Search

Aim: To investigate whether a novel decision support tool would effectively minimize physical restraint use in critically ill adult patients. Design A nonequivalent quasi‐experimental design combined with a descriptive qualitative approach was used. Methods: A Restraint Decision Tree was developed based on a qualitative study that explored the barriers to employ the Restraint Decision Wheel. During the quasi‐experimental study, patients admitted to the unit between October 2017 and March 2018 were enrolled as the control group receiving the Restraint Decision Wheel (n = 528), whereas patients between April 2018 and September 2018 were enrolled as the intervention group receiving the Restraint Decision Tree (n = 564). The physical restraint rate, accidental catheter removal rate and nurses' satisfaction were compared. Results: The Restraint Decision Tree significantly decreased physical restraint use. No significant difference in the rate of accidental catheter removal was found. Nurses reported increased satisfaction with the restraint decision‐making. Conclusions: The Restraint Decision Tree could minimize physical restraint use. Physicians' involvement in the restraint decision‐making and nurses' competence in delirium assessment may be essential for successful implementation of the Restraint Decision Tree. Summary statement: What is already known about this topic? Physical restraint is a common practice in the intensive care unit.Minimizing physical restraint use does not increase the risk of catheter self‐removal.Nurses equipped with clinical decision‐making skills could promote the appropriateness of restraint application. What this paper adds? The Restraint Decision Tree could help nurses make appropriate restraint decisions for critically ill adult patients, thus decreasing the use of physical restraint.Multidisciplinary decision‐making improves nurses' satisfaction with the restraint decision process. The implications of this paper: This study suggests that the Restraint Decision Tree can be implemented in the intensive care unit as an effective decision‐making tool to decrease physical restraint use while maintaining patient safety.A strong culture of multidisciplinary collaboration and delirium screening is called for prior to utilizing the Restraint Decision Tree. [ABSTRACT FROM AUTHOR]

Drinking water arsenic poisoning has been a health concern, however the importance of dietary arsenic exposure to health also needs to be taken into account. The aim of this study was to conduct a comprehensive health risk assessment of arsenic-contaminated substances in drinking water and wheat-based food intake in the Guanzhong Plain, China. 87 samples of wheat and 150 samples of water were randomly selected from the research region and examined. The level of arsenic in 89.33% of the water samples in the region exceeded the limit for drinking water (10 μg/L), with an average concentration of 29.98 μg/L. The arsenic in 2.13% of the wheat samples exceeded the food limit (0.5 mg/kg) with an average concentration of 0.24 mg/kg. Under the situation of different exposure pathways, two scenarios of deterministic and probabilistic health risk assessments were compared and analyzed. By contrast, the probabilistic health risk assessment can ensure a certain degree of confidence in the assessment results. The findings of this study indicated that the total cancer risk value faced by the population aged 3–79 years, except for those aged 4–6 years, was 1.03E-4–1.21E-3, which exceeded the 10E-6–10E-4 range of thresholds usually used by USEPA as guidance recommendations for determination. And the non-cancer risk experienced by the population aged 6 months to 79 years was higher than the acceptable threshold (1), with children aged 9 months to 1 year having the highest total non-cancer risk of 7.25. The potential health risks of the exposed population were mainly due to the drinking water route, and consumption of arsenic-containing wheat increased both carcinogenic and non-carcinogenic risks. Finally, the sensitivity analysis revealed that the assessment findings were most significantly influenced by exposure time. The amount of intake was the second influencing factor in the health risk assessment from drinking water and dietary intakes of arsenic, and arsenic concentration was the second influencing factor in the health risk assessment due to dermal exposure to arsenic. The findings of this study can aid in understanding the negative health consequences of arsenic pollution to local residents and in adopting focused remediation strategies to alleviate environmental concerns. [Display omitted] • This is a comprehensive health risk assessment of people divided into 14 age groups. • This study gives exposure parameter values of Chinese people to improve credibility. • Comparing the health risk contribution of arsenic exposure to water and wheat. [ABSTRACT FROM AUTHOR]

Objective: To summarize gain characteristics of three pairs of semicircular canals in head impulse paradigm （HIMP） and suppression head impulse paradigm （SHIMP） in healthy young Chinese population. Methods: HIMP and SHIMP tests were performed on 40 healthy young volunteers enrolled as study group, by using EyeseeCam examiantion system （Interacoustics，Denmark）. The elicitation rates and gain values of the two saccades were recorded, and the gain values were compared and analyzed. Results: The results of 40 healthy young people were as follows: in HIMP, the instantaneous gain at 60 ms of the horizontal semicircular canals were 1.11±0.07 on the left side and 1.08±0.07 on the right side; the regression gain of the horizontal semicircular canals were 1.09±0.06 on the left side and 1.10±0.06 on the right side; the regression gain of the vertical semicircular canals were 1.08±0.12 on the right anterior, 1.07±0.11 on the left posterior, 1.41±0.16 on the right posterior and 1.42±0.16 on the left anterior. So in HIMP, no significant difference could be found between left and right side in both horizontal and vertical semicircular canal conjugate plane regarding regression gain （ P >0.05）, except that 60 ms instantaneous gain on the left horizontal semicircular canals was slightly higher than that on the right side （ P <0.05）.The instantaneous gain values of the horizontal semicircular canal at 60 ms in SHIMP were 1.08±0.08 on the left side and 1.06±0.07 on the right side; the regression gain in horizontal semicircular canals were 1.06±0.07 on the left side and 1.07±0.06 on the right side, respectively; the regression gains of vertical semicircular canal were 1.06±0.13, 1.08±0.16, 1.49±0.16, 1.39±0.15, on the right anterior, left posterior, right posterior, and left anterior side. So in SHIMP, no significant difference could be found in 60 ms instantaneous gain in horizontal conjugate plane, regression gain in horizontal conjugate plane and regression gain in right anterior left posterior conjugate plane （ P >0.05）, while the regression gain of the left anterior right posterior conjugate plane in the right was found slightly higher than that of the left （ P <0.05）.Both 60 ms instantaneous gain and regression gain in horizontal conjugate plane in HIMP were slightly higher than that of SHIMP （ P <0.05）, while no significant difference could be found in vertical conjugate planes （ P >0.05）. In both HIMP and SHIMP tests, gains of the left anterior right posterior conjugate plane was slightly higher than that of both horizontal plane and the right anterior left posterior conjugate plane （ P <0.05）, while no significant difference could be found in gains between horizontal and the right anterior left posterior conjugate plane （ P >0.05）. Conclusion: Gain values of HIMP and SHIMP were slightly different among different semicircular canals conjugate planes.It is suggested that each examination center should establish normal values for their own and make correction regularly., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

As the two most commonly used organophosphorus herbicides, glyphosate (Gly) and glufosinate-ammonium (Glu) have unique properties for weed control and algae removal in aquaculture. However, the occurrences and health risks of Gly and Glu in aquaculture ponds are rare known. This study aimed to investigate the occurrences of Gly, AMPA (primary metabolity of Gly) and Glu in surface water, sediment and aquatic products from the grass carp (ctenopharyngodon idella), crayfish (procambarus clarkii) and crab (eriocheir sinensis) ponds around Lake Honghu, the largest freshwater lake in Hubei province, China where aquaculture has become the local pillar industry. Three age groups (children, young adults, middle-aged and elderly) exposure to these compounds through edible aquatic products (muscle) consumption were also assessed by target hazard quotient (THQ) method. The results indicated that Gly, AMPA and Glu were widely occurred in surface water, sediment and organisms in the fish, crayfish and crab ponds. AMPA was more likely to accumulate in the intestine of aquatic products than Gly and Glu. According to the total THQ value (1.04＞1), muscle consumption of grass carp may pose potential risk to children., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The consumption of pharmaceuticals and personal care products (PPCPs) for controlling and preventing the COVID-19 would have sharply increased during the pandemic. To evaluate their post-pandemic environmental impacts, five categories of drugs were detected in lakes and WWTP-river-estuary system near hospitals of Jinyintan, Huoshenshan and Leishenshan in the three regions (J, H and L) (Regions J, H and L) in Wuhan, China. The total amount of PPCPs (ranging from 2.61 to 1122 ng/L in water and 0.11 to 164 ng/g dry weight in sediments) were comparable to historical reports in Yangtze River basin, whereas the detection frequency and concentrations of ribavirin and azithromycin were higher than those of historical studies. The distribution of concerned drugs varied with space, season, media and water types: sampling sites located at WWTPs-river-estuary system around two hospitals (Regions L and J) usually had relatively high waterborne contamination levels, most of which declined in autumn; lakes had relatively low waterborne contamination levels in summer but increased in autumn. The potential risks of detected PPCPs were further evaluated using the multiple-level ecological risk assessment (MLERA): sulfamethoxazole and azithromycin were found to pose potential risks to aquatic organisms according to a semi-probabilistic approach and classified as priority pollutants based on an optimized risk assessment. In general, the COVID-19 pandemic did not cause serious pollution in lakes and WWTPs-river-estuary system in Wuhan City. However, the increased occurrence of certain drugs and their potential ecological risks need further attention. A strict source control policy and an advanced monitoring and risk warning system for emergency response and long-term risk control of PPCPs is urgent., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Purpose: This study aimed to investigate the incidence of emergence delirium (ED) in elderly patients under general anesthesia and to determine the correlation between ED and delirium at five subsequent postoperative days., Design: This research is a descriptive correlational study., Methods: A total of 168 aged patients undergoing elective general anesthesia were recruited from a comprehensive tertiary teaching hospital with 2,400 beds in Southern China from April 2018 to September 2018. The Nursing Delirium Screening Scale was used to assess delirium at 30 and 60 minutes after extubation or on discharge from the postanesthesia care unit. Patients were assessed for delirium at postoperative days one through five using the same method. Patients' demographic information, including cognitive function, were collected., Findings: Among the 168 aged patients, 58 suffered from ED (34.5%), including the 79.3% for the 46 patients who experienced postoperative delirium (POD). A positive correlation existed between ED and POD (χ 2  = 111.744; P < .01). Logistic regression analysis included seven variables: age, preoperative Mini-Mental State Examination score, underlying diseases, American Society of Anesthesiologists grade, surgery duration, postoperative complications, and the presence of ED. Age and ED were concluded to be independent predictive factors of POD., Conclusions: ED in the first hour after tracheal tube removal is a predictor of delirium at five subsequent postoperative days. Accurate and timely assessment of recovery period can effectively guide the treatment and rehabilitation of POD and maximize prevention of adverse consequences., (Copyright © 2020. Published by Elsevier Inc.)

Dechloranes, a type of additive polychlorinated flame retardant, which include Dechlorane (Dec) Plus (DP), Dec 602, Dec 603, and Dec 604, were detected in surficial water and sediment from the Jiulong River Estuary (JRE). The total concentration of dechloranes in the water and sediments ranged from 1.4 to 4.1 ng/L and 9.3 to 36.2 ng/g dry weight, respectively. The distribution patterns of dechloranes in the water and sediments were both dominated by DP. The average values of the anti-DP fractional abundances (f anti ) in the water and sediment samples both were fell in the range of commercial DP mixtures. The relationships of DP in the water with suspended particulate matter (SPM), total organic carbon (TOC), and tides indicated that the combined actions of these environmental factors influenced the distribution of DP in the JRE. The deleterious risk associated with exposure to dechloranes via the water for adults was very low, suggesting that exposure of the local population of dechloranes via water is relatively safe in the JRE.

This study was designed to estimate the human risk to polybrominated diphenyl ethers (PBDEs) exposure via two main exposure routes (dust and diet) in an e-waste recycling area in southern China. A total of 134 dust samples and 129 food samples were analyzed by gas chromatography/mass spectrometry (GC/MS). The mean concentration of ΣPBDE in in-house dust (38,685ng/g dw) was higher than that in out-house dust (24,595ng/g). For food samples, the highest concentration of ΣPBDE was found in fish and shellfish (2755ng/kg ww), followed in descending order by eggs (2423ng/kg), cereals (2239ng/kg) and meat (1799ng/kg). The estimated total daily dietary intake of PBDEs was 1671ng/day for adults and 952ng/day for children. The present study indicated that dust intake was the dominant PBDE exposure route for children, and the dietary intake was the dominant PBDE exposure route for adults. Our findings revealed high PBDE concentrations in dust and food samples collected at the center of e-waste recycling area, raising significant health concerns for residents in this particular region, especially for children., (Copyright © 2014 Elsevier B.V. All rights reserved.)