Bjerrumsvenningsen4463

Direct admission refers to admitting a patient to a unit avoiding usual entry points such as the emergency department. Inappropriate placement of direct admissions can result in rapid response activations, codes and unanticipated pediatric intensive care unit (PICU) transfers, which correlate with higher mortality and longer lengths of stay. The objective of the project was to improve the safety of the direct admission process as evidenced by decreasing the transfer of direct admission patients to the PICU within 6 hours.

Utilizing the model for improvement, a multidisciplinary team was assembled to improve our screening process and reduce unanticipated direct admission-to-PICU transfers within 6 hours of arrival. Our emergency department-based direct admission process includes screening vital signs (temperature, heart rate, respiratory rate, blood pressure, and pulse oximetry) and a Pediatric Early Warning Score. Five Plan-Do-Study-Act cycles focused on role definition, improved documentation, referring the rate of unanticipated transfer to a higher level of care.

By utilizing QI methodology our team was able to implement and sustain a direct admission process that was more consistent, easier to document and improved the safety of our patients. Our study demonstrates that screening direct admissions reliably and consistently can decrease the rate of unanticipated transfer to a higher level of care.

The electroencephalogram (EEG) may be useful for monitoring anesthetic depth and avoiding overdose. We aimed to characterize EEG-recorded brain oscillations during increasing depth of anesthesia in a real-life surgical scenario. We hypothesized that alpha power and coherency will diminish as propofol dose increases between loss of consciousness (LOC) and an EEG burst suppression (BS) pattern.

This nonrandomized dose-response clinical trial with concurrent control included EEG monitoring in 16 patients receiving slowly increasing doses of propofol. We assessed 3 intraoperative EEG segments (LOC, middle-dose, and BS) with spectral analysis.

Alpha band power diminished with each step increase in propofol dose. click here Average alpha power and average delta power during the BS step (-1.4±3.8 and 6.2±3.1 dB, respectively) were significantly lower than during the LOC step (2.8±2.6; P=0.004 and 10.1±5.2 dB; P=0.03, respectively). Peak alpha power was significantly higher during the LOC (5.4±2.6 dB) compared with middle-dose (2.6±3.6; P=0.04) and BS (0.7±3.2; P=0.0002) steps. In addition, as propofol dose increased, alpha band coherence between the F7 and F8 electrodes decreased, whereas delta band coherence exhibited a biphasic response (initial increase between LOC and middle-dose steps and decrease between middle-dose and BS steps).

We report compelling data regarding EEG patterns associated with increases in propofol dose. This information may more accurately define "therapeutic windows" for anesthesia and provide insights into brain dynamics that are sequentially affected by increased anesthetic doses.

We report compelling data regarding EEG patterns associated with increases in propofol dose. This information may more accurately define "therapeutic windows" for anesthesia and provide insights into brain dynamics that are sequentially affected by increased anesthetic doses.Dexmedetomidine (DEX), an α2-adrenergic agonist, has been widely used for anesthesia, pain control, and intensive care unit sedation. Besides sleep-like sedation, DEX has many other beneficial effects, such as anti-inflammation, antioxidation, and anticell death. Subarachnoid hemorrhage (SAH), a severe and potentially fatal form of stroke, is a complex disease that is divided into 2 phases early brain injury and delayed cerebral ischemia. In each phase, several pathologic changes are involved, including disturbed intracranial homeostasis, metabolic failure, blood-brain barrier damage, vasospasm, microthrombosis, and cortical spreading depolarization. DEX has been shown to have an effect on these SAH-related pathologic processes. Research shows that DEX could serve as a protective therapy for patients with SAH due to its ability to maintain stable intracerebral homeostasis, balance coagulation-fibrinolysis, repair a damaged blood-brain barrier as well as prevent vasospasm and suppress cortical spreading depolarization by anti-inflammatory, antioxidative, antiapoptotic, and vasoconstriction-dilation effects. In this scoping review, we critically assess the existing data on the potential protective effect of DEX after SAH. So far, only 1 retrospective clinical trial assessing the effect of DEX on clinical outcomes after SAH has been performed. Hence, more trials are still needed as well as translational research bringing results from bench to bedside.

During awake craniotomy, securing the patient's airway might be necessary electively or emergently. The objective of this study was to compare the feasibility of airway management using a laryngeal mask airway (LMA) and 4 alternative airway management techniques in an awake craniotomy simulation.

After completing a questionnaire, 9 anesthesia providers attempted airway management in a cadaver positioned to simulate awake craniotomy conditions. Following the simulation, participants rated and ranked the devices in their order of preference.

Only 3 approaches resulted in the successful securement of an airway device for 100% of participants LMA (median; interquartile range time to secure the airway 6 s, 5 to 10 s), fiberoptic bronchoscopy through an LMA (41 s; 23 to 51 s), and video laryngoscopy (49 s; 43 to 127 s). In contrast, the oral and nasal fiberoptic approaches demonstrated only 44.4% (154.5 s; 134.25 to 182 s) and 55.6% (75 s; 50 to 117 s) success rates, respectively. The LMA was the fastest and LMA should be attempted before removing it for alternative techniques.

Stroboscopic training has repeatedly been shown to improve visuomotor abilities. However, although performance improvements were attributed to visual processes, information on the neurophysiological mechanisms is missing. Part 2 of this study investigated the effects of stroboscopic training on neural visual and motor functions and its contribution to training-induced changes in visuomotor reaction time.

45 young elite badminton athletes participated in this study, of which 32 (13.7 years) were included in the final data analysis. Participants were assigned to an intervention (stroboscopic vision) or control group (normal vision). Prior to and after a 10-week training and following a 6-week retention period, participants performed visual perception and reaction tasks in response to visual motion stimuli. The N2 and N2-r motion onset visual evoked potentials, its linear combination (Vlc) and the BA6 negativity potential were determined using a 64-channel EEG.

A significant Time × Group effect was observed processing while motor processes seemed to be unaffected. Stroboscopic training may be promising to specifically address the visual system in visuomotor demanding sports.

Recent research suggests that stroboscopic training is an effective tool to improve visual and visuomotor performance. However, many studies were limited by small samples, short training interventions, inexperienced athletes, and an exclusive focus on short-term effects. This first part of the study evaluates the short- and long-term effects of stroboscopic training on visuomotor reaction speed in elite athletes.

45 young elite badminton athletes participated in this study, of which 32 (13.7 years) were included in the final data analysis. Participants were assigned to an intervention (stroboscopic vision) or control group (normal vision). Both groups performed identical badminton-specific training drills implemented into the regular training schedule. Prior to and after a 10-week training period and after a 6-week retention interval, athletes performed a laboratory reaction test to determine EMG onset and visuomotor reaction time (VMRT). In addition, a field test investigated stroboscopic training effecte badminton players. Stroboscopic eyewear may be an effective training tool to accelerate visuomotor reactions in highly skilled athletes.

Adults with obesity are at an increased risk of incident hypertension. Regular aerobic exercise is recommended for the prevention and treatment of hypertension, but whether young adults with obesity exhibit impaired post-exercise blood pressure (BP) and vascular responses remains unclear.

We tested the hypothesis that young adults with obesity exhibit attenuated post-exercise hypotension (PEH) and post-exercise peripheral vasodilation compared with young adults without obesity.

Thirty-six normotensive adults without and with obesity (11 males and 7 females per group) underwent measurements of brachial and central BP, and leg blood flow (Doppler ultrasound) at baseline, and 30-min, 60-min, and 90-min following acute one-hour moderate-intensity cycling. Leg vascular conductance (LVC) was calculated as flow/mean arterial pressure (MAP).

Both groups exhibited similar brachial and central PEH (peak change from baseline -2 mm Hg and -4 mm Hg for brachial and central systolic BPs, respectively, for both grouions in the peripheral vasculature following exercise.

Pulmonary artery hypertension (PAH) imposes right heart and lung detrimental remodeling which impairs cardiac contractility, physical effort tolerance, and survival. The effects of an early moderate-intensity continuous aerobic exercise training on the right ventricle and lung structure, and on contractility and the calcium (Ca2+) transient in isolated myocytes from rats with severe PAH induced by monocrotaline were analyzed. link2 Rats were divided into control sedentary (CS), control exercise (CE), monocrotaline sedentary (MS), and monocrotaline exercise (ME) groups. Animals from control exercise and ME groups underwent a moderate-intensity aerobic exercise on a treadmill (60 min/d; 60% intensity) for 32 days, after a monocrotaline (60 mg/kg body weight i.p.) or saline injection. The pulmonary artery resistance was higher in MS than in control sedentary (1.36-fold) and was reduced by 39.39% in ME compared with MS. Compared with MS, the ME group presented reduced alveolus (17%) and blood vessel (46%) wall, fibro and intracellular Ca2+ transient [ie, decreased times to peak (16.06%) and to 50% decay (7.41%)] compared with MS. Thus, early moderate-intensity continuous aerobic exercise prevents detrimental remodeling in the right heart and lung increases in the pulmonary artery resistance and dysfunction in single myocyte contraction and Ca2+ cycling in this model.

Non-vitamin K antagonist oral anticoagulants (NOACs) are a widely prescribed treatment to prevent stroke in patients with nonvalvular atrial fibrillation, and a therapy and preventative measure to prevent recurrences following venous thromboembolism. Optimal use of NOACs requires a thorough knowledge of the pharmacology of these drugs, as well as an understanding of patient factors affecting their use. The 4 NOACs-dabigatran, apixaban, edoxaban, and rivaroxaban are available in a range of doses suitable for differing indications and with a variety of dose reduction criteria. Identification of the correct dose is one of the key challenges in the individualization of treatment. Elderly patients with atrial fibrillation are at a greater risk of both ischemic and bleeding events than younger patients. link3 Consequently, it is essential to achieve balance in anticoagulation strategies. Medication adherence to NOACs is important for safe and effective treatment, particularly in elderly populations. A growing body of evidence shows that once-daily dosing improves adherence and persistence to therapy, without having an impact on bleeding risk.