Rapid development of a ventilator for use during the COVID-19 pandemic: Clinical, human factor & engineering considerations.

The arrival of the COVID-19 pandemic in early 2020 threatened to overwhelm the NH ability to provide sufficient critical care support to patients in the UK. In response to a rapid rise in cases in March 2020, the UK Government issued a call to industry to rapidly design and develop additional ventilators to expand the UK's capacity for mechanical ventilation. Three NHS consultants working in conjunction with TTP Plc (The Technology Partnership), were at the forefront, evolving the Government brief and developing a safe and effective ventilator, the CoVent™, in less than 5 weeks. The project demonstrates the ability of physicians to guide industry and pool knowledge and resources to rapidly develop and evolve technology in the face of a national emergency. This article discusses key aspects of the design process, highlights the unique human factors and engineering aspects of undertaking this amidst the coronavirus pandemic. Overall we demonstrated that when industry, healthcare and regulatory bodies collaborate and communicate efficiently, huge progress can be made in a fraction of the usual timescales.

Serum levels of 9α,11ß-PGF2 and apolipoprotein A1 achieve high predictive power as biomarkers of anaphylaxis.

Anaphylaxis is a life-threatening hypersensitivity reaction. To identify biomarkers for the condition, we assessed serum levels of apolipoprotein (Apo)A and ApoE. We found a reduction of both lipoproteins in anaphylactic mice as well as in orally challenged food allergic patients. We then compared patients after acute anaphylaxis with several control groups (nonallergic, history of allergen-triggered anaphylaxis, acute cardiovascular/febrile reactions). In this unpaired setting, ApoE levels were unaltered, while ApoA1 was reduced in the anaphylactic group. Although unable to discriminate between anaphylaxis and cardiovascular/febrile reactions, ROC curve analysis revealed a reasonably high area under the curve (AUC) of 0.91 for ApoA1. Serum 9α,11ß-PGF2 , recently identified as a suitable biomarker for anaphylaxis, outperformed ApoA1 with AUC=0.95. Intriguingly however its power further increased upon combination of both mediators reaching AUC=1. Our data suggest that ApoA1 combined with 9α,11ß-PGF2 represents a useful composite biomarker of anaphylaxis, achieving superior diagnostic power over either factor alone.

Head injuries in Leeds: changes in epidemiology and survival over 12 years.

OBJECTIVES: To map the pattern of survival and epidemiology of patients admitted to accident and emergency, at a regional neurosciences unit with an isolated head injury, over a 12 year period. METHODS: The TARN database of a regional neuroscience referral centre was analysed to identify patients who where admitted after a significant, isolated head injury between January 1990 and December 2001. Demographic data about the patient and nature and cause of the injury were extracted and survival was mapped over the time period. Statistical analysis was performed to identify change in survival. RESULTS: There were 810 eligible patients. The most common cause of injury was road traffic accident (47%) with an average of 42.6% patients transferred from other hospitals. The most common disposal of patients was to an intensive care unit (35%). There was an overall increase in the number of patients but survival did not increase over the time period. Mean survival was 81.8% and overall survival decreased from 95.0% in 1990 to 81.6% in 2001, although this did not represent significant change (p = 0.990). CONCLUSIONS: Short term survival after significant head injury has not changed significantly over the 12 year period studied. No subset of patients is having a disproportionate effect on survival but in patients aged over 75, survival increased significantly. Further multicentre work is indicated to map a more accurate clinical picture of head injury survival.

Effects of oral diazepam on intravenous access in same day surgery patients.

STUDY OBJECTIVE: To determine the effects of 5 mg oral diazepam on vein quality, patient anxiety, and intravenous (i.v.) access. DESIGN: Prospective, randomized, double-blind, placebo controlled study. SETTING: Preoperative holding area of a large university hospital. PATIENTS: 202 adult ASA physical status I, II, and III patients scheduled for elective outpatient surgery. INTERVENTIONS: Patients were randomized to receive either 5 mg oral diazepam or placebo, 30 minutes prior to i.v. access. MEASUREMENTS AND MAIN RESULTS: Vein quality and patient anxiety were assessed prior to, and 30 minutes following, premedication (just prior to venipuncture) using a 5 point ordinal scale and 10 cm visual analog scale, respectively. The number of attempts at venous access and the gauge of the catheter used were also recorded. Baseline patient anxiety was similar between the two groups and both showed a significant improvement in patient anxiety at 30 minutes following drug administration. The diazepam group, however, had a significantly greater reduction in anxiety scores (p < 0.05). There were no differences in baseline vein quality between the two groups; however, the quality of the vein was subjectively improved following diazepam administration. The mean number of attempts at i.v. access between the diazepam group (1.26 +/- 0.56) and the placebo group (1.32 +/- 0.65) was not significantly different. However, the ability to place larger gauge catheters was significantly enhanced in the diazepam group. CONCLUSIONS: The administration of 5 mg oral diazepam prior to the establishment of i.v. access improved vein quality and decreased patient anxiety. This technique may be a useful method for i.v. catheter placement, particularly when large gauge catheters are required, or when difficult i.v. access is anticipated.

Diabetes education project: community networking in rural Utah.

People in rural areas often lack the financial resources, workforce, and professional network needed to sustain a diabetes education pro gram in their own community. HealthInsight, a nonprofit organization that works to improve the quality of health care in its community, developed a 2-day seminar in an effort to facilitate the networking of rural health professionals who educate patients with diabetes and to help those educators better learn how to use existing resources. Participants included nurses, dietitians, diabetes educators, quality managers, and education directors from hospitals and home health agencies in both rural and metropolitan areas. Speakers presented information on a variety of topics related to program development, and a resource manual containing numerous materials was given to each participant. At the end of the seminar, the group turned in goals for their own programs. Too often, providers of health care compete rather than collaborate with one another. There is a great need for such networking opportunities among health care professionals working on common goals--especially in rural areas.

Comparison of flurbiprofen and acetaminophen with codeine in postoperative foot pain.

The purpose of this double-blind, randomized, parallel, multiple-dose study was to compare the efficacy and safety of flurbiprofen with acetaminophen with codeine phosphate in the 96-hr postoperative period following foot surgery. Analysis of mean pain intensity and mean pain relief for the patients not requiring rescue medication did not reveal any significant differences between treatment groups. There were also no significant differences between treatment groups with respect to patient and investigator global evaluations of therapy. The incidence of termination of the study because of side effects was higher for the acetaminophen with codeine group.

Five domains of interpersonal competence in peer relationships.

In three studies we investigated the utility of distinguishing among different domains of interpersonal competence in college students' peer relationships. In Study 1 we developed a questionnaire to assess five dimensions of competence: initiating relationships, self-disclosure, asserting displeasure with others' actions, providing emotional support, and managing interpersonal conflicts. Initial validation evidence was gathered. We found that self-perceptions of competence varied as a function of sex of subject, sex of interaction partner, and competence domain. In Study 2 we found moderate levels of agreement between ratings of competence by subjects and their roommates. Interpersonal competence scores were also related in predictable ways to subject and roommate reports of masculinity and femininity, social self-esteem, loneliness, and social desirability. In Study 3 we obtained ratings of subjects' competence from their close friends and new acquaintances. Relationship satisfaction among new acquaintances was predicted best by initiation competence, whereas satisfaction in friendships was most strongly related to emotional support competence. The findings provide strong evidence of the usefulness of distinguishing among domains of interpersonal competence.