Optimizing Pediatric Mask Induction Fresh Gas Flow.

INTRODUCTION: The environmental impact of inhaled anesthetics is a subject of increasing research. However, little attention has been paid to optimizing high-concentration volatile anesthetics during the inhalational (mask) inductions that begin most pediatric anesthetics. METHODS: The performance of the GE Datex Ohmeda TEC 7 sevoflurane vaporizer was analyzed at different fresh gas flow (FGF) rates and two clinically relevant ambient temperatures. We found that an FGF rate of 5 liters per minute (LPM) is likely optimal for inhalational inductions, rapidly achieving dialed sevoflurane concentrations at the elbow of an unprimed pediatric breathing circuit while minimizing waste associated with higher FGF rates. We began educating our department regarding these findings, first with QR code labels on anesthetic workstations, then with targeted e-mails to pediatric anesthesia teams. We analyzed peak induction FGF in 100 consecutive mask inductions at our ambulatory surgery center at three different periods - baseline, post-labels, and post-emails - to assess the efficacy of these educational interventions. We also analyzed the time from induction to the start of myringotomy tube placement in a subset of these cases to determine if reducing mask induction FGF was associated with any change in the speed of induction. RESULTS: Our institution's median peak FGF during inhalational inductions decreased from 9.2 LPM at baseline to 8.0 LPM after labels were placed on anesthetic workstations to 4.9 LPM after targeted e-mails. There was no associated decrease in the speed of induction. CONCLUSION: Total fresh gas flow can be limited to 5 LPM during pediatric inhalational inductions, decreasing anesthetic waste and environmental impact without slowing the speed of induction. Educational labels on anesthetic workstations and direct e-mails to clinicians were effectively used in our department to enact change in this practice.

Effects of wearing fixed orthodontic appliance on dynamic balance, reaction time, and pain perception in adolescents and young adult elite athletes.

OBJECTIVE: To investigate the effects of using fixed orthodontic appliance on dynamic balance, auditory/visual reaction times, as well as pain perception in adolescent and young adult elite athletes. METHODS: A total of 34 elite athletes (n = 19 males) aged 16-21 years from different sports (track and field sprint, long jump and discus throw) were randomly allocated to treatment (n = 17) or control (n = 17) groups. The treatment group received self-ligating brackets with 0.04 cm super-elastic nickel-titanium arch wire, placed in the brackets to correct the teeth position. Perceived pain (i.e., visual analogue scale), dynamic balance (i.e., Y balance test), and auditory reaction time and visual reaction time using Direct RT software were assessed before (day-1), and on five occasions after fixed orthodontic appliance placement (day+1, +3, +7, +14, and +30). The two groups' quantitative data [expressed as mean (standard deviation)] for each occasion were compared using the Student's t-test. Comparisons of the Y-balance test, auditory reaction time, visual reaction time, and pain visual analogue scale data were each made between the 6 occasions via a factorial A × B analysis of variance in order to check for the possible interaction between the two groups and the (6) consecutive days (occasions). RESULTS: Compared to the control group, the treatment group showed significantly (i) lower values of anterior reach for both the dominant ([78(4) vs. 75(3)%, respectively]) and the non-dominant [76(3) vs. 74(4)%, respectively] legs at day+3, and (ii) higher values of pain visual analogue scale at day+1, day+3, and day+7 [0.00(0.00) vs. 4.94(1.25); 0.00(0.00) vs. 4.12(1.17), and 0.00(0.00) vs. 0.41(0.51), respectively). Factorial analysis of variance revealed that only pain visual analogue scale values were different between the two groups at day+1 and day+3. CONCLUSION: FOA induced a high pain level during the first week following its placement in elite athletes.

What should a family physician know about nutrition and physical exercise rehabilitation' advices to communicate to 'long-term COVID-19' patients?

In real practice, there is a paradox in the management of patients with 'long-term Covid-19.' Indeed, Family physicians (FPs) are on the front line in the management process of these patients. For 'long-term Covid-19' patients, and according to the World Health Organization guideline, the cardiopulmonary rehabilitation (CPR) should be provided not only at tertiary- or secondary care but mainly at primary care with a real implication of FPs. However, specific guidelines/recommendations were addressed for FPs. Therefore, an alternative including the CPR minimal advice that an FP should provide to 'long-term Covid-19' patients, seems to be necessary to respond to the needs of FPs to face their involvement with 'long-term Covid-19' patients. Thus, this paper aimed to report the CPR 'minimal advice' that should be provided by FPs managing 'long-term Covid-19' patients with incapacity (i.e.; alteration of the cardiorespiratory and muscular chain). According to the authors, FPs should be more cautious in the prescription of exercise and nutrition program and informed about the minimal advices related to nutritional and physical exercise rehabilitation guidelines when taking care of 'long-term Covid-19' patients, and how these guidelines can relieve the mental and physical problems, improve immunity, and accelerate the recovery process of the patients. With the occurrence of new variants of the severe acute respiratory syndrome coronavirus 2, the nutritional and exercise rehabilitation guidelines implemented by FPs become indispensable to promote the recovery of Covid-19 patients and support a return to normal life.

Referral Rates Vary Widely Between Family Medicine Practices.

INTRODUCTION: Referral rates and patterns to specialists by family physicians have a significant impact on numerous aspects of medical care, including the quality and cost of care provided. The aim of this study was to examine the referral rate and pattern of family physician practices associated with a large academic health center. METHODS: We conducted a retrospective chart review of referrals for patients seen in the family medicine clinics associated with a large academic institution. Basic demographic information was collected. The primary outcome was the monthly referral rate, measured as the proportion of patient visits that resulted in a consult to a specialist outside of the referring family medicine clinic. Binomial and γ generalized linear mixed models were fit to determine the associations between high/medium/low referral rate clinics and patient demographics. RESULTS: The average monthly referral rate for all of the clinics was 20.3%, and the rate varied significantly between clinic groups. Patient gender, race, and being in a committed relationship were noted to be associated with lower referral rate. DISCUSSION: Referral rates among family physician practices differ widely and are associated with gender, race, and relationship status of patients. Referrals to several specific specialties are common among family physicians.