Discharge Criteria Research Articles

High-flow humidified oxygen as an early intervention in children with acute severe asthma: a feasibility randomised controlled trial.

Treating children with acute severe asthma (ASA) who fail to respond to first-line inhaled bronchodilators is problematic: use of intravenous agents is inconsistent and side-effects are common. High-flow humidified oxygen (HiFlo) has shown promise in other respiratory conditions and is increasingly used in ASA, but with little evidence. We conducted a feasibility randomised controlled trial with deferred consent to assess early HiFlo in children aged 2-11 years with ASA not responding to "burst" therapy (high-dose inhaled salbutamol ± ipratropium). Children with Paediatric Respiratory Assessment Measure (PRAM) score 5+ after "burst" were randomised to commence HiFlo or follow standard care. Candidate primary outcomes assessed were treatment failure requiring escalation, and time to meeting hospital discharge criteria. The target was met despite coronavirus disease 2019 pandemic disruption: 56 children were randomised across four sites, with deferred consent received in 50 out of 56 (89%), and mean recruitment rate 1.1 per site per month. 28 were allocated early HiFlo and 22 standard care. Data collection was complete for both candidate primary outcomes. Treatment failure requiring escalation occurred in 18 of 28 children (64%) in the HiFlo arm and in 19 of 22 (86%) in the standard care arm. Median (interquartile range) time from randomisation to meeting discharge criteria was 29.3 h (21.8-43.7 h) in the HiFlo arm and 36.8 h (24.1-46.3 h) in the standard care arm. HiFlo in childhood ASA is a potentially promising intervention whose use is increasing despite lack of evidence. A definitive randomised controlled trial to assess its effectiveness is required and appears to be feasible.

External validation of the SHA2PE score and its comparison to the Oakland score for the prediction of safe discharge in patients with lower gastrointestinal bleeding.

The growing incidence of lower gastrointestinal bleeding (LGIB) is leading to a rise in-hospital admissions even though most LGIB episodes are self-limiting. The Oakland and SHA2PE scores were designed to identify patients best suited to outpatient care. Our aim is explore the validity of the SHA2PE score and compare both of these scores in terms of predictiveness of safe discharge. Retrospective observational study of LGIB patients admitted to a tertiary hospital between June 2014 and June 2019. Safe discharge was defined as the absence of all the following: blood transfusion, haemostatic intervention, re-bleeding, in-hospital death, and re-admission due to LGIB within 28days after discharge. From 595 hospital admissions for LGIB, 398 episodes were included. Fifty-four per cent met safe discharge criteria, with these cases being younger, with a lower score in the Charlson's index and significantly higher haemoglobin concentration upon arrival. The performance of both scores was good, with an AUC for the Oakland score of 0.85 (95% CI 0.82-0.89) and of 0.797 (95% CI 0.75-0.84) for the SHA2PE score. The Oakland score performed better in terms of prediction of safe discharge, with a positive predictive value and specificity of 100% when a cut-off value of ≤ 8 points was used; however, only a minority of patients might benefit from its implementation given its low sensitivity. Almost half of the patients admitted for LGIB met criteria for safe discharge. However, the available indexes only allow for the identification of a small proportion of those patients candidates for outpatient care.

Open-source simulation platform for air source heat pump integrated with thermal energy storage

This article introduces a modular simulation platform for assessing thermal energy storage (TES) integrated with air source heat pumps (ASHP). The Python platform is an open-source library that includes classes for modeling air-air and air-water heat pumps, TES devices, and the heating load of residential buildings. To validate the ASHP model, the study utilized experimental data obtained from a commercial heat pump evaluated at the National Renewable Energy Laboratory (NREL). The results indicate a mean deviation of 0.7% for COP across the operating range, with a maximum relative deviation of 12.6%. In terms of system heating capacity, the model had an average deviation of 4.3% compared to experimental results, with a maximum deviation of 8.2%. Three classes were implemented for modeling distinct types of TES devices: a generic TES based on energy balances, a sensible isothermal water tank, and a stratified water tank. Details of the mathematical models are provided, along with their respective strengths and limitations. An example is provided showcasing the integration of a residential 10 kWh thermal storage unit with an ASHP operating in Denver, CO. The comparison of two different discharge criteria for the TES unit highlights the importance of control strategies in the system performance.

Using Clinical-based Discharge Criteria to Discharge Patients After Endoscopy Procedures Under Drug-induced Intravenous Sedation in the Outpatient Care Unit: An Observational Study

PurposeTo verify the feasibility of clinical-based discharge (CBD) criteria and to find out the reasons for the delayed discharge of outpatients after endoscopy procedures under drug-induced intravenous sedation. DesignA prospectively observational study conducted at a tertiary endoscopy center. MethodsMedical records were collected from outpatients admitted for endoscopy procedures under drug-induced intravenous sedation from June 1, 2021 to December 30, 2021. Patients were scheduled to discharge at least 30 minutes based on the time-based discharge (TBD) method. Postanesthetic discharge scoring system in the outpatient post-anesthesia care unit (PACU) recorded the time of patients discharged home on the CBD criteria. Postoperative complications were recorded in the PACU and within 24 hours after discharge. Multivariate analysis was applied to identify the factors relating to late discharges. Findings10,597 patients were safely and successfully discharged home, and we were informed of no serious emergency or accidental readmissions to the hospital. The mean CBD time (21.77 ± 11.35 minutes) was compared with the TBD time (30 minutes) and actual TBD discharge time (61.56 ± 4.93 minutes), which were statistically significant, without changes in the patient's vital signs (P < .01). Primarily, further univariate and multivariate analyses showed that abdominal pain and fatigue were key factors accountable for delay in PACU discharge (P < .05). ConclusionsThe study concluded that in patients undergoing ambulatory endoscopy procedures with drug-induced intravenous sedation, discharge times based on physiological scoring systems can efficiently and safely guide ambulatory patient discharge as compared to the traditional TBD method. Postoperative fatigue and pain were the main factors affecting patients discharge associated with a relatively long PACU length of stay.

Improving Accessibility to Outpatient Department Through Reduction of Third Next Available Appointment in Tertiary Hospital in Taif, Saudi Arabia

Background The Outpatient Department (OPD) of Al Hada Armed Forces Hospital - Taif Region (AHAFH) plays a critical role in providing specialized medical services to a diverse population in Taif region, Saudi Arabia. The hospital faces the challenge of ensuring timely access to a comprehensive array of 40 specialized services and subspecialties, supported by 120 rooms in the OPD. This article outlines a significant understanding of the patient flow process and queuing mechanism in the context of the OPD and the dynamics of supply and demand. Local Problem Our project was initiated during the last few weeks of fourth quarter 2020, which revealed a concerning trend of increasing the third next available appointment (TNAA), surpassing the optimal target of &lt;14 days. Methods The study used pre-test and post-test monitoring of the TNAA. Patients’ categories of referral were identified as urgent and routine. We also established a referral and discharge criteria for each clinic specialty and reminder messages on patient appointments 24 hours and 48 hours prior to their actual appointment. Interventions The Plan-Do-Study-Act (PDSA) model for improvement was utilized to implement action plans and interventions to address the increase of TNAA (in days) in the OPD. Weekly huddles were conducted to monitor project progress, action plans, data, and challenges. Results During the intervention phase, notable changes were observed in the control chart, including shifts in TNAA mean decreasing from 9.4 days to 5.6 days after the implementation of four PDSA cycles. Moreover, the average TNAA in each quarter showed consistent reduction in TNAA, with an average of six days in Q1 2022. Conclusions The study sheds light on the complexity of managing the patient flow and access in an outpatient setting. By implementing effective strategies and continuous and vigilant monitoring of the outcomes, outpatient departments can strive to ensure that patients receive specialized care in a timely manner.

Hybrid and combined electro-oxidation and peroxi-coagulation processes in effective treatment of textile reverse osmosis concentrate

In this study, the treatment of reverse osmosis concentrate from a textile industry by hybrid and combined electrochemical processes was investigated. Firstly, the operating parameters of single electro-oxidation (EO) and peroxi-coagulation (PC) processes were optimized, and then the performances of hybrid EO-PC, PC-EO, and combined EO/PC processes were evaluated in pollutant removal under optimum conditions. Optimum conditions for processes were determined as pH: 5, 22.5 mA/cm2, inter-electrode distance: 3 cm, 120 min. Removal efficiency of chemical oxygen demand (COD) for the optimum conditions of EO, PC, EO-PC, PC-EO, and EO/PC were 78.5 %, 73.0 %, 73.8 %, 82.0 %, and 91.9 %, respectively. Specific energy consumption of EO, PC, EO-PC, PC-EO, and EO/PC processes were 61.9, 74.0, 64.0, 60.9, and 56.8 kWh/kg COD, respectively. The EO/PC process was the most effective and feasible one among applied single, hybrid, and combined processes. With the EO/PC, reverse osmosis concentrate met the receiving environment discharge criteria.

Clinical decision-making before discharge in hospitalized persons with schizophrenia: a Spanish Delphi expert consensus.

The care of people with schizophrenia (PWS) is usually provided in an outpatient setting by community mental health teams. However, PWS frequently require inpatient treatment because of a wide array of clinical, personal and/or social situations. Unfortunately, to our knowledge, there are no guidelines available to help psychiatrists in the decision-making process on hospital discharge for PWS. The aim of this project was to develop an expert consensus on discharge criteria for PWS after their stay in an acute inpatient psychiatric unit. Using a modified Delphi method a group of 42 psychiatrists throughout Spain evaluated four areas of interest regarding this issue: clinical symptomatology, treatment-related factors, follow-up health care units after discharge, and physical health and monitoring. After two rounds, among the 64 statements, a consensus was reached for 59 (92.2%) statements. In three (17.7%) of the 17 statements on 'clinical symptomatology' and 2 (13.3%) of the 15 statements on 'follow-up health care units after discharge', a consensus was not reached; in contrast, a consensus was reached for all statements concerning 'treatment-related factors' and those concerning 'physical health and monitoring'. The consensus results highlight the importance for discharge of the control of symptoms rather than their suppression during admission and of tolerability in the selection of anantipsychotic. Although there is a lack of relevant data for guiding the discharge of PWS after hospitalization in an acute inpatient psychiatric unit, we expect that this consensus based on expert opinion may help clinicians to take appropriate decisions.

Probiotic Compounds Enhanced Recovery after Surgery for Patients with Distal Gastric Cancer: A Prospective, Controlled Clinical Trial.

Enhanced recovery after surgery (ERAS) for radical distal gastrectomy needs to be improved urgently. We investigated the effects of probiotic compounds (including Lactobacillus plantarum, L. rhamnosus, L. acidophilus, and Bifidobacterium animalis subsp.lactis) on enhance recovery after gastrectomy. The patients in this prospective study were divided into probiotic group (PG group, n = 36) and placebo group (CG group, n = 38), taking corresponding capsule according to the protocol during the perioperative period. We compared the trends in perioperative hematologic findings and the postoperative outcomes. Patients' feces were collected for bacterial 16S rRNA sequencing. Patients were followed up at 1 month postoperatively. After the application of probiotics, the patients' postoperative inflammatory response level was reduced, and the trend of postoperative NLR decrease was significantly faster in the patients of the PG group than in the CG group (P = 0.047, partial η2 = 0.054). The trend of postoperative increase in serum albumin concentration in the patients of the PG group was significantly better than that in the CG group (P = 0.016, partial η2 = 0.078). In addition, patients in the PG group met discharge criteria earlier postoperatively and had fewer medical expenses. The quality of life of PG group was improved postoperatively. Postoperative inflammation-related markers, including the ratio of Firmicutes/Bacteroidetes, were increasing in untreated patients. In addition, the postoperative microbial diversity and abundance in the PG group remained stable. Probiotic compounds can reduce the inflammatory response after gastrectomy and enhance the recovery of the DGC patients by maintaining the stability of the gut microbiota.

The current state of intensive care unit discharge practices - Results of an international survey study.

Increasing pressure on limited intensive care capacities often requires a subjective assessment of a patient's discharge readiness in the absence of established Admission, Discharge, and Transfer (ADT) guidelines. To avoid suboptimal care transitions, it is important to define clear guidelines for the admission and discharge of intensive care patients and to optimize transfer processes between the intensive care unit (ICU) and lower care levels. To achieve these goals, structured insights into usual ICU discharge and transfer practices are essential. This study aimed to generate these insights by focusing on involved stakeholders, established processes, discharge criteria and tools, relevant performance metrics, and current barriers to a timely and safe discharge. In 2022, a structured, web-based, anonymous cross-sectional survey was conducted, aimed at practicing ICU physicians, nurses, and bed coordinators. The survey consisted of 29 questions (open, closed, multiple choice, and scales) that were divided into thematic blocks. The study was supported by several national and international societies for intensive care medicine and nursing. A total of 219 participants from 40 countries (105 from Germany) participated in the survey. An overload of acute care resources with ~90% capacity utilization in the ICU and the general ward (GW) leads to not only premature but also delayed patient transfers due to a lack of available ward and intermediate care (IMC) beds. After multidisciplinary rounds within the intensive care team, the ICU clinician on duty usually makes the final transfer decision, while one-third of the panel coordinates discharge decisions across departmental boundaries. By the end of the COVID-19 pandemic, half of the hospitals had implemented ADT policies. Among these hospitals, nearly one-third of the hospitals had specific transfer criteria established, consisting primarily of vital signs and laboratory data, patient status and autonomy, and organization-specific criteria. Liaison nurses were less common but were ranked right after the required IMC capacities to bridge the care gap between the ICU and normal wards. In this study, 80% of the participants suggested that transfer planning would be easier if there was good transparency regarding the capacity utilization of lower care levels, a standardized transfer process, and improved interdisciplinary communication. To improve care transitions, transfer processes should be managed proactively across departments, and efforts should be made to identify and address care gaps.

Implementation of outpatient hip and knee arthroplasty in a multicenter public healthcare setting.

Length of hospital stay after hip and knee arthroplasty is about 1 day in Denmark with few patients discharged on the day of surgery. Hence, a protocol for multicenter implementation of discharge on day of surgery has been instituted. We aimed to describe the implementation of outpatient hip and knee arthroplasty in a multicenter public healthcare setting. We performed a prospective multicenter study from 7 public hospitals across Denmark. Patients were screened using well-defined in- and exclusion criteria and were discharged on day of surgery when fulfilling functional discharge criteria. The study period was from September 2022 to February 2023 with variable start of implementation. Data from the same centers in a 6-month period before the COVID pandemic from July 2019 to December 2019 was used for baseline control. Of 2,756 primary hip and knee arthroplasties, 37% (95% confidence interval [CI] 35-39) were eligible (range 21-50% in centers) and 52% (range 24-62%) of these were discharged on day of surgery. 21% (CI 20-23) of all patients (eligible and non-eligible) were discharged on day of surgery with a range of 10-31% within centers. This was an additional 15% (CI 13-17, P < 0.001) compared with patients discharged in the control period (6% in 2019). We found it possible to perform outpatient hip and knee replacement in 21% of patients in a public healthcare setting, probably to be increased with further center experience.

Low back pain management in primary healthcare: findings from a scoping review on models of care

IntroductionModels of care (MoCs) describe evidence-informed healthcare that should be delivered to patients. Several MoCs have been implemented for low back pain (LBP) to reduce evidence-to-practice gaps and increase the...

Administration of Low-dose Hyperbaric Bupivacaine for Spinal Anesthesia in the Setting of Outpatient Arthroplasty.

With the rise of ambulatory surgery centers (ASCs), rapid motor and sensory recovery after anesthesia is crucial. The purpose of this study was to evaluate the safety and efficacy of low-dose single-shot hyperbaric bupivacaine for spinal anesthesia (SA) for patients undergoing outpatient arthroplasty. Data were reviewed from a single ASC from 2018 to 2020 for two arthroplasty-trained surgeons for all patients with primary arthroplasties that had administration of low-dose hyperbaric bupivacaine. Data collected from the ASC records were then further evaluated for total spinal block time, length of blockade, time to discharge criteria, visual analog scale (VAS) scores, and time to discharge. Two hundred twenty-seven patients undergoing 244 primary arthroplasties received SA with low-dose hyperbaric bupivacaine. The volume of 0.75% bupivacaine varied: 115 patients received 0.8 mL (6 mg), 111 patients received 1.0 mL (7.5 mg), and 17 patients received 1.2 mL (9 mg). Total SA time averaged 144 minutes with a mean of 30 minutes from post anesthesia care unit arrival to motor recovery. The mean time from post anesthesia care unit arrival to discharge criteria was 89 minutes. The average VAS at discharge was 1.44; the average VAS on POD1 was 3.0. No episodes of urinary retention and no reports of transient neurologic symptoms were noted in the study population. Low-dose, single-shot hyperbaric bupivacaine SA is an effective option in the ASC for arthroplasty, providing a fast return of motor function, facilitating rapid discharge, and is safe with a relatively low-risk profile.

Implementation of a day-stay joint replacement pathway in an Australian regional public hospital: A descriptive study.

To describe the implementation, feasibility and safety of a day-stay joint replacement pathway in a regional public hospital in Australia. Over a 12-month pilot period, a prospective descriptive analysis of consecutive patients undergoing total knee and hip arthroplasty was conducted. The number of eligible day-stay patients, proportion of successful same-day discharges and reasons for same-day failure to discharge were recorded. Outcome measures captured for all joint replacements across this period included length of stay (LoS), patient reported outcomes, complications and patient satisfaction. The implementation pathway as well as patient and staff identified success factors derived from interviews were outlined. Forty-one/246 (17%) patients booked for joint replacement surgery were eligible for day-stay and 21/41 (51%) achieved a successful same-day discharge. Unsuccessful same-day discharges were due to time of surgery too late in the day (7/20), no longer meeting same-day discharge criteria (11/20) and declined discharge same-day (2/20). Over the implementation period 65% (162/246) of all patients were discharged with a LoS of 2 days or less. Patient satisfaction for the day-stay pathway was high. Complication rates and patient-reported outcomes were equivalent across LoS groups. The day-stay joint replacement surgery pathway was feasible to implement, safe and acceptable to patients. Day-stay pathways have potential patient and system-level efficiency benefits.

Features of Management with Biological Waste of Patients after Radioiodotherapy in Different Countries

The analysis of existing in different countries of the world approaches to the management of liquid radioactive waste (LRW) of patients generated during radionuclide therapy with 131I is carried out. The regulated values are given, on the basis of which criteria for the discharge of LRW containing 131I into a centralized urban sewage system are established for medical organizations in a number of countries. The most common strategies for the management of patients’ LRW after radiotherapy are considered. Compliance with the discharge criteria may be achieved by delaying radioactive effluents for decay in specially designed delay tanks or by its dilution with inactive effluents of a medical organization at the discharge point. The chosen strategy should be determined by the parameters characterizing the discharges of a particular organization, so as not to affect the capacity of the department and, as a result, the availability of the radiotherapy procedure to patients in the country. Defining a case-by-case treatment strategy or using the two strategies considered in combination with each other may be a more effective practice for treating patients with LRW. The latter may be relevant for medical organizations in Russia, where the discharge criteria is conservative, and at the legal level it is prohibited to use another strategy for handling LRW, except for storage for decay.

Selection of Key Socio-Economic Factors for Establishing Relese Criteria Patients after Radioioidine Therapy

Purpose: To assess the association between socioeconomic factors and release criteria after iodine-131 radionuclide therapy in different countries. Material and methods: 15 countries and 104 socioeconomic characteristics were selected for the study. The association between characteristics and the residual activity level at which a patient may be released for different countries was established according to the value of Pearson product moment correlation coefficient (r&gt;0.3). A linear regression model was constructed for the selected characteristics using Microsoft Excel analysis package. The model was used to calculate the acceptable activity level at which a patient may be released for Russia. Results: A fundamental difference between the model used for calculation of release criteria after radionuclide therapy with iodine-131 in Russia and the model recommended by the Nuclear Regulatory Commission was shown: the use of the effective half-life in the second one. Replacing the physical halflife by the effective half life allows increasing the discharge criteria of patients after therapy with Na131I by 30 %. A moderate correlation was found between the value of acceptable activity at patient discharge after radioactive iodine therapy and the following socioeconomic characteristics: scientific activity (r=0.32), quality of higher education (r=0.36), Global Health Security Index (r=0.34), length of roads (r=0.36), population growth rate (r=0.36), average housing area (r=0.38), and average salary per year (r=–0.33). A linear regression was constructed using the factors listed above. The following recommended value of activity and effective dose rate at patient discharge from hospital was obtained: 0.6 GBq and 30 µSv/hour. Conclusion: The study demonstrates that the release criteria for radioactive iodine therapy used in the Russian Federation (0.4 GBq and 20 µSv/h) do not correspond to the standard of living achieved in Russia, which is reflected by the socio-economic factors considered in the paper. The proposed arguments raise the task of revising the currently used model with a consequent increase in the discharge criteria. It was observed that the release criteria in the world are independent of some factors that are directly related to population exposure. The need to develop a unified objective algorithm for establishing release criteria, which takes into account different socio-economic status of states and can be applied for different radionuclides and radiopharmaceuticals, including innovative ones, has been identified.

Efficacy and safety of ciprofol for sedation in outpatient gynecological procedures: a phase III multicenter randomized trial.

Ciprofol (also known as cipepofol and HSK3486), is a compound similar to propofol in chemical structure and hypnotic effect. Herein we evaluated the efficacy and safety of ciprofol for sedation in outpatient gynecological procedures. This phase III multicenter randomized trial with a non-inferiority design was conducted in nine tertiary hospitals. We enrolled 135 women aged 18-65 years who were scheduled for ambulatory gynecological procedures. Patients were randomly assigned to receive either ciprofol (0.4 mg/kg for induction and 0.2 mg/kg for maintenance) or propofol (2.0 mg/kg for induction and 1.0 mg/kg for maintenance) sedation in a 2:1 ratio. Patients and investigators for data collection and outcome assessment were blinded to study group assignments. The primary outcome was the success rate of sedation, defined as completion of procedure without remedial anesthetics. The non-inferiority margin was set at -8%. Secondary outcomes included time to successful induction, time to full awake, time to meet discharge criteria, and satisfaction with sedation assessed by patients and doctors. We also monitored occurrence of adverse events and injection pain. A total of 135 patients were enrolled; 134 patients (90 patients received ciprofol sedation and 44 patients propofol sedation) were included in final intention-to-treat analysis. The success rates were both 100% in the two groups (rate difference, 0.0%; 95% CI, -4.1 to 8.0%), i.e., ciprofol was non-inferior to propofol. When compared with propofol sedation, patients given ciprofol required more time to reach successful induction (median difference [MD], 2 s; 95% CI, 1 to 7; p < 0.001), and required more time to reach full awake (MD, 2.3 min; 95% CI, 1.4 to 3.1; p < 0.001) and discharge criteria (MD, 2.3 min; 95% CI, 1.5 to 3.2; p < 0.001). Fewer patients in the ciprofol group were dissatisfied with sedation (relative risk, 0.21; 95% CI, 0.06 to 0.77; p = 0.024). Patients given ciprofol sedation had lower incidences of treat-emergent adverse events (34.4% [31/90] vs. 79.5% [35/44]; p < 0.001) and injection pain (6.7% [6/90] vs. 61.4% [27/44]; p < 0.001). Ciprofol for sedation in ambulatory gynecological procedures was non-inferior to propofol, with less adverse events and injection pain. ClinicalTrials.gov, identifier NCT04958746.

Impact of discharge criteria on the length of stay in preterm infants: A retrospective study in Japan and Finland

BackgroundTo shorten the hospital stay in preterm infants, it is important to understand the factors extending the length of stay. AimsTo understand how different discharge criteria affect the length of stay in preterm infants. Study designA retrospective comparison study. SubjectsPreterm infants born at 28 to 31 gestational weeks in 2020–2021 in a Level IV NICU in Japan (n = 22) and a Level III NICU in Finland (n = 49). Outcome measuresWe compared the most common last discharge criteria and the postmenstrual age (PMA) between the two NICUs. The potential extending effects of each discharge criterion on the length of stay were also evaluated. The discharge criteria were classified into six categories: temperature, respiration, feeding, examination, weight limit, and family readiness. ResultsThe PMA at discharge was significantly higher in Japan than in Finland: median 40.7 (interquartile range 39.9–41.3) vs. 37.9 (36.9–39.0) weeks; r = 0.58; p < 0.001. The most common last discharge criterion was the family criterion in Japan (n = 19; 86 %) and the respiration criterion in Finland (n = 43; 88 %). In Japan, the length of stay was extended by 7.9 (standard deviation [SD] 7.0) days due to a lack of family readiness for discharge and 8.7 (SD 8.7) days due to not having discharged home with a feeding tube as a common practice. ConclusionsThe length of stay of preterm infants in Japan could be notably reduced by supporting the parents' earlier readiness for discharge and allowing tube feeding at home.

Isokinetic testing protocol-based discharge criteria after anterior ligament reconstruction: A systematic review

BACKGROUND: The return to activities and sports after the anterior cruciate ligament (ACL) reconstruction is a critical decision. OBJECTIVE: To verify the most used elements during the isokinetic evaluation for discharge after ACL reconstruction. METHODS: Systematic review (PROSPERO CRD42021224433). Research in the literature: PubMed, Medline, SciELO, Lilacs, CENTRAL, PEDro, Web of Science and Embase, in February 2022. Studies that performed isokinetic evaluation during the discharge period in male patients aged 18 to 59 years after ACL reconstruction. Descriptive synthesis on the most used parameters during isokinetic evaluation as a discharge criteria after ACL reconstruction. RESULT: Twenty-three studies involving 1,792 participants were included. Medium and high quality evidence identified that most isokinetic evaluations targeted only muscle strength after rehabilitation of the ACL (peak moment). CONCLUSION: The most used elements during the isokinetic evaluation were: angular velocity of 60∘/s, 1 set of 5 repetitions, concentric mode and peak moment.

Who is the Expert in Change? Exploring the Role of Therapists in Client Change Processes: A Systemic Therapy Case Study

ABSTRACT This case study focuses on the therapeutic change process, highlighting the crucial role of therapists in facilitating it. Rooted in constructivist epistemology, we employed an integrative systemic model. Our exploration centers on the presence or absence of system restructuring within the therapeutic process. We delve into the differing perceptions of change between the therapist and the client, particularly regarding the criteria for therapy discharge. A significant aspect of our analysis is the discussion on the authenticity of change. We examine the dual role of therapists as expert observers and participants in the therapy, navigating between “objective” and subjective perspectives in their interventions. This includes assessing various levels of change, first and second order. We highlight the client’s autonomy in defining the reality and authenticity of change, advocating for a balance between the therapist’s guidance and the client’s agency. Additionally, we emphasize the therapist’s need for self-reflection and adherence to ethical practices. Our study contributes to systemic therapy literature by demonstrating the effective application of an integrative approach. It reinforces the importance of collaboration in therapeutic change, offering insights into how therapists can navigate complex therapeutic dynamics.

Application of Pure and Modified Polyvinylidene Fluoride Materials for Wastewater Treatment Using UASB Reactor Technologies: A Review

Wastewater treatment is now required because of the problems caused by water constraints. Wastewater is anaerobically digested to produce biogas, which can be used as a source of energy for things like lighting and heating. The upflow anaerobic sludge blanket (UASB) reactor has been recognized as an important wastewater treatment technology among anaerobic treatment methods. Although their treated effluent typically does not meet most discharge criteria, UASB reactors are generally stated to have a chemical oxygen demand (COD) reduction ranging from 60 to 90% for most types of wastewater. In comparison to traditional anaerobic procedures, anaerobic municipal wastewater treatment using membranes can produce higher effluent quality in terms of COD, suspended solids (SSs) and pathogen counts, as well as a steady treatment performance to fulfill strict discharge regulations. The objective of this review was to perform a literature review on parameters to consider when selecting a membrane to include in a UASB reactor. Membranes that are available in the market were compared in terms of both physical and chemical properties. Polyvinylidene fluoride (PVDF) membranes were found be superior to the others, and their modification also reduced the fouling propensity. When comparing modified PVDF (PVDF/PVDF-g-PEGMA) to pristine PVDF (116 L·m−2 h−1), a higher pure water flux (5170 L·m−2 h−1) was noted. The main drawback of such modifications could significantly increase the final membrane production costs. Research is still lacking when it comes to research on comparing the membranes and PVDF and UASB reactor technology interaction, including effects of its modification as discussed (stability, longevity of improved flux, etc.