Neural networks as a prognostic tool in critically ill patients

Im Zeitraum 1. 11. 1993 bis 30. 3. 1997 wurden 1149 allgemeinchirurgische Intensivpatienten prospektiv erfaßt, von denen 114 die Kriterien des septischen Schocks erfüllten. Die Letalität der Patienten mit einem septischen Schock betrug 47,3%. Nach Training eines neuronalen Netzes mit 91 (von insgesamt n = 114) Patienten ergab die Testung bei den verbleibenden 23 Patienten bei der Berücksichtigung von Parameterveränderungen vom 1. auf den 2. Tag des septischen Schocks folgendes Ergebnis: Alle 10 verstorbenen Patienten wurden korrekt als nicht überlebend vorhergesagt, von den 13 Überlebenden wurden 12 korrekt als überlebend vorhergesagt (Sensitivität 100%; Spezifität 92,3%).Neural networks as a prognostic tool in critically ill patients Summary: From 1. 11. 93 to 30. 3. 97, 1149 patients were prospectively studied during their ICU stay. Of them,114 met the criteria of septic shock, with lethality of 47.3%. A neural network was trained with datasets from 91 of these 114 patients. Testing the trained neural network with the remaining 23 patients, the following result was obtained: all 10 patients dying from septic shock were correctly predicted; of 13 surviving patients, 12 were correctly identified (sensitivity 100%; specifity 92.3%)

PROUD: Effects of preoperative long-term immunonutrition in patients listed for liver transplantation

<p>Abstract</p> <p>Background</p> <p>Patients with end stage liver disease are characteristically malnourished which is associated with poor outcome. Formulas enriched with arginine, ω-3 fatty acids, and nucleotides, "immunonutrients", potentially improve their nutritional status. This study is designed to evaluate the clinical outcome of long-term "immunonutrition" of patients with end-stage liver disease while on the waiting list for liver transplantation.</p> <p>Methods/design</p> <p>A randomized controlled double blind multi-center clinical trial with two parallel groups comprising a total of 142 newly registered patients for primary liver transplantation has been designed to assess the safety and efficacy of the long-term administration of ORAL IMPACT^®, an "immunonutrient" formula, while waiting for a graft. Patients will be enrolled the day of registration on the waiting list for liver transplantation. Study ends on the day of transplantation. Primary endpoints include improved patients' nutritional and physiological status, as measured by mid-arm muscle area, triceps skin fold thickness, grip strength, and fatigue score, as well as patients' health related quality of life. Furthermore, patients will be followed for 12 postoperative weeks to evaluate anabolic recovery after transplantation as shown by reduced post-transplant mechanical ventilation, hospital stay, wound healing, infectious morbidities (pneumonia, intraabdominal abscess, sepsis, line sepsis, wound infection, and urinary tract infection), acute and chronic rejection, and mortality.</p> <p>Discussion</p> <p>Formulas enriched with arginine, ω-3 fatty acids, and nucleotides have been proven to be beneficial in reducing postoperative infectious complications and length of hospital stay among the patients undergoing elective gastrointestinal surgery. Possible mechanisms include downregulation of the inflammatory responses to surgery and immune modulation rather than a sole nutritional effect.</p> <p>Trial registration</p> <p>ClinicalTrials.gov NCT00495859</p

Acute cholecystitis – early laparoskopic surgery versus antibiotic therapy and delayed elective cholecystectomy: ACDC-study

<p>Abstract</p> <p>Background</p> <p>Acute cholecystitis occurs frequently in the elderly and in patients with gall stones. Most cases of severe or recurrent cholecystitis eventually require surgery, usually laparoscopic cholecystectomy in the Western World. It is unclear whether an initial, conservative approach with antibiotic and symptomatic therapy followed by delayed elective surgery would result in better morbidity and outcome than immediate surgery. At present, treatment is generally determined by whether the patient first sees a surgeon or a gastroenterologist. We wish to investigate whether both approaches are equivalent. The primary endpoint is the morbidity until day 75 after inclusion into the study.</p> <p>Design</p> <p>A multicenter, prospective, randomized non-blinded study to compare treatment outcome, complications and 75-day morbidity in patients with acute cholecystitis randomized to laparoscopic cholecystectomy within 24 hours of symptom onset or antibiotic treatment with moxifloxacin and subsequent elective cholecystectomy. For consistency in both arms moxifloxacin, a fluorquinolone with broad spectrum of activity and high bile concentration is used as antibiotic. Duration: October 2006 – November 2008</p> <p>Organisation/Responsibility</p> <p>The trial was planned and is being conducted and analysed by the Departments of Gastroenterology and General Surgery at the University Hospital of Heidelberg according to the ethical, regulatory and scientific principles governing clinical research as set out in the Declaration of Helsinki (1989) and the Good Clinical Practice guideline (GCP).</p> <p>Trial Registration</p> <p>ClinicalTrials.gov NCT00447304</p

NACA Technical Memorandums

"A selection of measurements obtained on experimental impellers for axial blowers will be reported. In addition to characteristic curves plotted for low and for high peripheral velocities, proportions and blade sections for six different blower models and remarks on the design of blowers will be presented" (p. 1)

Offener Brief der Wissenschaftlichen Medizinischen Fachgesellschaften in der Bundesrepublik Deutschland an die verantwortlichen Politiker

Die wissenschaftlichen medizinischen Fachgesellschaften verfolgen mit steigender Sorge die Entwicklung der klinischen und wissenschaftlichen Medizin in Deutschland. Dies betrifft insbesondere die Universitätsmedizin, da deren integrierte Aufgaben von Lehre, Forschung und Krankenversorgung durch die gegenwärtigen und zukünftigen Rahmenbedingungen besonders berührt werden. Die Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), die 152 medizinische Fachgesellschaften vertritt und sich in ihrer satzungsgemäßen Intention der Förderung der wissenschaftlichen Medizin in der Bundesrepublik Deutschland besonders verpflichtet fühlt, wendet sich deshalb mit der folgenden Stellungnahme an die in höchster Verantwortung stehenden Politiker. Die Stellungnahme basiert auf einer gemeinsamen Publikation der Präsidenten 2006/2007 von drei großen Wissenschaftlichen Medizinischen Fachgesellschaften: Prof. Dr. Hugo van Aken (Anästhesiologie und Intensivmedizin), Prof. Dr. Wolfgang Hiddemann (Innere Medizin) und Prof. Dr. Hans-Ulrich Steinau (Chirurgie) - erschienen in der Frankfurter Allgemeinen Zeitung vom 16. 05. 2007. Der Offene Brief wurde am 18. 9. 2007 an die Empfänger abgeschickt