Effects of a special continuous quality improvement in nursing on the management of adverse care events: a retrospective study.

OBJECTIVE: To explore the application effect of the direct reporting system of adverse nursing events and special continuous nursing quality improvement measures in the management of these adverse events. METHODS: The implementation time of continuous nursing improvement based on the direct reporting system was the demarcation point. We retrospectively collected and analyzed nursing adverse event reports and hospitalization data from Xiangtan Central Hospital before implementation (2015-2018) and after implementation (2019-2022). The active reporting rate of adverse events, the composition of these events and the processing time were compared between the two groups. RESULTS: The rate of active reporting of adverse events before the implementation was lower than that after the implementation (6.7% vs. 8.1%, X2 = 25.561, P < 0.001). After the implementation of the direct reporting system for nursing events and the continuous improvement of nursing quality, the reporting proportion of first-level and second-level events decreased significantly. Moreover, the reporting proportion of third-level events increased significantly. The proportion of falls and medication errors decreased, and the proportion of unplanned extubation, infusion xerostomia and improper operation increased. The processing time of the reported nursing adverse events was significantly reduced (31.87 ± 7.83 vs. 56.87 ± 8.21, t = 18.73, P < 0.001). CONCLUSION: The direct reporting system of adverse nursing events and the continuous improvement measures for nursing quality can effectively improve the active reporting rate of adverse events, change their composition and reduce their processing time, as well as help create a safe psychological environment for both patients and nursing staff.

Retinal GABAergic Alterations in Adults with Autism Spectrum Disorder.

Alterations in γ-aminobutyric acid (GABA) have been implicated in sensory differences in individuals with autism spectrum disorder (ASD). Visual signals are initially processed in the retina, and in this study, we explored the hypotheses that the GABA-dependent retinal response to light is altered in individuals with ASD. Light-adapted electroretinograms were recorded from 61 adults (38 males and 23 females; n = 22 ASD) in response to three stimulus protocols: (1) the standard white flash, (2) the standard 30 Hz flickering protocol, and (3) the photopic negative response protocol. Participants were administered an oral dose of placebo, 15 or 30 mg of arbaclofen (STX209, GABAB agonist) in a randomized, double-blind, crossover order before the test. At baseline (placebo), the a-wave amplitudes in response to single white flashes were more prominent in ASD, relative to typically developed (TD) participants. Arbaclofen was associated with a decrease in the a-wave amplitude in ASD, but an increase in TD, eliminating the group difference observed at baseline. The extent of this arbaclofen-elicited shift significantly correlated with the arbaclofen-elicited shift in cortical responses to auditory stimuli as measured by using an electroencephalogram in our prior study and with broader autistic traits measured with the autism quotient across the whole cohort. Hence, GABA-dependent differences in retinal light processing in ASD appear to be an accessible component of a wider autistic difference in the central processing of sensory information, which may be upstream of more complex autistic phenotypes.

Updated review of wet pack complications in pulse vacuum pressure steam sterilisation processes in central sterile supply departments.

The quality of sterilisation and disinfection in a central sterile supply department is directly related to the quality of the hospital services and the patients' safety. Wet packs occasionally occur following the process of pressure steam sterilisation; reducing this occurrence is an important issue. Therefore, the causes of wet pack following sterilisation were analysed to identify the influencing factors and suggest improvements to prevent its occurrence. Understanding the sterilisation process and possible causes of exposure helps with risk assessment and identifying necessary corrective measures.

Exploratory evidence for differences in GABAergic regulation of auditory processing in autism spectrum disorder.

Altered reactivity and responses to auditory input are core to the diagnosis of autism spectrum disorder (ASD). Preclinical models implicate ϒ-aminobutyric acid (GABA) in this process. However, the link between GABA and auditory processing in humans (with or without ASD) is largely correlational. As part of a study of potential biosignatures of GABA function in ASD to inform future clinical trials, we evaluated the role of GABA in auditory repetition suppression in 66 adults (n = 28 with ASD). Neurophysiological responses (temporal and frequency domains) to repetitive standard tones and novel deviants presented in an oddball paradigm were compared after double-blind, randomized administration of placebo, 15 or 30 mg of arbaclofen (STX209), a GABA type B (GABAB) receptor agonist. We first established that temporal mismatch negativity was comparable between participants with ASD and those with typical development (TD). Next, we showed that temporal and spectral responses to repetitive standards were suppressed relative to responses to deviants in the two groups, but suppression was significantly weaker in individuals with ASD at baseline. Arbaclofen reversed weaker suppression of spectral responses in ASD but disrupted suppression in TD. A post hoc analysis showed that arbaclofen-elicited shift in suppression was correlated with autistic symptomatology measured using the Autism Quotient across the entire group, though not in the smaller sample of the ASD and TD group when examined separately. Thus, our results confirm: GABAergic dysfunction contributes to the neurophysiology of auditory sensory processing alterations in ASD, and can be modulated by targeting GABAB activity. These GABA-dependent sensory differences may be upstream of more complex autistic phenotypes.

Shared Three-Dimensional Robotic Arm Control Based on Asynchronous BCI and Computer Vision.

OBJECTIVE: A brain-computer interface (BCI) can be used to translate neuronal activity into commands to control external devices. However, using noninvasive BCI to control a robotic arm for movements in three-dimensional (3D) environments and accomplish complicated daily tasks, such as grasping and drinking, remains a challenge. APPROACH: In this study, a shared robotic arm control system based on hybrid asynchronous BCI and computer vision was presented. The BCI model, which combines steady-state visual evoked potentials (SSVEPs) and blink-related electrooculography (EOG) signals, allows users to freely choose from fifteen commands in an asynchronous mode corresponding to robot actions in a 3D workspace and reach targets with a wide movement range, while computer vision can identify objects and assist a robotic arm in completing more precise tasks, such as grasping a target automatically. RESULTS: Ten subjects participated in the experiments and achieved an average accuracy of more than 92% and a high trajectory efficiency for robot movement. All subjects were able to perform the reach-grasp-drink tasks successfully using the proposed shared control method, with fewer error commands and shorter completion time than with direct BCI control. SIGNIFICANCE: Our results demonstrated the feasibility and efficiency of generating practical multidimensional control of an intuitive robotic arm by merging hybrid asynchronous BCI and computer vision-based recognition.

Effects of Different Intervention Methods on Intestinal Cleanliness in Children Undergoing Colonoscopy.

Objective: To explore the effects of different intervention methods on intestinal cleanliness in children undergoing colonoscopy. Methods: 61 children who underwent colonoscopy in our hospital from May 2020 to May 2021 were randomly divided into group A (n = 21), group B (n = 30), and group C (n = 10). The children in the three groups were intervened in different ways before the colonoscopy. Group A received a long-handled Kaiselu +1 cathartic intervention, while group B received a long-handled Kaiselu +2 cathartic intervention, and group C received an enema plus one cathartic intervention. The patients in the three groups were given the same diet before the examination until the examination was completed. The time-related indexes, cleanliness, adverse reactions, tolerance, and adaptability of the three groups under different dietary interventions and cleaning methods were evaluated. Results: The first defecation time in group C was lower than that in group A and group B, the hospital stay was longer than that in group A and group B (p > 0.05), and the colonoscopy time in group C was shorter than that in group A and group B (p < 0.05). The BBPS score of group C was (2.10 ± 0.32), which was significantly higher than that of group A (1.16 ± 0.19) and group B (1.77 ± 0.18) (p < 0.05). The BBPS scores of children with liquid food in the three groups were significantly higher than those of common food, and the BBPS scores of liquid food and common food in group C were significantly higher than those in group A and group B (p < 0.05). The incidence of adverse reactions in group C was 20.00%, which was significantly lower than 33.33% in group A and 23.33% in group B (p < 0.05). The proportion of grade I in group C was 50.00%, which was significantly higher than 38.10% in group A and 43.33% in group B (p < 0.05). Conclusion: Children undergoing colonoscopy take preintestinal preparation under different diets and intervention methods. The cleanliness of liquid food and enema + one-time laxative one day before colonoscopy is the best, which can significantly reduce adverse reactions and increase the acceptability and adaptability of children. It is worthy of clinical application.

GABAB receptor modulation of visual sensory processing in adults with and without autism spectrum disorder.

Sensory atypicalities in autism spectrum disorder (ASD) are thought to arise at least partly from differences in γ-aminobutyric acid (GABA) receptor function. However, the evidence to date has been indirect, arising from correlational studies in patients and preclinical models. Here, we evaluated the role of GABA receptor directly, in 44 adults (n = 19 ASD). Baseline concentration of occipital lobe GABA+ (GABA plus coedited macromolecules) was measured using proton magnetic resonance spectroscopy (1H-MRS). Steady-state visual evoked potential (SSVEP) elicited by a passive visual surround suppression paradigm was compared after double-blind randomized oral administration of placebo or 15 to 30 mg of arbaclofen (STX209), a GABA type B (GABAB) receptor agonist. In the placebo condition, the neurotypical SSVEP response was affected by both the foreground stimuli contrast and background interference (suppression). In ASD, however, all stimuli conditions had equal salience and background suppression of the foreground response was weaker. In the placebo condition, although there was no difference in GABA+ between groups, GABA+ concentration positively correlated with response to maximum foreground contrast during maximum background interference in neurotypicals, but not ASD. In neurotypicals, sensitivity to visual stimuli was disrupted by 30 mg of arbaclofen, whereas in ASD, it was made more "typical" and visual processing differences were abolished. Hence, differences in GABAergic function are fundamental to autistic (visual) sensory neurobiology and are modulated by GABAB activity.

A Hybrid Asynchronous Brain-Computer Interface Combining SSVEP and EOG Signals.

OBJECTIVE: A challenging task for an electroencephalography (EEG)-based asynchronous brain-computer interface (BCI) is to effectively distinguish between the idle state and the control state while maintaining a short response time and a high accuracy when commands are issued in the control state. This study proposes a novel hybrid asynchronous BCI system based on a combination of steady-state visual evoked potentials (SSVEPs) in the EEG signal and blink-related electrooculography (EOG) signals. METHODS: Twelve buttons corresponding to 12 characters are included in the graphical user interface (GUI). These buttons flicker at different fixed frequencies and phases to evoke SSVEPs and are simultaneously highlighted by changing their sizes. The user can select a character by focusing on its frequency-phase stimulus and simultaneously blinking his/her eyes in accordance with its highlighting as his/her EEG and EOG signals are recorded. A multifrequency band-based canonical correlation analysis (CCA) method is applied to the EEG data to detect the evoked SSVEPs, whereas the EOG data are analyzed to identify the user's blinks. Finally, the target character is identified based on the SSVEP and blink detection results. RESULTS: Ten healthy subjects participated in our experiments and achieved an average information transfer rate (ITR) of 105.52 bits/min, an average accuracy of 95.42%, an average response time of 1.34 s and an average false-positive rate (FPR) of 0.8%. CONCLUSION: The proposed BCI generates multiple commands with a high ITR and low FPR. SIGNIFICANCE: The hybrid asynchronous BCI has great potential for practical applications in communication and control.

EEG- and EOG-Based Asynchronous Hybrid BCI: A System Integrating a Speller, a Web Browser, an E-Mail Client, and a File Explorer.

This paper presents a new asynchronous hybrid brain-computer interface (BCI) system that integrates a speller, a web browser, an e-mail client, and a file explorer using electroencephalographic (EEG) and electrooculography (EOG) signals. More specifically, an EOG-based button selection method, which requires the user to blink his/her eyes synchronously with the target button's flashes during button selection, is first presented. Next, we propose a mouse control method by combining EEG and EOG signals, in which the left-/right-hand motor imagery (MI)-related EEG is used to control the horizontal movement of the mouse and the blink-related EOG is used to control the vertical movement of the mouse and to select/reject a target. These two methods are further combined to develop the integrated hybrid BCI system. With the hybrid BCI, users can input text, access the internet, communicate with others via e-mail, and manage files in their computer using only EEG and EOG without any body movements. Ten healthy subjects participated in a comprehensive online experiment, and superior performance was achieved compared with our previously developed P300- and MI-based BCI and some other asynchronous BCIs, therefore demonstrating the system's effectiveness.

An EEG-/EOG-Based Hybrid Brain-Computer Interface: Application on Controlling an Integrated Wheelchair Robotic Arm System.

Most existing brain-computer Interfaces (BCIs) are designed to control a single assistive device, such as a wheelchair, a robotic arm or a prosthetic limb. However, many daily tasks require combined functions which can only be realized by integrating multiple robotic devices. Such integration raises the requirement of the control accuracy and is more challenging to achieve a reliable control compared with the single device case. In this study, we propose a novel hybrid BCI with high accuracy based on electroencephalogram (EEG) and electrooculogram (EOG) to control an integrated wheelchair robotic arm system. The user turns the wheelchair left/right by performing left/right hand motor imagery (MI), and generates other commands for the wheelchair and the robotic arm by performing eye blinks and eyebrow raising movements. Twenty-two subjects participated in a MI training session and five of them completed a mobile self-drinking experiment, which was designed purposely with high accuracy requirements. The results demonstrated that the proposed hBCI could provide satisfied control accuracy for a system that consists of multiple robotic devices, and showed the potential of BCI-controlled systems to be applied in complex daily tasks.

An EOG-based wheelchair robotic arm system for assisting patients with severe spinal cord injuries.

OBJECTIVE: In this study, we combine a wheelchair and an intelligent robotic arm based on an electrooculogram (EOG) signal to help patients with spinal cord injuries (SCIs) accomplish a self-drinking task. The main challenge is to accurately control the wheelchair to ensure that the randomly located object is within a limited reachable space of the robotic arm (length: 0.8 m; width: 0.4 m; height: 0.6 m), which requires decimeter-level precision, and is still undemonstrated for EOG-based systems as well as EEG-based systems. APPROACH: A novel high-precision EOG-based human machine interface (HMI) is proposed which can effectively translate two kinds of eye movements (i.e. blinking and eyebrow raising) into various commands. For the wheelchair, positional precision can reach decimeter-level and the minimal steering angle is [Formula: see text]. For the intelligent robotic arm, shared control is implemented based on an EOG-based HMI, two cameras and the arm's own intelligence. MAIN RESULTS: After brief training, five healthy subjects and five paralyzed patients with severe SCIs successfully completed three experiments. For the healthy subjects/patients with SCIs, the system achieved an average accuracy of 99.3%/97.3%, an average response time of 1.91 s/2.02 s per command and an average stop-response time of 1.30 s/1.36 s with a 0 false operation rate. SIGNIFICANCE: The EOG-based HMI can provide sufficient precision control to integrate a wheelchair and a robotic arm into a system which can help patients with SCIs to accomplish a self-drinking task. (ChiCTR1800019764).

An EOG-Based Human-Machine Interface to Control a Smart Home Environment for Patients With Severe Spinal Cord Injuries.

OBJECTIVE: This paper presents an asyn-chronous electrooculography (EOG)-based human-machine interface (HMI) for smart home environmental control with the purpose of providing daily assistance for severe spinal cord injury (SCI) patients. METHODS: The proposed HMI allows users to interact with a smart home environment through eye blinking. Specifically, several buttons, each corresponding to a control command, randomly flash on a graphical user interface. Each flash of the buttons functions as a visual cue for the user to blink. To issue a control command, the user can blink synchronously with the flashes of the corresponding button. Through detecting blinks based on the recorded EOG signal, the target button and its corresponding control command are determined. Seven SCI patients participated in an online experiment, during which the patients were required to control a smart home environment including household electrical appliances, an intelligent wheelchair, as well as a nursing bed via the proposed HMI. RESULTS: The average false operation ratio in the control state was 4.1%, whereas during the idle state, no false operations occurred. CONCLUSION: All SCI patients were able to control the smart home environment using the proposed EOG-based HMI with satisfactory performance in terms of the false operation ratio in both the control and the idle states. SIGNIFICANCE: The proposed HMI offers a simple and effective approach for patients with severe SCIs to control a smart home environment. Therefore, it is promising to assist severe SCI patients in their daily lives.

An EOG-Based Human-Machine Interface for Wheelchair Control.

OBJECTIVE: Nonmanual human-machine interfaces (HMIs) have been studied for wheelchair control with the aim of helping severely paralyzed individuals regain some mobility. The challenge is to rapidly, accurately, and sufficiently produce control commands, such as left and right turns, forward and backward motions, acceleration, deceleration, and stopping. In this paper, a novel electrooculogram (EOG) based HMI is proposed for wheelchair control. METHODS: A total of 13 flashing buttons, each of which corresponds to a command, are presented in the graphical user interface. These buttons flash on a one-by-one manner in a predefined sequence. The user can select a button by blinking in sync with its flashes. The algorithm detects the eye blinks from a channel of vertical EOG data and determines the user's target button based on the synchronization between the detected blinks and the button's flashes. RESULTS: For healthy subjects/patients with spinal cord injuries, the proposed HMI achieved an average accuracy of 96.7% / 91.7% and a response time of 3.53 s/3.67 s with 0 false positive rates (FPRs). CONCLUSION: Using one channel of vertical EOG signals associated with eye blinks, the proposed HMI can accurately provide sufficient commands with a satisfactory response time. SIGNIFICANCE: The proposed HMI provides a novel nonmanual approach for severely paralyzed individuals to control a wheelchair. Compared with a newly established EOG-based HMI, the proposed HMI can generate more commands with higher accuracy, lower FPR, and fewer electrodes.

[Multicomponent Content Difference Among Different Processing Degrees of Moutan Cortex Charcoal].

Objective: To establish a method of simultaneously determining gallic acid,5-HMF,catechin and paeonol in the different processing degrees of Moutan Cortex charcoal by HPLC,and to compare the difference. Methods: The HPLC separation was carried out on a UltimateTMXB-C18column( 250 mm × 4. 6 mm,5 µm) with a mobile phase of acetonitrile and water containing 0. 5% formic acid. The flow rate was 1. 0 m L / min at 30 ℃ column temperature,and the detection wavelength was 245 nm. Results: The contents of gallic acid and 5-HMF were increased with the extension of processing time,but declined when it reached to a certain extent. And the contents of catechin and paeonol were decreased in the heating process. Conclusion: The differences of compounds content in different processing degree of Moutan Cortex charcoal were greatly. It provides a scientific basis for quality standard of Moutan Cortex charcoal.