Nanoengineered Shear-Thinning Hydrogel Barrier for Preventing Postoperative Abdominal Adhesions.

More than 90% of surgical patients develop postoperative adhesions, and the incidence of hospital re-admissions can be as high as 20%. Current adhesion barriers present limited efficacy due to difficulties in application and incompatibility with minimally invasive interventions. To solve this clinical limitation, we developed an injectable and sprayable shear-thinning hydrogel barrier (STHB) composed of silicate nanoplatelets and poly(ethylene oxide). We optimized this technology to recover mechanical integrity after stress, enabling its delivery though injectable and sprayable methods. We also demonstrated limited cell adhesion and cytotoxicity to STHB compositions in vitro. The STHB was then tested in a rodent model of peritoneal injury to determine its efficacy preventing the formation of postoperative adhesions. After two weeks, the peritoneal adhesion index was used as a scoring method to determine the formation of postoperative adhesions, and STHB formulations presented superior efficacy compared to a commercially available adhesion barrier. Histological and immunohistochemical examination showed reduced adhesion formation and minimal immune infiltration in STHB formulations. Our technology demonstrated increased efficacy, ease of use in complex anatomies, and compatibility with different delivery methods, providing a robust universal platform to prevent postoperative adhesions in a wide range of surgical interventions.

The meaning of home for ageing women living alone: An evolutionary concept analysis.

The concept of home to women ageing should be visited in the light of ongoing cultural, political, temporal and disciplinary evolutions. In part, to compliment policies increasing focus on supporting older adults to age in place and a growing attention on the home as a place where healthcare is designed and provided. The following concept analysis utilises Rodgers' evolutionary method to inductively analyse literature in order to elicit the meaning and experience of home among older women who are ageing at home. Literature was collected over an 18-month period during 2014-2015 and the sample was made up of 49 articles. The analysis led to the concept of home among women ageing in communities to be defined by four attributes. These attributes are home as (i) a resource, (ii) an attachment, (iii) the precariousness of maintaining and sustaining home and (iv) a cultural expectation. This analysis of the meaning and experience of home among women ageing at home has shed light on the needs for this group of women, while highlighting the need to continue to further clarify and define the concept through research.

Validation de la version francophone d'une échelle composite multidimensionnelle pour l'évaluation de la douleur postopératoire chez les chats.

Validation of the French version of the UNESP-Botucatu multidimensional composite pain scale for assessing postoperative pain in cats. The aim of this study was to validate the French version of the UNESP-Botucatu multidimensional composite pain scale (MCPS-Fr) to assess postoperative pain in cats. Two veterinarians and one DVM student identified three domains of behavior based on video analyses: "psychomotor change", "protection of the painful area" and "physiological variables". Internal consistency was excellent (Cronbach's alpha coefficient of 0.94, 0.90 and 0.61, respectively). Criterion validity was good to very good when evaluations from the three observers were compared with a "gold standard". Inter- and intra-rater reliability for each scale item were good to very good. The optimal cut-off point identified with a ROC curve was > 7 (scale range 0-30 points), with a sensitivity of 97.8% and specificity of 99.1%. The MCPS-Fr is a valid, reliable and responsive instrument for assessing acute pain in cats undergoing ovariohysterectomy.(Translated by Dr. Beatriz Monteiro).

[Overlapping, interdependence or complementarity, interprofessional collaboration between nurse practitioners and other health professionals in Ontario]. / Chevauchement, interdépendance ou complémentarité?, la collaboration interprofessionnelle entre l?infirmière praticienne et d?autres professionnels de santé en Ontario.

OBJECTIVE: The Naylor Report (2015) states that nurse practitioners (NP) are still underutilized in Canada despite positive evidence of their work and the benefits they provide to health systems and, more generally, the health of the population. METHODS: Why are nurse practitioners not more actively involved in the Canadian health care system? A socio-historical literature review showed that there is overlap, interdependence or complementarity between the role of NPs and that of other health professionals and that this concerns their status, training as well as the scope of their practice. The development of an interprofessional collaborative approach, although supported by most professional nursing associations in Canada, is difficult to establish in NP practice and training. RESULTS: This article describes the emergence of the role of NPs in Canada and provides an update on the current status of their integration in the health system with reference to the Ontario example. It provides insight into the overlap and zones of complementarity or interdependence between NPs and other health professionals. CONCLUSION: In conclusion, the authors call for improved governance by the contribution of a new collaborative contract with other health professionals. This contract should be based on the interdependence of practices and the complementarity of roles between all health professionals including NPs.

Pharmacokinetics of bupivacaine after intraperitoneal administration to cats undergoing ovariohysterectomy.

OBJECTIVE To evaluate pharmacokinetics of bupivacaine after IP administration to cats undergoing ovariohysterectomy. ANIMALS 8 healthy cats. PROCEDURES Anesthesia was induced with propofol and maintained with isoflurane. Buprenorphine (0.02 mg/kg, IV) and meloxicam (0.2 mg/kg, SC) were administered. A 20-gauge catheter was inserted into a jugular vein for blood sample collection. A ventral midline incision was made, and a solution of 0.5% bupivacaine (2 mg/kg) diluted with an equal volume of saline (0.9% NaCl) solution (final concentration, 0.25% bupivacaine) was injected into the peritoneal space over the right and left ovarian pedicles and caudal aspect of the uterus before ovariohysterectomy. Cats were monitored for signs of bupivacaine toxicosis. Venous blood samples (2 mL) were collected before (time 0) and 2, 5, 10, 15, 20, 30, 60, 120, and 240 minutes after bupivacaine administration. Plasma bupivacaine concentrations were determined with a liquid chromatography-tandem mass spectrometry method. Pharmacokinetic parameters were determined by data plotting followed by analysis with a noncompartmental model. RESULTS No signs of bupivacaine toxicosis were observed. Maximum bupivacaine plasma concentration was 1,030 ± 497.5 ng/mL at a mean ± SD value of 30 ± 24 minutes after administration. Mean elimination half-life was 4.79 ± 2.7 hours. Mean clearance indexed by bioavailability and volume of distribution indexed by bioavailability were 0.35 ± 0.18 L•h/kg and 2.10 ± 0.84 L/kg, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Intraperitoneal administration of bupivacaine resulted in concentrations that did not cause observable toxicosis. Studies to investigate analgesic effects for this technique in cats are warranted.

Analgesic efficacy of intraperitoneal administration of bupivacaine in cats.

Objectives The aim of this study was to evaluate the analgesic efficacy of intraperitoneal (IP) bupivacaine in cats undergoing ovariohysterectomy (OVH). Methods Forty-five cats were included in a randomized, prospective, blinded study after owners' written consent was obtained. The anesthetic protocol included acepromazine-buprenorphine-propofol-isoflurane. A ventral midline incision was made and cats (n = 15/group) were administered either IP saline 0.9% (negative and positive control groups; NG and PG, respectively) or IP bupivacaine (2 mg/kg; bupivacaine group; BG). Cats in the PG received meloxicam (0.2 mg/kg SC). An OVH was performed and postoperative pain was evaluated using a dynamic interactive visual analog scale (DIVAS), the UNESP-Botucatu multidimensional composite pain scale (MCPS) and mechanical nociceptive thresholds (MNT) for up to 8 h after the end of surgery. Postoperative sedation was evaluated using DIVAS. Rescue analgesia was provided with buprenorphine and/or meloxicam. Repeated measures linear models and a Cochran-Mantel-Haenszel test were used for statistical analysis ( P <0.05). Results There was a significant effect of treatment on the number of times rescue analgesia was administered ( P = 0.002) (PG, n = 2, 13%; NG, n = 12, 80%; BG, n = 4, 27%) with the number of rescues being higher in the NG group than in the PG ( P = 0.0004) and BG ( P = 0.02) groups. The DIVAS, MCPS and MNT were significantly different when compared with baseline values at different time points; however, data were not significantly different among groups. Conclusions and relevance Treatments PG and BG produced similar analgesia in terms of pain scores, number of times rescue analgesia was administered and MNT. Based on rescue analgesia, IP administration of bupivacaine provides analgesia in cats after OVH.

The ED90 of prophylactic oxytocin infusion after delivery of the placenta during cesarean delivery in laboring compared with nonlaboring women: an up-down sequential allocation dose-response study.

BACKGROUND: Prophylactic administration of oxytocin as a part of active management of the third stage of labor reduces the risk of postpartum hemorrhage. Prophylactic oxytocin is often administered as an infusion rather than a bolus. The aim of the current up-down sequential allocation dose-response study was to test the hypothesis that parturients who receive intrapartum exogenous oxytocin therapy, and who subsequently undergo cesarean delivery for labor dystocia, will have a higher estimated effective dose in 90% of paturients (ED90) for oxytocin infusion in the third stage of labor compared with nonlaboring parturients. METHODS: The study design was a single-blinded, dual-arm, dose-response study using a 9:1 biased-coin sequential allocation method to estimate the ED90 of an infusion of prophylactic oxytocin in women undergoing cesarean delivery with neuraxial anesthesia. The experimental (laboring) group included women scheduled for intrapartum cesarean delivery after prior exposure to exogenous oxytocin, and the control (nonlaboring) group included women scheduled for elective cesarean delivery. The starting infusion rate was 18 IU/h, with an incremental dose of 2 IU/h. The outcome was satisfactory uterine tone 4 minutes after delivery as judged by the obstetrician. Secondary outcomes included requirement for additional uterotonic agents and maternal side effects (e.g., nausea and vomiting, ST-segment depression). Dose-response data for each group were evaluated by a log-logistic function and ED90 estimates derived from the fitted equations using the delta method. RESULTS: Thirty-eight and 32 subjects participated in the nonlaboring and laboring groups, respectively. The oxytocin ED90 was significantly greater for the laboring group (44.2 IU/h [95% confidence interval (CI), 33.8-55.6]) compared with that for the nonlaboring group (16.2 IU/h [95% CI, 13.1-19.3]; difference in dose 28 IU/h [95% CI of difference, 26-29, P < 0.001]). Significantly more women in the laboring group (34%) than in the nonlaboring group (8%) required supplemental uterotonic agents (difference 26% [95% CI of the difference, 7%-44%, P = 0.008]). The overall incidence of side effects was greater in the laboring group (69%) than in the nonlaboring group (34%; difference 25% [95% CI of the difference, 10%-59%, P = 0.004]). CONCLUSIONS: Women with prior exposure to exogenous oxytocin require a higher initial infusion rate of oxytocin to prevent uterine atony after cesarean delivery than women without prior exposure.

Preliminary investigation of the thermal antinociceptive effects of codeine in cats.

OBJECTIVES: The aim of this study was to evaluate the potential thermal antinociceptive effects of oral administration of a single dose of codeine in cats compared with positive (buprenorphine) and negative (saline 0.9%) controls. METHODS: Six adult healthy cats weighing 5.14 ± 0.6 kg were used. Skin temperature and thermal thresholds (TTs) were evaluated using a wireless device (Topcat Metrology) at baseline, 0.5, 1, 3, 6 and 10 h after treatment. In period 1, TTs were evaluated after subcutaneous administration of saline 0.9%. In period 2, cats were administered either oral codeine (10 mg total, 2.0 ± 0.2 mg/kg) or buccal buprenorphine (0.04 mg/kg) in a cross-over, blinded study design. Half of the volume of buprenorphine was administered into each cheek pouch. Δ TT (difference between TTs after and before treatment) was used for data comparison. Mean ± SD data were analyzed using one-way ANOVA followed by Dunnett's or Tukey's test when appropriate (P <0.05). RESULTS: Adverse effects did not occur in any group. Skin temperature was not different between groups nor over time. Temporal changes in TTs were not observed after saline or codeine. Buprenorphine increased Δ TT at 3 h (2.7 ± 3.3°C) when compared with baseline or saline (P <0.05). For buprenorphine, TTs were not >47.6°C at any time point in four cats. The mean highest temperature recorded in the two other cats in that group was 54.5 and 52.8°C at 3 h. CONCLUSIONS AND CLINICAL RELEVANCE: At the dose administered, codeine did not produce thermal antinociception. Mild increases in TT after buccal buprenorphine might be related to the first-pass effect after drug swallowing, drug spillage during administration and/or individual variability. These factors should be taken in to consideration when administering buprenorphine by this route in the clinical setting.

[The vulnerability of women Francophone parent at risk of homelessness in a community in Northern Ontario]. / La vulnérabilité de femmes monoparentales francophones à risque de sans-abrisme dans une communauté du Nord de l'Ontario.

OBJECTIVE: This study aimed to examine the vulnerability of Francophone single mothers at risk of homelessness in Northern Ontario. The project also endeavoured to document the quest for autonomy of these women in a minority context. METHOD: Employing a qualitative approach, eleven life stories were obtained from five women. Although none were homeless at the time of the interviews, in terms of living on the street, two were living with friends and the others were at risk of becoming homeless. All of the participants were between 20 and 59 years old and had completed their secondary education. RESULTS: Taking into account their economic and social situation, as well as the participants' health and cultural resources, vulnerabilities throughout the life course were analyzed. CONCLUSION: The life trajectory of these women showed us that their significant vulnerabilities are relative to the amount of autonomy they are able to secure through the services provided by supporting agencies, particularly in a linguistic minority context. In addition, the triple stigmatization (economic, linguistic and gender relations) requires a broader understanding of the resilience of these women in their journey from poverty (economic) to social (and linguistic) exclusion, and vulnerability. Despite these challenges, each of the individuals interviewed in this study, for whom the quest for autonomy is a continual struggle, demonstrated resilience.

Multimodal postcesarean delivery analgesia.

Cesarean deliveries can be associated with moderate to severe postoperative pain. Appropriate management of pain is important because it results in better patient satisfaction, earlier mobilization, and improved maternal-infant bonding. There are many individual options for treatment of pain; however, multimodal analgesic therapy has become the mainstay of treatment. In this article, the epidemiology of postcesarean delivery pain, pain mechanisms, and the multiple options available to providers for treatment of postoperative pain are discussed.

[Nursing training in Canada]. / La formation infirmière au Canada.

Job prospects for nurses in Canada are excellent. By bringing nursing studies up to degree level, new opportunities have been created. Before undertaking a bachelor's, master's or doctoral degree, it is important that students understand the content of the lessons, the desired level of studies and how the programme works. Canadian students can choose whether to start work or to continue their studies at a higher level.

Older adult mistreatment risk screening: contribution to the validation of a screening tool in a domestic setting.

ABSTRACTThe hidden nature of older adult mistreatment renders its detection in the domestic setting particularly challenging. A validated screening instrument that can provide a systematic assessment of risk factors can facilitate this detection. One such instrument, the "expanded Indicators of Abuse" tool, has been previously validated in the Hebrew language in a hospital setting. The present study has contributed to the validation of the "e-IOA" in an English-speaking community setting in Ontario, Canada. It consisted of two phases: (a) a content validity review and adaptation of the instrument by experts throughout Ontario, and (b) an inter-rater reliability assessment by home visiting nurses. The adaptation, the "Mistreatment of Older Adult Risk Factors" tool, offers a comprehensive tool for screening in the home setting. This instrument is significant to professional practice as practitioners working with older adults will be better equipped to assess for risk of mistreatment.

Montreal's contribution to the Quebec anesthesia workforce: a comparison between anesthesia residents trained at McGill University and those trained at Université de Montréal.

PURPOSE: Alumni from McGill University (MAA) and alumni from Université de Montréal (UMA) anesthesia residency programs were compared with regard to demographic characteristics and practice location. METHODS: McGill University alumni and UMA (1990-2010) were studied according to age, sex, pre-anesthesia education, fellowship training, advanced research training, and practice location. Logistic regression analysis of demographics in relation to practice location was performed. RESULTS: Alumni were mostly male (MAA [n = 102]; male:female 72 [71%]: 30 [29%] vs UMA [n = 89]; male:female 51 [57%]: 38 [43%]) in their early thirties [mean 32; standard deviation (3.2) and 32 (3.0), respectively]. Approximately 45% of MAA obtained an undergraduate education in provinces other than Quebec compared with 6% of UMA. A majority of alumni from either institution practice in Quebec (MAA 67%; UMA 94%). Of the MAA who received undergraduate education in Quebec, approximately 80% practice in that province compared with approximately 46% of those who were educated in other provinces. Fellowship training for MAA who work in Quebec or in other provinces was similar (68%). About one-third (33%) of UMA who work in Quebec obtained fellowship training. All alumni who received undergraduate education abroad (MAA n = 9; UMA n = 1) practice in Quebec. Three MAA and one UMA practice in the USA. Regression analysis suggests that working in Quebec is associated with obtaining an undergraduate medical education in that province (odds ratio 4.3; 95% confidence interval 1.1 to 21.2). CONCLUSIONS: The majority of MAA and UMA practice in Quebec, particularly if they received their undergraduate education there. Residents educated (undergraduate) in the rest of Canada are more likely to practice in other provinces. Residents with undergraduate education from abroad are highly likely to practice anesthesia in Quebec. A small portion of alumni elect to practice anesthesia in the USA.

[Quantitative and qualitative research methods, can they coexist yet?]. / Les méthodes de recherche quantitatives et qualitatives peuvent-elles déjà coexister?

Qualitative design is gaining ground in Nursing research. In spite of a relative progress however, the evidence based practice movement continues to dominate and to underline the exclusive value of quantitative design (particularly that of randomized clinical trials) for clinical decision making. In the actual context convenient to those in power making utilitarian decisions on one hand, and facing nursing criticism of the establishment in favor of qualitative research on the other hand, it is difficult to chose a practical and ethical path that values the nursing role within the health care system, keeping us committed to quality care and maintaining researcher's integrity. Both qualitative and quantitative methods have advantages and disadvantages, and clearly, none of them can, by itself, capture, describe and explain reality adequately. Therefore, a balance between the two methods is needed. Researchers bare responsibility to society and science, and they should opt for the appropriate design susceptible to answering the research question, not promote the design favored by the research funding distributors.

Anesthetic dose neuraxial blockade increases the success rate of external fetal version: a meta-analysis.

PURPOSE: This study is a meta-analysis evaluating the efficacy of central neuraxial blockade (CNB) (epidural or spinal) to facilitate fetal version. METHODS: A search with no language restriction for all available randomized controlled trials (RCT) was conducted in PUBMED on July 2, 2009, EMBASE 1980 to 2009 Week 27, Ovid MEDLINE(R) 1950 to Week 4 in June 2009, EBM Reviews - Cochrane Central Register of Controlled Trials 2(nd) Quarter 2009, and CINAHL on July 4, 2009. Reference lists of all studies were also checked. Two investigators extracted data independently. The optimal information size (OIS) was calculated on a 50% failure rate of fetal version for a relative reduction of 25% (alpha = 0.05 two-tailed, beta = 0.2). RESULTS: The OIS was 494. Seven RCTs were found, including 681 pregnant women with a Jadad score from 1 to 3. Central neuraxial blockade increases the success rate of fetal version (risk ratio [RR] = 1.44; 95% confidence interval [CI] = 1.16-1.79; P = 0.001) (random effects model; I(2) = 30.25%; P value for heterogeneity = 0.20). Three studies used a CNB at anesthetic dose of local anesthetic (RR = 1.95; 95% CI = 1.46-2.60; P < 0.001; I(2) = 0.00%; P value for heterogeneity = 0.86; number needed to treat = 4; 95% CI = 3-6). Four studies used an analgesic dose (RR = 1.18; 95% CI = 0.94-1.49; P = 0.15; I(2) = 0.00%; P value for heterogeneity = 0.77). These two subgroups were significantly different one from the other with a P value of 0.007. CONCLUSION: Anesthetic dose neuraxial blockade increases the success rate of external fetal version.

[Evaluation of a conflict situation between two services in a seniors' residence according to the Herzberg Theory]. / Evaluation d'une situation conflictuelle entre deux services dans un centre d'hébergement de personnes âgées selon la théorie de Herzberg.

The objectives of this research are to identify employee dissatisfaction in two seniors' residences and to find resolutions to these problems. Conflicts between employees from two different services are not unusual in health care. It remains a major preoccupation for supervisors. Such a conflict arose in a seniors' residence between employees from the food services and the health care members. At every opportunity the quarreling groups would antagonize each other. They were all self-proclaimed experts when it came to the nutritional needs of the residents. The employees were convinced they knew more about the likes and dislikes of the residents than anyone, even more than the nutritionist and the family. The directors wanted to know what originated such conflicting behavior amongst both groups. The Herzberg Theory on hygiene and motivation served as a reference guide for the identification and classification of these factors as well as proposed solutions by the groups of participants. This theoretical model defines the interpretation of dissatisfaction and guides the directors in decision-making and implementation of solutions. Results showed that the food services personnel were more concerned about hygiene whereas the health care noticed dissatisfaction related to motivational factors. Thanks to the application of this model the food service personnel who were experiencing difficulty with hygiene matters saw modifications in their environment and health care employees enjoyed improvements in their tasks.

[Relocation in a nursing home of a spouse with cognitive impairment: experience of wives]. / Le relogement en centre d'hébergement d'un conjoint atteint de problèmes cognitifs: l'expérience des epouses.

The goal of this phenomenological study was to describe the experience of wives during the relocation to a long-term care facility of their spouse with cognitive impairment. Four wives shared their experience four to six weeks after the relocation of their husband. The process involved four phases: decision making, a long waiting period before relocation, the adjustment to the living accommodation, and the new direction of their life. For the wives, the decision making was characterized by numerous disillusions involving a lack of support from their children and their social service providers. The waiting period to find a location is exhausting for the wives bringing them to intimidate the interveners ; hoping to accelerate the process of finding living accommodations. Once a location is found, the spouses are generally relieved and content with their new surroundings even though they remain concerned with the security of their spouse. In conclusion, the reorganization of their life is very difficult seeing as they experience a significant loss of revenue due to incurred living accommodation expenses and maintaining their responsibility for their husband.