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First Experience (first + experience)
Kinds of First Experience Selected AbstractsFirst Experiences for Pulmonary Vein Isolation with the High-Density Mesh Ablator (HDMA): A Novel Mesh Electrode Catheter for Both Mapping and Radiofrequency Delivery in a Single UnitJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2009AXEL MEISSNER M.D. Background: Interventional therapy of atrial fibrillation (AF) is often associated with long examination and fluoroscopy times. The use of mapping catheters in addition to the ablation catheter requires multiple transseptal sheaths for left atrial access. Objectives: The purpose of this prospective study was to evaluate feasibility and safety of pulmonary vein (PV) isolation using the high-density mesh ablator (HDMA), a novel single, expandable electrode catheter for both mapping and radiofrequency (RF) delivery at the left atrium/PV junctions. Methods: Twenty-six patients with highly symptomatic paroxysmal AF (14, 53.8%) and persistent AF (12, 46.2%) were studied. Segmental PV isolation via the HDMA was performed using a customized pulsed RF energy delivery program (target temperature 55,60°C, power 70,100 W, 600,900 seconds RF application time/PV). Results: All 104 PVs in 26 patients could be ablated by the HDMA. Segmental PV isolation was achieved with a mean of 3.25 ± 1.4 RF applications for a mean of 603 ± 185 seconds. Entrance conduction block was obtained in 94.2% of all PV. The mean total procedure and fluoroscopy time was 159.0 ± 32 minutes and 33.5 ± 8.6 minutes, respectively. None of the patients experienced severe acute complications. After 3 months no PV stenosis was observed, and 85.6% and 41.6% of the patients with PAF and persistent AF, respectively, did not report symptomatic AF. Conclusions: In this first study of PV isolation using the HDMA, our findings suggest that this method is safe and yields good primary success rates. The HDMA simplifies AF ablation, favorably impacting procedure and fluoroscopy times. [source] First experience of compressible gas dynamics simulation on the Los Alamos roadrunner machineCONCURRENCY AND COMPUTATION: PRACTICE & EXPERIENCE, Issue 17 2009Paul R. Woodward Abstract We report initial experience with gas dynamics simulation on the Los Alamos Roadrunner machine. In this initial work, we have restricted our attention to flows in which the flow Mach number is less than 2. This permits us to use a simplified version of the PPM gas dynamics algorithm that has been described in detail by Woodward (2006). We follow a multifluid volume fraction using the PPB moment-conserving advection scheme, enforcing both pressure and temperature equilibrium between two monatomic ideal gases within each grid cell. The resulting gas dynamics code has been extensively restructured for efficient multicore processing and implemented for scalable parallel execution on the Roadrunner system. The code restructuring and parallel implementation are described and performance results are discussed. For a modest grid size, sustained performance of 3.89 Gflops,1 CPU-core,1 is delivered by this code on 36 Cell processors in 9 triblade nodes of a single rack of Roadrunner hardware. Copyright © 2009 John Wiley & Sons, Ltd. [source] MR-guided percutaneous core biopsy of small breast lesions: First experience with a vertically open 0.5T scannerJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 4 2002Jens P. Schneider MD Abstract Purpose The growing use of highly sensitive but only moderate specific breast MRI requires the development of both minimal-invasive as well as precise biopsy systems. The aim of the study was to prove the accuracy and feasibility of a biopsy procedure carried out in prone position in a vertically opened MR imager. Materials and Methods The biopsies were carried out in 21 women with lesions visible on MRI alone using an open breast coil with an integrated biopsy device. A 14 G coaxial needle was placed under near real-time MRI-guidance. After the tip of this needle was verified in contact with the lesion, we used a non MR-compatible, but MR-safe biopsy gun with a 16 G canula to take four to eight cores. Results We found eight malignant and 12 benign lesions. In one patient the procedure was not successful. In case of malignancy, the operation confirmed the diagnosis in all cases. The 12/21 patients with benign lesions have been followed without evidence of lesions growth over eight to 28 months. Conclusion The described procedure allows MRI-guided minimal invasive core biopsy of small breast lesions (five to 17 mm) with a high degree of accuracy. J. Magn. Reson. Imaging 2002;15:374-385. © 2002 Wiley-Liss, Inc. [source] First experience with The IRIS retinal implant systemACTA OPHTHALMOLOGICA, Issue 2009M VELIKAY-PAREL Purpose To report on the first 4 months experience of a patient with the active IRIS- Implant. Methods 4 weeks after implantation the training with the active implant started. Thresholds were measured at each training day. Light perception, light localisation, point to point discrimination and motion detection were measured with special test procedures. Visual function training was performed. Results Visual perception was achieved, when the stimuli were generated by the computer and with the camera mode. All tests were successful. Conclusion Successful stimulation and major improvements during the training demonstrates that with the Iris Implant System a visual perception can be achieved, which is relevant for daily life. [source] Acute Effects of Ethanol on Behavior of Adolescent Rats: Role of Social ContextALCOHOLISM, Issue 3 2001Elena I. Varlinskaya Background: First experiences with alcohol in humans occur predominantly in adolescence, and to a large extent the attractiveness of alcohol at this age is based on its ability to facilitate certain forms of social behavior (social facilitation). Adolescence is strongly marked by a focus on peer relationships, and the social nature of the situation plays an important role in responsiveness to alcohol. Peer-directed social activity of adolescent rats may be a valuable experimental model for the study of ethanol-induced changes in social behavior and assessment of the role of the social context in responsiveness to ethanol. Method: In the present study we used a modified dyad social interaction test to characterize acute effects of ethanol on different forms of social behavior (social investigation, contact behavior, and play) and social motivation (preference/avoidance of a peer) in adolescent rats. Ethanol effects on behavior directed toward a peer were compared with those induced by exposure to an inanimate novel object. Results: In the social context, the effects of ethanol were dose-dependent and biphasic. Low doses of ethanol (0.25,0.75 g/kg) produced apparent social facilitation (increased social activity and enhanced social preference), whereas higher doses (3 and 4 g/kg) caused social inhibition (decreased social activity and avoidance of a peer). This pattern was not observed for a nonsocial stimulus: Although overall activity in the nonsocial context was suppressed by 2 and 3 g/kg of ethanol, 0.5 g/kg of ethanol did not activate overall activity directed to the inanimate object. Conclusions: These findings demonstrate that the social nature of the testing situation plays an important role in responsiveness to alcohol in adolescence, especially to its activating effects. The results suggest also that the study of ethanol effects on social behavior of adolescent rats may be an effective tool for the study of adolescent alcohol use and abuse. [source] First experiences of pediatric kidney transplantation in Sri LankaPEDIATRIC TRANSPLANTATION, Issue 4 2007C. K. Abeysekera Abstract:, KT is the most effective therapeutic option for ESRF. We present our first experiences in a developing country. All children who underwent kidney transplantation since the inception of this program in July 2004 until 30 September 2005 were studied. Their demographic data, operative and peri-operative details, graft and host survival, and drug compliance are described here. Data were collected from patient records and nursing observation records. Eleven children were transplanted during this period (median recipient age 10.75 yr, range: 8,16). The median age of the donors was 41 yr (range: 38,45) and was the mother in eight, father in two and uncle in one. The median (range) follow-up period following transplantation was 12.5 months (7,12). The vascular anastomotic site was aorta and inferior vena cava in nine patients and the cold ischemia time was mean (s.d.) 1.9 h (0.96). All patients received steroids, cyclosporine and MMF for immunosuppression. Hypotension, heart failure and septicemia were common medical complications. Four were treated for acute rejection. Vascular anastomotic leak, burst abdomen, intestinal obstruction, intra-abdominal leak of supra pubic catheter and vesico-ureteric junction obstruction were surgical complications. There were no graft losses or deaths. Despite limited resources good outcomes are possible following renal transplantation in children in developing countries. [source] Nursing students' experiences of their first encounter with death during clinical practice in TaiwanJOURNAL OF CLINICAL NURSING, Issue 15-16 2010Xuan-Yi Huang Aims and objectives., The aim of this study was to elucidate the experiences of first encountering death by nursing students during clinical practice. The objective is to assist nursing educational and clinical professionals to provide essential assistance for nursing students who encounter patient death. Background., Increasingly, deaths are occurring in hospitals. However, there has been little qualitative research in Taiwan on the experiences of nursing students who encounter patient death for the first time. Design., A descriptive qualitative method was employed to explore nursing students' first experience with death during clinical practice in Taiwan. Methods., Purposive sampling, one-on-one, in-depth with semi-structured interviews were conducted to collect data. Participants were selected from an acute haematological ward in a major teaching hospital in Central Taiwan. Narratives were analysed using Colaizzi's seven-step method. Results., Data saturation was achieved after interviewing 12 nursing students. The average age of the students was 20, and seven and half days was the average time spent attending dying patients. Three themes and eleven sub-themes were identified: Providing Care During the Dying Period (feelings of dread and terror, hardship of experiencing patient's life fading away, devotion to patient care and self-affirmation); Facing the Moment of Patient Death (state of being scared or trapped, emotional breakdown); Adjustment after Patient Death (acceptance or avoidance, growth or escape). Conclusions., Findings demonstrate the importance of understanding such first experiences, and the results are beneficial to clinical instructors and nursing personnel in understanding the students' pressure and difficulties experienced before, during and after the patients' death. Relevance to clinical practice., Several recommendations have been made, including teaching and support not only in the period of dying, but at the moment of patient death and postmortality. Avoiding topics about death in local culture have been noted. [source] Factors that prevent learning in electrochemistryJOURNAL OF RESEARCH IN SCIENCE TEACHING, Issue 2 2007Hans-Jürgen Schmidt Electrochemistry plays an important role in curricula, textbooks, and in everyday life. The purpose of the present study was to identify and understand secondary-school students' problems in learning electrochemistry at an introductory chemistry level. The investigation covered four areas: (a) electrolytes, (b) transport of electric charges in electrolyte solutions, (c) the anode and the cathode, and (d) the minus and plus poles. Written tests were given to high-school students in five cycles. The population from which random samples were drawn totalled 15,700 subjects. Students were asked to select the correct answers and to justify their choices. It was found that students based their reasoning on four alternative concepts: (a) During electrolysis, the electric current produces ions; (b) electrons migrate through the solution from one electrode to the other; (c) the cathode is always the minus pole, the anode the plus pole; and (d) the plus and minus poles carry charges. The results suggest a teaching strategy in which students first experience and learn about electrochemistry concepts. In the second step, appropriate concept terms are added, and students then are confronted with the alternative concepts described in this article. © 2006 Wiley Periodicals, Inc. J Res Sci Teach 44: 258,283, 2007 [source] Medical students' first clinical experiences of deathMEDICAL EDUCATION, Issue 4 2010Emily Kelly Medical Education 2010: 44: 421,428 Objectives, Many medical students feel inadequately prepared to address end-of-life issues, including patient death. This study aimed to examine medical students' first experiences of the deaths of patients in their care. Methods, Final-year medical students at the Schulich School of Medicine & Dentistry, University of Western Ontario were invited to share their first experience of the death of a patient in their care. The students could choose to participate through telephone interviews, focus groups or e-mail. All responses were audiotaped, transcribed verbatim and analysed using a grounded theory approach. Results, Twenty-nine students reported experiencing the death of a patient in their care. Of these, 20 chose to participate in an interview, five in a focus group and four through e-mail. The issues that emerged were organised under the overlying themes of ,young', ,old' or ,unexpected' deaths and covered seven major themes: (i) preparation; (ii) the death event; (iii) feelings; (iv) the role of the clinical clerk; (v) differential factors between deaths; (vi) closure, and (vii) relationships. These themes generated a five-stage cyclical model of students' experiences of death, consisting of: (i) preparation; (ii) the event itself; (iii) the crisis; (iv) the resolution, and (v) the lessons learned. ,Preparation' touches on personal experience and pre-clinical instruction. ,The event itself' could be categorised as referring to a ,young' patient, an ,old' patient or a patient in whom death was ,unexpected'. In the ,resolution' phase, coping mechanisms included rationalisation, contemplation and learning. The ,lessons learned' shape medical students' experiences of future patient deaths and their professional identity. Conclusions, A tension between emotional concern and professional detachment was pervasive among medical students undergoing their first experience of the death of a patient in their care. How this tension was negotiated depended on the patient's clinical circumstances, supervisor role-modelling and, most importantly, the support of supervisors and peers, including debriefing opportunities. Faculty members and residents should be made aware of the complexities of a medical student's first experience of patient death and be educated regarding sympathetic debriefing. [source] How Useful is PET/CT Imaging in the Management of Post-Transplant Lymphoproliferative Disease After Liver Transplantation?AMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2006L. McCormack Post-transplant lymphoproliferative disease (PTLD) is a serious and potentially life-threatening complication after solid organ transplantation. Here, we report our first experience with the use of PET/CT (positron emission tomography combined with computed tomogram) for the management of patients with PTLD after liver transplantation. Four patients with histologically proven PTLD were analyzed. Conventional work-up included physical examination and head-to-pelvis CT. PET/CT was used in one patient for initial staging and in all patients for follow-up. PET/CT positive findings underwent biopsy. Information provided by PET/CT resulted in a change of medical management in three of the four patients. Conventional work-up missed residual disease after surgery in one and failed to detect a tumor relapse in another patient. However, one patient disclosed a false positive PET/CT finding in the lungs. In conclusion, PET/CT may be a useful tool for staging and therapy monitoring of PTLD after liver transplantation. [source] Intraoperative vascular localization to facilitate endopyelotomy after renal transplantationANZ JOURNAL OF SURGERY, Issue 8 2001Mark Siddins Background: Pelviureteric junction (PUJ) obstruction after renal transplantation is uncommon. Surgical correction can be technically challenging due to dense perinephric adhesions and variable hilar vascular anatomy. Endopyelotomy is well established in the treatment of PUJ obstruction in native kidneys. Methods: The present paper reports the first experience of antegrade visual cold-knife endopyelotmy performed in a renal allograft. In orientating the incision at the PUJ, preoperative imaging was supplemented by intrarenal Doppler ultrasound, using a probe designed for transoesophageal cardiac monitoring. To the authors' knowledge this approach has not previously been reported. Results: Renal vascular relationships were readily indentified by identifying arterial and venous waveforms. Conclusions: For this uncommon procedure the use of intrarenal Doppler ultrasound provides greater security in avoiding inadvertent vascular injury. [source] 4261: FNA biopsies for genomic analysis and adjuvant therapy for uveal melanomaACTA OPHTHALMOLOGICA, Issue 2010L DESJARDINS Purpose Recent changes in the management of uveal melanoma include the use of biopsies for genomic analysis and the identification of patients with a high risk of metastasis. We wish to describe our first experience with fine needle aspiration (FNA), genome profiling and adjuvant therapy protocol for high risk patients Methods we have started a multicentric adjuvant phase III trial of intravenous fotemustine (FOTEADJ) for high risk uveal melanoma patients. Patients with tumor of 15 mm or more in diameter with retinal detachment or extrascleral extension, patients with tumors of 18 mm or more in diameter and patients with loss of chromosome 3 and gain of entire 8q were considered high risk and eligible. Tumour genome profiling was achieved by array-CGH on a NimbleGen 72K microarray, after whole genome amplification (WGA) in cases of FNAs Local treatment consisted in enucleation or proton beam radiotherapy. FNA was offered to patients treated by radiotherapy for a tumor of 5 mm of thickness or more. Results Between May 2009 and May 2010, 74 patients were offered to participate. Only 16 patients were included because of various reasons: technical problems with the biopsy (13 samples evaluable out of 26 FNA), refusal of the biopsy or the protocol or non inclusion criteria. There has been some improvement in our results since the introduction of WGA for FNA specimens Conclusion Proposing fine needle aspiration biopsy and obtaining sufficient material is not always easy. Including patients in randomized protocols is always a challenge. During the first year for FOTEADJ, only 22% of the eligible patients were enrolled but this percentage is greatly improving with time and experience . [source] Magnetic resonance microscopy versus light microscopy in human embryology teachingCLINICAL ANATOMY, Issue 5 2004J. Puerta-Fonollá Abstract A study was carried out on the application of magnetic resonance microscopy (MRM) in teaching prenatal human development. Human embryos measuring 8 mm, 15 mm, 18.5 mm, and 22 mm were fixed in a 4% paraformaldehyde solution and sections obtained with magnetic resonance imaging (MRI) were compared to those prepared for light microscopy (LM), using the same embryos. The MRM and LM slices were of a similar quality. In the MRM sections, embryonic organs and systems were clearly visible, particularly the peripheral and central nervous systems, and the cardiovascular and digestive systems. The digitalization and clarity of the MRM images make them an ideal teaching aid that is suitable for students during the first years of a health-science degree, particularly medicine. As well as providing students with their first experience of MRM, these images allow students to access, at any time, all embryos used, to assess changes in the positions of different organs throughout their stages of development, and to acquire spatial vision, an absolute requirement in the study of human anatomy. We recommend that this technique be incorporated into the wealth of standard embryonic teaching methods already in use. Clin. Anat. 17:429,435, 2004. © 2004 Wiley-Liss, Inc. [source] Transcatheter Closure of Patent Ductus Arteriosus: Experience with a New DeviceCLINICAL CARDIOLOGY, Issue 11 2009Agnetti Aldo MD Abstract Transcatheter closure is the preferred method of treatment of patent ductus arteriosus (PDA). Detachable coils are widely used to close small ducts, while the Amplatzer duct occluder (ADO) is generally employed for moderate or large ducts. Recently a new device, the Amplatzer duct occluder II (ADO II), a nitinol flexible mesh, with a symmetrical design to provide high conformability for treatment of all types of PDA, has received the European Community mark approval. We report on one of the first experience, four cases (1 male, 3 female, age ranging from six months to seven years old) with different type and size of PDA treated with the new device. The use of this new Amplatzer duct occluder in our experience has the advantage of ease and safety of placement, conformability, stability, low profile catheters, adaptability for long ducts as in type E. Copyright © 2009 Wiley Periodicals, Inc. [source] Delayed disclosure and disrupted communication during forensic investigation of child sexual abuse: a study of 47 corroborated casesACTA PAEDIATRICA, Issue 12 2002RL Sjöberg Aim: To study factors of relevance for the understanding of disclosure of child sexual abuse. Methods: Cases from a Swedish district court involving 47 children in which allegations of child sexual abuse had been corroborated by a confession from the defendant were studied. Results: Delayed disclosure was related to a close relationship with the perpetrator and young age at the first experience of abuse. Disrupted communication during the police interview was related to less violent abuse. Conclusion: The findings highlight the importance of social factors in children's disclosure of sexual abuse. [source] A virtual classroom for information technology in constructionCOMPUTER APPLICATIONS IN ENGINEERING EDUCATION, Issue 2 2008Danijel Rebolj Abstract The paper describes a new postgraduate program called "ITC-Euromaster." It briefly outlines the development process, explains the content of the program, the methodological and didactic approach and the learning environment. The paper concludes with the first experiences in delivering the courses of the new program. © 2008 Wiley Periodicals, Inc. Comput Appl Eng Educ 16: 105,114, 2008; Published online in Wiley InterScience (www.interscience.wiley.com); DOI 10.1002/cae.20129 [source] In vivo functions of the prolyl-4-hydroxylase domain oxygen sensors: direct route to the treatment of anaemia and the protection of ischaemic tissuesACTA PHYSIOLOGICA, Issue 4 2009D. M. Katschinski Abstract The prolyl-4-hydroxylase domain (PHD) 1,3 enzymes have been identified based on their ability to regulate the stability of hypoxia-inducible factor , subunits and thus to modify hypoxia-inducible gene expression. Transgenic mouse models provided insights into the isoform-specific functions of these oxygen sensors with physiological implications for angiogenesis, erythropoiesis/oxygen transport, cardiovascular function, metabolism and tissue homeostasis. This knowledge is important for the ongoing development of small molecule PHD inhibitors that are currently tested in preclinical and clinical trials for the treatment of anaemia and for cytoprotection. This review aims at summarizing the insights obtained from key mouse knock-out models as well as first experiences in the therapeutic application of PHD inhibitors. [source] Culture Matters: How Our Culture Affects the Audit,ACCOUNTING PERSPECTIVES, Issue 3 2010PHILIP COWPERTHWAITE audit; culture; normes internationales Abstract If the influence of national cultures on the implementation of global standards is not taken into account, the result will be inconsistent implementation at best and outright failure at worst. The experiences in fields such as medicine, peacekeeping, aviation, and environmental protection offer insight into possible difficulties with the implementation, beginning in 2010, of International Standards on Auditing (ISAs) by members of the International Federation of Accountants. Some countries may have difficulty with implementation because of the differences between their cultural assumptions and those embodied in the standards to be adopted. It is too soon to know if and where that will happen, especially because the data on first experiences will not begin to be available until 2013. However, cultural-comparison data can be used to foresee which countries may have difficulty with implementation. But if unintended consequences do become evident, it will be important not to assume that the standards and the standard-setting process are defective; it is more likely that practitioners will need help in interpreting the ISAs in light of their local culture. A useful first step would be for standard-setting bodies to identify explicitly the cultural assumptions inherent in the standards they produce. The standard setters can then give that information to those responsible for standards implementation at the practitioner level to help promote consistent application of the standards globally. Question de culture : en quoi la culture influe sur l'audit Résumé Si l'on ne tient pas compte de l'influence des cultures nationales sur la mise en ,uvre de normes internationales, les résultatsde l'exercice seront incohérents, au mieux, ouse solderont par un échec pur et simple, au pire. Les expériences dans des domaines comme la médecine, le maintien de la paix, l'aviation et la protection de l'environnement nous livrent des indications quant aux problèmes que pourrait présenter la conversion, à compter de 2010, aux normes internationales d'audit et de certification établies par les membres de l'International Federation of Accountants (IFAC). Certains pays pourraient éprouver de la difficultéà instaurer ces normes en raison des différences entre leurs a priori culturels et ceux que véhiculent les normes devant être adoptées. Il est trop tôt pour dire si ces difficultés se manifesteront et à quel moment, notamment du fait que les données relatives aux premières expériences ne seront accessibles qu'à compter de 2013. Toutefois, des donnéesculturelles comparatives peuvent être utilisées pour prévoir quels pays risquent defaire face à des embûches dans la mise en ,uvre de ces normes. Toutefois, s'il émergedu processus des conséquences non souhaitées évidentes, il importera de ne pas en conclure que les normes et les processus de normalisation sont défectueux, mais plutôt que les professionnels en exerciceont besoin d'assistance pour interpréter les normes internationales à la lumière de leur culture nationale. Les organismes de normalisation pourraient faire un premier pas dans ce sens en définissant explicitement les a priori culturels inhérents aux normes qu'ils produisent. Les normalisateurs pourraient ensuite communiquer cette information aux responsables de la mise en ,uvre des normes chez lesprofessionnels en exercice et contribuer ainsi à promouvoir la cohérence dans l'application des normes à l'échelle mondiale. [source] One Step Back, Two Steps Forward: The Maneuvering of Brazilian Avant-GardeJOURNAL OF ARCHITECTURAL EDUCATION, Issue 4 2002Fernando Luiz Lara This paper discusses the arrival and later development of avant-gardist architectural movements in Brazil, illuminated by a unique attitude towards the past. From the first experiences with an avant-garde curriculum in 1930 until the construction of the Pampulha buildings in 1942, modernists (identified with the avant-garde) and academics (identified with classical styles) battled for an architecture that represented the ideas of "brazilianess." As a result of this struggle, Brazilian avant-gardists triggered a unique attitude towards past traditions that stitched modernism and baroque together. [source] Nursing students' experiences of their first encounter with death during clinical practice in TaiwanJOURNAL OF CLINICAL NURSING, Issue 15-16 2010Xuan-Yi Huang Aims and objectives., The aim of this study was to elucidate the experiences of first encountering death by nursing students during clinical practice. The objective is to assist nursing educational and clinical professionals to provide essential assistance for nursing students who encounter patient death. Background., Increasingly, deaths are occurring in hospitals. However, there has been little qualitative research in Taiwan on the experiences of nursing students who encounter patient death for the first time. Design., A descriptive qualitative method was employed to explore nursing students' first experience with death during clinical practice in Taiwan. Methods., Purposive sampling, one-on-one, in-depth with semi-structured interviews were conducted to collect data. Participants were selected from an acute haematological ward in a major teaching hospital in Central Taiwan. Narratives were analysed using Colaizzi's seven-step method. Results., Data saturation was achieved after interviewing 12 nursing students. The average age of the students was 20, and seven and half days was the average time spent attending dying patients. Three themes and eleven sub-themes were identified: Providing Care During the Dying Period (feelings of dread and terror, hardship of experiencing patient's life fading away, devotion to patient care and self-affirmation); Facing the Moment of Patient Death (state of being scared or trapped, emotional breakdown); Adjustment after Patient Death (acceptance or avoidance, growth or escape). Conclusions., Findings demonstrate the importance of understanding such first experiences, and the results are beneficial to clinical instructors and nursing personnel in understanding the students' pressure and difficulties experienced before, during and after the patients' death. Relevance to clinical practice., Several recommendations have been made, including teaching and support not only in the period of dying, but at the moment of patient death and postmortality. Avoiding topics about death in local culture have been noted. [source] Disruption of Maternal Behavior by Alcohol Intoxication in the Lactating Rat: A Behavioral and Metabolic AnalysisALCOHOLISM, Issue 8 2002Marta Yanina Pepino Background Preweanling rats exhibit clear behavioral signs of distress after interacting with an alcohol-intoxicated dam. Interestingly, behavioral reactivity of infants to the experience of alcohol in the nursing context decreases as a function of repeated alcohol administrations to the mother. In this study, maternal activities were examined when dams were exposed to repeated administrations of a subnarcoleptic alcohol dose. Maternal changes in alcohol metabolism were also analyzed as a function of repeated exposures to the drug. Methods During postpartum days 3, 5, 7, 9, 11, and 13, nursing dams received an intragastric administration of either 2.5 g/kg of alcohol or water. Maternal behaviors were evaluated (experiment 1). Blood alcohol levels (BALs) of the dams were determined on postpartum day 16 after all mothers received either an intragastric (experiment 2) or an intraperitoneal (experiment 3) dose of alcohol. The doses used (2.5 g/kg intragastrically and 1.5 g/kg intraperitoneally) were chosen because they promote similar peak BALs in dams naive to alcohol. Results Maternal behaviors were strongly affected by the state of intoxication. Nevertheless, these disruptions clearly subsided with progression of alcohol-related experiences (experiment 1). Chromatographic analysis of alcohol metabolism indicated the development of tolerance in dams that had prior experience with alcohol (experiment 2). Changes in BALs as a function of prior experience with alcohol seemed related to first-pass alcohol metabolism rather than hepatic oxidative processes of the drug (experiments 2 and 3). Conclusions When the dam first experiences a moderate state of alcohol intoxication, maternal behaviors are uniformly disrupted. Subsequent exposures to alcohol lead to maternal metabolic tolerance. In conjunction with previous studies, these data indicate that infantile reactivity to alcohol is dependent on how the members of the dam/pup dyad express or perceive ethanol's postabsorptive effects. [source] Medical students' first clinical experiences of deathMEDICAL EDUCATION, Issue 4 2010Emily Kelly Medical Education 2010: 44: 421,428 Objectives, Many medical students feel inadequately prepared to address end-of-life issues, including patient death. This study aimed to examine medical students' first experiences of the deaths of patients in their care. Methods, Final-year medical students at the Schulich School of Medicine & Dentistry, University of Western Ontario were invited to share their first experience of the death of a patient in their care. The students could choose to participate through telephone interviews, focus groups or e-mail. All responses were audiotaped, transcribed verbatim and analysed using a grounded theory approach. Results, Twenty-nine students reported experiencing the death of a patient in their care. Of these, 20 chose to participate in an interview, five in a focus group and four through e-mail. The issues that emerged were organised under the overlying themes of ,young', ,old' or ,unexpected' deaths and covered seven major themes: (i) preparation; (ii) the death event; (iii) feelings; (iv) the role of the clinical clerk; (v) differential factors between deaths; (vi) closure, and (vii) relationships. These themes generated a five-stage cyclical model of students' experiences of death, consisting of: (i) preparation; (ii) the event itself; (iii) the crisis; (iv) the resolution, and (v) the lessons learned. ,Preparation' touches on personal experience and pre-clinical instruction. ,The event itself' could be categorised as referring to a ,young' patient, an ,old' patient or a patient in whom death was ,unexpected'. In the ,resolution' phase, coping mechanisms included rationalisation, contemplation and learning. The ,lessons learned' shape medical students' experiences of future patient deaths and their professional identity. Conclusions, A tension between emotional concern and professional detachment was pervasive among medical students undergoing their first experience of the death of a patient in their care. How this tension was negotiated depended on the patient's clinical circumstances, supervisor role-modelling and, most importantly, the support of supervisors and peers, including debriefing opportunities. Faculty members and residents should be made aware of the complexities of a medical student's first experience of patient death and be educated regarding sympathetic debriefing. [source] First experiences of pediatric kidney transplantation in Sri LankaPEDIATRIC TRANSPLANTATION, Issue 4 2007C. K. Abeysekera Abstract:, KT is the most effective therapeutic option for ESRF. We present our first experiences in a developing country. All children who underwent kidney transplantation since the inception of this program in July 2004 until 30 September 2005 were studied. Their demographic data, operative and peri-operative details, graft and host survival, and drug compliance are described here. Data were collected from patient records and nursing observation records. Eleven children were transplanted during this period (median recipient age 10.75 yr, range: 8,16). The median age of the donors was 41 yr (range: 38,45) and was the mother in eight, father in two and uncle in one. The median (range) follow-up period following transplantation was 12.5 months (7,12). The vascular anastomotic site was aorta and inferior vena cava in nine patients and the cold ischemia time was mean (s.d.) 1.9 h (0.96). All patients received steroids, cyclosporine and MMF for immunosuppression. Hypotension, heart failure and septicemia were common medical complications. Four were treated for acute rejection. Vascular anastomotic leak, burst abdomen, intestinal obstruction, intra-abdominal leak of supra pubic catheter and vesico-ureteric junction obstruction were surgical complications. There were no graft losses or deaths. Despite limited resources good outcomes are possible following renal transplantation in children in developing countries. [source] Low radiation dose imaging of myocardial perfusion and coronary angiography with a hybrid PET/CT scannerCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 1 2009S. Kajander Summary Objectives:, To test the image quality and feasibility of a sequential low radiation dose protocol for hybrid cardiac PET/CT angiography (CTA). Background:, Multidetector computed tomography (MDCT) is a non-invasive method for coronary angiography. The negative predictive value of MDCT is high but perfusion imaging has a role in detecting functional significance of coronary lesions. This has encouraged combining these techniques. However, radiation dose is of concern. We report our first experiences with a low dose sequential CTA mode applicable to hybrid imaging. Methods:, In the first phase, 10 consecutive cardiac MDCT angiographies were performed with spiral acquisition and compared in terms of image quality and dose with the following 10 patients performed with a new sequential mode. In the second phase, feasibility and radiation dose of a combined 15O-water rest-stress PET perfusion/sequential CTA protocol were assessed in another group of 61 consecutive patients. Results:, Mean effective radiation dose was 60% lower in the sequential group than in the spiral group (19·3 versus 7·6 mSv, P<0·001). In the second phase, the new sequential hybrid protocol proved possible in 87% of the patients given the preconditions determined by the manufacturer. Mean effective dose of the CT acquisition was 7·6 mSv and total dose from the PET/CTA hybrid study 9·5 mSv. Conclusion:, Low dose PET/CT allows cardiac hybrid studies with <10 mSv. The protocol can be applied to almost nine out of 10 patients with CT image quality comparable to spiral acquisition. [source] | |||||||||||||||||||||||||||||||