Perioperative use of crystalloids in patients undergoing open radical cystectomy: balanced Ringer's maleate versus a glucose 5%/potassium-based balanced solution: study protocol for a randomized controlled trial

BACKGROUND The optimal crystalloid solution to use perioperatively in patients undergoing open radical cystectomy remains unclear. Many of the fluids used for intravenous hydration contain supraphysiologic concentrations of chloride, which can induce hyperchloremia and metabolic acidosis, resulting in renal vasoconstriction and decreased renal function. In addition, patients receiving less fluid and less sodium show faster recovery of gastrointestinal (GI) function after colonic surgery. METHODS AND DESIGN This is an investigator-initiated, single-center, randomized, controlled, parallel group trial with assessor-blinded outcome assessment, in the Department of Urology, University Hospital Bern, Switzerland. The study will involve 44 patients with bladder cancer scheduled for radical cystectomy and urinary diversion. The primary outcome is the duration between the end of surgery and the return of the GI function (first defecation). Secondary outcomes are fluid balance (body weight difference postoperatively versus preoperatively) and the incidence of kidney function disorders according to the Risk-Injury-Failure-Loss-End Stage Renal Disease (RIFLE classification). An equal number of patients are allocated to receive Ringerfundin® solution or a glucose/potassium-based balanced crystalloid solution as baseline infusion during the entire time that intravenous administration of fluid is necessary during the perioperative period. The randomized crystalloid solution is infused at a rate of 1 ml/kg/h until the bladder has been removed, followed by 3 ml/kg/h until the end of surgery. Postoperative hydration is identical in both groups and consists of 1,500 ml of the randomized crystalloid solution per 24 hours. Postoperative patient care is identical in both groups; patients are allowed to drink clear fluids immediately after surgery, and liquid diet is started on postoperative day 1, as well as active mobilization and the use of chewing gum. Body weight is measured daily in the morning. Time of first flatus and first defecation are recorded. DISCUSSION This trial assesses the benefits and harms of two different balanced crystalloid solutions for perioperative fluid management in patients undergoing open radical cystectomy with urinary diversion, with regard to return of GI function and effects on postoperative renal function. TRIAL REGISTRATION Current Controlled Trials ISRCTN32976792 (registered on November 21 2013).

Crystalloid strong ion difference determines metabolic acid-base change during acute normovolaemic haemodilution

Objective. To study the acid-base effects of crystalloid strong ion difference (SID) during haemodilution. Design. Prospective in vivo study. Setting. University laboratory. Subjects. Anaesthetised, mechanically ventilated Sprague-Dawley rats. Interventions. Rats were studied in seven groups of three. Each group underwent normovolaemic haemodilution with one of seven crystalloids, with SID values from 0 to 40 mEq/l. Six exchanges of 9 ml crystalloid for 3 ml blood were performed. Measurements and main results. [Hb] fell from 142+/-17 to 44+/-10 g/l (p

Masticatory afficiency in denture wearers with bilateral balanced occlusion and canine guidance

The maintenance of masticatory function is especially important for patients wearing complete dentures due to their limitations. Thus, the bilateral balanced occlusal concept is used to achieve greater masticatory efficiency. However, a critical review of the literature reveals that there is not sufficient scientific evidence to support bilateral balanced occlusion as the most appropriate occlusal concept in complete dentures. Therefore, the aim of this study was to evaluate the masticatory efficiency in complete dentures wearers with bilateral balanced occlusion and canine guidance. A double-blinded controlled crossover clinical trial was conducted. The sample was composed by 24 edentulous patients who wore sets of complete dentures with both occlusal concepts during equal periods of 3 months. Objective data were collected through the masticatory efficiency test performed by the colorimetric method with the beads, in which capsules of a synthetic material enclosing fuchsine-containing granules were used. Subjective data were recorded by patient's ratings of their chewing function. No significant statistical difference was found for masticatory efficiency (p=0.095) between the two occlusal concepts studied. The results suggest that bilateral balanced occlusion does not improve the masticatory efficiency in complete denture wearers.

Soft tissue profile in white Brazilian adults with normal occlusions and well-balanced faces

Objective: To analyze anteroposterior soft tissue facial parameters for a sample of white Brazilian adults and to compare these measurements with the values proposed for white North American adults. Materials and Methods: Facial profile photographs were taken of 59 white Brazilians (30 men and 29 women) with normal occlusions and balanced faces with ages ranging from 18 to 30 years. The independent Student's t-test (P < .05) was used to compare the soft tissue parameters of the Brazilians with those of the North Americans. Results: White Brazilian women presented a less protruded face compared with white American women except for the glabella region. White Brazilian women showed a smaller nasal projection, less protruded upper and lower lips, a more obtuse nasolabial angle, and a smaller projection of the B' point and chin than white American women. Conversely, the two male groups demonstrated less evident soft tissue profile differences, with the exception of the nose projection, which was smaller in white Brazilian men than in white American men. Conclusions: A universal standard of facial esthetic is not applicable to diverse white populations. Differences regarding the soft tissue profile features were found between white Brazilians and white Americans. These differences should be considered in the orthodontic/orthognathic surgery diagnosis and treatment plan for white Brazilians together with the patient's individual opinion and perception of beauty.

On the construction of nearest neighbour balanced row-column designs

Nearest–neighbour balance is considered a desirable property for an experiment to possess in situations where experimental units are influenced by their neighbours. This paper introduces a measure of the degree of nearest–neighbour balance of a design. The measure is used in an algorithm which generates nearest–neighbour balanced designs and is readily modified to obtain designs with various types of nearest–neighbour balance. Nearest–neighbour balanced designs are produced for a wide class of parameter settings, and in particular for those settings for which such designs cannot be found by existing direct combinatorial methods. In addition, designs with unequal row and column sizes, and designs with border plots are constructed using the approach presented here.

The line structure of balanced ternary designs with block size three, index three and rho(2) = 1, 2

In this paper necessary and sufficient conditions for a vector to be the fine structure of a balanced ternary design with block size 3, index 3 and rho(2) = 1 and 2 are determined with one unresolved case.

Comparative Analysis of the Performance of Various Crystalloid Cardioplegic Solutions on Myocardial Protection After Prolonged Cold Ischemia

Introduction. The quality and effectiveness of myocardial protection are fundamental problems to expand the use of and consequently good outcomes of donated hearts for transplantation. Objective. The purpose of this investigation was to compare the cardioprotective effects of Krebs-Henseleit, Bretschneider-HTK, St Thomas, and Celsior solutions using a modified nonrecirculating Langendorff column model of isolated perfused rat heart during prolonged cold storage. Materials and Methods. After removal 36 rat hearts underwent isolated perfusion into a Langendorff apparatus using Krebs-Henseleit solution for a 15-minute period of recovery; we excluded organs that did not maintain an aortic pressure above 100 m Hg. Subsequently, we equally distributed the hearts into four groups according to the cardioprotection solution; group 1, Krebs-Henseleit (control); group II, Bretschneider-HTK; group III, St Thomas; and group IV, Celsior. Each heart received the specific cardioplegic solution at 10 C for 2-hour storage at 20 C, before a 15 minutes perfusion with Krebs-Henseleit solution for recovery and stabilization. After 60 additional minutes of perfusion, every 5 minutes we determined heart rate (HR), coronary flow (CF), left ventricular systolic pressure (LVSP), and positive and negative peak of the first derivative of left ventricular pressure (+dP/dt and dP/dt, respectively). Results. Comparative analysis by Turkey`s test showed the following performances among the groups at 60 minutes of reperfusion: HR: II = IV > III > I; CF: II = IV > I = III; LVSP: IV > I = II = III; +dP/dt: IV > I = II = III; and dP/dt: IV = II > I = II. Conclusion. Cardioprotective solutions generally used in clinical practice are not able to avoid hemodynamic alterations in hearts exposed to prolonged ischemia. Celsior solution showed better performance than Bretschneider-HTK, St Thomas, and Krebs-Henseleit.

Proportionally balanced designs: Some further results and general constructions

Proportionally balanced designs were introduced by Gray and Matters in response to a need for the allocation of markers of the Queensland Core Skills Test to have a certain property. Put simply, markers were allocated to pairs of units in proportions that reflected the relative numbers of markers allocated in total to each unit. In this paper, the first author extends the theoretical results relating to such designs and provides further instances, and two general constructions, in the case that the design comprises blocks of precisely two sizes.

Two-dimensional balanced sampling plans excluding contiguous units

A balanced sampling plan excluding contiguous units (or BSEC for short) was first introduced by Hedayat, Rao and Stufken in 1988. These designs can be used for survey sampling when the units are arranged in one-dimensional ordering and the contiguous units in this ordering provide similar information. In this paper, we generalize the concept of a BSEC to the two-dimensional situation and give constructions of two-dimensional BSECs with block size 3. The existence problem is completely solved in the case where lambda = 1.

Back to (non)-Basics: Recent developments in neutral and charge-balanced glycosidase inhibitors

Certain glycosidase inhibitors possess potent antiviral, antitumour and antidiabetic properties. Glyconic acid lactones, the earliest glycosidase inhibitors identified, have planar anomeric carbons that mimic the transition state of glycoside hydrolysis. Other classes include lactams, glycals, epoxides, halides and sulfonium ions, the latter based on the natural product salacinol from an antidiabetic herb.

Balanced scorecard (BSC): uma vis??o metodol??gica para o acompanhamento de sua implementa????o

A Embrapa, na inten????o de operacionalizar a gest??o dos seus planos estrat??gicos (Plano Diretor da Embrapa ??? PDE e Planos Diretores das Unidades ??? PDUs) desenvolveu a metodologia Mogest para a implementa????o do seu Modelo de Gest??o Estrat??gica (MGE), no ??mbito corporativo e de suas 40 unidades de neg??cio, com base na modifica????o do m??todo Balanced Scorecard ??? BSC, de Kaplan. Posteriormente, ap??s a implementa????o dos MGEs, no per??odo de 1999 at?? os dias atuais, inicia-se e desenvolve-se a fase de acompanhamento por meio da elabora????o do m??todo MGE/Acompanha. Este trabalho aborda, de forma modificada, o uso do diagrama elaborado por Norton, apud Coutinho (2002), para acompanhar/avaliar a implementa????o do BSC para uma organiza????o orientada ?? estrat??gia, inserido no m??todo MGE/Acompanha (2000), elaborado pela Equipe MGE e aplicado em uma das unidades de neg??cio da Embrapa. Os resultados mostraram a efici??ncia do m??todo e proporcionaram a internaliza????o do conceito ???painel de bordo???, desenvolvido no software Oracle BSC (OBSC).

Balanced Scorecard: adequa????o para a gest??o estrat??gica nas organiza????es p??blicas

Os ??rg??os da Administra????o P??blica Federal (APF) ter??o maior ??xito no alcance de seus objetivos estrat??gicos, investindo na implanta????o de um modelo de gest??o estrat??gica, adaptado para o ambiente de governo, mantendo o alinhamento estrat??gico com os ??rg??os normativos e de controle. Este artigo tem como objetivo apresentar um modelo de gest??o estrat??gica, adaptado a partir das perspectivas do Balanced Scorecard (BSC) desenvolvido pelos professores da Harvard Business School, Robert Kaplan e David Norton, em 1992, para ser utilizado pelos ??rg??os da APF; tal modelo mant??m um alinhamento estrat??gico organizacional com as recomenda????es do Tribunal de Contas da Uni??o (TCU). O modelo ir?? permitir a gest??o estrat??gica a partir da identifica????o dos objetivos estrat??gicos, metas, indicadores e a????es referentes ??s perspectivas do Balanced Scorecard, o que permitir?? o equil??brio entre os indicadores de efici??ncia no acompanhamento das metas de cada ??rg??o da APF, colaborando para uma gest??o estrat??gica integrada, que venha a modernizar a gest??o p??blica, agilizando as tomadas de decis??es e a troca de informa????es.

O balanced scorecard e a gestão ambiental: um estudo no sector público e privado português

Os aspectos sociais e ambientais são reconhecidos cada vez mais como estratégicos na organização, na medida que constituem novas oportunidades de criação de valor mediante o desenvolvimento de vantagens competitivas capazes de diferenciar as empresas dos seus concorrentes actuais e potenciais. A adopção e o desenvolvimento de novas tecnologias, estratégias e instrumentos de gestão das questões sociais e ambientais parece ser hoje uma matéria indiscutível. No entanto, são várias as dificuldades encontradas na quantificação económica e financeira das políticas de desenvolvimento sustentável, levando ao desenvolvimento ou adaptação de ferramentas de gestão, como é o caso do Balanced Scorecard (BSC). Assim, no sentido de averiguarmos se as organizações públicas e privadas portuguesas incluem nos seus scorecards indicadores sociais e ambientais e se existe relação entre a utilização do BSC e os sistemas de certificação ambiental enviamos um questionário a 591 organizações públicas e 549 organizações privadas portuguesas, com uma taxa de resposta de 31,3%. Os resultados obtidos permitem concluir que a maioria dos inquiridos inclui indicadores sociais e ambientais nos seus scorecards e que as empresas certificadas em termos ambientais utilizam mais o BSC do que as não certificadas.

O balanced scorecard como ferramenta de gestão estratégica no setor hoteleiro

O setor hoteleiro opera num mercado com transformações acentuadas, ressaltando a necessidade de utilização de técnicas de gestão mais sofisticadas para medir, avaliar e melhorar o seu desempenho. O Balanced Scorecard (BSC) tem sido destacado na literatura como uma poderosa ferramenta de gestão estratégica para enfrentar a forte concorrência sentida nos distintos setores de atividade. A adoção desta ferramenta ainda está relativamente pouco documentada no setor hoteleiro, pelo que se impõe a necessidade de desenvolver investigação sobre esta temática. Assim, este artigo tem como objetivo proporcionar algumas ideias sobre a importância e necessidade da implementação de metodologias de avaliação de desempenho e de gestão estratégica no setor hoteleiro, destacando o caso particular da ferramenta BSC.

O Balanced Scorecard como Ferramenta de Gestão Estratégica da Qualidade

A melhoria do desempenho organizacional tem sido um dos principais objetivos das organizações. A procura da racionalização na gestão dos recursos e a necessidade de melhorar a qualidade dos produtos e serviços prestados motivaram a aplicação nas organizações públicas e privadas da ferramenta de Contabilidade de Gestão Balanced Scorecard (BSC) e do modelo de excelência EFQM (European Foundation for Quality Management). O EFQM e o BSC são dois modelos de gestão amplamente aceitos na gestão empresarial atual para alcançar a inovação, a aprendizagem e a melhoria contínua. Assim, este artigo tem como objetivo proporcionar algumas ideias acerca da importância do desenvolvimento de programas de gestão da qualidade total (TQM), destacando as principais características, as semelhanças e as diferenças entre os modelos BSC e EFQM, bem como apresentar um modelo de integração das duas filosofias de gestão.