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Standard Group (standard + group)
Selected AbstractsSpectral entropy monitoring allowed lower sevoflurane concentration and faster recovery in childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2010S. R. CHOI Background: Anesthetic titration using spectral entropy monitoring reduces anesthetic requirements and shortens recovery in adult surgical patients. This study was performed to evaluate the effect of entropy monitoring on end-tidal sevoflurane concentration and recovery characteristics in pediatric patients undergoing sevoflurane anesthesia. Methods: Seventy-eight children (aged 3,12 years) scheduled for a tonsillectomy and/or an adenoidectomy were randomly divided into one of two groups: standard practice (Standard) or entropy-guided (Entropy). In the Standard group, sevoflurane was adjusted to maintain the heart rate and systolic blood pressure (BP) within 20% of the baseline values. In the Entropy group, sevoflurane was adjusted to achieve a state entropy of 40,50. We compared the entropy values, end-tidal sevoflurane concentration and recovery times between groups. Results: During maintenance of anesthesia, the entropy and BP values were higher in the Entropy group (P<0.05). The end-tidal sevoflurane concentration during maintenance was lower in the Entropy group (2.2 (0.3) vol%) compared with the Standard group (2.6 (0.4) vol%) (P<0.05). Recovery times were faster in the Entropy group (P<0.05). Conclusions: Compared with standard practice, we found that entropy-guided anesthetic administration was associated with a reduced sevoflurane concentration and a slightly faster emergence and recovery in 3,12-year-old children. [source] Change in post-traumatic stress symptoms following psychosocial treatment for breast cancerPSYCHO-ONCOLOGY, Issue 8 2005Ellen G. Levine The diagnosis of cancer is a traumatic experience, which may result in post-traumatic stress symptoms, such as arousal, re-experiencing the diagnostic process and avoidance. Changes in post-traumatic symptoms were assessed in 181women with breast cancer who participated in either a standard support group or complementary/alternative (CAM) oriented intervention. At baseline 26 women were classified as having significant PTSD symptoms. After the 12-week sessions, significant decreases in the number of women with PTSD was seen in both interventions, however it was more evident in the Standard group where there was a 91% reduction in the number of women with PTSD versus an 80% reduction in the CAM group. For women with PTSD both groups showed significant decreases in overall PTSD symptoms and arousal. However, only the women in the Standard support group showed significant decreases in re-experiencing and avoidance symptoms. For the entire sample only women in the Standard group had significant decreases in overall PTSD, re-experiencing, and arousal. These results indicate that PTSD symptoms can be prevalent among women with breast cancer, and that while psychosocial interventions can be effective in reducing this type of distress, a support group might be more effective than a more complementary/alternative oriented intervention. Copyright © 2005 John Wiley & Sons, Ltd. [source] Examining the Utility of In-Clinic "Rescue" Therapy for Acute MigraineHEADACHE, Issue 6 2008Veronica Morey RN Background., Management options currently are limited for patients with acute migraine whose symptoms prove refractory to self-administered therapy. Objective., To evaluate the clinical utility and cost-effectiveness of a management program offering in-clinic "rescue" treatment for patients with acute migraine. Methods., Two hundred consecutive migraine patients presenting to a university-based headache clinic were randomized to receive either optimal self-administered medical therapy for acute migraine ("standard therapy") or similar therapy plus the option of in-clinic parenteral drug administration should self-administered therapy prove ineffective ("rescue therapy"). Patients randomized to the latter group were restricted to a maximum of 2 "rescue visits" per month, and all patients were followed for one year. Patients "rescued" in clinic were contacted by telephone 24 hours following treatment to evaluate their treatment response. The primary analysis involved a comparison of the number of emergency department (ED) visits for headache recorded within each group over the one-year period of study. For all ED visits in the rescue group and for a randomly selected and equal number of ED visits within the standard group, the direct costs associated with those visits were assessed, and the direct costs of all in-clinic rescue visits also were recorded and analyzed. Results., The 2 groups studied were similar in terms of age, gender ratio, migraine subtype, migraine-related disability status at baseline and type/extent of medical insurance coverage. Over the one-year study period, the rescue group recorded 423 in-clinic rescue visits and reported 27 ED visits for headache treatment. The standard therapy group reported 73 ED visits (27 vs 73 visits; P < .01). The total direct costs associated with ED visits were $45,330 for the rescue group (mean $1690 per ED visit) and (by extrapolation from the sample selected) $147,971 for the standard therapy group (mean $2027 per ED visit). The total direct cost of the 423 "rescue visits" was $33,647 (mean $80 per visit). In 79% of the 423 rescue encounters, the patients involved reported no residual functional disability 24 hours following treatment. Of those in the rescue group who sought in-clinic rescue, 89% reported themselves "very satisfied" with such management. Conclusion., Providing the alternative of in-clinic "rescue" for acute migraine refractory to self-administered therapy offers an attractive alternative for patients and appears to substantially lower use of an ED for headache treatment and the cost associated with that use. [source] The effect of the Lockit epidural catheter clamp on epidural migration: a controlled trialANAESTHESIA, Issue 9 2001apparatus We investigated the efficacy of using the Lockit epidural catheter clamp in preventing epidural catheter migration in patients receiving postoperative analgesia via an epidural infusion after major surgery. Patients were randomly allocated to receive either a standard epidural dressing, a coiled catheter with transparent adhesive dressing and tape (n = 54), or the Lockit epidural catheter clamp (n = 48). There was no movement from the insertion position in 88% of the Lockit group compared with only 28% in the standard group (p < 0.001). Outward migration of >,2 cm occurred in 26% of the standard group compared with just 6% of the Lockit group (p < 0.01). Inward migration of >,1 cm occurred in 17% of the standard group but in none of the Lockit group (p < 0.01). Catheter migration was assessed as being the cause of analgesic failure in 15% of the standard group but in only 4% of the Lockit group (p < 0.05). We conclude that the Lockit epidural catheter clamp significantly reduces catheter migration in a safe and non-invasive fashion. [source] Cricothyrotomy Technique Using Gum Elastic Bougie Is Faster Than Standard Technique: A Study of Emergency Medicine Residents and Medical Students in an Animal LabACADEMIC EMERGENCY MEDICINE, Issue 6 2010Chandler Hill MD Abstract Objectives:, The objective was to compare time to completion, failure rate, and subjective difficulty of a new cricothyrotomy technique to the standard technique. The new bougie-assisted cricothyrotomy technique (BACT) is similar to the rapid four-step technique (RFST), but a bougie and endotracheal tube are inserted rather than a Shiley tracheostomy tube. Methods:, This was a randomized controlled trail conducted on domestic sheep. During a 3-month period inexperienced residents or students were randomized to perform cricothyrotomy on anesthetized sheep using either the standard technique or the BACT. Operators were trained with an educational video before the procedure. Time to successful cricothyrotomy was recorded. The resident or student was then asked to rate the difficulty of the procedure on a five-point scale from 1 (very easy) to 5 (very difficult). Results:, Twenty-one residents and students were included in the study: 11 in the standard group and 10 in the BACT group. Compared to the standard technique, the BACT was significantly faster with a median time of 67 seconds (interquartile range [IQR] = 55,82) versus 149 seconds (IQR = 111,201) for the standard technique (p = 0.002). The BACT was also rated easier to perform (median = 2, IQR = 1,3) than the standard technique (median = 3, IQR = 2,4; p = 0.04). The failure rate was 1/10 for the BACT compared to 3/11 for the standard method (p = NS). Conclusions:, This study demonstrates that the BACT is faster than the standard technique and has a similar failure rate when performed by inexperienced providers on anesthetized sheep. ACADEMIC EMERGENCY MEDICINE 2010; 17:666,669 © 2010 by the Society for Academic Emergency Medicine [source] | ||||||||||