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1.
Spine (Phila Pa 1976) ; 46(21): 1485-1494, 2021 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-34618709

RESUMEN

STUDY DESIGN: A prospective single center observational study. OBJECTIVES: The aim of this study was to examine the potential role of sonication in the diagnosis of low-grade infections and its association with pedicle screw (PS) loosening, and to describe risk factors and radiological findings associated with spinal implant infection. SUMMARY OF BACKGROUND DATA: Although PS loosening has mainly been attributed to mechanical overload, implant colonization and biofilm formation have recently been suggested. Culturing of sonication fluid implants is promising in the field of spine instrumentation infection, but little data are available. METHODS: We prospectively included all patients who were subjected to implant removal. PS loosening was assessed with computed tomography (CT) scan. Different clinical and radiological parameters which could serve as indicators of implant infection were studied. RESULTS: Thirty-eight patients were included in the study and 11 of them (29%) had a positive sonication result. Patients with spinal implant infection were associated with screw loosening (P = 0.005). Particularly, those screws with a positive microbiological culture showed signs of screw loosening in the preoperative CT scan (P < 0.001). Our results also showed that radiological screw loosening at L1-L3 level, and loosened larger constructs were associated with screw microbial colonization. The most common isolated microorganisms were coagulase-negative staphylococci and Cutibacterium acnes. An implant-based multivariate analysis indicated that screw loosening, the absence of prophylactic cefazolin, ICU hospitalization, screw breakage, and L1-L3 spine level were independent risk factors for implant-associated infection. Our model exhibited a high predictive power with an area under the curve of 0.937. CONCLUSION: As clinical presentation of deep implant chronic infection is unspecific, consideration of these factors enables preoperative prediction and risk stratification of implant colonization, thus helping patient's management.Level of Evidence: 3.


Asunto(s)
Tornillos Pediculares , Sonicación , Falla de Equipo , Humanos , Vértebras Lumbares , Estudios Prospectivos
2.
Sensors (Basel) ; 21(19)2021 Sep 29.
Artículo en Inglés | MEDLINE | ID: mdl-34640839

RESUMEN

DC-DC converters are widely used in a large number of power conversion applications. As in many other systems, they are designed to automatically prevent dangerous failures or control them when they arise; this is called functional safety. Therefore, random hardware failures such as sensor faults have to be detected and handled properly. This proper handling means achieving or maintaining a safe state according to ISO 26262. However, to achieve or maintain a safe state, a fault has to be detected first. Sensor faults within DC-DC converters are generally detected with hardware-redundant sensors, despite all their drawbacks. Within this article, this redundancy is addressed using observer-based techniques utilizing Extended Kalman Filters (EKFs). Moreover, the paper proposes a fault detection and isolation scheme to guarantee functional safety. For this, a cross-EKF structure is implemented to work in cross-parallel to the real sensors and to replace the sensors in case of a fault. This ensures the continuity of the service in case of sensor faults. This idea is based on the concept of the virtual sensor which replaces the sensor in case of fault. Moreover, the concept of the virtual sensor is broader. In fact, if a system is observable, the observer offers a better performance than the sensor. In this context, this paper gives a contribution in this area. The effectiveness of this approach is tested with measurements on a buck converter prototype.


Asunto(s)
Algoritmos , Falla de Equipo , Análisis de Falla de Equipo
3.
PLoS One ; 16(10): e0253818, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34705838

RESUMEN

INTRODUCTION: The catheter is the only intravascular portion of an implanted port and plays a crucial role in catheter related complications. Both polyurethane and silicone are biocompatible materials which are utilized for catheter manufacturing, but their correlation to complications remains controversial. The aim of this study was to try to analyze the relationship between catheter materials and complications. MATERIALS AND METHODS: A total of 3144 patients who underwent intravenous port implantation between March 2012 and December 2018 at Chang Gung Memorial Hospital, Linkou, Taiwan were recruited. Of these, 1226 patients received silicone catheter port implantation and 1679 received polyurethane catheter ports. Case matching was done prior to analysis and catheter related complications and cumulative complication incidence for each group were compared. RESULTS: Intergroup differences were identified in entry vessel (p = 0.0441), operation year (p < 0.0001), operation method (p = 0.0095), functional period (p < 0.0001), patient follow up status (p < 0.0001), operating time for vessel cutdown (p < 0.0001) and wire assisted approach (p = 0.0008). Stratified by specific entry vessel, no statistical difference was found in complication rate or incidence between the silicone and polyurethane groups. We further compared the cumulative complication incidence of the silicone and polyurethane groups, and also found no statistical difference (p = 0.4451). CONCLUSION: As long as external stress forces generated by surrounding structures and focused on potential weak points are avoided, both silicone and polyurethane materials provide sufficient structural stability to serve as reliable vascular access for patients.


Asunto(s)
Cateterismo Venoso Central/métodos , Vena Cava Superior/química , Administración Intravenosa/métodos , Catéteres de Permanencia , Falla de Equipo , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Rendimiento Físico Funcional , Poliuretanos/química , Siliconas/química , Taiwán
4.
BMC Med Inform Decis Mak ; 21(1): 295, 2021 10 28.
Artículo en Inglés | MEDLINE | ID: mdl-34711186

RESUMEN

BACKGROUND: Occlusions of intravenous (IV) tubing can prevent vital and time-critical medication or solutions from being delivered into the bloodstream of patients receiving IV therapy. At low flow rates (≤ 1 ml/h) the alarm delay (time to an alert to the user) can be up to 2 h using conventional pressure threshold algorithms. In order to reduce alarm delays we developed and evaluated the performance of two new real-time occlusion detection algorithms and one co-occlusion detector that determines the correlation in trends in pressure changes for multiple pumps. METHODS: Bench-tested experimental runs were recorded in triplicate at rates of 1, 2, 4, 8, 16, and 32 ml/h. Each run consisted of 10 min of non-occluded infusion followed by a period of occluded infusion of 10 min or until a conventional occlusion alarm at 400 mmHg occurred. The first algorithm based on binary logistic regression attempts to detect occlusions based on the pump's administration rate Q(t) and pressure sensor readings P(t). The second algorithm continuously monitored whether the actual variation in the pressure exceeded a threshold of 2 standard deviations (SD) above the baseline pressure. When a pump detected an occlusion using the SD algorithm, a third algorithm correlated the pressures of multiple pumps to detect the presence of a shared occlusion. The algorithms were evaluated using 6 bench-tested baseline single-pump occlusion scenarios, 9 single-pump validation scenarios and 7 multi-pump co-occlusion scenarios (i.e. with flow rates of 1 + 1, 1 + 2, 1 + 4, 1 + 8, 1 + 16, and 1 + 32 ml/h respectively). Alarm delay was the primary performance measure. RESULTS: In the baseline single-pump occlusion scenarios, the overall mean ± SD alarm delay of the regression and SD algorithms were 1.8 ± 0.8 min and 0.4 ± 0.2 min, respectively. Compared to the delay of the conventional alarm this corresponds to a mean time reduction of 76% (P = 0.003) and 95% (P = 0.001), respectively. In the validation scenarios the overall mean ± SD alarm delay of the regression and SD algorithms were respectively 1.8 ± 1.6 min and 0.3 ± 0.2 min, corresponding to a mean time reduction of 77% and 95%. In the multi-pump scenarios a correlation > 0.8 between multiple pump pressures after initial occlusion detection by the SD algorithm had a mean ± SD alarm delay of 0.4 ± 0.2 min. In 2 out of the 9 validation scenarios an occlusion was not detected by the regression algorithm before a conventional occlusion alarm occurred. Otherwise no occlusions were missed. CONCLUSIONS: In single pumps, both the regression and SD algorithm considerably reduced alarm delay compared to conventional pressure limit-based detection. The SD algorithm appeared to be more robust than the regression algorithm. For multiple pumps the correlation algorithm reliably detected co-occlusions. The latter may be used to localize the segment of tubing in which the occlusion occurs. Trial registration Not applicable.


Asunto(s)
Bombas de Infusión , Preparaciones Farmacéuticas , Algoritmos , Falla de Equipo , Humanos , Presión
5.
Int J Oral Maxillofac Implants ; 36(5): e121-e140, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34698720

RESUMEN

PURPOSE: Dynamic navigation is a technique that allows for the placement of dental implants using a computer-guided approach according to preoperative planning. Its accuracy has been assessed in several previous studies. The purpose of this study was to summarize data on implant placement accuracy using dynamic navigation, to synthesize the frequency of intraoperative complications and implant failures, and to compare this technique with static computer-guided surgery and a freehand approach. MATERIALS AND METHODS: Electronic and manual literature searches until December 2019 were performed. The outcome variables were implant placement accuracy using dynamic navigation, accuracy differences between dynamic and static techniques and between dynamic and freehand techniques, intraoperative complications, and implant failures. Random-effects meta-analyses were performed. RESULTS: A total of 32 studies were included; 29 reported accuracy values (2,756 implants), and 10 focused on complications and implant failures (1,039 implants). The pooled mean implant placement errors were 0.81 (95% CI: 0.677 to 0.943) mm at the entry point and 0.910 (95% CI: 0.770 to 1.049) mm at the apical point. The pooled mean vertical and angular deviations were 0.899 (95% CI: 0.721 to 1.078) mm and 3.807 (95% CI: 3.083 to 4.530) degrees. The navigation group showed significantly lower implant placement errors with respect to the freehand technique (P < .01) and similar accuracy values (P ≥ .05) compared with the static technique. The pooled prevalence of failures was 1% (95% CI: 0.00% to 2%). CONCLUSION: Dynamic navigation provided small implant placement errors, comparable with those obtained using static computer-guided surgery, and can be considered a more accurate technique than conventional freehand surgery.


Asunto(s)
Implantes Dentales , Cirugía Asistida por Computador , Implantación Dental Endoósea , Falla de Equipo , Humanos , Complicaciones Intraoperatorias
6.
Medicine (Baltimore) ; 100(42): e27492, 2021 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-34678880

RESUMEN

ABSTRACT: With the rapid development of medical technology, the use of electrosurgical instruments is dramatically increased in various types of surgery. However, the damage of the insulation layer of the reusable electrosurgical instrument often causes surgical accidents. The procedures of packaging and cleaning contribute to many damages to insulating layer of reusable electrosurgical instruments.Various types of reusable electrosurgical instruments were detected for insulation failures, conduction failures, short-circuit by using a high-voltage detector, DIATEG (Morgate company). In addition, reusable electrosurgical instruments were detected for insulation failures after packaging and cleaning by different procedures.13.1% (129/740) electrosurgical instruments had an insulation test failure; 6.2% (9/146) monopolar wires were with conduction failure; and 7.7% (16/207) bipolar wires were with short-circuit. Different packaging and cleaning procedures contribute to various degrees of damages to insulating property of reusable electrosurgical instruments.Insulation failure was a wide problem of reusable electrosurgical instruments, while fixed packaging method and mild cleaning procedures result in fewer damages to insulating property of reusable electrosurgical instruments.


Asunto(s)
Electrocirugia/instrumentación , Falla de Equipo , Embalaje de Productos/métodos , Esterilización/métodos , Instrumentos Quirúrgicos , Humanos
7.
J Long Term Eff Med Implants ; 31(4): 1-4, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34587408

RESUMEN

This study was designed to increase understanding of mini-implants as well as causes of mini-implant complications and failure in orthodontic patients. Orthodontic case sheets were evaluated to identify retraction in mini-implant cases. Samples were taken and tabulated to determine causes and sites of mini-implant failure. The overall success rate of mini-implants over a period of 3 months postplacement follow-up was 83.5%, indicating that screw implants can be used for orthodontic anchorage. To minimize failure, clinicians should attempt to reduce inflammation around screw implants.


Asunto(s)
Implantes Dentales , Métodos de Anclaje en Ortodoncia , Tornillos Óseos , Implantes Dentales/efectos adversos , Falla de Equipo , Humanos , Prevalencia
8.
J Endod ; 47(12): 1924-1932, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34534555

RESUMEN

INTRODUCTION: This study aimed to compare ProGlider (Dentsply Sirona, Ballaigues, Switzerland) and R-Pilot (VDW, Munich, Germany) instruments in terms of their cyclic fatigue resistance using an artificial stainless steel canal showing an abrupt apical curvature, torsional resistance according to the ISO specification, and topographic changes on the instrument surface after glide path management in mesial canals of mandibular first molars with the abrupt curvature selected based on their micro-computed tomographic examination. METHODS: Eighty instruments were used: 40 ProGlider (size 0.16, .02v taper) and 40 R-Pilot (size 0.125, .04 taper) instruments. The cyclic fatigue resistance was tested in a static test model using an artificial canal with an abrupt apical curvature (angle of curvature of 90° and radius of curvature of 2 mm). The torsional resistance test was performed according to ISO 3630-1 specifications. To determine surface topography of the unused and used instruments, mesial root canals of mandibular molars with an abrupt apical curvature were selected to prepare a glide path with either the ProGlider or R-Pilot instrument. An optical profilometer and scanning electron microscopy were used to determine the surface properties. Normally distributed torsional and cyclic resistance data were analyzed using the Student t test, whereas quantitative data obtained by the optical profilometer were analyzed with the Kruskal-Wallis H test with a 5% significance threshold. RESULTS: The R-Pilot showed significantly higher cyclic fatigue and torsional resistance than the ProGlider (P < .05). Angular deflection values were similar between instruments (P < .05). Measurements made from the blade area showed that the surface roughness values of the ProGlider were larger. Cutting blade measurements showed that unused instruments had significantly greater roughness values than used ones (P < .05). Although there was a 14% increase between the blade edge radii of the used and unused R-Pilot instruments, this difference was determined as 61% in ProGlider instruments. CONCLUSIONS: The R-Pilot exhibited greater cyclic fatigue strength than the ProGlider when tested in an artificial canal with an inner diameter of 1.0 mm and an abrupt apical curvature. Torsional resistance of the R-Pilot was higher than the ProGlider, but the angular deflection values were similar. Glide path preparation in a mesial root canal with an abrupt apical curvature did not increase the surface roughness of both instruments but resulted in a greater blade edge radius.


Asunto(s)
Instrumentos Dentales , Preparación del Conducto Radicular , Diseño de Equipo , Falla de Equipo , Humanos , Ensayo de Materiales , Titanio
9.
J Invasive Cardiol ; 33(9): E748-E749, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34473075

RESUMEN

Owing to the demonstrated safety and cost-effectiveness, balloon mitral valvuloplasty is frequently performed using reused hardware. However, chances of hardware malfunction are higher in such settings, making it pertinent for operators to be adept at recognition and management of such complications. This case illustrates that when the rent is small, a coronary balloon may be used to tackle the inflation failure.


Asunto(s)
Valvuloplastia con Balón , Procedimientos Quirúrgicos Cardíacos , Estenosis de la Válvula Mitral , Valvuloplastia con Balón/efectos adversos , Falla de Equipo , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/diagnóstico , Estenosis de la Válvula Mitral/cirugía
10.
Anesth Analg ; 133(5): 1296-1302, 2021 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-34473654

RESUMEN

BACKGROUND: The erector spinae block is an efficacious analgesic option for the management of rib fracture--related pain. Despite there being minimal published data specifically addressing the safety profile of this block, many societies have made statements regarding its safety and its use as an alternative to traditional regional anesthesia techniques in patients at risk of complications. The primary aim of this study was to characterize the safety profile of erector spinae plane block catheters by determining the incidence of early complications. The secondary aim of this study was to characterize the incidence of late adverse events, as well as the erector spinae plane block catheter failure rate. METHODS: We analyzed electronic medical record data of patients who had an erector spinae plane block catheter inserted for the management of rib fractures between November 2017 and September 2020. To assess early adverse events, data collection included hypotension, hypoxemia, local anesthetic systemic toxicity, and pneumothorax thought to be associated with erector spinae plane block catheter insertion. Late complications included catheter site infection and catheter site hematoma. RESULTS: A total of 224 patients received 244 continuous erector spinae catheters during the study period. After insertion of the erector spinae, there were no immediate complications such as hypotension, hypoxia, local anesthetic toxicity, or pneumothorax. Of all blocks inserted, 7.7% were removed due to catheter failure (8.4 per 100 catheters; 95% confidence interval [CI], 5.1-13.9 per 100 catheters). This resulted in a failure rate of 1.9 per 1000 catheter days (95% CI, 1.1-6.7 catheter days). Late complications included 2 erythematous catheter sites and 2 small hematomas not requiring intervention. The incidence of a minor late complication was 16.7 per 1000 catheters (95% CI, 6.1-45.5 per 1000 catheters). CONCLUSIONS: This study supports the statements made by regional anesthesia societies regarding the safety of the erector spinae plane block. Based on the results presented in this population of trauma patients, the erector spinae plane block catheter is a low-risk analgesic technique that may be performed in the presence of abnormal coagulation status or systemic infection.


Asunto(s)
Anestésicos Locales/administración & dosificación , Catéteres de Permanencia , Bloqueo Nervioso/instrumentación , Manejo del Dolor/instrumentación , Fracturas de las Costillas/terapia , Anciano , Anestésicos Locales/efectos adversos , Infecciones Relacionadas con Catéteres/etiología , Catéteres de Permanencia/efectos adversos , Remoción de Dispositivos , Registros Electrónicos de Salud , Falla de Equipo , Femenino , Hematoma/etiología , Humanos , Masculino , Persona de Mediana Edad , Bloqueo Nervioso/efectos adversos , Manejo del Dolor/efectos adversos , Seguridad del Paciente , Estudios Retrospectivos , Fracturas de las Costillas/diagnóstico por imagen , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
11.
Int Heart J ; 62(5): 1156-1159, 2021 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-34544971

RESUMEN

A rare complication about "Twiddler syndrome" is reported, and an interesting image about "double twist" is presented. A 78-year-old woman received a single-chamber implantable cardioverter defibrillator (ICD) for secondary prevention of ventricular arrhythmia. After she played mahjong (a traditional Chinese board game) overnight, her ICD lead sense amplitude decreased suddenly and did not recover. The intracardiac electrogram of ICD also found ventricular lead noise before this episode. Chest radiography revealed a twisted lead at the ICD pocket and a twisted and retracted ICD lead in the right atrium. An old ICD lead could not be straightened and removed, and a new ICD lead was implanted at the right ventricle. Anti-coagulation was used to prevent thrombosis for the old ICD lead.


Asunto(s)
Desfibriladores Implantables/efectos adversos , Electrodos Implantados/efectos adversos , Prevención Secundaria/métodos , Taquicardia Ventricular/cirugía , Anciano , Anticoagulantes/uso terapéutico , Remoción de Dispositivos/instrumentación , Electrocardiografía/métodos , Falla de Equipo , Femenino , Ventrículos Cardíacos/fisiopatología , Ventrículos Cardíacos/cirugía , Humanos , Trombosis/prevención & control , Resultado del Tratamiento
12.
Ann R Coll Surg Engl ; 103(8): e252-e254, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34464573

RESUMEN

Synthetic mesh is often utilised for reinforcement in pelvic organ prolapse surgery. Mesh erosion to surrounding structures is a recognised complication following sacrocolpopexy, but translocation to the vagina is more common. We report an unusual case of delayed asymptomatic erosion of the mesh into the rectum 12 years after sacrocolpopexy.


Asunto(s)
Cuerpos Extraños/patología , Recto/patología , Mallas Quirúrgicas/efectos adversos , Anciano , Colonoscopía , Falla de Equipo , Femenino , Humanos
13.
Adv Skin Wound Care ; 34(9): 1-6, 2021 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-34415257

RESUMEN

OBJECTIVE: To investigate the protective effect of a hydrocolloid nasal dressing on the incidence and severity of nasal injury and continuous positive airway pressure (CPAP) failure in preterm infants receiving nasal CPAP (N-CPAP). METHODS: A randomized controlled trial was conducted over 4 months in 2019 at level 3 neonatal ICUs in two hospitals affiliated with Isfahan University of Medical Sciences, Iran. Eighty eligible infants were born at 32 weeks of gestation or younger and/or with a birth weight of 1,500 g or less and had received between 4 and 72 hours of CPAP. Infants were randomly assigned to two groups; the intervention group used a protective dressing, and the control group received routine care. Data collection tools included a demographic questionnaire and nasal injury assessment score chart. MAIN OUTCOME MEASURES: The incidence and severity of nasal injury in preterm infants undergoing N-CPAP. RESULTS: Infants in the intervention group had a significantly lower incidence and severity of nasal injury compared with the control group: 15 of 40 (37.5%) versus 37 of 40 (92.5%; P < .001). Overall, the injuries identified in this study were mostly mild and moderate, with only three severe injuries in the intervention group and five in the control group. No significant differences were detected in CPAP failure (P > .05). CONCLUSIONS: The studied nasal barrier dressing is a safe and convenient solution to reduce nasal injury in preterm infants receiving N-CPAP.


Asunto(s)
Vendajes/normas , Presión de las Vías Aéreas Positiva Contínua/estadística & datos numéricos , Falla de Equipo/estadística & datos numéricos , Heridas y Lesiones/etiología , Vendajes/estadística & datos numéricos , Presión de las Vías Aéreas Positiva Contínua/efectos adversos , Presión de las Vías Aéreas Positiva Contínua/métodos , Femenino , Humanos , Incidencia , Recién Nacido , Recien Nacido Prematuro/fisiología , Unidades de Cuidado Intensivo Neonatal/organización & administración , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Irán/epidemiología , Masculino , Síndrome de Dificultad Respiratoria/epidemiología , Síndrome de Dificultad Respiratoria/terapia , Heridas y Lesiones/epidemiología
14.
Medicine (Baltimore) ; 100(31): e26770, 2021 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-34397823

RESUMEN

OBJECTIVE: Current methods for the diagnosis of ventriculoperitoneal (VP) shunt malfunction lack specific standards; therefore, it may be missed or misdiagnosed. Hence, providing a reliable diagnostic method will help improve the accuracy of preoperative decision-making. Therefore, the aim of the study was to provide a new method for the diagnosis of VP shunt malfunction. METHODS: After in vitro testing, we enrolled a total of 12 patients with VP shunt malfunction. Before revision surgery, 0.1 mL of a 5% sodium valproate (SV) solution was injected into the reservoir; 0.1 mL of the cerebrospinal fluid (CSF) was withdrawn 20 minutes later from the reservoir to measure the SV concentration. The process was repeated on the seventh day after surgery and compared with the preoperative results. RESULTS: The mean ±â€Šstandard deviation preoperative SV concentration in the cerebrospinal fluid was greater than the postoperative concentration (5967.8 ±â€Š1281.3 vs 391.1 ±â€Š184.6 µg/mL, P = .001). CONCLUSION: The proposed method is a reliable, safe, and relatively simple alternative for the diagnosis of VP shunt malfunction and further provides a reference for treatment.


Asunto(s)
Falla de Equipo , Técnicas de Dilución del Indicador/instrumentación , Derivación Ventriculoperitoneal/instrumentación , Adulto , Femenino , Humanos , Hidrocefalia/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Estándares de Referencia , Derivación Ventriculoperitoneal/efectos adversos
15.
Emerg Med J ; 38(10): 776-779, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34429370

RESUMEN

BACKGROUND: We aimed to determine the incidence, nature of and predisposing factors for risk events (REs) that occur during the intrahospital transport of patients from the ED. METHODS: We undertook a prospective, observational study of intrahospital patient transports from a single ED between 30 January and 20 March 2020. An investigator attended each transport and recorded any RE on a specifically designed data collection document. An RE was any mishap, even if not foreseen, that had the potential to cause the patient harm. A patient equipment number was assigned based on the number of pieces of equipment required during the transport. Poisson regression generated incidence rate ratios (IRRs) and determined risk factors for REs. RESULTS: Of 738 transports, 289 (39.1%, 95% CI 35.6% to 42.8%) had at least one RE. The total of 521 REs comprised 125 patient-related, 279 device-related and 117 line/catheter-related REs. The most common included trolley collisions (n=142), intravenous fluid line catching/tangling (n=93), agitation/aggression events (n=31) and cardiac monitoring issues (n=31). Thirty-four (6.5%) REs resulted in an undesirable patient outcome, most commonly distress and pain. Predisposing factors for REs included an equipment number ≥3 (IRR 5.68, 95% CI 3.95 to 8.17), transport to a general ward (IRR 2.68, 95% CI 2.12 to 3.39), hypertension (IRR 1.93, 95% CI 1.07 to 3.50), an abnormal temperature and a GCS<14. CONCLUSIONS: REs are common in transport of patients from the ED and can result in undesirable patient outcomes. Adequate pre-transfer preparation, especially securing equipment and lines, would result in a reduced risk.


Asunto(s)
Servicio de Urgencia en Hospital/normas , Transferencia de Pacientes/normas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Enfermedad Crítica/terapia , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Falla de Equipo/estadística & datos numéricos , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Transferencia de Pacientes/clasificación , Transferencia de Pacientes/estadística & datos numéricos , Estudios Prospectivos , Agitación Psicomotora/tratamiento farmacológico , Agitación Psicomotora/prevención & control , Factores de Riesgo , Victoria
16.
J Endod ; 47(10): 1657-1663, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34298031

RESUMEN

Two cases are reported to present the "Burrow platform" (BP) technique. The BP technique uses a partial platform for retrieving instrument fragments, thereby reducing the loss of radicular dentin.The BP technique is a microscope-aided approach implementing coated ultrasonic tips to create an access to instrument fragments in the middle and apical thirds of the root canal. The technique consists of 4 steps: (1) coronal access, (2) radicular access, (3) partial platform, and (4) exposure of the fragment and retrieval. A precise, angulated access pathway is specific to the BP technique. In the coronal half, the radicular access pathway extends toward the outer wall of the curvature. In the apical half, the radicular access pathway is oriented toward the inside of the curvature. One and 4 instrument fragments were successfully retrieved in the respective cases. At follow-up, all teeth were asymptomatic and had responded favorably to the treatment.The BP technique may present a suitable alternative to fragment removal from curved canals and slender roots to avoid ledge formation, transportation, and perforation. Instrument retrieval using the BP technique can be performed using commonly available armamentarium.


Asunto(s)
Cuerpos Extraños , Preparación del Conducto Radicular , Cavidad Pulpar/diagnóstico por imagen , Cavidad Pulpar/cirugía , Falla de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tratamiento del Conducto Radicular
19.
J Contemp Dent Pract ; 22(4): 427-434, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-34267014

RESUMEN

AIM: The aim of this systemic review is to investigate these parameters by analyzing the characteristics of fractured instruments to determine which is the most relevant mechanical stress that induces intracanal separation in vivo. BACKGROUND: The fracture of nickel-titanium (Ni-Ti) instruments is a result of flexural fatigue and torsional fatigue. An electronic search was conducted in MEDLINE database, Web of Science, and Cochrane following preferred reporting items for systematic reviews and meta-analyses guidelines. Data were collected and the key features from the included studies were extracted. Overview quality assessment questionnaire scoring assessed the quality of the articles. A total of 12 articles were selected, where the lowest score was 13. REVIEW RESULTS: Considering Ni-Ti rotary instruments, this overall evaluation comprehends 939 broken instruments with an incidence of fracture of 5%. Out of the 12 selected articles, 10 studies revealed that flexural failure was the predominant mode (range of 62-92%). It appears that motion plays an important role when it comes to mechanisms of fracture. The majority of defects found in hand-operated instruments were in the form of torsional failure. Although the major cause of separation of rotary instruments is flexural fatigue, smaller instruments show more torsional fracture than the larger instruments. The average fragment length was found to be 2.5 mm and 3.35 mm, respectively, for torsional failure and flexural failure. The risk of bias depends on fractographic analysis. CONCLUSION: Flexural fatigue is the predominant mode of fracture in rotary Ni-Ti instruments. The type of motion and size of the instrument seem to affect the mechanism of fracture. Fragment length may show a strong association with the type of fracture mechanism. CLINICAL SIGNIFICANCE: This systemic review found that flexural fatigue is the most relevant mechanical stress that induces intracanal separation in vivo. Moreover, in clinical practice, the fragment length might be an excellent indicator of the type of fracture.


Asunto(s)
Níquel , Titanio , Aleaciones Dentales , Instrumentos Dentales , Diseño de Equipo , Falla de Equipo , Incidencia , Preparación del Conducto Radicular , Estrés Mecánico , Torsión Mecánica
20.
Br J Nurs ; 30(14): S24-S32, 2021 Jul 22.
Artículo en Inglés | MEDLINE | ID: mdl-34288746

RESUMEN

HIGHLIGHTS: 2% taurolidine catheter lock solution without additives is safe and efficient. CRBSI and dysfunction rates compare favorably against other studies in hemodialysis. BACKGROUND: In hemodialysis patients, catheter-related bloodstream infection (CRBSI) and catheter dysfunction are common and cause significant morbidity, mortality, and costs. Catheter lock solutions reduce CRBSI and catheter dysfunction rates, but solutions containing heparin, citrate, or antibiotics are associated with adverse effects. Due to its antimicrobial and antithrombotic properties and benign safety profile, taurolidine is suitable for use in catheter lock solutions. In this study the effectiveness and safety of a catheter lock solution containing 2% taurolidine without citrate or heparin (TauroSept®, Geistlich Pharma AG, Wolhusen, Switzerland) in hemodialysis patients were investigated for the first time. METHODS: Data from 21 patients receiving chronic hemodialysis via tunneled central venous catheters with 2% taurolidine solution as a catheter lock were analyzed in a single-center retrospective study and compared with the existing literature in a review. The primary endpoint was CRBSI rate. Secondary endpoints included catheter dysfunction, treatment, and costs; catheter technical problems, resolution, and costs; and adverse events. Data were compared to outcomes with standard lock solutions in the literature. RESULTS: No CRBSIs occurred during the observation period of 5,639 catheter days. The catheter dysfunction rate was 0.71 per 1,000 catheter days, and the catheter dysfunction treatment costs were CHF (Swiss Franc) 543 per patient. No technical problems or adverse events related to the use of 2% taurolidine-containing catheter lock solution were observed. These results compare favorably with other catheter lock solutions. CONCLUSIONS: A solution containing 2% taurolidine seems suitable as a hemodialysis catheter lock. In a Swiss cohort, it prevented CRBSI, limited catheter dysfunction, and was cost-efficient.


Asunto(s)
Bacteriemia , Infecciones Relacionadas con Catéteres , Catéteres Venosos Centrales , Taurina/análogos & derivados , Tiadiazinas , Bacteriemia/etiología , Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/prevención & control , Catéteres Venosos Centrales/efectos adversos , Falla de Equipo , Humanos , Diálisis Renal/instrumentación , Estudios Retrospectivos , Suiza , Taurina/uso terapéutico , Tiadiazinas/uso terapéutico
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