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1.
Isr Med Assoc J ; 22(2): 94-99, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32043326

RESUMO

BACKGROUND: Internal thoracic impedance (ITI) measurement is a sensitive method for detecting preclinical pulmonary edema and pleural effusion. OBJECTIVES: To investigate the efficacy of this non-invasive method for detecting early pleural effusion among geriatric patients and to monitor increased ITI during its resolution. METHODS: This prospective, controlled study was conducted between July 2012 and August 2015. The study comprised 70 patients aged 65 to 94 years; and 39 of the patients had pleural effusion. ITI was measured continuously with a RS-207 monitor. The predictive value of ITI monitoring was determined based on a total of eight measurements taken at 12-hour intervals over 84 hours. RESULTS: As a result of medical treatment, the median ITI of the study group increased from 31 (interquartile range [IQR] 28-33 ohms) to 41 ohms (IQR 38-41 ohms; P < 0.001) compared to non-significant changes in the control group. Average respiratory rate (per minute) in the study group decreased from 29 (IQR 28-34) to 19 (IQR 18-20). CONCLUSIONS: ITI monitoring is efficient for diagnosis and for ongoing clinical evaluation of the treatment of elderly patients with pleural effusion. Timely treatment may prevent serious complications of effusions avoiding extended hospitalization.


Assuntos
Pletismografia de Impedância/métodos , Derrame Pleural , Idoso , Diagnóstico Precoce , Feminino , Avaliação Geriátrica/métodos , Humanos , Israel , Masculino , Monitorização Fisiológica/métodos , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Derrame Pleural/fisiopatologia , Testes Imediatos , Recidiva , Reprodutibilidade dos Testes
2.
Isr Med Assoc J ; 22(2): 104-110, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32043328

RESUMO

BACKGROUND: Autologous hematological stem cell transplantation (HSCT) is a novel therapy for systemic sclerosis (SSc) that has been validated in three randomized controlled trials. OBJECTIVES: To report the first Israeli experience with HSCT for progressive SSc and review the current literature. METHODS: Five SSc patients who were evaluated in our department and were treated by HSCT were included. Medical records were evaluated retrospectively. Demographic, clinical, and laboratory data were recorded. Continuous data are presented as the mean ± standard deviation. Categorical variables are presented as frequencies and percentages. RESULTS: Five SSc patients were treated with HSCT. Four patients were adults (mean age 53 ± 12 years) and one was a 12-year-old pediatric patient. All patients were female. HSCT was initiated 1.4 ± 0.8 years after diagnosis. Two patients were RNA POLIII positive, two were anti-topoisomerase 1 positive, and one only antinuclear antibodies positive. All patients had skin and lung involvement. The mean modified Rodnan Skin Score was 29 ± 4.7 before HSCT, which improved to 10.4 ± 9.6 after HSCT. The forced vital capacity improved from 68 ± 13% to 90 ± 28%. Diffusing capacity of the lungs for carbon monoxide increased by 6%. Among severe adverse events were cyclophosphamide-related congestive heart failure, antithymocyte globulin-related capillary leak syndrome, and scleroderma renal crisis. All symptoms completely resolved with treatment without sequela. No treatment related mortality was recorded. CONCLUSIONS: HSCT is an important step in the treatment of progressive SSc in Israel. Careful patient selection reduces treatment related morbidity and mortality.


Assuntos
Ciclofosfamida , Transplante de Células-Tronco Hematopoéticas , Escleroderma Sistêmico , Adulto , Autoanticorpos/sangue , Autoanticorpos/classificação , Criança , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Feminino , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Israel/epidemiologia , Pulmão/patologia , Monitorização Fisiológica/métodos , Testes de Função Respiratória/métodos , Estudos Retrospectivos , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/epidemiologia , Escleroderma Sistêmico/imunologia , Escleroderma Sistêmico/terapia , Pele/patologia , Transplante Autólogo
3.
Adv Exp Med Biol ; 1232: 285-290, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893422

RESUMO

In neonatal intensive care units (NICUs), 87.5% of alarms by the monitoring system are false alarms, often caused by the movements of the neonates. Such false alarms are not only stressful for the neonates as well as for their parents and caregivers, but may also lead to longer response times in real critical situations. The aim of this project was to reduce the rates of false alarms by employing machine learning algorithms (MLA), which intelligently analyze data stemming from standard physiological monitoring in combination with cerebral oximetry data (in-house built, OxyPrem). MATERIALS & METHODS: Four popular MLAs were selected to categorize the alarms as false or real: (i) decision tree (DT), (ii) 5-nearest neighbors (5-NN), (iii) naïve Bayes (NB) and (iv) support vector machine (SVM). We acquired and processed monitoring data (median duration (SD): 54.6 (± 6.9) min) of 14 preterm infants (gestational age: 26 6/7 (± 2 5/7) weeks). A hybrid method of filter and wrapper feature selection generated the candidate subset for training these four MLAs. RESULTS: A high specificity of >99% was achieved by all four approaches. DT showed the highest sensitivity (87%). The cerebral oximetry data improved the classification accuracy. DISCUSSION & CONCLUSION: Despite a (as yet) low amount of data for training, the four MLAs achieved an excellent specificity and a promising sensitivity. Presently, the current sensitivity is insufficient since, in the NICU, it is crucial that no real alarms are missed. This will most likely be improved by including more subjects and data in the training of the MLAs, which makes pursuing this approach worthwhile.


Assuntos
Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal , Aprendizado de Máquina , Monitorização Fisiológica , Oximetria , Teorema de Bayes , Circulação Cerebrovascular , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Terapia Intensiva Neonatal/métodos , Monitorização Fisiológica/métodos , Oximetria/métodos , Oximetria/normas
4.
Adv Exp Med Biol ; 1232: 291-297, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893423

RESUMO

We present an IoT-based monitoring system for healthcare that allows for long-term measurements of blood pressure (BP), heart rate (HR), and body weight (BW), as well as near-infrared spectroscopy (NIRS) for measurement of prefrontal cortex (PFC) activity. To verify the applicability of the system, it was set up in a local fitness gym for a preliminary study. A total of 39 subjects, selected from members of the gym, participated in the study. We analyzed the BP, HR, and BW data, collected from the subjects over one half-year. In addition, to assess the degree of mental stress of the subjects, we analysed left-right asymmetry of the PFC activity using the laterality index at rest (LIR) of the NIRS parameter. Results show that the subjects were able to measure their physiological data by themselves when they visited the gym, after being instructed how to perform the measurements. Furthermore, the results also indicate that ordinary people can continuously monitor physiological functions such as brain function in a non-medical facility, such as a fitness gym.


Assuntos
Monitorização Fisiológica , Córtex Pré-Frontal , Espectroscopia de Luz Próxima ao Infravermelho , Idoso , Feminino , Lateralidade Funcional , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Autoexame/normas , Estresse Psicológico
5.
Hu Li Za Zhi ; 67(1): 25-32, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-31960394

RESUMO

With Taiwan now an "aged society", home safety for older individuals has become a very important issue. The purpose of establishing early warning systems in homes and/or communities is to generate and disseminate meaningful warning information to medical institutions or rescue units in a timely manner so that they may take timely and appropriate action. The main purpose of this paper is to introduce the current application of information and communication technology (ICT, especially the Internet of Things and artificial intelligence) in early warning systems for home and community care. Two approaches to developing these systems are introduced: instant detection and prevention monitoring. Instant detection facilitates fall detection and personnel tracking, while the focus of prevention monitoring is on preventing falls and physiological status monitoring. The challenges faced by in incorporating ICT into these early monitoring systems are discussed as well.


Assuntos
Serviços de Assistência Domiciliar , Tecnologia da Informação , Monitorização Fisiológica/métodos , Acidentes por Quedas/prevenção & controle , Idoso , Inteligência Artificial , Humanos , Taiwan
6.
World Neurosurg ; 133: e18-e25, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31394360

RESUMO

BACKGROUND: Intracranial pressure monitoring remains the foundation for prevention of secondary injury after traumatic brain injury and is most commonly performed using an external ventricular drain or intraparenchymal pressure monitor. The Integra Flex ventricular catheter combines an external ventricular catheter with a pressure transducer embedded in the tip of the catheter to allow continuous pressure readings while simultaneously draining cerebrospinal fluid. Discrepancies between measurements from the continuously reported internal pressure transducer and intermittently assessed and externally transduced ventricular drain prompted an analysis and characterization of pressures transduced from the same ventricular source. METHODS: More than 500 hours of high-resolution (125 Hz) continuous recordings were manually reviewed to identify 73 hours of simultaneous measurements (clamped external ventricular drain) from internal and external transducers in patients with traumatic brain injury. RESULTS: A significant positive bias was found in pressure readings obtained from external relative to internal measurements. The 2 methods of measurement generally correlated poorly with each other and variably. Although proportional bias was found with Bland-Altman analysis, coherence revealed rare shifts in the external transducer as a major source of discrepancy. Infrequent changes in the 0-level of the external transducer were found to be the primary source of discrepancy. Relative to the observed differences, no significant trend was observed over time between the 2 modalities. CONCLUSIONS: This study suggests that the internal pressure transducer may be a more reliable estimate of intracranial pressure relative to bedside external transducers due to the inherent behavioral requirement of leveling.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Erros de Diagnóstico , Drenagem/instrumentação , Hipertensão Intracraniana/diagnóstico , Pressão Intracraniana , Manometria/instrumentação , Transdutores de Pressão , Lesões Encefálicas Traumáticas/complicações , Cateteres , Humanos , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/prevenção & controle , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Transdutores de Pressão/classificação
7.
Br J Nurs ; 28(19): 1256-1259, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31680572

RESUMO

Clinical surveillance provides essential data on changes in a patient's condition. The common method for performing this surveillance is the assessment of vital signs. Despite the importance of these signs, research has found that vital signs are not rigorously assessed in clinical practice. Respiratory rate, arguably the most important vital sign, is the most neglected. Poor understanding might contribute to nurses incorrectly valuing oxygen saturation more than respiratory rate. Nurses need to understand the importance of respiratory rate assessment as a vital sign and the benefits and limitations of pulse oximetry as a clinical tool. By better understanding pulse oximetry and respiratory rate assessment, nurses might be more inclined to conduct rigorous vital signs' assessment. Research is needed to understand why many nurses do not appreciate the importance of vital signs' monitoring.


Assuntos
Monitorização Fisiológica/enfermagem , Avaliação em Enfermagem/estatística & dados numéricos , Oximetria/enfermagem , Taxa Respiratória , Humanos , Monitorização Fisiológica/métodos , Sinais Vitais
8.
Surg Clin North Am ; 99(6): 1095-1109, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676050

RESUMO

Treatment of inflammatory bowel disease (IBD) is often multidimensional, requiring both medical and surgical therapies at different times throughout the course of the disease. Both medical and surgical treatments may be used in the acute setting, during a flare, or in a more elective maintenance role. These treatments should be planned as complementary and synergistic. Gastroenterologists and colorectal surgeons should collaborate to create a cohesive treatment plan, arranging the sequence and timing of various treatments. This article reviews the anticipated postoperative recovery after surgical treatment of IBD, possible postoperative complications, and considerations of timing surgery with medical therapy.


Assuntos
Colectomia/efeitos adversos , Colite Ulcerativa/cirurgia , Colostomia/efeitos adversos , Doença de Crohn/cirurgia , Anastomose Cirúrgica , Colectomia/métodos , Colite Ulcerativa/diagnóstico , Bolsas Cólicas/efeitos adversos , Colostomia/métodos , Doença de Crohn/diagnóstico , Feminino , Seguimentos , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/cirurgia , Masculino , Monitorização Fisiológica/métodos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Recidiva , Medição de Risco , Fatores de Tempo
9.
Br J Nurs ; 28(19): 1156-1159, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31647734

RESUMO

Clinical surveillance provides essential data on changes in a patient's condition. The common method for performing this surveillance is the assessment of vital signs. Despite the importance of these signs, research has found that vital signs are not rigorously assessed in clinical practice. Respiratory rate, arguably the most important vital sign, is the most neglected. Poor understanding might contribute to nurses incorrectly valuing oxygen saturation more than respiratory rate. Nurses need to understand the importance of respiratory rate assessment as a vital sign and the benefits and limitations of pulse oximetry as a clinical tool. By better understanding pulse oximetry and respiratory rate assessment, nurses might be more inclined to conduct rigorous vital signs' assessment. Research is needed to understand why many nurses do not appreciate the importance of vital signs' monitoring.


Assuntos
Monitorização Fisiológica/enfermagem , Avaliação em Enfermagem/estatística & dados numéricos , Oximetria/enfermagem , Taxa Respiratória , Humanos , Monitorização Fisiológica/métodos , Sinais Vitais
10.
BMC Health Serv Res ; 19(1): 662, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31514743

RESUMO

BACKGROUND: Pre-gestational and gestational diabetes mellitus are common complications in pregnancy affecting one in six pregnancies. The maternity services are under significant strain managing the increasing number of complex pregnancies. This has an impact on patients' experience of antenatal care. Therefore, there is a clear need to address pregnancy care. One possible solution is to use home-based digital technology to reduce clinic visits and improve clinical monitoring. METHODS: The aim of this study was to evaluate the antenatal services provided to pregnant women with diabetes who were monitored at the joint metabolic and obstetric clinic at the Southern Health and Social Care Trust in Northern Ireland. RESULTS: The questionnaires were completed by sixty-three women, most of whom had gestational diabetes mellitus. Most of the participants were between 25 and 35 years of age (69.8%), had one or more children (65.1%) and spent over 2 h attending the clinics (63.9%); 78% of women indicated that their travel time to and from the clinic appointment was over 15 min. Over 70% of women used smartphones for health-related purposes. However, only 8.8% used smartphones to manage their health or diabetes. Less than 25% of the women surveyed expressed concerns about using digital technology from home to monitor various aspects of their health in pregnancy. CONCLUSIONS: Overall, pregnant women who had or developed diabetes in pregnancy experience frequent hospital visits and long waiting times in the maternity clinics. Most of these pregnant women are willing to self-manage their condition from home and to be monitored remotely by the healthcare staff.


Assuntos
Diabetes Gestacional/terapia , Maternidades , Monitorização Fisiológica/métodos , Complicações na Gravidez/terapia , Autogestão , Telemedicina , Adulto , Diabetes Gestacional/fisiopatologia , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Irlanda do Norte , Gravidez , Complicações na Gravidez/fisiopatologia , Autogestão/estatística & dados numéricos
11.
Zoo Biol ; 38(6): 498-507, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31517405

RESUMO

The use of radio frequency identification (RFID) technology is common in animal-monitoring applications in the wild and in zoological and agricultural settings. RFID is used to track animals and to collect information about movements and other behaviors, as well as to automate or improve husbandry. Disney's Animal Kingdom® uses passive RFID technology to monitor nest usage by a breeding colony of northern carmine bee-eaters. We implemented RFID technologies in various equipment configurations, initially deploying low-frequency (LF) 125 kHz RFID and later changing to high-frequency (HF) 13.56 MHz RFID technology, to monitor breeding behavior in the flock. We installed antennas connected to RFID readers at the entrances of nest tunnels to detect RFID transponders attached to leg bands as birds entered and exited tunnels. Both LF-RFID and HF-RFID systems allowed the characterization of nest visitation, including the timing of nest activity, breeding pair formation, identification of egg-laying females, participation by nonresidents, and detection of nest disruptions. However, we collected a substantially larger volume of data using the increased bandwidth and polling speed inherent with HF-RFID, which permitted tag capture of multiple birds simultaneously and resulted in fewer missed nest visits in comparison to LF-RFID. Herein, we describe the evolution of the RFID setups used to monitor nest usage for more than 7 years, the types of data that can be gained using RFID at nests, and how we used these data to gain insights into carmine bee-eater breeding behavior and improve husbandry.


Assuntos
Aves/fisiologia , Monitorização Fisiológica/veterinária , Comportamento de Nidação/fisiologia , Dispositivo de Identificação por Radiofrequência , Telemetria , Animais , Animais de Zoológico , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos
12.
IEEE J Biomed Health Inform ; 23(6): 2276-2285, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31478880

RESUMO

Mental illnesses are vast and cause a lot of individual and social discomfort, with significant healthcare costs associated in terms of diagnosis and treatment. They can be triggered by a number of factors including stress, fatigue or anxiety. The associated physiological, cardiac and autonomic changes can be assessed, centrally, through brain imaging or, peripherally, by other signal recording modalities. With recent advances in wearable devices, these parameters can now be assessed in natural living conditions as associated mood disorders such as obsessive/compulsive behavior or depression are difficult to be examined in controlled settings. In this paper, we present a low-powered and flexible device with electrocardiogram (ECG), galvanic skin response (GSR), temperature and bio-motion detection channels, with signal accuracies of 62 µV for ECG, 6.6 kΩ for GSR, 0.13 °C for temperature and 0.04 g for acceleration. Potential applications include mental health assessment of patients during daily activities at home and/or work through non-continuous and multimodal sensing as demonstrated in this paper during exercise, rest and mental activities performed by healthy individuals only, achieving an overall accuracy of 89% in the classification of the different tasks executed by volunteers.


Assuntos
Resposta Galvânica da Pele/fisiologia , Frequência Cardíaca/fisiologia , Transtornos Mentais , Monitorização Fisiológica/instrumentação , Dispositivos Eletrônicos Vestíveis , Adulto , Algoritmos , Eletrocardiografia/instrumentação , Desenho de Equipamento , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/fisiopatologia , Transtornos Mentais/terapia , Monitorização Fisiológica/métodos , Movimento/fisiologia , Processamento de Sinais Assistido por Computador/instrumentação , Termometria/instrumentação
13.
Int Heart J ; 60(5): 1219-1221, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484873

RESUMO

We recently experienced a 43-year-old man with dilated cardiomyopathy transported under the Impella support to a high-volume left ventricular assist device (LVAD) center. Stabilized hemodynamics with the Impella and firm fixation of the device were important for safe transportation of the patient.


Assuntos
Cardiomiopatia Dilatada/cirurgia , Coração Auxiliar , Segurança do Paciente , Adulto , Cardiomiopatia Dilatada/diagnóstico , Humanos , Japão , Masculino , Monitorização Fisiológica/métodos , Medição de Risco , Transporte de Pacientes/métodos
14.
J Clin Neurophysiol ; 36(5): 358-364, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31491786

RESUMO

PURPOSE: Continuous EEG (cEEG) monitoring is primarily used for diagnosing seizures and status epilepticus, and for prognostication after cardiorespiratory arrest. The purpose of this study was to investigate whether cEEG could predict survival and meaningful recovery. METHODS: The authors reviewed inpatient cEEG reports obtained between January 2013 and November 2015 and recorded demographics, preadmission modified Rankin Scale, history of preexisting epilepsy, Glasgow Coma Scale for those admitted to the intensive care unit, and EEG data (posterior dominant rhythm, reactivity, epileptiform discharges, seizures, and status epilepticus). Associations between clinical outcomes (death vs. survival or clinically meaningful recovery [inpatient rehabilitation, home-based rehabilitation, or home] vs. other [death, skilled nursing facility]) and cEEG findings were assessed with logistic regression models. P < 0.05 was considered significant. RESULTS: For 218 cEEG reports (197 intensive care unit admits), the presence of at least a unilateral posterior dominant rhythm was associated with survival (odds ratio for death, 0.38; 95% confidence interval, 0.19-0.77; P = 0.01) and with a clinically meaningful outcome (odds ratio, 3.26; 95% confidence interval, 1.79-5.93; P < 0.001); posterior dominant rhythm remained significant after adjusting for preadmission disability. Those with preexisting epilepsy had better odds of a meaningful recovery (odds ratio, 3.31; 95% CI, 1.34-8.17; P = 0.001). Treated seizures and status epilepticus were not associated with a worse mortality (P = 0.6) or disposition (P = 0.6). High Glasgow Coma Scale (≥12) at intensive care unit admission was associated with a clinically meaningful recovery (odds ratio, 16.40; 95% confidence interval, 1.58-170.19; P = 0.02). CONCLUSIONS: Continuous EEG findings can be used to prognosticate survival and functional recovery, and provide guidance in establishing goals of care.


Assuntos
Eletroencefalografia/tendências , Unidades de Terapia Intensiva/tendências , Monitorização Fisiológica/tendências , Admissão do Paciente/tendências , Convulsões/fisiopatologia , Estado Epiléptico/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Eletroencefalografia/métodos , Feminino , Escala de Coma de Glasgow , Parada Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Convulsões/diagnóstico , Estado Epiléptico/diagnóstico , Taxa de Sobrevida/tendências , Adulto Jovem
15.
Ann Biol Clin (Paris) ; 77(4): 391-396, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31418700

RESUMO

The SFBC working group aimed to deal with biological tests outside the French nomenclature that may be useful for the follow-up of dialysis patients. Our discussion was divided into 3 parts: 1) evaluation of peritoneal membrane characteristics; 2) monitoring of renal replacement therapy using regional citrate anticoagulation; 3) estimation of residual renal function (RRF). International recommendations underline the importance of assessing peritoneal membrane characteristics for peritoneal dialysis prescription. This peritoneal equilibrium test requires the measurement in dialysate of the following parameters: glucose, urea, creatinine and sodium. As part of the monitoring of continuous renal replacement therapy using regional citrate anticoagulation, the determination of ionized calcium assay is essential according to national and international guidelines to ensure a balance between effective anticoagulation and appropriate calcium levels. Finally, the RRF plays a key role in the dialysis adequacy and patient survival. European and international recommendations highlight the potential interest of RRF in peritoneal dialysis and hemodialysis. The RRF corresponds to the mean of urinary urea and creatinine clearance, assessed from a urine collection with measurement of urinary urea.


Assuntos
Testes de Função Renal/métodos , Rim/fisiopatologia , Monitorização Fisiológica/métodos , Peritônio/fisiologia , Diálise Renal/métodos , Anticoagulantes/química , Anticoagulantes/metabolismo , Cálcio/metabolismo , Ácido Cítrico/química , Ácido Cítrico/metabolismo , Humanos , Rim/metabolismo , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Diálise Peritoneal/métodos
16.
Ann Biol Clin (Paris) ; 77(4): 407-414, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31418702

RESUMO

Like all proteins, plasma albumin can undergo glycation to produce glycated albumin. This glycation will change the structure and therefore functionalities of albumin. Because of its accessibility, its high concentration and its half-life the glycation of albumin is greater than that of haemoglobin. Laboratory measurement of glycated albumin is possible. The value of glycated albumin reflects the glycaemic balance over a period of 3 weeks, and shows its interest in cases where the determination of HbA1c is impossible or deficient. It also seems that the glycated albumin has a prognostic interest in the chronic kidney disease patients dialyzed or not. In some patients, the assay of glycated albumin could replace measurement of fructosamines and provide additional information to HbA1c values.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Monitorização Fisiológica/métodos , Albumina Sérica/análise , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/diagnóstico , Hemoglobina A Glicada/análise , Hemoglobina A Glicada/metabolismo , Humanos , Valor Preditivo dos Testes , Prognóstico , Diálise Renal , Albumina Sérica/metabolismo
17.
Med Klin Intensivmed Notfmed ; 114(6): 567-588, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31456009

RESUMO

Right ventricular heart failure is a frequent and serious but often undetected and complex clinical challenge on the intensive care unit. The commonest causes include acute decompensation of pulmonary hypertension, pulmonary embolism, sepsis, acute respiratory distress, and cardiothoracic surgery. The gold standard of bedside diagnosis is a combination of clinical symptoms, biochemical markers (NT-proBNP) and echocardiography. For the purposes of hemodynamic monitoring and treatment management, the indication to place a pulmonary artery catheter should be made generously. The major components of management include treating the underlying disease and triggering factors, reducing pulmonary vascular resistance, increasing contractility, volume optimization, and maintenance of adequate perfusion. Mechanical circulatory support should be considered before irreversible end-organ failure develops.


Assuntos
Insuficiência Cardíaca , Monitorização Fisiológica/métodos , Disfunção Ventricular Direita , Ecocardiografia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Humanos , Hipertensão Pulmonar/complicações , Unidades de Terapia Intensiva
18.
Anaesthesia ; 74(12): 1534-1541, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31448406

RESUMO

A Patient Blood Management programme was established at the University Hospital of Zurich, along with a monitoring and feedback programme, at the beginning of 2014 with a first analysis reported in 2015. Our study aimed to investigate the further impact of this Patient Blood Management monitoring and feedback programme on transfusion requirements and related costs. We included adult patients discharged between 2012 and 2017. A total of 213,882 patients underwent analysis: 66,659 patients in the baseline period (2012-2013); 35,309 patients in the year after the introduction of the Patient Blood Management monitoring and feedback programme (2014) and 111,914 patients in the continued sustainability period (2015-2017). The introduction of the Patient Blood Management monitoring and feedback programme reduced allogeneic blood product transfusions by 35%, from 825 units per 1000 hospital discharges in 2012 to 536 units in 2017. The most sustained effect was an approximately 40% reduction in red blood cell transfusions, from 535 per 1000 discharges to 319 units. Fewer patients were transfused in the periods after the introduction of the Patient Blood Management monitoring and feedback programme (6251 (9.4%) vs. 2932 (8.3%) vs. 8196 (7.3%); p < 0.001). Compared with 2012, the yearly OR for being exposed to any blood transfusion declined steadily after the introduction of the Patient Blood Management monitoring and feedback programme to 0.64 (95%CI 0.61-0.68; p < 0.001) in 2017. For patients requiring extracorporeal membrane oxygenation, transfusion requirements were also sustainably reduced. This reduction in allogeneic blood transfusions led to savings of 12,713,754 Swiss francs (£ 9,497,000 sterling; EUR 11,100,000; US$ 12,440,000) in blood product acquisition costs over 4 years. In-hospital mortality was not affected by the programme. The Patient Blood Management monitoring and feedback programme sustainably reduced transfusion requirements and related costs, without affecting in-hospital mortality.


Assuntos
Transfusão de Sangue/economia , Monitorização Fisiológica/economia , Monitorização Fisiológica/métodos , Adulto , Redução de Custos , Transfusão de Eritrócitos/economia , Oxigenação por Membrana Extracorpórea , Retroalimentação , Feminino , Fidelidade a Diretrizes , Mortalidade Hospitalar , Humanos , Masculino
19.
Sensors (Basel) ; 19(16)2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31426480

RESUMO

In precision sports, the control of breathing and heart rate is crucial to help the body to remain stable in the shooting position. To improve stability, archers try to adopt similar breathing patterns and to have a low heartbeat during each shot. We proposed an easy-to-use and unobtrusive smart textile (ST) which is able to detect chest wall excursions due to breathing and heart beating. The sensing part is based on two FBGs housed into a soft polymer matrix to optimize the adherence to the chest wall and the system robustness. The ST was assessed on volunteers to figure out its performance in the estimation of respiratory frequency (fR) and heart rate (HR). Then, the system was tested on two archers during four shooting sessions. This is the first study to monitor cardio-respiratory activity on archers during shooting. The good performance of the ST is supported by the low mean absolute percentage error for fR and HR estimation (≤1.97% and ≤5.74%, respectively), calculated with respect to reference signals (flow sensor for fR, photopletismography sensor for HR). Moreover, results showed the capability of the ST to estimate fR and HR during different phases of shooting action. The promising results motivate future investigations to speculate about the influence of fR and HR on archers' performance.


Assuntos
Frequência Cardíaca/fisiologia , Monitorização Fisiológica/métodos , Adulto , Feminino , Humanos , Masculino , Respiração , Esportes , Dispositivos Eletrônicos Vestíveis , Adulto Jovem
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