The Association of Inflammation with Food Intake in Older Hospitalized Patients.

OBJECTIVES: An acute inflammatory process may play a role in inhibiting appetite and food intake particularly in acutely ill older individuals. However, there is a lack of knowledge on the effect of inflammation on food intake in humans. In this study, we sought to investigate the association of C-reactive protein (CRP), as an inflammatory marker, with food intake in acutely ill older hospitalized patients. DESIGN AND SETTING: This cross-sectional study investigated older participants who were consecutively admitted to a geriatric acute care ward. Food intake during previous week was measured according to the Nutritional Risk Screening (NRS-2002) and patients were grouped into two categories as intake ≥75% and <75% of requirements. Disease severity and mobility were measured based on the NRS-2002 and Mini Nutritional Assessment Short Form (MNA-SF), respectively. Serum CRP was analyzed according to standard procedures. RESULTS: Of 177 older participants (mean age 83.1 ± 6.5 y, BMI range of 14.7-43.6 kg/m2; 116 females), 67 (38.0%) had moderate to severe inflammation (CRP>3.0 mg/dl). In addition, 109 (62.0%) patients had intake <75% of requirements during previous week, in which 34 (31.0%) and 54 (50.0%) demonstrated mild and moderate to severe inflammation, respectively. Furthermore, there were significant differences in CRP levels between intake ≥75% and <75% of requirements (P<0.001). In a logistic regression analysis, CRP level (odds ratio; OR, 1.14; P=0.006), disease severity (OR, 2.94; P=0.022), mobility (OR, 0.44; P=0.005) and BMI (OR, 0.89; P=0.003) were the major independent predictors of low food intake. CONCLUSION: Our findings confirm a close association between food intake and inflammation in older hospitalized patients. In addition, CRP level and disease severity together were the most important independent predictors associated with food intake in these patients.

Survey for the presence of a vitronectin-like protein in micro- and macroalgae and cyanobacteria.

Vitronectin (Vn) is a glycoprotein that serves a wide variety of roles in multicellular organisms. It was first identified in multicellular animals but has also been isolated from land plants and some algae, where it appears to serve as an extracellular adhesive molecule. In order to further elucidate presence and localization of a Vn-like protein and its potential role in algae, we surveyed different morphological regions of 24 species of macro- and microalgae and three species of cyanobacteria for the presence of a Vn-like protein. Vn-like proteins were not detected in any of the species of cyanobacteria, microalgae or Rhodophyta investigated. They were detected in several species of the Phaeophyceae and Chlorophyta where their localization was limited to the holdfast and rhizoids of these organisms, respectively. Detection of a Vn-like protein (between 0.0125 and 0.097 µg · µL-1 protein extract) was therefore limited to locations associated with substrate attachment.

A compact high-resolution X-ray ion mobility spectrometer.

For the ionization of gaseous samples, most ion mobility spectrometers employ radioactive ionization sources, e.g., containing (63)Ni or (3)H. Besides legal restrictions, radioactive materials have the disadvantage of a constant radiation with predetermined intensity. In this work, we replaced the (3)H source of our previously described high-resolution ion mobility spectrometer with 75 mm drift tube length with a commercially available X-ray source. It is shown that the current configuration maintains the resolving power of R = 100 which was reported for the original setup containing a (3)H source. The main advantage of an X-ray source is that the intensity of the radiation can be adjusted by varying its operating parameters, i.e., filament current and acceleration voltage. At the expense of reduced resolving power, the sensitivity of the setup can be increased by increasing the activity of the source. Therefore, the performance of the setup can be adjusted to the specific requirements of any application. To investigate the relation between operating parameters of the X-Ray source and the performance of the ion mobility spectrometer, parametric studies of filament current and acceleration voltage are performed and the influence on resolving power, peak height, and noise is analyzed.

A setup for synchrotron-radiation-induced total reflection X-ray fluorescence and X-ray absorption near-edge structure recently commissioned at BESSY II BAMline.

An automatic sample changer chamber for total reflection X-ray fluorescence (TXRF) and X-ray absorption near-edge structure (XANES) analysis in TXRF geometry was successfully set up at the BAMline at BESSY II. TXRF and TXRF-XANES are valuable tools for elemental determination and speciation, especially where sample amounts are limited (<1 mg) and concentrations are low (ng ml(-1) to µg ml(-1)). TXRF requires a well defined geometry regarding the reflecting surface of a sample carrier and the synchrotron beam. The newly installed chamber allows for reliable sample positioning, remote sample changing and evacuation of the fluorescence beam path. The chamber was successfully used showing accurate determination of elemental amounts in the certified reference material NIST water 1640. Low limits of detection of less than 100 fg absolute (10 pg ml(-1)) for Ni were found. TXRF-XANES on different Re species was applied. An unknown species of Re was found to be Re in the +7 oxidation state.

Temperature effects in tuning fork enhanced interferometric photoacoustic spectroscopy.

Temperature dependent measurements with a compact fiber coupled sensor for trace gas detection in the near-infrared based on tuning fork enhanced interferometric photoacoustic spectroscopy are presented. The temperature effects on the sensor have been investigated in a range from T = -41 °C to T = 107 °C, in particular the influence on the resonance frequency and the Q-factor of the micro tuning fork. The refined sensor head contains a combination of a silicon tuning fork and an acoustic off-beam resonator and permits methane detection with a detection limit of S = (3.85 ± 0.01) ppm. The functional capability of a numerical model for the optimization of acoustic off-beam resonators in COMSOL Multiphysics® is presented.

Selective initiation and transmission of disseminated neoplasia in the soft shell clam Mya arenaria dependent on natural disease prevalence and animal size.

Disseminated neoplasia, a diffuse tumor of the hemolymph system, is one of the six most destructive diseases among bivalve mollusk populations, characterized by the development of abnormal, rounded blood cells that actively proliferate. Though the specific etiology of disseminated neoplasia in Mya arenaria remains undetermined, the involvement of viral pathogens and/or environmental pollutants has been suggested and considered. The current study used 5-bromodeoxyuridine (BrDU) known to induce the murine leukemia virus and filtered neoplastic hemolymph to initiate disseminated neoplasia in clams from different populations and size classes respectively. M. arenaria from three locations of different natural neoplasia occurrences were divided into a control and three experimental treatments and injected with 200 µl of sterile filtered seawater or 50-200 µg/ml BrDU respectively. In a concurrent experiment, animals from different size classes were injected with 2.5% total blood volume of 0.2 µm filtered blood from a fully neoplastic animal. Animals were biopsied weekly and cell neoplasia development was counted and scored as 0-25, 26-50, 51-75 and 76-100% neoplastic hemocytes (stages 1-4) in 50 µl samples. BrDU injection demonstrated that neoplasia development in M. arenaria was dose dependent on BrDU concentration. In addition, natural disease prevalence at the source location determined initiation of neoplasia induction, with animals from the area of the highest natural disease occurrence displaying fastest neoplasia development (p=0.0037). This could imply that depending on the natural disease occurrence, a potential infectious agent may remain dormant in normal (stage 1) individuals in higher concentrations until activated, i.e. through chemical injection or potentially stress. The size experiment demonstrated that only M. arenaria between 40 and 80 mm developed 26-100% neoplastic hemocytes when injected with filtered neoplastic hemolymph, indicating that individuals smaller than 20mm or larger than 80 mm were not or no longer susceptible to disease development. So far neoplasia studies have not considered natural disease prevalence or size involvement in neoplasia development and our results indicate that these should be future considerations in neoplasia examinations.

Cytoplasmic sequestration of the tumor suppressor p53 by a heat shock protein 70 family member, mortalin, in human colorectal adenocarcinoma cell lines.

While it is known that cytoplasmic retention of p53 occurs in many solid tumors, the mechanisms responsible for this retention have not been positively identified. Since heatshock proteins like mortalin have been associated with p53 inactivation in other tumors, the current study sought to characterize this potential interaction in never before examined colorectal adenocarcinoma cell lines. Six cell lines, one with 3 different fractions, were examined to determine expression of p53 and mortalin and characterize their cellular localization. Most of these cell lines displayed punctate p53 and mortalin localization in the cell cytoplasm with the exception of HCT-8 and HCT116 379.2 cells, where p53 was not detected. Nuclear p53 was only observed in HCT-116 40-16, LS123, and HT-29 cell lines. Mortalin was only localized in the cytoplasm in all cell lines. Co-immunoprecipitation and immunohistochemistry revealed that p53 and mortalin were bound and co-localized in the cytoplasmic fraction of four cell lines, HCT-116 (40-16 and 386; parental and heterozygous fractions respectively of the same cell line), HT-29, LS123 and LoVo, implying that p53 nuclear function is limited in those cell lines by being restricted to the cytoplasm. Mortalin gene expression levels were higher than gene expression levels of p53 in all cell lines. Cell lines with cytoplasmic sequestration of p53, however, also displayed elevated p53 gene expression levels compared to cell lines without p53 sequestration. Our data reveal the characteristic cytoplasmic sequestration of p53 by the heat shock protein mortalin in human colorectal adenocarcinoma cell lines, as is the case for other cancers, such as glioblastomas and hepatocellular carcinomas.

p53 Superfamily proteins in marine bivalve cancer and stress biology.

The human p53 tumour suppressor protein is inactivated in many cancers and is also a major player in apoptotic responses to cellular stress. The p53 protein and the two other members of this protein family (p63, p73) are encoded by distinct genes and their functions have been extensively documented for humans and some other vertebrates. The structure and relative expression levels for members of the p53 superfamily have also been reported for most major invertebrate taxa. The functions of homologous proteins have been investigated for only a few invertebrates (specifically, p53 in flies, nematodes and recently a sea anemone). These studies of classical model organisms all suggest that the gene family originally evolved to mediate apoptosis of damaged germ cells or to protect germ cells from genotoxic stress. Here, we have correlated data from a number of molluscan and other invertebrate sequencing projects to provide a framework for understanding p53 signalling pathways in marine bivalve cancer and stress biology. These data suggest that (a) the two identified p53 and p63/73-like proteins in soft shell clam (Mya arenaria), blue mussel (Mytilus edulis) and Northern European squid (Loligo forbesi) have identical core sequences and may be splice variants of a single gene, while some molluscs and most other invertebrates have two or more distinct genes expressing different p53 family members; (b) transcriptional activation domains (TADs) in bivalve p53 and p63/73-like protein sequences are 67-69% conserved with human p53, while those in ecdysozoan, cnidarian, placozoan and choanozoan eukaryotes are ≤33% conserved; (c) the Mdm2 binding site in the transcriptional activation domain is 100% conserved in all sequenced bivalve p53 proteins (e.g. Mya, Mytilus, Crassostrea and Spisula) but is not present in other non-deuterostome invertebrates; (d) an Mdm2 homologue has been cloned for Mytilus trossulus; (e) homologues for both human p53 upstream regulatory and transcriptional target genes exist in molluscan genomes (missing are ARF, CIP1 and BH3 only proteins) and (f) p53 is demonstrably involved in bivalve haemocyte and germinoma cancers. We usually do not know enough about the molecular biology of marine invertebrates to address molecular mechanisms that characterize particular diseases. Understanding the molecular basis of naturally occurring diseases in marine bivalves is a virtually unexplored aspect of toxicoproteomics and genomics and related drug discovery. Additionally, increases in coastal development and concomitant increases in aquatic pollutants have driven interest in developing models appropriate for evaluating potential hazardous compounds or conditions found in the aquatic environment. Data reviewed in this study are coupled with recent developments in our understanding the molecular biology of the marine bivalve p53 superfamily. Taken together, they suggest that both structurally and functionally, bivalve p53 family proteins are the most highly conserved members of this gene superfamily so far identified outside of higher vertebrates and invertebrate chordates. Marine bivalves provide some of the most relevant and best understood models currently available for experimental studies by biomedical and marine environmental researchers.

Morphology and microanatomy of harbor porpoise (Phocoena phocoena) dorsal fin tubercles.

The unique pattern of small tubercles on the leading edge of the dorsal fins of harbor porpoises (Phocoena phocoena) has been widely noted in the literature, though their structure or function has never been conclusively identified. We examined external morphology and microanatomy of the tubercles for further understanding of the nature of the tubercles. Measurements were taken of height and peak-to-peak distance of the tubercles using scaled photographs. Mean tubercle height was standardized as a percentage of the dorsal fin height and ranged from 0.63 to 0.87%. Mean peak-to-peak distance ranged from 4.2 ± 2.0 to 5.6 ± 2.0 mm. The microstructure analysis of the dorsal fin leading edge, trailing edge and tubercles revealed an epidermal thickness of 0.7-2.7 mm with the thickest epidermis at the tubercular apex. The epidermis contained three distinct strata (=layers), including the stratum corneum, spinosum, and basale. The stratum corneum was significantly thickened in tubercles, over four times thicker than in the leading or trailing edge of the fin. The stratum spinosum, composed of lipokeratinocytes and lamellar oil bodies, was significantly thinner in the trailing edge than in the other two sites. There was no significant difference in the stratum basale among the three sites. Volume fraction of lipokeratinocytes was significantly higher at the sides of the leading edge and the apex of the tubercles, while volume fraction of lamellar oil bodies was significantly lower at the apex of the tubercles. Though the function of the tubercles is unknown, their position, hardened structure and increased epidermal stratum corneum suggest that they may have hydrodynamic importance.

The effects of chronic inorganic and organic phosphate exposure on bactericidal activity of the coelomic fluid of the sea urchin Lytechinus variegatus (Lamarck) (Echinodermata: Echinoidea).

The sea urchin Lytechinus variegatus can survive chronic exposure to sodium phosphate (inorganic phosphate) concentrations as high as 3.2 mg L-1, and triethyl phosphate (organic phosphate) concentrations of 1000 mg L-1. However, chronic exposure to low (0.8 mg L-1 inorganic and 10 mg L-1 organic phosphate), medium (1.6 mg L-1 inorganic and 100 mg L-1 organic phosphate) or high (3.2 mg L-1 inorganic and 1000 mg L-1 organic phosphate) sublethal concentrations of these phosphates inhibit bactericidal clearance of the marine bacterium Vibrio sp. Bacteria were exposed to coelomic fluid collected from individuals maintained in either artificial seawater, or three concentrations of either inorganic phosphate or organic phosphate. Sterile marine broth, natural seawater and cell free coelomic fluid (cfCF) were employed as controls. Bacterial survival indices were measured at 0, 24 and 48 h periods once a week for four weeks. Bacteria were readily eliminated from the whole coelomic fluid (wCF) of individuals maintained in artificial seawater. Individuals maintained in inorganic phosphates were able to clear bacteria following a two week exposure period, while individuals maintained at even low concentrations of organic phosphates failed to clear all bacteria from their coelomic fluid. Exposure to phosphates represses antimicrobial defenses and may ultimately compromise survival of L. variegatus in the nearshore environment.

Mass culture and characterization of tumor cells from a naturally occurring invertebrate cancer model: applications for human and animal disease and environmental health.

On the northeastern coast of the United States and Canada, Mya arenaria, the soft shell clam, develops a diffuse, hemopoetic tumor (a fatal leukemia-like cancer) resulting from inactivation of p53-like family member proteins.These malignant cells provide a model for an unrelated set of human cancer cells that are also characterized by mortalin-based cytoplasmic sequestration of wild-type p53 tumor suppressor protein (mortalin is the mitochondrial Hsp70 protein). Here we describe methods for mass culture and long-term storage of tumor cells from this cancer. These are the first successful efforts at maintaining malignant cells from any marine invertebrate in vitro. Following passage (subculture), these cultures undergo transition from primary cultures to non-immortalized cell lines that continue to proliferate and do not re-differentiate the normal hemocyte phenotype. We also characterize normal clam hemocytes and the pathology of cancerous clam hemocytes in vitro and in vivo using light and electron microscopy, cyto- and immunocytochemistry, molecular biology, and a phagocytosis assay. Our protocols provide biomedical and environmental researchers with ready access to this naturally occurring cancer model. We discuss the clam cancer model regarding (a) human health and disease; (b) animal health, disease, and aquaculture; (c) environmental health monitoring; and (d) future research directions.

Examination of computer assisted prescribing of an initial calculated antibiotic treatment.

The objective of this prospective clinical usage study was to examine the value of the rule based 'Therapeutic Assistant' integrated into an existing Patient Data Management System (PDMS) in helping to prescribe a initial antibiotic regime in accordance with the requirements of accepted guidelines. A prospective study comparing data before and after the introduction of the 'Therapeutic Assistant' was carried out. An adequate therapy resulted significantly more often after the introduction of the 'Therapeutic Assistant' [p<0.05]; however no difference between the regimes with and without the 'Therapeutic Assistant' in the period after its introduction could be established. Whether the 'Therapeutic Assistant' influenced the prescriptions made without it will have to be established in a further study.

Colonic duplication: diagnostic dilemma.

Colonic duplication is a rare congenital anomaly which presents as a diagnostic and therapeutic challenge. We report a 5-year-old boy with colonic duplication who required multiple hospital admissions, multiple diagnostic tests, and evaluation by various clinical specialists before the diagnosis was made intraoperatively. He was known to have left renal hypoplasia, low spinal abnormalities, hypoplasia of the left hemipelvis, and mild hypoplasia of the left lower limb, all of which were considered to be a variant of caudal regression syndrome.

Outcome prediction in a surgical ICU using automatically calculated SAPS II scores.

The objective of this study was to establish a complete computerized calculation of the Simplified Acute Physiology Score (SAPS) II within 24 hours after admission to a surgical intensive care unit (ICU) based only on routine data recorded with a patient data management system (PDMS) without any additional manual data entry. Score calculation programs were developed using SQL scripts (Structured Query Language) to retrospectively compute the SAPS II scores of 524 patients who stayed in ICU for at least 24 hours between April 1, 1999 and March 31, 2000 out of the PDMS database. The main outcome measure was survival status at ICU discharge. Score evaluation was modified in registering missing data as being not pathological and using surrogates of the Glasgow Coma Scale (GCS). Computerized score calculation was possible for all investigated patients. The 459 (87.6%) survivors had a median SAPS II of 28 (interquartile range (IQR) 13) whereas the 65 (12.4%) decreased patients had a median score of 43 (IQR 16; P < 0.001). Of the physiological variables for SAPS II score calculation, bilirubin was missing in 84%, followed by PaO2/FiO2 ratio (34%), and neurological status (34%). Using neurological diagnoses and examinations as surrogates for the GCS, a pathological finding was seen in only 8.8% of all results. The discriminative power of the computerized SAPS II checked with a receiver operating characteristic (ROC) curve was 0.81 (95% confidence interval (CI): 0.74-0.87). The Hosmer-Lemeshow goodness-of-fit statistics showed good calibration (H = 5.55, P = 0.59, 7 degrees of freedom; C = 5.55, P = 0.68, 8 degrees of freedom). The technique used in this study for complete automatic data sampling of the SAPS II score seems to be suitable for predicting mortality rate during stay in a surgical ICU. The advantage of the described method is that no additional manual data recording is required for score calculation.

Effects of inorganic and organic phosphate exposure on aspects of reproduction in the common sea urchin Lytechinus variegatus (Echinodermata: Echinoidea).

The common nearshore sea urchin Lytechinus variegatus is capable of surviving exposure to inorganic phosphate concentrations as high as 3.2 mg/l(-1) and organic phosphate concentrations of 1,000 mg/l(-1). However, chronic exposure to low, medium, or high sublethal concentrations of these phosphates inhibits gonadal tissue indices and spawning activity while altering biochemical composition of gonads, reducing size frequencies of oocyte diameters, and changing gonadal volume fractions. Gonad indices declined significantly in individuals maintained in all phosphate concentrations after both one- and two-month exposures, while percentages of ripe individuals (oozing gametes upon dissection) were reduced after a two-month exposure in individuals maintained in medium and high organic phosphate concentrations. Levels of carbohydrates and lipids were lower in gonads of individuals maintained in all concentrations of both phosphates. Size frequency distributions of oocyte diameters revealed a dramatic decrease in oocyte size with increasing concentrations of both phosphates. Gonadal volume fractions of developing male and female gametes decreased with exposure to increasing phosphate levels. Volume fractions of nutritive phagocytes declined in testes of individuals held in the highest concentration of organic phosphate but displayed no significant change in ovaries. Volume fractions of mature gametes also decreased in gonads of individuals exposed to increasing concentrations of inorganic phosphate, but they remained constant in individuals exposed to all concentrations of organic phosphate. These findings indicate that shallow-water populations of L. variegatus subjected to inorganic and organic phosphate pollutants will exhibit stress that may impair reproductive output, gametogenesis, and spawning in the natural environment.

The effects of organic and inorganic phosphates on fertilization and early development in the sea urchin Lytechinus variegatus (Echinodermata: Echinoidea).

The embryos of the sea urchin Lytechinus variegatus are capable of surviving chronic exposure to inorganic sodium phosphate and organic triethyl phosphate concentrations as high as 6 and 1000 mg l(-1) seawater, respectively. However, chronic exposure to sub-lethal concentrations of these phosphates may cause arrested or abnormal embryonic development. We measured fertilization success and percentages of normal, arrested and abnormal embryos exposed to low, medium and high sub-lethal concentrations of inorganic and organic phosphate. Fertilization success was significantly reduced in all phosphate treatments. After attaining the 4-cell stage, embryos exposed to the highest phosphate concentrations displayed arrested development. Percentages of abnormally developing embryos showed a strong concentration dose-response with a significant increase in abnormal embryonic development with increasing phosphate concentration. Overall, these results indicate that the gametes and embryos of L. variegatus may provide a rapid and sensitive model bioassay for the evaluation of phosphate pollutants in marine systems. Our findings also indicate that shallow-water populations of L. variegatus spawning in areas subjected to inorganic and organic phosphate pollutants may suffer detrimental effects on fertilization and embryonic development.

[Using an anesthesia information management system (AIMS) for documentation in a day care unit for ambulatory surgery]. / Einsatz eines Anästhesie-Informations-Management-Systems (AIMS) in einer Operativen Tagesklinik.

UNLABELLED: From January 1997 until June 1999, the complete durations of stay of 3152 outpatients were entered into a computerized documentation system. The scope of the data entry went from patient admission to patient release. The objective was to determine the usefulness of the anaesthesia information management system (AIMS) in producing complete and high-quality documentation in the field of outpatient operations. Some aspects and results from routine work are presented here. METHOD: The system was installed in eight bedside computers, in addition to a further client connected to the existing AIMS via Ethernet. Patient medical courses were documented both preoperatively and postoperatively in outpatient bedsides until their discharge or admission. The online documentation software NarkoData (Version 4, Imeso GmbH, Hüttenberg, Germany) was used to document and store patient data in a database. This program contains all relevant information concerning the course of anaesthesia and outpatient duration of stay, including application of drugs, vital signs, observation times, and medical findings as well as the data sets of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI), ICD, and ICPM. Data was analyzed by exporting from the database into a statistical program using "structured query language." RESULTS: Data sets of 3152 outpatients were entered into the online documentation software. Most (54.2%) of the ambulatory surgical procedures were performed by the Department of Traumatology. General Surgery followed with 16.0%, and Urology managed 9.5% of the cases. The most frequent ambulatory surgical procedures were: diagnostic arthroscopy (923, 31.2%), removal of osteosynthetic material (410, 13.8%), and circumcision (250, 8.4%). Anesthesia procedures consisted of inhalative (38.6%, n = 1218) and intravenous anesthesia (IVA) (29.9%, n = 938). In 22.6% (713) of the cases, regional anaesthesia was performed. The average postoperative observation time was 289.2 +/- 140.1 minutes. One hundred sixty-nine patients (5.4%) were unexpectedly admitted to overnight care. The decision to admit patients to normal wards took place within the first 3 postoperative hours in 51.9% of the cases. CONCLUSION: The AIMS described above is sufficient in documenting the entire care process of patients in a day care unit. Integration into the existing AIMS was an important prerequisite for the integrity of the documentation chain. This allowed for a sensitive communication with other clinical data processing systems. The quality of documentation and flow of information at the workplaces in the day care unit were increased, similarly to other anaesthesiological workplaces in the hospital. Medical and administrative data and information for analyses of clinical processes are possible with such tools.

Use of an anesthesia information management system (AIMS) to evaluate the physiologic effects of hypnotic agents used to induce anesthesia.

OBJECTIVE: The aim of this study was to utilize an anesthesia information management system (AIMS) in investigating the effects of hypnotic agents used to induce anesthesia on blood pressure, heart rate and arterial oxygen saturation. The characteristics of these agents, known from previous studies, were compared to the effects documented in this study during routine clinical use. METHODS: During the years 1997 and 1998, all relevant data from anesthetic procedures were recorded online using the automated anesthesia information system NarkoData. The data from 8,078 general anesthesia procedures using endotracheal intubation were exported via "structured query language" (SQL) from the AIMS database into a statistics program after excluding children (age < 14), patients who received atropine during induction and procedures with use of extracorporeal circulation. The effects of drug administration on systolic, diastolic and mean arterial blood pressure (SBP, DBP, MBP), heart rate (HR) and arterial oxygen saturation (SpO2) were analyzed prior to induction and at 5, 10 and 15 minutes following bolus administration of the hypnotic agent. The data were classified into three groups based on the induction agent used: thiopental, etomidate or propofol and further separated into two groups based on ASA status (ASA < or = II and ASA > II). The mean and standard deviations were calculated for each parameter at each point in time. Statistical comparisons were performed to determine whether the results for each time point differed from the previous time point. RESULTS: There was a significant decrease in blood pressure (MAP, SBP, DBP) after bolus administration of all three hypnotics in all of the 8,078 procedures analyzed. The decrease was greater in patients of ASA class > II than in those of ASA class < or = II. Propofol caused the greatest drop in blood pressure whereas etomidate caused the least. During the observation period the HR also fell in each group, except for thiopental where an initial rise of the HR could be observed. An initial rise of SpO2 was recorded in each group with no differences observed between the individual hypnotics. CONCLUSIONS: The effects of the induction hypnotic agents thiopental, etomidate and propofol on blood pressure and heart rate as documented by an AIMS corresponded to those found in clinical studies. An AIMS with the corresponding documentation, software and database structure is suitable for collecting and evaluating data for dinical investigations.

Using an anesthesia information management system to prove a deficit in voluntary reporting of adverse events in a quality assurance program.

OBJECTIVE: A deficit is suspected in the manual documentation of adverse events in quality assurance programs in anesthesiology. In order to verify and quantify this, we retrospectively compared the incidence of manually recorded perioperative adverse events with automatically detected events. METHODS: In 1998, data of all anesthetic procedures, including the data set for quality assurance of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI), was recorded online with the Anesthesia Information Management System (AIMS) NarkoData4 (Imeso GmbH). SQL (Structured Query Language) queries based on medical data were defined for the automatic detection of common adverse events. The definition of the SQL statements had to be in accordance with the definition of the DGAI for perioperative adverse events: A potentially harmful change of parameters led to therapeutic interventions by an anesthesiologist. RESULTS: During 16,019 surgical procedures, anesthesiologists recorded 911 (5.7%) adverse events manually, whereas 2966 (18.7%) events from the same database were detected automatically. With the exception of hypoxemia, the incidence of automatically detected events was considerably higher than that of manually recorded events. Fourteen and a half percent (435) of all automatically detected events were recorded manually. CONCLUSION: Using automatic detection, we were able to prove a considerable deficit in the documentation of adverse events according to the guidelines of the German quality assurance program in anesthesiology. Based on the data from manual recording, the results of the quality assurance of our department match those of other comparable German departments. Thus, we are of the opinion that manual incident reporting seriously underestimates the true occurrence rate of incidents. This brings into question the validity of quality assurance comparisons based on manually recorded data.