Point-of-care prothrombin time testing in paediatric intensive care: an observational study of the ease of use of two devices

Two major difficulties arise when taking blood samples in children: the challenge of venous access and the comparatively large amount of blood required.

Morbidity rate of reoperation in thyroid surgery: a different point of view

Goitre recurrence is a common problem following subtotal thyroid gland resection for multinodular goitre disease. The aim of the present study was to evaluate morbidity rate in relation to the side of initial and redo-surgery for recurrent disease.

Phonetic Aspects of Speech Communication

Nadeina set out to develop methods of speech development in Russian as a mother tongue, focusing on improving diction, training in voice quality control, intonation control, the removal of dialect, and speech etiquette. She began with training in the receptive skills of language, i.e. reading and listening, since the interpretation of someone else's language plays an important role in language production. Her studies of students' reading speed of students showed that it varies between 40 and 120 words per minute, which is normally considered very slow. She discovered a strong correlation between speed of reading and speaking skills: the slower a person reads the worse is their ability to speak and has designed exercises to improve reading skills. Nadeina also believes that listening to other people's speech is very important, both to analyse its content and in some cases as an example, so listening skills need to be developed. Many people have poor pronunciation habits acquired as children. On the basis of speech samples from young Russians (male and female, aged 17-22), Nadeina analysed the commonest speech faults - nasalisation, hesitation and hemming at the end of sense-groups, etc. Using a group of twenty listeners, she looked for a correlation between how voice quality is perceived and certain voice quality parameters, e.g. pitch range, tremulousness, fluency, whispering, harshness, sonority, tension and audible breath. She found that the less non-linguistic segment variations in speech appeared, the more attractive the speech was rated. The results are included in a textbook aimed at helping people to improve their oral skills and to communicate ideas to an audience. She believes this will assist Russian officials in their attempts to communicate their ideas to different social spheres, and also foreigners learning Russian.

Point-of-care testing in the cardiovascular operating theatre

Point-of-care testing (POCT) remains under scrutiny by healthcare professionals because of its ill-tried, young history. POCT methods are being developed by a few major equipment companies based on rapid progress in informatics and nanotechnology. Issues as POCT quality control, comparability with standard laboratory procedures, standardisation, traceability and round robin testing are being left to hospitals. As a result, the clinical and operational benefits of POCT were first evident for patients on the operating table. For the management of cardiovascular surgery patients, POCT technology is an indispensable aid. Improvement of the technology has meant that clinical laboratory pathologists now recognise the need for POCT beyond their high-throughput areas.

Multicentre evaluation of a new point-of-care test for the determination of NT-proBNP in whole blood

BACKGROUND: The Roche CARDIAC proBNP point-of-care (POC) test is the first test intended for the quantitative determination of N-terminal pro-brain natriuretic peptide (NT-proBNP) in whole blood as an aid in the diagnosis of suspected congestive heart failure, in the monitoring of patients with compensated left-ventricular dysfunction and in the risk stratification of patients with acute coronary syndromes. METHODS: A multicentre evaluation was carried out to assess the analytical performance of the POC NT-proBNP test at seven different sites. RESULTS: The majority of all coefficients of variation (CVs) obtained for within-series imprecision using native blood samples was below 10% for both 52 samples measured ten times and for 674 samples measured in duplicate. Using quality control material, the majority of CV values for day-to-day imprecision were below 14% for the low control level and below 13% for the high control level. In method comparisons for four lots of the POC NT-proBNP test with the laboratory reference method (Elecsys proBNP), the slope ranged from 0.93 to 1.10 and the intercept ranged from 1.8 to 6.9. The bias found between venous and arterial blood with the POC NT-proBNP method was < or =5%. All four lots of the POC NT-proBNP test investigated showed excellent agreement, with mean differences of between -5% and +4%. No significant interference was observed with lipaemic blood (triglyceride concentrations up to 6.3 mmol/L), icteric blood (bilirubin concentrations up to 582 micromol/L), haemolytic blood (haemoglobin concentrations up to 62 mg/L), biotin (up to 10 mg/L), rheumatoid factor (up to 42 IU/mL), or with 50 out of 52 standard or cardiological drugs in therapeutic concentrations. With bisoprolol and BNP, somewhat higher bias in the low NT-proBNP concentration range (<175 ng/L) was found. Haematocrit values between 28% and 58% had no influence on the test result. Interference may be caused by human anti-mouse antibodies (HAMA) types 1 and 2. No significant influence on the results with POC NT-proBNP was found using volumes of 140-165 muL. High NT-proBNP concentrations above the measuring range of the POC NT-proBNP test did not lead to false low results due to a potential high-dose hook effect. CONCLUSIONS: The POC NT-proBNP test showed good analytical performance and excellent agreement with the laboratory method. The POC NT-proBNP assay is therefore suitable in the POC setting.

Patients benefit--partners suffer? The impact of heart transplantation on the partner relationship

Terminal heart disease affects not only the patient, but also members of the patient's family, and especially the spouse. The aim of this prospective study of 26 couples was to collect information about the impact of heart transplantation on the partner relationship. Data were collected from patients and spouses when the patients were placed on the waiting list for transplantation, 1 year postoperatively, and 5 years postoperatively. The Family Assessment Measure (FAM III), a self-report instrument that provides quantitative indices of family functioning on seven interacting dimensions, was used. In the course of the transplant process, both patients and spouses reported a significant deterioration in the partner relationship in general. While patients perceived only one clear-cut point of conflict communication about emotions - as crucial, the spouses reported a significant worsening in role performance, communication, emotional involvement, and values and norms. These changes were discernible 1 year after transplantation and persisted for at least 5 years. We conclude that heart transplantation has a significant negative impact on the partner relationship 1-5 years after transplantation. Consequently, more attention should be paid to all aspects of the partner relationship in a holistic approach to the treatment of heart transplant recipients and their partners.

Effective water treatment for rural communities in Suriname : a comparison of point-of-use ceramic filters and centralized treatment with sand filters

For countless communities around the world, acquiring access to safe drinking water is a daily challenge which many organizations endeavor to meet. The villages in the interior of Suriname have been the focus of many improved drinking water projects as most communities are without year-round access. Unfortunately, as many as 75% of the systems in Suriname fail within several years of implementation. These communities, scattered along the rivers and throughout the jungle, lack many of the resources required to sustain a centralized water treatment system. However, the centralized system in the village of Bendekonde on the Upper Suriname River has been operational for over 10 years and is often touted by other communities. The Bendekonde system is praised even though the technology does not differ significantly from other failed systems. Many of the water systems that fail in the interior fail due to a lack of resources available to the community to maintain the system. Typically, the more complex a system becomes, so does the demand for additional resources. Alternatives to centralized systems include technologies such as point-of-use water filters, which can greatly reduce the necessity for outside resources. In particular, ceramic point-of-use water filters offer a technology that can be reasonably managed in a low resource setting such as that in the interior of Suriname. This report investigates the appropriateness and effectiveness of ceramic filters constructed with local Suriname clay and compares the treatment effectiveness to that of the Bendekonde system. Results of this study showed that functional filters could be produced from Surinamese clay and that they were more effective, in a controlled laboratory setting, than the field performance of the Bendekonde system for removing total coliform. However, the Bendekonde system was more successful at removing E. coli. In a life-cycle assessment, ceramic water filters manufactured in Suriname and used in homes for a lifespan of 2 years were shown to have lower cumulative energy demand, as well as lower global warming potential than a centralized system similar to that used in Bendekonde.

Assessing drinking water quality at source and point-of-use : a case study of Koila Bamana, Mali, West Africa

Ensuring water is safe at source and point-of-use is important in areas of the world where drinking water is collected from communal supplies. This report describes a study in rural Mali to determine the appropriateness of assumptions common among development organizations that drinking water will remain safe at point-of-use if collected from a safe (improved) source. Water was collected from ten sources (borehole wells with hand pumps, and hand-dug wells) and forty-five households using water from each source type. Water quality was evaluated seasonally (quarterly) for levels of total coliform, E.coli, and turbidity. Microbial testing was done using the 3M Petrifilm™ method. Turbidity testing was done using a turbidity tube. Microbial testing results were analyzed using statistical tests including Kruskal-Wallis, Mann Whitney, and analysis of variance. Results show that water from hand pumps did not contain total coliform or E.coli and had turbidity under 5 NTUs, whereas water from dug wells had high levels of bacteria and turbidity. However water at point-of-use (household) from hand pumps showed microbial contamination - at times being indistinguishable from households using dug wells - indicating a decline in water quality from source to point-of-use. Chemical treatment at point-of-use is suggested as an appropriate solution to eliminating any post-source contamination. Additionally, it is recommended that future work be done to modify existing water development strategies to consider water quality at point-of-use.