Comparing methods to secure a tracheal tube placed via a surgical cricothyroidotomy: a randomised controlled study in cadavers

Abstract Objective In the ‘can’t intubate can’t oxygenate’ scenario, techniques to achieve front of neck access to the airway have been described in the literature but there is a lack of guidance on the optimal method for securing the tracheal tube (TT) placed during this procedure. The aim of this study was to compare three different methods of securing a TT to prevent extubation following a surgical cricothyroidotomy. Methods A randomised controlled trial was undertaken. The population studied were emergency physicians (EPs) attending a cadaveric airway course. The intervention was securing a TT placed via a surgical cricothyroidotomy by suture. The comparison was securing the TT using fabric tape with two different tying techniques. The primary outcome was the force required to extubate the trachea. The trial was registered with ANZCTR.org.au (ACTRN12621000320853). Results 17 emergency physicians completed intubations using all three of the securing methods on 12 cadavers for a total of 51 experiments. The mean extubation force was 6.54 KG (95 % CI 5.54–7.55) in the suture group compared with 2.28 KG (95 % CI 1.91–2.64) in the ‘Wilko tie’ group and 2.12 KG (95 % CI 1.63–2.60) in the ‘Lark’s foot tie’ group; The mean difference between the suture and fabric tie techniques was significant (p < 0.001). Conclusions Following a surgical cricothyroidotomy in cadavers, EPs were able to effectively secure a TT using a suture technique, and this method was superior to tying the TT using fabric tape.

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Continuous bilateral thoracic paravertebral blockade for analgesia after cardiac surgery: a randomised, controlled trial

Perfusion ◽

10.1177/0267659117715507 ◽

2017 ◽

Vol 32 (7) ◽

pp. 591-597 ◽

Cited By ~ 5

Author(s):

Geoff G. Lockwood ◽

Leilani Cabreros ◽

Dorota Banach ◽

Prakash P. Punjabi

Keyword(s):

Cardiac Surgery ◽

Primary Outcome ◽

Controlled Trial ◽

Morphine Consumption ◽

Controlled Study ◽

Double Blind ◽

Clinical Trial Registration ◽

Subcutaneous Infusion ◽

Randomised Controlled Study ◽

Randomised Controlled

Background: Continuous bilateral thoracic paravertebral blockade has been used for analgesia after cardiac surgery, but its efficacy has never been formally tested. Method: Fifty adult patients were enrolled in a double-blind, randomised, controlled study of continuous bilateral thoracic paravertebral infusion of 0.5% lidocaine (1 mg.kg-1.hr-1) for analgesia after coronary surgery. Control patients received a subcutaneous infusion of lidocaine at the same rate through catheters inserted at the same locations as the study group. The primary outcome was morphine consumption at 48 hours using patient-controlled analgesia (PCA). Secondary outcomes included pain, respiratory function, nausea and vomiting. Serum lidocaine concentrations were measured on the first two post-operative days. Results: There was no difference in morphine consumption or in any other outcome measure between the groups. Serum lidocaine concentrations increased during the study, with a maximum of 5.9 mg.l-1. There were no adverse events as a consequence of the study. Conclusion: Bilateral paravertebral infusion of lidocaine confers no advantage over systemic lidocaine infusion after cardiac surgery. Clinical trial registration: ISRCTN13424423 ( https://www.isrctn.com )

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A Controlled Trial of Home-Based Acute Psychiatric Services

The British Journal of Psychiatry ◽

10.1192/bjp.163.1.49 ◽

1993 ◽

Vol 163 (1) ◽

pp. 49-54 ◽

Cited By ~ 90

Author(s):

Tom Burns ◽

Alan Beadsmoore ◽

Ashok V. Bhat ◽

Andrew Oliver ◽

Carola Mathers

Keyword(s):

Controlled Trial ◽

Controlled Study ◽

Control Group ◽

Community Based ◽

Home Based ◽

Randomised Controlled Study ◽

One Year ◽

Randomised Controlled ◽

Clinical Measures ◽

Experimental Group

While research has shown community-based psychiatric care to be as good as, or better than, hospital-based care, generalisation to clinical practice has been difficult. This prospective, randomised controlled study examined a community-based approach feasible within NHS conditions. Ninety-four patients were randomly allocated to experimental and 78 to control treatments and followed for one year. The groups were well matched apart from an excess of psychotic control patients. No differences in clinical or social functioning outcome were found. Both groups improved substantially on clinical measures in the first six weeks, with some slow consolidation thereafter. There were three suicides in the control group and one in the experimental group. Access to care was better in the experimental group (93% attended assessment) than in the control group (75% attended assessment).

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Effects of nasal lavage with and without mupirocin after endoscopic endonasal skull base surgery: a randomised, controlled study

The Journal of Laryngology & Otology ◽

10.1017/s0022215119002329 ◽

2019 ◽

Vol 133 (12) ◽

pp. 1059-1063

Author(s):

B H K Ng ◽

I P Tang ◽

P Narayanan ◽

R Raman ◽

R L Carrau

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Controlled Trial ◽

Nasal Lavage ◽

Nasal Endoscopy ◽

Controlled Study ◽

Endoscopic Endonasal ◽

Randomised Controlled Study ◽

Skull Base Lesions ◽

Randomised Controlled

AbstractBackgroundNasal lavage with mupirocin has the potential to reduce sinonasal morbidity in endoscopic endonasal approaches for skull base surgery.ObjectiveTo evaluate the effects of nasal lavage with and without mupirocin after endoscopic endonasal skull base surgery.MethodsA pilot randomised, controlled trial was conducted on 20 adult patients who had undergone endoscopic endonasal approaches for skull base lesions. These patients were randomly assigned to cohorts using nasal lavages with mupirocin or without mupirocin. Patients were assessed in the out-patient clinic, one week and one month after surgery, using the 22-item Sino-Nasal Outcome Test questionnaire and nasal endoscopy.ResultsPatients in the mupirocin nasal lavage group had lower nasal endoscopy scores post-operatively, and a statistically significant larger difference in nasal endoscopy scores at one month compared to one week. The mupirocin nasal lavage group also showed better Sino-Nasal Outcome Test scores at one month compared to the group without mupirocin.ConclusionNasal lavage with mupirocin seems to yield better outcomes regarding patients’ symptoms and endoscopic findings.

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Impact of provision of time in therapeutic range value on anticoagulation management in atrial fibrillation patients on warfarin

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2017-135457 ◽

2018 ◽

Vol 94 (1110) ◽

pp. 207-211 ◽

Cited By ~ 2

Author(s):

Duo Huang ◽

Chi-Lap Wong ◽

Kwan-Wa Cheng ◽

Pak-Hei Chan ◽

Wen-Sheng Yue ◽

...

Keyword(s):

Atrial Fibrillation ◽

Therapeutic Range ◽

Clinic Visit ◽

Controlled Study ◽

Anticoagulation Management ◽

Time In Therapeutic Range ◽

Randomised Controlled Study ◽

The Mean ◽

Randomised Controlled ◽

The Impact

IntroductionThe importance of time in therapeutic range (TTR) in patients prescribed warfarin therapy for stroke prevention in atrial fibrillation (AF) cannot be overemphasised.AimTo evaluate the impact of provision of TTR results during clinic visits on anticoagulation management.DesignSingle-centred, randomised controlled study.SettingFifteen arrhythmia clinics in Hong Kong.PatientsAF patients prescribed warfarin.InterventionsProvision of TTR or no provision of TTR.Main outcome measuresA documented discussion between doctors and patients about switching warfarin to a non-vitamin K oral anticoagulant (NOAC).ResultsFour hundred and eighty one patients with AF prescribed warfarin were randomly assigned to (1) a TTR provision group or (2) control. Their mean age was 73.6±12.0 years and 60.7% were men. The mean CHA2DS2-VASc score was 3.2±1.6 and the mean HASBLED score was 1.7±1.2. The mean TTR was 63.9%±29.9%. At the index clinic visit, 71 of 481 patients (14.8%) had a documented discussion about switching warfarin to a NOAC. Patients with provision of TTR results were more likely to discuss switching warfarin to a NOAC than controls (19.1% vs 10.6%, P=0.03), especially those with a TTR <65% (35.2% vs 10.6%, P<0.001). A higher proportion of patients with provision of TTR results switched to a NOAC (5.9% vs 4.1%, P=0.49).ConclusionsThe provision of TTR among patients on warfarin was associated with a discussion about switching from warfarin to a NOAC in those with TTR <65%, but did not result in actual switching to a NOAC, suggesting additional barriers.

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Effect of Acupuncture on Knee Function in Advanced Osteoarthritis of the Knee: A Prospective, Non-Randomised Controlled Study

Acupuncture in Medicine ◽

10.1136/aim.20.1.19 ◽

2002 ◽

Vol 20 (1) ◽

pp. 19-21 ◽

Cited By ~ 20

Author(s):

Abhay Tillu ◽

Sumedha Tillu ◽

Sarah Vowler

Keyword(s):

Controlled Trial ◽

Knee Function ◽

Controlled Study ◽

Control Group ◽

Osteoarthritis Of The Knee ◽

Randomised Controlled Study ◽

Total Knee ◽

Randomised Controlled ◽

Hss Score

We report a prospective controlled trial, comparing acupuncture with no treatment, in patients with advanced osteoarthritis of the knee awaiting total knee replacement. Knee function was assessed at the beginning of study and at the end of two months, using four parameters: HSS score, time to walk 50 metres, time to climb 20 steps, and degree of pain. Acupuncture was given at four local points around the knee and at one distal point. The acupuncture group improved in all parameters, whereas the control group deteriorated, a finding that was highly statistically significant (p<0.0002). Further randomised-controlled trials with longer follow-up are required to confirm these findings.

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Microinterventional endocapsular nucleus disassembly: novel technique and results of first-in-human randomised controlled study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311766 ◽

2018 ◽

Vol 103 (2) ◽

pp. 176-180 ◽

Cited By ~ 3

Author(s):

Tsontcho Ianchulev ◽

David F Chang ◽

Edward Koo ◽

Susan MacDonald ◽

Ernesto Calvo ◽

...

Keyword(s):

Controlled Trial ◽

Cell Loss ◽

Controlled Study ◽

Endothelial Cell Loss ◽

Nuclear Fragmentation ◽

Corrected Visual Acuity ◽

Randomised Controlled Study ◽

Registration Number ◽

Grade 3 ◽

Randomised Controlled

AimTo assess the safety and efficacy of microinterventional endocapsular nuclear fragmentation in moderate to severe cataracts.MethodsThis was a prospective single-masked multisurgeon interventional randomised controlled trial (ClinicalTrials.gov NCT02843594) where 101 eyes of 101 subjects with grade 3‒4+ nuclear cataracts were randomised to torsional phacoemulsification alone (controls) or torsional phacoemulsification with adjunctive endocapsular nuclear fragmentation using a manual microinterventional nitinol filament loop device (miLOOP group). Outcome measures were phacoemulsification efficiency as measured by ultrasound energy (cumulative dispersed energy (CDE) units) and fluidics requirements (total irrigation fluid used) as well as incidence of intraoperative and postoperative complications.ResultsOnly high-grade advanced cataracts were enrolled with more than 85% of eyes with baseline best corrected visual acuity (BCVA) of 20/200 or worse in either group. Mean CDE was 53% higher in controls (32.8±24.9 vs 21.4±13.1 with miLOOP assistance) (p=0.004). Endothelial cell loss after surgery was low and similar between groups (7‒8%, p=0.561) One-month BCVA averaged 20/27 Snellen in miLOOP eyes and 20/24 in controls. No direct complications were caused by the miLOOP. In two cases, capsular tears occurred during IOL implantation and in all remaining cases during phacoemulsification, with none occurring during the miLOOP nucleus disassembly part of the procedure.ConclusionsMicrointerventional endocapsular fragmentation with the manual, disposable miLOOP device achieved consistent, ultrasound-free, full-thickness nucleus disassembly and significantly improved overall phaco efficiency in advanced cataracts.Trial registration numberNCT02843594

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A Prospective, Randomised, Controlled Trial Comparing Wound Dressings Used in Hip and Knee Surgery: Aquacel and Tegaderm Versus Cutiplast

Annals of The Royal College of Surgeons of England ◽

10.1308/003588406x82989 ◽

2006 ◽

Vol 88 (1) ◽

pp. 18-22 ◽

Cited By ~ 55

Author(s):

MJ Ravenscroft ◽

J Harker ◽

KA Buch

Keyword(s):

Randomised Controlled Trial ◽

Odds Ratio ◽

Elective Surgery ◽

Controlled Trial ◽

Wound Dressings ◽

Controlled Study ◽

Randomised Controlled Study ◽

Randomised Controlled ◽

To Receive ◽

Hip And Knee Surgery

INTRODUCTION Cutiplast (absorbent perforated dressing with adhesive border; Smith & Nephew) is commonly used following orthopaedic operation, but complications of its use have been reported. A prospective, randomised, controlled study was performed to compare the efficacy of Cutiplast versus an Aquacel (hydrofibre dressing; ConvaTec) covered with Tegaderm (vapour-permeable dressing; 3M). PATIENTS AND METHODS Two-hundred patients were randomised to receive one of the two dressings following elective and non-elective surgery of the hip and the knee. We were able to study 183 patients. The condition of the wound and any complications such as skin blistering or signs of infection was noted as was the frequency of dressing changes. RESULTS The Aquacel and Tegaderm dressing was 5.8 times more likely to result in a wound with no complications as compared to a Cutiplast dressing (odds ratio, 5.8; 95% CI 2.8–12.5; P < 0.00001). CONCLUSION Aquacel covered by Tegaderm is a superior dressing to Cutiplast following surgery to the hip and knee.

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Effects of high-oleic peanuts within a hypoenergetic diet on inflammatory and oxidative status of overweight men: a randomised controlled trial

British Journal Of Nutrition ◽

10.1017/s0007114519003246 ◽

2019 ◽

Vol 123 (6) ◽

pp. 673-680

Author(s):

Ana Paula Silva Caldas ◽

Raquel Duarte Moreira Alves ◽

Helen Hermana Miranda Hermsdorff ◽

Leandro Licursi de Oliveira ◽

Josefina Bressan

Keyword(s):

Inflammatory Markers ◽

Controlled Trial ◽

Daily Intake ◽

Oxidative Status ◽

Controlled Study ◽

High Oleic ◽

Randomised Controlled Study ◽

Randomised Controlled ◽

And Oxidative Stress ◽

High Oleic Peanuts

AbstractThe consumption of food with MUFA has been associated with improvement of inflammation and oxidative stress in overweight individuals. In the present study, we evaluate the effect of high-oleic peanut intake within a hypoenergetic diet on inflammatory and oxidative status markers in overweight men. Sixty-four overweight men (BMI 26–35 kg/m2, 18–50 years old) participated in this randomised controlled study for 4 weeks, allocated into three groups: control (CT, n 22), conventional peanut (CVP, n 21) and high-oleic peanut (HOP, n 21). They followed a hypoenergetic diet (−250 kcal/d; −1045 kJ/d) with or without 56 g of high-oleic or conventional peanuts. After the intervention, the inflammatory markers did not show significant changes in fasting concentrations or postprandial response among the experimental groups (P > 0·05). The activity of oxidative status markers remained unchanged after the intervention. However, in the CT, malondialdehyde showed lower concentration in comparison with the baseline (P = 0·020) and among the groups (P = 0·002). In the present study, the daily intake of high-oleic peanuts within a hypoenergetic diet did not modify the inflammatory markers and oxidative status in overweight men. More studies are needed to better understand the effect of high-oleic peanut intake on health outcomes.

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