scholarly journals Evaluation of High Flow Local Extraction on control of the aerosol plume in an operating theatre

2021 ◽  
Author(s):  
Logan Marriott ◽  
Matthew Harper ◽  
Tongming Zhou ◽  
Chenlin Sun
Keyword(s):  
Laser Sheet ◽  
High Flow ◽  
Operating Theatre ◽  
Cumulative Probability ◽  
Delivery Of Care ◽  
Safe Delivery ◽  
Engineering Controls ◽  
Particle Counts ◽  
The Impact ◽  
Aerosol Plume

Background Engineering controls are a necessity for minimising aerosol transmission of SARS-CoV-2, yet so far, little attention has been given to such interventions. High flow local extraction (HFLE) is a standard in other industries that deal with airborne contaminants. This study provides a quantitative evaluation of an HFLE concept feasible to implement in most real clinical settings. Method A unique combined experimental model of Laser sheet illumination videography paired with continuous nanoparticle counts was used to quantitatively assess the impact of HFLE in an operating theatre. Propylene Glycol was aerosolised via a customised physiological lung simulator and dispersion was measured in 3 dimensions. Cumulative probability heat maps were generated to describe aerosol behaviour. Continuous particle counts were made at 15 locations throughout the room to validate laser assessments. Results HFLE effectively reduced dispersion of simulated exhaled aerosols to undetectable levels. With the HFLE in operation and optimally positioned, the aerosol plume was tightly controlled. Particle counts remained at baseline when HFLE was active. HFLE becomes less effective with increasing distance from source. Plume behaviour in the absence of HFLE was highly variable and unpredictable. Conclusions This analysis demonstrates great potential for HFLE to have a significant impact in reducing aerosol transmission. Simple HFLE devices can be easily engineered and could be widely deployed without impacting on the safe delivery of care. Keywords: aerosol; high flow local extraction; aerosol-generating procedure; tracheal intubation; SARS-CoV-2; COVID-19; plume; personal protective equipment; engineering controls

scholarly journals COVD-25. THE PARADOXICAL EFFECTS OF COVID-19 ON CANCER CARE IN THE NEURO-ONCOLOGY SETTING

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii26-ii26
Author(s):  
Nicole Cort ◽  
Alex Broom ◽  
Katherine Kenny ◽  
Alexander Page ◽  
Jennifer Durling ◽  
...  
Keyword(s):  
Cancer Care ◽  
Standard Of Care ◽  
Adult Brain ◽  
Evidence Based ◽  
Negative Consequences ◽  
Traditional Practice ◽  
Delivery Of Care ◽  
Paradoxical Effects ◽  
Oncology Care ◽  
The Impact

Abstract COVID-19 has caused ongoing interruptions to healthcare systems worldwide, shifting care to virtual platforms, and placing significant economic and logistical burdens on clinical practice. The pandemic has created uncertainty in delivering the standard of care, both in areas of cancer diagnosis and treatment, especially within neuro-oncology. Due to the pandemic, care and operational planning goals have shifted to infection prevention, modifying recommendations to decrease viral transmission and increasing telemedicine use, potentially creating a burden on implementing evidence-based medicine. These dynamics have since begun to redefine traditional practice and research regimens, impacting the comprehensive care that cancer patients can and should receive; and the enduring consequences for the delivery of healthcare. The impact of COVID-19 on oncology practice and trials might endure well beyond the short- to mid-term of the active pandemic. Therefore, these shifts must be accompanied by improved training and awareness, enhanced infrastructure, and evidence-based support to harness the positives and offset the potential negative consequences of the impacts of COVID-19 on cancer care. To address these paradoxical effects, we will conduct iterative, qualitative (face-to-face/video conference) interviews with neuro-oncology clinical and research professionals and adult brain tumor patients receiving care during the pandemic. We will capture unique aspects of oncology care: the lived, subjective, situated, and contingent accounts of patients and medical professionals, especially during a pandemic. We will also specifically compare the impact of telehealth during the pandemic on delivery of care to complex neuro-oncology patients. A summary of this in-depth, qualitative approach will result in a sophisticated understanding of neuro-oncology care on the frontline at a time of crisis, as experienced during a pandemic, to articulate best practices for future implementation.

scholarly journals 53. Incidence of Bloodstream Infections and Outcomes in Patients with Severe COVID-19 Pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S156-S157
Author(s):  
Aikaterini Papamanoli ◽  
Jeanwoo Yoo ◽  
Azad Mojahedi ◽  
Robin Jacob ◽  
Prabhjot Grewal ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Medical Records ◽  
Bloodstream Infections ◽  
Blood Stream ◽  
Blood Cultures ◽  
High Flow ◽  
University Hospital ◽  
Skin Microbiota ◽  
Prolonged Recovery ◽  
The Impact

Abstract Background Coronavirus disease 19 (COVID-19) leading to acute respiratory distress syndrome is associated with need for intensive care (IC), mechanical ventilation (MV), and prolonged recovery. These patients are thus predisposed to blood stream infections which can worsen outcomes. This risk may be aggravated by adjunctive therapies. Methods We reviewed the medical records of all adults admitted to Stony Brook University Hospital, NY, from March 1 to April 15, 2020 with severe COVID-19 pneumonia (requiring high-flow O2). Patients who received MV or died within 24h were excluded. Patients were followed until death or hospital discharge. We reviewed positive blood cultures (PBC) for pathogenic microorganisms, and calculated the incidence of bacteremia, rates of infective endocarditis (IE), and impact on mortality. Microbes isolated only once and belonging to groups defined as commensal skin microbiota were labelled as contaminants. We also examined the impact of adjunctive therapies with immunosuppressive potential (steroids and tocilizumab), on bacteremia. Results A total of 469 patients with severe COVID-19 pneumonia were included (Table 1). Of these, 199 (42.4%) required IC and 172 (36.7%) MV. Median length of stay was 13 days (8–22) and 94 (20.0%) had PBC. Of these, 43 were considered true pathogens (bacteremia), with predominance of E. faecalis and S. epidermidis, and 51 were considered contaminants (Table 2). The incidence of bacteremia (43/469, 9.2%) was 5.1 per 1000 patient-days (95%CI 3.8–6.4). An echocardiogram was performed in 21 patients, 1 had an aortic valve vegetation (IE) by methicillin sensitive S. aureus. Bacteremia rates were nonsignificantly higher with steroids (5.9 vs 3.7 per 1000 patient-days; P=0.057). Use of tocilizumab was not associated with bacteremia (5.8 vs 4.8 per 1000 patient-days; P=0.28). Mortality was nonsignificantly higher in patients with (15/43, 34.9%) vs. without (108/426, 25.4%) bacteremia (P=0.20). Length of stay was the strongest predictor of bacteremia, with risk increasing by 7% (95%CI 6%-9%, P< 0.001) per additional day. Cohort Characteristics of Patients with Severe COVID-19 Pneumonia on High-Flow O2 (N= 469) All Microorganisms Isolated from Blood Cultures Conclusion The incidence of bacteremia was relatively low and IE was uncommon in this study of severe COVID-19 patients. Risk of bacteremia increased with longer hospital stay and with steroids use, but not with tocilizumab. Disclosures All Authors: No reported disclosures

Numerical Investigation of a Cantilevered Compressor Stator at Varying Clearance Sizes

2015 ◽  
Author(s):  
Chengwu Yang ◽  
Xingen Lu ◽  
Yanfeng Zhang ◽  
Shengfeng Zhao ◽  
Junqiang Zhu
Keyword(s):  
Flow Field ◽  
Axial Compressor ◽  
High Flow ◽  
Leakage Flow ◽  
Streamwise Direction ◽  
Stall Margin ◽  
Axial Compressors ◽  
Pressure Surface ◽  
The Impact ◽  
Highly Loaded

The clearance size of cantilevered stators affects the performance and stability of axial compressors significantly. Numerical calculations were carried out using the commercial software FINE/Turbo for a 2.5-stage highly loaded transonic axial compressor, which is of cantilevered stator for the first stage, at varying hub clearance sizes. The aim of this work is to improve understanding of the impact mechanism of hub clearance on the performance and the flow field in high flow turning conditions. The performance of the front stage and the compressor with different hub clearance sizes of the first stator has been analyzed firstly. Results show that the efficiency decreases as clearance size varies from 0 to 3% of hub chordlength, but the operating range has been extended. For the first stage, the efficiency decreases about 0.5% and the stall margin is extended. The following analysis of detailed flow field in the first stator shows that the clearance leakage flow and elimination of hub corner separation is responsible for the increasing loss and stall margin extending respectively. The effects of hub clearance on the downstream rotor have been discussed lastly. It indicates that the loss of the rotor increases and the flow deteriorates due to increasing of clearance size and hence the leakage mass flow rate, which mainly results from the interaction of upstream leakage flow with the passage flow near pressure surface. The affected region of rotor passage flow field expands in spanwise and streamwise direction as clearance size grows. The hub clearance leakage flow moves upward in span as it flows toward downstream.

Abstract 085: Discordance in Patient-Physician Perceptions of Angina Experiences and Delivery of Care

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Suzanne V Arnold ◽  
Prakash C Deedwania ◽  
Cherilyn Heggen-Peay ◽  
Laurence Greene ◽  
Jeffrey D Carter ◽  
...  
Keyword(s):  
Improve Patient Care ◽  
Poor Quality ◽  
Assessment Tools ◽  
Delivery Of Care ◽  
Physician Perceptions ◽  
Patient Reported ◽  
Angina Frequency ◽  
Artery Disease ◽  
Stable Cad ◽  
The Impact

Background: Recent findings from the APPEAR study indicate that physicians under-recognize angina frequency in many patients with coronary artery disease (CAD). We surveyed patients with angina and the physicians who treat them to further explore factors that may contribute to under-recognition and the impact of under-recognition on patients’ experiences. Methods: Surveys were completed by 29 US physicians and 122 of their patients with stable CAD. Patients reported burden of angina and satisfaction with medication. Physicians estimated the average experience of their patients with stable CAD. Results: As with prior studies, physicians under-estimated burden of angina as reported by the patients (physician vs. patient report: weekly of more angina: 24% vs 50%, p=0.014; CCS III/IV: 22% vs 43%, p<0.001). Physicians also over-estimated patients’ satisfaction with control of their angina (70% vs 50%, p<0.001). Over 90% of physicians reported routinely asking patients about the frequency of their angina and adherence to antianginal medications (Figure). Most physicians estimate angina using NYHA or CCS class (59% and 24%, respectively) whereas 7% used a patient-reported assessment. While lack of time was reported as the biggest barrier to accurately assessing patients’ burden of angina, most physicians reported having no challenges to conducting these assessments. Conversely, 68% of patients reported that their physicians effectively communicated with them. Conclusions: Using a detailed survey of patients with stable CAD and their physicians, we found that physicians believe they are communicating effectively and most patients agreed (although to a lesser degree); yet, a substantial discordance between physician and patient perceptions of angina remains. These discordances may contribute to suboptimal treatment decisions, decreased treatment satisfaction, and poor quality of life. The observed discordances may be explained partly by the fact that <10% of physicians reported using a tool to assess angina burden directly from the patients, as physicians appeared to over-estimate their ability to accurately assess angina using traditional interview techniques. Education and use of validated angina assessment tools are essential for aligning perceptions to improve patient care and outcomes.

scholarly journals Air embolism: A rare complication of esophagogastroduodenoscopy!

2014 ◽  
Vol 05 (03) ◽  
pp. 114-115
Author(s):  
Ajay B. Jhaveri ◽  
Sharad C. Shah ◽  
Prasanna S. Shah
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Rare Complication ◽  
Air Embolism ◽  
Neurological Complications ◽  
High Flow ◽  
Cerebral Air Embolism ◽  
Left Lateral Decubitus Position ◽  
Lateral Decubitus ◽  
High Index Of Suspicion ◽  
The Impact

AbstractNeurological complications of gastrointestinal endoscopy are extremely rare; cerebral air embolism has been described and can be severe and fatal. A high index of suspicion for an air embolism is a must in case of procedural or periprocedural cardiopulmonary instability and neurologic symptoms, particularly in patients with recognized risk factors. The diagnosis of an air embolism is often difficult and is complicated by the fact that air may be rapidly absorbed from the circulation. Simple maneuvers to decrease the impact of a potential air embolism include; stopping the procedure, administering high flow 100% oxygen, placing the patient in Trendelenburg and left lateral decubitus position, and discontinuing nitrous oxide. C T Scan and 2 D ECHO are important diagnostic tests.

scholarly journals The Impacts of Land Use Patterns on Water Quality in a Trans-Boundary River Basin in Northeast China Based on Eco-Functional Regionalization

2018 ◽  
Vol 15 (9) ◽  
pp. 1872 ◽  
Author(s):  
Peixuan Cheng ◽  
Fansheng Meng ◽  
Yeyao Wang ◽  
Lingsong Zhang ◽  
Qi Yang ◽  
...  
Keyword(s):  
Water Quality ◽  
Land Use ◽  
River Basin ◽  
Natural Environment ◽  
Flow Region ◽  
High Flow ◽  
Land Use Patterns ◽  
Use Patterns ◽  
The Impact ◽  
Degraded Water Quality

The relationships between land use patterns and water quality in trans-boundary watersheds remain elusive due to the heterogeneous natural environment. We assess the impact of land use patterns on water quality at different eco-functional regions in the Songhua River basin during two hydrological seasons in 2016. The partial least square regression indicated that agricultural activities associated with most water quality pollutants in the region with a relative higher runoff depth and lower altitude. Intensive grazing had negative impacts on water quality in plain areas with low runoff depth. Forest was related negatively with degraded water quality in mountainous high flow region. Patch density and edge density had major impacts on water quality contaminants especially in mountainous high flow region; Contagion was related with non-point source pollutants in mountainous normal flow region; landscape shape index was an effective indicator for anions in some eco-regions in high flow season; Shannon’s diversity index contributed to degraded water quality in each eco-region, indicating the variation of landscape heterogeneity influenced water quality regardless of natural environment. The results provide a regional based approach of identifying the impact of land use patterns on water quality in order to improve water pollution control and land use management.

Patient safety in the operating theatre

2020 ◽  
Vol 6 (2) ◽  
pp. 25-31
Author(s):  
Katarzyna Tomaszewska ◽  
Dorota Gos
Keyword(s):  
Patient Safety ◽  
Operating Theatre ◽  
Survey Method ◽  
Length Of Service ◽  
Operating Theater ◽  
Level Of Education ◽  
Operating Team ◽  
Time Period ◽  
The Impact ◽  
Legal Consequences

Introduction Patient safety in the operating theatre depends on the multi-track activities of the entire medical team. Guaranteeing total patient safety will allow the patient to meet his expectations, will be a source of satisfaction for the whole team, which provides care and treatment, and helps avoid legal consequences. Aim The aim of the study was to investigate which factors, according to the operating team, guarantee patient safety in the time period from the admission to the operating theatre until the transfer to the specialist ward. Material and methods The diagnostic survey method and analysis of literature were used. A propriety questionnaire created by the authors was used in order to verify the hypotheses. Results and Conclusions There were no significant correlations between age, level of education and length of service and the assessment of the impact of other activities on patient’s safety in the operating theatre. Gender and workplace did not significantly influence the evaluation of the significance of other analysed factors. The profession did not significantly differ in the evaluation of the analysed factors for the patient safety in an operating theatre. Compliance with standards and procedures before, during and after the procedure guarantees patient safety in the operating theater to a large extent in the respondents’ opinion.

Abstract WP281: Pharmacists Improve Door to Needle Times in the Emergency Department

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kevin Phan ◽  
Megan Degener
Keyword(s):  
Emergency Department ◽  
Cerebral Perfusion ◽  
Stroke Care ◽  
Time Frame ◽  
Safe Delivery ◽  
Team Meetings ◽  
Stroke Team ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
The Impact

Background: An estimated two million brain cells die every minute cerebral perfusion is impaired. The best outcomes for acute ischemic strokes are achieved by decreasing the time from emergency department (ED) arrival to thrombolytic therapy. Alteplase, a high risk medication, was dosed and prepared in the pharmacy. This contributed to prolonged door to needle (DTN) times. Purpose: To describe the impact of pharmacist interventions on DTN times in the ED. Methods: All patients who received alteplase for acute ischemic stroke from January 2012 to April 2019 were reviewed. In November 2012, the ED pharmacy program began with a dedicated ED pharmacist for 8 hours a day and expanded to 13 hours a day in September 2014. During those hours alteplase was prepared at bedside in the ED. In November 2015, all pharmacists were trained on the ED code stroke process. Monthly case reviews and DTN times were reported to the stroke coordinators starting January 2017. Alteplase preparation and administration in the computed tomography (CT) room started April 2017. Following comprehensive stroke center certification, routine stroke competency exams were administered to pharmacists in 2018. In 2019, pharmacists started reporting DTN times at neuroscience core team meetings. Results: During this time frame, a total of 407 patients received alteplase. Average DTN times decreased from a baseline of 130.9 minutes to 45.3 minutes. Interventions that resulted in the largest decrease in average DTN times were the expanded ED service hours (34.6 minutes) and pharmacist preparation of alteplase in the CT room (21.9 minutes). Conclusions: Pharmacists directly impacted stroke care in the ED by decreasing DTN times. Presence of a pharmacist in the ED enabled fast and safe delivery of alteplase by ensuring accurate dosing and preparation. Pharmacists also performed rapid medication reconciliation and expedited antihypertensive therapies. In conclusion, having pharmacists as part of the stroke team is a model that could be adopted by hospitals to enhance stroke care.

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