A multi-center study on the attitudes of Malaysian emergency health care staff towards allowing family presence during resuscitation of adult patients

BACKGROUND The practice of allowing family members to witness on-going active resuscitation has been gaining ground in many developed countries since it was first introduced in the early 1990s. In many Asian countries, the acceptability of this practice has not been well studied. AIM We conducted a multi-center questionnaire study to determine the attitudes of health care professionals in Malaysia towards family presence to witness ongoing medical procedures during resuscitation. METHODS Using a bilingual questionnaire (in Malay and English language), we asked our respondents about their attitudes towards allowing family presence (FP) as well as their actual experience of requests from families to be allowed to witness resuscitations. Multiple logistic regression was used to analyze the association between the many variables and a positive attitude towards FP. RESULTS Out of 300 health care professionals who received forms, 270 responded (a 90% response rate). Generally only 15.8% of our respondents agreed to allow relatives to witness resuscitations, although more than twice the number (38.5%) agreed that relatives do have a right to be around during resuscitation. Health care providers are significantly more likely to allow FP if the procedures are perceived as likely to be successful (e.g., intravenous cannulation and blood taking as compared to chest tube insertion). Doctors were more than twice as likely as paramedics to agree to FP (p-value = 0.002). This is probably due to the Malaysian work culture in our health care systems in which paramedics usually adopt a 'follow-the-leader' attitude in their daily practice. CONCLUSION The concept of allowing FP is not well accepted among our Malaysian health care providers

The semi-seated position slightly reduces the effort to breathe during difficult weaning

PURPOSE: The influence of posture on breathing effort in patients with difficult weaning is unknown. We hypothesized that posture could modulate the breathing effort in difficult-to-wean patients. METHODS: A prospective, crossover, physiologic study was performed in 24 intubated patients breathing with pressure support who had already failed a spontaneous breathing trial or an extubation episode. Their median duration of mechanical ventilation before measurements was 25 days. Breathing pattern, occlusion pressure (P (0.1)), intrinsic PEEP (PEEP(i)), and inspiratory muscle effort evaluated by the pressure-time product of the respiratory muscles and the work of breathing were measured during three postures: the seated position in bed (90\ub0LD), simulating the position in a chair, the semi-seated (45\ub0), and the supine (0\ub0) positions consecutively applied in a random order. A comfort score was obtained in 17 cooperative patients. The influence of position on chest wall compliance was measured in another group of 11 sedated patients. RESULTS: The 45\ub0 position was associated with the lowest levels of effort (p 64 0.01) and occlusion pressure (p < 0.05), and tended to be more often comfortable. Respiratory effort was the lowest at 45\ub0 in 18/24 patients. PEEP(i) and PEEP(i)-related work were slightly higher in the supine position (p 64 0.01), whereas respiratory effort, heart rate, and P (0.1) values were increased in the seated position (p < 0.05). CONCLUSION: A 45\ub0 position helps to unload the respiratory muscles, moderately reduces PEEP(i), and is often considered as comfortable. The semi-seated position may help the weaning process in ventilator-dependent patient

Overview of NSTX Upgrade initial results and modelling highlights

The National Spherical Torus Experiment (NSTX) has undergone a major upgrade, and the NSTX Upgrade (NSTX-U) Project was completed in the summer of 2015. NSTX-U first plasma was subsequently achieved, diagnostic and control systems have been commissioned, the H-mode accessed, magnetic error fields identified and mitigated, and the first physics research campaign carried out. During ten run weeks of operation, NSTX-U surpassed NSTX record pulse-durations and toroidal fields (TF), and high-performance ∼1 MA H-mode plasmas comparable to the best of NSTX have been sustained near and slightly above the n = 1 no-wall stability limit and with H-mode confinement multiplier H98y,2 above 1. Transport and turbulence studies in L-mode plasmas have identified the coexistence of at least two ion-gyro-scale turbulent micro-instabilities near the same radial location but propagating in opposite (i.e. ion and electron diamagnetic) directions. These modes have the characteristics of ion-temperature gradient and micro-tearing modes, respectively, and the role of these modes in contributing to thermal transport is under active investigation. The new second more tangential neutral beam injection was observed to significantly modify the stability of two types of Alfven eigenmodes. Improvements in offline disruption forecasting were made in the areas of identification of rotating MHD modes and other macroscopic instabilities using the disruption event characterization and forecasting code. Lastly, the materials analysis and particle probe was utilized on NSTX-U for the first time and enabled assessments of the correlation between boronized wall conditions and plasma performance. These and other highlights from the first run campaign of NSTX-U are described