Background: Patients receiving long‐term parenteral nutrition (PN) are at increased risk of aluminium (Al) toxicity because of bypass of the gastrointestinal tract during PN infusion. Complications of Al toxicity include metabolic bone disease (MBD), Al‐associated encephalopathy in adults, and impaired neurological development in preterm infants. Unlike the United States, there are no regulations regarding Al content of large‐ and small‐volume parenterals in Canada. We, therefore, aimed to present our data on plasma Al concentration and Al intake from our cohort of pediatric patients receiving long‐term PN. Methods: Plasma Al concentration was retrospectively gathered from the patient charts of all 27 patients with intestinal failure (IF) receiving long‐term PN at The Hospital for Sick Children, Toronto, Canada, and compared with age‐ and sex‐matched controls recruited for comparison. In addition, Al concentration was measured in PN samples collected from 10 randomly selected patients with IF and used to determine their Al intake. Results: The plasma Al concentration of patients with IF receiving long‐term PN was significantly higher than that of control participants (1195 ± 710 vs 142 ± 63 nmol/L; P < .0001). In the subgroup of 10 patients for whom Al intake from their PN solution was determined, mean ± SD Al intake from PN was 15.4 ± 15 µg/kg, 3 times the Food and Drug Administration upper recommended intake level, and Al intake was significantly related to plasma Al concentration (P = .02, r2 = 0.52). Conclusion: Pediatric patients receiving long‐term PN for IF in Canada are at risk for Al toxicity. 相似文献
Forms of collaborative knowledge production, such as community-academic partnerships (CAP), have been increasingly used in health care. However, instructions on how to deliver such processes are lacking. We aim to identify practice ingredients for one element within a CAP, a 6-month co-design process, during which 26 community- and 13 research-partners collaboratively designed an intervention programme for children whose parent have a mental illness. Using 22 published facilitating and hindering factors for CAP as the analytical framework, eight community-partners reflected on the activities which took place during the co-design process. From a qualitative content analysis of the data, we distilled essential practices for each CAP factor. Ten community- and eight research-partners revised the results and co-authored this article. We identified 36 practices across the 22 CAP facilitating or hindering factors. Most practices address more than one factor. Many practices relate to workshop design, facilitation methods, and relationship building. Most practices were identified for facilitating ‘trust among partners’, ‘shared visions, goals and/or missions’, ‘effective/frequent communication’, and ‘well-structured meetings’. Fewer practices were observed for ‘effective conflict resolution’, ‘positive community impact’ and for avoiding ‘excessive funding pressure/control struggles’ and ‘high burden of activities’. Co-designing a programme for mental healthcare is a challenging process that requires skills in process management and communication. We provide practice steps for delivering co-design activities. However, practitioners may have to adapt them to different cultural contexts. Further research is needed to analyse whether co-writing with community-partners results in a better research output and benefits for participants. 相似文献
Abstract
Vertebral artery injuries can be seen following trauma. Most traumatic vertebral artery injuries are limited to an intimal
dissection. Rarely, transection of the vertebral artery can be seen with extravasation of hemorrhage into the surrounding
soft tissues of the neck. Dural tears are rare in the setting of trauma. They are usually the result of penetrating trauma
or severe blunt trauma. We present a case with both a vertebral artery transection and a dural tear. The combination of these
lethal injuries resulted in extravasation of hemorrhage into the soft tissues of the neck, through the dural tear, and into
the subarachnoid space of the cervical spine. The subarachnoid hemorrhage extended superiorly into the brain. The diagnosis
was made by computed tomography (CT) and computed tomography angiography (CTA). The treatment of traumatic vertebral artery
transections and dural tears are discussed. 相似文献
Background: The authors compared the speed of induction of anesthesia with sevoflurane with and without nitrous oxide with the speed of halothane and nitrous oxide using a single-breath vital capacity induction.
Methods: With informed parental consent, 51 healthy unpremedicated children aged 5-12 yr were randomized to inhale a single breath of one of three gas mixtures: 8% sevoflurane in 66% nitrous oxide, 8% sevoflurane in oxygen, or 5% halothane in 66% nitrous oxide. A blinded observer recorded the times to loss of the eyelash reflex, return of conjugate gaze, the presence of airway reflex responses, involuntary movement, and hemodynamic responses.
Results: Forty-two children completed the study. The times (mean +/- SD) to loss of the eyelash reflex with sevoflurane/nitrous oxide, 38 +/- 8 s, and for sevoflurane-oxygen, 34 +/- 12 s, were less than that with halothane-nitrous oxide, 58 +/- 17 s (P < 0.01). Movement occurred less frequently during sevoflurane than during halothane anesthesia (P < 0.05). The times to return of conjugate gaze and the incidence of airway reflex responses were similar among the groups. The incidence of dysrhythmias in the sevoflurane groups was less than that in the halothane group (P < 0.01). 相似文献
To determine the quality of anaesthesia and speed of recovery after propofol anaesthesia for myringotomy in children, 100 children 2–12 years were randomized to one of four anaesthetic regimens for induction/maintenance: thiopentone (STP) (5 mg·kg−1)/halothane, propofol (3 mg·kg−1)/halothane, halothane/halothane or propofol (3 mg·kg−1)/propofol bolus (0.5 mg·kg−1 every 3 min (10 mg·kg−1·h−1)). Nitrous oxide (70%) in oxygen (30%) was used to facilitate insertion of an intravenous catheter and was continued throughout the anaesthetic. We found that the incidence of intraoperative movement in response to surgical stimulation was significantly greater in the prop/prop group 32%, compared with the three other groups ( P <0.02). Although some recovery variables (time to response to questions, sit unaided, tolerate oral fluids, and discharge with fluids) were achieved more rapidly by the prop/prop group than the other three groups, the times to open eyes, obey commands and, most importantly, discharge from recovery without fluids did not differ between the prop/prop and the hal/hal groups. We conclude that there is little benefit in using propofol as an induction agent alone or in combination with a propofol maintenance anaesthetic for paediatric myringotomy and tube surgery. 相似文献
This study examined the knowledge a small group of community nurses have of the Vietnamese culture In our multi-cultural society nurses are being challenged to offer culturally appropriate care Provision of care depends on an accurate assessment of health care needs which may differ from those of the dominant culture The results indicated a lack of knowledge of the Vietnamese culture and the specific health care practices of the Vietnamese This lack of knowledge is being rectified by in-service education 相似文献
Recent shifts in the patient, family and caregiver engagement field have focused greater attention on measurement and evaluation, including the impacts of engagement efforts. Current evaluation tools offer limited support to organizations seeking to reorient their efforts in this way. We addressed this gap through the development of an impact measurement framework and accompanying evaluation toolkit—the Engage with Impact Toolkit.
Methods
The measurement framework and toolkit were co-designed with the Evaluating Patient Engagement Working Group, a multidisciplinary group of patient, family and caregiver partners, engagement specialists, researchers and government personnel. Project activities occurred over four phases: (1) project scoping and literature review; (2) modified concept mapping; (3) working group deliberations and (4) toolkit web design.
Results
The project scope was to develop a measurement framework and an evaluation toolkit for patient engagement in health systems that were practical, accessible, menu-driven and aligned with current system priorities. Concept mapping yielded 237 impact statements that were sorted, discussed and combined into 81 unique items. A shorter list of 50 items (rated 8.0 or higher out of 10) was further consolidated to generate a final list of 35 items mapped across 8 conceptual domains of impact: (1) knowledge and skills; (2) confidence and trust; (3) equity and inclusivity; (4) priorities and decisions; (5) effectiveness and efficiency; (6) patient-centredness; (7) culture change and (8) patient outcomes and experience. Working Group members rated the final list for importance (1–5) and identified a core set of 33 items (one for each of the 8 domains and 25 supplementary items). Two domains (priorities and decisions; and culture change) yielded the highest overall importance ratings (4.8). A web-based toolkit ( www.evaluateengagement.ca ) hosts the measurement framework and related evaluation supports.
Conclusion
The Engage with Impact Toolkit builds on existing engagement evaluation tools but brings a more explicit focus to supporting organizations to assess the impacts of their engagement work.
Patient Contribution
Patient, family and caregiver partners led the early conceptualization of this work and were involved at all stages and in all aspects of the work. As end-users of the toolkit, their perspectives, knowledge and opinions were critical. 相似文献
To investigate the impact of T2 relaxation of the carotid wall on measurements of its thickness.
Materials and Methods:
The common carotid artery wall was imaged using a spin echo sequence acquired at four echo times (17 ms to 68 ms) in 65 participants as part of VALIDATE study. Images were acquired transverse to the artery 1.5 cm proximal to the flow divider. Mean wall thickness, mean wall signal intensity, lumen area, and outer wall area were measured for each echo. Contours were also traced on the image from the fourth echo and then propagated to the images from the preceding echoes. This was repeated using the image from the first echo. Mean wall signal intensity measurements at the four echo times were fit to a mono‐exponential decay curve to derive the mean T2 relaxation time for each set of contours.
Results:
Mean wall thickness decreased with increasing echo time, with an average thickness reduction of 8.6% between images acquired at the first and last echo times (TE) (0.93 mm at TE 17 ms versus 0.85 mm at TE 68 ms, P < 0.001). Average T2 relaxation time of the carotid wall decreased by 3% when the smaller contours from the last echo were used, which excluded the outer‐most layer (54.3 ± 7.6 ms versus 52.7 ± 6.6 ms, P = 0.03).