In this study, the effect of bonding surface conditions on the strength evolution of Cu/Cu joints during ultrasonic welding was investigated. Lap shear tests and microstructure characterisation ...revealed that contact area formation could be affected by bonding surface conditions and clamping force. That is, the fraction of contact area quickly evolved with smoother bonding surfaces, leading to a rapid strength increase to base metal fracture (1100 N of lap shear load after 1.0 s of welding). Comparatively, rough surface combinations exhibited a slow strength evolution owing to a lower fraction of contact areas. To overcome this situation, a higher clamping force was employed to facilitate contact area formation (1100 N of lap shear load after 0.5 s of welding).
Emergency department (ED) overcrowding is a public health crisis that affects patient care quality. Space management in the ED can affect patient flow dynamics and clinical practice. We proposed a ...novel design of the "emergency procedure zone" (EPZ). The purpose of the EPZ was to provide an isolated area for clinical practice and procedure teaching, to ensure a secure area with adequate equipment and monitors, and safeguard patient privacy and safety. This study aimed to analyze the impact of the EPZ on procedural practice and patient flow dynamics.
This study was conducted at the ED of a tertiary teaching hospital in Taiwan. Data were collected from 1 March 2019 to 31 August 2020 (pre-EPZ period) and from 1 November 2020 to 30 April 2022 (post-EPZ period). Statistical analyses were performed using IBM SPSS Statistics software. This study focused on the number of procedures and length of stay in the emergency department (LOS-ED). Variables were analyzed using the chi-square test and Mann-Whitney U test. Statistical significance was defined as
< 0.05.
There were 137,141 (pre-EPZ period) and 118,386 (post-EPZ period) ED visits recorded during this period. The post-EPZ period showed a significant increase in central venous catheter insertion, chest tube or pigtail placement, arthrocentesis, lumbar puncture, and incision and drainage procedures (
< 0.001). For patients who were directly discharged from the ED, the post-EPZ period also had a higher percentage of ultrasound studies performed in the ED and a shorter LOS-ED for patients who were directly discharged from the ED (
< 0.001).
The establishment of an EPZ in the ED has a positive impact on procedural efficiency. The EPZ improved diagnosis and disposition efficiency, shortened the length of stay, and provided benefits such as improved management, patient privacy, and teaching opportunities.
Background
Although some studies have reported evidence of the effectiveness of virtual‐reality interventions implemented for children undergoing intravenous (IV) cannulation, children's perceptions ...of virtual‐reality interventions implemented during IV cannulation warrant further exploration.
Aims
To explore the school‐aged children's perceptions of interactive virtual‐reality interventions implemented before and after IV cannulation.
Methods
A qualitative descriptive study was adopted. Sixty‐nine children aged 6–12 years from two medical centers were recruited and interviewed from June to September 2020. After the completion of the immersive virtual‐reality scene of IV cannulation before undergoing actual IV cannulation and the emotionally cathartic virtual‐reality play after the placement process, individual interviews were conducted with the children in the paediatric wards. Inductive content analysis was performed to analyse children's perceptions. The study complied with the Consolidated Criteria for Reporting Qualitative Research.
Results
Three categories related to children's perception of interactive virtual‐reality interventions implemented before and after IV cannulation were identified: (1) feelings towards and coping strategies employed during IV cannulation; (2) mental preparation through immersion in the virtual‐reality scene; and (3) healing effects of immersive cathartic play.
Conclusions
The findings indicate that interactive virtual‐reality interventions can help hospitalised children mentally prepare for medical procedures, obtain knowledge regarding such procedures, and overcome their fear of needles. The children's reported perceptions of the virtual‐reality interventions indicated that the interventions were age‐appropriate, safe and fun. The results of this study highlight the need to more thoroughly understand the perceptions of hospitalised children and may serve as a reference for designing child‐friendly care interventions for nursing practice.
Aerosols and droplets are the transmission routes of many respiratory infectious diseases. The COVID-19 management guidance recommends against the use of nebulized inhalation therapy directly in the ...emergency room or in an ambulance to prevent possible viral transmission. The three-dimensional printing method was used to develop an aerosol inhalation treatment mask that can potentially prevent aerosol dispersion. We conducted this utility validation study to understand the practicability of this new nebulizer mask system. The fit test confirmed that the filter can efficiently remove small particles. The different locations of the mask had an excellent fit with a high pressure making a proper face seal usability. The full-face mask appeared to optimize filtration with pressure and is an example of materials that perform well for improvised respiratory protection using this design. The filtering effect test confirmed that the contamination of designated locations could be protected when using the mask with filters. As in the clinical safety test, a total of 18 participants (10 55.6% females; aged 33.1 + or - 0.6 years) were included in the final analysis. There were no significant changes in SPO.sub.2, EtCO.sub.2, HR, SBP, DBP, and RR at the beginning, 20th, 40th, or 60th minutes of the test (all p >.05). The discomfort of wearing a mask increased slightly after time but remained within the tolerable range. The vision clarity score did not significantly change during the test. The mask also passed the breathability test. The results of our study showed that this mask performed adequately in the fit test, the filtering test, and the clinical safety test. The application of a full-face mask with antiviral properties, together with the newly designed shape of a respirator that respects the natural curves of a human face, will facilitate the production of personal protective equipment with a highly efficient filtration system. We conducted three independent tests in this validation study: (1) a fit test to calculate the particle number concentration and its association with potential leakage; (2) a filtering effect test to verify the mask's ability to contain aerosol spread; and (3) a clinical safety test to examine the clinical safety, comfortableness, and visual clarity of the mask.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This article is an example of Lessons from the Field highlighting the practical implementation of a novel time‐controlled mechanism in the gamification of emergency department evacuation training via ...tabletop exercise. Tabletop exercise is one of the most common drill types for disaster preparedness. It is easy to use, effective, and low in cost, but it has some shortcomings. For example, its lack of authenticity is often criticized. We add a time‐control mechanism to the tabletop exercise and use settings similar to real events in an attempt to increase the authenticity of the tabletop exercise and the learning effect. We completed a 3‐h tabletop gamification of emergency room evacuation, which included a time control mechanism. Medical staff in our emergency department were asked to join this tabletop training. We evaluated the effectiveness of the time‐control tabletop exercise through the results of the pretest and posttests and feedback from the participants. A total of 97 emergency medical staff from the Emergency Department of Cheng Kung University Hospital, including 64 nurses, 29 emergency doctors and four nurse practitioners, participated in this tabletop exercise. After experiencing the time‐control tabletop exercise, the participants significantly improved their approach to mass casualty incidents, their method for evacuating patients, and their triage skills. The correct answer rate for the pretest and post‐test rose from 68.75% to 94.33% with statistically significant. The feedback from the participants also showed that the time‐control tabletop exercise was interesting and could increase learning motivation. The time‐control mechanism had a positive impact on the learning effect. It increased the reality of tabletop exercises, promoted participants' learning motivation, and improved their performance on the test.
Abstract
Background
Laparoscopic sleeve gastrectomy (LSG) is a commonly performed bariatric surgery. Gastric stenosis and leaks are 2 major complications associated with LSG and revision surgery ...might be needed. Herein, we report our experience of intraoperative endoscopy (IOE) to evaluate stenosis and leaks during LSG.
Methods
LSG was performed by three surgeons. Patients who underwent LSG and IOE between January 2016 and March 2020 were enrolled and assigned to two groups: group 1 (1st–30th LSG case for each surgeon) and group 2 (> 30th LSG for each surgeon). Patients’ anthropometric and biochemical data pre- and post-LSG, as well as IOE findings and follow-up esophagogastroduodenoscopy records were reviewed.
Results
In total, 352 patients were enrolled including 90 patients in group 1 and 262 patients in group 2. Three out of 352 patients (0.9%) were found to have stenosis by IOE, which was related to tightly gastropexy stitch or reinforcement stitch, all of which were in group 1. Stenosis was resolved after removal of the stitch during LSG. The incidence of gastric stenosis detected by IOE was 3.3% (3/90) and 0% (0/262) in group 1 and group 2, respectively (
P
= 0.003). No leakage was found in this study and no patient developed clinical or endoscopic stenosis after LSG.
Conclusions
The existing evidence showed that IOE can help detect gastric stenosis during LSG, especially for novice surgeons, and the stenosis could be resolved during operation.
This article proposes an intelligent calorie management system, named iBuffet, based on artificial intelligence over the Internet of Things (AIoT) techniques for eating buffet meals with calorie ...intake control. The proposed iBuffet system consists of intelligent buffet table modules, an artificial intelligence (AI) Wi-Fi base station, a mobile device application (app), and a cloud-based health management platform. The goal of the proposed iBuffet system is to improve consumer dining health through suitable calorie intake control by recording daily meals with calorie intake calculations via the proposed mobile device app. Furthermore, the related information is sent to the cloud-based platform for user health management. The experimental results show that the proposed iBuffet system can recognize 30 kinds of meals within 1 s, which can meet the requirements of actual buffet restaurants.
Fever can occur after acute myocardial infarction (MI). The influence of body temperature (BT) after hospital arrival on patients with acute MI has rarely been investigated.
Patients who were ...diagnosed with acute MI in the emergency department (ED) of a tertiary teaching hospital between 1 January 2020 and 31 December 2020 were enrolled. Based on the tympanic temperature obtained at the ED triage, patients were categorized into normothermic (35.5°C-37.5°C), hypothermic (< 35.5°C), or hyperthermic (> 37.5°C) groups. The primary outcome was in-hospital cardiac arrest (IHCA), while the secondary outcomes were adverse events. Statistical significance was set at p < 0.05.
There were 440 enrollees; significant differences were found among the normothermic (n = 369, 83.9%), hypothermic (n = 27, 6.1%), and hyperthermic (n = 44, 10.0%) groups in the triage respiratory rate (median IQR) (20.0 4.0 cycles/min versus 20.0 4.0 versus 20.0 7.5, p = 0.009), triage heart rate (88.0 29.0 beats/min versus 82.0 28.0 versus 102.5 30.5, p < 0.001), presence of ST-elevation MI (42.0% versus 66.7% versus 31.8%, p = 0.014), need for cardiac catheterization (87.3% versus 85.2% versus 72.7%, p = 0.034), initial troponin T level (165.9 565.2 ng/L versus 49.1 202.0 versus 318.8 2002.0, p = 0.002), peak troponin T level (343.8 1405.9 ng/L versus 218.7 2318.2 versus 832.0 2640.8, p = 0.003), length of ICU stay (2.0 3.0 days versus 3.0 8.0 versus 3.0 9.5, p = 0.006), length of hospital stay (4.0 4.5 days versus 6.0 15.0 versus 10.5 10.8, p < 0.001), and infection during hospitalization (19.8% versus 29.6% versus 63.6%, p < 0.001) but not in IHCA (7.6% versus 14.8% versus 11.4%, p = 0.323) or any adverse events (50.9% versus 48.1% versus 63.6%, p = 0.258). Multivariable analysis showed no significant association of triage BT with IHCA or any major complication.
Triage BT did not show a significant association with IHCA or adverse events in patients with acute MI. However, triage BT could be associated with different clinical presentations and should warrant further investigation.
Background
This study aimed to ascertain if the incorporation of intensity‐modulated radiotherapy (IMRT) with chemotherapy (CTx) offered any advantages for patients diagnosed with stage pT3N0 rectal ...cancer located in the proximal (upper) region following a complete total mesorectum excision (TME).
Methods
We retrospectively examined medical records of stage II/III rectal cancer patients who had undergone CTx or concurrent chemoradiation (CCRT) with IMRT after a successful TME. We juxtaposed a variety of survival outcomes across two patient cohorts. Each outcome was further classified according to Gunderson's risk stratification between proximal and distal (middle and low) rectal cancer patients, and we evaluated the factors associated with each outcome.
Results
The median follow‐up duration was 4.9 years. Our research comprised 236 rectal adenocarcinoma patients treated at our institution between 2007 and 2019. They received either the CTx (n = 135) or the CCRT (n = 101) with 10‐year locoregional recurrence‐free survival (LRRFS) of 90.1% and 96.1%, respectively (p = 0.163). However, after performing multivariate adjustments, a pattern emerged hinting at a better LRRFS for the CCRT group (p = 0.052). Perforation had a strong correlation with locoregional recurrence. No significant differences were observed in other survival between the two treatment arms and their respective subgroups. The CCRT group witnessed significantly higher immediate and chronic complications with p = 0.007 and 0.009, respectively. The CCRT group had two secondary cancer‐related fatalities (2%, one attributed to IMRT), and another reported by the CTx group (1%). The sole classified locoregional recurrence within the cohort of 37 individuals treated with CTx for proximal pT3N0 rectal cancer was, in fact, the development of sigmoid colon cancer.
Conclusion
The results suggest that for patients with proximal pT3N0 rectal cancer post‐TME, IMRT is better when not combined with CTx, except in highly perilous scenarios or those involving perforation.
The 10‐year locoregional recurrence‐free survival with or without radiotherapy (RT) is essentially identical for clear‐margin proximal rectal pT3N0 cancer patients. More significant complications will be associated with RT. We suggest that for patients with proximal pT3N0 rectal cancer postoperation, RT is better when not combined with chemotherapy, except in highly perilous scenarios or those involving perforation.
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