Comparación entre la gravedad del paciente y la carga de trabajo de la enfermería antes y después de la ocurrencia de eventos adversos en ancianos con cuidados críticos

Indexación: Scopus.Objective: to compare the patient severity and the nursing workload before and after the occurrence of moderate and severe adverse events in elderly hospitalized at intensive care units. Method: comparative study developed at nine intensive therapy units of a University Hospital in São Paulo. The events were collected from the patient histories and classified as moderate and severe according to the World Health Organization. For the severity analysis, the Simplified Acute Physiologic Score II was used and, for the workload analysis, the Nursing Activities Score was applied 24 hours before and after the moderate and severe event. The t-test with 5% significance was used to compare the mean clinical severity and workload scores before and after the event. Results: the sample consisted of 315 elderly, 94 (29.8%) of whom were victims of moderate and severe events at the units. Among the 94 events, the clinical process and procedure type was predominant (40.0%). The installation and maintenance of therapeutic artifacts and catheters were the prevalent interventions that resulted in moderate (76.5%) physiopathological damage (66.0%). The mean workload score (75.19%) dropped 24 hours after the occurrence of the event (71.97%, p=0.008), and the severity, represented by the probability of death, increased from 22.0% to 29.0% after the event (p=0.045). Conclusion: in the patient safety context, the identification of the changes in clinical conditions and the nursing workload in elderly victims of events supports the prevention of these occurrences. © 2018, Universidade Federal de Santa Catarina. All rights reserved.Objetivo: comparar a gravidade do paciente e a carga de trabalho de enfermagem antes e após a ocorrência de evento adverso moderado e grave em idosos internados em unidades de terapia intensiva. Método: estudo comparativo, realizado em nove unidades de terapia intensiva de um Hospital Universitário de São Paulo. Os eventos foram coletados dos prontuários dos pacientes e classificados em moderados e graves segundo a Organização Mundial de Saúde. A análise da gravidade foi realizada segundo o Symplified Acute Phsiologic Score II e a carga de trabalho segundo o Nursing Activities Score, 24 horas antes e depois do evento moderado e grave. O teste t, com significância de 5%, foi utilizado para a comparação das médias da gravidade clínica e da carga de trabalho, antes e após o evento. Resultados: a amostra foi composta por 315 idosos, sendo que 94 (29,8%) sofreram eventos moderados e graves nas unidades. Dos 94 eventos, predominou o tipo processo clínico e procedimento (40,0%). A instalação e manutenção de artefatos terapêuticos e cateteres foram as intervenções prevalentes que resultaram em danos fisiopatológicos (66,0%), de grau moderado (76,5%). A média de pontuação da carga de trabalho (75,19%) diminuiu 24 horas após a ocorrência do evento (71,97%, p=0,008) e, a gravidade, representada pela probabilidade de morte, aumentou de 22,0% para 29,0% depois do evento (p=0,045). Conclusão: no contexto da segurança do paciente, a identificação das alterações nas condições clínicas e na carga de trabalho de enfermagem em idosos que sofrem eventos subsidiam a prevenção dessas ocorrências.Objetivo: comparar la gravedad del paciente y la carga de trabajo en enfermería antes y después de ocurrir un evento adverso moderado y grave en ancianos internados en unidades de terapia intensiva. Método: estudio comparativo realizado en nueve unidades de terapia intensiva de un Hospital Universitario de São Paulo. Los eventos fueron obtenidos a través de los prontuarios de los pacientes y clasificados en moderados y graves según la Organización Mundial de la Salud. El análisis sobre la gravedad fue realizado de acuerdo al Symplified Acute Physiologic Score II y la carga de trabajo se hizo conforme al Nursing Activities Score, 24 horas antes y después del evento moderado y grave. El test t, con una significancia del 5%, fue utilizado para la comparación de los promedios de la gravedad clínica y de la carga de trabajo antes y después del evento. Resultados: la muestra incluyó 315 ancianos, siendo que 94 (29,8%) sufrieron eventos moderados y graves en las unidades. De los 94 eventos, predominó el tipo de proceso clínico y el procedimiento (40,0%). La instalación y mantenimiento de artefactos terapéuticos y catéteres fueron las intervenciones prevalentes que resultaron en daños fisiopatológicos (66,0%) y de grado moderado (76,5%). El promedio de puntuación de la carga de trabajo (75,19%) disminuyó 24 horas después de ocurrido el evento (71,97%, p=0,008) y la gravedad, representada por la probabilidad de muerte, aumentó de 22,0% para 29,0% después del evento (p=0,045). Conclusion: en el contexto de seguridad del paciente, la identificación de las alteraciones en las condiciones clínicas y en la carga de trabajo de enfermería en los ancianos que sufren eventos subsidia la prevención de tales ocurrencias.http://ref.scielo.org/wcg6x

General model for delayed feedback and its application to transimpedance amplifier's bandwidth optimization

Delays in real systems can be of two types: i) intrinsic delays - due to the physical principles of operation of each electronic device; ii) designed delays - due to extra circuits used to add the desired delay. Previous work established the possibility of achieving bandwidth improvements using small delays inside the feedback loop of feedback amplifiers. The modeling approach followed on these contributions used only one designed delay element. The bandwidth reduction effect due to intrinsic delays was not considered on these contributions. This paper extends the concept to the general case of feedback amplifiers that incorporates delays of both types. An experimental demonstration using a simple 0.35μm BiCMOS transimpedance amplifier further confirms the proposed model. © 2006 IEEE

Anti-Inflammatory Effect of Dexamethasone Controlled Released From Anterior Suprachoroidal Polyurethane Implants on Endotoxin-Induced Uveitis in Rats.

Targeted drug delivery to the ocular tissues remains a challenge. Biodegradable intraocular implants allow prolonged controlled release of drugs directly into the eye. In this study, we evaluated an anterior suprachoroidal polyurethane implant containing dexamethasone polyurethane dispersions (DX-PUD) as a drug delivery system in the rat model of endotoxin-induced uveitis (EIU). In vitro drug release was studied using PUD implants containing 8%, 20%, and 30% (wt/wt) DX. Cytotoxicity of the degradation products of DX-PUD was assessed on human ARPE-19 cells using 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide (MTT) test. Short-term ocular biocompatibility of suprachoroidal DX-PUD implants was evaluated in normal rat eyes. Endotoxin-induced uveitis was then induced in rat eyes preimplanted with DX-PUD. Clinical examination was performed at 24 hours; eyes were used to assess inflammatory cell infiltration and macrophage/microglial activation. Cytokine and chemokine expression in the iris/ciliary body and in the retina was investigated using quantitative PCR. Feasibility of anterior suprachoroidal PUD implantation was also tested using postmortem human eyes. A burst release was followed by a sustained controlled release of DX from PUD implants. By-products of the DX-PUD were not toxic to human ARPE-19 cells or to rat ocular tissues. Dexamethasone-PUD implants prevented EIU in rat eyes, reducing inflammatory cell infiltration and inhibiting macrophage/microglial activation. Dexamethasone-PUD downregulated proinflammatory cytokines/chemokines (IL-1β, IL-6, cytokine-induced neutrophil chemoattractant [CINC]) and inducible nitric oxide synthase (iNOS) and upregulated IL-10 anti-inflammatory cytokine. Polyurethane dispersion was successfully implanted into postmortem human eyes. Dexamethasone-PUD implanted in the anterior suprachoroidal space may be of interest in the treatment of intraocular inflammation