Peripherally Inserted Central Catheter Placement in a Cardiology Ward: A Focus Group Study of Nurses’ Perspectives

info:eu-repo/semantics/publishedVersio

The population genomics of archaeological transition in west Iberia: Investigation of ancient substructure using imputation and haplotype-based methods

We analyse new genomic data (0.05–2.95x) from 14 ancient individuals from Portugal distributed from the Middle Neolithic (4200–3500 BC) to the Middle Bronze Age (1740–1430 BC) and impute genomewide diploid genotypes in these together with published ancient Eurasians. While discontinuity is evident in the transition to agriculture across the region, sensitive haplotype-based analyses suggest a significant degree of local hunter-gatherer contribution to later Iberian Neolithic populations. A more subtle genetic influx is also apparent in the Bronze Age, detectable from analyses including haplotype sharing with both ancient and modern genomes, D-statistics and Y-chromosome lineages. However, the limited nature of this introgression contrasts with the major Steppe migration turnovers within third Millennium northern Europe and echoes the survival of non-Indo-European language in Iberia. Changes in genomic estimates of individual height across Europe are also associated with these major cultural transitions, and ancestral components continue to correlate with modern differences in stature

Controle de danos: uma opção tática no tratamento dos traumatizados com hemorragia grave Damage control: a tactical alternative for the management of exanguinating trauma patients

RACIONAL: O choque hemorrágico persistente cursa com alta mortalidade. Grande importância tem sido dada para o "controle de danos" como opção terapêutica nestes casos. OBJETIVO: Avaliar a definição, indicações, técnicas e resultados do controle de danos no tratamento dos traumatizados com hemorragia grave. MÉTODO: Revisão bibliográfica. RESULTADOS: Como "controle de danos" entende-se a interrupção da operação antes que o choque hemorrágico alcance a sua fase irreversível, mesmo que as lesões encontradas não tenham o tratamento definitivo neste primeiro momento. Esta alternativa envolve três tempos: a operação abreviada, a recuperação na unidade de terapia intensiva e a reoperação programada. Desta forma, frente à acidose metabólica, hipotermia e coagulopatia, a operação é abreviada através do controle temporário da hemorragia e contaminação. São empregadas técnicas como o tamponamento hepático com compressas e ligadura de eventuais cotos intestinais. Na unidade de terapia intensiva são realizados o aquecimento do doente, restauração da volemia e débito cardíaco, e adequada oferta de oxigênio, além da reposição dos fatores de coagulação. Somente após a estabilização, o traumatizado é levado novamente ao centro cirúrgico para o tratamento definitivo das lesões. Trata-se de uma tática com bons resultados, mas que deve ser restrita a centros especializados, com supervisão cirúrgica contínua e recursos disponíveis para o tratamento de doentes graves. CONCLUSÃO: O controle de danos é opção prática nos casos de hemorragia grave, contudo deve ser empregado com julgamento crítico devido a complicações que podem decorrer da sua indicação.<br>BACKGROUND: Despite the advances in the treatment of exanguinating patients, hemorrhage remains as the leading cause of early deaths. A great deal of attention has been given to "damage control" as a therapeutic alternative in this scenario. AIM: To appraise the definition, indications, operative techniques and results of damage control for the treatment of exanguinating trauma patients. METHOD: Bibliographic review. RESULTS: Damage control introduces the concept of breaking the vicious cycle of metabolic acidosis, hypothermia and coagulopathy which results from hemorrhagic shock. Thus, the operation has to be interrupted before this irreversible stage, even if the injured organs were not given the definitive treatment at this moment. So, damage control involves three steps: an abbreviated operation, a recovering period in the intensive care unit, and the reoperation for the definitive treatment. At the abbreviated operation, operative techniques as stapling intestinal injuries or packing liver wounds are applied, allowing rapid control of the bleeding and spillage. In the intensive care unit, the patient is warmed, oxygen delivery and consumption are restored and coagulation factors administered. As soon as the hemodynamic stability, ideal body temperature and coagulation status are reached, the definitive operation is carried out. Damage control is a helpful option if correctly used. However, there are also severe complications that can occur. Therefore, it should be employed only in centers that could provide optimum resources. CONCLUSION: Damage control is an important tactical alternative for the treatment of exanguinating trauma patients