Comparison of three different techniques of endotracheal tube cuff inflation: just seal, stethoscope guided and pressure volume loop: a prospective randomized study

Background: Cuffed endotracheal tubes not only ensure a proper seal during positive pressure ventilation, but at the same time also prevent aspiration of gastric secretions. The aim of this prospective, randomized study was to compare three methods of ETT cuff inflation-- palpation of the leak in suprasternal notch (Just seal), a stethoscope guided method of tracheal tube cuff inflation and PVL guided cuff inflation.Methods: After approval by institutional ethical committee, 192 patients of either sex in age group of 18-50 years belonging to ASA physical status I or II were enrolled. Each patient was randomly allocated into one of three groups: one group received standard 'just seal' method of tracheal cuff inflation (JS), the second group, the stethoscope-guided method (SG) and in third group cuff was inflated using Pressure Volume Loop (PVL). Volume of air introduced into the cuff and pressure within the cuff was recorded.Results: A total of 192 patients were recruited to the study. The median (IQR [range]) tracheal cuff pressure was 12 (10-22 [6-28]) cm H2O, 16 (12-24[6-38]) and 14 (10-22[8-32]) cmH2O in JS, SG and PVL group respectively. Cuff pressures within the recommended range of 20-30 cm H2O fell in 25% of the patients in both JS and SG group and 31% patients in PVL group. The mean volumes of air introduced in the cuff and the resultant mean cuff pressure in all groups was found to be statistically insignificant (p= 0.4, 0.18 respectively). Tidal volume discrepancy was more and 75% of cuff pressures were less than the recommended range in JS than the other two groups.Conclusions: Real time PVL displayed on most modern anaesthesia machine is a good alternative to check for proper ETT cuff inflation, avoid high cuff pressure and monitor air leak.

The roles of stethoscopes and sphygmomanometers in hospital-acquired infections: a case study of some district hospitals in Enugu state, Southeast Nigeria

Background: Hospital acquired infections (HAIs) are infections that patients acquire while receiving treatments for other conditions. Studies have shown that stethoscopes and sphygmomanometers can act as potential sources of these infections in patients accessing treatment in healthcare facilities. This study aimed to increase awareness among health workers in Nigeria of the potentials of stethoscopes and sphygmomanometers to transmit HAIs.Methods: Moist swab sticks were used to collect samples from 38 randomly selected stethoscopes and sphygmomanometers from some departments of four district hospitals. Collected samples were cultured using standard microbiological techniques. In addition, self-designed questionnaire was used to assess the knowledge and practice of doctors and nurses on the roles of stethoscopes and sphygmomanometers in HAIs.Results: About 83.8% of the health workers demonstrated some awareness of the roles of stethoscopes and sphygmomanometers in HAIs. 42.5% cleaned their stethoscopes, while 5% their sphygmomanometers. Staphylococcus aureus, (65.9% of stethoscopes), proteus mirabilis, Pseudomonas aeruginosa (67.6% of sphygmomanometers), Streptococcus and Coliform species were isolated. There was no significant difference between the contamination of stethoscopes and sphygmomanometers by the isolates, except for Pseudomonas aeruginosa (t=3.49, p=0.04).Conclusions: Awareness did not match practice in cleaning the stethoscopes and sphygmomanometers in the four facilities. Staphylococcus aureus and Pseudomonas aeruginosa were the two most common organisms isolated with a significant difference (t=3.49, p=0.04) between stethoscopes and sphygmomanometers in isolation of Pseudomonas aeruginosa. To curb HAIs, health workers need to improve on their practice of cleaning stethoscopes and sphygmomanometers.

Caracterización y Clasificación de Señales de Auscultación Cervical Adquiridas con Estetoscopio para Detección Automática de Sonidos Deglutorios / Characterization and Classification of Cervical Auscultation Signals Acquired with Stethoscope for Automatic Detection of Swallowing Sound

Resumen: La evaluación automática de sonidos de auscultación cervical (AC) es una herramienta no invasiva para evaluación de la deglución. Sin embargo, los eventos deglutorios pueden verse enmascarados por fuentes de ruido. Este trabajo propone una metodología de caracterización y clasificación de señales de AC con alta resolución temporal a partir de estetoscopio, para discriminar entre sonidos deglutorios y asociados a ruido. Se adquirieron señales de AC en 10 sujetos sanos durante tres pruebas: toma de líquido, pronunciación del fonema /a/ y aclaramiento de garganta. Se extrajeron características de la señal de AC basadas en coeficientes cepstrales en la escala Mel, transformada wavelet discreta y entropía de Shannon. Las características con mayor relevancia fueron utilizadas como entrada a una máquina de vectores de soporte. Utilizando ventanas de 60 ms - alta resolución temporal - y validación cruzada, se obtuvieron exactitudes del 97.7% para detección de eventos acústicos y 91.7% para sonidos deglutorios. El método propuesto permite clasificación de sonidos deglutorios utilizando estetoscopio -dispositivo común en la práctica clínica- con exactitud comparable a otros trabajos que tienen menor resolución temporal o que utilizan otro tipo de sensores. Este trabajo constituye una primera etapa en el desarrollo de un algoritmo robusto para clasificación de sonidos deglutorios asociados a desórdenes de la deglución, a partir de auscultación cervical, para fines de diagnóstico automático.

Abstract: Automatic evaluation of cervical auscultation sounds (AC) is a non-invasive tool for swallowing assessment. However, the swallowing events could be perturbed by acoustic noise. This paper proposes a methodology of characterization and classification of AC signals acquired by stethoscope with high temporal resolution, in order to discriminate between swallowing sounds and other acoustic noise. AC signals from 10 healthy individuals were acquired with stethoscope during three tasks: liquid ingestion, phoneme /a/ pronunciation and throat clearing. Features based in Mel frequency cepstral coefficients, discrete wavelet transform and Shannon entropy, were extracted. Features with highest Fisher's discriminant ratio were used as input of a support vector machine. By application of 60 ms windows and cross validation, the obtained accuracies were 97.7% for acoustic event detection and 91.7% for swallowing sound detection. The proposed method allows classification swallowing sounds with higher temporal resolution­ than other works but with comparable accuracy. Furthermore, the use of stethoscope could lead to better acceptation than other sensors by physicians, because it is a common device in clinical practice. This work is a first stage in the development of a robust classification algorithm for sounds in swallowing disorders, oriented to automatic diagnosis.

Tarjeta de adquisición de datos para el sistema integrado de estetoscopio digital y ECGAR del proyecto SEDAR / Data acquisition card for integrated system of digital stethoscope and ECGAR of SEDAR Project

El artículo presenta el desarrollo de una tarjeta de adquisición de datos (TAD) para uso biomédico. Este diseño forma parte de un sistema que permite realizar un análisis comparativo entre los sonidos cardiopulmonares (SC) y el electrocardiograma de alta definición (ECGAR). La TAD reportada digitaliza simultáneamente tres señales adquiridas. Los dos primeros canales digitalizan las señales correspondientes a las derivaciones dI y dIII del ECGAR. El tercer canal digitaliza la señal captada del SC. El instrumento consta de dos partes, una etapa de hardware para adquirir la señal y un software para la manipulación de datos en la computadora. El hardware está compuesto por un microcontrolador de alto rendimiento, una interfaz de comunicación con la computadora vía USB y los circuitos de seguridad eléctrica inherentes a un equipo médico. El software permite la adquisición de las señales transmitidas desde el hardware, su visualización gráfica y el almacenamiento de la información en una base de datos. Las pruebas de funcionamiento demostraron errores inferiores al 0,1 % en las mediciones de amplitud y no se registró perdida de información en la comunicación con la computadora

The paper reports the development of a data acquisition card (TAD) for biomedical use. This design is part of a system that allows a comparative analysis between cardiopulmonary sounds (SC) and the high-definition electrocardiogram (ECGAR). The reported TAD simultaneously digitizes three acquired signals. The channels 1 and 2 digitize the ECGAR signals corresponding to leads dI and dIII. The channel 3 digitizes to SC captured signal. The instrument consists of two parts, a hardware for acquire the signal and a software for data manipulation in the computer. The hardware consists of a high performance microcontroller, a USB communication interface with the computer and the electrical safety circuits inherent to medical equipment. The software allows the signals acquisition transmitted from the hardware, its graphic visualization and the information storage in a database. The performance tests showed errors less than 0.1 % in amplitude measurements and no loss of information in the communication with the computer

Comparison of domestic infantile type video intubationscope and stethoscope in positioning of double-lumen endobronchial tube / 中国内镜杂志

Objective To compare the effect of the domestic infantile type video intubationscope (VIS) and stethoscope in positioning of double-lumen endobronchial tube (DLT). Methods 100 cases of patients underwent elective thoracic surgery requiring single lung ventilation were randomly divided into two groups: domestic infantile type video intubationscope group (group V) and stethoscope group (group S), with 50 cases in each. After intubating with a DLT, the positions of DLT were judged and adjusted by VIS (group V) and stethoscope (group S) respectively, and then reviewed by fiberoptic bronchoscopy (FOB), the positioning time and accuracy were recorded. Results Comparing with the group S, the positioning time of DLT was significantly shorter and the total positioning accuracy of DLT was significantly higher in group V (P < 0.05). Conclusion It is easy and quickly, high accuracy with domestic infantile type video intubationscope in positioning of DLT, which is worthy of clinical popularization and application.

Comparison of domestic infantile type video intubationscope and stethoscope in positioning of double-lumen endobronchial tube / 中国内镜杂志

Objective To compare the effect of the domestic infantile type video intubationscope (VIS) and stethoscope in positioning of double-lumen endobronchial tube (DLT). Methods 100 cases of patients underwent elective thoracic surgery requiring single lung ventilation were randomly divided into two groups: domestic infantile type video intubationscope group (group V) and stethoscope group (group S), with 50 cases in each. After intubating with a DLT, the positions of DLT were judged and adjusted by VIS (group V) and stethoscope (group S) respectively, and then reviewed by fiberoptic bronchoscopy (FOB), the positioning time and accuracy were recorded. Results Comparing with the group S, the positioning time of DLT was significantly shorter and the total positioning accuracy of DLT was significantly higher in group V (P < 0.05). Conclusion It is easy and quickly, high accuracy with domestic infantile type video intubationscope in positioning of DLT, which is worthy of clinical popularization and application.

La exploración del tórax: una guía para descifrar sus mensajes / Thoracic exploration: a guide to decipher their messages

Resumen La exploración adecuada del tórax tiene una secuencia que ayuda al clínico a seguir varios pasos e integrar sus hallazgos en síndromes, mismos que lo llevarán con más seguridad hacia el diagnóstico más adecuado. Al cumplirse los 200 años de la invención del estetoscopio por René Laënec, tomamos esta oportunidad para recordarlo y detallar los pasos de la exploración del tórax. El hecho de contar con más herramientas tecnológicas para el diagnóstico, no le resta importancia a esta etapa tan importante de la relación entre el médico y su paciente, que es la exploración.

Abstract Thoracic exploration has a sequence of steps that help the clinician to integrate its findings in syndromes, which will lead the physician to better diagnosis. This year the stethoscope, invented by René Laënec, turns 200 years old and we use this opportunity to remember him and provide a detailed description of the thoracic exploration. To have access to more sophisticated diagnostic tools should not diminish the relevance of a direct exploration of the patient, which is a very important step in the patient-physician relationship.

Serendipia: Historias de científicos que revolucionaron la Odontología / Serendipity: stories of scientists who revolutionized dentistry

Resumen Serendipia, una palabra común en la literatura científica en inglés; pero que luego de casi 300 años de su acuñación no ha sido aceptada por la Real Academia Española. En todo caso, se refiere a los descubrimientos realizados por accidente, casualidad o hechos fortuitos, pero siempre detrás de una mente acuciosa, capaz de comprender, explicar y aplicar, eso que algunos llaman accidentes afortunados, que incluyen desde la ley de la gravedad, la invención de la máquina de vapor y muchos otros inventos, incluyendo descubrimientos de uso cotidiano en la odontología. En esta última rama de las ciencias biológicas, se recopila información referente al estetoscopio, la anestesia, los rayos x, la penicilina y los implantes dentales, todos producto de la serendipia.

Abstract Serendipity is an usual word in the English scientific literature; but after almost 300 years the word still is not accepted by the Real Academia Española. However, it means the discovery by accident, chance or fortuity but always behind a diligent mind, capable of comprehend, explain and apply those fortuity accidents, such as the gravity discover, the invention of the vapor machine and others more, including some inventions of daily use in dentistry. In this branch of biological science, we collect information about the stethoscope, anesthesia, x-rays, penicillin and dental implants all of them have occurred by serendipity.

¿Estetoscopio o estafiloscopio?: Potencial vector en las infecciones asociadas a la atención de la salud / Stethoscope or staphyloscope?: Potential vector in nosocomial infections

Healthcare-associated infections (HCAI) are a problem worldwide. In our country, the estimated incidence of HCAI is 70,000 per year. This results in an increase in the average length of hospital stay by 10 days per patient, an estimated annual cost of US $ 70 million and an overstay of 700 thousand bed days a year. For over 30 years stethoscopes have been considered as potential HCAI vectors, since pathogens like methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus strains adhere and colonize them. These organisms can be transmitted between patients if the instruments are not sanitized. Several studies conclude that disinfecting the stethoscope with isopropyl alcohol eliminates up to 99% of bacteria. Simple, economic measures such as implementation of guidelines for stethoscope disinfection are a clear opportunity for preventing infections.

Las infecciones asociadas a la atención de la salud (IAAS) son un problema a mundial. Sólo en nuestro país se estima una incidencia de 70.000 al año, lo que se traduce en un aumento de la estadía hospitalaria en 10 días promedio por paciente, un costo anual estimado en 70 millones de dólares y una sobre-estadía de 700 mil días cama al año. La evidencia señala que diferentes instrumentos de uso hospitalario resultan contaminados por patógenos; entre ellos, el estetoscopio se ha identificado como potencial vector de IAAS hace más de 30 años y adquiere gran relevancia al ser de uso generalizado. Microorganismos patógenos, incluyendo cepas de Staphylococcus aureus resistente a meticilina y cepas de Enterococcus resistente a vancomicina se adhieren y contaminan los estetoscopios, pudiendo transmitirse a otros pacientes si no son desinfectados. Diversos estudios concluyen que la desinfección del estetoscopio con alcohol isopropílico elimina hasta 99% de estas y otras bacterias, por lo que existe una clara oportunidad para aportar a la prevención de las IAAS, interviniendo a través de la implementación de medidas sencillas, económicas y operativas al corto plazo, normando por ejemplo la limpieza del estetoscopio.

The oropharyngeal bleeding after esophageal stethoscope insertion: A case report

The daily insertion of endotracheal tubes, laryngeal mask airways, oral/nasal airways, gastric tubes, transesophageal echocardiogram probes, esophageal dilators and emergency airways all involve the risk of airway structure damage. In the closed claims analysis of the American Society of Anesthesiologists, 6% of all claims concerned airway injury. Among the airway injury claims, the most common cause was difficult intubation. Among many other causes, esophageal stethoscope is a relatively noninvasive monitor that provides extremely useful information. Relatively not many side effects that hardly is ratable. Some of that was from tracheal insertion, bronchial insertion resulting in hypoxia, hoarseness due to post cricoids inflammation, misguided surgical dissection of esophagus. Also oropharyngeal bleeding and subsequent anemia probably are possible and rarely pharyngeal/esophageal perforations are also possible because of this device. Careful and gentle procedure is necessary when inserting esophageal stethoscope and observations for injury and bleeding are needed after insertion.

Estetoscópio: instrumento de diagnóstico e de propagação microbiana? / The stethoscope: is it an instrument for diagnosis orfor microbial dissemination?

O presente artigo teve por objetivo conhecer o potencial de contaminação e disseminação de estetoscópios para infecções relacionadas a serviços de saúde à luz da literatura. A fonte de busca foi a Biblioteca Virtual de Saúde, nas bases de dados Medline, Lilacs e SciELO, realizado no mês de fevereiro de 2015, referente aos anos de 2004 a 2014. Utilizou-se os seguintes critérios de inclusão: teses e periódicos escritos em língua inglesa, espanhola e portuguesa e acessados em texto completo sobre o tema. Foram incluídos nessa revisão 14 artigos. A presença de contaminação e a possível disseminação de micro-organismos pelos estetoscópios foi descrita por todos os estudos analisados. Dessa forma, foi possível identificar que o tema merece maior atenção, já que os estetoscópios podem atuar como vetores para as infecções nosocomiais.

The contamination and dissemination capacity of infections by stethoscopes reported in the literature is analyzed. The Virtual Health Library and databases of Medline, Lilacs and SciELO were used during February 2015 for the 2004 ­ 2014 period. The following inclusion criteria were employed: theses and journals in English, Spanish and Portuguese accessed in full text online. Fourteen articles were included where contamination and possible dissemination of microorganisms by stethoscopes were described. The theme requires deeper attention since stethoscopes may be vectors of hospital infections.

Contaminación bacteriana en estetoscopios de las unidades de cuidados intensivos pediátricos: Hospital Central de San Cristóbal 2012 / Bacterial contamination of stethoscopes in pediatric intensive care units: Hospital Central de San Cristóbal 2012

Las infecciones adquiridas durante los cuidados de la salud (IACS), es un problema importante en Salud Pública. El presente trabajo tiene como objetivo determinar el porcentaje de estetoscopios contaminados con bacterias potencialmente productoras de IACS en las áreas de cuidados intensivos de pediatría y adultos. Se realizó un estudio clínico prospectivo transversal comparativo en la Unidades de Cuidados Intensivos pediátrico, neonatal y adulto del Hospital Central de San Cristóbal. Se tomaron cultivos a 37 instrumentos de los cuales 17 eran estetoscopios (52,9%). Nueve correspondieron a Pediatría y 8 al área de adulto. El tipo de personal que los utiliza representó un riego mayor de contaminación. De los estetoscopios con cultivos positivos el 85,6% venían de pediatría y el 36,4% de adultos; con una Odds ratio de 14.0. Conclusión: Los estetoscopios son una fuente de contaminación bacteriana siendo el área pediátrica un factor de riesgo elevado para su contaminación

Infections acquired during the (IACS) health care, is an important public health problem. This study aims to determine the percentage of stethoscopes contaminated with potentially producing bacteria of IACS in the areas of Pediatric and adult intensive care. A comparative study was conducted clinical prospective cross in the intensive care units paediatric, neonatal and adult of the Central Hospital of San Cristóbal. Cultures were taken at 37 instruments of which 17 (52,9%) were stethoscopes (9 corresponded to Pediatrics and 8 to the adult area). The type of personnel using it represented one major contamination risk. The stethoscopes with positive cultures the 85.6% came from Pediatrics and adults 36.4; with an Odds ratio of 14.0. Conclusion: Stethoscopes are a source of bacterial contamination being the Pediatric area a high risk of contamination of stethoscopes

Hosting the Unwanted: Stethoscope Contamination Threat.

Aims: Stethoscopes represent a vehicle of bacteria and other microorganisms and may play a role in the spread of health-care associated infections (HAIs). We aimed to evaluate the contamination levels of stethoscopes before and after use of a disinfecting technique (DT). Study Design: Matched cross-over study. Place and Duration of Study: The study was conducted in July 2012 and involved three hospitals in Siena Province (Italy). Two were public hospitals with about 750 and 140 beds, and the other was private with 40 beds. Methodology: We evaluated: i) contamination on 74 shared and non shared stethoscopes; ii) bacterial load before and after use of a DT. Total bacterial count (TBC) at 36ºC and 22ºC, Staphylococcus spp., molds, Enterococcus spp., Pseudomonas spp., Escherichia coli and total coliforms bacteria were evaluated. Mann Whitney and Wilcoxon tests were used for comparisons (p<0.05). Results: Before DT, 49 stethoscopes were positive for TBC at 36ºC, 48 for TBC at 22ºC, 40 for Staphylococcus spp., 18 for methicillin-resistant Staphylococcus aureus, 33 for coliforms (9 for Escherichia coli), 5 for Enterococcus spp. and 2 for molds. After cleaning, the percentage reduction in CFUs was close at 100% in most comparisons. Shared stethoscopes proved to be less contaminated than non shared ones (p<0.05). Conclusion: Our results suggest that stethoscopes may be potential vehicles of HAIs. The DT was effective in reducing bacterial contamination.

Survey on the current status of stethoscope cleaning and disinfection of medical staff in a tertiary hospital / 中国实用护理杂志

Objective To investigate the current status and influencing factors of stethoscope cleaning and disinfection of medical staff in a tertiary hospital.Methods With simple random sampling,168 medical staff of a tertiary hospital were recruited and surveyed using a self-designed questionnaire.Results 4.88％ of the respondents never cleaned or disinfected stethoscopes,73.17％ of them used alcohol cotton to wipe stethoscopes.After cleaning or disinfecting stethoscopes,83.54％ used natural drying method.Only 33.53％ respondents stored stethoscopes in clean bags or containers while not using them.The mean of respondents' scores of stethoscope cleaning and disinfection was (20.42±3.07)points.There were significant differences in scores of stethoscope cleaning and disinfection between different occupations.However,there were no significant differences among different age groups or different departments.Conclusions The current status of stethoscope cleaning and disinfection of medical staff is not satisfactory.It is imperative for medical staff to improve the drying and storage method and promote their compliance with stethoscope cleaning and disinfection.Appropriate interventions should be taken aiming at the influencing factors of stethoscope cleaning and disinfection.

Microorganismosppresentes en fonendoscopios, maos, cavidad oral y nasal de esttudiantes de una facultad de medicina / Microorganiss inn stethoscopes, hands,oral ad nasal cavity from students inn a school of medicine / Microorganimos ppresentes em estetoscópios, mãos, cavidade ral e nasal de estudantes de uma faculdade de medicnaa

La formación académica de estudiantes de medicina implica interacción con pacientes y superficies del entorno hospitalario, los microorganismos presentes allí pueden ser adquiridos y transmitidos con los riesgos consecuentes para la comunidad hospitalaria. El presente es un estudio descriptivo cuantitativo donde se analizan muestras provenientes de estudiantes de medicina (n= 155) en rotaciones de 3 semanas, tomando hisopados de nariz, boca, manos y fonendoscopio, gram y cultivo en agar sangre, incubación 24 horas a 37°C y 5% de CO2. Se hizo la identificación mediante gram y pruebas de biotipificación convencionales y susceptibilidad antibiótica según técnica de kirbybauer. Los hallazgos aquí presentados evidencian alta frecuencia de bacterias patógenas en las fuentes de aislamiento, siendo relevante la presencia del Staphylococcus aureus en un 41,7% y la resistencia a antibióticos tanto por gram positivos como por gram negativos; por tanto, es de considerar la implementación de estrategias que minimicen la circulación de estos microorganismos en el ambiente hospitalario. El objetivo de este estudio es establecer la frecuencia de los microorganismos aislados en estudiantes de una Facultad de Medicina.

The academic training of medical students involves interaction with patients, where microorganisms in contact with different surfaces can be acquired and transmitted with the consequent risk to the community hospital.This is a quantitative descriptive study on students of medicine (n = 155) with clinic rotations of 3 weeks, swabs were taking from the nose, mouth, hands and stethoscope, following by gram and blood agar cultures, incubation 24 hours at 37° C and 5% CO2, final Identification was performed by gram, biotyping tests and antibiotic susceptibility by kirbybauer technique.The findings presented here show high frequency of bacterial pathogens in source isolation, to be relevant the presence of Staphylococcus aureus in 41.7% and resistan cetoantibiotics both grampositive andgramnegative, therefore is to consider the implementation of strategies to minimize the movement of these microorganisms in the hospital environment.The objective of this study is to establish the frequency of microorganisms isolated from students at a medical school.

A formação acadêmica dos estudantes de medicina implica interação com pacientes e superfícies do entorno hospitalar, os microorganismos presentes ali podem ser adquiridos e transmitidos com os riscos consequentes para a comunidade hospitalar. O presente é um estudo descritivo quantitativo onde foram analisadas amostras provenientes de estudantes de medicina (n= 155) em rotações de 3 semanas, colhidas do nariz, da boca, das mãos e de estetoscópios, gram e cultivo em ágar sangue, incubação 24 horas a 37°C e 5% de CO2, foi feita a identificação mediante gram e testes de biotipificação convencionais e suscetibilidade antibiótica segundo técnica de kirbybauer. Os descobrimentos aqui apresentados evidenciam alta frequência de bactérias patógenas nas fontes de isolamento, sendo relevante a presença do Staphylococcus aureus em 41,7% e a resistência a antibióticos tanto por gram positivos como por gram negativos; portanto, é necessário considerar a implementação de estratégias que minimizem a circulação destes microorganismos no ambiente hospitalar. O objetivo deste estudo foi estabelecer a frequência dos microorganismos isolados em estudantes de uma Faculdade de Medicina.

How to measure Blood Pressure

Correct measurement of blood pressure is essential in the diagnosis and management of hypertension. Having a blood pressure machine with the proper-sized cuff is crucial, as are the correct procedural steps in taking the reading. This article outlines the steps in measuring blood pressure, to ensure that accurate readings are taken.

A história do estetoscópio e da ausculta cardíaca / The history of the stethoscope and cardiac auscultation

Este trabalho apresenta os principais fatos e acontecimentos relacionados ao desenvolvimento do estetoscópio e à história da ausculta cardíaca. Destaca o papel e contribuição de diversas personalidades do campo científico, apresenta o estetoscópio em seus variados modelos históricos e sumariza as descobertas realizadas pelo método antes e depois da invenção desse instrumento. Aborda, ainda, a ausculta e o estetoscópio no contexto do exame físico e da construção da relação médico-paciente.

This paper reports the major facts and events related to the stethoscope development and the history of cardiac auscultation. It describes the role and contribution of several scientists, presents the several historical models of stethoscopes, and summarizes the discoveries relying on the auscultation method both before and after the invention of the stethoscope. It also approaches auscultation and stethoscope within the context of physical examination and physician-patient relationship

Frecuencia de colonización de Staphylococcus Aureus Meticilino - Resistente, de Enterobacterias y de Candida spp. en estetoscopios y teléfonos móviles en una Unidad de Cuidados Intensivos Neonatal / Frequency of colonization of methicillin-resistant Staphylococcus Aureus, Enterobacteria and Candida Spp. in stethoscopes and cellular phones, inside a Neonatal Intensive Care Unit

Resultados: se encontró un 80% de los estetoscopios contaminados, con una mediana de colonización de 2.58 Unidades Formadoras de Colonias (UFC)/cm2 y un 100% de los teléfonos móviles contaminados con una mediana de 0.401 UFC/cm2. En estetoscopios se aislaron SAMR (n=3) y Enterobacterias resistentes a cefalosporinas de tercera generación (n=2). En teléfonos móviles se aislaron SAMR(n=1), Candida spp (n=1) y Enterobacterias (n=5). La encuesta permitió establecer una tendencia de hábitos de higiene inapropiados sobre el uso de los fómites. Conclusiones: el hallazgo de bacterias resistentes en estos fómites los convierte en fuentes potenciales de transmisión cruzada y de brotes de infección intrahospitalaria. Estos resultados deben orientar el desarrollo de protocolos para el uso racional de dispositivos médicos y tecnología portátil dentro de ambientes hospitalarios.

Results: 80% of the stethoscopes (n=40) were found contaminated with a median count of 2,58 CFU/cm2 meanwhile 100% of cellular phones where found contaminated with a median count of 0,401 CFU/cm2. MRSA (n=3) and third generation cephalosporin-resistant Enterobacteriaceae (n=2) were isolated from stethoscopes, whereas in cellular phones MRSA (n=1), Candida (n=1) and third generation cephalosporin-sensitive Enterobacteriaceae (n=5) where found. Survey results indicated a trend towards inappropriate hygiene habits with fomites; however no statistical correlation could be established between these habits and colonization. Conclusion: The finding of nosocomial pathogens in these fomites transforms them in potential sources of crosscontamination and hospital-acquired infections outbreaks. Present results must steer development of protocols for rational use of medical devices and portable technology gadgets within hospital controlled environments.

Contamination status and cleaning frequency of stethoscopes in community health institutions / 中华全科医师杂志

Stethoscope diaphragms were sampled randomly for bacteria culture and identification from nursing and medical staff in 3 community health institutions in Zhongshan city. Anonymous filling in questionnaire was taken for investigating frequency of cleaning stethoscope by staff. A total of 100 stethoscope diaphragms were sampled, and a total of 523 bacteria strains were isolated. Eighty-six percent of stethoscopes surveyed were contaminated with bacteria, among the isolated organisms, G+ bacteria and G-bacteria accounted for 78% and 22% respectively. The Bacterial contamination rate and G- rate of stethoscopes used by inpatient staff were 6. 2 strains and 2. 1 strains per stethoscope respectively, which were significantly higher than those used by outpatient staff (4. 8 strain and 1. 1 strain per stethoscope, P ＜0. 05 and P < 0. 01, respectively). A total of 105 questionnaires showed that 21% (6/28) of nursing staff cleaned stethoscope monthly, meanwhile 12% (7/56) of outpatient medical staff and 14% (3/21) of inpatient medical staff (P ＜0. 01) did so; 29% (8/28) of nursing staff cleaned their stethoscopes once a year or never, meanwhile, the figures for outpatient and inpatient medical staff were 55% (31/56) and 57% (12/21) respectively (P ＜0. 01). Results indicate that there is high rate of bacterial contamination in stethoscopes, and G- is more frequently found in stethoscopes used by inpatient staff than outpatient. In general, the frequency of stethoscope cleaning is low, however, more frequently for nursing staff than medical staff.