Pressure-flow breath representation eases asynchrony identification in mechanically ventilated patients

Breathing asynchronies are mismatches between the requests of mechanically ventilated subjects and the support provided by mechanical ventilators. The most widespread technique in identifying these pathological conditions is the visual analysis of the intra-tracheal pressure and flow time-trends. This work considers a recently introduced pressure-flow representation technique and investigates whether it can help nurses in the early detection of anomalies that can represent asynchronies. Twenty subjects—ten Intensive Care Unit (ICU) nurses and ten persons inexperienced in medical practice—were asked to find asynchronies in 200 breaths pre-labeled by three experts. The new representation increases significantly the detection capability of the subjects—average sensitivity soared from 0.622 to 0.905—while decreasing the classification time—from 1107.0 to 567.1 s on average—at the price of a not statistically significant rise in the number of wrong identifications—specificity average descended from 0.589 to 0.52. Moreover, the differences in experience between the nurse group and the inexperienced group do not affect the sensitivity, specificity, or classification times. The pressure-flow diagram significantly increases sensitivity and decreases the response time of early asynchrony detection performed by nurses. Moreover, the data suggest that operator experience does not affect the identification results. This outcome leads us to believe that, in emergency contexts with a shortage of nurses, intensive care nurses can be supplemented, for the sole identification of possible respiratory asynchronies, by inexperienced staff

Surgical site infection after caesarean section. Space for post-discharge surveillance improvements and reliable comparisons

Surgical site infections (SSI) after caesarean section (CS) represent a substantial health system concern. Surveying SSI has been associated with a reduction in SSI incidence. We report the findings of three (2008, 2011 and 2013) regional active SSI surveillances after CS in community hospital of the Latium region determining the incidence of SSI. Each CS was surveyed for SSI occurrence by trained staff up to 30 post-operative days, and association of SSI with relevant characteristics was assessed using binomial logistic regression. A total of 3,685 CS were included in the study. A complete 30 day post-operation follow-up was achieved in over 94% of procedures. Overall 145 SSI were observed (3.9% cumulative incidence) of which 131 (90.3%) were superficial and 14 (9.7%) complex (deep or organ/space) SSI; overall 129 SSI (of which 89.9% superficial) were diagnosed post-discharge. Only higher NNIS score was significantly associated with SSI occurrence in the regression analysis. Our work provides the first regional data on CS-associated SSI incidence, highlighting the need for a post-discharge surveillance which should assure 30 days post-operation to not miss data on complex SSI, as well as being less labour intensive

Theretical and experimental characterisation of stearic acid based sustained release devices obtained by hot melt co-extrusion

This study was conducted to develop and characterize a hot melt co-extruded cylindrical system for controlled drug delivery. Different lengths and configurations (homogeneous, hollow and heterogeneous) co-extrudates were considered. Stearic acid and polyethylene glycol were used as hydrophobic and hydrophilic components, respectively. Acetaminophen and theophylline were used as model drug. Release kinetics were studied on the basis of in vitro tests and experimental data were analyzed by a new mathematical model accounting for drug dissolution and diffusion inside the cylindrical matrix. Surface tension measurements were carried on the two model drugs and the hydrophobic matrix. Experimental results showed that co-extruded length and configuration sensibly affect release kinetics of both drugs. Additionally, the proposed mathematical model proved to be reliable and yielded an explanation for the lower acetaminophen release rate with respect to that of theophylline. This behavior could be explained by the formation of a low permeable layer surrounding the acetaminophen-loaded systems. In addition, surface property analysis evidenced the higher hydrophobic nature of acetaminophen-loaded systems with respect to theophylline systems