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Background & Problems: Intra-arterial thrombectomy (IAT) is a novel surgery that may restore cerebral blood flow in patients with ischemic stroke and lower the risks of permanent brain damage and disability. Because the process of preoperative preparation for IAT is complicated, error rates for this process have been reported in previous studies to be as high as 100%. Although these errors did not result in serious damage to patients, the risk to patient safety remains. Therefore, reducing the error rate for IAT preoperative preparation is necessary to improve patient safety., Purpose: To reduce the rate of IAT preoperative preparation error in an emergency room., Resolution: This project applied healthcare failure mode and effect analysis (HFMEA) to evaluate the potential risks of IAT preoperative preparation in an emergency room. Based on the resultant hazard score, critical preventive measures were adopted, including creating a quick response code consent form, designing order packages, developing a checklist form, modifying stroke operating procedures and policies, planning suitable education content for staffs, developing criteria for evaluating preoperative preparation procedures, and installing vital signs equipment., Results: After implementation of these measures, the hazard scores of 13 out of the 16 potential failure causes decreased to < 8, and the progress rate was 81.3%. The follow-up error rate for preoperative preparation was 0% in October 2019, which fulfilled the goal of this project., Conclusions: Preoperative preparation for IAT is complicated and time-consuming. In this project, HFMEA was introduced to ensure that preoperative preparation was accomplished in a complete and timely manner. Based on the results, after implementation, preparation work was effectively completed and operations were performed on schedule. Other hospitals may consider using this tool to evaluate potential risks to patient safety and to develop solutions to improve the quality of healthcare processes.

Facing the lowest birth rates in its history, Taiwan is increasingly recognizing the centrality of children's healthcare needs to effective family care. The World Health Organization's goal of health for all emphasizes health promotion. However, little research attention has been given to how families actively promote personal health in everyday life. This article considers 'family-centric' healthcare, with a particular emphasis on children's health and well-being and the mother health promotion model. Authors employ a 'toy library' as the health promotion platform to build community interaction and empower the health enhancement process. Results suggested the following: 1. The fixed-point type toy library may be an effective tool in a health promotion strategy; 2. A model may be developed for rural institution agencies; 3. Cooperation may be facilitated using a medical service vehicle; 4. The love bag program can serve extended purposes. The authors found that the empowerment and growth of tribal mothers is a key element to facilitate the successful development of their children. Based on findings, the implementation of a toy library as the platform to build community-based health promotion model is suggested.

Pulmonary edema may develop in healthy patients after anesthesia. It usually results from upper airway obstruction which may be caused by laryngospasm or aspiration. Increased inspiratory effort following airway obstruction significantly produces negative intrathoracic pressure that may lead to pulmonary edema. We reported two cases of post-obstructive pulmonary edema following extubation. They were essentially healthy young males, one of whom received urethroplasty and the other received pulmonary blebectomy. Their hemodynamic and ventilatory conditions had been kept stable during surgery. Upper airway obstruction followed by pulmonary edema developed immediately after extubation, which was successfully treated without any sequelae.

At the end of abdominal surgery, a brief but profound neuromuscular blockade may be needed to facilitate closure of abdominal wall. Succinylcholine (Sch) was the agent used in this regard before. This study was undertaken to observe the effect after administration of Sch (1 mg/kg) at various levels of recovery from atracurium. 40 ASA I or II patients undergoing elective surgery were randomly assigned to one of four groups with 10 in each. Anesthesia was induced with thiopental 5 mg/kg and Sch 1.5 mg/kg i.v., and maintained with 0.7% isoflurane (end-tidal concentration) and 50% N2O in O2 The electromyographic response of the hypothenar muscle was recorded in response to supramaximal train-of-four stimuli delivered to the ulnar nerve at 20 s intervals using a relaxograph (Datex). Control records were obtained after induction of anesthesia. When the first twitch (T1) had recovered above 50% from the intubating dose of Sch, atracurium 0.5 mg/kg was administered. Spontaneous recovery of T1 was observed. Patients in group I received 1 mg/kg of Sch, when T1 returned to 20% and those in groups II, III, and IV received the same dose of Sch when T1 returned to 40%, 60% or 80% of control respectively. The response was observed at 20s intervals for at least 5 min after the administration of Sch. It was regarded as effective response if the T1 returned to less than 5% of control.(ABSTRACT TRUNCATED AT 250 WORDS)

Delayed hard palate closure (after age 6-7) was widely used for palatal repair in cleft palate children from 1976 to 1982. Since 1982, the approach has been revised into early complete closure of the soft and hard palate (before age 2). The articulation skills of 60 children with cleft lip and palate (age 3-5:11) who underwent early complete palate closure were compared with 47 children of similar age with soft palate closure only. The results indicated that the early complete closure group had more children with adequate articulation skills than the delayed hard palate closure group. Detailed analysis of the articulation patterns in each group revealed that the articulation substitution patterns made by the early complete closure group followed the trends of developmental articulation patterns, i.e. unaspirated, stopping and fronting phonological features. On the contrary, the articulation substitution patterns made by the delayed hard palate closure group were more related to structural deficits, i.e. compensatory articulation. Age 3-5 is a critical period for articulation maturation. We advocate that the complete palatal closure should be achieved before age 2 in order to equip cleft palate children with an equally normal oral structures to enhance speech/language development in a normal learning process during this critical period.