RESUMO
RATIONALE: Response of the burned patient to surgical medical treatment might depend not only upon the damages brought about by thermal aggression, namely, increased metabolic requirements, onset of the Systemic Inflamatory Response Syndrome, and microbial infections, but also the cultural practices embedded within nutritional care institutional processes. GOAL: To assess how conduction of nutritional care processes of assessment and intervention may influence therapeutical effectiveness indicators of hospital Burn Services. STUDY SERIES: Forty-two patients with a Burn Body Surface Area (BBSA)>10% assisted at the Burn Service of the "Hermanos Ameijeiras" Clinical Surgical Hospital (La Habana, Cuba), between January 2001-December 2003. METHODS: Nutritional care of assessment and intervention conducted upon the burn patient were audited after reviewing clinical charts. The audited processes were declared as Completed (or not). Completeness of the process was related to complications and mortality rates, and length of hospital stay predicted from BBSA. RESULTS: Nutritional care processes of assessment and intervention were completed in 49.4% and 22.6% of the audited charts, respectively. Prospective recording of patient's body weight was associated with lower mortality. Early nutritional assessment and sufficient energy supply to patients with BBSA>20% were associated with lower complications rates and better compliance with BBSA-predicted length of stay. CONCLUSIONS: This work is the first enquiry into the behaviour of the institution's Burn Service, in anticipation of the design and implementation of a medical care Continuous Quality Improvement Program. In spite of the current state of nutritional care processes completeness, their observance might favorably influence the Service's effectiveness indicators.
Assuntos
Queimaduras/terapia , Apoio Nutricional , Adolescente , Adulto , Idoso , Feminino , Departamentos Hospitalares , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-IdadeRESUMO
Plasma levels of corticosterone are often used as a measure of "stress" in wild animal populations. However, we lack conclusive evidence that different stress levels reflect different survival probabilities between populations. Galápagos marine iguanas offer an ideal test case because island populations are affected differently by recurring El Niño famine events, and population-level survival can be quantified by counting iguanas locally. We surveyed corticosterone levels in six populations during the 1998 El Niño famine and the 1999 La Niña feast period. Iguanas had higher baseline and handling stress-induced corticosterone concentrations during famine than feast conditions. Corticosterone levels differed between islands and predicted survival through an El Niño period. However, among individuals, baseline corticosterone was only elevated when body condition dropped below a critical threshold. Thus, the population-level corticosterone response was variable but nevertheless predicted overall population health. Our results lend support to the use of corticosterone as a rapid quantitative predictor of survival in wild animal populations.
Assuntos
Corticosterona/sangue , Iguanas/fisiologia , Tempo (Meteorologia) , Análise de Variância , Animais , Desastres , Equador , Radioimunoensaio , Reprodutibilidade dos Testes , Água do Mar , Estresse Psicológico/sangue , SobrevidaRESUMO
Retention volumes of 21 aliphatic alcohols were measured at five temperatures between 30 and 60 degrees C in columns packed with different percentages of squalane or with solutions of tri-n-octylphosphine oxide (TOPO) in squalane coated on previously deactivated Chromosorb W. Experimental data fit to a 1:1 alcohol-TOPO association model, with association constants ranging from 26 to 59 dm3 mol(-1) at 45 degrees C. Association constants follow the trend primary alcohols>secondary alcohols>tertiary alcohols, with minor differences between the members of each of these three groups. The association enthalpy for the 21 alcohols averages -21.8 kJ mol(-1), with a standard deviation of -1.3 kJ mol(-1).