Comparison of two cardiac output monitors, qCO and LiDCO, during general anesthesia

Background: Optimization of cardiac output (CO) has been evidenced to reduce postoperative complications and to expedite the recovery. Likewise, CO and other dynamic cardiac parameters can describe the systemic blood flow and tissue oxygenation state and can be useful in different clinical fields. This study aimed to validate the qCO monitor (Quantium Medical, Barcelona, Spain), a new device to estimate CO and other related parameters in a continuous, fully non-invasive way using advanced digital signal processing of impedance cardiography. Methods: The LiDCOrapidv2 (LiDCO Ltd, London, UK) was used to compare the performance of the qCO in 15 patients during major surgery under general anesthesia. Full surgeries were recorded and cardiac output obtained by both devices was compared by using correlation and Bland-Altman analysis. Results: The Bland-Altman analysis showed sufficient agreement with a mean bias of -0.03 ± 0.71 L/min. Conclusions: The findings showed that both systems offered comparable values and thus the non-invasive measurement of CO with qCO is a promising, feasible method. Further investigation will be required to validate this new device against calibrated devices and outcome studies would also be highly recommended.Postprint (author's final draft

Comparison of the qCON and qNOX indices for the assessment of unconsciousness level and noxious stimulation response during surgery

The objective of this work is to compare the performances of two electroencephalogram based indices for detecting loss of consciousness and loss of response to nociceptive stimulation. Specifically, their behaviour after drug induction and during recovery of consciousness was pointed out. Data was recorded from 140 patients scheduled for general anaesthesia with a combination of propofol and remifentanil. The qCON 2000 monitor (Quantium Medical, Barcelona, Spain) was used to calculate the qCON and qNOX. Loss of response to verbal command and loss of eye-lash reflex were assessed during the transition from awake to anesthetized, defining the state of loss of consciousness. Movement as a response to laryngeal mask (LMA) insertion was interpreted as the response to the nociceptive stimuli. The patients were classified as movers or non-movers. The values of qCON and qNOX were statistically compared. Their fall times and rise times defined at the start and at the end of the surgery were calculated and compared. The results showed that the qCON was able to predict loss of consciousness such as loss of verbal command and eyelash reflex better than qNOX, while the qNOX has a better predictive value for response to noxious stimulation such as LMA insertion. From the analysis of the fall and rise times, it was found that the qNOX fall time (median: 217 s) was significantly longer (p value <0.05) than the qCON fall time (median: 150 s). At the end of the surgery, the qNOX started to increase in median at 45 s before the first annotation related to response to stimuli or recovery of consciousness, while the qCON at 88 s after the first annotation related to response to stimuli or recovery of consciousness (p value <0.05). The indices qCON and qNOX showed different performances in the detection of loss of consciousness and loss of response to stimuli during induction and recovery of consciousness. Furthermore, the qCON showed faster decrease during induction. This behaviour is associated with the hypothesis that the loss of response to stimuli (analgesic effect) might be reached after the loss of consciousness (hypnotic effect). On the contrary, the qNOX showed a faster increase at the end of the surgery, associated with the hypothesis that a higher probability of response to stimuli might be reached before the recovery of consciousness.Postprint (author's final draft

Importance of the methodology nurse in the improvement of the quality of care in patients with severe head trauma

Los traumatismos craneoencefálicos (TCE) constituyen un importante problema de salud pública en los países occidentales, por el elevado índice de mortalidad, discapacidad y la prolongada hospitalización que conllevan. Son la primera causa de muerte e incapacidad en la población menor de 45 años y una causa importante de pérdida prematura de vida productiva, de altos costes de atención médica y de pérdidas socioeconómicas grandes para la sociedad. El objetivo del estudio es revisar la literatura actual relacionada con los cuidados de Enfermería aplicados a los pacientes con TCE grave, así como la influencia de los mismos en la mejora de la práctica asistencial y en la calidad de vida de los pacientes y sus familias. Para la realización del trabajo se lleva a cabo una revisión narrativa de la literatura relacionada sobre los aspectos más importantes que influyen en la atención y cuidados de los pacientes con TCE grave. Se revisan las bases de datos MEDLINE, CUIDEN, BDIE, INDEX, CINAHL, LILACS y revisiones sistemáticas de la COCHRANE. La aplicación de la metodología enfermera favorece el cuidado integral al paciente y familia, ayuda a prevenir complicaciones que puedan empeorar la recuperación del paciente disminuyendo las secuelas a largo plazo, y favorece la calidad de vida de estos pacientes además de contribuir en la mejora de la calidad asistencial.The traumatic brain injury (TBI) constitutes a major public health problem in the Western countries, by the high rate of mortality, disability and prolonged hospital stay involving. They are the leading cause of death and disability in the population under 45 years and a major cause of premature loss of productive life, high costs of medical care and of large socio-economic loss to society. The objective of this study is to review the current literature related to nursing care applied to patients with severe TBI, as well as the influence of the same in the improvement of the health care practice and the quality of life of patients and their families. To carry out the work is performed a narrative review of the literature on the most important aspects that influence the attention and care of patients with severe TBI. We review the databases MEDLINE, CUIDEN, BDIE, INDEX, CINAHL, LILACS and the Cochrane systematic reviews. Applying nursing methodology integral care helps the patient and family, helps to prevent complications that can worsen the patient’s recovery by reducing long-term sequelae, and enhances the quality of life of these patients as well as contributes to the improvement of the quality of care

Perinatal mortality in the European Union. What influences whether birth is hospital or at home? Literature review

OBJETIVOS: - Describir el modelo de control de la gestación y asistencia al parto domiciliario tomando como referencia Países Bajos. - Comparar la Tasa de Mortalidad Perinatal (TMP) de los países europeos donde sea usual el parto domiciliario con los que la mayoría de sus partos sean atendidos en el hospital. - Mostrar los datos de Tasa de Mortalidad en Países Europeos. - Abrir nuevas vías de investigación respecto al tema. MÉTODOS: Revisión bibliográfica mediante búsqueda en bases de datos y buscadores genéricos de Internet. RESULTADOS: Según un estudio holandés donde comparan tipo de parto y resultados obstétricos, no hay diferencias. Estudios PERISTAT I y II: después de Francia, Países Bajos tuvieron la mayor tasa de mortalidad fetal y la mayor tasa de mortalidad neonatal precoz. Estudio de Erasmus MC: en países similares a Países Bajos la TMP puede ser un 30% menos. Meta-análisis en American Journal of Obstetrics & Gynecology: los nacimientos planificados en casa de madres sanas y bajo riesgo duplicaba el riesgo de mortalidad neonatal. TMP según Comisión Europea: España de las más bajas (TMP=4,9), mucho más que Países Bajos (TMP=6,6). Sube en Reino Unido (TMP= 8,1) o Francia con una TMP de las más altas de Europa (TMP=11,1). CONCLUSIONES: Extrapolar el sistema Holandés a nuestro país sería difícil porque: - Es imprescindible ir al hospital para analgesia farmacológica (muy demandada en España). - El parto hospitalario en España es gratuito (no en Holanda). - Lejanía de algunos domicilios a los hospitales.OBJECTIVES: - Explain the control model of pregnancy and birthing house Netherlands by reference. - Compare the perinatal mortality rate (TMP) of the European countries where home birth is usual with most of their births are attended in the hospital. - Show data-mortality rate in European countries. - Open new avenues of research on the subject. METHODS: Literature review by searching databases and general Internet search engines. RESULTS: According to a Dutch study which compared mode of delivery and obstetric outcomes, no differences. PERISTAT Studies I and II: After France, the Netherlands had the highest fetal mortality rate and the highest rate of early neonatal mortality. Erasmus MC Study: in countries like the Netherlands TMP can be 30% less. Meta-analysis in the American Journal of Obstetrics & Gynecology: planned home births for low risk healthy mothers and doubled the risk of neonatal mortality. TMP as European Commission: the lowest Spain (TMP = 4.9), much more than Netherlands (TMP = 6.6). Add in the UK (TMP = 8.1) or France with a TMP of the highest in Europe (TMP = 11.1). CONCLUSIONS: Extrapolate the Dutch system in our country would be difficult because: - It is essential to go to hospital for pharmacological analgesia (high demand in Spain). - The hospital birth in Spain is free (not in Holland). - Remoteness of some homes to hospitals

Prognostic value of cutaneous reinnervation with GAP-43 in oxaliplatin-induced neuropathy.

Background and purpose: Oxaliplatin-induced neuropathy (OIN) implies axonal damage of both small and large sensory nerve fibers. We aimed at comparing the neurophysiological changes occurred after treatment and the capability to recovery based on histological marker of re-innervation GAP-43. Methods: 48 patients with cancer were assessed before and after chemotherapy (at 3 months and 12 months if available). We recorded ulnar and sural sensory nerve action potentials (SNAP), determined quantitative sensory thresholds for warm and cold (WDT, CDT), pain thresholds and collected a distal biopsy of skin to assess the intra-epidermal nerve fiber density (IENFD) with PGP9.5 and GAP-43 markers (in a subgroup of 19 patients). Results: Increased WDT and CDT as well as diminished IENFD at distal leg were already found in 30% of oncologic patients before treatment. After oxaliplatin, there was a significant increase in thermal thresholds in 52% of patients, and a decrease of SNAP amplitude in the sural nerve in 67% patients. IENFD was reduced in 47% and remained unchanged in 37% after oxiplatin. The density of GAP-43 + fibers and GAP-43/PGP 9.5 ratio was similar before and after treatment showing that cutaneous re-innervation is preserved despite no clinical recovery was observed after one year. Conclusion: Non-selective axonal loss affects sensory fibers in OIN. However, the presence of intra-epidermal regenerative sprouts detected by GAP-43 may reduce the impact of neurotoxicity in the small fibers with long-term sequelae mostly on myelinated nerve endings. Pre-oxaliplatin GAP-43 failed to identify patients with higher risk of damage or worse recovery after treatment

Comparación de resultados de dos técnicas de biología de sistemas para la aplicación de un análisis de reposicionamiento de fármacos

El presente trabajo se ha propuesto, para comparar los resultados de dos de estas metodologías: la TPMS (Therapeutic Performance Mapping System), de Anaxomics Biotech y el método basado en segmentación de estructuras químicas. Para alcanzar dicha finalidad, se ha llevado a cabo un análisis de reposicionamiento para la patología del acné común, aplicando ambos métodos y se ha comparado la concordancia de los resultados.It has been proposed for the present work, to compare the results of two different methods: TPMS (Therapeutic Performance Mapping System) of Anaxomics Biotech, and the fragment based chemical method-Aim to that, it has been carried out a reprofiling analysis for the acne vulgaris, applying both methods, and it has been compared the concordance of the results.El present treball s'ha proposat, per a comparar els resultats de dos d'aquestes metodologies: la TPMS (Therapeutic Performance Mapping System), de Anaxomics Biotech i el mètode basat en segmentació d'estructures químiques. Per a aconseguir aquesta finalitat, s'ha dut a terme una anàlisi de reposicionament per a la patologia de l'acne comú, aplicant tots dos mètodes i s'ha comparat la concordança dels resultats

Comparison of the qCON and qNOX indices for the assessment of unconsciousness level and noxious stimulation response during surgery

The objective of this work is to compare the performances of two electroencephalogram based indices for detecting loss of consciousness and loss of response to nociceptive stimulation. Specifically, their behaviour after drug induction and during recovery of consciousness was pointed out. Data was recorded from 140 patients scheduled for general anaesthesia with a combination of propofol and remifentanil. The qCON 2000 monitor (Quantium Medical, Barcelona, Spain) was used to calculate the qCON and qNOX. Loss of response to verbal command and loss of eye-lash reflex were assessed during the transition from awake to anesthetized, defining the state of loss of consciousness. Movement as a response to laryngeal mask (LMA) insertion was interpreted as the response to the nociceptive stimuli. The patients were classified as movers or non-movers. The values of qCON and qNOX were statistically compared. Their fall times and rise times defined at the start and at the end of the surgery were calculated and compared. The results showed that the qCON was able to predict loss of consciousness such as loss of verbal command and eyelash reflex better than qNOX, while the qNOX has a better predictive value for response to noxious stimulation such as LMA insertion. From the analysis of the fall and rise times, it was found that the qNOX fall time (median: 217 s) was significantly longer (p value <0.05) than the qCON fall time (median: 150 s). At the end of the surgery, the qNOX started to increase in median at 45 s before the first annotation related to response to stimuli or recovery of consciousness, while the qCON at 88 s after the first annotation related to response to stimuli or recovery of consciousness (p value <0.05). The indices qCON and qNOX showed different performances in the detection of loss of consciousness and loss of response to stimuli during induction and recovery of consciousness. Furthermore, the qCON showed faster decrease during induction. This behaviour is associated with the hypothesis that the loss of response to stimuli (analgesic effect) might be reached after the loss of consciousness (hypnotic effect). On the contrary, the qNOX showed a faster increase at the end of the surgery, associated with the hypothesis that a higher probability of response to stimuli might be reached before the recovery of consciousness