Systematic review and meta-analysis of clinical trials: In-hospital use of sensors for prevention of falls.

BACKGROUND: Intra-hospital falls have become an important public health problem globally. The use of movement sensors with alarms has been studied as elements with predictive capacity for falls at hospital level. However, in spite of their use in some hospitals throughout the world, evidence is lacking about their effectiveness in reducing intra-hospital falls. Therefore, this study aims to develop a systematic review and meta-analysis of existing scientific literature exploring the impact of using sensors for fall prevention in hospitalized adults and the elderly population. METHODS: We explored literature based on clinical trials in Spanish, English, and Portuguese, assessing the impact of devices used for hospital fall prevention in adult and elderly populations. The search included databases such as IEEE Xplore, the Cochrane Library, Scopus, PubMed, MEDLINE, and Science Direct databases. The critical appraisal was performed independently by two researchers. Methodological quality was assessed based on the ratings of individual biases. We performed the sum of the results, generating an estimation of the grouped effect (Relative Risk, 95% CI) for the outcome first fall for each patient. We assessed heterogeneity and publication bias. The study followed PRISMA guidelines. RESULTS: Results were assessed in three randomized controlled clinical trials, including 29,691 patients. A total of 351 (3%) patients fell among 11,769 patients assigned to the intervention group, compared with 426 (2.4%) patients who fell among 17,922 patients assigned to the control group (general estimation RR 1.20, 95% CI 1.04, 1.37, P = .02, I2 = 0%; Moderate GRADE). CONCLUSION: Our results show an increase of 19% in falls among elderly patients who are users of sensors located in their bed, bed-chair, or chair among their hospitalizations. Other types of sensors such as wearable sensors can be explored as coadjutants for fall prevention care in hospitals.

Developing an emergency department crowding dashboard: A design science approach.

BACKGROUND: As an emergency department (ED) is a complex adaptive system, the analysis of continuously gathered data is valuable to gain insight in the real-time patient flow. To support the analysis and management of ED operations, relevant data should be provided in an intuitive way. AIM: Within this context, this paper outlines the development of a dashboard which provides real-time information regarding ED crowding. METHODS: The research project underlying this paper follows the principles of design science research, which involves the development and study of artifacts which aim to solve a generic problem. To determine the crowding indicators that are desired in the dashboard, a modified Delphi study is used. The dashboard is implemented using the open source Shinydashboard package in R. RESULTS: A dashboard is developed containing the desired crowding indicators, together with general patient flow characteristics. It is demonstrated using a dataset of a Flemish ED and fulfills the requirements which are defined a priori. CONCLUSIONS: The developed dashboard provides real-time information on ED crowding. This information enables ED staff to judge whether corrective actions are required in an effort to avoid the adverse effects of ED crowding.

Air-kerma evaluation at the maze entrance of HDR brachytherapy facilities.

In the absence of procedures for evaluating the design of brachytherapy (BT) facilities for radiation protection purposes, the methodology used for external beam radiotherapy facilities is often adapted. The purpose of this study is to adapt the NCRP 151 methodology for estimating the air-kerma rate at the door in BT facilities. Such methodology was checked against Monte Carlo (MC) techniques using the code Geant4. Five different facility designs were studied for (192)Ir and (60)Co HDR applications to account for several different bunker layouts.For the estimation of the lead thickness needed at the door, the use of transmission data for the real spectra at the door instead of the ones emitted by (192)Ir and (60)Co will reduce the lead thickness by a factor of five for (192)Ir and ten for (60)Co. This will significantly lighten the door and hence simplify construction and operating requirements for all bunkers.The adaptation proposed in this study to estimate the air-kerma rate at the door depends on the complexity of the maze: it provides good results for bunkers with a maze (i.e. similar to those used for linacs for which the NCRP 151 methodology was developed) but fails for less conventional designs. For those facilities, a specific Monte Carlo study is in order for reasons of safety and cost-effectiveness.

[The hybrid operating room: a cross between a catheterisation room and an operating room]. / De hybride operatiekamer: een kruising tussen een katheterisatiekamer en een operatiekamer.

A hybrid operating room is a space that meets all the stringent requirements of an operating room harbouring the facilities of an interventional radiology or cardiology room. This technical innovation facilitates complex endovascular and hybrid operations in a sterile environment. The high-end imaging technique with the ability to perform three-dimensional reconstructions will lead to improved quality of endovascular operations. Moreover, this technique enables physicians to explore and extend the boundaries not only of cardiovascular but also of navigated minimally invasive surgical techniques.

Adding additional grab bars as a possible strategy for safer hospital stays.

Patient room design should fulfill the safety needs of most patients. This article addresses the safety concerns related to grab bars and handrails (a United States-based review) and describes our proposed innovative approaches to promote safer hospital stays. The fixed augmentation of high-low grab bars and handrails can economically prevent inpatient falls in the areas commonly used by patients (e.g., patient rooms, patients' bathrooms, and hallways). The optimum grab bar and handrail configurations require further research. Revisions to guidelines for health care facilities related to grab bars and handrails should allow a range that respond to age- and disability-specific needs.

Planning a cardiovascular hybrid operating room: the technical point of view.

INTRODUCTION: The integration of interventional techniques into cardiovascular surgery requires angiographic imaging capabilities in the operating room. A deep understanding of the technology and its implication for the surgical workflow is scarce. METHODS AND RESULTS: Before planning a hybrid operating room, a clear vision for the utilization should be established. Commonly, the theaters are in interdisciplinary usage by interventionalists, anesthesiologists, and surgeons of various disciplines. The multitude of requirements determines necessary resources -- location, space, and imaging equipment. Besides fluoroscopy, intraoperative 3D imaging with the angiography system and its combination with fluoroscopy evolves as a very important imaging modality enabling the surgeon to navigate in 3D anatomy. CONCLUSION: With the growing trend toward endovascular procedures during surgery, the hybrid operating room will become an integral part of every cardiovascular center. This new operating room concept enables new cardiac surgery therapies and will play a vital role for minimally invasive surgery. Careful planning and professional expertise is a key factor for every hybrid room project.

Los orígenes del Lazareto pabellonario. La arquitectura cuarentenaria en el cambio del setecientos al ochocientos / The origins of the pavilion Lazaretto. Quarantine architecture between the 18th and 19th centuries

El modelo de lazareto pabellonario se configuró a partir de las bases científicas establecidas durante el proceso de reforma hospitalaria acaecido en Francia en el último tercio del setecientos. La adopción de soluciones que dieran forma a la nueva tipología cuarentenaria no vino dada precisamente por el ejemplo prestado por los nuevos tipos de hospital resultantes de este debate sino por el de otras instalaciones de cuarentena y, en general, de encierro, ya existentes. En este artículo se analizarán todos los factores que influyeron en la configuración de este modelo de lazaretos (AU)

The model of pavilion lazaretto was built abovethe scientific basis established during the hospital reform process held in France on the lasts decades of Eighteenth Century. Themorphological solutions adopted for the new quarantine taxonomy has not been given by the example borrowed by the new typology of hospital as resulted in this discussion, but by existing quarantine and detention facilities in general. In this paper we will analyse all factors that have influenced in the configuration of this model of lazarettos (AU)

Radiation shielding for gamma stereotactic radiosurgery units.

Shielding calculations for gamma stereotactic radiosurgery units are complicated by the fact that the radiation is highly anisotropic. Shielding design for these devices is unique. Although manufacturers will answer questions about the data that they provide for shielding evaluation, they will not perform calculations for customers. More than 237 such units are now installed in centers worldwide. Centers installing a gamma radiosurgery unit find themselves in the position of having to either invent or reinvent a method for performing shielding design. This paper introduces a rigorous and conservative method for barrier design for gamma stereotactic radiosurgery treatment rooms. This method should be useful to centers planning either to install a new unit or to replace an existing unit. The method described here is consistent with the principles outlined in Report No. 151 from the U.S. National Council on Radiation Protection and Measurements. In as little as 1 hour, a simple electronic spreadsheet can be set up, which will provide radiation levels on planes parallel to the barriers and 0.3 m outside the barriers.

Minimizing entrance door thickness for direct-entry radiotherapy rooms.

When medical linear accelerator rooms are constructed without entrance mazes, the entrance doors can be as thick as 50 cm, weigh 10,000 kg, and cost 50-60 thousand dollars. We describe a method of room design in which the therapy unit is positioned 180 degrees from the usual orientation. A short stub wall that attenuates the leakage component of the secondary radiation protects the door. Using this approach, the door can be reduced to approximately half the usual thickness with a significant impact on cost. For these motor-driven doors, there are also long-term benefits related to maintenance of the operating hardware.

Adjoint acceleration of Monte Carlo simulations using TORT/MCNP coupling approach: a case study on the shielding improvement for the cyclotron room of the Buddhist Tzu Chi General Hospital.

Full-scale Monte Carlo simulations of the cyclotron room of the Buddhist Tzu Chi General Hospital were carried out to improve the original inadequate maze design. Variance reduction techniques are indispensable in this study to facilitate the simulations for testing a variety of configurations of shielding modification. The TORT/MCNP manual coupling approach based on the Consistent Adjoint Driven Importance Sampling (CADIS) methodology has been used throughout this study. The CADIS utilises the source and transport biasing in a consistent manner. With this method, the computational efficiency was increased significantly by more than two orders of magnitude and the statistical convergence was also improved compared to the unbiased Monte Carlo run. This paper describes the shielding problem encountered, the procedure for coupling the TORT and MCNP codes to accelerate the calculations and the calculation results for the original and improved shielding designs. In order to verify the calculation results and seek additional accelerations, sensitivity studies on the space-dependent and energy-dependent parameters were also conducted.

Design with dignity.

Adapting facilities to accomodate obese patients calls for thoughtful design that allows for comfort flexibility and safety--and, above all, is respectful to the individual.

Ergonomics: requirements for adjusting the height of laparoscopic operating tables.

BACKGROUND AND OBJECTIVES: In the last few years many new instruments and devices have been developed and introduced into the operating room (OR). A debate has been ongoing about the optimal ergonomic posture for the operating staff. From practical experience, we have learned that the operating tables cannot be adjusted adequately to allow surgeons of different stature to maintain a comfortable posture. The goal of this study was to establish the most ergonomic table height for the particular physique of the surgeon and the different types of laparoscopic instrument handles that he or she uses. METHODS: In a simulated model, two probands of different stature (50th [BS 50] and 95th [BS 95] percentile) used laparoscopic instruments with four different handle designs (shank, pistol, axial, and rod). The instruments were inserted into a board in three different angles ([IA] = 20 degrees, 30 degrees, 40 degrees). Additionally the elbow angles (EA) of the volunteers were fixed to either 90 degrees or 120 degrees. For every variable (size of surgeon and his or her elbow angle, design of handle, insertion angle of the instrument) the height of the board, as a parameter for the level of the abdominal wall of a patient with pneumoperitioneum, was measured from the floor. RESULTS: All parameters had an effect on the optimal operating table height. The lowest required operating table level was 30 cm, the highest was 60.5 cm. In laparoscopic surgery-long shafted instruments and patients with pneumoperitoneum-the tabletops are too high for over 95% of all surgeons. As skin incision and wound suture are performed the conventional way, the operating tabletop must be adjustable up to the common height of 122 cm. The maximal difference between the optimal heights of the OR-table for one volunteer using two different handles with different insertion angles of the instruments (BS 95, EA 90 degrees, IA 20 degrees, rod handle to BS 50, EA 120 degrees, IA 40 degrees, axial handle) was about 27 cm. CONCLUSION: New operating tables with a much lower adjustability are necessary to fulfill ergonomic requirements. The use of differently designed handles can hinder the ergonomic posture of the surgeon, because each handle requires a different working height.

Ergonomic surgeon's chair for use during minimally invasive surgery.

The characteristic working situation in laparoscopic surgery involves elongated instruments and limited mobility of the surgeon during the operation. These circumstances require new technical solutions to enhance the surgeon's comfort. In other surgical fields with special ergonomic situations, such as microsurgery, some surgeons prefer to operate from a seated position at the operating room table. We developed a new surgeon's chair dedicated to the ergonomic and functional requirements of laparoscopic surgery. The chair allows the surgeon to maintain a semi-standing position during the operation. Foot pedals for high frequency and suction/irrigation are integrated into the base of the chair. The pedals are purposely aligned to be comparable to foot pedals in a car. The chair is driven by electromotors, controlled with a special foot switch that operates independent of assisting personnel during surgery. Initial clinical testing of the chair could prove the theory that supporting the surgeon with a cockpit type of operating room chair helps to avoid fatigue during long endoscopic procedures. Such assistance is especially important in combination with robotic devices for use during solo surgery.

Protocolo de acuerdo para la elaboración de un proyecto de un centro hospitalario en la Ciudad de Buenos Aires

Protocolo firmado entre el Gobierno de la Ciudad de Buenos Aires y la Corporación Médica Canadiense para evaluar la factibilidad de eregir el Centro Hospitalario Norte, en esa zona de la ciudad. El proyecto incluía una fase de estudio, una segunda de recomendaciones, y la realización del contenido del informe

Protocolo de acuerdo para la elaboración de un proyecto de un centro hospitalario en la Ciudad de Buenos Aires

Protocolo firmado entre el Gobierno de la Ciudad de Buenos Aires y la Corporación Médica Canadiense para evaluar la factibilidad de eregir el Centro Hospitalario Norte, en esa zona de la ciudad. El proyecto incluía una fase de estudio, una segunda de recomendaciones, y la realización del contenido del informe

Utilización de la energía solar en el Hospital Queen Elizabeth, en Bridgetown, Barbados / Use of solar energy at the Queen Elizabeth Hospital in Bridgetown, Barbados

En los meses de febrero y marzo de 1981 se estudió si la energía solar podría servir eficazmente al Hospital Quenn Elizabeth, de Brigetown, Barbados. El estudio indicó que un sistema de energía solar destinado a calentar el agua para uso doméstico podría ser efectivo en relación con el costo y se recomendó que el hospital pusiera en práctica los planes pertinentes para instalar un sistema limitado de energía solar de este tipo (AU)

Utilizacion de la energia solar en el Hospital Queen Elizabeth, en Bridgetown, Barbados. / Use of solar energy at the Queen Elizabeth Hospital in Bridgetown, Barbados

En los meses de febrero y marzo de 1981 se estudio si la energia solar podria servir eficazmente al hospital Queen Elizabeth de Bridgetown, Barbados.El estudio indico que un sistema de energia solar destinado a calentar el agua para uso domestico podria ser efectivo en relacion con el costo y se recomendo que el hospital pusiera en practica los planes pertinentes para instalar un sistema limitado de energia solar de este tipo