Approaches and adjuncts used by physiotherapists when suctioning adult patients who are intubated and ventilated in intensive care units in Australia and New Zealand: A cross-sectional survey

Background: Suctioning is an integral component of care for patients who are intubated and ventilated in an intensive care unit (ICU). There appears to be no published data of physiotherapy suctioning practices in Australia or New Zealand. Objective: To describe suctioning practices and the factors which have shaped these practices, of experienced physiotherapists working with adults who are intubated and ventilated in an ICU across Australia and New Zealand. Areas of investigation focused on: (i) suctioning approach (i.e. open vs. closed system); (ii) use of adjuncts to suctioning such as hyperoxygenation, hyperinflation and saline lavage; (iii) use of subglottic suctioning and; (iv) factors influencing suctioning practices. Methods: Electronic surveys were emailed to experienced physiotherapists working in ICUs across Australia and New Zealand which had the capacity to intubate and ventilate adult patients for =24. h. Results: The participation rate was 84.8% (112/132). Closed suction system was used in most ICUs (97/112, 86.6%). Hyperoxygenation was commonly performed on 'all' or 'most' patients before suctioning (71/112, 63.4%), but less frequently after suctioning (38/112, 33.9%). Hyperinflation was infrequently performed on 'all' or 'most' patients before (22/112, 19.6%) or after suctioning (22/112, 19.6%). Saline lavage and subglottic suctioning were infrequently performed on 'all' or 'most' patients (3/112, 2.7%; 17/112, 15.2%, respectively). 'Personal experience' and 'established practice in the ICU' had the greatest influence on suctioning practices. Conclusions: Most ICUs in Australia and New Zealand are equipped for closed system suctioning. As hyperoxygenation minimises desaturation during suctioning, there may be scope for a larger proportion of physiotherapists to use this adjunct. The practice of hyperinflation before and after suctioning was uncommon despite the emerging evidence for improved lung compliance with this procedure. Subglottic suctioning was infrequently available as a choice for physiotherapists despite the strong evidence, which suggests an evidence-practice gap. © 2017 Australian College of Critical Care Nurses Ltd

Portfolio-Based Approach for Disaster Recovery Planning for IT

With the integration of IT with business operations and management, organizations are vulnerable to a myriad of threats ranging from computer viruses to natural disasters and deliberate acts of sabotage. Consequently, IT disaster recovery has emerged as a critical organizational issue. This paper proposes an application portfolio-based framework for IT disaster recovery planning based on the role of IT and the consequence of IT disaster. The findings and recommendations of the paper are based on interviews with disaster recovery experts and senior IT professionals and a case study

Progenitor cell markers predict outcome of patients with hepatocellular carcinoma beyond Milan criteria undergoing liver transplantation.

BACKGROUND & AIMS: In patients with hepatocellular carcinoma (HCC), liver transplantation (LT) is an excellent therapy if tumor characteristics are within the Milan criteria. We aimed to define genomic features enabling to identify HCC patients beyond Milan criteria who have acceptable transplant outcomes. METHODS: Among 770 consecutive HCC patients transplanted between 1990 and 2013, 132 had tumors exceeding Milan criteria on pathology and were enrolled in the study; 44% of the patients satisfied the 'up-to-7 rule' [7=sum of the size of the largest tumor and the number of tumors]. Explant tumors were assessed for genomic signatures and immunohistochemical markers associated with poor outcome. RESULTS: At a median follow-up of 88months, 64 patients had died and 45 recurred; the 5-year overall survival (OS) and recurrence rates were 57% and 35%, respectively. Cytokeratin 19 (CK19) gene signature was independently associated with recurrence [Hazard ratio (HR)=2.95, p<0.001], along with tumor size (HR=3.37, p=0.023) and presence of satellites (HR=2.98, p=0.001). S2 subclass signature was independently associated with poor OS (HR=3.18, p=0.001), along with tumor size (HR=5.06, p<0.001) and up-to-7 rule (HR=2.50, p=0.002). Using the presence of progenitor cell markers (either CK19 or S2 signatures) patients were classified into poor prognosis (n=58; 5-year recurrence 53%, survival 45%) and good prognosis (n=74; 5-year recurrence 19%, survival 67%) (HR=3.16, p<0.001 for recurrence, and HR=1.72, p=0.04 for OS). CONCLUSIONS: HCC patients transplanted beyond Milan criteria without gene signatures of progenitor markers (CK19 and S2) achieved survival rates similar as those within Milan criteria. Once prospectively validated, these markers may support a limited expansion of LT indications

Incorporation of the Biopsychosocial Model in Education is Lacking

Studying medicine has long been considered a biomedical pursuit. Education of future medical practitioners reflects this in its narrow focus on obtaining high GPAs and a competitive MCAT score. Opponents argue that this framework causes physicians to be callous and economically driven. Instead, they suggest teaching medical students according to the biopsychosocial (BPS) model, so they receive a comprehensive perspective of medicine that encompasses the biological as well as the behavioral components of treatment. The purpose of this literature review is to observe the ways in which the BPS model has been incorporated into medical education. In the three articles that fulfilled the eligibility criteria, it was demonstrated that there is a large variability to the incorporation of the BPS model in the medical curriculum. Overall, both medical schools and students report needing more formal training in BPS topics before they feel comfortable using the model

Towards Expert Consensus on Diagnosing Higher Order Visual Dysfunction in Patients with Preexisting Ophthalmic Disease

Age-related eye disease commonly causes low vision, which can impede diagnosis of neurodegenerative disease causing visual processing dysfunction. Diagnosis of neurodegenerative disease in the setting of low vision is clinically important to guide comprehensive management for both low vision and dementia. Barriers to recognition of co-existing eye disease and visual processing dysfunction include attribution of visual symptoms to ophthalmic disease and lack of sufficient vision to complete standard visual processing tests. There is a need for consensus strategies for visual processing dysfunction detection in people with low vision due to ophthalmic disease

ADAPTIVE PERFORMANCE OF PROACTIVE INDIVIDUALS : UNDERSTANDING THE ROLES OF PRACTICAL INTELLIGENCE AND NEGATIVE AFFECTIVITY

Bachelor'sBACHELOR OF SOCIAL SCIENCES (HONOURS

Flexible work arrangements : why you have it and i don't - a study of the critical factors that influence the implementation.

This study investigates the extent to which selected factors from previous literature, influence companies’ reluctance to adopt FWAs in Singapore and to find out if companies of different sizes and in different industries are similar in this aspect. A quantitative and qualitative approach is taken to achieve this objective

Disaster recovery planning for IT (Vol. 1).

This paper addresses key issues such as the types of disasters organizations face, the importance of business impact analysis (BIA) and how organizations may carry out disaster recovery planning

Singapore 2010 Youth Olympic Games CAN! Create (Arts Phase)

Create Action Now! (CAN!) Arts festival is a youth-for-youth campaign conducted by a team of final year undergraduates, in continuation of the CAN! Festivities adopted by the Singapore Youth Olympic Games Organizing Committee (SYOGOC) in 2009. The campaign aims to create youth excitement and engagement in the celebrations preceding the Singapore 2010 Youth Olympic Games (Singapore 2010), through the local sports and arts arenas. This report discusses the marketing strategies introduced by the authors from Wee Kim Wee School of Communication & Information (WKW SCI) in collaboration with the SYOGOC for the Singapore 2010 CAN! Arts festival, and summarizes the subsequent action plan for the campaign.Bachelor of Communication Studie