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Articles by E George
Total Records ( 3 ) for E George
  C. C Apfel , A Saxena , O. S Cakmakkaya , R Gaiser , E George and O. Radke
 

No clear consensus exists on how to best prevent severe headache from occurring after accidental dural puncture. We conducted a quantitative systematic review to identify all available evidence for the prevention of postdural puncture headache (PDPH) and included 17 studies with 1264 patients investigating prophylactic epidural blood patch (PEBP), epidural morphine, intrathecal catheters, and epidural or intrathecal saline. The relative risk (RR) for headache after PEBP was 0.48 [95% confidence interval (CI): 0.23–0.99] in five non-randomized controlled trials (non-RCTs) and 0.32 (0.10–1.03) in four randomized controlled trials (RCTs). The RR for epidural morphine (based on a single RCT) was 0.25 (0.08–0.78). All other interventions were based on non-RCTs and failed statistical significance, including long-term intrathecal catheters with an RR of 0.21 (0.02–2.65). There are a number of promising options to prevent PDPH, yet heterogeneity between the studies and publication bias towards small non-RCTs with positive results limits the available evidence. Thus, a large multicentre RCT is needed to determine the best preventative practices.

  A Butterly , E. A Bittner , E George , W. S Sandberg , M Eikermann and U. Schmidt
  Background

Postoperative residual curarization (PORC) [train-of-four ratio (T4/T1) <0.9] is associated with increased morbidity and may delay postoperative recovery room (PACU) discharge. We tested the hypothesis that postoperative T4/T1 <0.9 increases PACU length of stay.

Methods

At admission to the PACU, neuromuscular transmission was assessed by acceleromyography (stimulation current: 30 mA) in 246 consecutive patients. The potential consequences of PORC-induced increases in PACU length of stay on PACU throughput were estimated by application of a validated queuing model taking into account the rate of PACU admissions and mean length of stay in the joint system of the PACU plus patients recovering in operation theatre waiting for PACU beds.

Results

PACU length of stay was significantly longer in patients with T4/T1 <0.9 (323 min), compared with patients with adequate recovery of neuromuscular transmission (243 min). Age (P=0.021) and diagnosis of T4/T1 <0.9 (P=0.027), but not the type of neuromuscular blocking agent, were independently associated with PACU length of stay. The incidence of T4/T1 <0.9 was higher in patients receiving vecuronium. Delayed discharge significantly increases the chances of patients having to wait to enter the PACU. The presence of PORC is estimated to be associated with significant delays in recovery room admission.

Conclusions

PORC is associated with a delayed PACU discharge. The magnitude of the effect is clinically significant. In our system, PORC increases the chances of patients having to wait to enter the PACU.

  M Eigel , E George and M. Kirkilionis
 

We present a numerical method for solving partial differential equations on domains with distinctive complicated geometrical properties. These will be called complex domains. Such domains occur in many real-world applications, for example in geology or engineering. We are, however, particularly interested in applications stemming from the life sciences, especially cell biology. In this area complex domains, such as those retrieved from microscopy images at different scales, are the norm and not the exception. Therefore geometry is expected to directly influence the physiological function of different systems, for example signalling pathways. New numerical methods that are able to tackle such problems in this important area of application are urgently needed. In particular, the mesh generation problem has imposed many restrictions in the past. The approximation approach presented here for such problems is based on a promising mesh-free Galerkin method: the partition of unity method (PUM). We introduce the main approximation features and then focus on the construction of appropriate covers as the basis of discretizations. As a main result we present an extended version of cover construction, ensuring fast convergence rates in the solution process. Parametric patches are introduced as a possible way of approximating complicated boundaries without increasing the overall problem size. Finally, the versatility, accuracy and convergence behaviour of the PUM are demonstrated in several numerical examples.

 
 
 
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