Heterogeneity of Multidrug-Resistant Salmonella enterica Isolates with Increasing Frequency of Resistance to Ciprofloxacin During a 4-Year Period in Iran

Microbial Drug Resistance , Vol. 0, No. 0.


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Molecular Characterization of Penicillinase–Producing Neisseria gonorrhoeae Isolated in Two Time Periods, 2003–2004 and 2014–2015, in Italy

Microbial Drug Resistance , Vol. 0, No. 0.


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Comparison of Various Nuclear Localization Signal-Fused Cas9 Proteins and Cas9 mRNA for Genome Editing in Zebrafish

CRISPR/Cas9 system has been proven to be an efficient and precise genome editing technology in various organisms. However, the gene editing efficiencies of Cas9 proteins with a nuclear localization signal (NLS) fused to different termini and Cas9 mRNA have not been systematically compared. Here, we compared the ability of Cas9 proteins with NLS fused to the N, C, or both N and C termini and N-NLS-Cas9-NLS-C mRNA to target two sites in the tyr gene and two sites in the gol gene related to pigmentation in zebrafish. Phenotypic analysis revealed that all types of Cas9 led to hypopigmentation in similar proportions of injected embryos. Genome analysis by T7E1 assays demonstrated that all types of Cas9 similarly induced mutagenesis in four target sites. Sequencing results further confirmed that high frequency of indels occurred in the target sites (tyr1>63%, tyr2>74%, gol1>50% and gol2>35%), as well as various types ( > 6 ) of indel mutations observed in all four types of Cas9 injected embryos. Furthermore, all types of Cas9 showed efficient targeted mutagenesis on multiplex genome editing, resulting in multiple phenotypes simultaneously. Collectively, we conclude that various NLS-fused Cas9 proteins and Cas9 mRNA have similar genome editing efficiencies on targeting single or multiple genes, suggesting that the efficiency of CRISPR/Cas9 genome editing is highly dependent on gRNAs and gene loci. These findings may help to simplify selection of Cas9 for gene editing using the CRISPR/Cas9 system.

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The ABC Transporter Eato Promotes Cell Clearance in the Drosophila melanogaster Ovary

The clearance of dead cells is a fundamental process in maintaining tissue homeostasis. Genetic studies in Drosophila melanogaster, Caenorhabditis elegans, and mammals have identified two evolutionarily conserved signaling pathways that act redundantly to regulate this engulfment process: the ced-1/-6/-7 and ced-2/-5/-12 pathways. Of these engulfment genes, only the ced-7/ABCA1 ortholog remains to be identified in D. melanogaster. Homology searches revealed a family of putative ced-7/ABCA1 homologs encoding ABC transporters in D. melanogaster. To determine which of these genes functions similarly to ced-7/ABCA1, we analyzed mutants for engulfment phenotypes in oogenesis, during which nurse cells in each egg chamber undergo programmed cell death and are removed by neighboring phagocytic follicle cells. Our genetic analyses indicate that one of the ABC transporter genes, which we have named Eato, is required for nurse cell clearance in the ovary and acts in the same pathways as drpr, the ced-1 ortholog, and in parallel to Ced-12 in the follicle cells. Additionally, we show that Eato acts in the follicle cells to promote accumulation of the transmembrane receptor Drpr, and promote membrane extensions around the nurse cells for their clearance. Since ABCA class transporters, such as CED-7 and Eato, are known to be involved in lipid trafficking, we propose that Eato acts to transport membrane material to the growing phagocytic cup for cell corpse clearance. Our work presented here identifies Eato as the ced-7 ortholog in D. melanogaster, and demonstrates a role for Eato in Drpr accumulation and phagocytic membrane extensions during nurse cell clearance in the ovary.

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Local changes in computational non-rapid eye movement sleep depth in infants

Publication date: February 2018
Source:Clinical Neurophysiology, Volume 129, Issue 2
Author(s): Anna-Liisa Satomaa, Outi Saarenpää-Heikkilä, Eero Huupponen, Turkka Kirjavainen, Juhani Heinonen, Sari-Leena Himanen
ObjectiveDeep NREM sleep and its hallmark EEG phenomenon slow wave activity (SWA) are under homeostatic control in adults. SWA is also locally regulated as it increases in the brain areas that have been used intensively. Moreover, in children, SWA is a marker of cortical maturation. In the present study the local properties of NREM sleep depth were evaluated using the quantitative mean frequency method. We aimed to study if age is related to NREM sleep depth in young infants. In addition, we studied if young infants have local differences in their NREM sleep.MethodsAmbulatory over-night polysomnographies were recorded in 59 healthy and full-term infants at the age of one month. The infants were divided into two age groups (<44 weeks and ≥44 weeks) to allow maturational evaluations.ResultsThe quantitative sleep depth analysis showed differences between the age groups. In addition, there were local sleep depth differences within the age groups.ConclusionsThe sleep depth change with age is most likely related to cortical maturation, whereas the local sleep depth gradients might also reflect the use-dependent properties of SWA.SignificanceThe results support the idea that young infants have frontal cortical processing.



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Comparison of mobility and user satisfaction between a microprocessor knee and a standard prosthetic knee: a summary of seven single-subject trials

Insufficient evidence of the benefits provided by costlier microprocessor knees (MPKs) over nonmicroprocessor knees (NMPKs) often causes concern when considering MPK prescription. Thus, more studies are needed to demonstrate differences between MPKs and NMPKs and define sensitive outcomes to guide MPK prescription. The aim of this study was to evaluate the impact of switching from NMPK to MPK on measures of mobility and preference. Seven long-term NMPK users (all men, ages 50–84, 3–64 years postamputation) participated in this study, which use a single-subject design (ABA or BAB; A=NMPK, B=MPK). Mobility was assessed with the Amputee Mobility Predictor, Berg Balance Scale (BBS), L-Test, 6-Min Walk Test (6MWT) with Physiological Cost Index, and self-selected normal and very fast gait speeds. The preference between NMPK and MPK was evaluated by the Prosthesis Evaluation Questionnaire (PEQ) and the visual analog scale. Mobility improved with the MPK in six of seven participants, which was most often captured with BBS (median: +6 points) and 6MWT (median: +63 m). These improvements typically exceeded minimal clinically important difference or minimal detectable change thresholds. Most participants scored the MPK higher on the PEQ (median: +20 points) and six of seven expressed a global preference toward MPK. In the BAB group, the Amputee Mobility Predictor and BBS correlated with perception of change on several PEQ domains (Ρ≥0.59). In conclusion, MPKs may provide better outcomes and user satisfaction, particularly in those with lower mobility function. BBS and 6MWT were found to be the most sensitive measures to capture changes in mobility while using MPK for several weeks. Correspondence to Charla L. Howard, PhD, Methodist Rehabilitation Center, 1350 E. Woodrow Wilson Drive, Jackson, MS 39216, USA Tel: +1 601 364 3314; fax: +1 601 364 3305; e-mail: research@mmrcrehab.org Received June 15, 2017 Accepted November 6, 2017 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Use of clinical measures to document the effect of passive cycling on knee extensor spasticity and the ability to perform activities of daily living in spinal cord injury: a case report

The effects, on spasticity-related clinical measure results [initial knee flexion velocity during the pendulum test (F1-VEL); Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET) scores], of a 5-week passive cycling program were assessed in a 67-year-old man with chronic, complete, thoracic-level SCI. Three weekly evaluations were performed before and after training, at the start, middle, and end of the training (ET), and 24 h following ET. The F1-VEL increased significantly from baseline, from ET to the 2-week follow-up evaluation. A trend was found for an improvement from baseline in SCI-SET scores, from middle of training onwards. These findings, which can inform clinical decisions and clinical trial development, suggest that the F1-VEL pendulum test result may be used to document the effect on knee extensor spasticity of a passive cycling program in chronic, complete, thoracic-level SCI. Whether this is also true for the SCI-SET requires future confirmation. Correspondence to Désirée B. Maltais, PhD, PT, Department of Rehabilitation, Université Laval; 1050, avenue de la médecine, Room 4457, Quebec City, QC, Canada G1V 0A6 Tel: 418 656 2131 x7964; fax: 418 656 5476; e-mail: desiree.maltais@rea.ulaval.ca Received November 8, 2017 Accepted December 13, 2017 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Effects of rehabilitation aftercare on work participation in patients with musculoskeletal disorders: a propensity score-matched analysis

Meta-analyses of rehabilitation studies in chronic back pain patients in Germany showed a lack of sustainability of rehabilitation programs. The German Pension Insurance therefore developed an intensified aftercare program to support rehabilitation outcomes. The aim of this study was to compare disability pension rates, income from regular employment, and duration of welfare benefits in patients with and without rehabilitation aftercare. We used administrative data on finished rehabilitation services. Patients were included if they were aged 18–60 years, had musculoskeletal disorders, and attended an outpatient or an inpatient rehabilitation program during the first term of 2007. Patients were excluded if they received an old-age pension, started a disability pension before January 2008, or died during the follow-up period. Patients with rehabilitation aftercare were matched by propensity scores with patients without rehabilitation aftercare. Estimation of the propensity score considered 20 potential confounders. There were no differences in the cumulative probability of receiving a disability pension. Moreover, patients with and without aftercare did not differ in their income from regular employment and the duration of different types of welfare benefits during the follow-up period. However, stratified analyses found a positive effect of an aftercare program on income in patients who attended a postacute rehabilitation program and patients who were at least 3 months absent because of sickness during the year preceding the initial rehabilitation program. Only patients with strong impairments benefit from attending an aftercare program. Allocation to aftercare programs and the focus on exercise only have to be reconsidered and revised. Correspondence to Dr Matthias Bethge, Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany Tel: +49 451 500 51280; fax: +49 451 500 51204; e-mail: matthias.bethge@uksh.de Received July 25, 2017 Accepted December 4, 2017 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Pneumococcal and Influenza vaccine uptake in adults with Inflammatory Bowel Disease in France: results from a web-based study.

Despite specific immunization guidelines for immunocompromised patients, there is a dearth of studies on Inflammatory Bowel Disease (IBD) population in France.

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Pneumococcal and Influenza vaccine uptake in adults with Inflammatory Bowel Disease in France: results from a web-based study.

Despite specific immunization guidelines for immunocompromised patients, there is a dearth of studies on Inflammatory Bowel Disease (IBD) population in France.

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Analysis of risk factors for sagittal translation after pedicle subtraction osteotomy in ankylosing spondylitis patients

Sagittal translation, a potential complication of pedicle subtraction osteotomy (PSO), can results in neurologic damage. However, few studies have been conducted on sagittal translation and its risk factors after PSO in patients with ankylosing spondylitis (AS).

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Developing a Postpartum Depression Screening and Referral Procedure in Pediatric Primary Care

Postpartum depression affects approximately 10% to 20% of mothers and impairs a mother's ability to engage with her child at an emotional and cognitive level, placing the child at greater risk for impaired development. Early diagnosis and management can reduce its negative impacts. Despite mothers being receptive to screening, screening rates are less than 50%.

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Length of Recovery From Sports-Related Concussions in Pediatric Patients Treated at Concussion Clinics

Objectives: We quantified the length of recovery time by week in a cohort of pediatric sports–related concussion patients treated at concussion clinics, and examined patient and injury characteristics associated with prolonged recovery. Design: A retrospective, cohort design. Setting: Seven concussion clinics at a Midwest children's hospital. Patients: Patients aged 10 to 17 years with a diagnosed sports-related concussion presenting to the clinic within 30 days of injury. Main Outcome Measures: Length of recovery by week. Methods: Unadjusted and adjusted multinomial logistic regression analyses were used to model the effect of patient and injury characteristics on length of recovery by week. Results: Median length of recovery was 17 days. Only 16.3% (299/1840) of patients recovered within one week, whereas 26.4% took longer than four weeks to recover. By 2 months postinjury, 6.7% of patients were still experiencing symptoms. Higher symptom scores at injury and initial visit were significantly associated with prolonged symptoms by week. Patients who presented to the clinic more than 2 weeks postinjury or who had 2 or more previous concussions showed increased risk for prolonged recovery. Females were at greater risk for prolonged recovery than males (odds ratio = 2.08, 95% confidence interval = 1.49-2.89). Age was not significantly associated with recovery length. Conclusions: High symptom scores at injury and initial visit, time to initial clinical presentation, presence of 2 or more previous concussions, and female sex are associated with prolonged concussion recovery. Further research should aim to establish objective measures of recovery, accounting for treatment received during the recovery. Clinical Relevance: The median length of recovery is 17 days among pediatric sports–related concussion patients treated at concussion clinics. Only 16.3% of patients recovered within one week, whereas 26.4% took longer than 4 weeks to recover.

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Safety and Prognostic Utility of Provocative Exercise Testing in Acutely Concussed Adolescents: A Randomized Trial

Objective: To evaluate (1) systematic assessment of exercise tolerance in adolescents shortly after sport-related concussion (SRC) and (2) the prognostic utility of such assessment. Design: Prospective randomized controlled trial. Setting: University and community sports medicine centers. Participants: Adolescents with SRC (1–9 days from injury). Sixty-five were randomized and 54 completed the study (mean age 15 years, 4 days after injury). Interventions: Buffalo Concussion Treadmill Test (BCTT, n = 27) or not (controls, n = 27) on visit day #1. Heart rate threshold (HRt) at symptom exacerbation represented level of exercise tolerance. Participants reported symptoms daily for 14 days and then had follow-up BCTT (n = 54). Recovery was defined as returning to normal level of symptoms and exercise tolerance, verified by independent physician examination. Main Outcome Measures: Days to recovery and typical (≤21 days) versus prolonged recovery (>21 days). Mixed effects linear models and linear regression techniques examined symptom reports and time to recovery. Linear regression assessed the association of HRt with recovery time. Results: Days to recovery (P = 0.7060) and typical versus prolonged recovery (P = 0.1195) were not significantly different between groups. Symptom severity scores decreased in both groups over 14 days (P

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In Response to: Use of Head Guards in AIBA Boxing Tournaments—A Cross-Sectional Observational Study

No abstract available

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Ultrasound Guidance Does Not Improve the Results of Shock Wave for Plantar Fasciitis or Calcific Achilles Tendinopathy: A Randomized Control Trial

Objective: To establish whether the use of ultrasound to direct shock waves to the area of greater calcification in calcaneal enthesopathies was more effective than the common procedure of directing shock waves to the point where the patient has the most tenderness. Design: Two-armed nonblinded randomized control trial with allocation concealment. Setting: The Sports Clinic at Sydney University. Patients: Participants 18 years or older with symptomatic plantar fasciitis (PF) (with heel spur) or calcific Achilles tendinopathy (CAT). Seventy-four of 82 cases completed treatment protocol and 6-month follow-up. Interventions: Patients were randomized to receive either ultrasound-guided (UG) or patient-guided (PG) shock wave at weekly intervals over 3 to 5 weeks. Main Outcome Measures: Reduced pain on visual analog scale (VAS) and improved functional score on Maryland Foot Score (MFS) (for PF) or Victorian Institute of Sport Assessment-Achilles (VISA-A) (for CAT). Follow-up was at 6 weeks and 3 and 6 months. Results: Comparative 6-month improvements in MFS for the 47 PF cases were PG +20/100 and UG +14/100 (P = 0.20). Comparative 6-month improvement in VISA-A score for the 27 CAT cases were PG +35/100 and UG +27/100 (P = 0.37). Comparative (combined PF and CAT) 6-month improvement in VAS pain scores for all 38 PG cases were +38/100 with +37/100 for all 36 UG shock wave cases. Conclusions: Although both treatment groups had good clinical outcomes in this study, results for the 2 study groups were almost identical. Clinical Relevance: This study shows that there is no major advantage in the addition of ultrasound for guiding shock waves when treating calcaneal enthesopathies (PF and CAT).

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Smartphone-Enabled Heart Rate Variability and Acute Mountain Sickness

Introduction: The autonomic system and sympathetic activation appears integral in the pathogenesis of acute mountain sickness (AMS) at high altitude (HA), yet a link between heart rate variability (HRV) and AMS has not been convincingly shown. In this study we investigated the utility of the smartphone-derived HRV score to predict and diagnose AMS at HA. Methods: Twenty-one healthy adults were investigated at baseline at 1400 m and over 10 days during a trek to 5140 m. HRV was recorded using the ithlete HRV device. Results: Acute mountain sickness occurred in 11 subjects (52.4%) at >2650 m. HRV inversely correlated with AMS Scores (r = −0.26; 95% CI, −0.38 to −0.13: P 5 had a sensitivity of 83% and specificity of 60% to identify severe AMS (likelihood ratio 1.9). Baseline HRV at 1400 m was not predictive of either AMS at higher altitudes. Conclusions: The ithlete HRV score can be used to help in the identification of severe AMS; however, a baseline score is not predictive of future AMS development at HA.

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The Efficacy of Dynamic Contract-Relax Stretching on Delayed-Onset Muscle Soreness Among Healthy Individuals: A Randomized Clinical Trial

Objective: To evaluate the efficacy of dynamic contract-relax stretching on delayed-onset muscle soreness (DOMS) in the calf muscle of healthy individuals. Design: Randomized clinical trial. Setting: Research laboratory. Participants: Three groups of 16 healthy participants (n = 48) were recruited by convenience sampling. Interventions: Three sets of resisted bilateral heel-raising exercises until exhaustion were conducted to initiate DOMS. Participants were randomly allocated into control group without any interventions, dynamic contract-relax stretching (DS), or static stretching (SS) groups. Dynamic contract-relax stretching and SS groups performed DS and SS, respectively, on the dominant leg twice a day for 5 consecutive days (before time points of outcome measurements at 24, 48, 72, 96, and 120 hours postexercise, respectively). Main Outcome Measures: Muscle soreness, lower leg girth, pressure pain threshold (PPT), range of motion (ROM), and muscle strength were measured before exercise, immediately after, and at 24, 48, 72, 96, and 120 hours postexercise. Results: There was a significant effect of time in all outcome measures including muscle soreness, lower leg girth, PPT, ROM, and muscle strength; however, there were no significant group differences or group by time interactions. Conclusions: The effect of DS on relieving DOMS in the calf muscle is insignificant in this study. Further evidence is needed to prove the efficacy of DS on DOMS. Clinical Relevance: Stretching is commonly recommended before and after exercise; however, this study showed no significant impact of DS or SS in treating DOMS.

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Why Professional Football Players Chose Not to Reveal Their Concussion Symptoms During a Practice or Game

Objective: To determine why professional football players in Canada decided not to seek medical attention during a game or practice when they believed they had suffered a concussion. Design: Retrospective survey. Setting: Preseason Canadian Football League training camps. Participants: Four hundred fifty-four male professional football players. Main Outcome Measures: Reasons athletes did not seek medical attention for a presumed concussion during the previous season, how often this occurred and how important these reasons were in the decision process. Results: One hundred six of the 454 respondents (23.4%) believed they had suffered a concussion during their previous football season and 87 of the 106 (82.1%) did not seek medical attention for a concussion at least once during that season. The response "Did not feel the concussion was serious/severe and felt you could still continue to play with little danger to yourself" was the most commonly listed reason (49/106) for not seeking medical attention for a presumed concussion. Many players answered that they did not seek medical attention because they did not want to be removed from a game (42/106) and/or they did not want to risk missing future games (41/106) by being diagnosed with a concussion. Conclusions: Some professional football players who believed they had suffered a concussion chose not to seek medical attention at the time of injury. Players seemed educated about the concussion evaluation process and possible treatment guidelines, but this knowledge did not necessarily translate into safe and appropriate behavior at the time of injury.

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First-Aid Treatment for Friction Blisters: “Walking Into the Right Direction?”

Objective: Blisters are common foot injuries during and after prolonged walking. However, the best treatment remains unclear. The aim of the study was to compare the effect of 2 different friction blister treatment regimens, wide area fixation dressing versus adhesive tape. Design: A prospective observational cohort study. Setting: The 2015 Nijmegen Four Days Marches in the Netherlands. Participants: A total of 2907 participants (45 ± 16 years, 52% men) were included and received 4131 blister treatments. Interventions: Blisters were treated with either a wide area fixation dressing or adhesive tape. Main Outcome Measures: Time of treatment application was our primary outcome. In addition, effectiveness and satisfaction were evaluated in a subgroup (n = 254). During a 1-month follow-up period, blister healing, infection and the need for additional medical treatment were assessed in the subgroup. Results: Time of treatment application was lower (41.5 minutes; SD = 21.6 minutes) in the wide area fixation dressing group compared with the adhesive tape group (43.4 minutes; SD = 25.5 minutes; P = 0.02). Furthermore, the wide area fixation dressing group demonstrated a significantly higher drop-out rate (11.7% vs 4.0%, P = 0.048), delayed blister healing (51.9% vs 35.3%, P = 0.02), and a trend toward lower satisfaction (P = 0.054) when compared with the adhesive tape group. Conclusions: Wide area fixation dressing decreased time of treatment application by 2 minutes (4.5%) when compared with adhesive tape. However, because of lower effectiveness and a trend toward lower satisfaction, we do not recommend the use of wide area fixation dressing over adhesive tape in routine first-aid treatment for friction blisters.

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Associations Between Pedometer-Determined Physical Activity and Adiposity in Children and Adolescents: Systematic Review

Objective: The present review sought to examine the evidence on the associations between pedometer-determined physical activity and adiposity. Design: Of 304 potentially eligible articles, 36 were included. A search for observational studies was carried out using Cochrane Library (CENTRAL), the OVID (MEDLINE, Embase, and PsycINFO), EBSCOhost (Sportdiscus), and PEDro database from their commenced to July 2015. Of 304 potentially eligible articles, 36 were included. Results: Most studies (30/36; 83%) were cross sectional and all used proxies for adiposity, such as body mass index (BMI) or BMI z-score as the outcome measure. Few studies (2/36; 6%) focused on preschool children. There was consistent evidence of negative associations between walking and adiposity; significant negative associations were observed in 72% (26/36) of studies overall. Conclusions: The present review supports the hypothesis that higher levels of walking are protective against child and adolescent obesity. However, prospective longitudinal studies are warranted; there is a need for more research on younger children and for more "dose-response" evidence.

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Do Neurocognitive SCAT3 Baseline Test Scores Differ Between Footballers (Soccer) Living With and Without Disability? A Cross-Sectional Study

Objective: To determine if baseline Sport Concussion Assessment Tool, third Edition (SCAT3) scores differ between athletes with and without disability. Design: Cross-sectional comparison of preseason baseline SCAT3 scores for a range of England international footballers. Setting: Team doctors and physiotherapists supporting England football teams recorded players' SCAT 3 baseline tests from August 1, 2013 to July 31, 2014. Participants: A convenience sample of 249 England footballers, of whom 185 were players without disability (male: 119; female: 66) and 64 were players with disability (male learning disability: 17; male cerebral palsy: 28; male blind: 10; female deaf: 9). Assessment and Outcome Measures: Between-group comparisons of median SCAT3 total and section scores were made using nonparametric Mann–Whitney–Wilcoxon ranked-sum test. Main Results: All footballers with disability scored higher symptom severity scores compared with male players without disability. Male footballers with learning disability demonstrated no significant difference in the total number of symptoms, but recorded significantly lower scores on immediate memory and delayed recall compared with male players without disability. Male blind footballers' scored significantly higher for total concentration and delayed recall, and male footballers with cerebral palsy scored significantly higher on balance testing and immediate memory, when compared with male players without disability. Female footballers with deafness scored significantly higher for total concentration and balance testing than female footballers without disability. Conclusions: This study suggests that significant differences exist between SCAT3 baseline section scores for footballers with and without disability. Concussion consensus guidelines should recognize these differences and produce guidelines that are specific for the growing number of athletes living with disability.

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Twenty-Year Systematic Review of the Hip Pathology, Risk Factors, Treatment, and Clinical Outcomes in Artistic Athletes—Dancers, Figure Skaters, and Gymnasts

Objective: To identify (1) the predominant level of evidence of the clinical studies regarding the hip pathology, risk factors, treatment, and clinical outcomes in artistic athletes (dancers, figure skaters, and gymnasts) (2) the most commonly reported hip pathology, risk factors, treatments, and clinical outcomes in dancers, figure skaters, and gymnasts. Methods: To conduct this systematic review PubMed, EMBASE, and Scopus databases were searched for relevant studies and pertinent data were collected from the eligible articles. Included were studies which reported hip injuries in artistic athletes, the risk factors, treatment, and/or the clinical outcomes. We excluded case reports or irrelevant studies. No meta-analysis was performed because of study heterogeneity. The methodical index for nonrandomized studies (MINORS) criteria were used for quality control. Main Results: Thirty-eight studies were included in the analysis. The mean MINORS score was 13.6 ± 4.6 points indicating fair quality of evidence of the included articles. The predominant level of evidence was level IV. Chondrolabral pathology and muscle injuries were the most commonly reported pathologies. We found only 2 risk factor analysis studies; however, many studies reported risk correlation between artistic sports or imaging findings and hip pathology. Treatment strategies were reported in only 7 studies, clinical outcomes are significantly underreported. Conclusion: Chondrolabral pathology was the most commonly reported hip pathology in artistic athletes, however, prospective cohort studies are necessary to really understand these injuries and their associated risk factors. The lack of clinical outcomes is significant and future data collection is required to assess the effectiveness of the various treatments.

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Service Providers' Attitudes Toward Athletes With Eating Disorders

Objective: This study explored the nature and extent of Athlete Support Personnel's (ASP's) attitudes and beliefs toward athletes with symptoms of anorexia nervosa (AN) compared with those with symptoms of depression. Design: A cross-sectional study with a survey instrument. Setting: Sport and Exercise Science Professional Bodies and Associations in the Republic of Ireland, Northern Ireland, and mainland United Kingdom. Participants: One hundred fifty-two ASP. Main Outcome Measures: Participants read 2 vignettes describing a fictional female athlete with symptoms of AN or depression after which they completed an on-line survey examining attitudes toward such athletes. Results: Significant differences in patterns of responses were found between the 2 mental health conditions. The athlete with AN was viewed as significantly more difficult to communicate with F(1,148) = 18.17, P = 0.000, η2 = 0.11, more likely to be using her disorder to gain attention F(1,148) = 21.69, P = 0.000, η2 = 0.13, personally responsible for her condition F(1,148) = 10.10, P = 0.00, η2 = 0.06, and less likely to recover F(1,148) = 23.03, P = 0.000, η2 = 0.14 than the athlete with depression. Male service providers were more likely to believe that the athletes depicted were attention seeking F(1,148) = 10.69, P = 0.001, η2 = 0.07 and only had themselves to blame for their mental health condition F(1,148) = 12.97, P = 0.000, η2 = 0.08. Conclusions: Athlete support personnel report stigmatizing attitudes toward athletes with eating disorders such as AN. Male service providers hold greater negative attitudes toward athletes with mental health conditions.

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Can Functional Movement Assessment Predict Football Head Impact Biomechanics?

ABSTRACTPurposeTo determine functional movement assessments' ability to predict head impact biomechanics in college football players, and to determine whether head impact biomechanics could explain preseason to postseason changes in functional movement performance.MethodsParticipants (N = 44, mass = 109.0 ± 20.8 kg, age = 20.0 ± 1.3 years) underwent two preseason and postseason functional movement assessment screenings: 1) Fusionetics Movement Efficiency Test, and 2) Landing Error Scoring System (LESS). Fusionetics is scored 0 to 100, and participants were categorized into the following movement quality groups as previously published: good (≥75); moderate (50 to 75); and poor ( 7 errors). The Head Impact Telemetry (HIT) System measured head impact frequency and magnitude (linear acceleration and rotational acceleration). An encoder with six single-axis accelerometers was inserted between the padding of a commercially available Riddell football helmet. We employed random intercepts general linear mixed models to analyze our data.ResultsThere were no effects of preseason movement assessment group on the two HIT System impact outcomes: linear acceleration and rotational acceleration. Head impact frequency did not significantly predict preseason to postseason score changes obtained from the Fusionetics (F1,36 = 0.22, P = 0.643, R2=0.006) or the LESS (F1,36 7 errors). The Head Impact Telemetry (HIT) System measured head impact frequency and magnitude (linear acceleration and rotational acceleration). An encoder with six single-axis accelerometers was inserted between the padding of a commercially available Riddell football helmet. We employed random intercepts general linear mixed models to analyze our data. Results There were no effects of preseason movement assessment group on the two HIT System impact outcomes: linear acceleration and rotational acceleration. Head impact frequency did not significantly predict preseason to postseason score changes obtained from the Fusionetics (F1,36 = 0.22, P = 0.643, R2=0.006) or the LESS (F1,36

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Comparison of DNA Damage and Oxidative Stress in Patients Anesthetized With Desflurane Associated or Not With Nitrous Oxide: A Prospective Randomized Clinical Trial

BACKGROUND: Little is known about the effects of desflurane associated or not with nitrous oxide (N2O) on oxidative stress and patient genetic material. The aim of this study was to compare the effects of anesthesia maintained with desflurane associated or not with N2O on DNA damage (as a primary outcome) and oxidative stress (as a secondary outcome) in patients who underwent an elective minimally invasive surgery. METHODS: This prospective randomized clinical trial analyzed 40 patients of both sexes with an American Society of Anesthesiologists physical status I who were 18–50 years of age and scheduled for septoplasty. The patients were randomly allocated into 2 groups according to anesthesia maintenance as follows: desflurane (n = 20) or desflurane/N2O (n = 20). Blood samples were collected before anesthesia (T1 = baseline), 1.5 hours after anesthesia induction (T2), and on the morning of the postoperative first day (T3). Basal and oxidative DNA damage (determined using formamidopyrimidine DNA glycosylase to detect oxidized purines and endonuclease III to detect oxidized pyrimidines) were evaluated using the comet assay. Oxidative stress markers were evaluated based on lipid peroxidation (by assessing 4-hydroxynonenal and 8-iso-prostaglandin F2α [8-isoprostane] using enzyme linked immunosorbent immunoassay), protein carbonyls (assessed by enzyme linked immunosorbent immunoassay), and antioxidant defense (ferric-reducing antioxidant power by spectrophotometry). The effect size was expressed as the mean differences between groups and the corresponding 95% confidence interval (CI). RESULTS: There was no significant mean difference between groups in relation to DNA damage (−1.7 [95% CI, −7.0 to 3.5]), oxidized DNA pyrimidines (−1.8 [95% CI, −12.5 to 8.9]) and purines (−1.9 [95% CI, −13.9 to 10.1]), 4-hydroxynonenal (−0.2 [95% CI, −2.8 to 2.4]), 8-isoprostane (549 [95% CI, −2378 to 3476]), protein carbonyls (0.2 [95% CI, −2.1 to 2.3]), or ferric-reducing antioxidant power (24 [95% CI, −52.0 to 117.2]). CONCLUSIONS: The coadministration of 60% N2O with desflurane did not seem to impair the effects on DNA or the redox status compared with desflurane anesthesia, suggesting that both studied anesthetic techniques can be suitable options for healthy individuals who undergo minimally invasive surgery lasting at least 1.5 hours. However, due to the low power of the study, more research is necessary to confirm our findings. Accepted for publication November 2, 2017. Funding: Supported by grant 2013/16842-0 from the São Paulo Research Foundation (FAPESP). F.R.N. was granted a scholarship from the National Council for Scientific and Technological Development-CNPq (2014–2015) and from the Coordination of Improvement for Higher Education Personnel-CAPES (2016), and J.R.C.B. received a fellowship from CNPq (303673/2015-0). The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). This report was previously presented in part at Euroanaesthesia 2016, London, United Kingdom, May 28-30, 2016. Clinical trial number: the Brazilian Clinical Trials Registry (RBR-6jg23g; Trial Identification UTN Number: U1111-1150-0903). Registry URL: http://ift.tt/2CG5pp6. Reprints will not be available from the authors. Address correspondence to Mariana G. Braz, PhD, Department of Anesthesiology, Botucatu Medical School, São Paulo State University (UNESP), Professor Mário Rubens G. Montenegro Av, 18618–687, Botucatu, SP, Brazil. Address e-mail to mgbraz@hotmail.com. © 2017 International Anesthesia Research Society

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Dexmedetomidine for Improved Quality of Emergence From General Anesthesia: A Dose-Finding Study

BACKGROUND: Dexmedetomidine provides smooth and hemodynamically stable emergence at the expense of hypotension, delayed recovery, and sedation. We investigated the optimal dose of dexmedetomidine for prevention of cough, agitation, hypertension, tachycardia, and shivering, with minimal side effects. METHODS: In this prospective, randomized, double-blind trial, 216 adult patients were randomly assigned to dexmedetomidine 1 µg/kg (D 1), 0.5 µg/kg (D 0.5), 0.25 µg/kg (D 0.25), or control (C). During emergence, cough, agitation, hemodynamic parameters, shivering, time to extubation, and sedation scores were recorded. RESULTS: A total of 190 patients were analyzed. The respective incidences for the groups D 1, D 0.5, and D 0.25 versus group C were 48%, 64%, and 64% vs 84% for cough—corrected P

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Characteristics of Desaturation and Respiratory Rate in Postoperative Patients Breathing Room Air Versus Supplemental Oxygen: Are They Different?

BACKGROUND: Routine monitoring of postoperative patients with pulse oximetry–based surveillance monitoring has been shown to reduce adverse events. However, there is some concern that pulse oximetry is limited in its ability to detect deterioration quickly enough to allow for intervention in patients receiving supplemental oxygen. To address such concerns, this study expands on the current limited knowledge of differences in desaturation and respiratory rate characteristics between patients breathing room air and those receiving supplemental oxygen. METHODS: PPulse oximetry–derived data and patient characteristics were used to examine overnight desaturation patterns of 67 postoperative patients who were receiving either supplemental oxygen or breathing room air. The 2 modalities with respect to the speed of desaturation, in addition to magnitude and duration of desaturation events, are compared. Night-time pulse rate, oxygen saturation, respiratory rate, and the transition times from normal oxygen saturation levels to desaturated states are also compared. The behavior of respiratory rate in proximity to desaturation events is described. Statistical methods included multivariable regression and inverse probability of treatment weighted to adjust for any imbalance in patient characteristics between the oxygen and room air patients and linear mixed effect models to account for clustering by patient. RESULTS: The study included 33 patients on room air and 34 receiving supplemental oxygen. The speed of desaturation was not different for room air versus oxygen for 2 types of desaturation (adjusted % difference, 95% confidence interval [CI]: type I; 22.4%, -51.5% to 209%; P = .67, type II; -17.3%, -53.8% to 47.6%; P = .52). Patients receiving supplemental oxygen had a higher mean oxygen saturation (adjusted difference, 95% CI, 2.4 [0.7–4.0]; P = .006). No differences were found for the average overnight respiratory or pulse rate, or proportion of time in desaturation states between the 2 groups. The time to transition from a normal oxygen saturation (92%) to 88% or below was not longer for supplemental oxygen patients (P = .42, adjusted difference 26.1%: 95% CI, -28.1% to 121%). Respiratory rates did not differ between the overall mean and desaturation or recovery phases or between the oxygen and room air group. CONCLUSIONS: In this study, desaturation characteristics did not differ between patients receiving supplemental oxygen and breathing room air with regard to speed, depth, or duration of desaturation. Transition time for desaturations to reach low oxygen saturation alarms was not different, while respiratory rate remained in the normal range during these events. These findings suggest that pulse oximetry–based surveillance monitoring for deterioration detection can be used equally effectively for patients on supplemental oxygen and for those on room air. Accepted for publication November 9, 2017. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Funding: This project was supported by Grant Number P30HS024403 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Andreas H. Taenzer, MS, MD, Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756. Address e-mail to andreas.h.taenzer@dartmouth.edu. © 2017 International Anesthesia Research Society

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American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway

Patient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on traditional measures of health care quality such as complications and hospital length of stay. These measures do not capture postdischarge outcomes that are meaningful to patients such as function or freedom from disability. PROs can be used to facilitate shared decisions between patients and providers before surgery and establish benchmark recovery goals after surgery. PROs can also be utilized in quality improvement initiatives and clinical research studies. An expert panel, the Perioperative Quality Initiative (POQI) workgroup, conducted an extensive literature review to determine best practices for the incorporation of PROs in an ERP. This international group of experienced clinicians from North America and Europe met at Stony Brook, NY, on December 2–3, 2016, to review the evidence supporting the use of PROs in the context of surgical recovery. A modified Delphi method was used to capture the collective expertise of a diverse group to answer clinical questions. During 3 plenary sessions, the POQI PRO subgroup presented clinical questions based on a literature review, presented evidenced-based answers to those questions, and developed recommendations which represented a consensus opinion regarding the use of PROs in the context of an ERP. The POQI workgroup identified key criteria to evaluate patient-reported outcome measures (PROMs) for their incorporation in an ERP. The POQI workgroup agreed on the following recommendations: (1) PROMs in the perioperative setting should be collected in the framework of physical, mental, and social domains. (2) These data should be collected preoperatively at baseline, during the immediate postoperative time period, and after hospital discharge. (3) In the immediate postoperative setting, we recommend using the Quality of Recovery-15 score. After discharge at 30 and 90 days, we recommend the use of the World Health Organization Disability Assessment Scale 2.0, or a tailored use of the Patient-Reported Outcomes Measurement Information System. (4) Future study that consistently applies PROMs in an ERP will define the role these measures will have evaluating quality and guiding clinical care. Consensus guidelines regarding the incorporation of PRO measures in an ERP were created by the POQI workgroup. The inclusion of PROMs with traditional measures of health care quality after surgery provides an opportunity to improve clinical care. Accepted for publication November 3, 2017. Funding: The Perioperative Quality Initiative meeting received financial assistance from the American Society for Enhanced Recovery. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Timothy E. Miller, MB, ChB, FRCA, Division of General, Vascular and Transplant Anesthesia, Duke University Medical Center, Box 3094, Durham, NC 27710. Address e-mail to timothy.miller2@duke.edu. © 2017 International Anesthesia Research Society

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Adductor Canal Block With Continuous Infusion Versus Intermittent Boluses and Morphine Consumption: A Randomized, Blinded, Controlled Clinical Trial

BACKGROUND: Based on the assumption that relatively large volumes of local anesthetic optimize an adductor canal block (ACB), we theorized that an ACB administered as repeated boluses would improve analgesia without compromising mobility, compared with a continuous infusion. METHODS: We performed a randomized, blinded, controlled study, including patients scheduled for total knee arthroplasty with spinal anesthesia. Patients received 0.2% ropivacaine via a catheter in the adductor canal administered as either repeated intermittent boluses (21 mL/3 h) or continuous infusion (7 mL/h). The primary outcome was total (postoperative day [POD], 0–2) opioid consumption (mg), administered as patient-controlled analgesia. Pain, ambulation, and quadriceps muscle strength were secondary outcomes. RESULTS: We randomized 110 patients, of whom 107 were analyzed. Total opioid consumption (POD, 0–2) was a median (range) of 23 mg (0–139) in the bolus group and 26 mg (3–120) in the infusion group (estimated median difference, 4 mg; 95% confidence interval [CI], −13 to 5; P = .29). Linear mixed-model analyses revealed no difference in pain during knee flexion (mean difference, 2.6 mm; 95% CI, −2.9 to 8.0) or at rest (mean difference, 1.7 mm; 95% CI, −1.5 to 4.9). Patients in the bolus group had improved quadriceps sparing on POD 2 (median difference, 7.4%; 95% CI, 0.5%–15.5%). However, this difference was not present on POD 1 or reflected in the ambulation tests (P > .05). CONCLUSIONS: Changing the mode of administration for an ACB from continuous infusion to repeated intermittent boluses did not decrease opioid consumption, pain, nor mobility. Accepted for publication October 24, 2017. Funding: This work was supported by an unrestricted research grant from Smiths Medical (St Paul, MN). In addition, Smiths Medical provided the portable infusion pumps used in this trial. The company had no input or influence into any aspect of study conceptualization, design, data analysis, or reporting of the study. None of the authors have a personal financial interest in this research. Conflicts of Interest: See Disclosures at the end of the article. The abstract has been accepted for presentation at the annual meeting of the American Society of Regional Anesthesia, San Francisco, CA, January 6–8, 2017, and at the IX SIMPAR-ISURA SIMPAR-ISURA (Study In Multidisciplinary Pain Research-International Symposium of Ultrasound for Regional Anesthesia and Pain Medicine) Congress, Florence, Italy, March 29 to April 1, 2017. Clinical trial number: Clinicaltrials.gov Identifier: NCT02539628. Ethics committees approval: H-2-2014-114. Pia Jaeger and Jonas Baggesgaard share first authorship. Reprints will not be available from the authors. Address correspondence to Pia Jaeger, MD, PhD, Department of Anaesthesia 4231, Centre of Head and Orthopaedics, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen E, Denmark. Address e-mail to pia.therese.jaeger@regionh.dk. © 2017 International Anesthesia Research Society

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Airway Management by Laryngeal Mask Airways for Cervical Tracheal Resection and Reconstruction: A Single-Center Retrospective Analysis

BACKGROUND: Supraglottic airway devices (SADs) may have advantages over endotracheal intubation for tracheal resection and reconstruction in cases of severe and proximally located subglottic stenosis. This retrospective case series examines the feasibility of using SADs as a novel approach to airway management in tracheal resections. METHODS: All patients who were managed with SADs for cervical tracheal resection and reconstruction during the study period (2010–2015) in our university hospital were included. To examine the feasibility of airway management with SADs for tracheal resection, medical records were obtained from our institution's electronic database and reviewed. RESULTS: SADs were used in 10 patients who had extensive tracheal stenosis and a high prevalence of severe comorbidities. SAD insertion and subsequent positive pressure ventilation were successful in all patients, although 1 patient with preoperative respiratory failure had persistent hypercarbia. During the phase of resection and reconstruction, high-frequency jet ventilation was used to ensure adequate oxygenation. There were no intraoperative complications related to anesthetic management, apart from transient hypercarbia during and after jet ventilation. Most patients (n = 6; 60%) had an uneventful postoperative course. In this high-risk cohort, postoperative complications (ie, vocal cord edema, postoperative hemorrhage, pneumonia) occurred in 4 patients (40%). CONCLUSIONS: This retrospective case series demonstrates the feasibility of using supraglottic airways alongside high-frequency jet ventilation for airway management in at least some cases of cervical tracheal resection and reconstruction. However, the small number of cases examined limits conclusions regarding indications, contraindications, and periprocedural safety. Accepted for publication November 13, 2017. Funding: None. The authors declare no conflicts of interest. Patient consent: Requirement waived by institutional review board. Ethics approval: Approval by institutional review board of the University Hospital Witten/Herdecke, Medical Center Cologne-Merheim, Board supervisor: Professor Maune. Reprints will not be available from the authors. LMA is a registered trademark of Teleflex Incorporated or its affiliates. Address correspondence to Mark Schieren, MD, Department of Anesthesiology and Intensive Care Medicine, Medical Centre Cologne, University Witten/Herdecke, Ostmerheimer Strasse 200, 51109 Cologne, Germany. Address e-mail to mark.schieren@uni-wh.de. © 2017 International Anesthesia Research Society

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American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery

The primary driver of length of stay after bowel surgery, particularly colorectal surgery, is the time to return of gastrointestinal (GI) function. Traditionally, delayed GI recovery was thought to be a routine and unavoidable consequence of surgery, but this has been shown to be false in the modern era owing to the proliferation of enhanced recovery protocols. However, impaired GI function is still common after colorectal surgery, and the current literature is ambiguous with regard to the definition of postoperative GI dysfunction (POGD), or what is typically referred to as ileus. This persistent ambiguity has impeded the ability to ascertain the true incidence of the condition and study it properly within a research setting. Furthermore, a rational and standardized approach to prevention and treatment of POGD is needed. The second Perioperative Quality Initiative brought together a group of international experts to review the published literature and provide consensus recommendations on this important topic with the goal to (1) develop a rational definition for POGD that can serve as a framework for clinical and research efforts; (2) critically review the evidence behind current prevention strategies and provide consensus recommendations; and (3) develop rational treatment strategies that take into account the wide spectrum of impaired GI function in the postoperative period. Accepted for publication October 27, 2017 Funding: The Perioperative Quality Initiative (POQI) meeting received financial assistance from the American Society for Enhanced Recovery (ASER). Conflicts of Interest: See Disclosures at the end of the article. For the Perioperative Quality Initiative (POQI) 2 Workgroup, see Appendix 1. Reprints will not be available from the authors. Address correspondence to Timothy E. Miller, MB, ChB, FRCA, Division of General, Vascular and Transplant Anesthesia, Duke University Medical Center, Box 3094, Durham, NC 27710. Address e-mail to timothy.miller2@duke.edu. © 2017 International Anesthesia Research Society

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Anesthesia for Cesarean Delivery: A Cross-Sectional Survey of Provincial, District, and Mission Hospitals in Zimbabwe

BACKGROUND: Cesarean delivery is the most common surgical procedure in low- and middle-income countries, so provision of anesthesia services can be measured in relation to it. This study aimed to assess the type of anesthesia used for cesarean delivery, the level of training of anesthesia providers, and to document the availability of essential anesthetic drugs and equipment in provincial, district, and mission hospitals in Zimbabwe. METHODS: In this cross-sectional survey of 8 provincial, 21 district, and 13 mission hospitals, anesthetic providers were interviewed on site using a structured questionnaire adapted from standard instruments developed by the World Federation of Societies of Anaesthesiologists and the World Health Organization. RESULTS: The anesthetic workforce for the hospitals in this survey constituted 22% who were medical officers and 77% nurse anesthetists (NAs); 55% of NAs were recognized independent anesthetic providers, while 26% were qualified as assistants to anesthetic providers and 19% had no formal training in anesthesia. The only specialist physician anesthetist was part time in a provincial hospital. Spinal anesthesia was the most commonly used method for cesarean delivery (81%) in the 3 months before interview, with 19% general anesthesia of which 4% was ketamine without airway intubation. The mean institutional cesarean delivery rate was 13.6% of live births, although 5 district hospitals were

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Prophylactic Platelet Transfusions for Critically Ill Patients With Thrombocytopenia: A Single-Institution Propensity-Matched Cohort Study

BACKGROUND: Thrombocytopenia is frequently encountered in critically ill patients, often resulting in prophylactic transfusion of platelets for the prevention of bleeding complications. However, the efficacy of this practice remains unclear. The objective of this study was to determine the relationship between prophylactic platelet transfusion and bleeding complications in critically ill patients. METHODS: This is a retrospective cohort study of adults admitted to surgical, medical, or combined medical-surgical intensive care units (ICUs) at a single academic institution between January 1, 2009, and December 31, 2013. Inclusion criteria included age ≥18 years and a platelet count measured during ICU admission. Propensity-matched analyses were used to evaluate associations between prophylactic platelet transfusions and the outcomes of interest with a primary outcome of red blood cell transfusion in the ensuing 24 hours and secondary outcomes of ICU and hospital-free days and changes in sequential organ failure assessment scores. RESULTS: A total of 40,693 patients were included in the investigation with 3227 (7.9%) receiving a platelet transfusion and 1065 (33.0%) for which platelet transfusion was prophylactic in nature. In propensity-matched analyses, 994 patients with prophylactic platelet transfusion were matched to those without a transfusion. Patients receiving prophylactic platelets had significantly higher red blood cell transfusion rates (odds ratio 7.5 [5.9–9.5]; P

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Heating and Cooling Rates With an Esophageal Heat Exchange System

BACKGROUND: The Esophageal Cooling Device circulates warm or cool water through an esophageal heat exchanger, but warming and cooling efficacy in patients remains unknown. We therefore determined heat exchange rates during warming and cooling. METHODS: Nineteen patients completed the trial. All had general endotracheal anesthesia for nonthoracic surgery. Intraoperative heat transfer was measured during cooling (exchanger fluid at 7°C) and warming (fluid at 42°C). Each was evaluated for 30 minutes, with the initial condition determined randomly, starting at least 40 minutes after induction of anesthesia. Heat transfer rate was estimated from fluid flow through the esophageal heat exchanger and inflow and outflow temperatures. Core temperature was estimated from a zero-heat-flux thermometer positioned on the forehead. RESULTS: Mean heat transfer rate during warming was 18 (95% confidence interval, 16–20) W, which increased core temperature at a rate of 0.5°C/h ± 0.6°C/h (mean ± standard deviation). During cooling, mean heat transfer rate was −53 (−59 to −48) W, which decreased core temperature at a rate of 0.9°C/h ± 0.9°C/h. CONCLUSIONS: Esophageal warming transferred 18 W which is considerably less than the 80 W reported with lower or upper body forced-air covers. However, esophageal warming can be used to supplement surface warming or provide warming in cases not amenable to surface warming. Esophageal cooling transferred more than twice as much heat as warming, consequent to the much larger difference between core and circulating fluid temperature with cooling (29°C) than warming (6°C). Esophageal cooling extracts less heat than endovascular catheters but can be used to supplement catheter-based cooling or possibly replace them in appropriate patients. Accepted for publication October 20, 2017. Funding: This work was supported by Advanced Cooling Therapy (Chicago, IL). Conflicts of Interest: See Disclosures at the end of the article. Institutional review board: Cleveland Clinic Institutional Review Board, 9500 Euclid Ave, Desk OS01, Cleveland, OH 44195. E-mail: IRBCOI@ccf.org. This study was registered at ClinicalTrials.gov. Reprints will not be available from the authors., Address correspondence to Daniel I. Sessler, MD, Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave—P77, Cleveland, OH 44195. Address e-mail to DS@OR.org. © 2017 International Anesthesia Research Society

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Axillary Temperature, as Recorded by the iThermonitor WT701, Well Represents Core Temperature in Adults Having Noncardiac Surgery

BACKGROUND: Core temperature can be accurately measured from the esophagus or nasopharynx during general anesthesia, but neither site is suitable for neuraxial anesthesia. We therefore determined the precision and accuracy of a novel wireless axillary thermometer, the iThermonitor, to determine its suitability for use during neuraxial anesthesia and in other patients who are not intubated. METHODS: We enrolled 80 adults having upper abdominal surgery with endotracheal intubation. Intraoperative core temperature was measured in distal esophagus and was estimated at the axilla with a wireless iThermonitor WT701 (Raiing Medical, Boston MA) at 5-minute intervals. Pairs of axillary and reference distal esophageal temperatures were compared and summarized using linear regression and repeated-measured Bland–Altman methods. We a priori determined that the iThermonitor would have clinically acceptable accuracy if most estimates were within ±0.5°C of the esophageal reference, and suitable precision if the limits of agreement were within ±0.5°C. RESULTS: There were 3339 sets of paired temperatures. Axillary and esophageal temperatures were similar, with a mean difference (esophageal minus axillary) of only 0.14°C ± 0.26°C (standard deviation). The Bland–Altman 95% limits of agreement were reasonably narrow, with the estimated upper limit at 0.66°C and the lower limit at −0.38°C, thus ±0.52°C, indicating good agreement across the range of mean temperatures from 34.9°C to 38.1°C. The absolute difference was within 0.5°C in 91% of the measurements (95% confidence interval, 88%–93%). CONCLUSIONS: Axillary temperature, as recorded by the iThermonitor WT701, well represents core temperature in adults having noncardiac surgery and thus appears suitable for clinical use. Accepted for publication September 29, 2017. Funding: This work was supported by the Raiing Medical, Boston, MA. None of the authors has a personal financial interest in this research. The sponsor was not involved in data analysis or interpretation. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Yuguang Huang, MD, Department of Anesthesiology, Peking Union Medical College Hospital (PUMCH), 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China. Address e-mail to garybeijing@163.com (www.OR.org). © 2017 International Anesthesia Research Society

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EMS agency turns ambulance pink for breast cancer awareness

"The breast cancer awareness ambulance is our way of showing support for our citizens who have been involved in the fight against breast cancer," officials said

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5 tips for securing a patient's airway

You are on scene with a patient who has suffered significant facial trauma; what are some strategies to improve your ability to manage his airway?

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Patient actions and reactions after receiving negative results from expanded carrier screening

ABSTRACT

With the expansion of carrier screening to general preconception and prenatal patient populations, most patients will receive negative results, which we define as indicating <25% risk of having a child with a genetic condition. Because there is limited experience with expanded carrier screening, it is important to understand how receiving negative results affects patients, especially as providers, payers, and policymakers consider whether to offer it. In this mixed-methods study, we asked preconception patients enrolled in the NextGen study about their expectations and experiences receiving negative expanded carrier screening results. Participants completed surveys at study enrollment (n=110 women, 51 male partners), after receiving carrier results (n=100 women, 38 male partners), after receiving secondary findings (n=98 women, 36 male partners), and 6 months after receiving results (n=95 women, 28 male partners). We also interviewed a subset of participants 12-24 months after receiving results (n=24 women, 12 male partners). We found minimal negative emotional impact and privacy concerns, increased confidence in reproductive plans, and few changes to health behaviors, although some patients made health decisions based on misunderstandings of their results. These findings suggest that expanded carrier screening causes minimal psychosocial harms, but systems are needed to reduce the risk of misinterpreting results.

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Reference values for short-term resting-state heart rate variability in healthy adults: Results from the Brazilian Longitudinal Study of Adult Health—ELSA-Brasil study

Abstract

Heart rate variability (HRV) is a psychophysiological phenomenon with broad implications, providing an accessible index of vagal function, underpinning psychological constructs, including the capacity for social engagement and emotion regulation, and may predict future morbidity and mortality. However, the lack of reference values for short-term HRV indices for participants of both sexes across the age spectrum is a limiting factor. This was the objective of the present study. Resting electrocardiographic records were obtained from 13,214 participants (both sexes, 35–74 years), and HRV indices in time and frequency domains (mean ± SD) were determined from 5-min records. Results were based on a subsample of 2,874 nonmedicated, healthy participants stratified by sex across 10-year age groupings. Men showed lower heart rate (HR, 64 ± 8 bpm vs. 68 ± 8 bpm, p < .05) and normalized high frequency (HF; 39.4 ± 18.0 normalized units [n.u.] vs. 50.4 ± 18.5 n.u., p < .05) than women, and higher N-N variance (2,214 ± 1,890 ms² vs. 1,883 ± 1,635 ms², p < .05), standard deviation of all N-N intervals (SDNN; 43.7 ± 17.3 ms vs. 40.3 ± 15.8 ms, p < .05) and LF/HF (2.30 ± 2.68 vs. 1.33 ± 1.82, p < .05). HR and HF (n.u.) were also higher in younger than older women. LF/HF was lower in women than men. Percentile curves showed almost all HRV indices decreasing with aging. The availability of short-term, resting-state HRV reference values in a large sample of healthy and nonmedicated participants from 35–74 years will provide a valuable tool for researchers, clinicians, and those in the quantified-self community.

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European guidelines on perioperative venous thromboembolism prophylaxis

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Day surgery and fast-track surgery

In recent years, day surgery and fast-track surgery have experienced a continuous increase in volume. Many procedures are now performed on an outpatient protocol, including general, orthopaedic, oncological, reconstructive or vascular surgery. The management of these patients is safe, but the incidence of venous thromboembolism in this population remains unknown. Several risk factors can be identified and stratified derived from studies of inpatient surgical management (e.g. Caprini score). Recommendations for thromboprophylaxis should be tailored from the assessment of both personal and procedure-related risk factors, although with a lack of evidence for application in outpatient management. For patients undergoing a low-risk procedure without additional risk factors, we recommend only general measures of thromboprophylaxis (early ambulation, optimal hydration) (Grade 1B). For patients undergoing a low-risk procedure with additional risk factors, or a high-risk procedure without additional risk factors, we recommend general measures of thromboprophylaxis (Grade 1B) and we suggest the administration of pharmacological prophylaxis with low molecular weight heparins (Grade 2B). For patients undergoing a high-risk procedure with additional risk factors we recommend general measures of thromboprophylaxis (Grade 1B) and pharmacological prophylaxis with low molecular weight heparins over other drugs (Grade 1B), or suggest specific mechanical measures in case of increased bleeding risk (Grade 2C). Pharmacological prophylaxis should last a minimum of 7 days (Grade 1B), although in selected cases of fast-track surgery, thromboprophylaxis could be limited to hospitalisation only (Grade 2C) and in specific cases of high-risk procedures, thromboprophylaxis could be extended for up to 4 weeks (Grade 2B).

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European Guidelines on perioperative venous thromboembolism prophylaxis: Executive summary

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Aspirin

There is a good rationale for the use of aspirin in venous thromboembolism prophylaxis in some orthopaedic procedures, as already proposed by the 9th American College of Chest Physicians' guidelines (Grade 1C). We recommend using aspirin, considering that it may be less effective than or as effective as low molecular weight heparin for prevention of deep vein thrombosis and pulmonary embolism after total hip arthroplasty, total knee arthroplasty and hip fracture surgery (Grade 1C). Aspirin may be less effective than or as effective as low molecular weight heparins for prevention of deep vein thrombosis and pulmonary embolism after other orthopaedic procedures (Grade 2C). Aspirin may be associated with a low rate of bleeding after total hip arthroplasty, total knee arthroplasty and hip fracture surgery (Grade 1B). Aspirin may be associated with less bleeding after total hip arthroplasty, total knee arthroplasty and hip fracture surgery than other pharmacological agents (Grade 1B). No data are available for other orthopaedic procedures. We do not recommend aspirin as thromboprophylaxis in general surgery (Grade 1C). However, this type of prophylaxis could be interesting especially in low-income countries (Grade 2C) and adequate large-scale trials with proper study designs should be carried out (Grade 1C).

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European guidelines on perioperative venous thromboembolism prophylaxis: Cardiovascular and thoracic surgery

None of the predictive models for venous thromboembolism (VTE) prophylaxis have been designed for and validated in patients undergoing cardiothoracic and vascular surgery. The presence of one or more risk factors [age over 70 years old, transfusion of more than 4 U of red blood cells/fresh frozen plasma/cryoprecipitate, mechanical ventilation lasting more than 24 h, postoperative complication (e.g. acute kidney injury, infection/sepsis, neurological complication)] should place the cardiac population at high risk for VTE. In this context, we suggest the use of pharmacological prophylaxis as soon as satisfactory haemostasis has been achieved, in addition to intermittent pneumatic compression (IPC) (Grade 2C). In patients undergoing abdominal aortic aneurysm repair, particularly when an open surgical approach is used, the risk for VTE is high and the bleeding risk is high. In this context, we suggest the use of pharmacological prophylaxis as soon as satisfactory haemostasis is achieved (Grade 2C). Patients undergoing thoracic surgery in the absence of cancer could be considered at low risk for VTE. Patients undergoing thoracic surgery with a diagnosis of primary or metastatic cancer should be considered at high risk for VTE. In low-risk patients, we suggest the use of mechanical prophylaxis using IPC (Grade 2C). In high-risk patients, we suggest the use of pharmacological prophylaxis in addition to IPC (Grade 2B).

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European guidelines on perioperative venous thromboembolism prophylaxis: Intensive care

Venous thromboembolism is a common and potentially life-threatening complication that occurs in 4 to 15% of patients admitted to ICUs despite the routine use of pharmacological prophylaxis. We therefore recommend an institution-wide protocol for the prevention of venous thromboembolism (Grade 1B). The routine use of ultrasonographic screening for deep vein thrombosis is not recommended when thromboprophylactic measures are in place (Grade 1B), as the detection of asymptomatic deep vein thrombosis may prompt therapeutic anticoagulation that may increase bleeding risk but has no proven reduction of clinically significant thrombotic events. In critically ill patients, we recommend pharmacological prophylaxis with low molecular weight heparin over low-dose heparin (Grade 1B). For critically ill patients with severe renal insufficiency, we suggest the use of low-dose heparin (Grade 2C), dalteparin (Grade 2B) or reduced doses of enoxaparin (Grade 2C). Monitoring of anti-Xa activity may be considered when low molecular weight heparin is used in these patients (Grade 2C). No study has prospectively evaluated the efficacy and safety of deep vein thrombosis prophylaxis in critically ill patients with severe liver dysfunction. Thus, the use of pharmacological prophylaxis in these patients should be carefully balanced against the risk of bleeding. For critically ill patients, we recommend against the routine use of inferior vena cava filters for the primary prevention of venous thromboembolism (Grade 1C). When the diagnosis of heparin-induced thrombocytopaenia is suspected or confirmed, all forms of heparin must be discontinued (Grade 1B). In these patients, immediate anticoagulation with a nonheparin anticoagulant rather than discontinuation of heparin alone is recommended (Grade 1C).

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European guidelines on perioperative venous thromboembolism prophylaxis: Neurosurgery

Although there are numerous publications addressing venous thromboembolism and its prevention in neurosurgery, there are relatively few high-quality studies to guide decisions regarding thromboprophylaxis. In patients undergoing craniotomy, we recommend that if intermittent pneumatic compression (IPC) is used, it should be applied before the surgical procedure or on admission (Grade 1C). In craniotomy patients at particularly high risk for venous thromboembolism, we suggest considering the initiation of mechanical thromboprophylaxis with IPC preoperatively with addition of low molecular weight heparin (LMWH) postoperatively when the risk of bleeding is presumed to be decreased (Grade 2C). In patients with non-traumatic intracranial haemorrhage, we suggest thromboprophylaxis with IPC (Grade 2C). For patients who have had non-traumatic intracranial haemorrhage, we suggest giving consideration to commencement of LMWH or low-dose unfractionated heparin when the risk of bleeding is presumed to be low (Grade 2C). We suggest continuing thromboprophylaxis until full mobilisation of the patient (Grade 2C). For patients undergoing spinal surgery with no additional risk factors, we suggest no active thromboprophylaxis intervention apart from early mobilisation (Grade 2C). For patients undergoing spinal surgery with additional risk factors, we recommend starting mechanical thromboprophylaxis with IPC (Grade 1C), and we suggest the addition of LMWH postoperatively when the risk of bleeding is presumed to be decreased (Grade 2C).

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European guidelines on perioperative venous thromboembolism prophylaxis: Surgery in the elderly

The risk for postoperative venous thromboembolism (VTE) is increased in patients aged more than 70 years and in elderly patients presenting with co-morbidities, for example cardiovascular disorders, malignancy or renal insufficiency. Therefore, risk stratification, correction of modifiable risks and sustained perioperative thromboprophylaxis are essential in this patient population. Timing and dosing of pharmacoprophylaxis may be adopted from the non-aged population. Direct oral anti-coagulants are effective and well tolerated in the elderly; statins may not replace pharmacological thromboprophylaxis. Early mobilisation and use of non-pharmacological means of thromboprophylaxis should be exploited. In elderly patients, we suggest identification of co-morbidities increasing the risk for VTE (e.g. congestive heart failure, pulmonary circulation disorder, renal failure, lymphoma, metastatic cancer, obesity, arthritis, post-menopausal oestrogen therapy) and correction if present (e.g. anaemia, coagulopathy) (Grade 2C). We suggest against bilateral knee replacement in elderly and frail patients (Grade 2C). We suggest timing and dosing of pharmacological VTE prophylaxis as in the non-aged population (Grade 2C). In elderly patients with renal failure, low-dose unfractionated heparin (UFH) may be used or weight-adjusted dosing of low molecular weight heparin (Grade 2C). In the elderly, we recommend careful prescription of postoperative VTE prophylaxis and early postoperative mobilisation (Grade 1C). We recommend multi-faceted interventions for VTE prophylaxis in elderly and frail patients, including pneumatic compression devices, low molecular weight heparin (and/or direct oral anti-coagulants after knee or hip replacement) (Grade 1C). This article is part of the European guidelines on perioperative venous thromboembolism prophylaxis. For details concerning background, methods, and members of the ESA VTE Guidelines Task Force, please, refer to: Samama CM, Afshari A, for the ESA VTE Guidelines Task Force. European guidelines on perioperative venous thromboembolism prophylaxis. Eur J Anaesthesiol 2018; 35:73–76. A synopsis of all recommendations can be found in the following accompanying article: Afshari A, Ageno W, Ahmed A, et al., for the ESA VTE Guidelines Task Force. European Guidelines on perioperative venous thromboembolism prophylaxis. Executive summary. Eur J Anaesthesiol 2018; 35:77–83.

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European guidelines on perioperative venous thromboembolism prophylaxis: Patients with preexisting coagulation disorders and after severe perioperative bleeding

In patients with inherited bleeding disorders undergoing surgery, we recommend assessment of individual risk for venous thromboembolism, taking into account the nature of the surgery and anaesthetic, type and severity of bleeding disorder, age, BMI, history of thrombosis, the presence of malignancy and other high-risk comorbidities. Venous thromboembolism risk should be balanced against the increased bleeding risk associated with anticoagulant use in patients with known bleeding disorders (Grade 1C). In these patients undergoing major surgery, we recommend against routine postoperative use of pharmacological thromboprophylaxis, especially for patients with haemophilia A and B (Grade 1B). Glomerular filtration rate should be assessed before initiation of each direct oral anticoagulant, and also at least once a year or more frequently as needed, such as postoperatively before the resumption of therapeutic direct oral anticoagulant administration, when it is suspected that renal function could decline or deteriorate (Grade 1C). Reduced dosages of low molecular weight heparins may be used relatively safely during transient severe (

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European guidelines on perioperative venous thromboembolism prophylaxis: Surgery during pregnancy and the immediate postpartum period

Thromboembolic events in the pregnant and postpartum patient remain rare but potentially fatal complications. The aim of this section was to analyse the few prospective studies addressing the issue of thromboprophylaxis following a surgical procedure during and immediately after pregnancy, as well as national guidelines, and to propose European guidelines on this specific condition. Thromboprophylaxis is broadly recommended due to the combined risks of surgery and pregnancy or the postpartum period, regardless of the mode of delivery. We recommend prophylactic thromboprophylaxis following surgery during pregnancy or the postpartum period when they imply, as a consequence, bed rest, until full mobility is recovered (Grade 1C). Similarly, thromboprophylaxis should be used in cases of perioperative infection during pregnancy or the postpartum period. Concerning thromboprophylaxis following a caesarean section, it seems avoidable only in elective procedures in low-risk patients, after a normal pregnancy, and with an early rehabilitation protocol. The duration of thromboprophylaxis following caesarean section should be at least 6 weeks for high-risk patients, and at least 7 days for the other patients requiring anticoagulation (Grade 1C).

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European guidelines on perioperative venous thromboembolism prophylaxis: Inferior vena cava filters

The indications for the use of an inferior vena cava filter (IVCF) in the context of deep venous thrombosis to prevent pulmonary embolism remain controversial. Despite wide use in clinical practice, great variation exists in national and international guidelines in regard to the indications. In addition, clinical practice is based on poor-quality data from trauma and bariatric surgery with a high incidence of complications. It is often difficult to assess their efficacy and lack of filter retrieval appears to be a substantial issue compared with a potential benefit by insertion of these devices. Complications usually refer to increased risk of deep venous thrombosis, filter perforation, filter penetration, filter migration, inferior vena cava occlusion and subsequently failure in pulmonary embolism prevention. Evidence from low-quality studies or registries, with small numbers of patients and conflicting findings, does not allow for a strong recommendation for or against the use of IVCFs. IVCFs should only be considered in cases of very high risk of pulmonary embolism and in perioperative situations at very high risk of bleeding, resulting in a prolonged contra-indication to pharmacological prophylaxis.

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European guidelines on perioperative venous thromboembolism prophylaxis: Chronic treatments with antiplatelet agents

Antiplatelet agents (APA) are considered first-line therapy in preventing cardiovascular thrombotic events, but they are of limited value in the prophylaxis of venous thromboembolism (VTE) during the perioperative period. Consequently, many patients should receive both an APA and an anticoagulant. This combination can increase the bleeding risk and it is necessary to make some recommendations to minimise that risk. In patients receiving APA chronically, if the risk of VTE outweighs the risk of bleeding, we suggest pharmacological prophylaxis (grade 2C). In patients treated with dual antiplatelet therapy undergoing a procedure associated with a high risk of VTE, resuming both APA shortly after the procedure must be prioritised over pharmacological VTE prevention (grade 2C). If the risk of bleeding from a combination of an APA and an anticoagulant outweighs the risk of VTE, we suggest mechanical thromboprophylaxis over anticoagulant prophylaxis, without discontinuing the APA (grade 2C). Patients in whom neuraxial anaesthesia is planned, a higher rate of complications could occur if pharmacological thromboprophylaxis is administered concurrently and postoperative thromboprophylaxis initiation should be suggested (grade 2C). After surgery, the first dose of aspirin should be given once haemostasis is guaranteed (grade 2B). In the case of clopidogrel, give the drug without a loading dose between 24 and 48 h after surgery (grade 2C).

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European guidelines on perioperative venous thromboembolism prophylaxis: Mechanical prophylaxis

Institutional protocols need to address the indications for pharmacological and mechanical thromboprophylaxis. The use of graduated compression stockings (GCS) and intermittent pneumatic compression (IPC) strongly differs between institutions. As a consequence, no strong recommendations can be made based on the contemporary high-level evidence. Although different clinical practices can be supported, such approaches should be part of an institutional strategy to reduce the burden of venous thromboembolism (VTE). We recommend against the use of GCS alone without pharmacological thromboprophylaxis for prevention of VTE in patients at intermediate and high risk. For patients at high risk of VTE with contraindications for pharmacological thromboprophylaxis, we recommend the use of mechanical prophylaxis and suggest the use of IPC over GCS. However, for those patients receiving pharmacological thromboprophylaxis who are without a very high risk of VTE prophylaxis, we recommend against the routine use of mechanical thromboprophylaxis either with GCS or IPC. We suggest combined mechanical and pharmacological prophylaxis in selected patients at very high risk of VTE prophylaxis and suggest IPC rather than GCS in these selected patients.

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European guidelines on perioperative venous thromboembolism prophylaxis: Surgery in the obese patient

A systematic literature search was performed and patients were selected as obese patients undergoing bariatric surgery or obese patients undergoing nonbariatric surgical procedures. In addition, patients were stratified according to low risk of venous thromboembolism and high risk of venous thromboembolism (age >55 years, BMI >55 kg m−2, history of venous thromboembolism, venous disease, sleep apnoea, hypercoagulability or pulmonary hypertension). Prophylaxis of venous thromboembolism was analysed depending on the type of modality: compression devices of the lower extremities (including intermittent pneumatic compression and graduated compression stockings), pharmacological prophylaxis or inferior vena cava filters. Two prospective studies compared mechanical devices and pharmacological prophylaxis vs. a mechanical device alone without significant differences. A few randomised controlled studies and most of the prospective nonrandomised studies showed that low-dose low molecular weight heparin (3000 to 4000 anti-Xa IU 12 h−1 subcutaneously) was acceptable for obese patients with a lower risk of venous thromboembolism, but a higher dose of low molecular weight heparin (4000 to 6000 anti-Xa IU 12 h−1 subcutaneously) should be proposed for obese patients with a higher risk of venous thromboembolism. Extended prophylaxis for 10 to 15 days was well tolerated for obese patients with a high risk of venous thromboembolism in the postdischarge period. The safety and efficacy of inferior vena cava filters in bariatric surgical patients is highly heterogeneous. There were no randomised trials that analysed prophylaxis of venous thromboembolism in obese patients undergoing nonbariatric surgery. Higher doses of anticoagulants could be proposed for obese patients with a BMI more than 40 kg m−2. The lack of good quality randomised trials with a low risk of bias did not allow us to propose strong recommendations.

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Robustness of an innate releasing mechanism against degradation of acoustic communication signals in the grasshopper Chorthippus biguttulus

Abstract

Noise is a challenge for animals that use acoustic communication to find a mate. A potent source of noise in animal communication is that arising from other conspecific signals, whose co-occurrence can result in extensive interference—evident as the so called "cocktail-party problem"—that may affect the receiver mechanisms to detect potential mates. We studied grasshopper females to explore how modifications of the song pattern influence song recognition. First, we degraded an attractive model song with random fluctuations of increasing amplitudes out of different frequency bands, and determined "critical degradation levels" at which the females ceased to respond. A masker band with frequencies between 0 and 200 Hz, which covers the frequency range of the natural song envelope, was by 3–5 dB more destructive in hampering signal recognition than frequencies above 200 Hz. As second approach, we applied temporal disturbances such as accentuations or gaps at different positions within the song subunits and observed how response behavior was affected. Accentuations at subunit start increased, whereas those in the midst or at the end of a subunit reduced attractiveness. Gaps at these positions had diverse effects. The results are discussed with respect to neuronal filtering.

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Neighborhood Disadvantage and Neighborhood Affluence: Associations with Breastfeeding Practices in Urban Areas

Abstract

Objective To estimate the associations between neighborhood disadvantage and neighborhood affluence with breastfeeding practices at the time of hospital discharge, by race-ethnicity. Methods We geocoded and linked birth certificate data for 111,596 live births in New Jersey in 2006 to census tracts. We constructed indices of neighborhood disadvantage and neighborhood affluence and examined their associations with exclusive (EBF) and any breastfeeding in multilevel models, controlling for individual-level confounders. Results The associations of neighborhood disadvantage and affluence with breastfeeding practices differed by race-ethnicity. The odds of EBF decreased as neighborhood disadvantage increased for all but White women [Asian: Adjusted odds ratio (AOR) 0.82 (95% confidence interval (CI) 0.69–0.97); Black: AOR 0.77 (95% CI 0.70–0.86); Hispanic: AOR 0.78 (95% CI 0.70–0.86); White: AOR 0.99 (95% CI 0.91–1.08)]. The odds of EBF increased as neighborhood affluence increased for Hispanic [AOR 1.19 (95% CI 1.08–1.31)] and White [AOR 1.12 (95% CI 1.06–1.18)] women only. The odds of any breastfeeding decreased with increasing neighborhood disadvantage only for Hispanic women [AOR 0.85 (95% CI 0.79–0.92)], and increased for White women [AOR 1.16 (95% CI 1.07–1.26)]. The odds of any breastfeeding increased as neighborhood affluence increased for all except Hispanic women [Asian: AOR 1.31 (95% CI 1.13–1.51); Black: AOR 1.19 (95% CI 1.07–1.32); Hispanic: AOR 1.08 (95% CI 0.99–1.18); White: AOR 1.30 (95% CI 1.24–1.38)]. Conclusions Race-ethnic differences in associations between neighborhood disadvantage and affluence and breastfeeding practices at the time of hospital discharge indicate the need for specialized support to improve access to services.

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Low night-time heart rate is longitudinally associated with lower augmentation index and central systolic blood pressure in hypertension

Abstract

Purpose

Several studies have shown that the augmentation index (AIx) is negatively correlated with heart rate (HR). This led some authors to claim that the use of HR-lowering drugs may be detrimental in hypertension. The aim of this study was to assess the longitudinal and cross-sectional relationships of HR with AIx and central blood pressure (BP) in 346 subjects from the HARVEST (mean age 30.7 ± 8.5 years).

Methods

At baseline, HR was measured with 24-h ambulatory recording. Central hemodynamics were evaluated with Specaway DAT system after a median of 8.0 years from baseline. In multivariate linear regression analyses, AIx and central systolic BP were used as dependent variables and night-time HR or office HR as predictors adjusting for several risk factors and confounders.

Results

In fully adjusted models, baseline night-time HR was a significant positive predictor of AIx (p < 0.001) and central BP (p = 0.014) measured 8 years later. Adjusted office HR measured at the time of arterial distensibility assessment was inversely correlated with AIx (p = 0.001) a relationship which was attenuated after physical activity (p = 0.004) and left ventricular ejection time (p = 0.015) were taken into account. In addition, office HR was inversely correlated with central BP (p = 0.039) a relationship which was no longer significant after physical activity and ejection time were accounted for.

Conclusions

These data show that HR measured during sleep is longitudinally associated with AIx and central BP. Thus, low HR in the long term may have beneficial effects on central hemodynamics and the wall properties of the large arteries in hypertension.

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