Effect of Implementation of Standard Clinical Practice Guideline on Management of Gastrointestinal Bleeding Patients in Emergency Department; a Cross-Sectional Study

Introduction: A clinical practice guideline (CPG) is developed with the aim of improving the quality of health care and reducing unnecessary interventions, hospitalization time, and related costs. Objective: This study attempted to design a standard protocol for gastrointestinal bleeding (GIB) patients. Method: This was a cross-sectional study conducted during 2013 and 2014 in an educational medical center in Isfahan, Iran. A checklist containing questions about waiting time for the services, hospitalization time, and costs was completed for the GIB patients. After this primary data gathering, a CPG was designed, codified, underwent several revisions, and finally implemented. Thereafter, the checklist was completed by GIB patients and compared with the previous ones. Result: Fifty patients in each of the two phases were included. The mean age and sex of the studied patients were not different. The time from emergency departments (ED) arrival until the first visit (14 ± 9.8 Vs. 19.4 ± 13.4 minutes; p = 0.03), hospitalization (73.7 ± 49.2 Vs. 116.2 ± 7.2 hours; p=0.003) and costs (1.3 ± 0.81 Vs. 3.68 ± 3.51 million rials; p < 0.001) were significantly reduced following the CPG implementation. The time from admission until conducting endoscopy was not different in the two study periods (16.5 ± 7.8 Vs. 23.9 ± 24.5 hours, p = 0.89). Conclusion: The implementation of the CPG for the management of GIB patients in the ED resulted in a reduction in the waiting time for the services and, further, reduction of hospitalization time and related costs

Effect of Implementation of Standard Clinical Practice Guideline on Management of Gastrointestinal Bleeding Patients in Emergency Department; a Cross-Sectional Study

Introduction: A clinical practice guideline (CPG) is developed with the aim of improving the quality of health care and reducing unnecessary interventions, hospitalization time, and related costs. Objective: This study attempted to design a standard protocol for gastrointestinal bleeding (GIB) patients. Method: This was a cross-sectional study conducted during 2013 and 2014 in an educational medical center in Isfahan, Iran. A checklist containing questions about waiting time for the services, hospitalization time, and costs was completed for the GIB patients. After this primary data gathering, a CPG was designed, codified, underwent several revisions, and finally implemented. Thereafter, the checklist was completed by GIB patients and compared with the previous ones. Result: Fifty patients in each of the two phases were included. The mean age and sex of the studied patients were not different. The time from emergency departments (ED) arrival until the first visit (14 ± 9.8 Vs. 19.4 ± 13.4 minutes; p = 0.03), hospitalization (73.7 ± 49.2 Vs. 116.2 ± 7.2 hours; p=0.003) and costs (1.3 ± 0.81 Vs. 3.68 ± 3.51 million rials; p < 0.001) were significantly reduced following the CPG implementation. The time from admission until conducting endoscopy was not different in the two study periods (16.5 ± 7.8 Vs. 23.9 ± 24.5 hours, p = 0.89). Conclusion: The implementation of the CPG for the management of GIB patients in the ED resulted in a reduction in the waiting time for the services and, further, reduction of hospitalization time and related costs

Low temperature synthesis of CaZrO3 nanoceramics from CaCl2–NaCl molten eutectic salt

CaZrO3 nanoceramics were successfully synthesized at 700 C using the molten salt method, and the effects of processing parameters, such as temperature, holding time, and amount of salt on the crystallization of CaZrO3 were investigated. CaCl2, Na2CO3, and nano-ZrO2 were used as starting materials. On heating, CaCl2–NaCl molten eutectic salt provided a liquid medium for the reaction of CaCO3 and ZrO2 to form CaZrO3. The results demonstrated that CaZrO3 started to form at about 600C and that, after the temperature was increased to 1,000C, the amounts of CaZrO3 in the resultant powders increased with a concomitant decrease in CaCO3and ZrO2 contents. After washing with hot distilled water, the samples heated for 3 h at 700C were single-phase CaZrO3 with 90–95 nm particle size. Furthermore, the synthesized CaZrO3 particles retained the size and morphology of the ZrO2 powders which indicated that a template mechanism dominated the formation of CaZrO3 by molten-salt method

Virtual patients: year 1

At the University of Southampton Medical School virtual patients are the key to delivering its patient centred curriculum. In year 1, the aim of the virtual patients is to present a realistic clinical scenario from which students can experience a patient journey and the clinical processes involved. The virtual patients consist of interactive linear animated clinical scenarios with interactive tasks and embedded guided learning materials. They are designed to guide year 1 students through each clinical process whilst helping them apply and integrate their knowledge of the basic sciences in a clinical context

Microstructural evolution of a commercial ultrafine alumina powder densified by different methods

The densification and grain growth of bodies made from a commercial ultrafine alumina powder was investigated. The primary powder was initially subjected to dry (uniaxial cold pressing) and wet shaping (slip casting), followed by conventional (CS)-, two step (TSS)-, and microwave (MS) sintering to explore the effect of each series of treatments on the densification and microstructural evolution of the specimens. It was demonstrated that a uniform microstructure with higher density would be obtained using the wet shaping method. In addition, microwave sintering was found to be more effective into the densification of the specimens and in yielding a finer grain structure. It is believed that the high heating rate and effective particle packing are responsible for the improvements in these properties. On this basis, it was also demonstrated that the fracture toughness of the samples increased significantly through the application of microwave sintering. (C) 2010 Elsevier Ltd. All rights reserved

High/room temperature mechanical properties of 3Y-TZP/CNTs composites

Spark Plasma Sintering (SPS) method was practiced, in the current investigation, to obtain fully dense materials with an excellent dispersion of MWCNTs (Multi-walled Carbon Nanotubes) within the matrix. Scanning and transmission electron microscopy micrographs as well as Raman Spectroscopy revealed no conspicuous signs of damages on the nanotubes' structure, as a result of applying appropriate processing measures. Measurements of mechanical properties' revealed the value of 15.2 +/- 0.4 MPa m(1/2) for indentation fracture toughness, impling our success to align transformation toughening (while the zirconia has the grain size around 1 mu m) with the effects of MWCNTs addition (5 wt%). High temperature mechanical properties of the composites have been investigated using Mechanical Spectroscopy (MS) up to 1600 K at frequency equal to 1 Hz. The MS results proved that CNTs could hinder grain-boundary sliding and subsequently lead to an enhanced creep resitance at high temperatures. (C) 2013 Elsevier Ltd and Techna Group S.r.l. All rights reserved

Pozzolanic activity of mechanochemically and thermally activated kaolins in cement

This paper reports on the mechanochemical activation by intensive grinding as an alternative way to produce pozzolanically reactive metakaolin. The physicochemical properties, pozzolanic reactivity and impact on cement hydration of mechanochemically and thermally activated kaolinitic clays were compared. Mechanochemical activation of kaolin led to an amorphous hydrous material with increased specific surface area and high water content. Unlike in thermally activated kaolins, the Al coordination environment was partially retained during mechanochemical treatment. At low clinker replacement levels of 10%, the use of mechanochemically activated kaolins accelerated the hydration of the blended cement. The pozzolanic reaction reduced portlandite contents strongly and from early on. The combined effect of enhanced cement hydration and pozzolanic reaction at early ages was reflected in a higher early age strength development (up to 7 days). The differences between mechanochemically and thermally activated kaolins largely disappeared at later ages. (C) 2015 Elsevier Ltd. All rights reserved