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1.
Br J Anaesth ; 111(5): 818-24, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23761221

RESUMO

BACKGROUND: Manual changeover of vasoactive drug infusion pumps (CVIP) frequently lead to haemodynamic instability. Some of the newest smart pumps allow automated CVIP. The aim of this study was to compare automated CVIP with manual 'Quick Change' relays. METHODS: We performed a prospective, quasi-experimental study, in a university-affiliated intensive care unit (ICU). All adult patients receiving continuous i.v. infusion of vasoactive drugs were included. CVIP were successively performed manually (Phase 1) and automatically (Phase 2) during two 6-month periods. The primary endpoint was the frequency of haemodynamic incidents related to the relays, which were defined as variations of mean arterial pressure >15 mm Hg or heart rate >15 bpm. The secondary endpoints were the nursing time dedicated to relays and the number of interruptions in care because of CVIP. A multivariate mixed effects logistic regression was fitted for analytic analysis. RESULTS: We studied 1329 relays (Phase 1: 681, Phase 2: 648) from 133 patients (Phase 1: 63, Phase 2: 70). Incidents related to CVIP decreased from 137 (20%) in Phase 1 to 73 (11%) in Phase 2 (P<0.001). Automated relays were independently associated with a 49% risk reduction of CVIP-induced incidents (adjusted OR=0.51, 95% confidence interval 0.34-0.77, P=0.001). Time dedicated to the relays and the number of interruptions in care to manage CVIP were also significantly reduced with automated relays vs manual relays (P=0.001). CONCLUSIONS: These results demonstrate the benefits of automated CVIP using smart pumps in limiting the frequency of haemodynamic incidents related to relays and in reducing the nursing workload.


Assuntos
Bombas de Infusão , Infusões Intravenosas/instrumentação , Infusões Intravenosas/métodos , Vasoconstritores/administração & dosagem , Adulto , Idoso , Automação , Feminino , Hemodinâmica/efeitos dos fármacos , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/organização & administração , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Estudos Prospectivos , Choque/terapia , Seringas , Vasoconstritores/efeitos adversos , Recursos Humanos , Carga de Trabalho
2.
Osteoarthritis Cartilage ; 12(10): 765-70, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15450525

RESUMO

RATIONALE: The quality of medial tibial plateau (MT-Plateau) alignment is one of the key elements for accuracy and sensitivity to change of knee radiography in knee osteoarthritis (OA). AIM: To evaluate the influence of the quality of the MT-Plateau alignment on the reproducibility of joint space width (JSW) measurement in knee radiographs. METHODS: One hundred and twenty-seven knee radiographs (99 OA), performed using a standardized radiographic procedure (Lyon schuss (LS) view). Evaluation of the quality of MT-Plateau alignment. Computerized measurement of the JSW, twice, 1-month apart, using a semi-automated and an automated method of measurement. Assessment of the reproducibility of repeated measurements: calculation of intra-observer coefficient of correlation, smallest detectable difference (SDD) and coefficient of variation (CV). RESULTS: MT-Plateau alignment was satisfactory in 99 radiographs (77.9%). Reproducibility was excellent in both satisfactory and non-satisfactory radiographs, irrespective of the method of measurement used. The automated measurement was more reproducible than the semi-automated one (CV 1.15% and 3.23%). SDD and CV were better in satisfactory than in non-satisfactory MT-Plateau aligned radiographs. CONCLUSION: These results confirm that computer measurement of the medial tibio-femoral JSW, from LS digitized radiographs, is highly reproducible, irrespective of the quality of the radiograph. However, the quality of the MT-Plateau alignment influences the reproducibility of JSW measurement. The automated measurement was more reproducible than the semi-automated one.


Assuntos
Articulação do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/diagnóstico por imagem , Tíbia/diagnóstico por imagem , Idoso , Antropometria , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/patologia , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Reprodutibilidade dos Testes
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