The Compassionate Communities Connectors programme: experiences of supported families and referring healthcare providers

Background and Aim

Comprehensive evaluations that include the experience of patients and service providers are vital if interventions are to be translated into the standard practice of health services and allow formal networks to work as partners with informal community networks. However, published evaluations are limited in the palliative care volunteering literature. The objective of the study is to explore the experiences and views of both patients and their family carers who received support and their referring healthcare providers concerning their participation in the Compassionate Communities Connectors programme, in the south-west region of Western Australia. Connectors identified and addressed gaps in community and healthcare provision by accessing resources and mobilising social networks of people with life-limiting illnesses. The perspectives of patients, carers and service providers concerning the feasibility and acceptability of the intervention were sought.

Methods

Semistructured interviews were undertaken with 28 patients/families and 12 healthcare providers, resulting in 47 interviews in total (March 2021-April 2022). An inductive content analysis was used in analysing interview transcripts to identify key themes.

Results

Families greatly appreciated the support and enablement received from the Connectors. Healthcare providers were impressed with the high level of resourcefulness exhibited by the Connectors and perceived a great need for the programme, particularly for those socially isolated. Three themes captured the patients'/families' perspectives: connector as an advocate, increasing social connectedness and taking the pressure off families. Healthcare providers' perspectives were captured in three themes: reducing social isolation, filling a gap in service provision and building the capacity of the service.

Conclusions

Perspectives of patients/families and healthcare providers demonstrated the mediating role of Connectors. Each group saw the Connectors' contribution through the lens of their particular interests or needs. However, there were indications that the connection was shifting the way each group understood and practised care, encouraging or restoring agency to families and reminding healthcare providers that collaborating beyond the boundaries of their roles actually enhances the whole ecology of care. Using a Compassionate Communities approach to mobilise health and community sectors has the potential to develop a more holistic approach that addresses the social, practical and emotional domains of care.

The all-glass Lüer syringe: Historical facts around concepts, introduction and patents

More than 125 years have elapsed since the "Maison Lüer" in Paris produced their quintessential all-glass hypodermic syringe. The product would subsequently conquer the medical world, with billions of plastic syringes produced on a yearly basis nowadays. One wonders how a world would look without this priceless diagnostic and therapeutic tool, facilitating the administration of drugs, fluids, and blood products to billions of patients worldwide. The Lüer syringe dates to 1894, when Parisian medical instrument maker Hermann Wülfing-Lüer manufactured a unique graduated all-glass hypodermic syringe. Its conical tip allowed accurate injections with rapid leak-free connections, and was heat-resistant without breaking while autoclaving at 120 °C. The authors of this article rectified several inaccuracies of historical facts, and obtained copies of original patents, documents and syringes to reveal accurate details regarding the originators of the all-glass syringes. The Lüer fittings are simple devices that connect virtually all syringes, needles and tubing. They are used in medicine and beyond, whether it is a Lüer-Slip or a Lüer-Lok™ (Lüer-Lock) version. In 1995, The International Organization of Standardization recommended the standard use of the Lüer-tipped syringe worldwide. Despite this, their popularity has sustained significant setbacks at times, including when reports were published on misconnections and wrong-route administration of drugs, resulting in harm to patients with sometimes fatal outcomes. Healthcare workers mistakenly connected devices with a specific use to other devices used for a different application. Current syringes are now mostly mass-produced, disposable plastic syringes, which still come with Lüer fittings for intravascular and hypodermic needles, whereas specific non-Lüer connectors are designed for other systems.

Stress Analysis for Different Designs of Implant-borne and Tooth-implant Fixed Partial Dentures in Mandibular Posterior Region

AIM

The utilization of fixed partial dentures (FPD) ceramic frameworks for replacing the missing posterior teeth is observed to have reported high failure rates. For this reason, 3-units FPD are designed and used extensively in the clinical practices, particularly for posterior mandibular region. The current study however, aims to carry out an evaluation of different stress patterns that are induced in a 3-units FPD within posterior part of mandible using finite element analysis (FEA).

MATERIALS AND METHODS

Different modalities of the implant-supported FPDs such as type of connector, length and diameter of implants were taken into account. A three-dimensional (3D) model simulation of a mandibular Kennedy class II removal partial denture (RPD) was designed from a computerized tomography (CT) input with digital imaging communication on medicine (DICOM) format. In addition, occlusal load of 100 N was also used for central fossae of first premolar, first molar and second molar of the 3-units' reconstruction for each model. The magnitude of von Mises stress including minimum stress, maximum stress and average stress were also evaluated for each loading condition.

RESULTS

The findings of the current study showed evidence that tooth-implant design with a nonrigid connector has significantly increased the average stress. Furthermore, it was observed that rigid connector has considerably minimized the stress within the tooth-implant-supported FPD.

CONCLUSION

The study concluded that stress designs significantly influence the stress distribution around the bone.

CLINICAL SIGNIFICANCE

This study gives some guidance and criteria for the selection of the type of fixed implant prosthesis in the posterior mandibular region.

Physical and thermal processing of Waste Printed Circuit Boards aiming for the recovery of gold and copper

The recovery of electronic waste to obtain secondary raw materials is a subject of high relevance in the context of circular economy. Accordingly, the present work relies on the evaluation of mining separation/concentration techniques (comminution, size screening, magnetic separation and gravity concentration) alone as well as combined with thermal pre-treatment to recover gold and copper from Waste Printed Circuit Boards. For that purpose, Waste Printed Circuit Boards were subjected to physical processing (comminution, size screening in 6 classes from <0.425 mm to > 6.70 mm, magnetic separation and gravity concentration) alone and combined with thermal treatment (200-500 °C), aiming the recovery of gold and copper. Mixed motherboards and graphic cards (Lot 1 and 3) and highly rich components (connectors separated from memory cards, Lot 2) were analyzed. Gold and copper concentrations were determined before and after treatment. Before treatment, concentrations from 0.01 to 0.6 % wt. and from 9 to 20 % wt. were found for gold and copper respectively. The highest concentrations were observed in the size fractions between 0.425 and 1.70 mm. The highest copper concentration was around 35 % wt. (class 0.425-0.85 mm) and when analyzing memory card connectors alone, gold concentrations reached almost 2% in the same class, reflecting the interest of separating such components. The physical treatment alone was more effective for Lot 1/3, compared to Lot 2, allowing recoveries of 67 % wt. and 87 % wt. for gold and copper respectively, mostly due to differences in particles size and shape. The thermal treatment showed unperceptive influence on gold concentration but significant effect for copper concentration, mostly attributed to the size of the copper particles. Concentrations increased in a factor of around 10 when the thermal treatment was performed at 300 °C for the larger particles (1.70-6.70 mm); the best results were obtained at 400 °C for the other sizes, when the highest rate of thermal decomposition of the material occurred.

A three-dimension finite element analysis to evaluate the stress distribution in tooth supported 5-unit intermediate abutment prosthesis with rigid and nonrigid connector

Objective:

The aim of the study is to evaluate the stress distribution in tooth supported 5-unit fixed partial denture (FPD) having tooth as pier abutment using rigid and nonrigid connectors respectively, under simultaneous and progressive loading.

Material and Methods:

The three-dimensional (3D) finite element program (ANSYS software) was used to construct the mathematical model. Two 5-unit FPD’S were simulated, one with rigid connector and another one with nonrigid connector. For analysis, each of these models were subjected to axial and oblique forces under progressive loading (180, 180, 120, 120, 80 N force on first and second molars, premolars and canine respectively) and simultaneous loading (100, 100, 100, 100, 100 N force on first and second molars, premolars and canine respectively).

Results:

The rigid and nonrigid connector design have effect on stress distribution in 5-unit FPDs with pier abutments.

Conclusion:

Oblique forces produce more stresses than vertical forces. Nonrigid connector resulted in decrease in stress at the level of prosthesis and increase in stress at the level of alveolar crest.

Pressure injectors for radiologists: A review and what is new

Pressure Injectors are used routinely in diagnostic and interventional radiology. Advances in medical science and technology have made it is imperative for both diagnostic as well as interventional radiologists to have a thorough understanding of the various aspects of pressure injectors. Further, as many radiologists may not be fully conversant with injections into ports, central lines and PICCs, it is important to familiarize oneself with the same. It is also important to follow stringent operating protocols during the use of pressure injectors to prevent complications such as contrast extravastion, sepsis and air embolism. This article aims to update existing knowledge base in this respect.

Anastomotic devices in coronary artery surgery: it is about the anastomosis?

Excellent long-term graft patency remains the primary goal of any surgical coronary revascularization procedure, irrespective of how the operation itself is performed. Inter- and intra-surgeon variability in the surgical technique and in the subsequent quality of the anastomosis have the potential to significantly impact not only on graft patency but also, as a result, on patient outcomes. Anastomotic devices, proximal and distal, can facilitate the creation of rapid, reproducible, compliant anastomoses, on- or off-pump, in potentially difficult-to-access areas, often through minimal-access incisions, potentially with neuro-protective benefits, and can thus mitigate some of the hazards inherent in manually constructing anastomoses in technically challenging or suboptimal conditions. We review the three most commonly employed anastomotic devices in adult cardiac surgical practice today.

Some Connectors in Distraction-based Growing Rods Fail More Than Others

STUDY DESIGN

Retrospective review of a prospectively collected patient cohort.

OBJECTIVES

This study examined the rate of failure of various types of spinal rod connectors in distraction-based growing rod constructs for early-onset scoliosis.

SUMMARY OF BACKGROUND DATA

Distraction-based growing rods have a high rate of reported complications.

METHODS

We performed a retrospective review of a single surgeon's consecutive cases with growing rod constructs for early-onset scoliosis. Connector failure was defined as loosening of the connector-rod interface, which resulted in shortening of the construct and loss of distractive force. We included 30 patients with average age of 5 years (range, 1-10 years) with diagnoses of congenital scoliosis (15), neuromuscular (10), idiopathic (4), and other (1). Minimum follow-up was 2 years, with a mean follow-up of 49 months (range, 24-83 months).

RESULTS

Of 98 connectors, there were 12 connector failures (12.2%) in 9 patients. In all failures, the set screw loosened, resulting in rod slippage. On average, failures occurred 25.5 months after the index procedure, and after the third lengthening. Simple side-to-side closed connectors with circular slots had the highest rate of slippage (7 of 17; 41%). Side-to-side connectors with V-groove slots that mechanically lock the rod had 10 times fewer failures, (1 of 27; 4%) (p = .006). Only 1 of 34 longitudinal connectors failed (3%) (p = .002). The average T1-S1 gain during growth was 6.5 mm/year for patients with a connector failure and 9.0 mm/year for those who did not (p = .25). Connectors failed in dual rods (6 of 18; 33%) and single rods (6 of 15; 40%) at similar rates (p = .97).

CONCLUSIONS

Connector failure in distraction-based growing rods is associated with 28% less T1-S1 gain. Side-to-side connectors with circular slots had a failure rate of 41% compared with side-to-side connectors with V-groove slots (4%). Longitudinal connectors had a failure rate of 4%.