Purpose: Delirium is a common disorder in intensive care unit (ICU) patients. It is unclear whether ICU environment affects delirium. We investigated the influence of ICU environment on the number of days with delirium during ICU admission. Methods: In this prospective before-after study, ICU delirium was compared between a conventional ICU with wards and a single-room ICU with, among others, improved daylight exposure. We included patients admitted for more than 24 h between March and June 2009 (ICU with wards) or between June and September 2010 (single-room ICU). Patients who remained unresponsive throughout ICU admission were excluded. The presence of delirium in the preceding 24 h was assessed daily with the confusion assessment method for the ICU (CAM-ICU) by research physicians combined with evaluation of medical and nursing charts. The number of days with delirium was investigated with Poisson regression analysis. Results: We included 55 patients (449 observation days) in the ICU with wards and 75 patients (468 observation days) in the single-room ICU. After adjusting for confounding, the number of days with delirium decreased by 0.4 days (95 % confidence interval 0.1-0.7) in the singleroom ICU (p = 0.005). The incidence of delirium during ICU stay was similar in the ICU with wards (51 %) and in the single-room ICU (45 %, p = 0.53). Conclusions: This study is the first to show that ICU environment may influence the course of delirium in ICU patients.
Background Long-term treatment with peritoneal dialysis (PD) results in peritoneal fibrosis. Peritoneal biopsies have been used to determine the severity of fibrosis. Ultrasonography (US) of the abdominal wall has been used to measure peritoneal thickness non-invasively. However, direct comparison of both methods in the same patient has never been done. Furthermore, the validity of US to measure peritoneal thickness has not been investigated. Methods We performed 3 studies: 1) a human biopsy study to compare US measurement of peritoneal thickness with histological examination; 2) a human cadaver study to investigate the effect of removing the peritoneum on US results; and 3) a phantom study in which we used US to measure the thickness of membrane-like structures with a known thickness to investigate the influence of different US settings. Results The median thickness in biopsies of the peritoneum was 113 μm (interquartile range [IQR] 72 –129 μm), while this was 370 μm (IQR 324 – 458 μm) when measured by US ( p < 0.0001). The mean difference between the 2 measures was -257 μm (limits of agreement -4.6 and -511 μm). In the cadaver study, removal of the peritoneum did not have an effect on the presence or thickness of the hyperechoic line reported to represent the peritoneum. In the phantom study, results were highly dependent on frequency of the transducer, scan depth, and gain settings. Conclusions Ultrasonography results differ markedly from histological measurement using peritoneal biopsies. However, the hyperechoic line generated by US represents the interface between 2 neighboring tissues and not a separate morphological structure. Moreover, its thickness is greatly influenced by user-defined US settings.
Background Post-haemorrhagic ventricular dilatation can be measured accurately by MRI. However, two-dimensional (2-D) cranial US can be used at the bedside on a daily basis. Objective To assess whether the ventricular volume can be determined accurately using US. Materials and methods We included 31 preterm infants with germinal matrix intraventricular haemorrhage. Two-dimensional cranial US images were acquired and the ventricular index, anterior horn width and thalamo-occipital distance were measured. In addition, cranial MRI was performed. The ventricular volume on MRI was determined using a previously validated automatic segmentation algorithm. We obtained the correlation and created a linear model between MRI-derived ventricular volume and 2-D cranial US measurements. Results The ventricular index, anterior horn width and thalamo-occipital distance as measured on 2-D cranial US were significantly associated with the volume of the ventricles as determined with MRI. A general linear model fitted the data best: ∛ventricular volume (ml) = 1.096 + 0.094 × anterior horn width (mm) + 0.020 × thalamo-occipital distance (mm) with R 2 = 0.831. Conclusion The volume of the lateral ventricles of infants with germinal matrix intraventricular haemorrhage can be estimated using 2-D cranial US images by application of a model.
Rigid endoscopes degrade during clinical use due to sterilization, ionizing radiation and mechanical forces. Despite visual checks on functionality at the department of sterilization, surgeons are still confronted with suboptimal instruments as it is difficult to assess this degradation in an objective manner. To guarantee that endoscopes have sufficient optical quality for minimal invasive surgery, an experimental opto-electronic test bench has been developed in order to be used at the department of sterilization. Transmission of illumination fibres and lens contrast values are stored in a database to enable empirical criteria to reject endoscope for further clinical usage or to accept endoscopes after repair. Results of the test bench are given for an eight month period, where a trained operator performed 1599 measurements on 46 different types. Stability of the system, trends in quality of clinical endoscopes, and effect of repair or replacement were assessed. Although the period was too short to draw firm conclusions, a slow downwards trend in quality of clinically used endoscopes could be observed. Also, endoscopes generally improve in quality after repair or replacement, while endoscope replacement seems to slightly outperform endoscope repair. To optimize the measurement process, a new system is being developed requiring less user interaction and measuring more optical parameters of an endoscope. By commercializing this system, we hope that measurements at different hospitals will give improved insight which acceptance and rejection criteria to use and which factors (usage, cleaning protocol, and brands) determine the economic lifetime of endoscopes.
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