Surgical stress response and the potential role of preoperative glucocorticoids on post-anesthesia care unit recovery

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Steinthorsdottir, Kristin J; Kehlet, Henrik; Aasvang, Eske K

2017-01-01

The immediate postoperative course in the post-anesthesia care unit (PACU) remains a challenge across surgical procedures. Postoperative pain, sedation/cognitive dysfunction, nausea and vomiting (PONV), circulatory and respiratory problems and orthostatic intolerance constitute the bulk of the di......-anesthesia care unit (PACU), but with a scarcity of intervention studies using glucocorticoids to control inflammation. We, therefore, suggest a future research focus on the role of inflammation and effect of glucocorticoids in the PACU setting to improve patient recovery....

Water temperature, body mass and fasting heat production of pacu (Piaractus mesopotamicus).

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Aguilar, Fredy A A; Cruz, Thaline M P DA; Mourão, Gerson B; Cyrino, José Eurico P

2017-01-01

Knowledge on fasting heat production (HEf) of fish is key to develop bioenergetics models thus improving feeding management of farmed species. The core of knowledge on HEf of farmed, neotropical fish is scarce. This study assessed the effect of body mass and water temperature on standard metabolism and fasting heat production of pacu, Piaractus mesopotamicus, an omnivore, Neotropical fresh water characin important for farming and fisheries industries all through South American continent. An automated, intermittent flow respirometry system was used to measure standard metabolic rate (SMR) of pacu (17 - 1,050 g) at five water temperatures: 19, 23, 26, 29 and 33 °C. Mass specific SMR increased with increasing water temperature but decreased as function of body mass. The allometric exponent for scaling HEf was 0.788, and lied in the range recorded for all studied warm-water fish. The recorded van't Hoff factor (Q10) for pacu (2.06) shows the species low response to temperature increases. The model HEf = 0.04643×W0.7882×T1.837 allows to predict HEf (kJ d-1) from body mass (W, kg) and water temperature (T, °C), and can be used in bioenergetical models for the species.

Water temperature, body mass and fasting heat production of pacu (Piaractus mesopotamicus

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FREDY A.A. AGUILAR

Full Text Available ABSTRACT Knowledge on fasting heat production (HEf of fish is key to develop bioenergetics models thus improving feeding management of farmed species. The core of knowledge on HEf of farmed, neotropical fish is scarce. This study assessed the effect of body mass and water temperature on standard metabolism and fasting heat production of pacu, Piaractus mesopotamicus, an omnivore, Neotropical fresh water characin important for farming and fisheries industries all through South American continent. An automated, intermittent flow respirometry system was used to measure standard metabolic rate (SMR of pacu (17 - 1,050 g at five water temperatures: 19, 23, 26, 29 and 33 °C. Mass specific SMR increased with increasing water temperature but decreased as function of body mass. The allometric exponent for scaling HEf was 0.788, and lied in the range recorded for all studied warm-water fish. The recorded van't Hoff factor (Q10 for pacu (2.06 shows the species low response to temperature increases. The model HEf = 0.04643×W0.7882×T1.837 allows to predict HEf (kJ d-1 from body mass (W, kg and water temperature (T, °C, and can be used in bioenergetical models for the species.

Length of Stay in Ambulatory Surgical Oncology Patients at High Risk for Sleep Apnea as Predicted by STOP-BANG Questionnaire

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Diwakar D. Balachandran

2016-01-01

Full Text Available Background. The STOP-BANG questionnaire has been used to identify surgical patients at risk for undiagnosed obstructive sleep apnea (OSA by classifying patients as low risk (LR if STOP-BANG score < 3 or high risk (HR if STOP-BANG score ≥ 3. Few studies have examined whether postoperative complications are increased in HR patients and none have been described in oncologic patients. Objective. This retrospective study examined if HR patients experience increased complications evidenced by an increased length of stay (LOS in the postanesthesia care unit (PACU. Methods. We retrospectively measured LOS and the frequency of oxygen desaturation (<93% in cancer patients who were given the STOP-BANG questionnaire prior to cystoscopy for urologic disease in an ambulatory surgery center. Results. The majority of patients in our study were men (77.7%, over the age of 50 (90.1%, and had BMI < 30 kg/m2 (88.4%. STOP-BANG results were obtained on 404 patients. Cumulative incidence of the time to discharge between HR and the LR groups was plotted. By 8 hours, LR patients showed a higher cumulative probability of being discharged early (80% versus 74%, P=0.008. Conclusions. Urologic oncology patients at HR for OSA based on the STOP-BANG questionnaire were less likely to be discharged early from the PACU compared to LR patients.

Leukocytes respiratory burst activity as indicator of innate immunity of pacu Piaractus mesopotamicus

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JD Biller-Takahashi

Full Text Available The present study evaluated the assay to quantify the respiratory burst activity of blood leukocytes of pacu as an indicator of the innate immune system, using the reduction of nitroblue tetrazolium (NBT to formazan as a measure of the production of reactive oxygen species (ROS. In order to assess the accuracy of the assay, fish were challenged by Aeromonas hydrophila and sampled one week after challenge. The A. hydrophila infection increased the leukocyte respiratory burst activity. The protocol showed a reliable and easy assay, appropriate to determine the respiratory burst activity of blood leukocytes of pacu, a neotropical fish, in the present experimental conditions.

Digestible energy of crude glycerol for pacu and silver catfish

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Rafael Ernesto Balen

2014-01-01

Full Text Available The increase in global biodiesel production is originating a glycerol surplus, which has no defined destination. An alternative to overcome this problem is its use as energy source in animal feeding. In Brazil, Pacu (Piaractus mesopotamicus is one of the most farmed native fish species, whereas Silver catfish (Rhamdia quelen is suitable for production in subtropical region. Considering little knowledge about crude glycerol utilization in feeds for Neotropical fish species, it was evaluated the apparent digestibility coefficients (ADCs for energy of crude glycerol for P. mesopotamicus and R. quelen. The digestibility and digestible energy content of crude glycerol can be considered excellent even when compared to energy of common ingredients such as maize and wheat, presenting 0.97 and 0.89 of energy ADCs, and 15.2 and 13.95MJ kg-1 of digestible energy for Pacu and Silver catfish, respectively. In conclusion, crude glycerol is an energetic ingredient with good potential in Brazilian native fish diets.

Computed tomographic and cross-sectional anatomy of the normal pacu (Colossoma macroponum).

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Carr, Alaina; Weber, E P Scott; Murphy, Chris J; Zwingenberger, Alison

2014-03-01

The purpose of this study was to compare and define the normal cross-sectional gross and computed tomographic (CT) anatomy for a species of boney fish to better gain insight into the use of advanced diagnostic imaging for future clinical cases. The pacu (Colossoma macropomum) was used because of its widespread presence in the aquarium trade, its relatively large body size, and its importance in the research and aquaculture settings. Transverse 0.6-mm CT images of three cadaver fish were obtained and compared to corresponding frozen cross sections of the fish. Relevant anatomic structures were identified and labeled at each level; the Hounsfield unit density of major organs was established. The images presented good anatomic detail and provide a reference for future research and clinical investigation.

[Mortality and length of stay in a surgical intensive care unit.].

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Abelha, Fernando José; Castro, Maria Ana; Landeiro, Nuno Miguel; Neves, Aida Maria; Santos, Cristina Costa

2006-02-01

Outcome in intensive care can be categorized as mortality related or morbidity related. Mortality is an insufficient measure of ICU outcome when measured alone and length of stay may be seen as an indirect measure of morbidity related outcome. The aim of the present study was to estimate the incidence and predictive factors for intrahospitalar outcome measured by mortality and LOS in patients admitted to a surgical ICU. In this prospective study all 185 patients, who underwent scheduled or emergency surgery admitted to a surgical ICU in a large tertiary university medical center performed during April and July 2004, were eligible to the study. The following variables were recorded: age, sex, body weight and height, core temperature (Tc), ASA physical status, emergency or scheduled surgery, magnitude of surgical procedure, anesthesia technique, amount of fluids during anesthesia, use of temperature monitoring and warming techniques, duration of the anesthesia, length of stay in ICU and in the hospital and SAPS II score. The mean length of stay in the ICU was 4.09 +/- 10.23 days. Significant risk factors for staying longer in ICU were SAPS II, ASA physical status, amount of colloids, fresh frozen plasma units and packed erythrocytes units used during surgery. Fourteen (7.60%) patients died in ICU and 29 (15.70%) died during their hospitalization. Statistically significant independent risk factors for mortality were emergency surgery, major surgery, high SAPS II scores, longer stay in ICU and in the hospital. Statistically significant protective factors against the probability of dying in the hospital were low body weight and low BMI. In conclusion, prolonged ICU stay is more frequent in more severely ill patients at admission and it is associated with higher hospital mortality. Hospital mortality is also more frequent in patients submitted to emergent and major surgery.

Low minute ventilation episodes during anesthesia recovery following intraperitoneal surgery as detected by a non-invasive respiratory volume monitor.

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Cavalcante, Alexandre N; Martin, Yvette N; Sprung, Juraj; Imsirovic, Jasmin; Weingarten, Toby N

2017-12-20

An electrical impedance-based noninvasive respiratory volume monitor (RVM) accurately reports minute volume, tidal volume and respiratory rate. Here we used the RVM to quantify the occurrence of and evaluate the ability of clinical factors to predict respiratory depression in the post-anesthesia care unit (PACU). RVM generated respiratory data were collected from spontaneously breathing patients following intraperitoneal surgeries under general anesthesia admitted to the PACU. Respiratory depression was defined as low minute ventilation episode (LMVe, respiratory rate (respiratory rate was a poor predictor of LMVe (sensitivity = 11.8%). Other clinical variables (e.g., obstructive sleep apnea) were not found to be predictors of LMVe. Using RVM we identified that mild, clinically nondetectable, respiratory depression prior to opioid administration in the PACU was associated with the development of substantial subsequent respiratory depression during the PACU stay.

Disease resistance of pacu Piaractus mesopotamicus (Holmberg, 1887 fed with β-glucan

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JD Biller-Takahashi

Full Text Available Effects of β-glucan on innate immune responses and survival were studied in pacu experimentally infected with Aeromonas hydrophila. Fish fed diets containing 0, 0.1% and 1% β-glucan were injected with A. hydrophila. β-glucan enhanced fish survival in both treated groups (26.7% and 21.2% of the control, respectively. Leukocyte respiratory burst and alternative complement pathway activities were elevated after bacterial challenge regardless the β-glucan concentration. Lysozyme activity was higher after infection and showed a gradual increase as β-glucan concentration increased. A significant elevation in WBC count was observed either after bacterial challenge or by influence of β-glucan separately. The same response was observed in the number of thrombocytes, lymphocytes, eosinophils, LG-PAS positive cell and monocytes. It can be concluded that feeding pacu with β-glucan can increase protection against A. hydrophila, due to changes in non-specific immune responses.

Leukocytes respiratory burst and lysozyme level in pacu (Piaractus mesopotamicus Holmberg, 1887

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JS. Abreu

Full Text Available Innate immune responses are useful to determine the health status of fish and to evaluate the effect of immunomodulatory substances in fish farming. Leukocytes respiratory burst was measured in pacu (Piaractus mesopotamicus using chemiluminescence assay and nitroblue tetrazolium (NBT reduction assay. The nitroblue tetrazolium reduction seemed more adequate than chemiluminescence assay for leukocytes oxidative burst determination, since it was difficult to isolate the blood leucocytes for chemiluminescence assay. Plasma and serum lysozyme were measured using a turbidimetric assay. The heating of serum and plasma samples (56 ºC for 30 minutes for complement system inactivation darkened the plasma samples and interfered in the results. The lysozyme activity in serum was higher than in plasma, suggesting that serum samples are more appropriate for the analysis. This study established protocols that can be useful tools in the study of immune mechanisms of the tropical fish pacu.

Modeling the effect of short stay units on patient admissions

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Zonderland, Maartje Elisabeth; Boucherie, Richardus J.; Carter, Michael W.; Stanford, David A.

Two purposes of Short Stay Units (SSU) are the reduction of Emergency Department crowding and increased urgent patient admissions. At an SSU urgent patients are temporarily held until they either can go home or transferred to an inpatient ward. In this paper we present an overflow model to evaluate

Age and admission times as predictive factors for failure of admissions to discharge-stream short-stay units.

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Shetty, Amith L; Shankar Raju, Savitha Banagar; Hermiz, Arsalan; Vaghasiya, Milan; Vukasovic, Matthew

2015-02-01

Discharge-stream emergency short-stay units (ESSU) improve ED and hospital efficiency. Age of patients and time of hospital presentations have been shown to correlate with increasing complexity of care. We aim to determine whether an age and time cut-off could be derived to subsequently improve short-stay unit success rates. We conducted a retrospective audit on 6703 (5522 inclusions) patients admitted to our discharge-stream short-stay unit. Patients were classified as appropriate or inappropriate admissions, and deemed successful if discharged out of the unit within 24 h; and failures if they needed inpatient admission into the hospital. We calculated short-stay unit length of stay for patients in each of these groups. A 15% failure rate was deemed as acceptable key performance indicator (KPI) for our unit. There were 197 out of 4621 (4.3%, 95% CI 3.7-4.9%) patients up to the age of 70 who failed admission to ESSU compared with 67 out of 901 (7.4%, 95% CI 5.9-9.3%, P 70 years of age have higher rates of failure after admission to discharge-stream ESSU. Although in appropriately selected discharge-stream patients, no age group or time-band of presentation was associated with increased failure rate beyond the stipulated KPI. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

[Medical short stay unit for geriatric patients in the emergency department: clinical and healthcare benefits].

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Pareja, Teresa; Hornillos, Mercedes; Rodríguez, Miriam; Martínez, Javier; Madrigal, María; Mauleón, Coro; Alvarez, Bárbara

2009-01-01

To evaluate the impact of comprehensive geriatric assessment and management of high-risk elders in a medical short stay unit located in the emergency department of a general hospital. We performed a descriptive, prospective study of patients admitted to the medical short stay unit for geriatric patients of the emergency department in 2006. A total of 749 patients were evaluated, with a mean (standard deviation) stay in the unit of 37 (16) h. The mean age was 86 (7) years; 57% were women, and 50% had moderate-severe physical impairment and dementia. Thirty-five percent lived in a nursing home. The most frequent reason for admission was exacerbation of chronic cardiopulmonary disease. Multiple geriatric syndromes were identified. The most frequent were immobility, pressure sores and behavioral disorders related to dementia. Seventy percent of the patients were discharged to home after being stabilized and were followed-up by the geriatric clinic and day hospital (39%), the home care medical team (11%), or the nursing home or primary care physician (20%). During the month after discharge, 17% were readmitted and 7.7% died, especially patients with more advanced age or functional impairment. After the unit was opened, admissions to the acute geriatric unit fell by 18.2%. Medical short stay units for geriatric patients in emergency departments may be useful for geriatric assessment and treatment of exacerbations of chronic diseases. These units can help to reduce the number of admissions and optimize the care provided in other ambulatory and domiciliary geriatric settings.

PHYSIOLOGICAL RESPONSES OF PACU (Piaractus mesopotamicus, FED CASSAVA (Manihot esculenta FOLIAGE IN DIETS RESPOSTAS FISIOLÓGICAS DO PACU (Piaractus mesopotamicus, ALIMENTADO COM RAMA DE MANDIOCA (Manihot esculenta NA RAÇÃO

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João Teodoro Padua

2009-07-01

Full Text Available Brazil is the largest world producer of cassava. Leafs and stem of cassava can be a alternative source of protein for omnivorous fish. However, the potential use is limited by the presence of high level of cyanide acid. The present study evaluated physiological responses of juvenile pacu submitted to increasing levels of the final third of the cassava foliage meal in diets. A completely randomized design was used in factorial scheme 4x2, four levels, 0, 12, 24 and 36 % of cassava foliage meal (CFM, and 2 levels of crude protein (CP, 24 % and 30 %, with three replicates. Three hundred twelve fish (55.33±6.19 g were distributed into 24 ponds of 13 m2. Results indicated that the levels of CFM inclusion affected the hemoglobin values (P<0.01, as well as the CP level (P<0.05, with interaction of these factors (P<0.01. Significant interaction among the CFM levels and CP was also observed for hematocrit, plasma protein (P<0.01 and plasma lipid (P<0.05. In the 24 % CP level was observed higher values of Hb in control and 36 % of CFM (3.51 g/dl and 3.25 g/dl respectively while with 30 % CP the control diet and 36 % CFM presented the smallest values (3.29 g/dl and 2.78 g/dl respectively. The higher level of CFM tested, inside of any protein level, had low influence on the pacu metabolism.

KEY WORDS: Cassava leaf and stem fish metabolism, pacu, P. Mesopotamicus.
O Brasil é o maior produtor mundial de mandioca, disponibilizando a rama de mandioca como fonte alternativa na alimentação de peixes onívoros. No entanto, o potencial de uso da rama é limitado pela toxidez do ácido cianídrico. Objetivou-se avaliar a resposta fisiológica do pacu alimentado com níveis crescentes da rama de mandioca. Utilizou-se delineamento inteiramente casualizado, em fatorial 4x2, quatro níveis de rama de mandioca (RM (0%, 12%, 24% e 36% e dois níveis de proteína bruta (PB (24% e 30% com três repetições. Trezentos e doze peixes (55,33±6,19 g foram

Prevalence of sarcopenia in a media and long stay Unit.

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Rubio-Maicas, C; Duarte-Alfonso, E; Beseler-Soto, M R; Moreno-Muñoz, I; Moral-Moral, P; Merino-Torres, J F

2014-01-01

Sarcopenia is characterized by the loss of skeletal muscle mass and strength and represents a risk factor for frailty, loss of independence and physical disabilities. This study aimed to assess the prevalence of sarcopenia in a population of patients admitted to a media and long-stay unit. Descriptive, cross-sectional observational study that included 166 patients over 18 years who were admitted consecutively for a year to palliative care, convalescence or rehabilitation. Administrative and anthropometric data were recorded. Sarcopenia detection was performed by assessing the strength in the scapular and pelvic girdle muscles, grip strength in the hands, muscle mass and physical functional capacity. The overall prevalence of sarcopenia was 77.6%. Most patients had severe sarcopenia (91.2%), with reduced levels of the 3 assessed parameters: muscle strength (88.2%), muscle mass (85.5%) and physical performance (94.70%). The prevalence of sarcopenia in patients admitted to our media and long-stay unit is higher than that reported in noninstitutionalized populations, and often has a significant degree of severity. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Residual neuromuscular block as a risk factor for critical respiratory events in the post anesthesia care unit.

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Norton, M; Xará, D; Parente, D; Barbosa, M; Abelha, F J

2013-04-01

Residual neuromuscular block is an important postoperative complication associated to the use of neuromuscular blocking drugs. The purpose of this study was to access the incidence of residual neuromuscular block in a post-anesthesia care unit and to evaluate its association with critical respiratory events. Prospective cohort study was conducted in a Post Anesthetic Care Unit (PACU) for a period of 3 weeks. Two hundred two adult patients who submitted to scheduled non-cardiac and non-intracranial surgery were eligible to the study. The primary outcome variable was residual neuromuscular block after arrival to PACU that was defined as train-of-four ratio <0.9 and objectively quantified using acceleromyography. Demographic data, perioperative variables, lengths of hospital and recovery room stay and critical respiratory events were recorded. Inadequate emergence was classified in its different forms according to the Richmond agitation and sedation scale 10 min after admission to the recovery room. Residual neuromuscular block incidence in the post-anesthesia care unit was 29.7% (95% confidence interval: 23.4, 36.1). Patients with residual neuromuscular block had more frequently overall critical respiratory events (51% versus 16%, P<0.001), airway obstruction (10% versus 2%, P=0.029), mild-moderate hypoxemia (23% versus 4%, P<0.001), severe hypoxemia (7% versus 1%, P=0.033), respiratory failure (8% versus 1%, P=0.031), inability to breathe deeply (38% versus 12%, P<0.001) and muscular weakness (16% versus 1%, P<0.001). Residual neuromuscular block was more common after high-risk surgery (53% versus 33%, P=0.011) and was more often associated with post-operative hypoactive emergence as defined by the Richmond Agitation and Sedation Scale (21% versus 6%, P=0.001). This study suggests that residual neuromuscular block is common in the PACU and is associated with more frequent critical respiratory events. Copyright © 2012 Sociedad Española de Anestesiología, Reanimaci

Incorporation of conjugated linoleic acid (CLA and α-linolenic acid (LNA in pacu fillets

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Deoclécio José Barilli

2014-03-01

Full Text Available The objective of this study was to evaluate the incorporation of conjugated linoleic acid and α-linolenic acid in fillets of pacu fish raised in net cages and fed diets enriched with these acids. The fish were fed for 49 days, and at the end of this period the fatty acid content in the fillets was determined by gas chromatography. Concentrations of α-linolenic acid, eicosapentaenoic acid, and the total omega-3 (n-3 fatty acid in the fillets increased, improving the n-6/n-3 ratio. In addition, the incorporation of conjugated linoleic acid in the fish fillets proved well established. This study showed that the use of diets enriched with conjugated linoleic acid and α-linolenic acid results in the incorporation of these acids in the of pacu fish fillets, improving their nutritional quality.

A clinical audit of postoperative urinary retention in the postanesthesia care unit.

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McLeod, Laura; Southerland, Kerry; Bond, Jade

2013-08-01

Postoperative urinary retention (PUR) is a common postsurgical complication. Early detection and management of PUR is of particular concern to nurses working in the postanesthesia care unit (PACU) because a single episode of bladder distention may result in permanent bladder damage. A clinical audit (CA) was conducted that examined the risk factors that may contribute to the development of PUR in the PACU. The CA was conducted over a 1-week time period and used a data collection tool that was developed from the current literature. A total of 34 patients met the inclusion criteria for the CA, and a prevalence rate of 20.6% was reported, which was consistent with prevalence rates reported by larger research studies. Despite the small sample size of this CA, results suggested that PUR should be of concern to nurses in the PACU. Recommendations included the development and implementation of a guideline relating to bladder scanning in the PACU and modification of existing PACU discharge criteria to include bladder management. Copyright © 2013 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Gastrointestinal transit of extruded or pelletized diets in pacu fed distinct inclusion levels of lipid and carbohydrate

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Claucia Aparecida Honorato

2014-11-01

Full Text Available The objective of this work was to evaluate the effect of pelletized or extruded diets, with different levels of carbohydrate and lipid, on the gastrointestinal transit time (GITT and its modulation in pacu (Piaractus mesopotamicus. One hundred and eighty pacu juveniles were fed with eight isonitrogenous diets containing two carbohydrate levels (40 and 50% and two lipid levels (4 and 8%. Four diets were pelletized and four were extruded. Carbohydrate and lipid experimental levels caused no changes to the bolus transit time. However, the bolus permanence time was related to diet processing. Fish fed pelletized diets exhibited the highest gastrointestinal transit time. Regression analysis of bolus behavior for pelletized and extruded diets with 4% lipid depicted different fits. GITT regression analysis of fish fed 8% lipid was fitted to a cubic equation and displayed adjustments of food permanence, with enhanced utilization of the diets, either with extruded or pelletized diets. GITT of fish fed extruded diets with 4% lipid was adjusted to a linear equation. The GITT of pacu depends on the diet processing and is affected by dietary levels of lipid and carbohydrate.

Estudo do potencial do pacu (Piaractus mesopotamicus como agente de controle biológico de Egeria densa, E. najas e Ceratophyllum demersum Evaluation of the biocontrol potential of pacu (Piaractus mesopotamicus for Egeria densa, E. najas and Ceratophyllum demersum

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D.M.Y. Miyazaki

2003-01-01

Full Text Available Visando fornecer subsídios para elaboração de sistema de manejo integrado das grandes massas de plantas daninhas aquáticas submersas em lagos e represas, o presente trabalho teve como objetivo verificar a eficiência do pacu (Piaractus mesopotamicus como agente de controle biológico de Egeria densa, E. najas e Ceratophyllum demersum. As espécies de plantas daninhas foram oferecidas individualmente, duas a duas e as três espécies juntas. Verificou-se que este peixe tem uma eficiência média de controle dessas plantas daninhas variando entre 28 e 100%, podendo eliminar uma massa verde dessas plantas, com a mesma quantidade de seu peso, em sete dias. A eficiência de controle diária aumentou com o tempo de predação. O pacu é mais seletivo para E. densa ou E. najas quando na presença de C. demersum. Não ocorreu alteração na eficiência de controle do pacu sobre E. densa ou E. najas em todos os tratamentos e nos três períodos estudados (três, cinco e sete dias.In order to provide basic information for the establishment of integrated management systems for submersed aquatic weeds in lakes and reservoirs, this research evaluated the efficiency of pacu (Piaractus mesopotamicus as a biocontrol agent of Egeria densa, E. najas and Ceratophyllum demersum. One, two and the three plant species together were offered to the fish. The average efficacy of this fish to control these plants ranged between 28 and 100%. The fish could eliminate a fresh mass of these plants, equivalent to its body weight, in seven days of predation period. Control efficiency increased with increasing duration of the trials. Pacu is more selective in controlling E. densa or E. najas when in the presence of C. demersum. No decreased efficacy was observed in the control of E. densa or E. najas in any of the treatments nor in any of three time periods studied (3, 5, and 7 days.

Seletividade alimentar de organismos-alimento por formas jovens de pacu Piaractus mesopotamicus (Holmberg, 1887 e curimba Prochilodus lineatus (Valenciennes, 1836 - DOI: 10.4025/actascibiolsci.v29i2.523 Selective feeding of food organisms by fish larvae of Piaractus mesopotamicus (Holmberg, 1887 and Prochilodus lineatus (Valenciennes, 1836 - DOI: 10.4025/actascibiolsci.v29i2.523

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Carlos Eduardo Bento Fernandes

2007-12-01

Full Text Available Objetivou-se avaliar a seleção alimentar de organismos-alimento por formas jovens de pacu (Piaractus mesopotamicus e curimba (Prochilodus lineatus com diferentes idades (6, 12, 19 e 26 dias, na presença e ausência de Pistia stratiotes. Foram utilizados quatro tratamentos (T1 = pacu + P. stratiotes; T2 = pacu; T3 = curimba + P. stratiotes; T4 = curimba e quatro repetições. A cada sete dias, foram coletadas 24 larvas de cada espécie de peixe dos tanques, sendo estas mantidas em jejum por 24 horas. Depois de distribuídas nos aquários com plâncton, as larvas permaneceram por três horas, sendo coletadas e fixadas para análise, juntamente com as amostras de água. Os tratos digestórios das larvas foram retirados e analisados sob microscópio óptico. Observaram-se diferenças estatísticas na seletividade alimentar de organismos planctônicos por larvas de mesma espécie, em diferentes idades e também entre larvas de espécies diferentes, com mesma idade, não diferindo quanto à presença ou ausência de P. stratiotes. As formas jovens de pacu e curimba selecionaram organismos similares aos seis dias de idade, passando por alterações até o 26º dia. À medida que se desenvolveram, as larvas de pacu passaram a selecionar cladóceros e ostrácodos e as de curimba, protozoários e algas.The objective was to evaluate the feeding selection of food organisms for two species of fish larvae (pacu and curimba at different ages (6, 12, 19 and 26 days after eclosion, in the presence or absence of Pistia stratiotes. Four treatments were used (T1 = pacu + P. stratiotes; T2 = pacu; T3 = curimba + P. stratiotes; T4 = curimba and four replications. Every seven days, 24 fish larvae of each species were collected, and kept without food for 24 hours. After being distributed in the aquariums with plankton, the larvae stayed for three hours, and were collected and prepared for analysis, along with the water samples. The digestive tract of the fish larvae

Biological indicators of stress in pacu (Piaractus mesopotamicus after capture

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JS. Abreu

Full Text Available The effects of capture (chasing, netting and air exposure on cortisol, glucose, chloride, sodium, potassium and calcium concentrations, osmolality, hematocrit, hemoglobin concentration, red blood cells count (RBC and mean corpuscular volume (MCV were investigated in pacu (Piaractus mesopotamicus. A total of 132 fish (49.7 ± 11.7 g were subjected to capture and 3 minutes air exposure and capture and 5 minutes air exposure. Nine fish at each treatment were sampled at 5, 15, 30, 60 minutes and 24 hours after the procedure. Nine undisturbed fish were sacrificed before the handling and used as controls. Capture resulted in a rise in blood cortisol and glucose 30 and 5 minutes, respectively, after both air exposures. Both indicators returned to resting levels 24 hours after capture. In both fish groups, plasma chloride decreased 60 minutes after capture, not recovering the resting levels within 24 hours after, and serum sodium rose at 15 and 30 minutes and recovered the resting levels 24 hours later. There were no significant changes neither in potassium, calcium and osmolality nor in hematocrit, hemoglobin, RBC and MCV as a consequence of capture. The sequential stressors imposed to pacu during capture activated the brain-pituitary-interrenal axis (cortisol and glucose responses but the activation of the brain-sympathetic-chromaffin cell axis was apparently moderate (ionic and hematological responses.

Eficácia do fembendazole no controle de nematódeos de pacu Piaractus mesopotamicus (Holmberg, 1987 The efficiency of fembendazole in the control of nematodes in pacu Piaractus mesopotamicus (Holmberg, 1987

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Jorge Erick Garcia Parra

1997-06-01

Full Text Available O presente trabalho foi realizado no Centro de Pesquisa e Treinamento em Aquicultura (CEPTA/1BAMA, município de Pirassununga, SP. Foram utilizados 60 pacus, dos viveiros da Estação de Piscicultura do CEPTA, com peso médio de 600g. Foi realizado um teste visando avaliar o efeito do Femben-dazote (adicionado no alimento em diferentes dosagens, sobre os nematódeos presentes no tubo intestinal do pacu, utilizando três tratamentos: Tl - grupo testemunha (ração sem Fembendazole, T2 - 20mg de Fembendazole/kg de ração e T3 - 40mg de Fembendazo-le/kg de ração. O delineamento foi inteiramente casualizado. A unidade experimental foi o peixe. Não houve diferença significativa (P 0,05 entre os tratamentos com anti-helmintico Fembendazole nas dosagens de 20mg/kg e 40/ng/kg de ração e o grupo testemunha.This study was done at lhe Agricultural Centre for Training and Research (CEPTA/IBAMA m the municipality of Pirassununga, São Paulo. Sixty pacus, wilh an average weight of 600g were obtained from the nurseries of the fish statíon at CEPTA. An experiment to determine the ejfect of fenbendazole (added to the ration in varíous doses on nematodes in the alimentary canal ofthe pacu was realized using three treatments. Tl - contrai group (ration without fenbendazole, T2 - 20mg fenbendazole/kg ration, and T3 - 40mgfenbendazole/kg ration. The experimental ouüine was totally random. The fish was the experimental unit. There was no significam dijference (P 0.05 befween the treatments wilh the anti-helminthic fenbendazole added to the ration in doses of 20 and 40 mg/kg and the contrai group.

Obese patients: Respiratory complications in the post-anesthesia care unit

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J. Mendonça

2014-01-01

Full Text Available Introduction: Obesity has been associated with respiratory complications, and the majority of these complications occur in the Post-Anesthesia Care Unit (PACU. The aim of this study was to evaluate the outcome and incidence of adverse respiratory events (AREs in obese patients during their stay in the PACU. Methods: We conducted a prospective control study that included 27 obese patients matched with an equal number of patients with body mass index (BMI  0,025. A análise multivariada identificou a obesidade e o bloqueio neuromuscular residual como fatores de risco independentes para a ocorrência de eventos respiratórios. A duração da estadia na UPA foi superior nos doentes obesos (120 min vs 84 min, p > 0,01. Conclusões: A incapacidade de respirar profundamente foi o ARE mais frequente no período pós-operatório imediato nos doentes obesos. A obesidade foi considerada um fator de risco independente para ocorrência de ARE na UPA. Os doentes obesos tiveram maior tempo de estadia na UPA mas não tiveram maior tempo de internamento hospitalar. Keywords: Obesity, Body mass index, Respiratory events, Postoperative outcome, Palavras chave: Obesidade, Índice de massa corporal, Eventos respiratórios, Resultados pós-operatórios

Aditivos na conservaÃÃo de CMS e estabilidade de empanados de pacu de tanques-rede do Pantanal

OpenAIRE

Jovana Silva Garbelini Zuanazzi

2013-01-01

O presente estudo està dividido em dois artigos cientÃficos. O primeiro artigo teve como objetivos avaliar a carne mecanicamente separada (CMS) de pacu com adiÃÃo de eritorbato de sÃdio e tripolifosfato de sÃdio, e verificar algumas de suas propriedades fÃsicas e quÃmicas nos intervalos de 0, 30, 60, 90 e 120 dias de armazenamento a -18ÂC. O segundo artigo trata-se da elaboraÃÃo de empanado a partir da CMS de pacu, avaliando os parÃmetros fÃsicos, quÃmicos, sensoriais e microbiolÃgicos nos in...

Initial experience with the unrestricted introduction of sugammadex at a large academic medical center: a retrospective observational study examining postoperative mechanical ventilation and efficiency outcomes.

Science.gov (United States)

Reilly-Shah, Vikas N O'; Lynde, Grant C; Mitchell, Matthew L; Maffeo, Carla L; Jabaley, Craig S; Wolf, Francis A

2018-05-30

Sugammadex can rapidly reverse deep neuromuscular blockade, but due to cost questions remain as to its optimal utilization. After introduction for unrestricted use at an academic medical center, we hypothesized that reductions would be demonstrated in the primary outcome of post-anesthesia care unit (PACU) mechanical ventilation (MV) and secondary outcomes of PACU length of stay (LOS), and emergence time (surgery end to anesthesia end time in PACU). We conducted a retrospective observational study of patients undergoing general anesthesia over a 12-month period. Using multiple variable penalized logistic regression in a one group before-and-after design, we compared categorized rates of PACU MV to examine the effect of sugammadex introduction following a post-hoc chart review to ascertain the reason for postoperative MV. Additionally, multiple variable linear regression was used to assess for differences in PACU LOS and emergence time within a propensity matched set of patients receiving neostigmine or sugammadex. 7,217 cases met inclusion criteria: 3,798 before and 3,419 after the introduction of sugammadex. The incidence of PACU MV was 2.3% before and 1.8% after (p=0.118). PACU MV due to residual neuromuscular blockade (rNMB) decreased from 0.63% to 0.20% (p=0.005). Ventilation due to other causes was unchanged. PACU LOS and emergence time were unchanged in a propensity matched set of 1,444 cases. We identified rNMB as an important contributor to PACU MV utilization and observed a significant decrease after sugammadex was introduced. The selected efficiency measures may not have been sufficiently granular to identify improvements following introduction.

Why the United States will stay engaged in Afghanistan and Pakistan beyond 2017

DEFF Research Database (Denmark)

Jakobsen, Peter Viggo

This chapter takes issue with this view arguing that the American willingness to stay engaged first and foremost will depend upon the ability of the US President to craft a strategic narrative that can convince most members of Congress that it is necessary to stay engaged, that it is the right...... thing to do, and that the United States, Afghanistan and the world will benefit from it. In addition, the President must promise success at an acceptable price and deliver it by demonstrating that progress is being made on a continuous basis. My argument has three parts. Part one explains why elite...

Postoperative delirium in intensive care patients: risk factors and outcome.

Science.gov (United States)

Veiga, Dalila; Luis, Clara; Parente, Daniela; Fernandes, Vera; Botelho, Miguela; Santos, Patricia; Abelha, Fernando

2012-07-01

Postoperative delirium (POD) in Surgical Intensive Care patients is an important independent outcome determinant. The purpose of our study was to evaluate the incidence and determinants of POD. Prospective cohort study conducted during a period of 10 months in a Post-Anesthesia Care Unit (PACU) with five intensive care beds. All consecutive adult patients submitted to major surgery were enrolled. Demographic data, perioperative variables, length of stay (LOS) and the mortality at PACU, hospital and at 6-months follow-up were recorded. Postoperative delirium was evaluated using the Intensive Care Delirium Screening Checklist (ICDSC). Descriptive analyses were conducted and the Mann-Whitney test, Chi-square test or Fisher's exact test were used for comparisons. Logistic regression analysis evaluated the determinants of POD with calculation of odds ratio (OR) and its confidence interval 95% (95% CI). There were 775 adult PACU admissions and 95 patients had exclusion criteria. Of the remaining 680 patients, 128 (18.8%) developed POD. Independent determinants of POD identified were age, ASA-PS, emergency surgery and total amount of fresh frozen plasma administered during surgery. Patients with delirium had higher mortality rates, were more severely ill and stayed longer at the PACU and in the hospital. POD was an independent risk factor for hospital mortality There was a high incidence of delirium had a high incidence in intensive care surgical patients. POD was associated with worse severity of disease scores, longer LOS in hospital, and in PACU and higher mortality rates. The independent risk factors for POD were age, ASAPS, emergency surgery and the amount of plasma administered during surgery. Copyright © 2012 Elsevier Editora Ltda. All rights reserved.

Lack of utility of a decision support system to mitigate delays in admission from the operating room to the postanesthesia care unit.

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Ehrenfeld, Jesse M; Dexter, Franklin; Rothman, Brian S; Minton, Betty Sue; Johnson, Diane; Sandberg, Warren S; Epstein, Richard H

2013-12-01

When the phase I postanesthesia care unit (PACU) is at capacity, completed cases need to be held in the operating room (OR), causing a "PACU delay." Statistical methods based on historical data can optimize PACU staffing to achieve the least possible labor cost at a given service level. A decision support process to alert PACU charge nurses that the PACU is at or near maximum census might be effective in lessening the incidence of delays and reducing over-utilized OR time, but only if alerts are timely (i.e., neither too late nor too early to act upon) and the PACU slot can be cleared quickly. We evaluated the maximum potential benefit of such a system, using assumptions deliberately biased toward showing utility. We extracted 3 years of electronic PACU data from a tertiary care medical center. At this hospital, PACU admissions were limited by neither inadequate PACU staffing nor insufficient PACU beds. We developed a model decision support system that simulated alerts to the PACU charge nurse. PACU census levels were reconstructed from the data at a 1-minute level of resolution and used to evaluate if subsequent delays would have been prevented by such alerts. The model assumed there was always a patient ready for discharge and an available hospital bed. The time from each alert until the maximum census was exceeded ("alert lead time") was determined. Alerts were judged to have utility if the alert lead time fell between various intervals from 15 or 30 minutes to 60, 75, or 90 minutes after triggering. In addition, utility for reducing over-utilized OR time was assessed using the model by determining if 2 patients arrived from 5 to 15 minutes of each other when the PACU census was at 1 patient less than the maximum census. At most, 23% of alerts arrived 30 to 60 minutes prior to the admission that resulted in the PACU exceeding the specified maximum capacity. When the notification window was extended to 15 to 90 minutes, the maximum utility was system to mitigate

Haff disease associated with the ingestion of the freshwater fish Mylossoma duriventre (pacu-manteiga).

Science.gov (United States)

Tolesani Júnior, Oswaldo; Roderjan, Christian Nejm; do Carmo Neto, Edgard; Ponte, Micheli Mikaeli; Seabra, Mariana Cristina Pelli; Knibel, Marcos Freitas

2013-01-01

Haff disease associated rhabdomyolysis is correlated with the ingestion of certain freshwater fish and shellfish and is caused by an unidentified toxin. We report the case of a patient who experienced rhabdomyolysis approximately 2 hours after ingestion of the freshwater fish Mylossoma duriventre (pacu-manteiga) approximately 3 years after an outbreak had been reported in Manaus, Brazilian Amazon.

A medical admission unit reduces duration of hospital stay and number of readmissions

DEFF Research Database (Denmark)

Vork, Jan C; Brabrand, Mikkel; Folkestad, Lars

2011-01-01

Political initiatives promoting a more efficient emergency admission process have triggered a reorganisation of the Danish health system with a view to creating fewer and larger admission units counting more experienced physicians. At our hospital, a medical admission unit (MAU) was established. ...... present the effect of this on the length of hospital stay, mortality rates and the number of readmissions for the last year with the previous structure and the first year of the new MAU structure....

[The development and benefits of working together in geriatric short stay units].

Science.gov (United States)

Dumont, Magali

2014-01-01

Ambroise-Paré hospital (AP-HP, 92) set up a new work organisation based on the nurse/nursing auxiliary partnership in the geriatric short stay unit in response to the wishes of the healthcare manager and nursing team. It was introduced over three months and in several stages in order to limit sticking points and support the team in its new practice.

The short mean length of stay of post-emergency geriatric units is associated with the rate of early readmission in frail elderly.

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Traissac, Thalie; Videau, Marie-Neige; Bourdil, Marie-José; Bourdel-Marchasson, Isabelle; Salles, Nathalie

2011-06-01

Specific postemergency short-stay geriatric units may decrease length of hospital stay, functional decline, and early readmission rates. The aim of this study was to evaluate risk factors of early rehospitalization in a shortstay geriatric unit. This study was a prospective observational study comprising over one year patients aged over 75 years, admitted to the post-emergency short-stay geriatric unit (Hôpital Saint André, Bordeaux, France) and discharged home. Socio-demographic data, length of hospital stay, and a standardized geriatric assessment were collected for all patients. One month after home discharge, patients were followed-up by phone, and the hospital readmission rate was calculated. descriptive, unvaried and multivariate analyses were carried out. A total of 476 patients were included in this study (mean age 86.5±6 yrs; 154 men, 322 women). Mean length of stay in the post-emergency short-stay geriatric unit was 6.3±2.7 days, and a total of 68 (14.3%) patients were readmitted within one month after home discharge. The readmission rate was associated with a diagnosis of delirium (Odds Ratio (OR) 1.9; 95% CI 1.1-3.3; p=0.02), mean length of stay exceeding 6 days (OR 1.9, 95% CI 1.1-3.5; p=0.02), and decision of home discharge (OR 2.4; 95% CI 1.4-4.1; p=0.002). Short mean lengths of stay were not considered as a risk factor for readmissions within one month, even in frail, dependent, hospitalized elderly persons.

Crescimento e estruturas do sistema digestório de larvas de pacu alimentadas com dieta microencapsulada produzida experimentalmente Growth and structure of the digestive system of pacu larvae fed microencapsulated diet produced experimentally

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Olívia Cristina Camilo Menossi

2012-01-01

Full Text Available Foram comparados os efeitos de diferentes dietas e da transição alimentar sobre o desempenho zootécnico e a morfologia do trato digestório de larvas de pacu alimentadas com duas dietas comerciais e uma dieta experimental microencapsulada produzida por gelificação interna. Larvas com quatro dias de vida receberam os seguintes protocolos alimentares: somente náuplios de artêmia em quantidades crescentes (controle positivo; larvas mantidas em jejum (controle negativo; três tipos de alimento formulado durante todo o experimento (dieta experimental microencapsulada, dieta comercial NRD1.2/2.0, Inve, USA, e dieta Poli-Peixe 450F, PoliNutri, Brasil; e três protocolos de transição alimentar com náuplios de artêmia durante os seis primeiros dias, seis dias de coalimentação, e somente as respectivas dietas formuladas após esse período. O experimento foi conduzido por 23 dias em delineamento inteiramente casualizado, com avaliações periódicas do crescimento e do sistema digestório. A taxa de sobrevivência foi determinada ao final do experimento. Os melhores desempenhos de crescimento e sobrevivência, assim como mais acelerada organogênese do sistema digestório, foram verificados entre os animais que receberam alimento vivo. As larvas que passaram pela transição alimentar apresentaram médias intermediárias de crescimento e sobrevivência e não diferiram entre si. Entre os grupos que receberam apenas dieta inerte, somente naquele alimentado com a dieta nacional houve sobrevivência até o final do experimento. Nenhuma das dietas formuladas é adequada para uso como alimento exclusivo para larvas de pacu. Na fase de transição alimentar, a dieta experimental microencapsulada proporciona resultados de sobrevivência e crescimento semelhantes aos obtidos com dietas comerciais.The effects of different diets and dietary transition on the performance and morphology of the digestive tract of pacu larvae fed two commercial formulated

Vitamina A em dieta de juvenis de pacu cultivados em tanques-rede

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Arcangelo Augusto Signor

2013-08-01

Full Text Available O objetivo deste trabalho foi avaliar o efeito da suplementação de vitamina A na alimentação de juvenis de pacu cultivados em tanques-rede. Foram utilizados 2.000 peixes, com peso inicial médio de 66,93±15,03 g, distribuídos em delineamento inteiramente casualizado, em 20 tanques-rede de 5,0 m³, com cinco tratamentos e quatro repetições. As rações foram formuladas com 0, 3.000, 6.000, 9.000 e 12.000 UI de vitamina A por quilograma de dieta, por meio da suplementação com acetato de retinol. O arraçoamento foi realizado às 8:30, 13:30 e 17:30 h, até a saciedade aparente dos animais. Não foram observadas diferenças quanto aos parâmetros de desempenho produtivo, rendimento e composição química da carcaça, e aos parâmetros hematológicos e lipídios no fígado dos peixes que foram alimentados com diferentes níveis de vitamina A. A suplementação de vitamina A em dietas para juvenis de pacu criados em tanques-rede não influencia o desempenho produtivo dos peixes.

Considerações sobre a reprodução artificial e alevinagem de pacu (Piaractus mesopotamicus, Holmberg, 1887 em viveiros Considerations on artificial reproduction and fingerling culture of pacu (Piaractus mesopotamicus, Holmberg, 1887 in ponds

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Carlos Roberto Padovani

2000-05-01

Full Text Available Este trabalho apresenta uma revisão bibliográfica sobre a reprodução artificial, incubação e alevinagem de pacu em viveiros de terra. As técnicas de propagação artificial possibilitam o suprimento de ovos para uma grande variedade de peixes destinados à criação em viveiros e outros corpos de água confinados, bem como para sistemas superintensivos. Essas técnicas tornaram igualmente possível introduzir várias espécies importantes de peixes em áreas geográficas separadas. Além disso, permitem a incubação, a eclosão de ovos e larvicultura em condições bem protegidas e independentes das condições climáticas. Dependendo do sistema, 20 a 70% dos ovos produzidos têm possibilidade de se transformarem em alevinos; em contrapartida, a taxa de sobrevivência, sob condições naturais, geralmente é muito inferior a 1% dos ovos produzidosThis paper presents a literature review on pacu artificial reproduction, incubation and fingerling culture of pacu in ponds. The techniques of artificial propagation facilitate egg supply for a great variety of fish set aside to be raised in ponds and other impounded water bodies, as well as for superintensive systems. Those techniques made it equally possible to introduce several important fish species in separate geographical areas. Besides, they allow incubation, eggs eclosion and larvae culture under protected conditions, independently of climatic conditions. Depending on the system perfection, 20 to 70% of the eggs are liable to hatch and produce fingerlings. On the other hand the survival rate under natural conditions is generally lower than 1% of eggs

Pacu fish (Cuvier, 1818 (Characiformes: Characidae landed in Porto Velho (Rondônia fish market from 1985 to 2004

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Maria Alice Leite Lima

2008-09-01

Full Text Available This study evaluated various aspects of the profile of pacu (Mylossoma spp., Myleus spp., Metynnis spp. fish marketed on the Cai N’água floating platform of Porto Velho (RO from 1985 to 2004. Inter- and intra-annual variations in yield, variation in fish length and general characteristics of the fishing are reported. The annual pacu yield ranged from 33,000kg to 146,000kg (average = 86,585kg, representing from 6.6% to 20.45% of the total landings in the studied period. These variations followed the hydrologic cycle, and the greatest yields were recorded in the years following the highest water levels. The monthly production ranged from 0 to 42,366kg (average = 5,772kg and it was related to reproductive migration. The pacu presented variations in standard length from 14 to 20cm (18.72cm ± 3.69, mean ± sd. The fishing was based on the use of seines and gill nets and the main environments of capture were tributaries of the low Madeira River (Jamari, Oropiara, Machado and Novo Aripuanã. The CPUE calculated for 2003 to 2005 was 15kg*fisherman 1day-1 (sd = ±21. The results show that the category constituted during this period an important resource for local commercial exploitations, as verified in other regions of the Amazon.

Prolonged Stay in the Intensive Care Unit: a Report of 2 Cases | Tobi ...

African Journals Online (AJOL)

... and impact on patients' morbidity and mortality. We present a report of two cases of prolonged stay in the ICU (32 and 39 days respectively) with emphasis on the course of illness and intervention. The role of serial arterial blood gas analysis, early tracheostomy and the presence of a dedicated consultant in the unit in the ...

Doentes obesos: complicações respiratórias na unidade pós-anestésica

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J. Mendonça

2014-01-01

Full Text Available Resumo: Introdução: A obesidade tem sido associada a eventos respiratórios e a maioria destes ocorrem no pós-operatório imediato na unidade pós-anestésica (UPA. O objetivo deste estudo foi avaliar o «outcome» e a incidência de eventos adversos respiratórios (ARE pós-operatórios em doentes com obesidade durante a sua permanência na UPA. Métodos: Estudo prospetivo caso-controlo com emparelhamento de 27 pares de adultos com obesidade e doentes com IMC  0,025. A análise multivariada identificou a obesidade e o bloqueio neuromuscular residual como fatores de risco independentes para a ocorrência de eventos respiratórios. A duração da estadia na UPA foi superior nos doentes obesos (120 min vs 84 min, p > 0,01. Conclusões: A incapacidade de respirar profundamente foi o ARE mais frequente no período pós-operatório imediato nos doentes obesos. A obesidade foi considerada um fator de risco independente para ocorrência de ARE na UPA. Os doentes obesos tiveram maior tempo de estadia na UPA mas não tiveram maior tempo de internamento hospitalar. Abstract: Introduction: Obesity has been associated with respiratory complications, and the majority of these complications occur in the Post-Anesthesia Care Unit (PACU. The aim of this study was to evaluate the outcome and incidence of adverse respiratory events (AREs in obese patients during their stay in the PACU Methods: We conducted a prospective control study that included 27 obese patients matched with an equal number of patients with body mass index (BMI < 30 (non-obese control group; the 2 groups of patients were similar in respect to gender distribution, age, and type of surgery and had been admitted into the PACU after elective surgery (May 2011. The AREs were identified during PACU stay. Descriptive analysis of variables was performed, and the Mann-Whitney U test, Chi-square test, or Fisher's exact test

Predação de larvas de pacu (Piaractus mesopotamicus, Holmberg por copépodes ciclopóides (Mesocyclops longisetus, Thiébaud em diferentes densidades e ambientes e com diferentes contrastes visuais Predation of pacu (Piaractus mesopotamicus, Holmberg larvae by cyclopoid copepods (Mesocyclops longisetus, Thiébaud at different densities in environments with different visual contrast

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Carmino Hayashi

2001-05-01

Full Text Available O objetivo do presente trabalho foi avaliar a influência da densidade de copépodes ciclopóides (Mesocyclops longisetus na predação de larvas de pacu (Piaractus mesopotamicus em ambientes com diferentes contrastes visuais. Foram utilizadas 360 larvas de pacu (Lt = 5,77±0,23 mm e Wt = 6,57 mg, distribuídas em 24 aquários (1-L de vidro transparente, em um delineamento em blocos casualizados com oito tratamentos e três repetições, que constaram de 0, 10, 20 e 30 copépodes/L, em aquários com paredes sem revestimento ou com paredes revestidas de plástico escuro. Realizou-se a contagem, a cada uma hora, das larvas mortas e em seguida elas eram retiradas com uma pipeta. Observou-se um aumento linear nas taxas de predação (p Influence of density of cyclopoid copepods (Mesocyclops longisetus on pacu larvae (Piaractus mesopotamicus predation in environments with different visual contrast is provided. Three hundred and sixty larvae (Lt: 5.77±0.23 mm and Wt: 6.57 mg were distributed in 24 one-liter light-color-lined aquaria, in a entirely randomized design, with eight treatments and three replications, with densities 0, 10, 20 and 30 copepods/L. Similar densities were used and distributed in aquaria with dark plastic lined interior. Dead larvae were counted hourly and removed with a pipette. After three hours from the start of experiment a linear increase in predation rate (p th to the 9th observation, with smaller survival values of pacu larvae in light-colored aquaria. It may be concluded that increase in copepod density and absence of lining on walls of aquaria favor higher predation rates of copepods on pacu larvae

The effect of high risk pregnancy on duration of neonatal stay in neonatal intensive care unit.

Science.gov (United States)

Afrasiabi, Narges; Mohagheghi, Parisa; Kalani, Majid; Mohades, Gholam; Farahani, Zahra

2014-08-01

High risk pregnancies increase the risk of neonatal mortality and morbidity. In order to identify the influence of pregnancy complications on the period of neonatal stay in Neonatal Intensive Care Units (NICUs), an analysis has been carried out in our center. In a cross-sectional-descriptive analytical study, the data including NICU length of stay was gathered from 526 medical records of neonates. We also assessed their maternal complications such as premature rapture of membranes (PROM), urinary tract infection (UTI), preeclampsia, oligohydramnios, and twin/triplet pregnancy. Finally we analyzed the relation between variables by SPSS statistics software version 19. The level of significance was considered PUTI (P=0.02), multiple gestation (P=0.03), and oligohydramnios (P=0.003). We found a positive correlation between numbers of gestation and length of NICU stay (P=0.03). A positive correlation existed between neonatal complication and length of NICU stay (P<0.001). By increasing maternal health level and prenatal care services, neonatal outcome can be improved and length of stay in NICUs decreased.

Early Exercise in the Burn Intensive Care Unit Decreases Hospital Stay, Improves Mental Health, and Physical Performance

Science.gov (United States)

2017-10-01

Decreases Hospital Stay, Improves Mental Health , and Physical Performance 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Oscar E. Suman, PhD...Multicenter Study of the Effect of In-Patient Exercise Training on Length of Hospitalization, Mental Health , and Physical Performance in Burned...Intensive Care Unit Decreases Hospital Stay, Improves Mental Health , and Physical Performance,” Proposal Log Number 13214039, Award Number W81XWH-14

The administration of exogenous prostaglandin may improve ovulation in pacu (Piaractus mesopotamicus).

Science.gov (United States)

Criscuolo-Urbinati, E; Kuradomi, R Y; Urbinati, E C; Batlouni, S R

2012-12-01

Based on the reports of unsuccessful ovulation in pacu (Piaractus mesopotamicus) by fish farmers and researchers undertaking artificial reproduction programs, we evaluated the use of prostaglandin F (PGF) to improve pacu ovulation. This study was conducted during two spawning seasons (2009/2010 and 2010/2011) with two samplings in the first season and one sampling in the second season. A total of 45 females was sampled in this study. The control group was injected with carp pituitary extract (crude extract, 6 mg/kg), and the treatment group received PGF (2 mL per fish in the 2009/2010 season and 5 mL per fish in the 2010/2011 season) in addition to the crude extract. In both seasons, 100% (N = 4, 2009/2010 first sampling; N = 5, 2009/2010 second sampling; and N = 3, 2010/2011) of the PGF-treated fish spawned. In contrast, 53.0% (N = 9) and 83.3% (N = 10) of the control fish spawned in the first and second samplings of the 2009/2010 season, respectively, and only 25.0% (N = 1) spawned in the 2010/2011 season. Fecundity, fertility, and hatching rates did not differ (P > 0.05) between the treated and control fish. Based on oocyte volume frequency analysis, ovaries of the control fish had more (P fish. In conclusion, administration of exogenous prostaglandin may improve the outcome of hormonally induced spawning in tropical migratory fish. Copyright © 2012 Elsevier Inc. All rights reserved.

Desempenho produtivo, composição corporal e parâmetros fisiológicos de pacu alimentado com níveis crescentes de fibra Productive performance, body composition and physiological parameters of pacu fed increasing levels of fiber

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Laurindo André Rodrigues

2010-08-01

Full Text Available O objetivo deste trabalho foi avaliar os efeitos de teores de fibra bruta na dieta sobre o desempenho produtivo, composição centesimal da carcaça e parâmetros fisiológicos de juvenis de pacu. O experimento teve duração de 84 dias, e foram utilizados 360 juvenis de pacu, com peso médio de 23,97±0,59 g, distribuídos aleatóriamente em 30 tanques com 180 L de água, em delineamento inteiramente casualizado, com seis tratamentos (5, 7, 9, 11, 13 e 15% de fibra bruta e cinco repetições. Dietas com altos teores de fibra (11, 13 e 15% resultaram em piores taxas de ganho de peso, conversão alimentar e crescimento específico, além de menor eficiência proteica e consumo de ração. A composição da carcaça dos animais foi alterada pelo aumento do teor de fibra das dietas. Os teores de proteína e cinza tiveram aumento com o incremento nos teores de fibra. O metabolismo foi alterado com o emprego de teores crescentes de fibra, o que resultou em pequena elevação do colesterol plasmático. Teores de fibra bruta de até 9% não tiveram efeitos negativos no metabolismo; entretanto, teores acima de 11% reduziram o crescimento dos peixes.The objective of this work was to evaluate the effects of dietary crude fiber contents on productive performance, carcass composition and physiological parameters of pacu juveniles. The experiment was carried out during 84 days, 360 pacu juveniles were used with mean weight 23.97±0.59 g, stocked in 30 tanks with 180 L of water, in a completely randomized design, with six treatments (5, 7, 9, 11, 13 and 15% crude fiber and five replicates. Diets with high fiber contents (11, 13 and 15% resulted in worse rates of weight gain, feed conversion, and specific growth, besides lower protein efficiency ratio and feed consumption. Carcass composition changed by increasing the contents of dietary fiber. Body contents of protein and ash increased along with the fiber levels. The metabolism changed with the use of

The effect of passive exposure to tobacco smoke on perioperative respiratory complications and the duration of recovery.

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Simsek, Esen; Karaman, Yucel; Gonullu, Mustafa; Tekgul, Zeki; Cakmak, Meltem

2016-01-01

The incidence of perioperative respiratory complications and postoperative care unit recovery time investigated in patients with passive tobacco smoke exposure according to the degree of exposure. Total 270 patients ranging in age from 18 to 60 years with the ASA physical status I or II exposed and not exposed to passive tobacco smoke received general anesthesia for various elective surgical operations evaluated for the study. Patients divided into two groups as exposed and non-exposed to passive tobacco smoke, those exposed to passive smoke are also divided into two groups according to the degree of exposure. Patients taken to the postoperative care unit (PACU) at the end of the operation and monitorized until Modified Aldrete's Scores became 9 and more. Respiratory complications evaluated and recorded in intraoperative and postoperative period. A total of 251 patients were enrolled; 63 (25.1%) patients had airway complications, 11 (4.4%) had complications intraoperatively and 52 (20.7%) patients had complications postoperatively. There has been found significant relation with passive tobacco smoke exposure and high incidences of perioperative and postoperative respiratory complications. The risk of cough, desaturation and hypersecretion complications were found to be increased depending on the degree of exposure. There was significant relation between the degree of passive smoke exposure and the duration of PACU stay. Passive tobacco smoke exposed general anesthesia receiving patients also regarding to the degree of exposure having high rates of perioperative respiratory complications and prolongation of PACU stays when compared with unexposed patients. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

[The effect of passive exposure to tobacco smoke on perioperative respiratory complications and the duration of recovery].

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Simsek, Esen; Karaman, Yucel; Gonullu, Mustafa; Tekgul, Zeki; Cakmak, Meltem

2016-01-01

The incidence of perioperative respiratory complications and postoperative care unit recovery time investigated in patients with passive tobacco smoke exposure according to the degree of exposure. Total 270 patients ranging in age from 18 to 60 years with the ASA physical status I or II exposed and not exposed to passive tobacco smoke received general anesthesia for various elective surgical operations evaluated for the study. Patients divided into two groups as exposed and non-exposed to passive tobacco smoke, those exposed to passive smoke are also divided into two groups according to the degree of exposure. Patients taken to the postoperative care unit (PACU) at the end of the operation and monitorized until Modified Aldrete's Scores became 9 and more. Respiratory complications evaluated and recorded in intraoperative and postoperative period. A total of 251 patients were enrolled; 63 (25.1%) patients had airway complications, 11 (4.4%) had complications intraoperatively and 52 (20.7%) patients had complications postoperatively. There has been found significant relation with passive tobacco smoke exposure and high incidences of perioperative and postoperative respiratory complications. The risk of cough, desaturation and hypersecretion complications were found to be increased depending on the degree of exposure. There was significant relation between the degree of passive smoke exposure and the duration of PACU stay. Passive tobacco smoke exposed general anesthesia receiving patients also regarding to the degree of exposure having high rates of perioperative respiratory complications and prolongation of PACU stays when compared with unexposed patients. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Proposed method for agglutinating antibody titer analysis and its use as indicator of acquired immunity in pacu, Piaractus mesopotamicus

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JD Biller-Takahashi

Full Text Available Antibody can be assessed by agglutinating antibody titer which is a quantitative measure of circulating antibodies in serum from fish previously immunized. The antibody evaluation has been performed with different fish species, and is considered a reliable method that can be applied to confirm several hypothesis regarding acquired immunity, even in conjunction with precise methods to describe immune mechanisms. In order to provide appropriate analytical methods for future studies on the specific immune system of native fish, the present study standardized on assay to measure the serum agglutinating antibody titer produced after immunization with inactivated A. hydrophila and levamisole administration in pacu. It was possible to determine the agglutinating antibodies titer in a satisfactorily way in pacu immunized with inactive A. hydrophila, and the highest titers were observed on fish fed with levamisole.

Determinants of postoperative acute kidney injury.

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Abelha, Fernando José; Botelho, Miguela; Fernandes, Vera; Barros, Henrique

2009-01-01

Development of acute kidney injury (AKI) during the perioperative period is associated with increases in morbidity and mortality. Our aim was to evaluate the incidence and determinants of postoperative AKI after major noncardiac surgery in patients with previously normal renal function. This retrospective cohort study was carried out in the multidisciplinary Post-Anaesthesia Care Unit (PACU) with five intensive care beds. The study population consisted of 1166 patients with no previous renal insufficiency who were admitted to these intensive care unit (ICU) beds over 2 years. After admission patients were followed for the development of AKI, defined as proposed by The Acute Kidney Injury Network (increment of serum creatinine [greater than or equal to] 0.3 mg/dL or 50% from baseline within 48 hours or urine output 6 hours despite fluid resuscitation when applicable). Patient preoperative characteristics, intraoperative management and outcome were evaluated for associations with acute kidney injury using an univariate and multiple logistic regression model. A total of 1597 patients were admitted to the PACU and of these, 1166 met the inclusion criteria. Eighty-seven patients (7.5%) met AKI criteria. Univariate analysis identified age, American Society of Anesthesiologists (ASA) physical status, emergency surgery, high risk surgery, ischemic heart disease, congestive heart disease and Revised Cardiac Risk Index (RCRI) score as independent preoperative determinants for AKI in the postoperative period. Multivariate analysis identified ASA physical status, RCRI score, high risk surgery and congestive heart disease as preoperative determinants for AKI in the postoperative period. Patients that developed AKI had higher Simplified Acute Physiology Score (SAPS) II and Acute Physiology and Chronic Health Evaluation (APACHE) II, higher PACU length of stay (LOS), higher PACU mortality, higher hospital mortality and higher mortality at 6 months follow-up. AKI was an independent

Nicotine addiction management following surgery: a quality improvement approach in the post anesthesia care unit.

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Finegan, Barry A; Roblin, Daniel; Hammal, Fadi

2018-03-14

For smokers, hospital admission is accompanied by forced involuntary nicotine abstinence due to smoke-free site/grounds policies. An audit of patients admitted to our surgical wards revealed that identification of smoking status was inadequate and that nicotine addiction management (NAM) was infrequently offered. The project aimed to enhance both these metrics by initiating NAM in the post anesthesia care unit (PACU). Out of 744 patients admitted to our PACU in August 2015, 54% had their smoking status documented. The 200 patients (27%) out of the 744 were smokers and only 50% were offered NAM before discharge. PACU unit staff to determine the smoking status of every patient before discharge from the PACU (later changed to OR nursing staff) and, if a patient was identified as a smoker, to offer NRT (patch and mouth spray only) and initiate therapy prior to transfer of the patient to the ward. Data about number of patients admitted, presence of documented smoking status, number of identified smokers, and number offered/accepted nicotine replacement therapy (NRT) were collected at baseline and thereafter quarterly. Engaging video education sessions addressed the education gaps highlighted in a needs assessment. Identification of smoking status was made part of preoperative checklist and NRT was made available in post-operative recovery room. These interventions resulted in an increase in screening for tobacco use from 54% at baseline to 95% and the offer of NRT to smokers from 50 to 89%.

Differential expression of myogenic regulatory factor MyoD in pacu skeletal muscle (Piaractus mesopotamicus Holmberg 1887: Serrasalminae, Characidae, Teleostei) during juvenile and adult growth phases.

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de Almeida, Fernanda Losi Alves; Carvalho, Robson Francisco; Pinhal, Danillo; Padovani, Carlos Roberto; Martins, Cesar; Dal Pai-Silva, Maeli

2008-12-01

Skeletal muscle is the edible part of the fish. It grows by hypertrophy and hyperplasia, events regulated by differential expression of myogenic regulatory factors (MRFs). The study of muscle growth mechanisms in fish is very important in fish farming development. Pacu (Piaractus mesopotamicus) is one of the most important food species farmed in Brazil and has been extensively used in Brazilian aquaculture programs. The aim of this study was to analyze hyperplasia and hypertrophy and the MRF MyoD expression pattern in skeletal muscle of pacu (P. mesopotamicus) during juvenile and adult growth stages. Juvenile (n=5) and adult (n=5) fish were anaesthetized, sacrificed, and weight (g) and total length (cm) determined. White dorsal region muscle samples were collected and immersed in liquid nitrogen. Transverse sections (10 microm thick) were stained with Haematoxilin-Eosin (HE) for morphological and morphometric analysis. Smallest fiber diameter from 100 muscle fibers per animal was calculated in each growth phase. These fibers were grouped into three classes (50 microm) to evaluate hypertrophy and hyperplasia in white skeletal muscle. MyoD gene expression was determined by semi-quantitative RT-PCR. PCR products were cloned and sequenced. Juvenile and adult pacu skeletal muscle had similar morphology. The large number of fish confirms active hyperplasia. In adult fish, most fibers were over 50 microm diameter and denote more intense muscle fiber hypertrophy. The MyoD mRNA level in juveniles was higher than in adults. A consensus partial sequence for MyoD gene (338 base pairs) was obtained. The Pacu MyoD nucleotide sequence displayed high similarity among several vertebrates, including teleosts. The differential MyoD gene expression observed in pacu white muscle is possibly related to differences in growth patterns during the phases analyzed, with hyperplasia predominant in juveniles and hypertrophy in adult fish. These results should provide a foundation for

Prospective double blind randomized placebo-controlled clinical trial of the pectoral nerves (Pecs) block type II.

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Versyck, Barbara; van Geffen, Geert-Jan; Van Houwe, Patrick

2017-08-01

The aim of this clinical trial was to test the hypothesis whether adding the pectoral nerves (Pecs) block type II to the anesthetic procedure reduces opioid consumption during and after breast surgery. A prospective randomized double blind placebo-controlled study. A secondary hospital. 140 breast cancer stage 1-3 patients undergoing mastectomy or tumorectomy with sentinel node or axillary node dissection. Patients were randomized to receive either a Pecs block with levobupivacaine 0.25% (n=70) or placebo block with saline (n=70). The pain levels were evaluated by Numeric Rating Scale (NRS) pain scores at 15-minute intervals during the post anesthesia care unit stay time (PACU), at 2-hour intervals for the first 24h on the ward and at 4-hour intervals for the next 24h. Intraoperative and postoperative opioid consumption were recorded during the full stay. Patient satisfaction was evaluated upon discharge using a 10-point scale. Intraoperative sufentanil requirements were comparable for the Pecs and placebo group (8.0±3.5μg and 7.8±3.0μg, P=0.730). Patients in the Pecs group experienced significantly less pain than patients in the control group (P=0.048) during their PACU stay. Furthermore, patients in the Pecs group required significant less postoperative opioids (9.16±10.15mg and 14.97±14.38mg morphine equivalent, P=0.037) and required significant fewer postsurgical opioid administration interventions than patients in the control group (P=0.045). Both patient-groups were very satisfied about their management (9.6±0.6 and 9.1±1.8 on a 10-point scale, P=0.211). The Pecs block reduces postsurgical opioid consumption during the PACU stay time for patients undergoing breast surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

Wound Botulism in Injection Drug Users: Time to Antitoxin Correlates with Intensive Care Unit Length of Stay

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Offerman, Steven R

2009-11-01

Full Text Available Objectives: We sought to identify factors associated with need for mechanical ventilation (MV, length of intensive care unit (ICU stay, length of hospital stay, and poor outcome in injection drug users (IDUs with wound botulism (WB.Methods: This is a retrospective review of WB patients admitted between 1991-2005. IDUs were included if they had symptoms of WB and diagnostic confirmation. Primary outcome variables were the need for MV, length of ICU stay, length of hospital stay, hospital-related complications, and death.Results: Twenty-nine patients met inclusion criteria. Twenty-two (76% admitted to heroin use only and seven (24% admitted to heroin and methamphetamine use. Chief complaints on initial presentation included visual changes, 13 (45%; weakness, nine (31%; and difficulty swallowing, seven (24%. Skin wounds were documented in 22 (76%. Twenty-one (72% patients underwent mechanical ventilation (MV. Antitoxin (AT was administered to 26 (90% patients but only two received antitoxin in the emergency department (ED. The time from ED presentation to AT administration was associated with increased length of ICU stay (Regression coefficient = 2.5; 95% CI 0.45, 4.5. The time from ED presentation to wound drainage was also associated with increased length of ICU stay (Regression coefficient = 13.7; 95% CI = 2.3, 25.2. There was no relationship between time to antibiotic administration and length of ICU stay.Conclusion: MV and prolonged ICU stays are common in patients identified with WB. Early AT administration and wound drainage are recommended as these measures may decrease ICU length of stay.[West J Emerg Med. 2009;10(4:251-256.

Utility of screening questionnaire and polysomnography to predict postoperative outcomes in children.

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Kako, Hiromi; Tripi, Jennifer; Walia, Hina; Tumin, Dmitry; Splaingard, Mark; Jatana, Kris R; Tobias, Joseph D; Raman, Vidya T

2017-11-01

The prevalence of pediatric obstructive sleep apnea (OSA) has increased concurrently with the increasing prevalence of obesity. We have previously validated a short questionnaire predicting the occurrence of OSA on polysomnography (PSG). This follow-up study assessed the utility of the questionnaire in predicting postoperative outcomes. Children undergoing surgery and completing a sleep study were prospectively screened for OSA using a short questionnaire. Procedures within 1 year of PSG were included in the analysis. Questionnaires were scored according to a cutoff previously deemed optimal for predicting OSA (apnea-hypopnea index ≥ 5) on the sleep study. Postoperative outcomes included prolonged (>60 min) length of stay (LOS) in the post-anesthesia care unit (PACU) and oxygen requirement in the PACU. The study cohort included 185 patients (100/85 male/female) age 8 ± 4 years, undergoing adenotonsillectomy (n = 109), other ear, nose, and throat (ENT) procedures (n = 18), or non-ENT procedures (n = 58). There were 45 patients with OSA documented by PSG and 122 patients identified as likely to have OSA according to questionnaire responses (89% sensitivity, 41% specificity). PACU LOS was prolonged in 55/181 (30%) cases and supplemental oxygen was used in the PACU in 29/181 (16%) cases. In separate multivariable models, supplemental oxygen use in the PACU was more common if a patient scored ≥2/6 points on the short questionnaire scale (OR = 5.0; 95% CI: 1.3, 19.9; p = 0.023) or if the patient was diagnosed with OSA on PSG (OR = 4.6; 95% CI: 1.6, 13.5; p = 0.005). Neither OSA on PSG nor questionnaire score ≥2/6 were associated with prolonged PACU stay. Both OSA diagnosis based on the AHI and the questionnaire scale achieved comparable predictive value for the need for oxygen use in the PACU. The utility of the questionnaire in predicting rare adverse events (e.g., unplanned admission or rapid response team activation) remains to be determined

Ingestão de ração e comportamento de larvas de pacu em resposta a estímulos químicos e visuais Diet ingestion rate and pacu larvae behavior in response to chemical and visual stimuli

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Marcelo Borges Tesser

2006-10-01

Full Text Available Este estudo foi realizado com o objetivo de comparar a influência dos estímulos visual e/ou químico de náuplios de Artemia e de dieta microencapsulada sobre a taxa de ingestão da dieta microencapusulada por larvas de pacu Piaractus mesopotamicus. Utilizou-se um esquema fatorial 7 x 4 (estímulos e idades com duas repetições. Verificou-se efeito da idade das larvas e dos estímulos, mas não houve efeito para a interação idade ´ estímulos. O estímulo químico da Artemia e ambos os estímulos da Artemia resultaram em maior taxa de ingestão de dieta inerte. Resultado intermediário foi obtido com o estímulo visual da dieta microencapsulada. O estímulo químico, em comparação ao estímulo visual da Artemia, resultou em maiores taxas de ingestão da dieta. Com o aumento da idade, houve incremento na taxa de ingestão. Os estímulos visual e químico dos náuplios e o estímulo visual da ração aumentaram a ingestão de dieta inerte por larvas de pacu. Náuplios de Artemia devem ser oferecidos antes do fornecimento da dieta inerte, pois podem auxiliar no processo de transição alimentar. Os resultados deste trabalho apontaram novas possibilidades de estudos com larvas de peixes neotropicais visando a substituição precoce do alimento vivo para o inerte.The effect of visual, chemical and the combination of both stimuli from Artemia nauplii and from microencapsulated diet on dry diet ingestion by pacu Piaractus mesopotamicus larvae was evaluated in this research. The experiment was analyzed as a 7 x 4 factorial arrangement (seven stimuli and four ages with two replicates. It was observed effect of larvae age and stimuli, but no interaction (age ´ stimuli was observed. The chemical effect from Artemia and both effects from Artemia resulted in higher ingestion rates. An intermediary result was obtained with visual effect from microencapsulated diet. The chemical stimulus from Artemia resulted in higher ingestion rates than that

Recovery at the post anaesthetic care unit after breast cancer surgery

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Gärtner, Rune; Callesen, Torben; Kroman, Niels Thorndahl

2010-01-01

Extant literature shows that women having undergone breast cancer surgery have substantial problems at the post-anaesthesia care unit (PACU). Based on nursing reports and elements of the discharge scoring system recommended by The Danish Society of Anaesthesiology and Intensive Care Medicine...

A risk stratification algorithm using non-invasive respiratory volume monitoring to improve safety when using post-operative opioids in the PACU.

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Voscopoulos, Christopher; Theos, Kimberly; Tillmann Hein, H A; George, Edward

2017-04-01

Late detection of respiratory depression in non-intubated patients compromises patient safety. SpO 2 is a lagging indicator of respiratory depression and EtCO 2 has proven to be unreliable in non-intubated patients. A decline in minute ventilation (MV) is the earliest sign of respiratory depression. A non-invasive respiratory volume monitor (RVM) that provides accurate, continuous MV measurements enables clinicians to predict and quantify respiratory compromise. For this observational study, practitioners were blinded to the RVM measurements and pain management followed the usual routine. Patients were stratified by their MV on PACU admission and classified as "At-Risk" or "Not-At-Risk," with progression to "Low MV" status following opioids assessed for each category. The purpose was to determine if stratifying based on MV on PACU arrival could identify patients at higher risk for respiratory depression. Ability to identify in advance patients at higher risk for respiratory depression following standard opioid dosing would drive changes in pain management and improve patient care. RVM and opioid administration data from 150 PACU patients following elective joint-replacement surgery were collected in an observational study. "Predicted" MV (MV PRED ) and "Percent Predicted" (MV MEASURED /MV PRED  × 100 %) were calculated for each patient using standard formulas. Prior to opioid administration, patients were classified as either "Not-At-Risk" (MV ≥ 80 % MV PRED ) or "At-Risk" (MV safety across the continuum of care.

Effects of simulation-based educational program in improving the nurses' self-efficacy in caring for patients' with COPD and CHF in a post-acute care (PACU) setting.

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Genuino, Mary Jane

2018-02-01

The 2014 national percentage for 30-day readmissions among Medicare recipients from Post-Acute Care Unit (PACU) showed: Heart Failure (HF) with major complications and co-morbidities, an average of 24.09%, and Chronic Obstructive Pulmonary Disease (COPD) with complications and co-morbidities 23.12%. The percentage of readmissions for New Jersey among PACU showed: HF with major complications and co-morbidities, an average of 24.40% and COPD 26.35% (Avalere Health, 2014). For this study site, the hospital readmission rate was not specifically broken down according to condition/diagnosis. Overall, the hospital readmission rate was approximately 20%. A few percent lower than the national and state average, but still a considerable number. This study is significant in finding out whether a simulation based educational program will increase the nurses' self-efficacy in caring for these patients. The positive outcome of this study can provide a template for training PACU nurses to aid in decreasing hospital readmissions in this vulnerable population. The simulation-based educational program was approximately 5h in length, and it was divided into two parts, a presentation on HF and COPD, and the actual simulation scenario, using a low-fidelity manikin (LFM). There were approximately 20 Registered nurses as participants but 4 did not complete the post-simulation self-efficacy scale, and the 16 were included in the actual study. This study was able to define the effects of simulation-based educational program on the RNs self-efficacy in caring for COPD and HF patients. The participants' demographic information, i.e. age, educational attainment, years of experience, and previous work experience, did not show any differences in how much the nurses' self-efficacy improved. The post-simulation self-efficacy score of the participants showed approximately 5% increase compared to the pre-simulation score. The outcome of the study concluded the simulation-based educational program

Plasma testosterone and 11-ketotestosterone levels of male pacu Piaractus mesopotamicus (Cypriniformes, Characidae

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R. Gazola

1997-12-01

Full Text Available The levels of testosterone (T and 11-ketotestosterone (11-KT of the South American pacu Piaractus mesopotamicus were determined by radioimmunoassay during two stages of the reproductive cycle, i.e., resting and maturation, and the gonadosomatic index (GSI was calculated. The highest levels of T and 11-KT were reached during the maturation stage (T = 2400 ± 56 pg/ml; 11-KT = 2300 ± 60 pg/ml and lower levels were maintained during the resting period. The rise in androgen levels occurred with the appearance of spermatozoa in the maturation stage, when GSI was highest

Postanesthesia emergence in patients with post-traumatic stress disorder.

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Umholtz, Matthew; Cilnyk, John; Wang, Christopher K; Porhomayon, Jahan; Pourafkari, Leili; Nader, Nader D

2016-11-01

Recovery from anesthesia may be complicated with development of severe panic symptoms and anxiety. Preexisting anxiety disorder has been reported as a risk factor for development of these symptoms. We aimed to examine the frequency of emergence delirium (EDL) among veterans diagnosed with posttraumatic stress disorders (PTSDs). Retrospective cohort. Postoperative recovery area. Perioperative information of 1763 consecutive patients who underwent a surgical procedure requiring general anesthesia were collected. The patients were grouped on the basis of previous diagnosis of PTSD. A total of 317 patients were identified with a positive history of PTSD and were compared to 1446 patients without such a history for the occurrence of EDL in the postanesthesia care unit (PACU) as the primary endpoint. Duration of stay in PACU in minutes and the frequency of hospital admission were the secondary endpoints. Multivariate binary logistic regression analysis was performed to identify the predictors of EDL among the veteran population. Emergence delirium was reported in 37 cases (2.1%) after general anesthesia. Fifteen (4.7%) of 317 patients with PTSD and 22 (1.5%) of 1446 patients without history of PTSD demonstrated symptoms related to EDL in the PACU (P=.002). After propensity matching, there were 8 patients with EDL in the PTSD group whereas there were only 2 patients with EDL among controls. Posttraumatic stress disorder was also an independent predictor of EDL in multivariate analysis with an odds ratio of 6.66 and a 95% confidence interval of 2.04 to 21.72 (P=.002). Posttraumatic stress disorder independently predicted the frequency of EDL even after correcting for preexisting depression and anxiety disorders. A relatively longer duration of PACU stay in PTSD patients may reflect raised awareness of the health care workers about this debilitating mental disorder. Published by Elsevier Inc.

Mentol e eugenol como substitutos da benzocaína na indução anestésica de juvenis de pacu = Menthol and eugenol as benzocaine substitutes in anesthetic induction of pacu juveniles

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André Fernando Nascimento Gonçalves

2008-07-01

Full Text Available Objetivou-se verificar a eficiência de anestésicos naturais na indução à anestesia de juvenis de pacu. Foram avaliadas quatro concentrações de mentol (50, 100, 150 e 200 mg L-1, quatro de eugenol (10, 25, 50 e 100 mg L-1 e uma de benzocaína (100 mg L-1. Durante o procedimento de anestesia, foram monitorados e avaliados quatro estágios de sedação, da redução dos movimentos operculares até a perda total de reação à manipulação. Após o procedimento de biometria, foram avaliados o tempo de recuperação e a mortalidade até48h após anestesia. As concentrações de 100, 150 e 200 mg L-1 de mentol e as concentrações de 50 e 100 mg L-1 de eugenol apresentaram tempos de indução à anestesia e recuperação similares aos da benzocaína. Os resultados obtidos mostraram que o mentol e o eugenol são anestésicos eficientes para pacus em substituição à benzocaína, sugerindo a concentração de 100 mg L-1 de mentol e 50 mg L-1 de eugenol.This study aimed to verify the efficacy of natural anestheticinduction of pacu juveniles. Were evaluated four menthol (50, 100, 150 and 200 mg L-1, four eugenol (10, 25, 50 and 100 mg L-1 and one benzocaine (100 mg L-1 concentrations. During the anesthetic procedure, four sedative stages were monitored and evaluated until no reaction of the fish to handling was registered. After performingbiometric evaluation on the anesthetized fish, were recorded the recovery time and mortality rate up to 48 hours after the anesthetic experiments. Concentrations of 100, 150 and 200 mg L-1 of menthol, 50 and 100 mg L-1 of eugenol showed anesthetic induction timeand recovery time similar to that of benzocaine. The obtained results showed that menthol and eugenol are efficient anesthetics for pacu juveniles in substitution of benzocaine, suggesting the concentration of 100 mg L-1 of menthol and 50 mg L-1 of eugenol.

Stress responses in juvenile pacu (Piaractus mesopotamicus submitted to repeated air exposure = Respostas de estresse em juvenis de pacu (Piaractus mesopotamicus submetidos à exposição aérea repetitiva

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Jaqueline Dalbello Biller

2008-01-01

Full Text Available Pacu juveniles (5.2 ± 1.5 g were submitted to two one-minute air exposures in a 24h interval, and sampled before the exposure (control and 5, 15, 30 and 60 min., 24 and 48h afterwards for whole-body cortisol, sodium, potassium and calcium ion concentrations. For the first air exposure, there was a trend of increased cortisol concentration after 15 min., whereas in the second air exposure, the cortisol concentration increased significantly within 5 min. after stress was induced. Sodium ion concentrationincreased significantly 24h after both air exposures. Potassium concentration presented fluctuations over the experimental period. Calcium ion concentration increased progressively from 5 to 30 min., in both air exposures. The repeated air exposures exacerbated the cortisol response, but they did not affect the recovery ability of pacu over the experimental period. Additionally, the whole-body cortisol measurement might be a reliable indicator of stress, when sampled fish are smaller and blood volumes are very low, making samples inadequate for analysis.Juvenis de pacu (5,2 ± 1,5 g foram submetidos a duas exposições aéreas de um minuto, em intervalo de 24 horas, e amostradosantes da exposição (controle e 5, 15, 30 e 60 min., 24 e 48 horas depois para análise da concentração corporal de cortisol e dos íons sódio, potássio e cálcio. Na primeira exposição, os peixes apresentaram concentrações de cortisol aumentadas a partir de 15 min., embora não diferissem estatisticamente do controle. Na segunda exposição, a concentração de cortisol aumentou significativamente aos 5 min., retornando às concentrações equivalentes às dos peixes-controle em 30 min.. A concentração do íon sódio aumentousignificativamente 24 horas depois das duas exposições aéreas. A concentração do íon potássio apresentou flutuações durante o experimento, enquanto a do cálcio apresentou-se reduzida aos 5 min, aumentando gradativamente até os 30

Changes in Nutritional and Functional Status in Longer Stay Patients Admitted to a Geriatric Evaluation and Management Unit.

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Whitley, A; Skliros, E; Graven, C; McIntosh, R; Lasry, C; Newsome, C; Bowie, A

2017-01-01

Malnutrition and functional decline are common in older inpatients admitted to subacute care settings. However the association between changes in nutritional status and relevant functional outcomes remains under-researched. This study examined changes in nutritional status, function and mobility in patients admitted to a Geriatric Evaluation and Management (GEM) unit who had a length of stay (LOS) longer than 21 days. A prospective, observational study. Two GEM units at St Vincent's Hospital Melbourne, Australia. Patients admitted to the GEM units who stayed longer than 21 days were included in the study. Patients were assessed on admission and prior to discharge using the Subjective Global Assessment (SGA), Functional Independence Measure (FIM) motor domain and the Modified Elderly Mobility Scale (MEMS). Fifty-nine patients (Mean age 84.0 ± 7 years) met the required length of stay and were included in the study. Fifty-four per cent (n=32) were malnourished on admission (SGA B/C) and 44% (n=26) were malnourished on discharge. Twenty-two per cent (n=13) improved SGA category, 75% remained stable (n=44) and 3% deteriorated (n=2) from admission to discharge. Total Motor FIM scores significantly increased from admission to discharge in both the improved (pnutritional status groups. Subjects who improved in nutritional status had a significantly higher MEMS score at discharge (pnutritional status at the time of discharge. Improvement in nutritional status was associated with greater improvement in mobility scores. Further studies are required to investigate the effectiveness of nutrition interventions, which will inform models of care aiming to optimise nutritional, functional, and associated clinical outcomes in patients admitted to GEM units.

Postoperative environmental anesthetic vapour concentrations following removal of the airway device in the operating room versus the postanesthesia care unit.

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Cheung, Sara K; Özelsel, Timur; Rashiq, Saifee; Tsui, Ban C

2016-09-01

This study was designed to compare waste anesthetic gas (WAG) concentrations within patients' breathing zones after removal of the patient's airway device in the postanesthesia care unit (PACU) vs in the operating room (OR). Following Research Ethics Board approval and patient consent, we recruited patients undergoing surgery who received volatile anesthesia via an endotracheal tube or supraglottic airway. Patients had their airway device removed in the OR or in the PACU depending on the attending anesthesiologist's preference. Upon the patient's arrival in the PACU, concentrations of exhaled sevoflurane and desflurane were measured at their breathing zone (i.e., 15 cm from the patient's mouth and nose) using a single-beam infrared spectrophotometer. Seventy patients were recruited during the five-month study period. The median [interquartile range] WAG levels in the patients' breathing zones were higher when their airway devices were removed in the PACU vs in the OR. The WAG levels for sevoflurane were 0.7 [0.4-1.1] parts per million (ppm) vs 0.5 [0.4-0.7] ppm, respectively; median difference, 0.3; 95% confidence interval (CI), 0.1 to 0.6; P = 0.04. The WAG levels for desflurane were 2.4 [1.2-3.4] ppm vs 4.1 [2.5-5.2] ppm, respectively; median difference, 1.5; 95% CI, 0.3 to 2.7; P = 0.04. After a volatile-based anesthetic, our results suggest that removal of the airway device in the PACU vs in the OR increases the amount of waste anesthetic gas in a patient's breathing zone and thus potentially in the PACU nurse's working zone.

A bacia hidrográfica como unidade fundamental de análise da paisagem: a Bacia do Pacuí e a sua relação com a Bacia do São Francisco

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Maria Ivete Soares de Almeida

2015-06-01

Full Text Available Este artigo procura entender a bacia hidrográfica como unidade espacial e básica na análise do ambiente, ficando implícita a adoção da visão integrada da paisagem e do meio ambiente. Neste sentido, apresenta uma breve revisão teórica sobre a evolução dos estudos sobre as bacias hidrográficas. Esta discussão se faz necessária para o entendimento de como o conceito bacia hidrográfica tem sido trabalhado na geografia. A seguir é feita uma contextualização da paisagem da Bacia do Pacuí e a sua relação com a Bacia do São Francisco. Ao mesmo tempo contempla breves reflexões acerca do uso e ocupação dos solos urbanos e rurais, e sobre as grandes diferenças socioeconômicas e ambientais dos municípios que fazem parte da Bacia do Pacuí. Ao finalizar este artigo percebe-se que a paisagem do Pacuí necessita de um planejamento que contemple medidas concretas de manejo e conservação dos recursos naturais existentes na Bacia do Pacuí.

Humidification of Blow-By Oxygen During Recovery of Postoperative Pediatric Patients: One Unit's Journey.

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Donahue, Suzanne; DiBlasi, Robert M; Thomas, Karen

2018-02-02

To examine the practice of nebulizer cool mist blow-by oxygen administered to spontaneously breathing postanesthesia care unit (PACU) pediatric patients during Phase one recovery. Existing evidence was evaluated. Informal benchmarking documented practices in peer organizations. An in vitro study was then conducted to simulate clinical practice and determine depth and amount of airway humidity delivery with blow-by oxygen. Informal benchmarking information was obtained by telephone interview. Using a three-dimensional printed simulation model of the head connected to a breathing lung simulator, depth and amount of moisture delivery in the respiratory tree were measured. Evidence specific to PACU administration of cool mist blow-by oxygen was limited. Informal benchmarking revealed that routine cool mist oxygenated blow-by administration was not widely practiced. The laboratory experiment revealed minimal moisture reaching the mid-tracheal area of the simulated airway model. Routine use of oxygenated cool mist in spontaneously breathing pediatric PACU patients is not supported. Copyright © 2017 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Growth and hematology of juvenile pacu Piaractus mesopotamicus (Holmberg 1887 fed with increasing levels of vitamin E (DL-α-tocopheryl acetate

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RICARDO Y. SADO

2013-03-01

Full Text Available Intensive fish production systems are characterized by 100% artificial feeding, so any dietary imbalances or deficiencies may lead to diseases outbreaks and economic losses. This study was set out to determine the effects of increasing levels of dietary vitamin E on growth and hematology of juvenile pacu. Fishes were fed for 90 days, twice a day until apparent satiation with semi-purified diets containing 0.0; 25; 50; 150; 300 or 600 mg.kg−1 diet DL-α-tocopheryl acetate in a completely randomized design trial (n=4; biometrical and hematological data were collected and analyzed. Fishes fed with vit E diet (150 mg.kg−1 showed higher (p<0.05 weight gain and specific growth. Hematocrit, erythroblast number and total plasma protein were increased (p<0.05 in fishes fed diet with no vit E diet. Vitamin E supplementation in artificial diets for pacu is essential for growth and maintenance of normal erythropoiesis.

Stress responses in juvenile pacu (Piaractus mesopotamicus submitted to repeated air exposure - DOI: 10.4025/actascianimsci.v30i1.3618 Stress responses in juvenile pacu (Piaractus mesopotamicus submitted to repeated air exposure - DOI: 10.4025/actascianimsci.v30i1.3618

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Leonardo Susumu Takahashi

2008-06-01

Full Text Available Juvenis de pacu (5,2 Pacu juveniles (5.2 ± 1.5 g were submitted to two one-minute air exposures in a 24 h interval, and sampled before the exposure (control and 5, 15, 30 and 60 min, 24 and 48 h afterwards for whole-body cortisol, sodium, potassium and calcium ion concentrations. For the first air exposure, there was a trend of increased cortisol concentration after 15 min, whereas in the second air exposure, the cortisol concentration increased significantly within 5 min after stress was induced. Sodium ion concentration increased significantly 24 h after both air exposures. Potassium concentration presented fluctuations over the experimental period. Calcium ion concentration increased progressively from 5 to 30 min, in both air exposures. The repeated air exposures exacerbated the cortisol response, but they did not affect the recovery ability of pacu over the experimental period. Additionally, the whole-body cortisol measurement might be a reliable indicator of stress, when sampled fish are smaller and blood volumes are very low, making samples inadequate for analysis1,5 g foram submetidos a duas exposições aéreas de um minuto, em intervalo de 24 horas, e amostrados antes da exposição (controle e 5, 15, 30 e 60 min, 24 e 48 horas depois para análise da concentração corporal de cortisol e dos íons sódio, potássio e cálcio. Na primeira exposição, os peixes apresentaram concentrações de cortisol aumentadas a partir de 15 min, embora não diferissem estatisticamente do controle. Na segunda exposição, a concentração de cortisol aumentou significativamente aos 5 min, retornando às concentrações equivalentes às dos peixes-controle em 30 min. A concentração do íon sódio aumentou significativamente 24 horas depois das duas exposições aéreas. A concentração do íon potássio apresentou flutuações durante o experimento, enquanto a do cálcio apresentou-se reduzida aos 5 min, aumentando gradativamente até os 30 min

Evaluation of the impact of implementation of a Medical Assessment and Planning Unit on length of stay

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Brand, Caroline A.; Kennedy, Marcus P.; King-Kallimanis, Bellinda L.; Williams, Ged; Bain, Christopher A.; Russell, David M.

2010-01-01

Objective: The Medical Assessment and Planning Unit (MAPU) model provides a multidisciplinary and 'front end loading' approach to acute medical care. The objective of this study was to evaluate the impact of a 10-bed MAPU in Royal Melbourne Hospital (RMH) on hospital length of stay. A pre-post study

Doença de Haff associada ao consumo de carne de Mylossoma duriventre (pacu-manteiga

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Oswaldo Tolesani Junior

2013-12-01

Full Text Available A rabdomiólise associada à doença de Haff é correlacionada com a ingestão de certos peixes e crustáceos de água doce, sendo causada por uma toxina não identificada. Relatamos o caso de um paciente que apresentou rabdomiólise cerca de 2 horas após ingerir o peixe de água doce Mylossoma duriventre (pacu-manteiga cerca de 3 anos após o relato de um surto de doença de Haff em Manaus.

Factors associated with mortality and length of stay in the Oporto burn unit (2006-2009).

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Bartosch, Isabel; Bartosch, Carla; Egipto, Paula; Silva, Alvaro

2013-05-01

Retrospective studies are essential to evaluate and improve the efficiency of care of burned patients. This study analyses the work done in the burn unit of Hospital de S. João in the north of Portugal. A retrospective review was performed in patients admitted from 2006 to 2009. The study population was characterised regarding patient demographics, admissions profile, burn aetiology, burn site, extension and treatment. Multiple linear and logistic regression models were done in order to elucidate which of these factors influenced the mortality and length of stay. The characteristics before and after the creation of the burn unit, as well as the similarities and differences with the published data of other national and international burn units, are analysed. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

The Definition of a Prolonged Intensive Care Unit Stay for Spontaneous Intracerebral Hemorrhage Patients: An Application with National Health Insurance Research Database

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Chien-Lung Chan

2014-01-01

Full Text Available Introduction. Length of stay (LOS in the intensive care unit (ICU of spontaneous intracerebral hemorrhage (sICH patients is one of the most important issues. The disease severity, psychosocial factors, and institutional factors will influence the length of ICU stay. This study is used in the Taiwan National Health Insurance Research Database (NHIRD to define the threshold of a prolonged ICU stay in sICH patients. Methods. This research collected the demographic data of sICH patients in the NHIRD from 2005 to 2009. The threshold of prolonged ICU stay was calculated using change point analysis. Results. There were 1599 sICH patients included. A prolonged ICU stay was defined as being equal to or longer than 10 days. There were 436 prolonged ICU stay cases and 1163 nonprolonged cases. Conclusion. This study showed that the threshold of a prolonged ICU stay is a good indicator of hospital utilization in ICH patients. Different hospitals have their own different care strategies that can be identified with a prolonged ICU stay. This indicator can be improved using quality control methods such as complications prevention and efficiency of ICU bed management. Patients’ stay in ICUs and in hospitals will be shorter if integrated care systems are established.

The Effect of Physiotherapy on Ventilatory Dependency and the Length of Stay in an Intensive Care Unit

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Malkoc, Mehtap; Karadibak, Didem; Yldrm, Yucel

2009-01-01

The aim of this study was to assess the effect of physiotherapy on ventilator dependency and lengths of intensive care unit (ICU) stay. Patients were divided into two groups. The control group, which received standard nursing care, was a retrospective chart review. The data of control patients who were not receiving physiotherapy were obtained…

Choice of primary anesthetic regimen can influence intensive care unit length of stay after coronary surgery with cardiopulmonary bypass

NARCIS (Netherlands)

de Hert, Stefan G.; van der Linden, Philippe J.; Cromheecke, Stefanie; Meeus, Roel; ten Broecke, Pieter W.; de Blier, Ivo G.; Stockman, Bernard A.; Rodrigus, Inez E.

2004-01-01

BACKGROUND: Volatile anesthetics protect the myocardium during coronary surgery. This study hypothesized that the use of a volatile agent in the anesthetic regimen would be associated with a shorter intensive care unit (ICU) and hospital length of stay (LOS), compared with a total intravenous

[Results of pulmonary embolism treatment in a tertiary hospital short stay unit. Is this the right place?].

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Rosa Salazar, V; Bernal Martínez, L; García Pino, M J; Hernández Contreras, M E; García Méndez, M M; García Pérez, B; Marras Fernández-Cid, C

2016-01-01

To determine the mean stay (MS) of patients with pulmonary embolism (PE) in a thrombosis unit (TU) with a short stay unit (SSU) in a tertiary hospital. To compare the data collected with those of other hospitals in the same region, of other regions (Autonomous Communities [AACC]), and within the same hospital in the year before the SSU opened. A descriptive retrospective observational study that included patients with a diagnosis of PE in the University Hospital Virgen de la Arrixaca (HCUVA) in 2012. These data were classified by hospital department, and used for calculating the mean stay. This was then compared with that of other hospitals in our region, with the rest of the regions, and with the data in 2007 (the last year without a TU). A total of 113patients with PE were included, 60 (53%) in the TU with an MS of 4.39, in Oncology, 7.45, and Internal Medicine (IM), 15.38days. There were no deaths in the TU and only 3 (5%) readmissions. Published data showed that the MS in all hospitals in our region was 8.25, 5.18 in our hospital, and higher in the rest of hospitals. The best AACC was the Basque Country with an MS of 6.85days. In 2007, there were 70patients with PE in the HCUVA, 34 (49%) in IM, with an MS of 8.50, Oncology 11 (31%) with an MS 9.64, and Chest Diseases 3 (4.3%) with an MS 19days, and with an overall mortality of 11% and a rate of readmissions in IM of 6%. The mean stay for a PE in the SSU of a TU was lower than in the rest of the hospital departments, lower than the rest hospitals of our region, lower than the rest of the regions, and lower than any department of our hospital before the SSU existed, without increasing the readmission or mortality rate. Copyright © 2015 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

Urinary neutrophil gelatinase-associated lipocalin as an early predictor of prolonged intensive care unit stay after cardiac surgery

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Elena Bignami

2012-01-01

Full Text Available Neutrophil gelatinase-associated lipocalin (NGAL is a protein of lipocalin family highly expressed in various pathologic states and is an early biomarker of acute kidney injury in cardiac surgery. We performed an observational study to evaluate the role of NGAL in predicting postoperative intensive care stay in high-risk patients undergoing cardiac surgery. We enrolled 27 consecutive patients who underwent high-risk cardiac surgery with cardiopulmonary bypass. Urinary NGAL (uNGAL was measured before surgery, at intensive care unit (ICU arrival and 24 h later. Univariate and multivariate predictors of ICU stay were performed. uNGAL was 18.0 (8.7-28.1 ng/mL at baseline, 10.7 (4.35-36.0 ng/mL at ICU arrival and 29.6 (9.65-29.5 24 h later. The predictors of prolonged ICU stay at the multivariate analysis were body mass index (BMI, uNGAL 24 h after surgery, and aortic cross-clamp time. The predictors of high uNGAL levels 24 h after at a multivariate analysis were preoperative uNGAL and logistic European System for Cardiac Operative Risk Evaluation. At a multivariate analysis the only independent predictors of prolonged ICU stay were BMI, uNGAL 24 h after surgery and aortic cross-clamp time.

Effect of ractopamine on the chemical and physical characteristics of pacu(Piaractus mesopotamicus steaks

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L.M.F.S. Oliveira

2014-02-01

Full Text Available The objective was to evaluate the use of ractopamine (RAC in the diet for pacu (Piaractus mesopotaminus in the finishing phase on some quality parameters of the fillets. Thirty-five animals weighing 0.868±0.168kg were distributed in a completely randomised design with five treatments (0.0 - control; 11.25, 22.50, 33.75 and 45 ppm of RAC and seven replicates with two fillets obtained from the same animal. The diets were isocaloric and isoprotein and experimental time was 90 days. RAC did not affect (P>0.05 the initial pH or ph after 24 hours of the fillets. Compared to the control, RAC increased (P<0.05 the moisture content of the fillets in natura and lipid oxidation of samples stored for 12 days in the refrigerator or freezer for 60 days. The RAC in 11.25 ppm reduced (P<0.05 the lipid content, while 45 ppm reduced (P<0.05 the crude protein in the fillets. Considering only RAC, there was a linear increase (P<0.05 in the lipid content (P<0.05 and a linear reduction in crude protein and weight loss after cooking the fillets. There was a quadratic effect (P<0.05 on the ash content, weight loss and lipid oxidation in fillets stored in the refrigerator or freezer. A RAC dose of 33.75 ppm resulted in a lower lipid oxidation index. In conclusion, ractopamine at 11.25 ppm is effective for reducing the fat content in fillets of pacu, although it increases the formation of peroxides in samples kept in the freezer for longer than 60 days. At 33.75 ppm, ractopamine is effective in reducing the effect of oxidation during storage in the refrigerator or freezer.

Patients with a high risk for obstructive sleep apnea syndrome: postoperative respiratory complications.

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Pereira, H; Xará, D; Mendonça, J; Santos, A; Abelha, F J

2013-01-01

STOP-BANG score (snore; tired; observed apnea; arterial pressure; body mass index; age; neck circumference and gender) can predict the risk of a patient having Obstructive Syndrome Apnea (OSA). The aim of this study was to evaluate the incidence STOP-BANG score≥3, in surgical patients admitted to the Post-Anesthesia Care Unit (PACU). Observational, prospective study conducted in a post-anesthesia care unit (PACU) during three weeks (2011). The study population consisted of adult patients after noncardiac and non-neurological surgery. Patients were classified as high risk of OSA (HR-OSA) if STOP-BANG score≥3 and Low-risk of OSA (LR-OSA) if STOP-BANG score<3 (LR-OSA). Patient demographics, intraoperative and postoperative data were collected. Patient characteristics were compared using Mann-Whitney U-test, t-test for independent groups, and chi-square or Fisher's exact test. A total of 357 patients were admitted to PACU; 340 met the inclusion criteria. 179 (52%) were considered HR-OSA. These patients were older, more likely to be masculine, had higher BMI, higher ASA physical status, higher incidence of ischemic heart disease, heart failure, hypertension, dyslipidemia and underwent more frequently insulin treatment for diabetes. These patients had more frequently mild/moderated hypoxia in the PACU (9% vs. 3%, p=0.012) and had a higher incidence of residual neuromuscular blockade (NMB) (20% vs. 16%, p=0.035). Patients with HR-OSA had a longer hospital stay. Patients with HR-OSA had an important incidence among patients scheduled for surgery in our hospital. These patients had more co-morbidities and were more prone to post-operative complications. Copyright © 2012 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

Pediatric Cardiopulmonary Arrest in the Postanesthesia Care Unit, Rare but Preventable: Analysis of Data From Wake Up Safe, The Pediatric Anesthesia Quality Improvement Initiative.

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Christensen, Robert E; Haydar, Bishr; Voepel-Lewis, Terri D

2017-04-01

Nearly 20% of anesthesia-related pediatric cardiac arrests (CAs) occur during emergence or recovery. The aims of this case series were to use the Wake Up Safe database to describe the following: (1) the nature of pediatric postanesthesia care unit (PACU) CA and subsequent outcomes and (2) factors associated with harm after pediatric PACU CA. Pediatric CAs in the PACU were identified from the Wake Up Safe Pediatric Anesthesia Quality Improvement Initiative, a multicenter registry of adverse events in pediatric anesthesia. Demographics, underlying conditions, cause of CA, and outcomes were extracted. Descriptive statistics were used to characterize data and to assess risk of harm in those suffering CA. A total of 26 CA events were included: 67% in children anesthesia care providers until emergence from anesthesia may further reduce the preventable arrest rate. The root cause analyses conducted by individual institutions reporting these data to the Wake Up Safe provided only limited insight, so multicenter collaborative approaches may allow for greater insight into effective CA-prevention strategies.

Digestibilidade e tempo de trânsito gastrintestinal de dietas contendo níveis crescentes de fibra bruta para pacu - doi: 10.4025/actascianimsci.v32i2.8625 Digestibility and gastrointestinal transit time of diets with increasing dietary fiber levels to pacu - doi: 10.4025/actascianimsci.v32i2.8625

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Thiago Matias Torres Nascimento

2010-07-01

Full Text Available O objetivo deste trabalho foi avaliar a digestibilidade e o tempo de trânsito gastrintestinal (TTGI de dietas contendo níveis crescentes de fibra bruta (FB para pacus. Para avaliar a digestibilidade foram utilizados 288 pacus, em delineamento inteiramente casualizado, alimentados em aquários e transferidos para coletores do tipo Guelf Modificado, utilizando-se o método de coleta parcial de fezes. As rações foram marcadas com 1% de óxido de crômio para a determinação da digestibilidade das dietas. No ensaio de TTGI, 288 pacus foram distribuídos em 24 aquários em delineamento inteiramente casualizado e alimentados com rações contendo 1% óxido de titânio ou crômio, que apresentam cores diferentes, verde ou branca, respectivamente. Por meio de massagem abdominal foi averiguada periodicamente a cor das fezes, e o TTGI foi estabelecido quando as fezes de todos os peixes apresentaram cor verde. Os coeficientes de digestibilidade aparente das dietas e o TTGI foram reduzidos com aumento do nível de FB nas dietas. Conclui-se que em dietas para pacus pode-se empregar até 9% de FB sem efeito negativo na digestibilidade da energia, proteína, matéria seca e estrato etéreo e sem alterar o TTGI.This work aimed to evaluate the effect of increasing dietary fiber levels on the digestibility and gastrointestinal transit time (GTT for pacu. The digestibility trial used 288 pacu in a completely randomized design, fed in aquaria and transferred to a modified Guelf-type feces collector, using the partial sampling method. The inert marker on the diets was chromic oxide (1% to establish the diet digestibility. In the GTT assay, 288 pacu were distributed in 24 aquaria in a completely randomized design. Fish were fed with two colored diets – green and white – and feces color was determined after abdominal pressure. The white and green diets used 1% of titanium and chromic oxides, respectively. Total GTT was determined when all fish showed green

Costs for Hospital Stays in the United States, 2011

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... Lauren M. Wier, M.P.H., and Claudia Steiner, M.D., M.P.H. Introduction Health care ... Truven Health Analytics), Wier, LM (Truven Health Analytics), Steiner, C (AHRQ). Costs for Hospital Stays in the ...

A comparison of the fascia iliaca block to the lumbar plexus block in providing analgesia following arthroscopic hip surgery: A randomized controlled clinical trial.

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Badiola, Ignacio; Liu, Jiabin; Huang, Stephanie; Kelly, John D; Elkassabany, Nabil

2018-05-31

This randomized controlled single blinded clinical trial compared the fascia iliaca block (FIB) and the lumbar plexus block (LPB) in patients with moderate to severe pain following hip arthroscopic surgery. Single blinded randomized trial. Postoperative recovery area, postoperative days 0 and 1. Fifty patients undergoing hip arthroscopy were approached in the Post Anesthesia Care Unit (PACU) if they had moderate to severe pain (defined as > or equal 4/10 on the numeric rating scale). Twenty-five patients were allocated to the FIB and twenty-five patients to the LPB. Fascia iliaca block or lumbar plexus block. A blinded observer recorded pain scores just prior to the block, 15 min following the block (primary endpoint), and then every 15 min for 2 h (or until the patient was discharged). Total PACU time and opioid use were recorded. Pain scores and analgesic use on postoperative day (POD) 0, and POD 1 were recorded. At 24 h post block the Quality of Recovery 9 questionnaire was administered. The mean pre-block pain scores were comparable between the two groups (P = 0.689). There was no difference in mean post block pain scores between the two groups at 15 min (P = 0.054). In the PACU patients who underwent a LPB consumed less opioids compared to FIB patients (P = 0.02), however no differences were noted between the two groups in PACU length of stay, or POD 0 or 1 opioid use. A fascia iliaca block is not inferior to a lumbar plexus block in reducing PACU pain scores in patients with moderate to severe pain following hip arthroscopic surgery and is a viable option to help manage postoperative pain following hip arthroscopic surgery. Copyright © 2018. Published by Elsevier Inc.

Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs.

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Sodhi, Jitender; Satpathy, Sidhartha; Sharma, D K; Lodha, Rakesh; Kapil, Arti; Wadhwa, Nitya; Gupta, Shakti Kumar

2016-04-01

Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. This prospective study was done in the seven bedded PICU of a large multi-specialty tertiary care hospital in New Delhi, India. A total of 20 children with HAI (cases) and 35 children without HAI (controls), admitted to the PICU during the study period (January 2012 to June 2012), were matched for gender, age, and average severity of illness score. Each patient's length of stay was obtained prospectively. Costs of healthcare were estimated according to traditional and time driven activity based costing methods approach. The median extra length of PICU stay for children with HAI (cases), compared with children with no HAI (controls), was seven days (IQR 3-16). The mean total costs of patients with and without HAI were ' 2,04,787 (US$ 3,413) and ' 56,587 (US$ 943), respectively and the mean difference in the total cost between cases and controls was ' 1,48,200 (95% CI 55,716 to 2,40,685, pcosts for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care.

Enterococcal bacteremia is associated with prolonged stay in the medical intensive care unit

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Viju Moses

2012-01-01

Full Text Available Background: Although enterococci are relatively common nosocomial pathogens in surgical intensive care units (ICUs, their significance in blood cultures from patients in the medical ICU is unclear. Materials and Methods: In this retrospective study spanning 2 years, the clinical and microbiological characteristics of enterococcal bacteremia among medical ICU patients were evaluated. Results: Of 1325 admissions, 35 with enterococcal bacteremia accounted for 14.8% of positive blood cultures. They were significantly older (P=0.03 and had various co-morbidities. Most had vascular (96.9% and urinary (85.3% catheters, and 67.7% were mechanically ventilated. In addition to blood, enterococci were isolated from vascular catheters (8.6% and other sites (20%, while no focus was identified in 77% of patients. Prior use of broad-spectrum antimicrobials was nearly universal. All isolates tested were sensitive to vancomycin and linezolid. Resistance to ampicillin and gentamicin were 44.7% and 52.6%, respectively. Compared with other medical ICU patients, patients with enterococcal bacteremia had a longer ICU stay (P<0.0001 and a trend toward higher ICU mortality (P=0.08. Conclusions: Enterococcal bacteremia is an important nosocomial infection in the medical ICU, with a predilection for older patients with multiple comorbidities. Its occurrence is associated with a significantly longer ICU stay and a trend to a higher mortality. The choice of antibiotics should be dictated by local susceptibility data.

Stay Rates of Foreign Doctorate Recipients from U.S. Universities, 2007

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Dr. Michael G. Finn

2010-01-04

Study of the stay rate in the United States of foreign nationals receiving their S/E doctorates from U.S. universities. This study has estimated stay rates in 2007 for persons receiving a doctorate one, two, five, and ten years previously. The two-year stay rate (for 2005 graduates) recovered from the decline experienced earlier in the decade. The five-year stay rate (for 2002 graduates) is lower; the ten-year stay rate (for 1997 graduates) reached a new high.

Considerações sobre a reprodução artificial e alevinagem de pacu (Piaractus mesopotamicus, Holmberg, 1887) em viveiros Considerations on artificial reproduction and fingerling culture of pacu (Piaractus mesopotamicus, Holmberg, 1887) in ponds

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Carlos Roberto Padovani; Claudio Luiz Bock

2000-01-01

Este trabalho apresenta uma revisão bibliográfica sobre a reprodução artificial, incubação e alevinagem de pacu em viveiros de terra. As técnicas de propagação artificial possibilitam o suprimento de ovos para uma grande variedade de peixes destinados à criação em viveiros e outros corpos de água confinados, bem como para sistemas superintensivos. Essas técnicas tornaram igualmente possível introduzir várias espécies importantes de peixes em áreas geográficas separadas. Além disso, permitem a...

Suplementação de lisina e metionina em dietas com baixo nível protéico para o crescimento inicial do pacu, Piaractus mesopotamicus (Holmberg Lysine and methionine supplementation in diets with low protein level for the initial growth of pacu Piaractus mesopotamicus (Holmberg

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Adriana Patrícia Muñoz-Ramírez

2002-04-01

Full Text Available O objetivo deste trabalho foi estudar os efeitos da suplementação de metionina ou lisina em dietas com baixo teor protéico para o crescimento do pacu Piaractus mesopotamicus (Holmberg (Characiformes, Characidae. Foram formuladas uma dieta basal com 22% de proteína bruta (PB, 4100kcal de energia bruta (EB/kg, 0,42% de metionina e 1,16% de lisina e outras 6 dietas, com a mesma formulação básica, suplementadas com 0,2, 0,4 ou 0,6% de metionina ou lisina. Uma 8ª dieta (controle continha 26% PB, 4100kcal EB/kg, 0,48% metionina e 1,43% de lisina. As dietas foram administradas à vontade a 144 alevinos com 14,98 ± 1,16g de peso médio inicial. As médias de ganho em peso, eficiência de retenção de energia bruta e dos consumos alimentares da dieta controle mostraram-se maiores (P The objective of this research was to study the effects of methionine or lysine supplementation in diets with low protein level for growth of pacu Piaractus mesopotamicus (Holmberg (Characiformes, Characidae. Diets were formulated as a basal diet presenting 22% crude protein (CP, 4100 kcal gross energy (GE/kg, 0.42% of methionine and 1.16% of lysine and other six diets, with the same basic formulation, supplemented with 0.2%, 0.4% or 0.6% methionine or lysine. An eighth diet (control contained 26% CP, 4100 kcal (GE/kg, 0.48% methionine and 1.43% of lysine. The diets were administered ad libitum to 144 fingerlings with initial medium weight of 14.98 ± 1.16 g. Averages weight gain, gross energy efficiency retention and feed intake for the control treatment were significantly higher (P < 0.05 than those of smaller protein level diets. Averages protein retention efficiency were only higher (P < 0.01 in the diets supplemented with lysine, showing the advantages of lysine supplementation in diets with low crude protein level. A higher growth of pacu was confirmed with diets containing 26% of CP.

Eficácia do florfenicol e da oxitetraciclina no controle de Aeromonas hydrophila em pacu (Piaractus mesopotamicus

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S.P. Carraschi

2011-06-01

Full Text Available Determinou-se a concentração eficaz de oxitetraciclina (OTC e florfenicol (FFC no tratamento de Aeromonas hydrophila em pacu (Piaractus. mesopotamicus. Os pacus foram submetidos à captura duas vezes ao dia por quatro dias e em seguida foram infectados com A. hydrophila (2,4x10(7 bactéria mL-1. Os tratamentos utilizados foram: controle sem infecção (CSI, controle com infecção (CCI e tratados com 110,0; 140,0 e 170,0mgOTC.kg-1, e 5,0; 10,0 e 15,0mgFFC.kg-1. As variáveis de qualidade da água foram monitoradas diariamente. Após o tratamento, no CSI dos dois testes, ocorreu 100% de sobrevivência. Nos testes com OTC, no CCI, a sobrevivência foi de 29,2%; em 110,0mg.kg-1, 37,5%; em 140,0mg.kg-1, 29,2%; e em 170,0mg.kg-1, 50,0%. Nos testes com FFC, foi eficaz com 10,0mg.kg-1, e no CCI a sobrevivência foi de 76,9%; em 5,0mg.kg-1, 81,81%; em 10,0mg/L.kg-1, 100% e em 15,0mg.kg-1, 87,5%. A OTC, em concentrações de até 170,0mg.kg-1 de ração, não é eficaz para o controle de A. hydrophila em pacu, e o FFC é eficaz na concentração de 10,0mg.kg-1 e ambos não alteram as variáveis de qualidade de água.

Stay Rates of Foreign Doctorate Recipients from U.S. Universities, 2005

Energy Technology Data Exchange (ETDEWEB)

Mike Finn

2008-02-01

This is the latest in a series of studies conducted for the National Science Foundation to estimate the proportion of foreign science / engineering doctorate recipients from U.S. universities who stayed in the United States after graduation. Sixty-six percent of those who graduated in 2003 were still in the United States in 2005, a 5 percent decline since the last report. But the five-year stay rate continues to climb, now at 68 percent.

Congestive heart failure as a determinant of postoperative delirium.

Science.gov (United States)

Parente, Daniela; Luís, Clara; Veiga, Dalila; Silva, Hugo; Abelha, Fernando

2013-09-01

Postoperative delirium (POD) is a frequent post-surgical complication that is associated with increased mortality and poor patient outcomes. POD is a complex disorder with multiple risk factors such as pre-existing patient comorbidities and perioperative complications. The aim of this study was to evaluate the incidence of POD and to identify risk factors for the development of POD in a post-anesthesia care unit (PACU). We enrolled 97 adult patients admitted to a PACU over a five-day period (start date September 6, 2010). Patient demographics and intraoperative and postoperative data were collected. Patients were followed for the development of delirium using the Intensive Care Delirium Screening Checklist. Descriptive analyses of variables were used to summarize data, and the Mann-Whitney U test was used to compare continuous variables; the chi-square or Fisher's exact test was used for comparisons. Univariate analysis was performed using simple binary logistic regression with odds ratios (OR) and 95% confidence intervals (95% CI). The significance level for multiple comparisons was controlled by applying the Bonferroni correction for multiple comparisons and variables were deemed significant if p≤0.0025. Six percent of patients developed POD. These patients were older and more likely to have higher American Society of Anesthesiologists (ASA) physical status (83 vs. 22% with ASA III/IV, p=0.004) as well as a higher frequency of congestive heart failure (50 vs. 3%, p=0.003) and a higher Revised Cardiac Risk Index (RCRI) score (33 vs. 6% with RCRI ≥2, p=0.039). The duration of anesthesia for patients with POD was also longer and they received a greater volume of crystalloids, colloids, and erythrocytes during surgery. Congestive heart disease was an independent risk factor for POD (OR 29.3, 95% CI 4.1-210.6; p<0.001). In addition, patients who developed POD had higher in-hospital mortality and longer PACU and hospital stays. Patients who developed POD had longer

Hospitalisation in an emergency department short-stay unit compared to an internal medicine department is associated with fewer complications in older patients - an observational study

DEFF Research Database (Denmark)

Strøm, Camilla; Mollerup, Talie Khadem; Kromberg, Laurits Schou

2017-01-01

Medicine Department (IMD). METHODS: Observational study evaluating adverse events during hospitalisation in non-emergent, age-matched, internal medicine patients ≥75 years, acutely admitted to either the SSU or the IMD at Holbaek Hospital, Denmark, from January to August, 2014. Medical records were......, unplanned readmission, and nosocomial infection. CONCLUSIONS: Adverse events of hospitalisation were significantly less common in older patients acutely admitted to an Emergency Department Short-stay Unit as compared to admission to an Internal Medicine Department.......BACKGROUND: Older patients are at particular risk of experiencing adverse events during hospitalisation. OBJECTIVE: To compare the frequencies and types of adverse events during hospitalisation in older persons acutely admitted to either an Emergency Department Short-stay Unit (SSU) or an Internal...

Managing Postoperative Analgesic Failure: Tramadol Versus Morphine for Refractory Pain in the Post-Operative Recovery Unit.

Science.gov (United States)

Byrne, Kelly; Nolan, Aoife; Barnard, John; Tozer, Megan; Harris, David; Sleigh, Jamie

2017-02-01

This study aimed to discover whether co-analgesia with tramadol or additional morphine was more effective for patients who still had severe pain despite being given 10 mg intravenous morphine in the post-anesthesia care unit (PACU). All eligible patients were consented and recruited to the trial pre-operatively, but only a small subgroup – whose pain was not successfully controlled (pain score 6/10 or more) after receiving 10 mg of morphine in the PACU—were then randomized to enter the trial and receive, in a double blinded fashion, the analgesic study drug; which consisted of either a further 10 mg of morphine, or 100 mg of tramadol, titrated intravenously to control their pain. The groups were compared as to: the time to readiness for discharge, the patient’s pain scores over time, and the presence of side effects. There was no statistically significant difference in any of the outcomes measured. The time to readiness for discharge from PACU was 119 minutes in the morphine group and 120 minutes in the tramadol group. However in approximately half the cases who entered the trial (i.e., where pain had not been controlled with the pre-enrollment baseline 10 mg of morphine in PACU) neither a further 10 mg of morphine nor 100 mg of tramadol effectively relieved the patient’s pain. We found no difference between additional morphine and co-analgesia with tramadol in this study. Patients who don’t respond to reasonable doses of opioids in PACU are very likely to be unresponsive to further opioids, and other non-opioid analgesic techniques (such as regional anesthesia) should be considered early in this group of patients.

Análise da degradação de dieta microencapsulada por larvas de pacu (Piaractus mesopotamicus, Holmberg, 1887 através de microscopia eletrônica de varredura - DOI: 10.4025/actascianimsci.v25i1.2088 Degradation analysis of microencapsulated diet in pacu (Piaractus mesopotamicus Holmberg, 1887 larvae intestine through scanning electron microscopy (SEM - DOI: 10.4025/actascianimsci.v25i1.2088

Directory of Open Access Journals (Sweden)

Maria Célia Portella

2003-04-01

Full Text Available Este trabalho teve como objetivo analisar o grau de degradabilidade de dietas microencapsuladas por larvas de pacu (Piaractus mesopotamicus, através da microscopia eletrônica de varredura. Os seguintes tratamentos alimentares foram testados: AMD - larvas alimentadas por 6 dias, com náuplios de Artemia, com transição brusca para dieta microencapsulada; C6MD - alimentação inicial com Artemia por 6 dias, 6 dias de co-alimentação e o restante do tempo (8 dias somente com dieta microencapsulada; e C9MD - idêntico ao tratamento anterior, porém, com 9 dias de co-alimentação. O conteúdo presente no trato digestório das larvas foi coletado e processado para análise em microscópio eletrônico de varredura. Os grânulos provenientes das larvas do tratamento de transição brusca (AMD possuíam poucas áreas de degradação, semelhantes às dietas secas. Já as dietas coletadas das larvas durante o período de co-alimentação possuíam uma maior área degradada. Os resultados sugerem uma influência dos náuplios de Artemia sobre a degradação das dietas microencapsuladas.This research analyzed the microencapsulated diet degradation in pacu (Piaractus mesopotamicus larvae intestine. The pacu larvae received the following feeding treatments: AMD- larvae fed initially Artemia nauplii for six days, followed by microencapsulated diet; C6MD- larvae fed initially Artemia for six days, followed by six days of co-feeding and the rest of the experiment (8 days with microencapsulated diet; C9MD- larvae fed initially Artemia for six days, followed by nine days of co-feeding and the rest of the experiment (5 days with microencapsulated diet. The pacu digestive tract contents were removed, processed and analyzed under scanning electronic microscopy. Diets from AMD larvae treatment showed few degradation areas, when compared to original dry diets. On the other hand, diets removed during co-feeding period showed the highest degradation areas. The

Stay Rates of Foreign Doctorate Recipients from U.S. Universities, 2011

Energy Technology Data Exchange (ETDEWEB)

Finn, Michael G. [Oak Ridge Inst. for Science and Education (ORISE), Oak Ridge, TN (United States)

2014-01-02

This report provides estimates of stay rates for foreign students who received doctorates in science or engineering (S/E) from U.S. universities. For this paper, the stay rate represents the proportion of foreign doctorate recipients from U.S. universities who stayed in the United States after graduation for any reason and is always specific to a particular year. Each line in the tables that follow describes a different group of these degree recipients.

Aging and growth parameter from the Piaractus mesopotamicus (pacu from the Cuiabá river, Mato Grosso, Brazil

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Angela M. Ambrosio

2014-12-01

Full Text Available This study has aims to determine the age and to estimate the growth parameters using scales of the species. Individuals of Piaractus mesopotamicus (Holmberg, 1887 used in this study were captured in the commercial fishery conducted in the region, along the year 2006. The model selected to express the growth of the species was the von Bertalanffy Sl= Sl∞*[1-exp-k(t-to]. To determine if scales are suitable for studying the growth of pacu, we analyzed the relation between standard length (Sl and the radius of the scales through linear regression. The period of annuli formation was determined analyzing the variations in the marginal increment and evaluating the consistency of the readings through the analysis of the coefficient of variations (CVs for the average standard lengths of each age (number of rings observed in the scales. The relationship between Ls of the fish and the radius of the scales showed that scales can be used to study the age and growth of P. mesopotamicus (R= 0.79. CVs were always below 20%, demonstrating the consistency of the readings. Annuli formation occurred in February, probably related to trophic migration that occurs in this month in the region. Equations that represents the growth in length obtained for P. mesopotamicus are Sl=50.00*[1-exp-0.18(t-(-3.00] for males and Sl=59.23*[1-exp-0.14(t-(-3.36] for females. The growth parameters obtained in this study were lower compared to other studies previously conducted for the same species and can related to overexploitation that species is submitted by fishing in the region. These values show also that females of pacu attain greater asymptotic length than males that growth faster.

Family members' satisfaction with care and decision-making in intensive care units and post-stay follow-up needs-a cross-sectional survey study.

Science.gov (United States)

Frivold, Gro; Slettebø, Åshild; Heyland, Daren K; Dale, Bjørg

2018-01-01

The aim of this study was to explore family members' satisfaction with care and decision-making during the intensive care units stay and their follow-up needs after the patient's discharge or death. A cross-sectional survey study was conducted. Family members of patients recently treated in an ICU were participating. The questionnaire contented of background variables, the instrument Family Satisfaction in ICU (FS-ICU 24) and questions about follow-up needs. Descriptive and non-parametric statistics and a multiple linear regression were used in the analysis. A total of 123 (47%) relatives returned the questionnaire. Satisfaction with care was higher scored than satisfaction with decision-making. Follow- up needs after the ICU stay was reported by 19 (17%) of the participants. Gender and length of the ICU stay were shown as factors identified to predict follow-up needs.

Mentol e eugenol como substitutos da benzocaína na indução anestésica de juvenis de pacu - DOI: 10.4025/actascianimsci.v30i3.1081 Eugenol and menthol as benzocaine substitutes in anaesthesic induction of pacu juveniles - DOI: 10.4025/actascianimsci.v30i3.1081

Directory of Open Access Journals (Sweden)

João Batista Kochenborger Fernandes

2008-11-01

Full Text Available Objetivou-se verificar a eficiência de anestésicos naturais na indução à anestesia de juvenis de pacu. Foram avaliadas quatro concentrações de mentol (50, 100, 150 e 200 mg L-1, quatro de eugenol (10, 25, 50 e 100 mg L-1 e uma de benzocaína (100 mg L-1. Durante o procedimento de anestesia, foram monitorados e avaliados quatro estágios de sedação, da redução dos movimentos operculares até a perda total de reação à manipulação. Após o procedimento de biometria, foram avaliados o tempo de recuperação e a mortalidade até 48h após anestesia. As concentrações de 100, 150 e 200 mg L-1 de mentol e as concentrações de 50 e 100 mg L-1 de eugenol apresentaram tempos de indução à anestesia e recuperação similares aos da benzocaína. Os resultados obtidos mostraram que o mentol e o eugenol são anestésicos eficientes para pacus em substituição à benzocaína, sugerindo a concentração de 100 mg L-1 de mentol e 50 mg L-1 de eugenol.Anaesthetics represents important tool for management procedures in aquaculture. This study aimed to verify the efficacy of natural anaesthesic induction of pacu juvenile. Were evaluated four menthol concentrations (50, 100, 150 and 200 mg L-1, four eugenol (10, 25, 50 and 100 mg L-1 and one of benzocaine (100 mg L-1. During the anaesthesic procedure were monitored and evaluated four sedative stages, until no reaction to handling. After biometric was evaluated recovery time and mortality 48 hours after anaesthesia. Concentrations 100, 150 and 200 mg L-1 of menthol, 50 and 100 mg L-1 of eugenol showed anaesthesic induction time and recovery time similar of benzocaine. The obtained results showed that menthol is an efficient anaesthesic for pacu juvenile in substitution of benzocaine, suggesting the concentration of 100 mg L-1 of menthol and 50 mg L-1 of eugenol.

[Impact of an emergency department short-stay unit on clinical management and quality of hospital care indicators].

Science.gov (United States)

Richard Espiga, Fernando; Mòdol Deltell, Josep María; Martín-Sánchez, Francisco Javier; Fernández Sierra, Abel; Fernández Pérez, Cristina; Pastor, Antoni Juan

2017-06-01

The primary aim was to study the impact that creating a short-stay unit (SSU) had on clinical management and quality of care indicators of a hospital overall and its conventional wards. The secondary aim was to establish values for those indicators and determine the level of satisfaction of patients admitted to the SSU. Quasi-experimental before-after study of the impact of establishing a SSU in a tertiary care teaching hospital. The first period (without the SSU) was in 2012, the second (with the SSU) was from 2013 through 2015. To meet the first objective we selected cases in 2012 in which patients were hospitalized for problems related to the 5 diagnosis-related groups most often admitted to the SSU in the second period. To meet the second objective, we studied all patients admitted to the SSU in the second period Data related to quality of care and clinical management were analyzed retrospectively. and asked them to complete a questionnaire on patient satisfaction. A total of 76 241 admissions were included: 19 090 in the first period and 57 151 in the second (2705 admissions were to the SSU). The mean hospital stay decreased in the second period (incidence rate ratio [IRR], 0.93; 95% CI, 0.91-0.95); the mean stay also decreased on medical wards (IRR, 0.94; 95% CI, 0.92-0.96) with no impact on adverse outcomes. The mean stay in the SSU was under 3 days in spite of an increase in the weighted mean (IRR,1.08; 95% CI, 1.05-1.11). A total of 320 questionnaires were received (11.8% response rate); all aspects were assessed very highly. Our experience suggests that opening a SSU could improve clinical management and quality of care indicators for a hospital overall and for its conventional wards in the context of the GRDs that most frequently lead to admissions.

Métodos de coleta de fezes e determinação dos coeficientes de digestibilidade da fração protéica e da energia de alimentos para o pacu, Piaractus mesopotamicus (Holmberg, 1887 Fecal collection methods and determination of crude protein and of gross energy digestibility coefficients of feedstuffs for pacu, Piaractus mesopotamicus (Holmberg, 1887

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Eduardo Gianini Abimorad

2004-10-01

Full Text Available Para melhorar a alimentação do pacu (Piaracatus mesopotamicus, é necessário conhecer o nível de aproveitamento dos ingredientes utilizados em suas dietas. Neste trabalho, inicialmente, foram analisados quatro métodos de coleta de fezes, em função da precisão e da versatilidade (dissecação, extrusão, Guelph e Guelph modificado, e o tempo entre as coletas de fezes nos sistemas de Guelph, por intermédio do coeficiente de digestibilidade da proteína bruta de uma dieta-referência para o pacu. Não houve diferença entre os métodos de coleta de fezes; já os intervalos de tempo das coletas apresentaram diferenças, podendo interferir nos resultados de digestibilidade da proteína. Em uma segunda etapa, para determinação dos coeficientes de digestibilidade da proteína e da energia de cinco concentrados protéicos de origem animal, cinco de origem vegetal e quatro energéticos, foram utilizadas rações elaboradas com 69,5% de uma dieta-referência, 30% do ingrediente teste e 0,5% de Cr2O3, utilizando o método de extrusão manual para a coleta de fezes. Os valores de digestibilidade da proteína da maioria dos alimentos apresentaram-se altos e não variaram estatisticamente, de 93,89 a 75,73% para o farelo de trigo e a farinha de penas, respectivamente. Entretanto, a farinha de sangue e a levedura apresentaram valores de digestibilidade da fração protéica significativamente inferiores (57,72 e 68,86%, respectivamente. Os coeficientes de digestibilidade da energia dos alimentos variaram consideravelmente, apresentando altos valores (acima de 90% para o sorgo, o farelo de arroz e as sojas crua e tostada, e baixos valores (menores que 70% para as farinhas de vísceras e de sangue, os farelos de soja e de algodão e a levedura. Quanto aos métodos de coleta de fezes, conclui-se que qualquer um pode ser adotado para a determinação de digestibilidade, desde que sejam rigorosamente aplicados. De maneira geral, a maioria dos

Association between increased blood interleukin-6 levels on emergency department arrival and prolonged length of intensive care unit stay for blunt trauma.

Science.gov (United States)

Taniguchi, Masashi; Nakada, Taka-Aki; Shinozaki, Koichiro; Mizushima, Yasuaki; Matsuoka, Tetsuya

2016-01-01

Systemic immune response to injury plays a key role in the pathophysiological mechanism of blunt trauma. We tested the hypothesis that increased blood interleukin-6 (IL-6) levels of blunt trauma patients on emergency department (ED) arrival are associated with poor clinical outcomes, and investigated the utility of rapid measurement of the blood IL-6 level. We enrolled 208 consecutive trauma patients who were transferred from the scene of an accident to a level I trauma centre in Japan and admitted to the intensive care unit (ICU). Blood IL-6 levels on ED arrival were measured by using a rapid measurement assay. The primary outcome variable was prolonged ICU stay (length of ICU stay > 7 days). The secondary outcomes were 28-day mortality, probability of survival and Abbreviated Injury Scale (AIS) scores. Patients with prolonged ICU stay had significantly higher blood IL-6 levels on ED arrival than the patients without prolonged ICU stay (P tool to improve assessment of injury severity and prediction of clinical outcomes in the initial phase of trauma care.

Outcome and quality of life of patients with acute kidney injury after major surgery.

Science.gov (United States)

Abelha, F J; Botelho, M; Fernandes, V; Barros, H

2009-01-01

In postoperative critically-ill patients who develop Acute Kidney Injury (AKI) it is important to focus on survival and quality of life beyond hospital discharge. The aim of the study was to evaluate outcome and quality of life in patients that develop AKI after major surgery. This retrospective study was carried out in a Post-Anaesthesia Care Unit with five intensive care beds during 2 years. Patients were followed for the development of AKI. Preoperative characteristics, intra-operative management and outcome were evaluated. Six months after discharge, these patients were contacted to complete a Short Form-36 questionnaire (SF-36) and to have their dependency in ADL evaluated. Chi-square or Fischer's exact test were used to compare proportions between groups. A "t test" and a paired "t test" for independent groups was used for comparisons. Of 1584 patients admitted to the PACU, 1200 patients met the inclusion criteria. One hundred-fourteen patients (9.6%) met AKI criteria. Patients with AKI were more severely ill, stayed longer at the PACU. Among 71 hospital survivors at 6 months follow-up, 50 completed the questionnaires. Fifty-two percent of patients reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients that met AKI criteria after surgery had worse SF-36 scores for physical function, role physical and role emotional domains. Six months after PACU discharge, patients that met AKI criteria were more dependent in I-ADL but not in P-ADL. Patients that develop AKI improved self-perception of quality of life despite having high rate of dependency in ADL tasks. For physical function and role physical domains they had worse scores than PACU patients that did not develop AKI.

Public Response to Wildfire: Is the Australian "Stay and Defend or Leave Early" Approach an Option for Wildfire Management in the United States?

Science.gov (United States)

Sarah M. McCaffrey; Alan Rhodes

2009-01-01

In the United States, the increasing costs and negative impacts of wildfires are causing fire managers and policymakers to reexamine traditional approaches to fire management including whether mass evacuation of populations threatened by wildfire is always the most appropriate option. This article examines the Australian "stay and defend or leave early" (SDLE...

A comprehensive payment model for short- and long-stay psychiatric patients.

Science.gov (United States)

Fries, B E; Durance, P W; Nerenz, D R; Ashcraft, M L

1993-01-01

In this article, a payment model is developed for a hospital system with both acute- and chronic-stay psychiatric patients. "Transition pricing" provides a balance between the incentives of an episode-based system and the necessity of per diem long-term payments. Payment is dependent on two new psychiatric resident classification systems for short- and long-term stays. Data on per diem cost of inpatient care, by day of stay, was computed from a sample of 2,968 patients from 100 psychiatric units in 51 Department of Veterans Affairs (VA) Medical Centers. Using a 9-month cohort of all VA psychiatric discharges nationwide (79,337 with non-chronic stays), profits and losses were simulated.

Serotonin Transporter Gene ("SLC6A4") Methylation Associates with Neonatal Intensive Care Unit Stay and 3-month-old Temperament in Preterm Infants

Science.gov (United States)

Montirosso, Rosario; Provenzi, Livio; Fumagalli, Monica; Sirgiovanni, Ida; Giorda, Roberto; Pozzoli, Uberto; Beri, Silvana; Menozzi, Giorgia; Tronick, Ed; Morandi, Francesco; Mosca, Fabio; Borgatti, Renato

2016-01-01

Preterm birth and Neonatal Intensive Care Unit (NICU) stay are early adverse stressful experiences, which may result in an altered temperamental profile. The serotonin transporter gene ("SLC6A4"), which has been linked to infant temperament, is susceptible to epigenetic regulation associated with early stressful experience. This study…

Alimentação e comportamento de larvas de pacu, Piaractus mesopotamicus (Holmberg, 1887 Feeding and behavior of pacu, Piaractus mesopotamicus (Holmberg, 1887 larvae

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Eduardo Lopes Beerli

2004-02-01

Full Text Available Conduziu-se este trabalho com o objetivo de avaliar o efeito da utilização de dietas naturais e artificiais sobre o desempenho e comportamento de larvas de pacu (Piaractus mesopotamicus, entre o 2º e o 10º dia de vida. Foram utilizadas 30 caixas plásticas, cada uma com 30 litros de água e renovação contínua, onde as larvas foram mantidas durante o período experimental. Cada caixa recebeu 10 larvas por litro, totalizando 300 larvas/caixa. Foram testados 6 tratamentos, cada qual com 5 repetições. Os tratamentos foram: T1-ração, T2-plâncton, T3-artêmia, T4-plâncton + ração, T5-artêmia + ração e T6-artêmia + plâncton. As larvas foram alimentadas 6 vezes ao dia, nos horários de 4, 8, 12, 16, 20 e 24 horas. A temperatura da água foi mantida constante a 27ºC, o oxigênio dissolvido permaneceu na faixa de 6,16 ± 0,34 e o pH, entre 7,16 ± 0,22. Aos 2, 4, 6, 8 e 10 dias de vida, foram coletadas amostras de 30 larvas para determinação do comprimento total e peso. No final do experimento (10º dia, as larvas que receberam artêmia + plâncton (T6 alcançaram os maiores valores de comprimento total (8,35 mm e peso corporal (3518 µg, em relação a todas as outras dietas testadas. As larvas devem permanecer em laboratório por um período de 6 dias após a eclosão, recebendo alimento do terceiro ao sexto dia. A partir do sexto dia, as larvas estão com a vesícula gasosa completamente inflada e apresentam nado contínuo.The objective of this research was to evaluate the effect of natural and artificial diets on the development and behavior of pacu (Piaractus mesopotamicus larvae, between the 2nd and 10th day post hatch. The larvaes were kept in 30L - plastic boxes (n = 30 boxes, in constant flow-through. The larvae density was 10 post-larvae/L (300 larvae/box. Six diets with 4 sampling days (4, 6, 8 and 10 days post-hatch, n = 30 larvae using 5 repetitions were tested. The diets were: T1- commercial feed, T2- plancton, T3

Ultrasonography of gallbladder in surgical patients with a prolonged stay (> 14 days) in the intensive care unit

International Nuclear Information System (INIS)

Sustic, A.; Miletic, D.; Cicvaric, T.

2005-01-01

Background. The aim of this study was to establish the incidence of abnormal ultrasonographic (US) findings of gallbladder (GB) in surgical patients with the prolonged stay in the intensive care unit (ICU) and to correlate these findings with the severity of illness. Methods. In the prospective study fifty-seven (57) adult surgical patients (male 66%; age 49±18 yr.) with the prolonged stay in ICU (>14 days) were analyzed. In all patients the US examination was performed on the 15th day of their stay in ICU. The presence of the following US findings was analyzed: GB wall thickening (?4 mm), biliary sludge, GB hydrops, striated GB wall and pericholecystitic fluid. The severity of illness was also evaluated on the 15th day of the stay in ICU using Simplified Acute Physiology Score (SAPS II). Results. At least one abnormal US finding was found in 36 (63%), patients with GB wall thickening in 32 (56%), biliary sludge in 23 (40%), pericholecystitic fluid in 9 (16%), hydrops of GB in 7 (12%), and striated GB wall in 4 (7%) cases, respectively. Two to five US findings were found in 20 (35%) patients, three to five in 12 (21%), four to five in 10 (18%), while all five US findings were present in 4 (7%) cases. The patients with one and more US findings had significantly higher SAPS II than the patients who presented regular US findings of the GB (36±9 vs. 28±7; p < 0.01). The patients with two and more US findings had higher SAPS II than those with one or none US criteria (40±8 vs. 29±6; p < 0.001), while the patients with three and more had higher SAPS II than those with two, one or none (41±8 vs. 31±9; p < 0.001). The patients with four or five US findings had higher SAPS II than those with three or less (42±11 vs. 31±6; p < 0.001) while the patients with all five had higher SAPS II than all others (45±10 vs. 32±9; p < 0.001). A significant positive correlation between the number of US findings and SAPS II was present (r 0.57; p < 0.001). Conclusions. More than

The efficacy of oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy - a prospective, placebo controlled study.

Science.gov (United States)

Breazu, Caius Mihai; Ciobanu, Lidia; Hadade, Adina; Bartos, Adrian; Mitre, Călin; Mircea, Petru Adrian; Ionescu, Daniela

2016-04-01

Pain control after a laparoscopic cholecystectomy can represent a challenge, considering the side effects due to standard analgesia methods. Recently the transversus abdominis plane block (TAP Block) has been used as a part of multimodal analgesia with promising results. The subcostal approach (OSTAP Block), a variant on the TAP block, produces reliable unilateral supraumbilical analgesia. This study evaluated the efficacy of the OSTAP block with bupivacaine in laparoscopic cholecystectomy compared with the placebo OSTAP block. Sixty ASA I/II adult patients listed for elective laparoscopic cholecystectomy were randomly allocated in one of two groups: Group A (OSTAP placebo) received preoperatively bilateral OSTAP block with sterile normal saline and Group B (OSTAP bupivacaine) received bilateral preoperatively OSTAP block with the same volumes of 0.25% bupivacaine. Twenty-four hours postoperative opioid consumption, the dose of opioid required during surgery, opioid dose in the recovery unit (PACU) and PACU length of stay were evaluated. The quality of analgesia was assessed by the Visual Analogue Scale (VAS) at specific interval hours during 24 h, at rest and with movement. The mean intraoperative opioid consumption showed a significant difference between the two groups, (385 ± 72.52 mg in group A vs 173.67 ± 48.60 mg in group B, p consumption showed a statistically significant difference between groups (32 ± 26.05 mg vs 79 ± 16.68 mg, p < 0.001). PACU length of stay was significantly lower for group B patients compared with group A patients (20.67 ± 11.27 min vs 41.67 ± 12.41 min, p < 0.001). The OSTAP bupivacaine group had a statistically significant lower pain score than the OSTAP placebo group at 0, 2, 4, 6, 12, 24 h, both at rest and with movement. No signs or symptoms of local anaesthetic systemic toxicity or other complications were detected. OSTAP block with bupivacaine 0.25% can provide effective analgesia up to 24 hours after laparoscopic

Processamento da carne do pacu (Piaractus mesopotamicus cultivado em tanques-rede no reservatório de Itaipu = Processing of pacu (Piaractus mesopotamicus meat from net cage farming in the Itaipu reservoir

Directory of Open Access Journals (Sweden)

Robie Allan Bombardelli

2007-10-01

Full Text Available O trabalho objetivou avaliar as características morfométricas, bromatológicas e o rendimento de cortes da carne do pacu (Piaractus mesopotamicus, cultivados em tanquesrede. Utilizaram-se 45 animais, distribuídos em três tratamentos e 15 repetições cada uma.Os tratamentos constituíram-se de animais alimentados com ração extrusada comercial (REC, resíduos de vegetal cozido (RPV e resíduos cozidos de produção pesqueira (RPP. Realizaram-se as medidas individuais dos animais de comprimento-padrão (CP,comprimento total (CT, comprimento da cabeça (CC, altura da cabeça (AC, largura do tronco (LT, comprimento do tronco (CTR, altura do tronco (AT e, a partir delas, avaliaram-se as relações morfométricas de CC/CP, CC/AC, CP/CT, LT/CTR, LT/AT e AT/CTR. Avaliaram-se os rendimentos: carcaça (RCARC, tronco limpo (TL, musculaturadorsal (MD, filé (FL, costelas (COST, nadadeiras (NAD, gordura visceral (GVISC, pele com escamas (PELE, e os teores de umidade (UM, matéria mineral (MM, proteína bruta (PB e extrato etéreo (EE dos diferentes cortes. Observaram-se maiores resultados (pThis work was carried out to evalue the morphometric and chemical characteristics, as well as the meat cut yields from pacu (Piaractusmesopotamicus reared in net cages. Forty-five specimens were used, distributed in three treatments and 15 replications. The treatments consisted of animals fed with commercial extruded ration (CER, vegetal by-products (VBP and fishery by-products (FBP. Individual morphometric characteristics were measures in terms of standard length (SL, total length (TL, head length (HL head height (HH, body width (BW, body lenght (BL, body height (BH, to evaluate the morphometric ratio of HL/SL, HL/HH, SL/TL, BW/BL, BW/BH and BH/BL. Next, the carcass (CARC, clean body (CB, dorsal muscle (DM, fillet (FL, ribs (RIB, fin (FIN, visceral fat (VISCF, skin with scales (SKIN, as well as the levels of moisture (M, ash (ASH, crude protein (CPB and fat (FAT

Influência da adição de iodeto de potássio e citrato de sódio na qualidade do sêmen de pacu (Piaractus mesopotamicus - Holmberg, 1887 The effects of potassium iodide and sodium citrate on semen quality of pacu (Piaractus mesopotamicus

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Alexandre Nízio Maria

2004-02-01

Full Text Available Atualmente, tem-se dado maior atenção ao desenvolvimento de tecnologias para estocagem de sêmen de peixes em curto prazo, por dias ou semanas, utilizando diluentes de sêmen que não ativem a motilidade espermática. Essa técnica é indicada em piscicultura para facilitar a reprodução artificial ou aumentar sua eficiência. Conduziu-se este trabalho com o objetivo de verificar o efeito do diluidor BTS (Beltsville Thawing Solution - MINITUB® na qualidade do sêmen de pacu, após a coleta, enriquecido com iodeto de potássio e com citrato de sódio. Foram utilizados seis reprodutores de pacu (Piaractus mesopotamicus submetidos à indução hormonal e liberação dos gametas, manualmente. O sêmen coletado de cada macho foi dividido em três frações, as quais receberam diluição (1:3 com o diluidor 1 (BTS 5% + iodeto de potássio 0,16%, diluidor 2 (BTS 5% + citrato de sódio 1,28% e uma fração não diluída (controle. A ativação espermática foi realizada com água destilada, e, a seguir, foram avaliadas as taxas e duração da motilidade espermática, cujos valores médios respectivos foram de 95,00 ± 3,16% e 486,83 ± 314,55 segundos para o sêmen in natura, 80,00 ± 9,49% e 221,50 ± 207,89 segundos para o sêmen com o diluidor 1 e 80,00 ± 11,40% e 320,66 ± 181,14 segundos para o sêmen no diluidor 2. Em seguida, foram coletadas amostras para a avaliação da concentração espermática, que obteve um valor médio de 13,89 ± 1,26 x 10(9/mL. Pelas análises estatísticas, verificou-se que não houve diferença significativa na duração da motilidade (P>0,05 entre o sêmen “in natura” e os diluidores 1 e 2. A motilidade espermática foi estatisticamente melhor (PCurrently, it has been given a special attention to developing technologies for short-term storage of fish semen, for a few days to weeks, using extenders of semen that do not activate the sperm motility. The short-term storage technique is indicated for fish culture

Changes in the epidemiology of gastroenteritis in a paediatric short stay unit following the introduction of rotavirus immunisation.

Science.gov (United States)

Akikusa, Jonathan D; Hopper, Sandy M; Kelly, Julian J; Kirkwood, Carl D; Buttery, Jim P

2013-02-01

Acute gastroenteritis (AGE) has been a significant component of the clinical load in the short stay unit (SSU) at the Royal Children's Hospital (RCH) since its establishment in 2004. Since the introduction of routine rotavirus immunisation in Australia in 2007 there has been a clinical impression of a substantial reduction in AGE managed in the SSU. This study aimed to examine changes in the epidemiology of AGE in the SSU, and RCH overall, between 2005 and 2009 and explore whether this reflects a change specifically in AGE due to rotavirus. Discharge coding data for AGE from all inpatient wards, the SSU and emergency department (ED) at the RCH were examined. Stool virology results for the same period were analysed. Since 2007 there has been a 58% reduction in AGE admissions to the SSU. The median age of patients admitted to the RCH with rotaviral enteritis has increased from 1.3 years to 3.8 years. Presentations to the ED for AGE have fallen from 53 to 34 cases per 1000 attendances between 2004 and 2009, and admission rates from the ED have fallen from 23 to 13% of AGE presentations. Detection rates of rotavirus fell from 13.1 to 6.7% between 2005 and 2009. A marked decrease in AGE-related clinical activity and reduction in rotavirus detection at the RCH has occurred since the introduction of routine rotavirus immunisation in Australia. This has significant resource planning implications for units based on short stay models of care. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Association of bystander interventions and hospital length of stay and admission to intensive care unit in out-of-hospital cardiac arrest survivors.

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Riddersholm, Signe; Kragholm, Kristian; Mortensen, Rikke Nørmark; Pape, Marianne; Hansen, Carolina Malta; Lippert, Freddy K; Torp-Pedersen, Christian; Christiansen, Christian F; Rasmussen, Bodil Steen

2017-10-01

The impact of bystander interventions on post-arrest hospital course is sparsely studied. We examined the association between bystander interventions and length of hospital stay and admission to intensive care unit (ICU) in one-day survivors after OHCA. This cohort study linked data of 4641 one-day OHCA survivors from 2001 to 2014 to data on hospital length of stay and ICU admission. We examined associations between bystander efforts and outcomes using regression, adjusted for age, sex, comorbidities, calendar year and witnessed status. We divided bystander efforts into three categories: 1. No bystander interventions; 2.Bystander CPR only; 3. Bystander defibrillation with or without bystander CPR. For patients surviving to hospital discharge, hospital length of stay was 20days for patients without bystander interventions, compared to 16 for bystander CPR, and 13 for bystander defibrillation. 82% of patients without bystander interventions were admitted to ICU compared to 77.2% for bystander CPR, and 61.2% for bystander defibrillation. In-hospital mortality was 60% in the first category compared to 40.5% and 21.7% in the two latter categories. In regression models, bystander CPR and bystander defibrillation were associated with a reduction of length of hospital stay of 21% (Estimate: 0.79 [95% CI: 0.72-0.86]) and 32% (Estimate: 0.68 [95% CI: 0.59-0.78]), respectively. Both bystander CPR (OR: 0.94 [95% CI: 0.91-0.97]) and bystander defibrillation (OR: 0.81 [0.76-0.85]), were associated with lower risk of ICU admission. Bystander interventions were associated with reduced hospital length of stay and ICU admission, suggesting that these efforts improve recovery in OHCA survivors. Copyright © 2017 Elsevier B.V. All rights reserved.

Opioids and immunosupression in oncological postoperative patients

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José Luis Bonilla-García

Full Text Available Summary Introduction: Recent animal studies demonstrated immunosuppressive effects of opioid withdrawal resulting in a higher risk of infection. The aim of this study was to determine the impact of remifentanil discontinuation on Post-Anesthesia Care Unit (PACU-acquired infection after a schedule of sedoanalgesia of at least 6 days. Method: All patients over 18 years of age with a unit admission of more than 4 days were consecutively selected. The study population was the one affected by surgical pathology of any origin where sedation was based on any hypnotic and the opioid remifentanil was used as analgesic for at least 96 hours in continuous perfusion. Patients who died during admission to the unit and those with combined analgesia (peripheral or neuroaxial blocks were excluded. Bivariate analysis was performed to determine risk factors for infection acquired in the unit. A comparative study between periods of 6 days before and after the cessation of remifentanil was performed. Paired samples test and McNemar test was used for quantitative and categorical variables, respectively. Results: There were 1,789 patients admitted to the PACU during the study and the population eligible was constituted for 102 patients. The incidence rate of PACU-acquired infection was 38 per 1,000 PACU days. Ventilator-associated pneumonia was the most frequently diagnosed PACU-acquired infection. Pseudomona aeruginosa was the most frequently isolated microorganism. Hospital mortality was 36.27%. No statistically significant differences were seen in the incidence of HAI in cancer patients in relation to discontinuation of remifentanil (p=0.068. Conclusion: The baseline state of immunosuppression of cancer patients does not imply a higher incidence of HAI in relation to the interruption of remifentanil. It would be of interest to carry out a multicenter PACU study that included immunological patterns.

Care of "new" long-stay patients in a district general hospital psychiatric unit. The first two years of a hospital-hostel.

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Gibbons, J S

1986-05-01

The paper describes the need for long-term inpatient care in an English health district whose psychiatric services were based on a unit in a District General Hospital. Patients who became long-stay were placed in a new hospital-hostel in a city centre. Three quarters of those eligible could be managed in the hostel, with those rejected posing more control problems. Patients in the hostel became less withdrawn and increased their activity and use of community facilities.

Paid sick days and stay-at-home behavior for influenza

OpenAIRE

Piper, Kaitlin; Youk, Ada; James, A. Everette; Kumar, Supriya

2017-01-01

Access to paid sick days (PSD) differs by workplace size, race/ethnicity, gender, and income in the United States. It is not known to what extent decisions to stay home from work when sick with infectious illnesses such as influenza depend on PSD access, and whether access impacts certain demographic groups more than others. We examined demographic and workplace characteristics (including access to PSD) associated with employees' decisions to stay home from work for their own or a child's ill...

Segmental thoracic spinal has advantages over general anesthesia for breast cancer surgery.

Science.gov (United States)

Elakany, Mohamed Hamdy; Abdelhamid, Sherif Ahmed

2013-01-01

Thoracic spinal anesthesia has been used for laparoscopic cholecystectomy and abdominal surgeries, but not in breast surgery. The present study compared this technique with general anesthesia in breast cancer surgeries. Forty patients were enrolled in this comparative study with inclusion criteria of ASA physical status I-III, primary breast cancer without known extension beyond the breast and axillary nodes, scheduled for unilateral mastectomy with axillary dissection. They were randomly divided into two groups. The thoracic spinal group (S) (n = 20) underwent segmental thoracic spinal anesthesia with bupivacaine and fentanyl at T5-T6 interspace, while the other group (n = 20) underwent general anesthesia (G). Intraoperative hemodynamic parameters, intraoperative complications, postoperative discharge time from post-anesthesia care unit (PACU), postoperative pain and analgesic consumption, postoperative adverse effects, and patient satisfaction with the anesthetic techniques were recorded. Intraoperative hypertension (20%) was more frequent in group (G), while hypotension and bradycardia (15%) were more frequent in the segmental thoracic spinal (S) group. Postoperative nausea (30%) and vomiting (40%) during PACU stay were more frequent in the (G) group. Postoperative discharge time from PACU was shorter in the (S) group (124 ± 38 min) than in the (G) group (212 ± 46 min). The quality of postoperative analgesia and analgesic consumption was better in the (S) group. Patient satisfaction was similar in both groups. Segmental thoracic spinal anesthesia has some advantages when compared with general anesthesia and can be considered as a sole anesthetic in breast cancer surgery with axillary lymph node clearance.

Interscalene brachial plexus block for outpatient shoulder arthroplasty: Postoperative analgesia, patient satisfaction and complications

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Shah Anand

2007-01-01

Full Text Available Background: Shoulder arthroplasty procedures are seldom performed on an ambulatory basis. Our objective was to examine postoperative analgesia, nausea and vomiting, patient satisfaction and complications of ambulatory shoulder arthroplasty performed using interscalene brachial plexus block (ISB. Materials and Methods: We prospectively examined 82 consecutive patients undergoing total and hemi-shoulder arthroplasty under ISB. Eighty-nine per cent (n=73 of patients received a continuous ISB; 11% (n=9 received a single-injection ISB. The blocks were performed using a nerve stimulator technique. Thirty to 40 mL of 0.5% ropivacaine with 1:400,000 epinephrine was injected perineurally after appropriate muscle twitches were elicited at a current of less than 0.5% mA. Data were collected in the preoperative holding area, intraoperatively and postoperatively including the postanesthesia care unit (PACU, at 24h and at seven days. Results: Mean postoperative pain scores at rest were 0.8 ± 2.3 in PACU (with movement, 0.9 ± 2.5, 2.5 ± 3.1 at 24h and 2.8 ± 2.1 at seven days. Mean postoperative nausea and vomiting (PONV scores were 0.2 ± 1.2 in the PACU and 0.4 ± 1.4 at 24h. Satisfaction scores were 4.8 ± 0.6 and 4.8 ± 0.7, respectively, at 24h and seven days. Minimal complications were noted postoperatively at 30 days. Conclusions: Regional anesthesia offers sufficient analgesia during the hospital stay for shoulder arthroplasty procedures while adhering to high patient comfort and satisfaction, with low complications.

Theme: Staying Current--Horticulture.

Science.gov (United States)

Shry, Carroll L., Jr.; And Others

1986-01-01

This theme issue on staying current in horticulture includes articles on sex equity in horticulture, Future Farmers of America, career opportunities in horticulture, staying current with your school district's needs, staying current in horticulture instruction, staying current with landscape trade associations, emphasizing the basics in vocational…

Establishing a Nurse Mentor Program to Improve Nurse Satisfaction and Intent to Stay.

Science.gov (United States)

Jones, Sara Jane

Mentoring is an intervention to foster development and socialization of new registered nurses to an organization or unit. A nurse mentor program was developed and implemented with the purpose to improve new registered nurse satisfaction and intent to stay. A pre- and postintervention design was used in a rural emergency department to evaluate nurse job satisfaction and intent to stay in the job. Intent to stay in the job mean scores increased, and the registered nurse participants reported program satisfaction through verbal and written feedback.

[Effectiveness of the application of therapeutic touch on weight, complications, and length of hospital stay in preterm newborns attended in a neonatal unit].

Science.gov (United States)

Domínguez Rosales, Rosario; Albar Marín, M Jesús; Tena García, Beatriz; Ruíz Pérez, M Teresa; Garzón Real, M Josefa; Rosado Poveda, M Asunción; González Caro, Eva

2009-01-01

To determine the effectiveness of therapeutic touch on weight, the presence of postnatal complications, and length of hospital stay in preterm newborns, as well as on parental satisfaction with the care provided. We performed an experimental study in the Neonatal Intensive Care Unit of the Virgen Macarena University Hospital in Seville (Spain). Seventy eight premature neonates were randomly assigned to one of the comparison groups (39 in the control group and 39 in the experimental group). The outcome variables of weight, length of hospital stay, the presence of complications, and parental satisfaction were evaluated. Control variables related to maternal socio-demographic and clinic characteristics were also measured. The intervention was based on the application of therapeutic touch. The mean weight in grams was 1,867.80 (SD=149.72) in the experimental group and 1,860 (SD=181.92) in the control group (t=0.148; p=0.883). Length of hospital stay was 16.82 (SD=6.47) in the experimental group and 20.30 (SD=8.04) in the control group (t=2.100; p=0.039). Complications developed in 5.3% of the premature neonates in the experimental group and in 20% of those in the control group (chi(2)=3.78; p=0.049). The odds ratio for developing complications was 1.673 (CI 1.089-2.571). The application of therapeutic touch reduces the length of hospital stay and the presence of complications. Nevertheless, further research in larger samples is required.

Major determinants of survival and length of stay in the neonatal intensive care unit of newborns from women with premature preterm rupture of membranes.

Science.gov (United States)

Kurek Eken, Meryem; Tüten, Abdülhamit; Özkaya, Enis; Karatekin, Güner; Karateke, Ateş

2017-08-01

To assess the predictors of outcome in terms of length of stay in the neonatal intensive care unit (NICU) and survival of neonates from women with preterm premature rupture of membranes (PPROM). A population-based retrospective study including 331 singleton pregnant women with PPROM at 24-34 gestational weeks between January 2013 and December 2015 was conducted. Gestational age at delivery, birth weight, route of delivery, newborn gender, maternal age, oligohydramnios, premature retinopathy (ROP), necrotising enterocolitis (NEC), sepsis, fetal growth retardation (FGR), intracranial hemorrhagia (ICH), bronchopulmonary dysplasia (BPD), respiratory distress syndrome (RDS), primary pulmonary hypertension (PPH), congenital cardiac disease (CCD), patent ductus arteriosus (PDA), use of cortisol (betamethasone) and maternal complications including gestational diabetes, preeclampsia and chorioamnionitis were used to predict neonatal outcomes in terms of length of stay in the NICU and survival. In linear regression analyses, birth weight, ROP, CCD, BPD, PDA, NEC and preeclampsia were significant confounders for length of stay in the NICU. Among them, birth weight was the most powerful confounder for prolongation of the NICU stay (t: -6.43; p Prematurity-related complications are the most important problems for which precautions should be taken. Therefore, premature deliveries should be avoided to prevent infection and to prolong the latent period in cases of PPROM in order to decrease prematurity-related outcomes.

Optimal Damping of Stays in Cable-Stayed Bridges for In-Plane Vibrations

DEFF Research Database (Denmark)

Jensen, C.N.; Nielsen, S.R.K.; Sørensen, John Dalsgaard

2002-01-01

cable-stayed bridges are often designed as twin cables with a spacing of, say 1m. In such cases, it is suggested in the paper to suppress the mentioned in-plane types of vibrations by means of a tuned mass–damper (TMD) placed between the twin cables at their midpoints. The TMD divides the stay into four......Significant vibrations have been reported in stays of recently constructed cable stayed bridges. The vibrations appear as in-plane vibrations that may be caused by rain–wind- induced aeroelastic interaction or by resonance excitation of the cables from the motion of the pylons. The stays of modern...

Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients

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Pierce JT

2017-10-01

Full Text Available John T Pierce,1 Guy Kositratna,2 Mark A Attiah,1 Michael J Kallan,3 Rebecca Koenigsberg,1 Peter Syre,1 David Wyler,4 Paul J Marcotte,1 W Andrew Kofke,1,2 William C Welch1 1Department of Neurosurgery, 2Department of Anesthesiology and Critical Care, 3Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 4Department of Anesthesiology and Critical Care, Neurosurgery, Jefferson Hospital of Neuroscience, Thomas Jefferson University, Philadelphia PA, USA Background: Previous studies have shown varying results in selected outcomes when directly comparing spinal anesthesia to general in lumbar surgery. Some studies have shown reduced surgical time, postoperative pain, time in the postanesthesia care unit (PACU, incidence of urinary retention, postoperative nausea, and more favorable cost-effectiveness with spinal anesthesia. Despite these results, the current literature has also shown contradictory results in between-group comparisons. Materials and methods: A retrospective analysis was performed by querying the electronic medical record database for surgeries performed by a single surgeon between 2007 and 2011 using procedural codes 63030 for diskectomy and 63047 for laminectomy: 544 lumbar laminectomy and diskectomy surgeries were identified, with 183 undergoing general anesthesia and 361 undergoing spinal anesthesia (SA. Linear and multivariate regression analyses were performed to identify differences in blood loss, operative time, time from entering the operating room (OR until incision, time from bandage placement to exiting the OR, total anesthesia time, PACU time, and total hospital stay. Secondary outcomes of interest included incidence of postoperative spinal hematoma and death, incidence of paraparesis, plegia, post-dural puncture headache, and paresthesia, among the SA patients. Results: SA was associated with significantly lower operative time, blood loss, total anesthesia time, time

Effectiveness of a structured education reminiscence-based programme for staff on the quality of life of residents with dementia in long-stay units: A study protocol for a cluster randomised trial

LENUS (Irish Health Repository)

O'Shea, Eamon

2011-02-14

Abstract Background Current projections indicate that there will be a significant increase in the number of people with dementia in Ireland, from approximately 40,000 at present to 100,000 by 2036. Psychosocial interventions, such as reminiscence, have the potential to improve the quality of life of people with dementia. However, while reminiscence is used widely in dementia care, its impact on the quality of life of people with dementia remains largely undocumented and there is a need for a robust and fair assessment of its overall effectiveness. The DementiA education programme incorporating REminiscence for Staff study will evaluate the effectiveness of a structured reminiscence-based education programme for care staff on the quality of life of residents with dementia in long-stay units. Methods\\/Design The study is a two-group, single-blind cluster randomised trial conducted in public and private long-stay residential settings in Ireland. Randomisation to control and intervention is at the level of the long-stay residential unit. Sample size calculations suggest that 18 residential units each containing 17 people with dementia are required for randomisation to control and intervention groups to achieve power of at least 80% with alpha levels of 0.05. Each resident in the intervention group is linked with a nurse and care assistant who have taken the structured reminiscence-based education programme. Participants in the control group will receive usual care. The primary outcome is quality of life of residents as measured by the Quality of Life-AD instrument. Secondary outcomes include agitation, depression and carer burden. Blinded outcome assessment is undertaken at baseline and at 18-22 weeks post-randomisation. Discussion Trials on reminiscence-based interventions for people with dementia have been scarce and the quality of the information arising from those that have been done has been undermined by methodological problems, particularly in relation to scale

Crescimento de juvenis de pacu em tanques com aeração noturna - DOI: 10.4025/actascianimsci.v25i1.2122 Growth of pacu juveniles in nightly aerated system - DOI: 10.4025/actascianimsci.v25i1.2122

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Evoy Zaniboni Filho

2003-04-01

Full Text Available O presente estudo avalia o efeito de duas densidades de estocagem (20 e 40 peixes/m2 e da aeração noturna da água dos tanques de cultivo do pacu Piaractus mesopotamicus (Holmberg, 1887. Um total de 12 tanques com fundo de terra e paredes de alvenaria foram utilizados em 4 tratamentos com 3 repetições cada. Foram utilizados alevinos com 30 dias de idade, pesando em média 1,93 ± 1,70g, e o experimento foi conduzido durante 60 dias. A aeração noturna possibilitou a obtenção de valores médios de oxigênio de 5,6 ± 0,5 e 5,8 ± 0,5mg O2/l para as densidades de 20 e 40 peixes/m2, enquanto nos tanques sem a aeração os valores de oxigênio foram de 4,3 ± 0,7 e 3,4 ± 0,7mg O2/l, respectivamente. A biomassa foi o único parâmetro que aumentou com a aeração noturna, enquanto que a sobrevivência e o crescimento apresentaram efeitos discretos.The present study evaluated the effects of two stocking densities (20 and 40 fish/m2 and nightly aeration on water quality and growth of pacu, Piaractus mesopotamicus (Holmberg, 1887. Twelve ponds with concrete walls and earthen bottom were used to set 4 treatments with 3 repetitions each. 30-day old fish with average weight (mean standard ± deviation of 1.93 ± 1.70g in the beginning of the experiment were observed for 60 days. Nightly aeration promoted 5.6 ± 0.5 and 5.8 ± 0.5mg O2/l at dawn in the population densities of 20 and 40 fish/m2, while the unaerated ponds allowed 4.3 ± 0.7 and 3.4 ± 0.7mg O2/l for these densities, respectively. Fish biomass was the only biological parameter increased by nightly aeration, while discrete effects were observed in growth and survival.

Efeito da granulometria do milho no desempenho de juvenis de pacu, Piaractus mesopotamicus (Holmberg, 1887

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M.F Polese

2010-12-01

Full Text Available Avaliou-se o efeito de diferentes granulometrias do milho da ração no desempenho de juvenis de pacu, Piaractus mesopotamicus. Foram utilizados 120 juvenis com peso inicial de 8,42±0,89, comprimento total de 7,03±0,20cm, comprimento padrão de 6,32±0,13cm e altura de 3,21±0,11cm, distribuídos em 20 aquários (300L, na densidade de seis peixes por unidade experimental (aquário, em delineamento inteiramente ao acaso, com cinco tratamentos constituídos por diferentes granulometrias - 850, 710, 500, 300, 150µm - do milho na composição da ração. Cada tratamento tinha quatro repetições. O tratamento que proporcionou melhor desempenho dos animais foi o com granulometria do milho de 150µm, destacando-se a conversão alimentar de 1,38, enquanto no tratamento com maior granulometria a conversão alimentar foi de 1,61. Assim, recomenda-se usar a granulometria de 150µm.

What Predicts Whether Foreign Doctorate Recipients from U.S. Institutions Stay in the United States: Foreign Doctorate Recipients in Science and Engineering Fields from 2000 to 2010

Science.gov (United States)

Roh, Jin-Young

2015-01-01

Using data from the Survey of Earned Doctorates by the National Science Foundation, this study examines factors influencing foreign doctorate recipients' decisions to stay in the United States after they complete their degrees. This study expands the existing literature on human capital theory on migration decision by exploring the variables that…

Paid sick days and stay-at-home behavior for influenza.

Directory of Open Access Journals (Sweden)

Kaitlin Piper

Full Text Available Access to paid sick days (PSD differs by workplace size, race/ethnicity, gender, and income in the United States. It is not known to what extent decisions to stay home from work when sick with infectious illnesses such as influenza depend on PSD access, and whether access impacts certain demographic groups more than others. We examined demographic and workplace characteristics (including access to PSD associated with employees' decisions to stay home from work for their own or a child's illness. Linking the 2009 Medical Expenditure Panel Survey (MEPS consolidated data file to the medical conditions file, we used multivariate Poisson regression models with robust variance estimates to identify factors associated with missed work for an employee's own or a child's illness/injury, influenza-like-illness (ILI, and influenza. Controlling for gender, race/ethnicity, education, and income, access to PSD was associated with a higher probability of staying home for an employee's own illness/injury, ILI, or influenza, and for a child's illness/injury. Hispanic ethnicity was associated with a lower prevalence of staying home for the employee's own or a child's illness compared to non-Hispanic Whites. Access to PSD was associated with a significantly greater increase in the probability of staying home among Hispanics than among non-Hispanic Whites. Women had a significantly higher probability of staying home for their child's illness compared to men, suggesting that women remain the primary caregivers for ill children. Our results indicate that PSD access is important to encourage employees to stay home from work when sick with ILI or influenza. Also, PSD access may be important to enable stay-at-home behavior among Hispanics. We conclude that access to PSD is likely to reduce the spread of disease in workplaces by increasing the rate at which sick employees stay home from work, and reduce the economic burden of staying home on minorities, women, and

Development of Intention to Stay Model for Temporary Nursing Staff in RS UNAIR

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Ike Nesdia Rahmawati

2016-09-01

Full Text Available Introduction: Intention to stay of nurses is important to reduce turnover rate and to improve the stability of hospital. Quality of nursing work life (QNWL has been found to influence intention to stay. However, reliable information of this effect is limited. The purpose of this study was to develop the model of intention to stay for temporary nursing staff in RS UNAIR. Method: Anexplanative cross-sectional survey design was used in this study. Data were collected by using questionnaire among 32 nurses working at different units in this hospital through simple random sampling and analyzed by partial least square (PLS. Result: QNWL affected job satisfaction but did not affect commitment. Commitment was significantly affected by job satisfaction. There was effect of job satisfaction on intention to stay. Commitment also significantly affected intention to stay Discussion: QNWL is a predictor of intention to stay trough job satisfaction and commitment. It is recommended that more focused interventions on QNWL, job satisfaction, and commitment developments may improve intention to stay. Recruitment of non-nursing staff to carry out billing and administrative tasks is urgently needed. Suggestions for further research is to analyze the effect of empowerment, remuneration, and career ladder on nurses’ intention to stay. Keywords: intention to stay, quality of nursing work life, job satisfaction, commitment.

Resource savings and outcomes associated with outpatient laparoscopic appendectomy for nonperforated appendicitis.

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Gurien, Lori A; Burford, Jeffrey M; Bonasso, Patrick C; Dassinger, Melvin S

2017-11-01

Postoperative admission for acute appendicitis utilizes health care system resources. We evaluated outcomes and hospital charges for children with nonperforated appendicitis who underwent outpatient laparoscopic appendectomy. A retrospective chart review was performed for patients ≤18years old who underwent laparoscopic appendectomy for acute appendicitis in 2015. Patients were categorized into discharge from postanesthesia care unit (PACU) (outpatient), admission for 24-h. Continuous variables were compared using analysis of variance and categorical variables were compared using chi-square test, with p24-h. There were no differences in postoperative emergency department/clinic visits, complications, or readmissions. Hospital charges for admission 24-h were $1007 and $2237 more per patient than the PACU-discharge group, respectively. Outpatient laparoscopic appendectomies became more common over time, occurring in only 20% of patients with acute appendicitis in the first quarter of the year versus 49% of patients in the last quarter. Outpatient laparoscopic appendectomy for nonperforated appendicitis in children is a safe practice that decreases length of stay and hospital charges. Adoption of an outpatient strategy allows for better standardization of care and can lead to savings in health care resources. III (Treatment: retrospective comparative study). Copyright © 2017 Elsevier Inc. All rights reserved.

Health-related quality of life after prolonged pediatric intensive care unit stay.

LENUS (Irish Health Repository)

Conlon, Niamh P

2012-02-01

OBJECTIVE: To investigate the long-term health-related quality of life (HRQOL) outcomes for patients requiring at least 28 days of pediatric intensive care. DESIGN: Retrospective cohort and prospective follow-up study. SETTING: A 21-bed pediatric intensive care unit (PICU) in a university-affiliated, tertiary referral pediatric hospital. PATIENTS: One hundred ninety-three patients who spent 28 days or longer in the PICU between January 1, 1997 and December 31, 2004. INTERVENTIONS: Quality of life was measured using the Pediatric Quality of Life Inventory (Peds QL 4.0) parent-proxy version at 2 to 10 yrs after discharge. The PedsQL 4.0 is a modular measure of HRQOL, which is reliable in children aged 2 to 18 yrs. It generates a total score and physical, emotional, social, school, and psychosocial subscores. MEASUREMENTS AND MAIN RESULTS: Of the 193 patients, 41 died during their PICU admission and 27 died between PICU discharge and follow-up. Quality of life questionnaires were posted to parents of 108 of the 125 survivors and 70 were returned completed. Forty children (57.1%) had scores indicating a normal quality of life, whereas 30 (42.9%) had scores indicating impaired HRQOL. Of these, 14 (20%) had scores indicating poor quality of life with ongoing disabling health problems requiring hospitalization or the equivalent. CONCLUSIONS: Our results indicate that, while long PICU stay is associated with significant mortality, the long-term HRQOL is normal for the majority of surviving children.

Predicting mortality and length-of-stay for neonatal admissions to ...

African Journals Online (AJOL)

Objectives: To predict neonatal mortality and length of stay (LOS) from readily available perinatal data for neonatal intensive care unit (NICU) admissions in Southern African private hospitals. Methods: Retrospective observational study using perinatal data from a large multicentre sample. Fifteen participating NICU centres ...

Quality of life after carotid endarterectomy

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Barros Henrique

2008-11-01

Full Text Available Abstract Background Most studies documenting beneficial outcomes after carotid endarterectomy (CE are limited to mortality and morbidity rates, costs, and length of hospital stay (LOS. Few have examined the dependency of patients and how they perceive their own health changes after surgery. The aim of the present study was to evaluate quality of life and independence in activities of daily living (ADL and to study its determinants. Methods Sixty-three patients admitted in the Post Anaesthesia Care Unit (PACU after CE were eligible for this 14-month follow-up study. Patients were contacted 6 months after discharge to complete a Short Form-36 questionnaire (SF-36 and to have their dependency in ADL evaluated. Results Among 59 hospital survivors at 6 months follow-up, 43 completed the questionnaires. Sixty-three percent reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients had worse SF-36 scores for all domains except bodily pain than a general urban population, and comparison with a group of patients 6 months after surgical ICU discharge showed no differences. Six months after PACU discharge, the Lawton Instrumental Activities of ADL Scale and the Katz Index of ADL demonstrated higher dependency scores (5.9 ± 2.2 versus 4.3 ± 2.4 and 0.3 ± 0.8 versus 0.6 ± 0.9, p Conclusion Patients undergoing CE have improved self-perception of quality of life despite being more dependent. Almost all their scores are worse than those in an urban population. We could identify no predictors of greater dependency in ADL tasks six months after PACU discharge.

Phrenic palsy and analgesic quality of continuous supraclavicular vs. interscalene plexus blocks after shoulder surgery.

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Wiesmann, T; Feldmann, C; Müller, H H; Nentwig, L; Beermann, A; El-Zayat, B F; Zoremba, M; Wulf, H; Steinfeldt, T

2016-09-01

Hemidiaphragmatic palsy is a common consequence of the interscalene brachial plexus block. It occurs less commonly with the supraclavicular approach. Register data suggest that the analgesic quality of a supraclavicular blockade is sufficient for arthroscopic shoulder surgery, although data on the post-operative analgesic effect are lacking. After approval by the ethics committee, patients having arthroscopic shoulder surgery under general anaesthesia were randomized to receive a continuous interscalene or supraclavicular blockade. Phrenic nerve function was evaluated through ultrasound examination of the diaphragm in combination with spirometry. Pain scores at rest and activity etc. were determined before catheter insertion, during observation in the post- anaesthesia care unit (PACU) and on post-operative day 1 (POD1). The initial application of 10 ml of ropivacaine 0.2% was followed by continuous application of 4 ml of ropivacaine 0.2%, plus a patient controlled analgesia (PCA) bolus of 4 ml/h. One hundred and twenty patients were randomized, of which 114 data sets were analysed. Complete hemidiaphragmatic paresis occurred in 43% of the interscalene group vs. 24% in the supraclavicular group during PACU stay. Rates of dyspnoea and hoarseness were similar. Horner's syndrome occurred in 21% of the interscalene but only 3% of the supraclavicular group on POD1. Pain scores were comparable for pain at rest and during stress at each time point. This trial showed a significantly greater incidence of phrenic nerve palsy of the interscalene group in PACU, but not on POD1. Post-operative analgesic quality was similar in both groups. Continuous supraclavicular blockade is a suitable alternative to the continuous interscalene technique. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Comparison of Postoperative Pain between Infiltrative Local Anesthesia plus Paracetamol and Total Intravenous Anesthesia plus Paracetamol in Ambulatory Breast Surgery

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Kasra Karvandian

2015-08-01

Full Text Available Background: Acute postoperative pain is an important surgical side effect that may delay patient discharge in ambulatory operations; moreover, the strategies used to alleviate pain may cause side effects that require longer hospitalization to recover. In this clinical trial, we compared two current anesthetic methods with special concerns about postoperative pain intensity beside other important components of ambulatory anesthesia.Methods: This clinical trial was conducted on two age-matched groups of 75 members who underwent ambulatory breast surgery. Patients in the first group (GA underwent general anesthesia with propofol plus remifentanil by employing a laryngeal mask airway. In the second group (LA, the surgeon used infiltration of 2% lidocaine in the breast tissue and midazolam was applied as premedication. At the end of surgery, paracetamol was administered to all patients in both groups. The pain score was evaluated when the patients were fully awake using a numerical pain rating scale. Patients with severe pain received analgesia. The length of postanesthesia care unit (PACU stay was recorded for each patient.Results: None of the patients in the LA group were satisfied because of the experience of needle insertion into their breast tissue (P = 0.001. The patients in the LA group experienced more pain in PACU requiring adjuvant analgesia (P = 0.001. Patients in the LA group had longer PACU admission (P = 0.001.Conclusions: Patients in the LA group had higher pain scores and were dissatisfied with the plan of their anesthesia. This may confirm the role of preemptive analgesia or the effect of emotional stress of breast tissue needling in wakeful patient.

Effectiveness of a structured education reminiscence-based programme for staff on the quality of life of residents with dementia in long-stay units: A study protocol for a cluster randomised trial

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Jordan Fionnuala

2011-02-01

Full Text Available Abstract Background Current projections indicate that there will be a significant increase in the number of people with dementia in Ireland, from approximately 40,000 at present to 100,000 by 2036. Psychosocial interventions, such as reminiscence, have the potential to improve the quality of life of people with dementia. However, while reminiscence is used widely in dementia care, its impact on the quality of life of people with dementia remains largely undocumented and there is a need for a robust and fair assessment of its overall effectiveness. The DementiA education programme incorporating REminiscence for Staff study will evaluate the effectiveness of a structured reminiscence-based education programme for care staff on the quality of life of residents with dementia in long-stay units. Methods/Design The study is a two-group, single-blind cluster randomised trial conducted in public and private long-stay residential settings in Ireland. Randomisation to control and intervention is at the level of the long-stay residential unit. Sample size calculations suggest that 18 residential units each containing 17 people with dementia are required for randomisation to control and intervention groups to achieve power of at least 80% with alpha levels of 0.05. Each resident in the intervention group is linked with a nurse and care assistant who have taken the structured reminiscence-based education programme. Participants in the control group will receive usual care. The primary outcome is quality of life of residents as measured by the Quality of Life-AD instrument. Secondary outcomes include agitation, depression and carer burden. Blinded outcome assessment is undertaken at baseline and at 18-22 weeks post-randomisation. Discussion Trials on reminiscence-based interventions for people with dementia have been scarce and the quality of the information arising from those that have been done has been undermined by methodological problems, particularly in

Length of stay and cost analysis of neonates undergoing surgery at a tertiary neonatal unit in England.

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Shetty, S; Kennea, N; Desai, P; Giuliani, S; Richards, J

2016-01-01

Introduction There is a lack of knowledge on the average length of stay (LOS) in neonatal units after surgical repair of common congenital anomalies. There are few if any publications reporting the activity performed by units undertaking neonatal surgery. Such activity is important for contracting arrangements, commissioning specialist services and counselling parents. The aim of this study was to describe postnatal LOS for infants admitted to a single tertiary referral neonatal unit with congenital malformations requiring surgery. Methods Data on nine conditions were collected prospectively for babies on the neonatal unit over a five-year period (2006-2011). For those transferred back to their local unit following surgery, the local unit was contacted to determine the total LOS. Only those babies who had surgery during their first admission to our unit and who survived to discharge were included in the study. Cost estimates were based on the tariffs agreed for neonatal care between our trust and the London specialised commissioning group in 2011-2012. Results The median LOS for the conditions studied was: gastroschisis 35 days (range: 19-154 days), oesophageal atresia 33 days (range: 9-133 days), congenital diaphragmatic hernia 28 days (range: 7-99 days), intestinal atresia 24 days (range: 6-168 days), Hirschsprung's disease 21 days (range: 15-36 days), sacrococcygeal teratoma 17 days (range: 12-55 days), myelomeningocoele 15.5 days (range: 8-24 days), anorectal malformation 15 days (range: 6-90 days) and exomphalos 12 days (range: 3-228 days). The total neonatal bed day costs for the median LOS ranged from £8,701 (myelomeningocoele) to £23,874 (gastroschisis). The cost of surgery was not included. Conclusions There is wide variation in LOS for the same conditions in a single neonatal unit. This can be explained by different types and severity within the same congenital anomalies, different surgeons and other clinical confounders (eg sepsis, surgical

Toward improved surveillance: the impact of ventilator-associated complications on length of stay and antibiotic use in patients in intensive care units.

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Hayashi, Yoshiro; Morisawa, Kenichiro; Klompas, Michael; Jones, Mark; Bandeshe, Hiran; Boots, Robert; Lipman, Jeffrey; Paterson, David L

2013-02-01

Hospitals and quality improvement agencies are vigorously focusing on reducing rates of hospital-acquired infection. Ventilator-associated pneumonia (VAP) is notoriously difficult to diagnose and surveillance is thwarted by the subjectivity of many components of the surveillance definition. Alternative surveillance strategies are needed. Ventilator-associated complications (VAC) is a simple, objective measure of respiratory deterioration. VAC is defined by increases in fraction of inspired oxygen (FiO(2)) by ≥ 15% or positive end-expiratory pressure (PEEP) by ≥ 2.5 cm H(2)O lasting ≥ 2 days after stable or decreasing FiO(2) or PEEP lasting ≥ 2 days. We retrospectively assessed patients on mechanical ventilation for ≥ 48 hours in our study intensive care unit (ICU) using electronic medical record data. We analyzed the association between VAC and clinical diagnoses, ICU length of stay, duration of mechanical ventilation, antibiotic use, and mortality. We assessed 153 patients with VAC and 390 without VAC. VAC events were associated with significantly increased ICU length of stay, duration of mechanical ventilation, and consumption of broad-spectrum antibiotics but not with longer hospital stays or ICU mortality. Surveillance for VAP is subjective and labor intensive. VAC is an objective measure which can be readily obtained from electronic records. It is associated with adverse outcomes and increased broad-spectrum antibiotic usage. VAC may be a useful surveillance tool. The utility of VAC prevention bundles merits assessment.

Why we stay with our social partners: Neural mechanisms of stay/leave decision-making.

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Heijne, Amber; Rossi, Filippo; Sanfey, Alan G

2017-09-03

How do we decide to keep interacting (e.g., stay) with a social partner or to switch (e.g., leave) to another? This paper investigated the neural mechanisms of stay/leave decision-making. We hypothesized that these decisions fit within a framework of value-based decision-making, and explored four potential mechanisms underlying a hypothesized bias to stay. Twenty-six participants underwent functional Magnetic Resonance Imaging (fMRI) while completing social and nonsocial versions of a stay/leave decision-making task. On each trial, participants chose between four alternative options, after which they received a monetary reward. Crucially, in the social condition, reward magnitude was ostensibly determined by the generosity of social partners, whereas in the nonsocial condition, reward amounts were ostensibly determined in a pre-programmed manner. Results demonstrated that participants were more likely to stay with options of relatively high expected value, with these values updated through Reinforcement Learning mechanisms and represented neurally within ventromedial prefrontal cortex. Moreover, we demonstrated that greater brain activity in ventromedial prefrontal cortex, caudate nucleus, and septo-hypothalamic regions for social versus nonsocial decisions to stay may underlie a bias towards staying with social partners in particular. These findings complement existing social psychological theories by investigating the neural mechanisms of actual stay/leave decisions.

Inspection method of cable-stayed bridge using magnetic flux leakage detection: principle, sensor design, and signal processing

International Nuclear Information System (INIS)

Xu, Fengyu; Wang, Xingsong; Wu, Hongtao

2012-01-01

A nondestructive testing technique based on magnetic flux leakage is presented to inspect automatically the stay cables with large diameters of a cable-stayed bridge. Using the proposed inspection method, an online nondestructive testing (NDT) modular sensor is developed. The wreath-like sensor is composed of several sensor units that embrace the cable at equal angles. Each sensor unit consists of two permanent magnets and a hall sensor to detect the magnetic flux density. The modular sensor can be installed conveniently on cables with various diameters by increasing the number of sensor units and adjusting the relative distances between adjacent sensor units. Results of the experiments performed on a man-made cable with faults prove that the proposed sensor can inspect the status signals of the inner wires of the cables. To filter the interfering signals, three processing algorithms are discussed, including the moving average method, improved detrending algorithm, and signal processing based on a digital filter. Results show that the developed NDT sensor carried by a cable inspection robot can move along the cable and monitor the state of the stay cables

Independent risk factors for postoperative pain in need of intervention early after awakening from general anaesthesia.

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Mei, Wei; Seeling, Matthes; Franck, Martin; Radtke, Finn; Brantner, Benedikt; Wernecke, Klaus-Dieter; Spies, Claudia

2010-02-01

Despite advances in postoperative pain management, the proportion of patients with moderate to severe postoperative pain is still ranging 20-80%. In this retrospective study, we investigated 1736 patients to determine the incidence of postoperative pain in need of intervention (PPINI)defined as numeric rating scale >4 at rest in the post anaesthesia care unit early after awakening from general anaesthesia, and to identify possible risk factors. The proportion of patients with PPINI was 28.5%. On multivariate analysis, younger age (OR=1.300 [1.007-1.678], p=0.044), female gender (OR=1.494 [1.138-1.962], p=0.004), obesity (OR=1.683 [1.226-2.310], p=0.001), use of nitrous oxide (OR=1.621 [1.110-2.366], p=0.012), longer duration of surgery (OR=1.165 [1.050-1.292], p=0.004), location of surgery (musculoskeletal OR=2.026 [1.326-3.095], p=0.001; intraabdominal OR=1.869 [1.148-3.043], p=0.012), and ASA-PS I-II (OR=1.519 [1.131-2.039], P=0.005) were identified as independent risk factors for PPINI. Patients with PPINI experienced significantly more PONV (10.3% vs. 6.2%, p=0.003), more psychomotor agitation (5.5% vs. 2.7%, p=0.004), needed more application of opioid in PACU (62.8% vs. 24.2%, p<0.001), stayed significantly longer in PACU (89.6min [70-120] vs. 80min [60-100], p<0.001), had a longer median length of hospital stay (6.6 days [4.0-8.8] vs. 6.0 days [3.2-7.8

Effect of PACS/CR on cost of care and length of stay in a medical intensive care unit

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Langlotz, Curtis P.; Kundel, Harold L.; Brikman, Inna; Pratt, Hugh M.; Redfern, Regina O.; Horii, Steven C.; Schwartz, J. Sanford

1996-05-01

Our purpose was to determine the economic effects associated with the introduction of PACS and computed radiology (CR) in a medical intensive care unit (MICU). Clinical and financial data were collected over a period of 6 months, both before and after the introduction of PACS/CR in our medical intensive care unit. Administrative claims data resulting from the MICU stay of each patient enrolled in our study were transferred online to our research database from the administrative databases of our hospital and its affiliated clinical practices. These data included all charge entries, sociodemographic data, admissions/discharge/transfer chronologies, ICD9 diagnostic and procedure codes, and diagnostic related groups. APACHE III scores and other case mix adjusters were computed from the diagnostic codes, and from the contemporaneous medical record. Departmental charge to cost ratios and the Medicare Resource-Based Relative Value Scale fee schedule were used to estimate costs from hospital and professional charges. Data were analyzed using both the patient and the exam as the unit of analysis. Univariate analyses by patient show that patients enrolled during the PACS periods were similar to those enrolled during the Film periods in age, sex, APACHE III score, and other measures of case mix. No significant differences in unadjusted median length of stay between the two Film and two PACS periods were detected. Likewise, no significant differences in unadjusted total hospital and professional costs were found between the Film and PACS periods. In our univariate analyses by exam, we focused on the subgroup of exams that had triggered primary clinical actions in any period. Those action-triggering exams were divided into two groups according to whether the referring clinician elected to obtain imaging results from the workstation or from the usual channels. Patients whose imaging results were obtain from the workstation had significantly lower professional costs in the 7 days

Lean Six Sigma to Reduce Intensive Care Unit Length of Stay and Costs in Prolonged Mechanical Ventilation.

Science.gov (United States)

Trzeciak, Stephen; Mercincavage, Michael; Angelini, Cory; Cogliano, William; Damuth, Emily; Roberts, Brian W; Zanotti, Sergio; Mazzarelli, Anthony J

Patients with prolonged mechanical ventilation (PMV) represent important "outliers" of hospital length of stay (LOS) and costs (∼$26 billion annually in the United States). We tested the hypothesis that a Lean Six Sigma (LSS) approach for process improvement could reduce hospital LOS and the associated costs of care for patients with PMV. Before-and-after cohort study. Multidisciplinary intensive care unit (ICU) in an academic medical center. Adult patients admitted to the ICU and treated with PMV, as defined by diagnosis-related group (DRG). We implemented a clinical redesign intervention based on LSS principles. We identified eight distinct processes in preparing patients with PMV for post-acute care. Our clinical redesign included reengineering daily patient care rounds ("Lean ICU rounds") to reduce variation and waste in these processes. We compared hospital LOS and direct cost per case in patients with PMV before (2013) and after (2014) our LSS intervention. Among 259 patients with PMV (131 preintervention; 128 postintervention), median hospital LOS decreased by 24% during the intervention period (29 vs. 22 days, p < .001). Accordingly, median hospital direct cost per case decreased by 27% ($66,335 vs. $48,370, p < .001). We found that a LSS-based clinical redesign reduced hospital LOS and the costs of care for patients with PMV.

Jordanian Nursing Work Environments, Intent to Stay, and Job Satisfaction.

Science.gov (United States)

Al-Hamdan, Zaid; Manojlovich, Milisa; Tanima, Banerjee

2017-01-01

The purpose of this study was to examine associations among the nursing work environment, nurse job satisfaction, and intent to stay for nurses who practice in hospitals in Jordan. A quantitative descriptive cross-sectional survey design was used. Data were collected through survey questionnaires distributed to 650 registered nurses (RNs) who worked in three hospitals in Jordan. The self-report questionnaire consisted of three instruments and demographic questions. The instruments were the Practice Environment Scale of the Nursing Work Index (PES-NWI), the McCain Intent to Stay scale, and Quinn and Shepard's (1974) Global Job Satisfaction survey. Descriptive statistics were calculated for discrete measures of demographic characteristics of the study participants. Multivariate linear regression models were used to explore relationships among the nursing work environment, job satisfaction, and intent to stay, adjusting for unit type. There was a positive association between nurses' job satisfaction and the nursing work environment (t = 6.42, p job satisfaction increased by 1.3 points, controlling for other factors. Overall, nurses employed in public hospitals were more satisfied than those working in teaching hospitals. The nursing work environment was positively associated with nurses' intent to stay (t = 4.83, p job satisfaction. More attention should be paid to create positive work environments to increase job satisfaction for nurses and increase their intent to stay. Hospital and nurse managers and healthcare policymakers urgently need to create satisfactory work environments supporting nursing practice in order to increase nurses' job satisfaction and intent to stay. © 2016 Sigma Theta Tau International.

Division of overall duration of stay into operative stay and postoperative stay improves the overall estimate as a measure of quality of outcome in burn care.

Directory of Open Access Journals (Sweden)

Islam Abdelrahman

Full Text Available Surgically managed burn patients admitted between 2010-14 were included. Operative stay was defined as the time from admission until the last operation, postoperative stay as the time from the last operation until discharge. The difference in variation was analysed with F-test. A retrospective review of medical records was done to explore reasons for extended postoperative stay. Multivariable regression was used to assess factors associated with operative stay and postoperative stay.Operative stay/TBSA% showed less variation than total duration/TBSA% (F test = 2.38, p<0.01. The size of the burn, and the number of operations, were the independent factors that influenced operative stay (R2 0.65. Except for the size of the burn other factors were associated with duration of postoperative stay: wound related, psychological and other medical causes, advanced medical support, and accommodation arrangements before discharge, of which the two last were the most important with an increase of (mean 12 and 17 days (p<0.001, R2 0.51.Adjusted operative stay showed less variation than total hospital stay and thus can be considered a more accurate outcome measure for surgically managed burns. The size of burn and number of operations are the factors affecting this outcome measure.

Determinants of Length of Stay in Stroke Patients: A Geriatric Rehabilitation Unit Experience

Science.gov (United States)

Atalay, Ayce; Turhan, Nur

2009-01-01

The objective was to identify the predictors of length of stay--the impact of age, comorbidity, and stroke subtype--on the outcome of geriatric stroke patients. One hundred and seventy stroke patients (129 first-ever ischemic, 25 hemorrhagic, and 16 ischemic second strokes) were included in the study. The Oxfordshire Community Stroke Project…

Predictors of nursing faculty's job satisfaction and intent to stay in academe.

Science.gov (United States)

Derby-Davis, Marcia J

2014-01-01

The retention of nursing faculty is a growing concern in the United States and a major challenge for nursing education administrators. This descriptive study used Herzberg's Motivation-Hygiene Theory of Job Satisfaction to explore the factors that predict nursing faculty's job satisfaction and intent to stay in academe. Institutional review board approval was obtained, and consent forms with self-administered questionnaires were posted on Survey Monkey. Participants included a convenience sample of nursing faculty teaching in baccalaureate and graduate nursing programs in Florida during the months of May and June 2010. Participants (N = 134) were directed to an on-line site to retrieve and complete the following questionnaires: (a) Job Satisfaction Survey, (b) Nurse Educators' Intent to Stay in Academe Scale, and (c) a researcher-designed demographic questionnaire. Highly educated, experienced nursing faculty reported having more intent to stay (P motivation-hygiene factor score and the intent to stay score, F(4, 94) = 13.196, P motivational factors (job satisfiers) and the hygiene factors (job dissatisfiers) and intent to stay indicated that the nursing faculty overall were satisfied with their jobs. The mean job satisfaction score was 105.20, with a standard deviation of 30.712. The results provide support that Herzberg's Motivation-Hygiene Theory is a strong predictor of nursing faculty's intent to stay in academe in Florida. Copyright © 2014 Elsevier Inc. All rights reserved.

Two-Dimensional Analysis of Cable Stayed Bridge under Wave Loading

Science.gov (United States)

Seeram, Madhuri; Manohar, Y.

2018-06-01

In the present study finite element analysis is performed for a modified fan type cable-stayed bridge using ANSYS Mechanical. A cable stayed bridge with two towers and main deck is considered for the present study. Dynamic analysis is performed to evaluate natural frequencies. The obtained natural frequencies and mode shapes of cable stayed bridge are compared to the existing results. Further studies have been conducted for offshore area application by increasing the pylon/tower height depending upon the water depth. Natural frequencies and mode shapes are evaluated for the cable stayed bridge for offshore area application. The results indicate that the natural periods are higher than the existing results due to the effect of increase in mass of the structure and decrease in stiffness of the pylon/tower. The cable stayed bridge is analyzed under various environmental loads such as dead, live, vehicle, seismic and wave loading. Morison equation is considered to evaluate the wave force. The sum of inertia and drag force is taken as the wave force distribution along the fluid interacting height of the pylon. Airy's wave theory is used to assess water particle kinematics, for the wave periods ranging from 5 to 20 s and unit wave height. The maximum wave force among the different regular waves is considered in the wave load case. The support reactions, moments and deflections for offshore area application are highlighted. It is observed that the maximum support reactions and support moments are obtained due to wave and earthquake loading respectively. Hence, it is concluded that the wave and earthquake forces shall be given significance in the design of cable stayed bridge.

A new multiconstraint method for determining the optimal cable stresses in cable-stayed bridges.

Science.gov (United States)

Asgari, B; Osman, S A; Adnan, A

2014-01-01

Cable-stayed bridges are one of the most popular types of long-span bridges. The structural behaviour of cable-stayed bridges is sensitive to the load distribution between the girder, pylons, and cables. The determination of pretensioning cable stresses is critical in the cable-stayed bridge design procedure. By finding the optimum stresses in cables, the load and moment distribution of the bridge can be improved. In recent years, different research works have studied iterative and modern methods to find optimum stresses of cables. However, most of the proposed methods have limitations in optimising the structural performance of cable-stayed bridges. This paper presents a multiconstraint optimisation method to specify the optimum cable forces in cable-stayed bridges. The proposed optimisation method produces less bending moments and stresses in the bridge members and requires shorter simulation time than other proposed methods. The results of comparative study show that the proposed method is more successful in restricting the deck and pylon displacements and providing uniform deck moment distribution than unit load method (ULM). The final design of cable-stayed bridges can be optimised considerably through proposed multiconstraint optimisation method.

A New Multiconstraint Method for Determining the Optimal Cable Stresses in Cable-Stayed Bridges

Directory of Open Access Journals (Sweden)

B. Asgari

2014-01-01

Full Text Available Cable-stayed bridges are one of the most popular types of long-span bridges. The structural behaviour of cable-stayed bridges is sensitive to the load distribution between the girder, pylons, and cables. The determination of pretensioning cable stresses is critical in the cable-stayed bridge design procedure. By finding the optimum stresses in cables, the load and moment distribution of the bridge can be improved. In recent years, different research works have studied iterative and modern methods to find optimum stresses of cables. However, most of the proposed methods have limitations in optimising the structural performance of cable-stayed bridges. This paper presents a multiconstraint optimisation method to specify the optimum cable forces in cable-stayed bridges. The proposed optimisation method produces less bending moments and stresses in the bridge members and requires shorter simulation time than other proposed methods. The results of comparative study show that the proposed method is more successful in restricting the deck and pylon displacements and providing uniform deck moment distribution than unit load method (ULM. The final design of cable-stayed bridges can be optimised considerably through proposed multiconstraint optimisation method.

Parametrically excited oscillation of stay cable and its control in cable-stayed bridges.

Science.gov (United States)

Sun, Bing-nan; Wang, Zhi-gang; Ko, J M; Ni, Y Q

2003-01-01

This paper presents a nonlinear dynamic model for simulation and analysis of a kind of parametrically excited vibration of stay cable caused by support motion in cable-stayed bridges. The sag, inclination angle of the stay cable are considered in the model, based on which, the oscillation mechanism and dynamic response characteristics of this kind of vibration are analyzed through numerical calculation. It is noted that parametrically excited oscillation of a stay cable with certain sag, inclination angle and initial static tension force may occur in cable-stayed bridges due to deck vibration under the condition that the natural frequency of a cable approaches to about half of the first model frequency of the bridge deck system. A new vibration control system installed on the cable anchorage is proposed as a possible damping system to suppress the cable parametric oscillation. The numerical calculation results showed that with the use of this damping system, the cable oscillation due to the vibration of the deck and/or towers will be considerably reduced.

Early Exercise in the Burn Intensive Care Unit Decreases Hospital Stay, Improves Mental Health, and Physical Performance

Science.gov (United States)

2016-10-01

of Hospitalization, Mental Health, and Physical Performance in Burned Patients DOCUMENTS: Protocol , Version Date: June 30, 2016 The UTMB...throughout hospital stay across the US and (Aim 2) outcomes in burn in- patients . Over 4 years, we will enroll 96 patients (24 per site; MP10 n=64 and...to be safe) and during the entire BICU, on ventilator and in- hospital stay in burn individuals. UTMB, UC-Davis and UTSW are enrolling patients . The

Modeling length of stay as an optimized two-dass prediction problem

NARCIS (Netherlands)

Verduijn, M.; Peek, N.; Voorbraak, F.; de Jonge, E.; de Mol, B. A. J. M.

2007-01-01

Objectives. To develop a predictive model for the outcome length of stay at the Intensive Care Unit (ICU LOS), including the choice of an optimal dichotomization threshold for this outcome. Reduction of prediction problems of this type of outcome to a two-doss problem is a common strategy to

Quality of life after stay in surgical intensive care unit.

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Abelha, Fernando J; Santos, Cristina C; Maia, Paula C; Castro, Maria A; Barros, Henrique

2007-07-24

In addition to mortality, Health Related Quality of Life (HRQOL) has increasingly been claimed as an important outcome variable. The aim of this study was to assess HRQOL and independence in activities of daily living (ADL) six months after discharge from an Intensive Care Unit (ICU), and to study its determinants. All post-operative adult patients admitted to a surgical ICU between October 2004 and July 2005, were eligible for the study. The following variables were recorded on admission: age, gender, American Society of Anesthesiologists physical status (ASA-PS), type and magnitude of surgical procedure, ICU and hospital length of stay (LOS), mortality and Simplified Acute Physiology Score II (SAPS II). Six months after discharge, a Short Form-36 questionnaire (SF-36) and a questionnaire to assess dependency in ADL were sent to all survivors. Descriptive statistics was used to summarize data. Patient groups were compared using non-parametric tests. A logistic regression analysis was performed to identify covariate effects of each variable on dependency in personal and instrumental ADL, and for the change-in-health question of SF-36. Out of 333 hospital survivors, 226 completed the questionnaires. Fifty-nine percent reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients with greater co-morbidities (ASA-PS III/IV), had lower SF-36 scores in all domains and were more frequently dependent in instrumental and personal ADL. Logistic regression showed that SAPS II was associated with changes in general level of health (OR 1.06, 95%CI, 1.01-1.11, p = 0,016). Six months after ICU discharge, 60% and 34% of patients, respectively, were dependent in at least one activity in instrumental ADL (ADLI) and personal ADL (ADLP). ASA-PS (OR 3.00, 95%CI 1.31-6.87, p = 0.009) and age (OR 2.36, 95%CI, 1.04-5.34, p = 0.04) were associated with dependency in ADLI. For ADLP, only ASA-PS (OR 4.58, 95%CI, 1

[Length of stay in patients admitted for acute heart failure].

Science.gov (United States)

Martín-Sánchez, Francisco Javier; Carbajosa, Virginia; Llorens, Pere; Herrero, Pablo; Jacob, Javier; Miró, Òscar; Fernández, Cristina; Bueno, Héctor; Calvo, Elpidio; Ribera Casado, José Manuel

2016-01-01

To identify the factors associated with prolonged length of hospital stay in patients admitted for acute heart failure. Multipurpose observational cohort study including patients from the EAHFE registry admitted for acute heart failure in 25 Spanish hospitals. Data were collected on demographic and clinical variables and on the day and place of admission. The primary outcome was length of hospital stay longer than the median. We included 2,400 patients with a mean age of 79.5 (9.9) years; of these, 1,334 (55.6%) were women. Five hundred and ninety (24.6%) were admitted to the short stay unit (SSU), 606 (25.2%) to cardiology, and 1,204 (50.2%) to internal medicine or gerontology. The mean length of hospital stay was 7.0 (RIC 4-11) days. Fifty-eight (2.4%) patients died and 562 (23.9%) were readmitted within 30 days after discharge. The factors associated with prolonged length of hospital stay were chronic pulmonary disease; being a device carrier; having an unknown or uncommon triggering factor; the presence of renal insufficiency, hyponatremia and anaemia in the emergency department; not being admitted to an SSU or the lack of this facility in the hospital; and being admitted on Monday, Tuesday or Wednesday. The factors associated with length of hospital stay≤7days were hypertension, having a hypertensive episode, or a lack of treatment adherence. The area under the curve of the mixed model adjusted to the center was 0.78 (95% CI: 0.76-0.80; p<0.001). A series of factors is associated with prolonged length of hospital stay and should be taken into account in the management of acute heart failure. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

The Role of Preceptorship and Group Cohesion on Newly Licensed Registered Nurses' Satisfaction and Intent to Stay.

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Bontrager, Sarah; Hart, Patricia L; Mareno, Nicole

2016-03-01

Thirteen percent of newly licensed registered nurses (NLRNs) vacate their first job after 1 year, and 37% report that they feel ready to change jobs. Turnover can lead to consistent and detrimental nursing shortages in nursing units, as well as increased costs for health care systems. A descriptive, prospective, cross-sectional design was used to understand how preceptor role effectiveness and group cohesion affect NLRNs' satisfaction and intent to stay. NLRNs reported high levels of perceived preceptor role effectiveness, group cohesion, and job satisfaction, with only moderate levels of intent to stay. Statistically significant relationships were found among preceptor role effectiveness, job satisfaction, and intent to stay, as well as among group cohesion, job satisfaction, and intent to stay. Preceptor role effectiveness and group cohesion are predictors of NLRNs' level of job satisfaction. Job satisfaction is a predictor of NLRNs' intent to stay. Effective preceptors and positive group cohesion are factors that are important to NLRNs' job satisfaction and intent to stay. Copyright 2016, SLACK Incorporated.

Staying Active: Physical Activity and Exercise

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... Events Advocacy For Patients About ACOG Staying Active: Physical Activity and Exercise Home For Patients Search FAQs Staying ... Exercise FAQ045, November 2016 PDF Format Staying Active: Physical Activity and Exercise Women's Health What are the benefits ...

Histologia e ultraestrutura do rim e rim cefálico do pacu

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Gerlane M. Costa

2012-05-01

Full Text Available O pacu, Piaractus mesopotamicus, é um teleósteo da Família Characidae, intensivamente cultivado no Brasil devido sua rusticidade, crescimento rápido e fácil adaptação. O conhecimento morfológico dos sistemas corpóreos, incluído órgãos linfóide, se faz necessário, para uma melhor produção no cultivo de peixes, fornecendo subsídios na manutenção dos estoques. O objetivo deste estudo foi descrever morfologicamente o rim e rim cefálico de Piaractus mesopotamicus, analisando os perfis celulares de cada órgão com o uso de microscopia de luz e microscopia eletrônica de transmissão. O resultado da análise macroscópica mostrou que a localização do rim e rim cefálico são as mesmas encontradas na maioria dos teleósteos. O rim apresentou uma forma em "H", onde a região média se expandia sobre a bexiga natatória. O rim cefálico se apresentou como uma dilatação na região cranial do rim, mostrando-se bem visível. Na microscopia eletrônica de transmissão também foram observadas similaridades ultraestruturais com outros teleósteos. Observando nossos resultados concluímos que histologicamente e ultraestruturalmente, os órgãos linfóides rim e rim cefálico de Piaractus mesopotamicus são similares aos de outros teleósteos.

New-Onset Depression Following Hip Fracture Is Associated With Increased Length of Stay in Hospital and Rehabilitation Centers

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Anna C. Phillips

2015-05-01

Full Text Available This article examines the coincident effects of new-onset depression post hip fracture on length of hospital stay, readmission rates, and incidence of infections in older adults. Participants were 101 hip fracture patients aged 60+ years; 38 developed depressive symptoms following their fracture. Infection rates, readmissions to hospital and rehabilitation units, and length of hospital stay were assessed over the 6 months post hip fracture from hospital and general practitioner notes. Patients who developed depression by Week 6 post fracture were likely to spend more time in hospital/rehabilitation wards (p = .02 and more likely to be discharged to a rehabilitation unit (p < .05. There were no group differences in readmissions or infection rates. New-onset depression coincident with hip fracture in older adults is associated with longer hospital ward stays and greater need for rehabilitation.

Long-term consequences of an intensive care unit stay in older critically ill patients: design of a longitudinal study

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Hantikainen Virpi

2011-09-01

Full Text Available Abstract Background Modern methods in intensive care medicine often enable the survival of older critically ill patients. The short-term outcomes for patients treated in intensive care units (ICUs, such as survival to hospital discharge, are well documented. However, relatively little is known about subsequent long-term outcomes. Pain, anxiety and agitation are important stress factors for many critically ill patients. There are very few studies concerned with pain, anxiety and agitation and the consequences in older critically ill patients. The overall aim of this study is to identify how an ICU stay influences an older person's experiences later in life. More specific, this study has the following objectives: (1 to explore the relationship between pain, anxiety and agitation during ICU stays and experiences of the same symptoms in later life; and (2 to explore the associations between pain, anxiety and agitation experienced during ICU stays and their effect on subsequent health-related quality of life, use of the health care system (readmissions, doctor visits, rehabilitation, medication use, living situation, and survival after discharge and at 6 and 12 months of follow-up. Methods/Design A prospective, longitudinal study will be used for this study. A total of 150 older critically ill patients in the ICU will participate (ICU group. Pain, anxiety, agitation, morbidity, mortality, use of the health care system, and health-related quality of life will be measured at 3 intervals after a baseline assessment. Baseline measurements will be taken 48 hours after ICU admission and one week thereafter. Follow-up measurements will take place 6 months and 12 months after discharge from the ICU. To be able to interpret trends in scores on outcome variables in the ICU group, a comparison group of 150 participants, matched by age and gender, recruited from the Swiss population, will be interviewed at the same intervals as the ICU group. Discussion Little

A prospective observational study comparing a physiological scoring system with time-based discharge criteria in pediatric ambulatory surgical patients.

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Armstrong, James; Forrest, Helen; Crawford, Mark W

2015-10-01

Discharge criteria based on physiological scoring systems can be used in the postanesthesia care unit (PACU) to fast-track patients after ambulatory surgery; however, studies comparing physiological scoring systems with traditional time-based discharge criteria are lacking. The purpose of this study was to compare PACU discharge readiness times using physiological vs time-based discharge criteria in pediatric ambulatory surgical patients. We recorded physiological observations from consecutive American Society of Anesthesiologists physical status I-III patients aged 1-18 yr who were admitted to the PACU after undergoing ambulatory surgery in a tertiary academic pediatric hospital. The physiological score was a combination of the Aldrete and Chung systems. Scores were recorded every 15 min starting upon arrival in the PACU. Patients were considered fit for discharge once they attained a score ≥12 (maximum score, 14), provided no score was zero, with the time to achieve a score ≥12 defining the criteria-based discharge (CBD) time. Patients were discharged from the PACU when both the CBD and the existing time-based discharge (TBD) criteria were met. The CBD and TBD data were compared using Kaplan-Meier and log-rank analysis. Observations from 506 children are presented. Median (interquartile range [IQR]) age was 5.5 [2.8-9.9] yr. Median [IQR] CBD and TBD PACU discharge readiness times were 30 [15-45] min and 60 [45-60] min, respectively. Analysis of Kaplan-Meier curves indicated a significant difference in discharge times using the different criteria (hazard ratio, 5.43; 95% confidence interval, 4.51 to 6.53; P < 0.001). All patients were discharged home without incident. This prospective study suggests that discharge decisions based on physiological criteria have the potential for significantly speeding the transit of children through the PACU, thereby enhancing PACU efficiency and resource utilization.

The Effects of Cannabis on Inpatient Agitation, Aggression, and Length of Stay.

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Johnson, Joseph M; Wu, Chris Y; Winder, Gerald Scott; Casher, Michael I; Marshall, Vincent D; Bostwick, Jolene R

2016-01-01

This study examines the association between cannabis use and the hospital course of patients admitted to the psychiatric inpatient unit with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder. Many confounding variables potentially contribute to the clinical presentation of hospitalized patients in the psychiatric unit. Illicit drug use, in particular, has been associated with acute agitation, and questions can be raised as to what lasting effects drug use prior to admission may have throughout a patient's hospital stay. Subjects with a discharge diagnosis of bipolar disorder, schizophrenia, schizoaffective disorder, or psychosis not otherwise specified (N = 201) were retrospectively identified, and those with positive results of urine drug screen for cannabis on admission were compared to negative counterparts. Agitation and aggression were measured using an adaptation of the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC). These markers were also quantified by comparing charted episodes of restraint and seclusion and administration of as needed medications, such as benzodiazepines and antipsychotics. Positive urine drug screen results for cannabis was correlated with young (p = .001) males (p = .003) with bipolar disorder (p = .009) exhibiting active manic symptoms (p = .003) at the time of admission. Cannabis use was further associated with a shorter length of stay (p = .008), agitation triggering adapted PANSS-EC nursing assessments (p = .029), and oral medications as needed (p = .002) for agitation. Cannabis use, as defined by positive urine drug screen results, was more common in patients with bipolar disorder and was accompanied by a higher incidence of inpatient agitation. Although these patients also had short hospital lengths of stay, there was no clear relationship between level of agitation and length of stay across all patient groups. One possible explanation for patients with bipolar disorder

All tied up: Tied staying and tied migration within the United States, 1997 to 2007

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Thomas J. Cooke

2013-10-01

Full Text Available Background: The family migration literature presumes that women are cast into the role of the tied migrant. However, clearly identifying tied migrants is a difficult empirical task since it requires the identification of a counterfactual: Who moved but did not want to? Objective: This research develops a unique methodology to directly identify both tied migrants and tied stayers in order to investigate their frequency and determinants. Methods: Using data from the 1997 through 2009 U.S. Panel Study of Income Dynamics (PSID, propensity score matching is used to match married individuals with comparable single individuals to create counterfactual migration behaviors: who moved but would not have moved had they been single (tied migrants and who did not move but would have moved had they been single (tied stayers. Results: Tied migration is relatively rare and not limited just to women: rates of tied migration are similar for men and women. However, tied staying is both more common than tied migration and equally experienced by men and women. Consistent with the body of empirical evidence, an analysis of the determinants of tied migration and tied staying demonstrates that family migration decisions are imbued with gender. Conclusions: Additional research is warranted to validate the unique methodology developed in this paper and to confirm its results. One line of future research should be to examine the effects of tied staying, along with tied migration, on well-being, union stability, employment, and earnings.

Experience with day stay surgery.

Science.gov (United States)

Cohen, D; Keneally, J; Black, A; Gaffney, S; Johnson, A

1980-02-01

Potential advantages of day stay surgery are cost saving, improved utilization of staff and hospital facilities, and reduction of stress for the paediatric patient and his family. The successful program requires careful case selection, full operating and anesthetic facilities and good follow-up. Day stay surgery was initiated at Royal Alexandra Hospital for Children in 1974. Experience is reviewed in relation to the total number and nature of surgical admissions and the daily utilisation of the facility. Utilization has markedly increased in the past 2 yr. Current practice is reviewed with regard to initial assessment, preparation for surgery and overall management during the day admission. Parental attitudes towards day stay surgery were evaluated indicating both the advantages and the problems encountered. These related mainly to insufficient information, transport difficulties and afternoon operations. Recommendations for improving the day stay service are discussed with special reference to: (1) communication with the parents as to adequate pre-operative explanation, revision of the day stay information pamphlet and improved distribution, and clear postoperative instructions, (2) the timing of operations, and (3) transport and parking facilities.

Caffeine for the prevention of postoperative nausea and vomiting

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Richard A Steinbrook

2013-01-01

Statistical analysis: Statistical comparisons were tested using bivariable linear and logistic regression for each outcome and then adjusted for high/low risk. Results: Nausea in the postanesthesia care unit (PACU was more common in the caffeine (16 of 62 patients than the placebo group (seven of 69; P = 0.02. There were no significant differences in the use of rescue antiemetics in the PACU, in the incidence of nausea or vomiting over 24 h postoperatively, nor in other outcomes (headache, fatigue, or overall satisfaction either in the PACU or at 24 h; time-to-discharge was similar for both groups. Conclusion: Caffeine was not effective in the prevention of PONV or headache, and did not improve time-to-discharge or patient satisfaction.

Profit of solar energy for salting and drying of a brazilian fish Colossoma mitrei Berg, 1895; Utilizacao da energia solar para avaliacao da salga e secagem do pacu, Colossoma mitrei Berg, 1895

Energy Technology Data Exchange (ETDEWEB)

Sales, Ronaldo de Oliveira [1Ceara Univ., Fortaleza, CE (Brazil). Centro de Ciencias Agrarias; Beirao, Luiz Henrique [Santa Catarina Univ., Florianopolis, SC (Brazil). Dept. de Ciencias e Tecnologia de Alimentos

1986-12-01

This paper studied a simple method for processing dried-salted `pacu` fish. The average weight in relation to total weight was 58,6% and the result came very close to the average of weight of other dried salted fishes, when treated in same way. The main purpose of this process was to reduce the long time expanded by the conventional process, allowing to reduce the humidity of the dried-salted product from 56 to 43,5% in 28 hours only. (author) 20 refs., 3 figs., 8 tabs.

The impact of reducing intensive care unit length of stay on hospital costs: evidence from a tertiary care hospital in Canada.

Science.gov (United States)

Evans, Jessica; Kobewka, Daniel; Thavorn, Kednapa; D'Egidio, Gianni; Rosenberg, Erin; Kyeremanteng, Kwadwo

2018-02-23

To use theoretical modelling exercises to determine the effect of reduced intensive care unit (ICU) length of stay (LOS) on total hospital costs at a Canadian centre. We conducted a retrospective cost analysis from the perspective of one tertiary teaching hospital in Canada. Cost, demographic, clinical, and LOS data were retrieved through case-costing, patient registry, and hospital abstract systems of The Ottawa Hospital Data Warehouse for all new in-patient ward (30,483) and ICU (2,239) encounters between April 2012 and March 2013. Aggregate mean daily variable direct (VD) costs for ICU vs ward encounters were summarized by admission day number, LOS, and cost centre. The mean daily VD cost per ICU patient was $2,472 (CAD), accounting for 67.0% of total daily ICU costs per patient and $717 for patients admitted to the ward. Variable direct cost is greatest on the first day of ICU admission ($3,708), and then decreases by 39.8% to plateau by the fifth day of admission. Reducing LOS among patients with ICU stays ≥ four days could potentially result in an annual hospital cost saving of $852,146 which represents 0.3% of total in-patient hospital costs and 1.2% of ICU costs. Reducing ICU LOS has limited cost-saving potential given that ICU costs are greatest early in the course of admission, and this study does not support the notion of reducing ICU LOS as a sole cost-saving strategy.

Nurse practitioner coverage is associated with a decrease in length of stay in a pediatric chronic ventilator dependent unit

Science.gov (United States)

Rowan, Courtney M; Cristea, A Ioana; Hamilton, Jennifer C; Taylor, Nicole M; Nitu, Mara E; Ackerman, Veda L

2016-01-01

AIM: To hypothesize a dedicated critical care nurse practitioner (NP) is associated with a decreased length of stay (LOS) from a pediatric chronic ventilator dependent unit (PCVDU). METHODS: We retrospectively reviewed patients requiring care in the PCVDU from May 2001 through May 2011 comparing the 5 years prior to the 5 years post implementation of the critical care NP in 2005. LOS and room charges were obtained. RESULTS: The average LOS decreased from a median of 55 d [interquartile range (IQR): 9.8-108.3] to a median of 12 (IQR: 4.0-41.0) with the implementation of a dedicated critical care NP (P < 1.0001). Post implementation of a dedicated NP, a savings of 25738049 in room charges was noted over 5 years. CONCLUSION: Our data demonstrates a critical care NP coverage model in a PCVDU is associated with a significantly reduced LOS demonstrating that the NP is an efficient and likely cost-effective addition to a medically comprehensive service. PMID:27170929

Outcome and quality of life after aorto-bifemoral bypass surgery.

Science.gov (United States)

Abelha, Fernando J; Botelho, Miguela; Fernandes, Vera; Barros, Henrique

2010-03-18

Aorto-bifemoral bypass (AFB) is commonly performed to treat aorto-iliac disease and a durable long-term outcome is achieved. Most studies documenting beneficial outcomes after AFB have been limited to mortality and morbidity rates, costs and length of hospital stay (LOS). Few studies have examined the dependency of patients and how their perception of their own health changes after surgery. The aim of the present study was to evaluate outcome after AFB and to study its determinants. This retrospective study was carried out in the multidisciplinary Post-Anaesthesia Care Unit (PACU) with five intensive care beds. Out of 1597 intensive care patients admitted to the PACU, 75 were submitted to infrarenal AFB and admitted to these intensive care unit (ICU) beds over 2 years. Preoperative characteristics and outcome were evaluated by comparing occlusive disease with aneurysmatic disease patients. Six months after discharge, the patients were contacted to complete a Short Form-36 questionnaire (SF-36) and to have their dependency in Activities of Daily Living (ADL) evaluated. Patient's characteristics and postoperative follow-up data were compared using Mann-Whitney U test, t test for independent groups, chi-square or Fisher's exact test. Patient preoperative characteristics were evaluated for associations with mortality using a multiple logistic regression analysis. The mortality rate was 12% at six months. Multivariate analysis identified congestive heart disease and APACHE II as independent determinants for mortality. Patients submitted to AFB for occlusive disease had worse SF-36 scores in role physical and general health perception. Patients submitted to AFB had worse SF-36 scores for all domains than a comparable urban population and had similar scores to other PACU patients. Sixty-six percent and 23% of patients were dependent in at least one activity in instrumental and personal ADL, respectively, but 64% reported having better general health. This study shows that

Admission clinicopathological data, length of stay, cost and mortality in an equine neonatal intensive care unit

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M.N. Saulez

2007-06-01

Full Text Available Veterinary internists need to prognosticate patients quickly and accurately in a neonatal intensive care unit (NICU. This may depend on laboratory data collected on admission, the cost of hospitalisation, length of stay (LOS and mortality rate experienced in the NICU. Therefore, we conducted a retrospective study of 62 equine neonates admitted to a NICU of a private equine referral hospital to determine the prognostic value of venous clinicopathological data collected on admission before therapy, the cost of hospitalisation, LOS and mortality rate. The WBC count, total CO2 (TCO2 and alkaline phosphatase (ALP were significantly higher (P < 0.05 and anion gap lower in survivors compared with nonsurvivors. A logistic regression model that included WBC count, hematocrit, albumin / globulin ratio, ALP, TCO2, potassium, sodium and lactate, was able to correctly predict mortality in 84 % of cases. Only anion gap proved to be an independent predictor of neonatal mortality in this study. In the study population, the overall mortality rate was 34 % with greatest mortality rates reported in the first 48 hours and again on day 6 of hospitalisation. Amongst the various clinical diagnoses, mortality was highest in foals after forced extraction during correction of dystocia. Median cost per day was higher for nonsurvivors while total cost was higher in survivors.

Length of stay after vaginal birth: sociodemographic and readiness-for-discharge factors.

Science.gov (United States)

Weiss, Marianne; Ryan, Polly; Lokken, Lisa; Nelson, Magdalen

2004-06-01

The impact of reductions in postpartum length of stay have been widely reported, but factors influencing length of hospital stay after vaginal birth have received less attention. The study purpose was to compare the sociodemographic characteristics and readiness for discharge of new mothers and their newborns at 3 discharge time intervals, and to determine which variables were associated with postpartum length of stay. The study sample comprised 1,192 mothers who were discharged within 2 postpartum days after uncomplicated vaginal birth at a tertiary perinatal center in the midwestern United States. The sample was divided into 3 postpartum length-of-stay groups: group 1 (18-30 hr), group 2 (31-42 hr), and group 3 (43-54 hr). Sociodemographic and readiness-for-discharge data were collected by self-report and from a computerized hospital information system. Measures of readiness for discharge included perceived readiness (single item and Readiness for Discharge After Birth Scale), documented maternal and neonatal clinical problems, and feeding method. Compared with other groups, the longest length-of-stay group was older; of higher socioeconomic status and education; and with more primiparous, breastfeeding, white, married mothers who were living with the baby's father, had adequate home help, and had a private payor source. This group also reported greater readiness for discharge, but their newborns had more documented clinical problems during the postbirth hospitalization. In logistic regression modeling, earlier discharge was associated with young age, multiparity, public payor source, low socioeconomic status, lack of readiness for discharge, bottle-feeding, and absence of a neonatal clinical problem. Sociodemographic characteristics and readiness for discharge (clinical and perceived) were associated with length of postpartum hospital stay. Length of stay is an outcome of a complex interface between patient, provider, and payor influences on discharge timing

[Hospital length-of-stay after childbirth in France].

Science.gov (United States)

Coulm, B; Blondel, B

2013-02-01

To study hospital length-of-stay (LOS) after childbirth and its determinants and to describe home care offered after discharge. We studied 10,302 women with vaginal delivery from the 2010 French National Perinatal Survey. Maternal, newborn, maternity unit characteristics and the region of birth were considered. Simple and polytomial regression analyses were used to study determinants of postpartum LOS. Maternity units that offered routinely home visits by midwives after discharge were described. Around 29,0% of women had a LOS ≤ 3 days, with significant variations between regions. LOS ≤ 3 days was more common among multiparas and women who bottle-fed their newborn. In the Greater Parisian Region, LOS ≤ 3 days ranged from 16,6% in private units women who had a LOS ≤ 3 days, only 19,7% were in a unit, which offered home visits routinely. LOS varies mainly according to the place of delivery. The trends towards short LOS are likely to continue due to economic pressures and home care services should be developed to ensure continuity of care for all mothers after discharge. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Comprehensive stroke units: a review of comparative evidence and experience.

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Chan, Daniel K Y; Cordato, Dennis; O'Rourke, Fintan; Chan, Daniel L; Pollack, Michael; Middleton, Sandy; Levi, Chris

2013-06-01

Stroke unit care offers significant benefits in survival and dependency when compared to general medical ward. Most stroke units are either acute or rehabilitation, but comprehensive (combined acute and rehabilitation) model (comprehensive stroke unit) is less common. To examine different levels of evidence of comprehensive stroke unit compared to other organized inpatient stroke care and share local experience of comprehensive stroke units. Cochrane Library and Medline (1980 to December 2010) review of English language articles comparing stroke units to alternative forms of stroke care delivery, different types of stroke unit models, and differences in processes of care within different stroke unit models. Different levels of comparative evidence of comprehensive stroke units to other models of stroke units are collected. There are no randomized controlled trials directly comparing comprehensive stroke units to other stroke unit models (either acute or rehabilitation). Comprehensive stroke units are associated with reduced length of stay and greatest reduction in combined death and dependency in a meta-analysis study when compared to other stroke unit models. Comprehensive stroke units also have better length of stay and functional outcome when compared to acute or rehabilitation stroke unit models in a cross-sectional study, and better length of stay in a 'before-and-after' comparative study. Components of stroke unit care that improve outcome are multifactorial and most probably include early mobilization. A comprehensive stroke unit model has been successfully implemented in metropolitan and rural hospital settings. Comprehensive stroke units are associated with reductions in length of stay and combined death and dependency and improved functional outcomes compared to other stroke unit models. A comprehensive stroke unit model is worth considering as the preferred model of stroke unit care in the planning and delivery of metropolitan and rural stroke services

28 CFR 71.41 - Stay pending appeal.

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2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Stay pending appeal. 71.41 Section 71.41 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) IMPLEMENTATION OF THE PROVISIONS OF THE PROGRAM....41 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a...

5 CFR 185.141 - Stay pending appeal.

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2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Stay pending appeal. 185.141 Section 185.141 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PROGRAM FRAUD CIVIL REMEDIES § 185.141 Stay pending appeal. (a) An initial decision is stayed automatically pending...

22 CFR 224.41 - Stay pending appeal.

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2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Stay pending appeal. 224.41 Section 224.41 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT IMPLEMENTATION OF THE PROGRAM FRAUD CIVIL REMEDIES ACT § 224.41 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition...

40 CFR 27.41 - Stay pending appeal.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Stay pending appeal. 27.41 Section 27.41 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL PROGRAM FRAUD CIVIL REMEDIES § 27.41 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a...

10 CFR 1013.41 - Stay pending appeal.

Science.gov (United States)

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Stay pending appeal. 1013.41 Section 1013.41 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) PROGRAM FRAUD CIVIL REMEDIES AND PROCEDURES § 1013.41 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a motion for...

49 CFR 31.41 - Stay pending appeal.

Science.gov (United States)

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false Stay pending appeal. 31.41 Section 31.41 Transportation Office of the Secretary of Transportation PROGRAM FRAUD CIVIL REMEDIES § 31.41 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a motion for reconsideration...

Desempenho, enzimologia e metabolismo de juvenis de pacu (Piaractus mesopotamicus) alimentados com dietas peletizadas e extrusadas com níveis médio e alto de lipídeos e carboidratos

OpenAIRE

Claucia Aparecida Honorato da Silva

2008-01-01

O objetivo desse trabalho foi avaliar as respostas bioquímicas e metabólicas em adaptação ao processamento da dieta (peletizadas e extrusadas) contendo baixo e alto nível de carboidratos e lipídeos na alimentação do pacu Piaractus mesopotamicus. Foram analisadas as características das dietas, os índices de crescimento, a eficiência de retenção dos nutrientes e da energia, o perfil de ácidos graxos presentes no filé, o tempo de trânsito gastrointestinal, digestibilidade de proteína e da energi...

34 CFR 33.41 - Stay pending appeal.

Science.gov (United States)

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Stay pending appeal. 33.41 Section 33.41 Education Office of the Secretary, Department of Education PROGRAM FRAUD CIVIL REMEDIES ACT § 33.41 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a motion for...

22 CFR 521.41 - Stay pending appeal.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Stay pending appeal. 521.41 Section 521.41 Foreign Relations BROADCASTING BOARD OF GOVERNORS IMPLEMENTATION OF THE PROGRAM FRAUD CIVIL REMEDIES ACT § 521.41 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a...

22 CFR 35.41 - Stay pending appeal.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Stay pending appeal. 35.41 Section 35.41 Foreign Relations DEPARTMENT OF STATE CLAIMS AND STOLEN PROPERTY PROGRAM FRAUD CIVIL REMEDIES § 35.41 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a motion for...

6 CFR 13.41 - Stay pending appeal.

Science.gov (United States)

2010-01-01

... 6 Domestic Security 1 2010-01-01 2010-01-01 false Stay pending appeal. 13.41 Section 13.41 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY PROGRAM FRAUD CIVIL REMEDIES § 13.41 Stay pending appeal. (a) An Initial Decision is stayed automatically pending disposition of a...

45 CFR 79.41 - Stay pending appeal.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Stay pending appeal. 79.41 Section 79.41 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.41 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a...

[Business travel and staying abroad].

Science.gov (United States)

Holdener, F; Stahel, E

1989-11-01

The growing internationalization of business and the economy is leading more and more working people to spend short or even long stays abroad. With fast journeys across several time zones, travellers are mainly confronted with problems of time difference adjustment, commonly known as "jet lag". For longer stays, especially when the family comes along too, a number of additional difficulties may arise which are not normally faced by tourists. People's physical ability to tolerate a long stay in the tropics is rarely questioned nowadays, except in cases of serious physical illness. However, the effects of such stays on an individual's psychological condition are receiving increasing attention. Inoculations and advice are largely determined by the epidemiology of infectious diseases and the medical infrastructure of the country of destination. Death caused by illness can almost always be avoided through the appropriate prophylaxis and/or therapy. Unfortunately, the same does not apply to accidents. The local medical infrastructure in the larger cities of the developing countries and the range of flights available for sick and injured people are continually improving with a few exceptions.

Effects of multimedia nursing education on disease-related depression and anxiety in patients staying in a coronary intensive care unit.

Science.gov (United States)

Demircelik, Muhammed Bora; Cakmak, Muzaffer; Nazli, Yunus; Şentepe, Esra; Yigit, Derya; Keklik, Mevlude; Arslan, Muzeyyen; Cetin, Mustafa; Eryonucu, Beyhan

2016-02-01

We evaluated the effectiveness of an accessibility-enhanced multimedia informational educational program in reducing depression and anxiety increasing satisfaction with the information and materials received by patients in coronary care unit. We selected 100 patients from among the patients who stayed at or who underwent surgery at one of two ICUs for any reason who satisfied the eligibility criteria, and agreed to participate in the research. The participants were included in the control or experimental group by random selection. The patients completed the Hospital Anxiety Depression Scale during ICU admission and 1week after hospital discharge. The difference in HADSA score was significantly greater in patients who received education than in patients who did not receive multimedia nursing education (4.2±0.58 vs. 0.6±0.42; pnursing education (2.2±0.53 vs. 0.64±0.46; pdepression associated with hospital can be reduced with multimedia nursing education. Copyright © 2015 Elsevier Inc. All rights reserved.

17 CFR 201.401 - Consideration of stays.

Science.gov (United States)

2010-04-01

... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Consideration of stays. 201... PRACTICE Rules of Practice Appeal to the Commission and Commission Review § 201.401 Consideration of stays... consideration. Where the action complained of has already taken effect and the motion for stay is filed within...

10 CFR 13.41 - Stay pending appeal.

Science.gov (United States)

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Stay pending appeal. 13.41 Section 13.41 Energy NUCLEAR REGULATORY COMMISSION PROGRAM FRAUD CIVIL REMEDIES § 13.41 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a motion for reconsideration or of an appeal to the authority...

43 CFR 35.41 - Stay pending appeal.

Science.gov (United States)

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Stay pending appeal. 35.41 Section 35.41... CLAIMS AND STATEMENTS § 35.41 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a motion for reconsideration or of an appeal to the Secretary. (b) No...

15 CFR 25.41 - Stay pending appeal.

Science.gov (United States)

2010-01-01

... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Stay pending appeal. 25.41 Section 25.41 Commerce and Foreign Trade Office of the Secretary of Commerce PROGRAM Fraud Civil Remedies § 25.41 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a...

38 CFR 42.41 - Stay pending appeal.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Stay pending appeal. 42...) STANDARDS IMPLEMENTING THE PROGRAM FRAUD CIVIL REMEDIES ACT § 42.41 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a motion for reconsideration or of an appeal to the...

12 CFR 308.540 - Stay pending appeal.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Stay pending appeal. 308.540 Section 308.540... PRACTICE AND PROCEDURE Program Fraud Civil Remedies and Procedures § 308.540 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a motion for reconsideration or of an...

Emergency Department Length of Stay for Critical Care Admissions. A Population-based Study.

Science.gov (United States)

Rose, Louise; Scales, Damon C; Atzema, Clare; Burns, Karen E A; Gray, Sara; Doing, Christina; Kiss, Alex; Rubenfeld, Gordon; Lee, Jacques S

2016-08-01

Hospital emergency department (ED) strain is common in North America. Excessive strain may result in prolonged ED length of stay and may lead to worse outcomes for patients admitted to intensive care units (ICUs). To describe patient, ED, and hospital characteristics associated with prolonged ED length of stay for adult patients admitted from EDs to ICUs. We conducted a population-based cohort study in the Province of Ontario, Canada, including patients admitted to an adult ICU from an ED and excluding only interhospital transfers and scheduled visits. Using regression modeling, we examined associations between patient- and hospital-level characteristics and two ED performance measures: length of stay in the ED of more than 6 hours and 90-day mortality. From April 2007 to March 2012, 261,274 adults presented to 118 EDs in Ontario, generating 314,836 ICU admissions. This activity represented 4.1% of all adult ED visits (incidence, 1,374 ICU admissions/100,000 ED visits). Median (interquartile range) ED length of stay was 7 (4-13) hours. Less than half (41.4%; 95% confidence interval [CI], 41.2-41.5) of these patients had an ED length of stay of 6 hours or less, whereas 10.5% (95% CI, 10.4-10.6) stayed 24 hours or longer. Hospital characteristics associated with ED length of stay more than 6 hours included shift-level ED crowding (mean length of stay of patients of similar acuity registering during same 8 h epoch) (odds ratio [OR], 1.19/h; 95% CI, 1.19-1.19), ED annual visit volume (OR, 1.01/1,000 patients; 95% CI, 1.01-1.01), time of ED presentation (00:00-07:59) (OR, 1.41; 95% CI, 1.38-1.45), and ICU functioning at greater than 20% above the average annual census (OR, 1.10; 95% CI, 1.08-1.12). ED length of stay more than 6 hours was not associated with 90-day mortality after adjustment for selected confounders (OR, 0.99; 95% CI, 0.97-1.02). In this population-based study, less than half of adult ED patients were admitted to an ICU 6 hours or less after arrival to

14 CFR 1264.140 - Stay pending appeal.

Science.gov (United States)

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Stay pending appeal. 1264.140 Section 1264... FRAUD CIVIL PENALTIES ACT OF 1986 § 1264.140 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a motion for reconsideration or of an appeal to the authority head. (b) No...

20 CFR 355.41 - Stay pending appeal.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Stay pending appeal. 355.41 Section 355.41... REGULATIONS UNDER THE PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 § 355.41 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a motion for reconsideration or of an appeal to the...

7 CFR 1.340 - Stay pending appeal.

Science.gov (United States)

2010-01-01

... 7 Agriculture 1 2010-01-01 2010-01-01 false Stay pending appeal. 1.340 Section 1.340 Agriculture... Hearings Under the Program Fraud Civil Remedies Act of 1986 § 1.340 Stay pending appeal. (a) A decision is stayed automatically pending disposition of a motion for reconsideration or of an appeal to the judicial...

Length of stay of general psychiatric inpatients in the United States: systematic review.

LENUS (Irish Health Repository)

Tulloch, Alex D

2011-05-01

Psychiatric length of stay (LOS) has reduced but is still longer than for physical disorders. Inpatient costs are 16% of total mental health spending. Regression analyses of the determinants of LOS for US adult psychiatric inpatients were systematically reviewed. Most studies predated recent LOS reductions. Psychosis, female gender and larger hospital size were associated with longer LOS, while discharge against medical advice, prospective payment, being married, being detained and either younger or middle age were associated with shorter LOS. Associations appeared consistent, especially where sample size was above 3,000. Updated studies should be adequately powered and include the variables above.

Combined Sciatic and Lumbar Plexus Nerve Blocks for the Analgesic Management of Hip Arthroscopy Procedures: A Retrospective Review.

Science.gov (United States)

Jaffe, J Douglas; Morgan, Theodore Ross; Russell, Gregory B

2017-06-01

Hip arthroscopy is a minimally invasive alternative to open hip surgery. Despite its minimally invasive nature, there can still be significant reported pain following these procedures. The impact of combined sciatic and lumbar plexus nerve blocks on postoperative pain scores and opioid consumption in patients undergoing hip arthroscopy was investigated. A retrospective analysis of 176 patients revealed that compared with patients with no preoperative peripheral nerve block, significant reductions in pain scores to 24 hours were reported and decreased opioid consumption during the post anesthesia care unit (PACU) stay was recorded; no significant differences in opioid consumption out to 24 hours were discovered. A subgroup analysis comparing two approaches to the sciatic nerve block in patients receiving the additional lumbar plexus nerve block failed to reveal a significant difference for this patient population. We conclude that peripheral nerve blockade can be a useful analgesic modality for patients undergoing hip arthroscopy.

Advanced pulse oximeter signal processing technology compared to simple averaging. II. Effect on frequency of alarms in the postanesthesia care unit.

Science.gov (United States)

Rheineck-Leyssius, A T; Kalkman, C J

1999-05-01

To determine the effect of a new pulse oximeter (Nellcor Symphony N-3000, Pleasanton, CA) with signal processing technique (Oxismart) on the incidence of false alarms in the postanesthesia care unit (PACU). Prospective study. Nonuniversity hospital. 603 consecutive ASA physical status I, II, and III patients recovering from general or regional anesthesia in the PACU. We compared the number of alarms produced by a recently developed "third"-generation pulse oximeter (Nellcor Symphony N-3000) with Oxismart signal processing technique and a conventional pulse oximeter (Criticare 504, Waukesha, WI). Patients were randomly assigned to either a Nellcor pulse oximeter or a Criticare with the signal averaging time set at either 12 or 21 seconds. For each patient the number of false (artifact) alarms was counted. The Nellcor generated one false alarm in 199 patients and 36 (in 31 patients) "loss of pulse" alarms. The conventional pulse oximeter with the averaging time set at 12 seconds generated a total of 32 false alarms in 17 of 197 patients [compared with the Nellcor, relative risk (RR) 0.06, confidence interval (CI) 0.01 to 0.25] and a total of 172 "loss of pulse" alarms in 79 patients (RR 0.39, CI 0.28 to 0.55). The conventional pulse oximeter with the averaging time set at 21 seconds generated 12 false alarms in 11 of 207 patients (compared with the Nellcor, RR 0.09, CI 0.02 to 0.48) and a total of 204 "loss of pulse" alarms in 81 patients (RR 0.40, CI 0.28 to 0.56). The lower incidence of false alarms of the conventional pulse oximeter with the longest averaging time compared with the shorter averaging time did not reach statistical significance (false alarms RR 0.62, CI 0.3 to 1.27; "loss of pulse" alarms RR 0.98, CI 0.77 to 1.3). To date, this is the first report of a pulse oximeter that produced almost no false alarms in the PACU.

29 CFR 22.41 - Stay pending appeal.

Science.gov (United States)

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Stay pending appeal. 22.41 Section 22.41 Labor Office of the Secretary of Labor PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 § 22.41 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a motion for reconsideration or of an appeal to the...

31 CFR 16.41 - Stay pending appeal.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Stay pending appeal. 16.41 Section 16... PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 § 16.41 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a motion for reconsideration or of an appeal to the authority head. (b) No...

Quality of life after carotid endarterectomy.

Science.gov (United States)

Abelha, Fernando José; Quevedo, Susana; Barros, Henrique

2008-11-20

Most studies documenting beneficial outcomes after carotid endarterectomy (CE) are limited to mortality and morbidity rates, costs, and length of hospital stay (LOS). Few have examined the dependency of patients and how they perceive their own health changes after surgery. The aim of the present study was to evaluate quality of life and independence in activities of daily living (ADL) and to study its determinants. Sixty-three patients admitted in the Post Anaesthesia Care Unit (PACU) after CE were eligible for this 14-month follow-up study. Patients were contacted 6 months after discharge to complete a Short Form-36 questionnaire (SF-36) and to have their dependency in ADL evaluated. Among 59 hospital survivors at 6 months follow-up, 43 completed the questionnaires. Sixty-three percent reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients had worse SF-36 scores for all domains except bodily pain than a general urban population, and comparison with a group of patients 6 months after surgical ICU discharge showed no differences. Six months after PACU discharge, the Lawton Instrumental Activities of ADL Scale and the Katz Index of ADL demonstrated higher dependency scores (5.9 +/- 2.2 versus 4.3 +/- 2.4 and 0.3 +/- 0.8 versus 0.6 +/- 0.9, p < 0.001 and p = 0.047). Sixty-five percent and 33% were dependent in at least one activity in instrumental and personal ADL, respectively. Patients dependent in at least one ADL task had higher Revised Cardiac Risk Index (RCRI) scores (1.0 versus 1.5, p = 0.017). After controlling for multiple comparisons, no significant differences were found. Patients undergoing CE have improved self-perception of quality of life despite being more dependent. Almost all their scores are worse than those in an urban population. We could identify no predictors of greater dependency in ADL tasks six months after PACU discharge.

Apolipoprotein E e4 allele does not increase the risk of early postoperative delirium after major surgery.

Science.gov (United States)

Abelha, Fernando José; Fernandes, Vera; Botelho, Miguela; Santos, Patricia; Santos, Alice; Machado, J C; Barros, Henrique

2012-02-01

BACKGROUND: A relationship between patients with a genetic predisposition to and those who develop postoperative delirium has not been yet determined. The aim of this study was to determine whether there is an association between apolipoprotein E epsilon 4 allele (APOE4) and delirium after major surgery. METHODS: Of 230 intensive care patients admitted to the post anesthesia care unit (PACU) over a period of 3 months, 173 were enrolled in the study. Patients' demographics and intra- and postoperative data were collected. Patients were followed for the development of delirium using the Intensive Care Delirium Screening Checklist, and DNA was obtained at PACU admission to determine apolipoprotein E genotype. RESULTS: Fifteen percent of patients developed delirium after surgery. Twenty-four patients had one copy of APOE4. The presence of APOE4 was not associated with an increased risk of early postoperative delirium (4% vs. 17%; P = 0.088). The presence of APOE4 was not associated with differences in any studied variables. Multivariate analysis identified age [odds ratio (OR) 9.3, 95% confidence interval (CI) 2.0-43.0, P = 0.004 for age ≥65 years), congestive heart disease (OR 6.2, 95% CI 2.0-19.3, P = 0.002), and emergency surgery (OR 59.7, 95% CI 6.7-530.5, P < 0.001) as independent predictors for development of delirium. The Simplified Acute Physiology Score II (SAPS II) and The Acute Physiology and Chronic Health Evaluation II (APACHE II) were significantly higher in patients with delirium (P < 0.001 and 0.008, respectively). Hospital mortality rates of these patients was higher and they had a longer median PACU stay. CONCLUSIONS: Apolipoprotein e4 carrier status was not associated with an increased risk for early postoperative delirium. Age, congestive heart failure, and emergency surgery were independent risk factors for the development of delirium after major surgery.

Fatores associados à maior mortalidade e tempo de internação prolongado em uma unidade de terapia intensiva de adultos Factors associated with increased mortality and prolonged length of stay in an adult intensive care unit

Directory of Open Access Journals (Sweden)

Ana Beatriz Francioso de Oliveira

2010-09-01

Full Text Available OBJETIVO: A unidade de terapia intensiva é sinônimo de gravidade e apresenta taxa de mortalidade entre 5,4% e 33%. Com o aperfeiçoamento de novas tecnologias, o paciente pode ser mantido por longo período nessa unidade, ocasionando altos custos financeiros, morais e psicológicos para todos os envolvidos. O objetivo do presente estudo foi avaliar os fatores associados à maior mortalidade e tempo de internação prolongado em uma unidade de terapia intensiva adulto. MÉTODOS: Participaram deste estudo todos os pacientes admitidos consecutivamente na unidade de terapia intensiva de adultos, clínica/cirúrgica do Hospital das Clínicas da Universidade Estadual de Campinas, no período de seis meses. Foram coletados dados como: sexo, idade, diagnóstico, antecedentes pessoais, APACHE II, dias de ventilação mecânica invasiva, reintubação orotraqueal, traqueostomia, dias de internação na unidade de terapia intensiva, alta ou óbito na unidade de terapia intensiva. RESULTADOS: Foram incluídos no estudo 401 pacientes, sendo 59,6% homens e 40,4% mulheres, com idade média de 53,8±18,0 anos. A média de internação na unidade de terapia intensiva foi de 8,2±10,8 dias, com taxa de mortalidade de 13,46%. Dados significativos para mortalidade e tempo de internação prolongado em unidade de terapia intensiva (p11, traqueostomia e reintubação. CONCLUSÃO: APACHE >11, traqueostomia e reintubação estiveram associados, neste estudo, à maior taxa de mortalidade e tempo de permanência prolongado em unidade de terapia intensiva.OBJECTIVE: The intensive care unit is synonymous of high severity, and its mortality rates are between 5.4 and 33%. With the development of new technologies, a patient can be maintained for long time in the unit, causing high costs, psychological and moral for all involved. This study aimed to evaluate the risk factors for mortality and prolonged length of stay in an adult intensive care unit. METHODS: The study

The contribution of maternal psychological functioning to infant length of stay in the Neonatal Intensive Care Unit

Directory of Open Access Journals (Sweden)

Cherry AS

2016-06-01

Full Text Available Amanda S Cherry,1 Melissa R Mignogna,1 Angela Roddenberry Vaz,1 Carla Hetherington,2 Mary Anne McCaffree,2 Michael P Anderson,3 Stephen R Gillaspy1 1Section of General and Community Pediatrics, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 2Neonatal Perinatal Medicine, Department of Pediatrics, University of Oklahoma, College of Medicine, Oklahoma City, OK, 3Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, College of Public Health, Oklahoma City, OK, USA Objective: Assess maternal psychological functioning within the Neonatal Intensive Care Unit (NICU and its contribution to neonate length of stay (LOS in the NICU.Study design: Mothers of infants admitted to the NICU (n=111 were assessed regarding postpartum depression, postpartum social support, postpartum NICU stress, and maternal anxiety at 2 weeks postpartum. Illness severity was assessed with the Clinical Risk Index for Babies (CRIB.Results: Postpartum depression was not significantly correlated with LOS, but was significantly correlated with trait anxiety (r=0.620, which was significantly correlated with LOS (r=0.227. Among mothers with previous mental health history, substance abuse history and CRIB score were the best predictors of LOS. For mothers without a prior mental health issues, delivery type, stress associated with infant appearance, and CRIB scores were the best predictors of LOS. In this group, LOS was found to increase on average by 7.06 days per one unit increase in stress associated with infant appearance among mothers with the same delivery type and CRIB score.Conclusion: Significant correlations of trait anxiety, stress associated with infant appearance, and parental role with LOS support the tenet that postpartum psychological functioning can be associated with NICU LOS. Keywords: NICU, postpartum depression, postpartum anxiety, parental stress, CRIB

4 CFR 28.133 - Stay proceedings.

Science.gov (United States)

2010-01-01

... GOVERNMENT ACCOUNTABILITY OFFICE GENERAL PROCEDURES GOVERNMENT ACCOUNTABILITY OFFICE PERSONNEL APPEALS BOARD; PROCEDURES APPLICABLE TO CLAIMS CONCERNING EMPLOYMENT PRACTICES AT THE GOVERNMENT ACCOUNTABILITY OFFICE Corrective Action, Disciplinary and Stay Proceedings § 28.133 Stay proceedings. (a) Prior to the effective...

Effectiveness of Advanced Stay Strong, Stay Healthy in Community Settings

Directory of Open Access Journals (Sweden)

Emily M. Crowe MS

2015-07-01

Full Text Available The goal of this research was to investigate the effectiveness of the 10-week, University of Missouri (MU Extension strength training program Advanced Stay Strong, Stay Healthy (ASSSH. It was hypothesized that the program can improve strength, balance, agility, and flexibility—all physical measures of falling among seniors. Matched pair t tests were used to compare differences in five physical measures of health, body composition, and percent body fat (%BF. Two-way ANOVA was conducted to examine the age effects on changes in physical health from the start and finish of the exercise program. Following programming, participants significantly improved strength, flexibility, and balance, and significantly reduced %BF ( p < .05. Our data indicate that ASSSH can improve the physical health of senior citizens and can successfully be translated into community practice by MU Extension professionals.

Genetic diversity of pacu and piapara broodstocks in restocking programs in the rivers Paraná and Paranapanema (Brazil

Directory of Open Access Journals (Sweden)

Nelson Mauricio Lopera-Barrero

2016-09-01

Full Text Available The genetic diversity of Piaractus mesopotamicus (pacu and Leporinus elongatus (piapara broodstocks used in restocking programs in the rivers Paraná and Paranapanema is analyzed. One hundred and twenty specimens (two broodstocks of each species from fish ponds in Palotina PR Brazil and in Salto Grande SP Brazil were assessed. Ten primers produced 96 fragments, comprising 68 (70.83% and 94 (97.92% polymorphic fragments for P. mesopotamicus and L. elongatus broodstocks, respectively. Differences (p < 0.05 in the frequency of 15 and 27 fragments were detected for each species, without exclusive fragments. Shannon Index (0.347 - 0.572 and the percentage of polymorphic fragments (57.3% - 94.8% revealed high intra-population genetic variability for all broodstocks. Results of molecular variance analyses (AMOVA showed that most variations do not lie between the broodstocks but within each broodstock (89%. Genetic (0.088 and 0.142 and identity (0.916 and 0.868 distance rates demonstrated similarity between the broodstocks of each species, corroborated by Fst (0.1023 and 010.27 and Nm (4.18 and 4.33 rates, with a slight genetic difference due to genic flux. High intrapopulation genetic variability and similarity between the broodstocks of each species was also detected, proving a common ancestry.

17 CFR 10.106 - Reconsideration; stay pending judicial review.

Science.gov (United States)

2010-04-01

... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Reconsideration; stay pending... COMMISSION RULES OF PRACTICE Appeals to the Commission; Settlements § 10.106 Reconsideration; stay pending... operate to stay the effective date of the Commission's order. (b) Stay pending judicial appeal—(1...

Staying Power of Churn Prediction Models

NARCIS (Netherlands)

Risselada, Hans; Verhoef, Peter C.; Bijmolt, Tammo H. A.

In this paper, we study the staying power of various churn prediction models. Staying power is defined as the predictive performance of a model in a number of periods after the estimation period. We examine two methods, logit models and classification trees, both with and without applying a bagging

Prediction of immediate postoperative pain using the analgesia/nociception index: a prospective observational study.

Science.gov (United States)

Boselli, E; Bouvet, L; Bégou, G; Dabouz, R; Davidson, J; Deloste, J-Y; Rahali, N; Zadam, A; Allaouchiche, B

2014-04-01

The analgesia/nociception index (ANI) is derived from heart rate variability, ranging from 0 (maximal nociception) to 100 (maximal analgesia), to reflect the analgesia/nociception balance during general anaesthesia. This should be correlated with immediate postoperative pain in the post-anaesthesia care unit (PACU). The aim of this study was to evaluate the performance of ANI measured at arousal from general anaesthesia to predict immediate postoperative pain on arrival in PACU. Two hundred patients undergoing ear, nose, and throat or lower limb orthopaedic surgery with general anaesthesia using an inhalational agent and remifentanil were included in this prospective observational study. The ANI was measured immediately before tracheal extubation and pain intensity was assessed within 10 min of arrival in PACU using a 0-10 numerical rating scale (NRS). The relationship between ANI and NRS was assessed using linear regression. A receiver-operating characteristic (ROC) curve was used to evaluate the performance of ANI to predict NRS>3. A negative linear relationship was observed between ANI immediately before extubation and NRS on arrival in PACU. Using a threshold of 3 were both 86% with 92% negative predictive value, corresponding to an area under the ROC curve of 0.89. The measurement of ANI immediately before extubation after inhalation-remifentanil anaesthesia was significantly associated with pain intensity on arrival in PACU. The performance of ANI for the prediction of immediate postoperative pain is good and may assist physicians in optimizing acute pain management. ClinicalTrials.gov NCT01796249.

41 CFR 105-70.041 - Stay pending appeal.

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Stay pending appeal. 105... Administration 70-IMPLEMENTATION OF THE PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 § 105-70.041 Stay pending appeal. (a) An initial decision is stayed automatically pending disposition of a motion for reconsideration...

12 CFR 308.41 - Stays pending judicial review.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Stays pending judicial review. 308.41 Section... OF PRACTICE AND PROCEDURE Uniform Rules of Practice and Procedure § 308.41 Stays pending judicial... finds just, stay the effectiveness of all or any part of its order pending a final decision on a...

School Social Workers' Intent to Stay

Science.gov (United States)

Caselman, Tonia D.; Brandt, Mary D.

2007-01-01

This study presents findings from a survey that examined school social workers' intent to stay in the field of school social work. Forty-eight school social workers from a midwestern state participated in the study. Effect size estimates were used to examine the relationship between social workers' intent to stay and years of experience,…

Pharmacodynamic Comparison of Rocuronium Bromide between Patients from the Plateau Area and from the Plain Area.

Science.gov (United States)

Xie, Min; Huang, Jianxin; Li, Peng; Ou, Zhiyan; Hou, Jing

2016-06-23

We aimed to conduct a pharmacodynamic comparison of rocuronium bromide between patients from the plateau area and from the plain area. A total of 104 patients who received laparoscopic cholecystectomy in Sichuan Provincial People's Hospital and Aba Autonomous Prefecture People's Hospital from October 2015 to December 2015 were included in this study. Among them, 46 patients were from the plateau area and 58 were from the plain area. Both groups received total intravenous anesthesia (TIVA) with a dose of 0.6mg/kg rocuronium bromide during induction. In the meantime, neuromuscular block was monitored using a train-of-four (TOF) stimulation mode. The onset time (time to achieve the lowest TOF value after the injection of rocuronium bromide), duration of maximal neuromuscular block (duration of lowest T1 value), time to 25% recovery, time to 75% recovery, recovery index (time from 25% recovery to 75% recovery), time to extubation, length of stay in Post Anesthesia Care Unit (PACU) and muscle strength upon PACU discharge were all recorded. The onset time, time to 25% recovery, time to 75% recovery and time to extubation were all significantly prolonged in patients from the plateau area after receiving one single dose of rocuronium bromide (P0.05). Compared to patients from the plain area, patients from the plateau area showed prolonged onset time of rocuronium bromide, reduced metabolic capabilities and longer duration of muscular relaxation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Placebo controlled trial of zinc supplementation on duration of hospital stay in children with pneumonia

International Nuclear Information System (INIS)

Singh, A.K.; Iqbal, M.J.; Akhtar, R.; Afzal, M.F.

2012-01-01

Background: Pneumonia is one of the leading causes of morbidity and mortality in children younger than 5 years of age. Zinc may have an important protective role in cases of childhood pneumonia. Objectives: To study the effect of zinc supplementation on duration of hospital stay in children (6 months to 5 years) with pneumonia. Methodology: This Randomized control trial was conducted in the Department of Paediatrics Unit - I, King Edward Medical University / Mayo Hospital, Lahore from January to December 2011. After consent, 150 children from 6 months to 5 years of age with pneumonia consistent with WHO ARI definition along with crepitations on auscultation were registered by non-probability purposive sampling and were randomized into treatment group (Group A) and placebo group (Group B). Seventy five children supplemented with zinc for 14 days while 75 children were supplemented with placebo. Outcome measure was duration of hospital stay. T-test was used to compare the groups. Results: Out of total study population of 150, majority (35%) of children were below 2 years. There was male predominance (64%). Mean duration of hospital stay was significantly reduced in treatment group (p value < 0.05). Conclusion: Zinc supplementation results in statistically significant reduction in the duration of hospital stay in children (6 months to 5 years) with pneumonia. (author)

[Post-traumatic stress disorder-related to intensive care stay: influence of sedation practices].

Science.gov (United States)

Bauerheim, Nadège; Masseret, Elodie; Mercier, Emmanuelle; Dequin, Pierre-François; El-Hage, Wissam

2013-03-01

The stay in intensive care unit can be potentially traumatic at the origin of post-traumatic stress symptoms. The severity of post-traumatic stress symptoms is linked to the intensity and the type of traumatic memories of the intensive care stay. Sedatives and analgesics given to ventilated patients in intensive care influence the traumatic memory. The level, the duration and the type of sedation-analgesia protocol are risk factors of post-traumatic stress symptoms. Links between sedation, dissociative symptoms, delirium and post-traumatic stress symptoms are documented. Environmental and pharmacological measures are to be considered to reduce the traumatic potential risk of the intensive care. Intensive care caregivers, liaison-psychiatrist and general practitioner have each a specific role to play in the screening of the post-traumatic stress symptoms. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Processamento da carne do pacu (Piaractus mesopotamicus cultivado em tanques-rede no reservatório de Itaipu - DOI: 10.4025/actascianimsci.v29i4.1018 Processing of pacu (Piaractus mesopotamicus meat from net cage farming in the Itaipu reservoir - DOI: 10.4025/actascianimsci.v29i4.1018

Directory of Open Access Journals (Sweden)

Beatriz Cristina Bencke

2008-03-01

Full Text Available O trabalho objetivou avaliar as características morfométricas, bromatológicas e o rendimento de cortes da carne do pacu (Piaractus mesopotamicus, cultivados em tanques-rede. Utilizaram-se 45 animais, distribuídos em três tratamentos e 15 repetições cada uma. Os tratamentos constituíram-se de animais alimentados com ração extrusada comercial (REC, resíduos de vegetal cozido (RPV e resíduos cozidos de produção pesqueira (RPP. Realizaram-se as medidas individuais dos animais de comprimento-padrão (CP, comprimento total (CT, comprimento da cabeça (CC, altura da cabeça (AC, largura do tronco (LT, comprimento do tronco (CTR, altura do tronco (AT e, a partir delas, avaliaram-se as relações morfométricas de CC/CP, CC/AC, CP/CT, LT/CTR, LT/AT e AT/CTR. Avaliaram-se os rendimentos: carcaça (RCARC, tronco limpo (TL, musculatura dorsal (MD, filé (FL, costelas (COST, nadadeiras (NAD, gordura visceral (GVISC, pele com escamas (PELE, e os teores de umidade (UM, matéria mineral (MM, proteína bruta (PB e extrato etéreo (EE dos diferentes cortes. Observaram-se maiores resultados (p This work was carried out to evalue the morphometric and chemical characteristics, as well as the meat cut yields from pacu (Piaractus mesopotamicus reared in net cages. Forty-five specimens were used, distributed in three treatments and 15 replications. The treatments consisted of animals fed with commercial extruded ration (CER, vegetal by-products (VBP and fishery by-products (FBP. Individual morphometric characteristics were measures in terms of standard length (SL, total length (TL, head length (HL head height (HH, body width (BW, body lenght (BL, body height (BH, to evaluate the morphometric ratio of HL/SL, HL/HH, SL/TL, BW/BL, BW/BH and BH/BL. Next, the carcass (CARC, clean body (CB, dorsal muscle (DM, fillet (FL, ribs (RIB, fin (FIN, visceral fat (VISCF, skin with scales (SKIN, as well as the levels of moisture (M, ash (ASH, crude protein (CPB and fat

Risk of postoperative hypoxemia in ambulatory orthopedic surgery patients with diagnosis of obstructive sleep apnea: a retrospective observational study

Directory of Open Access Journals (Sweden)

Ma Yan

2010-06-01

Full Text Available Abstract Background It is unclear when it is safe to discharge patients with a diagnosis of Obstructive Sleep Apnea (OSA after ambulatory surgical procedures due to concern for postoperative respiratory compromise and hypoxemia. Our OSA patients undergoing ambulatory-type orthopedic procedures are monitored overnight in the PACU, thus we reviewed patient records to determine incidence of complications. Methods Two hundred and six charts of patients with preoperative diagnosis of OSA based on ICD-9 codes were reviewed for outcomes including episodes of hypoxemia. Univariate analysis followed by logistic regression and propensity analysis was performed to determine independent risk factors for hypoxemia and association with adverse outcomes. Results The majority of patients had regional anesthesia (95%. Thirty four percent of patients had hypoxemia in the PACU. Initial risk factors for hypoxemia identified by univariate analysis were BMI ≥ 35, increased age, history of COPD, upper extremity procedure, and use of peripheral nerve block. Independent risk factors identified by logistic regression were history of COPD (OR 3.64 with 95% CI 1.03-12.88 and upper extremity procedure (2.53, 1.36-4.68. After adjustment with propensity scores, adverse events were rare, and unplanned hospital admission after PACU stay was not increased with hypoxemia (11% vs 16% Conclusions Episodes of postoperative hypoxemia in OSA patients undergoing ambulatory surgery with regional anesthesia are not associated with increased adverse outcomes or unplanned hospital admission.

Impact on patient outcome of emergency department length of stay prior to ICU admission.

Science.gov (United States)

García-Gigorro, R; de la Cruz Vigo, F; Andrés-Esteban, E M; Chacón-Alves, S; Morales Varas, G; Sánchez-Izquierdo, J A; Montejo González, J C

2017-05-01

The favorable evolution of critically ill patients is often dependent on time-sensitive care intervention. The timing of transfer to the intensive care unit (ICU) therefore may be an important determinant of outcomes in critically ill patients. The aim of this study was to analyze the impact upon patient outcome of the length of stay in the Emergency Care Department. A single-center ambispective cohort study was carried out. A general ICU and Emergency Care Department (ED) of a single University Hospital. We included 269 patients consecutively transferred to the ICU from the ED over an 18-month period. Patients were first grouped into different cohorts based on ED length of stay (LOS), and were then divided into two groups: (a) ED LOS ≤5h and (b) ED LOS >5h. Demographic, diagnostic, length of stay and mortality data were compared among the groups. Median ED LOS was 277min (IQR 129-622). Patients who developed ICU complications had a longer ED LOS compared to those who did not (349min vs. 209min, p5h. The odds ratio of dying for patients with ED LOS >5h was 2.5 (95% CI 1.3-4.7). Age and sepsis diagnosis were the risk factors associated to prolongation of ED length of stay. A prolonged ED stay prior to ICU admission is related to the development of time-dependent complications and increased mortality. These findings suggest possible benefit from earlier ICU transfer and the prompt initiation of organ support. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Hyponatraemia in cancer patients on an inpatient rehabilitation unit.

Science.gov (United States)

Nelson, M; Palmer, J L; Fu, J; Williams, J L; Yadav, R; Guo, Y

2014-05-01

This study identifies the incidence of hyponatraemia in cancer patients on an inpatient rehabilitation unit and examines the association between admission hyponatraemia and rehabilitation length of stay (LOS), functional outcome, and survival. After institutional review committee's approval, we retrospectively reviewed medical records of 295 consecutive patients who were admitted to this inpatient cancer rehabilitation unit between 27 January 2009 through 31 July 2010 in a tertiary cancer centre. The incidence of hyponatraemia in cancer patients admitted to our inpatient rehabilitation unit was 41.4%. Median rehabilitation LOS for patients with mild (Na 130-134 mEq/L) and moderate-severe (Na rehabilitation stay was not significantly different between three different patient groups. We concluded that large portion of patients who require acute inpatient rehabilitation presented with hyponatraemia, which is associated with prolonged rehabilitation LOS. Whether aggressive management of hyponatraemia will shorten rehabilitation stay needs further study. © 2013 John Wiley & Sons Ltd.

Aloe vera enhances the innate immune response of pacu (Piaractus mesopotamicus) after transport stress and combined heat killed Aeromonas hydrophila infection.

Science.gov (United States)

Zanuzzo, Fábio S; Sabioni, Rafael E; Montoya, Luz Natalia F; Favero, Gisele; Urbinati, Elisabeth C

2017-06-01

In this study, pacu (Piaractus mesopotamicus) were fed with diets containing Aloe vera for 10 days prior to transport stress and infection with heat killed Aeromonas hydrophila. A. vera is popular around the world due to its medicinal properties, including immunostimulatory effects which was observed in this study. The results show that transport causes immunosuppression, an effect that was prevented by A. vera. Specifically, A. vera prevented reductions of both leukocyte respiratory burst and hemolytic activity of complement system caused by transport. Further, fish fed with A. vera also showed significantly higher leukocyte respiratory burst, serum lysozyme concentrations and activity of complement system 24 h after bacterial infection. Additionally, we observed that A. vera may modulate the innate response through activation of complement system during bacterial immune stimulation. In summary, A. vera extract enhanced innate immune parameters and consequently the ability of fish to cope with pathogens following transport stress. These findings show that A. vera has promise for use in aquaculture and add further evidence that medicinal herbs added to fish feed assist to prevent disease outbreaks. Copyright © 2017 Elsevier Ltd. All rights reserved.

Factors Affecting the Neonatal Intensive Care Unit Stay Duration in Very Low Birth Weight Premature Infants

OpenAIRE

Niknajad, Akram; Ghojazadeh, Morteza; Sattarzadeh, Niloufar; Bashar Hashemi, Fazileh; Dezham Khoy Shahgholi, Farid

2012-01-01

Introduction: Improved survival of very low birth weight (VLBW) premature infants requires urgent intensive care, professional nursing and medical care. On the other hand, long hospital stay period imposes emotional and economic burdens on the family and society. Therefore, it is necessary to clarify the most important factors affecting their hospitalization duration to lessen unwanted outcomes of premature birth and to eliminate or relieve the problems. Methods: In a descri...

Dynamic characteristics of stay cables with inerter dampers

Science.gov (United States)

Shi, Xiang; Zhu, Songye

2018-06-01

This study systematically investigates the dynamic characteristics of a stay cable with an inerter damper installed close to one end of a cable. The interest in applying inerter dampers to stay cables is partially inspired by the superior damping performance of negative stiffness dampers in the same application. A comprehensive parametric study on two major parameters, namely, inertance and damping coefficients, are conducted using analytical and numerical approaches. An inerter damper can be optimized for one vibration mode of a stay cable by generating identical wave numbers in two adjacent modes. An optimal design approach is proposed for inerter dampers installed on stay cables. The corresponding optimal inertance and damping coefficients are summarized for different damper locations and interested modes. Inerter dampers can offer better damping performance than conventional viscous dampers for the target mode of a stay cable that requires optimization. However, additional damping ratios in other vibration modes through inerter damper are relatively limited.

Parallel monostrand stay cable bending fatigue

DEFF Research Database (Denmark)

Winkler, Jan Pawel

This dissertation investigates the bending fatigue response of high-strength steel monostrands and multistrand stay cables to cyclic transverse deformations. Increasing bridge stock numbers and a push for longer cable-supported span lengths have led to an increased number of reported incidents...... of damage and replacement of bridge stay cables due to wind and traffic-induced fatigue. The understanding of fatigue mechanisms in most steel structures is well established. However, in the case of cables composed of steel strands, many important aspects related with bending fatigue remain to be clarified...... associated with variable loading, and different testing procedures. As most of the contemporary stay cables are comprised of a number of individual highstrength steel monostrands, the research study started with an extensive experimental work on the fatigue response of a single monostrand to cyclic flexural...

Impact of medical training and clinical experience on the assessment of oxygenation and hypoxaemia after general anaesthesia: an observational study.

Science.gov (United States)

Aust, Hansjörg; Kranke, Peter; Eberhart, Leopold H J; Afshari, Arash; Weber, Frank; Brieskorn, Melanie; Heine, Julian; Arndt, Christian; Rüsch, Dirk

2015-06-01

In Germany it is common practice to use pulse oximetry and supplementary oxygen only on request in patients breathing spontaneously transferred to the post-anaesthesia care unit (PACU) following surgery under general anaesthesia. The main aim was to study the influence of medical training and clinical experience on assessing SpO(2) and detecting hypoxaemia in these patients. The second aim was to do a preliminary assessment whether this practice can be found in countries other than Germany. Anaesthetists, nurses and medical students estimated SpO(2) in patients breathing room air at the end of transfer to the PACU following surgery (including all major surgical fields) under general anaesthesia. Estimated SpO(2) was compared to SpO(2) measured by pulse oximetry. A survey was carried out among European anaesthesists concerning the use of pulse oximetry and supplementary oxygen during patient transfer to the PACU. Hypoxaemia (SpO(2) < 90 %) occurred in 154 (13.5 %) out of 1,138 patients. Anaesthetists, nurses, and medical students identified only 25, 23, and 21 patients of those as being hypoxaemic, respectively. Clinical experience did not improve detection of hypoxaemia both in anaesthetists (p = 0.63) and nurses (p = 0.18). Use of pulse oximetry and supplemental oxygen during patient transfer to the PACU in European countries differs to a large extent. It seems to be applied only on request in many hospitals. Considering the uncertainty about deleterious effects of transient, short lasting hypoxaemia routine use of pulse oximetry is advocated for patient transfer to the PACU.

Effects of Modification of Pain Protocol on Incidence of Post Operative Nausea and Vomiting.

Science.gov (United States)

Schwarzkopf, Ran; Snir, Nimrod; Sharfman, Zachary T; Rinehart, Joseph B; Calderon, Michael-David; Bahn, Esther; Harrington, Brian; Ahn, Kyle

2016-01-01

A Perioperative Surgical Home (PSH) care model applies a standardized multidisciplinary approach to patient care using evidence-based medicine to modify and improve protocols. Analysis of patient outcome measures, such as postoperative nausea and vomiting (PONV), allows for refinement of existing protocols to improve patient care. We aim to compare the incidence of PONV in patients who underwent primary total joint arthroplasty before and after modification of our PSH pain protocol. All total joint replacement PSH (TJR-PSH) patients who underwent primary THA (n=149) or TKA (n=212) in the study period were included. The modified protocol added a single dose of intravenous (IV) ketorolac given in the operating room and oxycodone immediate release orally instead of IV Hydromorphone in the Post Anesthesia Care Unit (PACU). The outcomes were (1) incidence of PONV and (2) average pain score in the PACU. We also examined the effect of primary anesthetic (spinal vs . GA) on these outcomes. The groups were compared using chi-square tests of proportions. The incidence of post-operative nausea in the PACU decreased significantly with the modified protocol (27.4% vs . 38.1%, p=0.0442). There was no difference in PONV based on choice of anesthetic or procedure. Average PACU pain scores did not differ significantly between the two protocols. Simple modifications to TJR-PSH multimodal pain management protocol, with decrease in IV narcotic use, resulted in a lower incidence of postoperative nausea, without compromising average PACU pain scores. This report demonstrates the need for continuous monitoring of PSH pathways and implementation of revisions as needed.

Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting

Directory of Open Access Journals (Sweden)

Elayne Kelen de Oliveira

2013-09-01

Full Text Available INTRODUCTION: Characteristics of the patient and the coronary artery bypass grafting may predispose individuals to prolonged hospitalization, increasing costs and morbidity and mortality. OBJECTIVE: The objective of this study was to evaluate individual and perioperative risk factors of prolonged hospitalization in intensive care units and wards. METHODS: We conducted a case-control study of 104 patients undergoing isolated coronary artery bypass grafting with cardiopulmonary bypass. Patients hospitalized >3 days in the intensive care unit or >7 days in the ward were considered for the study. The association between variables was estimated by the chi-square test, odds ratio and logistic regression; P 3 days in the intensive care unit occurred for 22.1% of patients and >7 days in the ward for 27.9%. Among preoperative factors, diabetes (OR=3.17 and smoking (OR=4.07 were predictors of prolonged intensive care unit stay. Combining the pre-, intra-and postoperative variables, only mechanical ventilation for more than 24 hours (OR=6.10 was predictive of intensive care unit outcome. For the ward outcome, the preoperative predictor was left ventricular ejection fraction 24 hours for the intensive care unit and presence of infection for the ward.

Factors related to intention to stay in the current workplace among long-term care nurses: A nationwide survey.

Science.gov (United States)

Eltaybani, Sameh; Noguchi-Watanabe, Maiko; Igarashi, Ayumi; Saito, Yumiko; Yamamoto-Mitani, Noriko

2018-04-01

Keeping long-term care nurses employed is necessary to sustain the current and future demand for high-quality long-term care services. Understanding the factors relating to intention to stay among long-term care nurses is limited by the scarcity of studies in long-term care settings, lack of investigation of multiple factors, and the weakness of existing explanatory models. To identify the factors associated with long-term care nurses' intention to stay in their current workplace. A cross-sectional questionnaire survey. Two hundred and fifty-seven hospitals with long-term care wards across Japan. A total of 3128 staff nurses and 257 nurse managers from the long-term care wards of the participating hospitals. The questionnaire assessed nurses' intention to continue working in the current workplace as well as potential related factors, including individual factors (demographic data, reason for choosing current workplace, burnout, work engagement, somatic symptom burden) and unit factors (unit size, nurse-manager-related data, patients' medical acuity, average number of overtime hours, recreational activities, social support, perceived quality of care process, educational opportunities, feeling of loneliness, and ability to request days off). Multilevel logistic regression analysis was used to determine which variables best explained nurses' intention to stay in their workplace. Only 40.1% of the respondents reported wanting to continue working at their current workplace. The regression analysis revealed that long-term care nurses' intention to stay was positively associated with nurses' age (odds ratio [95% confidence interval]: 1.02 [1.01-1.03]), work engagement (1.24 [1.14-1.35]), getting appropriate support from nurse managers (2.78 [1.60-4.82]), perceived quality of care process (1.04 [1.01-1.06]), educational opportunities (1.06 [1.0-1.13]), and various specific reasons for choosing their workplace (e.g., a good workplace atmosphere, being interested in

Resource utilization for observation-status stays at children's hospitals.

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Fieldston, Evan S; Shah, Samir S; Hall, Matthew; Hain, Paul D; Alpern, Elizabeth R; Del Beccaro, Mark A; Harding, John; Macy, Michelle L

2013-06-01

Observation status, in contrast to inpatient status, is a billing designation for hospital payment. Observation-status stays are presumed to be shorter and less resource-intensive, but utilization for pediatric observation-status stays has not been studied. The goal of this study was to describe resource utilization characteristics for patients in observation and inpatient status in a national cohort of hospitalized children in the Pediatric Health Information System. This study was a retrospective cohort from 2010 of observation- and inpatient-status stays of ≤2 days; all children were admitted from the emergency department. Costs were analyzed and described. Comparison between costs adjusting for age, severity, and length of stay were conducted by using random-effect mixed models to account for clustering of patients within hospitals. Observation status was assigned to 67 230 (33.3%) discharges, but its use varied across hospitals (2%-45%). Observation-status stays had total median costs of $2559, including room costs and $678 excluding room costs. Twenty-five diagnoses accounted for 74% of stays in observation status, 4 of which were used for detailed analyses: asthma (n = 6352), viral gastroenteritis (n = 4043), bronchiolitis (n = 3537), and seizure (n = 3289). On average, after risk adjustment, observation-status stays cost $260 less than inpatient-status stays for these select 4 diagnoses. Large overlaps in costs were demonstrated for both types of stay. Variability in use of observation status with large overlap in costs and potential lower reimbursement compared with inpatient status calls into question the utility of segmenting patients according to billing status and highlights a financial risk for institutions with a high volume of pediatric patients in observation status.

Recall of intensive care unit stay in patients managed with a sedation protocol or a sedation protocol with daily sedative interruption: a pilot study.

Science.gov (United States)

Ethier, Cheryl; Burry, Lisa; Martinez-Motta, Carlos; Tirgari, Sam; Jiang, Depeng; McDonald, Ellen; Granton, John; Cook, Deborah; Mehta, Sangeeta

2011-04-01

Analgesics and sedatives are integral for the relief of pain and anxiety in critically ill patients. However, these agents may contribute to amnesia for intensive care unit (ICU) events; which has been associated with development of posttraumatic stress disorder. Drug administration strategies that minimize sedative use have been associated with less amnesia. The objective of this pilot study was to evaluate recall of ICU stay in patients managed with 2 sedation strategies: a sedation protocol or a combination of sedation protocol and daily sedative/analgesic interruption. A questionnaire was administered on day 3 following ICU discharge to evaluate patients' recollections of pain, anxiety, fear, and sleep, as well as memories for specific ICU procedures. Participants were ICU survivors who had been enrolled in SLEAP - a randomized pilot trial comparing two sedation strategies, at 3 university-affiliated medical/surgical ICUs. Twenty-one patients who regained orientation within 72 hours of ICU discharge completed the questionnaire. More than 50% of patients recalled experiencing pain, anxiety, and fear to a moderate or extreme extent; and 57% reported inadequate sleep while in the ICU. Of the 21 patients, 48%, 33%, and 29% had no memories of endotracheal tube suctioning, being on a "breathing machine," and being bathed, respectively. A notable percentage of patients discharged from the ICU report moderate to extreme pain, anxiety, and fear, and inability to sleep during their ICU stay; and 29% to 48% have no recall of specific ICU events. Copyright © 2011 Elsevier Inc. All rights reserved.

Using a Critical Incident Scenario With Virtual Humans to Assess Educational Needs of Nurses in a Postanesthesia Care Unit.

Science.gov (United States)

White, Casey; Chuah, Joon; Robb, Andrew; Lok, Benjamin; Lampotang, Samsun; Lizdas, David; Martindale, James; Pi, Guillermo; Wendling, Adam

2015-01-01

During critical incidents, teamwork failures can compromise patient safety. This study provides evidence that virtual humans can be used in simulated critical incidents to assess the learning needs of health professionals, and provide important information that can inform the development of continuing education programs in patient safety. We explored the effectiveness of information transfer during a devolving medical situation between postanesthesia care unit (PACU) nurses and a virtual attending physician. We designed a three-stage scenario: tutorial, patient transfer, and critical incident. We developed 2 checklists to assess information transfer: Critical Patient Information and Interprofessional Communication Skills. All participants were videotaped; 2 raters reviewed all videos and assessed performance using the checklists. Participants (n = 43) who completed all 3 stages scored 62.3% correct on critical patient information transfer and 61.6% correct on interprofessional communication skills. Almost 87% missed a fatal drug error. The checklists measured each item on a 1/0 (done/not) calculation. Additionally, no relationship was found between years of nursing experience and performance on either checklist. The PACU nurses in this study did not consistently share critical information with an attending (virtual) physician during a critical incident, and most missed a fatal dosage error. These findings strongly suggest a crucial need for additional structured team training among practicing health care teams, and they demonstrate the utility of using virtual humans to simulate team members. © 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

Sarcopenia is a risk factor for complications and an independent predictor of hospital length of stay in trauma patients.

Science.gov (United States)

DeAndrade, James; Pedersen, Mark; Garcia, Luis; Nau, Peter

2018-01-01

Sarcopenia is an independent risk factor for adverse outcomes in critically ill patients. The impact of sarcopenia on morbidity and length of stay in a trauma population has not been completely defined. This project evaluated the influence of sarcopenia on patients admitted to the trauma service. A retrospective review of 778 patients presenting as a trauma alert at a single institution from 2012-2014 was completed. Records were abstracted for comorbidities and hospital complications. The Hounsfield Unit Area Calculation was collected from admission computed tomography scans. Criteria for sarcopenia were based on the lowest 25th percentile of muscle density measurements. Relationships to patient outcomes were evaluated by univariate and multivariable regression or analyses of variance, when applicable. A total of 432 (55.6%) patients suffered a complication. Sarcopenia was associated with overall complications (P sarcopenia into a novel length of stay calculator showed increased prognostic ability for prolonged length of stay over Abbreviated Injury Scale alone (P = 0.0002). Sarcopenia is an independent risk factor for adverse outcomes and increased length of stay in trauma patients. Prognostic algorithms incorporating sarcopenia better predict hospital length of stay. Identification of patients at risk may allow for targeted interventions early in the patient's hospital course. Copyright © 2017 Elsevier Inc. All rights reserved.

CMS proposes to OK one-midnight inpatient stays.

Science.gov (United States)

2015-09-01

The Centers for Medicare & Medicaid Services (CMS) has proposed that stays shorter than two midnights be reimbursed as inpatient stays if the documentation in the medical record supports it. CMS made the proposal in the Outpatient Prospective Payment System proposed rule for 2016 and left the policy unchanged for stays of two midnights or longer. CMS also announced that the two Beneficiary and Family Centered Care Quality Improvement Organizations (QIOs), Livanta and KEPRO, will take over the responsibility of Probe and Educate and will review cases for medical necessity when patient stays are one midnight or less, referring hospitals with high denial rates to the Recovery Auditors. Case managers should continue to assist physicians in determining patient status and to make sure that the documentation is complete, accurate, and specifies the severity of illness.

Admissions to acute adolescent psychiatric units: a prospective study of clinical severity and outcome

Directory of Open Access Journals (Sweden)

Jensen Gunnar

2011-01-01

Full Text Available Abstract Background Several countries have established or are planning acute psychiatric in-patient services that accept around-the-clock emergency admission of adolescents. Our aim was to investigate the characteristics and clinical outcomes of a cohort of patients at four Norwegian units. Methods We used a prospective pre-post observational design. Four units implemented a clinician-rated outcome measure, the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA, which measures mental health problems and their severity. We collected also data about the diagnoses, suicidal problems, family situations, and the involvement of the Child Protection Service. Predictions of outcome (change in HoNOSCA total score were analysed with a regression model. Results The sample comprised 192 adolescents admitted during one year (response rate 87%. Mean age was 15.7 years (range 10-18 and 70% were girls. Fifty-eight per cent had suicidal problems at intake and the mean intake HoNOSCA total score was 18.5 (SD 6.4. The largest groups of main diagnostic conditions were affective (28% and externalizing (26% disorders. Diagnoses and other patient characteristics at intake did not differ between units. Clinical psychiatric disorders and developmental disorders were associated with severity (on HoNOSCA at intake but not with outcome. Of adolescents ≥ 16 years, 33% were compulsorily admitted. Median length of stay was 8.5 days and 75% of patients stayed less than a month. Compulsory admissions and length of stay varied between units. Mean change (improvement in the HoNOSCA total score was 5.1 (SD 6.2, with considerable variation between units. Mean discharge score was close to the often-reported outpatient level, and self-injury and emotional symptoms were the most reduced symptoms during the stay. In a regression model, unit, high HoNOSCA total score at intake, or involvement of the Child Protection Service predicted improvement during admission

5 CFR 1209.8 - Filing a request for a stay.

Science.gov (United States)

2010-01-01

... WHISTLEBLOWING Stay Requests § 1209.8 Filing a request for a stay. (a) Time of filing. An appellant may request a stay of a personnel action allegedly based on whistleblowing at any time after the appellant becomes...

A bacia hidrográfica como unidade fundamental de análise da paisagem: a Bacia do Pacuí e a sua relação com a Bacia do São Francisco

OpenAIRE

Maria Ivete Soares de Almeida

2015-01-01

Este artigo procura entender a bacia hidrográfica como unidade espacial e básica na análise do ambiente, ficando implícita a adoção da visão integrada da paisagem e do meio ambiente. Neste sentido, apresenta uma breve revisão teórica sobre a evolução dos estudos sobre as bacias hidrográficas. Esta discussão se faz necessária para o entendimento de como o conceito bacia hidrográfica tem sido trabalhado na geografia. A seguir é feita uma contextualização da paisagem da Bacia do Pacuí e a sua re...

Home Stay Accommodation for Tourism Development in East Coast Economic Region

OpenAIRE

Md. Anowar Hossain Bhuiyan; Chamhuri Siwar; Shaharuddin Mohamad Ismail; Rabiul Islam

2012-01-01

Problem statement: Home stay program provided tourists multi ethnic life condition with cultural experiences and economic well beings for the local people. Malaysian home stay program differed from the other commercial home stay in the world. Home stay accommodation can create a scope to the local communities for active participation in tourism activities. Home stay accommodation might be a potential economic activity in the East Coast Economic Region (ECER). The study examined the potentiali...

Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs

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Jitender Sodhi

2016-01-01

Interpretation & conclusions: This study highlights the effect of HAI on costs for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care.

Effectiveness of structured multidisciplinary rounding in acute care units on length of stay and satisfaction of patients and staff: a quantitative systematic review.

Science.gov (United States)

Mercedes, Angela; Fairman, Precillia; Hogan, Lisa; Thomas, Rexi; Slyer, Jason T

2016-07-01

Consistent, concise and timely communication between a multidisciplinary team of healthcare providers, patients and families is necessary for the delivery of quality care. Structured multidisciplinary rounding (MDR) using a structured communication tool may positively impact length of stay (LOS) and satisfaction of patients and staff by improving communication, coordination and collaboration among the healthcare team. To evaluate the effectiveness of structured MDR using a structured communication tool in acute care units on LOS and satisfaction of patients and staff. Adult patients admitted to acute care units and healthcare providers who provide direct care for adult patients hospitalized in in-patient acute care units. The implementation of structured MDR utilizing a structured communication tool to enhance and/or guide communication. Quasi-experimental studies and descriptive studies. Length of stay, patient satisfaction and staff satisfaction. The comprehensive search strategy aimed to find relevant published and unpublished quantitative English language studies from the inception of each database searched through June 30, 2015. Databases searched include Cumulative Index to Nursing and Allied Health Literature, PubMed, Excerpta Medica Database, Health Source, Cochrane Central Register of Controlled Trials and Scopus. A search of gray literature was also performed. All reviewers independently evaluated the included studies for methodological quality using critical appraisal tools from the Joanna Briggs Institute (JBI). Data related to the methods, participants, interventions and findings were extracted using a standardized data extraction tool from the JBI. Due to clinical and methodological heterogeneity in the interventions and outcome measures of the included studies, statistical meta-analysis was not possible. Results are presented in narrative form. Eight studies were included, three quasi-experimental studies and five descriptive studies of quality

Modelling length of hospital stay in motor victims

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Mercedes Ayuso-Gutiérrez

2015-03-01

Full Text Available Objective. To analyze which socio-demographic and other factors related to motor injuries affect the length of hospital recovery stay. Materials and methods. In the study a sample of 17 932 motor accidents was used. All the crashes occurred in Spain between 2000 and 2007. Different regression models were fitted to data to identify and measure the impact of a set of explanatory regressors. Results. Time of hospital stay for men is on average 41% larger than for women. When the victim has a fracture as a consequence of the accident, the mean time of hospital stay is multiplied by five. Injuries located in lower extremities, the head and abdomen are associated with greater hospitalization lengths. Conclusions. Gender, age and type of victim, as well as the location and nature of injuries, are found to be factors that have significant impact on the expected length of hospital stay.

Sleep in the Intensive Care Unit measured by polysomnography

DEFF Research Database (Denmark)

Andersen, J H; Boesen, Hans Christian Toft; Olsen, Karsten Skovgaard

2013-01-01

Sleep deprivation has deleterious effects on most organ systems. Patients in the Intensive care unit (ICU) report sleep deprivation as the second worst experience during their stay only superseded by pain. The aim of the review is to provide the clinician with knowledge of the optimal sleep-frien......-friendly care and environment.......Sleep deprivation has deleterious effects on most organ systems. Patients in the Intensive care unit (ICU) report sleep deprivation as the second worst experience during their stay only superseded by pain. The aim of the review is to provide the clinician with knowledge of the optimal sleep...

5 CFR 1209.10 - Hearing and order ruling on stay request.

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2010-01-01

... set forth the factual and legal bases for the decision. The judge must decide whether there is a... WHISTLEBLOWING Stay Requests § 1209.10 Hearing and order ruling on stay request. (a) Hearing. The judge may hold a hearing on the stay request. (b) Order ruling on stay request. (1) The judge must rule upon the...

42 CFR 456.236 - Continued stay review process.

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2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan... each continued stay of a recipient in the mental hospital, the committee, subgroup or designee reviews... committee, subgroup or designee finds that a recipient's continued stay in the mental hospital is needed...

An Outbreak of Clostridium difficile Ribotype 027 Associated with Length of Stay in the Intensive Care Unit and Use of Selective Decontamination of the Digestive Tract: A Case Control Study.

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Yvette H van Beurden

Full Text Available An outbreak of Clostridium difficile ribotype 027 infection (CDI occurred at an university hospital, involving 19 departments. To determine what hospital-associated factors drove the outbreak of this particular strain we performed a case-control study.Cases (n = 79, diagnosed with CDI due to C. difficile ribotype 027 were matched for age and treating medical specialty to four control patients (n = 316. Patients diagnosed with CDI due to other ribotypes were included as a second control group. A random selection of C. difficile ribotype 027 strains (n = 10 was genotyped by Whole Genome Sequencing (WGS.WGS showed the outbreak was likely caused by a single strain of C. difficile (two or less single-nucleotide variants between isolates. Ninety-five percent of cases had used antibiotics, compared to 56% of controls. Previous admission to the intensive care unit (ICU (OR: 2.4, 95% CI 1.0-5.6, longer length of stay (LOS, and recent hospital admission were associated with CDI ribotype 027. Cases were less likely to have been admitted to a ward with a known isolated CDI patient (OR: 0.2, 95% CI 0.1-0.6. Analysis of patients who stayed at the ICU (35 cases; 51 controls, indicated that the use of selective decontamination of the digestive tract (SDD and a longer LOS in the ICU were associated with CDI risk.In this large outbreak, any antibiotic use, including SDD use, appeared as a prerequisite for acquisition of the outbreak strain. The role of use of SDD and prolonged stay on the ICU could not be disentangled, but both factors can play a biologically plausible role in C. difficile acquisition and infection.

38 CFR 20.1410 - Rule 1410. Stays pending court action.

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2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Rule 1410. Stays pending court action. 20.1410 Section 20.1410 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... Clear and Unmistakable Error § 20.1410 Rule 1410. Stays pending court action. The Board will stay its...

12 CFR 1780.57 - Stays pending judicial review.

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2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Stays pending judicial review. 1780.57 Section... Posthearing Proceedings § 1780.57 Stays pending judicial review. The commencement of proceedings for judicial... Director pending a final decision on a petition for review of that order. ...

Aterações químicas e microbiológicas em PACU (piaractus mesopotamicus armazenado sob refrigeração a 5°c

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Mauro F.F. Leitão

1997-08-01

Full Text Available A pesquisa foi conduzida com o objetivo de analisar a vida útil e o processo de deterioração do pacu (Piaractus mesopotanicus armazenado sob refrigeração em temperatura inadequada (5°C. Amostras do pescado, imediatamente após a captura, foram armazenadas a 5°C e analisadas nos intervalos de 0-7-14 e 21 dias, com relação a características sensoriais e de natureza química (bases nitrogenadas voláteis - BNV, nitrogênio não protéico - NNP, aminoácidos livres totais, histidina livre e histamina e microbiológicos (contagem padrão, produtores de histamina em ágar Niven, contagem de microrganismos gelatinase e H2S positivos, nas temperaturas de 35°C, 20° e 5°C. Os resultados obtidos confirmaram que, a exemplo de outros peixes fluviais de regiões tropicais, o pacu revelou-se bastante resistente ao armazenamento, somente evidenciando uma alteração marcante após 14 dias de estocagem. Assim mesmo, a rejeição do pescado foi baseada principalmente em características sensoriais (odor, aspecto, textura uma vez que com relação aos índices químicos (BNV e mesmo microbiológicos, não se caracterizava uma situação definitiva de deterioração e rejeição. Observou-se, também, que o processo de deterioração pareceu concentrar-se principalmente no muco superficial, sendo que as características químicas do tecido muscular não evidenciaram alterações marcantes, mesmo após 21 dias de armazenamento. A presença de histamina não foi positivada nas amostras e os níveis de histidina livre, embora relativamente elevadas, não sugerem maiores riscos desta espécie de peixe como eventual veículo de intoxicação por histamina. No entanto, bactérias his+ foram isoladas das amostras iniciais, entre elas cepas de Plesiomonas shigelloides e Vibrio fluvialis. A microbiota contaminante natural foi reduzida, predominando microrganismos mesófilos/psicrotrófilos, com baixas contagens iniciais a 5°C. Ao longo do armazenamento a 5�

Hook selectivity of the pacu Piaractus mesopotamicus (Holmberg, 1887 in the Pantanal, the state of Mato Grosso do Sul, Brazil

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J. Peixer

Full Text Available The Pacu Piaractus mesopotamicus is the most captured fish species in the Pantanal, Mato Grosso do Sul State, and since 1994, its maximum sustainable yield had already been exceeded. Its capture is carried out only by hooks, as mesh gears are forbidden either for professional or for recreational fishing. The aim of this study was to determine selectivity for different hook sizes used in P. mesopotamicus fishing and to verify which sizes capture only adults. Data were collected in the rivers Miranda, Aquidauana, and Vermelho, in January, March, and April 2002. Six longlines with eight hook sizes were used and we adopted the hook opening as a measure related to selectivity. Different hooks captured individuals of the same length and their medians were similar, evidencing the great overlap among sizes. Regression results showed no significant relationship between ln[c2 (l/c1 (l] and total length of captured individuals. In addition, the Kolmogorov-Smirnov test also did not detect significant differences in the size of captured fish. Several hypotheses, such as the selectivity models, shape of selection curves, scarcity of large fishes, and behavior are used in order to explain the absence of hook selectivity for this species. Size of recruitment for this gear was 28 cm of total length, when individuals are still immature.

Randomized Controlled Trial Comparing Daycare and Overnight Stay Laparoscopic Cholecystectomy.

Science.gov (United States)

Salleh, A A M; Affirul, C A; Hairol, O; Zamri, Z; Azlanudin, A; Hilmi, M A; Razman, J

2015-01-01

This present study sought to review the feasibility and patients' satisfaction of laparoscopic cholecystectomy to be perform as daycare procedure. Sixty-two patients with symptomatic gallstones were recruited within a year. They were randomized into overnight stay and daycare groups. The outcomes and post-operative complications were analyzed. Fifty-eight patients were eligible for analysis and four patients were excluded because of conversion to open cholecystectomy. All patients in daycare group reported no fever but two patients in the overnight stay group complaint of post-operative fever (p=0.150). The mean pain score using Visual Analogue Score (VAS) in daycare group was 2.93 but in the overnight stay was recorded as 3.59 (p=0.98). Five patients had post-operative nausea and vomiting (PONV) in daycare group compared to 2 patients in the overnight stay group (p=0.227). Patient's satisfaction were higher in the daycare group (p=0.160). All patients in daycare group were back at work within a week but in overnight stay, 11 patients had to stay off work for more than one week (p=0.01). Daycare laparoscopic cholecystectomy is safe and feasible. The satisfaction of daycare surgery is higher than overnight stay group. Patients' selection is an important aspect of its success.

46 CFR 59.15-5 - Stayed furnaces and combustion chambers.

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2010-10-01

... 46 Shipping 2 2010-10-01 2010-10-01 false Stayed furnaces and combustion chambers. 59.15-5 Section... and combustion chambers. (a) Where the plate forming the walls of stayed furnaces or combustion... wall of a stayed furnace or combustion chamber, the defective portion of the plate shall be cut away...

[Clinic-internal and -external factors of length of hospital stay].

Science.gov (United States)

Schariatzadeh, R; Imoberdorf, R; Ballmer, P E

2011-01-19

In the context of forthcoming initiation of Diagnosis Related Groups (DRG) in Switzerland, the objective of the study was to find factors having an impact on the inpatient's length of hospital stay. The study was performed on two general-medical wards of the Kantonsspital Winterthur, where all admitted patients were included in the study over two months. The various periods of diagnostic and therapeutic management of the patients and all diagnostic and therapeutic measures plus the arrangements after hospitalization were recorded. The determinants influencing the length of hospital stay were classified in clinic-internal or -external. 124 inpatients entered the study. 91 (73.4%) had a length of hospital stay without delay, whereas 33 (26.6%) patients had an extended length of hospital stay. The cumulative length of hospital stay of all patients was 1314 days, whereof 216 days (16.4%) were caused by delays. 67 days were caused by clinic-internal (5.1%) and 149 days by clinic-external factors (11.3%). Delays were substantially more generated by clinic-internal than -external factors. Clinic-internal factors were mainly weekends with interruption of the diagnostic and therapeutic procedures, dead times waiting for diagnostic results and waiting times for consultations. Clinic-external factors were caused by delayed transfer in nursing homes or rehabilitation institutions, waiting for family members for the backhaul and by indetermination of the patient. Also factors relating to the patients' characteristics had an influence on the length of hospital stay. Summing up, a substantial part of the length of hospital stay was caused by delays. However, the many different clinic-internal factors complicate solutions to lower the length of hospital stay. Moreover, factors that cannot be influenced such as waiting for microbiological results, contribute to extended length of hospital stay. Early scheduling of post-hospital arrangements may lower length of hospital stay

Staying Well at Work.

Science.gov (United States)

Blai, Boris, Jr.

Employee wellness directly affects business/industry operations and costs. When employees are helped and encouraged to stay well, this people-positive policy results in triple benefits: reduced worker absenteeism, increased employee productivity, and lower company expenditures for health costs. Health care programs at the worksite offer these…

12 CFR 747.41 - Stays pending judicial review.

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2010-01-01

... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Stays pending judicial review. 747.41 Section... of Practice and Procedure § 747.41 Stays pending judicial review. The commencement of proceedings for... part of its order pending a final decision on a petition for review of that order. ...

42 CFR 3.550 - Stay of the Secretary's decision.

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2010-10-01

... PATIENT SAFETY ORGANIZATIONS AND PATIENT SAFETY WORK PRODUCT Enforcement Program § 3.550 Stay of the... security. (c) The ALJ must rule upon a respondent's request for stay within 10 days of receipt. ...

Stay away from asthma triggers

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Asthma triggers - stay away from; Asthma triggers - avoiding; Reactive airway disease - triggers; Bronchial asthma - triggers ... clothes. They should leave the coat outside or away from your child. Ask people who work at ...

Análise de um modelo de risco pré-operatório específico para cirurgia valvar e a relação com o tempo de internação em unidade de terapia intensiva Analysis of specific pre-operative model to valve surgery and relationship with the length of stay in intensive care unit

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Felipe Montes Pena

2010-12-01

Full Text Available OBJETIVOS: O tempo de internação prolongado após cirurgia cardíaca é associado a resultados imediatos ruins e aumento dos custos. O objetivo deste estudo foi analisar o poder preditor do escore de Ambler na previsão do tempo de internação em unidade de terapia intensiva. MÉTODOS: Estudo de coorte retrospectiva com dados coletados de 110 pacientes submetidos à cirurgia de troca valvar isolada ou associada. Os valores do escore aditivo e logístico do escore de Ambler e as performances preditivas do escore de Ambler foram obtidos por meio da curva ROC. A estadia em unidade de terapia intensiva definiu-se como normal 3 dias. A área sobre as curvas dos modelos aditivo e logístico foram comparadas por meio do teste de Hanley-MacNeil. RESULTADOS: A média de permanência em unidade de terapia intensiva foi de 4,2 dias. Sessenta e três pacientes pertenciam ao sexo masculino. O modelo logístico apresentou área sob a curva ROC de 0,73 e 0,79 para internação >3 dias e 3 dias e OBJECTIVES: The length of stay after prolonged cardiac surgery has been associated with poor immediate outcomes and increased costs. This study aimed to evaluate the predictive power of the Ambler Score to anticipate the length of stay in the intensive care unit. METHODS: This was a retrospective cohort study based on data collected from 110 patients undergoing valve replacement surgery alone or in combination with other procedures. Additive and logistic Ambler Scores were obtained and their predictive performances calculated using the Receiver Operating Characteristic curve. The normal length stay in the intensive care unit was assumed to be 3 days. The areas under the receiver operating curves for both the additive and logistic models were compared using the Hanley-MacNeil test. RESULTS: The mean intensive care unit length of stay was 4.2 days. Sixty-three patients were male. The logistic model showed areas under the receiver operating characteristic curve of 0

12 CFR 509.41 - Stays pending judicial review.

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2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Stays pending judicial review. 509.41 Section... pending judicial review. The commencement of proceedings for judicial review of a final decision and order... finds just, stay the effectiveness of all or any part of its order pending a final decision on a...

12 CFR 263.41 - Stays pending judicial review.

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2010-01-01

... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Stays pending judicial review. 263.41 Section... SYSTEM RULES OF PRACTICE FOR HEARINGS Uniform Rules of Practice and Procedure § 263.41 Stays pending... the effectiveness of all or any part of its order pending a final decision on a petition for review of...

12 CFR 19.41 - Stays pending judicial review.

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2010-01-01

... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Stays pending judicial review. 19.41 Section 19... PROCEDURE Uniform Rules of Practice and Procedure § 19.41 Stays pending judicial review. The commencement of... effectiveness of all or any part of an order pending a final decision on a petition for review of that order. ...

Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review

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David Snowdon

2014-06-01

Full Text Available Question: Does preoperative intervention in people undergoing cardiac surgery reduce pulmonary complications, shorten length of stay in the intensive care unit (ICU or hospital, or improve physical function? Design: Systematic review with meta-analysis of (quasi randomised trials. Participants: People undergoing coronary artery bypass grafts and/or valvular surgery. Intervention: Any intervention, such as education, inspiratory muscle training, exercise training or relaxation, delivered prior to surgery to prevent/reduce postoperative pulmonary complications or to hasten recovery of function. Outcome measures: Time to extubation, length of stay in ICU and hospital (reported in days. Postoperative pulmonary complications and physical function were measured as reported in the included trials. Results: The 17 eligible trials reported data on 2689 participants. Preoperative intervention significantly reduced the time to extubation (MD -0.14 days, 95% CI -0.26 to -0.01 and the relative risk of developing postoperative pulmonary complications (RR 0.39, 95% CI 0.23 to 0.66. However, it did not significantly affect the length of stay in ICU (MD -0.15 days, 95% CI -0.37 to 0.08 or hospital (MD -0.55 days, 95% CI -1.32 to 0.23, except among older participants (MD -1.32 days, 95% CI -2.36 to -0.28. When the preoperative interventions were separately analysed, inspiratory muscle training significantly reduced postoperative pulmonary complications and the length of stay in hospital. Trial quality ranged from good to poor and considerable heterogeneity was present in the study features. Other outcomes did not significantly differ. Conclusion: For people undergoing cardiac surgery, preoperative intervention reduces the incidence of postoperative pulmonary complications and, in older patients, the length of stay in hospital. [Snowdon D, Haines TP, Skinner EH (2014 Preoperative intervention reduces postoperative pulmonary complications but not length of stay in

Noise and light exposures for extremely low birth weight newborns during their stay in the neonatal intensive care unit.

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Lasky, Robert E; Williams, Amber L

2009-02-01

The objectives of this study were to characterize noise and light levels for extremely low birth weight newborns throughout their stay in the NICU, evaluate factors influencing noise and light levels, and determine whether exposures meet recommendations from the American Academy of Pediatrics. Sound and light were measured inside the beds of extremely low birth weight newborns (n = 22) from birth to discharge. Measurements were recorded for 20 consecutive hours weekly from birth until 36 weeks' postmenstrual age, biweekly until 40 weeks, and every 4 weeks thereafter. Clinical variables including bed type and method of respiratory support were recorded at each session. Age-related changes in respiratory support and bed type explained the weekly increase of 0.22 dB in sound level and 3.67 lux in light level. Old incubators were the noisiest bed types, and new incubators were the quietest. Light levels were significantly higher in open beds than in incubators. The variations in noise and light levels over time were greatest for open beds. Noise and light levels were much less affected by respiratory support in incubators compared with open beds. A typical extremely low birth weight neonate was exposed to noise levels averaging 56.44 dB(A) and light levels averaging 70.56 lux during their stay from 26 to 42 weeks' postmenstrual age in the NICU. Noise levels were rarely within American Academy of Pediatrics recommendations (5.51% of the time), whereas light levels almost always met recommendations (99.37% of the time). Bed type and respiratory support explained differences in noise and light levels that extremely low birth weight newborns experience during their hospital stay. Noise levels exceeded recommendations, although evidence supporting those recommendations is lacking. Well-designed intervention studies are needed to determine the effects of noise reduction on the development of extremely low birth weight newborns.

Role of sugammadex in accelerating postoperative discharge: A meta-analysis.

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Carron, Michele; Zarantonello, Francesco; Lazzarotto, Nadia; Tellaroli, Paola; Ori, Carlo

2017-06-01

Sugammadex has been introduced for reversal of neuromuscular blockade (NMB) induced by rocuronium (or vecuronium). Although its efficacy and safety have been established, data are conflicting as to whether it accelerates discharge to the surgical ward compared with neostigmine, which is traditionally used for reversing NMB. The object of this systematic review and meta-analysis was to review the research comparing sugammadex and neostigmine in the context of patient discharge after general anesthesia. Systematic review and meta-analysis. University medical hospital. Five-hundred eighteen patients from six studies were included. A comprehensive search was conducted using PubMed, Web of Science, Google Scholar, and Cochrane Library electronic databases to identify randomized controlled trials written in English. Two reviewers independently selected the studies, extracted data regarding postoperative discharge, and assessed the trials' methodological quality and evidence level. Postoperative discharge time was determined from the operating room (OR) to the postanesthesia care unit (PACU) and from the PACU to the surgical ward. This study was conducted using PRISMA methodology. Time to discharge after NMB reversal with sugammadex or neostigmine. Compared with neostigmine, sugammadex was associated with a significantly faster discharge from the OR to the PACU (mean difference [MD]=22.14min, 95% CI (14.62, 29.67), Psugammadex than for neostigmine from the OR to the PACU (MD=5.58min, 95% CI (3.03, 8.14), P≤0.0001, I 2 =0%). However, discharge-readiness was similar in both groups for patients moving from the PACU to the surgical ward (MD=-1.10min, 95% CI (-5.69, 3.50), P=0.6394, I 2 =25.3%). Results from this meta-analysis suggest that sugammadex accelerates postoperative discharge of patients after general anesthesia compared with neostigmine. Copyright © 2017 Elsevier Inc. All rights reserved.

Cumulative incidence of postoperative severe pain at Hospital Universitario San Jose, Popayan. Preliminar report

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Ingrid Muñoz

2013-12-01

Full Text Available Introduction: Postoperative pain remains as a problem. National studies report incidences of 31% for moderate and 22% for severe pain. Inadequate analgesia is related to dissatisfaction and adverse outcomes. The aim of this study was to describe the incidence and characteristics of the postoperative pain in the post-anesthesia care unit (PACU at Hospital Universitario San José of Popayán (HUSJ in patients undergoing general anesthesia during the first postoperative hour. Methods: Cohort study. We recruited patients attending PACU and undergoing procedures using general anesthesia, between 18 and 70 years. Using a standardized collection form medical history, demographic data, medical history, anesthetic management, intraoperative analgesia and postoperative pain assessment by verbal and numerical pain scale (1-10 were recorded. Postoperative outcome data were also collected in the PACU. Results: The incidence of severe postoperative pain at 10 minutes was 12.3% 95%CI [7.1-18.2] (19 patients. Within 30 minutes of assessment 4.5% 95%CI [1.3-8.4] (7 patients and 1.9% 60 minutes 95%CI [0-4.5] (3 patients. 48.7% required rescue analgesic at PACU. Incidence of postoperative nausea and vomiting (PONV was significantly different in patients requiring rescue analgesic. Conclusion: The incidence of severe postoperative pain in the first postoperative hour at HUSJ is close to 12% and it decreases as time goes by. Patients requiring rescue analgesic have a higher incidence of postoperative complications such as PONV.

Understanding the factors which promote registered nurses' intent to stay in emergency and critical care areas.

Science.gov (United States)

Van Osch, Mary; Scarborough, Kathy; Crowe, Sarah; Wolff, Angela C; Reimer-Kirkham, Sheryl

2018-03-01

To explore the influential factors and strategies that promote an experienced nurse's intent to stay in their emergency or critical care area. Turnover among registered nurses (herein referred to as nurses) working in specialty areas of practice can result in a range of negative outcomes. The retention of specialty nurses at the unit level has important implications for hospital and health systems. These implications include lost knowledge and experience which may in turn impact staff performance levels, patient outcomes, hiring, orientating, development of clinical competence and other aspects of organizational performance. This qualitative study used an interpretive descriptive design to understand nurses' perceptions of the current factors and strategies that promote them staying in emergency or critical care settings for two or more years. Focus groups were conducted with 13 emergency and critical care nurses. Data analysis involved thematic analysis that evolved from codes to categories to themes. Four themes were identified: leadership, interprofessional relationships, job fit and practice environment. In addition, the ideas of feeling valued, respected and acknowledged were woven throughout. Factors often associated with nurse attrition such as burnout and job stresses were not emphasised by the respondents in our study as critical to their intent to stay in their area of practice. This study has highlighted positive aspects that motivate nurses to stay in their specialty areas. To ensure quality care for patients, retention of experienced emergency and critical care nurses is essential to maintaining specialty expertise in these practice settings. © 2017 John Wiley & Sons Ltd.

An orthopaedic geriatric rehabilitation unit: the first two years experience.

Science.gov (United States)

Sainsbury, R; Gillespie, W J; Armour, P C; Newman, E F

1986-08-13

Experience of the first two years of an orthopaedic geriatric rehabilitation unit is described. There were 325 admissions comprising 271 females and 54 males. The predominant diagnosis was fracture of the proximal femur. Average length of stay in the unit was 43 days for males and 36.7 days for females. 75.9% of patients admitted from home returned there and 66.1% of patients admitted from residential care returned to similar accommodation. In the first year there was a fall of 13.5 days in the average length of stay for elderly females with proximal femoral fracture, resulting in 2175 less bed days for this diagnosis. This improvement has continued.

Long-Term Persistency of Abnormal Heart Rate Variability following Long NICU Stay and Surgery at Birth

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Mélanie Morin

2014-01-01

Full Text Available Preterm birth is associated with painful procedures during the neonatal intensive care unit (NICU stay. Full-term newborns can also experience pain, following surgery. These procedures can have long-lasting consequences. It has been shown that children born preterm show pain responses and cardiac alterations. This study aimed to explore the heart rate reactivity to pain in 107 subjects born either preterm or full-term who were between 7 and 25 years old at testing. We also evaluated the effect of pain experienced at birth, as represented by a longer NICU stay, time under ventilation, and surgery at birth. Participants were asked to immerse their right forearm in 10°C water for 2 minutes. Electrocardiograms were recorded at baseline and during the immersion procedure. Full-term subjects showed a stable increase in heart rate throughout the procedure, whereas preterm ones showed a strong increase at the beginning, which decreased over time. Also, preterm and full-term subjects who experienced pain at birth showed higher resting heart rate, stronger sympathetic activity, and lower cardiac vagal activity. Our study demonstrated a long-term impact of a long NICU stay and surgery at birth on cardiac autonomic activity. This could lead to impaired reactions to pain or stress in later life.

Risk model of prolonged intensive care unit stay in Chinese patients undergoing heart valve surgery.

Science.gov (United States)

Wang, Chong; Zhang, Guan-xin; Zhang, Hao; Lu, Fang-lin; Li, Bai-ling; Xu, Ji-bin; Han, Lin; Xu, Zhi-yun

2012-11-01

The aim of this study was to develop a preoperative risk prediction model and an scorecard for prolonged intensive care unit length of stay (PrlICULOS) in adult patients undergoing heart valve surgery. This is a retrospective observational study of collected data on 3925 consecutive patients older than 18 years, who had undergone heart valve surgery between January 2000 and December 2010. Data were randomly split into a development dataset (n=2401) and a validation dataset (n=1524). A multivariate logistic regression analysis was undertaken using the development dataset to identify independent risk factors for PrlICULOS. Performance of the model was then assessed by observed and expected rates of PrlICULOS on the development and validation dataset. Model calibration and discriminatory ability were analysed by the Hosmer-Lemeshow goodness-of-fit statistic and the area under the receiver operating characteristic (ROC) curve, respectively. There were 491 patients that required PrlICULOS (12.5%). Preoperative independent predictors of PrlICULOS are shown with odds ratio as follows: (1) age, 1.4; (2) chronic obstructive pulmonary disease (COPD), 1.8; (3) atrial fibrillation, 1.4; (4) left bundle branch block, 2.7; (5) ejection fraction, 1.4; (6) left ventricle weight, 1.5; (7) New York Heart Association class III-IV, 1.8; (8) critical preoperative state, 2.0; (9) perivalvular leakage, 6.4; (10) tricuspid valve replacement, 3.8; (11) concurrent CABG, 2.8; and (12) concurrent other cardiac surgery, 1.8. The Hosmer-Lemeshow goodness-of-fit statistic was not statistically significant in both development and validation dataset (P=0.365 vs P=0.310). The ROC curve for the prediction of PrlICULOS in development and validation dataset was 0.717 and 0.700, respectively. We developed and validated a local risk prediction model for PrlICULOS after adult heart valve surgery. This model can be used to calculate patient-specific risk with an equivalent predicted risk at our centre in

Fontes e níveis de proteína bruta em dietas para alevinos de pacu (Piaractus mesopotamicus

Directory of Open Access Journals (Sweden)

Fernandes João Batista Kochenborger

2000-01-01

Full Text Available Foi conduzido um experimento, com 100 dias duração, utilizando-se 288 alevinos de pacu, distribuídos em 36 caixas de cimento amianto com volume de 100 litros, para avaliar a substituição da farinha de peixe por farelo de soja e os níveis protéicos nas dietas. Durante o período experimental, a temperatura média da água permaneceu em 28ºC e os demais parâmetros limnológicos (oxigênio dissolvido, pH, alcalinidade e condutividade apresentaram-se dentro dos níveis adequados para o desenvolvimento desta espécie. O delineamento experimental foi de blocos casualizados, em que foram avaliados nove tratamentos em esquema fatorial 3 x 3, três níveis de proteína bruta (22, 26 e 30% e três níveis de substituição da farinha de peixe pelo farelo de soja (0, 50 e 100%. O nível de 26% de proteína bruta foi mais adequado. A farinha de peixe pode ser substituída parcial ou totalmente pelo farelo de soja, sem influir no ganho de peso, na conversão alimentar, na taxa de crescimento específico e na taxa de eficiência protéica dos alevinos. A substituição das fontes protéicas também não influenciou a composição corporal dos peixes, a eficiência de retenção de nitrogênio, o nitrogênio corporal, a gordura corporal e o nitrogênio e a gordura no ganho de peso.

Device-associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International Nosocomial Infection Control Consortium’s findings

Science.gov (United States)

Salgado Yepez, Estuardo; Bovera, Maria M; Rosenthal, Victor D; González Flores, Hugo A; Pazmiño, Leonardo; Valencia, Francisco; Alquinga, Nelly; Ramirez, Vanessa; Jara, Edgar; Lascano, Miguel; Delgado, Veronica; Cevallos, Cristian; Santacruz, Gasdali; Pelaéz, Cristian; Zaruma, Celso; Barahona Pinto, Diego

2017-01-01

AIM To report the results of the International Nosocomial Infection Control Consortium (INICC) study conducted in Quito, Ecuador. METHODS A device-associated healthcare-acquired infection (DA-HAI) prospective surveillance study conducted from October 2013 to January 2015 in 2 adult intensive care units (ICUs) from 2 hospitals using the United States Centers for Disease Control/National Healthcare Safety Network (CDC/NHSN) definitions and INICC methods. RESULTS We followed 776 ICU patients for 4818 bed-days. The central line-associated bloodstream infection (CLABSI) rate was 6.5 per 1000 central line (CL)-days, the ventilator-associated pneumonia (VAP) rate was 44.3 per 1000 mechanical ventilator (MV)-days, and the catheter-associated urinary tract infection (CAUTI) rate was 5.7 per 1000 urinary catheter (UC)-days. CLABSI and CAUTI rates in our ICUs were similar to INICC rates [4.9 (CLABSI) and 5.3 (CAUTI)] and higher than NHSN rates [0.8 (CLABSI) and 1.3 (CAUTI)] - although device use ratios for CL and UC were higher than INICC and CDC/NSHN’s ratios. By contrast, despite the VAP rate was higher than INICC (16.5) and NHSN’s rates (1.1), MV DUR was lower in our ICUs. Resistance of A. baumannii to imipenem and meropenem was 75.0%, and of Pseudomonas aeruginosa to ciprofloxacin and piperacillin-tazobactam was higher than 72.7%, all them higher than CDC/NHSN rates. Excess length of stay was 7.4 d for patients with CLABSI, 4.8 for patients with VAP and 9.2 for patients CAUTI. Excess crude mortality in ICUs was 30.9% for CLABSI, 14.5% for VAP and 17.6% for CAUTI. CONCLUSION DA-HAI rates in our ICUs from Ecuador are higher than United States CDC/NSHN rates and similar to INICC international rates. PMID:28289522

Research on Collapse Process of Cable-Stayed Bridges under Strong Seismic Excitations

Directory of Open Access Journals (Sweden)

Xuewei Wang

2017-01-01

Full Text Available In order to present the collapse process and failure mechanism of long-span cable-stayed bridges under strong seismic excitations, a rail-cum-road steel truss cable-stayed bridge was selected as engineering background, the collapse failure numerical model of the cable-stayed bridge was established based on the explicit dynamic finite element method (FEM, and the whole collapse process of the cable-stayed bridge was analyzed and studied with three different seismic waves acted in the horizontal longitudinal direction, respectively. It can be found from the numerical simulation analysis that the whole collapse failure process and failure modes of the cable-stayed bridge under three different seismic waves are similar. Furthermore, the piers and the main pylons are critical components contributing to the collapse of the cable-stayed bridge structure. However, the cables and the main girder are damaged owing to the failure of piers and main pylons during the whole structure collapse process, so the failure of cable and main girder components is not the main reason for the collapse of cable-stayed bridge. The analysis results can provide theoretical basis for collapse resistance design and the determination of critical damage components of long-span highway and railway cable-stayed bridges in the research of seismic vulnerability analysis.

Effect of nosocomial vancomycin-resistant enterococcal bacteremia on mortality, length of stay, and costs.

Science.gov (United States)

Song, Xiaoyan; Srinivasan, Arjun; Plaut, David; Perl, Trish M

2003-04-01

To determine the impact of vancomycin-resistant enterococcal bacteremia on patient outcomes and costs by assessing mortality, excess length of stay, and charges attributable to it. A population-based, matched, historical cohort study. A 1,025-bed, university-based teaching facility and referral hospital. Two hundred seventy-seven vancomycin-resistant enterococcal bacteremia case-patients and 277 matched control-patients identified between 1993 and 2000. The crude mortality rate was 50.2% and 19.9% for case-patients and control-patients, respectively, yielding a mortality rate of 30.3% attributable to vancomycin-resistant enterococcal bacteremia. The excess length of hospital stay attributable to vancomycin-resistant enterococcal bacteremia was 17 days, of which 12 days were spent in intensive care units. On average, dollars 77,558 in extra charges was attributable to each vancomycin-resistant enterococcal bacteremia. To adjust for severity of illness, 159 pairs of case-patients and control-patients, who had the same severity of illness (All Patient Refined-Diagnosis Related Group complexity level), were further analyzed. When patients were stratified by severity of illness, the crude mortality rate was 50.3% among case-patients compared with 27.7% among control-patients, accounting for an attributable mortality rate of 22.6%. Attributable excess length of stay and charges were 17 days and dollars 81,208, respectively. Vancomycin-resistant enterococcal bacteremia contributes significantly to excess mortality and economic loss, once severity of illness is considered. Efforts to prevent these infections will likely be cost-effective.

20 CFR 802.105 - Stay of payment pending appeal.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Stay of payment pending appeal. 802.105... PROCEDURE General Provisions Introductory § 802.105 Stay of payment pending appeal. (a) As provided in... ten days after it becomes due pending final decision in any proceeding before the Board unless so...

[Medico-economic assessment of the Pontoise Hospital stroke unit].

Science.gov (United States)

Yekhlef, F; Decup, D; Niclot, P; Servan, J; Descombes, S; Richecoeur, J; Ollivier, A

2010-11-01

Annually, approximately 120,000 people in France have a stroke. Various controlled studies have pointed out the benefits of treatment in a stroke unit (SU). The objective of this study was to evaluate, from a medical point of view, the economic impact of the Pontoise Hospital SU. Based on the national cost study (NCS [étude nationale des coûts: ENC]) we analyzed data of five diagnosis related groups (DRG) which have a principle diagnosis in relation with stroke. This work was limited to strokes and transient ischemic events in adults and excluded sub-arachnoid hemorrhage. Medical and economic parameters were collected over the period from January to October 2006 and compared with those of the same period in 2005, that is to say before the opening of the SU. Three hundred and twenty-three hospital stays occurred between January 1st and October 31st, 2006 and 216 during the same time period before the opening of the SU, an increase of approximately 50% of all stroke-related admissions in our hospital. The number of stays carried out in the neurology unit increased by 29%. There was no significant difference between the two periods regarding age (median 69 versus 70 years) and sex- ratio. Average length of stay (ALS) was the same (9 days). There were no significant differences concerning the death rate (5.6% versus 6.2%) and that of discharge to home (44.6% versus 44.4%). The cost by stay in 2006 was 3534 euros [median; min 664-max 57,542] versus 3541 euros in 2005 [681-35,149] (p=0.57). Analysis by DRG highlighted an increase in the cost for serious strokes, cerebral infarctions and hemorrhages. For transitory ischemic events, the cost and the ALS decreased. After the opening of the SU, there was an increase in the activity without an increase in the total cost. This could be related in part to the limited means allocated to the stroke unit at its opening (in particular medical staff). The NCS can be used to evaluate the activity of a stroke unit. This work could

Short Hospital Stay after Laparoscopic Colorectal Surgery without Fast Track

DEFF Research Database (Denmark)

Burgdorf, Stefan K; Rosenberg, Jacob

2012-01-01

Purpose. Short hospital stay and equal or reduced complication rates have been demonstrated after fast track open colonic surgery. However, fast track principles of perioperative care can be difficult to implement and often require increased nursing staff because of more concentrated nursing tasks...... care, that is, without implementing fast track principles, on length of stay after colorectal resection for cancer. Methods. Records of all patients operated for colorectal cancer from November 2004 to December 2008 in our department were reviewed. No specific patients were selected for laparoscopic...... in our department resulted in shorter hospital stay without using fast track principles for peri- and postoperative care in patients not receiving a stoma during the operation. Consequently, we aimed to reduce hospitalisation without increasing cost in nursing staff per hospital bed. Length of stay...

Predictors of length of stay in a ward for demented elderly: gender differences.

Science.gov (United States)

Ono, Toshiyuki; Tamai, Akira; Takeuchi, Daisuke; Tamai, Yuzuru; Iseki, Hidenori; Fukushima, Hiromi; Kasahara, Sumie

2010-09-01

In our previous studies, we found both gender differences among care recipients and predictors that influenced outcomes after discharge from a ward for demented elderly. Here, we investigate predictors that influence the length of stay for each sex. We studied the data of 390 patients with dementia who were hospitalized in a ward for demented elderly between 1 April 2000 and 31 March 2008, and treated until 31 March 2009. The patients were divided into groups classified by gender. We analyzed the gender differences of characteristics and evaluated the predictors that influenced the length of stay in the ward for demented elderly using Cox's proportional hazards model. A model using the initial scores of the Revised Hasegawa Dementia Scale (HDS-R), Assessment Scale for Symptoms of Dementia (ASSD) and Nishimura's activity of daily living scale (N-ADL), which were examined on admission, was named Model 1. In Model 1, we checked the effect of each patient's characteristics, except for complications and destinations, on their length of stay. Model 2 used the final scores of HDS-R, ASSD and N-ADL including complications and destinations. There was a clear gender difference in the length of stay. The length of stay of women was longer than that of men. It was difficult to predict the length of stay in Model 1. Age was the only predictor in women and no predictor was identified in men. In Model 2, complications and the final HDS-R and N-ADL scores were predictors of the length of stay in men. Age, complications and destinations were predictors of the length of stay in women. It was observed that there were gender differences among predictors of the length of stay. However, it was difficult to predict the length of stay on admission. Retrospectively, the length of stay was determined by physical and psychological conditions, not by the social variables in men. In women, it was supposed that the caregiver's wish to give care at home reduced the length of stay. Besides

Interhospital transfer delays emergency abdominal surgery and prolongs stay.

Science.gov (United States)

Limmer, Alexandra M; Edye, Michael B

2017-11-01

Interhospital transfer of patients requiring emergency surgery is common practice. It has the potential to delay surgical intervention, increase rate of complications and thus length of hospital stay. A retrospective cohort study was conducted of adult patients who underwent emergency surgery for abdominal pain at a large metropolitan hospital in New South Wales (Hospital A) in 2013. The impact of interhospital transfer on time to surgical intervention, post-operative length of stay and overall length of stay was assessed. Of the 910 adult patients who underwent emergency surgery for abdominal pain at Hospital A in 2013, 31.9% (n = 290) were transferred by road ambulance from a local district hospital (Hospital B). The leading surgical procedures performed were appendicectomy (n = 299, 32.9%), cholecystectomy (n = 174, 19.1%), gastrointestinal endoscopy (n = 95, 10.4%), cystoscopy (n = 86, 9.5%), hernia repair (n = 45, 4.9%), salpingectomy (n = 19, 2.1%) and oversewing of perforated peptic ulcer (n = 13, 1.4%). Overall, interhospital transfer (n = 290, 31.9%) was associated with increases in mean time to surgical intervention (14.2 h, P < 0.001), post-operative length of stay (1.1 days, P = 0.001) and overall length of stay (1.6 days, P < 0.001). Delayed surgical intervention was observed across all procedure types except surgery for perforated peptic ulcer, where transferred patients underwent surgery within a comparable timeframe to direct admissions. Interhospital transfer delays surgical intervention and increases length of hospital stay. This mandates attention due to the implications for patient outcomes and added burden to the healthcare system. The system did, however, show capability to appropriately expedite surgery for acutely life-threatening cases. © 2016 Royal Australasian College of Surgeons.

17 CFR 9.24 - Petition for stay pending review.

Science.gov (United States)

2010-04-01

... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Petition for stay pending... Respect to Appeals § 9.24 Petition for stay pending review. (a) Time to file. (1) Within ten days after... disciplinary or access denial action pending consideration by the Commission of the notice of appeal and, if...

Visas for entry and stays in the Host States

CERN Multimedia

DG Unit

2010-01-01

1. What is a visa? A visa is an administrative document authorising nationals of countries subject to the visa requirement to transit, enter and stay in a foreign country. The numerous types of visa include in particular: a) Short-stay visas (the Schengen C-type visa), which allows their holders to enter and reside in the Schengen Area1) for a continuous or a non-continuous period not exceeding 3 months within any six-month period with effect from initial entry into the Schengen Area; b) Long-stay visas (D-type visa or national visa for the purposes of taking up employment), which are required for stays of over three months, allowing the holder to obtain a legitimation document (titre de séjour) from the Host States: A “carte de légitimation” issued by the Swiss Federal Department of Foreign Affairs; A “titre de séjour spécial” issued by the French Ministry of Foreign and European Affairs. Since 5 April 2010...

5 CFR 1209.9 - Content of stay request and response.

Science.gov (United States)

2010-01-01

... WHISTLEBLOWING Stay Requests § 1209.9 Content of stay request and response. (a) Only an appellant, his or her... based on whistleblowing, as defined in § 1209.4(b) of this part; and (iii) There is a substantial...

Newborn follow-up after discharge from the maternity unit: Compliance with national guidelines.

Science.gov (United States)

Roisné, J; Delattre, M; Rousseau, S; Bourlet, A; Charkaluk, M-L

2018-02-01

In the context of shorter hospital stays in maternity units, in 2014 the French health authorities issued guidelines for newborn follow-up after discharge from maternity units. A medical visit is recommended between the 6th and 10th day of life, as are home visits from midwives. This study was designed to evaluate compliance with these guidelines. The study was observational, prospective, multicenter, and was conducted in March and April 2015 in three maternity units in northern France that participate in the Baby Friendly Hospital Initiative (BFHI). Follow-up practices (medical visit between the 6th and 10th day, home visits from a midwife) and demographic, social, and medical data were recorded during the stay in the maternity unit, and through a phone interview 1 month later, in singleton term-born infants. The study population included 108 mother-infant pairs. The recommended medical visit was effectively performed by a physician between the 6th and 10th day of life for 20 newborns (19%) (95% CI: [11; 26]). During the 1st month, at least one home visit from a midwife was recorded for 96 mother-infant pairs (89%). The only factor positively correlated with a medical visit between the 6th and 10th day was the mother's choice, made early during the hospital stay and independently of the real length of stay, for early discharge from the maternity unit. Compliance with national guidelines was poor for the recommended medical visit between the 6th and 10th day of life. Information needs to be improved. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Reducing liver transplant length of stay: a Lean Six Sigma approach.

Science.gov (United States)

Toledo, Alexander H; Carroll, Tracy; Arnold, Emily; Tulu, Zeynep; Caffey, Tom; Kearns, Lauren E; Gerber, David A

2013-12-01

Organ transplant centers are under increasing scrutiny to maintain outcomes while controlling cost in a challenging population of patients. Throughout health care and transplant specifically, length of stay is used as a benchmark for both quality and resource utilization. To decrease our length of stay for liver transplant by using Lean Six Sigma methods. The Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) method was used to systematically analyze our process from transplant listing to hospital discharge after transplant, identifying many factors affecting length of stay. Adult, single-organ, primary liver transplant recipients between July 2008 and June 2012 were included in the study. Recipients with living donors or fulminant liver failure were excluded. Multiple interventions, including a clinical pathway and enhanced communication, were implemented. Length of stay after liver transplant and readmission after liver transplant.R ESULTS: Median length of stay decreased significantly from 11 days before the intervention to 8 days after the intervention. Readmission rate did not change throughout the study. The improved length of stay was maintained for 24 months after the study. Using a Lean Six Sigma approach, we were able to significantly decrease the length of stay of liver transplant patients. These results brought our center's outcomes in accordance with our goal and industry benchmark of 8 days. Clear expectations, improved teamwork, and a multidisciplinary clinical pathway were key elements in achieving and maintaining these gains.

Leadership practices and staff nurses' intent to stay: a systematic review.

Science.gov (United States)

Cowden, Tracy; Cummings, Greta; Profetto-McGrath, Joanne

2011-05-01

The aim of the present study was to describe the findings of a systematic review of the literature that examined the relationship between managers' leadership practices and staff nurses' intent to stay in their current position. The nursing shortage demands that managers focus on the retention of staff nurses. Understanding the relationship between leadership practices and nurses' intent to stay is fundamental to retaining nurses in the workforce. Published English language articles on leadership practices and staff nurses' intent to stay were retrieved from computerized databases and a manual search. Data extraction and quality assessments were completed for the final 23 research articles. Relational leadership practices influence staff nurses' intentions to remain in their current position. This study supports a positive relationship between transformational leadership, supportive work environments and staff nurses' intentions to remain in their current positions. Incorporating relational leadership theory into management practices will influence nurse retention. Advancing current conceptual models will increase knowledge of intent to stay. Clarifying the distinction between the concepts intent to stay and intent to leave is needed to establish a clear theoretical foundation for further intent to stay research. Nurse managers and leaders who practice relational leadership and ensure quality workplace environments are more likely to retain their staff. The findings of the present study support the claim that leadership practices influence staff nurse retention and builds on intent to stay knowledge. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

Seismic Passive Control of Cable-Stayed Bridges

Directory of Open Access Journals (Sweden)

Hosam-Eddin M. Ali

1995-01-01

Full Text Available A three-dimensional modeling procedure is proposed for cable-stayed bridges with rubber, steel, and lead energy dissipation devices. The passive control technique is investigated by considering the response of bridge models with and without energy dissipation devices. The impact of various design parameters on the seismic response of current and future bridge designs is studied. Appropriate locations and properties of the passive devices can achieve better performance for cable-stayed bridges by balancing the significant reduction in earthquake-induced forces against tolerable displacements. Proper design of passive systems can help provide solutions for retro-fitting some existing bridges.

Aerodynamic problems of cable-stayed bridges spanning over one thousand meters

Institute of Scientific and Technical Information of China (English)

Chen Airong; Ma Rujin; Wang Dalei

2009-01-01

Tbe elongating of cable-stayed bridge brings a series of aerodynamic problems. First of all, geometric nonlin-ear effect of extreme long cable is much more significant for cable-stayed bridge spanning over one thousand meters. Lat-eral static wind load will generate additional displacement of long cables, which causes the decrease of supporting rigidi-ty of the whole bridge and the change of dynamic properties. Wind load, being the controlling load in the design of ca-hie-stayed bridge, is a critical problem and needs to be solved. Meanwhile, research on suitable system between pylon and deck indicates fixed-fixed connection system is an effective way for improvement performance of cable-stayed bridges under longitudinal wind load. In order to obtain aerodynamic parameters of cable-stayed bridge spanning over one thou-sand meters, identification method for flutter derivatives of full bridge aero-elastic model is developed in this paper. Furthermore, vortex induced vibration and Reynolds number effect are detailed discussed.

Stay Rates of Foreign Doctorate Recipients from U.S. Universities, 2013

Energy Technology Data Exchange (ETDEWEB)

Finn, Michael G. [Oak Ridge Inst. for Science and Education (ORISE), Oak Ridge, TN (United States); Pennington, Leigh Ann [Oak Ridge Inst. for Science and Education (ORISE), Oak Ridge, TN (United States)

2018-01-01

This study estimates the stay rate of foreign nationals who receive doctorates in science and engineering from U.S. universities. Stay rates are estimated using tax records in a way that does not violate individual confidentiality. The 2013 stay rate for all foreign doctorate recipients, including those on permanent visas at graduation, was 70 percent for those graduating 5 years earlier, and 62 percent for those graduating 10 years earlier.

Staying Safe in the Water

Centers for Disease Control (CDC) Podcasts

In this podcast, Dr. Julie Gilchrist, a pediatrician and medical epidemiologist from CDC’s Injury Center, talks about staying safe in the water. Tips are for all audiences, with a focus on preventing drownings and keeping children safe in and around the pool, lake, or ocean.

Cold Ischemia Time is an Important Risk Factor for Post-Liver Transplant Prolonged Length of Stay.

Science.gov (United States)

Pan, Evelyn T; Yoeli, Dor; Galvan, N Thao N; Kueht, Michael L; Cotton, Ronald T; O'Mahony, Christine A; Goss, John A; Rana, Abbas

2018-02-24

Risk analysis of cold ischemia time (CIT) in liver transplantation has largely focused on patient and graft survival. Post-transplant length of stay is a sensitive marker of morbidity and cost. We hypothesize that CIT is a risk factor for post-transplant prolonged length of stay (PLOS) and aim to conduct an hour-by-hour analysis of CIT and PLOS. We retrospectively reviewed all adult, first-time liver transplants between March 2002 and September 2016 in the United Network for Organ Sharing database. 67,426 recipients were categorized by hourly CIT increments. Multivariable logistic regression of PLOS (defined as > 30 days), CIT groups, and an extensive list of confounding variables was performed. Linear regression between length of stay and CIT as continuous variables was also performed. CIT 1-6 hours was protective against PLOS, while CIT greater than 7 hours was associated with increased odds for PLOS. The lowest odds for PLOS were observed with 1-2 (odds ratio (OR) = 0.65, 95% confidence interval (CI) 0.45-0.92) and 2-3 hours (OR = 0.65, 95% CI 0.55-0.78) of CIT. OR for PLOS steadily increased with increasing CIT, reaching the greatest odds for PLOS with 13-14 hours (OR = 2.05, 95% CI 1.57-2.67) and 15-16 hours (OR = 2.06, 95% CI 1.27-3.33) of CIT. Linear regression revealed a positive correlation between length of stay and cold ischemia time with a correlation coefficient of +0.35 (p < 0.001). Post-liver transplant length of stay is sensitive to CIT, with substantial increase in the odds of PLOS observed with nearly every additional hour of cold ischemia. We conclude that CIT should be minimized to protect against the morbidity and cost associated with post-transplant PLOS. This article is protected by copyright. All rights reserved. © 2018 by the American Association for the Study of Liver Diseases.

Observation-status patients in children's hospitals with and without dedicated observation units in 2011.

Science.gov (United States)

Macy, Michelle L; Hall, Matthew; Alpern, Elizabeth R; Fieldston, Evan S; Shanley, Leticia A; Hronek, Carla; Hain, Paul D; Shah, Samir S

2015-06-01

Pediatric observation units (OUs) have demonstrated reductions in lengths of stay (LOS) and costs of care. Hospital-level outcomes across all observation-status stays have not been evaluated in relation to the presence of a dedicated OU in the hospital. To compare observation-status stay outcomes in hospitals with and without a dedicated OU. Cross-sectional analysis of hospital administrative data. Observation-status stay outcomes were compared in hospitals with and without a dedicated OU across 4 categories: (1) LOS, (2) standardized costs, (3) conversion to inpatient status, and (4) return care. Observation-status stays in 31 free-standing children's hospitals contributing observation patient data to the Pediatric Health Information System database, 2011. Fifty-one percent of the 136,239 observation-status stays in 2011 occurred in 14 hospitals with a dedicated OU; the remainder were in 17 hospitals without. The percentage of observation-status same-day discharges was higher in hospitals with a dedicated OU compared with hospitals without (23.8 vs 22.1, P hospitals with a dedicated OU (11.06%) compared with hospitals without (9.63%, P hospital-level outcomes. Inclusion of location of care (eg, dedicated OU, inpatient unit, emergency department) in hospital administrative datasets would allow for more meaningful comparisons of models of hospital care. © 2015 Society of Hospital Medicine.

Does a specialist unit improve outcomes for hospitalized patients with Parkinson's disease?

Science.gov (United States)

Skelly, Rob; Brown, Lisa; Fakis, Apostolos; Kimber, Lindsey; Downes, Charlotte; Lindop, Fiona; Johnson, Clare; Bartliff, Caroline; Bajaj, Nin

2014-01-01

Objective Suboptimal management of Parkinson's disease (PD) medication in hospital may lead to avoidable complications. We introduced an in-patient PD unit for those admitted urgently with general medical problems. We explored the effect of the unit on medication management, length of stay and patient experience. Methods We conducted a single-center prospective feasibility study. The unit's core features were defined following consultation with patients and professionals: specially trained staff, ready availability of PD drugs, guidelines, and care led by a geriatrician with specialty PD training. Mandatory staff training comprised four 1 h sessions: PD symptoms; medications; therapy; communication and swallowing. Most medication was prescribed using an electronic Prescribing and Administration system (iSOFT) which provided accurate data on time of administration. We compared patient outcomes before and after introduction of the unit. Results The general ward care (n = 20) and the Specialist Parkinson's Unit care (n = 24) groups had similar baseline characteristics. On the specialist unit: less Parkinson's medication was omitted (13% vs 20%, p < 0.001); of the medication that was given, more was given on time (64% vs 50%, p < 0.001); median length of stay was shorter (9 days vs 13 days, p = 0.043) and patients' experience of care was better (p = 0.01). Discussion If replicated and generalizable to other hospitals, reductions in length of stay would lead to significant cost savings. The apparent improved outcomes with Parkinson's unit care merit further investigation. We hope to test the hypothesis that specialized units are cost-effective and improve patient care using a randomized controlled trial design. PMID:25264022

Dermatology in the Intensive Care Unit

Directory of Open Access Journals (Sweden)

Uwe Wollina

2012-10-01

Full Text Available Introduction: The intensive care unit (ICU represents a special environment for patients. We analyzed patients in the ICU/ high care unit (HCU with respect to dermatology counselling and skin problems.Setting: Academic Teaching Hospital over a 10 month period.Methods: The total number of patients of the ICU was 1,208 with a mean stay of 4.1 days. In the HCU the mean stay was 16 days. Diagnosis leading to admission were analyzed. All files of dermatological counselling were evaluated in detail.Results: Fifty-five patients with dermatologic problems were identified: 19 women and 26 males. The age ranged from 22 to 90 years of life (mean ± standard deviation: 67.2 ± 17.4 years. The total number of consultations were 85. The range of repeated dermatological consultation ranged from two to ten. The major reasons were skin and soft tissue infections, adverse drug reactions, chronic wounds including pressure sores and skin irritation or dermatitis. Pre-existing skin conditions may complicate the treatment and care during ICU/HCU stay.Conclusion: A tight collaboration between of the medical staff of ICU/HCU and dermatology department will ensure a rapid diagnosis and treatment of various skin conditions in the ICU, without increasing the costs significantly. Interdisciplinary education of nursing staff contributes to improved skin care in the ICU/HCU and helps to prevent acute skin failure.

Why do Jordanian women stay in an abusive relationship: implications for health and social well-being.

Science.gov (United States)

Gharaibeh, Muntaha; Oweis, Arwa

2009-01-01

The purpose of this study was to explore why Jordanian women stay with an abusive husband. The study used a qualitative approach to collect data from 28 abused women who were recruited through their community during the summer and fall of 2007. Data were collected using an open-ended question through one-on-one in-depth interviews. Results from analysis of the qualitative data revealed that abused Jordanian women identified five main reasons for staying with an abusive husband: the inherited social background, financial dependency, lack of family support, sacrificing self for the sake of the children, and the adverse social consequences of divorce. The results indicate that Jordanian women are strongly bound by traditions and cultural rules and lack all means of empowerment. Results of the study have implications for healthcare providers, social workers, policy makers, and educators to enhance the health and social well-being of Arab Muslim women in Jordan. The findings may also apply to Arab families immigrating to the United States, Canada, and Europe who tend to bring their cultural beliefs, values, and norms, and may help healthcare professionals dealing with violence against women in these countries. Healthcare professionals worldwide need to play an instrumental role in providing culture-specific and evidence-based care to empower women staying in abusive relationships, taking into consideration the influence of Arab Muslim culture.

Effects of jazz on postoperative pain and stress in patients undergoing elective hysterectomy.

Science.gov (United States)

Rafer, Lorenzo; Austin, Flower; Frey, Jessica; Mulvey, Christie; Vaida, Sonia; Prozesky, Jansie

2015-01-01

Anesthesiologists use various medications to provide surgical patients with pain relief in the postoperative period. Other modalities, such as music, could be used in conjunction with opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease pain and lower heart rate and blood pressure. Our hypothesis was that patients listening to jazz in a postanesthesia care unit (PACU) would have lower heart rates and blood pressures and reduced pain and anxiety. The study objective was to determine if listening to jazz music in the PACU, when compared to wearing noise-canceling headphones with no music playing, would decrease heart rate, blood pressure, pain, or anxiety in patients undergoing a hysterectomy. The research design was a prospective, randomized study. The study was conducted in the PACU at the Penn State Hershey Medical Center in Hershey, PA, USA. A total of 56 patients, aged 18-75 y, who were categorized as status 1 or 2 according to the American Society of Anesthesiologists (ASA) Physical Status Classification System, and who were undergoing elective laparoscopic or abdominal hysterectomies, were enrolled in the study. Patients were randomly assigned either to listen to jazz music where the beats per min (BPM) was jazz group, heart rates were significantly lower at 15, 20, 25, and 30 min when compared with baseline. The pain scores were significantly lower (P jazz group at 10 min into the recovery period. Overall, the results showed that patients responded not only to music but also to silence in the PACU. Using music and/or noise reduction could decrease opioid administration, promote relaxation, and improve patient satisfaction.

[A hospital stay without bedsores].

Science.gov (United States)

Papas, Anne; Dérémience, Virginie; Tettiravou, Lucia; De Poix, Alix Tyrel

2013-10-01

A hospital stay without bedsores. The skin of elderly people is thin and fragile. After extended bed-rest, the skin's resources are rapidly depleted. The risk of bedsores becomes imminent. But a high-quality multi-disciplinary partnership can prevent bedsores in elderly patients with multiple illnesses. Example around a clinical case.

Factors Influencing Hospital Stay for Pulmonary Embolism. A Cohort Study.

Science.gov (United States)

Rodríguez-Núñez, Nuria; Ruano-Raviña, Alberto; Abelleira, Romina; Ferreiro, Lucía; Lama, Adriana; González-Barcala, Francisco J; Golpe, Antonio; Toubes, María E; Álvarez-Dobaño, José M; Valdés, Luis

2017-08-01

The aim of this study was to identify factors influencing hospital stay due to pulmonary embolism. We performed a retrospective cohort study of patients hospitalized between 2010 and 2015. Patients were identified using information recorded in hospital discharge reports (ICD-9-CM codes 415.11 and 415.19). We included 965 patients with a median stay of 8 days (IQR 6-13 days). Higher scores on the simplified Pulmonary Embolism Severity Index (sPESI) were associated with increased probability of longer hospital stay. The probability of a hospital stay longer than the median was 8.65 (95% CI 5.42-13.79) for patients referred to the Internal Medicine Department and 1.54 (95% CI 1.07-2.24) for patients hospitalized in other departments, compared to those referred to the Pneumology Department. Patients with grade 3 on the modified Medical Research Council dyspnea scale had an odds ratio of 1.63 (95% CI: 1.07-2.49). The likelihood of a longer than median hospital stay was 1.72 (95% CI: 0.85-3.48) when oral anticoagulation (OAC) was initiated 2-3 days after admission, and 2.43 (95% CI: 1.16-5.07) when initiated at 4-5 days, compared to OAC initiation at 0-1 days. sPESI grade, the department of referral from the Emergency Department, the grade of dyspnea and the time of initiating OAC were associated with a longer hospital stay. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

Effectiveness of a structured education reminiscence-based programme for staff on the quality of life of residents with dementia in long-stay units: a study protocol for a cluster randomised trial.

LENUS (Irish Health Repository)

O'Shea, Eamon

2011-02-01

Current projections indicate that there will be a significant increase in the number of people with dementia in Ireland, from approximately 40,000 at present to 100,000 by 2036. Psychosocial interventions, such as reminiscence, have the potential to improve the quality of life of people with dementia. However, while reminiscence is used widely in dementia care, its impact on the quality of life of people with dementia remains largely undocumented and there is a need for a robust and fair assessment of its overall effectiveness. The DementiA education programme incorporating REminiscence for Staff study will evaluate the effectiveness of a structured reminiscence-based education programme for care staff on the quality of life of residents with dementia in long-stay units.

Comparative Effect of Massage Therapy versus Kangaroo Mother Care on Body Weight and Length of Hospital Stay in Low Birth Weight Preterm Infants

Directory of Open Access Journals (Sweden)

Priya Singh Rangey

2014-01-01

Full Text Available Background. Massage therapy (MT and kangaroo mother care (KMC are both effective in increasing the weight and reducing length of hospital stay in low birth weight preterm infants but they have not been compared. Aim. Comparison of effectiveness of MT and KMC on body weight and length of hospital stay in low birth weight preterm (LBWPT infants. Method. 30 LBWPT infants using convenience sampling from Neonatal Intensive Care Unit, V.S. hospital, were randomly divided into 2 equal groups. Group 1 received MT and Group 2 received KMC for 15 minutes, thrice daily for 5 days. Medically stable babies with gestational age < 37 weeks and birth weight < 2500 g were included. Those on ventilators and with congenital, orthopedic, or genetic abnormality were excluded. Outcome measures, body weight and length of hospital stay, were taken before intervention day 1 and after intervention day 5. Level of significance was 5%. Result. Data was analyzed using SPSS16. Both MT and KMC were found to be effective in improving body weight (P = 0.001, P = 0.001. Both were found to be equally effective for improving body weight (P = 0.328 and reducing length of hospital stay (P = 0.868. Conclusion. MT and KMC were found to be equally effective in improving body weight and reducing length of hospital stay. Limitation. Long term follow-up was not taken.

Physical Activity Helps Seniors Stay Mobile

Science.gov (United States)

... Subscribe July 2014 Print this issue Health Capsule Physical Activity Helps Seniors Stay Mobile En español Send us your comments A carefully structured, moderate physical activity program helped vulnerable older people maintain their mobility. ...

Incidence of constipation in an intensive care unit.

Science.gov (United States)

Guerra, Tatiana Lopes de Souza; Mendonça, Simone Sotero; Marshall, Norma Guimarães

2013-01-01

To evaluate the incidence of constipation in critical patients on enteral nutrition in a hospital intensive care unit and to correlate this incidence with the variables found for critical patients. The present investigation was a retrospective analytical study conducted in the intensive care unit of Hospital Regional da Asa Norte (DF) via the analysis of medical records of patients admitted during the period from January to December 2011. Data on the incidence of constipation and enteral nutritional support, gastrointestinal changes, stool frequency, ventilatory support, and outcomes were collected and analyzed. The initial sample consisted of 127 patients admitted to the unit during the period from January to December 2011. Eighty-four patients were excluded, and the final sample consisted of 43 patients. The incidence of constipation, defined as no bowel movement during the first 4 days of hospitalization, was 72% (n=31). The patients were divided into a control group and a constipated group. The group of constipated patients reached the caloric target, on average, at 6.5 days, and the control group reached the caloric target in 5.6 days (p=0.51). Constipation was not associated with the length of hospital stay, suspension of nutritional support, or outcome of hospitalization. There was an association between evacuation during hospitalization and a longer duration of hospitalization for a subgroup of patients who did not evacuate during the entire period (p=0.009). The incidence of constipation in the unit studied was 72%. Only the absence of evacuation during hospitalization was associated with longer hospital stays. Constipation was not associated with the length of hospital stay, suspension of nutritional support, or outcome of hospitalization.

Predictive modelling of survival and length of stay in critically ill patients using sequential organ failure scores.

Science.gov (United States)

Houthooft, Rein; Ruyssinck, Joeri; van der Herten, Joachim; Stijven, Sean; Couckuyt, Ivo; Gadeyne, Bram; Ongenae, Femke; Colpaert, Kirsten; Decruyenaere, Johan; Dhaene, Tom; De Turck, Filip

2015-03-01

The length of stay of critically ill patients in the intensive care unit (ICU) is an indication of patient ICU resource usage and varies considerably. Planning of postoperative ICU admissions is important as ICUs often have no nonoccupied beds available. Estimation of the ICU bed availability for the next coming days is entirely based on clinical judgement by intensivists and therefore too inaccurate. For this reason, predictive models have much potential for improving planning for ICU patient admission. Our goal is to develop and optimize models for patient survival and ICU length of stay (LOS) based on monitored ICU patient data. Furthermore, these models are compared on their use of sequential organ failure (SOFA) scores as well as underlying raw data as input features. Different machine learning techniques are trained, using a 14,480 patient dataset, both on SOFA scores as well as their underlying raw data values from the first five days after admission, in order to predict (i) the patient LOS, and (ii) the patient mortality. Furthermore, to help physicians in assessing the prediction credibility, a probabilistic model is tailored to the output of our best-performing model, assigning a belief to each patient status prediction. A two-by-two grid is built, using the classification outputs of the mortality and prolonged stay predictors to improve the patient LOS regression models. For predicting patient mortality and a prolonged stay, the best performing model is a support vector machine (SVM) with GA,D=65.9% (area under the curve (AUC) of 0.77) and GS,L=73.2% (AUC of 0.82). In terms of LOS regression, the best performing model is support vector regression, achieving a mean absolute error of 1.79 days and a median absolute error of 1.22 days for those patients surviving a nonprolonged stay. Using a classification grid based on the predicted patient mortality and prolonged stay, allows more accurate modeling of the patient LOS. The detailed models allow to support

Longest cable-stayed bridge TATARA; Longest shachokyo Tatara Ohashi

Energy Technology Data Exchange (ETDEWEB)

Fujii, K. [Hiroshima University, Hiroshima (Japan). Faculty of Engineering

1998-06-15

The world`s longest cable-stayed bridge Tatara having a central span of 890 m had the both ends closed in August 1997, linking Namakuchi Island and Omishima Island. Final finishing work is continuing for opening of the West Seto Expressway in the spring of 1999. A cable-stayed bridge supports the bridge girders by perpendicular components of tensile force of cables stayed obliquely. On the other hand, there is a concern that the girders may have axial compression force generated due to horizontal components of the force from the cable tensile force, which can cause buckling of the girders. Therefore, in order to suspend the girders efficiently by increasing the perpendicular components of the cable force, and moreover to suppress the axial compression force on the girders, it is more advantageous to make bridge towers high, hence the towers of this bridge are highest among the bridges on the Shimanami Ocean Road. This bridge whose long girders are stayed with 21-stage multi cables presented a problem in designing the buckling in steel girders near the towers due to the horizontal components of the force generated by the bridge. Discussions were given, therefore, by using load withstanding force experiments using a whole bridge model of 1/50 scale, buckling experiments on full-size reinforcing plate models, and load withstanding force analysis using a tower model. A number of other technical discussions were repeated, by which the world`s longest cable-stayed bridge was completed. 9 figs., 1 tab.

History of cable-stayed bridges

DEFF Research Database (Denmark)

Gimsing, Niels Jørgen

1999-01-01

The principle of supporting a bridge deck by inclined tension members leading to towers on either side of the span has been known for centuries. However, the real development of cable-stayed bridges did not begin before the 1950s. Since then the free span has been increased from 183 m in the Strö...

Length of stay for childbirth in Trentino (North-East of Italy): the impact of maternal characteristics and organizational features of the maternity unit on the probability of early discharge of healthy, term infants.

Science.gov (United States)

Pertile, Riccardo; Pavanello, Lucia; Soffiati, Massimo; Manica, Laura; Piffer, Silvano

2018-01-01

Early discharge (ED) of healthy term infants has become a common practice due to current social and economic needs. The primary objective of the present study was to evaluate trends in early discharge of healthy term neonates (≥ 37 gestational weeks) by delivery method (cesarean and vaginal) in maternity units in the Province of Trento. The secondary objective was to identify the socio-demographic characteristics (including the area of residence and distance from the designated hospital) and clinical characteristics of mothers whose infants were discharged early. This retrospective study reviewed records of live births from 2006 to 2016, for a total of 45, 314 healthy term infants. The trend for ED grew significantly during the period 2006-2016, for both cesarean and vaginal deliveries. The multiple logistic regression analysis shows how the determinants of ED are maternal age, birth order, citizenship of mother, maternal smoking, maternal employment status, and the number of births at the hospital on the day of birth. The post-partum length of stay should be adjusted based on the characteristics and needs of the mother-infant dyad, identifying the criteria for safe discharge. In Trento, various procedures and programs are becoming more uniform today with the intention to provide family assistance service. What is Known: • Admission for childbirth is one of the primary causes of hospitalization in industrialized countries. • The length of stay for childbirth has been steadily declining in recent decades, with the aim of reducing costs while also demedicalizing pregnancy. What is New: • A higher rate of early discharge (ED) was recorded for neonates of women having foreign citizenship, entrepreneurs, self-employed professionals or managers. • ED was more common when the new mother gave birth on a day in which there was a higher number of births at the hospital, indicating overcrowding in the maternity unit.

Beverage can stay-tabs: still a source for inadvertently ingested foreign bodies in children

Energy Technology Data Exchange (ETDEWEB)

Donnelly, Lane F. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, MLC 5031, Cincinnati, OH (United States); University of Cincinnati, College of Medicine, Departments of Radiology and Pediatrics, Cincinnati, OH (United States)

2010-09-15

In the 1970s in part to avoid inadvertent ingestion, the beverage-can industry changed can construction from pull-tabs to the stay-tabs (remain attached to can after opening) used today. Our purpose is to identify the number of inadvertent ingestions of beverage-can stay-tabs by children recognized at our institution. The medical information system of a children's hospital was searched with key terms to identify cases in which a witnessed or self-reported inadvertent ingestion of a beverage-can stay-tab resulted in a radiograph to rule out presence of a foreign body. Demographics, identification of stay-tab on radiographs, associated abnormalities, and patient management were reviewed. Nineteen cases of stay-tab ingestion were identified over 16 years. Mean age of ingesters was 8.5 years with the majority being teenagers and 15 (79%) >5 years of age. The stay-tab could be seen radiographically only in 4 (21%) cases - all with the stay-tab identified in the stomach. The identification of 19 children who inadvertently ingested beverage-can stay-tabs at a single children's hospital suggests that such ingestions still occur. Radiologists should be aware that stay-tabs are radiographically visible in the minority (21%) of cases. (orig.)

Beverage can stay-tabs: still a source for inadvertently ingested foreign bodies in children

International Nuclear Information System (INIS)

Donnelly, Lane F.

2010-01-01

In the 1970s in part to avoid inadvertent ingestion, the beverage-can industry changed can construction from pull-tabs to the stay-tabs (remain attached to can after opening) used today. Our purpose is to identify the number of inadvertent ingestions of beverage-can stay-tabs by children recognized at our institution. The medical information system of a children's hospital was searched with key terms to identify cases in which a witnessed or self-reported inadvertent ingestion of a beverage-can stay-tab resulted in a radiograph to rule out presence of a foreign body. Demographics, identification of stay-tab on radiographs, associated abnormalities, and patient management were reviewed. Nineteen cases of stay-tab ingestion were identified over 16 years. Mean age of ingesters was 8.5 years with the majority being teenagers and 15 (79%) >5 years of age. The stay-tab could be seen radiographically only in 4 (21%) cases - all with the stay-tab identified in the stomach. The identification of 19 children who inadvertently ingested beverage-can stay-tabs at a single children's hospital suggests that such ingestions still occur. Radiologists should be aware that stay-tabs are radiographically visible in the minority (21%) of cases. (orig.)

Static and Dynamic Mechanical Properties of Long-Span Cable-Stayed Bridges Using CFRP Cables

Directory of Open Access Journals (Sweden)

Mei Kuihua

2017-01-01

Full Text Available The elastic modulus and deadweight of carbon fiber-reinforced polymer (CFRP cables are different from those of steel cables. Thus, the static and dynamic behaviors of cable-stayed bridges using CFRP cables are different from those of cable-stayed bridges using steel cables. The static and dynamic performances of the two kinds of bridges with a span of 1000 m were studied using the numerical method. The effects of geometric nonlinear factors on static performance of the two kinds of cable-stayed bridges were analyzed. The live load effects and temperature effects of the two cable-stayed bridges were also analyzed. The influences of design parameters, including different structural systems, the numbers of auxiliary piers, and the space arrangement types of cable, on the dynamic performance of the cable-stayed bridge using CFRP cables were also studied. Results demonstrate that sag effect of the CFRP cable is much smaller than that of steel cable. The temperature effects of CFRP cable-stayed bridge are less than those of steel cable-stayed bridge. The vertical bending natural vibration frequency of the CFRP cable-stayed bridge is generally lower than that of steel cable-stayed bridge, whereas the torsional natural vibration frequency of the former is higher than that of the latter.

Staying Safe on Social Network Sites

Science.gov (United States)

... Tips Security Tip (ST06-003) Staying Safe on Social Networking Sites Original release date: January 26, 2011 | Last revised: ... so you should take certain precautions. What are social networking sites? Social networking sites, sometimes referred to as "friend- ...

Primary tetralogy of Fallot repair: predictors of intensive care unit morbidity.

Science.gov (United States)

Egbe, Alexander C; Uppu, Santosh C; Mittnacht, Alexander J C; Joashi, Umesh; Ho, Deborah; Nguyen, Khanh; Srivastava, Shubhika

2014-09-01

Primary repair of tetralogy of Fallot has low surgical mortality, but some patients still experience significant postoperative morbidity. Our objectives were to review our institutional experience with primary tetralogy of Fallot repair, and identify predictors of intensive care unit morbidity. We reviewed all patients with tetralogy of Fallot who underwent primary repair in infancy from 2001 to 2012. Preoperative, operative, and postoperative demographic and morphologic data were analyzed. Intensive care unit morbidity was defined as prolonged intensive care unit stay (≥ 7 days) and/or prolonged duration of mechanical ventilation (≥ 48 h). 97 patients who underwent primary surgical repair during the study period were included in the study. The median age was 4.9 months (range 1-9 months) and the median weight was 5.3 kg (range 3.1-9.8 kg). There was no early surgical mortality. The incidence of junctional ectopic tachycardia and persistent complete heart block was 2% and 1%, respectively. The median intensive care unit stay was 6 days (range 2-21 days) and the median duration of mechanical ventilation was 19 h (range 0-136 h). Age and weight were independent predictors of intensive care unit stay, while surgical era predicted the duration of mechanical ventilation. Primary tetralogy of Fallot repair is a safe procedure with low mortality and morbidity in a medium-sized program with outcomes comparable to national standards. Age and weight at the time of surgery were significant predictors of morbidity. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Periprosthetic hip fractures: A review of the economic burden based on length of stay.

Science.gov (United States)

Lyons, Rebecca F; Piggott, Robert P; Curtin, William; Murphy, Colin G

2018-03-01

With the increasing rates of total hip replacements being performed worldwide, there is an increasing incidence of periprosthetic fractures. As our patients' demographics change to include older patients with multiple medical co-morbidities, there is a concurrent increase in morbidity and mortality rates. This leads to longer hospital stays and increasing hospital costs. In the current economic climate, the cost of treating periprosthetic fractures must be addressed and appropriate resource and funding allocation for future provision of services should be planned. All periprosthetic hip fractures that were admitted to a single trauma unit over a three-year period were reviewed. Independent chart review, haematological and radiological review was undertaken. All patients with a periprosthetic fracture associated with a total hip arthroplasty or hemiarthroplasty were included. Follow up data including complications were collated. Data from the hospital inpatient database and finance department was utilized for cost analysis. All statistical analysis was preformed using Minitab version 17. 48 patients were identified who met the inclusion criteria for review. The majority of participants were female with a mean age of 73.5 years. The mean time to fracture was 4.5 years (9 months-18.5 years). Periprosthetic fracture was associated with total hip arthroplasty in 24 cases and a Vancouver B2 classification was most common at n = 20. The majority of patients had revision arthroplasty, with a mean length of stay of 24 days for the whole cohort (9-42). Vancouver B3 fractures had the longest inpatient stay at a mean of 26 days. The mean cost of for a full revision of stem with additional plate and cable fixation was over €27000 compared to €14,600 for ORIF and cable fixation based on length of hospital stay. The prolonged length of stay associated with Vancouver B2 and B3 fractures leads to increased costs to the healthcare service. Accurately calculating

When nurse emotional intelligence matters: How transformational leadership influences intent to stay.

Science.gov (United States)

Wang, Lin; Tao, Hong; Bowers, Barbara J; Brown, Roger; Zhang, Yaqing

2018-05-01

The purpose of this study was to examine the role of staff nurse emotional intelligence between transformational leadership and nurse intent to stay. Nurse intent to stay and transformational leadership are widely recognized as vital components of nurse retention. Staff nurse emotional intelligence that has been confirmed improvable has been recently recognized in the nursing literature as correlated with retention. Yet, the nature of the relationships among these three variables is not known. Cross-sectional data for 535 Chinese nurses were analysed using Structural Equation Modelling. Transformational leadership and staff nurse emotional intelligence were significant predictors of nurse intent to stay, accounting for 34.3% of the variance in nurse intent to stay. Staff nurse emotional intelligence partially mediates the relationship between transformational leadership and nurse intent to stay. The findings of the study emphasized the importance of transformational leadership in enhancing nurse emotional intelligence and to provide a deeper understanding of the mediating role of emotional intelligence in the relationship between nurse manager's transformational leadership and nurse's intent to stay. Nurse leaders should develop training programmes to improve nursing manager transformational leadership and staff nurse emotional intelligence in the workplace. © 2018 John Wiley & Sons Ltd.

On Staying with Our Students

Science.gov (United States)

Jennings, Marianne

2009-01-01

This paper describes the author's experience and strategy in teaching business law and ethics. Jennings shares how business scandals have changed her three decades of teaching and describes how she has found a way of connecting with students by introducing some cognitive dissonance that stays with them when they are asked to do something in their…

Predictors of Hospitalization, Length of Stay, and Costs of Care Among Adult and Pediatric Inpatients With Atopic Dermatitis in the United States

DEFF Research Database (Denmark)

Narla, Shanthi; Hsu, Derek Y; Thyssen, Jacob P

2018-01-01

household income, Medicaid or no insurance and fewer chronic conditions. Increased cost of care and prolonged length of stay were also associated with nonwhite race/ethnicities, lowest-quartile annual household income, Medicaid or no insurance, and having a higher number of chronic conditions. In conclusion...

29 CFR 500.269 - Stay pending decision of the Secretary.

Science.gov (United States)

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Stay pending decision of the Secretary. 500.269 Section 500.269 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR... Vacation of Order of Administrative Law Judge § 500.269 Stay pending decision of the Secretary. (a) The...

Optimization technique of the stay of person in the middle-altitude conditions

Directory of Open Access Journals (Sweden)

Borisenko O.V.

2013-12-01

Full Text Available The objective: In order to improve exercise capacity in the middle-altitude conditions a technique of urgent adaptation with use of the compact device has been developed. Material and Methods. The study included two groups of people involved in mountain tourism, on the move and stay in the midlands, which used (experimental group and didn't use (control group the developed technique. Considering the specificity of observations directly on the mountain route, the compact equipment and functional studies (pulse oximetry, spirometry, peak flow, the dynamic measurement of pulse and blood pressure with the calculation of double product index were used to monitor the experiment. Results. During the experiment changes of the data characterizing positive development of the functioning of human cardiore-spiratory system during the physical activities in the conditions of middle mountains were recorded (peak expiratory flow rate (from 512,86 to 592,86 I / min, t = 2,25, or by 115,6% in the experimental group and double product index (from 95,66 to 127,09 units., t = 2,41, or by 132,9% in the experimental group. Conclusion. Thus, the offered device and its technique compose an effective scheme of preliminary preparation of cardiorespiratory system to stay in the middle-altitude condition and can be recommended for use in need short-term adaptation.

Duration of hospital stay following orthognathic surgery at the jordan university hospital.

Science.gov (United States)

Jarab, Fadi; Omar, Esam; Bhayat, Ahmed; Mansuri, Samir; Ahmed, Sami

2012-09-01

Major oral and maxillofacial surgery procedures have been routinely performed on an inpatient basis in order to manage both, the recovery from anesthesia and any unpredictable morbidity that may be associated with the surgery. The use of inpatient beds is extremely expensive and if the surgical procedures could be done on an outpatient setting, it would reduce the costs and the need for inpatient care. The aim was to determine the length of hospital stay (LHS) and the factors which influence the LHS following orthognathic surgery at the Jordan University Hospital over 5 years (2005-2009). This was a retrospective record review of patients who underwent orthognathic surgery at Jordan University Hospital between 2005 and 2009. The variables were recorded on a data capture form which was adapted and developed from previous studies. Descriptive and analytical statistical methods were used to correlate these variables to the LHS. Ninety two patients were included in the study and 74% of them were females. The mean age was 23.7 years and the mean LHS was 4 days. The complexity of the procedure, length of operation time, intensive care unit (ICU) stay and year of operation were significantly correlated with a positive LHS (P LHS over the progressing years and this could be due to an increase in experience and knowledge of the operators and an improvement in the hospital facilities.

Multimedia campaign on a shoestring: promoting 'Stay Active - Stay Independent' among seniors.

Science.gov (United States)

John-Leader, Franklin; Van Beurden, Eric; Barnett, Lisa; Hughes, Karen; Newman, Beth; Sternberg, Jason; Dietrich, Uta

2008-04-01

This paper describes a multimedia campaign implemented in rural New South Wales on a budget smaller than that typical of many published campaigns. The 'To Be Young at Heart - Stay Active Stay Independent' (SASI) campaign was one arm of a multi-strategic program to reduce falls among seniors by promoting physical activity. This 18-month campaign used social marketing techniques. Central to this campaign was strong formative research, significant use of corporate, community and media partnerships and a detailed, strategic distribution plan. Campaign reach was evaluated by a community intercept survey. A variety of high-quality information, education and communication (IEC) resources were developed. Overall, the campaign cost was calculated at USD 191,000. The actual cost of USD 42,000 (excluding staff time) was used to generate almost double this amount in sponsorship (USD 82,000). In the mid-campaign reach survey, 36% recognised the campaign and attributed this to television (58%), newspaper (33%), poster (13%) and bus-back advertising (8%). Of these respondents, 21% reported seeking information about physical activity, 33% reported increased intention to be more active, and 22% reported becoming more active as a result of the campaign. It is possible to develop and deliver a well-designed, multi-media campaign on a limited budget by using sound formative research and engaging community and corporate partners to generate sponsorship. An effective distribution strategy is crucial and may require additional partnerships at State or national level.

'Imported risk' or 'health transition'? Smoking prevalence among ethnic German immigrants from the Former Soviet Union by duration of stay in Germany - analysis of microcensus data

Directory of Open Access Journals (Sweden)

Spallek Jacob

2010-06-01

Full Text Available Abstract Background It can be assumed that resettlers (ethnic German immigrants from the Former Soviet Union show similar smoking patterns as persons in their countries of origin at the time of migration. We analysed how the smoking prevalence among resettlers differs from that among the general population of Germany and whether the prevalence differs between groups with increasing duration of stay. Methods To estimate the smoking prevalence we used the scientific-use-file (n = 477,239 of the German 2005 microcensus, an annual census representing 1% of all German households. Participation in the microcensus is obligatory (unit-nonresponse resettlers and the comparison group (population of Germany without resettlers by age, sex, educational level and duration of stay. In total, 14,373 (3% of the total persons were identified as resettlers. Results Female resettlers with short duration of stay had a significantly lower smoking prevalence than women in the comparison group. With increasing duration of stay their smoking prevalence appears to converge to that of the comparison group (e.g.: high educational level, age group 25-44 years: short duration of stay 15%, long duration of stay 24%, comparison group 28%. In contrast, the smoking prevalence among male resettlers with short duration of stay was significantly higher than that among men in the comparison group, but also with a trend towards converging (e.g.: high educational level, age group 25-44 years: short duration of stay 44%, long duration of stay 35%, comparison group 36%. Except for female resettlers with short duration of stay, the participants with low educational level had on average a higher smoking prevalence than those with a high educational level. Conclusions This is the first study estimating the smoking prevalence among resettlers by duration of stay. The results support the hypothesis that resettlers brought different smoking habits from their countries of origin shortly after

Seismic Fragility Assessment of an Isolated Multipylon Cable-Stayed Bridge Using Shaking Table Tests

Directory of Open Access Journals (Sweden)

Yutao Pang

2017-01-01

Full Text Available In recent decades, cable-stayed bridges have been widely built around the world due to the appealing aesthetics and efficient and fast mode of construction. Numerous studies have concluded that the cable-stayed bridges are sensitive to earthquakes because they possess low damping characteristics and high flexibility. Moreover, cable-stayed bridges need to warrant operability especially in the moderate-to-severe earthquakes. The provisions implemented in the seismic codes allow obtaining adequate seismic performance for the cable-stayed bridge components; nevertheless, they do not provide definite yet reliable rules to protect the bridge. To date, very few experimental tests have been carried out on the seismic fragility analysis of cable-stayed bridges which is the basis of performance-based analyses. The present paper is aimed at proposing a method to derive the seismic fragility curves of multipylon cable-stayed bridge through shake table tests. Toward this aim, a 1/20 scale three-dimensional model of a 22.5 m cable-stayed bridge in China is constructed and tested dynamically by using the shaking table facility of Tongji University. The cable-stayed bridge contains three pylons and one side pier. The outcomes of the comprehensive shaking table tests carried out on cable-stayed bridge have been utilized to derive fragility curves based on a systemic approach.

Long and short hospice stays among nursing home residents at the end of life.

Science.gov (United States)

Huskamp, Haiden A; Stevenson, David G; Grabowski, David C; Brennan, Eric; Keating, Nancy L

2010-08-01

To identify characteristics of nursing homes and residents associated with particularly long or short hospice stays. Observational study using administrative data on resident characteristics and hospice utilization from a large regional hospice linked with publicly available data on nursing home characteristics. A total of 13,479 residents who enrolled in hospice during 2001-2008. Logistic regression models of the probability of a long (>180 days) or very short (stay, adjusting for nursing home characteristics, a measure of nursing home quality developed using Minimum Data Set Quality Indicator/Quality Measures data, and resident characteristics. Nursing home characteristics were not statistically significant predictors of long stays. The probability of a short stay increased with the facility's nurse staffing ratio and decreased with the share of residents covered by Medicaid. Men (relative to women) and blacks (relative to whites) were less likely to have a long stay and more likely to have a short stay, while those 70 years or younger (relative to those 81-90) and residents with Alzheimer's disease/dementia were more likely to have long stays and less likely to have short stays. Fourteen percent of hospice users were discharged before death because they failed to meet Medicare hospice eligibility criteria, and these residents had longer lengths of stay, on average. Few facility characteristics were associated with very long or very short hospice stays. However, high rates of discharge before death that may reflect a less predictable life trajectory of nursing home residents suggests that further evaluation of the hospice benefit for nursing home residents may be needed.

Family Dynamics of the Stay-at-Home Father and Working Mother Relationship.

Science.gov (United States)

Rushing, Cassie; Powell, Lisa

2015-09-01

A phenomenological qualitative study was utilized to explore family dynamics in stay-at-home father and working mother households. A total of 20 working mothers were asked to describe family interactions and daily routines with regard to their stay-at-home father and working mother dynamic. All participants were married, heterosexual women with biological children ages 1 to 4 and who worked outside the home and the father stayed home as primary caretaker and did not contribute financially. The study indicated that the family dynamic of a working mother and stay-at-home father provided a positive parent-child relationship, enhanced parenting cohesion, and enhanced quality time. © The Author(s) 2014.

Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality-improvement project.

Science.gov (United States)

Hoyer, Erik H; Friedman, Michael; Lavezza, Annette; Wagner-Kosmakos, Kathleen; Lewis-Cherry, Robin; Skolnik, Judy L; Byers, Sherrie P; Atanelov, Levan; Colantuoni, Elizabeth; Brotman, Daniel J; Needham, Dale M

2016-05-01

To determine whether a multidisciplinary mobility promotion quality-improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS). Implemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. There were 3352 patients admitted during the QI project period. The Johns Hopkins Highest Level of Mobility (JH-HLM) scale, an 8-point ordinal scale ranging from bed rest (score = 1) to ambulating ≥250 feet (score = 8), was used to quantify mobility. Changes in JH-HLM scores were compared for the first 4 months of the project (ramp-up phase) versus 4 months after project completion (post-QI phase) using generalized estimating equations. We compared the relative change in median LOS for the project months versus 12 months prior among the QI units, using multivariable linear regression analysis adjusting for 7 demographic and clinically relevant variables. Comparing the ramp-up versus post-QI phases, patients reaching JH-HLM's ambulation status increased from 43% to 70% (P mobility scores between admission and discharge increased from 32% to 45% (P 7 days), were associated with a significantly greater adjusted median reduction in LOS of 1.11 (95% CI: -1.53 to -0.65, P mobility was not associated with an increase in injurious falls compared to 12 months prior on the QI units (P = 0.73). Active prevention of a decline in physical function that commonly occurs during hospitalization may be achieved with a structured QI approach. In an adult medicine population, our QI project was associated with improved mobility, and this may have contributed to a reduction in LOS, particularly for more complex patients with longer expected hospital stay. Journal of Hospital Medicine 2016. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

Avaliação do crescimento e do custo da alimentação do pacu (Piaractus mesopotamicus Holmberg, 1887 submetido a ciclos alternados de restrição alimentar e realimentação Evaluation of the growth and feeding costs of pacu (Piaractus mesopotamicus submitted to alternate cycles of feeding restriction and refeeding

Directory of Open Access Journals (Sweden)

Valéria Leão Souza

2003-02-01

Full Text Available Avaliaram-se os efeitos da utilização de ciclos alternados de restrição alimentar e realimentação no crescimento do pacu, durante o período de engorda, e a viabilidade desta prática na produção comercial da espécie. Juvenis foram distribuídos em três tanques e submetidos a diferentes manejos alimentares, constituindo os tratamentos: A (alimentado ad libitum, B (restrição alimentar de 4 semanas, realimentado por 9 semanas e C (6 semanas de restrição alimentar, realimentado por 7 semanas, em um total de 13 semanas por ciclo (4 ciclos experimentais. No final de cada ciclo alimentar, 20 peixes de cada tratamento foram amostrados e os dados biométricos registrados. Os valores obtidos para peso, comprimento total e fator de condição (K foram submetidos a ANOVA e as médias comparadas pelo teste de Duncan. Os resultados mostraram que o tratamento C é o mais indicado somente para outono/inverno, promovendo maior crescimento, menor custo com ração, baixa conversão alimentar e maior receita líquida parcial. Entretanto, durante as estações mais quentes do ano (primavera/verão outros programas de alimentação devem ser testados, utilizando-se períodos mais curtos de restrição alimentar. Quando se tratou da produção anual, o tratamento A respondeu melhor em termos de biomassa produzida, apesar do maior gasto com alimentação, visto que, com o aumento da temperatura, o crescimento dos peixes dos demais tratamentos ficou prejudicado.The present study evaluated the effects of alternating food restriction and refeeding cycles on the growth of pacu, during the growout phase and the viability of this practice in the commercial production of the species. Juvenile fish were distributed in 3 tanks and submitted to different feeding strategies: group A (fed ad libitum daily, B (food restricted to 4 weeks and refed for 9 weeks and C (food restricted to 6 weeks and refed for 7 weeks totalizing 13 weeks per cycle (4 experimental cycles

Stay Safe and Healthy This Winter!

Centers for Disease Control (CDC) Podcasts

2010-11-23

In this podcast for kids, the Kidtastics offer some simple ways to stay safe and healthy during the winter holiday season.  Created: 11/23/2010 by CDC Office of Women’s Health.   Date Released: 11/23/2010.

Effects of the Length of Stay on the Cost of Total Knee and Total Hip Arthroplasty from 2002 to 2013.

Science.gov (United States)

Molloy, Ilda B; Martin, Brook I; Moschetti, Wayne E; Jevsevar, David S

2017-03-01

Utilization of total knee and hip arthroplasty has greatly increased in the past decade in the United States; these are among the most expensive procedures in patients with Medicare. Advances in surgical techniques, anesthesia, and care pathways decrease hospital length of stay. We examined how trends in hospital cost were altered by decreases in length of stay. Procedure, demographic, and economic data were collected on 6.4 million admissions for total knee arthroplasty and 2.8 million admissions for total hip arthroplasty from 2002 to 2013 using the National (Nationwide) Inpatient Sample, a component of the Healthcare Cost and Utilization Project. Trends in mean hospital costs and their association with length of stay were estimated using inflation-adjusted, survey-weighted generalized linear regression models, controlling for patient demographic characteristics and comorbidity. From 2002 to 2013, the length of stay decreased from a mean time of 4.06 to 2.97 days for total knee arthroplasty and from 4.06 to 2.75 days for total hip arthroplasty. During the same time period, the mean hospital cost for total knee arthroplasty increased from $14,988 (95% confidence interval [CI], $14,927 to $15,049) in 2002 to $22,837 (95% CI, $22,765 to $22,910) in 2013 (an overall increase of $7,849 or 52.4%). The mean hospital cost for total hip arthroplasty increased from $15,792 (95% CI, $15,706 to $15,878) in 2002 to $23,650 (95% CI, $23,544 to $23,755) in 2013 (an increase of $7,858 or 49.8%). If length of stay were set at the 2002 mean, the growth in cost for total knee arthroplasty would have been 70.8% instead of 52.4% as observed, and the growth in cost for total hip arthroplasty would have been 67.4% instead of 49.8% as observed. Hospital costs for joint replacement increased from 2002 to 2013, but were attenuated by reducing inpatient length of stay. With demographic characteristics showing an upward trend in the utilization of joint arthroplasty, including a shift

Application of Microwave Remote Sensing to Dynamic Testing of Stay-Cables

Directory of Open Access Journals (Sweden)

Carmelo Gentile

2009-12-01

Full Text Available Recent advances in radar techniques and systems have favoured the development of microwave interferometers, suitable for the non-contact vibration monitoring of large structures. The paper addresses the application of microwave remote sensing to the measurement of the vibration response in the stay-cables of cable-stayed bridges. The reliability and accuracy of the proposed technique were investigated by comparing the natural frequencies (and the cable tensions predicted from natural frequencies identified from radar data and the corresponding quantities obtained using more conventional techniques. The investigation, carried out on the cables of two different cable-stayed bridges, clearly highlights: (a the accuracy of the results provided by the microwave remote sensing; (b the simplicity of use of the radar technique (especially when compared with conventional approaches and its effectiveness to simultaneously measuring the dynamic response of all the stay-cables of an array.

The implementation of quantitative electromyographic neuromuscular monitoring in an academic anesthesia department.

Science.gov (United States)

Todd, Michael M; Hindman, Bradley J; King, Brian J

2014-08-01

Although experts agree on the importance of quantitative neuromuscular blockade monitoring, particularly for managing reversal, such monitoring is not in widespread use. We describe the processes and results of our departmental experience with the introduction of such quantitative monitoring. In mid-2010, the senior authors became concerned about the management of nondepolarizing neuromuscular blockers (NMB) by providers within the department, based on personal observations and on a review of a departmental quality assurance/adverse event database. This review indicated the occurrence of 2 to 4 reintubations/year in the postanesthesia care unit (PACU) that were deemed to be probably or possibly related to inadequate reversal. In response, quantitative blockade equipment (Datex-Omeda ElectroSensor™ EMG system) was installed in all our main operating rooms in January 2011. This introduction was accompanied by an extensive educational effort. Adoption of the system was slow; by mid-2011, the quantitative system was being used in system. In the initial (August 2011) PACU survey of 96 patients receiving nondepolarizing NMBs, 31% had a TOF ratio of ≤0.9, 17% had a ratio of ≤0.8, and 4 patients (4%) had ratios of ≤0.5. A record review showed that the quantitative monitoring system had been used to monitor reversal in only 51% of these patients, and 23% of patients had no evidence of any monitoring, including qualitative TOF assessment. By December of 2012 (after 2 interim PACU monitoring surveys), a fourth survey showed 15% of 101 monitored patients had a TOF ratio ≤0.9, and only 5% had ratios ≤0.8. (P system was present in 83% of cases (P < 0.05 vs August 2011). A final survey in July 2013 showed nearly identical values to those from December 2012. The lowest TOF ratio observed in any patient not receiving a nondepolarizing NMB was 0.92. There were no changes in the patterns of either rocuronium or neostigmine use over the duration of the project (through

Anesthetic considerations for patients with esophageal achalasia undergoing peroral endoscopic myotomy: a retrospective case series review.

Science.gov (United States)

Löser, Benjamin; Werner, Yuki B; Punke, Mark A; Saugel, Bernd; Haas, Sebastian; Reuter, Daniel A; Mann, Oliver; Duprée, Anna; Schachschal, Guido; Rösch, Thomas; Petzoldt, Martin

2017-05-01

Peroral endoscopic myotomy (POEM) is a novel technique for treating esophageal achalasia. During POEM, carbon dioxide (CO 2 ) is insufflated to aid surgical dissection, but it may inadvertently track into surrounding tissues, causing systemic CO 2 uptake and tension capnoperitoneum. This in turn may affect cardiorespiratory function. This study quantified these cardiorespiratory effects and treatment by hyperventilation and percutaneous abdominal needle decompression (PND). One hundred and seventy-three consecutive patients who underwent POEM were included in this four-year retrospective study. Procedure-related changes in peak inspiratory pressure (p max ), end-tidal CO 2 levels (etCO 2 ), minute ventilation (MV), mean arterial pressure (MAP), and heart rate (HR) were analyzed. We also quantified the impact of PND on these cardiorespiratory parameters. During the endoscopic procedure, cardiorespiratory parameters increased from baseline: p max 15.1 (4.5) vs 19.8 (4.7) cm H 2 O; etCO 2 4.5 (0.4) vs 5.5 (0.9) kPa [34.0 (2.9) vs 41.6 (6.9) mmHg]; MAP 73.9 (9.7) vs 99.3 (15.2) mmHg; HR 67.6 (12.4) vs 85.3 (16.4) min -1 (P < 0.001 for each). Hyperventilation [MV 5.9 (1.2) vs 9.0 (1.8) L·min -1 , P < 0.001] was applied to counteract iatrogenic hypercapnia. Individuals with tension capnoperitoneum treated with PND (n = 55) had higher peak p max values [22.8 (5.7) vs 18.4 (3.3) cm H 2 O, P < 0.001] than patients who did not require PND. After PND, p max [22.8 (5.7) vs 19.9 (4.3) cm H 2 O, P = 0.045] and MAP [98.2 (16.3) vs 88.6 (11.8) mmHg, P = 0.013] decreased. Adverse events included pneumothorax (n = 1), transient myocardial ischemia (n = 1), and subcutaneous emphysema (n = 49). The latter precluded immediate extubation in eight cases. Postanesthesia care unit (PACU) stay was longer in individuals with subcutaneous emphysema than in those without [74.9 min (34.5) vs 61.5 (26.8 min), P = 0.007]. Carbon dioxide insufflation during POEM produces systemic CO 2 uptake and

Perceptions of Why Women Stay in Physically Abusive Relationships: A Comparative Study of Chinese and U.S. College Students.

Science.gov (United States)

Pugh, Brandie; Li, Luye; Sun, Ivan Y

2018-05-01

In both China and the United States, public attitudes toward intimate partner violence (IPV) have shifted from viewing IPV as a tolerable, private matter to viewing it as a matter of public concern that should be dealt with as a crime. Empirical and comparative examinations of the perceptions of why women stay in physically abusive relationships are lacking. Answering this question calls for comprehensive, methodologically rigorous research. Using survey data collected from approximately 1,000 college students from two Chinese and two U.S. universities, this study empirically compared and contrasted factors that impact U.S. and Chinese students' perceptions as to why women remain in physically abusive relationships. Utilizing a theoretical framework of social constructionism, two common reasons were assessed: Women stay in physically abusive relationships because of learned helplessness and positive beliefs in the relationship/hope for the future. The results show that viewing IPV as a crime, gender, and beliefs of the causes of IPV were robust predictors of college students' perceptions toward why women stay in physically abusive relationships. U.S. college students were more likely to express sympathy and understanding toward why women remain in abusive relationships than Chinese students. Directions for future research and policy implications were discussed.

Impact of a stay in the intensive care unit on the preparation of Advance Directives: Descriptive, exploratory, qualitative study.

Science.gov (United States)

Andreu, Pascal; Dargent, Auguste; Large, Audrey; Meunier-Beillard, Nicolas; Vinault, Sandrine; Leiva-Rojas, Uriel; Ecarnot, Fiona; Prin, Sébastien; Charles, Pierre-Emmanuel; Fournel, Isabelle; Rigaud, Jean-Philippe; Quenot, Jean-Pierre

2018-04-01

Our objective was to assess, through a qualitative, exploratory study, the thought processes of patients regarding the formulation of advance directives (AD) after a stay in the ICU. The study was conducted from May to July 2016 using telephone interviews performed by four senior ICU physicians. Inclusion criteria were: patients discharged from ICU to home>3 months earlier. Semi-directive interviews with patients focused on 5 main points surrounding AD. In total, among 159 eligible patients, data from 94 (59%) were available for analysis. Among all those interviewed, 83.5% had never heard of "advance directives". Only 2% had executed AD before ICU admission, and 7% expressed a desire to prepare AD further to their ICU stay. Among the barriers to preparation of AD, lack of information was the main reason cited for not executing AD. Patients noted the following in their AD: withdrawal of life-support in case of vegetative/minimally conscious state or when there is no longer any hope, in case of uncontrollable pain, and if impossible to wean from mechanical ventilation. The ideal time to engage patients in these discussions is most likely well before an acute health event occurs, although this warrants further investigation both before and after ICU admissions. Copyright © 2017 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Intention to stay and nurses' satisfaction dimensions.

Science.gov (United States)

Zaghloul, Ashraf A; Al-Hussaini, Mashael F; Al-Bassam, Nora K

2008-08-01

The study was conducted to identify the satisfaction dimensions in relation to anticipated nurse turnover in an academic medical institution using an ordinal regression model. A cross-sectional descriptive study was designed to describe nurse job satisfaction in relation to their intention to stay at King Faisal University's Hospital, Al-Khobar, Saudi Arabia. All nurses available at the time of the study were included (499 nurses in different departments). The response rate was 55.3% (276 questionnaires suitable for analysis). A self-administered questionnaire with 26 items was developed for this study with a five-point Likert scale ranging from 1 = highly dissatisfied to 5 = highly satisfied). Nurses were least satisfied with the hospital's benefits (1.2 ± 0.4), hospital policies (1.4 ± 0.5), bonuses (1.1 ± 0.3), fairness of the performance appraisal system (1.5 ± 0.5) paid time off (1.5 ± 0.5), and recognition of achievements (1.5 ± 0.5). The mean general job satisfaction score was 2.2 ± 0.4. Ordinal regression analysis revealed leadership styles and challenging opportunities as predictive dimensions for the intention to stay. There are nurse job satisfaction dimensions other than salary and incentive that may be anticipated with the intention to stay in the health facility. Namely, leadership styles in the health organization and challenging opportunities at work.

A Framework for Evaluating Stay Detection Approaches

Directory of Open Access Journals (Sweden)

Cornelia Schneider

2017-10-01

Full Text Available In recent years, sensors of mobile devices are increasingly used in the research field of Active and Assisted Living (AAL, in particular, for movement analysis. Questions, such as where users typically stay (and for how long, where they have been or where they will most likely be going to, are of utmost importance for implementing smart AAL services. Due to the plethora of application scenarios and varying requirements, the challenge is the identification of an appropriate stay detection approach. Thus, this paper presents a comprehensive framework covering the entire process from data acquisition, pre-processing, parameterization to evaluation so that it can be applied to evaluate various stay detection methods. Additionally, ground truth data as well as application field data are used within the framework. The framework has been validated with three different spatio-temporal clustering approaches (time-based/incremental clustering, extended density based clustering, and a mixed method approach. Using the framework with ground truth data and data from the AAL field, it can be concluded that the time-based/incremental clustering approach is most suitable for this type of AAL applications. Furthermore, using two different datasets has proven successful as it provides additional data for selecting the appropriate method. Finally, the way the framework is designed it might be applied to other domains such as transportation, mobility, or tourism by adapting the pre-selection criteria.

7 CFR 1.339 - Stays ordered by the Department of Justice.

Science.gov (United States)

2010-01-01

... judicial officer shall stay the process immediately. (b) If the judicial officer stays the administrative process in accordance with paragraph (a) of this section, the judicial officer may order the process... of the administrative process described in this subpart with respect to a claim or statement may...

Early Appropriate Care: A Protocol to Standardize Resuscitation Assessment and to Expedite Fracture Care Reduces Hospital Stay and Enhances Revenue.

Science.gov (United States)

Vallier, Heather A; Dolenc, Andrea J; Moore, Timothy A

2016-06-01

We hypothesized that a standardized protocol for fracture care would enhance revenue by reducing complications and length of stay. Prospective consecutive series. Level 1 trauma center. Two hundread and fifty-three adult patients with a mean age of 40.7 years and mean Injury Severity Score of 26.0. Femur, pelvis, or spine fractures treated surgically. Hospital and professional charges and collections were analyzed. Fixation was defined as early (<36 hours) or delayed. Complications and hospital stay were recorded. Mean charges were US $180,145 with a mean of US $66,871 collected (37%). The revenue multiplier was US $59,882/$6989 (8.57), indicating hospital collection of US $8.57 for every professional dollar, less than half of which went to orthopaedic surgeons. Delayed fracture care was associated with more intensive care unit (4.5 vs. 9.4) and total hospital days (9.4 vs. 15.3), with mean loss of actual revenue US $6380/patient delayed (n = 47), because of the costs of longer length of stay. Complications were associated with the highest expenses: mean of US $291,846 charges and US $101,005 collections, with facility collections decreased by 5.1%. An uncomplicated course of care was associated with the most favorable total collections: (US $60,017/$158,454 = 38%) and the shortest mean stay (8.7 days). Facility collections were nearly 9 times more than professional collections. Delayed fixation was associated with more complications, and facility collections decreased 5% with a complication. Furthermore, delayed fixation was associated with longer hospital stay, accounting for US $300K more in actual costs during the study. A standardized protocol to expedite definitive fixation enhances the profitability of the trauma service line. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Staying in "the stream of life"

DEFF Research Database (Denmark)

Rasmussen, Birgitte; Delmar, Charlotte; Dolmer, Ilone

2009-01-01

Staying in the stream of life is about being the author of one's own meaningful life. It takes into account life phenomena embodied in the maintenance aspect of health care; dignity in relation to identity and integrity; and an understanding of the dialectical relation between frailty and strength....

Post-anaesthetic emergence delirium in adults

DEFF Research Database (Denmark)

Munk, L; Andersen, G; Møller, A M

2016-01-01

BACKGROUND: Emergence delirium (ED) after general anaesthesia (GA) is a well-known phenomenon, yet the risk factors are still unclear. The aims of this study were to determine the incidence and independent predictors of ED and secondly to determine to which degree ED has any relevant, clinical...... consequences to medical staff as well as to patients. METHOD: This prospective, observational cohort study assessed adult patients emerging from GA in the operating room, using the Richmond Agitation-Sedation Scale (RASS). Signs of ED, defined as RASS≥1 along with possible clinical consequences were noted....... Patients with ED were re-evaluated in the post-anaesthesia care unit (PACU) and concomitant patient and anaesthesia related factors were noted. RESULTS: Among the 1970 patients enrolled, 73 (3.7%) showed signs of ED when emerging from anaesthesia. When reassessed in PACU, the number had declined to 25...

Discomfort and factual recollection in intensive care unit patients

NARCIS (Netherlands)

van de Leur, JP; van der Schans, CP; Loef, BG; Deelman, BG; Geertzen, JHB; Zwaveling, JH

2004-01-01

Introduction A stay in the intensive care unit (ICU), although potentially life-saving, may cause considerable discomfort to patients. However, retrospective assessment of discomfort is difficult because recollection of stressful events may be impaired by sedation and severe illness during the ICU

5 CFR 185.140 - Stays ordered by the Department of Justice.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Stays ordered by the Department of Justice. 185.140 Section 185.140 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PROGRAM FRAUD CIVIL REMEDIES § 185.140 Stays ordered by the Department of Justice. If, at any time...

40 CFR 27.40 - Stay ordered by the Department of Justice.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Stay ordered by the Department of Justice. 27.40 Section 27.40 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL PROGRAM FRAUD CIVIL REMEDIES § 27.40 Stay ordered by the Department of Justice. If at any time the Attorney...

Staying Safe in the Water

Centers for Disease Control (CDC) Podcasts

2008-05-15

In this podcast, Dr. Julie Gilchrist, a pediatrician and medical epidemiologist from CDC’s Injury Center, talks about staying safe in the water. Tips are for all audiences, with a focus on preventing drownings and keeping children safe in and around the pool, lake, or ocean.  Created: 5/15/2008 by National Center for Injury Prevention and Control (NCIPC).   Date Released: 5/19/2008.

Monitoring calculation of closure change of Extradosed Cable-stayed Bridge

Science.gov (United States)

Shi, Jing Xian; Ran, Zhi Hong

2018-06-01

During the construction of extradosed cable-stayed bridge in Yunnan province, China, the construction unit has made certain changes in the construction process of the closure section due to environmental restrictions: remove the hanging basket after the closure, the sling shall not be provided in closure section, the function of the sling is realized by the hanging basket on the 16th beam. In case of this change, the bridge has been constructed to section 15th. In order to ensure the smooth and orderly progress of each stage in the closure phase, this article is arranged according to the construction plan, appropriate adjustment of related procedures, checking the bridge safety at all stages of construction, the stress and force of the main girder are compared to ensure the safety of the construction after closure changes. Adjust the height of the beam of the 16th and 17th to adapt the new construction plan, and the bridge closure smoothly.

Leadership behaviours, organizational culture and intention to stay amongst Jordanian nurses.

Science.gov (United States)

AbuAlRub, R F; Nasrallah, M A

2017-12-01

To investigate the impact of leadership behaviours of nurse managers and organizational culture on Jordanian nurses' intention to stay at work in public, private and university hospitals. Leadership behaviours of nurses and organizational culture are considered important factors in enhancing retention of nurses. A correlational design was used in the study. A sample of 285 Jordanian nurses was conveniently selected to complete a self-administered questionnaire that consisted of three measures; Kouzes and Posner's Leadership Practise Inventory, Professional Organizational Culture questionnaire and McCain's Intent to Stay Scale. Nurse managers' leadership behaviours and organizational culture were positively associated with the level of intention to stay at work. The study variables explained almost 43% of the variance in nurses' intention to stay at work. The limitation of the study was the use of convenience sampling method. The results asserted that transformational leadership styles of nurse managers enhance positive hospitals' culture as well as the intention of nurses to stay at work. Nurse executives should promote leadership behaviours of nurse managers through training. The regulatory bodies of nursing profession in collaboration with nurse educators and administrators should help in developing competencies for nurse managers that are based on transformational leadership and incorporate such competencies in nursing education programs as well as continuous education programs. © 2017 International Council of Nurses.

22 CFR 521.40 - Stays ordered by the Department of Justice.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Stays ordered by the Department of Justice. 521.40 Section 521.40 Foreign Relations BROADCASTING BOARD OF GOVERNORS IMPLEMENTATION OF THE PROGRAM FRAUD CIVIL REMEDIES ACT § 521.40 Stays ordered by the Department of Justice. If at any time the...

10 CFR 1013.40 - Stays ordered by the Department of Justice.

Science.gov (United States)

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Stays ordered by the Department of Justice. 1013.40 Section 1013.40 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) PROGRAM FRAUD CIVIL REMEDIES AND PROCEDURES § 1013.40 Stays ordered by the Department of Justice. If at any time the Attorney General or an...

22 CFR 224.40 - Stays ordered by the Department of Justice.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Stays ordered by the Department of Justice. 224.40 Section 224.40 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT IMPLEMENTATION OF THE PROGRAM FRAUD CIVIL REMEDIES ACT § 224.40 Stays ordered by the Department of Justice. If at any time the...

49 CFR 31.40 - Stays ordered by the Department of Justice.

Science.gov (United States)

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false Stays ordered by the Department of Justice. 31.40 Section 31.40 Transportation Office of the Secretary of Transportation PROGRAM FRAUD CIVIL REMEDIES § 31.40 Stays ordered by the Department of Justice. If at any time the Attorney General or an Assistant...

6 CFR 13.40 - Stays ordered by the Department of Justice.

Science.gov (United States)

2010-01-01

... 6 Domestic Security 1 2010-01-01 2010-01-01 false Stays ordered by the Department of Justice. 13.40 Section 13.40 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY PROGRAM FRAUD CIVIL REMEDIES § 13.40 Stays ordered by the Department of Justice. If at any time the Attorney...

Simple model of cable-stayed bridge deck subjected to static wind loading

Science.gov (United States)

Kang, Yi-Lung; Wang, Yang Cheng

1997-05-01

Cable-stayed bridges have been known since 18th century with aesthetics design. The structural system and the structural behavior are significantly different from those of continuous bridges. Compared to continuous bridge, cable- stayed bridges have more flexure bridge deck than those of continuous bridges.On the other hand, cable-stayed bridges have less stiffness to resist wind loading especially for lateral loads. The first considering of bridge engineering is safety. In 1940's, Tacoma Narrows Suspension Bridge destroyed by wind loading is a good example even though it is not a cable-stayed bridge. After the bridge was destroyed, a lot of research articles have been published regarding cable supported bridge subjected to wind loading. In recent days, high strength materials have been served. The bridge engineers use the advantages to expand the span length of cable-stayed bridges. Due to the span length increased and the use of high strength materials, cable- stayed bridges have more significant nonlinear behavior subjected to wind loading. In this paper, a slice bridge deck of cable-stayed bridge connected to internal support cables is considered. The deck has been considered to be subjected to lateral static wind loading. Since cables can not take compressive force, the deck has strongly nonlinear behavior even though the materials are linear elastic. Several primary load combinations have ben considered in this paper such as the bridge deck supposed to be moved horizontally without rotation or the bridge deck supposed to be moved horizontally with rotational deformation. The mathematical formulas and the numerical solutions are found and represented in graphical forms. The results can be provided to bridge designers and researchers for further study of this type of structure subjected to wind loading.

Parkinson’s disease permanent care unit: managing the chronic-palliative interface

Directory of Open Access Journals (Sweden)

Lökk J

2011-04-01

Full Text Available Johan LökkDepartment of Neurobiology, Caring Sciences, and Society, Karolinska Institutet; Geriatric Department, Karolinska University Hospital Huddinge, Stockholm, SwedenBackground: Parkinson’s disease (PD eventually leads to severe functional decline and dependence. Specialized care units for PD patients in need of permanent care are lacking.Methods: Patients with severe PD are referred to the PD permanent care unit harboring 30 patients with specialized medical and health care provided by trained staff. Patients need to have intensive medical and care needs, and be no longer able to stay at home or at an ordinary institution. A written and continuously reviewed care plan is made for each patient at admission, with the overriding aim to preserve quality of life and optimize functionality.Results: After five years, the PD permanent care unit has cared for 70 patients (36 men and 34 women with a mean age of 76.6 years and a mean duration of Parkinsonism of 11.8 years. Hoehn and Yahr severity of disease was 3.7, cognition was 25.3 (Mini-Mental State Examination, and the mean daily levodopa dose was 739 mg. The yearly fatality rate was seven, and the mean duration of stay was 26.9 months. Only five patients moved out from the unit.Conclusion: A specially designed and staffed care unit for Parkinsonism patients seems to fill a need for patients and caregivers, as well as for social and health care authorities. This model is sensitive to the changing needs and capacities of patients, ensuring that appropriate services are available in a timely manner. There was a rather short duration of patient stay and remaining life span after admission to the unit. Despite the chronic/palliative state of patients at the PD permanent care unit, there are many therapeutic options, with the overriding objective being to allow the patients to end their days in a professional and comfortable environment.Keywords: Parkinsonism, palliative care, end-stage disease

Neonates are Over Exposed to X-Ray Radiation During Their Stay in NICUs

International Nuclear Information System (INIS)

Datz, H.; Margaliot, M.; Ben-Shlemo, A.; Shani, G.; Bader, D.; Uster, A.; Marks, K.; Solomkin, T.; Zangen, D.; Sadetzki, S.

2004-01-01

Diagnostic radiology plays an important role in the assessment and treatment of neonates requiring intensive care. It is often necessary to perform multiple radiographic examinations depending upon the infants birth weight, gestational age and respiratory problems, especially to those infants with very low birth weight (< 1500g). The high frequency of these examinations raises the radiological issue due to the potentially long-term adverse effects. We hypothesize that unnecessary organs of those infants are exposed to X-ray radiation during their hospitalization, leading to an increased risk of long-term adverse effects. The goal of this study was to examine if organs, other than those originally intended, were exposed to excessive radiation in a population of neonates during their stay in the Neonatal Intensive Care Unit - NICU

In-kennel behavior predicts length of stay in shelter dogs.

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Alexandra Protopopova

Full Text Available Previous empirical evaluations of training programs aimed at improving dog adoption rates assume that dogs exhibiting certain behaviors are more adoptable. However, no systematic data are available to indicate that the spontaneous behavior of shelter dogs has an effect on adopter preference. The aim of the present study was to determine whether any behaviors that dogs exhibit spontaneously in the presence of potential adopters were associated with the dogs' length of stay in the shelter. A sample of 289 dogs was videotaped for 1 min daily throughout their stay at a county shelter. To account for differences in adopter behavior, experimenters varied from solitary passive observers to pairs of interactive observers. Dogs behaved more attentively to active observers. To account for adopter preference for morphology, dogs were divided into "morphologically preferred" and "non-preferred" groups. Morphologically preferred dogs were small, long coated, ratters, herders, and lap dogs. No theoretically significant differences in behavior were observed between the two different dog morphologies. When accounting for morphological preference, three behaviors were found to have a significant effect on length of stay in all dogs: leaning or rubbing on the enclosure wall (increased median length of stay by 30 days, facing away from the front of the enclosure (increased by 15 days, and standing (increased by 7 days. When combinations of behaviors were assessed, back and forth motion was found to predict a longer stay (increased by 24 days. No consistent behavioral changes were observed due to time spent at the shelter. These findings will allow shelters to focus behavioral modification efforts only on behaviors likely to influence adopters' choices.

Static and Dynamic Characteristics of a Long-Span Cable-Stayed Bridge with CFRP Cables

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Xu Xie

2014-06-01

Full Text Available In this study, the scope of CFRP cables in cable-stayed bridges is studied by establishing a numerical model of a 1400-m span of the same. The mechanical properties and characteristics of CFRP stay cables and of a cable-stayed bridge with CFRP cables are here subjected to comprehensive analysis. The anomalies in the damping properties of free vibration, nonlinear parametric vibration and wind fluctuating vibration between steel cables and CFRP cables are determined. The structural stiffness, wind resistance and traffic vibration of the cable-stayed bridge with CFRP cables are also analyzed. It was found that the static performances of a cable-stayed bridge with CFRP cables and steel cables are basically the same. The natural frequencies of CFRP cables do not coincide with the major natural frequencies of the cable-stayed bridge, so the likelihood of CFRP cable-bridge coupling vibration is minuscule. For CFRP cables, the response amplitudes of both parametric vibration and wind fluctuating vibration are smaller than those of steel cables. It can be concluded from the research that the use of CFRP cables does not change the dynamic characteristics of the vehicle-bridge coupling vibration. Therefore, they can be used in long-span cable-stayed bridges with an excellent mechanical performance.

Static and Dynamic Characteristics of a Long-Span Cable-Stayed Bridge with CFRP Cables.

Science.gov (United States)

Xie, Xu; Li, Xiaozhang; Shen, Yonggang

2014-06-23

In this study, the scope of CFRP cables in cable-stayed bridges is studied by establishing a numerical model of a 1400-m span of the same. The mechanical properties and characteristics of CFRP stay cables and of a cable-stayed bridge with CFRP cables are here subjected to comprehensive analysis. The anomalies in the damping properties of free vibration, nonlinear parametric vibration and wind fluctuating vibration between steel cables and CFRP cables are determined. The structural stiffness, wind resistance and traffic vibration of the cable-stayed bridge with CFRP cables are also analyzed. It was found that the static performances of a cable-stayed bridge with CFRP cables and steel cables are basically the same. The natural frequencies of CFRP cables do not coincide with the major natural frequencies of the cable-stayed bridge, so the likelihood of CFRP cable-bridge coupling vibration is minuscule. For CFRP cables, the response amplitudes of both parametric vibration and wind fluctuating vibration are smaller than those of steel cables. It can be concluded from the research that the use of CFRP cables does not change the dynamic characteristics of the vehicle-bridge coupling vibration. Therefore, they can be used in long-span cable-stayed bridges with an excellent mechanical performance.

43 CFR 35.40 - Stays ordered by the Department of Justice.

Science.gov (United States)

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Stays ordered by the Department of Justice. 35.40 Section 35.40 Public Lands: Interior Office of the Secretary of the Interior ADMINISTRATIVE REMEDIES FOR FRAUDULENT CLAIMS AND STATEMENTS § 35.40 Stays ordered by the Department of Justice. If at any...

10 CFR 13.40 - Stays ordered by the Department of Justice.

Science.gov (United States)

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Stays ordered by the Department of Justice. 13.40 Section 13.40 Energy NUCLEAR REGULATORY COMMISSION PROGRAM FRAUD CIVIL REMEDIES § 13.40 Stays ordered by the Department of Justice. If at any time the Attorney General or an Assistant Attorney General designated by the...

22 CFR 35.40 - Stays ordered by the Department of Justice.

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2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Stays ordered by the Department of Justice. 35.40 Section 35.40 Foreign Relations DEPARTMENT OF STATE CLAIMS AND STOLEN PROPERTY PROGRAM FRAUD CIVIL REMEDIES § 35.40 Stays ordered by the Department of Justice. If at any time the Attorney General or an...

45 CFR 79.40 - Stays ordered by the Department of Justice.

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2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Stays ordered by the Department of Justice. 79.40 Section 79.40 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.40 Stays ordered by the Department of Justice. If at any time the Attorney General...

34 CFR 33.40 - Stays ordered by the Department of Justice.

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2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Stays ordered by the Department of Justice. 33.40 Section 33.40 Education Office of the Secretary, Department of Education PROGRAM FRAUD CIVIL REMEDIES ACT § 33.40 Stays ordered by the Department of Justice. If at any time the Attorney General or an Assistant...

Transfusion strategy in hematological intensive care unit: study protocol for a randomized controlled trial.

Science.gov (United States)

Chantepie, Sylvain P; Mear, Jean-Baptiste; Guittet, Lydia; Dervaux, Benoît; Marolleau, Jean-Pierre; Jardin, Fabrice; Dutheil, Jean-Jacques; Parienti, Jean-Jacques; Vilque, Jean-Pierre; Reman, Oumedaly

2015-11-23

Packed red blood cell (PRBC) transfusion is required in hematology patients treated with chemotherapy for acute leukemia, autologous (auto) or allogeneic (allo) hematopoietic stem cell transplantation (HSCT). In certain situations like septic shock, hip surgery, coronary disease or gastrointestinal hemorrhage, a restrictive transfusion strategy is associated with a reduction of infection and death. A transfusion strategy using a single PRBC unit has been retrospectively investigated and showed a safe reduction of PRBC consumption and costs. We therefore designed a study to prospectively demonstrate that the transfusion of a single PRBC unit is safe and not inferior to standard care. The 1versus2 trial is a randomized trial which will determine if a single-unit transfusion policy is not inferior to a double-unit transfusion policy. The primary endpoint is the incidence of severe complication (grade ≥ 3) defined as stroke, transient ischemic attack, acute coronary syndrome, heart failure, elevated troponin level, intensive care unit transfer, death, new pulmonary infiltrates, and transfusion-related infections during hospital stays. The secondary endpoint is the number of PRBC units transfused per patient per hospital stay. Two hundred and thirty patients will be randomized to receive a single unit or double unit every time the hemoglobin level is less than 8 g/dL. All patients admitted for induction remission chemotherapy, auto-HSCT or allo-HSCT in hematology intensive care units will be eligible for inclusion. Sample size calculation has determined that a patient population of 230 will be required to prove that the 1-unit PRBC strategy is non-inferior to the 2-unit PRBC strategy. Hemoglobin threshold for transfusion is below 8 g/dL. Estimated percentage of complication-free hospital stays is 93 %. In a non-inferiority hypothesis, the number of patients to include is 230 with a power of 90 % and an alpha risk of 5 %. 14-128; Clinicaltrials.gov NCT02461264

Nursing students´perception of taking part in an Inter-professional Clinical Study Unit

DEFF Research Database (Denmark)

Bahnsen, Iben Bøgh; Braad, Mette; Lisby, Hanne

2013-01-01

the stay at ICSU in their final clinical placement. Moreover, students spent a considerable amount of time an basic nursing tasks during their stay at the ICSU; skills already acquired earlier in their education programme. Conclusion: Staying in an ICSU improved inter-professional collaboration skills......Background: Length of hospitalization is reduced demanding effective and timely interventions from all health professions. In an Inter-professional Clinical Study Unit (ICSU) students have the opportunity to develop inter-professional competencies. Nevertheless some nursing students have commented...... that staying in an ICSU is an interruption in their final clinical placement with limited learning possibilities. Aim: The aim of the study was to explore nursing students´perceptions of taking part in an ICSU Methods: The study was qualitative with explorative, decriptive and interpretative aspects. Data were...

Staying at work with chronic nonspecific musculoskeletal pain: a qualitative study of workers' experiences

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Geertzen Jan HB

2011-06-01

Full Text Available Abstract Background Many people with chronic nonspecific musculoskeletal pain (CMP have decreased work ability. The majority, however, stays at work despite their pain. Knowledge about workers who stay at work despite chronic pain is limited, narrowing our views on work participation. The aim of this study was to explore why people with CMP stay at work despite pain (motivators and how they manage to maintain working (success factors. Methods A semi-structured interview was conducted among 21 subjects who stay at work despite CMP. Participants were included through purposeful sampling. Interviews were audio-recorded, transcribed verbatim, and imported into computer software Atlas.ti. Data was analyzed by means of thematic analysis. The interviews consisted of open questions such as: "Why are you working with pain?" or "How do you manage working while having pain?" Results A total of 16 motivators and 52 success factors emerged in the interviews. Motivators were categorized into four themes: work as value, work as therapy, work as income generator, and work as responsibility. Success factors were categorized into five themes: personal characteristics, adjustment latitude, coping with pain, use of healthcare services, and pain beliefs. Conclusions Personal characteristics, well-developed self-management skills, and motivation to work may be considered to be important success factors and prerequisites for staying at work, resulting in behaviors promoting staying at work such as: raising adjustment latitude, changing pain-coping strategies, organizing modifications and conditions at work, finding access to healthcare services, and asking for support. Motivators and success factors for staying at work may be used for interventions in rehabilitation and occupational medicine, to prevent absenteeism, or to promote a sustainable return to work. This qualitative study has evoked new hypotheses about staying at work; quantitative studies on staying at

Efeito do ambiente pós-transporte na recuperação dos indicadores de estresse de pacus juvenis, Piaractus mesopotamicus = Effect of post-transport environment on the stress indicators recovery of pacu juveniles , Piaractus mesopotamicus

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Leonardo Susumu Takahashi

2006-10-01

Full Text Available O objetivo deste trabalho foi avaliar a recuperação das respostas fisiológicas de estresse após transporte de pacus em diferentes condições de es tocagem. Após transporte por 2h30min, os peixes foram transferidos para tanque de terra ou para caixas de polietileno em laboratório. Houve significativa redução dos valores de cortisol observados na chegada 24 horas depois, nas duas condições de estocagem , enquanto a concentração de glicose caiu significativamente 72 horas depois nos peixes estocados no tanque de t 1erra e 120 horas nos peixes estocados no laboratório. A osmolalidade, sódio, potássio e cloreto suger em um retorno à homeostase durante o perío do de recuperação, principalmente nos peixes no tanque de terra. Os parâmetros hematológicos, sem efeito da condição de estocagem, não se caracterizaram indicadores sensíveis. Após o transporte, uma prática de manejo que causa estresse em peixes, o retorno às condições normais foi favorecido quando os pacus foram estocados em tanque de terra.The aim of this work was to evaluate the recovery of physiological stress responses after the transport of pacu juveniles in different stocking conditions. After being transported for 2 h30min, fish were transferred to earthen ponds or indoor polyethylene boxes. There was a significant reduction of cortisol values registered at fish arrival , 24 hours after, in both stocking conditions . The glucose concentration reduced significantly 72 hours after in fish stocked in earthen ponds , and 120 hours in fish stocked indoor. Osmolality, sodium, potassium and chloride behavior suggested the re-establishment of the homeostasis during the recovery period, mainly in fish kept in the earthen ponds. Concerning the hematological parameters, only hemoglobin concentration reduced significantly in the recovery period , without effect of stockingcondition, which does not characterize feasible indicators. After transport, a management

29 CFR 22.40 - Stays ordered by the Department of Justice.

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2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Stays ordered by the Department of Justice. 22.40 Section 22.40 Labor Office of the Secretary of Labor PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 § 22.40 Stays ordered by the Department of Justice. If at any time the Attorney General or an Assistant Attorney General...

15 CFR 25.40 - Stays ordered by the Department of Justice.

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2010-01-01

... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Stays ordered by the Department of Justice. 25.40 Section 25.40 Commerce and Foreign Trade Office of the Secretary of Commerce PROGRAM Fraud Civil Remedies § 25.40 Stays ordered by the Department of Justice. If at any time the Attorney General...

Obesity and Mortality, Length of Stay and Hospital Cost among Patients with Sepsis: A Nationwide Inpatient Retrospective Cohort Study.

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Anh Tuan Nguyen

Full Text Available The objective of this study was to examine the association between obesity and all-cause mortality, length of stay and hospital cost among patients with sepsis 20 years of age or older.It was a retrospective cohort study. The dataset was the Nationwide Inpatient Sample 2011, the largest publicly available all-payer inpatient care database in the United States. Hospitalizations of sepsis patients 20 years of age or older were included. All 25 primary and secondary diagnosis fields were screened to identify patients with sepsis using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Obesity was the exposure of interest. It was one of the 29 standardized Elixhauser comorbidity measures and readily available in the dataset as a dichotomized variable. The outcome measures were all-cause in-hospital death, length of stay and hospital cost.After weighting, our sample projected to a population size of 1,763,000, providing an approximation for the number of hospital discharges of all sepsis patients 20 years of age or older in the US in 2011. The overall all-cause mortality rate was 14.8%, the median hospital length of stay was 7 days and the median hospital cost was $15,917. After adjustment, the all-cause mortality was lower (adjusted OR = 0.84; 95% CI = 0.81 to 0.88; the average hospital length of stay was longer (adjusted difference = 0.65 day; 95% CI = 0.44 to 0.86 and the hospital cost per stay was higher (adjusted difference = $2,927; 95% CI = $1,606 to $4,247 for obese sepsis patients as compared to non-obese ones.With this large and nationally representative sample of over 1,000 hospitals in the US, we found that obesity was significantly associated with a 16% decrease in the odds of dying among hospitalized sepsis patients; however it was also associated with greater duration and cost of hospitalization.

Prospect theory and the decision to move or stay.

Science.gov (United States)

Clark, William A V; Lisowski, William

2017-09-05

Migration has always involved stress and risk. More risk-averse households are less likely to move, while less risk-averse households will seek out opportunities and migrate. We investigate how the theoretical contributions of prospect theory, and specifically the endowment effect, can provide new understanding about decisions whether to migrate or not. We test the hypothesis that risk aversion extends the length of stay in the dwelling and, by extension, in the local labor and housing markets. How long people remain in place is a function, we hypothesize, of their independently self-assessed propensity to take risks, after controlling for a range of demographic and socioeconomic characteristics. We use the theoretical insights of prospect theory and the endowment effect (the notion of the "use value" differing from the "exchange value") to explain the likelihood of staying after controlling for life-course events. The results confirm the explanatory power of self-assessed risk in the decision to migrate or stay and, equally important, confirm the role of the endowment effect.

Length of stay in asylum centres and mental health in asylum seekers

DEFF Research Database (Denmark)

Hallas, Peter; Hansen, Anne R; Staehr, Mia A

2007-01-01

BACKGROUND: The length of stay in asylum centres is generally mentioned as a possible health risk to asylum seekers. Medical staff working with asylum seekers has claimed that long lengths of stay in asylum centres might cause or aggravate mental disorders. We used records from a large, multiethnic...... specialists. If an asylum seeker needed more than three specialist consultations for mental illness or five consultations for physical illness the referrals had to be approved by The Danish Immigration Service. Between July 2001 - December 2002 the Red Cross prospectively registered health related data on all......: Length of stay in asylum centres was associated with an increase in referrals for mental disorders in a large, multiethnic group of asylum seekers. The present study supports the view that prolonged length of stay in an asylum centre is a risk factor for mental health. The risk of psychiatric illness...

Psychosocial Intervention Use in Long-Stay Dementia Care: A Classic Grounded Theory.

Science.gov (United States)

Hunter, Andrew; Keady, John; Casey, Dympna; Grealish, Annmarie; Murphy, Kathy

2016-12-01

The objective of this study was to develop a substantive grounded theory of staff psychosocial intervention use with residents with dementia in long-stay care. "Becoming a person again" emerged as the core category accounting for staffs' psychosocial intervention use within long-stay care. Interview data were collected from participants in nine Irish long-stay settings: 14 residents with dementia, 19 staff nurses, one clinical facilitator, seven nurse managers, 21 nursing assistants, and five relatives. Constant comparative method guided the data collection and analysis. The researcher's theoretical memos, based on unstructured observation, and applicable extant literature were also included as data. By identifying the mutuality of the participants' experiences, this classic grounded theory explains staff motivation toward psychosocial intervention use within long-stay care. It also explains how institutional factors interact with those personal factors that incline individuals toward psychosocial intervention use. © The Author(s) 2016.

Estimation of cables’ tension of cable-stayed footbridge using measured natural frequencies

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Jakiel Przemysław

2017-01-01

Full Text Available This paper presents analysis of cables’ tension of steel cable-stayed footbridge using their field-test natural frequencies. A vibration method is usually used for the measured cable tension during the construction of cable systems stiffened with inclined cables. Practical formulas for the vibration method applied herein, mainly based on cable-sag and vertical angle effects (a survey measurement, have been verified on the one-tower steel cable-stayed bridge. The bridge is situated in Sieradz (Poland and it was the structure with the longest span concerning all the cable-stayed bridges in Poland until 1999. The obtained cable axial forces for estimated natural frequencies of low- and high-order modes are verified using FEM models. The final conclusions drawn on the basis of conducted studies can be useful for technical diagnosis, monitoring programs and repair works of similar class of cable-stayed bridges.

How Much Time Do Unhospitalized Patients Applying for Emergency Services Stay in Emergency Department

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Mansur Kürsad Erkuran

2013-12-01

Full Text Available INTRODUCTION: The patients applying to a emergency service may stay longer than necessary for diagnosis, monitoring and treatment. This can be due to the inadequacy of the treatment performed in emergency department or to the absence of the required unit in the hospital. In this study, we analyzed the waiting period of the patients who have not been hospitalized. METHODS: The patients applying to Bolu İzzet Baysal Public Hospital Emergency Unit between 24.11.2009 and 25.08.2011 have been studied regarding their application date, the season, and their waiting period in the emergency unit. The data have been analyzed using the statistics software Package for the Social Sciences (SPSS, Inc., Chicago, IL, version 17.0 for Windows. The chi-square χ2 test has been used for the determination of the percentage distribution and significance and p<0,05 has been considered significant. RESULTS: 4215 patients applying to Bolu İzzet Baysal Public Hospital Emergency Unit between 24.11.2009 and 25.08.2011 and monitored without hospitalization have been studied. The patients mainly presented during spring (p<0.05. The application occurred more often between 20.00 PM – 23.59 PM (p<0.005. The mean duration of the accept-standby of the patients in emergency unit was 09±12 (minimum 0 minute, maximum 130 minutes. The patients waited 0,26 ±70 minutes in emergency unit examination (minimum 0 minute, maximum 1292 minutes. The total waiting time in emergency unit was 52 ±100 minutes (minimum 10, maximum 1435 minutes. DISCUSSION AND CONCLUSION: In this study, we observed that the duration of the hospitalization in emergency unit is longer than the ideal duration.

Promoting job safety for workers with intellectual disabilities: the staying safe at work training curriculum.

Science.gov (United States)

Dewey, Robin

2011-01-01

In the United States, approximately 125,000 people with disabilities are employed through Community Rehabilitation Programs in manufacturing, assembly, and service jobs. These jobs have significant hazards and, consequently, the workers are at risk of injury. Training that empowers workers to participate in prevention efforts can help reduce work-related injuries. In general this kind of health and safety training in the United States is limited. It is even more so for workers with intellectual disabilities, in part because there have not been programs for teaching individuals with cognitive challenges health and safety skills, adapted to their learning needs. This paper describes the development and promotion of the Staying Safe at Work curriculum of UC Berkeley's Labor Occupational Health Program, which is designed for use by support agencies and employers of workers with intellectual disabilities. The goal of this program is to teach these workers essential occupational safety and health skills in a manner they can understand.

Short Hospital Stay after Laparoscopic Colorectal Surgery without Fast Track

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Stefan K. Burgdorf

2012-01-01

Full Text Available Purpose. Short hospital stay and equal or reduced complication rates have been demonstrated after fast track open colonic surgery. However, fast track principles of perioperative care can be difficult to implement and often require increased nursing staff because of more concentrated nursing tasks during the shorter hospital stay. Specific data on nursing requirements after laparoscopic surgery are lacking. The purpose of the study was to evaluate the effect of operative technique (open versus laparoscopic operation, but without changing nurse staffing or principles for peri- or postoperative care, that is, without implementing fast track principles, on length of stay after colorectal resection for cancer. Methods. Records of all patients operated for colorectal cancer from November 2004 to December 2008 in our department were reviewed. No specific patients were selected for laparoscopic repair, which was solely dependent on the presence of two specific surgeons at the same time. Thus, the patients were not selected for laparoscopic repair based on patient-related factors, but only on the simultaneous presence of two specific surgeons on the day of the operation. Results. Of a total of 540 included patients, 213 (39% were operated by a laparoscopic approach. The median hospital stay for patients with a primary anastomosis was significantly shorter after laparoscopic than after conventional open surgery (5 versus 8 days, while there was no difference in patients receiving a stoma (10 versus 10 days, ns, with no changes in the perioperative care regimens. Furthermore there were significant lower blood loss (50 versus 200 mL, and lower complication rate (21% versus 32%, in the laparoscopic group. Conclusion. Implementing laparoscopic colorectal surgery in our department resulted in shorter hospital stay without using fast track principles for peri- and postoperative care in patients not receiving a stoma during the operation. Consequently, we

42 CFR 456.231 - Continued stay review required.

Science.gov (United States)

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan... a review of each recipient's continued stay in the mental hospital to decide whether it is needed...

Predicting stay/leave behavior among volleyball referees

NARCIS (Netherlands)

Van Yperen, N.W.

1998-01-01

This study aimed to predict stay/leave behavior among volleyball referees. The predictor variables reflect commitment aspects from the literature: attraction, perceived lack of alternatives, personal investments, and feelings of obligation to remain. Intent to quit was assumed to mediate the link

Paraoxonase activity in sera from Piaractus mesopotamicus Holmberg (Characidae and Hypostomus punctatus Valenciennes (Siluridae

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Vera Lucia F. Cunha Bastos

1998-01-01

Full Text Available A paraoxonase activity present in serum of two Brazilian fish species was consistently assayed at pH 8.5 using 7.5 mM paraoxon final concentration. The paraoxonase activity was more activated by 0.5 M NaCl in serum of Piaractus mesopotanricus Holmberg, 1887 (pacu than in serum of Hypostomus punctatus Valenciennes, 1840 (cascudo. Apparent values of K M were 3.3 x 10-3 M for cascudo and pacu paraoxonase activity in the presence of 0.5 M NaCl. Apparent maximum velocity values calculated in the presence of 0.5 M NaCl were 6.1 and 6.5 nmole/min/mL of serum for cascudo and pacu, respectively. Vmax/K M ratio values of determinations in the presence and absence of 0.5 M NaCl showed that NaCl had a more evident effect on increasing the affinity of serum paraoxonase for paraoxon in pacu serum. Young specimens of pacu showed a marked decreased paraoxonase serum activity when kept in tanks treated with 0.25 ppm methyl-parathion.

Constipation in intensive care unit: incidence and risk factors.

Science.gov (United States)

Nassar, Antonio Paulo; da Silva, Fernanda Maria Queiroz; de Cleva, Roberto

2009-12-01

Although gastrointestinal motility disorders are common in critically ill patients, constipation and its implications have received very little attention. We aimed to determine the incidence of constipation to find risk factors and its implications in critically ill patients During a 6-month period, we enrolled all patients admitted to an intensive care unit from an universitary hospital who stayed 3 or more days. Patients submitted to bowel surgery were excluded. Constipation occurred in 69.9% of the patients. There was no difference between constipated and not constipated in terms of sex, age, Acute Physiology and Chronic Health Evaluation II, type of admission (surgical, clinical, or trauma), opiate use, antibiotic therapy, and mechanical ventilation. Early (constipation, a finding that persisted at multivariable analysis (P Constipation was not associated with greater intensive care unit or mortality, length of stay, or days free from mechanical ventilation. Constipation is very common among critically ill patients. Early enteral nutrition is associated with earlier return of bowel function.

Do critical care units play a role in the management of gynaecological oncology patients? The contribution of gynaecologic oncologist in running critical care units.

Science.gov (United States)

Davidovic-Grigoraki, Miona; Thomakos, Nikolaos; Haidopoulos, Dimitrios; Vlahos, Giorgos; Rodolakis, Alexandros

2017-03-01

Routine post-operative care in high dependency unit (HDU), surgical intensive care unit (SICU) and intensive care unit (ICU) after high-risk gynaecological oncology surgical procedures may allow for greater recognition and correct management of post-operative complications, thereby reducing long-term morbidity and mortality. On the other hand, unnecessary admissions to these units lead to increased morbidity - nosocomial infections, increased length of hospital stay and higher hospital costs. Gynaecological oncology surgeons continue to look after their patient in the HDU/SICU and have the final role in decision-making on day-to-day basis, making it important to be well versed in critical care management and ensure the best care for their patients. Post-operative monitoring and the presence of comorbid illnesses are the most common reasons for admission to the HDU/SICU. Elderly and malnutritioned patients, as well as, bowel resection, blood loss or greater fluid resuscitation during the surgery have prolonged HDU/SICU stay. Patients with ovarian cancer have a worse survival outcome than the patients with other types of gynaecological cancer. Dependency care is a part of surgical management and it should be incorporated formally into gynaecologic oncology training programme. © 2016 John Wiley & Sons Ltd.

Comparison of the effects of dexmedetomidine-ketamine and sevoflurane-sufentanil anesthesia in children with obstructive sleep apnea after uvulopalatopharyngoplasty: An observational study

Directory of Open Access Journals (Sweden)

Xinqi Cheng

2014-01-01

Full Text Available Background: Children with obstructive sleep apnea (OSA are particularly at risk under anesthesia after uvulopalatopharyngoplasty (UPPP. This prospective randomized double-blind study focused on the comparison of dexmedetomidine-ketamine and sevoflurane-sufentanil anesthesia on children with respect to safety, feasibility, and clinical effects. Materials and Methods: A total of 60 children, aged 2-10 years, classified as American Society of Anesthesiologists (ASA status I and II scheduled for UPPP were prospectively studied. Patients were randomly allocated to receive either dexmedetomidine-ketamine-based anesthesia (group DK, n = 30 or sevoflurane-sufentanil-based anesthesia (group SS, n = 3 0. Heart rate (HR and systolic blood pressure during the first 60 min of the procedure, Ramsay sedation score, the Pediatric Anesthesia Emergence Delirium (PAED scale and a 5-point scale used to evaluate emergence agitation (EA in postanesthesia care unit (PACU and postoperative outcomes data were recorded. Results: During the first 60 min of anesthesia, mean HR, and mean diastolic noninvasive arterial blood pressure (NIBP were not statistically different in the two groups (P > 0.05 Compared with group SS, the patients in group DK had lower rescue tramadol requirement and lower pain score, PAED score, and EA score at 5, 10, 15, and 30 min in PACU; but had a higher Ramsay scale at 10, 15, 30, 45, and 60 min in PACU and the incidence of SpO 2 below 95%, also the time of first bowel movement and ambulation in group DK was shorter. Conclusions: The dexmedetomidine-ketamine combination was not superior to a sevoflurane-sufentanil combination because of late awake time and a high potential for adverse respiratory events in PACU, the benefit of dexmedetomidine administration being a decreased incidence of EA and a lower recovery time of bowel movement and ambulation.

Comparison of immediate postoperative pain after transvaginal versus traditional laparoscopic cholecystectomy.

Science.gov (United States)

Wood, Stephanie G; Dabu-Bondoc, Susan; Dai, Feng; Mikhael, Hosni; Vadivelu, Nalini; Roberts, Kurt E

2014-04-01

Transvaginal cholecystectomy (TVC) is the most common natural orifice transluminal surgery (NOTES) performed in women, yet there is a paucity of data on intraoperative and immediate postoperative pain management. Previous studies have demonstrated that NOTES procedures are associated with less postoperative pain and faster recovery times. This study analyzes intraoperative and postoperative opioid use for TVC compared with traditional four-port laparoscopic cholecystectomies (LCs). This is a retrospective analysis of consecutive TVC and LC female patients between August 2009 and August 2012 in an academic institution. We compared demographics, intraoperative and postoperative opioid use and times in the operating room (OR) and in the post anesthesia care unit (PACU). A total of 68 TVC and 67 LC patients were included in this study. The TVC and LC groups were similar in terms of age (both 41 years) and body mass index (29 and 31 kg/m2, respectively). The intraoperative preparation, surgical, and emergence times were significantly longer for the TVC than for the LC (p ≤ 0.01). Compared with the LC group, the intraoperative opioid requirement was significantly greater (TVC 27 mg vs. LC 25 mg; p = 0.003), but after adjusting for anesthesia time, the difference in OR opioid consumption became non-significant (p = 0.08). The PACU opioid requirement (TVC 2.5 vs. LC 5 mg; p = 0.04) was significantly lower for the TVC group, and a greater proportion of patients did not need any pain medications (TVC 38 % vs. LC 21 %; p = 0.04), compared with the LC group. The average PACU pain scores were not significantly different between the groups (p = 0.45). TVC patients did not experience more pain than LC patients. Although the average pain scores of TVC patients did not differ from those of the LC patients, TVC patients did require less pain medication in the PACU.

Association of Resident Coverage with Cost, Length of Stay, and Profitability at a Community Hospital

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Shine, Daniel; Beg, Sumbul; Jaeger, Joseph; Pencak, Dorothy; Panush, Richard

2001-01-01

OBJECTIVE The effect of care by medical residents on hospital length of stay (LOS), indirect costs, and reimbursement was last examined across a range of illnesses in 1981; the issue has never been examined at a community hospital. We studied resource utilization and reimbursement at a community hospital in relation to the involvement of medical residents. DESIGN This nonrandomized observational study compared patients discharged from a general medicine teaching unit with those discharged from nonteaching general medical/surgical units. SETTING A 620-bed community teaching hospital with a general medicine teaching unit (resident care) and several general medicine nonteaching units (no resident care). PATIENTS All medical discharges between July 1998 and February 1999, excluding those from designated subspecialty and critical care units. MEASUREMENTS AND MAIN RESULTS Endpoints included mean LOS in excess of expected LOS, mean cost in excess of expected mean payments, and mean profitability (payments minus total costs). Observed values were obtained from the hospital's database and expected values from a proprietary risk–cost adjustment program. No significant difference in LOS between 917 teaching-unit patients and 697 nonteaching patients was demonstrated. Costs averaged $3,178 (95% confidencence interval (CI) ± $489) less than expected among teaching-unit patients and $4,153 (95% CI ± $422) less than expected among nonteaching-unit patients. Payments were significantly higher per patient on the teaching unit than on the nonteaching units, and as a result mean, profitability was higher: $848 (95% CI ± $307) per hospitalization for teaching-unit patients and $451 (95% CI ± $327) for patients on the nonteaching units. Teaching-unit patients of attendings who rarely admitted to the teaching unit (nonteaching attendings) generated an average profit of $1,299 (95% CI ± $613), while nonteaching patients of nonteaching attendings generated an average profit of $208

Relationship Between Severity of Illness and Length of Stay on Costs Incurred During a Pediatric Critical Care Hospitalization.

Science.gov (United States)

Hsu, Benson S; Lakhani, Saquib; Brazelton, Thomas B

2015-08-01

To estimate the impact of severity of illness and length of stay on costs incurred during a pediatric intensive care unit (PICU) hospitalization. This is a retrospective cohort study at an academic PICU located in the U.S. that examined 850 patients admitted to the PICU from Jan. 1 to Dec. 31, 2009. The study population was segmented into three severity levels based on pediatric risk of mortality (PRISM) III scores: low (PRISM score 0), medium (PRISM score 1-5), and high (PRISM score greater than 5). Outcome measures were total and daily PICU costs (2009 U.S. dollars). Eight hundred and fifty patients were admitted to the PICU during the study period. Forty-eight patients (5.6 percent) had incomplete financial data and were excluded from further analysis. Mean total PICU costs for low (n = 429), medium (n = 211), and high (n = 162) severity populations were $21,043, $37,980, and $55,620 (p costs for the low, medium, and high severity groups were $5,138, $5,903, and $5,595 (p = 0.02). Higher severity of illness resulted in higher total PICU costs. Interestingly, although daily PICU costs across severity of illness showed a statistically significant difference, the practical economic difference was minimal, emphasizing the importance of length of stay to total PICU costs. Thus, the study suggested that reducing length of stay independent of illness severity may be a practical cost control measure within the pediatric intensive care setting.

Nonlinear Vibration Signal Tracking of Large Offshore Bridge Stayed Cable Based on Particle Filter

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Ye Qingwei

2015-12-01

Full Text Available The stayed cables are key stress components of large offshore bridge. The fault detection of stayed cable is very important for safe of large offshore bridge. A particle filter model and algorithm of nonlinear vibration signal are used in this paper. Firstly, the particle filter model of stayed cable of large offshore bridge is created. Nonlinear dynamic model of the stayed-cable and beam coupling system is dispersed in temporal dimension by using the finite difference method. The discrete nonlinear vibration equations of any cable element are worked out. Secondly, a state equation of particle filter is fitted by least square algorithm from the discrete nonlinear vibration equations. So the particle filter algorithm can use the accurate state equations. Finally, the particle filter algorithm is used to filter the vibration signal of bridge stayed cable. According to the particle filter, the de-noised vibration signal can be tracked and be predicted for a short time accurately. Many experiments are done at some actual bridges. The simulation experiments and the actual experiments on the bridge stayed cables are all indicating that the particle filter algorithm in this paper has good performance and works stably.

The Effect of Sufentanil Administration on Remifentanil-Based Anaesthesia during Laparoscopic Gynaecological Surgery: A Double-Blind Randomized Controlled Trial

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Ilsoon Son

2014-01-01

Full Text Available This study assessed the effect of sufentanil administered before conclusion of remifentanil-based anaesthesia on postoperative hyperalgesia and haemodynamic stability in patients undergoing laparoscopic gynaecological surgery. The patients were randomly allocated to a sufentanil administration group (S group or a normal saline administration group (C group. Anaesthesia was induced and maintained with controlled administration of remifentanil at 10 ng·mL−1 and propofol under bispectral index guidance. Once the surgical specimen was procured, sufentanil or normal saline was administered at 0.15 ng·mL−1 and maintained until extubation. The haemodynamic status during anaesthetic emergence was evaluated. The pain and postoperative nausea and vomiting (PONV were assessed for 72 h following postanaesthetic care unit (PACU discharge. The S group had significantly lower mean systemic arterial blood pressure and heart rate changes between the start of drug administration and extubation. Postoperative pain was significantly lower in the S group until 24 h following PACU discharge. There were no significant differences in PONV incidence and severity 72 h after PACU discharge between the two groups. Sufentanil administration before concluding remifentanil-based anaesthesia improved postoperative hyperalgesia and achieved haemodynamic stability at extubation without delaying recovery or increasing PONV during laparoscopic gynaecological surgery. Clinical trial registration is found at KCT0000785.

Assessment of post-operative pain in children: who knows best?

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Anjalee Brahmbhatt

2012-03-01

Full Text Available Pain assessment in children can be extremely challenging. Most professional bodies recommend that parents or carers should be involved with their child’s pain assessment; but the evidence that parents can accurately report pain on behalf of their children is mixed. Our objective was to examine whether there were differences in post-operative pain score ratings between the child, nurse and parent or carer after surgery. Cognitively intact children aged four upwards, undergoing all surgical procedures, whose parents were present in the post-anaesthetic recovery unit (PACU, were studied. Thirty-three children were included in the study. The numerical rating scale was used to rate the child’s pain by the child, nurse and parent on arrival to the PACU and prior to discharge. We found strong correlations between children’s, nurses’ and parent’s pain scores on admission and discharge from PACU. The intraclass correlation of pain scores reported by children, nurses and parents was 0.94 (95% confidence intervals 0.91-0.96, P<0.0001. In cognitively intact children, it is adequate to manage pain based upon the assessment of children’s and nurses’ pain scores alone. The numerical rating scale appeared to be suitable for younger children. Whilst there are benefits of parents being present in recovery, it is not essential for optimizing the assessment of pain.

Length of Stay and Tourism Facility Assessment: The Viewpoint of Malaysian Tourists at Langkawi

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Jaafar Mastura

2014-01-01

Full Text Available This investigation employed partial least square analysis to scrutinize factors influencing the social perceptions of Malaysian tourists of tourism facilities at an island tourism destination. It focuses on the effect of one particular socio-demographic variable, length of stay, on consumer satisfaction. Data was collected from a major tourism destination at Langkawi, Malaysia. The results indicate that length of stay has an effect on tourists’ social perceptions and contributes to their dissatisfaction with the destination. Tourists who stayed more than 10 days were less satisfaction than those who stayed for less than 10 days. The implications of this finding and recommendations for further study are discussed as well.

Implementing a Nurse Manager Profile to Improve Unit Performance.

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Krugman, Mary E; Sanders, Carolyn L

2016-06-01

Nurse managers face significant pressures in the rapidly changing healthcare environment. Staying current with multiple sources of data, including reports that detail institutional and unit performance outcomes, is particularly challenging. A Nurse Manager Customized Profile was developed at a western academic hospital to provide a 1-page visual of pertinent data to help managers and director supervisors focus coaching to improve unit performance. Use of the Decisional Involvement Scale provided new insights into measuring manager performance.

[Decree of anaesthesia of 1994, day surgery and medical responsibility: necessary reflections on the inevitable conciliation between regulations and recommendations].

Science.gov (United States)

Bontemps, G; Daver, C; Ecoffey, C

2014-12-01

Day surgery is often considered as a marker of the necessity of reorganizing the hospital to take care globally and so better meet the expectations of improvement of the management of patients. But the actual deployment of day surgery can also act as a real revelation of the stakes of conciliation between the regulations, which supervise professional practices and organization, and the functioning of hospitals. Between the regulations supervising hospitals and professional practices and the place of the recommendations, between the general legal framework of the medical activity and specific legal framework (decree of anesthesia of 1994) and the Evidence-Based Medicine, the pretext of the improvement of the patient flow in day surgery, recommended by several institutions (Sfar, ANAP, HAS), questions about the legal obligation of the passage of all the patients in the postanesthesia care unit (PACU). Seen under the angle of a legal action against a medical doctor, the study of the French jurisprudence reveals that every practitioner has to respect the recommendations and the Evidence-Based Medicine, and this in the standardized frame of the MD's activity and the respect for a very strict legal environment. The question of an obvious conciliation between all these measures arises today clearly. In the case of a potential conflict, the key of resolution, based only on legal standards (constitution, laws, decrees), is not enough for arbitrating. Applying that the only respect for the decree of anesthesia would be enough for exempting itself from any contentious risk does not satisfy more. There is a real difficulty defining the legal precise nature of the recommendations, so best practices as better organization, which are more and more frequently. Even if these recommendations originally had not their place in the hierarchy of the legal standards, they are brought in there today. There is a real brake in the deployment of the day surgery because the strict respect for

Radiation doses received by premature babies in the neonatal intensive care unit

International Nuclear Information System (INIS)

Thierry-Chef, I.; Maccia, C.; Thierry-Chef, I.; Laurier, D.; Tirmarche, M.; Costil, J.

2005-01-01

Purpose. Because of frequent radiological investigations performed in 1 neonatal intensive care unit, a dosimetry study was carried out to assess the level of doses received by premature babies. Materials and methods. In vivo measurements were performed and effective doses were evaluated for single radiographs. Individual cumulative doses received over the period of stay were then estimated, for each premature baby entering the intensive care unit in 2002, taking into account the number of radiographs they underwent. Results. On average, babies stayed for a week and more than one radio-graph was taken per day. Results showed that, even if average doses per radiograph were relatively low (25μSv), cumulative doses strongly depended on the length of stay, and can reach a few mSv. Conclusion. Even if doses per radiograph are in agreement with European recommendations, optimisation of doses is particularly important because premature babies are more sensitive to radiation than adults and because they usually undergo further radiological examinations in other services. On the basis of the results of this dosimetry study, the implementation of a larger study is being discussed. (author)

MR damping system on Dongting Lake cable-stayed bridge

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Chen, Z. Q.; Wang, X. Y.; Ko, J. M.; Ni, Y. Q.; Spencer, Billie F., Jr.; Yang, G.

2003-08-01

The Dongting Lake Bridge is a cable-stayed bridge crossing the Dongting Lake where it meets the Yangtze River in southern central China. After this bridge was completed in 1999, its cables were observed to be sensitive to rain-wind-induced vibration, especially under adverse weather conditions of both rain and wind. To investigate the possibility of using MR damping systems to reduce cable vibration, a joint project between the Central South University of China and the Hong Kong Polytechnic University was conducted. Based on the promising research results, the bridge authority decided to install MR damping systems on the longest 156 stay cables. The installation started in July 2001 and finished in June 2002, making it the world's first application of MR dampers on cable-stayed bridge to suppress the rain-wind-induced cable vibration. As a visible and permanent aspect of bridge, the MR damping system must be aesthetically pleasing, reliable, durable, easy to maintain, as well as effective in vibration mitigation. Substantial work was done to meet these requirements. This paper describes the implementation of MR damping systems for cable vibration reduction.

Reducing Length of Stay in Total Joint Arthroplasty Care.

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Walters, Megan; Chambers, Monique C; Sayeed, Zain; Anoushiravani, Afshin A; El-Othmani, Mouhanad M; Saleh, Khaled J

2016-10-01

As health care reforms continue to improve quality of care, significant emphasis will be placed on evaluation of orthopedic patient outcomes. Total joint arthroplasty (TJA) has a proven track record of enhancing patient quality of life and are easily replicable. The outcomes of these procedures serve as a measure of health care initiative success. Specifically, length of stay, will be targeted as a marker of quality of surgical care delivered to TJA patients. Within this review, we will discuss preoperative and postoperative methods by which orthopedic surgeons may enhance TJA outcomes and effectively reduce length of stay. Copyright © 2016 Elsevier Inc. All rights reserved.

Trends In Complicated Newborn Hospital Stays and Costs..

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U.S. Department of Health & Human Services — The article, Trends In Complicated Newborn Hospital Stays and Costs, 2002-2009, Implications For the Future, published in Volume 4, Issue 4 of Medicare and Medicaid...

41 CFR 105-70.040 - Stays ordered by the Department of Justice.

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Stays ordered by the Department of Justice. 105-70.040 Section 105-70.040 Public Contracts and Property Management Federal... Stays ordered by the Department of Justice. If at any time the Attorney General or an Assistant Attorney...

Missing dosages and neuroleptic usage may prolong length of stay in hospitalized Parkinson's disease patients.

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Daniel Martinez-Ramirez

Full Text Available Parkinson's disease patients are more likely to be hospitalized, have higher rates of hospital complications, and have an increased risk of deterioration during hospitalization. Length of stay is an important underlying factor for these increased risks. We aimed to investigate potential medication errors that may occur during hospitalization and its impact on length of hospital stay.A cross-sectional chart review of 339 consecutive hospital encounters from 212 PD subjects was performed. Medication errors were defined as wrong timing or omission of administration for dopaminergic drugs and administration of contraindicated dopamine blockers. An analysis of covariance was applied to examine whether these medication errors were related to increased length of hospital stays.A significant effect for dopaminergic administration (p<0.01 on length of hospital stay was observed. Subjects who had delayed administration or missed at least one dose stayed longer (M=8.2 days, SD=8.9 vs. M=3.6 days SD=3.4. Contraindicated dopamine blocking agents were administered in 23% (71/339 of cases, and this was also significantly related to an increased length of stay (M=8.2 days, SD=8.9 vs. M=3.6 days SD=3.4, p<0.05. Participants who received a contraindicated dopamine blocker stayed in the hospital longer (M=7.5 days, SD=9.1 compared to those who did not (M=5.9 days, SD=6.8. Neurologists were consulted in 24.5% of encounters. Specialty consultation had no effect on the medication related errors.Missing dopaminergic dosages and administration of dopamine blockers occur frequently in hospitalized Parkinson's disease patients and this may impact length of stay. These potentially modifiable factors may reduce the risk of a longer stay related to hospitalization.

Children’s experiences of acute hospitalisation to a paediatric emergency and assessment unit – A qualitative study

DEFF Research Database (Denmark)

Jensen, Claus Sixtus; Jackson, Karen; Kolbæk, Raymond

2012-01-01

Short-stay treatment has become a popular form of care as a strategy to cope with increased demands on health care. There is little research that considers children’s experiences of acute hospitalisation to a short-stay care facility such as a Paediatric Emergency and Assessment Unit (PEAU...... provided some limited insight into the child’s experiences of acute hospitalisation, which should inform nursing care....

Is Postoperative Intensive Care Unit Care Necessary following Cranial Vault Remodeling for Sagittal Synostosis?

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Wolfswinkel, Erik M; Howell, Lori K; Fahradyan, Artur; Azadgoli, Beina; McComb, J Gordon; Urata, Mark M

2017-12-01

Of U.S. craniofacial and neurosurgeons, 94 percent routinely admit patients to the intensive care unit following cranial vault remodeling for correction of sagittal synostosis. This study aims to examine the outcomes and cost of direct ward admission following primary cranial vault remodeling for sagittal synostosis. An institutional review board-approved retrospective review was undertaken of the records of all patients who underwent primary cranial vault remodeling for isolated sagittal craniosynostosis from 2009 to 2015 at a single pediatric hospital. Patient demographics, perioperative course, and outcomes were recorded. One hundred ten patients met inclusion criteria with absence of other major medical problems. Average age at operation was 6.7 months, with a mean follow-up of 19.8 months. Ninety-eight patients (89 percent) were admitted to a general ward for postoperative care, whereas the remaining 12 (11 percent) were admitted to the intensive care unit for preoperative or perioperative concerns. Among ward-admitted patients, there were four (3.6 percent) minor complications; however, there were no major adverse events, with none necessitating intensive care unit transfers from the ward and no mortalities. Average hospital stay was 3.7 days. The institution's financial difference in cost of intensive care unit stay versus ward bed was $5520 on average per bed per day. Omitting just one intensive care unit postoperative day stay for this patient cohort would reduce projected health care costs by a total of $540,960 for the study period. Despite the common practice of postoperative admission to the intensive care unit following cranial vault remodeling for sagittal craniosynostosis, the authors suggest that postoperative care be considered on an individual basis, with only a small percentage requiring a higher level of care. Therapeutic, III.

Development of lengths of stay and DRG cost weights in dermatology from 2003 to 2006.

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Wenke, Andreas; Müller, Marcel L; Babapirali, Judith; Rompel, Rainer; Hensen, Peter

2009-08-01

The G-DRG per case payments are calculated annually on the basis of present output and cost data provided from German hospitals. The economic valuation of dermatology-related DRGs depends largely on inpatients' length of stay. At present, longitudinal analyses of dermatologic hospital data considering the development of length of stay under DRG conditions are not available. A multicenter, longitudinal study of clinical data from hospitals with different care levels was performed (n = 23). Frequent and relevant dermatologic diagnoses were grouped and analyzed over a time period of four years (2003-2006). The development of lengths of stay and of G-DRG cost weights were studied in detail. Descriptive statistical methods were applied. After introduction of DRG, the data reveal a) reduction of length of stay in inpatient dermatology and b) after an initial abrupt rise, DRG valuation of dermatologic groups moderately decreased over time. Both trends changed most rapidly in the early years but reached a stable niveau in 2006. The study furthermore points out that not only length of stay, but also other type of costs influence DRG calculations. German dermatology reflects the international trend showing reductions of length of stay after introduction of a DRG-based hospital funding system. The DRG calculation and valuation of inpatient services depend on the duration of hospital stay. However, increasing per diem costs resulting from higher performances of every inpatient bed day are also taken into account. Further reduction of length of stay must not threaten the quality of inpatient care in dermatology.

Discrete Event Simulation of Patient Admissions to a Neurovascular Unit

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S. Hahn-Goldberg

2014-01-01

Full Text Available Evidence exists that clinical outcomes improve for stroke patients admitted to specialized Stroke Units. The Toronto Western Hospital created a Neurovascular Unit (NVU using beds from general internal medicine, Neurology and Neurosurgery to care for patients with stroke and acute neurovascular conditions. Using patient-level data for NVU-eligible patients, a discrete event simulation was created to study changes in patient flow and length of stay pre- and post-NVU implementation. Varying patient volumes and resources were tested to determine the ideal number of beds under various conditions. In the first year of operation, the NVU admitted 507 patients, over 66% of NVU-eligible patient volumes. With the introduction of the NVU, length of stay decreased by around 8%. Scenario testing showed that the current level of 20 beds is sufficient for accommodating the current demand and would continue to be sufficient with an increase in demand of up to 20%.

Job satisfaction and intention to stay within community and residential aged care employees.

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Radford, Katrina; Meissner, Ellen

2017-09-01

This study investigated the different facets of job satisfaction that influence community care and residential care employees' intention to stay in the aged care workforce. A survey of four organisations in Australia was undertaken. t-Tests were conducted to analyse differences between groups. Regression analyses were performed to examine the factors influencing intentions to stay in the workforce. Community care workers were more satisfied with various facets of job satisfaction including work on their present job, supervision, people in their present job and the job in general. There was a difference between how the various facets of job satisfaction influenced intentions to stay for residential care compared to community care workers. Both workers were satisfied with their work conditions and work to different extents. There is an opportunity for residential care to look to the practices within the community care sector to improve employees' intentions to stay. © 2017 AJA Inc.

Job satisfaction, occupational commitment and intent to stay among Chinese nurses: a cross-sectional questionnaire survey.

Science.gov (United States)

Wang, Lin; Tao, Hong; Ellenbecker, Carol H; Liu, Xiaohong

2012-03-01

This study was designed to identify the level of nurses' job satisfaction, occupational commitment and intent to stay among mainland Chinese nurses, to explore the relationship among them.   Little is known about the magnitude of Chinese nurses' intent to stay. Understanding the association among demographic characteristics and job satisfaction, occupational commitment and intent to stay among Chinese nurses is most important in a time of nurse shortages. Methods.  A descriptive correlation design was used to examine the relationship among variables related to intent to stay. Data were collected by a self-administered survey questionnaire from 560 nurses working in four large hospital facilities in Shanghai in 2009. The mean scores for nurses' job satisfaction, occupational commitment and intent to stay were 3·25(0·48), 3·11(0·40) and 3·56(0·65), respectively. Job satisfaction and occupational commitment were significantly related to intent to stay. A statistically significant positive correlation was found between occupational commitment and job satisfaction. Age and job position were significantly related to job satisfaction, occupational commitment and intent to stay. Levels of job satisfaction, occupational commitment and intent to stay reported by nurses in this study can be improved. Suggested strategies for improvement are: increasing salaries, decreasing workloads, modifying task structure, cultivating work passion and creating more professional opportunity for nurses' personal growth development and promotion. Enhancing nurses' job satisfaction and occupational commitment are vital to improve nurses' intent to stay and for strategies to address the nursing shortage. © 2011 Blackwell Publishing Ltd.

Inherent Risk Factors for Nosocomial Infection in the Long Stay Critically Ill Child Without Known Baseline Immunocompromise: A Post Hoc Analysis of the CRISIS Trial.

Science.gov (United States)

Carcillo, Joseph A; Dean, J Michael; Holubkov, Richard; Berger, John; Meert, Kathleen L; Anand, Kanwaljeet J S; Zimmerman, Jerry; Newth, Christopher J; Harrison, Rick; Burr, Jeri; Willson, Douglas F; Nicholson, Carol; Bell, Michael J; Berg, Robert A; Shanley, Thomas P; Heidemann, Sabrina M; Dalton, Heidi; Jenkins, Tammara L; Doctor, Allan; Webster, Angie

2016-11-01

Nosocomial infection remains an important health problem in long stay (>3 days) pediatric intensive care unit (PICU) patients. Admission risk factors related to the development of nosocomial infection in long stay immune competent patients in particular are not known. Post-hoc analysis of the previously published Critical Illness Stress induced Immune Suppression (CRISIS) prevention trial database, to identify baseline risk factors for nosocomial infection. Because there was no difference between treatment arms of that study in nosocomial infection in the population without known baseline immunocompromise, both arms were combined and the cohort that developed nosocomial infection was compared with the cohort that did not. There were 254 long stay PICU patients without known baseline immunocompromise. Ninety (35%) developed nosocomial infection, and 164 (65%) did not. Admission characteristics associated with increased nosocomial infection risk were increased age, higher Pediatric Risk of Mortality version III score, the diagnoses of trauma or cardiac arrest and lymphopenia (P risk of developing nosocomial infection (P risk factors (P < 0.05); whereas trauma tended to be related to nosocomial infection development (P = 0.07). These data suggest that increasing age, cardiac arrest and lymphopenia predispose long stay PICU patients without known baseline immunocompromise to nosocomial infection. These findings may inform pre-hoc stratification randomization strategies for prospective studies designed to prevent nosocomial infection in this population.

Copper sulfate acute ecotoxicity and environmental risk for tropical fish

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Adilson Ferreira da Silva

2014-10-01

Full Text Available The aim of this study was to estimate copper sulfate acute toxicity and to determine death percentage and environmental risk on guppy fish (Phallocerus caudimaculatus, zebrafish (Brachydanio rerio, mato grosso (Hyphessobrycon eques, and pacu (Piaractus mesopotamicus. Fish were exposed to 0.01, 0.03, 0.05, 0.07, 0.10, and 0.30 mg L-1 (guppy, 0.05, 0.07, 0.10, and 0.30 mg L-1 (zebrafish, 0.07, 0.10, 0.20, and 0.30 mg L-1 (mato grosso and 9.5, 10.0, 10.5, 11.0, 11.5, and 12.0 mg L-1 (pacu of copper sulfate, with triplicate control. The estimated 50% average lethal concentrations (LC50; 96 hours were 0.05 (guppy, 0.13 (zebrafish; 0.16 (mato grosso and 10.36 mg L-1 (pacu. Copper sulfate was extremely toxic for guppy, highly toxic for zebrafish and mato grosso and lightly toxic for pacu and presents environmental risk of high adverse effects on the guppy, zebrafish and mato grosso and moderate adverse effect to the pacu. Therefore, the guppy fish, zebrafish, and mato grosso are important alternatives for copper sulfate toxicity evaluation in waterbodies.

The use of Classical Rolling Pendulum Bearings (CRPB for vibration control of stay-cables

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Papastergiou Georgia

2018-01-01

Full Text Available Cables are efficient structural elements that are used in cable-stayed bridges, suspension bridges and other cable structures. A significant problem which arose from the praxis is the cables’ rain-wind induced vibrations as these cables are subjected to environmental excitations. Rain-wind induced stay-cable vibrations may occur at different cable eigenfrequencies. Large amplitude Rain-Wind-Induced-Vibrations (RWIV of stay cables are a challenging problem in the design of cable-stayed bridges. Several methods, including aerodynamic or structural means, have been investigated in order to control the vibrations of bridge’s stay-cables. The present research focuses on the effectiveness of a movable anchorage system with a Classical Rolling Pendulum Bearing (CRPB device. An analytical model of cable-damper system is developed based on the taut string representation of the cable. The gathered integral-differential equations are solved through the use of the Lagrange transformation. . Finally, a case study with realistic geometrical parameters is also presented to establish the validity of the proposed system.

Geometric nonlinear analysis of self-anchored cable-stayed suspension bridges.

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Hui-Li, Wang; Yan-Bin, Tan; Si-Feng, Qin; Zhe, Zhang

2013-01-01

Geometric nonlinearity of self-anchored cable-stayed suspension bridges is studied in this paper. The repercussion of shrinkage and creep of concrete, rise-to-span ratio, and girder camber on the system is discussed. A self-anchored cable-stayed suspension bridge with a main span of 800 m is analyzed with linear theory, second-order theory, and nonlinear theory, respectively. In the condition of various rise-to-span ratios and girder cambers, the moments and displacements of both the girder and the pylon under live load are acquired. Based on the results it is derived that the second-order theory can be adopted to analyze a self-anchored cable-stayed suspension bridge with a main span of 800 m, and the error is less than 6%. The shrinkage and creep of concrete impose a conspicuous impact on the structure. And it outmatches suspension bridges for system stiffness. As the rise-to-span ratio increases, the axial forces of the main cable and the girder decline. The system stiffness rises with the girder camber being employed.

Geometric Nonlinear Analysis of Self-Anchored Cable-Stayed Suspension Bridges

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Wang Hui-Li

2013-01-01

Full Text Available Geometric nonlinearity of self-anchored cable-stayed suspension bridges is studied in this paper. The repercussion of shrinkage and creep of concrete, rise-to-span ratio, and girder camber on the system is discussed. A self-anchored cable-stayed suspension bridge with a main span of 800 m is analyzed with linear theory, second-order theory, and nonlinear theory, respectively. In the condition of various rise-to-span ratios and girder cambers, the moments and displacements of both the girder and the pylon under live load are acquired. Based on the results it is derived that the second-order theory can be adopted to analyze a self-anchored cable-stayed suspension bridge with a main span of 800 m, and the error is less than 6%. The shrinkage and creep of concrete impose a conspicuous impact on the structure. And it outmatches suspension bridges for system stiffness. As the rise-to-span ratio increases, the axial forces of the main cable and the girder decline. The system stiffness rises with the girder camber being employed.

Preoperative oral dextromethorphan does not reduce pain or analgesic consumption in children after adenotonsillectomy.

Science.gov (United States)

Rose, J B; Cuy, R; Cohen, D E; Schreiner, M S

1999-04-01

In this randomized, double-blinded, placebo-controlled, prospective study, we evaluated the analgesic efficacy of dextromethorphan 0.5 mg/kg or 1.0 mg/kg p.o. 1 h before adenotonsillectomy in 57 children 6-12 yr of age. Anesthetic management was standardized. Morphine 0.075 mg/kg i.v. and acetaminophen 25-35 mg/kg p.r. were administered after anesthetic induction but before the start of surgery. A 4-point behavioral score (1 = asleep, 2 = awake and calm, 3 = awake and crying, 4 = thrashing) was recorded on admission to and discharge from the postanesthesia care unit (PACU). In the PACU, pain was assessed with Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and recorded every 15 min until the patient was transferred to the day surgery unit (DSU). In the DSU, patients rated their pain using a 10-cm baseline 0-10 visual analog pain scale (VAS) every 30 min until they were discharged home. A 24-h VAS was obtained by phone interview, and parental satisfaction was scored (yes/no) regarding their child's postoperative analgesia. Morphine 0.025 mg/kg i.v. was administered to children with CHEOPS score >6, who verbalized pain, or who were crying in any consecutive 5-min observation periods in the PACU. Total morphine consumption was recorded. The study groups were comparable with respect to demographic variables. We were unable to detect any differences between study groups with respect to postoperative morphine consumption, CHEOPS, behavior scores, VAS, or parental satisfaction. Premedication with dextromethorphan 0.5 or 1.0 mg/kg p.o. does not improve postoperative analgesia in school-aged children who receive preemptive morphine 0.075 mg/kg i.v. and acetaminophen 25-35 mg/kg p.r. during nitrous oxide and desflurane anesthesia for adenotonsillectomy.

The 'stay-at-home' mother, postfeminism and neoliberalism: content analysis of UK news coverage

OpenAIRE

Shani Orgad; Sara De Benedictis

2015-01-01

This article analyzes the construction in the UK media of the ‘stay-at-home mother’, a maternal figure who received increasing visibility during the recession and its aftermath. Based on a content analysis of UK national newspaper coverage of stay-at-home mothers (2008–2013), this article argues that the stay-at-home mother emerges from its press coverage as a neoliberal postfeminist subject. On the one hand, the coverage complicates claims about antifeminist backlash and women’s harking back...

Postintensive care unit psychological burden in patients with chronic obstructive pulmonary disease and informal caregivers: A multicenter study.

Science.gov (United States)

de Miranda, Sandra; Pochard, Frédéric; Chaize, Marine; Megarbane, Bruno; Cuvelier, Antoine; Bele, Nicolas; Gonzalez-Bermejo, Jesus; Aboab, Jérome; Lautrette, Alexandre; Lemiale, Virginie; Roche, Nicolas; Thirion, Marina; Chevret, Sylvie; Schlemmer, Benoit; Similowski, Thomas; Azoulay, Elie

2011-01-01

To determine the prevalence and risk factors of symptoms of anxiety, depression, and posttraumatic stress disorder-related symptoms in patients with chronic obstructive pulmonary disease and their relatives after an intensive care unit stay. Prospective multicenter study. Nineteen French intensive care units. One hundred twenty-six patients with chronic obstructive pulmonary disease who survived an intensive care unit stay and 102 relatives. None. Patients and relatives were interviewed at intensive care unit discharge and 90 days later to assess symptoms of anxiety and depression using Hospital Anxiety and Depression Scale (HADS) and posttraumatic stress disorder-related symptoms using the Impact of Event Scale (IES). At intensive care unit discharge, 90% of patients recollected traumatic psychological events in the intensive care unit. At day 90, we were able to conduct telephone interviews with 53 patients and 47 relatives. Hospital Anxiety and Depression Scale scores indicated symptoms of anxiety and depression in 52% and 45.5% of patients at intensive care unit discharge and in 28.3% and 18.9% on day 90, respectively. Corresponding prevalence in relatives were 72.2% and 25.7% at intensive care unit discharge and 40.4% and 14.9% on day 90, respectively. The Impact of Event Scale indicated posttraumatic stress disorder-related symptoms in 20.7% of patients and 29.8% of relatives on day 90. Peritraumatic dissociation assessed using the Peritraumatic Dissociative Experiences Questionnaire was independently associated with posttraumatic stress disorder-related symptoms in the patients and relatives. Previous intensive care unit experience and recollection of bothersome noise in the intensive care unit predicted posttraumatic stress disorder-related symptoms in the patients. Psychiatric symptoms were found to be common in a group of 126 patients with chronic obstructive pulmonary disease who survived an intensive care unit stay and their relatives at intensive care

What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark

DEFF Research Database (Denmark)

Husted, Henrik; Hansen, Hans Christian; Holm, Gitte

2009-01-01

satisfaction with components of their stay, co-morbidity, sex and age. RESULTS: Mean LOS was 7.4 and 8.0 days after THA and TKA, respectively staying from 4.5 to 12 days. Departments with short hospital stay were characterised by both logistical (homogenous entities, regular staff, high continuity, using more...

Construction control of cable-stayed bridges

OpenAIRE

Lozano Galant, José Antonio

2013-01-01

Premi extraordinari doctorat curs 2012-2013, àmbit d’Enginyeria Civil This work presents a study of the simulation of cable-stayed bridges built on temporary supports focused on their response during construction and in service. To simulate the behavior during construction, a set of four different algorithms has been developed to deal with initial design (Backward Algorithm), updating the tensioning process when deviations on site are measured (Forward Algorithm), optimization processes (D...

Using Lean Management to Reduce Emergency Department Length of Stay for Medicine Admissions.

Science.gov (United States)

Allaudeen, Nazima; Vashi, Anita; Breckenridge, Julia S; Haji-Sheikhi, Farnoosh; Wagner, Sarah; Posley, Keith A; Asch, Steven M

The practice of boarding admitted patients in the emergency department (ED) carries negative operational, clinical, and patient satisfaction consequences. Lean tools have been used to improve ED workflow. Interventions focused on reducing ED length of stay (LOS) for admitted patients are less explored. To evaluate a Lean-based initiative to reduce ED LOS for medicine admissions. Prospective quality improvement initiative performed at a single university-affiliated Department of Veterans Affairs (VA) medical center from February 2013 to February 2016. We performed a Lean-based multidisciplinary initiative beginning with a rapid process improvement workshop to evaluate current processes, identify root causes of delays, and develop countermeasures. Frontline staff developed standard work for each phase of the ED stay. Units developed a daily management system to reinforce, evaluate, and refine standard work. The primary outcome was the change in ED LOS for medicine admissions pre- and postintervention. ED LOS at the intervention site was compared with other similar VA facilities as controls over the same time period using a difference-in-differences approach. ED LOS for medicine admissions reduced 26.4%, from 8.7 to 6.4 hours. Difference-in-differences analysis showed that ED LOS for combined medicine and surgical admissions decreased from 6.7 to 6.0 hours (-0.7 hours, P = .003) at the intervention site compared with no change (5.6 hours, P = .2) at the control sites. We utilized Lean management to significantly reduce ED LOS for medicine admissions. Specifically, the development and management of standard work were key to sustaining these results.

Restaurant Dining: Seven Tips for Staying Gluten Free

Science.gov (United States)

GiG Education Bulletin Restaurant Dining: Seven Tips for Staying Gluten-Free Updated May 2014 Tips for Dining Away from Home 1. Selection of ... a number of factors, including the type of restaurant you choose. • Be careful in restaurants where language ...

Full On-Device Stay Points Detection in Smartphones for Location-Based Mobile Applications

Directory of Open Access Journals (Sweden)

Rafael Pérez-Torres

2016-10-01

Full Text Available The tracking of frequently visited places, also known as stay points, is a critical feature in location-aware mobile applications as a way to adapt the information and services provided to smartphones users according to their moving patterns. Location based applications usually employ the GPS receiver along with Wi-Fi hot-spots and cellular cell tower mechanisms for estimating user location. Typically, fine-grained GPS location data are collected by the smartphone and transferred to dedicated servers for trajectory analysis and stay points detection. Such Mobile Cloud Computing approach has been successfully employed for extending smartphone’s battery lifetime by exchanging computation costs, assuming that on-device stay points detection is prohibitive. In this article, we propose and validate the feasibility of having an alternative event-driven mechanism for stay points detection that is executed fully on-device, and that provides higher energy savings by avoiding communication costs. Our solution is encapsulated in a sensing middleware for Android smartphones, where a stream of GPS location updates is collected in the background, supporting duty cycling schemes, and incrementally analyzed following an event-driven paradigm for stay points detection. To evaluate the performance of the proposed middleware, real world experiments were conducted under different stress levels, validating its power efficiency when compared against a Mobile Cloud Computing oriented solution.

Full On-Device Stay Points Detection in Smartphones for Location-Based Mobile Applications.

Science.gov (United States)

Pérez-Torres, Rafael; Torres-Huitzil, César; Galeana-Zapién, Hiram

2016-10-13

The tracking of frequently visited places, also known as stay points, is a critical feature in location-aware mobile applications as a way to adapt the information and services provided to smartphones users according to their moving patterns. Location based applications usually employ the GPS receiver along with Wi-Fi hot-spots and cellular cell tower mechanisms for estimating user location. Typically, fine-grained GPS location data are collected by the smartphone and transferred to dedicated servers for trajectory analysis and stay points detection. Such Mobile Cloud Computing approach has been successfully employed for extending smartphone's battery lifetime by exchanging computation costs, assuming that on-device stay points detection is prohibitive. In this article, we propose and validate the feasibility of having an alternative event-driven mechanism for stay points detection that is executed fully on-device, and that provides higher energy savings by avoiding communication costs. Our solution is encapsulated in a sensing middleware for Android smartphones, where a stream of GPS location updates is collected in the background, supporting duty cycling schemes, and incrementally analyzed following an event-driven paradigm for stay points detection. To evaluate the performance of the proposed middleware, real world experiments were conducted under different stress levels, validating its power efficiency when compared against a Mobile Cloud Computing oriented solution.

Length of stay for older adults residing in nursing homes at the end of life.

Science.gov (United States)

Kelly, Anne; Conell-Price, Jessamyn; Covinsky, Kenneth; Cenzer, Irena Stijacic; Chang, Anna; Boscardin, W John; Smith, Alexander K

2010-09-01

To describe lengths of stay of nursing home decedents. Retrospective cohort study. The Health and Retirement Study (HRS), a nationally representative survey of U.S. adults aged 50 and older. One thousand eight hundred seventeen nursing home residents who died between 1992 and 2006. The primary outcome was length of stay, defined as the number of months between nursing home admission and date of death. Covariates were demographic, social, and clinical factors drawn from the HRS interview conducted closest to the date of nursing home admission. The mean age of decedents was 83.3 ± 9.0; 59.1% were female, and 81.5% were white. Median and mean length of stay before death were 5 months (interquartile range 1-20) and 13.7 ± 18.4 months, respectively. Fifty-three percent died within 6 months of placement. Large differences in median length of stay were observed according to sex (men, 3 months vs women, 8 months) and net worth (highest quartile, 3 months vs lowest quartile, 9 months) (all P home lengths of stay are brief for the majority of decedents. Lengths of stay varied markedly according to factors related to social support. © 2010, Copyright the Authors. Journal compilation © 2010, The American Geriatrics Society.

Modern techniques in prestressed concrete cable-stayed bridges. Puresutoresuto concrete shachokyo ni okeru atarashii gijutsu

Energy Technology Data Exchange (ETDEWEB)

Miyamoto, A. (Kobe Univ. (Japan). Faculty of Engineering)

1994-03-31

Because the prestressed concrete (PC) cable-stayed bridges combine the distinctive features such as a rationality of the structure or a structural beauty, it will not stay on a development of the technologies to make them longer and larger, and a rationalization of the execution, an investigation from various aspects such as the scenery design, material selection, pursuit of new structure and so forth will become necessary. In a main meeting, 15 volumes of paper on the most advanced technologies of PC cable-stayed bridges were presented. The presentations from Japan were 11 volumes, and occupied about 70%, and therefore a high interest to the PC cable-stayed bridges in Japan was inferred. In the presentation from Japan, there were many relevancies of the important study themes which would become a foundation for a development of PC cable-stayed bridges in the future, like ones that an improvement effect of dynamic behavior such as the aseismatic property, wind endurance and so forth was made as an objective, ones that a safety evaluation at an ultimate state as the oblique member anchoring part, main tower or entire structure was related, ones that a construction of the various control systems when the cable-stayed bridges were executed was concerned and so forth. 23 figs., 1 tab.

Trends of Heller myotomy hospitalizations for achalasia in the United States, 1993-2005: effect of surgery volume on perioperative outcomes.

Science.gov (United States)

Wang, Y Richard; Dempsey, Daniel T; Friedenberg, Frank K; Richter, Joel E

2008-10-01

Achalasia is a rare chronic disorder of esophageal motor function. Single-center reports suggest that there has been greater use of laparoscopic Heller myotomy for achalasia in the United States since its introduction in 1992. We aimed to study the trends of Heller myotomy and the relationship between surgery volume and perioperative outcomes. The Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) is a 20% stratified sample of all hospitalizations in the United States. It was used to study the macro-trends of Heller myotomy hospitalizations during 1993-2005. We also used the NIS 2003-2005 micro-data to study the perioperative outcomes of Heller myotomy hospitalizations, using other achalasia and laparoscopic cholecystectomy hospitalizations as control groups. The generalized linear model with repeated observations from the same unit was used to adjust for multiple hospitalizations from the same hospital. The national estimate of Heller myotomy hospitalizations increased from 728 to 2,255 during 1993-2005, while its mean length of stay decreased from 9.9 to 4.3 days. Of the 1,117 Heller myotomy hospitalizations in the NIS 2003-2005, 10 (0.9%) had the diagnosis of esophageal perforation at discharge. Length of stay was negatively correlated with a hospital's number of Heller myotomy per year (correlation coefficient -0.171, P Heller myotomy per year was negatively associated with length of stay (coefficient -0.215 to -0.119, both P Heller myotomy for achalasia was associated with greater use of surgery and shorter length of stay. A larger volume of Heller myotomy in a hospital was associated with better perioperative outcomes in terms of shorter length of stay and lower total charges.

Staying Safe in Your Home During a Hurricane

Centers for Disease Control (CDC) Podcasts

2006-08-10

If you are not ordered to evacuate, and you stay in your home through a hurricane, there are things you can do to protect yourself and your family.  Created: 8/10/2006 by Emergency Communications System.   Date Released: 8/13/2008.

Prediction of emergence agitation using withdrawal reaction following rocuronium injection in preschool-aged patients undergoing inguinal herniorrhaphy: a preliminary exploratory observational trial.

Science.gov (United States)

Kim, Dae Hee; Roh, Go Un; Lee, Young Bok; Choi, Chang Ik; Lee, Jae Moon; Chae, Yun Jeong

2018-01-01

The development of emergence agitation (EA) is associated with several factors including age, preoperative anxiety, postoperative pain, anesthesia method, and surgery type. No studies have investigated whether the withdrawal reaction following rocuronium injection can predict the occurrence of EA. Therefore, we investigated this relationship in preschool-aged children undergoing inguinal herniorrhaphy, and which grade of withdrawal reaction is appropriate for identifying patients at risk of experiencing EA. A total of 40 patients were enrolled in this study. During anesthesia induction, the withdrawal reaction after loss of consciousness following rocuronium injection was assessed using a 4-point scale. After surgery, EA was assessed using the Watcha scale. There was a correlation between withdrawal reaction and EA on admission to the postanesthesia care unit (PACU). Patients with a severe withdrawal reaction (grade 3) showed a significantly higher incidence of severe EA requiring medication on admission to the PACU. The findings of this preliminary exploratory observational study suggest that it is possible for withdrawal movement following rocuronium injection during anesthesia induction to reflect pain sensitivity of pediatric patients, which in turn may be useful in identifying those at risk of severe EA on admission to the PACU among preschool children undergoing inguinal herniorrhaphy. Further studies with a larger sample size are required to validate these findings. The exact correlation between pain reaction following rocuronium injection and postoperative pain or pain-related phenomenon should be elucidated.

Pre- or postoperative interscalene block and/or general anesthesia for arthroscopic shoulder surgery: a retrospective observational study.

Science.gov (United States)

Bosco, Laura; Zhou, Cheng; Murdoch, John A C; Bicknell, Ryan; Hopman, Wilma M; Phelan, Rachel; Shyam, Vidur

2017-10-01

Arthroscopic shoulder surgery can be performed with an interscalene brachial plexus block (ISBPB) alone, ISBPB combined with general anesthesia (GA), or GA alone. Postoperative pain is typically managed with opioids; however, both GA and opioids have adverse effects which can delay discharge. This retrospective study compares the efficacy of four methods of anesthesia management for arthroscopic shoulder surgery. Charts of all patients who underwent shoulder surgery by a single surgeon from 2012-2015 were categorized by analgesic regimen: GA only (n = 177), single-shot ISBPB only (n = 124), or pre- vs postoperative ISBPB combined with GA (ISBPB + GA [n = 72] vs GA + ISBPB [n = 52], respectively). The primary outcome measure was the time to discharge from the postanesthesia care unit (PACU). Mean (SD) time in the PACU ranged from 70.5 (39.9) min for ISBPB only to 111.2 (56.9) min for GA only. Use of ISBPB in any combination and regardless of timing resulted in significantly reduced PACU time, with a mean drop of 27.2 min (95% confidence interval [CI], 17.3 to 37.2; P shoulder surgery are confirmed. Postoperative ISBPBs may also be beneficial for reducing pain and opioid requirements and could be targeted for patients in severe pain upon emergence. A sufficiently powered randomized-controlled trial could determine the relative efficacy, safety, and associated financial implications associated with each method.

A semi-Markov model for the duration of stay in a non-homogenous ...

African Journals Online (AJOL)

The semi-Markov approach to a non-homogenous manpower system is considered. The mean duration of stay in a grade and the total duration of stay in the system are obtained. A renewal type equation is developed and used in deriving the limiting distribution of the semi – Markov process. Empirical estimators of the ...

Conflict management style of Jordanian nurse managers and its relationship to staff nurses' intent to stay.

Science.gov (United States)

Al-Hamdan, Zaid; Nussera, Hayat; Masa'deh, Rami

2016-03-01

To explore the relationship between conflict management styles used by nurse managers and intent to stay of staff nurses. Nursing shortages require managers to focus on the retention of staff nurses. Understanding the relationship between conflict management styles of nurse managers and intent to stay of staff nurses is one strategy to retain nurses in the workforce. A cross-sectional descriptive quantitative study was carried out in Jordan. The Rahim organization conflict inventory II (ROCI II) was completed by 42 nurse managers and the intent to stay scale was completed by 320 staff nurses from four hospitals in Jordan. The anova analysis was carried out. An integrative style was the first choice for nurse managers and the last choice was a dominating style. The overall level of intent to stay for nurses was moderate. Nurses tend to keep their current job for 2-3 years. There was a negative relationship between the dominating style as a conflict management style and the intent to stay for nurses. The findings of the present study support the claim that leadership practices affect the staff nurses' intent to stay and the quality of care. Nurse managers can improve the intent to stay for staff nurses if they use the appropriate conflict management styles. © 2015 John Wiley & Sons Ltd.

Physiological responses of fish, Piaractus mesopotamicus, to infection with the freshwater fish louse, Dolops carvalhoi. Abstract

NARCIS (Netherlands)

Castro, F.J.; Wendelaar Bonga, S.E.; Fernandes, N.N.

2007-01-01

The freshwater fish louse Dolops carvalhoi, is an ectoparasite of pacu, Piaractus mesopotamicus, that causes severe damage to its hosts. The aim of this study was to investigate the physiological responses of pacu to the stress of D. carvalhoi infection. After acclimation at the laboratory

Direct costs associated with the appropriateness of hospital stay in elderly population

Directory of Open Access Journals (Sweden)

Sánchez-García Sergio

2009-08-01

Full Text Available Abstract Background Ageing of Mexican population implies greater demand of hospital services. Nevertheless, the available resources are used inadequately. In this study, the direct medical costs associated with the appropriateness of elderly populations hospital stay are estimated. Methods Appropriateness of hospital stay was evaluated with the Appropriateness Evaluation Protocol (AEP. Direct medical costs associated with hospital stay under the third-party payer's institutional perspective were estimated, using as information source the clinical files of 60 years of age and older patients, hospitalized during year 2004 in a Regional Hospital from the Mexican Social Security Institute (IMSS, in Mexico City. Results The sample consisted of 724 clinical files, with a mean of 5.3 days (95% CI = 4.9–5.8 of hospital stay, of which 12.4% (n = 90 were classified with at least one inappropriate patient day, with a mean of 2.2 days (95% CI = 1.6 – 2.7. The main cause of inappropriateness days was the inexistence of a diagnostic and/or treatment plan, 98.9% (n = 89. The mean cost for an appropriate hospitalization per patient resulted in US$1,497.2 (95% CI = US$323.2 – US$4,931.4, while the corresponding mean cost for an inappropriate hospitalization per patient resulted in US$2,323.3 (95% CI = US$471.7 – US$6,198.3, (p Conclusion Elderly patients who were inappropriately hospitalized had a higher rate of inappropriate patient days. The average of inappropriate patient days cost is considerably higher than appropriate days. In this study, inappropriate hospital-stay causes could be attributable to physicians and current organizational management.

Staying Home While Studying Abroad: Anti-Imperial Praxis for Globalizing Feminist Visions

Directory of Open Access Journals (Sweden)

Shireen Roshanravan

2012-05-01

Full Text Available This paper hinges on the recognition that when study-abroad opportunities are presented and perceived as a means of access to global perspectives on women and gender, they reduce the problem of US-centrism in Women's Studies to a geographic rather than an epistemic limitation. According to this logic, physical travel away from the United States can serve as an effective method for overcoming US-centrism and attending to the "global," a curricular strategy that Chandra Mohanty and M. Jacqui Alexander call "the cartographic rule of the transnational as always 'elsewhere'" (Mohanty and Alexander 2010, 33. This cartographic rule reinforces hegemonic representations of the United States as a unified "modern" white/Anglo nation against which the culturally Other terrain of the "global" becomes understandable. As such, the study-abroad approach to internationalizing US Women's Studies relies on the re-erasure of US Women of Color genealogies and epistemologies that disrupt the white/Anglo cultural assumptions grounding the field's central category of "woman/women." If challenging US-centrism in US Women's Studies is meant to dismantle the white/Anglo monocultural perspective of US imperialism, I argue that the geographic travel imperative of "study abroad" must be tempered by a re-inhabitation of the field through the radical genealogies and epistemologies of US Women of Color, a strategy I call the anti-imperial feminist praxis of "staying home."

[Shortened hospital stay for elective cesarean section after initiation of a fast-track program and midwifery home-care].

Science.gov (United States)

Gunnarsdottir, Johanna; Bjornsdottir, Thorbjörg Edda; Halldorsson, Thorhallur Ingi; Halldorsdottir, Gudrun; Geirsson, Reynir Tomas

2011-07-01

To audit whether hospital stay shortened without increasing readmissions after implementation of fast-track methodology for elective cesarean section and characterize what influences length of stay. A fast-track program was initiated in November 2008, with a one year clinical audit and satisfaction survey. Discharge criteria were predefined and midwife home visits included if discharge was within 48 hours. Hospital stay by parity for women with elective section for singleton pregnancy between 1.11. 2008 - 31.10. 2009 (n=213, fast-track 182) was compared to 2003 (n=199) and 2007 (n=183). Readmissions and outpatient visits 2007 and 2008-9 were counted. Reasons for longer stay were recorded in fast-track, and body mass index. Median hospital stay decreased significantly from 81 to 52 hours between 2007 and 2008-9. Readmissions were four in each period and outpatient visit rates similar. In 2008-9, 66% of all women were discharged within 48 hours. Women in the fast-track program were satisfied with early discharge. Hospital stay for parous women was shorter in 2007 compared to 2003, but unchanged for nulliparas. Parity had a minimal influence on length of stay in 2008-9, although nulliparous women ≤ 25 years were more likely to stay >48 hours. Body mass index did not correlate with length of stay. Pain was rarely the reason for a longer stay in the fast-track program and 90% were satisfied with pain-medication after discharge. Most healthy women can be discharged early after singleton birth by elective cesarean, without increasing readmissions.

Readmission rates after a planned hospital stay of 2 versus 3 days in fast-track colonic surgery

DEFF Research Database (Denmark)

Andersen, Jens; Hjort-Jakobsen, Dorthe; Christiansen, P. S.

2007-01-01

BACKGROUND: Initial programmes of fast-track open colonic surgery with a planned 2-day postoperative hospital stay have had a high readmission rate (about 20 per cent). The aim of this large, consecutive series was to compare readmission rates after a fast-track open colonic surgery programme...... from August 2004. All patients were examined 8 and 30 days after surgery. RESULTS: Readmission rates fell from 20.1 per cent in 408 patients with a planned 2-day hospital stay (period 1) to 11.3 per cent in 133 patients with a planned 3-day hospital stay (period 2) (P ... hospital stay was 2 and 3 days, median stay after readmission was 5 and 5.5 days, and median (mean) total stay was 3 (5.6) and 3 (5.7) days in periods 1 and 2 respectively. The readmission rate in period 2 was lower because there were fewer readmissions for short-term observation or social reasons...

12 CFR 908.67 - Stay of final decision and order pending judicial review.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Stay of final decision and order pending... Hearing and Post-hearing Proceedings § 908.67 Stay of final decision and order pending judicial review... the effectiveness of all or any part of an order of the Board of Directors pending a final decision on...

Immunonutrition - the influence of early postoperative glutamine supplementation in enteral/parenteral nutrition on immune response, wound healing and length of hospital stay in multiple trauma patients and patients after extensive surgery.

Science.gov (United States)

Lorenz, Kai J; Schallert, Reiner; Daniel, Volker

2015-01-01

In the postoperative phase, the prognosis of multiple trauma patients with severe brain injuries as well as of patients with extensive head and neck surgery mainly depends on protein metabolism and the prevention of septic complications. Wound healing problems can also result in markedly longer stays in the intensive care unit and general wards. As a result, the immunostimulation of patients in the postoperative phase is expected to improve their immunological and overall health. A study involving 15 patients with extensive ENT tumour surgery and 7 multiple-trauma patients investigated the effect of enteral glutamine supplementation on immune induction, wound healing and length of hospital stay. Half of the patients received a glutamine-supplemented diet. The control group received an isocaloric, isonitrogenous diet. In summary, we found that total lymphocyte counts, the percentage of activated CD4+DR+ T helper lymphocytes, the in-vitro response of lymphocytes to mitogens, as well as IL-2 plasma levels normalised faster in patients who received glutamine-supplemented diets than in patients who received isocaloric, isonitrogenous diets and that these parameters were even above normal by the end of the second postoperative week. We believe that providing critically ill patients with a demand-oriented immunostimulating diet is fully justified as it reduces septic complications, accelerates wound healing, and shortens the length of ICU (intensive care unit) and general ward stays.

Job stress, recognition, job performance and intention to stay at work among Jordanian hospital nurses.

Science.gov (United States)

AbuAlRub, Raeda Fawzi; Al-Zaru, Ibtisam Moawiah

2008-04-01

To investigate: (1) relationships between job stress, recognition of nurses' performance, job performance and intention to stay among hospital nurses; and (2) the buffering effect of recognition of staff performance on the 'stress-intention to stay at work' relationship. Workplace stress tremendously affects today's workforce. Recognition of nurses' performance needs further investigation to determine if it enhances the level of intention to stay at work and if it can buffer the negative effects of stress on nurses' intention to stay at work. The sample of the present study was a convenience one. It consisted of 206 Jordanian staff nurses who completed a structured questionnaire. The findings of the study indicated a direct and a buffering effect of recognition of nurses' performance on job stress and the level of intention to stay at work. The results of the study indicated the importance of recognition for outstanding performance as well as achievements. Implications for nursing management The results of this study support the need to focus on the implementation of recognition strategies in the workplace to reduce job stress and enhance retention.

Staying at work with chronic nonspecific musculoskeletal pain : a qualitative study of workers' experiences

NARCIS (Netherlands)

de Vries, Haitze J.; Brouwer, Sandra; Groothoff, Johan W.; Geertzen, Jan H. B.; Reneman, Michiel F.

2011-01-01

Background: Many people with chronic nonspecific musculoskeletal pain (CMP) have decreased work ability. The majority, however, stays at work despite their pain. Knowledge about workers who stay at work despite chronic pain is limited, narrowing our views on work participation. The aim of this study

Association of bystander interventions and hospital length of stay and admission to intensive care unit in out-of-hospital cardiac arrest survivors

DEFF Research Database (Denmark)

Riddersholm, Signe; Kragholm, Kristian; Mortensen, Rikke Nørmark

2017-01-01

for bystander defibrillation. 82% of patients without bystander interventions were admitted to ICU compared to 77.2% for bystander CPR, and 61.2% for bystander defibrillation. In-hospital mortality was 60% in the first category compared to 40.5% and 21.7% in the two latter categories. In regression models.......76-0.85]), were associated with lower risk of ICU admission. CONCLUSIONS: Bystander interventions were associated with reduced hospital length of stay and ICU admission, suggesting that these efforts improve recovery in OHCA survivors....

Cost effectiveness of day stay versus inpatient radiofrequency (RF) ablation for the treatment of supraventricular tachyarrhythmias

International Nuclear Information System (INIS)

Weerasooriya, H.R.; Harris, A.H.; Davis, M.J.E.

1996-01-01

It is well established that radiofrequency (RF) ablation is the most cost effective treatment strategy for patients with supraventricular tachycardia. Previous cost estimates assumed at least an overnight stay following RF ablation. Day stay RF ablation however appears to be a safe alternative. The aim of this study was to compare day stay and inpatient catheter ablation in terms of cost, efficacy and safety. This was a retrospective cost effectiveness analysis. The study population consisted of 25 consecutive patients who underwent impatient RF ablation (historical controls). Economic analysis was based upon a detailed clinical costing. The mean overall cost per patient of inpatient RF ablation in 1994 Australian dollar values is $2354 (SD, $642) compared with $1876 (SD, $595) for day stay RF ablation (p<0.01). Day stay RF ablation is a cost effective alternative to inpatient RF ablation. 16 refs., 2 tabs

The Relationship of Trust and Intent to Stay Among Registered Nurses at Jordanian Hospitals.

Science.gov (United States)

Atiyeh, Huda Mohammad; AbuAlRub, Raeda Fawzi

2017-10-01

This study examined the relationship between the level of trust with immediate supervisor and the level of intent to stay at work among registered nurses (RNs) in Jordan and explored if there is a significant difference between RNs working in governmental- and university-affiliated teaching hospitals. Financial retention strategies are not feasible in low- and middle-income countries. This study investigated if the level of trust that RNs hold toward their immediate supervisors could affect their intent to stay at work, so as to be used as a nonfinancial strategy. A descriptive correlational design was used to examine this relationship among a convenience sample of 260 hospital nurses in Jordan. Descriptive and inferential statistics were used to analyze the data. When the level of trust increased, the level of intent to stay at work also increased. RNs working in governmental-affiliated teaching hospitals reported higher levels of trust and intent to stay at work than those working in university-affiliated teaching hospitals. The findings emphasized the positive effect of trust with immediate supervisor on the level of RNs' intent to stay. Building trust between RNs and their immediate supervisors could be an important retention strategy. © 2016 Wiley Periodicals, Inc.

Probabilistic Approach to Fatigue Assessment for Stay Cables

DEFF Research Database (Denmark)

Baussaron, Julien; Sørensen, John Dalsgaard; Toft, Henrik Stensgaard

2013-01-01

Many parameters used for predicting times to failure of structure due to fatigue are uncertain and their variations have a big influence on the real lifetime. This paper focus on a global methodology to take main sources of variability in fatigue prediction for stay cables into account. The first...

Increased length of stay and costs associated with weekend admissions for failure to thrive.

Science.gov (United States)

Thompson, Rachel T; Bennett, William E; Finnell, S Maria E; Downs, Stephen M; Carroll, Aaron E

2013-03-01

To evaluate whether admission day of the week affects the length of stay (LOS) and health care costs for failure to thrive (FTT) admissions. Administrative data were obtained for all children aged <2 years (N = 23 332) with a primary admission diagnosis of FTT from 2003-2011 from 42 freestanding US hospitals. Demographic characteristics, day of admission, LOS, costs per stay, number of discharge diagnoses, primary discharge diagnoses, primary procedure code, number of radiologic and laboratory units billed during admission were obtained for each admission. Linear regression and zero-truncated Poisson regression were used for analysis. Weekend admission was significantly correlated with increased LOS and increased average cost (P < .002). This finding was also true for children with both admission and discharge diagnoses of FTT (P < .001). The number of procedures for children admitted on the weekend was not significantly different compared with children admitted on the weekdays (incident rate ratio [IRR]:1.04 [95% confidence interval (CI): 0.99-1.09]). However, weekend admissions did have more radiologic studies (IRR: 1.13 [95% CI: 1.10-1.16]) and laboratory tests (IRR: 1.39 [95% CI: 1.38-1.40]) performed. If one-half of weekend admissions in 2010 with both admission and discharge diagnoses of FTT were converted to Monday admissions, total savings in health care dollars for 2010 would be $534, 145. Scheduled FTT admissions on weekends increased LOS and health care costs compared with weekday admissions of similar levels of complexity. Reduction in planned weekend admissions for FTT could significantly reduce health care costs.

Seismic Responses of a Cable-Stayed Bridge with Consideration of Uniform Temperature Load

Directory of Open Access Journals (Sweden)

Junjun Guo

2016-12-01

Full Text Available The effects of temperature load on the dynamic responses of cable-stayed bridges have attracted the attention of researchers in recent years. However, these investigations mainly focus on the influence of temperature on the dynamic characteristics of structures, such as vibration mode and frequency. This paper discusses the effects of uniform temperature changes on the seismic responses of a cable-stayed bridge. A three dimensional finite element model of a cable-stayed bridge using OpenSees is established for nonlinear time history analysis, and uniform temperature load is applied to the prototype bridge before the conducting of seismic excitation. Three ground motion records are selected from the PEER strong motion database based on the design spectrum. Case studies are then performed considering the varying temperature and the connections between the deck and pylons of the bridge. The result shows that the seismic responses of the bridge are significantly increased with the consideration of temperature load. Meanwhile, the types between the deck and pylon also have notable impacts on the seismic responses of the bridge with and without temperature changes. This research could provide a reference for designers during the design phase of cable-stayed brides.

Comparing Outcomes of Coronary Artery Bypass Grafting Among Large Teaching and Urban Hospitals in China and the United States.

Science.gov (United States)

Zheng, Zhe; Zhang, Heng; Yuan, Xin; Rao, Chenfei; Zhao, Yan; Wang, Yun; Normand, Sharon-Lise; Krumholz, Harlan M; Hu, Shengshou

2017-06-01

Coronary artery disease is prevalent in China, with concomitant increases in the volume of coronary artery bypass grafting (CABG). The present study aims to compare CABG-related outcomes between China and the United States among large teaching and urban hospitals. Observational analysis of patients aged ≥18 years, discharged from acute-care, large teaching and urban hospitals in China and the United States after hospitalization for an isolated CABG surgery. Data were obtained from the Chinese Cardiac Surgery Registry in China and the National Inpatient Sample in the United States. Analysis was stratified by 2 periods: 2007, 2008, and 2010; and 2011 to 2013 periods. The primary outcome was in-hospital mortality, and the secondary outcome was length of stay. The sample included 51 408 patients: 32 040 from 77 hospitals in the China-CABG group and 19 368 from 303 hospitals in the US-CABG group. In the 2007 to 2008, 2010 period and for all-age and aged ≥65 years, the China-CABG group had higher mortality than the US-CABG group (1.91% versus 1.58%, P =0.059; and 3.12% versus 2.20%, P =0.004) and significantly higher age-, sex-, and comorbidity-adjusted odds of death (odds ratio, 1.58; 95% confidential interval, 1.22-2.04; and odds ratio, 1.73; 95% confidential interval, 1.24-2.40). There were no significant mortality differences in the 2011 to 2013 period. For preoperative, postoperative, and total hospital stay, respectively, the median (interquartile range) length of stay across the entire study period between China-CABG and US-CABG groups were 9 (8) versus 1 (3), 9 (6) versus 6 (3), and 20 (12) versus 7 (5) days (all P China and the United States. The longer length of stay in China may represent an opportunity for improvement. © 2017 The Authors.

The relationships between safety climate, teamwork, and intent to stay at work among Jordanian hospital nurses.

Science.gov (United States)

Abualrub, Raeda F; Gharaibeh, Huda F; Bashayreh, Alaa Eddin I

2012-01-01

The purpose of the present study is to examine the relationships among safety climate, teamwork, and intent to stay at work as perceived by Jordanian hospital nurses. A descriptive correlational design was used to investigate these relationships among a convenience sample of 381 hospital nurses. Data were collected through a self-administered questionnaire that included the Safety Climate and Teamwork Scale and the McCain's Intent to Stay Scale. Descriptive statistics, Pearson correlation, analysis of variance, and hierarchical regression analysis were used to analyze the data. The findings showed (a) a strong positive correlation between safety climate and teamwork; and (b) moderate positive correlations between safety climate and intent to stay at work, and between teamwork and intent to stay at work. Moreover, the overall model of hierarchical regression showed that 45% of the variation in the level of intent to stay at work was explained by background variables, leadership styles, decision-making styles, and safety climate. The findings emphasized the positive effect of safety climate and teamwork on the level of nurses' intent to stay. Nurse administrators should design and implement strategies that create a culture of safety climate and teamwork in their organizations. © 2012 Wiley Periodicals, Inc.

Length of stay, discharge destination, and functional improvement: utility of the Australian National Subacute and Nonacute Patient Casemix Classification.

Science.gov (United States)

Tooth, Leigh; McKenna, Kryss; Goh, Kong; Varghese, Paul

2005-07-01

Although implemented in 1998, no research has examined how well the Australian National Subacute and Nonacute Patient (AN-SNAP) Casemix Classification predicts length of stay (LOS), discharge destination, and functional improvement in public hospital stroke rehabilitation units in Australia. 406 consecutive admissions to 3 stroke rehabilitation units in Queensland, Australia were studied. Sociodemographic, clinical, and functional data were collected. General linear modeling and logistic regression were used to assess the ability of AN-SNAP to predict outcomes. AN-SNAP significantly predicted each outcome. There were clear relationships between the outcomes of longer LOS, poorer functional improvement and discharge into care, and the AN-SNAP classes that reflected poorer functional ability and older age. Other predictors included living situation, acute LOS, comorbidity, and stroke type. AN-SNAP is a consistent predictor of LOS, functional change and discharge destination, and has utility in assisting clinicians to set rehabilitation goals and plan discharge.

Professional values, job satisfaction, career development, and intent to stay.

Science.gov (United States)

Yarbrough, Susan; Martin, Pam; Alfred, Danita; McNeill, Charleen

2017-09-01

Hospitals are experiencing an estimated 16.5% turnover rate of registered nurses costing from $44,380 - $63,400 per nurse-an estimated $4.21 to $6.02 million financial loss annually for hospitals in the United States of America. Attrition of all nurses is costly. Most past research has focused on the new graduate nurse with little focus on the mid-career nurse. Attrition of mid-career nurses is a loss for the profession now and into the future. The purpose of the study was to explore relationships of professional values orientation, career development, job satisfaction, and intent to stay in recently hired mid-career and early-career nurses in a large hospital system. A descriptive correlational study of personal and professional factors on job satisfaction and retention was conducted. Participants and research context: A convenience sample of nurses from a mid-sized hospital in a metropolitan area in the Southwestern United States was recruited via in-house email. Sixty-seven nurses met the eligibility criteria and completed survey documents. Ethical considerations: Institutional Review Board approval was obtained from both the university and hospital system. Findings indicated a strong correlation between professional values and career development and that both job satisfaction and career development correlated positively with retention. Newly hired mid-career nurses scored higher on job satisfaction and planned to remain in their jobs. This is important because their expertise and leadership are necessary to sustain the profession into the future. Nurse managers should be aware that when nurses perceive value conflicts, retention might be adversely affected. The practice environment stimulates nurses to consider whether to remain on the job or look for other opportunities.

Post-operative recovery profile after laparoscopic cholecystectomy: a prospective, observational study of a multimodal anaesthetic regime

DEFF Research Database (Denmark)

Jensen, K; Kehlet, H; Lund, Claus Michael

2007-01-01

BACKGROUND: Laparoscopic cholecystectomy is now often an ambulatory procedure, but dependent on short-term post-operative complaints of pain and post-operative nausea and vomiting (PONV). The efficacy of post-anaesthesia care units (PACUs) is therefore important to facilitate return to normal fun...... are predictors of a complicated recovery profile and deserve further attention. Transient oxygen desaturations postpone discharge from the PACU, but the clinical significance of this fact is questionable. Udgivelsesdato: 2007-Apr...

The length of stay determinants for sun-and-sand tourism: An application for the Region of Murcia

Directory of Open Access Journals (Sweden)

Sánchez García, Juan Francisco

2008-01-01

Full Text Available While tourist arrivals increase annually in Spain, tourist average real expenditure has decreased significantly over the last few years, with important effects on tourism revenues. The process is clearly driven by the reduction of the length of stay of tourists at destinations, but surprisingly this variable has received little attention in the literature. We estimate a length of stay function for sun-and-sand tourists visiting the Region of Murcia over the period 2002-2006 using count data models. Our results show that both tourists’ personal and family characteristics together with economic variables (budget restrictions, income and prices are key factors in determining the duration of the stay. Quantitative identification of the determinants of a tourist’s length of stay could provide important guidelines for designing policies aimed at influencing length of stay in tourist‘s seaside destinations.

Characteristics and needs of long-stay forensic psychiatric inpatients: A rapid review of the literature

NARCIS (Netherlands)

Huband, N.; Furtado, V.; Schel, S.H.H.; Eckert, M.; Cheung, N.; Bulten, B.H.; Vö llm, B.

2018-01-01

This rapid review summarises currently available information on the definition, prevalence, characteristics and needs of long-stay patients within forensic psychiatric settings. Sixty nine documents from 14 countries were identified. Reports on what constitutes 'long-stay' and on the characteristics

The use of enhanced recovery after surgery (ERAS) principles in Scottish orthopaedic units--an implementation and follow-up at 1 year, 2010-2011: a report from the Musculoskeletal Audit, Scotland.

Science.gov (United States)

Scott, Nicholas B; McDonald, David; Campbell, Jane; Smith, Richard D; Carey, A Kate; Johnston, Ian G; James, Kate R; Breusch, Steffen J

2013-01-01

To establish whether a nationally guided programme can lead to more widespread implementation of enhanced recovery after surgery (ERAS), a well-established optimised care pathway for lower limb arthroplasty. In 2010, National Services Scotland's Musculoskeletal Audit was asked to perform a 'snapshot' audit of the current peri-operative management of patients undergoing total hip and knee arthroplasty in all 22 Scottish orthopaedic units with an identical follow-up audit in 2011 after input and support from the national steering group. Audit 1 and audit 2 involved 1,345 and 1,278 patients, respectively. The number of Scottish units that developed an ERAS programme increased from 8 (36 %) to 15 (68 %). Units that included more ERAS patients had earlier mobilisation rates (146/474, 36 % ERAS patients mobilised same day vs. 34/873, 4 % non-ERAS; n = 22 units, r = 0.55, p = 0.008) and shorter post-operative length of stay (median 4 days vs. ERAS, 5 days non-ERAS, n = 22 units, r = -0.64, p = 0.001). ERAS knee arthroplasty patients had lower blood transfusion rates (5/205, 2 % vs. 51/399, 13 %, n = 22 units, r = -0.62, p = 0.002). Units that restricted the use of IV fluids post-operatively had higher early mobilisation rates (n = 22 units, r = 0.48, p = 0.03) and shorter post-operative length of stay (n = 22 units, r = -0.56, p = 0.007). Reduced use of patient-controlled analgesia was also associated with earlier mobilisation (n = 22 units, r = 0.49, p = 0.02) and shorter length of stay (n = 22 units, r = -0.39, p = 0.07). Urinary catheterisation rates also dropped from 468/1,345 (35 %) in 2010 to 337/1,278 (26 %) in 2011 (n = 22 units, z = 2.19, p = 0.03). A clinically guided and nationally supported process has proven highly successful in achieving a further uptake of enhanced recovery principles after lower limb arthroplasty in Scotland, which has resulted in clinical benefits to patients and reduced length of hospital stay.

Antibiotic resistence of Aeromonas hydrophila isolated from Piaractus mesopotamicus (Holmberg, 1887 and Oreochromis niloticus (Linnaeus, 1758 Resistência de Aeromonas hydrophila isolada de Piaractus mesopotamicus (Holmberg, 1887 e Oreochromis niloticus (Linnaeus, 1758 a antibióticos

Directory of Open Access Journals (Sweden)

Andréa Belém-Costa

2006-06-01

Full Text Available One of the most important problems involving treatments with antibiotics against Aeromonas hydrophila isolated from fishes is that antibiotic resistance develops readily. The antimicrobial activity of chemotherapeutants in isolates from pacu Piaractus mesopotamicus (Holmberg, 1887 and tilapia Oreochromis niloticus (Linnaeus, 1758 was tested by the Kirby-Bauer disk method, over Mueller-Hinton surface agar previously inoculated with 100 µL of bacterial suspensions. After regular incubation, isolates from tilapia and pacu were uniformly resistant to amoxicillin, ampicillin, lincomycin, novobiocin, oxacillin, penicillin, and trimetoprim+sulfametoxazole. The A. hydrophila type strain presented resistance to the same antimicrobial substances and also against rifampicin; the bacterial isolate from pacu were the only strain resistant to tetracyclin. Isolates from both pacu and tilapia had intermediate reaction with erytromycin. The use of drugs in commercial fish farms in Brazil can favor the development of resistant bacterial strains in native fish species as already observed for exotic species, commercially produced for longer time.Um dos maiores problemas envolvendo o tratamento com antibióticos contra Aeromonas hydrophila isolada de peixes confinados é a rápida resistência ao antibiótico desenvolvida pela bactéria. A atividade antimicrobiana de quimioterapêuticos em isolados a partir de pacu Piaractus mesopotamicus (Holmberg, 1887 e tilápia Oreochromis niloticus (Linnaeus, 1758 foi verificada pelo método de difusão de antibiótico em discos de Kirby-Bauer, sobre uma superfície de Agar Mueller-Hinton previamente inoculada com 100 µL de suspensão bacteriana. Após o período de incubação, os isolados de tilápia e pacu foram uniformemente resistentes a amoxicilina, ampicilina, lincomicina, novobiocina, oxacilina, penicilina e trimetoprim+sulfametoxazol. A cepa tipo para A. hydrophila apresentou resistência às mesmas subst

Factors affecting length of hospital stay for people with spinal cord injuries at Kanombe military hospital, Rwanda

Directory of Open Access Journals (Sweden)

PB Bwanjugu

2012-12-01

Full Text Available In patients with spinal cord injuries increased length ofhospital stay is often as a result of secondary complications such as pressuresores, urinary tract infection and respiratory infection. An increased lengthof hospital stay was observed at Kanombe Military Hospital in Rwanda.The aim of this study was to determine specific factors affecting length ofhospital stay for individuals with spinal cord injuries at Kanombe MilitaryHospital in Rwanda. The records of 124 individuals with spinal cordinjuries who were discharged from the hospital between 1st January1996and 31st December 2007 were reviewed to collect data. Information collected and captured on a data gathering sheetincluded demographic data, information relating to the injury, occurrence of medical complications and length ofhospital stay. Linear regression analysis was computed in SPSS to determine factors affecting the length of stay.The necessary ethical considerations were adhered to during the implementation of the study. Current employmentstatus and the occurrence of pressure sores were significantly associated with the length of hospital stay (p=0.021 andp=0.000 respectively. A strong relationship was noted between pressure sores and length of stay (R= 0.703. There is aneed for all members of the rehabilitation team to devise and implement effective measures to prevent the developmentof pressure sores, in patients with spinal cord injuries in the study setting.

Late Intensive Care Unit Admission in Liver Transplant Recipients: 10-Year Experience.

Science.gov (United States)

Atar, Funda; Gedik, Ender; Kaplan, Şerife; Zeyneloğlu, Pınar; Pirat, Arash; Haberal, Mehmet

2015-11-01

We evaluated late intensive care unit admission in liver transplant recipients to identify incidences and causes of acute respiratory failure in the postoperative period and to compare these results with results in patients who did not have acute respiratory failure. We retrospectively screened the data of 173 consecutive adult liver transplant recipients from January 2005 through March 2015 to identify patients with late admission (> 30 d posttransplant) to an intensive care unit. Patients were divided into 2 groups: patients with and without acute respiratory failure. Acute respiratory failure was defined as severe dyspnea, respiratory distress, decreased oxygen saturation, hypoxemia or hypercapnia on room air, or need for noninvasive or invasive mechanical ventilation. Demographic, laboratory, clinical, and respiratory data were collected. Model for End-Stage Liver Disease, Acute Physiology and Chronic Health Evaluation II, and Sequential Organ Failure Assessment scores; lengths of intensive care unit and hospital stays; and hospital mortality were assessed. Among 173 patients, 37 (21.4%) were admitted to an intensive care unit, including 22 (59.5%) with acute respiratory failure. The leading cause of acute respiratory failure was pneumonia (n = 19, 86.4%). Patients with acute respiratory failure had significantly lower levels of albumin before intensive care unit admission (P = .003). In patients with acute respiratory failure, severe sepsis and septic shock were more frequently observed and tracheotomy was more frequently performed (P = .041). Acute respiratory failure developed in 59.5% of liver transplant recipients with late intensive care unit admission. The leading cause was pneumonia, with this group of patients having higher requirements for invasive mechanical ventilation and tracheotomy, longer stays in an intensive care unit, and higher mortality.

Effect of differences in tendon properties on functionality of the passive stay apparatus in horses

NARCIS (Netherlands)

Gussekloo, S.W.S.; Lankester, J.; Kersten, W.; Back, W.

2011-01-01

Objective—To determine the effect of differences in structural and mechanical tendon properties on functionality of the passive stay apparatus in horses. Sample—5 forelimbs each from nondwarf Friesians, dwarf Friesians, and ponies. Procedures—Harvested forelimbs were loaded to test the passive stay

Nationwide analysis of prolonged hospital stay and readmission after elective ventral hernia repair

DEFF Research Database (Denmark)

Helgstrand, Frederik; Rosenberg, Jacob; Kehlet, Henrik

2011-01-01

Early outcome after elective ventral hernia repair is unsatisfactory, but detailed analyses are lacking. The aim of this study was to describe the aetiology of prolonged hospital stay (LOS), readmission and death <30 days after elective ventral hernia repair.......Early outcome after elective ventral hernia repair is unsatisfactory, but detailed analyses are lacking. The aim of this study was to describe the aetiology of prolonged hospital stay (LOS), readmission and death

Modal analysis of cable-stayed UHPC bridge

Directory of Open Access Journals (Sweden)

Tej Petr

2017-01-01

Full Text Available This paper deals with the dynamic analysis of cable-stayed UHPC bridge over the Vltava river near town Melnik in Czech Republic, Europe. Bridge serves for pedestrians and cyclists. This work aims to familiarize the reader with dynamic calculations carried out and the results obtained, describing the dynamic properties of proposed bridge. The construction of bridge is designed as a cable-stayed structure with prestressed bridge deck consisting of prefabricated UHPC panels and reversed “V” shaped steel pylon with height of approximately 40 meters. The deck is anchored using 24 steel hangers in one row in a steel pylon - 17 ropes in the main span and 7 cables on the other side. Range of the main span is 99.18 meters and the secondary span is 31.9 m. Deck width is 4.5 meters with 3.0 meters passing space. The bridge is designed for the possibility of passage of vehicles weighting up to 3.5 tonnes. Deck panels are made of UHPC with reinforcement. At the edge of the bridge on the side of the shorter span the bridge deck is firmly connected with abutment and on the other deck it is stored using a pair of sliding bearings.

Editor's Choice - Prolonged ICU Length of Stay after AAA Repair: Analysis of Time Trends and Long-term Outcome.

Science.gov (United States)

Gavali, H; Mani, K; Tegler, G; Kawati, R; Covaciu, L; Wanhainen, A

2017-08-01

The aim of the study was to investigate the frequency and outcome of prolonged intensive care unit (ICU) length of stay (LOS) after abdominal aortic aneurysm (AAA) repair in the endovascular era. All patients operated on for AAA between 1999 and 2013 at Uppsala University hospital were identified. Data were retrieved from the Swedish Vascular registry, the Swedish Intensive Care registry, the National Population registry, and case records. Prolonged ICU LOS was defined as ≥ 48 h during the primary hospital stay. Patients surviving ≥ 48 h after AAA surgery were included in the analysis. A total of 725 patients were identified, of whom 707 (97.5%) survived ≥ 48 h; 563 (79.6%) underwent intact AAA repair and 144 (20.4%) ruptured AAA repair. A total of 548 patients (77.5%) required AAA repairs in 1999 to 7.3% in 2013 (p < .001) whereas the use of endovascular aortic repair (EVAR) increased from 6.9% in 1999 to 78.0% in 2013 (p < .001). The 30 day survival rate was 98.2% for those with < 48 h ICU stay versus 93.0% for 2-6 days versus 81.8% for ≥ 7 days (p < .001); the corresponding 90 day survival was 97.1% versus 86.1% versus 63.6% (p < .001) respectively. For patients surviving 90 days after repair, there was no difference in long-term survival between the groups. During the period of progressively increasing use of EVAR, a simultaneous significant reduction in frequency of prolonged ICU LOS occurred. Although prolonged ICU LOS was associated with a high short-term mortality, long-term outcome among those surviving the initial 90 days was less affected. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Halloween: Have Fun and Stay Safe and Healthy!

Centers for Disease Control (CDC) Podcasts

2010-10-25

Halloween is a fun time for kids, but it's no fun if you get sick or hurt. In this podcast for kids, the Kidtastics offer some simple ways to stay safe and healthy on Halloween.  Created: 10/25/2010 by CDC Office of Women’s Health.   Date Released: 10/25/2010.

Job stress and intent to stay at work among registered female nurses working in Thai hospitals.

Science.gov (United States)

Kaewboonchoo, Orawan; Yingyuad, Boonrord; Rawiworrakul, Tassanee; Jinayon, Adchara

2014-01-01

Job stress is one of the factors that increase the likelihood of turnover. Intent to leave work is one of the most accurate predictors of turnover. This cross-sectional study was created to evaluate the intent of nurses working at hospitals to continue working and to determine the relationship between job stress and intent to stay at work. The subjects were 514 female hospital nurses aged 21-58 years old, who had worked full time at the study hospitals for at least 1 year. Data were collected using a self-administered questionnaire, which included sections on demographic characteristics, the Thai version of the Job Content Questionnaire (JCQ), and intent to stay at work. Multiple regression analysis was used to identify factors related to intent to stay at work. The prevalences of high job strain and low intent to stay at work were 17.5 and 22.4%, respectively. The mean (SD) scores of the nurses for psychological job demand, decision latitude, workplace social support, and intent to stay at work were 33.5 (4.4), 70.7 (6.9), 23.8 (2.8), and 14.6 (2.9), respectively. Multiple regression analysis indicated that intent to stay at work was significantly correlated with only supervisor support among the nurses with high-strain jobs and with coworker support in nurses with active jobs. The findings suggest that different job types need different sources of social support in the workplace. Proactive steps by nurse managers to increase workplace social support might lead to an increase in intent to stay and reduce nursing turnover in hospitals and possibly other settings.

A mobility program for an inpatient acute care medical unit.

Science.gov (United States)

Wood, Winnie; Tschannen, Dana; Trotsky, Alyssa; Grunawalt, Julie; Adams, Danyell; Chang, Robert; Kendziora, Sandra; Diccion-MacDonald, Stephanie

2014-10-01

For many patients, hospitalization brings prolonged periods of bed rest, which are associated with such adverse health outcomes as increased length of stay, increased risk of falls, functional decline, and extended-care facility placement. Most studies of progressive or early mobility protocols designed to minimize these adverse effects have been geared toward specific patient populations and conducted by multidisciplinary teams in either ICUs or surgical units. Very few mobility programs have been developed for and implemented on acute care medical units. This evidence-based quality improvement project describes how a mobility program, devised for and put to use on a general medical unit in a large Midwestern academic health care system, improved patient outcomes.

Testing a theoretical model of clinical nurses' intent to stay.

Science.gov (United States)

Cowden, Tracy L; Cummings, Greta G

2015-01-01

Published theoretical models of nurses' intent to stay (ITS) report inconsistent outcomes, and not all hypothesized models have been adequately tested. Research has focused on cognitive rather than emotional determinants of nurses' ITS. The aim of this study was to empirically verify a complex theoretical model of nurses' ITS that includes both affective and cognitive determinants and to explore the influence of relational leadership on staff nurses' ITS. The study was a correlational, mixed-method, nonexperimental design. A subsample of the Quality Work Environment Study survey data 2009 (n = 415 nurses) was used to test our theoretical model of clinical nurses' ITS as a structural equation model. The model explained 63% of variance in ITS. Organizational commitment, empowerment, and desire to stay were the model concepts with the strongest effects on nurses' ITS. Leadership practices indirectly influenced ITS. How nurses evaluate and respond to their work environment is both an emotional and rational process. Health care organizations need to be cognizant of the influence that nurses' feelings and views of their work setting have on their intention decisions and integrate that knowledge into the development of retention strategies. Leadership practices play an important role in staff nurses' perceptions of the workplace. Identifying the mechanisms by which leadership influences staff nurses' intentions to stay presents additional focus areas for developing retention strategies.

Role of the nurse in the short stay immunotherapy Unit during the administration of intravenous anda subcutaneous gammaglobulin

Directory of Open Access Journals (Sweden)

Rosales Sánchez Isis

2014-07-01

Full Text Available With the increasing development of medical specialties, an urgent necessity of parallel specialties in the laboratories and nursing fields becomes evident. Immunology is the field of science responsible for the study of defense responses developed by an individual in the face of aggression by microorganisms or foreign particles as well as those coming from the internal environment such as neoplastic cells.1 Immunology is considered as a young discipline with an spectacular development that took place in the second half of 20th century. From then till date, there have been many important spectacular advances in the area leading to its consolidation as an independent science separate from microbiology. As part of the Immunology Service at the Instituto Nacional de Pediatria (INP, the Short-Stay Immunotherapy Unity (SSI was established. This unity has been fundamental in ensuring adequate treatment for patients with primary immunodeficiency and autoim- mune in the long term. We highlight the roles of the nursing staff of SSI in the area of drug preparation and patient care.

Patient outcomes for the chronically critically ill: special care unit versus intensive care unit.

Science.gov (United States)

Rudy, E B; Daly, B J; Douglas, S; Montenegro, H D; Song, R; Dyer, M A

1995-01-01

The purpose of this study was to compare the effects of a low-technology environment of care and a nurse case management case delivery system (special care unit, SCU) with the traditional high-technology environment (ICU) and primary nursing care delivery system on the patient outcomes of length of stay, mortality, readmission, complications, satisfaction, and cost. A sample of 220 chronically critically ill patients were randomly assigned to either the SCU (n = 145) or the ICU (n = 75). Few significant differences were found between the two groups in length of stay, mortality, or complications. However, the findings showed significant cost savings in the SCU group in the charges accrued during the study period and in the charges and costs to produce a survivor. The average total cost of delivering care was $5,000 less per patient in the SCU than in the traditional ICU. In addition, the cost to produce a survivor was $19,000 less in the SCU. Results from this 4-year clinical trial demonstrate that nurse case managers in a SCU setting can produce patient outcomes equal to or better than those in the traditional ICU care environment for long-term critically ill patients.

Anesthesiologists' practice patterns for treatment of postoperative nausea and vomiting in the ambulatory Post Anesthesia Care Unit

Directory of Open Access Journals (Sweden)

Claybon Louis

2006-06-01

Full Text Available Abstract Background When patients are asked what they find most anxiety provoking about having surgery, the top concerns almost always include postoperative nausea and vomiting (PONV. Only until recently have there been any published recommendations, mostly derived from expert opinion, as to which regimens to use once a patient develops PONV. The goal of this study was to assess the responses to a written survey to address the following questions: 1 If no prophylaxis is administered to an ambulatory patient, what agent do anesthesiologists use for treatment of PONV in the ambulatory Post-Anesthesia Care Unit (PACU?; 2 Do anesthesiologists use non-pharmacologic interventions for PONV treatment?; and 3 If a PONV prophylaxis agent is administered during the anesthetic, do anesthesiologists choose an antiemetic in a different class for treatment? Methods A questionnaire with five short hypothetical clinical vignettes was mailed to 300 randomly selected USA anesthesiologists. The types of pharmacological and nonpharmacological interventions for PONV treatment were analyzed. Results The questionnaire was completed by 106 anesthesiologists (38% response rate, who reported that on average 52% of their practice was ambulatory. If a patient develops PONV and received no prophylaxis, 67% (95% CI, 62% – 79% of anesthesiologists reported they would administer a 5-HT3-antagonist as first choice for treatment, with metoclopramide and dexamethasone being the next two most common choices. 65% (95% CI, 55% – 74% of anesthesiologists reported they would also use non-pharmacologic interventions to treat PONV in the PACU, with an IV fluid bolus or nasal cannula oxygen being the most common. When PONV prophylaxis was given during the anesthetic, the preferred PONV treatment choice changed. Whereas 3%–7% of anesthesiologists would repeat dose metoclopramide, dexamethasone, or droperidol, 26% (95% confidence intervals, 18% – 36% of practitioners would re

Editor's Choice-The organization of chest pain units: Position statement of the Acute Cardiovascular Care Association.

Science.gov (United States)

Claeys, Marc J; Ahrens, Ingo; Sinnaeve, Peter; Diletti, Roberto; Rossini, Roberta; Goldstein, Patrick; Czerwińska, Kasia; Bueno, Héctor; Lettino, Maddalena; Münzel, Thomas; Zeymer, Uwe

2017-04-01

Chest pain units are defined as organizational short stay units with specific management protocols designed to facilitate and optimize the diagnosis of patients presenting with chest pain in the emergency department. The present document is intended to standardize and facilitate the installation of chest pain units nearby to the emergency department or as an integral part of the emergency department. Recommendations on organizational structure, physical and technical requirements and on disease management are presented. More standardized installation and implementation of chest pain units will enhance the quality of chest pain units and improve the quality of care of our chest pain patients.

Postoperative nausea and vomiting: Validation of the Portuguese version of the Postoperative Nausea and Vomiting Intensity Score.

Science.gov (United States)

Dalila, Veiga; Pereira, Helder; Moreno, Carlos; Martinho, Clarisse; Santos, Cristina; Abelha, Fernando José

2013-01-01

The Postoperative Nausea and Vomiting (PONV) Intensity Scale was developed to define clinically important PONV. The aim of this study was to translate, retranslate and validate the PONV Intensity Scale for use in Portuguese Post Anesthetic Care Unit (PACU) settings. The PONV Intensity Scale was translated and back-translated in accordance with available guidelines. The research team conducted an observational and cohort prospective study in a PACU. One-hundred fifty-seven adult patients admiited after surgery over three weeks were evaluated for PONV. Measurements included nausea visual analogic scale (VAS) at 6 and 24 hours, postoperatively. We assessed reliability and observer disagreement using interclass correlation (ICC) and Information-Based Measure of Disagreement (IBMD). We compared VAS scores between patients with clinically significant (≥50) and not significant (<50) PONV. Thirty-nine patients (25%) had PONV at 6 hours and 54 (34%) had PONV at 24 hours. Thirty-six and 54 patients experienced nausea at 6 and 24 hours, respectively. Among patients with PONV, 6 patients (15%) and 9 patients (27%) had a clinically significant PONV intensity scale score at 6 and at 24 hours, respectively. The reliability was good both for PONV intensity scale score and for VAS and observer disagreement was slightly higher for VAS. The median nausea VAS scores were higher in patients with clinically significant PONV Intensity score. The PONV Intensity Scale appears to be an accurate and reliable assessment and monitoring instrument for PONV in the PACU settings. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

42 CFR 456.128 - Initial continued stay review date.

Science.gov (United States)

2010-10-01

... norms to assign the initial continued stay review date, the number of days between the individual's... and criteria required to be described under § 456.129; (2) The individual's condition; and (3) The individual's projected discharge date; (c)(1) The committee uses any available appropriate regional medical...

Factors influencing work productivity and intent to stay in nursing.

Science.gov (United States)

Letvak, Susan; Buck, Raymond

2008-01-01

The researchers document the individual and workplace characteristics associated with decreased work productivity and intent to stay in nursing for nurses employed in direct patient care in the hospital setting. Factors associated with decreased work productivity were age, total years worked as a RN, quality of care provided, job stress score, having had a job injury, and having a health problem. Nurse leaders must place additional efforts on changes needed to improve the hospital workplace environment to decrease job stress, improve RNs' ability to provide quality care, and to assure the health and safety of nurses. Reducing job stress and providing adequate staffing so quality of care can be provided will enhance job satisfaction which will also encourage RNs to stay at the bedside. Improved work environments may delay older RNs' retirement from the workforce.

Nurse characteristics, leadership, safety climate, emotional labour and intention to stay for nurses: a structural equation modelling approach.

Science.gov (United States)

Liang, Hui-Yu; Tang, Fu-In; Wang, Tze-Fang; Lin, Kai-Ching; Yu, Shu

2016-12-01

The aim of this study was to propose a theoretical model and apply it to examine the structural relationships among nurse characteristics, leadership characteristics, safety climate, emotional labour and intention to stay for hospital nurses. Global nursing shortages negatively affect the quality of care. The shortages can be reduced by retaining nurses. Few studies have independently examined the relationships among leadership, safety climate, emotional labour and nurses' intention to stay; more comprehensive theoretical foundations for examining nurses' intention to stay and its related factors are lacking. Cross-sectional. A purposive sample of 414 full-time nurses was recruited from two regional hospitals in Taiwan. A structured questionnaire was used to collect data from November 2013-June 2014. Structural equation modelling was employed to test the theoretical models of the relationships among the constructs. Our data supported the theoretical model. Intention to stay was positively correlated with age and the safety climate, whereas working hours per week and emotional labour were negatively correlated. The nursing position and transformational leadership indirectly affected intention to stay; this effect was mediated separately by emotional labour and the safety climate. Our data supported the model fit. Our findings provide practical implications for healthcare organizations and administrators to increase nurses' intent to stay. Strategies including a safer climate, appropriate working hours and lower emotional labour can directly increase nurses' intent to stay. Transformational leadership did not directly influence nurses' intention to stay; however, it reduced emotional labour, thereby increasing intention to stay. © 2016 John Wiley & Sons Ltd.

Factors Predicting Staying in School to Eat Lunch

Science.gov (United States)

Beaulieu, Dominique; Godin, Gaston

2011-01-01

Purpose: Easy access to fast-food restaurants in the immediate environment of a high school is such that a high proportion of students do not remain in school for lunch. Hence, the probability that they will eat a healthy meal is reduced. The aim of this study is to identify the behavioral determinants of "staying in school to eat lunch" among…

Waiving the three-day rule: admissions and length-of-stay at hospitals and skilled nursing facilities did not increase.

Science.gov (United States)

Grebla, Regina C; Keohane, Laura; Lee, Yoojin; Lipsitz, Lewis A; Rahman, Momotazur; Trivedi, Amal N

2015-08-01

The traditional Medicare program requires an enrollee to have a hospital stay of at least three consecutive calendar days to qualify for coverage of subsequent postacute care in a skilled nursing facility. This long-standing policy, implemented to discourage premature discharges from hospitals, might now be inappropriately lengthening hospital stays for patients who could be transferred sooner. To assess the implications of eliminating the three-day qualifying stay requirement, we compared hospital and postacute skilled nursing facility utilization among Medicare Advantage enrollees in matched plans that did or did not eliminate that requirement in 2006-10. Among hospitalized enrollees with a skilled nursing facility admission, the mean hospital length-of-stay declined from 6.9 days to 6.7 days for those no longer subject to the qualifying stay but increased from 6.1 to 6.6 days among those still subject to it, for a net decline of 0.7 day when the three-day stay requirement was eliminated. The elimination was not associated with more hospital or skilled nursing facility admissions or with longer lengths-of-stay in a skilled nursing facility. These findings suggest that eliminating the three-day stay requirement conferred savings on Medicare Advantage plans and that study of the requirement in traditional Medicare plans is warranted. Project HOPE—The People-to-People Health Foundation, Inc.