Edge Of Bed Research Articles

Mobilization With Femoral Catheters in the Burn ICU: A Retrospective Review Following Change in Practice Guidelines.

Femoral catheters are commonly viewed as a barrier to Burn ICU mobility progression due to anatomical location and potential risk of complications. The purpose of this review was to examine outcomes and complication rates following implementation of femoral catheter mobilization guidelines, as well as determine safety and feasibility of mobilization with femoral catheters in place within the burn population. A retrospective review was completed on 17 patients prior to and following the implementation of new femoral catheter mobility guidelines, 34 patients total. Burn therapy notes were reviewed for burn admissions with at least 1 femoral catheter in place, including arterial, central, and dialysis catheters. Demographic data, admission statistics, line placement timelines, and active mobility achieved during therapy sessions were recorded for both the nonmobilization group (NMG) and mobilization group (MG). The 34 patients reviewed had 99 total lines placed (30 NMG, 69 MG). Change in mobility protocols for the MG resulted in more therapy sessions (n = 516 vs 281) and a significant increase in active mobility sessions (n = 83 vs 5, P < .001), including 146 total mobility activities such as transitions to chairs, tilt table, sitting edge of bed, standing, active chair transfers, ambulation, and cycle ergometry. No catheter-associated adverse events occurred during active mobility sessions and no complications were associated with participation in mobility. This review supports that the presence of femoral catheters alone should not limit the progression of mobility interventions with the use of clinical judgment in specialty-trained burn therapists.

Dynamic damage evolution of double-block ballastless track structure under train derailment impact

Train derailment is a rare event, which seriously threatens the safety of personnel and the service status of track structures along the line. Aiming at the impact damage of high-speed train on ballastless track structure, a nonlinear dynamic analysis model of vehicle-ballastless track-bridge was established based on the theory of concrete plastic damage and impact dynamics. Based on the energy conversion characteristics, the damage evolution and energy dissipation characteristics of ballastless track are studied by using the plastic damage and failure constitutive model. The results show that the contact force during sleeper collision is mainly composed of longitudinal resistance and vertical pressure. At this time, the tensile damage of ballastless track develops rapidly and the shoulder is almost destroyed. When the track bed is collided, the contact force is characterized by a single peak. At this time, the edge of the track bed is seriously damaged by tension, and the shoulder falls off due to tensile damage. At the peak position of the collision contact force, the damage of the sleeper and the track slab is the largest. Compared with the collision track bed, the ballastless track has a larger damage volume when colliding with the sleeper, and can dissipate the kinetic energy of the train faster, and the dissipated energy is 5.07 times that of the former. The research results can provide help for the repair and protection design of the early structure of the accident.

Distribution and influencing factors of macrobenthos on three seagrass beds in the intertidal zone of Shandong province, China

IntroductionThe macrobenthos plays a vital role within the ecosystem of seagrass beds, with its characteristics and spatial distribution serving as indicators of the well-being of the seagrass beds.MethodsIn August 2018, three seagrass beds located in the Yellow River Estuary of Dongying, the west coast of Yantai, and Swan Lake of Weihai, were investigated to compare the ecological influences of seagrass habitat on the benthic environment and macrobenthic community. Within each seagrass bed, porewater, sediment, and macrobenthos were sampled from three separate stations (center of seagrass bed, edge of seagrass bed and bare area).Results and discussionOne-way ANOVA showed significant differences (p &amp;lt; 0.05) in environmental factors and macrobenthos species, abundance, biomass and diversity indices among the three seagrass beds. The present data did not show significant impacts on habitat and macrobenthos in the different coverage areas of seagrass beds at the investigated spatial scales, though crustacea and some carnivores were relatively more inclined to inhabit areas with higher seagrass densities. Aquaculture and eutrophication may trigger the loss of seagrass bed habitats, that affects macrobenthic biodiversity, and conservation measures are needed to protect seagrass bed habitats.

Physical relief potential through robot-assisted mobilization in nursing care: an exploratory study

PurposePhysically demanding activities at the nursing bed are a key factor in the overwork of nursing staff and play a major role in the development of musculoskeletal disorders. The heavy back strain plays a significant part in this. Technical aids such as robotic assistance systems have the potential to minimize this overload during nursing activities. In the present work, we have investigated the relief potential of a supporting robotic assistance system developed in the AdaMeKoR project. An exploratory study design was developed to assess the relief potential of the robotic system for nurses during the care action of repositioning from the supine position to the sitting position at the edge of a nursing bed under kinaesthetic principles.MethodsThe study was conducted in March 2022 with a total of 21 nursing professionals participating. Safety precautions at this stage of the robot’s development made it necessary to use a 40 kg patient simulator instead of having a human act as the patient. Each participant performed the repositioning three times in the conventional manner and three times with the robotic-assistance. The conventional and the robotic-assisted task execution was compared using different perspectives of analysis. From a sensory perspective, ground reaction forces and electromyography data were collected and analyzed. A kinaesthetic perspective was added using 3D-video data which was analyzed by professional kinaesthetics trainers. A third perspective was added by collecting the subjective workload experiences of the participants.ResultsWhile participants’ self-assessment based on a NASA-TLX questionnaire suggests more of a physical and psychological strain from using the robot, electromyography shows a 24.41% reduction in muscle activity for left back extensors and 7.99% for right back extensors. The kinaesthetic visual inspection of the study participants also allows conclusions to be made that the robot assistance system has a relieving effect when performing the nursing task.ConclusionsThe conducted study suggests that overall the robotic-assistance has the potential of relieving nurses of partial physical exertion during mobilization. However, the different focuses of analysis show varying results in regard to external, i.e. sensor data and expert analysis, compared to internal, i.e. the nurses, perspectives. Going forward, these results have to be further expanded to get more robust analyses and insights on the interdependencies of subjective factors contributing to the experience of workload. In view of the fact that robotics for nursing is still a relatively new field and there are various lessons to be learned regarding the conceptualization of studies and corresponding evaluations, our approach of combining perspectives of analysis allows for a more differentiated view of the subject at hand.

Relationship of Age And Mobility Levels During Physical Rehabilitation With Clinical Outcomes in Critical Illness

ObjectiveTo determine whether age, mobility level, and change in mobility level across the first 3 physical rehabilitation sessions associate with clinical outcomes of patients who are critically ill. DesignRetrospective, observational cohort study. SettingMedical Intensive Care Unit (MICU). ParticipantsHospitalized adults (n = 132) who received 3 or more, consecutive rehabilitation sessions in the MICU. InterventionsNot applicable. Measurements and Main ResultsSample included 132 patients with 60 (45%) classified as younger (18-59 years) and 72 (55%) as older (60+ years). The most common diagnosis was sepsis/septicemia (32.6%). Older relative to younger patients had a significantly slower rate of improvement in ICU Mobility Scale (IMS) scores across rehabilitation sessions (mean slope coefficient 0.3 vs 0.6 points, P<.001), were less likely to be discharged to home (30.6% vs 55.0%, P=.005), and were more likely to die within 12 months (41.7% vs 25.0%, P=.046). Covariate-adjusted models indicated greater early improvement in IMS scores were associated with discharge home (P=.005). Longer time to first rehabilitation session, lower initial IMS scores, and slower improvement in IMS scores were associated with increased ICU days (all P<.03). ConclusionOlder age and not achieving the mobility milestone of sitting at edge of bed or limited progression of mobility across sessions is associated with poor patient outcomes. Our findings suggest that age and mobility level contribute to outcome prognostication, and can aide in clinical phenotyping and rehabilitative service allocation.

559 Verticalization Therapy for ICU-Level Burn Patient: A Case Study

Abstract Introduction The entire interdisciplinary team can be faced with many challenges when treating a bariatric, critically ill patient with significant burn injuries. Some studies suggest that the care of these patients increases staff workload and leads to the need for increased assistance for proper turning, positioning, and completion of wound care. When caring for these types of patients, patient and staff safety should be considered, as well as what will ensure the best patient outcomes. Our rehab team initiated the use of verticalization therapy with a patient on the burn unit with 28% TBSA full-thickness burns to back, chest, BUEs and a BMI of 45.8 in order to promote improved healing, cognitive status, and pulmonary function. While verticalization therapy is described for use in patients with pulmonary issues or invasive cardiac support devices, this was the first time this therapy was used in our busy ABA-verified burn center. Methods Once deemed appropriate for participation with PT/OT, a collaborative protocol with nursing, therapy, and burn provider team was developed. The patient was transitioned into a specialized bed allowing for verticalization up to 90 degrees. The patient was incrementally verticalized by 10 degrees at a time while monitoring vitals, assessing patient safety and pain response. Ultimately, the patient reached 40 degrees vertical and maintained this position for up to 2 hours. This intervention was utilized by both rehab specialists and nursing staff and was taught to nursing staff to be performed daily until patient was able to actively participate and tolerate edge of bed or out of bed activity. Results Use of the verticalization positioning was used to promote weight bearing activity, improve pulmonary function, improve cognitive status through upright positioning, and for pressure relief of graft areas specifically for offloading pressure to back wounds and grafts. The bed was used for 1 month. During this time, the patient successfully liberated from mechanical ventilation and shock state and mobilized with therapy assistance. The patient demonstrated improved strength, active participation with therapies, and decreased agitation as the month progressed. Autograft split-thickness skin grafts with autologous cell suspension epithelial autografts to the patient’s posterior torso healed well and were fully closed by the time of discharge to inpatient rehabilitation. Conclusions Use of verticalization beds can be implemented in the care of patients with burn injuries safely and successfully. Further research regarding skin healing related to use of the bed and verticalization therapy in burn injured patients should be conducted. Applicability of Research to Practice This intervention can be used for patients of all sizes and can be implemented as soon as hospital day one, if the patient is medically appropriate

Characterization of scanning orientation and lateral response artifact for EBT4 Gafchromic film.

The purpose of this study was to investigate the impact of scanning orientation and lateral response artifact (LRA) effects on the dose-response of EBT4 films and compare it with that of EBT3 films. Dose-response curves for EBT3 and EBT4 films in red-green-blue (RGB) color channels in portrait orientation were created for unexposed films and for films exposed to doses ranging from 0 to 1000cGy. Portrait and landscape orientations of the EBT3 and EBT4 films were scanned to investigate the scanning orientation effect in the red channel. EBT3 and EBT4 films were irradiated to assess the LRA in the red channel using a field size of 15×15cm2 and delivered doses of 200, 400, and 600cGy. Films were scanned at the edge of the scanner bed, and the measured doses were compared with the treatment planning system (TPS) calculated doses at a position 100mm lateral to the scanner center. At a dose of 200cGy, the differences in optical density (OD) in the red, green, and blue color channels between EBT3 and EBT4 films were 0.035 (24.8%), 0.042 (49.7%), and 0.022 (64.4%), respectively. The EBT4 film slightly improved the scanning orientation compared to the EBT3 film. The OD difference in the different scanning orientations for the EBT3 and EBT4 films was 0.015 (6.8%) and 0.007 (3.9%), respectively, at a dose of 200cGy. This is equivalent to a 20 or 10cGy variation at a dose of 200cGy. Compared with the TPS calculation, the measurement doses for EBT3 and EBT4 films irradiated at 200cGy were approximately 16% and 13% higher, respectively, at the 100mm off-centered position. The EBT4 film showed an improvement concerning the impact of LRA compared with the EBT3 film. This study demonstrated that the response of EBT4 film to a dose in the blue channel was less sensitive and showed an improvement in the scanning orientation and LRA effects.

Body Surface Radiation Exposure in Interventional Echocardiographers During Structural Heart Disease Procedures

BackgroundThe distribution of radiation exposure on the body surface of interventional echocardiographers during structural heart disease (SHD) procedures is unclear. ObjectivesThis study estimated and visualized radiation exposure on the body surface of interventional echocardiographers performing transesophageal echocardiography by computer simulations and real-life measurements of radiation exposure during SHD procedures. MethodsA Monte Carlo simulation was performed to clarify the absorbed dose distribution of radiation on the body surface of interventional echocardiographers. The real-life radiation exposure was measured during 79 consecutive procedures (44 transcatheter edge-to-edge repairs of the mitral valve and 35 transcatheter aortic valve replacements [TAVRs]). ResultsThe simulation demonstrated high-dose exposure areas (>20 μGy/h) in the right half of the body, especially the waist and lower body, in all fluoroscopic directions caused by scattered radiation from the bottom edge of the patient bed. High-dose exposure occurred when obtaining posterior-anterior and cusp-overlap views. The real-life exposure measurements were consistent with the simulation estimates: interventional echocardiographers were more exposed to radiation at their waist in transcatheter edge-to-edge repair than in TAVR procedures (median 0.334 μSv/mGy vs 0.053 μSv/mGy; P < 0.001) and in TAVR with self-expanding valves than in those with balloon-expandable valves (median 0.067 μSv/mGy vs 0.039 μSv/mGy; P < 0.01) when the posterior-anterior or the right anterior oblique angle fluoroscopic directions were used. ConclusionsDuring SHD procedures, the right waist and lower body of interventional echocardiographers were exposed to high radiation doses. Exposure dose varied between different C-arm projections. Interventional echocardiographers, especially young women, should be educated regarding radiation exposure during these procedures. (The development of radiation protection shield for catheter-based treatment of structural heart disease [for echocardiologists and anesthesiologists]; UMIN000046478)

The influence of printing orientation on the flexural strength of PA 12 specimens produced by SLS

This article aims to investigate the mechanical characteristics of specimens fabricated using Selective Laser Sintering technology. The research covers flexural specimens, produced by PA12 materials. CAD model dimensions were selected according to the ISO 178 standard, and the chosen specimen geometry is 96 x 8 x 4 [mm] in bulk. All specimens were produced using a specialized machine Fuse 1 (FormLabs, Summerville, MA). Four specimen batches were produced, each with a different printing orientation (i.e. vertical and horizontal) and location on the printing plate (i.e. in the middle and on the edge of the powder bed). The specimens are tested using a Shimadzu universal machine for testing the mechanical characteristics of materials, AGS-X 100 kN, with a unique additional tool for testing 3-point bending specimens.

A Human Space.

A Human Space.

Physiotherapy Practice Pattern in the Adult Intensive Care Units of Singapore – A Multi-Centre Survey

Background The roles of physiotherapy in Intensive Care Unit (ICU) have significantly developed from the traditional management of respiratory conditions to early rehabilitation and mobilisation of patients on mechanical ventilation. Surveys of United Kingdom, Australia and regional ICU physiotherapy practice have been published but there are no local data sets. This study aims to report the physiotherapy practices across the adult ICUs of Singapore. Methods Twenty-nine item questionnaire was mailed to 90 physiotherapists working in 15 adult ICUs across restructured and private hospitals in Singapore. Data sets were summarised from the returned questionnaires. This includes identifying common physiotherapy techniques and exercise prescription protocols for both mechanically and non-mechanically ventilated patients in the ICU. Results A total of 63 (70%) questionnaires were returned. The most used physiotherapy interventions were airway secretion clearance, techniques to improve lung ventilation and mobilisation out of bed. Positioning was most used respiratory technique (60/61, 98%). Sitting on the edge of bed is the most preferred physical activity for ICU patients (43/44, 98%). Exercise was routinely prescribed (50/61, 83%) although only a minority (8/50, 16%) have established exercise prescription protocols. For mechanically ventilated patients, active/active assisted exercises were most used (40/44, 91%). 12% of ICU use either Chelsea Critical Care Physical Assessment Tool or the Functional Status Score for the Intensive Care Unit as routine outcome measures. Conclusion Airway clearance was stated as the most used physiotherapy technique. Exercise is routinely prescribed in ICU. Validated outcome measures are only used by few.

Changes in barriers to implementing early mobilization in the intensive care unit: a single center retrospective cohort study.

ABSTRACTThis study was undertaken to investigate the rate of mobilization, defined as a rehabilitation level of sitting on the edge of a bed or higher, and its association with changes in barriers in the intensive care unit (ICU). Consecutive patients from January 2016 to March 2019 admitted to the ICU, 18 years old or older, who did not meet exclusion criteria, were eligible. The primary outcome was the rate of mobilization. Barriers, their changes on a daily basis, and clinical outcomes, such as walking independence at hospital discharge, were also investigated. The association between the barriers and mobilization, and walking independence were analyzed by multivariate logistic regression analysis. During the study period, 177 patients were enrolled. Mobilization was achieved by 116 patients (66%) by the 7th ICU day. The barrier to mobilization was circulatory status on days 1 and 2, consciousness level on days 3 to 5, and medical staff factors on days 6 and 7. Multivariate analysis showed that consciousness level (OR: 0.38, p=0.01), and medical staff factors (OR: 0.49, p=0.01) were significantly associated with mobilization. By hospital discharge 125 patients (71%) could walk independently. Consciousness level was associated (OR: 0.52, p=0.04) with walking independence. In this study, over half of patients could achieve mobilization within the first 7 days. Barriers to mobilization in the ICU change over time. Consciousness level is significantly associated with both mobilization and independent walking at discharge.

A variable cross-section annular fins type metal hydride reactor for improving the phenomenon of inhomogeneous reaction in the thermal energy storage processes

Metal hydride (MH) has been of great interest as one of the potential thermochemical heat storage materials. Previous studies have revealed that with the progress of the reaction, the inhomogeneous reaction will gradually appear in the metal hydride heat storage reactor (MHHSR), which will lead to the decrease of the heat output capacity of the reactor. In this study, an innovative MHHSR with a variable cross-section annular fin (VCSAF) structure is proposed. The thermal coupling model between the powder bed and VCSAF is established. It is found that the VCSAF can effectively resolve the inhomogeneous reaction phenomenon in the reaction process by adjusting the inclination angle between outer profile of VCSAF and outer edge of bed (θfin). At the same time, the influence of different fin structures parameters is analyzed on the uniformity of the reactor based on sensitivity analysis. The width of the largest fin (Lfin,max) is the main factor affecting the uniformity in comparison with fin thickness (hfin), fin spacing (Δh). With the increase of Lfin,max, Δh and hfin, exergy output (Ex,out) changes from 266.12 kJ to 249.65 kJ, 222.64 kJ to 282.99 kJ, and 264.01 kJ to 255.82 kJ, respectively, gravimetric exergy-output power of reactor (GEOPR) changes from 41.96 W kg−1 to 48.22 W kg−1, 49.88 W kg−1 to 42.41 W kg−1, and 43.11 W kg−1 to 47.40 W kg−1, respectively, and gravimetric efficient exergy-output (GEEO) remains unchanged. Besides, the simulation results of four different designs: no fin (NF), same cross-section fin (SCSF), longitudinal fin (LF) and VCSAF are compared to assess their performance. Compared to NF, SCSF and LF, VCSAF has a more uniform heat transfer effect and better performance. Finally, the performance improvement of the enlarged VCSAF reactor is analyzed. With the increase of length (L), the platform end time difference between the SCSF and VCSAF and between LF and VCSAF (Δt1 and Δt2) increases from 800 s to 2800 s and 2250 s to 4800 s, respectively. Compared with NF, the growth rates of Ex,out, exergy efficiency (ηEx), GEEO and GEOPR for VCSAF change from 4.04% to 16.07%, 6.79% to 14.42%, 10.60% to 22.22%, and 31.74% to 6.81%, respectively. Compared with SCSF, the growth rates of Ex,out, ηEx, GEEO and GEOPR change from 12.41% to 26.23%, 9.74% to 17.97%, 12.54% to 26.01%, and 5.00% to 2.18%, respectively. Compared with LF, the growth rates of Ex,out, ηEx, GEEO and GEOPR change from 14.52% to 34.02%, 10.12% to 20.18%, 13.53% to 27.99%, and 7.70% to 5.56%, respectively. The VCSAF structure has an excellent performance in eliminating inhomogeneous reaction. With the enlargement of the reactor, the heat output capacity has been improved obviously, which has an important guiding significance for the engineering application of the MH high-temperature heat storage technology.

Therapeutic Management of a Patient with Necrotizing Fasciitis Resulting in Quadrilateral Amputation and Critical Illness Myopathy in the Intensive Care Setting: A Case Report.

Purpose: The purpose of this case is to illustrate the best available evidence to provide early therapeutic intervention for a critically ill patient presenting with cardiovascular and pulmonary complications due to multi-system compromise. Case Description: A 19-year-old male was admitted to the hospital with the diagnosis of necrotizing fasciitis and necrotizing pneumonia. He experienced numerous additional medical complications ultimately leading to tracheostomy, delirium, critical illness myopathy, and quadrilateral amputation secondary to necrotizing fasciitis and critical limb ischemia following prolonged veno-venous extracorporeal membrane oxygenation (VV-ECMO). Outcomes: Patient was discharged to an outside rehabilitation hospital after 103 days in the acute setting (56 days in the ICU) and was able to tolerate 40 minutes sitting edge of bed with supervision, perform bed mobility with supervision, and propel a standard wheelchair up to 50 feet independently. At 10 months’ post-discharge from the acute setting, the patient was ambulating independently up to 150 feet without assistive device using bilateral lower extremity prosthetics, able to propel a lightweight wheelchair community distances, independent in all transfers, and returned to school and work. Discussion: These findings suggest that clinicians may want to consider examining and combining the best available evidence of multiple medical conditions to provide a well-rounded therapeutic approach including but not limited to, close monitoring of vitals and early mobilization, to managing complex patients in the intensive care setting.

Seagrass resilience: Where and how to collect donor plants for the ecological restoration of eelgrass Zostera marina in Rongcheng Bay, Shandong Peninsula, China

As seagrasses are not available with commercial nursery stocks, the removal of a large amount of plant materials may damage donor populations. We evaluated the recovery of the eelgrass Zostera marina following the removal of entire plant patches (0.01–0.49 m2) at the edge and interior of an eelgrass bed in Rongcheng Bay, Shandong Peninsula, China, through a field experiment. We investigated the shoot density, morphology and growth of recovering plants following excavation. We found that the removal of entire small patches with excavation areas ≤0.25 m2 in the interior of the eelgrass bed was the most suitable strategy for harvesting donor plants of Z. marina. Small patch excavation (≤ 0.25 m2) was able to promote asexual reproduction in recovering plants, and their shoot density and morphology equaled or exceeded those of natural plants <7 months after harvesting. These results indicate that Z. marina plants have a strong capacity for resilience from physical disturbance through rhizome elongation in the harvested area.

A numerical study of particle jetting in a dense particle bed driven by an air-blast

In this work, the particle jetting behavior in a blast-driven dense particle bed is studied at early times. Four-way coupled Euler–Lagrange simulations are performed using a high-order discontinuous Galerkin spectral element solver coupled with a high-order Lagrangian particle solver, wherein the inter-particle collisions are resolved using a discrete element method collision model. Following the experiments of Rodriguez et al. [“Formation of particle jetting in a cylindrical shock tube,” Shock Waves 23(6), 619–634 (2013)] and the simulations of Osnes et al. [“Numerical simulation of particle jet formation induced by shock wave acceleration in a Hele-Shaw cell,” Shock Waves 28(3), 451–461 (2018)], the simulations are performed in a quasi-two-dimensional cylindrical geometry (Hele-Shaw cell). Parametric studies are carried out to assess the impact of the coefficient of restitution and the strength of the incident shock on the particle jetting behavior. The deposition of vorticity through a multiphase (gas–particle) analog of Richtmyer–Meshkov instability is observed to play a crucial role in channeling the particles into well-defined jets at the outer edge of the particle bed. This is confirmed by the presence of vortex pairs around the outer jets. Furthermore, the effect of the relaxation of the relative velocity between the two phases on the vorticity generation is explored by analyzing the correlation between the radial velocity of particles and the radial velocity of the gas at the particle location.

Simplest Way to Establish COVID-19 Quarantine Observation Wards Within 24 Hours

Reducing nosocomial transmission within health care facilities is important, but the number of negative-pressure airborne infection isolation rooms for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is limited. It is a daunting challenge to cope with a surge of suspected infectious patients in hospitals. We installed air exhaust fans on the windows to change the pressure direction within the wards rapidly. The best location for the fans was 90 cm from the floor and 90 cm from the edge of bed whether the indoor air conditioners were on or off. The noise level should be <60 dB(A) as per government regulations. General wards can be transformed into makeshift negative-pressure rooms easily and effectively within 24 hours, which is really the simple, fast, and effective way for the transformation being applied.

834 Early Ambulation Initiative Following LE Grafts in Comparison to Our Center’s Traditional Standard of Care: A Retrospective Data Review

Abstract Introduction Our ambulation guideline following LE grafting is loosely defined as bedrest vs. lateral transfers only until POD#5. Patient’s mobility status is increased POD#5 with WB per physician discretion. A proposal was created to initiate mobility earlier than POD#5 for patients with LE grafts. Two of our three surgeons were in agreement with the early ambulation protocol. The third surgeon wished to follow the traditional ambulation practice guideline. This request was respected and made known to all staff for carryover. This afforded us the opportunity of a comparison group with our center’s traditional standard of care functioning as the control group. Methods The proposed early ambulation protocol was influenced by evidence-based practice guidelines as well as surgeon input. Criteria was based upon the location of grafting, graft crossing a joint, size of wound being grafted (&amp;lt; or = 400 cm), and general medical status of the patient. Our early ambulation protocol was established as follows: POD#1 Lateral transfers with involved LE elevated. POD#2 Dependent LE at edge of bed, WBAT short distance ambulation to chair or bathroom with AD. POD#3–4 Increase ambulation as tolerated, assess need for continued splinting, appropriateness of progressive ambulation, AROM exercises. POD# 4–5 Progress ambulation with AD as needed, stairs as needed for discharge, home exercise program. Our inclusion criteria consisted of patients of any age, LE burns with STSG not involving joints/involving joints with appropriate immobilization. Exclusion criteria consisted of fractures of involved LE, patients who were non-ambulatory at baseline, wounds &amp;gt;400 cm2, STSG to plantar aspect of foot, medically unstable patients, and surgeon discretion. Results Data reviewed over an eight month period of time yielded 27 patients who met our established criteria; 26 had no graft loss on the first dressing change. The patient with graft loss was attributed to graft placement directly over bone of the distal phalanx. Comparatively, no loss was noted in the control group with 10/10 patients ambulating on POD#5. Of note, early ambulation was granted for several patients with larger surface areas with no graft loss demonstrated, but were not included in this study. Conclusions In conclusion, 96% of patients demonstrated no graft loss with first dressing change following our early ambulation guideline. All patients who followed the traditional ambulation guideline demonstrated no graft loss on the first dressing change. Based on our findings, early mobility is not detrimental to graft integrity following specific established guidelines. Applicability of Research to Practice Our data supports early mobility of LE grafting up to 400 cm2 with 96% success rate. This may be supportive of further research with early mobility involving a larger surface area of LE STSG.

Arthroscopic simplified double-pulley double row suture technique to fix the bigger glenoid anterior edge fracture

Objective To investigate the clinical results of arthroscopic double-pulley double row suture technique for the treatment of bigger Ideberg Ia glenoid fracture. Methods From January 2014 to July 2017, data of patients with Ideberg Ia glenoid fracture who were treated by arthroscopic double-pulley double row suture technique were retrospectively analyzed. Totally 24 patients were enrolled of whom 13 were males and 11 were females. The mean age was 50.14±10.60 years (range, 34-67). In those patients, there were 8 cases of glenoid fracture alone, 4 cases of glenoid fracture associated with greater tuberosity fracture, 5 cases of glenoid fracture with rotator cuff tear, 4 cases of glenoid fracture with shoulder anterior dislocation and greater tuberosity fracture, 2 cases of glenoid fracture with shoulder anterior dislocation and rotator cuff tear, and 1 case of shoulder anterior dislocation with ipsilateral distal radius fracture. The fragment accounts for 28.91±5.35% (range, 25.1%-38.5%) of the glenoid articular surface. According to the size of the fragment, one medial row anchor was used to implant at the medial edge of the fracture bed of the anterior edge of the glenoid; two to four lateral row suture anchors were used to implant at the margin of the glenoid joint surface sequentially from low level to higher level, and simplified double-pulley technique was finally used to fix the fragment. The situation of fracture reduction and healing and the post-operative complications were evaluated. The Constant-Murley, DASH and VAS were also recorded. Results Satisfactory fracture reduction and fixation were achieved in all 24 patients. The mean follow-up time was 19.5 months (range, 12-36). Mean VAS was 0.8±0.8 (range, 0-2). The range of motion at the latest follow-up was: anterior flexion 145°-180° (mean, 161.00°±5.77°), external rotation at the side 35°-60° (mean, 46.43°±6.63°), internal rotation L3-T10 level. The mean Constant-Murley score was 88.1±3.7 (range, 81-93), and mean DASH score was 8.4±4.7 (range, 0-40.4). All cases except one showed no dislocation or disability of the shoulder. The CT scans showed: 19 cases of which the step-off of articular surface was less than 2 mm; 4 cases of which the step-off was between 2 mm to 4 mm and 1 case of which the step-off was more than 4 mm. No severe osteoarthritis was identified at the latest follow-up, and only 1 patient at the age of 67 showed slight osteoarthritis. Two patients with shoulder anterior dislocation and rotator cuff tear committed significant restricted shoulder range of motion. Conclusion The arthroscopic simplified double-pulley double row suture technique was identified safe, effective and reliable for treating the bigger Ideberg Ia glenoid fracture. The technique is able to provide clear visulization of the fracture and achieve excellent clinical results. Key words: Shoulder fractures; Arthroscopy; Suture anchors

Early Therapeutic Mobility and Changes in Scores for Pain and Fatigue.

This report is a secondary analysis of data from a larger study of a nurse-led early therapeutic mobility intervention among patients receiving mechanical ventilation. This analysis evaluated whether intervention frequency or intensity was associated with pain or fatigue. Frequency was defined as once-daily versus twice-daily interventions. Intensity was defined as low (in-bed activities) or moderate (out-of-bed activities). Thirty-nine patients self-reported pain and fatigue immediately before and after the intervention. Neither pain nor fatigue increased significantly (mean increase, <1 [scale of 0-10] for 95% of interventions). Four patients reported decrements in pain; 1 reported a decrease in fatigue. Less than 5% of enrolled patients indicated a score change of +4 to +6 for pain or fatigue, typically with the first intervention that included sitting at the edge of the bed. Future research could examine the distress associated with these symptoms in critically ill adults receiving early therapeutic mobility interventions.