Elaboration of neonatal and pediatric mechanical lungs

Pediatric patients or newborns admitted to Neonatal Intensive Care Units (NICU) receive life support care due to various conditions and pathologies. The physiotherapist controls and applies medicinal gases, institutes and monitors invasive and non-invasive mechanical ventilation, as well as performs weaning, among others. Learning ventilatory management must be appropriate for the age and, therefore, consider different lungs for the proper simulations of compliance and resistance. Although the insertion of physical therapists is relatively recent, there are several postgraduate courses and training in this area. The creation of a mechanical lungthat covers, separately, neonatal and pediatric patients will be a fundamental tool for the learning and training of future professionals who will work in the area. To develop two neonatal and pediatric mechanical lungs, as well as to simulate different elastic and resistive behaviors inherent in clinical practice. Experimental study, bench, divided into two stages: creation of mechanical lungs and evaluation of mechanical characteristics. The lungs will be made on a two-story metallic base: on the upper floor, the pediatric lung and the lower floor, the neonatal. In the second stage, the mechanical lung will be connected to a mechanical ventilator, using its own ventilatory parameters used in both types of patients. For the neonatal, respiratory rate of 35rpm, inspiratory time of 0.45 and endotracheal tube of 3.0 mm. The pediatric lung will be ventilated with a volume between 100-120mL, 20-25 compliance and a 4.5mm orotracheal tube. The construction of the neonatal and pediatric mechanical lung will strongly add the teaching of the Neonatal and Pediatric Intensive Physical Therapy specialty in the Undergraduate and Graduate settings, adding value to the teaching and training of professionals.

Development of A Clinical Decision Support System for Trauma Emergency Care: Identifying Main Features and Usability Test (Preprint)

BACKGROUND Computerized clinical decision support system is a solution to promote ATLS protocol for traumatic injuries. To study its design based on user requirements and usability, a Kano questionnaire research to survey perspectives of physicians was undergone. OBJECTIVE This study aims to elicit user requirements for a CDSS treating traumatic patients in a hospital setting and it’s usability by evaluating the features of TFA. METHODS We applied Kano mode research studying user requirements to further provide theoretical support for the development of the system. A 5-level questionnaire was designed based on the perspectives of Kano. The features of TFA were evaluated by pairs of questions: first a functional question and subsequently a dysfunctional question. The questionnaire along with system introduction and instructions were sent to the physicians in ED from five different hospitals that work as regional trauma centers and have ability to treat severe trauma patients. RESULTS A total of 63 physicians in ED responded the questionnaire completely and were concluded into the study including 16 physicians qualified with ATLS certificate and 47 having not passed the ATLS training. A total of 16 features were rated and classified using the Kano evaluation table. Five features are classified as indifferent (5/16, 31.3%), with five being one-dimensional (5/16, 31.3%), four being attractive (4/16, 25%) and two being must-be (2/16,12.5%). Both physicians with and without ATLS experience were indifferent to most of the evaluated features (11/16, 68.8%). A difference in user requirements between physicians with ATLS qualification and those without the qualification regarding 3,4,8,13,14 features. CONCLUSIONS The study provides recommendations to developers on the user requirements that need to be addressed when developing a CDSS for advanced trauma life support care in-hospital. Two features of must-be attributes must be incorporated in the TFA. In addition, four features (attractive attributes) would result in higher user satisfaction. Among those five one-dimensional features, ISS and knowledge database display high score in both positive and negative values that indicates developers to especially prioritize the features to be implemented when developing the CDSS.

Autopsy Report of a Woman with Infantile Alexander Disease Who Survived 39 Years

Patients with infantile Alexander disease (AxD) usually do not survive beyond their early teens without life support care because of progressive central hypoventilation. We present the autopsy report of a woman with infantile AxD carrying an R239C mutation in the glial fibrillary acidic protein gene, who survived 39 years. She presented with psychomotor retardation in infancy and regressed after age 5. Brain computed tomography scans showed bilateral low frontal white matter density. She became quadriplegic with bulbar palsy and was intellectually handicapped after a measles infection at age 7. Tube feeding was introduced because of dysphagia at age 15. Noninvasive positive pressure ventilation was required due to central hypoventilation in her early thirties. She died of neurogenic respiratory failure at 39 years. Autopsy findings revealed a markedly atrophic brain (709 g, −6.0 standard deviation), especially in the frontal lobe, cerebellum, and brainstem portions. We found demyelination, gliosis, and cystic lesions throughout the brain, and we saw Rosenthal fibers accumulating in the perivascular spaces. We also identified a variety of abnormalities in other organs such as pancreatic necrosis, completely desquamated epithelium in the lower esophagus and stomach, foreign-body giant cells in the colon submucosa, glomerular sclerosis, and multiple bladder stones. This is the first autopsied case report of a patient with infantile AxD with long survival, who showed not only central nervous system characteristic findings, but also unexpected pathological changes in other organs.

Emergency surgery

This chapter begins by discussing the basic principles of Advanced Trauma Life Support, care of the critically ill surgical patient, shock, SIRS and sepsis, and blood products and transfusion, before focusing on the key areas of knowledge, namely traumatic head injury, spine and spinal cord trauma, maxillofacial trauma, cardiothoracic trauma, abdominal trauma, urological trauma, vascular trauma, assessment of the acute abdomen, acute appendicitis, acute upper gastrointestinal haemorrhage, lower gastrointestinal haemorrhage, gastrointestinal obstruction, gastrointestinal perforation, acute pancreatitis, and superficial sepsis. The chapter concludes with relevant case-based discussions.

The Relationship Between Job Stress and Urinary Cytokines in Healthy Nurses: A Cross-Sectional Study

Cytokines such as angiogenin (ANG) and interleukin (IL-8) have been shown to be related to depressive symptoms and inflammatory diseases like coronary heart disease. They may thus be used as stress biomarkers to identify and prevent health problems. To investigate the relationship between cytokines and nurses' job-related stress, levels of urinary ANG and IL-8 were measured in healthy female hospital nurses in Japan. The level of job-related stress of the subjects was evaluated using the Nursing Stress Scale (NSS), with the participants being classified into high- or low-stress groups for each subscale according to their scores. The participants' subjective psychological states were assessed using the Profile of Mood States—Short Form Japanese version (POMS-SFJ). Urinary ANG, IL-8, and cortisol levels and subjective psychological states for two groups were compared for each NSS subscale. The fatigue and depression scores of POMS-SFJ subscales in the present study were higher than those of the general healthy Japanese population. Based on the mean score of the combined participants, nurses were experiencing the highest stress related to the pressure of having responsibility for patients' life support care (PPLC). Nurses reporting high levels of stress related to PPLC and conflict with physicians had high levels of urinary ANG. Urinary ANG levels may thus be associated with high levels of job stress.