Ultrasound to Verify Gastric Tube Position in Infants and Children: A Systematic Review.

BACKGROUND: Placement of gastric tubes is commonly performed in infants and children but malpositioning is common and is associated with significant complications. OBJECTIVE: The aim of this systematic review is to identify the evidence on the use of ultrasound to verify correct gastric tube placement in infants and children and gaps in the research. METHODS: This review was performed using CINAHL, PUBMED, EMBASE and Web of Science databases. Studies were included if they used an empirical study design, were published in English, included infants or children, and evaluated the use of ultrasound to verify correct gastric tube placement compared to radiograph. Sensitivity, specificity, positive and negative predictive values were evaluated. RESULTS: Four articles were included in the review. Sensitivity estimates were 0.88 to 1.00 and a positive predictive value of 0.99 was reported in one study. Specificity was not reported in any of the included studies. Ultrasound may be an important method to correctly identify gastric tube placement in infants and children with less radiation exposure and cost. IMPLICATIONS FOR PRACTICE: Ultrasound could be a used to verify gastric tube positioning in infants and children for both initial placement and continued verification leading to reduced radiation exposure and cost. IMPLICATIONS FOR RESEARCH: Research should focus on evaluating ultrasound specificity and the clinical feasibility of using ultrasound as a standard practice, including cost and time required to complete the exam, as well as the ability of ultrasound to verify gastric tube placement in infants weighing less than 1500 grams.

Taxonomic classification of strain PO100/5 shows a broader geographic distribution and genetic markers of the recently described Corynebacterium silvaticum.

The bacterial strain PO100/5 was isolated from a skin abscess taken from a pig (Sus scrofa domesticus) in the Alentejo region of southern Portugal. It was identified as Corynebacterium pseudotuberculosis using biochemical tests, multiplex PCR and Pulsed Field Gel Electrophoresis. After genome sequencing and rpoB phylogeny, the strain was classified as C. ulcerans. To better understand the taxonomy of this strain and improve identification methods, we compared strain PO100/5 to other publicly available genomes from C. diphtheriae group. Taxonomic analysis reclassified it and three others strains as the recently described C. silvaticum, which have been isolated from wild boar and roe deer in Germany and Austria. The results showed that PO100/5 is the first sequenced genome of a C. silvaticum strain from livestock and a different geographical region, has the unique sequence type ST709, and could be could produce the diphtheriae toxin, along with strain 05-13. Genomic analysis of PO100/5 showed four prophages, and eight conserved genomic islands in comparison to C. ulcerans. Pangenome analysis of 38 C. silvaticum and 76 C. ulcerans genomes suggested that C. silvaticum is a genetically homogeneous species, with 73.6% of its genes conserved and a pangenome near to be closed (α > 0.952). There are 172 genes that are unique to C. silvaticum in comparison to C. ulcerans. Most of these conserved genes are related to nutrient uptake and metabolism, prophages or immunity against them, and could be genetic markers for species identification. Strains PO100/5 (livestock) and KL0182T (wild boar) were predicted to be potential human pathogens. This information may be useful for identification and surveillance of this pathogen.

Práticas de si de cuidadores familiares na atenção domiciliar / Self-care practices of family caregivers in home care / Prácticas de sí de cuidadores familiares en la atención domiciliar

INTRODUÇÃO: Atualmente há expansão de serviços de atenção domiciliar, sendo necessário que algum familiar seja o cuidador. Deste modo, é relevante compreender as práticas de si dos cuidadores familiares no contexto da atenção domiciliar. MATERIAIS E MÉTODOS: Pesquisa qualitativa, inserida na vertente pós-estruturalista. Participaram da pesquisa 18 cuidadores familiares de pacientes com doenças crônicas ou terminais vinculados ao serviço de atenção domiciliar de um hospital do sul do Brasil. A produção de informações ocorreu por meio de entrevista narrativa, realizada entre julho de 2015 e março de 2016. Os participantes foram entrevistados em três encontros, com periodicidade semanal. A análise se constituiu de questões elaboradas diante das informações produzidas articuladas com as teorizações foucaultianas, sobre cuidado de si, relações de poder e discurso. RESULTADOS E DISCUSSÃO: Duas categorias foram elaboradas: Constituição do sujeito cuidador: quais os discursos que o atravessam? e práticas de si como caminho de ressignificação ao cuidado. As práticas de si foram configuradas como modo de acesso a verdade, se caracterizando como fio condutor do cuidado de si, levando os cuidadores, nas suas mais diversas formas de ser, a se subjetivarem e se reconstituírem, através de si e do outro. CONCLUSÕES: Ser cuidador familiar é circundado por diversos discursos que atravessam seu modo de cuidar e que as práticas de si foram configuradas como modo de acesso a verdade.

INTRODUCTION: Currently, home care services have expanded, making it necessary for some family member become the caregiver. Thus, it is relevant to understand the self-care practices of the family caregivers within the home care context. MATERIALS AND METHODS: This was a qualitative research, inserted in the post-structuralist approach. The research had the participation of 18 family caregivers of patients with chronic or terminal disease linked to the home care service of a hospital in southern Brazil. Information was produced through a narrative interview, conducted between July 2015 and March 2016. Participants were interviewed during three weekly meetings. The analysis consisted of questions elaborated regarding the information produced articulated with Foucauldian theorizations on self-care, power relations, and discourse. RESULTS AND DISCUSSION Two categories were created: constitution of the caregiver subject: what are the discourses crossing it? and self-care practices as re-signification path to care. The self-care practices were configured as a way of accessing the truth, characterized as the guiding thread of self-care, leading caregivers, in their most diverse ways of being, to subjectivate and reconstitute themselves, through themselves and another. CONCLUSIONS: Being family caregivers is surrounded by diverse discourses that go through their way of caring and that their self-care practices have been configured as a way of accessing the truth.

INTRODUCCIÓN: Actualmente hay expansión de servicios de atención domiciliaria, siendo necesario que algún familiar sea el cuidador. Por lo tanto, es relevante comprender las prácticas de los cuidadores familiares en el contexto de la atención domiciliaria. MATERIALES Y MÉTODOS: Investigación cualitativa, inserida en la vertiente post-estructuralista. Participaron en la investigación 18 cuidadores familiares de pacientes con enfermedades crónicas o terminales vinculadas al servicio de atención domiciliaria de un hospital del sur de Brasil. La producción de informaciones ocurrió a través de una entrevista narrativa, realizada entre julio de 2015 y marzo de 2016. Los participantes fueron entrevistados en tres encuentros, con periodicidad semanal. El análisis se constituyó de cuestiones elaboradas ante las informaciones producidas articuladas con las teorizaciones foucaultianas, sobre cuidado de sí, relaciones de poder y discurso. RESULTADOS Y DISCUSIÓN: Dos categorías fueron elaboradas: Constitución del sujeto cuidador: ¿cuáles son los discursos que lo atraviesan? y, prácticas de sí como camino de resignificación al cuidado. Las prácticas de sí fueron configuradas como modo de acceso a la verdad, caracterizándose como hilo conductor del cuidado de sí, llevando a los cuidadores, en sus más diversas formas de ser, a subjetivarse y reconstituirse, a través de sí y del otro. CONCLUSIONES: Ser cuidador familiar es circundado por diversos discursos que atraviesan su modo de cuidar y que las prácticas de sí fueron configuradas como modo de acceso a la verdad.

Significados e Percepções em cuidados paliativos: olhar de pacientes domiciliares / Meaning and Perceptions in Palliative Care: over view of patients on homecare

Objetivo: Conhecer os significados e percepções de cuidados paliativos pelos pacientes do Programa deInternação Domiciliar Interdisciplinar. Metodologia: O estudo foi qualitativo-descritivo, realizado compacientes oncológicos em cuidados paliativos, vinculados ao Programa de Internação DomiciliarInterdisciplinar, situado em Pelotas, Rio Grande do Sul, Brasil. A coleta de dados se deu por meio deentrevistas semiestruturadas, realizadas no domicílio dos sujeitos do estudo, de agosto a outubro de 2015.Resultados e Discussão: a partir da análise foram elaboradas três categorias, as quais foram denominadas:Impressões acerca do diagnóstico, Benefícios do PIDI, e Cuidados Paliativos: (des)conhecimentos.Considerações Finais: pode-se conhecer os significados e percepções de cuidados paliativos pelos pacientes,pelo interesse da investigação que vai além das condições físicas e que interferem diretamente no processode adoecimento, como também a busca por questões que possam contribuir para uma assistência paliativaefetiva, levando em consideração a singularidade do sujeito e a busca pela qualidade de vida.

Objective: to know the meanings and perceptions on palliative care by patients of the Interdisciplinary homecare program. Method: this is a qualitative-descriptive study, which was carried out with oncological patientsunder palliative care, who were also bound to the Interdisciplinary Home Care Program, which is localized inPelotas, Rio Grande do Sul, Brazil. Data collection happened through semi-structured interviews, which weredone at patients’ homes, from August to October of 2015. Results and Discussion: from the analysis, threecategories were elaborated, which are: Feelings about the diagnosis, The benefits of the Program, andPalliative Care: (un)knowledge. Final Considerations: for the interest on investigation, it is possible to knowthe meanings and perceptions on palliative care by patients, which goes beyond physical conditions anddirectly interfere in the process of illness, additionally to the search for questions that might contribute to aneffective palliative intervention, considering the individual’s singularity and the looking for quality of life.