16,776 research outputs found
Short interruptions between pre‐warming and intraoperative warming are associated with low intraoperative hypothermia rates
No full textBACKGROUND: Prevention of inadvertent hypothermia is recommended for procedures >30 minutes because hypothermia increases the risk of myocardial ischemia, intraoperative blood loss, transfusion and wound complications. Therefore, short warming interruptions between pre-warming and intraoperative warming might result in lower hypothermia rates. The aim of this retrospective investigation was to determine whether the incidence of inadvertent intraoperative hypothermia was affected by the warming interruption. METHODS: The lowest intraoperative body core temperature value and the warming interruption time were taken from anaesthesia records. Body core temperature was recorded continuously, and a patient was classified to be hypothermic if the lowest recorded temperature value was 20 minutes showed significantly higher hypothermia rates than those with interruptions of ≤20 minutes (P < .0001). CONCLUSION: Intraoperative hypothermia rates increased significantly with longer forced-air warming interruptions between pre-warming and intraoperative warming. Short warming interruptions can preserve the effect of pre-warming and are associated with low intraoperative hypothermia rates
Does sodium bicarbonate infusion really have no effect on the incidence of acute kidney injury after cardiac surgery? A prospective observational trial
No full textIntroduction: Postoperative acute kidney injury (AKI) is a frequently observed phenomenon after cardiac surgery with cardio-pulmonary bypass (CPB); this severe complication is associated with adverse patient outcomes. There are multiple mechanisms involved in AKI during cardiac surgery, including CPB-dependent hemolysis. An IV infusion of sodium bicarbonate, which leads to urine alkalization, may play a role in preventing AKI. Recently, several trials have investigated the effect of sodium bicarbonate and reported controversial results. The purpose of this investigation was to investigate the following question. Under what circumstances can sodium bicarbonate prevent postoperative AKI? Methods: We analyzed data from 342 patients undergoing CPB surgery at the University Hospital Goettingen, Germany. A total of 174 patients received a preemptive dose of sodium bicarbonate. Directly after the induction of anesthesia, the continuous infusion of 0.15 mmol/kg body weight/h was started and continued until 2 pm on the first postoperative day. Patients who were not treated with sodium bicarbonate formed the control group (n = 168). To verify the AKI risk configuration of each group, we surveyed risk factors and determined the commonly used clinical predictive score according to Thakar and colleagues. We recorded the concentration of free hemoglobin (fhb) to estimate the amount of CPB-dependent hemolysis. The definition of AKI was acquired by applying the AKI-network (AKIN) classification over the course of five postoperative days. Results: Patients who received the sodium bicarbonate infusion showed a significantly lower incidence (35.6 vs. 50%) of AKI than that of patients who did not receive the infusion (p = 0.01). AKIN levels 2 and 3 were also more frequent when sodium bicarbonate was not administered. Particularly, in the low-risk cohort (<3 Thakar points), the incidence of AKI was significantly reduced (26 vs. 46%) when patients received sodium bicarbonate (p = 0.01), whereas in the high-risk patients, no significant reduction was observed. Conclusion: In this study, we observed that low-risk patients particularly benefited from the preventive treatment with sodium bicarbonate. The incidence of AKI was significantly reduced in low-risk patients while there was no statistically significant difference in the high-risk patient cohort.Open-Access-Publikationsfonds 201
An Article About Albertus C. Van Raalte, Author Unknown, Except for Parts Taken from an Article by Anna C. Post
No full textAn article about Albertus C. Van Raalte, author unknown, except for parts taken from an article by Anna C. Post. The author knew first generation persons in the Holland settlement and therefore, the article has some value.https://digitalcommons.hope.edu/vrp_1890s/1012/thumbnail.jp
Influence of oral premedication and prewarming on core temperature of cardiac surgical patients: a prospective, randomized, controlled trial
No full textAbstract Background Perioperative hypothermia is still very common and associated with numerous adverse effects. The effects of benzodiazepines, administered as premedication, on thermoregulation have been studied with conflicting results. We investigated the hypotheses that premedication with flunitrazepam would lower the preoperative core temperature and that prewarming could attenuate this effect. Methods After approval by the local research ethics committee 50 adult cardiac surgical patients were included in this prospective, randomized, controlled, single-centre study with two parallel groups in a university hospital setting. Core temperature was measured using a continuous, non-invasive zero-heat flux thermometer from 30 min before administration of the oral premedication until beginning of surgery. An equal number of patients was randomly allocated via a computer-generated list assigning them to either prewarming or control group using the sealed envelope method for blinding. The intervention itself could not be blinded. In the prewarming group patients received active prewarming using an underbody forced-air warming blanket. The data were analysed using Student’s t-test, Mann-Whitney U-test and Fisher’s exact test. Results Of the randomized 25 patients per group 24 patients per group could be analysed. Initial core temperature was 36.7 ± 0.2 °C and dropped significantly after oral premedication to 36.5 ± 0.3 °C when the patients were leaving the ward and to 36.4 ± 0.3 °C before induction of anaesthesia. The patients of the prewarming group had a significantly higher core temperature at the beginning of surgery (35.8 ± 0.4 °C vs. 35.5 ± 0.5 °C, p = 0.027), although core temperature at induction of anaesthesia was comparable. Despite prewarming, core temperature did not reach baseline level prior to premedication (36.7 ± 0.2 °C). Conclusions Oral premedication with benzodiazepines on the ward lowered core temperature significantly at arrival in the operating room. This drop in core temperature cannot be offset by a short period of active prewarming. Trial registration This trial was prospectively registered with the German registry of clinical trials under the trial number DRKS00005790 on 20th February 2014
Unexpectedly high incidence of hypothermia before induction of anesthesia in elective surgical patients
No full textStudy objective: Perioperative hypothermia is a frequently observed phenomenon of general anesthesia and is associated with adverse patient outcome. Recently, a significant influence of core temperature before induction of anesthesia has been reported. However, there are still little existing data on core temperature before induction of anesthesia and no data regarding potential risk factors for developing preoperative hypothermia. The purpose of this investigation was to estimate the incidence of hypothermia before anesthesia and to determine if certain factors predict its incidence. Design/setting/patients: Data from 7 prospective studies investigating core temperature previously initiated at our department were analyzed. Patients undergoing a variety of elective surgical procedures were included. Interventions/measurements: Core temperature was measured before induction of anesthesia with an oral (314 patients), infrared tympanic (143 patients), or tympanic contact thermometer (36 patients). Available potential predictors included American Society of Anesthesiologists status, sex, age, weight, height, body mass index, adipose ratio, and lean body weight. Association with preoperative hypothermia was assessed separately for each predictor using logistic regression. Independent predictors were identified using multivariable logistic regression. Main results: A total of 493 patients were included in the study. Hypothermia was found in 105 patients (21.3%; 95% confidence interval, 17.8%-25.2%). The median core temperature was 36.3 degrees C (25th-75th percentiles, 36.0 degrees C-36.7 degrees C). Two independent factors for preoperative hypothermia were identified: male sex and age (>52 years). Conclusions: As a consequence of the high incidence of hypothermia before anesthesia, measuring core temperature should be mandatory 60 to 120 minutes before induction to identify and provide adequate treatment to hypothermic patients. (C) 2016 Elsevier Inc. All rights reserved
Richardson, Barbauld, and the construction of an early modern fan club
No full textMPhilMuch has been written about the life and long works of the eighteenth century epistolary novelist, Samuel Richardson, but the prospect of his position as the first celebrity novelist – responsible for courting his own fame as well as initiating his own fan club – has largely been ignored. The body of manuscripts housed at the National Art Library in the Victoria and Albert Museum in London provides the modern scholar with evidence of the skeletal beginnings of an early fan club. This thesis aims to show how these manuscripts were turned into a saleable commodity by the publisher and entrepreneur Richard Phillips, while under the guiding hand of another, slightly later, literary celebrity, Anna Laetitia Barbauld. In order to restore Richardson’s reputation amongst a new nineteenth century audience, Barbauld was required to construct her own idea of him as an eighteenth century celebrity author, and in doing so the insecurities of a self-professed, apparently diffident man, are revealed. Barbauld’s capacious, but heavily edited selection of letters is analyzed in this thesis, providing ample evidence that Richardson’s correspondents were more than just eager letter writers. By using Barbauld’s biography of Richardson this thesis aims to show how she manipulates the genre of life writing in her construction of him.
This thesis offers an alternative reading of how the Richardson manuscripts are viewed, redefining them as not simply a collection of letters, but as a collective entity, deliberately selected and archived as evidence of an early modern fan club, and its celebrity managing director
Selection of work by Anna Gerber
No full textVarious journals and magazines Anna Gerber has contributed to. Anna Gerber is a graphic designer and writer based in London.
She is the author and designer of All Messed Up: Unpredictable Graphics (Laurence King, 2004) and co-editor and co-designer
of Influences: A Lexicon of Contemporary Graphic Design (Die Gestalten Verlag, 2006) with Anja Lutz. She writes regularily for magazines such as Print, Eye, Creative Review, Varoom and Idea Magazine and her work has also been published in shift!, dot dot dot and +rosebud.
She teaches at the London College of Communication on the BA Graphic Design and MA Design Writing Criticism programmes. She has also held workshops and lectures across the U.K. (including Tate Modern and the V&A Museum), as well as in India, the U.S., Australia and Malaysia.
Anna Gerber is currently engaged in research and developing projects relating to sustainability and how it applies to graphic
design as well as exploring contemporary graphic design in India
Prewarming. Yesterday's luxury, today's minimum requirements
No full textPrewarming is a useful and effective measure to reduce perioperative hypothermia. Due to A 23(3) of the German Infektionsschutzgesetz (Gesetz zur Verhutung und Bekampfung von Infektionskrankheiten beim Menschen, Infection Act, act on protection and prevention of infectious diseases in man) and the recommendations of the Hospital Hygiene and Infection Prevention Committee of the Robert Koch Institute, implementation of prewarming is clearly recommended. There are several technically satisfactory and practicable devices available allowing prewarming on the normal hospital ward, in the preoperative holding area or in the induction room of the operating theater (OR) The implementation of prewarming requires additional equipment and training of staff. Using a locally adapted concept for the implementation of prewarming does not lead to inefficiency in the perioperative process. In contrast, the implementation can help to achieve stable arrival times for patients in the OR
Author and Lecturer Anna Bird Stewart will Speak at the University of Dayton
No full textNews release announcing the visitation and speech of author and lecturer Anna Bird Stewart to the University of Dayton
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