Maternal Knowledge and Unsafe Baby Sleep Position: A Cross-Sectional Survey in Southern Brazil.

Objective to evaluate women's knowledge about the best baby sleeping position and to identify factors associated with a greater probability of putting infants to sleep in an unsafe position, in Rio Grande, Southern Brazil. Method This is a cross-sectional population-based study that included all women who bore children in 2013 in this municipality. A single, standardized questionnaire was given within 48 h after delivery in the only two local maternity hospitals. The outcome was that women reported the lateral and the ventral decubitus as the best sleeping positions for babies. A Chi square test was used for proportions and Poisson regression was used with robust variance adjustment in the multivariate analysis. The prevalence ratio was the measure of effect used. Results We included 2624 women in this study. Of these, 82.1% (95% CI 80.6-83.6) stated that the baby should sleep in the lateral or ventral decubitus positions. 76.4% reported having acquired this knowledge from their mothers and 34.7% were willing to adopt the correct (supine) sleeping position for their child if recommended by doctors. The adjusted analysis showed that the lower the schooling of the mothers and the greater the number of people per bedroom and number of children, the greater the probability of women choosing an unsafe baby sleeping position. Conclusions for Practice This study showed that the percentage of women who are unaware of the correct baby sleeping position is very high, that doctors should be convinced to recommend the supine baby sleeping position, and that campaigns on this subject should also include grandparents as a priority intervention group.

Risk assessment for perioperative pressure injuries / Classificação de risco de desenvolvimento de lesões decorrentes do posicionamento cirúrgico / Clasificación de riesgo de desarrollo de lesiones derivadas del posicionamiento quirúrgico

ABSTRACT Objectives: to evaluate and classify patients according to the Risk Assessment Scale for Perioperative Pressure Injuries; verify the association between sociodemographic and clinical variables and the risk score; and identify the occurrence of pressure injuries due to surgical positioning. Method: observational, longitudinal, prospective and quantitative study carried out in a teaching hospital with 278 patients submitted to elective surgeries. A sociodemographic and clinical characterization questionnaire and the Risk Assessment Scale for Perioperative Pressure Injuries were used. Descriptive, bivariate and logistic regression analyses were applied. Results: the majority of patients (56.5%) presented a high risk for perioperative pressure injury. Female sex, elderly group, and altered body mass index values were statistically significant (p < 0.05) for a higher risk of pressure injuries. In 77% of the patients, there were perioperative pressure injuries. Conclusion: most of the participants presented a high risk for development of perioperative decubitus ulcers. The female sex, elderly group, and altered body mass index were significant factors for increased risk. The Risk Assessment Scale for Perioperative Pressure Injuries allows the early identification of risk of injury, subsidizing the adoption of preventive strategies to ensure the quality of perioperative care.

RESUMO Objetivos: avaliar e classificar pacientes segundo a Escala de Avaliação de Risco para Desenvolvimento de Lesões Decorrentes do Posicionamento Cirúrgico; verificar se há associação entre variáveis sociodemográficas, clínicas e escore de risco; e identificar a ocorrência de lesões por pressão, decorrentes do posicionamento cirúrgico. Método: estudo observacional, longitudinal, prospectivo e quantitativo, realizado em hospital de ensino, com 278 pacientes submetidos a cirurgias eletivas. Utilizaram-se questionário de caracterização sociodemográfica e clínica e Escala de Avaliação de Risco para Desenvolvimento de Lesões Decorrentes do Posicionamento Cirúrgico. Empregaram-se análises descritiva, bivariada e de regressão logística. Resultados: a maioria dos pacientes (56,5%) apresentou alto risco para lesão perioperatória por posicionamento. Sexo feminino, idoso e valores de índice de massa corporal alterados foram estatisticamente significativos (p<0,05) para maior risco de ocorrência dessas lesões. Em 77% dos pacientes houve lesões por posicionamento. Conclusão: a maioria dos participantes apresentou alto risco para desenvolvimento de lesão perioperatória por posicionamento. Sexo feminino, idoso e índice de massa corporal alterado foram fatores significativos para aumento do risco. A Escala de Avaliação de Risco para Desenvolvimento de Lesões Decorrentes do Posicionamento Cirúrgico possibilita identificar risco de lesão precocemente, subsidiando a adoção de estratégias preventivas para assegurar a qualidade do cuidado perioperatório.

RESUMEN Objetivos: evaluar y clasificar pacientes según la Escala de Evaluación de Riesgo para el Desarrollo de Lesiones Derivadas por Posicionamiento Quirúrgico, verificar si hay asociación entre variables sociodemográficas, clínicas y escore de riesgo e identificar si existen lesiones por presión, derivadas del posicionamiento quirúrgico. Método: estudio observacional, longitudinal, prospectivo y cuantitativo, realizado en hospital de enseñanza, con 278 pacientes sometidos a cirugías electivas. Se utilizó un cuestionario de caracterización sociodemográfica y clínica y Escala de Evaluación de Riesgo para el Desarrollo de Lesiones Derivadas por Posicionamiento Quirúrgico. Empleamos análisis descriptivos, bivariados y de regresión logística. Resultados: la mayoría de los pacientes (56,5%) presentó alto riesgo para lesión peri operatoria por posicionamiento. El sexo femenino, ancianos y valores de índice de masa corporal alterados fueron estadísticamente significativos (p <0,05) para mayor riesgo de existencia de esas lesiones. En el 77% de los pacientes hubo lesiones por posicionamiento. Conclusión: la mayoría de los participantes presentó alto riesgo de desarrollo de lesión peri operatoria por posicionamiento. El sexo femenino, ancianos e índice de masa corporal alterado fueron factores significativos para el aumento del riesgo. La Escala de Evaluación de Riesgo para el Desarrollo de Lesiones Derivadas del Posicionamiento Quirúrgico posibilita identificar precozmente el riesgo de lesión, subsidiando la adopción de estrategias preventivas para asegurar la calidad del periodo perioperatorio.

Pre-analytical phase management: a review of the procedures from patient preparation to laboratory analysis.

The pre-analytical phase encompasses all the procedures before the start of laboratory testing. This phase of the testing process is responsible for the majority of the laboratory errors, since the related procedures involve many sorts of non-laboratory professionals working outside the laboratory setting, thus without direct supervision by the laboratory staff. Therefore, either correct organization or management of both personnel and procedures that regard blood specimen collection by venipuncture are of fundamental importance, since the various steps for performing blood collection represent per se sources of laboratory variability. The aim of this (non-systematic) review addressed to healthcare professionals is to highlight the importance of blood specimen management (from patient preparation to laboratory analyses), as a tool to prevent laboratory errors, with the concept that laboratory results from inappropriate blood specimens are inconsistent and do not allow proper treatment nor monitoring of the patient.

A sonographic technique to evaluate the anterior bundle of the ulnar collateral ligament of the elbow: imaging features and anatomic correlation.

OBJECTIVES: The aim of this study was to test a sonographic technique used to view the anterior bundle of the ulnar collateral ligament (UCL), describe its sonographic characteristics in healthy volunteers, and verify these characteristics by determining interobserver variability and their correlations in cadavers. METHODS: Sonographic studies of the anterior bundle of the UCL were performed on 48 elbows of asymptomatic healthy volunteers. The participants were examined by 3 experts, who identified the insertion sites of the anterior bundle and subjectively evaluated its echogenicity and echo texture. A sonographic examination of the anterior bundle of the UCL in a cadaveric elbow was performed, and the same aspects were evaluated. RESULTS: In all cases, the anterior bundle of the UCL appeared as a triangular structure in the coronal plane and had a hyperechoic homogeneous echo texture in most of these cases. The cadaveric elbow had the same sonographic characteristics as the volunteers. CONCLUSIONS: As shown by examining the interobserver variability and determining the correlation with cadaveric tissue, sonography proved to be a reliable tool for evaluating the normal aspects of the anterior bundle of the UCL.

Assessment of Quality of Fetal Heart Views by 3D/4D Ultrasonography Using Spatio-Temporal Image Correlation in the Second and Third Trimesters of Pregnancy.

OBJECTIVE: To assess the quality of fetal heart views by three-dimensional/four-dimensional (3D/4D) ultrasonography using spatio-temporal image correlation (STIC) in the second and third trimester of pregnancy. METHODS: This prospective and cross-sectional study was conducted at a single referral service for the screening of congenital heart diseases (CHDs), with pregnant women at 20-30 weeks' gestation with a normal fetal heart. 3D/4D STIC were obtained from the fetal heart screening in the following views: four-chamber (4C), left and right ventricular outflow tracts (LVOT and RVOT), 3 vessels and trachea (3VT), aortic arch (AA), and ductal arch (DA). We categorized the images as satisfactory or unsatisfactory and performed McNemar's test to evaluate the differences between the two-dimensional (2D) echocardiography and 3D/4D STIC techniques. The inter-observer concordance was obtained by kappa coefficient. RESULTS: The rate of satisfactory fetal heart views using 3D/4D STIC was 54% by using 4 planes (4C, RVOT, LVOT, and 3VT) and 14% by using 6 planes (4C, RVOT, LVOT, 3VT, AA, and DA). In contrast, 100% of the 2D echocardiography images were satisfactory (McNemar's test, P < 0.001). We observed moderate inter-observer concordance to both 4- and 6 planes (κ = 0.56 and 0.43, respectively). CONCLUSION: The quality of the main fetal heart views by 3D/4D STIC still present some limitations compared with the 2D echocardiography.

A prospective study to assess the performance of the improved Boron Neutron Capture Therapy Facility in Argentina.

From 2008 to 2011, several planned modifications were implemented at the RA-6 reactor in Argentina, leading to significant benefits for future BNCT treatments. New capabilities have been implemented in NCTPlan treatment planning system. To assess the performance of the new BNCT facility, a dosimetric reevaluation of previous clinical cases was performed, taking into account the modifications carried out in the new facility and compared the results of the original treatment plans with optimized plans that are considered as feasible patient setups.

Evaluation of common operator errors in panoramic radiography in Trinidad and Tobago: a comparison of formally vs informally trained operators / La evaluación de los errores comunes de los operadores de radiografía panorámica en Trinidad y Tobago comparación de los operadores adiestrados formalmente frente a los adiestrados informalmente

AIM: To evaluate and compare the frequency of common operator errors seen on panoramic radiographs in dental private practices and in the dental hospital (taken by informally and formally trained operators, respectively) in Trinidad and Tobago. METHOD: One thousand panoramic radiographs of patients over the age of 10 years were included in this study. These comprised 500 from the dental hospital and 500 from dental private practices. The radiographs were reviewed using standardized criteria to identify the most common operator errors. RESULTS: There were only 21 (4.2%) error free radiographs in the dental private practice sample and 29 (5.8%) in the dental hospital sample. Frequencies of specific errors were significantly higher in the dental private practice sample in each category except for "Chin tipped too low" (Chi-square p < 0.05) CONCLUSION: This study supports the need for the introduction of statutory guidelines with respect to the use of ionizing radiation in dentistry in Trinidad and Tobago and in particular, the implementation of formally assessed dedicated dental radiography training for all operators of dental X-ray equipment.

OBJETIVO: Evaluar y comparar la frecuencia de los errores comunes de los operadores, observados en las radiografías panorámicas en las clínicas dentales privadas y en el hospital de odontología (tomadas por operadores adiestrados formalmente e informalmente, de forma respectiva) en Trinidad y Tobago. MÉTODO: Mil radiografías panorámicas de pacientes de más de 10 años de edad, fueron incluidas en este estudio. Las mismas comprendían 500 provenientes del hospital odontológico y 500 provenían de las prácticas privadas de dentistas. Las radiografías fueron examinadas a partir de criterios estandarizados, a fin de identificar los errores más comunes de los operadores. RESULTADOS: Hubo sólo 21 (4.2%) radiografías sin errores en la muestra de la clínica dental privada, y 29 (5.8%) en la muestra del hospital de odontología. Las frecuencias de errores específicos fueron significativamente más altas en la muestra de la clínica dental privada en cada categoría, salvo el caso del "mentón inclinado excesivamente hacia abajo" (Chi-cuadrado p < 0.05) CONCLUSIÓN: Este estudio subraya la necesidad de introducir pautas reglamentarias con respecto al uso de la radiación ionizante en la cirugía dental en Trinidad y Tobago, particularmente en lo que concierne al adiestramiento especializado en radiografía dental, formalmente evaluado, para todos los operadores de equipos de rayos x para el trabajo dental.

Evaluation of common operator errors in panoramic radiography in Trinidad and Tobago: a comparison of formally vs informally trained operators.

AIM: To evaluate and compare the frequency of common operator errors seen on panoramic radiographs in dental private practices and in the dental hospital (taken by informally and formally trained operators, respectively) in Trinidad and Tobago. METHOD: One thousand panoramic radiographs of patients over the age of 10 years were included in this study. These comprised 500 from the dental hospital and 500 from dental private practices. The radiographs were reviewed using standardized criteria to identify the most common operator errors. RESULTS: There were only 21 (4.2%) error free radiographs in the dental private practice sample and 29 (5.80%) in the dental hospital sample. Frequencies of specific errors were significantly higher in the dental private practice sample in each category except for "Chin tipped too low" (Chi-square p < 0.05) CONCLUSION: This study supports the need for the introduction of statutory guidelines with respect to the use of ionizing radiation in dentistry in Trinidad and Tobago and in particular, the implementation of formally assessed dedicated dental radiography training for all operators of dental X-ray equipment.

A radiological investigation of the hepatorenal space: the importance of the ventral decubitus for safer percutaneous right renal access.

We investigated anatomical and radiological morphometric parameters, aiming to minimize the risk of hepatic and colonic injuries during right percutaneous kidney access under either ventral or dorsal decubitus of patients. Prone and supine abdominal computerized tomographic examinations from 31 normal adult volunteers (men = 12; women = 19; without history of abdominal pathology) were analyzed morphometrically in order to study the dynamic anatomical relations between the liver and the right kidney. The age of the volunteers ranged from 22 to 64 years old (mean +/- SD = 42.77 +/- 2.10). We observed a significantly greater distance between the liver and the right kidney (hepatorenal space) when the examinee is positioned in ventral decubitus (3.93 +/- 0.37 cm) in comparison with dorsal decubitus (1.98 +/- 0.20 cm). Accordingly, we conclude that right percutaneous access to the inferior right renal pole implies a significantly lower risk (P < 0.01) of both hepatic and biliary injuries when performed in ventral decubitus, comparatively to dorsal decubitus.