Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Masentuneen asiakkaan ohjaus työterveyshuollossa: opetusvideo terveydenhoitajaopiskelijoille

Noin 5–7 % suomalaisista aikuisista kärsii masennuksesta vuosittain. Masennus aiheuttaa elämänlaadun heikkenemistä ja vaikuttaa yksilön työ- ja toimintakykyyn. Työkyvyttömyyseläkkeelle jäämiset ovat lisääntyneet ja nämä näkyvät tuottavuuden heikentymisenä sekä lisääntyneinä poissaoloina työpaikalla. Sairauspäivärahamenot aiheuttavat yhteiskunnalle koko ajan kasvavia kustannuksia. Kuitenkin masennuksesta kärsivistä vain vähemmistö hakee sairauteensa aktiivisesti hoitoa. Tästä syystä työterveyshuolto ja työterveyshoitaja ovat tärkeässä roolissa masennusoireiden varhaisessa tunnistamisessa. Tämä opinnäytetyö on kehittämistyönä tehty opetusvideo sairaanhoitaja- ja terveydenhoitajaopiskelijoille. Video on tuotettu Savonia-ammattikorkeakoululle opetusmateriaaliksi, jota se voi käyttää opetuksessaan demonstroidakseen työterveydenhoitajan kompetensseja. Tämä video sisältää työkaluja, joilla masennusta voidaan seuloa sekä lisäksi ohjataan niiden käyttöä. Tässä opinnäytetyössä esitellään, kuinka työterveyshoitaja voi antaa ohjausta mielenterveyden edistämiseen elintapamuutoksilla. Opetusvideon tarkoituksena on lisätä tietoisuutta mielenterveyden häiriöistä ja siitä, kuinka antaa asianmukaista ohjausta työterveyshuollon vastaanotolla. Opetusvideo on esitetty kahden mielenterveys- ja päihdehoitotyön perusopetusjakson kurssilaisille. Palautteet videosta kerättiin heti videon esittämisen jälkeen Webropol-kyselyn avulla. Tämän myötä palautteet säilyivät anonyymeina ja totuudenmukaisina. Suurin osa opiskelijoista oli sitä mieltä, että opetusvideo antoi heille jotain uutta tietoa siitä, kuinka antaa asiakkaalle ohjausta masennusoireisiin. Jotkut kokivat videon myötä saaneensa enemmän varmuutta esittää asiakkaalle kysymyksen itsemurha-aikeista

Vibrotactile mapping of the upper extremity : absolute perceived intensity is location-dependent ; perception of relative changes is not

Vibrotactile sensation is an essential part of the sense of touch. In this study, the localized vibrotactile sensation of the arm-shoulder region was quantified in 10 able-bodied subjects. For this analysis, the six relevant dermatomes (C3-T2) and three segments—the lower arm, the upper arm, and the shoulder region were studied. For psychometric evaluation, tasks resulting in the quantification of sensation threshold, just noticeable difference, Weber fraction, and perception of dynamically changing vibrotactile stimuli were performed. We found that healthy subjects could reliably detect vibration in all tested regions at low amplitude (2–6% of the maximal amplitude of commonly used vibrotactors). The detection threshold was significantly lower in the lower arm than that in the shoulder, as well as ventral in comparison with the dorsal. There were no significant differences in Weber fraction (20%) detectable between the studied locations. A compensatory tracking task resulted in a significantly higher average rectified error in the shoulder than that in the upper arm, while delay and correlation coefficient showed no difference between the regions. Here, we presented a conclusive map of the vibrotactile sense of the healthy upper limb. These data give an overview of the sensory bandwidth that can be achieved with vibrotactile stimulation at the arm and may help in the design of vibrotactile feedback interfaces (displays) for the hand/arm/shoulder-region.PeerReviewe

ASIP and TYR pigmentation variants associate with cutaneous melanoma and basal cell carcinoma.

Contains fulltext : 69041.pdf (publisher's version ) (Closed access)Fair color increases risk of cutaneous melanoma (CM) and basal cell carcinoma (BCC). Recent genome-wide association studies have identified variants affecting hair, eye and skin pigmentation in Europeans. Here, we assess the effect of these variants on risk of CM and BCC in European populations comprising 2,121 individuals with CM, 2,163 individuals with BCC and over 40,000 controls. A haplotype near ASIP, known to affect a similar spectrum of pigmentation traits as MC1R variants, conferred significant risk of CM (odds ratio (OR) = 1.45, P = 1.2 x 10(-9)) and BCC (OR = 1.33, P = 1.2 x 10(-6)). The variant in TYR encoding the R402Q amino acid substitution, previously shown to affect eye color and tanning response, conferred risk of CM (OR = 1.21, P = 2.8 x 10(-7)) and BCC (OR = 1.14, P = 6.1 x 10(-4)). An eye color variant in TYRP1 was associated with risk of CM (OR = 1.15, P = 4.6 x 10(-4)). The association of all three variants is robust with respect to adjustment for the effect of pigmentation

Intraoperative ventilator settings and their association with postoperative pulmonary complications in neurosurgical patients: post-hoc analysis of LAS VEGAS study

Background: Limited information is available regarding intraoperative ventilator settings and the incidence of postoperative pulmonary complications (PPCs) in patients undergoing neurosurgical procedures. The aim of this post-hoc analysis of the 'Multicentre Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study was to examine the ventilator settings of patients undergoing neurosurgical procedures, and to explore the association between perioperative variables and the development of PPCs in neurosurgical patients. Methods: Post-hoc analysis of LAS VEGAS study, restricted to patients undergoing neurosurgery. Patients were stratified into groups based on the type of surgery (brain and spine), the occurrence of PPCs and the assess respiratory risk in surgical patients in Catalonia (ARISCAT) score risk for PPCs. Results: Seven hundred eighty-four patients were included in the analysis; 408 patients (52%) underwent spine surgery and 376 patients (48%) brain surgery. Median tidal volume (VT) was 8 ml [Interquartile Range, IQR = 7.3-9] per predicted body weight; median positive end-expiratory pressure (PEEP) was 5 [3 to 5] cmH20. Planned recruitment manoeuvres were used in the 6.9% of patients. No differences in ventilator settings were found among the sub-groups. PPCs occurred in 81 patients (10.3%). Duration of anaesthesia (odds ratio, 1.295 [95% confidence interval 1.067 to 1.572]; p = 0.009) and higher age for the brain group (odds ratio, 0.000 [0.000 to 0.189]; p = 0.031), but not intraoperative ventilator settings were independently associated with development of PPCs. Conclusions: Neurosurgical patients are ventilated with low VT and low PEEP, while recruitment manoeuvres are seldom applied. Intraoperative ventilator settings are not associated with PPCs

Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications

Background: The aim of this post hoc analysis of a large cohort study was to evaluate the association between night-time surgery and the occurrence of intraoperative adverse events (AEs) and postoperative pulmonary complications (PPCs). Methods: LAS VEGAS (Local Assessment of Ventilatory Management During General Anesthesia for Surgery) was a prospective international 1-week study that enrolled adult patients undergoing surgical procedures with general anaesthesia and mechanical ventilation in 146 hospitals across 29 countries. Surgeries were defined as occurring during 'daytime' when induction of anaesthesia was between 8: 00 AM and 7: 59 PM, and as 'night-time' when induction was between 8: 00 PM and 7: 59 AM. Results: Of 9861 included patients, 555 (5.6%) underwent surgery during night-time. The proportion of patients who developed intraoperative AEs was higher during night-time surgery in unmatched (43.6% vs 34.1%; P<0.001) and propensity-matched analyses (43.7% vs 36.8%; P = 0.029). PPCs also occurred more often in patients who underwent night-time surgery (14% vs 10%; P = 0.004) in an unmatched cohort analysis, although not in a propensity-matched analysis (13.8% vs 11.8%; P = 0.39). In a multivariable regression model, including patient characteristics and types of surgery and anaesthesia, night-time surgery was independently associated with a higher incidence of intraoperative AEs (odds ratio: 1.44; 95% confidence interval: 1.09-1.90; P = 0.01), but not with a higher incidence of PPCs (odds ratio: 1.32; 95% confidence interval: 0.89-1.90; P = 0.15). Conclusions: Intraoperative adverse events and postoperative pulmonary complications occurred more often in patients undergoing night-time surgery. Imbalances in patients' clinical characteristics, types of surgery, and intraoperative management at night-time partially explained the higher incidence of postoperative pulmonary complications, but not the higher incidence of adverse events