Singap Med J
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Controlled Clinical Trial
Computer-integrated patient-controlled epidural analgesia: a preliminary study on a novel approach of providing pain relief in labour.
The need for individualisation of analgesic therapy in labour cannot be overemphasised. We have devised a programme, based on a novel clinical algorithm, that converts a continuous infusion pump into a patient-controlled epidural analgesia (PCEA) pump that is responsive to the patient's needs by varying its rate of infusion. ⋯ Our study also showed that with the CI-PCEA programme, we were able to convert an ordinary infusion pump to one which analyses the patients' needs in the previous hour (based on analgesic demands) and automatically adjusts the basal infusion accordingly. CI-PCEA reduced the incidence of breakthrough pain without the evidence of increasing drug consumption when compared with CEI.
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A 46-year-old Indonesian woman presented with signs and symptoms suggestive of an ovarian tumour and was advised to have surgery with exploratory laparotomy and removal of the mass. She agreed but refused blood transfusion any time in the course of her treatment or procedure, as she was a Jehovah Witness. ⋯ The ethical conflict is between respecting patient autonomy and compromising standards of care, arising from the refusal of a standard therapy. The latest developments in the blood transfusion doctrine policy for the Jehovah Witnesses are also discussed in this case study.
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Paediatric risk of mortality and paediatric index of mortality (PIM) are the commonly-used mortality prediction models (MPM) in children admitted to paediatric intensive care unit (PICU). The current study was undertaken to develop a better MPM using artificial neural network, a domain of artificial intelligence. ⋯ The current study demonstrated the process of predictive mortality risk model development using ANN. Further multicentre studies are required to produce a representative ANN-based mortality prediction model for use in different PICUs.
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Randomized Controlled Trial Clinical Trial
Comparison of the VBM laryngeal tube and laryngeal mask airway for ventilation during manual in-line neck stabilisation.
The purpose of this study is to assess whether the newly-developed VBM (Medizintechnik GmbH, Sulz, Germany) laryngeal tube (LT) is able to provide adequate ventilation and oxygenation to patients with an unstable neck and require airway management. The haemodynamic responses to insertion between the two devices were also studied. We compared the LT to the laryngeal mask airway (LMA) as an alternative airway management tool in adult patients with unstable neck and who underwent intubation with manual in-line neck stabilisation. ⋯ We conclude that, under anaesthesia, the LT was a valuable and better alternative to LMA for ventilation and airway management when the patient's head and neck are stabilised by the manual in-line method.