Advanced Variables to Optimize Hemodynamic Monitoring.

Measuring hemodynamic parameters has become safer and more precise than in the past. Accurately monitoring and evaluating the effectiveness of fluid, inotrope, and vasoactive medication administration can improve patient outcomes. Arbitrary fluid administration without stroke volume measurement can be detrimental to patient outcomes. Early detection and prompt treatment of shock states is essential to combat deleterious effects on critically ill patients. In addition to measuring traditional hemodynamic variables, the use of advanced variables such as hypotension prediction index, dynamic arterial elastance, and systolic slope can improve the precision of treat ment for critically ill patients. Using predictive analytics can help the bedside critical care nurse provide patient care that is proactive rather than reactive.

Characterization of Different Commercial Dietary Supplements in the Peri-Weaning Period on Consumption and Growth Performance in C57Bl/6J Mice.

This experiment was conducted to investigate the effects of common commercially available dietary supplementation in the peri-weaning period on feed intake, growth, and survival in C57Bl/6J mouse pups and lactating dams. A total of 96 pups and their dams were randomized to the control group or one of three nutritional supplement treatment groups: (i) control group without supplementation, or (ii) weanling-targeted Clear H2O gel (Gel), (iii) transgenic-targeted Bio-Serv dough (Dough), or (iv) dam diet as a mash (Chow), in the peri-weaning period (from 11 to 28 days). Stool was observed daily for a dye marker indicating supplement consumption. Pups were weaned at 21 days and followed for a total of 42 days. No pup morbidity or mortality was observed. There was a higher proportion of pups consuming dough and gel earlier than chow (p = 0.0091). The majority of treated pups (>95%) were consuming the supplement by day 23 (range 15-23), suggesting interplay between organoleptic properties of the supplement and pup maturity. All groups gained weight, with typical sexual dimorphism observed in the growth curves. Dough treatment led to significantly higher average daily gain in male pups (0.64 ± 0.03 g/d) as compared with controls (0.58 ± 0.03 g/d). The highest average daily gain in all groups was observed pre-weaning between days 21 and 28. Compared with controls, the weight gain slope was significantly higher in the Dough and Chow treatment groups and lower in Gel treatment groups, with a more pronounced effect in males. In this study, the composition of nutritional supplementation was the dominant factor in increasing the growth trend as opposed to energy density. Peri-weaning supplementation with Dough and Chow treatments improved pre- and post-growth performance in a comparable way and was more effective than Gel treatment during adaptation to solid feeding. Proper application of supplements to support weanlings can directly improve welfare and limit unintended experimental variability.

Evaluating the influence of perceived pain control on patient satisfaction in a hospital setting.

The authors evaluated whether a patient's perceived pain control influenced the relationships between four attributes (nursing, physician, staff, and environment) and patient satisfaction. Multiple linear regression analyses were conducted to examine overall satisfaction and intention to recommend, controlling for race, gender, age, and education. The authors found that no matter the level of pain control, nursing was always the most influential attribute in patient satisfaction. The influence of the other attributes varied, depending on the patients' pain control. Hospital managers may improve patient satisfaction by focusing on pain management nursing care.

A novel alternative placement site and technique for totally implantable vascular access ports in non-human primates.

BACKGROUND: Two novel approaches to implanting a central venous catheter port in non-human primates (NHPs) using peripheral insertion are presented and compared. METHODS: Sixty vascular access port (VAP) implants were attempted in 52 NHPs by saphenous vein puncture (n = 20) or saphenous vein cutdown (n = 40). RESULTS: Fifty eight procedures were successful. Eighteen of 20 VAPs were successfully placed using saphenous vein puncture, and 40 of 40 using saphenous vein cutdown. There were no significant differences between procedures. Mean implantation times were similar between groups. At explant or study endpoint, all 58 VAPs were patent. CONCLUSIONS: Vascular access port implantation by saphenous vein puncture or saphenous vein cutdown is safe and effective in NHPs. It is less invasive than conventional procedures, has fewer complications, provides outstanding patency, and reduces surgery time. Furthermore, it allows for cooperative in-homecage VAP use, minimizing handling stress. We recommend these refined methods for long-term vascular access in NHPs.