Maternal adherence to guidance on breast milk collection process.

INTRODUCTION: Breast milk expression with a breast pump increases the risk of contaminating milk with pathogenic bacteria; how to decontaminate breast pumps is controversial. The aim of this study was to investigate maternal adherence to updated French guidance on the breast milk collection process, including breast pump decontamination, and to identify potential sources of increased bacterial counts in breast milk in order to improve prevention messages to mothers. METHODS: Descriptive prospective study conducted between November 2015 and April 2016 in a French tertiary perinatal center. Oral and written instructions on the breast milk collection process and breast pump decontamination were given to mothers by trained healthcare professionals. Mothers whose neonates were admitted to the neonatal care unit and expressing milk for the human milk bank were eligible if breast milk bacterial counts before pasteurization were≥106 colony-forming units (cfu)/mL for total aerobic flora or ≥104 cfu/mL for Staphylococcus aureus. Maternal adherence to the guidance was investigated with a questionnaire and a face-to-face interview. RESULTS: One hundred and fourteen mothers with neonates admitted to the neonatal care unit expressed milk for the milk bank; 44 (39%) were eligible and 29 (66%) included: most of them (76%) with increased counts of total aerobic flora in breast milk and 24% with increased counts of S. aureus. At least three divergences from the guidance provided were reported for 16 mothers (55%). The most frequent ones were inadequate storage of the breast pump collection kit (62%), ineffective decontamination of the breast pump collection kit (52%), inappropriate cleaning of the breast pump (48%), and inadequate breast milk transport from home to hospital (31%). CONCLUSION: Despite standardized instructions, mothers with increased bacterial counts in breast milk frequently declared several divergences from the guidance on the breast milk collection process. Giving mothers and any person of their choice repeated clear instructions with illustrated guidance, demonstrations, and practice may help improve the microbiological safety of expressed breast milk.

Post-operative blood loss monitoring device: a new tool for nursing activities.

In most medical specialties, after surgery, it is usual to place a drain at the operative site level, in order to assist the blood flow-out if necessary. This drainage allows avoiding the formation of hematomas and contributes to tissues recovery. However, postoperative blood loss can lead to serious consequences. Also, it is necessary to continuously check the blood output volume in order to be able to intervene quickly in case of too significant losses. In daily clinical practice, this task is due to the nursing staff that periodically records the blood level inside the supple bag connected to the drain. However, this method is not accurate about the volume of lost blood and does not reflect the flow of losses which is an important parameter regarding the evolution of the patient setting. We have designed and developed a prototype of a blood loss monitoring device based on the continuous weight measurement of the blood bag connected to the drain. This device is fixed on the bed and is able to instantaneously alert the medical staff in case of abnormal blood flow-out.

Heart rate variability analysis for arterial hypertension etiological diagnosis during surgical procedures under tourniquet.

Pneumatic tourniquets are widely used to provide a bloodless operative field during upper or lower limb surgery. If tourniquet inflation during general anesthesia is initially a mild stimulus, a long duration of inflation can imply heart rate and blood pressure increasing. However, heart rate or blood pressure increasing can also be caused by other external stimuli. Indeed, in the case of an insufficient analgesia, painful surgical stimuli can also cause an increase in heart rate and blood pressure. Therefore, in the case of the use of a tourniquet during surgery, it's very difficult for the anesthesiologist to distinguish hypertension caused by pain from hypertension caused by tourniquet inflation. In such a case, an efficient and reliable hypertension diagnosis could help the anesthesiologist in the medication choice. We have previously developed and evaluated an Analgesia / Nociception Index (ANI) based on the magnitude analysis of the respiratory patterns on the RR series. We hypothesize that the use of such an index could help in the arterial hypertension etiological diagnosis during surgical procedures under tourniquet.

Heart rate variability analysis for newborn infants prolonged pain assessment.

Pain management is a general concern for healthcare quality. In the particular context of neonatal care, it's well known that an efficient pain management will decrease mortality and morbidity of newborn infants. Furthermore, the plasticity of developing brain is vulnerable to pain and/or stress, that in turn may cause long term neurodevelopmental changes, including altered pain sensitivity and neuroanatomic and behavioural abnormalities. During neonatal intensive care stay, large number of painful procedures are performed, the majority of which are not accompanied by adequate analgesia. Optimal management requires competent pain assessment which can be especially difficult to perform in this non verbal population. We have developed an instantaneous heart rate variability (HRV) analysis method, non intrusive and user-friendly, based on the ECG signal acquisition. This analysis method enabled us to design parameters related to the influence of pain on the Autonomic Nervous System (ANS) activity. This paper presents the application of this method, previously validated for adults under general anesthesia, to the domain of newborn infants prolonged pain assessment.

From pain to stress evaluation using heart rate variability analysis: development of an evaluation platform.

Heart Rate Variability analysis has been shown in several studies to measure the Autonomic Nervous System tone, which is strongly influenced by pain, stress or anxiety. We have previously described and developed an Analgesia/Nociception Index for pain measurement during surgical procedure. This index based on a heart rate variability analysis can be considered as a vagal tone index and used in several other environments. In this paper, we present an adaptation of our technology for stress / anxiety evaluation in the particular domain of incident management teams training.

An easy-to-use phantom and protocol for weekly PET quality assessment: a multicenter study.

The authors have developed a simple phantom and dedicated software for the quality assessment of positron emission tomography (PET) scanners. The phantom is a parallelepiped box filled with a relatively low activity 18FDG solution and in which simple test objects are placed. Various image quality parameters are checked, including signal-to-noise ratio, image uniformity, slice thickness, slice sensitivity profile, spatial resolution, and dose calibration accuracy. Automatic image analysis consists in detecting surfaces and objects, defining regions of interest, acquiring reference point coordinates, and establishing gray-scale profiles. The total time needed for quality assessment (preparation and image acquisition) is less than 15 min with 37 MBq (1 mCi) 18FDG. The system's ease of use encourages frequent image quality assessment-for example, the comparison of PET scanners in interdepartment studies and the monitoring and evaluation of possible drifts over time. By way of an example, the authors present weekly quality assessment results obtained over up to 7 months at four PET facilities.

Ultrasound image registration for patient setup in conformal radiotherapy of prostate cancer.

The goal of 3D conformal radiotherapy (CRT) is to conform the high dose region to the target volume while sparing surrounding normal tissue. Knowledge about the mobility of organs relative to the bony anatomy and to the reference position is of great importance when daily positioning patient. In this work we present a method to monitor patient setup during CRT of prostate cancer. The method is based on ultrasound tracking and matching with planning modality.