1,720,975 research outputs found
What is the minimum time interval for reporting of intraoperative core body temperature measurements in pediatric anesthesia? A secondary analysis
No full textAbstract Given that perioperative normothermia represents a quality parameter in pediatric anesthesia, numerous studies have been conducted on temperature measurement, albeit with heterogeneous measurement intervals, ranging from 30 s to fifteen minutes. We aimed to determine the minimum time interval for reporting of intraoperative core body temperature across commonly used measurement intervals in children. Data were extracted from the records of 65 children who had participated in another clinical study and analyzed using a quasibinomial mixed linear model. Documented artifacts, like probe dislocations or at the end of anesthesia, were removed. Primary outcome was the respective probability of failing to detect a temperature change of 0.2 °C or more at any one measurement point at 30 s, one minute, two minutes, five minutes, ten minutes, and fifteen minutes, considering an expected probability of less than 5% to be acceptable. Secondary outcomes included the probabilities of failing to detect hypothermia ( 38.0 °C). Following the removal of 4,909 exclusions, the remaining 222,366 timestamped measurements (representing just over 60 h of monitoring) were analyzed. The median measurement time was 45 min. The expected probabilities of failing to detect a temperature change of 0.2 °C or more were 0.2% [95%-CI 0.0-0.7], 0.5% [95%-CI 0.0-1.2], 1.5% [95%-CI 0.2–2.6], 4.8% [95%-CI 2.7–6.9], 22.4% [95%-CI 18.3–26.4], and 31.9% [95%-CI 27.3–36.4], respectively. Probabilities for the detection of hyperthermia ( n = 9) were lower and omitted for hypothermia due to low prevalence ( n = 1). In conclusion, the core body temperature should be reported at intervals of no more than five minutes to ensure the detection of any temperature change in normothermic ranges. Further studies should focus on hypothermic and hyperthermic ranges.Clinical trial registration This study is a secondary analysis from a prospective cohort study, which was registered in the German Clinical Trials Register (DRKS00024703).Abstract Given that perioperative normothermia represents a quality parameter in pediatric anesthesia, numerous studies have been conducted on temperature measurement, albeit with heterogeneous measurement intervals, ranging from 30 s to fifteen minutes. We aimed to determine the minimum time interval for reporting of intraoperative core body temperature across commonly used measurement intervals in children. Data were extracted from the records of 65 children who had participated in another clinical study and analyzed using a quasibinomial mixed linear model. Documented artifacts, like probe dislocations or at the end of anesthesia, were removed. Primary outcome was the respective probability of failing to detect a temperature change of 0.2 °C or more at any one measurement point at 30 s, one minute, two minutes, five minutes, ten minutes, and fifteen minutes, considering an expected probability of less than 5% to be acceptable. Secondary outcomes included the probabilities of failing to detect hypothermia ( 38.0 °C). Following the removal of 4,909 exclusions, the remaining 222,366 timestamped measurements (representing just over 60 h of monitoring) were analyzed. The median measurement time was 45 min. The expected probabilities of failing to detect a temperature change of 0.2 °C or more were 0.2% [95%-CI 0.0-0.7], 0.5% [95%-CI 0.0-1.2], 1.5% [95%-CI 0.2–2.6], 4.8% [95%-CI 2.7–6.9], 22.4% [95%-CI 18.3–26.4], and 31.9% [95%-CI 27.3–36.4], respectively. Probabilities for the detection of hyperthermia ( n = 9) were lower and omitted for hypothermia due to low prevalence ( n = 1). In conclusion, the core body temperature should be reported at intervals of no more than five minutes to ensure the detection of any temperature change in normothermic ranges. Further studies should focus on hypothermic and hyperthermic ranges.Clinical trial registration This study is a secondary analysis from a prospective cohort study, which was registered in the German Clinical Trials Register (DRKS00024703)
A Brief Introduction on Latent Variable Based Ordinal Regression Models With an Application to Survey Data
No full textABSTRACT The analysis of survey data is a frequently arising issue in clinical trials, particularly when capturing quantities which are difficult to measure. Typical examples are questionnaires about patient's well‐being, pain, or consent to an intervention. In these, data is captured on a discrete scale containing only a limited number of possible answers, from which the respondent has to pick the answer which fits best his/her personal opinion. This data is generally located on an ordinal scale as answers can usually be arranged in an ascending order, for example, “bad”, “neutral”, “good” for well‐being. Since responses are usually stored numerically for data processing purposes, analysis of survey data using ordinary linear regression models are commonly applied. However, assumptions of these models are often not met as linear regression requires a constant variability of the response variable and can yield predictions out of the range of response categories. By using linear models, one only gains insights about the mean response which may affect representativeness. In contrast, ordinal regression models can provide probability estimates for all response categories and yield information about the full response scale beyond the mean. In this work, we provide a concise overview of the fundamentals of latent variable based ordinal models, applications to a real data set, and outline the use of state‐of‐the‐art‐software for this purpose. Moreover, we discuss strengths, limitations and typical pitfalls. This is a companion work to a current vignette‐based structured interview study in pediatric anesthesia
The pediatric anesthesiology publication activity and landscape over the past two decades: A longitudinal scientometric analysis
No full textAbstract Background Scientometric analyses characterize the output of research publications using quantitative methods. While it has been reported that the number of publications in anesthesiology has been increasing for years, the global research activity in pediatric anesthesiology and its landscape is largely unknown. Aims To examine the activity, developmental dynamics, and collaboration landscape of research publications in pediatric anesthesiology over the past two decades. Methods PubMed and WebOfScience were searched for pediatric anesthesiology publications published between 2001 and 2020. The identified publications were exported into a database, matched, curated, and then assigned to one or more countries according to their affiliation field(s). The primary outcome was the publication activity and its growth rate. Secondary outcomes included the geographical distribution, the evolution of international collaborations (as indicated by articles affiliated with more than one country), and the main sources. Results Thirty‐four thousand, three hundred and forty‐three pediatric anesthesiology publications were retrieved. The compound annual growth rate over the study period was +7.6%. The highest annual growth rate was +20.6% from 2019 to 2020. Corresponding authors were most often affiliated with USA (32.5%), Germany (5.5%), and China (5.5%). China (+22.9%), Iran (+21.7%), and India (+16.1%) had the highest compound annual growth rates. 6001 (17.5%) articles involved international collaboration, with a compound annual growth rate of +13.1%. The most frequent collaboration was between USA and Canada (716 articles together). The most prominent source was Pediatric Anesthesia (10.0%). Conclusions Publication activity in pediatric anesthesiology has increased from 2001 to 2020 and has become more geographically diverse. With the volume of international collaborations even outpacing this growth, it is hoped that this will gradually lead to a larger evidence base in pediatric anesthesia
Global evolution of female authorships in anesthesiology articles: an affiliation-based, longitudinal, scientometric analysis
No full textAbstract Background Although a gender gap in anesthesiology articles has been reported in certain subsets of anesthesiology literature, a comprehensive analysis is still lacking. Our objective was to conduct a scientometric analysis of the evolution of gender equity among anesthesiology authors worldwide, including all available affiliations. We hypothesized that gender inequity has diminished over time, with relevant differences among countries. Methods The MEDLINE/PubMed 2024 Baseline Repository was queried for all articles whose authors were affiliated with a department of anesthesiology. Author positions were sequenced into first, co-authors, and senior authors. Gender was inferred using online classification tools (genderize.io and gender-api.com). Geolocation was identified through text mining of the first author’s affiliation. The primary endpoint was the evolution of female authors from 1987 to 2023, calculated descriptively and by average annual growth rates. Secondary endpoints included the proportion of female authors in first or senior author position, the influence of senior authors’ gender on first authors’ gender, geographical differences, and future projections of parity (defined as 50% female authors). Results Among 374,301 anesthesiology articles and 7,574 journals, the proportion of female authors increased from 13.6% (1987) to 34.3% (2023) with an average annual growth of 0.57% (95%-confidence interval 0.38% − 0.77%). First authors were female in 30.0% and senior authors in 20.7%, with increases from 11.7% (1987) to 36.9% (2023), and from 11.0% (1987) to 25.9% (2023), respectively. Female authors were overall more likely to be first authors when the senior author was also female. In 2023, only Thailand and Portugal had a percentage of female authors over 50%. Tunisia achieved the highest average annual growth rate of female authors at 2.28% (95%-CI 1.51% − 3.06%). Based on the assumption that current trends continue unchanged, overall gender parity is estimated to be achieved by 2050, for first authors by 2043 and for senior authors by 2072. Conclusions Despite an increase in recent decades, women are still underrepresented as authors in academic anesthesiology, particularly in leading authorship positions. While relevant differences between countries exist, strategies addressing this gender gap at a country-specific level are needed to promote female authorship in academic anesthesiology
Perioperative Hypothermia in Children
No full textBackground: First described by paediatric anaesthesiologists, perioperative hypothermia is one of the earliest reported side effects of general anaesthesia. Deviations from normothermia are associated with numerous complications and adverse outcomes, with infants and small children at the highest risk. Nowadays, maintenance of normothermia is an important quality metric in paediatric anaesthesia. Methods: This review is based on our collection of publications regarding perioperative hypothermia and was supplemented with pertinent publications from a MEDLINE literature search. Results: We provide an overview on perioperative hypothermia in the paediatric patient, including definition, history, incidence, development, monitoring, risk factors, and adverse events, and provide management recommendations for its prevention. We also summarize the side effects and complications of perioperative temperature management. Conclusions: Perioperative hypothermia is still common in paediatric patients and may be attributed to their vulnerable physiology, but also may result from insufficient perioperative warming. An effective perioperative warming strategy incorporates the maintenance of normothermia during transportation, active warming before induction of anaesthesia, active warming during anaesthesia and surgery, and accurate measurement of core temperature. Perioperative temperature management must also prevent hyperthermia in children
Preoperative Anxiety Management Practices in Pediatric Anesthesia: Comparative Analysis of an Online Survey Presented to Experts and Social Media Users
No full textAbstract
BackgroundManaging preoperative anxiety in pediatric anesthesia is challenging, as it impacts patient cooperation and postoperative outcomes. Both pharmacological and nonpharmacological interventions are used to reduce children’s anxiety levels. However, the optimal approach remains debated, with evidence-based guidelines still lacking. Health care professionals using social media as a source of medical expertise may offer insights into their management approaches.
ObjectiveA public survey targeting health care professionals was disseminated via social media platforms to evaluate current practices in anxiety management in children. The same questions were posed during an annual meeting of pediatric anesthesiologists with their responses serving as reference. The primary objective was to compare pediatric anesthesia expertise between the groups, while secondary objectives focused on identifying similarities and differences in preoperative anxiety management strategies hypothesizing expertise differences between the groups.
MethodsTwo surveys were conducted. The first survey targeted 100 attendees of the German Scientific Working Group on Pediatric Anesthesia in June 2023 forming the “Expert Group” (EG). The second open survey was disseminated on social media using a snowball sampling approach, targeting followers of a pediatric anesthesia platform to form the “Social Media Group” (SG). The answers to the 24 questions were compared and statistically analyzed. Questions were grouped into 5 categories (pediatric anesthesia expertise, representativity, structural conditions, practices of pharmacological management, and practices in nonpharmacological management).
ResultsA total of 194 responses were analyzed (82 in EG and 112 in SG). The EG cohort exhibited significantly greater professional experience in pediatric anesthesia than the SG cohort (median 19 vs 10 y, PPP
ConclusionsDespite heterogeneous approaches, health care professionals using social media demonstrated less expertise in pediatric anesthesia but showed minimal differences in the daily management of preoperative anxiety compared with pediatric anesthesia experts. Our study highlights the potential for meaningful use of social media but future studies should explore the impact of social media health care professionals’ knowledge in other specific topics. Additionally, regarding preoperative anxiety, further recommendations are needed that could help to standardize and improve anxiety levels in children
Characteristics and outcome of prehospital paediatric tracheal intubation attended by anaesthesia-trained emergency physicians
No full textAim: To collect data regarding prehospital paediatric tracheal intubation by emergency physicians skilled in advanced airway management. Methods: A prospective 8-year observational study of a single emergency physician-staffed emergency medical service. Self-reporting by emergency physicians of all children aged 0-14 years who had prehospital tracheal intubation and were attended by either anaesthesia-trained emergency physicians (group 1) or by a mixture of anaesthesia and non-anaesthesia-trained emergency physicians (group 2). Results: Eighty-two out of 2040 children (4.0%) had prehospital tracheal intubation (58 in group 1). The most common diagnoses were trauma (50%; in school children, 73.0%), convulsions (13.4%) and SIDS (12.2%: in infants, 58.8%). The overall tracheal intubation success rate was 57 out of 58 attempts (98.3%). Compared to older children, infants had a higher number of Cormack-Lehane scores of 3 or 4, "difficult to intubate" status (both 3 Out of 13; 23.1%) and a lower first attempt Success Fate for tracheal intubation (p = 0.04). Among all 82 children 71 (86.6%) survived to hospital admission and 63 (76.8%) to discharge. Of the 63 survivors, 54 (85.7%) demonstrated a favourable OF Unchanged neurological outcome (PCPC 1-3). The survival and neurological outcomes of infants were inferior compared to older children (p < 0.001). On average an emergency physician performed one prehospital tracheal intubation in 3 years in a child and one in 13 years in an infant. Conclusions: Anaesthesia-trained emergency physicians working in our system report high success rates for prehospital tracheal intubation in children. Survival and neurological Outcomes were considerably better than reported in previous Studies. (C) 2009 Elsevier Ireland Ltd. All rights reserved
Guedel oropharyngeal airway: The validation of facial landmark-distances to estimate sizing in children – Visualisation by magnetic resonance imaging (GUEDEL-I): A prospective observational study
No full textReply to Letter: Paediatric tracheal prehospital intubation-What makes different our practice across the Ocean?
No full textFactors Influencing Willingness to Participate in Clinical Studies in Pediatric Anesthesia ( FILIPPA ): A vignette‐based, structured interview study
No full textAbstract Background Informed consent is a relevant backdrop for conducting clinical trials, particularly those involving children. While several factors are known to influence the willingness to consent to pediatric anesthesia studies, the influence of study design on consenting behavior is unknown. Aims To quantify the impact of study complexity on willingness to consent to pediatric anesthesia studies. Methods We conducted a vignette‐based interview study by presenting three hypothetical studies to 106 parents or legal guardians whose children were scheduled to undergo anesthesia. These studies differed in level of complexity and included an example of a prospective observational study, a randomized controlled trial, and a phase‐II‐pharmacological study. Primary outcome was the willingness to consent, using a 5‐point Likert scale ranging from “absolutely consent” to “absolutely decline”. Secondary outcomes were the effects of child‐related (such as sex, age, previous anesthesia, research exposure) and proxy‐related factors. Results Response probabilities for “absolute consent” were 90.9% [95% CI 85.3–96.5] for the observational study, 48.6% [95% CI 38.3–58.9] for the randomized controlled trial, and 32.7% [95% CI 23.9–41.6] for the phase‐II‐pharmacological study. Response probabilities for “absolutely decline” were 1.6% [95% CI 0.3–2.8], 14.4% [95% CI 8.3–20.5], and 24.7% [95% CI 16.6–32.7], respectively. Significant effects were found for previous research exposure (OR = 0.486 [95% CI 0.256–0.923], p = .027), older age (OR = 0.963 [95% CI 0.927–0.999], p = .045) and the gender of the parent or legal guardian, as mothers were less willing to consent (OR = 0.234 [95% CI 0.107–0.512], p < .001). Conclusions Willingness to consent decreased with increasing level of study complexity. When conducting more complex studies, greater efforts need to be made to increase the enrollment of pediatric patients
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