Impact of multicomponent intervention on hospitalized clinical patient outcomes: A pre-post study in a university hospital.

BACKGROUND AND OBJECTIVE: Hospitalization significantly interferes with the individual's well-being and it occurs both during and after the hospitalization period. Different approaches to minimize morbidity related to hospitalization and the post-discharge period have been proposed, especially to those aimed at reducing readmission rates. The aim of this study is to evaluate the effect of multicomponent intervention (MI) on operational indicators and continuity of care outcomes. MATERIALS AND METHODS: A quasi-experimental study conducted in a Brazilian university hospital in order to compare the impact of the intervention with usual care. The MI was the implementation of multidisciplinary rounds, the inclusion of the role of the navigator nurse, and care transition actions with half of the Internal Medicine teams in a clinical unit of a general hospital. Adult patients hospitalized were included in 2 periods and divided in 3 groups - Group A: before the intervention; Group B: after and with MI; Group C after and without MI. RESULTS: A total of 2333 hospitalizations were evaluated. There was a reduction in the rate of intensive care transfers to intensive care unit (ICU) and in the length of stay (LOS). LOS, discharge before noon, and transfers to ICU improved when comparing before and after the intervention, but were not different in post-intervention groups with and without MI. CONCLUSION: These results reflect the improvement of care provided by MI, an effect that could be due to cross contamination also to teams without the intervention.

Silagem de grãos úmidos de milho de textura dura ou macia em dietas com polpa cítrica para vacas em lactação / High moisture silage of hard or soft corn grain in citrus pulp diets for lactating cows

Avaliou-se o desempenho de vacas leiteiras que consumiram polpa cítrica e dois teores dietéticos de silagem de grão úmido de milho. Os tratamentos foram: milho de textura dura ou milho de textura macia ensilado na linha negra, em fatorial com 9% ou 18% de milho na dieta. O teor de polpa cítrica na dieta foi de 16,2% ou 25,6%, com alto e baixo milho, respectivamente. Doze vacas receberam os tratamentos em quadrados latinos 4x4. A produção diária de leite foi 27,9kg no milho duro e 28,8 no macio (P=0,19). Alto milho diminuiu o teor de gordura do leite de 3,38 para 3,26% (P=0,04) e aumentou o teor de proteína de 2,99 para 3,03% (P=0,05) e a eficiência alimentar de 1,50 para 1,57kg de leite/kg de consumo (P=0,03). Aumento no teor de milho induziu maior queda no pH ruminal na dieta com milho macio do que na dieta com milho duro (P=0,05 para a interação textura versus teor de milho). O milho macio aumentou o consumo diário de matéria orgânica digestível de 11,7 para 12,3kg (P=0,05). Os parâmetros digestivos sugerem que a ensilagem não eliminou totalmente o efeito da textura do endosperma sobre a digestibilidade do milho.

Lactating cow performance on diets containing citrus pulp and two levels of high moisture corn silage was evaluated. Treatments were: hard texture corn or soft texture corn ensiled at the black layer, with a 9% or 18% factorial corn in the diet. Dietary citrus pulp content was 16.2% or 25.6%, for high and low corn, respectively. Twelve cows received the treatments in 4x4 Latin Squares. Daily milk yield was 27.9kg for hard corn and 28.8 for soft (P=0.19). High corn decreased milk fat content from 3.38 to 3.26% (P=0.04), and increased protein content from 2.99 to 3.03% (P=0.05) and feed efficiency from 1.50 to 1.57kg of milk/kg of intake (P=0.03). The increase of corn content generated a greater decrease in ruminal pH in the soft corn diet than in the hard corn diet (P=0.05 for the interaction of texture versus corn content). Soft corn increased the daily intake of digestible organic matter from 11.7 to 12.3kg (P=0.05). Digestive parameters suggest that ensilaging did not totally eliminate the endosperm texture effect on corn digestibility.

Effect of salbutamol on pulmonary responsiveness in chronic pulmonary allergic inflammation in guinea pigs

Beta-2-agonists have been widely used by asthmatic subjects to relieve their obstructive symptoms. However, there are reports that continuous use could lead to loss of bronchial protection and exacerbation of asthma symptoms. We evaluated the effect of two regimens of salbutamol administration (twice and five times a week) in a model of chronic airway inflammation in male Hartley guinea pigs (protocol starting weight: 286 ± 30 g) induced by repeated exposures to aerosols of ovalbumin (OVA). After sensitization, guinea pigs were exposed to aerosols of 0.1 mg/ml salbutamol solution twice a week (OVA + S2x, N = 7) or five times a week (OVA + S5x, N = 8). We studied allergen-specific (OVA inhalation time) and -nonspecific (response to methacholine) respiratory system responsiveness. Seventy-two hours after the last OVA challenge, guinea pigs were anesthetized and tracheostomized, respiratory system resistance and elastance were measured and a dose-response curve to inhaled methacholine chloride was obtained. Specific IgG1 was also quantified by the passive cutaneous anaphylactic technique. OVA-sensitized guinea pigs (N = 8) showed reduction of the time of OVA exposure before the onset of respiratory distress, at the 5th, 6th and 7th exposures (P < 0.001). The OVA + S2x group (but not the OVA + S5x group) showed a significant increase in OVA inhalation time. There were no significant differences in pulmonary responsiveness to methacholine among the experimental groups. OVA + S2x (but not OVA + S5x) animals showed a decrease in the levels of IgG1-specific anaphylactic antibodies compared to the OVA group (P < 0.05). Our results suggest that, in this experimental model, frequent administration of ß2-agonists results in a loss of some of their protective effects against the allergen.