Pulmonary outcomes following specialized respiratory management for acute cervical spinal cord injury: a retrospective analysis.

Study designRetrospective analysis.ObjectivesTo identify multivariate interactions of respiratory function that are sensitive to spinal cord injury level and pharmacological treatment to promote strategies that increase successful liberation from mechanical ventilation.SettingUnited States regional spinal cord injury (SCI) treatment center.MethodsRetrospective chart review of patients consecutively admitted to Santa Clara Valley Medical Center between May 2013 and December 2014 for ventilator weaning with C1-C5 American Spinal Injury Association Impairment Scale (AIS) A or B SCI, <3 months from injury and who had a tracheostomy in place. A nonlinear, categorical principal component analysis (NL-PCA) was performed to test the multivariate interaction of respiratory outcomes from patients (N=36) being weaned off ventilator support after acute SCI with (N=15) or without (N=21) theophylline treatment.ResultsIn total, 36 patients met inclusion criteria (2 C1, 5 C2, 11 C3, 14 C4 and 4 C5). The NL-PCA returned three independent components that accounted for 95% of the variance in the data set. Multivariate general linear models hypothesis tests revealed a significant syndromic interaction between theophylline treatment and SCI level (Wilks' Lambda, P=0.028, F (12,64)=2.116, η2=0.256, 1-β=0.838), with post hoc testing demonstrating a significant interaction on PC1, explained by a positive correlation between improved forced vital capacity and time it took to reach 16 h of ventilator-free breathing. Thirty-three patients (92%) achieved 16 h of ventilator-free breathing (VFB) and 30 patients (83%) achieved 24 h of VFB.ConclusionsWe suspect that some portion of the high success rate of ventilator weaning may be attributable to theophylline use in higher cervical SCI, in addition to our aggressive regimen of high volume ventilation, medication optimization and pulmonary toilet (positive pressure treatments and mechanical insufflation-exsufflation)

An investigation of pressure ulcer risk, comfort and pain in medical imaging

In this study, we investigated the interface pressure of healthy volunteers on medical imaging (MI) table surfaces to determine the risks of developing pressure ulcers (PU). We also investigated volunteers’ perception of pain and comfort while lying on the MI table surfaces. Evidence from this study will enhance the understanding of factors contributing to PU formation and help improve service delivery to patients undergoing MI procedures

The effectiveness of NEWSGAME as an educational tool in the teaching of current events.

The purpose of this study was to determine if an educational tool such as NEWSGAME affects students' learning about current events. To determine the effectiveness of this game, an end-of-year post-test was given to the following groups: (1) students that played NEWSGAME regularly; (2) students that played NEWSGAME occasionally; (3) students that never played NEWSGAME. In addition, demographic data such as age and sex was analyzed to determine if differences in knowledge of various current event categories existed among these groups. A survey measuring students' opinion of NEWSGAME was also collected. This study involved the participation of 350 students in 11 social studies classrooms. Of the total sample, there were 183 males and 157 females. Ten cases were not identified. The students ranged in age from 11 to 19 with the majority being 12-15 year-olds. Instrumentation consisted of a Current Events Questionnaire composed of 81 questions covering 14 areas of international, national and state issues. These consisted of multiple choice and fill-in-the-blank statements. The data analysis indicated that students who played NEWSGAME regularly scored higher than those who played occasionally. Those who played NEWSGAME occasionally scored higher than those who never played NEWSGAME. Males were found to score higher than females whether NEWSGAME was played regularly or in the occasional/none category. Students over the age of 14 who played regularly scored higher than students under the age of 14. An unusual finding was that students under the age of 14 who played occasionally or not at all scored better than students over age 14 who played occasionally or not at all. Overall, it can be concluded that the NEWSGAME experience was most beneficial for males who were older than 14 who played the game regularly. In response to the question whether students liked or disliked NEWSGAME, 91% indicated they liked this educational tool

Pulmonary outcomes following specialized respiratory management for acute cervical spinal cord injury: a retrospective analysis.

Study designRetrospective analysis.ObjectivesTo identify multivariate interactions of respiratory function that are sensitive to spinal cord injury level and pharmacological treatment to promote strategies that increase successful liberation from mechanical ventilation.SettingUnited States regional spinal cord injury (SCI) treatment center.MethodsRetrospective chart review of patients consecutively admitted to Santa Clara Valley Medical Center between May 2013 and December 2014 for ventilator weaning with C1-C5 American Spinal Injury Association Impairment Scale (AIS) A or B SCI, <3 months from injury and who had a tracheostomy in place. A nonlinear, categorical principal component analysis (NL-PCA) was performed to test the multivariate interaction of respiratory outcomes from patients (N=36) being weaned off ventilator support after acute SCI with (N=15) or without (N=21) theophylline treatment.ResultsIn total, 36 patients met inclusion criteria (2 C1, 5 C2, 11 C3, 14 C4 and 4 C5). The NL-PCA returned three independent components that accounted for 95% of the variance in the data set. Multivariate general linear models hypothesis tests revealed a significant syndromic interaction between theophylline treatment and SCI level (Wilks' Lambda, P=0.028, F (12,64)=2.116, η2=0.256, 1-β=0.838), with post hoc testing demonstrating a significant interaction on PC1, explained by a positive correlation between improved forced vital capacity and time it took to reach 16 h of ventilator-free breathing. Thirty-three patients (92%) achieved 16 h of ventilator-free breathing (VFB) and 30 patients (83%) achieved 24 h of VFB.ConclusionsWe suspect that some portion of the high success rate of ventilator weaning may be attributable to theophylline use in higher cervical SCI, in addition to our aggressive regimen of high volume ventilation, medication optimization and pulmonary toilet (positive pressure treatments and mechanical insufflation-exsufflation)