Clinician Monitoring.

Since the first public demonstration of general anesthesia in 1846, anesthesiology has seen major advancements as a specialty. These include both important technological improvements and the development and implementation of internationally accepted patient safety standards. Together, these ultimately resulted in the recognition of anesthesiology as the leading medical specialty advocating for patient safety. Modern-day anesthesiology faces a new challenge of automated anesthesia delivery. Despite evidence for a more refined and precise delivery of anesthesia through this platform, there is currently no substitute for the presence of an appropriately trained anesthesia clinician to manage the complex interplay of human factors and patient safety in the perioperative setting.

Explanation of health requirements and surveillance specifications for radiation worker / 中华放射医学与防护杂志

Chinese National Standards GBZ 98-2020 Health Requirements and Surveillance Specifications for Radiation Worker was published and will replace the current standards GBZ 98-2017 Health Requirements for Radiation Workers and GBZ 235-2011 Specifications for Occupational Health Surveillance for Radiation Workers from May 1 in 2021. The significance of this new National Standards, the background, basic principles, basis of revision of important indicators and the matters needing attention in the application of the standard are described in detail, especially for the medical institutions carrying out occupational health examination requirements, the determination of occupational health examination items, examination method and examination reports, so as to avoid the possible misunderstandings and doubts in using the standards.

Transcutaneous CO2 versus end-tidal CO2 in neonates and infants undergoing surgery: a prospective study.

Aim: End-tidal CO2 (EtCO2) is the standard in operative care along with pulse oximetry for ventilation assessment. It is known to be less accurate in the infant population than in adults. Many neonatal intensive care units (NICU) have converted to utilizing transcutaneous CO2 (tcPCO2) monitoring. This study aimed to compare perioperative EtCO2 to tcPCO2 in the pediatric perioperative population specifically below 10 kg, which encompasses neonates and some infants. Methods: After IRB approval and parental written informed consent, we enrolled neonates and infants weighing less than 10 kg, who were scheduled for elective surgery with endotracheal tube under general anesthesia. PCO2 was monitored with EtCO2 and with tcPCO2. Venous blood gas (PvCO2) samples were drawn at the end of the anesthetic. We calculated a mean difference of EtCO2 minus PvCO2 (Delta EtCO2), and tcPCO2 minus PvCO2 (Delta tcPCO2) from end-of-case measurements. The mean differences in the NICU and non-NICU patients were compared by t-tests and Bland-Altman analysis. Results: Median age was 10.9 weeks, and median weight was 4.4 kg. NICU (n=6) and non-NICU (n=14) patients did not differ in PvCO2. Relative to the PvCO2, the Delta EtCO2 was much greater in the NICU compared to the non-NICU patients (-28.1 versus -9.8, t=3.912, 18 df, P=0.001). Delta tcPCO2 was close to zero in both groups. Although both measures obtained simultaneously in the same patients agreed moderately with each other (r =0.444, 18 df, P=0.05), Bland-Altman plots indicated that the mean difference (bias) in EtCO2 measurements differed significantly from zero (P<0.05). Conclusions: EtCO2 underestimates PvCO2 values in neonates and infants under general anesthesia. TcPCO2 closely approximates venous blood gas values, in both the NICU and non-NICU samples. We, therefore, conclude that tcPCO2 is a more accurate measure of operative PvCO2 in infants, especially in NICU patients.

Emergency Nurse Transport of Telemetry Patients: Benefits and Drawbacks.

PROBLEM: Emergency nurse-accompanied telemetry transport on admission to the hospital is a common practice. Potential drawbacks include inefficient use of nursing resources, unnecessary telemetry transports, and disruption of care for remaining ED patients. METHODS: This was a 2-part descriptive quality improvement study using retrospective chart review and prospective documentation of patient transports. Charts were selected by American Heart Association Practice Standards for ECG Monitoring to classify transported telemetry patients into 3 categories. Patient characteristics and adverse events were assessed. Prospectively, the length of transport time and the number and severity of patients the transport nurse left in the emergency department were also recorded. RESULTS: Zero adverse events occurred during any transport. Transport time ranged from 5 to 38 minutes, with a mean of 16.5 minutes. The normal patient ratio increased for nursing staff remaining in the emergency department for the period of the transport, with 74% of patients left in the emergency department classified into high-risk Emergency Severity Index categories 1 and 2. IMPLICATIONS FOR PRACTICE: Findings provided evidence that low-risk telemetry patients had minimal chance of adverse events during transport and highlighted added risks for the remaining emergency patients. Alternative models and interventions are needed to identify appropriate patients for telemetry transport, assign appropriate staff such as licensed paramedics for transport, and evaluate alternative models of nursing care and teamwork in the emergency department.

[Influence of anticoagulant on the plasma level of fifteen biochemical parameters]. / Influence de la nature de l'anticoagulant sur le dosage plasmatique de quinze paramètres biochimiques.

The study of the influence of the anticoagulant used in blood collection tubes to obtain plasma was performed for fifteen biochemical parameters measured with automated Cobas 6000 (Roche Diagnostics). For each parameter tested the entire measurement domain was studied. The comparison of results obtained on plasma blood sample obtained by lithium heparin and EDTA include: correlation, the limits of acceptability in the standards of monitoring and interpretation standards regression defined by the SFBC and analysis of Bland-Altman. The parameters studied were classified into three categories. The parameters for which the assay is not influenced by the nature of the anticoagulant used: apolipoprotéin A1, apolipoprotein B, alanine amino-transferase, creatine kinase, creatinine, total cholesterol, HDL-cholesterol, lipase, NT-Pro BNP, troponine T and urea. The parameters for which the results are underestimated EDTA plasma, including those for which the impact is moderate and for which the interpretive standards are not changed: triglycerides, and those for which performance standards are changed on one or more levels: aspartate aminotransferase and lactate dehydrogenase; and finally the not practicable EDTA plasma parameters: alkaline phosphatase.

Culturally appropriate measures for monitoring child development at family and community level: a WHO collaborative study.

Culturally appropriate techniques for monitoring child psychosocial development were prepared and tested in China, India and Thailand on a total of 28,139 children. This is the largest study of its kind ever undertaken. Representative groups aged between birth and 6 years were examined and the results were used to produce national development standards-separately for rural and urban children in China and India, and for all children combined in Thailand-which are considered to be more satisfactory than foreign-based standards. In each country, between 13 and 19 key milestones of psychosocial development were selected for a simplified developmental screening operation and these have been incorporated on a home-based record of a child's growth and development. Between 35 and 67 tests have been devised in each country to test the children at first-referral level.

PIP: Protocols of psychosocial development for children 0-6 years old, locally developed in order to be culturally appropriate, were applied to 8995 children from urban and rural areas from 6 provinces in Shanghai, China; fewer than 13,720 children in Chandigarh, Hyderabad, and Jabalpur states in India; and 5424 children from urban and rural areas in Thailand. The findings were intended to be used to develop national child development standards. This study was the largest multicultural study of its kind ever conducted. Cultural variation was the major reason accounting for the very wide range of differences in the age of attainment of a small number of items (e.g., use of cups). A wider variation between urban and rural living conditions in China and Thailand account for differences between urban and rural children in these countries. The tests did not assume that rural children might have an advantage in some areas (e.g., recognizing different types of grain or plant). Very high intertester reliability within centers existed. Lack of time and money prevented the researchers from checking reliability between centers. The researchers discarded two of the culturally appropriate tests initially selected in Thailand (walks on coconut shells and walks on sticks before 72 months of age) since few children could do them before age 6. Teams in all 3 countries selected appropriate test items (milestones) and incorporated them on the weight-for-age home-based record (19 in China, 13 in India and Thailand). The Chinese records present the milestones in pictorial form with red and yellow to represent high and moderate risks, respectively. The next phase of the study aims to determine whether developmental screening can be applied in the home, the community, and primary health care programs to identify developmental delays early enough to implement simple interventions to improve performance and prognosis.