Effect of educational program on pediatric nurses' knowledge and practice regarding selected nonpharmacological techniques to relive pain in neonates

BackgroundNewborn infants have an increased sensitivity to pain and are more reactive to pain than older children and adults. Nurses play a crucial role in assessing pain, implementing and evaluating interventions to minimize neonatal pain using available resources especially nonpharmacologic techniques.Aim of the studyto develop and apply an educational program on pediatric nurses regarding selected nonpharmacologic techniques to relieve pain in neonates.Research designA pre/post quasi-experimental research design was utilized in the present study. The study was carried out at Minia University for Obstetric and Pediatric and General Hospitals at neonatal care units. A convenient sample of 41 nurses was included in this study. Educational program for nurses was done through using the following data collection tools 1) Pre-designed questionnaire sheet, 2) Observation checklists sheet and 3) Educational and training program.ResultsIt was revealed that there was an obvious increase in the total mean scores of knowledge and practice in post and follow up program phase compared with pretest phase, with a very highly significant difference (p < 0.001).ConclusionThe education program had a significant impact on pediatric nurses' knowledge and practices regarding selected nonpharmacologic techniques to relieve pain in neonates.RecommendationsA continuous training and educational program should be planned and offered on regular basis for nurses regarding nonpharmacologic techniques to relieve pain in neonates.     

Intracardiac echocardiography for the guidance of percutaneous procedures

Interventional cardiology has seen great advances in the past decade. A wide range of interventional procedures has been established as standard therapeutic modalities and more are yet to come. Multiple imaging modalities have been used to guide these procedures. Intracardiac echocardiography (ICE) provides an accurate imaging tool to guide the appropriate performance of many of these procedures. Early studies compared ICE as a new imaging modality to guide interventional closure of atrial communications with other more established imaging techniques, such as transesophageal echocardiography, with excellent accuracy. In this article, we discuss the value of using ICE in guiding some percutaneous interventional procedures. We also discuss the imaging protocol for using ICE to guide atrial level shunt device closure. Our experience in using ICE for guiding percutaneous valve placement is also discussed.     

The prevalence of coronary artery anomalies in Qassim Province detected by cardiac computed tomography angiography

Background

Coronary artery anomalies (CAAs) affect about 1% of the general population based on invasive coronary angiography (ICA) data, computed tomography angiography (CTA) enables better visualization of the origin, course, relation to the adjacent structures, and termination of CAAs compared to ICA.

Ultra-fast,low dose high-pitch (FLASH) versus prospectively-gated coronary computed tomography angiography: Comparison of image quality and patient radiation exposure

Background

Coronary computed tomography angiography (CCTA) is increasingly being used for the evaluation of coronary artery disease; however, radiation exposure remains a major limitation of its use.

Accessibility to biologics and its impact on disease activity and quality of life in patients with rheumatoid arthritis in Kuwait

Clinical Rheumatology - Biologics are indicated in rheumatoid arthritis (RA) in case of persistent high disease activity despite conventional disease-modifying anti-rheumatic drugs (cDMARDs) or...     

Multiple Amplatzer septal occluder devices for multiple atrial communications: immediate and long-term follow-up results.

OBJECTIVES: We report on the feasibility, effectiveness, and long-term outcome of transcatheter closure of multiple ASD's using multiple ASO devices. BACKGROUND: Little is known about the use and long-term outcome of multiple Amplatzer Septal Occluder (ASO) devices to close multiple atrial septal defects (ASD's). METHODS: From May 1997 to June 2006, 33 patients (mean age 38.9 years and mean weight 68 kg) underwent transcatheter closure of multiple ASD's under transesophageal (TEE) or intracardiac echocardiographic (ICE) guidance. RESULTS: Unless not available, the device size chosen to be deployed was +/-2 mm larger than the stretched diameter or no more than 30-40% larger than the ICE/TEE 2D diameter. Sixty-seven devices were deployed in 33 patients. The mean diameters of the larger and smaller defects were 12.9 and 7.7 mm, and the corresponding mean balloon stretched diameters were 19.2 and 12.0 mm, respectively. The mean larger and smaller device diameters were 19.0 and 13.4 mm, respectively. The mean QP: Qs ratio was 1.8:1. The mean fluoroscopy time, and procedure time were 16.4 and 81.6 min respectively. Immediately after the procedure 15 patients had complete closure, 8 had trivial shunt, 9 had small shunt and one had large shunt. Complications included a device embolization within 24 hr and left atrial-aortic wall erosion and pericardial effusion at 2 years. The mean follow-up interval was 34.8+25.7 months. CONCLUSIONS: Device closure of multiple ASD's using multiple ASO's is safe and effective. Continued follow-up is important to assess the long-term outcome.     

Reducing Maternal Mortality from Direct Obstetric Causes during 2013 in Sudan

Despite the worldwide commitment to improve maternal health, measuring, monitoring and comparing mortality estimates remain a challenge. This study was done to assess maternal mortality from direct obstetric causes （obstetric haemorrhage, hypertensive disorders and sepsis） after suitable interventions in Sudan during 2013. Facility and community-based MDR （maternal death review） was conducted in Sudan since 2009. National and states＇ MDRCs （Maternal Death Review Committees） were established. A focal person for each state, health facility and locality was nominated. Notification of MD （maternal deaths） was done by telephone, followed by review of all notified maternal deaths using a structured format. Recommendations for reducing MM （maternal mortality） from obstetric haemorrhage, hypertensive disorders and sepsis have been generated. Management protocols, training of care providers and availing of necessary requirements for these cases have been approved and implemented in all states. Reported MD were reviewed and analyzed using SPSS, version 18.0 and the resulting MMR （maternal mortality ratio） was compared with years 2010-2012 to assess improvement. During 2013, 1,110 maternal deaths were notified, out of 645,881 LB （live births）. MMR was 172/100,000 LB, with different variation between states. Facility maternal deaths were 937 （84.4%） and community deaths were 173 （15.6%）. Direct obstetric deaths were 678 （61. I%）, mainly due to haemorrhage 311 （28.0%）, hypertensive disorders 116 （10.5%） and sepsis 110 （9.9%）. Indirect causes were 432 （38.9%）, mainly due to hepatitis and anemia. Most of the hospital deaths 707 （75.5%） were admitted late from home and 559 （59.7%） died within 24 hours. MDs from hypertensive disorders and sepsis decreased significantly, while MDs from haemorrhage are persistently high compared to 2010-2012. Home delivery, late presentation, unavailability of blood and poor referral system, are the main factors behind maternal death     

Combined cilioretinal artery and hemi-retinal vein occlusion in Sturge Weber syndrome: Expanding the clinical spectrum

A 9-year-old boy with the diagnosis of Sturge-Weber Syndrome, and port-wine stain involving the right side of the face, presented with acute visual loss of the right eye. Examination revealed a high intraocular pressure and a combined cilioretinal artery and inferior hemi-retinal vein occlusion in the right eye. Systemic work-up was negative. After controlling the intraocular pressure, gradual improvement of vision was noticed with simultaneous disappearance of signs of vascular occlusion.     

Frequency of Mammary Artery Coiling in Single-Ventricle Patients and Future Coronary Artery Grafting

Pre-Fontan coil closure of aorto-pulmonary collaterals decreases single-ventricle volume load and improves outcome. Coiling of right and left internal mammary arteries may present a challenge to cardiothoracic surgery teams caring for these patients when future coronary artery bypass grafting is needed for SV patients. The goal of this study was to determine the frequency of internal mammary artery coil closure in SV patients in a single tertiary care center. A retrospective review of all pediatric single-ventricle patients who underwent cardiac catheterization between March 2009 and October 2015 at Rush Center for Congenital Heart Disease was performed. Fifty-one patients’ charts were reviewed. Twenty-five patients received coil closure of one or more internal mammary artery (coil group) and 26 received no coil closure (no-coil group). In the coil group, 21 (84 %) had their collateral vessels coiled in the pre-Fontan period and 4 (16 %) had their vessels coiled in the post-Fontan period. In the coil group, 18 (72 %) had their right internal mammary artery coiled and 7 (28 %) had both right and left internal mammary arteries coiled. None of the coil group had isolated coil closure of the left internal mammary artery. This study is the first to verify the frequency of right and/or left internal mammary artery coil closure in SV patients and the potential impact on future coronary artery bypass grafting. Extensive peri-Fontan coiling of the internal mammary arteries presents a significant potential challenge for subsequent management of SV patients as older adults.