Delirium Reduction Strategies For The Critically Ill

Delirium, an acute and fluctuating disturbance of consciousness and cognition, is a common manifestation of acute brain dysfunction in critically ill patients. Patients with delirium have longer hospital stays and a lower 6-month survival rate than do patients without delirium. Preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after discharge. In a large acute care hospital, the cardiac intensive care staff became interested in mitigating their unit’s high delirium rate of ventilated patients. At baseline, many members of the healthcare team did not believe that delirium could be prevented and the predominant view was that critically ill patients were too ill to mobilize. An extensive literature review suggested that early mobilization was extremely beneficial in delirium reduction. As a result, the goal of this performance improvement project was to reduce the prevalence and severity of delirium through progressive mobilization. Several barriers to preventing delirium were identified through a root cause analysis. Using improvement measures of operational excellence, a number of countermeasures were established. Several positive outcomes of this project were realized to include the development of an early mobility pathway and a bedside mobility assessment tool. Next steps include a prospective study of the effect this KPI might have on decreasing duration of ventilation days as well as overall length of hospital stay

AVALIAÇÃO DA QUALIDADE SENSORIAL DE SUCO DE MARACUJÁ-AMARELO ( Passiflora edulis var. flavicarpa) SUBMETIDO À PASTEURIZAÇÃO E ARMAZENAMENTO

Usou-se a Análise Descritiva Quantitativa (ADQ) para avaliar as características sensoriais de suco de maracujá-amarelo ( Passiflora edulis var. flavicarpa), submetido a três binômios de pasteurização (85oC/27s, 80oC/41s, 75oC/60s) e armazenamento por 120 dias sob duas temperaturas (25 ± 5oC e 5 ± 1oC). As características sensoriais (homogeneidade da cor, cor laranja, aroma característico, aroma floral, aroma doce, sabor característico, sabor estranho, sabor oxidado, sabor cozido, gosto doce e gosto amargo) foram apresentadas por meio de perfis sensoriais, junto com a descrição dos atributos sensoriais e a definição de referências para treinamento dos julgadores. Não foram detectadas diferenças significativas para a maioria das características sensoriais entre as amostras, considerando apenas os binômios de tempo-temperatura de pasteurização. Durante o armazenamento, as amostras pasteurizadas a 85oC/ 27s apresentaram as menores alterações nas características sensoriais estudadas. A pasteurização a 75oC/60s mostrou-se prejudicial, principalmente para as características de cor, aroma doce, aroma característico, aroma floral e sabor característico. O armazenamento sob refrigeração apresentou melhor tendência para a manutenção das características de qualidade sensorial do suco de maracujá. SENSORY QUALITY OF YELLOW PASSION FRUIT JUICE (Passiflora edulis var. flavicarpa) UNDER PASTEURIZATION AND STORAGE Abstract Quantitative descriptive analysis (QDA) was used to evaluate the sensory characteristics of yellow passion fruit juice ( Passiflora edulis flavicarpa) submitted to three pasteurization binomial (85oC/27s, 80oC/41s, 75oC/60s) and stored for 120 days under two different temperatures (25±5oC e 5±1oC). The sensory characteristics (color homogeneity, orange color, typical aroma, floral aroma, sweet aroma, typical flavor, off flavor, oxidized flavor, cooked flavor and sweet and bitter tastes) are presented by sensory profiles with the description of sensory attributes and reference definitions to train the judges. The results show that the pasteurization had different effects on the juice sensory attributes. However, it was not found significant differences for most of the sensory characteristics when the different time-temperature binomial of the juice pasteurization were compared. During the storage, the passion fruit juice pasteurized at 85oC/27s presented the lowest changes on the sensory attributes. The pasteurization at 75oC/60s was harmful mainly to the color characteristics, sweet aroma, characteristic aroma, floral aroma and typical flavor. Storage under refrigeration tended to keep the best juice quality characteristics

Análise da eficiência do atendimento do sistema único de saúde nos municípios paranaenses

According to the facts, the Brazilian public health has intriguing challenges to the management of resources destined to Brazilian public health, it´s one of the most crisis of history, which comes from main factors: increased demand and lack of effectiveness and management. In this scenario, this research aims analyze the level of effectiveness of the Brazilian Unified Health System Service (SUS) in the Paraná municipalities (Brazil) in 2015. The study comprises 244 Paraná municipalities. The techniques used to measure efficiency were Data Envelopment Analysis (DEA) and Free Disposal Hull (FDH). The use of two techniques of analysis can be better assist in the planning and in the management decisions for the allocation of resources. The results indicate that there are significant differences in the level of efficiency of Paraná municipalities, by both techniques.O atual cenário da economia brasileira tem colocado grandes desafios a gestão dos recursos destinados a saúde pública brasileira, sendo essa uma das maiores crises da sua história, alguns dos fatores que influenciam tal fato são: aumento da demanda e ausência de efetividade e gestão. Nesse sentido, o presente estudo tem como objetivo analisar o nível de eficiência do atendimento do Sistema Único de Saúde (SUS) nos municípios paranaenses (Brasil) referente ao ano de 2015. As técnicas utilizadas para mensurar a eficiência foram Data Envelopment Analysis (DEA) e Free Disposal Hull (FDH). A utilização de duas técnicas de análise pode melhor auxiliar no planejamento e na tomada de decisões gerenciais para a alocação de recursos. Os resultados indicam que ocorrem diferenças significativas no nível de eficiência dos municípios paranaenses, por ambas as técnicas.El actual escenario de la economía brasileña hay grandes desafíos a la gestión de los recursos destinados a la salud pública brasileña, siendo esa una de las mayores crisis de su historia, algunos de los factores que influencian tal situación son: aumento de la demanda y ausencia de efectividad y gestión. En este sentido, el presente estudio tiene como objetivo analizar el nivel de eficiencia de lo servicio del Sistema Único de Salud (SUS) en los municipios paranaenses (Brasil) referente al año 2015. Las técnicas utilizadas para medir la eficiencia fueron Data Envelopment Analysis (DEA) y Free Disposal Hull (FDH). La utilización de dos técnicas de análisis puede ayudarle mejor en la planificación y la toma de decisiones gerenciales para la asignación de recursos. Los resultados indican que ocurren diferencias significativas en el nivel de eficiencia de los municipios paranaenses, por ambas técnicas

Validation of the Ask Suicide-Screening Questions for Adult Medical Inpatients: A Brief Tool for All Ages

BACKGROUND: Few brief suicide risk screening instruments are validated for use in both adult and pediatric medical populations. Using the pediatric Ask Suicide-Screening Questions (ASQ) development study as a model, this study aimed to determine whether the ASQ is a valid suicide risk-screening instrument for use among adults medical patients, as well as to evaluate a set of other potential screening questions for use in adults. METHODS: Adult patients hospitalized on inpatient medical/surgical units from 4 hospitals were recruited to participate in a cross-sectional instrument-validation study. The 4-item ASQ and other candidate items were compared against the 25-item, previously validated Adult Suicidal Ideation Questionnaire as the criterion standard. RESULTS: A total of 727 adult medical inpatients completed the screening process. Compared with the Adult Suicidal Ideation Questionnaire, the ASQ performed best among the full set of candidate items, demonstrating strong psychometric properties, with a sensitivity of 100% (95% confidence interval = 90%-100%), a specificity of 89% (95% confidence interval = 86%-91%), and a negative predictive value of 100% (95% confidence interval = 99%-100%). A total of 4.8% (35/727) of the participants screened positive for suicide risk based on the standard criterion Adult Suicidal Ideation Questionnaire. CONCLUSIONS: The ASQ is a valid and brief suicide risk-screening tool for use among adults. Screening medical/surgical inpatients for suicide risk can be performed effectively for both adult and pediatric patients using this brief, primary screener

Principles of Safety Pharmacology

Safety Pharmacology is a rapidly developing discipline that uses the basic principles of pharmacology in a regulatory-driven process to generate data to inform risk/benefit assessment. The aim of Safety Pharmacology is to characterize the pharmacodynamic/pharmacokinetic (PK/PD) relationship of a drug's adverse effects using continuously evolving methodology. Unlike toxicology, Safety Pharmacology includes within its remit a regulatory requirement to predict the risk of rare lethal events. This gives Safety Pharmacology its unique character. The key issues for Safety Pharmacology are detection of an adverse effect liability, projection of the data into safety margin calculation and finally clinical safety monitoring. This article sets out to explain the drivers for Safety Pharmacology so that the wider pharmacology community is better placed to understand the discipline. It concludes with a summary of principles that may help inform future resolution of unmet needs (especially establishing model validation for accurate risk assessment). Subsequent articles in this issue of the journal address specific aspects of Safety Pharmacology to explore the issues of model choice, the burden of proof and to highlight areas of intensive activity (such as testing for drug-induced rare event liability, and the challenge of testing the safety of so-called biologics (antibodies, gene therapy and so on.)