The Experts below are selected from a list of 99765 Experts worldwide ranked by ideXlab platform
Franco Filipponi - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of a new software version of the FloTrac/Vigileo (version 3.02) and a comparison with previous data in cirrhotic patients undergoing liver Transplant Surgery.
Anesthesia and analgesia, 2011Co-Authors: Gianni Biancofiore, L A H Critchley, Xiaoxing Yang, L Bindi, Massimo Esposito, M Bisa, L Meacci, Roberto Mozzo, Anna Lee, Franco FilipponiAbstract:Reliable cardiac output monitoring is particularly useful in the cirrhotic patient undergoing liver Transplant Surgery, because cirrhosis of the liver is associated with a vasodilated and high output state, known as cirrhotic cardiomyopathy, that challenges the reliability of pulse contour cardiac output technology. The contractility of the ventricle in cirrhosis is impaired, which is tolerated even though the ejection fraction and cardiac output are elevated because of the low peripheral resistance. However, during Surgery the cirrhotic patient can decompensate because of the physiological changes and stress of Surgery. Recently, we showed that the FloTrac/Vigileo™ failed to perform in cirrhotic patients undergoing Transplant Surgery. In response, the company upgraded their software. Therefore, we have assessed the accuracy and reliability of this new third-generation (version 3.02) FloTrac/Vigileo algorithm software in the same setting. The cardiac index was measured simultaneously by single-bolus thermodilution (CI(TD)), using a pulmonary artery catheter, and pulse contour analysis, using the FloTrac/Vigileo (CI(V)). Readings were made at 10 time points during and after liver Transplant Surgery in 21 patients. Comparisons with data from our 2009 study, which used second-generation (version 01.10) software, were also made. Our new data show that version 3.02 software significantly reduced the adverse effect on pulse contour cardiac output reading bias in low peripheral resistance states, and thus improves the overall precision and trending ability of the system. Regression analysis between CI(TD) and CI(V) showed that the correlation was moderate (r =0.67, 95% confidence interval, 0.40 to 0.86). The Bland and Altman analysis showed that bias was 0.4 L.min(-1) · m(-2), and the percentage error was 52% (95% confidence interval, 49% to 55%). Trending ability of the new software also was improved but was still well below the current benchmarks. The new software (version 3.02) provided substantial improvements over the previous versions with better overall precision and trending ability. Further algorithm refinements will increase this technology's reliability to be extensively used in the highly complex setting of cirrhotic patients undergoing liver Transplantation.
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evaluation of a new software version of the flotrac vigileo version 3 02 and a comparison with previous data in cirrhotic patients undergoing liver Transplant Surgery
Anesthesia & Analgesia, 2011Co-Authors: Gianni Biancofiore, L A H Critchley, Xiaoxing Yang, L Bindi, Massimo Esposito, M Bisa, L Meacci, Roberto Mozzo, Franco FilipponiAbstract:BACKGROUND: Reliable cardiac output monitoring is particularly useful in the cirrhotic patient undergoing liver Transplant Surgery, because cirrhosis of the liver is associated with a vasodilated and high output state, known as cirrhotic cardiomyopathy, that challenges the reliability of pulse contour cardiac output technology. The contractility of the ventricle in cirrhosis is impaired, which is tolerated even though the ejection fraction and cardiac output are elevated because of the low peripheral resistance. However, during Surgery the cirrhotic patient can decompensate because of the physiological changes and stress of Surgery. Recently, we showed that the FloTrac/Vigileo™ failed to perform in cirrhotic patients undergoing Transplant Surgery. In response, the company upgraded their software. Therefore, we have assessed the accuracy and reliability of this new third-generation (version 3.02) FloTrac/Vigileo algorithm software in the same setting. METHODS: The cardiac index was measured simultaneously by single-bolus thermodilution (CI(TD)), using a pulmonary artery catheter, and pulse contour analysis, using the FloTrac/Vigileo (CI(V)). Readings were made at 10 time points during and after liver Transplant Surgery in 21 patients. Comparisons with data from our 2009 study, which used second-generation (version 01.10) software, were also made. RESULTS: Our new data show that version 3.02 software significantly reduced the adverse effect on pulse contour cardiac output reading bias in low peripheral resistance states, and thus improves the overall precision and trending ability of the system. Regression analysis between CI(TD) and CI(V) showed that the correlation was moderate (r =0.67, 95% confidence interval, 0.40 to 0.86). The Bland and Altman analysis showed that bias was 0.4 L.min(-1) · m(-2), and the percentage error was 52% (95% confidence interval, 49% to 55%). Trending ability of the new software also was improved but was still well below the current benchmarks. CONCLUSION: The new software (version 3.02) provided substantial improvements over the previous versions with better overall precision and trending ability. Further algorithm refinements will increase this technology's reliability to be extensively used in the highly complex setting of cirrhotic patients undergoing liver Transplantation.
Gianni Biancofiore - One of the best experts on this subject based on the ideXlab platform.
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haemodynamic monitoring during liver Transplant Surgery
2021Co-Authors: Annabel Blasi, Gianni Biancofiore, D A GreenAbstract:Haemodynamic monitoring (HM) is fundamental under anaesthesia for liver Transplantation (LT) given the previously described haemodynamic profiles of patients with end-stage liver disease or acute liver failure, potential rapid and significant blood loss, fluid shifts, vascular clamping and unclamping, the long anhepatic phase of LT, reperfusion syndrome, and primary liver nonfunction. Significant haemodynamic changes can affect graft reperfusion, myocardial performance, and the functions of all other organs. There is no standard for HM during LT. The fact that there is such a variety of options for HM shows that each has advantages and disadvantages in terms of accuracy, validity, and reproducibility. Although different mechanical, electronic, and optical systems provide HM data, the human brain must understand and interpret these data and use them to better understand haemodynamic changes (which are just part of a much more complex process) and the choice of treatment. Knowledge of the value of monitor-derived data and the most frequent complications during anaesthesia for LT specifically is essential in the decision-making process. In this chapter we present the most common HM used during LT, with a summary of recent knowledge on this topic.
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Evaluation of a new software version of the FloTrac/Vigileo (version 3.02) and a comparison with previous data in cirrhotic patients undergoing liver Transplant Surgery.
Anesthesia and analgesia, 2011Co-Authors: Gianni Biancofiore, L A H Critchley, Xiaoxing Yang, L Bindi, Massimo Esposito, M Bisa, L Meacci, Roberto Mozzo, Anna Lee, Franco FilipponiAbstract:Reliable cardiac output monitoring is particularly useful in the cirrhotic patient undergoing liver Transplant Surgery, because cirrhosis of the liver is associated with a vasodilated and high output state, known as cirrhotic cardiomyopathy, that challenges the reliability of pulse contour cardiac output technology. The contractility of the ventricle in cirrhosis is impaired, which is tolerated even though the ejection fraction and cardiac output are elevated because of the low peripheral resistance. However, during Surgery the cirrhotic patient can decompensate because of the physiological changes and stress of Surgery. Recently, we showed that the FloTrac/Vigileo™ failed to perform in cirrhotic patients undergoing Transplant Surgery. In response, the company upgraded their software. Therefore, we have assessed the accuracy and reliability of this new third-generation (version 3.02) FloTrac/Vigileo algorithm software in the same setting. The cardiac index was measured simultaneously by single-bolus thermodilution (CI(TD)), using a pulmonary artery catheter, and pulse contour analysis, using the FloTrac/Vigileo (CI(V)). Readings were made at 10 time points during and after liver Transplant Surgery in 21 patients. Comparisons with data from our 2009 study, which used second-generation (version 01.10) software, were also made. Our new data show that version 3.02 software significantly reduced the adverse effect on pulse contour cardiac output reading bias in low peripheral resistance states, and thus improves the overall precision and trending ability of the system. Regression analysis between CI(TD) and CI(V) showed that the correlation was moderate (r =0.67, 95% confidence interval, 0.40 to 0.86). The Bland and Altman analysis showed that bias was 0.4 L.min(-1) · m(-2), and the percentage error was 52% (95% confidence interval, 49% to 55%). Trending ability of the new software also was improved but was still well below the current benchmarks. The new software (version 3.02) provided substantial improvements over the previous versions with better overall precision and trending ability. Further algorithm refinements will increase this technology's reliability to be extensively used in the highly complex setting of cirrhotic patients undergoing liver Transplantation.
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evaluation of a new software version of the flotrac vigileo version 3 02 and a comparison with previous data in cirrhotic patients undergoing liver Transplant Surgery
Anesthesia & Analgesia, 2011Co-Authors: Gianni Biancofiore, L A H Critchley, Xiaoxing Yang, L Bindi, Massimo Esposito, M Bisa, L Meacci, Roberto Mozzo, Franco FilipponiAbstract:BACKGROUND: Reliable cardiac output monitoring is particularly useful in the cirrhotic patient undergoing liver Transplant Surgery, because cirrhosis of the liver is associated with a vasodilated and high output state, known as cirrhotic cardiomyopathy, that challenges the reliability of pulse contour cardiac output technology. The contractility of the ventricle in cirrhosis is impaired, which is tolerated even though the ejection fraction and cardiac output are elevated because of the low peripheral resistance. However, during Surgery the cirrhotic patient can decompensate because of the physiological changes and stress of Surgery. Recently, we showed that the FloTrac/Vigileo™ failed to perform in cirrhotic patients undergoing Transplant Surgery. In response, the company upgraded their software. Therefore, we have assessed the accuracy and reliability of this new third-generation (version 3.02) FloTrac/Vigileo algorithm software in the same setting. METHODS: The cardiac index was measured simultaneously by single-bolus thermodilution (CI(TD)), using a pulmonary artery catheter, and pulse contour analysis, using the FloTrac/Vigileo (CI(V)). Readings were made at 10 time points during and after liver Transplant Surgery in 21 patients. Comparisons with data from our 2009 study, which used second-generation (version 01.10) software, were also made. RESULTS: Our new data show that version 3.02 software significantly reduced the adverse effect on pulse contour cardiac output reading bias in low peripheral resistance states, and thus improves the overall precision and trending ability of the system. Regression analysis between CI(TD) and CI(V) showed that the correlation was moderate (r =0.67, 95% confidence interval, 0.40 to 0.86). The Bland and Altman analysis showed that bias was 0.4 L.min(-1) · m(-2), and the percentage error was 52% (95% confidence interval, 49% to 55%). Trending ability of the new software also was improved but was still well below the current benchmarks. CONCLUSION: The new software (version 3.02) provided substantial improvements over the previous versions with better overall precision and trending ability. Further algorithm refinements will increase this technology's reliability to be extensively used in the highly complex setting of cirrhotic patients undergoing liver Transplantation.
John C. Magee - One of the best experts on this subject based on the ideXlab platform.
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What defines a Transplant surgeon? A needs assessment for curricular development in Transplant Surgery fellowship training
American Journal of Transplantation, 2010Co-Authors: Jonathan P Fryer, Debra A. Darosa, E. Wang, L. Han, David A. Axelrod, Michael B. Ishitani, Talia Baker, Richard J. Knight, Randall S. Sung, John C. MageeAbstract:This study compares the perceptions of Transplant Surgery program directors (PDs) and recent fellowship graduates (RFs) regarding the adequacy of training and relevancy to practice of specific curricular content items in fellowship training. Surveys were sent to all American Society of Transplant Surgery approved fellowship PDs and all RFs in practice
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optimizing the surgical residents educational experience on Transplant Surgery
Journal of Surgical Education, 2009Co-Authors: Jonathan P Fryer, John C. MageeAbstract:Introduction Surgical specialties with high service demands like Transplant Surgery are challenged to provide good educational value for rotating surgical residents while maintaining quality patient care. Based on poor resident evaluations, the Resident Review Committee for Surgery (RRC-S) has proposed removing the requirement for Transplant Surgery rotations from general Surgery residency programs. Objectives The objectives of this article are to provide a situation analysis pertaining to the problem of poor resident evaluations from the perspective of the American Society of Transplant Surgeons (ASTS), and to propose an action plan to improve the current situation. Setting and Participants The Fellowship Training and Curriculum committees of the ASTS together with ASTS leadership and ASTS fellowship program directors collaborated to address these concerns by identifying key contributory factors and by initiating an action plan to correct them. Results The following 4 major issues pertaining to Transplant Surgery rotations were considered most relevant to the problem: (1) high service demands, (2) inadequate prioritization of resident education, (3) competition with fellows for educational opportunities, and (4) the need by many programs to send their residents to other centers to obtain Transplant experience. Based on these issues, the ASTS leadership issued directives to all programs with rotating residents to (1) designate a Transplant surgeon to resident education experience on Transplant; (2) create a service infrastructure that is not dependent on surgical residents; (3) re-educate faculty, fellows, support staff and residents regarding resident expectations on Transplant Surgery; (4) create a structured and sustainable educational experience; (5) increase resident involvement in surgical procedures; and (6) obtain ongoing feedback from rotating residents and the program directors. Conclusions Transplant Surgery can be a valuable educational experience for surgical residents. The ASTS is dedicated to collaborating with general Surgery residents and program directors in ongoing efforts to enhance this experience.
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Optimizing the Surgical Residents' Educational Experience on Transplant Surgery
Journal of surgical education, 2009Co-Authors: Jonathan P Fryer, John C. MageeAbstract:Surgical specialties with high service demands like Transplant Surgery are challenged to provide good educational value for rotating surgical residents while maintaining quality patient care. Based on poor resident evaluations, the Resident Review Committee for Surgery (RRC-S) has proposed removing the requirement for Transplant Surgery rotations from general Surgery residency programs. The objectives of this article are to provide a situation analysis pertaining to the problem of poor resident evaluations from the perspective of the American Society of Transplant Surgeons (ASTS), and to propose an action plan to improve the current situation. The Fellowship Training and Curriculum committees of the ASTS together with ASTS leadership and ASTS fellowship program directors collaborated to address these concerns by identifying key contributory factors and by initiating an action plan to correct them. The following 4 major issues pertaining to Transplant Surgery rotations were considered most relevant to the problem: (1) high service demands, (2) inadequate prioritization of resident education, (3) competition with fellows for educational opportunities, and (4) the need by many programs to send their residents to other centers to obtain Transplant experience. Based on these issues, the ASTS leadership issued directives to all programs with rotating residents to (1) designate a Transplant surgeon to resident education experience on Transplant; (2) create a service infrastructure that is not dependent on surgical residents; (3) re-educate faculty, fellows, support staff and residents regarding resident expectations on Transplant Surgery; (4) create a structured and sustainable educational experience; (5) increase resident involvement in surgical procedures; and (6) obtain ongoing feedback from rotating residents and the program directors. Transplant Surgery can be a valuable educational experience for surgical residents. The ASTS is dedicated to collaborating with general Surgery residents and program directors in ongoing efforts to enhance this experience.
Jin U Kang - One of the best experts on this subject based on the ideXlab platform.
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optical coherence tomography guided robotic device for autonomous needle insertion in cornea Transplant Surgery
Intelligent Robots and Systems, 2019Co-Authors: Shoujing Guo, Nicolas R Sarfaraz, William G Gensheimer, Axel Krieger, Jin U KangAbstract:This paper reports the design and evaluation of a novel robotic device for cornea Transplant Surgery. The device enables the OCT-sensor guided Big Bubble hydro-dissection approach for deep anterior lamellar keratoplasty (DALK) cornea Transplant Surgery. DALK is highly challenging because it requires precise placement of a needle into the stroma of the cornea down to Descemets Membrane (DM) and injects a fluid to separate the remaining stroma from Descemet’s membrane. Finally, the stroma is removed and replaced with the donor cornea graft. Compared to traditional penetrating keratoplasty (PK), which involves a full-thickness graft, this method significantly reduces the risk of rejection of the donor cornea by keeping the DM intact. A comparison of autonomous OCT guided needle insertions with expert manual needle insertions showed that the device significantly increased the precision and consistency of the needle placement, which could lead to better visual outcomes and fewer complications. In a study on cadaver porcine eyes, the measured insertion depth as a percentage of cornea thickness for the robotic device was 90.05% +/- 2.33% compared to 79.16% +/- 5.68% for manual insertions.
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IROS - Optical Coherence Tomography Guided Robotic Device for Autonomous Needle Insertion in Cornea Transplant Surgery
2019 IEEE RSJ International Conference on Intelligent Robots and Systems (IROS), 2019Co-Authors: Shoujing Guo, Nicolas R Sarfaraz, William G Gensheimer, Axel Krieger, Jin U KangAbstract:This paper reports the design and evaluation of a novel robotic device for cornea Transplant Surgery. The device enables the OCT-sensor guided Big Bubble hydro-dissection approach for deep anterior lamellar keratoplasty (DALK) cornea Transplant Surgery. DALK is highly challenging because it requires precise placement of a needle into the stroma of the cornea down to Descemets Membrane (DM) and injects a fluid to separate the remaining stroma from Descemet’s membrane. Finally, the stroma is removed and replaced with the donor cornea graft. Compared to traditional penetrating keratoplasty (PK), which involves a full-thickness graft, this method significantly reduces the risk of rejection of the donor cornea by keeping the DM intact. A comparison of autonomous OCT guided needle insertions with expert manual needle insertions showed that the device significantly increased the precision and consistency of the needle placement, which could lead to better visual outcomes and fewer complications. In a study on cadaver porcine eyes, the measured insertion depth as a percentage of cornea thickness for the robotic device was 90.05% +/- 2.33% compared to 79.16% +/- 5.68% for manual insertions.
M Bisa - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of a new software version of the FloTrac/Vigileo (version 3.02) and a comparison with previous data in cirrhotic patients undergoing liver Transplant Surgery.
Anesthesia and analgesia, 2011Co-Authors: Gianni Biancofiore, L A H Critchley, Xiaoxing Yang, L Bindi, Massimo Esposito, M Bisa, L Meacci, Roberto Mozzo, Anna Lee, Franco FilipponiAbstract:Reliable cardiac output monitoring is particularly useful in the cirrhotic patient undergoing liver Transplant Surgery, because cirrhosis of the liver is associated with a vasodilated and high output state, known as cirrhotic cardiomyopathy, that challenges the reliability of pulse contour cardiac output technology. The contractility of the ventricle in cirrhosis is impaired, which is tolerated even though the ejection fraction and cardiac output are elevated because of the low peripheral resistance. However, during Surgery the cirrhotic patient can decompensate because of the physiological changes and stress of Surgery. Recently, we showed that the FloTrac/Vigileo™ failed to perform in cirrhotic patients undergoing Transplant Surgery. In response, the company upgraded their software. Therefore, we have assessed the accuracy and reliability of this new third-generation (version 3.02) FloTrac/Vigileo algorithm software in the same setting. The cardiac index was measured simultaneously by single-bolus thermodilution (CI(TD)), using a pulmonary artery catheter, and pulse contour analysis, using the FloTrac/Vigileo (CI(V)). Readings were made at 10 time points during and after liver Transplant Surgery in 21 patients. Comparisons with data from our 2009 study, which used second-generation (version 01.10) software, were also made. Our new data show that version 3.02 software significantly reduced the adverse effect on pulse contour cardiac output reading bias in low peripheral resistance states, and thus improves the overall precision and trending ability of the system. Regression analysis between CI(TD) and CI(V) showed that the correlation was moderate (r =0.67, 95% confidence interval, 0.40 to 0.86). The Bland and Altman analysis showed that bias was 0.4 L.min(-1) · m(-2), and the percentage error was 52% (95% confidence interval, 49% to 55%). Trending ability of the new software also was improved but was still well below the current benchmarks. The new software (version 3.02) provided substantial improvements over the previous versions with better overall precision and trending ability. Further algorithm refinements will increase this technology's reliability to be extensively used in the highly complex setting of cirrhotic patients undergoing liver Transplantation.
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evaluation of a new software version of the flotrac vigileo version 3 02 and a comparison with previous data in cirrhotic patients undergoing liver Transplant Surgery
Anesthesia & Analgesia, 2011Co-Authors: Gianni Biancofiore, L A H Critchley, Xiaoxing Yang, L Bindi, Massimo Esposito, M Bisa, L Meacci, Roberto Mozzo, Franco FilipponiAbstract:BACKGROUND: Reliable cardiac output monitoring is particularly useful in the cirrhotic patient undergoing liver Transplant Surgery, because cirrhosis of the liver is associated with a vasodilated and high output state, known as cirrhotic cardiomyopathy, that challenges the reliability of pulse contour cardiac output technology. The contractility of the ventricle in cirrhosis is impaired, which is tolerated even though the ejection fraction and cardiac output are elevated because of the low peripheral resistance. However, during Surgery the cirrhotic patient can decompensate because of the physiological changes and stress of Surgery. Recently, we showed that the FloTrac/Vigileo™ failed to perform in cirrhotic patients undergoing Transplant Surgery. In response, the company upgraded their software. Therefore, we have assessed the accuracy and reliability of this new third-generation (version 3.02) FloTrac/Vigileo algorithm software in the same setting. METHODS: The cardiac index was measured simultaneously by single-bolus thermodilution (CI(TD)), using a pulmonary artery catheter, and pulse contour analysis, using the FloTrac/Vigileo (CI(V)). Readings were made at 10 time points during and after liver Transplant Surgery in 21 patients. Comparisons with data from our 2009 study, which used second-generation (version 01.10) software, were also made. RESULTS: Our new data show that version 3.02 software significantly reduced the adverse effect on pulse contour cardiac output reading bias in low peripheral resistance states, and thus improves the overall precision and trending ability of the system. Regression analysis between CI(TD) and CI(V) showed that the correlation was moderate (r =0.67, 95% confidence interval, 0.40 to 0.86). The Bland and Altman analysis showed that bias was 0.4 L.min(-1) · m(-2), and the percentage error was 52% (95% confidence interval, 49% to 55%). Trending ability of the new software also was improved but was still well below the current benchmarks. CONCLUSION: The new software (version 3.02) provided substantial improvements over the previous versions with better overall precision and trending ability. Further algorithm refinements will increase this technology's reliability to be extensively used in the highly complex setting of cirrhotic patients undergoing liver Transplantation.
