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

Dexamethasone intravitreal implant in previously treated patients with diabetic macular edema : Subgroup analysis of the MEAD study

Background: Dexamethasone intravitreal implant 0.7 mg (DEX 0.7) was approved for treatment of diabetic macular edema (DME) after demonstration of its efficacy and safety in the MEAD registration trials. We performed subgroup analysis of MEAD study results to evaluate the efficacy and safety of DEX 0.7 treatment in patients with previously treated DME. Methods: Three-year, randomized, sham-controlled phase 3 study in patients with DME, best-corrected visual acuity (BCVA) of 34.68 Early Treatment Diabetic Retinopathy Study letters (20/200.20/50 Snellen equivalent), and central retinal thickness (CRT) 65300 \u3bcm measured by time-domain optical coherence tomography. Patients were randomized to 1 of 2 doses of DEX (0.7 mg or 0.35 mg), or to sham procedure, with retreatment no more than every 6 months. The primary endpoint was 6515-letter gain in BCVA at study end. Average change in BCVA and CRT from baseline during the study (area-under-the-curve approach) and adverse events were also evaluated. The present subgroup analysis evaluated outcomes in patients randomized to DEX 0.7 (marketed dose) or sham based on prior treatment for DME at study entry. Results: Baseline characteristics of previously treated DEX 0.7 (n = 247) and sham (n=261) patients were similar. In the previously treated subgroup, mean number of treatments over 3 years was 4.1 for DEX 0.7 and 3.2 for sham, 21.5 % of DEX 0.7 patients versus 11.1 % of sham had 6515-letter BCVA gain from baseline at study end (P = 0.002), mean average BCVA change from baseline was +3.2 letters with DEX 0.7 versus +1.5 letters with sham (P = 0.024), and mean average CRT change from baseline was -126.1 \u3bcm with DEX 0.7 versus -39.0 \u3bcm with sham(P < 0.001). Cataract-related adverse events were reported in 70.3 % of baseline phakic patients in the previously treated DEX 0.7 subgroup; vision gains were restored following cataract surgery. Conclusions: DEX 0.7 significantly improved visual and anatomic outcomes in patients with DME previously treated with laser, intravitreal anti-vascular endothelial growth factor, intravitreal triamcinolone acetonide, or a combination of these therapies. The safety profile of DEX 0.7 in previously treated patients was similar to its safety profile in the total study population

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

EFFECT OF FALLOW LAND, CULTIVATED PASTURE AND ABANDONED PASTURE ON SOIL FERTILITY IN TWO DEFORESTED AMAZONIAN REGIONS

The effect of two practices adopted by settlers (abandoned pasture and fallow land) on soil fertility of two deforested Amazonian regions (Belém-Pará and Ariquemes-Rondônia) was studied. Whenever possible, cultivated pasture, over similar time periods in both cases and in natural forest, were employed as soil fertility reference standards. Nutrient dynamics was studied using the electroultra-filtration technique. In general, deforestation, as practiced in these areas, has a degrading effect on soil fertility. The effect of burning normally leads to a pH rise caused by ash. This usually yields a favorable transitory effect, improving soil fertility conditions, however not sufficient for plant needs, as inferred from the low P and K levels. Cattle excrements, improved the K level for cultivated pastures. Qualitative differences related to N were observed between cultivated pasture and both, fallow land or abandoned pasture. In the first, a certain recovery of available N levels was detected, mainly affecting the EUF-Norg fraction. On the other hand, a regeneration of organic compounds, in the fallow land and the abandoned pasture, closely related to those existing in the natural forest, was verified. This is mainly due to the presence of a higher proportion of NO3-_N and, consequently, a EUF-Norg/EUF-NO3- ratio close to 1.<br>Comparou-se o efeito de duas práticas de manejo, ou seja, o abandono da pastagem e o pousio, sobre a fertilidade do solo de duas regiões desmatadas da Amazônia (Belém-Pará e Ariquemes-Rondônia). Quando possível, pastagens cultivadas por períodos semelhantes e florestas nativas foram usadas como padrões da fertilidade do solo. A dinâmica dos nutrientes foi estuda pela técnica da eletroultrafiltração (EUF). De um modo geral, o desmatamento, como praticado nessas regiões, tem efeito degradador sobre a fertilidade do solo. A queima da biomassa vegetal normalmente leva a um aumento do pH causado pelas cinzas, resultando em um efeito favorável transitório. Manifesta-se um melhoramento das condições de fertilidade do solo que, no entanto, não é suficiente para a nutrição das plantas, considerando-se os baixos níveis de P e K. Os excrementos do gado geralmente causam um aumento do nível de K do solo sob pastagens cultivadas. Foram observadas diferenças qualitativas relacionadas aos teores de N entre as pastagens cultivadas e as áreas em pousio ou pastagens abandonadas. Nas primeiras, observou-se certa recuperação na disponibilidade de N, principalmente da fração Norg-EUF. Por outro lado, verificou-se uma regeneração de compostos orgânicos nas áreas em pousio e nas pastagens abandonadas, que alcançaram valores próximos aos observados na floresta natural. Isso se deve, principalmente, à proporção maior de N-NO3- encontrada nessas áreas, resultando em uma relação Norg-EUF/ NO3--EUF próxima a 1

A bypass of Cohen’s impossibility result

Abstract. Detecting illegal resource access in the setting of grid computing is similar to the problem of virus detection as put forward by Fred Cohen in 1984. We discuss Cohen’s impossibility result on virus detection, and introduce “risk assessment of security hazards”, a notion that is decidable for a large class of program behaviors. Keywords: Malcode, Program algebra, Thread algebra, Virus, Worm.

Immunohistochemical detection of cell proliferation in gastric carcinomas with the monoclonal antibody ki-67. A study of 24 cases

The proliferative activity in 24 gastric carcinomas was determined by an immunohistochemical method using monoclonal antibody Ki-67 (ABC method). Immunostained nuclei were counted by two observers through a Nachet NS 1000 image numeriser. Three grades were defined according to stained nuclei percentage (proliferation index Pi = percentage of cells engaged in cellular cycle outside Go): grade 1 (Pi < 20%); grade 2 (20% 40%). About 60% of tumours were in grade 1 and 10% in grade 3. No correlations were observed between Pi and the following parameters: histological differentiation; parietal extension; presence or absence of metastasis. These results may be compared to the two other avalable studies of Ki-67 antibody in gastric cancers. Our study also showed a heterogeneous distribution of immunostained nuclei, within each single tumour and from one tumour to another, which has been noted in one previous study and in a similar one we made on colorectal carcinoma. This heterogeneity is the consequence of the variability of carcinomatous cell proliferative activity; an important biological factor in the evaluation of tumoral process. The proliferative activity in gastric carcinomas provides an estimation of tumour dynamics that might be a prospective criterium for tumoral process evaluation