70 research outputs found

    Errors and clinical supervision of intubation attempts by the inexperienced

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    Background: Tracheal intubation is an essential skill for anaesthetists and other disciplines that require emergency establishment of a secure airway. Early attempts in patients often meet with failure. Existing publications focus mainly on trainees in emergency settings and highlight the role of experience in success; most recommend prior simulation training. Common factors identified as contributing to difficulty have been difficult airways, emergencies and rapid sequence induction. Early intubation skill development in patients with anticipated straightforward airways in a controlled environment has received little attention.Objectives: This qualitative observational study aimed to identify common difficulties associated with a supervised intubation process by inexperienced personnel in the relatively stress-free conditions of elective surgical procedures in the operating theatre.Methods: Following institutional and ethical approval, participants, supervisors, anaesthetic assistants and patients consented to observation and video-recording of supervised intubations in a Durban teaching hospital. Anonymity and confidentiality were assured. Contemporaneous observations were recorded in theatre, and video-recordings were subsequently reviewed for content. Errors, and interactions between supervisor, assistant and participant, and associated outcomes, were identified.Results: Twenty participants (medical interns and medical, paramedical and nursing students) performing 72 intubations were observed. All participants had prior training using manikins or simulators. There were 61 successful intubations and 11 unsuccessful attempts. Factors associated with failure included unfamiliarity with airway, equipment or process. Process errors included inadequate head positioning, laryngoscope handling and tracheal tube manipulation. Anaesthetic assistants contributed to difficulties in some cases. Supervisor support was either verbal, physical or both. Less experienced supervisors tended to intervene earlier. There was a significant trend for success associated with the reported number of prior successful intubations. A successful intubation within the study was, however, no guarantee of subsequent success.Conclusion: Despite prior simulation training, many participants demonstrated lack of familiarity with the airway, intubation process and equipment. While improved simulation training might partly address these issues, supervision of early clinical intubation attempts needs to be redirected from the process of intubation itself to the process of intubation skills acquisition. A first step would be to ensure that all supervisors and assistants are trained for the latter goal, anticipating common errors and providing standardised conditions for success. The use of video-recording of the events is an invaluable aid to observation and interpretation, and is recommended as an adjunct to further studies of mechanical skills transfer.Keywords: clinical supervision, core clinical skills, skills assessment, skills transfer, tracheal intubation, video recordin

    The labour ward analgesic service at King Edward VIII Hospital, Durban

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    The provision of analgesic services to the labour ward at King Edward VIII Hospital was studied during a 1-week period. Of 249 patients, 113 (45%) received no analgesia whatsoever. Intramuscular pethidine was the commonest form of analgesia and was used in 97 patients (39%). Thirty-six patients (14%) received epidural analgesia and only 4 inhalational analgesia using nitrous oxide and oxygen (Entonox). A significant proportion of patients who received pethidine were given the drug between 1 and 3 hours before delivery, increasing the potential for opiate-related neonatal depression. Of the patients given opiate analgesia, 22 (23%) proceeded to caesarean section and could have been at increased risk of aspiration of gastric contents owing to delayed gastric emptying caused by the opiate. One hundred and eleven mothers (76%) who had an obstetric indication for epidural analgesia were denied it because of lack of medical staffing

    Measurement of the azimuthal anisotropy of Y(1S) and Y(2S) mesons in PbPb collisions at √S^{S}NN = 5.02 TeV

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    The second-order Fourier coefficients (υ2_{2}) characterizing the azimuthal distributions of Υ(1S) and Υ(2S) mesons produced in PbPb collisions at sNN\sqrt{s_{NN}} = 5.02 TeV are studied. The Υmesons are reconstructed in their dimuon decay channel, as measured by the CMS detector. The collected data set corresponds to an integrated luminosity of 1.7 nb1^{-1}. The scalar product method is used to extract the υ2_{2} coefficients of the azimuthal distributions. Results are reported for the rapidity range |y| < 2.4, in the transverse momentum interval 0 < pT_{T} < 50 GeV/c, and in three centrality ranges of 10–30%, 30–50% and 50–90%. In contrast to the J/ψ mesons, the measured υ2_{2} values for the Υ mesons are found to be consistent with zero

    Measurement of prompt D0^{0} and D\overline{D}0^{0} meson azimuthal anisotropy and search for strong electric fields in PbPb collisions at root SNN\sqrt{S_{NN}} = 5.02 TeV

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    The strong Coulomb field created in ultrarelativistic heavy ion collisions is expected to produce a rapiditydependent difference (Av2) in the second Fourier coefficient of the azimuthal distribution (elliptic flow, v2) between D0 (uc) and D0 (uc) mesons. Motivated by the search for evidence of this field, the CMS detector at the LHC is used to perform the first measurement of Av2. The rapidity-averaged value is found to be (Av2) = 0.001 ? 0.001 (stat)? 0.003 (syst) in PbPb collisions at ?sNN = 5.02 TeV. In addition, the influence of the collision geometry is explored by measuring the D0 and D0mesons v2 and triangular flow coefficient (v3) as functions of rapidity, transverse momentum (pT), and event centrality (a measure of the overlap of the two Pb nuclei). A clear centrality dependence of prompt D0 meson v2 values is observed, while the v3 is largely independent of centrality. These trends are consistent with expectations of flow driven by the initial-state geometry. ? 2021 The Author. Published by Elsevier B.V. This is an open access article under the CC BY licens

    Studies of charm and beauty hadron long-range correlations in pp and pPb collisions at LHC energies

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    Measurement of the Y(1S) pair production cross section and search for resonances decaying to Y(1S)μ⁺μ⁻ in proton-proton collisions at √s = 13 TeV

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    The fiducial cross section for Y(1S)pair production in proton-proton collisions at a center-of-mass energy of 13TeVin the region where both Y(1S)mesons have an absolute rapidity below 2.0 is measured to be 79 ± 11 (stat) ±6 (syst) ±3 (B)pbassuming the mesons are produced unpolarized. The last uncertainty corresponds to the uncertainty in the Y(1S)meson dimuon branching fraction. The measurement is performed in the final state with four muons using proton-proton collision data collected in 2016 by the CMS experiment at the LHC, corresponding to an integrated luminosity of 35.9fb1^{-1}. This process serves as a standard model reference in a search for narrow resonances decaying to Y(1S)μ+^{+}μ^{-} in the same final state. Such a resonance could indicate the existence of a tetraquark that is a bound state of two bquarks and two b̅ antiquarks. The tetraquark search is performed for masses in the vicinity of four times the bottom quark mass, between 17.5 and 19.5GeV, while a generic search for other resonances is performed for masses between 16.5 and 27GeV. No significant excess of events compatible with a narrow resonance is observed in the data. Limits on the production cross section times branching fraction to four muons via an intermediate Y(1S)resonance are set as a function of the resonance mass

    Measurement of the CP-violating phase ϕs_{s} in the B0^{0}s_{s}→J/ψ φ(1020) →μ⁺μ⁻K⁺K⁻ channel in proton-proton collisions at √s = 13 TeV

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    Measurement of nuclear modification factors of Υ(1S), Υ(2S), and Υ(3S) mesons in PbPb collisions at √sNN = 5.02 TeV

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    Production of Λ⁺c_{c} baryons in proton-proton and lead-lead collisions at √S^{S}NN = 5.02 TeV

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    Observation of electroweak production of Wγ with two jets in proton-proton collisions at √s = 13 TeV

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    A first observation is presented for the electroweak production of a W boson, a photon, and two jets in proton-proton collisions. The W boson decays are selected by requiring one identified electron or muon and an imbalance in transverse momentum. The two jets are required to have a high dijet mass and a large separation in pseudorapidity. The measurement is based on data collected with the CMS detector at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 35.9 fb1^{-1}. The observed (expected) significance for this process is 4.9 (4.6) standard deviations. After combining with previously reported CMS results at 8 TeV, the observed (expected) significance is 5.3 (4.8) standard deviations. The cross section for the electroweak Wγjj_{γjj} production in a restricted fiducial region is measured as 20.4 +/- 4.5 fb and the total cross section for Wγ_{γ} production in association with 2 jets in the same fiducial region is 108 +/- 16 fb. All results are in good agreement with recent theoretical predictions. Constraints are placed on anomalous quartic gauge couplings in terms of dimension-8 effective field theory operators
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