Thesis (M.Sc.(Anatomy))--University of Pretoria, 2009. / Includes bibliographical references.

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Critically ill patients in an intensive care unit (ICU) often require mechanical ventilation (MV). Humidification systems are essential devices for MV which replace the natural heat and moisture exchange process of inspired gases. A heat and moisture exchanger (HME) is commonly used for the humidification of MV patients in ICU. In contrast, a heated humidifier (HH) that is a more complicated device is used only for prolonged MV patients because of its higher cost and nurse workload. However, HME may increase the breathing workload of patients, thereby inflicting damage to their respiratory function, especially among respiratory failure patients. However, there was no evidence-based guideline that instructs nurses on choosing humidification devices in ICU. This dissertation aimed to 1) evaluate the current evidence and formulate evidence-based guideline in selecting a humidification device for mechanically ventilated acute respiratory distress syndrome (ARDS) patients in reducing the risks of breathing workload; 2) assess its implementation potential, as well as its feasibility and transferability; and 3) develop implementation strategies and evaluation plans for the use of this device in an adult ICU. Three electronic databases, namely, Proquest, Ovid, and Google Scholar, were searched for randomized controlled trials (RCTs) of humidification systems for MV. Eight articles were retrieved. Their reference lists were read and found two additional RCT. Four high-quality RCT showed that HH increased the breathing workload more than HME. Several studies showed that HME has potential drawbacks of significantly increase airway resistance, minute ventilation, CO2 retention, and respiratory discomfort. However, studies showed that no significant difference of ventilator-associated pneumonia (VAP) rate between HME and HH. The initial application of HME is safer and less costlyl. However, prolonged use of HME in ARDS patients may induce further workload on the respiratory system and worsen treatment progress. An evidence-based clinical guideline in choosing the humidification system was formulated and assessed using the appraisal instruments of Scottish Intercollegiate Guideline Network. It is deemed to be transferable with patient characteristics, clinical situation, and organizational infrastructure similar to studies evaluated the suggested innovation. Feasibility was also assessed and is considered to be high. The setup and running cost per year were HKD17450 and HKD6600. Although the humidification system had no actual cost reduction, non-material benefits such as prevention of tube blockage, reduction in breathing workload, and respiratory discomfort were more important than the cost. An implementation plan including a one-month communication plan with stakeholders and one-month pilot testing were developed. The evaluation of the guideline will last for 10 months. The effectiveness of the innovation will be determined by the reduction in breathing workload, cost and benefit ratio, and staff satisfaction level. / published_or_final_version / Nursing Studies / Master / Master of Nursing

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Recently, there has been extensive research in the area of diagnostic expertise. The model of diagnostic reasoning and clinical expertise has been well documented (Patel et al., in press). This study attempts to extend this research in order to include therapeutic reasoning. Using the expert-novice paradigm, this study attempts to investigate the use of knowledge, specifically, both biomedical and clinical sciences, and the directionality of reasoning during decision making about patient management and therapeutic planning in respiratory medicine. / Subjects at four levels of expertise were given two clinical problems with the diagnosis and asked (a) to provide therapeutic plans, and (b) describe the underlying pathophysiological explanations of the diseases. Think-aloud protocols were audio-taped and analyzed using methods of protocol analysis. The results showed that the use of basic medical sciences increased as a function of expertise in the procedure-oriented decision-making tasks. The novices generated rule-based prototypical textbook descriptions based on the clinical information, and the diagnosis given in the task. In contrast, the experts' therapeutic responses showed a predominance of causal-level inferences, reflecting more backward-directed inferences than novices. Although both the novices and experts generated forward-directed inferences, the novices were unable to provide accurate and adequate explanations for their decisions. Finally, the pathophysiological explanations of the disease were generated from a different knowledge source than that used to develop therapeutic decisions. / The implications of these findings for development of theory of expertise and for education in the medical domain are discussed.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 / Optimal ventilation of the lungs is essential to the function of the human body. Our lungs can be expanded and contracted by the elevation and depression of the ribs. This causes an increase and decrease of the anteroposterior diameter of the chest cavity and the lungs are then expanded by raising the rib cage. There are several different dysfunctions which the ribs are subjected to. These dysfunctions consist of restrictions in either inhalation or exhalation and are associated with increased tone of the intercostals muscles between the ribs. Therefore, if the chest wall movement is restricted in any way, this will cause decrements in pulmonary function and exercise capacity. Furthermore, there is a significant increase in oxygen cost associated with external chest wall restriction, which is directly related to the level of chest wall restriction. Mobilization of the ribs aims to restore mobility and function but no investigations into the immediate effect of rib mobilization on chest wall expansion and lung function have been conducted. Therefore this study aimed to test whether chest wall expansion and therefore lung function can be influenced in ten minutes following a mechanical intervention.

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<I>Moraxella catarrhalis</I> is a gram-negative diplococcus which until recently was thought to be a harmless commensal. Increasing awareness has established the pathogenic nature of this organism and it is now recognised as a major cause of otitis media in children, exacerbations of chronic bronchitis in elderly patients and an occasional cause of invasive disease. <I>M. catarrhalis</I> is spread nosocomially especially in respiratory wards containing elderly patients. This study evaluated four methods for typing nosocomially spread isolates:- immunoblotting with normal human serum (NHS), and three DNA fingerprinting methods. The most discriminatory method found was restriction endonuclease analysis (REA) using <I>Taq</I> I, although immunoblotting with NHS and pulsed-field gel electrophoresis (PFGE) using <I>Sma</I> I sub-divided isolates grouped together by the other methods. PFGE using <I>Not</I> I only confirmed groupings made by other methods. A study of <I>M. catarrhalis</I> and phenotypically similar organisms was performed using comparisons of partial 16S rDNA sequence. 16S rDNA of <I>M. catarrhalis</I> strains from disparate geographical locations was found to be extremely conserved <I>M. catarrhalis</I> 16S rDNA was very similar to that of other <I>Moraxella</I> species whilst <I>Moraxella</I> species were found to be generally distinct from the <I>Neisseria</I> and <I>Kingella</I> species studied. These results confirm <I>M. catarrhalis</I> as a genuine member of the <I>Moraxellae</I>.

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