Crystallisation properties of amorphous cyclodextrin powders and their complexation with fish oil.

Water-induced crystallisation of amorphous core-cyclodextrin (CD) complex is an essential step in a solid encapsulation process and removal of added water is a challenging. Ethanol addition is expected to shorten the complex dehydration time. This study investigated crystallisation of amorphous spray-dried α-, ß- and γ-CD powders by direct mixing 15% (w/w) of ethanol:water mixture (0:100, 20:80, 40:60, 60:40, 80:20 and 100:0) over 72 h period. The results showed α- and ß-CD powders crystallised at all concentrations of ethanol solutions. Especially mixed with 0:100 and 20:80 ethanol:water solutions, the crystallisation behaviour of α- and ß-CD powders was similar to that of commercial crystalline counterparts. γ-CD powders exhibited a crystallisation sign as mixed with 0:100 and 20:80 ethanol:water solutions only. In the study of fish oil encapsulation using the mixture of water and ethanol to induce the complex crystallisation, only γ-CD powder was able to form complex with fish oil.

Stop the Noise: A Quality Improvement Project to Decrease Electrocardiographic Nuisance Alarms.

BACKGROUND: As many as 99% of alarm signals may not need any intervention and can result in patients' deaths. Alarm management is now a Joint Commission National Patient Safety Goal. OBJECTIVES: To reduce the number of nuisance electrocardiographic alarm signals in adult patients on the medical cardiovascular care unit. METHODS: A quality improvement process was used that included eliminating duplicative alarms, customizing alarms, changing electrocardiography electrodes daily, standardizing skin preparation, and using disposable electrocardiography leads. RESULTS: In the cardiovascular care unit, the mean number of electrocardiographic alarm signals per day decreased from 28.5 (baseline) to 3.29, an 88.5% reduction. CONCLUSION: Use of a bundled approach to managing alarm signals decreased the mean number of alarm signals in a cardiovascular care unit.

Postoperative complications of coronary artery bypass grafting surgery.

Coronary artery bypass grafting (CABG) surgery continues to be an effective and well-used intervention for coronary artery disease. Older patients and those with sicker hearts will become the norm. In spite of increased risk for patients undergoing CABG, overall mortality rates have decreased. Nursing contributions to these improved outcomes cannot be overestimated. Continued understanding and appreciation of these complications will be necessary to effectively care for patients and create optimal outcomes.

Influence of music on the stress response in patients receiving mechanical ventilatory support: a pilot study.

BACKGROUND: Music is considered an ideal therapy for reducing stress in patients receiving mechanical ventilation. Previous studies of the effect of music on stress in such patients have focused solely on indirect markers of the stress response rather than on serum biomarkers. OBJECTIVE: To explore the influence of music on serum biomarkers of the stress response in patients receiving ventilatory support. METHODS: A convenience sample of 10 patients receiving mechanical ventilation was recruited from an 11-bed medical intensive care unit. Patients were randomly assigned to listen to music or to rest quietly for 60 minutes. Levels of corticotropin, cortisol, epinephrine, and norepinephrine were measured 4 times during the 60 minutes. RESULTS: The levels of the 4 biomarkers of the stress response did not differ significantly between patients who listened to music and patients who rested quietly, though the levels of corticotropin and cortisol showed interesting trends. CONCLUSIONS: Additional research is needed with a larger sample size to evaluate further the influence of music on biochemical markers of the stress response in patients receiving mechanical ventilatory support. In future studies, confounding factors such as endotracheal suctioning and administration of medications that influence the stress response should be controlled for.