Mean Application Time Research Articles

Nursing students' skills in applying short-stretch compression bandages using the control of compression bandaging score.

To assess the feasibility using the Control of Compression Bandaging (CCB) score to measure skills development on short-stretch compression therapy during a second-year nursing students' workshop. A quasi-experimental pilot study with one group. All students followed a blended learning unit comprising an e-learning unit on leg ulcers and compression therapy including videos, followed by hands-on workshops where they could exercise how to apply short-stretch compression bandages. Clinical nurse specialists in wound care collected pre- and post-workshop measures. Data collection included feasibility, absolute pressure under compression bandages and the CCB score. Six clinical nurse specialists (CNSs) collected data and 16 students participated in this pilot study. The mean application time was 8.02 minutes (min=2, max=20) pre and 9.25 minutes (min=5, max=17) post workshop. Pressure under compression bandages increased at the forefoot (P=0.01) and the calf muscle base (P=0.03) post workshop. One extreme outlier was observed. In addition, the CCB score increased from 3.57 to 4.47 (P=0.16). Using pressure measuring devices was described as essential by all the CNSs and the CCB score was easy to use. Using the CCB score and pressure measuring devices were feasible during an undergraduate education session. Recruitment procedure and modality of data collection were satisfactory. This score may be a valuable way to assess students' skills in short-stretch compression therapy. If used for formal assessment, a passing score should be defined.

Assessing Firefighters' Tourniquet Skill Attainment and Retention: A Controlled Simulation-Based Experiment.

The aim of this study was to train and assess firefighters' skill attainment in the use of tourniquets, and to assess their skill retention after 3 mo. The purpose is to show if firefighters can successfully apply a tourniquet after a short course based on the Norwegian national recommendation for civil prehospital tourniquet use. This is a prospective experimental study. The study population were firefighters, and the inclusion criterion was any on-duty firefighter. The first phase consisted of baseline precourse testing (T1), a 45-min course, followed by immediate retesting (T2). The second phase consisted of retesting of skill retention after 3 mo (T3). A total of 109 participants at T1, 105 at T2, and 62 participants at T3. The firefighters achieved a higher proportion of successful tourniquet applications at T2 (91.4%; 96 of 105) as well as T3 (87.1%; 54 of 62) compared with 50.5% at T1 (55 of 109) (P = 0.009). Mean application time was 59.6 s (55.1-64.2) in T1, 34.9 s (33.3-36.6) in T2 and 37.7 s (33.9-41.4) in T3. A sample of firefighters can successfully apply a tourniquet after a 45-min course based on the 2019 Norwegian recommendation for civil prehospital tourniquet use. Skill retention after 3 mo was satisfactory for both successful application and application time.

A Pediatric Intensive Care Checklist for Interprofessional Rounds: The R-PICniC Study.

The use of checklists in the pediatric intensive care unit can help improve the quality of care and patient safety. To build and validate a checklist for use in interprofessional rounds in a pediatric intensive care unit. This methodological study was conducted in a 20-bed pediatric intensive care unit serving children up to 14 years old. A checklist prototype was constructed through review of the literature and achievement of consensus among the professionals providing care in the unit. Content validation was performed using a modified Delphi technique involving specialists with more than 5 years of experience in pediatric intensive care, methodological studies, and patient safety. Content validity ratios were calculated for the elements of the checklist, which were considered valid when they reached values greater than 0.78. The checklist was tested for usability, application time, and effects on patient care, and feedback was obtained from potential users. Before content validation, the checklist contained 11 domains, 32 items, and 6 daily goals. The invitation to validate content was sent to 86 specialists, and content validity was achieved after 2 rounds of evaluation, with the checklist elements having content validity ratios ranging from 0.94 to 0.97. The mean application time of the checklist was 5 minutes. The final version consisted of 11 domains, 33 items, and 8 daily goals. This study resulted in a useful and valid instrument for application in interprofessional rounds that was tailored to the needs of local health care professionals.

Evaluating the effectiveness of Hybrid arch bar with Erich arch bar during maxillomandibular fixation

Aim: To evaluate the effectiveness of Hybrid arch bar and Erich arch bar during Maxillomandibular Fixation. Materials And Methods: We designed a parallel-group, randomized controlled trial to compare the 2 types of arch bars. A total of 20 patients with mandibular parasymphysis fractures within the age group of 25 - 30 years presenting to our institution were enrolled in the study and randomized into 1 of 2 groups: the hybrid arch bar group and the Erich arch bar group. The primary outcome variable was arch bar placement time. The secondary outcomes were glove tears during application and removal , patient comfort and the removal time of the device. The groups were compared using t tests. Results: A total of 20 patients participated in the study, out of which 10 were females and 10 were males.In group A the mean application time noted was 7 minutes . In group B the mean application time noted was 30 minutes (P < .0001). Significantly more glove tears or penetrations occurred during application in the Erichs arch bar when compared to the Erichs arch bar.

Optimal catheter-tissue contact value for ablation of ventricular arrythmias originating from the left ventricular papillary muscles

Abstract Funding Acknowledgements Type of funding sources: None. Background Good catheter-tissue contact is mandatory to create effective ablation lesions. The minimal contact force (CF) value for successful ablation of arrhythmias originating from the left ventricle (LV) was reported at the 8-10 g level, however, optimal CF values for ablation of arrhythmias arising from papillary muscles (PM) are not known. Purpose To determine optimal CF value for ablation of arrhythmias from LV PM. Methods Twenty-four consecutive patients (mean age 57,9 ± 11,9 years, 16 males) who from May 2017 to June 2020 underwent ablation of premature ventricular complexes (PVC) originating from LV PM were included. The primary endpoints were an acute procedural success (total elimination of PVC) and long-term success (median 27 months). Ablation was performed with the use of the CARTO electro-anatomical system and intracardiac echocardiography (ICE). Results Acute success – complete abolition of PVC, was obtained in 23 (96%) patients. The fluoroscopy time was 3,9 ± 3,5 min and the procedure duration was 114,8 ± 38 min. The mean number of applications was 8,74 ± 6,78 and the mean application time - 518,5 ± 437,25 sec. The mean CF during successful ablations was 3,1 ± 1,5 g, with 3 ± 1,1 g and 3,18 ± 1,8 g for anterolateral and posteromedial PM, respectively (p= 0,809975). The mean CF during one unsuccessful ablation was 3 g. At control Holter ECG, the mean PVC burden in all patients was reduced from 28,36 ± 14,48 % to 2,42 ± 2 %: in the anterolateral PM group from 18 ± 8 % to 2,6 ± 2 % (p= 0,005415) and in the posteromedial PM group - from 34,8 ± 13,7 % to 1,7 ± 1,3 % (p= 0,012694). During long-term follow-up (median 27, IQR 17-34) there was one recurrence among 23 patients who had acutely successful procedures. Conclusion The values of CF for successful ablation of PVC originating from LV PM are lower than those for ablation in other parts of LV. The values slightly exceeding 3 g seem to be sufficient to achieve ablation success.

ITClamp-Mediated Wound Closure Speeds Control of Arterial Hemorrhage With or Without Additional Hemostatic Agents.

Exsanguination is the leading cause of preventable posttraumatic death, especially in the prehospital arena. Traditional hemorrhage control methods involve packing the wound with hemostatic agents, providing manual pressure, and then applying a pressure dressing to stabilize the treatment. This is a lengthy process that frequently destabilizes upon patient transport. Conversely, the iTClamp, a compact wound closure device, is designed to rapidly seal wound edges mechanically, expediting clot formation at the site of injury. To determine the efficacy of the iTClamp with and without wound packing in the control of a lethal junction hemorrhage. Given the limited available information regarding the efficacy of the iTClamp in conjunction with traditional hemostatic agents, this study used a swine model of severe junctional hemorrhage. The goal was to compare a multiagent strategy using the iTClamp in conjunction with XSTAT to the traditional method of Combat Gauze packing with pressure dressing application. Readouts include application time, blood loss, and rebleed occurrence. Mean application times of the iTClamp treatment alone or in conjunction with other hemostatic agents were at least 75% faster than the application time of Combat Gauze with pressure dressing. Percent blood loss was not significantly different between groups but trended the highest for Combat Gauze treated swine, followed by iTClamp plus XSTAT, iTClamp alone and finally iTClamp plus Combat Gauze. The results from this study demonstrate that the iTClamp can be effectively utilized in conjunction with hemostatic packing to control junctional hemorrhages.

Camera Housing for Intraoperative Photography

Background: Intraoperative photography features key aspects of surgical procedures. However, out-field personnel are usually requested to take photos with a surgeon-owned camera, without acknowledgement of correct surgeon-needed perspectives. The present study presented a waterproof camera housing case that could be sterilized and host a camera in surgical field. Surgeons take better photos themselves with shorter time spent. Objective: To capture good intraoperative photos with a camera housed in a sterile case without any complications. Materials and Methods: Fifty photos from twenty patients were taken. Two photos were taken per one visual aspect, one in-field photo from the surgeon who owned the camera, applied in the sterile camera housing case (Group 1), another photo from out-field personnel (Group 2). Both photos were shot with the same camera (Nikon P310) and the same settings with a fixed point of focus. Photo quality, time consumed for each photo taken and the out-field personnel’s satisfaction rate for intraoperative photography were compared. The time consumed for application of the camera into the case was also recorded. Results: The mean application time until the camera was completely sealed was 36.30+5.25 seconds. Photo quality rate, from two blinded raters, was significantly higher in Group 1 (p-value=0.00). Less time consumed for each photo taken was found in Group 1 (p-value=0.00). Out-field personnel’s satisfaction rates were higher when the surgeon took intraoperative photos himself in Group 1 (p-value=0.00). There was no surgical site infectious complication in all patients in the present study. Conclusion: A sterile camera housing case, adapted from a waterproof case for underwater photography, could be used for intraoperative photography. Then, good intraoperative photos with less time consumed were achieved without any surgical site infections. Keywords: Camera housing; Intraoperative photography

Clinical effectiveness of resin-modified glass ionomer-based fluoride varnish for preventing occlusal caries lesions in partially erupted permanent molars: A randomised active-controlled trial.

Deep pits and fissures in partially erupted permanent molars are vulnerable to dental caries. To assess the clinical effectiveness of resin-modified glass ionomer-based fluoride varnish (RMGI-F varnish: Clinpro XT™ varnish) in preventing occlusal caries lesions in partially erupted permanent first molars. In this randomised active-controlled superiority trial with a single-blind parallel design, 74 children with 182 partially erupted first permanent molars were allocated into two groups: Group 1: RMGI-F varnish; and Group 2: GI sealant (active control), with an application of 0.1% sodium fluoride varnish for all other teeth. The primary outcome was ICDAS score ≥1 at 12months of follow-up. Data were analysed using adjusted Chi-square test and GEE regression for binary outcomes. Group 1 (15.7%) and Group 2 (13.8%) did not differ significantly in ICDAS ≥1 scores at 12months of follow-up (adjusted χ2 =0.373, p=.541). There was no significant difference in retention between Group 1 (48.3%) and Group 2 (20.7%) at 12months of follow-up (adjusted χ2 =0.1, p=.752). Mean application time per tooth (16±5.9 vs 20.2±5.4min) was significantly different (t=5.26, p=.014). RMGI-F varnish was not superior to GI sealant in preventing occlusal caries lesions in partially erupted molars.

Assessment of Intra-Operative Difficulties and Early Post-Operative Complications in Laparoscopic Inguinal Hernia Repair using Conventional Polypropylene Mesh Versus 3D Mesh

Abstract Background The fundamental mechanism of abdominal wall hernia formation is the loss of structural integrity at the musculotendinous layer. The exact cause of inguinal hernia is still unknown but the factors contributing in its occurrence include; preformed congenital sac, chronic passive rise in the intra-abdominal pressure and weak abdominal wall. Aim of the Work To assess intra-operative difficulties of laparoscopic inguinal hernia repair using two different meshes: The conventional polyproline mesh and the three-dimensional (3D) mesh, as regard the operative time. And early post-operative complications including post-operative seroma, early postoperative pain, chronic pain and limitation of function. Patients and Methods In our study 30 patients were recruited according to our preset inclusion and exclusion criteria. They were divided randomly into two groups, a group in which the 3D mesh was used and a group in which the polypropylene mesh was used. The study was conducted in Ain Shams University hospitals for 6 months, in which patients where followed up from 3 to 6 months and compared in terms of intraoperative time, post-operative pain after one week, restriction of physical activity, seroma formation and presence of chronic pain. Results In our study the mean application time (minutes) in 3D group was found to be 7.07 ± 2.66 while in PP group it was found to be 12.53±3.66 with highly statistically significant difference between them at p < 0.001. We believe that this difference in fixation time in our present study is attributed to easy insertion through the port, easy intraoperative handling, and easy unfolding of 3D mesh. Conclusion The use of three-dimensional mesh (3D mesh) for laparoscopic inguinal hernia repair is a safe and viable option. It offers many advantages in terms of less fixation time, shorter hospital stays, early recovery with a better movement limitation score. Whereas chronic pain was found to be similar in both groups. Further, elimination of tacks for fixation and shorter hospital stay may reduce the cost of 3D mesh. Longer-term studies are recommended with a larger sample size and follow up duration for better assessment of chronic pain, also for following up on recurrence.

Power chains as an alternative to steel-wire ligatures in temporary maxillomandibular fixation: a pilot study

The aim of this study was to compare two techniques for temporary intraoperative maxillomandibular fixation (TIO-MMF) during orthognathic surgery: steel-wire ligatures versus power chains. Patients undergoing orthognathic surgery between October 2019 and March 2020 were included in a prospective cross-sectional study conducted in three participating hospitals. Data were collected using a standardized measurement form. A total of 44 patients were included, in whom TIO-MMF was applied 79 times. A statistically significant difference in intraoperative loss of stability of the segment relationship was found between steel-wire ligatures (11.4%) and power chains (0%). The mean application time of TIO-MMF differed significantly between steel-wire ligatures (99 seconds) and power chains (157 seconds) (P < 0.001). There was no statistical difference in occurrence of adverse events between the two techniques. This study found that the application of TIO-MMF with power chains is more stable compared to steel-wire ligatures. Steel-wire ligatures were significantly faster to apply, although the absolute difference (less than 1 minute) was small. Other possible advantages of the proposed technique are discussed. The results of this study suggest that power chains for the application of TIO-MMF in orthognathic surgery are a valuable alternative to steel-wire ligatures.

ASSESSMENT OF PAVLIK HARNESS EFFECTIVENESS IN 3-6 MONTHS OLD PATIENTS WITH UNSTABLE HIPS

Objective: To investigate the effectiveness of the Pavlik harness (PH) in the treatment of patients who were diagnosed with unstable hips aged between three and six months. Material and Method: We retrospectively reviewed patients aged three to six months who were diagnosed with unstable hips and treated with the PH. The patients were treated using PH and were closely followed by a weekly clinical examination. The primary outcome was to assess the success rate of PH treatment in children with unstable hips (Graf Type IID, III, IV). A successful outcome as a result of PH treatment was defined as either obtaining a Type I hip based on Graf’s method of hip ultrasonography or a concentric reduction based on hip radiography. Results: Thirty-three patients’ 34 hips were included in this study with a diagnosis of DDH based on hip sonography performed according to the Graf’s method at the time of initial admission to our department. The mean age of the children in the beginning of the PH treatment was 17 weeks (range, 14–22); the mean follow-up was 48 months (range, 24–84). On admission, the mean alpha angle was 46 (range, 35–58). According to the Graf classification, DDH was determined as Type D in 18 hips (52%), Type IIIa in 5 hips, Type IIIB in 3 (24%) and Type IV in 8 (24%). Of these 34 hips, 28 (82%) were treated successfully using PH, with a mean application time of 11.24 weeks (range, 4–20). The success rate of PH treatment was determined as 82% (28/34 hips). Conclusions: Favorable outcomes can be expected from PH treatment in patients with unstable hips (Graf Type IID, III, IV) who are diagnosed between the age of three and six months.

Combat Application Tourniquet fares well in a chemical, biological, radiological or nuclear dress state

IntroductionThere is a need for a military tourniquet to control catastrophic haemorrhage in a chemical, biological, radiological or nuclear (CBRN) threat environment. No published data exist as to the efficacy...

The Use of Screw Retained Hybrid Arch Bar for Maxillomandibular Fixation in the Treatment of Mandibular Fractures: A Comparative Study.

Introduction:The use of screw-retained hybrid arch bars (HABs) is a relatively recent development in the treatment of mandibular fractures. The purpose of this study is to compare the clinical outcome between HAB and the conventional Erich arch bar (EAB) in the closed treatment of mandibular fractures.Materials and Methods:This study included 18 patients who were treated for mandibular fractures with maxillomandibular fixation (MMF), patients were randomly assigned into a control group (n = 10) in which EAB was used and study group (n = 8) in which HAB was used. The outcome variables were time required for application and removal, gingival inflammation scores, postoperative complications, and incidence of wire-stick injury or gloves perforation. The groups were compared using unpaired t-test, Mann–Whitney test, Chi-square test, or Fisher test. The differences were considered significant at P < 0.05.Results:The mean application time was significantly more in EAB than HAB (61.6 ± 11.4 vs. 41.6 ± 6 min, respectively). The mean time of removal for EAB was significantly less than HAB (11.1 ± 2 vs. 14.2 ± 3 min, respectively). There was nonsignificant difference in gingival inflammation between the groups. No major complications were recorded. Screw loosening and mucosal overgrowth were recorded in 12.5% and 31.2% of the screws, respectively, in HAB group. The incidence of gloves tear in EAB group was 70%.Discussion:HAB can be used as an alternative to EAB for MMF in patients with mandibular fracture, it requires less time for application and provides more safety for the surgeons.

Long-term feasibility of the new sutureless excimer laser-assisted non-occlusive anastomosis clip in a pig model

BackgroundHigh flow bypass surgery can be a last resort procedure for patients suffering from complex neurovascular pathology. Temporary occlusion of a recipient artery in these patients could result in debilitating neurological deficits. We developed a sutureless, mechanical anastomotic connection device, the SELANA clip (Sutureless Excimer Laser-Assisted Non-occlusive Anastomosis clip: SEcl). In the present study, we aim to determine the long-term non-inferiority of the SEcl technique compared with historical data of the conventional ELANA anastomosis technique.MethodsA total of 18 SEcl bypasses were created on the carotid artery in a porcine model in 6 different survival groups. Mean application times, flap retrieval rates, hemostasis, patency, flow, endothelialization, and remodeling were assessed.ResultsThe mean application time of the SEcl anastomoses was 15.2 ± 9.6 min, which was faster compared with the conventional ELANA anastomoses. The flap retrieval rate of the SEcl anastomoses was 86% (32/37). Direct hemostasis was achieved in 89% (33/37) SEcl anastomoses. Patency in all surviving animals was 94% (17/18). Bypass flow after six months was 156.5 ± 24.7 mL/min. Full endothelialization of the SEcl pins was observed after 3 weeks.ConclusionThe SEcl technique is not inferior to the ELANA technique regarding patency, flap retrieval rate, flow, and endothelialization. On the basis of a significantly shorter application time and superior hemostasis, the SEcl technique could be preferable over the ELANA technique. A pilot study in patients is a logical next step based on our current results.

A randomized prospective comparison of maxillomandibular fixation (MMF) techniques: “SMARTLock” hybrid MMF versus MMF screws

The aim of this study was to assess the efficacy of the "SMARTLock" hybrid system and determine whether it results in fewer intraoperative and postoperative complications compared with placement of intermaxillary fixation (IMF) screws in trauma patients. This prospective study, which was approved by the institutional review board, compared the results of MMF in mandibular fractures by using the Stryker "SMARTLock" hybrid system versus traditional IMF screws. Patients were recruited and assigned randomly to either group. The 2 groups were compared for placement time, intraoperative complications, loosening of hardware, postoperative complications, and time to device removal. We enrolled 32 patients in the study, with 13 patients randomized to the group receiving hybrid MMF (HMMF) with the SMARTLock system and 19 to the group of patients receiving MMF with traditional IMF screws. The mean application time for HMMF was 25.92 minutes compared with 18.28 minutes for IMF screws. After removal, the HMMF was associated with gingival overgrowth and gingival edema. This is the first study to compare HMMF with MMF with the use of IMF screws. Hybrid arch bars do require more manipulation for ideal placement compared with individually placed bone screws to achieve ideal MMF. Compared with IMF screws, the hybrid device was associated with gingival edema and overgrowth, but there was decreased incidence of loosening in the postoperative period.

The Efficacy of Novel Commercial Tourniquet Designs for Extremity Hemorrhage Control: Implications for Spontaneous Responder Every Day Carry.

Tourniquets (TQs) save lives. Although military-approved TQs appear more effective than improvised TQs in controlling exsanguinating extremity hemorrhage, their bulk may preclude every day carry (EDC) by civilian lay-providers, limiting availability during emergencies. The purpose of the current study was to compare the efficacy of three novel commercial TQ designs to a military-approved TQ. Nine Emergency Medicine residents evaluated four different TQ designs: Gen 7 Combat Application Tourniquet (CAT7; control), Stretch Wrap and Tuck Tourniquet (SWAT-T), Gen 2 Rapid Application Tourniquet System (RATS), and Tourni-Key (TK). Popliteal artery flow cessation was determined using a ZONARE ZS3 ultrasound. Steady state maximal generated force was measured for 30 seconds with a thin-film force sensor. Success rates for distal arterial flow cessation were 89% CAT7; 67% SWAT-T; 89% RATS; and 78% TK (H 0.89; P = .83). Mean (SD) application times were 10.4 (SD = 1.7) seconds CAT7; 23.1 (SD = 9.0) seconds SWAT-T; 11.1 (SD = 3.8) seconds RATS; and 20.0 (SD = 7.1) seconds TK (F 9.71; P <.001). Steady state maximal forces were 29.9 (SD = 1.2) N CAT7; 23.4 (SD = 0.8) N SWAT-T; 33.0 (SD = 1.3) N RATS; and 41.9 (SD = 1.3) N TK. All novel TQ systems were non-inferior to the military-approved CAT7. Mean application times were less than 30 seconds for all four designs. The size of these novel TQs may make them more conducive to lay-provider EDC, thereby increasing community resiliency and improving the response to high-threat events.

A randomized split mouth study for comparison of clinical success rate of GIOMER based sealant and conventional fluoride releasing pit and fissure sealant in first permanent molars

Objective: To compare and assess the application time, retention, marginal staining, development of carious lesion and plaque accumulation of GIOMER based pit and fissure sealants with conventional fluoride releasing pit and fissure sealant in first permanent molars. Study Design: Fifty children in the age range of 6-9 years, following acceptable home dental care, had participated in the study. A randomized split-mouth design was used in which two fissure sealants (Helioseal F and Beautisealant) were randomly placed in 50 harmonizing contralateral duo of permanent first molars. Sealants were gauged by a single skilled and calibrated examiner using mouth mirrors and probes following the USPHS criteria at 3-, 6- and 12-months follow up. Results: Mean application time for Beautisealant was significantly less i.e. 155.39 seconds than that of Helioseal F i.e. 260.91 seconds. The retention rates at 3, 6 and 12 months for Helioseal F was 80.4%, 76.1% and 60.9% and for Beautisealant was 71.7%, 65.2% and 47.8% respectively. Conclusion: Application time of Beautisealant was significantly less than Helioseal F, but Helioseal F demonstrates better retention rate, while both material displayed similarresults for marginal staining, development of carious lesion and plaque accumulation. Keywords: Pit and fissure sealants, Retention, Giomer.

Technical Development of the Sutureless ELANA Clip Anastomosis Device

Abstract A cranial bypass can be a last resort procedure for patients suffering from complex neurovascular pathology. Since the clinically proven excimer laser-assisted nonocclusive anastomosis (ELANA) technique has become available, it is no longer necessary to temporarily close the recipient artery to facilitate an anastomosis. Aiming to simplify and shorten the operation time of the ELANA technique, a sutureless ELANA, the so-called SELANA slide (SEsl) was developed, but it failed during clinical study. We developed an improved device, the SELANA clip (SEcl).We describe the SEcl design and the first in vitro test results. The SEsl design was optimized with a clip at the backside, creating the SEcl which facilitates smooth and friction-free insertion in the recipient artery. Subsequently, the laser catheter was optimized by adding a grid and conus to provide an improved vacuum and flat reaction surface during lasing. We aimed to compare the SEcl to the current ELANA regarding application time difference, anastomosis success (“flap retrieval”) and technical difficulties. Hereto 32 ELANA and 32 SEcl anastomoses were performed on pressurized rabbit arteries in the ELANA practice system. Mean application time difference was 14.0 min (95%CI 13.0–15.0). The flap retrieval rate of the ELANA anastomoses was 94% (30/32) and 100% (32/32) for the SEcl technique. During the experiments no technical difficulties were encountered. The SEcl is technical feasible with promising simplicity and application times. However, extensive in vivo short-term and long-term experiments are indispensable before clinical application.

Feasibility of the new sutureless excimer laser-assisted non-occlusive anastomosis clip in a rabbit model

The excimer laser-assisted non-occlusive anastomosis (ELANA) technique facilitates the construction of anastomoses without temporary occlusion of the recipient artery. Experiments aimed at simplifying the technique eventually resulted in a sutureless ELANA slide (SEsl) anastomosis. After the first clinical use, new insights lead to the application of a clip at the back of the device, the SELANA clip (SEcl). The SEcl offers a distinct advantage over the SEsl since no sealant is necessary. In this study, we determine the feasibility of the SEcl anastomosis in an in vivo rabbit model. 15 SEcl anastomoses and 15 conventional ELANA anastomoses were created on the abdominal aorta in 5 rabbits. Mean application times, flap retrieval rates, hemostasis, and burst pressures were assessed. The mean application time of the SEcl anastomoses was 11.4 min versus 39.0 min for the ELANA anastomoses (mean difference, 27.6 min; 95% CI, 20.6-34.7). The flap retrieval rate of the SEcl anastomoses (14/15) was not inferior to the flap retrieval rate of the ELANA anastomoses (13/15). Direct hemostasis was achieved in 13/15 (87%) SEcl anastomoses and in 14/15 (94%) ELANA anastomoses. All SEcl anastomoses were resistant to provoked pressures until 250 mmHg. The SEcl anastomosis is technically feasible in in vivo experiments. Mean application time, flap retrieval rate, hemostasis, and burst pressure are not inferior to the conventional ELANA anastomosis. Further long term experiments should be performed to assess safety, patency, and reendothelialization.

Efficacy of Novel Commercial Tourniquet Systems in Extremity Hemorrhage Control - An Ultrasound and Generated Force Study

Introduction:Tourniquets (TQ) save lives. Although military-approved TQ are more effective than improvised TQ in controlling exsanguinating extremity hemorrhage, their bulk may preclude every day carry (EDC) by civilian lay-providers.Aim:The purpose of the current study was to compare the efficacy of 3 novel commercial TQ to a military-approved TQ.Methods:A convenience sample of EM residents was utilized. Four different TQ were evaluated: Gen 7 Combat Application Tourniquet (CAT; control), Stretch Wrap and Tuck Tourniquet (SWAT-T), Gen 2 Rapid Application Tourniquet System (RATS), and Tourni-Key (TK). Popliteal artery occlusion was determined using a ZONARE ZS3 ultrasound. Steady-state maximal generated force was measured for 30 seconds with a thin-film force sensor (Singletract). Opinions were solicited at the conclusion of the study.Results:Nine residents participated in the study (7 male, 2 female). Success rates for complete arterial occlusion were 89% CAT, 67% SWAT-T, 89% RATS, and 78% TK (H 0.89, p = 0.83). Mean (± SD) times to achieve occlusion were 10.4 ± 1.7 sec CAT, 23.1 ± 9.0 sec SWAT-T, 11.1 ± 3.8 sec RATS, and 20.0 ± 7.1 sec TK (F 9.71, p &lt; 0.001). Steady-state maximal forces were 29.9 ± 1.2 N CAT, 23.4 ± 0.8 N SWAT-T, 33.0 ± 1.3 N RATS, and 41.9 ± 1.3 N TK. Participants felt that the CAT was easiest to apply (61%), followed by the RATS (33%). Participants were most likely to select the TK (44%) for EDC, followed by the RATS (33%).Discussion:In this small convenience sampling, all novel TQ systems were non-inferior to the military-approved CAT TQ. Mean application times were less than 30 seconds. The size and unique nature of these novel TQs may make them more conducive to lay-provider EDC, thereby improving the response to high threat events.