Final 24-hour Drain Output and Postoperative Day Are Poor Indicators for Appropriate Drain Removal.

Drains are used in plastic surgery to remove excess fluid while ameliorating complications. However, there is a paucity of evidence supporting guiding parameters on when to discontinue a drain. The aim of our study was to determine whether two of the most common parameters, drain volume 24 hours before removal or postoperative day, are valid indicators for drain removal. Methods: A retrospective chart review was conducted for surgical operations performed by our division between July 2014 and May 2019. Of the 1308 patients, 616 had a drain and a complete record. Demographics, medical history, operative time, antibiotic use, anatomic site, donor/recipient, and complication type were recorded. Complications were defined as events that deviated from expected postoperative course or required pharmacological/procedural intervention. T-test and Chi square were used to analyze data. Results: In total, 544 patients were in the no complication group, and 72 were in the complication group. The complication group patients had drains removed later than patients in the no complication group (15.7 days versus 12.5 days, P = 0.0003) and had similar final 24-hour drain volumes versus patients in the no complication group (16.7 mL versus 18.8 mL, P = 0.2548). The complication group had more operations on the pelvis (11% versus 2.1%; P = 0.000017) or thigh (8.5% versus 3.4%; P = 0.029). Conclusions: Our data suggest neither postoperative day nor 24-hour volume before drain removal are valid indicators for removal. Late removal correlates with more complications; however, persisting output leading to later removal may be predictive of an impending complication rather than delays in drain removal causing the complication.

Carbon-based artificial SEI layers for aqueous lithium-ion battery anodes.

Replacing flammable organic electrolytes with aqueous electrolytes in lithium-ion batteries (LIB) can greatly enhance the safety of next-generation energy storage systems. With the extended electrochemical stability window of electrolytes, 'water-in-salt' (WIS) electrolytes containing LIB presented significant performance improvements. However, the solubility limits of lithium salts in water restrain the extent of kinetic protection offered by the high salt concentration. Here, we report design strategies of anode structure to improve the cycle life of LIB with WIS electrolytes. We introduced partially graphitic protective carbon layers on anode particles using a versatile coating method. This protective layer not only improved charge transfer kinetics but also minimized the exposure of anode surface for water electrolysis. The effectiveness of anode structure developed in this study was exemplified on TiO2 anodes, where cycle performance and coulombic efficiency improved by 11 times and 29% respectively over the base anode material.

Basic Disaster Life Support (BDLS) Training Improves First Responder Confidence to Face Mass-Casualty Incidents in Thailand.

BACKGROUND: Medical response to mass-casualty incidents (MCIs) requires specialized training and preparation. Basic Disaster Life Support (BDLS) is a course designed to prepare health care workers for a MCI. The purpose of this study was to evaluate the confidence of health care professionals in Thailand to face a MCI after participating in a BDLS course. METHODS: Basic Disaster Life Support was taught to health care professionals in Thailand in July 2008. Demographics and medical experience were recorded, and participants rated their confidence before and after the course using a five-point Likert scale in 11 pertinent MCI categories. Survey results were compiled and compared with P<.05 statistically significant. RESULTS: A total of 162 health care professionals completed the BDLS course and surveys, including 78 physicians, 70 nurses, and 14 other health care professionals. Combined confidence increased among all participants (2.1 to 3.8; +1.7; P<.001). Each occupation scored confidence increases in each measured area (P<.001). Nurses had significantly lower pre-course confidence but greater confidence increase, while physicians had higher pre-course confidence but lower confidence increase. Active duty military also had lower pre-course confidence with significantly greater confidence increases, while previous disaster courses or experience increased pre-course confidence but lower increase in confidence. Age and work experience did not influence confidence. CONCLUSION: Basic Disaster Life Support significantly improves confidence to respond to MCI situations, but nurses and active duty military benefit the most from the course. Future courses should focus on these groups to prepare for MCIs. Kuhls DA , Chestovich PJ , Coule P , Carrison DM , Chua CM , Wora-Urai N , Kanchanarin T . Basic Disaster Life Support (BDLS) training improves first responder confidence to face mass-casualty incidents in Thailand. Prehosp Disaster Med. 2017;32(5):492-500 .

Multidisciplinary trauma intensive care unit checklist: impact on infection rates.

UNLABELLED: The purpose of this study was to implement a multidisciplinary daily quality checklist in a trauma intensive care setting to determine adherence to infection prevention protocols as well as the impact on infection and complications. METHODS: A multidisciplinary team developed a checklist incorporating evidence-based practice guidelines for the prevention of hospital-acquired infections. Infection rates were monitored and correlated with checklist completion. RESULTS: Central line, urinary tract infections, and ventilator-associated pneumonia decreased during the study period by 100%, 26%, and 82%, respectively. CONCLUSION: Initiation of a multidisciplinary daily quality checklist is correlated with decreased infection rates in a trauma intensive care setting.