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PubMed2005

Transfusion-related acute lung injury: lack of recognition because of unawareness of this complication?

BACKGROUND AND OBJECTIVE: Transfusion of blood components can trigger immunological reactions which may result in a transfusion-related acute lung injury (TRALI). The reported incidence is low; however, there is increasing evidence that the true incidence of this complication may be much higher. One reason for underdiagnosing TRALI could be a deficiency of knowledge about this complication. Therefore, we studied the level of knowledge concerning TRALI among clinicians working on intensive care units (ICU) of an university teaching hospital. METHODS: A total of 65 clinicians were asked to complete a confidential questionnaire designed to evaluate their knowledge about incidence, pathophysiology, clinical symptoms, therapy and outcome of TRALI. This questionnaire consisted of 13 questions which could be assessed by 'yes', 'no' or 'do not know'. RESULTS: Only 42 +/- 18% (mean +/- SD) of all answers were correct, while 33 +/- 17% were wrong and 25 +/- 8% unanswered ('do not know'). The 95% confidence interval for the correct answers was 30.8-53.8% implying that there was no significant difference compared to the probability of arbitrary guessing (33.3%). CONCLUSIONS: Our survey uncovered a marked deficit of knowledge about TRALI suggesting that the low reported incidence of this complication may be in part due to a lack of awareness for TRALI. We conclude that training programmes for clinicians should alert them to the symptoms, diagnosis and treatment options of TRALI.

Blood Component Transfusion↗
PubMed2004

Estimating core temperature in infants and children after cardiac surgery: a comparison of six methods.

BACKGROUND: Monitoring temperature in critically ill children is an important component of care, yet the accuracy of methods is often questioned. Temperature measured in the pulmonary artery is considered the 'gold standard', but this route is unsuitable for the majority of patients. An accurate, reliable and less invasive method is, however, yet to be established in paediatric intensive care work. AIM: To determine which site most closely reflects core temperature in babies and children following cardiac surgery, by comparing pulmonary artery temperature to the temperature measured at rectal, bladder, nasopharyngeal, axillary and tympanic sites. METHOD: A convenience sample of 19 postoperative cardiac patients was studied. INTERVENTIONS: Temperature was recorded as a continuous measurement from pulmonary artery, rectal, nasopharyngeal and bladder sites. Axillary and tympanic temperatures were recorded at 30 minute intervals for 6 1/2 hours postoperatively. STUDY LIMITATIONS: The small sample size of 19 infants and children limits the generalizability of the study. RESULTS: Repeated measures analysis of variance demonstrated no significant difference between pulmonary artery and bladder temperatures, and pulmonary artery and nasopharyngeal temperatures. Intraclass correlation showed that agreement was greatest between pulmonary artery temperature and temperature measured by bladder catheter. There was a significant difference between pulmonary artery temperature and temperature measured at rectal, tympanic and pulmonary artery and axillary sites. Repeated measures analysis showed a significant lag between pulmonary artery and rectal temperature of between 0 and 150 minutes after the 6-hour measurement period. CONCLUSIONS: In this study, bladder temperature was shown to be the best estimate of pulmonary artery temperature, closely followed by the temperature measured by nasopharyngeal probe. The results support the use of bladder or nasopharyngeal catheters to monitor temperature in critically ill children after cardiac surgery.

Analysis of Variance↗
PubMed2002

Effects of normal saline on endotracheal suctioning.

This study was designed to determine the effects of saline solution administered prior to endotracheal suctioning by nurses working in intensive care on oxygenation, heart rate and long-term pulmonary hygiene. The study was carried out on an experimental basis in the Intensive Care Unit of a university hospital in Turkey. A total of 20 patients were included, who were mechanically ventilated because of pulmonary or cardiovascular problems or trauma. Data were collected using a data form. Each patient was monitored for 5 minutes following suctioning with or without saline solution and findings of heart rate, SpO2, and blood gas measurements were recorded. Data were analysed using percentage calculations, the student's t-test and the Friedman test. The study showed that most of the patients were between 60 and 69 years and were intubated because of respiratory insufficiency. Evaluation of blood gases following suctioning with or without saline solution showed partial decreases in pO2, pCO2, HCO3, and oxygen saturation (SaO2), which did not reach a significant level. No significant difference was found between pH levels recorded prior to and 5 minutes after suctioning without saline solution; however, the increase in pH following suctioning with saline solution was significant. Patients undergoing suctioning with saline solution exhibited significantly increased heart rates in the fourth and fifth minutes, whereas no increases were detected in these undergoing suctioning without saline solution. SpO2 values obtained by pulse oxymeter did not show significant differences. Saline solution administered with suctioning resulted in undesirable, although not significant, alterations in oxygen saturation and arterial blood gas levels.

Adult↗
PubMedDate not supplied

Twelve-hour shift on ITU: a nursing evaluation.

This paper describes the introduction and subsequent evaluation of a 12-h shift system in a large ITU in the northeast of UK. To date, only a small number of studies has evaluated nurses working the 12-h shifts in critical care areas. To evaluate the level of staff satisfaction, data were collected by means of a questionnaire involving 41 nurses, at 3 months following the introduction of the 12-h shifts. The responses from the evaluation advocated the continuation of 12-h shifts with alternative shift patterns for nurses who felt dissatisfied with the current system. Twelve-hour shifts can be seen as a flexible system for nurses working in intensive care and may assist with staff satisfaction and improving nurse recruitment and retention.

Attitude of Health Personnel↗
PubMed2000

Tumour marker measurements in the diagnosis and monitoring of breast cancer.

Elevation of established blood tumour markers correlates with the stage of breast cancer. The major role of current blood markers is therefore in the diagnosis and monitoring of metastatic disease. A combination of markers is better than a single marker with the most widely adopted combination being CEA and one MUC1 mucin, commonly detected as either CA15.3 or CA27.29. Tumour marker measurement is now used as a complementary test in the diagnosis of symptomatic metastases. In the monitoring of therapeutic response to both endocrine and cytotoxic therapies in advanced disease, biochemical assessment using blood markers not only correlates with conventional UICC criteria but has a lot of advantages which make it a potentially superior way of assessment. In this regard, CA15.3, CEA and ESR are the best validated combination. Studies are ongoing to evaluate the use of sequential blood tumour marker measurements in the follow-up of patients after treatment for their primary breast cancer, in terms of both early detection and early therapeutic intervention. Further randomized studies are also required to ascertain that marker-directed therapy is superior to the current practice for metastatic disease. In line with clinical studies, intensive laboratory work is being carried out to optimize the use of blood markers in advanced disease as well as to exploit their use in screening and diagnosis of early primary breast cancer.

Biomarkers, Tumor↗
PubMed2001

[Immunisation rates of routine vaccinations for school starters as a quantitative measure in the vaccination behaviour].

The aim of this retrospective long-term investigation was to compare the recommended routine vaccinations for school starters in the region of Dingolfing-Landau, recording the results separately by birth years and comparing these with one another. It was to show to what extent changes in the quantitative measures in the vaccination behaviour were recorded over a period of one decade, respectively to what extent the current recommendations of any one time of the STIKO (Permanent Vaccination Commission of the Robert Koch-Institute) were reflected within each age group. For this purpose during the annual standardised examinations of school starters the rates of vaccinations were recorded according to the various birth years and sex, determined and anonomously evaluated. It was found that of the total eleven examined birth years the vaccinations in series of BCG was reduced continually from a commencing 50 % plus to under 10 %. Regarding vaccinations against diphtheria, tetanus and polio the frequency for the total examined period commenced at a rate of under 90 %, increasing to over 90 % for the birth years of 1989 and beyond. No child of the birth year of 1984 was completely vaccinated against HiB, whereas the rate of vaccinations rose relatively quickly so that by the birth year 1994 over 90 % of the school starters were completely immunised against this infectious disease. As far as the pertussis and MMR vaccinations were concerned the rate at the beginning of the observation period was between 40 % and 60 %, increasing continually in the following period to over 80 %. By the middle 'eighties hardly any school starters had been vaccinated against hepatitis B, whereas, in the last five examined birth years the rate increased relatively quickly to 64 % maximum. At the beginning of the observed period nearly every fifth school starter had, age related, complete vaccination protection, in respect of the then valid STIKO recommendations. At the end of this decade this applied only to every twelfth child. Due to the high rates of participation of school starters examinations carried out by the Public Child and Youth Health Service it is possible to determine the vaccination rates of children as it relates to the routine vaccinations carried out over a longer period and on a topical basis. As a result the vaccination behaviour, respectively the willingness of a relevant target group during that period can be shown quantitatively. As the investigations of the RKI (Robert Koch-Institute) have shown, the share of the strict opponents of vaccinations is merely between 1.5 % and 5 % resulting in the necessity for intensive educational work and the development of effective vaccination strategies which are needed in order to stabilise the rates of vaccinations, respectively to meet epidemiological requirements at a high level and to further improve the present rate.

Child↗
PubMed1999

Current practice of peri- and postoperative antibiotic therapy in cardiac surgery in Germany. Working Group on Cardiothoracic Surgical Intensive Care Medicine of the German Society for Thoracic and Cardiovascular Surgery.

BACKGROUND: The increasing development of antimicrobial resistance of common bacterial pathogens presents one of the most significant challenges to clinical medicine, particularly intensive care medicine. One factor which has contributed to this development is the (over)use of antibiotic treatment. Therefore the objective of this study was to scrutinize the current practice of empiric antibiotic therapy in cardiac surgery in Germany for 1) perioperative prophylaxis and 2) postoperative therapy prior to the availability of susceptibility patterns for the infecting pathogen. METHODS: A questionnaire was sent to all centers performing cardiac surgery in Germany. Questions referred to drugs used as well as dosage, homogeneity and duration of antibiotic prophylaxis, time and/or reason for changing this regimen, drugs used for first-, second-, and third-line empiric postoperative antibiotic treatment, and homogeneity of antibiotic usage. RESULTS: All but 3 institutions (96.3%) answered. 1. Perioperative prophylaxis: All but 4 centers (94%) use first- (n = 32 = 43%) or second-generation cephalosporins (n = 38 = 51%) most commonly for 24 hours (n = 60 = 81%). Prophylaxis never exceeds 3 days. 74% of all institutions (n = 55) use the same antimicrobial agent for all cardiac procedures performed, while 26% (n = 19) change their regimen in selected patient groups, most commonly for heart transplantation. The entire prophylaxis is changed mainly according to susceptibility patterns (n = 63 = 85%), 7 centers (10%) change according to a fixed time schedule, while 4 institutions (5%) never change the antimicrobial drug. 2. Empiric postoperative therapy: A total of 29 different antibiotics out of 8 subclasses are used. No major differences between 1st-, 2nd-, and 3rd-line therapy could be detected, with the exception of a decreasing usage of beta-lactams (carbapenems excluded) from 60% in 1st-line to 23% in 3rd-line therapy and an increasing usage of glycopeptides from 5% in 1st-line to 18% in 3rd-line therapy. 41 institutions (55%) use the same antibiotic regimen on the intensive care unit and the normal ward, 9 centers (12%) use the same drug for perioperative prophylaxis and postoperative therapy, and 12 institutions (16%) prescribe a combination therapy. CONCLUSIONS: Perioperative prophylaxis in cardiac surgery in Germany is performed on a relatively uniform basis and at low cost. The heterogeneity of antibiotic regimens for postoperative therapy may indicate the need for recommendations and/or guidelines for this type of treatment. The indications for the usage of reserve antibiotics, e.g. vancomycin, implying the possible risk of creating pathogens with untreatable resistance patterns, as well as strategies aimed at preventing the development of resistance should be the subject of further discussions.

Antibiotic Prophylaxis↗
PubMed1992

Altitude training and muscular metabolism.

To study the effects of training at moderate altitude on muscle metabolism; we defined the lowest altitude which affected the aerobic capacity in man, and we studied the differences between training at an altitude of 2300 m and at sea level, both at the same relative (to the VO2max) and absolute intensity of work. We confirmed that at 1200 m the VO2max is decreased in sedentary and well-trained persons. Elite athletes already at 900 m decrease their VO2max. We have found an increase in myoglobin, oxidative enzyme activities and endurance capacity and a decrease in some glycolytic enzyme activities associated with simulated altitude training. We conclude that when the amount of training performed at altitude is similar to the amount at sea level, the stimulus of hypoxia associated with the training stimulus induces improvements in the muscle oxidative enzymes and myoglobin.

Adaptation, Physiological↗
PubMed1991

[Histochemical identification of endogenous lectins using labelled neoglycoproteins in human head-and-neck squamous cell carcinoma].

According to the "Population-based cancer register" of the Federal Republic of Germany only malignant neoplasms of the buccal cavity, the pharynx and larynx as well as cancers of the respiratory tract show an increasing rate of incidence and mortality. The molecular mechanisms and etiological factors causing this phenomenon are still little understood despite intensive research work. Recognition between receptors on a cellular level may be mediated by specific amino acid sequences on the level of protein-protein recognition. Additionally, the interactions between cell sugars and the corresponding protein receptor may play a decisive role in development, regeneration and organisation of cells and tissue. The high specificity of the binding of biotinylated neoglycoproteins in tissue sections enables to detect glycohistochemically binding sites for the carbohydrate ligands of the glycosylated carrier protein. The evidence of lectins in squamous cell cancer of the oral cavity, oropharynx, larynx, and hypopharynx has not been established so far. Squamous cell cancer tissue samples of twelve patients with different tumour locations were investigated by incubation of sections of paraffin-embedded samples and application of an avidin-biotin-peroxidase complex for visualisation with synthetic biotinylated neoglycoproteins. Altogether 168 stained sections were evaluated including controls. Pronounced cytoplasmatic staining was seen with the following neoglycoproteins: sialic acid-bovine serum albumin (BSA), glucuronic acid-BSA, N-acetylglucosamine (glcNAc)-BSA, N-acetylgalactosamine (beta-galNAc)-BSA, lactose-BSA, maltose-BSA, mannose-BSA, mannose-6-phosphate-BSA. No corresponding lectins seems to exist for the following investigated sugars: fucoidan, heparin, and the alpha-anomeric form of N-acetylgalactosamine, because no specific staining was seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Biotin↗
PubMed1988

Cardiocirculatory, hormonal, and metabolic reactions to various forms of ergometric tests.

The sympathoadrenergic reaction is not only dependent on the duration and intensity of work but also on the body position and the involvement of small or large muscle masses. This observation made in field tests comparing different sports disciplines such as swimming, running, or diving encouraged us to investigate this topic under the following laboratory conditions. Twelve healthy sport students participated in ergometric tests on a bicycle ergometer in a horizontal and vertical body position as well as on a treadmill and a swim bench ergometer. The changes of plasma catecholamines (CA) obtained in the different ergometric tests were compared with those cardiocirculatory, metabolic, and hormonal parameters which can be influenced by the sympathoadrenergic stimulation. In the horizontal body position we found a smaller increase of norepinephrine at submaximal and maximal work loads combined with a similar reaction of renin, whereas the diastolic blood pressure and the mean arterial blood pressure increased more. The substrates of lipolysis and aerobic and anaerobic glycolysis did not show obvious differences depending on the body position. In the swim bench test, however, the lactate increase started earlier and was comparatively higher than in the other ergometric tests in which the maximal work load and VO2max were higher. Although a smaller muscle mass was used and a lower maximal oxygen uptake was reached, we did not find statistically different CA values during the swim bench ergometric test compared with the bicycle ergometric test in a horizontal body position. In our ergometric tests, the venous CA levels (especially norepinephrine) were predominantly influenced by the body position.

Adult↗
PubMed2003

Allergic and nonallergic forms of atopic diseases.

Atopic dermatitis, allergic rhinitis, and asthma are atopic diseases that develop on a complex genetic background, the so-called atopic diathesis. Although they target different organs, in most patients they are characterized by the presence of elevated total serum IgE levels. However, a subgroup of atopic patients exhibits normal IgE levels and mechanisms contributing to the so-called "intrinsic" or "nonallergic form" have been the matter of intensive research work in the last years. Because of the rapid advancements in the research field of atopic diseases, it now becomes possible for the first time to delineate a new disease classification of allergic and nonallergic subtypes of atopic diseases, thereby bringing hope to the clinician for a more specific treatment approach for each subgroup of these patients.

Animals↗
PubMed2003

Unraveling the mission of FcepsilonRI on antigen-presenting cells.

A decade ago, the discovery of the high-affinity receptor for IgE (FcepsilonRI) on epidermal Langerhans cells documented the end of the dogma that FcepsilonRI is only expressed on effector cells of anaphylaxis. Since then, the functional significance of this receptor on antigen-presenting cells (APCs) has been an area of intense research work. Scientists have focused on a better understanding of the molecular structure, regulation, and role of FcepsilonRI on APCs in the human immune system. Insights into the cellular events linked to the activation of APCs on ligation of FcepsilonRI by IgE and allergens might provide the basis for new aspects in the pathophysiology of allergic diseases and the design of future diagnostic and therapeutic strategies. This review is dedicated to the 10th anniversary of the discovery of FcepsilonRI on APCs and describes the numerous areas of research in this field.

Antigen-Presenting Cells↗
PubMed2001

Understanding adherence to hand hygiene recommendations: the theory of planned behavior.

BACKGROUND: Most health care workers (HCWs) are aware of the rationale for hand hygiene procedures, yet failure to adhere to guidelines is common. Little is known about factors that motivate HCWs to practice hand hygiene. PURPOSE: The purposes of this study were to (1) estimate adherence to hand hygiene recommendations; (2) describe relationships among motivational factors, adherence, and intensity of nursing unit activity; and (3) test an explanatory model for adherence to hand hygiene guidelines based on the theory of planned behavior (TPB). METHOD: A longitudinal, observational design was used to collect data from 120 registered nurses employed in critical care and postcritical care units. Nurses provided information about motivational factors and intentions and a self-report of the proportion of time they followed guidelines. At least 2 weeks later, the nurses' hand hygiene performance was observed while they provided patient care. Structural equation modeling was used to test the TPB-based model. RESULTS: Rate of adherence to recommendations for 1248 hand hygiene indications was 70%. The correlation between self-reported and observed adherence to handwashing recommendations was low (r = 0.21). TPB variables predicted intention to handwash, and intention was related to self-reported hand hygiene. Intensity of activity in the nursing unit, rather than TPB variables, predicted observed adherence to hand hygiene recommendations. CONCLUSIONS: The limited association between self-reported and observed hand hygiene scores remains an enigma to be explained. Actual hand hygiene behavior may be more sensitive to the intensity of work activity in the clinical setting than to internal motivational factors.

Attitude of Health Personnel↗
PubMed2002

The HIV/AIDS pandemic: a sign of instability in a complex global system.

Intense scientific work on HIV/AIDS has led to the development of effective combination drug therapies and there is hope that effective vaccines will soon be produced. However, the majority of people with HIV/AIDS in the world are not benefiting from such advances because of extreme poverty. This article focuses on the pandemic as a reflection of a complex trajectory of social and economic forces that create widening global disparities in wealth and health and concomitant ecological niches for the emergence of new infectious diseases. While the biomedical approach to HIV/AIDS is necessary, has prolonged the lives of many individuals and could offer much at the level of population health, it cannot, in isolation, improve the health of populations. To achieve the latter will require understanding and addressing the deeper social causes of pandemics. Broadening the discourse on ethics to include public health ethics and the ethics of international relations could contribute to reducing the impact of the pandemic and to preventing the emergence of new infectious diseases in the future.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Changes in oxidative stress markers and NF-kappaB activation induced by sprint exercise.

This study was aimed to investigate changes in blood markers of oxidative damage induced by short-term supramaximal anaerobic exercise and to determine whether oxidative stress was associated to activation of the redox-sensitive transcription factor nuclear factor-kappaB (NF-kappaB). Both a single Wingate test (WAnT) test and series of four WAnTs separated by 60 min rest intervals were carried out by eight professional cyclists. Leukocyte 8-OH-2-deoxyguanosine levels were significantly elevated 24 h after both exercise protocols. A significant decrease in blood reduced glutathione (GSH) concentration was observed immediately after and at 15, 60 and 120 min of the single WAnT, followed by a return to basal value after 24 h. This decrease was parallel to a significant increase of the oxidised/reduced glutathione (GSSG/GSH) ratio, to an activation of NF-kappaB and to a significant decrease in the protein level of its inhibitor IkappaB. GSH concentration and the GSSG/GSH ratio changed significantly for the first three of the WAnTs series and normalised thereafter. A significant activation of NF-kappaB and a decrease in the IkappaB protein level were also detected. We conclude that short-term supramaximal anaerobic exercise induces oxidative stress, as evidenced by non cumulative damage to macromolecules and changes in the glutathione status. Our data also indicate that high intensity anaerobic work gives rise to an activation of the transcription factor NF-kappaB accompanied by a degradation of IkappaB.

8-Hydroxy-2'-Deoxyguanosine↗
PubMed1998

Job Redesign Needs for Aged Workers.

The aim of this paper is to explore and present a proposal for redesigning elements of the workplace for agech workers. The method of research was to observe, record, and measure the actions of sitting workers performing assembly operations on electrical products in the Kani Plant Nagoya Works of Mitsubishi Electric Co. (Japan). The evaluation index used in the experiment was obtained by measuring time motion elements, cycle time per product, and motion velocity waves of elderly workers. Those motion characteristics were then compared to the motion characteristics of young workers. The results led to job redesign elements being identified to reduce handling factors of high difficulty for aged workers and to the necessity to consider a coefficient of correction in Method Time Measurement (MTM) according to differences in the manufactured object's weight.

aged workers↗
PubMed1983

Perceived exertion of physical effort for various manual handling tasks.

Ten trained male students between 18 and 28 years of age participated in a study, designed to determine the relationship between perceived exertion and physiological costs of exertion during various manual lifting and lowering tasks. Perceived exertion was defined as one's subjective rating of the intensity of work being performed. Five subjects performed lifting tasks and another five performed lowering tasks. Weight of load lifted or lowered (6.8, 13.6, 20.5 kg), frequency of lift or lower (3, 6, 9 times/min), height of lift or lower (floor to 76 cm, 76 to 127 cm, floor to 127 cm), box width (38, 66 cm), box length (38, 66 cm) and angle of twist of the body (0 degree, 90 degrees) were the independent variables studied. Heart rate, oxygen consumption, and ratings of perceived exertion (RPE) were the response measures. RPE was found almost linearly related to heart rate and oxygen consumption when lifting or lowering loads. For lifting tasks, the coefficient of correlation between RPE and heart rate was 0.673. In the case of lowering tasks, this coefficient was 0.604. When oxygen consumption was considered, the corresponding coefficients for lifting and lowering were 0.734 and 0.619, respectively. The correlation of RPE with the physiological response variables indicates that the severity of manual materials handling tasks in industry can be evaluated quickly and inexpensively by using perceived exertion ratings (RPE).

Adolescent↗
PubMed1999

A case-control study to detect modifiable risk factors for colonization with vancomycin-resistant enterococci.

A case-control study was conducted to determine the modifiable risk factors associated with vancomycin-resistant Enterococcus (VRE) colonization during a hospital outbreak. Cephalosporin use was identified as the only independent risk factor (odds ratio, 13.8; 95% confidence interval, 2.5-76.3; P = .01). Nursing work-load intensity was not associated with VRE colonization in this study.

Aged↗