Publications by authors named "Davinder Ramsingh"

Evidence regarding racial disparities in leadless pacemaker (LP) utilization and outcomes is limited. We aimed to explore ethnicity-based disparities in LP utilization and clinical outcomes of patients who underwent LP implantation. All consecutive patients who underwent LP between January 2019 and January 2023 at our institution were included.

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Study Objective: To implement and assess a cardiopulmonary point-of-care ultrasound (POCUS) objective structured clinical examination (OSCE) in a large cohort of graduating anesthesia residents.

Design: Observational cohort study.

Setting: University-affiliated hospitals.

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Purpose: Point-of-care ultrasound (POCUS) is ultrasound brought to the patient's bedside and performed in 'real time' by the healthcare provider. The utility of POCUS to facilitate management of the acutely ill patient has been demonstrated for multiple pathologies. However, the integration of ultrasonography and echocardiography training into residency curriculum varies across the acute care specialties.

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Hemodynamic (HD) monitoring remains integral to the assessment and management of perioperative and critical care patients. This review article seeks to provide an update on the different types of flow-guided HD monitoring technologies available, highlight their limitations, and review the therapies associated with the application of these technologies. Additionally, we will also comment on the expanding roles of HD monitoring in the future.

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Introduction: Point-of-care ultrasound (POCUS) is the most rapidly growing imaging modality for acute care. Despite increased use, there is still wide variability and less evidence regarding its clinical utility for the perioperative setting compared to other acute care settings. This study sought to demonstrate the impact of POCUS examinations for acute hypoxia and hypotension occurring in the post-anesthesia care unit (PACU) versus traditional bedside examinations.

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Article Synopsis
  • - Diagnostic point-of-care ultrasound (PoCUS) is becoming an essential tool for anesthesiologists to improve patient care in various medical settings.
  • - In 2018, the American Society of Anesthesiologists formed a committee to develop guidelines on diagnostic PoCUS, which were updated in 2021 based on expert opinions.
  • - The resulting guidelines emphasize the importance of adequate training for anesthesiologists to use PoCUS, outline its scope of practice, suggest competency requirements, and address ethical use and billing practices.
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Lean Six Sigma (LSS) is a process improvement strategy used in many industries. Its goal is to improve performance and quality by eliminating waste, optimizing flow, and reducing variability. This article describes LSS methods and their application in health care.

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Background: Excessive or inadequate fluid administration causes complications, but despite this, fluid administration during noncardiac surgery is highly variable. Goal-directed management helps optimize the amount and timing of fluid administration; however, implementation is difficult because algorithms are complex. The authors therefore tested the performance of the Acumen Assisted Fluid Management software (Edwards Lifesciences, USA), which is designed to guide optimal intravenous fluid administration during surgery.

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Point-of-care ultrasound (POCUS) is a critical skill for all regional anesthesiologists and pain physicians to help diagnose relevant complications related to routine practice and guide perioperative management. In an effort to inform the regional anesthesia and pain community as well as address a need for structured education and training, the American Society of Regional Anesthesia and Pain Medicine (ASRA) commissioned this narrative review to provide recommendations for POCUS. The guidelines were written by content and educational experts and approved by the Guidelines Committee and the Board of Directors of the ASRA.

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Point-of-care ultrasound (POCUS) is a critical skill for all regional anesthesiologists and pain physicians to help diagnose relevant complications related to routine practice and guide perioperative management. In an effort to inform the regional anesthesia and pain community as well as address a need for structured education and training, the American Society of Regional Anesthesia and Pain Medicine Society (ASRA) commissioned this narrative review to provide recommendations for POCUS. The recommendations were written by content and educational experts and were approved by the guidelines committee and the Board of Directors of the ASRA.

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Introduction: Cardiac surgery patients are at increased risk for post-operative complications and prolonged length of stay. Perioperative goal directed therapy (GDT) has demonstrated utility for non-cardiac surgery, however, GDT is not common for cardiac surgery. We initiated a quality improvement (QI) project focusing on the implementation of a GDT protocol, which was applied from the immediate post-bypass period into the intensive care unit (ICU).

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Hypotension is common in critically ill patients. Early prediction of hypotensive events in the Intensive Care Units (ICUs) allows clinicians to pre-emptively treat the patient and avoid possible organ damage. In this study, we investigate the performance of various supervised machine-learning classification algorithms along with a real-time labeling technique to predict acute hypotensive events in the ICU.

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Introduction: A non-radiographic technique to measure the location of the tracheal tube (TT) in children is of value given the risk of inappropriate TT placement along with concerns about radiation exposure. Airway point-of-care ultrasound (POCUS) has demonstrated utility in children, but the examinations vary by age and may require non-traditional techniques or utilize less common probes. This study evaluated the performance of measuring the tracheal location of the cuffed TT using a novel, linear probe-based POCUS examination over a wide age range of children.

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Background: Predicting hypotension well in advance provides physicians with enough time to respond with proper therapeutic measures. However, the real-time prediction of hypotension with high positive predictive value (PPV) is a challenge. This is due to the dynamic changes in patients' physiological status following drug administration, which limits the quantity of useful data available for the algorithm.

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Article Synopsis
  • Cesarean deliveries account for a significant portion of births globally, and repeat cesarean deliveries carry higher surgical complication risks, yet their impact on pain management is under-researched.
  • This study assessed opioid usage and pain levels in opioid-naïve patients after primary versus repeat non-emergent cesarean deliveries using a retrospective analysis of 594 patients.
  • Findings revealed that those undergoing repeat cesarean deliveries used less opioids postoperatively (median 35 vs. 58), although pain scores were similar between the two groups, indicating a need for tailored pain management strategies by healthcare providers.
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Introduction: Point-of-care ultrasound of the optic nerve sheath diameter (ONSD) to diagnose increased intracranial pressure (ICP) is of great interest in various clinical scenarios. Yet, the lack of examination standardization has made clinical utility difficult. We compare three ultrasound ocular plane views (inferior, sagittal, and transverse), which are currently used in the literature to evaluate their consistency.

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Point-of-care ultrasound (POCUS) is a rapidly expanding discipline that has proven to be a valuable modality in the hospital setting. Recent evidence has demonstrated the utility of commercially available video conferencing technologies, namely, FaceTime (Apple Inc, Cupertino, CA, USA) and Google Glass (Google Inc, Mountain View, CA, USA), to allow an expert POCUS examiner to remotely guide a novice medical professional. However, few studies have evaluated the ability to use these teleultrasound technologies to guide a nonmedical novice to perform an acute care POCUS examination for cardiac, pulmonary, and abdominal assessments.

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Introduction: The utility of perioperative point-of-care ultrasound (P-POCUS) is rapidly growing. The successful implementation of a comprehensive P-POCUS curriculum, Focused PeriOperative Risk Evaluation Sonography Involving Gastro-abdominal, Hemodynamic, and Trans-thoracic Ultrasound (FORESIGHT), has been demonstrated. This project sought to further evaluate the utility of P-POCUS with the following aims: (1) to assess the ability to train the FORESIGHT curriculum via a free, open-access, online platform; (2) to launch a P-POCUS clinical service as a quality improvement (QI) initiative; (3) to evaluate the diagnostic accuracy of the P-POCUS examinations to formal diagnostic studies; and (4) to compare the P-POCUS diagnostic accuracy with the diagnostic accuracy of traditional assessment (TA).

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Reports on the use of various smartphone-based video conference applications to guide point-of-care ultrasound (POCUS) examinations in resource-limited settings have been described. However, the use of an augmented reality-enabled smartphone video conference application in this same manner has not been described. Presented is a case in which such as application was used to remotely guide a point of care ultrasound examination.

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Evaluation of cardiac function during periods of stress is of key importance for the perioperative setting. Non-invasive hemodynamic monitors provide markers of cardiac function. This pilot study sought to evaluate the ability of a non-invasive hemodynamic monitor to detect cardiac stress during formal stress echocardiography testing.

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Caring for the trauma patient requires an in-depth knowledge of the pathophysiology of trauma, the ability to rapidly diagnose and intervene to reverse the derangements caused by shock states, and an aptitude for the use of advanced monitoring techniques and perioperative point-of-care ultrasonography (P-POCUS) to assist in diagnosis and delivery of care. Historically, anesthesiology has lagged behind in wholly embracing this technology. P-POCUS has the potential to allow the trauma anesthesiologist to diagnose numerous injuries, quickly guide the placement of central vascular catheters and invasive monitors, and assess the efficacy of interventions.

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Background: Anxiety associated with pediatric surgery can be stressful. Midazolam is a well-accepted anxiolytic in this setting. However, there are cases in which this medication is not effective.

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