Maximum airway inflation pressure achievable before a significant leak occurs.

Airway Control

The use of the PSA extraglottic airway for routine general anesthesia will be assessed for quality of airway management by measuring the seal pressure when using the device in 20 participants.

Experimental: Routine positive pressure airway management.

Hull University Teaching Hospital, Castle Hill Hospital.

PSA (Pharachute Supralaryngeal Airway) for Positive Pressure Ventilation (PPV)

PSA Extraglottic Airway for Positive Pressure Ventilation (Pharachute Supralaryngeal Airway)

Maximum airway inflation pressure that can be achieved before a significant leak becomes apparent must exceed 14 cm water pressure.

Sore throat, bleeding, voice changes, swallowing difficulty, localized neurological damage.

Hull University Teaching Hospitals NHS Trust

Participants of this group were assessed by the examiner twice, pre and post intervention, having recorded two values for each of the following variables:
Visual Analogue Scale
Range of movement
Hand grip strength. After a first assessment, scapula mobilization techniques were performed and participants reassessed.

Participants of this group were assessed by the examiner twice, pre and post intervention, having recorded two values for each of the following variables:
Visual Analogue Scale
Range of movement
Hand grip strength. The procedure was a contralateral calcaneus abduction and adduction mobilization technique was carried out.

Neck Pain

Musculoskeletal Diseases

Patient is sidelying with the testing side up. The auditor stands in front of the patient, reaches over the patient's shoulder to grasp the upper portion of the vertebral border of the scapula, and the other arm reaches under the patient's humerus to grasp the lower portion of the vertebral border of the scapula.
The auditor then slowly moves the scapula into elevation/depression, internal/external rotation/abduction and adduction.
To standardize the technique and be able to reproduce it in each participant, a set of 10 repetitions for each movement was performed in the same order.

Interscapular muscle release or scapular mobilization technique as described by Travell and Simons.

Abduction and adduction mobilization of the calcaneus is carried out in the opposite side of the upper extremity measured.

Calcaneus abduction and adduction mobilization technique

Aitor Vaquero Garrido

Effectiveness of Scapula Mobilization on Mechanosensitivity of Upper Limb Neural Test 1 in Mechanical Neck Pain

Effectiveness of Scapula Mobilization Technique on Neural Mechanosensitivity of Upper Limb Neural Test 1 (ULNT1) in Subjects With Mechanical Neck Pain

The axis of the Goniometer is placed On the elbow joint. The stationary arm is lined up with the arm and the moveable arm along the forearm. The subject is asked to perform elbow extension and the angle is measured.
Improvement of this angle 10º. Inmediately after the intervention

Improvement of this 0,5 Newtons. Using a visual pain scale, with values between 0 and 10, the subject marks the intensity level of the neck pain. Inmediately after the intervention

To measure the grip force of the hand we use the Dynamometer hydraulic baseline (SP-5030J1). We always place the subject in the same position to ensure that the conditions were the same, seated subject, shoulder adducted and in neutral rotation, 90º bend of the elbow, neutral position of the forearm, wrist in slight dorsal flexion (always between 0º and 30º) and a cubital deviation between 0º and 15º.

Research Master

Drug Name: budesonide Dose: 2000mcg (2mg) of budesonide nebulizer solution is mixed with normal saline solution to make a total volume of 8mL.
Frequency: Stat Dose Route: Nebulization

Drug Name: Dexamethasone Sodium phosphate Dose: 8mg of IV formula of dexamethasone is mixed with normal saline to make a total volume of 8ml.
Frequency: Stat Dose Route: Nebulization

Drug Name: Normal Saline Dose: 8ml. Frequency: Stat Dose Route: Nebulization

Acute Pharyngitis

Both medications used for the intervention groups are Glucocorticoids. The effect of glucocorticoids in AP can be attributed to their anti-inflammatory actions. They inhabit the formation of the pro-inflammatory mediators in the endothelial cells of the airways. This will decreases the inflammatory reaction at the pharynges which result in a reduction of throat pain.
Studies have shown that the use of a single dose of systemic glucocorticoids for acute pharyngitis did not result in significant adverse events and no serious adverse events were reported (7) (8).

Budesonide 0.25 MG/ML Inhalant Solution

Dexamethasone

Normal saline

KoKo Aung, Ambrish Ojha, Carson Lo. Viral Pharyngitis: Background, Pathophysiology, Epidemiology [Internet]. Medscape. 2018 [cited 2018 Dec 8]. Available from: https://emedicine.medscape.com/article/225362-overview

Anthony W Chow, Shira Doron. Evaluation of acute pharyngitis in adults. UPTODATE. 2018 [cited 2019 Jan 7].

Wendy Stead. Symptomatic treatment of acute pharyngitis in adults. UPTODATE. 2018 [cited 2019 Jan 7].

Courtney R Schadt, Scott M Jackson. Dermatology: Glucocorticoids Chapter. Fourth. Elsevier Limited; 2018 [cited 2019 Jan 2]. 2186-2199 p.

Armed Forces Hospital

Mortaafah Armed Medical Hospital (MAM)

Royal Oman Police Hospital

Inhaled Steroids for Acute Pharyngitis.

Nebulized Glucocorticoids in Acute Pharyngitis: A Randomized Clinical Trial

Direct report by the patient of presence or absence of complete resolution of sore throat at 24 hours by telephone.

Direct report of complete resolution of sore throat at 48 hours.

Direct report of time to onset of pain relief in hours within 7 days.

Direct report of time to complete symptom resolution in hours within 7 days.

Time missed from work or education over subsequent 7 days.

Attendance at ED within 15days with symptoms or complications associated with sore throat e.g. peritonsillar abscess

Hospital admission with related complications of sore throat within 15 day.

Al Yaqdhan Al Atbi

Emergency Medicine Resident, PGY 5

Oman Medical Speciality Board

20ml Liposomal Bupivacaine 1.3% (13.3mg/mL), injected to the buccal mucosal graft harvest site.

No local anesthetics injected to the buccal mucosal graft harvest site

Urethral Stricture

20ml of Liposomal Bupivacaine 1.3% (13.3mg/mL)

Liposomal Bupivacaine

Urology of Virginia

Liposomal Bupivacaine To Control Post-Operative Pain Following BMG

Liposomal Bupivacaine To Control Post-Operative Pain Following Buccal Mucosal Graft Harvesting

Continuous variables to be assessed as: Post-operative oral pain score measured using 10 point visual analogue score for pain assessment (minimum 0 or no pain to maximum 10 most painful)

Continuous variable to be assessed as : Narcotics requested by the patient and administered post-procedural day 1 and day 2 (Total and separately assessed). All narcotics will be converted to IV morphine equianalgesic equivalent conversion factors according to American Pain Society

Event rate nominal variable to be assessed as: oral morbidity post-procedure categorized according to Clavien Dindo-Classification

Event rate nominal variable to be assessed using survey question (yes or no)

Event rate nominal variable to be assessed using survey question (more, less or none)

Patient blinded for the intraoperative intervention given (With Liposomal Bupivacaine injection to the buccal mucosal graft harvest site or not)

Patient MR brain scans will be loaded and processed using the Brainsight TMS neuronavigation software and stereotaxic data for localization of the TMS stimulation site will be determined through a co-registration method between the TMS coil position and the projected site on the MR brain scan. The DLPFC will be located through MNI coordinates (-48, 20, 34). Electromyography (EMG) electrodes will be attached to the right abductor digiti minimi (ADM) muscle. The resting motor threshold (RMT) is determined as the minimal stimulation intensity required to elicit motor-evoked response of 50 microvolts peak-to-peak amplitude in at least 5 out of 10 consecutive trials of the ADM (contralateral to stimulation).

The same procedure for determining RMT as described above will be employed for the Sham Arm. However, a sham coil will be used when the treatment over the left DLPFC is applied.

Brain Injuries, Traumatic

Concussion, Brain

Headaches Chronic

Headache

Post-Traumatic Headache

Mild Traumatic Brain Injury

Transcranial Magnetic Stimulation

70% resting motor threshold amplitude; Frequency 10 Hz; 10 trains of 60 pulses/train (total of 600 pulses); Inter-train interval 45s.

rTMS - Real Air Film Coil

A sham coil will be applied to the scalp after the resting motor threshold is determined. Patients will be able to hear the sound and feel the vibration of sham coil, but will not experience any effective stimulation.

rTMS - Sham Coil

University Of Calgary

rTMS Treatment of Persistent Headache and Post Concussion Symptoms Attributed to Mild Traumatic Injury to the Head

Treatment of Persistent Headache Attributed to Mild Traumatic Injury to the Head (PHATIH) in Patients With Persistent Post Concussion Symptoms (PPCS) Using Repetitive Transcranial Magnetic Stimulation (rTMS)

Numeric Pain Rating Scale (NPRS): a tool to assess severity of pain, which is graded from 0-10 (11 points) with 0 defined as "no pain" and 10 as "worst possible pain".

Headache Impact Test (HIT-6): a global measure of headache impact. Addresses the 6 categories of headache impact including social, role, and cognitive functioning, vitality, psychological distress, and severity of headache pain. Each question is scored on a 5 point scale: never, rarely, sometimes, very often, and always. Total score can range from 36-78, with higher total score indicating greater impact.

Patient Health Questionnaire - 9 (PHQ-9): a 9 item tool used to assess the presence and severity of depressive symptoms. Each item is rated based on the frequency of occurrence in the past two weeks and is graded on a 0-3 scale (0=not at all, 1= several days, 3= nearly every day). Finally, one question rates how difficult problems have made completing tasks at home, doing work, and getting along with people. This is graded on a 4 point scale from not difficult at all to extremely difficult. Total score is calculated out of 27, with a values indicating severity of depression (i.e. 0-4= none to mild, 5-9 = mild, 10-14 = moderate, 15-19 = moderately severe, and 20-27 = very severe).

Generalized Anxiety Disorder (GAD-7): a 7-item tool where similar to the PHQ-9, each item is rated on frequency over a 2 week period based on a 0-3 scale (0=not at all, 1= several days, 3= nearly every day). Total score GAD-7 total score ranges from 0 to 21, with scores indicating severity of anxiety (i.e. 0-5= mild, 6-10 = moderate, 11-15 = moderately severe, 16-21 = very severe).

PTSD Checklist for DSM-5 (PCL-5): is a paper and pencil self-report measure, which rates the severity of PTSD symptoms over the past month. It is composed of 4 subscales, and is a total of 20 items long. Each item corresponds to the 20 criteria for PTSD defined in the DSM-5.

Montreal Cognitive Assessment (MoCA):a paper and pencil global cognitive assessment tool which measures 7 neurocognitive domains including visuospatial/executive function, naming, memory, attention, language, abstraction and orientation. It is composed of 16 items and scored out of 30 points.

The QOLIBRI is a health-related quality of life instrument developed specifically for patients who have experienced a traumatic brain injury. It has 6 subscales and a total of 37 items. The tool is divided into two sections. The first addresses satisfaction with health related quality of life, characterized by cognition, self, autonomy in daily life, and social aspects. These are reported on a 1-5 scale with 1 defined as "not at all satisfied" and 5 as "very satisfied". The second section is related to "feeing bothered by" emotions and physical problems. They are again scored from 1-5, however 1 is defined as "very bothered" and 5 as "not bothered at all". The score from all subscales are totaled, and then divided by the number of responses. This gives a mean score, which can range from 1-5. Next, 1 is subtracted from the mean and then multiplied by 25 to produce a score on the 0-100 scale (0=worst possible quality of life, 100= best possible quality of life).

Rivermead Post-concussion Symptoms Questionnaire (RPQ): an instrument developed to assess the frequency and severity of 16 common post-concussion symptoms. On this paper and pencil tool, patients rate the extent to which their symptoms (compared to their pre-injury levels) have become more problematic over the past 24 hours using a rating scale from 0-4 (0=not experienced, 1=no more of a problem, 2=mild problem, 3=moderate problem, 4=severe problem). A total symptom score is calculated out of 64.

British Columbia Post-concussion symptom inventory (BC-PSI): a 16 item instrument, where 13 questions are used to assess the frequency and intensity of post-concussion symptoms as defined by ICD-10 criteria over the past two weeks (i.e. headaches, dizziness or light-headedness, nausea, fatigue, phonophobia, sadness, nervousness or tension, temper problems, poor concentration, memory problems, reading difficulty, and sleep disturbance). Severity is rated from 0-5 (6 point scale) where 0 is defined as "not at all" and 5 as "constantly". Intensity is also rated from 0-5, where 0 is defined as "not at all" and 5 as "very severe problem". The two items are then multiplied (frequency x intensity) for each item. This is subsequently converted to item total scores where: 0-1=0, 2-3=1, 4-6=2, 8-12=3, and ≥15=4. Scores from 1-2 signify mild symptoms and ≥3 moderate to severe symptoms, which can be considered clinically significant.

University of Calgary

Hotchkiss Brain Institute, University of Calgary

Participants will be randomized with a random number generator to receive either sham or rTMS. Allocation will be concealed through the use of sequentially numbered, sealed, opaque envelopes.

neck pain/vomiting

PSA (Pharachute Supralaryngeal Airway) for Positive Pressure Ventilation (PPV)

Effectiveness of Scapula Mobilization on Mechanosensitivity of Upper Limb Neural Test 1 in Mechanical Neck Pain

Inhaled Steroids for Acute Pharyngitis.

Liposomal Bupivacaine To Control Post-Operative Pain Following BMG

rTMS Treatment of Persistent Headache and Post Concussion Symptoms Attributed to Mild Traumatic Injury to the Head

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