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51.
Sydney E.S. Brown Ryan M. Antiel Thane A. Blinman Susanna Shaw Mark D. Neuman Chris Feudtner 《Journal of pain and symptom management》2019,57(5):971-979
Context
Do-not-resuscitate (DNR) orders are common among children receiving palliative care, who may nevertheless benefit from surgery and other procedures. Although anesthesia, surgery, and pediatric guidelines recommend systematic reconsideration of DNR orders in the perioperative period, data regarding how clinicians evaluate and manage DNR orders in the perioperative period are limited.Objectives
To evaluate perioperative management of DNR orders at a tertiary care children's hospital.Methods
We reviewed electronic medical records for all children with DNR orders in place within 30 days of surgery at a tertiary care pediatric hospital from February 1, 2016, to August 1, 2017. Using standardized case report forms, we abstracted the following from physician notes: 1) patient/family wishes with respect to the DNR, 2) whether preoperative DNR orders were continued, modified, or suspended during the perioperative period, and 3) whether life-threatening events occurred in the perioperative period. Based on data from these reports, we created a process flow diagram regarding DNR order decision-making in the perioperative period.Results
Twenty-three patients aged six days to 17 years had a DNR order in place within 30 days of 29 procedures. No documented systematic reconsideration took place for 41% of procedures. DNR orders were modified for two (7%) procedures and suspended for 15 (51%). Three children (13%) suffered life-threatening events. We identified four time points in the perioperative period where systematic reconsideration should be documented in the medical record, and identified recommended personnel involved and important discussion points at each time point.Conclusion
Opportunities exist to improve how DNR orders are managed during the perioperative period. 相似文献52.
Akbar Dastjerdi John Carr Richard J. Ellis Falko Steinbach Susanna Williamson 《Emerging infectious diseases》2015,21(12):2235-2237
An outbreak of porcine epidemic diarrhea occurred in the summer of 2014 in Ukraine, severely affecting piglets <10 days of age; the mortality rate approached 100%. Full genome sequencing showed the virus to be closely related to strains reported from North America, showing a sequence identity of up to 99.8%. 相似文献
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This article is based on a study of children's experiences of being in care in which children were given the opportunity to choose either their own social worker or an outside researcher to interview them for the purposes of the research. We examine here how the children (N?=?15) describe their choice of interviewer and also explore how the social workers (N?=?8) experience their role as research interviewers. The findings highlight that there is no single reason for children to choose either a social worker or a researcher to be the interviewer. Familiarity, in particular, can either be a motivation or an obstacle. The dual positions of children as research interviewees and as clients as well as the dual positions of social workers both supported and hindered the interviews. Social workers reported new insights into their knowledge about children’s views as a result of the research interview experience. It is argued that the choice of the interviewer may be an option for some children to have their voice heard in research. Ethical balancing and critical dialogue are also suggested as having a role. 相似文献
57.
Patrick C.Y. Woo Rosana W.S. Poon Chuen-Hing Foo Kelvin K.W. To Susanna K.P. Lau 《Peritoneal dialysis international》2016,36(1):105-107
The most common pathogens associated with peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) are gram-positive bacteria, which constitute 60 – 80% of all isolates. With the advancement of molecular technologies for bacterial identification, cases of CAPD-related peritonitis caused by bacteria previously not known to be associated with this clinical condition have been reported. Here we report the first case of CAPD-related peritonitis due to Laribacter hongkongensis. 相似文献
58.
Aila Pikkarainen Katja Vähäsantanen Susanna Paloniemi Anneli Eteläpelto 《Scandinavian journal of occupational therapy》2015,22(6):424-434
Aims: This study investigates gerontological rehabilitation sessions of Finnish rehabilitees in the framework of life-course agency from the perspectives of temporal orientation and agency. Methods: The research data were obtained by non-participatory observation in 11 individual goal-setting sessions between 11 rehabilitees and their personal counsellors. The data were analysed in accordance with data-driven, qualitative content and narrative analysis, with an emphasis on the life-course agency approach. Results: Four temporal orientations of older rehabilitees were identified in the rehabilitation sessions: (i) timeless, (ii) past, (iii) present, and (iv) life course. For each temporal orientation, the rehabilitees displayed different kinds of agency. Fractured agency was intertwined with the timeless orientation, frozen agency was related to the past orientation, practical agency to the present orientation, and transitional agency emerged in relation to the life-course orientation. Conclusions: The article contributes to the discussion of how older adults’ rehabilitation should be reformed within the Finnish context. The study suggests that a person-centred gerontological rehabilitation process should be conceptualized in terms of an agency-based approach with a personally constructed and temporally embedded life-course perspective. This kind of conceptualizing could promote empowered cooperation and innovative interventions with flexible schedules in the rehabilitation processes of older adults. 相似文献
59.
Susanna Annibali MD DDS Isabella Bignozzi DDS Gerardo La Monaca DDS PhD Maria Paola Cristalli DDS PhD 《Clinical implant dentistry and related research》2012,14(1):3-40
Purpose: The purpose of this study was to review the reported evaluation criteria of the aesthetic result in oral implant rehabilitation. Materials and Methods: A literature search of MEDLINE, the Cochrane Collaboration, and EMBASE was performed to retrieve studies published between January 1990 and December 2008 using the following key words: “dental implants,”“clinical trial,” and “aesthetic index” (and their synonyms). A manual search of the literature published in the same period was also carried out using the following publications: Clinical Oral Implant Research, The International Journal of Oral and Maxillofacial Implants, and The International Journal of Periodontics and Restorative Dentistry. The inclusion criteria of the published studies were the following: human clinical trial, oral implant rehabilitation, at least 10 implants, at least 6 months of follow‐up from insertion of the prosthesis, and evaluation of the aesthetic result by means of an index. Results: The literature search revealed 650 relevant bibliographic references, of which 89 were selected for further analysis. A final total of 29 articles fulfilled the inclusion criteria; these included 10 retrospective case series, 11 prospective case series, 1 retrospective controlled clinical trial, 1 prospective controlled clinical trial, and 6 randomized controlled clinical trials. In general, evaluations of aesthetic results appear only in the more recent studies and refer mostly to implant rehabilitation in the maxillary anterior zone; the index used, in most cases, was the Papilla Index of Jemt. Conclusions: Although there appears to be a growing interest in aesthetics in dental implantology, there are as yet no universally accepted evaluation criteria of the aesthetic result. Therefore, further research is necessary to establish a common, complete, and reproducible index for the evaluation of aesthetic outcome that can add in the success criteria for implant therapy in the maxillary and mandibular anterior areas. 相似文献
60.
Felix Hauler Donna L. Mallery William A. McEwan Susanna R. Bidgood Leo C. James 《Proceedings of the National Academy of Sciences of the United States of America》2012,109(48):19733-19738
Tripartite motif-containing 21 (TRIM21) is a cytosolic IgG receptor that mediates intracellular virus neutralization by antibody. TRIM21 targets virions for destruction in the proteasome, but it is unclear how a substrate as large as a viral capsid is degraded. Here, we identify the ATPase p97/valosin-containing protein (VCP), an enzyme with segregase and unfoldase activity, as a key player in this process. Depletion or catalytic inhibition of VCP prevents capsid degradation and reduces neutralization. VCP is required concurrently with the proteasome, as addition of inhibitor after proteasomal degradation has no effect. Moreover, our results suggest that it is the challenging nature of virus as a substrate that necessitates involvement of VCP, since intracellularly expressed IgG Fc is degraded in a VCP-independent manner. These results implicate VCP as an important host factor in antiviral immunity. 相似文献