Ocular biometry through fully refocused steady-state magnetic resonance imaging sequence: reliability and agreement with the IOLMaster® 500.

PURPOSE: To evaluate the reliability and agreement between Fully Refocused Steady-State magnetic resonance sequences (FRSS) and the IOLMaster® 500 optical biometer for measuring anterior chamber depth (ACD) and axial length (AL). METHODS: In a sample of 32 healthy volunteers, separate observers measured the ACD and AL of both eyes using both techniques (inter-method) and through repeated FRSS measurements (interobserver) and by the same observer (intraobserver). We employed the Bland-Altman method to determine the agreement between FRSS and partial coherence interferometry (using the IOLMaster®) and the interobserver and intraobserver variability, providing the limits of agreement (LoA, or mean difference ± 1.96 SD). Correlation coefficients and intraclass correlation coefficients were also provided. RESULTS: For ACD measurements with FRSS in pseudo-color scale, we obtained an LoA of 0.016 ± 0.266 mm compared with partial coherence interferometry. For AL with FRSS in greyscale, the LoA was 0.019 ± 0.383 mm. Maximum interobserver variability showed a - 0.036 ± 0.247 mm LoA for ACD with FRSS in pseudo-color scale. Maximum intraobserver variability was 0.000 ± 0.157 mm LoA for AL with FRSS in greyscale. CONCLUSIONS: ACD and AL measurements using FRSS sequencing present high LoA and reliability when compared with partial coherence interferometry using the IOLMaster® 500. The results were better for FRSS in pseudo-color scale in ACD determination and for FRSS in greyscale in AL determination. FRSS would not be recommended for IOL power calculation due to variability of AL measurement.

[Enteral feeding set replacement as a key factor in preventing infectious complications]. / Nutrición enteral y complicaciones infecciosas: sustitución del set de administración como factor preventivo.

To know variables facilitating bacterial growth is critical and essential for nursing staff because of high risk of infectious complications associated with enteral nutrition. In this matter the frequency of delivery set changes has a great influence. The analysis of 6 papers showed a high ratio of bacterial growth to unacceptable levels in the sets after the first 24 hours. They observed that enteral tube became a reservoir and suggested that the endogenous mechanism plays an important role in the contamination of the hole set. Finally it concluded that delivery set must be replaced every 24 hours empirically The American Society for Parenteral and Enteral Nutrition (ASPEN) recommend the establishment of quality control processes to screen bacterial contamination levels in the administration of enteral feedings for health care institutions.

Measurement of the anterior chamber depth and ocular axial length: transpalpebral B-mode ultrasound using an 18-MHz linear probe compared with the IOL Master 500.

AIMS: To determine the reliability of transpalpebral ultrasound in B-mode (B-TUS) with a high-resolution linear probe (18 MHz) in estimating both the ocular anterior chamber depth (ACD) and axial length (AL), as well as its agreement with the IOL Master 500 optical biometer. MATERIAL AND METHODS: Cross-sectional study on 82 eyes of 41 volunteers with no history of eye disease. ACD and AL were determined using B-TUS and the IOL Master 500. The agreement between the two tech-niques and the variability of B-TUS (inter- and intra-observer) were analyzed with the Bland-Altman method. To this end, the mean difference between measures±1.96 SD was calculated to determine the limits of agreement (LoA). RESULTS: The mean difference±1.96SD between B-TUS and the IOL Master 500 was -0.41±0.25mm for ACD (p<0.001) and -0.48±0.45 mm for AL (p<0.001). The maximum variability for B-TUS (average±1.96SD) was 0.00±0.35 mm at the inter-observer level for AL, and 0.00±0.18mm at the intra-observer level for AL. CONCLUSION: The determination of ACD and AL by B-TUS has a good re-liability and variability, in line with other sonographic techniques. However, it systematically provides smaller measurements than those obtained with the IOL Master 500, similar to the conventional ultrasound techniques. B-TUS could be useful in the assessment and follow-up of a wide range of ophthalmic diseases, in which a high accuracy in ACD and AL is not determinant.

Hemostasis of arteriovenous fistula: Comparison of direct two-finger pressure to an adjustable device.

BACKGROUND AND OBJECTIVES: To evaluate the pressure generated by an adjustable hemostasis clamp on arteriovenous fistulas (AVF) during the hemostasis proccess, and compare it with the direct two-finger pressure applied by the patient. To evaluate the variations of the direct two-finger pressure along the hemostasis process. METHODS: We analyzed data obtained in 51 hemodialysis procedures from 15 patients. AVF intraaccess pressure was used as indirect indicator of the pressure generated by both methods. It was recorded before venous needle removal (PBasal), at clamp application (P1), after clamp adjustement by a nurse (P2), at the beginning of the direct two-finger pressure by the patient (M0), after 3 min of two-finger pressure (M3) and after 6 min of two-finger pressure (M6). RESULTS: Intra-access pressure was lower with the adjusted clamp (P2) than with the direct two-finger pressure by the patient (M0) (variation of -18.57%, 95%CI -14.09 to -4.77 mmHg, P < 0.001). Intraaccess pressure generated by the direct two-finger pressure method showed a decreasing trend along the hemostasis process (M3-M0: -8.82 mmHg, P < 0.001; M6-M0: -12.55 mmHg, P < 0.001). CONCLUSION: An adjustable fistula arm clamp generates a lower pressure in AVF than the direct two-finger pressure applied by the patient. The latter showed a decreasing trend along the hemostasis process. These data suggest that some of the recommendations from clinical guidelines could be based on inaccurate premises.

Can we improve the early detection of atrial fibrillation in a stroke unit? Detection rate of a monitor with integrated detection software.

INTRODUCTION: It is unknown whether monitors that include atrial fibrillation recognition software (AF-RS) increase the rate of early atrial fibrillation (AF) detection in acute stroke. We aimed to evaluate the AF detection rate of an AF-RS monitor and compare it with standard monitoring. METHODS: This was a retrospective, single-centre observational study conducted on consecutive patients with acute transient ischaemic attack or brain infarction attended in a stroke unit (SU) with six beds. Five beds had a standard monitor with a three-lead electrocardiogram (ECG)-tracing monitor that did not automatically detect AF, and one bed had a 12-lead ECG monitor with integrated AF-RS. All patients were monitored for at least 24 h and underwent a daily ECG during their stay in the SU. In case of unknown stroke aetiology, the patients underwent 24 h Holter monitoring. RESULTS: A total of 76 patients were included: 59 patients in the standard monitor group and 17 patients in the AF-RS monitor group. The mean age was 72.11 (±13.09) years, and 59.2% were men. A total of 20 new cases of AF were identified. The AF-RS monitor showed a higher rate of AF detection than the standard devices (57.1% vs 7.7%, p=0.031). The AF-RS monitor showed sensitivity, specificity, positive predictive value, and negative predictive values of 57.1%, 100%, 100% and 76.9%, respectively. For the standard monitors, these values were 7.7%, 100%, 100% and 79.3%, respectively. CONCLUSION: The monitor with AF-RS demonstrated a higher detection rate for AF than standard ECG monitoring in acute stroke patients in a SU.

The effect of telestroke systems among neighboring hospitals: more and better? The Madrid Telestroke Project.

A telestroke system was established between a community hospital lacking an on-call neurologist and a comprehensive stroke center only 13 km away. Our goal was to analyze the impact of telestroke on the number of intravenous thrombolysis (IVT), door-to-needle times and stroke outcomes. An observational before-and-after study of patients with acute ischemic stroke (IS) who were attended in a community hospital during the 2 years before the telestroke system was implemented (pre-telestroke group) and the first 2 years after telestroke was established (telestroke group). The number of IVT, the door-to-needle time (min), the outcomes [modified Rankin Scale (mRS)] and the safety (mortality and hemorrhagic transformations) were compared between groups. During the pre-telestroke years, 259 patients with IS were attended (28 phone activations), 12 of whom received IVT (4.7 %). During the telestroke years, 225 patients with IS were attended (42 telestroke activations), of whom 18 (8 %) received IVT. The door-to-needle times were lower in the telestroke group [median interquartile range: 66 (54) vs. 143.5 (48) min, P < 0.0001]. The safety was similar in both groups; however, the 3-month mRS scores were lower in the telestroke group (P = 0.049). The multiple linear regression analysis showed a negative association between telestroke and door-to-needle time [ß-coefficient (SE) = -59.089 (14.461)], adjusted for confounders. In conclusion, telestroke systems are effective, even between nearby hospitals, shortening door-to-needle time and improving stroke outcomes.

[Diagnostic accuracy of an automatic blood pressure device for ankle brachial index determination in ischemic stroke patients]. / Precisión diagnóstica de un dispositivo automático en la determinación del índice tobillo-brazo en pacientes con ictus isquémico.

INTRODUCTION: Ankle brachial index (ABI) is not widespread in clinical practice because the need for specific equipment and training. Doing it without these requirements, quicker and with a cheaper method would facilitate their routine use. AIMS: To evaluate sensitivity and specificity of an automatic blood pressure device detecting ABI < 0.90, when technique is performed by nurses. To evaluate agreement between two techniques for the ABI determination. PATIENTS AND METHODS. Diagnostic accuracy study in 30 ischemic stroke patients. For each patient, three measurements were performed with the automatic device, and one with the reference method. RESULTS: The automatic blood pressure device performance detecting ABI < 0.90 was acceptable for each of the three measurements (sensitivity: 78%, 87% and 100%; specificity: 95%, 100% and 100%; positive predictive value: 87%, 100% and 100%; negative predictive value: 91%, 96% y 100%; accuracy: 90%, 97% y 100%). The intraclass correlation coefficients for intra-observer, inter-observer and inter-method variability showed acceptable levels, with results of 0.64, 0.83 and 0.75, respectively. In the Bland Altman test only inter-method comparison had less than 5% of its values out of range. CONCLUSIONS: Sensitivity and specificity of an automatic blood pressure device detecting ABI < 0.90 shows acceptable levels when technique is performed by nurses. This suggests its potential as screening tool in transient ischemic attack/ischemic stroke patients.