When used properly, blood product transfusion can be lifesaving [12,13]. In addition, there is no doubt that anemia poses a risk to patient survival; however, in their current storage form, blood component transfusion does not alleviate this risk and carries its own significant inher- ent risks [12,13]. We have demonstrated that even in a SICU that does not operate under a fully ‘closed’ model in regards to patient orders, a restrictive protocol for PRBC and FFP trans- fusion can be implemented and successfully decrease overall blood product utilization. This oc- curred without an increase in morbidity or mortality, even inthe setting of having a larger patient census and higher risk patients, as suggested by slightly increased ages and mean APACHE II scores. Both ofthe aforementioned co-factors are independently associated with worse outcomes in hospitalized populations [14,15]. Although a direct correlation cannot be made by our study, there was a significantly decreased rate of urinary tract infections associated with theimplementationof this restrictive transfusion policy. In addition, at a minimal cost for implementing theprotocol, we estimate we could have saved more than $130,000 per year.
The criterion for transfusionofredblood cells (RBC) was concentrated hemoglobin (Hb) below 8 g/dl or 9 g/dl when there was hemodynamic instability. The number of units ofplasma, platelets and cryoprecipitate used were not assessed because it is not the aim ofthe study. A blood count was ob- tained before surgery, on arrival ofthe patient to theintensivecareunit (ICU), and 24 hours after the day of discharge. Thepackedcell volume (PCV) and Hb were tabulated, as well as the volume ofblood aspirated by HR, the volume ofblood infused, the number of RBC transfused, the type ofsurgical procedure and CPB time.
Spiess et al. have analyzed transfusion therapy data before and after TEG being included as routine for cardiac surgery in their institution. A total of 1079 patients were studied, 591 of whom after TEG implementation. No bloodtransfusion proto- col had been proposed andtransfusion decisions depended on the anesthetic andsurgical teams inthe OR, and on inten- sive care team inthe postoperative period. There has been significant decrease inthe use ofpackedred cells, platelets andfresh-frozenplasma after TEG implementation. Cryoprecipitate use was decreased however with p = 0.091 (non significant) between groups. Investigators have re- ported that the most impressive result was the decrease insurgical re-exploration due to increased bleeding, possibly attributed to high TEG negative predictive values. The study has also evaluated TEG-related costs: a relatively cheap monitor performing coagulation analysis 50% cheaper as compared to coagulation lab tests, in addition to generating costs savings with blood products and surgi- cal re-exploration 26 .
Regarding the perception of stressors separately among ICUs, the results revealed that ofthe ten main stressors mentioned, six were equivalent inthe two groups evaluated. Such similarities between the groups may be partially justiied by the fact that the bed distribution andthe operational setting were similar between both ICUs because all rooms had one or two beds, equipped with the same furniture, beds and pillows, in addition to clocks and individual lamps. Moreover, the main stressors identiied in this study only partially reinforce data found inthe literature, which names “being in pain”, “not being able to sleep”, “not being in control of yourself ”, “having tubes in your nose or mouth” and “being restricted by tubes/lines” as the most stressful factors. (2,11)
)n the context ofthe cohesion policy, solidarity must represent a support for development . For that purpose, solidarity can be seen as a help for self‐help and its success depends a great deal on the capacity andthe training ofthe people to whom the support of making maximum profit out of these addresses to. This support does not mean exclusively financial support, although it is necessary and important but, of all things, it means an exchange of experiences and cooperation, the development of capacity through training, open discussions with the interested factors and last but not least a critic, but a constructive dialogue between the various levels of government: European, national, regional, local. )n other words, a functional labor market should represent a catalyst for the general objective ofthe European Union – social and economical cohesion – because it has in view the connections with the different markets ofthe services andofthe goods and generates the necessary income for supporting the participation ofthe individuals, bringing them together, placing them in collaborations. )n this context, the starting points for promoting the inclusion through the activities of social economy have in view: adapting the institutional environment, developing the public‐private partnership, developing the social dialogue between players, investments inthe human capital and supporting the exchange of good practices within the European Union.
material for the present study. The animals were maintained in an extensive system on grazing areas of Capim Colonião (Panicum maximum Jacq. var. maximum). Tanzania (Panicum maximum to var. Tanzânia), with daily supplementation of grain, mineralized salt and water ad libitum. Among the mares studied, 89 were ofthe BH breed (14 non pregnant + 75 pregnant) and 86 were ofthe Breton breed (11 non pregnant + 75 pregnant). All mares were clinically healthy, and they were handled carefully to reduce any possible effects of stress on the parameters analyzed. The animals ofthe two breeds, Brasileiro de Hipismo and Breton, were distributed in accordance with the different physiological conditions and whether or not pregnant, into four different groups for the three gestation periods and a control. The first period was considered to be 25-110 days of gestation, the second 111-210 days andthe third 211-340 days. The BH groups included a control group of non pregnant mares (n=14) to which just one sample were collected during the experiment, group 1 for mares inthe first period (n=25); group 2 for mares inthe second period (n=25) and group 3 for mares inthe third period (n=25). The Breton groups included a control group of non pregnant mares (n=11) to which just one sample were collected during the experiment, group 1 for mares inthe first period (n=25), group 2 for mares inthe second period (n=25) and group 3 for mares inthe third period (n=25).
requirement will apply to every sort of article submitted to the Journal , including original research, reviews, editorials, letters to the editor, and any others, and should be disclosed at the time of submission. The simplest remedy for con ict of interest is disclosure. Inthe Journal , disclosure will henceforth be achieved by the inclusion of a short footnote with each published article. This information will be held in con dence while the paper is under review. It will not be shared with peer reviewers, and it will not in uence the editorial decision to accept or reject the manuscript. When an article is accepted for publication, the editors will usually discuss with the authors the manner in which such information is to be presented.
Ostriches’ erythrocytic parameters help on the diagnosis of specific pathologies and serve as basic knowledge for studies in comparative avian pathology. To obtain reference values of erythrocyte indices for ostriches (Struthio camelus) raised in a commercial system in Brazil and verify if there are differences between gender and age groups, 240 healthy from both sexes animals were bled. Heparinized blood samples were analyzed using standard techniques to determine theredbloodcell (RBC) count, hemoglobin concentration, packedcell volume (PCV), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) values, besides theredcell morphometry analysis using a computer software that calculates the greater andthe smaller diameters ofthe erythrocytes. Prior to data analysis, ostriches were divided into three different age groups: from four to 13 months, from 13 to 23 months and from 23 to 30 months the. Younger ostriches presented lower erythrocyte indices than the older ones. The age group effect was only significant in females for the erythrocyte, hemoglobin, MCV, MCH, and MCHC variables. The female ostriches presented PCV, MCV, MCH, and MCHC values significantly higher than males in some age groups. It was observed that the erythrocytes ofthe female ostriches are more elongated and larger than males. It was concluded that erythrocytic parameters of ostriches in São José do Rio Preto-SP, Brazil are influenced by gender and age, highlighting the importance of consider besides these factors also the geoclimatic conditions to an adequate interpretation ofthe erythrogram. Keywords: Avian influenza. Depopulation. Foam. Mechanical hypoxia. Poultry.
The specimen used in this test was platelet poor plasma (with citrate), this sample was extracted from healthy subjects who underwent routine physical examination at the health center of Guadalupe Nuevo. Immediately after blood collection, theblood was centrifuged at 3000 rpm for 30 minutes to obtain the platelet poor plasma. The samples containing crude extracts and calcium chloride were each pre-warmed to a temperature of 37 degree centigrade for 5 to 10 minutes to ensure that there is no contamination that may cause coagulation. Six test tubes were prepared; the first 3 were used as control andthe remaining 3 test tubes as tests. For the control tubes, 1000 uL ofplasma was transferred into 1 ofthe 3 tubes first to ensure close observation and added with 1000 uL of 0.025 M calcium chloride. The timing started here using a stopwatch while the tube was gently mixed. The tube was allowed to stay inthe water bath for 90 seconds while gently tilting it every 30 seconds. After 90 seconds, the tube was removed from the water bath and gently tilted at a rate of once per second. The stopwatch was stopped as soon as the clot formed. The procedure was repeated to the 2 remaining control tubes one at a time. The procedure was then repeated using the last 3 tubes and instead of using 0.025 M calcium chloride, the E. hirta, T. procumbens, and V. cinerea crude extracts were each utilized on their respective tubes with the same amount ofplasma as the controls.
transfusion rate probably adopts strict controls against blood spoliation, restrictive guidelines for RBC transfusions, control of causes of morbidity such as sepsis, intraventricular hemor- rhage and restricts, as far as possible, the use of mechanical ventilation 3 in compliance with good clinical practices.
We point to the following limitations of this study: it was an observational investigation in which unknown variables could have influenced final results; the retrospective design of this study is vulnerable to a lot of bias; some data were lacking (e.g. intra-operative and/or postoperative blood loss), making the results less accurate; the sample size is relatively small, which explains some variables found to be important predictors in larger studies (e.g. age, gender) were found not to be related to transfusionin this study; our institution does not have clinical protocols or clinical thresholds for transfusion during or after CABG, so there was no uniformity inthe criteria for transfusionin all patients; this is a sample ofthe institution, so that patients were not operated by the same surgeon, but, by various existing teams inthe hospital; we did not analyze the pre-operative use of anti-platelet drugs, which possibly should have some influence on the appearance of bleeding and therefore transfusions.
between investigators was present, conferring uniformity to the diagnostic criteria. Thirdly, the methodology used in our study (etiologic agent considered if isolated within a peri- od of 48 hours ofthe HAP diagnosis) could lead to some restrictions regarding positive microbiological identification. However, we think that from a pragmatic point of view, this methodology reflects more adequately the current medical practice in most ICUs. In addition, a 48-hour period ade- quately describes the incubation period ofthe most common bacteria and viruses. Finally, the relatively small sample studied (n = 60) did not allow for a more specific analysis, such as distinct clinical characteristics in special sub-groups of HAP, as is the case ofthe elderly, trauma, COPD, diabe- tes, patients with neoplasia or detailed clinical characteriza- tion of patients according to bacteriological profile.
Ferritin levels were recorded for the five patients on the chronic transfusion program. One patient with concomitant ulcerative colitis has persistent low ferritin values due to frequent gastro-intestinal bleeding, and was not considered. One patient presented with iron overload with ferritin levels over 1400 ng/mL at the start ofthe RBCX program and was treated with deferoxamine plus A-RBCX during one year with a reduction and stabilization of ferritin serum levels to 300 ng/mL. The other three patients had received simple transfusions prior to chronic A-RBCX and ferritin levels reduced (median: initial serum ferritin: 223 ng/mL, last ferritin value: 112 ng/mL, variation: -54%) after a median of five A-RBCX sessions.
We made an epidemiological case-control study to examine risk factors for the development of diarrhea intheintensivecareunit (ICU) of a public hospital in Santo André, SP, from January to October 2002. Forty-nine patients with diarrhea (cases) and 49 patients without diarrhea (controls), matched for age and gender, were included inthe study. A stool culture and enzyme immunoassays for Clostridium difficile toxins A and B were performed on fecal specimens from diarrhea patients. Fourteen of them presented positive cultures for Pseudomonas aeruginosa and 22 patients presented positive ELISA for Clostridium diffícile. Nosocomial diarrhea was associated with several factors, including use of antibiotics (P=0.001), use of ceftriaxone (P=0.001), presence of infection (P=0.010) and length of hospital stay (P=0.0001).
This study, through the use of ield reports, seeks to bring assistance to nurses, in order that they can work through their feelings and understand the importance of integral and humanised care during the process of initude of a child’s life. By revealing the percepions and coping mechanisms used by nurses working in NICU ( Neonatal IntensiveCareUnit) and or PICU (Paediatric IntensiveCareUnit) , facing the death and dying of a newborn or a child, this study contributes to nursing professionals, lead- ing them to understand that they are not alone in their feelings and everybody needs support to live and overcome this sort of situaion.
Objective: This study aims to reflect on the types of occupational hazards in an intensivecareunit, considering the aspects of occupational health as a focus of study related to the risks of exposure. Method: Qualitative study used a data collection tool (script) that served to environmental monitoring and identification of hazards, the data were compared with the theoretical framework which formed the basis for the debates. Results: It found may be classified inthe risk categories: biological, physical, chemical, ergonomic and accidents. Conclusion: The environment ofintensivecare, despite the high power therapeutic for the patient presents to the worker, all ofthe risks envisaged by legislation and requires a painstaking careand attention so that the employees maintain their health and healthiness. Descriptors: Accidents Occupational, Occupational health, Occupational risks.
ABSTRACT: This study evaluated the use of bipolar electrosurgery and laparoscopic clipping, and their effects on blood loss andthe inﬂ ammatory response, during a two portal video-assisted ovariohysterectomy technique (two groups with 10 animals each). Surgical time andblood loss volume were signiﬁ cantly lower inthe electrosurgery group. There were no signiﬁ cant changes in haematocrit between groups; however, haematocrit did differ between evaluated times, and decreased 10% from the initial measurement to four hours after the procedure. The inﬂ ammatory response was signiﬁ cantly higher throughout the post-surgical period, but without any different clinical signs between the two groups. Both techniques had good application for the two portal video-assisted procedure; however, the bipolar electrosurgery allowed for shorter surgical times, reduced blood loss and a minimal learning curve for the surgeon.
Carbon steel C120U grade is largely used on the tools for cutting, for dies and knives, for stamping and drawing tools, hobs, thread rolling tools andin many other applications due to her typical properties - high hardness, good toughness and compressive strength. The surface ofthe steel can be modified by using surface engineering's techniques. Remelting ofthe surface layer by the source of concentrated energy is promising technique to improve properties ofthe materials [1-6]. Laser or electron beam use to melting ofthe surface of tool steels aims to obtain a modified layer with increased microhardness and abrasion resistance [7,8]. The surface remelted layer has usually a finer and more homogenous structure than its original base material. The remelting with the arc plasma (TIG- tungsten inert gas or GTAW - gas tungsten arc welding) used as an economical and easily
his is a retrospective cohort analysis of patients admitted to the 30-bed, mixed medical-surgical ICU of Hospital Sírio-Libanês, a private tertiary hospital with a dedicated oncology unitin São Paulo, Brazil. Cardiac surgical patients are managed in a separate unit within our hospital. Because our ICU has an “open format” model, admission and discharge decisions are made after discussions between the patient’s attending physician andtheintensivecare physician. here is no formal follow-up by the ICU team after discharge. he hospital has an intermediate careunit with 40 beds, the 24-h presence of an intensivist, and a higher nurse-to-patient ratio than the ward. he study was approved by the local institutional ethics committee, which waived informed consent because ofthe observational design ofthe study (CAAE: 42763115.7.0000.5461).
There is no consensus regarding an ideal value of hemoglobin or hematocrit which suggests transfusionin cardiac surgeries. The American Society of Anesthesiologists (ASA) recommends that pRBC transfusionin patients with serum level of hemoglobin between 6 and 10 g/dL be based on the risk of developing complications or organic lesion by inappropriate oxygenation . The latest consensus concerning perioperative transfusionin cardiac surgery identiied six variables as being important risk indicators of pRBC transfusion: old age, small total amount ofredblood cells (anemia or small body size), use of antiplatelet or antithrombotic drugs, reoperation or complex procedures, emergency procedures and non-cardiac comorbidity. This same study stated, with a level A of evidence (class I), that all measures of pre and perioperative blood conservation must be taken into this group of patients, since they correspond to the greatest part of hemocomponent transfusions .