With broadening indications, more options for hematopoietic cell transplantation (HCT) and improvement in survival, the number of long-term HCT survivors is expected to increase steadily. Infertility ...is a frequent problem that long-term HCT survivors and their partners face and it can negatively impact on the quality of life. The most optimal time to address fertility issues is before the onset of therapy for the underlying disease; however, fertility preservation should also be addressed before HCT in all children and patients of reproductive age, with referral to a reproductive specialist for patients interested in fertility preservation. In vitro fertilization (IVF) and embryo cryopreservation, oocyte cryopreservation and ovarian tissue banking are acceptable methods for fertility preservation in adult women/pubertal females. Sperm banking is the preferred method for adult men/pubertal males. Frequent barriers to fertility preservation in HCT recipients may include the perception of lack of time to preserve fertility given an urgency to move ahead with transplant, lack of patient-physician discussion because of several factors (for example, time constraints, lack of knowledge), inadequate access to reproductive specialists, and costs and lack of insurance coverage for fertility preservation. There is a need to raise awareness in the medical community about fertility preservation in HCT recipients.
PURPOSE/GOALTo provide the learner with knowledge of AORN’s guidelinesrelated to fecal microbiota transplant (FMT), Zikavirus, autologous bone flap transfer, counting microsuture,and iodine ...allergy.OBJECTIVES1. Discuss practices that could jeopardize safety in theperioperative area.2. Discuss common areas of concern that relate to perioperativebest practices.3. Describe implementation of evidence-based practice inrelation to perioperative nursing care.
...the size of the skin squames alone presents an infection risk to the patient because particles between 2 and 20 |am in diameter may carry staphylococci.1,4 Bitkover et al7 found that occlusive ...clothing reduced environmental contamination of skin squames.Answer: The type of leg holders used when the patient is in the lithotomy position should be selected based on the individual patient's needs and the ability of the leg holders to support the patient's legs over the largest surface area of the leg possible.1-4 Boot-type leg holders support the entire leg, reducing the potential for nerve and pressure injury and evenly distributing pressure over the leg and the foot (Figure 1).5,6 Supporting the leg over the largest surface area possible redistributes pressure and helps to prevent pressure injury.2,4 Knee-crutch leg holders support the weight of the patient's leg, but may not redistribute pressure, potentially increasing pressure on the popliteal space and injuring the posterior and common peroneal nerves and the popliteal artery (Figure 2).5,7 The increased pressure associated with knee-crutch leg holders can obstruct or slow venous and lymphatic return, increase the risk for hypoperfusion in the lower extremities, and raise intracompartmental pressures.8 When candy cane-shaped leg holders are used, the weight of the patient's leg is supported by the foot straps and pressure is not redistributed (Figure 3).5 The patient's hips are particularly vulnerable to excessive rotation and hyperabduction.5,9 Excessive rotation or abduction (ie, more than 30 to 45 degrees) puts stress on the patient's hip joints and can cause a femoral, sciatic, obturator, or common peroneal neuropathy.5,7,10-16 When using candy caneshaped leg holders, there is potential for the patient's lower extremities to rest against the vertical leg-holder posts, which increases the patient's risk for injury to the common peroneal nerve.10,11,14,16 An injury to the common peroneal nerve can cause a paresthesia of the lateral lower leg and dorsum of the foot and result in foot drop.5,10,14 Pressure from the lower extremities resting against leg-holder posts raises compartment pressures and also increases the risk for inadequate lower-extremity perfusion.17
Focusing hard X-rays with old LPs Cederström, Björn; Cahn, Robert N; Danielsson, Mats ...
Nature,
04/2000, Letnik:
404, Številka:
6781
Journal Article
Recenzirano
Odprti dostop
We have found that two sections cut from a vinyl long-playing record can
form a spherical aberration-free refractive lens for hard X-rays. Our manufactured
saw-tooth refractive lens has a focal ...length of 22 cm for 23-keV X-rays. The
low cost and short focal length of this lens make it feasible for use in small-scale
experiments with conventional X-ray tubes.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
An evaluation of the dependence of detective quantum efficiency (DQE) on the incident energy spectrum has been made for mammography. The DQE dependence on the energy spectrum has been evaluated for ...energy-integrating detectors, photon-counting detectors, and detectors that measure the energy of each photon. To isolate the effect of the x-ray energy spectrum the detector has been assumed to be ideal, i.e., all noise sources are assumed to be zero except for quantum fluctuations. The result shows that the improvement in DQE, if the energy-integrating detector is compared to a single-photon counting detector, is of the order of 10%. Comparing the energy-integrating detector and the detector measuring the energy for each photon the improvement is around 30% using a molybdenum anode spectrum typical in mammography. It is shown that the optimal weight factors to combine the data in the case the energy is measured are very well approximated if the weight factors are proportional to
E
−3
.
Another conclusion is that in calculating the DQE, a detector should be compared to one that uses ideal energy weighting for each photon since this provides the best signal-to-noise ratio. This has generally been neglected in the literature.
Neuroimaging is crucial for assessing mass effect in brain-injured patients. Transport to an imaging suite, however, is challenging for critically ill patients. We evaluated the use of a low magnetic ...field, portable MRI (pMRI) for assessing midline shift (MLS). In this observational study, 0.064 T pMRI exams were performed on stroke patients admitted to the neuroscience intensive care unit at Yale New Haven Hospital. Dichotomous (present or absent) and continuous MLS measurements were obtained on pMRI exams and locally available and accessible standard-of-care imaging exams (CT or MRI). We evaluated the agreement between pMRI and standard-of-care measurements. Additionally, we assessed the relationship between pMRI-based MLS and functional outcome (modified Rankin Scale). A total of 102 patients were included in the final study (48 ischemic stroke; 54 intracranial hemorrhage). There was significant concordance between pMRI and standard-of-care measurements (dichotomous, κ = 0.87; continuous, ICC = 0.94). Low-field pMRI identified MLS with a sensitivity of 0.93 and specificity of 0.96. Moreover, pMRI MLS assessments predicted poor clinical outcome at discharge (dichotomous: adjusted OR 7.98, 95% CI 2.07-40.04, p = 0.005; continuous: adjusted OR 1.59, 95% CI 1.11-2.49, p = 0.021). Low-field pMRI may serve as a valuable bedside tool for detecting mass effect.
PDF
