Use of GlideScope® in adults: an overview.

This paper is an overview of the literature concerning the "know how" of the GlideScope® use in adults. We summarized the main evidences of the last 10 years with particular attention to experts' suggestions about clinical practice of the GlideScope®, noticing matters still debated on GlideScope® use. We used PubMed to search publications from January 2003 to June 2013 using the search terms "GlideScope", "video laryngoscope" and "videolaryngoscopy". These publications were searched manually or references to further publication not identified using PubMed. All works that made a point worth including were cited in the discussion. Our research confirms the value of GlideScope® use in airway management and highlights the debate about the use of videolaryngoscopes in routine cases and the operators who may use them in clinical practice.

Use of REP-PCR and 16S rRNA gene sequencing for comparison of Mannheimia haemolytica isolates obtained from fatal cases of bovine respiratory disease in the USA and Australia.

OBJECTIVE: Assess the variability of Mannheimia haemolytica isolates obtained from fatal cases of bovine respiratory disease (BRD) in the USA and Australia using repetitive sequence-based PCR (REP-PCR) and sequencing of the 16S ribosomal RNA (rRNA) gene. METHODS: We examined 22 isolates from the USA and 36 isolates from Australia using (GTG)5 and BOX-A1R REP-PCR primers, as well as sequencing a 700-base pair length of the 16S rRNA gene. The discriminatory ability of each typing method was assessed and correlation coefficients were calculated to assess concordance between the results of each approach. RESULTS: All methods appeared to discriminate among isolates, with BOX-A1R being the most sensitive and sequencing the least sensitive. Modest to moderate diversity was seen among the isolates, with as much variation within a continent as between the two. CONCLUSIONS: Using samples from diverse origins may permit extrapolation even to isolates with distant geographic and temporal relationships. Further, this information can serve as a baseline in assessing whether M. haemolytica is an opportunistic pathogen or if there are notable features that distinguish commensal isolates from those more likely to be associated with disease.

GlideScope® vs flexible fibreoptic scope for elective intubation in obese patients.

We hypothesised that in obese patients, tracheal intubation with the GlideScope® would be advantageous compared with flexible fibreoptic intubation. Seventy-five anaesthetised obese patients were randomly assigned to oral intubation by either GlideScope or flexible fibreoptic bronchoscope. We compared the two devices for time to intubate (p = 0.19), difficulty of intubation (p = 0.58), successful intubation on first attempt (p = 0.29), number of attempts (p = 0.24), incidence of hypoxaemia (p = 0.57), amount of post-intubation bleeding (p = 0.79) and sore throat (p = 0.82). None differed significantly. Median (IQR [range]) time to intubation was 37 (25-48 [19-81]) s and 95% of the first attempts were successful with the GlideScope, vs 43 (35-58 [26-96]) s and an 86% first-attempt success rate with the flexible fibreoptic bronchoscope. For experienced users, the time required to intubate the trachea in anaesthetised obese patients is similar with the GlideScope and a flexible bronchoscope.

Successful emergent reintubation using the Aintree intubation catheter and a laryngeal mask airway.

Tracheal extubation can be potentially catastrophic, especially in patients with difficult airways. This article describes a case where planned extubation in a patient with a large tongue lesion led to complete airway obstruction and subsequent cardiac arrest. Reintubation was facilitated using a laryngeal mask airway and an Aintree intubation catheter.

Imaging of hepatic infections.

Imaging plays a significant role in the detection, characterization and treatment of hepatic infections. Infectious diseases of the liver include pyogenic and amoebic abscesses and parasitic, fungal, viral and granulomatous infections. With increases in worldwide travel, immunosuppression and changing population demographics, identification of cases of hepatic infection is becoming more common in daily practice. Knowledge of the imaging features seen with hepatic infections can assist in early diagnosis and timely initiation of appropriate therapy. This review presents the imaging appearances of hepatic infections, emphasizing specific features that may contribute to the diagnosis. Examples of the imaging findings seen with pyogenic and amoebic abscesses, infection with Echinococcus granulosus (Hydatid), schistosomiasis, candidiasis and tuberculosis (TB) are presented.

Modeling a medical environment: an ontology for integrated medical informatics design.

Modern medical environments have seen an increase in technological complexity and pressures of handling more patients with fewer resources, resulting in higher demands on medical practitioners. Medical informatics designers will have to focus on the problem of organizing medical information more effectively to enable practitioners to cope with these challenges. This article addresses this research problem for the particular area of medical problem solving in patient care. First, we describe a traditional modeling approach for medical reasoning used as a basis for developing some decision support systems. We argue these models may be faithful to what is known about biomedical knowledge, but they have limitations for human problem solving, especially in unanticipated situations. Second, we present an ontological framework, known as the abstraction hierarchy (Rasmussen, IEEE Trans. Man. Cybernetics 15 (1985) 234-243), for integrating patient representations that are faithful to existing biomedical knowledge and that are consistent with what is known about human problem solving. Through an example of a critical event in the operating room, we reveal how this framework can support medical problem solving in unanticipated situations. Third, we show how to use these representations as a frame of reference for mapping medical roles, responsibilities, sensors, and controls in an operating room context. Finally, we provide some insight for medical informatics designers in using this framework to design novel training programs and human-computer displays.