Microbial Air Contamination in an Intensive Care Unit

Unit layout affects every aspect of intensive care services, including patient safety. A previous study has shown that patients admitted to beds adjacent to the sink and to the door of a large bayroom had the highest number of positive blood cultures and the highest blood culture incidence density, respectively. The present study measures microbial air contamination in a medical intensive care unit of a medical center in central Taiwan. Of the 17 rooms, 8 rooms with distinct physical environmental characteristics were selected. Sampling tests were conducted between December 2013 and February 2014 with a microbial air sampler (MAS-100NT). TSA was used for bacteria collection and DG18 for fungi collection. The overall average bacterial and fungal concentrations were 83CFU/m3 and 69CFU/m3, respectively. The ranges were between 8-354 CFU/m3 and 0-1468 CFU/m3, respectively. A significant difference was found in the bacterial concentration (p=.005) between different room locations. The highest concentration was found in the rooms located at the front end of the circulation (99 CFU/m3), while the lowest was found in the rooms located at the rear end of the circulation (55CFU/m3). Differences in fungal concentrations for different room locations did not reach statistical significance. In addition, differences in bacterial and fungal concentrations for rooms with different sink locations did not reach statistical significance. Even though the microbial concentrations generally complied with standards, the results may help designers and hospital administrators develop a healthier environment for patients

Microbial Air Contamination in an Intensive Care Unit

Unit layout affects every aspect of intensive care services, including patient safety. A previous study has shown that patients admitted to beds adjacent to the sink and to the door of a large bayroom had the highest number of positive blood cultures and the highest blood culture incidence density, respectively. The present study measures microbial air contamination in a medical intensive care unit of a medical center in central Taiwan. Of the 17 rooms, 8 rooms with distinct physical environmental characteristics were selected. Sampling tests were conducted between December 2013 and February 2014 with a microbial air sampler (MAS-100NT). TSA was used for bacteria collection and DG18 for fungi collection. The overall average bacterial and fungal concentrations were 83CFU/m3 and 69CFU/m3, respectively. The ranges were between 8-354 CFU/m3 and 0-1468 CFU/m3, respectively. A significant difference was found in the bacterial concentration (p=.005) between different room locations. The highest concentration was found in the rooms located at the front end of the circulation (99 CFU/m3), while the lowest was found in the rooms located at the rear end of the circulation (55CFU/m3). Differences in fungal concentrations for different room locations did not reach statistical significance. In addition, differences in bacterial and fungal concentrations for rooms with different sink locations did not reach statistical significance. Even though the microbial concentrations generally complied with standards, the results may help designers and hospital administrators develop a healthier environment for patients

Effects of cord pretension and stiffness of the Dynesys system spacer on the biomechanics of spinal decompression- a finite element study

BACKGROUND: The Dynesys system provides stability for destabilized spines while preserving segmental motion. However, clinical studies have demonstrated that the Dynesys system does not prevent adjacent segment disease. Moreover, biomechanical studies have revealed that the stiffness of the Dynesys system is comparable to rigid fixation. Our previous studies showed that adjusting the cord pretension of the Dynesys system alleviates stress on the adjacent level during flexion. We also demonstrated that altering the stiffness of Dynesys system spacers can alleviate stress on the adjacent level during extension of the intact spine. In the present study, we hypothesized that omitting the cord preload and changing the stiffness of the Dynesys system spacers would abate stress shielding on adjacent spinal segments. METHODS: Finite element models were developed for - intact spine (INT), facetectomy and laminectomy at L3-4 (DEC), intact spine with Dynesys system (IntDyWL), decompressed spine with Dynesys system (DecDyWL), decompressed spine with Dynesys system without cord preload (DecDyNL), and decompressed spine with Dynesys system assembled using spacers that were 0.8 times the standard diameter without cord pretension (DecDyNL0.8). These models were subjected to hybrid control for flexion, extension, axial rotation; and lateral bending. RESULTS: The greatest decreases in range of motion (ROM) at the L3-4 level occurred for axial rotation and lateral bending in the IntDyWL model and for flexion and extension in the DecDyWL model. The greatest decreases in disc stress occurred for extension and lateral bending in the IntDyWL model and for flexion in the DecDyWL model. The greatest decreases in facet contact force occurred for extension and lateral bending in the DecDyNL model and for axial rotation in the DecDyWL model. The greatest increases in ROMs at L2-3 level occurred for flexion, axial rotation and lateral bending in IntDyWL model and for extension in the DecDyNL model. The greatest increases in disc stress occurred for flexion, axial rotation and lateral bending in the IntDyWL model and for extension in the DecDyNL model. The greatest increases in facet contact force occurred for extension and lateral bending in the DecDyNL model and for axial rotation in the IntDyWL model. CONCLUSIONS: The results reveals that removing the Dynesys system cord pretension attenuates the ROMs, disc stress, and facet joint contact forces at adjacent levels during flexion and axial rotation. Removing cord pretension together with softening spacers abates stress shielding for adjacent segment during four different moments, and it provides enough security while not jeopardizes the stability of spine during axial rotation

Effects of job rotation and role stress among nurses on job satisfaction and organizational commitment

<p>Abstract</p> <p>Background</p> <p>The motivation for this study was to investigate how role stress among nurses could affect their job satisfaction and organizational commitment, and whether the job rotation system might encourage nurses to understand, relate to and share the vision of the organization, consequently increasing their job satisfaction and stimulating them to willingly remain in their jobs and commit themselves to the organization. Despite the fact that there have been plenty of studies on job satisfaction, none was specifically addressed to integrate the relational model of job rotation, role stress, job satisfaction, and organizational commitment among nurses.</p> <p>Methods</p> <p>With top managerial hospital administration's consent, questionnaires were only distributed to those nurses who had had job rotation experience. 650 copies of the questionnaire in two large and influential hospitals in southern Taiwan were distributed, among which 532 valid copies were retrieved with a response rate of 81.8%. Finally, the SPSS 11.0 and LISREL 8.54 (Linear Structural Relationship Model) statistical software packages were used for data analysis and processing.</p> <p>Results</p> <p>According to the nurses' views, the findings are as follows: (1) job rotation among nurses could have an effect on their job satisfaction; (2) job rotation could have an effect on organizational commitment; (3) job satisfaction could have a positive effect on organizational commitment; (4) role stress among nurses could have a negative effect on their job satisfaction; and (5) role stress could have a negative effect on their organizational commitment.</p> <p>Conclusion</p> <p>As a practical and excellent strategy for manpower utilization, a hospital could promote the benefits of job rotation to both individuals and the hospital while implementing job rotation periodically and fairly. And when a medical organization attempts to enhance nurses' commitment to the organization, the findings suggest that reduction of role ambiguity in role stress has the best effect on enhancing nurses' organizational commitment. The ultimate goal is to increase nurses' job satisfaction and encourage them to stay in their career. This would avoid the vicious circle of high turnover, which is wasteful of the organization's valuable human resources.</p

Coronary Computed Tomography Angiography—A Promising Imaging Modality in Diagnosing Coronary Artery Disease

BackgroundTraditionally, information on coronary artery lesions is obtained from invasive coronary angiography (CAG). The clinical applicability and diagnostic performance of the newly developed 64-slice multislice computed tomography (MSCT) scanner in coronary angiographic evaluation is not well evaluated.MethodsCoronary computed tomography angiography (CCTA) was performed in 345 patients (119 women, 226 men; mean age, 59.64 ±11.67 years). Concomitant CAG was performed in 53 patients. The diagnostic performance of CCTA for detecting significant lesions was compared with that of CAG by 3 independent cardiologists.ResultsAll CCTA was performed without complication. Comparison between CCTA and CAG was made in the 53 patients who underwent both studies. Sensitivity, specificity and the positive and negative predictive values for the 53 patients were: 81%, 99%, 87% and 99%, respectively.ConclusionThe 64-slice MSCT, developed in recent years, allows reliable noninvasive evaluation of coronary artery morphology, including plaque, stenosis and congenital anomaly. The diagnostic accuracy of MSCT scans for detecting lesions makes it a good imaging substitute for CAG in the evaluation of these coronary segments. [J Chin Med Assoc 2008;71(5):241–246

Successful treatment of methemoglobinemia in an elderly couple with severe cyanosis: two case reports

INTRODUCTION: Methemoglobinemia should be considered in all cyanotic patients who remain unresponsive to oxygen therapy. Rapid diagnosis is very important in emergency cases. Here, we present the cases of two patients, a married couple, admitted to our hospital with methemoglobinemia after exposure to sodium nitrite. CASE PRESENTATION: Two patients, a married couple, presented with methemoglobinemia. The 72-year-old Taiwanese man and 68-year-old Taiwanese woman were referred to our hospital with dizziness and tachypnea. On examination, their mucous membranes were cyanotic, and their blood samples showed the classic ‘chocolate brown’ appearance. The man also reported having experienced twitching of his right arm for a few minutes before arrival at the hospital. The symptoms of both patients failed to improve in response to supplemental oxygen delivered via oxygen masks, although the arterial blood gas data of these patients were normal and their pulse oximetry showed oxyhemoglobin levels of approximately 85%. A carbon monoxide-oximeter showed that the man’s methemoglobin concentration was 48.3%, and the woman’s was 36.4%. Methylene blue (100mg) was administered intravenously to both patients, and their symptoms improved dramatically. They were admitted to the intensive care unit and discharged three days later, without neurological sequelae. CONCLUSION: Severe methemoglobinemia is a life-threatening condition and, if untreated, may result in death. Early diagnosis and appropriate antidotal treatment are crucial in treating this emergency situation

Apoptosis induction in BEFV-infected Vero and MDBK cells through Src-dependent JNK activation regulates caspase-3 and mitochondria pathways

Our previous report demonstrated that bovine ephemeral fever virus (BEFV)-infected cultured cells could induce caspase-dependent apoptosis. This study aims to further elucidate how BEFV activates the caspase cascade in bovine cells. BEFV replicated and induced apoptosis in Vero and Madin-Darby bovine kidney (MDBK) cells, and a kinetic study showed a higher efficiency of replication and a greater apoptosis induction ability of BEFV in Vero cells. Src and c-Jun N-terminal kinase (JNK) inhibitor, but not extracellular signal-regulated kinase (ERK) or p38 inhibitor, alleviated BEFV-mediated cytopathic effect and apoptosis. In BEFV-infected Vero and MDBK cells, BEFV directly induced Src tyrosine-418 phosphorylation and JNK phosphorylation and kinase activity, which was inhibited specifically by SU6656 and SP600125, respectively. The caspase cascade and its downstream effectors, Poly (ADP-ribose) polymerase (PARP) and DFF45, were also activated simultaneously upon BEFV infection. In addition, cytochrome c, but not Smac/DIABLO, was released gradually from mitochondria after BEFV infection. SU6656 suppressed Src, JNK, and caspase-3 and -9 activation, as well as PARP and DFF45 cleavage; SP600125 reduced JNK and caspase-3 and -9 activation, as well as PARP and DFF45 cleavage. Taken together, these results strongly support the hypothesis that a Src-dependent JNK signaling pathway plays a key role in BEFV-induced apoptosis. The molecular mechanism identified in our study may provide useful information for the treatment of BEFV