Effect of a guide for clinical reasoning on Nursing students' diagnostic accuracy: A clinical trial.

Objective: to evaluate the effect of the Self-Instructional Guide for Clinical Reasoning on the diagnostic accuracy of undergraduate Nursing students.

Method: a randomized, parallel and double-blind (researchers and outcome evaluators) clinical trial, carried out with undergraduate Nursing students. Validated case studies were applied in two phases to identify the patient's Nursing diagnosis/problem, etiology and clues, using the Guide with the intervention group in the second phase.

Effects of Clinical Reasoning Prompts on Nursing Students' Clinical Judgment for a Patient Experiencing Respiratory Distress.

Purpose: To test the effects of clinical reasoning prompts on students' clinical judgment of a written case study.

Methods: An experimental pre- and posttest study with second semester nursing students (N = 163).

Findings: The intervention was insufficient to significantly improve clinical judgment.

Arteriovenous fistula maturation and the influence of fluid dynamics.

Arteriovenous fistula creation is the preferred vascular access for haemodialysis therapy, but has a large failure rate in the maturation period. This period generally lasts 6 to 8 weeks after surgical creation, in which the vein and artery undergo extensive vascular remodelling. In this review, we outline proposed mechanisms for both arteriovenous fistula maturation and arteriovenous fistula failure.

Clinical utility of pressure feedback to socket design and fabrication.

Background: The clinical utility of measuring pressure at the prosthetic socket-residual limb interface is currently unknown.

Objectives: This study aimed to identify whether measuring interface pressure during prosthetic design and fabrication results in closer agreement in pressure measurements between sockets made by different clinicians, and a reduction in pressure over areas of concern. It also investigated whether clinicians value knowing the interface pressure during the fabrication process.

Tracking geometric and hemodynamic alterations of an arteriovenous fistula through patient-specific modelling.

Background And Objective: The use of patient-specific CFD modelling for arteriovenous fistulae (AVF) has shown great clinical potential for improving surveillance, yet the use of imaging modes such as MRI and CT for the 3D geometry acquisition presents high costs and exposure risks, preventing regular use. We have developed an ultrasound based procedure to bypass these limitations.

Methods: A scanning procedure and processing pipeline was developed specifically for CFD modelling of AVFs, using a freehand ultrasound setup combining B-mode scanning with 3D probe motion tracking.

A Methodology for Non-Invasive 3-D Surveillance of Arteriovenous Fistulae Using Freehand Ultrasound.

Objective: Surveillance techniques for arteriovenous fistulae are required to maintain functional vascular access, with two-dimensional duplex ultrasound the most widely used imaging modality. This paper presents a surveillance method for an arteriovenous fistula using a freehand three-dimensional (3-D) ultrasound system. A patient-case study highlights the applicability in a clinical environment.

Reduction in anastomotic flow disturbance within a modified end-to-side arteriovenous fistula configuration: Results of a computational flow dynamic model.

Aim: We sought to determine if a modification to the peri-anastomotic vein configuration during end-to-side arteriovenous fistula (AVF) creation would achieve a favourable haemodynamic environment compared with the standard acute-angle AVF.

Methods: Computational fluid dynamics (CFD) modelling of two end-to-side AVF geometries (smooth-vein-loop vs. acute-angle) allowed for haemodynamic modelling.

Computational Fluid Dynamic Analysis of the Hemodialysis Plastic Cannula.

The jet of fluid returning to the patient through a hemodialysis venous needle has previously been reported as a potential source of endothelial damage which can lead to intimal hyperplasia (IH) in arteriovenous fistulae (AVF). Metal needles are the current standard practice for accessing the vascular system in hemodialysis. However, plastic cannulae have been used in Japan for 30 years.

Analysis of Blood Flow Characteristics in a Model of a Mature Side-to-Side Arteriovenous Fistula.

The creation of an arteriovenous fistula (AVF) is a common surgical procedure in hemodialysis patients suffering from end-stage renal disease (ESRD). However, several complications may occur after surgery, including thrombosis, stenosis, and aneurysm. These complications are attributed to hemodynamics perturbations including pathophysiological wall shear stress (WSS) and flow recirculation zones.

Mechanical characterization and comparison of energy storage and return prostheses.

The suitability of finite element analysis (FEA) for standardizing the mechanical characterization of energy storage and return (ESAR) prostheses was investigated. A methodology consisting of both experimental and numerical analysis was proposed and trialed for the Vari-flex Modular, Flex-foot Cheetah and Cheetah Xtreme by Össur and a 1E90 Sprinter by Ottobock. Gait analysis was conducted to determine suitable orientation angles for non-destructive testing (NDT) of the ESAR prostheses followed by a quasi-static inverse FEA procedure within COMSOL Multiphysics, where the NDT conditions were replicated to determine the homogenized material properties of the prostheses.

Facial deformations during nasal continuous positive airway pressure therapy.

Obstructive Sleep Apnoea (OSA), characterised by repeated collapse of the pharyngeal airway during sleep, causes cessation of breathing followed by arousal, restoring normality. Continuous Positive Airway Pressure (CPAP) is a non-invasive, effective treatment for OSA where positive pressure is applied to the airway through a mask, maintaining patency. Nasal masks are commonly used, contacting the face across the upper lip, sides of the nose and the nasal bridge.

A prosthesis-specific multi-link segment model of lower-limb amputee sprinting.

Lower-limb amputees commonly utilize non-articulating energy storage and return (ESAR) prostheses for high impact activities such as sprinting. Despite these prostheses lacking an articulating ankle joint, amputee gait analysis conventionally features a two-link segment model of the prosthetic foot. This paper investigated the effects of the selected link segment model׳s marker-set and geometry on a unilateral amputee sprinter׳s calculated lower-limb kinematics, kinetics and energetics.

Computational Model of the Arterial and Venous Needle During Hemodialysis.

Arteriovenous fistulae (AVF) are the favored choice of vascular access but still have poor long-term success. Hemodynamic parameters play an important role in vascular health and have been linked to the development of intimal hyperplasia (IH), a pathological growth of the blood vessel initiated by injury. This study aimed to investigate the hemodynamics surrounding the arterial needle (AN) and venous needle (VN), using computational fluid dynamics.

Quantifying prosthetic gait deviation using simple outcome measures.

Aim: To develop a subset of simple outcome measures to quantify prosthetic gait deviation without needing three-dimensional gait analysis (3DGA).

Methods: Eight unilateral, transfemoral amputees and 12 unilateral, transtibial amputees were recruited. Twenty-eight able-bodied controls were recruited.

Evaluation of Different Meshing Techniques for the Case of a Stented Artery.

The formation and progression of in-stent restenosis (ISR) in bifurcated vessels may vary depending on the technique used for stenting. This study evaluates the effect of a variety of mesh styles on the accuracy and reliability of computational fluid dynamics (CFD) models in predicting these regions, using an idealized stented nonbifurcated model. The wall shear stress (WSS) and the near-stent recirculating vortices are used as determinants.

Concurrent multibody and Finite Element analysis of the lower-limb during amputee running.

Lower-limb amputee athletes use Carbon fiber Energy Storage and Return (ESAR) prostheses during high impact activities such as running. The advantage provided to amputee athletes due to the energy-storing properties of ESAR prostheses is as yet uncertain. Conventional energy analysis methods for prostheses rely upon multibody models with articulating joints.

Energy Storage and Return Prostheses: A Review of Mechanical Models.

Conventional lower-limb mechanical models were originally developed for gait analysis of ablebodied Conventional lower-limb mechanical models were originally developed for gait analysis of ablebodied subjects and therefore potentially misrepresent prosthetic foot behavior when applied to modern energy storage and return (ESAR) prostheses. This review investigates the limitations of current models of prosthetic foot dynamics and kinematics. The Scopus online database was used to identify 236 articles on prosthetic foot behavior during either experiments or simulations, categorized into three main types of models: 74% (n = 175) of studies featured a rigid-link model, 17% (n = 39) a lumped-parameter model and 10% (n = 23) finite element (FE) analysis.

Haemodynamic analysis of femoral artery bifurcation models under different physiological flow waveforms.

Thrombus in a femoral artery may form under stagnant flow conditions which vary depending on the local arterial waveform. Four different physiological flow waveforms - poor (blunt) monophasic, sharp monophasic, biphasic and triphasic - can exist in the femoral artery as a result of different levels of peripheral arterial disease progression. This study aims to examine the effect of different physiological waveforms on femoral artery haemodynamics.

Spiral blood flow in aorta-renal bifurcation models.

The presence of a spiral arterial blood flow pattern in humans has been widely accepted. It is believed that this spiral component of the blood flow alters arterial haemodynamics in both positive and negative ways. The purpose of this study was to determine the effect of spiral flow on haemodynamic changes in aorta-renal bifurcations.

Particle image velocimetry study of aorta-renal bifurcation.

Background: Haemodynamic parameters such as separated flow regions play a key role in the progression and development of atherosclerotic lesions in renal arteries, which typically originate at the renal ostium.

Objective: The aim of this study was to analyse the flow dynamics in a two-dimensional model of aorta-renal bifurcation, with a particular focus on the effect of aorta-to-renal flow ratio on flow separation regions.

Method: A particle image velocimetry (PIV) experiment was conducted in an acrylic model of the aorta-renal ostium and the relationship between renal-to-aorta flow ratio and separated flow region was investigated.

The Hemodynamic Effects of Hemodialysis Needle Rotation and Orientation in an Idealized Computational Model.

Maintaining the patency of vascular access is essential for performing efficient hemodialysis. Appropriate cannulation technique is critical in maintaining the integrity of vascular access. This study focused on analyzing the hemodynamic effect of needle rotation, which is performed to alleviate the pressure if the needle becomes attached to the blood vessel wall.

Pulsatility Produced by the Hemodialysis Roller Pump as Measured by Doppler Ultrasound.

Microbubbles have previously been detected in the hemodialysis extracorporeal circuit and can enter the blood vessel leading to potential complications. A potential source of these microbubbles is highly pulsatile flow resulting in cavitation. This study quantified the pulsatility produced by the roller pump throughout the extracorporeal circuit.

Effectiveness of microbubble removal in an airtrap with a free surface interface.

An end stage renal disease patient will undergo haemodialysis (HD) three or four times a week for four to five hours per session. Because of the chronic nature of the treatment, any minor imperfection in the extracorporeal system may become significant over time. Clinical studies have raised concerns relating to small microbubbles entering HD patients.

Fibrinogen adsorption and platelet adhesion to silica surfaces with stochastic nanotopography.

In this study, the effect of surface nanoscale roughness on fibrinogen adsorption and platelet adhesion was investigated. Nanorough silica surfaces with a low level of surface roughness (10 nm Rrms) were found to support the same level of fibrinogen adsorption as the planar silica surfaces, while nanorough silica surfaces with higher levels of surface roughness (15 nm Rrms) were found to support significantly less fibrinogen adsorption. All surfaces analyzed were found to support the same level of platelet adhesion; however, platelets were rounded in morphology on the nanorough silica surfaces while platelets were spread with a well-developed actin cytoskeleton on the planar silica.