and angiogenesis, apoptosis promotion, anti-inflammatory effects, and induction of the master regulator of detoxification and antioxidant response nuclear factor erythroid 2-related factor 2 (Nrf2): leafy green vegetables, beans, garlic and onion, seeds and nuts, mushrooms, berries, and other carotenoid-rich fruits and vegetables, assuring rich sources of phytonutrients and plant lignans. Here, we present seven cases of patients who had adopted the NDPR diet following a cancer diagnosis and conveyed details of their results. Patients generally reported improved quality of life, intentional weight loss, no recurrence, and improvement in other aspects of health in the years after cancer diagnosis provoked their dietary change.

scholarly journals The Power of Empowerment: Predictors and Benefits of Shared Leadership in Organizations

2020 ◽  
Vol 11 ◽  
Author(s):  
Charlotte M. Edelmann ◽  
Filip Boen ◽  
Katrien Fransen
Keyword(s):  
Shared Leadership ◽  
Online Survey ◽  
Well Being ◽  
Survey Study ◽  
Team Identification ◽  
Peer Leaders ◽  
Peer Leadership ◽  
High Quality ◽  
Team Members ◽  
Leadership Quality

Leadership plays an essential part in creating competitive advantage and well-being among employees. One way in which formal leaders can deal with the variety of responsibilities that comes with their role is to share their responsibilities with team members (i.e., shared leadership). Although there is abundant literature on how high-quality peer leadership benefits team effectiveness (TE) and well-being, there is only limited evidence about the underpinning mechanisms of these relationships and how the formal leader can support this process. To address this lacuna, we conducted an online survey study with 146 employees from various organizations. The results suggest that an empowering leadership style of the formal leader is associated with higher perceived peer leadership quality (PLQ) on four different leadership roles (i.e., task, motivational, social, and external leader). In addition, formal leaders who empower their team members are also perceived as better leaders themselves. Moreover, the improved PLQ was in turn positively related to TE and work satisfaction, while being negatively related to burnout. In line with the social identity approach, we found that team identification mediated these relationships. Thus, high-quality peer leaders succeeded in creating a shared sense of “us” in the team, and this team identification in turn generated all the positive outcomes. To conclude, by sharing their lead and empowering the peer leaders in their team, formal leaders are key drivers of the team’s effectiveness, while also enhancing team members’ health and well-being.

Awake tracheal intubation using the Airtraq®laryngoscope: a case series

2009 ◽  
Vol 53 (7) ◽  
pp. 964-967 ◽  
Author(s):  
V. K. DIMITRIOU ◽  
I. D. ZOGOGIANNIS ◽  
D. G. LIOTIRI
Keyword(s):  
Tracheal Intubation ◽  
Case Series

scholarly journals Prehospital Use of the Intubating Laryngeal Mask Airway in Patients with Severe Polytrauma: A Case Series

2009 ◽  
Vol 2009 ◽  
pp. 1-7 ◽  
Author(s):  
Andrew M. Mason
Keyword(s):  
Laryngeal Mask Airway ◽  
Tracheal Intubation ◽  
Road Traffic ◽  
Case Series ◽  
Prehospital Setting ◽  
Laryngeal Mask ◽  
Probability Of Survival ◽  
Survival Study ◽  
Intubating Laryngeal Mask Airway ◽  
Better Than

A case series of five patients is described demonstrating the utility of the intubating laryngeal mask airway in the prehospital setting, both as a primary airway rescue device and as a bridge to tracheal intubation. All patients were hypoxaemic, had sustained severe polytrauma and were trapped in their vehicles following road traffic collisions. A probability of survival study showed better-than-predicted outcomes for the group as a whole.

scholarly journals An ICF-based education programme in amputation rehabilitation for medical residents in the Netherlands

2011 ◽  
Vol 35 (3) ◽  
pp. 318-322 ◽  
Author(s):  
Jan HB Geertzen ◽  
GM Rommers ◽  
Rienk Dekker
Keyword(s):  
The Netherlands ◽  
Occupational Therapists ◽  
Education Programme ◽  
Medical Residents ◽  
Physical Medicine ◽  
Team Members ◽  
The Common ◽  
Core Sets ◽  
Icf Core Sets ◽  
Further Development

Background and Aim: Education programmes of the International Society for Prosthetics and Orthotics (ISPO) are directed primarily at prosthetists and orthotists. In a multidisciplinary setting, greater attention should be given to other professionals working in the field of amputation, prosthetics and orthotics. This includes, among others, physiotherapists, occupational therapists and residents and physicians from orthopaedics, vascular surgery and physical medicine and rehabilitation (PM&R). The aim of this paper is to describe the education programme in amputation and prosthetics for residents in PM&R in the Netherlands. The programme is based on concepts of the International Classification on Functioning, Disability and Health (ICF). Technique: This narrative paper presents the amputation and prosthetics education programme for residents in PM&R in the Netherlands. The programme is based on two models: the ICF and the Canadian Medical Education Directives for Specialists (CanMEDS). Discussion: ICF core sets for amputation and prosthetics need further development. Subsequently, the application of these core sets can help stimulate the education of residents in PM&R, and other multidisciplinary team members who work in amputation rehabilitation Clinical relevance Through this education programme, residents work closely with other team members using the common language of the ICF, enhancing treatment and technical advice in amputee care.

scholarly journals LEVEL OF READINESS AND ACCEPTANCE OF MAINSTREAM TEACHERS TOWARDS THE IMPLEMENTATION OF INCLUSIVE EDUCATION IN LEARNING DISABILITY

2021 ◽  
Vol 9 (2) ◽  
pp. 79-90
Author(s):  
NIK HASSAN SEMAN ◽  
MOHD ISKANDAR DAUD ◽  
NOR KAMILAH MAKHTAR ◽  
NIK AZHAR NIK AB RAHMAN ◽  
FARAH DILLA RAMLI
Keyword(s):  
Learning Disability ◽  
Inclusive Education ◽  
Education Program ◽  
Primary Schools ◽  
Online Survey ◽  
Strong Field ◽  
Education Programme ◽  
Study Data ◽  
Mainstream Teachers ◽  
High Level

AbstractInclusive Education Program (IEP) is a challenging educational transformation as the teachers who are involved in it need to equip themselves with a strong field of knowledge, sound teaching skills as well as commendable attitudes. This study aims to examine the state of readiness of mainstream teachers in terms of knowledge and acceptance of the implementation of the Inclusive Education Program for learning disabilities. A total of 80 mainstream teachers in several primary schools in the district of Kota Bharu Kelantan were selected as respondents in this study. Data were collected through an online survey using a google form questionnaire and were analyzed descriptively. The findings show that the involved mainstream teachers have a high level of state of readiness in terms of knowledge of the Inclusive Education Program, while in the aspect of acceptance, most respondents obtained a moderate level. The results of this study show that many efforts and programmes are needed to help improve knowledge and the level of acceptance among mainstream teachers to successfully implement an Inclusive Education Program for learning disability.   AbstrakProgram Pendidikan Inklusif (Inclusive Education Programme, IEP) merupakan satu program transformasi Pendidikan negara yang mencabar kerana guru yang terlibat perlu melengkapkan diri dengan pengetahuan pendidikan inklusif yang mantap, kemahiran mengajar yang baik dan memiliki sikap yang terpuji. Kajian ini bertujuan untuk mengkaji tahap kesediaan guru arus perdana dari segi pengetahuan dan penerimaan pelaksanaan IEP dalam masalah pembelajaran. Seramai 80 orang guru arus perdana di beberapa sekolah rendah di daerah Kota Bharu, Kelantan telah dipilih sebagai responden kajian. Data dikumpulkan melalui kaedah tinjauan menggunakan borang soal selidik Google Form secara atas talian dan dianalisis secara deskriptif. Dapatan kajian menunjukkan guru arus perdana yang terlibat mempunyai tahap kesediaan yang tinggi dalam aspek pengetahuan berkaitan IEP, manakala dalam aspek penerimaan, majoriti responden menunjukkan tahap yang sederhana. Hasil kajian ini menunjukkan perlunya pelbagai usaha dan program dijalankan bagi membantu meningkatkan pengetahuan dan tahap penerimaan dalam kalangan guru arus perdana untuk melaksanakan IEP dalam kategori masalah pembelajaran.

scholarly journals Examination of views and suggestions about participation of families of children with special needs in individualised education programme

2018 ◽  
Vol 13 (1) ◽  
pp. 31-40
Author(s):  
Adile Emel Sardohan Yildirim ◽  
Gonul Akcamete
Keyword(s):  
Special Needs ◽  
Education Programme ◽  
Structured Interview ◽  
Children With Special Needs ◽  
Keywords Children ◽  
Interview Technique ◽  
Analysis Technique ◽  
The Family ◽  
Main Factor

Individualised education programmes (IEP) will be practiced with children with special needs (CWSN) and their families. The main factor for IEP’s success is the participation of the family and also, their children. In this study, views and suggestions about participation of families of CWSN in their IEP processes are examined. The research is based on qualitative research. Five mothers and a grandmother with CWSN were participated; data are collected via semi-structured interview technique and analysed with inductive analysis technique. This research uncovers that the participants didn’t participate in their children’s diagnosis, assessment, settlement and follow-up processes, and they were not content with the assessment results. Also, the participants who didn’t participate in the IEP weren’t even aware of the legal obligation that they had to and their children’s IEP, they weren’t in cooperation with the teacher in that process, and teachers didn’t show the progress in the children to the families even if they recorded that. Keywords: Children with special needs (CWSN), family, individualised education programmes (IEP).

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