Separator fluid volume requirements in multi-infusion settings

INTRODUCTION. Intravenous (IV) therapy is a widely used method for the administration of medication in hospitals worldwide. ICU and surgical patients in particular often require multiple IV catheters due to incompatibility of certain drugs and the high complexity of medical therapy. This increases discomfort by painful invasive procedures, the risk of infections and costs of medication and disposable considerably. When different drugs are administered through the same lumen, it is common ICU practice to flush with a neutral fluid between the administration of two incompatible drugs in order to optimally use infusion lumens. An important constraint for delivering multiple incompatible drugs is the volume of separator fluid that is sufficient to safely separate them. OBJECTIVES. In this pilot study we investigated whether the choice of separator fluid, solvent, or administration rate affects the separator volume required in a typical ICU infusion setting. METHODS. A standard ICU IV line (2m, 2ml, 1mm internal diameter) was filled with methylene blue (40 mg/l) solution and flushed using an infusion pump with separator fluid. Independent variables were solvent for methylene blue (NaCl 0.9% vs. glucose 5%), separator fluid (NaCl 0.9% vs. glucose 5%), and administration rate (50, 100, or 200 ml/h). Samples were collected using a fraction collector until <2% of the original drug concentration remained and were analyzed using spectrophotometry. RESULTS. We did not find a significant effect of administration rate on separator fluid volume. However, NaCl/G5% (solvent/separator fluid) required significantly less separator fluid than NaCl/NaCl (3.6 ± 0.1 ml vs. 3.9 ± 0.1 ml, p <0.05). Also, G5%/G5% required significantly less separator fluid than NaCl/NaCl (3.6 ± 0.1 ml vs. 3.9 ± 0.1 ml, p <0.05). The significant decrease in required flushing volume might be due to differences in the viscosity of the solutions. However, mean differences were small and were most likely caused by human interactions with the fluid collection setup. The average required flushing volume is 3.7 ml. CONCLUSIONS. The choice of separator fluid, solvent or administration rate had no impact on the required flushing volume in the experiment. Future research should take IV line length, diameter, volume and also drug solution volumes into account in order to provide a full account of variables affecting the required separator fluid volume

Identification et caractérisation des conditions aux limites pour des simulations biomécaniques patient-spécifiques

The purpose of the work is to find a way to estimate the boundary conditions of the liver. They play an essential role in forming the predictive capacity of the biomechanical model, but are presented mainly by ligaments, vessels, and surrounding organs, the properties of which are "patient specific" and cannot be measured reliably. We propose to present the boundary conditions as nonlinear springs and estimate their parameters. Firstly, we create a generalized initial approximation using the constitutive law available in the literature and a statistical atlas, obtained from a set of models with segmented ligaments. Then, we correct the approximation based on the nonlinear Kalman filtering approach, which assimilates data obtained from a modality during surgical intervention. To assess the approach, we performed experiments for both synthetic and real data. The results show a certain improvement in simulation accuracy for the cases with estimated boundaries.L'objectif de ce travail est trouvé un moyen d'estimer les conditions aux limites du foie. Elles jouent un rôle essentiel dans la capacité de prédiction du modèle biomécanique, mais sont principalement présentées par les ligaments, les vaisseaux et les organes environnants, dont les propriétés sont "spécifiques au patient" et ne peuvent être mesurées fidèlement. Nous proposons de présenter ces conditions comme des ressorts non linéaires et d'estimer ses paramètres. D’abord, nous créons une approximation initiale en utilisant la loi constitutive disponible dans la littérature et un atlas statistique obtenu à partir des modèles avec des ligaments segmentés. Après, nous la corrigeons basée sur le filtrage de Kalman non linéaire, qui assimile les données acquises d'une modalité pendant la chirurgie. Pour évaluation, nous avons réalisé des expériences avec des données synthétiques et réelles. Les résultats montrent une amélioration de la précision pour les cas avec des limites estimées

Volume 30, issue 4

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research. Visit the journal website at http://canjsurg.ca/ for more.https://ir.lib.uwo.ca/cjs/1218/thumbnail.jp

Utilisation de la lithotripsie électrohydraulique pour traiter des calculs vésicaux et urétraux chez 28 chiens

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Management of hypertension in pregnancy — prevention, diagnosis, treatment and long-term prognosis. A position statement of the Polish Society of Hypertension, Polish Cardiac Society and Polish Society of Gynaecologists and Obstetricians

ADDITIONAL INFORMATION This article has been co‑published in Kardiologia Polska (doi:10.33963/KP.14904), Arterial Hypertension (doi:10.5603/AH.a2019.0011), and Ginekologia Polska (doi:10.5603/GP.2019.0074). The articles in Kardiologia Polska, Arterial Hypertension, and Ginekologia Polska are identical except for minor stylistic and spelling differences in keeping with each journal’s style. Any citation can be used when citing this article

Comparison of conventional and laparoscopic repair of perforated peptic ulcer: an experimental and clinical study.

by Lau Wan Yee, Joseph.Thesis (M.D.)--Chinese University of Hong Kong, 1995.Includes bibliographical references (leaves 145-189).Title Page --- p.1Dedication --- p.2Table of Contents --- p.3Hypotheses --- p.7Precis to the thesis --- p.8List of Publications of my research work used in this thesis --- p.19List of Figures --- p.25List of Tables --- p.26Acknowledgments --- p.27Statement of Originality --- p.28Chapter PART I --- HISTORICAL REVIEW --- p.30Chapter Chapter 1 --- History of Endoscopic and Laparoscopic Surgery --- p.31Chapter 1.1 --- History of Endoscopic Surgery --- p.31Chapter 1.2 --- History of Documentation of Endoscopic and Laparoscopic Surgery --- p.38Chapter 1.3 --- History of Laparoscopic Surgery --- p.39Chapter 1.4 --- The future of Endoscopic and Laparoscopic Surgery --- p.52Chapter Chapter 2 --- History of Perforated Peptic Ulcer --- p.53Chapter PART II --- SIZE OF THE PROBLEM --- p.57Chapter Chapter 1 --- Incidence of Feptic Ulcer in Different Parts of The World --- p.58Chapter Chapter 2 --- Incidence of Peptic Ulcer in Hong Kong 1970 -1993 --- p.60Chapter Chapter 3 --- Incidence of Perforated Peptic Ulcer --- p.70Chapter 3.1 --- Incidence of Perforated Peptic Ulcer in Different Parts of The World --- p.70Chapter 3.2 --- Incidence of Perforated Peptic Ulcer in Hong Kong --- p.71Chapter 3.3 --- "Incidence of Perforated Peptic Ulcer in Prince of Wales Hospital, Hong Kong" --- p.71Chapter PART III --- CURRENT TREATMENT OF PERFORATED PEPTIC ULCER --- p.74Chapter Chapter 1 --- Recent Developments in Treatment of Uncomplicated Peptic Ulcer --- p.75Chapter Chapter 2 --- My Contributions to the Medical Treatment of Uncomplicated Peptic Ulcer --- p.78Chapter Chapter 3 --- Review on Current Treatment of Perforated Peptic Ulcer --- p.79Chapter 3.1 --- Introduction --- p.79Chapter 3.2 --- Currently Available Treatment Options --- p.80Chapter 3.2.1 --- Perforated Duodenal Ulcer --- p.81Chapter [A] --- Nonoperative Treatment --- p.81Chapter [B] --- Laparotomy and patch repair --- p.83Chapter [C] --- Definitive Ulcer Surgery --- p.84Chapter [D] --- Laparoscopic Treatment --- p.87Chapter 3.2.2 --- Perforated Gastric Ulcer --- p.89Chapter PART IV --- DEVELOPMENT OF LAPAROSCOPIC REPAIR OF PERFORATED PEPTIC ULCER IN OUR CENTRE --- p.91Chapter Chapter 1 --- Development of the Technique of Laparoscopic Suture Repair of Perforated Peptic Ulcer --- p.92Chapter 1.1 --- Surgical Technique --- p.93Chapter 1.2 --- Initial Results of Laparoscopic Suture Repair --- p.95Chapter Chapter 2 --- Development of the Technique of Laparoscopic Sutureless Repair of Perforated Peptic Ulcer --- p.98Chapter 2.1 --- Animal Studies --- p.98Chapter [A] --- Pilot Animal Study --- p.99Chapter [B] --- Mortality Rate on Different Methods of Repair of the Perforations --- p.100Chapter [C] --- Strength of the Repair Site by Studying the Bursting Pressure --- p.103Chapter [D] --- Detailed Histological Study --- p.108Chapter 2.2 --- Clinical Studies --- p.111Chapter [A] --- Surgical technique of Laparoscopic Sutureless Repair --- p.113Chapter [B] --- Initial Results of Laparoscopic Sutureless Repair --- p.114Chapter PART V --- TESTING THE HYPOTHESES OF THIS THESIS --- p.117Chapter Chapter 1 --- A Non-randomised Clinical Study --- p.119Chapter Chapter 2 --- A Randomised Clinical Study --- p.126Chapter PART VI --- CONCLUSIONS --- p.140Chapter PART VII --- THE FUTURE OF LAPAROSCOPIC REPAIR OF PERFORATED PEPTIC ULCER --- p.142Chapter PART VIII --- REFERENCES --- p.145References to the Precis --- p.146References to Part I Chapter 1 --- p.147References to Part I Chapter2 --- p.157References to Part II --- p.162References to Part III --- p.168References to Part IV --- p.183References to Part V --- p.186References to Part VII --- p.189APPENDIX I BRIEF SUMMARY OF MY CONTRIBUTIONS TO THE MEDICAL TREATMENT OF UNCOMPLICATED PEPTIC ULCER --- p.19

ESICM LIVES 2017 : 30th ESICM Annual Congress. September 23-27, 2017.

INTRODUCTION. Unplanned readmission to intensive care is highly undesirable in that it contributes to increased variance in care, disruption, difficulty in resource allocation and may increase length of stay and mortality particularly if subject to delays. Unlike the ICU admission from the ward, readmission prediction has received relatively little attention, perhaps in part because at the point of ICU discharge, full physiological information is systematically available to the clinician and so it is expected that readmission should be largely due to unpredictable factors. However it may be that there are multidimensional trends that are difficult for the clinician to perceive that may nevertheless be predictive of readmission. OBJECTIVES. We investigated whether machine learning (ML) techniques could be used to improve on the simple published SWIFT score [1] for the prediction of unplanned readmission to ICU within 48 hours. METHODS. We extracted systolic BP, pulse pressure, heart and respiration rate, temperature, SpO2, bilirubin, creatinine, INR, lactate, white cell count, platelet count, pH, FiO2, and total Glasgow Coma Score from ICU stays of over 2000 adult patients from our hospital electronic patient record system. We trained our own custom multidimensional / time-sensitive algorithmic ML system to predict failed discharges defined as either readmission or unexpected death within 48 hours of discharge. We used 10-fold cross validation to assess performance. We also assessed the effect of augmenting our system by transfer learning (TL) with 44,000 additional cases from the MIMIC III database. RESULTS. The SWIFT score performed relatively poorly with an AUROC of around 0.6 which our ML system trained on local data was also able to match. However when augmented with an additional dataset by TL, the AUROC for the ML system improved statistically and clinically significantly to over 0.7. CONCLUSIONS. Machine learning is able to improve on predictors based on simple multiple logistic regression. Thus there is likely to be information in the trends and in combinations of variables. A disadvantage with this technique is that ML approaches require large amounts of data for training. However, ML approaches can be improved by TL. Basing prediction models on locally derived data augmented by TL is a potentially novel approach to generating tools that customised to the institution yet can exploit the potential power of ML algorithms. REFERENCES [1] Gajic O, Malinchoc M, Comfere TB, et al. The Stability and Workload Index for Transfer score predicts unplanned intensive care unit patient readmission: initial development and validation. Crit Care Med. 2008;36(3):676–82. Grant Acknowledgement This work was internally funded

Biomedical Photoacoustic Imaging and Sensing Using Affordable Resources

The overarching goal of this book is to provide a current picture of the latest developments in the capabilities of biomedical photoacoustic imaging and sensing in an affordable setting, such as advances in the technology involving light sources, and delivery, acoustic detection, and image reconstruction and processing algorithms. This book includes 14 chapters from globally prominent researchers , covering a comprehensive spectrum of photoacoustic imaging topics from technology developments and novel imaging methods to preclinical and clinical studies, predominantly in a cost-effective setting. Affordability is undoubtedly an important factor to be considered in the following years to help translate photoacoustic imaging to clinics around the globe. This first-ever book focused on biomedical photoacoustic imaging and sensing using affordable resources is thus timely, especially considering the fact that this technique is facing an exciting transition from benchtop to bedside. Given its scope, the book will appeal to scientists and engineers in academia and industry, as well as medical experts interested in the clinical applications of photoacoustic imaging