Articles: prospective-studies.
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Air medical journal · Nov 2014
Randomized Controlled TrialIn-flight auscultation during medical air evacuation: comparison between traditional and amplified stethoscopes.
The aim of this study was to evaluate the capacity of a traditional stethoscope versus an electronically amplified one (expected to reduce background and ambient noise) to assess heart and respiratory sounds during medical transport. ⋯ This study showed that practitioners would be better helped in hearing cardiac and respiratory sounds with an electronically amplified stethoscope than with a traditional one during air medical transport in a medically configured Falcon 50 aircraft.
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Observational Study
The role of pain catastrophizing in the provision of rescue analgesia by health care providers following major joint arthroplasty.
After surgery, patient reports or health care professional evaluations of heightened acute pain intensity should lead to extra analgesia provision, which is designated by rescue analgesia (RA). Whether RA is administered or not, it is not directly dependent on the patient but rather on clinical decisions, which should be based on pain management guidelines. There is a general lack of studies focusing on pain-related decision-making regarding RA provision. ⋯ The findings of this study shed light on the importance of psychological factors in determining RA provision following MJA. This encourages further reflection on acute post-surgical pain management by health care providers, namely by raising clinicians' awareness about the factors that influence patient-provider interactions, as well as their impact on decision-making regarding RA provision. A global assessment of patients, wherein psychological variables are taken into account, is warranted in order to improve the quality of surgical pain management. Finally, these findings provide support for the design of acute post-surgical pain management interventions directed at clinicians, in order to augment professionals' awareness about the potential influence of patient-related psychological factors on RA decisions.
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Minerva anestesiologica · Nov 2014
Cardiac output monitoring with pulmonary Vs transpulmonary thermodilution during liver transplantation. Interchangeable methods?
Liver transplantation (LT) implies hemodynamic instability, making invasive monitoring of cardiac output (CO) mandatory. Intermittent thermodilution with pulmonary artery catheter (PAC) remains the clinical gold standard to measure CO. The agreement between PAC and new monitoring methods in LT needs to be further investigated. Our aim is to clarify whether cardiac index (CI) measurements with transpulmonary intermittent thermodilution, and continuous pulmonary thermodilution methods agree sufficiently with those performed intermittently with PAC to be considered interchangeable during LT. ⋯ Continuous pulmonary thermodilution with PAC is not an alternative monitoring method of CO. Transpulmonary thermodilution CO monitoring with PiCCO2 shows too questionable agreement with the clinical gold standard (PACi) being in the limit of acceptance to be considered interchangeable during liver transplantation.
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Scand J Trauma Resus · Oct 2014
Monitoring of cerebral oxygen saturation during resuscitation in out-of-hospital cardiac arrest: a feasibility study in a physician staffed emergency medical system.
Despite recent advances in resuscitation algorithms, neurological injury after cardiac arrest due to cerebral ischemia and reperfusion is one of the reasons for poor neurological outcome. There is currently no adequate means of measuring cerebral perfusion during cardiac arrest. It was the aim of this study to investigate the feasibility of measuring near infrared spectroscopy (NIRS) as a potential surrogate parameter for cerebral perfusion in patients with out-of-hospital resuscitations in a physician-staffed emergency medical service. ⋯ NIRS monitoring is feasible during resuscitation of patients with out-of-hospital cardiac arrest and can be a useful tool during resuscitation, leading to an earlier detection of ROSC and re-arrest. Higher initial rSO2 values during CPR seem to be associated with the occurrence of ROSC. The use of mechanical chest compression devices might result in higher rSO2. These findings need to be confirmed by larger studies.
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Anesthesia and analgesia · Oct 2014
Safety and Efficacy of Drug-Induced Sleep Endoscopy Using a Probability Ramp Propofol Infusion System in Patients with Severe Obstructive Sleep Apnea.
Drug-induced sleep endoscopy (DISE) uses sedative-hypnotics to induce moderate obstruction in sleep apnea patients, thereby facilitating anatomic assessment of obstructive physiology. Implementation of DISE with propofol requires a dosing strategy that reliably and efficiently produces obstruction while minimizing oxygen desaturation. ⋯ A propofol infusion strategy that requires limited experience with propofol dose selection and only 1 pump dosing change reliably produced airway obstruction in patients with severe sleep apnea. Clinical obstruction was achieved faster than target-controlled infusion-based systems for similar procedures reported in the literature. The observed degree of oxygen desaturation in the model system was within a clinically acceptable range.