Implementation of Neurally Adjusted Ventilatory Assist (NAVA): Patient characteristics and staff experiences.

OBJECTIVE: The objective of the study was to describe the implementation of Neurally Adjusted Ventilatory Assist (NAVA) by characteristics of patients receiving NAVA and by staff-experienced opportunities and barriers. METHODS: Design. A retrospective review of hospital records of mechanically ventilated patients over two time periods after implementation, as well as a questionnaire survey and interviews with staff. SETTING: A secondary Danish ICU. PARTICIPANTS: ICU patients, nurses, and intensivists. INTERVENTION: Implementation of NAVA, which included theoretical education, bedside training, and frequent updates. MAIN OUTCOME MEASURE: Evaluation of NAVA implementation measured by characteristics of patients receiving NAVA and staff experiences with NAVA. RESULTS: A total of 311 patients were included. Hereof 43 (27%) and 68 (44%) patients, respectively, had recieved NAVA. The patients receiving NAVA had higher severity scores and more hours on ventilators. A total of 35 nurses (76%) and 16 physicians (64%) completed the questionnaire. Most clinicians found, to a high (43%) or very high (41%) degree, that NAVA was an effective therapy option. Furthermore, 77% did not experience any barriers regarding NAVA therapy. The main advantages experienced with NAVA were increased patient comfort, respiratory synchrony with the ventilator, and improved opportunities for monitoring patient respiratory performance. The main disadvantage was the need for additional theoretical and practical knowledge. CONCLUSION: Despite staff experience of NAVA as a beneficial treatment option, more than half of the patients did not receive NAVA treatment two years after the start of its implementation. Implementation of a therapy which is substantially different to earlier practices is complicated.

Propetamphos resistance in Rhipicephalus bursa (Acari, Ixodidae).

Hard tick infestation is an important problem in both traditional and industrial animal husbandry as well as in veterinary and public health. Several acaricides have been used to control tick infestation in Iran. Poor control has been attributed to acaricide resistance in tick populations although this has not been demonstrated experimentally. In this study, susceptibility status to propetamphos (Blotic) of 2-3-week-old larvae of Rhipicephalus bursa, one of the most common tick species in Iran, was evaluated using the FAO recommended larval packet test (LPT) method with some modifications. Log dosage probit analysis of propetamphos dose-response regression lines produced a resistance ratio based on LC(50) in the most resistant strain of approximately 103-fold. Biochemical assays suggested that the tick strains contained multiple insecticide resistance mechanisms involving elevation of esterases, GSTs, MFOs and alteration of acetylcholinesterase. In light of this data, practical implications for pest and pesticide resistance management strategies are discussed.

Primary evaluation of methenamine as a NPN compound with probable effects on increasing ruminal escaped protein.

The effects of methenamine as a non-protein nitrogenous compound on protein and health status of feedlot lambs were studied in three groups of lambs receiving 5, 10, or 15 g of the substance daily in their feed for 100 days. The results were compared with data obtained from a control group receiving a diet low in crude protein without methenamine. Serum total protein, serum urea nitrogen and serum creatinine were measured every 10 days as indicators of protein metabolism and kidney function. Urine samples were also examined on the same days for possible side-effects of methenamine on the urinary tract. Following slaughter, various internal organs, including the brain and various parts of the gastrointestinal and urinary tracts, were examined both grossly and microscopically to detect any lesions. All groups receiving methenamine had serum total protein and serum urea nitrogen levels higher than those in the control group. The serum creatinine level was normal in all the groups throughout the experiment. No gross or microscopic lesion attributed to the toxic effects of methenamine was detected in any of the internal organs. Therefore, it is concluded that methenamine can be used as a non-protein nitrogenous compound without serious side-effects.