Development and validation of ester impregnated pH strips for locating nasogastric feeding tubes in the stomach—a multicentre prospective diagnostic performance study

Abstract Background NG (nasogastric) tubes are used worldwide as a means to provide enteral nutrition. Testing the pH of tube aspirates prior to feeding is commonly used to verify tube location before feeding or medication. A pH at or lower than 5.5 was taken as evidence for stomach intubation. However, the existing standard pH strips lack sensitivity, especially in patients receiving feeding and antacids medication. We developed and validated a first-generation ester-impregnated pH strip test to improve the accuracy towards gastric placements in adult population receiving routine NG-tube feeding. The sensitivity was improved by its augmentation with the action of human gastric lipase (HGL), an enzyme specific to the stomach. Methods We carried out a multi-centred, prospective, two-gate diagnostic accuracy study on patients who require routine NG-tube feeding in 10 NHS hospitals comparing the sensitivity of the novel pH strip to the standard pH test, using either chest X-rays or, in its absence, clinical observation of the absence of adverse events as the reference standard. We also tested the novel pH strips in lung aspirates from patients undergoing oesophageal cancer surgeries using visual inspection as the reference standard. We simulated health economics using a decision analytic model and carried out adoption studies to understand its route to commercialisation. The primary end point is the sensitivity of novel and standard pH tests at the recommended pH cut-off of 5.5. Results A total of 6400 ester-impregnated pH strips were prepared based on an ISO13485 quality management system. A total of 376 gastric samples were collected from adult patients in 10 NHS hospitals who were receiving routine NG-tube feeding. The sensitivities of the standard and novel pH tests were respectively 49.2% (95% CI 44.1‑54.3%) and 70.2% (95% CI 65.6‑74.8%) under pH cut-off of 5.5 and the novel test has a lung specificity of 89.5% (95% CI 79.6%, 99.4%). Our simulation showed that using the novel test can potentially save 132 unnecessary chest X-rays per check per every 1000 eligible patients, or direct savings of £4034 to the NHS. Conclusions The novel pH test correctly identified significantly more patients with tubes located inside the stomach compared to the standard pH test used widely by the NHS. Trial registration http://www.isrctn.com/ISRCTN11170249, Registered 21 June 2017—retrospectively registered

Download Full-text

Effect of Transcutaneous Vagus Nerve Stimulation in Dysphagia After Lateral Medullary Infarction: A Case Report

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-18-0262 ◽

2019 ◽

Vol 28 (4) ◽

pp. 1381-1387

Author(s):

Ying Yuan ◽

Jie Wang ◽

Dongyu Wu ◽

Dahua Zhang ◽

Weiqun Song

Keyword(s):

Vagus Nerve ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Rating Scale ◽

Tube Feeding ◽

Nasogastric Feeding ◽

Lateral Medullary Infarction ◽

Severe Dysphagia ◽

Transcutaneous Vagus Nerve Stimulation ◽

Medullary Infarction

Purpose Severe dysphagia with weak pharyngeal peristalsis after dorsal lateral medullary infarction (LMI) requires long-term tube feeding. However, no study is currently available on therapeutic effectiveness in severe dysphagia caused by nuclear damage of vagus nerve after dorsal LMI. The purpose of the present investigation was to explore the potential of transcutaneous vagus nerve stimulation (tVNS) to improve severe dysphagia with weak pharyngeal peristalsis after dorsal LMI. Method We assessed the efficacy of 6-week tVNS in a 28-year-old woman presented with persisting severe dysphagia after dorsal LMI who had been on nasogastric feeding for 6 months. tVNS was applied for 20 min twice a day, 5 days a week, for 6 weeks. The outcome measures included saliva spitted, Swallow Function Scoring System, Functional Oral Intake Scale, Clinical Assessment of Dysphagia With Wallenberg Syndrome, Yale Pharyngeal Residue Severity Rating Scale, and upper esophagus X-ray examination. Results After tVNS, the patient was advanced to a full oral diet without head rotation or spitting. No saliva residue was found in the valleculae and pyriform sinuses. Contrast medium freely passed through the upper esophageal sphincter. Conclusion Our findings suggest that tVNS might provide a useful means for recovery of severe dysphagia with weak pharyngeal peristalsis after dorsal LMI. Supplemental Material https://doi.org/10.23641/asha.9755438

Download Full-text

Novel Radiographic Indexes for Elbow Stability Assessment: Part B—Preliminary Clinical Study

Indian Journal of Orthopaedics ◽

10.1007/s43465-021-00399-1 ◽

2021 ◽

Author(s):

Francesco Luceri ◽

Davide Cucchi ◽

Enrico Rosagrata ◽

Carlo Eugenio Zaolino ◽

Alessandra Menon ◽

...

Keyword(s):

Case Series ◽

Radiographic Evaluation ◽

Healthy Population ◽

X Rays ◽

The Novel ◽

Level Of Evidence ◽

Orthopaedic Surgeons ◽

Joint Congruency ◽

Radiological Parameters ◽

The Mean

Abstract Introduction The coronoid process plays a key-role in preserving elbow stability. Currently, there are no radiographic indexes conceived to assess the intrinsic elbow stability and the joint congruency. The aim of this study is to present new radiological parameters, which will help assess the intrinsic stability of the ulnohumeral joint and to define normal values of these indexes in a normal, healthy population. Methods Four independent observers (two orthopaedic surgeons and two radiologists) selected lateral view X-rays of subjects with no history of upper limb disease or surgery. The following radiographic indexes were defined: trochlear depth index (TDI); anterior coverage index (ACI); posterior coverage index (PCI); olecranon–coronoid angle (OCA); radiographic coverage angle (RCA). Inter-observer and intra-observer reproducibility were assessed for each index. Results 126 subjects were included. Standardized lateral elbow radiographs (62 left and 64 right elbows) were obtained and analysed. The mean TDI was 0.46 ± 0.06 (0.3–1.6), the mean ACI was 2.0 ± 0.2 (1.6–3.1) and the mean PCI was 1.3 ± 0.1 (1.0–1.9). The mean RCA was 179.6 ± 8.3° (normalized RCA: 49.9 ± 2.3%) and the mean OCA was 24.6 ± 3.7°. The indexes had a high-grade of inter-observer and intra-observer reliability for each of the four observers. Significantly higher values were found for males for TDI, ACI, PCI and RCA. Conclusion The novel radiological parameters described are simple, reliable and easily reproducible. These features make them a promising tool for radiographic evaluation both for orthopaedic surgeons and for radiologists in the emergency department setting or during outpatient services. Level of evidence Basic Science Study (Case Series). Clinical relevance The novel radiological parameters described are reliable, easily reproducible and become handy for orthopaedic surgeons as well as radiologists in daily clinical practice.

Download Full-text

Selecting pH cut-offs for the safe verification of nasogastric feeding tube placement: a decision analytical modelling approach

BMJ Open ◽

10.1136/bmjopen-2017-018128 ◽

2017 ◽

Vol 7 (11) ◽

pp. e018128 ◽

Cited By ~ 3

Author(s):

Melody Zhifang Ni ◽

Jeremy R Huddy ◽

Oliver H Priest ◽

Sisse Olsen ◽

Lawrence D Phillips ◽

...

Keyword(s):

Care Pathway ◽

Feeding Tube ◽

Tube Placement ◽

X Rays ◽

Clinical Environment ◽

Nasogastric Feeding ◽

Relative Safety ◽

Checking Procedure ◽

The Impact ◽

Modelling Approach

ObjectivesThe existing British National Patient Safety Agency (NPSA) safety guideline recommends testing the pH of nasogastric (NG) tube aspirates. Feeding is considered safe if a pH of 5.5 or lower has been observed; otherwise chest X-rays are recommended. Our previous research found that at 5.5, the pH test lacks sensitivity towards oesophageal placements, a major risk identified by feeding experts. The aim of this research is to use a decision analytic modelling approach to systematically assess the safety of the pH test under cut-offs 1–9.Materials and methodsWe mapped out the care pathway according to the existing safety guideline where the pH test is used as a first-line test, followed by chest x-rays. Decision outcomes were scored on a 0–100 scale in terms of safety. Sensitivities and specificities of the pH test at each cut-off were extracted from our previous research. Aggregating outcome scores and probabilities resulted in weighted scores which enabled an analysis of the relative safety of the checking procedure under various pH cut-offs.ResultsThe pH test was the safest under cut-off 5 when there was ≥30% of NG tube misplacements. Under cut-off 5, respiratory feeding was excluded; oesophageal feeding was kept to a minimum to balance the need of chest X-rays for patients with a pH higher than 5. Routine chest X-rays were less safe than the pH test while to feed all without safety checks was the most risky.DiscussionThe safety of the current checking procedure is sensitive to the choice of pH cut-offs, the impact of feeding delays, the accuracy of the pH in the oesophagus, as well as the extent of tube misplacements.ConclusionsThe pH test with 5 as the cut-off was the safest overall. It is important to understand the local clinical environment so that appropriate choice of pH cut-offs can be made to maximise safety and to minimise the use of chest X-rays.Trial registration numberISRCTN11170249; Pre-results.

Download Full-text

Synthesis of Novel Compounds as New Potent Tyrosinase Inhibitors

BioMed Research International ◽

10.1155/2013/207181 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 8

Author(s):

Hooshang Hamidian

Keyword(s):

Kojic Acid ◽

Azo Compounds ◽

The Novel ◽

Mushroom Tyrosinase ◽

Reference Standard ◽

Tyrosinase Inhibition ◽

H Nmr ◽

Ft Ir ◽

Tyrosinase Inhibitors ◽

C Nmr

In the present paper, we report the synthesis and pharmacological evaluation of a new series of azo compounds with different groups (1-naphthol, 2-naphthol, andN,N-dimethylaniline) and trifluoromethoxy and fluoro substituents in the scaffold. All synthesized compounds (5a–5f) showed the most potent mushroom tyrosinase inhibition (IC50values in the range of 4.39 ± 0.76–1.71 ± 0.49 µM), comparable to the kojic acid, as reference standard inhibitor. All the novel compounds were characterized by FT-IR,1H NMR,13C NMR, and elemental analysis.

Download Full-text

Objective Evaluation of Deep Uncertainty Predictions for COVID-19 Detection

10.21203/rs.3.rs-890026/v1 ◽

2021 ◽

Author(s):

Hamzeh Asgharnezhad ◽

Afshar Shamsi ◽

Roohallah Alizadehsani ◽

Abbas Khosravi ◽

Saeid Nahavandi ◽

...

Keyword(s):

Uncertainty Quantification ◽

Performance Metrics ◽

Confusion Matrix ◽

Objective Evaluation ◽

X Rays ◽

The Novel ◽

X Ray ◽

Uncertainty Estimates ◽

Chest X Ray ◽

Novel Concept

Abstract Deep neural networks (DNNs) have been widely applied for detecting COVID-19 in medical images. Existing studies mainly apply transfer learning and other data representation strategies to generate accurate point estimates. The generalization power of these networks is always questionable due to being developed using small datasets and failing to report their predictive confidence. Quantifying uncertainties associated with DNN predictions is a prerequisite for their trusted deployment in medical settings. Here we apply and evaluate three uncertainty quantification techniques for COVID-19 detection using chest X-Ray (CXR) images. The novel concept of uncertainty confusion matrix is proposed and new performance metrics for the objective evaluation of uncertainty estimates are introduced. Through comprehensive experiments, it is shown that networks pertained on CXR images outperform networks pretrained on natural image datasets such as ImageNet. Qualitatively and quantitatively evaluations also reveal that the predictive uncertainty estimates are statistically higher for erroneous predictions than correct predictions. Accordingly, uncertainty quantification methods are capable of flagging risky predictions with high uncertainty estimates. We also observe that ensemble methods more reliably capture uncertainties during the inference. DNN-based solutions for COVID-19 detection have been mainly proposed without any principled mechanism for risk mitigation. Previous studies have mainly focused on on generating single-valued predictions using pretrained DNNs. In this paper, we comprehensively apply and comparatively evaluate three uncertainty quantification techniques for COVID-19 detection using chest X-Ray images. The novel concept of uncertainty confusion matrix is proposed and new performance metrics for the objective evaluation of uncertainty estimates are introduced for the first time. Using these new uncertainty performance metrics, we quantitatively demonstrate where and when we could trust DNN predictions for COVID-19 detection from chest X-rays. It is important to note the proposed novel uncertainty evaluation metrics are generic and could be applied for evaluation of probabilistic forecasts in all classification problems.

Download Full-text

The Paradox of Happy Hypoxia in COVID 19

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i38a32066 ◽

2021 ◽

pp. 119-124

Author(s):

Madhu Bansode ◽

Pankaj Bansode

Keyword(s):

Young Patients ◽

The Elderly ◽

Clinical Implications ◽

X Rays ◽

The Novel ◽

Human Race ◽

Self Monitoring ◽

Diagnostic Modalities ◽

High Index Of Suspicion ◽

Rule Out

Ever since the human race has been exposed to the novel COVID 19 illness, newer and newer intriguing features of the COVID viral plethora are seen with each passing day. Many manifestations of the COVID 19 illness have been baffling and unexplainable to researchers currently. One such unusual presentation seen is ‘happy hypoxia’ or silent hypoxemia in a third of patients' total number. This review article is intending to put some light on the puzzling condition of happy hypoxia. We authors refer you through various theories postulated for happy hypoxia. It has definite clinical implications in the sense that it can be lifesaving if detected early and promptly in a COVID patient. We conclude that happy hypoxia or silent hypoxemia is a new entity and should be diagnosed with a high index of suspicion in COVID suspect patients in both young patients with no co morbidities and the elderly and diabetics. Diagnostic modalities like pulse oximeter should be widely used at hospitals and clinics and for self-monitoring by the patients at homes. Also, chest X-rays or HRCT imaging of the lungs is essential in the early stages to identify the early infective changes with compromised lung function and rule out this happy hypoxia. Also, further research is essential to find the exact ethologic of this subclinical though ominous prognostic entity.

Download Full-text

ULTRASOUND;

The Professional Medical Journal ◽

10.29309/tpmj/2012.19.02.2005 ◽

2012 ◽

Vol 19 (02) ◽

pp. 187-192

Author(s):

EJAZ HUSSAIN SIDDIQUI ◽

SAAD SIDDIQUI ◽

NOREEN SHAH

Keyword(s):

Pediatric Population ◽

Adult Population ◽

Age Groups ◽

X Rays ◽

Geriatric Population ◽

Cross Sectional ◽

Study Results ◽

Significant Difference ◽

Ultrasound Findings ◽

Hepatobiliary Diseases

Objectives: To assess common presenting features and the role of Ultrasound in evaluation of Hepatobiliary diseases in ourpopulation. Design: Cross sectional study. Setting: Khyber X rays, Khyber Medical Centre, Peshawar. Period: August 2010 to December2010. Material and Methods: Data from patients presenting for evaluation of Hepatobiliary diseases was analyzed for presenting complaintsand ultrasound findings according to objectives of the study. Results: In total 197 cases were included in the study. The age wise categorizationincluded pediatric population (6.1%) adult population (87.3%) and geriatric population (6.6%). Upper abdominal pain was the most commonpresenting feature in all age groups as well as in both genders. Cholelithiasis with or without cholecystitis was the most common ultrasoundfinding in all age groups. No statistically significant difference was found between presenting features or ultrasound findings in different agegroups as well as across gender. Conclusions: Hepatobiliary diseases are among major illnesses in our region. Ultrasound is a sensitive anduseful tool for screening and evaluation of Hepatobiliary disorders.

Download Full-text

Is X-ray Exposure Related to Dentist Remuneration?

10.21203/rs.3.rs-252396/v1 ◽

2021 ◽

Author(s):

Olivier Kalmus ◽

Martin Chalkley ◽

Stefan Listl

Keyword(s):

Health Care Providers ◽

Fixed Effects ◽

Adult Population ◽

Common Source ◽

Fee For Service ◽

X Rays ◽

Care Providers ◽

X Ray ◽

Fixed Effects Panel Regression ◽

Provider Payment

Abstract Background: In many market settings individuals are encouraged to switch health care providers as a means of ensuring more competition. Switching may have a potentially undesirable side effect of increasing unnecessary treatment. Focusing on the most common source of medical radiation (dental X-rays), the purpose of this study was to assess whether, upon switching dentist, X-ray exposure increases depending on the type of provider payment. Methods: The analysis used longitudinal data from 2005 to 2016 covering a 5% random sample of the Scottish adult population covered by the National Health Service (NHS). Multiple fixed-effects panel regression analyses were employed to determine the correlation of provider remuneration with patients' likelihood of receiving an X-ray upon switching to a new dentist other things equal. A broad set of covariates including a patient’s copayment status was controlled for. Results: Upon switching to a dentist who was paid fee-for-service, patients had a by 9.6 %-points (95% CI: 7.4%-11.8%) higher probability of receiving an X-ray, compared to switching to a salaried dentist. Results were robust when accounting for patient exemption status, as well as unobserved patient and dentist characteristics. Conclusions: In comparison to staying with the same dentist, patients may be exposed to substantially more X-rays upon switching to a dentist who is paid fee-for-service. There may need to be better guidance and regulation to protect the health of those who have to switch provider due to moving and greater caution in advocating voluntary switching.

Download Full-text

The prevalance of femoroacetabular impingement findings on radiological survey of the emergeny service patients with trauma

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00066 ◽

2017 ◽

Vol 5 (2_suppl2) ◽

pp. 2325967117S0006

Author(s):

Gökhan Polat ◽

Koray Şahin ◽

Ufuk Arzu ◽

Mehmet Aşık

Keyword(s):

Emergency Service ◽

Pelvic Ring ◽

Adult Population ◽

Alpha Angle ◽

Symphysis Pubis ◽

Lower Limbs ◽

Female Group ◽

X Rays ◽

Pelvic Ring Fractures ◽

Asymptomatic Stage

Femoroacetabular impingemet (FAI) is a disease causing hip pain in young-adult population and can be diagnosed frequently on asymptomatic stage. The European studies on this subject show that 20-25% of the population actually has asymptomatic FAI. Actually, there is no study in Turkey on this topic. The purpose of our study is to determine the prevalance of FAI on the X-rays of the patients who applied to the emergency service with trauma. Materials-Methods: Patients applied between September 2015 and January 2016 aged 18-65 and who has pelvis AP and frog leg X-rays were included. Pelvic graphs on which both iliac crests and proximal femurs are seen, the X-ray tube is centralised to the symphysis pubis and the obturator foramens are symmetrical were included. The graphs with fractures or ligamentous injuries affecting the pelvic ring, fractures on long bones of the lower limbs, arthrosis on coxofemoral joint and findings of previous pelvic and hip surgery were excluded. Totally 3487 patients were evaluated and 528 of them were included. Alpha, lateral central edge (LCE), Tönnis and collodiaphyseal angle were measured. The morphological anomalies (FAI, dysplasia) were noted. The measured alpha angle value above 55° graphs were accepted as CAM type; Tönnis angle below 4° angle or LCE angle above 39° were accepted as Pincer type impingement. The graphs with LCE angle below 25° or with Tönnis angle above 10° were considered as dysplasia. Results: The average age of the 528 included patients was 43,38. 323 were female and 205 were male. We determined 15,5% CAM, 11,1% Pincer and 4,7% combined type FAI in these 528 patients.The ratios were noted in female group, 4,6% CAM, 13,3% Pincer and 1,5% combined type; in male group 32,7% CAM, 7,8% Pincer 9,8% combined type. Average alpha angle on pelvis AP graphs was 48,9° on right and 47,8° on left side. Average alpha angle on pelvis frog leg graphs was 51,7° on right, 49,8° on left side. Average LCE angle was 32,9° on right and 34,7° on left side. Average Tönnis angle was 6,7° for right and 5,8° for left side. SPSS.21 were used to analyse the data. Discussion: FAI can be seen in population asymptomatically with a seriously high rates. In our study, we evaluated the asypmtomatic patients with trauma applying to the emergency service and we found radiological FAI findings rate 19,5% in females and 50,2% in males.

Download Full-text

Design and Performance Study of a Novel Refrigeration System

Advanced Materials Research ◽

10.4028/www.scientific.net/amr.354-355.819 ◽

2011 ◽

Vol 354-355 ◽

pp. 819-827

Author(s):

Yan Ling Liu ◽

Ling Qun Wang ◽

Zai Zhong Xia

Keyword(s):

Cooling Capacity ◽

The Novel ◽

Conventional System ◽

Performance Study ◽

Continuous Adsorption ◽

Two Systems ◽

Refrigerant Circuit ◽

And Performance ◽

Set Up ◽

Similarity And Difference

In order to solve the problems of pressure drop and leakage in the refrigerant circuit, a novel continuous adsorption system suited to use low heat source (75-85 oC) was designed and set up. To analyze and compare with the conventional system to reveal the similarity and difference, this paper sets up the mathematical models for these two systems. The adsorbers, condensers and evaporators in these two systems are exactly the same and the two systems are compared by working at the identical conditions, which is not feasible in real experimental lab. All the parameters and models used in this calculation are based on experimental results. Analysis demonstrates that the two kinds of system have very close performances, that is, the novel system has a relatively higher cooling capacity while the conventional system has a relatively higher COP.

Download Full-text