Multicenter Survey on Staff Understanding of Preoperative Fasting Guidelines.

PURPOSE: To assess the knowledge of nursing staff regarding pediatric preoperative fasting in a tertiary pediatric center and a general hospital. DESIGN: Anonymous electronic survey with nine questions modified to each institution. METHODS: This was a prospective quantitative study. Nursing staff at a tertiary pediatric center and pediatric nursing staff at a general hospital with pediatric services were eligible for participation. An anonymous electronic survey with nine questions via Survey Monkey was used over a 2-month period. FINDINGS: There were 295 participants from the tertiary pediatric center and 24 from the general hospital which represented 10% of overall nursing staff at the tertiary pediatric center and approximately 50% of pediatric nursing staff at the general hospital. At both the tertiary pediatric center and the general hospital, 50 to 80% of participants correctly answered most questions. More participants were correct for the fasting times for infants less than 6 month of age than for those over 6 months old. For clear fluids, 61 (20.7%) and 13 (4.4%) considered jelly and breast milk as clear fluids respectively at the tertiary pediatric center. CONCLUSIONS: Preoperative fasting continues to be a core area of pediatric care that is not completely understood. Our survey showed that although the majority of staff claim to be able to access the hospital guidelines, knowledge of these guidelines can be improved. In light of ongoing changing evidence, it is clear that education is a key factor in reducing morbidity and improving patient experience related to preoperative fasting.

Reconstructing the lower urinary tract: The Mitrofanoff principle.

Since the original description of the trans-appendicular continent cystostomy by Mitrofanoff in 1980, a variety of techniques have been described for creating a continent catheterisable channel leading to the bladder, which avoids the native urethra. The Mitrofanoff principle involves the creation of a conduit going into a low pressure reservoir, which can emptied through clean intermittent catheterization through an easily accessible stoma. A variety of tissue segments have been used for creating the conduit, but the two popular options in current urological practice remain the appendix and Yang-Monti transverse ileal tube. The Mitrofanoff procedure has an early reoperation rate for bleeding, bowel obstruction, anastomotic leak or conduit breakdown of up to 8% and the most common long-term complication noted is stomal stenosis resulting in difficulty catheterizing the conduit. However, in both pediatric and adult setting, reports imply that the procedure is durable although it is associated with an overall re-operation rate of up to 32% in contemporary series. Initial reports of laparoscopic and robotic-assisted Mitrofanoff procedures are encouraging, but long-term outcomes are still awaited.

Computational studies of consciousness.

In this chapter we present a computational architecture intended to add clarity to the concept of consciousness. We briefly review some of the motivations of work done in this area in various institutes around the world and looks closely at our own work which specifically includes phenomenology, the sense of a self in a perceptual world. This breaks consciousness into five axioms: presence, imagination, attention, volition and emotions. It develops plausible mechanisms of each and how they interact to give a single sensation. An abstract architecture, the kernel architecture, is introduced as a starting point for building computational models. It is shown that through this architecture it is possible to discuss puzzling aspects of consciousness, for example are animals conscious? What happens when we dream? What goes on when we experience an illusion? This paper is intended to elucidate and update some concepts introduced in Aleksander (2005).

Phenomenology and digital neural architectures.

A model of conscious mechanisms called Axiomatic Consciousness Theory (ACT) is used to develop a neuroarchitectural model of visual phenomenology. The result is an extension of concepts in neural systems towards phenomenal intentionality: the lack of which is a common starting point for critiques of AI. Here the argument is developed at four interacting grain levels of description and the associated analysis. The visual domain is highlighted due to its dominance in discussions involving inner mental states.