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  • 1
    ISSN: 1573-2614
    Keywords: Automated anesthesia information system ; cesarean section ; malpractice claim ; reference limit ; reference value
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract Introduction. We evaluated whether automated anesthesia information systems can be used to calculate reference limits (population-based “normal values”) for vital signs. We considered four populations of women undergoing cesarean section: healthy under spinal anesthesia, healthy under general anesthesia, pre-eclamptic/eclamptic under spinal anesthesia, and pre-eclamptic/eclamptic under general anesthesia. Methods. Reference limits were calculated for each of the study populations by determination of percentiles for: minimum heart rate, maximum heart rate, minimum arterial oxyhemoglobin saturation (SaO2), minimum mean arterial pressure (MAP), maximum MAP, decrease in MAP, and increase in MAP. Results.There was one adverse anesthetic outcome among the 1,300 women in the study; the woman sustained a post-dural puncture headache. The 5th percentiles of SaO2 were at least 95% saturation under spinal versus90% under general. Under spinal anesthesia, 95th percentiles for decreases in MAP from baseline were 63 mmHg for healthy and 75 mmHg for pre-eclamptic/eclamptic women. Under general anesthesia, the 95th percentiles for maximum MAP were 161 and 177 mmHg, respectively. Two women of the 1,300 patients experienced simultaneously a minimum SaO2 〈92% and minimum MAP 〈50 mmHg. Discussion. Automated anesthesia information systems can be used to determine reference limits for vital signs during anesthesia. Reference limits may play a role in malpractice cases when an expert claims that care by an anesthesiologist was sub-standard as shown by vital signs that were not maintained within the normal range during the critical portions of an anesthetic. Automated anesthesia information systems may enhance expert witnesses’ clinical judgment.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Journal of clinical monitoring and computing 15 (1999), S. 45-51 
    ISSN: 1573-2614
    Keywords: Linear models ; statistical models ; operating room information systems ; operating rooms ; linear programming ; robust estimation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract We present a statistical model for predicting the time to complete a series of successive, elective surgical cases. The use of sample means of case times and turnover times when scheduling cases does not minimize the operating room labor costs associated with errors in predicting times to complete series of cases. The problem of minimizing associated labor costs (both under and over utilization) can be converted to the problem of least absolute deviation regression. The dependent variables are the times to complete series of cases. The independent variables are the numbers of cases in each series that are in various categories (i.e., combinations of scheduled procedures and surgeons). Although the computational method is preferred on theoretical grounds to that involving sample means, application of both methods shows that the more practical method is to use the sample means of previous case times and turnovers.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Journal of clinical monitoring and computing 13 (1997), S. 171-179 
    ISSN: 1573-2614
    Keywords: Clinical engineering ; Equipment failure ; Failure analysis ; Maintenance and engineering ; Hospital ; Reliability analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract Objective. The Food and Drug Administration’s (FDA) checkoutrecommendations are to be applied, at least daily, on anesthesia machines.Devices included in the checkout are crucial to the safe operation of themachine. Remaining devices do not need to be checked as often. However, theyshould be checked at some appropriate interval. We calculated the reliabilityof the non-FDA checkout devices, to predict failure rates of these devices.Methods. The study included 36 North American Drager Narkomed anesthesiamachines that were in service a total of 109,410 days at a universityhospital. Reliability (i.e., statistical) analyses were done using in-housedata recorded by biomedical technicians during 3359 monthly machineinspections. If any one device was operating outside of the limits of themanufacturer’s specifications, the machine was labeled as having failedits inspection. Results. Assumptions of the failure analysis were satisfied.The mean time between failures equaled 1351 days or 3.7 years (lower95%confidence bound 1123 days or 3.1 years). The mean daily probability of oneor more devices failing to perform within the manufacturer’sspecification between inspections equaled 1.1%, 2.2%, and4.4% for inspectionsevery 1, 2, or 4 months, respectively. Probabilities that a machine would failon demand between inspections were approximately equal to the mean dailyprobabilities of machine failure. The mean number of days per year that amachine would be operating with a device that is outside of the limits of itsspecifications equaled 4, 8, and 12 days, respectively. The mean dailyprobabilities of failure and the probabilities of failure on demand were bothdirectly proportional to the inspection interval. Conclusions. Our failureanalysis provides a rational basis for choosing an appropriate inspectioninterval for anesthesia machines’ devices that are not included in theFDA’s checkout recommendations.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Journal of clinical monitoring and computing 15 (1999), S. 153-162 
    ISSN: 1573-2614
    Keywords: operating rooms ; operating room information systems
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract Optimal sequencing of urgent cases (i.e., selecting which urgent case should be performed first and which second) may enhance patient safety, increase patient satisfaction with timeliness of surgery, and minimize surgeons' complaints. Before determining the optimal sequence of urgent cases, an operating room (OR) suite must identify the primary scheduling objective to be satisfied when prioritizing pending urgent cases. These scheduling objectives may include: 1) perform the cases in the sequence that minimizes the average length of time each surgeon and patient waits; 2) perform the cases in the order that they were submitted; or 3) perform the cases based on medical priority, as prioritized by an OR director, or surgeons discussing the cases among themselves. We provide mathematical structure which can be used to program a computerized surgical services information system to assist in optimizing the sequence of urgent cases. We use an example to illustrate that the opti mal sequence varies depending on the scheduling objective chosen.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1573-7365
    Keywords: Flumazenil ; glutamate ; hepatic encephalopathy ; hippocampus ; microdialysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Hepatic encephalopathy (HE) is a neuropsychiatric disorder that often occurs as a consequence of acute or chronic liver failure. Previous reports have suggested that alterations in amino acid neurotransmission, particularly glutamate, may play an important role in the pathogenesis of HE. The objectives of the present study were to test the hypothesis that extracellular glutamate concentration is increased during HE, and to determine if flumazenil, a benzodiazepine antagonist, alters the extracellular concentration of glutamate during HE. The experimental approach involved using microdialysis probes to measure rat hippocampal extracellular glutamate concentration. HE was brought about as a result of thioacetamide-induced liver failure. Thioacetamide produced behavioral and metabolic effects, such as somnolence, hyperventilation and hyperammonemia, consistent with stage three HE. Comparison with saline-treated rats demonstrated that HE was associated with a significant increase (p=0.010) in extracellular hippocampal glutamate concentration. Administration of flumazenil caused a transient increase in arousal level, but did not affect the increase in glutamate concentration (p=0.93). These results corroborate the theory that glutamate neurotransmission is altered during HE and suggest that the flumazenil arousal of HE rats is not mediated by a change in extracellular glutamate concentration.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    New York, NY [u.a.] : Wiley-Blackwell
    American Journal of Anatomy 1 (1902), S. 261-267 
    ISSN: 0002-9106
    Keywords: Life and Medical Sciences ; Cell & Developmental Biology
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Medicine
    Additional Material: 8 Ill.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    New York, NY [u.a.] : Wiley-Blackwell
    American Journal of Anatomy 2 (1902), S. 13-24 
    ISSN: 0002-9106
    Keywords: Life and Medical Sciences ; Cell & Developmental Biology
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Medicine
    Additional Material: 9 Ill.
    Type of Medium: Electronic Resource
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