BackgroundElderly patients are vulnerable to adverse drug reactions (ADRs). Drug-related readmissions (DRRs) can be a major consequence of ADR. Therefore, this study aimed to investigate the effects of a ward-based, comprehensive pharmaceutical care service on the occurrence of DRRs as the endpoint in dependent-living elderly patients.MethodsA randomized, controlled trial was performed at a German University Hospital. Patients fulfilling the following criteria were eligible: admission to a cooperating ward, existing drug therapy at admission, 65 years of age and older, home-care or nursing home residents in ambulatory care, and a minimum hospital stay of three days. Patients received either standard care (control group) or pharmaceutical care (intervention group). Follow-up consultations were conducted for each patient at 1, 8, 26, and 52 weeks after discharge. The time to DRR was defined as the primary outcome measure and was analysed using the log-rank test. The Cox-proportional hazard model was used for risk factor analysis.ResultsSixty patients (n = 31 intervention group, n = 29 control group) participated in the study. For patients in the intervention group, the median time to DRR was prolonged; however, the level of statistical significance was not reached (log-rank test P = 0.068; HR = 3.28, P = 0.086). When the risk factors ‘age’ or ‘length of stay on the ward’ were added to the Cox proportional hazard model, patients in the control group exhibited a significantly higher risk of experiencing a DRR than patients of the intervention group (HR = 4.62; P = 0.028 including age and HR = 5.76; P = 0.033 including length of stay on the ward).ConclusionsOur findings demonstrate the successful implementation of ward-based, comprehensive pharmaceutical care for dependent-living elderly. Despite a low participation rate, which led to an underpowered study, the results provide a preliminary efficacy signal and effect size estimates to power a definitive trial.Trial registrationClinicaltrials.gov identifier: NCT01578525, prospectively registered April 13, 2012.
Metallic seals are crucial machine elements in many important applications, e.g., in ultrahigh vacuum systems. Due to the high elastic modulus of metals, and the surface roughness which exists on all solid surfaces, if no plastic deformation would occur one expects in most cases large fluid flow channels between the contacting metallic bodies, and large fluid leakage. However, in most applications plastic deformation occurs, at least at the asperity level, which allows the surfaces to approach each other to such an extent that fluid leakage often can be neglected. In this study, we present an experimental set-up for studying the fluid leakage in metallic seals. We study the water leakage between a steel sphere and a steel body (seat) with a conical surface. The experimental results are found to be in good quantitative agreement with a (fitting-parameter-free) theoretical model. The theory predicts that the plastic deformations reduce the leak-rate by a factor $$\approx 8$$ ≈ 8 .
Background: Intubation of neonates is difficult and hazardous. Factors associated with procedure-related adverse events and unsuccessful intubation attempts are insufficiently evaluated, especially during neonatal nasotracheal intubations.Objective: Aim of this study was to determine the frequency of tracheal intubation–associated events (TIAEs) during neonatal nasotracheal intubations and to identify factors associated with TIAEs and unsuccessful intubation attempts in our neonatal unit.Methods: This was a prospective, single-site, observational study from May 2017 to November 2019, performed at a tertiary care neonatal intensive care unit in a German academic teaching hospital. All endotracheal intubation encounters performed by the neonatal team were recorded.Results: Two hundred and fifty-eight consecutive intubation encounters in 197 patients were analyzed. One hundred and forty-eight (57.4%) intubation encounters were associated with at least one TIAE. Intubation inexperience (<10 intubation encounters) (OR = 2.15; 95% CI, 1.257–3.685) and equipment problems (OR = 3.43; 95% CI, 1.12–10.52) were predictive of TIAEs. Intubation at first attempt (OR = 0.10; 95% CI, 0.06–0.19) and videolaryngoscopy (OR = 0.47; 96% CI, 0.25–0.860) were predictive of intubation encounters without TIAEs. The first intubation attempt was commonly done by pediatric residents (67.8%). A median of two attempts were performed until successful intubation. Restricted laryngoscopic view (OR = 3.07; 95% CI, 2.08–4.53; Cormack-Lehane grade 2 vs. grade 1), intubation by pediatric residents when compared to neonatologists (OR = 1.74; 95% CI, 1.265–2.41) and support by less experienced neonatal nurses (OR = 1.60; 95% CI, 1.04–2.46) were associated with unsuccessful intubation attempts.Conclusions: In our unit, TIAEs and unsuccessful intubation attempts occurred frequently during neonatal nasotracheal intubations. To improve success rates, quality improvement und further research should target interprofessional education and training, equipment problems and videolaryngoscopy.
Increasing the rotational speed of the internal gear pump entails addressing topics such as cavitation, overheating and filling problems of the tooth spaces. Besides the development of a tooth geometry and flow optimization, using CFD simulation is necessary. This paper discusses the design of the newly developed high speed internal gear pump. This includes a detailed description of the different parts as well as the dimensioning of the pump by using CFD simulations. The geometry of the pressure build-up groove has a significant effect of pressure build up inside the pump. Therefore, three different geometries are investigated. The calculation of the journal bearings for the internal gear as well as for the driving shaft is shown. To avoid cavitation problems, the suction pressure of the pump will be increased up to 25 bar. This paper will show the technical arrangements to reach this high suction pressure level whilst still using a radial shaft seal ring. In order to determine the efficiency of the newly developed high speed pump, a test rig was built up. The test rig allows the measurement of the volumetric efficiency as well as the hydraulic-mechanical efficiency at different operation points up to 10 000 rpm and 250 bar.
Background The detection, assessment and prevention of adverse drug reactions along the product's life cycle is known as pharmacovigilance. German pharmacists are obliged by law to conduct pharmacovigilance measures, a specific training is not required. Objectives To assess the knowledge, contribution and perception of German pharmacy professionals regarding pharmacovigilance activities, in order to identify their needs to report better on the issue. Setting A semi-quantitative survey among German pharmacy professionals was conducted in November 2017. Method A questionnaire with 20 questions was developed and distributed to pharmacy professionals in four different German regions. Main outcome measures To assess the knowledge the number of right answered questions were examined; for perception a six-point-Likert was used and for contribution, yes or no questions. Results The participation ratio was 64.5% (n = 127). Nearly half of the participants (47.2%, n = 60) stated that they had already reported adverse drug reactions. Regarding the knowledge questions, there was neither a statistically significant difference between the correct answers of pharmacists and pharmacy technical assistents (p = 0.7209), nor between the different regions (p > 0.5054). For better reporting, the participants recommended better training, shorter forms to fill in and/or a contact person to call. Conclusion For the successful integration of pharmacovigilance reporting in daily practice, we suggest the following: (1) A structured, mandatory training of the pharmacy team. (2) The preparation of a standard operating procedure for the pharmacy or its integration into the pharmacy software.
ISO 4409 is the most important international standard for measuring the efficiency of hydraulic pumps and motors, the latest edition being 4409:2007. The standard describes methods for determining the steady-state performance in terms of overall efficiency. It also defines equations for calculating the volumetric efficiency of pumps and motors. The hydro-mechanical efficiency is only defined for motors, not for pumps. This paper analyses the efficiency and losses of pumps and motors in an alternative way. The preference is on loss analysis instead of efficiencies. Especially the effects of the bulk modulus are considered in a different and more inclusive manner. The new methodology results in a higher total loss for motor and a lower total loss for pumps than the current ISO 4409 standard. Furthermore, it results in significant changes of the hydro-mechanical and volumetric losses. The differences between the new methodology and ISO 4409 become larger for high load pressures. The new methodology demands knowledge about the minimum volume of the displacement chamber. The ratio between this volume and the full displacement of a single displacement chamber strongly influences the hydro-mechanical and volumetric losses of the pump or motor. The new methodology is valid for all positive displacement hydrostatic pumps and motors. The volumetric efficiency, as defined in ISO 4409, can still be used as a flow rate factor, but should not be regarded as an energy conversion efficiency. The importance of adopting the proposed methodology is further demonstrated by analyzing and comparing the measurement data about a fixed displacement pump and motor, showing the differences in the loss analysis by means of ISO 4409 and the new equations. The methodology, observations and validation results presented in this paper are significant and can pave the road for improving the current ISO 4409:2007 standard, which would ultimately benefit the industry.
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