A study to explore the experiences of patient and family volunteers in a critical care environment: a phenomenological analysis

Introduction: ICU survivors suffer persistent physical, psychological and social problems in the months and years after discharge from critical care (1). Caregivers of these patients also suffer similar problems (2). As a result, an innovative, peer supported rehabilitation programme- Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) was created in Glasgow Royal Infirmary. This 5 week multi disciplinary programme, which is co facilitated by patient and family volunteers further along the recovery trajectory, aims to empower patients and caregivers to take control of their health and wellbeing. The objective of this study was to explore the experiences of the volunteers who participated in InS:PIRE. It also sought to identify the support required by volunteers from healthcare professionals involved in the project. Methods: Six in depth semi structured interviews were undertaken with volunteers (both patients and family members) involved in the InS:PIRE clinic by an assistant psychologist. A predetermined topic guide was utilised to guide interviews. Interviews were audio recorded and transcribed verbatim. Interpretative Phenomenological Analysis was used to analyse the transcripts (3). Peer Review was undertaken to ensure credibility of the findings. Results: Findings: Six key themes were identified from these interviews: the social impact of volunteering, shared experiences; supporting others; personal boundaries; support needs and personal gain. The importance of peer support and having a shared understanding of participants needs were key themes for the volunteers. Volunteers described the need for further support in areas such as: confidentiality; listening skills and understanding boundaries. Conclusions: The use of peer volunteers in this ICU rehabilitation service has been successful within this local context. Further, larger scale research studies, which explore further the impact of volunteering for ICU survivors are required

The shortwave infrared bands response to stomatal conductance in Conference" Pear Trees (Pyrus communis L.)"

Published: 8 October 201

Pretreatment with beta-blockers and the frequency of hypokalemia in patients with acute chest pain

Plasma potassium concentration was measured at admission in 1234 patients who presented with acute chest pain. One hundred and ninety five patients were on P blockers before admission. The potassium concentrations of patients admitted early (within four hours of onsetof symptoms) were compared with those admitted later (4-18 hours after onset of symptoms). There was a transient fall in plasma potassium concentrations in patients not pre-treated with , B blockers. This was not seen in patients who had been on P blockers before admission. Nonselective, B blockers were more effective than cardioselective agents in maintaining concentrationsof plasma potassium. These findings suggest a mechanism for the beneficial effects of ,B blockers on morbidity and mortality in acute myocardial infarction

Met and unmet palliative care needs of people living with HIV/AIDS in Rwanda

The rising number of people living with HIV/AIDS (PLWHA) worldwide has made health care professionals and policy makers search for accessible health care that will meet the needs of people who are suffering from the disease and enhance their quality of life (QoL).This study investigated met and unmet palliative care needs of PLWHA in selected areas in Rwanda.The study sample included 306 participants: PLWHA, health care professionals and coordinators of HIV/AIDS units. Quantitative and qualitative methodologies were used.The data were analysed separately and then triangulated. In the findings, over 50% of PLWHA had symptoms related to HIV/AIDS most of the time, with the most common symptom being pain. Participation in activities of daily living was significantly associated with the health status of PLWHA (

Revival of the magnetar PSR J1622-4950: observations with MeerKAT, Parkes, XMM-Newton, Swift, Chandra, and NuSTAR

New radio (MeerKAT and Parkes) and X-ray (XMM-Newton, Swift, Chandra, and NuSTAR) observations of PSR J1622-4950 indicate that the magnetar, in a quiescent state since at least early 2015, reactivated between 2017 March 19 and April 5. The radio flux density, while variable, is approximately 100x larger than during its dormant state. The X-ray flux one month after reactivation was at least 800x larger than during quiescence, and has been decaying exponentially on a 111+/-19 day timescale. This high-flux state, together with a radio-derived rotational ephemeris, enabled for the first time the detection of X-ray pulsations for this magnetar. At 5%, the 0.3-6 keV pulsed fraction is comparable to the smallest observed for magnetars. The overall pulsar geometry inferred from polarized radio emission appears to be broadly consistent with that determined 6-8 years earlier. However, rotating vector model fits suggest that we are now seeing radio emission from a different location in the magnetosphere than previously. This indicates a novel way in which radio emission from magnetars can differ from that of ordinary pulsars. The torque on the neutron star is varying rapidly and unsteadily, as is common for magnetars following outburst, having changed by a factor of 7 within six months of reactivation.Comment: Published in ApJ (2018 April 5); 13 pages, 4 figure

Physical Environmental Barriers to School Attendance among Children with Disabilities in two Community Based Rehabilitation Centres in Rwanda

Background: It is estimated that more than 90% of children with disabilities in developing countries do not attend schools. Children with disabilities either do not receive any education or, if they do, it is often inappropriate. The aim of this study was to identify the physical Environmental barriers to school attendance by children with disabilities in two community based rehabilitation (CBR) centres in Rwanda. Method: A quantitative, cross-sectional, descriptive study was conducted to identify barriers to school attendance in two CBR centres. Parents/caregivers of children with disabilities participated in the study. The data was analysed using Statistical Package for the Social Sciences (SPSS).The level of significance (alpha) was set at α=0.05. Results: The long distance from home to the nearest school, and the status of the school physical environment were the major barriers to school attendance. Conclusion: To meet the Special Needs Education, strengthening existing measures to make a conducive physical environment would enhance school attendance among children with disabilities and subsequently the overall inclusive education.Key words: Parents/caregivers, children with disabilities, barrier

Effective teaching in the college classroom: current perspectives and future directions

La efectividad de la enseñanza en la educación superior es importante tanto para los estudiantes, profesores e investigadores, como para los administradores, y, en consecuencia, ha originado un considerable interés. El propósito de este artículo es realizar una revisión de las evidencias empíricas acerca de cuál sea la enseñanza más eficaz en el nivel universitario, con el objetivo puesto en los siguientes problemas: las cualidades o conductas que caracterizan al profesor eficaz; el impacto que estas conductas tienen en los estudiantes, y las implicaciones de los hallazgos empíricos en la mejora de la enseñanza eficaz que se extraen de diversas experiencias, como son las de organización, claridad y expresividad; las distintas perspectivas principales para la obtención y acumulación de resultados de investigación, fundamentalmente, la descriptiva, la correlaciona y la experimental, y, por último, algunas de las virtualidades y limitaciones conceptuales y metodológicas de estas perspectivas. Esperamos que este artículo proporcione al lector una idea suficiente acerca del estado actual, métodos y preocupaciones de la investigación sobre la enseñanza en las instituciones universitarias de América del Norte

Risk stratification by pre-operative cardiopulmonary exercise testing improves outcomes following elective abdominal aortic aneurysm surgery : a cohort study

Background: In 2009, the NHS evidence adoption center and National Institute for Health and Care Excellence (NICE) published a review of the use of endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs). They recommended the development of a risk-assessment tool to help identify AAA patients with greater or lesser risk of operative mortality and to contribute to mortality prediction. A low anaerobic threshold (AT), which is a reliable, objective measure of pre-operative cardiorespiratory fitness, as determined by pre-operative cardiopulmonary exercise testing (CPET) is associated with poor surgical outcomes for major abdominal surgery. We aimed to assess the impact of a CPET-based risk-stratification strategy upon perioperative mortality, length of stay and non-operative costs for elective (open and endovascular) infra-renal AAA patients. Methods: A retrospective cohort study was undertaken. Pre-operative CPET-based selection for elective surgical intervention was introduced in 2007. An anonymized cohort of 230 consecutive infra-renal AAA patients (2007 to 2011) was studied. A historical control group of 128 consecutive infra-renal AAA patients (2003 to 2007) was identified for comparison. Comparative analysis of demographic and outcome data for CPET-pass (AT ≥ 11 ml/kg/min), CPET-fail (AT < 11 ml/kg/min) and CPET-submaximal (no AT generated) subgroups with control subjects was performed. Primary outcomes included 30-day mortality, survival and length of stay (LOS); secondary outcomes were non-operative inpatient costs. Results: Of 230 subjects, 188 underwent CPET: CPET-pass n = 131, CPET-fail n = 35 and CPET-submaximal n = 22. When compared to the controls, CPET-pass patients exhibited reduced median total LOS (10 vs 13 days for open surgery, n = 74, P < 0.01 and 4 vs 6 days for EVAR, n = 29, P < 0.05), intensive therapy unit requirement (3 vs 4 days for open repair only, P < 0.001), non-operative costs (£5,387 vs £9,634 for open repair, P < 0.001) and perioperative mortality (2.7% vs 12.6% (odds ratio: 0.19) for open repair only, P < 0.05). CPET-stratified (open/endovascular) patients exhibited a mid-term survival benefit (P < 0.05). Conclusion: In this retrospective cohort study, a pre-operative AT > 11 ml/kg/min was associated with reduced perioperative mortality (open cases only), LOS, survival and inpatient costs (open and endovascular repair) for elective infra-renal AAA surgery

Intravenous sodium nitrite in acute ST-elevation myocardial infarction: a randomized controlled trial (NIAMI).

AIM: Despite prompt revascularization of acute myocardial infarction (AMI), substantial myocardial injury may occur, in part a consequence of ischaemia reperfusion injury (IRI). There has been considerable interest in therapies that may reduce IRI. In experimental models of AMI, sodium nitrite substantially reduces IRI. In this double-blind randomized placebo controlled parallel-group trial, we investigated the effects of sodium nitrite administered immediately prior to reperfusion in patients with acute ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: A total of 229 patients presenting with acute STEMI were randomized to receive either an i.v. infusion of 70 μmol sodium nitrite (n = 118) or matching placebo (n = 111) over 5 min immediately before primary percutaneous intervention (PPCI). Patients underwent cardiac magnetic resonance imaging (CMR) at 6-8 days and at 6 months and serial blood sampling was performed over 72 h for the measurement of plasma creatine kinase (CK) and Troponin I. Myocardial infarct size (extent of late gadolinium enhancement at 6-8 days by CMR-the primary endpoint) did not differ between nitrite and placebo groups after adjustment for area at risk, diabetes status, and centre (effect size -0.7% 95% CI: -2.2%, +0.7%; P = 0.34). There were no significant differences in any of the secondary endpoints, including plasma troponin I and CK area under the curve, left ventricular volumes (LV), and ejection fraction (EF) measured at 6-8 days and at 6 months and final infarct size (FIS) measured at 6 months. CONCLUSIONS: Sodium nitrite administered intravenously immediately prior to reperfusion in patients with acute STEMI does not reduce infarct size