Early impact analysis of remote vital sign monitoring after esophagectomy: a multi-method study design

Background: Esophagectomy is associated with serious postoperative complications in 20-40% of the patients. Early recognition and treatment of these complications is critical to prevent secondary damage. To support medical professionals in the timely detection of clinical deterioration in patients admitted to the ward, it is of interest to use wireless sensor technologies allowing unobtrusive continuous vital sign tracking. However, it is yet unclear under which circumstances and to what extent telemonitoring provides beneficial effects in this patient population. Methods: We designed a multi-methods and multicenter study to evaluate the expected effects of continuous vital sign monitoring in the postoperative ward trajectory of patients undergoing esophagectomy. Semi-structured interviews with nurses and surgeons are conducted to elicit the probability of earlier detection and treatment of postoperative complications and the effects on related clinical outcome measures (mortality, ICU readmissions, and hospital stay length). To support valid estimations, interviews include scenario’s incorporating the characteristics and outcomes from center-specific patient population. Decision tree analysis is performed to assess the relation between clinical outcome for current situation and the conceived situation with continuous ward monitoring. Findings: We expect that the proposed study will provide insight in the clinical effects of continuous remote vital sign monitoring in the postoperative ward in patients undergoing esophagectomy. Discussion: Decision tree analysis combined with expert elicitation enables assessment of the afferent (i.e. monitoring) and efferent (i.e. response chain) arm of telemonitoring, and facilitates impact analysis in an early stage. The results of this study can be used to optimize the strategy of vital sign monitoring in wards, and to target situations where improvement in patient outcome and safety is expected

Научно-технический прогресс или безопасность человечества

Постепенное развитие общественного производства, его постоянное совершенствование являются фундаментальными закономерностями экономической жизни человечества. Они основываются на прогрессе науки и техники. Научно-технический прогресс за тысячелетия человеческой цивилизации прошел сложный и противоречивый путь развития. Это было вызвано тем, что именно технический прогресс, который осуществлялся на первых этапах развития общества, осуществлялся отдельно от научного прогресса до конца XVIII - начала XIX в. И только в период промышленной революции началось быстрое сближение научного и технического прогресса и возник целостный научно-технический прогресс.Gradual development of social production, its constant improvement of the fundamental laws of the economic life of mankind. They are based on the progress of science and technology. Scientific and technological progress for the millennium of human civilization has passed a complex and contradictory path of development. This was due to the fact that it was the technical progress that was carried out at the first stages of the development of society that was carried out separately from scientific progress until the end of the eighteenth and early nineteenth centuries. And only in the period of the industrial revolution did the rapid rapprochement of scientific and technological progress and the emergence of integral scientific and technological progress began

Development of a National Core Dataset for Preoperative Assessment

Objective:To define a core dataset for preoperative assessment to leverage uniform data collection in this domain. This uniformity is a prerequisite for data exchange between care providers and semantic interoperability between health record systems. Methods: To design this core dataset a combination of literature review and expert consensus meetings were used. In the first meeting a working definition for “core dataset” was specified. Subgroups were formed to address major headings of the core dataset. In the following eight meetings data items for each subheading were discussed. The items in the resulting draft of the dataset were compared to those retrieved from an earlier literature review study. In the last two expert meetings modifications of the dataset were performed based on the result of this literature study. Results: Based on expert consensus a draft dataset including 82 data items was designed. Seventy-six percent of data items in the draft dataset were covered by the literature study. Nine data items were modified in the draft and 14 data items were added to the dataset based on input from the literature review. The final dataset of 93 data items covers patient history, physical examination, supplementary examination and consultation, and final judgment. Conclusions: This preoperative-assessment dataset was defined based on expert con - sensus and literature review. Both methods proved to be valuable and complementary. This dataset opens the door for creating standardized approaches in data collection in the preoperative assessment field which will facilitate interoperability between different electronic health records and different users

Endocytosis in filamentous fungi

Endocytosis is little understood in filamentous fungi. For some time it has been controversial as to whether endocytosis occurs in filamentous fungi. A comparative genomics analysis between Saccharomyces cerevisiae and 10 genomes of filamentous fungal species showed that filamentous fungi possess complex endocytic machineries. The use of the endocytic marker dye FM4-64, and various vesicle trafficking inhibitors revealed many similarities between endocytosis in the filamentous fungus Neurospora crassa, and endocytosis in budding yeast and mammalian cells. Actin polymerization was found to be crucial for endocytosis in N. crassa, and the microtubule cytoskeleton seemed to be necessary for long distance movement of putative early endosomes. Brefeldin A (BFA) blocked vesicular transport to the Spitzenkörper. Three putative endocytic proteins (WASP, clathrin light chain and Rab5) were labelled with fluorescent proteins in N. crassa. WASP-GFP was found to localise to motile, punctate structures in the plasma membrane just behind the hyphal apex in growing hyphae. This localisation changed to the hyphal apex when growth was temporarily arrested, indicating a possible role in endocytosis and polarized growth. Clathrin light chain-GFP was found to be concentrated in a region just behind the Spitzenkörper, which is consistent with there being a high concentration of clathrinmediated endocytosis in this region. Clathrin light chain-GFP also labelled putative Golgi and this labelling was found to be BFA sensitive, whereas BFA did not have a detectable effect on FM4-64 internalisation and organelle staining. GFP-Rab5 labelled putative early endosomes and decorated microtubules. Knock-outs of putative endocytic proteins in N. crassa, generated as part of the Neurospora genome consortium gene knock-out project, were analysed for defects in endocytosis. 14 out of 17 gene knock-outs were found to be ascospore lethal. The Rab5 knock-out was viable, but did not show a detectable effect on the endocytic internalisation of FM4-64 or its pattern of staining. However, it did exhibit a defect in sexual crossing

Postoperative urinary retention:Risk factors, bladder filling rate and time to catheterization: an observational study as part of a randomized controlled trial

Background: Knowledge of risk factors for postoperative urinary retention may guide appropriate and timely urinary catheterization. We aimed to determine independent risk factors for postoperative urinary catheterization in general surgical patients. In addition, we calculated bladder filling rate and assessed the time to spontaneous voiding or catheterization. We used the patients previously determined individual maximum bladder capacity as threshold for urinary catheterization.Methods: Risk factors for urinary catheterization were prospectively determined in 936 general surgical patients. Patients were at least 18 years of age and operated under general or spinal anesthesia without the need for an indwelling urinary catheter. Patients measured their maximum bladder capacity preoperatively at home, by voiding in a calibrated bowl after a strong urge that could no longer be ignored. Postoperatively, bladder volumes were assessed hourly with ultrasound. When patients reached their maximum bladder capacity and were unable to void, they were catheterized by the nursing staff. Bladder filling rate and time to catheterization were determined.Results: Spinal anesthesia was the main independent modifiable risk factor for urinary catheterization (hyperbaric bupivacaine, relative risk 8.1, articaine RR 3.1). Unmodifiable risk factors were a maximum bladder capacity &lt;500 mL (RR 6.7), duration of surgery &gt;= 60 min (RR 5.5), first scanned bladder volume at the Post Anesthesia Care Unit &gt;= 250mL (RR 2.1), and age &gt;= 60 years (RR 2.0). Urine production varied from 100 to 200 mL/h. Catheterization or spontaneous voiding took place approximately 4 h postoperatively.Conclusion: Spinal anesthesia, longer surgery time, and older age are the main risk factors for urinary retention catheterization. Awareness of these risk factors, regularly bladder volume scanning (at least every 3 h) and using the individual maximum bladder capacity as volume threshold for urinary catheterization may avoid unnecessary urinary catheterization and will prevent bladder overdistention with the attendant risk of lower urinary tract injury.</p