Real-time prediction of acute cardiovascular events using hardware-implemented Bayesian networks.

This paper presents a decision support system that aims to estimate a patient׳s general condition and detect situations which pose an immediate danger to the patient׳s health or life. The use of this system might be especially important in places such as accident and emergency departments or admission wards, where a small medical team has to take care of many patients in various general conditions. Particular stress is laid on cardiovascular and pulmonary conditions, including those leading to sudden cardiac arrest. The proposed system is a stand-alone microprocessor-based device that works in conjunction with a standard vital signs monitor, which provides input signals such as temperature, blood pressure, pulseoxymetry, ECG, and ICG. The signals are preprocessed and analysed by a set of artificial intelligence algorithms, the core of which is based on Bayesian networks. The paper focuses on the construction and evaluation of the Bayesian network, both its structure and numerical specification.

Intraoperative monitoring of cerebral NIRS oximetry leads to better postoperative cognitive performance: a pilot study.

OBJECTIVES: The aim of this study is the assessment of the regional cerebral oximetry - NIRS (near infrared spectroscopy) as an intraoperative monitoring system to protect the patient against the incidents of brain desaturations. We hypothesize that patients monitored with NIRS present a smaller range of postoperative cognitive dysfunctions (POCD) in comparison with those without NIRS monitoring during lumbar spine surgery in a prone position. SETTINGS: This study was performed at the Clinical Department of Neurosurgery and Oncology of the Central Nervous System, Medical University of Lodz, Poland. PARTICIPANTS: The study completed 43 adult patients qualified for the surgical treatment of lumbar spondylosis. Before the procedures they were randomized into two subgroups: one monitored intraoperatively by means of NIRS cerebral oximetry (INVOS 5100), which numbered 13 patients ­ 30.2% (13 NIRS devices were made available to the authors) and the other without NIRS intraoperative monitoring, totaling 30 people ­ 69.8%. The patients who presented a history of psychiatric, neurological and cardiovascular disorders which impair cognitive processes were disqualified from the study. PRIMARY AND SECONDARY OUTCOME MEASURES: A comprehensive battery of neuropsychological tests was preoperatively performed on all patients. The subjects were then divided into two groups: with and without NIRS monitoring. Both groups were statistically homogeneous. Computerized anesthesia records were used to obtain intraoperative data: mean arterial pressure, heart rate, pulsoximetry and cerebral regional oxygenation. The depth of anesthesia monitor was not used. Besides, all the patients passed the same battery of neurocognitive tests 7 days and 1 month postoperatively. The Mann-Whitney test was performed to compare POCD and therefore assess the usefulness of NIRS as a monitoring mechanism during anesthesia in the prone position. RESULTS: There was a significant (p < 0.05) difference in the presence of cognitive deficiencies between the subgroup monitored with NIRS and the subgroup without NIRS. It included: Digit Span Test overall score and forward repetition score 7 days after operation, N- back Test results after 30 days in version 0 "back" - time, N-back Test version 1 "back" results in the number of correct answers and the number of errors. CONCLUSIONS: NIRS cerebral oximetry may be useful in reducing postoperative cognitive complications in patients operated on in the prone positioning. TRIAL REGISTRATION: RNN/556/08/KB ­ approval of the ethics committee at Medical University of Lodz, Poland.

[Patient satisfaction with anaesthesia and pre-anaesthetic information]. / Badanie satysfakcji chorych i ich opinii na temat jakosci swiadczen anestezjologicznych w swietle objawów niepozadanych znieczulenia.

BACKGROUND: Patient satisfaction with perioperative care plays an important role in the assessment of quality of care. Written evaluation forms are commonly used all over the world for this purpose. The aim of this study was to assess the quality of perioperative care, with special attention being directed to anaesthesia-associated side effects. METHODS: Forty-two adult patients, of both sexes, scheduled for abdominal surgery, were asked to complete a questionnaire consisting of 11 questions on anaesthesia, side effects and the general quality of perioperative care. The results were analysed using the X2 test, and p < 0.05 was considered significant. The Pearson correlation coefficient was used for comparison. RESULTS: There was a strong correlation between the quality of the pre-anaesthesia visit, including the information obtained on possible complications and alternative methods of anaesthesia, and the assessment of quality of the anaesthesia service. Post-anaesthesia care facilities were also found to be of major importance for patients. CONCLUSIONS: Adequate, detailed and easily understandable information plays a crucial role in patients satisfaction with anaesthesia. Special attention should be paid to the most common side effects and complications. Residents should be trained in communication in the early stages of their training.