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Evaluation of bluetooth as a replacement for cables in intensive care and surgery.
Wallin MK, Wajntraub S.
Department of Anesthesiology and Intensive Care, Karolinska Hospital and the. Division of Medical Engineering, Department of Medical Laboratory Science and Technology, Karolinska Insititute, Stockholm, Sweden.
In today's intensive care and surgery, a great number of cables are attached to patients. These cables can make the care and nursing of the patient difficult. Replacing them with wireless communications technology would facilitate patient care. Bluetooth is a modern radio technology developed specifically to replace cables between different pieces of communications equipment. In this study we sought to determine whether Bluetooth is a suitable replacement for cables in intensive care and during surgery with respect to electromagnetic compatibility. The following questions were addressed: Does Bluetooth interfere with medical equipment? And does the medical equipment decrease the quality of the Bluetooth communication? A Bluetooth link, simulating a patient monitoring system, was constructed with two laptops. The prototype was then used in laboratory and clinical tests according to American standards at the Karolinska Hospital in Stockholm. The tests, which included 44 different pieces of medical equipment, indicated that Bluetooth does not cause any interference. The tests also showed that the hospital environment does not affect the Bluetooth communication negatively. IMPLICATIONS: Bluetooth, a new radio technology transmitting at 2.4 GHz, was tested in a clinical setting. The study showed that a single Bluetooth link was robust and electromagnetically compatible with the tested electronic medical devices.
PMID: 14980934 [PubMed - in process]
 
Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies.
Helmerhorst FM, Perquin DA, Donker D, Keirse MJ.
Department of Obstetrics, Gynaecology and Reproductive Medicine, Leiden University Medical Center, NL 2300 Leiden, Netherlands. f.m.helmerhorst@lumc.nl
OBJECTIVE: To compare the perinatal outcome of singleton and twin pregnancies between natural and assisted conceptions. DESIGN: Systematic review of controlled studies published 1985-2002. STUDIES REVIEWED: 25 studies were included of which 17 had matched and 8 had non-matched controls. MAIN OUTCOME MEASURES: Very preterm birth, preterm birth, very low birth weight, low birth weight, small for gestational age, caesarean section, admission to neonatal intensive care unit, and perinatal mortality. RESULTS: For singletons, studies with matched controls indicated a relative risk of 3.27 (95% confidence interval 2.03 to 5.28) for very preterm (< 32 weeks) and 2.04 (1.80 to 2.32) for preterm (< 37 weeks) birth in pregnancies after assisted conception. Relative risks were 3.00 (2.07 to 4.36) for very low birth weight (< 1500 g), 1.70 (1.50 to 1.92) for low birth weight (< 2500 g), 1.40 (1.15 to 1.71) for small for gestational age, 1.54 (1.44 to 1.66) for caesarean section, 1.27 (1.16 to 1.40) for admission to a neonatal intensive care unit, and 1.68 (1.11 to 2.55) for perinatal mortality. Results of the non-matched studies were similar. In matched studies of twin gestations, relative risks were 0.95 (0.78 to 1.15) for very preterm birth, 1.07 (1.02 to 1.13) for preterm birth, 0.89 (0.74 to 1.07) for very low birth weight, 1.03 (0.99 to 1.08) for low birth weight, 1.27 (0.97 to 1.65) for small for gestational age, 1.21 (1.11 to 1.32) for caesarean section, 1.05 (1.01 to 1.09) for admission to a neonatal intensive care unit, and 0.58 (0.44 to 0.77) for perinatal mortality. The non-matched studies mostly showed similar trends. CONCLUSIONS: Singleton pregnancies from assisted reproduction have a significantly worse perinatal outcome than non-assisted singleton pregnancies, but this is less so for twin pregnancies. In twin pregnancies, perinatal mortality is about 40% lower after assisted compared with natural conception.
Publication Types:
PMID: 14742347 [PubMed - indexed for MEDLINE]
Surgical critical care: the Overnight Intensive Recovery (OIR) concept.
Aps C.
Publication Types:
PMID: 14722163 [PubMed - indexed for MEDLINE]
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Acquisition of multidrug-resistant Pseudomonas aeruginosa in patients in intensive care units: role of antibiotics with antipseudomonal activity.
Paramythiotou E, Lucet JC, Timsit JF, Vanjak D, Paugam-Burtz C, Trouillet JL, Belloc S, Kassis N, Karabinis A, Andremont A.
Bacteriology Laboratory, Bichat-Claude Bernard Hospital, Paris Cedex 18, France.
A matched case-control study was performed to identify risk factors for acquiring multidrug-resistant Pseudomonas aeruginosa (MDRPA) in intensive care unit (ICU) patients during a 2-year period. MDRPA was defined as P. aeruginosa with combined decreased susceptibility to piperacillin, ceftazidime, imipenem, and ciprofloxacin. Thirty-seven patients who were colonized or infected with MDRPA were identified, 34 of whom were matched with 34 control patients who had cultures that showed no growth of P. aeruginosa. Matching criteria were severity of illness and length of ICU stay, with each control patient staying in the ICU for at least as long as the time period between the corresponding case patient's admission to the ICU and the acquisition of MDRPA. Baseline demographic and clinical characteristics and the use of invasive procedures were similar for case patients and control patients. Multivariate analysis identified duration of ciprofloxacin treatment as an independent risk factor for MDRPA acquisition, whereas the duration of treatment with imipenem was of borderline significance. These data support a major role for the use of antibiotics with high antipseudomonal activity, particularly ciprofloxacin, in the emergence of MDRPA.
PMID: 14986251 [PubMed - in process]
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Prognosis of patients aged 80 years and over admitted in medical intensive care unit.
Boumendil A, Maury E, Reinhard I, Luquel L, Offenstadt G, Guidet B.
INSERM U444, Hopital Saint-Antoine, 184, rue du Fbg Saint-Antoine, 75571, Paris Cedex 12, France.
OBJECTIVE. To determine the prognostic indicators of long-term survival after admission to a medical intensive care unit (MICU) for patients aged 80 years and over. DESIGN. Prospective cohort study. SETTING. A 14-bed MICU in a 970-bed, acute care, tertiary, university hospital in Paris, France. PATIENTS. A total of 233 patients aged 80 years and over discharged from a MICU during a 2-year period. MEASUREMENTS AND MAIN RESULTS. Severity at admission was estimated using the Simplified Acute Physiology Score. The underlying condition was classified using the MacCabe classification. The functional status was assessed using the Knaus classification. The outcome after MICU discharge was determined after a median 2-year follow-up. The functional outcome was assessed by telephone interviews, employing the Instrumental Activities of Daily Living (IADL). The in-MICU mortality was 19.5% including death occurring during the 2 days following discharge. The long-term survival rates for patients admitted to the MICU were 59% at 2 months, 33% at 2 years, and 29% at 3 years. The multivariate analysis identified two prognostic factors of death after discharge: presence of an underlying fatal disease (HR 1.7; 95% CI 1.1-2.6) and severe functional limitation (HR 1.7; 95% CI 1.2-2.6). The IADL was excellent or good for 56% of the surviving patients. CONCLUSION. Long-term survival after MICU is mainly related to the underlying condition, whereas known factors for in-MICU survival do not influence long-term prognosis.
PMID: 14985964 [PubMed - as supplied by publisher]
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A new concept for DRG-based reimbursement of services in German intensive care units: results of a pilot study.
Neilson AR, Moerer O, Burchardi H, Schneider H.
HealthEcon AG, Steinentorstrasse 19, Posfach 1510, 4001, Basel, Switzerland.
OBJECTIVE. To evaluate LOS in developing a concept of borderline ICU LOS for a realistic reimbursement of intensive care. DESIGN. Retrospective analysis of LOS and cost data extracted from patients' electronic records. SETTING. Surgical ICU of the University Hospital Gottingen, Germany. PATIENTS AND PARTICIPANTS. All adult ICU admissions with LOS >24 h over a 24-month period (1 January 2000 to 31 December 2001; n=1631.) INTERVENTIONS. None. MEASUREMENTS AND RESULTS. Cluster analysis partitioned the ICU population into three homogenous groups based on ICU LOS and total direct costs: cluster 1 ( n=1405; mean LOS=2.8; mean cost=<euro>2399); cluster 2 ( n=190; mean LOS=13.4; mean cost=<euro>12,754); cluster 3 ( n=36; mean LOS=34.9; mean cost=<euro>34,173). Cost distribution between cluster 1 and clusters 2 and 3 combined was 48 vs 52%. Upper 95 percentile LOS of 6.7 allowed cluster 1 to be replaced by an LOS profile population of </= 7 days population ( n=1355; 96% population and 91% total ICU cost overlap with cluster 1) representing 83% of total ICU population and 44% of total ICU costs. Stratification of >7 day population into LOS less than or >20 days ( n=220; n=56) were further differentiated by mortality (11 vs 23%) and sepsis incidence (33 vs 79%). CONCLUSIONS. It may be feasible to formulate a LOS-based reimbursement scheme for ICU services in Germany based on the selection of (appropriate) patients' ICU LOS profiles.
PMID: 14985961 [PubMed - as supplied by publisher]
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Plasmatic cystatin C for the estimation of glomerular filtration rate in intensive care units.
Delanaye P, Lambermont B, Chapelle JP, Gielen J, Gerard P, Rorive G.
Nephrology, Department of Medicine, Liege University Hospital, CHU Sart Tilman (B35), 4000, Liege, Belgium.
OBJECTIVE. To compare the sensitivity of cystatin C and creatinine in detecting decreased glomerular filtration rate. DESIGN. Prospective observational study. SETTING. Medical intensive care unit at a university hospital. PATIENTS AND PARTICIPANTS. Fourteen patients hospitalised in a medical intensive care unit. INTERVENTIONS. Cystatin C and creatinine plasmatic levels were measured in 40 blood samples taken with an interval of at least 24 h. MEASUREMENTS AND RESULTS. Glomerular filtration rate was estimated by creatinine clearance using 24-h urine collection and the classical Cockcroft-Gault equation. The ability of cystatin C to detect a glomerular filtration rate under 80 ml/min per 1.73 m(2) was significantly better than that of creatinine ( p<0.05). CONCLUSIONS. Cystatin C, a new plasmatic marker of renal function, could be used to detect renal failure in intensive care in the future.
PMID: 14985953 [PubMed - as supplied by publisher]
Comment on:
Hemofiltration and the prevention of radiocontrast-agent-induced nephropathy.
Forman JP.
Publication Types:
PMID: 14978836 [PubMed - indexed for MEDLINE]
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 6-2004. A 35-year-old woman with extensive, deep burns from a nightclub fire.
Sheridan RL, Schulz JT, Ryan CM, McGinnis PJ.
Burn and Trauma Services, Massachusetts General Hospital, Boston, USA.
Publication Types:
- Case Reports
- Clinical Conference
PMID: 14973211 [PubMed - indexed for MEDLINE]
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