Acoustic Shadowing to Facilitate Ultrasound Guided Arterial Cannulation: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Aim and background: Ultrasound-guided arterial catheterization is a frequently performed procedure. Additional techniques such as acoustic shadowing-assisted ultrasound may be useful in improving success rate. This systematic review aimed to assess the efficacy of acoustic shadowing assisted ultrasound for arterial catheterization. Materials and methods: PubMed, Medline, EMBASE, Cochrane Library, EMCARE, and MedNar were searched in January 2024. Randomized controlled trials comparing the first attempt success rate of arterial catheterization using acoustic shadowing ultrasound vs unassisted ultrasound were included. Data were pooled for risk ratios (RRs) using the random-effects model. Subgroup analysis was conducted based on a single or double acoustic line. Sensitivity analysis was undertaken after excluding pediatric data. The certainty of evidence (COE) was assessed using the GRADE framework. Results: Six randomized controlled trials (n = 777) were included. A meta-analysis found the first attempt success rate is significantly higher in the acoustic ultrasound group (n = 6, RR: 0.47, 95% CI: 0.34-0.66, p ≤ 0.00001). Hematoma formation was significantly less in the acoustic ultrasound group (n = 6, RR: 0.52, 95% CI: 0.34-0.80, p = 0.003). First attempt success was significantly higher in the single acoustic line ultrasound (USG) group compared to the unassisted ultrasound group (n = 3, RR: 0.41, 95% CI: 0.28-0.59, p ≤ 0.00001). Sensitivity analysis after excluding pediatric data was similar to the primary analysis (n = 5, RR: 0.50, 95% CI: 0.33-0.70, p ≤ 0.00001). Certainty of evidence was "Moderate" for the first attempt cannulation. Conclusions: Acoustic shadowing-assisted ultrasound improved first-attempt arterial catheterization success rate and was associated with reduced hematoma formation. How to cite this article: Mishra L, Rath C, Wibrow B, Anstey M, Ho K. Acoustic Shadowing to Facilitate Ultrasound Guided Arterial Cannulation: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2024;28(7):677-685.

Eisenmenger's syndrome in pregnancy: Use of epidural anesthesia and analgesia for elective cesarean section.

We describe a case of a pregnant patient with a large ventricular septal defect (VSD) and pulmonary artery hypertension, presented to the hospital and underwent elective cesarean section under epidural anesthesia and postoperative analgesia. The procedure was uneventful till the patient was discharged on 10(th) day.

Bilateral transversus abdominis plane block as a sole anesthetic technique in emergency surgery for perforative peritonitis in a high risk patient.

Although transversus abdominis plane (TAP) block is an effective way of providing analgesia in post-operative abdominal surgery patients; however, it can be considered as an anesthetic technique in high-risk cases for surgery. We report a case of a geriatric female with chronic obstructive pulmonary disease in the respiratory failure, hypotension, posted in an emergency with old perforation leading to peritonitis. The surgery was successfully conducted under bilateral TAP block, which was used as a sole anesthetic technique. TAP block can be considered as an anesthetic technique for abdominal surgery in moribund patients.

Incidence of factor XII deficiency in critically ill patients with a prolonged activated partial thromboplastin time: a prospective observational study.

Limited data is available on factor XII deficiency in critically ill patients with prolonged activated partial thromboplastin time (aPTT). The association of factor XII deficiency with an increased risk of thromboembolism is unclear. This prospective observational study assessed the incidence of factor XII deficiency among critically ill patients with prolonged aPTT (>40 s), whether factor XII deficiency manifesting as prolonged aPTT was associated with an increased risk of thromboembolism, and clotting time on a viscoelastic (ROTEM) test was useful to predict factor XII deficiency. Of the 40 included patients, 48% [95% confidence interval (CI) 33-63) had a factor XII deficiency (mean ±â€Šstandard deviation of factor XII level of all patients: 54% ±â€Š29%). Factor XII levels were not significantly correlated with the measured aPTT ( r  = -0.163, P  = 0.315). Factor XII deficiency was significantly more common in patients who were less critically ill ( P  = 0.027), but it was not significantly related to Disseminated Intravascular Coagulation scores ( P  = 0.567). The incidence of symptomatic venous thromboembolism ( P  = 0.246), allogeneic blood transfusion ( P  = 0.816), and hospital mortality ( P  = 0.201) were not significantly different between those with and without factor XII deficiency. The clotting time on the viscoelastic test was not predictive of factor XII deficiency (area under the receiver-operating characteristic = 0.605, P  = 0.264). Factor XII deficiency was common in critically ill patients with a prolonged aPTT. There was no association between factor XII deficiency and risk of thromboembolism. The clotting time on ROTEM was not predictive of the presence of factor XII deficiency.

Wanted: interdisciplinary, multidisciplinary, and knowledge translation and exchange training for students of public health.

Students vocalized their concern with public health training programs in Canada at the 2010 CPHA Centennial Conference. Given these concerns, we reviewed the objectives and curricula of public health graduate (master's) programs in Canada. Our objective was to understand to what extent public and population health graduate programs in Canada support interdisciplinary, multidisciplinary and knowledge translation and exchange (KTE) training. This was achieved through a review of all public and population health master's programs in Canada identified from the public health graduate programs listed on the Public Health Agency of Canada website (n = 33) plus an additional four programs that were not originally captured on the list. Of the 37 programs reviewed, 28 (76%) stated that interdisciplinary, multidisciplinary or cross-disciplinary training opportunities are of value to their program, with 12 programs (32%) providing multidisciplinary or interdisciplinary training opportunities in their curriculum. Only 14 (38%) of the 37 programs provided value statements of KTE activities in their program goals or course objectives, with 10 (27%) programs offering KTE training in their curriculum. This review provides a glimpse into how public health programs in Canada value and support interdisciplinary and multidisciplinary collaboration as well as KTE activities.

An integrated model of social environment and social context for pediatric rehabilitation.

UNLABELLED: This article considers the conceptualization and operationalization of "social environment" and "social context" with implications for research and practice with children and youth with impairments. We first discuss social environment and social context as constructs important for understanding interaction between external environmental qualities and the individual's experience. The article considers existing conceptualizations within psychological and sociological bodies of literature, research using these concepts, current developmental theories and issues in the understanding of environment and participation within rehabilitation science. We then describe a model that integrates a person-focused perspective with an environment-focused perspective and that outlines the mechanisms through which children/youth and social environment interact and transact. Finally, we consider the implications of the proposed model for research and clinical practice. This conceptual model directs researchers and practitioners toward interventions that will address the mechanisms of child-environment interaction and that will build capacity within both children and their social environments, including families, peers groups and communities. Health is created and lived by people within the settings of their everyday life; where they learn, work, play, and love [p.2]. IMPLICATIONS FOR REHABILITATION: Understanding how social environment and personal factors interact over time to affect the development of children/youth can influence the design of services for children and youth with impairments. The model described integrates the individual-focused and environment-focused perspectives and outlines the mechanisms of the ongoing reciprocal interaction between children/youth and their social environments: provision of opportunities, resources and supports and contextual processes of choice, active engagement and collaboration. Addressing these mechanisms could contribute to creating healthier environments in which all children, including children with impairments, have experiences that lead to positive developmental benefits.

Constitutional rights to health, public health and medical care: the status of health protections in 191 countries.

United Nations (UN) member states have universally recognised the right to health in international agreements, but protection of this right at the national level remains incomplete. This article examines the level and scope of constitutional protection of specific rights to public health and medical care, as well as the broad right to health. We analysed health rights in the constitutions of 191 UN countries in 2007 and 2011. We examined how rights protections varied across the year of constitutional adoption; national income group and region; and for vulnerable groups within each country. A minority of the countries guaranteed the rights to public health (14%), medical care (38%) and overall health (36%) in their constitutions in 2011. Free medical care was constitutionally protected in 9% of the countries. Thirteen per cent of the constitutions guaranteed children's right to health or medical care, 6% did so for persons with disabilities and 5% for each of the elderly and the socio-economically disadvantaged. Valuable next steps include regular monitoring of the national protection of health rights recognised in international agreements, analyses of the impact of health rights on health outcomes and longitudinal multi-level studies to assess whether specific formulations of the rights have greater impact.