Quality improvement project demonstrating a sustained increase in the assessment and sampling of ascites for hospitalised patients with cirrhosis.

Objective: Using quality improvement techniques, we aimed to improve the rate of assessment and sampling of ascitic fluid for the purpose of diagnosing spontaneous bacterial peritonitis in patients with cirrhosis admitted to the hospitalist service of our institution. Design/methods: Based on stakeholder needs assessment, we implemented interventions targeting provider knowledge, procedure workflows and clinical decision support. We analysed key metrics during preintervention (September-December 2020), intervention roll-out (January-April 2021), postintervention (May-September 2021) and sustainability (September-December 2022) periods for admissions of patients with cirrhosis to our hospitalist service at Maine Medical Center, a 700-bed tertiary-care academic hospital in Portland, Maine, USA. Results: Among patients with cirrhosis admitted to our service, documentation of assessment for paracentesis increased from a preintervention baseline of 60.1% to 93.5% (p<0.005) postintervention. For patients with ascites potentially amenable to paracentesis, diagnostic paracentesis rate increased from 59.7% to 93% (p<0.005), with the rate of paracentesis within 24 hours increasing from 52.6% to 77.2% (p=0.01). These improvements persisted during our sustainability period. Complication rate was low (1.2%) across all study periods. Conclusion: Our quality improvement project led to a sustained improvement in the identification of patients with cirrhosis needing diagnostic paracentesis and an increased procedure completion rate. This improvement strategy serves as a model for needed work toward closing a national performance gap for patients with cirrhosis.

Mental workload, musculoskeletal discomfort and physical activity level in master's degree students in the COVID-19 context: A pilot study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to a change of pedagogical strategies from on-campus to "online" modality (synchronous and asynchronous learning) and may influence the health of university students, including their mental workload. OBJECTIVE: To identify the association between mental workload, perception of musculoskeletal discomfort (MSD), and the level of physical activity of Masters's students' online learning due to the pandemic. METHOD: This was a pilot descriptive study with a cross-sectional, quantitative, non-experimental study design. The sample consisted of 20 students. To collect the data, the participants answered a sociodemographic questionnaire, NASA-Task Load Index, International Physical Activity Questionnaire, and the Nordic Musculoskeletal Questionnaire. RESULTS: The students presented mental workload at medium (45%) and high (55%) levels, with time demands as the most prevalent dimension. In addition, 80% of the students reported experiencing MSD in the last seven days, with the most frequent areas being the neck and lower back. Regarding the level of physical activity, five students had a low level (25%), five students had a medium level (25%), and ten students had a high level (50%) of activity. CONCLUSION: Most of the students (95%) conduct their master's degree along with maintaining a full-time job. Therefore, the adaptive requirements according to "time demands" is a negative factor because of its contribution to mental workload. Especially in addition to students' perception of musculoskeletal discomfort, organizational aspects would be fundamental to prevent physical and mental health risks.

Alterations of pain pathways by experimental sleep disturbances in humans: central pain-inhibitory, cyclooxygenase, and endocannabinoid pathways.

STUDY OBJECTIVES: There is strong evidence that sleep disturbances are an independent risk factor for the development of chronic pain conditions. The mechanisms underlying this association, however, are still not well understood. We examined the effect of experimental sleep disturbances (ESDs) on three pathways involved in pain initiation/resolution: (1) the central pain-inhibitory pathway, (2) the cyclooxygenase (COX) pathway, and (3) the endocannabinoid (eCB) pathway. METHODS: Twenty-four healthy participants (50% females) underwent two 19-day long in-laboratory protocols in randomized order: (1) an ESD protocol consisting of repeated nights of short and disrupted sleep with intermittent recovery sleep; and (2) a sleep control protocol consisting of nights with an 8-hour sleep opportunity. Pain inhibition (conditioned pain modulation, habituation to repeated pain), COX-2 expression at monocyte level (lipopolysaccharide [LPS]-stimulated and spontaneous), and eCBs (arachidonoylethanolamine, 2-arachidonoylglycerol, docosahexaenoylethanolamide [DHEA], eicosapentaenoylethanolamide, docosatetraenoylethanolamide) were measured every other day throughout the protocol. RESULTS: The central pain-inhibitory pathway was compromised by sleep disturbances in females, but not in males (p < 0.05 condition × sex effect). The COX-2 pathway (LPS-stimulated) was activated by sleep disturbances (p < 0.05 condition effect), and this effect was exclusively driven by males (p < 0.05 condition × sex effect). With respect to the eCB pathway, DHEA was higher (p < 0.05 condition effect) in the sleep disturbance compared to the control condition, without sex-differential effects on any eCBs. CONCLUSIONS: These findings suggest that central pain-inhibitory and COX mechanisms through which sleep disturbances may contribute to chronic pain risk are sex specific, implicating the need for sex-differential therapeutic targets to effectively reduce chronic pain associated with sleep disturbances in both sexes. CLINICAL TRIALS REGISTRATION: NCT02484742: Pain Sensitization and Habituation in a Model of Experimentally-induced Insomnia Symptoms. https://clinicaltrials.gov/ct2/show/NCT02484742.

Manejo del delirium en el paciente oncológico y su repercusión en la toma de decisiones compartidas / Management of delirium in cancer patients and its impact on shared decisions

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Determination of the Dissolution/Permeation and Apparent Solubility for Microencapsulated Emamectin Benzoate Using In Vitro and Ex Vivo Salmo salar Intestine Membranes.

In this work, two microencapsulation techniques were used to protect and improve the absorption of emamectin benzoate (EB), which is an antiparasitic drug used to control Caligus rogercresseyi. EB has a low aqueous solubility, which affects its absorption in the intestine of Salmo salar. Microparticles were produced by spray drying and ionic gelation, using Soluplus® (EB−SOL) and sodium alginate (EB−ALG) as polymers, respectively. Studies were conducted on dissolution/permeation, apparent permeability (Papp), apparent solubility (Sapp), and absorption using synthetic and biological membranes. Based on these results, the amount of EB in the microparticles needed to achieve a therapeutic dose was estimated. The EB−ALG microparticles outperformed both EB−SOL and free EB, for all parameters analyzed. The results show values of 0.45 mg/mL (80.2%) for dissolution/permeation, a Papp of 6.2 mg/mL in RS−L, an absorption of 7.3% in RS, and a Sapp of 53.1% in EM medium. The EB−ALG microparticles decrease the therapeutic dose necessary to control the parasite, with values of 3.0−2 mg/mL and 1.1−2 mg/mL for EB in EM and RS, respectively. The Korsmeyer−Peppas kinetic model was the best model to fit the EB−ALG and EB−SOL dissolution/permeation experiments. In addition, some of our experimental results using synthetic membranes are similar to those obtained with biological membranes, which suggests that, for some parameters, it is possible to replace biological membranes with synthetic membranes. The encapsulation of EB by ionic gelation shows it is a promising formulation to increase the absorption of the poorly soluble drug. In contrast, the spray-dried microparticles produced using Soluplus® result in even less dissolution/permeation than free EB, so the technique cannot be used to improve the solubility of EB.

Parotiditis crónica recurrente infantil: alternativa de tratamiento / Recurrent chronic parotiditis in childhood: alternative of treatment

El presente reporte es un estudio clínico microbiológico radiográfico, histológico inmunológico y de tratamiento en 20 pacientes con parotiditis crónica recurrente infantil. El rango de edad de los pacientes es entre 1 y 10 años. Los microorganismos aislados de saliva parotídea fueron: S. pneumoniae (7), H. influenzae (3), S. viridans (5), y H. influenzae más S. viridans (3). Las técnicas radiográficas realizadas mediante sialografía demuestran que el 100 por ciento tenía sialectasia, ya sea unilateral o bilateral. En biopsia de glándulas salivales de labio se observó sialectasia en el 60 por ciento de los pacientes. Como resultados del tratamiento se encontró recuperación de la glándula en el 80 por ciento de los casos comprobada por sialografía