Background: For nurses in hospitals, the presence of close relatives in cardiopulmonary resuscitation (CPR) can be an uncertain experience. In 2015, 91 000 deaths occurred in Sweden, many of them in hospitals. Aim: This study aimed to explain nurses' experiences of relatives' presence at cardiopulmonary resuscitation in hospitals. Method: A literature review based on six qualitative and five quantitative articles was performed. Result: Two main themes, to invite and to not invite, constituted the result with four subthemes. The main theme to invite had two subthemes, good occupational experience and self-confidence. The main theme to not invite comprised likewise two subthemes, insecurity about absent guidelines and worry about relatives' reaction. Conclusion: A majority of the nurses believed that relatives should be present at CPR. Nurses believed that relatives easier could accept their relatives' death if they were able to touch their relative, share the last moments in life and say goodbye. Improvement of guidelines and development work is needed to maintain nurses' positive view of relatives' presence at CPR in hospital settings. To strengthen this, national guidelines are also necessary to assist local guidelines.

BACKGROUND: Late identification of deteriorating children undermines timely implementation of life-saving measures to prevent cardiopulmonary arrest (CPA) or death. The Pediatric Early Warning System (PEWS) has been validated for use in pediatric acute care settings for early identification of children at increased risk of physiologic deterioration, yet there is a dearth of evidence of the use of PEWS in primary care. Implementing the PEWS in primary care could guide rural primary care practitioners to early detection and prompt management of deteriorating children. This DNP project evaluated the attitudes and perceptions of rural practitioners towards the implementation of the PEWS scoring tool. METHODS: A cross-sectional descriptive design was conducted using an anonymous online survey via an email listserv. RESULTS: Seventeen practitioners responded to the survey, but only 14 participants met criteria for inclusion – 2 males and 11 females. The sex of one participant was not reported. Participants areas of specialization include 79% specialized in family practice, 79% pediatric specialists 14% and (7%) listed as "Other." Thirty-one percent of participants reported a travel distance of over 60 miles, while 39% reported a travel distance of over 60 miles lasting over 60 minutes via ground from a place of care to a hospital that specializes in the pediatric emergency care, and pediatric care respectively. Although 92% reported they have not heard of the PEWS tool prior to this survey, 54% strongly agree that the PEWS could help prevent cardiopulmonary arrest or death. Similarly, 54% of respondents reported they strongly agree that the PEWS can help identify deteriorating children, while 39% somewhat agree. Over 62% strongly agree that implementing the PEWS is appropriate in primary care, while 31% somewhat agree. Fifty-four percent of participants strongly agree they could use the PEWS tool in their practice. DISCUSSION: Participants have a positive view of the PEWS tool and perceive implementation of the PEWS to be a vital clinical decision support tool that could lead pediatric primary care providers to early detection of deteriorating children before the occurrence of an adverse event. Further study could determine the generalizability of implementing the PEWS in primary care.

The purpose of this study was to compare the relationship between immersion running and treadmill running through the measurement of cardiorespiratory parameters. Sixteen subjects completed two exercise protocols to exhaustion. The treadmill running protocol was initiated at 3.08 m*s-l and increased a 0.22 m*s-l every sixty seconds. The immersion running protocol utilized an immersion running Ergometer (IRE). The IRE is similar to a tethered swim machine. The initial weight was set at 1 kg and Increased a 1/2 kg every sixty seconds. Heart rate (HR), oxygen consumption (V02), ventilatory equivalent (VE/V02), and minute ventilation (VE) were determined at ventilatory threshold and at maximal effort, HR, V02, VE/V02 and VE were analyzed by MANOVA (RM). Tidal volume and frequency of breathing were collected for four subjects at ventilatory threshold and at maximal effort (no statistical analysis). Two subjects who had completed the initial exercise protocols volunteered for a follow up study of blood flow distribution testing (no statistical analysis). These subjects were injected with Tc-99 2-methyloxy isobutyl isonitrlle at ventilatory threshold during immersion and treadmill running. Imaging was performed with a Selmans Gamma Camera at the UBC Dept. of Nuclear Medicine. V02 and HR at ventilatory threshold and maximal effort were significantly lower (P < .05) during immersion running. VE/V02 was significantly greater at maximal effort during immersion. Minute ventilation was unaffected by immersion, however, there was a trend towards a smaller tidal volume and greater frequency of breathing. The blood flow distribution data varied considerably partially between subjects. The significant drop in V02 at maximum effort and at ventilation threshold during immersion running may be accounted for by changes in muscle mass recruitment, muscle fibre type recruitment, recruitment pattern and state of peripheral adaptation (muscular). A lower heart rate during immersion may be due to increases in intrathoracic blood volume. The trend towards a higher breathing frequency and lower tidal volume during immersion running may be due to the increased effort to breath caused by hydrostatic chest compression. The significant increase in VE/V02 at maximal effort during immersion running was due to the significant drop in V02. It may be concluded that immersion running causes significant changes in cardiorespiratory parameters at ventilatory threshold and at maximal effort. Research is needed to investigate the significance of the changes. / Education, Faculty of / Curriculum and Pedagogy (EDCP), Department of / Graduate

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23071号 / 医博第4698号 / 新制||医||1049(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊達 洋至, 教授 YOUSSEFIAN Shohab, 教授 平井 豊博 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20965号 / 医博第4311号 / 新制||医||1026(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊達 洋至, 教授 平井 豊博, 教授 江藤 浩之 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21263号 / 医博第4381号 / 新制||医||1029(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 柳田 素子, 教授 福田 和彦, 教授 木村 剛 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Background: Heparin-induced thrombocytopenia (HIT) is an iatrogenic immune-mediated prothrombotic disorder that is a direct consequence of heparin therapy. In HIT, antibodies are generated against complexes of platelet factor-4 (PF4) and heparin. Immunoglobulin G (IgG) antibodies bind to PF4/heparin complexes and cause Fc-receptor-mediated activation of platelets and monocytes. PF4 binds endogenous heparin-like polyanions to reveal cross-reactive epitopes that can also bind anti-PF4/heparin antibodies. Based on this observation, researchers have suggested that exposure to PF4/polyanion complexes can sensitize immune cells to become activated to produce HIT antibodies following iatrogenic heparin exposure. Research objective: The objective of this study is to determine whether the preoperative PF4-dependent immune response is associated with postoperative anti-PF4/heparin antibody production in a cohort of patients undergoing cardiopulmonary bypass surgery. Materials and methods: To assess the preoperative immune response to PF4, we utilized two assays: (1) a 3H-thymidine uptake assay to measure peripheral blood mononuclear cell (PBMC) proliferation in response to in vitro stimulation with PF4 and (2) a PBMC ELISPOT assay to measure the preoperative frequency of PF4-specific antibody-secreting cells. Proliferation was quantified as a stimulation index (SI). We then utilized a PF4/heparin-dependent enzyme immunoassay to measure the in vivo levels of anti-PF4/heparin antibodies produced by these patients in the postoperative period. Results: Our findings suggest that preoperative PF4-dependent proliferation is not associated with postoperative polyspecific anti-PF4/heparin antibody production [Spearman’s ρ (95% CI) = –0.02 (–0.32, 0.28), P = 0.91]. PF4-dependent proliferation had a weak negative association with postoperative anti-PF4/heparin IgG antibody production [Spearman’s ρ (95% CI) = –0.31 (–0.56, –0.02), P = 0.04], but was not associated with postoperative IgM or IgA anti-PF4/heparin antibody production [IgM: Spearman’s ρ (95% CI) = –0.04 (–0.33, 0.26), P = 0.78; IgA: Spearman’s ρ (95% CI) = –0.05 (–0.34, 0.25), P = 0.73]. Qualitative analysis demonstrated that two patients who had the strongest preoperative PF4-dependent proliferation responses produced the highest postoperative levels of anti-PF4/heparin IgM antibodies, but this relationship was not observed with postoperative anti-PF4/heparin IgG antibodies. Moreover, the preoperative frequency of PF4-specific antibody-secreting cells (ASCs) was also not associated with postoperative levels of anti-PF4/heparin IgM or IgG antibodies [IgM: Spearman’s ρ (95% CI) = 0.30 (–0.79, 0.93), P = 0.683; IgG: Spearman’s ρ (95% CI) = –0.21 (–0.92, 0.83), P = 0.600]; however, this was only completed on five patients and so the sample size should be increased before any meaningful conclusions can be drawn. We also demonstrated that PF4-dependent proliferation increases 5–6 days following cardiopulmonary bypass surgery [geometric mean (GM) postoperative PF4 alone proliferation (in SI) vs. GM preoperative PF4 alone proliferation (in SI) ± SEM: 23.7 ± 1.3 vs. 6.9 ± 1.5, P = 0.009]. Conclusions: Based on our findings, we conclude that preoperative PF4-dependent proliferation is unable to predict postoperative anti-PF4/heparin antibody production in this cohort of cardiopulmonary bypass patients. Due to the small sample size, we are unable to make conclusive statements regarding the relationship between preoperative PF4-specific ASC frequency and postoperative anti-PF4/heparin antibody production, but our findings would suggest that an association does not exist between these two variables in this patient cohort. Cardiopulmonary bypass surgery, however, may mobilize the postoperative immune cell repertoire to become activated against the self-protein PF4 and may therefore contribute to the postoperative HIT immune response. / Thesis / Master of Science (MSc) / Background: Heparin-induced thrombocytopenia (HIT) is an immune-mediated disorder that is a direct consequence of heparin therapy. In HIT, antibodies are generated against complexes of platelet factor-4 (PF4) and heparin. Antibodies bind to PF4/heparin complexes and cause activation of platelets and monocytes. Researchers have suggested that exposure to PF4/polyanion complexes can sensitize immune cells to become activated to produce HIT antibodies following iatrogenic heparin exposure. Research objective: The objective of this study is to determine whether the preoperative PF4-dependent immune response is associated with postoperative anti-PF4/heparin antibody production in a cohort of patients undergoing cardiopulmonary bypass surgery. Materials and methods: To assess the preoperative immune response to PF4, we measured cellular proliferation in response to PF4 stimulation and the preoperative frequency of PF4-specific antibody-secreting cells. We also measured the level of anti-PF4/heparin antibodies following surgery. Results: Our findings suggest that preoperative PF4-dependent proliferation is not associated with postoperative anti-PF4/heparin antibody production. Moreover, the preoperative frequency of PF4-specific antibody-secreting cells (ASCs) was also not associated with postoperative levels of anti-PF4/heparin antibodies; however, this was only completed on five patients and so the sample size should be increased before any meaningful conclusions can be drawn. We also demonstrated that proliferation increases 5–6 days following cardiopulmonary bypass surgery. Conclusions: Based on our findings, we conclude that preoperative proliferation is unable to predict postoperative anti-PF4/heparin antibody production in this cohort of patients. Due to the small sample size, we are unable to make conclusive statements regarding the relationship between preoperative ASC frequency and postoperative anti-PF4/heparin antibody production. Cardiopulmonary bypass surgery, however, may mobilize the postoperative immune cell repertoire to become activated against the self-protein PF4 and may therefore contribute to the HIT immune response.

No description available.

All forms of exercise equipment require a period of habituation in which individuals adapt to the novel movement required in operating the device and reach a point of physiological stability. During this adaptation period, physiological variables which indicate cardiopulmonary demand typically will change. In general, such changes are expected with devices that require complex movements. The influence of this habituation on physical performance is vital for establishing research methodology in which precise control of power output is necessary. The StairMaster® corporation has recently introduced the CrossRobics™ 2650UE (2650UE), an ergometer which simulates the kayak stroke pattern. In contrast to bicycle and arm crank ergometers, with which the user follows a set motion, the 2650UE allows the user to adopt a variety of movement patterns. To determine responses during habituation to the 2650UE, 14 female and 12 male subjects (18-32 years of age) were monitored during their first four exercise trials. Each session was 10 min long at a constant load of 0.36 watts/kg ± 0.02SD and 0.55 watt/kg ±0.02SD for female and male subjects, respectively. Significant differences (p<O.OOI) were found for V02, -.vO₂, -.vE, HR and RPE across the four trials, with decreases of 6.3% to 9.5% from the mean values in trial 1 to trial 2. Post hoc analysis indicates that a minimum of two 10 min practice trials are required for measures of oxygen consumption to stabilize, whereas one 10 min practice trial is required for measures of-.v E, HP and RPE to stabilize. / Master of Science

The design of a microcomputer-based monitoring and display system for a cardiopulmonary bypass loop is discussed. Analog signals representing blood temperature and oxygen saturation of sample points entering and leaving the blood oxygenator, patient temperature, oxygenator heat exchanger water temperature and hemoglobin content are monitored and displayed. The hemoglobin content and oxygen saturation signals, input from a reflective-type hemoglobin meter and oximeter are corrected for blood temperature and operator input pH. The oxygen saturation is also corrected for hemoglobin content. Oxygen transfer to the patient is calculated and displayed to evaluate the effectiveness of the system in cardiopulmonary support. Alarms are issued for free gas in blood, no blood flow, and high oxygenator water temperature. The hardware and software design is described along with schematics and flowcharts. A complete software listing is included. The monitoring and display system is operational, but has not been tested with flowing blood. / M.S.