Trach tubes designed to maximize safety may increase risk to ventilated patients

Dual-cannulae tracheostomy tubes with low-pressure cuffs, such as the Shiley LPC, are widely regarded as inherently safer than single lumen tubes with low-volume cuffs. For the patient who undergoes tracheostomy for failure to wean from mechanical ventilation, however, the insertion of a tube that occupies a large amount of space within the trachea can delay subsequent efforts to liberate him from the ventilator. With an aim to promote more timely rehabilitation of ventilated patients, London Ontario's University Hospital has been inserting the Bivona TTS, a single lumen tube with an elastic cuff, during tracheostomy. This allows caregivers to better exploit the benefits of a functional upper airway early during the weaning process, which may reduce complications associated with prolonged mechanical ventilation. We urge clinical studies to determine how the choice of initial tracheostomy tube can affect rehabilitation strategies and important patient outcomes

Internationalisation at Home in Finnish Higher Education Institutions and Research Institutes

This study on the current status of internationalisation at home was carried out for the Ministry of Education and Culture by the Finnish Institute for Educational Research, which is based at the University of Jyväskylä. The study was commissioned using the streamlined procedure for small-scale public procurement. The purpose of the study was to investigate how much attention had been paid to internationalisation at home in institutions of higher education and research and to ways in which related practices had been implemented. The research data was collected via an online questionnaire and interviews conducted at various institutions. On the basis of the data, there are clear differences within and between higher education institutions in terms of familiarity with the concept of internationalisation at home and the importance assigned to it, the extent to which equality had been achieved in student participation, and the roles of international staff and students. The researchers identified a number of promising practices as well as some challenges to language policy. Integrating internationalisation at home with established strategies and procedures calls for a holistic approach that covers everything from the national level to that of the individual student. The report sets out recommendations for action to be taken at various levels (nationwide, in institutions of higher education, in faculties and departments, in teaching and administration, and among students). These include the following: - including indicators of internationalisation at home in agreements on performance targets; - promoting internationalisation at home, cross-cultural competence and language skills among teachers and administrators; - refining intercultural teaching methods and evaluating skills; - including intercultural skills and internationalisation at home in personal study plans

Building a Comprehensive System of Services to Support Adults Living with Long-Term Mechanical Ventilation

Background. Increasing numbers of individuals require long-term mechanical ventilation (LTMV) in the community. In the South West Local Health Integration Network (LHIN) in Ontario, multiple organizations have come together to design, build, and operate a system to serve adults living with LTMV. Objective. The goal was to develop an integrated approach to meet the health and supportive care needs of adults living with LTMV. Methods. The project was undertaken in three phases: System Design, Implementation Planning, and Implementation. Results. There are both qualitative and quantitative evidences that a multiorganizational system of care is now operational and functioning in a way that previously did not exist. An Oversight Committee and an Operations Management Committee currently support the system of services. A Memorandum of Understanding has been signed by the participating organizations. There is case-based evidence that hospital admissions are being avoided, transitions in care are being thoughtfully planned and executed collaboratively among service providers, and new roles and responsibilities are being accepted within the overall system of care. Conclusion. Addressing the complex and variable needs of adults living with LTMV requires a systems response involving the full continuum of care

Reproducibility of Protected Brush Catheter Specimen Cultures in Critically Ill Patients with Suspected Nosocomial Pneumonia

OBJECTIVE: To determine the reproducibility of two protected brush catheter (PBC) specimens obtained during the same bronchoscopy in critically ill patients with suspected ventilator associated pneumonia

Institutional Care for Long-Term Mechanical Ventilation in Canada: A National Survey

INTRODUCTION: No national Canadian data define resource requirements and care delivery for ventilator-assisted individuals (VAIs) requiring long-term institutional care. Such data will assist in planning health care services to this population