Body temperature measurement in anesthetized dogs - comparison of nasal, axillary, rectal and esophageal temperature.

OBJECTIVE: To evaluate different methods of monitoring body temperature in anesthetized dogs with comparison to core temperature obtained via esophageal probe. METHODS: Client-owned dogs undergoing general anesthesia for various procedures were included in this observational study. The temperature was taken sequentially every 10 minutes from the rectum, axilla, and nasal cavity with a digital thermistor thermometer, and compared to esophageal core temperature via paired t-tests. Differences from the gold standard esophageal temperature were assessed via Bland-Altman plots and further evaluated for factors like time under anesthesia and presence of Hypo-/Normo- or Hyperthermia. In addition, it was analyzed whether a correction factor for peripheral measurement sites (nasal cavity and axilla) would be applicable in a reliable representation of the body temperature. The level of significance in all tests was set at p<0.05. RESULTS: In this study, 95 simultaneous temperature measurements at the 4 different sites were obtained from 30 dogs. Mean difference and limits of agreement from esophageal temperature for the different measurement methods were 0.0±0.72°C for rectal temperature, -1.2±1.42°C for axillary and -1.0±2.02°C for nasal temperature. Axillary and nasal temperatures were not significantly different (p=0.5721 and p=0.9287, respectively) from esophageal temperature with a +1.2°C and +1°C correction factor, respectively. CONCLUSION AND CLINICAL RELEVANCE: During perioperative temperature measurement in anesthetized patients, rectal and esophageal measurements can be used interchangeable. However, if these are not available, the use of axillary or nasal sites is only reliable after applying a correction factor.

Application of systems analysis to safety incident investigations in a single centre using anaesthesia as an example.

BACKGROUND: Systems analysis is widely recommended for patient safety investigations in medicine, but the method is poorly described in the veterinary literature. METHODS: Anaesthetic safety incidents were discussed in debriefs and then reported on standardised forms. Investigators performed informal interviews with team members involved in case management and interrogated clinical records. Finally, incidents were discussed during morbidity and mortality conferences. Systems analysis involved developing a timeline for the case, identifying any care delivery problems (CDPs) that occurred and contributing factors associated with them, and developing control measures to reduce system weaknesses. RESULTS: From 15 incidents, 32 CDPs were identified. These were categorised into 11 thematic groups. Misdiagnosis (n = 8), human resource allocation (n = 8), failure in planning (n = 6) and technical error (n = 5) were most frequent. Individual factors were identified in 15 (100%), team factors in 12 (80.0%), animal and owner factors in 11 (73.3%), organisation factors in 10 (66.7%), work environmental factors in 10 (66.7%) and task and technology factors in four (26.7%) investigations. Numerous immediate and longer term recommendations were made regarding how to manage systems weaknesses. LIMITATIONS: Investigations were limited to pre-procedural anaesthetic safety incidents. CONCLUSIONS: Systems analysis applied to incident investigations can highlight areas for improvement within veterinary healthcare systems.

Behavioral Outcomes Following Brain-Computer Interface Intervention for Upper Extremity Rehabilitation in Stroke: A Randomized Controlled Trial.

Stroke is a leading cause of persistent upper extremity (UE) motor disability in adults. Brain-computer interface (BCI) intervention has demonstrated potential as a motor rehabilitation strategy for stroke survivors. This sub-analysis of ongoing clinical trial (NCT02098265) examines rehabilitative efficacy of this BCI design and seeks to identify stroke participant characteristics associated with behavioral improvement. Stroke participants (n = 21) with UE impairment were assessed using Action Research Arm Test (ARAT) and measures of function. Nine participants completed three assessments during the experimental BCI intervention period and at 1-month follow-up. Twelve other participants first completed three assessments over a parallel time-matched control period and then crossed over into the BCI intervention condition 1-month later. Participants who realized positive change (≥1 point) in total ARAT performance of the stroke affected UE between the first and third assessments of the intervention period were dichotomized as "responders" (<1 = "non-responders") and similarly analyzed. Of the 14 participants with room for ARAT improvement, 64% (9/14) showed some positive change at completion and approximately 43% (6/14) of the participants had changes of minimal detectable change (MDC = 3 pts) or minimally clinical important difference (MCID = 5.7 points). Participants with room for improvement in the primary outcome measure made significant mean gains in ARATtotal score at completion (ΔARATtotal = 2, p = 0.028) and 1-month follow-up (ΔARATtotal = 3.4, p = 0.0010), controlling for severity, gender, chronicity, and concordance. Secondary outcome measures, SISmobility, SISadl, SISstrength, and 9HPTaffected, also showed significant improvement over time during intervention. Participants in intervention through follow-up showed a significantly increased improvement rate in SISstrength compared to controls (p = 0.0117), controlling for severity, chronicity, gender, as well as the individual effects of time and intervention type. Participants who best responded to BCI intervention, as evaluated by ARAT score improvement, showed significantly increased outcome values through completion and follow-up for SISmobility (p = 0.0002, p = 0.002) and SISstrength (p = 0.04995, p = 0.0483). These findings may suggest possible secondary outcome measure patterns indicative of increased improvement resulting from this BCI intervention regimen as well as demonstrating primary efficacy of this BCI design for treatment of UE impairment in stroke survivors. Clinical Trial Registration: ClinicalTrials.gov, NCT02098265.