Every Second Patient Does Not Fully Understand Written Preprocedure Information: An Explorative Study About Functional Health Literacy.

PURPOSE: To investigate the self-perceived functional health literacy (FHL) of patients who underwent advanced endoscopic treatment, explore whether FHL could explain aspects of patients' perioperative experiences, and determine whether patients read the provided patient information. DESIGN: A prospective cross-sectional explorative study. METHODS: One hundred patients who underwent endoscopic bile duct intervention were enrolled and asked to answer the Swedish version of the FHL Scale and their perioperative experiences of the intervention. Along with procedural data, all data were analyzed for group comparisons; high or low FHL. FINDINGS: The study included a total of 100 patients, with half of them rating their FHL as problematic or inadequate (low FHL). Among those who perceived their FHL as inadequate, a majority had not read the provided information before the procedure. Patients with problematic or inadequate FHL experienced perioperative anxiety and pain more frequently than those with sufficient FHL (high FHL). CONCLUSIONS: This study supports previous research on the association between low FHL and patients' well-being. To better meet patients' information needs, it is crucial for nurse anesthetists and other health care providers to have knowledge about FHL. Additionally, the study highlights the importance of using alternative and more effective means of delivering information to patients.

Mechanical integrated circuit materials.

Recent developments in autonomous engineered matter have introduced the ability for intelligent materials to process environmental stimuli and functionally adapt1-4. To formulate a foundation for such an engineered living material paradigm, researchers have introduced sensing5-11 and actuating12-16 functionalities in soft matter. Yet, information processing is the key functional element of autonomous engineered matter that has been recently explored through unconventional techniques with limited computing scalability17-20. Here we uncover a relation between Boolean mathematics and kinematically reconfigurable electrical circuits to realize all combinational logic operations in soft, conductive mechanical materials. We establish an analytical framework that minimizes the canonical functions of combinational logic by the Quine-McCluskey method, and governs the mechanical design of reconfigurable integrated circuit switching networks in soft matter. The resulting mechanical integrated circuit materials perform higher-level arithmetic, number comparison, and decode binary data to visual representations. We exemplify two methods to automate the design on the basis of canonical Boolean functions and individual gate-switching assemblies. We also increase the computational density of the materials by a monolithic layer-by-layer design approach. As the framework established here leverages mathematics and kinematics for system design, the proposed approach of mechanical integrated circuit materials can be realized on any length scale and in a wide variety of physics.

Patient-controlled sedation with propofol for endoscopic procedures-A cost analysis.

BACKGROUND: Patient-controlled sedation (PCS) with propofol accompanied by a bedside nurse anaesthetist is an alternative sedation method for endoscopic procedures compared with midazolam administered by a nurse or endoscopist. Increasing costs in health care demands an economic perspective when introducing alternative methods. We applied a hospital perspective on a cost analysis comparing different methods of sedation and the resource use that were expected to affect cost differences related to the sedation. METHODS: Based on two randomised previous studies, the direct costs were determined for different sedation methods during two advanced endoscopic procedures: endoscopic retrograde cholangiopancreatography (ERCP) and flexible bronchoscopy including endobronchial ultrasound. ERCP comparisons were made between midazolam sedation by the endoscopic team, PCS with a bedside nurse anaesthetist and propofol sedation administered by a nurse anaesthetist. Bronchoscopy comparisons were made between midazolam sedation by the endoscopic team and PCS with a bedside nurse anaesthetist, categorised by premedication morphine-scopolamine or glycopyrronium. RESULTS: Propofol PCS with a bedside nurse anaesthetist resulted in lower costs per patient for sedation for both ERCP (233 USD) and bronchoscopy (premedication morphine-scopolamine 267 USD, premedication glycopyrronium 269 USD) compared with midazolam (ERCP 425 USD, bronchoscopy 337 USD). Aborted procedures that needed to be repeated and prolonged hospital stays significantly increased the cost for the midazolam groups. CONCLUSION: Propofol PCS with a bedside nurse anaesthetist reduces the direct sedation costs for ERCP and bronchoscopy procedures compared with midazolam sedation.

Patient-controlled Sedation During Flexible Bronchoscopy: A Randomized Controlled Trial.

BACKGROUND: Patient-controlled sedation (PCS) is a documented method for endoscopic procedures considered to facilitate early recovery. Limited data have been reported, however, on its use during flexible bronchoscopy (FB). METHODS: This study hypothesized that PCS with propofol during FB would facilitate early recovery, with similar bronchoscopist and patient satisfaction compared with nurse-controlled sedation (NCS) with midazolam. A total of 150 patients were randomized 1:1:1 into a control group (premedication with morphine-scopolamine and NCS with midazolam), PCS-MS group (premedication with morphine-scopolamine and PCS with propofol), and PCS-G group (premedication with glycopyrronium and PCS with propofol). RESULTS: The procedures included transbronchial biopsy, transbronchial needle aspiration, cryotherapy/biopsy, and/or multistation endobronchial ultrasound. FB duration values in median (range) were 40 (10 to 80), 39 (12 to 68), and 44 (10 to 82) minutes for the groups NCS, PCS-MS, and PCS-G, respectively. An overall 81% of the patients in the combined PCS groups were ready for discharge (modified Post Anaesthetic Discharge Scoring System, score 10) 2 hours after bronchoscopy compared with 40% in the control group (P<0.0001). Between PCS groups, 96% of the PCS-G group patients were ready for discharge compared with 65% in the PCS-MS group (P=0.0002) at 2 hours. Bronchoscopists' and patients' satisfaction scores were high in all groups. Postdischarge quality scores showed no differences among the groups. CONCLUSION: PCS with propofol during FB is feasible, as it shortened recovery time without compromising procedure conditions for bronchoscopists or patients. A rapid postsedation stabilization of vital signs facilitates surveillance before the patient leaves the hospital.

Rectal ketamine during paediatric burn wound dressing procedures: a randomised dose-finding study.

BACKGROUND: Worldwide, ketamine is used during paediatric procedures, but no recommendations are available regarding a suitable dose for rectal administration during procedures involving high levels of pain and/or anxiety such as burn wound dressing change. METHODS: We evaluated three different single doses of rectally administered racemic ketamine mixed with a fixed dose of 0.5mg/kg of midazolam. In total, 90 children - aged 6 months to 4 years - were randomised 1:1:1 to receive 4mg/kg (K-4 group), 6mg/kg (K-6 group) or 8mg/kg (K-8 group) of racemic ketamine for a maximum of three consecutive procedures. Primary outcome measure was procedural pain evaluated by Face, Legs, Activity, Cry, Consolability (FLACC) behavioural scale. Secondary outcome included feasibility and recovery time. Patient safety was evaluated using surrogate outcomes. RESULTS: In total, 201 procedures in 90 children aged 19±8months were completed. The median maximum pain was FLACC 0 in all groups (p=0.141). The feasibility was better for groups K-6 (p=0.049) and K-8 (p=0.027) compared with K-4, and the mean recovery time was the longest for group K-8 (36±22min) compared with groups K-4 (25±15min; p=0.003) and K-6 (27±20min; p=0.025). Median maximum sedation measured by the University of Michigan Sedation Scale (UMSS) was higher in group K-8 compared with group K-4 (p<0.0001) and K-6 (p=0.023). One child in group K-8 had a study drug-related serious adverse event - laryngospasm/airway obstruction. No rescue analgosedative medication was administered for group K-6. CONCLUSIONS: A rectally administered mixture of racemic ketamine (6mg/kg) and midazolam (0.5mg/kg) during paediatric burn dressing procedures with a duration of approximately 30min provides optimal conditions regarding pain relief, feasibility, recovery time and patient safety, with no need for rescue analgosedative medication.

Pilot study on arsenic removal from groundwater using a small-scale reverse osmosis system-Towards sustainable drinking water production.

Arsenic contamination of groundwater is posing a serious challenge to drinking water supplies on a global scale. In India and Bangladesh, arsenic has caused the most serious public health issue in the world for nearly two decades. The aim of this work was to study an arsenic removal system based on reverse osmosis at pilot scale treating two different water sources from two different locations in the State of Bihar, India. For this purpose two villages, Bind Toli and Ramnagar in the Patna District were selected, both located very close to the river Ganga. The trials were conducted with aerated and non-aerated groundwater. It is the first time that the arsenic removal efficiency for aerated and non-aerated groundwater by reverse osmosis technology in combination with an energy-saving recovery system have been studied. As the principle of reverse osmosis requires a relatively high pressure, its energy demand is naturally high. By using an energy recovery system, this demand can be lowered, leading to an energy demand per liter permeate of 3-4Wh/L only. Due to high iron levels in the groundwater and as a consequence the precipitation of ferric (hydr)oxides, it was necessary to develop a granular media filter for the trials under aeration in order to protect the membrane from clogging. Two different materials, first locally available sand, and second commercially available anthracite were tested in the granular media filter. For the trials with aerated groundwater, total arsenic removal efficiency at both locations was around 99% and the arsenic concentration in permeate was in compliance with the WHO and National Indian Standard of 10µg/L. However, trials under anoxic conditions with non-aerated groundwater could not comply with this standard. Additionally a possible safe discharge of the reverse osmosis concentrate into an abandoned well was studied. It was observed that re-injection of reject water underground may offer a safe disposal option. However, long-term hydrogeological studies need to be conducted for confirmation.

Sedation during endoscopic retrograde cholangiopancreatography: a randomized controlled study of patient-controlled propofol sedation and that given by a nurse anesthetist.

OBJECTIVE: Different regimens are used for sedation during endoscopic retrograde cholangiopancreatography (ERCP). Our objectives were to compare safety, ease of treatment, recovery, and patients' experiences using patient-controlled sedation (PCS) with propofol, nurse anesthetist-controlled sedation (ACS), or the department's standard of care, midazolam given by the procedure team (control group). MATERIAL AND METHODS: The study included 281 adults in 301 procedures. The PCS group (n = 101) delivered bolus doses of 5 mg of propofol according to their need for sedation. The ACS group (n = 100) had 2-8 mg/kg/h of propofol infused, with the target for sedation being level 3 of the Observer's Assessment of Alertness/Sedation (OAA/S) scale. The control group was given 2-3 mg of midazolam for induction and additional 1 mg if required. RESULTS: PCS and ACS increased the ease of the procedure and reduced the number of sedation failures compared to midazolam sedation (ACS n = 0; PCS n = 4; midazolam n = 20). The ACS group had more deeply sedated patients (OAA/S level 2), desaturation, and obstructed airways than the PCS and midazolam groups. Time to full recovery (Aldrete score ≥9) was shortest following PCS. PCS resulted in the least fatigue and pain after the procedure. Patients' preference for PCS and ACS was the same. CONCLUSION: PCS with propofol is superior to midazolam and comparable to ACS. PCS resulted in a rapid recovery, fewer respiratory events, and was almost as effective as ACS in ensuring a successful examination.