The effect of supervision of residents on quality of care in five university-affiliated emergency departments

BACKGROUND: The purpose of the study was to compare the analgesic and side effects of two epidurally administered mixtures of bupivacaine and fentanyl with the same drug ratios. METHODS: One hundred patients scheduled for colorectal surgery were randomized to receive a thoracic epidural infusion of either bupivacaine 0.12% with fentanyl 2 micrograms/ml or bupivacaine 0.24% with fentanyl 4 micrograms/ml during 48 h postoperatively. The pumps were adjusted to keep the visual analogue scale (VAS) pain score at 3 or less (on a scale of 0-10) with a minimum of adverse effects. RESULTS: There were no statistically significantly differences between the two groups in VAS pain scores. The average VAS pain score resting varied between 0.5 and 1, and coughing between 1.9 and 3.4. One case of respiratory depression with breathing frequency 7 occurred in each group, but none of the patients required naloxone. One patient in the low concentration group developed partial motor weakness in both legs 36 h postoperatively. Equal drug amounts--bupivacaine 10.8-11 mg/h and fentanyl 18-18.4 micrograms/h--were given in both groups throughout the study. CONCLUSIONS: Both groups had low pain scores with few and comparable adverse effects. It thus seems that the volume is not important when mixtures of bupivacaine and fentanyl in the studies concentrations are infused epidurally at a low thoracic level. Practical reasons favour the higher concentration mixture.     

Apple Peel-Based Edible Film Development Using a High-Pressure Homogenization

ABSTRACT:  Biopolymer films were developed from apple peels of apple process co-products and their physical properties were determined. Apple peel-based films with glycerol (23%, 33%, and 44%[w/w, dry basis]) were prepared using high-pressure homogenization (HPH) at different levels of pressure (138, 172, and 207 MPa). An evaluation of the rheological properties (elastic modulus [ G '], viscous modulus [ G "], and viscosity) of the film-forming solutions was performed. For the apple peel films, the water sorption isotherms, the kinetics of water absorption, the water vapor permeability (WVP), the oxygen permeability (OP), and the tensile properties were determined. The  G ' and viscosity of the film-forming solutions decreased significantly with increasing processing pressure ( P  < 0.05). However, no difference was observed in  G " values at different homogenization pressures ( P  > 0.05). The viscosity decreased from 644 to 468 kPa·s as the pressure increased from 138 to 207 MPa at 90 °C. The monolayer water content of the apple peel films decreased with increasing content of glycerol from 23% to 33%. Further increase in glycerol content did not change the monolayer water content. The water diffusion coefficient of the films was highest at the intermediate level of glycerol content. The barrier properties (WVP and OP) of the films increased with increasing level of glycerol, while processing pressure did not influence the gas barrier properties. The films prepared at 207 MPa were less stiff and strong, but more stretchable than those prepared at 138 and 172 MPa.