Khresmoi Professional: Multilingual Semantic Search for Medical Professionals

There is increasing interest in and need for innovative solutions to medical search. In this paper we present the EU funded Khresmoi medical search and access system, currently in year 3 of 4 of development across 12 partners . The Khresmoi system uses a component based architecture housed in the cloud to allow for the development of several innovative applications to support target users medical information needs. The Khresmoi search systems based on this architecture have been designed to support the multilingual and multimod al information needs of three target groups the general public, general practitioners and consultant radiologists. In this paper we focus on the presentation of the systems to support the latter two groups using semantic, multilingual text and image based (including 2D and 3D radiology images) search

Prevention of laparoscopic surgery induced hypothermia with warmed humidified insufflation: Is the experimental combination of a warming blanket synergistic?

<div><p>Introduction</p><p>Maintaining normothermia during anesthesia is imperative to provide quality patient care and to prevent adverse outcomes. Prolonged laparoscopic procedures have been identified as a potential risk factor for hypothermia, due to continuous insufflation of cold and dry carbon dioxide. Perioperative hypothermia is associated with increased hospital cost and many complications including; impaired drug metabolism, impaired immune function, cardiac morbidity, shivering, coagulopathy.</p><p>Methods</p><p>In this experimental study, four pigs underwent four interventions each, resulting in 16 total trials. Using standardized general anesthesia in a randomized Latin-square sequence the four interventions include: 1. Control group without an administered pneumoperitoneum, 2. Administered standard pneumoperitoneum using 21°C insufflated gas and under-body forced-air warming, 3. Administered pneumoperitoneum with insufflation of warmed/humidified carbon dioxide, 4. Administered pneumoperitoneum with insufflation of warmed/humidified carbon dioxide and under-body forced-air warming. The primary outcome was distal esophageal temperature change 4 hours after trocar insertion.</p><p>Results</p><p>Four hours after trocar insertion, pigs in the control group lost 2.1 ± 0.4°C; pigs with warmed and humidified insufflation lost 1.8 ± 0.4°C; pigs with forced-air warming group lost 1.3 ± 0.9°C; and pigs exposed to a combination of warmed and humidified insufflation with forced-air warming increased by 0.3 ± 0.2°C.</p><p>Conclusion</p><p>This experimental animal study provides evidence that a combination of warmed and humidified insufflation of carbon dioxide (CO₂) in conjunction with forced-air warming is an effective strategy in the prevention of perioperative hypothermia. Further clinical trials investigating humans are therefore indicated.</p></div

Changes in core temperatures during the study period in each group.

<p><i>Circle blue line</i>: control group (no insufflation); <i>Square green line</i>: warmed insufflation group (heating and humidification of the insufflation CO₂); <i>Triangle orange line</i>: forced air group (standard insufflation with lower-body warming blanket); <i>Triangle red line</i>: combination group (heating and humidification of the insufflation CO₂ in association with underbody warming blanket).Red Star stands at time after which the difference in temperature becomes significant across groups control group versus combination group i.e. 210 min.</p

Is prolonged infusion of piperacillin/tazobactam and meropenem in critically ill patients associated with improved pharmacokinetic/pharmacodynamic and patient outcomes? An observation from the Defining Antibiotic Levels in Intensive care unit patients (DALI) cohort

Objectives: We utilized the database of the Defining Antibiotic Levels in Intensive care unit patients (DALI) study to statistically compare the pharmacokinetic/pharmacodynamic and clinical outcomes between prolonged- infusion and intermittent-bolus dosing of piperacillin/tazobactam and meropenem in critically ill patients using inclusion criteria similar to those used in previous prospective studies. Methods: This was a post hoc analysis of a prospective, multicentre pharmacokinetic point-prevalence study (DALI), which recruited a large cohort of critically ill patients from 68 ICUs across 10 countries. Results: Of the 211 patients receiving piperacillin/tazobactam and meropenem in the DALI study, 182 met inclusion criteria. Overall, 89.0% (162/182) of patients achieved the most conservative target of 50% fT 65MIC (time over which unbound or free drug concentration remains above the MIC). Decreasing creatinine clearance and the use of prolonged infusion significantly increased the PTA for most pharmacokinetic/pharmacodynamic targets. In the subgroup of patients who had respiratory infection, patients receiving \u3b2-lactams via prolonged infusion demonstrated significantly better 30 day survival when compared with intermittent-bolus patients [86.2% (25/29) versus 56.7% (17/30); P=0.012]. Additionally, in patients with a SOFA score of 65 9, administration by prolonged infusion compared with intermittent-bolus dosing demonstrated significantly better clinical cure [73.3% (11/15) versus 35.0% (7/20); P=0.035] and survival rates [73.3% (11/15) versus 25.0% (5/20); P=0.025]. Conclusions: Analysis of this large dataset has provided additional data on the niche benefits of administration of piperacillin/tazobactam and meropenem by prolonged infusion in critically ill patients, particularly for patients with respiratory infection