Comparison of the outcome of emergency endotracheal intubation in the general ward, intensive care unit and emergency department.

BACKGROUND: Emergency endotracheal intubations outside the operating room (OR) are associated with high complications. We compare the outcome of emergency endotracheal intubation in the general ward, the intensive care unit (ICU) and the emergency department (ED). METHODS: We retrospectively analyzed adult patients requiring emergency endotracheal intubation that called for anesthesiologists at our tertiary care institution from January 1, 2015 to December 31, 2016. We evaluated the outcomes, including aspiration, hemodynamic collapse, pneumothorax, emergency tracheostomy, and survival to hospital discharge in the general ward, ICU, and ED. RESULTS: There were 416 non-OR emergency endotracheal intubation calls for the anesthesiologist. Among these areas, the ED had the highest proportion of difficult endotracheal (DET) intubation (n = 144 [80.4%]), followed by the general ward (n = 85 [66.4%]), and then the ICU (n = 65 [59.6%]). The incidence of hemodynamic collapse was higher in the general ward (n = 44 [34.4%]) than the ICU (n = 18 [16.5%]) or the ED (n = 16 [9.0%]). We reported the survival rate of the general ward (55.5%), which was lower than the ICU (63.3%) and the ED (80.4%). Among these locations, the ED had the highest rate of neurologically intact (91%) to hospital discharge, compared to the ICU (56.6%) and the general ward (55%). As for the ED, although there was no difference in survival between non-preventive and preventive intubations, preventive intubations was associated with high neurological intact with hospital discharge. CONCLUSION: Emergency and DET intubation in the general ward and ICU resulted in a higher incidence of hemodynamic collapse and mortality than those performed in the ED. Early calls for the anesthesiologist for DET intubation without medications in the ED resulted in a higher rate of neurologically intact survival to hospital discharge.

Influences of ethanol on the structure of toxic trans-crotonaldehyde in mitochondria coming from rat myocardium.

Inappropriate use of ethanol (EtOH) had led to noticeable health problems, but a beneficial phenomenon was found that EtOH displayed unique influences for toxic trans-crotonaldehyde (TCA) derived from mitochondrial lipid peroxidation. The influences of EtOH on the structure of TCA were systematically probed by UV-vis & Raman spectroscopy in the absence and presence of mitochondria, respectively. The maximum UV-vis peak at 301 nm of TCA was red shifted by hydroxyl (-OH) and methyl (-CH3) of EtOH, respectively. Raman stretching band of aldehyde (-CH=O) of TCA (TCA-CH=O) was split by the -CH3 of EtOH. The -CH3 increased TCA-CH=O stretching frequency while the -OH induced it. The more exposed -OH, the less stretching frequency. The ectopic -CH3 red shifted the UV-vis peak at 301 nm and Raman band of TCA-CH=O. In mitochondria, EtOH red shifted Raman stretching band of TCA-CH=O. Raman stretching bands of C-H, C-O and C-C of EtOH were red shifted, while Raman stretching bands of -CH2 and C-C-O of EtOH disappeared. The paper unearths the influences of EtOH to trap and transform the structure of TCA-CH=O. This discovery has an important contribution to eliminate TCA in order to protect and repair mtDNA by means of the decrease of 8-oxoG.

Enhanced photoelectric properties by the coordinating role of doping and modification.

Dual technique design in this research has successfully enriched the complementation between doping and surface modification. Here, Co(2+) doped Ag-ZnO nanocomposites (CAZ NCs) are mass produced by the combustion method. The HRTEM image shows that the doped Co(2+) and the surface modified Ag nanoparticles on the ZnO NCs are influential on the preferential orientation. Based on the conductivity formula σ = nqµ and the actual verification, the improved photoelectric properties of CAZ NCs under visible light irradiation are attributed to the enhanced light absorption and the weakened recombination of photogenerated electron-hole pairs. It would be instructive for the sound design concept of subsequent material development.

Impact of health policy based on the self-management program on Cesarean section rate at a tertiary hospital in Taiwan.

BACKGROUND/PURPOSE: In 2005, a self-management program, based on the global budget system that met the criteria for reducing Cesarean delivery rates, was introduced to obstetric practices in Taiwan. The purpose of this study was to examine the impact of different national health policies on the Cesarean delivery rate at a tertiary hospital. METHODS: We constructed a Poisson regression model and conducted an interrupted time series analysis to detect the effects of the implementation of each health policy on Cesarean deliveries. We used data collected at two points before the implementation of the global budget system (GBS) policy (in 2001 and 2002), and at two points after the implementation of the hospital-based self-management (HBSM) policy (in 2005 and 2010). All monthly data were collected at these time points. RESULTS: Between June 2001 and August 2010, the rate of improvement of vaginal birth after Cesarean section (VBAC) during Period 1 revealed that VBAC may have long-term effects (p < 0.001). While there may have been a remarkable immediate improvement in the VBAC rate (p = 0.0276) in Period 3, the long-term effect of VBAC seemed to have decreased during the same period (p = 0.0003). Following the synergistic impacts of health policy implementation during Period 3, the immediate improved total Cesarean section (C/S) rate seemed to be maintained at an average value (p = 0.0183). CONCLUSION: Over the long term, the C/S rate seemed to reach a plateau; the immediate effect on the VBAC rate was a significant increase consistent with that of the initial health policy implementation.

The comparison of two recovery room warming methods for hypothermia patients who had undergone spinal surgery.

PURPOSE: The purpose of this study was to compare the time needed to reach a specified temperature and the efficiency of two warming methods-warm cotton blankets and a radiant warmer-for hypothermia patients in a postanesthetic care unit (PACU) after spinal surgery. DESIGN: This study was conducted according to a quasi-experimental design. Data were collected from a medical referral center in northern Taiwan. A total of 130 post-spinal surgery patients with hypothermia were recruited in the study. METHODS: Of the 130 patients in the PACU, 65 were warmed by the radiant warmer (group R); whereas the other 65 patients were warmed by warm cotton blankets (group B). Tympanic temperature was measured for each patient every 10 min until it reached 36 °C in the PACU. Analysis of covariance and generalized estimating equation regression analysis were performed to compare the time needed to reach a specified temperature and the efficiency of the two warming methods, respectively. FINDINGS: Both groups were similar in their baseline characteristics. After adjusting for temperature upon arrival at the PACU, group R needed a significantly shorter time for rewarming to 36 °C than group B (F [1, 125]= 58.17, p < .001). The results of the generalized estimating equation also showed that the radiant warmer was more efficient than warm cotton blankets in increasing patients' body temperatures to 36 °C (χ2 = 37.44, p < .001). None of the patients appeared to have wound infections, and there were no differences in the length of hospital stay or medical costs for current hospitalization in both groups. CONCLUSIONS: Using the radiant warmer may be a more efficient method than providing warm cotton blankets for warming post-spinal surgery hypothermia patients in the PACU. CLINICAL RELEVANCE: For hospitals that are unable to use forced-air warming to warm postsurgical hypothermia patients in the PACU, the radiant warmer is a more efficient device to rewarm patients.

Mental health implications of music: insight from neuroscientific and clinical studies.

Neuroscientific and clinical studies of music over the past two decades have substantially increased our understanding of its use as a means of therapy. The authors briefly review current literature related to music's effect on people with different mental illnesses, and examine several neurobiological theories that may explain its effectiveness or lack thereof in treating psychiatric disorders. Neuroscientific studies have shown music to be an agent capable of influencing complex neurobiological processes in the brain and suggest that it can potentially play an important role in treatment. Clinical studies provide some evidence that music therapy can be used as an alternative therapy in treating depression, autism, schizophrenia, and dementia, as well as problems of agitation, anxiety, sleeplessness, and substance misuse, though whether it can actually replace other modes of treatment remains undetermined. Future research should include translational studies involving both neuroscience and clinical medicine that investigate the long-term effects of music intervention and that lead to the development of new strategies for music therapy.