Patient Bed Research Articles

Bacterial contamination of neglected hospital surfaces and equipment in an Algerian hospital: an important source of potential infection

ABSTRACT Hospital surfaces are heavily contaminated with bacteria, which are a potential source of nosocomial infections. This study was undertaken to identify bacterial communities isolated from neglected hospital surfaces after cleaning routine in a Algerian public hospital. Screening of bacterial contamination in patient bed (PB), reception land-line phones (TF), door handles (DH) and medical equipment (ME) during five months generated 108 inocula. Isolates obtained were identified based on biochemical characteristics and confirmed by analysis of 16S rRNA sequences. Statistical analysis was performed to reveal possible relationship between bacterial diversity and swabbed surfaces. Our findings showed a high prevalence of bacteria in various hospital surfaces, reaching (65.25%), where a highest contaminated surface was the PB (47.22%) and a lowest contaminated was TF (5.55%). Gram negative bacteria were the dominant group (62.03%) mainly represented by Entrobacteriaceae (42.59%), whereas Staphylococcus aureus belonging to Gram positive was the main expanded pathogen with (15.74%).

A Deep-Learning-Based Smart Healthcare System for Patient’s Discomfort Detection at the Edge of Internet of Things

The Internet of Things (IoT) widely supports the smart healthcare field; combined with computer vision, machine, and deep learning techniques; it provides fast and accurate services for automated patient discomfort monitoring/detection systems. Traditional patient monitoring systems are commonly composed of wearable sensors and vision-based methods. In this article, an IoT-based noninvasive automated patient's discomfort monitoring/detection system is presented and implemented, using a deep-learning-based algorithm. The system is based on an IP camera device; the patient's body's movement and posture are detected without using any wearable devices. The Mask-RCNN method is employed for the extraction of different key points on the patient body. These detected key points are then transformed into six major body organs using association rules of data mining. Furthermore, for analyzing the patient's discomfort, detected key point coordinates information is measured. Finally, the distance and the temporal threshold are applied to classify movements as either associated with normal or discomfort conditions. These key points information is also used to determine the postures of the patient lying on the bed. The patient's body position and posture are continuously monitored, based on which comfort and discomfort level are discriminated. For experimental evaluation, different video sequences are recorded covering two patient's beds. The experimental results show the proposed system's worth by achieving a true-positive rate of 94% and a false-positive rate of 7%.

A prospective multicentre surveillance study to investigate the risk associated with contaminated sinks in the intensive care unit

ObjectivesThe aim was to assess the incidence of sink contamination by multidrug-resistant (MDR) Pseudomonas aeruginosa and Enterobacteriaceae, risk factors for sink contamination and splashing, and their association with clinical infections in the intensive care setting. MethodsA prospective French multicentre study (1 January to 30 May 2020) including in each intensive care unit (ICU) a point-prevalence study of sink contamination, a questionnaire of risk factors for sink contamination (sink use, disinfection procedure) and splashing (visible plashes, distance and barrier between sink and bed), and a 3-month prospective infection survey. ResultsSeventy-three ICUs participated in the study. In total, 50.9% (606/1191) of the sinks were contaminated by MDR bacteria: 41.0% (110/268) of the sinks used only for handwashing, 55.3% (510/923) of those used for waste disposal, 23.0% (62/269) of sinks daily bleached, 59.1% (126/213) of those daily exposed to quaternary ammonium compounds (QACs) and 62.0% (285/460) of those untreated; 459 sinks (38.5%) showed visible splashes and 30.5% (363/1191) were close to the bed (<2 m) with no barrier around the sink. MDR-associated bloodstream infection incidence rates ≥0.70/1000 patient days were associated with ICUs meeting three or four of these conditions, i.e. a sink contamination rate ≥51%, prevalence of sinks with visible splashes ≥14%, prevalence of sinks close to the patient's bed ≥21% and no daily bleach disinfection (6/30 (20.0%) of the ICUs with none, one or two factors vs. 14/28 (50.0%) of the ICUs with three or four factors; p 0.016). DiscussionOur data showed frequent and multifactorial infectious risks associated with contaminated sinks in ICUs.

Progress in cardiac imaging: from echocardiography to multimodality imaging

In the last few decades, echocardiography has represented one of the technological fields with the fastest evolution and progress. As a non-invasive method at relative low cost, it is also suitable for the future to an increasingly integrated use in any situation of clinical approach to the patient's bed, from emergency situations, to interventional environments, surgical rooms, clinical routine, outpatient clinics, diagnostics, prognosis and monitoring of therapies. Miniaturization of the equipment will allow an increasingly profound and complementary integration with the clinical physical examination (clinical echocardiography), and not only by cardiologists, but also by the multiplicity of medical and surgical clinical specialties. This involves great challenges in terms of training (both at university and post-graduate) and organization, aimed at appropriately integrating ultrasound diagnostic methods and multimodality imaging in the different sub-specialties' diagnostic and therapeutic paths. Further advances in miniaturized and handheld technologies are also needed, looking for a reliability at least comparable to that of the most top quality standard equipment. Artificial intelligence could help to improve this multidisciplinary approach to multimodality imaging in cardiology.

Knowledge Management-Based Nursing Care Educational Training: A Key Strategy to Improve Healthcare Associated Infection Prevention Behavior.

IntroductionKnowledge management-based nursing care has a positive effect in preventing healthcare associated infections (HAIs). Therefore, nursing professionals can utilize key strategies of knowledge management to support clinical decision making, reorganize nursing actions, and maximize patient outcomes.ObjectivesThe aim of this study was to determine the effect of knowledge management-based nursing care educational training on HAI prevention behavior at the High Care Unit (HCU) of Saiful Anwar Hospital Malang.MethodsA quasiexperimental design with a pretest, educational training intervention, and posttest were conducted on 15 nurses in the HCU of Saiful Anwar Hospital Malang, which lasted for 16 days. Furthermore, observation of nursing care documentation, nurses’ handwashing compliance, and presence of infection-causing bacteria in the HCU staff and environment (hands rub handle, medical record, and patient's bed) was carried out pre (day 1–7) and post training (day 10–16). Subsequently, educational training related to knowledge management-based nursing care was conducted for 2 days (day 8–9) by the Doktor Mengabdi Team of Universitas Brawijaya.ResultsThe knowledge level and completeness of the nursing care documentation in the HCU room significantly increased after the training (p < .05). Also, compliance to the six steps five moments of nurses’ handwashing increased after the training (p > .05). Infection-causing bacteria were found in the HCU environment and staff before and after the training involving Pseudomonas stutzeri, Sphingomonas paucimobilis, Enterobacter cloacae, Staphylococcus aureus, Acinetobacter baumannii, Pasteurella pneumotropica, and Acinetobacter lwoffii. Therefore, increased knowledge of HCU nurses and complete documentation (r = .890; p = .054), increased knowledge of HCU nurses and handwashing compliance (r = .770; p = .086), and handwashing compliance and bacterial presence (r = .816; p = .084) all had a positive correlation.ConclusionKnowledge management-based nursing care educational training increased infection prevention behavior in the HCU of Saiful Anwar Hospital Malang.

Survey on the Quality of Care Standards in a Nursing/Midwifery Training Hospital at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, 2019.

ObjectiveThe aim of this article was to conduct a survey on the quality of care standards in nursing/midwifery training hospital of Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia.MethodsA multiple methods design was used for the study. For the quantitative phase, 35 nurses, 35 patients, and 52 patient charts were selected by simple random sampling from eight randomly selected wards of the hospital. For the qualitative phase, purposive sampling was employed to select participants for focus group discussion and in-depth interview. Twelve instructors and 11 head nurses were recruited. The Quality Audit tool developed by Ethiopian Federal Ministry of Health was applied.ResultsIt was found that the nursing and midwifery service quality standards were low and did not meet Ministry of Health standards. The chart review showed that 83% of nursing and midwifery assessments were not completed within eight hours of patient arrival, and in over half the charts (58%), there was no written evidence of compilation of data based on Gordon's functional model. Only two wards met Standard 1 with adequate medical equipment for nursing diagnosis or intervention. Seventy-five percent of the wards had a scarcity of materials and supplies needed to provide a quality nursing service. Half the nursing stations had adequate patient visibility, and half had an organized chart filing system based on the patient’s bed number.ConclusionA high proportion of wards were not meeting Ministry of Health standards for nursing midwifery services. Improvement in care standards is vital to enable the hospital to function as a clinical setting for the education of health-care students. This might be achieved through ongoing attention to quality improvement and a program of in-service training regarding national care quality standards for managers, nurses, and midwives.

Patterns of behaviour in nursing staff actioning the afferent limb of the rapid response system (RRS): A focused ethnography.

To improve understanding of afferent limb behaviour in acute hospital ward settings, to define and specify who needs to do what differently and to report what afferent limb behaviours should be targeted in a subsequent multi-phase, theory-based, intervention development process. Focused ethnography was used including direct observation of nursing staff enacting afferent limb behaviours and review of vital signs charts. An observation guide focused observation on "key moments" of the afferent limb. Descriptions of observations from between 7 January 2019-18 December 2019 were recorded in a field journal alongside reflexive notes. Vital signs and early warning scores from charts were reviewed and recorded. Field notes were analysed using structured content analysis. Observed behaviour was compared with expected (policy-specified) behaviour. Observation was conducted for 300hr. Four hundred and ninety-nine items of data (e.g., an episode of observation or a set of vital signs) were collected. Two hundred and eighty-nine (58%) items of data were associated with expected (i.e. policy-specified) afferent limb behaviour; 210 (42%) items of data were associated with unexpected afferent limb behaviour (i.e. alternative behaviour or no behaviour). Ten specific behaviours were identified where the behaviour observed deviated (negatively) from policy or where no action was taken when it should have been. One further behaviour was seen to expedite the assessment of a deteriorating patient by an appropriate responder and was therefore considered a positive deviance. Afferent limb failure has been described as a problem of inconsistent staff behaviour. Eleven potential target behaviours for change are reported and specified using a published framework. Clear specification of target behaviour will allow further enquiry into the determinants of these behaviours and the development of a theory-based intervention that is more likely to result in behaviour change and can be tested empirically in future research.

Ultrasounds could be considered as a future tool for probing growing bone properties

Juvenile bone growth is well described (physiological and anatomical) but there are still lacks of knowledge on intrinsic material properties. Our group has already published, on different samples, several studies on the assessment of intrinsic material properties of juvenile bone compared to material properties of adult bone. The purpose of this study was finally to combine different experimental modalities available (ultrasonic measurement, micro-Computed Tomography analysis, mechanical compression tests and biochemical measurements) applied on small cubic bone samples in order to gain insight into the multiparametric evaluation of bone quality. Differences were found between juvenile and adult groups in term of architectural parameters (Porosity Separation), Tissue Mineral Density (TMD), diagonal stiffness coefficients (C33, C44, C55, C66) and ratio between immature and mature cross-links (CX). Diagonal stiffness coefficients are more representative of the microstructural and biochemical parameters of child bone than of adult bone. We also found that compression modulus E was highly correlated with several microstructure parameters and CX in children group while it was not at all correlated in the adult group. Similar results were found for the CX which was linked to several microstructure parameters (TMD and E) only in the juvenile group. To our knowledge, this is the first time that, on a same sample, ultrasonic measurements have been combined with the assessment of mechanical and biochemical properties. It appears that ultrasonic measurements can provide relevant indicators of child bone quality (microstructural and biochemical parameters) which is promising for clinical application since, B-mode ultrasound is the preferred first-line modality over other more constraining imaging modalities (radiation, parent–child accessibility and access to the patient's bed) for pediatric patients.

Integration of voltammetric analysis, protein electrophoresis and pH measurement for diagnosis of pleural effusions: a non-conventional diagnostic approach

Pleural effusion is very common, but an etiologic diagnosis is often difficult. We used three unconventional diagnostic techniques (voltammetric analysis, protein electrophoresis and pH measurement) performed on pleural effusion to do a preliminary distinction between a neoplastic and a non-neoplastic origin. Pleural fluid samples were collected through thoracentesis, thoracoscopy, or post-surgery pleural drainage of 116 patients admitted to acute care wards. Samples were analyzed with the three unconventional techniques: voltammetric analysis using the BIONOTE system, capillary electrophoresis and pH measurement using a potentiometric method. The BIONOTE system is an innovative system that performs a cyclic voltammetric analysis of a biological liquid sample. The final output of the electrochemical analysis is an electrical pattern that represents a fingerprint of the analyzed sample and each sample has a different fingerprint. Data from the three unconventional diagnostic techniques were analyzed using partial least squares discriminant analysis to discriminate neoplastic from non-neoplastic effusions; we also evaluated sensitivity, specificity and percentage of correct classification. The mean age was 68 years (SD: 12); 78 (67.24%) participants were men. Results obtained from all the unconventional techniques employed showed that neoplastic and non-neoplastic pleural effusions were correctly classified in 80.2% of cases, with a sensitivity of 77% and specificity of 83%. The combined use of voltammetric analysis, protein electrophoresis and pH measurement of pleural fluid can easily and quickly distinguish a neoplastic from a non-neoplastic pleural effusion with reliable accuracy and represents an innovative diagnostic approach. In fact, this protocol can be executed in just few minutes directly in the patient's bed and it holds great promise to improve the prognosis and therapeutic chances.

Performance analysis of portable HEPA filters and temporary plastic anterooms on the spread of surrogate coronavirus

The outbreak of COVID-19, and its current resurgence in the United States has resulted in a shortage of isolation rooms within many U.S. hospitals admitting COVID-19-positive cases. As a result, hospital systems, especially those at an epicenter of this outbreak, have initiated task forces to identify and implement various approaches to increase their isolation capacities. This paper describes an innovative temporary anteroom in addition to a portable air purifier unit to turn a general patient room into an isolation space. Using an aerosolization system with a surrogate oil-based substance, we evaluated the effectiveness of the temporary plastic anteroom and the portable air purifier unit. Moreover, the optimal location of the portable unit, as well as the effect of negative pressurization and door opening on the containment of surrogate aerosols were assessed. Results suggested that the temporary anteroom alone could prevent the migration of nearly 98% of the surrogate aerosols into the adjacent corridor. Also, it was shown that the best location of a single portable air purifier unit is inside the isolation room and near the patient's bed. The outcome of this paper can be widely used by hospital facilities managers when attempting to retrofit a general patient room into an airborne infection isolation room.

Letter: Neurosurgical Patients' Management During the COVID-19 Pandemic-An Institutional Report From an African Neurosurgical Center.

To the Editor: Since the first diagnosed case of COVID-19 on March 2, the Moroccan government has taken several strict measures to try to contain the pandemic and reduce the burden of an expanding disease: country borders shut down by March 14, early lockdown of airports and public spaces by March 18, and social distancing and restricted mobility by March 20. A full reorganization of the health system was initiated countrywide, creating regional admission centers, specific testing departments within a COVID-19 pathway, and specialty hubs for continuous medical service. Reducing admission activity rate was also one of the measures undertaken. Here we summarize and share our experience in managing neurosurgical patients during the COVID-19 pandemic at the Rabat WFNS reference training center. ORGANIZATION Early during the outbreak of the pandemic, the Rabat-Salé region (4.5 million people) turned out to be one of the 3 most affected regions. At the first stage of the disease spread, the Salé regional hospital was designated for all COVID-19 admissions. When phase 2 of the disease progression was announced by March 18, more extensive measures and departments remodeling were needed: Scheduled activity was stopped, and special COVID-19 pathways were created. Most departments were converted into COVID-19 facilities. The Oto-Neuro-Ophtalmology hospital, considered as an off-site hospital, was assigned to manage all non-COVID patients with urgent neurosurgical pathology. Admission Profiles and Measures Patients were either admitted directly, if belonging to the Rabat-Salé region (direct admission), or referred from regional hospitals (indirect admission). Prior to admission, patients undergo medical history checking and fever testing. Emergency Case Definition and Stratification Admitted patients belonged to 2 groups: those requiring immediate surgical procedure (group A) and those requiring urgent but still scheduled surgery (group B). Circuit for Patient Management Admission was limited to a maximum of 2 patients per room. Group A patients were operated in the emergency operating room (OR) and group B patients were operated in the mean operating theatre, directly connected to the intensive care unit (ICU). Discharge was made early, and patients followed up over regular phone calls. The patient's bed and room were then thoroughly sterilized and kept free of patients for at least 24 h. During hospitalization, only 1 visitor per day/patient was allowed. All wore protective masks. DISCUSSION African health systems needed to take proactive measures to lower the impact of such a disease. However, many of the recommendations published by other neurosurgical centers could not be achieved given the local limitations and resources.1-4 We believe that systematic pulmonary computed tomography (CT) scan helped initially in assessing a patient's COVID-19 status.1,5 COVID-19 testing further reinforced the algorithms set up by the local committee and accelerated the diagnosis of suspected cases. PERSPECTIVES To date, while achieving a regular surgical load (12 surgeries a week), only 1 case of a confirmed COVID-19 patient escaped the algorithm. Since, and being aware of future difficulties, we proposed a complementary algorithm, designed to help prevent cross-infections, in which the neurosurgery department will be further split into 2 units. Although the sustainability of this system may be questionable for the long term, it has proven to be efficient in preserving the non-COVID status of the hospital so far. Its reproducibility and adaptability for alike African countries may still be possible and might be one possible gateway for African countries against this outbreak. Disclosures The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

Development of rapid colorimetric assay for the detection of Influenza A and B viruses

The flu viruses are respiratory pathogens which, according to the World Health Organization (WHO), infect 5–10% of the world population resulting in 3–5 million cases of severe illness and 290,000 to 650,000 annual deaths. Early diagnosis and therapeutic intervention can ameliorate symptoms of infection and reduce mortality. The conventional diagnosis of viral infections, including flu viruses, has evolved over the years with diverse approaches, however, there are inherent short comings associated with these testing. There is an urgent need for rapid and low-cost diagnostic assays, due to the enormous annual burden of influenza diseases and its associated mortality.In this study, novel, low cost and easy to use colorimetric flu virus biosensor assay was developed. The sandwich assay format was utilized using antibodies immobilized onto cotton swabs, for the rapid detection of flu A and B viruses. These swabs serve as sample collection, analytes pre-concentration as well as sensing tool. The proof of concept was established for this assay in buffer and mucus samples. The limit of detection (LOD) of the colorimetric assay was 0.04 ng mL−1 for Flu A and Flu B respectively and with linear dynamic range between 0.04 ng ml−1 to 40 ng ml for both viruses in mucous samples. The assay can be performed at the patient's bed side by minimally skilled hospital personnel without the need for instrumentation. Cross-reactivity assays testing was done using Flu viruses specific activated swabs reacted with other common respiratory viral pathogens' antigen, in order to assess the specificity of the swabs.

Fall Prevention Practices and Implementation Strategies: Examining Consistency Across Hospital Units.

Our study examines how consistently fall prevention practices and implementation strategies are used by U.S. hospitals. We conducted a cross-sectional, descriptive study of 60 general adult hospital units.We administered a survey measuring 5 domains of fall prevention practices: visibility and identification, bed modification, patient monitoring, patient safety, and education. We measured 4 domains of implementation strategies including quality management (e.g., providing data and support for quality improvement), planning (e.g., designating leadership), education (e.g., providing consultation and training), and restructuring (e.g., revising staff roles and modifying equipment). Of 60 units, 43% were medical units and 57% were medical-surgical units. The hospital units varied in fall prevention practices, with practices such as keeping a patient's bed in a locked position (73% strongly agree) being used more consistently than other practices, such as scheduled toileting (15% strongly agree). Our study observed variation in fall prevention implementation strategies. For example, publicly posting fall rates (60% strongly agree) was more consistently used than having a multidisciplinary huddle after a fall event (12% strongly agree). There is substantial variation in the implementation of fall prevention practices and implementation strategies across inpatient units. Our study found that resource-intensive practices (e.g., scheduled toileting) are less consistently used than less resource-intensive practices and that interdisciplinary approaches to fall prevention are limited. Future studies should examine how units tailor fall prevention practices based on patient risk factors and how units decide, based on their available resources, which implementation strategies should be used.

Bed Exit Action Detection Based on Patient Posture with Long Short-Term Memory.

It has been known that the fall of a patient in a hospital is a serious accident. In order to prevent such accidents, we have been studying the fall prevention using image processing technology. Our previous studies have detected the patient's end sitting position with high accuracy, but have problems responding to the sitting position of patients who are eating or responding to visitors. In order to solve these problems, this paper proposes a method to detect the patient's bed exit action by analyzing the posture of the patient extracted from the image of the monocular camera by long short-term memory (LSTM). Our proposed method introduces two strategies - abstraction of input information and use of relative position information for the input time-series human images, achieving a 99.2[%] detection rate of bed exit action with a 5.7[%] false detection rate. Detecting the bed exit action with high accuracy contributes to preventing the patient from falling down. The proposed solution handles only posture information that abstracts camera images for patient privacy purposes.

Do established infection prevention and control measures prevent spread of SARS-CoV-2 to the hospital environment beyond the patient room?

SummaryThe role of the hospital environment in the transmission of infection is well described. With an emerging infection whose mode of transmission is under investigation, strict infection prevention and control measures, including patient isolation, hand hygiene, personal protective equipment that is doffed on exiting the patient room, and environmental cleaning should be implemented to prevent spread. Environmental testing demonstrated that COVID-19 patients contaminated the patient area (11/26, 42.3% of tests) but contamination of general ward areas was minimal (1/30, 3%) and the virus was detected after cleaning on one item only (1/25, 4%) which was noted to be in disrepair.

First experience of lung ultrasound application in patients with acute viral infection caused by SARS-CoV-2

The purpose of the studywas the estimation of lung ultrasound examination characteristic in patients with a new COVID-19 virus infection in the infectious Department.Materials and methods. 52 patients (male 29, middle age 51.2 ± 3.4) with an established coronavirus infection caused by the COVID-19 virus were participated in the research. The severity of the patients’ clinical condition was assessed by the NEWS scale. An ultrasound lungs examination was performed on the 1st day an ESAOTE MyLab 70 (Italy) device with S 3–5 MHz Probe. Ultrasound scanning was performed along the main topographic lines (midthoracic, anterior, middle and posterior axillary, scapular lines in the longitudinal and transverse planes).Results. Pathological ultrasound signs of lung tissue damage were determined in COVID–19 patients. Multiple B-lines were detected in all patients (100%): in 34 cases – merging B-lines, in 18 cases – scattered B-lines. Changes of the pleural line structure were visualized in all cases: thickening of more than 2 mm – in 33 cases, and discontinuous contours – in 25 cases. Нydrothorax was determined in 39 cases (75%); marginal zones of lung consolidation – in all patients (100%): homogeneous consolidations were observed in 38 cases (73.0%); heterogeneous consolidations (26%) – in 14 cases.Conclusions. Ultrasound lung scanning is an assistive method viral pneumonia diagnosing caused by the new COVID-19 coronavirus. The method can be applied in clinical situations where there is a mild course of the disease, if it is impossible to perform the research and to monitor patients who are on a ventilator. The advantages of the method include the ability to obtain a dynamic image in online mode, the ability to conduct research in the patient's bed. In addition, ultrasound scanning of lung tissue, in contrast to CT of the lungs, has an advantage in recognizing interstitial lesions and displays the distribution of blood flow in tissues with an assessment of the degree of angiogenesis in inflammatory viral lung lesions.

« Crown protection » ou velléités protectrices du Corona Covid-19 et ses rencontres improbables

The title of our paper could be receipted (intellectually receipted) like a paradox or like choking item. In real life of our hospital activity is not at all true because in both clinical situations the symptomatology of infectious disease was protected about a long psychotic or pseudo psychotic episode. The most important for the psychiatric stabilization was strictly observance and repetition of consultations who created a secure feel, necessarily for construction after psychodramatic real story Covid-19. Our clinical case shows the possibility of our patients to relativize the gravity of the pandemic and his impact. The modalities of psychotropic treatment are very important in this specific pathologic case and our presentation could give us new ideas in psychiatry and immunology about protection by ay antibiotherapy in pre- and post-operatory. Unlikely encounter with a disease that leads to an episode of madness and psychological care after a severe episode of Covid-19. Psychological support is upset by this disease, like the rest. The clinic returns to its original meaning: at the patient's bed to understand this new disease and its protective and/or revealing effects. Clinical presentation of an unlikely encounter in the context of the Covid-19 epidemic. Encounter with both a severe form of this new disease and psychopathological expression in intensive care and post-reanimation units. Psychological support in a patient suffering from a delusional episode and identity disorders related to Covid-19. Psychological support is disrupted by this disease, as is the rest. The clinic returns to its original meaning: in the patient's bed to understand this new disease and its protective and/or revealing effects. The singular and psychoanalytic listening allows the patient to understand the process of constructing his episode of delusional appearance, like dreamlike construction. Adaptation and creation of a clinic requiring to be as close as possible to the patient to allow the psychological restructuring having been disorganized in connection with the disease but also with the hospital and family environment, strongly impacted by anxiety.

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

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

Accuracy evaluation and comparison of three blood glucose meters in an emergency paediatric unit of a tertiary hospital in Nigeria

Backgrounds: Advances in technology have made available different types of glucose meters for use at the patient's bed side with significantvariation in accuracy among these glucose meters.Objectives: We evaluated the accuracy of three commonly used glucose meters in a children emergency room using laboratory method as reference.Subjects: Subjects were 206 children seen in emergency room over a period of 3 months.Methods: Capillary blood glucose was determined at the bed side using three glucose meters: Accu - Chek® Active, On Call® Plus and One Touch®Ultra Mini. Peripheral venous blood was simultaneously collected for comparative plasma glucose analysis at the laboratory. The mean absolute relative deviations (MARDs) were determined. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.Results: The MARD for Accu - Chek® Active, On Call® Plus and One Touch® Ultra Mini were 11.58%, 27.00%, and 13.91% respectively. In the diagnosis of hyperglycaemia, the sensitivity and specificity for Accu - Chek® Active, On Call® Plus, One Touch® Ultra Mini were 83.3% and 96.3%, 94.4% and 79.3%, 94.4 and 94.7% respectively. The PPV and NPV for Accu - Chek® Active, On Call® Plus, One Touch® Ultra Mini were 68.1% and 98.4%, 30.4% and 99.3%, 62.9% and 99.4% respectively. Four cases of hypoglycaemia were detected by the laboratory method and the 3 glucose meters detected 3 out of the 4 correctly.Conclusion: These three glucose meters varied in accuracy but the glucose values by the Accu - Chek® Active had the least variation from thelaboratory results. Key Words: Glucose meter, hyperglycaemia, hypoglycaemia, Dysglycaemia, Emergency Paediatric Unit.

Rodent models of obesity.

Obese or overweight people exceed one-third of the global population and obesity along with diabetes mellitus consist basic components of metabolic syndrome, both of which are known cardio-cerebrovascular risk factors with detrimental consequences. These data signify the pandemic character of obesity and the necessity for effective treatments. Substantial advances have been accomplished in preclinical research of obesity by using animal models, which mimic the human disease. In particular, rodent models have been widely used for many decades with success for the elucidation of the pathophysiology of obesity, since they share physiological and genetic components with humans and appear advantageous in their husbandry. The most representative rodents include the laboratory mouse and rat. Within this review, we attempted to consolidate the most widely used mice and rat models of obesity and highlight their strengths as well as weaknesses in a critical way. Our aim was to bridge the gap between laboratory facilities and patient's bed and help the researcher find the appropriate animal model for his/her obesity research. This tactful selection of the appropriate model of obesity may offer more translational derived results. In this regard, we included, the main diet induced models, the chemical/mechanical ones, as well as a selection of monogenic or polygenic models.