Journal of clinical monitoring and computing
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J Clin Monit Comput · Aug 2017
Observational StudySympatho-vagal balance, as quantified by ANSindex, predicts post spinal hypotension and vasopressor requirement in parturients undergoing lower segmental cesarean section: a single blinded prospective observational study.
Hypotension subsequent to spinal anesthesia occurs in a significant number of parturients undergoing lower segment caesarian section. Currently available methods to predict the incidence of hypotension, its severity and the outcome are sub-optimal. Many workers have used basal heart rate as one of the predictors. ⋯ Higher ANSindex value was significantly associated with post spinal hypotension (p 0.017). A value of 24 % indicated the critical level above which hypotension appeared commonly. The ANSindex value might help anesthesiologist to anticipate and prepare for hypotension that is likely to ensue.
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J Clin Monit Comput · Aug 2017
Design and validation of a questionnaire to evaluate the usability of computerized critical care information systems.
The implementation of computerized critical care information systems (CCIS) can improve the quality of clinical care and staff satisfaction, but also holds risks of disrupting the workflow with consecutive negative impacts. The usability of CCIS is one of the key factors determining their benefits and weaknesses. However, no tailored instrument exists to measure the usability of such systems. ⋯ We tested validity and reliability of the digital version of the questionnaire in a sample population. In the sample population of 535 participants both usability evaluation models showed a strong correlation with the overall rating of the system (multiple correlation coefficients ≥0.80) as well as a very high internal consistency (Cronbach's alpha ≥0.93). The novel questionnaire is a valid and reliable instrument to measure the usability of CCIS and can be used to study the influence of the usability on their implementation benefits and weaknesses.
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J Clin Monit Comput · Aug 2017
Assessment of an alternative calibration technique to record breathing pattern and its variability with respiratory inductive plethysmography.
Recent literature has raised doubts on the existing calibration methods for respiratory inductive plethysmography (RIP) which can lead to erroneous estimation of tidal volume. This study sought to validate an alternative calibration method to record tidal volume and tidal volume variability during rest and exercise by comparing the measurements obtained from a RIP device against a pneumotachograph (PT) for breath-by-breath analysis. 11 healthy individuals were recruited. Tidal volume and variability were simultaneously recorded during 30 min of rest and 20 min of exercises. ⋯ No statistical significant difference was observed in tidal volume variability between devices during rest and exercises. This study provides support for an alternative calibration method, which addresses existing limitations. The simplicity of equipment set up process and no need to perform subject cooperated calibration procedure will improve the respiratory monitoring process.
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This work aims to introduce a new needle insertion simulation to predict the deflection of a bevel-tip needle inside soft tissue. The development of such a model, which predicts the steering behavior of the needle during needle-tissue interactions, could improve the performance of many percutaneous needle-based procedures such as brachytherapy and thermal ablation, by means of the virtual path planning and training systems of the needle toward the target and thus reducing possible incidents of complications in clinical practices. The Arbitrary-Lagrangian-Eulerian (ALE) formulation in LS-DYNA software was used to model the solid-fluid interactions between the needle and tissue. ⋯ The effect of the needle diameter and its bevel tip angle on the final shape of the needle was investigated using this model. To maneuver around the anatomical obstacles of the human body and reach the target location, thin sharp needles are recommended, as they would create a smaller radius of curvature. The insertion model presented in this work is intended to be used as a base structure for path planning and training purposes for future studies.
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J Clin Monit Comput · Aug 2017
Electromyographic activation reveals cortical and sub-cortical dissociation during emergence from general anesthesia.
During emergence from anesthesia patients regain their muscle tone (EMG). In a typical population of surgical patients the actual volatile gas anesthetic concentrations in the brain (CeMAC) at which EMG activation occurs remains unknown, as is whether EMG activation at higher CeMACs is correlated with subsequent severe pain, or with cortical activation. Electroencephalographic (EEG) and EMG activity was recorded from the forehead of 273 patients emerging from general anesthesia following surgery. ⋯ Patients emerging from general anesthesia with an endotracheal tube in place are more likely to have an EMG activation at higher CeMAC concentrations. These activations are not associated with subsequent high-pain, nor with cortical arousal, as evidenced by continuing delta waves in the EEG. Conversely, patients emerging from general anesthesia with a laryngeal mask demonstrate marked neural inertia-EMG activation occurs at a low CeMAC, and is closely temporally associated with return of consciousness.