ABSTRACT
PURPOSE: Intradialytic hypotension (IDH) represents a common hemodialysis (HD) complication. Blood volume tracking (BVT) is a tool regulating the relative blood volume changes and potentially reducing the occurrence of IDH. The aim of this study was to evaluate the ability of BVT to reduce the staff workload associated to IDH. METHODS: Ten hypotension-prone HD patients were treated each with 39 conventional HD (HD) sessions and then switched to 39 HD sessions with BVT (HD-BVT). The staff interventions related to IDH were monitored by a trained staff. RESULTS: Dialysis sessions complicated by IDH and staff interventions were affected by BVT (HD: 102 and 127 vs. HD-BVT: 57 and 59, respectively, for both p<0.001). The time consumed by staff in IDH management was decreased by HD-BVT (1416 vs. 578 min, p<0.001). CONCLUSIONS: The effectiveness of BVT to reduce the frequency of IDH leads to a reduction of the dialysis staff workload with fewer staff interventions, allowing for major work-time saving.
Subject(s)
Blood Pressure , Blood Volume Determination , Blood Volume , Hypotension/prevention & control , Kidney Failure, Chronic/therapy , Personnel Staffing and Scheduling , Renal Dialysis/adverse effects , Workload , Aged , Aged, 80 and over , Cross-Over Studies , Female , Humans , Hypotension/diagnosis , Hypotension/etiology , Hypotension/physiopathology , Italy , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/physiopathology , Male , Predictive Value of Tests , Prospective Studies , Time Factors , Time and Motion Studies , Treatment OutcomeABSTRACT
BACKGROUND: Motion of human trunk segments in healthy subjects during activities of daily living has been described either with oversimplified models or with cumbersome techniques of isolated anatomical complex. This study describes multi-segmental trunk motion based on a new technique which is a compromise between technical limitations, implied with the experiments, and clinical relevance. METHODS: The thorax segment was tracked by the optimal spatial matching of four thoracic markers. The separate bi-dimensional shoulder line rotations and translations with respect to the thorax were calculated by markers on the two acromions. Spine motion was characterised by a 5-link-segment model from additional four skin markers, in the anatomical reference frame based on four pelvic spine markers. These 14 markers were tracked in 10 healthy subjects and one clinical case during static upright posture, chair rising-sitting, step up-and-down and level walking, and also during elementary flexion and extension, lateral bending, and axial rotation movements of the entire trunk. FINDINGS: Intra-subject repeatability over ten repetitions was found to be high for most of the measurements, with average standard deviations of less than 1.8° for all planar rotations at the spine, and less smaller than 1mm for shoulder translations. Large motion, albeit with different patterns, was found in all subjects, also revealing interesting couplings over the three anatomical planes. INTERPRETATION: Considerable subject-specific motion occurs at each of these different trunk segments in all three anatomical planes, in simple exercises and in motor tasks of daily living. Measurements taken with the present new trunk model in pathological subjects shall reveal corresponding patterns and ranges of motion in abnormal conditions.
Subject(s)
Exercise , Locomotion , Adult , Anthropometry , Biomechanical Phenomena , Case-Control Studies , Female , Gait , Humans , Lumbar Vertebrae/pathology , Male , Models, Anatomic , Movement , Posture , Rotation , Shoulder/physiology , Thorax/pathologyABSTRACT
BACKGROUND: A number of different models for human trunk kinematics during locomotion have been proposed, though mainly addressing specific clinical questions rather than general populations. These differ considerably for the skeletal segments considered, marker-set, anatomical axis and frame definitions, and joint conventions. The scope of the present study is to compare quantitatively these models on the basis of the same motion. METHODS: Ten subjects were analysed, instrumented with a single comprehensive marker-set of 14 markers identified from the union of the corresponding from eight current models for trunk kinematics. Activities of daily living (walking, chair rising/sitting, step-up/down), elementary trunk movements (flexion, bending and axial rotation), and isolated motion of the shoulders, both synchronous and asynchronous were collected. Resulting rotations in the three anatomical planes, both in the laboratory and in the pelvis reference frames, were calculated. FINDINGS: In addition to the expected bias between the rotation angle time-histories, very different patterns and range of motion were found between the models. In chair rising/sitting, and in the laboratory global frame, the range of flexion averaged over the subjects was measured by the different models in the full scale from about 28 degrees to 44 degrees. In elementary trunk rotation and in the pelvis anatomical reference frame, three models measured about 10 degrees excursion of the coupled bending motion, other two about 38 degrees and 49 degrees on average. INTERPRETATION: In trunk kinematics analysis, it is recommended that all models, both in terms of markers involved and of reference frame definitions, are understood carefully before interpreting the results in clinical decision making.
