scholarly journals Ultrasound guided lumbar puncture reduces failed punctures, spent time and number of attempts in emergency department

2020 ◽  
Vol 8 (1) ◽  
pp. 20-20
Author(s):  
Mahboub Pouraghaei ◽  
Mohammadkazem Tarzamani ◽  
Payman Moharramzadeh ◽  
Sahar Nikniaz ◽  
Soraiya Karimian ◽  
...  
Keyword(s):  
Success Rate ◽  
Primary Outcome ◽  
Ultrasound Guidance ◽  
Standard Technique ◽  
Needle Insertion ◽  
The Us ◽  
Manual Palpation ◽  
Male Patients ◽  
Made In

Introduction: The present study was an attempt to evaluate the role of ultrasonography on decreasing the number of attempts, failed punctures, time needed to perform the procedure and patients’ pain. Methods: This study is a prospective case-control. Patients were divided in two groups randomly. A two-dimensional probe was used to localize intervertebral space in the ultrasound guidance (US group). In manual palpation (MP group) however, insertion level was determined using the standard technique by manual palpation. The number of attempts (needle insertion) required for a successful tap and successful/unsuccessful attempts were considered as the primary outcome measures. Results: Male patients with an average age of 44.08±15.83 years accounted for 60% (30 individuals) of the population. Success rate was 92% in the US group and 34% in the MP group (P<0.001). It took 79.64± 19.91 and 85.4±11.62 minutes to identify the proper location in US and MP groups respectively (P=0.21). In the first attempt, it took 6.33±0.95 and 6.87±0.7 minutes to collect cerebrospinal fluid (CSF) in US and MP groups respectively (P=0.02). Average time taken to localize the sites in two attempts were 8.28±2.44 and 13.17±3.32 in US and MP groups respectively (P<0.001). Average number of attempts made in the US and MP groups were 1.08±0.27 and 1.64±0.66 (P<0.001) respectively. Conclusion: Ultrasonography has reduced the time needed for locating puncture to collect CSF, pain management in patients, determining the number of attempts, and defining the risk of traumatic puncture. Moreover, this technique is characterized by a higher success rate. Using ultrasonography in obese patients and people with lumbar problems is more important.

Self-sealing, Large Bore Arterial Punctures: A Counterintuitive New Phenomenon

2002 ◽  
Vol 124 (4) ◽  
pp. 342-346
Author(s):  
Blayne A. Roeder ◽  
Charles F. Babbs ◽  
William E. Schoenlein ◽  
Klod Kokini ◽  
Farshid Sadeghi
Keyword(s):  
Cardiac Catheterization ◽  
Femoral Artery ◽  
Standard Technique ◽  
Needle Insertion ◽  
Catheter Removal ◽  
Intraluminal Pressure ◽  
Modified Technique ◽  
Modeling Studies ◽  
Made In ◽  
Flap Valve

The human femoral artery can bleed dangerously following the removal of a catheter during cardiac catheterization. In this study, a modified technique of needle insertion, simply inserting the needle bevel-down instead of the standard bevel-up approach, was tested as a means to reduce bleeding after catheter removal. Large bore needle punctures were made in surgically exposed arteries of anesthetized pigs using either a standard technique (45 degree approach, bevel up) or a modified technique (25 degree approach, bevel down). For half the punctures, topical phenylephrine solution (1 mg/ml) was applied to the adventitia of the artery to cause constriction. Median bleeding rates were reduced from 81 to less than 1 ml/min/100 mmHg intraluminal pressure by the modified technique with application of phenylephrine. In most cases zero bleeding, that is self-sealing, of the arteries occurred. It is postulated that a flap-valve of tissue created by the modified technique produced this self-sealing behavior. Sophisticated modeling studies are needed to fully understand this new phenomenon.

Ultrasound guidance for internal jugular vein cannulation in PICU: a randomised controlled trial

2018 ◽  
Vol 103 (10) ◽  
pp. 952-956 ◽  
Author(s):  
Tiago Henrique de Souza ◽  
Marcelo Barciela Brandão ◽  
Thiago Martins Santos ◽  
Ricardo Mendes Pereira ◽  
Roberto José Negrão Nogueira
Keyword(s):  
Success Rate ◽  
Ultrasound Guidance ◽  
Jugular Vein ◽  
Controlled Trial ◽  
Anatomical Landmark ◽  
Control Group ◽  
Internal Jugular Vein Cannulation ◽  
The Us ◽  
Randomised Controlled ◽  
Landmark Technique

ObjectiveWe investigated whether ultrasound guidance was advantageous over the anatomical landmark technique when performed by inexperienced paediatricians.DesignRandomised controlled trial.SettingA paediatric intensive care unit of a teaching hospital.Patients80 children (aged 28 days to <14 years).InterventionsInternal jugular vein cannulation with ultrasound guidance in real time or the anatomical landmark technique.Main outcome measuresSuccess rate, success rate on the first attempt, success rate within three attempts, puncture time, number of attempts required for success and occurrence of complications.ResultsWe found a higher success rate in the ultrasound guidance than in the control group (95% vs 61%, respectively; p<0.001; relative risk (RR)=0.64, 95% CI (CI) 0.50 to 0.83). Success on the first attempt was seen in 95% and 34% of venous punctures in the US guidance and control groups, respectively (p<0.001; RR=0.35, 95% CI 0.23 to 0.54). Fewer than three attempts were required to achieve success in 95% of patients in the US guidance group but only 44% in the control group (p<0.001; RR=0.46, 95% CI 0.32 to 0.66). Haematomas, inadvertent arterial punctures, the number of attempts and the puncture time were all significantly lower in the ultrasound guidance than in the control group (p<0.015 for all).ConclusionsCritically ill children may benefit from the ultrasound guidance for internal jugular cannulation, even when the procedure is performed by operators with limited experience.Trial registration numberRBR-4t35tk.

scholarly journals A randomised clinical trial of ultrasound guided cannulation of difficult fistulae for dialysis access

2020 ◽  
pp. 112972982095472
Author(s):  
Joshua Eves ◽  
Paris Cai ◽  
Ross Latham ◽  
Clement Leung ◽  
Daniel Carradice ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Ultrasound Guidance ◽  
Controlled Trial ◽  
Standard Technique ◽  
Randomised Clinical Trial ◽  
Dialysis Access ◽  
Complication Rates ◽  
Ultrasound Guided ◽  
Prolonged Time ◽  
Randomised Controlled

Background: Arteriovenous fistulae (AVF) are preferred for dialysis access but require accurate cannulation for effective dialysis. Evidence supports improvements in cannulation and complication rates using ultrasound guidance (USG) in cannulating other sites. This mixed methods, randomised controlled trial aimed to assess effects of USG during AVF cannulation. Methods: Participants with difficult to cannulate AVF had each cannulation event randomised to USG or standard technique (no USG). The primary outcome was the incidence and number of additional needle passes. Secondary outcomes included: the incidence and number of additional skin punctures; time to achieve two needle cannulation; pain associated with cannulation; local complications. Qualitative outcomes were assessed using patient and staff questionnaires. Results: Thirty-two participants had 346 cannulation events randomised (170 to USG and 176 to standard cannulation). USG resulted in a significant reduction in additional needle passes (72 vs 99 p = 0.007) and additional skin punctures (10 vs 25 p = 0.016.) but prolonged time to cannulation ( p > 0.001). There was no difference in pain score ( p = 0.705) or complications between groups. Questionnaires demonstrated that USG cannulation is acceptable to patients and staff. Conclusion: USG cannulation of AVF is more accurate and no more painful than non-image guided cannulation, but prolonged time to cannulation. Some of the excess time involved may be due to the trial being performed early in cannulating staff’s learning curve with the USG technique. Further work to elucidate which patients gain most benefit from USG cannulation and the effect of USG on cannulation complications and AVF patency is warranted.

scholarly journals Myasthenia Gravis: A Review

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Annapurni Jayam Trouth ◽  
Alok Dabi ◽  
Noha Solieman ◽  
Mohankumar Kurukumbi ◽  
Janaki Kalyanam
Keyword(s):  
Myasthenia Gravis ◽  
Treatment Modalities ◽  
Initial Symptom ◽  
Significant Progress ◽  
The Past ◽  
The Us ◽  
Circulating Antibodies ◽  
New Treatment ◽  
Made In

Acquired myasthenia gravis is a relatively uncommon disorder, with prevalence rates that have increased to about 20 per 100,000 in the US population. This autoimmune disease is characterized by muscle weakness that fluctuates, worsening with exertion, and improving with rest. In about two-thirds of the patients, the involvement of extrinsic ocular muscle presents as the initial symptom, usually progressing to involve other bulbar muscles and limb musculature, resulting in generalized myasthenia gravis. Although the cause of the disorder is unknown, the role of circulating antibodies directed against the nicotinic acetylcholine receptor in its pathogenesis is well established. As this disorder is highly treatable, prompt recognition is crucial. During the past decade, significant progress has been made in our understanding of the disease, leading to new treatment modalities and a significant reduction in morbidity and mortality.

Exporting Spanishness: The Role of Netflix in Shaping How the World Imagines Spain

2020 ◽  
Vol 2 (2) ◽  
pp. 143-159
Author(s):  
NOVIA PAGONE
Keyword(s):  
Social Mobility ◽  
Female Friendship ◽  
Television Content ◽  
Diverse Backgrounds ◽  
The Us ◽  
The World ◽  
Similar Path ◽  
A Company ◽  
Made In

The worldwide leader in streaming television, Netflix exercises significant influence over what viewers watch through algorithms and the shaping of communities based on a set of culturally determined preferences, or ‘taste communities’. Furthermore, its reputation for producing noteworthy and boundary-pushing original television content creates the expectation that Netflix will follow a similar path in Spain, where viewers represent diverse backgrounds. This essay argues that as a company based in the US creating original shows for broadcast to a global audience, Netflix sidesteps many of the thorny issues surrounding contemporary Spanish national identity and the country’s multicultural ‘ethnoscape’ to focus on genres and storylines that have proved successful on the platform. In this way, the streaming company offers locally produced content that appeals to existing global taste communities. Their made-in-Spain original dramas - Las chicas del cable, La casa de papel and Élite - present common themes such as socio-economic inequality, social mobility and female friendship, and settings that resonate with a local audience while remaining accessible and relevant globally. In this way, Netflix influences how Spain is portrayed to a global audience while maintaining a local presence.

Role of routine use of ultrasonographic guidance for performing lumbar punctures

2019 ◽  
Vol 97 (1143) ◽  
pp. 23-28
Author(s):  
Sujay Halkur Shankar ◽  
Sagnik Biswas ◽  
Arvind Kumar ◽  
Akshita Gupta ◽  
Aastha Goel ◽  
...  
Keyword(s):  
Lumbar Puncture ◽  
Training Session ◽  
Needle Insertion ◽  
Procedure Time ◽  
Significant Difference ◽  
The Us ◽  
Low Body Mass Index ◽  
Ultrasonographic Guidance ◽  
A Prospective Study

Purpose of studyUltrasound (US) for lumbar puncture has seen the most success in obese patients and in patients with difficult to palpate landmarks. We aimed to elucidate the advantage of the use of routine US for performing lumbar punctures over the traditional landmark method.Study designThis was a prospective study with consecutive sampling with a sample size of convenience. Three residents were chosen to perform the lumbar punctures after a training session. Patients were assigned to either the US group or the landmark group. The outcomes studied were number of attempts at needle insertion, patient and physician anxiety, pain experienced, time to procedure, number of traumatic attempts and the difficulties faced during the procedure.ResultsA total of 77 patients were included in this study, of which 36 patients (46.8%) underwent landmark-based lumbar puncture and 41 (53.2%) underwent US-guided lumbar puncture. There was no statistically significant difference between the two groups among the following characteristics: number of attempts to a successful procedure, number of traumatic punctures, procedure time, preprocedure anxiety of the participants and physicians and pain score rating of the procedure.ConclusionThere was no significant difference between the landmark method and US-guided method for performing lumbar puncture in the number of successful attempts, number of traumatic punctures, procedure time and pain during the procedure. Further studies are required to elucidate the advantage of the use of ultrasonography in subsets of the population such as the low body mass index population.

scholarly journals FOREIGN POLICY MECHANISM IN USA: ROLE OF STAKEHOLDERS

2018 ◽  
Vol 01 (01) ◽  
Keyword(s):  
Foreign Policy ◽  
International Law ◽  
Policy Formulation ◽  
Us Foreign Policy ◽  
Foreign Affairs ◽  
Special Role ◽  
Liberal Democracies ◽  
The Us ◽  
Made In

Contrary to other liberal democracies in the world, the foreign policy in US is made in a very clumsy way. The constitution of USA has put the president and congress into constant tug of war over the issue of making US’s foreign policy. Constitutionally, the Department of Foreign Affairs, the bureaucracy, the President, the Congress, media and public opinion are given special role to frame the US foreign policy. The Constitution has built a bulwark against the despotic and tyrannical tendencies against any of these stakeholders. Apart from the compulsory role of all the said departments, much space is given to some external factors like UN, International law, NATO and the special interests of other US business and strategic partners to put pressure at numerous dimensions and aspects on US foreign policy mechanism. Consequently, it is difficult to figure out the more efficient stake holders involved in foreign policy formulation process in USA

scholarly journals Od „Made in China” do „Created in China” – droga Chin do supremacji innowacyjnej

2021 ◽  
Vol 19 ◽  
pp. 97--115
Author(s):  
Sylwia Pangsy-Kania
Keyword(s):  
United States ◽  
The United States ◽  
The European Union ◽  
The Past ◽  
Global Innovation ◽  
The Us ◽  
Made In China ◽  
Advanced Production ◽  
Made In

From “Made in China” to “Created in China” – China’s way to innovation supremacy China is not only a country of cheap production (“Made in China”). China is becoming more and more innovative, as evidenced by its growing position in the annual Global Innovation Index (GII) ranking. Over the past decade, China has become an emerging superpower while the economic position of the United States and the European Union has weakened. The purpose of this article is to answer the question of whether the US innovation supremacy becoming the past. The role of China is growing as a result of departing from “Made in China” and illegally obtained technological solutions in favor of innovation and technologically advanced production “Created in China.” Huawei is one of the most innovative companies in the world. The analysis is carried out in the context of the significance of the Thucydides trap in the technological war between the United States and China and the location of changes in the innovativeness of both countries in the aspect of the Kondratiev cycle. Additionally, China may come out stronger from the pandemic that has changed the whole world.

The role of clomiphene citrate in the resolution of hypogonadism in male patients with prolactinomas under cabergoline therapy

2018 ◽  
Author(s):  
Lucio Vilar ◽  
Clarice Vilar ◽  
Ruy Lyra ◽  
Ana Carolina The ◽  
Erik Trovao ◽  
...  
Keyword(s):  
Clomiphene Citrate ◽  
Male Patients

ASPECTS IN BUILDING A COMPANY WEB-SITE AND ITS ROLE FOR THE DEVELOPMENT OF BUSINESS

2018 ◽  
pp. 117-124
Author(s):  
Petar Halachev ◽  
Victoria Radeva ◽  
Albena Nikiforova ◽  
Miglena Veneva
Keyword(s):  
Life Cycle ◽  
Web Site ◽  
The Internet ◽  
A Company ◽  
The Web ◽  
Design Construction ◽  
Made In ◽  
Site Types

This report is dedicated to the role of the web site as an important tool for presenting business on the Internet. Classification of site types has been made in terms of their application in the business and the types of structures in their construction. The Models of the Life Cycle for designing business websites are analyzed and are outlined their strengths and weaknesses. The stages in the design, construction, commissioning, and maintenance of a business website are distinguished and the activities and requirements of each stage are specified.

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