Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project.

Background And Objectives: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia.

The periosteum: a simple tissue with many faces, with special reference to the antler-lineage periostea.

Periosteum is a thin membrane covering bone surfaces and consists of two layers: outer fibrous layer and inner cambium layer. Simple appearance of periosteum has belied its own complexity as a composite structure for physical bone protection, mechano-sensor for sensing mechanical loading, reservoir of biochemical molecules for initiating cascade signaling, niche of osteogenic cells for bone formation and repair, and "umbilical cord" for nourishing bone tissue. Periosteum-derived cells (PDCs) have stem cell attributes: self-renewal (no signs of senescence until 80 population doublings) and multipotency (differentiate into fibroblasts, osteoblasts, chondrocytes, adipocytes and skeletal myocytes).

Accuracy of cricothyroid membrane identification using ultrasound and palpation techniques in obese obstetric patients: an observational study.

Background: During performance of emergency front of neck access, the final step in management algorithms for the 'can't intubate, can't oxygenate' scenario, accurate identification of the cricothyroid membrane is crucial. Accurate identification using palpation techniques is low, with highest failure rates occurring in obese females.

Methods: This prospective observational study recruited 28 obese obstetric patients.

Emergency Front-of-Neck Airway Rescue Via the Cricothyroid Membrane: A High-Resolution Computed Tomography Study of Airway Anatomy in Adults.

Background: Emergency front-of-neck airway rescue is recommended in a can't intubate, can't oxygenate clinical scenario. Cannula cricothyroidotomy has been reported as having a high failure rate. Our primary aim was to estimate the angle of the trachea in relation to the horizontal axis in a simulated emergency front-of-neck airway rescue position.

Demonstrating the influence of HTA: INAHTA member stories of HTA impact.

A central function of health technology assessment (HTA) agencies is the production of HTA reports to support evidence-informed policy and decision making. HTA agencies are interested in understanding the mechanisms of HTA impact, which can be understood as the influence or impact of HTA report findings on decision making at various levels of the health system. The members of the International Network of Agencies for HTA (INAHTA) meet at their annual Congress where impact story sharing is one important activity.

Accuracy of pediatric cricothyroid membrane identification by digital palpation and implications for emergency front of neck access.

Background: Emergency front of neck access in a "can't intubate can't oxygenate" scenario in pediatrics is rare. Ideally airway rescue would involve the presence of an ear, nose, and throat surgeon. If unavailable however, responsibility lies with the anesthesiologist and accurate identification of anterior neck structures is essential for success.

Accuracy of ultrasound in measurement of the pediatric cricothyroid membrane.

Background: Emergency front of neck airway is a recommended airway rescue strategy in children over 1 year old. Surgical tracheostomy is advocated as the first-line technique, but in the absence of an ear, nose and throat surgeon cricothyroidotomy or tracheostomy is proposed. Recent research shows that clinical identification of the cricothyroid membrane is frequently inaccurate in older children and adults and has prompted investigation of ultrasound as a potential clinical tool for emergency front of neck airway.

Emergency cricothyroidotomy: an observational study to estimate optimal incision position and length.

Background: A vertical incision is recommended for cricothyroidotomy when the anatomy is impalpable, but no evidence-based guideline exists regarding optimum site or length. The Difficult Airway Society guidelines, which are based on expert opinion, recommend an 80-100 mm vertical caudad to cephalad incision in the extended neck position. However, the guidelines do not advise the incision commencement point.

Cannabis Oil in an Irish Children’s Critical Care Unit.

Aims We present a case of a five-year-old female admitted postoperatively to the Paediatric Critical Care Unit with a history of refractory seizures for which her parents were administering cannabis oil. Methods We discuss the issues surrounding cannabis prescription in Ireland and the role of parental autonomy in medication selection and administration. Results An administration regime was agreed upon following discussion with the child’s parents.

Theoretical optimal cricothyroidotomy incision length in female subjects, following identification of the cricothyroid membrane by digital palpation.

Background: Misidentification of the cricothyroid membrane is frequent in females, placing them at risk of difficult or failed cricothyroidotomy in the event of failed oxygenation. If anatomy is impalpable, the current guidelines of the Difficult Airway Society, based on expert opinion, recommend an 8-10 cm vertical incision to facilitate access to the cricothyroid membrane. At present no evidence-based guideline exists regarding optimum site or length.

A preference-based approach to deriving breeding objectives: applied to sheep breeding.

Using internet-based software known as 1000Minds, choice-experiment surveys were administered to experts and farmers from the Irish sheep industry to capture their preferences with respect to the relative importance - represented by part-worth utilities - of target traits in the definition of a breeding objective for sheep in Ireland. Sheep production in Ireland can be broadly separated into lowland and hill farming systems; therefore, each expert was asked to answer the survey first as if he or she were a lowland farmer and second as a hill farmer. In addition to the experts, a group of lowland and a group of hill farmers were surveyed to assess whether, and to what extent, the groups' preferences differ from the experts' preferences.

Increased expression and co-localization of ACE, angiotensin II AT(1) receptors and inducible nitric oxide synthase in atherosclerotic human coronary arteries.

Using immunohistochemistry and quantitative in vitro autoradiography, the present study was undertaken to examine whether co-expression of pro-atherosclerotic factors, ACE, the AT(1) receptor, and iNOS, is increased in early and advanced atherosclerotic lesions of human coronary arteries. In normal coronary arteries, ACE and eNOS were strongly co-expressed in endothelial cells (ECs), whereas the AT(1) receptor was expressed in medial smooth muscle cells (SMCs). By contrast, iNOS was not expressed in ECs and SMCs.

Articular / epiphyseal osteochondrosis in Thoroughbred foals at 5 months of age: influences of growth of the foal and prenatal copper supplementation of the dam.

Aims: To determine the influence of copper (Cu) supplementation by injection of mares in late gestation on the frequency and severity of osteochondrosis (OC) lesions in their foals at around 160 days of age. To determine if there was any influence of the concentration of Cu in the liver, growth rate, birthweight, weight at 160 days of age, fatness, sex, or year of birth of the foal on the frequency and severity of OC lesions. To determine the influence of dam's age, and sex and birthweight of the foal on the growth rate from birth to 160 days of age, and weight at 160 days of age.

Enlargements of the distal third metacarpus and metatarsus in Thoroughbred foals at pasture from birth to 160 days of age.

Aims: To assess the relationship between the radiographic and microscopic appearance of the physeal regions of the distal third metacarpal (Mc3) and metatarsal (Mt3) bones of Thoroughbred foals at 160 days of age, and to clinically assess changes in contour of the distal Mc3 and Mt3 physeal regions from birth to 160 days of age. To assess relationships between maximum clinical physis scores and age, time of year, foal's sex, condition score, growth rate, copper (Cu) concentration in the liver of the foal, and supplementation of the dam with Cu in late gestation.

Methods: Dams were given Cu (n=5 and n=11, in Years 1 and 2, respectively) or saline (n=5 and n=12, in Years 1 and 2, respectively) injections in late gestation.

Osteochondrosis and copper: histology of articular cartilage from foals out of copper supplemented and non-supplemented dams.

Copper (Cu) supplementation of dams in late gestation may be protective against articular cartilage abnormalities in foals. Articular cartilage was harvested from 22 Thoroughbred foals at 160 days of age, at sites predisposed to osteochondrosis (OC), and examined for evidence of early cartilage abnormalities and established dyschondroplastic (DCP) lesions to determine if there were any significant differences due to mare Cu supplementation by injection during late gestation, or foal liver Cu concentration. Cu supplemented mares received calcium Cu edetate injections in late gestation (250 mg at around 220, 248, 276 and 304 days gestation, then every two weeks until foaling).

Bodyweights and growth rates of spring- and autumn-born Thoroughbred horses raised on pasture.

Aim: To examine the growth of spring- and autumn-born Thoroughbred foals raised on pasture.

Methods: Bodyweight and growth rates were measured in pasture-raised Thoroughbred horses, born in either spring (n=56) or autumn (n=7), from birth to approximately 13 and 17 months of age.

Results: Birthweight tended to be lower in autumn- than spring-born foals (54.

The pituitary and testicular responses to GnRH challenge between 4 and 14 months of age in thoroughbred colts born in spring and autumn.

Gonadotropin releasing-hormone analogue (buserelin) challenges were carried out every 8 weeks from 4 to 14 months of age on thoroughbred colts born in the spring (n = 6) or autumn (n = 5) to define the onset of puberty. In all colts, luteinizing hormone (LH) secretion followed a seasonal pattern, with high baseline and maximal concentrations in the spring and summer and low concentrations in the winter. Testosterone concentrations were undetectable before spring and, thus, autumn-born colts were younger than spring-born colts when a testosterone response to buserelin was first observed.

Chemical body composition of 20 Thoroughbred foals at 160 days of age, and preliminary investigation of techniques used to predict body fatness.

Aims: To determine the chemical body composition of Thoroughbred foals born in two consecutive years, and to investigate several techniques used to predict body composition in foals born in the second year, with particular reference to fat.

Methods: The chemical composition of 20 foals at around 160 days of age, born in two years, was determined. In vivo techniques to predict body composition were assessed in 23 foals born in Year 2, before and after euthanasia; 10 of these foals were used for chemical body composition analysis.

Onset of puberty in pasture-raised Thoroughbreds born in southern hemisphere spring and autumn.

Reasons For Performing Study: There is little information on age, weight and time of year of puberty in Thoroughbred horses, and the interpretation of such data is difficult due to the wide variety of descriptions of the onset of puberty.

Objectives: To examine the age, bodyweight and date of onset of puberty in Thoroughbreds born in spring and autumn.

Methods: Bodyweight data and blood samples were collected in 59 pasture-raised Thoroughbred horses.

LH and testosterone responses to five doses of a GnRH analogue (buserelin acetate) in 12-month-old Thoroughbred colts.

To determine the responsiveness of the pituitary-gonadal axis of peri-pubertal colts to GnRH, buserelin (0.5, 1, 5, 10 and 40 microg) was given to 13 male Thoroughbred yearlings ( n=3-8 colts per dose). Jugular venous blood samples were taken at -10, 0, 10, 20, 30, 40, 60, 120 and 180 min relative to buserelin administration.

Improving question formulation for use in evidence appraisal in a tertiary care setting: a randomised controlled trial [ISRCTN66375463].

Background: The specificity of clinical questions is gauged by explicit descriptions of four dimensions: subjects, interventions, comparators and outcomes of interest. This study determined whether adding simple instructions and examples on clinical question formulation would increase the specificity of the submitted question compared to using a standard form without instructions and examples.

Methods: A randomised controlled trial was conducted in an evidence-search and appraisal service.