End-tidal capnometry during emergency department procedural sedation and analgesia: a randomized, controlled study.

BACKGROUND: This prospective, randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry (ETC) to pulse oximetry (PO) in patients undergoing procedural sedation and analgesia (PSA) in the emergency department (ED). METHODS: The patients were randomized to monitoring with or without ETC in addition to the current standard of care. Primary endpoints included respiratory adverse events, with secondary endpoints of level of sedation, hypotension, other PSA-related adverse events and patient satisfaction. RESULTS: Of 986 patients, 501 were randomized to usual care and 485 to additional ETC monitoring. In this series, 48% of the patients were female, with a mean age of 46 years. Orthopedic manipulations (71%), cardioversion (12%) and abscess incision and drainage (12%) were the most common procedures, and propofol and fentanyl were the sedative/analgesic combination used for most patients. There was no difference in patients experiencing de-saturation (SaO2<90%) between the two groups; however, patients in the ETC group were more likely to require airway repositioning (12.9% vs. 9.3%, P=0.003). Hypotension (SBP<100 mmHg or <85 mmHg if baseline <100 mmHg) was observed in 16 (3.3%) patients in the ETC group and 7 (1.4%) in the control group (P=0.048). CONCLUSIONS: The addition of ETC does not appear to change any clinically significant outcomes. We found an increased incidence of the use of airway repositioning maneuvers and hypotension in cases where ETC was used. We do not believe that ETC should be recommended as a standard of care for the monitoring of patients undergoing PSA.

End-tidal capnometry during emergency department procedural sedation and analgesia: a randomized, controlled study / 世界急诊医学杂志（英文）

@#BACKGROUND:This prospective, randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry (ETC) to pulse oximetry (PO) in patients undergoing procedural sedation and analgesia (PSA) in the emergency department (ED). METHODS:The patients were randomized to monitoring with or without ETC in addition to the current standard of care. Primary endpoints included respiratory adverse events, with secondary endpoints of level of sedation, hypotension, other PSA-related adverse events and patient satisfaction. RESULTS:Of 986 patients, 501 were randomized to usual care and 485 to additional ETC monitoring. In this series, 48％ of the patients were female, with a mean age of 46 years. Orthopedic manipulations (71％), cardioversion (12％) and abscess incision and drainage (12％) were the most common procedures, and propofol and fentanyl were the sedative/analgesic combination used for most patients. There was no difference in patients experiencing de-saturation (SaO2<90％) between the two groups; however, patients in the ETC group were more likely to require airway repositioning (12.9％ vs. 9.3％,P=0.003). Hypotension (SBP<100 mmHg or <85 mmHg if baseline <100 mmHg) was observed in 16 (3.3％) patients in the ETC group and 7 (1.4％) in the control group (P=0.048). CONCLUSIONS:The addition of ETC does not appear to change any clinically significant outcomes. We found an increased incidence of the use of airway repositioning maneuvers and hypotension in cases where ETC was used. We do not believe that ETC should be recommended as a standard of care for the monitoring of patients undergoing PSA.

Patient management in the emergency department by advanced care paramedics.

We describe an emergency department process using Advanced Care Paramedics in the management of patients identified as ambulatory and low acuity, or those able to be managed without an emergency nurse. Patients streamed in this way had shorter stays than other emergency patients, without affecting the care of the latter. The process was associated with improved patient flow indicators in spite of an increased patient burden.

Comparison of plaque removing ability of one standard and two flexible-head toothbrushes.

PURPOSE: This pilot study compared the plaque removing ability of two flexible-head toothbrushes and one nonflexible-head toothbrush. METHODS: Twenty individuals meeting specific criteria participated. Three quadrants on each subject were disclosed and scored using the Turesky modification of the Quigley-Hein plaque index. For consistency, one dental hygienist performed all brushing and another performed all indices. Pre- and post-brushing scores were compared using t-tests and analysis of variance (ANOVA) to determine differences. RESULTS: Differences between pre- and post-brushing scores of all groups were significant (p > 0.005). However, no significant differences were detected between mean scores of the test toothbrush groups and the control group of the two test toothbrush groups, or among the means of all groups. CONCLUSION: No differences in plaque removing ability were found between or among the toothbrushes tested.

Effects of an antimicrobial additive to toothbrushes on residual periodontal pathogens.

OBJECTIVE: Previous studies have reported the link between residual microbial contamination of toothbrushes and periodontal diseases. The goal of this pilot study was to evaluate the effects of an antimicrobial additive (Microban) to toothbrushes on residual retention of periodontal pathogens. METHODOLOGY: Twenty patients had one side of their mouths brushed with a toothbrush containing the antimicrobial agent (experimental side), and the other side with a toothbrush containing no agent (control). Toothbrushes were air-dried (25 degrees C) for four or 24 hours. Toothbrush heads were vortexed and cultured for Prevotella species (Ps), Porphyromonas gingivalis (Pg), Actinobacillus actinomycetemcomitans (Aa), and non-specific colony-forming units (NS). The plates were incubated and counted. Means and standard deviations were calculated, and data were analyzed using a series of t-tests (paired and unpaired) and Wilcoxon matched-pairs signed-rank test. RESULTS: No significant inter- or intra-group differences in mean counts were found; however, when four-hour and 24-hour data for Aa, Pg, or NS were combined, experimental counts were lower than controls in 39/50 (78%) of the matched pairs (Wilcoxon signed-rank test p = 0.01). CONCLUSION: Toothbrushes containing the antimicrobial additive showed lower microbial counts than those without, but between-group means were not statistically significant.

Diversity, cultural sensitivity, unequal treatment, and sexual harassment in a school of dental hygiene.

PURPOSE: The purpose of this study was to assess the cultural environment in the School of Dental Hygiene at the University of Texas Dental Branch (UTDB) at Houston. METHODS: A 36-item questionnaire was developed and administered to first- (DH1; n=34) and second-year (DH2, n=33) dental hygiene students. Questions explored satisfaction with diversity and interactions with faculty, staff, patients, and other students relative to gender, ethnicity/race, age, and sexual orientation. Data were analyzed using 2x3 and 2x5 contingency tables to calculate the chi square test statistic. RESULTS: Ninety-one percent of the 67 DH students responded. While the majority of students reported satisfaction with the cultural diversity and their interactions at UTDB at Houston, 76% of the DH2 students and 62% of the DH1 students reported that the curriculum did not prepare them to work with patients whose primary language is not English. Eighty-two percent of DH1 students and 59% of DH2 students reported that the curriculum did not prepare them to work with patients with different sexual orientations and religious backgrounds. The DH2 students reported unequal treatment by faculty of another gender (24%) and ethnicity (21%), and sexual harassment by other students (6%). DH1 reported 6%, 12%, and 0%, respectively. CONCLUSION: Data indicate that dental hygiene students in the UTDB at Houston dental hygiene program experienced unequal treatment and sexual harassment by either faculty, staff, patients, or other students. To create a more culturally sensitive environment, the students, faculty, and staff could benefit from training on diversity, cross-cultural competence and awareness, and sexual harassment prevention and management. The dental hygiene curriculum should be reviewed for the inclusion of topics related to diversity, cultural competence, and sexual harassment.

Effects of four prophylaxis pastes on surface roughness of a composite, a hybrid ionomer, and a compomer restorative material.

PURPOSE: This study was undertaken to compare the effects of three prophylaxis pastes (Nupro with coarse, medium, or fine pumice) with a new paste (Clinpro with perlite) on the surface roughness of a resin composite (Dyract AP), a hybrid ionomer (Fuji II LC), and a compomer (TPH Spectrum). MATERIALS AND METHODS: Twenty disks (2 mm thick x 10 mm in diameter) of each material were prepared in split molds and stored for 24 hours at 37 degrees C in a 100% relative humidity humidistat. Baseline Mylar surface roughness values were determined. A single operator polished each specimen for 10 seconds with each paste. Five tracings of each specimen of surface roughness (Ra, microm) were made using a surface profilometer. Means and standard deviations were calculated, and analyzed by two-way analysis of variance (three restorative materials and four prophylaxis pastes as factors) and compared using Tukey-Kramer intervals calculated at the 0.05 level of significance. RESULTS: Analysis of variance showed significant differences among restorative materials (after polishing) and prophylaxis polishing agents. Tukey-Kramer intervals for comparisons were 0.04 and 0.05 microm, respectively. All polishing agents produced significant increased roughness compared with baseline, yielding the following results (X + SD, microm) for the three restorative materials (Fuji II LC, TPH Spectrum, Dyract AP): perlite, 0.16 +/- 0.07, 0.28 +/- 0.26, 0.79 +/- 0.64; course pumice, 0.36 +/- 0.17, 0.48 +/- 0.25, 0.88 +/- 0.46; medium pumice, 0.26 +/- 0.10, 0.35 +/- 0.30, 0.46 +/- 0.21; and fine pumice, 0.16 +/- 0.06, 0.34 +/- 0.30, 0.42 +/- 0.24). Fine pumice and perlite produced the least roughness on the hybrid ionomer, medium and fine pumice on the resin composite, and perlite on the compomer. CLINICAL SIGNIFICANCE: Since prophylaxis pastes have the potential to increase the surface roughness of resin composite, hybrid ionomer, and compomer restorative materials, routine polishing during prophylaxis should be avoided.