Systematical study of BAL samples has a high diagnostic yield in our immunocompromised patients with suspected pneumonia. As economical and epidemiological conditions of regions are different, it should be tried everywhere.
Abstract--The usability test performed as part of the processes of biomedical equipment development has great importance for safety use of health care technology, between 50% and 70% of adverse events with medical devices are related with assembly mistakes, wrong connections and incorrect operation. Usability test requires detailed processes with rigorous methodologies that guarantee test to the user, who measures several aspects of the use, interface and process in the equipment. This article compares the usability of a prototype of vital signs monitor against a commercial product in terms of some aspects of the human factor engineering that were applied in order to test the usability of a Prototype, the commercial vital signs monitor is used as a reference. This paper integrates a methodology composed by 3 phases that allows an analysis of users` behavior interacting with medical devices. Time and steps were analyzed through statistics and heuristic analysis.
Introducción. El diagnóstico microbiológico de la neumonía permite optimizar el uso de antibióticos en pacientes con asistencia respiratoria mecánica. Para ello se han cultivado cuantitativamente las muestras del lavado broncoalveolar broncoscópico, procedimiento que no siempre es posible. Objetivo. Evaluar la concordancia microbiológica entre muestras respiratorias tomadas por lavado broncoalveolar broncoscópico y no broncoscópico, y establecer si el uso previo de antibióticos y el momento de presentación de la neumonía pueden afectarla. Materiales y métodos. Estudio prospectivo realizado en el Hospital Universitario San Vicente de Paúl, en 38 pacientes con sospecha de neumonía y con asistencia respiratoria mecánica. En todos se practicó el lavado broncoalveolar por fibrobroncoscopia y el lavado no broncoscópico usando un catéter telescopado de punta preformada (Balcath®). Todas las muestras fueron procesadas siguiendo protocolos microbiológicos convencionales. Resultados. Considerando el lavado broncoalveolar por fibrobroncoscopia como patrón de referencia, los cultivos permitieron identificar el agente en 60,5% de los casos. El acuerdo diagnóstico se logró en 82% de los pacientes y 79% de los aislamientos. Utilizando el índice kappa de Cohen, la concordancia general entre los dos métodos fue 0,76 [0,93]; pero en quienes habían recibido antibióticos previos fue 0,26 [0,05-0,48], versus 1,0 en quienes no lo habían hecho (p<0,0001). La concordancia no difirió significativamente cuando se compararon los casos de neumonía temprana y tardía. Conclusiones. La concordancia general entre los dos métodos de lavado broncoalveolar es buena en pacientes con neumonía y respiración asistida mecánicamente. Sin embargo, el uso previo de antibióticos y no el momento de aparición de la neumonía, disminuye ésta significativamente.Palabras clave: neumonía/etiología, respiración artificial, técnicas y procedimientos diagnósticos, técnicas microbiológicas, lavado broncoalveolar. Concordance between two methods of bronchoalveolar lavage for the microbiological diagnosis of pneumonia in mechanically ventilated patientsIntroduction. Microbiological diagnosis of pneumonia allows the optimal use of antibiotics in mechanically ventilated patients. That is why samples of bronchoscopic bronchoalveolar lavage had been quantitatively cultivated, but this procedure is not always possible. Objective. To evaluate the microbiological concordance between respiratory samples obtained by non-bronchoscopic protected bronchoalveolar lavage compared to the bronchoscopic ones, and to find out whether concordance was affected by previous use of antibiotics or the time of pneumonia onset.
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