bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnósticos/resultados de enfermagem para parturientes e puérperas utilizando a Classificação Internacional para Prática de Enfermagem
Authors: Silva Aline Franco da , Nóbrega Maria Miriam Lima da , Macedo Wânia Cristina Morais de
Published: September 2012

http://dx.doi.org/10.5216/ree.v14i2.11211O objetivo deste estudo foi desenvolver afirmativas de diagnósticos de enfermagem para parturientes e puérperas, utilizando o modelo dos setes eixos da Classificação Internacional para Prática de Enfermagem. Foram elaboradas 68 afirmativas de diagnóstico de enfermagem, as quais foram agrupadas de acordo com as necessidades humanas básicas de Horta. A formulação de diagnósticos de enfermagem expressa o julgamento clínico do enfermeiro acerca dos fenômenos pelos quais é responsável para atingir resultados de enfermagem, após realizar uma intervenção.  A utilização da linguagem padronizada para construção desses diagnósticos e resultados favorece a documentação de enfermagem, que por sua vez, contribui para evidenciar os conceitos importantes para prática profissional na atenção à saúde materna.
A percepção do formando de enfermagem sobre a função gerencial do enfermeiro
Authors: Silva Jadielma Clementino da , Rozendo Célia Alves , Brito Fátima Maria de Melo , Costa Teresinha De Jesus Gomes
Published: September 2012

http://dx.doi.org/10.5216/ree.v14i2.12565O presente estudo teve por objetivo identificar e analisar a percepção de formandos de graduação em enfermagem de uma universidade pública sobre a função gerencial do enfermeiro.  Trata-se de estudo descritivo-qualitativo, cujo cenário foi um curso de graduação em enfermagem de uma universidade pública nordestina.  Para a coleta de dados utilizou-se a entrevista semiestruturada com doze formandos de graduação. A análise temática foi a técnica escolhida para a análise dos dados, gerando três categorias: função gerencial do enfermeiro – faz funcionar o serviço; assistência e gerência – duas práticas dicotômicas; e ensino dos conteúdos de administração – muita teoria, pouca prática. Concluímos que a percepção dos formandos sobre a função gerencial do enfermeiro baseia-se mais na observação do trabalho do enfermeiro e menos na sua percepção em si e que, para esses sujeitos, trata-se de função importante, mas que se apresenta desarticulada da assistência e distante da prática.
Riscos ocupacionais no processamento de sistemas de hemodiálise
Authors: Hoefel Heloisa Helena Karnas , Lautert Liana , Fortes Caroline
Published: September 2012

http://dx.doi.org/10.5216/ree.v14i2.12601O presente estudo sobre o processamento em sistemas de hemodiálise foi realizado com objetivo de identificar os riscos aos profissionais e pacientes durante o reprocessamento.  Para tal, realizou-se um estudo observacional durante as atividades da equipe de enfermagem, em hospital universitário do sul no Brasil. Foram observados 36 fluxos de reprocessamento compondo 872 passos com algum risco potencial. Em 638 (73%) observações o risco relacionava-se aos pacientes e em 27%, aos profissionais. Foram observadas técnicas seguras em 573 (66%) ocasiões e inseguras em 299 (34%).  Das 299 ocasiões inseguras, 144 (48%) dependiam de infraestrutura ou rotina e não do comportamento profissional.  Pacientes estiveram significativamente sob maior risco do que profissionais (P<0,001). A diferença entre passos seguros e inseguros nas fases de pré-processamento, reprocessamento e secagem/armazenagem não foi não significativa (P>0,01). Conclui-se que pacientes e profissionais estiveram sob risco durante o reprocessamento, embora passos seguros sejam proporcionalmente maiores.
Significado do cuidado no idoso de 80 anos ou mais
Authors: Menezes Tânia Maria de Oliva , Lopes Regina Lúcia Mendonça
Published: September 2012

http://dx.doi.org/10.5216/ree.v14i2.13176Este estudo trata-se de pesquisa qualitativa, à luz da fenomenologia de Heidegger que objetivou compreender o significado do cuidado no idoso de 80 anos ou mais. Foi realizado com dezesseis idosos, ambos os sexos, integrantes de um Centro de Convivência, em Salvador-BA. A coleta dos depoimentos aconteceu entre janeiro e março de 2009. Obtiveram-se as seguintes temáticas: 1. Vivenciando o cuidado de si; 2. Compreendendo a necessidade de cuidado do outro; 3. Experimentando ser cuidado pelo outro, possibilitando a construção da Unidade de Significado: nos modos de ser do idoso de 80 anos ou mais, o cuidado está presente. Conclui-se que, frente ao novo panorama do envelhecimento no Brasil, a enfermagem poderá focar suas ações não só na recuperação e reabilitação da saúde, como também na promoção e prevenção de agravos pautados na educação em saúde, respeitando a independência e permeando com sua participação o processo de cuidado.
Implicações da interdisciplinaridade na organização do trabalho da enfermagem: estudo em equipe de cuidados paliativos
Authors: Matos Eliane , Pires Denise Elvira Pires de , Gelbcke Francine Lima
Published: September 2012

http://dx.doi.org/10.5216/ree.v14i2.13237Este trabalho trata-se de estudo exploratório-descritivo de natureza qualitativa, realizado com equipe interdisciplinar que presta cuidados paliativos a pessoas portadoras de câncer de uma instituição pública no sul do Brasil. Teve como objetivo identificar a influência da prática interdisciplinar na organização do trabalho da enfermagem. A coleta de dados foi realizada por meio de entrevistas semiestruturadas com catorze profissionais de diversas categorias, observação sistemática e estudo documental. Os resultados mostraram que a perspectiva interdisciplinar propicia a participação no processo de tomada de decisão; contribui para a integração das ações realizadas pelos diferentes profissionais e pelo conjunto dos profissionais de enfermagem; promove a valorização do trabalho de diversos integrantes da equipe, contribuindo para diminuir o conflito interno na enfermagem, promovendo melhorias na atenção aos usuários. Concluiu-se que os pressupostos orientadores da interdisciplinaridade contribuem para reorganização do trabalho de enfermagem em uma perspectiva mais colaborativa, satisfatória e integradora.
Imagem do cirurgião-dentista em sites de busca da web
Authors: Nunes Maria De Fátima , Ferreira Netto Alervi Alves , Silva Pedro Felipe de Paiva e , Nogueira Túlio Eduardo , Nunes Verena Naves
Published: September 2012

http://dx.doi.org/10.5216/ree.v14i2.13936O objetivo deste estudo foi analisar as imagens dos sites de busca da Web relacionadas ao cirurgião-dentista. Quatro pesquisadores realizaram o levantamento diariamente em sete grandes sites durante um mês. Foram usadas como palavras-chave para a busca: cirurgião-dentista, dentista e odontólogo.  Para a análise das imagens foi utilizado o método de análise da imagem proposto por Joly e análise descritiva. O resultado obtido após a análise conjunta pelos pesquisadores foi de onze categorias: Rotina (159=26,72%), Humor (104=17,47%), Visão restrita (58=9,74%), Sadismo/Brutalidade (57=9,57%), Insalubridade (47=7,89%), Medo (47=7,89%), Dor/Sofrimento (47=7,89%), Entretenimento (37=6,21%), Erotismo/Sexualidade (28=4,70%), Mutilação (8=1,34%) e Narcisismo (3=0,50%). Das 595 imagens encontradas, mais da metade (66,55%) representavam negativamente o cirurgião-dentista. Conclui-se que a profissão de cirurgião-dentista veiculada em grandes sites de busca aparece, dentre as imagens não convencionais do exercício da profissão, com predominância negativa.
Custo de educação continuada para equipe de enfermagem de um hospital universitário público
Authors: Costa Daniele Bernardi da , Vannuchi Marli Terezinha Oliveira , Haddad Maria do Carmo Fernandez Lourenço , Cardoso Magali Godoy Pereira , Silva Larissa Gutierrez da , Garcia Simone Domingues
Published: September 2012

http://dx.doi.org/10.5216/ree.v14i2.14540O presente estudo propôs-se a determinar o custo direto e indireto dos treinamentos de educação continuada realizados para a equipe de enfermagem. Trata-se de estudo transversal, de abordagem quantitativa. Os dados foram coletados a partir dos registros da Divisão de Educação e Pesquisa em Enfermagem de um hospital universitário público, no período de junho de 2009 a maio de 2010. Os dados obtidos foram processados eletronicamente no programa Microsoft Excel 2003. Observou-se que durante o período do estudo foram realizados 22 programas de educação continuada, totalizando um custo de 10.256,56 reais; deste valor, 86,42% foram custos diretos e 13,58%, custos indiretos. Houve uma média de 35 participantes e dez horas de duração por treinamento. Este estudo aponta a necessidade dos serviços de saúde conhecerem os custos dos programas de treinamento e a importância do investimento na formação e aprimoramento de recursos humanos.
The Clinical Utility of Vascular Mapping with Doppler Ultrasound Prior to Arteriovenous Fistula Construction for Hemodialysis Access
Authors: Ílhan Gökhan , Esi Ertap , Bozok Şahin , Yürekli Ísmail , Özpak Berkan , Özelçi Ahmet , Destan Buğra , Gürbüz Ali
Published: September 2012

Purpose

To compare the outcomes of vascular access (VA) procedures performed using physical examination (PE) alone to PE and ultrasound vein mapping for assessment of patients needing hemodialysis access.

Methods

Comparative analysis of data obtained by retrospective review of records of 63 patients who underwent PE and vascular mapping (VM) using colored Doppler ultrasonography (CDUS) and 76 patients assessed by physical examination alone to schedule vascular access surgery. The parameters assessed to study the impact of these two different pre-operative assessment approaches included selection of surgical site, procedure, construction of arteriovenous fistulas (AVF) and grafts (AVG), negative surgical exploration rates and surgical outcomes (maturation and patency rates).

Results

The rate of successfully constructed AVF increased significantly from 75% to 97% (P=.001) with pre-operative ultrasonographic vascular mapping. In 22 patients (34.9%) the access planned with physical examination was modified based on CDUS examination. In 12 patients, the surgical site for AVF creation and type of surgical procedure were modified based on the CDUS results. Permanent access placement rates were significantly higher in patients assessed with CDUS (P=.001). All patients who underwent vascular mapping had successful VA construction while the PE group had a 18.4% negative surgical exploration rate. When fistulas were assessed at six months, the patency rate was 80.7% for the physical examination (PE) group and 93.4% for the vascular mapping (VM) group.

Conclusions

Pre-operative vascular mapping using CDUS significantly increases the success of AVF construction and patency.
Determination of Aflatoxin M1 in Milk by ELISA Technique in Mashad (Northeast of Iran)
Authors: Mohamadi Sani Ali , Khezri Mohamad , Moradnia Halime
Published: September 2012

The aim of this study was to detect the amount of aflatoxin M1 (AFM1) in pasteurized milk samples in Mashad in northeast of Iran. For this purpose, 42 milk samples were collected from retail stores during fall 2011 and analyzed for AFM1 by enzyme-linked immunosorbent assay (ELISA) technique. All the analyses were done twice. Results showed presence of AFM1 in 97.6% of the examined milk samples by average concentration of 23 ± 16 ppt and contamination level ranging between 6 and 71 ppt. The concentration of AFM1 in all the samples was lower than the Iranian national standard and Food and Drug Administration limits (500 ppt), and, only in 3 (1.6%) samples, AFM1 concentration was more than the maximum tolerance limit (50 ppt) accepted by European Union and Codex Alimentarius Commission. According to our findings and previous studies, AFM1 contamination of milk is not a concern in this region, and the regional standard of AFM1 contamination in milk might be changed to lower than 100 ppt.
A High Dose Intravenous Immunoglobulin Therapy for Women with Four or More Recurrent Spontaneous Abortions
Authors: Yamada Hideto , Takeda Masamitsu , Maezawa Yoko , Ebina Yasuhiko , Hazama Ryoichi , Tanimura Kenji , Wakui Yukio , Shimada Shigeki
Published: September 2012

Recurrent spontaneous abortion (RSA) may have immunological etiology. The aim of this study was to assess the efficacy of a high dose intravenous immunoglobulin (HIVIg) therapy, in which 20 g of intact type immunoglobulin was infused daily for 5 days during early gestation, for women who had a history of four or more consecutive spontaneous abortions of unexplained etiology. A total of 60 pregnant RSA women underwent HIVIg therapy, and the pregnancy outcome was assessed. The live birth rate was 73.3% (44/60). Fifteen pregnancies ended in spontaneous abortion, and one ended in intrauterine fetal death. In 11 of the 15 spontaneous abortions, fetuses had abnormal chromosome karyotype. When the 11 pregnancies with abnormal chromosome karyotype were excluded, the live birth rate was as high as 89.8% (44/49). The HIVIg therapy may be effective for severe cases of unexplained RSA.
Synthesis and Biological Evaluation of Some Novel 5-[(3-Aralkyl Amido/Imidoalkyl) Phenyl]-1,2,4-Triazolo[3,4-b]-1,3,4-Thiadiazines as Antiviral Agents
Authors: Pandey Vinod Kumar , Tusi Zehra , Tusi Sumerah , Joshi Madhawanand
Published: September 2012

A series of novel 4-amino-5-mercapto-3-[(3-aralkyl amido/imidoalkyl) phenyl]-1,2,4-triazoles (5a-d) were obtained by treating m-(aralkyl amido/imidoalkyl) benzoic acid hydrazides (3a-d) with carbon disulphide in alcoholic KOH and hydrazine hydrate, respectively. These triazole derivatives were employed in the synthesis of 5-[(3′-aralkyl amido/imidoalkyl) phenyl]-1,2,4-triazolo[3,4-b]-1,3,4-thiadiazines (6a-d). The newly synthesized compounds were evaluated for their antiviral activity against two animal viruses, namely, Japanese encephalitis virus (JEV) strain P20778 and herpes simplex virus-1 (HSV-1) strain 753166.
Serum Retinol and Carotenoids in Association with Biomarkers of Insulin Resistance among Premenopausal Women
Authors: Blondin Stacy A. , Yeung Edwina H. , Mumford Sunni L. , Zhang Cuilin , Browne Richard W. , Wactawski-Wende Jean , Schisterman Enrique F.
Published: September 2012

Objective. The aim of this study was to investigate how serum retinol and carotenoids (β-carotene, β-cryptoxanthin, lutein/zeaxanthin, lycopene) are associated with biomarkers of insulin resistance. Research Methods and Procedures. The BioCycle Study (2005–2007) is a prospective cohort of 259 healthy premenopausal women. Fasting serum samples were collected at up to sixteen clinic visits, from which retinol, carotenoids, insulin, glucose, and sex hormone-binding globulin (SHBG) were measured. Insulin resistance was estimated by the homeostasis model assessment (HOMA-IR). Linear mixed models were used to determine associations adjusting for age, race, body mass index (BMI), education, smoking, physical activity, triglycerides, and energy intake. Results. Retinol was positively associated with HOMA-IR (β=0.19 (95% CI: 0.07, 0.32)) units per ug/mL increase in retinol; the relationship was driven by insulin (β=0.20 (95% CI: 0.08, 0.31)). Retinol was inversely associated with SHBG (β=−0.22 (95% CI: −0.28, −0.16)). Although no significant associations were found between serum carotenoids and HOMA-IR, β-carotene was positively associated with SHBG and β-cryptoxanthin inversely with fasting plasma glucose. Conclusion. Results indicate a possible role for serum retinol in the pathogenesis of type 2 diabetes. However, they do not support a strong association between individual or total serum carotenoids and insulin resistance.
Valence Bond Structures for the N3
- Anion, the N3 Radical and the N6
- Radical Anion
Authors: Harcourta Richard D. , Klapötke Thomas M.
Published: September 2012

With Heitler-London atomic orbital-type formulations of the wave functions for (fractional) electron-pair πx(NN) and πy(NN) bonds, increased-valence structures for the N3
- anion and N3
- radical are equivalent to resonance between familiar standard Lewis structures and singlet diradical (or “long-bond”) Lewis structures. Theory is developed for the calculation of the polarity parameters that are associated with the one-electron πx(NN) and πy(NN) bonds in the increased-valence structures, and illustrative STO-6G estimates of their values are reported. They show that the πx and πy electrons of these bonds are strongly charge-correlated relative to each other.

The increased-valence structures for the N3
- anion and the N3
- radical are used to help construct increased-valence structures for the N6
- radical anion with C2h symmetry
Komplexchemie perhalogenierter Cyclopentadiene und Alkine, Teil 31 [1]. Darstellung von 2,3-Dichlor- und 2,3,4-Trichlor-1-(2-pyridyl)ferrocen [CpFe{C5H2-nCl2+n(2-C5H4N)}] (n=0, 1). Molekülstrukturen von [Cpe{C5HCl3(2-C5H4N)}] und {C5HCl2(PPh3)(2-C5H4N)g, einem unerwarteten Nebenprodukt / Coordination Chemistry of Perhalogenated Cyclopentadienes and Alkynes, Part 31. Synthesis of 2,3-Dichloro- and 2,3,4-Trichloro-1-(2-pyridyl)ferrocene [CpFe{C5H2-nCl2+n(2-C5H4N)}] (n=0, 1). Molecular Structures of [CpFe{C5HCl3(2-C5H4N)}] and {C5HCl2(PPh3)(2-C5H4N)}, an Unexpected Side Product
Authors: Sünkel Karlheinz , Weigand Stefan
Published: September 2012

Lithiation of 1,2-dichloro- or 1,2,3-trichloroferrocene with lithium tetramethylpiperidinide, followed by transmetallation with ZnCl2 and Pd(II)-catalyzed coupling with 2-bromopyridine, yield the pyridylferrocenes [CpFe{C5H2-nCl2+n(2-C5H4N)}] (2a, b, n=0 or 1) as brown oils of low stability. Recrystallization of 2b produced a small number of X-ray quality crystals, which could be shown to have the proposed constitution. However, from the recrystallization solution of 2a a few crystals precipitated whose X-ray structure determination identified them as a metal-free phosphonium ylide {C5HCl2(2-C5H4N)(PPh3)} (3)
Diagnosis of Lung Cancer in Small Biopsies and Cytology: Implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society Classification
Authors: Travis William D. , Brambilla Elisabeth , Noguchi Masayuki , Nicholson Andrew G. , Geisinger Kim , Yatabe Yasushi , Ishikawa Yuichi , Wistuba Ignacio , Flieder Douglas B. , Franklin Wilbur , Gazdar Adi , Hasleton Philip S. , Henderson Douglas W. , Kerr Keith M. , Petersen Iver , Roggli Victor , Thunnissen Erik , Tsao Ming
Published: September 2012

The new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society lung adenocarcinoma classification provides, for the first time, standardized terminology for lung cancer diagnosis in small biopsies and cytology; this was not primarily addressed by previous World Health Organization classifications. Until recently there have been no therapeutic implications to further classification of NSCLC, so little attention has been given to the distinction of adenocarcinoma and squamous cell carcinoma in small tissue samples. This situation has changed dramatically in recent years with the discovery of several therapeutic options that are available only to patients with adenocarcinoma or NSCLC, not otherwise specified, rather than squamous cell carcinoma. This includes recommendation for use of special stains as an aid to diagnosis, particularly in the setting of poorly differentiated tumors that do not show clear differentiation by routine light microscopy. A limited diagnostic workup is recommended to preserve as much tissue for molecular testing as possible. Most tumors can be classified using a single adenocarcinoma marker (eg, thyroid transcription factor 1 or mucin) and a single squamous marker (eg, p40 or p63). Carcinomas lacking clear differentiation by morphology and special stains are classified as NSCLC, not otherwise specified. Not otherwise specified carcinomas that stain with adenocarcinoma markers are classified as NSCLC, favor adenocarcinoma, and tumors that stain only with squamous markers are classified as NSCLC, favor squamous cell carcinoma. The need for every institution to develop a multidisciplinary tissue management strategy to obtain these small specimens and process them, not only for diagnosis but also for molecular testing and evaluation of markers of resistance to therapy, is emphasized.
Control of Coagulation during Extracorporeal Membrane Oxygenation
Authors: Buck Marcia L.
Published: September 2012

The use of extracorporeal membrane oxygenation (ECMO) requires maintaining a delicate balance between the prevention of thrombosis and the avoidance of hemorrhage. Anticoagulation is necessary to maintain circuit flow. It counteracts the activation of clotting mechanisms that occurs as a result of the interaction between circulating blood and the foreign surfaces of the ECMO equipment as well as endothelial damage within the vasculature. Heparin remains the anticoagulant of choice; however, the difficulty in adjusting dosages and the risk of developing heparin-induced thrombocytopenia have led to the use of alternative therapies such as argatroban and lepirudin. In addition, thrombolysis with alteplase is now being used in patients who develop clots despite anticoagulation. Aminocaproic acid has been used for more than a decade to manage or prevent hemorrhage in patients on ECMO, but a new report suggests that activated recombinant factor VII may also be useful as a hemostatic agent. Over the next decade, it is likely that the role of these newer agents will grow, making them important tools in the management of patients on ECMO.
The Accuracy and Precision of Measuring Lorazepam From Three Liquid Preparations
Authors: Lee Wan-Man Ellaria , Lugo Ralph A. , Cash Jared , Rusho William J. , MacKay Mark , Welkie Katy
Published: September 2012

OBJECTIVES Commercially available lorazepam solution contains both polyethylene glycol (PEG) and propylene glycol. When large doses are administered for deep sedation in the pediatric intensive care unit (PICU), PEG may cause diarrhea, and the accumulation of propylene glycol may result in toxicity. These adverse effects may be avoided by preparing a slurry from crushed lorazepam tablets suspended in water immediately prior to administration. This slurry, which is extemporaneously prepared at bedside by nurses, lacks a suspending agent, and, therefore, the rapid settling of drug particles may produce suspensions that are not homogeneous. Thus, there may be significant inaccuracy and imprecision in dosage measurement. The objective of this study was to compare the accuracy and precision of lorazepam dosage measurement from three liquid preparations: 1) tablet slurry prepared at bedside by a nurse; 2) lorazepam suspension extemporaneously prepared by a pharmacist; and 3) the commercially available lorazepam solution.

METHODS Sixteen PICU nurses measured three doses of lorazepam (0.5 mg, 1.5 mg, 3.5 mg) in triplicate from each of the three liquid preparations using oral syringes. PICU nurses prepared the slurry by mixing crushed lorazepam tablet(s) with water and drawing up the appropriate dose in an oral syringe. Additionally, nurses drew up the appropriate dose from a pharmacist-prepared lorazepam suspension (1 mg/mL) and the commercially available lorazepam solution (2 mg/mL). All samples were analyzed by HPLC and the groups were compared using two-way ANOVA.

RESULTS Dosage accuracy for the slurry (91.2 ± 7.8%) and suspension (109.2 ± 4.9%) were significantly different from the commercially available solution (101.5 ± 3.1%) (P < .05). Imprecision in dosage measurement, as determined by the relative standard deviation, was greatest for the slurry (8.6%) as compared to the suspension (4.5%) and commercially available solution (3.0%).

CONCLUSIONS Dosage measurement from lorazepam slurry and suspension led to significant deviation from the intended dose. Dosage measurement using the slurry was the least precise among the three preparations.
Utility of Anti-Xa Monitoring in Children Receiving Enoxaparin for Therapeutic Anticoagulation
Authors: Leung Marianna , Ho Sharon H. , Hamilton Donald P. , Wu John K. , Dix David B. , Wadsworth Louis D. , Ensom Mary H. H.
Published: September 2012

Although enoxaparin is used to treat thromboembolism in children, current treatment guidelines are largely extrapolated from adults. The objectives of this study were to determine: i) correlation between enoxaparin dose and anti-factor Xa (anti-Xa) level, ii) intra-patient variability, and iii) whether dose or anti-Xa level is a predictor of outcomes. A retrospective chart review was conducted on all hospitalized patients receiving enoxaparin in a tertiary care pediatric institution. Simple linear regression, coefficient of variation (CV), and Student's t-test were used to analyze the objectives. Eighty treatment courses with interpretable anti-Xa levels were analyzed. Mean patient age was 6.5 years. Mean enoxaparin dose was 1.10 mg/kg q12h. Correlation between initial dosing and anti-Xa level was poor; R2 = 0.0307 and 0.0237 for patients > 2 months with and without cardiac or renal diseases, respectively. Four out of seven patients ≤ 2 months of age compared to 4/32 patients > 2 months had a CV > 40%. Similarly, 4/12 cardiac patients compared to 4/27 non-cardiac patients had a CV > 40%. Neither dose nor anti-Xa level predicted treatment success or adverse reactions (P > .05). These results suggest a need to reexamine the use of anti-Xa levels for guiding enoxaparin therapy. Further prospective studies are warranted to clarify whether routine or selective anti-Xa monitoring should be recommended in pediatric patients.
Protein and Nitrogen Metabolism Changes Following Closed Head Injury or Cardiothoracic Surgery in Pediatric Patients
Authors: Hak Emily B. , Rogers David A. , Storm Michael C. , Helms Richard A.
Published: September 2012

OBJECTIVE We compared markers of protein metabolism between children who had a controlled injury and an acute traumatic event. Significant protein catabolism occurs after acute severe injury. During surgery the injury is controlled and the degree of subsequent catabolism may be blunted.

METHODS This was a prospective, unblinded observational study in 10 children 2 to 12 years old with a closed head injury (CHI) and an admission Physiologic Stability Index of ≥ 10 and in 10 children who underwent elective cardiothoracic surgery (CTS). Nutrient intake, nitrogen balance, serum albumin and prealbumin, urinary 3-methylhistidine excretion, and 3-methylhistidine to creatinine ratios were evaluated on days 1, 2, 3, 4, and 10 after injury.

RESULTS Nutrient intake was similar in both groups on study days 1–4 and did not meet estimated needs. By day 10, 7 patients in the CTS group and 2 patients in the CHI group had been discharged home. The 3 CTS patients were still in the ICU while the 8 hospitalized CHI patients had been transferred to the floor. Compared to the CTS group, nitrogen balance in the CHI group was lower on day 1. On day 10, nitrogen balance and prealbumin were greater in the CHI group than in the CTS group, consistent with recovery and increased nutrient intake.

CONCLUSIONS Markers of protein metabolism follow similar patterns after CTS or CHI in children. However, markers of protein metabolism indicate more severe catabolism soon after injury in CHI.
Propofol-Related Infusion Syndrome in Critically Ill Pediatric Patients: Coincidence, Association, or Causation?
Authors: Timpe Erin M. , Eichner Samantha F. , Phelps Stephanie J.
Published: September 2012

Over the past two decades numerous reports have described the development of a propofol-related infusion syndrome (PRIS) in critically ill adult and pediatric patients who received continuous infusion propofol for anesthesia or sedation. The syndrome is generally characterized by progressive metabolic acidosis, hemodynamic instability and bradyarrhythmias that are refractory to aggressive pharmacological treatments. PRIS may occur with or without the presence of hepatomegaly, rhabdomyolysis or lipemia. To date, the medical literature contains accounts of 20 deaths in critically ill pediatric patients who developed features consistent with PRIS. These reports have generated considerable discussion and debate regarding the relationship, if any, between propofol and a constellation of clinical symptoms and features that have been attributed to its use in critically ill pediatric patients. This paper reviews the literature concerning PRIS, its clinical presentation, proposed mechanisms for the syndrome, and potential management should the syndrome occur.
Antibiotic Therapy for Infective Endocarditis in Childhood
Authors: Calza Leonardo , Manfredi Roberto , Chiodo Francesco
Published: September 2012

Infective endocarditis is relatively uncommon in childhood, but its epidemiology has changed in the past three to four decades and its incidence has been increasing in recent years. With the improved survival rates of children with congenital heart diseases and the overall decreased frequency of rheumatic valvular heart disease in developed countries, congenital cardiac abnormalities now represent the predominant underlying condition for infective endocarditis in children over the age of two years in Western Europe and Northern America. Moreover, the complex management of neonatal and pediatric intensive care unit patients has increased the risk of catheter-related endocarditis. More specifically, the surgical correction of congenital heart alterations is associated with the risk of postoperative infections. Endocarditis in children may be difficult to diagnosis and manage. Emerging resistant bacteria, such as methicillin- or vancomycin-resistant staphylococci and vancomycin-resistant enterococci, are becoming a new challenge for conventional antibiotic therapy. Newer antimicrobial compounds recently introduced in clinical practice, such as streptogramins and oxazolidinones, may be effective alternatives in children with endocarditis sustained by Gram-positive cocci resistant to glycopeptides. Home intravenous therapy has become an acceptable approach for stable patients who are at low risk for embolic complications. However, further clinical studies are needed in order to assess efficacy and safety of these antimicrobial agents in children. This review should help outline the most appropriate antimicrobial treatments for infective endocarditis in children.
Nuclear Medicine Imaging in the Pediatric Patient
Authors: Loveless Vivian
Published: September 2012

Pediatric nuclear medicine provides a wealth of information on a variety of disease states; however, precautions on dosing have to be taken into consideration. Also, expertise in conducting procedures and interpreting the results in pediatric patients is necessary. Emphasis is placed on diagnostic studies involving the central nervous system, musculoskeletal system, genitourinary system, gastrointestinal system, endocrine system, pulmonary system, and cardiovascular system along with a brief explanation of the mechanism of localization of the radiopharmaceuticals involved. Radiation safety issues are addressed when the expectant mother or nursing mother is administered radiopharmaceuticals.
Management of Exercise-Induced Bronchospasm in Children
Authors: Hendeles Leslie , Asmus Michael J. , Chesrown Sarah
Published: September 2012

Bronchospasm precipitated by exercise is often indistinguishable from bronchospasm produced by other stimuli. Symptoms result from airflow limitation and include wheezing, cough, chest tightness, dyspnea and sometimes hypoxemia. The prevalence of exercise-induced bronchospasm varies from 30%-90%, but virtually all patients with current asthma will experience a decrease in lung function if the exercise is sufficiently vigorous, especially in cold, dry environmental conditions. Exercise-induced bronchospasm is more prevalent in children than in adults, probably because children are physically more active. It is also more prevalent among elite winter sports athletes. The pathogenesis of exercise-induced bronchospasm involves a defect in respiratory heat exchange that probably triggers mast cell and eosinophil release of bronchoconstricting mediators. The goal of therapy is prevention of symptoms. This may be accomplished by pre-treating patients with isolated exercise-induced bronchospasm using an inhaled rapid-onset β2-adrenergic agonist before a scheduled activity or by treating the underlying inflammation when exercise-induced bronchospasm is part of the clinical syndrome of persistent asthma. In the later instance, either an inhaled corticosteroid, an oral leukotriene modifier, or a combination of both, depending on severity, may be required to prevent exercise-induced bronchospasm associated with activities of daily living. In addition, some of these patients may still require pre-treatment with a short-acting inhaled β2-agonist before a scheduled vigorous activity, especially in very cold ambient temperatures. Because the duration of bronchoprotection decreases with daily use (tachyphylaxis), long acting β2-adrenergic agonists (e.g., formoterol, salmeterol) have a limited role in treating exercise-induced bronchospasm.
β2-Adrenoreceptor Polymorphisms in Asthmatic Patients
Authors: Binaei Saeed , Rashed Sahar M. , Christensen Michael L.
Published: September 2012

β2-adrenergic receptors (β2AR) are GTP-binding protein (G-protein) coupled receptors widely distributed in human tissue. Inhaled β2-agonist drugs exert their primary effect on the β2AR of bronchial smooth muscles, causing relaxation and bronchial dilatation. Polymorphisms in the β2AR gene have been identified, which may affect responsiveness to β2-agonists and disease severity in asthmatics. Nine single nucleotide polymorphisms (SNPs) within the coding region and eight SNPs within in the 5′ upstream region of the β2AR gene have been identified. The two most studied polymorphisms are mutations in the coding region at codon 16, Arg to Gly (Arg16Gly) and at codon 27, Gln to Glu (Gln27Glu). Evidence suggests that carriers of Gly16, as well as carriers of Gln27, are prone to down-regulation of β2AR. Patients who are homozygous for Arg16 and/or Glu 27 may be more susceptible to tachyplaxis with chronic use of β2-agonists. Although β2AR polymorphism is not related to the severity of asthma, patients with nocturnal asthma have higher frequency of Gly16. A polymorphism in the 5′ upstream region, 5′ leader cistron (5′LC), encodes for a protein that regulates mRNA transcription. The Cys19 polymorphism in the 5′LC is associated with higher expression of β2AR. More recent studies have focused on combinations of polymorphisms across the gene region (haplotypes). The interaction of multiple SNPs within a haplotype may control β2AR function resulting in different phenotypic response in patients with asthma. β2AR polymorphism may have a significant implication in the pathophysiology of asthma and therapeutic response.
An Assessment of Vancomycin Pharmacokinetic Variability in Pediatric Cardiology Patients
Authors: Marlowe Karen F. , Chicella Michael F. , Claridge Tamara E. , Pittman Susan W.
Published: September 2012

Objectives To establish the steady-state pharmacokinetic profile of vancomycin in pediatric cardiology patients; determine an empiric vancomycin dose; and evaluate the correlation between fluid balance and volume of distribution (Vd), serum creatinine and clearance (CL), and daily dose of furosemide and Vd.

Methods Retrospective pharmacokinetic evaluation in 36 pediatric cardiology, cardiac surgery, or cardiac transplant patients treated with vancomycin. The pharmacokinetic profile for vancomycin including elimination half-life (t1/2), elimination rate constant (ke), volume of distribution (Vd), and clearance (CL) was calculated for each patient. The relationship between fluid balance and Vd, serum creatinine and CL, and the total daily dose of furosemide and Vd was evaluated.

Results The patient population had an average half-life of 5.9±1.2 hr and a Vd of 0.4±0.12 L/kg. A statistically significant correlation was noted between serum creatinine and CL (r2=0.19, P<0.01). Additionally, a statistically significant correlation exists between the total daily furosemide dose and the Vd (r2=0.31, P<0.01). A dose of 10 mg/kg/dose every 12 hrs was predicted to result in the greatest number of serum vancomycin concentrations within the reference range.

Conclusions Routine monitoring of serum vancomycin concentrations is prudent for this population, and special consideration should be given to those with elevated serum creatinine and to those receiving large doses of furosemide.
Drug Disposition and Therapy in Adolescence: The Effects of Puberty
Authors: Carr Roxane R. , Ensom Mary H.H.
Published: September 2012

Puberty, a part of adolescence, is a time of rapid physical, psychological, and psychosocial changes. Variability in drug absorption, distribution, metabolism and excretion occurs due to physical and hormonal changes, as well as those of body composition. Environmental factors affecting nutrition and compliance in the pubescent individual also affect success in achieving desired pharmacologic effects while minimizing toxicities. Based on available data, pharmacologic research has been relatively inadequate in providing information about drug disposition during puberty. The majority of available studies have neglected to provide staging for pubescent adolescents or have altogether excluded this population from their investigations. However, data are available that describe the effects of puberty on the pharmacokinetics of agents such as theophylline, digoxin, carbamazepine, lamotragine, vigabatrin and benzodiazepines.

To date, few clinically significant changes in drug disposition have been noted during puberty. However, factors such as compliance, concomitant drug use, and the potentially rebellious nature of adolescents must be taken into consideration in the medical management of the adolescent.
Selective Serotonin Reuptake Inhibitors for the Treatment of Obsessive-Compulsive Disorder in Children and Adolescents
Authors: Williams Jennifer Schoelles , Moore Thea , Collins Candace L. , Thomas Kerry-Ann E.
Published: September 2012

The introduction of the selective serotonin reuptake inhibitors (SSRIs) has been a major advance in pediatric psychiatry, while contemporary advances in the understanding of obsessive-compulsive disorder (OCD) phenomenon in children have facilitated its identification and treatment. Currently, fluvoxamine and sertraline are the only SSRIs that have received FDA approval for the treatment of childhood OCD. The purpose of this article is to review the safety and efficacy of SSRIs in the treatment of obsessive-compulsive disorder (OCD) in children and adolescents.
Measles-Mumps-Rubella Vaccine and the Development of Autism or Inflammatory Bowel Disease: The Controversy Should End
Authors: D'Souza Jennifer , Todd Timothy
Published: September 2012

Vaccines have been administered to millions of individuals, usually infants and children, with few serious adverse effects. In 1998 a report suggested that there may be a link between the measles-mumps-rubella vaccine and the development of behavioral abnormalities (i.e., autism) and inflammatory bowel disease in children. This report generated considerable media and political attention, which many feared would result in a decreased willingness of parents to immunize their children against these contagious diseases. Over the past decade, an increasing number of healthcare practitioners have been credentialed to administer vaccinations. Therefore, it is imperative for all medical professionals to understand the controversy surrounding this issue and to be able to appropriately educate and advise parents accordingly. This review article evaluated the primary and secondary literature pertaining to this topic and concluded that the available epidemiological and scientific evidence does not support a causal association between the MMR vaccine and autism or inflammatory bowel disease.
Review and Update of Insulin Dependent Diabetes Mellitus
Authors: Gorrell Jennifer Justice , Williams Jennifer Schoelles , Powell Paula
Published: September 2012

The purpose of this article is to provide the health care practitioner with a comprehensive review of the pathophysiology and treatment of Type 1 Diabetes Mellitus. Traditionally, insulin has been administered via an insulin syringe. In the recent past, diabetes research has focused on developing more convenient insulin delivery devices and longer acting insulin's in hopes of increasing compliance with insulin therapy and improving the management of Type 1 diabetes in both children and adults. Rapidly developing approaches to insulin delivery for Type 1 diabetes continue to be developed at a rapid rate, including administration via continuous subcutaneous insulin infusion in addition to other new approaches. With these advances in therapy, pediatric patients with Type 1 diabetes have been able to achieve strict glycemic control, although the treatment of hypoglycemia remains a burden. The objectives of this article are to the following: to review the epidemiology, risk factors, pathophysiology, clinical manifestations, and diagnostic criteria of Type 1 diabetes mellitus in children,; to discuss the management of these patients, including, insulin therapy, monitoring, diet and exercise, carbohydrate counting and treatment of hypoglycemia,; and to review insulin administration devices, including insulin pens, insulin jet injectors, insulin pumps, and novel insulin delivery systems.
Systematic Steps to Diminish Multi-Fold Medication Errors in Neonates
Authors: Pinheiro Joaquim M. B. , Mitchell Amy L. , Lesar Timothy S.
Published: September 2012

Tenfold and other multiple-of-dose errors are particularly common in the neonatal intensive care unit (NICU), where the fragility of the patients increases the potential for significant adverse outcomes. Such errors can originate at any of the sequential phases of the process, from medication ordering to administration. Each step of calculation, prescription writing, transcription, dose preparation, and administration is an opportunity for generating and preventing medication errors. A few simple principles and practical tips aimed at avoiding decimal and other multiple-dosing errors can be systematically implemented through the various steps of the process. The authors describe their experience with the implementation of techniques for error reduction in a NICU setting. The techniques described herein rely on simple, inexpensive technologies for information and automation, and on standardization and simplification of processes. They can be immediately adapted and applied in virtually any NICU and could be integrated into the development of computerized order entry systems appropriate to NICU settings. Either way, they should decrease the likelihood of undetected human error.
Metabolic Acidosis in a Pediatric Patient Receiving Topiramate
Authors: Malik Razia , Iacoune John
Published: September 2012

Topiramate is an anticonvulsant that is labeled for the management of several seizure types in children >2 years of age. With the exception of cognitive dysfunction, nephrolithiasis, weight loss, and paresthesia, adverse effects in children are similar to other those noted with other anticonvulsants. We describe a 33-month-old child with complex partial seizures and secondary generalization who received topiramate 45 mg orally twice daily (6.2 mg/kg/d) for approximately 4 weeks before admission. He developed asymptomatic metabolic acidosis that was evidenced by a decrease in HCO3−, which was unresponsive to treatment with sodium bicarbonate. The child was weaned off topiramate and the metabolic acidosis resolved 48 hours after its discontinuation.
Tour d’horizon des principaux programmes et dispositifs de soutien à l’insertion professionnelle en enseignement
Authors: Martineau Stéphane , Mukamurera Joséphine
Published: September 2012

Ce texte présente un bref portrait des programmes d’insertion professionnelle mis en place dans les commissions scolaires québécoises ainsi qu’une analyse de trois des principaux dispositifs de soutien utilisés. L’analyse se base à la fois sur les documents descriptifs des programmes d’insertion mis en ligne sur le site Web du Carrefour national de l’insertion professionnelle en enseignement (CNIPE) ainsi que sur une recension des recherches.
Teacher Professional Learning in Pursuit of the Common Good: A Discussion of the Role of demonstration schools in Teacher Education
Authors: Loughland Tony
Published: September 2012

The Federal Government in Australia has recently established Centres for Excellence in Teacher Education. These Centres represent a power shift towards schools in teacher education and away from centralised bureaucracies and university faculties of education. Given this shift, it is interesting to examine other historical and current school-based models of teacher education, specifically demonstration schools in the United Kingdom, United States, and Australia and professional development schools in the United States. This paper discusses both models with a detailed case study of the operation of one demonstration school in Sydney, Australia. The discussion and case study reinforces the lessons of the historical models that initiatives in this area need long-term support so that they can develop the momentum necessary to achieve the long-term cultural change required.
La división del trabajo moral: las críticas de J. Habermas a K.-O. Apel en torno a la realización histórica de la ética del discurso
Authors: Paolicchi Leandro
Published: September 2012

El trabajo se propone confrontar la solución que Jürgen Habermas ha propuesto para larealización histórica de la ética del discurso con aquella que ha desarrollado el otro creadorde esta propuesta, es decir, Karl-Otto Apel. El objetivo que persigue esta confrontaciónes dejar al descubierto ciertas falencias que pueden observarse en el planteo deKarl-Otto Apel o al menos mostrar la conveniencia de ciertas ideas que a este respectoha sugerido Jürgen Habermas. En este sentido, la confrontación puede leerse tambiéncomo la necesidad de complementar lo desarrollado por ambas propuestas como unasolución al problema de la realización histórica de la ética del discurso. Sin embargo, eltrabajo señala el alto precio que paga el esquema habermasiano - con su reforma de laarquitectónica del discurso - en función de institucionalizar un procedimiento de deliberacióndiscursiva en el marco del Estado democrático de Derecho al punto de abandonarel proyecto de una ética del discurso. Finalmente, en función de los aspectos positivos yde los aspectos negativos de las propuestas de Apel y Habermas, se sugieren unas líneas en las que es necesario continuar como una forma de resolver el problema de la realizaciónhistórica de la ética del discurso.
O disjuntivismo em Kant
Authors: Horácio de Sá Pereira Roberto
Published: September 2012

O objetivo deste trabalho é rever criticamente algumas interpretações contemporâneas da noção kantiana de intuição sensível. Defendo uma interpretação alternativa segundo a qual a intuição sensível em Kant deva ser entendida nos termos do que McDowell(seguindo Evans) denomina sentido de re cuja principal característica é a dependênciado objeto (object-dependence). Nesse sentido, a função da intuição sensível é introduzir entidades no discurso para que essas possam ser conceituadas em juízos. Por essa razão,as intuições sensíveis devem ser vistas como o modo de se dar dos objetos e seus atributos e relações que a eles se refere apenas na medida em que eles nos aparecem de forma dependente e relativa.
Juízo, imaginação e mentalidade alargada: a interpretação arendtiana do juízo estético kantiano
Authors: Correia Adriano
Published: September 2012

Pretendo apresentar, neste artigo, alguns dos conceitos kantianos na Crítica da faculdade do juízo apropriados na análise política arendtiana do juízo estético kantiano:juízo, imaginação, mentalidade alargada, senso comum. A despeito das dificuldades resultantes do caráter inacabado da abordagem arendtiana da vida do espírito, buscamos explicitar que ela encontra, na obra kantiana, os elementos básicos de sua análise da atividade mental do juízo. Ela sustenta não apenas que o juízo reflexionante estético pode ser apropriado politicamente, mas que na Crítica da faculdade do juízo encontra-se a filosofia política oculta da obra kantiana. A tal posição polêmica iremos apenas aludir, analisando os conceitos de pensamento crítico e mentalidade alargada.