ABSTRACT
Introduction: The dangers of hyperventilation during resuscitation are well known. Traditional bag valve mask (BVM) devices rely on end users to control tidal volume (Vt), rate, and peak inspiratory pressures (PIP) of ventilation. The Butterfly BVM (BBVM) is a novel device intending to give greater control over these parameters. The objective of this pilot study was to compare the BBVM against a traditional device in simulated resuscitations. Methods: Senior emergency medicine residents and fellows participated in a three-phase simulation study. First, participants used the Ambu Spur II BVM in adult and pediatric resuscitations. Vt, PIP, and rate were recorded. Second, participants repeated the resuscitations after a brief introduction to the BBVM. Third, participants were given a longer introduction to the BBVM and were tested on their ability to adjust its various settings. Results: Nineteen participants were included in the adult arm of the study, and 16 in the pediatric arm. The BBVM restricted Vt delivered to a range of 4-8 ml/kg vs 9 ml/kg and 13 ml/kg (Ambu adult and Ambu pediatric respectively). The BBVM never exceeded target minute ventilations while the Ambu BVMs exceeded target minute ventilation in 2 of 4 tests. The BBVM failed to reliably reach higher PIP targets in one test, while the pediatric Ambu device had 76 failures of excessive PIP compared to 2 failures by the BBVM. Conclusion: The BBVM exceeded the Ambu Spur II in delivering appropriate Vts and in keeping PIPs below target maximums to simulated adult and pediatric patients in this pilot study.
ABSTRACT
OBJECTIVES: Many physicians have been reluctant to embrace physician evaluation websites (PEWs) due to the overwhelming number of PEWs and concerns about negative anonymous feedback. This article provides perspective for the vast array of PEWs, website features and user characteristics, and identifies the most notable websites which merit attention from physicians concerned about their online reputations. METHODS: 35 PEWs met criteria for inclusion in the analysis. Each website was studied to assess its geographic focus, detailed features of physician profiles, nature of patient-generated reviews, number of monthly site visitors, and other points including user demographics and characteristics. RESULTS: Most PEWs provide their services free-of-charge, and physicians are usually allowed to create and enhance online profiles without payment. Anonymous posting of reviews is an almost universal feature of PEWs, but most reviews are positive. A few websites allow physicians to respond publicly or privately to negative patient reviews. These and other notable websites are identified. CONCLUSIONS: Physician evaluation websites have tremendous potential to help doctors and patients. With this review as a guide, physicians should collaborate with PEWs to harness their potential, to improve clinical practices, and to attract new patients. As physicians increasingly interact with the most "doctor-friendly" PEWs, this collaboration could motivate other websites to implement changes that give physicians greater control over their online reputations. The era of doctors avoiding online evaluations is closing, and in the future, physicians who embrace PEWs are most likely to succeed.
Subject(s)
Internet , Patient Satisfaction , Physician-Patient Relations , Physicians , Quality of Health Care , HumansABSTRACT
1. Curcumin is a naturally occurring poly-phenolic compound with a broad range of favourable biological functions, including anti-cancer, anti-oxidant and anti-inflammatory activities. The low bioavailability and in vivo stability of curcumin require the development of suitable carrier vehicles to deliver the molecule in a sustained manner at therapeutic levels. 2. In the present study, we investigated the feasibility and potential of poly(caprolactone) (PCL) nanofibres as a delivery vehicle for curcumin for wound healing applications. By optimizing the electrospinning parameters, bead-free curcumin-loaded PCL nanofibres were developed. 3. The fibres showed sustained release of curcumin for 72 h and could be made to deliver a dose much lower than the reported cytotoxic concentration while remaining bioactive. Human foreskin fibroblast cells (HFF-1) showed more than 70% viability on curcumin-loaded nanofibres. 4. The anti-oxidant activity of curcumin-loaded nanofibres was demonstrated using an oxygen radical absorbance capacity (ORAC) assay and by the ability of the fibres to maintain the viability of HFF-1 cells under conditions of oxidative stress. 5. The curcumin-loaded nanofibres also reduced inflammatory induction, as evidenced by low levels of interleukin-6 release from mouse monocyte-macrophages seeded onto the fibres following stimulation by Escherichia coli-derived lipopolysaccharide. 6. The in vivo wound healing capability of the curcumin loaded PCL nanofibres was demonstrated by an increased rate of wound closure in a streptozotocin-induced diabetic mice model. 7. These results demonstrate that the curcumin-loaded PCL nanofibre matrix is bioactive and has potential as a wound dressing with anti-oxidant and anti-inflammatory properties.
