Paediatric cardiac arrest and resuscitation provided by physician-staffed emergency care units

Background: Most paediatric cardiac arrest studies have been conducted in the USA, where paramedics provide prehospital emergency care. We wanted to study the outcome of paediatric cardiac arrest patients in an emergency medical system which is based on physician staffed emergency care units.
Methods: We analysed retrospectively the files of 100 prehospital cardiac arrest patients from Southern Finland during a 10-year study period. The patients were less than 16 years of age.
Results: Fifty patients were declared dead on the scene (DOS) without attempted resuscitation, and cardiopulmonary resuscitation (CPR) was initiated in 50 patients. The sudden infant death syndrome was the most common cause of arrest in the DOS patients (68%) as well as in those receiving CPR (36%). Asystole was the initial cardiac rhythm in 70% of the patients in whom CPR was attempted. Resuscitation was successful in 13 patients, 8 of whom were ultimately discharged. Six of the patients survived with mild or no disability and 4 of them had near-drowning aetiology. In multivariate analysis, the short duration of CPR (≤15 min) was the only factor significantly associated with better survival.
Conclusions: Although prehospital care was provided by physicians, the overall rate of survival was found to be equally poor as reported from systems with paramedics. The only major difference between physician- and paramedic-staffed emergency care units is the ability of physicians to refrain from resuscitation already on the scene when prognosis is poor.     

TARDBP mutations are not a frequent cause of ALS in Finnish patients

In previous studies 1-3 % of ALS patients have TARDBP mutations as the cause of the disease. TARDBP mutations have been reported in ALS patients in different populations but so far there are no studies on the frequency of TARDBP mutations in Finnish ALS patients. A cohort of 50 Finnish patients, 44 SALS and 6 FALS patients, were included in the study. Genomic DNA was extracted from venous blood or muscle tissue and a mutation analysis of TARDBP was performed. No definitely pathogenic mutations could be identified in TARDBP in our patient cohort. However, two previously unknown variations were found: one silent mutation in exon 2 and one relatively deep intronic single nucleotide insertion in intron 5. In addition, two previously known non-pathogenic polymorphisms in intron 5 were detected. The size of our cohort is obviously not large enough to conclusively exclude TARDBP mutations as a very rare cause of ALS in Finland. However, based on our results TARDBP mutations do not appear to be a frequent cause of familial or sporadic ALS in Finland.Key words: Amyotrophic lateral sclerosis, mutation screening, TARDBP     

The effect of REM sleep deprivation on somatostatin and growth hormone-releasing hormone gene expression in the rat hypothalamus

Growth hormone-releasing hormone (GHRH) and somatostatin (SRIF) have been implicated as sleep factors. We studied how the hypothalamic SRIF/GHRH system is affected by possible feedback regulation resulting from REM sleep deprivation at the level of gene expression and how this is reflected in serum growth hormone (GH) content. Male rats were deprived of REM sleep on small platforms for 24 or 72 h, and one group was allowed a rebound sleep of 24 h after 72 h deprivation. Animals maintained on large platforms and animals taken directly from their home cages served as controls. In situ hybridization was made from 20 μm cryosections through the periventricular, paraventricular and arcuate hypothalamic nuclei using oligonucleotide probes for GHRH and SRIF. The number of cells expressing SRIF or GHRH was counted. Serum GH was measured by means of radioimmunoassay in similarly treated rats. Fewer cells expressed GHRH in the paraventricular nucleus of animals subjected to 24 and 72 h of REM sleep deprivation than in home control animals. A similar trend was observed in the arcuate nucleus. The number of cells expressing SRIF was elevated in the arcuate nucleus after 24 h of REM sleep deprivation but not after 72 h. In the periventricular nucleus the number of cells expressing SRIF was higher after 72 h of deprivation when compared to expression in animals maintained on large platforms. Serum GH levels were decreased in animals maintained on either small or large platforms. It is concluded that the expression of the SRIF and GHRH genes is modulated by REM sleep deprivation.     

Effects of physical training on metabolism of connective tissues in young mice

The effects of physical training on the metabolism of collagen, calcium and glycosaminoglycans in various connective tissues were studied in male NMRI mice. The mice to be trained and their controls were about 3 weeks old (expt. I) and 8 weeks old (expt. II) at the commencement of training. The training was performed on a 5° inclined treadmill 5 days a week for 4 weeks in expt. I and for 3 weeks in expt. II. The daily exercise time was progressively increased from 20 min in the first week up to 80 min in the third week. The incorporation of ³H-proline to collagen hydroxyproline was increased by training in long bones, skeletal muscle and Achilles tendon, whereas the incorporation of ³⁵S-sulphate into glycosaminoglycans of bones was lower for the trained compared to the control mice. The differences between the two groups in the incorporation of ⁴⁵calcium were negligible. The results indicate that the metabolism of collagen is accelerated by physical training in several connective tissues in young rapidly growing mice, whereas the metabolism of glycosaminoglycans remains uneffected or is even retarded.     

Outcome of drowned hypothermic children with cardiac arrest treated with cardiopulmonary bypass

Background: There is a lack of data on the outcome of cardiopulmonary bypass (CPB) rewarming of hypothermic children with cardiac arrest following drowning. Aim of the study: To retrospectively analyze single‐center outcome of drowning victims treated with CPB. Materials and methods: This retrospective study included all hypothermic drowning victims admitted to the Hospital for Children and Adolescents with attempted resuscitation on CPB between 1994 and 2008 inclusive. Median sternotomy and cannulation of the ascending aorta and the right atrium for CPB were performed on all victims. Results: Nine hypothermic drowning victims, comprising five boys and four girls, with a median age of 3.8 years (range, 1.5–10 years). The median submersion time was 38 min (range, 5–75 min) and the median water temperature was 6.5 °C (range, 0.2–16.5 °C). The median core temperature was 21.9 °C (range 17.7–32.8 °C) at arrival to the hospital. All nine children were able to be weaned from CPB. Only one child, with mild to moderate neurological deficit, became a long‐term survivor. She was slowly rewarmed up to 33 °C with CPB and kept in mild hypothermia for 48 h. Conclusions: Large numbers of submerged children can be primarily resuscitated with CPB. Unfortunately, many of them will decease from severe hypoxic brain injury. Slow rewarming with CPB may improve the likelihood of a better neurological outcome.     

Client and information: a literature review

Summary

• ? This paper gives a brief review of existing research studies concerning patient information.
• ? The paper outlines two relevant perspectives on information giving and on the meaning of information to the individual patient: ideological and practical.
• ? From these two perspectives the knowledge structures of four patient groups: surgical patients, cancer patients, dialysis patients and psychiatric patients are looked at more closely.

     

Biofilm formation by Streptococcus pneumoniae isolates from paediatric patients

Tapiainen T, Kujala T, Kaijalainen T, Ikäheimo I, Saukkoriipi A, Renko M, Salo J, Leinonen M, Uhari M. Biofilm formation by Streptococcus pneumoniae isolates from paediatric patients. APMIS 2010; 118: 255–60. The clinical significance of pneumococcal biofilm formation is largely unknown. To clarify this, we tested whether the ability of pneumococcal clinical isolates to form biofilm in vitro accounts for the diverse clinical outcomes. Clinical pneumococcal isolates were cultured from the nasopharynx (n = 106), middle ear effusion (n = 43) and blood (n = 55) of 204 children altogether. Biofilm formation, assessed by measuring optical density (OD) values in microtitre plates after crystal violet staining, did not differ between the bacteria from different sources (p = 0.18), the mean OD values of the isolates being 0.119 [95% confidence interval (CI) 0.100–0.138] in the nasopharynx samples, 0.094 (95% CI 0.069–0.119) in the acute otitis media cases, 0.109 (95% CI 0.077–0.141) in the secretory otitis media cases, 0.122 (95% CI 0.084–0.160) in those with sepsis and 0.175 (95% CI 0.071–0.280) in those with other invasive infections. Serotypes 33 and 14 were the most efficient in forming biofilms, whereas serotypes 3 and 38 were poor biofilm producers. We conclude that the clinical presentation of pneumococcal disease did not differ in relation to biofilm formation in vitro, even though there was marked variation between the clinical isolates and serotypes.     

Effect of sleep deprivation on multi‐unit discharge activity of basal forebrain

The basal forebrain (BF) is an important wakefulness/arousal‐promoting structure involved in homeostatic responses to sleep deprivation (SD). However, the effects of SD and subsequent sleep recovery on the BF discharge have not been investigated. Multi‐unit BF activity was recorded on freely moving rats during 8 h of baseline (BL) and, on the following day, during 4 h of SD by gentle handling followed by 4 h of recovery. The effect of SD on the waking discharge was evaluated during the last 10 min of each hour when attentive waking was induced. The wakefulness level was defined based on the ratio between theta and delta electroencephalogram (EEG) powers, and epochs with ratios ≥1 but <2 (T/D‐1) and ≥2 but <4 (T/D‐2) were analysed separately. During T/D‐1 wakefulness, the BF multi‐unit discharge rate increased significantly during the second and third hours of SD and decreased during the third hour of recovery when compared with corresponding hours of BL. Non‐rapid eye movement sleep discharge rate during recovery decreased significantly in the second and third versus the first and last hours. The results suggest that maintenance of the level of vigilance necessary for adequate performance during SD requires increased activation of BF neurones when compared with the BL, whereas the same level of vigilance after several hours of recovery can be maintained with lesser activation of BF neurones.     

An outbreak of pneumonia associated with S. pneumoniae at a military training facility in Finland in 2006

Streptococcus pneumoniae is a well‐known cause of community‐acquired bacterial pneumonia. The purpose of this study was to assess the cause and extent of the outbreak of pneumonia which occurred among military recruits following a 1‐week hard encampment in Finland. We also assessed the carriage rate and molecular characteristics of the S. pneumoniae isolates. All pneumococcal isolates were studied for antibiotic susceptibility, serotyped, genotyped by multilocus sequence typing (MLST), and the presence of pneumococcal rlrA pilus islet was detected. The genotype results defined by MLST corresponded with the serotype results. S. pneumoniae serotype 7F, ST2331, seemed to be associated with an outbreak of pneumonia and nasopharyngeal carriage among 43 military recruits. Of the 43 military recruits, five (12%) were hospitalized with pneumonia and two (40%) of them were positive for S. pneumoniae serotype 7F, ST2331 by blood culture. Eighteen (42%) of the 43 men were found to be positive for S. pneumoniae by nasopharyngeal culture, and nine (50%) of them carried pneumococcal serotype 7F, ST2331. The outbreak strain covered 55% of all the pneumococcal findings. Outbreaks of invasive pneumococcal disease seem to occur in a crowded environment such as a military training facility even among previously healthy young men.     

Organizational vision: experience at the unit level

Aims The main focus of this follow-up study was to describe how the vision statements were perceived to describe the work in the units and what kind of relationships there were between the vision statements and background factors during the 3-year follow-up. Background The vision statement gives a competitive advantage to the organization. It helps find the desired direction during a period of transformation in the organization. Satisfaction, empowerment and motivation are challenged in the vision-realization process. Methods The data were gathered by questionnaire from the multidisciplinary team members on three occasions. The response rate was 58% (n = 115, n = 112) for the first and second data sets, and 53% (n = 103) for the third data set. The data was analysed statistically. Results The organizational vision was perceived as quite stable during the 3 years. Factors associated with the vision statement at the end of the 3-year period were workload, experience of stress, work motivation, work satisfaction, importance of work independence and general empowerment. Implications for nursing management Leaders are able to sustain the vision statement by motivating and empowering the staff. Empowerment especially is worth reinforcing in a vision-realization process.