The large amount of information available to the public regarding vaccines against Covid-19 coupled with pandemic stress and increased somatic attention could potentially precipitate development of functional neurological disorders (FNDs) following vaccination. A growing number of reports indicate that functional symptoms may follow Covid-19 vaccination, similar to those observed with other vaccines previously. We review previously reported cases of FND following vaccination against Covid-19 and present three additional cases. While two patients presented to the Emergency Department with functional movement disorders, one patient presented with protracted limb weakness and sensory dysfunction. The superficial resemblance to Guillain–Barré syndrome, a known but uncommon complication of vaccination prompted an extensive workup. Clinicians need to convey the diagnosis of FND in clear and unequivocal terms to facilitate institution of appropriate therapy and rehabilitation, but importantly also to dispel any doubts in the minds of the public regarding the safety of the available vaccines. Given the presence of significant vaccine hesitancy in many countries, this is critical to the success of the global immunisation effort.
Background Determination of fluid responsiveness (FR) associated with intravascular fluid resuscitation in hypotensive patients poses a challenge, with current best evidence methods fraught with poor retest reliability and difficulty in image acquisition (Osman, Crit Care Med 2007; 35: 64; Marik, Crit Care Med 2009; 37: 2642). Doppler carotid blood flow with passive leg raise (PLR) is a recent modality for determining FR (Marik, Chest 2013; 143: 364). Purpose This study aimed to determine whether emergency physicians with limited ultrasound experience can reliably acquire this skill. Method This prospective study recruited 60 emergency physicians with varying experience, who underwent a 3‐step learning programme. Participants performed carotid velocity time integral (VTi) Doppler on healthy subjects, followed by repeat measurements in the PLR position. A 16‐point checklist and time recorded were assessed for each sonographer, with each participant completing a post‐study questionnaire to evaluate perceived competence and ease of skill acquisition. Results Of the 60 emergency physicians recruited, 37 (61.6%) were inexperienced and 23 (38.4%) were experienced. Against the 16‐point assessment, 61% completed assessment without any errors. Fifty‐six out of 60 (94.3%) completed the assessment to acceptable standard with errors recognised and corrected, and four participants (6.7%) made critical errors without correction (Figure 1). Average (±SEM) total scan time was 4:52 ± 0:19, with no significant difference found between inexperienced and experienced groups. Conclusions This study demonstrated feasibility to train emergency physicians, demonstrating that average FR assessment was obtained within 5 min, with no difference between prior experience in scan quality/time taken. 94% completed the scan to acceptable standards, demonstrating ease of carotid Doppler flow with PLR to provide critical information in management of the hypotensive patient.
Introduction Successful press-fit implantation relies on an accurately reamed bone cavity. Inaccurate reaming can lead to a suboptimal press-fit risking fracture and cup deformation or excessive micromotion and loosening. Several factors may impact reaming accuracy including the reamer design, the surgeon’s technique and the bone quality. The aim of this study is to investigate the accuracy of reaming techniques and the accuracy of a novel reamer design. Methods Eighty composite bone models, half high density and half low density, were reamed with either a conventional or an additively manufactured reamer with a novel design employing either a straight or ‘whirlwind’ reaming technique. Reamed cavities were scanned using a 3D laser scanner and the median difference between achieved and expected diameters compared. Results The novel reamer design was more accurate than the unused conventional reamer, using both whirlwind (0.1 mm (IQR 0–0.2) vs. 0.3 mm (IQR 0.3–0.4); p < 0.001) and straight techniques (0.3 mm (IQR 0.1–1.0) vs. 1.2 mm (IQR 1–1.6); p = 0.001). Whirlwind reaming was more accurate than straight reaming using both conventional (0.3 mm (IQR 0.3–0.4) vs. 1.2 mm (IQR 1–1.6); p < 0.0001) and single use reamers (0.1 mm (IQR 0–0.2) vs. 0.3 mm (IQR 0.1–1.0); p = 0.007). Reaming errors were higher in low-density bone compared to high-density bone, for both reamer types and reaming techniques tested (0.6 mm (IQR 0.3–1.5) vs. 0.3 mm (IQR 0.1–0.8); p = 0.005). Conclusion We present a novel reamer design that demonstrates superior accuracy to conventional reamers in achieving the desired reaming diameter. Improved reaming accuracy was also demonstrated using both devices and in both bone models, using a ‘whirlwind’ technique. We recommend the use of this novel reamer design employing a ‘whirlwind’ technique to optimize reaming accuracy. Particular attention should be paid toward patients with lower bone quality which may be more susceptible to higher inaccuracies.
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