Intermediate care units : Recommendations on facilities and structure.

A growing number of patients with increasingly complex or specialized diseases are being treated in hospitals worldwide. The treatment requirements of some of these patients are exceeding the capacity of standard nursing units. However, the severity of these diseases or the treatment requirements for these specific clinical pictures do not always justify admission to an intensive care unit. For this reason, an increasing number of special units (intermediate care units) are being set up to offer highly specialized treatment and close monitoring, in order to fulfil an intermediate role between the standard care unit and the intensive care unit. The recommendations of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) on the personnel, capacity, equipment and structure of these units are intended to provide the framework for the setting up and operation of intermediate care units in collaboration with experts on both an evidence-based and an expert-based basis (where scientific evidence is not available). Where only minimal or indirect evidence is available, patient safety is paramount in the formulation of the recommendation.

Simulated evaluation of a non-Luer safety connector system for use in neuraxial procedures.

BACKGROUND: Spinal syringes, needles, and other devices with connectors that will not also connect with Luer devices could substantially reduce wrong-route drug administration errors. This study aimed to evaluate a newly designed non-Luer safety connector system for neuraxial procedures in terms of clinical acceptability and cross-connectivity with conventional Luer devices. METHODS: A non-Luer safety connector system (BD UniVia-6 Safety Connector system), which included non-Luer spinal needles, syringes, and blunt fill filter needles, was evaluated in a prospective, simulated use, randomized study. Clinicians evaluated the acceptability and performance characteristics using a normal saline injectate on an artificial back model. RESULTS: Forty-nine clinicians participated in the study. For 93 of 98 spinal injection procedures, clinicians agreed that overall, the safety system was clinically acceptable (94.9%; 95% lower bound 89.6%). Forty-eight clinicians (98%; 95% lower bound: 90.7%) agreed that the safety system prevented or reduced the risk of misconnection between a conventional syringe and a safety spinal needle. A lower proportion (63.3%; 95% lower bound: 50.5%) agreed that the safety system would prevent or reduce the risk of misconnections between a safety syringe filled with medication intended for spinal injection and an i.v. Luer device. CONCLUSIONS: Our study demonstrated that study clinicians found the safety system to be acceptable with minimal impact on technique in a simulated-use setting. The non-Luer system also appeared to decrease the risk of administration of i.v. medications into the intrathecal space. Further modifications will be required to completely eliminate the risk of administering intrathecal medication i.v. and evaluation in a clinical setting will help determine the true impact of this non-Luer system on patient safety.

[Changes of systolic time in dystrophia myotonica]. / Les modifications des temps systoliques dans la dystrophie myotonique

The left ventricular ejection time was studied by the external phonomechanocardiographic method on 17 patients affected by myotonic dystrophy (Steinert's disease), including 9 men and 8 women; aged from 25 to 68 years, with an average course for the neurological disease of 18.7 years. The case studied were those which demonstrated no signs of cardiac failure or of any disease liable to involve the heart. The results were compared on the one hand with the normal figures according to Blumberger, to Holldack and to Nazzi, Ricco and Meda, and on the other hand with the theoretical values computed, according to the regression equations of Weissler, Harris and Schoenfeld. The changes of systolic time intervals mechanical systole of the left ventricle. There was a narrow relationship between the length of the course of the neurological disease and the incidence of heart involvement, which seemed to be constant.