The effect of an algorithm-based sedation guideline on the duration of mechanical ventilation in an Australian intensive care unit

To examine the effect of an algorithm-based sedation guideline developed in a North American intensive care unit (ICU) on the duration of mechanical ventilation of patients in an Australian ICU. The intervention was tested in a pre-intervention, post-intervention comparative investigation in a 14-bed adult intensive care unit. Adult mechanically ventilated patients were selected consecutively (n =322) The pre-intervention and post-intervention groups were similar except for a higher number of patients with a neurological diagnosis in the pre-intervention group. An algorithm-based sedation guideline including a sedation scale was introduced using a multifaceted implementation strategy. The median duration of ventilation was 5.6 days in the post-intervention group, compared with 4.8 days for the pre-intervention group (P = 0.99). The length of stay was 8.2 days in the post-intervention group versus 7.1 days in the pre-intervention group (P = 0.04). There were no statistically significant differences for the other secondary outcomes, including the score on the Experience of Treatment in ICU 7 item questionnaire, number of tracheostomies and number of self-extubations. Records of compliance to recording the sedation score during both phases revealed that patients were slightly more deeply sedated when the guideline was used. The use of the algorithm-based sedation guideline did not reduce duration of mechanical ventilation in the setting of this study.

Modelling the effect of shear history on activated sludge flocculation

The aim of this paper is to investigate the effect of shear history on activated sludge flocculation dynamics and to model the observed relationships using population balances. Activated sludge flocs are exposed to dramatic changes in the shear rate within the treatment process, as they pass through localised high and low mixing intensities within the aeration basin and are cycled through the different unit operations of the treatment process. We will show that shear history is a key factor in determining floc size, and that the floc size varies irreversibly with changes in shear rate. A population balance model of the flocculation process is also introduced and evaluated.

Adoption of a sedation scoring system and sedation guideline in an intensive care unit

Aim. The paper presents a study assessing the rate of adoption of a sedation scoring system and sedation guideline. Background. Clinical practice guidelines including sedation guidelines have been shown to improve patient outcomes by standardizing care. In particular sedation guidelines have been shown to be beneficial for intensive care patients by reducing the duration of ventilation. Despite the acceptance that clinical practice guidelines are beneficial, adoption rates are rarely measured. Adoption data may reveal other factors which contribute to improved outcomes. Therefore, the usefulness of the guideline may be more appropriately assessed by collecting adoption data. Method. A quasi-experimental pre-intervention and postintervention quality improvement design was used. Adoption was operationalized as documentation of sedation score every 4 hours and use of the sedation and analgesic medications suggested in the guideline. Adoption data were collected from patients' charts on a random day of the month; all patients in the intensive care unit on that day were assigned an adoption category. Sedation scoring system adoption data were collected before implementation of a sedation guideline, which was implemented using an intensive information-giving strategy, and guideline adoption data were fed back to bedside nurses. After implementation of the guideline, adoption data were collected for both the sedation scoring system and the guideline. The data were collected in the years 2002-2004. Findings. The sedation scoring system was not used extensively in the pre-intervention phase of the study; however, this improved in the postintervention phase. The findings suggest that the sedation guideline was gradually adopted following implementation in the postintervention phase of the study. Field notes taken during the implementation of the sedation scoring system and the guideline reveal widespread acceptance of both. Conclusion. Measurement of adoption is a complex process. Appropriate operationalization contributes to greater accuracy. Further investigation is warranted to establish the intensity and extent of implementation required to positively affect patient outcomes.

A neuro-mechanical model for interpersonal coordination

The present study investigates the coordination between two people oscillating handheld pendulums, with a special emphasis on the influence of the mechanical properties of the effector systems involved. The first part of the study is an experiment in which eight pairs of participants are asked to coordinate the oscillation of their pendulum with the other participant's in an in-phase or antiphase fashion. Two types of pendulums, A and B, having different resonance frequencies (Freq A=0.98 Hz and Freq B=0.64 Hz), were used in different experimental combinations. Results confirm that the preferred frequencies produced by participants while manipulating each pendulum individually were close to the resonance frequencies of the pendulums. In their attempt to synchronize with one another, participants met at common frequencies that were influenced by the mechanical properties of the two pendulums involved. In agreement with previous studies, both the variability of the behavior and the shift in the intended relative phase were found to depend on the task-effector asymmetry, i.e., the difference between the mechanical properties of the effector systems involved. In the second part of the study, we propose a model to account for these results. The model consists of two cross-coupled neuro-mechanical units, each composed of a neural oscillator driving a wrist-pendulum system. Taken individually, each unit reproduced the natural tendency of the participants to freely oscillate a pendulum close to its resonance frequency. When cross-coupled through the vision of the pendulum of the other unit, the two units entrain each other and meet at a common frequency influenced by the mechanical properties of the two pendulums involved. The ability of the proposed model to address the other effects observed as a function of the different conditions of the pendulum and intended mode of coordination is discussed.