Purpose of family photographs displayed in the pediatric intensive care unit.

OBJECTIVE: To investigate why parents frequently display family photographs on their children's beds in the intensive care unit (ICU). DESIGN: Questionnaire. SETTING: Tertiary-care pediatric ICU. SUBJECTS: Twenty-three parents who displayed pictures, 25 parents who did not, and 50 ICU nurses. OUTCOME MEASURE: Content analysis. RESULTS: Parents' stated primary reasons for displaying pictures were (1) to motivate the staff and (2) to comfort themselves. Parents not displaying photographs had not thought of displaying them, and the idea had not been suggested to them. Sixty-eight percent of the nurses surveyed reported that they invite parents to display photographs. CONCLUSIONS: We recommend that ICU staff consider discussing with parents the potential benefit of displaying photographs of their children. Pictures may open an avenue for communication, allow parents to express unspoken concerns, and give parents comfort or a goal to strive for and thus alleviate some of the stress associated with having a child in the ICU.

Diurnal changes in lumbar intervertebral distance, measured using ultrasound.

STUDY DESIGN: This study measured the distances between the tips of the transverse processes of adjacent lumbar vertebrae (L1-L4) in the same subjects after 1 day of normal activities and again the next morning. OBJECTIVES: To determine the feasibility of directly measuring the lumbar intervertebral distance using ultrasound and to determine the magnitude of the diurnal change in the intervertebral distance. SUMMARY OF BACKGROUND DATA: A diurnal variation in height results from, in part, a decrease in height of the intervertebral discs with loading of the spine during the day. Previous estimates of the diurnal changes in disc height have used radiologic, stereophotographic, and magnetic resonance imaging techniques. No previous study has used ultrasound imaging. METHODS: Ultrasound was used to measure the distance between the tips of adjacent lumbar vertebral transverse processes. Measurements were made on six occasions in each of seven subjects after 6:00 PM in the evening and again the following morning before rising. RESULTS: The distance between the tips of adjacent transverse processes could be measured, within an individual, with a reproducibility of better than +/- 7.5% coefficient of variation. Reproducibility of the measurement of the total distance between L1 and L4 was better than +/- 4%. The intervertebral distances between L1 and L4 were significantly greater in the morning than in the evening. The average diurnal change in the total intervertebral distance L1-L4 was 5.3 mm. CONCLUSIONS: The study confirms the feasibility of using ultrasound to directly measure changes in the distances between the lumbar vertebrae.

Study design for microgravity human physiology experiments.

In some areas of research, such as microgravity life sciences, both the number of subjects and the opportunity for repeated observation under experimental conditions are limited. Small N study designs are appropriate for these situations since they require few subjects and few observations in the experimental condition. Small N studies compare treatment conditions separately for each subject so that between-subject variability does not obscure treatment effects. Multiple observations are collected for each individual in the baseline condition to ensure a stable reference point for comparison with the smaller number of observations collected under the experimental conditions. Individual differences can be overlooked in large N studies, but in small N studies the focus is on the individual, and differences observed between particular individuals can be suggestive of underlying causal processes. We present a step-by-step approach to designing and conducting a small N study.

In-flight stabilization of oxygen saturation by control of altitude for severe respiratory insufficiency.

A 4,907-mile medical air transport recently took place between Vancouver, Canada, and London, England. The patient was a 6-year-old boy with multiple pleural, pulmonary, and pericardial hemangiomata who required heart-lung transplant. Because his respiratory function was so poor (including oxygen-induced hypercarbia and sleep-induced hypoxia), a Lear 35 was used. The aircraft made a low altitude flight possible, allowing adjustment of cabin pressure to overcome the child's sensitivity to any significant reduction in partial pressure and to minimize his need for supplemental oxygen. Clinical observation and monitoring using oximetry and transcutaneous blood gas measurements were carried out en route to warn of excessive altitude effects. Sequential increases in altitude were made once oxygenation had stabilized at each cabin pressure. Cabin pressure was not allowed to rise above 3,700 ft to ensure an oxygen saturation level of at least 80%. The transport was accomplished successfully with no requirement for intervention. This approach to in-flight management has applications for other aero-medical transports.