Intra- and inter-rater reliability of electrical impedance myography using adhesive electrodes in healthy volunteers.

In spite of the growing use of the electrical impedance myography (EIM) measures for clinical assessment and follow-up of diseased muscle tissue, reliability studies are scarce. We evaluate the reliability of the (EIM) technique using four adhesive electrodes over the muscle of interest. Intra- and inter-rater reliability was studied within the same session and between sessions. Thirty-one healthy and volunteer subjects aged between 20 and 26 years were recruited. Phase angle, reactance and resistance were assessed for each EIM measurement. Intraclass correlation coefficient (ICC) was used to determine the relative reliability. Absolute reliability was expressed as the standard error of measurement and the minimum detectable change. Relative reliability within the same session and between sessions for the EIM technique was excellent (ICCs > 0.9) concerning both intra- and inter-rater reliability, except for the component reactance. The absolute reliability was very high for the three EIM components. EIM measures using four adhesive electrodes over the area of interest is a reliable technique to assess muscle tissue status. This study confirms that these measurement results barely vary depending on the examiner and the moment. The present study also confirms phase angle as the least affected EIM component by examiner and evaluation moment.

Temporary Fixation of Reduction with Fabric Adhesive Bandage in the Surgical Treatment of Pediatric Supracondylar Humerus Fractures.

Background and objectives: Supracondylar humerus fractures are common in children andcan be surgically treated. However, the general surgical procedures involving reduction andfixation might lead to reduction loss, failure to direct the Kirschner (K)-wire toward the desiredposition, prolonged surgery, or chondral damage. This study aimed to show that temporaryfixation of closed reduction with a fabric adhesive bandage in pediatric supracondylar humerusfractures could maintain reduction so that surgical treatment can be easily performed by a singlephysician. Materials and Methods: Forty-six patients with Gartland type 3 supracondylar humerusfractures who underwent surgical treatment between May 2017 and June 2018 were retrospectivelyevaluated. Fluoroscopy-guided reduction and fixation were performed from the distal third of theforearm to the proximal third of the humerus using a fabric adhesive bandage. Two crossed pinswere applied on the fracture line by first inserting a lateral-entry K-wire and then inserting anotherK-wire close to the anterior aspect of the medial epicondyle and diverging from the ulnar nervetunnel. A tourniquet was not applied in any patient and no patients required open reduction.Results: The study included 32 boys (69.6%) and 14 girls (30.4%) (mean age, 7.1; range, 2-16 years).The mean hospital stay and follow-up duration were 4.3 ± 3.9 days and 48.1 ± 14.3 weeks,respectively. Heterotopic ossification was detected in one patient, and ulnar nerve neuropraxia wasdetected in another patient. Functional (according to Flynn criteria) and cosmetic outcomes wereexcellent in 95.6%, moderate in 2.2%, and poor in 2.2% of patients. The mean duration of fixation ofthe closed reduction with a fabric adhesive bandage was 8.1 ± 3.9 min, and the mean duration ofpinning was 7.9 ± 1.4 min. Conclusions: Temporary preoperative fixation of supracondylar humerusfractures that require surgical treatment with a fabric adhesive bandage may be significantlyconvenient in practice.

First Aid for Skin Tears by Mini Patch Grafting from the Flap Edge.

BACKGROUND: Traumatic skin tears often occur in patients with dystrophic skin. Closing them with adhesive skin closures is useful for patients with a healthy flap, but occasionally fails to cover the entire defect. We describe a simple technique to perform mini patch grafting on the remaining raw surface without damaging healthy skin. DISCUSSION: The skin flap is spread out and fixed with adhesive skin strips to minimize defects first. Small pieces of skin are obtained by trimming the edges of the skin flap with curved tip scissors. They are placed on the defect with free spaces of 3 to 5 mm between each of the grafts. Then the whole wound is covered with a dressing and gauze pads. Healing of the ulcer could be markedly promoted with little enlargement of the skin defect. CONCLUSIONS: Small pieces of skin trimmed out from the edge of skin flap can be used as a mini patch graft that remarkably enhances healing of remaining open surface.

Outcomes of nasal bridling to secure enteral tubes in burn patients.

BACKGROUND: Reliable securement of nasally inserted enteral tubes is a problem in patients with facial burns that make use of traditional adhesive tape ineffective. OBJECTIVE: To implement the nasal bridle as a way to decrease inadvertent removal of nasally inserted enteral tubes and improve subsequent patient outcomes. METHODS: The nasal bridle was implemented in the burn unit of the University of Kansas Hospital, Kansas City, Kansas, as a quality improvement project. Outcomes for the calendar year 2010 were measured in patients treated before use of the bridle (prebridle control group) and in patients for whom the bridle was used. The groups were compared on measures of tube insertions per tube day, abdominal radiographs per tube day, and a number of complications. RESULTS: A total of 50 patients were studied: 33 in the control group and 17 in the bridle group. Baseline characteristics of age and sex did not differ between the groups. The bridle group had significantly fewer tube insertions and abdominal radiographs per tube day than the control group. Although complications were generally less common in the bridle group, the differences were not statistically significant. CONCLUSIONS: In burn patients, use of a nasal bridle to secure nasally inserted tubes had clinical advantages over securement with traditional adhesive tape.

Technical tips: Electrode application and preventing skin breakdown techniques.

The recording electrodes including their precise location, their ability to record during movements that can be intense during a convulsive seizure, and their capability to record for several days without causing skin breakdown are an integral part of long-term EEG recording. Many of the facets of EEG technology have changed dramatically with the introduction of digital EEG. But the electrode and the electrode/skin interface have not had many dramatic changes. The technologist still looks for ways to ensure correct electrode placement, good recording capabilities, and a patient with healthy skin when the electrodes are removed. This Technical Tips features ideas and experiences from several technologists. These technologists express suggestions and opinions which are accepted in Technical Tips.

Vascular access devices: securement and dressings.

Many patients admitted to hospital will require a vascular access device (VAD). Insertion of VADs is often viewed as a routine procedure, with little attention given to the importance of appropriate securement and dressing and how these factors can affect patient outcomes. This article discusses the types of VAD available and the rationale for VAD securement and appropriate dressings to minimise complications.

Infrared densitometry: a fast and non-destructive method for exact stratum corneum depth calculation for in vitro tape-stripping.

The investigation of drug penetration into the stratum corneum (SC) by tape-stripping requires an accurate measure of the amount of SC on each tape-strip in order to determine the depth inside the SC. This study applies infrared densitometry (IR-D) to in vitro tape-stripping using the novel Squame Scan(R) 850A. The device had recently been shown to provide accurate measurements of the SC depth for tape-stripping in vivo. Furthermore, the suitability of IR-D for determining the endpoint of tape-stripping, i.e. complete SC removal, was tested. The SC depth was computed from the IR-D data of sequential tape-strips and compared to the results of a protein assay as gold standard. IR-D provided accurate depth results both for freshly excised skin and for skin stored frozen for up to 3 months. In addition, the lower limit of quantification of IR-D indicates the complete removal of the SC (less than 5% of the total SC remaining) and can be used for adjusting the number of tapes applied in situ. Therefore, IR-D is an accurate, fast and non-destructive method for SC depth determination.

Pedicle screw augmentation with polyethylene tape: a biomechanical study in the osteoporotic thoracolumbar spine.

STUDY DESIGN: Biomechanical study using human thoracolumbar spines. OBJECTIVE: To assess the strength of fixation of pedicle screws augmented with Nesplon tape applied sublaminar or applied subpars. SUMMARY OF BACKGROUND DATA: There are no reports on the biomechanical assessment of Nesplon tape used for pedicle screw augmentation. METHODS: Experiment 1: pedicle screws were inserted into bilateral pedicles as follows: (1) pedicle screw alone connected to a rod (PS alone), (2) pedicle screw augmented with Nesplon tape applied sublaminar, connected to a rod [pedicle screw applied sublaminar (PSSL)], and (3) pedicle screw augmented with tape applied subpars, connected to a rod [pedicle screw applied subpars (PSSP)]. The rods were pulled and pushed until the pedicle screw was loose. Experiment 2: 6 thoracolumbar spines were biomechanically tested as follows: axial compression, flexion, extension, left and right lateral bending, and left and right axial rotation. This sequence was applied to: (1) the intact spine; (2) the spine made unstable; (3) the spine fixed by pedicle screws and rods (PS alone); (4) the same as 3, but with the pedicle screws augmented using Nesplon tape applied sublaminar (PSSL); and (5) the same as 3, but with pedicle screws augmented using tape applied subpars (PSSP). From the load-deformation curves, stiffness values were calculated. RESULTS: Experiment 1: the pedicle screws augmented by sublaminar or subpars tape (PSSL or PSSP) showed significantly greater fixation strength compared with those pedicles that were not augmented by tape (PS alone). Experiment 2: a pedicle screw/rod construct augmented by tape provided a stiffer construct than the same construct without augmentation. CONCLUSIONS: Pedicle screws that are inserted into the osteoporotic thoracolumbar spine and augmented by Nesplon tape applied sublaminar or subpars provide firmer fixation of the screws and a stiffer pedicle screw/rod construct than the same construct without augmentation by tape.

Intraoperative handling and wound healing of arthroscopic portal wounds: a clinical study comparing nylon suture with wound closure strips.

This prospective, single-centre study compared wound closure methods in patients undergoing arthroscopy. Closure of arthroscopic portal wounds with sterile adhesive strips is effective and convenient for wound management. The method was associated with a reduced potential for infection, faster renewal of tensile strength, greater cost effectiveness, and better cosmetic effects comparing with suture closure. This method of wound closure may also reduce the incidence of needle stick injury in the theatre environment. Thereby the incidence of percutaneous exposure following a surgical procedure may not facilitate transmission of blood borne pathogens such as human immunodeficiency virus (HIV), hepatitis C virus and hepatitis B virus. As a result it may reduce litigation in today's changing healthcare climate.

Evaluation of substrates for 90 degrees peel adhesion--a collaborative study. I. Medical tapes.

As part of a method development for peel testing, an interlaboratory comparison among Food and Drug Administration-Center for Drug Evaluation and Research, Food and Drug Administration-Center for Devices and Radiological Health and Southwest Research Institute was conducted using medical tapes. The aim was to determine which readily available substrate [stainless steel (SS), high density polyethylene (HDPE) or Vitro-Skin(R)] would best distinguish among various medical tapes. Five medical tapes (3M 1523, 3M 1525L, 3M 1776, Mepiform(R) and Mediderm(R) 3505) were evaluated on four different substrates (SS, HDPE, Vitro-Skin, and human cadaver skin) using the following peel parameters: approximately 3 min dwell time, 90 degrees peel angle, and 300 mm/min peel rate. No substrate mimics cadaver skin for all five tapes. SS had the best ability to distinguish among the medical tapes. Overall, for quality control purposes (yielding good discrimination and precision), SS would be the optimal substrate.

A comparison and cost-effectiveness analysis of peripheral catheter dressings.

Peripheral catheter dressing use is common but information about cost-effectiveness remains limited. A prospective, descriptive 3-month study was conducted to 1) assess the cost-effectiveness of two dressings used for peripheral venous catheters and 2) identify statistical associations between the effectiveness variables and the patient's gender and age, category of the professional involved in care, and length of time the dressing was in place. The study was conducted among a homogenous sample of 120 adult patients; the majority (71/59.2%) were women, mean age 54.5 (+/- 18.8) years. All catheters were inserted in the surgical unit of the University of São Paulo Hospital: 54 traditional (microporous tape) and 66 transparent film dressings were applied. Clinical effectiveness was defined as dressing adherence and the absence of complications. Cost effectiveness was assessed using incremental analysis and potential statistical associations. The measured outcomes are expressed in terms of the cost per unit/patient of success or effect. Traditional dressings were found to have a lower total cost ($12.53) but were less adherent (P <0.001) compared to film dressings. The rate of complications in each group was similar. Results confirm that traditional dressings may be used for short-term use catheter care (approximately 3 days); whereas, film dressings may be more cost-effective for longer-term use. Larger studies assessing the cost-effectiveness of various dressings to secure longer-term use catheters are needed.

Best practice in stabilisation of oral endotracheal tubes: a systematic review.

Mechanical ventilation of patients in intensive care units is common practice. Artificial airways are utilised to facilitate ventilation and the endotracheal tube (ETT) is most commonly used for this purpose. The ETT must be stabilised to optimise ventilation and avoid displacement or unplanned extubation. Tube movement is a major factor in causing airway trauma. A destabilised tube can cause fatal complications. A systematic review was conducted to identify and analyse the best available evidence on ETT stabilisation to determine which stabilisation method resulted in reduced tube displacement and the least amount of unplanned or accidental extubations. The types of stabilisations included one or a combination of the following methods: twill or cotton tape, adhesive tape, gauze, or a manufactured device. All relevant randomised controlled and quasi-experimental studies of ETT stabilisation practices, identified through electronic and hand searching, were assessed for inclusion in the study. One published randomised controlled trial and six published quasi-experimental studies met the inclusion and exclusion criteria and were retrieved. Data were extracted independently by two reviewers. Results of the systematic review showed that no single method of ETT stabilisation could be identified as superior for minimising tube displacement and unplanned or accidental extubations. Rigorous randomised controlled trials with clearly identified and described ETT stabilisation methods are required to establish best practice. In addition, comparative research to evaluate cost effectiveness and nursing time requirements would also be of significant benefit to critical care nursing practice.