Precision and reliability study of hospital infusion pumps: a systematic review.

BACKGROUND: Infusion Pumps (IP) are medical devices that were developed in the 1960s and generate fluid flow at pressures higher than that of normal blood pressure. Various hospital sectors make use of them, and they have become indispensable in therapies requiring continuity and precision in the administration of medication and/or food. As they are classified Class III (high risk) equipment, their maintenance is crucial for proper performance of the device, as well as patient and operator safety. The principal consideration of the pump is the volume infused, and the device demands great attention to detail when being calibrated. A lack of necessary care with this equipment can lead to uncertainty in volume and precision during the administration of substances. Because of this, it is essential to evaluate its reliability, to prevent possible failures at time of execution. This control aims at the quality of the intended infusion result, becoming an indication of quality. METHODS: This systematic review summarizes studies done over the last 10 years (2011 to December 2021) that address the reliability and accuracy of hospital infusion pumps, in order to identify planning of maintenance and/or other techniques used in management of the equipment. The Prisma method was applied and the databases utilized were Embase, MEDLINE/Pubmed, Web of Science, Scopus, IEEE Xplore, and Science Direct. In addition, similar reviews were studied in Prospero and the Cochrane Library. For data analysis, softwares such as Mendeley, Excel, RStudio, and VOSviewer were used, and Robvis helped in plotting risk of bias results for studies performed with Cochrane tools. RESULTS: The six databases selected produced 824 studies. After applying eligibility criteria (inclusion and exclusion), removing duplicates, and applying filters 1 and 2, 15 studies were included in the present review. It was found that the most relevant sources came from the Institute of Electrical and Electronics Engineers (IEEE) and that the most relevant keywords revolved around the terms ("device failure", "infusion pumps", "adverse effects", "complications", etc.). These results made clear that there remains substantial room for improvement as it relates to the study of accuracy and reliability of infusion. CONCLUSIONS: We verified that the reliability and precision analysis of hospital infusion pumps need to be performed in a more detailed and consistent way. New developments, considering the model and IP specification, are intended, clearly explaining the adopted methodology.

Relationship between inspiratory muscle strength and balance in women: A cross-sectional study.

BACKGROUND: There is scarce evidence on changes at the functional level associated with the respiratory area in women. This study aims to analyse the relationship between inspiratory muscle strength and balance in women. MATERIAL AND METHODS: In this cross-sectional observational study, the sample consisted of groups according to the results obtained in the balance test. Inspiratory muscle weakness was defined as maximum inspiratory pressure (MIP) ≤ 80% of the predictive value. MIP was carried out using through a mouthpiece, with an electronic manometer. Logistic regression model was used to examine if MIP predicts balance. RESULTS: 159 women participated in the study. Approximately 20% of them achieved balance ≤ 2 seconds and 18% presented MIP≤80%. MIP was associated with the time achieved in the one-leg support test. Subjects with MIP ≤ 80% of the predictive value show 3 times more risk of having a lower performance in the balance test (OR = 3.26). CONCLUSIONS: Inspiratory muscle weakness is associated with deficient balance in this sample. It shows the need for multidimensional assessment and rehabilitation strategies for patients identified as having MIP weakness and/or balance disorders.

UV-B tolerances of conidia, blastospores, and microsclerotia of Metarhizium spp. entomopathogenic fungi.

The aim of the present study was to analyze ten native Metarhizium spp. isolates as to their UV-B tolerances. Comparisons included: different fungal propagules (conidia, blastospores, or microsclerotia [MS]); conidia in aqueous suspensions or in 10% mineral oil-in-water emulsions; and conidia mixed with different types of soil. The UV-B effect was expressed as the germination of conidia or culturability of blastospores and MS relative to nongerminated propagules. Metarhizium anisopliae LCM S05 exhibited high tolerance as blastospores and/or MS, but not as conidia; LCM S10 and LCM S08 had positive results with MS or conidia but not blastospores. The formulations with 10% mineral oil did not always protect Metarhizium conidia against UV-B. Conidia of LCM S07, LCM S08, and LCM S10 exhibited the best results when in aqueous suspensions, 24 h after UV-B exposure. In general, conidia mixed with soil and exposed to UV-B yielded similar number of colony forming units as conidia from unexposed soil, regardless the soil type. It was not possible to predict which type of propagule would be the most UV-B tolerant for each fungal isolate; in conclusion, many formulations and propagule types should be investigated early in the development of new fungal biocontrol products.

Conidia and blastospores of Metarhizium spp. and Beauveria bassiana s.l.: Their development during the infection process and virulence against the tick Rhipicephalus microplus.

The current study compared the virulence of conidia and blastospores of Metarhizium robertsii (IP 146), M. anisopliae sensu lato (s.l.) (IP 363) and Beauveria bassiana s.l. (IP 361 and CG 307) against unfed larvae and engorged females of Rhipicephalus microplus (Acari: Ixodidae). In addition, the development of fungal propagules on tick cuticle was investigated. Tick larvae were treated with fungal suspensions at 106, 107 or 108 propagules mL-1, and percent mortality was assessed every two days. Engorged females were immersed in fungal suspensions (1.0 × 107 propagules mL-1) for 1 min, and their biological parameters monitored daily. The virulence of conidia and blastospores against larvae varied considerably among the isolates tested. Only females treated with blastospores of IP 146 or IP 361 presented lower nutrient and egg production indices than the control group; the higher percent control was reached when females were treated with blastospores of IP 146 (98%), IP 363 (79%), or IP 361 (93%) in comparison to the groups treated with conidia, 71%, 59%, or 63%, respectively. Engorged females treated with conidia or blastospores of IP 146 or IP 361 were also examined by scanning electron microscopy (SEM). Germination of blastospores of IP 146 and IP 361 was observed on tick cuticle after 4 h incubation at 27 ±â€¯1 °C and RH > 90%, whereas germ tubes from conidia of both isolates were observed at 48 h. Appressoria in developing blastospores of B. bassiana IP 361 were observed after 4 h incubation, whereas no appressoria were seen in developing blastospores of M. robertsii IP 146. Blastospore penetrations by both fungal isolates through natural openings was also evidenced by SEM; fine sections of R. microplus engorged females treated with blastospores of IP 146 or IP 361 confirmed that these isolates penetrated through their cuticle and natural openings. Blastospores might be promising for use in biocontrol of ticks, since they are virulent against R. microplus and present rapid development on their cuticle.

Eficácia da ivermectina comprimido no tratamento da sarna sarcóptica em cães naturalmente infestados / Efficacy of the ivermectin tablet for treatment of sarcoptic mange in naturally infested dogs

O objetivo deste trabalho foi avaliar a eficácia da ivermectina comprimido administrada por via oral no tratamento de Sarcoptes scabiei em cães naturalmente infestados. Foram selecionados 14 cães com raspados cutâneos positivos para o ácaro S. scabiei, idade de 1-5 anos, sem raça definida, distribuídos na mesma proporção de ambos os sexos, em dois grupos experimentais, compondo 7 animais por grupo. Todos os animais foram tratados a cada 7 dias, totalizando quatro tratamentos em cada cão (Dias 0,7,14 e 21). No grupo I foi administrada a ivermectina5 comprimido na dosagem de 0,2mg/kg e no grupo controle positivo (Grupo II) foi administrado um produto comercial a base de ivermectina comprimido na mesma dosagem do grupo I. Raspados cutâneos, avaliações clinicas e laboratoriais complementares dos cães foram realizadas durante o período de estudo. Clinicamente, não houve diferença significativa entre as avaliações antes e após o tratamento entre os dois grupos. Raspados negativos foram observados em ambos os grupos a partir do dia D+14, mantendo-se negativos até o final do período experimental. As lesões dermatológicas iniciais observadas no acompanhamento clínico regrediram e a partir do dia D+14 a melhora clínica era evidente em ambos os grupos. A ivermectina (Ivermectan Pet, UCBVET Saúde Animal) administrada por via oral foi eficaz no tratamento de S. scabiei em cães naturalmente infestados.(AU)

The aim of this study was to evaluate the efficacy of the ivermectin tablet administered orally for treatment of Sarcoptes scabiei in naturally infested dogs. Fourteen 1 to 5 year-old Mongrel dogs presenting positive skin scrapings for S. scabiei mites, distributed into two groups with equal proportions of both sexes, containing seven animals per group were used in this study. All dogs were treated every 7 days, totaling four treatments in each dog (days 0, +7, +14 and +21). Group I was administered the ivermectin5 tablet at a dose of 0.2mg/kg and positive control group II as given an ivermectin commercial product at the same dose of group I. Skin scrapings, clinical and laboratorial parameters analysis were performed during the experimental period. Clinically there were no significant differences between the two groups evaluated prior and after treatments. Negative skin scrapings were observed in both groups from day +14, remaining negative until the end of the experimental period. The initial skin lesions observed in clinical evaluation regressed from day +14, and clinical improvement was evident in both groups. The ivermectin tablet (Ivermectan Pet, UCBVET Saúde Animal) administered orally was effective to treat S. scabiei infection in naturally infested dogs.(AU)

Consentimento informado em genética forense / Consentimiento informado en genética forense / Informed consent in forensic genetics

O consentimento informado é uma demanda ética e legal na pesquisa com seres humanos, visando a expressão autônoma dos sujeitos. Contudo, a autonomia fica em risco quando os envolvidos encontram-se vulneradas socioculturalmente. Nos casos forenses, a Lei 12.654 de 2012 exclui a necessidade do consentimento e torna obrigatória a doação de material biológico pelos condenados por crimes hediondos. O trabalho buscou avaliar o nível de vulneração dos sujeitos encaminhados a exames de DNA no Instituto de Pesquisa e Perícias em Genética Forense (IPPGF). Foram avaliadas a legibilidade e adequação normativa do Termo de Consentimento Informado (TCI) utilizado. Tentou-se também, identificar o grau de instrução e o hábito de leitura dos doadores para relacionar ao entendimento correto do processo. Pôde-se constatar que o TCI apresentava legibilidade acima da requerida à média dos encaminhados ao IPPGF, além disso, apresentava carências normativas. Por fim, verificou-se que muitos doadores têm restrito hábito de leitura e sequer liam o TCI quando consentiam. Os resultados da análise levaram a profundas mudanças no procedimento de obtenção de consentimento para exames de DNA forense no IPPGF.

El consentimiento informado es una demanda ética y legal en la investigación con seres humanos, respetando la manifestación autónoma de los sujetos. Pero, la autonomía queda en riesgo cuando los sujetos se encuentran vulnerados socioculturalmente. En los casos forenses, la Ley 12.654 de 2012 excluye la necesidad del consentimiento informado y hace obligatoria la donación de material biológico por los condenados de crímenes graves. Este trabajo buscó evaluar el nivel de vulneración de los sujetos sometidos a exámenes de ADN en el Instituto de Investigación y Pericias en Genética Forense (IPPGF). Fueron evaluadas la legibilidad y la idoneidad normativa del Término de Consentimiento Informado (TCI) utilizado. Se intentó, también, identificar el grado de instrucción y el hábito de lectura de los donantes para relacionarlos a la comprensión correcta del proceso. Se puede constatar que el TCI presentaba inteligibilidad por encima de la requerida en la media de los encaminados al IPPGF; además de eso, presentaba carencias normativas. Por fin, ha verificado que muchos donantes tienen insuficiente hábito de lectura y siquiera leían el TCI al consentir. Los resultados del análisis llevaron a profundos cambios en el procedimiento de obtención de consentimiento informado para exámenes de ADN forense en el IPPGF.

Free and informed consent is an ethical and legal request in research involving human beings, seeking the manifestation of autonomy of the subject. However, autonomy is at risk when those involved are socio culturally vulnerable. In forensic cases, Law 12,654 of 2012 excludes the consent and makes mandatory the donation of biological materials by those convicted for heinous crimes. The aim of the study is to assess the level of damage to subjects referred for DNA testing at the Instituto de Pesquisa e Perícias em Genética Forense (IPPGF). We assessed the readability and normative appropriateness of the Informed Consent form (ICF) used. The study also tries to identify the degree of literacy and reading habits of donors relating to the correct understanding of the process. It was found that the ICF has degree of readability above that of the convicted sent to IPPGF and also had normative needs. Finally, it was found that many donors have restricted reading habits and literacy. The results led to profound changes in the procedure for obtaining consent for DNA forensic trials in IPPGF.

The pattern of acute intestinal obstruction in a peripheral district of eastern India.

This is a review of 146 patients operated upon over a period of five years, for 150 episodes of mechanical intestinal obstruction, in a developing country in the tropics. The pattern of intestinal obstructions reveals that external hernia accounts for the largest number of cases followed by volvulus which today still forms the second largest group. Operative mortality was 28%. The major adverse factors were gangrenous bowel and large bowel obstruction. The highest mortality rate (about 41.3%) was found in volvulus.