A Clinical Study for the Durability of Oxygenators on Cardiopulmonary Support

Abstract: Cardiopulmonary support (CPS) requires durability of the oxygenator. The life span of the oxygenator is affected by various clinical factors, including patient condition, perfusion condition, and equipment usage. Predictors for the durability of oxygenators were evaluated clinically in this study. Thirty-two patients, who had undergone CPS during the last 3 years in our institute were assigned to this study. Fifty oxygenators had been used (Capiox SX in 19, CB Maxima in 23, and AL-6000 in 8). Significant predictors for the durability of oxygenators were evaluated by nonparametric survival analysis and proportional hazards regression analysis. Univariate regression analysis revealed 6 significant predictors for the life span of oxygenators. These were the oxygenator type, type of centrifugal pump, acidosis with blood pH less than 7.35, base excess less than -5, blood glutamic-oxaloacetic transaminase (GOT) levels greater than 1,000 IU, and blood lactate dehydrogenase (LDH) levels greater than 3,000 IU. After multivariate analysis, there remained only 2 significant predictors. An oxygenator used with a noncoated CPS system (Capiox SX with Capiox EBS) proved to have a significantly shorter life span than one used with a heparin-coated system (CB Maxima or AL-6000 with CB BP-80) (hazards ratio, 3.588, p = 0.0065). Patient conditions, which revealed acidosis with less than -5 of base excess, significantly shortened the life of the oxygenator (hazards ratio, 3.595, p = 0.0188).     

Experience with the Berlin Heart Assist Device

Abstract: Different mechanical circulatory support systems (MCSS) have been in clinical use since 1987 to keep patients alive by assisting the heart during cardiac recovery after open heart surgery, myocardial infarction, acute graft failure after heart transplantation, or as a bridge to transplantation in heart transplant candidates. Four different hospitals in Germany used the Berlin Heart Assist Device. Up until 1993, there were 22 patients in the "recovery" group; 4 patients were weaned from the system, and only 1 patient was discharged from the hospital. In 112 patients the Berlin Heart Assist Device was implanted for the purpose of a bridge to transplantation, 68 were transplanted and 46 patients left the hospital. It was concluded that patients may be kept alive with this system for weeks and months after any kind of cardiogenic shock. Complete cardiac recovery may be achieved in patients with early posttransplant graft failure. Reliable prediction of outcome in bridge–to–transplantation patients requires further experience and improvement of system components.     

慢性阻塞性肺疾病患者家庭支持与自我概念的相关性研究

目的 探讨慢性阻塞性肺疾病(慢阻肺)患者的家庭支持与自我概念的关系。方法 用方便抽样法选取108位慢阻肺患者，应用修订的个人资源问卷、自我概念量表和一般资料问卷分别测定其家庭支持、自我概念水平和一般资料。结果 该组患者家庭支持程度为中到高度，自我概念中度积极；家庭支持与总的自我概念呈中度正相关，与自我概念中的体感、自我一致性、理想自我及道德一伦理一精神自我有显著相关．与体象无关。结论 慢阻肺患者的家庭支持水平越高，其自我概念越积极。     

Internet tools in the medical classroom

Summary: The Internet contains a vast amount of medically relevant information. In order to access this information, however, many networks require one to master applications written in UNIX, an operating system considered by many not to be user friendly. Although these tools may be available on the campus, it is difficult to teach their use unless there is some immediate benefit to the already busy user. From that standpoint, it is important for instructors to realize that common UNIX applications can be utilized as classroom tools to significantly enhance the learning experience by facilitating teacher/student communication. Also, whilst the student enjoys greater communication with the instructor (and with other students) he/she is also becoming adept at using information management tools.     

Effects of cadaver dissection on the attitudes of medical students

Summary: Summary. A study was conducted to determine whether the attitudes of medical students to death and caring changed during the 3 months following exposure to cadaver dissection. All first-year students were invited to complete a questionnaire immediately before their initial cadaver dissection experience, after 6 weeks, and after a further 3 months. The questionnaire reflected attitudes to death, violent death, death of someone known to the respondent and caring when someone known to the respondent is seriously injured. Ethnicity and previous exposure to dying has no effect on responses, but overall men students' reactions were significantly less than for women ( P < 0.001). The responses given on the final part of the questionnaire after 3 months were significantly lower than those to most questions in the first part of the questionnaire. The exceptions were those questions where the subject in the given scenario was known to the respondent, where reactions were rated significantly greater ( P < 0.001) in the follow-up questionnaire and can be explained on the basis that they were a personal referent.
Students rapidly develop a coping mechanism which enables them to view cadaver dissection as an occupation quite divorced from living human beings. During these early months of training solicitude decreases for those who die who are unknown to them, but concern for personal referents increases. Educators should be aware of the dramatic change of attitudes among students and the process of professionalization which might influence their caring of future patients.     

Early parental adjustment to visible congenital disfigurement

Summary When a baby is born with a visible disfigurement, then parents need to adjust to the loss of the anticipated 'perfect' child and thus accept their baby. The impact of the birth on the parents is described in the context of a measure which identifies areas of potential difficulty. The two groups studied were parents of children with cleft palates and parents of children with congenital hand deficit. A wide range of adjustment was found. There was no significant difference between the two groups in terms of their overall adjustment, but there were individual differences in adjustment which did not relate to the severity or type of anomaly. The only significant variable found to relate to parental adjustment was perceived family support.     

The potential of an anaesthesiologist–manned ambulance service in a rural/urban district

The use of anaesthesiologists in prehospital emergency care is controversial. We wanted to assess the impact of an anaesthesiologist and a short time interval from acceptance of a mission to take–off at survival rates in a rural/urban emergency medical service. Prospectively registered data for 991 consecutive patients through a 12–month period were retrospectively evaluated by an independent foreign expert. Of all primary missions, 3.3% were considered probably lifesaving from site of injury to receiving hospital. Of these, the lifesaving result in 50% were dependent on both the qualifications of the anaesthesiologist and a short response time. Survival from hospital admission to discharge was 44%. All patients were discharged to their own homes, able to live a fully functional life. The consistent use of anaesthesiologists compared to less qualified personnel and the maintaining of response times below presently required minima doubles the potential for lives saved in services comparable to the one studied.     

Risk factors for Caesarean section in Italy: results of amulticentre study

A recent large increase in Caesarean section (CS) in Italy was the initial stimulus for a study to identify risk factors for CS and, if possible, to suggest strategies to counteract the rise. The study was conducted in three hospitals where a wide range of individual variables was collected from the clinical records and from personal interviews. Crude CS rates and odds ratios were evaluated for each single variable while logistic regression has been used to investigate possible confounding factors. The study involved 1316 consecutive deliveries. Crude CS rates were 29.4%, 15.7% and 16.1%. Variables identified as high risk factors were pre-eclampsia, previous CS, breech and other non-vertex presentations. Antenatal care under an obstetrician working in the same hospital, a low number of antenatal consultations, previous miscarriages, offer (by obstetrician) and request (by women) for CS showed significantly high odds ratios (ORs). Previous live births was strongly negatively associated with CS. No relationship between type of delivery and social status was observed while a physician factor was detected in all three hospitals where rates for different physicians ranged from 0% to 52.8%. Apart from the main medical indications for Caesarean section (previous CS, breech presentation), the results seem to indicate that individual practice style may be an important determinant of the wide variation in the rates of Caesarean delivery. While this may have been suspected before this study, these results are the first hard data to indicate that, in Italy, CS is widely performed for non-medical reasons.