First experience with a new negative pressure incision management system on surgical incisions after cardiac surgery in high risk patients

<p>Abstract</p> <p>Background</p> <p>Sternal wound infection remains a serious potential complication after cardiac surgery. A recent development for preventing wound complications after surgery is the adjunctive treatment of closed incisions with negative pressure wound therapy. Suggested mechanisms of preventive action are improving the local blood flow, removing fluids and components in these fluids, helping keep the incision edges together, protecting the wound from external contamination and promoting incision healing. This work reports on our initial evaluation and clinical experience with the Prevena™Incision Management System, a recently introduced new negative pressure wound therapy system specifically developed for treating closed surgical incisions and helping prevent potential complications. We evaluated the new treatment on sternal surgical incisions in patients with multiple co-morbidities and consequently a high risk for wound complications.</p> <p>Methods</p> <p>The Prevena™incision management system was used in 10 patients with a mean Fowler risk score of 15.1 [Range 8-30]. The negative pressure dressing was applied immediately after surgery and left in place for 5 days with a continuous application of -125 mmHg negative pressure. Wounds and surrounding skin were inspected immediately after removal of the Prevena™ incision management system and at day 30 after surgery.</p> <p>Results</p> <p>Wounds and surrounding skin showed complete wound healing with the absence of skin lesions due to the negative pressure after removal of the Prevena™ dressing. No device-related complications were observed. No wound complications occurred in this high risk group of patients until at least 30 days after surgery.</p> <p>Conclusions</p> <p>The Prevena™system appears to be safe, easy to use and may help achieve uncomplicated wound healing in patients at risk of developing wound complications after cardiothoracic surgery.</p

Brain-Based Indices for User System Symbiosis

The future generation user system interfaces need to be user-centric which goes beyond user-friendly and includes understanding and anticipating user intentions. We introduce the concept of operator models, their role in implementing user-system symbiosis, and the usefulness of brain-based indices on for instance effort, vigilance, workload and engagement to continuously update the operator model. Currently, the best understood parameters in the operator model are vigilance and workload. An overview of the currently employed brain-based indices showed that indices for the lower workload levels (often based on power in the alpha and theta band of the EEG) are quite reliable, but good indices for the higher workload spectrum are still missing. We argue that this is due to the complex situation when performance stays optimal despite increasing task demands because the operator invests more effort. We introduce a model based on perceptual control theory that provides insight into what happens in this situations and how this affects physiological and brain-based indices.We argue that a symbiotic system only needs to intervene directly in situations of under and overload, but not in a high workload situation. Here, the system must leave the option to adapt on a short notice exclusively to the operator. The system should lower task demands only in the long run to reduce the risk of fatigue or long recovery times. We end by indicating future operator model parameters that can be reflected by brain-based indices