An assessment of physicians’ knowledge and attitudes toward the near-death experience.

ABSTRACT: The purpose of this study was to investigate physicians' knowl edge of and attitudes toward near-death experiences (NDEs). The study population consisted of 143 staff physicians in the Baptist Memorial Hospital System. Participants completed by mail a modified version o

Prospective analysis of hip arthroscopy with 2-year follow-up.

Purpose: Numerous indications, but little outcome data, have been reported for hip arthroscopy. The purpose of this prospective study is to report the 2-year results of hip arthroscopy performed on a consecutive series of patients for a variety of disorders. Type of Study: Case series. Materials and Methods: There were 38 procedures performed on 35 patients who have achieved 2-year follow-up. All patients were assessed with a modified Harris hip score (pain and function) preoperatively and postoperatively at 1, 3, 6, 12, and 24 months or until a subsequent procedure was performed. Variables studied included age, sex, diagnosis, duration of symptoms, onset of symptoms, centeredge angle, Workers' Compensation, and pending litigation. Results: Follow-up was obtained on all patients. The median score improved from 57 to 85 points. This included 10 cases (9 patients) who underwent a subsequent procedure at an average of 10 months (6 total hip arthroplasty, 1 core decompression, 3 second arthroscopy) with an index score of 54 compared with 52 at the time of the second procedure. The median improvement for the following diagnoses was: loose body (34), labral lesion (27), synovitis (26), chondral injury (18), arthriti

Near-Death Experiences in Patients Undergoing Cardiopulmonary Resuscitation

ABSTRACT: The purposes of this two-phase descriptive study were to docu ment the frequency of near-death experiences (NDEs) in a nonprobability convenience sample of patients undergoing cardiopulmonary resuscitation (CPR), to describe the types of NDE experienced most commonly during CPR, and to describe patients' views of helpful nursing responses to reports of NDEs. In Phase I a nurse read to subjects Greyson's (1983a) NDE scale. In Phase II, we used an open-ended interview designed to elicit patients' perception of helpful nursing responses to NDE reports. Results have implications for broad ening the groups of persons offering patients an opportunity to discuss NDEs after CPR. The quality of health care is not measured solely by the number of human beings who survive. Rather, it is measured by the number of patients who live on, for however long, with a sense of dignity, well being, and worth. In the 1990s we are faced with the fixed variables of Ms

(Sub)mm Interferometry Applications in Star Formation Research

This contribution gives an overview about various applications of (sub)mm interferometry in star formation research. The topics covered are molecular outflows, accretion disks, fragmentation and chemical properties of low- and high-mass star-forming regions. A short outlook on the capabilities of ALMA is given as well.Comment: 20 pages, 7 figures, in proceedings to "2nd European School on Jets from Young Star: High Angular Resolution Observations". A high-resolution version of the paper can be found at http://www.mpia.de/homes/beuther/papers.htm

Original Article Randomized Controlled Trial of Mindfulness-Based Therapy for Dyspnea in Chronic Obstructive Lung Disease

Abstract Objectives: Patients with chronic obstructive lung disease (COPD) suffer from significant dyspnea and may benefit from complementary and alternative medicine (CAM) therapies aimed at mitigating symptoms. The objective of this study was to test the efficacy of a mindfulness-based breathing therapy (MBBT) on improving symptoms and health-related quality of life in those with COPD. Design: We conducted a randomized controlled trial of 8-week mindfulness-based breathing therapy (MBBT) compared to support groups to test efficacy on improving symptoms and health-related quality of life in those with COPD. Setting: The setting for this study was an academic-affiliated veterans healthcare system. Subjects: The subjects consisted of 86 patients with COPD. Interventions: MBBT included weekly meetings practicing mindfulness mediation and relaxation response. Outcome measures: The main outcome measure was a post 6-minute-walk test (6MWT) Borg dyspnea assessment. Other outcome measures included health-related quality of life measures, 6MWT distance, symptom scores, exacerbation rates, and measures of stress and mindfulness. Analysis of covariance compared differences in outcomes between groups; paired t test evaluated changes within groups. Results: Participants were predominantly elderly men with moderate to severe COPD. We found no improvements in dyspnea (post 6MWT Borg difference between the MBBT and support group was 0.3 (95% confidence interval [CI]: À

Total Intravenous Anesthesia Including Ketamine versus Volatile Gas Anesthesia for Combat-related Operative Traumatic Brain Injury

Background: Traumatic brain injury is a leading cause of death and severe neurologic disability. The effect of anesthesia techniques on neurologic outcomes in traumatic brain injury and potential benefits of total intravenous anesthesia (TIVA) compared with volatile gas anesthesia (VGA), although proposed, has not been well evaluated. The purpose of this study was to compare TIVA versus VGA in patients with combatrelated traumatic brain injury. Methods: The authors retrospectively reviewed 252 patients who had traumatic brain injury and underwent operative neurosurgical intervention. Statistical analyses, including propensity score and matched analyses, were performed to assess differences between treatment groups (TIVA vs. VGA) and good neurologic outcome. Results: Two hundred fourteen patients met inclusion criteria and were analyzed; 120 received VGA and 94 received TIVA. Good neurologic outcome (Glasgow Outcome Score 4 -5) and decreased mortality were associated with TIVA compared with VGA (75% vs. 54%; P ‫؍‬ 0.002 and 5% vs. 16%; P ‫؍‬ 0.02, respectively). Multivariate logistic regression found admission Glasgow Coma Scale score of 8 or greater (odds ratio, 13.3; P < 0.001) and TIVA use (odds ratio, 2.3; P ‫؍‬ 0.05) to be associated with good neurologic outcomes. After controlling for confounding factors using propensity analysis and repeated one-to-one matching of patients receiving TIVA with those receiving VGA with regard to Injury Severity Score, Glasgow Coma Scale score, base deficit, Head Abbreviated Injury Score, and craniectomy or craniotomy, the authors could not find an association between treatment and neurologic outcome. Conclusion: Total intravenous anesthesia often including ketamine was not associated with improved neurologic outcom

Hyperbolic contraction measuring systems for extensional flow

In this paper an experimental method for extensional measurements on medium viscosity fluids in contraction flow is evaluated through numerical simulations and experimental measurements. This measuring technique measures the pressure drop over a hyperbolic contraction, caused by fluid extension and fluid shear, where the extensional component is assumed to dominate. The present evaluative work advances our previous studies on this experimental method by introducing several contraction ratios and addressing different constitutive models of varying shear and extensional response. The constitutive models included are those of the constant viscosity Oldroyd-B and FENE-CR models, and the shear-thinning LPTT model. Examining the results, the impact of shear and first normal stress difference on the measured pressure drop are studied through numerical pressure drop predictions. In addition, stream function patterns are investigated to detect vortex development and influence of contraction ratio. The numerical predictions are further related to experimental measurements for the flow through a 15:1 contraction ratio with three different test fluids. The measured pressure drops are observed to exhibit the same trends as predicted in the numerical simulations, offering close correlation and tight predictive windows for experimental data capture. This result has demonstrated that the hyperbolic contraction flow is well able to detect such elastic fluid properties and that this is matched by numerical predictions in evaluation of their flow response. The hyperbolical contraction flow technique is commended for its distinct benefits: it is straightforward and simple to perform, the Hencky strain can be set by changing contraction ratio, non-homogeneous fluids can be tested, and one can directly determine the degree of elastic fluid behaviour. Based on matching of viscometric extensional viscosity response for FENE-CR and LPTT models, a decline is predicted in pressure drop for the shear-thinning LPTT model. This would indicate a modest impact of shear in the flow since such a pressure drop decline is relatively small. It is particularly noteworthy that the increase in pressure drop gathered from the experimental measurements is relatively high despite the low Deborah number range explored

Evaluation of nurse's attitudes toward adult patients of size

Abstract Background: Obesity is a growing epidemic in the United States, with waistlines expanding (overweight) for almost 66% of the population (National Health and Nutrition Examination Survey 1999 -2004). The attitude of society, which includes healthcare providers, toward people of size has traditionally been negative, regardless of their own gender, age, experience, and occupation. The purpose of the present study was to determine whether bariatric sensitivity training could improve nursing attitudes and beliefs toward adult obese patients and whether nurses' own body mass index (BMI) affected their attitude and belief scores. Methods: An on-line survey was conducted of nursing attitudes and beliefs regarding adult obese patients. The responses were compared between 1 hospital that offered bariatric sensitivity training and 1 that did not. The primary study measures were 2 scales that have been validated to assess weight bias: Attitudes Toward Obese Persons (ATOP) and Beliefs Against Obese Persons (BAOP). The primary outcome measures were the scores derived from the ATOP and BAOP scales. Results: Data were obtained from 332 on-line surveys, to which 266 nurses responded with complete data, 145 from hospital 1 (intervention) and 121 from hospital 2 (control). The mean ATOP scores for hospital 1 were modestly greater than those for hospital 2 (18.0 versus 16.1, P ϭ .03). However, no differences were found between the 2 hospitals for the mean BAOP scores (67.1 versus 67.1, P ϭ .86). No statistically significant differences were found between the 2 hospitals among the BMI groups for either ATOP or BAOP. Within each hospital, no statistically significant trend was found among the BMI groups for either ATOP or BAOP. The association of BMI with the overall ATOP (r ϭ .13, P ϭ .04) and BOAP (r ϭ .12, P ϭ .05) scores was very weak, although marginally significant. The association of the overall ATOP score with the BAOP score was weak, although significant (r ϭ .26, P Ͻ .001). Conclusion: Annual bariatric sensitivity training might improve nursing attitudes toward obese patients, but it does not improve nursing beliefs, regardless of the respondent's BMI. (Surg Obes Relat Dis 2011;7:536 -540.

Risk factors for adverse postoperative outcomes in children presenting for cardiac surgery with upper respiratory tract infections. Anesthesiology.

Background: Otherwise healthy children who present for elective surgery with an upper respiratory infection (URI) may be at risk for perioperative respiratory complications. This risk may be increased in children with congenital heart disease who undergo cardiac surgery while harboring a URI because of their compromised cardiopulmonary status. Therefore, this study was designed to determine the incidence of peri-and postoperative complications in children undergoing cardiac surgery while harboring a URI. Methods: The study population consisted of 713 children scheduled to undergo cardiac surgery. Of these, 96 had symptoms of URI, and 617 were asymptomatic. Children were followed prospectively from induction of anesthesia to discharge from the hospital to determine the incidence of postoperative respiratory, cardiovascular, neurologic, and surgical adverse events. Duration of postoperative ventilation, time in the intensive care unit (ICU), and length of hospital stay were also recorded. Results: Children with URIs had a significantly higher incidence of respiratory and multiple postoperative complications than children with no URIs (29.2 vs. 17.3% and 25 vs. 10.3%, respectively; P < 0.01) and a higher incidence of postoperative bacterial infections (5.2 vs. 1.0%; P ‫؍‬ 0.01). Furthermore, logistic regression indicated that the presence of a URI was an independent risk factor for multiple postoperative complications and postoperative infections in children undergoing open heart surgery. Children with URIs also stayed longer in the intensive care unit than children with no URIs (75.9 ؎ 89.8 h vs. 57.7 ؎ 63.8, respectively; P < 0.01). However, the overall length of hospital stay was not significantly different (8.4 vs. 7.8 days, URI vs. non-URI groups; P > 0.05). Conclusions: The presence of a URI was predictive of postoperative infection and multiple complications in children presenting for cardiac surgery. Despite this, the presence of a URI does not appear to affect the patient's overall length of hospital stay nor the development of long-term sequelae

Neonatal Skin Maturation-Vernix Caseosa and Free Amino Acids

Abstract: Neonatal skin hydration decreases rapidly postnatally and then increases, indicating adaptive changes in stratum corneum water handling properties. Transition from high to low humidity at birth may initiate filaggrin proteolysis to free amino acids. Neonatal skin with vernix caseosa retained is more hydrated than skin with vernix removed. This study examines the potential roles of free amino acids and vernix in postnatal adaptation of infant stratum corneum in vivo. Specifically, the ontogeny of free amino acid generation in neonatal stratum corneum and the role of vernix caseosa in postnatal adaptation were examined using high performance liquid chromatography. Free amino acids were quantified for infant skin samples collected at (i) birth and 1 month and (ii) birth and 24 hours after vernix caseosa retention or removal and compared to neonatal foreskin, vernix caseosa, and adult stratum corneum using t-tests, analysis of variance, or univariate procedures. Free amino acids were extremely low at birth, significantly higher 1 month later but lower than in adults. Vernix caseosa retention led to significantly higher free amino acids 24 hours after birth compared to infants with vernix caseosa removed, and it paralleled the higher stratum corneum hydration of vernix caseosa-retained skin. Vernix caseosa contained free amino acids, with glutamic acid and histidine levels higher than in infants. Free amino acids in vernix caseosa-retained skin appear to originate from vernix caseosa. Free amino acids were lower in neonatal foreskin than adult forearm stratum corneum. Arginine was higher than citrulline at birth, but levels were comparable in older infants. The free amino acid increase at 1 month may be initiated by the humidity transition at birth and supports results in animals. The findings have implications for infant skin care practices