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Sample records for restraint venipuncture endotracheal

  1. Evaluation of Saphenous Venipuncture and Modified Tail-clip Blood Collection in Mice

    Science.gov (United States)

    Abatan, Omorodola I; Welch, Kathleen B; Nemzek, Jean A

    2008-01-01

    The purpose of this study was to evaluate the effects of 2 methods of blood collection in unanesthetized mice. The saphenous venipuncture method was compared with a modified tail-clip technique that requires minimal restraint. Mice were evaluated through behavioral observation and plasma corticosterone levels. The results showed that the 2 methods produced similar corticosterone responses and that the tail-clip method produced fewer behavioral reactions. In addition, the effects of saphenous venipuncture method appeared to be dependent on the handler's technical expertise. When a series of 4 blood collections were performed over 1 wk, the 2 methods yielded similar corticosterone levels that did not increase over time. Some of the behavioral signs appeared to increase over the series of blood collections obtained by the saphenous venipuncture method. Serial complete blood counts showed that the tail vessels yielded higher total white blood cell, neutrophil, and lymphocyte counts than did the saphenous vein. Neither method appeared to cause stress-associated changes in the leukogram after serial blood collection. Overall, the effects of modified tail-clip method were similar to those of the saphenous venipuncture method in unanesthetized mice. PMID:18459706

  2. Technological innovation for peripheral venipuncture: ultrasound training.

    Science.gov (United States)

    Oliveira, Andrey Maciel de; Danski, Mitzy Tannia Reichembach; Pedrolo, Edivane

    2016-01-01

    to evaluate the training of nurses in the use of ultrasound in peripheral venipuncture. descriptive research of quantitative approach performed with nurses as part of an analytical cross-sectional study in two patient care centers: an intensive care unit and an adult emergency center. the results showed contributions of training for professional skill and visibility of nurses, requiring, however, more time for complete assimilation of this technological innovation as a safer clinical practice. as the use of this technology represents an innovation aimed to facilitate difficult venipuncture and to provide subsidies to the most appropriate clinical decision-making, it is urgent to qualify nurses for its use.

  3. Health Instruction Packages: Venipuncture and Intravenous Therapy.

    Science.gov (United States)

    Gray, P. Allen, Jr.; And Others

    Text, illustrations, and exercises are utilized in these five learning modules to instruct nursing students in techniques for initiating intravenous (I.V.) therapy. The first module, "Selection of a Venipuncture Site: Arm" by P. Allen Gray, Jr., describes the utilization of a tourniquet in locating filled veins in the arm. The second…

  4. [The sitting position during peripheral venipunctures in young children, a practice to develop].

    Science.gov (United States)

    Dario-Meyer, Anne; Sangare, Sylvie; Dumas Laussinotte, Anne

    The children's nurse has several missions including that of caring for the child in a holistic approach, ensuring their physical safety and psychological security. When performing peripheral venipunctures in young children, caregivers must implement strategies to relieve pain and prevent psychological traumas which may generate stress for subsequent care procedures. In a paediatric unit, their observations and analysis have improved children's experience of this invasive procedure, with a need for less restraint. In this context, the sitting position seems beneficial for the young patient. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  5. Venipuncture procedure affects heart rate variability and chronotropic response.

    Science.gov (United States)

    Kliszczewicz, Brian; Esco, Michael R; E Bechke, Emily; Feito, Yuri; M Williamson, Cassie; Brown, Danielle; Price, Brandi

    2017-10-01

    Heart rate variability (HRV) has been shown to be influenced by several factors such as noise, sleep status, light, and emotional arousal; however, little evidence is available concerning autonomic responses to a venipuncture. The purpose of this study was to investigate changes of HRV indexes and heart rate (HR) during and following a venipuncture procedure among healthy individuals. 33 healthy individuals (22.8 ± 0.56 years, 167 ± 1.56 cm, 69.5 ± 2.61 kg) participated. Testing included 10-minute HRV analysis prior to the venipuncture, a 1-minute venipuncture procedure followed by a 10-minute analysis of HRV, and a total recording of 21 minutes. The first 5 minutes of the 21-minute recordings were discarded, and the remaining 5 minutes of the resting segment was analyzed (PRE), and the last 5 minutes of the 21-minute recording (POST). The log transformation of the time domain root mean squared of successive differences (lnRMSSD) and the frequency domains of high frequency (lnHF) and low frequency (lnLF) and LF/HF ratio (lnLF/HF) were used to quantify autonomic activity. HR was measured in 1-minute segments at 2 minutes prior (PRE), venipuncture (STICK), and post (P1-5). HR significantly increased at STICK (P = 0.002), and fell below resting at P-5 (P < 0.001). lnRMSSD and lnHF increased significantly by POST (P < 0.001, P = 0.005). lnLF/HF ratio significantly decreased at POST (P = 0.047), while no significant changes occurred for lnLF (P = 0.590). HRV and HR are influenced for 10 minutes following the venipuncture procedure. Practitioners and researchers who are interested in collecting blood and measuring HRV need to account for the influence of the venipuncture. © 2017 Wiley Periodicals, Inc.

  6. Endotracheal Suction a Reopened Problem

    OpenAIRE

    Almgren, Birgitta

    2005-01-01

    During mechanical ventilation, patients are connected to the ventilator by an endotracheal tube. The tube needs to be cleaned from mucus by suction, which can cause negative effects such as lung collapse, hypoxemia and desaturation. These can be avoided by preoxygenation, change of ventilator settings, use of closed suction systems and recruitment manoeuvres. The aim of the study was to investigate the effects of endotracheal suction during different ventilator settings and by different sucti...

  7. Use of restraints

    Science.gov (United States)

    Restraint devices ... Restraints may be used to keep a person in proper position and prevent movement or falling during surgery or while on a stretcher. Restraints can also be used to control or prevent ...

  8. Hypoglossal neuropraxia following endotracheal intubation.

    Science.gov (United States)

    Venkatesh, B; Walker, D

    1997-12-01

    A case of hypoglossal nerve neuropraxia following elective drainage of bilateral chronic subdural haematomas is described. We postulate that the cause of neuropraxia was inadvertent extubation of the trachea with the cuff inflated, leading to compression and stretch of the nerve against the greater horn of the hyoid bone. The literature on cranial nerve palsies following endotracheal intubation is reviewed.

  9. Venipuncture Nerve Injuries in the Upper Extremity From More Than 1 Million Procedures.

    Science.gov (United States)

    Tsukuda, Yukinori; Funakoshi, Tadanao; Nasuhara, Yasuyuki; Nagano, Yusuke; Shimizu, Chikara; Iwasaki, Norimasa

    2016-06-16

    The purpose of this study was to investigate the nerve injury rate for 1 million venipunctures and the efficacy of attempts to avoid severe nerve injury. We collected data for outpatients from whom a venipuncture blood sample was obtained in our hospital from 2005 to 2014. Every venipuncture procedure for outpatients was performed by a trained nurse or clinical technologist at the center for blood sampling in our hospital. In addition, a series of lectures by a specialist is held in our hospital at various times. All complaints related to venipuncture blood sampling were reported to our division of hospital safety management and were followed up using the guidelines for injuries related to the venipuncture. The number of venipuncture-related complications was 293 (0.027%, 1/3700) of 1,082,053 during the 10 years. A total of 40 of the 1,082,053 venipunctures were referred to the department of orthopedic surgery, and 16 (0.0015%, 1/67,000) were diagnosed with obvious nerve injuries. The average duration of the treatment was 46.4 days (range, 1-126 days); 69% of the patients recovered within 5 weeks, and all patients recovered within 18 weeks. Although it is impossible to completely prevent venipuncture-related complications, appropriate venipuncture skills and risk management decrease the incidence of chronic or permanent nerve injury risk after venipuncture.

  10. Clarification of the characteristics of needle-tip movement during vacuum venipuncture to improve safety

    OpenAIRE

    Fujii C

    2013-01-01

    Chieko FujiiFaculty of Nursing and Medical Care, Keio University, Kanagawa, JapanBackground: Complications resulting from venipuncture include vein and nerve damage, hematoma, and neuropathic pain. Although the basic procedures are understood, few analyses of actual data exist. It is important to improve the safety standards of this technique during venipuncture. This study aimed to obtain data on actual needle movement during vacuum venipuncture in order to develop appropriate educational pr...

  11. Vacuum-venipuncture skills: time required and importance of tube order

    OpenAIRE

    Fujii C

    2013-01-01

    Chieko FujiiFaculty of Nursing and Medical Care, Keio University, Fujisawa, JapanBackground: The purpose of this study was to assess specific vacuum-venipuncture skills and the influence of the time involved in skin puncture and blood collection.Methods: Thirty subjects undergoing venipuncture in which video analysis was possible were included. These procedures were carried out by four nurses and recorded with a digital camera. Venipuncture skills classified by our observations were delineate...

  12. The effect of psychological intervention on perceived pain in children undergoing venipuncture.

    Science.gov (United States)

    Sikorova, Lucie; Hrazdilova, Petra

    2011-06-01

    The main objective of the study was to determine the effect of structured psychological intervention on the level of perceived pain in children undergoing venipuncture. A second goal was to investigate how pain behavior during venipuncture is affected by age, sex, previous number of venipunctures, the presence of parents during the procedure and reason for the venipuncture. Children with indications for venipuncture aged 5-10 years, were randomly divided into a control group and an intervention group. The control group was prepared for the venipuncture routinely. Children in the intervention group were prepared according to prior structured psychological consultation. Perceived pain levels were assessed by the CHEOPS scale and the self report Wong and Baker faces pain rating scale. A significant difference in evaluated pain between the intervention group and the control group was found. The psychological intervention carried out by a nurse proved to lower pain levels from venipuncture as measured by the CHEOPS scale and evaluated using the self-report scale. A greater level of pain was found in children in the age group 5-7 years, in children where peripheral venous catheter was introduced and in children where the parents were present. Special consultation with the child one day before venipuncture reduced pain levels, especially in children below the age-category mentioned. Consultation should be part of the standard of care for children with indications for venipuncture.

  13. Mechanical restraint in psychiatry

    DEFF Research Database (Denmark)

    Bak, Jesper; Zoffmann, Vibeke; Sestoft, Dorte Maria

    2014-01-01

    PURPOSE: To examine how potential mechanical restraint preventive factors in hospitals are associated with the frequency of mechanical restraint episodes. DESIGN AND METHODS: This study employed a retrospective association design, and linear regression was used to assess the associations. FINDING...

  14. Venipuncture: an adjunct to home care services for older adults.

    Science.gov (United States)

    McKenna, D; Niles, S A

    1995-01-01

    Attention to policy and procedure development specific to home care, and strong communication and collaboration with laboratory personnel at multiple sites have been essential in supporting venipuncture services within a home care agency. Orientation, inservice training, skills verification, updated supplies, and the concise information kept in each nurse's field handbook have supported comprehensive quality services to an older, frail, homebound population. In addition, our quality evaluations from physicians, patients, caregivers, and laboratories indicate a greater than satisfactory level of performance and quality care for this skilled service.

  15. Endotracheal intubation in the ICU.

    Science.gov (United States)

    Lapinsky, Stephen E

    2015-06-17

    Endotracheal intubation in the ICU is a high-risk procedure, resulting in significant morbidity and mortality. Up to 40% of cases are associated with marked hypoxemia or hypotension. The ICU patient is physiologically very different from the usual patient who undergoes intubation in the operating room, and different intubation techniques should be considered. The common operating room practice of sedation and neuromuscular blockade to facilitate intubation may carry significant risk in the ICU patient with a marked oxygenation abnormality, particularly when performed by the non-expert. Preoxygenation is largely ineffective in these patients and oxygen desaturation occurs rapidly on induction of anesthesia, limiting the time available to secure the airway. The ICU environment is less favorable for complex airway management than the operating room, given the frequent lack of availability of additional equipment or additional expert staff. ICU intubations are frequently carried out by trainees, with a lesser degree of airway experience. Even in the presence of a non-concerning airway assessment, these patients are optimally managed as a difficult airway, utilizing an awake approach. Endotracheal intubation may be achieved by awake direct laryngoscopy in the sick ICU patient whose level of consciousness may be reduced by sepsis, hypercapnia or hypoxemia. As the patient's spontaneous respiratory efforts are not depressed by the administration of drugs, additional time is available to obtain equipment and expertise in the event of failure to secure the airway. ICU intubation complications should be tracked as part of the ICU quality improvement process.

  16. [Skillfulness is essential to improve venipuncture pain in combination with lidocaine containing adhesive tape].

    Science.gov (United States)

    Onji, I; Nakao, M

    1996-08-01

    We evaluated the effect of lidocaine containing adhesive tape (LT) on the venipuncture pain by using visual analogue scale (VAS). Patients were assigned prospectively to a control (65 cases) group and a LT (80 cases) group weekly. LT was applied 30 min before the scheduled entry into the operating room. A 20 gauge polyurethane venous catheter (Insyte; Becton-Dickinson) was punctured randomly by either experts (board certified anesthesiologists) or by novice staffs. VAS on venous puncture was significantly better by the experts; median of VAS by experts in control and LT groups were 48.5 and 26.5, while VAS by novice staff in control and LT group were 49.5 and 52.0, respectively. Smooth venipuncture was performed in 91% of those in expert group. However only 71% of venipuncture was done smoothly in the novice group. We conclude that skillful venipuncture in combination with LT is essential to reduce the venipuncture pain.

  17. Barriers to venipuncture-induced pain prevention in cancer patients: a qualitative study

    National Research Council Canada - National Science Library

    Filbet, Marilène; Larkin, Philip; Chabloz, Claire; Chirac, Anne; Monsarrat, Léa; Ruer, Murielle; Rhondali, Wadih; Collin, Cyrille

    2017-01-01

    .... Methods We used qualitative methodology based on semi-structured interviews conducted with nurses, focusing on practices of venipuncture-induced and needle change for implantable central venous access port (ICVAP...

  18. Improvement of knowledge and practical skills in venipuncture through web-based training.

    Science.gov (United States)

    Bodelle, Boris; Sziegoleit, Andreas

    2009-01-01

    This paper reports on the implementation of web-based training in venipuncture as standardizable knowledge transfer. For this purpose, we performed an experimental study with nursing students and medical students.

  19. Full body restraint system

    Science.gov (United States)

    Ryder, Susan (Inventor)

    1990-01-01

    A body restraint system (30) allows the user's body (10) to be in the zero gravity neutral posture. The system (30) includes a waist restraint (32) in the form of a curved, padded unit (34) containing a retractable belt (36) coiled on a spring loaded capstan (38) with a buckle (40) extending from front (42) of the unit (34). A second belt (44) is fastened around the user's waist (16). A clasp (46) is configured to engage the buckle (40). The waist restraint (32) is positioned near foot restraints (52). The foot restraints (52) have foot platforms (59) with pads (60) of a suitable two part attaching material, such as the fasteners available from Minnesota Mining and Manufacturing Company under the trademark Scotchmate Duallock. A mating pad (62) of the material is provided on soles (64) of cotton net shoes (66).

  20. Confidence level in venipuncture and knowledge on causes of in vitro hemolysis among healthcare professionals.

    Science.gov (United States)

    Milutinović, Dragana; Andrijević, Ilija; Ličina, Milijana; Andrijević, Ljiljana

    2015-01-01

    This study aimed to assess confidence level of healthcare professionals in venipuncture and their knowledge on the possible causes of in vitro hemolysis. A sample of 94 healthcare professionals (nurses and laboratory technicians) participated in this survey study. A four-section questionnaire was used as a research instrument comprising general information for research participants, knowledge on possible causes of in vitro hemolysis due to type of material used and venipuncture technique and specimen handling, as well as assessment of healthcare professionals' confidence level in their own ability to perform first and last venipuncture. The average score on the knowledge test was higher in nurses' than in laboratory technicians (8.11±1.7, and 7.4±1.5, respectively). The difference in average scores was statistically significant (P=0.035) and Cohen's d in the range of 0.4 indicates that there is a moderate difference on the knowledge test among the health care workers. Only 11/94 of healthcare professionals recognized that blood sample collection from cannula and evacuated tube is method which contributes most to the occurrence of in vitro hemolysis, whereas most risk factors affecting occurrence of in vitro hemolysis during venipuncture were recognized. There were no significant differences in mean score on the knowledge test in relation to the confidence level in venipuncture (P=0.551). Confidence level at last venipuncture among both profiles of healthcare staff was very high, but they showed insufficient knowledge about possible factors affecting hemolysis due to materials used in venipuncture compared with factors due to venipuncture technique and handling of blood sample.

  1. The burden of venipuncture pain in neonatal intensive care units: EPIPPAIN 2, a prospective observational study.

    Science.gov (United States)

    Courtois, Emilie; Cimerman, Patricia; Dubuche, Valérie; Goiset, Marie-France; Orfèvre, Claire; Lagarde, Audrey; Sgaggero, Betty; Guiot, Céline; Goussot, Mélanie; Huraux, Etienne; Nanquette, Marie-Christine; Butel, Céline; Ferreira, Anne-Marie; Lacoste, Sylvie; Séjourné, Sandrine; Jolly, Valérie; Lajoie, Gladys; Maillard, Valérie; Guedj, Romain; Chappuy, Hélène; Carbajal, Ricardo

    2016-05-01

    Newborns in intensive care units (ICUs) undergo numerous painful procedures including venipunctures. Skin-breaking procedures have been associated with adverse neurodevelopment long-term effects in very preterm neonates. The venipuncture frequency and its real bedside pain management treatment are not well known in this setting. To describe venipuncture frequency, its pain intensity, and the analgesic approach in ICU newborns; to determine the factors associated with the lack of preprocedural analgesia and with a high pain score during venipuncture. Further analysis of EPIPPAIN 2 (Epidemiology of Procedural Pain In Neonates), which is a descriptive prospective epidemiologic study. All 16 neonatal and pediatric ICUs in the Paris region in France. All newborns in the ICU with a maximum corrected age under 45 weeks of gestation on admission who had at least one venipuncture during the study period. Data on all venipunctures, their pain score assessed with the DAN scale and their corresponding analgesic therapies were prospectively collected. The inclusion period lasted six weeks, from June 2, 2011, to July 12, 2011. Newborns were followed from their admission to the 14th day of their ICU stay or discharge, whichever occurred first. 495 newborns who underwent venipunctures were included. The mean (SD) gestational age was 33.0 (4.4) weeks and duration of participation was 8.0 (4.5) days. A total of 257 (51.9%) neonates were very preterm (neonate during the study period was 3.8 (2.8; 1-19) for all neonates and 4.1 (2.9; 1-17) for neonates sedation/analgesia. High pain scores were significantly associated with absence of parents during procedures, surgery during the study period, and higher number of attempts. Venipuncture is very frequent in preterm and term neonates in the ICUs. 76% were performed with preprocedural analgesia. Strategies to reduce the number of attempts and to promote parental presence seem necessary. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Vacuum-venipuncture skills: time required and importance of tube order

    Directory of Open Access Journals (Sweden)

    Fujii C

    2013-08-01

    Full Text Available Chieko FujiiFaculty of Nursing and Medical Care, Keio University, Fujisawa, JapanBackground: The purpose of this study was to assess specific vacuum-venipuncture skills and the influence of the time involved in skin puncture and blood collection.Methods: Thirty subjects undergoing venipuncture in which video analysis was possible were included. These procedures were carried out by four nurses and recorded with a digital camera. Venipuncture skills classified by our observations were delineated on the basis of frame-by-frame video images, and a graph of x and y coordinates was created.Results: With the first blood-collection tube, strong blood flow required the practitioner to push the tube back in to compensate for the strong repulsive force in approximately 46% of cases. By the third blood-collection tube, the blood flow had weakened; therefore, the tube was moved up and down. In cases that required a second venipuncture, the tube was already pierced, so the time required to fill it to 5 mL was significantly longer.Conclusion: Hand movement of the practitioner is adjusted according to blood flow. Reflex movement in response to strong blood flow may increase the risk of pushing the needle through the vein with excessive force. The time required to fill the tube varies among nurses, tube order, and level of venipuncture skills.Keywords: blood collection, blood-collection tube, clinical practice, venipuncture skill

  3. A novel and simple method for endotracheal intubation of mice

    NARCIS (Netherlands)

    Spoelstra, E. N.; Ince, C.; Koeman, A.; Emons, V. M.; Brouwer, L. A.; van Luyn, M. J. A.; Westerink, B. H. C.; Remie, R.

    Endotracheal intubation in mice is necessary for experiments involving intratracheal instillation of various substances, repeated pulmonary function assessments and mechanical ventilation. Previously described methods for endotracheal intubation in mice require the use of injection anaesthesia to

  4. Nitrous oxide use and endotracheal tube rupture.

    Science.gov (United States)

    Mosby, E L; Schelkun, P M; Vincent, S K

    1988-01-01

    Nitrous oxide is an important and widely used anesthetic agent. However, during lengthy surgical procedures, significant amounts of nitrous oxide diffuse into the endotracheal tube cuff, causing sequelae that may include increased cuff pressures, tracheal trauma, increased postoperative discomfort, and cuff rupture. In this paper, two cases are presented in which the endotracheal tube cuff used to deliver this anesthetic agent ruptured after more than four hours of surgery. Two simple means of limiting the diffusion of nitrous oxide into the cuff and thus preventing this occurrence are described.

  5. Prehensile Foot Restraint

    Science.gov (United States)

    Willits, Charles A.

    1987-01-01

    Proposed prehensile foot restraint enables such workers as astronauts and divers to maintain fixed positions in zero gravity or in buoyancy with minimal effort. With foot restraint worker devotes attention fully to task at hand, with little concern about holding on to supporting structure. Claw near toe of shoe grips rail. Wearer uses flexible shaft, first to lock claw tightly on bar; then, when work is done, to open claw. Underwater or in space, device boosts productivity.

  6. Determinants of Nurses' Use of Physical Restraints in Surgical Intensive Care Unit Patients.

    Science.gov (United States)

    Dolan, Jeanne; Dolan Looby, Sara E

    2017-09-01

    Physical restraints are used in intensive care units, particularly among patients at risk for self-terminating necessary treatment interventions, including endotracheal tubes and invasive catheters. Assessments conducted by intensive care unit nurses often influence the collaborative decision to initiate and discontinue restraints in critical care patients. However, little is known about factors that influence the critical thought processes of intensive care unit nurses in determining use of restraints. To describe nurses' determinants of initiation and discontinuation of restraints in surgical intensive care unit patients. Semistructured interviews were conducted to identify and describe determinants of initiation and discontinuation of physical restraints. Demographic and employment data were collected via questionnaire. Interviews were recorded, transcribed, and analyzed by using conventional content analysis to establish categories and identify themes. A total of 13 nurses (mean age 43 [SD, 12] years, 92% female, mean of 18 [SD, 12] years of practice as a registered nurse, 69% bachelor of science in nursing) participated in the study. Content analysis revealed 3 general categories and 8 themes that indicated the thoughtful reflection processes nurses in a surgical intensive care unit use to determine use of restraints. Top priorities were ensuring patient safety and comfort. Nurses synthesized factors including practice experience, patient-specific behaviors and risk, and patients' need for devices in determining use of restraints. ©2017 American Association of Critical-Care Nurses.

  7. Vacuum-venipuncture skills: time required and importance of tube order.

    Science.gov (United States)

    Fujii, Chieko

    2013-01-01

    The purpose of this study was to assess specific vacuum-venipuncture skills and the influence of the time involved in skin puncture and blood collection. Thirty subjects undergoing venipuncture in which video analysis was possible were included. These procedures were carried out by four nurses and recorded with a digital camera. Venipuncture skills classified by our observations were delineated on the basis of frame-by-frame video images, and a graph of x and y coordinates was created. With the first blood-collection tube, strong blood flow required the practitioner to push the tube back in to compensate for the strong repulsive force in approximately 46% of cases. By the third blood-collection tube, the blood flow had weakened; therefore, the tube was moved up and down. In cases that required a second venipuncture, the tube was already pierced, so the time required to fill it to 5 mL was significantly longer. Hand movement of the practitioner is adjusted according to blood flow. Reflex movement in response to strong blood flow may increase the risk of pushing the needle through the vein with excessive force. The time required to fill the tube varies among nurses, tube order, and level of venipuncture skills.

  8. Clarification of the characteristics of needle-tip movement during vacuum venipuncture to improve safety.

    Science.gov (United States)

    Fujii, Chieko

    2013-01-01

    Complications resulting from venipuncture include vein and nerve damage, hematoma, and neuropathic pain. Although the basic procedures are understood, few analyses of actual data exist. It is important to improve the safety standards of this technique during venipuncture. This study aimed to obtain data on actual needle movement during vacuum venipuncture in order to develop appropriate educational procedures. Six experienced nurses were recruited to collect blood samples from 64 subjects. These procedures were recorded using a digital camera. Software was then used to track and analyze motion without the use of a marker in order to maintain the sterility of the needle. Movement along the X- and Y-axes during blood sampling was examined. Approximately 2.5 cm of the needle was inserted into the body, of which 6 mm resulted from advancing or moving the needle following puncture. The mean calculated puncture angle was 15.2°. Given the hazards posed by attaching and removing the blood collection tube, as well as by manipulating the needle to fix its position, the needle became unstable whether it was fixed or not fixed. This study examined venipuncture procedures and showed that the method was influenced by increased needle movement. Focusing on skills for puncturing the skin, inserting the needle into the vein, and changing hands while being conscious of needle-tip stability may be essential for improving the safety of venipuncture.

  9. Treatment of hypertension following endotracheal intubation

    African Journals Online (AJOL)

    R-adrenergic anragonist with weak a-adrenergic antagonist properties, on the haemodynamic effects of laryngo copy and endotracheal intubation. Labetalol was used in two dosages, their efficacy being compared with that of a single dose of practolol and saline placebo. every minute for 7 minutes after intubation, the need ...

  10. Miniature acoustic guidance system for endotracheal tubes

    Science.gov (United States)

    Juan, Eduardo J.

    Ensuring that the distal end of an endotracheal tube is properly located within the trachea, and that the tube is not obstructed by mucous deposition, is a major clinical concern in patients that require mechanical ventilation. A novel acoustic system was developed to allow for the continuous monitoring of endotracheal tube position and patency. A miniature sound source and two sensing microphones are placed in-line between the ventilator hose and the proximal end of the endotracheal tube. Reflections of an acoustic pulse from the endotracheal tube lumen and the airways are digitally analyzed to estimate the location and degree of obstruction, as well as the position of the distal end of the tube in the airway. The system was evaluated through computer simulations, in vitro studies, and in a rabbit model. The system noninvasively estimated tube position in vivo to within roughly 4.5 mm, and differentiated between proper tracheal, and erroneous bronchial or esophageal intubation in all cases. In addition, the system estimated the area and location of lumen obstructions in vitro to within 14% and 3.5 mm, respectively. These findings indicate that this miniature technology could improve the quality of care provided to the ventilated adult and infant.

  11. The Effect of Distraction Techniques on the Pain of Venipuncture in Children: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Mohammad Sadegh Rezai

    2016-12-01

    Full Text Available Context Venipuncture has been reported as one of the major sources of pain in the children’s wards. Various distraction techniques have been used so far to reduce this pain. Distraction technique is one of the non-pharmacological methods of pain control that uses the five senses in order to focus the patient’s attention on other stimuli. Objectives This study aimed to determine the effect of distraction techniques on the pain of venipuncture in children. Data Sources In this systematic review study, all RCTs about distraction techniques were reviewed with no time limit. In order to find evidence in this context, English and Persian scientific databases (PubMed, Elsevier, SID, e.g. were searched by specified keywords like venipuncture, distraction, and pain. Study Selection All studies assessing the effect of distraction techniques on the pain of venipuncture in children were examined in our systematic review. A number of 148 articles were found in the initial investigation of titles, abstracts, and main-texts. After the elimination of duplicates and irrelevant ones, eventually 31 RCT studies and 2 review articles entered the study. Data Extraction A checklist was used to extract required data from relevant articles on name, year and type of study, sample size, age range of participants, type of intervention, employed method, and obtained results. Results Based on the findings, various techniques of distraction were used on pain control in children including music, virtual reality, audio-visual equipment such as cartoons, animation and video game, squeezing rubber balls, Filippits distraction cards, Hugo point ice massage, making bubbles, breathing exercise, Kaleidoscope color screen and touching the palm of the hand to reduce the pain of venipuncture. Conclusions Distraction techniques can reduce the pain of venipuncture in children. It is suggested to make these techniques more effective and apply them by considering the age and mental and

  12. Component restraint system

    Science.gov (United States)

    Blake, John C.

    1983-05-24

    An object restraint system is provided with a collar for gripping the object and a plurality of struts attached to the collar and to anchor means by universal-type joints, the struts being arranged in tangential relation about the collar.

  13. Ultrasonographic Confirmation of Endotracheal Tube Position in Neonates.

    Science.gov (United States)

    Najib, Khadijehsadat; Pishva, Narjes; Amoozegar, Hamid; Pishdad, Parisa; Fallahzadeh, Ebrahim

    2016-10-08

    To compare endotracheal tube tip-to-carina distance obtained by ultrasonography vs. that obtained by chest X-ray in neonates. After endotracheal intubation of 40 neonates, chest X-ray and, within one hour, ultrasonography was obtained for each patient for measurement of endotracheal tube tip-to-carina distance. Means of endotracheal tube tip-to-carina distances were not significantly different by both modalities (mean difference 0.157 cm, P= 0.06). In addition, an intraclass correlation was observed between them (r2= 0.61, 95% CI= 0.26, 0.79). Ultrasonography and chest X-ray are equally accurate for determination of endotracheal tube tip-to-carina in infants. As ultrasonography is more easily available and is safer than X-ray, it may be a better modality for confirming proper placement of endotracheal tube in neonates.

  14. Developing a medical picture book for reducing venipuncture distress in preschool-aged children.

    Science.gov (United States)

    Tsao, Ying; Kuo, Hui-Chen; Lee, Hsui-Chuan; Yiin, Shuenn-Jiun

    2017-10-01

    Distress associated with needle-related procedures is a major concern in preschool-aged children nursing. This study developed a medical picture book for supporting preschool-aged children facing a venipuncture and determined the effectiveness of such a book intervention in decreasing behavioural distress. The picture book was designed in 3 stages: developing stories on medical situations, penning the text, and drafting the book. We conducted a quasiexperimental study to examine the effectiveness of the book. The behavioural distress of the control and picture book groups were assessed before, during, and after the intervention by using the Observational Scale of Behavioral Distress-Revised (OSBD-R). We created a 12-page picture book, Sick Rui-Rui Bear, in which cartoon characters were depicted undergoing venipunctures, as a guide for vein injection and for facilitating positive venipuncture outcomes in preschool-aged children. Over time, the OSBD-R scores of the picture book group were significantly lower than those of the control group (P picture book be routinely read and used during venipunctures to decrease procedural distress in preschool-aged children. © 2017 John Wiley & Sons Australia, Ltd.

  15. Warming Endotracheal Tube in Blind Nasotracheal Intubation throughout Maxillofacial Surgeries

    OpenAIRE

    Hamzeh Hosseinzadeh; Koroush Taheri Talesh; Samad EJ Golzari; Hossein Gholizadeh; Alireza Lotfi; Parisa Hosseinzadeh

    2013-01-01

    Introduction: Blind nasotracheal intubation is an intubation method without observation of glottis that is used when the orotracheal intubation is difficult or impossible. One of the methods to minimize trauma to the nasal cavity is to soften the endotracheal tube through warming. Our aim in this study was to evaluate endotracheal intubation using endotracheal tubes softened by hot water at 50 °C and to compare the patients in terms of success rate and complications. Methods: 60 patients ...

  16. Clarification of the characteristics of needle-tip movement during vacuum venipuncture to improve safety

    Directory of Open Access Journals (Sweden)

    Fujii C

    2013-07-01

    Full Text Available Chieko FujiiFaculty of Nursing and Medical Care, Keio University, Kanagawa, JapanBackground: Complications resulting from venipuncture include vein and nerve damage, hematoma, and neuropathic pain. Although the basic procedures are understood, few analyses of actual data exist. It is important to improve the safety standards of this technique during venipuncture. This study aimed to obtain data on actual needle movement during vacuum venipuncture in order to develop appropriate educational procedures.Methods: Six experienced nurses were recruited to collect blood samples from 64 subjects. These procedures were recorded using a digital camera. Software was then used to track and analyze motion without the use of a marker in order to maintain the sterility of the needle. Movement along the X- and Y-axes during blood sampling was examined.Results: Approximately 2.5 cm of the needle was inserted into the body, of which 6 mm resulted from advancing or moving the needle following puncture. The mean calculated puncture angle was 15.2°. Given the hazards posed by attaching and removing the blood collection tube, as well as by manipulating the needle to fix its position, the needle became unstable whether it was fixed or not fixed.Conclusion: This study examined venipuncture procedures and showed that the method was influenced by increased needle movement. Focusing on skills for puncturing the skin, inserting the needle into the vein, and changing hands while being conscious of needle-tip stability may be essential for improving the safety of venipuncture.Keywords: blood collection, nerve damage, motion analysis, patient safety, puncture angle, clinical education

  17. Turkish children loved distraction: using kaleidoscope to reduce perceived pain during venipuncture.

    Science.gov (United States)

    Tüfekci, Fatma Güdücü; Celebioğlu, Ayda; Küçükoğlu, Sibel

    2009-08-01

    To assess the effect of distraction (looking through kaleidoscopes) to reduce perceived pain, during venipuncture in healthy school-age children. Distraction has been noted to be an effective method to help children cope with painful procedures. In the studies carried out, although it was found out that distraction made with different distracters reduced the pain of venipuncture, there is only one study confirming analgesic effect of distracters. The study was carried out as an intervention-control group design. Children (n = 206), in whom venipuncture was applied in a laboratory for examination between the dates January-September 2006, were included in the study. The data were obtained by a form determining introductory features of the children and Wong-Baker FACES Pain Rating Scale and Visual Analogue Scale evaluating the pain. Descriptive statistics was used in the assessment of the data and t-test was used in comparisons of dependent-independent groups. Pain levels of the children according to both scales in intervention group were lower than those of control group. But, it was detected that the distinction between score averages of intervention and control group of Wong-Baker FACES Pain Rating Scale, not Visual Analogue Scale, was statistically significant (p pain related to venipuncture in healthy school children and that some features of the children influenced the perception of pain. Distraction with kaleidoscope is a method, which the nurse will be able to use for venipuncture to obtain optimal pain control. In addition, it is important for a nurse to know some features about the children for a pain free and positive experience.

  18. Estimation of the imprecision on clinical chemistry testing due to fist clenching and maintenance during venipuncture.

    Science.gov (United States)

    Lima-Oliveira, Gabriel; Guidi, Gian Cesare; Salvagno, Gian Luca; Brocco, Giorgio; Danese, Elisa; Lippi, Giuseppe

    2016-12-01

    An experimental study was planned to assess the influence on routine clinical chemistry parameters of fist making prior to, and maintenance during, venipuncture. Blood was collected from 16 healthy volunteers with two separate sequential procedures, entailing standard venipuncture with hand opened throughout blood collection, or clenching the fist 6 times before venipuncture and maintaining the fist until completion of blood collection. After separation of lithium-heparin plasma at vacuum tubes with gel separator, 28 routine clinical chemistry parameters and serum indices were measured on Roche Cobas 6000 〈c501〉 module. Fist clenching and maintaining were associated with significant variations of 8/26 (31%) analytes tested. Specifically, aspartate aminotransferase (+2.3%), calcium (+2.2%), chloride (+1.0%), creatine kinase (+2.0%), magnesium (+2.3%), potassium (+13.4%), and sodium (+0.7%) increased, whereas phosphate (-5.0%) decreased. All variations except aspartate aminotransferase and creatine kinase exceeded the quality specifications for desirable imprecision. A remarkable increase of free hemoglobin in plasma (i.e., +28.2%) was also observed. The ratio of plasma potassium was significantly associated with that of plasma CK (r=0.55; p=0.029), but not with variations of other analytes. No significant correlation was observed between the ratio of free hemoglobin and those of other analytes. The results of our investigation demonstrate that repeated clenching and maintenance of fist during venipuncture may trigger acute variations of several routine clinical chemistry parameters, which may be attributable to muscle contraction, hemolysis or both. Accordingly, venipuncture should be performed avoiding fist clenching and maintenance. Copyright © 2016 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  19. Endotracheal Intubation Training and Skill Maintenance for Respiratory Therapists.

    Science.gov (United States)

    Miller, Andrew G

    2017-02-01

    Endotracheal intubation is commonly performed outside the operating room (OR). Although respiratory therapists (RTs) performing endotracheal intubation is a well-established practice, the optimum way for RTs to be trained and maintain their skills is unspecified. The purpose of this study was to describe training methods and skills maintenance methods and to identify barriers that prevent RTs from intubating in some institutions. A survey instrument was developed by the author. The survey was posted on the AARConnect online social media platform management section in March of 2015 after approval from our institutional review board and approval from the American Association for Respiratory Care board of directors. Respondents from institutions where RTs intubate received questions about RT training and skill maintenance, whereas the other respondents received questions about barriers to RTs performing endotracheal intubation. Both groups answered questions about attitudes about endotracheal intubation practice. There were 74 respondents who completed the survey. Half (50%) of the respondents were from institutions where RTs performed endotracheal intubation. These institutions were larger in bed capacity and had more adult ICU beds. Other demographic data were similar. The most common training methods identified were simulation training (86%), supervised intubations (84%), and classroom training (65%). Classroom training lasted a mean of 4.3 h with a range of 1-16 h. The majority (91%) were required to complete 10 or fewer supervised endotracheal intubations before competency validation. Skill recertification was automatic if a minimum number of endotracheal intubations were performed annually in 78% of centers, and 11% required a written test or classroom training annually. The primary barrier cited for RTs not intubating was lack of need. Endotracheal intubation training for RTs varied among those surveyed. Simulation training and supervised endotracheal

  20. 42 CFR 460.114 - Restraints.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Restraints. 460.114 Section 460.114 Public Health...) Participant Rights § 460.114 Restraints. (a) The PACE organization must limit use of restraints to the least restrictive and most effective method available. The term restraint includes either a physical restraint or a...

  1. Laryngotracheal Injury following Prolonged Endotracheal Intubation

    Directory of Open Access Journals (Sweden)

    J. Mehdizadeh

    2006-07-01

    Full Text Available Background: Prolonged endotracheal intubation is a growing method for supporting ventilation in patients who require intensive care. Despite considerable advancement in endotracheal intubation, this method still has some complications; the most important is laryngo-tracheal injuries. Methods: Over a 2-year period, this retrospective study was conducted on 57 patients with history of prolonged intubation who were referred to the ENT Department of Amir Alam Hospital. For each patient, a complete evaluation including history, physical examination, and direct laryngoscopy and bronchoscopy was done under general anesthesia. Results: Fifty-seven patients (44 male; mean age, 23.014.7 years were studied. Mean intubation period was 15.88 days. The most common presenting symptom was dyspnea (62%. Head trauma was responsible for most cases of intubation (72.4%. The most common types of tracheal and laryngeal lesions were tracheal (56.9% and subglottic (55.2% stenosis, respectively. Mean length of tracheal stenosis was 0.810.83 cm. There was a statistically significant relationship between length of tracheal stenosis and intubation period (P=0.0001 but no relation was observed between tracheal stenosis and age, sex, and etiology of intubation (All P=NS. Among the glottic lesions, inter- arytenoids adhesion was the most common lesion (25.9%. No statistically significant relation was found between glottic and subglottic lesions and age, sex and intubation period (all P=NS. Length of stenosis and intubation period was significantly greater in tracheal/ subglottic lesions than those in glottic/ supraglottic lesions (all P=NS. Conclusion: After prolonged endotracheal intubation, laryngo-tracheal lesions had no relation with patient’s age, sex, and cause of intubation.There was direct relation between length of tracheal stenosis and intubation period. Glottic lesions were more commonly observed in head trauma patients. Lesion length and intubation

  2. Variations in endotracheal tube cuff pressure: Is 8-hourly monitoring ...

    African Journals Online (AJOL)

    Background. Most patients admitted to an intensive care unit (ICU) for mechanical ventilation require endotracheal intubation. Cuffed endotracheal tubes (ETTs) are utilised as they provide a better seal to facilitate ventilation and minimise aspiration. Complications due to overinflation or underinflation of the cuff may occur.

  3. Difficulties with tooth protectors in endotracheal intubation.

    Science.gov (United States)

    Aromaa, U; Pesonen, P; Linko, K; Tammisto, T

    1988-05-01

    The suitability of three tooth protectors for routine use during endotracheal intubation was studied in 300 consecutive patients undergoing elective operations under general anaesthesia. The main disadvantages of the protectors were lack of space and the consequent difficulty of guiding the endotracheal tube into the larynx, and poor visibility, especially when the Camo protector was used. These difficulties could be avoided in most cases by cutting off the right angle of the Camo protector. The less experienced anaesthesiologists especially had difficulties with the protectors: 20% of patients in the Camo group were considered impossible to intubate unless the protector was removed. The silicone inlay of the Camo protector melts and becomes adhesive at body temperature, which makes its prolonged use hazardous. Two patients lost a maxillary incisor despite the proper use of a protector (Denex). Thus the use of a tooth protector alone does not guarantee avoidance of dental trauma. Better results could be obtained by improving the design of the protectors and by careful pre-anaesthetic dental examination.

  4. [Construction of an educational technology for teaching about nursing on peripheral venipuncture].

    Science.gov (United States)

    Frota, Natasha Marques; Barros, Lívia Moreira; de Araújo, Thiago Moura; Caldini, Luana Nunes; do Nascimento, Jennara Cândido; Caetano, Joselany Afio

    2013-06-01

    The aim of the study was to describe the construction of a course on peripheral venipuncture using the Information and Communication Technologies. This is a methodological research, developed at the Federal University of Ceara from January to March 2012. The construction phases are: the analysis, design and development according to the theoretical framework of Galvis-Panqueva. In the analysis, objectives, content target audience, the study environment and technology infrastructure were delimited. During the design phase the environment interface and navigation structure of the course were evaluated. The development consisted in the materialization of all that was designed in the previous phase Once all three phases of construction of the course were conducted it was available in the Virtual Learning Environment SOLAR. The finalproduct of the course is presented as support of nursing students and consequently the training of future nurses in their care practice on peripheral venipuncture.

  5. Does infrared visualization improve selection of venipuncture sites for indwelling needle at the forearm in second-year nursing students?

    Science.gov (United States)

    Fukuroku, Keiko; Narita, Yugo; Taneda, Yukari; Kobayashi, Shinji; Gayle, Alberto A

    2016-05-01

    To evaluate the effectiveness of a vein visualization display system using near-infrared light ("Vein Display") for the safe and proper selection of venipuncture sites for indwelling needle placement in the forearm. Ten second year nursing students were recruited to apply an indwelling needle line with and without Vein Display. Another ten participants were recruited from various faculty to serve as patients. The quality of the venipuncture procedure at various selected sites was evaluated according to a scale developed by the authors. Time, scores and patterns of puncture-site selection were compared with respect to three different methods: [1] attempt 1 (tourniquet only), [2] attempt 2 (Vein Display only) and [3] attempt 3 (both). To validate the effectiveness of Vein Display, 52 trials were conducted in total. We found that venipuncture site selection time was significantly improved with the Vein Display, particularly in the case of difficult to administer venipuncture sites. Overall, we found no significant difference with respect to venipuncture quality, as determined by our scale. These results suggest that equipment such as the Vein Display can contribute immensely to the improvement of practical skills, such as venipuncture, especially in the context of elderly patients. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. Evaluation of a Jugular Venipuncture Alpaca Model to Teach the Technique of Blood Sampling in Adult Alpacas.

    Science.gov (United States)

    Rousseau, Marjolaine; Beauchamp, Guy; Nichols, Sylvain

    2017-01-01

    The effectiveness of teaching aids in veterinary medical education is not often assessed rigorously. The objective in the present study was to evaluate the effectiveness of a commercially available jugular venipuncture alpaca model as a complementary tool to teach veterinary students how to perform venipuncture in adult alpacas. We hypothesized that practicing on the model would allow veterinary students to draw blood in alpacas more rapidly with fewer attempts than students without previous practice on the model. Thirty-six third-year veterinary students were enrolled and randomly allocated to the model (group M; n=18) or the control group (group C; n=18). The venipuncture technique was taught to all students on day 0. Students in group M practiced on the model on day 2. On day 5, an evaluator blinded to group allocation evaluated the students' venipuncture skills during a practical examination using live alpacas. Success was defined as the aspiration of a 6-ml sample of blood. Measured outcomes included number of attempts required to achieve success (success score), total procedural time, and overall qualitative score. Success scores, total procedural time, and overall scores did not differ between groups. Use of restless alpacas reduced performance. The jugular venipuncture alpaca model failed to improve jugular venipuncture skills in this student population. Lack of movement represents a significant weakness of this training model.

  7. Venipuncture-Induced Complex Regional Pain Syndrome: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Foad Elahi

    2014-01-01

    Full Text Available Venipuncture, the most frequently performed invasive medical procedure, is usually benign. Generally it produces only transitory mild discomfort. Venipuncture-induced neuropathic pain is hard to recognize at an early stage. Medical literature reviews show that there is not adequate medical knowledge about this important subject. The inciting incident in complex regional pain syndrome (CRPS can often seem far too trivial to result in a condition with such severe pathophysiologic effects. The practicing physician has little information available to enable early recognition of the condition, initiation of multidisciplinary treatment modalities, and proper referral to pain specialists. We encountered a unique case of venipuncture-induced complex regional pain syndrome (CRPS. The patient is a 52-year-old school teacher with no significant past medical history, who presented initially to the Center of Pain Medicine with left upper extremity pain. The pain started while phlebotomy was performed in the patient’s left antecubital area for routine blood check. The patient’s pain did not improve with multiple medications, physical therapy, or several nerve blocks. The patient demonstrated all the signs and symptoms of chronic neuropathic pain of CRPS in the upper extremity with minimal response to the continuous pain management. We decided to proceed with cervical spinal cord nerve stimulation along with continuing other modalities. The patient responded to this combination. During the follow-up, we noticed that the patient’s pain course was complicated by extension of the CRPS to her lower extremity. We will describe the course of treatment for the patient in this paper. In this paper we will discuss the electrical neuromodulation as an important modality in addition to the multidisciplinary pain management for a patient with venipuncture-induced chronic neuropathic pain.

  8. Venipuncture-induced complex regional pain syndrome: a case report and review of the literature.

    Science.gov (United States)

    Elahi, Foad; Reddy, Chandan G

    2014-01-01

    Venipuncture, the most frequently performed invasive medical procedure, is usually benign. Generally it produces only transitory mild discomfort. Venipuncture-induced neuropathic pain is hard to recognize at an early stage. Medical literature reviews show that there is not adequate medical knowledge about this important subject. The inciting incident in complex regional pain syndrome (CRPS) can often seem far too trivial to result in a condition with such severe pathophysiologic effects. The practicing physician has little information available to enable early recognition of the condition, initiation of multidisciplinary treatment modalities, and proper referral to pain specialists. We encountered a unique case of venipuncture-induced complex regional pain syndrome (CRPS). The patient is a 52-year-old school teacher with no significant past medical history, who presented initially to the Center of Pain Medicine with left upper extremity pain. The pain started while phlebotomy was performed in the patient's left antecubital area for routine blood check. The patient's pain did not improve with multiple medications, physical therapy, or several nerve blocks. The patient demonstrated all the signs and symptoms of chronic neuropathic pain of CRPS in the upper extremity with minimal response to the continuous pain management. We decided to proceed with cervical spinal cord nerve stimulation along with continuing other modalities. The patient responded to this combination. During the follow-up, we noticed that the patient's pain course was complicated by extension of the CRPS to her lower extremity. We will describe the course of treatment for the patient in this paper. In this paper we will discuss the electrical neuromodulation as an important modality in addition to the multidisciplinary pain management for a patient with venipuncture-induced chronic neuropathic pain.

  9. The Effects of Massage and Breastfeeding on Response to Venipuncture Pain among Hospitalized Neonates.

    Science.gov (United States)

    Zargham-Boroujeni, Ali; Elsagh, Azamolmolouk; Mohammadizadeh, Majid

    2017-01-01

    Untreated procedural pain leads to long-term and short-term complications in neonates. Preventing pain in sick infants and neonates, whose conditions are getting worse, not only is a professional and legal duty but also a prevention measure to decrease future psychological and even neurological complications. Therefore, nurses should prevent newborns' pain. The aim of this study was to compare the effects of massage and breastfeeding on the pain of the neonates. This was a clinical trial conducted among 75 full-term and near-term infants who underwent venipuncture. The newborns were randomly allocated to the following groups (n = 25 for each): group 1, breastfeeding; group 2, massage; and group 3, control. In the first group, venipuncture was done 2 minutes after breastfeeding. In the second group, massage was done with effleurage technique for 3 minutes and venipuncture was done 2 minutes after massage. The Neonatal Infant Pain Scale (NIPS) was used for pain measurement in the first 30 seconds of venipuncture. Data were analyzed by t-test and one-way analysis of variance (ANOVA). The lowest mean pain score recorded in the massage group (0.92) whereas it was 4.84 in the breastfeeding group and 6.16 in the control group. ANOVA test and post-hoc statistics revealed that both interventions resulted in a significant reduction of the pain scores. According to the findings of this study, the lowest pain score was in massage group, then in breastfeeding group and control group accordingly. Considering the fact that massage and breastfeeding are natural, useful, and cost free interventions and do not need any special facility, these methods are suggested in pain management and pain control during painful procedures administrated for infants.

  10. Barriers to venipuncture-induced pain prevention in cancer patients: a qualitative study.

    Science.gov (United States)

    Filbet, Marilène; Larkin, Philip; Chabloz, Claire; Chirac, Anne; Monsarrat, Léa; Ruer, Murielle; Rhondali, Wadih; Collin, Cyrille

    2017-01-17

    Procedural pain reduces the quality of life of cancer patients. Although there are recommendations for its prevention, there are some obstacles for its management. The purpose of this study was to analyze the barriers to procedural pain prophylaxis in cancer patients reflecting the views of the nurses. We used qualitative methodology based on semi-structured interviews conducted with nurses, focusing on practices of venipuncture-induced and needle change for implantable central venous access port (ICVAP) pain management in cancer patients. A thematic analysis approach informed the data analysis. Interviews were conducted with 17 nurses. The study highlighted 4 main themes; technical and relational obstacles, nurses' professional recognition, the role of the team, and organizational issues. Participants understood the painful nature of venipuncture. Despite being aware of the benefits of the anesthetic patch, they did not utilize it in a systematic way. We identified several barriers at different levels: technical, relational and previous experience of incident pain. Several organizational issues were also highlighted (e.g. lack of protocol, lack of time). The prevention of venipuncture-induced cancer pain requires a structured training program, which should reflect the views of nurses in clinical practice.

  11. Differences in hematocrit of blood samples obtained from two venipuncture sites in sharks.

    Science.gov (United States)

    Mylniczenko, Natalie D; Curtis, Eric W; Wilborn, Rachel E; Young, Forrest A

    2006-11-01

    To evaluate differences in Hct between 2 venipuncture sites in captive and free-ranging sharks. 32 healthy adult captive sharks (Carcharhinus melanopterus, Carcharhinus plumbeus, Stegastoma fasciatum, Orectolobus japonicus, and Triaenodon obesus) and 15 captured free-ranging adult sharks (Carcharhinus limbatus and Carcharhinus acronotus). Blood samples were collected from the caudal tail artery followed by collection from the sinus located immediately caudal to the cranial dorsal fin. The Hct was determined for each sample and results were compared. Additionally, results for sharks that were highly active and used aerobic metabolism were compared with results for sharks that were less active and tolerant of anaerobic conditions. Mean Hct for all sharks was significantly less (8% less) in blood samples obtained from the cranial dorsal fin sinus, compared with the Hct for samples obtained from the caudal tail artery. When compared on the basis of metabolic class, sharks that were more tolerant of anaerobic conditions had lower Hct values and smaller differences between the 2 venipuncture sites. Hct values were significantly lower in blood samples collected from the cranial dorsal fin sinus compared with values for samples collected from the caudal tail artery. It is important to recognize this difference when evaluating hematologic variables in sharks and when establishing reference ranges for Hcts for shark populations. Sharks that were more active and relied on aerobic metabolism had higher Hct values than did anaerobic-tolerant sharks, and the difference in Hct values between venipuncture sites was more pronounced.

  12. 32 CFR 636.34 - Restraint systems.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Restraint systems. 636.34 Section 636.34 National... Restraint systems. (a) Restraint systems (seat belts) will be worn by all operators and passengers of U.S. Government vehicles on or off the installations. (b) Restraint systems will be worn by all civilian personnel...

  13. Optimized ventricular restraint therapy: adjustable restraint is superior to standard restraint in an ovine model of ischemic cardiomyopathy.

    Science.gov (United States)

    Lee, Lawrence S; Ghanta, Ravi K; Mokashi, Suyog A; Coelho-Filho, Otavio; Kwong, Raymond Y; Kwon, Michael; Guan, Jian; Liao, Ronglih; Chen, Frederick Y

    2013-03-01

    The effects of ventricular restraint level on left ventricular reverse remodeling are not known. We hypothesized that restraint level affects the degree of reverse remodeling and that restraint applied in an adjustable manner is superior to standard, nonadjustable restraint. This study was performed in 2 parts using a model of chronic heart failure in the sheep. In part I, restraint was applied at control (0 mm Hg, n = 3), low (1.5 mm Hg, n = 3), and high (3.0 mm Hg, n = 3) levels with an adjustable and measurable ventricular restraint (AMVR) device. Restraint level was not altered throughout the 2-month treatment period. Serial restraint level measurements and transthoracic echocardiography were performed. In part II, restraint was applied with the AMVR device set at 3.0 mm Hg (n = 6) and adjusted periodically to maintain that level. This was compared with restraint applied in a standard, nonadjustable manner using a mesh wrap (n = 6). All subjects were followed up for 2 months with serial magnetic resonance imaging. In part I, there was greater and earlier reverse remodeling in the high restraint group. In both groups, the rate of reverse remodeling peaked and then declined as the measured restraint level decreased with progression of reverse remodeling. In part II, adjustable restraint resulted in greater reverse remodeling than standard restraint. Left ventricular end diastolic volume decreased by 12.7% (P = .005) with adjustable restraint and by 5.7% (P = .032) with standard restraint. Left ventricular ejection fraction increased by 18.9% (P = .014) and 14.4% (P standard restraint, respectively. Restraint level affects the rate and degree of reverse remodeling and is an important determinant of therapy efficacy. Adjustable restraint is more effective than nonadjustable restraint in promoting reverse remodeling. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  14. Air bag restraint device

    Science.gov (United States)

    Marts, D.J.; Richardson, J.G.

    1995-10-17

    A rear-seat air bag restraint device is disclosed that prevents an individual, or individuals, from continuing violent actions while being transported in a patrol vehicle`s rear seat without requiring immediate physical contact by the law enforcement officer. The air bag is activated by a control switch in the front seat and inflates to independently restrict the amount of physical activity occurring in the rear seat of the vehicle while allowing the officer to safely stop the vehicle. The air bag can also provide the officer additional time to get backup personnel to aid him if the situation warrants it. The bag is inflated and maintains a constant pressure by an air pump. 8 figs.

  15. Air bag restraint device

    Science.gov (United States)

    Marts, Donna J.; Richardson, John G.

    1995-01-01

    A rear-seat air bag restraint device is disclosed that prevents an individual, or individuals, from continuing violent actions while being transported in a patrol vehicle's rear seat without requiring immediate physical contact by the law enforcement officer. The air bag is activated by a control switch in the front seat and inflates to independently restrict the amount of physical activity occurring in the rear seat of the vehicle while allowing the officer to safely stop the vehicle. The air bag can also provide the officer additional time to get backup personnel to aid him if the situation warrants it. The bag is inflated and maintains a constant pressure by an air pump.

  16. Warming Endotracheal Tube in Blind Nasotracheal Intubation throughout Maxillofacial Surgeries

    Directory of Open Access Journals (Sweden)

    Hamzeh Hosseinzadeh

    2013-12-01

    Conclusion: In conclusion, our study showed that using an endotracheal tube softened by warm water could reduce the incidence and severity of epistaxis during blind nasotracheal intubation; however it could not facilitate blind nasotracheal intubation.

  17. Sudden endotracheal tube block in a patient of Achalasia Cardia

    Directory of Open Access Journals (Sweden)

    Ajit Gupta

    2012-01-01

    Full Text Available Endotracheal tube block due to various mechanical causes such as mucous, blood clot, denture, and ampoules have been reported. A patient of achalasia cardia with chronic passive aspiration pneumonitis developed mucoid mass in the respiratory passage which dislodged during the surgical procedure. The episode occurred almost an hour after induction of anesthesia and the dislodged mucoid mass blocked the lumen of endotracheal tube, leading to hypoxia and impending cardiac arrest. However, the patient was salvaged by replacing the tube.

  18. Optimized ventricular restraint therapy: Adjustable restraint is superior to standard restraint in an ovine model of ischemic cardiomyopathy

    Science.gov (United States)

    Lee, Lawrence S.; Ghanta, Ravi K.; Mokashi, Suyog A.; Coelho-Filho, Otavio; Kwong, Raymond Y.; Kwon, Michael; Guan, Jian; Liao, Ronglih; Chen, Frederick Y.

    2014-01-01

    Objective The effects of ventricular restraint level on left ventricular reverse remodeling are not known. We hypothesized that restraint level affects the degree of reverse remodeling and that restraint applied in an adjustable manner is superior to standard, nonadjustable restraint. Methods This study was performed in 2 parts using a model of chronic heart failure in the sheep. In part I, restraint was applied at control (0 mm Hg, n = 3), low (1.5 mm Hg, n = 3), and high (3.0 mm Hg, n = 3) levels with an adjustable and measurable ventricular restraint (AMVR) device. Restraint level was not altered throughout the 2-month treatment period. Serial restraint level measurements and transthoracic echocardiography were performed. In part II, restraint was applied with the AMVR device set at 3.0 mm Hg (n = 6) and adjusted periodically to maintain that level. This was compared with restraint applied in a standard, nonadjustable manner using a mesh wrap (n = 6). All subjects were followed up for 2 months with serial magnetic resonance imaging. Results In part I, there was greater and earlier reverse remodeling in the high restraint group. In both groups, the rate of reverse remodeling peaked and then declined as the measured restraint level decreased with progression of reverse remodeling. In part II, adjustable restraint resulted in greater reverse remodeling than standard restraint. Left ventricular end diastolic volume decreased by 12.7% (P = .005) with adjustable restraint and by 5.7% (P = .032) with standard restraint. Left ventricular ejection fraction increased by 18.9% (P = .014) and 14.4% (Prestraint, respectively. Conclusions Restraint level affects the rate and degree of reverse remodeling and is an important determinant of therapy efficacy. Adjustable restraint is more effective than nonadjustable restraint in promoting reverse remodeling. PMID:22698557

  19. Restraint and seclusion in India

    Directory of Open Access Journals (Sweden)

    Sudhir K Khandelwal

    2015-01-01

    Full Text Available Psychiatric management in India often includes the practice of restraint and seclusion of violent and difficult to control patients, both in inpatient medical facilities and in places of traditional healing. However, without any informed guidelines and regulation, these practices have flourished from necessary last resort to accepted ways of control. The upcoming draft mental health bill have now provided with a set of basic guidelines for preventing restraint. The scientific literature is also sparse on the subject from India, despite a robust body of evidence being available from the Western literature. This review, summarizes the evidence from India, looks into the causes and outcomes of restraint and seclusion and also discusses methods and stratagems that might be beneficial for reducing restraint and seclusion in the country.

  20. Child restraint device loaner programs

    Science.gov (United States)

    1981-06-01

    The child restraint device (CRD) loaner programs in Tennessee were evaluated. In-Lerviews were conducted with loaner program clients in Memphis, Chattanooga, and Knoxville. Administrators of programs in all three sites also were interviewed. The prog...

  1. Analgesia by cooling vibration during venipuncture in children with cognitive impairment.

    Science.gov (United States)

    Schreiber, Silvana; Cozzi, Giorgio; Rutigliano, Rosaria; Assandro, Paola; Tubaro, Martina; Cortellazzo Wiel, Luisa; Ronfani, Luca; Barbi, Egidio

    2016-01-01

    Children with cognitive impairment experience pain more frequently than healthy children and are more likely to require venipuncture or intravenous cannulation for various procedures. They are frequently unable to report pain and often receive poor pain assessment and management. This study assessed the effectiveness of physical analgesia during vascular access in children with cognitive impairments. We conducted a prospective randomised controlled study at a tertiary-level children's hospital in Italy from April to May 2015 to assess whether a cooling vibration device called Buzzy decreased pain during venipuncture and intravenous cannulation in children with cognitive impairment. None of the children had verbal skills and the main cognitive impairments were cerebral palsy, epileptic encephalopathy and genetic syndromes. We tested 70 children with a median age of nine years: 34 in the Buzzy group and 36 in the no-intervention group. Parents were trained in the use of the Noncommunicating Children's Pain Checklist--postoperative version scale, and they reported no or mild procedural pain in 32 cases (91.4%) in the Buzzy group and in 22 cases (61.1%) in the no-intervention group (p = 0.003). Cooling vibration analgesia during vascular access reduced pain in children with cognitive impairment. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  2. Can presence of a dog reduce pain and distress in children during venipuncture?

    Science.gov (United States)

    Vagnoli, Laura; Caprilli, Simona; Vernucci, Chiara; Zagni, Silvia; Mugnai, Francesca; Messeri, Andrea

    2015-04-01

    The aim of this study was to investigate the effectiveness of animal-assisted intervention as distraction for reducing children's pain and distress before, during, and after standard blood collection procedure. Fifty children (ages 4-11 years) undergoing venipuncture were randomly assigned to the experimental group (EG; n = 25) or to the control group (CG; n = 25). The blood collection procedure was carried on the children in the EG arm in the presence of a dog, whereas no dog was present when venipuncture was conducted on children in CG. In both cases, parents accompanied the child in the procedure room. Distress experienced by the child was measured with the Amended Observation Scale of Behavioral Distress, while perceived pain was measured with a visual analog scale or the Wong Baker Scale (Faces Scale); levels of cortisol in blood also were analyzed. Parental anxiety during the procedure was measured with State Trait Anxiety Inventory. Children assigned to the EG group reacted with less distress than children in the CG arm. Furthermore, cortisol levels were lower in the EG group compared with the CG group. There were no significant differences in pain ratings and in the level of parental anxiety. It appears that the presence of dogs during blood draw procedures reduces distress in children. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  3. System Design and Development of a Robotic Device for Automated Venipuncture and Diagnostic Blood Cell Analysis.

    Science.gov (United States)

    Balter, Max L; Chen, Alvin I; Fromholtz, Alex; Gorshkov, Alex; Maguire, Tim J; Yarmush, Martin L

    2016-10-01

    Diagnostic blood testing is the most prevalent medical procedure performed in the world and forms the cornerstone of modern health care delivery. Yet blood tests are still predominantly carried out in centralized labs using large-volume samples acquired by manual venipuncture, and no end-to-end solution from blood draw to sample analysis exists today. Our group is developing a platform device that merges robotic phlebotomy with automated diagnostics to rapidly deliver patient information at the site of the blood draw. The system couples an image-guided venipuncture robot, designed to address the challenges of routine venous access, with a centrifuge-based blood analyzer to obtain quantitative measurements of hematology. In this paper, we first present the system design and architecture of the integrated device. We then perform a series of in vitro experiments to evaluate the cannulation accuracy of the system on blood vessel phantoms. Next, we assess the effects of vessel diameter, needle gauge, flow rate, and viscosity on the rate of sample collection. Finally, we demonstrate proof-of-concept of a white cell assay on the blood analyzer using in vitro human samples spiked with fluorescently labeled microbeads.

  4. Microgravity Workstation and Restraint Evaluations

    Science.gov (United States)

    Chmielewski, C.; Whitmore, M.; Mount, F.

    1999-01-01

    Confined workstations, where the operator has limited visibility and physical access to the work area, may cause prolonged periods of unnatural posture. Impacts on performance, in terms of fatigue and posture, may occur especially if the task is tedious and repetitive or requires static muscle loading. The glovebox design is a good example of the confined workstation concept. Within the scope of the 'Microgravity Workstation and Restraint Evaluation' project, funded by the NASA Headquarters Life Sciences Division, it was proposed to conduct a series of evaluations in ground, KC-135 and Shuttle environments to investigate the human factors issues concerning confined/unique workstations, such as gloveboxes, and also including crew restraint requirements. As part of the proposed integrated evaluations, two Shuttle Detailed Supplementary Objectives (DSOs) were manifested; one on Space Transportation System (STS)-90 and one on STS-88. The DSO on STS-90 evaluated use of the General Purpose Workstation (GPWS). The STS-88 mission was planned to evaluate a restraint system at the Remote Manipulator System (RMS). In addition, KC- 1 35 flights were conducted to investigate user/workstation/restraint integration for long-duration microgravity use. The scope of these evaluations included workstations and restraints to be utilized in the ISS environment, but also incorporated other workstations/ restraints in an attempt to provide findings/requirements with broader applications across multiple programs (e.g., Shuttle, ISS, and future Lunar-Mars programs). In addition, a comprehensive electronic questionnaire has been prepared and is under review by the Astronaut Office which will compile crewmembers' lessons learned information concerning glovebox and restraint use following their missions. These evaluations were intended to be complementary and were coordinated with hardware developers, users (crewmembers), and researchers. This report is intended to provide a summary of the

  5. Child restraint workshop series. Volume 1

    Science.gov (United States)

    1979-09-01

    This final report describes the planning and implementing details of the Child Restraint Workshop series. A child restraint workshop was conducted in each of the : ten NHTSA regions. The purpose of the workshops was to improve the effectiveness of gr...

  6. THE OCCURRENCE OF HIGH-LEVELS OF ACUTE BEHAVIORAL DISTRESS IN CHILDREN AND ADOLESCENTS UNDERGOING ROUTINE VENIPUNCTURES

    NARCIS (Netherlands)

    HUMPHREY, GB; BOON, CMJ; VANDENHEUVELL, GFECV; VANDEWIEL, HBM

    While there is no question that children dislike needles, there are very little data available on the occurrence of high levels of distress experienced by children undergoing routine venipunctures. To provide some insight into this problem, trained observers evaluated distress in 223 different

  7. Distraction as a technique to control pain in pediatric patients during venipuncture. A narrative review of literature.

    Science.gov (United States)

    Vetri Buratti, Carlo; Angelino, Francesco; Sansoni, Julita; Fabriani, Loredana; Mauro, Lucia; Latina, Roberto

    2015-01-01

    Distraction is a non-pharmacological intervention aimed to reduce procedural pain in children. Venipuncture is one of the most widely used diagnostic and therapeutic procedure in pediatric patients. Analgesia during venipuncture may be efficiently achieved with distracting techniques. To describe active and passive distraction techniques to reduce distress in children undergoing venipuncture. Data from CINHAL, PubMed, ILISI and Cochrane's databases were used to review existing literature and primary and secondary studies published between 2003 and 2014 were included. Queries were obtained with keywords such as distraction, complementary therapies, pain, pediatric, the Boolean operators AND and OR were used. Twenty eligible articles out of the one hundred and forty-three retrieved (20/143) were selected; among these there were 3 systematic and 5 narrative reviews, 11 experimental and quasi-experimental studies and 1 observational study. Active and passive distraction techniques seemed extremely effective to reduce distress and pain in children undergoing venipuncture. Modest evidence of efficacy and absent side effects support this approach. Further RCTs are needed to compare the different types of existing active and passive distraction techniques. The presence of parents and the location where painful procedures are administered should be included in the assessment of this approach.

  8. Molecular analysis of microbial communities in endotracheal tube biofilms.

    Directory of Open Access Journals (Sweden)

    Scott Cairns

    Full Text Available BACKGROUND: Ventilator-associated pneumonia is the most prevalent acquired infection of patients on intensive care units and is associated with considerable morbidity and mortality. Evidence suggests that an improved understanding of the composition of the biofilm communities that form on endotracheal tubes may result in the development of improved preventative strategies for ventilator-associated pneumonia. METHODOLOGY/PRINCIPAL FINDINGS: The aim of this study was to characterise microbial biofilms on the inner luminal surface of extubated endotracheal tubes from ICU patients using PCR and molecular profiling. Twenty-four endotracheal tubes were obtained from twenty mechanically ventilated patients. Denaturing gradient gel electrophoresis (DGGE profiling of 16S rRNA gene amplicons was used to assess the diversity of the bacterial population, together with species specific PCR of key marker oral microorganisms and a quantitative assessment of culturable aerobic bacteria. Analysis of culturable aerobic bacteria revealed a range of colonisation from no growth to 2.1×10(8 colony forming units (cfu/cm(2 of endotracheal tube (mean 1.4×10(7 cfu/cm(2. PCR targeting of specific bacterial species detected the oral bacteria Streptococcus mutans (n = 5 and Porphyromonas gingivalis (n = 5. DGGE profiling of the endotracheal biofilms revealed complex banding patterns containing between 3 and 22 (mean 6 bands per tube, thus demonstrating the marked complexity of the constituent biofilms. Significant inter-patient diversity was evident. The number of DGGE bands detected was not related to total viable microbial counts or the duration of intubation. CONCLUSIONS/SIGNIFICANCE: Molecular profiling using DGGE demonstrated considerable biofilm compositional complexity and inter-patient diversity and provides a rapid method for the further study of biofilm composition in longitudinal and interventional studies. The presence of oral microorganisms in

  9. 77 FR 11625 - Child Restraint Systems

    Science.gov (United States)

    2012-02-27

    ... Highway Traffic Safety Administration 49 CFR Parts 571 and 572 Child Restraint Systems; Hybrid III 10-Year... Administration 49 CFR Part 571 RIN 2127-AL10 (Formerly RIN 2127-AJ44) Child Restraint Systems AGENCY: National.... SUMMARY: This final rule amends the Federal motor vehicle safety standard for child restraint systems to...

  10. 21 CFR 880.6760 - Protective restraint.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Protective restraint. 880.6760 Section 880.6760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... Devices § 880.6760 Protective restraint. (a) Identification. A protective restraint is a device, including...

  11. The use of restraints in psychiatric patients

    Directory of Open Access Journals (Sweden)

    M Y H Moosa

    2009-10-01

    Full Text Available Restraints are usually used for the protection of patients and others when medication and verbal therapies are insufficient to control potentially violent patients. Many fear the abuse of restraints as well as their psychological, physical and emotional consequences. In South Africa, according to the Mental Health Care Act No. 17 of 2002, the use of restraints is permissible but subject to certain regulations. Restraint may not be used any longer than is necessary to prevent serious bodily harm to the patient or others. When restraint has the desired effect of settling the patient’s behaviour to the point where control is regained, its further imposition is illegal. Restraints may be classified into three main categories: ( i environmental restraints; ( ii physical restraints; and ( iii chemical restraints. There is much debate over what types of restraint are superior. There may be differences in cost, risk of serious staff injury, requirements of staff time for monitoring and implementation, and impacts on staff and patient attitudes. It is hoped that the use of environmental and physical restraint will be rendered obsolete by advances in the field of psychiatry such psychopharmacology and the therapeutic milieu. In order to reach this goal more research needs to be done on restraint practices across a wide range of psychiatric treatment settings.

  12. Anxiety, Restraint, and Eating Behavior

    Science.gov (United States)

    Herman, C. Peter; Polivy, Janet

    1975-01-01

    It was hypothesized that individual differences in eating behavior based on the distinction between obese and normal subjects could be demonstrated within a population of normal subjects classified as to the extent of restraint chronically exercised with respect to eating. (Editor)

  13. A week of Israeli restraint

    NARCIS (Netherlands)

    Reinhart, T.

    2006-01-01

    In Israeli discourse, Israel is always the side exercising restraint in its conflict with the Palestinians. This was true again for the events of the past week: As the Qassam rockets were falling on the Southern Israeli town of Sderot, it was “leaked” that the Israeli Minister of Defense had

  14. Safety effects of traffic restraint.

    NARCIS (Netherlands)

    Janssen, S.T.M.C.

    1986-01-01

    In recent years the effectiveness and acceptability of traffic restraint measures in residential areas has been investigated. Results of accident investigations indicate that a new layout of residential areas has a positive effect on traffic safety. Research into road safety should not be restricted

  15. Endotracheal tube connector defect causing airway obstruction in an ...

    African Journals Online (AJOL)

    Acase of difficulty was recently encountered in ventilating an anaesthetised infant after intubating the trachea with size 3.5 mm endotra- cheal tube. It was found that the problem had occurred due to a manufacturing defect in the endotracheal tube connector where the connector was abnormally tapered and had an ...

  16. Prehospital endotracheal intubation; need for routine cuff pressure measurement?

    NARCIS (Netherlands)

    Peters, J.H.; Hoogerwerf, N.

    2013-01-01

    In endotracheal intubation, a secured airway includes an insufflated cuff distal to the vocal cords. High cuff pressures may lead to major complications occurring after a short period of time. Cuff pressures are not routinely checked after intubation in the prehospital setting, dealing with a

  17. Endotracheal tube verification in adult mechanically ventilated patients

    African Journals Online (AJOL)

    ARTICLE. 20 SAJCC June 2015, Vol. 31, No. 1. Endotracheal tube verification in adult mechanically ventilated patients. P Jordan, PhD; W Ten Ham, PhD; D Fataar, RN, CCN. School of Clinical Care Sciences, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa. Corresponding author: P Jordan ...

  18. Influence of head flexion after endotracheal intubation on intraocular ...

    African Journals Online (AJOL)

    Background: During preparation and draping of periorbital area, neck flexion causes displacement of the endotracheal tube tip toward the carina. Stimulation of the tracheal mucosa may cause bucking, increased intraocular pressure (IOP), laryngospasm, bronchospasm, change in end-tidal carbon dioxide pressure ...

  19. Endotracheal tube verification in adult mechanically ventilated patients

    African Journals Online (AJOL)

    An integrative literature search was conducted in 2012 - 2013 of research citations published in English on the topic of discussion. Electronic databases ... has been classified as a highly technical and clinical skill that is accompanied by the danger of ..... Appropriate depth of placement of oral endotracheal tube and its ...

  20. Endotracheal intubation and oral gavage in the domestic chicken.

    Science.gov (United States)

    Alworth, Leanne C; Kelly, Lisa M

    2014-10-01

    The domestic chicken (Gallus gallus) is increasing in popularity as a laboratory animal, as it is useful in multiple fields of biomedical research and has the practical benefits of being relatively inexpensive, easy to handle and able to adapt to various settings. Here, we describe two procedures commonly used with chickens in research: endotracheal intubation and oral gavage.

  1. Effect of Nitrous Oxide Anaesthesia on Endotracheal Cuff Pressure

    Directory of Open Access Journals (Sweden)

    Özlem Koşar

    2017-03-01

    Full Text Available Aim: When N2Ois used for general anaesthesia, it diffuses into the air-filled endotracheal cuff causing the cuff pressure to rise by over inflating the cuff, which results in tracheal damage. This study aimed to estimate changes in the endotracheal-cuff pressure with time during oxygen-air- and oxygen-N2O -induced anaesthesia and to determine its sore throat and hoarseness incidence. Methods: Fifty patients with American Society of Anesthesiologists physical status 1-2, aged 18-60 years were icluded to our study. Orotracheal intubation was performed using polyvinyl chloride high volume-low pressure endotracheal tubes. The AIR group 40% O2/60% air and N2O group 40% O2/60% N2O was used. The endotracheal cuff pressure at 5, 10, 15, 20 minutes immediately after intubation and at 10-minute intervals were recorded. When the cuff pressure reached 45 cm H2O, was attenuated to 25-30-cm H2O. At the post operative first and the 24th hour, the patients were queried for sore throat and hoarseness. Results: The N2O -group cuff pressure rose from the fifth minute onwards. Also, the N2O group had a higher incidence of sore throat and hoarseness. Conclusion: N2O results in elevated cuff pressure and tracheal morbidities. Cuff-pressure should be routinely monitored during anaesthesia using N2O.

  2. Endotracheal suctioning in intubated newborns: an integrative literature review

    Science.gov (United States)

    Gonçalves, Roberta Lins; Tsuzuki, Lucila Midori; Carvalho, Marcos Giovanni Santos

    2015-01-01

    Evidence-based practices search for the best available scientific evidence to support problem solving and decision making. Because of the complexity and amount of information related to health care, the results of methodologically sound scientific papers must be integrated by performing literature reviews. Although endotracheal suctioning is the most frequently performed invasive procedure in intubated newborns in neonatal intensive care units, few Brazilian studies of good methodological quality have examined this practice, and a national consensus or standardization of this technique is lacking. Therefore, the purpose of this study was to review secondary studies on the subject to establish recommendations for endotracheal suctioning in intubated newborns and promote the adoption of best-practice concepts when conducting this procedure. An integrative literature review was performed, and the recommendations of this study are to only perform endotracheal suctioning in newborns when there are signs of tracheal secretions and to avoid routinely performing the procedure. In addition, endotracheal suctioning should be conducted by at least two people, the suctioning time should be less than 15 seconds, the negative suction pressure should be below 100 mmHg, and hyperoxygenation should not be used on a routine basis. If indicated, oxygenation is recommended with an inspired oxygen fraction value that is 10 to 20% greater than the value of the previous fraction, and it should be performed 30 to 60 seconds before, during and 1 minute after the procedure. Saline instillation should not be performed routinely, and the standards for invasive procedures must be respected. PMID:26465249

  3. Endotracheal tube cuff pressures – the worrying reality: A ...

    African Journals Online (AJOL)

    Secondary aims were to determine whether the tube size, tube make or place of intubation affected cuff pressure. Method. Endotracheal tube cuff pressures of 91 patients in the trauma centre and 100 patients in the theatre complex were randomly measured using a Mallinckrodt cuff pressure gauge. The measurements ...

  4. Novel automatic endotracheal position confirmation system: mannequin model algorithm evaluation.

    Science.gov (United States)

    Lederman, Dror; Shamir, Micha Y

    2010-10-01

    A novel endotracheal intubation accurate positioning confirmation system based on image classification algorithm is introduced and evaluated using a mannequin model. The system comprises a miniature complementary metal oxide silicon sensor (CMOS) attached to the tip of a semi rigid stylet and connected to a digital signal processor (DSP) with an integrated video acquisition component. Video signals acquired and processed by an algorithm implemented on the processor. During mannequin intubations, video signals were continuously recorded. A total of 10 videos were recorded. From each video, 7 images of esophageal intubation and 8 images of endotracheal intubation (in which the carina could be clearly seen) were extracted, yielding a total of 150 images taken from arbitrary positions and angles which were processed by the confirmation algorithm. The performance of the confirmation algorithm was evaluated using a leave-one-out method: in each iteration, 149 images were used to train the system and estimate the models, and the remaining image was used to test the system. This process was repeated 150 times such that each image participated once in testing. The system correctly identified 80 out of 80 endotracheal intubations and 70 out of 70 esophageal intubations. This fully automatic image recognition system was used successfully to discriminate airway carina and non-carina endotracheal tube positioning. The system had a 100% success rate using a mannequin model and therefore further investigation including live tissue model and human research should follow.

  5. Warming Endotracheal Tube in Blind Nasotracheal Intubation throughout Maxillofacial Surgeries.

    Science.gov (United States)

    Hosseinzadeh, Hamzeh; Taheri Talesh, Koroush; Golzari, Samad Ej; Gholizadeh, Hossein; Lotfi, Alireza; Hosseinzadeh, Parisa

    2013-01-01

    Blind nasotracheal intubation is an intubation method without observation of glottis that is used when the orotracheal intubation is difficult or impossible. One of the methods to minimize trauma to the nasal cavity is to soften the endotracheal tube through warming. Our aim in this study was to evaluate endotracheal intubation using endotracheal tubes softened by hot water at 50 °C and to compare the patients in terms of success rate and complications. 60 patients with ASA Class I and II scheduled to undergo elective jaw and mouth surgeries under general anesthesia were recruited. success rate for Blind nasotracheal intubation in the control group was 70% vs. 83.3% in the study group. Although the success rate in the study group was higher than the control group, this difference was not statistically significant. The most frequent position of nasotracheal intubation tube was tracheal followed by esophageal and anterior positions, respectively. In conclusion, our study showed that using an endotracheal tube softened by warm water could reduce the incidence and severity of epistaxis during blind nasotracheal intubation; however it could not facilitate blind nasotracheal intubation.

  6. The Effectiveness of Distraction (Cartoon-Patterned Clothes and Bubble-Blowing) on Pain and Anxiety in Preschool Children during Venipuncture in the Emergency Department.

    Science.gov (United States)

    Lilik Lestari, Made Pande; Wanda, Dessie; Hayati, Happy

    2017-01-01

    In preschool children, venipuncture is considered a bodily threat that can cause pain and anxiety, as well as being a traumatic experience. If the pain and anxiety felt by a child during a venipuncture is not addressed properly, it can result in a traumatic experience, and traumatic events in childhood can have long-term consequences. Atraumatic treatment in the emergency department has been little explored in previous research; therefore, the present study assessed the effectiveness of using the distractions of cartoon-patterned clothes and bubble-blowing on the pain and anxiety of preschool children during venipuncture in the emergency department. This was a quasi-experiment that used a post-test only, control group design approach. The sample consisted of 57 preschool children who were due to undergo venipuncture and who were divided into 3 intervention groups. The results showed that distraction using bubble-blowing is effective in reducing pain and anxiety during venipuncture, while cartoon-patterned clothing is only effective in reducing anxiety. Distractions can refocus the attention of a child away from pain and anxiety during venipuncture. It can inhibit the transmission of pain impulses, such that these impulses are not transmitted to the brain. As a result, the sensation of pain is not experienced.

  7. Cross-sectional study on differences in pain perception and behavioral distress during venipuncture between Italian and Chinese children

    Directory of Open Access Journals (Sweden)

    Sofia Bisogni

    2014-12-01

    Full Text Available Venipuncture is perhaps the scariest aspect of hospitalization for children as it causes pain and high levels of behavioral distress. Pain is a complex experience which is also influenced by social factors such as cultural attitudes, beliefs and traditions. Studies focusing on ethnic/cultural differences in pain perception and behavioral distress show controversial results, in particular with regards to children. The aim of this paper is to evaluate differences in pain perception and behavioral manifestations between Italian and Chinese children undergoing a venipuncture, through a cross-sectional study. Behavioral distress and self-reported pain were measured in Chinese and Italian outpatient children during a standardized blood-drawing procedure, using the Observational Scale of Behavioral Distress (OSBD and pain scales. We observed 332 children: 93 Chinese and 239 Italian. Chinese children scored higher than Italians on pain scales − mean scores 5.3 (95%CI 4.78-5.81 vs. 3.2 (95%CI 2.86-3.53 − but lower mean OSBD scores − mean 4.1 (95%CI 3.04-5.15 vs. 8.1 (95%CI 7.06-9.14. Our data suggest that Chinese children experience higher levels of pain than their Italian peers, although they show more self-control in their behavioral reaction to pain when experiencing venipuncture.

  8. Comparison of hematology, plasma biochemistry, and blood gas variables between 2 venipuncture sites in Southern Stingrays (Dasyatis americana).

    Science.gov (United States)

    Phillips, Brianne E; Christiansen, Emily F; Stoskopf, Michael K; Broadhurst, Heather; George, Robert; Harms, Craig A

    2016-12-01

    The Southern Stingray (Dasyatis americana) is a batoid elasmobranch frequently exhibited in zoological institutions. Blood is commonly collected from the caudal hemal arch at the tail base in stingrays for the purpose of health assessment and clinical pathology tests. An alternative site that allows a dorsal or ventral approach without necessitating puncture of a cartilaginous structure has been identified between the cartilaginous pectoral fin rays (ceratotrichia). The purpose of the study was to compare CBC, plasma biochemistry analytes, and blood gas variables between blood samples collected from the caudal and pectoral fin vasculature sites of the Southern Stingray. Fifteen captive Southern Stingrays (10 females, 5 males) from 4 zoo and aquarium facilities were sampled. Lithium heparinized blood samples were collected from the caudal and pectoral venipuncture sites of each animal. Values from estimated total and differential leukocyte counts, plasma biochemistry analytes, and blood gas variables were compared. There were no statistically significant differences between venipuncture sites for the measured analytes except for CK activity, which was statistically significantly higher in the pectoral site samples. Levels of agreement between sites were good or moderate for 22 analytes and poor for ALT, AST, CK, pO2 , lactate, monocytes, and eosinophils. The good agreement between sampling sites for the majority of the measured analytes and the lack of differences that would alter clinical interpretation support the use of the pectoral site as an alternative to the traditional caudal fin venipuncture site in Southern Stingrays. © 2016 American Society for Veterinary Clinical Pathology.

  9. Effects of distraction on pain, fear, and distress during venous port access and venipuncture in children and adolescents with cancer.

    Science.gov (United States)

    Windich-Biermeier, Andrea; Sjoberg, Isabelle; Dale, Juanita Conkin; Eshelman, Debra; Guzzetta, Cathie E

    2007-01-01

    This study evaluates the effect of self-selected distracters (ie, bubbles, I Spy: Super Challenger book, music table, virtual reality glasses, or handheld video games) on pain, fear, and distress in 50 children and adolescents with cancer, ages 5 to 18, with port access or venipuncture. Using an intervention-comparison group design, participants were randomized to the comparison group (n = 28) to receive standard care or intervention group (n = 22) to receive distraction plus standard care. All participants rated their pain and fear, parents rated participant fear, and the nurse rated participant fear and distress at 3 points in time: before, during, and after port access or venipuncture. Results show that self-reported pain and fear were significantly correlated (P = .01) within treatment groups but not significantly different between groups. Intervention participants demonstrated significantly less fear (P <.001) and distress (P = .03) as rated by the nurse and approached significantly less fear (P = .07) as rated by the parent. All intervention parents said the needlestick was better because of the distracter. The authors conclude that distraction has the potential to reduce fear and distress during port access and venipuncture.

  10. [Unanticipated endotracheal tube displacement in a short-neck patient with a history of chronic rheumatoid arthritis: a comparison of three kinds of endotracheal tubes].

    Science.gov (United States)

    Takara, Itaru; Fukuda, Akiko; Koja, Hiroki; Tomiyama, Hiroshi; Tokumine, Joho; Sugahara, Kazuhiro

    2004-10-01

    Endotracheal tubes are known to have a risk of being displaced at neck extension or flexion or rotation. However, the displacement seldom causes clinical problems. An 74-year-old patient suffering from chronic rheumatoid arthritis underwent debridement in the infected knee under general anesthesia. Mechanical ventilation had to be continued because of poor oxygenation after the operation. She had been intubated with Hi Lo Evac endotracheal tube (HLE) for 3 days, then extubated. However, she again needed mechanical ventilation because of aggravated oxygenation. At that time, Profile cuff siliconised endotracheal tube (PCS) was placed for 3 days. We encountered dangerous displacement of HLE during the first mechanical ventilation, but did not have any clinically dangerous displacement of PCS during the second mechanical ventilation. Therefore, we compared the hardness of the three popular endotracheal tubes. We found the hardness of HLE was higher than the others. This might be one of the reasons for dangerous displacement of the endotracheal tube in our case.

  11. Electrosurgery-induced endotracheal tube ignition during tracheotomy.

    Science.gov (United States)

    Aly, A; McIlwain, M; Duncavage, J A

    1991-01-01

    Electrosurgery was the most common source of ignition for operating room fires prior to the advent of lasers. When combined with volatile anesthetic mixtures, electrosurgery has caused ignition of plastic, rubber, paper, enteric gases, and combustible preparation solutions. We report on an intubated patient whose polyvinyl chloride endotracheal tube ignited during a tracheotomy performed with an electrosurgical unit. The oxygen-rich environment, the polyvinyl chloride tube, and the heat generated by the electrosurgical unit combined to produce a fire. Since otolaryngologists are called upon often to perform tracheotomies on intubated patients, it is imperative that they understand the factors involved in the development of such a fire. This case is presented with an explanation of why this type of fire occurs. A brief review of the literature is included. Different kinds of electrosurgical units, precautions as to their use, and the management of electrosurgery-induced endotracheal tube fires are also discussed.

  12. Predictors of restraint use among child occupants.

    Science.gov (United States)

    Benedetti, Marco; Klinich, Kathleen D; Manary, Miriam A; Flannagan, Carol A

    2017-11-17

    The objective of this study was to identify factors that predict restraint use and optimal restraint use among children aged 0 to 13 years. The data set is a national sample of police-reported crashes for years 2010-2014 in which type of child restraint is recorded. The data set was supplemented with demographic census data linked by driver ZIP code, as well as a score for the state child restraint law during the year of the crash relative to best practice recommendations for protecting child occupants. Analysis used linear regression techniques. The main predictor of unrestrained child occupants was the presence of an unrestrained driver. Among restrained children, children had 1.66 (95% confidence interval, 1.27, 2.17) times higher odds of using the recommended type of restraint system if the state law at the time of the crash included requirements based on best practice recommendations. Children are more likely to ride in the recommended type of child restraint when their state's child restraint law includes wording that follows best practice recommendations for child occupant protection. However, state child restraint law requirements do not influence when caregivers fail to use an occupant restraint for their child passengers.

  13. Fixed Or Controlled-Movement Foot Restraint

    Science.gov (United States)

    Reilly, Gloria B.; Blizzard, Noah

    1992-01-01

    Foot restraint gives user three options: holds user's feet in fixed position, allows them to slide sideways, or allows them to pivot independently about axis through ball of foot, as user chooses. Selects degree of restraint to suit task at hand. Movements to enter and leave foot restraint simple and direct. Simply forces each cleat lightly into space between rails until spring force of movable rail secures it. Body movements for sliding and rotation equally straightforward. Designed for use in absence of gravitation, restraint useful on Earth, underwater or in some hazardous locations where movements restricted.

  14. Adaptive Kinematic Control of a Robotic Venipuncture Device Based on Stereo Vision, Ultrasound, and Force Guidance.

    Science.gov (United States)

    Balter, Max L; Chen, Alvin I; Maguire, Timothy J; Yarmush, Martin L

    2017-02-01

    Robotic systems have slowly entered the realm of modern medicine; however, outside the operating room, medical robotics has yet to be translated to more routine interventions such as blood sampling or intravenous fluid delivery. In this paper, we present a medical robot that safely and rapidly cannulates peripheral blood vessels-a procedure commonly known as venipuncture. The device uses near-infrared and ultrasound imaging to scan and select suitable injection sites, and a 9-DOF robot to insert the needle into the center of the vessel based on image and force guidance. We first present the system design and visual servoing scheme of the latest generation robot, and then evaluate the performance of the device through workspace simulations and free-space positioning tests. Finally, we perform a series of motion tracking experiments using stereo vision, ultrasound, and force sensing to guide the position and orientation of the needle tip. Positioning experiments indicate sub-millimeter accuracy and repeatability over the operating workspace of the system, while tracking studies demonstrate real-time needle servoing in response to moving targets. Lastly, robotic phantom cannulations demonstrate the use of multiple system states to confirm that the needle has reached the center of the vessel.

  15. May we practise endotracheal intubation on the newly dead?

    Science.gov (United States)

    Ardagh, M

    1997-10-01

    Endotracheal intubation (ETI) is a valuable procedure which must be learnt and practised, and performing ETI on cadavers is probably the best way to do this, although lesser alternatives do exist. Performing ETI on a cadaver is viewed with a real and reasonable repugnance and if it is done without proper authorisation it might be illegal. Some form of consent is required. Presumed consent would preferably be governed by statute and should only occur if the community is well informed and therefore in a position of being able to decline. Currently neither statute nor adequate informing exists. Endotracheal intubation on the newly dead may be justifiable according to a Guttman scale if the patient has already consented to organ donation and if further research supports the relevance of the Guttman scale to this question. A "mandated choice" with prior individual consent as a matter of public policy is the best of these solutions, however until such a solution is in place we may not practise endotracheal intubation on the newly dead.

  16. Cholinergic Modulation of Restraint Stress Induced Neurobehavioral ...

    African Journals Online (AJOL)

    The involvement of the cholinergic system in restraint stress induced neurobehavioral alterations was investigated in rodents using the hole board, elevated plus maze, the open field and the light and dark box tests. Restraint stress (3h) reduced significantly (p<0.05) the number of entries and time spent in the open arm, ...

  17. 25 CFR 11.403 - Unlawful restraint.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Unlawful restraint. 11.403 Section 11.403 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Criminal Offenses § 11.403 Unlawful restraint. A person commits a misdemeanor if he or she...

  18. Nuclear component horizontal seismic restraint

    Science.gov (United States)

    Snyder, Glenn J.

    1988-01-01

    A nuclear component horizontal seismic restraint. Small gaps limit horizontal displacement of components during a seismic occurrence and therefore reduce dynamic loadings on the free lower end. The reactor vessel and reactor guard vessel use thicker section roll-forged rings welded between the vessel straight shell sections and the bottom hemispherical head sections. The inside of the reactor guard vessel ring forging contains local vertical dovetail slots and upper ledge pockets to mount and retain field fitted and installed blocks. As an option, the horizontal displacement of the reactor vessel core support cone can be limited by including shop fitted/installed local blocks in opposing alignment with the reactor vessel forged ring. Beams embedded in the wall of the reactor building protrude into apertures in the thermal insulation shell adjacent the reactor guard vessel ring and have motion limit blocks attached thereto to provide to a predetermined clearance between the blocks and reactor guard vessel ring.

  19. Endotracheal suctioning versus minimally invasive airway suctioning in intubated patients : a prospective randomised controlled trial

    NARCIS (Netherlands)

    Van de Leur, JP; Zwaveling, JH; Loef, BG; Van der Schans, CP

    Study objective: Endotracheal suctioning in intubated patients is routinely applied in most ICUs but may have negative side effects. We hypothesised that on-demand minimally invasive suctioning would have fewer side effects than routine deep endotracheal suctioning, and would be comparable in

  20. Accidental Perforation of Endotracheal Tube during Orthognathic Surgery for Maxillary Prognathism - a Case Report

    Directory of Open Access Journals (Sweden)

    Manish Jain

    2008-01-01

    Full Text Available Maxillary prognathism(excess is a congenital anomaly characterized by facial disfigurement. Accidental perforation of endotracheal tube during corrective surgery is not an uncommon complication. A case of accidental perforation of endotracheal tube during surgery and its management is presented here.

  1. Striving for Balance Between Caring and Restraint

    DEFF Research Database (Denmark)

    Moberg, Julie Y; Larsen, Dorte; Brødsgaard, Anne

    2017-01-01

    with 14 young adults were conducted. RESULTS: The essence of the phenomenon of having a parent with multiple sclerosis was synthesized into 'Striving for balance between caring and restraint' from two themes 'caring' and 'restraint' and eight subthemes. Participants' experiences of caring for parents...... with multiple sclerosis continued influencing their other close relationships, in which they tended to assume responsibility while concealing some of their feelings and desires. Most participants showed restraint among parents with and without multiple sclerosis, friends, and partners. CONCLUSION: It seems...

  2. Taking charge. The role of nursing administrators in removing restraints.

    Science.gov (United States)

    Dunbar, J M; Neufeld, R R; Libow, L S; Cohen, C E; Foley, W J

    1997-03-01

    The leadership and commitment of nursing administrators play a pivotal role in minimizing the use of restraints and maintaining a restraint-free environment. This article describes the role of nursing administrators in reducing the use of physical restraints as part of a 2-year, national nursing home restraint-reduction project. It reviews important information about restraint-free care the benefits of restraint-free care, and strategies to reduce the use of restraints in nursing homes, much of which is applicable to settings other than nursing homes.

  3. Mechanical Restraint - Which Interventions Prevent Episodes of Mechanical Restraint? - A Systematic Review

    DEFF Research Database (Denmark)

    Bak, Jesper; Brandt-Christensen, Anne Mette; Sestoft, Dorte Maria

    2012-01-01

    PURPOSE:  To identify interventions preventing mechanical restraints. DESIGN AND METHODS:  Systematic review of international research papers dealing with mechanical restraint. The review combines qualitative and quantitative research in a new way, describing the quality of evidence and the effect...... of intervention. FINDINGS:  Implementation of cognitive milieu therapy, combined interventions, and patient-centered care were the three interventions most likely to reduce the number of mechanical restraints. PRACTICE IMPLICATIONS:  There is a lack of high-quality and effective intervention studies. This leaves...... patients and metal health professionals with uncertainty when choosing interventions in an attempt to prevent mechanical restraints....

  4. Dietary restraint and cognitive performance in children.

    Science.gov (United States)

    Brunstrom, Jeffrey M; Davison, Claire J; Mitchell, Gemma L

    2005-12-01

    Adults who attempt to restrict their dietary intake also tend to perform worse on a range of cognitive tasks. However, the extent to which this finding generalises to children has remained unclear. Following studies involving adults, we asked 44 girls (mean age = 10.1 years) to complete a simple reaction-time task and the Tower of London task. This group was selected from a local community school in the East Midlands (UK). Dietary restraint was measured using a version of the Dutch Eating Behaviour Questionnaire that had been adapted for use by children. Our results indicate that children with high restraint scores have longer reaction times and they also tend to perform worse on the TOL task. Other aspects of our data also suggest the dietary restraint may be correlated negatively with a measure of academic ability. We discuss reasons why restraint and performance might be related causally and we conclude that this issue warrants further scrutiny.

  5. Children restraint systems for civil aircraft.

    Science.gov (United States)

    1978-03-01

    Child restraint systems have been developed to provide protection to children involved in automobile crashes. These systems are not yet approved for use in civil aircraft. Six typical systems were exposed to controlled impacts on a test sled to simul...

  6. Child restraint systems for civil aircraft.

    Science.gov (United States)

    1978-03-01

    Child restraint systems have been developed to provide protection to children involved in automobile crashes. These systems are not yet approved for use in civil aircraft. Six typical systems were exposed to controlled impacts on a test sled to simul...

  7. Geospatial Analysis of Pediatric EMS Run Density and Endotracheal Intubation

    Directory of Open Access Journals (Sweden)

    Matthew Hansen

    2016-09-01

    Full Text Available Introduction: The association between geographic factors, including transport distance, and pediatric emergency medical services (EMS run clustering on out-of-hospital pediatric endotracheal intubation is unclear. The objective of this study was to determine if endotracheal intubation procedures are more likely to occur at greater distances from the hospital and near clusters of pediatric calls. Methods: This was a retrospective observational study including all EMS runs for patients less than 18 years of age from 2008 to 2014 in a geographically large and diverse Oregon county that includes densely populated urban areas near Portland and remote rural areas. We geocoded scene addresses using the automated address locator created in the cloud-based mapping platform ArcGIS, supplemented with manual address geocoding for remaining cases. We then use the Getis-Ord Gi spatial statistic feature in ArcGIS to map statistically significant spatial clusters (hot spots of pediatric EMS runs throughout the county. We then superimposed all intubation procedures performed during the study period on maps of pediatric EMS-run hot spots, pediatric population density, fire stations, and hospitals. We also performed multivariable logistic regression to determine if distance traveled to the hospital was associated with intubation after controlling for several confounding variables. Results: We identified a total of 7,797 pediatric EMS runs during the study period and 38 endotracheal intubations. In univariate analysis we found that patients who were intubated were similar to those who were not in gender and whether or not they were transported to a children’s hospital. Intubated patients tended to be transported shorter distances and were older than non-intubated patients. Increased distance from the hospital was associated with reduced odds of intubation after controlling for age, sex, scene location, and trauma system entry status in a multivariate logistic

  8. International Space Station Crew Restraint Design

    Science.gov (United States)

    Whitmore, M.; Norris, L.; Holden, K.

    2005-01-01

    With permanent human presence onboard the International Space Station (ISS), crews will be living and working in microgravity, dealing with the challenges of a weightless environment. In addition, the confined nature of the spacecraft environment results in ergonomic challenges such as limited visibility and access to the activity areas, as well as prolonged periods of unnatural postures. Without optimum restraints, crewmembers may be handicapped for performing some of the on-orbit tasks. Currently, many of the tasks on ISS are performed with the crew restrained merely by hooking their arms or toes around handrails to steady themselves. This is adequate for some tasks, but not all. There have been some reports of discomfort/calluses on the top of the toes. In addition, this type of restraint is simply insufficient for tasks that require a large degree of stability. Glovebox design is a good example of a confined workstation concept requiring stability for successful use. They are widely used in industry, university, and government laboratories, as well as in the space environment, and are known to cause postural limitations and visual restrictions. Although there are numerous guidelines pertaining to ventilation, seals, and glove attachment, most of the data have been gathered in a 1-g environment, or are from studies that were conducted prior to the early 1980 s. Little is known about how best to restrain a crewmember using a glovebox in microgravity. In 2004, The Usability Testing and Analysis Facility (UTAF) at the NASA Johnson Space Center completed development/evaluation of several design concepts for crew restraints to meet the various needs outlined above. Restraints were designed for general purpose use, for teleoperation (Robonaut) and for use with the Life Sciences Glovebox. All design efforts followed a human factors engineering design lifecycle, beginning with identification of requirements followed by an iterative prototype/test cycle. Anthropometric

  9. Does Brief Bradycardia at the Onset of Arm-Restraint Predict Infants' Emotional Reactivity during Restraint?

    Science.gov (United States)

    Porter, Christin L.; Jones, Blake L.

    2011-01-01

    Using electrocardiogram data with 78 six-month-old infants, this study examined the presence or absence of brief orienting bradycardia during the onset of maternal arm-restraint and subsequent differences between infants on behavioral organization during restraint. Results showed that 45 of the infants exhibited brief episodes of bradycardia at…

  10. Restraint Safety: An Analysis of Injuries Related to Restraint of People with Intellectual Disabilities

    Science.gov (United States)

    Williams, Don E.

    2009-01-01

    Background: There is little research on the safety of the various types of restraint commonly used with individuals with intellectual disabilities who exhibit severely aggressive or self-injurious behaviour. Method: This study analysed the use of restraint with 209 individuals with intellectual disabilities over a 12-month period. Results: Planned…

  11. Reliability and Criterion-Related Validity Testing (construct) of the Endotracheal Suction Assessment Tool (ESAT©).

    Science.gov (United States)

    Davies, K; Bulsara, M; Ramelet, A S; Monteroso, L

    2018-01-18

    To establish criterion-related construct validity and test-retest reliability for the Endotracheal Suction Assessment Tool© (ESAT©). Endotracheal tube suction performed in children can significantly affect clinical stability. Previously identified clinical indicators for endotracheal tube suction were used as criteria when designing the ESAT©. Content validity was reported previously. The final stages of psychometric testing are presented. Observational testing was used to measure construct validity and determine whether the ESAT© could guide 'inexperienced' paediatric intensive care nurses' decision-making regarding endotracheal tube suction. Test-retest reliability of the ESAT© was performed at two time points. The researchers and paediatric intensive care nurse 'experts' developed 10 hypothetical clinical scenarios with predetermined endotracheal tube suction outcomes. 'Experienced' (n=12) and 'inexperienced' (n=14) paediatric intensive care nurses were presented with the scenarios and the ESAT© guiding decision-making about whether to perform endotracheal tube suction for each scenario. Outcomes were compared with those predetermined by the 'experts' (n=9). Test-retest reliability of the ESAT© was measured at two consecutive time points (4 weeks apart) with 'experienced' and 'inexperienced' PIC nurses using the same scenarios and tool to guide decision-making. No differences were observed between endotracheal tube suction decisions made by 'experts' (n=9), 'inexperienced' (n=14) and 'experienced' (n=12) nurses confirming the tool's construct validity. No differences were observed between groups for endotracheal tube suction decisions at T1 and T2. Criterion-related construct validity and test-retest reliability of the ESAT© were demonstrated. Further testing is recommended to confirm reliability in the clinical setting with the 'inexperienced' nurse to guide decision-making related to endotracheal tube suction. This article is protected by copyright

  12. Management of avulsed permanent maxillary central incisors during endotracheal intubation

    Directory of Open Access Journals (Sweden)

    Ritesh R Kalaskar

    2016-01-01

    Full Text Available Avulsion is serious injury that may encounter during endotracheal intubation and its management often presents a challenge. Replantation of the avulsed tooth can restore esthetic appearance and occlusal function shortly after the injury. The present article describes the management of air-dried maxillary permanent incisors that have been avulsed due to direct laryngoscopy during the induction of general anesthesia for tonsillectomy procedure. The replanted maxillary central incisors had maintained its function and esthetic for 1 year after replantation. Children in a mixed dentition phase are high-risk group children for traumatic dental injury during laryngoscopy; therefore, Anesthetic Departments should have local protocols to refer patients for dental treatment postoperatively in the event of trauma.

  13. Special Purpose Crew Restraints for Teleoperation

    Science.gov (United States)

    Whitmore, Mihriban; Holden, Kritina; Norris, Lena

    2004-01-01

    With permanent human presence onboard the International Space Station (ISS), and long duration space missions being planned for the moon and Mars, humans will be living and working in microgravity over increasingly long periods of time. In addition to weightlessness, the confined nature of a spacecraft environment results in ergonomic challenges such as limited visibility, and access to the activity area. These challenges can result in prolonged periods of unnatural postures for the crew, ultimately causing pain, injury, and loss of productivity. Determining the right set of human factors requirements and providing an ergonomically designed environment is crucial to mission success. While a number of general purpose restraints have been used on ISS (handrails, foot loops), experience has shown that these general purpose restraints may not be optimal, or even acceptable for some tasks that have unique requirements. For example, some onboard activities require extreme stability (e.g., glovebox microsurgery), and others involve the use of arm, torso and foot movements in order to perform the task (e-g. robotic teleoperation); standard restraint systems will not work in these situations. The Usability Testing and Analysis Facility (WAF) at the NASA Johnson Space Center began evaluations of crew restraints for these special situations by looking at NASAs Robonaut. Developed by the Robot Systems Technology Branch, Robonaut is a humanoid robot that can be remotely operated through a tetepresence control system by an operator. It was designed to perform work in hazardous environments (e.g., Extra Vehicular Activities). A Robonaut restraint was designed, modeled for the population, and ultimately tested onboard the KC-135 microgravity aircraft. While in microgravity, participants were asked to get in and out of the restraint from different locations, perform maximum reach exercises, and finally to teleoperate Robonaut while in the restraint. The sessions were videotaped

  14. [Tolerance of endotracheal tubes in patients on mechanical ventilation].

    Science.gov (United States)

    Nydahl, P; Hermes, C; Dubb, R; Kaltwasser, A; Schuchhardt, D

    2015-02-01

    Modern concepts for sedation and analgesia and guidelines recommend light analgesia and sedation, so that patients on mechanically ventilation are more awake, compared to previous concepts. Hence, these patients are more alert and able to experience their situation on the ventilator and their endotracheal tube (ETT). There is currently no convincing evidence of how patients tolerate the tube under present conditions, which interventions could help them, or whether they want to be sedated deeper because of the tube. Based upon our own observations, a broad range of reactions are possible. The tolerance of the ETT in intensive care patients was explored. A systematic literature research without time constraints in the databases PubMed and CINAHL was performed. Included were quantitative and qualitative studies written in German or English that investigated tolerance of the ETT in adult intensive care patients. Excluded were anesthetic studies including in- and extubation immediately before and after operations. Of the 2348 hits, 14 studies were included, including 4 qualitative studies about the experience of intensive care, 8 quantitative studies including 2 randomized controlled studies, and 2 studies with a mixed approach. Within the studies different aspects could be identified, which may in- or decrease the tolerance of an ETT. Aspects like breathlessness, pain during endotracheal suctioning and inability to speak decrease the tolerance. Information, the presence of relatives and early mobilization appear to increase the tolerance. Tolerance of the ETT is a complex phenomenon. A reflected and critical evaluation of the behavior of the patient with an ETT is recommended. Interventions that increase the tolerance of the ETT should be adapted to the situation of the patient and should be evaluated daily.

  15. Roadside observation of child passenger restraint use

    Directory of Open Access Journals (Sweden)

    Beth Bruce

    2015-10-01

    Full Text Available Background: Despite legislation and research evidence supporting the use of childhood vehicle restraints, motor vehicle crashes remain the leading cause of injury, death and disability among Canadian children. Methods: Working in collaboration with trained car seat specialists and police officers, roadside checks were conducted to observe correct use of child restraints. Results: Of the 1323 child vehicle restraints inspected, 99.6% of the children were restrained, 91% were in the correct seat, and 48% of restraints were correctly installed. The seat/restraint types most used incorrectly used were booster seats (31% and seat belts (53%. The majority of incorrectly installed or fitted seats (55% were forward facing. Common errors in installation and fit included the seat not being secured tightly enough to the vehicle, incorrect tether strap use, the harness not being tight enough, and/or the chest clip being in the wrong place. Conclusions: The greatest proportion of incorrect seat use was among those children who transitioned to a seat belt too soon. The greatest proportion of installation and fit errors were among forward facing seats. Researchers recommend: 1 targeting parents with older children (ages 3 and above regarding transitioning too soon from forward facing seats to booster seats, and from booster seats to seat belts; 2 targeting parents with younger children regarding correct installation of rear facing and forward facing seats; 3 collaborating with police officers to review the most common errors and encourage observation at roadside checks; and 4 creating community awareness by way of roadside checks.

  16. Acute Cold / Restraint Stress in Castrated Rats

    Directory of Open Access Journals (Sweden)

    Farideh Zafari Zangeneh

    2008-09-01

    Full Text Available Objective: The present study aimed to determine whether castration altered osmotically stimulated vasopressin (VP release and urinary volume and what is the role of endocrine-stress axis in this process.Materials and methods: Totally 108 mice were studied in two main groups of castrated (n=78 and control (n=30. Each group was extracted by acute cold stress (4◦C for 2h/day, restraint stress (by syringes 60cc 2h/day and cold/restraint stress. The castrated group was treated in sub groups of testosterone, control (sesame oil as vehicle of testosterone. Propranolol as blocker of sympathetic nervous system was given to both groups of castrated mice and main control.Results: Our results showed that, there is interactions between testosterone and sympathetic nervous system on vasopressin, because urine volume was decreased only in testoctomized mice with cold/restraint and cold stress (P<0.001; propranolol as the antagonist of sympathetic nervous system could block and increase urine volume in castrated mice. This increased volume of urine was due to acute cold stress, not restraint stress (p<0.001. The role of testosterone, noradrenalin (NA and Vasopressin (VP in the acute cold stress is confirmed, because testosterone could return the effect of decreased urine volume in control group (P<0.001. Conclusion: Considering the effect of cold/restraint stress on urinary volume in castrated mice shows that there is interaction between sex hormone (testosterone, vasopressin and adrenergic systems.

  17. Interactive music as a treatment for pain and stress in children during venipuncture: a randomized prospective study.

    Science.gov (United States)

    Caprilli, Simona; Anastasi, Francesca; Grotto, Rosa Pia Lauro; Scollo Abeti, Marianna; Abeti, Mariana Scollo; Messeri, Andrea

    2007-10-01

    The experience of venipuncture is seen by children as one of the most fearful experiences during hospitalization. Children experience anxiety both before and during the procedure. Therefore, any intervention aiming to prevent or reduce distress should focus on the entire experience of the procedure, including waiting, actual preparation, and conclusion. This study was designed to determine whether the presence of musicians, who had attended specific training to work in medical settings, could reduce distress and pain in children undergoing blood tests. Our sample population was composed of 108 unpremedicated children (4-13 years of age) undergoing blood tests. They were randomly assigned to a music group (n=54), in which the child underwent the procedure while interacting with the musicians in the presence of a parent or to a control group (n=54), in which only the parent provided support to the child during the procedure. The distress experienced by the child before, during and after the blood test was assessed with the Amended Form of the Observation Scale of Behavioral Distress, and pain experience with FACES scale (Wong Baker Scale) only after the venipuncture. Our results show that distress and pain intensity was significantly lower (pmusic group compared with the control group before, during, and after blood sampling. This controlled study demonstrates that songs and music, performed by "professional" musicians, have a beneficial effect in reducing distress before, during, and after blood tests. This study shows, moreover, that the presence of musicians has a minor, but yet significant, effect on pain due to needle insertion.

  18. Endotracheal suctioning of the adult intubated patient--what is the evidence?

    DEFF Research Database (Denmark)

    Pedersen, Carsten M; Rosendahl-Nielsen, Mette; Hjermind, Jeanette

    2008-01-01

    bleeding, infection, atelectasis, hypoxemia, cardiovascular instability, elevated intracranial pressure, and may also cause lesions in the tracheal mucosa. The aim of this article was to review the available literature regarding endotracheal suctioning of adult intubated intensive care patients...

  19. Experience of monitoring the recurrent laryngeal nerve in thyroid surgery with endotracheal intubation

    Directory of Open Access Journals (Sweden)

    Liang Feng

    2017-01-01

    Full Text Available Purpose:To analysis clinical experience of applying recurrent laryngeal monitoring endotracheal tube (NIM EMG Endotracheal Tube in the surgery of thyroid. Method: A retrospective analysis of 84 patients who underwent endotracheal intubation laryngeal nerve monitoring by thyroid surgery in the Chinese-Japanese Friendship Hospital of Jilin University from March to December in 2015. To summarize the experience of intubation with NIM EMG Endotracheal Tube. Result 77 (91.7%had initial intubation achievement in the 84 patients.FROM the 77 cases we had gotten s atisfactory nerve monitoring signal.Whereas there are 7 cases (8.3% appear abnormal EMG or signal missing, in the 7 cases there is one which being intubated too deep, 3 cases which being intubated too shallow and 3 cases with malrotation intubation.Conclusion: We got the satisfactory signals after adjust1ing the tube by using the visual laryngoscope.

  20. Passive zero-gravity leg restraint

    Science.gov (United States)

    Miller, Christopher R. (Inventor)

    1989-01-01

    A passive zero or microgravity leg restraint is described which includes a central support post with a top and a bottom. Extending from the central support post are a calf pad tab, to which calf pad is attached, and a foot pad tab, to which foot tab is attached. Also extending from central support post are knee pads. When the restraint is in use the user's legs are forced between pads by a user imposed scissors action of the legs. The user's body is then supported in a zero or microgravity neutral body posture by the leg restraint. The calf pad has semi-ridig elastic padding material covering structural stiffener. The foot pad has padding material and a structural stiffener. Knee pads have s structural tube stiffener at their core.

  1. 75 FR 9613 - Draft NIJ Restraints Standard for Criminal Justice

    Science.gov (United States)

    2010-03-03

    ... industry technical representatives, criminal justice agencies and organizations, research, development and... of Justice Programs Draft NIJ Restraints Standard for Criminal Justice AGENCY: National Institute of Justice, Office of Justice Programs, DOJ. ACTION: Notice of Draft NIJ Restraints Standard for Criminal...

  2. Child restraint workshop series. Volume 2, Ongoing and planned programs

    Science.gov (United States)

    1979-09-01

    This final report describes the planning and implementing details of the Child Restraint Workshop series. A child restraint workshop was conducted in each of the : ten NHTSA regions. The purpose of the workshops was to improve the effectiveness of gr...

  3. Physical Restraint Initiation in Nursing Homes and Subsequent Resident Health

    Science.gov (United States)

    Engberg, John; Castle, Nicholas G.; McCaffrey, Daniel

    2008-01-01

    Purpose: It is widely believed that physical restraint use causes mental and physical health decline in nursing home residents. Yet few studies exist showing an association between restraint initiation and health decline. In this research, we examined whether physical restraint initiation is associated with subsequent lower physical or mental…

  4. 49 CFR 213.110 - Gage restraint measurement systems.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Gage restraint measurement systems. 213.110... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION TRACK SAFETY STANDARDS Track Structure § 213.110 Gage restraint measurement systems. (a) A track owner may elect to implement a Gage Restraint Measurement System (GRMS...

  5. 49 CFR 575.201 - Child restraint performance.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Child restraint performance. 575.201 Section 575... Recall Enhancement, Accountability, and Documentation Act; Consumer Information § 575.201 Child restraint... performance of child restraints. The agency makes the information developed under this rating program...

  6. 28 CFR 570.44 - Supervision and restraint requirements.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Supervision and restraint requirements... PROGRAMS AND RELEASE COMMUNITY PROGRAMS Escorted Trips § 570.44 Supervision and restraint requirements... all times. Restraints may be applied to an inmate going on an escorted trip, after considering the...

  7. 49 CFR 179.14 - Coupler vertical restraint system.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Coupler vertical restraint system. 179.14 Section... TANK CARS General Design Requirements § 179.14 Coupler vertical restraint system. (a) Performance... not be equipped with couplers having this vertical restraint capability. (b) Test verification. Except...

  8. 45 CFR 1310.11 - Child Restraint Systems.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Child Restraint Systems. 1310.11 Section 1310.11... PROGRAM HEAD START TRANSPORTATION Transportation Requirements § 1310.11 Child Restraint Systems. (a... safety restraint systems. (b) ...

  9. Restraint, tendency toward overeating and ice cream consumption

    NARCIS (Netherlands)

    Van Strien, T; Cleven, A.H.G.; Schippers, G.

    2000-01-01

    OBJECTIVE: The examination of the prediction of grams of ice cream eaten by preload, restraint, susceptibility toward overeating, and interaction terms. METHOD: A milkshake-ice cream study on 200 females using the Restraint Scale (RS) and the restraint and disinhibition scales from the Three-Factor

  10. The use of restraints in psychiatric patients

    African Journals Online (AJOL)

    2009-09-17

    Sep 17, 2009 ... and careful physical examination. The initial assessment should determine whether restraint is contraindicated or must be used with caution. 2. The core competencies of clinical staff should be continuously monitored and evaluated. These competencies to include early recognition of signs/symptoms of ...

  11. Restraint Age Forming Of Machined Panels

    Science.gov (United States)

    Wood, Rebecca

    1993-01-01

    Panels bent permanently without cracking. In restraint age forming, panel wrapped onto mandrel having necessary curved contour, restrained on mandrel clamps and vacuum, and heat treated. When panel released after end of heat treatment, retains contour of mandrel except for small springback. Process repeatable: panels subsequently processed under same mechanical and thermal conditions on same contour emerge with same final contour.

  12. Rollover: a methodology for restraint system development

    NARCIS (Netherlands)

    Altamore, P.F.; Ridella, S.A.; Nayef, A.

    2001-01-01

    Concern about crash conditions other than frontal and side crashes has accelerated restraint development with respect to rollover events. Previous analysis of rollover field data indicates the high probability of ejection and consequent serious injury or death to unbelted occupants. Partial ejection

  13. Restraint and Seclusion with Institutionalized Adolescents.

    Science.gov (United States)

    Crespi, Tony D.

    1990-01-01

    Tens of thousands of the nation's young people are placed in psychiatric and criminal justice programs annually. Within those settings, many confront an assortment of restraint and seclusionary measures. This paper discusses the population of young people exposed to such procedures and examines the implications within these settings and elsewhere.…

  14. The minimal leak test technique for endotracheal cuff maintenance.

    Science.gov (United States)

    Harvie, D A; Darvall, J N; Dodd, M; De La Cruz, A; Tacey, M; D'Costa, R L; Ward, D

    2016-09-01

    Endotracheal tube (ETT) cuff pressure management is an essential part of airway management in intubated and mechanically ventilated patients. Both under- and over-inflation of the ETT cuff can lead to patient complications, with an ideal pressure range of 20-30 cmH2O defined. A range of techniques are employed to ensure adequate ETT cuff inflation, with little comparative data. We performed an observational cross-sectional study in a tertiary metropolitan ICU, assessing the relationship between the minimal leak test and cuff manometry. Forty-five mechanically ventilated patients, over a three-month period, had ETT cuff manometry performed at the same time as their routine cuff maintenance (minimal leak test). Bedside nurse measurements were compared with investigator measurements. At the endpoint of cuff inflation, 20 of 45 patients (44%) had cuff pressures between 20 and 30 cmH2O; 11 of 45 patients (24%) had cuff pressures analysis demonstrated an association between both patient obesity and female gender requiring less ETT cuff volume (P=0.008 and P analysis. No association was demonstrated between any measured variables and cuff pressures. Inter-operator reliability in performing the minimal leak test showed no evidence of bias between nurse and investigators (Pearson coefficient = 0.897). We conclude the minimal leak test for maintenance of ETT cuffs leads to both over- and under-inflation, and alternative techniques, such as cuff manometry, should be employed.

  15. Reinforced laryngeal mask airway compared with endotracheal tube for adenotonsillectomies.

    Science.gov (United States)

    Doksrød, Simen; Løfgren, Brith; Nordhammer, Anita; Svendsen, Martin V; Gisselsson, Lars; Raeder, Johan

    2010-11-01

    The endotracheal tube (ETT) has traditionally been considered the best airway device during adenotonsillectomy because a well protected and secured airway is provided. This has been challenged by the introduction of the reinforced laryngeal mask airway (RLMA). It does not kink, is less traumatic during insertion and better tolerated during emergence. The purpose of this study was to compare the use of the RLMA with ETT with regards to postoperative pain, nausea, vomiting and perioperative efficacy in a series of children due for adenotonsillectomy. One hundred and thirty-four children, aged 3-16 years and scheduled for ambulatory adenotonsillectomies, were randomly assigned to two groups where the airways were secured with either the ETT (n = 62) or the RLMA (n = 69). We registered the incidence of peroperative and postoperative anaesthesiological complications and time consume, in addition to postoperative pain, nausea and overall satisfaction. The Group RLMA scored significantly lower for maximal pain during the first 4 h postoperatively (P = 0.015). There were no significant differences in pain scores at 24 h or rescue pain medication postoperatively. The Group RLMA spent mean 4.2 min less in the operating room after surgery (P = 0.001). There were no significant differences in postoperative nausea. In those patients finally treated with ETT, including five conversions from RLMA, significantly more patients (10 vs. 2) had airway irritations (P children, with beneficial effects on airway irritations, operating room efficiency and early postoperative pain.

  16. Restraint reduction: research utilization and case study with cognitive impairment.

    Science.gov (United States)

    Mayhew, P A; Christy, K; Berkebile, J; Miller, C; Farrish, A

    1999-01-01

    Although great strides have been made in restraint reduction, restraints still present a challenge for long-term care facilities. Restraint reduction is particularly difficult with cognitively impaired residents. This article presents the implementation of a research-based approach to restraint reduction and a case study with a cognitively impaired resident. Two year after implementing the research-based approach, the restraint rate had decreased 28%. The case study with the cognitively impaired resident revealed an increase in nurse contacts but a decrease in nurse time after restraint reduction. Concern for the cognitively impaired resident's safety remained an issue for the staff. Discussion includes weighing the risk/benefit ratio of restraint use and considering dignity and quality of life.

  17. [Analysis on risk factors of endotracheal cuff under inflation in mechanically ventilated patients].

    Science.gov (United States)

    Fu, You; Xi, Xiuming

    2014-12-01

    To investigate the prevalent condition of endotracheal cuff pressure and risk factors for under inflation. A prospective cohort study was conducted. Patients admitted to the Department of Critical Care Medicine of Fuxing Hospital Affiliated to Capital Medical University, who were intubated with a high-volume low-pressure endotracheal tube, and had undergone mechanical ventilation for at least 48 hours, were enrolled. The endotracheal cuff pressure was determined every 8 hours by a manual manometer connected to the distal edge of the valve cuff at 07 : 00, 15 : 00, and 23 : 00. Measurement of the endotracheal cuff pressure was continued until the extubation of endotracheal or tracheostomy tube, or death of the patient. According to the incidence of under inflation of endotracheal cuff, patients were divided into the incidence of under inflation lower than 25% group (lower low cuff pressure group) and higher than 25% group (higher low cuff pressure group). The possible influencing factors were evaluated in the two groups, including body mass index (BMI), size of endotracheal tube, duration of intubation, use of sedative or analgesic, number of leaving from intensive care unit (ICU), the number of turning over the patients, and aspiration of sputum. Logistic regression analysis was used to determine risk factors for under-inflation of the endotracheal cuff. During the study period, 53 patients were enrolled. There were 812 measurements, and 46.3% of them was abnormal, and 204 times (25.1%) of under inflation of endotracheal cuff were found. There were 24 patients (45.3%) in whom the incidence of under inflation rate was higher than 25%. The average of under inflation was 7 (4, 10) times. Compared with the group with lower rate of low cuff pressure, a longer time for intubation was found in group with higher rate of low cuff pressure [hours: 162 (113, 225) vs. 118 (97, 168), Z=-2.034, P=0.042]. There were no differences between the two groups in other factors

  18. Antimicrobial-coated endotracheal tubes: an experimental study.

    Science.gov (United States)

    Berra, Lorenzo; Curto, Francesco; Li Bassi, Gianluigi; Laquerriere, Patrice; Pitts, Betsey; Baccarelli, Andrea; Kolobow, Theodor

    2008-06-01

    Antibiotic-resistant bacterial biofilm may quickly form on endotracheal tubes (ETTs) and can enter the lungs, potentially causing pneumonia. In an attempt to prevent bacterial colonization, we developed and tested in an in-vitro study and animal study several antibacterial-coated ETTs (silver sulfadiazine with and without carbon in polyurethane, silver sulfadiazine and chlorhexidine with and without carbon in polyurethane, silver-platinum with and without carbon in polyurethane, chlorhexidine in polyurethane, and rose bengal for UV light). DESIGN, SETTING, ANIMALS, INTERVENTIONS: After preliminary studies, silver sulfadiazine in polyurethane (SSD-ETT) was selected among the coatings to be challenged every 24 h with 10(4)-10(6) Pseudomonas aeruginosa/ml and evaluated at 6 h, 24 h, and 72 h with standard microbiological studies, scanning electron microscopy, and confocal scanning microscopy. Subsequently, eight sheep were randomized to receive either a SSD-ETT or a standard ETT (St-ETT). After 24 h of mechanical ventilation, standard microbiological studies were performed together with scanning electron microscopy and confocal microscopy. In the in-vitro study SSD-ETT remained bacteria-free for up to 72 h, whereas St-ETT showed heavy P. aeruginosa growth and biofilm formation (p < 0.01). In sheep, the SSD-ETT group showed no bacterial growth in the ETT, ventilator tubing, and lower respiratory tract, while heavy colonization was found in the St-ETT (p < 0.01), ventilator tubing (p=0.03), and lower respiratory tract (p < 0.01). This study describes several effective and durable antibacterial coatings for ETTs. Particularly, SSD-ETT showed prevention against P. aeruginosa biofilm formation in a 72-h in-vitro study and lower respiratory tract colonization in sheep mechanically ventilated for 24 h.

  19. Endotracheal tube biofilm translocation in the lateral Trendelenburg position.

    Science.gov (United States)

    Li Bassi, Gianluigi; Fernandez-Barat, Laia; Saucedo, Lina; Giunta, Valeria; Marti, Joan Daniel; Tavares Ranzani, Otavio; Aguilera Xiol, Eli; Rigol, Montserrat; Roca, Ignasi; Muñoz, Laura; Luque, Nestor; Esperatti, Mariano; Saco, Maria Adela; Ramirez, Jose; Vila, Jordi; Ferrer, Miguel; Torres, Antoni

    2015-02-27

    Laboratory studies demonstrated that the lateral Trendelenburg position (LTP) is superior to the semirecumbent position (SRP) in the prevention of ventilator-associated pulmonary infections. We assessed whether the LTP could also prevent pulmonary colonization and infections caused by an endotracheal tube (ETT) biofilm. Eighteen pigs were intubated with ETTs colonized by Pseudomonas aeruginosa biofilm. Pigs were positioned in LTP and randomized to be on mechanical ventilatin (MV) up to 24 hour, 48 hour, 48 hour with acute lung injury (ALI) by oleic acid and 72 hour. Bacteriologic and microscopy studies confirmed presence of biofilm within the ETT. Upon autopsy, samples from the proximal and distal airways were excised for P.aeruginosa quantification. Ventilator-associated tracheobronchitis (VAT) was confirmed by bronchial tissue culture ≥3 log colony forming units per gram (cfu/g). In pulmonary lobes with gross findings of pneumonia, ventilator-associated pneumonia (VAP) was confirmed by lung tissue culture ≥3 log cfu/g. P.aeruginosa colonized the internal lumen of 16 out of 18 ETTs (88.89%), and a mature biofilm was consistently present. P.aeruginosa colonization did not differ among groups, and was found in 23.6% of samples from the proximal airways, and in 7.1% from the distal bronchi (P = 0.001). Animals of the 24 hour group never developed respiratory infections, whereas 20%, 60% and 25% of the animals in group 48 hour, 48 hour-ALI and 72 hour developed P.aeruginosa VAT, respectively (P = 0.327). Nevertheless, VAP never developed. Our findings imply that during the course of invasive MV up to 72 hour, an ETT P.aeruginosa biofilm hastily colonizes the respiratory tract. Yet, the LTP compartmentalizes colonization and infection within the proximal airways and VAP never develops.

  20. Comparison of LMA CTrach and Video Laryngoscope in Endotracheal Intubation

    Science.gov (United States)

    Gümüş, Nevzat; Dilek, Ahmet; Ülger, Fatma; Köksal, Ersin; Çetinoğlu, Erhan Çetin; Özkan, Fatih; Güldoğuş, Fuat

    2014-01-01

    Objective In this study, our objective was to compare the Cormack and Lehane (C-L) sight scores of direct laryngoscopy in endotracheal intubation with the endoscopic sight scores of the LMA CTrach and video laryngoscope. We also compared the success of endoscopy with the LMA CTrach and video laryngoscopy, intubation time, and its effects on haemodynamic and stress responses. Methods The study included 100 patients, with American Society of Anesthesiologists (ASA) scores I–III and aged 18–65, who will undergo elective surgery. Patients were randomly divided into two groups: Group C and Group V. The patients in both groups underwent direct laryngoscopy with a Macintosh laryngoscope, and their C-L scores were recorded. In Group C, the patients were intubated with the LMA CTrach, and in Group V, the patients were intubated with a video laryngoscope. Patients’ haemodynamic parameters, oxygen saturation, end-tidal carbondioxide, and endoscopic sight scores were recorded. Results The demographic characteristics and the ASA classifications of the groups were similar. When endoscopic sight scores were compared with C-L, better sight was obtained in the LMA CTrach group; no significant difference was detected in Group V. Regarding the success of the intubation, no significant difference was detected between groups. However, when intubation times were compared, there was a significant difference between groups. The intubation time was longer in Group C. There was no difference between groups in terms of the percentage changes of haemodynamic parameters, oxygen saturation, and end-tidal carbondioxide values of the patients. Conclusion In this study, when endoscopic sight scores were compared, better visualization was obtained in the LMA CTrach group. Therefore, in cases where intubation is difficult to apply in patients, the LMA CTrach can be an alternative application. PMID:27366431

  1. Tracheal palpation to assess endotracheal tube depth: an exploratory study.

    Science.gov (United States)

    McKay, William P; Klonarakis, Jim; Pelivanov, Vladko; O'Brien, Jennifer M; Plewes, Chris

    2014-03-01

    Correct placement of the endotracheal tube (ETT) occurs when the distal tip is in mid-trachea. This study compares two techniques used to place the ETT at the correct depth during intubation: tracheal palpation vs placement at a fixed depth at the patient's teeth. With approval of the Research Ethics Board, we recruited American Society of Anesthesiologists physical status I-II patients scheduled for elective surgery with tracheal intubation. Clinicians performing the tracheal intubations were asked to "advance the tube slowly once the tip is through the cords". An investigator palpated the patient's trachea with three fingers spread over the trachea from the larynx to the sternal notch. When the ETT tip was felt in the sternal notch, the ETT was immobilized and its position was determined by fibreoptic bronchoscopy. The position of the ETT tip was compared with our hospital standard, which is a depth at the incisors or gums of 23 cm for men and 21 cm for women. The primary outcome was the incidence of correct placement. Correct placement of the ETT was defined as a tip > 2.5 cm from the carina and > 3.5 cm below the vocal cords. Movement of the ETT tip was readily palpable in 77 of 92 patients studied, and bronchoscopy was performed in 85 patients. Placement by tracheal palpation resulted in more correct placements (71 [77%]; 95% confidence interval [CI] 74 to 81) than hospital standard depth at the incisors or gums (57 [61%]; 95% CI 58 to 66) (P = 0.037). The mean (SD) placement of the ETT tip in palpable subjects was 4.1 (1.7) cm above the carina, 1.9 cm (1.5-2.3 cm) below the ideal mid-tracheal position. Tracheal palpation requires no special equipment, takes only a few seconds to perform, and may improve ETT placement at the correct depth. Further studies are warranted.

  2. A Novel Artificial Intelligence System for Endotracheal Intubation.

    Science.gov (United States)

    Carlson, Jestin N; Das, Samarjit; De la Torre, Fernando; Frisch, Adam; Guyette, Francis X; Hodgins, Jessica K; Yealy, Donald M

    2016-01-01

    Adequate visualization of the glottic opening is a key factor to successful endotracheal intubation (ETI); however, few objective tools exist to help guide providers' ETI attempts toward the glottic opening in real-time. Machine learning/artificial intelligence has helped to automate the detection of other visual structures but its utility with ETI is unknown. We sought to test the accuracy of various computer algorithms in identifying the glottic opening, creating a tool that could aid successful intubation. We collected a convenience sample of providers who each performed ETI 10 times on a mannequin using a video laryngoscope (C-MAC, Karl Storz Corp, Tuttlingen, Germany). We recorded each attempt and reviewed one-second time intervals for the presence or absence of the glottic opening. Four different machine learning/artificial intelligence algorithms analyzed each attempt and time point: k-nearest neighbor (KNN), support vector machine (SVM), decision trees, and neural networks (NN). We used half of the videos to train the algorithms and the second half to test the accuracy, sensitivity, and specificity of each algorithm. We enrolled seven providers, three Emergency Medicine attendings, and four paramedic students. From the 70 total recorded laryngoscopic video attempts, we created 2,465 time intervals. The algorithms had the following sensitivity and specificity for detecting the glottic opening: KNN (70%, 90%), SVM (70%, 90%), decision trees (68%, 80%), and NN (72%, 78%). Initial efforts at computer algorithms using artificial intelligence are able to identify the glottic opening with over 80% accuracy. With further refinements, video laryngoscopy has the potential to provide real-time, direction feedback to the provider to help guide successful ETI.

  3. Gold Mine or Minefield: Understanding Russian Law on Vertical Restraints

    Directory of Open Access Journals (Sweden)

    Valentina Rucker

    2014-01-01

    Full Text Available While the Russian Federation represents a significant opportunity for growth, that opportunity is coupled with serious risks. As it relates to managing product distribution, Russian vertical restraint law remains significantly more restrictive than that of the U.S. and, since unless a company is fully integrated, it must manage its distribution system by way of vertical agreements, presents a large problem for businesses seeking to conduct business in Russia. While Russia has made significant steps in the right direction, the lack of consistent application of economic analysis to evaluation of vertical restraints leaves companies exposed. Further, the sometimes inconsistent application of the laws also makes it hard to predict how any particular vertical agreement would be evaluated. Neither American nor Russian antitrust laws establish a list of possible vertical restraints. Thus, there is no exhaustive guidance regarding how these restraints should be treated. U.S. antitrust laws, however, generally place all vertical restraints into one of two categories, intrabrand restraints and interbrand restraints. Intrabrand restraints are those that restrain the downstream firm’s freedom with regard to the resale of the product at issue (distribution restrictions. Interbrand restraints are those that restrict a downstream or upstream firm’s freedom to deal with competitors of the firm imposing the restraint (interbrand restrictions. It should be noted that Russian law does not make this distinction.

  4. Gold Mine or Minefield: Understanding Russian Law on Vertical Restraints

    Directory of Open Access Journals (Sweden)

    Valentina Rucker

    2015-02-01

    Full Text Available While the Russian Federation represents a significant opportunity for growth, that opportunity is coupled with serious risks. As it relates to managing product distribution, Russian vertical restraint law remains significantly more restrictive than that of the U.S. and, since unless a company is fully integrated, it must manage its distribution system by way of vertical agreements, presents a large problem for businesses seeking to conduct business in Russia. While Russia has made significant steps in the right direction, the lack of consistent application of economic analysis to evaluation of vertical restraints leaves companies exposed. Further, the sometimes inconsistent application of the laws also makes it hard to predict how any particular vertical agreement would be evaluated. Neither American nor Russian antitrust laws establish a list of possible vertical restraints. Thus, there is no exhaustive guidance regarding how these restraints should be treated. U.S. antitrust laws, however, generally place all vertical restraints into one of two categories, intrabrand restraints and interbrand restraints. Intrabrand restraints are those that restrain the downstream firm’s freedom with regard to the resale of the product at issue (distribution restrictions. Interbrand restraints are those that restrict a downstream or upstream firm’s freedom to deal with competitors of the firm imposing the restraint (interbrand restrictions. It should be noted that Russian law does not make this distinction.

  5. Loneliness, dysphoria, dietary restraint, and eating behavior.

    Science.gov (United States)

    Rotenberg, K J; Flood, D

    1999-01-01

    The study was designed to examine Herman and Polivy's restrained eating theory (Journal of Abnormal Psychology, 84, 666-672, 1975) using two different methods: situational-experimental and dispositional-correlational. Fifty-eight female college students were administered the revised UCLA Loneliness Scale, the Beck Depression Inventory (Short Form), and the Restraint scale. Subsequently, the students were subjected to either a neutral, sad, or loneliness mood induction and then ate cookies under the pretext of participating in a taste test. Consistent with expectation, dieters tended to consume more food in the loneliness than neutral mood condition, whereas nondieters displayed the opposite pattern. A comparable pattern was found in the relation between the revised UCLA Loneliness Scale and food consumption with respect to Restraint; the amount of food consumed increased as a function of loneliness for high restrained eaters, whereas the amount of food consumed decreased as a function of loneliness for low restrained eaters. There were no appreciable effects of the sad mood induction, nor prediction by dispositional depression, regarding the amount of food consumed as a function of dietary restraint. The findings were discussed with respect to the motivational role that loneliness may play in inhibiting and disinhibiting food consumption.

  6. Dietary restraint and heightened reactivity to food.

    Science.gov (United States)

    Brunstrom, Jeffrey M; Yates, Heather M; Witcomb, Gemma L

    2004-03-01

    Previously, studies have explored the relationship between dietary behavior and salivary reactivity to food. Despite this, it remains unclear which behaviors are associated with enhanced reactivity. One problem is that measures of behavior have not been compared directly. In particular, it is unclear whether elevated reactivity is associated with measures of dietary restraint or with measures of failed dietary control and a tendency to overeat. To address this problem, we compared the association between salivary reactivity and scores on the subscales of the Three-Factor Eating Questionnaire (restraint, disinhibition, and hunger). Estimates of reactivity were derived from the difference between a baseline saliva measure and a similar measure taken in close proximity to hot pizza. Our second aim was to explore how salivary reactivity changes after a meal. Female participants (N=40) were tested before and after a lunch (cheese sandwiches). All tended to show reactivity to pizza before but not after lunch. No significant differences were associated with the disinhibition or hunger subscales. However, prelunch reactivity was significantly greater in those participants with high scores on the restraint scale. This does not appear to be related to reported levels of hunger before lunch. Rather, it may reveal an intrinsic difference between the reaction of restrained and unrestrained eaters to food.

  7. End effector with astronaut foot restraint

    Science.gov (United States)

    Monford, Leo G., Jr. (Inventor)

    1991-01-01

    The combination of a foot restraint platform designed primarily for use by an astronaut being rigidly and permanently attached to an end effector which is suitable for attachment to the manipulator arm of a remote manipulating system is described. The foot restraint platform is attached by a brace to the end effector at a location away from the grappling interface of the end effector. The platform comprises a support plate provided with a pair of stirrups for receiving the toe portion of an astronaut's boots when standing on the platform and a pair of heel retainers in the form of raised members which are fixed to the surface of the platform and located to provide abutment surfaces for abutting engagement with the heels of the astronaut's boots when his toes are in the stirrups. The heel retainers preclude a backward sliding movement of the feet on the platform and instead require a lifting of the heels in order to extract the feet. The brace for attaching the foot restraint platform to the end effector may include a pivot or swivel joint to permit various orientations of the platform with respect to the end effector.

  8. Lateral restraint assembly for reactor core

    Science.gov (United States)

    Gorholt, Wilhelm; Luci, Raymond K.

    1986-01-01

    A restraint assembly for use in restraining lateral movement of a reactor core relative to a reactor vessel wherein a plurality of restraint assemblies are interposed between the reactor core and the reactor vessel in circumferentially spaced relation about the core. Each lateral restraint assembly includes a face plate urged against the outer periphery of the core by a plurality of compression springs which enable radial preloading of outer reflector blocks about the core and resist low-level lateral motion of the core. A fixed radial key member cooperates with each face plate in a manner enabling vertical movement of the face plate relative to the key member but restraining movement of the face plate transverse to the key member in a plane transverse to the center axis of the core. In this manner, the key members which have their axes transverse to or subtending acute angles with the direction of a high energy force tending to move the core laterally relative to the reactor vessel restrain such lateral movement.

  9. The Effect of a Restraint Reduction Program on Physical Restraint Rates in Rehabilitation Settings in Hong Kong

    Science.gov (United States)

    Lai, Claudia K. Y.; Chow, Susan K. Y.; Suen, Lorna K. P.; Wong, Ivan Y. C.

    2011-01-01

    Background. In view of the adverse effects of using restraints, studies examining the use of restraint reduction programs (RRPs) are needed. Objectives. To investigate the effect of an RRP on the reduction of physical restraint rates in rehabilitation hospitals. Methods. A prospective quasi-experimental clinical trial was conducted. Demographic data, medical and health-related information on recruited patients from two rehabilitation hospitals, as well as facility data on restraint rates were collected. Results. The increase in the restraint rate in the control site was 4.3 times greater than that in the intervention site. Changes in the restraint mode, from continuous to intermittent, and the type of restraint used were found between the pre- and postintervention periods in both the control site and the intervention site. Discussion. Compared with that in the control site, the RRP in the intervention site helped arrest any increase in the restraint rate although it had no effect on physical restraint reduction. The shift of restraint mode from continuous to intermittent in the intervention site was one of the positive outcomes of the RRP. PMID:22110972

  10. A comprehensive review of pediatric endotracheal suctioning: Effects, indications, and clinical practice.

    Science.gov (United States)

    Morrow, Brenda M; Argent, Andrew C

    2008-09-01

    To provide a comprehensive, evidence-based review of pediatric endotracheal suctioning: effects, indications, and clinical practice. PubMed, Cumulative Index of Nursing and Allied Health Literature, and PEDro (Physiotherapy Evidence Database) electronic databases were searched for English language articles, published between 1962 and June 2007. Owing to the paucity of objective pediatric data, all reports dealing with this topic were examined, including adult and neonatal studies. One hundred eighteen references were included in the final review. Despite the widespread use of endotracheal suctioning, very little high-level evidence dealing with pediatric endotracheal suctioning exists. Studies of mechanically ventilated neonatal, pediatric, and adult patients have shown that suctioning causes a range of potentially serious complications. Current practice guidelines are not based on evidence from controlled clinical trials. There is no clear evidence that endotracheal suctioning improves respiratory mechanics, with most studies pointing to the detrimental effect it has on lung mechanics. Suctioning should be performed when obstructive secretions are present rather than routinely. There is no clear evidence for the superiority of closed- or open-system suctioning, nor is there clear evidence for appropriate vacuum pressures and suction catheter size. Sterility does not seem to be necessary when suctioning. Preoxygenation has short-term benefits, but the longer-term impact is unknown. Routine saline instillation before suctioning should not be performed. Recruitment maneuvers performed after suctioning have not been shown to be useful as standard practice. Endotracheal suctioning is a procedure used regularly in the pediatric intensive care unit. Despite this, good evidence supporting its practice is limited. Further, controlled clinical studies are needed to develop evidence-based protocols for endotracheal suctioning of infants and children, and to examine the

  11. Staff resistance to restraint reduction: identifying & overcoming barriers.

    Science.gov (United States)

    Curran, Staci Silver

    2007-05-01

    Professional organizations, regulating agencies, and hospital administrators have taken a strong stance on restraint reduction policies. When implementing a restraint reduction initiative, it is important to identify the barriers to restraint reduction, such as concern for personal safety, lack of knowledge about and practice using alternate de-escalation skills, and fear of disrupting the therapeutic milieu by using a variety of de-escalation methods. Education aimed to reduce the use of restraints needs to do more than simply provide information. It is important to acknowledge the emotional response of the nursing staff and the culture of the current practice. A variety of educational strategies, including role-playing, and case studies will help identify attitudes, beliefs, and behaviors that are congruent with reducing the use of restraints. If the ultimate goal of restraint reduction is philosophical change, it will eventually lead to a new culture of practice.

  12. Psychiatric Nurses’ Perceptions about Physical Restraint; A Qualitative Study

    Science.gov (United States)

    Fereidooni Moghadam, Malek; Fallahi Khoshknab, Masoud; Pazargadi, Mehrnoosh

    2014-01-01

    Background: The use of physical restraint as an intervention in the care of psychiatric patients dates back to the beginning of psychiatry. Although it is a challenging question, it is still one of the common procedures in psychiatry. Considering that very little research has been done in Iran in relation to physical restraint, this qualitative study aimed to investigate the experiences of  nurses working in psychiatric wards regarding physical restraint. Methods: This qualitative study was done on 14 nurses working in the psychiatric hospitals of Ahvaz city, southern Iran, during 2011-2012. The participants were selected by purposive sampling. Semi-structured interviews were used for data collection, which were continued until data saturation and emergence of themes. Inductive content analysis was used to analyze the data. Results: Four categories emerged: (1) Restraint as a multi-purpose procedure, (2) Processing of physical restraint, (3) Restraint as a challenging subject and (4) The effects of restraint on the spectrum. Each category has several different sub-categories. Conclusion: The participants described using physical restraint as one of the main strategies to control psychiatric patients, and despite having negative consequences, it is extensively used. Given the risks and challenges of using physical restraint, nursing education should find alternative methods. PMID:25349842

  13. The restraint bias: how the illusion of self-restraint promotes impulsive behavior

    NARCIS (Netherlands)

    Nordgren, L.F.; van Harreveld, F.; van der Pligt, J.

    2009-01-01

    Four studies examined how impulse-control beliefs—beliefs regarding one's ability to regulate visceral impulses, such as hunger, drug craving, and sexual arousal—influence the self-control process. The findings provide evidence for a restraint bias: a tendency for people to overestimate their

  14. Measuring dietary restraint status: Comparisons between the Dietary Intent Scale and the Restraint Scale

    Directory of Open Access Journals (Sweden)

    Jessica A Boyce

    2015-04-01

    Full Text Available The measurement of young women’s self-reported dietary restraint status is complex. Compared to Herman and Polivy’s commonly utilized Restraint Scale (RS, Stice’s Dietary Intent Scale (DIS is less understood. Because the DIS is becoming a popular research tool, it is important to understand how this scale compares to more traditional measures of restraint. We conducted two correlational studies (Study 1 N = 110; Study 2 N = 216 to ascertain the similarities and the differences between the DIS and - as a comparison measure - the well-researched RS. We explored how the two scales were related to several body image variables (e.g., thin-ideal internalization; with a range of self-regulatory variables (e.g., dispositional self-control; with observed food intake during a taste test; and with 18-month weight change (Study 2 only. Participants were female University students and were not selected for dieting or disordered eating. Unlike RS scores, DIS scores were not significantly correlated with the majority of variables tapping into unsuccessful self-regulation. However, our data also highlighted similarities between the two restraint scales (e.g., association with 18-month weight-loss and demonstrated that not only were participants’ DIS scores un-related to unsuccessful self-regulatory variables, neither were they related to the variables tapping into successful self-regulation.

  15. Reducing Restraint With Clozapine in Involuntarily Admitted Patients With Schizophrenia.

    Science.gov (United States)

    Ifteni, Petru; Szalontay, Andreea S; Teodorescu, Andreea

    In the entire world, restraint and seclusion are common interventions in psychiatric inpatient settings because of aggressive behavior. Our objective was to test for the immediate antiaggressive property of clozapine compared with other antipsychotic treatments in an enriched cohort with high rates of restraint during early hospitalization. We present a retrospective chart review in all involuntary admissions with schizophrenia during 2011-2014 in Psychiatry and Neurology Hospital, Brasov, Romania. Timing and number of restraints in addition to clinical, demographic, and treatment characteristics were extracted. Based on our earlier observation of clinical efficacy of early, fast titration of clozapine, we tested the hypothesis that clozapine treatment was associated with reduced use of restraint and with longer restraint-free periods. In 115 consecutive patients with schizophrenia (age = 39.7 ± 11.1 years; male = 59%) involuntarily admitted because of externalized (74.7%) or self-directed violence (25.2%), restraint was used in 89.6%; with a median duration of 3 hours until restraint past admission. Antipsychotics used immediately after hospitalization included haloperidol (70.4%), clozapine (11.3%), olanzapine (10.4%), and other second-generation antipsychotics (7.9%). Comparison of restraint characteristics favored immediate clozapine use with highly reduced rates of restraint (23% vs. 95.6%; P < 0.001) and significantly extended hours until restraint [(118, 24, 426 hours) vs. (3, 0.25, 48 hours); median; 25th, 75th percentile; P < 0.001] relative to the remaining cohort. These effects remained highly significant after controlling for potential moderators of restraint use in multivariate models. These retrospective data suggest an early antiaggressive effect of clozapine during the immediate use of clozapine in highly problematic patients.

  16. Restraint Use in Older Adults Receiving Home Care.

    Science.gov (United States)

    Scheepmans, Kristien; Dierckx de Casterlé, Bernadette; Paquay, Louis; Van Gansbeke, Hendrik; Milisen, Koen

    2017-08-01

    To determine the prevalence, types, frequency, and duration of restraint use in older adults receiving home nursing care and to determine factors involved in the decision-making process for restraint use and application. Cross-sectional survey of restraint use in older adults receiving home care completed by primary care nurses. Homes of older adults receiving care from a home nursing organization in Belgium. Randomized sample of older adults receiving home care (N = 6,397; mean age 80.6; 66.8% female). For each participant, nurses completed an investigator-constructed and -validated questionnaire collecting information demographic, clinical, and behavioral characteristics and aspects of restraint use. A broad definition of restraint was used that includes a range of restrictive actions. Restraints were used in 24.7% of the participants, mostly on a daily basis (85%) and often for a long period (54.5%, 24 h/d). The most common reason for restraint use was safety (50.2%). Other reasons were that the individual wanted to remain at home longer, which necessitated the use of restraints (18.2%) and to provide respite for the informal caregiver (8.6%). The latter played an important role in the decision and application process. The physician was less involved in the process. In 64.5% of cases, there was no evaluation after restraint use was initiated. Use of restraints is common in older adults receiving home care nursing in Belgium. These results contribute to a better understanding of the complexity of use of restraints in home care, a situation that may be even more complex than in nursing homes and acute hospital settings. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  17. SUPRAGLOTTIC JET VENTILATION VERSUS CONVENTIONAL ENDOTRACHEAL VENTILATION IN MINOR LARYNGEAL SURGERIES

    Directory of Open Access Journals (Sweden)

    Illendual Upendranath

    2016-08-01

    Full Text Available Any attempt at intubation will cause many cardiovascular responses and the major concern during this time is to attenuate the same. Similar response is seen during procedures on Larynx in microlaryngeal surgery which produces an intense cardiovascular stimulation during suspension laryngoscopy and intubation. AIM OF STUDY Supraglottic jet ventilation versus conventional endotracheal ventilation in minor laryngeal surgeries. To evaluate the haemodynamic response in supraglottic jet ventilation and conventional intubation in minor laryngeal surgeries. METHODS Patients were randomised to 2 Groups: 30 patients in each group; Group A - in whom supraglottic jet ventilation was planned and Group B - in whom endotracheal intubation was planned. RESULT The haemodynamic response in terms of increase in MAP and HR is significantly more with endotracheal intubation than with supraglottic jet ventilation. CONCLUSION Our study showed that supraglottic jet ventilation showed a better haemodynamic stability when compared to conventional endotracheal intubation in patients undergoing minor laryngeal surgeries. Statistical scores were also in favour of the patients treated with supraglottic jet ventilation based on the p values.

  18. Retrospective study shows that doxapram therapy avoided the need for endotracheal intubation in most premature neonates

    NARCIS (Netherlands)

    Flint, R.B.; Halbmeijer, N.; Meesters, N.; Rosmalen, J. van; Reiss, I.; Dijk, M.; Simons, S.

    2017-01-01

    AIM: Using doxapram to treat neonates with apnoea of prematurity might avoid the need for endotracheal intubation and invasive ventilation. We studied whether doxapram prevented the need for intubation and identified the predictors of the success. METHODS: This was a retrospective study of preterm

  19. Endotracheal temperature and humidity measurements in laryngectomized patients: intra- and inter-patient variability

    NARCIS (Netherlands)

    Scheenstra, R.J.; Muller, S.H.; Vincent, A.; Sinaasappel, M.; Zuur, J.K.; Hilgers, F.J.M.

    2009-01-01

    This study assesses intra- and inter-patient variability in endotracheal climate (temperature and humidity) and effects of heat and moister exchangers (HME) in 16 laryngectomized individuals, measured repeatedly (N = 47). Inhalation Breath Length (IBL) was 1.35 s without HME and 1.05 s with HME (P <

  20. Use and care of an endotracheal/ tracheostomy tube cuff — are ...

    African Journals Online (AJOL)

    Enrique

    Otolaryngology. 3rd ed. Philadelphia: WB Saunders, 1991: 2391-2397. 2. Ferdinande P, Kim DO. Prevention of postintubation laryngotracheal stenosis. Acta Otorhinolaryngol Belg 1995; 49: 341-346. 3. Guyton DC, Barlow MR, Besselievre TR. Influence of airway pressure on mini- mum occlusive endotracheal tube cuff ...

  1. [A case of endotracheal intubation in prone position utilizing PENTAX-Airwayscope for morbidly obese patient].

    Science.gov (United States)

    Suzuki, Hiroto; Nakajima, Waka; Aoyagi, Mitsuo; Takahashi, Minori; Kuzuta, Toshimichi; Osaki, Mami

    2012-04-01

    We experienced the airway management of a morbidly obese patient in prone position utilizing PENTAX-Airwayscope (AWS) which is a novel airway device for endotracheal intubation. A 29-year-old man, who was 150 kg in weight and 51.9 kg x m(-2) in body mass index, was scheduled for the discectomy for lumbar disc herniation. After the topical anesthesia with lidocaine spray, the patient lay on his stomach by himself on the table. Following the induction of general anesthesia with ketamine and dexmedetomidine in prone position, an anatomically curved blade (INTLOCK) was inserted to his oral cavity first, then the body of AWS was attached. With the patient breathing spontaneously, we successfully inserted the reinforced endotracheal tube. After the maintenance of anesthesia with continuous infusion of dexmedetomidine, ketamin and remifentanil, the patient awoke clearly without pain and endotracheal tube was removed safely in the prone position. Although the prone position is not the standard position for endotracheal intubation under general anesthesia, our technique could be performed in emergency situations.

  2. Silver-coated endotracheal tubes for prevention of ventilator-associated pneumonia in critically ill patients

    NARCIS (Netherlands)

    Tokmaji, George; Vermeulen, Hester; Müller, Marcella C. A.; Kwakman, Paulus H. S.; Schultz, Marcus J.; Zaat, Sebastian A. J.

    2015-01-01

    Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections in intubated and mechanically ventilated patients. Endotracheal tubes (ETTs) appear to be an independent risk factor for VAP. Silver-coated ETTs slowly release silver cations. It is these silver ions that appear to

  3. Capnography rapidly confirmed correct endotracheal tube placement during resuscitation of extremely low birthweight babies (< 1000 g).

    Science.gov (United States)

    Salthe, J; Kristiansen, S M; Sollid, S; Oglaend, B; Søreide, E

    2006-09-01

    During neonatal resuscitation, the routine use of capnography to verify correct placement of the endotracheal tube is not an established international practice. We present four cases that illustrate the successful use of immediate capnography to verify correct tracheal tube placement even in extremely low birthweight (ELBW) prematures (babies.

  4. Obstruction of endotracheal tube with relevant respiratory acidosis during pediatric cardiac surgery

    NARCIS (Netherlands)

    Morei, N.M.; Mungroop, H. E.; Michielon, Guido; Scheeren, Thomas

    2014-01-01

    We describe a case of pediatric cardiac surgery in a 21- days old baby, in whom a nasal endotracheal tube (ETT) was inserted. At the end of surgery both ventilatory pressures and end-tidal CO2 increased suggesting airway obstruction. Suctioning of the ETT lumen did not relieve the problem, only ETT

  5. Comparative evaluation of intraocular pressure changes subsequent to insertion of laryngeal mask airway and endotracheal tube.

    Directory of Open Access Journals (Sweden)

    Ghai B

    2001-07-01

    Full Text Available AIMS: To evaluate the intraocular pressure and haemodynamic changes subsequent to insertion of laryngeal mask airway and endotracheal tube. SUBJECTS AND METHODS: The study was conducted in 50 adult patients. A standard general anaesthesia was administered to all the patients. After 3 minutes of induction of anaesthesia baseline measurements of heart rate, non-invasive blood pressure and intraocular pressure were taken following which patients were divided into two groups: laryngeal mask airway was inserted in group 1 and tracheal tube in group 2. These measurements were repeated at 15-30 second, every minute thereafter up to 5 minutes after airway instrumentation. RESULTS: A statistically significant rise in heart rate, systolic blood pressure, diastolic blood pressure and intraocular pressure was seen in both the groups subsequent to insertion of laryngeal mask airway or endotracheal tube. Mean maximum increase was statistically more after endotracheal intubation than after laryngeal mask airway insertion. The duration of statistically significant pressure responses was also longer after endotracheal intubation. CONCLUSION: Laryngeal mask airway is an acceptable alternative technique for ocular surgeries, offering advantages in terms of intraocular pressure and cardiovascular stability compared to tracheal intubation.

  6. Distribution of endotracheally instilled surfactant protein SP-C in lung-lavaged rabbits.

    NARCIS (Netherlands)

    Bambang Oetomo, Sidarto; de Leij, Louis; Curstedt, T; ter Haar, J G; Schoots, Coenraad; Wildevuur, Charles; Okken, Albert

    In lung-lavaged surfactant-deficient rabbits (n = 6) requiring artificial ventilation, porcine surfactant was instilled endotracheally. This resulted in improvement of lung function so that the animals could be weaned off artificial ventilation. The animals were killed 4 1/2 h after surfactant

  7. Endotracheal temperature and humidity measurements in laryngectomized patients: intra- and inter-patient variability

    NARCIS (Netherlands)

    Scheenstra, R. J.; Muller, S. H.; Vincent, A.; Sinaasappel, M.; Zuur, J. K.; Hilgers, Frans J. M.

    2009-01-01

    This study assesses intra- and inter-patient variability in endotracheal climate (temperature and humidity) and effects of heat and moister exchangers (HME) in 16 laryngectomized individuals, measured repeatedly (N = 47). Inhalation Breath Length (IBL) was 1.35 s without HME and 1.05 s with HME (P

  8. Measurement of respiratory impedance by impulse oscillometry--effects of endotracheal tubes.

    Science.gov (United States)

    Kuhnle, G E; Brandt, T; Roth, U; Goetz, A E; Smith, H J; Peter, K

    2000-12-01

    Impulse Oscillometry is a new, noninvasive method to measure respiratory impedance, i.e. airway resistance and reactance at different oscillation frequencies. These parameters are potentially useful for the monitoring of respiratory mechanics in the critically ill patent with respiratory dysfunction. The endotracheal tube, used to mechanically ventilate these patients, however, represents an additional nonlinear impedance that introduces artifacts into the measurements. The objective of this work was therefore to investigate the effects of clinically available endotracheal tubes on resistance and reactance of an in vitro analogue of the respiratory system. Additionally, the effects of decreasing the compressible gas volume in this experimental model, as a simulation of decreased lung capacity and compliance, was investigated. Impulse oscillometric measurements of the test analogue gave highly reproducible results with and without an endotracheal tube. The tubes had significant influence on the measurement of the test object at all frequencies investigated. Changes of low frequent reactance were negligible - at least if repetitive measurements of the same system are performed - for realistic measurement of airway resistance, a correction of the tube impedance or measurement of the pressure distal of the tube is required. Resistance increased and low frequent reactance decreased significantly with decreasing gas volume. These changes were of magnitudes higher than the variations due to the introduction of the endotracheal tubes. Our results suggest that changes of respiratory reactance measured with impulse oscillometry may be used as a monitoring parameter in intubated patients.

  9. Verification of endotracheal intubation in obese patients - temporal comparison of ultrasound vs. auscultation and capnography

    DEFF Research Database (Denmark)

    Pfeiffer, P; Bache, Stefan Holst; Isbye, D L

    2012-01-01

    Ultrasound (US) may have an emerging role as an adjunct in verification of endotracheal intubation. Obtaining optimal US images in obese patients is generally regarded more difficult than for other patients. This study compared the time consumption of bilateral lung US with auscultation and capno...

  10. Time limit of apneic anesthesia with intermittent ventilation applied in endotracheal papilloma removal in childhood patients

    Directory of Open Access Journals (Sweden)

    Jun SHI

    2011-09-01

    Full Text Available Objective To evaluate the safety of apneic anesthesia with intermittent ventilation(AAIV employed in endotracheal papilloma removal in childhood patients,and explore the gateway of prolonging the apneic duration,so as to facilitate the endotracheal surgical procedure as safe as possible.Methods Twenty-two children,aged 2-10 years,suffering from endotracheal papilloma without severe heart and lung diseases,were enrolled.After over-ventilation with 100% oxygen,ventilation was stopped by pulling out the endotracheal tube.The time intervals of saturated pulse oxygen(SpO2 declining from 100% down to 95%,90% and 85% were recorded.Heart rate(HR,arterial oxygen pressure(PaO2 and arterial carbon dioxide pressure(PaCO2 were also recorded when SpO2 reached 90%,85% and 80%.Results The time intervals of SpO2 decline from 100% down to 95%,90% and 85% were 202±50s,224±55s and 240±59s,respectively.When SpO2 reached 95%,90% and 85%,the PaO2 was 86±12mmHg,62±12mmHg and 57±11mmHg respectively,while PaCO2 was 56±12mmHg,70±11mmHg and 83±16mmHg respectively.Conclusions Apneic anesthesia with intermittent ventilation can be safely used in the surgery of children with endotracheal papilloma.The time of single apnea may be up to 180-240 seconds under the condition of sufficient oxygenation and proper ventilation.

  11. How effective is tetracaine 4% gel, before a venipuncture, in reducing procedural pain in infants: a randomized double-blind placebo controlled trial

    Directory of Open Access Journals (Sweden)

    Sherlock Rebecca

    2007-02-01

    Full Text Available Abstract Background Procedural pain relief is sub-optimal in neonates. Topical tetracaine provides pain relief in children. Evidence of its efficacy and safety in neonates is limited. The objective of this study was to assess the efficacy and safety of topical tetracaine on the pain response of neonates during a venipuncture. Methods Medically stable infants greater than or equal to 24 weeks gestation, requiring a venipuncture, were included. Following randomization and double blinding, 1.1 g of tetracaine or placebo was applied to the skin for 30 minutes. Participants received oral sucrose if they met local eligibility criteria. The venipuncture was performed according to a standard protocol. A medium effect size in the pain score (corresponding to about 2 point difference in the PIPP score was considered clinically significant, leading to a sample size of 142 infants, with 80% statistical power. Local skin reactions and immediate adverse cardiorespiratory events were noted. The primary outcome, PIPP score at 1 minute, was analysed using an independent Student's t-test. Results One hundred and forty two infants were included, 33 +/- 4 weeks gestation, 2100 +/- 900 grams and 6 +/- 3 days of age. There was almost no difference in PIPP scores at 1 minute between groups (mean difference -0.09; 95% confidence interval [CI]: -1.68 to 1.50; P = . 91. Similarly, there were no differences in PIPP scores during the 2nd, 3rd and 4th minute. Duration of cry did not differ between the groups (median difference, 0; 95% CI, -3 to 0; P = . 84. The majority of infants in both groups received sucrose 24%. Sucrose had a significant effect on the PIPP score, as assessed by an ANOVA model (p = 0.0026. Local skin erythema was observed transiently in 11 infants (7 in the tetracaine and 4 in the placebo group. No serious side effect was observed. Conclusion Tetracaine did not significantly decrease procedural pain in infants undergoing a venipuncture, when used in

  12. Impact of the phlebotomy training based on CLSI/NCCLS H03-a6 - procedures for the collection of diagnostic blood specimens by venipuncture.

    Science.gov (United States)

    Lima-Oliveira, Gabriel; Lippi, Giuseppe; Salvagno, Gian Luca; Montagnana, Martina; Picheth, Geraldo; Guidi, Gian Cesare

    2012-01-01

    The activities involving phlebotomy, a critical task for obtaining diagnostic blood samples, are poorly studied as regards the major sources of errors and the procedures related to laboratory quality control. The aim of this study was to verify the compliance with CLSI documents of clinical laboratories from South America and to assess whether teaching phlebotomists to follow the exact procedure for blood collection by venipuncture from CLSI/NCCLS H03-A6 - Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture might improve the quality of the process. A survey was sent by mail to 3674 laboratories from South America to verify the use of CLSI documents. Thirty skilled phlebotomists were trained with the CLSI H03-A6 document to perform venipuncture procedures for a period of 20 consecutive working days. The overall performances of the phlebotomists were further compared before and after the training program. 2622 from 2781 laboratories that did answer our survey used CLSI documents to standardize their procedures and process. The phlebotomists' training for 20 days before our evaluation completely eliminated non-conformity procedures for: i) incorrect friction of the forearm, during the cleaning of the venipuncture site to ease vein location; ii) incorrect sequence of vacuum tubes collection; and iii) inadequate mixing of the blood in primary vacuum tubes containing anticoagulants or clot activators. Unfortunately the CLSI H03-A6 document does not caution against both unsuitable tourniquet application time (i.e., for more than one minute) and inappropriate request to clench the fist repeatedly. These inadequate procedures were observed for all phlebotomists. We showed that strict observance of the CLSI H03-A6 document can remarkably improve quality, although the various steps for collecting diagnostic blood specimens are not a gold standard, since they may still permit errors. Tourniquet application time and forearm clench should be verified by

  13. Influence of physical restraint on the onset of experimentally induced ...

    African Journals Online (AJOL)

    The role of intermittent repeated physical restraint on the onset of diabetes mellitus (DM) was in-vestigated in this study. The study compared the onset of DM in mice dosed with streptozotocin (STZ), a DM-inducing drug, with immediate subsequent exposure to either physical restraint stress or non- exposure to the stress.

  14. 30 CFR 57.9301 - Dump site restraints.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Dump site restraints. 57.9301 Section 57.9301 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE... § 57.9301 Dump site restraints. Berms, bumper blocks, safety hooks, or similar impeding devices shall...

  15. Use of Restraint in the Psychiatric Setting: Knowledge of Medical ...

    African Journals Online (AJOL)

    Background: Restraint is a widely used method of controlling patient's behaviour throughout the world. However, next to nothing is known about its use in the developing countries. Aims: To assess the knowledge of medical staff of a Nigerian psychiatric hospital concerning the use of restraint. Methods: We administered a ...

  16. Restraint, Detainment, and Seclusion of Students in Public Schools

    Science.gov (United States)

    Tidwell, Deidra Michelle

    2013-01-01

    This study examines how the courts have addressed the restraint, detainment, and seclusion of students in public schools. The study includes an analysis of 100 court cases on the topic of restraint, detainment, and seclusion of students in public schools, which occurred in state and federal jurisdictions, from 1977 to 2012. Cases were examined…

  17. Seclusion and Restraint: Federal Updates and Advocacy Opportunities

    Science.gov (United States)

    Vaillancourt, Kelly; Klotz, Mary Beth

    2012-01-01

    Over the past several years, allegations of abuse and death related to seclusion and restraint, media coverage of these events, subsequent federal investigations, and Congressional hearings about this topic have resulted in increased pressure on Congress to pass legislation to address the use of seclusion and restraint in the school setting.…

  18. 30 CFR 56.9301 - Dump site restraints.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Dump site restraints. 56.9301 Section 56.9301 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE... § 56.9301 Dump site restraints. Berms, bumper blocks, safety hooks, or similar impeding devices shall...

  19. Dietary Restraint Moderates Genetic Risk for Binge Eating

    Science.gov (United States)

    Racine, Sarah E.; Burt, S. Alexandra; Iacono, William G.; McGue, Matt; Klump, Kelly L.

    2010-01-01

    Dietary restraint is a prospective risk factor for the development of binge eating and bulimia nervosa. Although many women engage in dietary restraint, relatively few develop binge eating. Dietary restraint may only increase susceptibility for binge eating in individuals who are at genetic risk. Specifically, dietary restraint may be a behavioral “exposure” factor that activates genetic predispositions for binge eating. We investigated this possibility in 1,678 young adolescent and adult same-sex female twins from the Minnesota Twin Family Study and the Michigan State University Twin Registry. Twin moderation models were used to examine whether levels of dietary restraint moderate genetic and environmental influences on binge eating. Results indicated that genetic and non-shared environmental factors for binge eating increased at higher levels of dietary restraint. Importantly, these effects were present after controlling for age, body mass index, and genetic and environmental overlap among dietary restraint and binge eating. Results suggest that dietary restraint may be most important for individuals at genetic risk for binge eating, and the combination of these factors could enhance individual differences in risk for binge eating. PMID:21171725

  20. Restraint Use in Residential Programs: Why Are Best Practices Ignored?

    Science.gov (United States)

    LeBel, Janice; Huckshorn, Kevin Ann; Caldwell, Beth

    2010-01-01

    Several states and providers have embarked on initiatives to reduce using restraint and seclusion in residential programs. Restraint and seclusion are associated with harm to youth and staff, significant costs, reduced quality of care, and less engagement of youth and families. Successful reduction/prevention strategies have been identified,…

  1. Continuous restraint control systems: safety improvement for various occupants

    NARCIS (Netherlands)

    Laan, E. van der; Jager, B. de; Veldpaus, F.; Steinbuch, M.; Nunen, E. van; Willemsen, D.

    2009-01-01

    Occupant safety can be significantly improved by continuous restraint control systems. These restraint systems adjust their configuration during the impact according to the actual operating conditions, such as occupant size, weight, occupant position, belt usage and crash severity. In this study,

  2. Child restraint system for children in cars - CREST results

    NARCIS (Netherlands)

    Schrooten, M.; Cassan, F.; Trosseille, X.

    2001-01-01

    Child restraint systems (CRS) for cars are intended to protect children in the case of a car accident. Unfortunately their effectiveness is still too low: in the range 30-50% when it would be expected to be much higher. The low effectiveness of child restraint systems can partly be explained for the

  3. Deep venous thrombosis and pulmonary embolism following physical restraint

    DEFF Research Database (Denmark)

    Laursen, S B; Jensen, T N; Bolwig, T

    2005-01-01

    physical restraint may occur in spite of no pre-existing risk factors. Medical guidelines for the prevention of thrombosis following physical restraint are presented. Despite the absence of controlled trials of treatment effectiveness, the catastrophic outcome of DVT and PE warrants early and vigorous......OBJECTIVE: We describe a case of deep venous thrombosis (DVT) and pulmonary embolism (PE) following the use of physical restraint in a patient with a diagnosis of acute delusional psychotic disorder. METHOD: A new case report of DVT and PE associated with prolonged physical restraint is presented....... The literature on physical restraint, DVT, and PE was reviewed using a search of Medline and Psychinfo from 1966 to the present. RESULTS: Four other reported cases of DVT and PE were found in association with physically restrained patients. CONCLUSION: Risk of DVT and PE in association with immobilization during...

  4. A clinical study to evaluate the efficacy of ELA-Max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics cream for pain reduction of venipuncture in children.

    Science.gov (United States)

    Eichenfield, Lawrence F; Funk, Ann; Fallon-Friedlander, Sheila; Cunningham, Bari B

    2002-06-01

    A double-randomized, blinded crossover trial was performed to assess the efficacy of ELA-Max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics (EMLA) for pain relief during pediatric venipuncture procedures. Safety was assessed by evaluation for topical or systemic effects and measurement of serum lidocaine concentrations. A total of 120 children who were scheduled for repeat venipuncture for non-study-related reasons at 2 sites participated in the study. Patients were doubly randomized to treatment regimen (study medication application time of either 30 or 60 minutes) and to the order of application of the topical anesthetics for each venipuncture. The primary outcome measures were the child's rating of pain immediately after the venipuncture procedures using a 100-mm visual analog scale (VAS) tool and the parent's and blinded research observer's Observed Behavioral Distress scores. Both ELA-Max and EMLA seemed to alleviate venipuncture pain. There was no clinically or statistically significant difference in the patient VAS scores within the 30-minute or 60-minute treatment groups, and there was no clinical or statistical difference in VAS scores between the 30-minute ELA-Max treatment without occlusion and the 60-minute EMLA treatment with occlusion. There were no clinically or statistically significant differences between treatment with ELA-Max and EMLA in parental or blinded researcher Observed Behavioral Distress scores, the most frequent response at any observation time being "no distress." This study demonstrates that a 30-minute application of ELA-Max without occlusion is as safe and as effective for ameliorating pain associated with venipuncture as a 60-minute application of the prescription product EMLA requiring occlusion.

  5. Multipurpose Crew Restraints for Long Duration Space Flights

    Science.gov (United States)

    Whitmore, Mihriban; Baggerman, Susan; Ortiz, M. R.; Hua, L.; Sinnott, P.; Webb, L.

    2004-01-01

    With permanent human presence onboard the International Space Station (ISS), a crew will be living and working in microgravity, interfacing with their physical environment. Without optimum restraints and mobility aids (R&MA' s), the crewmembers may be handicapped for perfonning some of the on-orbit tasks. In addition to weightlessness, the confined nature of a spacecraft environment results in ergonomic challenges such as limited visibility and access to the activity area and may cause prolonged periods of unnatural postures. Thus, determining the right set of human factors requirements and providing an ergonomically designed environment are crucial to astronauts' well-being and productivity. The purpose of this project is to develop requirements and guidelines, and conceptual designs, for an ergonomically designed multi-purpose crew restraint. In order to achieve this goal, the project would involve development of functional and human factors requirements, design concept prototype development, analytical and computer modeling evaluations of concepts, two sets of micro gravity evaluations and preparation of an implementation plan. It is anticipated that developing functional and design requirements for a multi-purpose restraint would facilitate development of ergonomically designed restraints to accommodate the off-nominal but repetitive tasks, and minimize the performance degradation due to lack of optimum setup for onboard task performance. In addition, development of an ergonomically designed restraint concept prototype would allow verification and validation of the requirements defined. To date, we have identified "unique" tasks and areas of need, determine characteristics of "ideal" restraints, and solicit ideas for restraint and mobility aid concepts. Focus group meetings with representatives from training, safety, crew, human factors, engineering, payload developers, and analog environment representatives were key to assist in the development of a restraint

  6. Effect of applying positive pressure with or without endotracheal suctioning during extubation: a laboratory study.

    Science.gov (United States)

    Andreu, Mauro F; Salvati, Iris G; Donnianni, Mariana C; Ibañez, Belén; Cotignola, Mariana; Bezzi, Marco

    2014-12-01

    During invasive mechanical ventilation, secretions accumulate in the subglottic space; consequently, there is a risk of aspiration of these secretions into the airway during cuff deflation and extubation. To minimize this risk, 2 extubation methods are used. The first consists of introducing a suction catheter into the endotracheal tube (ETT) and the trachea. After initiating suctioning, the cuff is deflated and the ETT is removed together with the suction catheter. The second technique involves applying positive pressure to the ETT using a resuscitation bag. Once the manual breath is delivered, the ETT cuff is deflated and the ETT is removed without suction. The aim of this laboratory study is to determine the existence and magnitude of differences in leak volume during cuff deflation and extubation using various combinations of positive pressure with or without endotracheal suctioning. An ETT connected to a ventilator was placed in a model trachea. Colored water was instilled in the space above the cuff. To measure the leak volume, a collection chamber was attached to the distal end of the model. Nine procedures were defined, based on the delivery of different positive pressure levels with or without endotracheal suctioning during extubation. The volume of leakage, in milliliters, was the unit of analysis. Procedures yielding values lower than 1 mL were assessed by the Friedman test, and a P value of less than .05 was considered significant. Post hoc comparisons were performed with a Wilcoxon test, followed by a Bonferroni correction. The application of CPAP 15, pressure support ventilation (PSV)15/10, and PSV 20/5 produced 0.4, 0.2, and 0.1 mL of leak volume, respectively. Statistically significant differences were found between CPAP 15 and PSV 15/10 (P = .003) and between CPAP 15 and PSV 20/5 (P = .01), but not between PSV 15/10 and PSV 20/5 (P = .30). The addition of suctioning increased leak volume, with statistically significant differences between CPAP 15

  7. Effect of closed endotracheal suction in high-frequency ventilated premature infants measured with electrical impedance tomography

    NARCIS (Netherlands)

    van Veenendaal, M.B.; Miedema, M.; de Jongh, F.H.C.; van der Lee, J.H.; Frerichs, I.; van Kaam, A.H.

    2009-01-01

    Objective: To determine the global and regional changes in lung volume during and after closed endotracheal tube (ETT) suction in high-frequency ventilated preterm infants with respiratory distress syndrome (RDS). Design: Prospective observational clinical study. Setting: Neonatal intensive care

  8. An editor for the generation and customization of geometry restraints.

    Science.gov (United States)

    Moriarty, Nigel W; Draizen, Eli J; Adams, Paul D

    2017-02-01

    Chemical restraints for use in macromolecular structure refinement are produced by a variety of methods, including a number of programs that use chemical information to generate the required bond, angle, dihedral, chiral and planar restraints. These programs help to automate the process and therefore minimize the errors that could otherwise occur if it were performed manually. Furthermore, restraint-dictionary generation programs can incorporate chemical and other prior knowledge to provide reasonable choices of types and values. However, the use of restraints to define the geometry of a molecule is an approximation introduced with efficiency in mind. The representation of a bond as a parabolic function is a convenience and does not reflect the true variability in even the simplest of molecules. Another complicating factor is the interplay of the molecule with other parts of the macromolecular model. Finally, difficult situations arise from molecules with rare or unusual moieties that may not have their conformational space fully explored. These factors give rise to the need for an interactive editor for WYSIWYG interactions with the restraints and molecule. Restraints Editor, Especially Ligands (REEL) is a graphical user interface for simple and error-free editing along with additional features to provide greater control of the restraint dictionaries in macromolecular refinement.

  9. Psychiatric Nurses' Attitude and Practice toward Physical Restraint.

    Science.gov (United States)

    Mahmoud, Amal Sobhy

    2017-02-01

    This study was to assess psychiatric nurses' attitude and practice toward physical restraint among mentally ill patients. A descriptive research design was used to achieve the study objective. The present study was carried out in three specialized governmental mental hospitals and two psychiatric wards in general hospital. A convenient purposive sample of 96 nurses who were working in the previously mentioned setting was included. The tool used for data collection was the Self-Administered Structured Questionnaire; it included three parts: The first comprised items concerned with demographic characteristics of the nurses, the second comprised 10 item measuring nurses' attitudes toward physical restraint, and the third was used to assess nurses' practices regarding use of physical restraint. There were insignificant differences between attitudes and practices in relation to nurses' sex, level of education, years of experience and work place. Moreover, a positive significant correlation was found between nurses' total attitude scores, and practices regarding use of physical restraint. Psychiatric nurses have positive attitude and adequate practice toward using physical restraints as an alternative management for psychiatric patients. It is important for psychiatric nurses to acknowledge that physical restraints should be implemented as the last resort. The study recommended that it is important for psychiatric nurses to acknowledge that physical restraints should be implemented as the last resort. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Physical Restraint of People with Intellectual Disability: A Review of Implementation Reduction and Elimination Procedures

    Science.gov (United States)

    Luiselli, James K.

    2009-01-01

    Background: This review describes procedures to reduce and eliminate physical restraint of people with intellectual disability. One approach is to assess antecedent conditions associated with restraint and change them so that they no longer produce restraint-provoking behaviour. A second approach is to decrease the duration of restraint by…

  11. 42 CFR 483.358 - Orders for the use of restraint or seclusion.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Orders for the use of restraint or seclusion. 483... FACILITIES Condition of Participation for the Use of Restraint or Seclusion in Psychiatric Residential... for the use of restraint or seclusion. (a) Orders for restraint or seclusion must be by a physician...

  12. 32 CFR 884.3 - Placing member under restraint pending delivery.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Placing member under restraint pending delivery... member under restraint pending delivery. Continue restraint only as long as is reasonably necessary to... cause exists and whether a reasonable belief exists that restraint is necessary, the commander should...

  13. 28 CFR 552.24 - Use of four-point restraints.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Use of four-point restraints. 552.24... CUSTODY Use of Force and Application of Restraints on Inmates § 552.24 Use of four-point restraints. When the Warden determines that four-point restraints are the only means available to obtain and maintain...

  14. Restraints in daily care for people with moderate intellectual disabilities.

    Science.gov (United States)

    Van der Meulen, Anne Pier S; Hermsen, Maaike A; Embregts, Petri Jcm

    2018-02-01

    Self-determination is an important factor in improving the quality of life of people with moderate intellectual disabilities. A focus on self-determination implies that restraints on the freedom of people with intellectual disabilities should be decreased. In addition, according to the Dutch Care and Coercion bill, regular restraints of freedom, such as restrictions on choice of food or whom to visit, should be discouraged. Such restraints are only allowed if there is the threat of serious harm for the clients or their surroundings. What do support staff consider as restraints on freedom and how do they justify these restraints? In this study, data were collected by semi-structured interviews. Participants and research context: Fifteen support staff working with clients with moderate intellectual disabilities were interviewed. All participants work within the same organisation for people with intellectual disabilities in the Eastern part of the Netherlands. Ethical considerations: The study was conducted according to good scientific inquiry guidelines and ethical approval was obtained from a university ethics committee. Most restraints of freedom were found to be centred around the basic elements in the life of the client, such as eating, drinking and sleeping. In justifying these restraints, support staff said that it was necessary to give clarity in what clients are supposed to do, to structure their life and to keep them from danger. In the justification of restraints of freedom two ethical viewpoints, a principle-guided approach and an ethics of care approach, are opposing one other. Here, the self-determination theory can be helpful, while it combines the autonomy of the client, relatedness to others and the client's competence. Despite the reasonable grounds support staff gave for restraining, it raises the question whether restraints of freedom are always in the interest of the client.

  15. Taser use in restraint-related deaths.

    Science.gov (United States)

    Strote, Jared; Range Hutson, H

    2006-01-01

    The Taser is an electric weapon capable of releasing significant amounts of electricity in rapid pulses, causing uncontrollable muscle contraction. Use of this weapon has dramatically increased over the past decade, and it is now commonly used by law enforcement officers nationwide. Emergency medical services providers are, likewise, seeing more patients who have recently been subjected to application of a Taser. We examined the autopsy reports of patients who died after application of a Taser in an attempt to identify high-risk interactions. This is a case series of Taser-related deaths. Fatalities occurring over four years beginning in January 2001 were identified through an Internet search, and autopsy reports were requested. Reports were analyzed for patient demographics, preexisting cardiac disease, toxicology, evidence of excited delirium, restraint techniques used, and listed cause of death. Of 75 cases identified, 37 (49.3%) had autopsy reports available for review. All cases involved men, with ages ranging from 18 to 50 years. Cardiovascular disease was found in 54.1%. Illegal substance use was found on toxicology screening for 78.4%; within that group, 86.2% were found to have been using stimulants. A diagnosis of excited delirium was given for 75.7% of the cases. Use of a Taser was considered a potential or contributory cause of death in 27%. This is the largest review of Taser-related fatalities reported in the medical literature. The findings are consistent with prior studies, suggesting a high frequency of restraint-related and excited delirium-related fatalities.

  16. Intrathoracic Endotracheal Metastasis from Nasopharyngeal Carcinoma:A First Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Heming Lu

    2010-05-01

    Full Text Available Intrathoracic endotracheal metastasis from a very distant site is extremely rare. We report the first case of such a disease in a 68-year-old man with nasopharyngeal carcinoma who presented with a cough and hemoptysis 34 months after finishing radiotherapy. Prior to tracheal metastasis, he developed a solitary metastasis in the lung and underwent chemotherapy followed by radiotherapy. Computed tomography showed the presence of an enlarged lymph node in the para-aortic arch. Fiberoptic bronchoscopy revealed an endotracheal tumor 1 cm above the carina. Histological and immunohistochemical analyses confirmed its nasopharyngeal origin. He was treated with conventional radiotherapy and three-dimensional conformal radiotherapy; complete tumor remission was achieved. He died of nonmalignant disease with no signs of tumor recurrence 2 years after treatment completion. Radiotherapy may be an appropriate management approach to achieve long-term tumor control for this disease.

  17. Audit of Endotracheal Tube Suction in a Pediatric Intensive Care Unit.

    Science.gov (United States)

    Davies, Kylie; Bulsara, Max K; Ramelet, Anne-Sylvie; Monterosso, Leanne

    2017-02-01

    We report outcomes of a clinical audit examining criteria used in clinical practice to rationalize endotracheal tube (ETT) suction, and the extent these matched criteria in the Endotracheal Suction Assessment Tool(ESAT)©. A retrospective audit of patient notes ( N = 292) and analyses of criteria documented by pediatric intensive care nurses to rationalize ETT suction were undertaken. The median number of documented respiratory and ventilation status criteria per ETT suction event that matched the ESAT© criteria was 2 [Interquartile Range (IQR) 1-6]. All criteria listed within the ESAT© were documented within the reviewed notes. A direct link was established between criteria used for current clinical practice of ETT suction and the ESAT©. The ESAT©, therefore, reflects documented clinical decision making and could be used as both a clinical and educational guide for inexperienced pediatric critical care nurses. Modification to the ESAT © requires "preparation for extubation" to be added.

  18. Comparison of an Endotracheal Cardiac Output Monitor to a Pulmonary Artery Catheter

    Science.gov (United States)

    2017-12-04

    Medicine, San Antonio Military Medical Center, San Antonio, TX, 3CREST Program, Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX 4University of...of a FDA approved device , the CONMED endotracheal cardiac output monitor (ECOM) ™ apparatus, by comparing it to the Edwards Vig ilance II monitor...3.1) suggested 8 an imals would be sufficient for comparisons. After induction of anesthesia, instrumentation, and stabilization in experiment 1

  19. Endotracheal intubation without the use of muscle relaxants in patients with myasthenia gravis

    OpenAIRE

    Vlajković Gordana; Sinđelić Radomir; Marković Dejan; Terzić Milica; Bumbaširević Vesna

    2009-01-01

    Introduction. Although muscle relaxants have been widely used to facilitate endotracheal intubation, the administration of these drugs in myasthenic patients may be associated with adverse events. Material and methods. After obtaining Institutional Reviewing Board approval and informed, patient consent, 30 patients with myasthenia gravis were enrolled in a prospective, double-blind, randomized clinical trial. We compared intubating conditions (ease of laryngoscopy, vocal cords, cough, jaw rel...

  20. Comparison of the Macintosh and Airtraq Laryngoscopes in Endotracheal Intubation Success

    Science.gov (United States)

    Ertürk, Tuna; Deniz, Süleyman; Şimşek, Fatih; Purtuloğlu, Tarık; Kurt, Ercan

    2015-01-01

    Objective Endotracheal intubation of patients is an effective method for controlling airway and breathing. However, laryngoscopy and endotracheal intubation is not easy in every case. There is a recent abundance of equipment used for controlling ventilation and intubation. Airtraq is one of those equipments. In this study, our main objective is to compare the success rates of the Airtraq and Macintosh (direct and classic) laryngoscopes in endotracheal intubation. Methods In this single-center, prospective, randomized, clinical study was performed on 80 patients who were operated under general anesthesia, ASA I–II, 18–65 years old. Patients were intubated using two different endotracheal intubation tools. Group A was intubated using the Macintosh (direct and classic) laryngoscope, meanwhile Group B was intubated using the Airtraq laryngoscope. Patients’ snoring complaints, modified Mallampati scores, sternomental distances, thyromental distances, interincisor distance measurements and Cormack-Lehane (C-L) laryngoscopic classification, upper lip bite test results, intubation time, number of intubation attempts, maneuvers and techniques used for facilitating intubation and complications arising from intubation were recorded. Results There was a statistically significant difference between the groups in terms of C-L scores (p=0.041). In all, 8 patients in the Macintosh group, and 2 patients in the Airtraq group were C-L grade III. In intubation of the Airtraq group, only 3 patients required facilitating techniques, meanwhile in intubation of the Macintosh group 15 patients we had to use one or more facilitating maneuver. The rate of Mallampati scoring “difficult” was 4/6 in the Macintosh and 2/11 in Airtraq laryngoscopy groups (p=0.553). Conclusion In cases with seemingly difficult intubations, we believe the Airtraq laryngoscope has an advantage over the Macintosh laryngoscope, owing to its better view of the oropharyngeal and glottic areas in addition to

  1. Intrathoracic Endotracheal Metastasis from Nasopharyngeal Carcinoma: A First Case Report and Review of the Literature

    OpenAIRE

    Lu, Heming; Chen, Jiaxin; Xie, Yanyan; Cheng, Jinjian; Hao, Yanrong; Peng, Luxing; Pang, Qiang; Deng, Shan; Gu, Junzhao; Qin, Jian; Lu, Zhiping

    2010-01-01

    Intrathoracic endotracheal metastasis from a very distant site is extremely rare. We report the first case of such a disease in a 68-year-old man with nasopharyngeal carcinoma who presented with a cough and hemoptysis 34 months after finishing radiotherapy. Prior to tracheal metastasis, he developed a solitary metastasis in the lung and underwent chemotherapy followed by radiotherapy. Computed tomography showed the presence of an enlarged lymph node in the para-aortic arch. Fiberoptic broncho...

  2. Intensive care unit patients' experience of being conscious during endotracheal intubation and mechanical ventilation.

    Science.gov (United States)

    Holm, Anna; Dreyer, Pia

    2017-03-01

    There is a change in paradigm in intensive care units with trends towards lighter sedation. Light or no sedation protocols are, however, a radical change for clinical practice and can cause challenges for the patients. Undergoing mechanical ventilation when conscious can be a distressing experience for the patients. Receiving a tracheostomy increases patient comfort, but some patients still undergo prolonged endotracheal intubation during mechanical ventilation. The experience of being conscious during endotracheal intubation and mechanical ventilation in the intensive care unit has not previously been described. The aim of the study was to explore adult intensive care unit patients' experience of being conscious during endotracheal intubation and mechanical ventilation. Data collection was performed through semi-structured interviews and four patients were enrolled. Data were collected at two multidisciplinary intensive care units in Denmark. Data were analysed using Ricoeur's theory of interpretation, using the method described by Dreyer and Pedersen. The scientific tradition was phenomenological-hermeneutic. During the analysis, three themes emerged: (1) The tube in the throat. (2) To be conscious but feeling doped. (3) When passing of time is dragging on. The findings shed a light over the experience of being conscious during endotracheal intubation and mechanical ventilation in the intensive care unit. A no-sedation protocol may cause problems for the patients both of a physical and an existential character, but despite this, patients seem positive towards being conscious. The study suggests that clinical nursing practice may have to be further developed to accommodate the patients' needs, e.g. communicating and participating as well as optimizing nursing interventions towards thirst, pain and tube management. Furthermore, the intensive care unit setting may need revision, providing space for the patient and sensory meaningful inputs in the technologically

  3. Effectiveness of the endotracheal tube cuff on the trachea: physical and mechanical aspects

    Science.gov (United States)

    Negro, Maira Soliani Del; Barreto, Gilson; Antonelli, Raíssa Quaiatti; Baldasso, Tiago Antônio; de Meirelles, Luciana Rodrigues; Moreira, Marcos Mello; Tincani, Alfio José

    2014-01-01

    Introduction The inflation pressure of the endotracheal tube cuff can cause ischemia of the tracheal mucosa at high pressures; thus, it can cause important tracheal morbidity and tracheal microaspiration of the oropharyngeal secretion, or it can even cause pneumonia associated with mechanical ventilation if the pressure of the cuff is insufficient. Objective In order to investigate the effectiveness of the RUSCH® 7.5 mm endotracheal tube cuff, this study was designed to investigate the physical and mechanical aspects of the cuff in contact with the trachea. Methods For this end, we developed an in vitro experimental model to assess the flow of dye (methylene blue) by the inflated cuff on the wall of the artificial material. We also designed an in vivo study with 12 Large White pigs under endotracheal intubation. We instilled the same dye in the oral cavity of the animals, and we analyzed the presence or not of leakage in the trachea after the region of the cuff after their deaths (animal sacrifice). All cuffs were inflated at the pressure of 30 cmH2O. Results We observed the passage of fluids through the cuff in all in vitro and in vivo experimental models. Conclusion We conclude that, as well as several other cuff models in the literature, the RUSCH® 7.5 mm tube cuffs are also not able to completely seal the trachea and thus prevent aspiration of oropharyngeal secretions. Other prevention measures should be taken. PMID:25714208

  4. Restraint use in acute and critical care settings: changing practice.

    Science.gov (United States)

    Martin, Beth

    2002-05-01

    Reduction of physical restraint use in the acute and critical care setting is a complex issue. Ethical considerations, regulatory and professional standards, legal liability concerns, healthcare team members' knowledge and attitudes, and unit culture and practice traditions must all be considered. Restraint reduction programs may use a process improvement format that engages the support of the organization's leadership. Specific interventions for restraint reduction, such as understanding the meaning of a patient's behavior, using a team approach, and involving the family can be evaluated and modified for application in the acute and critical care setting. Successful initiatives to decrease the use of restraint in this setting require an understanding of the many factors that support and oppose this practice.

  5. Child restraint use survey : LATCH use and misuse

    Science.gov (United States)

    2006-12-01

    NHTSA conducted a survey from April to October 2005 to collect information about the types of restraint systems that were being used to keep children safe while riding in passenger vehicles. In particular, NHTSA was interested in whether drivers with...

  6. Restraint system usage in the traffic population. 1984 annual report

    Science.gov (United States)

    1985-03-01

    This report presents findings from four independent studies on occupant restraint use for various segments of the traffic population. Field observations, collected in 19 U.S. cities from January through December, 1984, are the basis for this report. ...

  7. Restraint use (seat belt and child passenger seat) survey

    Science.gov (United States)

    2008-12-01

    In Arizona, lack of restraint usage (seat belts and child passenger seats) was a contributing factor to an average of 687 fatalities per year which is nearly 60% of total fatalities. These tragic statistics could be dramatically decreased if effectiv...

  8. Restraint system usage in the traffic population. 1986 annual report

    Science.gov (United States)

    1987-03-01

    This report presents findings from four independent studies on occupant restraint use for various segments of the traffic population. Field observations, collected in 19 U.S. cities from January through December, 1986, are the basis for this report. ...

  9. Restraint of the Automobile in American Residential Neighborhoods

    Science.gov (United States)

    1978-04-01

    Two techniques for restraining the use of the automobile have recently become popular in the United States: residential parking permit programs and traffic restraint devices. While both the these approaches are aimed at restraining the use of the aut...

  10. Restraint system usage in the traffic population. 1985 annual report

    Science.gov (United States)

    1986-05-01

    This report presents findings from four independen studies on occupant restraint use for various segments of the traffic population. Field observations, collected in 19 U.S. cities from January through December 1985, are the basis for this report. Th...

  11. Restraint system usage in the traffic population. 1983 annual report

    Science.gov (United States)

    1984-07-01

    This report presents findings from four independent studies on occupant restraint use for various segments of the traffic population. Field observations, collected in 19 U.S. cities from November, 1982 through December, 1983, are basis for this repor...

  12. Sanctions under GATT article XIX versus voluntary export restraints

    OpenAIRE

    Lang, Franz Peter

    1988-01-01

    Voluntary export restraints play a substantial part in international trade today. This article compares the effects such restraints have upon certain exporting countries with the effect of sanctions applied under Article XIX of the GATT. It is shown that the microeconomic protectionism analysis used as a basis for the current debate on the reform of the GATT is unable to provide a conclusive answer as to which variant of protectionism would be preferable from the exporting economies' point of...

  13. Psychiatric Patients Experiences with Mechanical Restraints: An Interview Study

    Directory of Open Access Journals (Sweden)

    Klas Lanthén

    2015-01-01

    Full Text Available Objective. To examine psychiatric patients’ experience of mechanical restraints and to describe the care the patients received. Background. All around the world, threats and violence perpetrated by patients in psychiatric emergency inpatient units are quite common and are a prevalent factor concerning the application of mechanical restraints, although psychiatric patients’ experiences of mechanical restraints are still moderately unknown. Method. A qualitative design with an inductive approach were used, based on interviews with patients who once been in restraints. Results. This study resulted in an overbridging theme: Physical Presence, Instruction and Composed Behaviour Can Reduce Discontent and Trauma, including five categories. These findings implicated the following: information must be given in a calm and sensitive way, staff must be physically present during the whole procedure, and debriefing after the incident must be conducted. Conclusions. When mechanical restraints were unavoidable, the presence of committed staff during mechanical restraint was important, demonstrating the significance of training acute psychiatric nurses correctly so that their presence is meaningful. Nurses in acute psychiatric settings should be required to be genuinely committed, aware of their actions, and fully present in coercive situations where patients are vulnerable.

  14. Ergonomic Evaluation of the Foot Restraint Equipment Device (FRED)

    Science.gov (United States)

    Whitmore, Mihriban; Chmielewski, Cindy; Qazi, A. S.; Mount, Francis

    1999-01-01

    Within the scope of the Microgravity Workstation and Restraint Evaluation project, funded by the NASA Headquarters Life Sciences Division, evaluations were proposed to be conducted in ground, KC-135, and/or Shuttle environments to investigate the human factors engineering (HFE) issues concerning confined/unique workstations, including crew restraint requirements. As part of these evaluations, KC-135 flights were conducted to investigate user/ workstation/ restraint integration for microgravity use of the FRED with the RMS workstation. This evaluation was a pre-cursor to Detailed Supplementary Objective (DSO) - 904 on STS-88. On that mission, a small-statured astronaut will be using the FRED restraint while working at the Aft RMS workstation. The DSO will collect video for later posture analyses, as well as subjective data in the form of an electronic questionnaire. This report describes the current FRED KC-135 evaluations. The primary objectives were to evaluate the usability of the FRED and to verify the DSO in-flight setup. The restraint interface evaluation consisted of four basic areas of restraint use: 1) adjustability; 2) general usability and comfort; 3) usability at the RMS workstation; and 4) assembly and disassembly.

  15. Ultrasound-guided versus conventional femoral venipuncture for catheter ablation of atrial fibrillation: a multicentre randomized efficacy and safety trial (ULTRA-FAST trial).

    Science.gov (United States)

    Yamagata, Kenichiro; Wichterle, Dan; Roubícek, Tomáš; Jarkovský, Patrik; Sato, Yuriko; Kogure, Takamichi; Peichl, Petr; Konecný, Petr; Jansová, Helena; Kucera, Pavel; Aldhoon, Bashar; Cihák, Robert; Sugimura, Yoichi; Kautzner, Josef

    2017-05-30

    Complications of catheter ablation for atrial fibrillation (AF) are frequently related to vascular access. We hypothesized that ultrasound-guided (USG) venipuncture may facilitate the procedure and reduce complication rates. We conducted a multicentre, randomized trial in patients undergoing catheter ablation for AF on uninterrupted anticoagulation therapy. The study enrolled consecutive 320 patients (age: 63 ± 8 years; male: 62%) and were randomized to USG or conventional venipuncture in 1:1 fashion. It was prematurely terminated due to substantially lower-than-expected complication rates, which doubled the population size needed to maintain statistical power. While the complication rates did not differ between two study arms (0.6% vs. 1.9%, P = 0.62), intra-procedural outcome measures were in favour of the USG approach (puncture time, 288 vs. 369 s, P < 0.001; first pass success, 74% vs. 20%, P < 0.001; extra puncture attempts 0.5 vs. 2.1, P < 0.001; inadvertent arterial puncture 0.07 vs. 0.25, P < 0.001; unsuccessful cannulation 0.6% vs. 14%, P < 0.001). Though these measures varied between trainees (49% of procedures) and expert operators, between-arm differences (except for unsuccessful cannulation) were comparably significant in favour of USG approach for both subgroups. Ultrasound-guided puncture of femoral veins was associated with preferable intra-procedural outcomes, though the major complication rates were not reduced. Both trainees and expert operators benefited from the USG strategy. (www.clinicaltrials.gov ID: NCT02834221).

  16. Obtaining blood cultures by venipuncture versus from central lines: impact on blood culture contamination rates and potential effect on central line-associated bloodstream infection reporting.

    Science.gov (United States)

    Boyce, John M; Nadeau, Jacqueline; Dumigan, Diane; Miller, Debra; Dubowsky, Cindy; Reilly, Lenore; Hannon, Carla V

    2013-10-01

    Reduce the frequency of contaminated blood cultures that meet National Healthcare Safety Network definitions for a central line-associated bloodstream infection (CLABSI). An observational study. A 500-bed university-affiliated hospital. A new blood culture policy discouraged drawing blood samples from central lines. Phlebotomists were reeducated regarding aseptic technique when obtaining blood samples by venipuncture. The intravenous therapy team was taught how to draw blood samples by venipuncture and served as a backup when phlebotomists were unable to obtain blood samples. A 2-nurse protocol and a special supply kit for obtaining blood samples from catheters were developed. Rates of blood culture contamination were monitored by the microbiology laboratory. The proportion of blood samples obtained for culture from central lines decreased from 10.9% during January-June 2010 to 0.4% during July-December 2012 (P cultures that were contaminated decreased from 84 (1.6%) of 5,274 during January-June 2010 to 21 (0.5%) of 4,245 during January-June 2012 (P culture, the reduction in blood culture contaminants yielded an estimated annualized savings of $378,000 in 2012 when compared to 2010. In mid-2010, 3 (30%) of 10 reported CLABSIs were suspected to represent blood culture contamination compared with none of 6 CLABSIs reported from mid-November 2010 through June 2012 (P = 0.25). Multiple interventions resulted in a reduction in blood culture contamination rates and substantial cost savings to the hospital, and they may have reduced the number of reportable CLABSIs.

  17. A randomized controlled trial of sucrose and/or pacifier as analgesia for infants receiving venipuncture in a pediatric emergency department

    Directory of Open Access Journals (Sweden)

    Vandermeer Ben

    2007-07-01

    Full Text Available Abstract Background Although sucrose has been accepted as an effective analgesic agent for procedural pain in neonates, previous studies are largely in the NICU population using the procedure of heel lance. This is the first report of the effect of sucrose, pacifier or the combination thereof for the procedural pain of venipuncture in infants in the pediatric emergency department population. Methods The study design was a double (sucrose and single blind (pacifier, placebo-controlled randomized trial – factorial design carried out in a pediatric emergency department. The study population was infants, aged 0 – 6 months. Eighty-four patients were randomly assigned to one of four groups: a sucrose b sucrose & pacifier c control d control & pacifier. Each child received 2 ml of either 44% sucrose or sterile water, by mouth. The primary outcome measure: FLACC pain scale score change from baseline. Secondary outcome measures: crying time and heart rate change from baseline. Results Sucrose did not significantly reduce the FLACC score, crying time or heart rate. However sub-group analysis revealed that sucrose had a much greater effect in the younger groups. Pacifier use reduced FLACC score (not statistically significant, crying times (statistically significant but not heart rate. Subgroup analysis revealed a mean crying time difference of 76.52 seconds (p 3 months pacifier did not have any significant effect on crying time. Age adjusted regression analysis revealed that both sucrose and pacifier had significant effects on crying time. Crying time increased with both increasing age and increasing gestational age. Conclusion Pacifiers are inexpensive, effective analgesics and are easy to use in the PED for venipuncture in infants aged 0–3 months. The benefits of sucrose alone as an analgesic require further investigation in the older infant, but sucrose does appear to provide additional benefit when used with a pacifier in this age group. Trial

  18. Factors influencing decisions on seclusion and restraint.

    Science.gov (United States)

    Larue, C; Dumais, A; Ahern, E; Bernheim, E; Mailhot, M-P

    2009-06-01

    Seclusion with or without restraint is a measure for managing aggressive or agitated clients and promoting site security, particularly in an emergency psychiatric setting. The decision to control a potentially dangerous person's behaviour by removal or seclusion seems ethically justifiable in such a setting. However, although the decisions on these restrictive measures are based on rational needs, they are also influenced by the healthcare team's perceptions of the client and by the characteristics of the team and the environment. The purpose of this paper is to set out and categorize the factors in play in aggression- and agitation-management situations as perceived by the healthcare teams, particularly the nurses. The first part of the paper deals briefly with the settings in which control measures are applied in a province in eastern Canada and the effect of such measures on patients and healthcare teams. The second part identifies the factors involved in the management of agitation and aggression behaviour. The final part discusses the current spin-offs from this knowledge as well as promising paths for further research on the factors involved. The ultimate objective is to reduce recourse to coercive measures and enhance professional practices.

  19. Microbial investigation of biofilms recovered from endotracheal tubes using sonication in intensive care unit pediatric patients

    Directory of Open Access Journals (Sweden)

    Thiago de Oliveira Ferreira

    Full Text Available Abstract Objectives To compare cultured microorganisms identified on endotracheal tubes biofilms through sonication technique with traditional tracheal aspirate collected at extubation of pediatric intensive care unit patients. Methods Demographic and epidemiological data were analyzed to identify factors possibly related with the microbiological profile of the two collection methods. Associations between categorical and continuous variables were analyzed using the chi-square or Fisher's exact test, or Student's t test. p-Value <0.05 were considered significant. Results Thirty endotracheal tubes and tracheal aspirates samples from 27 subjects were analyzed. Only one patient presented the clinical diagnosis of ventilator-associated pneumonia. Overall, 50% of bacteria were Gram-negative bacilli, followed by Gram-positive bacteria in 37%, and fungi in 10%. No statistically significant difference on the distribution of Gram-positive or Gram-negative bacteria (p = 0.996, and fungi (p = 0.985 were observed between the collection methods. Pseudomonas spp. was the most frequent microorganism identified (23.8%, followed by Streptococcus spp. (18.5%, Acinetobacter spp. (15.9%, coagulase-negative staphylococci (11.2%, and Klebsiella spp. (8.6%. Concordant results between methods amounted to 83.3%. Pseudomonas aeruginosa and Acinetobacter baumannii showed carbapenem resistance in 50% and 43.7% of the isolates, respectively. In general, cultures after endotracheal tubes sonication (non-centrifuged sonication fluid and centrifuged sonication fluid yielded bacteria with higher rates of antimicrobial resistance compared to tracheal aspirates cultures. Additionally, in 12 subjects (40%, we observed discrepancies regarding microbiologic profiles of cultures performed using the collection methods. Conclusions Our study demonstrated that sonication technique can be applied to ET biofilms to identify microorganisms attached to their surface with a great variety of

  20. Low-dose esmolol: hemodynamic response to endotracheal intubation in normotensive patients

    Directory of Open Access Journals (Sweden)

    Suresh Lakshmanappa

    2012-06-01

    Full Text Available Abstract Purpose: Endotracheal intubation is a frequently utilized and highly invasive component of anesthesia that is often accompanied by potentially harmful hemodynamic pressor responses. The purpose of this study was to investigate the efficiency of a single pre-induction 1 mg/kg bolus injection of esmolol for attenuating these hemodynamic responses to endotracheal intubation in normotensive patients. Material and methods: The study was composed of 100 randomly selected male and female patients between the ages of 18 and 60 that were scheduled for elective surgery and belonged to ASA grade I or II. Two minutes prior to intubation the control group received 10 mL of saline (n=50 and the experimental group received an injection of esmolol 1 mg/kg diluted to 10 mL (n=50. Heart rate (HR, systolic blood pressure (SBP, diastolic blood pressure (DBP, mean arterial pressure (MAP, and rate pressure product (RPP were compared to basal values before receiving medication (T-0, during pre-induction (T-1, induction (T-2, intubation (T-3, and post-intubation at 1 (T-4, 3 (T-6, 5 (T-8, and 10 (T-13 minutes. Results: Esmolol significantly attenuated the hemodynamic responses to endotracheal intubation at the majority of measured points. Attenuation of HR (10.8%, SBP (7.04%, DBP (3.99%, MAP (5%, and RPP (16.9% was observed in the esmolol group when compared to the control group values. Conclusions: A single pre-induction 1 mg/kg bolus injection of esmolol successfully attenuated the hemodynamic pressor response in normotensive patients. A significant attenuation of heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure was observed at the majority of measured time points in the esmolol administered group compared to the control group. [J Contemp Med 2012; 2(2.000: 69-76

  1. I-gel as an alternative to endotracheal tube in adult laparoscopic surgeries: A comparative study

    Directory of Open Access Journals (Sweden)

    Jigisha Prahladrai Badheka

    2015-01-01

    Full Text Available Background: The tracheal tube is always considered to be the gold standard for laparoscopic surgeries. As conventional laryngoscopy guided endotracheal intubation evokes significant hypertension and tachycardia, we have used I-gel, second generation extraglottic airway device, in an attempt to overcome these drawbacks. We conducted this study to compare haemodynamic changes during insertion, efficacy of ventilation, and complications with the use of I-gel when compared with endotracheal tube (ETT in laparoscopic surgeries. Materials and Methods: A total of 60 American Society of Anaesthesiologists physical status I and II adult patients undergoing elective laparoscopic surgeries were randomly allocated to one of the two groups of 30 patients each: Group-A (I-gel in which patients airway was secured with appropriate sized I-gel, and Group-B (ETT in which patients airway was secured with laryngoscopy - guided endotracheal intubation. Ease, attempts and time for insertion of airway device, haemodynamic and ventilatory parameters at different time intervals, and attempts for gastric tube insertion, and perioperative complications were recorded. Results: There was significant rise in pulse rate and mean blood pressure during insertion with use of ETT when compared to I-gel. Furthermore, time required for I-gel insertion was significantly less when compared with ETT. However ease and attempts for airway device insertion, attempts for gastric tube insertion and efficacy of ventilation were comparable between two groups. Conclusion: We concluded that I-gel requires less time for insertion with minimal haemodynamic changes when compared to ETT. I-gel also provides adequate positive-pressure ventilation, comparable with ETT. Hence I-gel can be a safe and suitable alternative to ETT for laparoscopic surgeries.

  2. Risks Facing the Retailers and Vertical Restraints

    Directory of Open Access Journals (Sweden)

    Dzagurova Nataliya, B.

    2016-07-01

    Full Text Available Vertical restraints such as exclusive territories may be considered as an alternative to the compensation paid to retailers for taking the risks associated with market shocks. For the first time this approach has been put forward in (Rey and Tirole, 1986. In (Hansen and Motta, 2015 this concept has been further developed, but these authors have come a diametrically opposite result to what Rey & Tirole had reported. The goal of both papers was to compare exclusive territories and retailers’ competition from the point of view of the supplier. In (Rey and Tirole, 1986 the competition was the preferred solution, in (Hansen and Motta, 2015 - the exclusive territories. The explanation of this discrepancy proposed in (Hansen and Motta, 2015 doesn't look convincing enough. The paper proposes a new explanation based on the analysis of the attractiveness of the considered lotteries for the retailers. In (Rey and Tirole, 1986 they were ready to pay for the lottery, but in (Hansen and Motta, 2015 - pretend to get a compensation. Accordingly, in the first case the supplier prefers to allow competition between dealers, in the second - to provide exclusive territories in order to reduce the compensation to be paid to the dealer for participating in the lottery. The paper discusses that the better solution is to consider not the risks associated with market shocks, but the retailers’ risks associated with the so called «cooperative specific investments» (manufacturer can prefer another partner on ex post stage. Trying to support the retailers’ incentives to make cooperative investments, supplier voluntarily redistributes control in favor of retailers.

  3. Endotracheal tube obstruction: a rare complication in laser ablation of recurrent laryngeal papillomas.

    Science.gov (United States)

    Skoulas, Ioannis G; Kountakis, Stilianos E

    2003-07-01

    During the past 25 years, use of the carbon dioxide (CO2) laser has been accepted as the most appropriate surgical method for the treatment of recurrent laryngeal papillomatosis. Although CO2 laser technology and surgical techniques continue to improve, laser-related complications still occur. We describe a case of a very rare complication--to our knowledge, only the second such case reported in the literature--in which an endotracheal tube was almost completely obstructed by a piece of papillomatous tissue during CO2 laser microlaryngoscopy for the treatment of recurrent laryngeal papillomatosis.

  4. [Contact allergy-induced tracheal stenosis caused by vulcanization accelerators in the endotracheal tube?].

    Science.gov (United States)

    Niehaus, H H; Enzmann, H

    1995-07-01

    Tracheal stenoses occur mainly under iatrogenic conditions: they develop specially after long-term intubation, but also after tracheotomy. Etiological-pathogenic relevant factors include the mechanical irritation of mucosa, perichondrium and cartilage in addition to infected tracheal secretions. An allergic cell-mediated reaction in the respiratory tract has been already described. It is seldom recognized. The possibility of such a hyperergic, allergic, delayed reaction (Type IV Coombs-Gell response) with subsequent tracheal stenosis caused by rubber chemicals (accelerators) found in endotracheal tubes is presented in the following case report.

  5. Interventions via Social Influence for Emergent Suboptimal Restraint Use

    Directory of Open Access Journals (Sweden)

    Ziad KOBTI

    2013-08-01

    Full Text Available Although restraint use has increased primarily in developed countries, vehicle accident-related injuries and deaths continue to be a problem. Alongside lack of restraint use, studies involving suboptimal restraint use have gained recent popularity. In this study we investigate the use of social influence forinterventions to counter emerging suboptimal restraint use in groups of agents.A multi-agent simulation model is provided where dominant individuals use randomly assigned influence rates to repeatedly alter the knowledge of lessinfluential group members. Cultural influence is implemented via a cultural algorithm and used to simulate individuals affected by beliefs in the community. Objectives include investigating the emergence of patterns of restraint selection and use as well as interventions targeted at more influential agents. Results demonstrate that prominent patterns of behaviour similar to the influentialmembers of the groups do emerge. Furthermore, interventions targeted at influential group members outperform interventions targeted at a percentage of the population at large. Interventions succeed at some level both in the presence and absence of cultural influence.

  6. Technical communication: design and in vitro testing of a pressure-sensing syringe for endotracheal tube cuffs.

    Science.gov (United States)

    Slocum, Alexander H; Slocum, Alexander H; Spiegel, Joan E

    2012-05-01

    Endotracheal intubation is a frequently performed procedure in the prehospital setting, intensive care unit, and for patients undergoing surgery. The endotracheal tube cuff must be inflated to a pressure that prevents air leaks without compromising tracheal mucosal blood flow. For simultaneous endotracheal tube cuff inflation and measurement, we designed and tested a novel pressure-sensing syringe in vitro. The prototype was developed using a standard 10-mL polycarbonate syringe body that houses a plunger and a silicone rubber bellows, the pressure-sensing element. Bellow feasibility was determined and modeled using finite element analysis. Repeatability testing at each pressure measurement for each bellows (pressure versus deflection) was within an average standard deviation of 0.3 cm to 1.61 cm (1%-5% error). Using an aneroid manometer for comparison, there was excellent linear correlation with a Spearman rank of 0.99 (P < 0.001), up to 30 cm H(2)O.

  7. Endotracheal temperature and humidity in laryngectomized patients in a warm and dry environment and the effect of a heat and moisture exchanger

    NARCIS (Netherlands)

    Scheenstra, R.J.; Muller, S.H.; Hilgers, F.J.M.

    2011-01-01

    Background: This study was designed to assess endotracheal climate in laryngectomized patients in a warm and dry environment and the effects of a heat and moisture exchanger (HME). Methods: Endotracheal temperature and humidity were measured in 11 laryngectomized patients with a regularly used HME

  8. MEASUREMENT OF ENDOTRACHEAL TUBE CUFF PRESSURE IN MECHANICALLYVENTILATED PATIENTS ON ARRIVAL TO INTENSIVE CARE UNIT - A CROSS-SECTIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Arun Kumar Ajjappa

    2017-04-01

    Full Text Available BACKGROUND The monitoring of Endotracheal Tube (ETT cuff pressure in intubated patients on arrival to intensive care unit is very essential. The cuff pressure must be within an optimal range of 20-30cm H2O ensuring ventilation with no complications related to cuff overinflation and underinflation. This can be measured with a cuff pressure manometer. The aim of the study is to measure the endotracheal tube cuff pressure in patients on arrival to intensive care unit and to identify prevalence of endotracheal cuff underinflation and overinflation. MATERIALS AND METHODS A cross-sectional study was done on mechanically-ventilated patients who were intubated in casualty (emergency department on arrival to intensive care unit in S.S. Institute of Medical Sciences and Research Centre, Davangere. About 50 critically-ill patients intubated with a high volume, low pressure endotracheal tube were included in the study. An analogue manometer was used to measure the endotracheal tube cuff pressure. It was compared with the recommended level. The settings of mechanical ventilation, endotracheal tube size and peak airway pressure were recorded. RESULTS It was found that the mean cuff pressure was 64.10 cm of H2O with a standard deviation of 32.049. Of the measured cuff pressures, only 2% had pressures within an optimal range (20-30cm of H2O. 88% had cuff pressures more than 30cm of H2O. The mean peak airway pressure found to be 20.50cm of H2O with a Standard Deviation (SD of 5.064. CONCLUSION This study is done to emphasise the importance of cuff pressure measurement in all mechanically-ventilated patients as cuff pressure is found to be high in most of the patients admitted to intensive care unit. Complications of overinflation and underinflation can only be prevented if the acceptable cuff pressures are achieved.

  9. Effect of habituation on the susceptibility of the rat to restraint ulcers

    Science.gov (United States)

    Martin, M. S.; Martin, F.; Lambert, R.

    1980-01-01

    The frequency and gravity of restraint ulcers were found to significantly diminish in rats previously exposed to brief periods of immobilization. The rats' becoming habituated to restraint conditions probably explains this phenomenon.

  10. Relations between dietary restraint, depressive symptoms, and binge eating; A longitudinal study

    NARCIS (Netherlands)

    Spoor, S.T.P.; Stice, E.; Bekker, M.H.J.; Strien, T. van; Croon, M.A.; Heck, G.L. van

    2006-01-01

    Temporal relations between dietary restraint, depressive symptoms, and binge eating are tested through three competing models that demonstrate the relationship between future binge eating, dietary restraint and depressive symptoms. The pattern of relations and effect sizes suggest that depressive

  11. Comparative modelling by restraint-based conformational sampling

    Directory of Open Access Journals (Sweden)

    Gore Swanand

    2008-01-01

    Full Text Available Abstract Background Although comparative modelling is routinely used to produce three-dimensional models of proteins, very few automated approaches are formulated in a way that allows inclusion of restraints derived from experimental data as well as those from the structures of homologues. Furthermore, proteins are usually described as a single conformer, rather than an ensemble that represents the heterogeneity and inaccuracy of experimentally determined protein structures. Here we address these issues by exploring the application of the restraint-based conformational space search engine, RAPPER, which has previously been developed for rebuilding experimentally defined protein structures and for fitting models to electron density derived from X-ray diffraction analyses. Results A new application of RAPPER for comparative modelling uses positional restraints and knowledge-based sampling to generate models with accuracies comparable to other leading modelling tools. Knowledge-based predictions are based on geometrical features of the homologous templates and rules concerning main-chain and side-chain conformations. By directly changing the restraints derived from available templates we estimate the accuracy limits of the method in comparative modelling. Conclusion The application of RAPPER to comparative modelling provides an effective means of exploring the conformational space available to a target sequence. Enhanced methods for generating positional restraints can greatly improve structure prediction. Generation of an ensemble of solutions that are consistent with both target sequence and knowledge derived from the template structures provides a more appropriate representation of a structural prediction than a single model. By formulating homologous structural information as sets of restraints we can begin to consider how comparative models might be used to inform conformer generation from sparse experimental data.

  12. Endotracheal Intubation Using the Macintosh Laryngoscope or KingVision Video Laryngoscope during Uninterrupted Chest Compression

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    Ewelina Gaszynska

    2014-01-01

    Full Text Available Objective. Advanced airway management, endotracheal intubation (ETI, during CPR is more difficult than, for example, during anesthesia. However, new devices such as video laryngoscopes should help in such circumstances. The aim of this study was to assess the performance of the KingVision video laryngoscopes in a manikin cardiopulmonary resuscitation (CPR scenario. Methods. Thirty students enrolled in the third year of paramedic school took part in the study. The simulated CPR scenario was ETI using the standard laryngoscope with a Macintosh blade (MCL and ETI using the KingVision video laryngoscope performed during uninterrupted chest compressions. The primary endpoints were the time needed for ETI and the success ratio. Results. The mean time required for intubation was similar for both laryngoscopes: 16.6 (SD 5.11, median 15.64, range 7.9–27.9 seconds versus 17.91 (SD 5.6, median 16.28, range 10.6–28.6 seconds for the MCL and KingVision, respectively (P=0.1888. On the first attempt at ETI, the success rate during CPR was comparable between the evaluated laryngoscopes: P=0.9032. Conclusion. The KingVision video laryngoscope proves to be less superior when used for endotracheal intubation during CPR compared to the standard laryngoscope with a Mackintosh blade. This proves true in terms of shortening the time needed for ETI and increasing the success ratio.

  13. Clinical evaluation of propofol as sedative for endotracheal intubation in neonates.

    Science.gov (United States)

    Simons, S H P; van der Lee, R; Reiss, Irwin K M; van Weissenbruch, M M

    2013-11-01

    To determine the effects of propofol for endotracheal intubation in neonates in daily clinical practice. We prospectively studied the pharmacodynamic effects of intravenous propofol administration in neonates who needed endotracheal intubation at the neonatal intensive care unit. Propofol was used for 62 intubations in neonates with postmenstrual ages ranging from 24 + 3 weeks to 44 + 5 weeks and bodyweights ranging from 520 to 4380 g. A 2 mg/kg bodyweight propofol starting dose was sufficient in 37% of patients; additional propofol was needed less often on the first postnatal day. The mean amount of propofol used was 3.3 (±1.2) mg/kg. The success rate of intubation depended on the experience of the physician and was related to the total administered amount of propofol. Hypotension occurred in 39% of patients and occurred more often at the first postnatal day. In 15% of procedures, propofol mono therapy was insufficient. This study shows that high doses of propofol are needed to reach effective sedation in neonates for intubation, with hypotension as a side effect in a considerable percentage of patients. Further research in newborn patients needs to identify optimal propofol doses and risk factors for hypotension. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  14. Differential lung ventilation via tracheostomy using two endotracheal tubes in an infant: a case report.

    Science.gov (United States)

    Demirkol, Demet; Ataman, Yasemin; Gündoğdu, Gökhan

    2017-09-08

    This case report presents differential lung ventilation in an infant. The aim is to define an alternative technique for performing differential lung ventilation in children. To the best of our knowledge, this is the first report of this kind. A 4.2-kg, 2.5-month-old Asian boy was referred to our facility with refractory hypoxemia and hypercarbia due to asymmetric lung disease with atelectasis of the left lung and hyperinflation of the right lung. He was unresponsive to conventional ventilator strategies; different ventilator settings were required. To perform differential lung ventilation, two separate single-lumen endotracheal tubes were inserted into the main bronchus of each lung by tracheotomy; the tracheal tubes were attached to discrete ventilators. The left lung was ventilated with a lung salvage strategy using high-frequency oscillatory ventilation, and the right lung was ventilated with a lung-protective strategy using pressure-regulated volume control mode. Differential lung ventilation was performed successfully with this technique without complications. Differential lung ventilation may be a lifesaving procedure in select patients who have asymmetric lung disease. Inserting two single-lumen endotracheal tubes via tracheotomy for differential lung ventilation can be an effective and safe alternative method.

  15. Intraoperative Atelectasis Due to Endotracheal Tube Cuff Herniation: A Case Report

    Directory of Open Access Journals (Sweden)

    Hossein Madineh

    2012-09-01

    Full Text Available Endotracheal tube (ETT cuff herniation is a rare, and often difficult to diagnose, cause of bronchial obstruction. We present a case of outside cuff herniation of an endotracheal tube that caused pulmonary right lung atelectasis. A 29-year-old man ,a case of car accident with multiple fractures, was admitted to the emergency ward and transferred to the operating room(OR for open reduction and internal fixation (ORIF of all fractures .The procedures were done under general anesthesia (G/A. The past medical history of the patient did not indicate any problem. Anesthesia was induced with thiopental, atracurium and then maintained by propofol and remifentanyl infusions and 100% O2 via orally inserted ETT. The patient was positioned in left lateral decubitus position for operation. Two hours after induction of anesthesia, the oxygen saturation level dropped to 85 % and the breath sounds in the right side of the chest were weakened. The chest x-ray images showed right lung atelectasis especially in the upper lobe. The problem was disappeared after removal of the ETT. In this case, we observed that an ETT cuff herniation can be a cause of airway obstruction. If there is a decreased unilateral breath sounds, we recommend replacement or repositioning of ETT.

  16. [Evaluation of oxygenation, ventilation and respiratory mechanics before and after endotracheal suction in mechanically ventilated children].

    Science.gov (United States)

    Avena, Marta J; de Carvalho, Werther Brunow; Beppu, Oswaldo Shigueomi

    2003-01-01

    The aim of this study was to know the effects of endotracheal suction in respiratory mechanics and oxigenation of patients with mechanical ventilation. 13 children were studied in the pediatric intensive care unit of Hospital São Paulo, age between 47 days and 5 years old, male and female, surgical and clinic pathology, intubated by cuffed endotracheal tube, sedated and paralyzed few minutes before measurements, under previous established suction routine without preventive maneuvers, followed by a continuous monitoring of oxygenation, ventilation and respiratory mechanics under identical ventilatory sets. The parameters analyzed was Heart rate; SpO2; ph arterial; PaO2; PaCO2; SaO2; inspiratory and expiratory tidal volume; minute volume; dynamic compliance, respiratory resistance; mean airway pressure; PEEP and PEEPi., and the measurements were made immediately before suction, immediately after, ten and twenty minutes after suction The results showed that the technique increase the CO2 arterial pressures (PaCO2) even after 20 minutes; decrease the oxygen saturation (SpO2) immediately after the procedure with regular recuperation after 10 minutes and decrease the lung compliance (Cdin.) immediately after with lower recuperation after 10 minutes. We concluded that intratracheal suction in front of compromise of oxygenation, ventilation or respiratory mechanic, applied as minimal as possible under preventive maneuvers. We need more studies to establish the real need of intratracheal suction and a practice guideline of intervention to avoid deleterious effects of that in pediatric patients.

  17. Respiratory pathogen colonization of dental plaque, the lower airways, and endotracheal tube biofilms during mechanical ventilation.

    Science.gov (United States)

    Sands, Kirsty M; Wilson, Melanie J; Lewis, Michael A O; Wise, Matt P; Palmer, Nicki; Hayes, Anthony J; Barnes, Rosemary A; Williams, David W

    2017-02-01

    In mechanically ventilated patients, the endotracheal tube is an essential interface between the patient and ventilator, but inadvertently, it also facilitates the development of ventilator-associated pneumonia (VAP) by subverting pulmonary host defenses. A number of investigations suggest that bacteria colonizing the oral cavity may be important in the etiology of VAP. The present study evaluated microbial changes that occurred in dental plaque and lower airways of 107 critically ill mechanically ventilated patients. Dental plaque and lower airways fluid was collected during the course of mechanical ventilation, with additional samples of dental plaque obtained during the entirety of patients' hospital stay. A "microbial shift" occurred in dental plaque, with colonization by potential VAP pathogens, namely, Staphylococcus aureus and Pseudomonas aeruginosa in 35 patients. Post-extubation analyses revealed that 70% and 55% of patients whose dental plaque included S aureus and P aeruginosa, respectively, reverted back to having a predominantly normal oral microbiota. Respiratory pathogens were also isolated from the lower airways and within the endotracheal tube biofilms. To the best of our knowledge, this is the largest study to date exploring oral microbial changes during both mechanical ventilation and after recovery from critical illness. Based on these findings, it was apparent that during mechanical ventilation, dental plaque represents a source of potential VAP pathogens. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Safety and Efficacy of a Needle-free Powder Lidocaine Delivery System in Pediatric Patients Undergoing Venipuncture or Peripheral Venous Cannulation: Randomized Double-blind COMFORT-004 Trial.

    Science.gov (United States)

    Schmitz, Michael L; Zempsky, William T; Meyer, James M

    2015-08-01

    The goal of this study was to determine if a lidocaine hydrochloride monohydrate powder intradermal system designed to provide cutaneous analgesia is efficacious, safe, and tolerable for pediatric subjects compared with a sham placebo system. COMFORT-004, A Phase III, Randomized, Double-Blind, Placebo-Controlled Study to Confirm the Effectiveness and Safety of ALGRX 3268 in Pediatric Subjects, was a single-dose, parallel group study of children undergoing venipuncture or peripheral venous cannulation at the antecubital fossa or back of the hand. Included were subjects (3-18 years) in 3 age groups: 3-7, 8-12, and 13-18 years. Excluded were those with recent similar procedures or with implantable devices or skin pathologies at the anatomical site, insufficient cognitive skills, or allergies to local anesthetics or adhesives. Subjects were randomized to receive the needle-free powder lidocaine delivery system (active system, 0.5 mg of lidocaine/21 ± 1 bar of pressure [n = 269]) or sham placebo (n = 266) 1-3 minutes before venipuncture or peripheral venous cannulation. Analgesic efficacy was assessed patient self-report of venous access pain (Wong-Baker FACES Pain Rating Scale [3-18 years] and visual analog scale [VAS; 8-18 years]) and parental observational VAS. Safety assessments included adverse events (AEs) and relationship to study treatment. Skin signs and symptoms were graded numerically. Wong-Baker FACES scores, VAS, and parental VAS were analyzed by using an ANOVA model. Responder ratings and success rates were compared by using a Cochran-Mantel-Haenszel test stratified according to center, age group, and body site. The active system group had significantly (P = 0.0022) less pain compared with the sham placebo in all age groups combined according to the modified Wong-Baker FACES scale. Secondary efficacy analyses found that the active system resulted in less pain as assessed by subjects' VAS pain assessments aged 8-18 years (P = 0.1856), responder analysis (P

  19. Service user perspectives on coercion and restraint in mental health.

    Science.gov (United States)

    Rose, Diana; Perry, Emma; Rae, Sarah; Good, Naomi

    2017-08-01

    Coercion remains a central aspect of many people's mental healthcare. It can include the use of legislation to restrict freedoms, the use of physical restraint, the restriction of freedom of movement and/or association, and the forced or covert administration of medication. There is good evidence that the use of such measures can traumatise service users. This article reports the findings of a survey of service users regarding their experiences of coercion and restraint and embeds this in the wider international and institutional environment.

  20. Motion sickness, body movement, and claustrophobia during passive restraint.

    Science.gov (United States)

    Faugloire, Elise; Bonnet, Cédrick T; Riley, Michael A; Bardy, Benoît G; Stoffregen, Thomas A

    2007-03-01

    Standing participants were passively restrained and exposed to oscillating visual motion. Thirty-nine percent of participants reported motion sickness. Despite passive restraint, participants exhibited displacements of the center of pressure, and prior to the onset of motion sickness the evolution of these displacements differed between participants who later became sick and those who did not. Claustrophobia occurred during restraint, but only among participants who became motion sick. The results are consistent with the postural instability theory of motion sickness. We discuss the possible relation between claustrophobia symptoms, postural movements and motion sickness incidence.

  1. 14 CFR 135.128 - Use of safety belts and child restraint systems.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Use of safety belts and child restraint systems. 135.128 Section 135.128 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF.... 213 (49 CFR 571.213)), vest- and harness-type child restraint systems, and lap held child restraints...

  2. 75 FR 68664 - Federal Motor Vehicle Safety Standards; Child Restraint Systems; Booster Seat Effectiveness...

    Science.gov (United States)

    2010-11-08

    ... National Highway Traffic Safety Administration Federal Motor Vehicle Safety Standards; Child Restraint... Standard 213, Child Restraint Systems. The report's title is: Booster Seat ] Effectiveness Estimates Based... standards for child restraint systems, including booster seats, manufactured for use in motor vehicles as...

  3. 49 CFR 579.25 - Reporting requirements for manufacturers of child restraint systems.

    Science.gov (United States)

    2010-10-01

    ... restraint systems. 579.25 Section 579.25 Transportation Other Regulations Relating to Transportation... § 579.25 Reporting requirements for manufacturers of child restraint systems. For each reporting period... introduction in interstate commerce, or imported child restraint systems into the United States, shall submit...

  4. 42 CFR 483.362 - Monitoring of the resident in and immediately after restraint.

    Science.gov (United States)

    2010-10-01

    ... restraint. 483.362 Section 483.362 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... CARE FACILITIES Condition of Participation for the Use of Restraint or Seclusion in Psychiatric....362 Monitoring of the resident in and immediately after restraint. (a) Clinical staff trained in the...

  5. 76 FR 16472 - Consumer Information; Program for Child Restraint Systems; Correction

    Science.gov (United States)

    2011-03-23

    ... National Highway Traffic Safety Administration Consumer Information; Program for Child Restraint Systems... Car Assessment Program, to help caregivers find a child restraint system (``child safety seat'') that... FURTHER INFORMATION CONTACT: For non-legal issues related to the Vehicle-Child Restraint System (CRS) Fit...

  6. Use of Physical Restraints in Dutch Intensive Care Units: A Prospective Multicenter Study

    NARCIS (Netherlands)

    Kooi, A.W. van der; Peelen, L.M.; Raijmakers, R.J.; Vroegop, R.L.; Bakker, D.F.; Tekatli, H.; Boogaard, M.H.W.A. van den; Slooter, A.J.

    2015-01-01

    BACKGROUND: Increasing evidence indicates that harmful effects are associated with the use of physical restraint. OBJECTIVES: To characterize the use of physical restraint in intensive care units. Prevalence, adherence to protocols, and correlates of the use of physical restraint were determined.

  7. The Effects of Non-Contingent Self-Restraint on Self-Injury

    Science.gov (United States)

    Kerth, Denise Marzullo; Progar, Patrick R.; Morales, Sabrina

    2009-01-01

    Background: Self-restraint is a pervasive phenomenon among individuals who engage in self-injurious behaviour (SIB). Materials and Methods: The present study examined the use of clothing as a socially acceptable alternative to self-restraint to reduce SIB and other topographies of self-restraint in an adolescent diagnosed with autism. Two separate…

  8. Effect of blood collection by the push-pull technique from an indwelling catheter versus direct venipuncture on venous blood gas values before and after administration of alfaxalone or propofol in dogs.

    Science.gov (United States)

    Barr, Ciara A; Gianotti, Giacomo; Graffeo, Carly E; Drobatz, Kenneth J; Silverstein, Deborah C

    2017-11-15

    OBJECTIVE To compare the effect of blood collection by a push-pull technique from an indwelling IV catheter versus direct venipuncture on venous blood gas values before and after administration of alfaxalone or propofol to dogs. DESIGN Prospective randomized clinical study. ANIMALS 30 healthy client-owned dogs that weighed ≥ 10 kg (22 lb) and were anesthetized for elective surgical procedures. PROCEDURES All dogs were premedicated with methadone (0.5 mg/kg [0.2 mg/lb], IM), and 20 to 30 minutes later, anesthesia was induced with either alfaxalone (1 to 3 mg/kg [0.5 to 1.4 mg/lb], IV to effect; n = 15) or propofol (2 to 6 mg/kg [0.9 to 2.7 mg/lb], IV to effect; 15). Immediately prior to premedication and after anesthesia induction, paired blood samples were collected from the cephalic veins; 1 by direct venipuncture and 1 by use of a push-pull technique from a 20-gauge catheter. All blood samples underwent venous blood gas analysis immediately after collection. Results were compared between sample collection techniques before and after anesthesia induction and between anesthesia induction protocols. RESULTS All results were within established reference ranges. For many variables, statistically significant but clinically irrelevant differences were detected between samples collected by direct venipuncture and those collected by the push-pull technique but not between the 2 anesthesia induction protocols. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated the push-pull technique was an acceptable method for collection of blood samples from dogs for venous blood gas analysis that could be used instead of direct venipuncture for patients with patent IV catheters.

  9. Endotracheal intubation

    Science.gov (United States)

    ... the esophagus or stomach. Risks include: Bleeding Infection Trauma to the voice box (larynx), thyroid gland, vocal cords and windpipe (trachea), or esophagus Puncture or tearing (perforation) of body parts in the chest cavity, leading to lung collapse

  10. Digital palpation of endotracheal tube tip as a method of confirming endotracheal tube position in neonates: an open-label, three-armed randomized controlled trial.

    Science.gov (United States)

    Saboo, Ashwin R; Dutta, Sourabh; Sodhi, Kushaljit Singh

    2013-10-01

    To compare the malposition rates of endotracheal tubes (ETTs) when the insertional length (IL) is determined by a weight-based nomogram versus when IL is determined by palpation of the ETT tip. Open-label, randomized controlled trial (RCT). Level III neonatal intensive care unit (NICU). All newborn babies admitted in NICU requiring intubation. Subjects were randomly allocated to one of three groups, wherein IL was determined by (i) weight-based nomogram alone, (ii) weight-based nomogram combined with suprasternal palpation of ETT tip performed by specially trained neonatology fellows, or (iii) combination of weight-based and suprasternal methods by personnel not specially trained. Rate of malposition of ETT as judged on chest X-ray (CXR). Fifty seven babies were randomized into group 1(n = 15), group 2 (n = 20), and group 3 (n = 22). The proportion of correct ETT placement was highest in group 2, being 66.7%, 83.3%, and 66.7% in groups 1 through 3, respectively (P value = 0.58). No complication was attributable to palpation technique. Suprasternal palpation shows promise as a simple, safe, and teachable method of confirming ETT position in neonates. © 2013 John Wiley & Sons Ltd.

  11. General endotracheal vs. non-endotracheal regional anesthesia for elective inguinal hernia surgery in very preterm neonates: A single institution experience.

    Science.gov (United States)

    Gurria, Jean; Kuo, Phillip; Kao, Angie; Christensen, Luisa; Holterman, AiXuan

    2017-01-01

    Very pre-term infants (VP) at complications from general endotracheal anesthesia GE during elective inguinal hernia repair. A retrospective cohort study was done to compare pulmonary-related perioperative risks between VP patients undergoing non-emergent inguinal hernia repair prior to NICU discharge under GE (n=58) vs regional anesthesia RA (n=37). Median PMA (RA 26 vs GE 27 weeks), operative weight (RA 2.2 vs GE 2.27 kg), % with BPD, medical and surgical comorbidities, number of concurrent procedures are similar between groups, except for sac laparoscopy (0% RA vs 36% GE). Procedural anesthesia time was 40 minutes for RA vs 69 minutes for GE, (p Oral feeding was fully tolerated in RA (97%) vs GE (72%, p=0.002) by 48h after surgery. The statistical differences hold after regression analysis controlling for sac laparoscopy and procedure time. No difference in intraoperative or postoperative hernia complications is found. RA is safe. RA is associated with early resumption of full feed, avoidance of prolonged mechanical intubation. We recommend a randomized controlled trial comparing the safety and efficacy of GE vs RA in VP infants undergoing elective NICU inguinal hernia repair. II Retrospective study. Copyright © 2017. Published by Elsevier Inc.

  12. Tracheal rupture after intubation and placement of an endotracheal balloon catheter (A-view(R)) in cardiac surgery

    NARCIS (Netherlands)

    Timman, S.T.; Mourisse, J.M.J.; Heide, S.M. van der; Verhagen, A.F.T.M.

    2016-01-01

    The endotracheal balloon catheter (A-view(R)) is a device developed to locate atherosclerotic plaques of the ascending aorta (AA) in cardiac surgery to prevent stroke. The saline-filled balloon is located in the trachea and combines the advantages of transoesophageal echocardiography (e.g. used

  13. Heat and moisture exchange capacity of the upper respiratory tract and the effect of tracheotomy breathing on endotracheal climate

    NARCIS (Netherlands)

    Scheenstra, R.J.; Muller, S.H.; Vincent, A.; Hilgers, F.J.M.

    2011-01-01

    Background. The aim of this study was to assess the heat and moisture exchange (HME) capacity of the upper respiratory tract and the effect of tracheotomy breathing on endotracheal climate in patients with head and neck cancer. Methods. We plotted the subglottic temperature and humidity measurements

  14. HEAT AND MOISTURE EXCHANGE CAPACITY OF THE UPPER RESPIRATORY TRACT AND THE EFFECT OF TRACHEOTOMY BREATHING ON ENDOTRACHEAL CLIMATE

    NARCIS (Netherlands)

    Scheenstra, Renske J.; Muller, Sara H.; Vincent, Andrew; Hilgers, Frans J. M.

    2011-01-01

    Background. The aim of this study was to assess the heat and moisture exchange (HME) capacity of the upper respiratory tract and the effect of tracheotomy breathing on endotracheal climate in patients with head and neck cancer. Methods. We plotted the subglottic temperature and humidity measurements

  15. Effect of closed endotracheal suction in high-frequency ventilated premature infants measured with electrical impedance tomography

    NARCIS (Netherlands)

    van Veenendaal, Mariëtte B.; Miedema, Martijn; de Jongh, Frans H. C.; van der Lee, Johanna H.; Frerichs, Inez; van Kaam, Anton H.

    2009-01-01

    To determine the global and regional changes in lung volume during and after closed endotracheal tube (ETT) suction in high-frequency ventilated preterm infants with respiratory distress syndrome (RDS). Prospective observational clinical study. Neonatal intensive care unit. Eleven non-muscle relaxed

  16. A Comparison of Insertion and Success Rate in the Use of Two Methods of Endotracheal Intubation and Laryngeal Mask Airway

    Directory of Open Access Journals (Sweden)

    Roohollah Farhadloo

    2017-01-01

    Full Text Available Background and Objectives: Providing and making airway is the first known measure that comes to mind at an emergency situation. Laryngeal mask airway (LMA is an alternative for airway management, which its insertion training in beginners and professionals is easier than endotracheal intubation. This study was conducted to compare the speed of insertion and success rate in using two LMA and ETT methods in nursing students. Methods: In this quasi-experimental study, 49 last year nursing students were selected by simple random sampling method. After airway management training course, the students were tested on endotracheal intubation and LMA insertion in a manikin. Data were analyzed using t-test at the p<0.05 significance level. Results: The time for endotracheal intubation was obtained 28.73 s and for LMA was 5.05 s. Also, gender of the students had no significant relationship with airway management (p=0.45. Ninety-eight percent of the student succeeded to insert LMA with no error, but this rate for ETT was just 28%. Conclusion: Given that shorter time, lower error, and ease of insertion of LMA in comparison with the ETT method, use of this method is recommended as an appropriate alternative for endotracheal intubation, especially in emergency situation.

  17. Independent Paramagnetic Restraints Through a Tagged Reporter Protein

    Science.gov (United States)

    Camacho-Zarco, Aldo R.; Munari, Francesca; Wegstroth, Melanie; Liu, Wei-Min; Ubbink, Marcellus; Becker, Stefan; Zweckstetter, Markus

    2017-01-01

    Paramagnetic effects provide structure and dynamics information of biomolecules. We developed a robust method that paramagnetically lightens up high-molecular weight proteins through binding of a reporter protein that carries lanthanide tags at distinct locations. Transmission of several independent molecular alignments provides a multitude of paramagnetic restraints for proteins of unknown 3D structure. PMID:25293958

  18. Restraint stress and social defeat: What they have in common.

    Science.gov (United States)

    Motta, Simone Cristina; Canteras, Newton Sabino

    2015-07-01

    Bob Blanchard was a great inspiration for our studies on the neural basis of social defense. In the present study, we compared the hypothalamic pattern of activation between social defeat and restraint stress. As important stress situations, both defeated and immobilized animals displayed a substantial increase in Fos in the parvicellular part of the paraventricular nucleus,mostly in the region that contains the CRH neurons. In addition, socially defeated animals, but not restrained animals, recruited elements of the medial hypothalamic conspecific-responsive circuit, a region also engaged in other forms of social behavior. Of particular interest, both defeated and immobilized animals presented a robust increase in Fos expression in specific regions of the lateral hypothalamic area (i.e., juxtaparaventricular and juxtadorsomedial regions) likely to convey septo-hippocampal information encoding the environmental boundary restriction observed in both forms of stress, and in the dorsomedial part of the dorsal premammillary nucleus which seems to work as a key player for the expression of, at least, part of the behavioral responses during both restraint and social defeat. These results indicate interesting commonalities between social defeat and restraint stress, suggesting, for the first time, a septo-hippocampal–hypothalamic path likely to respond to the environmental boundary restriction that may act as common stressor component for both types of stress. Moreover, the comparison of the neural circuits mediating physical restraint and social defense revealed a possible path for encoding the entrapment component during social confrontation.

  19. Restraints in daily care for people with moderate intellectual disabilities

    NARCIS (Netherlands)

    van der Meulen, A.P.S.; Hermsen, Maaike; Embregts, P.J.C.M.

    2018-01-01

    Background: Self-determination is an important factor in improving the quality of life of people with moderate intellectual disabilities. A focus on self-determination implies that restraints on the freedom of people with intellectual disabilities should be decreased. In addition, according to the

  20. Child restraint safety practices among Arab children in Israel.

    Science.gov (United States)

    Baron-Epel, Orna; Magid, Avi; Bord, Shiran; Assi, Naseem; Klein, Michal; Levi, Sharon

    2013-01-01

    Because the rate of injury and mortality from car crashes among Arab children is higher than among Jewish children in Israel, this study assesses the patterns of age-appropriate child restraint system (CRS) use in Arab towns in Israel. From October 2010 to September 2011, 4396 children ages 0 to 14 were observed while seated in vehicles in 9 Arab towns and villages in Israel. Among infants aged 0 to 1 year old, 31.2 percent were observed in an age-appropriate restraint, whereas among children aged 1 to 4 years, only 12.4 percent were age-appropriately restrained. Children aged 5 to 9 were observed to have the lowest levels of age-appropriate restraint use (1.3%). The variation between the various villages was large and dependent on the age of the child. The low rates of CRS use may explain to some degree the high rates of injury and mortality of Arab children in car crashes. These low rates indicate that previous interventions have not been successful in increasing restraint use in the Arab community in Israel and there is a need to plan targeted interventions specifically for this population. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.

  1. Patient restrictions: are there ethical alternatives to seclusion and restraint?

    Science.gov (United States)

    Kontio, Raija; Välimäki, Maritta; Putkonen, Hanna; Kuosmanen, Lauri; Scott, Anne; Joffe, Grigori

    2010-01-01

    The use of patient restrictions (e.g. involuntary admission, seclusion, restraint) is a complex ethical dilemma in psychiatric care. The present study explored nurses' (n = 22) and physicians' (n = 5) perceptions of what actually happens when an aggressive behaviour episode occurs on the ward and what alternatives to seclusion and restraint are actually in use as normal standard practice in acute psychiatric care. The data were collected by focus group interviews and analysed by inductive content analysis. The participants believed that the decision-making process for managing patients' aggressive behaviour contains some in-built ethical dilemmas. They thought that patients' subjective perspective received little attention. Nevertheless, the staff proposed and appeared to use a number of alternatives to minimize or replace the use of seclusion and restraint. Medical and nursing staff need to be encouraged and taught to: (1) tune in more deeply to reasons for patients' aggressive behaviour; and (2) use alternatives to seclusion and restraint in order to humanize patient care to a greater extent.

  2. Restraint stress impairs glucose homeostasis through altered insulin ...

    African Journals Online (AJOL)

    The study investigated the potential alteration in the level of insulin and adiponectin, as well as the expression of insulin receptors (INSR) and glucose transporter 4 GLUT-4 in chronic restraint stress rats. Sprague-Dawley rats were randomly divided into two groups: the control group and stress group in which the rats were ...

  3. Safety restraint systems in heavy truck rollover scenarios

    NARCIS (Netherlands)

    Slaats, P.M.A.; Coo, P.J.A. de

    2003-01-01

    Safety restraint systems have been widely applied in the passenger car industry. The heavy truck industry has followed along, integrating the seat belts in the seat system. The effectiveness of seat belts, in particular in rollover scenarios, was studied for a number of heavy truck rollover

  4. The Influence of Restraint Systems on Panel Behavior

    Science.gov (United States)

    Jegley, Dawn C.

    2011-01-01

    When a panel is tested in uniaxial compression in a test machine, the boundary conditions are not quite the same as they would be if it were part of a complete structure. A restraint system may be used to simulate conditions found in a complete vehicle. Quantifying the quality of the restraint with only point-measurement devices can leave an inadequate characterization of the out-of-plane behavior. However, today s full-field displacement monitoring techniques allow for much more accurate views of the global panel deformation and strain, and therefore allow for a better understanding of panel behavior. In the current study, the behavior of a hat-stiffened and two rod-stiffened carbon-epoxy panels is considered. Panels were approximately 2 meters tall and 0.76 to 1.06 m wide. Unloaded edges were supported by knife edges and stiffeners were attached to a support structure at selected locations to restrain out-of-plane motion. A comparison is made between test results based on full-field measurements and analyses based on assumptions of boundary conditions of a completely rigid edge restraint and the absence of any edge restraint. Results indicate that motion at the restrained edges must be considered to obtain accurate test-analysis correlation.

  5. Restraint system usage in the traffic population. 1987 annual report

    Science.gov (United States)

    1988-08-01

    This study continued to monitor the use of occupant restraint systems and motorcycle/moped helmet usage in 19 U.S. cities during 1987. A total of 272,857 observations of automobile drivers indicated an overall driver safety belt usage rate of 42.3 pe...

  6. Ligamentous and capsular restraints to experimental posterior elbow joint dislocation

    DEFF Research Database (Denmark)

    Deutch, Søren R; Olsen, Bo S; Jensen, Steen L

    2003-01-01

    Pathological external forearm rotation (PEFR) relates to posterolateral elbow joint instability, and is considered a possible requisite step in a simple posterior elbow joint dislocation. The aim of this study was to evaluate the capsuloligamentous restraint to PEFR. In all, 18 elbow joint...

  7. The relationship between restraints of trade and garden leave ...

    African Journals Online (AJOL)

    garden leave" clause and a post-termination restraint of trade clause in employment contracts, in view of the decision in Vodacom (Pty) Ltd v Motsa 2016 3 SA 116 (LC). The Labour Court grappled with the question of whether the enforcement of ...

  8. Reward Improves Cancellation and Restraint Inhibition across Childhood and Adolescence

    Science.gov (United States)

    Sinopoli, Katia J.; Schachar, Russell; Dennis, Maureen

    2011-01-01

    Inhibitory control allows for the regulation of thought and action and interacts with motivational variables, such as reward, to modify behavior adaptively as environments change. The authors examined the effects of reward on two distinct forms of inhibitory control, cancellation and restraint. Typically developing children and adolescents…

  9. The Use of Physical Restraint in Norwegian Adult Psychiatric Hospitals

    Directory of Open Access Journals (Sweden)

    Rolf Wynn

    2015-01-01

    Full Text Available Background. The use of coercion within the psychiatric services is problematic and raises a range of ethical, legal, and clinical questions. “Physical restraint” is an emergency procedure used in psychiatric hospitals to control patients that pose an imminent physical danger. We wished to review the literature published in scientific peer-reviewed journals describing studies on the use of physical restraint in Norway, in order to identify the current state of knowledge and directions for future research. Design. The databases PubMed, PsycINFO, CINAHL, Web of Science, and Embase were searched for studies relating to physical restraint (including holding in Norwegian psychiatric hospitals, supplemented with hand searches. Results. 28 studies were included. Most of the studies were on rates of restraint, but there were also some studies on perceptions of patients and staff, case studies, and ethnographic studies. There was only one intervention study. There are differences in use between wards and institutions, which in part may be explained by differences in patient populations. Staff appear to be less negative to the use of restraint than patients. Conclusions. The studies that were identified were primarily concerned with rates of use and with patients’ and staff’s perspectives. More interventional studies are needed to move the field forward.

  10. Child restraint device use and misuse in Michigan

    Science.gov (United States)

    1997-09-01

    In 1994, nearly 87,000 children under the age of five were injured or killed in traffic crashes across the nation, with 2,336 of these injuries and fatalities occurring in Michigan. The use of child restraint devices (CRDs, also called child safety s...

  11. Decreasing Aggression Using Four-Point Restraints and Symbol Programs.

    Science.gov (United States)

    Bluestone, Michael A.

    Physical aggression among institutionalized mentally retarded persons arouses great social concern. To examine the effectiveness of four-point mechanical restraints and a positive adaptive symbol program in the reduction of high frequency, high intensity aggression, three institutionalized severely mentally retarded adolescents (2 females, 1 male)…

  12. Problem definition for pre-crash sensing advanced restraints.

    Science.gov (United States)

    2009-04-01

    This report presents the results of crash analyses that defined and prioritized target crashes for advanced restraint systems based on pre-crash sensors. These analyses targeted the driver and front-seat passenger 13 or older, traveling in light vehi...

  13. The use of restraints in psychiatric patients | Moosa | South African ...

    African Journals Online (AJOL)

    Restraints are usually used for the protection of patients and others when medication and verbal therapies are insufficient to control potentially violent patients. ... There may be differences in cost, risk of serious staff injury, requirements of staff time for monitoring and implementation, and impacts on staff and patient attitudes.

  14. The Cost of Prior Restraint: "U. S. v. The Progressive."

    Science.gov (United States)

    Soloski, John; Dyer, Carolyn Stewart

    Increased litigation and rising litigation costs threaten the future of newspapers and magazines. A case study was conducted to determine the costs and effects of "United States v. 'The Progressive,'" a prior restraint case over the publication in 1979 of an article on the hydrogen bomb. "The Progressive," which operates at a…

  15. Lightwand-Guided Endotracheal Intubation Performed by the Nondominant Hand is Feasible

    Directory of Open Access Journals (Sweden)

    Yi-Wei Kuo

    2007-10-01

    Full Text Available The aim of this study was to evaluate the efficiency of lightwand-guided endotracheal intubation (LWEI performed using either the right (dominant or left (nondominant hand. Two hundred and forty patients aged 21–64 years, with a Mallampati airway classification grade of I—II and undergoing endotracheal intubation under general anesthesia, were enrolled in this randomized and controlled study. Induction of anesthesia was initiated by intravenous administration of fentanyl (2 mg/kg and thiopentone (5mg/kg, and tracheal intubation was facilitated by intravenous atracurium (0.5 mg/kg. In the direct-vision laryngoscope group (group D; n = 80, the intubator held the laryngoscope in the left hand and inserted the endotracheal tube (ETT into the glottic opening with the right hand. In the group in which LWEI was performed with the right hand (group R; n = 80, the intubator lifted the patients' jaws with the left hand and inserted the ETT-LW unit into the glottic openings with the right hand. On the contrary, in the group in which LWEI was performed with the left hand (group L; n = 80, the intubator lifted the jaws with the right hand and inserted the ETT-LW unit with the left hand. Data including total intubation time, the number of intubation attempts, hemodynamic changes during intubation, and side effects following intubation, were collected. Regardless of whether lightwand manipulation was performed with the left hand (group L; 11.4 ± 9.3 s or the right-hand (group R; 12.4 ± 9.2 s, less time was consumed in the LWEI groups than in the laryngoscope group (group D; 17.9 ± 9.9s (p 95% on their first intubation attempts. The changes in mean arterial blood pressure and heart rate were similar among the three groups. A higher incidence of intubation-related oral injury and ventricular premature contractions (VPC was found in group D compared with groups L and R (oral injury: group D 8.5%, group L 1.3%, group R 0%, p = 0.005; VPC: group D 16

  16. Factors associated with swallowing assessment after oral endotracheal intubation and mechanical ventilation for acute lung injury.

    Science.gov (United States)

    Brodsky, Martin B; González-Fernández, Marlís; Mendez-Tellez, Pedro A; Shanholtz, Carl; Palmer, Jeffrey B; Needham, Dale M

    2014-12-01

    Endotracheal intubation is associated with postextubation swallowing dysfunction, but no guidelines exist for postextubation swallowing assessments. We evaluated the prevalence, patient demographic and clinical factors, and intensive care unit (ICU) and hospital organizational factors associated with swallowing assessment after oral endotracheal intubation and mechanical ventilation in patients with acute lung injury (ALI). We performed a secondary analysis of a prospective cohort study in which investigators evaluated 178 eligible patients with ALI who were mechanically ventilated via oral endotracheal tube. The patients were recruited from 13 ICUs at four teaching hospitals in Baltimore, Maryland. Patient demographic and clinical factors, types of ICU, and hospital study sites were evaluated for their association with completion of a swallowing assessment both in the ICU and after the ICU stay before hospital discharge. Factors significantly associated with a swallow assessment were evaluated in a multivariable logistic regression model. Before hospital discharge, 79 (44%) patients completed a swallowing assessment, among whom 59 (75%) had their assessments initiated in ICU and 20 (25%) had their assessments initiated on the hospital ward. Female sex (odds ratio [OR] = 2.01; 95% confidence interval [95% CI] = 1.03-3.97), orotracheal intubation duration (OR = 1.13 per day; 95% CI = 1.05-1.22), and hospital study site (Site 3: OR = 2.41; 95% CI = 1.00-5.78) were independently associated with swallowing assessment. Although Site 3 had a twofold increase in swallowing assessments in the ICU, there was no significant difference between hospitals in the frequency of swallowing assessments completed after ICU discharge (P = 0.287) or in the proportion of patients who failed a swallowing assessment conducted in the ICU (P = 0.468) or on the ward (P = 0.746). In this multisite prospective study, female sex, intubation duration, and

  17. Automatic endotracheal tube position confirmation system based on image classification--a preliminary assessment.

    Science.gov (United States)

    Lederman, Dror; Lampotang, Samsun; Shamir, Micha Y

    2011-10-01

    Endotracheal intubation is a complex medical procedure in which a ventilating tube is inserted into the human trachea. Improper positioning carries potentially fatal consequences and therefore confirmation of correct positioning is mandatory. This paper introduces a novel system for endotracheal tube position confirmation. The proposed system comprises a miniature complementary metal oxide silicon sensor (CMOS) attached to the tip of a semi rigid stylet and connected to a digital signal processor (DSP) with an integrated video acquisition component. Video signals are acquired and processed by a confirmation algorithm implemented on the processor. The confirmation approach is based on video image classification, i.e., identifying desired expected anatomical structures (upper trachea and main bifurcation of the trachea) and undesired structures (esophagus). The desired and undesired images are indicators of correct or incorrect endotracheal tube positioning. The proposed methodology is comprised of a continuous and probabilistic image representation scheme using Gaussian mixture models (GMMs), estimated using a greedy algorithm. A multi-dimensional feature space, which consists of several textural-based features, is utilized to represent the images. The performance of the proposed algorithm was evaluated using two datasets: a dataset of 1600 images extracted from 10 videos recorded during intubations on dead cows, and a dataset of 358 images extracted from 8 videos recorded during intubations performed on human subjects. Each one of the video images was classified by a medical expert into one of three categories: upper tracheal intubation, correct (carina) intubation and esophageal intubation. The results, obtained using a leave-one-case-out method, show that the system correctly classified 1530 out of 1600 (95.6%) of the cow intubations images, and 351 out of the 358 human images (98.0%). Misclassification of an image of the esophagus as carina or upper

  18. Moderation: an alternative to restraint as a mode of weight self-regulation.

    Science.gov (United States)

    Stotland, S

    2012-12-01

    This study considered two types of eating and weight self-regulation, in five groups, including four types of weight controllers and one non-dieting group. New scales were developed to measure eating moderation and restraint. Moderation was largely uncorrelated with restraint in 4 groups and had a fairly strong positive relation in 1 group. The moderation scale was unrelated to the Dutch Eating Behavior Questionnaire (DEBQ) restraint scale and the Three Factor Eating Questionnaire (TFEQ) rigid restraint subscale and weakly positively related to TFEQ flexible restraint. The restraint scale was strongly correlated to the DEBQ restraint scale, and to both flexible and rigid restraint subscales of the TFEQ. Across the five groups, moderation had exclusively positive relationships with attitude, behavior and emotion variables, while restraint had primarily negative relationships. The study supports moderation as a new dimension of weight self-regulation, independent of restraint. The new measures of moderation and restraint can be used together in research on the processes of change in weight management. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. Improved protection for children in forward-facing restraints during side impacts.

    Science.gov (United States)

    Bilston, Lynne E; Brown, Julie; Kelly, Paul

    2005-06-01

    This study aims to determine the potential for improved child occupant protection in side impacts that can be obtained using rigid and semi-rigid anchorage systems and the addition of energy-absorbing padding in the side structures of child restraints. This study uses a comprehensive set of simulated side impacts to evaluate the potential for improved side impact protection in forward-facing child restraints. Factors investigated included methods of anchoring the restraint to the vehicle, energy-absorbing materials in the side structure of restraints, and design features of the restraints such as side wing geometry and seat belt routing. The results show clearly that completely rigid lower attachment of restraints offers the potential for great reductions in head injury risk, which anchorage systems employing a combination of a rigid anchorage bar and webbing attached to a child restraint cannot match. The addition of energy absorbing material in the side structure of restraint systems is effective when the head is fully contained within an adequately designed side wing structure. For restraints anchored by seat belts and loop style semi rigid anchorage straps, belt routing has the potential to significantly affect occupant head excursion. The results suggest that current child restraint standards and consumer testing protocols do not adequately encourage best practice design of child restraints for side impact protection.

  20. Choosing Staff Members Reduces Time in Mechanical Restraint Due to Self-Injurious Behaviour and Requesting Restraint

    Science.gov (United States)

    Jensen, Craig C.; Lydersen, Tore; Johnson, Paul R.; Weiss, Shannon R.; Marconi, Michael R.; Cleave, Mary L.; Weber, Patricia

    2012-01-01

    Background: Using mechanical restraints to protect a person who engaged in dangerous self-injury was decreased by manipulation of an establishing operation involving the client choosing the staff person who would work with her. Materials and Methods: The client was a 28-year-old woman diagnosed with autism, bipolar disorder, static cerebral…

  1. Sensitization of restraint-induced corticosterone secretion after chronic restraint in rats: Involvement of 5-HT7 receptors

    Science.gov (United States)

    García-Iglesias, Brenda B.; Mendoza-Garrido, María E.; Gutiérrez-Ospina, Gabriel; Rangel-Barajas, Claudia; Noyola-Díaz, Martha; Terrón, José A.

    2013-01-01

    Serotonin (5-HT) modulates the hypothalamic-pituitary-adrenal (HPA) axis response to stress. We examined the effect of chronic restraint stress (CRS; 20 min/day) as compared to control (CTRL) conditions for 14 days, on: 1) restraint-induced ACTH and corticosterone (CORT) secretion in rats pretreated with vehicle or SB-656104 (a 5-HT7 receptor antagonist); 2) 5-HT7 receptor-like immunoreactivity (5-HT7-LI) and protein in the hypothalamic paraventricular nucleus (PVN) and adrenal glands (AG); 3) baseline levels of 5-HT and 5-hydroxyindolacetic acid (5-HIAA), and 5-HIAA/5-HT ratio in PVN and AG; and 4) 5-HT-like immunoreactivity (5-HT-LI) in AG and tryptophan hydroxylase (TPH) protein in PVN and AG. On day 15, animals were subdivided into Treatment and No treatment groups. Treatment animals received an i.p. injection of vehicle or SB-656104; No Treatment animals received no injection. Sixty min later, Treatment animals were either decapitated with no further stress (0 min) or submitted to acute restraint (10, 30, 60 or 120 min); hormone serum levels were measured. No Treatment animals were employed for the rest of measurements. CRS decreased body weight gain and increased adrenal weight. In CTRL animals, acute restraint increased ACTH and CORT secretion in a time of restraint-dependent manner; both responses were inhibited by SB-656104. Exposure to CRS abolished ACTH but magnified CORT responses to restraint as compared to CTRL conditions; SB-656104 had no effect on ACTH levels but significantly inhibited sensitized CORT responses. In CTRL animals, 5-HT7-LI was detected in magnocellular and parvocellular subdivisions of PVN and sparsely in adrenal cortex. Exposure to CRS decreased 5-HT7-LI and protein in the PVN, but increased 5-HT7-LI in the adrenal cortex and protein in whole AG. Higher 5-HT and 5-HIAA levels were detected in PVN and AG from CRS animals but 5-HIAA/5-HT ratio increased in AG only. Finally, whereas 5-HT-LI was sparsely observed in the adrenal cortex

  2. A Note regarding Problems with Interaction and Varying Block Sizes in a Comparison of Endotracheal Tubes

    Directory of Open Access Journals (Sweden)

    Richard L. Einsporn

    2014-01-01

    Full Text Available A randomized clinical experiment to compare two types of endotracheal tubes utilized a block design where each of the six participating anesthesiologists performed tube insertions for an equal number of patients for each type of tube. Five anesthesiologists intubated at least three patients with each tube type, but one anesthesiologist intubated only one patient per tube type. Overall, one type of tube outperformed the other on all three effectiveness measures. However, analysis of the data using an interaction model gave conflicting and misleading results, making the tube with the better performance appear to perform worse. This surprising result was caused by the undue influence of the data for the anesthesiologist who intubated only two patients. We therefore urge caution in interpreting results from interaction models with designs containing small blocks.

  3. Studies of Poly(vinyl chloride) Based Endotracheal Tubes From the Microscopic to Macroscopic Scale

    Science.gov (United States)

    Brodie, Kristin; Ortiz, Christine

    2003-03-01

    The endotracheal tube (ET) is a polymeric conduit that forms a closed system of pulmonary ventilation that is most often used to allow delivery of air to critically ill patients via intubation. Currently used ETs cause a wide variety of clinical problems including laryngeal edema (inflammation), severe morbidity, and occasionally death. To investigate the origins of this behavior, mechanical, chemical, morphological, and biocompatibility characterization of injection-molded (Endotrol) tubes of poly(vinyl chloride) (PVC) containing 35 wtplasticizer was conducted. Experiments included fourier-transform infrared spectroscopy, gel permeation chromatography, differential scanning calorimetry, accelerated solvent extraction, uniaxial tensile testing, high-resolution force spectroscopy, atomic force microscopy, and plasticizer leaching. We intend for these studies to form the basis for future ET materials selection and design.

  4. Normative Values and Interrelationship of MDVP Voice Analysis Parameters Before and After Endotracheal Intubation

    DEFF Research Database (Denmark)

    Sørensen, Martin Kryspin; Durck, Tina Trier; Bork, Kristian

    2016-01-01

    PURPOSE: The Multi-Dimensional Voice Program (MDVP) is used for assessment of voice quality. A simple procedure for MDVP recordings was used in a randomized clinical trial (RCT) on induced vocal fold trauma due to intubation. This secondary study compares the common MDVP parameters with other...... normative values for adults and investigates the correlation between these MDVP parameters in relation to the "standardized" trauma of endotracheal intubation. METHODS: Preoperative and postoperative assessments of vocal fold pathology with flexible videolaryngoscopy and voice analysis with MDVP using...... the best-of-three standardized recording were performed in 121 patients with normal voices included consecutively in the RCT. The procedures of anesthesia were standardized. RESULTS: The normative MDVP values of this study are consistently lower compared with most normative values presented in other...

  5. Learning endotracheal intubation using a novel videolaryngoscope improves intubation skills of medical students.

    Science.gov (United States)

    Herbstreit, Frank; Fassbender, Philipp; Haberl, Helge; Kehren, Clemens; Peters, Jürgen

    2011-09-01

    Teaching endotracheal intubation to medical students is a task provided by many academic anesthesia departments. We tested the hypothesis that teaching with a novel videolaryngoscope improves students' intubation skills. We prospectively assessed in medical students (2nd clinical year) intubation skills acquired by intubation attempts in adult anesthetized patients during a 60-hour clinical course using, in a randomized fashion, either a conventional Macintosh blade laryngoscope or a videolaryngoscope (C-MAC®). The latter permits direct laryngoscopy with a Macintosh blade and provides a color image on a video screen. Skills were measured before and after the course in a standardized fashion (METI Emergency Care Simulator) using a conventional laryngoscope. All 1-semester medical students (n = 93) were enrolled. The students' performance did not significantly differ between groups before the course. After the course, students trained with the videolaryngoscope had an intubation success rate on a manikin 19% higher (95% CI 1.1%-35.3%; P students.

  6. Restraint use in older adults in home care: A systematic review.

    Science.gov (United States)

    Scheepmans, Kristien; Dierckx de Casterlé, Bernadette; Paquay, Louis; Milisen, Koen

    2017-11-23

    To get insight into restraint use in older adults receiving home care and, more specifically, into the definition, prevalence and types of restraint, as well as the reasons for restraint use and the people involved in the decision-making process. Systematic review. Four databases (i.e. Pubmed, CINAHL, Embase, Cochrane Library) were systematically searched from inception to end of April 2017. The study encompassed qualitative and quantitative research on restraint use in older adults receiving home care that reported definitions of restraint, prevalence of use, types of restraint, reasons for use or the people involved. We considered publications written in English, French, Dutch and German. One reviewer performed the search and made the initial selection based on titles and abstracts. The final selection was made by two reviewers working independently; they also assessed study quality. We used an integrated design to synthesise the findings. Eight studies were reviewed (one qualitative, seven quantitative) ranging in quality from moderate to high. The review indicated there was no single, clear definition of restraint. The prevalence of restraint use ranged from 5% to 24.7%, with various types of restraint being used. Families played an important role in the decision-making process and application of restraints; general practitioners were less involved. Specific reasons, other than safety for using restraints in home care were noted (e.g. delay to nursing home admission; to provide respite for an informal caregiver). Contrary to the current socio demographical evolutions resulting in an increasing demand of restraint use in home care, research on this subject is still scarce and recent. The limited evidence however points to the challenging complexity and specificity of home care regarding restraint use. Given these serious challenges for clinical practice, more research about restraint use in home care is urgently needed. Copyright © 2017. Published by Elsevier

  7. Temperature monitored on the cuff surface of an endotracheal tube reflects body temperature.

    Science.gov (United States)

    Haugk, Moritz; Stratil, Peter; Sterz, Fritz; Krizanac, Danica; Testori, Christoph; Uray, Thomas; Koller, Julia; Behringer, Wilhelm; Holzer, Michael; Herkner, Harald

    2010-07-01

    When treating patients with cardiac arrest with mild therapeutic hypothermia, a reliable and easy-to-use temperature probe is desirable. This study was conducted to investigate the accuracy and safety of tracheal temperature as a measurement of body temperature. Observational cohort study. Emergency department of a tertiary care university hospital. Patients successfully resuscitated from cardiac arrest intended for mild hypothermia therapy. Intubation was performed with a newly developed endotracheal tube that contains a temperature sensor inside the cuff surface. During the cooling, mild hypothermia maintenance, and rewarming phases, the temperature was recorded minute by minute. These data were compared with the temperature assessed by esophageal and blood temperature probes. Thereafter, tracheoscopy was performed to evaluate the condition of the tracheal mucosa. Approximately 2000 measurements per temperature sensor per patient were recorded in 21 patients. The mean bias between the blood temperature and the tracheal temperature was -0.16 degrees C (limits of agreement: -0.36 degrees C to 0.04 degrees C). The mean bias between the esophageal and tracheal temperatures was -0.22 degrees C (limits of agreement: -0.49 degrees C to 0.07 degrees C). Agreement between temperature probes investigated by the Bland-Altman method showed a mean bias of less than -(1/4) degrees C, and time lags assessed graphically by hysteresis plots were negligible. No clinically relevant injury to the tracheal mucosa was detected. Temperature monitoring at the cuff surface of an endotracheal tube is safe and provides accurate and reliable data in all phases of therapeutically induced mild hypothermia after cardiac arrest.

  8. "COMPARISON OF HEMODYNAMIC CHANGES AFTER INSERTION OF LARYNGEAL MASK AIRWAY, FACEMASK AND ENDOTRACHEAL INTUBATION"

    Directory of Open Access Journals (Sweden)

    K. Montazari

    2004-11-01

    Full Text Available Hemodynamic changes are major hazards of general anesthesia and are probably generated by direct laryngoscopy and endotracheal intubation. We designed this prospective randomised study to assess the cardiovascular changes after either laryngeal mask airway (LMA, face mask (FM or endotracheal tube (ETT insertion in the airway management of adult patients anesthetised with nitrous oxide and halothane. A total of 195 healthy normotensive adult patients with normal airways were randomly assigned to one of the three groups according to their airway management (n= 65 each for transurethral lithotripsy procedures. Heart rate (HR, systolic blood pressure (SBP, diastolic blood pressure (DBP and mean arterial blood pressure (MAP values were recorded before the induction of anesthesia, and then every three minutes until 30 min thereafter. The mean maximum HR and MAP values obtained during 15 and 30 minutes after insertion of LMA were 81±13, 73±8 bpm and 82±14, 79 ±11 mmHg, respectively which were significantly smaller compared to those with FM (84±12, 80±6 bpm and 86±10, 83±13 mmHg and ETT (96±8, 88±7 bpm and 91±11, 82±9 mmHg (P< 0.05. Direct stimulation of the trachea appears to be a major cause of the hemodynamic changes associated with tracheal intubation during general anesthesia, but why hemodynamic changes in LMA were smaller than facemask needs further study. In healthy normotensive patients the use of LMA for the airway management during general anesthesia results in a smaller cardiovascular change than FM and ETT.

  9. Corrosion casting of the subglottis following endotracheal tube intubation injury: a pilot study in Yorkshire piglets

    Science.gov (United States)

    2013-01-01

    Purpose Subglottic stenosis can result from endotracheal tube injury. The mechanism by which this occurs, however, is not well understood. The purpose of this study was to examine the role of angiogenesis, hypoxia and ischemia in subglottic mucosal injury following endotracheal intubation. Methods Six Yorkshire piglets were randomized to either a control group (N=3, ventilated through laryngeal mask airway for corrosion casting) or accelerated subglottic injury group through intubation and induced hypoxia as per a previously described model (N=3). The vasculature of all animals was injected with liquid methyl methacrylate. After polymerization, the surrounding tissue was corroded with potassium hydroxide. The subglottic region was evaluated using scanning electron microscopy looking for angiogenic and hypoxic or degenerative features and groups were compared using Mann–Whitney tests and Friedman’s 2-way ANOVA. Results Animals in the accelerated subglottic injury group had less overall angiogenic features (P=.002) and more overall hypoxic/degenerative features (P=.000) compared with controls. Amongst angiogenic features, there was decreased budding (P=.000) and a trend toward decreased sprouting (P=.037) in the accelerated subglottic injury group with an increase in intussusception (P=.004), possibly representing early attempts at rapid revascularization. Amongst hypoxic/degenerative features, extravasation was the only feature that was significantly higher in the accelerated subglottic injury group (P=.000). Conclusions Subglottic injury due to intubation and hypoxia may lead to decreased angiogenesis and increased blood vessel damage resulting in extravasation of fluid and a decreased propensity toward wound healing in this animal model. PMID:24401165

  10. Endotracheal Intubation Using a Direct Laryngoscope and the Protective Performances of Respirators: A Randomized Trial

    Directory of Open Access Journals (Sweden)

    Taeho Lim

    2017-01-01

    Full Text Available Purpose. Emergency physicians are at risk for infection during invasive procedures, and the respirators can reduce this risk. This study aimed to determine whether endotracheal intubation using direct laryngoscopes affected protection performances of respirators. Methods. A randomized crossover study of 24 emergency physicians was performed. We performed quantitative fit tests using respirators (cup type, fold type without a valve, and fold type with a valve before and during intubation. The primary outcome was respirators’ fit factors (FF, and secondary outcomes were acceptable protection (percentage of scores above 100 FF [FF%]. Results. 24 pieces of data were analyzed. Compared to fold-type respirator without a valve, FF and FF% values were lower when participants wore a cup-type respirator (200 FF [200-200] versus 200 FF [102.75–200], 100% [78.61–100] versus 74.16% [36.1–98.9]; all P<0.05 or fold-type respirator with a valve (200 FF [200-200] versus 142.5 FF [63.50–200], 100% [76.10–100] versus 62.50% [8.13–100]; all P<0.05. There were no significant differences in intubation time and success rate according to respirator types. Conclusions. Motion during endotracheal intubation using direct laryngoscopes influenced the protective performance of some respirators. Therefore, emergency physicians should identify and wear respirators that provide the best personalized fit for intended tasks.

  11. [Efficacy and safety of endotracheal intubation performed in moving vs motionless environments].

    Science.gov (United States)

    Castejón de la Encina, M ª Elena; Sanjuán Quiles, Ángela; Del Moral Vicente-Mazariegos, Ignacio; García Aracil, Noelia; José Alcaide, Lourdes; Richart Martínez, Miguel

    2017-02-01

    To compare the efficacy and safety of endotracheal intubation (ETI) in a simulated clinical environment in motion vs a motionless one. Clinical simulation trial of ETI with 3 endotracheal tubes (Airtraq, Fast-trach, Macintosh laryngoscope) in mannequins with realistic physiological responses (MetiMan) in 2 scenarios: an environment in motion vs a motionless one. Thirty-six physicians expert in prehospital ETI participated. Outcome variables were successful intubation, effective intubation, number of attempts, maximum apnea time, and total maneuver time. The safety variables were the presence of bradycardia, tachycardia, or high or low systolic blood pressures (ie, 20% variation from baseline); hypoxemia (decrease in oxygen saturation to <90% or 10% below baseline), tube placement in the esophagus or main bronchus, and dental trauma. No statistically significant differences between the 2 scenarios were found in the numbers of successful ETI (motionless, 71 [65.7%]; in motion, 67 [62.0%]; P=.277) or effective ETI (motionless, 104 [96.3%]; in motion, 105 [97.2%]; P=.108). Likewise, the number of attempts were similar (motionless, 91 [84.2%]; in motion, 90 [83.3%]; P=.305). Nor did we see differences in the mean (SD) maximum apnea times (motionless, 14.0 [5.6] seconds; in motion, 14.9 [8.1] seconds; P=.570) or mean total maneuver times (motionless, 236.7 [73.4] seconds; in motion, 210.3 [77.9] seconds; P=.164). The prevalences of bradycardia, tachycardia, high or low systolic blood pressure, hypoxemia, placements in the esophagus or bronchus, and dental trauma also did not differ significantly between the 2 scenarios. Neither efficacy nor safety variables differed significantly when ETI was performed in mannequins in a motionless environment vs one simulating ambulances in motion.

  12. Endotracheal Tube Cuff Pressure Assessment: Education May Improve but not Guarantee the Safety of Palpation Technique

    Science.gov (United States)

    Seyed Siamdoust, Seyed Alireza; Mohseni, Masood; Memarian, Arash

    2015-01-01

    Background: Endotracheal Tube Cuff Pressure (ETCP) should be kept in the range of 20 - 30 cm H2O. Earlier studies suggested that ETCP assessment by palpation of pilot balloon results in overinflation or underinflation and subsequent complications such as tracheal wall damage and aspiration. Objectives: The current study aimed to evaluate the effect of an in vitro educational program on the ability of anesthesia personnel to inflate Endotracheal Tube Cuffs (ETT) within safe pressure limits. Patients and Methods: The survey included two series of blinded ETCP measurements in intubated patients before and two weeks after an in vitro educational intervention. The in vitro educational program included two separate trials. The anesthesia personnel were asked to inflate an ETT cuff inserted in a tracheal model using their usual inflation technique. In the same session, six ETTs at different pressure levels were examined by the participants and their estimation of ETCP was recorded. After the in vitro assessment, the participants were informed about the actual pressure of the in vitro ETCPs and were allowed to train their fingers by in vitro pilot balloon palpation with validated manometer measurements. Results: The mean ETCP after the in vitro survey was significantly lower than the mean ETCP before the intervention (45 ± 13 vs. 51 ± 15 cm H2O, P = 0.002). The rate of measurements within the safe pressure limits significantly improved after the in vitro education (24.2% vs. 39.7%, P = 0.002). Conclusions: Implementing educational programs with the introduction of estimation techniques besides the use of manometer as a standard intraoperative monitoring will improve the safety of the practice. PMID:26161313

  13. Understanding Mental Health Service User Experiences of Restraint Through Debriefing: A Qualitative Analysis

    Science.gov (United States)

    Ling, Sara; Cleverley, Kristin; Perivolaris, Athina

    2015-01-01

    Objective: To examine debriefing data to understand experiences before, during, and after a restraint (seclusion, chemical, and physical) event from the perspective of inpatients at a large urban mental health and addiction hospital. Method: Audits were conducted on a purposeful sample of inpatient charts containing post-restraint event inpatient debrief forms (n = 55). Qualitative data from the forms were analyzed thematically. Results: Loss of autonomy and related anger, conflict with staff and other inpatients, and unmet needs were the most common factors precipitating restraint events. Inpatients often reported that increased communication with staff could have prevented restraint. Inpatients described having had various negative emotional states and responses during restraint events, including fear and rejection. Post-restraint, inpatients often desired to leave the unit for fresh air or to engage in leisure activities. Conclusions: To our knowledge, our study is the first to use debriefing form data to explore mental health inpatients’ experiences of restraint. Inpatients view restraint negatively and do not experience it as a therapeutic intervention. Debriefing, guided by a form, is useful for understanding the inpatient’s experience of restraint, and should be used to re-establish the therapeutic relationship and to inform plans of care. In addition, individual and collective inpatient perspectives should inform alternatives to restraint. PMID:26454726

  14. Poor compliance with child safety restraint use while travelling.

    LENUS (Irish Health Repository)

    Fallon, R

    2011-02-01

    Road traffic accidents are a leading cause of death of children. It is the law that all children should be appropriately secured when traveling in vehicles. The aim of this study was to evaluate parental conformity with these regulations and to test if advice given at a Paediatric outpatient clinic could improve compliance. Two groups were assigned, an intervention group (parents given an information leaflet and a clear explanation about appropriate restraints for their children) and a non-intervention group (received no information). They were contacted again after 2 months and asked regarding compliance. A total of 394 children from 186 families were initially given the questionnaire. Nearly one third of children (29.2%) were not using any restraint while travelling rising to 35.3% on follow up. This study concluded that once off parental education made negligible difference to an already inconsistent and haphazard approach to compliance with safety regulations.

  15. Effects of child restraint system features on installation errors.

    Science.gov (United States)

    Klinich, Kathleen D; Manary, Miriam A; Flannagan, Carol A C; Ebert, Sheila M; Malik, Laura A; Green, Paul A; Reed, Matthew P

    2014-03-01

    This study examined how child restraint system (CRS) features contribute to CRS installation errors. Sixteen convertible CRS, selected to include a wide range of features, were used in volunteer testing with 32 subjects. Subjects were recruited based on their education level (high or low) and experience with installing CRS (none or experienced). Each subject was asked to perform four child restraint installations in the right-rear passenger seat of a 2006 Pontiac G6 sedan using a crash dummy as a child surrogate. Each subject installed two CRS forward-facing (FF), one with LATCH and one with the vehicle seatbelt, and two CRS rear-facing (RF), one with LATCH and one with the seatbelt. After each installation, the experimenter evaluated 42 factors for each installation, such as choice of belt routing path, tightness of installation, and harness snugness. Analyses used linear mixed models to identify CRS installation outcomes associated with CRS features. LATCH connector type, LATCH strap adjustor type, and the presence of belt lockoffs were associated with the tightness of the CRS installation. The type of harness shoulder height adjuster was associated with the rate of achieving a snug harness. Correct tether use was associated with the tether storage method. In general, subject assessments of the ease-of-use of CRS features were not highly correlated with the quality of their installation, suggesting a need for feedback with incorrect installations. The data from this study provide quantitative assessments of some CRS features that were associated with reductions in CRS installation errors. These results provide child restraint designers with design guidelines for developing easier-to-use products. Research on providing effective feedback during the child restraint installation process is recommended. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  16. STS-102 Onboard Photograph-The Payload Equipment Restraint System

    Science.gov (United States)

    2001-01-01

    In this Space Shuttle STS-102 mission image, the Payload Equipment Restraint System (PERS) Single-Strap and H-Strap are shown behind astronaut James S. Voss (left) and cosmonaut Yury V. Usachev in the U.S. Laboratory. PERS is an integrated modular system of components designed to assist the crew of the International Space Station (ISS) in restraining and carrying necessary payload equipment and tools in a microgravity environment. The Operations Development Group, Flight Projects Directorate at the Marshall Space Flight Center (MSFC), while providing operation support to the ISS Materials Science Research Facility (MSRF), recognized the need for an on-orbit restraint system to facilitate control of lose objects, payloads, and tools. The PERS is the offspring of that need and it helps the ISS crew manage tools and rack components that would otherwise float away in the near-zero gravity environment aboard the Space Station. The system combines Kevlar straps, mesh pockets, Velcro, and a variety of cornecting devices into a portable, adjustable system. The system includes the Single Strap, the H-Strap, the Belly Pack, the Laptop Restraint Belt, and the Tool Page Case. The Single Strap and the H-Strap were flown on this mission. The PERS concept was developed by industrial design students at Auburn University and the MSFC Flight Projects Directorate.

  17. Construct Validation of the Portuguese Version of the Restraint Scale

    Directory of Open Access Journals (Sweden)

    João Carvalho

    2016-08-01

    Full Text Available AimThe main purpose of this study was to adapt the Restraint Scale (RS to Portuguese and examine its psychometric properties, specifically its construct validity.MethodIn this study, 238 normal-weight adults (82% women; Mean age = 36.6, SD = 15.0 participated in an online survey containing measures of Restraint Scale, Three Factor Eating Questionnaire, Dutch Eating Behaviour Questionnaire, and Body Dissatisfaction and Drive for Thinness scales.ResultsExploratory factor analyses corroborated the two-factors structure found in previous studies, in particular when three items without clear factorial assignment and low correlation were excluded. A final two-factors version of the RS containing seven items presented a very good fit to the measurement model and good internal consistency. Confirmatory factor analysis of the 7-items RS in relation to a three-factor model of overeating, dieting and body dissatisfaction measures revealed that the RS was the only restraint measure loading in all three factors.ConclusionThis suggests that the 7-items Portuguese version of the RS has good psychometric properties and unique features that lend it appropriate to identify and study unsuccessful chronic dieters.

  18. Using a laryngeal tube during cardiac arrest reduces "no flow time" in a manikin study: a comparison between laryngeal tube and endotracheal tube.

    Science.gov (United States)

    Wiese, Christoph H R; Bartels, Utz; Bergmann, Anna; Bergmann, Ingo; Bahr, Jan; Graf, Bernhard M

    2008-01-01

    In 2005 the European Resuscitation Council published new guidelines for advanced life support. One of the issues was to reduce the "no flow time", which is defined as the time without chest compression in the first period of cardiac arrest. In a manikin study, we evaluated whether using the laryngeal tube instead of endotracheal intubation for airway management during cardiac arrest could reduce the "no flow time". The study was prospective and included 50 volunteers who performed standardized management of simulated cardiac arrest in a manikin. All participants had completed an obligatory course in emergency medicine but had not been specifically trained in endotracheal intubation; they were therefore designated as unfamiliar in using the endotracheal tube to secure the airway, in accordance with the definition of the European Resuscitation Council. We defined two groups for the study: the LT group, who used the laryngeal tube to secure the airway; and the ET group, who used the endotracheal tube and bag-mask ventilation to ventilate the manikin. The participants were initially randomly assigned to one of the groups and thereafter completed the other scenario. Study endpoints were the total "no flow time" and adherence to guidelines of the European Resuscitation Council. Use of the laryngeal tube during cardiac arrest in the manikin significantly reduced the "no flow time" when compared with endotracheal intubation (109.3 s vs. 190.4 s; P cardiac arrest supraglottic airway devices should be used by emergency personnel unfamiliar with endotracheal intubation.

  19. The Application of Rapid Prototyping Technology and Quality Functional Deployment (QFD approach in enhancing the Endotracheal Tube Holder Model in Medical Application

    Directory of Open Access Journals (Sweden)

    Way Yusoff

    2015-01-01

    Full Text Available This paper presents a development of a current design the Endotracheal tube holding device. At present, the medical teams have faced a lot of problems when doing the endotracheal intubation. Misplacement of endotracheal tube into the esophagus and extubation due to patient’s movement are among the problems by surgeons during medical treatment. This is important as the successful management of the potential risk can reduce the number of patients who suffer a serious consequence of endtracheal tube therapy such as a potential risk to patient safety, with associated risks varying from minor complications to death. This paper presents a product design specification for endotracheal tube-holding device is translated from user’s requirements by employing Quality Functional Deployment (QFD. Several design concepts are generated by using CATIA software to be evaluated by endotracheal tube-holding device users for concept selection. Selection of design concept was done in two phases which are concept screening and concept scoring. For selecting the design concept for further development, a prototype of endotracheal tube was fabricated by using Fused Deposition Modelling (FDM.

  20. BLOOD GAS, LACTATE, AND HEMATOLOGY EFFECTS OF VENIPUNCTURE TIMING AND LOCATION AFTER MIST-NET CAPTURE OF MOURNING DOVES (ZENAIDA MACROURA), BOAT-TAILED GRACKLES (QUISCALUS MAJOR), AND HOUSE SPARROWS (PASSER DOMESTICUS).

    Science.gov (United States)

    Harms, Craig A; Jinks, Maggie R; Harms, Ronald V

    2016-04-01

    Venous blood gas partial pressures, pH, bicarbonate and lactate concentrations, packed cell volume, white blood cell differential counts, and heterophil/lymphocyte ratios were measured from Mourning Doves (Zenaida macroura), Boat-tailed Grackles (Quiscalus major), and House Sparrows (Passer domesticus). Birds were bled promptly after mist-net capture and banding or following a targeted delay of 45-60 min, in order to assess the impacts of a brief holding period commonly practiced in large-scale bird banding operations. Additionally, effects of venipuncture location (basilic [=ulnar] vein versus jugular vein) were evaluated in male Boat-tailed Grackles sampled promptly after capture and banding. All comparisons were with unpaired samples; no birds were subjected to more than one venipuncture. All three species exhibited moderate improvements in blood gas and acid-base status after the delay, with reductions in lactate concentrations with or without concurrent increases in pH and bicarbonate. Boat-tailed Grackles exhibited an increased proportion of heterophils in the differential white blood cell count following a delay in sampling, suggestive of a stress leukogram. There were no significant differences between basilic and jugular venipuncture results from male Boat-tailed Grackles. Most metabolic, respiratory, and acid-base alterations were minor, but a small number of birds exhibited values (e.g., temperature-corrected pH 10 mmol/L) that could be of concern if combined with other adverse conditions. For such birds, a short delay between capture and processing could benefit their blood gas and acid-base status, although loss of time foraging or feeding young and greater activation of the hypophyseal-pituitary-adrenal axis are additional considerations.

  1. ProSeal laryngeal mask airway: An alternative to endotracheal intubation in paediatric patients for short duration surgical procedures

    Directory of Open Access Journals (Sweden)

    Jaya Lalwani

    2010-01-01

    Full Text Available The laryngeal mask airway (LMA is a supraglottic airway management device. The LMA is preferred for airway management in paediatric patients for short duration surgical procedures. The recently introduced ProSeal (PLMA, a modification of Classic LMA, has a gastric drainage tube placed lateral to main airway tube which allows the regurgitated gastric contents to bypass the glottis and prevents the pulmonary aspiration. This study was done to compare the efficacy of ProSeal LMA with an endotracheal tube in paediatric patients with respect to number of attempts for placement of devices, haemodynamic responses and perioperative respiratory complications. Sixty children, ASA I and II, weighing 10-20 kg between 2 and 8 years of age group of either sex undergoing elective ophthalmological and lower abdominal surgeries of 30-60 min duration, randomly divided into two groups of 30 patients each were studied. The number of attempts for endotracheal intubation was less than the placement of PLMA. Haemodynamic responses were significantly higher (P<0.05 after endotracheal intubation as compared to the placement of PLMA. There were no significant differences in mean SpO 2 (% and EtCO 2 levels recorded at different time intervals between the two groups. The incidence of post-operative respiratory complications cough and bronchospasm was higher after extubation than after removal of PLMA. The incidence of soft tissue trauma was noted to be higher for PLMA after its removal. There were no incidences of aspiration and hoarseness/sore throat in either group. It is concluded that ProSeal LMA can be safely considered as a suitable and effective alternative to endotracheal intubation in paediatric patients for short duration surgical procedures.

  2. Creating protective appliances for preventing dental injury during endotracheal intubation using intraoral scanning and 3D printing: a technical note.

    Science.gov (United States)

    Cho, Jin-Hyung; Park, Wonse; Park, Kyeong-Mee; Kim, Seo-Yul; Kim, Kee-Deog

    2017-03-01

    Digital dentistry has influenced many dental procedures, such as three-dimensional (3D) diagnosis and treatment planning, surgical splints, and prosthetic treatments. Patient-specific protective appliances (PSPAs) prevent dental injury during endotracheal intubation. However, the required laboratory work takes time, and there is the possibility of tooth extraction while obtaining the dental impression. In this technical report, we utilized new digital technology for creating PSPAs, using direct intraoral scanners and 3D printers for dental cast fabrication.

  3. A Study of the Use of Laryngeal Mask Airway (LMA) in Children and its Comparison with Endotracheal Intubation

    OpenAIRE

    Shahin N Jamil; Mehtab Alam; Hammad Usmani; M M Khan

    2009-01-01

    Summary Laryngeal mask airway (LMA) is increasingly being used in children as it is less invasive compared to endotracheal intubation and causes less discomfort in the postoperative period. However, some concerns remained about its safety during positive pressure ventilation in children. In a prospective randomized trial, 100 ASA I and II children weighing between 10-20 kg in the range of 2-10 years of age, scheduled for elective surgery were randomly allocated to one of the two groups of 50 ...

  4. Influence of head flexion on intraocular pressure, cardiovascular, and respiratory responses in patients undergoing cataract surgery after endotracheal intubation

    Directory of Open Access Journals (Sweden)

    MR Safavi

    2007-11-01

    Full Text Available Background: In cataract surgery, the periorbital area is prepared anddraped after induction of general anesthesia and endotracheal intubation (ETI.For this purpose, the patient’s head and neck is usually flexed 30 to 45degrees. Neck flexion causes displacement of the endotracheal tube tip towardthe carina. Stimulation of the tracheal mucosa may cause bucking, increasedintraocular pressure (IOP, laryngospasm and/or bronchospasm, during lightanesthesia. Laryngeal constriction and all components of the tracheal responsemay affect end-tidal carbon dioxide pressure (PETCO2 and peripheral arterialhemoglobin oxygen saturation (SpaO2. Thus, in the current study, weinvestigated the influence of head and neck flexion on heart rate (HR, systolicand diastolic blood pressure (SAP and DAP, SpaO2, PETCO2, and IOP in patientsundergoing cataract surgery with endotracheal intubation during generalanesthesia.Patients and Methods: The present prospective study comprised patientsaged from 40 to 80 year with 106 American Society of Anesthesia (ASA physicalstatus I and II. Anesthesia was induced with thiopental sodium, lidocaine andfentanyl. Atracurium 0.5 mg/kg was administered to facilitate trachealintubation. HR, SAP, DAP, SpaO2, PETCO2, and IOP were measured at 1, 2, and 5minutes after head flexion.Results: Mean SAP, DAP, IOP, and HR was increased after ETI and headflexion compared with baseline values. PETCO2 and SpaO2 were decreased after ETIand at 1, 2 minutes after head flexion compared with baseline values.Conclusion: In patients undergoing cataract surgery during generalanesthesia, endotracheal tube movement caused changes in head and neck positionresulting in significant effects on heart rate, systolic and diastolic bloodpressures, laryngeal reflexes, SpaO2, PETCO2, and intraocular pressure.

  5. Creating protective appliances for preventing dental injury during endotracheal intubation using intraoral scanning and 3D printing: a technical note

    OpenAIRE

    Cho, Jin-Hyung; Park, Wonse; Park, Kyeong-Mee; Kim, Seo-Yul; Kim, Kee-Deog

    2017-01-01

    Digital dentistry has influenced many dental procedures, such as three-dimensional (3D) diagnosis and treatment planning, surgical splints, and prosthetic treatments. Patient-specific protective appliances (PSPAs) prevent dental injury during endotracheal intubation. However, the required laboratory work takes time, and there is the possibility of tooth extraction while obtaining the dental impression. In this technical report, we utilized new digital technology for creating PSPAs, using dire...

  6. Endotracheal Tube Cuff Pressures in Patients Intubated Prior to Helicopter EMS Transport

    Directory of Open Access Journals (Sweden)

    Joseph Tennyson

    2016-11-01

    Full Text Available Introduction Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS transportation. Measurement of endotracheal tube (ETT cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmH2O impede mucosal capillary blood flow. Multiple prior studies have recommended 30 cmH2O as the maximum safe cuff inflation pressure. This study sought to evaluate the inflation pressures in ETT cuffs of patients presenting to HEMS. Methods We enrolled a convenience sample of patients presenting to UMass Memorial LifeFlight who were intubated by the sending facility or emergency medical services (EMS agency. Flight crews measured the ETT cuff pressures using a commercially available device. Those patients intubated by the flight crew were excluded from this analysis as the cuff was inflated with the manometer to a standardized pressure. Crews logged the results on a research form, and we analyzed the data using Microsoft Excel and an online statistical analysis tool. Results We analyzed data for 55 patients. There was a mean age of 57 years (range 18–90. The mean ETT cuff pressure was 70 (95% CI= [61–80] cmH2O. The mean lies 40 cmH2O above the maximum accepted value of 30 cmH2O (p120 cmH2O, the maximum pressure on the analog gauge. Conclusion Patients presenting to HEMS after intubation by the referral agency (EMS or hospital have ETT cuffs inflated to pressures that are, on average, more than double the recommended maximum. These patients are at risk for tracheal mucosal injury and scarring from decreased mucosal capillary blood flow. Hospital and EMS providers should use ETT cuff manometry to ensure that they inflate ETT cuffs to safe pressures.

  7. Outcome of life-threatening malaria in African children requiring endotracheal intubation

    Directory of Open Access Journals (Sweden)

    Ka Amadou S

    2007-04-01

    Full Text Available Abstract Background Little is known about children undergoing critical care for malaria. The purpose of this survey was to evaluate the outcome in African children requiring endotracheal intubation for life-threatening malaria. Methods All children with a primary diagnosis of severe malaria (2000 WHO definition requiring endotracheal intubation, hospitalised over a five-year period, within a tertiary-care hospital in Dakar, Senegal, were enrolled in a retrospective cohort study. Results 83 consecutive patients were included (median PRISM h24 score: 14; IQR: 10–19, multiple organ dysfunctions: 91.5%. The median duration of ventilation was 36 hrs (IQR: 4–72. Indications for intubation were deep coma (Glasgow score ≤7, n = 16, overt cortical or diencephalic injury, i.e, status epilepticus/decorticate posturing (n = 20, severe brainstem involvement, i.e., decerebrate posturing/opisthotonus (n = 15, shock (n = 15, cardiac arrest (n = 13 or acute lung injury (ALI (PaO2/FiO2 h24 scores: 12.5 among non-survivors versus 11 among survivors, p = 0.02. Median PRISMh24 score was significantly lower when testing deep coma against other indications (10 vs 15, p h24 score (2.5 vs 13, p = 0.02. Multivariate analysis identified deep coma as having a better outcome than other indications (CFR, 12.5% vs 40.0 to 93.3%, p 3 was associated with death (aRR 2.6, 95% CI 1.2–5.8 and second-line anticonvulsant use (clonazepam or thiopental with survival (aRR 0.4, 95% CI 0.2–0.9. Complications, mostly nosocomial infections (n = 20, ALI/ARDS (n = 9 or sub-glottic stenosis (n = 3, had no significant prognostic value. Conclusion In this study, the outcome of children requiring intubation for malaria depends more on clinical presentation and progression towards organ failures than on critical care complications per se. In sub-Saharan Africa, mechanical ventilation for life-threatening childhood malaria is feasible, but seems unlikely to dramatically improve the

  8. Use of physical restraint: Nurses' knowledge, attitude, intention and practice and influencing factors.

    Science.gov (United States)

    Eskandari, Fatemeh; Abdullah, Khatijah Lim; Zainal, Nor Zuraida; Wong, Li Ping

    2017-12-01

    To investigate the knowledge, attitude, intention and practice of nurses towards physical restraint and factors influencing these variables. A literature review showed a lack of studies focused on the intention of nurses regarding physical restraint throughout the world. Considering that very little research on physical restraint use has been carried out in Malaysia, assessment of nurses' knowledge, attitude, intention and practice is necessary before developing a minimising programme in hospitals. A cross-sectional study was used. A questionnaire to assess the knowledge, attitude, intention and practice was completed by all nurses (n = 309) in twelve wards of a teaching hospital in Kuala Lumpur. Moderate knowledge and attitude with strong intention to use physical restraint were found among the nurses. Less than half of nurses considered alternatives to physical restraint and most of them did not understand the reasons for the physical restraint. Nurses' academic qualification, read any information source during past year and nurses' work unit showed a significant association with nurses' knowledge. Multiple linear regression analysis found knowledge, attitude and intention were significantly associated with nurses' practice to use physical restraint. This study showed some important misunderstandings of nurses about using physical restraint and strong intention regarding using physical restraint. Findings of this study serve as a supporting reason for importance of educating nurses about the use of physical restraint. Exploring the knowledge, attitude, intention and current practice of nurses towards physical restraint is important so that an effective strategy can be formulated to minimise the use of physical restraints in hospitals. © 2017 John Wiley & Sons Ltd.

  9. Nurses' feelings and thoughts about using physical restraints on hospitalized older patients.

    Science.gov (United States)

    Chuang, Yeu-Hui; Huang, Hui-Tzu

    2007-03-01

    To explore nurses' feelings and thoughts about physically restraining older hospitalized patients. The use of physical restraints is still highly prevalent in hospitals; furthermore, older patients are most likely to be so restrained. Studies in acute care settings have focused mainly on nurses' knowledge, attitudes, or practice concerning physical restraints, on physical restraint reduction programmes, on nurses' perceptions about the use of physical restraints, or on elderly patients' experiences with physical restraints. To the best of our knowledge no studies have been conducted on hospital nurses' feelings and thoughts about the use of physical restraints in Taiwan. A qualitative approach was used to understand this phenomenon. Semi-structured interviews were carried out, from August 2002 to March 2003, with 12 nurses working in three hospitals. The interviews were audiotaped and transcribed verbatim; content analysis was used to analyse the data. Nurses reported a variety of emotional responses regarding the use of physical restraints, including sadness, guilt, conflicts, retribution, absence of feelings, security, and pity for the restrained older people. Rationalization, sharing with colleagues, and compensating behaviours were ways that nurses used to manage their negative feelings. Most nurses had negative feelings towards the use of physical restraints. Among these nurses there was a struggle between patients' autonomy and the practice of care. However, other nurses said they had 'no feelings' or 'feeling of security' while using physical restraints. The findings of this study may contribute to filling the gaps in nursing knowledge, to improving protocols for physical restraint use in hospitals, and may also assist nurse managers to create a supportive practice environment. It is recommended that in-service training programmes should cover misconceptions regarding physical restraint use, ethical issues and how to cope with feelings while using physical

  10. Effects of user experience and method in the inflation of endotracheal tube pilot balloon on cuff pressure.

    Science.gov (United States)

    Ozer, A B; Demirel, I; Gunduz, G; Erhan, O L

    2013-01-01

    Endotracheal tube cuff pressure (ETCP) is recommended to be maintained between 20-30 cm H2O limits. While insufficient inflation of ETC may cause aspirations, over-inflation of it may lead to damage in tracheal epithelium. We planned to investigate the effects of user experience and cuff pressure inflation method differences following endotracheal tube cuff pressure and complaints about it. Two hundred and fifty patients planned for general anaesthesia were included in this study. ETC was inflated by users with different experience according to leakage or pilot balloon palpation techniques. ETCPs were measured by manometer at three periods (5 and 60 minutes after endotracheal intubation, and before extubation). Complaints about it were recorded in post anaesthetic care unit and 24 hours postoperatively. Though we found experience of user had significant effect on the ETCP regulations, we observed inflation methods did not have any effect. However we found ETCP was higher than normal range with experienced users. A correlation was observed between cuff pressure and anaesthesia duration with postoperative complaints. Our study concluded that the methods used do not have any significant advantage over one another. While ETC inflated at normal pressure increases as user's experience increases, experience alone is not enough in adjusting ETCP. A manometer should be used in routine inflation of ETC instead of conventional methods. CP and anaesthesia duration have correlations with some postoperative complaints.

  11. The effect of user experience and inflation technique on endotracheal tube cuff pressure using a feline airway simulator.

    Science.gov (United States)

    White, Donna M; Redondo, José I; Mair, Alastair R; Martinez-Taboada, Fernando

    2017-09-01

    The effect of user experience and inflation technique on endotracheal tube cuff pressure using a feline airway simulator. Prospective, experimental clinical study. Participants included veterinary students at the beginning (group S1) and end (group S2) of their 2-week anaesthesia rotation and veterinary anaesthetists (group A). The feline airway simulator was designed to simulate an average size feline trachea, intubated with a 4.5 mm low-pressure, high-volume cuffed endotracheal tube, connected to a Bain breathing system with oxygen flow of 2 L minute-1. Participants inflated the on-endotracheal tube cuff by pilot balloon palpation and by instilling the minimum occlusive volume (MOV) required for loss of airway leaks during manual ventilation. Intracuff pressures were measured by manometers obscured to participants and ideally were 20-30 cm H2O. Student t, Fisher exact, and Chi-squared tests were used where appropriate to analyse data (p Experience had no effect on this skill and, as such, a cuff manometer is recommended. Copyright © 2017 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.

  12. Restraint stress induces and exacerbates intestinal inflammation in interleukin-10 deficient mice

    Science.gov (United States)

    Koh, Seong-Joon; Kim, Ji Won; Kim, Byeong Gwan; Lee, Kook Lae; Kim, Joo Sung

    2015-01-01

    AIM: To investigate the effects of restraint stress on chronic colitis in interleukin (IL)-10 deficient (IL-10-/-) mice. METHODS: The first experiment compared the effect of restraint stress on the development of intestinal inflammation in wild-type and IL-10-/- mice. Both wild-type and IL-10-/- mice were physically restrained in a well-ventilated, 50 cm3 conical polypropylene tube for 2 h per day for three consecutive days. The second experiment was performed to assess the effect of restraint stress on exacerbation of colitis induced by piroxicam in IL-10-/- mice. The IL-10-/- mice were exposed to restraint stress for 2 h per day for 3 consecutive days, and then treated with piroxicam for 4 d at a dose of 200 ppm administered in the rodent chow. RESULTS: In the first experiment, none of the wild-type mice with or without restraint stress showed clinical and histopathological abnormality in the gut. However, IL-10-/- mice exposed to restraint stress exhibited histologically significant intestinal inflammation as compared to those without restraint stress. In the second experiment, restraint stress significantly reduced body weight and increased the severity of intestinal inflammation assessed by histopathologic grading in IL-10-/- mice. Colonic IL12p40 mRNA expression was strongly increased in mice exposed to restraint stress. CONCLUSION: This novel animal model could be useful in future study of psychological stress in the pathogenesis of inflammatory bowel disease. PMID:26229400

  13. Randomized trial of laryngeal mask airway versus endotracheal intubation for surfactant delivery.

    Science.gov (United States)

    Pinheiro, J M B; Santana-Rivas, Q; Pezzano, C

    2016-03-01

    To compare the effectiveness of surfactant delivery via endotracheal tube (ETT) using an intubation-surfactant-rapid extubation approach with premedication) vs laryngeal mask airway (LMA) in preventing the need for mechanical ventilation in preterm neonates with moderate respiratory distress syndrome (RDS). Moderately preterm infants diagnosed with RDS, receiving nasal continuous positive airway pressure with FiO2 0.30 to 0.60, were randomized to two groups at age 3 to 48 h. Those in the ETT group were intubated following premedication with atropine and morphine, whereas the LMA group received only atropine. Both groups received calfactant before a planned reinstitution of nasal continuous positive airway pressure, and had equivalent pre-specified criteria for subsequent mechanical ventilation and surfactant retreatment. The primary outcome was failure of surfactant treatment strategy to avoid mechanical ventilation; we differentiated early from late failures to assess the contribution of potential mechanisms such as respiratory depression versus less-effective surfactant delivery. Secondary outcomes addressed efficacy and safety end points. Sixty-one patients were randomized, one excluded and 30 analyzed in each group, with similar baseline characteristics. Failure rate was 77% in the ETT group and 30% in the LMA group (Psedation. The efficacy of surfactant in decreasing RDS severity appears similar with both methods. Morphine premedication likely contributed to early post-surfactant failures.

  14. [Endotracheal intubation without the use of muscle relaxants in patients with myasthenia gravis].

    Science.gov (United States)

    Vlajković, Gordana; Sindelić, Radomir; Marković, Dejan; Terzić, Milica; Bumbasirević, Vesna

    2009-01-01

    Although muscle relaxants have been widely used to facilitate endotracheal intubation, the administration of these drugs in myasthenic patients may be associated with adverse events. After obtaining Institutional Reviewing Board approval and informed, patient consent, 30 patients with myasthenia gravis were enrolled in a prospective, double-blind, randomized clinical trial. We compared intubating conditions (ease of laryngoscopy, vocal cords, cough, jaw relaxation, limb movement) following fentanyl 2 mg/kg and propofol 2 mg/kg (group PRO, n = 15) vs fentanyl 2 mg/kg and sevoflurane 5% in a 1:2 mixture of oxygen and nitrous oxide (group SEVO, n = 15). The statistical analysis was performed using Student's t test and Chi-quadrate test, p 0.05). One patient in each group had clinically unacceptable conditions for intubation. The mean intubation score was 5.7 +/- 1.0 in the group PRO vs 5.9 +/- 0.9 in the group SEVO (p > 0.05). Three patients receiving propofol and one patient receiving sevoflurane had mild hoarseness after the surgery (p > 0.05). Both propofol and sevoflurane, supplemented with fentanyl, provide good intubating conditions without the use of muscle relaxants in patients with myasthenia gravis.

  15. A Dose – Response Study of Magnesium Sulfate in Suppressing Cardiovascular Responses to Laryngoscopy & Endotracheal Intubation

    Directory of Open Access Journals (Sweden)

    K Montazeri

    2005-03-01

    Full Text Available Background: The effects of pretreatment with magnesium on cardiovascular responses associated with intubation have been studied previously. In this study we wanted to find optimal dose of magnesium that causes decreased cardiovascular responses after laryngoscopy & endotracheal intubation. Methods: In a double-blind , randomized, clinical trial ,120 ASA-1 patients with ages between 15-50 years old , who were candidates for elective surgery, were selected and classified in 6 groups (20 patients in each . The pulse rate and arterial blood pressure were measured and recorded at 5 minutes before taking any drug then, according to different groups, patients took magnesium sulfate (10, 20, 30, 40, 50mg/kg and lidocaine (1.5 mg/kg. The induction of anesthesia was same in all groups and the pulse rate and arterial blood pressure were measured and recorded just before intubation and also at 1, 3 , and 5 minutes after intubation (before surgical incision . Statistical analysis was performed by use of ANOVA, Post Hoc test (Duncan, Pearson correlation, and Chi square test. Results: there were no statistically significant differences in blood pressure, pulse rate, Train Of Four (TOF, and complications between groups who received magnesium but the significant differences in these parameters were seen between magnesium and lidocaine groups. Conclusion: We concluded that pretreatment with different doses of magnesium sulfate have a safe decreasing effect on cardiovascular responses that is more effective than pretreatment with lidocaine. Keywords: magnesium sulfate, cardiovascular responses, lidocaine.

  16. Comparison of endotracheal tube cuff pressure values before and after training seminar.

    Science.gov (United States)

    Özcan, Ayça Tuba Dumanlı; Döğer, Cihan; But, Abdülkadir; Kutlu, Işık; Aksoy, Şemsi Mustafa

    2017-07-22

    It is recommended that endotracheal cuff (ETTc) pressure be between 20 and 30 cm H2O. In this present study, we intend to observe average cuff pressure values in our clinic and the change in these values after the training seminar. The cuff pressure values of 200 patients intubated following general anesthesia induction in the operating theatre were measured following intubation. One hundred patients whose values were measured before the training seminar held for all physician assistants, and 100 patients whose values were measured after the training seminar were regarded as Group 1 and Group 2, respectively. Cuff pressures of both groups were recorded, and the difference between them was shown. Moreover, cuff pressure values were explored according to the working period of the physician assistants. There was no significant difference between the groups in terms of age, gender and tube diameters. Statistically significant difference was found between cuff pressure values before and after the training (p values decreased, however no statistically significant different was found (p values and potential complications.

  17. Correlation between oro and hypopharynx shape and position with endotracheal intubation difficulty

    Directory of Open Access Journals (Sweden)

    Daher Rabadi

    2014-12-01

    Full Text Available Background and objective: Prediction of intubation difficulty can save patients from major preoperative morbidity or mortality. The purpose of this paper is to assess the correlation between oro-hypo pharynx position, neck size, and length with endotracheal intubation difficulty. The study also explored the diagnostic value of Friedman Staging System in prediction cases with difficult intubation. Method: The consecutive 500 ASA (I, II adult patients undergoing elective surgery were evaluated for oro and hypopharynx shape and position by modified Mallampati, Cormack and Lehane score as well as Friedman obstructive sleep apnea classification systems. Neck circumference and length were also measured. All cases were intubated by a single anesthesiologist who was uninformed of the above evaluation and graded intubation difficulty in visual analog score. Correlation between these findings and difficulty of intubation was assessed. Sensitivity, Specificity, Positive and Negative Predictive Values were also reported. Results: Cormack-Lehane grade had the strongest correlation with difficulty of intubation followed by Friedman palate position. Friedman palate position was the most sensitive and had higher positive and negative predictive values than modified Mallampati classification. Cormack-Lehane grade was found to be the most specific with the highest negative predictive value among the four studied classifications. Conclusion: Friedman palate position is a more useful, valuable and sensitive test compared to the modified Mallampati screening test for pre-anesthetic prediction of difficult intubation where its involvement in Multivariate model may raise the accuracy and diagnostic value of preoperative assessment of difficult airway.

  18. Incidence and endoscopic characteristics of acute laryngeal lesions in children undergoing endotracheal intubation

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    Eliandra da Silveira de Lima

    Full Text Available ABSTRACT INTRODUCTION: Acute laryngeal lesions after intubation appear to be precursors of chronic lesions. OBJECTIVE: To describe the incidence and type of acute laryngeal lesions after extubation in a pediatric intensive care unit (PICU. METHODS: A cohort study involving children from birth to <5 years, submitted to intubation for more than 24 h in the PICU of an university hospital. In the first eight hours after extubation, a flexible fiberoptic laryngoscopy (FFL was performed at the bedside. Those with moderate to severe abnormalities underwent a second examination seven to ten days later. RESULTS: 177 patients were included, with a median age of 2.46 months. The mean intubation time was 8.19 days. Seventy-three (41.2% patients had moderate or severe alterations at the FFL, with the remaining showing only minor alterations or normal results. During follow-up, 16 children from the group with moderate to severe lesions developed subglottic stenosis. One patient from the normal FFL group had subglottic stenosis, resulting in an incidence of 9.6% of chronic lesions. CONCLUSION: Most children in the study developed mild acute laryngeal lesions caused by endotracheal intubation, which improved in a few days after extubation.

  19. Pharmacokinetics and Tissue Disposition of Nanosystem-Entrapped Betulin After Endotracheal Administration to Rats.

    Science.gov (United States)

    Pozharitskaya, Olga N; Karlina, Marina V; Shikov, Alexander N; Kosman, Vera M; Makarov, Valery G; Casals, Eudald; Rosenholm, Jessica M

    2017-04-01

    Betulin is a triterpene extracted from the cork layer of the outer bark of Betula spp. It has a wide spectrum of pharmacological activities, including being lung protective; however, its bioavailability is low. To increase its bioavailability, betulin was entrapped in a nanosystem (BN). In this study, we investigated the pharmacokinetics and tissue distribution of nanosystem-entrapped betulin after single dose endotracheal administration to rats. Betulin was nanosystem-entrapped using a solvent exchange technique. The surface morphology and size of the nanosystem were characterized by transmission electron microscopy and dynamic light scattering. The plasma and tissue concentrations of betulin were determined using a validated high-performance liquid chromatography method. The highest concentration of betulin was found in lungs and liver, and the lowest in the heart. Betulin did not penetrate highly vascularized tissues or tissue with an average degree of vascularization, nor did it cross the blood-brain barrier. Tissue availability in the lungs was 1.3 times higher for BN than for free betulin. Betulin was detected in the bloodstream at 15 min after administration of BN compared with only at 1 h after administration of free betulin. Penetration of betulin in the liver tissue was characterized by a high degree of intensity both for BN and free betulin. Betulin in the heart tissue was detected in much smaller quantities than in the liver. Entrapment of betulin in nanosystem form shows promise as a novel strategy in the treatment of pulmonary diseases.

  20. Comparison of proseal laryngeal mask and endotracheal tube for airway safety in pediatric strabismus surgery.

    Science.gov (United States)

    Gul, Rauf; Goksu, Sitki; Ugur, Berna K; Sahin, Levent; Koruk, Senem; Okumus, Seydi; Erbagci, Ibrahim

    2012-04-01

    To compare proseal laryngeal mask airway (PLMA) with an endotracheal tube (ET) for airway safety, maintained ease of insertion, and hemodynamic stability in pediatric strabismus surgery (PSS). This prospective-randomized clinical study was carried out in the Department of Anesthesiology, Faculty of Medicine, Gaziantep University, Turkey between April 2008 and July 2009. Eighty American Society of Anesthesiology (ASA) I-II children, weight 10-30 kg, aged between 1-12 years undergoing PSS were selected. The anesthesia was induced with 8% sevoflurane, 50% nitrous oxide/oxygen mixture, and a neuromuscular blockade with 0.5 mg/kg atracurium in both groups. After a sufficient dosage of anesthesia, the patients were randomized into 2 groups (Group P: PLMA, n= 40, Group T: ET, n=40) and an airway management device; either a PLMA or ET was inserted. The number of placement attempts, placement success or failure, success or failure of a gastric suction tube placement during the procedures and perioperative complications were assessed. Thirty-eight patients (95%) in the PLMA group, 39 (97.5%) patients in the ET group were successfully placed with a PLMA and ET on the first attempt (p>0.05). There were no statistically significant differences in the hemodynamic parameters, end-tidal carbon dioxide, and complications. This study revealed that PLMA may offer an alternative airway to ET wherein positive pressure ventilation was the preferred choice for children undergoing PSS.

  1. [Evaluation of pain during mobilization and endotracheal aspiration in critical patients].

    Science.gov (United States)

    Robleda, G; Roche-Campo, F; Membrilla-Martínez, L; Fernández-Lucio, A; Villamor-Vázquez, M; Merten, A; Gich, I; Mancebo, J; Català-Puigbó, E; Baños, J E

    2016-03-01

    1) To assess the prevalence of pain during nursing care procedures, and 2) to evaluate the usefulness of certain vital signs and the bispectral index (BIS) in detecting pain. A prospective, observational analytical study was made of procedures (endotracheal aspiration and mobilization with turning) in critically ill sedated patients on mechanical ventilation. The Behavioral Pain Scale was used to assess pain, with scores of ≥3 indicating pain. Various physiological signs and BIS values were recorded, with changes of >10% being considered clinically relevant. A total of 146 procedures in 70 patients were analyzed. Pain prevalence during the procedures was 94%. Vital signs and BIS values increased significantly during the procedures compared to resting conditions, but only the changes in BIS were considered clinically relevant. In the subgroup of patients receiving preemptive analgesia prior to the procedure, pain decreased significantly compared to the group of patients who received no such analgesia (-2 [IQR: {-5}-0] vs. 3 [IQR: 1-4]; P<.001, respectively). The procedures evaluated in this study are painful. Changes in vital signs are not good indicators of pain. Changes in BIS may provide useful information about pain, but more research is needed. The administration of preemptive analgesia decreases pain during the procedures. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  2. Assessment of microbial diversity in biofilms recovered from endotracheal tubes using culture dependent and independent approaches.

    Science.gov (United States)

    Vandecandelaere, Ilse; Matthijs, Nele; Van Nieuwerburgh, Filip; Deforce, Dieter; Vosters, Peter; De Bus, Liesbet; Nelis, Hans J; Depuydt, Pieter; Coenye, Tom

    2012-01-01

    Ventilator-associated pneumonia (VAP) is a common nosocomial infection in mechanically ventilated patients. Biofilm formation is one of the mechanisms through which the endotracheal tube (ET) facilitates bacterial contamination of the lower airways. In the present study, we analyzed the composition of the ET biofilm flora by means of culture dependent and culture independent (16 S rRNA gene clone libraries and pyrosequencing) approaches. Overall, the microbial diversity was high and members of different phylogenetic lineages were detected (Actinobacteria, beta-Proteobacteria, Candida spp., Clostridia, epsilon-Proteobacteria, Firmicutes, Fusobacteria and gamma-Proteobacteria). Culture dependent analysis, based on the use of selective growth media and conventional microbiological tests, resulted in the identification of typical aerobic nosocomial pathogens which are known to play a role in the development of VAP, e.g. Staphylococcus aureus and Pseudomonas aeruginosa. Other opportunistic pathogens were also identified, including Staphylococcus epidermidis and Kocuria varians. In general, there was little correlation between the results obtained by sequencing 16 S rRNA gene clone libraries and by cultivation. Pyrosequencing of PCR amplified 16 S rRNA genes of four selected samples resulted in the identification of a much wider variety of bacteria. The results from the pyrosequencing analysis suggest that these four samples were dominated by members of the normal oral flora such as Prevotella spp., Peptostreptococcus spp. and lactic acid bacteria. A combination of methods is recommended to obtain a complete picture of the microbial diversity of the ET biofilm.

  3. Assessment of microbial diversity in biofilms recovered from endotracheal tubes using culture dependent and independent approaches.

    Directory of Open Access Journals (Sweden)

    Ilse Vandecandelaere

    Full Text Available Ventilator-associated pneumonia (VAP is a common nosocomial infection in mechanically ventilated patients. Biofilm formation is one of the mechanisms through which the endotracheal tube (ET facilitates bacterial contamination of the lower airways. In the present study, we analyzed the composition of the ET biofilm flora by means of culture dependent and culture independent (16 S rRNA gene clone libraries and pyrosequencing approaches. Overall, the microbial diversity was high and members of different phylogenetic lineages were detected (Actinobacteria, beta-Proteobacteria, Candida spp., Clostridia, epsilon-Proteobacteria, Firmicutes, Fusobacteria and gamma-Proteobacteria. Culture dependent analysis, based on the use of selective growth media and conventional microbiological tests, resulted in the identification of typical aerobic nosocomial pathogens which are known to play a role in the development of VAP, e.g. Staphylococcus aureus and Pseudomonas aeruginosa. Other opportunistic pathogens were also identified, including Staphylococcus epidermidis and Kocuria varians. In general, there was little correlation between the results obtained by sequencing 16 S rRNA gene clone libraries and by cultivation. Pyrosequencing of PCR amplified 16 S rRNA genes of four selected samples resulted in the identification of a much wider variety of bacteria. The results from the pyrosequencing analysis suggest that these four samples were dominated by members of the normal oral flora such as Prevotella spp., Peptostreptococcus spp. and lactic acid bacteria. A combination of methods is recommended to obtain a complete picture of the microbial diversity of the ET biofilm.

  4. A randomized trial of suprasternal palpation to determine endotracheal tube position in neonates.

    Science.gov (United States)

    Jain, Alok; Finer, Neil N; Hilton, Saskia; Rich, Wade

    2004-03-01

    To compare suprasternal palpation, a previously described bedside technique, with standard chest radiography for correct positioning of the endotracheal tube (ETT) in newborn infants. A randomized single-blinded study in an academic medical center. Preterm and term newborn infants requiring intubation were eligible, provided that they had not had their initial chest roentgenogram (CXR). Infants were randomized to ETT palpation and non-adjustment (Controls), or to ETT palpation and adjustment (Treatment), following digital palpation of the ETT tip in the suprasternal notch. ETT position was considered correct when only the tip of the ETT was palpable in the suprasternal notch. ETT position by CXR was blindly assessed by an experienced pediatric radiologist. Fifty-five infants were enrolled in the delivery room or neonatal intensive care unit. Correct tube placements improved from 48% pre-study to 85 and 93% in the Control and Treatment arms, respectively. The majority of incorrect estimations were that the ETT position using palpation was judged to be too low when it was, in fact, in correct position, as noted in 11 infants. ETT palpation had a 70% concordance with the position determined by CXR. No difficulties or complications were associated with the use of suprasternal palpation. Suprasternal palpation is a simple, safe, teachable, method of confirming ETT position in neonates when CXR is unavailable, and may especially helpful during neonatal resuscitation prior to surfactant administration.

  5. Community analysis of dental plaque and endotracheal tube biofilms from mechanically ventilated patients.

    Science.gov (United States)

    Marino, Poala J; Wise, Matt P; Smith, Ann; Marchesi, Julian R; Riggio, Marcello P; Lewis, Michael A O; Williams, David W

    2017-06-01

    Mechanically ventilated patients are at risk for developing ventilator-associated pneumonia, and it has been reported that dental plaque provides a reservoir of respiratory pathogens that may aspirate to the lungs and endotracheal tube (ETT) biofilms. For the first time, metataxonomics was used to simultaneously characterize the microbiome of dental plaque, ETTs, and non-directed bronchial lavages (NBLs) in mechanically ventilated patients to determine similarities in respective microbial communities and therefore likely associations. Bacterial 16S rRNA gene sequences from 34 samples of dental plaque, NBLs, and ETTs from 12 adult mechanically ventilated patients were analyzed. No significant differences in the microbial communities of these samples were evident. Detected bacteria were primarily oral species (e.g., Fusobacterium nucleatum, Streptococcus salivarius, Prevotella melaninogenica) with respiratory pathogens (Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcuspneumoniae, and Haemophilus influenzae) also in high abundance. The high similarity between the microbiomes of dental plaque, NBLs, and ETTs suggests that the oral cavity is indeed an important site involved in microbial aspiration to the lower airway and ETT. As such, maintenance of good oral hygiene is likely to be highly important in limiting aspiration of bacteria in this vulnerable patient group. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Oral and endotracheal tubes colonization by periodontal bacteria: a case-control ICU study.

    Science.gov (United States)

    Porto, A N; Cortelli, S C; Borges, A H; Matos, F Z; Aquino, D R; Miranda, T B; Oliveira Costa, F; Aranha, A F; Cortelli, J R

    2016-03-01

    Periodontal infection is a possible risk factor for respiratory disorders; however, no studies have assessed the colonization of periodontal pathogens in endotracheal tubes (ET). This case-control study analyzed whether periodontal pathogens are able to colonize ET of dentate and edentulous patients in intensive care units (ICU) and whether oral and ET periodontal pathogen profiles have any correlation between these patients. We selected 18 dentate and 18 edentulous patients from 78 eligible ICU patients. Oral clinical examination including probing depth, clinical attachment level, gingival index , and plaque index was performed by a single examiner, followed by oral and ET sampling and processing by quantitative polymerase chain reaction (total bacterial load, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythia). Data were statistically analyzed by Mann-Whitney U, two-way analysis of variance (p oral and ET bacterial levels, while edentulous patients showed positive correlations between oral and ET levels of A. actinomycetemcomitans, P. gingivalis, and T. forsythia. Periodontal pathogens can colonize ET and the oral cavity of ICU patients. Periodontal pathogen profiles tend to be similar between dentate and edentulous ICU patients. In ICU patients, oral cavity represents a source of ET contamination. Although accompanied by higher oral bacterial levels, teeth do not seem to influence ET bacterial profiles.

  7. Lung recruitment and endotracheal suction in ventilated preterm infants measured with electrical impedance tomography.

    Science.gov (United States)

    Hough, Judith L; Shearman, Andrew D; Liley, Helen; Grant, Caroline A; Schibler, Andreas

    2014-11-01

    Although suctioning is a standard airway maintenance procedure, there are significant associated risks, such as loss of lung volume due to high negative suction pressures. This study aims to assess the extent and duration of change in end-expiratory level (EEL) resulting from endotracheal tube (ETT) suction and to examine the relationship between EEL and regional lung ventilation in ventilated preterm infants with respiratory distress syndrome. A prospective observational clinical study of the effect of ETT suction on 20 non-muscle-relaxed preterm infants with respiratory distress syndrome (RDS) on conventional mechanical ventilation was conducted in a neonatal intensive care unit. Ventilation distribution was measured with regional impedance amplitudes and EEL using electrical impedance tomography. ETT suction resulted in a significant increase in EEL post-suction (P suction, suggesting heterogeneity. Tidal volume was significantly lower in volume-guarantee ventilation compared with pressure-controlled ventilation (P = 0.04). ETT suction in non-muscle-relaxed and ventilated preterm infants with RDS results in significant lung volume increase that is maintained for at least 90 min. Regional differences in distribution of ventilation with ETT suction suggest that the behaviour of the lung is heterogeneous in nature. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  8. Reduction of potential respiratory pathogens by oral hygienic treatment in patients undergoing endotracheal anesthesia.

    Science.gov (United States)

    Okuda, Minori; Kaneko, Yuzuru; Ichinohe, Tatsuya; Ishihara, Kazuyuki; Okuda, Katsuji

    2003-01-01

    This study was conducted to evaluate the usefulness of mechanical and chemical prophylactic oral cleansing treatments for reducing potential respiratory pathogens existing in the oral cavity. Thirty-two patients scheduled to undergo oral and maxillofacial surgery that required endotracheal anesthesia were randomly allocated to one of the two groups, the oral cleansing group (n = 16) or the noncleansing group (n = 16). Culture and polymerase chain reaction (PCR) methods were used to detect and enumerate pathogens. Oral cleansing was carried out with an electric toothbrush capable of automatically supplying and aspirating povidone-iodine solution before surgery, followed by rinsing twice a day after surgery. Cephazolin (3 g x day(-1)) was given to all patients for 5 days after surgery. The PCR detection rates of Streptococcus pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, and Porphyromonas gingivalis in gargle samples before treatment were 87.5%, 68.8%, 53.1%, and 40.6%, respectively. Oral cleansing reduced the detection rates and numbers of methicillin-sensitive Staphylococcus species, S. pneumoniae, and H. influenzae. In contrast, there was no significant reduction of methicillin-resistant Staphylococcus species, S. pneumoniae, H. influenzae, or P. aeruginosa in subjects who underwent systemic cephazolin administration without oral cleansing. The combination of mechanical and chemical oral cleansing resulted in a significant reduction of potential respiratory pathogens in the oral cavity.

  9. Performance of an Optimized Paper-Based Test for Rapid Visual Measurement of Alanine Aminotransferase (ALT in Fingerstick and Venipuncture Samples.

    Directory of Open Access Journals (Sweden)

    Sidhartha Jain

    Full Text Available A paper-based, multiplexed, microfluidic assay has been developed to visually measure alanine aminotransferase (ALT in a fingerstick sample, generating rapid, semi-quantitative results. Prior studies indicated a need for improved accuracy; the device was subsequently optimized using an FDA-approved automated platform (Abaxis Piccolo Xpress as a comparator. Here, we evaluated the performance of the optimized paper test for measurement of ALT in fingerstick blood and serum, as compared to Abaxis and Roche/Hitachi platforms. To evaluate feasibility of remote results interpretation, we also compared reading cell phone camera images of completed tests to reading the device in real time.96 ambulatory patients with varied baseline ALT concentration underwent fingerstick testing using the paper device; cell phone images of completed devices were taken and texted to a blinded off-site reader. Venipuncture serum was obtained from 93/96 participants for routine clinical testing (Roche/Hitachi; subsequently, 88/93 serum samples were captured and applied to paper and Abaxis platforms. Paper test and reference standard results were compared by Bland-Altman analysis.For serum, there was excellent agreement between paper test and Abaxis results, with negligible bias (+4.5 U/L. Abaxis results were systematically 8.6% lower than Roche/Hitachi results. ALT values in fingerstick samples tested on paper were systematically lower than values in paired serum tested on paper (bias -23.6 U/L or Abaxis (bias -18.4 U/L; a correction factor was developed for the paper device to match fingerstick blood to serum. Visual reads of cell phone images closely matched reads made in real time (bias +5.5 U/L.The paper ALT test is highly accurate for serum testing, matching the reference method against which it was optimized better than the reference methods matched each other. A systematic difference exists between ALT values in fingerstick and paired serum samples, and can be

  10. Evaluation of Multi Canister Overpack (MCO) Handling Machine Uplift Restraint for a Seismic Event During Repositioning Operations

    Energy Technology Data Exchange (ETDEWEB)

    SWENSON, C.E.

    2000-05-15

    Insertion of the Multi-Canister Overpack (MCO) assemblies into the Canister Storage Building (CSB) storage tubes involves the use of the MCO Handling Machine (MHM). During MCO storage tube insertion operations, inadvertent movement of the MHM is prevented by engaging seismic restraints (''active restraints'') located adjacent to both the bridge and trolley wheels. During MHM repositioning operations, the active restraints are not engaged. When the active seismic restraints are not engaged, the only functioning seismic restraints are non-engageable (''passive'') wheel uplift restraints which function only if the wheel uplift is sufficient to close the nominal 0.5-inch gap at the uplift restraint interface. The MHM was designed and analyzed in accordance with ASME NOG-1-1995. The ALSTHOM seismic analysis reported seismic loads on the MHM uplift restraints and EDERER performed corresponding structural calculations to demonstrate structural adequacy of the seismic uplift restraint hardware. The ALSTHOM and EDERER calculations were performed for a parked MHM with the active seismic restraints engaged, resulting in uplift restraint loading only in the vertical direction. In support of development of the CSB Safety Analysis Report (SAR), an evaluation of the MHM seismic response was requested for the case where the active seismic restraints are not engaged. If a seismic event occurs during MHM repositioning operations, a moving contact at a seismic uplift restraint would introduce a friction load on the restraint in the direction of the movement. These potential horizontal friction loads on the uplift restraints were not included in the existing restraint hardware design calculations. One of the purposes of the current evaluation is to address the structural adequacy of the MHM seismic uplift restraints with the addition of the horizontal friction associated with MHM repositioning movements.

  11. An unexpected increase in restraint duration alters the expression of stress response habituation

    Science.gov (United States)

    Kearns, Rachael R.; Spencer, Robert L.

    2013-01-01

    While habituation develops to a repeated psychological stressor, manipulating certain parameters of the stress challenge experience may lead to dishabituation of the stress response. In this experiment, we investigated whether the behavioral, endocrine, and neural responses (c-fos mRNA immediate early gene expression) to a psychological stressor (restraint) differ when the duration of the stressor given on the test day violates expectations based on prior stress experience. Rats experienced 10 min of daily restraint on Days 1-4 followed by challenge with either the same duration (10 min) or a longer duration (30 min) of restraint on Day 5. Rats’ behavior was video recorded during the Day 5 restraint episode, and trunk blood and brain tissue were collected 30 min following restraint onset. Struggling behavior was manually scored as active attempts to escape the restraint device. Rats who experienced the same duration of repeated restraint showed a significant decrease of plasma corticosterone (CORT) compared to the 10 min acute restraint group (habituation). In addition, these rats showed decreased active struggling over repeated restraint trials. Conversely, the rats showed an increased CORT response (dishabituation) when they experienced a longer duration of restraint on Day 5 than they had previously. These rats showed a habituated behavioral response during the first 10 min of restraint, however struggling behavior increased once the duration of restraint exceeded the expected duration (with a peak at 12 min). This peak in struggling behavior did not occur during 30 min acute restraint, indicating that the effect was related to memory of previous restraint experience and not due to a longer duration of restraint. In contrast, these animals showed habituated c-fos mRNA expression in the paraventricular nucleus (PVN), lateral septum (LS), and medial prefrontal cortex (mPFC) in response to the increased stressor duration. Thus, there was dissociation between c

  12. Coping with budget restraint in a Scandinavian welfare state

    DEFF Research Database (Denmark)

    Nielsen, Annemette Ljungdalh; Holm, Lotte; Lund, Thomas Bøker

    2015-01-01

    , and using left overs, expressed some kind of extra resources in comparison to the interviewees with negative experiences in the shape of e.g. more secure life circumstances, cooking skills, and a supporting social network. The qualitative study also indicated that certain similar coping strategies...... such as eating seasonal fruits and vegetables, storing and using leftovers, and cooking from filling ingredients could result in either a higher or a lower intake of fruits and vegetables in adults and children. The study concludes that food budget restraint and the consequences of it are relevant to discuss...

  13. Crew Restraint Design for the International Space Station

    Science.gov (United States)

    Norris, Lena; Holden, Kritina; Whitmore, Mihriban

    2006-01-01

    With permanent human presence onboard the International Space Station (ISS), crews will be living and working in microgravity, dealing with the challenges of a weightless environment. In addition, the confined nature of the spacecraft environment results in ergonomic challenges such as limited visibility and access to the activity areas, as well as prolonged periods of unnatural postures. Without optimum restraints, crewmembers may be handicapped for performing some of the on-orbit tasks. Currently, many of the tasks on ISS are performed with the crew restrained merely by hooking their arms or toes around handrails to steady themselves. This is adequate for some tasks, but not all. There have been some reports of discomfort/calluses on the top of the toes. In addition, this type of restraint is simply insufficient for tasks that require a large degree of stability. Glovebox design is a good example of a confined workstation concept requiring stability for successful use. They are widely used in industry, university, and government laboratories, as well as in the space environment, and are known to cause postural limitations and visual restrictions. Although there are numerous guidelines pertaining to ventilation, seals, and glove attachment, most of the data have been gathered in a 1-g environment, or are from studies that were conducted prior to the early 1980 s. Little is known about how best to restrain a crewmember using a glovebox in microgravity. Another ISS task that requires special consideration with respect to restraints is robotic teleoperation. The Robot Systems Technology Branch at the NASA Johnson Space Center is developing a humanoid robot astronaut, or Robonaut. It is being designed to perform extravehicular activities (EVAs) in the hazardous environment of space. An astronaut located inside the ISS will remotely operate Robonaut through a telepresence control system. Essentially, the robot mimics every move the operator makes. This requires the

  14. Palatable Foods, Stress, and Energy Stores Sculpt Corticotropin-Releasing Factor, Adrenocorticotropin, and Corticosterone Concentrations after Restraint

    National Research Council Canada - National Science Library

    Foster, Michelle T; Warne, James P; Ginsberg, Abigail B; Horneman, Hart F; Pecoraro, Norman C; Akana, Susan F; Dallman, Mary F

    2009-01-01

    Previous studies have shown reduced hypothalamo-pituitary-adrenal responses to both acute and chronic restraint stressors in rats allowed to ingest highly palatable foods (32% sucrose ± lard) prior to restraint...

  15. 75 FR 44284 - Notice of Draft NIJ Criminal Justice Restraints Selection and Application Guide

    Science.gov (United States)

    2010-07-28

    ... is open to industry technical representatives, criminal justice agencies and organizations, research... of Justice Programs Notice of Draft NIJ Criminal Justice Restraints Selection and Application Guide... of Draft NIJ Criminal Justice Restraints Selection and Application Guide. SUMMARY: In an effort to...

  16. Weight gain, dietary restraint, and disordered eating in the freshman year of college.

    Science.gov (United States)

    Delinsky, Sherrie S; Wilson, G Terence

    2008-01-01

    The aims of the study were to assess whether women during the first year of college experience (1) significant weight gain; (2) a prospective relation between dietary restraint and weight gain; (3) an increase in disordered eating; and (4) a prospective relation between dietary restraint or concern about the Freshmen 15 (i.e., weight gain of 15 lbs during the freshman year of college) and disordered eating. Participants were 336 female students in their first year of college who completed questionnaire measures of Body Mass Index (BMI), eating disorder pathology, dietary restraint, body image, and self-esteem. Participants' mean weight gain was approximately 3 lbs (1.5 kg), and among those who gained weight, the mean gain was 7.32 lbs (3.3 kg). Dietary restraint in September did not predict weight change in April, but participants who lost weight reported significantly greater dietary restraint than those participants who gained weight. Eating disorder symptoms increased significantly from September to April. Dietary restraint, concern about the "Freshman 15", and self-esteem in September uniquely predicted EDE-Q Weight and Shape Concern subscale scores in April. Female students in their first year of college gain a small but significant amount of weight, and weight gain was mostly unrelated to dietary restraint. Disordered eating increases during the first year of college and, is predicted by prospective dietary restraint and concerns about weight gain.

  17. Clinical decision making on the use of physical restraint in intensive care units

    Directory of Open Access Journals (Sweden)

    Xinqian Li

    2014-12-01

    Full Text Available Physical restraint is a common nursing intervention in intensive care units and nurses often use it to ensure patients' safety and to prevent unexpected accidents. However, existing literature indicated that the use of physical restraint is a complex one because of inadequate rationales, the negative physical and emotional effects on patients, but the lack of perceived alternatives. This paper is aimed to interpret the clinical decision-making theories related to the use of physical restraint in intensive care units in order to facilitate our understanding on the use of physical restraint and to evaluate the quality of decisions made by nurses. By reviewing the literature, intuition and heuristics are the main decision-making strategies related to the use of physical restraint in intensive care units because the rapid and reflexive nature of intuition and heuristics allow nurses to have a rapid response to urgent and emergent cases. However, it is problematic if nurses simply count their decision-making on experience rather than incorporate research evidence into clinical practice because of inadequate evidence to support the use of physical restraint. Besides that, such a rapid response may lead nurses to make decisions without adequate assessment and thinking and therefore biases and errors may be generated. Therefore, despite the importance of intuition and heuristics in decision-making in acute settings on the use of physical restraint, it is recommended that nurses should incorporate research evidence with their experience to make decisions and adequate assessment before implementing physical restraint is also necessary.

  18. Suppression of Pica by Overcorrection and Physical Restraint: A Comparative Analysis.

    Science.gov (United States)

    Singh, Nirbhay N.; Bakker, Leon W.

    1984-01-01

    Each occurrence of pica (ingestion of inedible objects) in two profoundly retarded adults was followed by either overcorrection or physical restraint. Although both procedures reduced the occurrence of pica and had a similar effect on collateral behaviors, physical restraint was clinically more effective in terms of immediate response reduction.…

  19. Dieting, Dietary Restraint, and Binge Eating Disorder among Overweight Adolescents in Turkey

    Science.gov (United States)

    Bas, Murat; Bozan, Nuray; Cigerim, Nevin

    2008-01-01

    The purpose of this study was to determine the relationship among dieting, dietary restraint, disinhibition, hunger, and binge eating among overweight adolescent girls. Participants were 743 overweight adolescent girls between 16 and 19 years of age. The mean BMI was 24.9 [+ or -] 0.8 kg/[m[superscript 2] in the low-restraint group and 25.1 [+ or…

  20. [Vision on and use of physical restraints and 'smart technology' in nursing homes in Flanders].

    Science.gov (United States)

    Carlassara, V; Lampo, E; Degryse, B; Van Audenhove, C; Spruytte, N

    2017-04-01

    The STAFF-project investigates in what way 'smart technology' can offer an alternative for physical restraints in nursing homes. A survey is realized aimed at gaining more insight into the vision on and the use of physical restraints and 'smart technology'. Two partly overlapping structured questionnaires were developed and sent to nursing home staff in Flanders (Belgium). One hundred fifty six administrators (managers or assistant-managers) and 238 caregiving staff (nurses, nursing aids, paramedical staff and other) completed the online questionnaire. In general there is a low acceptability of physical restraint use, however, a more nuanced picture of acceptability is present depending on the specific motivation for using physical restraints and on the specific means of physical restraints. About half of the administrators say they use smart technology in the nursing home. The two main reasons for not applying (yet) smart technology are 'too high price for smart technology' and 'inadequate infrastructure of the nursing home'. All respondents underscore the importance of multiple strategies to diminish the use of physical restraints in nursing homes. Physical restraint use is a complex theme and needs a nuanced analysis and management. This study shows that there is still room for improvement in diminishing the use of physical restraints and that nursing homes in Flanders are open to use smart technology.

  1. The Use of Physical Restraint in the Care of the Mentally Ill by ...

    African Journals Online (AJOL)

    Background: The use of physical restraint as an intervention in the care of psychiatric patients is as old as psychiatry and remains one of the common procedures in psychiatry. Nurses play crucial roles in the application. Aim: To evaluate the practice of physical restraint by nurses in a tertiary psychiatric hospital. Methods: ...

  2. 19 CFR 159.44 - Special duties on merchandise imported under agreements in restraint of trade.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Special duties on merchandise imported under agreements in restraint of trade. 159.44 Section 159.44 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION... § 159.44 Special duties on merchandise imported under agreements in restraint of trade. Whenever it...

  3. CCBD's Position Summary on the Use of Physical Restraint Procedures in School Settings

    Science.gov (United States)

    Peterson, Reece; Albrecht, Susan; Johns, Bev

    2009-01-01

    This document provides policy recommendations of the Council for Children with Behavioral Disorders regarding the use of physical restraint procedures in schools. It includes (a) an introduction, (b) a declaration of principles, and (c) recommendations regarding the use of physical restraint in school settings. Explanation or elaboration of…

  4. Success and failure in the measurement of restraint : notes and data

    NARCIS (Netherlands)

    van Strien, T

    OBJECTIVE: The clarification of the present confusion about the confounding of success and failure in the measurement of restrained eating. METHOD: Close inspection of results regarding the Restraint Scale (RS) and the restraint scales of homogeneous measures of restrained eating, for example, the

  5. The Association for Behavior Analysis International Position Statement on Restraint and Seclusion

    Science.gov (United States)

    Vollmer, Timothy R.; Hagopian, Louis P.; Bailey, Jon S.; Dorsey, Michael F.; Hanley, Gregory P.; Lennox, David; Riordan, Mary M.; Spreat, Scott

    2011-01-01

    A task force authorized by the Executive Council of the Association for Behavior Analysis International (ABAI) generated the statement below concerning the techniques called "restraint" and "seclusion." Members of the task force independently reviewed the scientific literature concerning restraint and seclusion and agreed unanimously to the…

  6. Recent Changes in State Policies and Legislation Regarding Restraint or Seclusion

    Science.gov (United States)

    Freeman, Jennifer; Sugai, George

    2013-01-01

    In this article, we describe and evaluate the extent to which recent changes to state-level policy are related to seclusion and restraint in schools and detail what components of comprehensive restraint and seclusion policy are indicated. We examined state policy documents and coded them for the presence of specific characteristics related to…

  7. CCBD's Position Summary on Physical Restraint & Seclusion Procedures in School Settings

    Science.gov (United States)

    Peterson, Reece; Albrecht, Susan; Johns, Bev

    2009-01-01

    This document is a summary of policy recommendations from two longer and more detailed documents available from the Council for Children with Behavioral Disorders (CCBD) regarding the use of physical restraint and seclusion procedures in schools. These recommendations include: (1) CCBD believes that physical restraint or seclusion procedures…

  8. Electroconvulsive Stimulation, but not Chronic Restraint Stress, Causes Structural Alterations in Adult Rat Hippocampus

    DEFF Research Database (Denmark)

    Olesen, Mikkel V.; Wörtwein, Gitta; Pakkenberg, Bente

    2015-01-01

    of newly formed neurons in the hippocampal subgranular zone. Also estimated were the total number of neurons and the volume of the granule cell layer in adult rats subjected to chronic restraint stress and electroconvulsive stimulation either alone or in combination. We found that chronic restraint stress...

  9. The story behind the Dutch model: the consensual politics of wage restraint

    NARCIS (Netherlands)

    Hendriks, C.

    2011-01-01

    The idea of wage restraint has a long history in the Netherlands and has been presented as the recipe for economic recovery for many years now. In times of economic (and political) crisis, wage restraint has been the standard response of the Dutch government, often in cooperation with unions and

  10. Education on physical restraint reduction in dementia care: a review of the literature.

    Science.gov (United States)

    De Bellis, A; Mosel, K; Curren, D; Prendergast, J; Harrington, A; Muir-Cochrane, E

    2013-01-01

    Dementia is a priority area for all countries as populations age and dementia prevalence increases. The use of physical restraint is a possible clinical practice for persons with dementia across settings when behaviours indicate a perceived need. Indeed, this may be the first choice in practice, occurring in part because of lack of education, safety concerns, perceived costs and staffing issues. This article reviews the literature on the issues surrounding, and use of, physical restraint for people with dementia, highlighting the rationales for use and the benefits and barriers to physical restraint. Recommendations include the importance of education and policy to reduce or eliminate physical restraint of persons with dementia to overcome identified barriers at the individual, cultural and organizational levels. An educational programme from the literature review is proposed specific to the reduction or elimination of physical restraint.

  11. PERMOL: restraint-based protein homology modeling using DYANA or CNS.

    Science.gov (United States)

    Möglich, Andreas; Weinfurtner, Daniel; Gronwald, Wolfram; Maurer, Till; Kalbitzer, Hans Robert

    2005-05-01

    PERMOL is a new restraint-based program for homology modeling of proteins. Restraints are generated from the information contained in structures of homologous template proteins. Employing the restraints generated by PERMOL, three-dimensional structures are obtained using MD programs such as DYANA or CNS. In contrast to other programs PERMOL is mainly based on the use of dihedral angle information which is optimally suited to preserve the local secondary structure. The global arrangement of these elements is then facilitated by a small number of distance restraints. Using PERMOL homology, models of high quality are obtained. A key advantage of the proposed method is its flexibility, which allows the inclusion of data from other sources, such as experimental restraints and the use of modern molecular dynamics programs to calculate structures. The software and a detailed manual are available free of charge (http://www.biologie.uni-regensburg.de/Biophysik/Kalbitzer/permol/permol.html)

  12. Altitude-Related Change in Endotracheal Tube Cuff Pressures in Helicopter EMS.

    Science.gov (United States)

    Weisberg, Stacy N; McCall, Jonathan C; Tennyson, Joseph

    2017-06-01

    Over-inflation of endotracheal tube (ETT) cuffs has the potential to lead to scarring and stenosis of the trachea.1, 2,3, 4 The air inside an ETT cuff is subject to expansion as atmospheric pressure decreases, as happens with an increase in altitude. Emergency medical services helicopters are not pressurized, thereby providing a good environment for studying the effects of altitude changes ETT cuff pressures. This study aims to explore the relationship between altitude and ETT cuff pressures in a helicopter air-medical transport program. ETT cuffs were initially inflated in a nonstandardized manner and then adjusted to a pressure of 25 cmH 2 O. The pressure was again measured when the helicopter reached maximum altitude. A final pressure was recorded when the helicopter landed at the receiving facility. We enrolled 60 subjects in the study. The mean for initial tube cuff pressures was 70 cmH 2 O. Maximum altitude for the program ranged from 1,000-3,000 feet above sea level, with a change in altitude from 800-2,480 feet. Mean cuff pressure at altitude was 36.52 ± 8.56 cmH 2 O. Despite the significant change in cuff pressure at maximum altitude, there was no relationship found between the maximum altitude and the cuff pressures measured. Our study failed to demonstrate the expected linear relationship between ETT cuff pressures and the maximum altitude achieved during typical air-medical transportation in our system. At altitudes less than 3,000 feet above sea level, the effect of altitude change on ETT pressure is minimal and does not require a change in practice to saline-filled cuffs.

  13. Congenital diaphragmatic hernia: endotracheal fluid phospholipidic profile following tracheal occlusion in an experimental model.

    Science.gov (United States)

    Pelizzo, Gloria; Mimmi, Maria Chiara; Peiro, Jose Luis; Marotta, Mario; Amoroso, Francesco; Fusillo, Mario; Carlini, Veronica; Calcaterra, Valeria

    2017-02-01

    To compare endotracheal fluid (EF) and amniotic fluid (AF) phospholipidic profile changes following tracheal occlusion (TO) in the congenital diaphragmatic hernia (CDH) fetal lamb model, in order to support the efficacy of TO on lung maturity. A diaphragmatic defect was induced at 70 days' gestation, TO was carried out at day 102 and cesarean section at 136 days' gestation. EF and AF samples, collected at delivery, were evaluated using mass spectrometry (the analysis focused on palmitoyloleoyl-phosphatidylcholine [POPC, PC(18:1/16:0)], dipalmitoyl-phosphatidylcholine [DPPC, PC(16:0/16:0)] and sphingomyelins [SMs]). The effects of CDH and TO were different on AF and EF. POPC levels were higher than DPPC levels in AF of healthy lambs. Following induction of the diaphragmatic malformation, an evident decrease in POPC was noted, while a substantial return to normal POPC levels and an increased DPPC peak were prompted by the TO. After CDH induction, a decrease in N-palmitoyl-D-sphingomyelin [SM(d18:1/16:0)] was revealed (P<0.01) and an increased peak in SMs in AF was prompted by the TO (P=0.05). While the most represented phosphatidylcholine (PC) species in EF of healthy lambs was DPPC, CDH induced a decrease in the DPPC peak and treatment with TO induced its partial recovery. SMs were detectable only in healthy EF samples. The phospholipid recovery profile following TO suggests the potential role of this therapy in restoring processes involved in surfactant-mediated lung maturation, even though other interactions involved in AF turnover should be considered. Moreover, these metabolites could be used as biomarkers of fetal pulmonary development.

  14. Incremental change in cross sectional area in small endotracheal tubes: A call for more size options.

    Science.gov (United States)

    Mortelliti, Caroline L; Mortelliti, Anthony J

    2016-08-01

    To elucidate the relatively large incremental percent change (IPC) in cross sectional area (CSA) in currently available small endotracheal tubes (ETTs), and to make recommendation for lesser incremental change in CSA in these smaller ETTs, in order to minimize iatrogenic airway injury. The CSAs of a commercially available line of ETTs were calculated, and the IPC of the CSA between consecutive size ETTs was calculated and graphed. The average IPC in CSA with large ETTs was applied to calculate identical IPC in the CSA for a theoretical, smaller ETT series, and the dimensions of a new theoretical series of proposed small ETTs were defined. The IPC of CSA in the larger (5.0-8.0 mm inner diameter (ID)) ETTs was 17.07%, and the IPC of CSA in the smaller ETTs (2.0-4.0 mm ID) is remarkably larger (38.08%). Applying the relatively smaller IPC of CSA from larger ETTs to a theoretical sequence of small ETTs, starting with the 2.5 mm ID ETT, suggests that intermediate sizes of small ETTs (ID 2.745 mm, 3.254 mm, and 3.859 mm) should exist. We recommend manufacturers produce additional small ETT size options at the intuitive intermediate sizes of 2.75 mm, 3.25 mm, and 3.75 mm ID in order to improve airway management for infants and small children. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. The effectiveness of preformed tooth protectors during endotracheal intubation: an upper jaw model.

    Science.gov (United States)

    Monaca, Enrico; Fock, Norbert; Doehn, Manfred; Wappler, Frank

    2007-11-01

    In anesthetic practice, tooth damage may impair patient safety and is a common reason for litigation. The use of dental shields may reduce this complication. In this study, we examined the effectiveness of dental shields for altering the force on the teeth during endotracheal intubation. Five preformed dental shields (Endoragard, Ormco, Nouveau Dispositif (ND), PEB, and Camo) were evaluated in three different categories: (a) horizontal force reduction, (b) axial force reduction, and (c) impact on the view of the oral cavity. Force reduction was examined by using an upper jaw model. The upper incisors of the model were covered with each of the dental shields and then loaded with a force of 150 N via a blade of a laryngoscope directed to the maxillary left central incisor (tooth 9). The force distributed to the four maxillary central and lateral incisors by the dental shield was also measured by strain gauges placed to estimate the force applied to each tooth. The reduction in oral view was determined by measuring the thickness of each dental shield with a micrometer. Dental shield Ormco Sports-Guard achieved the highest force reduction results, followed by Camo and Endoragard. ND and PEB showed poor, but statistically significant, force reduction with either the worst axial (ND) or horizontal (PEB) results. In contrast, Ormco was the most voluminous model, followed by ND and Camo. PEB and Endoragard were the thinnest models. Preformed dental shields are useful to reduce the force applied to the teeth and potentially reduce the probability of tooth damage during laryngoscopy. However, the shield with the most force reduction capability is rather large and also expensive, making general use impossible. Further prospective studies are needed to evaluate efficacy and safety of tooth protectors.

  16. Motion capture measures variability in laryngoscopic movement during endotracheal intubation: a preliminary report.

    Science.gov (United States)

    Carlson, Jestin N; Das, Samarjit; De la Torre, Fernando; Callaway, Clifton W; Phrampus, Paul E; Hodgins, Jessica

    2012-08-01

    Success rates with emergent endotracheal intubation (ETI) improve with increasing provider experience. Few objective metrics exist to quantify differences in ETI technique between providers of various skill levels. We tested the feasibility of using motion capture videography to quantify variability in the motions of the left hand and the laryngoscope in providers with various experience. Three providers with varying levels of experience [attending physician (experienced), emergency medicine resident (intermediate), and postdoctoral student with no previous ETI experience (novice)] each performed ETI 4 times on a mannequin. Vicon, a 16-camera system, tracked the 3-dimensional orientation and movement of markers on the providers, handle of the laryngoscope, and mannequin. Attempt duration, path length of the left hand, and the inclination of the plane of the laryngoscope handle (mean square angular deviation from vertical) were calculated for each laryngoscopy attempt. We compared interattempt and interprovider variability of each measure. All ETI attempts were successful. Mean (SD) duration of laryngoscopy attempts differed between experienced [5.50 (0.68) seconds], intermediate [6.32 (1.13) seconds], and novice [12.38 (1.06) seconds] providers (P = 0.021). Mean path length of the left hand did not differ between providers (P = 0.37). Variability of the plane of the laryngoscope differed between providers: 8.3 (experienced), 28.7 (intermediate), and 54.5 (novice) degrees squared. Motion analysis can detect interprovider differences in hand and laryngoscope movements during ETI, which may be related to provider experience. This technology has potential to objectively measure training and skill in ETI.

  17. [Correlation between oro and hypopharynx shape and position with endotracheal intubation difficulty].

    Science.gov (United States)

    Rabadi, Daher; Baker, Ahmad Abu; Al-Qudah, Mohannad

    2014-01-01

    Prediction of intubation difficulty can save patients from major preoperative morbidity or mortality. The purpose of this paper is to assess the correlation between oro-hypo pharynx position, neck size, and length with endotracheal intubation difficulty. The study also explored the diagnostic value of Friedman Staging System in prediction cases with difficult intubation. The consecutive 500 ASA (I, II) adult patients undergoing elective surgery were evaluated for oro and hypopharynx shape and position by modified Mallampati, Cormack and Lehane score as well as Friedman obstructive sleep apnea classification systems. Neck circumference and length were also measured. All cases were intubated by a single anesthesiologist who was uninformed of the above evaluation and graded intubation difficulty in visual analog score. Correlation between these findings and difficulty of intubation was assessed. Sensitivity, Specificity, Positive and Negative Predictive Values were also reported. Cormack-Lehane grade had the strongest correlation with difficulty of intubation followed by Friedman palate position. Friedman palate position was the most sensitive and had higher positive and negative predictive values than modified Mallampati classification. Cormack-Lehane grade was found to be the most specific with the highest negative predictive value among the four studied classifications. Friedman palate position is a more useful, valuable and sensitive test compared to the modified Mallampati screening test for pre-anesthetic prediction of difficult intubation where its involvement in Multivariate model may raise the accuracy and diagnostic value of preoperative assessment of difficult airway. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  18. Evaluation of an automated endotracheal tube cuff controller during simulated mechanical ventilation.

    Science.gov (United States)

    Chenelle, Christopher T; Oto, Jun; Sulemanji, Demet; Fisher, Daniel F; Kacmarek, Robert M

    2015-02-01

    Maintaining endotracheal tube cuff pressure within a narrow range is an important factor in patient care. The goal of this study was to evaluate the IntelliCuff against the manual technique for maintaining cuff pressure during simulated mechanical ventilation with and without movement. The IntelliCuff was compared to the manual technique of a manometer and syringe. Two independent studies were performed during mechanical ventilation: part 1, a 2-h trial incorporating continuous mannikin head movement; and part 2, an 8-h trial using a stationary trachea model. We set cuff pressure to 25 cm H2O, PEEP to 10 cm H2O, and peak inspiratory pressures to 20, 30, and 40 cm H2O. Clinical importance was defined as both statistically significant (P10%). In part 1, the change in cuff pressure from before to after ventilation was clinically important for the manual technique (P<.001, Δ=-39.6%) but not for the IntelliCuff (P=.02, Δ=3.5%). In part 2, the change in cuff pressure from before to after ventilation was clinically important for the manual technique (P=.004, Δ=-14.39%) but not for the IntelliCuff (P=.20, Δ=5.65%). There was a clinically important drop in manually set cuff pressure during simulated mechanical ventilation in a stationary model and an even larger drop with movement, but this was significantly reduced by the IntelliCuff in both scenarios. Additionally, we observed that cuff pressure varied directly with inspiratory airway pressure for both techniques, leading to elevated average cuff pressures. Copyright © 2015 by Daedalus Enterprises.

  19. Feasibility of an endotracheal tube-mounted camera for percutaneous dilatational tracheostomy.

    Science.gov (United States)

    Grensemann, J; Eichler, L; Hopf, S; Jarczak, D; Simon, M; Kluge, S

    2017-07-01

    Percutaneous dilatational tracheostomy (PDT) in critically ill patients is often led by optical guidance with a bronchoscope. This is not without its disadvantages. Therefore, we aimed to study the feasibility of a recently introduced endotracheal tube-mounted camera (VivaSight™-SL, ET View, Misgav, Israel) in the guidance of PDT. We studied 10 critically ill patients who received PDT with a VivaSight-SL tube that was inserted prior to tracheostomy for optical guidance. Visualization of the tracheal structures (i.e., identification and monitoring of the thyroid, cricoid, and tracheal cartilage and the posterior wall) and the quality of ventilation (before puncture and during the tracheostomy) were rated on four-point Likert scales. Respiratory variables were recorded, and blood gases were sampled before the interventions, before the puncture and before the insertion of the tracheal cannula. Visualization of the tracheal landmarks was rated as 'very good' or 'good' in all but one case. Monitoring during the puncture and dilatation was also rated as 'very good' or 'good' in all but one. In the cases that were rated 'difficult', the visualization and monitoring of the posterior wall of the trachea were the main concerns. No changes in the respiratory variables or blood gases occurred between the puncture and the insertion of the tracheal cannula. Percutaneous dilatational tracheostomy with optical guidance from a tube-mounted camera is feasible. Further studies comparing the camera tube with bronchoscopy as the standard approach should be performed. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  20. Resuscitation Prior to Emergency Endotracheal Intubation: Results of a National Survey

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    Robert S. Green

    2016-09-01

    Full Text Available Introduction: Respiratory failure is a common problem in emergency medicine (EM and critical care medicine (CCM. However, little is known about the resuscitation of critically ill patients prior to emergency endotracheal intubation (EETI. Our aim was to describe the resuscitation practices of EM and CCM physicians prior to EETI. Methods: A cross-sectional survey was developed and tested for content validity and retest reliability by members of the Canadian Critical Care Trials Group. The questionnaire was distributed to all EM and CCM physician members of three national organizations. Using three clinical scenarios (trauma, pneumonia, congestive heart failure, we assessed physician preferences for use and types of fluid and vasopressor medication in pre-EETI resuscitation of critically ill patients. Results: In total, 1,758 physicians were surveyed (response rate 50.2%, 882/1,758. Overall, physicians would perform pre-EETI resuscitation using either fluids or vasopressors in 54% (1,193/2,203 of cases. Most physicians would “always/often” administer intravenous fluid pre-EETI in the three clinical scenarios (81%, 1,484/1,830. Crystalloids were the most common fluid physicians would “always/often” administer in congestive heart failure (EM 43%; CCM 44%, pneumonia (EM 97%; CCM 95% and trauma (EM 96%; CCM 96%. Pre-EETI resuscitation using vasopressors was uncommon (4.9%. Training in CCM was associated with performing pre-EETI resuscitation (odds ratio, 2.20; 95% CI, [1.44-3.36], p<0.001. Conclusion: Pre-EETI resuscitation is common among Canadian EM and CCM physicians. Most physicians use crystalloids pre-EETI as a resuscitation fluid, while few would give vasopressors. Physicians with CCM training were more likely to perform pre-EETI resuscitation.

  1. Treatment with endotracheal therapeutics after sarin microinstillation inhalation exposure increases blood cholinesterase levels in guinea pigs.

    Science.gov (United States)

    Che, Magnus M; Song, Jian; Oguntayo, Samuel; Doctor, Bhupendra P; Rezk, Peter; Perkins, Michael W; Sciuto, Alfred M; Nambiar, Madhusoodana P

    2012-05-01

    Acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activities were measured in the blood and tissues of animals that are treated with a number of endotracheally aerosolized therapeutics for protection against inhalation toxicity to sarin. Therapeutics included, aerosolized atropine methyl bromide (AMB), scopolamine or combination of AMB with salbutamol, sphingosine 1-phosphate, keratinocyte growth factor, adenosine A1 receptor antisense oligonucleotide (EPI2010), 2,3-diacetyloxybenzoic acid (2,3 DABA), oxycyte, and survanta. Guinea pigs exposed to 677.4 mg/m(3) or 846.5 mg/m(3) (1.2 LCt(50)) sarin for 4 min using a microinstillation inhalation exposure technique and treated 1 min later with the aerosolized therapeutics. Treatment with all therapeutics significantly increased the survival rate with no convulsions throughout the 24 h study period. Blood AChE activity determined using acetylthiocholine as substrate showed 20% activity remaining in sarin-exposed animals compare to controls. In aerosolized AMB and scopolamine-treated animals the remaining AChE activity was significantly higher (45-60%) compared to sarin-exposed animals (p treatment with all the combination therapeutics resulted in significant increase in blood AChE activity in comparison to sarin-exposed animals although the increases varied between treatments (p treatment with aerosolized therapeutics but was lesser in magnitude compared to AChE activity changes. Various tissues showed elevated AChE activity after therapeutic treatment of sarin-exposed animals. Increased AChE and BChE activities in animals treated with nasal therapeutics suggest that enhanced breathing and reduced respiratory toxicity/lung injury possibly contribute to rapid normalization of chemical warfare nerve agent inhibited cholinesterases.

  2. Pro: one-lung ventilation is best accomplished with the Univent endotracheal tube.

    Science.gov (United States)

    Gayes, J M

    1993-02-01

    Over the years, thoracotomy has changed from a procedure that prompted major concern over cross-contamination caused by infection to pulmonary tumors. Assisting the thoracic surgeon by providing OLV is one of the most specialized skills an anesthesiologist can offer. This must be done in a safe, easy, and efficient manner. The Univent tube appears to be a hybrid, combining the best qualities of both the DLT and the single-lumen endotracheal tube with separate Fogarty-like catheter. The Univent tube is a technical improvement over separate endobronchial blocking catheters because its blocker shaft is attached to the main tube and, therefore, displacement is less likely. In addition, the Univent's axial blocker shaft has a lumen that provides for irrigation, suction, oxygen insufflation, CPAP, and HFV. Though equally as effective as the DLT in treatment of intraoperative hypoxemia, the Univent tube presents a unique advantage in the areas of aspiration prevention, prolonged intubation without tube exchange, and selective blockade of lung segments. The Univent tube is also easier to insert and has fewer associated risks compared to the DLT. Is it my purpose to suggest that because the Univent tube is equal to, or better than, the DLT in many areas, we should abandon the use of DLTs? Definitely not. Double-lumen tubes have performed well in the past and will continue to offer specialized functions, such as postoperative independent lung ventilation in single-lung transplant recipients. As with the acquisition of any new medical skill, the use of the Univent tube has a learning curve. It is worth the time and effort to learn to use the Univent tube.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Appropriate depth of placement of oral endotracheal tube and its possible determinants in Indian adult patients

    Directory of Open Access Journals (Sweden)

    Manu Varshney

    2011-01-01

    Full Text Available Background: Optimal depth of endotracheal tube (ET placement has been a serious concern because of the complications associated with its malposition. Aims: To find the optimal depth of placement of oral ET in Indian adult patients and its possible determinants viz. height, weight, arm span and vertebral column length. Settings and Design: This study was conducted in 200 ASA I and II patients requiring general anaesthesia and orotracheal intubation. Methods: After placing the ET with the designated black mark at vocal cords, various airway distances were measured from the right angle of mouth using a fibre optic bronchoscope. Statistical Analysis: The power of the study is 0.9. Mean (SD and median (range of various parameters and Pearson correlation coefficient was calculated. Results: The mean (SD lip-carina distance, i.e., total airway length was 24.32 (1.81 cm and 21.62 (1.34 cm in males and females, respectively. With black mark of ET between vocal cords, the mean (SD ET tip-carina distance of 3.69 (1.65 cm in males and 2.28 (1.55 cm females was found to be considerably less than the recommended safe distance. Conclusions: Fixing the tube at recommended 23 cm in males and 21 cm in females will lead to carinal stimulation or endobronchial placement in many Indian patients. The lip to carina distance best correlates with patient′s height. Positioning the ET tip 4 cm above carina as recommended will result in placement of tube cuff inside cricoid ring with currently available tubes. Optimal depth of ET placement can be estimated by the formula "(Height in cm/7-2.5."

  4. Plasma cortisol levels in captive wild felines after chemical restraint

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    Nogueira G.P.

    1997-01-01

    Full Text Available Eight Panthera onca (Po, 13 Felis concolor (Fc, 7 Felis yagouaroundi (Fy, 7 Felis tigrina (Ft and 5 Felis pardalis (Fp specimens from São Paulo State zoos were used. All animals were restrained with darts containing 10 mg/kg ketamine and 1 mg/kg xylazine. Venous blood samples were collected as soon as possible (within 15-20 min and serum was frozen until the time for cortisol quantification. Cortisol was determined using a solid phase radioimmunoassay with an intra-assay coefficient of 8.51%. Data were analyzed statistically by the Kruskal-Wallis test, followed by Dunn's multiple comparisons test, and the one-sample t-test, with the level of significance set at P<0.05. Data are reported as means ± SEM. Cortisol levels differed among the captive felines: Po = 166 ± 33a, Fc = 670 ± 118b, Fy = 480 ± 83b, Ft = 237 ± 42ab, Fp = 97 ± 12a nmol/l (values followed by different superscript letters were significantly different (P<0.001. Since most of the veterinary procedures on these species involve chemical restraint, these results show the necessity of preventive measures in order to minimize the effect of restraint stress on more susceptible species

  5. Automated Design of Restraint Layer of an Inflatable Vessel

    Science.gov (United States)

    Spexarth, Gary

    2007-01-01

    A Mathcad computer program largely automates the design and analysis of the restraint layer (the primary load-bearing layer) of an inflatable vessel that consists of one or more sections having cylindrical, toroidal, and/or spherical shape(s). A restraint layer typically comprises webbing in the form of multiple straps. The design task includes choosing indexing locations along the straps, computing the load at every location in each strap, computing the resulting stretch at each location, and computing the amount of undersizing required of each strap so that, once the vessel is inflated and the straps thus stretched, the vessel can be expected to assume the desired shape. Prior to the development of this program, the design task was performed by use of a difficult-to-use spreadsheet program that required manual addition of rows and columns depending on the numbers of strap rows and columns of a given design. In contrast, this program is completely parametric and includes logic that automatically adds or deletes rows and columns as needed. With minimal input from the user, this program automatically computes indexing locations, strap lengths, undersizing requirements, and all design data required to produce detailed drawings and assembly procedures. It also generates textual comments that help the user understand the calculations.

  6. Comparison of chemical restraint techniques in ostrich (Struthio camelus

    Directory of Open Access Journals (Sweden)

    R Ciboto

    2006-06-01

    Full Text Available Chemical restraint in ostriches is usually required for short-time interventions. Thus, this study established and evaluated intravenous anesthetics formulated from commonly used drugs in order to accomplish total restraint on this species and allow painful procedures to be performed. Thirty male and female ostriches weighing from 40 to 90 kg were randomly distributed into five groups. Animals in Groups I, II and III were given acepromazine (0.25 mg/kg i.m. and those in Groups IV and V were given xylazine (1.0 mg/kg i.m.. The following drugs were administered intravenously 15 to 20 min later: Group I - propofol (4.0 mg/kg, Groups II and IV - ketamine (5.0 mg/kg and diazepam (0.25 mg/kg, Groups III and V - tiletamine-zolazepam (3.0 mg/kg. All protocols have produced satisfactory results regarding total containment, muscular relaxation and maintenance of the evaluated parameters within a normal range.

  7. Feasibility of an anticipatory noncontact precrash restraint actuation system

    Energy Technology Data Exchange (ETDEWEB)

    Kercel, S.W.; Dress, W.B. [Oak Ridge National Lab., TN (United States). Instrumentation and Controls Div.

    1995-12-31

    The problem of providing an electronic warning of an impending crash to a precrash restraint system a fraction of a second before physical contact differs from more widely explored problems, such as providing several seconds of crash warning to a driver. One approach to precrash restraint sensing is to apply anticipatory system theory. This consists of nested simplified models of the system to be controlled and of the system`s environment. It requires sensory information to describe the ``current state`` of the system and the environment. The models use the sensory data to make a faster-than-real-time prediction about the near future. Anticipation theory is well founded but rarely used. A major problem is to extract real-time current-state information from inexpensive sensors. Providing current-state information to the nested models is the weakest element of the system. Therefore, sensors and real-time processing of sensor signals command the most attention in an assessment of system feasibility. This paper describes problem definition, potential ``showstoppers,`` and ways to overcome them. It includes experiments showing that inexpensive radar is a practical sensing element. It considers fast and inexpensive algorithms to extract information from sensor data.

  8. Torsional Restraint Problem of Steel Cold-Formed Beams Restrained By Planar Members

    Science.gov (United States)

    Balázs, Ivan; Melcher, Jindřich; Pešek, Ondřej

    2017-10-01

    The effect of continuous or discrete lateral and torsional restraints of metal thinwalled members along their spans can positively influence their buckling resistance and thus contribute to more economical structural design. The prevention of displacement and rotation of the cross-section results in stabilization of the member. The restraints can practically be provided e.g. by planar members of cladding supported by metal members (purlins, girts). The rate of stabilization of a member can be quantified using values of shear and rotational stiffness provided by the adjacent planar members. While the lateral restraint effected by certain shear stiffness can be often considered as sufficient, the complete torsional restraint can be safely considered in some practical cases only. Otherwise the values of the appropriate rotational stiffness provided by adjacent planar members may not be satisfactory to ensure full torsional restraint and only incomplete restraint is available. Its verification should be performed using theoretical and experimental analyses. The paper focuses on problem of steel thin-walled coldformed beams stabilized by planar members and investigates the effect of the magnitude of the rotational stiffness provided by the planar members on the resistance of the steel members. Cold-formed steel beams supporting planar members of cladding are considered. Full lateral restraint and incomplete torsional restraint are assumed. Numerical analyses performed using a finite element method software indicate considerable influence of the torsional restraint on the buckling resistance of a steel thin-walled member. Utilization of the torsional restraint in the frame of sizing of a stabilized beam can result in more efficient structural design. The paper quantifies this effect for some selected cases and summarizes results of numerical analysis.

  9. LMA C Trach aided endotracheal intubation in simulated cases of cervical spine injury: A series of 30 cases

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    Deepshikha C Tripathi

    2013-01-01

    Full Text Available Background: Laryngeal mask airway (LMA C Trach is a novel device designed to intubate trachea without conventional laryngoscopy. The aim of the study was to evaluate the clinical efficacy of C trach in the simulated scenario of cervical spine injury where conventional laryngoscopy is not desirable. Methods: This prospective pilot study was carried out in 30 consenting adults of either gender, ASAPS I or II, scheduled for surgery requiring endotracheal intubation. An appropriate sized rigid cervical collar was positioned around the patient′s neck to restrict the neck movements and simulate the scenario of cervical spine injury. After induction of anesthesia, various technical aspects of C Trach facilitated endotracheal intubation, changes in hemodynamic variables, and complications were recorded. Results: Mask ventilation was easy in all the patients. Successful insertion of C Trach was achieved in 27 patients at first attempt, while 3 patients required second attempt. Majority of patients required one of the adjusting maneuvers to obtain acceptable view of glottis (POGO score >50%. Intubation success rate was 100% with 26 patients intubated at first attempt and the rest required second attempt. Mean intubation time was 69.8±27.40 sec. With experience, significant decrease in mean intubation time was observed in last 10 patients as compared to first 10 (46±15.77 sec vs. 101.3±22.91 sec. Minor mucosal injury was noted in four patients. Conclusion: LMA C Trach facilitates endotracheal intubation under direct vision and can be a useful technique in patients with cervical spine injury with cervical collar in situ.

  10. Use of lidocaine in endotracheal intubation. Blood and urine concentrations in patients and deceased after unsuccessful resuscitation.

    Science.gov (United States)

    Wunder, Cora; Meier, Jens; Reyher, Christian; Könitz, Verena; Paulke, Alexander; Zacharowski, Kai; Toennes, Stefan W

    2014-11-01

    In toxicological analysis of postmortem samples the local anesthetic lidocaine is often identified. In most cases, lidocaine levels result from its use as aid in endotracheal intubation. The range of the drug's concentration in blood and urine was studied under controlled conditions from a cohort of cardiac surgery patients (n=35). Plasma concentrations 1 h after exposure to lidocaine in the range of the recommended 81 mg coating the endotracheal tube were less than 0.2 mg/l, its metabolite monoethylglycinxylidide (MEGX) less than 0.05 mg/l (median ratio 0.18, range 0.03-1.23). Also the concentrations of lidocaine and MEGX in urine samples were low (less than 1.2 and 0.1 mg/l, respectively) with MEGX/lidocaine ratios of 0.11 (median, range up to 1.2). These data were compared with results obtained by analyzing postmortem blood and urine samples of 18 deceased with a documented cardiopulmonary resuscitation attempt prior to death. Blood concentrations were in the same range (lidocaine median 0.07, range 0.02-1.07 mg/l; MEGX median 0.01, range lidocaine concentrations in urine. MEGX was detected only in 2 out of 9 urine samples. The results of the present study confirm that lidocaine is absorbed in the trachea from the endotracheal tube coated with lidocaine containing gel. Postmortem quantitative results can be explained on the basis of the data obtained in the controlled study. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  11. Endotracheal intubation using the C-MAC® video laryngoscope or the Macintosh laryngoscope: A prospective, comparative study in the ICU

    Science.gov (United States)

    2012-01-01

    Introduction Endotracheal intubation in the ICU is a challenging procedure and is frequently associated with life-threatening complications. The aim of this study was to investigate the effect of the C-MAC® video laryngoscope on laryngeal view and intubation success compared with direct laryngoscopy. Methods In a single-center, prospective, comparative before-after study in an anesthetist-lead surgical ICU of a tertiary university hospital, predictors of potentially difficult tracheal intubation, number of intubation attempts, success rate and glottic view were evaluated during a 2-year study period (first year, Macintosh laryngoscopy (ML); second year, C-MAC®). Results A total of 274 critically ill patients requiring endotracheal intubation were included; 113 intubations using ML and 117 intubations using the C-MAC® were assessed. In patients with at least one predictor for difficult intubation, the C-MAC® resulted in more successful intubations on first attempt compared with ML (34/43, 79% vs. 21/38, 55%; P = 0.03). The visualization of the glottis with ML using Cormack and Lehane (C&L) grading was more frequently rated as difficult (20%, C&L grade 3 and 4) compared with the C-MAC® (7%, C&L grade 3 and 4) (P < 0.0001). Conclusion Use of the C-MAC® video laryngoscope improved laryngeal imaging and improved the intubating success rate on the first attempt in patients with predictors for difficult intubation in the ICU setting. Video laryngoscopy seems to be a useful tool in the ICU where potentially difficult endotracheal intubations regularly occur. PMID:22695007

  12. Comparison of laryngeal mask airway use with endotracheal intubation during anesthesia of western lowland gorillas (Gorilla gorilla gorilla).

    Science.gov (United States)

    Cerveny, Shannon N; D'Agostino, Jennifer J; Davis, Michelle R; Payton, Mark E

    2012-12-01

    The laryngeal mask airway is an alternative to endotracheal intubation that achieves control of the airway by creating a seal around the larynx with an inflatable cuff. This study compared use of the laryngeal mask airway with endotracheal intubation in anesthetized western lowland gorillas (Gorilla gorilla gorilla). Eight adult gorillas were immobilized for routine and diagnostic purposes for a total of nine anesthetic events. During each anesthetic event, gorillas were either intubated (n = 4; group A) or fitted with a laryngeal mask airway (n= 5; group B). Time required to place each airway device, physiologic parameters, and arterial blood gas were measured and compared between the two groups. There were no significant differences between the two groups for time required to place airway device, heart rate, hemoglobin oxygen saturation, end-tidal carbon dioxide, arterial partial pressure of carbon dioxide, or arterial pH between the two groups. Mean arterial partial pressure of oxygen was significantly greater in group B, 15 (group A: 94 +/- 44 mm Hg; group B: 408 +/- 36 mm Hg; P= 0.0025) and 45 (group A: 104 +/- 21 mm Hg; group B: 407 +/- 77 mm Hg; P = 0.0026) min after airway device placement. Mean respiratory rate was significantly greater in group A at multiple time points. Mean arterial pressure (group A: 129 +/- 16 mm Hg; group B: 60 +/- 8 mm Hg) and diastolic blood pressure (group A: 115 +/- 21 mm Hg; group B: 36 +/- 10 mm Hg) were significantly greater in group A at the time of airway device placement. The laryngeal mask airway maintained oxygenation and ventilation effectively in all gorillas and is a useful alternative to endotracheal intubation in western lowland gorillas.

  13. Endotracheal tube placement confirmation: 100% sensitivity and specificity with sustained four-phase capnographic waveforms in a cadaveric experimental model.

    Science.gov (United States)

    Silvestri, Salvatore; Ladde, Jay G; Brown, James F; Roa, Jesus V; Hunter, Christopher; Ralls, George A; Papa, Linda

    2017-06-01

    Waveform capnography is considered the gold standard for verification of proper endotracheal tube placement, but current guidelines caution that it is unreliable in low-perfusion states such as cardiac arrest. Recent case reports found that long-deceased cadavers can produce capnographic waveforms. The purpose of this study was to determine the predictive value of waveform capnography for endotracheal tube placement verification and detection of misplacement using a cadaveric experimental model. We conducted a controlled experiment with two intubated cadavers. Tubes were placed within the trachea, esophagus, and hypopharynx utilizing video laryngoscopy. We recorded observations of capnographic waveforms and quantitative end-tidal carbon dioxide (ETCO2) values during tracheal versus extratracheal (i.e., esophageal and hypopharyngeal) ventilations. 106 and 89 tracheal ventilations delivered to cadavers one and two, respectively (n=195) all produced characteristic alveolar waveforms (positive) with ETCO2 values ranging 2-113mmHg. 42 esophageal ventilations (36 to cadaver one and 6 to cadaver two), and 6 hypopharyngeal ventilations (4 to cadaver one and 2 to cadaver two) all resulted in non-alveolar waveforms (negative) with ETCO2 values of 0mmHg. Esophageal and hypopharyngeal measurements were categorized as extratracheal (n=48). A binary classification test showed no false negatives or false positives, indicating 100% sensitivity (NPV 1.0, 95%CI 0.98-1.00) and 100% specificity (PPV 1.0, 95%CI 0.93-1.00). Though current guidelines question the reliability of waveform capnography for verifying endotracheal tube location during low-perfusion states such as cardiac arrest, our findings suggest that it is highly sensitive and specific. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Research study on neck injury lessening with active head restraint using human body FE model.

    Science.gov (United States)

    Kitagawa, Yuichi; Yasuki, Tsuyoshi; Hasegawa, Junji

    2008-12-01

    The objective of this study is to examine the effectiveness of the active head restraint system in reducing neck injury risk of car occupants in low-speed rear impacts. A human body FE model "THUMS" was used to simulate head and neck kinematics of the occupant and to evaluate loading to the neck. Joint capsule strain was calculated to predict neck injury risk as well as NIC. The validity of the model was confirmed comparing its mechanical responses to those in human subjects in the literatures. Seat FE models were also prepared representing one with a fixed head restraint and the other one with an active head restraint system. The active head restraint system was designed to move the head restraint forward and upward when the lower unit was lower unit was loaded by the pelvis. Rear impact simulations were performed assuming a triangular acceleration pulse at a delta-V of 25 km/h. The model reproduced similar head and neck motions to those measured in the human volunteer test, except for active muscular responses. The calculated joint capsule strain also showed a good match with those of PMHS tests in the literature. A rear-impact simulation was conducted using the model with the fixed head restraint. The result revealed that NIC was strongly correlated with the relative acceleration between the head and the torso and that its maximum peak appeared when the head contacted the head restraint. It was also found that joint capsule strain grew in later timing synchronizing with the relative displacement. Another simulation with the active head restraint system showed that both NIC and joint capsule strain were lowered owing to the forward and upward motion of the head restraint. A close investigation of the vertebral motion indicated that the active head restraint reduced the magnitude of shear deformation in the facet joint, which contributed to the strain growth in the fixed head restraint case. Rear-impact simulations were conducted using a human body FE model, THUMS

  15. Do organisational constraints explain the use of restraint? A comparative ethnographic study from three nursing homes in Norway.

    Science.gov (United States)

    Øye, Christine; Jacobsen, Frode Fadnes; Mekki, Tone Elin

    2017-07-01

    To investigate (1) what kind of restraint is used in three nursing homes in Norway and (2) how staff use restraint under what organisational conditions. Restraint use in residents living with dementia in nursing homes is controversial, and at odds with fundamental human rights. Restraint is a matter of hindering residents' free movement and will by applying either interactional, physical, medical, surveillance or environmental restraint. Previous research has identified use of restraint related to individual resident characteristics such as agitation, aggressiveness and wandering. This model is embedded in an overall mixed-method education intervention design study called Modelling and evaluating evidence-based continuing education program in dementia care (MEDCED), applying ethnography postintervention to examine the use of restraint in 24 nursing homes in Norway. Based on restraint diversity measured in the trial, ethnographic investigation was carried out in three different nursing homes in Norway over a 10-month period to examine restraint use in relation to organisational constraints. Several forms of restraint were observed; among them, interactional restraint was used most frequently. We identified that use of restraint relates to the characteristics of individual residents, such as agitation, aggressiveness and wandering. However, restraint use should also be explained in relation to organisational conditions such as resident mix, staff culture and available human resources. A fluctuating and dynamic interplay between different individual and contextual factors determines whether restraint is used - or not in particular situations with residents living with dementia. Educational initiatives targeting staff to reduce restraint must be sensitive towards fluctuating organisational constraints. © 2016 John Wiley & Sons Ltd.

  16. Aceh Free Pasung: Releasing the mentally ill from physical restraint

    Directory of Open Access Journals (Sweden)

    Marthoenis M

    2011-05-01

    Full Text Available Abstract Background Physical restraint and confinement of the mentally ill (called pasung in Indonesia is common in Aceh. In early 2010, the local government initiated a program called Aceh Free Pasung 2010. The main goal of the program is to release the mentally ill in the province from restraint and to provide appropriate medical treatment and care. The aim of the paper is to report the findings of a preliminary investigation of the demographic and clinical characteristics of patients who have been admitted to the Banda Aceh Mental Hospital as part of the Aceh Free Pasung program. Methods This is a cross-sectional descriptive study conducted at the Banda Aceh Mental Hospital, where people who had been restrained or confined in the community are being admitted for psychiatric treatment and, where necessary, physical rehabilitation, as part of the Aceh Free Pasung program. Results Fifty-nine of former ex-pasung patients were examined. The majority (88.1% of the patients were male, aged 18 to 68 years. The duration of pasung varied from a few days to 20 years, with a mean duration of 4.0 years. The reasons for applying pasung are many, with concerns about dangerousness being most common. The great majority (89.8% had a diagnosis of schizophrenia. Discussion The development of a community mental health system and the introduction of a health insurance system in Aceh (together with the national health insurance scheme for the poor has enabled access to free hospital treatment for people with severe mental disorders, including those who have been in pasung. The demographic and clinical characteristics of this group of ex-pasung patients are broadly similar to those reported in previous studies. Conclusions The Aceh Free Pasung program is an important mental health and human rights initiative that can serve to inform similar efforts in other parts of Indonesia and other low and middle-income countries where restraint and confinement of the mentally

  17. [Therapeutic restraint management in Intensive Care Units: Phenomenological approach to nursing reality].

    Science.gov (United States)

    Acevedo-Nuevo, M; González-Gil, M T; Solís-Muñoz, M; Láiz-Díez, N; Toraño-Olivera, M J; Carrasco-Rodríguez-Rey, L F; García-González, S; Velasco-Sanz, T R; Martínez-Álvarez, A; Martin-Rivera, B E

    2016-01-01

    To identify nursing experience on physical restraint management in Critical Care Units. To analyse similarities and differences in nursing experience on physical restraint management according to the clinical context that they are involved in. A multicentre phenomenological study was carried out including 14 Critical Care Units in Madrid, classified according to physical restraint use: Common/systematic use, lacking/personalised use, and mixed use. Five focus groups (23 participants were selected following purposeful sampling) were convened, concluding in data saturation. Data analysis was focused on thematic content analysis following Colaizzi's method. Six main themes: Physical restraint meaning in Critical Care Units, safety (self-retreat vital devices), contribution factors, feelings, alternatives, and pending issues. Although some themes are common to the 3 Critical Care Unit types, discourse differences are found as regards to indication, feelings, systematic use of pain and sedation measurement tools. In order to achieve real physical restraint reduction in Critical Care Units, it is necessary to have a deep understanding of restraints use in the specific clinical context. As self-retreat vital devices emerge as central concept, some interventions proposed in other settings could not be effective, requiring alternatives for critical care patients. Discourse variations laid out in the different Critical Care Unit types could highlight key items that determine the use and different attitudes towards physical restraint. Copyright © 2015 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  18. 24-hour-restraint stress induces long-term depressive-like phenotypes in mice

    Science.gov (United States)

    Zhou, Ying; Hu, Zhiqiang; Lou, Jingyu; Song, Wei; Li, Jing; Liang, Xiao; Chen, Chen; Wang, Shuai; Yang, Beimeng; Chen, Lei; Zhang, Xu; Song, Jinjing; Dong, Yujie; Chen, Shiqing; He, Lin; Xie, Qingguo; Chen, Xiaoping; Li, Weidong

    2016-01-01

    There is an increasing risk of mental disorders, such as acute stress disorder (ASD), post-traumatic stress disorder (PTSD) and depression among survivors who were trapped in rubble during earthquake. Such long-term impaction of a single acute restraint stress has not been extensively explored. In this study, we subjected mice to 24-hour-restraint to simulate the trapping episode, and investigated the acute (2 days after the restraint) and long-term (35 days after the restraint) impacts. Surprisingly, we found that the mice displayed depression-like behaviors, decreased glucose uptake in brain and reduced adult hippocampal neurogenesis 35 days after the restraint. Differential expression profiling based on microarrays suggested that genes and pathways related to depression and other mental disorders were differentially expressed in both PFC and hippocampus. Furthermore, the depression-like phenotypes induced by 24-hour-restraint could be reversed by fluoxetine, a type of antidepressant drug. These findings demonstrated that a single severe stressful event could produce long-term depressive-like phenotypes. Moreover, the 24-hour-restraint stress mice could also be used for further studies on mood disorders. PMID:27609090

  19. Disparities in Age-Appropriate Child Passenger Restraint Use Among Children Aged 1 to 12 Years

    Science.gov (United States)

    Cunningham, Rebecca M.; Resnicow, Ken; Freed, Gary L.

    2014-01-01

    OBJECTIVE: Observed racial disparities in child safety seat use have not accounted for socioeconomic factors. We hypothesized that racial differences in age-appropriate restraint use would be modified by socioeconomic status and child passenger safety information sources. METHODS: A 2-site, cross-sectional tablet-based survey of parents seeking emergency care for their 1- to 12-year-old child was conducted between October 2011 and May 2012. Parents provided self-report of child passenger safety practices, demographic characteristics, and information sources. Direct observation of restraint use was conducted in a subset of children at emergency department discharge. Age-appropriate restraint use was defined by Michigan law. RESULTS: Of the 744 eligible parents, 669 agreed to participate and 601 provided complete responses to key variables. White parents reported higher use of car seats for 1- to 3-year-olds and booster seats for 4- to 7-year-olds compared with nonwhite parents. Regardless of race, restraint use compared with nonwhite parents, controlling for education, income, information sources, and site. There was substantial agreement (82.6%, κ = 0.74) between parent report of their child’s usual restraint and the observed restraint at emergency department discharge. CONCLUSIONS: Efforts should be directed at eliminating racial disparities in age-appropriate child passenger restraint use for children <8 years. Booster seat use, seat belt use, and rear seating represent opportunities to improve child passenger safety practices among older children. PMID:24420814

  20. Smoking, dietary restraint, gender, and the relative reinforcing value of snack food in a large university sample.

    Science.gov (United States)

    Goldfield, Gary S; Lumb, Andrew

    2008-01-01

    The present study examined the independent and interactive association between smoking, gender, dietary restraint and the relative reinforcing value of snack food in a university sample. Four hundred and three introductory psychology students completed questionnaires assessing age, gender, BMI, hunger, smoking status, nicotine dependence, dietary restraint, hedonic ratings and the relative reinforcing value of snack food and fruits and vegetables. The relative reinforcing value of snack food was determined by the number of button presses subjects would be willing to do to obtain (100g) of snack food versus 100g of fruits and vegetables. Multiple regression analyses yielded a significant three-way interaction of gender, restraint, and smoking in predicting the relative reinforcing value of snack food indicating that in female smokers, dietary restraint was inversely associated with the relative reinforcing value of snack food, whereas in male smokers, restraint was not significantly related with the reinforcing value of snacks. These findings remained significant after controlling for BMI, hunger, and hedonics, suggesting that there are gender differences in relationship between smoking, dietary restraint, and snack food reinforcement. Among female university students, smoking moderates the relationship between dietary restraint and food reinforcement whereby high-restraint female smokers appear to be at lower risk of over-consuming energy dense snack food compared to low-restraint female smokers, while high-restraint male smokers may not be at higher risk than low-restraint male smokers.

  1. Mental Health Nursing, Mechanical Restraint Measures and Patients’ Legal Rights

    DEFF Research Database (Denmark)

    Birkeland, Søren; Gildberg, Frederik Alkier

    2016-01-01

    . This article presents an in-principle Danish Psychiatric Complaint Board decision concerning MR use initiated by untrained staff. The case illustrates that, judicially, weight must be put on the patient perspective on course of happenings and especially when health professional documentation is scant, patients......Abstract: Coercive mechanical restraint (MR) in psychiatry constitute the perhaps most important exception from the common health law requirement for involving patients in health care decisions and achieving their informed consent prior to treatment. Coercive measures and particularly MR constitute...... a serious collision with patient autonomy principles, pose a particular challenge to psychiatric patients’ legal rights, and put intensified demands on health professional performance. Legal rights principles require rationale for coercive measure use be thoroughly considered and rigorously documented...

  2. Chronic restraint stress upregulates erythropoiesis through glucocorticoid stimulation.

    Directory of Open Access Journals (Sweden)

    Jeffrey L Voorhees

    Full Text Available In response to elevated glucocorticoid levels, erythroid progenitors rapidly expand to produce large numbers of young erythrocytes. Previous work demonstrates hematopoietic changes in rodents exposed to various physical and psychological stressors, however, the effects of chronic psychological stress on erythropoiesis has not be delineated. We employed laboratory, clinical and genomic analyses of a murine model of chronic restraint stress (RST to examine the influence of psychological stress on erythropoiesis. Mice exposed to RST demonstrated markers of early erythroid expansion involving the glucocorticoid receptor. In addition, these RST-exposed mice had increased numbers of circulating reticulocytes and increased erythropoiesis in primary and secondary erythroid tissues. Mice also showed increases in erythroid progenitor populations and elevated expression of the erythroid transcription factor KLF1 in these cells. Together this work reports some of the first evidence of psychological stress affecting erythroid homeostasis through glucocorticoid stimulation.

  3. Computer-aided interpretation of ICU portable chest images: automated detection of endotracheal tubes

    Science.gov (United States)

    Huo, Zhimin; Li, Simon; Chen, Minjie; Wandtke, John

    2008-03-01

    In intensive care units (ICU), endotracheal (ET) tubes are inserted to assist patients who may have difficulty breathing. A malpositioned ET tube could lead to a collapsed lung, which is life threatening. The purpose of this study is to develop a new method that automatically detects the positioning of ET tubes on portable chest X-ray images. The method determines a region of interest (ROI) in the image and processes the raw image to provide edge enhancement for further analysis. The search of ET tubes is performed within the ROI. The ROI is determined based upon the analysis of the positions of the detected lung area and the spine in the image. Two feature images are generated: a Haar-like image and an edge image. The Haar-like image is generated by applying a Haar-like template to the raw ROI or the enhanced version of the raw ROI. The edge image is generated by applying a direction-specific edge detector. Both templates are designed to represent the characteristics of the ET tubes. Thresholds are applied to the Haar-like image and the edge image to detect initial tube candidates. Region growing, combined with curve fitting of the initial detected candidates, is performed to detect the entire ET tube. The region growing or "tube growing" is guided by the fitted curve of the initial candidates. Merging of the detected tubes after tube growing is performed to combine the detected broken tubes. Tubes within a predefined space can be merged if they meet a set of criteria. Features, such as width, length of the detected tubes, tube positions relative to the lung and spine, and the statistics from the analysis of the detected tube lines, are extracted to remove the false-positive detections in the images. The method is trained and evaluated on two different databases. Preliminary results show that computer-aided detection of tubes in portable chest X-ray images is promising. It is expected that automated detection of ET tubes could lead to timely detection of

  4. Diagnostic Value of Endotracheal Aspirates Sonication on Ventilator-Associated Pneumonia Microbiologic Diagnosis

    Science.gov (United States)

    Motos, Ana; Li Bassi, Gianluigi; Aguilera Xiol, Elisabet; Senussi, Tarek; Travierso, Chiara; Chiurazzi, Chiara; Idone, Francesco; Muñoz, Laura; Vila, Jordi; Ferrer, Miquel; Pelosi, Paolo; Torres, Antoni

    2017-01-01

    Microorganisms are able to form biofilms within respiratory secretions. Methods to disaggregate such biofilms before utilizing standard, rapid, or high throughput diagnostic technologies may aid in pathogen detection during ventilator associated pneumonia (VAP) diagnosis. Our aim was to determine if sonication of endotracheal aspirates (ETA) would increase the sensitivity of qualitative, semi-quantitative, and quantitative bacterial cultures in an animal model of pneumonia caused by Pseudomonas aeruginosa or by methicillin resistant Staphylococcus aureus (MRSA). Material and methods: P. aeruginosa or MRSA was instilled into the lungs or the oropharynx of pigs in order to induce severe VAP. Time point assessments for qualitative and quantitative bacterial cultures of ETA and bronchoalveolar lavage (BAL) samples were performed at 24, 48, and 72 h after bacterial instillation. In addition, at 72 h (autopsy), lung tissue was harvested to perform quantitative bacterial cultures. Each ETA sample was microbiologically processed with and without applying sonication for 5 min at 40 KHz before bacterial cultures. Sensitivity and specificity were determined using BAL as a gold-standard. Correlation with BAL and lung bacterial burden was also determined before and after sonication. Assessment of biofilm clusters and planktonic bacteria was performed through both optical microscopy utilizing Gram staining and Confocal Laser Scanning Microscopy utilizing the LIVE/DEAD®BacLight kit. Results: 33 pigs were included, 27 and 6 from P. aeruginosa and MRSA pneumonia models, respectively. Overall, we obtained 85 ETA, 69 (81.2%) from P. aeruginosa and 16 (18.8%) from MRSA challenged pigs. Qualitative cultures did not significantly change after sonication, whereas quantitative ETA cultures did significantly increase bacterial counting. Indeed, sonication consistently increased bacterial burden in ETAs at 24, 48, and 72 h after bacterial challenge. Sonication also improved sensitivity of

  5. Exploring the effects of sparse restraints on protein structure prediction.

    Science.gov (United States)

    Mandalaparthy, Varun; Sanaboyana, Venkata Ramana; Rafalia, Hitesh; Gosavi, Shachi

    2017-12-03

    One of the main barriers to accurate computational protein structure prediction is searching the vast space of protein conformations. Distance restraints or inter-residue contacts have been used to reduce this search space, easing the discovery of the correct folded state. It has been suggested that about 1 contact for every 12 residues may be sufficient to predict structure at fold level accuracy. Here, we use coarse-grained structure-based models in conjunction with molecular dynamics simulations to examine this empirical prediction. We generate sparse contact maps for 15 proteins of varying sequence lengths and topologies and find that given perfect secondary-structural information, a small fraction of the native contact map (5%-10%) suffices to fold proteins to their correct native states. We also find that different sparse maps are not equivalent and we make several observations about the type of maps that are successful at such structure prediction. Long range contacts are found to encode more information than shorter range ones, especially for α and αβ-proteins. However, this distinction reduces for β-proteins. Choosing contacts that are a consensus from successful maps gives predictive sparse maps as does choosing contacts that are well spread out over the protein structure. Additionally, the folding of proteins can also be used to choose predictive sparse maps. Overall, we conclude that structure-based models can be used to understand the efficacy of structure-prediction restraints and could, in future, be tuned to include specific force-field interactions, secondary structure errors and noise in the sparse maps. © 2017 Wiley Periodicals, Inc.

  6. Comparison of ProSeal laryngeal mask airway (PLMA) with cuffed and uncuffed endotracheal tubes in infants.

    Science.gov (United States)

    Ozden, Eyyup Sabri; Meco, Basak Ceyda; Alanoglu, Zekeriyya; Alkıs, Neslihan

    2016-11-10

    We aimed to compare cuffed and uncuffed endotracheal tubes (ETTs) with ProSealTM laryngeal mask airway (PLMA) in terms of airway security and extubation, starting out from the hypothesis that PLMA will provide alternative airway safety to the endotracheal tubes, and that airway complications will be less observed. After obtaining approval from the local Ethics Committee and parental informed consent, 120 pediatric patients 1-24 months old, American Society of Anesthesiologists physical status I-II, requiring general anesthesia for elective lower abdominal surgery, were randomized into PLMA (Group P, n = 40), cuffed ETT (Group C, n = 40), and uncuffed ETT (Group UC, n = 40) groups. The number of intubation or PLMA insertion attempts was recorded. Each patient's epigastrium was auscultated for gastric insufflation, leak volumes and air leak fractions (leak volume/inspiratory volume) were recorded. Post-operative adverse events related to airway management were also followed up during the first post-operative hour. Demographic and surgical data were similar among the groups. There were significantly fewer airway manipulations in the Group P than in the other groups (p manipulation and lower incidence of laryngospasm.

  7. Hemodynamic responses to endotracheal intubation performed with video and direct laryngoscopy in patients scheduled for major cardiac surgery.

    Science.gov (United States)

    Sarkılar, Gamze; Sargın, Mehmet; Sarıtaş, Tuba Berra; Borazan, Hale; Gök, Funda; Kılıçaslan, Alper; Otelcioğlu, Şeref

    2015-01-01

    This study aims to compare the hemodynamic responses to endotracheal intubation performed with direct and video laryngoscope in patients scheduled for cardiac surgery and to assess the airway and laryngoscopic characteristics. One hundred ten patients were equally allocated to either direct Macintosh laryngoscope (n = 55) or indirect Macintosh C-MAC video laryngoscope (n = 55). Systolic, diastolic, and mean arterial pressure, and heart rate were recorded prior to induction anesthesia, and immediately and two minutes after intubation. Airway characteristics (modified Mallampati, thyromental distance, sternomental distance, mouth opening, upper lip bite test, Wilson risk sum score), mask ventilation, laryngoscopic characteristics (Cormack-Lehane, percentage of glottic opening), intubation time, number of attempts, external pressure application, use of stylet and predictors of difficult intubation (modified Mallampati grade 3-4, thyromental distance Cormack-Lehane grade 3-4) were recorded. Hemodynamic parameters were similar between the groups at all time points of measurement. Airway characteristics and mask ventilation were no significant between the groups. The C-MAC video laryngoscope group had better laryngoscopic view as assessed by Cormack-Lehane and percentage of glottic view, and a longer intubation time. Number of attempts, external pressure, use of stylet, and difficult intubation parameters were similar. Endotracheal intubation performed with direct Macintosh laryngoscope or indirect Macintosh C-MAC video laryngoscope causes similar and stable hemodynamic responses.

  8. [Effect of endotracheal intubation and laryngeal mask airway on perioperative respiratory adverse events in children with upper airway infections].

    Science.gov (United States)

    Huang, Hua-jun; Fang, Xiang-ming

    2013-12-03

    To investigate the effect of endotracheal intubation (TT) or the laryngeal mask airway (LMA) on the incidence of perioperative respiratory adverse events in children with upper respiratory tract infection undergo general anesthesia. From November, 2006 to October, 2012 in the Zhuji People's Hospital, 76 children with upper respiratory tract infection approved by hospital ethic committee were randomly divided into 2 groups:group I (n = 36), children were applied with endotracheal intubation during general anesthesia (TT group), while groupII (n = 40), laryngeal mask airway were used (LMA group).Intraoperative mean arterial pressure (MAP), hear rate (HR), pulse oximetry (SPO2), and end-tidal carbon dioxide partial pressure (P ETCO2) were recorded during the surgery. The incidence of adverse events such as hypoxemia, fidgety, sore throat, and laryngospasm were evaluated in resuscitation room.We also assessed the pre- and postoperative symptoms of respiratory tract infection. There was no significant difference in upper respiratory tract infection symptoms between two groups, and the children in both groups have good tolerance to TT or LMA.However, the hemodynamics status in LMA group were more stable than those in TT group after the LMA insertion or removing (P children with upper respiratory tract infection undergo general anesthesia.

  9. [Clinical effect of endotracheal lavage with porcine pulmonary surfactant in term neonates with severe meconium aspiration syndrome].

    Science.gov (United States)

    Lin, Xin-Zhu; Lai, Ji-Dong; Lan, Zhao-Yang; Lin, Ya-Yin

    2014-07-01

    To evaluate the clinical effect of endotracheal lavage with porcine pulmonary surfactant (PS) in term neonates with severe meconium aspiration syndrome (MAS). A total of 136 full-term infants with severe MAS who were admitted to the neonatal intensive care unit between January 2010 and June 2013 were randomly and equally divided into PS lavage and PS injection groups. In the PS lavage group, patients were treated with endotracheal lavage using 3-5 mL of diluted PS (12 mg/mL) each time, and the PS injection group was given PS by intratracheal injection at the first dose of 200 mg/kg. Blood gas, oxygenation index (OI), and PaO2/FiO2 (P/F) of the two groups were evaluated before and 2, 12, 24, and 48 hours after the treatment, and the duration of mechanical ventilation, complication rate, and cure rate were compared between the two groups. Compared with the PS injection group, the PS lavage group had significantly higher PaO2 and P/F ration and significantly lower PaCO2 and OI at 12, 24, and 48 hours post-treatment (Pneonates with severe MAS can increase ventilation and oxygenation efficiency, shorten the duration of mechanical ventilation, reduce the complication rate, and increase the cure rate, indicating that this method is a safe and effective therapeutic strategy.

  10. CLASSIFICATION OF RESTRAINTS IN THE OPTIMIZATION PROBLEM OF A COLD-FORMED PROFILE

    Directory of Open Access Journals (Sweden)

    Agnieszka Łukowicz

    2015-11-01

    Full Text Available This work describes the restraints in the optimization problem. This is an important and complicated issue because it requires taking into account a vast range of information related to the design and production. In order to describe the relations of a specific optimization problem, it is essential to adopt appropriate criteria and to collect information on all kinds of restraints, i.e. boundary conditions. The following paper verifies the various restraints and defines three subsets: design assumptions, technological limitations and standard conditions. The provided classification was made with reference to the analysis of the construction applicability of the newly patented cold-formed profile.

  11. [Physical and pharmacological restraints in geriatric and gerontology services and centers].

    Science.gov (United States)

    Ramos Cordero, Primitivo; López Trigo, José Antonio; Maíllo Pedraz, Herminio; Paz Rubio, José María

    2015-01-01

    Physical and pharmacological restraints are a controversial issue in the context of geriatric care due to their moral, ethical, social and legal repercussions and, despite this fact, no specific legislation exists at a national level. The use of restraints is being questioned with growing frequency, as there are studies that demonstrate that restraints do not reduce the number of falls or their consequences, but rather can increase them, cause complications, injuries and potentially fatal accidents. Restraints are not always used rationally, despite compromising a fundamental human right, that is, freedom, protected in the Constitution, as well as values and principles, such as dignity and personal self-esteem. There are centers where restraints are applied to more than 50% of patients, and in some cases without the consent of their legal representatives. On some occasions, restraints are used for attaining organizational or environmental objectives, such as complying with tight schedules, and for reducing or avoiding the supervision of patients who walk erratically and, at times, are used indefinitely. Even greater confusion exists with respect to the emerging concept of chemical or pharmacological restraints, since no conceptual framework exists based on scientific evidence, and with sufficient consensus for guiding healthcare workers. In this context, the Sociedad Española de Geriatría y Gerontología (SEGG--Spanish Geriatrics and Gerontology Society), aware of the significance and transcendence of the issue, and in an attempt to preserve and guarantee maximum freedom, dignity and self-esteem, on the one hand, and to ensure the maximum integrity and legal certainty of the persons cared for in geriatric and gerontology services and centers, on the other, decided to create an "Interdisciplinary Committee on Restraints" made up by members from different disciplines and members of SEGG Working Groups or Committees, external health care workers, groups

  12. Predictive Power of Different Types of Experimental Restraints in Small Molecule Docking: A Review.

    Science.gov (United States)

    Fu, Darwin Y; Meiler, Jens

    2018-01-18

    Incorporating experimental restraints is a powerful method of increasing accuracy in computational protein small molecule docking simulations. Different algorithms integrate distinct forms of biochemical data during the docking and/or scoring stages. These so-called hybrid methods make use of receptor-based information such as nuclear magnetic resonance (NMR) restraints or small molecule-based information such as structure-activity relationships (SARs). A third class of methods directly interrogates contacts between the protein receptor and the small molecule. This work reviews the current state of using such restraints in docking simulations, evaluates their feasibility across broad systems, and identifies potential areas of algorithm development.

  13. Can implementing a quiet room reduce the use of mechanical restraints?

    DEFF Research Database (Denmark)

    Lauge Berring, Lene; Bonde, SM; Johansen, L

    BackgroundIn order to reduce the use of mechanical restraints, this project aimed to implement a Quiet Room in a Psychiatric Intensive Care Unit (PICU). Previous studies has demonstrated that quiet rooms, such ascomfort rooms (Cf. Cummings, Grandfield and Coldwell, 2010) and sensory rooms......(Cf. Bjôrkdahl 2015), contributed to higher patient satisfaction and lower rates of violence, seclusion and restraints. This poster describes the preliminary results and the implementations process.AimThe study aim was to 1) reduce the use of coercive measures such as mechanical restraints, 2) redirect...... used the room between 1 and 5 times. Staff and patients report that coercive measures were avoided, however, we were not able to identify any changes within the registered use of mechanical restraints. Generally, patients experienced great benefits and reported that they appreciated the opportunity...

  14. Professionals' attitudes toward reducing restraint: the case of seclusion in the Netherlands.

    Science.gov (United States)

    van Doeselaar, Marjan; Sleegers, Peter; Hutschemaekers, Giel

    2008-06-01

    Despite public opinion and policy interventions, restraint remains a common practice. This is also the case in the Netherlands, where projects aimed to reduce seclusion, have not led to a decreased use of restraint. Is this lack of effectiveness related to attitudes of the professionals? The aim of this study was to explore the attitudes of professionals working in mental health care toward restraint. A questionnaire with eight scales was constructed for measuring attitudes of professionals. Scores of 540 professionals were studied, using analysis of variance and cluster analysis and related to several personnel and organizational characteristics. The more professionals were personally involved in seclusion, the more they believed in it. Three types of professionals were identified: Transformers, Doubters and Maintainers. More than half of the psychiatrists (56%) belonged to the type of maintainers. Nurses were more divided. Professionals working in clinical settings are not really opposed to restraint. This could explain the limited effects of innovation projects.

  15. Video recording study of infants undergoing primary cheiloplasty: are arm restraints really needed?

    National Research Council Canada - National Science Library

    Tokioka, Kazuyuki; Park, Susam; Sugawara, Yasushi; Nakatsuka, Takashi

    2009-01-01

    Arm restraints are traditionally used during the perioperative period for cleft surgery to prevent the affected infant from damaging the wound, but the benefits of this standard practice have been controversial...

  16. Occupant restraint preferences of individuals traveling in motor vehicles while seated in their wheelchairs.

    Science.gov (United States)

    van Roosmalen, Linda; Lutgendorf, Marlies; Manary, Miriam A

    2008-01-01

    A survey among 127 wheelchair users was conducted to characterize wheelchair occupant restraint usage patterns, restraint deficiencies, user characteristics, and essential wheelchair occupant restraint design parameters for when individuals travel in motor vehicles while seated in their wheelchairs. Survey respondents value independent travel and seem generally interested in the use of an occupant restraint system that is attached to the wheelchair frame and that can be used independently by the wheelchair user without caregiver or vehicle driver assistance. Results of the survey further indicate that despite the relatively high percentage of respondents who are attempting to travel safely (78.8%), almost half of these wheelchair users have experienced injury or compromised wheelchair balance while traveling in motor vehicles.

  17. Disclosure of Pre-Trail Investigation Data in Court when Imposing Measures of Restraint

    National Research Council Canada - National Science Library

    Ernestas Rimselis

    2005-01-01

    ... imposition of measures of restraint on a suspect. This problem is related to a very significant aspect of succeeding organisation of pre-trial investigation - confidentiality of present data of pre-trial investigation as well as implementation...

  18. A comparison between the v-gel supraglottic airway device and the cuffed endotracheal tube for airway management in spontaneously breathing cats during isoflurane anaesthesia

    NARCIS (Netherlands)

    van Oostrom, H.|info:eu-repo/dai/nl/340414634; Krauss, M.W.; Sap, R.

    2013-01-01

    Abstract OBJECTIVE: To compare airway management using the v-gel supraglottic airway device (v-gel SGAD) to that using an endotracheal tube (ETT), with respect to practicability, leakage of volatile anaesthetics and upper airway discomfort in cats. STUDY DESIGN: Prospective, randomized clinical

  19. Differential Effects of Endotracheal Suctioning on Gas Exchanges in Patients with Acute Respiratory Failure under Pressure-Controlled and Volume-Controlled Ventilation

    Directory of Open Access Journals (Sweden)

    Xiao-Wei Liu

    2015-01-01

    Full Text Available This study was conducted to evaluate the effects of open endotracheal suctioning on gas exchange and respiratory mechanics in ARF patients under the modes of PCV or VCV. Ninety-six ARF patients were treated with open endotracheal suctioning and their variations in respiratory mechanics and gas exchange after the suctions were compared. Under PCV mode, compared with the initial level of tidal volume (VT, ARF patients showed 30.0% and 27.8% decrease at 1 min and 10 min, respectively. Furthermore, the initial respiratory system compliance (Crs decreased by 29.6% and 28.5% at 1 min and 10 min, respectively. Under VCV mode, compared with the initial level, 38.6% and 37.5% increase in peak airway pressure (PAP were found at 1 min and 10 min, respectively. Under PCV mode, the initial PaO2 increased by 6.4% and 10.2 % at 3 min and 10 min, respectively, while 18.9% and 30.6% increase of the initial PaO2 were observed under VCV mode. Summarily, endotracheal suctioning may impair gas exchange and decrease lung compliance in ARF patients receiving mechanical ventilation under both PCV and VCV modes, but endotracheal suctioning effects on gas exchange were more severe and longer-lasting under PCV mode than VCV.

  20. Dieting, restraint, and disinhibition predict women's weight change over 6 y.

    Science.gov (United States)

    Savage, Jennifer S; Hoffman, Lesa; Birch, Leann L

    2009-07-01

    Although disinhibited eating is positively associated with higher weight in women, it is not known whether restrained eating and dieting moderate the influence of disinhibited eating on weight change. The objective was to investigate over 6 y the interactive effects of restrained and disinhibited eating and self-reported dieting to lose weight as predictors of weight gain in women. Data were collected from non-Hispanic white women (n = 163) every 2 y. Height and weight were measured in triplicate. Dietary restraint and disinhibition were assessed by using the Eating Inventory. Participants were also asked if they were "currently dieting to lose weight." Multilevel modeling was used to examine change in weight as a function of time-invariant and time-varying predictors, including dietary restraint, dietary disinhibition, and self-reported dieting. After covariates were adjusted for, growth curve models showed that within-person increases in restraint over time were associated with concurrent decreases in weight and that higher levels of restraint moderated the positive association between dietary disinhibition and weight. Women who reported dieting at study entry were heavier at study entry and gained more weight over time than did nondieters. Finally, a significant interaction between restraint, disinhibition, and dieting showed that restraint moderated the effect of disinhibition on weight differently in nondieters than in dieters. Increasing levels of dietary restraint may be beneficial in moderating weight by attenuating the positive association between disinhibition and weight in dieting women. An understanding of weight and weight change requires examination of the interactive effects of restraint, disinhibition, and dieting.

  1. Dieting, restraint, and disinhibition predict women's weight change over 6 y123

    Science.gov (United States)

    Savage, Jennifer S; Hoffman, Lesa

    2009-01-01

    Background: Although disinhibited eating is positively associated with higher weight in women, it is not known whether restrained eating and dieting moderate the influence of disinhibited eating on weight change. Objective: The objective was to investigate over 6 y the interactive effects of restrained and disinhibited eating and self-reported dieting to lose weight as predictors of weight gain in women. Design: Data were collected from non-Hispanic white women (n = 163) every 2 y. Height and weight were measured in triplicate. Dietary restraint and disinhibition were assessed by using the Eating Inventory. Participants were also asked if they were “currently dieting to lose weight.” Multilevel modeling was used to examine change in weight as a function of time-invariant and time-varying predictors, including dietary restraint, dietary disinhibition, and self-reported dieting. Results: After covariates were adjusted for, growth curve models showed that within-person increases in restraint over time were associated with concurrent decreases in weight and that higher levels of restraint moderated the positive association between dietary disinhibition and weight. Women who reported dieting at study entry were heavier at study entry and gained more weight over time than did nondieters. Finally, a significant interaction between restraint, disinhibition, and dieting showed that restraint moderated the effect of disinhibition on weight differently in nondieters than in dieters. Conclusions: Increasing levels of dietary restraint may be beneficial in moderating weight by attenuating the positive association between disinhibition and weight in dieting women. An understanding of weight and weight change requires examination of the interactive effects of restraint, disinhibition, and dieting. PMID:19439461

  2. Applying sensory modulation to mental health inpatient care to reduce seclusion and restraint

    DEFF Research Database (Denmark)

    Andersen, Charlotte; Kolmos, Anne; Andersen, Kjeld

    2017-01-01

    BACKGROUND: Clinical training in managing conflicts and preventing violence seldom contains sensory modulation (SM) as a method to de-escalate and prevent restraint and seclusion. Sensory-based interventions promote adaptive regulation of arousal and emotion. SM is a complementary approach...... a SM approach in mental healthcare facilities has a significant effect on the reduction of restraint and seclusion. As a part of the implementation, staff training and education in SM are crucial....

  3. 49 CFR 571.213 - Standard No. 213; Child restraint systems.

    Science.gov (United States)

    2010-10-01

    ... 572 Subpart S dummy need not meet S5.1.2 and S5.1.3. S5.1 Dynamic performance. S5.1.1Child restraint... restraint system, neither knee pivot point shall, at any time during the dynamic test, pass through a... not less than 24 square inches for systems recommended for children weighing 20 pounds or more, or 48...

  4. Interactive effects of dietary restraint and adiposity on stress-induced eating and the food choice of children.

    Science.gov (United States)

    Roemmich, James N; Lambiase, Maya J; Lobarinas, Christina L; Balantekin, Katherine N

    2011-12-01

    The Individual Differences Model posits that individual differences in physiological and psychological factors explain eating behaviors in response to stress. The purpose was to determine the effects of individual differences in adiposity, dietary restraint and stress reactivity on children's energy intake and food choices. A total of 40 boys and girls, age 8-12 years, with wide ranges of dietary restraint, adiposity, and stress reactivity were measured for total energy intake and choice of energy dense 'comfort' and lower density 'healthy' foods following reading and speech stressor manipulations. When exploring the interaction of dietary restraint and stress reactivity, lower restraint/lower reactivity and lower restraint/higher reactivity were associated with reductions in energy intake (37-62 kcal) and comfort food (33-89 kcal). Higher restraint/lower reactivity was associated with consuming 86 fewer total kcal and 45 fewer kcal of comfort food. Only higher restraint/higher reactivity predicted increased energy intake (104 kcal) and comfort food (131 kcal). The interaction of dietary restraint and percentage body fat revealed that lower restraint/lower adiposity was associated with consuming 123 fewer kcal after being stressed with the entire reduction due to a decrease in comfort food. Lower restraint/higher adiposity was associated with consuming 116 kcal more after being stressed with 70% (81 kcal) of the increase in the form of comfort foods. Higher restraint/lower adiposity and higher restraint/higher adiposity were associated with smaller changes in total energy intake of 22 kcal and 1 kcal; respectively. Both restraint and adiposity moderated the effect of stress on energy intake and food choice. Children with greater adiposity may be at risk for stress-induced eating to contribute to their obesity. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Mixed selection. Effects of body images, dietary restraint, and persuasive messages on females' orientations towards chocolate.

    Science.gov (United States)

    Durkin, Kevin; Hendry, Alana; Stritzke, Werner G K

    2013-01-01

    Many women experience ambivalent reactions to chocolate: craving it but also wary of its impact on weight and health. Chocolate advertisements often use thin ideal models and previous research indicates that this exacerbates ambivalence. This experiment compared attitudes to, and consumption of, chocolate following exposure to images containing thin or overweight models together with written messages that were either positive or negative about eating chocolate. Participants (all female) were categorised as either low- or high-restraint. Approach, avoidance and guilt motives towards chocolate were measured and the participants had an opportunity to consume chocolate. Exposure to thin ideal models led to higher approach motives and this effect was most marked among the high restraint participants. Avoidance and guilt scores did not vary as a function of model size or message, but there were clear differences between the restraint groups, with the high restraint participants scoring substantially higher than low restraint participants on both of these measures. When the participants were provided with an opportunity to eat some chocolate, those with high restraint who had been exposed to the thin models consumed the most. Copyright © 2012 Elsevier Ltd. All rights reserved.

  6. Rappertk: a versatile engine for discrete restraint-based conformational sampling of macromolecules

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    Karmali Anjum M

    2007-03-01

    Full Text Available Abstract Background Macromolecular structures are modeled by conformational optimization within experimental and knowledge-based restraints. Discrete restraint-based sampling generates high-quality structures within these restraints and facilitates further refinement in a continuous all-atom energy landscape. This approach has been used successfully for protein loop modeling, comparative modeling and electron density fitting in X-ray crystallography. Results Here we present a software toolkit (Rappertk which generalizes discrete restraint-based sampling for use in structural biology. Modular design and multi-layered architecture enables Rappertk to sample conformations of any macromolecule at many levels of detail and within a variety of experimental restraints. Performance against a Cα-tracing benchmark shows that the efficiency has not suffered despite the overhead required by this flexibility. We demonstrate the toolkit's capabilities by building high-quality β-sheets and by introducing restraint-driven sampling. RNA sampling is demonstrated by rebuilding a protein-RNA interface. Ability to construct arbitrary ligands is used in sampling protein-ligand interfaces within electron density. Finally, secondary structure and shape information derived from EM are combined to generate multiple conformations of a protein consistent with the observed density. Conclusion Through its modular design and ease of use, Rappertk enables exploration of a wide variety of interesting avenues in structural biology. This toolkit, with illustrative examples, is freely available to academic users from http://www-cryst.bioc.cam.ac.uk/~swanand/mysite/rtk/index.html.

  7. Rappertk: a versatile engine for discrete restraint-based conformational sampling of macromolecules.

    Science.gov (United States)

    Gore, Swanand P; Karmali, Anjum M; Blundell, Tom L

    2007-03-21

    Macromolecular structures are modeled by conformational optimization within experimental and knowledge-based restraints. Discrete restraint-based sampling generates high-quality structures within these restraints and facilitates further refinement in a continuous all-atom energy landscape. This approach has been used successfully for protein loop modeling, comparative modeling and electron density fitting in X-ray crystallography. Here we present a software toolkit (Rappertk) which generalizes discrete restraint-based sampling for use in structural biology. Modular design and multi-layered architecture enables Rappertk to sample conformations of any macromolecule at many levels of detail and within a variety of experimental restraints. Performance against a Calpha-tracing benchmark shows that the efficiency has not suffered despite the overhead required by this flexibility. We demonstrate the toolkit's capabilities by building high-quality beta-sheets and by introducing restraint-driven sampling. RNA sampling is demonstrated by rebuilding a protein-RNA interface. Ability to construct arbitrary ligands is used in sampling protein-ligand interfaces within electron density. Finally, secondary structure and shape information derived from EM are combined to generate multiple conformations of a protein consistent with the observed density. Through its modular design and ease of use, Rappertk enables exploration of a wide variety of interesting avenues in structural biology. This toolkit, with illustrative examples, is freely available to academic users from http://www-cryst.bioc.cam.ac.uk/~swanand/mysite/rtk/index.html.

  8. Knot-So-Fast: a learning plan to minimize patient restraint in critical care.

    Science.gov (United States)

    Hurlock-Chorostecki, Christina; Kielb, Cathy

    2006-01-01

    In 2001, new legislation in Ontario, the Patient Restraint Minimization Act, mandated that all hospitals develop a policy to minimize the use of restraints. Since restraining patients was a common practice in our intensive care unit (ICU), a practice change was necessary. To do this, a learning plan was created to share key information pertaining to the Act that would support humane and dignified care for our critically ill patients. Change was accomplished through a survey of nursing staff to establish learning needs, the development of a learning plan titled "Knot-So-Fast", and the creation of a tool titled the "Restraint Decision Wheel" to support staff in making restraint decisions quickly and appropriately. To measure the effect of our Knot-So-Fast learning plan, the staff was resurveyed one year later. Results showed there was a statistically significant decrease in restraint use in our ICU. The learning plan and tools developed have been found to be adaptable to other hospital units and are provided. This article includes the educational content and methods used in our ICU to effect a change in restraint practice. Tools, such as a nursing survey and a decision wheel, developed to enhance learning are also included.

  9. Effects of chronic restraint stress on body weight, food intake, and hypothalamic gene expressions in mice.

    Science.gov (United States)

    Jeong, Joo Yeon; Lee, Dong Hoon; Kang, Sang Soo

    2013-12-01

    Stress affects body weight and food intake, but the underlying mechanisms are not well understood. We evaluated the changes in body weight and food intake of ICR male mice subjected to daily 2 hours restraint stress for 15 days. Hypothalamic gene expression profiling was analyzed by cDNA microarray. Daily body weight and food intake measurements revealed that both parameters decreased rapidly after initiating daily restraint stress. Body weights of stressed mice then remained significantly lower than the control body weights, even though food intake slowly recovered to 90% of the control intake at the end of the experiment. cDNA microarray analysis revealed that chronic restraint stress affects the expression of hypothalamic genes possibly related to body weight control. Since decreases of daily food intake and body weight were remarkable in days 1 to 4 of restraint, we examined the expression of food intake-related genes in the hypothalamus. During these periods, the expressions of ghrelin and pro-opiomelanocortin mRNA were significantly changed in mice undergoing restraint stress. Moreover, daily serum corticosterone levels gradually increased, while leptin levels significantly decreased. The present study demonstrates that restraint stress affects body weight and food intake by initially modifying canonical food intake-related genes and then later modifying other genes involved in energy metabolism. These genetic changes appear to be mediated, at least in part, by corticosterone.

  10. Methodology of estimating restraint use in children: roadside observation or parking lot interview survey.

    Science.gov (United States)

    Snowdon, Anne; Rothman, Linda; Slater, Morgan; Kolga, Carol; Hussein, Abdul; Boase, Paul; Howard, Andrew

    2010-11-01

    To compare the differences in Canadian national estimates of correct child restraint use obtained using the standard roadside observation method compared to a detailed parking lot interview. A multi-stage stratified survey design was used to conduct roadside observational and interview data collection at 182 randomly selected sites across Canada. For each site, a roadside intersection location and a parking lot location were used for the roadside observational survey and the interview respectively. Weighted estimates of correct restraint use from both locations were compared. Estimates of correct restraint use were significantly higher for all children under the age of 9 in the parking lot sample. The largest discrepancy between the two samples was in booster seat aged children (ages 4-8) where 29.1% versus 67.8% of children were observed to be correctly restrained using the roadside and the parking lot methodology respectively. There was a 67% participation refusal rate in the parking lot survey. There are specific advantages and limitations to both survey designs. The purpose of the data collection must be considered when selecting the methodology. Parking lot surveys provide richer data regarding restraint use/misuse. Estimates of correct restraint use must be approached with caution due to the effect of consent bias resulting in over inflation of estimates. Roadside observation is adequate and appropriate for providing national estimates of correct restraint use. 2010 Elsevier Ltd. All rights reserved.

  11. Are specialized endotracheal tubes and heat-and-moisture exchangers cost-effective in preventing ventilator associated pneumonia?

    Science.gov (United States)

    Gentile, Michael A; Siobal, Mark S

    2010-02-01

    Ventilator-associated pneumonia (VAP) is a common and serious complication of mechanical ventilation via an artificial airway. As with all nosocomial infections, VAP increases costs, morbidity, and mortality in the intensive care unit (ICU). VAP prevention is a multifaceted priority of the intensive care team, and can include the use of specialized artificial airways and heat-and-moisture exchangers (HME). Substantial evidence supports the use of endotracheal tubes (ETTs) that allow subglottic suctioning; silver-coated and antiseptic-impregnated ETTs; ETTs with thin-walled polyurethane cuffs; and HMEs, but these devices also can have adverse effects. Controversy still exists regarding the evidence, cost-effectiveness, and disadvantages and risks of these devices.

  12. Ciprofloxacin plus erythromycin or ambroxol ameliorates endotracheal tube-associated Pseudomonas aeruginosa biofilms in a rat model.

    Science.gov (United States)

    Cheng, Chen; Du, Lizhong; Yu, Jialin; Lu, Qi; He, Yu; Ran, Tao

    2015-12-01

    Pseudomonas aeruginosa is a multi-drug resistant bacterium, with its biofilm-growing mucoid (alginate-producing) strains being particularly resistant. As atomized drug administration is a common practice in pediatric patients, we compared the effect of inhalational therapy with erythromycin plus ciprofloxacin, with that of ambroxol plus ciprofloxacin, against biofilm producing strains of P. aeruginosa. Both combined treatment regimens were associated with a significant reduction in bacterial counts in endotracheal (ET) tubes and lungs, as compared to that observed with ambroxol and erythromycin monotherapies (Perythromycin, both in lowering bacterial counts (PErythromycin or ambroxol in combination with ciprofloxacin could eliminate P. aeruginosa biofilms. When combined with ciprofloxacin, ambroxol outperformed erythromycin in eradicating P. aeruginosa biofilm. Copyright © 2015 Elsevier GmbH. All rights reserved.

  13. The impact of restraint reduction meetings on the use of restrictive physical interventions in English residential services for children and young people.

    Science.gov (United States)

    Deveau, R; Leitch, S

    2015-07-01

    The aim was to examine the impact of post restraint reduction meetings upon the frequency and restrictiveness of restraint use in English children's residential services. Attention has been drawn to the misuse, overuse and safety of some techniques used to physically restrain children in residential services. Successful interventions to reduce restraints have been reported, mostly from the USA. Demonstrate a significant overall reduction in both, frequency and restrictiveness of restraints; the greatest percentage decrease in the most restrictive floor restraints. Whilst five services reduced both frequency and restrictiveness, five services showed some increases in frequency and/or restrictiveness of restraints employed. Restraint reduction is most effectively reduced through employing multiple strategies and that post restraint reduction meetings maybe one useful component. Organisations seeking to promote restraint reduction meetings need to allocate sufficient priority and resources to support these. © 2014 John Wiley & Sons Ltd.

  14. Comparison of hemodynamic and metabolic stress responses caused by endotracheal tube and Proseal laryngeal mask airway in laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Handan Güleç

    2012-01-01

    Full Text Available Background: We aimed to compare hemodynamic and endocrine alterations caused by stress response due to Proseal laryngeal mask airway and endotracheal tube usage in laparoscopic cholecystectomy. Materials and Methods: Sixty-three ASA I-II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated into two groups of endotracheal tube and Proseal laryngeal mask airway. Standard general anaesthesia was performed in both groups with the same drugs in induction and maintenance of anaesthesia. After anaesthesia induction and 20 minutes after CO 2 insufflations, venous blood samples were obtained for measuring adrenalin, noradrenalin, dopamine and cortisol levels. Hemodynamic and respiratory parameters were recorded at the 1 st , 5 th , 15 th , 30 th and 45 th minutes after the insertion of airway devices. Results: No statistically significant differences in age, body mass index, gender, ASA physical status, and operation time were found between the groups (p > 0.05. Changes in hemodynamic and respiratory parameters were not statistically significant when compared between and within groups (p > 0.05. Although no statistically significant differences were observed between and within groups when adrenalin, noradrenalin and dopamine values were compared, serum cortisol levels after CO 2 insufflation in PLMA group were significantly lower than the ETT group (p = 0.024. When serum cortisol levels were compared within groups, cortisol levels 20 minutes after CO 2 insufflation were significantly higher (46.1 (9.5-175.7 and 27.0 (8.3-119.4 in the ETT and PLMA groups, respectively than cortisol levels after anaesthesia induction (11.3 (2.8-92.5 and 16.6 (4.4-45.4 in the ETT and PLMA groups, respectively in both groups (p = 0.001. Conclusion: PLMA usage is a suitable, effective and safe alternative to ETT in laparoscopic cholecystectomy patients with lower metabolic stress.

  15. Comparison of ProSeal laryngeal mask airway (PLMA with cuffed and uncuffed endotracheal tubes in infants

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    Eyyup Sabri Ozden

    2016-11-01

    Full Text Available We aimed to compare cuffed and uncuffed endotracheal tubes (ETTs with ProSealTM laryngeal mask airway (PLMA in terms of airway security and extubation, starting out from the hypothesis that PLMA will provide alternative airway safety to the endotracheal tubes, and that airway complications will be less observed. After obtaining approval from the local Ethics Committee and parental informed consent, 120 pediatric patients 1-24 months old, American Society of Anesthesiologists physical status I-II, requiring general anesthesia for elective lower abdominal surgery, were randomized into PLMA (Group P, n = 40, cuffed ETT (Group C, n = 40, and uncuffed ETT (Group UC, n = 40 groups. The number of intubation or PLMA insertion attempts was recorded. Each patient’s epigastrium was auscultated for gastric insufflation, leak volumes and air leak fractions (leak volume/inspiratory volume were recorded. Post-operative adverse events related to airway management were also followed up during the first post-operative hour. Demographic and surgical data were similar among the groups. There were significantly fewer airway manipulations in the Group P than in the other groups (p < 0.01, and leak volume and air leak fractions were greater in the Group UC than in the other two groups (p < 0.01. Laryngospasm was significantly lower in the Group P during extubation and within the first minute of post-extubation than in the other groups (p < 0.01. Based on this study, PLMA may be a good alternative to cuffed and uncuffed ETTs for airway management of infants due to the ease of manipulation and lower incidence of laryngospasm.

  16. Inflation lung mechanics deteriorates markedly after saline instillation and open endotracheal suctioning in mechanically ventilated healthy piglets.

    Science.gov (United States)

    Cunha-Goncalves, Doris; Perez-de-Sá, Valéria; Ingimarsson, Jónas; Werner, Olof; Larsson, Anders

    2007-01-01

    Non-bronchoscopic bronchoalveolar lavage is an alternative to diagnostic bronchoscopy in pediatric patients, as fiberoptic bronchoscopes with aspiration channels are too large for small infants. There are many variations of the method in clinical practice, and saline instillation followed by open endotracheal suctioning is still commonly used. Lung function can deteriorate with these procedures, and we have investigated the effects on lung mechanics and oxygenation in healthy piglets. The lungs of anesthetized and mechanically ventilated piglets were recruited with CPAP 35 cmH2O. Thereafter we instilled 5 ml of saline into the endotracheal tube, followed by three breaths from the ventilator. Saline was retrieved through a suction catheter wedged far distally in the airway. The procedure was followed by a new recruitment maneuver. Complete inspiratory/expiratory pressure - volume loops (PV-loops) were obtained just before and 5 min after saline instillation. Arterial blood gases were collected at equivalent times in 14 similar piglets submitted to exactly the same procedure. The inspiratory limb of the PV-loops changed markedly, as the lower inflection point was displaced towards higher pressures (P=0.004), and hysteresis measured at 15 and 30 cmH2O increased (P=0.004 and P=0.012, respectively). Although PaO2 decreased significantly (P=0.001), values after saline instillation/suctioning were still in the high normal range, that is, 22.2 +/- 2.6 kPa. Opening pressures of the lungs increase markedly after saline instillation/suctioning in healthy piglets. In this situation, adequate recruitment maneuvers and PEEP might prevent lung collapse and deteriorations in arterial oxygenation. (c) 2006 Wiley-Liss, Inc.

  17. Effect of ambroxol on pneumonia caused by Pseudomonas aeruginosa with biofilm formation in an endotracheal intubation rat model.

    Science.gov (United States)

    Li, Fang; Wang, Wenlei; Hu, Linyan; Li, Luquan; Yu, Jialin

    2011-01-01

    Pseudomonas aeruginosa, especially the mucoid phenotype, is responsible for most of the morbidity and mortality in ventilator-associated pneumonia. Although ambroxol is widely used in neonatal lung problems as a mucolytic as well as an antioxidant agent, its anti-infective role is not well demonstrated by studies in vivo. To explore the effect of ambroxol on the biofilms of mucoid P. aeruginosa and on the associated lung infection using a rat model. We developed a rat model of acute lung infection by endotracheal intubation with a tube covered with mucoid P. aeruginosa biofilm. Then, we studied the effect of ambroxol on the biofilm using saline treatment as a control. Subsequently, we studied the microstructure of the biofilm, bacterial count in the tubes and lungs, pathological changes that occurred in the lungs, and the cytokine response. Alteration of the microstructure of the biofilm with ambroxol treatment was demonstrated by scanning electron microscopy. The bacterial counts on the biofilm-covered tube in the ambroxol-treated group were significantly lower than those in the saline-treated group on both post-bacterial challenge days 4 and 7 (p ambroxol-treated group and of the saline-treated group on post-bacterial challenge day 7 were not significantly different (p > 0.05). The pathological changes in lungs were milder with the effect of ambroxol. The cytokine responses, namely the level of IFN-γ and the ratio of IFN-γ and IL-10, were also reduced with the effect of ambroxol. We demonstrated that the ambroxol treatment could destroy the structure of the biofilm on the tube used for intubation and decrease the bacterial load. Further, the reduced cytokine response and milder pathological changes in lungs in an endotracheal intubation rat model indicate that ambroxol can attenuate the damage caused by biofilm-associated infection in the lung. Copyright © 2011 S. Karger AG, Basel.

  18. Anticipatory precrash restraint sensor feasibility study: Final report

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    Kercel, S.W.; Dress, W.B.

    1995-08-01

    This report explores feasibility of an anticipatory precrash restraint sensor. The foundation principle is the anticipation mechanism found at a primitive level of biological intelligence and originally formalized by the mathematical biologist Robert Rosen. A system based on formal anticipatory principles should significantly outperform conventional technologies. It offers the prospect of high payoff in prevention of death and injury. Sensors and processes are available to provide a good, fast, and inexpensive description of the present dynamical state of the vehicle to the embedded system model in the anticipation engine. The experimental part of this study found that inexpensive radar in a real-world setting does return useful data on target dynamics. The data produced by a radar system can be converted to target dynamical information by good, fast and inexpensive signal-processing techniques. Not only is the anticipatory sensor feasible, but further development under the sponsorship of the National Highway Traffic Safety Administration is necessary and desirable. There are a number of possible lines of follow-on investigation. The level of effort and expected benefits of various alternatives are discussed.

  19. Dietary restraint and telomere length in pre- and postmenopausal women.

    Science.gov (United States)

    Kiefer, Amy; Lin, Jue; Blackburn, Elizabeth; Epel, Elissa

    2008-10-01

    Leukocyte telomere shortening can serve as a biomarker of aging, as telomere length (TL) can decline with age and shortening is positively associated with morbidity and mortality. It is therefore important to identify psychological and behavioral factors linked to accelerated telomere shortening. Stress and poorer metabolic health (greater adiposity, insulin resistance, and cortisol) correlate with shorter telomeres. Self-reported dietary restraint (DR), defined as chronic preoccupation with weight and attempts at restricting food intake, is linked to greater perceived stress, cortisol, and weight gain, when assessed in community studies (versus in weight loss programs). To test for an association between DR and TL in healthy women across a range of ages. We examined whether DR is linked to TL in two samples, one of premenopausal women (aged 20-50 years;N = 36) and one of postmenopausal women (aged 53-69 years; N = 20). In both samples, higher levels of DR were associated with shorter leukocyte TL, independent of body mass index, smoking, and age. Chronic DR, as assessed by self-report (i.e. not caloric restriction), may be a risk factor for premature telomere shortening. Potential mechanisms are discussed.

  20. Dietary restraint and US devaluation predict evaluative learning.

    Science.gov (United States)

    Brunstrom, Jeffrey M; Higgs, Suzanne; Mitchell, Gemma L

    2005-08-07

    Previous research has indicated that flavor-flavor learning is impaired in restrained eaters. In Experiment 1 we sought to extend this finding using a larger sample and a more comprehensive assessment of dietary behavior. Participants (N=90, including 30 current dieters) sampled three novel flavors (CSs), each on 10 separate occasions, in a randomized order. Each flavor was paired with chocolate (US) either 10%, 50%, or 90% of the time. We then assessed liking for the three CSs and asked participants to complete the DEBQ-restraint and TFEQ-disinhibition sub-scales. After these CS-US parings, restrained eaters tended to prefer the 10% paired flavor whereas unrestrained eaters tended to prefer the 90% paired flavor. Differential CS liking was not evident in dieters and it was not predicted by disinhibition. Using a similar methodology, in Experiment 2 (N=76) we assessed evaluative change following picture-sweet pairings. Relative to the other CSs, the restrained eaters reported a greater increase in their liking for the 10% paired CS and the unrestrained eaters reported a greater increase in their liking for the 90% paired CS. We also discovered that evaluative change is related to the level of US devaluation that takes place during conditioning. Evidence that a sweet US can bring about a decrease in liking has not been reported previously. One interpretation is that negative beliefs and attitudes can contaminate the representation of the US during training.

  1. Effect of repeated restraint stress on memory in different tasks

    Directory of Open Access Journals (Sweden)

    G.D. Gamaro

    1999-03-01

    Full Text Available The present study investigated the effect of repeated stress applied to female rats on memory evaluated by three behavioral tasks: two-way shuttle avoidance, inhibitory avoidance and habituation to an open field. Repeated stress had different effects on rat behavior when different tasks were considered. In the two-way active avoidance test the stressed animals presented memory of the task, but their memory scores were impaired when compared to all other groups. In the habituation to the open field, only the control group showed a significant difference in the number of rearings between training and testing sessions, which is interpreted as an adequate memory of the task. In the handled and chronically stressed animals, on the other hand, no memory was observed, suggesting that even a very mild repeated stress would be enough to alter habituation to this task. The performance in the inhibitory avoidance task presented no significant differences between groups. The findings suggest that repeated restraint stress might induce cognitive impairments that are dependent on the task and on stress intensity.

  2. State and trait positive and negative affectivity in relation to restraint intention and binge eating among adults with obesity.

    Science.gov (United States)

    Smith, Kathryn E; Mason, Tyler B; Crosby, Ross D; Engel, Scott G; Crow, Scott J; Wonderlich, Stephen A; Peterson, Carol B

    2018-01-01

    Restraint and binge eating are cognitive and behavioral processes that are particularly important in the context of obesity. While extensive research has focused on negative affect (NA) in relation to binge eating, it is unclear whether affective valence (i.e., positive versus negative) and stability (i.e., state versus trait) differentially predict binge eating and restraint among individuals with obesity. Distinguishing between valence and stability helps elucidate under which affective contexts, and among which individuals, restraint and binge eating are likely to occur. Therefore, the present study examined relationships between trait and state levels of NA and positive affect (PA), binge eating, and restraint intention among 50 adults with obesity (BMI ≥ 30). Participants completed baseline assessments followed by a two-week ecological momentary assessment (EMA) protocol. Structural equation modeling assessed a trait model of person-level measures of affect in relation to overall levels of binge eating and restraint intention, while general estimating equations (GEEs) assessed state models examining relationships between momentary affect and subsequent binge eating and restraint. The trait model indicated higher overall NA was related to more binge eating episodes, but was unrelated to overall restraint intention. Higher overall PA was related to higher overall restraint intention, but was unrelated to binge eating. State models indicated momentary NA was associated with a greater likelihood of subsequent binge eating and lower restraint intention. Momentary PA was unrelated to subsequent binge eating or restraint intention. Together, findings demonstrate important distinctions between the valence and stability of affect in relationship to binge eating and restraint intention among individuals with obesity. While NA is a more salient predictor of binge eating than PA, both overall PA and momentary NA are predictors of restraint intention. Published by

  3. Use of physical restraint in hospital patients: A descriptive study in a tertiary hospital in South Africa

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    Sebastiana Z. Kalula

    2016-02-01

    Full Text Available Background: The use of physical restraint in patient management is a common and emotive issue, and has legal and ethical dimensions.Objective: To document the prevalence of physical restraint use, patient characteristics associated with physical restraint use, and nurses’ and doctors’ knowledge and perceptions towards the practice.Methods: A cross-sectional study of 572 patients, of whom 132 were physically restrained, was conducted in acute wards of a tertiary hospital. Data were collected on the 132 physically restrained patients. Fifty-nine doctors and 159 nurses completed a specially constructed questionnaire. Descriptive statistics were derived and expressed as numbers and percentages.Results: Prevalence of restraint use was 23% (132/572. The distribution in acute wards was: medical 54.5%; surgical 44.7%; maternity 0.8%; psychiatry none. Mean age (SD of the restrained patients was 49 years (20.5; 53.8% were male. The commonest types of restraints used were bed rails 93% and wrist belts 12%. Restraints were used largely to protect medical devices and as protection from harm. Less than 15% of the nurses reported having received training and 36% of the doctors reported having received some guidance on the use of restraints. Only a minority of nurses and doctors knew of a hospital policy on restraint use. Documentation on the prescription and indication for the use of restraint was poor.Conclusion: Prevalence of restraint use is high and poorly coordinated. A policy on the use of restraint and comprehensive guidelines should be developed to guide health care practitioners in the management of patients where restraint cannot be avoided.

  4. De-escalation techniques used, and reasons for seclusion and restraint, in a forensic psychiatric hospital.

    Science.gov (United States)

    Kuivalainen, Satu; Vehviläinen-Julkunen, Katri; Louheranta, Olavi; Putkonen, Anu; Repo-Tiihonen, Eila; Tiihonen, Jari

    2017-10-01

    In Finland, the Mental Health Act determines the legal basis for seclusion and restraint. Restrictive measures are implemented to manage challenging situations and should be used as a last resort in psychiatric inpatient care. In the present study, we examined the reasons for seclusion and restraint, as well as whether any de-escalation techniques were used to help patients calm down. Seclusion and restraint files from a 4-year period (1 June 2009-31 May 2013) were retrospectively investigated and analysed by content analysis. Descriptive statistics were calculated. A total of 144 episodes of seclusion and restraint were included to analyse the reasons for seclusion and restraint, and 113 episodes were analysed to examine unsuccessful de-escalation techniques. The most commonly-used techniques were one-to-one interaction with a patient (n = 74, 65.5% of n = 113) and administration of extra medication (n = 37, 32.7% of n = 113). The reasons for seclusion and restraint were threatening harmful behaviour (n = 51, 35.4% of n = 144), direct harmful behaviour (n = 43, 29.9%), indirect harmful behaviour (n = 42, 29.1%), and other behaviours (n = 8, 5.6%). In general, the same de-escalation techniques were used with most patients. Most episodes of seclusion or restraint were due to threats of violence or direct violence. Individual means of self-regulation and patient guidance on these techniques are needed. Additionally, staff should be educated on a diverse range of de-escalation techniques. Future studies should focus on examining de-escalation techniques for the prevention of seclusion. © 2017 Australian College of Mental Health Nurses Inc.

  5. Physical restraint use among nursing home residents: A comparison of two data collection methods

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    Voyer Philippe

    2004-10-01

    Full Text Available Abstract Background In view of the issues surrounding physical restraint use, it is important to have a method of measurement as valid and reliable as possible. We determined the sensitivity and specificity of physical restraint use a reported by nursing staff and b reviewed from medical and nursing records in nursing home settings, by comparing these methods with direct observation. Methods We sampled eight care units in skilled nursing homes, seven care units in nursing homes and one long-term care unit in a hospital, from eight facilities which included 28 nurses and 377 residents. Physical restraint use was assessed the day following three periods of direct observation by two different means: interview with one or several members of the regular nursing staff, and review of medical and nursing records. Sensitivity and specificity values were calculated according to 2-by-2 contingency tables. Differences between the methods were assessed using the phi coefficient. Other information collected included: demographic characteristics, disruptive behaviors, body alignment problems, cognitive and functional skills. Results Compared to direct observation (gold standard, reported restraint use by nursing staff yielded a sensitivity of 87.4% at a specificity of 93.7% (phi = 0.84. When data was reviewed from subjects' medical and nursing records, sensitivity was reduced to 74.8%, and specificity to 86.3% (phi = 0.54. Justifications for restraint use including risk for falls, agitation, body alignment problems and aggressiveness were associated with the use of physical restraints. Conclusions The interview of nursing staff and the review of medical and nursing records are both valid and reliable techniques for measuring physical restraint use among nursing home residents. Higher sensitivity and specificity values were achieved when nursing staff was interviewed as compared to reviewing medical records. This study suggests that the interview of nursing

  6. Restraint stress alters immune parameters and induces oxidative stress in the mouse uterus during embryo implantation.

    Science.gov (United States)

    Liu, Guanhui; Dong, Yulan; Wang, Zixu; Cao, Jing; Chen, Yaoxing

    2014-12-01

    The influence of stress on embryo implantation is not well understood. Prior studies have focused on later gestational stages and the long-term impact of stress on immune function. The objective of this study is to investigate the effects of restraint stress on the immune parameters and the oxidative states of the uterus during implantation. In this study, pregnant CD1 mice were subjected to restraint stress (4 h/d) on embryonic day 1 (E1) and sacrificed on E3, E5, and E7. Maternal plasma corticosterone (CORT) secretion and implantation sites in the uterus were examined. The uterine (excluding embryos) homogenate and uterine lymphocytes were collected to examine oxidative stress states and associated immune parameters. The results demonstrated that restraint stress increased maternal plasma CORT secretion and reduced the number of implantation sites by 15.3% on E5 and by 26.1% on E7. Moreover, restraint stress decreased the density of uterine natural killer (uNK) cells in the endometrium by 22.1-47.9% and increased the density of mast cells in the myometrium by 55.6-76.9%. Restraint stress remarkably decreased the CD3(+)CD4(+) T/CD3(+)CD8(+) T cell ratio (by 26.2-28.9%) and attenuated uterine lymphocyte proliferation and secretion of cytokines. In addition, restraint stress threatened the intracellular equilibrium between oxidants and antioxidants, resulting in decreased glutathione peroxidase (GSH-PX) (32.2% and 45.7%), superoxide dismutase (SOD) (15.5% and 26.1%), and total antioxidant capacity (T-AOC) (18.4% and 18.2%) activities and increased malondialdehyde (MDA) (34.4% and 43.0%) contents on E5 and E7. In conclusion, these findings demonstrate that restraint stress causes abnormal implantation and negatively impacts immune parameters in association with oxidative stress in mice.

  7. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients.

    Science.gov (United States)

    Bruder, Eric A; Ball, Ian M; Ridi, Stacy; Pickett, William; Hohl, Corinne

    2015-01-08

    trials in patients undergoing emergency endotracheal intubation for critical illness, including but not limited to trauma, stroke, myocardial infarction, arrhythmia, septic shock, hypovolaemic or haemorrhagic shock, and undifferentiated shock states. We included single (bolus) dose etomidate for emergency airway intervention compared to any other rapid-acting intravenous bolus single-dose induction agent. Refinement of our initial search results by title review, and then by abstract review was carried out by three review authors. Full-text review of potential studies was based on their adherence to our inclusion and exclusion criteria. This was decided by three independent review authors. We reported the decisions regarding inclusion and exclusion in accordance with the PRISMA statement.Electronic database searching yielded 1635 potential titles, and our grey literature search yielded an additional 31 potential titles. Duplicate titles were filtered leaving 1395 titles which underwent review of their titles and abstracts by three review authors. Sixty seven titles were judged to be relevant to our review, however only eight met our inclusion criteria and seven were included in our analysis. We included eight studies in the review and seven in the meta-analysis. Of those seven studies, only two were judged to be at low risk of bias. Overall, no strong evidence exists that etomidate increases mortality in critically ill patients when compared to other bolus dose induction agents (odds ratio (OR) 1.17; 95% confidence interval (CI) 0.86 to 1.60, 6 studies, 772 participants, moderate quality evidence). Due to a large number of participants lost to follow-up, we performed a post hoc sensitivity analysis. This gave a similar result (OR 1.15; 95% CI 0.86 to 1.53). There was evidence that the use of etomidate in critically ill patients was associated with a positive adrenocorticotropic hormone (ACTH) stimulation test, and this difference was more pronounced at between 4 to 6

  8. Comparative study between benzydamine hydrochloride gel, lidocaine 5% gel and lidocaine 10% spray on endotracheal tube cuff as regards postoperative sore throat.

    Science.gov (United States)

    Mekhemar, Nashwa Abdallah; El-Agwany, Ahmed Samy; Radi, Wafaa Kamel; El-Hady, Sherif Mohammed

    2016-01-01

    Postoperative sore throat is a common complication after endotracheal intubation. After tracheal intubation, the incidence of sore throat varies from 14.4% to 50%. The aim of the study was to compare between benzydamine hydrochloride gel, lidocaine 5% gel and lidocaine 10% spray on the endotracheal tube cuff as regards postoperative sore throat. The present study was carried out on 124 patients admitted to Alexandria university hospitals for lumbar fixation surgery requiring general anesthesia. Patients were randomly allocated into 4 groups. Benzydamine hydrochloride gel, 5% lidocaine hydrochloride gel, 10% lidocaine hydrochloride spray, or normal saline were applied on endotracheal tube cuffs before endotracheal intubation. The patients were examined for sore throat (none, mild, moderate, or severe) at 0, 1, 6, 12, and 24h after extubation. The results were collected, analyzed and presented in table and figure. The highest incidence of postoperative sore throat occurred at 6h after extubation in all groups. There was a significantly lower incidence of postoperative sore throat in the benzydamine group than 5% lidocaine gel, 10% lidocaine spray, and normal saline groups. The benzydamine group had significantly decreased severity of postoperative sore throat compared with the 10% lidocaine, 5% lidocaine, and normal saline groups at observation time point. Compared with the 5% lidocaine the 10% lidocaine group had significantly increased incidence and severity of postoperative sore throat after extubation. Compared with normal saline the 10% lidocaine group had increased incidence of postoperative sore throat. There were no significant differences among groups in local or systemic side effects. So in conclusion, benzydamine hydrochloride gel on the endotracheal tube cuff is a simple and effective method to reduce the incidence and severity of postoperative sore throat. Application of 10% lidocaine spray should be avoided because of worsening of postoperative sore

  9. Venous blood gas and lactate values of mourning doves (Zenaida macroura), boat-tailed grackles (Quiscalus major), and house sparrows (Passer domesticus) after capture by mist net, banding, and venipuncture.

    Science.gov (United States)

    Harms, Craig A; Harms, Ronald V

    2012-03-01

    Blood gas partial pressures, pH, and bicarbonate and lactate concentrations were measured from the basilic vein of mourning doves (Zenaida macroura) and the jugular vein of boat-tailed grackles (Quiscalus major) and house sparrows (Passer domesticus) to assess immediate impacts of mist net capture and handling for banding and venipuncture. Mourning doves and house sparrows exhibited mild acidemia (median [minimum-maximum] venous blood pH(41 degrees C) = 7.394 [7.230-7.496] and 7.395 [7.248-7.458], respectively), relative to boat-tailed grackles (Quiscalus major; 7.452 [7.364-7.512]), but for different reasons. Mourning doves exhibited relative metabolic acidosis (lower venous blood pH, higher lactate concentrations, lower bicarbonate, and no significant differences in partial pressure of CO2 (pCO2) or partial pressure of O2 (pO2) compared with boat-tailed grackles). House sparrows exhibited relative respiratory acidosis (lower venous blood pH, higher pCO2, lower pO2, and no significant differences in bicarbonate and lactate concentrations compared with boat-tailed grackles). All birds captured by mist net and handled for banding and venipuncture experienced some degree of lactic acidemia; and values were greater in mourning doves (lactate, 7.72 [3.94-14.14] mmol/L) than in boat-tailed grackles (5.74 [3.09-8.75] mmol/L) and house sparrows (4.77 [2.66-12.03] mmol/L), despite mourning doves resisting least and being easiest to disentangle from the mist net. House sparrows were more susceptible to respiratory acidosis, warranting particular care in handling birds <30 g to minimize interference with ventilation. The different sample collection site for mourning doves may have affected results in comparison with the other two species, due to activity of the wing muscles. However, despite the higher lactate concentrations, pCO2 was relatively low in doves. The metabolic, respiratory, and acid-base alterations observed in this study were minor in most cases, indicative of

  10. Child restraint system misuse and/or inappropriate use in Australia.

    Science.gov (United States)

    Koppel, Sjaanie; Charlton, Judith L

    2009-06-01

    Motor vehicle crashes are one of the leading causes of child death and acquired disability. Child restraint systems (CRS) for vehicles are designed to provide specialized protection for child occupants in the event of a crash. However, the effectiveness of a CRS is critically dependent on: correct installation of the CRS in the vehicle, the correct harnessing of the child in the CRS, and use of an appropriate CRS. The current study aimed to investigate the incidence misuse and/or inappropriate use of CRS through a CRS inspection program in the Australian states of New South Wales (NSW), Victoria (VIC), Queensland (QLD), South Australia (SA), Western Australia (WA), and Tasmania (TAS). Participants were recruited through an advertisement for free CRS inspections displayed at childcare centers, kindergartens, community centers, hospitals, and child expos. At each inspection, the CRS fitting specialist inspected and reported to the owner of the CRS on the installation of the child restraint(s) and/or system(s) and any fitting faults and/or concerns with the fitting and/or use if the child restraint(s) and or system(s). The following results are based on the inspection of 1386 vehicles, in which there were 1995 restraints. Of all the restraints inspected, the majority (79%) were reported as having at least one instance of misuse. The most common forms of misuse included harness strap errors such as the straps being adjusted, faulty, twisted, and/or incorrectly positioned (38%); seat belt errors such as the seatbelt being incorrectly routed, twisted, and/or incorrectly adjusted (32%); missing or incorrect fitting of gated buckle/locking clip (23%); the need for a missing sash guide (8%); tether errors such as the tether being incorrectly routed and/or adjusted (7%); inappropriate use of a CRS for the size of the child (6%); anchor errors such as the anchor was fitted incorrectly or not the correct type (5%); and the H Harness(1) being used incorrectly (5%). In addition

  11. Influence of dosage and chemical restraints on feline excretory urography.

    Science.gov (United States)

    Ajadi, R A; Adetunji, A; Omoerah, V O; Okoh, J U

    2006-12-01

    Three series of trials involving 10 domestic short-haired cats were carried out to determine the influence of dosage of contrast media or type of chemical restraint on feline excretory urography. The 1st series (group A) involved 5 cats sedated with 2.0 mg/kg intramuscular (i.m) injection of 2% xylazine and receiving 800 mg/kg of 76 % meglumine diatrizoate (urografin). The 2nd series (group B) involved another 5 cats sedated with 2.0 mg/kg (i.m) injection of 2% xylazine and receiving 1200 mg/kg of 76% urografin. The 3rd series (group C) involved the repeat urography of the group B cats but sedated with 15 mg/kg (i.m) injection of 5% ketamine hydrochloride. Ventrodorsal radiographs were obtained immediately, 5, 15 and 40 minutes after the injection of 76% urografin. Scores were assigned to nephrographic opacification as described in the literature. The heart rates, respiratory rates and rectal temperatures of the cats were also determined before sedation, after sedation, immediately after the injection of 76% urografin and at 15-minute intervals over a period of 60 minutes. In this study, there were significant differences (P 0.05) in heart rates, respiratory rates and rectal temperatures between the 3 groups of cats. It was therefore concluded that increasing the dosage of urografin above 800 mg/kg in cats does not provide additional beneficial effects on the nephrograms produced. Xylazine sedation was observed to produce better nephrographic opacification, however, with delayed nephrographic fading compared to ketamine sedation.

  12. Restraint stress intensifies interstitial K+ accumulation during severe hypoxia

    Directory of Open Access Journals (Sweden)

    Christian eSchnell

    2012-03-01

    Full Text Available Chronic stress affects neuronal networks by inducing dendritic retraction, modifying neuronal excitability and plasticity, and modulating glial cells. To elucidate the functional consequences of chronic stress for the hippocampal network, we submitted adult rats to daily restraint stress for three weeks (6 h/day. In acute hippocampal tissue slices of stressed rats, basal synaptic function and short-term plasticity at Schaffer collateral/CA1 neuron synapses were unchanged while long-term potentiation was markedly impaired. The spatiotemporal propagation pattern of hypoxia-induced spreading depression episodes was indistinguishable among control and stress slices. However, the duration of the extracellular direct current (DC potential shift was shortened after stress. Moreover, K+ fluxes early during hypoxia were more intense, and the postsynaptic recoveries of interstitial K+ levels and synaptic function were slower. Morphometric analysis of immunohistochemically stained sections suggested hippocampal shrinkage in stressed rats, and the number of cells that are immunoreactive for GFAP (glial fibrillary acidic protein was increased in the CA1 subfield indicating activation of astrocytes. Western blots showed a marked downregulation of the inwardly rectifying K+ channel Kir4.1 in stressed rats. Yet, resting membrane potentials, input resistance and K+-induced inward currents in CA1 astrocytes were indistinguishable from controls. These data indicate an intensified interstitial K+ accumulation during hypoxia in the hippocampus of chronically stressed rats which seems to arise from a reduced interstitial volume fraction rather than impaired glial K+ buffering. One may speculate that chronic stress aggravates hypoxia-induced pathophysiological processes in the hippocampal network and that this has implications for the ischemic brain.

  13. Chemical restraint in routine clinical practice: a report from a general hospital psychiatric ward in Greece

    Directory of Open Access Journals (Sweden)

    Papamichael Georgios

    2011-02-01

    Full Text Available Abstract Background There is a dearth of studies regarding chemical restraint in routine clinical psychiatric practice. There may be wide variations between different settings and countries. Methods A retrospective study on chemical restraint was performed in the 11-bed psychiatric ward of the General Hospital of Arta, in northwestern Greece. All admissions over a 2-year-period (from March 2008 to March 2010 were examined. Results Chemical restraint was applied in 33 cases (10.5% of total admissions. From a total of 82 injections, 22 involved a benzodiazepine and/or levomepromazine, whereas 60 injections involved an antipsychotic agent, almost exclusively haloperidol (96.7% of cases, usually in combination with a benzodiazepine (61.7% of cases. In 36.4% of cases the patient was further subjected to restraint or seclusion. Conclusions In our unit, clinicians prefer the combined antipsychotic/benzodiazepine regimen for the management of patients' acute agitation and violent behaviour. Conventional antipsychotics are administrated almost exclusively and in a significant proportion of cases further coercive measures are applied. Studies on the practice of chemical restraint should be regularly performed in clinical settings.

  14. The validity of the transdiagnostic cognitive behavioural model of eating disorders in predicting dietary restraint.

    Science.gov (United States)

    Hoiles, Kimberley J; Egan, Sarah J; Kane, Robert T

    2012-04-01

    The study examined the validity of the transdiagnostic cognitive behavioural theory of eating disorders. The aim was to determine if the maintaining mechanisms of clinical perfectionism, core low self esteem, mood intolerance and interpersonal difficulties have a direct impact on dietary restraint or an indirect impact via eating, shape and weight concerns. The model was tested in a community sample of 224 females recruited via the internet. The structural equation model provided a good fit for the data. The relationship between maintaining mechanisms and dietary restraint was due to maintaining mechanisms impacting indirectly on dietary restraint via eating disorder psychopathology. The results lend support for the validity of the transdiagnostic model of eating disorders as the maintaining mechanisms lead to restraint via the core psychopathology of eating concerns, weight concerns and shape concerns. The findings suggest the four maintaining mechanisms alone are not enough to lead to dietary restraint, the core psychopathology of eating disorders needs to be present, which supports the predictions of the theory. These results help establish the validity of the transdiagnostic cognitive behavioural theory of eating disorders. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

  15. Numerical simulation of a child restraint system in an aircraft crash-test.

    Science.gov (United States)

    Oggero, E; Pipino, M; Deweese, R; Mugnai, A; Aljundi, B; Pagnacco, G

    2000-01-01

    Studies conducted at the FAA Civil Aeromedical Institute have shown that when used in aircraft, automotive child restraint devices do not always provide the level of safety desired. Various factors that contribute to poor performance, such as seat belt anchor location, cushion stiffness, and child restraint device design features, were evaluated by a dynamic impact test program. To efficiently continue the research, a computer model was developed using MADYMO. Results of two of the impact tests were used to validate the model. Both test configurations utilized a typical commercial transport airplane passenger seat and a popular automotive child restraint device. These tests were considered representative of the extremes of child restraint device and occupant kinematics due to variance in seat belt anchor location. Details are presented of the test parameters and geometry, as well as cushion and restraint system properties. Test and modelling results for these two impact conditions are summarized and compared. Parametric studies were then conducted that used the model to investigate the effect of cushion stiffness, belt anchor spacing, and initial belt tension.

  16. Factors affecting tether use and correct use in child restraint installations.

    Science.gov (United States)

    Jermakian, Jessica S; Klinich, Kathleen D; Orton, Nichole R; Flannagan, Carol A C; Manary, Miriam A; Malik, Laura A; Narayanaswamy, Prabha

    2014-12-01

    Field studies show that top tethers go unused in half of forward-facing child restraint installations. In this study, parent volunteers were asked to use the Lower Anchors and Tethers for Children (LATCH) to install child restraints in several vehicles to identify tether anchor characteristics that are associated with tether use. Thirty-seven volunteers were assigned to four groups. Each group tested two forward-facing child restraints in four of 16 vehicle models. Logistic regression models were used to identify predictors of tether use and correct use. Subjects used the tether in 89% of the 294 forward-facing child restraint installations and attached the tether correctly in 57% of the installations. Tethers were more likely to be used when the anchor was located on the rear deck as typically found in sedans compared with the seatback, floor, or roof. Tethers were less likely to be attached correctly when there was potentially confusing hardware present. No vehicle tether hardware characteristics or vehicle manual directions were associated specifically with correct tether routing and head restraint position. This study provides laboratory evidence that specific vehicle features are associated with tether use and correct use. Modifications to vehicles that make tether anchors easier to find and identify likely will result in increases in tether use and correct use. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres

    Science.gov (United States)

    van Arkel, R. J.; Amis, A. A.; Cobb, J. P.; Jeffers, J. R. T.

    2015-01-01

    In this in vitro study of the hip joint we examined which soft tissues act as primary and secondary passive rotational restraints when the hip joint is functionally loaded. A total of nine cadaveric left hips were mounted in a testing rig that allowed the application of forces, torques and rotations in all six degrees of freedom. The hip was rotated throughout a complete range of movement (ROM) and the contributions of the iliofemoral (medial and lateral arms), pubofemoral and ischiofemoral ligaments and the ligamentum teres to rotational restraint was determined by resecting a ligament and measuring the reduced torque required to achieve the same angular position as before resection. The contribution from the acetabular labrum was also measured. Each of the capsular ligaments acted as the primary hip rotation restraint somewhere within the complete ROM, and the ligamentum teres acted as a secondary restraint in high flexion, adduction and external rotation. The iliofemoral lateral arm and the ischiofemoral ligaments were primary restraints in two-thirds of the positions tested. Appreciation of the importance of these structures in preventing excessive hip rotation and subsequent impingement/instability may be relevant for surgeons undertaking both hip joint preserving surgery and hip arthroplasty. Cite this article: Bone Joint J 2015; 97-B:484–91. PMID:25820886

  18. Chronic restraint or variable stresses differently affect the behavior, corticosterone secretion and body weight in rats.

    Science.gov (United States)

    Marin, Marcelo T; Cruz, Fabio C; Planeta, Cleopatra S

    2007-01-30

    Organisms are constantly subjected to stressful stimuli that affect numerous physiological processes and activate the hypothalamo-pituitary-adrenal (HPA) axis, increasing the release of glucocorticoids. Exposure to chronic stress is known to alter basic mechanisms of the stress response. The purpose of the present study was to compare the effect of two different stress paradigms (chronic restraint or variable stress) on behavioral and corticosterone release to a subsequent exposure to stressors. Considering that the HPA axis might respond differently when it is challenged with a novel or a familiar stressor we investigated the changes in the corticosterone levels following the exposure to two stressors: restraint (familiar stress) or forced novelty (novel stress). The changes in the behavioral response were evaluated by measuring the locomotor response to a novel environment. In addition, we examined changes in body, adrenals, and thymus weights in response to the chronic paradigms. Our results showed that exposure to chronic variable stress increased basal plasma corticosterone levels and that both, chronic restraint and variable stresses, promote higher corticosterone levels in response to a novel environment, but not to a challenge restraint stress, as compared to the control (non-stressed) group. Exposure to chronic restraint leads to increased novelty-induced locomotor activity. Furthermore, only the exposure to variable stress reduced body weights. In conclusion, the present results provide additional evidence on how chronic stress affects the organism physiology and point to the importance of the chronic paradigm and challenge stress on the behavioral and hormonal adaptations induced by chronic stress.

  19. Dietary restraint and impulsivity modulate neural responses to food in adolescents with obesity and healthy adolescents.

    Science.gov (United States)

    Hofmann, Johannes; Ardelt-Gattinger, Elisabeth; Paulmichl, Katharina; Weghuber, Daniel; Blechert, Jens

    2015-11-01

    Despite alarming prevalence rates, surprisingly little is known about neural mechanisms underlying eating behavior in juveniles with obesity. To simulate reactivity to modern food environments, event-related potentials (ERP) to appetizing food images (relative to control images) were recorded in adolescents with obesity and healthy adolescents. Thirty-four adolescents with obesity (patients) and 24 matched healthy control adolescents watched and rated standardized food and object images during ERP recording. Personality (impulsivity) and eating styles (trait craving and dietary restraint) were assessed as potential moderators. Food relative to object images triggered larger early (P100) and late (P300) ERPs. More impulsive individuals had considerably larger food-specific P100 amplitudes in both groups. Controls with higher restraint scores showed reduced food-specific P300 amplitudes and subjective palatability ratings whereas patients with higher restraint scores showed increased P300 and palatability ratings. This first ERP study in adolescents with obesity and controls revealed impulsivity as a general risk factor in the current obesogenic environment by increasing food-cue salience. Dietary restraint showed paradoxical effects in patients, making them more vulnerable to visual food-cues. Salutogenic therapeutic approaches that deemphasize strict dietary restraint and foster healthy food choice might reduce such paradoxical effects. © 2015 The Obesity Society.

  20. The effects of dexmedetomidine on attenuation of stress response to endotracheal intubation in patients undergoing elective off-pump coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Sajith Sulaiman

    2012-01-01

    Full Text Available This study was designed to study the efficacy of intravenous dexmedetomidine for attenuation of cardiovascular responses to laryngoscopy and endotracheal intubation in patients with coronary artery disease. Sixty adult patients scheduled for elective off-pump coronary artery bypass surgery were randomly allocated to receive dexmedetomidine (0.5 mcg/kg or normal saline 15 min before intubation. Patients were compared for hemodynamic changes (heart rate, arterial blood pressure and pulmonary artery pressure at baseline, 5 min after drug infusion, before intubation and 1, 3 and 5 min after intubation. The dexmedetomidine group had a better control of hemodynamics during laryngoscopy and endotracheal intubation. Dexmedetomidine at a dose of 0.5 mcg/kg as 10-min infusion was administered prior to induction of general anesthesia attenuates the sympathetic response to laryngoscopy and intubation in patients undergoing myocardial revascularization. The authors suggest its administration even in patients receiving beta blockers.

  1. Ethical considerations for evaluating the issue of physical restraint in psychiatry.

    Science.gov (United States)

    Petrini, Carlo

    2013-01-01

    This article examines some of the ethical issues associated with the use of physical restraint in psychiatry and neurology. It offers no specific answers to individual operational problems, but a methodological matrix is proposed as an aid to experts in the various settings in which decisions are taken. The subject is addressed mainly by considering two sources: reference documents published by eminent organisations, and the theoretical framework of ethical values (or principles). A number of analytical criteria arising from these sources are then identified and proposed. The proposed criteria can be applied in cases for which the legitimate use of restraint may be an option, bearing in mind that restraint is an extremely serious affront to human dignity and is widely held to be of no therapeutic value. Its abuse is illegitimate in both ethical and legal terms.

  2. Geometrically Nonlinear Transient Response of Laminated Plates with Nonlinear Elastic Restraints

    Directory of Open Access Journals (Sweden)

    Shaochong Yang

    2017-01-01

    Full Text Available To investigate the dynamic behavior of laminated plates with nonlinear elastic restraints, a varied constraint force model and a systematic numerical procedure are presented in this work. Several kinds of typical relationships of force-displacement for spring are established to simulate the nonlinear elastic restraints. In addition, considering the restraining moments of flexible pads, the pads are modeled by translational and rotational springs. The displacement- dependent constraint forces are added to the right-hand side of equations of motion and treated as additional applied loads. These loads can be explicitly defined, via an independent set of nonlinear load functions. The time histories of transverse displacements at typical points of the laminated plate are obtained through the transient analysis. Numerical examples show that the present method can effectively treat the geometrically nonlinear transient response of plates with nonlinear elastic restraints.

  3. Greater hunger and less restraint predict weight loss success with phentermine treatment.

    Science.gov (United States)

    Thomas, Elizabeth A; Mcnair, Bryan; Bechtell, Jamie L; Ferland, Annie; Cornier, Marc-Andre; Eckel, Robert H

    2016-01-01

    Phentermine is thought to cause weight loss through a reduction in hunger. It was hypothesized that higher hunger ratings would predict greater weight loss with phentermine. This is an observational pilot study in which all subjects were treated with phentermine for 8 weeks and appetite and eating behaviors were measured at baseline and week 8. Outcomes were compared in subjects with ≥5% vs. hunger (P = 0.017), desire to eat (P =0.003), and prospective food consumption (0.006) and lower baseline cognitive restraint (P = 0.01). In addition, higher baseline home prospective food consumption (P = 0.002) and lower baseline cognitive restraint (P hunger and less restraint are more likely to achieve significant weight loss with phentermine. This information can be used clinically to determine who might benefit most from phentermine treatment. © 2015 The Obesity Society.

  4. [Mechanical restraints in the elderly: technical proposals and recommendations for use in the social environment].

    Science.gov (United States)

    Rodríguez Delgado, Joan

    2013-01-01

    There is some confusion in the national gerontological literature in the use of terms that refer to mechanical restraints. There is a lack of dialogue as regards ethical conflicts that suggest their use, as well as a significant generalization of the claims against, and the absence of positive references despite its high prevalence as shown by some authors. This paper presents some technical proposals on the definition, the use of terms, and the use of mechanical restraints in the social environment, such as putting the ethical dialogue to arguments based on the prevalence, define them in terms of their intent, agree on a classification of the different restraint methods, identify the types and levels of risk, and intervene specifically in accordance with these proposals. Finally, recommendations are added with regards to risks, the decision process, prescription and the withdrawal process. Copyright © 2012 SEGG. Published by Elsevier Espana. All rights reserved.

  5. Effects of body movement restraint on cardiac response to auditory stimulation in sleeping infants.

    Science.gov (United States)

    Kahn, A; Rebuffat, E; Sottiaux, M

    1992-12-01

    When exposed to an unfamiliar and sudden noise, infant rodents may show an abrupt bradycardia, as part of a "fear-paralysis response". The response is enhanced by body movements restraint. To investigate if this reaction is seen in humans, 15 normal infants with a median age of 12 weeks were studied polygraphically. They were exposed to a 100-dB (A) white noise, while sleeping in REM sleep. Each infant was studied in both "unrestrained" and "restrained" conditions. Restraint of body movement was obtained by means of sand bags and tightly-binding bed sheets. During movement restraint, the infants had a significantly greater and earlier decrease in heart rate compared with during the unrestrained condition. No infant had a minimal heart rate less than 95 beats/min. The present observation raises questions about the possible unfavorable effects of tightly wrapped bed sheets around sleeping infants.

  6. How Farm Animals React and Perceive Stressful Situations Such As Handling, Restraint, and Transport

    Directory of Open Access Journals (Sweden)

    Temple Grandin

    2015-12-01

    Full Text Available An animal that has been carefully acclimated to handling may willingly re-enter a restrainer. Another animal may have an intense agitated behavioral reaction or refuse to re-enter the handling facility. Physiological measures of stress such as cortisol may be very low in the animal that re-enters willingly and higher in animals that actively resist restraint. Carefully acclimating young animals to handling and restraint can help improve both productivity and welfare by reducing fear stress. Some of the topics covered in this review are: How an animal perceives handling and restraint, the detrimental effects of a sudden novel event, descriptions of temperament and aversion tests and the importance of good stockmanship.

  7. Proposal to place a supplementary order for LHC cryodipole end restraints

    CERN Document Server

    2004-01-01

    This document concerns a proposal to place a supplementary order for LHC cryodipole end restraints. The Finance Committee is invited to agree to the placing of a supplementary order with STAINLESS METALCRAFT (GB) for the supply of 125 additional end restraints for an amount not exceeding 215 500 pounds sterling (492 797 Swiss francs), not subject to revision, bringing the total order value to an amount not exceeding 534 996 pounds sterling (1 223 407 Swiss francs), not subject to revision with an option for up to 80 extra transport end restraints for an amount of 137 920 pounds sterling (315 390 Swiss francs), not subject to revision. The rate of exchange used is that stipulated in the tender. The firm has indicated the following distribution by country of the contract value covered by this adjudication proposal: GB - 100%.

  8. Comparison of bolus and continuous infusion of esmolol on hemodynamic response to laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft

    Directory of Open Access Journals (Sweden)

    Esra Mercanooglu Efe

    2014-07-01

    Full Text Available BACKGROUND AND OBJECTIVE: The aim of this randomized, prospective and double blinded study is to investigate effects of different esmolol use on hemodynamic response of laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft surgery. METHODS: After approval of local ethics committee and patients' written informed consent, 45 patients were randomized into three groups equally. In Infusion Group; from 10 min before intubation up to 5th minute after sternotomy, 0.5 mg/kg/min esmolol infusion, in Bolus Group; 2 min before intubation and sternotomy 1.5 mg/kg esmolol IV bolus and in Control Group; %0.9 NaCl was administered. All demographic parameters were recorded. Heart rate and blood pressure were recorded before infusion up to anesthesia induction in every minute, during endotracheal intubation, every minute for 10 minutes after endotracheal intubation and before, during and after sternotomy at first and fifth minutes. RESULTS: While area under curve (AUC (SAP × time was being found more in Group B and C than Group I, AUC (SAP × T int and T st and AUC (SAP × T2 was found more in Group B and C than Group I (p < 0.05. Moreover AUC (HR × T st was found less in Group B than Group C but no significant difference was found between Group B and Group I. CONCLUSION: This study highlights that esmolol infusion is more effective than esmolol bolus administration on controlling systolic arterial pressure during endotracheal intubation and sternotomy in CABG surgery.

  9. Noninvasive mechanical ventilation with BiPAP therapy for comatose exacerbation of chronic obstructive pulmonary disease through an endotracheal tube: is it justified?

    OpenAIRE

    Esquinas A; Agarwal R

    2012-01-01

    Antonio Esquinas,1 Ritesh Agarwal21Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain; 2Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaWe read with interest the paper by Rawat et al1 related to the role of bilevel positive airway pressure (BiPAP) delivered via endotracheal tube in unconscious patients suffering from acute exacerbations of chronic obstructive pulmonary disease in a real-world situation. Although the autho...

  10. Dexmedetomidine as an adjunct to anesthetic induction to attenuate hemodynamic response to endotracheal intubation in patients undergoing fast-track CABG

    Directory of Open Access Journals (Sweden)

    Menda Ferdi

    2010-01-01

    Full Text Available During induction of general anesthesia hypertension and tachycardia caused by tracheal intubation may lead to cardiac ischemia and arrhythmias. In this prospective, randomized study, dexmedetomidine has been used to attenuate the hemodynamic response to endotracheal intubation with low dose fentanyl and etomidate in patients undergoing myocardial revascularization receiving beta blocker treatment. Thirty patients undergoing myocardial revascularization received in a double blind manner, either a saline placebo or a dexmedetomidine infusion (1 µg/kg before the anesthesia induction. Heart rate (HR and blood pressure (BP were monitored at baseline, after placebo or dexmedetomidine infusion, after induction of general anesthesia, one, three and five minutes after endotracheal intubation. In the dexmedetomidine (DEX group systolic (SAP, diastolic (DAP and mean arterial pressures (MAP were lower at all times in comparison to baseline values; in the placebo (PLA group SAP, DAP and MAP decreased after the induction of general anesthesia and five minutes after the intubation compared to baseline values. This decrease was not significantly different between the groups. After the induction of general anesthesia, the drop in HR was higher in DEX group compared to PLA group. One minute after endotracheal intubation, HR significantly increased in PLA group while, it decreased in the DEX group. The incidence of tachycardia, hypotension and bradycardia was not different between the groups. The incidence of hypertension requiring treatment was significantly greater in the PLA group. It is concluded that dexmedetomidine can safely be used to attenuate the hemodynamic response to endotracheal intubation in patients undergoing myocardial revascularization receiving beta blockers.

  11. The effects of sex and hormonal status on restraint-stress-induced working memory impairment

    Directory of Open Access Journals (Sweden)

    Brennan Avis

    2006-03-01

    Full Text Available Abstract Background Restraint stress has been shown to elicit numerous effects on hippocampal function and neuronal morphology, as well as to induce dendritic remodeling in the prefrontal cortex (PFC. However, the effects of acute restraint stress on PFC cognitive function have not been investigated, despite substantial evidence that the PFC malfunctions in many stress-related disorders. Methods The present study examined the effects of restraint stress on PFC function in both male rats and cycling female rats in either the proestrus (high estrogen or estrus (low estrogen phase of the estrus cycle. Animals were restrained for 60 or 120 minutes and then tested on spatial delayed alternation, a PFC-mediated task. Performance after stress was compared to performance on a different day under no-stress conditions, and analyzed using analysis of variance (ANOVA. Results Sixty minutes of restraint impaired only females in proestrus, while 120 minutes of restraint produced significant impairments in all animals. Increases in task completion times did not affect performance. Conclusion These results demonstrate an interaction between hormonal status and cognitive response to stress in female rats, with high estrogen levels being associated with amplified sensitivity to stress. This effect has been previously observed after administration of a pharmacological stressor (the benzodiazepine inverse agonist FG7142, and results from both studies may be relevant to the increased prevalence of stress-related disorders, such as major depressive disorder, in cycling women. Overall, the results show that restraint stress has important effects on the cognitive functions of the PFC, and that hormonal influences in the PFC are an important area for future research.

  12. Improving Working Conditions for Astronauts: An Electronic Personal Restraint System for Use in Microgravity Environments

    Directory of Open Access Journals (Sweden)

    Kevin Tait

    2012-01-01

    Full Text Available While in microgravity, astronauts are preoccupied with physical restraint, which takes attention away from the maintenance task or scientific experiment at hand. This may directly lead to safety concerns and increased time for extravehicular activity, as well as potentially inhibit or corrupt data collection. A primary concern is the time it takes to manipulate the current restraint system. The portable foot restraint currently in use by NASA employs a series of pins in order to engage the system or release in an emergency. This requires considerable time for the user to detach, and there is an increased risk of entanglement. If restraint operating time could be reduced by 50%, the astronaut’s assigned experiment time could be increased an average of 100 minutes per mission. Another problem identified by NASA included the inability of the current system to release the user upon failure. Research and design was conducted following the Six-Sigma DMEDI project architecture, and a new form of restraint to replace the existing system was proposed. The research team first studied the customer requirements and relevant standards set by NASA, and with this information they began drafting designs for a solution. This project utilized electromagnetism to restrain a user in microgravity. The proposed system was capable of being manipulated quickly, failing in a manner that released the user, and being electronically controlled. This active electronic control was a new concept in restraint systems, as it enabled an astronaut to effectively “walk” along a surface while remaining restrained to it. With the design prototype and a limited budget, a rudimentary test assembly was built by the team, and most of NASA’s specifications were met. With recommendations from NASA, the research team concluded by developing potential material and design solutions that can be explored in the future by Purdue University or other parties.

  13. Contextual influences on nurses' decision-making in cases of physical restraint.

    Science.gov (United States)

    de Casterlé, Bernadette Dierckx; Goethals, Sabine; Gastmans, Chris

    2015-09-01

    In order to fully understand nurses' ethical decision-making in cases of physical restraint in acute older people care, contextual influences on the process of decision-making should be clarified. What is the influence of context on nurses' decision-making process in cases of physical restraint, and what is the impact of context on the prioritizing of ethical values when making a decision on physical restraint? A qualitative descriptive study inspired by the Grounded Theory approach was carried out. In total, 21 in-depth interviews were carried out with nurses working on acute geriatric wards in Flanders, Belgium. The research protocol was approved by the Ethics Committee of the Faculty of Medicine, Leuven. Relationships with nursing colleagues and the patient's family form an inter-personal network. Nurses also point to the importance of the procedural-legal context as expressed in an institutional ethics policy and procedures, or through legal requirements concerning physical restraint. Furthermore, the architectural structure of a ward, the availability of materials and alternatives for restraint use can be decisive in nurses' decision-making. All interviewed nurses highlighted the unquestionable role of the practical context of care. Context can have a guiding, supportive, or decisive role in decision-making concerning the application of physical restraint. The discussion focuses on the role of the inter-personal network of nurses on the process of decision-making. An institutional ethics policy and a value-supportive care environment can support nurses in their challenge to take ethically sound decisions. © The Author(s) 2014.

  14. A CLINICAL ASSESSMENT OF MACINTOSH BLADE, MILLER BLADE AND KING VISIONTM VIDEOLARYNGOSCOPE FOR LARYNGEAL EXPOSURE AND DIFFICULTY IN ENDOTRACHEAL INTUBATION

    Directory of Open Access Journals (Sweden)

    Apoorva Mahendera

    2016-03-01

    Full Text Available CONTEXT Previous studies suggest glottic view is better achieved with straight blades while tracheal intubation is easier with curved blades and videolaryngoscope is better than conventional laryngoscope. AIMS Comparison of conventional laryngoscope (Macintosh blade and Miller blade with channelled videolaryngoscope (King Vision TM with respect to laryngeal visualisation and difficulty in endotracheal intubation. SETTINGS AND DESIGN This prospective randomised comparative study was conducted at a tertiary care hospital (in ASA I and ASA II patients after approval from the Institutional Ethics Committee. METHODS We compared Macintosh, Miller, and the King VisionTM videolaryngoscope for glottic visualisation and ease of tracheal intubation. Patients undergoing elective surgeries under general anaesthesia requiring endotracheal intubation were randomly divided into three groups (N=180. After induction of anaesthesia, laryngoscopy was performed and trachea intubated. We recorded visualisation of glottis (Cormack-Lehane grade-CL, ease of intubation, number of attempts, need to change blade, and need for external laryngeal manipulation. STATISTICAL ANALYSIS Demographic data, Mandibular length, Mallampati classification were compared using ANOVA, Chi-square test, Kruskal-Wallis Test, where P value <0.005 is statically significant. RESULTS CL grade 1 was most often observed in King Vision -TM VL group (90% which is followed by Miller (28.33%, and Macintosh group (15%. We found intubation was to be easier (grade 1 with King Vision -TM VL group (73.33%, followed by Macintosh (38.33%, and Miller group (1.67%. External manipulation (BURP was needed more frequently in patients in Miller group (71.67%, followed by Macintosh (28.33% and in King Vision -TM VL group (6.67%. All (100% patients were intubated in the 1 st attempt with King Vision -TM VL group, followed by Macintosh group (90% and Miller group (58.33%. CONCLUSIONS In patients with normal airway

  15. Using restraint with nursing home residents: a qualitative study of nursing staff perceptions and decision-making.

    Science.gov (United States)

    Hantikainen, V; Käppeli, S

    2000-11-01

    The study reported in this paper applied a qualitative and interpretative approach to nursing staff perceptions of the use of restraint with elderly nursing home residents, and into nurses' decision-making on restraint use. The data were collected using unstructured interviews with a purposive sample of 20 trained and untrained nursing staff from two Swiss nursing homes. Data analysis was based on Colaizzi's phenomenological method. Three main themes were extracted from the data: (1) understanding the term restraint, (2) situations in which the decision to apply restraint is considered justified and (3) situations in which nursing staff are uncertain about the use of restraint. The underlying bases with respect to decision-making were: understanding restraint, the rights and responsibilities of both residents and staff, and the duties of staff. Staff members were ambiguous in their understanding of restraint and they showed positive as well as confused attitudes towards its use. Their behaviour was defensive and protective rather than challenging. Further research is required on what is meant by safety in care of the elderly nursing today. In nursing practice, as far as issues of restraint are concerned, greater attention should be devoted to the relationship between elderly residents' self-determination and responsibility for their actions.

  16. Dietary restraint in college women : Fear of an imperfect fat self is stronger than hope of a perfect thin self

    NARCIS (Netherlands)

    Dalley, Simon E.; Toffanin, Paolo; Pollet, Thomas V.

    We predicted that the perceived likelihood of acquiring a hoped-for thin self would mediate perfectionistic strivings on dietary restraint, and that the perceived likelihood of acquiring a feared fat self would mediate perfectionistic concerns on dietary restraint. We also predicted that the

  17. Restraint factors and partial coefficients for crack risk analyses of early age concrete structures:diagrams and tables

    OpenAIRE

    Nilsson, Martin

    2003-01-01

    This report contains all background data for the Doctoral Thesis 2003:19 "Restraint Factors and Partial Coefficients for Crack Risk Analyses of Early Age Concrete Structures" by Martin Nilsson. This report contains all background data for the Doctoral Thesis 2003:19 "Restraint Factors and Partial Coefficients for Crack Risk Analyses of Early Age Concrete Structures" by Martin Nilsson.

  18. RECOORD: a recalculated coordinate database of 500+ proteins from the PDB using restraints from the BioMagResBank

    NARCIS (Netherlands)

    Nederveen, Aart J.; Doreleijers, Jurgen F.; Vranken, Wim; Miller, Zachary; Spronk, Chris A. E. M.; Nabuurs, Sander B.; Güntert, Peter; Livny, Miron; Markley, John L.; Nilges, Michael; Ulrich, Eldon L.; Kaptein, Robert; Bonvin, Alexandre M. J. J.

    2005-01-01

    State-of-the-art methods based on CNS and CYANA were used to recalculate the nuclear magnetic resonance (NMR) solution structures of 500+ proteins for which coordinates and NMR restraints are available from the Protein Data Bank. Curated restraints were obtained from the BioMagResBank FRED database.

  19. Analysis of Heart Rate and Self-Injury with and without Restraint in an Individual with Autism

    Science.gov (United States)

    Jennett, Heather; Hagopian, Louis P.; Beaulieu, Lauren

    2011-01-01

    The relation between self-injury and heart rate was analyzed for an individual who appeared anxious while engaging in self-injury. The analysis involved manipulating the presence or absence of restraint while simultaneously measuring heart rate. The following findings were obtained and replicated: (a) when some form of restraint was applied, heart…

  20. Effect of maternal restraint stress during gestation on temporal lipopolysaccharide-induced neuroendocrine and immune responses of progeny

    Science.gov (United States)

    The impact of gestational dam restraint stress on progeny immune and neuroendocrine temporal hormone responses to lipopoly-saccharide (LPS) challenge was assessed. Maternal stress (5-min snout snare restraint stress during days 84 to 112 of gestation) increased (P < 0.05) the magnitude of tumor necr...

  1. Reducing and Eliminating Restraint of People with Developmental Disabilities and Severe Behavior Disorders: An Overview of Recent Research

    Science.gov (United States)

    Williams, Don E.

    2010-01-01

    This paper provides a brief overview of the most recent research (1999-2009) on restraint reduction and elimination efforts in the literature and also examines the characteristics of restraint along with the risks and benefits. Some earlier papers were included in this review because of their importance to the topic. The results of this literature…

  2. Variation Found in Rates of Restraint and Seclusion among Students with a Disability. Paper 206. National Issue Brief No. 67

    Science.gov (United States)

    Gagnon, Douglas J.; Mattingly, Marybeth; Connelly, Vincent J.

    2013-01-01

    The restraint and seclusion of individuals--practices usually associated with highly restrictive environments--are extreme responses to student behavior used in some public schools. In this brief, authors Douglas Gagnon, Marybeth Mattingly, and Vincent Connelly report that restraint and seclusion are used much more frequently on students with a…

  3. Dietary restraint in college women: Fear of an imperfect fat self is stronger than hope of a perfect thin self

    NARCIS (Netherlands)

    Dalley, S.E.; Toffanin, P.; Pollet, T.V.

    2012-01-01

    We predicted that the perceived likelihood of acquiring a hoped-for thin self would mediate perfectionistic strivings on dietary restraint, and that the perceived likelihood of acquiring a feared fat self would mediate perfectionistic concerns on dietary restraint. We also predicted that the

  4. Exploring perspectives on restraint during medical procedures in paediatric care: a qualitative interview study with nurses and physicians

    Science.gov (United States)

    Svendsen, Edel Jannecke; Pedersen, Reidar; Moen, Anne; Bjørk, Ida Torunn

    2017-01-01

    ABSTRACT The aim of this study was to explore nurses’ and physicians’ perspectives on and reasoning about the use of restraint during medical procedures on newly admitted preschoolers in somatic hospital care. We analysed qualitative data from individual interviews with a video recall session at the end with seven physicians and eight nurses. They had earlier participated in video recorded peripheral vein cannulations on preschool children. The data were collected between May 2012 and May 2013 at a paediatric hospital unit in Norway. The analysis resulted in three main themes: (1) disparate views on the concept of restraint and restraint use (2), ways to limit the use of physical restraint and its negative consequences, and (3) experience with the role of parents and their influence on restraint. Perspectives from both healthcare professions were represented in all the main themes and had many similarities. The results of this study may facilitate more informed and reflective discussions of restraint and contribute to higher awareness of restraint in clinical practice. Lack of guidance and scientific attention to restraint combined with conflicting interests and values among healthcare providers may result in insecurity, individual dogmatism, and a lack of shared discussions, language, and terminology. PMID:28889788

  5. "A Very Fine Line": Parents' Experiences of Using Restraint with Their Adult Son/Daughter with Intellectual Disabilities

    Science.gov (United States)

    Elford, Helen; Beail, Nigel; Clarke, Zara

    2010-01-01

    Background: Restraint is sometimes used on people with intellectual disabilities who display challenging behaviours, and may be justifiable as a last resort to prevent harm. A substantial proportion of such people are cared for within the family home. The aim of this paper is to explore parents' experiences of using restraint with their…

  6. Preventing the Use of Restraint and Seclusion with Young Children: "The Role of Effective, Positive Practices". Issue Brief

    Science.gov (United States)

    Dunlap, Glen; Ostryn, Cheryl; Fox, Lise

    2011-01-01

    In recent years, there have been major concerns expressed regarding the use of restraint and seclusion to control the behavior of children with disabilities and/or challenging behavior. In May of 2009, for example, the US Government Accountability Office (GAO) released findings regarding a number of cases in which seclusion and restraint were…

  7. The effects of public reporting on physical restraints and antipsychotic use in nursing home residents with severe cognitive impairment.

    Science.gov (United States)

    Konetzka, R Tamara; Brauner, Daniel J; Shega, Joseph; Werner, Rachel M

    2014-03-01

    To assess whether reductions in physical restraint use associated with quality reporting may have had the unintended consequence of increasing antipsychotic use in nursing home (NH) residents with severe cognitive impairment. Retrospective analysis of NH clinical assessment data from 1999 to 2008 comparing NHs subject to public reporting of physical restraints with nonreporting NHs. Medicare- and Medicaid-certified NHs in the United States. Observations (N = 3.9 million) on 809,645 residents with severe cognitive impairment in 4,258 NHs in six states. Public reporting of physical restraint use rates. Use of physical restraints and antipsychotic medications. Physical restraint use declined significantly from 1999 to 2008 in NH residents with severe cognitive impairment. The decline was larger in NHs that were subject to reporting of restraints than in those that were not (-8.3 vs -3.3 percentage points, P < .001). Correspondingly, antipsychotic use in the same residents increased more in NHs that were subject to public reporting (4.5 vs 2.9 percentage points, P < .001). Approximately 36% of the increase in antipsychotic use may be attributable to public reporting of physical restraints. This analysis suggests that public reporting of physical restraint use had the unintended consequence of increasing use of antipsychotics in NH residents with severe cognitive impairment. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  8. Exploring perspectives on restraint during medical procedures in paediatric care: a qualitative interview study with nurses and physicians.

    Science.gov (United States)

    Svendsen, Edel Jannecke; Pedersen, Reidar; Moen, Anne; Bjørk, Ida Torunn

    2017-12-01

    The aim of this study was to explore nurses' and physicians' perspectives on and reasoning about the use of restraint during medical procedures on newly admitted preschoolers in somatic hospital care. We analysed qualitative data from individual interviews with a video recall session at the end with seven physicians and eight nurses. They had earlier participated in video recorded peripheral vein cannulations on preschool children. The data were collected between May 2012 and May 2013 at a paediatric hospital unit in Norway. The analysis resulted in three main themes: (1) disparate views on the concept of restraint and restraint use (2), ways to limit the use of physical restraint and its negative consequences, and (3) experience with the role of parents and their influence on restraint. Perspectives from both healthcare professions were represented in all the main themes and had many similarities. The results of this study may facilitate more informed and reflective discussions of restraint and contribute to higher awareness of restraint in clinical practice. Lack of guidance and scientific attention to restraint combined with conflicting interests and values among healthcare providers may result in insecurity, individual dogmatism, and a lack of shared discussions, language, and terminology.

  9. [Endotracheal tube selection in children: which is the better predictor for the selection, tracheal internal diameter in X-ray photograph or age-based formula?].

    Science.gov (United States)

    Furuya, Atsushi; Nomura, Hidehiko; Kuroiwa, Genya; Tamaki, Fumimasa; Suzuki, Satomi; Nonaka, Akihiko; Abe, Fumiaki; Matsukawa, Takashi

    2009-06-01

    Age-based formula has been widely used to predict the appropriate size of the endotracheal tube in children. Tracheal internal diameter in X-ray photograph is reported to show higher correlation with a correct tube than age. In our institution, X-ray photographs were stored as digital images, enabling us to measure tracheal internal diameters more accurately than conventional X-ray films. Therefore, we investigated whether tracheal size in digital X-ray photograph is a better predictor for the tube selection than age. We reviewed data from children aged 1 to 8 years for the past 5 years. The data included age, tracheal internal diameter at 6th cervical (C6), 2nd thoracic vertebrae (T2) in X-ray photograph and selected tube size. The tube size was estimated by the age-based formula or on the basis of tracheal size. The endotracheal tube size correlated significantly with the age, and tracheal internal diameter at C6 or T2 in X-ray photograph (correlation coefficients P=0.898, 0.653, and 0.771 respectively; P<0.0001). The tube size predicted by the age allowed appropriate intubation in 62.2%, but that by the tracheal size at C6 and T2 in 42.8% and 43.7% respectively. The age-based formula is more reliable and appropriate to decide the size of endotracheal tube for children than the tracheal size.

  10. Adhesion of Pseudomonas aeruginosa strains to untreated and oxygen-plasma treated poly(vinyl chloride) (PVC) from endotracheal intubation devices.

    Science.gov (United States)

    Triandafillu, K; Balazs, D J; Aronsson, B-O; Descouts, P; Tu Quoc, P; van Delden, C; Mathieu, H J; Harms, H

    2003-04-01

    Pseudomonas aeruginosa pneumonia is a life threatening complication in mechanically ventilated patients that requires the ability of the bacteria to adhere to, and colonize the endotracheal intubation device. New strategies to prevent or reduce these nosocomial infections are greatly needed. We report here the study of a set of P. aeruginosa clinical isolates, together with specific mutants, regarding their adhesion on native and chemically modified poly(vinyl chloride) (PVC) surfaces from endotracheal intubation devices. The adhesion of the different strains to untreated PVC varied widely, correlating with several physico-chemical characteristics known to influence the attachment of bacteria to inert surfaces. The adhesion patterns were compared to the calculations obtained with the DLVO theory of colloidal stability. These results illustrate the importance of testing different clinical isolates when investigating bacterial adhesion. Oxygen plasma treatment of the PVC pieces yielded a hydrophilic surface and reduced the number of adhering bacteria by as much as 70%. This reduction is however unlikely to be sufficient to prevent P. aeruginosa colonization of endotracheal intubation devices. Copyright 2002 Elsevier Science Ltd.

  11. The effect of lidocaine jelly on a taper-shaped cuff of an endotracheal tube on the postoperative sore throat: a prospective randomized study: A CONSORT compliant article.

    Science.gov (United States)

    Lee, Jiwon; Lee, Yong-Cheol; Son, Je-Do; Lee, Jae-Yoon; Kim, Hyun-Chang

    2017-09-01

    Postoperative sore throat (POST) following general anesthesia with endotracheal intubation is a common complication. We hypothesized that lidocaine jelly applied to the tapered cuff of the endotracheal tube (ETT) might decrease the incidence of POST most commonly arising from endotracheal intubation. A total of 208 patients under general anesthesia were randomly assigned into 1 of 2 groups. In the lidocaine group (n = 104), the distal part of ETTs with tapered-shaped cuff was lubricated with lidocaine jelly. In the control group (n = 104), the distal part of ETTs with tapered-shaped cuff was lubricated with normal saline. The incidence of POST, hoarseness, and cough in the postanesthesia patients was compared. The overall incidence of POST was higher in the lidocaine group than in the normal saline group [60 (58%) vs 40 (39%), P = .006]. The incidence of POST at 1 hour postoperatively was higher in the lidocaine group than in the normal saline group [53 (51%) vs 32 (31%), P = .003]. The overall incidence of hoarseness for 24 hours postoperatively was comparable (P = .487). The overall incidence of cough for 24 hours postoperatively is higher in the lidocaine group (P = .045). The lidocaine jelly applied at the distal part of ETT with tapered-shaped cuff increased the overall incidence of POST in patients undergoing general anesthesia.

  12. Influence of dosage and chemical restraints on feline excretory urography

    Directory of Open Access Journals (Sweden)

    R.A. Ajadi

    2006-06-01

    Full Text Available Three series of trials involving 10 domestic short-haired cats were carried out to determine the influence of dosage of contrast media or type of chemical restraint on feline excretory urography. The 1st series (group A involved 5 cats sedated with 2.0 mg/kg intramuscular (i.m injection of 2 % xylazine and receiving 800 mg/kg of 76 % meglumine diatrizoate (urografin. The 2nd series (group B involved another 5 cats sedated with 2.0 mg/kg (i.m injection of 2 % xylazine and receiving 1200 mg/kg of 76% urografin. The 3rd series (group C involved the repeat urography of the group B cats but sedated with 15 mg/kg (i.m injection of 5% ketamine hydrochloride. Ventrodorsal radiographs were obtained immediately, 5, 15 and 40 minutes after the injection of 76 % urografin. Scores were assigned to nephrographic opacification as described in the literature. The heart rates, respiratory rates and rectal temperatures of the cats were also determined before sedation, after sedation, immediately after the injection of 76 % urografin and at 15-minute intervals over a period of 60 minutes. In this study, there were significant differences (P < 0.05 in the nephrographic opacification scores between the group A and group B cats at times 0 and 40 minutes post-administration of urografin. Group A cats had good initial nephrographic opacification which faded later while the nephrographic opacification of group B cats progressively increased. Similarly, nephrographic opacification was significantly (P < 0.05 higher in the xylazine-sedated cats (groups A and B than the ketamine-sedated cats (group C. However, there were no significant differences (P > 0.05 in heart rates, respiratory rates and rectal temperatures between the 3 groups of cats. It was therefore concluded that increasing the dosage of urografin above 800 mg/kg in cats does not provide additional beneficial effects on the nephrograms produced. Xylazine sedation was observed to produce better nephrographic

  13. Protein Loop Closure Using Orientational Restraints from NMR Data

    Science.gov (United States)

    Tripathy, Chittaranjan; Zeng, Jianyang; Zhou, Pei; Donald, Bruce Randall

    Protein loops often play important roles in biological functions such as binding, recognition, catalytic activities and allosteric regulation. Modeling loops that are biophysically sensible is crucial to determining the functional specificity of a protein. A variety of algorithms ranging from robotics-inspired inverse kinematics methods to fragmentbased homology modeling techniques have been developed to predict protein loops. However, determining the 3D structures of loops using global orientational restraints on internuclear vectors, such as those obtained from residual dipolar coupling (RDC) data in solution Nuclear Magnetic Resonance (NMR) spectroscopy, has not been well studied. In this paper, we present a novel algorithm that determines the protein loop conformations using a minimal amount of RDC data. Our algorithm exploits the interplay between the sphero-conics derived from RDCs and the protein kinematics, and formulates the loop structure determination problem as a system of low-degree polynomial equations that can be solved exactly and in closed form. The roots of these polynomial equations, which encode the candidate conformations, are searched systematically, using efficient and provable pruning strategies that triage the vast majority of conformations, to enumerate or prune all possible loop conformations consistent with the data. Our algorithm guarantees completeness by ensuring that a possible loop conformation consistent with the data is never missed. This data-driven algorithm provides a way to assess the structural quality from experimental data with minimal modeling assumptions. We applied our algorithm to compute the loops of human ubiquitin, the FF Domain 2 of human transcription elongation factor CA150 (FF2), the DNA damage inducible protein I (DinI) and the third IgG-binding domain of Protein G (GB3) from experimental RDC data. A comparison of our results versus those obtained by using traditional structure determination protocols on the

  14. Compatibility or restraint? The effects of sexual timing on marriage relationships.

    Science.gov (United States)

    Busby, Dean M; Carroll, Jason S; Willoughby, Brian J

    2010-12-01

    Very little is known about the influence of sexual timing on relationship outcomes. Is it better to test sexual compatibility as early as possible or show sexual restraint so that other areas of the relationship can develop? In this study, we explore this question with a sample of 2035 married individuals by examining how soon they became sexually involved as a couple and how this timing is related to their current sexual quality, relationship communication, and relationship satisfaction and perceived stability. Both structural equation and group comparison analyses demonstrated that sexual restraint was associated with better relationship outcomes, even when controlling for education, the number of sexual partners, religiosity, and relationship length.

  15. Use of psychotropic medication among inpatients during focused efforts in prevention of coercion and restraint

    DEFF Research Database (Denmark)

    Højlund, Mikkel; Høgh, Lene; Munk-Jørgensen, Povl

    and reduced life expectancy. The aim of this study is therefore to quantify the use of psychotropic medication when implementing interventions to reduce coercion and restraint. Methods: Cohort study on patients in risk of agitation and coercion in a psychiatric ward operating without physical restraint....... Prescription history is collected from patients admitted with diagnosis of organic mental disorders, substance abuse, psychotic disorders, mania, bipolar affective disease and personality disorders (ICD-10: F0x, F1x, F2x, F30-31, F60) and compared with prescription history of similar patients admitted before...

  16. The impact of new legislation on child restraint system (CRS) misuse and inappropriate use in Australia.

    Science.gov (United States)

    Koppel, S; Charlton, J L; Rudin-Brown, C M

    2013-01-01

    The current study aimed to investigate the incidence of child restraint system (CRS) misuse and/or inappropriate use of CRS through an Australian CRS inspection program conducted by CRS fitting specialists between October 2004 and October 2011 and to determine whether CRS misuse and/or inappropriate use of CRS changed following new Australian legislation regarding CRS and motor vehicle restraint use for children aged 7 years and under. Participants were recruited through an advertisement for free CRS inspections displayed at childcare centers, kindergartens, community centers, hospitals, and child expos. At each inspection, a CRS fitting specialist inspected each child in their CRS while in their vehicle and reported to the owner of the CRS on the installation of the child restraint(s) and/or system(s) and any fitting faults and/or concerns with the fitting and/or use of the child restraint(s) and or system(s). Results are based on the inspection of 2674 CRS. Of all of the CRS inspected, the majority (79%) were reported as having at least one instance of misuse and/or inappropriate use. The most common forms of CRS misuse and/or inappropriate use observed were harness strap errors (twisted, poorly adjusted, and/or incorrectly positioned, 41%), seat belt errors (incorrectly routed, twisted, and/or incorrectly adjusted, 32%), and a missing or incorrect fitting of the gated buckle/locking clip (24%). Significant differences were found across the proportion of CRS misuse and/or inappropriate use across restraint types (infant restraint/forward-facing CRS/convertible [birth to 18 kg] CRS/convertible [8-26 kg] CRS/boosters [booster seat/cushion/booster with harness combination]), χ(2)(4) = 147.852, P .5. Based on the findings of the current study, it was concluded that, despite the introduction of new, definitive CRS legislation, CRS misuse and/or inappropriate use remains widespread in Australia. The findings highlight the need for CRS education and legislation that

  17. Knowledge and application of correct car seat head restraint usage among chiropractic college interns: a cross-sectional study.

    Science.gov (United States)

    Taylor, John Am; Burke, Jeanmarie; Gavencak, John; Panwar, Pervinder

    2005-03-01

    Cervical spine injuries sustained in rear-end crashes cost at least $7 billion in insurance claims annually in the United States alone. When positioned correctly, head restraint systems have been proven effective in reducing the risk of whiplash associated disorders. Chiropractors should be knowledgeable about the correct use of head restraint systems to educate their patients and thereby prevent or minimize such injuries. The primary objective of this study was to determine the prevalence of correct positioning of car seat head restraints among the interns at our institution. The secondary objective was to determine the same chiropractic interns' knowledge of the correct positioning of car seat head restraints. It was hypothesized that 100 percent of interns would have their head restraint correctly positioned within an acceptable range and that all interns would possess the knowledge to instruct patients in the correct positioning of head restraints. Cross-sectional study of a convenient sample of 30 chiropractic interns from one institution. Interns driving into the parking lot of our health center were asked to volunteer to have measurements taken and to complete a survey. Vertical and horizontal positions of the head restraint were measured using a beam compass. A survey was administered to determine knowledge of correct head restraint position. The results were recorded, entered into a spreadsheet, and analyzed. 13.3 percent of subjects knew the recommended vertical distance and only 20 percent of subjects knew the recommended horizontal distance. Chi Square analyses substantiated that the majority of subjects were unaware of guidelines set forth by the National Highway Traffic Safety Administration (NHTSA) for the correct positioning of the head restraint (chi(2) (vertical) = 16.13, chi(2) (horizontal) = 10.80, p .05). Interestingly, the 13.3 percent of the subjects who were aware of the vertical plane recommendations did not correctly position their own

  18. Seclusion and restraint in psychiatry: patients' experiences and practical suggestions on how to improve practices and use alternatives.

    Science.gov (United States)

    Kontio, Raija; Joffe, Grigori; Putkonen, Hanna; Kuosmanen, Lauri; Hane, Kimmo; Holi, Matti; Välimäki, Maritta

    2012-01-01

    This study explored psychiatric inpatients' experiences of, and their suggestions for, improvement of seclusion/restraint, and alternatives to their use in Finland. The data were collected by focused interviews (n= 30) and were analyzed with inductive content analysis. Patients' perspectives received insufficient attention during seclusion/restraint processes. Improvements (e.g., humane treatment) and alternatives (e.g., empathetic patient-staff interaction) to seclusion/restraint, as suggested by the patients, focused on essential parts of nursing practice but have not been largely adopted. Patients' basic needs have to be met, and patient-staff interaction has to also continue during seclusion/restraint. Providing patients with meaningful activities, planning beforehand, documenting the patients' wishes, and making patient-staff agreements reduce the need for restrictions and offer alternatives for seclusion/restraint. Service users must be involved in all practical development. © 2011 Wiley Periodicals, Inc.

  19. MECHANISMS RESPONSIBLE FOR PROGESTERONE’S PROTECTION AGAINST LORDOSIS-INHIBITING EFFECTS OF RESTRAINT I. ROLE OF PROGESTERONE RECEPTORS

    Science.gov (United States)

    Hassell, James; Miryala, Chandra Suma Johnson; Hiegel, Cindy

    2011-01-01

    Progestins and antiprogestins are widely used therapeutic agents in humans. In many cases, these are indicated for the treatment of reproductive activites. However, progesterone has widespread physiological effects including a reduction of the response to stress. We have reported that 5 min of restraint reduced lordosis behavior of ovariectomized rats hormonally primed with estradiol benzoate. When ovariectomized rats received both estradiol benzoate and progesterone priming, restraint had minimal effects on lordosis. Progesterone influences behavior through classical intracellular progesterone receptor-mediated nuclear events as well as extranuclear events. How these multiple events contribute to the response to stress are unclear. The current project was designed to initiate examination of the mechanisms responsible for progesterone’s ability to protect against the effects of the restraint. In the first experiment, ovariectomized rats, primed with 10 µg estradiol benzoate, received 500 µg progesterone 4 hr, 1 hr, or 30 min before restraint. When progesterone was injected 4 hr before restraint, progesterone eliminated the effects of restraint. In contrast, progesterone 30 min before restraint offered no protection. Effects of progesterone 1 hr before restraint were equivocal allowing the suggestion that less than 4 hr of progesterone priming might be sufficient. In the second experiment, the synthetic progestin, medroxyprogesterone, was shown to mimic effects of progesterone in preventing effects of restraint. Finally, the progesterone receptor antagonist, RU486, attenuated progesterone’s protection against restraint. These findings offer evidence that ligand-activated progesterone receptor mechanisms contribute to the maintenance of lordosis behavior in the presence of mild stress. PMID:21635894

  20. A comparative study of efficacy of esmolol and fentanyl for pressure attenuation during laryngoscopy and endotracheal intubation

    Directory of Open Access Journals (Sweden)

    Shobhana Gupta

    2011-01-01

    Full Text Available Objective: To compare the effectiveness of single bolus dose of esmolol or fentanyl in attenuating the hemodynamic responses during laryngoscopy and endotracheal intubation. Methods: Ninety adult ASA I and ASA II patients were included in the study who underwent elective surgical procedures. Patients were divided into three groups. Group C (control receiving 10 ml normal saline, group E (esmolol receiving bolus dose of esmolol 2 mg/kg and group F (fentanyl receiving bolus dose of fentanyl 2 μg/kg intravenously slowly. Study drug was injected 3 min before induction of anesthesia. Heart rate, systemic arterial pressure and ECG were recorded as baseline and after administration of study drug at intubation and 15 min thereafter. Results: Reading of heart rate, blood pressure and rate pressure product were compared with baseline and among each group. The rise in heart rate was minimal in esmolol group and was highly significant. Also the rate pressure product at the time of intubation was minimal and was statistically significant rate 15 min thereafter in group E. Conclusion: Esmolol 2 mg/kg as a bolus done proved to be effective in attenuating rises in heart rate following laryngoscopy and intubation while the rise in blood pressure was suppressed but not abolished by bolus dose of esmolol.

  1. Effectiveness of heat moisture exchangers (hmes) in preventing perioperative hypothermia among adult patients undergoing abdominal surgery under general endotracheal anaesthesia.

    Science.gov (United States)

    Anaegbu, Nc; Olatosi, Oj; Tobi, Ku

    2013-01-01

    Heat Moisture Exchangers (HMEs) conserve heat and moisture during expiration and make this available to inspired gases during subsequent inspiration. We sought to evaluate the effectiveness of HMEs in the prevention of perioperative hypothermia in patients scheduled for abdominal surgery under general anaesthesia relaxant technique with endotrachael intubation (GART.) Lagos University Teaching Hospital, in Modular theatre, Anaesthesia unit. The study was a randomized, controlled, longitudinal, interventional study Methods: 100 ASA I, II and III patients aged 18 to 65 years scheduled for abdominal surgery under GART were randomly assigned to 2 groups, groups H and C. Group H had HMEs, while group C served as controls. Core temperature measured using tympanic probe was every 10 minutes till end of anaesthesia Data from total 99 patients, 49 in group H and 50 in group C were eventually analysed. Although patients in both groups developed hypothermia in the course of anaesthesia, core temperature was significantly lower pHeat Moisture Exchangers, General endotracheal anaesthesia, Hypothermia, abdominal surgery.

  2. Comparison of EMG signals recorded by surface electrodes on endotracheal tube and thyroid cartilage during monitored thyroidectomy

    Directory of Open Access Journals (Sweden)

    Feng-Yu Chiang

    2017-10-01

    Full Text Available A variety of electromyography (EMG recording methods were reported during intraoperative neural monitoring (IONM of recurrent laryngeal nerve (RLN in thyroid surgery. This study compared two surface recording methods that were obtained by electrodes on endotracheal tube (ET and thyroid cartilage (TC. This study analyzed 205 RLNs at risk in 110 patients undergoing monitored thyroidectomy. Each patient was intubated with an EMG ET during general anesthesia. A pair of single needle electrode was inserted obliquely into the TC lamina on each side. Standard IONM procedure was routinely followed, and EMG signals recorded by the ET and TC electrodes at each step were compared. In all nerves, evoked laryngeal EMG signals were reliably recorded by the ET and TC electrodes, and showed the same typical waveform and latency. The EMG signals recorded by the TC electrodes showed significantly higher amplitudes and stability compared to those by the ET electrodes. Both recording methods accurately detected 7 partial loss of signal (LOS and 2 complete LOS events caused by traction stress, but only the ET electrodes falsely detected 3 LOS events caused by ET displacement during surgical manipulation. Two patients with true complete LOS experienced temporary RLN palsy postoperatively. Neither permanent RLN palsy, nor complications from ET or TC electrodes were encountered in this study. Both electrodes are effective and reliable for recording laryngeal EMG signals during monitored thyroidectomy. Compared to ET electrodes, TC electrodes obtain higher and more stable EMG signals as well as fewer false EMG results during IONM.

  3. Anterior Submandibular Approach for Transmylohyoid Endotracheal Intubation: A Reappraisal with Prospective Study in 206 Cases of Craniomaxillofacial Fractures.

    Science.gov (United States)

    Bhola, Nitin; Jadhav, Anendd; Kala, Atul; Deshmukh, Rahul; Bhutekar, Umesh; Prasad, G S V

    2017-12-01

    Despite a paradigm shift in anesthesia and trauma airway management, the craniomaxillofacial fracture (CMF) patients continue to pose a challenge. A prospective study was planned between April 2007 and March 2015 to investigate the safety, efficacy, utility, and complications of anterior submandibular approach for transmylohyoid intubation (TMI) in CMFs using an armored endotracheal tube (ETT). Out of 1,207 maxillofacial trauma cases reported, this study recruited 206 patients (152 males and 54 females) aged between 21 and 60 years. No episode of oxygen desaturation was noted intraoperatively. Mean time to perform TMI was 6 ± 2 minutes. The mean transmylohyoid ETT withdrawal time/disconnection time from ventilator was approximately 1.5 minutes. Accidental partial extubation of ETT was noted in two patients (0.97%), and three patients (1.45%) developed abscess formations at anterior submandibular site which were managed by incision and drainage. The anterior submandibular approach for TMI was successfully used and provided stable airway in all elective CMF surgery cases, where oral or nasal intubations were not indicated/feasible and long-term ventilation support was not required. It permitted simultaneous dental occlusion-guided reduction and fixation of all the facial fractures without interference from the tube during the surgery with unhindered maintenance of the anesthesia and airway. The advantages include easy, swift, efficient, and reliable approach with a small learning curve.

  4. Sedation management during therapeutic hypothermia for neonatal encephalopathy: atropine premedication for endotracheal intubation causes a prolonged increase in heart rate.

    Science.gov (United States)

    Gill, Hannah; Thoresen, Marianne; Smit, Elisa; Davis, Jonathan; Liu, Xun; Dingley, John; Elstad, Maja

    2014-10-01

    Heart rate (HR) plays an important role in the assessment of stress during therapeutic hypothermia (TH) for neonatal encephalopathy; we aimed to quantify the effect on HR of endotracheal (ET) intubation and drugs given to facilitate it. If atropine premedication independently increased HR, the main indicator of effective sedation, we hypothesised that increased sedation would have been given. Thirty-two, term, neonates recruited into a randomised pilot study comparing TH and TH combined with 50% Xenon inhalation were studied. Indications for ET intubation included: resuscitation at delivery, clinical need and elective re-intubation with a cuffed ET tube if randomised to Xenon. Standard intubation drugs comprised one or more of intravenous morphine, atropine, and suxamethonium. Local cooling guidelines were followed including morphine infusion for sedation. At postnatal hours five to eight atropine increased HR in a linear regression model (psedation given up to 8h into the treatment period was significantly higher (psedation and total morphine dose for sedation during early TH was increased where more than one dose of atropine was given. Bradycardia was not reported in any neonate, even without atropine premedication. We suggest that the use of atropine as part of standard premedication for ET intubation of term neonates undergoing TH should be reconsidered. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Knowledge and practice of intensive care nurses for endotracheal suctioning in a teaching hospital in western Turkey.

    Science.gov (United States)

    Bülbül Maraş, Gül; Kocaçal Güler, Elem; Eşer, İsmet; Köse, Şükran

    2017-04-01

    This study was conducted to determine intensive care nurses' knowledge and practice levels regarding open system endotracheal suctioning and to investigate if there is a relationship between nurses' demographic characteristics and their knowledge and practice. The study was conducted as a cross-sectional and non-participant structured observational design. Data were collected using a 45-item structured and self-administered questionnaire and a 31-item observational checklist. The study sample included 72 nurses. Three adult intensive care units in a teaching hospital. The nurses' mean scores of knowledge and practice were 23.79±3.83 and 12.88±2.53. Their level of knowledge was very good in 59.7%, good in 34.7%, and the level of practice was fair in 79.2% and good in 18.1%. The relationship between the type of unit and the nurses' knowledge scores was statistically significant (p=0.013). The correlation between the nurses' scores of knowledge and practice was not statistically significant (r=0.220; p=0.063). This study suggests that the knowledge level of most of the nurses was good and their practice level was fair. Intensive care nurses must perform suctioning procedures safely and effectively to ensure delivery of quality of care and eliminate complications. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Physicochemical characterization of hexetidine-impregnated endotracheal tube poly(vinyl chloride) and resistance to adherence of respiratory bacterial pathogens.

    Science.gov (United States)

    Jones, David S; McGovern, James G; Woolfson, A David; Adair, Colin G; Gorman, Sean P

    2002-06-01

    Ventilator-associated pneumonia is a frequent cause of mortality in intensive care patients. This study describes the physicochemical properties of hexetidine-impregnated poly(vinyl chloride) (PVC) endotracheal tube (ET) biomaterials and their resistance to microbial adherence (Staphylococcus aureus and Pseudomonas aeruginosa). PVC emulsion was cured in the presence of hexetidine (0-20% w/w) and was characterized in terms of drug release, surface properties (i.e., microrugosity/contact angle), mechanical (tensile) properties, and resistance to microbial adherence. Under sink conditions, hexetidine release from PVC was diffusion-controlled. Increasing the concentration of hexetidine from 1% to 10% (w/w) (but not from 10% to 20% w/w) increased the subsequent rate of drug release. In general, increasing the concentration of hexetidine decreased both the tensile properties and hydrophobicity, yet increased PVC microrugosity. Following hexetidine release (21 days), the surface properties were similar to those of native PVC. The resistance of hexetidine-containing PVC (1% or 5%) to microbial adherence (following defined periods of drug release) was greater than that of native PVC and was constant over the examined period of hexetidine release. ET PVC containing 1% (w/w) hexetidine offered an appropriate balance between suitable physicochemical properties and resistance to microbial adherence. This may offer an approach with which to reduce the incidence of ventilator-associated pneumonia.

  7. Use of GlideScope for double lumen endotracheal tube insertion in an awake patient with difficult airway.

    Science.gov (United States)

    Onrubia, X; Lluch-Oltra, A; Armero, R; Baldó, J

    2014-01-01

    There is scientific evidence that an anticipated difficult airway must be managed with the patient being awake. The GlideScope has been proven to be a useful device to intubate the trachea in some instances when difficult airway is present, and particularly in the awake patient. It has also been used for double lumen tube (DLT) in the anaesthetized patient, but its use with DLT in both circumstances, awake patients with difficult airway has not been described. GlideScope enabled us to achieve accurate local anesthetic spraying and a successful endotracheal intubation with a double lumen tube (DLT) in an awake patient with predicted difficult airway and bronchoaspiration risk. Different ways to resolve cases like this can be found in the anesthetic literature, but we think this could be another option to bear in mind. We also describe a new variation in the maneuver of introducing a DLT into the trachea under GlideScope view as DLT presents with some difficulties when introduced under normal circumstances. This option could add some risk for the patients when used in inexperienced hands and there is not sufficient scientific evidence in the literature to recommend it for all cases. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  8. The efficacy of labetalol vs dexmedetomidine for attenuation of hemodynamic stress response to laryngoscopy and endotracheal intubation.

    Science.gov (United States)

    El-Shmaa, Nagat S; El-Baradey, Ghada F

    2016-06-01

    To assess the effectiveness of labetalol vs dexmedetomidine for attenuation of hemodynamic stress response to laryngoscopy and endotracheal intubation. Prospective, randomized, controlled, observer-blinded study. This study was carried out in Tanta University Hospital. Ninety patients of both sexes; American Society of Anesthesiologists physical status I and II; age range from 20 to 60 years; scheduled for elective surgery under general anesthesia. Patients were divided into 3 groups (30 each). Group A received 1 μg/kg of dexmedetomidine as intravenous (IV) infusion, group B received labetalol 0.25mg/kg IV, and group C received 10mL saline IV. The groups were compared for heart rate (HR), mean arterial pressure (MAP), and rate pressure product (RPP). Hemodynamic parameters were recorded during the preinduction; after induction; at intubation; and at 1, 3, 5, 10, and 15minutes. The primary outcomes were hemodynamic changes (HR, MBP, and RPP), and the secondary outcome was propofol dose requirement for induction of general anaesthesia. Significant decrease (P labetalol without any deleterious effects. Furthermore, dexmedetomidine decreases dose of propofol for induction of anesthesia as guided by bispectral index. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Executive-level reviews of seclusion and restraint promote interdisciplinary collaboration and innovation.

    Science.gov (United States)

    Allen, Diane E; de Nesnera, Alexander; Souther, Justin W

    2009-08-01

    Elimination of seclusion and restraint requires support at all levels of an organization, especially from leaders who visibly champion and communicate their vision. Nurses, physicians, educators, and administrators at New Hampshire Hospital, an acute psychiatric inpatient facility, have established a standard meeting time and place for an executive-level review of every episode of seclusion and restraint. The standing meeting demonstrates the organization's commitment to caring for both patients and staff. The daily meetings foster a spirit of interdisciplinary collaboration, where direct care staff have the opportunity to tell their stories and share their ideas and concerns in an environment that is caring, supportive, and devoid of criticism or blame. Narrative descriptions of emergency interventions, including what was learned from debriefings with patients and staff involved, provide data about factors that may contribute to the use of seclusion or restraint. This forum provides visible administrative and clinical support that promotes creative thinking, collaborative problem solving, and the exploration of new ideas recommended by those directly involved in providing patient care. It has fostered exploration and development of strategies that have minimized episodes of aggressive behavior as well as seclusion and restraint.

  10. Reduction of Restraint of People with Intellectual Disabilities: An Organizational Behavior Management (OBM) Approach

    Science.gov (United States)

    Williams, Don E.; Grossett, Deborah L.

    2011-01-01

    We used an organizational behavior management (OBM) approach to increase behavior intervention plans and decrease the use of mechanical restraint. First, recipients were tracked as a member of the priority group if they engaged in frequent self-injurious behavior or physical aggression toward others and/or if they had been placed in mechanical…

  11. The Validity of Dietary Restraint Scales: Comment on Stice et al. (2004)

    Science.gov (United States)

    van Strien, Tatjana; Engels, Rutger C. M. E.; van Staveren, Wija; Herman, C. Peter

    2006-01-01

    In 4 empirical studies, E. Stice, M. Fisher, and M. R. Lowe (see record 2004-11653-006) calculated the correlations between some widely used dietary restraint scales and food intake. Failing to find substantial negative correlations, they concluded that these scales were invalid. The current article challenges this conclusion. For one thing, there…

  12. Console video games, postural activity, and motion sickness during passive restraint.

    Science.gov (United States)

    Chang, Chih-Hui; Pan, Wu-Wen; Chen, Fu-Chen; Stoffregen, Thomas A

    2013-08-01

    We examined the influence of passive restraint on postural activity and motion sickness in individuals who actively controlled a potentially nauseogenic visual motion stimulus (a driving video game). Twenty-four adults (20.09 ± 1.56 years; 167.80 ± 7.94 cm; 59.02 ± 9.18 kg) were recruited as participants. Using elastic bands, standing participants were passively restrained at the head, shoulders, hips, and knees. During restraint, participants played (i.e., controlled) a driving video game (a motorcycle race), for 50 min. During game play, we recorded the movement of the head and torso, using a magnetic tracking system. Following game play, participants answered a forced choice, yes/no question about whether they were motion sick, and were assigned to sick and well groups on this basis. In addition, before and after game play, participants completed the Simulator Sickness Questionnaire, which provided numerical ratings of the severity of individual symptoms. Five of 24 participants (20.83 %) reported motion sickness. Participants moved despite being passively restrained. Both the magnitude and the temporal dynamics of movement differed between the sick and well groups. The results show that passive restraint of the body can reduce motion sickness when the nauseogenic visual stimulus is under participants' active control and confirm that motion sickness is preceded by distinct patterns of postural activity even during passive restraint.

  13. The validity of dietary restraint scales: Comment on Stice et al.

    NARCIS (Netherlands)

    Strien, van T.; Engels, R.; Staveren, van W.A.; Herman, C.P.

    2006-01-01

    In 4 empirical studies, E. Stice, M. Fisher, and M. R. Lowe (2004) calculated the correlations between some widely used dietary restraint scales and food intake. Failing to find substantial negative correlations, they concluded that these scales were invalid. The current article challenges this

  14. Program Fidelity Measures Associated With an Effective Child Restraint Program: Buckle-Up Safely

    Science.gov (United States)

    Keay, Lisa; Simpson, Judy M.; Brown, Julie; Bilston, Lynne E.; Fegan, Maureen; Cosgrove, Louise; Stevenson, Mark; Ivers, Rebecca Q.

    2015-01-01

    Objectives. We sought to identify the program fidelity factors associated with successful implementation of the Buckle-Up Safely program, targeting correct use of age-appropriate child car restraints. Methods. In 2010, we conducted a cluster randomized controlled trial of 830 families with children attending preschools and long day care centers in South West Sydney, New South Wales, Australia. Families received the Buckle-Up Safely program in the intervention arm of the study (13 services). Independent observers assessed the type of restraint and whether it was used correctly. Results. This detailed process evaluation showed that the multifaceted program was implemented with high fidelity. Program protocols were adhered to and messaging was consistently delivered. Results from multilevel and logistic regression analyses show that age-appropriate restraint use was associated with attendance at a parent information session hosted at the center (adjusted odd ratio [AOR] = 3.66; 95% confidence interval [CI] = 1.61, 8.29) and adversely affected by the child being aged 2 to 3 years (AOR = 0.14; 95% CI = 0.07, 0.30) or being from a family with more than 2 children (AOR = 0.34; 95% CI = 0.17, 0.67). Conclusions. Findings highlight the importance of parents receiving hands-on education regarding the proper use of age-appropriate child restraints. PMID:25602901

  15. The New Aztecs: Ritual and Restraint in Contemporary Western Military Operations (Advancing Strategic Thought Series)

    Science.gov (United States)

    2011-07-01

    itself. With the arrival of the Middle Ages came some re- turn to ritual and restraint. The church was at the heart of efforts to restrain warfare...process, which continued in Byzantine fashion throughout the bombing. There were constant con- cerns about treachery within the Alliance, including the

  16. Restraint of Statehood and the Quality of Governance by Multinational Companies in Sub-Saharan Africa

    NARCIS (Netherlands)

    Hoenke, Jana; Börzel, Tanja A.

    2013-01-01

    This paper explores to what extent the quality of governance by MNC in areas of limited statehood depends on the limitation, and, more importantly, on the restraint of statehood. The control over the monopoly of force and a minimum of state capacity to set and enforce rules are only one condition

  17. A smart base restraint for wind turbines to mitigate undesired effects due to structural vibrations

    DEFF Research Database (Denmark)

    Caterino, N.; Georgakis, Christos T.; Spizzuoco, M.

    2016-01-01

    . This smart restraint is made of a central smooth hinge, elastic springs and SA magnetorheological dampers driven by a control algorithm properly designed for the specific application. A commercial 105 m tall wind turbine has been assumed as a case study. Several numerical simulations have been performed...

  18. Issues to Consider in the Use of Physical Restraint and Time-Out Procedures.

    Science.gov (United States)

    Smith, Carl R.

    The author discusses the legal and administrative concerns, best professional practices concerns, and political concerns related to the use of physical restraint and time out procedures with seriously behaviorally disordered children. Among the points made are that the courts may consider such approaches to be cruel and unusual; that direct…

  19. The Pattern of Physical Restraints applied to the Mentally-ill in the ...

    African Journals Online (AJOL)

    Diagnostic groups found among the patients included Bipolar Affective Disorder current episode manic with psychotic symptoms (30%), Delirium (25%), Schizophrenia (20%), Acute polymorphic psychotic disorder without symptoms of schizophrenia (20%) and Dementia (5%). The reason for the use of restraints was ...

  20. 14 CFR 91.107 - Use of safety belts, shoulder harnesses, and child restraint systems.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Use of safety belts, shoulder harnesses, and child restraint systems. 91.107 Section 91.107 Aeronautics and Space FEDERAL AVIATION... OPERATING AND FLIGHT RULES Flight Rules General § 91.107 Use of safety belts, shoulder harnesses, and child...