Fatores de risco para quedas em pacientes adultos hospitalizados: um estudo caso-controle

Objective: to identify risk factors for falls in hospitalized adult patients. Methods: a matched case-control study (one control for each case). A quantitative study conducted in clinical and surgical units of a teaching hospital in Southern Brazil. The sample comprised 358 patients. Data were collected over 18 months between 2013-2014. Data analysis was performed with descriptive statistics and conditional logistic regression using Microsoft Excel and SPSS version 18.0. Results: risk factors identified were: disorientation/confusion [OR 4.25 (1.99 to 9.08), p<0.001]; frequent urination [OR 4.50 (1.86 to 10.87), p=0.001]; walking limitation [OR 4.34 (2.05 to 9.14), p<0.001]; absence of caregiver [OR 0.37 (0.22 to 0.63), p<0.001]; postoperative period [OR 0.50 (0.26 to 0.94), p=0.03]; and number of medications administered within 72 hours prior the fall [OR 1.20 (1.04 to 1.39) p=0.01]. Conclusion: risk for falls is multifactorial. However, understanding these factors provides support to clinical decision-making and positively influences patient safety.Objetivo: identificar los factores de riesgo para la ocurrencia de caídas en pacientes adultos hospitalizados. Métodos: un estudio caso-control emparejado (un control para cada caso). Investigación cuantitativa llevada a cabo en unidades clínicas y quirúrgicas de un hospital universitario en el Sur de Brasil. La muestra constó de 358 pacientes. Se recopilaron datos durante 18 meses, entre 2013-2014. El análisis de los datos se realizó mediante estadística descriptiva y regresión logística condicional, utilizando el Microsoft Excel y el SPSS versión 18.0. Resultados: los factores de riesgo identificados fueron: desorientación/confusión [OR 4,25 (1,99 a 9,08), p<0,001]; micción frecuente [OR 4,50 (1,86 a 10,87), p=0,001]; limitación para caminar [OR 4,34 (2,05 a 9,14), p<0,001]; ausencia de cuidadores [OR 0,37 (0,22 a 0,63), p<0,001]; período postoperatorio [OR 0,50 (0,26 a 0,94), p=0,03]; y número de medicamentos administrados dentro de las 72 horas previas a la caída [OR 1,20 (1,04 a 1,39) p=0,01]. Conclusión: los riesgos de caídas son multifactoriales. Sin embargo, la comprensión de estos factores respalda la toma de decisiones clínicas y tiene un impacto positivo en la seguridad del paciente.Objetivo: identificar os fatores de risco para a ocorrência de quedas em pacientes adultos hospitalizados. Métodos: estudo do tipo caso-controle pareado (um controle para cada caso). Pesquisa quantitativa realizada em unidades clínicas e cirúrgicas de um hospital universitário da região Sul do Brasil. A amostra incluiu 358 pacientes. Os dados foram coletados durante 18 meses, entre 2013-2014. A análise dos dados foi realizada por meio de estatística descritiva e regressão logística condicional, utilizando o Microsoft Excel e o SPSS versão 18.0. Resultados: os fatores de risco identificados foram: desorientação/confusão [OR 4,25 (1,99 a 9,08), p<0,001]; micção frequente [OR 4,50 (1,86 a 10,87), p=0,001]; limitação para caminhar [OR 4,34 (2,05 a 9,14), p<0,001]; ausência de cuidador [OR 0,37 (0,22 a 0,63), p<0,001]; período pós-operatório [OR 0,50 (0,26 a 0,94), p=0,03]; e o número de medicamentos administrados nas 72 horas anteriores à queda [OR 1,20 (1,04 a 1,39) p=0,01]. Conclusão: os riscos para quedas são multifatoriais. Todavia, conhecê-los dá suporte à decisão clínica do enfermeiro, o que contribui para a busca das melhores intervenções preventivas e impacta positivamente na segurança dos pacientes

Adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colon cancer at high risk of peritoneal carcinomatosis; the COLOPEC randomized multicentre trial

Background: The peritoneum is the second most common site of recurrence in colorectal cancer. Early detection of peritoneal carcinomatosis (PC) by imaging is difficult. Patients eventually presenting with clinically apparent PC have a poor prognosis. Median survival is only about five months if untreated and the benefit of palliative systemic chemotherapy is limited. Only a quarter of patients are eligible for curative treatment, consisting of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CR/HIPEC). However, the effectiveness depends highly on the extent of disease and the treatment is associated with a considerable complication rate. These clinical problems underline the need for effective adjuvant therapy in high-risk patients to minimize the risk of outgrowth of peritoneal micro metastases. Adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) seems to be suitable for this purpose. Without the need for cytoreductive surgery, adjuvant HIPEC can be performed with a low complication rate and short hospital stay. Methods/Design: The aim of this study is to determine the effectiveness of adjuvant HIPEC in preventing the development of PC in patients with colon cancer at high risk of peritoneal recurrence. This study will be performed in the nine Dutch HIPEC centres, starting in April 2015. Eligible for inclusion are patients who underwent curative resection for T4 or intra-abdominally perforated cM0 stage colon cancer. After resection of the primary tumour, 176 patients will be randomized to adjuvant HIPEC followed by routine adjuvant systemic chemotherapy in the experimental arm, or to systemic chemotherapy only in the control arm. Adjuvant HIPEC will be performed simultaneously or shortly after the primary resection. Oxaliplatin will be used as chemotherapeutic agent, for 30 min at 42-43 degrees C. Just before HIPEC, 5-fluorouracil and leucovorin will be administered intravenously. Primary endpoint is peritoneal disease-free survival at 18 months. Diagnostic laparoscopy will be performed routinely after 18 months postoperatively in both arms of the study in patients without evidence of disease based on routine follow-up using CT imaging and CEA. Discussion: Adjuvant HIPEC is assumed to reduce the expected 25 % absolute risk of PC in patients with T4 or perforated colon cancer to a risk of 10 %. This reduction is likely to translate into a prolonged overall survival

Put down six and carry two, gee! But this is hard to do [first line of chorus]

Performance Medium: Piano, Voice and Chord

Cyclic Fatigue Durability of Woven Geotextiles for Use in Sustainable Waste-Dewatering Systems

Geosynthetics are increasingly used in geotechnical engineering to replace conventional solutions due to their cost-effective and environmental benefits. For example, geotextiles can be used in sustainable waste-dewatering systems to confine solid waste for final disposal. This study is presented to analyze the durability of a geotextile regarding cyclic fatigue induced during the pumping stages in these sustainable waste-dewatering systems. A polypropylene woven geotextile was used and subjected to cyclic tensile loading levels of 10%, 30% and 50% of the ultimate average tensile strength. We also used hysteresis loops with a frequency of 0.1 Hz at different numbers of cycles (10, 20, 30, and 90 cycles). With a 95% confidence level and response surface, the results show that increasing the tensile loading levels and the number of cycles made the geotextile lose its tensile strength. Laboratory experiments simulated scenarios where the geotextile was subjected to cyclic fatigue that might directly impact its strength–strain and hysteretic stiffness performance over its design lifetime. This study contributes to a better understanding of the durability of geotextiles to subsidize decision-making involving social, environmental, and technical impacts in waste-dewatering system applications

Ultrafast carrier dynamics and THz conductivity in epitaxial-grown LT-GaAs on silicon for development of THz photoconductive antenna detectors

Carrier dynamics and photoconductivity in epitaxial-grown low-temperature GaAs on nominal and vicinal Si(1 0 0) substrates (\u27LT-GaAs/Si\u27) were studied to predict their actual performance as THz photoconductive antenna (PCA) detectors. An optical-pump terahertz-probe technique was used to obtain the transmittance, carrier lifetime and photoconductivity of two LT-GaAs/Si samples, grown using different substrates and different growth protocols. The LT-GaAs grown on Si(1 0 0) substrate with a 4° tilt to 1 1 0 has better crystallinity, in agreement with other reports; while the LT-GaAs layer grown on nominal Si(1 0 0) substrate, though more structurally defective, has a much faster electron trapping time. Fabricated test PCAs with either dipole or bowtie geometries confirm the characterization results. The photoconductivity and carrier lifetime results manifest in the PCA performance, in responsivity, and in detection bandwidth. The prototypes\u27 sensitivities, bandwidths and dynamic ranges show that with some growth optimization, LT-GaAs/Si can be tailored to create economical, broadband THz detectors. © 2019 IOP Publishing Ltd

Detection performance of LT-GaAs-on-silicon bowtie photoconductive antenna prototype

Bowtie photoconductive antennas (PCAs) with a 10-μm gap were fabricated on epitaxial grown LT-GaAs layers on Silicon substrates (LT-GaAs-on-Si). The samples used were grown with distinct growth parameters. The performance of the PCAs as terahertz detectors are presented in this report. © 2019 IEEE