Head Of Bed Research Articles

To study the prescriptions of the bed-head tickets of inpatients of the selected depts. of JNIMS hospital about the appropriateness of the prescriptions in geriatric patients

Background: Polypharmacy is an increasing problem among the health care providers. This happened during the management of old age people with much comorbidity and weak functioning of the vital organs like heart, lungs and kidneys, etc. Over and above this, self-medication and adverse drug effects of using many drugs are the causes of polypharmacy. Age 65 years or above is considered as Geriatric.Methods: 550 case sheets or Bed head tickets of the inpatients of selected departments were examined for a period of three months. 434 bed head tickets having discharge slips with written prescriptions of 5 or more drugs were re-examined as it fulfilled the criteria of Polypharmacy or inappropriate prescriptions. Demographic data, clinical and drug history were recorded in the prepared data sheet. These data were studied as per guidelines of the tools-Beer’s criteria, STOPP criteria, START criteria, MAI criteria.Results: Accordingly, the reasons for polypharmacy and inappropriate prescriptions were elicited. The common drugs mostly prescribed are antibiotics and NSAIDs preparations. The status of polypharmacy or inappropriate prescription were more in the age group of 65-75 years and also mainly among the male geriatric patients. The maximum number of comorbidity was observed in the age group 65-75 years.Conclusions: As per the criteria of the tools, the number of overprescribing was 70 (19.15%), inappropriate prescription as 17 (4.6%). For prevention and decreasing the incidence of polypharmacy or inappropriate prescriptions, the tools (Beer’s criteria, STOPP criteria, START criteria, MAI criteria) are nowadays put forward to the prescriber as a guideline of good and appropriate prescription. Therefore, the present study can find out the status of prescription i.e. under-prescription, over-prescription, avoid prescription and inappropriate prescription. Hence, the study can draw the attention of the prescribers before and during prescribing drugs to the patients particularly old age patients.

Time of elevation of head of bed for patients receiving mechanical ventilation and its related factors

IntroductionThe semirecumbent position is a widespread recommendation for the prevention of pneumonia associated with mechanical ventilation. AimsTo identify the time of elevation of head of bed for patients under mechanical ventilation and the factors related to such elevation in an intensive care unit. Materials and methodsAn observational, descriptive cross-sectional study. Conducted in an intensive care unit of a tertiary hospital from April to June 2015. The studied population were mechanically ventilated patients. Daily hours in which patients remained with the head of the bed elevated (≥30°), socio-demographic data and clinical variables were recorded. Results261 head elevation measurements were collected. The average daily hours that patients remained at ≥30° was 16h28′ (SD±5h38′), equivalent to 68.6% (SD±23.5%) of the day. Factors related to elevations ≥30° for longer were: enteral nutrition, levels of deep sedation, cardiac and neurocritical diagnostics. Factors that hindered the position were: sedation levels for agitation and abdominal pathologies. Sex, age and ventilation mode did not show a significant relationship with bed head elevation. ConclusionsAlthough raising the head of the bed is an easy to perform, economical and measurable preventive measure, its compliance is low due to specific factors specific related o the patient's clinical condition. Using innovations such as continuous measurement of the head position helps to evaluate clinical practice and allows to carry out improvement actions whose impact is beneficial to the patient.

Current insights in CSF leaks: a literature review of mechanisms, pathophysiology and treatment options

Abstract A cerebrospinal fluid (CSF) leak occurs when there appears a fistula between the dura and the skull base and it is usually characterized by discharge of cerebrospinal fluid from the nose. Cerebrospinal fluid leaks may have many etiologies, the most common being trauma. The most common site of dural lesion is the cribriform plate of the ethmoid. Diagnosis can be achieved by a multitude of techniques, high-resolution computed tomography being the modality of choice and it may be completed with magnetic resonance imaging or cisternography. Treatment may be either conservative, either surgical, related to the cause, the site and the duration of CSF leak. Conservative treatment usually includes strict bed rest, elevated bed head and no straining, nose blowing or stretching, with resolution of the majority of traumatic CSF leaks in seven days. Surgical treatment consists of a variety of approaches (intracranial/extracranial, open/endoscopic). The future trend is represented by minimally invasive endoscopic approaches, with a success rate of almost 90%; however, open transcranial or extracranial interventions still have indications in the surgical management. CSF leaks must be correctly diagnosed and treated, because the risk of intracranial complications increases 10-fold when the leakage persists.

Effects of bedside elevation angle on ventilator-associated pneumonia and pressure sores in critically ill patients with mechanical ventilation: a Meta analysis

Objective To evaluate the effects of different bedside elevation angles on ventilator-associated pneumonia and pressure sores in critically ill patients with mechanical ventilation. Methods The randomized controlled trials of raising the angle of the bed at the Cochrane Library, JBI, PubMed, Embase, Ovid, CMB, VIP, CNKI and Wanfang database on ventilator-associated pneumonia and pressure sores in critically ill patients with mechanical ventilation were retrieved. Meta-analysis was performed on the included literatures after including literature review, evaluation and extraction by 3 researchers. Results A total of 6 literatures were included involving 518 patients. The overall quality of the included literature was medium The results of meta-analysis showed that the incidence rate of VAP in patients with bedside elevation angles >30° was significantly lower than that in patients with bedside elevation angles ≤30° (OR=0.42, P=0.02) . There was no significant difference in the risk of pressure sore (OR=0.85, P=0.55) . There was no significant difference in the increase of death outcome (OR=0.86, P=0.52) . Conclusions In the clinic, it is appropriate to raise the head of a bed more than 30°without any contraindication, but further attention should be paid to the durability of raising the head of a bed more than 30°and the medical staffs' compliance. Key words: Respiration, artificial; Bedside elevation angle; Meta analysis

Evaluation of volume overload in critical patients by monitoring change of cardiac output under bed head raising combined with passive leg raising

To investigate whether the change of cardiac output (CO) with bed head raising (BHR) combined with passive leg raising (PLR) can be used to assess volume overload in critical patients. A prospective observational diagnostic trial was designed. The patients who underwent fluid resuscitation 6 hours or more, and admitted to intensive care unit (ICU) of Meizhou People's Hospital in Guangdong Province from January to December in 2016 were enrolled. Volume overload were identified with the criteria including the increasing of pulmonary rales, the higher levels of N-terminal brain natriuretic peptide (NT-proBNP) and new pulmonary exudates in chest radiograph. CO and heart rate (HR) were monitored with impedance cardiography at supine position and BHR by 30degree angle (BHR30), 60degree angle (BHR60), and PLR in all patients. The changes of CO (ΔCO30, ΔCO60, ΔCOPLR) and HR (ΔHR30, ΔHR60, ΔHRPLR) were calculated at different positions. The receiver operating characteristic curve (ROC) was used to evaluate the predictive values of ΔCO30, ΔCO60 and combination of ΔCO60 and ΔCOPLR on volume overload. A total of 62 patients were enrolled in this study, with 44 males and 18 females, age of (58.9±15.9) years, a body mass index of (22.7±2.4) kg/m2, and an acute physiology and chronic health evaluation II (APACHE II) score of 18.7±4.4. The CO of 32 patients with volume overload was significantly increased at BHR30 or BHR60 compared with supine position [ΔCO30 was (14.5±11.5)%, ΔCO60 was (26.9±17.5)%, both P < 0.01], and the ΔCO60 was increased more than the ΔCO30 (P < 0.01); while CO was slightly decreased after PLR, ΔCOPLR was (-8.4±11.3)% (P > 0.05). There was no consistent change of CO at BHR30 or BHR60 compared with supine position in 30 patients without volume overload, ΔCO30 was (-3.4±9.1)% (P < 0.05), ΔCO60 was (-2.4±14.0)% (P > 0.05), while CO was significantly increased after PLR, ΔCOPLR was (12.4±11.3)% (P < 0.01). There was no significant change of HR after BHR and PLR in patients with volume overload and non volume overload. ROC curve showed that when the cut-off value of ΔCO30≥3.3%, the area under ROC curve (AUC) was 0.903±0.039, the sensitivity was 90.6%, the specificity was 80.0%, and the accuracy was 85.5% for predicting volume overload; when the cut-off value of ΔCO60≥5.6%, the AUC was 0.911±0.036, the sensitivity was 96.9%, the specificity was 73.3%, and the accuracy was 85.5% for predicting volume overload. If volume overload was assessed by the increase of ΔCO60 combining with the decrease of ΔCOPLR, the AUC was 0.928±0.034, the optimal cut-off value for the new combined predictive indicator in predicting volume overload was -0.008, and the sensitivity, specificity, accuracy was 96.9%, 83.3%, 90.3%, respectively, and its evaluation effect is better than the use of ΔCO30 or ΔCO60 alone. The change of CO with BHR combined with PLR can be used to accurately evaluate volume overload in patient with critically illness.

The Comparison of the Effect of the Head of Bed Elevation to 30 and 45 Degreess on the Incidence of Ventilator Associated Pneumonia and the Risk for Pressure Ulcers: A Controlled Randomized Clinical Trial

Background: The prevention of ventilator-associated pneumonia (VAP) can decrease the duration of mechanical ventilation, length of hospital stay, mortality, and healthcare costs. Objectives: The aim of this study was to compare the effect of the elevation of head of bed (HOB) to 30 and 45 degreess on the incidence of VAP. Methods: This study was a 3 group controlled randomized clinical trial. It consisted of 120 patients who were under mechanical ventilation and hospitalized in the intensive care unit (ICU) from February to July 2016 in the selected governmental hospitals of Iran University of Medical Sciences. The patients were allocated into 3 groups. The patients of intervention groups received interventions consisting of HOB elevation to 30 and 45 degreess for 3 consecutive days. The patients in the control group were in the routine position in the bed for 3 consecutive days. The HOB elevation was measured using the goniometer and recorded by nurses in perticular forms. At the end of the third day, VAP and pressure ulcers were evaluated using the clinical pulmonary infection score (CPIS) as well as Braden scales. The data were analyzed using descriptive and inferential statistics. Results: Statistically significant differences were reported in terms of VAP between the groups of the HOB evelation to 30 degrees (32.50%) and 45 degrees (20.00%) and control groups (52.50%) (P = 0.01). However, the mean scores of pressure ulcer showed no statistically significant differences between the groups (P = 0.625). The greatest change in position was performed by the staff nurses for nursing care in the group of 45 degrees elevation that reported as 6.125 ± 3.13 hours. Conclusions: The HOB elevation to 45 degrees helped with the prevention of VAP compared with the HOB elevation to 30 degrees as well as bed routine. Therefore, it is suggested that nurses elevate HOB to 45 degrees (more than 30 degrees) among mechanically-ventilated patients admitted to the ICU.

Psychopathology in Sri Lankan patients with first-episode psychosis

Background First episode psychosis (FEP) is the first episode of a psychiatric illness with psychotic symptoms. Delay in diagnosis increases the duration of untreated psychosis (DUP) and leads to poorer outcome. Aims To explore the psychopathology of patients with FEP presenting to the National Hospital of Sri Lanka (NHSL). Methods This was an observational descriptive study. Patients admitted to ward-59, NHSL from March 2012 to November 2013 who met inclusion criteria were considered for the study. Data was collected retrospectively from bed head tickets using a structured questionnaire. Results The sample size was 101, of which 57 were male. A majority of the participants were in the 13-26 year age group. Delusions were the most common psychopathology noted in this sample, with persecutory themes being the most common content. Of the hallucinations, second person auditory hallucinations were the commonest type. Non-euthymic mood was seen in over two-thirds of participants, with depressed mood being the most common finding. Insight was poor in over half the participants. Schizophrenia was the most common diagnosis noted in this group of patients, followed by mania with psychotic features. Conclusions Persecutory delusions, second person auditory hallucinations, mood and speech abnormalities were prominent among participants of this study. A better understanding of psychopathology in FEP may help to reduce DUP.

Tiempo de elevación del cabezal de la cama del paciente con ventilación mecánica y factores relacionados

IntroductionThe semirecumbent position is a widespread recommendation for the prevention of pneumonia associated with mechanical ventilation. AimsTo identify the time of elevation of head of bed for patients under mechanical ventilation and the factors related to such elevation in an intensive care unit. Materials and methodsAn observational, descriptive cross-sectional study. Conducted in an intensive care unit of a tertiary hospital from April to June 2015. The studied population were mechanically ventilated patients. Daily hours in which patients remained with the head of the bed elevated (≥30°), socio-demographic data and clinical variables were recorded. Results261 head elevation measurements were collected. The average daily hours that patients remained at ≥30° was 16h28’ (SD ±5h38’), equivalent to 68.6% (SD ±23.5%) of the day. Factors related to elevations ≥30° for longer were: enteral nutrition, levels of deep sedation, cardiac and neurocritical diagnostics. Factors that hindered the position were: sedation levels for agitation and abdominal pathologies. Sex, age and ventilation mode did not show a significant relationship with bed head elevation. ConclusionsAlthough raising the head of the bed is an easy to perform, economical and measurable preventive measure, its compliance is low due to specific factors specific related o the patient's clinical condition. Using innovations such as continuous measurement of the head position helps to evaluate clinical practice and allows to carry out improvement actions whose impact is beneficial to the patient.

Blood Transfusion during caesarean delivery

Introduction: Blood transfusion is considered as a life saving measure in obstetrics. However, at present it is not considered safe all the time due to transfusion reactions and infections. The mother is at risk of increased bleeding, because caesarean section may result in twice the blood loss of vaginal delivery (due to placental attachment and two surgical scars). In Sri Lankan setup, grouping and cross matching are done prior to each and every caesarean section without considering the presence or absence of risk factors even with less facilities available. During caesarean section in Sri Lanka blood transfusion to cross matching ratio is considered to be low. Objectives: To determine the proportion of blood transfusions performed among mothers whose blood was grouped and cross-matched for Lower segment caesarean section (LSCS). To find out the indications/ associated factors for blood transfusion in LSCS Method &amp; Materials: A retrospective cross sectional study carried out in Obstetric Units, General Hospital Matara Sri Lanka. Data collected from all the bed head tickets and other records available at Blood Bank General Hospital Matara belong to mothers who underwent elective and emergency caesarean sections from 30th July 2013 to 1st of June 2014 Results: Our sample size was 3174 mothers majority underwent Elective Lower segment caesarean section (EL/LSCS) (57.5%) &amp; 42.5% were Emergency Lower segment caesarean section (EM/LSCS). Only 1.85% of mothers transfused blood during LSCS, as 3.38% during EL/LSCS &amp; 96.6% during EM/LSCS. Lower segment large fibroid (50%) &amp; placenta accreta + past section (50%) were two indications that need blood transfusion during EL/LSCS in our research. Antepartum haemorrhage (APH) (15.78%), pregnancy induced hypertension (PIH) (8.77%), postpartum haemorrhage (26.31%), Anaemia Hb 7.6-8.2g/dl (36.84%), Twin pregnancy (5.26%) &amp; placenta previa were other indication that need blood transfusion in EM/LSCS. Conclusions: This study shows each &amp; every mother who undergo EL/LSCS do not need blood transfusion &amp; cross matching especially in EL/LSCS. According to our study patients with following risk factors need blood grouping &amp; cross matching. APH, PIH, Placental abnormalities, Anaemia (Hb 7.6-8.2g/dl), Twin pregnancy, and pregnancy complicated with abnormal uterine condition eg: - fibroids, placenta accrete.

Effect of different angle of head on intracranial pressure and cerebral perfusion pressure in patients with severe traumatic brain injury

Objective To investigate the effects of different angles of the head of bed on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in patients with severe traumatic brain injury. Methods A prospective self-controlled study was used. The parameters of mean arterial pressure (MABP) and cerebral blood flow on 43 patients with STBI, were measured at 0°, 10°, 20° and 30° respectively. The changes of ICP and CPP were calculated according to the formula. Results With the angles of head of bed was up from 0°to 30°, MABP gradually reduced, (102.57±8.34) mmHg (1 mmHg= 0.133kPa), (100.74 ± 8.12) mmHg, (97.32 ± 7.94) mmHg, (94.82 ± 8.38) mmHg, so was ICP, which were (24.50±6.29) mmHg, (22.88±6.18) mmHg, (19.57±6.22) mmHg, (17.32±6.77) mmHg, and the difference was statistically significant (F=13.38, F=14.03, P 0.05). For moderate increased intracranial pressure patients (ICP 0.05). Conclusions Elevating the head to 30 °can rapidly reduce the intracranial pressure and ensure enough cerebral perfusion. It is a safe and effective treatment for the similar patients in emergency rescue and nursing. At the same time, for the patients with moderate intracranial hypertension (ICP ≥25 mmHg), elevation the head of bed up to 20 ° can reduce the adverse effects of intracranial pressure adaptability shortage and the cerebral hypoperfusion, increase the safety of nursing care, and reduce the secondary brain injuries. Key words: Posture; Traumatic brain injury; Intracranial pressure; Cerebral perfusion pressure

PSY25 - Utilization of Antimicrobial Agents at the Haematology Ward in a Public Hospital

Antimicrobials are among the most utilized drugs on haematological patients in most hospitals. To determine its appropriateness, a drug utilization review was conducted to provide an insight on the pattern of use, determinants of use, quality of use and outcome of use in a public hospital. This is a descriptive study where 200 patient’s data were randomly extracted from the electronic hospital information system based on the defined inclusion criteria. Details of patient signs and symptoms and microbiological culture/sensitivity testing were retrieved by using Medication History Assessment, Pharmacotherapy Review Form, and Bed Head Ticket (BHT). Outcome is measured by examining the concordance to guidelines and DDD where the pattern and factors that influence its use. 152 patient data were evaluated. Their mean age was 46.0 (SD 16.9) years. The most antimicrobial prescribed were antibacterial (n=40) types, antifungal (n=8) and antiviral (n=2). Reason for the low number of cases for antifungal and antiviral agent was because it was been used as an adjunct therapy for fever neutropenic sepsis, stem cell transplants procedure and fungal and viral infection. Generally, the antimicrobial prescribed adhered to the current guideline. Most patients received antimicrobials for <7 days. No significant difference was observed of antimicrobial prescribing in terms of age, gender, race, and diagnosis. DDD for the most prescribed antibacterial:222 (Inj. cefepime), 96.3 (Inj meropenem) and 51.4 (Inj. piperacillin/tazobactam injection). The highest DDD for antifungal and antiviral agents: fluconazole capsule (53.79), acyclovir tablet (8.74) respectively. VEN analysis found the highest use for antibacterial, antifungal and antiviral were injection linezolid, injection caspofungin and acyclovir tablet respectively. Significant association were observed between diagnosis and prescriber category and CNS of antibacterial versus combination antibacterial (p<0.05). This study showed that the choice and dosing of prophylaxis antimicrobial agents in haematological patients is in accordance with their appropriate indications and standard therapy guideline.

Study on effects of early improved decubitus of general anesthesia downlink sinus endoscope operation

Objective To discuss the effects of early improved decubius of general anesthesia downlink sinus endoscope operation. Methods A total of 106 cases of patients who received nasal sinus open surgery in a certain hospital in Beijing from September 2014 to May 2015 were randomly divided into a control group and an experimental group according to the random number table method, 54 cases in the control group and 52 cases in the experimental group.The control group adopted recumbent position after general open nasal endoscopic sinus surgery of our hospital (changing to semirecumbent position after 4 hours' prostration without pillow). The experimental group adopted semirecumbent position at the early stage after surgery(the head of bed was elevated for 40 degrees after the postoperative evaluation for general anesthesia, patients with clear consciousness are able to correctly answer questions). The blood pressure, heart rate, breathing and blood oxygen saturation of the two groups 4 hours before and after the operation were compared.The nasal hemorrhagic secretions seepage quantity, wound pain and general discomfort of the two groups 4 hours after operation were compared. Results There were no statistical significances in terms of the comparison of the mean systolic pressure, diastolic blood pressure, heart rate, breathing and blood oxygen saturation of the two groups 4 hours after operation (t value respectively -1.834, -0.071, -0.144, -0.813, -0.818, P>0.05). There were no statistical significances in terms of the wound pain condition 4 hours after operation(Z=-0.572, P>0.05). The seepage quantity of nasal bloody secretions of the experimental group 4 hours after operation was better than that of the control group, and the difference was statistically significant(Z=-2.014, P<0.05). The discomfort of the experimental group's patients 4 hours after operation was obviously reduced compared with the control group, and the difference was statistically significant(Z=-2.270, P<0.05). Conclusions The early improved decubitus of general anesthesia downlink sinus endoscope operation proved no obvious effect on patients' systolic pressure, diastolic blood pressure, heart rate, breathing, blood oxygen saturation and nasal wound pain, but it is helpful for discharging the nasal secretions, reducing overall discomfort of patients, increasing patients' comfort and improving the quality of nursing. Key words: General anesthesia; Nasal endoscopy; Sinus operation; Recumbent position

Heads Up! A Novel Provocative Maneuver to Guide Acute Ischemic Stroke Management

Background: A common dilemma in acute ischemic stroke management is whether to pursue recanalization therapy in patients with large vessel occlusions but minimal neurologic deficits. We describe and report preliminary experience with a provocative maneuver, i.e. 90-degree elevation of the head of bed for 30 min, which stresses collaterals and facilitates decision-making. Methods: A prospective cohort study of <7.5 h of acute anterior circulation territory ischemia patients with minimal deficits despite middle cerebral artery (MCA) or internal carotid artery (ICA) occlusive disease. Results: Five patients met the study entry criteria. Their mean age was 78.4 years (range 65-93). All presented with substantial deficits (median NIHSS score 11, range 5-22), but improved while in supine position during initial imaging to normal or near-normal (NIHSS score 0-2). MRA showed persistent M1 MCA occlusions in 4, critical ICA stenosis or occlusion in 1, and substantial perfusion-diffusion mismatch in all. To evaluate the potential for eventual collateral failure, patients were placed in a head of bed upright posture. Mean arterial pressure and heart rate were unchanged. Two showed no neurologic worsening and were treated with supportive care with excellent final outcome. Three showed worsening, including recurrent hemiparesis and aphasia at the 6th, recurrent aphasia at the 23rd, and recurrent hemineglect at the 15th upright minute. These 3 underwent endovascular recanalization therapies with successful reperfusion and excellent final outcome. Conclusion: The ‘Heads Up' test may be a useful, simple maneuver to assess the risk of collateral failure and guide the decision to pursue recanalization therapy in acute cerebral ischemia patients with minimal deficits despite persisting large cerebral artery occlusion.

False history expressed by victims during medico-legal examinations: experience of a Forensic medicine practitioner in Sri Lanka

During the medico-legal practice sometimes false history is expressed by victims. Such instances can be divided as false statements related to injuries, events of the incident, sex assault, child abuse and intimate partner violence. Detailed history taking, second history taking following physical examination, collection of information from other sources such as from relations, records of bed head ticket, and police are helpful to obtain true history during reexamination. Medico-legal opinion should be mainly based on evidence such as examination findings and investigation results. False history is one possibility that should be considered before expressing the final medicolegal opinion.

Effect of Uncertainty of Tensile Strength of Mortar Joints on the Behavior of Masonry Walls under Lateral Loads

AbstractAnalyzing the behavior of a masonry structure is a complex issue due to the complicated nature of masonry. Moreover, random spatial variation of masonry properties due to workmanship quality makes the prediction of its behavior even harder. This paper studies the effect of random spatial variability of mortar joint properties on the lateral strength of masonry walls under in-plane loads. Tensile strength of mortar joints is considered a random variable whose variation represents different quality of workmanship. Using a 3D nonlinear FE model, the influence of the random spatial variability of bed joint and head joint properties on the performance of unreinforced masonry walls is investigated. Results show the considerable effect of random spatial variability of bed joint properties on the performance of masonry walls under in-plane loads, while similar variation in head joint properties has a negligible effect on the wall response. The influence of correlation in bed joint properties on the wall s...

Head Elevation and Intraocular Pressure in Glaucoma.

To investigate the effect of different methods of head elevation on intraocular pressure (IOP) in patients with open-angle glaucoma (OAG). Seventy-one patients of OAG were included in this prospective observational study. We measured IOP in the sitting position and in the supine positions with head flat and 30-degree up using two different methods: (1) bed head elevation (BHE) and (2) using multiple pillows (MP). We measured IOP using Tonopen AVIA in both eyes 10 minutes after assuming each position in a randomized sequence. By comparing the mean deviation (MD) of visual field between both eyes of a patient, we classified the eyes into either the better-MD eye or worse-MD eye. Compared with that measured in the supine position with head flat, the mean IOP was significantly lower when measured in the supine position with the head 30 degrees up by BHE, with an average drop of 2.0 mmHg (p < 0.001), whereas the mean IOP did not differ significantly when measured in the supine position with head 30 degrees up using MP (p = 0.081). Twenty-five (35.2%) patients showed IOP elevation when the head was kept up by MP. Compared between the better-MD and worse-MD eye, the IOPs did not differ in all positions. The mean IOP of the better-MD eye was lower in the 30-degree head-up (-1.9 mmHg, BHE; -0.8 mmHg, MP) positions compared with that in the flat-lying position, whereas the mean IOP of the worse-MD eye did not differ between the lying flat position and the head-up position with MP. Different head-elevating methods had different influences on IOPs of glaucoma patients in the supine position. Although raising the bed head by 30 degrees significantly lowers IOP compared to the supine position, resting on multiple pillows does not appear to offer the same IOP reduction in glaucoma patients.

Original Research Article: Clinical Profile and Outcome of Patients with Acute Encephalitis Syndrome in a Tertiary Care Hospital, Assam, India.

Background: Acute Encephalitis Syndrome (AES) is a leading cause of mortality and morbidity. Japanese encephalitis (J.E.) is the most prevalent mosquito borne viral encephalitis , occurring in Japan, China, Southeast Asia and India, affecting around 50,000 people and 15,000 deaths annually (4, 5). Acute Encephalitis Syndrome (AES) is a major health problem in the state of Assam. In the state of Assam, several districts of upper Assam , have been experiencing recurrent episodes of AES ( J E and non JE ) with different magnitudes in the post monsoon period leading to many deaths and greater numbers as disabled (7) . Under this backdrop, the present study was undertaken to know the epidemiology, clinical profile and outcome of AES patients. Methods: The present study was carried out in department of Medicine, F.A.A. Medical College and hospital, Barpeta, Assam. F.A.A Medical College hospital is a tertiary care hospital, located in rural Assam. A total number of 60 patients with acute encephalitis syndrome admitted in Medicine ward over a period of 2 years from February 2014 to January 2016, were included in this study. This was a retrospective study. We collected the bed head tickets and all investigation reports (medical files) of all AES patients from medical record department of the hospital. Relevant data of the AES cases were collected. Next, data were analyzed and interpreted accordingly. Results: A total number of 60 AES cases were included in the present study. Out of 60 AES patients, majority 37(61.7%) of them were below 30 years of age. Male were 38 (63.3%) and female cases were 22(36.7%). Most of the cases were seen in rural area 56 (93.3%) suggesting that AES mainly affect rural population of Assam .Peak incidence was seen in monsoon and post monsoon period. The most common presenting clinical manifestations were fever with altered sensorium (100%) followed by headache (93.3%) and vomiting (58.3%). Seizure was seen in 26 (43.3%) cases. The most common outcome of AES cases was full recovery, seen in 38 cases (65.5%). Partial recovery i.e. with neurological sequelae was seen in 11 (18.9%) cases. The mortality rate of AES was 15.5% in this study. Conclusion: Acute viral (Non J E) encephalitis still remains most common cause of AES followed by JE positive encephalitis. Immunization programme with J E vaccine is an important measure for prevention of the diseases. Proper supporative care and timely intervention in intensive care unit will save many lives. Physiotherapy and family support will improve long term outcome of AES cases with neurological sequelae. Case reporting and appropriate workup of all cases would strengthen the AES surveillance and go a long way in bringing down the morbidity and mortality associated with AES.

의료용 베드 헤드 콘솔의 강도조건을 고려한 최적 설계

Medical bed head consoles (BHC) are generally used to increase the efficiency of medical equipment and speed the medical treatment response time. The BHC design has been consistently improved including a movable shelf unit that is embedded to mount stably medical instruments on the lower part of the main console. The cost of a BHC can be reduced through design optimization to limit the overall weight. However, as the size of a head console might decrease due to design optimization, the BHC deflection could be increased. In this study, multi-objective optimal design was adopted to consider this BHC design problem. In order to reduce the cost of optimization planning, an approximate model was applied for the design optimization. In the context of approximate optimization, we used the response surface method and non-dominant sorting genetic algorithm developed from various fields. Multi-objective optimal solutions were also compared with a single objective optimal design.

Prevention of Ventilator-Associated Pneumonia in the Intensive Care Unit: Beyond the Basics.

Ventilated-associated pneumonia (VAP) is a major concern for hospitals and a major problem for ventilated patients in the intensive care unit. Included in the basics are hand hygiene, wearing gloves, endotracheal tube suctioning, head of bed at 30°, stress ulcer prophylaxis, turning patient side to side at least every two hours, and giving the patient a sedation vacation each morning. Beyond the basics included here are oral hygiene, oral suctioning, endotracheal tube cuff pressure, artificial humidification, the difference in practice between registered nurses and respiratory therapists, using the beach chair position and early mobilization, and the VAP bundle. The prevention of VAP becomes the focus for both nurses and respiratory therapists working with patients who are ventilated.

Critical Care Nurses Cannot "Phone It In".

Critical Care Nurses Cannot "Phone It In".