Separator fluid volume requirements in multi-infusion settings

INTRODUCTION. Intravenous (IV) therapy is a widely used method for the administration of medication in hospitals worldwide. ICU and surgical patients in particular often require multiple IV catheters due to incompatibility of certain drugs and the high complexity of medical therapy. This increases discomfort by painful invasive procedures, the risk of infections and costs of medication and disposable considerably. When different drugs are administered through the same lumen, it is common ICU practice to flush with a neutral fluid between the administration of two incompatible drugs in order to optimally use infusion lumens. An important constraint for delivering multiple incompatible drugs is the volume of separator fluid that is sufficient to safely separate them. OBJECTIVES. In this pilot study we investigated whether the choice of separator fluid, solvent, or administration rate affects the separator volume required in a typical ICU infusion setting. METHODS. A standard ICU IV line (2m, 2ml, 1mm internal diameter) was filled with methylene blue (40 mg/l) solution and flushed using an infusion pump with separator fluid. Independent variables were solvent for methylene blue (NaCl 0.9% vs. glucose 5%), separator fluid (NaCl 0.9% vs. glucose 5%), and administration rate (50, 100, or 200 ml/h). Samples were collected using a fraction collector until <2% of the original drug concentration remained and were analyzed using spectrophotometry. RESULTS. We did not find a significant effect of administration rate on separator fluid volume. However, NaCl/G5% (solvent/separator fluid) required significantly less separator fluid than NaCl/NaCl (3.6 ± 0.1 ml vs. 3.9 ± 0.1 ml, p <0.05). Also, G5%/G5% required significantly less separator fluid than NaCl/NaCl (3.6 ± 0.1 ml vs. 3.9 ± 0.1 ml, p <0.05). The significant decrease in required flushing volume might be due to differences in the viscosity of the solutions. However, mean differences were small and were most likely caused by human interactions with the fluid collection setup. The average required flushing volume is 3.7 ml. CONCLUSIONS. The choice of separator fluid, solvent or administration rate had no impact on the required flushing volume in the experiment. Future research should take IV line length, diameter, volume and also drug solution volumes into account in order to provide a full account of variables affecting the required separator fluid volume

Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.

BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p &lt; 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p &lt; 0.001). Males were significantly more likely to be admitted than females (p &lt; 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted

PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL

The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies have revealed differences between conventional osteotomes, such as rotating or sawing devices, and ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness values of osteotomized bone surfaces. Objective: the present study compares the micro-morphologies and roughness values of osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery Medical® and Piezosurgery Medical New Generation Powerful Handpiece. Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded. Micromorphologies and roughness values to characterize the bone surfaces following the different osteotomy methods were described. The prepared surfaces were examined via light microscopy, environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were investigated, as well as the proportion of apoptosis or cell degeneration. Results and Conclusions: The potential positive effects on bone healing and reossification associated with different devices were evaluated and the comparative analysis among the different devices used was performed, in order to determine the best osteotomes to be employed during cranio-facial surgery

Front Lines of Thoracic Surgery

Front Lines of Thoracic Surgery collects up-to-date contributions on some of the most debated topics in today's clinical practice of cardiac, aortic, and general thoracic surgery,and anesthesia as viewed by authors personally involved in their evolution. The strong and genuine enthusiasm of the authors was clearly perceptible in all their contributions and I'm sure that will further stimulate the reader to understand their messages. Moreover, the strict adhesion of the authors' original observations and findings to the evidence base proves that facts are the best guarantee of scientific value. This is not a standard textbook where the whole discipline is organically presented, but authors' contributions are simply listed in their pertaining subclasses of Thoracic Surgery. I'm sure that this original and very promising editorial format which has and free availability at its core further increases this book's value and it will be of interest to healthcare professionals and scientists dedicated to this field

Measuring mental health provider stigma: The development of a valid and reliable self-assessment instrument

Provider-based stigma is defined as the negative attitudes, beliefs, and behaviors of mental health providers toward clients they serve. Often unintentional and unknowingly conveyed, this phenomenon has been indicated in previous research (e.g. Lauber, Nordt, Braunschweig, & Rössler, 2006; Nordt, Rössler, & Lauber, 2006; Hugo, 2001; Schulze, 2007). Other instruments crafted to measure provider stigma have utilized theory in their development, without incorporating the voice of the client (e.g. Wilkins & Abell, 2010; Kennedy, Abell, & Mennicke 2014). To better address the social injustice posed by provider stigma, the profession requires a valid and reliable measure, guided by theory, which also reflects the client and family experience. This study attempts to do so, referencing the five themes of the experience-based model (Charles, 2013) to guide item development. These themes include: blame & shame; disinterest, annoyance, and/or irritation; degradation & dehumanization; poor prognosis/fostering dependence; coercion/lack of ‘real’ choice. The measure’s item pool was generated following Nunnally and Bernstein’s (1994) domain sampling method, in reflection of the experience-based model, and reviewed by a series of focus groups. The electronically hosted survey was distributed to a purposive sample of mental health service providers employed at Virginia’s public mental health agencies. Using a final sample of N = 220, factor analysis indicated a four factor solution, accounting for 32.454% of the items’ variance. Refinement resulted in a scale of 20-items demonstrating adequate internal consistency, measured by Cronbach’s alpha = 0.817. The four factors of the Mental Health Provider Self-Assessment of Stigma Scale (MHPSASS) were labeled: Irritation & Impatience (eight items); Choice & Capacity (five items); Adherence & Dependence (four items); Devalue & Depersonalize (three items). Hypothesized relationships were found between provider self-rating of burnout and MHPSASS score (Pearson’s r = 0.235, p = 0.001) as well as social desirability level and MHPSASS score (r = -0.169, p = 0.015), supporting the MHPSASS’ construct validity. As a measure of provider-based stigma, the MHPSASS displays adequate reliability and validity. Future studies are indicated, including replication. Limitations include agency response rate, unknowable individual level-response rate, social desirability, and the potentially burdensome length of the survey package

Temas de actualidad en salud pública

La salud pública es una disciplina importante para la salud en el mundo. Se define como la ciencia y el arte de prevenir las enfermedades, prolongar la vida y promover la salud a través de los esfuerzos organizados y decisiones con conocimiento de la sociedad, las organizaciones (públicas y privadas), las comunidades y los individuos, esta disciplina se ha renovado con la incorporación de múltiples actores, profesiones, áreas de conocimiento, además de ser afectados y promovido por múltiples tecnologías, en particular los de información. Como un campo cambiante del conocimiento, la salud pública requiere la información basada en la evidencia y actualizaciones regulares, más aún en el contexto de un mundo en transición epidemiológica. "Temas actuales en la salud pública", presenta información actualizada sobre varios temas relacionados con las áreas reales de interés en esta ciencia médica creciente y emocionante, con la concepción y la filosofía que estamos trabajando para mejorar la salud de la población, en lugar que el tratamiento de las enfermedades de los pacientes individuales, la toma de decisiones sobre el cuidado de la salud colectiva que se basan en la mejor evidencia disponible, actualizada, válida y pertinente, y, finalmente, en el contexto de los recursos disponibles. La salud pública debe ser una ciencia compleja, ayudando en las decisiones, acciones y cambios en la salud del mundo. En una sociedad globalizada esto se hizo hincapié no sólo en una nación en particular, sino en todo el mundo.Public health is a major health discipline in the world. Defined as the science and art of preventing diseases, prolonging life and promoting health through the organized efforts and informed choices of the society, organizations (public and private), communities and individuals, this discipline has been renewed by the incorporation of multiple actors, professions, knowledge areas, as well as being impacted and promoted by multiple technologies, particularly information ones. As a changing field of knowledge, public health requires evidence-based information and regular updates, even more in the context of a world in epidemiological transition. Health impacts of climate change are currently in the quest of the Millennium Development Goals, and most of them are related to the activities of public health. “Current Topics in Public Health” presents updated information on multiple topics related to actual areas of interest in this growing and exciting medical science, with the conception and philosophy that we are working to improve the health of the population, rather than treating diseases of individual patients; taking decisions about collective health care that are based on the best available, current, valid and relevant evidence; and finally within the context of available resources. Public health should be a complex science helping in the decision, actions and changes in the health of the world. In a globalized society this is emphasized not just in a particular nation but in the whole world

The epidemiology and experience of chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a common and debilitating disorder. There is a deficit of knowledge about the epidemiology of CRS or the experience of sufferers. The aims of the study were to identify differences in socio-economic variables and quality of life between patients with chronic rhinosinusitis and healthy controls, to identify any significant associations between CRS and other medical co-morbidities, psychiatric disease or environmental exposures and to explore the experience of CRS from the perspective of CRS sufferers. This study consisted of a self-reported questionnaire distributed from 30 ENT clinics across the UK, and qualitative interviews with 21 patients with CRS. Additional studies were undertaken to support this work including further qualitative interviews with patients who have disturbed olfaction, and studies to assess new or unproven treatment regimens including a feasibility study for Clarithromycin for CRS and a trial of sodium citrate for hyposmia. No clear differences in socioeconomic variables were identified between cases and controls. CRS was found to be strongly associated with asthma and inhaled allergies as well as significantly impairing quality of life. Quality of life issues were very important to sufferers, and had been poorly addressed, particularly with regards to sense of smell. Further research is needed to better understand and manage CRS although better adherence to current guidelines would improve care in the interim

The Impact of Air Pollution on Health, Economy, Environment and Agricultural Sources

This book aims to strengthen the knowledge base dealing with Air Pollution. The book consists of 21 chapters dealing with Air Pollution and its effects in the fields of Health, Environment, Economy and Agricultural Sources. It is divided into four sections. The first one deals with effect of air pollution on health and human body organs. The second section includes the Impact of air pollution on plants and agricultural sources and methods of resistance. The third section includes environmental changes, geographic and climatic conditions due to air pollution. The fourth section includes case studies concerning of the impact of air pollution in the economy and development goals, such as, indoor air pollution in México, indoor air pollution and millennium development goals in Bangladesh, epidemiologic and economic impact of natural gas on indoor air pollution in Colombia and economic growth and air pollution in Iran during development programs. In this book the authors explain the definition of air pollution, the most important pollutants and their different sources and effects on humans and various fields of life. The authors offer different solutions to the problems resulting from air pollution