Medicine
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Randomized Controlled Trial
Combination of general anesthesia and peripheral nerve block with low-dose ropivacaine reduces postoperative pain for several days after outpatient arthroscopy: A randomized controlled clinical trial.
Effective methods for postoperative pain relief are an important concern in outpatient surgery. For arthroscopies we combine a single-shot peripheral nerve block using low-volume, low-concentration ropivacaine with general anesthesia. We hypothesized that the patients would have less postoperative pain and be more rapidly home ready than after general anesthesia alone. ⋯ The combination of a peripheral nerve block with low-dose ropivacaine and general anesthesia reduced postoperative pain compared with general anesthesia alone for several days after outpatient arthroscopy. It also shortened the time to home discharge.
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Randomized Controlled Trial
Stylet angulation for routine endotracheal intubation with McGrath videolaryngoscope.
The McGrath videolaryngoscope (VL) provides excellent laryngoscopic views, but directing an endotracheal tube can be difficult, and thus the routine use of a stylet is recommended. The goal of this study is to determine the appropriate angle (60° vs 90°) of the stylet when using the McGrath VL by comparing the time to intubation (TTI). ⋯ When intubating the patients with the McGrath videolaryngoscope, the 60° angled stylet allowed for faster orotracheal intubation than did the 90° angled stylet.
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Randomized Controlled Trial Multicenter Study Observational Study
Free and total p-cresol sulfate levels and infectious hospitalizations in hemodialysis patients in CHOICE and HEMO.
The uremic syndrome is attributed to progressive retention of compounds that, under normal conditions, are excreted by the healthy kidneys. p-cresol sulfate (PCS), a prototype protein-bound uremic retention solute, has been shown to exert toxic effects in vitro. Recent studies have identified relations between increased levels of PCS and indoxyl sulfate (IS) and adverse clinical outcomes in hemodialysis patients. We explored the relationship between free and total PCS and IS with infection-related hospitalizations (IH) and septicemia in 2 cohorts, Choices for Healthy Outcomes in Caring for end-stage renal disease (ESRD) Study (CHOICE) and Hemodialysis Study (HEMO). ⋯ No significant risk of IH or septicemia was noted with higher levels of free or total IS in either GI or no-GI disease group. These results suggest an association between higher concentrations of free PCS and infection-related and sepsis-related hospitalizations in hemodialysis patients. Better methods of dialysis should be developed to evaluate the utility of removing PCS and its effect on the outcome and also therapies to decrease gastrointestinal tract production of uremic solutes.
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Randomized Controlled Trial
Impact of standardized patients on the training of medical students to manage emergencies.
Teaching emergency management should educate medical students not only for facts and treatment algorithms but also for time effective physical examination, technical skills, and team interaction. We tested the hypothesis, that using standardized emergency patients would be more effective in transmitting knowledge and skills compared with a more traditional teaching approach. ⋯ Teaching management of emergencies using standardized patients can improve medical students' performance in clinical tests, and a change from traditional seminars in favor of practice sessions with standardized patients does not compromise the learning of medical facts.
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Endotracheal tube (ETT) positioning using the cuff ballottement test, which confirms that the inflated cuff is positioned at the suprasternal notch with squeezing or inflating a pilot balloon, has been reported to be a simple and reliable method of preventing endobronchial intubation. However, in patients with a short vocal cord-to-suprasternal notch, ETT placement using the cuff ballottement test can cause vocal cord injury. In the present study, we assessed the distance from a point 15 mm below the vocal cord to the suprasternal notch (VSD-15), the safe position for ETT cuff placement above the suprasternal notch, and investigated variables for predicting VSD-15. ⋯ In multiple linear regression models, a formula was obtained for VSD-15 (VSD-15 [mm] = -6.220 + 0.744 × TSD [mm] + 0.092 × height [cm] - 0.065 × age [years], R = 0.621). The cuff ballottement test should be used cautiously in patients with a predicted short VSD-15. VSD-15 can be predicted from TSD, height, and age.