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British Journal of Anaesthesia Oct 1991Since the 1940s there has been an increase in the number of patients submitted for surgery of the spinal axis necessitating use of the prone position. Specifically... (Review)
Review
Since the 1940s there has been an increase in the number of patients submitted for surgery of the spinal axis necessitating use of the prone position. Specifically designed operating tables were both rare and expensive, and probably only existed in a few highly specialized centres. Apparatus which could be easily made locally and used in conjunction with normal operating tables has been invented and generally used to good effect. The important historical landmarks in these developments are traced and a review of the methods and hazards is presented. Similar methods evolved almost simultaneously in differing centres. It is recommended that the Tarlov "seated prone" position should be widely used, in view of its physiological advantages and lack of adverse reports.
Topics: History, 20th Century; Humans; Intervertebral Disc; Laminectomy; Prone Position; Spine
PubMed: 1931403
DOI: 10.1093/bja/67.4.452 -
BMJ (Clinical Research Ed.) Aug 2002To determine the accuracy with which a cervicovaginal fetal fibronectin test predicts spontaneous preterm birth in women with or without symptoms of preterm labour. (Review)
Review
OBJECTIVE
To determine the accuracy with which a cervicovaginal fetal fibronectin test predicts spontaneous preterm birth in women with or without symptoms of preterm labour.
DESIGN
Systematic quantitative review of studies of test accuracy.
DATA SOURCES
Medline, Embase, PASCAL, Biosis, Cochrane Library, Medion, National Research Register, SCISEARCH, conference papers, manual searching of bibliographies of known primary and review articles, and contact with experts and manufacturer.
STUDY SELECTION
Two reviewers independently selected and extracted data on study characteristics, quality, and accuracy.
DATA EXTRACTION
Accuracy data were used to form 2x2 contingency tables with spontaneous preterm birth before 34 and 37 weeks' gestation and birth within 7-10 days of testing (for symptomatic pregnant women) as reference standards. Data were pooled to produce summary receiver operating characteristic curves and summary likelihood ratios for positive and negative test results.
DATA SYNTHESIS
64 primary articles were identified, consisting of 28 studies in asymptomatic women and 40 in symptomatic women, with a total of 26 876 women. Among asymptomatic women the best summary likelihood ratio for positive results was 4.01 (95% confidence interval 2.93 to 5.49) for predicting birth before 34 weeks' gestation, with corresponding summary likelihood ratio for negative results of 0.78 (0.72 to 0.84). Among symptomatic women the best summary likelihood ratio for positive results was 5.42 (4.36 to 6.74) for predicting birth within 7-10 days of testing, with corresponding ratio for negative results of 0.25 (0.20 to 0.31).
CONCLUSION
Cervicovaginal fetal fibronectin test is most accurate in predicting spontaneous preterm birth within 7-10 days of testing among women with symptoms of threatened preterm birth before advanced cervical dilatation.
Topics: Biomarkers; Cervix Uteri; Female; Fibronectins; Humans; Obstetric Labor, Premature; Predictive Value of Tests; Pregnancy; Pregnancy, High-Risk; Vagina
PubMed: 12169504
DOI: 10.1136/bmj.325.7359.301 -
BioMed Research International 2021West Africa has witnessed the unprecedented outbreak of Ebola virus disease (EVD). The Ebola virus (EBOV) can cause Ebola hemorrhagic fever, which is documented as the... (Review)
Review
BACKGROUND
West Africa has witnessed the unprecedented outbreak of Ebola virus disease (EVD). The Ebola virus (EBOV) can cause Ebola hemorrhagic fever, which is documented as the most deadly viral hemorrhagic fever in the world. RT-PCR had been suggested to be employed in the detection of Ebola virus; however, this method has high requirements for laboratory equipment and takes a long time to determine Ebola infection. Although Xpert Ebola is a fast and simple instrument for the detection of Ebola virus, its effect is still unclear. This study is aimed at evaluating the accuracy of Xpert Ebola in diagnosing Ebola virus infection.
METHODS
Using the keywords "Xpert" and "Ebola virus", relevant studies were retrieved from the database of PubMed, Embase, Web of Science, and Cochrane. RT-PCR was employed as a reference standard to evaluate whether the study is eligible to be included in the meta-analysis. Data from these included studies were extracted by two independent assessors and were then analyzed by the Meta-DiSc 1.4 software to produce the heterogeneity of sensitivity (SEN), specificity (SP), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic advantage ratio (DOR) of the study. The results of pooled analysis were plotted, together with the summary receiver operating characteristic (SROC) curve plotted by calculating the area under the curve (AUC). Generated pooled summary estimates (95% CIs) were calculated for the evaluation of the overall accuracy of this study.
RESULTS
Five fourfold tables were made from the four studies that were included in the meta-analysis. The pooled sensitivity of Xpert Ebola was 0.98 (95% confidence interval (CI) (0.95, 0.99)), and the pooled specificity was 0.98 (95% CI (0.97, 0.99)). The pooled values of positive likelihood ratio was 53.91 (95% CI (12.82, 226.79)), with negative likelihood ratio being 0.04 (95% CI (0.02, 0.08)) and diagnostic odds ratio being 2649.45 (95% CI (629.61, 11149.02)). The AUC was 0.9961.
CONCLUSIONS
Compared with RT-PCR, Xpert Ebola has high sensitivity and specificity. Therefore, it is a valued alternative method for the clinical diagnosis of Ebola virus infection. However, the Xpert Ebola test is a qualitative test that does not provide quantitative testing of EBOV concentration. Whether it can completely replace other methods or not calls for further evidences.
Topics: Africa, Western; Animals; Area Under Curve; Databases, Factual; Ebolavirus; Hemorrhagic Fever, Ebola; Humans; Molecular Diagnostic Techniques; Odds Ratio; ROC Curve; Reference Standards; Sensitivity and Specificity
PubMed: 34055977
DOI: 10.1155/2021/5527505 -
The Cochrane Database of Systematic... Mar 2017Procedural sedation and analgesia (PSA) is used frequently in the emergency department (ED) to facilitate painful procedures and interventions. Capnography, a monitoring... (Review)
Review
BACKGROUND
Procedural sedation and analgesia (PSA) is used frequently in the emergency department (ED) to facilitate painful procedures and interventions. Capnography, a monitoring modality widely used in operating room and endoscopy suite settings, is being used more frequently in the ED setting with the goal of reducing cardiopulmonary adverse events. As opposed to settings outside the ED, there is currently no consensus on whether the addition of capnography to standard monitoring modalities reduces adverse events in the ED setting.
OBJECTIVES
To assess whether capnography in addition to standard monitoring (pulse oximetry, blood pressure and cardiac monitoring) is more effective than standard monitoring alone to prevent cardiorespiratory adverse events (e.g. oxygen desaturation, hypotension, emesis, and pulmonary aspiration) in ED patients undergoing PSA.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (2016, Issue 8), and MEDLINE, Embase, and CINAHL to 9 August 2016 for randomized controlled trials (RCTs) and quasi-randomized trials of ED patients requiring PSA with no language restrictions. We searched meta-registries (www.controlled-trials.com, www.clinicalstudyresults.org, and clinicaltrials.gov) for ongoing trials (February 2016). We contacted the primary authors of included studies as well as scientific advisors of capnography device manufacturers to identify unpublished studies (February 2016). We handsearched conference abstracts of four organizations from 2010 to 2015.
SELECTION CRITERIA
We included any RCT or quasi-randomized trial comparing capnography and standard monitoring to standard monitoring alone for ED patients requiring PSA.
DATA COLLECTION AND ANALYSIS
Two authors independently performed study selection, data extraction, and assessment of methodological quality for the 'Risk of bias' tables. An independent researcher extracted data for any included studies that our authors were involved in. We contacted authors of included studies for incomplete data when applicable. We used Review Manager 5 to combine data and calculate risk ratios (RR) and 95% confidence intervals (CI) using both random-effects and fixed-effect models.
MAIN RESULTS
We identified three trials (κ = 1.00) involving 1272 participants. Comparing the capnography group to the standard monitoring group, there were no differences in the rates of oxygen desaturation (RR 0.89, 95% CI 0.48 to 1.63; n = 1272, 3 trials; moderate quality evidence) and hypotension (RR 2.36, 95% CI 0.98 to 5.69; n = 986, 1 trial; moderate quality evidence). There was only one episode of emesis recorded without significant difference between the groups (RR 3.10, 95% CI 0.13 to 75.88, n = 986, 1 trial; moderate quality evidence). The quality of evidence for the primary outcomes was moderate with downgrades primarily due to heterogeneity and reporting bias.There were no differences in the rate of airway interventions performed (RR 1.26, 95% CI 0.94 to 1.69; n = 1272, 3 trials; moderate quality evidence). In the subgroup analysis, we found a higher rate of airway interventions for adults in the capnography group (RR 1.44, 95% CI 1.16 to 1.79; n = 1118, 2 trials; moderate quality evidence) with a number needed to treat for an additional harmful outcome of 12. Although statistical heterogeneity was reduced, there was moderate quality of evidence due to outcome definition heterogeneity and limited reporting bias. None of the studies reported recovery time.
AUTHORS' CONCLUSIONS
There is a lack of convincing evidence that the addition of capnography to standard monitoring in ED PSA reduces the rate of clinically significant adverse events. Evidence was deemed to be of moderate quality due to population and outcome definition heterogeneity and limited reporting bias. Our review was limited by the small number of clinical trials in this setting.
Topics: Analgesia; Blood Pressure Determination; Capnography; Emergency Service, Hospital; Emergency Treatment; Heart Rate; Humans; Hypotension; Hypoxia; Monitoring, Physiologic; Oximetry; Pneumonia, Aspiration; Randomized Controlled Trials as Topic; Vomiting
PubMed: 28334427
DOI: 10.1002/14651858.CD010698.pub2 -
German Medical Science : GMS E-journal Nov 2009Nowadays, drug research and surveillance after authorisation becomes more and more important for several reasons. Non-interventional studies (NIS) investigate various...
Nowadays, drug research and surveillance after authorisation becomes more and more important for several reasons. Non-interventional studies (NIS) investigate various aspects of drug use including efficacy and safety under real life conditions. Such kind of health services research should be on a high scientific, methodological and organisational level. Therefore accompanying measures to improve or to keep the quality are highly recommended. The aim of quality management is: first to avoid bias of results by using an appropriate study design and an adequate data analysis, second to assure authenticity, completeness and validity of the data and third to identify and resolve deficiencies at an early stage. Basic principles are laid down in corresponding guidelines and recommendations of authorities, institutes and societies. Various guidelines for good epidemiological practice (GEP) were published by the U.S. Food and Drug Administration (FDA) and international and regional societies for epidemiology. In addition in Germany the Federal Institute for Drugs and Medical Devices (BfArM) together with the Paul Ehrlich Institute (PEI) and the German Association of Research-Based Pharmaceutical Companies (VFA) have published respectively recommendations dealing with quality aspects of non-interventional observational studies. Key points are the advanced publishing of information about the project, developing of a study plan/protocol containing the scientific objectives, a sample size justification and a description of the planned analyses and the publishing of a summary of the results timely after completion of the study. The quality of the data can be improved by using standardized case report forms (CRF) and the CRF should be reviewed and tested before start of study by some participants. A source data verification (SDV) should be performed in randomly selected centres - in between 2% and 5% of the centres depending on the number of participating centres. Before start of statistical analysis a statistical analysis plan (SAP) should be created. The use of standardized tables and figures is highly recommended. The basis of the report writing should be the STROBE-statement "Strengthening the Reporting of Observational studies in Epidemiology Initiative" containing a checklist of 22 points to be covered in the report. The development of own standard operating procedures (SOP) describing the processes during planning, conduct and evaluation of a non-interventional study as well as the quality management and the regular training of all involved people is also highly recommended. All accompanying measures to improve or to keep the quality of the NIS should not violate the concept of non-intervention.
Topics: Controlled Clinical Trials as Topic; Epidemiologic Methods; Evidence-Based Medicine; Germany; Guidelines as Topic; Quality Assurance, Health Care
PubMed: 19949447
DOI: 10.3205/000088 -
Ginekologia Polska 2020Ergonomics in laparoscopy has been gaining increasing attention. The research literature on ergonomics is growing worldwide; however, there are no studies or data from...
OBJECTIVES
Ergonomics in laparoscopy has been gaining increasing attention. The research literature on ergonomics is growing worldwide; however, there are no studies or data from Turkey. Our study provides information on the awareness and use of ergonomics in laparoscopic gynecology in Turkey.
MATERIAL AND METHODS
A questionnaire consisting of 25 questions was sent by email to 225 laparoscopists who are members of the Turkish Society of Gynecological Endoscopy.
RESULTS
In response, 45.7% of the questionnaires were returned. Six respondents (5.9%) had never experienced pain, and two respondents (1.9%) always experienced pain during or after laparoscopy. The shoulders, neck, and back were the most common sites where respondents experienced pain. Most of the respondents (64.1%) utilized one monitor during laparoscopic surgery, and only 2% of respondents utilized a monitor below eye level. Less than 50% of the respondents were aware of ergonomic guidelines.
CONCLUSIONS
Even though less than half of the Turkish gynecological laparoscopist respondents were aware of ergonomic guidelines, more than half used appropriate visual systems, operating tables, hand instruments, and had large enough operating rooms. Only the number and level of monitors used by respondents were not in accordance with ergonomic guidelines.
Topics: Ergonomics; Gynecology; Humans; Laparoscopy; Musculoskeletal Diseases; Occupational Diseases; Operating Rooms; Pain; Posture; Turkey
PubMed: 32236933
DOI: 10.5603/GP.a2020.0036 -
British Journal of Anaesthesia Feb 2015
Topics: Ergonomics; Female; Humans; Intubation, Intratracheal; Larynx; Male; Operating Tables
PubMed: 25596227
DOI: 10.1093/bja/aeu475 -
BMC Surgery Mar 2013European Healthcare Systems are facing a difficult period characterized by increasing costs and spending cuts due to economic problems. There is the urgent need for new...
BACKGROUND
European Healthcare Systems are facing a difficult period characterized by increasing costs and spending cuts due to economic problems. There is the urgent need for new tools which sustain Hospitals decision makers work. This project aimed to develop a data recording system of the surgical process of every patient within the operating theatre. The primary goal was to create a practical and easy data processing tool to give hospital managers, anesthesiologists and surgeons the information basis to increase operating theaters efficiency and patient safety.
METHODS
The developed data analysis tool is embedded in an Oracle Business Intelligence Environment, which processes data to simple and understandable performance tachometers and tables. The underlying data analysis is based on scientific literature and the projects teams experience with tracked data. The system login is layered and different users have access to different data outputs depending on their professional needs. The system is divided in the tree profile types Manager, Anesthesiologist and Surgeon. Every profile includes subcategories where operators can access more detailed data analyses. The first data output screen shows general information and guides the user towards more detailed data analysis. The data recording system enabled the registration of 14.675 surgical operations performed from 2009 to 2011.
RESULTS
Raw utilization increased from 44% in 2009 to 52% in 2011. The number of high complexity surgical procedures (≥120 minutes) has increased in certain units while decreased in others. The number of unscheduled procedures performed has been reduced (from 25% in 2009 to 14% in 2011) while maintaining the same percentage of surgical procedures. The number of overtime events decreased in 2010 (23%) and in 2011 (21%) compared to 2009 (28%) and the delays expressed in minutes are almost the same (mean 78 min). The direct link found between the complexity of surgical procedures, the number of unscheduled procedures and overtime show a positive impact of the project on OR management. Despite a consistency in the complexity of procedures (19% in 2009 and 21% in 2011), surgical groups have been successful in reducing the number of unscheduled procedures (from 25% in 2009 to 14% in 2011) and overtime (from 28% in 2009 to 21% in 2011).
CONCLUSIONS
The developed project gives healthcare managers, anesthesiologists and surgeons useful information to increase surgical theaters efficiency and patient safety. In difficult economic times is possible to develop something that is of some value to the patient and healthcare system too.
Topics: Database Management Systems; Efficiency, Organizational; Humans; Operating Rooms; Safety
PubMed: 23496977
DOI: 10.1186/1471-2482-13-7 -
Data in Brief Jun 2023This paper provides experimental data on the temperature rise during granular flows in a small-scale rotating drum due to heat generation. All heat is believed to be...
This paper provides experimental data on the temperature rise during granular flows in a small-scale rotating drum due to heat generation. All heat is believed to be generated by conversion of some mechanical energy, through mechanisms such as friction and collisions between particles and between particles and walls. Particles of different material types were used, while multiple rotation speeds were considered, and the drum was filled with different amounts of particles. The temperature of the granular materials inside the rotating drum was monitored using a thermal camera. The temperature increases at specific times of each experiment are presented in form of tables, along with the average and standard deviation of the repetitions of each setup configuration. The data can be used as a reference to set the operating conditions of rotating drums, in addition to calibrating numerical models and validating computer simulations.
PubMed: 37383737
DOI: 10.1016/j.dib.2023.109282 -
Anesthesia, Essays and Researches 2014Quality assurance of providing a work ready machine in multiple theatre operating rooms in a tertiary modern medical center in Riyadh.
CONTEXT
Quality assurance of providing a work ready machine in multiple theatre operating rooms in a tertiary modern medical center in Riyadh.
AIMS
The aim of the following study is to keep high quality environment for workers and patients in surgical operating rooms.
SETTINGS AND DESIGN
Technicians based audit by using key performance indicators to assure inspection, passing test of machine worthiness for use daily and in between cases and in case of unexpected failure to provide quick replacement by ready to use another anesthetic machine.
MATERIALS AND METHODS
The anesthetic machines in all operating rooms are daily and continuously inspected and passed as ready by technicians and verified by anesthesiologist consultant or assistant consultant. The daily records of each machines were collected then inspected for data analysis by quality improvement committee department for descriptive analysis and report the degree of staff compliance to daily inspection as "met" items. Replaced machine during use and overall compliance.
STATISTICAL ANALYSIS USED
Distractive statistic using Microsoft Excel 2003 tables and graphs of sums and percentages of item studied in this audit.
RESULTS
Audit obtained highest compliance percentage and low rate of replacement of machine which indicate unexpected machine state of use and quick machine switch.
CONCLUSIONS
The authors are able to conclude that following regular inspection and running self-check recommended by the manufacturers can contribute to abort any possibility of hazard of anesthesia machine failure during operation. Furthermore in case of unexpected reason to replace the anesthesia machine in quick maneuver contributes to high assured operative utilization of man machine inter-phase in modern surgical operating rooms.
PubMed: 25886335
DOI: 10.4103/0259-1162.143142