Orotracheal intubation: physicians knowledge assessment and clinical practices in intensive care units

OBJECTIVES: To assess the physician s knowledge on intubation techniques and to identify the common practices. METHODS: This was a prospective study, involving three different intensive care units within a University hospital: Anesthesiology (ANEST), Pulmonology (PULMO) and Emergency Department (ED). All physicians working in these units and consenting to participate in the study completed a questionnaire with their demographic data and questions on orotracheal intubation. RESULTS: 85 completed questionnaires were retrieved (90.42% of the physicians). ANEST had the higher mean age (p=0.001), being 43.5% of them intensivists. The use of hypnotic and opioid association was reported by 97.6%, and pre-oxygenation by 91.8%, but only 44.6% reported sub-occipital pad use, with no difference between the ICUs. On ANEST an increased neuromuscular blockade use was reported (p<0.000) as well as increased caution with full stomach (p=0.002). The rapid sequence knowledge was restricted (mean 2.20 ± 0.89), p=0.06 between the different units. The Sellick maneuver was known by 97.6%, but 72% used it inappropriately. CONCLUSIONS: Physicians knowledge on orotracheal intubation in the intensive care unit is unsatisfactory, even among qualified professionals. It is necessary to check if the responses to the questionnaire and actual clinical practices agree.OBJETIVOS: Avaliar o conhecimento médico sobre as técnicas de intubação e identificar as práticas mais realizadas. MÉTODOS: Estudo prospectivo, envolvendo três diferentes unidades de terapia intensiva de um hospital universitário: da anestesiologia (ANEST), da pneumologia (PNEUMO) e do pronto socorro (PS). Todos os médicos que trabalham nessas unidades e que concordaram em participar do estudo, responderam um questionário contendo dados demográficos e questões sobre intubação orotraqueal. RESULTADOS: Foram obtidos 85 questionários (90,42% dos médicos). ANEST teve maior média de idade (p = 0,001), com 43,5% sendo intensivistas. Foi referido uso da associação hipnótico e opióide (97,6%) e pré oxigenação (91,8%), mas apenas 44,6% referiram utilização de coxim suboccipital, sem diferença entre as UTIs. Na ANEST, referiu-se maior uso de bloqueador neuromuscular (p < 0,000) e maior cuidado com estômago cheio (p = 0,002). O conhecimento sobre sequência rápida foi restrito (nota média - 2,20 ± 0,89, com p = 0,6 entre as unidades de terapia intensiva. A manobra de Sellick era conhecida por (97,6%), mas 72% usaram-na inapropriadamente. CONCLUSÕES: O conhecimento médico sobre intubação orotraqueal em terapia intensiva não é satisfatório, mesmo entre profissionais qualificados para tal procedimento. É necessário avaliar se há concordância entre as respostas dos questionários e as práticas clínicas efetivamente adotadas.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Curso de MedicinaUniversidade Federal de São Paulo (UNIFESP) Disciplina de Emergências ClinicasUniversidade Federal de São Paulo (UNIFESP) Disciplina de PneumologiaUniversidade Federal de São Paulo (UNIFESP) Disciplina de Anestesiologia, Dor e Terapia Intensiva Unidade de Terapia IntensivaUniversidade Federal de São Paulo (UNIFESP) Disciplina de Emergências Clínicas Unidade de Terapia IntensivaUniversidade Federal de São Paulo (UNIFESP) Disciplina de Pneumologia Unidade de Terapia IntensivaUniversidade Federal de São Paulo (UNIFESP) Disciplina de Anestesiologia, Dor e Terapia Intensiva Setor de Terapia IntensivaUniversidade Federal de São Paulo (UNIFESP) Disciplina de Anestesiologia, Dor e Terapia IntensivaUNIFESP, EPM, Curso de MedicinaUNIFESP, Disciplina de Emergências ClinicasUNIFESP, Disciplina de PneumologiaUNIFESP, Disciplina de Anestesiologia, Dor e Terapia Intensiva Unidade de Terapia IntensivaUNIFESP, Disciplina de Emergências Clínicas Unidade de Terapia IntensivaUNIFESP, Disciplina de Pneumologia Unidade de Terapia IntensivaUNIFESP, Disciplina de Anestesiologia, Dor e Terapia Intensiva Setor de Terapia IntensivaUNIFESP, Disciplina de Anestesiologia, Dor e Terapia IntensivaSciEL

Identification and functional analysis of a splice variant of mouse sodium-dependent phosphate transporter Npt2c

Mutations in the SLC34A3 gene, a sodium-dependent inorganic phosphate (Pi) cotransporter, also referred to as NaPi IIc, causes hereditary hypophosphatemic rickets with hypercalciuria (HHRH), an autosomal recessive disorder. In human and rodent, NaPi IIc is mainly localized in the apical membrane of renal proximal tubular cells. In this study, we identified mouse NaPi IIc variant (Npt2c-v1) that lacks the part of the exon 3 sequence that includes the assumed translation initiation site of Npt2c. Microinjection of mouse Npt2c-v1 cRNA into Xenopus oocytes demonstrated that Npt2c-v1 showed sodium-dependent Pi cotransport activity. The characterization of pH dependency showed activation at extracellular alkaline-pH. Furthermore, Npt2c-v1 mediated Pi transport activity was significantly higher at any pH value than those of Npt2c. In an in vitro study, the localization of the Npt2c-v1 protein was detected in the apical membrane in opossum kidney cells. The expression of Npt2c-v1 mRNA was detected in the heart, spleen, testis, uterus, placenta, femur, cerebellum, hippocampus, diencephalon and brain stem of mouse. Using mouse bone primary cultured cells, we showed the expression of Npt2c-v1 mRNA. In addition, the Npt2c protein was detected in the spermatozoa head. Thus, Npt2c-v1 was expressed in extra-renal tissues such as epididymal spermatozoa and may function as a sodium-dependent phosphate transporter

Superconductivity-induced Resonance Raman Scattering in Multi-layer High-Tc Superconductors

Resonant Raman scattering below Tc has been discovered in several Bi-, Hg-, Tl-based high-Tc superconductors with three or four CuO2-layers. For Bi2Si2Ca2Cu3O10+d, we found an unexpected crossover of the pair-breaking peak in the A1g-spectrum from a broad bump at hw = 6kBTc for Eexc = 2.54eV to a sharp peak at hw = 8kBTc for Eexc = 2.18eV, together with a strong enhancement of the Ca-phonons. Under resonant conditions, the relative positions of the pair breaking peaks in A1g, B1g, and B2g channels are 2Delta(A1g) = 2Delta(B1g) > 2Delta(B2g). This relation implies that the A1g Raman channel is free from the Coulomb screening effect, just as predicted theoretically for a d-wave multi-layer superconductor but have never been observed experimentally thus far. The observed resonance effect is the evidence that the electronic state in the inner CuO2-planes is different from that of the outer CuO2-planes.Comment: 16 pages, 6 figures. submitted to Phys.Rev.

上級生模擬患者による看護学生の学び

本研究は、看護学部上級生(4年生)による模擬患者(SP)を活用した成人看護学演習において、受講した同学部3年生106名を対象に、この上級生SP演習授業による学びを明らかにし、臨地実習に向けた成人看護学演習の教育方法について示唆を得ることを目的とした。研究者間で作成した自記式質問紙調査を行い、99名(回収率94.3%)の学びについての回答を、質的帰納的に分析した。その結果、44コード、25サブカテゴリー、および【準備の大切さ】【目的・根拠を考えたケア】【患者に適した看護のありよう】【患者への配慮】【看護の現実味】の5カテゴリーが生成された。また学びとはならなかったが、『自己の振り返り』や『先輩の存在から感じたこと』についても抽出することができた。上級生SPは、経験や訓練が必要な一般のSPと比較して、実習経験から学生へのフィードバックができていることから効果的である可能性が示唆された。また上級生SPを活用した演習を領域実習前に取り入れることは、実習での学生の過度な緊張や不安を和らげ、看護援助や患者理解を深める効果が期待できる