ACERTO PROJECT: IMPACT ON ASSISTANCE OF A PUBLIC EMERGENCY HOSPITAL.

BACKGROUND: In Brazil, the goal-based approach was named Project ACERTO and has obtained good results when applied in elective surgeries with shorter hospitalization time, earlier return to activities without increased morbidity and mortality. AIM: To analyze the impact of ACERTO on emergency surgery care. METHODS: An intervention study was performed at a trauma hospital. Were compared 452 patients undergoing emergency surgery and followed up by the general surgery service from October to December 2018 (pre-ACERTO, n=243) and from March to June 2019 (post-ACERTO, n=209). Dietary reintroduction, volume of infused postoperative venous hydration, duration of use of catheters, probes and drains, postoperative analgesia, prevention of postoperative vomiting, early mobilization and physiotherapy were evaluated. RESULTS: After the ACERTO implantation there was earlier reintroduction of the diet, the earlier optimal caloric intake, earlier venous hydration withdrawal, higher postoperative analgesia prescription, postoperative vomiting prophylaxis and higher physiotherapy and mobilization prescription were achieved early in all (p<0.01); in the multivariate analysis there was no change in the complication rates observed before and after ACERTO (10.7% vs. 7.7% (p=0.268) and there was a decrease in the length of hospitalization after ACERTO (8,5 vs. 6,1 dias (p=0.008). CONCLUSION: The implementation of the ACERTO project decreased the length of hospital stay, improved medical care provided without increasing the rates of complications evaluated.

Acerto project: impact on assistance of a public emergency hospital / Projeto acerto: impacto na assistência de um hospital público de emergência

ABSTRACT Background: In Brazil, the goal-based approach was named Project ACERTO and has obtained good results when applied in elective surgeries with shorter hospitalization time, earlier return to activities without increased morbidity and mortality. Aim: To analyze the impact of ACERTO on emergency surgery care. Methods: An intervention study was performed at a trauma hospital. Were compared 452 patients undergoing emergency surgery and followed up by the general surgery service from October to December 2018 (pre-ACERTO, n=243) and from March to June 2019 (post-ACERTO, n=209). Dietary reintroduction, volume of infused postoperative venous hydration, duration of use of catheters, probes and drains, postoperative analgesia, prevention of postoperative vomiting, early mobilization and physiotherapy were evaluated. Results: After the ACERTO implantation there was earlier reintroduction of the diet, the earlier optimal caloric intake, earlier venous hydration withdrawal, higher postoperative analgesia prescription, postoperative vomiting prophylaxis and higher physiotherapy and mobilization prescription were achieved early in all (p<0.01); in the multivariate analysis there was no change in the complication rates observed before and after ACERTO (10.7% vs. 7.7% (p=0.268) and there was a decrease in the length of hospitalization after ACERTO (8,5 vs. 6,1 dias (p=0.008). Conclusion: The implementation of the ACERTO project decreased the length of hospital stay, improved medical care provided without increasing the rates of complications evaluated.

RESUMO Racional: No Brasil, a abordagem baseada em metas foi nomeada de Projeto ACERTO e tem obtido bons resultados quando aplicada em operações eletivas com diminuição do tempo de internação, retorno mais precoce as atividades sem incremento de morbimortalidade. Objetivo: Analisar o impacto do ACERTO na assistência prestada em operações de emergência. Métodos: Foi realizado um estudo de intervenção em hospital de trauma. Foram comparados 452 pacientes submetidos à operações de emergência e acompanhados pelo serviço de cirurgia geral no período de outubro a dezembro de 2018 (fase pré-ACERTO, n=243) e no período de março a junho de 2019 (fase pós-ACERTO, n=209). Foram avaliados: reintrodução da dieta, volume de hidratação venosa pós-operatória infundido, tempo de uso de catéteres, sondas e drenos, analgesia pós-operatória, prevenção de vômitos pós-operatórios, mobilização precoce e fisioterapia. Resultados: Após a implantação do ACERTO houve reintrodução mais precoce da dieta, foi atingido o aporte calórico ideal mais precocemente, retirada mais precoce da hidratação venosa, maior prescrição de analgesia pós-operatória, de profilaxia de vômitos pós-operatórios e maior prescrição de fisioterapia e mobilização precoce em todos (p<0,01); na análise multivariada não houve alteração nas taxas de complicações observadas pré e pós-ACERTO (10,7% vs. 7,7% (p=0,268) e houve diminuição do tempo de internação pós-ACERTO (8,5 vs. 6,1 dias (p=0.008). Conclusão: A implantação do projeto ACERTO diminuiu o tempo de internação hospitalar, melhorou a assistência médica prestada sem incremento das taxas de complicações avaliadas.

Influence of light and plant size on the reproduction and growth of small palm tree species: Comparing two methods for measuring canopy openness.

PREMISE OF THE STUDY: The reproduction and growth of large palms are influenced by many factors, including light and plant size, but few studies have examined smaller species (up to 2 m tall). We examined the effect of incident light and individual size on growth rates, the probability of reproduction, and the number of inflorescences of three small palm species and compared two methods for estimating canopy openness. METHODS: We measured canopy openness above the crowns of 132 adult plants and in the centers of 72 subplots (10 × 10 m) where individuals were sampled. We also recorded individual size and the number of leaves and inflorescences produced in two years. KEY RESULTS: Reproductive individuals of Butia paraguayensis tend to occur in illuminated microhabitats. Reproduction of Acrocomia emensis was correlated with stem diameter, but not with light. Reproduction was inversely related to individual size and light in Syagrus petraea, probably because this clonal palm invests heavily in sexual reproduction during its younger stages and clonal activity in older stages and may be adapted to the low-light conditions of the woodland understory. Growth was not predicted by light or individual size. Stronger correlations were found when incident light was measured directly above the crown, as opposed to the subplot center. CONCLUSIONS: The influences of light on reproduction are dependent on plant life histories, even among related and sympatric species. Light measurements directly above individual crowns provide better understanding of the reproductive effort rather than in subplot center.

Improvement of fluconazole flowability and its effect on dissolution from tablets and capsules / Melhoria da fluidez fluconazol e seu efeito sobre a dissolução de comprimidos e cápsulas

The aim of this work was to improve fluconazole flowability by wet granulation and to study the effect of granulation on drug dissolution from tablets and capsules. Fluconazole was submitted to a process of wet granulation in a high-speed granulator using Plasdone® K29/32 or K90. Flow properties of granules and dissolution profiles for tablets and capsules produced with them were determined. Fluconazole granules demonstrated better flowability, calculated by angle of repose and compressibility index data, compared with powder. Additionally, it was observed that the granulation process improved the dissolution efficiency (ED) of fluconazole from tablets and capsules, which could also suggest an increase in bioavailability. Higher dissolution efficiencies were achieved with Plasdone® K29/32.

O objetivo deste trabalho foi melhorar as características de fluxo do fluconazol com o emprego da granulação úmida e estudar o efeito desse processo na dissolução do fármaco em cápsulas e comprimidos. O fluconazol foi submetido ao processo de granulação úmida num granulador de alta velocidade empregando Plasdone K29/32 e K90. Foram determinadas as propriedades de fluxo dos grânulos e obtidos os perfis de dissolução de cápsulas e comprimidos obtidos com os granulados em estudo. Os grânulos de fluconazol apresentaram melhores características de fluxo após o processamento, demonstradas por meio das determinações do ângulo de repouso e do índice de compressibilidade, comparativamente à matéria-prima. Adicionalmente, observou-se que o processo de granulação melhorou a eficiência de dissolução (ED) do fluconazol nos comprimidos e cápsulas.

Cyproterone acetate quantification in human plasma by high-performance liquid chromatography coupled to atmospheric pressure photoionization tandem mass spectrometry. Application to a comparative pharmacokinetics study.

A specific, fast and sensitive high performance liquid chromatography (HPLC) coupled to atmospheric pressure photoionization (APPI) tandem mass spectrometric (LC-MS/MS) assay was developed for the determination of cyproterone (CYP) acetate (CAS 427-51-0) in human plasma. The retention times were 3.26 and 2.90 min for CYP acetate and its internal standard (I. S.) finasteride (FIN), respectively. The overall mean recovery, using liquid/liquid extraction, was found to be 109.0, 107.7 and 100.3%, for low, medium and high concentrations, respectively. Calibration curves were linear in the concentration range of 0.1-50.0 ng/ml, and the lower limit of quantification (LLOQ) was 0.1 ng/ml. The LLOQ, 0.1 ng/ml, was sensitive enough for detecting terminal phase concentrations of the drug. Inter-batch precision of the method ranged from 2.2 to 5.55%, while Inter-batch accuracy ranged from 95.5 to 100.0%. Intra-batch precision ranged from 1.8 to 5.6%, while Intra-batch accuracy ranged from 92.0 to 99.4% at concentrations of 0.3 ng/ml, 20.0 and 40.0 ng/ml. The developed method was applied to a bioequivalenc study of CYP acetate in a group of 44 female volunteers at a single oral dose of a 2 mg tablet, in a combination of ethinylestradiol/CYP acetate (0.25/2 mg). The plasma concentration of CYP acetate did not differ significantly after administration of both formulations (test formulation and the reference one). The geometric mean and respective 90% CI of CYP acetate test/reference percent ratios were 90.66% (84.39-97.40%) for Cmax and 96.20% (90.45-102.33%) for AUC0-t.

Abordagem estatística na validação retrospectiva do processo de fabricação de mistura polivitamínica / Statistical approach on retrospective validation process of polyvitaminic mixture

As exigências legais relativas à rotulagem de alimentos, em especial aqueles constituídos de polivitamínicos e minerais destinados a lactentes e crianças de primeira infância, requerem processos de fabricação que assegurem os valores declarados. Dessa forma, os fornecedores de mistura de polivitamínicos devem demonstrar que o processo de homogeneização dos pós conduz aos resultados esperados, conforme especificado. Os estudos de validação devem contemplar tal exigência e podem ser efetuados de forma prospectiva, concorrente ou retrospectiva. A abordagem retrospectiva, fundamentada na revisão e análise de registros históricos, pode ser efetuada no caso dos lotes considerados terem sido produzidos segundo os mesmos parâmetros operacionais e especificações. Assim sendo, o objetivo do presente trabalho foi validar o processo de fabricação de produto constituído pela mistura das seguintes vitaminas: cloridrato de piridoxina, nicotinamida, ácido ascórbico e pantotenato de cálcio, empregando abordagem retrospectiva. A análise estatística dos dados relativos ao teor de cada componente foi efetuada empregando gráficos de controle objetivando a avaliação da estabilidade do processo. Os índices de capacidade Cp e Cpk foram calculados após avaliação da distribuição dos dados empregando teste de Anderson-Darling. Todos os dados apresentaram distribuição normal exceto aqueles relativos ao teor de nicotinamida. Esses dados foram normalizados utilizando método proposto por Box-Cox (lambda igual a -4,24). Os índices de capacidade (Cpk) obtidos foram 1,01, 1,14, 1,21 e 1,96, respectivamente, para cloridrato de piridoxina, nicotinamida, ácido ascórbico e pantotenato de cálcio. Tais resultados indicaram que o processo de mistura de polivitaminas pode ser considerado validado. Além disso, investigações adicionais visando à centralização da concentração teórica, na faixa relativa aos limites de controle, devem ser conduzidas.

The regulatory demands related to the labeling of food, mainly the one constituted of polyvitaminics and minerals destined to lactants and children in their first infancy, require manufactured process that assure the labeled content. Therefore, the suppliers of polyvitaminics have to demonstrate that the process of powder homogeneity leads to expected results, according to the specifications. Thus, the objective of this work was to validate the process of the mixture of the following vitamins: pyridoxine hydrochloride, nicotinamide, ascorbic acid and calcium pantothenate, based on retrospective approach. Control charts were employed for the statistic analysis of the data related to the assay of each vitamin targeting the evaluation of the stability of the process. The capacity indexes, Cp and Cpk, were calculated after the evaluation of the data distribution using Anderson-Darling test. All data showed normal distribution, except for nicotinamide assay. This data was treated by a method proposed by Box-Cox (lambda equal -4.24) aimed at obtaining the normality of the data. The capacity indexes (Cpk) obtained were 1.01, 1.14, 1.21 and 1.96, respectively, for pyridoxine hydrochloride, nicotinamide, ascorbic acid and calcium pantothenate. Therefore, the process of polyvitaminic mixture can be considered validated.