A smartphone app to communicate child passenger safety: an application of theory to practice

Child passenger safety remains an important public health problem because motor vehicle crashes are the leading cause of death for children, and the majority of children ride improperly restrained. Using a mobile app to communicate with parents about injury prevention offers promise but little information is available on how to create such a tool. The purpose of this article is to illustrate a theory-based approach to developing a tailored, smartphone app for communicating child passenger safety information to parents. The theoretical basis for the tailoring is the elaboration likelihood model, and we utilized the precaution adoption process model (PAPM) to reflect the stage-based nature of behavior change. We created assessment items (written at ≤6th grade reading level) to determine the child's proper type of car seat, the parent's PAPM stage and beliefs on selected constructs designed to facilitate stage movement according to the theory. A message library and template were created to provide a uniform structure for the tailored feedback. We demonstrate how messages derived in this way can be delivered through new m-health technology and conclude with recommendations for the utility of the methods used here for other m-health, patient education interventions.

Autotransplantation of a single functioning kidney following rupture of renal artery aneurysm

Renal artery aneurysms (RAA) are the second most common visceral artery aneurysm. In cases of rupture they pose a significant and emergent surgical challenge. Extracorporeal arterial reconstruction and autotransplantation is often necessary in certain complex cases that are not amenable to aneurysm repair in vivo. We report a case of a 35 year old female with a RAA in a solitary functioning kidney, requiring ex vivo reconstruction and autotransplantation to the iliac vessels.

Organ donation following the circulatory determination of death (DCD): an audit of donation and outcomes following renal transplantation

Organ Donation following the Circulatory determination of Death was introduced in Beaumont Hospital during 2011. The Intensive Care Society of Ireland formally endorsed a national DCD clinical practice guideline in 2012. This retrospective audit covers a 2-year period during which eleven patients were considered suitable for DCD and where consent was obtained. Nine patients died within the ninety-minute period following the withdrawal of life sustaining therapies and subsequently donated organs (82%). Eighteen kidneys were recovered and seventeen patients received renal transplants--one patient received a nephron-dosing dual renal transplant. Lungs were recovered on two occasions and one patient received a lung transplant. Heart valves were recovered on one occasion. To date sixteen of seventeen recipient patients have functioning renal transplants (94%). In conclusion, this model of deceased donation has proven acceptable to families, nursing and medical staff and the outcomes reported are consistent with international best practice.

The Houdini effect--an unusual case of blunt abdominal trauma resulting in perforative appendicitis

We present a unique case of perforative appendicitis that occurred in an adult following blunt abdominal trauma. This case represents the first such reported case from Ireland. It also represents a modern practical example of Laplace's theory of the effect of increased pressure on colonic wall tension leading to localized perforation, and serves to highlight not only the importance in preoperative imaging for blunt abdominal trauma, but also the importance of considering appendiceal perforation.

Triple-vessel mesenteric ischaemia presenting with gastric ulceration

We present an unusual presentation of chronic mesenteric ischaemia in a patient with recurrent gastric ulceration that highlights both the importance of recognition of ischaemia as a possible aetiology in those refractory to conventional treatment and the success of percutaneous transluminal mesenteric angioplasty in these cases.

Low molecular weight heparin prophylaxis in day case surgery

BACKGROUND

The role of Low molecular weight heparins (LMWH) in day case/short-stay surgery is unknown.

AIM

To characterise the current national use of LMWH prophylaxis in specific day and short stay surgeries.

METHODS

A standardised anonymous postal questionnaire was sent to all consultant general surgeons in Ireland. The operations selected were herniorraphy, anorectal, varicose vein and laparoscopic cholecystectomy.

RESULTS

Questionnaires were sent to 82 surgeons in 2003. There was a response rate of 68.3% (56). Fifty-four per cent of respondents said there was a protocol in place for administration of LMWH in day case surgery. Of these 41% were not confident that their protocols were being adhered. Fifty-nine per cent of all respondents said they stratified patients according to individual risk. Thirteen per cent reported occurrence of VTE post day case surgery

CONCLUSION

This study demonstrates a heterogeneous pattern of administration of LMWH. In the absence of published validated protocols, the authors suggest a consensus day case protocol.

The subjective experience of the self in the large group: two models for study

More and more opportunities now exist for group therapists to engage in the study of the self in the large group at local, national, and international conferences as well as in clinical and other organizational settings. This may be particularly important for the group therapist in the next century with potential benefit not only for individuals but also for groups and social systems of all kinds. In this article, I review my own subjective experiences in the large group context and in large study group experiences. Then, I contrast the group analytic and the group relations approaches to the large group with particular reference to Winnicott's theory about maturational processes in a facilitating environment.

Hope and the inclination to be troublesome: Winnicott and the treatment of character disorder in group therapy

While some group participants communicate about the problems in their lives by patterns of troublesome behavior, others may accommodate superficially to the needs of the group but feel an inner sense of futility and quiet desperation. Through use of Winnicott's paradoxical emphasis on the hope that is expressed within the "antisocial inclination" in all character disorders, the group may negotiate an adequate alliance for the discovery, containment, and exploration of the inclination to be troublesome in group in all participants. It may also provide supportive holding during the experience of affects that formerly were overwhelming, such as shame and unresolved guilty anxiety. This approach is applicable to the group as a whole as well as to individuals.

Aliveness in the work of the group: a subjective guide to creative character change

The subjective response of aliveness in the work of the group may be a valuable signal on the journey toward creative character change in group therapy. In order to promote change in others, the group therapist must engage deeply and use internal responses as guides during interactions with group members as well as in relation to the group as a whole. Subjective awareness of increased aliveness that is linked with a sense of the work of the group may guide both therapist and group participants in the midst of inevitable anxieties and passions aroused during this quest for new vitality and freedom in relationships in the group. Winnicott's concept of potential space as well as group-relations theory about the primary task provide a conceptual foundation for this approach not only on the level of the individual member within the group but also on the level of the group as a whole.

The use of confocal microscopy in evaluating corneal wound healing after excimer laser keratectomy

Corneal wound healing following excimer laser keratectomy is the major cause of regression of treatment results. The amount of anterior stromal haze that develops may be influenced by topical medications. Over a period of 6 months, we followed 15 New Zealand white rabbit eyes that underwent excimer laser keratectomy with the VISX 193-nm ArF laser at a fluence of 150 mJ/cm2 for a depth of 130 microns. Eyes were randomized to treatment with prednisolone acetate, diclofenac sodium (Voltaren), a combination of both, and a control group. Drops were administered four times a day for 1 week, two times a day for 3 weeks, and the drops were then tapered. All eyes were reepithelialized by 5 to 7 days. The tandem scanning confocal microscope (TSCM) was used to evaluate the corneal wound in vivo weekly for a month and monthly for 6 months. During the early postoperative period, the TSCM revealed significant anterior stromal keratocyte activation with cell elongation and the spindle-shaped appearance of fibroblasts in all groups. Collagenous stromal scarring was evident initially, then slowly decreased in all treatment groups. This study shows that TSCM is clinically useful for successive in vivo examinations of corneal wounds after excimer laser keratectomy and for comparing the effects of various topical medications.

Confocal microscopy of the living eye

Confocal microscopy is an imaging paradigm that allows optical sectioning of almost any material with increased axial and lateral spatial resolution and better image contrast. We have applied this technology to the study of the living eye of cats, albino rabbits, and humans. The technique allows in vivo, noninvasive, real time images of the eye at magnifications (630x) which allow resolution of anatomical detail at the cellular level. In this paper we report details of our current instrument techniques and some of our results. The past development, present state-of-the-art, and projected future advances and applications of this novel microscopy are discussed. Preliminary observations are reported for all layers of the cornea, the limbus, and wound-healing responses in single animals.

Fluorescein angiography complication survey

This is a report on the results of a national survey designed to study the nature and frequency of moderate and severe complications of intravenous fluorescein angiography. In this survey, 2434 responding ophthalmologists reported on 221,781 fluorescein angiograms performed in the year 1984. Adverse reactions were classified as mild, moderate, severe, and death, depending on the duration of the effect, the necessity for medical intervention, the time required for its resolution, and the final outcome. The frequency rate for a moderate reaction was (1:63), for a severe reaction (1:1900), and for death (1:222,000). A review of previous studies on adverse reactions to the drug, a compilation of suggested methods for the amelioration and prevention of the complications, and a comparison of the responses of the general ophthalmic public to the members of The Macula Society are also reported.