The Experts below are selected from a list of 28011 Experts worldwide ranked by ideXlab platform
Roberto Jose Negrao Nogueira - One of the best experts on this subject based on the ideXlab platform.
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ultrasound guidance for pediatric central venous catheterization a meta analysis
Pediatrics, 2018Co-Authors: Tiago Henrique De Souza, Marcelo Barciela Brandao, Jose Antonio Nadal, Roberto Jose Negrao NogueiraAbstract:CONTEXT: Central venous catheterization is routinely required in patients who are critically ill, and it carries an associated morbidity. In pediatric patients, the procedures can be difficult and challenging, predominantly because of their Anatomic characteristics. OBJECTIVE: To determine whether ultrasound-guided techniques are associated with a reduced incidence of failures and complications when compared with the Anatomic Landmark technique. DATA SOURCES: We conducted a systematic search of PubMed and Embase. STUDY SELECTION: We included randomized controlled trials and nonrandomized studies in which researchers compare ultrasound guidance with the Anatomic Landmark technique in children who underwent central venous catheterization. DATA EXTRACTION: Study characteristics, sample sizes, participant characteristics, settings, descriptions of the ultrasound technique, puncture sites, and outcomes were analyzed. Pooled analyses were performed by using random-effects models. RESULTS: A total of 23 studies (3995 procedures) were included. Meta-analysis revealed that ultrasound guidance significantly reduced the risk of cannulation failure (odds ratio = 0.27; 95% confidence interval: 0.17–0.43), with significant heterogeneity seen among the studies. Ultrasound guidance also significantly reduced the incidence of arterial punctures (odds ratio = 0.34; 95% confidence interval: 0.21–0.55), without significant heterogeneity seen among the studies. Similar results were observed for femoral and internal jugular veins. LIMITATIONS: Potential publication bias for cannulation failure and arterial puncture was detected among the studies. However, no publication bias was observed when analyzing only the subgroup of randomized clinical trials. CONCLUSIONS: Ultrasound-guided techniques are associated with a reduced incidence of failures and inadvertent arterial punctures in pediatric central venous catheterization when compared with the Anatomic Landmark technique.
Alphonse G Taghian - One of the best experts on this subject based on the ideXlab platform.
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Perometry versus simulated circumferential tape measurement for the detection of breast cancer-related lymphedema
Breast Cancer Research and Treatment, 2018Co-Authors: Fangdi Sun, Alexander Hall, Megan P Tighe, Cheryl L Brunelle, Hoda E Sayegh, Tessa C Gillespie, Kayla M Daniell, Alphonse G TaghianAbstract:Purpose Despite increasing emphasis on screening and early intervention for breast cancer-related lymphedema (BCRL), there is marked heterogeneity in diagnostic methodology, including for volumetric measures. This retrospective study compared two volumetric modalities, perometry and simulated circumferential tape measurement (Anatomic- and interval-based), for BCRL detection. Methods Between 2005 and 2017, 287 female patients with unilateral breast cancer were prospectively screened for BCRL by perometry and the relative volume change (RVC) formula. Circumferential measurement was performed by sampling at five Anatomic Landmark-based points or 4-cm intervals from pairs of perometer arm diameter measurements. Volumetric conversion was by a frustum model. The Bland–Altman method was used to compare segmental volume differences. Confusion matrix analysis was performed for each circumferential measurement technique against perometry. Results Median follow-up was 34.7 months over 4 postoperative visits. There was no difference in total arm volume comparing any of the circumferential measurement techniques to perometry. Landmark-based methods significantly underestimated upper arm volume (mean difference − 207 mL [− 336, − 78 mL]) and overestimated forearm volume (mean difference + 170 mL [+ 105, + 237 mL]). Landmark-based methods had greater sensitivity and specificity compared to 4-cm interval methods for detection of both RVC ≥ 10 and 5–10%. Landmark-based methods were comparable to perometry for detection of RVC ≥ 10%, but sensitivity was only 63.2–66.7% for RVC 5–10%. Conclusions This hypothesis-generating study suggested the superiority of Anatomic Landmark-based circumferential tape measurement compared to interval-based methods, while generating questions about the underestimation of upper arm volume and overestimation of forearm volume of circumferential tape measurement compared to perometry.
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perometry versus simulated circumferential tape measurement for the detection of breast cancer related lymphedema
Breast Cancer Research and Treatment, 2018Co-Authors: Fangdi Sun, Alexander Hall, Megan P Tighe, Cheryl L Brunelle, Hoda E Sayegh, Tessa C Gillespie, Kayla M Daniell, Alphonse G TaghianAbstract:Despite increasing emphasis on screening and early intervention for breast cancer-related lymphedema (BCRL), there is marked heterogeneity in diagnostic methodology, including for volumetric measures. This retrospective study compared two volumetric modalities, perometry and simulated circumferential tape measurement (Anatomic- and interval-based), for BCRL detection. Between 2005 and 2017, 287 female patients with unilateral breast cancer were prospectively screened for BCRL by perometry and the relative volume change (RVC) formula. Circumferential measurement was performed by sampling at five Anatomic Landmark-based points or 4-cm intervals from pairs of perometer arm diameter measurements. Volumetric conversion was by a frustum model. The Bland–Altman method was used to compare segmental volume differences. Confusion matrix analysis was performed for each circumferential measurement technique against perometry. Median follow-up was 34.7 months over 4 postoperative visits. There was no difference in total arm volume comparing any of the circumferential measurement techniques to perometry. Landmark-based methods significantly underestimated upper arm volume (mean difference − 207 mL [− 336, − 78 mL]) and overestimated forearm volume (mean difference + 170 mL [+ 105, + 237 mL]). Landmark-based methods had greater sensitivity and specificity compared to 4-cm interval methods for detection of both RVC ≥ 10 and 5–10%. Landmark-based methods were comparable to perometry for detection of RVC ≥ 10%, but sensitivity was only 63.2–66.7% for RVC 5–10%. This hypothesis-generating study suggested the superiority of Anatomic Landmark-based circumferential tape measurement compared to interval-based methods, while generating questions about the underestimation of upper arm volume and overestimation of forearm volume of circumferential tape measurement compared to perometry.
Vincent W S Chan - One of the best experts on this subject based on the ideXlab platform.
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ultrasound guided versus Anatomic Landmark guided ankle blocks a 6 year retrospective review
Regional Anesthesia and Pain Medicine, 2011Co-Authors: Ki Jinn Chin, Natalie W Y Wong, Alan J R Macfarlane, Vincent W S ChanAbstract:Background and Objectives: Ultrasound-guided (USG) ankle block has been described; however, its clinical efficacy compared with conventional Anatomic Landmark-guided (ALG) techniques remains undetermined. Methods: We performed a 6-year retrospective cohort study of all ankle blocks performed for foot surgery and extracted demographic, intraoperative, and postoperative outcome data. We divided blocks into 2 groups for comparison, depending on whether they were performed using an ALG technique or a USG technique. Results: We identified 655 patients who received unilateral ankle block and 58 patients who received bilateral ankle block; we analyzed these separately. Trainees performed most blocks (approximately 80%). In patients receiving unilateral ankle block, successful surgical anesthesia was more likely in the USG group (84% versus 66%, P Conclusions: This study demonstrates that the USG technique of ankle block improves clinical efficacy compared with a conventional ALG technique, particularly in the hands of less-experienced practitioners.
Graeme Maclaren - One of the best experts on this subject based on the ideXlab platform.
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ultrasound imaging reduces failure rates of percutaneous central venous catheterization in children
Pediatric Critical Care Medicine, 2015Co-Authors: Nobuaki Shime, Koji Hosokawa, Graeme MaclarenAbstract:Objective: Ultrasound imaging has been shown to be beneficial for percutaneous central venous cannulation in systematic reviews of randomized controlled trials in adult patients, but not in pediatrics. The aim of this updated review was to determine whether percutaneous central venous catheterization with the aid of ultrasound reduces cannulation failure in children. Data Sources: PubMed was searched using the terms: ultrasound, catheterization, central vein (including internal jugular and femoral veins), and pediatrics. Study Selection: Both nonrandomized comparative studies and randomized controlled trials were eligible for inclusion if they assessed the rate of cannulation failure using real-time, dynamic ultrasound guidance, ultrasound-Assisted vein prelocation, and/or Anatomic Landmark technique. Data Extraction: Five nonrandomized studies and nine randomized controlled trials were included. The rates of cannulation failure and arterial puncture were retrieved. Data Synthesis: Random-effects meta-Analysis was applied. Conclusions: The meta-Analysis of five nonrandomized studies showed that the rate of cannulation failure was significantly lower with real-time ultrasound guidance than Anatomic Landmark technique (odds ratio, 0.44 [95% CI, 0.27-0.72]; p = 0.001). The combination of nine randomized controlled trials also showed lower failure rates with either the real-time ultrasound guidance or the prelocation technique over the Landmark technique (odds ratio, 0.22 [95% CI, 0.07-0.69]; p = 0.0003) and fewer arterial punctures in the ultrasound group (odds ratio, 0.31 [95% CI, 0.09-1.08]; p = 0.07). However, seven out of nine studies were assessed as having high risk of bias. Since the lower cannulation failure and less frequent chance of arterial puncture with ultrasound were predominantly shown in studies at high risk of bias, further definitive and adequately powered studies with clear outcomes are needed.
Tiago Henrique De Souza - One of the best experts on this subject based on the ideXlab platform.
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ultrasound guidance for pediatric central venous catheterization a meta analysis
Pediatrics, 2018Co-Authors: Tiago Henrique De Souza, Marcelo Barciela Brandao, Jose Antonio Nadal, Roberto Jose Negrao NogueiraAbstract:CONTEXT: Central venous catheterization is routinely required in patients who are critically ill, and it carries an associated morbidity. In pediatric patients, the procedures can be difficult and challenging, predominantly because of their Anatomic characteristics. OBJECTIVE: To determine whether ultrasound-guided techniques are associated with a reduced incidence of failures and complications when compared with the Anatomic Landmark technique. DATA SOURCES: We conducted a systematic search of PubMed and Embase. STUDY SELECTION: We included randomized controlled trials and nonrandomized studies in which researchers compare ultrasound guidance with the Anatomic Landmark technique in children who underwent central venous catheterization. DATA EXTRACTION: Study characteristics, sample sizes, participant characteristics, settings, descriptions of the ultrasound technique, puncture sites, and outcomes were analyzed. Pooled analyses were performed by using random-effects models. RESULTS: A total of 23 studies (3995 procedures) were included. Meta-analysis revealed that ultrasound guidance significantly reduced the risk of cannulation failure (odds ratio = 0.27; 95% confidence interval: 0.17–0.43), with significant heterogeneity seen among the studies. Ultrasound guidance also significantly reduced the incidence of arterial punctures (odds ratio = 0.34; 95% confidence interval: 0.21–0.55), without significant heterogeneity seen among the studies. Similar results were observed for femoral and internal jugular veins. LIMITATIONS: Potential publication bias for cannulation failure and arterial puncture was detected among the studies. However, no publication bias was observed when analyzing only the subgroup of randomized clinical trials. CONCLUSIONS: Ultrasound-guided techniques are associated with a reduced incidence of failures and inadvertent arterial punctures in pediatric central venous catheterization when compared with the Anatomic Landmark technique.