RESUMO
Spacer-induced flow shadows and limited mechanical stability due to module construction and geometry are the main obstacles to improving the filtration performance and cleanability of microfiltration spiral-wound membranes (SWMs), applied to milk protein fractionation in this study. The goal of this study was first to improve filtration performance and cleanability by utilising pulsed flow in a modified pilot-scale filtration plant. The second goal was to enhance membrane stability against module deformation by flow-induced friction in the axial direction ("membrane telescoping"). This was accomplished by stabilising membrane layers, including spacers, at the membrane inlet by glue connections. Pulsed flow characteristics similar to those reported in previous lab-scale studies could be achieved by establishing an on/off bypass around the membrane module, thus enabling a high-frequency flow variation. Pulsed flow significantly increased filtration performance (target protein mass flow into the permeate increased by 26%) and cleaning success (protein removal increased by 28%). Furthermore, adding feed-side glue connections increased the mechanical membrane stability in terms of allowed volume throughput by ≥100% compared to unmodified modules, thus allowing operation with higher axial pressure drops, flow velocities and pulsation amplitudes.
RESUMO
OBJECTIVE: Medication errors can have detrimental effects on patient outcomes, yet there are limited data on the prevalence of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) among older adult inpatients in New Zealand (NZ). This study investigated exposure to PIMs and PPOs in older adults in a New Zealand hospital. METHODS: Electronic medical records of 846 older adults (≥ 65 years) discharged from the Auckland District Health Board between June 2020 and May 2021 were retrospectively reviewed to extract data on sociodemographic, medication and diagnostic information. STOPP/START version 2 was used to evaluate PIMs and PPOs on admission and discharge. RESULTS: The mean age was 77.47 ± 8.12 years, and 51% were female. On admission, 48% had ≥1 PIMs and 40% had ≥1 PPOs. On discharge, 45% had ≥1 PIMs and 40% had ≥1 PPOs. Increasing age (adjusted odds ratio [AOR] = 1.02, 95% CI [confidence interval] 1.01, 1.04), number of medicines (AOR = 1.23, CI 1.17, 1.29) and 28-day admission history (AOR = 1.58, CI 1.15, 2.18) were associated with higher odds of PIMs use on admission. At discharge, the number of medicines (AOR = 1.19, CI 1.13, 1.25) and history of readmission (AOR = 1.47, CI 1.08, 2.02) were associated with higher odds of PIMs. Female patients had higher odds of PPOs both on admission (AOR = 1.35, CI 1.02, 1.78) and discharge (AOR = 1.34, CI 1.01, 1.78). Maori, Asian and Pacific patients were more likely to have prescribing omissions compared to NZ Europeans. CONCLUSIONS: Prescribing omissions and inappropriate medications were common in older inpatients. There were differences observed between different ethnic groups, with NZ Europeans having fewer omissions than other ethnic groups. These findings highlight key opportunities for health-care providers to improve medication use in older adults in NZ.