Benefits of early ambulation within 24 h after total knee arthroplasty:a multicenter retrospective cohort study in China

Background:Postoperative care has been evolving since the concept of enhanced recovery after surgery(ERAS)was introduced in China.This study aimed to evaluate the effects of early ambulation within 24h after unilateral total knee arthroplasty(TKA)on postoperative rehabilitation and costs in a Chinese population.Methods:This cohort study of patients with knee osteoarthritis who had undergone TKA at 24 large teaching hospitals between January 2014 and November 2016 involved 2687 patients who began ambulating within 24h(Group A)and 3761 patients who began ambulating later than 24h(Group B).The outcome measurements,such as length of stay(LOS),total hospitalization costs,dynamic pain level,knee flexion range of motion(ROM),results of the 12-Item Short Form Survey(SF-12),incidence of thromboembolic events and other complications,were recorded and compared.Results:The early ambulation group(Group A)had a shorter LOS and lower hospitalization costs and pain levels than the late ambulation group(Group B).There was a favorable effect in enhancing ROM for patients in Group A compared with patients in Group B.In Group A,patients had significantly higher postoperative SF-12 scores than those in Group B.The incidence of deep venous thrombosis(DVT)and pulmonary infection was significantly lower in Group A than in Group B.The incidence of pulmonary embolism(PE)and other complications did not differ between the two groups.Conclusions:Early ambulation within 24h after TKA was associated with reduced LOS,improved knee function,lower hospitalization costs and lower incidence of DVT and pulmonary infection in the Chinese population.

Effect of pelvic fixation on ambulation in children with neuromuscular scoliosis

BACKGROUND The effect of posterior spinal fusion(PSF)incorporating the pelvis on an ambulatory patient’s ability to mobilize after the fusion is not well understood.AIM To see whether a posterior spinal fusion with pelvic fixation using iliac or sacral alar iliac screws in ambulatory neuromuscular scoliosis(NMS)patients influences postoperative ambulatory ability.METHODS A retrospective review of all patients with NMS that underwent PSF with fixation incorporating the pelvis between January 1,2012 and February 29,2019.A total of 118 patients were eligible,including 11 ambulatory patients.The primary outcome was the maintenance of ambulatory status postoperatively.Secondary outcomes included postoperative curve magnitude,pelvic obliquity,and complications,comprising infections,instrumentation failure,and any unplanned returns to the operative room.RESULTS The ambulatory function was maintained in all 11 ambulatory NMS patients.One patient had an improvement in functional status with equipment-free ambulation postoperatively.An average postoperative follow-up was 19 mo.The overall complication rate was 19.4%(n=23)with no significant differences between the groups in infection(P=0.365),hardware failure(P=0.505),and reoperation rate(P=1.0).Ambulatory status did not affect complication rate(P=0.967).CONCLUSION Spinal fusion to the pelvis in ambulatory patients with NMS provides effective deformity correction without the reduction in ambulatory capabilities.

Effect of Intermittent Pneumatic Compression on Functional Level and Quality of Life in Community-Dwelling Older Adults with Limited Ambulation Due to Leg Pain: A Randomized Controlled Trial

Background and Purpose: Walking difficulties are defined as any reduction in speed, balance, or change of gait, causing limited ambulation. These difficulties are a common problem in older adults and may greatly affect their quality of life (QOL) and restrict their personal independence and participation. This study aimed to determine the effect of intermittent pneumatic compression (IPC) on lower leg pain, walking capacity, functional mobility, ankle range of motion (AROM), and QOL of community-dwelling older people with walking difficulties. Methods: In this randomized controlled trial, 34 eligible participants with self-reported lower limb pain and limited ambulation were randomized either to the intermittent pneumatic compression intervention group (IPCIG) or static compression control group (SCCG). The IPCIG and SCCG were trained to receive IPC and SC respectively for both lower legs and instructed to continue the application independently at home for 15 minutes per session, 2 sessions a day, 7 days per week for 4 weeks independently at the home. Outcome measures of lower leg pain, AROM, walking capacity, and functional mobility were assessed at baseline and at the first, second, third, and fourth weeks after randomization. Quality of life was assessed at baseline and immediately after the intervention. Results and Discussion: IPCIG showed a more significant improvement compared to the SCCG at the post-interventional stage for QOL and all the subscales. The findings show that “80% improved QOL” is 53% higher with the application of IPC than with SC for 4 weeks. The IPCIG showed a more significant improvement in the 6-minute walk test (6 MWT) at the third and fourth weeks compared to the SCCG. A pairwise comparison of mean values of 6 MWT over 4 weeks within the IPCIG showed a significant difference between all the weeks. Pairwise comparisons between groups at each time point showed that the IPCIG showed a more significant improvement in the timed up and go (TUG) test at the third and fourth weeks compared to the SCCG. Pairwise comparison of mean values of TUG test within the IPCIG showed a significant difference over 4 weeks, except between the second and third weeks, fourth week, and third and fourth weeks. The IPCIG showed a more significant improvement in lower leg pain between all weeks except the first week compared to the SCCG. Pairwise comparison of mean values of lower leg pain over 4 weeks within the IPCIG showed a significant difference among all weekly outcomes except between 1 and 2 weeks. The IPCIG showed a more significant improvement in left and right ankle dorsiflexion ROM at the third and fourth weeks compared to the SCCG. Conclusions: The IPC was effective in reducing lower leg pain and increasing the AROM and improving the walking capacity, functional mobility level, and QOL of community-dwelling older people with walking disabilities. Walking disability in old age is a common condition requiring physical therapy. Intermittent pneumatic compression can be used as a physical therapy modality for this patient group.

Early mobilization implementation for critical ill patients:A cross-sectional multi-center survey about knowledge,attitudes,and perceptions of critical care nurses

Objective To explore critical care clinicians’knowledge,attitudes and perceptions toward early mobilization of critically ill patients in ICUs.Design A cross-sectional national survey was conducted.From January to August 2020,ICU nurses in 11 hospitals were surveyed by using a questionnaire on the knowledge,attitudes and perceptions of ICU early mobilization.Results Totally 512 nurses completed the questionnaire.The respondents’mean score for knowledge of early mobilization was 6.89±2.91.The level of knowledge was good in 2.5%(13/512),fair in 52.3%(268/512).The attitudes toward early mobilization were positive in 31.4%(161/512).In terms of perceived implementation of ICU early mobilization,42.9%(220/512)of nurses did not believe that this should be a top priority in intensive care.The attitudes of nurses from different ICUs were significantly different(F=3.58,P<0.05).The knowledge(7.34±2.78 vs.6.49±2.97,t=3.37,P<0.001)and attitudes(3.82±0.58 vs.3.52±0.56,t=5.63,P<0.001)of nurses who had early mobilization related training were higher than those of nurses who had no training.Conclusions The importance of early ICU early mobilization is increasingly recognized by critical care providers.However,there is still a gap in the knowledge,attitudes and perceptions of ICU early mobilization among nurses.In future studies,it is necessary to further systematically identify the reasons leading to the gaps in these aspects and implement targeted interventions around these gaps.Meanwhile,more nurses should be encouraged to participate in decision-making to ensure the efficient and quality implementation of ICU early mobilization practices.

Changes in a cerebellar peduncle lesion in a patient with Dandy-Walker malformation A diffusion tensor imaging study

We report a patient with severe ataxia due to Dandy-Walker malformation, who showed functional recovery over 10 months corresponding to a change in a cerebellar peduncle lesion. A 20-month-old female patient who was diagnosed with Dandy-Walker syndrome and six age- and sex-matched healthy control subjects were enrolled. The superior cerebellar peduncle, the middle cerebellar peduncle, and the inferior cerebellar peduncle were evaluated using fractional anisotropy and the apparent diffusion coefficient. The patients＇ functional ambulation category was 0 at the initial visit, but improved to 2 at the follow-up evaluation, and Berg＇s balance scale score also improved from 0 to 7. Initial diffusion tensor tractography revealed that the inferior cerebellar peduncle was not detected, that the fractional anisotropy of the superior cerebellar peduncle and middle cerebellar peduncle decreased by two standard deviations below, and that the apparent diffusion coefficient increased by two standard deviations over normal control values. However, on follow-up diffusion tensor tractography, both inferior cerebellar peduncles could be detected, and the fractional anisotropy of superior cerebellar peduncle increased to within two standard deviations of normal controls. The functional improvement in this patient appeared to correspond to changes in these cerebellar peduncles. We believe that evaluating cerebellar peduncles using diffusion tensor imaging is useful in cases when a cerebellar peduncle lesion is suspected.

Corticoreticular tract lesion in children with developmental delay presenting with gait dysfunction and trunk instability

The corticoreticular tract （CRT） is known to be involved in walking and postural control. Using diffusion tensor tractography （DTT）, we investigated the relationship between the CRT and gait dysfunction, includ- ing trunk instability, in pediatric patients. Thirty patients with delayed development and 15 age-matched, typically-developed （TD） children were recruited. Fifteen patients with gait dysfunction （bilateral trunk instability） were included in the group A, and the other 15 patients with gait dysfunction （unilateral trunk instability） were included in the group B. The Growth Motor Function Classification System, Functional Ambulation Category scale, and Functional Ambulation Category scale were used for measurement of functional state. Fractional anisotropy, apparent diffusion coefficient, fiber number, and tract integrity of the CRT and corticospinal tract were measured. Diffusion parameters or integrity of corticospinal tract were not significantly different in the three study groups. However, CRT results revealed that both CRTs were disrupted in the group A, whereas CRT disruption in the hemispheres contralateral to clinical mani- festations was observed in the group B. Fractional anisotropy values and fiber numbers in both CRTs were decreased in the group A than in the group TD. The extents of decreases of fractional anisotropy values and fiber numbers on the ipsilateral side relative to those on the contralateral side were greater in the group B than in the group TD. Functional evaluation data and clinical manifestations were found to show strong correlations with CRT status, rather than with corticospinal tract status. These findings suggest that CRT status appears to be clinically important for gait function and trunk stability in pediatric patients and DTT can help assess CRT status in pediatric patients with gait dysfunction.

Subrectal and Subcutaneous Wound Infiltration with Bupivacaine versus Pethidine for Post Cesarean Section Pain Relief: Randomized Controlled Trial

Background: Cesarean section (CS), one of the most common major operative procedures, performed all over the world. Incisional infiltration with local anesthetics is a simple, cheap and effective mean of providing good analgesia for surgical operations without any major side effects & allowing early patients’ mobilization & postoperative recovery, so the purpose of study is to compare between the effect of wound infiltration with bupivacaine versus pethidine for post cesarean section pain relief. Patients and Methods: A randomized controlled trial (RCT) was conducted in Ain Shams University Maternity hospital in the period from August 2016 and January 2017. 100 full term pregnant females randomized into two groups: Group A (50 patients) Bupivacaine group: Subcutaneous and subrectal infiltration with 10 ml 0.25% Bupivacaine (2.5 mg/ml) diluted in 10 ml normal saline before closure of the wound was done;Group B (50 patients) Pethidine group: Subcutaneous and subrectal infiltration with 1 ml pethidine (50 mg/ml) diluted in 19 ml normal saline before closure of the wound was done. All patients had cesarean section under spinal anesthesia. Study outcome measures post-operative pain scores using visual analogue scale, post-operative analgesia requirement time to first rescue analgesia, onset of mobilization, side effect of local anesthetic, wound infection (after one week). It was registered on clinical trials.gov with ID: NCT03652116. Results: Visual analogue scale values differ significantly between pethidine group and that of bupivacaine at rest and on coughing at 4, 8, 12, 24 hours & analgesic consumption (P value st time request analgesia per minute comparing group A to group B (P value 0.001). There is no significant difference between bupivacaine and pethidine regarding time of ambulation, side effects or complications. Conclusion: Infiltration of the wound of cesarean section with pethidine gives effective analgesia for several hours as compared to Bupivacaine.

Quantitative Analysis of Nursing Observation Employing a Portable Eye-Tracker

Background: Observation is an important skill for making appropriate nursing decisions and engaging in good practice. However, experts’ observation behavior and cognitive processes cannot be easily verbalized or documented in an objective and accurate manner. Quantitative analysis of the observation behavior of nurses with rich clinical experience will yield effective educational data for fostering and improving nursing students’ observation skills. Objectives: To improve nursing assessment education, the differences in the information gathering processes between clinical nurses and nursing students were analyzed by using a portable eye-tracker. Design: An experimental study. Settings: The experiment was performed at a university in Japan. Participants: The participants were 11 clinical nurses with at least 5 years of clinical experience for postoperative patients, and 10 fourth-year nursing students. Methods: In a mock hospital room, wherein we recreated a situation where a patient in postoperative day 1 was confined to a bed, participants wore an eye-tracking camera and engaged in nursing observation to make an early postoperative ambulation assessment of the patient. Participants’ gaze points and gaze fixation durations were extracted from the gaze measurement data and compared. Results: Clinical nurses had shorter observation times and gaze durations than did nursing students, and focused more on the patient chart, intravenous drip, and indwelling drain. Students gazed for longest at the measuring devices for vital signs. Conclusions: We quantitatively analyzed differences in nursing observation according to clinical experience. Although no significant difference was found in gaze points, nursing students had a greater tendency to focus on information that was numerically displayed. Nurses with clinical experience conducted observations by gazing at information that they needed to focus on the most according to the patients’ postoperative course.

Mobility after Heart Surgery： What Are Influential Factors？

Objective： To analyze postoperative mobility after cardiac surgery. Methods： Observational study in patients, aged 〉 18 years, undergoing myocardial revascularization and/or valvular heart surgery, hospitalized in a Brazil hospital. The data collection took place between April 2016 and March 2017. On admission to the ward, patients received a calibrated pedometer. They were asked to use the device during five consecutive days, yet only three days of full use were analyzed. Results： Analyzed were data of 87 individuals with mean age of 58.70 ~ 12.59 years, 52 （59.8%） of them were males. Regarding surgery, 53 （60.9%） underwent myocardial revascularization. The median number of steps was 738 （185-1,557）, which showed a weak and inverse correlation with the length of stay in the intensive care unit （r = -0.3/p = 0.02）, however, it was not statistically significant when related to clinical and surgical data. Male patients had a better mobility when compared to patients of the female sex （p = 0.04）. Conclusions： Individuals who had a longer stay in the intensive care unit, as well as females, had a lower mobility in the ward. The mobility did not show a relation with intra- and postoperative factors.

由“ambulance”所联想到的

在美国几乎所有的人都有“family doctor／家庭(特约)医生”，人们通常是按“family doctor”的医嘱就医．或到药店买所需药品。然而，当人们在旅行或外出时，突然出现高烧、呼吸困难或因某种事故负伤了，已不可能同“family doctor”联系，这时应马上向旅馆工作人员或行人请求帮助呼叫“ambulance”：

Air temperature was associated with ambulance transports in Osaka area, Japan

We investigated the link between ambulance transports and meteorological parameters of summer by using daily data in Osaka area, Japan. Daily observations for ambulance transports (from July 1 to September 30, 2009) were obtained from Fire Department Service in Osaka. Data of meteorological parameters in Osaka area, Japan (from July 1 to September 30, 2009) were also obtained from Japan Meteorological Agency. Effect of meteorological parameters on ambulance transports was analyzed. A total of 49,526 ambulance transports were observed from July 1 to September 30, 2009 in Osaka, Japan. Ambulance transports were significantly correlated with mean air temperature (r = 0.298), the highest air temperature (r = 0.347), the lowest air temperature (r = 0.209) and daylight hours (r = 0.301). The higher air temperature was associated with higher ambulance transports of summer in Osaka area, Japan.

The relation between ambulance transports due to heat stroke and air temperature using daily data in Okayama prefecture, Japan

The aim of this study was to investigate the link between ambulance transports due to heat stroke and air temperature by using daily data of ambulance transports in Okayama prefecture, Japan. Daily observations for ambulance transports due to heat stroke from July to September in 2010 in Okayama prefecture, Japan were obtained from Fire and Disaster Management Agency in Japan. Data of meteorological parameters in Okayama prefecture, Japan were also obtained from Japan Meteorological Agency. Effect of meteorological parameters on ambulance transports due to heat stroke was analyzed. A total of 1133 ambulance transports due to heat stroke were observed in from July to September of 2010 in Okayama prefecture, Japan. Ambulance transports due to heat stroke was significantly correlated with air temperature. In addition, number of subjects with ambulance transports due to heat stroke over 34°C in the highest air temperature was 21.2 ± 9.8 per day. Higher air temperature was closely associated with higher ambulance transports due to heat stroke by using daily data in Okayama, prefecture, Japan.

A GIS-Based Decision Support System for Reducing Air Ambulance Response Times: A Case Study on Public Schools in Jeddah City

In injuries reducing ambulance response time (time from injury to hospital arrival) is an important factor for saving people’s lives. Helicopter emergency medical services can reduce out-of-hospital transport times because of their high speed and their ability to travel in straight paths?unlike ground ambulance which are restricted to road network paths, as well as the ability toaccess rural or remote area injuries that are difficult to reach by ground ambulance. GIS technology aids air ambulance movement planning to reduce out-of-hospital response time based on mathematical and geographic models to support decision making which is necessary from out-of-hospital care providers. The goal of this study is to use GIS to develop an efficient DSS to outline where air ambulance can reduce response times, by using spatial analysis tools to create Euclidean distance and direction zones around receiving hospitals. The study concludes that GIS technology can be used to develop an efficient DSS to outline where air ambulance can reduce response times, by creating surfaces of Euclidean allocation, direction, and distance that can be used to improve initial response times for the civil defense air rescue and air ambulance services.

The higher air temperature was closely associated with higher ambulance transports due to heat stroke in elderly Japanese

To investigate the link between higher air temperature and ambulance transports due to heat stroke, especially in elderly subjects, using daily data in Sai-tama prefecture in August, 2010, Japan. We obtained daily data of air temperature in Saitama prefecture in August, 2010, Japan from Japan Meteorological Agency. Number of ambulance transports due to heat stroke was also used by Saitama prefecture official website. The effect of high air temperature on am-bulance transports due to heat stroke was evaluated. A total of 1688 ambulance transports due to heat stroke was observed in Saitama prefecture in August, 2010, Japan. Seven hundred and twenty one subjects (42.7%) were over the age of 65. Mean air temperature, the highest air temperature and day light hours were significantly associated with ambulance transports due to heat stroke in total subjects (mean air temperature: r = 0.749, p < 0.0001) and the over the age of 7. In addition, by separate analysis as classified by age groups, the correlation coefficient between ambulance transports due to heat stroke and mean air temperature was the highest in subjects with over 65. However, the lowest air temperature was not cor-related with ambulance transports due to heat stroke. Higher air temperature was closely associated with higher ambulance transports due to heat stroke using daily data in Saitama prefecture in August, 2010, Ja-pan, especially in elderly subjects.

Higher Temperatures Were Closely Associated with Higher Ambulance Transports in Takamatsu Area,Japan

The link between high temperatures and ambulance transports in Takamatsu area, Japan was investigated. Monthly observations for ambulance transports (2004-2008) were obtained from Fire Department Service in Takamatsu. Data of temperatures in Takamatsu area, Japan (2004-2008) were used by Japan Meteorological Agency. Effect of high temperatures on ambulance transports was analyzed. By using data from July to September, there were not clear differences of mean temperatures and ambulance transports among years. Ambulance transports were significantly correlated with parameters of temperatures. Correlation coefficient rate between ambulance transports and the mean temperature of maximum temperatures in a month was highest among parameters (r = 0.738, p = 0.0017). In addition, ambulance transports were also significantly correlated with the number of days over the level of 32?C in a month (r = 0.782, p = 0.0006). Higher temperatures were closely associated with higher ambulance transports in Takamatsu area, Japan.

Characteristics of non-conveyance ambulance runs: A retrospective study in the Netherlands

Dear editor,Emergency medical services(EMS)have developed from conveyance facilities into providers of advanced pre-hospital care.[1,2]Alongside this development there is a growing demand for EMS care,and the number of ambulance deployments is increasing.[3,4]Suggested reasons for this growing demand are changes in social support of people,accessibility of healthcare and social facilities,and the aging population.

Time of arrival and in-hospital evaluation processes among patients with acute ischemic stroke at Yozgat City Hospital in Turkey: A retrospective study

Objective: To reveal the factors leading to delay in the evaluation processes of patients with suspected acute ischemic stroke at Yozgat City Hospital in Turkey and suggest potential solutions. Methods: Patients who visited the emergency service of Yozgat City Hospital between 1 April 2017 and 1 July 2017 and those hospitalized with a diagnosis of ischemic stroke, were included in this retrospective study. The clinical information of the patients was collected via hospital files and telephone interviews. In addition, the potential association between arrival time and the clinical parameters was investigated. Results: A total of 87 patients were included. The median arrival time to emergency service was 5 (IQR=9) h. Forty-four percent of patients arrived within the first 4.5 h from symptom onset. However, intravenous thrombolytic treatment was performed in only 7% of the patients. The median time from arrival to neuroimaging performing was 20.0 (IQR=34) min. Fifty-one percent of patients were screened within the first 20 min from arrival to emergency service. There was no association between arrival time and transfer method of the patients. Conclusions: The main problem regarding acute stroke care in our region may be inefficient use of emergency ambulance. This study provides basis for measures to shorten the arrival time.

A Novel Quantum-Behaved Particle Swarm Optimization Algorithm

The efficient management of ambulance routing for emergency requests is vital to save lives when a disaster occurs.Quantum-behaved Particle Swarm Optimization(QPSO)algorithm is a kind of metaheuristic algorithms applied to deal with the problem of scheduling.This paper analyzed the motion pattern of particles in a square potential well,given the position equation of the particles by solving the Schrödinger equation and proposed the Binary Correlation QPSO Algorithm Based on Square Potential Well(BC-QSPSO).In this novel algorithm,the intrinsic cognitive link between particles’experience information and group sharing information was created by using normal Copula function.After that,the control parameters chosen strategy gives through experiments.Finally,the simulation results of the test functions show that the improved algorithms outperform the original QPSO algorithm and due to the error gradient information will not be over utilized in square potential well,the particles are easy to jump out of the local optimum,the BC-QSPSO is more suitable to solve the functions with correlative variables.

Feasibility of using ultrasound in ambulances in Saudi Arabia

BACKGROUND In developed countries,the economic feasibility of using ultrasound in ambulances before arriving at the hospital has been achieved through comprehensive studies,and this of course does not apply to Arab countries,as there are no current studies to support this.Therefore,this study is a preliminary measure of the economic feasibility of using ultrasound in ambulances in Saudi Arabia.AIM To measure the demand for ultrasound equipment in ambulances in Saudi Arabia.METHODS A cross-sectional study of five different groups of participants including radiation technologists,emergency physicians,paramedics,Red Crescent managers and the public.Email and social media were used to deliver a questionnaire to these groups.The questionnaire included specific questions to measure the purpose of ultrasound use in each group of participants.RESULTS Each group had some knowledge on ultrasound and its benefits.More than 50%in each study group supported the availability of ultrasound in ambulances.Additionally,60%of emergency physicians reported that they had difficulties in venous access,checking the presence of internal bleeding,recognizing pregnancy in trauma cases,and inserting endotracheal tubes,and the majority of them confirmed the effective role of ultrasound in achieving such tasks.Almost all paramedics(93.33%),physicians(98.89%),and Saudi Red Crescent managers(96.3%)emphasized the importance of communication between ambulance staff and emergency departments.Moreover,most physicians(77.78%),and technologists(82.73%)supported the presence of paramedics in ambulances to operate ultrasound in order to improve patient outcomes.CONCLUSION Most of the study groups evaluated had knowledge on ultrasound and supported the presence of ultrasound devices in ambulances.

Enhanced Surveillance for National (Handicapped) Sports Games in Wakayama, Japan 2015

Introduction: We undertook enhanced surveillance of the 2015 Kinokuni Wakayama National Sports Games (70th National Sports Games) and the Kinokuni Wakayama Handicapped Sports Games (15th National Handicapped Sports Games) held in Wakayama prefecture in 2015, for which this paper presented operational details and an evaluation. Methods: Enhanced surveillance conducted involved (Nursery) School Absenteeism Surveillance system ((N)SASSy), Prescription Surveillance, and Ambulance Transfer Surveillance from 30 August through 9 November. We evaluated those surveillances on all days including weekends, integrated the results as a daily report, and published it on the web. Results: We found no cluster or cases requiring more tracing and investigation except for suspected cases of rubella in (N)SASSy. Moreover, no moderate aberration was found for two consecutive days for the same area and symptom. Conclusion: Our experience with this enhanced surveillance presents important lessons for countermeasures by local governments for mass gatherings or politically important events.