Notes

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Lidocaine and magnesium sulfate have become increasingly utilized in general anesthesia. The present study evaluated the effects of these drugs, isolated or combined, on hemodynamic parameters as well as on the cisatracurium-induced neuromuscular blockade (NMB).

At a university hospital, 64 patients, ASA physical status I and II, undergoing elective surgery with similar pain stimuli were randomly assigned to four groups. Patients received a bolus of lidocaine and magnesium sulfate before the tracheal intubation and a continuous infusion during the operation as follows 3 mg.kg
and 3 mg.kg
.h
(lidocaine - L group), 40 mg.kg
and 20 mg.kg
.h
(magnesium - M group), equal doses of both drugs (magnesium plus lidocaine - ML group), and an equivalent volume of isotonic solution (control - C group). Hemodynamic parameters and neuromuscular blockade features were continuously monitored until spontaneous recovery of the train of four (TOF) ratio (TOFR > 0.9).

The magnesium sulfate significantly prolonge use of these drugs by encouraging their association in multimodal anesthesia or other therapeutic purposes.

NCT02483611 (registration date 06-29-2015).
NCT02483611 (registration date 06-29-2015).
Most patients nearing the end of life can benefit from a palliative approach in primary care. We currently do not know how to measure a palliative approach in family practice. The objective of this study was to describe the provision of a palliative approach and evaluate clinicians' perceptions of the results.

We conducted a descriptive study of deceased patients in an interprofessional team family practice. Lomeguatrib We integrated conceptual models of a palliative approach to create a chart review tool to capture a palliative approach in the last year of life and assessed a global rating of whether a palliative approach was provided. Clinicians completed a questionnaire before learning the results and after, on perceptions of how often they believed a palliative approach was provided by the team.

Among 79 patients (mean age at death 73years, 54% female) cancer and cardiac diseases were the top conditions responsible for death. One-quarter of patients were assessed as having received a palliative approach. 53% of decedents had a documented discussion about goals of care, 41% had nurse involvement, and 15.2% had a discussion about caregiver well-being. These indicators had the greatest discrimination between a palliative approach or not. Agreement that elements of a palliative approach were provided decreased significantly on the clinician questionnaire from before to after viewing the results.

This study identified measurable indicators of a palliative approach in family practice, that can be used as the basis for quality improvement.
This study identified measurable indicators of a palliative approach in family practice, that can be used as the basis for quality improvement.
In 2007, the Faculty of Medical Sciences, University of Sri Jayewardenepura revised its medical curriculum from discipline-based to one that was student-centered and integrated. This study aimed to evaluate the perceptions of students regarding the educational environment and compare them to those prior to curricular revision.

The Dundee Ready Education Environment Measure (DREEM) questionnaire was administered to all volunteering students enrolled in the medical degree programme at the time of the study (n = 595). Results were compared to DREEM scores obtained prior to curricular revision.

The overall DREEM score and sub-scale scores were positive and showed improvement compared to previous scores. The score for Students' Perceptions of Atmosphere showed progression from 'there are many issues which need changing' to the next highest category 'a more positive attitude'. The mean scores in pre-clinical, para-clinical and clinical phases also showed an improvement. 'The teachers are knowledgeable' was the highest rated item overall and within each phase of learning. All sub-scales were rated highest by pre-clinical students and lowest by para-clinical students, in contrast to previous results where such patterns were not observed. Certain items, especially those related to teaching/learning, received exclusively low scores in particular student subsets.

Students' perceptions towards the educational environment overall, have improved following curricular revision. However, certain negative areas warranting further evaluation were highlighted.
Students' perceptions towards the educational environment overall, have improved following curricular revision. However, certain negative areas warranting further evaluation were highlighted.
Intravenous bolus injection of fentanyl has been frequently reported to be associated with cough reflex during patient anesthesia. However, the search for the most effective protocol continues. This study aimed to compare the effect of reducing cough reflex after injection of fentanyl in a fusion protocol by combining the injections of lidocaine and Huffing maneuver and comparing with a placebo control group, before anesthesia induction.

This prospective randomized controlled trial study was performed on 400 patients who were divided into four groups of combined protocol (group 1), lidocaine group (group 2), Huffing maneuver group (group 3), and the control receiving normal saline (group 4). Then patients were injected with 2. 5 μg /kg fentanyl and monitored for 2 min regarding their cough reflex, as well as the severity.

In group one, 9 patients (9%), in group two, 45 patients (45%), 22 patients (22%) in group three, and in group four, 75 patients (75%), developed cough reflex following fentanyl injection. Also, 13 patients (13%) developed moderate and 4 (4%) developed severe coughs in the control group reported, while no reports of severe or moderate cough were among the intervention groups. There was a significant difference between the intervention group and the control group both in terms of the rate and severity of the fentanyl-induced cough.

By using a combination of lidocaine injection along and Huffing maneuver, better results can be obtained in reducing the frequency, and also the severity of cough followed by fentanyl injection.

The trial was registered with IRCT.IR (09/03/2018-No. IRCT20141009019470N74 ).
The trial was registered with IRCT.IR (09/03/2018-No. IRCT20141009019470N74 ).
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