Giomer restoratives, like other direct and indirect composites, are softened by foodsimulating liquids, especially citric acid and ethanol. They are also roughened by citric acid. SUMMARYThis study examined the effects of food-simulating liquid (FSL) on the hardness and roughness of giomer restoratives based on prereacted glass ionomer (PRG) technology. The materials investigated included a regular (Beautifil II [BT]) and a recently introduced injectable (Beautifil Flow Plus F00 [BF]) hybrid PRG composite. A direct hybrid composite (Filtek Z250 [ZT]) and an indirect hybrid composite (Ceramage [CM]) were used for comparison. The materials were placed into customized square molds (5 mm 3 5 mm 3 2.5 mm), covered with Mylar strips, and cured according to manufacturers' instructions. The materials were then conditioned in air (control), distilled water, 50% ethanol solution, and 0.02 N citric acid at 378C for seven days. Specimens (n=6) were then subjected to hardness testing (Knoop) and surface profilometry. Data were analyzed using one-way analysis of variance and post hoc Scheffe test (p,0.05). Mean Knoop hardness values for the control group (air) ranged from 53.4 6 3.4 (BF) to 89.5 6 5.2 (ZT), while mean surface roughness values values ranged from 0.014 6 0.002 (ZT) to 0.032 6 0.001 (BT). All materials were significantly softened by FSL. The degree of soften-
BackgroundHospital usage and service demand during an Infectious Disease (ID) outbreak can tax the health system in different ways. Herein we conceptualize hospital surge elements, and lessons learnt from such events, to help build appropriately matched responses to future ID surge threats.MethodsWe used the Interpretive Descriptive qualitative approach. Interviews (n = 35) were conducted with governance and public health specialists; hospital based staff; and General Practitioners. Key policy literature in tandem with the interview data were used to iteratively generate a Hospital ID Surge framework. We anchored our narrative account within this framework, which is used to structure our analysis.ResultsA spectrum of surge threats from combinations of capacity (for crowding) and capability (for treatment complexity) demands were identified. Starting with the Pyramid scenario, or an influx of high screening rates flooding Emergency Departments, alongside fewer and manageable admissions; the Reverse-Pyramid occurs when few cases are screened and admitted but those that are, are complex; during a ‘Black’ scenario, the system is overburdened by both crowding and complexity. The Singapore hospital system is highly adapted to crowding, functioning remarkably well at constant near-full capacity in Peacetime and resilient to Endemic surges. We catalogue 26 strategies from lessons learnt relating to staffing, space, supplies and systems, crystalizing institutional memory. The DECIDE model advocates linking these strategies to types of surge threats and offers a step-by-step guide for coordinating outbreak planning and response.ConclusionsLack of a shared definition and decision making of surge threats had rendered the procedures somewhat duplicative. This burden was paradoxically exacerbated by a health system that highly prizes planning and forward thinking, but worked largely in silo until an ID crisis hit. Many such lessons can be put into play to further strengthen our current hospital governance and adapted to more diverse settings.
BackgroundIn the aftermath of an upsurge in the number of dengue cases in 2013 and 2014, the SD BIOLINE Dengue Duo rapid diagnostic Point-of-Care Test (POCT) kit was introduced in Tan Tock Seng Hospital, Singapore in June 2013. It is known that the success of POCT usage is contingent on its implementation within the health system. We evaluated health services delivery and the Dengue Duo rapid diagnostic test kit application in Singapore from healthcare workers’ perspectives and patient experiences of dengue at surge times.MethodsFocus group discussions were conducted with dengue patients, from before and after the POCT implementation period. In-depth interviews with semi-structured components with healthcare workers were carried out. A patient centred process mapping technique was used for evaluation, which mapped the patient’s journey and was mirrored from the healthcare worker’s perspective.ResultsPatients and healthcare workers confirmed a wide range of symptoms in adults, making it challenging to determine diagnosis. There were multiple routes to help seeking, and no ‘typical patient journey’, with patients either presenting directly to the hospital emergency department, or being referred there by a primary care provider. Patients groups diagnosed before and after POCT implementation expressed some differences between speed of diagnoses and attitudes of doctors, yet shared negative feelings about waiting times and a lack of communication and poor information delivery. However, the POCT did not in its current implementation do much to help waiting times. Healthcare workers expressed that public perceptions of dengue in recent years was a major factor in changing patient management, and that the POCT kit was helpful in improving the speed and accuracy of diagnoses.ConclusionsHealth service delivery for dengue patients in Singapore was overall perceived to be of an acceptable clinical standard, which was enhanced by the introduction of the POCT. However, improvements can be focused on Adapting to outbreaks by reducing and rendering Waiting experiences more comfortable; Advancing education about symptom recognition, while also Recognising better communication strategies; and Expanding follow-up care options. This is presented as the Dengue AWARE model of care delivery.
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