RESUMO
OBJECTIVE: Intensive care units (ICUs) increasingly rely on advanced practice providers (APPs) to care for critically ill patients. Our institutional APPs perceived functional anatomical knowledge deficits. To meet this need, a cadaver-based prosection course was developed. The purpose of our study was to describe and evaluate the learner-perceived course efficacy. DESIGN: A precourse survey collected participant demographics. Precourse and postcourse surveys assessed perceived confidence in 13 anatomical areas. The postcourse survey also evaluated preparedness to perform ICU procedures and to care for postoperative patients, and additionally, gauged participant satisfaction and opinions. Summary statistics and pre-post survey comparisons were performed using Stata 14.0. PARTICIPANTS: Twenty-five APPs, all Advanced Practice Registered Nurse certified and working within our tertiary care ICUs, completed the course. Participants practiced in a variety of ICUs, inclusive of neurologic/neurosurgical (4.0%), burn (8.0%), medical (12.0%), trauma (28.0%) and surgical (48.0%), and typically held a Masters of Science in Nursing as his/her highest attained degree. Experience levels ranged from 0 to 8 years. RESULTS: Precourse survey results confirmed perceived anatomical knowledge deficits, noting median APP scores 3.00 or less, correlating to neutral to very little confidence, in all 13 queried anatomical areas. Wilcoxon signed-rank statistical analysis revealed significantly improved confidence level in anatomic knowledge following course completion in all 13 anatomical areas. Aligning with the improved confidence, most participants felt they were better prepared to perform ICU procedures and care for patients following operative intervention. CONCLUSION: Cadaver-based anatomical training has significant benefit to ICU APPs perceived knowledge and performance.
Assuntos
Prática Avançada de Enfermagem/educação , Anatomia/educação , Competência Clínica , Enfermagem de Cuidados Críticos/educação , Unidades de Terapia Intensiva/organização & administração , Cadáver , Currículo , Dissecação/métodos , Feminino , Humanos , Masculino , Inquéritos e Questionários , Análise e Desempenho de Tarefas , Estados UnidosRESUMO
Vitamin C (VC) is a crucial antioxidant in the brain. To assess whether different brain regions vary in their sensitivity to oxidative stress induced by VC depletion, we used the gulonolactone oxidase (gulo) knockout mouse. This mouse, like humans, cannot synthesize VC and thus its tissue VC levels can be varied by dietary VC intake. Gulo knockout mice were fed drinking water containing standard (0.33g/L), low (0.033g/L) or zero (0g/L) VC supplementation levels. After 4weeks, mice were sacrificed and different brain regions removed for assay of VC and malondialdehyde, a marker of lipid peroxidation. Compared to age-matched wild-type controls, the cerebellum, olfactory bulbs and frontal cortex had the highest VC content, whereas the pons and spinal chord had the lowest. However, in mice that did not receive VC, area differences were no longer significant as all values trended towards zero. Malondialdehyde increased in the cortex as VC supplementation was decreased. The same changes were not observed in the cerebellum or pons, suggesting that cortex is more susceptible to oxidative damage from low VC. These results suggest enhanced susceptibility of the cortex to oxidative stress induced by low VC compared to other brain regions.
Assuntos
Deficiência de Ácido Ascórbico/patologia , Ácido Ascórbico/metabolismo , Encéfalo/metabolismo , Estresse Oxidativo/fisiologia , Animais , Ácido Ascórbico/administração & dosagem , Deficiência de Ácido Ascórbico/etiologia , Modelos Animais de Doenças , L-Gulonolactona Oxidase/deficiência , Malondialdeído/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Estatísticas não Paramétricas , Distribuição TecidualRESUMO
PURPOSE: To describe a 7-year experience with abdominal aortic aneurysm (AAA) repair using fenestrated Zenith endovascular endografts. METHODS: Six endovascular surgeons from 7 medical centers in Perth, Western Australia, contributed data to this retrospective study of 58 AAA patients (51 men; mean age 75.5+/-8.5 years, range 60-94) treated with fenestrated endografts. Fenestrations were applied to 116 target vessels; more than half of patients had >/=2 target vessels. The results were based on satisfactory deployment of the stent-graft and fenestrations (technical success), technical success and no complications (procedural success), and aneurysm exclusion with no endoleak, rupture, unresolved complications, or dialysis (treatment success). RESULTS: Technical success was 82.8% for patients (90.5% for target vessels), procedural success was 74.1%, and treatment success was 94.8%. There were no cases of conversion or rupture. The 30-day mortality rate was 3.4% (n=2). Over a mean follow-up of 1.4+/-1.2 years, 10 (17.2%) patients experienced loss of a target vessel (9.5% of target vessels). Factors associated with target vessel loss were no stent, >60 degrees neck angulation, multiple renal vessels, and vessel diameter =4 mm. Four (6.9%) patients developed renal impairment, but none required dialysis. Fourteen (24.1%) patients had a secondary intervention. Unresolved endoleaks persisted in 1 (1.7%) patient. CONCLUSION: Fenestrated endografts extend the treatment options for infrarenal AAAs with necks unsuitable for standard endovascular repair. This early data show a trend toward higher mortality of selected patients with fenestrated endografts than for standard stent-graft repair, but the mortality rate is comparable to open repair. Target vessel occlusion predominantly results from pre-existing disease or the lack of a stent. The lessons learned from this experience contributed toward guidelines for users of fenestrated endografts.