A Bundled Approach to Integrative Care for Peripherally Inserted Extracorporeal Membrane Oxygenation Cannula Insertion Site

Purpose and Rationale: This project is designed to translate the collective knowledge and evidence-based interventions surrounding the reduction of central line-associated bloodstream infections (CLABSIs) and use these evidence-based practices to create an extracorporeal membrane oxygenation (ECMO) cannula site bundle. The desired outcome of creating an ECMO cannula-site bundle is increased cannula site integrity, decreased frequency of dressing changes, and minimized risk of cannula-site infections. Synthesis of Evidence: Currently, there are no clinical practice guidelines for ECMO cannula site care to guide bedside practice. The ELSO Infectious Disease Taskforce recommends implementation of a CLABSI bundle for ECMO site care, but many of the products used for CLABSI prevention are not intended for large ECMO cannula sites. Practice Change and Implementation Strategies: The DNP students will create an ECMO cannula site bundle inspired by the CLABSI evidence available, as there is currently no ECMO specific products available. Evaluation: To evaluate project success, the DNP students will investigate the number of dressing changes required for ECMO insertion sites due to saturated and/or not intact dressings comparing pre and post implementation cohorts. Conclusion and Implications for Practice: This project would serve as a mean to standardize approaches to dressing the ECMO cannula insertion site, and potential serve as a clinical practice guideline to cannula site care

Ativação de um braço robótico através de sinais mioelétricos e redes neurais artificiais como protótipo para um estudo preliminar de sensibilidade háptica

As próteses de membro superior representam uma alternativa para melhorar a qualidade de vida de pessoas que passaram pelo processo de amputação. Apesar dos benefícios potencialmente propostos, a taxa de rejeição desse tipo de tecnologia é alta. Dentre os motivos, destaca-se a ausência de uma resposta referente à sensibilidade háptica, relacionada à sensação do toque e à propriocepção, o que torna o acionamento da prótese estressante e os períodos de treinamento prolongados. Com o objetivo de avaliar o impacto do retorno háptico no acionamento de próteses mioelétricas de membro superior, foi implementada a ativação de um braço robótico utilizando sinais mioelétricos e um classificador baseado em Redes Neurais Artificiais (RNA), capaz de distinguir entre movimentos e intensidades a partir de características dos sinais de Eletromigrafia de Superfície (sEMG). O sistema é realimentado, fornecendo uma resposta vibrotátil referente à intensidade de movimento realizada pelo dispositivo. Foram realizados testes com voluntários utilizando apenas resposta visual, apenas resposta háptica e as duas respostas em conjunto. Para os testes com resposta apenas visual, a taxa de estabilidade da ativação foi de 81.1% para a intensidade Fraca, 55.6% para a intensidade Média e 78.4% para a intensidade Forte. Utilizando apenas a resposta háptica, as taxas de estabilidade foram 69.3%, 60.0% e 77.9%, respectivamente. Por fim, as taxas de estabilidade utilizando os dois tipos de reposta foi 81.7%, 65.5% e 84.2%, demonstrando preliminarmente que a performance dos usuários foi superior nessa configuração. As respostas dos questionátios preenchidos ao final dos testes endossaram os resultados obtidos. Porém, é importante notar que os estudos na área devem ser continuados para sua correspondente validação.Upper limb prostheses represent an alternative to improve the life quality of people who have undergone an amputation process. Despite the potential benefits proposed, the rejection rate of this type of technology is high. Among the reasons, the absence of a response regarding haptic sensitivity, related to touch sensation and proprioception, stands out, which makes the activation of the prosthesis stressful and the training periods prolonged. With the objective of evaluating the impact of the haptic feedback on the activation of myeloelectric upper limb prostheses, the activation of a myoelectric robotic arm was implemented using a classifier based on Artificial Neural Networks (ANN), capable of distinguishing between movements and intensities using characteristics of Surface Electrographic signs (sEMG). The system loop is closed, providing a vibratory response relative to the movement intensity performed by the device. Tests with volunteers were performed using only visual response, only haptic response and the two responses together. For the visual-only response tests, the activation stability rate was 81, 1% for the Weak intensity, 55, 6% for the Medium intensity, and 78.4% for the intensity Strong. Using only the haptic response, stability rates were 69, 3%, 60, 0% and 77, 9%, respectively. Finally, stability rates using the two types of response were 81, 7%, 65, 5% and 84, 2%, showing preliminarily that the users performance was superior in this configuration. The questionnaire completed at the end of the tests corroborates the preliminary statement. However, it is important to note that continued studies should be carried out for their corresponding validation

Case Study: The Surgical Management of Angiokeratoma Resulting from Radiotherapy for Penile Cancer

Angiokeratoma is a rare, benign skin lesion and a recognised complication of radiation therapy. Here we describe a case of extensive angiokeratoma of the groin and external genitalia resulting from external beam radiation to that area in a patient with penile carcinoma. Furthermore, we outline the management of this problem by surgical reconstruction

Inguinal recurrence of malignant mesothelioma of the tunica vaginalis: one case report with delayed recurrence and review of the literature

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Marcas no Second Life : um breve estudo de como a Adidas se relaciona com o consumidor no metaverso

Este trabalho tem por objetivo apresentar um estudo de como as marcas se comportam e se relacionam com o consumidor utilizando novos suportes de media como os universos virtuais. Para tanto, realizou-se um estudo de caso da marca de artigos esportivos Adidas e sua loja virtual dentro do Second Life. O estudo foi baseado em uma pesquisa exploratória por meio de entrevistas abertas viabilizadas por questionário aplicado aos vários freqüentadores da loja. A partir do conjunto de dados analisados, foi possível concluir como a Adidas se posicionou nesse meio e qual sua relação com o consumidor do metaverso

Total phallic reconstruction after penile amputation for donkey bite: Case report and review of the literature

There are very few reported cases of traumatic amputation of the male genitalia due to animal bite. The management involves thorough washout of the wounds, debridement, antibiotic prophylaxis, tetanus and rabies immunization followed by immediate reconstruction or primary wound closure with delayed reconstruction, when immediate reconstruction is not feasible. When immediate reconstruction is not feasible, long-term good functional and cosmetic results are still possible in the majority of cases by performing total phallic reconstruction. In particular, it is now possible to fashion a cosmetically acceptable sensate phallus with incorporated neourethra, to allow the patient to void while standing and to ejaculate, and with enough bulk to allow the insertion of a penile prosthesis to guarantee the rigidity necessary to engage in penetrative sexual intercourse

Paraganglioma of the Spermatic Cord: Case Report and Review of the Literature

Paragangliomas rarely involve the genitourinary tract. We present a case of a paraganglioma arising from the spermatic cord and review the literature on the topic

Penile Prosthesis: What Should We Do about Complications?

Even in the era of phoshodiesterase type 5 inhibitors, penile implants are considered the definitive solution for the treatment of organic erectile disfunction. The advent of new surgical tools and new infection-resistant materials has significantly reduced the risk of intra and post-operative complications and the need for revision surgery. Various companies have also improved their mechanical systems in order to reduce the risk of failures, and their products are now so good they may last lifelong. In this article, we evaluate the intraoperative and postoperative complications recorded in our experience and in literature reports, and make some suggestions as to how to prevent or correct them