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M Benson

Publications and source records attributed to M Benson.

At least 19 recordsLinked to original sources
PubMed2001

Factors determining length of stay of surgical day-case patients.

BACKGROUND AND OBJECTIVE: Factors which lead to prolonged stay in the day-care unit and unplanned admission after day-case surgery are poorly understood. METHODS: Data sets of 3152 day-case patients were collected with a computerized online record keeping system (NarkoData). Predictors of prolonged postoperative stay including unanticipated admission were identified using univariate analysis. Charts of patients, who needed admission, were reviewed. RESULTS: 13.2% of day-case patients had a postoperative stay < or = 3 h, 55.3% 3-6 h and 26.2% > or = 6 h. The rate of unanticipated admission was 5.4%. Intraoperative haemoglobin concentration and blood loss were the best predictors of a prolonged postoperative stay. Other significant predictors were female gender, advanced age, longer duration of surgery, larger volume of infusions, intubation, spinal anaesthesia, intraoperative use of opioids and non-depolarizing muscle relaxants, high pain score, nausea and vomiting and prolonged preoperative waiting time. Chart review of patients admitted to hospital confirmed the validity of the statistically significant predictors. CONCLUSIONS: In day-case surgery, the predictors of prolonged stay in the day-care unit and unplanned Hospital admission are mainly related to the surgical procedure.

Ambulatory Surgical Procedures↗
PubMed2001

The use of an anesthesia information management system for prediction of antiemetic rescue treatment at the postanesthesia care unit.

UNLABELLED: We used an anesthesia information management system (AIMS) to devise a score for predicting antiemetic rescue treatment as an indicator for postoperative nausea and vomiting (PONV) in the postanesthesia care unit (PACU). Furthermore, we wanted to investigate whether data collected with an AIMS are suitable for comparable clinical investigations. Over a 3-yr period (January 1, 1997, to December 31, 1999), data sets of 27,626 patients who were admitted postoperatively to the PACU were recorded online by using the automated anesthesia record keeping system NarkoData(R) (IMESO GmbH, Hüttenberg, Germany). Ten patient-related, 5 operative, 15 anesthesia-related, and 4 postoperative variables were studied by using forward stepwise logistic regression. Not only can the probability of having PONV in the PACU be estimated from the 3 previously described patient-related (female gender, odds ratio [OR] = 2.45; smoker, OR = 0.53; and age, OR = 0.995) and one operative variables (duration of surgery, OR = 1.005), but 3 anesthesia-related variables (intraoperative use of opioids, OR = 4.18; use of N(2)O, OR = 2.24; and IV anesthesia with propofol, OR = 0.40) are predictive. In implementing an equation for risk calculation into the AIMS, the individual risk of PONV can be calculated automatically. IMPLICATIONS: The aim of this study was to investigate predictors for postoperative nausea and vomiting by using online anesthesia records. With the help of computerized data evaluation, 7 of 34 variables could be detected as risk factors. By implementing an automatic score into the record keeping system, an individual risk calculation could be made possible.

Adult↗
PubMed2000

[Influences and predictors of unanticipated admission after ambulatory surgery].

UNLABELLED: In order to plan the daily routine of a surgical day care unit optimally and effectively, it is indispensable to know the causes of unanticipated admission of outpatients. The purpose of this experiment was to evaluate the influences and predictors of unanticipated admission of patients in our day care unit for ambulatory surgery. The data sets of 3152 surgical outpatients were evaluated. The duration of stay had been entered online by computers. METHOD: From January 1997 until June 1999, all clinically relevant parameters from any outpatient were entered into an anesthesia information management system (NarkoData, Imeso GmbH, Hüttenberg-Rechtenbach, Germany). The correlation of potential nominal and ordinal scaled predictors of unanticipated admission was tested using the chi-squared test. Univariate analysis was used in determining predictors for the occurrence of unanticipated admission. Pearson's contingency coefficient (CC) was used as a standard for the correlation rigidity in nominal and ordinal scaled parameters. The correlation standard eta was used for metrical parameters. RESULTS: Unanticipated admission occurred in 169 (5.4%) of the 3152 outpatients. The following parameters significantly influenced unanticipated admission: age, ASA status, diagnosis (ICD-9), time of admission, different anesthesia procedures and anesthetics (opioids and non-depolarizing muscle relaxants), surgical department, type of surgery (ICPM), duration of operation, blood loss, intraoperative hemoglobin values, and the administration of colloid and crystalloid solutions. The parameters blood loss, intraoperative hemoglobin values, and administration of colloid solutions were evaluated as being good predictors. CONCLUSION: The causes of unanticipated admission of patients in our day care unit for ambulatory surgery are manifold. Some relate to the patient, the anesthesia, and the organization of the day care unit, whereas lengthy operative trauma leading to intraoperative blood loss also plays a major role.

Adult↗
PubMed2000

[Using an anesthesia information management system (AIMS) for documentation in a day care unit for ambulatory surgery].

UNLABELLED: From January 1997 until June 1999, the complete durations of stay of 3152 outpatients were entered into a computerized documentation system. The scope of the data entry went from patient admission to patient release. The objective was to determine the usefulness of the anaesthesia information management system (AIMS) in producing complete and high-quality documentation in the field of outpatient operations. Some aspects and results from routine work are presented here. METHOD: The system was installed in eight bedside computers, in addition to a further client connected to the existing AIMS via Ethernet. Patient medical courses were documented both preoperatively and postoperatively in outpatient bedsides until their discharge or admission. The online documentation software NarkoData (Version 4, Imeso GmbH, Hüttenberg, Germany) was used to document and store patient data in a database. This program contains all relevant information concerning the course of anaesthesia and outpatient duration of stay, including application of drugs, vital signs, observation times, and medical findings as well as the data sets of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI), ICD, and ICPM. Data was analyzed by exporting from the database into a statistical program using "structured query language." RESULTS: Data sets of 3152 outpatients were entered into the online documentation software. Most (54.2%) of the ambulatory surgical procedures were performed by the Department of Traumatology. General Surgery followed with 16.0%, and Urology managed 9.5% of the cases. The most frequent ambulatory surgical procedures were: diagnostic arthroscopy (923, 31.2%), removal of osteosynthetic material (410, 13.8%), and circumcision (250, 8.4%). Anesthesia procedures consisted of inhalative (38.6%, n = 1218) and intravenous anesthesia (IVA) (29.9%, n = 938). In 22.6% (713) of the cases, regional anaesthesia was performed. The average postoperative observation time was 289.2 +/- 140.1 minutes. One hundred sixty-nine patients (5.4%) were unexpectedly admitted to overnight care. The decision to admit patients to normal wards took place within the first 3 postoperative hours in 51.9% of the cases. CONCLUSION: The AIMS described above is sufficient in documenting the entire care process of patients in a day care unit. Integration into the existing AIMS was an important prerequisite for the integrity of the documentation chain. This allowed for a sensitive communication with other clinical data processing systems. The quality of documentation and flow of information at the workplaces in the day care unit were increased, similarly to other anaesthesiological workplaces in the hospital. Medical and administrative data and information for analyses of clinical processes are possible with such tools.

Adult↗
PubMed2000

Cerebral arterial gas embolism by helium: an unusual case successfully treated with hyperbaric oxygen and lidocaine.

A 27-year-old man inhaled helium from an unregulated pressurized cylinder and underwent cerebral arterial gas embolism (CAGE), leaving him blind and with radiologic evidence initially suggesting cortical infarction. There was complete recovery of vision and substantial regression of the radiologic changes after 4 hyperbaric oxygen treatments and a 54-hour lidocaine infusion, which began 6 hours after the accident. This is the second reported case of CAGE occurring by this mechanism and the first case of unequivocal CAGE in which lidocaine has been used as an adjunctive treatment with hyperbaric oxygen.

Adult↗
PubMed2000

Clinical and practical requirements of online software for anesthesia documentation an experience report.

The aim of this paper is the presentation of a new version of the anesthesia documentation software, NarkoData, that has been used in routine clinical work in our department as part of an anesthesia information management system (AIMS) since 1995. The performance of this software is presented along with requirements for future development of such a system. The originally used version, NarkoData 3.0, is an online anesthesia documentation software established by the software company ProLogic GmbH. It was primarily developed as a disk-based system for the MacOS operating system (Apple Computer Inc.). Based on our routine experience with the system, a catalogue of requirements was developed that concentrated on improvement in the sequence of work, administration and data management. In 1996, the concepts developed in our department, in close co-operation with medical personnel and the software company, led to a considerable enlargement of the program functions and the subsequent release of a new version of NarkoData. Since 1997, more than 20 000 anesthesia procedures have been recorded annually with this new version at 115 decentralized work stations at our university hospital.

Anesthesiology↗
PubMed2000

Low levels of interferon-gamma in nasal fluid accompany raised levels of T-helper 2 cytokines in children with ongoing allergic rhinitis.

The T-helper 2 (Th2) cytokines interleukin-(IL-) 4, IL-5, IL-6, IL-10 and the Th1 cytokine IFN-gamma and their associations with eosinophil, eosinophil cationic protein (ECP) and immunoglobulin (Ig) E were studied in nasal lavage fluid from 60 school children with allergic seasonal rhinitis and 36 nonatopic healthy controls, before and during the pollen season. Eosinophil differential counts and IgE increased significantly in the patients during the pollen season. The eosinophil differential counts, ECP and IgE were all significantly higher during the season than in specimens simultaneously obtained from the nonatopic controls. Before season, the levels of ECP and IgE, but not eosinophils, were significantly higher in the patients than in the controls. During the season the nasal lavage fluid levels of IFN-gamma were significantly lower and the IL-4/IFN-gamma quotients significantly higher in the allergic than in the control children. In the allergic children, but not in the controls, the nasal fluid levels of the Th2 cytokines IL-4, IL-5 and IL-10 increased during the season, and together with IL-6, were correlated with the differential counts of eosinophils, and with the levels of ECP and IgE. These findings are compatible with the hypothesis that a deficient release of the Th1 cytokine IFN-gamma plays an important role in the pathogenesis of allergic inflammation. Regardless of whether the defective IFN-gamma secretion is primary or a consequence of suppression by other cytokines, it will in the atopic subjects enhance the release of Th2 cytokines, which in turn will facilitate the development of allergic inflammation.

Adolescent↗
PubMed2000

[Recovery of balanced anesthesia with various inhalation anesthetics in comparison to intravenous anesthetics: a retrospective analysis of 20,060 patients].

BACKGROUND: The aim of this investigation was to compare routine balanced anaesthesia with different inhalation agents to intravenous anaesthesia (IVA) using an Anaesthesia-Information-Management-System (AIMS) with regard to time of recovery from anaesthesia, the time of discharge from the postanaesthesia care unit (PACU) and postoperative nausea as well as postoperative therapy with analgesics. METHODS: In 1997 and 1998 all relevant data of each anaesthesia procedure have been recorded using the online documentation Software NarkoData. These data sets have been stored into a relational database during each anaesthesia procedure. For evaluation the information has been exported from the database to a statistics program via 'Structured Query Langvage' (SOL). Balanced anaesthesia has been performed using isoflurane, halothane, and sevoflurane, respectively, supplemented with or without nitrous Oxide (N2O). The intravenous based anaesthesia-groups included propofol-fentanyl or propofol-remifentanil. RESULTS: The fastest recovery was seen in patients of the isoflurane group (11.2 +/- 7.7 minutes), and the longest time for extubation was observed in patients wich halothane anaesthesia (12.8 +/- 9.3 minutes); the overall mean difference was 1.7 minutes. The earliest patient admitted to the PACU had received sevoflurane (7.0 +/- 6.3 minutes) and propofol-remifentanil (7.0 +/- 7.4 minutes) whereas patients of the halothane group (9.5 +/- 7.5 minutes) took more. The shortest stay in PACU was seen in patients of the sevoflurane and isoflurane groups (105.13 +/- 35.7 and 108.4 +/- 60.5 minutes), whereas propofol-remifentanil (126.2 +/- 89.1 minutes) and halothan (120.0 +/- 86.1 minutes) anaesthetised patients had the longest stay in PACU. No difference was noted in the incidence of postoperative nausea and vomiting nor in the amount of postoperatively given analgesics. CONCLUSION: Results achieved in routine correspond only in part to results from studies. In our investigation balanced anaesthesia with isoflurane and sevoflurane correspond with the shortest stay in PACU compared to balanced anaesthesia with halothane and IVAs with propofol-fentanyl or propofol-remifentanil. One reason for this could be the intraoperatively administered opioide piritramide in IVAs. Furthermore we conclude that an AIMS may provide additional information about overall costs-effectiveness. However this information depends largely on local factors, e.g. patient case mix, staffing, policy of discharge from the PACU etc.

Adolescent↗
PubMed2000

Topical steroid treatment of allergic rhinitis decreases nasal fluid TH2 cytokines, eosinophils, eosinophil cationic protein, and IgE but has no significant effect on IFN-gamma, IL-1beta, TNF-alpha, or neutrophils.

BACKGROUND: Topical treatment with glucocorticoids (GCs) is known to decrease eosinophils but not neutrophils in patients with allergic rhinitis. OBJECTIVE: We sought to examine whether the differential effects of GC treatment on eosinophils and neutrophils are mirrored by differential effects on T(H)1/T(H)2 cytokines and the neutrophil-associated cytokines IL-1beta and TNF-alpha. METHODS: Differential counts of eosinophils and neutrophils in nasal fluids from 60 children with seasonal allergic rhinitis treated with a topical GC were examined after staining with May-Grünwald-Giemsa stain. Nasal fluid levels of IFN-gamma, IL-4, IL-6, IL-10, IL-1beta, and TNF-alpha were examined with ELISA, and IgE and eosinophil cationic protein (ECP) levels were examined with RIA. RESULTS: After GC treatment, there was a statistically significant decrease of the T(H)2 cytokines IL-4, IL-6, and IL-10, as well as ECP and IgE. By contrast, there were no significant changes of the levels of IFN-gamma, IL-1beta, TNF-alpha, or neutrophils. In the GC-treated patients IL-1beta and TNF-alpha levels correlated with neutrophils and ECP, and IL-1beta correlated with eosinophils. Furthermore, ECP correlated with both eosinophils and neutrophils. Neither IL-1beta nor TNF-alpha correlated with IgE. Patients with high neutrophil counts after GC treatment were found to have significantly higher eosinophil counts and ECP than patients with low counts. CONCLUSIONS: The beneficial effects of topical treatment with GC in patients with allergic rhinitis could be attributed to downregulation of T(H)2 cytokines, with an ensuing decrease of eosinophils, ECP, and IgE. It is possible that neutrophils could counteract the beneficial effects of GCs by releasing the proinflammatory cytokines IL-1beta and TNF-alpha.

Administration, Topical↗
PubMed2000

Loss of connectivity in Alzheimer's disease: an evaluation of white matter tract integrity with colour coded MR diffusion tensor imaging.

A novel MRI method--diffusion tensor imaging--was used to compare the integrity of several white matter fibre tracts in patients with probable Alzheimer's disease. Relative to normal controls, patients with probable Alzheimer's disease showed a highly significant reduction in the integrity of the association white matter fibre tracts, such as the splenium of the corpus callosum, superior longitudinal fasciculus, and cingulum. By contrast, pyramidal tract integrity seemed unchanged. This novel finding is consistent with the clinical presentation of probable Alzheimer's disease, in which global cognitive decline is a more prominent feature than motor disturbance.

Aged↗
PubMed2000

Dexamethasone does not significantly contribute to the response rate of docetaxel and estramustine in androgen independent prostate cancer.

PURPOSE: We evaluated the independent response rate of dexamethasone before docetaxel and estramustine administration as measured by changes in serum prostate specific antigen (PSA) in patients with androgen independent prostate cancer. MATERIALS AND METHODS: A total of 12 patients received 20 mg. dexamethasone orally every 6 hours for 3 doses repeated every 3 weeks before starting cytotoxic therapy with estramustine and docetaxel. After progression on dexamethasone 280 mg. estramustine orally 3 times daily on days 1 to 5 and 70 mg./m.2 docetaxel intravenously for 1 hour on day 2 were given. RESULTS: None of the patients initially treated with dexamethasone monotherapy (median 1 cycle, range 1 to 5) had a PSA decline of 50% or greater. Median PSA increase on monotherapy was 47% (range 0% to 22%). On estramustine and docetaxel therapy PSA decreased 50% or greater in 11 patients (92%, 95% confidence intervals [CI] 60 to 99) and 80% or greater in 7 (58%, 95% CI 29 to 84), and normalized in 5 (42%, 95% CI 16 to 71), with a median duration of response of 153 (range 42 to 371), 132 (range 84 to 287) and 84 (range 21 to 174) days, respectively. Median times to reach 50% and 80% decreases in baseline PSA were 21 (range 21 to 209) and 63 (range 21 to 138) days, respectively. In 9 patients (75%, 95% CI 43 to 93) PSA decreased at least 50% by week 9. Of 4 patients with bidimensionally measurable disease 3 had a partial response. Median time to progression was 263 days (range 91 to 378). CONCLUSIONS: Administration of 20. mg. dexamethasone orally every 6 hours for 3 doses every 3 weeks does not significantly contribute to the PSA response rate of estramustine and docetaxel.

Adenocarcinoma↗
PubMed2000

[From data entry to data presentation at a clinical workstation--experiences with Anesthesia Information Management Systems (AIMS)].

Anesthesia Information Management Systems (AIMS) are required to supply large amounts of data for various purposes such as performance recording, quality assurance, training, operating room management and research. It was our objective to establish an AIMS that enables every member of the department to independently access queries at his/her work station and at the same time allows the presentation of data in a suitable manner in order to increase the transfer of different information to the clinical workstation. Apple Macintosh Clients (Apple Computer, Inc. Cupertino, California) and the file- and database servers were installed into the already partially existing hospital network. The most important components installed on each computer are the anesthesia documenting software NarkoData (ProLogic GmbH, Erkrath), HIS client software and a HTML browser. More than 250 queries for easy evaluation were formulated with the software Voyant (Brossco Systems, Espoo, Finland). Together with the documentation they are the evaluation module of the AIMS. Today, more than 20,000 anesthesia procedures are recorded each year at 112 decentralised workstations with the AIMS. In 1998, 90.8% of the 20,383 performed anesthetic procedures were recorded online and 9.2% entered postopeatively into the system. With a corresponding user access it is possible to receive all available patient data at each single anesthesiological workstation via HIS (diagnoses, laboratory results) anytime. The available information includes previous anesthesia records, statistics and all data available from the hospitals intranet. This additional information is of great advantage in comparison to previous working conditions. The implementation of an AIMS allowed to greatly enhance the quota but also the quality of documentation and an increased flow of information at the anesthesia workstation. The circuit between data entry and the presentation and evaluation of data, statistics and results directly available at the clinical workstation was put into practice.

Anesthesia↗
PubMed2000

Design principles of a clinical information system for intensive care units (ICUData).

The aim of this project was to develop a cost-effective, standard-based and scalable clinical information system for use in Intensive Care Units (ICUs). The development started in 1998 at the University Giessen, Germany. Since its introduction as the basic documentation system at the ICU ward of the Department of Anesthesiology and Intensive Care Medicine in January 1999, all relevant clinical data of 1723 patients have been recorded. The implementation of the system in two further ICUs is scheduled for the year 2000. The following article describes some of the principal design goals of the system, including the medical vision that drove its interface design, and focuses on the technological underpinnings of the overall system architecture.

Computer Systems↗
PubMed2000

Comparison of manual and automated documentation of adverse events with an Anesthesia Information Management System (AIMS).

In this study, an Anesthesia Information Management System (AIMS) is used for the comparison of manually recorded adverse events with automatically detected events from anesthesiological procedures. In 1998, data from all anesthesia procedures, including the data set for quality assurance defined by the German Society of Anesthesiology and Intensive Care Medicine (DGAI), were recorded online with the documentation software NarkoData 4 (IMESO GmbH, Hüttenberg, Germany) followed by storage into a relational database (Oracle Corporation). The occurrence of manually recorded adverse events, as defined by the DGAI, is compared with automatically detected events. Automated detection was done with SQL-statements. The following adverse events were selected: hypotension, hypertension, bradycardia, tachycardia and hypovolemia. Data obtained from 16,019 electronic anesthesia records show that in 911 patients (5.7%), one of the selected adverse events was documented manually whereas in 2,996 patients (18.7%) a adverse event was detected automatically. The incidence of automatically detected events is obviously higher compared to manually recorded events. With the help of an AIMS, automatic detection proved significant deficiencies in the manual documentation of adverse events.

Anesthesia↗
PubMed2000

Data processing at the anesthesia workstation: from data entry to data presentation.

Main requirements for an Anesthesia Information Management System (AIMS) are the supply of additional information for the anesthesiologist at his workstation and complete documentation of the anesthetic procedure. With the implementation of an AIMS (NarkoData) and effective user support, the quality of documentation and the information flow at the anesthesia workstation could be increased. Today, more than 20,000 anesthesia procedures are annually recorded with the AIMS at 112 decentralized workstations. The network for data entry and the presentation and evaluation of data, statistics and results directly available at the clinical workstation was made operational.

Anesthesia↗