Anaesthesia
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We examined the light intensity delivered by the Trachlight™ reusable lightwand and the effect of repeated sterilisation on this light intensity. Using a light meter and test chamber, the light intensity of 12 new Trachlights and 31 Trachlights available in operating theatres was measured. In addition, five new devices underwent 30 repeated sterilisations with light intensity measurement after each cleaning. ⋯ The median (range) number of uses for devices currently in service was only 3 (0-9). There was, however, significant light intensity loss after 10, 20 and 30 cleanings (p = 0.001). After 10 cleanings, the mean light intensity was 75% of initial output, and after 30 cycles, light intensity was 59% of initial output.
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Review Meta Analysis
The influence of clinical risk factors on pre-operative B-type natriuretic peptide risk stratification of vascular surgical patients.
The role of the revised cardiac risk index in risk stratification has recently been challenged by studies reporting on the superior predictive ability of pre-operative B-type natriuretic peptides. We found that in 850 vascular surgical patients initially risk stratified using B-type natriuretic peptides, reclassification with the number of revised cardiac risk index risk factors worsened risk stratification (p < 0.05 for > 0, > 2, > 3 and > 4 risk factors, and p = 0.23 for > 1 risk factor). ⋯ The only independent predictor was B-type natriuretic peptide stratification (OR 5.1, 95% CI 1.8-15 for the intermediate class, and OR 25, 95% CI 8.7-70 for the high-risk class). The clinical risk factors in the revised cardiac risk index cannot improve a risk stratification model based on B-type natriuretic peptides.
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Randomized Controlled Trial
The influence of patient position on withdrawal force of thoracic epidural catheters.
We investigated the forces required to remove thoracic epidural catheters to determine the effect of patient position on removal. Eighty-four patients undergoing open thoracotomy and thoracic patient-controlled epidural analgesia were enrolled. Catheterisation was performed under fluoroscopic guidance before surgery, and the patients were allocated to one of three position groups for removal: prone; sitting; and lateral. ⋯ No differences in mean (SD) forces were found between groups: prone 1.61 (0.39) N, supine 1.62 (0.61) N and lateral 1.36 (0.56) N (p = 0.140). The withdrawal forces required to remove thoracic epidural catheters were not affected by the position. Thus, the position for removal can be determined by patient's choice and clinical judgement.
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There should be protocol-driven, fast-track admission of patients with hip fractures through the emergency department. Patients with hip fractures require multidisciplinary care, led by orthogeriatricians. Surgery is the best analgesic for hip fractures. ⋯ Pre-operative management should include consideration of planning for discharge from hospital. Measures should be taken to prevent secondary falls. 10. Continuous audit and targeted research is required in order to inform and improve the management of patients with hip fracture.