Bed rails in an internal medicine clinical setting: a medico-legal analysis based on a systemic review of available literature

The use of restraints and, specifically, bed rails embody a controversial topic. Bedrails are commonly considered to be a protective device; however, they may be used as a form of restraint, and they may lead to severe injuries. Often restraints are used despite the lack of indication and prescription, without complete informed consent and without adequate reporting in medical records. Due to these reasons, restraints may lead to lawsuits. We present two cases where the use of physical restraints was complicated by health consequences, leading to litigation and medico-legal evaluation of medical and/or nurse liability.

Strategy to Reduce the Collective Equivalent Dose for the Lens of the Physician’s Eye Using Short Radiation Protection Curtains to Prevent Cataracts

A short curtain that improves on the low versatility of existing long curtains was developed as a dedicated radiation protective device for the over-table tube fluorographic imaging units. The effect of this short curtain in preventing cataracts was then examined. First, the physician lens dose reduction rate was obtained at the position of the lens. Next, the reduction rate in the collective equivalent dose for the lens of the physician’s eye was estimated. The results showed that lens dose reduction rates with the long curtain and the short curtain were 88.9% (literature-based value) and 17.6%, respectively, higher with the long curtain. In our hospital, the reduction rate in the collective equivalent dose for the lens of the physician’s eye was 9.8% and 17.6% with a procedures mixture, using the long curtain where technically possible and no curtain in all other procedures, and the short curtain in all procedures, respectively, higher with the short curtain. Moreover, a best available for curtains raised the reduction rate in the collective equivalent dose for the lens of the physician’s eye a maximum of 25.5%. By introducing the short curtain, it can be expected to have an effect in preventing cataracts in medical staff.

P–754 A novel warmed device protecting the embryo transfer catheter is effective in preventing the cooling of embryos during the embryo transfer procedure

Study question Can cooling of embryos during the embryo transfer be alleviated with the use of a 37 °C temperature protective device covering the ET catheter? Summary answer Cooling of embryos during embryo transfer can be effectively alleviated by using a 37 °C pre-warmed temperature protective device covering the ET catheter. What is known already An optimized physicochemical environment is crucial for maintenance of normal homeostasis, metabolism, and spindle stability to minimize stress on gametes and embryos. During preimplantation embryo development, epigenetic reprogramming occurs and environmental stress factors including temperature can disrupt this critical process and potentially damage embryos. IVF laboratories use heated stages, warming blocks and incubators to control and maintain temperature within set control limits. However, it has recently been shown that during the ET procedure, the temperature of fluid in the catheter tip drops significantly. To date no means of preventing this has been reported, or to our knowledge, implemented. Study design, size, duration In this prospective controlled study, 100 simulated embryo transfer procedures were carried out at 5 European clinics. The catheters were loaded with medium according to clinic protocol. In 50, the transfer catheter was then transported to the clinician and handled according to standard practice, and in the other 50 the catheter was covered with the temperature protecting device after loading but otherwise handled identically. 10 control and 10 intervention procedures were performed at each clinic. Participants/materials, setting, methods The temperature inside the ET catheter tip (Wallace Sure View) was measured with a calibrated thermocouple probe (diameter of 0.25 mm) placed at the location of an embryo and monitored during standard operating ET procedures (control group), and with the ET catheter-syringe set inserted into a temperature protective device (37 °C pre-warmed aluminium core, 15x90 mm) allowing retraction of the ET catheter tip immediately after embryo loading (study group). No embryos were employed in this study. Main results and the role of chance During standard operating ET procedures (control group), a considerable variation was observed in the embryo loading temperature between clinics, ranging from 34 °C to 37 °C. A profound temperature drop down to 20.8 °C–25.6 °C was recorded within 20 seconds of loading the ET catheter and in all 5 clinics a very rapid decline in catheter tip temperature down to ambient temperature was observed regardless of environment, type of workstation, or standard operating ET procedures in use. In contrast, when the ET catheter-syringe set was placed into a 37 °C pre-warmed temperature protective device from the time of embryo loading until the end of the simulated ET procedure, the drop of temperature was minimal, effectively maintaining the temperature at the loading temperature of between 34 °C and 37 °C °C throughout the simulated ET procedure. The mean loss of temperature of 14.8 °C in the control group was reduced to just to 0.4 °C in the study group. The consistent and profound differences in catheter tip temperature between the control and device groups across repeated measurements at different sites indicate the findings to be robust. Limitations, reasons for caution Numerous permutations of laboratory culture systems exist and the equipment, consumables and procedure for ET, including time, are highly variable and operator dependent. Therefore, the results and conclusions of this study may not be universally applicable. Furthermore, the impact of embryo cooling during ET on live birth rate remains uncertain. Wider implications of the findings: The ET procedure represents a ‘weak link’ in temperature control from the IVF laboratory to the patient until the embryo is safely deposited into its physiological environment, the uterine cavity. We demonstrate the effectiveness of a novel device for maintaining the temperature during ET, which could potentially improve embryo viability. Trial registration number Not applicable

Distribution System Fault Analysis Using MATLAB/SIMULINK

In this paper, the impacts of various faults in the distribution network system (DNS) have been analyzed. Modelling and simulation is done using MATLAB/Simulink software package. The proposed model is simple and it can be used by power engineers as a platform. The designed model is used to study various common faults in distribution network at different points. The waveform display due to the various faults gives us an idea of hazardousness of the respective fault. The response of the system after introducing protective device is also observed.

Do Face Masks Increase the Rate of Staphylococcus Aureus Infection as Secondary Infection during Covid-19?

Nowadays due to the coronavirus disease 2019 (COVID-19) and to save our lives, we have to use masks in a wider range. Since masks are now considered a protective device to prevent some bacterial or viral diseases, especially COVID-19, and the advice is that we should use them to save our lives and the lives of others. It is true that masks have many benefits, but maybe they are also harmful. It seems that is possible in long- term masking, itself cause side effects or even other diseases. Therefore, since masks are now more widely used, its advantages and even disadvantages are important to us. We think, maybe there are harms that may cause other bacterial diseases as secondary bacterial infection that may be confused with COVID-19 because they may have similar symptoms or may increase the severity of it. In this article, we review Staphylococcus Aureus that may be exacerbate or cause infectious diseases and increase the risk of infection. We may be able to prevent them with some recommendations.