Fragilidades na atenção ao potencial doador de órgãos: percepção de enfermeiros / Weaknesses in the care for potential organ donors: the perception of nurses / Deficiencias en la atención al potencial donante de órganos: la percepción de los enfermeros

Resumo Objetivou-se conhecer a percepção de enfermeiros sobre fragilidades na atenção ao potencial doador de órgãos. Trata-se de estudo exploratório-descritivo, com abordagem qualitativa, envolvendo oito enfermeiros de hospital de referência. Entrevista semiestruturada foi utilizada e os resultados foram analisados conforme a técnica de análise do discurso. Emergiram duas categorias: "percepção dos enfermeiros sobre o trabalho com potenciais doadores de órgãos" e "fragilidades na atenção aos potenciais doadores". Verificou-se atuação limitada no âmbito da organização de procura de órgãos. Entraves envolvem recursos humanos e financeiros, recusa familiar, elevado tempo de espera por exames e problemas estruturais. Assim, o trabalho nesta comissão está limitado a ações assistenciais, em detrimento das gerenciais. Os profissionais percebem fragilidades e temem interferência negativa. Há que se investir em estrutura e educação permanente para que isso se reflita em melhor atenção ao potencial doador e sua família.

Abstract This study aimed to get to know the perception of nurses about weaknesses in the care for potential organ donors. This is an exploratory-descriptive study with a qualitative approach, involving eight nurses from a reference hospital. It used semi-structured interviews and the results were analyzed according to discourse analysis. Two categories emerged: "perception of nurses on working with potential organ donors" and "weaknesses in the care for potential donors". There is a limited role of the organ procurement organization. The barriers involve human and financial resources, family refusal, long wait for test results and structural problems. The work of this committee is limited to health care activities, in detriment of management. The professionals perceive weaknesses and fear negative repercussions. One must invest in structure and continuing education for this to be reflected in better care to potential donors and their family.

Resumen Este estudio tuvo como objetivo conocer la percepción de los enfermeros sobre las deficiencias en la atención al potencial donante de órganos. Se trata de estudio exploratorio-descriptivo con enfoque cualitativo, con la participación de ocho enfermeros de un hospital de referencia. Se utilizaron entrevistas semiestructuradas y los resultados fueron analizados siguiendo la técnica de análisis del discurso. Emergieron dos categorías: "percepción de los enfermeros sobre el trabajo con potenciales donantes de órganos" y "deficiencias en la atención a los posibles donantes". Fue identificada actuación limitada en el ámbito de la organización de búsqueda de órganos. Los obstáculos están relacionados con los recursos humanos y financieros, la negativa de la familia, los prolongados tiempos de espera de resultados de exámenes y problemas estructurales. Por lo tanto, el trabajo de este grupo se limita a acciones asistenciales, en detrimento de las de gestión. Los profesionales perciben las deficiencias y temen una interferencia negativa. Es necesario invertir en la estructura y en la formación permanente para que esto se refleja en una mejor atención al donante potencial y a su familia.

Non-invasive positive pressure ventilation versus invasive pressure support ventilation for post extubation respiratory distress in patients recovered from respiratory failure

Respiratory failure after a planned extubation is reported to be a common event, leading to reintubation and can occur in as many as 3-20% of extubated patients. It is crucial to identify the right time to extubate a patient, since re-intubation after pre-term extubation is associated with an increased risk for nosocomial pneumonia, prolonged intensive care unit [ICU] stay and death, and also accounts for substantially increased costs. This study was planned to assess the effectiveness of non-invasive pressure support ventilation [NIPPV] as a weaning technique in patients who develop respiratory distress after discontinuation of mechanical ventilation and extubation in comparison with conventional weaning through invasive pressure support ventilation. This is a randomized controlled study, sixty patients with either type I or II respiratory failure who developed post extubation respiratory failure were enrolled; they were randomly divided into two groups to receive either NIPPV or invasive pressure support ventilation. The primary outcome measure was the technique outcone; secondary outcome measures were incidence of complications, hemodynamic parameters, arterial blood gas parameters, ventilator parameters and length of ICU stay. Despite a longer time to failure observed with invasive pressure support ventilation, no statistically significant differences were observed in success rate, hemodynamic, and arterial blood gas parameters, although incidence of complications differs greatly according to the technique used. In a heterogonous group of patients; NIPPV is not superior to invasive pressure support ventilation in patients who developed post-extubation respiratory distress after successful weaning

Extracorporeal life support for acute respiratory distress syndrome

The morbidity and mortality of acute respiratory distress syndrome remain to be high. Over the last 50 years, the clinical management of these patients has undergone vast changes. Significant improvement in the care of these patients involves the development of mechanical ventilation strategies, but the benefits of these strategies remain controversial. With a growing trend of extracorporeal support for critically ill patients, we provide a historical review of extracorporeal membrane oxygenation [ECMO] including its failures and successes as well as discussing extracorporeal devices now available or nearly accessible while examining current clinical indications and trends of ECMO in respiratory failure

The Mortality of Serving African Presidents: A Lesson for the Health Profession and the Lay Public

Although Africa has the worst mortality data in the world; the picture painted by the high mortality rate of serving Africa leaders in the last five years suggests reasons and causes far beyond poor socio-economic conditions. This study examined the causes and age at death of serving African leaders; in the last five years; and draws out the lessons; for the health profession and the general public.Material and methods: An internet search of creditable websites was carried out to determine the number; causes and age at deaths of the leaders; within the study period of 2008 to 2012. The life expectancy rates of the bereaved countries were also considered.Results: A total of 13 presidential mortalities took place in the world during the study period; with 10 (76.92) involving serving African leaders. The leaders died at an average age of 66.9 +/- 7.22 years; an average of 12.1 years above the life expectancy rate of their respective countries; but less than the world average of 68 years. Most (80.00) of the leaders died from non-communicable diseases; 3 died from cardiovascular diseases; 3 died from cancer; while two were known diabetics. The remaining two leaders were killed in a violent change of government.Conclusion: The African leaders died mainly from non-communicable diseases; at an age that is below the world average. Public enlightenment campaigns and greater emphasis on patient-centered chronic care of non-communicable diseases are hereby recommended

Cuidar de pacientes em prolongamento artificial da vida: concepção das enfermeiras / Caring for patients on artificial prolongation of life: development of nurses

A morte continua sendo um fenômeno que as pessoas têm medo e tentam, de toda forma, negá-la, resistindo falar abertamente. As enfermeiras, mesmo àquelas que trabalham em Unidade de Terapia Intensiva, vivenciam constantemente situações de dor e perda pela morte, mesmo assim, não é com naturalidade que esta é vista. Os tratamentos dispensados aos pacientes fora de possibilidade de cura, nessas unidades, continuam sendo ostensivos, gerando conflitos na equipe multiprofissional. Esta pesquisa, de caráter exploratório-descritivo, com abordagem qualitativa, teve como objetivo analisar a concepção das enfermeiras sobre o cuidado de pacientes em prolongamento artificial da vida em UTI. Foi desenvolvido em UTI de um hospital público de grande porte da cidade de Salvador. Foram entrevistadas dezessete enfermeiras e, para análise dos dados foi utilizado a análise de conteúdo temática. Os principais achados se dividiram em três categorias, sendo estas: Percebendo o processo de morte-morrer, Percebendo o cuidado diante da perspectiva da morte e Percebendo a obstinação terapêutica. Conclui-se que as enfermeiras desenvolvem uma cuidado sem demonstrar envolvimento emocional, considerado mais como um cuidado técnico, acreditando que a vida tem um fim e que deve-se existir uma limitação nas condutas e na terapêuticas pois para elas o prolongamento artificial da vida é, tão somente, fonte geradora de sofrimento para o paciente e família.(AU)

The In-hospital Clinical Outcomes of Extracorporeal Life Support after Adult Cardiovascular Surgery / 대한흉부외과학회지

BACKGROUND: We analyzed the clinical results and the factors for survival of patients who underwent extracorporeal life support system after adult cardiovascular surgery. MATERIAL AND METHOD: We retrospectively reviewed the medical record of 44 patients (1.6% of the total adult cardiovascular surgical cases) who underwent the use of a ventricular assisted device or extracorporeal membrane oxygenation from January 2002 to August 2008. There were 32 (72.7%) males and their mean age was 61.7+/-14.9 (range: 20~73) years old. The mean duration of extracorporeal life support system was 5.3+/-3.0 (range: 1~12) days. RESULT: Of these 44 patients, 24 (54.5%) patients were successfully weaned from the extracorporeal device. Eighteen (40.9%) survivors were able to be discharged from the hospital. Complications were noted in 38 patients (86.4%). An emergency operation, no usage of a concomitant intraaortic balloon pump and major complications during use of the extracorporeal life support system such as bleeding, flow instability and renal failure were identified as significant risk factors for poor survival on univariated analysis. Owing to educational support and a continuous renal replacement therapy system, the clinical outcomes of these patients have improved since 2006. On multivariated analysis, renal failure and bleeding during extracorporeal life support were significant risk factors for poor survival. CONCLUSION: Although using extracorporeal life support systems after adult cardiovascular surgery revealed acceptable clinical results, determining the optimal treatment strategy and further well designed larger studies are needed to improve the survival rate of patients who undergo extracorporeal life support after adult cardiovascular surgery

Current Mechanical Circulatory Support Devices for End Stage Heart Failure

Mechanical circulatory support is necessary when heart failure becomes refractory to medical support. It is typically instituted when organ dysfunction occurs as a result of hypoperfusion. Enthusiasm has recently developed for the role of mechanical circulatory support in the ever-growing population of heart failure patients. Indeed, efforts in developing this technology have allowed for the relatively recent development of a variety of complete circulatory support devices. The use of left ventricular assist devices (LVADs) in patients with advanced heart failure results in a clinically meaningful survival benefit and an improved quality of life, and LVADs could be an acceptable alternative therapy for selected patients who are not candidates for cardiac transplantation.

Eugenesia social en tiempos del genoma: intervenciones totalitarias del poder / Social eugenism in times of genome: About powers totalitarian interventions

En estos tiempos la dimensión Biopolítica está caracterizada por la eugenesia social. Es el estado deexcepción permanente al cual están sometidos los conjuntos poblacionales. El nuevo aforismo deestos tiempos amplia el presupuesto foucaultinao por "hacer vivir/dejar morir en vida". Implica por unlado estirar la vida, racionalizar al extremo el cuidado de sí, gestionar privadamente los riegos; por elotro se fomenta la "muerte en vida"1 mediante agendas de desigualdad al cual están sometidas laspoblaciones. Se trata de caracterizar el a-bandono del poder que somete con violencia y condena ala in- dignidad de vivir en condiciones mínimas de sobrevivencia respuestas homogenizadoras,desingularizadas. Este modelo biopolítico corresponde al formato del ciudadano adaptado: todociudadano adaptado es igual a otro, reemplazable, dependiente del mercado en el consumo o delEstado cuando es sometido a una declaración oficial de improductividad que legítima de este modoa las políticas sociales. El ejercicio del poder se ejerce con violencia e impunidad pues somete a la in-dignidad, discrimina, extermina pero no comete ni pena ni es juzgado; delinea una imagen masificada,desubjetivada del hombre; coloca a las poblaciones en un umbral de indiferenciación - entre eladentro y el afuera, entre la inclusión y la exclusión, entre exterior e interior. Por ejemplo la salud esuna estrategia biopolítica de segregación; promueve el bienestar, el logro de mejor calidad de vida,el cuidado de "sí". Pero es inequitativa por cuanto la brecha social se amplia cada vez más y elacceso a la atención compromete recursos y gastos de bolsillo de la población. Del mismo modo lasagendas de los Estados son restrictivas a la hora de financiar en el tiempo los crecientes costos queimplican las enfermedades crónicas en contextos de pobreza; los costos que implica la medicinabiológica - estrategias de intervención genéticas para prolongar la vida: clonación, técnicas deinseminación artificial- son restrictivas y por lo tanto no son accesibles masivamente

Nowadays, the biopolitical dimension is characterized by social eugenism: a permanent exceptionstate populations are submitted to. Nowadays, a fresh aphorism widens Michel Foucault'spostulate with "let make people live / let people dying alive". This implies stretching life out,rationalizing one's own care extremely, managing risks privately, on the one hand. On theother hand, "death in life" is encouraged through inequality-based plans aiming at crushingpopulations down. So, the idea is characterizing the abandonment of a power devoted tosubmitting through violence, and sentencing people to the indignity ­i.e. living within minimumsurvival conditions, under homogenized, de-singularized ukases. Such a biopolitical modelresponds to the format of an adapted citizen: every adapted citizen is just the same as anotheradapted citizen, they are replaceable, they depend on the market, as far as consumption isconcerned, or they are State-dependent inasmuch as they are subjected to an official statement ofunproductiveness, aimed at legitimizing social policies. Power is exerted through both violenceand impunity inasmuch as power submits people to indignity, power discriminates, exterminatesbut does not commit any crime ­thus, power is neither tried nor sentenced. Power traces a massimage, a de-subjectived image of humans. Power places populations on the threshold ofindifferentiation ­between inside and outside, between inclusion and exclusion, between innerand outer. Let us take an example: health has become a segregation-aimed biopolitical strategyfavoring well-being, a longing for a better quality of life, taking care of oneself. However this isnot an equitable process inasmuch as the social gap widens more and more, and having access tocare services is attacking people's resources and pocket money more and more. At the sametime, States' activities are restrictive when it comes to financing over time costs caused bychronic diseases within a poverty-ridden context as well as the biological medicine costs ­suchas genetic intervention strategies aimed at extending life, clonation, artificial insemination, allthese are restricted processes ­thus, impossible to be attained at massively

Pattern of toy bomb injuries in Azad Jammu and Kashmir [a hospital based study]

An observational, hospital based study was conducted at CMH, Muzaffarabad to see the pattern of Toy Bomb blast injuries in a period from 1st Jan 2002 to 31st Dec 2003. On an incidence of Toy Bomb Blast injuries, patients reporting to a hospital in Azad Jammu and Kashmir [AJandK] were the core study material for this article. To study the pattern of injuries and their consequences in the studied population. Patients reporting to the hospital with history of toy bomb blast injuries were examined evaluated and followed up. Documents of patient with similar injuries in past treated in the hospital were also included in the study. A checklist guided the follow up of the patients from the incidence that triggered the study. The patients were scrutinized/evaluated according to Advanced Trauma Life Support [ATLS] system of trauma care. Altogether 48 patients record was checked. The age ranged from 1 - 63 years [majority of the patients [80%] were male below 13 years of age], 38 [79%] cases sustained major trauma with multiple injuries of head/neck, maxillofacial, chest, Abdomen and all four limbs. Twenty-four cases [50%] had permanent disabilities. Mortality rate was 20%. Wound infection was very high [60%]. The major complications were depending upon the organ involved/injured. This study points to the need for further studies of this unique method of causation of injuries [toy bomb blast injuries], the pattern they evoke and possible handling of such eventualities. It is desired that at one end the community must be informed and educated about the type, shape, injuries and prevention of the toy bomb casualties and on the other end quick evacuation and proper management of cases be ensured

Culture of Spirulina platensis in human urine for biomass production and O(2) evolution / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Attempts were made to culture Spirulina platensis in human urine directly to achieve biomass production and O(2) evolution, for potential application to nutrient regeneration and air revitalization in life support system. The culture results showed that Spirulina platensis grows successfully in diluted human urine, and yields maximal biomass at urine dilution ratios of 140 approximately 240. Accumulation of lipid and decreasing of protein occurred due to N deficiency. O(2) release rate of Spirulina platensis in diluted human urine was higher than that in Zarrouk medium.

Life Support Systems in Terms of Energy

BACKGROUND: The pro's and con's of pulsatile versus nonpulsatile perfusion during acute and chronic mechanical circulatory support is a longstanding controversial issue, some investigators have suggested that the simplest explanation for this controversy is a failure to quantitate adequately the pulsatile components of flow in studies. The aim of this study was to examine the pulsatility generated by centrifugal pump (CP) and a pulsatile extracorporeal life support (twin pulse life support, T-PLS) in terms of energy equivalent pressure (EEP) and surplus hemodynamic energy (SHE). METHODS: In each of the 5 cardiac arrested pigs, the outflow cannula of the CP or T-PLS was inserted into the ascending aorta, and the inflow cannula of the CP or T-PLS was placed in the right atrium. Extracorporeal circulation was maintained for 30 minutes using a pump flow of 75 ml/kg/min by CP or T-PLS, respectively. Pressure and flow were measured in the right internal carotid artery. RESULTS: No statistical difference was observed between CP and T-PLS in terms of mean carotid artery pressure. However, pulse pressure, the percent change from mean arterial pressure to EEP, and SHE in T-PLS were higher than CP (pulse pressure: 36.1 +/- 3.6 mmHg vs 9.1 +/- 1.3 mmHg, P < 0.05, the percent change from mean arterial pressure to EEP: 19.8 +/- 6.2% vs 0.2 +/- 0.3%, P < 0.05). CONCLUSIONS: In a cardiac arrested animal model, CP revealed nonpulsatility and pulsatility generated by T-PLS was effective in terms of EEP and SHE.

A Study of Optimal Model for the Circuit Configuration of Korean Pulsatile Extracorporeal Life Support System (T-PLS) / 대한흉부외과학회지

BACKGROUND: We have hypothesized that, if a low resistant gravity-flow membrane oxygenator is used, then the twin blood sacs of TPLS can be located at downstream of the membrane oxyenator, which may double the pulse rate at a given pump rate and increase the pump output. The purpose of this study was to determine the optimal configuration for the ECLS circuits by using the concept of pulse energy and pump output. MATERIAL AND METHOD: Animals were randomly assigned to 2 groups in a total cardiopulmonary bypass model. In the serial group, a conventional membrane oxygenator was located between the twin blood sacs. In the parallel group, the twin blood sacs were placed downstream of the gravity-flow membrane oxygenator. Energy equivalent pressure (EEP) and pump output were collected at pump-setting rates of 30, 40, and 50 BPM. RESULT: At the given pump-setting rate, the pulse rate was doubled in the parallel group. Percent changes of mean arterial pressure to EEP were 13.0+/-1.7, 12.0+/-1.9 and 7.6+/-0.9% in the parallel group, and 22.5+/-2.4, 23.2+/-1.9, and 21.8+/-1.4% in the serial group at 30, 40, and 50 BPM of pump-setting rates. Pump output was higher in the parallel circuit at 40 and 50 BPM of pump-setting rates (3.1+/-0.2, 3.7+/-0.2 L/min vs. 2.2+/-0.1 and 2.5+/-0.1 L/min, respectively, p=0.01). CONCLUSION: Either parallel or serial circuit configuration of the ECLS generates effective pulsatility. As for the pump out, the parallel circuit configuration provides higher flow than the serial circuit configuration.

Application of a Single-pulsatile Extracorporeal Life Support System for Extracorporeal Membrane Oxygenation: An experimental study / 대한흉부외과학회지

BACKGROUND: Extracorporeal life support (ECLS) system is a device for respiratory and/or heart failure treatment, and there have been many trials for development and clinical application in the world. Currently, a non-pulsatile blood pump is a standard for ECLS system. Although a pulsatile blood pump is advantageous in physiologic aspects, high pressure generated in the circuits and resultant blood cell trauma remain major concerns which make one reluctant to use a pulsatile blood pump in artificial lung circuits containing a membrane oxygenator. The study was designed to evaluate the hypothesis that placement of a pressure-relieving compliance chamber between a pulsatile pump and a membrane oxygenator might reduce the above mentioned side effects while providing physiologic pulsatile blood flow. MATERIAL AND METHOD: The study was performed in a canine model of oleic acid induced acute lung injury (N=16). The animals were divided into three groups according to the type of pump used and the presence of the compliance chamber. In group 1, a non-pulsatile centrifugal pump was used as a control (n=6). In group 2 (n=4), a single-pulsatile pump was used. In group 3 (n=6), a single-pulsatile pump equipped with a compliance chamber was used. The experimental model was a partial bypass between the right atrium and the aorta at a pump flow of 1.8~2 L/min for 2 hours. The observed parameters were focused on hemodynamic changes, intra-circuit pressure, laboratory studies for blood profile, and the effect on blood cell trauma. RESULT: In hemodynamics, the pulsatile group II & III generated higher arterial pulse pressure (47+/-10 and 41+/-9 mmHg) than the nonpulsatile group I (17+/-7 mmHg, p<0.001). The intra-circuit pressure at membrane oxygenator were 222+/-8 mmHg in group 1, 739+/-35 mmHg in group 2, and 470+/-17 mmHg in group 3 (p<0.001). At 2 hour bypass, arterial oxygen partial pressures were significantly higher in the pulsatile group 2 & 3 than in the non-pulsatile group 1 (77+/-41 mmHg in group 1, 96+/-48 mmHg in group 2, and 97+/-25 mmHg in group 3; p<0.05). The levels of plasma free hemoglobin which was an indicator of blood cell trauma were lowest in group 1, highest in group 2, and significantly decreased in group 3 (55.7+/-43.3, 162.8+/-113.6, 82.5+/-25.1 mg%, respectively; p<0.05). Other laboratory findings for blood profile were not different. CONCLUSION: The above results imply that the pulsatile blood pump is beneficial in oxygenation while deleterious in the aspects to high pressure generation in the circuits and blood cell trauma. However, when a pressure-relieving compliance chamber is applied between the pulsatile pump and a membrane oxygenator, it can significantly reduce the high circuit pressure and result in low blood cell trauma.

Utilization of spaceflight technology on medicinal plant study / 中国中药杂志

Utilization of spaceflight technology will benefit the modernization of Traditional Chinese Medicine study. Many countries, such as USA or Russia, have conducted extensive experimental research with plants in the regenerative life-support system in space stations as well as the research on breeding or chromosomal aberration after spaceflight. The space botany is still in its preliminary stage in our country. Research has mainly been focused on breeding under space-environment. In addition, many experiments have been conducted with the spaceflown plants to investigate the growth, development, biochemical and physiological changes, as well as the inheritance and variation. Little has been done with regard to the facility development to contain the spaceflying seeds and no research has been reported on plant growth in spacecrafts. Medicinal plant study has certain characteristics and advantages in our country where small biological vessels are developed for the spaceflown seeds, which are then distinguished to microgravity group and radiation exposed group with analytical instrument. However, research has been carried out in medicinal plant breeding or inheritance. In future research, more effort should be directed to the study of medicinal plants as an important link of a future biological life support system as well as to the health care of astronauts by.

Short-term Mechanical Circulatory Support with Centrifugal Pump in Cardiac Arrest or Cardiogenic Shock: Report of 5 cases / 대한흉부외과학회지

Mechanical circulatory support (MCS) has been used for myocardium failure, but moreover, it may be essential for the life support in cardiac arrest or cardiogenic shock. Many commercial devices can be used effectively for the long-term support. However, there are some limitations in the aspects of the cost and technical support by production company. Short-term support with centrifugal type has been reported numerously with the purpose of bridging to heart transplantation or recovery. We successfully treated 5 patitents who were in the status of cardiogenic shock (n=3) or arrest (n=2) with the technique of extracorporeal life support system (ECLS) or left ventricular assist device (LVAD) using the centrifugal type pump. The MCS were performed emergently (n=2) under cardiac arrest caused by ischemic heart disease, and urgently (n=3) under cardiogenic shock with ischemic heart disease (n=1) or acute fulminant viral myocarditis (n=2). All patients were weaned from MCS. Complications related to the use of MCS were bleeding and acute renal failure, but there were no major complications related to femoral cannulations. Mechanical circulatory support may be essential for the life support and rescue in cardiac arrest or cardiogenic shock.

Effects of an Extra-corporeal Life Support System Using a Dual Pulsatile Pump

PURPOSE: The purpose of this study was to observe and compare the changes in the patterns of hemodynamic and blood profiles on the circuit of Extra-corporeal life support system (ECLS) by using a dual pulsatile pump (T-PLS). METHODS: An acute heart failure model using partial pulmonary artery banding was constructed in 12 piglets (20 -25kg). The animals were divided into centrifugal (n=6) and dual pulsatile pump (n=6) group. Each animal was placed on an ECLS system with a membrane oxygenator bypassing the right atrium and the aorta for 2 hours under general anesthesia. The parameters mainly observed were intra-circuit pressure changes, arterial pulsatility (pulse pressure), plasma free hemoglobin, hemodynamic changes, and other blood profiles. The parameters obtained just prior to the bypass were compared with the corresponding parameters obtained two hours after the bypass. RESULTS: Before bypass, the parameters were statistically the same between the groups. Two hours after the bypass, no significant differences were observed between the groups in ABGA, VBGA, AST/ALT, BUN/Cr, and electrolytes; the plasma free hemoglobin was 14.8+/-4.7 g/dl in the dual pulsatile group and 19.1+/-9.1 g/dl in the centrifugal group (p=NS). The pulse pressure was higher in the dual pulsatile pump than in the centrifugal pump group (35+/-8 vs. 11+/-7 mmHg, p=0.0253 mmHg). The highest circuit pressure was generated at the inlet of the membrane oxygenator and was higher in the dual pulsatile group than in the centrifugal group (173+/-12 mmHg vs. 222+/-8 mmHg, p=0.0000). CONCLUSION: The results demonstrate that a dual pulsating mechanism lessens blood cell trauma while providing physiologic pulsatile blood flow. The ECLS system using a dual pulsatile pump (T-PLS) can be useed as an effective and safe driving motor for an ECLS.

Perceptions on bioethics among general practitioners in Karachi, Pakistan

To study the perceptions on bioethics among general practitioners in Karachi, Pakistan. A questionnaire based cross sectional survey. 85 general practitioners in Karachi were surveyed at their clinic premises. Main outcome measures: Perceptions on the broad principles of bioethics. The majority of general practitioners were males, with mean age of 36.3 years, had minimal postgraduate qualifications and continuing medical education. They reported the top five moral duties of a physician and their reaction in the event of the death of a close relative due to a doctor's negligence. A significant number of respondents agreed that a 'doctor is next to God'. Other issues studied include discontinuation of artificial life support, giving of gifts by pharmaceutical companies to doctors, sickness certification, organ donation, human cloning, disclosure of information to cancer patient and patient confidentiality. We have documented the perceptions of general practitioners on broad principles of bioethics. These views have significant implications for medical practice