The patient's organic dysfunction primarily determines illness-specific complaints but has little relevance for the psychological and social aspects of the HRQL. These aspects are predominantly determined by the patient's depressive disposition and by the experienced social support. A successful therapy should therefore take biological as well as psycho-social determinants of the quality of life into account.
Wireless implants for interaction with the cortex have developed rapidly over the last decade and increasingly meet demands of clinical brain-computer interfaces. For such applications, well-established technologies are available, suitable for recording of neural activity at different spatial scales and adequate for modulating brain activity by cortical electrical stimulation. The incorporation of recording and stimulation into closed-loop systems is a major aim in active, fully implantable medical device design. To reduce clinical long-term implantation risk and to increase the spatial specificity of epicortical recordings and stimulation, micro-electrocorticography is a promising technology. However, currently there is a lack of implants suitable for chronic human clinical applications that utilize micro-electrocorticography and possess closed-loop functionality. Here, we describe the clinical importance of cortical stimulation, give an overview of existing implants that use mainly epicortical recording methods, and present results of a closed-loop microelectrocorticography system developed for clinical application within a collaborative framework. Finally, we conclude with our vision of future design options in the field of neuroprosthetic devices.
BackgroundWhile gastrointestinal problems are common in ICU patients with multiple organ failure, gastrointestinal failure has not been given the consideration other organ systems receive. The aim of this study was to evaluate the incidence of gastrointestinal failure (GIF), to identify its risk factors, and to determine its association with ICU mortality.MethodsA retrospective analysis of adult patients (n = 2588) admitted to three different ICUs (two ICUs at the university hospital Charité-Universitätsmedizin Berlin, Germany and one at Tartu University Clinics, Estonia) during the year 2002 was performed.Data recorded in a computerized database were used in Berlin. In Tartu, the data documented in the patients' charts was retrospectively transferred into a similar database. GIF was defined as documented gastrointestinal problems (food intolerance, gastrointestinal haemorrhage, and/or ileus) in the patient data at any period of their ICU stay. ICU mortality, length of stay, and duration of mechanical ventilation were assessed as outcome parameters.ResultsGIF was identified in 252 patients (9.7% of all patients). Only 20% of GIF patients were identifiable at admission. GIF was related to significantly higher mortality (43.7% vs. 5.3% in patients without GIF), as well as prolonged length of ICU stay (10 vs. 2 days) and mechanical ventilation (8 vs. 1 day), p < 0.001, respectively. Patients' profile (emergency surgical or medical), APACHE II and SOFA scores and the use of catecholamines at admission were identified as independent risk factors for the development of GIF. Development of GIF during ICU stay was an independent predictor for death.ConclusionGastrointestinal failure represents a relevant clinical problem accompanied by an increased mortality, longer ICU stay and mechanical ventilation.
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