AIM:To compare the impact of carbon dioxide(CO2) and air insufflation on patient tolerance/safety in deeply sedated patients undergoing colonoscopy.METHODS:Patients referred for colonoscopy were randomized to receive ...AIM:To compare the impact of carbon dioxide(CO2) and air insufflation on patient tolerance/safety in deeply sedated patients undergoing colonoscopy.METHODS:Patients referred for colonoscopy were randomized to receive either CO2 or air insufflation during the procedure.Both the colonoscopist and patient were blinded to the type of gas used.During the procedure,insertion and withdrawal times,caecal intubationrates,total sedation given and capnography readings were recorded.The level of sedation and magnitude of patient discomfort during the procedure was assessed by a nurse using a visual analogue scale(VAS)(0-3).Patients then graded their level of discomfort and abdominal bloating using a similar VAS.Complications during and after the procedure were recorded.RESULTS:A total of 142 patients were randomized with 72 in the air arm and 70 in the CO2 arm.Mean age between the two study groups were similar.Insertion time to the caecum was quicker in the CO2 group at 7.3 min vs 9.9 min with air(P = 0.0083).The average withdrawal times were not significantly different between the two groups.Caecal intubation rates were 94.4% and 100% in the air and CO2 groups respectively(P = 0.012).The level of discomfort assessed by the nurse was 0.69(air) and 0.39(CO2)(P = 0.0155) and by the patient 0.82(air) and 0.46(CO2)(P = 0.0228).The level of abdominal bloating was 0.97(air) and 0.36(CO2)(P = 0.001).Capnography readings trended to be higher in the CO2 group at the commencement,caecal intubation,and conclusion of the procedure,even though this was not significantly different when compared to readings obtained during air insufflation.There were no complications in both arms.CONCLUSION:CO2 insufflation during colonoscopy is more efficacious than air,allowing quicker and better cecal intubation rates.Abdominal discomfort and bloating were significantly less with CO2 insufflation.展开更多
Bioaerosol exposure has been linked to adverse respiratory conditions.Intensive farming and composting facilities are important anthropogenic sources of bioaerosols.We aimed to characterise populations living close to...Bioaerosol exposure has been linked to adverse respiratory conditions.Intensive farming and composting facilities are important anthropogenic sources of bioaerosols.We aimed to characterise populations living close to intensive farming and composting facilities.We also infer whether the public are becoming more concerned about anthropogenic bioaerosol emissions,using reports of air pollution related incidents attributed to facilities.We mapped the location of 1,257 intensive farming and 310 composting facilities in England in relation to the resident population and its characteristics(sex and age),area characteristics(deprivation proxy and rural/urban classification)and school locations stratified by pre-defined distance bands from these bioaerosol sources.We also calculated the average number of air pollution related incidents per year per facility.We found that more than 16%of the population and 15%of schools are located within 4,828 m of an intensive farming facility or 4,000 m of a composting facility;few people(0.01%)live very close to these sites and tend to be older people.Close to composting facilities,populations are more likely to be urban and more deprived.The number of incidents were attributed to a small proportion of facilities;population characteristics around these facilities were similar.Results indicate that populations living near composting facilities(particularly>250 to≤4,000 m)are mostly located in ur6an areas(80188%of the population),which supports the need for more community health studies to be conducted.Results could also be used to inform risk management strategies at facilities with higher numbers of incidents.展开更多
文摘AIM:To compare the impact of carbon dioxide(CO2) and air insufflation on patient tolerance/safety in deeply sedated patients undergoing colonoscopy.METHODS:Patients referred for colonoscopy were randomized to receive either CO2 or air insufflation during the procedure.Both the colonoscopist and patient were blinded to the type of gas used.During the procedure,insertion and withdrawal times,caecal intubationrates,total sedation given and capnography readings were recorded.The level of sedation and magnitude of patient discomfort during the procedure was assessed by a nurse using a visual analogue scale(VAS)(0-3).Patients then graded their level of discomfort and abdominal bloating using a similar VAS.Complications during and after the procedure were recorded.RESULTS:A total of 142 patients were randomized with 72 in the air arm and 70 in the CO2 arm.Mean age between the two study groups were similar.Insertion time to the caecum was quicker in the CO2 group at 7.3 min vs 9.9 min with air(P = 0.0083).The average withdrawal times were not significantly different between the two groups.Caecal intubation rates were 94.4% and 100% in the air and CO2 groups respectively(P = 0.012).The level of discomfort assessed by the nurse was 0.69(air) and 0.39(CO2)(P = 0.0155) and by the patient 0.82(air) and 0.46(CO2)(P = 0.0228).The level of abdominal bloating was 0.97(air) and 0.36(CO2)(P = 0.001).Capnography readings trended to be higher in the CO2 group at the commencement,caecal intubation,and conclusion of the procedure,even though this was not significantly different when compared to readings obtained during air insufflation.There were no complications in both arms.CONCLUSION:CO2 insufflation during colonoscopy is more efficacious than air,allowing quicker and better cecal intubation rates.Abdominal discomfort and bloating were significantly less with CO2 insufflation.
文摘Bioaerosol exposure has been linked to adverse respiratory conditions.Intensive farming and composting facilities are important anthropogenic sources of bioaerosols.We aimed to characterise populations living close to intensive farming and composting facilities.We also infer whether the public are becoming more concerned about anthropogenic bioaerosol emissions,using reports of air pollution related incidents attributed to facilities.We mapped the location of 1,257 intensive farming and 310 composting facilities in England in relation to the resident population and its characteristics(sex and age),area characteristics(deprivation proxy and rural/urban classification)and school locations stratified by pre-defined distance bands from these bioaerosol sources.We also calculated the average number of air pollution related incidents per year per facility.We found that more than 16%of the population and 15%of schools are located within 4,828 m of an intensive farming facility or 4,000 m of a composting facility;few people(0.01%)live very close to these sites and tend to be older people.Close to composting facilities,populations are more likely to be urban and more deprived.The number of incidents were attributed to a small proportion of facilities;population characteristics around these facilities were similar.Results indicate that populations living near composting facilities(particularly>250 to≤4,000 m)are mostly located in ur6an areas(80188%of the population),which supports the need for more community health studies to be conducted.Results could also be used to inform risk management strategies at facilities with higher numbers of incidents.
