Browsing by Author "Jacobs, Jan"

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    Comparison of a novel low-cost hyperangulated video intubation stylet with the Bonfils fiberscope: a simulated difficult airway manikin study.
    (2023) Jacobs, Jan; Roodt, Francois
    Introduction Optic stylets are safe, efficient airway tools, with improved intubation success rates compared to direct laryngoscopy. Economic constraints often limit access to costly difficult airway equipment. The Hyperangulated Video Intubation Stylet (HiVIS) is a novel, low-cost, stainless-steel stylet with a Wi-Fi camera connecting to a smartphone. We aim to demonstrate that performance of the HiVIS, as an alternative low-cost device, is non-inferior to the Bonfils. Methods We performed a randomised, cross-over non-inferiority study following institutional and ethics approval (UCT HREC 816/2020). Randomised participants received training (instructional video and practice intubations on a Laerdel airway manikin™) and subsequently intubated a Trucorp Airsim manikin™ simulating a difficult airway with the Bonfils and HiVIS alternately. Our primary outcome was time-to-intubation with a pre-specified non-inferiority margin of 5 seconds. Secondary outcomes were best laryngeal view, airway trauma, and number of attempts. Participants completed a questionnaire regarding device preference and overall satisfaction. Results Thirty doctors participated: 33% interns and 54% medical officers from various specialties. 63% performed ≤1 intubation per week, and 10% had optical stylet experience. Both devices had 100% first-pass intubation success: 10.4 seconds Bonfils versus 11.2 seconds HiVIS (p<0.0001). The mean difference in time-to-intubation was 0.8 seconds (90% CI -0.4; 2.1). All Bonfils intubations had a grade 1 laryngeal view compared to 83% of HiVIS intubations (27% grade 2). The Bonfils had the only incident of airway trauma. Two-thirds of participants preferred HiVIS, with similar user satisfaction scores for both devices. Conclusion The HiVIS is non-inferior to Bonfils in a single attempt difficult airway manikin simulation with predominantly novice, non-anaesthesia users. The HiVIS could be a cost-effective tool for difficult airway management in resource-constrained settings.
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    Diagnosis of neglected tropical diseases among patients with persistent digestive disorders (diarrhoea and/or abdominal pain [greater than or equal to]14days): Pierrea multi-country, prospective, non-experimental case-control study
    (BioMed Central Ltd, 2015) Polman, Katja; Becker, Soren; Alirol, Emilie; Bhatta, Nisha; Bhattarai, Narayan; Bottieau, Emmanuel; Bratschi, Martin; Burza, Sakib; Coulibaly, Jean; Doumbia, Mama; Horie, Ninon; Jacobs, Jan; Khanal, Basudha; Landoure, Aly; Mahendradhata, Yodi; Meheu
    BACKGROUND: Diarrhoea still accounts for considerable mortality and morbidity worldwide. The highest burden is concentrated in tropical areas where populations lack access to clean water, adequate sanitation and hygiene. In contrast to acute diarrhoea (<14days), the spectrum of pathogens that may give rise to persistent diarrhoea ([greater than or equal to]14days) and persistent abdominal pain is poorly understood. It is conceivable that pathogens causing neglected tropical diseases play a major role, but few studies investigated this issue. Clinical management and diagnostic work-up of persistent digestive disorders in the tropics therefore remain inadequate. Hence, important aspects regarding the pathogenesis, epidemiology, clinical symptomatology and treatment options for patients presenting with persistent diarrhoea and persistent abdominal pain should be investigated in multi-centric clinical studies.METHODS/DESIGN:This multi-country, prospective, non-experimental case-control study will assess persistent diarrhoea ([greater than or equal to]14days; in individuals aged [greater than or equal to]1year) and persistent abdominal pain ([greater than or equal to]14days; in children/adolescents aged 1-18 years) in up to 2000 symptomatic patients and 2000 matched controls. Subjects from Cote d'Ivoire, Indonesia, Mali and Nepal will be clinically examined and interviewed using a detailed case report form. Additionally, each participant will provide a stool sample that will be examined using a suite of diagnostic methods (i.e., microscopic techniques, rapid diagnostic tests, stool culture and polymerase chain reaction) for the presence of bacterial and parasitic pathogens. Treatment will be offered to all infected participants and the clinical treatment response will be recorded. Data obtained will be utilised to develop patient-centred clinical algorithms that will be validated in primary health care centres in the four study countries in subsequent studies.DISCUSSION:Our research will deepen the understanding of the importance of persistent diarrhoea and related digestive disorders in the tropics. A diversity of intestinal pathogens will be assessed for potential associations with persistent diarrhoea and persistent abdominal pain. Different diagnostic methods will be compared, clinical symptoms investigated and diagnosis-treatment algorithms developed for validation in selected primary health care centres. The findings from this study will improve differential diagnosis and evidence-based clinical management of digestive syndromes in the tropics.TRIAL REGISTRATION:ClinicalTrials.gov; identifier: NCT02105714.