The USG during IJ CVC placement by novice practitioners is essential to improve patient safety. If these data are extrapolated to impact on patient care, an arterial stick may be avoided in one of every two IJ CVCs placed by novice practitioners. The USG technology should be made available to novice practitioners needing to place CVCs.
Zusammenfassung Fragestellung: Die laparoskopische suprazervikale Hysterektomie (LASH) ist bei benignen, therapieresistenten uterinen Erkrankungen eine Alternative zur totalen Hysterektomie. Es gibt nur wenig Daten zur Methodik und Präparation, Technik, Komplikationen und postoperativem Befinden aus dem deutschen Sprachraum. Material und Methodik: In sechs vergleichbaren Tageskliniken des VAAO wurden zwischen dem 1. 4. 2003 und dem 31. 3. 2004 191 laparoskopische suprazervikale Hysterektomien (LASH) prospektiv erfasst. Prä-, intra-und postoperativ wurden relevante Daten in einem einheitlichen Fragebogen erhoben. Alle Patientinnen wurden sechs Monate nach der Operation nachbefragt. Ergebnisse: Das Alter der Patientinnen betrug im Mittel 43 Jahre. Die Hauptindikation zur Operation waren Blutungsstörungen und Dysmenorrhö (65%). Die durchschnittliche Operationszeit lag bei 119 Minuten. Das Durchschnittsgewicht der durch Morcellement extrahierten Korpusanteile betrug 239 g. Die Arteriae uterinae wurden überwiegend bipolar koaguliert (81%). Am häu-
AbstractStudy Objective: Laparoscopic supracervical hysterectomy (LASH) is an alternative to total hysterectomy for benign conditions in cases where conservative treatment options fail and hysterectomy is indicated. Only little data from German-speaking countries concerning surgical techniques, postoperative wellbeing and complications is available. Methods: The data of 191 patients scheduled for laparoscopic supracervical hysterectomy were prospectively registered between April 1, 2003 and March 31, 2004. A questionnaire was filled in by the physician recording data pre-, intra-and postoperatively. All patients were interviewed six months after surgery and asked about their well-being, possible complaints and their fitness to work by telephone. Results: The average age of the patients was 43 years. The main indications for the operation were abnormal uterine bleeding and dysmenorrhea (65%). The mean operation time was 119 minutes and the average weight of the uterus corpus was 239 g. The uterine arteries were coagulated with bipolar current in most
IntroductionIn 2013 the Society for Critical Care Medicine (SCCM) published guidelines for the management of pain and agitation in the intensive care unit (ICU). These guidelines recommend using an analgesia-first strategy in mechanically ventilated patients as well as reducing the use of benzodiazepines. Benzodiazepines increase delirium in ICU patients thereby increasing ICU length of stay. We sought to determine whether a simple educational intervention for emergency department (ED) staff, as well as two simple changes in workflow, would improve adherence to the SCCM guidelines.MethodsThis was a cohort study that took place from 2014–2016. All patients who were intubated in the ED by an emergency physician (EP) during this time were eligible for inclusion in this study. In January 2015, we began an educational campaign with the ED staff consisting of a series of presentations and online trainings. The impetus for our educational campaign was to have best practices in place for our new emergency medicine residency program starting in July 2016. We made two minor changes in our ED workflow to support this educational objective. First, fentanyl infusions were stocked in the ED. Second, we instituted a medication order set for mechanically ventilated patients. This order set nudged EPs to choose medications consistent with the SCCM guidelines. We then evaluated the use of opioids and benzodiazepines in mechanically ventilated patients from 2014 through 2016 using Fisher’s exact test. All analyses were conducted in the overall sample (n=509) as well as in subgroups after excluding patients with seizures/status epilepticus as their primary admission diagnosis (n=461).ResultsIn 2014 prior to the interventions, 41% of mechanically ventilated patients received an opioid, either as an intravenous (IV) push or IV infusion. In 2015 immediately after the intervention, 71% of patients received an opioid and 64% received an opioid in 2016. The use of benzodiazepine infusions decreased from 22% in 2014 to 7% in 2015 to 1% in 2016.ConclusionA brief educational intervention along with two simple changes in ED workflow can improve compliance with the SCCM guidelines for the management of pain and agitation in mechanically ventilated patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.