Effects of ECMO Simulations and Protocols on Patient Safety.

The use of extracorporeal membrane oxygenation (ECMO) has greatly increased over the years; however, the survival rate is only above 56%. There has been a drastic increase in ECMO centers and cases. ECMO has become a popular therapy route for patients with respiratory and cardiac complications; however, patient safety is a major concern. Perfusion and non-perfusion students from the University of Nebraska Medical Center were recruited to participate in three simulation trials. The trials consisted of five different tasks that are required for managing or preventing catastrophic events on ECMO. Students were evaluated for the time it took to complete each task, number of errors made, and protocol referencing. The data indicated that there was a decrease in time for the 1st vs. 2nd trial (p = .02) for perfusion students and a decrease from the 1st to 3rd trial (p = .001) for the circuit set-up simulation. There was a decrease in priming time from the 1st to 3rd trial (p = .02) and for the pump change (p = .0098) for the perfusion students as well. The non-perfusion students had a significant decrease in time for the circuit set-up in the 1st vs. 2nd (p = .004) and 1st vs. 3rd trial (p = .002). There was a decrease in time for priming (.004), pump change (p = .002), tubing change (p = .0098), and errors during the tubing change (p = .02) in the non-perfusion students. Both groups felt more confident after the simulations and the non-perfusion students specifically felt like they were more familiar with the purpose of ECMO after the simulation. ECMO simulations and protocols may improve patient safety by strengthening the skills needed for rapid management, fewer errors, and higher levels of confidence during the management of ECMO and catastrophic events.

Dental composite fillings and bisphenol A among children: a survey in South Korea.

AIMS: Bisphenol A (BPA)-based dental composites have commonly been used to fill dental cavities or seal pits and fissures on teeth. However, epidemiological evidence with regard to the BPA exposure from dental composites among children has rarely been reported. This study investigated whether there is a relationship between the BPA concentration in urine and the presence of composite restorations and sealants among South Korean children. METHODS: Oral examinations and urine sample analyses were conducted on a total of 495 children aged 8-9 years. We classified the participants into four groups by the number of resin composites and sealant surfaces (0, 1-5, 6-10 and 11+). RESULTS: BPA concentrations in urine were higher in children with 11 or more surfaces restored with sealants and resin composites than in those with zero restored surfaces, although no difference was seen in the group with 1-10 surfaces. After adjusting for gender and age, the urinary BPA concentration in children with 11 or more resin composite surfaces was 2.67 µg/g creatinine, which was higher than the concentration found in those with no filling surfaces (P < 0.01). CONCLUSIONS: Having many dental composite filling surfaces on teeth may increase the urinary BPA concentration in children.

Korean medicine treatments including blood stasis-removing therapy and auriculotherapy for persistent headache after traumatic brain injury: A case report.

Headache after traumatic brain injury (TBI) is a common symptom which includes moderate-to-severe pain more than 5 years after the injury and severely limits the quality of life. Some guidelines have indicated that there are several cases where headaches do not respond adequately to conventional therapies. Therefore, effective alternative approaches are needed. In this case report, we present a 74-year-old woman, who had persistent headache attributed to traumatic injury to the head and subjective cognitive impairment. By using the Korean Medical (KM) treatment blood stasis-removing therapy using Dangguixu-san and auriculotherapy, her headache improved markedly. Improvements in the cognitive function and hemorrhage were also observed. This case report suggests that KM treatments using Dangguixu-san and auriculotherapy may be an alternative therapeutic approach for headache after TBI.

Comparison between CT colonography and double-contrast barium enema for colonic evaluation in patients with renal insufficiency.

OBJECTIVE: To compare the CT colonography (CTC) and double-contrast barium enema (DCBE) for colonic evaluation in patients with renal insufficiency. MATERIALS AND METHODS: Two sequential groups of consecutive patients with renal insufficiency who had a similar risk for colorectal cancer, were examined by DCBE (n = 182; mean ± SD in age, 51 ± 6.4 years) and CTC (n = 176; 50 ± 6.7 years), respectively. CTC was performed after colon cleansing with 250-mL magnesium citrate (n = 87) or 4-L polyethylene glycol (n = 89) and fecal tagging. DCBE was performed after preparation with 250-mL magnesium citrate. Patients with colonic polyps/masses of ≥ 6 mm were subsequently recommended to undergo a colonoscopy. Diagnostic yield and positive predictive value (PPV) for colonic polyps/masses, examination quality, and examination-related serum electrolyte change were retrospectively compared between the two groups. RESULTS: Both the CTC and DCBE were positive for colonic polyps/masses in 28 (16%) of 176 and 11 (6%) of 182 patients, respectively (p = 0.004). Among patients with positive findings, 17 CTC and six DCBE patients subsequently underwent a colonoscopy and yielded a PPV of 88% (15 of 17 patients) and 50% (3 of 6 patients), respectively (p = 0.089). Thirteen patients with adenomatous lesions were detected in the CTC group (adenocarcinoma [n = 1], advanced adenoma [n = 6], and non-advanced adenoma [n = 6]), as compared with two patients (each with adenocarcinoma and advanced adenoma) in the DCBE group (p = 0.003). Six (3%) of 176 CTC and 16 (9%) of 182 DCBE examinations deemed to be inadequate (p = 0.046). Electrolyte changes were similar in the two groups. CONCLUSION: In patients with renal insufficiency, CTC has a higher diagnostic yield and a marginally higher PPV for detecting colorectal neoplasia, despite a similar diagnostic yield for adenocarcinoma, and a lower rate of inadequate examinations as compared with DCBE.

The strength of age effect on tooth loss and periodontal condition in Korean elderly.

Aging is a well-known risk factor associated with oral diseases. The aim of this cross-sectional study was to compare tooth loss and periodontal health between the relatively young elderly (65-74 years) and the old elderly (≥ 75 years) and to investigate the strength of the age effect on oral health status in the Korean elderly. Study population 65 years of age or older were selected from the participants of the Korean National Oral Health Survey (2006) (n = 1193). Oral examination was conducted by eight dentists trained in the World Health Organization (WHO) recommended examination procedure. The chi-square test, multiple regression analyses and multinomial logistic regression analyses were performed using SAS 9.1.3. The oral health status including decayed, missing, and filled teeth (DMFT), missing teeth, and residual teeth significantly differed between the young elderly and the old elderly (p < 0.01). Moreover, the regression coefficients of tooth loss linearly increased across different age groups (5-year intervals, starting at age 65 years) (p < 0.05). However, the odds ratios of periodontal health did not significantly differ across 5-year interval age groups. The findings that age and the number of missing teeth are significantly and linearly related could contribute to the development of oral health care and promotion programs for the elderly tailored to their own age.