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P Sefrin

Publications and source records attributed to P Sefrin.

At least 37 records · Page 2Linked to original sources
PubMed1998

A risk score to predict the probability of postoperative vomiting in adults.

BACKGROUND: The aim of this study was to identify factors most relevant for postoperative vomiting (PV) and to develop a risk score to predict the probability of PV. METHODS: Adult inpatients scheduled for elective ear, nose and throat (ENT) surgery under general anaesthesia were offered to participate in a prospective study for PV over 24 h. No prophylactic antiemetics were used. The data of 1137 patients were randomized and split into an evaluation set (n=553) and a validation set (n=584). The evaluation set was subjected to logistic regression analysis to quantify the relative impact of anaesthetic, surgical and individual factors and to develop a risk score. The score was then tested by applying it to the validation set. The area under a receiver operation characteristic (ROC) curve was calculated and the predicted and actual incidences of patients were correlated. RESULTS: In the evaluation set, patient-related factors (female gender, young age, non-smoking, history of PV or motion sickness) and a high duration of anaesthesia were independent risk factors for PV. The probability of PV could be estimated from the equation: PV=1/(1+exp(-z)) where z=1.28 (gender)-0.029 (age)-0.74 x (smoking)+0.63 x (history of PV or motion sickness)+0.26 x (duration)-0.92. In the validation set this score achieved an area under the ROC-curve of 0.78 and the actual incidence correlated strongly with the predicted risks (R2=0.93, P<0.001). CONCLUSION: The data suggest that the probability of PV following ENT surgery under inhalational anaesthesia with low-dose opioids can be predicted by a score mainly based upon patient-related risk factors.

Adult↗
PubMed1998

The discriminating power of a risk score for postoperative vomiting in adults undergoing various types of surgery.

BACKGROUND: Recently, we have demonstrated that the probability of postoperative vomiting (PV) following ENT surgery with inhalational anaesthetics can be predicted using a risk score. This score is based on gender, age, smoking status, history of motion sickness or postoperative nausea and vomiting and the duration of anaesthesia. Therefore, it is of interest whether this score is also accurate in predicting PV in patients undergoing different types of surgery. METHODS: Inpatients scheduled for bone, vascular, general or eye surgery were included in a prospective survey for PV over 24 h. Data of 1091 patients were analyzed, of which 542 were used for the validation of the previously constructed risk score (Score I). The data of the remaining 549 patients were used to evaluate the risk factors that contribute to PV in this setting and to develop a new score (Score II). The discriminating power of both scores to predict PV was tested in the validation set (n=542) and compared by calculating the area under the receiver operating characteristic (ROC) curves. RESULTS: The area under the ROC curve of Score I was 0.77 (SD 0.024). Risk factors for PV in the evaluation set were female gender, young age, history of motion sickness or postoperative nausea and vomiting and the type of surgery. The area under the curve of Score II was 0.75 (SD 0.026) and was not significantly different from Score I (P=0.57). CONCLUSION: Score I was accurate in predicting PV in patients after most types of surgery with volatile anaesthetics, which suggests that this score might be useful for other centres as well.

Adult↗
PubMed1998

[Changes in blood coagulation in treatment with hydroxyethyl starch].

The aim of the study was to investigate the influence on coagulation and platelet function of two 6% medium molecular weight hydroxyethylstarch solutions (HES, MW 200,000, DS 0.5) made of potato (K) and corn (M) starch. Twenty patients undergoing elective vertebral disc surgery were randomly assigned to one of the groups. Haemoglobin, haematocrit, protein concentration, fibrinogen, antithrombin III, factor VIII:C, von-Willebrand-factor, prothrombin time, activated partial thromboplastin time and platelet maximum aggregation and maximum gradient of aggregation (inductors: ADP, epinephrine, collagen and ristocetin) were measured before infusion and 30, 240 minutes and one day after infusion. The reduction of the prothrombin time (Quick) and antithrombin III and the decrease in fibrinogen and protein concentration, haemoglobin and haematocrit were due to haemodilution. The prolongation of the activated partial thromboplastin time (38.3 s K-group and 38.0 s M-group) and the decrease in factor VIII:C (71% K-group and 84% M-group) and von-Willebrand-factor (72% K group and 79% M group) were similar in both groups within 30 minutes of infusion of 1,000 ml HES. There was no change in platelet function within the groups. The infusion of a medium molecular weight solution is an effective and cost-saving method in volume therapy. Despite the physicochemical differences of the two HES solutions, there were no clinically apparent effects on coagulation and platelet function. Both preparations of HES up to a volume of 1,000 ml can be used equally in the clinical setting.

Adult↗
PubMed1995

[Consensus as the basis of interdisciplinary graduate education curriculum].

Especially in the field of emergency medicine, it is necessary that medical standards are developed in general agreement with all faculty members. Standards should not only be understood as a basis for quality control but also as a helpful guide for the daily routine. The necessary agreement based on scientific discoveries and practical experiences, which find their expression in the general accepted knowledge of the specialty, has to be adapted to the special situation of emergency. Taking the head injury as an example, a special treatment schedule will be developed based on an interdisciplinary consent. The resulting training documents can than be offered to groups at different levels, since the content can be handled in a modular manner. The continuing education course will be available in a set of slides and provides an extensive overview of the topic "head injury" and supports the practical application with an algorithm.

Audiovisual Aids↗
PubMed1995

[Preclinical management of the emergency by the established physician].

Within a short time, acute diseases and injuries may alter the vital functions so much that the life of the patient is endangered. Undisturbed consciousness, breathing, and circulation are the requirements for a proper organ function. The task of the first treating physician is to recognize and avert the acute threat to the patient's life and to bridge the time until qualified help arrives. The physical examination in emergency medicine has to be based on a few findings acquired at a short time. The symptoms of the acute threat can be divided in dysfunctions of breathing, circulation, and consciousness as well as symptoms of their failure. According to the emergency diagnosis, the necessary first aid techniques have to be applied. In this context, the cardiac arrest plays a particular role as an extreme special case of an emergency situation. The necessary steps are demonstrated as well as the decision to stop the resuscitation. An emergency box, which includes all drugs and equipment for the first aid, is desirable for the emergency treatment. The rescue line can only work if the general practitioner agrees to take on the role as a medical emergency therapist.

Cardiopulmonary Resuscitation↗
PubMed1994

[Resuscitation skills of hospital nursing staff].

The hospital nursing staff represents a distinct group of cardiopulmonary resuscitation (CPR) providers. Differences in the success rates of resuscitation attempts inside or outside the hospital seem to be attributable to the skill of the various rescuers. Whereas the definite success rate for prehospital resuscitation is 7%, the corresponding rate for in-hospital settings is 15%. METHODS. During 53 CPR refresher courses offered to nursing staff members, their individual skills and competence in CPR procedures were examined according to the standards and guidelines of the German Medical Association (Bundesärztekammer). The efficacy of cardiac massage and artificial ventilation performed by each nurse was recorded. Quality criteria were defined, grouped and analysed statistically by the Chi-square test. RESULTS. Only 6.6% of the nursing staff were found to have good skills in artificial ventilation. The main faults observed were insufficient tilting of the head (24%) and failure to prevent leakage from the insufflation airway (35%). For 42.8% it proved impossible to insufflate a minimum ventilatory tidal volume of 400 ml. The attempts at resuscitation made by 58.6% were completely inadequate. Although 14.1% of the nurses carried out effective cardiac massage, the majority of the test group (44.7%) failed to do so. For 29.4% the appropriate position of their own upper body to allow adequate chest compression remained elusive. In 41.4% of the compression cycles, the rescuer's hands lost contact with the sternum. The compression period proved too long in relation to the decompression period in 21.4%. Only 4 individuals (0.9%) were able to perform all standard CPR procedures as recommended by the guidelines and 71.8% failed to perform effective CPR manoeuvers. The test results did not differ with respect to the nurses' educational or professional status, clinical CPR experience or work area within the hospital. CONCLUSION. Cardiopulmonary resuscitation skills of hospital nurses are inadequate, mainly because of lack of manual dexterity. Obviously the special skills learned in CPR courses are lost after a relatively short time. These results, however, do not suggest completely inadequate handling of CPR procedures in the hospital setting. Indeed an increasing rate of successful resuscitations inside the hospital (up to 27%) has been reported in the literature. In consequence of our findings, refresher courses in specific CPR techniques must be demanded, which should be made obligatory for nursing staff every 2 years. Qualified nursing personnel routinely trained in CPR and supported by effective hospital logistics is essential if the life-saving benefits of modern CPR are to be provided to our patients.

Humans↗
PubMed1994

Skills and self-assessment in cardio-pulmonary resuscitation of the hospital nursing staff.

UNLABELLED: Differences in the success rates of the pre-hospital or in-hospital resuscitation attempts seem to be attributable to the skill of the various rescuers. Whereas the definite success rate for pre-hospital resuscitation is 7%, the corresponding rate for in-hospital settings is 15%. In this context, the resuscitation skills and the self-assessment of CPR methods of hospital staff were investigated. METHODS: during 53 CPR refresher courses offered to nursing staff members, the individual skills and competence in CPR procedures of 425 nurses were examined according to the standards and guidelines of the German Medical Association. During the first part of the study the participants were asked to subjectively rate their proficiencies in CPR followed by a practical assessment of their manual CPR skills by an independent observer. Scores were calculated for artificial ventilation and chest compression. Quality criteria were defined, grouped and analysed statistically by the chi-squared test. RESULTS: 16.2% of the participants felt sufficiently trained to perform CPR independently and 77.2% did not. Thirty-six percent estimated their CPR skills to be sufficient or good. Only four participants (0.9%) were able to perform all standard CPR procedures as recommended by the guidelines and 71.8% failed to perform effective CPR manoeuvres. The CPR skills did not differ with regard to the nurses' educational degree, professional experience, previous CPRs performed or work area within the hospital. Of the nursing staff, 6.6% were found to have good skills in artificial ventilation. The attempts at artificial ventilation made by 58.6% were completely inadequate. Correct chest compression was performed by 14.1%. The majority of the test group (44.7%) failed to carry out effective cardiac message. CONCLUSIONS: CPR skills of hospital staff are inadequate, mainly because of lack of manual dexterity. Obviously the special skills learned in CPR courses are lost in spite of a positive self-assessment after a relatively short time. The results, however, do not suggest completely inadequate handling of CPR procedures in a hospital setting. Indeed, an increasing rate of successful resuscitations inside the hospital (up to 27%) has been reported in the literature. As a consequence of our findings, refresher courses in specific CPR techniques must be demanded, which should be made compulsory for nursing staff every 2 years.

Cardiopulmonary Resuscitation↗
PubMed1993

Current level of prehospital care in severe head injury--potential for improvement.

The fact that 50-60% of cases with severe head injury result from traffic accidents underlines the great significance of emergency care and of its organization. Many patients with severe head injury are threatened from vital complications diagnosed with delay, or not at all, which plays a major role not only for survival but also for the quality of recovery and regaining of employment capabilities. Thus, the necessity of qualified and trained physicians with experience in emergency care is obvious. Emergency care can be divided into an early resuscitation phase of securing or reestablishment of general vital functions, and a following stabilisation phase with administration of measures directed towards the specific conditions underlying trauma. 1. Prevention and treatment of respiratory complications. In addition to classical emergency care measures, endotracheal suction might be employed. The most effective method for clearance of airways and, thus, securing of the cerebral oxygenation is endotracheal intubation. Early intubation provides also for control of the intracranial pressure by hyperventilation and administration of O2. Recently assistant ventilation is available as compared to the past when only controlled ventilation was possible. 2. Circulatory support. A major requirement for a sufficient cerebral perfusion is an adequate cerebral perfusion pressure making necessary early fluid substitution. In case the patient is in circulatory shock, shock-specific treatment may compete with adequate positioning of the patient. 3. Pharmacological treatment in the prehospital phase. Although dexamethasone has been reported to directly influence brain edema, its benefits in head injury are not clear. Currently conducted clinical studies using markedly higher doses may provide so far missing information.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Damage, Chronic↗
PubMed1993

[Effect of external cervical spine immobilization on intracranial pressure].

We measured the intracranial pressure (ICP) in 18 patients with severe head injury in the neurosurgical intensive-care unit before and after placement of a rigid collar for cervical spine immobilisation. The purpose of the study was to determine whether the rigid collars, commonly used to, prevent cervical spine movement during transport to the treatment facility could lead to an increase in ICP. Patients who had an epidural transducer in place were studied and their ICP recorded during placement of either the Spieth cervical collar (n = 12) or the Philadelphia cervical collar (n = 6). The baseline ICP was 17.0 +/- 6.1 mmHg versus 17.7 +/- 6.4 mmHg 10 min after placement of the cervical collar 5 min after removal the ICP was 17.2 +/- 5.9 mmHg. No significant changes in ICP could be demonstrated during this study. Placement of the cervical collar is a simple and practical measure to immobilize the cervical spine during rescue and transport of intubated and ventilated patients. Its risk of increasing the ICT appears to be low even in the patient with severe head injury.

Adolescent↗
PubMed1993

[Thrombogenicity of central venous catheters: comparison of two polyurethane catheters].

BACKGROUND: Thrombosis represents a possible catheter-related risk. Beside many endogenous and exogenous factors, the material as well as its condition do have a decisive influence on thrombogenicity. One factor of thrombogenicity is the surface of the catheter. Therefore, two different types of polyurethane catheters were compared according to their surface structure by electron microscopy. Furthermore, an in vivo testing should confirm a possible, different thrombogenicity. MATERIAL AND METHODS: A model with a single aperture at the catheter tip and a model with multiple apertures were tested. We compared the electron-microscopic pictures of specific areas which were expected to cause problems. Thrombogenicity in the vena cava inferior was tested in 20 rabbits. For statistical evaluation the Wilcoxon U test was used. RESULTS: Polyurethane catheters have a smooth and homogeneous surface inside and outside of the catheter. However, there are many production-related, qualitative differences in the morphology of the apertures. The model with multiple apertures and a closed catheter tip turned out to have a much more irregular surface compared to the model with a single aperture. In vivo testing showed that each catheter causes thrombosis, independent of the type. The catheter with multiple apertures proved to have no advantages as far as thrombogenicity is concerned; catheter-specific complications of this type are possible. Also, atraumatic insertion by means of Seldinger's technique is not possible using a catheter with a closed tip. CONCLUSION: The catheter with multiple apertures does not have any advantages to the catheter with a single aperture.

Animals↗
PubMed1993

[Emergency equipment for the physician].

In case of an emergency it is the moral and legal obligation of every physician render first aid. For immediate and effective prehospital treatment a certain minimum of medical equipment should be available. In this article, drugs and essential technical equipment of a doctor's first aid kit are recommended which has proved useful in the management of respiratory and cardiovascular emergencies. Monitoring of vital functions as well as the emergency treatment itself require technical equipment. The proposed essential equipment allows every first-aid doctor--beyond simple measures of basic life support--to reverse life--threatening derangements of vital organ systems and to save time before definite treatment in the hospital.

First Aid↗