Hasil untuk "Anesthesiology"

S. Howard, D. Gaba, K. Fish et al.

M. Mythen, A. Webb

Peggy Sunarjo, Luh Karunia Wahyuni, Dita Aditianingsih et al.

Background: Post-Intensive Care Syndrome (PICS) encompasses cognitive, motor, and mental impairments persisting for years in ICU survivors. Despite its significance, the prevalence of PICS in Indonesia remains uncertain due to limited research and a lack of validated measurement tools. This study aims to translate and validate the PICS Questionnaire for use among ICU survivors in Indonesia. Methods: The study followed a two-phase approach: translation and evaluation. The translation phase adhered to the 10-step process of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines. The analysis phase involved 184 subjects, using Confirmatory Factor Analysis (CFA) for validation and Cronbach's α and Intraclass Correlation Coefficient (ICC) for reliability testing. Results: The CFA reported factor loadings (λ >0.40) for each item in its relevant domain. Fit index values indicated a good-to-acceptable fit. Internal reliability was high for the mental, physical, and cognitive domains (0.812 vs. 0.779 vs. 0.855), with Cronbach's α of > 0.70. Test-retest reliability and ICC demonstrated dependable results (>0.70) for each domain. Conclusion: The translated and validated Indonesian PICS Questionnaire demonstrates good validity and reliability. This tool will enable healthcare professionals to assess PICS among ICU survivors in Indonesia and facilitate further research on its prevalence and impact on quality of life.

U. Ali, Kieron Moloney, Andras Mikor

Filip Njavro, Erin Kos, Karin Zibar Tomšić et al.

<b>Background/Objectives</b>: Adrenal vein sampling is the gold standard for differentiating between unilateral and bilateral primary aldosteronism and guiding treatment. This study evaluates the utility of inspiratory CT scans in interventional planning, specifically assessing the right adrenal vein visualization and positional discrepancies during fluoroscopy. <b>Methods</b>: A retrospective analysis of 133 patients who underwent adrenal vein sampling was performed. Pre-procedural inspiratory CT scans were reviewed for visualization and location of the right adrenal vein using vertebral body levels as reference. The position of the right adrenal vein was then compared with the fluoroscopic findings during adrenal veins sampling. <b>Results</b>: The right adrenal vein was visualized on CT scans in 99.2% of patients. Cohen’s kappa demonstrated almost perfect agreement for both visualization of the right adrenal vein and position measurement. A median difference of three vertebral levels was observed between the level of the right adrenal vein on CT and fluoroscopy, with fluoroscopy showing a more cranial position in 91.7% of cases. <b>Conclusions</b>: Inspiratory CT scans visualize the right adrenal vein effectively and aid the planning of adrenal vein sampling. Understanding the positional discrepancies caused by respiratory motion is crucial for successful cannulation of the right adrenal vein, minimizing procedure time and contrast consumption and ultimately enhancing patient outcomes in the management of primary aldosteronism.

Islam El Malky, Wael Elshazly Aita, Alaa Elkordy et al.

Abstract The most common diagnostic error of IIH is inaccurate funduscopic examination. Moreover, IIH could be diagnosed without papilledema. Trans orbital sonography could be used as a non-invasive and cheap tool for discovering increased ICP (intracranial Pressure). Aim of our study was discovering the changes in ultra-sonographic indices and which one could predict the increased ICP. Sixty-eight patients were diagnosed as definite IIH and 68 healthy volunteers are included in the study who had the same sex and age. ONSD, peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) were estimated by transorbital color Doppler. Multivariate linear regression was used to discover the predictors of increased ICP. ROC curve was plotted for the predictor. A statistically significant difference was found between IIH patients and controls regarding ONSD, EDV and RI. Multivariate linear regression revealed that ONSD is the only predictor of increased CSP pressure. Its cut-off value indicating high ICP was 5.7 mm on Rt and Lt eye (AUC: 0.916; 95% confidence interval 0.867–0.965; p < 0.001; 90% sensitivity, 80% specificity at Rt eye. AUC: 0.902; 95% confidence interval 0.845–0.958; p < 0.001; 91% sensitivity, 80% specificity at Lt eye).

Davood Attaran, Shima Baniassad, Zahra Behrooznia et al.

ABSTRACT A 27‐year‐old male with known CGD presented with severe dyspnea and a productive cough. Following clinical and diagnostic evaluations, he was diagnosed with pulmonary tuberculosis. This case highlights the challenges in diagnosing TB in patients with CGD and the need for more precise diagnostic approaches when treating this vulnerable population.

Taiyang Liuru, Dazhi Pang, Jitian Zhang et al.

Abstract Background The study aims to compare the safety and cost-effectiveness of low-cost video-assisted thoracoscopic surgery (VATS) lobectomy, utilizing the twining high-tension knot method, with regular stapler-based VATS lobectomy. Methods This retrospective cohort study included 102 patients who underwent VATS lobectomy at a single center between January 2013 and April 2020. Patients were divided into a regular group (n = 57) and a low-cost group (n = 45). Propensity score matching (1:1) balanced baseline characteristics between the groups (45 patients each). Clinical and cost outcomes were analyzed. Results The operative time (256.24 ± 87.45 min vs. 252.67 ± 73.46 min, p = 0.834), intraoperative blood loss (102.89 ± 96.38 mL vs.138.44 ± 257.07 mL, p = 0.39), and postoperative drainage tube indwelling time (3.04 ± 1.62 days vs. 4.02 ± 4.8 days, p = 0.19) were comparable between the low-cost and regular groups. The length of hospital stay was significantly lower in low-cost VATS (5.91 ± 2.51) compared to regular VATS (8.47 ± 7.39) (P = 0.03). The low-cost group demonstrated significantly reduced intraoperative consumable expenses (11,830.09 ± 7,565.13 CNY vs. 25,965.42 ± 7,441.93 CNY, P < 0.001) and total hospitalization costs (34,001.55 ± 12,649.06 CNY vs. 53,166.76 ± 10,966.48 CNY, P < 0.001). Conclusions Low-cost VATS lobectomy, using the twining high-tension knot method, is as safe and effective as conventional stapler-based VATS lobectomy while significantly reducing costs. This innovative technique offers a practical, accessible alternative for minimally invasive thoracic surgery, particularly in resource-limited settings. Clinical trial registration number ChiCTR2100047430 in Chinese Clinical Trial Registry.

J. Johansen, P. Sebel

Veronica Vikne, Pål André Hegland, Gro Hovland et al.

Bakgrunn: Simuleringsbasert trening har vært anvendt av helsepersonell siden 1990-tallet. Studier har vist at metoden forbedrer både tekniske og ikke-tekniske ferdigheter, noe som øker pasientsikkerheten. Nasjonale føringer pålegger helseforetakene å simulere, og regionale enheter for simulering (RegSim) koordinerer denne aktiviteten. Implementering av simuleringsbasert trening er tid- og ressurskrevende, og ulike barrierer forhindrer innføringen. Tidligere studier har identifisert flere barrierer, inkludert manglende tid, høye kostnader, lav støtte fra ledelsen og økende krav til resultatmåling av tjenestene, for å nevne noen. Det foreligger lite forskning på hvilke implementeringsstrategier som kan fremme simuleringsbasert trening innen anestesi i en anestesiavdeling. Hensikt: Å få innsikt i hvilke faktorer som kan fremme implementering av simuleringsbasert trening innen anestesi, og hvordan praksisen kan etableres innenfor helseforetakenes mål- og resultatbaserte styringsform. Metode: Kvalitativ tilnærming med et eksplorerende design, forankret i et sosialkonstruksjonistisk kunnskapssyn. Datamaterialet består av fem semistrukturerte individuelle dybdeintervju og åtte dokumenter av typen møtereferat og resultatrapporter. Kildene er innsamlet ved et universitetssykehus i Norge. Programvaren NVivo er benyttet, og dataene er analysert ved bruk av Tjoras stegvisdeduktiv induktiv metode (SDI).  Resultater: Analyse av dataene resulterte i to hovedtemaer med fem tilhørende kategorier: 1) bestillingsanmodning til ledelsen, med tre kategorier: ressurstildeling, dokumentering og ressursallokering; 2) tjenestelevering, med to kategorier: evaluering og rapportering. Konklusjon: Studien viser at ressurstildeling som frigjør tid, engasjement fra nøkkelpersoner i strategiske roller og praksisens tilpasning til økonomiske styringsformer, kan være essensielt for implementering av simuleringsbasert trening innen anestesi. Kontinuerlig evaluering og rapportering om effekter og læringsutbytter, kan styrke praksisens legitimitet og ressursstøtte.  ENGLISH ABSTRACT Strategies for Implementing Simulation-Based Training in Anesthesiology: A Qualitative and Exploratory Study Background: Simulation-based training has been used by healthcare professionals since the 1990s. Studies have shown that the method improves technical and non-technical skills, thereby enhancing patient safety. National directives require health trusts to conduct simulations, and regional units for simulation (RegSim) coordinate this activity. Implementing simulation-based training is time-consuming and resource-intensive, and various barriers hinder its introduction. Previous studies have identified several barriers, including lack of time, high costs, low support from management, and increasing demands for outcome measurement of services, to name a few. There is limited research on which implementation strategies can promote simulation-based training in anesthesia departments. Purpose: To gain insight into the factors that can promote the implementation of simulationbased training in anesthesia, and how the practice can be established within the goal- and outcomeoriented management framework of healthcare organizations. Method: A qualitative approach with an exploratory design, grounded in a socialconstructionist epistemology. The data material consists of five semi-structured individual in-depth interviews and eight documents, including meeting minutes and result reports. The sources were collected at a University Hospital in Norway. NVivo software was used for analysis, and the data were analyzed using Tjora’s stepwise-deductive-inductive method (SDI). Results: Data analysis resulted in two main themes with five associated categories: 1) service commissioning request to management, with three categories: resource allocation, documentation, and resource distribution; 2) service delivery, with two categories: evaluation and reporting. Conclusion: The study reveals that resource allocation that frees up time, engagement from key personnel in strategic roles, and the practice’s adaptation to economic management models are essential for the implementation of simulation-based training in anesthesia. Continuous evaluation and reporting on effects and learning outcomes, can enhance the legitimacy and resource support of the practice. 

P. Phutrakool, K. Pongpirul

Background Complementary and Alternative Medicine (CAM) has gained popularity among the general population, but its acceptance and use among medical specialists have been inconclusive. This systematic review aimed to identify relevant studies and synthesize survey data on the acceptance and use of CAM among medical specialists. Methods We conducted a systematic literature search in PubMed and Scopus databases for the acceptance and use of CAM among medical specialists. Each article was assessed by two screeners. Only survey studies relevant to the acceptance and use of CAM among medical specialists were reviewed. The pooled prevalence estimates were calculated using random-effects meta-analyses. This review followed both PRISMA and SWiM guidelines. Results Of 5628 articles published between 2002 and 2017, 25 fulfilled the selection criteria. Ten medical specialties were included: Internal Medicine (11 studies), Pediatrics (6 studies), Obstetrics and Gynecology (6 studies), Anesthesiology (4 studies), Surgery (3 studies), Family Medicine (3 studies), Physical Medicine and Rehabilitation (3 studies), Psychiatry and Neurology (2 studies), Otolaryngology (1 study), and Neurological Surgery (1 study). The overall acceptance of CAM was 52% (95%CI, 42–62%). Family Medicine reported the highest acceptance, followed by Psychiatry and Neurology, Neurological Surgery, Obstetrics and Gynecology, Pediatrics, Anesthesiology, Physical Medicine and Rehabilitation, Internal Medicine, and Surgery. The overall use of CAM was 45% (95% CI, 37–54%). The highest use of CAM was by the Obstetrics and Gynecology, followed by Family Medicine, Psychiatry and Neurology, Pediatrics, Otolaryngology, Anesthesiology, Internal Medicine, Physical Medicine and Rehabilitation, and Surgery. Based on the studies, meta-regression showed no statistically significant difference across geographic regions, economic levels of the country, or sampling methods. Conclusion Acceptance and use of CAM varied across medical specialists. CAM was accepted and used the most by Family Medicine but the least by Surgery. Findings from this systematic review could be useful for strategic harmonization of CAM and conventional medicine practice. Systematic review registration PROSPERO CRD42019125628 Graphical abstract

Xiangdong Chen, Yanhong Liu, Yahong Gong et al.

The outbreak of the new Coronavirus disease, COVID-19, has been involved in 77,262 cases in China as well as in 27 other countries as of February 24, 2020. Because the virus is novel to human beings, and there is no vaccine yet available, every individual is susceptible and can become infected. Healthcare workers are at high risk, and unfortunately, more than 3,000 healthcare workers in China have been infected. Anesthesiologists are among healthcare workers who are at an even higher risk of becoming infected because of their close contact with infected patients and high potential of exposure to respiratory droplets or aerosol from their patients’ airways. In order to provide healthcare workers with updated recommendations on the management of patients in the perioperative setting as well as for emergency airway management outside of the operating room, the two largest anesthesia societies, the Chinese Society of Anesthesiology (CSA) and the Chinese Association of Anesthesiologists (CAA) have formed a task force to produce the recommendations. The task force hopes to help healthcare workers, particularly anesthesiologists, optimize the care of their patients and protect patients, healthcare workers, and the public from becoming infected. The recommendations were created mainly based on the practice and experience of anesthesiologists who provide care to patients in China. Therefore, adoption of these recommendations outside of China must be done with caution, and the local environment, culture, uniqueness of the healthcare system, and patients’ needs should be considered. The task force will continuously update the recommendations and incorporate new information in future versions.

Valentina Bellini, M. Cascella, Franco Cutugno et al.

Background and aim: Artificial intelligence was born to allow computers to learn and control their environment, trying to imitate the human brain structure by simulating its biological evolution. Artificial intelligence makes it possible to analyze large amounts of data (big data) in real-time, providing forecasts that can support the clinician’s decisions. This scenario can include diagnosis, prognosis, and treatment in anesthesiology, intensive care medicine, and pain medicine. Machine Learning is a subcategory of AI. It is based on algorithms trained for decisions making that automatically learn and recognize patterns from data. This article aims to offer an overview of the potential application of AI in anesthesiology and analyzes the operating principles of machine learning Every Machine Learning pathway starts from task definition and ends in model application. Conclusions: High-performance characteristics and strict quality controls are needed during its progress. During this process, different measures can be identified (pre-processing, exploratory data analysis, model selection, model processing and evaluation). For inexperienced operators, the process can be facilitated by ad hoc tools for data engineering, machine learning, and analytics. (www.actabiomedica.it)

Rimanatou Seyni-Boureima, Zongze Zhang, M. Antoine et al.

There has been an observed increase in theprevalence of obesity over the past few decades. The prevalence of anesthesiology related complications is also observed more frequently in obese patients as compared to patients that are not obese. Due to the increased complications that accompany obesity, obese patients are now more often requiring surgical interventions. Therefore, it is important that anesthesiologists be aware of this development and is equipped to manage these patients effectively and appropriately. As a result, this review highlights the effective management of obese patients undergoing surgery focusing on the preoperative, perioperative and postoperative care of these patients.

A. Oron, M. Souter, N. Flournoy

SUMMARY For the task of estimating a target benchmark dose such as the ED50 (the dose that would be effective for half the population), an adaptive dose-finding design is more effective than the standard approach of treating equal numbers of patients at a set of equally spaced doses. Up-and-down is the most popular family of dose-finding designs and is in common use in anesthesiology. Despite its widespread use, many aspects of up-and-down are not well known, implementation is often misguided, and standard, up-to-date reference material about the design is very limited. This article provides an overview of up-and-down properties, recent methodologic developments, and practical recommendations, illustrated with the help of simulated examples. Additional reference material is offered in the Supplemental Digital Content.

J. Beard, Emily Methangkool, Shane Angus et al.

DOI: 10.1213/ANE.0000000000006539 From the *Department of Medical Affairs, GE HealthCare, Patient Care Solutions, Chicago, Illinois; †Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine; University of California, Los Angeles, California; ‡Department of Anesthesiology and Perioperative Medicine, Case Western Reserve University School of Medicine, Washington, DC; and §Department of Anesthesiology, The Ohio State University and Wexner Medical Center, Columbus, Ohio.

Klaus Görlinger, J. Levy

Accepted for publication December 18, 2020. Published online first on January 8, 2021. From the Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany (K.G.); Tem Innovations GmbH, Munich, Germany (K.G.); and Departments of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, North Carolina (J.H.L.).

Noh Sung Hoon

Surgical treatment for gastric cancer has been developed over several decades with improvement in surgical skills, instruments, anesthesiology, radiological intervention, and nutritional support. Gastric cancer, however, is still second leading causes of cancer death in the world and the most prevailing malignancy in Korea. There are three major factors influencing the prognosis of gastric cancer:tumor factor,patient factor,and therapeutic factor.Among these, since the principal treatment modality of gastric cancer is surgery, therapeutic factor includes postoperative complications,perioperative transfusion, the extent of lymph node dissection,surgeon’s experience,and the number of operation in the institute along with adjuvant chemotherapy. Here we mainly discuss the current standard procedure of surgical treatment for gastric cancer in our department based on the results from clinical studies we have conducted.

Xinran Hou, Xinran Hou, Jiajia Hu et al.

Objective: Self-reported sleep disturbance is common but its association with mortality has rarely been investigated.Methods: This prospective cohort analysis included 41,257 participants enrolled in the National Health and Nutrition Examination Survey from 2005 to 2018. Self-reported sleep disturbance in the present study refers to the patients who have ever consulted doctors or other professionals for trouble sleeping. Univariate and multivariate survey-weighted Cox proportional hazards models were used to evaluate the association of self-reported sleep disturbance with all-cause and disease-specific mortality.Results: Approximately 27.0% of US adults were estimated to have self-reported sleep disturbance. After adjusting for all sociodemographic variables, health behavioral factors, and common comorbidities, participants with self-reported sleep disturbance tend to have higher all-cause mortality risk with a hazard ratio (HR) of 1.17 (95% CI, 1.04–1.32) and chronic lower respiratory disease mortality risk (HR, 1.88; 95% CI, 1.26–2.80), but not cardiovascular disease mortality risk (HR, 1.19; 95% CI, 0.96–1.46) and cancer mortality risk (HR, 1.10; 95% CI, 0.90–1.35).Conclusion: Self-reported sleep disturbance could be associated with higher mortality in adults, and may need to be paid more attention in public health management.

Engy T. Said, Brennan P. Marsh-Armstrong, Seth J. Fischer et al.

Abstract Introduction Ultrasound-guided percutaneous cryoneurolysis provides analgesia using cold temperatures to reversibly ablate peripheral nerves. Cryoneurolysis probes pass a gas through a small internal annulus, rapidly lowering the pressure and temperature, forming an ice ball to envelope the target nerve. Analgesia is compromised if a nerve is inadequately frozen, and laboratory studies suggest that pain may be paradoxically induced with a magnitude and duration in proportion with the incomplete ablation. We therefore investigated the relative effects of various factors that may contribute to the size of the ice ball and the effective cryoneurolysis zone. Methods A cryoprobe was inserted into a piece of meat, a gas was passed through for 2 min, and the resulting ice ball width (cross-section) and length (axis parallel to the probe) were measured using ultrasound, with the temperature evaluated in nine concentric locations concurrently. Results The factor with the greatest influence on ice ball size was probe gauge: in all probe types, a change from 18 to 14 increased ice ball width, length, and volume by up to 70%, 113%, and 512% respectively, with minimum internal temperature decreasing as much as from −5 to −32 °C. In contrast, alternating the type of meat (chicken, beef, pork) and the shape of the probe tip (straight, coudé) affected ice ball dimensions to a negligible degree. The ice ball dimensions and the zone of adequate temperature drop were not always correlated, and, even within a visualized ice ball, the temperature was often inadequate to induce Wallerian degeneration. Conclusions Percutaneous probe design can significantly influence the effective cryoneurolysis zone; visualizing a nerve fully encompassed in an ice ball does not guarantee adequate treatment to induce the desired Wallerian degeneration because ice forms at temperatures between 0 and −20 °C, whereas only temperatures below −20 °C induce Wallerian degeneration. The correlation between temperatures in isolated pieces of meat and perfused human tissue remains unknown, and further research to evaluate these findings in situ appears highly warranted.