PubMed Health⌕ Search

Biomedical subjects

M St Pierre

Publications and source records attributed to M St Pierre.

At least 19 recordsLinked to original sources
PubMed2004

[Simulator-based modular human factor training in anesthesiology. Concept and results of the module "Communication and Team Cooperation"].

BACKGROUND: Human factors (HF) play a major role in crisis development and management and simulator training can help to train HF aspects. We developed a modular training concept with psychological intensive briefing. The aim of the study was to see whether learning and transfer in the treatment group (TG) with the module "communication and team-cooperation" differed from that in the control group (CG) without psychological briefing ("anaesthesia crisis resource management type course"). METHODS: A total of 34 residents (TG: n=20, CG: n=14) managed 1 out of 3 scenarios and communication patterns and management were evaluated using video recordings. A questionnaire was answered at the end of the course and 2 months later participants were asked for lessons learnt and behavioral changes. RESULTS: Good communication and medical management showed a significant correlation (r=0.57, p=0.001). The TG showed greater initiative ( p=0.001) and came more often in conflict with the surgeon ( p=0.06). The TG also reported more behavioral changes than the CG 2 months later. The reported benefit of the simulation was training for rare events in the CG, whereas in the TG it was issues of communication and cooperation ( p=0.001). CONCLUSIONS: A training concept with psychological intensive briefing may enhance the transfer of HF aspects more than classical ACRM.

Anesthesia↗
PubMed2002

[Recovery from anaesthesia and incidence and intensity of postoperative nausea and vomiting following a total intravenous anaesthesia (TIVA) with S-(+)-ketamine/propofol compared to alfentanil/propofol].

BACKGROUND: Opioids contribute to postoperative nausea and vomiting (PONV). An intraoperative analgesia with S-(+)-ketamine will make opioid administration dispensable and may reduce postoperative analgesic requirements. The aim of the study was to record the incidence and intensity of PONV following a total intravenous anesthesia (TIVA) with S-(+)-ketamine/propofol (K/P) or alfentanil/propofol (A/P) as well as recovery from anaesthesia. PATIENTS AND METHODS: A total of 145 patients received a TIVA with K/P or A/P. Recovery time,PONV, intensity of pain and overall acceptance of the delivered anaesthesia were recorded. RESULTS: Recovery times were prolonged in the K/P group. Both groups had a comparable incidence of PONV (26% and 22% for K/P vs A/P, respectively), the intensity was low in both groups with a VAS of <6/100 mm at all times. The intensity of postoperative pain and analgesic requirement did not differ. Overall acceptance of the delivered anaesthesia was lower in the K/P group. Unpleasant dreams were not more common in the K/P group. CONCLUSIONS: A TIVA with K/P did not reduce PONV when compared to A/P, but prolonged recovery.

Adolescent↗
PubMed2001

Partner understanding of the breast and prostate cancer experience.

PURPOSE: This exploratory study was designed to examine partners' understanding of patients' experience with prostate or breast cancer and to assess the congruence between patient and partner perceptions regarding social support and the cancer experience. METHODS: Partner understanding of patient mood was assessed by comparing the Profile of Mood States (POMS) questionnaire scores of patients with the POMS scores of their partners (who were instructed to complete the questionnaire as patient proxies). A semistructured interview with corresponding questions for patients and partners assessed the congruency between patient and partner perceptions regarding social support and the cancer experience. RESULTS AND CONCLUSIONS: Twenty-three couples participated. Eight couples were woman with breast cancer and their husbands, and 15 couples were men with prostate cancer and their wives. The patients with breast cancer and their partners were an average age of 48 years and had been married for 20 years, while the patients with prostate cancer and their partners were 67 years of age and had been married for 40 years, on average. Overall, female partners possessed a more accurate understanding of their husbands' experience with prostate cancer than male partners had of women's breast cancer experience. These men tended to overestimate the breast cancer patients' self-reported levels of distress. Patient and partner perceptions regarding social support in the relationship and the cancer experience were also more congruent in prostate couples than in breast couples. This may be a factor not only of gender but also of age and the length of time that these couples had been together, which was twice as long for the prostate couples. Overall, however, patients were well adjusted and felt understood by their partners and satisfied with the support their partners provided.

Affect↗
PubMed2000

Awareness during laryngoscopy and intubation: quantitating incidence following induction of balanced anesthesia with etomidate and cisatracurium as detected with the isolated forearm technique.

STUDY OBJECTIVE: To measure the incidence of awareness during induction of anesthesia with etomidate and fentanyl, and to model its frequency as a function of dose of etomidate. DESIGN: Prospective cohort study. SETTING: Anesthesia department of a university hospital. PATIENTS: 30 ASA physical status I, II, and III patients undergoing elective general surgery. INTERVENTIONS: Patients were assigned to one of three groups of etomidate (0.2 mg/kg, 0.3 mg/kg, 0.4 mg/kg) and received fentanyl (2 microg/kg) and 2 x ED(95) of cisatracurium (0.1 mg/kg). Neuromuscular block was monitored with a peripheral nerve stimulator. Intubation was performed after maximum T(1)-depression. To identify awareness, the isolated forearm technique (IFT) was used. The IFT was performed by prompting the patient every 20 seconds. Only a verified response was considered a positive IFT response. Anesthesia was maintained with isoflurane in oxygen/air and fentanyl. MEASUREMENTS AND MAIN RESULTS: Maximum neuromuscular block occurred after 352 +/- 96 seconds and intubation was performed 424 +/- 86 seconds after loss of consciousness (LOC). Awareness was dose dependent: 80% of patients receiving 0.2 mg/kg etomidate, 70% of patients receiving 0.3 mg/kg etomidate, and 20% of patients receiving 0.4 mg/kg etomidate had a positive IFT response. Awareness occurred in one patient 3 minutes after LOC, in 65% during laryngoscopy, and in 30% within the following 120 seconds. One patient had explicit recall without finding awareness unpleasant. Hemodynamic parameters did not differ between patients with a positive or a negative IFT response. CONCLUSIONS: The incidence of awareness during bolus induction can be modeled as dose dependent. However, when combining a short-acting induction drug and a delayed-onset neuromuscular blocker, the continuous infusion of the hypnotic drug may prevent awareness during induction.

Adult↗
PubMed2000

Does etomidate increase postoperative nausea? A double-blind controlled comparison of etomidate in lipid emulsion with propofol for balanced anaesthesia.

In a double-blind randomized study, the incidence and severity of postoperative nausea and vomiting was investigated with a new formulation of etomidate (Etomidate-(R)Lipuro, B. Braun Melsungen AG, Germany) compared with propofol for induction of a balanced anaesthesia with isoflurane/fentanyl in air. The incidence and intensity of nausea was examined by use of a visual analogue scale (VAS; 0-100 mm) at 1, 2, between 6 and 8, and 24 h postoperatively. One-hundred-and-sixty-four patients undergoing orthopedic procedures were studied. For etomidate vs. propofol, 14.6% vs. 14.2% male and 26.8% vs. 27.5% female patients were nauseated during the first two postoperative hours. The median rating for nausea remained below 5 mm at any time in both groups, i.e. the intensity of nausea was very low. The incidence of vomiting was higher in women receiving etomidate (26.8% vs. 10%). We conclude that etomidate does not increase nausea during the early postoperative period.

Adult↗
PubMed2000

Home health PPS: new payment system, new hope.

In light of the financial turmoil most home health providers experienced over the past two years, a new payment system brings a sense of hope. The prospective payment methodology will provide different incentives than a cost-based reimbursement system. These new incentives will open the way for new approaches to deliver home health care. However, this new hope is accompanied by a sense of anxiety because the system is new and untested.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2000

How will PPS realign financial incentives and care? An indepth panel discussion by NAHC experts. National Association for Home Care.

The new prospective payment system (PPS) that will take effect for Medicare-participating agencies on October 1, 2000 will create a dramatic change in the culture of home care that has existed since the inception of the home care benefit in 1965. Will these changes be for the better or for the worse? Who will be the winners, and who will be the losers? How will these incentives change the behavior of home care agencies and the caregivers they employ in their efforts to provide health care to the infirm and disabled?

Aged↗
PubMed1999

A look to the future. Home health PPS.

HCFA continues to move toward its goal of implementing a per-episode prospective payment system for home health care. What is in store for agencies, and how can they be prepared for all of the changes that will come when the shift from the current interim payment system to the new model is complete? If they are to thrive, agencies must understand the background behind IPS and PPS and what the future holds.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1999

Interim payment system and risk management.

Agencies need to be aware of the legal implications of the Medicare reimbursement system changes in the high-risk areas of patient care. Agencies must take deliberate steps to manage the risks that are sure to ensue under the new system of restricted payments and to minimize liability concerns.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1998

Interim Payment System and risk management.

To stay afloat under the new Interim Payment System, agencies will need to be aware of the legal implications of the new changes. Agencies need to take deliberate steps to manage the risks that are sure to ensue under the new system of restricted payments.

Budgets↗