New general synthesis of alpha-alkoxyketones via alpha'-alkylation, alpha-alkylation and alpha,alpha'-dialkylation of alpha-alkoxyketimines

alpha-Methoxy- and alpha-ethoxyketones, as important intermediates in organic synthesis and flavor compounds in food chemistry, were synthesized by deprotonation of N-(1-alkoxy-2-propylidene)isopropylamine, prepared by condensation of the corresponding alpha-alkoxyacetone with isopropylamine, and subsequent reaction of the corresponding 1-azaallylic anions with alkyl halides to afford alpha'-alkylated, alpha-alkylated and alpha,alpha'-dialkylated ketimines. Hydrolysis of the imino function led to the desired substituted alpha-alkoxyketones. The ratio of alpha-, alpha'-, and alpha,alpha'-(di)alkylated compounds depended on the amount of base used and on the nature of the alkylating reagent

Service-oriented subscription management of medical decision data in the intensive care unit

Objectives: This paper addresses the design of a platform for the management of medical decision data in the ICU. Whenever new medical data from laboratories of monitors is available or at fixed times, the appropriate medical support services are activated and generate a medical alert or suggestion to the bedside terminal, the physician's PDA, smart phone or mailbox. Since future ICU systems will rely ever more on medical decision support, a generic and flexible subscription platform is of high importance. Methods: Our platform is designed based on the principles of service-oriented architectures, and is fundamental for service deployment since the medical support services only need to implement their algorithm and can rely on the platform for general functionalities. A secure communication and execution environment are also provided. Results: A prototype, where medical support services can be easily plugged in, has been implemented using Web service technology and is currently being evaluated by the Department of Intensive Cafe of the Ghent University Hospital. To illustrate the platform operation and performance, two prototype medical support services are used, showing that the extra response time introduced by the platform is less than 150 ms. Conclusions: The platform allows for easy integration with hospital information systems. The platform is generic and offers user-friendly patient/service subscription, transparent data and service resource management and priority-based filtering of messages. The performance has been evaluated and it was shown that the response time of platform components is negligible compared to the execution time of the medical support services

Has information technology finally been adopted in Flemish intensive care units?

<p>Abstract</p> <p>Background</p> <p>Information technology (IT) may improve the quality, safety and efficiency of medicine, and is especially useful in intensive Care Units (ICUs) as these are extremely data-rich environments with round-the-clock changing parameters. However, data regarding the implementation rates of IT in ICUs are scarce, and restricted to non-European countries. The current paper aims to provide relevant information regarding implementation of IT in Flemish ICU's (Flanders, Belgium).</p> <p>Methods</p> <p>The current study is based on two separate but complementary surveys conducted in the region of Flanders (Belgium): a written questionnaire in 2005 followed by a telephone survey in October 2008. We have evaluated the actual health IT adoption rate, as well as its evolution over a 3-year time frame. In addition, we documented the main benefits and obstacles for taking the decision to implement an Intensive Care Information System (ICIS).</p> <p>Results</p> <p>Currently, the computerized display of laboratory and radiology results is almost omnipresent in Flemish ICUs, (100% and 93.5%, respectively), but the computerized physician order entry (CPOE) of these examinations is rarely used. Sixty-five % of Flemish ICUs use an electronic patient record, 41.3% use CPOE for medication prescriptions, and 27% use computerized medication administration recording. The implementation rate of a dedicated ICIS has doubled over the last 3 years from 9.3% to 19%, and another 31.7% have plans to implement an ICIS within the next 3 years. Half of the tertiary non-academic hospitals and all university hospitals have implemented an ICIS, general hospitals are lagging behind with 8% implementation, however. The main reasons for postponing ICIS implementation are: (i) the substantial initial investment costs, (ii) integration problems with the hospital information system, (iii) concerns about user-friendly interfaces, (iv) the need for dedicated personnel and (v) the questionable cost-benefit ratio.</p> <p>Conclusions</p> <p>Most ICUs in Flanders use hospital IT systems such as computerized laboratory and radiology displays. The adoption rate of ICISs has doubled over the last 3 years but is still surprisingly low, especially in general hospitals. The major reason for not implementing an ICIS is the substantial financial cost, together with the lack of arguments to ensure the cost/benefit.</p

Use of web services for computerized medical decision support, including infection control and antibiotic management, in the intensive care unit

The increasing complexity of procedures in the intensive care unit (ICU) requires complex software services, to reduce improper use of antibiotics and inappropriate therapies, and to offer earlier and more accurate detection of infections and antibiotic resistance. We investigated whether web-based software can facilitate the computerization of complex medical processes in the ICU. The COSARA application contains the following modules: Infection overview, Thorax, Microbiology, Antibiotic therapy overview, Admission cause with comorbidity and admission diagnosis, infection linking and registration, and Feedback. After the implementation and test phase, the COSARA software was installed on a physician's off ice PC and then on the bedside PCs of the patients. Initial evaluation indicated that the services had been integrated easily into the daily clinical workflow of the medical staff. The use of a service oriented architecture with web service technology for the development of advanced decision support in the ICU offers several advantages over classical software design approaches

Diastereoselective Aldol reaction of Zincated 3-Chloro-3-methyl-1-azaallylic anions as key step in the synthesis of 1,2,3,4-Tetrasubstituted 3-Chloroazetidines

Zincated 3-chloro-3-methyl-1-azaallylic anions undergo a stereoselective aldol addition across aromatic aldehydes and subsequent mesylation to produce syn alpha-chloro-beta-mesyloxyketimines, which were isolated in 80-84% yield and high diastereomeric excess (dr > 97/3) after purification via flash chromatography. The syn alpha-chloro-beta-mesyloxyketimines were further stereoselectively reduced to give stereochemically defined 3-aminopropyl mesylates, which were cyclized to 1,2,3,4-tetrasubstituted 3-chloroazetidines containing three contiguous stereogenic centers. DFT calculations on the key aldol addition revealed the presence of a highly ordered bimetallic six-membered twist-boat-like transition state structure with a tetra-coordinated metal cyclic structure. DFT calculations revealed that chelation of both zinc and lithium cations in the transition state structure leads to the experimentally observed high syn diastereoselectivity of aldol reactions

Random survival forests for predicting the bed occupancy in the intensive care unit

Predicting the bed occupancy of an intensive care unit (ICU) is a daunting task. The uncertainty associated with the prognosis of critically ill patients and the random arrival of new patients can lead to capacity problems and the need for reactive measures. In this paper, we work towards a predictive model based on Random Survival Forests which can assist physicians in estimating the bed occupancy. As input data, we make use of the Sequential Organ Failure Assessment (SOFA) score collected and calculated from 4098 patients at two ICU units of Ghent University Hospital over a time period of four years. We compare the performance of our system with a baseline performance and a standard Random Forest regression approach. Our results indicate that Random Survival Forests can effectively be used to assist in the occupancy prediction problem. Furthermore, we show that a group based approach, such as Random Survival Forests, performs better compared to a setting in which the length of stay of a patient is individually assessed