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The impact of Pulsed Electric Field (PEF) processing pre-treatment on the texture and kinetics of in vitro starch digestibility of French fries made from two potato cultivars (Solanum tuberosum L.) containing dry matter content ranging from 19 to 22% was investigated. Whole and steam-peeled potato tubers were treated with a pilot scale PEF unit (electric field strength of 1.1 and 1.9 kV/cm with energy input <10 kJ/kg or ∼50 kJ/kg). This trial was carried out in a commercial French-fry plant using an industrial scale cutter, blancher, fryer and blast-freezer to prepare the frozen par-fried French fry samples. After subsequent final batch frying of the frozen fries, at 180 °C for 3 min to mimic the typical preparation practice at restaurant, retail and household, the outer crust of the fries produced from PEF-treated potatoes was significantly harder (9.4–16.3 N) than crust produced from untreated potatoes (6.9–8.5 N). High intensity (1.9 kV/cm with energy input ∼50 kJ/kg) PEF processing was found to cause defects (i.e. hollowness in the internal core) in the fries. A fractional conversion model was a good fit for the starch digestion kinetics of all French fry samples during the small intestinal phase (based on standardised INFOGEST static in vitro digestion assay). A lower % of total starch hydrolysis was predicted for French fries produced from high dry matter (>21%) tubers pretreated with PEF at electric field strength of 1.9 kV/cm. The findings generated in this study demonstrate PEF pretreatment may influence the texture of French fries and the extent of starch digestion that occurs.
Plant-based proteins are rapidly emerging, while novel technologies are explored to offer more efficient extraction processes. The current study aimed to evaluate the effects of pulsed electric fields (PEFs) and temperature on the extraction of soluble proteins from nettle leaves (Urtica dioica L.) and identify an optimal operational range for the highest yield of soluble proteins. Extractions and kinetic modeling were conducted with whole and ground dried leaves at different temperatures (30–70 °C) and specific energy of PEF (0–30 kJ kg−1) with extraction times of up to 60 min. The influence of temperature and specific energy on the soluble protein extraction yields was investigated and modeled using composite central design and response surface methodology. The experimental results were fitted to Peleg's kinetic model, which satisfactorily described the extraction process (R2 > 0.902), and PEF treated samples resulted in a higher soluble protein yield and shortened processing time. Response surface methodology showed that the linear effect of temperature and quadratic effect of PEF (p < 0.01) were highly significant for protein yield. In the optimized PEF-extraction region (specific energy between 10 and 24 kJ kg−1, and 70–78 °C), soluble protein yield was higher than 60% after 5 minutes of extraction. The achieved results are relevant for developing processes for PEF assisted extraction of soluble proteins from leaves. Understanding the effects of PEFs and process parameters is crucial to obtain high protein yields, while requiring low energy and short processing time.
Ohmic heating (OH) is an alternative sustainable heating technology that has demonstrated its potential to modify protein structures and aggregates. Furthermore, certain protein aggregates, namely amyloid fibrils (AF), are associated with an enhanced protein functionality, such as gelation. This study evaluates how Ohmic heating (OH) influences the formation of AF structures from ovalbumin source under two electric field strength levels, 8.5 to 10.5 and 24.0–31.0 V/cm, respectively. Hence, AF aggregate formation was assessed over holding times ranging from 30 to 1200 sunder various environmental conditions (3.45 and 67.95 mM NaCl, 80, 85 and 90 °C, pH = 7). AF were formed under all conditions. SDS-PAGE revealed that OH had a higher tendency to preserve native ovalbumin molecules. Furthermore, Congo Red and Thioflavin T stainings indicated that OH reduces the amount of AF structures. This finding was supported by FTIR measurements, which showed OH samples to contain lower amounts of beta-sheets. Field flow fractioning revealed smaller-sized aggregates or aggregate clusters occurred after OH treatment. In contrast, prolonged holding time or higher treatment temperatures increased ThT fluorescence, beta-sheet structures and aggregate as well as cluster sizes. Ionic strength was found to dominate the effects of electric field strength under different environmental conditions.
Olive oil holds significant importance in the European diet and is renowned globally for its sensory attributes and health benefits. The effectiveness of producing olive oil is greatly influenced by factors like the maturity and type of olives used, as well as the milling techniques employed. Generally, mechanical methods can extract approximately 80% of the oil contained in the olives. The rest 20% of the oil remains in the olive waste generated at the end of the process. Additionally, significant amounts of bioactive compounds like polyphenols are also lost in the olive pomace. Traditionally, heat treatment, enzymes, and other chemicals are used for the enhancement of oil extraction; however, this approach may impact the quality of olive oil. Therefore, new technology, such as pulsed electric field (PEF), is of great benefit for nonthermal yield and quality improvements.
Hintergrund
Die Anämie hat eine hohe Prävalenz bei Patienten vor Hüftgelenkrevisionsoperation und ist mit einer erhöhten Komplikationsrate assoziiert. Die vorliegende Arbeit untersucht erstmals den Zusammenhang von Kosten, realen DRG-Erlösen und Falldeckung der präoperativen Anämie bei elektiven Hüftgelenkrevisionsoperationen.
Methoden
Für alle Patienten, die sich von 2010 bis 2017 an 2 Campi der Charité – Universitätsmedizin Berlin einer Hüftgelenkrevisionsoperation unterzogen, wurden Daten zu Patienten sowie Transfusionen, Kosten und Erlösen gesammelt. Subgruppen- und lineare Regressionsanalysen untersuchten die Falldeckung anämischer und nichtanämischer Patienten.
Ergebnisse
Von 1187 eingeschlossenen Patienten waren 354 (29,8 %) präoperativ anämisch. Insgesamt wurden 565 (47,6 %) Patienten, mit einem deutlichen Überwiegen anämischer Patienten (72,6 % vs. 37,0 %, p < 0,001), transfundiert. Kosten (12.318 € [9027;20.044 €] vs. 8948 € [7501;11.339 €], p < 0,001) und Erlöse (11.788 € [8992;16.298 €] vs. 9611 € [8332;10.719 €], p < 0,001) waren für anämische Patienten höher, die Fallkostendeckung defizitär (−1170 € [−4467;1238 €] vs. 591 € [−1441;2103 €] €, p < 0,001). Bei anämischen Patienten nahm die Falldeckung mit zunehmender Transfusionsrate ab (p ≤ 0,001). Komorbiditäten hatten keinen signifikanten ökonomischen Einfluss.
Schlussfolgerung
Die präoperative Anämie und perioperative Transfusionen bei Hüftgelenkrevisionsoperationen sind mit erhöhten Behandlungskosten und einer finanziellen Unterdeckung für Kostenträger im Gesundheitswesen verbunden. Konzepte zur Behandlung der präoperativen Anämie (z. B. Patient Blood Management) könnten mittelfristig Behandlungskosten senken.
Introduction Postoperative delirium (POD) is seen in approximately 15% of elderly patients and is related to poorer outcomes. In 2017, the Federal Joint Committee (Gemeinsamer Bundesausschuss) introduced a ‘quality contract’ (QC) as a new instrument to improve healthcare in Germany. One of the four areas for improvement of in-patient care is the ‘Prevention of POD in the care of elderly patients’ (QC-POD), as a means to reduce the risk of developing POD and its complications.
The Institute for Quality Assurance and Transparency in Health Care identified gaps in the in-patient care of elderly patients related to the prevention, screening and treatment of POD, as required by consensus-based and evidence-based delirium guidelines. This paper introduces the QC-POD protocol, which aims to implement these guidelines into the clinical routine. There is an urgent need for well-structured, standardised and interdisciplinary pathways that enable the reliable screening and treatment of POD. Along with effective preventive measures, these concepts have a considerable potential to improve the care of elderly patients.
Methods and analysis The QC-POD study is a non-randomised, pre–post, monocentric, prospective trial with an interventional concept following a baseline control period. The QC-POD trial was initiated on 1 April 2020 between Charité-Universitätsmedizin Berlin and the German health insurance company BARMER and will end on 30 June 2023. Inclusion criteria: patients 70 years of age or older that are scheduled for a surgical procedure requiring anaesthesia and insurance with the QC partner (BARMER). Exclusion criteria included patients with a language barrier, moribund patients and those unwilling or unable to provide informed consent. The QC-POD protocol provides perioperative intervention at least two times per day, with delirium screening and non-pharmacological preventive measures.
Ethics and dissemination This protocol was approved by the ethics committee of the Charité-Universitätsmedizin, Berlin, Germany (EA1/054/20). The results will be published in a peer-reviewed scientific journal and presented at national and international conferences.
A brief questionnaire for measuring alarm fatigue in nurses and physicians in intensive care units
(2023)
When exposed to hundreds of medical device alarms per day, intensive care unit (ICU) staff can develop “alarm fatigue” (i.e., desensitisation to alarms). However, no standardised way of quantifying alarm fatigue exists. We aimed to develop a brief questionnaire for measuring alarm fatigue in nurses and physicians. After developing a list of initial items based on a literature review, we conducted 15 cognitive interviews with the target group (13 nurses and two physicians) to ensure that the items are face valid and comprehensible. We then asked 32 experts on alarm fatigue to judge whether the items are suited for measuring alarm fatigue. The resulting 27 items were sent to nurses and physicians from 15 ICUs of a large German hospital. We used exploratory factor analysis to further reduce the number of items and to identify scales. A total of 585 submissions from 707 participants could be analysed (of which 14% were physicians and 64% were nurses). The simple structure of a two-factor model was achieved within three rounds. The final questionnaire (called Charité Alarm Fatigue Questionnaire; CAFQa) consists of nine items along two scales (i.e., the “alarm stress scale” and the “alarm coping scale”). The CAFQa is a brief questionnaire that allows clinical alarm researchers to quantify the alarm fatigue of nurses and physicians. It should not take more than five minutes to administer.
Introduction: Patients undergoing revision total hip surgery (RTHS) have a high prevalence of mild and moderate preoperative anemia, associated with adverse outcomes. The aim of this study was to investigate the association of perioperative allogeneic blood transfusions (ABT) and postoperative complications in preoperatively mild compared to moderate anemic patients undergoing RTHS who did not receive a diagnostic anemia workup and treatment before surgery. Methods: We included 1,765 patients between 2007 and 2019 at a university hospital. Patients were categorized according to their severity of anemia using the WHO criteria of mild, moderate, and severe anemia in the first Hb level of the case. Patients were grouped as having received no ABT, 1–2 units of ABT, or more than 2 units of ABT. Need for intraoperative ABT was assessed in accordance with institutional standards. Primary endpoint was the compound incidence of postoperative complications. Secondary outcomes included major/minor complications and length of hospital and ICU stay. Results: Of the 1,765 patients, 31.0% were anemic of any cause before surgery. Transfusion rates were 81% in anemic patients and 41.2% in nonanemic patients. The adjusted risks for compound postoperative complication were significantly higher in patients with moderate anemia (OR 4.88, 95% CI: 1.54–13.15, p = 0.003) but not for patients with mild anemia (OR 1.93, 95% CI: 0.85–3.94, p < 0.090). Perioperative ABT was associated with significantly higher risks for complications in nonanemic patients and showed an increased risk for complications in all anemic patients. In RTHS, perioperative ABT as a treatment for moderate preoperative anemia of any cause was associated with a negative compound effect on postoperative complications, compared to anemia or ABT alone. Discussion: ABT is associated with adverse outcomes of patients with moderate preoperative anemia before RTHS. For this reason, medical treatment of moderate preoperative anemia may be considered.
Background
Beta-blocker (BB) therapy plays a central role in the treatment of cardiovascular diseases. An increasing number of patients with cardiovascular diseases undergoe noncardiac surgery, where opioids are an integral part of the anesthesiological management. There is evidence to suggest that short-term intravenous BB therapy may influence perioperative opioid requirements due to an assumed cross-talk between G-protein coupled beta-adrenergic and opioid receptors. Whether chronic BB therapy could also have an influence on perioperative opioid requirements is unclear.
Methods
A post hoc analysis of prospectively collected data from a multicenter observational (BioCog) study was performed. Inclusion criteria consisted of elderly patients (≥ 65 years) undergoing elective noncardiac surgery as well as total intravenous general anesthesia without the use of regional anesthesia and duration of anesthesia ≥ 60 min. Two groups were defined: patients with and without BB in their regular preopreative medication. The administered opioids were converted to their respective morphine equivalent doses. Multiple regression analysis was performed using the morphine-index to identify independent predictors.
Results
A total of 747 patients were included in the BioCog study in the study center Berlin. 106 patients fulfilled the inclusion criteria. Of these, 37 were on chronic BB. The latter were preoperatively significantly more likely to have arterial hypertension (94.6%), chronic renal failure (27%) and hyperlipoproteinemia (51.4%) compared to patients without BB. Both groups did not differ in terms of cumulative perioperative morphine equivalent dose (230.9 (BB group) vs. 214.8 mg (Non-BB group)). Predictive factors for increased morphine-index were older age, male sex, longer duration of anesthesia and surgery of the trunk. In a model with logarithmised morphine index, only gender (female) and duration of anesthesia remained predictive factors.
Conclusions
Chronic BB therapy was not associated with a reduced perioperative opioid consumption.
Die Entscheidung für eine Teilzeitbeschäftigung von examinierten Pflegekräften gewinnt in der Bundesrepublik Deutschland zunehmend an Bedeutung. Dieses Thema ist von zentraler Relevanz, da es zwangsläufig eine kritische Auseinandersetzung mit den Arbeitsbedingungen im Gesundheitswesen, der Sicherstellung des gesellschaftlichen Versorgungsauftrages sowie der Berücksichtigung der sich verändernden Lebensrealitäten der in der Pflege tätigen Fachkräfte erfordert. Ziel dieser Forschungsarbeit ist es, eine methodische Annäherung an das Phänomen der individuellen Entscheidungsprozesse von examinierten Pflegekräften in Bezug auf ein reduziertes Arbeitszeitmodell darzustellen. Zu diesem Zweck wird eine literaturgestützte empirische Untersuchung in Form von Experteninterviews mit beruflich Pflegenden durchgeführt. Besonderes Augenmerk wird dabei auf die subjektiven Erfahrungen und Sichtweisen der Interviewpartner gelegt. Die gewonnenen Erkenntnisse dienen dazu, eine vergleichende Analyse mit den Ergebnissen aus der einschlägigen Literatur durchzuführen. Abschließend erfolgt die Darstellung aktueller Entwicklungen innerhalb des Pflegeberufes sowie die Diskussion zukunftsfähiger Ansätze hinsichtlich der Arbeitsbedingungen.