The Experts below are selected from a list of 39 Experts worldwide ranked by ideXlab platform
Joseph C Wenke - One of the best experts on this subject based on the ideXlab platform.
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comparison of irrigation solutions and devices in a contaminated musculoskeletal wound survival model
Journal of Bone and Joint Surgery American Volume, 2009Co-Authors: Brett D Owens, Daniel W White, Joseph C WenkeAbstract:Background: There is much to learn about the effectiveness of different methods currently used for the irrigation of open wounds. The purpose of this study was to compare various approaches in a survival animal model. Methods: We used an established goat model involving the creation of a reproducible complex musculoskeletal wound followed by inoculation with Pseudomonas aeruginosa (lux) bacteria. This genetically altered luminescent bacterium provides the ability for quantitative analysis with a photon-counting camera system. For Study 1, wound irrigation was performed six hours after the injury and inoculation; the goats were assigned to four treatment groups: normal saline solution, bacitracin solution, castile soap, and benzalkonium chloride. All wounds received sharp debridement and irrigation with use of a pulsatile lavage device (19 psi). Images and photon counts were obtained prior to irrigation, after irrigation, and forty-eight hours after injury and inoculation. For Study 2, we used the same animal model and compared Bulb Syringe and pulsatile lavage irrigation with saline solution. Results: In Study 1, the irrigation treatment lowered the bacterial counts in all treatment groups. The greatest reduction was seen with castile soap, which lowered the photon count to 13% of the pretreatment level. This was followed by benzalkonium chloride, bacitracin, and saline solution at 18%, 22%, and 29%, respectively. At forty-eight hours, imaging showed a rebound in bacterial counts in every group. The highest rebound was measured in the castile soap group, which rebounded to 120% of the pretreatment level. The benzalkonium chloride group experienced a rebound to 94% of the pretreatment level. These were followed by bacitracin solution (89%) and normal saline solution (68%). In Study 2, both treatment methods were effective in removing 75% of the bacteria initially. At forty-eight hours, the bacterial levels in the pulsed lavage group rebounded to 94% of the original levels (compared with 48% in the Bulb Syringe group). The difference in the mean photon count ratios at forty-eight hours was significant (p = 0.048). Conclusions: Approaches used to remove bacteria from wounds, such as irrigants other than saline solution or high-pressure devices, may not have the best clinical outcome. Clinical Relevance: These data suggest that use of a low-pressure device and saline solution to irrigate wounds is the best choice.
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Comparison of Bulb Syringe and pulsed lavage irrigation with use of a bioluminescent musculoskeletal wound model.
Journal of Bone and Joint Surgery American Volume, 2006Co-Authors: Major Steven J. Svoboda, Heather A. Gooden, Darryl B. Thomas, Daniel E Brooks, Terry G Bice, Joseph C WenkeAbstract:Background: Despite the fact that wound irrigation is a common surgical procedure, there are many variables, including delivery device, irrigant type, and fluid volume, that have yet to be optimized. The purpose of this study was to compare, with use of transgenic bioluminescent bacteria and standard quantitative microbiological methods, the efficacy of pulsed lavage and Bulb Syringe irrigation in reducing wound bacterial counts. Methods: A caprine model of a complex, contaminated musculoskeletal wound was developed with use of a bioluminescent strain of Pseudomonas aeruginosa that can be quantified. Luminescent activity was recorded as relative luminescent units with use of a photon-counting camera six hours after the wound was created and inoculated. Twelve goats were randomly assigned to either the pulsed lavage group or the Bulb Syringe irrigation group. Each wound was irrigated with normal saline solution in 3-L increments for a total of 9 L and was imaged after each 3-L increment. In addition, quantitative culture samples were obtained from different tissues within the wound before and after irrigation. Results: Pulsed lavage decreased the amount of relative luminescent units by 52%, 64%, and 70% at 3, 6, and 9 L, respectively. The Bulb Syringe irrigation reduced the amount of relative luminescent units by 33%, 44%, and 51% at these same time-points. Significant differences in luminescence were noted between the two groups after both 6 and 9 L of irrigation (p ≤ 0.04). The correlation coefficients between relative luminescent units and quantitative cultures for the condition before irrigation and after irrigation were r = 0.96 and 0.83, respectively. Conclusions: Pulsed lavage was more effective than Bulb Syringe irrigation in reducing bacterial luminescence after both 6 and 9 L of irrigation. Both device and volume effects can be demonstrated with use of this model. Bioluminescent bacteria provide a method to visualize bacterial distribution and to quantify the bacteria in a wound. Clinical Relevance: Pulsed lavage is a more effective and efficient method of irrigation to remove bacteria in a complex musculoskeletal wound. In the model we used, pulsed lavage irrigation with 3 L of saline solution resulted in a reduction of approximately the same amount of bacteria as did irrigation with 9 L with use of a Bulb Syringe.
Richard S Irwin - One of the best experts on this subject based on the ideXlab platform.
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comparison of a self inflating Bulb Syringe and a colorimetric co2 indicator with capnography and radiography to detect the misdirection of naso orogastric tubes into the airway of critically ill adult patients
Chest, 2015Co-Authors: Nicholas A Smyrnios, Richard Lenard, Sunil Rajan, Michael S Newman, Stephen P Baker, Nehal Thakkar, Wahid Wassef, Niraj K Ajmere, Richard S IrwinAbstract:OBJECTIVE The objective of this study was to develop a mechanism of discovering misdirection into the airway of naso/orogastric (NG) tubes before they reach their full depth of placement in adults. METHODS A prospective, observational study was performed in humans, evaluating both the self-inflating Bulb Syringe (SIBS) and a colorimetric CO 2 detector. A prospective convenience sample of 257 NG tube placements was studied in 199 patients in medical ICUs of a tertiary care medical center. Findings were compared to a “standard” (ie, end tidal CO 2 results of a capnograph and the results of a chest radiograph performed at the completion of the tube placement). RESULTS On the first tube placement attempt in any patient, the SIBS had a sensitivity of 91.5% and a specificity of 87.0% in detecting nonesophageal placement, while the colorimetric device exhibited 99.4% sensitivity and 91.3% specificity. On subsequent insertions, the SIBS showed 95.7% sensitivity and 100% specificity, while the colorimetric device exhibited 97.8% sensitivity and 100% specificity. The colorimetric device was eight times more expensive than the SIBS. CONCLUSIONS The SIBS and the colorimetric CO 2 detector are very good at detecting NG tube malpositioning into the airway, although the colorimetric device is slightly more sensitive and specific. Neither method adds substantial time or difficulty to the insertion process. The colorimetric device is substantially more expensive. The decision as to which method to use may be based on local institutional factors, such as expense.
Paul Little - One of the best experts on this subject based on the ideXlab platform.
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managing earwax in primary care efficacy of self treatment using a Bulb Syringe
British Journal of General Practice, 2008Co-Authors: Richard Coppin, Dorothy Wicke, Paul LittleAbstract:Background Irrigating ears to remove wax is a time-consuming procedure in UK primary care. In many other countries Bulb Syringes are used for self-clearance of earwax but evidence of their effectiveness is lacking. Aim To compare the effectiveness of self-treatment Bulb Syringes with routine care. Design of study Open, randomised, controlled trial. Setting Seven practices in Hampshire, UK. Method Participants were 237 patients attending their GP or practice nurse with symptomatic occluding earwax. A further 128 patients did not want to be part of the randomisation but allowed their data to be analysed. Patients randomised to intervention ( n = 118) were given ear drops, a Bulb Syringe, and instructions on its use. Patients in the control group ( n = 119) received ear drops, followed by ear irrigation by the GP or practice nurse. Main outcome measures were symptoms (on a 7-point scale), wax clearance, need for further treatment, and the acceptability of treatment. Results Comparing patients using the Bulb Syringe with those treated with conventional irrigation, the change in mean symptom score was −0.81 and −1.26 respectively (difference −0.45, 95% confidence interval [CI] = −0.11 to −0.79) and, regarding the proportion requiring no further irrigation, 51 % and 69% respectively. Although irrigation was preferred by more patients, most patients using the Bulb Syringe would use it again (75% versus 100%) and were satisfied with treatment (71 % versus 99%). Conclusions Advising patients with ears blocked by wax to try Bulb syringing before irrigation is effective and acceptable, and could significantly reduce the use of NHS resources.
Nicholas A Smyrnios - One of the best experts on this subject based on the ideXlab platform.
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comparison of a self inflating Bulb Syringe and a colorimetric co2 indicator with capnography and radiography to detect the misdirection of naso orogastric tubes into the airway of critically ill adult patients
Chest, 2015Co-Authors: Nicholas A Smyrnios, Richard Lenard, Sunil Rajan, Michael S Newman, Stephen P Baker, Nehal Thakkar, Wahid Wassef, Niraj K Ajmere, Richard S IrwinAbstract:OBJECTIVE The objective of this study was to develop a mechanism of discovering misdirection into the airway of naso/orogastric (NG) tubes before they reach their full depth of placement in adults. METHODS A prospective, observational study was performed in humans, evaluating both the self-inflating Bulb Syringe (SIBS) and a colorimetric CO 2 detector. A prospective convenience sample of 257 NG tube placements was studied in 199 patients in medical ICUs of a tertiary care medical center. Findings were compared to a “standard” (ie, end tidal CO 2 results of a capnograph and the results of a chest radiograph performed at the completion of the tube placement). RESULTS On the first tube placement attempt in any patient, the SIBS had a sensitivity of 91.5% and a specificity of 87.0% in detecting nonesophageal placement, while the colorimetric device exhibited 99.4% sensitivity and 91.3% specificity. On subsequent insertions, the SIBS showed 95.7% sensitivity and 100% specificity, while the colorimetric device exhibited 97.8% sensitivity and 100% specificity. The colorimetric device was eight times more expensive than the SIBS. CONCLUSIONS The SIBS and the colorimetric CO 2 detector are very good at detecting NG tube malpositioning into the airway, although the colorimetric device is slightly more sensitive and specific. Neither method adds substantial time or difficulty to the insertion process. The colorimetric device is substantially more expensive. The decision as to which method to use may be based on local institutional factors, such as expense.
Major Steven J. Svoboda - One of the best experts on this subject based on the ideXlab platform.
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Comparison of Bulb Syringe and pulsed lavage irrigation with use of a bioluminescent musculoskeletal wound model.
Journal of Bone and Joint Surgery American Volume, 2006Co-Authors: Major Steven J. Svoboda, Heather A. Gooden, Darryl B. Thomas, Daniel E Brooks, Terry G Bice, Joseph C WenkeAbstract:Background: Despite the fact that wound irrigation is a common surgical procedure, there are many variables, including delivery device, irrigant type, and fluid volume, that have yet to be optimized. The purpose of this study was to compare, with use of transgenic bioluminescent bacteria and standard quantitative microbiological methods, the efficacy of pulsed lavage and Bulb Syringe irrigation in reducing wound bacterial counts. Methods: A caprine model of a complex, contaminated musculoskeletal wound was developed with use of a bioluminescent strain of Pseudomonas aeruginosa that can be quantified. Luminescent activity was recorded as relative luminescent units with use of a photon-counting camera six hours after the wound was created and inoculated. Twelve goats were randomly assigned to either the pulsed lavage group or the Bulb Syringe irrigation group. Each wound was irrigated with normal saline solution in 3-L increments for a total of 9 L and was imaged after each 3-L increment. In addition, quantitative culture samples were obtained from different tissues within the wound before and after irrigation. Results: Pulsed lavage decreased the amount of relative luminescent units by 52%, 64%, and 70% at 3, 6, and 9 L, respectively. The Bulb Syringe irrigation reduced the amount of relative luminescent units by 33%, 44%, and 51% at these same time-points. Significant differences in luminescence were noted between the two groups after both 6 and 9 L of irrigation (p ≤ 0.04). The correlation coefficients between relative luminescent units and quantitative cultures for the condition before irrigation and after irrigation were r = 0.96 and 0.83, respectively. Conclusions: Pulsed lavage was more effective than Bulb Syringe irrigation in reducing bacterial luminescence after both 6 and 9 L of irrigation. Both device and volume effects can be demonstrated with use of this model. Bioluminescent bacteria provide a method to visualize bacterial distribution and to quantify the bacteria in a wound. Clinical Relevance: Pulsed lavage is a more effective and efficient method of irrigation to remove bacteria in a complex musculoskeletal wound. In the model we used, pulsed lavage irrigation with 3 L of saline solution resulted in a reduction of approximately the same amount of bacteria as did irrigation with 9 L with use of a Bulb Syringe.
