The number of patients who undergo heart transplant is increasing. Due to surgical emergencies, many of those may require general anesthesia in hospitals where subspecialized anesthetists may not be available. We present a case of a male patient who had heart transplant and required general anesthesia for emergency appendicectomy. Physiology of the heart after transplant, preoperative considerations, and postoperative monitoring has been discussed in our report.
SummaryChlorhexidine contamination of equipment used in central neuraxial anaesthesia has been implicated in causing adhesive arachnoiditis. We measured the extent of chlorhexidine splash during pouring into a gallipot (antiseptic skin preparation container) from heights of 5 cm, 10 cm, 15 cm and 20 cm. Twenty experiments were performed at each height. Measurements made up to a horizontal distance of 40 cm radius from the gallipot showed a median (IQR [range]) maximum spread of splash droplets ≥ 2 mm diameter of 26.2 (10.2-36.4 [0-40]) cm. The 40-cm radius measurement area was divided into 5-cm-wide zones to assess spread. At pouring heights of 15 cm and 20 cm, all zones were contaminated. These results demonstrate that pouring chlorhexidine into a gallipot generates significant splash, and we recommend that this should be avoided near equipment used for neuraxial anaesthesia.
Background: Hip osteoarthritis in canines is a common diagnosis. The prevalence in adult dogs is estimated to be 20 percent. The primary treatment is usually an NSAID. Acupuncture as treatment for pain conditions is commonly used within human medicine and is becoming more frequently used within veterinary medicine. Acupuncture studies that show the pain relieving effects in animals are few, which make it important to elucidate the effects of this treatment method. Objectives: The aim of this study was to examine the effects of acupuncture in relation to function, passive range of motion, thigh circumference and palpation for pain in a ten year-old German Shepard dog with x-ray verified left sided osteoarthritis of the hip. Materials and methods:The study was conducted with a single subject experimental ABA-design. Twice before the first treatment (A1-baseline) function, passive range of motion (PROM), thigh circumference and palpation for pain were assessed. The dog then received three acupuncture treatments, once a week (B1-3-intervention). The choice of points in order of insertion was Bai Hui intraspinal L7-S1, BL 25 bilateral, BL 23 bilateral, and GB 30 left. The needles were stimulated during insertion as well as before removal. During intervention, PROM was measured after each treatment. Seven days after the last acupuncture treatment the same examination that was conducted initially was conducted again (A2-evaluation). Data were analyzed with 2SD-line where all the results that orient above 2SD-line are significant. Celeration line shows the trend before, during and after the intervention. Results: The results showed decreased symptoms regarding limpness and rigidity and normalized functional tests, improved passive range of motion in the left hip joint (Fig. 3), decreased pain of the outer part of passive extension, increased thigh circumference bilaterally, and decreased pain with palpation. Conclusions: The single subject experimental design has great clinical applicability for the scientist-practitioner and can provide clinicians with useful information. This single subject experimental design indicates that acupuncture seems to have an effect on dogs with hip osteoarthritis. Further studies with larger study groups need to be conducted to be able to make evidence-based treatment decisions.
Background Medical education has changed continually throughout the covid-19 pandemic, creating additional stress for medical students. Personal reflection can empower an individual to adapt to new challenges, and reflection has gradually become incorporated into medical student training. Schwartz Rounds (SR) offer a compassionate group reflective forum for healthcare staff. SRs have been extensively introduced throughout the NHS, however medical student rounds are yet to be widely adopted. Entirely unresearched is how the multi-disciplinary team impacts a medical student SR. This study aims to compare medical student experience of a single-discipline and a multi-discipline SR using mixed methodology. Methods Two virtual SRs were run at an NHS district general hospital, using the existing structure of the Trust’s rounds. The first round included only medical students on placement at the hospital, whereas the second round also involved other student health disciplines. Following each round Likert scale questionnaires were collected, and focus groups were held with a small number of participants. Quantitative analysis used median averages as well direct comparison of scores for each round. Qualitative data from the focus groups underwent thematic analysis. Results The quantitative data showed a positive response to both styles of student SRs, with over 87% of participants at both rounds stating they intended to attend further rounds. Direct comparison between the two rounds showed higher feedback scores for the single-discipline round. Qualitative analysis showed strong student interest in further group reflection, noting the value of SRs in improving workplace culture and inter-professional relationships. The analysis also highlighted frustrations with the existing SR structure, namely large group sizes and scripted panellists. Conclusions Both data sets showed a strong positive response to SRs, and a desire to attend again. There is some evidence to suggest the addition of multiple student disciplines at SRs impaired medical student reflection. Changes to the format of the round could result in even greater success in student rounds.
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