Search

Kenneth J Tomaszewski,1 Nicole Ferko,2 Sarah S Hollmann,2 Simona C Eng,3 Howard M Richard,4 Lynn Rowe,5 Susan Sproule6 1KJT Group, Inc., Honeoye Falls, NY, USA; 2Cornerstone Research Group, Inc., Burlington, ON, Canada; 3Department of Hospitalist/Inpatient Services, Peninsula Regional Medical Center, Salisbury, MD, USA; 4Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore, MD, USA; 5Department of Research, Florida Hospital, Maitland, FL, USA; 6Department of Diagnostic Imaging, Unity Hospital, Rochester, NY, USA Background: The Sherlock 3CG™ Tip Confirmation System (TCS) provides real-time peripherally inserted central catheter (PICC) tip insertion information using passive magnetic navigation and patient cardiac electrical activity. It is an alternative tip confirmation method to fluoroscopy or chest X-ray for PICC tip insertion confirmation in adults. The purpose of this study was to evaluate time and cost of the Sherlock 3CG TCS and blind insertion with chest X-ray tip confirmation (BI/CXR) for PICC insertions.Methods: A cross-sectional, observational Time and Motion study was conducted. Data were collected at four hospitals in the US. Two hospitals used Sherlock 3CG TCS and two hospitals used BI/CXR to place/confirm successful PICC tip location. Researchers observed PICC insertions, collecting data from the beginning (ie, PICC kit opening) to catheter tip confirmation (ie, released for intravenous [IV] therapy). An economic model was developed to project outcomes for a larger population.Results: A total of 120 subjects were enrolled, with 60 subjects enrolled in each arm and 30 enrolled at each of the four US hospitals. The mean time from initiation of the PICC procedure to the time to release for IV therapy was 33.93 minutes in the Sherlock 3CG arm and 176.32 minutes in the BI/CXR arm (p < 0.001). No malpositions were observed for PICC insertions using the Sherlock 3CG TCS, while 20% of subjects in the BI/CXR arm had a malposition. BI/CXR subjects had significantly more total malpositions (mean 0.23 vs. 0, p < 0.001). For a hypothetical population of 1,000 annual patients, adoption of Sherlock 3CG TCS was predicted to be cost saving compared with BI/CXR in all three analysis years.Conclusion: The results from this study demonstrate that Sherlock 3CG TCS, when compared with BI/CXR, is a superior alternative with regard to time to release subject to therapy, malposition rates, and minimization of X-ray exposure. Keywords: vascular access devices, catheters, catheterization, peripheral, X-ray therapy, cost analysis, Time and Motion studies

Dispersers are often assumed to have the mean phenotype observed across the entire metapopulation, despite growing evidence of dispersal--phenotype correlations. We examined three dispersal--phenotype correlations in Green Frogs (Rana clamitans Latreille, 1801 = Lithobates clamitans (Latreille, 1801)). Two were in traits that have been previously tied to fitness (body size and body condition), while a third (relative hindlimb length) has been linked to movement performance. We constructed a spatially dispersed array of experimental ponds in close proximity to source ponds known to support Green Frog breeding populations. Over the course of two breeding seasons (four sampling periods), we measured phenotypes of all Green Frogs that had colonized the experimental ponds and a sample of individuals from the source ponds. After only 1 month, a positive correlation was detected between dispersal and body size within the population of dispersers occupying the experimental ponds. After a 2nd month, this positive dispersal--body size correlation was also present when comparing the population of dispersers to the population of nondispersers remaining at the source ponds. Even if generated solely by plasticity, a positive correlation between dispersal and body size (a trait tightly linked to fitness) has the ability to alter metapopulation capacity and thus the probability of regional species persistence.Key words: body condition, body size, Green Frog, hindlimb length, metapopulation, Rana clamitans.Il est souvent tenu pour acquis que les individus qui se dispersent ont le phenotype moyen observe a l'echelle de toute la metapopulation, malgre l'accumulation de donnees indiquant des correlations entre dispersion et phenotype. Nous avons examine trois correlations entre dispersion et phenotype chez les grenouilles vertes (Rana clamitans Latreille, 1801 = Lithobates clamitans (Latreille, 1801)), dont deux portent sur des caracteres deja relies a l'aptitude (taille du corps et embonpoint), alors que la troisieme (longueur relative des membres posterieurs) a ete reliee a la performance de deplacement. Nous avons construit un reseau disperse dans l'espace d'etangs experimentaux situes tres pres d'etangs sources qui supportent des populations reproductrices de grenouilles vertes. Au cours de deux saisons de reproduction (quatre periodes d'echantillonnage), nous avons mesure les phenotypes de toutes les grenouilles vertes qui avaient colonise les etangs experimentaux et un echantillon d'individus des etangs sources. Apres un seul mois, une correlation positive etait decelee entre la dispersion et la taille du corps au sein de la population d'individus s'etant disperses dans les etangs experimentaux. Au bout d'un deuxieme mois, cette correlation positive entre la dispersion et la taille du corps etait aussi observee en comparant la population de specimens disperses a la population de specimens non disperses demeurant dans les etangs sources. Meme si elle n'etait le seul fait de la plasticite, une correlation positive entre la dispersion et la taille du corps (un caractere etroitement relie a l'aptitude) pourrait modifier la capacite de la metapopulation et ainsi la probabilite de persistance regionale de l'espece. [Traduit par la Redaction]Mots-cles: embonpoint, taille du corps, grenouille verte, longueur des membres posterieurs, metapopulation, Rana clamitans., IntroductionMany models in ecology and evolutionary biology assume that dispersal propensity is uncorrelated with other phenotypic characters (e.g., Hadfield 2016; Edelaar et al. 2017). However, a comprehensive review has shown [...]