Evaluating Nurses' Implementation of an Infant-Feeding Counseling Protocol for HIV-Infected Mothers: The Ban Study in Lilongwe, Malawi

A process evaluation of nurses’ implementation of an infant-feeding counseling protocol was conducted for the Breastfeeding, Antiretroviral and Nutrition (BAN) Study, a prevention of mother-to-child transmission of HIV clinical trial in Lilongwe, Malawi. Six trained nurses counseled HIV-infected mothers to exclusively breastfeed for 24 weeks postpartum and to stop breastfeeding within an additional four weeks. Implementation data were collected via direct observations of 123 infant feeding counseling sessions (30 antenatal and 93 postnatal) and interviews with each nurse. Analysis included calculating a percent adherence to checklists and conducting a content analysis for the observation and interview data. Nurses were implementing the protocol at an average adherence level of 90% or above. Although not detailed in the protocol, nurses appropriately counseled mothers on their actual or intended formula milk usage after weaning. Results indicate that nurses implemented the protocol as designed. Results will help to interpret the BAN Study’s outcomes

Effects of Heme Modulation on Ovophis and Trimeresurus Venom Activity in Human Plasma

Geographic isolation and other factors result in evolution-driven diversity of the enzymatic composition of venom of pit vipers in the same genus. The present investigation sought to characterize venoms obtained from such genetically diverse Ovophis and Trimeresurus pit vipers utilizing thrombelastographic coagulation kinetic analyses. The coagulation kinetics of human plasma were assessed after exposure to venom obtained from two Ovophis and three Trimeresurus species. The potency of each venom was defined (mu g/mL required to equivalently change coagulation); additionally, venoms were exposed to carbon monoxide (CO) or a metheme-inducing agent to modulate any enzyme-associated heme. All venoms had fibrinogenolytic activity, with four being CO-inhibitable. While Ovophis venoms had similar potency, one demonstrated the presence of a thrombin-like activity, whereas the other demonstrated a thrombin-generating activity. There was a 10-fold difference in potency and 10-fold different vulnerability to CO inhibition between the Trimeresurus species. Metheme formation enhanced fibrinogenolytic-like activity in both Ovophis species venoms, whereas the three Trimeresurus species venoms had fibrinogenolytic-like activity enhanced, inhibited, or not changed. This novel venom kinetomic approach has potential to identify clinically relevant enzymatic activity and assess efficacy of antivenoms between genetically and geographically diverse species.Department of Anesthesiology, the University of Arizona, College of Medicine, Tucson, Arizona, USAOpen access journal.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Protective ventilation measures improve outcomes during major vascular surgery

Background: In major endovascular and open vascular surgery cases, pulmonary complications remain persistently high and the most prevalent. Despite strong evidence from intensive care unit (ICU) practices demonstrating benefits of ventilation management with low tidal volume and high positive end expiratory pressure (PEEP), no consensus exists regarding protective ventilation use intraoperatively. Methods: A single institute, patient and surgeon blinded, prospective, randomized study design was used. Patients undergoing major vascular surgery (vascular surgery scheduled for &gt;120 minutes and requiring general anesthesia) from 2015-2016 were randomized to pre-defined control (n = 14) or intervention (n =19) intraoperative ventilation arms. As described later, intervention consisted of a combination of low tidal volume, optimized positive end expiratory pressure (PEEP) and low intraoperative FiO2. Primary outcomes included all-cause mortality, myocardial infarction (MI) and reintubation within 7 post-operative days (POD). Secondary outcomes included atelectasis, pulmonary function measures, hospital length of stay and post-operative complications of re-intubation, pneumonia, sespsis, unplanned readmission or return to operating room, and/or mortality. Results: The intervention arm had significantly reduced post-operative atelectasis ((p &lt;0.02) and increased post-operative SpO2 (p&lt; 0.02). The intervention arm also had a significantly lower length of hospital stay (6.9±5.5 vs 3.3±1.8, p &lt; 0.016). This was corroborated by a multivariate regression analysis that showed therapy was independently correlated with decreased length of stay (p&lt;0.007). Conclusion: Our data indicate a combination of low tidal volumes, optimized PEEP and low FiO2 improves outcomes of patients undergoing major vascular surgery. Importantly, our study demonstrates that these study parameters for evaluation of intraoperative ventilation management are feasible in a busy academic center and a larger clinical trial is worthy. Protective intraoperative ventilation measures could have significant effects on vascular surgery outcomes.</jats:p