Development and validation of an instrument to measure nursing workload in the postanaesthesia care unit: An observational study.

BACKGROUND: There are no instruments specifically developed for the measurement of nursing workload in postanaesthesia care units (PACUs). An objective and valid instrument is essential for planning work flow and staffing in this unique hospital environment that encompasses elements of elective and acute postsurgical care. Previous studies show that increased workload is associated with increased complication rates in ICUs. Thus, workload assessment may be an important tool for improving postsurgical outcomes. OBJECTIVE: The aim of this study was to develop and validate a postanaesthesia workload instrument (PAWI) for measurement of workload in PACUs for adults above 18 years of age. DESIGN: Development and validation consisted of three parts: Delphi consensus to establish content validity; internal validation including feasibility, face validity and inter-rater reliability testing; and national external validation consisting of feasibility, inter-rater reliability, criterion validity, construct and face validities. SETTING: PACUs in nine university and regional hospitals in Sweden. RESULTS: The final instrument consisted of 11 workload domains. The response rate was 98% and overall feasibility of PAWI was 100%. Content and face validity were demonstrated by consensus after two Delphi rounds. In national external validation, good agreement between experts was demonstrated with Cohen's κ greater than 0.75 in nine domains and 0.6 to 0.74 in the remaining two domains. A significant relationship was seen between PAWI and the nine equivalents of nursing manpower use score (NEMS) (r = 0.439, P < 0.001). There were no floor or ceiling effects. There was a significant association between PAWI points and American Society of Anesthesiologists' (ASA) physical status grade (P = 0.007) but not between PAWI points and age. CONCLUSION: We developed and validated PAWI, an instrument for objectively measuring workload in postanaesthesia care units. PAWI demonstrated good feasibility and metric properties.

Predicting Blood Lactate Concentration and Oxygen Uptake from sEMG Data during Fatiguing Cycling Exercise.

This article presents a study of the relationship between electromyographic (EMG) signals from vastus lateralis, rectus femoris, biceps femoris and semitendinosus muscles, collected during fatiguing cycling exercises, and other physiological measurements, such as blood lactate concentration and oxygen consumption. In contrast to the usual practice of picking one particular characteristic of the signal, e.g., the median or mean frequency, multiple variables were used to obtain a thorough characterization of EMG signals in the spectral domain. Based on these variables, linear and non-linear (random forest) models were built to predict blood lactate concentration and oxygen consumption. The results showed that mean and median frequencies are sub-optimal choices for predicting these physiological quantities in dynamic exercises, as they did not exhibit significant changes over the course of our protocol and only weakly correlated with blood lactate concentration or oxygen uptake. Instead, the root mean square of the original signal and backward difference, as well as parameters describing the tails of the EMG power distribution were the most important variables for these models. Coefficients of determination ranging from R(2) = 0:77 to R(2) = 0:98 (for blood lactate) and from R(2) = 0:81 to R(2) = 0:97 (for oxygen uptake) were obtained when using random forest regressors.

A mass spectrometric study on meloxicam metabolism in horses and the fungus Cunninghamella elegans, and the relevance of this microbial system as a model of drug metabolism in the horse.

This paper describes a study where the metabolism of the non-steroidal anti-inflammatory drug meloxicam was investigated in six horses and in the filamentous fungus Cunninghamella elegans. The metabolites identified were compared between the species, and then the fungus was used to produce larger amounts of the metabolites for future use as reference material. C. elegans proved to be a good model of phase I meloxicam metabolism in horses since all four metabolites found were the same in both species. Apart from the two main metabolites, 5'-hydroxymethylmeloxicam and 5'-carboxymeloxicam, a second isomer of hydroxymeloxicam and dihydroxylated meloxicam were detected for the first time in horse urine and the microbial incubations. Phase II metabolites were not discovered in the C. elegans samples but hydroxymeloxicam glucuronide was detected intact in horse urine for the first time in this study. Urine from six horses was further analyzed in a semi-quantitative sense and 5'-hydroxymethylmeloxicam gave peaks with much higher intensity compared to the parent drug and the other metabolites, and was detected for at least 14 days after the last given dose in some of the horses. From the results presented in this article, we suggest that analytical methods developed for the detection of meloxicam in horse urine after prohibited use should focus on the 5'-hydroxymethyl metabolite and that C. elegans can be used to produce large amounts of this metabolite for potential future use as a reference compound.