Journal of clinical monitoring and computing
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J Clin Monit Comput · Oct 2023
ReviewLinear thinking does not reflect the newer 21st-century anesthesia concepts. A narrative review.
The brain constitutes a good example of a chaotic, nonlinear biological system where large neuronal networks operate chaotically with random connectivity. This critical state is significantly affected by the anesthetic loss of consciousness induced by drugs whose pharmacological behavior has been classically based on linear kinetics and dynamics. Recent developments in pharmacology and brain monitoring during anesthesia suggest a different view that we tried to explore in this article. The concepts of effect-site for hypnotic drugs modeling a maximum effect, electroencephalographic dynamics during induction, maintenance, and recovery from anesthesia are discussed, integrated into this alternative view, and how it may be applied in daily clinical practice.
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J Clin Monit Comput · Oct 2023
Contrast-enhanced transcranial doppler versus contrast transthoracic echocardiography for right-to-left shunt diagnosis.
RLS can be diagnosed using US, CT angiography, and right heart catheterization. However, most reliable diagnostic modality remains undetermined. c-TCD was more sensitive than c-TTE in the diagnosis of RLS. This was true especially for the detection of provoked shunts or mild shunts. c-TCD can be used as the preferred screening method for RLS.
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J Clin Monit Comput · Oct 2023
Randomized Controlled TrialEffects of preoperative education using virtual reality on preoperative anxiety and information desire: a randomized clinical trial.
This study aimed to investigate the effect of preoperative education using virtual reality (VR) on preoperative anxiety and information desire. The participants were randomly assigned to the VR group and control group. The VR group received preoperative education using VR content describing preoperative and postoperative processes and their management, and the control group received preoperative education with traditional verbal education. ⋯ Preoperative education using VR effectively reduced preoperative anxiety and information desire. Trial registration CRIS, KCT0007489. Registered 30 June 2022. http://cris.nih.go.kr/cris/ .
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Cybersecurity has seen an increasing frequency and impact of cyberattacks and exposure of Protected Health Information (PHI). The uptake of an Electronic Medical Record (EMR), the exponential adoption of Internet of Things (IoT) devices, and the impact of the COVID-19 pandemic has increased the threat surface presented for cyberattack by the healthcare sector. Within healthcare generally and, more specifically, within anaesthesia and Intensive Care, there has been an explosion in wired and wireless devices used daily in the care of almost every patient-the Internet of Medical Things (IoMT); ventilators, anaesthetic machines, infusion pumps, pacing devices, organ support and a plethora of monitoring modalities. ⋯ There has, at the same time, been a chronic underfunding of cybersecurity in healthcare. This lack of cybersecurity investment has left the sector exposed, and with the monetisation of PHI, the introduction of technically unsecure IoT devices for monitoring and direct patient care, the healthcare sector is presenting itself for further devastating cyberattacks or breaches of PHI. Coupled with the immense strain that the COVID-19 pandemic has placed on healthcare and the changes in working patterns of many caregivers, this has further amplified the exposure of the sector to cyberattacks.
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J Clin Monit Comput · Oct 2023
Observational StudyFeasibility analysis of a novel non-invasive ultrasonographic method for the measurement of intra-abdominal pressure in the intensive care unit.
Increased intra-abdominal pressure (IAP) is an important vital sign in critically ill patients and has a negative impact on morbidity and mortality. This study aimed to validate a novel non-invasive ultrasonographic approach to IAP measurement against the gold standard intra-bladder pressure (IBP) method. We conducted a prospective observational study in an adult medical ICU of a university hospital. ⋯ Bland and Altman's analysis showed a bias (0.39 and 0.61 mmHg) and precision (1.38 and 1.51 mmHg) for the comparison of IAPUS1 and IAPUS2 and vs. IBP, respectively with small limits of agreement that were in line with the research guidelines of the Abdominal Compartment Society (WSACS). Our novel ultrasound-based IAP method displayed good correlation and agreement between IAP and IBP at levels up to 15 mmHg and is an excellent solution for quick decision-making in critically ill patients.