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.

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.

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.

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.

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.

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.

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.

[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.

Does electronic monitoring influence adherence to medication? Randomized controlled trial of measurement reactivity.

BACKGROUND: Electronic monitoring is recommended for accurate measurement of medication adherence but a possible limitation is that it may influence adherence. PURPOSE: To test the reactive effect of electronic monitoring in a randomized controlled trial. METHODS: A total of 226 adults with type 2 diabetes and HbA1c ≥58 mmol/mol were randomized to receiving their main oral glucose lowering medication in electronic containers or standard packaging. The primary outcomes were self-reported adherence measured with the MARS (Medication Adherence Report Scale; range 5-25) and HbA1c at 8 weeks. RESULTS: Non-significantly higher adherence and lower HbA1c were observed in the electronic container group (differences in means, adjusting for baseline value: MARS, 0.4 [95 % CI -0.1 to 0.8, p = 0.11]; HbA1c (mmol/mol), -1.02 [-2.73 to 0.71, p = 0.25]). CONCLUSIONS: Electronic containers may lead to a small increase in adherence but this potential limitation is outweighed by their advantages. Our findings support electronic monitoring as the method of choice in research on medication adherence. (Trial registration Current Controlled Trials ISRCT N30522359).

Performance of single-use and multiuse diamond rotary cutting instruments with turbine and electric handpieces.

STATEMENT OF PROBLEM: As single-use rotary cutting instruments and electric handpieces become more available, the performance of these instruments with electric as compared to turbine handpieces requires evaluation. In addition, if rotary cutting instruments marketed as single-use instruments are used for multiple patients, the effects on their performance of cleaning, sterilization, and repeated use are of interest to the clinician. PURPOSE: The purpose of the study was to evaluate how the cleaning, autoclaving, and repeated use of single-use and multiuse rotary cutting instruments, with either a turbine or electric handpiece, affected their performance. MATERIAL AND METHODS: The effects on cutting performance of 2 handpieces (turbine and electric), 2 cleaning and sterilization conditions (cleaned and autoclaved versus noncleaned and nonautoclaved), and 6 different diamond rotary cutting instruments (4 single-use and 2 multiuse) during simulated tooth preparations were evaluated by using a 24-treatment condition full-factorial experimental design. A computer-controlled dedicated testing apparatus was used to simulate the cutting procedures, and machinable glass ceramic blocks were used as the cutting substrate for tangential cuts. In addition, for each treatment condition, 8 consecutive cuts, for a total of 192 cuts, were measured to assess the durability of the rotary cutting instruments. A linear mixed model was used to study the effect of instrument type, handpiece, cleaning, and sterilization, as well as the status and number of cuts on the outcome variables. The Tukey honestly significant difference test was used for the post hoc pairwise comparisons (α=.05). RESULTS: Performance, as measured by the rate of advancement, decreased with the repeated use of rotary cutting instruments (P<.001), while cleaning and sterilization procedures improved the average performance of the 8 cuts (P=.002). The electric handpiece showed a greater load than the turbine (P<.001) and a lower rate/load metric, but no differences in the rate of advancement. Significant differences were also detected among the different rotary cutting instruments tested with the Two Striper, which showed the highest cumulative performance of all groups. CONCLUSIONS: The repeated use of both single-use and multiuse rotary cutting instruments decreased cutting performance. The use of a cleaning and sterilization procedure between cuts improved the average cutting performance. During a tangential cutting process, although the ease of advancement (rate/load) was greater for the turbine, the electric handpiece did not produce a statistically different cutting rate.

Use of electronic apex locators may improve determination of working length.

DATA SOURCES: PubMed, LILACS, Science Direct, Cochrane Collaboration, NHS Evidence databases and in Evidence Based Dentistry and Journal of Evidence-Based Dental Practice. STUDY SELECTION: Randomised controlled trials (RCTs), clinical trials (CTs), diagnostic comparative studies and evaluation studies undertaken in adults where working length determination by both electronic and radiographic methods were used were considered. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently assessed study quality. RESULTS: Twenty-one studies were included, five RCTs and 16 in vivo diagnostic test studies. There was considerable heterogeneity between the EALs used and the study designs and a narrative summary of the findings were presented. Working length measurement was compared using three different methods: distance to the radiographic apex in teeth undergoing root canal treatment, (11 studies); concordance between the comparative measurements with EAL and radiography, (two studies); distance to specific anatomic apical reference points evaluated after tooth extraction (four studies)ded. The body of evidence was once again assessed as of low quality. CONCLUSIONS: Within the limitations of this review, it is suggested that working length determination by using EAL may perform better than radiography alone.

[State-of-the-art and prospects of high-tech medical aid to patients with cardiac arrhythmia based at military medical facilities].

Analysis of provision of high-tech medical aid to patients with cardiac arrhythmia based at military medical facilities showed that the available means and workforce are sufficient for the purpose. In order to facilitate access to high-tech medical aid it is necessary to equip arrhythmologic departments with up-to-date-instruments and set up cabinets of electrocardiostimulation in regional (naval) hospitals for implantation of temporary and permanent pacemakers. A program is pending for education (primary specialization) and advanced training of specialists in clinical cardiac electrophysiology, interventional and surgical arrhythmology.

Lockout/tagout accident investigation.

When I was in boot camp, our drill instructor told us that assume makes an ass out of u and me. It was true then, and it is true today. In this instance, assumptions came into play several times, both by the worker and by the companies involved. The good news is that it did not result in a fatality, but that does not relieve the pain and suffering that the employee had to endure. This same type of scenario is likely repeated at many job sites throughout the United States. Multiple contractors, dozens--maybe hundreds--of workers, power system equipment and devices; all of these have to be taken into consideration when performing maintenance activities. It can become a blur. People are people, and people make mistakes. That is why we have OSHA regulations, NFPA 70E, company procedures, policies, etc. Most if not all of us have either been involved in accidents or know people who have been. It's not like it's a secret that people make mistakes, but talk to some and they seem to think only others have that failing. Safety is not about just any one procedure or rule. It's about slowing down, making a plan, and executing that plan. There are plenty of tools available to help us: policies, procedures, codes, standards, federal regulations, and state and local laws. I am not about to say that the worker involved in this incident was not taking safety seriously, but he failed to follow some fundamental safety rules like test-before-touch. If he had taken just that one step, there would be nothing to write about.

[Reference the YY/T 0841-2011 standard to improve preventive maintenance of medical electrical equipment and experience].

In this paper, we interpret the new YY/T 0841-2011 standard and contrast the difference between it and GB9706.1-2007 standard. Then, we improved the current preventive maintenance work. After the improvement, we not only have more effective detection of the electrical safety performance of all kinds of medical electrical equipment, but also reduce the workload of clinical engineers, improve efficiency, and reduce the risk of electrical shock.

In vivo accuracy of three electronic root canal length measurement devices: Dentaport ZX, Raypex 5 and ProPex II.

AIM: To compare in vivo three different electronic root canal length measurement devices: Dentaport ZX, Raypex 5 and ProPex II. METHODOLOGY: Thirty single-rooted permanent teeth scheduled for extraction because of periodontal disease were selected from 10 adult patients (ranging from 45 to 67 years) and divided into three groups of 10 teeth. Before the extraction, an access cavity was prepared and the crown was adjusted to establish a stable reference point for all measurements. The working length in Group 1 was determined using the Dentaport ZX apex locator. A K-file with the largest diameter that could reach the last green bar on the screen was stabilized in the canal using a dual-curable flow resin composite. The same procedure was used for the Raypex 5 (the file reached the last yellow bar) and Propex II (0.0 orange bar) apex locators. The teeth were then extracted and cleared. The distance between the tip of the file and the major foramen was then calculated for each tooth using digital photography according to Axiovision AC software (Carl Zeiss). Positive values were assigned when the file tip passed beyond the major foramen, negative values when the tip was short of the foramen and zero value when the file tip and the foramen coincided. Statistical analysis was performed using the chi-squared test or Fisher's exact test (P ≤ 0.05). RESULTS: Dentaport ZX, Raypex 5 and ProPex ΙΙ produced, respectively, 6, 2 and 4 out of 10 correct measurements, 0, 6 and 5 long measurements and 4, 2, and 1 short measurements. The differences between the three electronic root canal length measurement devices were not significant (P = 0.507). CONCLUSIONS: Under the in vivo conditions of this study, the three electronic root canal length measurement devices were not significantly different in terms of locating the major foramen.

[Test for dangerous limits of capacitor energy].

For dangerous limits of capacitor energy, according to national standards of medical device regulations' test requirement, we analysis it and list its test methods and requirement. According to capacitor energy's formation and characteristics, we put forward a simple method for its test and calculation.

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.