Women's experiences of a telemedicine abortion service (up to 12 weeks) implemented during the coronavirus (COVID-19) pandemic: a qualitative evaluation

Objective

To explore the experiences of women in Scotland who accessed medical abortion at home up to 12 weeks’ gestation, delivered via a telemedicine abortion service implemented in response to the coronavirus (COVID‐19) pandemic, to identify areas for improvement and inform service provision.

Design

Qualitative interview study.

Setting

Abortion service in one National Health Service health board in Scotland.

Population or sample

Twenty women who accessed telemedicine abortion services and self‐administered mifepristone and misoprostol at home up to 12 weeks’ gestation.

Methods

Thematic analysis of semi‐structured qualitative interviews, informed by the Framework analytic approach.

Main outcome measures

Women’s experiences of accessing telemedicine for medical abortion at home, specifically: acceptability of the telephone consultation and remote support; views on no pre‐abortion ultrasound scan; and self‐administration of abortion medications at home.

Results

Novel study findings were three‐fold: (1) participants valued the option of accessing abortion care via telemedicine and emphasised the benefits of providing a choice of telephone and in‐person consultation to suit those with different life circumstances; (2) the quality of abortion care was enhanced by the telemedicine service in relation to access, comfort and flexibility, and ongoing telephone support; (3) participants described being comfortable with, and in some cases a preference for, not having an ultrasound scan.

Conclusions

This research demonstrates support for the continuation of telemedicine abortion services beyond the temporary arrangements in place during COVID‐19, and lends weight to the argument that offering the option of telemedicine abortion care can enable women to access this essential health service.

Tweetable abstract

#Telemedicine provision of medical #abortion at home up to 12 weeks’ gestation is acceptable and highly valued by #women #Research #SRHR @nbw80 @doctorjjrw @jeniharden @cameronsharon @mrc_crh @edinuniusher.

#Telemedicine provision of medical #abortion at home up to 12 weeks’ gestation is acceptable and highly valued by #women #Research #SRHR @nbw80 @doctorjjrw @jeniharden @cameronsharon @mrc_crh @edinuniusher.

This article includes Author Insights, a video abstract available at: https://vimeo.com/bjog/authorinsights16813

Haemodialyser Reuse: Impact on Function and Biocompatibility

The functional performance (clearance of small molecules, ultrafiltration and blood loss) and biocompatibility (haemodialysis leucopenia) has been studied for disposable flat plate and hollow fibre haemodialysers utilizing Cuprophan membranes on their first use, and compared with that obtained when reusing by a manual and automated technique. The results obtained relating to functional performance remain unchanged with the exception of blood loss which shows an increase compared with first use. Biocompatibility is modified on reuse but only if the membrane has not been exposed to a rinsing process using sodium hypochlorite.

Gene flow from single and stacked herbicide-resistant rice (Oryza sativa): modeling occurrence of multiple herbicide-resistant weedy rice

BACKGROUND

Provisia™ rice (PV), a non-genetically engineered (GE) quizalofop-resistant rice, will provide growers with an additional option for weed management to use in conjunction with Clearfield^® rice (CL) production. Modeling compared the impact of stacking resistance traits versus single traits in rice on introgression of the resistance trait to weedy rice (also called red rice). Common weed management practices were applied to 2-, 3- and 4-year crop rotations, and resistant and multiple-resistant weedy rice seeds, seedlings and mature plants were tracked for 15 years.

RESULTS

Two-year crop rotations resulted in resistant weedy rice after 2 years with abundant populations (exceeding 0.4 weedy rice plants m^-2 ) occurring after 7 years. When stacked trait rice was rotated with soybeans in a 3-year rotation and with soybeans and CL in a 4-year rotation, multiple-resistance occurred after 2-5 years with abundant populations present in 4-9 years. When CL rice, PV rice, and soybeans were used in 3- and 4-year rotations, the median time of first appearance of multiple-resistance was 7-11 years and reached abundant levels in 10-15 years.

CONCLUSION

Maintaining separate CL and PV rice systems, in rotation with other crops and herbicides, minimized the evolution of multiple herbicide-resistant weedy rice through gene flow compared to stacking herbicide resistance traits. © 2017 Society of Chemical Industry.

Children's experiences of managing Type 1 diabetes in everyday life: a thematic synthesis of qualitative studies

AIMS

To explore the everyday experiences of children (aged ≤ 12 years) with Type 1 diabetes to identify factors that help or hinder diabetes self-management practices.

METHODS

Eight databases (Embase, Medline, CINAHL, Web of Science, PsychInfo, ASSIA, ERIC and ProQuest Dissertations) were searched in 2016 to identify qualitative studies exploring children's views about self-managing diabetes. Data were extracted, coded and analysed using thematic synthesis.

RESULTS

Eighteen studies from five countries were included in the review. Synthesis of studies' findings resulted in the identification of three overarching analytical themes. The first theme, 'Understandings of diabetes and involvement in self-management', outlines ways in which children understand diabetes and develop self-management responsibilities. The second theme, 'Disruption to life and getting on with it', reports children's frustrations at disruptions to everyday life when managing diabetes, and how attempts to appear normal to family and friends affect self-management practices. The third theme, 'Friends' support', describes how friends' reactions and responses to diabetes affect children's ability to appear normal and willingness to disclose information about diabetes, and support provided by 'informed friends', or peers with diabetes.

CONCLUSIONS

Although the synthesis has identified how children's everyday life experiences inform ways in which they undertake diabetes self-management, it was not possible to determine new ways to provide support. To help children optimise their glycaemic control, further work should be undertaken to identify their need for support and which takes into account the potential ways in which parents, friends and peers can offer assistance.

Self-management of first trimester medical termination of pregnancy: a qualitative study of women's experiences

OBJECTIVE

To explore the experiences of women in Scotland who return home to complete medical termination of pregnancy (TOP) ≤63 days of gestation, after being administered with mifepristone and misoprostol at an NHS TOP clinic.

DESIGN

Qualitative interview study.

SETTING

One National Health Service health board (administrative) area in Scotland.

POPULATION OR SAMPLE

Women in Scotland who had undergone medical TOP ≤63 days, and self-managed passing the pregnancy at home; recruited from three clinics in one NHS health board area between January and July 2014.

METHODS

In-depth, semi-structured interviews with 44 women in Scotland who had recently undergone TOP ≤63 days of gestation, and who returned home to pass the pregnancy. Data were analysed thematically using an approach informed by the Framework method.

MAIN OUTCOME MEASURES

Women's experiences of self-management of TOP ≤63 days of gestation.

RESULTS

Key themes emerging from the analysis related to self-administration of misoprostol in clinic; reasons for choosing home self-management; facilitation of self-management and expectation-setting; experiences of getting home; self-managing and monitoring treatment progress; support for self-management (in person and remotely); and pregnancy self-testing to confirm completion.

CONCLUSIONS

Participants primarily found self-administration of misoprostol and home self-management to be acceptable and/or preferable, particularly where this was experienced as a decision made jointly with health professionals. The way in which home self-management is presented to women at clinic requires ongoing attention. Women could benefit from the option of home administration of misoprostol.

TWEETABLE ABSTRACT

Women undergoing medical TOP 63 days found home self-management to be acceptable and/or preferable.

A collaborative improvement project by an NHS Emergency Department and Scottish Ambulance Paramedics to improve the identification and delivery of sepsis 6

Early identification of patients with sepsis is key to the delivery of the sepsis 6 bundle including antibiotic therapy within an hour.[1-3] Demand versus capacity challenges in the Emergency Department (ED) led to delays in antibiotic and sepsis 6 delivery. An alerting tool was developed that provided criteria for Scottish Ambulance Service (SAS) Paramedics to alert the ED of potential sepsis patients.

Data from patients presenting to the ED prior to the alerting process commencing (n=50) and during alerting (n=50) were analysed, a questionnaire was used to ascertain feedback from all staff groups; nurses doctors, and paramedics (n=38). Mean Time to triage improved by 82% from 17 minutes to 3 minutes (p=0.01), time to first antibiotic improved by 39% from 49 minutes to 30 minutes. Overall 78% of patients received antibiotics within an hour of leaving their home; no significant increase in workload was reported by staff.

In conclusion alerting by paramedics of potential sepsis patients reduced the time taken to deliver the Sepsis 6 Bundle. Process reliability has been sustained over several months. This process has been spread to seven regional ambulance stations in Lanarkshire Scotland.

Challenges of optimizing glycaemic control in children with Type 1 diabetes: a qualitative study of parents' experiences and views

AIMS

To explore the difficulties parents encounter in trying to achieve clinically recommended blood glucose levels and how they could be better supported to optimize their child's glycaemic control.

METHODS

In-depth interviews were conducted with 54 parents of children with Type 1 diabetes (≤ 12 years). Data were analysed thematically.

RESULTS

Parents described being reluctant and finding it difficult to keep their child's blood glucose levels consistently within clinically recommended ranges. As well as worrying about their child's ability to detect/report hypoglycaemia, parents highlighted a multitude of factors that had an impact on their child's blood glucose levels and over which they could exercise little control. These included: leaving their child with other caregivers who could not be trusted to detect hypoglycaemia; difficulties remotely monitoring and regulating their child's food consumption and activity; and physical and social changes accompanying childhood development. Most parents used two sets of blood glucose targets, with clinically recommended targets employed when their child was in their immediate care and higher targets when in the care of others. Parents described health professionals as lacking understanding of the difficulties they encountered keeping blood glucose within target ranges and needing more empathetic, tailored and realistic advice.

CONCLUSION

It is not parents' fear of hypoglycaemia in isolation that leads to decisions to raise their child's blood glucose but, rather, parental fear in conjunction with other factors and considerations. Hence, to improve diabetes management in children, these factors may need to be addressed; for instance, by training others in diabetes management and using new technologies. Changes to consultations are also recommended.

Parents' experiences of managing their child's diabetes using an insulin pump: a qualitative study

AIMS

Continuous subcutaneous insulin infusion delivered via a pump is increasingly recommended for younger children with Type 1 diabetes. Our aims were: to understand the impact on parents who care for young children using insulin pumps; to help interpret psychological outcomes reported in quantitative research; and to inform provision of support to future parents.

METHODS

We conducted in-depth interviews with 19 parents of children (aged ≤ 12 years) with Type 1 diabetes who used an insulin pump. Data were analysed thematically.

RESULTS

Parents reported multiple benefits from using insulin pumps, including: no longer having to administer painful injections; fewer restrictions on the frequency, timing and carbohydrate contents of snacks and meals; and improvements in family life and their child's glycaemic control. Parents liked and felt less anxious about using bolus calculators to determine insulin doses; however, parents also described undertaking additional and unanticipated work to manage their child's diabetes using a pump. This included performing more blood glucose tests to calculate insulin doses for snacks and to address their concerns that the pump increased their child's risk of hypoglycaemia. Some parents reported doing additional blood glucose checks because they could adjust pump settings to better manage hypo- and hyperglycaemia.

CONCLUSIONS

Parents liked and perceived benefits for their child and themselves from using an insulin pump; however, parents would benefit from being made aware of the additional work involved in using a pump and also from education and support to address concerns about hypoglycaemia. Better measures to evaluate parents' experiences are also recommended.

Parental decision-making in uptake of the MMR vaccination: a systematic review of qualitative literature

BACKGROUND

Controversy has surrounded MMR vaccination in the aftermath of Wakefield's 1998 paper suggesting links between MMR and the development of pervasive developmental disorder in children. The paper sparked off media debate and contributed to a lack of parental trust in health-care providers and reduction in MMR uptake. This review aims to identify and evaluate research on the subject, with a view to present the reasons behind, and influences on parental decision-making in relation to MMR.

METHODS

Systematic search strategy identified 14 relevant papers on which thematic analysis was performed.

RESULTS

Themes identified were categorized as follows: perceptions of risk; roles and responsibility; experience and knowledge. There were limited changes in parental decision-making factors over the time period despite an increase in uptake. Many studies fail to differentiate between accepters and rejecters, making it difficult to draw out clear conclusions.

CONCLUSION

Policymakers need to adapt information provided to address these concerns. Future research should focus more on distinguishing between accepters and rejecters to determine which factors can alter outcome.

Piezoelectric fiber mats containing polar rod-shaped pigment particles

We prepared electrospun polylactic acid (PLA) fiber mats containing anisometric pigment nanoparticles and demonstrate their converse piezoelectric behavior.

Interaction between saflufenacil and imazethapyr in red rice (Oryza ssp.) and hemp sesbania (Sesbania exaltata) as affected by light intensity

BACKGROUND

Saflufenacil is a broadleaf herbicide for preplant burndown and pre-emergence applications in various crops. This study was established to evaluate the absorption and translocation of saflufenacil in hemp sesbania and imazethapyr in red rice as a function of their post-emergence interaction and light intensity.

RESULTS

Imazethapyr plus saflufenacil provided a greater uptake (30%) and translocation (35%) of (14) C-imazethapyr than imazethapyr alone. In the section above treated leaf (ATL), a higher percentage of the absorbed imazethapyr (23%) was quantified in the imazethapyr plus saflufenacil treatment after 168 h. Faster basipetal movement of imazethapyr was identified under higher light availability. Absorption of (14) C-saflufenacil ranged from approximately 40 to 60% among herbicide and light intensity treatments. At 12 and 24 h after treatment (HAT) a greater percentage (15-20%) of the absorbed saflufenacil was quantified above the treated leaf at the two lower light intensities. Similar trends were observed for basipetal movement of saflufenacil.

CONCLUSION

Saflufenacil enhanced absorption, overall translocation and acropetal movement of imazethapyr in the TX4 red rice. Basipetal movement of imazethapyr was faster under higher light intensities. Overall, imazethapyr improved absorption of saflufenacil in hemp sesbania plants. Reduction in light intensity resulted in greater translocation of saflufenacil, promoting acropetal and basipetal distribution at the two lower light intensity treatments.

Electro-optic technique to study biaxiality of liquid crystals with positive dielectric anisotropy: the case of a bent-core material

We propose that, for materials having positive dielectric anisotropy, the biaxiality can be clearly verified or excluded by measuring the transmitted light intensity as a function of electric field. If the material is biaxial and is observed in homeotropically aligned cells, the schlieren texture should not disappear (transmitted intensity is not zero) even at very high fields, since the field does not affect the distribution of the second director normal to the main director. On the other hand, if the material is uniaxial the transmitted intensity should decrease with increasing field and a perfect homeotropic texture can be achieved at high fields. We have studied a bent-core compound in which a uniaxial-biaxial nematic (N_{u}-N_{b}) transition has been reported. This material has a positive dielectric anisotropy at low frequencies, so we could apply the technique described above. Our studies indicate that the material is uniaxial in the entire nematic range.

Chirality of lipids makes fluid lamellar phases piezoelectric

The role of chirality in membrane-forming lipids is not well appreciated at present. Here we demonstrate that the chirality of phospholipids makes fluid lipid bilayers piezoelectric. Thus, chiral lipids would play a central role in the functioning of cell membranes as active mechanotransducers. By periodically shearing and compressing nonaqueous lamellar phases of left ( L-alpha -phosphatidylcholine), right (D- alpha -phosphatidylcholine), and racemic (DL- alpha -phosphatidylcholine) lipids, we induced a tilt of the molecules with respect to the bilayer's normal and produced electric current perpendicular to the tilt plane, with the chiral lipids only. This effect is due to the Sm-A;{*} phase liquid crystal structure of the bilayers, which under molecular tilt becomes a ferroelectric Sm-C;{*} phase, where the polarization is normal to the tilt plane. This coupling allows for a wide variety of sensory possibilities of cell membranes such as mechanoreception, magnetosensitivity, as well as in-plane proton membrane transport and related phenomena such as adenosine triphosphate (ATP) synthesis, soft molecular machine performance, etc.

Converse flexoelectric effect in a bent-core nematic liquid crystal

Flexoelectricity is a unique property of liquid crystals; it is a linear coupling between electric polarizations and bend and/or splay distortions of the direction of average molecular orientation. Recently it was shown [J. Harden, Phys. Rev. Lett. 97, 157802 (2006)] that the bend flexoelectric coefficient in bent-core nematic liquid crystals can be three orders of magnitude higher than the effect with calamitic (rod-shaped) molecular shape. Here we report the converse of the flexoelectric effect: An electric field applied across a bent-core liquid crystal sandwiched between thin flexible substrates produces a director distortion which is manifested as a polarity-dependent flexing of the substrates. The flex magnitude is shown to be consistent with predictions based upon both the measured value of the bend flexoelectric constant and the elastic properties of the substrates. Converse flexoelectricity makes possible a new class of microactuators with no internal moving parts, which offers applications as diverse as optical beam steering to artificial muscles.

Giant flexoelectricity of bent-core nematic liquid crystals

Flexoelectricity is a coupling between orientational deformation and electric polarization. We present a direct method for measuring the flexoelectric coefficients of nematic liquid crystals (NLCs) via the electric current produced by periodic mechanical flexing of the NLC's bounding surfaces. This method is suitable for measuring the response of bent-core liquid crystals, which are expected to demonstrate a much larger flexoelectric effect than traditional, calamitic liquid crystals. Our results reveal that not only is the bend flexoelectric coefficient of bent-core NLCs gigantic (more than 3 orders of magnitude larger than in calamitics) but also it is much larger than would be expected from microscopic models based on molecular geometry. Thus, bent-core nematic materials can form the basis of a technological breakthrough for conversion between mechanical and electrical energy.

A comparison of transgenic barley lines produced by particle bombardment and Agrobacterium-mediated techniques

Two barley transformation systems, Agrobacterium-mediated and particle bombardment, were compared in terms of transformation efficiency, transgene copy number, expression, inheritance and physical structure of the transgenic loci using fluorescence in situ hybridisation (FISH). The efficiency of Agrobacterium-mediated transformation was double that obtained with particle bombardment. While 100% of the Agrobacterium-derived lines integrated between one and three copies of the transgene, 60% of the transgenic lines derived by particle bombardment integrated more than eight copies of the transgene. In most of the Agrobacterium-derived lines, the integrated T-DNA was stable and inherited as a simple Mendelian trait. Transgene silencing was frequently observed in the T1 populations of the bombardment-derived lines. The FISH technique was able to reveal additional details of the transgene integration site. For the efficient production of transgenic barley plants, with stable transgene expression and reduced silencing, the Agrobacterium-mediated method appears to offer significant advantages over particle bombardment.

Opaque contact lens color choices among women of different ethnic groups

PURPOSE

The opaque contact lens (OCL) market is profitable and expanding. This pilot study sought to identify OCL color preferences among women of three ethnic groups, African American (A), white (W), and Hispanic Americans (H).

METHODS

Sixty-three brown-eyed female subjects (19 A; 22 W; 22 H), 18 to 35 years of age, with uncorrected near visual accuity of at least 20/50 were recruited. Each subject was presented with OCLs of three different color pattern designs in each of four colors (blue, green, gray, and hazel). The subjects viewed their appearance in a mirror while wearing each lens. Once all lenses had been observed, the subjects chose their lens color preference.

RESULTS

Using the nonparametric Kruskal-Wallis test, an ethnic preference was shown for all but the gray contact lenses. In group A 47.4% rated the hazel lens as their first choice whereas 0% chose the blue lens. In contrast, 45.5% of group C chose the blue lens over the other colors but did not favor the hazel lens, which was their first choice only 4.5% of the time. Group H demonstrated the most diversity in color preference, however, 36.4% chose green as their overall lenscolor preference.

CONCLUSIONS

Distinct differences exist in OCL color preferences among the three ethnic groups studied. Improved understanding of this ethnic difference could increase the efficiency of the trial lens process while possibly decreasing inventory costs when one ethnic group dominates a practice patient base.

Endocervical curettage in evaluating abnormal cervical cytology

OBJECTIVE

To determine the role of endocervical curettage (ECC) in the evaluation of women with abnormal cervical cytology and following treatment for cervical intraepithelial neoplasia.

STUDY DESIGN

A retrospective chart review using the records of 2,126 patients who were seen at the Colposcopy Clinic, Baylor College of Medicine, between 1980 and 1995. All patients were referred because of an abnormal cervical smear and underwent repeat Pap smear, colposcopic examination in each case with biopsies as indicated, endocervical curettage and treatment, consisting of either cryotherapy, laser vaporization or a LOOP electrosurgical excision procedure. Following treatment, Pap smears were performed on a scheduled basis, and ECC was performed annually.

RESULTS

The ECC was negative in 1,849 (87%) of the women. It was abnormal in 33% of women with unsatisfactory colposcopy and 10% of women with satisfactory colposcopy. ECC was abnormal in 21% of patients with a negative biopsy result and 42% of patients who did not have a biopsy performed. There was a significant increase in abnormal ECC results with increasing age. ECC had a high positive predictive value for ectocervical disease (86%) and a high negative predictive value for endocervical disease (90%). One year following treatment, < 4% of patients with a negative cervical smear had a high grade lesion detected on ECC.

CONCLUSION

The use of ECC is helpful in detecting disease missed by routine colposcopy and biopsy and is most likely to detect ectocervical disease rather than true endocervical disease. Following treatment, ECC does not appear to be significantly more reliable than the Pap smear in detecting the presence of significant residual disease.

Language, discourse and the chronotope: applying literary theory to the narratives in health care

Language, discourse and the chronotope: applying literary theory to the narratives in health care One of the most significant developments in nursing has been the recognition of the power of the narrative approach. Narrative knowing has evolved from both the patient and the nurse experience. In the case of the individual, it can be told through case history (clinical) and life story (theory-building). The life story of the individual as a patient represents him or her to the nurse and is in turn responded to through appropriate care. Alternatively, the life story of the individual as research participant represents him or her to the researcher and is in turn responded to through appropriate interpretation. The value of the narrative is that the 'otherness' of the teller/writer can be regarded by the listener/reader. There resides a major tension, however, whether in theory building or the practice setting: meaning What this paper argues, is that the emphasis placed on the subject to provide an authentic story of their life is misguided, whether in the care setting or in interpretive research. My contention is that we need to develop a less naive understanding of the complexities of the language with which the individual speaks. This can be achieved by adopting post-structural analyses of the spoken or written word, from both the originator's and recipient's experiences. By reconceptualizing such narratives as 'autobiographies' it is possible to borrow from the field of literary criticism a tool known as chronotopic analysis to perform this task.

Air-tower sprayers increase spray application efficiency in mature citrus trees

Summary. Conventional pesticide spraying in citrus crops with low-profile sprayers results in pest management problems because of the poor distribution of pesticide throughout the tree. Pesticide losses, particularly drift, are a concern with this type of sprayer especially in orchards situated in or near urban areas. The spray deposit on citrus leaves and fruit and off-target losses (canopy run-off and drift) were determined for air-assisted low-profile sprayers and air-assisted sprayers fitted with tower air conveyors (air-towers). The air-tower sprayers produced even distribution of leaf spray deposits through the full height of the tree canopy while the low-profile sprayers produced decreasing leaf spray deposits with increasing height in the trees. The Metters tower sprayer and Cropliner low-profile sprayer resulted in increasing deposits from the 0˚ axis through to the 90˚ axis to sprayer travel while the Barlow tower sprayer and the Hardi low-profile sprayer produced a more even distribution of deposits through the axes to sprayer travel. Fruit deposits were not significantly different between sprayers. The Barlow tower sprayer produced significantly less canopy spray run-off compared with the low-profile sprayers. The Barlow tower sprayer resulted in a significant reduction in spray drift in the above tree zone compared with the Hardi low-profile sprayer. Better distribution of pesticides in citrus tree canopies will improve pest control especially in the top sections of the tree as this is where the greatest increase in pesticide deposit is achieved with air-tower sprayers. Both ground and air contamination from pesticides can also be reduced by using sprayers fitted with air-tower conveyors designed to produce even airflows for the full height of the citrus trees being sprayed.

Enlightenment, empowerment and emancipation: the case for critical pedagogy in nurse education

This paper explores the notion that nurse education is a political activity which is value laden and has multiple social meaning. As long as teachers continue to pursue liberal and andragogical theories of learning, students will fail to develop a critical consciousness. The implications are vast as nursing prepares to enter the next millennium: notions such as the reflective practitioner and the knowledgeable doer feature highly on the profession's educational agenda, both of which implicitly require critical thinking skills. By using Habermas' definition of 'critique' as a framework and Paulo Freire's concept of 'conscientisation' as an educational model, it is argued that nurse teachers can expose the oppressive structures which confine and limit the nursing experience. Only then, when our oppression, both as women and nurses has been recognised, and a critical consciousness achieved, can true humanistic care be given. Through the development of emancipatory nursing actions can the profession stop colluding with the social structures which keep many people and groups in oppressive conditions. We should, in short, be teaching for 'peaceful revolution'.

The effect of catheter type and site on infection rates in total parenteral nutrition patients

Infections pose a major problem in patients receiving total parenteral nutrition. Controversy continues concerning the effect of catheter type (triple-, double-, single-lumen, or pulmonary artery), insertion site (subclavian, internal jugular, or femoral vein), and the incidence of catheter-related infections. We retrospectively studied multi-lumen catheter use for total parenteral nutrition over a 6-month period in 192 patients, a total of 3334 catheter days. Nonintensive care unit catheters were inserted by the Nutrition Support Service, and intensive care unit catheters were inserted by the intensive care unit staff. All catheters were cared for using Nutrition Support Service protocols, with multi-lumen catheters changed every 7 to 10 days and pulmonary artery catheters changed every 4 days. Infections were determined by semiquantitative cultures (> 15 colonies/plate). The incidence of infections for triple-lumen catheters was 5 (subclavian), 17 (internal jugular), and 36% (femoral) respectively; total infection rate for triple-lumen catheters was 10%. Infection rates for pulmonary artery catheters were 4 (subclavian), and 6% internal (jugular site), respectively, the overall infection rate was 5%. There were no differences in infection rates at any site based on catheter type; however, when triple-lumen catheter sites were compared, the differences were significant (p < .001 vs subclavian, chi 2). Catheter duration was 7.8 days (subclavian),, 7.3 days (internal jugular), and 4.6 (femoral) days. These data suggest that the use of multi-lumen catheters for total parenteral nutrition is safe, that there is a benefit associated with the subclavian route, and that the femoral site should be avoided.

Laparoscopic cholecystectomy: anesthesia-related complications and guidelines

Although laparoscopic cholecystectomy is gaining worldwide acceptance, it is associated with some nonsurgical complications. We report the occurrence of massive subcutaneous emphysema, bradycardia, malfunctioning oximeters, pulmonary edema, endobronchial intubation, and the patient falling from the table with change in position during this surgical procedure. Choice of anesthetics, commonly occurring anesthetic complications, and management of these problems during laparoscopic surgery are discussed.

Inpatient participation in treatment planning: a preliminary report

This study investigated the effect of patient participation in treatment planning conferences (TPCs) upon length of hospitalization and upon the frequency of military soldiers being returned to duty. Patients with major affective disorders and schizophrenic disorders showed an 8.2% decrease in hospital stay whereas patients with minor affective disorders, personality disorders, substance abuse, and adjustment disorders showed a 98.8% increase. Additionally, the percentage of active duty soldiers with a major depressive episode who were returned to duty increased significantly when they participated in their TPC.

Haemodialyser reuse: impact on function and biocompatibility

The functional performance (clearance of small molecules, ultrafiltration and blood loss) and biocompatibility (haemodialysis leucopenia) has been studied for disposable flat plate and hollow fibre haemodialysers utilizing Cuprophan membranes on their first use, and compared with that obtained when reusing by a manual and automated technique. The results obtained relating to functional performance remain unchanged with the exception of blood loss which shows an increase compared with first use. Biocompatibility is modified on reuse but only if the membrane has not been exposed to a rinsing process using sodium hypochlorite.

Natural processes in the phonologies of four error-rate groups

Processes involved in the misarticulations of 97 children were used to identify patients associated with error rate. Results indicated that while no processes are unique to subjects with higher error rates, the moderate and high error-rate children either used more processes in unusual ways or overused a few, less-differentiated processes. Groups of intercorrelating processes were determined by factor analysis.

Comparison of glottal area changes as measured from ultrahigh-speed photographs and photoelectric glottographs

To determine the relationship of information on glottal area function provided by deviations sensed by the photoelectric glottograph to that derived from a frame-by-frame analysis of ultrahigh-speed photographic film, simultaneous photographic and glottographic recordings were obtained from five subjects. From the investigation, the following results were obtained: (1) the measurements of the light deviations sensed by the photoelectric glottograph during laryngeal vibrations produced curves that approximated those developed from photographic film frame-by-frame measurements of the visual image in vocal fry, modal, and falsetto voice registers, and (2) the Fourier coefficients of the compared data indicated that there was no significant difference between the curves.