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Allan C.K.,Harvard University | Pigula F.,Cardiac Surgery | Pigula F.,Harvard University | Bacha E.A.,Morgan Stanley | And 9 more authors.
Simulation in Healthcare | Year: 2013

INTRODUCTION: American Heart Association guidelines recommend timely extracorporeal membrane oxygenation (ECMO) cannulation during cardiopulmonary resuscitation for pediatric cardiac arrest refractory to conventional resuscitation. Traditional cannulation training relies on the apprenticeship model. We hypothesized that a simulation-based ECMO cannulation curriculum featuring a novel integrated skills trainer would improve ECMO cannulation during cardiopulmonary resuscitation performance by cardiothoracic surgery trainees. METHODS: An embedded surgical neck cannulation trainer, designed in collaboration with expert surgeons, formed the focus for a simulation-based cannulation curriculum. The course included a didactic presentation and 2 neck cannulations during cardiopulmonary resuscitation with video-assisted expert feedback with a further cannulation at 3 months. Primary outcome was time to cannulation on the trainer. Secondary outcomes were performance on a validated Global Rating Scale (GRS) of surgical technique and a novel Composite ECMO Cannulation Score (CECS). RESULTS: Ten cardiothoracic surgery trainees participated. The trainer was rated as authentic, and sessions was rated as highly useful. Median time to cannulation decreased between cannulation 1 and 2 (15 minutes 24 seconds vs. 12 minutes 15 seconds, P = 0.002). Improvement was sustained at 3 months (13 minutes 36 seconds, P = 0.157 vs. attempt 2). Likewise, GRS increased significantly at attempt 2 versus 1 (77% vs. 62%, P = 0.003) as did CECS (88% vs. 52%, P = 0.002). No deterioration in GRS or CECS was measured at 3 months. CONCLUSIONS: Cardiothoracic surgery trainees found a contextualized ECMO cannulation during cardiopulmonary resuscitation cannulation curriculum to be highly useful and demonstrated sustained improvement in time to cannulation, CECS, and GRS. Further work will focus on determining the clinical impact of this training and defining the optimal interval and number of training sessions. Copyright © 2013 Society for Simulation in Healthcare.

Festus O.,Medical Laboratory Science | Okhiai O.,Nursing | Akpamu D.,Ambrose Alli University
Research Journal of Obstetrics and Gynecology | Year: 2011

Normal pregnancy has been found to be associated with a high metabolic demand and elevated requirements for tissue oxygen which results in increased oxidative stress and antioxidant defenses. Hence this study evaluates in pregnancy the state of oxidative stress express by product of lipid peroxidation via the level of ThioBarbituric Acid-Reactive substances (TBARS). It involves 180 apparently healthy pregnant Nigerian women age between 20-40 years of different gestation period parity and socia status. In addition 20 apparently healthy tested non pregnant women formed the control group. The test groups were women attending ante-natal clinic at the University of Benin Teaching Hospital (UBTH) Benin City Edo state, Nigeria. Data from standard laboratory procedure were then subjected to statistical analysis using the paired sample t test of SPSS software version 17. Result shows increase in plasma TBARS as age advances and as the number of pregnancy increases. TBARS was lowest in women indulge in physical activity as in farm works (7.6±3.24 μM) and highest among the physical inactivity as in full house-wife (16.28±6.69 μM). A significant rise in TBARS in pregnant women (13.09±2.34 μM) was observed compared to the non pregnant women (the control 4.41±0.50 μM). There was a steady increase in TBARS as the gestation period advances and this was significantly different (p<0.05) from the control. Conclusively, normal pregnancy is associated with oxidative stress. We recommend therefore that there is a need for moderate physical activity during pregnancy and antioxidant supplementation which should increase as age, gestation and number of pregnancy (parity) advances. © 2011 Asian Network for Scientific Information.

Evans D.G.,Royal Infirmary | Freeman S.,Royal Infirmary | Gokhale C.,Royal Infirmary | Wallace A.,Royal Infirmary | And 33 more authors.
Journal of Medical Genetics | Year: 2015

Background Neurofibromatosis type 2 (NF2) is an autosomal dominant condition with high spontaneous mutation rate which predisposes to the development of multiple nerve sheath tumours (schwannomas), meningiomas and ependymoma. The cardinal feature and main diagnostic criterion for the diagnosis of NF2 remains the development of bilateral vestibular schwannoma (BVS). With increasing use of MRI screening the possibility of a 'chance' diagnosis of BVS has been mooted with a potential frequency of one in two million people in their lifetime. Until now, however, no evidence for such an event has been published. We aimed to demonstrate that chance occurrence can occur and to estimate its frequency among those with just BVS late in life. Methods Two vestibular schwannomas from the same patient were DNA sequenced and underwent loss of heterozygosity analysis. Results We show that a man who developed BVS, at ages 52 and 67 years developed these tumours sporadically by demonstrating that there were no molecular events in common between the two tumours. Furthermore from a database of over 1200 patients with NF2, we have estimated that ~25% of cases of BVS over 50 years and 50% over 70 years of age where no other features of NF2 are present represent a chance occurrence rather than due to an underlying mosaic or constitutional NF2 mutation. Conclusions Patients presenting with BVS later in life should be appraised of the potential likelihood they may not have NF2 and the resultant further reduction in risks of transmission to offspring. © 2015 by the BMJ Publishing Group Ltd.

Alexander R.T.,PIC LD Services | Green F.N.,Nursing | O'Mahony B.,Psychology | Gunaratna I.J.,PIC LD Services | And 2 more authors.
Journal of Intellectual Disability Research | Year: 2010

Aim: To establish any differences between patients with and without a diagnosis of personality disorders, being treated in a secure inpatient service for offenders with intellectual disability (ID) in the UK. Method: A cohort study involving a selected population of people with ID and offending behaviours. Results: The study included a total of 138 patients, treated over a 6 year period - 77 with a dissocial or emotionally unstable personality disorder and 61 without. Women were more likely to be in the personality disorder group. Both groups had high prevalence of abuse with no significant differences. Depressive disorders and substance abuse were more common in the personality disorder group, while epilepsy and autistic spectrum disorders were more common in the non-personality disorder group. Rather than differences, what was more striking was the rate and range of these comorbidities across both groups. Although past histories of violence and institutional aggression were no different, compulsory detention under criminal sections and restriction orders were more common in the personality disorder group. There were no differences in treatment outcomes. Conclusions: Although about half of patients detained in secure units for offenders with ID have a personality disorder, there were more similarities than differences between this group and the rest. While good treatment outcomes supported the case for specialised secure treatment units for people with ID, the case for establishing a more specialised ID-personality disorder unit was less convincing. There is also a need to explore whether there are alternative diagnostic models that can delineate better the group with personality difficulties in this population. © 2010 The Authors. Journal Compilation © 2010 Blackwell Publishing Ltd.

PubMed | Institute National Of Sante Publique Du Quebec, CHU Sainte Justine, Nursing and University of Montréal
Type: | Journal: Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners | Year: 2016

There are health risks to workers occupationally exposed to antineoplastic drugs. We hypothesized that implementing a biological monitoring program would be feasible. The goal was to present the results of our pilot cross-sectional study of biological monitoring of four antineoplastic drugs.We recruited workers from the hematology-oncology department and control workers in a mother-child university health center. This study was preceded by an information period during which we aimed at enhancing the workers awareness and knowledge of the risks of occupational exposure. Participants filled out a journal containing activities performed and personal protective equipment worn. One urine sample was collected at the end of their shift. Samples were analyzed by UPLC/MS-MS for the presence of cyclophosphamide, ifosfamide, methotrexate, and alpha-fluoro-beta-alanine (5-fluorouraciles main urinary metabolite).The participation rate was 85.7% (102/119). No urine sample had detectable concentrations of any of the four drugs evaluated (0/101; 0/74 nurses, 0/11 pharmacists, 0/9 pharmacy technicians, and 0/7 doctors). In the 5 days before sampling, 67/92 (72.8%) hematology-oncology participants performed at least one activity with antineoplastic drugs. Nurses wore all of the recommended protection for technical activities (86.2%), but rarely for non-technical activities (14.9%). Pharmacists and pharmacy technicians wore all of the recommended protection for all activities (100.0%).This pilot study had a good participation rate. The absence of positive samples was a good indication that the measures in place ensured workers safety, even though we found areas where the worker protection can be enhanced.

Stevens S.,Nursing
Nursing Clinics of North America | Year: 2015

Preventing 30-day readmissions to hospitals is a top priority in the era of health care reform. New regulations will be costly to health care facilities because of payment guidelines. The most frequently readmitted medical conditions are acute myocardial infarction, heart failure, and pneumonia. The transition from the hospital and into the home has been classified as a vulnerable time for many patients. During this time of transition patients may fail to fully understand their discharge instructions. Ineffective communication, low health literacy, and compliance issues contribute to readmissions. Telehealth and the use of technology may be used to prevent some readmissions. © 2015 Elsevier Inc.

PubMed | Nursing
Type: Journal Article | Journal: Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2016

Your article on former nursing student Andrew Moyhing, who unsuccessfully brought a sexual discrimination case against Homerton University Hospital NHS Trust and Barts and The London NHS Trust (analysis January 4) contained some inaccuracies.

PubMed | Nursing.
Type: Journal Article | Journal: Nursing management (Harrow, London, England : 1994) | Year: 2016

IT IS CRUCIAL to quality assurance that nursing students are given opportunities to evaluate their learning environments ( NHS Education for Scotland 2003 , Quality Assurance Agency for Higher Education 2001 ).

PubMed | Nursing
Type: Journal Article | Journal: The Nursing clinics of North America | Year: 2015

Preventing 30-day readmissions to hospitals is a top priority in the era of health care reform. New regulations will be costly to health care facilities because of payment guidelines. The most frequently readmitted medical conditions are acute myocardial infarction, heart failure, and pneumonia. The transition from the hospital and into the home has been classified as a vulnerable time for many patients. During this time of transition patients may fail to fully understand their discharge instructions. Ineffective communication, low health literacy, and compliance issues contribute to readmissions. Telehealth and the use of technology may be used to prevent some readmissions.

Background. - Established consecutive-day inpatient intravenous dihydroergotamine protocols administered by bolus intravenous injection or continuous infusion injection in the hospital have demonstrated efficacy and safety in modifying the course of daily intractable headache. We conducted a study to determine efficacy, tolerability, and feasibility to treat patients with daily intractable headache with continuous intravenous dihydroergotamine in an outpatient home-based setting. Methods. - A total of 31 patients fulfilling ICHD-II criteria for chronic daily headache, 25 with chronic migraine and 6 with medication overuse headache, were treated with outpatient home-based continuous intravenous dihydroergotamine for 3 days. Patients were pretreated with 10 mg intravenous metoclopramide prior to the first day of infusion and administered 3 mg dihydroergotamine given continuously at a rate of 42 mL/hour on day 1 and 2, and administered 1.5 mg on day 3 at the rate of 21 mL/hour. The primary end point was a change in pain intensity, as measured by an 11-point numeric pain intensity scale at the end of 3 days. The secondary end point was reduction in headache frequency at long-term follow-up. Results. - Patients reported an average of 63.4% reduction in the intensity of migraine pain by the end of the 3-day infusion. Side effects were minimal and no serious adverse effects occurred. Approximately one-third of patients became completely headache-free after day 3, and 1 patient had no improvement. Long-term follow-up data indicated an average 86% reduction in headache frequency and almost every patient converted from chronic daily headache to episodic migraine except for 1 patient. Patients with medication overuse headache were no longer consuming the daily offending medication. Conclusions. - Efficacy and safety of our outpatient home-based intravenous dihydroergotamine program compared favorably to that of established inpatient intravenous pulse injection and continuous infusion protocols for the treatment of intractable migraine. The use of outpatient continuous intravenous dihydroergotamine is an effective and well-tolerated therapy for intractable migraine but without the added cost and inconvenience of hospitalization. © 2010 the Authors. Journal compilation.

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