Exploring Patient Perspectives on Bedside Procedures: A Mixed Methods Study

INTRODUCTION Medical procedures are often performed on patients as part of their hospital stay. Common medical procedures include paracentesis, thoracentesis, lumbar punctures, knee arthrocentesis and central line insertions. These procedures can be performed at the patient’s bedside or in Interventional Radiology (IR). Much research has been done to improve procedural education and patient outcomes. However, little is known about the patient’s perspective. We explored how patients felt about their medical procedures and compared patient satisfaction between the bedside and IR groups.   METHODS We conducted a mixed-methods study (May – August, 2014), on consenting medical inpatients that had procedures performed as part of their hospital stay. Participants completed a 13-item satisfaction survey (Cronbach’s alpha =0.99). Patients also had the option of participating in a semi-structured interview. Transcripts of the interviews were analyzed using principles of grounded theory with common themes identified using open coding.   RESULTS Of the 96 eligible participants, 29 (30%) completed the survey and 12 (13%) patients completed the interview. Participants in the bedside group reported less wait time, compared with those in the IR group (median 2 hours, IQR 1-24 versus 24 hours, IQR 24-48 hrs respectively, p =0.009).  However, participants in IR group reported higher satisfaction with the time it took to complete the procedure itself (4.91 ± 0.30 vs 4.07 ± 1.14; p = 0.02 where 5 = very satisfied and 1 = very dissatisfied). In addition, patients reported higher satisfaction with their aftercare when returning from IR (p=0.05).  Overall, survey results suggests that irrespective of group assignment, participants were satisfied with their procedure  (4.79  ± 0.42). Of those who consented to the interview (n-12), the majority of the comments were positive (92%). Predominant themes included communication, attributes of the health care professionals, procedural comfort, efficiency, outcome and timing of the procedure.  Some negative comments pertained to patients’ sense of lack of control over information and timing of the procedure, transport and pain during the procedure. Interview results suggest that patients were satisfied with their procedure, but felt a lack of control in the process.  DISCUSSION AND CONCLUSIONS Results from the survey and the interview were concordant as patients reported being satisfied with their medical procedure. We found that there are significant differences between the bedside and IR group that make a profound impact on patient experience including wait time, efficiency and aftercare. The bedside group had higher patient satisfaction with wait times while IR group scored higher on efficiency and aftercare. Both are reasonable trade offs and support the notion that overall satisfaction is similar between the bedside and IR groups. Although patients reported high satisfaction with medical procedures, they noted that transport, timing of procedures, and communication are in need of improvement. Specifically, our findings support the need for quality improvement projects surrounding communication as participant satisfaction on this item varied depending on provider. Good communication can lead to a patient’s improved understanding of their medical procedure [1]. Limitations of this study include that is a single-center study and a small sample size. Overall, patients reported being satisfied with their medical procedures.

A study of aerosol liquid water content based on hygroscopicity measurements at high relative humidity in the North China Plain

Water can be a major component of aerosol particles, also serving as a medium for aqueous-phase reactions. In this study, a novel method is presented to calculate the aerosol liquid water content at high relative humidity based on measurements of aerosol hygroscopic growth factor, particle number size distribution and relative humidity in the Haze in China (HaChi) summer field campaign (July–August 2009) in the North China Plain. The aerosol liquid water content calculated using this method agreed well with that calculated using a thermodynamic equilibrium model (ISORROPIA II) at high relative humidity (>60%) with a correlation coefficient of 0.96. At low relative humidity (<60%), an underestimation was found in the calculated aerosol liquid water content by the thermodynamic equilibrium model. This discrepancy mainly resulted from the ISORROPIA II model, which only considered limited aerosol chemical compositions. The mean and maximum values of aerosol liquid water content during the HaChi campaign reached 1.69 × 10−4 g m−3 and 9.71 × 10−4 g m−3, respectively. A distinct diurnal variation of the aerosol liquid water content was found, with lower values during daytime and higher ones at night. The aerosol liquid water content depended strongly on the relative humidity. The aerosol liquid water content in the accumulation mode dominated the total aerosol liquid water content

Production Optimization,Molecular Characterization and Biological Activities of Exopolysaccharides from Xylaria nigripes

The optimal culture conditions of exopolysaccharides (EPS) production in submerged culture medium by Xylaria nigripes were determined using orthogonal matrix method. The optimal medium (per liter) EPS was 60.0 g L–1 maltose, 1.0 g L–1 peptone, 5 mmol L–1 KH2PO4, and initial pH 7.0 at 28 oC. In the optimal culture medium, the maximum EPS production was 11.967 g L–1 in shake flask. Two groups of EPSs (designated as Fr-I and Fr-II) were obtained from the culture filtrates by size exclusion chromatography (SEC), and their molecular characteristics were examined by a multiangle laser-light scattering (MALLS) and refractive index (RI) detector system. The weight-average molar masses of Fr-I and Fr-II of EPS were determined to be 6.327104 and 1.478104 g mol–1, respectively. The SEC/MALLS analysis revealed that the molecular formation of Fr-I is of nearly globular shape. Furthermore, the experiments in vitro indicated that X. nigripes EPS exhibited high antioxidative effects though its antitumour activity was limited

Treatment options for pediatric patent ductus arteriosus: Systematic review and meta-analysis

BACKGROUND: Patent ductus arteriosus (PDA) in the nonpremature pediatric patient is currently treated by surgical ligation or catheter occlusion. There is no clear superiority of one technique over the other. This meta-analysis compares the clinical outcomes of the two treatment options for PDA. METHODS: We performed a literature search of MEDLINE, Embase, PubMed, and the Cochrane database of randomized controlled trials (RCTs) that took place between 1950 and February 2014 and hand-searched references from included studies. We excluded studies of adult or premature patients and those without a direct comparison between surgical and catheter-based treatments of PDAs. Outcomes of interest were reintervention, total complications, length of stay, and cost. RESULTS: One thousand three hundred thirty-three manuscripts were screened. Eight studies fulfilled the inclusion criteria (one RCT and seven observational studies [N = 1,107]). In pooled observational studies, there were significantly decreased odds (OR, 0.12; 95% CI, 0.03-0.42) for reintervention in the surgical ligation group but insignificantly higher odds for overall complications (OR, 2.01; 95% CI, 0.68-5.91). There were no complications reported in the RCT, but surgical ligation was associated with decreased odds for reintervention and a longer length of stay. Funnel plots revealed a possible publication bias and a quality review identified comparability bias. CONCLUSIONS: Both therapies have comparable outcomes. Reintervention is more common with catheter-based treatment, but overall complication rates are not higher and hospital stay is shorter. Our data span \u3e 2 decades and may not reflect current surgical and catheterization outcomes. Large, randomized, prospective studies may help determine the optimal treatment strategy

Structure-properties relationships in solution-processable single-material molecular emitters for efficient green organic light-emitting diodes

The electroluminescent properties of a series of solution-processable fluorescent molecular emitters have been systematically investigated. While the introduction of the electron-deficient benzothiadiazole unit in the structure confers efficient electron-injection on the emitter materials, they exhibit different hole-transport properties. The device characteristics of the OLEDs based on these various emitters are discussed on the basis of (i) the energy levels of their HOMO and LUMO and (ii) their hole-transport properties in relation with the charge-transport and blocking properties of the electron- and hole-transport layers. (C) 2012 Elsevier B.V. All rights reserved

Angiotensin-converting enzyme (ACE) inhibition in type 2, diabetic patients – interaction with ACE insertion/deletion polymorphism

Angiotensin-converting enzyme (ACE) insertion(I)/deletion (D) polymorphism may modify the effect of inhibition of the renin–angiotensin–aldosterone system (RAAS) on survival and cardiorenal outcomes in type 2, diabetes. A consecutive cohort of 2089 Chinese type 2 diabetic patients with mean (±standard deviation) age of 59.7±13.1 years were genotyped for this polymorphism by polymerase chain reaction method and were followed prospectively for a median period of 44.6 (interquartile range: 23.7, 57.5) months. Clinical outcomes, including all-cause mortality, cardiovascular and renal end points, were examined. The frequency for I allele was 67.1 and 32.9% for D allele, with observed genotype frequencies of 45.8, 42.6, and 11.6% for 3, DI and DD, respectively. ACE DD polymorphism was an independent predictor for renal end point with hazard ratio (HR) (95% confidence interval) of 1.72 (1.16, 2.56), but not for cardiovascular end point or mortality. After controlling for confounding factors, including ACE I/D genotype, the usage of RAAS inhibitors was associated with reduced risk of mortality (HR 0.34 (0.23, 0.50)) and renal end point (HR 0.55 (0.40, 0.75)). On subgroup analysis, the beneficial effects on survival (II vs DI vs DD: HR 0.29 (0.16, 0.51) vs 0.25 (0.14, 0.46) vs 1.33 (0.41, 4.31)) and renoprotection (II vs DI vs DD: 0.52 (0.30, 0.90) vs 0.43 (0.25, 0.72) vs 0.95 (0.43, 2.12)) were most evident in II and DI carriers. In conclusion, inhibition of RAAS was associated with reduced risk of mortality and occurrence of renal end point in Chinese type 2 diabetic patients. These benefits were most evident among II and DI carriers

High-Efficiency Transduction of Liver Cancer Cells by Recombinant Adeno-Associated Virus Serotype 3 Vectors

Recombinant vectors based on a non-pathogenic human parvovirus, the adeno-associated virus 2 (AAV2) have been developed, and are currently in use in a number of gene therapy clinical trials. More recently, a number of additional AAV serotypes have also been isolated, which have been shown to exhibit selective tissue-tropism in various small and large animal models1. Of the 10 most commonly used AAV serotypes, AAV3 is by far the least efficient in transducing cells and tissues in vitro as well as in vivo

Incompressible SPH method based on Rankine source solution for violent water wave simulation

With wide applications, the smoothed particle hydrodynamics method (abbreviated as SPH) has become an important numerical tool for solving complex flows, in particular those with a rapidly moving free surface. For such problems, the incompressible Smoothed Particle Hydrodynamics (ISPH) has been shown to yield better and more stable pressure time histories than the traditional SPH by many papers in literature. However, the existing ISPH method directly approximates the second order derivatives of the functions to be solved by using the Poisson equation. The order of accuracy of the method becomes low, especially when particles are distributed in a disorderly manner, which generally happens for modelling violent water waves. This paper introduces a new formulation using the Rankine source solution. In the new approach to the ISPH, the Poisson equation is first transformed into another form that does not include any derivative of the functions to be solved, and as a result, does not need to numerically approximate derivatives. The advantage of the new approach without need of numerical approximation of derivatives is obvious, potentially leading to a more robust numerical method. The newly formulated method is tested by simulating various water waves, and its convergent behaviours are numerically studied in this paper. Its results are compared with experimental data in some cases and reasonably good agreement is achieved. More importantly, numerical results clearly show that the newly developed method does need less number of particles and so less computational costs to achieve the similar level of accuracy, or to produce more accurate results with the same number of particles compared with the traditional SPH and existing ISPH when it is applied to modelling water waves

Hygroscopic properties of aerosol particles at high relative humidity and their diurnal variations in the North China Plain

The hygroscopic properties of submicron aerosol particles were determined at a suburban site (Wuqing) in the North China Plain among a cluster of cities during the period 17 July to 12 August, 2009. A High Humidity Tandem Differential Mobility Analyser (HH-TDMA) instrument was applied to measure the hygroscopic growth factor (GF) at 90%, 95% and 98.5% relative humidity (RH) for particles with dry diameters between 50 and 250 nm. The probability distribution of GF (GF-PDF) averaged over the period shows a distinct bimodal pattern, namely, a dominant more-hygroscopic (MH) group and a smaller nearly-hydrophobic (NH) group. The MH group particles were highly hygroscopic, and their GF was relatively constant during the period with average values of 1.54 ± 0.02, 1.81 ± 0.04 and 2.45 ± 0.07 at 90%, 95% and 98.5% RH (D0 = 100 nm), respectively. The NH group particles grew very slightly when exposed to high RH, with GF values of 1.08 ± 0.02, 1.13 ± 0.06 and 1.24 ± 0.13 respectively at 90%, 95% and 98.5% RH (D0 = 100 nm). The hygroscopic growth behaviours at different RHs were well represented by a single-parameter Köhler model. Thus, the calculation of GF as a function of RH and dry diameter could be facilitated by an empirical parameterization of κ as function of dry diameter. A strong diurnal pattern in number fraction of different hygroscopic groups was observed. The average number fraction of NH particles during the day was about 8%, while during the nighttime fractions up to 20% were reached. Correspondingly, the state of mixing in terms of water uptake varied significantly during a day. Simulations using a particle-resolved aerosol box model (PartMC-MOSAIC) suggest that the diurnal variations of aerosol hygroscopicity and mixing state were mainly caused by the evolution of the atmospheric mixing layer. The shallow nocturnal boundary layer during the night facilitated the accumulation of freshly emitted carbonaceous particles (mainly hydrophobic) near the surface while in the morning turbulence entrained the more aged and more hygroscopic particles from aloft and diluted the NH particles near the surface resulting in a decrease in the fraction of NH particles

Size-resolved and bulk activation properties of aerosols in the North China Plain

Size-resolved and bulk activation properties of aerosols were measured at a regional/suburban site in the North China Plain (NCP), which is occasionally heavily polluted by anthropogenic aerosol particles and gases. A Cloud Condensation Nuclei (CCN) closure study is conducted with bulk CCN number concentration (NCCN) and calculated CCN number concentration based on the aerosol number size distribution and size-resolved activation properties. The observed CCN number concentration (NCCN-obs) are higher than those observed in other locations than China, with average NCCN-obs of roughly 2000, 3000, 6000, 10 000 and 13 000 cm−3 at supersaturations of 0.056, 0.083, 0.17, 0.35 and 0.70%, respectively. An inferred critical dry diameter (Dm) is calculated based on the NCCN-obs and aerosol number size distribution assuming homogeneous chemical composition. The inferred cut-off diameters are in the ranges of 190–280, 160–260, 95–180, 65–120 and 50–100 nm at supersaturations of 0.056, 0.083, 0.17, 0.35 and 0.7%, with their mean values 230.1, 198.4, 128.4, 86.4 and 69.2 nm, respectively. Size-resolved activation measurements show that most of the 300 nm particles are activated at the investigated supersaturations, while almost no particles of 30 nm are activated even at the highest supersaturation of 0.72%. The activation ratio increases with increasing supersaturation and particle size. The slopes of the activation curves for ambient aerosols are not as steep as those observed in calibrations with ammonium sulfate suggesting that the observed aerosols is an external mixture of more hygroscopic and hydrophobic particles. The calculated CCN number concentrations (NCCN-calc) based on the size-resolved activation ratio and aerosol number size distribution correlate well with the NCCN-obs, and show an average overestimation of 19%. Sensitivity studies of the CCN closure show that the NCCN at each supersaturation is well predicted with the campaign average of size-resolved activation curves. These results indicate that the aerosol number size distribution is critical in the prediction of possible CCN. The CCN number concentration can be reliably estimated using time-averaged, size-resolved activation efficiencies without accounting for the temporal variations