Search

Background: Cognitive aids (CAs) are clinical tools guiding clinical decision-making during critical events in the operating room. They may counteract the adverse effects of stress on the non-technical skills of the attending clinician(s). Although most clinicians acknowledge the importance of CAs, their uptake in clinical practice seems to be lagging behind. This situation has led us to investigate which features of CAs may enhance their uptake. Therefore, in this systematic review we explored the optimums regarding the 1) timing to consult the CA, 2) person consulting the CA, 3) location of the CA in the operating room, 4) CA design (paper vs. electronic), 5) CA lay-out, 6) reader of the CA and 7) if the use of CAs in the form of decision support tools lead to improved outcome. Methods: Seven PICO-questions guided our literature search in 4 biomedical databases (MEDLINE, Embase, Web of Science and Google Scholar). We selected English-language randomized controlled trials (RCTs), observational studies and expert opinions discussing the use of cognitive aids during life-threatening events in the operating theatre. Articles discussing non-urgent or non-operating room settings were excluded. The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: We found 7 RCTs, 14 observational studies and 6 expert opinions. All trials were conducted in a simulation environment. The person who should trigger the use of a cognitive aid and the optimal timing of its initiation, could not be defined by the current literature. The ideal location of the cognitive aids remains also unclear. A favorable lay-out of an aid should be well-structured, standardized and easily readable. In addition, several potentially beneficial design features are described. RCT’s could not demonstrate a possible superiority of either electronic or paper-based aids. Both have their advantages and disadvantages. Furthermore, electronic decision support tools are potentially associated with an enhanced performance of the clinician. Likewise, the presence of a reader was associated with an improved performance of key steps in the management of a critical event. However, it remains unclear who should fulfill this role. Conclusion: Several features of the design or utilization of CAs may play a role in enhancing the uptake of CAs in clinical practice during the management of a critical event in the operating room. However, robust evidence supporting the use of a certain feature over another is lacking.

Background We examined whether a context and process-sensitive ‘intelligent' checklist increases compliance with best practice compared with a paper checklist during intensive care ward rounds. Methods We conducted a single-centre prospective before-and-after mixed-method trial in a 35 bed medical and surgical ICU. Daily ICU ward rounds were observed during two periods of 8 weeks. We compared paper checklists (control) with a dynamic (digital) clinical checklist (DCC, intervention). The primary outcome was compliance with best clinical practice, measured as the percentages of checked items and unchecked critical items. Secondary outcomes included ICU stay and the usability of digital checklists. Data are presented as median (interquartile range). Results Clinical characteristics and severity of critical illness were similar during both control and intervention periods of study. A total of 36 clinicians visited 197 patients during 352 ward rounds using the paper checklist, compared with 211 patients during 366 ward rounds using the DCC. Per ICU round, a median of 100% of items (94.4–100.0) were completed by DCC, compared with 75.1% (66.7–86.4) by paper checklist (P=0.03). No critical items remained unchecked by the DCC, compared with 15.4% (8.3–27.3) by the paper checklist (P=0.01). The DCC was associated with reduced ICU stay (1 day [1–3]), compared with the paper checklist (2 days [1–4]; P=0.05). Usability of the DCC was judged by clinicians to require further improvement. Conclusions A digital checklist improved compliance with best clinical practice, compared with a paper checklist, during ward rounds on a mixed ICU. Clinical trial registration NCT 03599856.

Background The current coronavirus infectious disease 2019 (COVID-19) pandemic has caused unexpected pressure on medical supplies, interrupting supply chains and increasing prices. The supply of antiviral filters which form an essential part of the ventilator circuit have been affected by these issues. Three-dimensional (3D) printing may provide a solution to some of these issues. Methods We designed and tested 3D printed heat and moisture exchange (HME) and antiviral casing. For each casing we tested two different filter materials derived from a sediment water filter cartridge or 1.5-μm glass fiber filter paper. A polyurethane sponge was used for the HME. Each design was tested for circuit leak, circuit compliance, peak inspiratory pressure and casing integrity using methylene blue dye. Results We designed, produced, and tested two different types of antiviral filters with six different internal configurations. Overall, we tested 10 modified filter designs and compared them with the original commercial filter. Except for the combination of 1.5-μm filter paper and 5 mm sponge peak inspiratory pressure and circuit compliance of the filters produced were within the operating limits of the ventilator. All In addition, all filters passed the dye test. Conclusions Our filter may be of particular importance to those working in low middle-income countries unable to compete with stronger economies. Our design relies on products available outside the healthcare supply chain, much of which can be purchased in grocery stores, hardware stores, or industrial and academic institutions. We hope that these HMEs and viral filters may be beneficial to clinicians who face critical supply chain issues during the COVID-19 pandemic.

This article deals with formulating a suitable title and an appropriate abstract for an original research paper. The "title" and the "abstract" are the "initial impressions" of a research article, and hence they need to be drafted correctly, accurately, carefully, and meticulously. Often both of these are drafted after the full manuscript is ready. Most readers read only the title and the abstract of a research paper and very few will go on to read the full paper. The title and the abstract are the most important parts of a research paper and should be pleasant to read. The "title" should be descriptive, direct, accurate, appropriate, interesting, concise, precise, unique, and should not be misleading. The "abstract" needs to be simple, specific, clear, unbiased, honest, concise, precise, stand-alone, complete, scholarly, (preferably) structured, and should not be misrepresentative. The abstract should be consistent with the main text of the paper, especially after a revision is made to the paper and should include the key message prominently. It is very important to include the most important words and terms (the "keywords") in the title and the abstract for appropriate indexing purpose and for retrieval from the search engines and scientific databases. Such keywords should be listed after the abstract. One must adhere to the instructions laid down by the target journal with regard to the style and number of words permitted for the title and the abstract.

The visual analogue scale (VAS) is an established, validated, self-report measure usually consisting of a 10 cm line on paper with verbal anchors labeling the ends. Palmtop computers (PTCs also known as personal digital appliances) have incorporated VAS entry by use of a touch screen. However, the validity and psychophysical properties of the electronic VAS have never been formally compared with the conventional paper VAS. The aim of this study is to determine the agreement between the electronic (eVAS) and paper (pVAS) modes. Twenty-four healthy volunteers were recruited for this study. Each study participant provided input using both measurement methods by marking the eVAS and pVAS in response to two kinds of stimuli, cognitive and sensory. A verbal rating scale of seven descriptors of intensity represented the cognitive stimuli. Participants were asked to mark the location that best corresponded to the pain intensity described by each word on scales from 'no pain' to 'worst possible pain'. The sensory stimuli used were a set of test weights consisting of plastic containers ranging from 7 to 129 g. The VAS for sensory stimuli ranged from 0 (no weight) to 'reference weight' (the heaviest weight outside the range of test weights). There were two types of input stimuli and two modes for recording responses for a total of four experimental conditions. Two evaluators independently measured and recorded all the pVAS forms to the nearest millimeter. A total of 2016 stimuli were rated. The overall correlation for ratings of both sensory and cognitive stimuli on eVAS and pVAS was r = 0.91. For paired verbal stimuli the correlation was r = 0.97. For paired sensory stimuli the correlation was r = 0.86. The correlation between group eVAS and pVAS ratings to common verbal stimuli was r = 0.99. For common sensory stimuli the group correlation was r = 0.99. The median of correlations comparing eVAS and pVAS ratings was 0.99 for verbal stimuli and 0.98 for sensory stimuli. Multivariate analyses showed equivalent stimuli to be rated much the same whether entered on paper VAS or PTC touch screen VAS (P < 0.0001). Support was found for the validity of the computer version of the VAS scale.

Electronic data collection for monitoring pain has become increasingly popular in clinical research. However, no direct comparison has been made between electronic diaries and self-report paper diaries or phone interviews. We asked 36 patients with chronic low back pain to monitor their pain for 1 year; 20 of them used both a palmtop computer and paper diaries, and 16 used paper diaries alone. All patients were called once a week and asked to rate their pain. Regression analyses with a measurement error model were run on hourly pain scores recorded by both palmtop computer and paper diaries. Ratings of pain intensity were highly reliable between data recorded with a palmtop computer and with data from paper diaries. Patients who monitored their pain with the palmtop computer entered data on average 6.75 times a week and were 89.9% compliant with daily monitoring throughout the year. Two-way messaging available through the palmtop computer seemed to encourage continued use of the device. Internal consistency of reporting and correlations with phone reports and standardized measures were highly significant, suggesting that data from electronic diaries are both reliable and valid. Patients using electronic diaries preferred them to paper diaries and showed much higher rates of compliance and satisfaction over the 1-year trial.

Various phases of solar energy were evaluated for possible medical application, using the Bi-Digital O-Ring Test. A 2-4 minute interval of highly beneficial phase during sunrise and sunset which is comparable or is stronger than (+) Qigong Energy was detected. This energy was stored on 3 x 5 inch index cards. The sun energy stored on the exposed surface had a Bi-Digital O-Ring Test extremely strong positive (+) response, and the opposite side of the index card which was not exposed to the sun showed an equally strong negative (-) response. When the Bi-Digital O-Ring Test strong positive side (+) was applied to the patient's skin above various intractable painful areas with circulatory disturbances, including gangrenous pain, muscle pain, joint pain, & migraine headache, most of the pain disappeared or was significantly reduced within between 10 seconds and 5 minutes, with accelerated wound healing compared with Qigong energy stored paper of the same exposure, which caused pain to disappear within between 1.5 minutes and 15 minutes. When this Special Solar Energy Stored Paper was applied either directly to the skin above cancer positive areas or the midline of the upper chest above the thymus gland representation area, or the occipital area above the medulla oblongata, various cancer related parameters returned to close to normal values, with immediate clinical improvement. The beneficial effects of 10-60 seconds of application of the Special Solar Energy Stored Paper lasted for between 7 and 40 days, depending on the individual and their environmental electromagnetic field, how the special solar energy was stored, and how it was applied to the patient.

A disposable heat and moisture exchanger ("Artificial Nose") which is designed for use during endotracheal anaesthesia is described together with an evaluation of its performance. It has a low dead space, minimal resistance to gas flow, and is potentially capable of conserving 50 per cent of the respiratory water loss in the intubated patient.

SUMMARY A 15-year-old girl developed rhabdomyolysis with myoglobinuria after anaesthesia during which suxamethonium 250 mg was injected in divided doses. The laboratory methods used for demonstration of myoglobinuria are described. The study was extended to 63 patients submitted to minor surgery. Myoglobinuria could not be demonstrated in any of these cases whether or not anaesthesia included suxamethonium as a single dose of 1 mg/kg. Creatine kinase activity measurement in 25 of these patients disclosed no significant difference between pre- and postoperative values. It is concluded that myoglobinuria in the patient presented was due to an excessive dose of suxamethonium.