Beliefs about humanized care in a pediatric intensive care unit

This study aimed to understand the nurses' beliefs about humanized care in the Pediatric Intensive Care Unit (PICU). Data collection was accomplished through open interviews with five nurses, which were then taped and fully transcribed. The content analyzed was realized in the framework of symbolic interactionism as a theoretical reference base, and used the Grounded Theory methodology. This study allowed for the understanding that the nurse, although she has difficulties in rendering humanized assistance, seems to be giving up the belief that the PICU is a technicist unit and starts looking for strategies to deliver a more humanized assistance.     

End-of-life practices in seven Brazilian pediatric intensive care units.

OBJECTIVE: To evaluate the incidence of life support limitation and medical practices in the last 48 hrs of life of children in seven Brazilian pediatric intensive care units (PICUs). DESIGN: Cross-sectional multicenter retrospective study based on medical chart review. SETTING: Seven PICUs belonging to university and tertiary hospitals located in three Brazilian regions: two in Porto Alegre (southern region), two in S?o Paulo (southeastern region), and three in Salvador (northeastern region). PATIENTS: Medical records of all children who died in seven PICUs from January 2003 to December 2004. Deaths in the first 24 hrs of admission to the PICU and brain death were excluded. INTERVENTIONS: Two pediatric intensive care residents from each PICU were trained to fill out a standard protocol (kappa = 0.9) to record demographic data and all medical management provided in the last 48 hrs of life (inotropes, sedatives, mechanical ventilation, full resuscitation maneuvers or not). Student's t-test, analysis of variance, chi-square test, and relative risk were used for comparison of data. MEASUREMENTS AND MAIN RESULTS: Five hundred and sixty-one deaths were identified; 97 records were excluded (61 because of brain death and 36 due to <24 hrs in the PICU). Thirty-six medical charts could not be found. Cardiopulmonary resuscitation was performed in 242 children (57%) with a significant difference between the southeastern and northeastern regions (p = .0003). Older age (p = .025) and longer PICU stay (p = .001) were associated with do-not-resuscitate orders. In just 52.5% of the patients with life support limitation, the decision was clearly recorded in the medical chart. No ventilatory support was provided in 14 cases. Inotropic drug infusions were maintained or increased in 66% of patients with do-not-resuscitate orders. CONCLUSIONS: The incidence of life support limitation has increased among Brazilian PICUs but with significant regional differences. Do-not-resuscitate orders are still the most common practice, with scarce initiatives for withdrawing or withholding life support measures.     

Posterior sternoclavicular dislocations

The frequency of posterior sternoclavicular dislocations represents 0.019% of the shoulder injuries in the Centre of Traumatology and Orthopedics of Dakar. The posterior form is 0.033% compared to the anterior form. The authors report the cases of posterior sternoclavicular dislocations, occurred with seven men and one woman. Seven of these dislocations were located on the left side, including one case of polytraumatism, one associated with a brachial plexus compression, and one case with a fracture of the kneecap. The authors show the interest of the incidence of Heinig in the diagnosis. The open treatment following the technique of burrows which uses the tendon of the subclavius gives satisfactory results in both functional and anatomical respects. They discuss the orthopaedic methods and insist on their disadvantages, especially in the event of vascular lesion with a risk of haemorrhage of a clogged breach or source of instability, and the difficulty of radiological control after reduction.     

CD4 T cells integrate signals delivered during successive DC encounters in vivo

The cellular mode of T cell priming in vivo remains to be characterized fully. We investigated the fate of T cell-dendritic cell (DC) interactions in the late phase of T cell activation in the lymph node. In general, CD4 T cells detach from DCs before undergoing cell division. Using a new approach to track the history of antigen (Ag)-recognition events, we demonstrated that activated/divided T cells reengage different DCs in an Ag-specific manner. Two-photon imaging of intact lymph nodes suggested that T cells could establish prolonged interactions with DCs at multiple stages during the activation process. Importantly, signals that are delivered during subsequent DC contacts are integrated by the T cell and promote sustained IL-2Ralpha expression and IFN-gamma production. Thus, repeated encounters with Ag-bearing DCs can occur in vivo and modulate CD4 T cell differentiation programs.     

Sharing the death process with the family: a nurse's experience in the pediatric ICU

Death is present in the daily reality of nurses who work with children in ICU. This research aimed to comprehend nurses' experience while taking care of children and his/her family experiencing the death process. Symbolic Interactionism was adopted as a theoretical reference framework, while Interpretative Interactionism was used as a methodological reference framework to analyze the biographical narratives of seven nurses who took part in the research. The events that determined the nurses' history in this context were: FACING THE DEATH OF THE CHILD, PROJECTING YOURSELF IN THE MOTHER'S ROLE and PROMOTING FAREWELL. The analyzed data made it possible to understand the nurses' experience in care for children and their families during the death process.