Intracranial pressure monitoring in normal dogs using subdural and intraparenchymal miniature strain-gauge transducers.

BackgroundMonitoring of intracranial pressure (ICP) is a critical component in the management of intracranial hypertension. Safety, efficacy, and optimal location of microsensor devices have not been defined in dogs.Hypothesis/objectiveAssessment of ICP using a microsensor transducer is feasible in anesthetized and conscious animals and is independent of transducer location. Intraparenchymal transducer placement is associated with more adverse effects.AnimalsSeven adult, bred-for-research dogs.MethodsIn a prospective investigational study, microsensor ICP transducers were inserted into subdural and intraparenchymal locations at defined rostral or caudal locations within the rostrotentorial compartment under general anesthesia. Mean arterial pressure and ICP were measured continuously during physiological maneuvers, and for 20 hours after anesthesia.ResultsBaseline mean ± SD values for ICP and cerebral perfusion pressure were 7.2 ± 2.3 and 78.9 ± 7.6 mm Hg, respectively. Catheter position did not have a significant effect on ICP measurements. There was significant variation from baseline ICP accompanying physiological maneuvers (P < .001) and with normal activities, especially with changes in head position (P < .001). Pathological sequelae were more evident after intraparenchymal versus subdural placement.Conclusions and clinical importanceUse of a microsensor ICP transducer was technically straightforward and provided ICP measurements within previously reported reference ranges. Results support the use of an accessible dorsal location and subdural positioning. Transient fluctuations in ICP are normal events in conscious dogs and large variations associated with head position should be accounted for when evaluating animals with intracranial hypertension

Computer Algorithms To Detect Bloodstream Infections

Automated bloodstream infection surveillance using electronic data is an accurate alternative to surveillance using manually collected data

Knowledge-based best of breed approach for automated detection of clinical events based on German free text digital hospital discharge letters

OBJECTIVES: The secondary use of medical data contained in electronic medical records, such as hospital discharge letters, is a valuable resource for the improvement of clinical care (e.g. in terms of medication safety) or for research purposes. However, the automated processing and analysis of medical free text still poses a huge challenge to available natural language processing (NLP) systems. The aim of this study was to implement a knowledge-based best of breed approach, combining a terminology server with integrated ontology, a NLP pipeline and a rules engine. METHODS: We tested the performance of this approach in a use case. The clinical event of interest was the particular drug-disease interaction "proton-pump inhibitor [PPI] use and osteoporosis". Cases were to be identified based on free text digital discharge letters as source of information. Automated detection was validated against a gold standard. RESULTS: Precision of recognition of osteoporosis was 94.19%, and recall was 97.45%. PPIs were detected with 100% precision and 97.97% recall. The F-score for the detection of the given drug-disease-interaction was 96,13%. CONCLUSION: We could show that our approach of combining a NLP pipeline, a terminology server, and a rules engine for the purpose of automated detection of clinical events such as drug-disease interactions from free text digital hospital discharge letters was effective. There is huge potential for the implementation in clinical and research contexts, as this approach enables analyses of very high numbers of medical free text documents within a short time period

Performance and safety of femoral central venous catheters in pediatric autologous peripheral blood stem cell collection

IntroductionAutologous peripheral blood hematopoietic progenitor cell collection (A‐HPCC) in children typically requires placement of a central venous catheter (CVC) for venous access. There is scant published data regarding the performance and safety of femoral CVCs in pediatric A‐HPCC.MethodsSeven‐year, retrospective study of A‐HPCC in pediatric patients collected between 2009 and January 2017. Inclusion criteria were an age ≤ 21 years and A‐HPCC using a femoral CVC for venous access. Femoral CVC performance was examined by CD34 collection rate, inlet rate, collection efficiency (MNC‐FE, CD34‐FE), bleeding, flow‐related adverse events (AE), CVC removal, and product sterility testing. Statistical analysis and graphing were performed with commercial software.ResultsA total of 75/119 (63%) pediatric patients (median age 3 years) met study criteria. Only 16% of children required a CVC for ≥ 3 days. The CD34 collect rate and CD34‐FE was stable over time whereas MNC‐FE decreased after day 4 in 80% of patients. CD34‐FE and MNC‐FE showed inter‐ and intra‐patient variability over time and appeared sensitive to plerixafor administration. Femoral CVC showed fewer flow‐related AE compared to thoracic CVC, especially in pediatric patients (6.7% vs. 37%, P = 0.0005; OR = 0.12 (95%CI: 0.03‐0.45). CVC removal was uneventful in 73/75 (97%) patients with hemostasis achieved after 20–30 min of pressure. In a 10‐year period, there were no instances of product contamination associated with femoral CVC colonization.ConclusionFemoral CVC are safe and effective for A‐HPCC in young pediatric patients. Femoral CVC performance was maintained over several days with few flow‐related alarms when compared to thoracic CVCs.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139987/1/jca21548.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139987/2/jca21548_am.pd

Committed to Safety: Ten Case Studies on Reducing Harm to Patients

Presents case studies of healthcare organizations, clinical teams, and learning collaborations to illustrate successful innovations for improving patient safety nationwide. Includes actions taken, results achieved, lessons learned, and recommendations

Obesity As A Risk Factor For Hospital Acquired Infections In Pediatric Trauma Patients: A Pilot Study

Context The prevalence of obesity among young Americans in the 6 to 19 year old category has tripled since the 1960\u27s. Today, 50% of individuals in this age group are either overweight or obese (Kimm, 2002). Studies have shown that increased percentage of body fat weakens the body\u27s immune system (Falagas, 2009). Moreover, trauma can be an immuno-compromising condition. A study by Brown et al. in 2006 showed that obese pediatric trauma patients had more sepsis (15% vs 4%, P = .007) and wound infection (26% vs. 8%, p = .03), along with other clinical complications. Objective This project serves as an extension of the Brown study in 2006. The goal was to focus on all infections and infection risk factors that occured during a pediatric trauma patient\u27s hospitalization as it related with Body Mass Index percentile. Design A retrospective chart review of pediatric patients entered into the Trauma Registry at Dell Children\u27s Medical Center of Central Texas (DCMC). Main Outcome Measures: Infection events using ICD-9 Coding System Infection events using NHSN Surveillance definitions Risk Factors for Infection: Days on Mechanical Ventilation Days with a Central Venous Catheter Results From the 1279 patients analyzed between June 1st, 2010 and March 31st, 2011, only 3 official hospital acquired infections were detected using NHSN surveillance criteria. On the other hand, 9 patients in this cohort received ICD-9 codes for infection. The rates of mechanical ventilation and central venous catheterization also yielded statistically insignificant results. Conclusion I cannot conclude that obesity is a risk factor for hospital Acquired Infections (HAIs) in pediatric trauma patients; nor can I conclude that obesity increases the risk for known HAI risk factors: prolonged hospitalization, mechanical ventilation and use of Central Venous Catheterization

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

OBJECTIVE: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012." DESIGN: A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS: The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. RESULTS: The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. CONCLUSIONS: Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality