Bed Angle Research Articles

Drug Delivery Angle for Various Atherosclerosis and Aneurysm Percentages of the Carotid Artery.

Stroke is the second cause of mortality among adult males and the first cause of death in adult females all around the world. It is also recognized as one of the most important causes of morbidity and dementia in adults. Stenosis or rupture of the only channels of the blood supply from the heart to the brain (carotid arteries) is among the main causes of stroke. In this regard, treatment of the lesions of carotid arteries, including atherosclerosis and aneurysm, could be a huge step in preventing stroke and improving brain performance. Targeted drug delivery by drug-carrying nanoparticles is the latest method for optimal delivery of drug to the damaged parts of the artery. In this study, a wide range of carotid artery lesions, including different percentages of atherosclerosis and aneurysm, were considered. After analyzing the dynamics of the fluid flow in different damaged regions and selecting the magnetic framework with proper ligand (Fe3O4@MOF) as the drug carrier, the size of the particles and their number per cycle were analyzed. Based on the results, the particle size of 100 nm and the use of 300 particles per injection at each cardiac cycle can result in maximum drug delivery to the target site. Then, the effect of the hospital bed angle on drug delivery was investigated. The results showed a unique optimal drug delivery angle for each extent of atherosclerosis or aneurysm. For example, in a 50% aneurysm, drug delivery at an angle of 30° is about 387% higher than that at an angle of 15°. Finally, simulation of real geometry indicated the effectiveness of simple geometry instead of real geometry for the simulation of carotid arteries, which can remarkably decrease the computational time and costs.

Impacts of bed roughness and orientation on hydraulic jump: A review

Hydraulic jumps are a prevalent phenomenon in flows through spillways, chutes, and sluice gates. As hydraulic jumps exhibit substantial kinetic energy, the downstream of a hydraulic structure is prone to scour. To mitigate downstream scour and enhance energy dissipation, hydraulic jumps are often directed into stilling basins with various bed configurations, including horizontal, sloping, rough, and their combinations. This review compiles numerous analytical and experimental studies on hydraulic jumps under various bed conditions. The effect of bed roughness on sequent depth ratio, roller and jump lengths, shear stress, and energy dissipation is critically reviewed. The impacts of roughness height, flow Froude number, and bed angle on jump characteristics are discussed, substantiated by comparative analyses for distinct roughness heights. The results indicate that bed roughness intensifies shear stress, resulting in augmented energy dissipation and reductions in jump length and sequent depth. Additionally, the analytical and empirical equations proposed by researchers for different jump scenarios are discussed, and their applicability under various conditions is summarized. Finally, it suggests considering the scale effect in future research to refine the comprehension of jump stability over adverse slopes.

A retrospective study on improving the accuracy of radiotherapy for patients with breast cancer with lymph node metastasis using Styrofoam.

To retrospectively analyze the accuracy of radiotherapy using cone beam computed tomography (CBCT), Styrofoam fixation, and breast bracket fixation in the chest wall target area and supraclavicular lymphatic drainage area (supraclavicular target area) of patients with breast cancer.and compare the setting efficiency and comfort satisfaction. A total of 65 patients with postoperative lymphatic metastasis of breast cancer, including 36 cases of Styrofoam fixation and 29 cases of breast bracket fixation, were recruited from March 2021 to August 2022 and retrospectively analyzed. All the patients underwent CBCT scans weekly, and the setup errors of the chest wall and supraclavicular target volume were compared and recorded. The planning target volume (PTV) margins of the two groups were calculated using the correlation MPTV = 2.5Σ + 0.7σ. The setup time and comfort satisfaction scores of the two groups were recorded and analyzed. The correlations among errors in each direction were analyzed using the Pearson correlation analysis. There was a significant difference in the left-right direction (X) axis of the chest wall target area between the Styrofoam and breast bracket groups (1.59 ± 1.47 mm vs. 2.05 ± 1.64 mm, P = 0.012). There were statistical differences in the ventrodorsal direction (Z) and bed angle of the supraclavicular target area, the data were (1.36 ± 1.27 mm vs. 1.75 ± 1.55 mm, P = 0.046; 0.47 ± 0.47° vs. 0.66 ± 0.59°, P = 0.006, respectively). In the X, Y, and Z directions, the respective PTV margins of the two groups in the chest wall target area were 5.01 mm, 5.99 mm, and 5.47 mm in the Styrofoam group, while those in the breast bracket group were 6.10 mm, 6.34 mm, and 6.10 mm, respectively. Moreover, the PTV margins of the supraclavicular target in the three directions were 3.69 mm, 3.86 mm, and 4.28 mm in the Styrofoam group, while those in the breast bracket group were 3.99 mm, 3.72 mm, and 5.45 mm, respectively. The setup time of the two groups was 3.4 ± 1.1 min and 5.5 ± 3.1 min (P = 0.007). The subjective comfort satisfaction scores of the two groups were 27.50 ± 1.24 and 25.44 ± 1.23 (P < 0.001). The application of Styrofoam fixation in radiotherapy of breast cancer in the supraclavicular lymph node area has several advantages as compared to breast bracket fixation, including higher positioning accuracy, smaller external expansion boundary, improved work efficiency, and patients' comfort, which might provide a reference for clinical work.

Effect of Changing Angle of Bed on Pain Severity and Vascular Complications among Cardiac Catheterization Patients

Effect of Changing Angle of Bed on Pain Severity and Vascular Complications among Cardiac Catheterization Patients

Study on Pulling Dynamic Characteristics of White Radish and the Optimal Design of a Harvesting Device

The loss rate is an important index to evaluate the harvesting performance of white radish. To reduce the loss rate, it is necessary to analyze the pulling dynamic characteristics of white radish and then optimize the structure and operating parameters of the harvesting device. In this paper, according to the growth characteristics of white radish in the field, the discrete element method (DEM) was used to simulate the pulling process. The pulling force was calculated using the Edinburgh elasto-plastic adhesion model (EEPA), and the effects of soil bed compactness, pulling speed and angle on the pulling force were analyzed. The tests on pulling mechanics were carried out in the laboratory to verify the accuracy of DEM simulation results. The results showed that in the soft soil bed with compactness less than 2.8 MPa, the pulling force of radish is generally smaller than the leaf breaking force, and it is feasible to pull the radish out directly. While in a soil bed with high compactness, it is necessary to install a loosening shovel to reduce the pulling force thus reducing the loss rate due to leaf breakage. The structure and operating parameters of the harvesting device were designed according to the pulling dynamic characteristics, and the white radish harvesting tests were carried out in different fields. Statistical results show that when the soil compaction was increased from 1.47 MPa to 2.21 MPa, the average loss rate increased from 0.68% to 1.75%, and the average damage rate increased from 2.41% to 2.70%. Similarly, when the forward speed was increased from 0.18 to 0.47 m/s, the average loss rate increased from 1.08% to 1.30%, and the average damage rate increased from 2.34% to 2.74%. Overall, the maximum loss rate and the maximum damage rate could be controlled below 2.0% and 3.0%, respectively. In the hard soil bed, the loss rate can be effectively reduced from 15% to 2.5% by installing a loosening shovel.

Pilot Study Examining Bed Angles and Heights During Ramped Position Intubation in the Emergency Department.

Ramped positioning during emergent endotracheal intubation has been associated with fewer peri-intubation complications, including a decrease in difficult intubations, esophageal intubations, pulmonary aspiration, and hypoxemia. However, the optimal bed angle and height for ramped position intubation have not been determined. Our objective was to examine the effect bed angle and height in the ramped position may have on laryngeal views during emergent intubation in the emergency department (ED). We performed a secondary analysis of prospectively collected quality improvement data on intubations from our ED. All adult medical intubations performed with ramped positioning in the ED over a 24-month study period (September 1, 2020, through August 30, 2022) were eligible. We compared laryngeal views using the percentage of glottic opening (POGO) score between ramp angles (≥30° and <30° from horizontal) and bed heights (relative to the intubator, including xiphoid or above, umbilicus or below, and between xiphoid and umbilicus). Of the 251 patients intubated during the study period, 201 were intubated in the supine position and 50 in the ramped position. Data forms were completed for 25 patients intubated using ramped position in the ED during the study period. The median ramp angle was 30° (interquartile range (IQR) 25, 40) with 16 (64%) subjects intubated at ≥30° and 9 (36%) subjects at <30°. The median POGO scores for bed angles ≥30° and <30° were 95% (IQR 79, 100) and 90% (IQR 75, 100), respectively. Bed heights varied, with four (16%) intubated at the xiphoid or above height, one (4%) at the umbilicus or below, and 20 (80%) between the xiphoid and umbilicus. The median POGO scores at each position were 95% (IQR 76, 100), 0% (IQR 0, 0), and 95% (IQR 79, 100), respectively. ED clinicians use a variety of bed angles and heights when intubating in the ramped position. More robust investigations are necessary to determine the optimal bed angle and height for ramped position intubation in the ED.

DAVINCI-SP tests for debris bed formation and spreading in a pool with center conical structure under two-phase condition

In case of severe accidents in light water reactors (LWRs), the coolability of relocated corium from the reactor vessel is a significant safety issue. The failure in cooling and stabilizing the molten core in the containment vessel can threaten the integrity of the containment boundary. In a flooded cavity, a porous corium debris bed is expected to develop on the bottom of the cavity pool due to the melt jet breakup and fragmentation. The geometric configuration of the porous debris bed is important for accurate coolability assessment under accident conditions. Earlier, Kim et al. (2016a, 2016b) presented an analytical model to estimate the spreading of the debris bed in terms of two-phase flow and the debris injection parameters. Here we are testing the effect of conical bottom surface in passively dispersing the debris particle to obtain a levelled bed formation. For this, the previous model for debris bed development is modified to simulate the development of debris bed over conical bottom surface. The existing ‘The Debris Bed Research Apparatus for Validation of the Bubble-Induced Natural Convection Effect Issue (DAVINCI) - Spreading (SP) experimental facility was modified with a center conical structure. Five kilograms of stainless steel simulant debris were injected stepwise from the top of the water level, while air bubbles simulating the two-phase vapor flow were injected from the bottom of the particle catcher plate. The test results from the current study to describe the spreading of the debris bed in terms of two-phase flow, debris injection parameters, and conical bottom surface geometrical parameters are discussed. Subsequently, the model for characteristics length and side slope angle of debris bed were modified using the empirical parameters from the tests. Comparison between the tests results and modified model prediction are presented. Lastly, the effectiveness of the conical bottom surface on particle dispersion is discussed.

Developing a prototype device to measure nail bed angle – An exploratory multiphasic study

Developing a prototype device to measure nail bed angle – An exploratory multiphasic study

Formulasi Granul Effervescent Ekstrak Aseton Rimpang Kencur (Kaempferia Galanga L.) dengan Variasi Konsentrasi Polivinilpirolidon

Kencur is one of the plants that is useful as an anthelmintic drug. This study aims to formulate effervescent granules of acetone extract of Kencur rhizome (Kaempferia galanga L.) with various concentrations of polyvinylpyrrolidone. Kencur rhizome extraction was carried out by maceration method using acetone solvent for 3 days then filtered and concentrated with a rotary vacuum evaporator. The extract was granulated using the wet granulation method with a ratio of citric acid monohydrate and tartaric acid 1:2. Variations in PVP concentrations were 2%, 4%, and 6%. Physical evaluation of granules includes Density and Porosity, Compressibility Index (Carr Index), Flow Time, and Angle of Bed. The best porosity was in formula 3 with 30.47±1.471. The compressibility index (Carr Index) of the three formulas is in the range of 515%. The best dosage flow times were formulas 2 and 3 with 8.67±0.526 and 7.58±0.344. The Hausner Ratio of the three formulas is below 1.25. The angles of repose in formulas 1 and 2 are 24.94º and 29.74º with a recline angle &lt;40. The foam stopping time is 23 seconds. From theresults abtained it can be concluded that the formula with good pharmaceutical properties is formula 3 with a variation of 6% pvp concentration.

Setup error and residual error analysis of ExacTrac X-ray image guidance system in stereotactic radiotherapy for brain metastases

ObjectiveThis study aims to analyze the setup errors of the ExacTrac X-ray image guidance system in stereoscopic radiotherapy for brain metastases and discuss the necessity of setup error verification after bed angle movement. MethodsTwelve patients with brain metastases were treated with stereotactic radiotherapy. ExacTrac X-ray image guidance system was used to register and verify the image. Besides, the intra- and inter-fractional setup errors and residual errors were analyzed. ResultsTwelve patients received head stereotactic radiotherapy 56 times. The inter-fractional setup errors and residual errors were x (1.04 ± 0.16) and (0.15 ± 0.05) mm in left and right directions, y (1.25 ± 0.28) and (0.18 ± 0.07) mm in head and foot direction, and z (0.93 ± 0.81) and (0.14 ± 0.13) mm in abdominal and dorsal direction, respectively; Rx (0.81 ± 0.24) and (0.24 ± 0.09) degree in the sagittal plane, Ry (0.95 ± 0.19), (0.22 ± 0.06) degree in the cross-section, and Rz (1.03 ± 0.26), (0.22 ± 0.06) in the coronal plane. The difference was statistically significant (P < 0.05). Only 19.6% of the intra-fractional non-coplanar arc setup verification passed without correction for the first time, and the others were significantly improved after correction, presenting statistical significance (P < 0.05). The inter-fractional setup errors and residual errors were x (0.82 ± 0.25) and (0.13 ± 0.04) mm in left and right directions, y (0.67 ± 0.23) and (0.18 ± 0.08) mm in head and foot direction, and z (0.74 ± 0.21) and (0.19 ± 0.08) mm in abdominal and dorsal direction, respectively; Rx (0.67 ± 0.13) and (0.20 ± 0.08) degree in the sagittal plane, Ry (0.68 ± 0.13) and (0.17 ± 0.10) degree in the cross-section, and Rz (0.60 ± 0.28) and (0.19 ± 0.07) degree in the coronal plane. The difference was statistically significant (P < 0.05). ConclusionThe ExacTrac image guidance system enhanced the accuracy of setup in stereoscopic radiotherapy for brain metastases and satisfied the clinical requirements. It is necessary to verify the non-coplanar arc setup.

Justification of the stress-strain state’s parameters of the mine workings contours depending on the influencing factors

The complication of mining and geological conditions is associated with the involvement in the development of areas and entire deposits with complex tectonics, an increase in the depth of development, the manifestation of dangerous dynamic effects of rock pressure, which necessitates the improvement of methods, systems, methods and means of supporting mine workings, as well as improving the quality of materials used for support. Mining and geological factors affecting the use of mining support include: the depth of occurrence, which determines the magnitude of the vertical and horizontal components of the rock pressure; layer thickness, developed deposit; bed angle; properties of the host rocks, structure and physical and mechanical properties of rocks and minerals. The paper presents the conduction of the analytical modelling of the rock mass stress-strain state around the active mine workings using the ANSYS software with the assessment of the influence of its cross-section shape and the angle of the coal seam fall on the value of the maximum stresses arising in the rock mass when the workings are supported with the anchoring support depending on the thickness of the easily collapsible rock layer at different lengths of anchoring.

Accurate Heart Rate and Respiration Rate Detection Based on a Higher-Order Harmonics Peak Selection Method Using Radar Non-Contact Sensors.

Vital signs such as heart rate and respiration rate are among the most important physiological signals for health monitoring and medical applications. Impulse radio (IR) ultra-wideband (UWB) radar becomes one of the essential sensors in non-contact vital signs detection. The heart pulse wave is easily corrupted by noise and respiration activity since the heartbeat signal has less power compared with the breathing signal and its harmonics. In this paper, a signal processing technique for a UWB radar system was developed to detect the heart rate and respiration rate. There are four main stages of signal processing: (1) clutter removal to reduce the static random noise from the environment; (2) independent component analysis (ICA) to do dimension reduction and remove noise; (3) using low-pass and high-pass filters to eliminate the out of band noise; (4) modified covariance method for spectrum estimation. Furthermore, higher harmonics of heart rate were used to estimate heart rate and minimize respiration interference. The experiments in this article contain different scenarios including bed angle, body position, as well as interference from the visitor near the bed and away from the bed. The results were compared with the ECG sensor and respiration belt. The average mean absolute error (MAE) of heart rate results is 1.32 for the proposed algorithm.

Application of multimodal neuroelectrophysiological monitoring technology in surgical treatment of thoracic tuberculosis

To explore the value of multimodal neuroelectrophysiological monitoring technology in the evaluation of spinal cord and nerve root function for the treatment of thoracic tuberculosis with debridement and bone grafting and posterior internal fixation by transcostal transverse process approach. The clinical data of 25 patients with thoracic tuberculosis underwent debridement and bone grafting and posterior vertebral arch internal fixation by transcostal transverse process approach from December 2018 to September 2019 was retrospectively analyzed. Among these 25 patients, including 14 males and 11 females;aged from 20 to 83 years old, with a mean of (63.45±9.65) years;there were 3 cases of single vertebral body destruction, 13 cases of 2 vertebral bodies destruction, and 9 cases of 3 or more vertebral bodies destruction. All surgical patients underwent intraoperative detection of somatosensory evoked potential(SEP) and transcranial electric stimulation-motor evoked potential(TES-MEP);and electromyography (EMG) was used to monitor the pedicle screw placement and lesion removal. The erythrocyte sedimentation rate(ESR) was used to evaluate the decline of inflammatory indexes, the visual analogue scale (VAS) was used to evaluate the thoracic spine pain, and the Cobb angle and Oswestry Disability Index(ODI) were used to evaluate the improvement of function. All 25 patients were successfully monitored. Five patients had abnormal SEP waveforms during operation, 3 cases were caused by intraoperative clearing of lesions and spinal cord compression during irrigation, timely replacement of instruments and gestures, and adjustment of irrigation water flow rate returned the waveform to normal; one case was caused by a decrease in systolic blood pressure, and the waveform returned to normal after timely treatment of increased blood pressure;after 1 case of SEP waveform abnormality, the operation was suspended for 10 minutes and recovered spontaneously, and the waveform abnormality did not reappear until the end of the operation. Seven patients had abnormal TES-MEP waveforms, 5 cases occurred when the pedicle screw was inserted, the nail path was adjusted in time, and the waveform recovered after nail repositioning;one case was caused by tilting the operation bed during operation, and the waveform gradually recovered after adjusting the tilt angle of operation bed; one case occurred during the correction of the pedicle screw and rod system, and the waveform gradually returned to normal after the contralateral screw and rod correction were completed during operation. In 5 cases, the EMG burst potential was detected at the same time when the TES-MEP waveform was abnormal. After adjustment, the EMG burst potential disappeared. There was no abnormality in the TES-MEP and SEP waveforms at the same time. Postoperative VAS, ESR, Cobb angle, and ODI were improved compared with preoperatively (P<0.05). In patients with thoracic tuberculosis, the use of debridement and bone grafting and posterior internal fixation by transcostal transverse process approach combined with intraoperative SEP, TES-MEP and EMG monitoring can timely reflect the spinal cord and nerve root function, avoid intraoperative injuries while achieving good fixation and lesion removal.

The Correlation between Head of Bed Angle and Intra-Abdominal Pressure of Intubated Patients; a Pre-Post Clinical Trial

Introduction:The recommended position for measuring Intra-Abdominal Pressure (IAP) is the supine position. However, patients put in this position are prone to Ventilator-associated pneumonia. This study was done to evaluate the relationship between bed head angle and IAP measurements of intubated patients in the intensive care unit.Methods:In this clinical trial, seventy-six critically ill patients under mechanical ventilation were enrolled. IAP measurement was performed every 8 hours for 24 hours using the KORN method in three different degrees of the head of bed (HOB) elevation (0, 15, and 30). Bland-Altman analysis was performed to identify the bias and limits of agreement among the three HOBs. According to World Society of the Abdominal Compartment Syndrome (WSACS), we can consider two IAP techniques equivalent if a bias of <1 mmHg and limits of agreement of - 4 to +4 were found between them. Data were analyzed using SPSS statistical software (v. 19), and the significance level was considered as 0.05.Results:The prevalence of intra-abdominal hypertension was 18.42%. Mean ± standard deviation (SD) of IAP were 8.44 ± 4.02 mmHg for HOB angle 0°, 9.58 ± 4.52 for HOB angle 15 and 11.10 ± 4.73 for HOB angle 30o (p = 0.0001). The IAP measurement bias between HOB angle 0°and HOB angle 15° was 1.13 mmHg. This bias was 2.66 mmHg between HOB angle 0° and HOB angle 30°. Conclusion:Elevation of HOB angle from 0 to 30 degree significantly increases IAP. It seems that the measurement of IAP at HOB angle 15° was more reliable than 30°.

Comparison of the effectiveness of position change for patients with pain and vascular complications after transfemoral coronary angiography: a randomized clinical trial

BackgroundProlonged immobilization after transfemoral coronary angiography (TFA) may cause pain and vascular complications in patients. This study aimed to evaluate the effectiveness of a change in position to decrease pain and vascular complications for patients after TFA.MethodsThis randomized clinical trial was conducted in 2020. Purposive sampling of 72 eligible patients undergoing TFA were selected and randomly assigned to either an experimental or control group. Patients in the experimental group (EG) were placed in a supine position for 2 h after angiography, followed by a semi-seated position with the bed angle gradually increased to 45° over 4 h. Patients in the control group (CG) remained in the supine position for 6 h. Vital signs, groin, back and leg pain, hematoma, hemorrhage, and urinary retention were assessed in both groups before, immediately after, and over 6 h after angiography. The Visual Analogue Scale was used to measure pain, the Christensen scale to measure hematoma, counting bloody gases to measure hemorrhage, and patient self-rating to determine urinary retention.ResultsThere was no significant difference between EG and CG on score of groin (2.69 ± 1.00 vs. 2.61 ± 1.00, P = 0.74), back (2.19 ± 0.98 vs. 2.47 ± 0.87, P = 0.21), and leg pain (2.14 ± 0.71 vs. 2.50 ± 1.08, P = 0.27) before the TFA. However, from the second hour to the sixth hour after the TFA, the pain in the EG was significantly less than the CG (P < 0.001). So that pain in the groin (1.36 ± 0.48 vs. 3.28 ± 0.81), back (1.25 ± 0.50 vs. 3.81 ± 1.06), and leg (1.44 ± 0.55 vs. 3.28 ± 0.81) for the EG patients was significantly less than the CG in the sixth hour after TFA (P < 0.001). No patients experienced hematoma. No differences were noted between groups in hemorrhage and urinary retention.ConclusionsPosition change to a semi-seated position in patients after TFA is effective and safe for reduction of pain without increasing vascular complications.Trial registrationIranian Registry of Clinical Trials: IRCT registration number: IRCT20200410047011N1, Registration date: 30/04/2020

Hydraulic jump control using stilling basin with adverse slope and positive step

ABSTRACT Water flow often releases excess energy after passing through gates and spillways. This energy should be reduced to avoid destruction of downstream structures. The hydraulic jump, a natural phenomenon, inevitably reduces incoming flow energy. In this research, effect of adverse slope and positive step on hydraulic jump characteristics including sequent depth ratio, jump length, roller length and energy losses were simultaneously investigated. In place of four adverse bed angle slopes of 0, 0.015, 0.03 and 0.05 (m/m) and three positive step heights of 0, 3 and 6 (cm) were tested. An analytical solution, based on momentum equation, was developed for estimating the sequent depth ratio with considering initial Froude number, bed slope and positive step height and its estimations were compared to the experimental measurements. Results showed that although both the adverse slope and positive step reduced the sequent depth ratio, jump length and roller length to a greater degree compared to the classic jump, the effect of adverse slope was greater than the positive step. Energy loss in the presence of adverse slope and positive step was greater than in the classic conditions. Furthermore, the result of the analytical solution was in good agreement with the corresponding experimental measurements.

Frequency-dependent reflection of elastic wave from thin bed in porous media**Project supported by the National Natural Science Foundation of China (Grant Nos. 41764006, 41364004, and 41504095), the Chinese Study Abroad Fund (Grant No. 201508360117), the National Key Research and Development Program of China (Grant No. 2018YFC0309901), and the COMRA Major Project, China (Grant No. DY135-S1-01-01).

The reflection of elastic wave from thin bed in porous media is important for oil and gas reservoir seismic exploration. The equations for calculating frequency-dependent reflection amplitude versus incident angle (FDAVA) from thin bed in porous media are obtained based on porous media theory. Some conclusions are obtained from numerical analysis, specifically, slow compression wave may be ignored when considering boundary conditions in most situations; the dispersion of reflection from thin bed is much higher than that from thick layer and is periodic in frequency domain, which is affected by the thickness of thin bed, velocity, and incident angle; the reflection amplitude envelope in frequency domain decays exponentially, which is affected by the thickness of thin bed, attenuation, and incident angle; the reflection amplitude increases with thickness of thin bed increasing, and then it decreases when the thickness reaches to a quarter of wavelength.

Impact of bed angle and height on intubation success during simulated endotracheal intubation in the ramped position.

ObjectiveThe ramped position is often used during endotracheal intubation to improve oxygenation, improve laryngeal views, and reduce airway complications. We sought to compare the impact of ramp angle and bed height on intubation outcomes during simulated endotracheal intubation.MethodsWe enrolled emergency medicine residents and fourth‐year medical students to perform simulated direct laryngoscopy and endotracheal intubation in random order with the mannequin in the following combinations of ramp angles and bed heights; ramp angles of 25° and 45° at bed heights including knee, mid‐thigh, umbilicus, xiphoid, and nipple/intermammary fold. Our primary outcome was the reported percentage of glottic opening (POGO) score. Secondary outcomes included number of laryngoscopy attempts and intubation time.ResultsWe enrolled 25 participants. There was no difference in reported POGO scores at 25° between bed heights, but at 45°, the umbilicus bed height had an improved reported POGO score (20; 95% confidence interval [CI] 7–33, P < 0.01) relative to xyphoid. The nipple/inframammary fold height required longer intubation times in seconds (mean difference [MD] 95% CI) at 25°, (MD, 23.9 [4.6–37.6], P < 0.01) and more laryngoscopy attempts at 45° (MD, 0.48 [0.16–0.79], P < 0.01) relative to xyphoid. There was no difference in laryngoscopy attempts and video POGO between 25° and 45° at all bed heights, but reported POGO at the umbilicus position was better at 25° than 45° (12 [1–23], P = 0.03).ConclusionThe umbilicus bed height resulted in the highest reported POGO at 45°. Nipple/inframammary fold height resulted in worse intubating conditions.

Measuring Sleep Orthopnea using the Angle of Bed in Heart Failure to Assess Readiness for Discharge

Background Few reliable, non-invasive clinical markers have been identified for evaluating readiness for discharge in patients with heart failure. Worsening sleep orthopnea, including the use of additional pillows, has long been considered a sign of worsening heart failure symptoms, however in the hospital the adjusted angle of the bed could be another way to assess sleep orthopnea. This study examined variation in the angle of the bed, whether the angle of bed the night prior to discharge could be useful as a non-invasive clinical indicator and whether there is a relationship between the angle of bed while patients are sleeping the night prior to discharge and 30-day readmission. Objectives It was hypothesized that the angle of the head of bed the night prior to discharge from the index admission would be higher in patients who are readmitted within 30 days of discharge. In addition, it was hypothesized that the correlation between angle of bed and amount of diuresis would allow for use of angle of bed as a clinical indicator. Methods In this prospective observational study, nurses measured the angle at which patients self-adjusted the bed for nighttime sleeping. Patients from a progressive cardiac care unit were included if the primary admitting diagnosis was volume overload related to heart failure. Results Patients (n = 145) were 46.2% female, 46.2% African American with a mean age of 63.4 ± 14.7 years. Mean length of stay was 12.5 ± 10.5 days, and 22.8% were readmitted within 30 days. The average angle of bed prior to discharge was 29.1 ± 18.7 degrees and only 13% were able to lay flat while sleeping on the night prior to discharge. There was a significant difference between the highest and lowest angle of HOB (p Conclusions We did not demonstrate the utility of angle of bed the night prior to discharge as a marker of readiness for discharge in patients with heart failure. However, this innovative, nurse-led project did demonstrate that angle of bed is non-invasive and easy to capture. Further studies should consider the role of angle of bed as an indication of orthopnea and in evaluating readiness for discharge during a heart failure admission.

Nursing Research on Patients with Hypertensive Intracerebral Hemorrhage Based on Fuzzy Neural Network Related Algorithm Under Postural Adjustment

Objective: To use the multi-mode fuzzy neural network monitoring measures explored in this project to clarify the trends of rSO2, ICP and CPP in patients with neurological HICH after different postures, and to screen the best nursing position for patients after HICH. Provide a basis for development. Methods: A total of 34 HICH patients admitted to the hospital from January 2017 to December 2018 were included in the study. The patient was placed in the supine position with the head position raised by 0°, 15°, 30°, 45°, 0°, and the interval between different body positions was 5 minutes. Each position was kept for 5 minutes, and the monitoring index values were read after stabilization. EGOS-600A near-infrared tissue blood oxygen parameters non-destructive monitor was used for bedside, dynamic and non-invasive real-time monitoring of rSO2; Codman intracranial pressure monitor was used for continuous dynamic monitoring of ICP; all patients were monitored with ICP and HPM-1205A ECG The monitor measures heart rate (HR), non-invasive blood pressure (BP), and pulse oximetry (SPO2). Results: When the bed angle of the patient was raised by 0°, 15°, 30° and 45°, the ICP value showed a decreasing trend with the elevation of the patient's bed angle. The ICP values were compared at various angles, and the difference was significant. Significance (P = 0.000); MAP value comparison, no significant difference (P = 0.074); CPP value showed an increasing trend with the elevation of the patient's bedside angle, the difference was significant, statistically significant (P = 0.000). There was no significant difference in HR values (P = 0.470). There was no significant difference in SPO2 values (P = 0.780). Conclusion: For patients with HICH with a GCS score of 5 to 12, multi-mode neurological monitoring, supine position elevation of 15°∼30° is a relatively suitable position; HICH patients with NIRS for rSO2 non-invasive monitoring is very Necessary, and should pay more attention to cerebral blood oxygenation changes in patients undergoing medical care after tracheotomy; use multiple modes of monitoring to ensure that patients SaO2, PaO2, MAP, ICP, CPP, and RSO2 are within the normal range. Choosing the most effective and reliable data support for the care and treatment measures that are most beneficial to improve the cerebral ischemia and hypoxia in patients has certain clinical value.