Efficacy and Safety of Elective Switching from Intravenous to Subcutaneous Infliximab [CT-P13]: A Multicentre Cohort Study.

Background: Intravenous [IV] infliximab is a well-established therapy for inflammatory bowel diseases [IBD] patients. A subcutaneous [SC] formulation of infliximab [CT-P13] has recently been shown to be as effective as IV infliximab after two doses of IV induction in a randomised trial, but there are no data to support elective switching of patients on maintenance IV infliximab therapy. We aimed to assess the effectiveness of an elective switching programme to SC CT-P13 in patients treated with IV infliximab.

Comparison of wrack dynamics between mangrove forests with and without seawalls.

The supply and fate of wrack (dead organic matter) is a critical determinant of the structure and function of shoreline ecosystems, and their role as carbon repositories. The increasingly common practise of armouring urbanised shorelines with seawalls impacts wrack deposits of unvegetated estuarine and coastal shorelines by truncating the intertidal zone and/or by modifying the physical and biological processes that deliver and remove wrack. This study tested whether such effects also extend to mangrove forests.

Problem opioid use and HIV primary care engagement among hospitalized people who use drugs and/or alcohol.

Background: There is growing public health concern around the potential impact of the opioid crisis on efforts to eradicate HIV. This secondary analysis seeks to determine if those who report opioids as their primary problem drug compared to those who report other drugs and/or alcohol differ in engagement in HIV primary care among a sample of hospitalized people with HIV (PWH) who use drugs and/or alcohol, a traditionally marginalized and difficult to engage population key to ending the HIV epidemic.

Setting And Participants: A total of 801 participants (67% male; 75% Black, non-Hispanic; mean age 44.

The roles of heavy drinking and drug use in engagement in HIV care among hospitalized substance using individuals with poorly controlled HIV infection.

Background: Substance use can reduce care engagement for individuals with HIV. However, little is known as to whether heavy drinkers differ from drug users. This study compares heavy drinkers, drug users, and those drinking heavily and using drugs on their HIV care engagement.

Journal of clinical monitoring and computing end of year summary 2018: hemodynamic monitoring and management.

Hemodynamic management is a mainstay of patient care in the operating room and intensive care unit (ICU). In order to optimize patient treatment, researchers investigate monitoring technologies, cardiovascular (patho-) physiology, and hemodynamic treatment strategies. The Journal of Clinical Monitoring and Computing (JCMC) is a well-established and recognized platform for publishing research in this field.

Journal of Clinical Monitoring and Computing 2017 end of year summary: cardiovascular and hemodynamic monitoring.

Hemodynamic monitoring provides the basis for the optimization of cardiovascular dynamics in intensive care medicine and anesthesiology. The Journal of Clinical Monitoring and Computing (JCMC) is an ideal platform to publish research related to hemodynamic monitoring technologies, cardiovascular (patho)physiology, and hemodynamic treatment strategies. In this review, we discuss selected papers published on cardiovascular and hemodynamic monitoring in the JCMC in 2017.

Journal of Clinical Monitoring and Computing 2016 end of year summary: cardiovascular and hemodynamic monitoring.

The assessment and optimization of cardiovascular and hemodynamic variables is a mainstay of patient management in the care for critically ill patients in the intensive care unit (ICU) or the operating room (OR). It is, therefore, of outstanding importance to meticulously validate technologies for hemodynamic monitoring and to study their applicability in clinical practice and, finally, their impact on treatment decisions and on patient outcome. In this regard, the Journal of Clinical Monitoring and Computing (JCMC) is an ideal platform for publishing research in the field of cardiovascular and hemodynamic monitoring.

The effect of head up tilting on bioreactance cardiac output and stroke volume readings using suprasternal transcutaneous Doppler as a control in healthy young adults.

To compare the performance of a bioreactance cardiac output (CO) monitor (NICOM) and transcutaneous Doppler (USCOM) during head up tilting (HUT). Healthy young adult subjects, age 22 ± 1 years, 7 male and 7 female, were tilted over 3-5 s from supine to 70° HUT, 30° HUT and back to supine. Positions were held for 3 min.

Inferior Vena Cava Ultrasonography before General Anesthesia Can Predict Hypotension after Induction.

Background: Hypotension is a common side effect of general anesthesia induction, and when severe, it is related to adverse outcomes. Ultrasonography of inferior vena cava (IVC) is a reliable indicator of intravascular volume status. This study investigated whether preoperative ultrasound IVC measurements could predict hypotension after induction of anesthesia.

The effect of aorta unfolding and remodelling on oesophageal Doppler readings as probe depth is varied.

Background: The thoracic aorta elongates and unfolds with advancing age. Lateral displacement and tortuosity of the descending part may affect oesophageal Doppler monitoring (ODM) readings because probe alignment becomes slanted. This investigation aimed to relate aortic displacement as it appears on the chest radiograph with variations in ODM readings as the probe is inserted to different depths.

Does using two Doppler cardiac output monitors in tandem provide a reliable trend line of changes for validation studies?

The demise of the pulmonary artery catheter as a gold standard in cardiac output measurement has created the need for new standard. Doppler cardiac output can be measured suprasternally (USCOM) and via the oesophagus (CardioQ). Use in tandem they may provide a reliable trend line of cardiac output changes against which new technologies can be assessed.

Five algorithms that calculate cardiac output from the arterial waveform: a comparison with Doppler ultrasound.

Background: Different mathematical approaches are used to calculate arterial pulse pressure wave analysis (PPWA) cardiac output. The CardioQ-Combi is a research oesophageal Doppler (COODM) monitor that includes these five fundamental PPWA algorithms. We compared these PPWA cardiac output readings to COODM and suprasternal USCOM Doppler (COUS) over a range of cardiac output values induced by dopamine infusion in patients undergoing major surgery.

Major Upper Abdominal Surgery Alters the Calibration of Bioreactance Cardiac Output Readings, the NICOM, When Comparisons Are Made Against Suprasternal and Esophageal Doppler Intraoperatively.

Background: Minimally invasive continuous cardiac output measurements are recommended for use during anesthesia to guide fluid therapy, but such measurements must trend changes reliably. The NICOM Cheetah, a BioReactance monitor, is being recommended for intraoperative use. To validate its use, Doppler methods, suprasternal USCOM and esophageal CardioQ, were used in tandem to provide reliable estimates of changing trends in cardiac output.

Introducing Final-Year Medical Students to Pocket-Sized Ultrasound Imaging: Teaching Transthoracic Echocardiography on a 2-Week Anesthesia Rotation.

Problem: The availability of less expensive and smaller ultrasound machines has enabled the use of ultrasound in virtually all major medical/surgical disciplines. Some medical schools have incorporated point-of-care ultrasound training into their undergraduate curriculum, whereas many postgraduate programs have made ultrasound training a standard. The Chinese University of Hong Kong has charged its Department of Anaesthesia and Intensive Care to spearhead the introduction of ultrasound into the final-year medical curriculum by introducing handheld transthoracic echocardiography as part of perioperative assessment.

Evidence of virtual patients as a facilitative learning tool on an anesthesia course.

Virtual patients are computerised representations of realistic clinical cases. They were developed to teach clinical reasoning skills through delivery of multiple standardized patient cases. The anesthesia course at The Chinese University of Hong Kong developed two novel types of virtual patients, formative assessment cases studies and storyline, to teach its final year medical students on a 2 week rotational course.

An assessment of two Doppler-based monitors to track cardiac output changes in anaesthetised patients undergoing major surgery.

Minimally-invasive cardiac output (CO) monitoring to follow changes in CO would be helpful in anaesthesia practice. Two Doppler systems marketed for this purpose include the CardioQ (Deltex Medical Group, Chichester, United Kingdom), which uses an oesophageal probe, and the USCOM (USCOM Ltd., Sydney, NSW, Australia), which uses a hand-held probe.

Risk of perioperative respiratory complications and postoperative morbidity in a cohort of adults exposed to passive smoking.

Objective: To evaluate the risks of perioperative respiratory complications and postoperative morbidity associated with active and passive cigarette smoking.

Background: Environmental tobacco smoke is associated with perioperative respiratory events in children, but its effect in adults is unknown.

Methods: We conducted a cohort study of 736 adult patients receiving general anesthesia for major elective surgery.

Correlation between supra-sternal Doppler cardiac output (USCOM) measurements and chest radiological features.

Cardiac output can be measured non-invasively using supra-sternal Doppler (USCOM, Sydney, NSW, Australia). However, scanning can be difficult in practice in older patients, the reason for which has not been elucidated previously. Chest radiographs from 60 previously studied anaesthetised patients were reviewed and scored for aortic unfolding, enlargement and calcification, and cardiac enlargement.

Systematic error of cardiac output measured by bolus thermodilution with a pulmonary artery catheter compared with that measured by an aortic flow probe in a pig model.

Objective: The precision of thermodilution cardiac output measurement using a pulmonary artery catheter can be divided into random and systematic errors. This study determined the systematic component.

Design: Comparative validation against a transonic flow probe on the aortic root.