ERS International Congress 2022: highlights from the Respiratory Intensive Care Assembly.

Early Career Members of Assembly 2 (Respiratory Intensive Care) attended the 2022 European Respiratory Society (ERS) International Congress in Barcelona, Spain. The conference covered acute and chronic respiratory failure. Sessions of interest to our Assembly members and to those interested in respiratory critical care included the state-of-the-art session on respiratory critical care, the journal session (ERS/Lancet) on acute respiratory distress syndrome (ARDS) phenotyping into precision medicine, and sessions on specificity of coronavirus disease 2019 ARDS and its post-critical care. A symposium on treatment of acute respiratory failure in patients with COPD and innovations in mechanical ventilation either in the intensive care unit or at home were also reported upon. These sessions are summarised in this article.

Wikipedia in Vascular Surgery Medical Education: Comparative Study.

BACKGROUND: Medical students commonly refer to Wikipedia as their preferred online resource for medical information. The quality and readability of articles about common vascular disorders on Wikipedia has not been evaluated or compared against a standard textbook of surgery. OBJECTIVE: The aims of this study were to (1) compare the quality of Wikipedia articles to that of equivalent chapters in a standard undergraduate medical textbook of surgery, (2) identify any errors of omission in either resource, and (3) compare the readability of both resources using validated ease-of-reading and grade-level tools. METHODS: Using the Medical Council of Canada Objectives for the Qualifying Examination, 8 fundamental topics of vascular surgery were chosen. The articles were found on Wikipedia using Wikipedia's native search engine. The equivalent chapters were identified in Schwartz Principles of Surgery (ninth edition). Medical learners (n=2) assessed each of the texts on their original platforms to independently evaluate readability, quality, and errors of omission. Readability was evaluated with Flesch Reading Ease scores and 5 grade-level scores (Flesch-Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook Index, and Automated Readability Index), quality was evaluated using the DISCERN instrument, and errors of omission were evaluated using a standardized scoring system that was designed by the authors. RESULTS: Flesch Reading Ease scores suggested that Wikipedia (mean 30.5; SD 8.4) was significantly easier to read (P=.03) than Schwartz (mean 20.2; SD 9.0). The mean grade level (calculated using all grade-level indices) of the Wikipedia articles (mean 14.2; SD 1.3) was significantly different (P=.02) than the mean grade level of Schwartz (mean 15.9; SD 1.4). The quality of the text was also assessed using the DISCERN instrument and suggested that Schwartz (mean 71.4; SD 3.1) had a significantly higher quality (P=.002) compared to that of Wikipedia (mean 52.9; SD 11.4). Finally, the Wikipedia error of omission rate (mean 12.5; SD 6.8) was higher than that of Schwartz (mean 21.3; SD 1.9) indicating that there were significantly fewer errors of omission in the surgical textbook (P=.008). CONCLUSIONS: Online resources are increasingly easier to access but can vary in quality. Based on this comparison, the authors of this study recommend the use of vascular surgery textbooks as a primary source of learning material because the information within is more consistent in quality and has fewer errors of omission. Wikipedia can be a useful resource for quick reference, particularly because of its ease of reading, but its vascular surgery articles require further development.

Dose-Response Curves for Intrathecal Bupivacaine, Levobupivacaine, and Ropivacaine Given for Labor Analgesia in Nulliparous Women.

BACKGROUND AND OBJECTIVES: Bupivacaine, levobupivacaine, and ropivacaine are often given intrathecally for labor analgesia, but limited data are available for their dose-response properties in this context. The objective of this study was to describe the dose-response curves of these local anesthetics when given intrathecally for labor analgesia, to determine values for D50 (dose producing a 50% response) and to compare the calculated values of D50 for levobupivacaine and ropivacaine with those for bupivacaine. METHODS: With ethics approval and written consent, we randomized 270 nulliparous laboring patients requesting neuraxial analgesia at 5-cm cervical dilation or less to receive a single dose of intrathecal local anesthetic without opioid as part of a combined spinal-epidural technique. Patients received either bupivacaine, levobupivacaine, or ropivacaine at a dose of 0.625, 1.0, 1.5, 2.5, 4.0, or 6.25 mg (n = 15 per group). Visual analog scale pain scores were measured for 15 minutes, after which further analgesia and management were at the clinician's discretion. The primary end point was percentage reduction of pain score at 15 minutes. Logistic sigmoidal dose-response curves were fitted to the data using nonlinear regression, and D50 values were calculated for each drug. RESULTS: Data were analyzed from 270 patients. Patient characteristics were similar between groups. The calculated D50 and 95% confidence interval values were as follows: bupivacaine, 1.56 mg (1.25-1.94 mg); ropivacaine, 1.95 mg (1.57-2.43 mg); and levobupivacaine, 2.20 mg (1.76-2.73 mg). CONCLUSIONS: The results of this study support previous work showing that intrathecal levobupivacaine and ropivacaine are less potent than bupivacaine. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (identifier: ChiCTR-TRC-09000773) and Centre of Clinical Trials Clinical Registry of the Chinese University of Hong Kong (identifier: CUHK_CCT00245).

Efficacy of a novel sanitizer composed of lactic acid and peroxyacetic acid against single strains of nonpathogenic Escherichia coli K-12, Listeria innocua, and Lactobacillus plantarum in aqueous solution and on surfaces of romaine lettuce and spinach.

A novel sanitizer composed of lactic acid and peroxyacetic acid (LA-PAA) was developed as an alternative to chlorinated water (CW) for fresh produce processing. Single strains of Lactobacillus plantarum, nonpathogenic Escherichia coli K-12, and Listeria innocua were used to demonstrate the microbial efficacy of LA-PAA. LA-PAA achieved a >7.8-log reduction of L. innocua and L. plantarum suspended in water at 4°C for 20 s, and LA, PAA, and CW achieved reductions of 0.4, 4.8, and 2.7 log, respectively. LA-PAA, when compared with LA, PAA, and CW, enhanced the reduction of L. innocua attached to romaine leaves by >2.2 log, and improved the removal of E. coli attached to spinach leaves by >2.4 log. The exponential improvement in the microbial efficacy of LA-PAA showed synergism between LA and PAA. LA-PAA microbial efficacy was inversely proportional to pH value and directly correlated with residence time and concentration. Despite an improvement in microbial reduction through the addition of surfactant to LA-PAA, the usage of surfactant in washing fresh produce was impeded by excessive foaming during actual processing. Effects of organic matter on the performance of LA-PAA were minimal. External sensory evaluations showed that LA-PAA had no negative effects on the quality of lettuce and tender leaves. Temperature-abuse studies demonstrated that LA-PAA reduced decay by ∼50% when compared with CW. Overall, these results support the premise that LA-PAA has significant potential to be an alternative to CW for fresh produce processing.