Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Children’s Influence – Complex and Conditional : Preschoolers descriptions of the work with Children’s Influence in preschool activities

The purpose of this work is to provide knowledge about the influence of children in preschool activities using preschool teachers' descriptions of their views on and work with children's influence. In order to achieve the goal of my purpose, I chose to use a qualitative method, semi-structured interview, where I interviewed three legitimate preschool teachers. The interviews were based on my three questions; How the preschool teachers describe their views on and work with the influence of children and what challenges and opportunities are present in the work on children's influence. The result shows that influence is complex and conditional, which in my survey means that there are varying degrees of influence. My analysis tools, Ribaeus Institutional democracy events and Harts ladder of participation, helped me to understand that preschoolers descriptions often describe adult-induced situations where children are given the opportunity to exercise influence.Syftet med arbetet är att bidra med kunskap om barns inflytande i förskolans verksamhet med hjälp av förskollärares beskrivningar av sin syn på och arbete med barns inflytande. För att uppnå målet med mitt syfte valde jag att använda en kvalitativ metod, semi-strukturerad intervju, där jag intervjuade tre legitimerade förskollärare. Intervjuerna skapades utifrån mina tre frågeställningar; Hur förskollärarna beskriver sin syn på och arbete med barns inflytande samt vilka utmaningar och möjligheter som finns i arbetet med barns inflytande. Resultatet visar att inflytande är komplext och villkorat vilket i min undersökning innebär att det finns varierande grader av inflytande. Mina analysverktyg, Ribaeus institutionella demokratihändelser och Harts delaktighetsstege, hjälpte mig att förstå att förskollärarnas beskrivningar ofta beskriver vuxeninitierade situationer där barn till viss mån ges möjlighet att utöva inflytande

Sjuksköterskornas val : Hur arbetsgivare förblir attraktiva på en omättad arbetsmarknad

Syftet med studien har varit att ur ett arbetspsykologiskt perspektiv undersöka vilka faktorer som påverkar en sjuksköterskas val av arbetsgivare. De frågeställningar studien ämnar besvara är om det finns samband mellan olika motivationsfaktorer och sjuksköterskors benägenhet att byta arbetsgivare, vilka aspekter av arbetet som anses viktiga samt vilka faktorer som skapar mest upplevd nöjdhet med arbetssituationen. Studien har genomförts med en kvantitativ ansats och 115 deltagare har besvarat en enkät med frågor som har formulerats kring ämnesområdet. Studiens resultat visar att sjuksköterskor anställda inom privat sektor är mer nöjda med sina arbetsgivare och att den största andelen av deltagarna hade valt att byta till en arbetsgivare inom privat sektor. Resultatet visar även att det främst var faktorerna en högre lön och lägre arbetsbelastning som påverkade sjuksköterskorna inom offentlig sektors benägenhet att byta arbetsgivare. För sjuksköterskor inom privat sektor var det faktorerna större gemenskap på arbetsplatsen och mer patientkontakt som främst skulle påverka valet att byta arbetsgivare. Faktorerna att känna sig nöjd med sin lön och arbetstider samt att ha möjligheten att hjälpa andra sågs som de viktigaste aspekterna av arbetet. The aim of this study is to, from a work psychology perspective, investigate which factors that can affect a nurse’s choice of employer. The study aims to seek out whether a correlation between different factors and nurses desire to change employer can be found, which factors of the workplace that were considered most important and which factors that creates the greatest perceived satisfaction with the work situation. The study has been conducted with a quantitative approach and 115 participants has answered a questionnaire based upon the subject matter. The result of the study shows that nurses working in the private sector are more satisfied with their employer and the greater part of the participants would have chosen to switch to an employer in the private sector. The results also show that is was primarily the factors higher salary and a lower workload that affected the nurses in the public sector tendency to change employer. For the nurses in the private sector, the factors were greater community in the workplace and more patient contact that would primarily affect the choice to change employer. The study states that the most important aspects of the work situation were a satisfying salary, satisfying working hours and to have the opportunity to help others

Multiple tracheal resections and anastomoses in a blue and gold macaw (Ara ararauna)

A 1.5-year-old, male blue and gold macaw (Ara ararauna) was anesthetized for a health examination and blood collection. The following day it was returned for episodes of coughing. The bird was presented again 13 days after the initial presentation with severe dyspnea. A tracheal stenosis was diagnosed by endoscopy and treated by surgical resection of 5 tracheal rings and tracheal anastomosis. The bird was discharged but returned 2 days later with a recurrent stenosis. Bougienage and balloon dilation of the stenotic area were performed separately; each resulted in less than 48 hours\u27 improvement in clinical signs after treatment. A second tracheal resection and anastomosis was performed, during which an additional 10 tracheal rings were removed. This second anastomosis was significantly more difficult to complete given the marked variation in diameter of the proximal and distal tracheal segments. The macaw recovered without complication and has had no recurrence of respiratory abnormalities 2 years after the second surgery. This report describes the longest total tracheal segment to be resected, followed by tracheal anastomosis, in a psittacine bird. The positive outcome in this case suggests that, when surgical therapy is elected, an aggressive approach is necessary to prevent recurrence of tracheal stenosis. In addition, macaws can recover well even after significant lengths of the trachea are resected