How Does Triage by an Electronic Symptom Checker Match with Triage by a Nurse?

Omaolo© electronic symptom checkers (ESCs) have been developed to make triage for primary health care patients in Finland. Based on the analysis of the patient's responses to a set of questions, the ESC classifies him/her as emergent, urgent, not urgent, or advices on self-care. In this study the user answered the questions posed by the electronic symptom checker, after which a nurse assessed the urgency of the same user's symptom. The triage nurse was not allowed to know the result of the electronic symptom assessment until he or she had assessed the patient's condition. The level of triage was compared between ESC and nurse in each individual case. Findings from 825 individual cases were analyzed. The mean "exactly matched" for all symptom estimates was 52.6%. The mean "exactly matched" or "overconservative but suitable" for all symptom assessments was 66.6%. Safe assessments of electronic symptom checkers accounted for 98.6% of all assessments. A case was defined as "safe" if the recommendation for action given by the symptom assessment was at most one level less urgent than the nurse's triage assessment of the same case. The findings show that electronic symptom assessments are safe compared to the assessment of an experienced nurse.

Early intervention mechanism for preventing electrocution in construction engineering.

The aim of this study is to establish an effective early intervention mechanism for construction engineering to prevent electrocution while improving labor safety and reducing the casualty risk. This study used narrative text analysis and the Haddon Matrix for data collection, and analyzed the causes from the 113 electrocution deaths among in the construction industry, the exhaustive chi-square automatic interaction detector algorithm was employed the segmentation of the correlations. Based on the theory of inventive problem solving, through IDEF0 (ICAM DEFinition) for function modeling was designed the early intervention mechanism. This study revealed the operating features related to electric shock hazards. Early intervention was introduced to reduce the relevant risks and establish safety mechanisms. The first contribution of this study is the determination of hazard correlations between operating features and conductive media, and entry point for the prevention of electrocutions. The second contribution is the suggestion of the establishment of inspection stations for electric tools, thereby ensuring that the portable power tools are safe. The final contribution is the joint application of TRIZ (Teoriya Resheniya Izobreatatelskikh Zadatch) and IDEF0, which establishing the pre-entry testing, strengthening safety mechanisms.

Accuracy of Four Electronic Apex Locators During Root Canal Length Determination / Precisión de Cuatro Localizadores de Ápice en la Determinación de la Longitud de Trabajo

ABSTRACT: The apical limit of tooth roots for instrumentation and obturation is a controversial subject due to the high morphological complexity presented by the apical zone of the root. The development of electronic apex locators (EALs) has made working length (WL) determination more predictable, producing more accurate results; however, the interpretation mechanisms of different devices may affect measurements taken under different clinical conditions. One hundred premolars were used to compare the effectiveness of Propex II, Raypex 6, Propex Pixi and Root ZX II in locating the apical foramen (AF). No statistically significant differences were observed when the accuracy of measurement was compared between the different groups of EALs, however Root ZX II and Raypex 6 presented the best overall performance.

RESUMEN: El límite apical radicular para la instrumentación y obturación es un tema controversial, debido a la alta complejidad morfológica que presenta la zona apical de la raíz. El desarrollo de localizadores de ápice electrónicos (EALs) ha hecho la determinación de la longitud de trabajo (WL) más predecible y con resultados más precisos. Sin embargo, el mecanismo de interpretación de cada dispositivo puede afectar la determinación de las mediciones en diferentes condiciones clínicas. Cien premolares fueron utilizados para comparar la efectividad de Propex II, Raypex 6, Propex Pixi y Root ZX II en localizar el foramen apical (AF). No se observaron diferencias estadísticamente significativas cuando se comparó la precisión de medición entre los diferentes grupos de EALs, sin embargo, Root ZX II y Raypex 6 mostraron un mejor desempeño global.

Positive Impacts of Electronic hand-off systems designs on Nurses' communication effectiveness.

AIM: Different designs of electronic hand-off systems might have different levels of effectiveness; this study validated the effectiveness of systems with an Identify, Situation, Background, Assessment and Recommendation (ISBAR) design to one without such a design. BACKGROUND: Adverse consequences in hospital commonly occur when there are breakdowns in the transmission of information between team members. To ensure information accuracy and consistency, some Taiwan hospitals implemented electronic hand-off systems. However, the effectiveness of such systems was not investigated. METHODS: A quasi-experiment was conducted to the nurses of two Taiwan case hospitals, one with ISBAR and the other with non-ISBAR design systems and 200 questionnaires were used to collect data. RESULTS: The respondent rate was 72%. Using system with ISBAR design, nurses can enhance their communication effectiveness and further increase their individual benefits at hand-off. Using a non-ISBAR hand-off system, communication effectiveness depends solely on the nurses' individual cognitive and expressive ability. CONCLUSION: System with ISBAR design can ensure effective information transmission among nurses for care continuity and prevention of adverse events. IMPLICATIONS FOR NURSING MANAGEMENT: Ensuring the design of electronic systems is adequate, nursing managers can save nurses' time and effort while using the system to perform their regular work effectively and gain competitive advantage.

Construction and application of service quality evaluation system in the preclinical research on cardiovascular implant devices.

BACKGROUND: Services for the preclinical development and evaluation of cardiovascular implant devices (CVIDs) is a new industry. However, there is still no indicator system for quality evaluation. Our aim is to construct a service for quality evaluation system for the preclinical research and development of CVIDs based on Fuzzy Analytical Hierarchy Process (FAHP). METHODS: First, we reviewed the related literature to identify and select possible factors. Second, we developed an analytic hierarchy process framework. Third, we developed a questionnaire based on pairwise comparisons and invited 10 experienced specialists to rate these factors. We then used FAHP to compute the weights of these factors and prioritize them. Finally, to demonstrate the effectiveness of the proposed indicator system, a case study was performed as a practical example. RESULTS: Four main indicators (professionalism, functionality, stability and security) and 15 subindicators were selected to form the service evaluation system based on literature review and expert's proposals. According to the weight calculation data, the order of primary indicators by importance, is professionalism (0.6457), security (0.1193), functionality (0.0958) and stability (0.0596) in sequence. Top five secondary indices are personnel's technical ability, facility and equipment attractiveness, data auditability, confidentiality capability and professional service procedures. In the case study, FW's final actual effectiveness value was 0.9076, which is the same as the actual situation. CONCLUSION: The indicator system established in this study is comprehensive, reasonable, reliable and with strong practicality. It is worth popularizing and applying. The implementation of this evaluation system can provide measurable evidence for service demander and a way to improve service quality for suppliers.

Evaluation of the safety of users of active implantable medical devices (AIMD) in the working environment in terms of exposure to electromagnetic fields - Practical approach to the requirements of European Directive 2013/35/EU.

OBJECTIVES: Electromagnetic fields (EMF) may cause malfunctions in electronic devices, in particular in active implantable medical devices (AIMD), along with discomfort or health hazards to users. The use of AIMD by workers is increasing (especially cardiac pacemakers, implantable cardioverter defibrillators and wearable insulin infusion pumps). Electromagnetic fields may be much stronger in the working environment than applied in basic immunity tests of AIMD (based on EN 60601- 1-2:2015 and EN 50527-1:2016). European Directive 2013/35/EU regarding the safety of workers exposed to EMF considered the AIMD users to be "workers at particular risk" who need an individual evaluation of EMF hazards. The study aimed at evaluating the safety of users of AIMD in medical and industrial working environments exposed to EMF. MATERIAL AND METHODS: Near the common sources of strong EMF applied in medical and industrial use, the "standard safety distances" (SSD) for AIMD users were evaluated (i.e., distances from the EMF source, where exposure drops below limits from Recommendation 1999/519/EC and AIMD safety may be expected). The analysis is based on the results of measurements of magnetic and electric field strengths near 127 typical devices, in their normal use. RESULTS: The longest electric field related SSD was identified near dielectric sealers (up to 180 cm), and the longest magnetic field related SSD - near induction heaters (up to 450 cm). CONCLUSIONS: Electromagnetic fields related AIMD malfunctions need to be considered up to several meters from EMF sources. The "individual safety distance," that is sufficient to ensure the safety of a particular AIMD user may be significantly different (usually shorter) from the presented SSD, but needs to be considered in the context of detailed safety data from the AIMD manufacturer (if available). The labelling indicating the location of the area of a strong EMF increases safety of AIMD users in the work environment. Int J Occup Med Environ Health 2018;31(6):795-808.

Achieving reliable coincidence resolving time measurement of PET detectors using multichannel waveform digitizer based on DRS4 chip.

Coincidence resolving time (CRT) is one of the most important physical-performance measures for positron emission tomography (PET), as reconstruction with accurate time-of-flight information enhances the lesion detectability in patient studies. Accordingly, various PET detector designs and high-performance front-end readout circuits have been actively investigated to improve timing performance. The resulting PET detectors are often evaluated using multichannel waveform digitizers for versatile data analysis of the output signals. However, we have found that inappropriate data acquisition (DAQ) using a multichannel waveform digitizer based on the domino-ring-sampler 4 (DRS4) chip can lead to a considerable error when determining CRT. To address this issue, we performed CRT measurements using a pair of Hamamatsu R9800 photomultiplier tube based PET detectors. Then, considering intra- and inter-chip sampling, we employed four different combinations of input channels into the CAEN DT5742B waveform digitizer and obtained 2D CRT maps according to the leading-edge discriminator threshold for assessing each DAQ scheme. The intra-chip CRT measurement exhibited unusual streak patterns in the 2D CRT map and yielded the artificially-low CRT information in PET detector pairs, whereas the inter-chip CRT measurement provided the reliable estimation of timing resolution. Further, we could prevent the high-frequency signal crosstalk among input channels within the DRS4 chip using the inter-chip CRT measurement. We expect that our findings will also be useful for achieving the reliable CRT measurements when using other single-chip-based multichannel waveform digitizers.

Quality assurance of geometric accuracy based on an electronic portal imaging device and log data analysis for Dynamic WaveArc irradiation.

The purpose of this study was to develop a simple verification method for the routine quality assurance (QA) of Dynamic WaveArc (DWA) irradiation using electronic portal imaging device (EPID) images and log data analysis. First, an automatic calibration method utilizing the outermost multileaf collimator (MLC) slits was developed to correct the misalignment between the center of the EPID and the beam axis. Moreover, to verify the detection accuracy of the MLC position according to the EPID images, various positions of the MLC with intentional errors in the range 0.1-1 mm were assessed. Second, to validate the geometric accuracy during DWA irradiation, tests were designed in consideration of three indices. Test 1 evaluated the accuracy of the MLC position. Test 2 assessed dose output consistency with variable dose rate (160-400 MU/min), gantry speed (2.2-6°/s), and ring speed (0.5-2.7°/s). Test 3 validated dose output consistency with variable values of the above parameters plus MLC speed (1.6-4.2 cm/s). All tests were delivered to the EPID and compared with those obtained using a stationary radiation beam with a 0° gantry angle. Irradiation log data were recorded simultaneously. The 0.1-mm intentional error on the MLC position could be detected by the EPID, which is smaller than the EPID pixel size. In Test 1, the MLC slit widths agreed within 0.20 mm of their exposed values. The averaged root-mean-square error (RMSE) of the dose outputs was less than 0.8% in Test 2 and Test 3. Using log data analysis in Test 3, the RMSE between the planned and recorded data was 0.1 mm, 0.12°, and 0.07° for the MLC position, gantry angle, and ring angle, respectively. The proposed method is useful for routine QA of the accuracy of DWA.

Safety of Electro-Medical Equipment in Floods in Austere Environment.

Pakistan is prone to floods. In 2010, floods in North-Western Pakistan caused devastation in wide areas. Electro-medical equipment is very expensive and without proper equipment adequate surgery is not possible. We retrospectively analyzed how expensive electro-medical equipment got damaged during floods of 2010 at a district-level hospital in North-Western Pakistan and how we could have saved this equipment or reduced the damage to the minimum. The article provides the lessons learned and recommendations aimed to prevent or minimize damage to the valuable and expensive equipment in the areas prone to floods. (Disaster Med Public Health Preparedness. 2018;12:803-805).

The Recognizability and Localizability of Auditory Alarms: Setting Global Medical Device Standards.

Objective Four sets of eight audible alarms matching the functions specified in IEC 60601-1-8 were designed using known principles from auditory cognition with the intention that they would be more recognizable and localizable than those currently specified in the standard. Background The audible alarms associated with IEC 60601-1-8, a global medical device standard, are known to be difficult to learn and retain, and there have been many calls to update them. There are known principles of design and cognition that might form the basis of more readily recognizable alarms. There is also scope for improvement in the localizability of the existing alarms. Method Four alternative sets of alarms matched to the functions specified in IEC 60601-1-8 were tested for recognizability and localizability and compared with the alarms currently specified in the standard. Results With a single exception, all prototype sets of alarms outperformed the current IEC set on both recognizability and localizability. Within the prototype sets, auditory icons were the most easily recognized, but the other sets, using word rhythms and simple acoustic metaphors, were also more easily recognized than the current alarms. With the exception of one set, all prototype sets were also easier to localize. Conclusion Known auditory cognition and perception principles were successfully applied to an existing audible alarm problem. Application This work constitutes the first (benchmarking) phase of replacing the alarms currently specified in the standard. The design principles used for each set demonstrate the relative ease with which different alarm types can be recognized and localized.

Use of local noise power spectrum and wavelet analysis in quantitative image quality assurance for EPIDs.

PURPOSE: To investigate the use of local noise power spectrum (NPS) to characterize image noise and wavelet analysis to isolate defective pixels and inter-subpanel flat-fielding artifacts for quantitative quality assurance (QA) of electronic portal imaging devices (EPIDs). METHODS: A total of 93 image sets including custom-made bar-pattern images and open exposure images were collected from four iViewGT a-Si EPID systems over three years. Global quantitative metrics such as modulation transform function (MTF), NPS, and detective quantum efficiency (DQE) were computed for each image set. Local NPS was also calculated for individual subpanels by sampling region of interests within each subpanel of the EPID. The 1D NPS, obtained by radially averaging the 2D NPS, was fitted to a power-law function. The r-square value of the linear regression analysis was used as a singular metric to characterize the noise properties of individual subpanels of the EPID. The sensitivity of the local NPS was first compared with the global quantitative metrics using historical image sets. It was then compared with two commonly used commercial QA systems with images collected after applying two different EPID calibration methods (single-level gain and multilevel gain). To detect isolated defective pixels and inter-subpanel flat-fielding artifacts, Haar wavelet transform was applied on the images. RESULTS: Global quantitative metrics including MTF, NPS, and DQE showed little change over the period of data collection. On the contrary, a strong correlation between the local NPS (r-square values) and the variation of the EPID noise condition was observed. The local NPS analysis indicated image quality improvement with the r-square values increased from 0.80 ± 0.03 (before calibration) to 0.85 ± 0.03 (after single-level gain calibration) and to 0.96 ± 0.03 (after multilevel gain calibration), while the commercial QA systems failed to distinguish the image quality improvement between the two calibration methods. With wavelet analysis, defective pixels and inter-subpanel flat-fielding artifacts were clearly identified as spikes after thresholding the inversely transformed images. CONCLUSIONS: The proposed local NPS (r-square values) showed superior sensitivity to the noise level variations of individual subpanels compared with global quantitative metrics such as MTF, NPS, and DQE. Wavelet analysis was effective in detecting isolated defective pixels and inter-subpanel flat-fielding artifacts. The proposed methods are promising for the early detection of imaging artifacts of EPIDs.

Improved Active Harmonic Current Elimination Based on Voltage Detection.

With the increasing penetration of power electronic equipment in modern residential distribution systems, harmonics mitigation through the distributed generation (DG) interfacing converters has received significant attention. Among recently proposed methods, the so-called active resonance damper (ARD) and harmonic voltage compensator (HVC) based on voltage detection can effectively reduce the harmonic distortions in selected areas of distribution systems. However, it is found out that when traditional ARD algorithm is used to eliminate harmonic current injected by non-linear loads, its performance is constrained by stability problems and can at most eliminate half of the load harmonic currents. Thus, inspired by the duality between ARD and HVC, this paper presents a novel improved resistive active power filter (R-APF) algorithm based on integral-decoupling control. The design guideline for its parameters is then investigated through carefully analyzing the closed-loop poles' trajectory. Computer studies demonstrate that the proposed algorithm can effectively mitigate the load harmonic currents and its performance is much better than traditional ARD based on proportional control.

Adherence to hydroxyurea medication by children with sickle cell disease (SCD) using an electronic device: a feasibility study.

Adherence to hydroxyurea (HU) is a significant modifying factor in sickle cell vaso-occlusive pain. We conducted a study using an electronic medication container-monitor-reminder device (GlowCap™) to track adherence and determine whether use of this device affected rates of HU adherence. Subjects were regular attendees to our clinic. They were given a 37-item questionnaire and were asked to use a GlowCap containing HU. When the device cap is opened, it makes a remote "medication taken" record. The device also provides usage reminder in the form of lights and alarm sounds if the cap opening is delayed. Nineteen subjects participated in the survey, and 17 in the intervention phase. Of the 17, 12 had reliable adherence data. Seventeen caregivers of patients and two patients completed the survey. Two most common barriers to adherence identified were lack of reminders and absence of medicine home delivery. The intervention component of this study, which used both the electronic (GlowCap) method and medication possession ratio showed that the median adherence rate for the 12 patients evaluated was 85 %. The GlowCap device accurately kept a record of adherence rates. This device may be an effective tool for increasing HU medication adherence.

Radioterapia em paciente com neoplasia pulmonar e marcapasso ipsilateral / Radiotherapy in a patient with pulmonary neoplasia and ipsilateral pacemaker

Durante anos, o tratamento com radioterapia de portadores de dispositivos eletrônicos implantáveisfoi considerado perigoso. Se a zona a ser irradiada envolvesse o lado em que o dispositivo estivesse localizado, aestratégia envolvia inclusive mudanças no local do implante. Passaram-se os anos e tanto os dispositivos como aradioterapia evoluíram, e o que antes era regra para a segurança do binômio marcapasso-radioterapia hoje pode serexceção. Relatamos o caso de um paciente portador de neoplasia maligna de lobo superior de pulmão direito, emposição ipsilateral ao marcapasso implantado previamente...

For years treatment with radiotherapy in patients with implantable electronic devices was considered dangerous. If the area to be irradiated involved the side where the device was located, the strategy involved including changes at the implant site. The years have gone by, the devices have evolved, radiotherapy has evolved,and what used to be the safety rule for the pacemaker-radiotherapy binomial may be the exception today. We report the case of a patient with malignant neoplasia of the upper lobe of the right lung, ipsilateral to a previously implanted pacemaker...

Detecting Malposition of Coil Couple for Transcutaneous Energy Transmission.

Transcutaneous energy transmission technology based on coil coupling is widely required for various wireless powering implanted devices in human body. However, the coupling performance is commonly affected by malposition between coils in practice. It is difficult for users to know the actual position of the implanted receiver coil (RC) and how to realign the transmitter coil (TC) outside the body. This article proposes a detecting method of coil-coupling malposition based on a sensing board with coil array fitted on the TC. In this article, the sensing system and the data processing algorithm separating the sensing coil (SC) signals induced by TC and RC currents, respectively, are introduced. Then, an analytical model formulating the induction effect between the RC and SCs is given. Inverse computation algorithms of the malposition based on the processed sensing data and the induction effect model are presented at last. The proposed method is validated by experiments simulating malposition both in distance and concentricity on an actual coil couple. The results show that the sensing system can provide accurate parameterized guide for users to adjust the installation of the TC for good energy transmission performance.

Six Tips to Improve Your Lockout/Tagout Program.

A program that encourages communication can identify strengths and weaknesses much more efficiently than a program that remains static and unchanging after initial training.

[Interpretation of YY/T 0841-2011 Medical electrical equipment--recurrent test and test after repair of medical electrical equipment standard].

The paper introduces the background of YY/T 0841 standard, and interprets the main content of this standard. It is helpful to understand and applicate the standard.

Electronic apex locators may be better at determining endodontic working length than radiographs and could reduce patient radiation exposure.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Clinical efficacy of electronic apex locators: Systematic review. Martins JNR, Marques M, Mata A, Carames J.J Endod 2014;40(6):759-77. REVIEWER: Nicholas Chandler, BDS, MSc, PhD, LDSRCS, MRACDS (Endo), FDSRCPS, FDSRCSEd, FFDRCSI PURPOSE/QUESTION: The authors conducted a systematic review to compare radiographic and electronic methods of determining endodontic working length. SOURCE OF FUNDING: The authors reported no external funding sources. TYPE OF STUDY/DESIGN: Systematic review LEVEL OF EVIDENCE: Level 2: Limited-quality patient-oriented evidence STRENGTH OF THE RECOMMENDATION GRADE: Grade B: Limited-quality patient-oriented evidence.

The child and family experience of power mobility: a qualitative synthesis.

AIM: The aim of this study was to critically synthesize qualitative evidence regarding the child and family experience of power mobility, and to examine how this evidence fits with current theoretical concepts. METHOD: Electronic database/hand searches were undertaken in September 2012 and updated in February 2014. The searches were restricted to qualitative studies published in English before February 2014 that included at least one child under the age of 19 with a disability and described an outcome related to the use of power mobility. Inclusion criteria were set a priori. Two reviewers independently screened titles, abstracts, and full-text articles and extracted data. McMaster qualitative review forms were used for quality appraisal. RESULTS: Of 259 titles, 21 met inclusion criteria. From 143 codes, 15 second-order themes were developed using constant comparison and analysis. Three overarching themes emerged: power mobility experience promotes developmental change and independent mobility; power mobility enhances social relationships and engagement in meaningful life experiences; and power mobility access and use is influenced by factors in the physical, social, and attitudinal environment. INTERPRETATION: This qualitative research provides rich and rigorous evidence supporting the benefits of power mobility for children and families. Numerous factors, which warrant careful consideration, influence power mobility access and use.