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238 results on '"Guglielminotti J"'

18. Association of the US Affordable Care Act-Dependent Coverage Provision With Labor Neuraxial Analgesia Use

Author

Guglielminotti, J., Daw, J.R., Landau, R., Friedman, A.M., and Li, G.

Abstract

(Anesthesiology. 2023;139:274–286)Neuraxial analgesia during labor is both safe and effective and has been associated with a lower risk of severe maternal morbidity. However, utilization is lower in minority groups, who experience a higher risk of severe maternal morbidity. Therefore, it is imperative to increase utilization and access, especially among minority ethnic and racial groups. This study examined the factor of health insurance access, specifically the effect of the Dependent Coverage Provision for the Patient Protection and Affordable Care Act on the use of neuraxial analgesia during labor, both in women from minority groups and overall.

Published
2024
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22. Emergency-to-Elective Surgery Ratio: A Global Indicator of Access to Surgical Care

Author

Guglielminotti, J., Li, G., Charles, A., Prin, M., and Mtalimanja, O.

Abstract

Background: Surgical care is essential to health systems but remains a challenge for low- and middle-income countries (LMICs). Current metrics to assess access and delivery of surgical care focus on the structural components of surgery and are not readily applicable to all settings. This study assesses a new metric for surgical care access and delivery, the ratio of emergent surgery to elective surgery (Ee ratio), which represents the number of emergency surgeries performed for every 100 elective surgeries. Methods: A systematic search of PubMed and Medline was conducted for studies describing surgical volume and acuity published between 2006 and 2016. The relationship between Ee ratio and three national indicators (gross domestic product, per capital healthcare spending, and physician density) was analyzed using weighted Pearson correlation coefficients (rw) and linear regression models. Results: A total of 29 studies with 33 datasets were included for analyses. The median Ee ratio was 14.6 (IQR 5.5–62.6), with a range from 1.6 to 557.4. For countries in sub-Saharan Africa the median value was 62.6 (IQR 17.8–111.0), compared to 9.4 (IQR 3.4–13.4) for the United States and 5.5 (IQR 4.4–10.1) for European countries. In multivariable linear regression, the per capita healthcare spending was inversely associated with the Ee ratio, with a 63-point decrease in the Ee ratio for each 1 point increase in the log of the per capita healthcare spending (regression coefficient β = −63.2; 95% CI −119.6 to −6.9; P = 0.036). Conclusions: The Ee ratio appears to be a simple and valid indicator of access to available surgical care. Global health efforts may focus on investment in low-resource settings to improve access to available surgical care.

Published
2018
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34. Marfan Syndrome During Pregnancy

Author

Allyn, J., primary, Guglielminotti, J., additional, Omnes, S., additional, Guezouli, L., additional, Egan, M., additional, Jondeau, G., additional, Longrois, D., additional, and Montravers, P., additional

Published
2014
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40. Bedside detection of retained tracheobronchial secretions in patients receiving mechanical ventilation: is it time for tracheal suctioning?

Author

Guglielminotti J, Alzieu M, Maury E, Guidet B, Offenstadt G, Guglielminotti, J, Alzieu, M, Maury, E, Guidet, B, and Offenstadt, G

Abstract

Objective: To identify parameters that indicate retained secretions and the need for tracheal suctioning (TS) in patients receiving mechanical ventilation (MV).Design: Prospective observational study.Setting: A 14-bed medical ICU in a 946-bed university hospital.Patients: Sixty-six consecutive patients receiving MV.Interventions: Two successive tracheal suctions, TS1 and TS2, performed at a 2-h interval as usual patient care. Retained secretions were considered significant if the volume of secretions removed by TS2 was > 0.5 mL.Measurements and Results: Variations between TS1 and TS2 of pulse oximetric saturation (SpO(2)), peak inspiratory pressure (Ppeak), tidal volume (VT), and Ramsay score were compared between patients with TS2 < or = 0.5 mL (group 1; n = 27) and patients with TS2 > 0.5 mL (group 2; n = 39). The presence of a sawtooth pattern on flow-volume loop displayed on the monitor screen of the ventilator and of respiratory sounds heard over the trachea before TS2 were compared between the two groups. Variations of Ppeak, VT, SpO(2), and Ramsay score between TS1 and TS2 did not differ between the two groups. However, group 2 had a sawtooth pattern (82% vs 29.6%; p = 0.0001) and respiratory sounds (66.6% vs. 25.9%; p = 0. 001) more frequently than group 1 before TS2. For the sawtooth pattern, the likelihood ratio (LR) of a positive test was 2.70 and the LR of a negative test was 0.25, while for respiratory sounds it was 2.50 and 0.45, respectively. When the presence of a sawtooth pattern and of respiratory sounds was combined, the LR of a positive test rose to 14.7 and the LR of a negative test was 0.42.Conclusions: A sawtooth pattern and/or respiratory sounds over the trachea are good indicators of retained secretions in patients receiving MV and may indicate the need for TS. Conversely, the absence of a sawtooth pattern may rule out retained secretions. [ABSTRACT FROM AUTHOR]

Published
2000
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44. A fatal sandwich

Author

Tonnellier, M, primary, Maury, E, additional, Guglielminotti, J, additional, and Offenstadt, G, additional

Published
2001
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