Attitudes of visitors at adult intensive care unit toward organ donation and organ support

The concept of brain death was 1st introduced in the 1960s, providing an essential conceptual change to medical practice,[1] and its diagnosis is based on demonstrating the complete, irreversible cessation of brainstem function.

Examining advanced nursing practice in Hong Kong and Guangzhou

Objective:There were studies evaluating advanced nursing practice independently in the mainland and Hong Kong Special Administrative Region of China,but there was no attempt to make a comparison of practice between them.This study employed a case study method to examine and compare advanced nursing practice in Hong Kong and Guangzhou.Method:Purposive sampling method was used to recruit 24 advanced practice nurses(APN)who came from the specialty of medical,surgical and pediatric in Hong Kong and Guangzhou.A questionnaire survey and semi-structured interview were conducted to solicit quantitative and qualitative data for exploring the structure-process-outcome of advanced nursing practice.The structure component explored the factors influencing advanced nursing practice.The process part examined APN role components and illustrations of exemplary advanced nursing practice.The outcomes described outcome indicators that best reflected advanced nursing practice.Findings:Findings revealed that in the structure domain,APN education and career development,team approach in healthcare,and support from management,physicians and professional associations were important contextual factors for APN development in both cities.For the process domain,participants had at least 80%of their time practicing independently/interdependently and were engaged in APN activities including direct/indirect patient care,research/project work,initiation of staff and patient protocols.All participants demonstrated competencies with impacts on patient,service and profession in their description of exemplary practice.Participants from both cities ranked patient-related outcomes as top indicators for their advanced nursing practice.Conclusion:This study has revealed that APNs in Guangzhou and Hong Kong shared similar work involvement and impacts and their demonstrated competencies were on par with international counterparts.Continued efforts need to be put in establishing formal APN education,clear clinical career pathway and title protection to empower nurses to provide optimal care to the fullest extent that they are prepared for.

Near-fatal Panton-Valentine leukocidin-positive Staphylococcus aureus pneumonia,shock and complicated extracorporeal membrane oxygenation cannulation:A case report

BACKGROUND Panton-Valentine leukocidin(PVL)is an exotoxin secreted by Staphylococcus aureus(S.aureus),responsible for skin and soft tissue infections.As a cause of severe necrotising pneumonia,it is associated with a high mortality rate.A rare entity,the epidemiology of PVL S.aureus(PVL-SA)pneumonia as a complication of influenza coinfection,particularly in young adults,is incompletely understood.CASE SUMMARY An adolescent girl presented with haemoptysis and respiratory distress,deteriorated rapidly,with acute respiratory distress syndrome(ARDS)and profound shock requiring extensive,prolonged resuscitation,emergency critical care and venovenous extracorporeal membrane oxygenation(ECMO).Cardiac arrest and a rare complication of ECMO cannulation necessitated intra-procedure extracorporeal cardiopulmonary resuscitation,i.e.,venoarterial ECMO.Coordinated infectious disease,microbiology and Public Health England engagement identified causative agents as PVL-SA and influenza A/H3N2 from bronchial aspirates within hours.Despite further complications of critical illness,the patient made an excellent recovery with normal cognitive function.The coordinated approach of numerous multidisciplinary specialists,nursing staff,infection control,specialist cardiorespiratory support,hospital services,both adult and paediatric and Public Health are testimony to what can be achieved to save life against expectation,against the odds.The case serves as a reminder of the deadly nature of PVL-SA when associated with influenza and describes a rare complication of ECMO cannulation.CONCLUSION PVL-SA can cause severe ARDS and profound shock,with influenza infection.A timely coordinated multispecialty approach can be lifesaving.

Contractility detection of isolated mouse papillary muscle using myotronic Myostation-Intact device

Background:To understand the relationship between myocardial contractility and ex-ternal stimuli,detecting ex vivo myocardial contractility is necessary.Methods:We elaborated a method for contractility detection of isolated C57 mouse papillary muscle using Myostation-Intact system under different frequencies,volt-ages,and calcium concentrations.Results:The results indicated that the basal contractility of the papillary muscle was 0.27±0.03 mN at 10 V,500-ms pulse duration,and 1 Hz.From 0.1 to 1.0 Hz,con-tractility decreased with an increase in frequency(0.45±0.11-0.10±0.02 mN).The voltage-initiated muscle contractility varied from 3 to 6 V,and the contractility gradu-ally increased as the voltage increased from 6 to 10 V(0.14±0.02-0.28±0.03 mN).Moreover,the muscle contractility increased when the calcium concentration was increased from 1.5 to 3 mM(0.45±0.17-1.11±0.05 mN);however,the contractility stopped increasing even when the concentration was increased to 7.5 mM(1.02±0.23 mN).Conclusions:Our method guaranteed the survivability of papillary muscle ex vivo and provided instructions for Myostation-Intact users for isolated muscle contractility investigations.

Clinical application and management of temporary mechanical circulatory support:A clinical consensus

Temporary mechanical circulatory support(tMCS)plays a pivotal role in managing severe or refractory cardiogenic shock(CS),furnishing essential hemodynamic support,and sustaining organ perfusion from hours to weeks,or to even months.In the past decade,the utilization of tMCS has witnessed a signicant increase in American and European countries.Meanwhile in Asia,the newly developed concepts and devices constituting tMCS have also made rapid progress.Nevertheless,the absence of a consensus or standardized guidelines,especially for the Asian population considering inherited polymorphism,is evident.To address this knowledge gap,eight associations/societies and experts in thiseld came up with the present consensus after repeated discussions,more specically for the Asian population.It comprehensively elucidates the commonly employed tMCS devices,criteria for patient selection,indications and contraindications,clinical management,and the optimal timing for implantation and weaning.The goal of this statement is to promote the standardized application of tMCS and make reasonable decisions in clinical practice.Full-length version of the consensus can be seen in Supplementary File,http://links.lww.com/CM9/B883.

When is parenteral nutrition indicated?

The indications and contraindications of parenteral nutrition(PN)are discussed in view of recent clinical find-ings.For decades,PN has been restricted to patients unable to tolerate enteral nutrition(EN)intake owing to the perceived risk of severe side-effects.The evolution of the PN substrate composition and delivery of nutrition via all-in-one bags has dramatically improved the application prospects of PN.Recent studies show similar compli-cation rates of nutrition therapy administered through enteral and intravenous routes.Therefore,indications of PN have,based on evidence,extended beyond complete gastrointestinal(GI)failure to include conditions such as insufficient EN generating persistent negative energy balance and insufficient protein intakes,malabsorption,or specific needs that are impossible to cover with EN feeds.

Risk of ischaemic and haemorrhagic stroke in Chinese undergoing percutaneous coronary intervention treated with potent P2Y12 inhibitor versus clopidogrel

Background Stroke after acute coronary syndrome(ACS)can be devastating.It is uncertain whether the risks of ischaemic stroke or intracranial haemorrhage(ICH)are associated with different choices of P2Y12 inhibitors(potent P2Y12 inhibitors such as ticagrelor and prasugrel vs clopidogrel).Even though East Asians are known to have different thrombotic and haemorrhagic profiles from Caucasians,data on Chinese patients are sparse.Method This was a retrospective cohort study conducting in Chinese patients with ACS who underwent first-ever percutaneous coronary intervention from 14 hospitals in Hong Kong between 2010 and 2017.The primary efficacy endpoint was ischaemic stroke.The secondary efficacy endpoint was a composite outcome of thrombotic events including all-cause mortality,non-fatal myocardial infarction and ischaemic stroke.The primary safety endpoint was ICH.The secondary safety endpoint was a composite of major bleeding events.Results After adjustment of baseline characteristics by 1:1 propensity score matching,a total of 6220 patients(3110 on each group)were analysed.Compared with clopidogrel,potent P2Y12 inhibitors were associated with a lower risk of ischaemic stroke(HR 0.57;95%CI 0.37 to 0.87;p=0.008)and a lower risk of thrombotic events(HR 0.77;95%CI 0.66 to 0.90;p=0.001).Potent P2Y12 inhibitor was associated with similar risk of ICH(HR 0.65;95%CI 0.34 to 1.25,p=0.20)and major bleeding(HR 0.83;95%CI 0.68 to 1.01,p=0.069).Conclusions Potent P2Y12 inhibitors were associated with a lower adjusted risk of ischaemic stroke and thrombotic events,compared with clopidogrel.The risks of ICH and major bleeding were similar.

慢性阻塞性肺疾病与哮喘研究中对重症监护病房患者预后悲观所产生的影响：英国多中心观察队列研究

目的确定临床医生对入住重症监护病房（ICU）的COPD急性加重期患者预后的预测与实际结果是否一致。设计前瞻性队列研究。地点英国92个ICU及3个呼吸机依赖病房。参与者832例COPD或哮喘急性加重或COPD合并哮喘患者，表现气促、呼吸衰竭或精神状态改变，年龄在45岁及以上。结局评估指标由临床医生预测的结果以及实际观察的180天存活率。结果517例患者（62％）存活到180天。临床医生预测的180天存活率却是悲观的，平均只有49％。依照临床医生的预测，1／5预后最差的存活率仅为10％，而实际存活率却是40％。来自于覆盖英国74％的ICU数据库的信息提示，参与研究和未参与研究的ICU并没有实质性差别。在同一个ICU中入选患者与未入选患者的病情相似。结论因为决定COPD或哮喘患者是否需要气管插管，入住ICU取决于临床医生对其预后的预测．因此，一些本也许会生存下来的患者却由于那些没有根据的对其预后的悲观预测，而很可能被拒绝收入ICU。