Adapting to Change: A Systematic Literature Review of Environmental Flexibility in Emergency Departments

PURPOSE

This study aimed to offer a comprehensive analysis of distinct design strategies identified, evaluated, or discussed in the existing literature that promote environmental flexibility in the context of emergency departments (EDs).

BACKGROUND

EDs are subject to constant changes caused by several factors, including seasonal disease trends, the emergence of new technologies, and surges resulting from local or global disasters, such as mass casualty incidents or pandemics. Thus, integrating flexibility into ED design becomes crucial to effectively addressing these evolving needs.

METHODS

A systematic search was conducted in four databases: CINAHL, MEDLINE, PubMed, and ScienceDirect, in addition to a hand search. A two-stage review process was employed to determine the final list of included articles based on the inclusion criteria. Included studies were evaluated for quality, and findings were categorized using a hybrid deductive and inductive coding approach.

RESULTS

From the initial yield of 900 records, 22 studies met the inclusion criteria and were included in the final full-text review. The identified design strategies were organized into five categories: modifiability (n = 13 articles), versatility (n = 8 articles), tolerance (n = 6 articles), convertibility (n = 4 articles), and scalability (n = 7 articles). Specific design strategies under each category are reported in detail.

CONCLUSIONS

Our findings suggest that most flexibility design solutions are based on anecdotal evidence or descriptive studies, which carry less weight in terms of reliable support for conclusions. Therefore, more studies employing quantitative, relational, or causal designs are recommended.

Hierarchy of Evidence: An Appraisal Tool for Weighting the Evidence in Healthcare Design Research Based on Internal Validity

PURPOSE

This inquiry aims to develop an appraisal tool to offer greater granularity in weighing evidence in the field of healthcare design research.

BACKGROUND

In evidence-based design (EBD), the goal is to implement interventions that result in a meaningful and optimal effect based on current best evidence. Although multiple appraisal tools (many adopted from medical disciplines) have been instrumental in evaluating studies in the field of healthcare design research to identify the best evidence, they do not necessarily consider the unique contexts of healthcare design research, and methodologies appropriate to the field.

METHODS

Five basic types of studies are ranked based on the level of confidence that they offer regarding the estimate of an effect: (1) meta-analysis studies, (2) causal studies, (3) correlational studies, (4) descriptive studies, and (5) anecdotal evidence. Causal studies are further divided into four levels based on the interaction of two factors: (1) type of intervention and (2) groups' equivalency and extraneous variable control.

RESULTS

An eight-level hierarchy of evidence for healthcare design research is proposed that is expected to improve upon previous hierarchies in three major ways: (a) including research methods that are more relevant to healthcare design research, (b) enhancing evaluation accuracy and reliability by providing a clearer definition of studies based on their key components rather than using study labels alone, and (c) distinguishing different levels of evidence, particularly in causal studies.

CONCLUSIONS

The proposed appraisal tool is developed specifically for EBD by reflecting on the unique context of healthcare design research and practice.

Association between Food Insecurity and Vision Impairment among Older Adults: A Pooled Analysis of Data from Six Low- and Middle-Income Countries

OBJECTIVES

Food insecurity has gained attention as a potential risk factor for vision impairment. However, research on this topic is limited. This objective of this study was to investigate the relationship between food insecurity and visual impairment among adults aged 50 years or older using data from six low-and middle-income countries (LMIC).

DESIGN AND SETTING

Data from the longitudinal Study on global AGEing and adult health (SAGE) were analyzed in a community-based, cross-sectional, and nationally representative sample.

PARTICIPANTS

Adults aged 50 years or older from six low- and middle-income countries (LMICs) including China, India, Mexico, Russia, South Africa, and Ghana.

MEASUREMENTS

Food insecurity was evaluated using a questionnaire comprised of two questions that addressed the frequency of eating inadequately and hunger due to a lack of food in last 12 months. Distance and/or near vision impairment was considered as a visual acuity score of less than 6/18 in the eye with better vision.

RESULTS

The analytical sample consisted of 29,804 adults (mean (SD) for age: 63.2 (9.54) years; 54.3% female). The prevalence of food insecurity, near vision and distance vision impairment in the sample was 16.4%, 36.7%, and 13.9%, respectively. Adjusted pooled analyses across countries revealed a significant association between food insecurity and distance (OR: 1.16; 95% CI: 1.01, 1.33; P=0.04, significant individually in India and South Africa) and near (OR: 1.12; 95% CI: 1.02, 1.22; P=0.01, significant individually in South Africa) vision impairment, and a between-country heterogeneity of 46.30% and 25.99%, respectively.

CONCLUSION

Food insecurity was associated with both distance and near vision impairment in adults aged 50 years or older across six LMIC. Food policies and intervention programs targeted at decreasing food insecurity in vulnerable households are essential.

The Impact of the Built Environment on Patient Falls in Hospital Rooms: An Integrative Review

OBJECTIVES

The aims of this study were to identify and evaluate scientific evidence examining the impact of the built environment on patient falls in hospital rooms.

METHODS

An integrative review (IR) with a systematic literature search was performed using the patient, intervention, comparison, outcome framework. We searched CINAHL, PsychINFO, PubMED, and Web of Science databases. The search included peer-reviewed studies from 1990 to 2017 written in English. An additional hand search was also conducted. Selected articles were reviewed and rated based on a hierarchical categorization, comprising six evidence levels, developed by the American Association of Critical-Care Nurses and adapted for evidence-based design systematic literature reviews.

RESULTS

After a multitiered process, 30 articles met the selection criteria. Thematic areas were created based on the examined elements of the physical environment including patient room configuration and available space, bathroom configuration, bathtub and shower, door, bed height and bed rail, flooring, floor mats, patient chair, lighting, toilet, handrail, grab bars, intravenous pole, sink, ceiling lift, and wheelchair and walking aids. Findings of studies on each element are discussed in detail.

CONCLUSIONS

Some environmental elements have not been examined in past relational or causal studies, and the level of evidence for the examined attributes is not high enough to gain robust confidence in healthcare design decision-making. Because of the low level of evidence for several environmental elements, conclusions must be taken with caution. More studies using quantitative, relational, or causal designs are recommended to develop actionable interventions on patient falls in hospital rooms.

Wayfinding in Interior Environments: An Integrative Review

Wayfinding is an issue in complex facilities-including hospitals, airports, and office buildings-and wayfinding difficulties are associated with negative psychological and physiological consequences. In addition, since finding one's way in a building is a prerequisite for successfully using that building, wayfinding has attracted the attention of scholars and decision makers. The goal of this article is to review and synthesize the published literature on wayfinding in interior environments. A systematic search was conducted of four databases: PsychINFO, JSTOR, ProQuest, and EBSCO. A hand search was also conducted. From the initial harvest of 804 records, a total of 84 records met the inclusion criteria for full review. After several rounds of review, four broad domains were identified: (1) wayfinding cognition, (2) wayfinding behavior, (3) individual and group differences, and (4) environmental factors. These domains are used as a framework to organize the findings, and the review shows that the sub-domains most thoroughly addressed in the literature are spatial memories, floor plan configuration, landmarks, signs, and maps. This review can deepen the field's understanding of factors that contribute to interior wayfinding and can serve as a resource for decision makers and designers.

Histological evaluation of inferior alveolar nerve injury after osteotomy of mandibular buccal cortex using piezoelectric versus conventional rotary devices: a split-mouth randomised study in rabbits

Up until now, only a limited number of evidence-based studies with different results has evaluated traumatic nerve injury after maxillofacial surgery using piezoelectric devices versus rotary instruments. The present experiment was performed to evaluate damage to the inferior alveolar nerve (IAN), histologically, after osteotomy of the buccal cortex of the mandible using piezoelectric devices versus surgical handpieces. Forty rabbits underwent bilateral osteotomy of the mandibular buccal cortex. For the osteotomy of one side, piezoelectric devices were used, and for the other, conventional rotary handpieces. After cleavage of the osteotomised cortical bone segments, the exposed part of the IAN was excised and examined histologically for nerve injury. IAN damage was scored histologically from Grade 0 (no nerve damage) to Grade 4 (complete nerve transection). It was found that 25% and 17.5% of nerves had Grade 0; 17.5% and 10% had Grade 1; 25% and 20% had Grade 2; 17.5% and 27.5% had Grade 3; and 15% and 25% had Grade 4 injury in piezosurgery and rotary groups, respectively. Statistical analyses revealed no significant difference between groups in damage to the IAN. The present study showed that piezosurgery devices, similar to conventional rotary instruments, have the potential to cause severe nerve damage during surgery and should therefore be used with care.

A Narrative Review of Theories of Wayfinding Within the Interior Environment

PURPOSE

The aim of this article is to provide a narrative overview of theories that are available in the published literature on wayfinding in interior environments.

BACKGROUND

Wayfinding is an issue in healthcare facilities, and it has been documented that wayfinding problems have negative impacts on patients, visitors, caregivers' time, and the organization's bottom line. This issue can be more challenging for people with illness, low vision, cognitive disorders, and limited physical mobility. Wayfinding is a complex phenomenon depending on a variety of cognitive processes and behaviors.

METHODS

This article is a part of a broader literature review that searched for empirical studies on interior wayfinding. Four databases were systematically searched-PsychINFO, JSTOR, ProQuest, and EBSCO. A total of 81 articles satisfied all inclusion criteria for the broader study. Each article included in the broader study was reviewed to identify theory or theories, if any, that a study was founded on.

RESULTS

After an in-depth review of the theories, the authors proposed four categories of theories relating to human wayfinding. The four classes and the specific theories in those are articulated in this article, including major changes during their evolution. The four classes of theories explain four facets of wayfinding: (1) theories of perception, (2) theories of spatial knowledge development, (3) theories of mental representation of spatial knowledge, and (4) theories of spatial cognition.

CONCLUSION

Since wayfinding is essentially a cognitive/problem-solving phenomenon, understanding the theoretical underpinnings of wayfinding may result in more meaningful and impactful design decisions.

Predictors of return to work in patients with occupational hand injury

Work-related hand injuries are the primary cause of disability and prolonged time away from work. This prospective cohort study was conducted to determine the predictors of return to work (RTW) after traumatic work-related hand injuries. Our study included 280 patients who were referred to the Plastic and Reconstructive Center for treatment of their occupational hand injuries from July 2017 to February 2018. Several functional questionnaires were completed, and they were followed up at 1, 3 and 8 weeks. Telephone interviews were done 3 months later. Approximately half the subjects had returned to work during the first 3 months after a median time away of 57 days. No relationship was found between age, gender, marital status, hand dominance and RTW time. Nevertheless, there was correlation between RTW time with cigarette smoking, injury severity and disability. Our study findings suggest that injury severity and higher work disability scores are prognostic factors for RTW. Also, smoking was associated with later RTW, which could be the result of poor circulation and delayed healing. Employers should implement injury prevention programs with appropriate rehabilitation that takes into consideration the severity of the hand injury, and health strategies to improve unhealthy lifestyle factors such as smoking.

Evaluation of scalp hair nickel and chromium level changes in patients with fixed orthodontic appliance: a one-year follow-up study

BACKGROUND AND OBJECTIVES

The release of metal ions from orthodontic appliances is part of the dissolution and biomechanical processes of alloys. Nickel (Ni) and chromium (Cr) are the elements commonly used in the manufacture of various components of fixed orthodontic appliances, including bands, brackets and wires. This study was aimed to measure the Ni and Cr ions levels in the scalp hair of patients treated with fixed orthodontic appliances in comparison of the control group.

MATERIALS AND METHODS

The patient group consisted of 24 patients treated with fixed orthodontic appliances for one year, while the control group included 28 healthy individuals without orthodontic appliances. Analysis of the Cr and Ni was performed using atomic absorption spectrophotometer by graphite furnace method. The data were analyzed via student and paired samples t-test and ANOVA repeated measurement test.

RESULTS

After one year, the levels of Ni and Cr in two groups showed significant differences (0.086 ± 0.007 and 0.258 ± 0.009 µg/g for control group and 0.149 ± 0.010 and 0.339 ± 0.013 µg/g for patient group, respectively for Ni and Cr, p < .001). ANCOVA test by removing the effects of age, gender and the baseline levels of Ni and Cr showed that changes in these ions in the scalp hair of both groups after one year were statistically significant.

CONCLUSION

Due to the slightly elevated levels of Ni and Cr ions in the scalp hair of patients treated with fixed orthodontic appliances and considering the cytotoxic and allergic effects of these ions, changing the ingredients in fixed orthodontic appliances is suggested for the future.

Predicting In vitro Culture Medium Macro-Nutrients Composition for Pear Rootstocks Using Regression Analysis and Neural Network Models

Two modeling techniques [artificial neural network-genetic algorithm (ANN-GA) and stepwise regression analysis] were used to predict the effect of medium macro-nutrients on in vitro performance of pear rootstocks (OHF and Pyrodwarf). The ANN-GA described associations between investigating eight macronutrients (NO[Formula: see text], NH[Formula: see text], Ca(2+), K(+), Mg(2+), PO[Formula: see text], SO[Formula: see text], and Cl(-)) and explant growth parameters [proliferation rate (PR), shoot length (SL), shoot tip necrosis (STN), chlorosis (Chl), and vitrification (Vitri)]. ANN-GA revealed a substantially higher accuracy of prediction than for regression models. According to the ANN-GA results, among the input variables concentrations (mM), NH[Formula: see text] (301.7), and NO[Formula: see text], NH[Formula: see text] (64), SO[Formula: see text] (54.1), K(+) (40.4), and NO[Formula: see text] (35.1) in OHF and Ca(2+) (23.7), NH[Formula: see text] (10.7), NO[Formula: see text] (9.1), NH[Formula: see text] (317.6), and NH[Formula: see text] (79.6) in Pyrodwarf had the highest values of VSR in data set, respectively, for PR, SL, STN, Chl, and Vitri. The ANN-GA showed that media containing (mM) 62.5 NO[Formula: see text], 5.7 NH[Formula: see text], 2.7 Ca(2+), 31.5 K(+), 3.3 Mg(2+), 2.6 PO[Formula: see text], 5.6 SO[Formula: see text], and 3.5 Cl(-) could lead to optimal PR for OHF and optimal PR for Pyrodwarf may be obtained with media containing 25.6 NO[Formula: see text], 13.1 NH[Formula: see text], 5.5 Ca(2+), 35.7 K(+), 1.5 Mg(2+), 2.1 PO[Formula: see text], 3.6 SO[Formula: see text], and 3 Cl(-).

The Comparative Evaluation of the Performance of Two Phytoremediation Systems for Domestic Wastewater Treatment

The constructed wetlands as well engineered techniques have been used effectively for phytoremediation of wastewater and pollution control during the last decades. In these technologies, the naturally occurring processes of plants alongside micro-organisms present in the bio-film attached to the roots, soil substrate and water column degrade the organic pollutants. The study seeks to compare the potential use of Phragmites sp. reed bed and floating macrophyte water hyacinth (Eichhornia crassipes) system for domestic wastewater treatment. The sewage treatment performance is evaluated as 80% & 76% chemical oxygen demand (COD), 90% & 87% biological oxygen demand (BOD5), 24% & 18% total dissolved solids (TDS), 69% & 67% total suspended solids (TSS), 12% & 5% Chlorides, 73% & 69% ammonia nitrogen (NH3-N), 42% & 31% phosphate (PO4-P), 93% & 91% most probable number (MPN) and 95% & 92% total viable count (TVC) reduction at optimum hydraulic retention time (HRT) of 24 & 43 h in Phragmites sp. and water hyacinth systems, respectively. Likewise, the floating macrophyte pond contrary to reed bed process shows insignificant pollutant diminution at 24 h HRT. This paper also highlights the microbial population present through the wetland systems by estimation of total viable count (TVC). The botanical aspect with reference to the plant growth is shown a significant increase in vegetation yield. The overall studies indicate the better treatment efficiency by preferred Phragmites sp. root zone system at low foot print area for domestic wastewater.

Disseminated Leishmaniasis Caused by Leishmania tropica in a Puppy from Karaj, Central Iran

A 5-month old puppy with muco-cutaneous lesions in the chin, around lips and eyes was examined physically and microscopically for leishmaniasis. Muco-cutaneous lesions containing a large number of amastigotes of Leishmania spp. were observed. Amastigotes were also detected in liver and spleen of the puppy. The animal was positive with Dipstick rK39 kit and high level of anti-Leishmania antibodies was detected by direct agglutination test (DAT). DNA, Using PCR-RFLP technique extracted from cultured Leishmania promastigotes and L. tropica was identified. This is the first report of concurrent mucosal and visceral involvement of L. tropica in a puppy from Iran.

Effect of diltiazem on retention and retrieval of memory in young and aged mice

Diltiazem (DTZ) is widely used in the prophylaxis of hypertension and treatment of angina. The effects of DTZ and other calcium channel blockers on memory have been discussed with several procedures and different theories have been suggested. In the present study, the effect of DTZ on retention and retrieval of memory in young and aged mice was investigated by using the passive avoidance apparatus. For this purpose, after weighting, coding and classifying the mice, they were grouped as follow: test group received electric shock plus DTZ (10 and 30 mg kg(-1), i.p.), blank group received electric shock plus normal saline and control group received only electric shock. In all three groups delay time of leaving the platform for both retention and retrieval test of memory was measured. DTZ was administered immediately after receiving electric shock in the retention test, but in retrieval test DTZ was administered 24 h after receiving electric shock. The results indicated that 30 mg kg(-1) of DTZ impaired retention and retrieval of young mice memory. The 30 mg kg(-1) of DTZ enhanced retention while 10 and 30 mg kg(-1) of it improved retrieval of aged mice memory.

Seroprevalence of Toxoplasma gondii infection in stray and household cats in Tehran

The prevalence of anti-Toxoplasma gondii specific IgG in stray and household cats in Tehran was determined by Indirect Fluorescent Antibody Test (IFAT) on serum samples from 100 cats (50 stray and 50 households). Overall infection rate was 63%. The infection rate in stray cats (90%) was significantly higher (p<0.001) than that of household cats (36%). Last serum positive dilutions varied from 1: 32 to 1: 512 titres in which the highest percentage (27%) was for 1:256 and the least (4.8%) was at 1:32. The rate of infection between male and female cats of both groups was not significantly different; 90.3% versus 89.5% for male and female in stray cats, respectively. Different sexes of household cats were seropositive at the same rate (36%). A high positive correlation (r(2)=0.97) between age and the rate of infection was observed. The prevalence of Toxoplasma gondii infection in cats in Tehran was high, especially in stray cats which are probably the main source of Toxoplasma infection in this area.

Vaccine trial against canine visceral leishmaniasis in the Islamic republic of Iran

Sixteen dogs were randomly divided into four groups. Group 1 received autoclaved Leishmania infantum vaccine with BCG. Group 2 received autoclaved L. major vaccine with BCG. Group 3 received BCG alone and Group 4 received normal saline. Dogs received the vaccines intradermally three times each at 30-day intervals. All dogs were tested at 2-month intervals with the leishmanin skin test and anti-Leishmania ELISA. Ninety days after the third dose, each dog received an intraperitoneal challenge of 2.5 X 10 [6] infective promastigotes of L. infantum. Necropsy was performed on all dogs to investigate for parasites. All of the dogs in the unvaccinated groups were infected with L. infantum but of the dogs in the vaccinated groups, only one dog was infected

Computed tomography of an optic chiasm glioma in an elderly patient

A 75-year-old white woman, otherwise healthy, developed progressively reduced visual acuity primarily in her left eye over 2 months. A computed tomography scan of the head demonstrated a moderately large, round, circumscribed, benign-appearing suprasellar mass that was enhanced with infusion of contrast medium. At craniotomy, a glioma of the optic chiasm that extended into the left optic nerve was observed.

Wegener granulomatosis invading the cavernous sinus: a CT demonstration

A case of localized cranial Wegener granulomatosis was imaged with high resolution computed tomography. The mass extended from the infratemporal fossa, through the basal foramina, and into the cavernous sinus, causing complete occlusion of the internal carotid artery. Computed tomography demonstrated absence of bone destruction and a normal parotid gland and nasopharynx. Although uncommon, Wegener granulomatosis should be considered in the differential diagnosis of a parapharyngeal mass with intracranial extension.

Traumatic posterior atlantoaxial dislocation without neurological deficit: case report

A case is presented in which a patient sustained a closed head injury with subsequent acute subdural hematoma and delayed posterior dislocation of the atlas without fracture of the odontoid process and with an intact C-1 arch. The subdural hematoma was treated operatively. The atlas dislocation was managed with closed reduction without manipulation and subsequent posterior fusion of C-1, C-2, and C-3. The patient was intact neurologically on admission and remained so throughout his hospitalization.

An analysis of reproductive motivation in Shiraz, Iran

In a sample of 260 married men in Shiraz, the relationship is studied of fertility to demographic, socioeconomic and psychosocial variables, the last measuring the perceived economic value of children. The number of children ever born is closely associated with duration of marriage, but socioeconomic variables also exert a significant influence, especially the wife's educational level. Recent fertility is more closely associated with age of wife, but also with ownership of modern goods which is also the major factor in current contraceptive use. The perceived value of children appears unimportant, negligible in recent fertility and contraceptive use, and only showing a slight positive relationship between expected reliance on children for support in old age and the number of children ever born.