Developing a portable field unit to improve well-child care.

BACKGROUND: Pediatric growth tracking has been identified as a top priority by international health agencies to assess the severity of malnutrition and stunting. However, remote low-resource settings often lack the necessary infrastructure for longitudinal analysis of growth for the purposes of early identification and immediate intervention of stunting. METHODS: To address this gap, we developed a portable field unit (PFU) capable of identifying a child over the course of multiple visits, each time adding new anthropomorphic measurements. We conducted a preliminary field evaluation of the PFU by using the unit on two distinct visits to three schools in the area surrounding a medical clinic in rural San Jose, Honduras. The unit was used to assess children at each school as part of the community outreach. RESULTS: Community outreaches to three schools were conducted by two distinct teams, where they used the device to assess 210 children. Of the 180 children registered during the first visit, 112 were re-identified and assessed on the subsequent visit. Twenty-four instances of moderate-to-severe malnutrition were identified and referred for further evaluation to the central clinic. CONCLUSION: This initial assessment suggests that the PFU could be an effective means of identifying at-risk children.

CONTEXTE: Les organismes internationaux de santé ont identifié le suivi de la croissance des enfants comme une priorité absolue pour évaluer la gravité de la malnutrition et les retards de croissance. Cependant, les zones reculées à faibles ressources n'ont souvent pas les infrastructures nécessaires à l'analyse longitudinale de la croissance à des fins d'identification précoce et d'intervention immédiate de lutte contre les retards de croissance. MÉTHODES: Pour combler ces lacunes, nous avons développé un appareil portatif de terrain (PFU) capable d'identifier un même enfant lors de plusieurs visites et d'ajouter les nouvelles mesures anthropomorphiques de chaque visite. Nous avons réalisé une évaluation de terrain préliminaire du PFU en utilisant l'appareil lors de deux visites différentes dans trois écoles de la zone rurale aux alentours d'une clinique médicale de San Jose, Honduras. L'appareil a été utilisé pour évaluer les enfants de chaque école dans le cadre d'un programme de sensibilisation communautaire. RÉSULTATS: Des programmes de sensibilisation communautaire ont été menés dans trois écoles par deux équipes différentes, qui ont utilisé l'appareil pour évaluer 210 enfants. Sur les 180 enfants enregistrés lors de la première visite, 112 ont été de nouveau identifiés et évalués lors de la visite suivante. Vingt-quatre cas de malnutrition modérée à sévère ont été identifiés et adressés pour examen complémentaire à la clinique centrale. CONCLUSION: Cette évaluation initiale suggère que le PFU pourrait être un moyen efficace d'identification des enfants à risque.

Neurologic manifestations of cerebral air embolism as a complication of central venous catheterization.

UNLABELLED: OBJECTIVE, PATIENTS, AND METHODS: A severe case of cerebral air embolism after unintentional central venous catheter disconnection was the impetus for a systematic literature review (1975-1998) of the clinical features of 26 patients (including our patient) with cerebral air embolism resulting from central venous catheter complications. RESULTS: The jugular vein had been punctured in eight patients and the subclavian vein, in 12 patients. Embolism occurred in four patients during insertion, in 14 patients during unintentional disconnection, and in eight patients after removal and other procedures. The total mortality rate was 23%. Two types of neurologic manifestations may be distinguished: group A (n = 14) presented with encephalopathic features leading to a high mortality rate (36%); and group B (n = 12) presented with focal cerebral lesions resulting in hemiparesis or hemianopia affecting mostly the right hemisphere, with a mortality rate as high as 8%. In 75% of patients, an early computed tomography indicated air bubbles, proving cerebral air embolism. Hyperbaric oxygen therapy was performed in only three patients (12%). A cardiac defect, such as a patent foramen ovale was considered the route of right to left shunting in 6 of 15 patients (40%). More often, a pulmonary shunt was assumed (9 of 15 patients; 60%). For the remainder, data were not available. CONCLUSION: When caring for critically ill patients needing central venous catheterization, nursing staff and physicians should be aware of this potentially lethal complication.