Application of evidence-based nursing in blind intubation of helico-nasointestinal tube in patients with stroke-associated pneumonia in intensive care unit / 中华临床营养杂志

Objective To study the effect of evidence-based nursing in patients with cerebral apoplexy in ICU by blind bedside spiral nasointestinal tube application.Methods To choose between September 2016 and September 2017 in our hospital ICU were 140 cases of patients with cerebral apoplexy as analysis object,randomly divided into two groups,two groups all use bedside blind spiral nose long intestinal tube technology,the control group using conventional nursing method for nursing,observation group using evidence-based nursing intervention,compared two groups of a success rate of catheter,accident to take off the tube (unscheduled decannulation rate),reflux hiccups,vomiting incidence of aspiration and patient satisfaction.Results The success rate of catheterization in the observation group was higher than that in the control group,and the incidence of accidental catheterization was lower than that in the control group.The incidence of reflux hiccup and vomiting aspiration was significantly lower than that in the control group,and the patient satisfaction was higher than that in the control group (all P＜0.05).Conclusion For patients with cerebral apoplexy in the ICU bed of blind plug spiral nasal bowel technology combined evidence-based nursing intervention,clinical effect is remarkable,improve the success rate of catheter,reduces the surprise success rate of tube,unscheduled tube drawing number,reduces the incidence of reflux hiccups,vomiting aspiration,improve patient satisfaction and quality of life.

Comparison of three different insertion techniques with LMA-UniqueTM in adults: results of a randomized trial / Comparação de três técnicas diferentes de inserção com a máscara laríngea LMA-UniqueTM em adultos: resultados de um estudo randômico

Abstract Background The triple airway maneuver insertion technique allowed faster insertion of the LMA. This study compared three different insertion techniques of the laryngeal mask airway-UniqueTM. Methods One hundred and eighty ASA I-II patients aged 18-65 years were included into the study. Patients were randomly allocated to the standard, rotational and triple airway maneuver (triple) group. In the standard group (n = 60), the LMA (Laryngeal Mask Airway) was inserted with digital intraoral manipulation. In the triple group (n = 60), the LMA was inserted with triple airway maneuver (mouth opening, head extension and jaw thrust). In the rotational group (n = 60), LMA was inserted back-to-front, like a Guedel airway. Successful insertion at first attempt, time for successful insertion, fiber optic assessment, airway morbidity and hemodynamic responses were assessed. Results Successful insertion at the first attempt was 88.3% for the standard, 78.3% for the rotational and 88.3% for the triple group. Overall success rate (defined as successful insertion at first and second attempt) was 93% for the standard, 90% for the rotational and 95% for the triple group. Time for successful insertion was significantly shorter in the triple group (mean [range] 8.63 [5-19]s) compared with the standard (11.78 [6-24]s) and rotational group (11.57 [5-31]s). Fiber optic assessment, airway morbidity and hemodynamic responses were similar in all groups. Conclusions Rotational and triple airway maneuver insertion techniques are acceptable alternatives. Triple airway maneuver technique shows higher overall success rates and allows shorter insertion time for LMA insertion and should therefore be kept in mind for emergent situations.

Resumo Justificativa A técnica de inserção com a manobra tripla das vias aéreas permitiu a inserção mais rápida da ML. Este estudo comparou três técnicas de inserção da máscara laríngea UniqueTM. Métodos Foram incluídos no estudo 180 pacientes ASA I-II, entre 18-65 anos. Os pacientes foram aleatoriamente designados para grupos de manobra das vias aéreas padrão, rotacional e tripla. No grupo padrão (n = 60), a máscara laríngea (ML) foi inserida com a técnica digital intraoral. No grupo tripla (n = 60), a ML foi inserida com a técnica de manobra tripla das vias aéreas (abertura bucal, extensão da cabeça e elevação da mandíbula). No grupo rotacional (n = 60), a ML foi inserida com a técnica de inserção de trás para frente, como uma cânula de Guedel. Inserção bem-sucedida na primeira tentativa, tempo de inserção bem-sucedida, avaliação por fibra óptica, morbidade das vias aéreas e respostas hemodinâmicas foram avaliados. Resultados O sucesso da inserção na primeira tentativa foi de 88,3% para o grupo padrão, 78,3% para o grupo rotacional e 88,3% para o grupo tripla. A taxa de sucesso global (definida como inserção bem-sucedida na primeira e segunda tentativas) foi de 93% para o grupo padrão, 90% para o grupo rotacional e 95% para o grupo tripla. O tempo de inserção bem-sucedida foi significativamente menor no grupo tripla (média [intervalo] 8,63 [5-19]s), em comparação com o grupo padrão (11,78 [6-24]s) e o grupo rotacional (11,57 [5-31]s). A avaliação por fibra óptica, a morbidade das vias aéreas e as respostas hemodinâmicas foram semelhantes em todos os grupos. Conclusões As técnicas de inserção rotacional e de manobra tripla das vias aéreas são opções aceitáveis. A técnica de manobra tripla das vias aéreas apresenta taxas mais altas de sucesso global e permite um tempo menor de inserção da ML e, portanto, deve ser considerada em situações de emergência.

Training in Endoscopy: Enteroscopy

The balloon-assisted enteroscope has been regarded as the standard device for direct visualization of deep small bowels and allows for the diagnosis and treatment of small bowel disease. At the beginning, its application was focused on the diagnosis of obscure gastrointestinal bleeding, inflammatory bowel disease, and small bowel tumor. However, the indications are being expanded to various therapeutic procedures, not only confined to bleeding control. With the expansion of the indications, the need to perform enteroscopy effectively and safely is increasing. Recent studies have been focused on the diagnostic yield, therapeutic yield, and long-term outcomes of the device. However, with the increasing number of procedures, procedural guidelines and quality indicators are also needed.

Pedicle Screw Instrumentation for Adolescent Idiopathic Scoliosis: The Insertion Technique, the Fusion Levels and Direct Vertebral Rotation

The pedicle is a power nucleus of the vertebra and offers a secure grip of all 3 columns. Pedicle screw instrumentation has advantages of rigid fixation with improved three-dimensional (3D) correction and it is accepted as a reliable method with a high margin of safety. Accurate placement of the pedicle screws is important to reduce possible irreversible complications. Many methods of screw insertion have been reported. The author has been using the K-wire method coupled with the intraoperative single posteroanterior and lateral radiographs, which is the most safe, accurate and fast method. Identification of the curve patterns and determining the fusion levels are very important. The ideal classification of adolescent idiopathic scoliosis should address the all patterns, predict the extent of accurate fusion and have good inter/intraobserver reliability. My classification system matches with the ideal classification system, and it is simple and easy to learn; and my classification system has only 4 structural curve patterns and each curve has 2 types. Scoliosis is a 3D deformity; the coronal and sagittal curves can be corrected with rod rotation, and rotational deformity has to be corrected with direct vertebral rotation (DVR). Rod derotation and DVR are true methods of 3D deformity correction with shorter fusion and improved correction of both the fused and unfused curves, and this is accomplished using pedicle screw fixation. The direction of DVR is very important and it should be opposite to the direction of the rotational deformity of the vertebra. A rigid rod has to be used to prevent rod bend-out during the derotation and DVR.

Influência da técnica de inserção de resina composta sobre o selamento marginal em restaurações estéticas oclusais / The influence of the insertion technique of composite resin on the microleaakage of occlusal esthetic restorations

Este trabalho objetiva avaliar a influência da técnica de inserção de resina composta sobre o selamento marginal de restaurações oclusais. Cavidades oclusais em 60 molares humanos foram restauradas de acordo com os grupos: 1 - Filtek Z350/3M ESPE; 2 - Ice®/SDI e 3 - Concept Advantage®/Vigodent, subdivididos em: A - Técnica de inserção incremental e B - Técnica de Inserção cruciforme. Os corpos de prova sofreram: estresse térmico (500 ciclos; 5ºC +/- 1 e 55ºC +/-1); exposição ao agente químico traçador (AQT); seccionamento e análise (lupa estereoscópica 25X) para atribuição de escores de 0 (sem penetração do AQT) a 2 (penetração máxima do AQT). Os resultados evidenciaram os maiores percentuais para o escore 0 para 3-B (80,0%), 2-A (75,0%), 2-B (75,0%), 1-A (70,0%). Houve diferenças estatisticamente significantes nos grupos 1 e 3, não ocorrendo no grupo 2 (testes de Mann-Whiteny e Kruskal-Wallis / nível de significância de 5%). Concluiu-se que nenhuma técnica de inserção foi capaz de impedir a microinfiltração e que a técnica cruciforme representa uma alternativa à técnica incremental, considerando o tipo de resina composta empregado.

The aim of this study was to evaluate the influence of the insertion technique of composite resin on the microleakage of occlusal restorations. Occlusal cavities in 60 human molars were restored according to the following groups: 1 - Filtek Z350?/3M ESPE; 2 - Ice?/ SDI and 3 - Concept Advantage ? / Vigodent; subdivided into: A - Technique of incremental insertion and B - cruciform Insertion Technique. The specimens were toexposed: heat stress (500 cycles, 5 ? C + / - 1 and 55 ? C + / -1); exposure to the chemical tracer (AQT); sectioning and examination (25X stereomicroscope) for assigning scores from 0 (no penetration of AQT) to 2 (maximum penetration of AQT). The results showed the highest percentages for the score 0 for 3-B (80.0%), 2-A (75.0%), 2-B (75.0%), 1-A (70.0%). There were statistically significant differences in groups 1 and 3, which did not occur in group 2 (Mann-Whiteny and Kruskal-Wallis / significance level of 5%). It was concluded that no technique of insertion was able to prevent microleakage and the cruciform technique represents an alternative to the incremental technique depending on the type of composite resin used.