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1.
Medicine (Baltimore) ; 99(9): e19331, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118765

RESUMEN

BACKGROUND: Cricothyroidotomy is the final strategy in the "cannot intubate, cannot oxygenate" scenario, but half of needle cricothyroidotomy attempts result in failure. The most frequent complication in needle cricothyroidotomy is posterior tracheal wall injury. We hypothesized that needle length is related to posterior wall injury and compared needle cricothyroidotomy with a commercial kit to a modified shorter needle to evaluate success and posterior wall injury rates. METHODS: The commercial kit has a needle stopper to prevent posterior wall injury, with a penetrating length of 25 mm. We made long stopper to shorten the length by 5 mm (net 20 mm penetrating length). Residents were recruited, received a lecture about cricothyroidotomy and practiced needle cricothyroidotomy using the commercial kit on a simulator. They then performed cricothyroidotomy using the commercial kit or the shorter needle on an ex-vivo porcine larynx covered with artificial skin. An intra-tracheal endoscope recorded the procedure. The video was evaluated for success/failure or posterior wall injury by independent evaluators. Larynxes with a distance from the outer surface to the inner lumen exceeding 13 mm were excluded. The distance in each larynx was measured by dissection after the study. Success and posterior wall injury rates were analyzed using Fisher exact test (P < .05 was statistically significant). RESULTS: Forty-seven residents participated in the study. Data for two residents were excluded. There was no statistically significant difference in success rate between the commercial kit (100%, 45/45) and the shorter needle (91%, 41/45, P = .12). Failure was defined if the needle tip did not reach the lumen in four trials. Cannulated but complicated by posterior wall injury occurred in 33% (15/45) with the commercial kit and 5% (2/43) with the shorter needle (P < .01). CONCLUSION: During needle cricothyroidotomy, force is needed for the needle to penetrate the cricothyroid ligament. The advancing needle sometimes cannot be stopped after penetrating the cricothyroid ligament. These data suggest that needle length is associated with posterior wall injury.


Asunto(s)
Cartílago Cricoides/cirugía , Agujas/efectos adversos , Tráquea/lesiones , Animales , Estudios Cruzados , Modelos Animales de Enfermedad , Diseño de Equipo/métodos , Diseño de Equipo/normas , Agujas/tendencias , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/fisiopatología , Porcinos/lesiones , Enseñanza
2.
Medicine (Baltimore) ; 99(9): e19393, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118791

RESUMEN

BACKGROUND: Due to advances in technology and medical devices, intra-thoracic left ventricular assisted devices such as the fully magnetically levitated centrifugal-flow pump may now prolong the life of patients with advanced heart failure. However, several concerns have been raised about pump thrombosis and durability of the device. We aimed to systematically compare the two year outcomes of magnetic levitated centrifugal continuous flow circulatory pump versus the axial continuous flow pump for advanced heart failure. METHODS: Following the PRISMA guideline, online databases were searched for relevant trials based on centrifugal continuous flow circulatory pump and axial continuous flow pump in patients with advanced heart failure. The adverse clinical outcomes reported at 2 years follow-up were considered as the endpoints. This analysis was carried out by the RevMan 5.3 software whereby odds ratios (OR) and 95% confidence intervals (CI) were generated. RESULTS: A total number of 1011 patients with advanced heart failure was included. At 2 years, pump thrombosis was not significantly different between the two groups, with OR: 0.43, 95% CI: 0.06-3.29; P = .42. However, pump replacement was significantly higher with the axial continuous-flow pump with OR: 0.36, 95% CI: 0.15-0.84; P = .02. Stroke, sepsis and bleeding events were not significantly different. In addition, outcomes such as right heart failure, cardiac arrhythmia, the need for right ventricular assisted device, respiratory failure, renal failure and hepatic dysfunction were also not significantly different. CONCLUSIONS: At a follow-up time period of 2 years, pump replacement was significantly higher with the axial continuous-flow pump in comparison to the magnetic levitated centrifugal continuous flow circulatory pump. However, no significant difference was observed with the other adverse outcomes.


Asunto(s)
Diseño de Equipo/normas , Insuficiencia Cardíaca/cirugía , Corazón Auxiliar/normas , Resultado del Tratamiento , Insuficiencia Cardíaca/fisiopatología , Corazón Auxiliar/tendencias , Humanos , Oportunidad Relativa , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos
3.
PLoS One ; 15(1): e0227754, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31961909

RESUMEN

Aesthetic perception is a human instinct that is responsive to multimedia stimuli. Giving computers the ability to assess human sensory and perceptual experience of aesthetics is a well-recognized need for the intelligent design industry and multimedia intelligence study. In this work, we constructed a novel database for the aesthetic evaluation of design, using 2,918 images collected from the archives of two major design awards, and we also present a method of aesthetic evaluation that uses machine learning algorithms. Reviewers' ratings of the design works are set as the ground-truth annotations for the dataset. Furthermore, multiple image features are extracted and fused. The experimental results demonstrate the validity of the proposed approach. Primary screening using aesthetic computing can be an intelligent assistant for various design evaluations and can reduce misjudgment in art and design review due to visual aesthetic fatigue after a long period of viewing. The study of computational aesthetic evaluation can provide positive effect on the efficiency of design review, and it is of great significance to aesthetic recognition exploration and applications development.


Asunto(s)
Distinciones y Premios , Diseño de Equipo/normas , Estética , Procesamiento de Imagen Asistido por Computador/métodos , Aprendizaje Automático , Simulación por Computador , Conjuntos de Datos como Asunto , Humanos
4.
J Nurs Care Qual ; 35(1): 6-12, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31290776

RESUMEN

BACKGROUND: There was an increase in peripheral intravenous catheter (PIVC) complications and adverse patient events after product conversion during the merger between a rural hospital and a larger hospital system. A review of the existing literature identified a gap in evidence evaluating 2 closed PIVC systems compared with an open PIVC system. PURPOSE: The purpose of the current project was to ascertain whether open or closed PIVCs are best for patients, staff, and the health care system in terms of 3 main criteria: quality, safety, and cost. METHODS: A prospective, 2-site randomized controlled trial was used to compare outcomes. RESULTS: There were no differences in the complication rates between catheter types. There was a statistically significant increase in blood leakage and a decrease in clinician satisfaction with the open-system catheter. CONCLUSIONS: Our project supports current clinical recommendation that a closed PIVC system, regardless of type, is not only safer and cost-effective but also preferred by patients and clinicians.


Asunto(s)
Cateterismo Periférico/instrumentación , Catéteres de Permanencia/normas , Diseño de Equipo/normas , Evaluación de Resultado en la Atención de Salud/normas , Adulto , Anciano , Anciano de 80 o más Años , Cateterismo Periférico/métodos , Cateterismo Periférico/normas , Catéteres de Permanencia/efectos adversos , Catéteres de Permanencia/estadística & datos numéricos , Análisis Costo-Beneficio , Diseño de Equipo/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Estudios Prospectivos , Factores de Tiempo
5.
AAPS PharmSciTech ; 20(8): 329, 2019 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-31676991

RESUMEN

The objective of this study was to optimize the performance of a high-efficiency pediatric inhaler, referred to as the pediatric air-jet DPI, using computational fluid dynamics (CFD) simulations with supporting experimental analysis of aerosol formation. The pediatric air-jet DPI forms an internal flow pathway consisting of an inlet jet of high-speed air, capsule chamber containing a powder formulation, and outlet orifice. Instead of simulating full breakup of the powder bed to an aerosol in this complex flow system, which is computationally expensive, flow-field-based dispersion parameters were sought that correlated with experimentally determined aerosolization metrics. For the pediatric air-jet DPI configuration that was considered, mass median aerodynamic diameter (MMAD) directly correlated with input turbulent kinetic energy normalized by actuation pressure and flow kinetic energy. Emitted dose (ED) correlated best with input flow rate multiplied by the ratio of capillary diameters. Based on these dispersion parameters, an automated CFD process was used over multiple iterations of over 100 designs to identify optimal inlet and outlet capillary diameters, which affected system performance in complex and unexpected ways. Experimental verification of the optimized designs indicated an MMAD < 1.6 µm and an ED > 90% of loaded dose. While extrathoracic depositional loss will be determined in future studies, at an operating flow rate of 15 L/min, it is expected that pediatric mouth-throat or even nose-throat aerosol deposition fractions will be below 10% and potentially less than 5% representing a significant improvement in the delivery efficiency of dry powder pharmaceutical aerosols to children.


Asunto(s)
Sistemas de Liberación de Medicamentos/métodos , Inhaladores de Polvo Seco/métodos , Diseño de Equipo/métodos , Hidrodinámica , Administración por Inhalación , Aerosoles , Niño , Sistemas de Liberación de Medicamentos/normas , Inhaladores de Polvo Seco/normas , Diseño de Equipo/normas , Humanos , Tamaño de la Partícula , Polvos
6.
Nat Rev Urol ; 16(11): 675-689, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31548731

RESUMEN

Vaginal meshes used in the treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) have produced highly variable outcomes, causing life-changing complications in some patients while providing others with effective, minimally invasive treatments. The risk:benefit ratio when using vaginal meshes is a complex issue in which a combination of several factors, including the inherent incompatibility of the mesh material with some applications in pelvic reconstructive surgeries and the lack of appropriate regulatory approval processes at the time of the premarket clearance of these products, have contributed to the occurrence of complications caused by vaginal mesh. Surgical mesh used in hernia repair has evolved over many years, from metal implants to knitted polymer meshes that were adopted for use in the pelvic floor for treatment of POP and SUI. The evolution of the material and textile properties of the surgical mesh was guided by clinical feedback from hernia repair procedures, which were also being modified to obtain the best outcomes with use of the mesh. Current evidence shows how surgical mesh fails biomechanically when used in the pelvic floor and materials with improved performance can be developed using modern material processing and tissue engineering techniques.


Asunto(s)
Diseño de Equipo , Prolapso de Órgano Pélvico/cirugía , Polipropilenos , Mallas Quirúrgicas , Incontinencia Urinaria de Esfuerzo/cirugía , Diseño de Equipo/normas , Femenino , Humanos , Vagina
7.
J Pediatr Orthop B ; 28(6): 564-571, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31503104

RESUMEN

We investigated the impact of changes in bar length of Steenbeek foot abduction brace on foot and ankle range of motion in 150 children. The ankle dorsiflexion and foot abduction was measured without brace, with standard brace size (0) as depicted in Steenbeek manual and after variations in bar length (-2˝ to +2˝). The bar length (0) was also compared with shoulder width for Indian population. The Steenbeek foot abduction brace bar length in current use (11.53±1.2˝) was longer than shoulder size (8.14±1.18˝) with no true correlation. Steenbeek foot abduction brace usefulness was evident for foot abduction (46°) but not for dorsiflexion. The varied bar lengths tested did not significantly altered available dorsiflexion or abduction. The currently used Steenbeek foot abduction brace were larger than shoulder widths. The Steenbeek foot abduction brace was dynamic but required prefabrication for its effectiveness. The changes in bar length did not significantly alter foot dynamics occurring with brace.


Asunto(s)
Articulación del Tobillo/diagnóstico por imagen , Pie Equinovaro/diagnóstico por imagen , Diseño de Equipo/normas , Ortesis del Pié , Pie/diagnóstico por imagen , Rango del Movimiento Articular/fisiología , Tirantes/normas , Niño , Preescolar , Pie Equinovaro/terapia , Estudios Transversales , Femenino , Ortesis del Pié/normas , Humanos , Lactante , Masculino , Proyectos Piloto
8.
Ital J Pediatr ; 45(1): 97, 2019 Aug 07.
Artículo en Inglés | MEDLINE | ID: mdl-31391074

RESUMEN

OBJECTIVES: This article describes the detailed project aimed to realize a dedicated ground ambulance for neonatal emergency transport service (NETS). To date, the European Community rules specify requirements for the design, testing, performance, and equipping of road ambulance used for transport and care of adult injured or ill patients, completely ignoring neonatal transport. METHODS: The project consisted of electric and gas supply planning, interior design taking into account ergonomic and occupant protection principles, both during travel and during medical care performances. RESULTS: A detailed project is presented. Main differences between European Type C ambulance and the new proposed Type D neonatal ground ambulance are the presence on board of air compressed cylinder, iNO cylinders and delivery system, phototheraphy, shock adsorbing stretcher support, cooling device, patient's placenta (refrigeration box), and transcutaneous gas analyzer. CONCLUSION: The European Community rules specify requirements for road ambulance used for transport and care of adult injured or ill patients, completely ignoring neonatal transport. This study describes the detailed project aimed to realize a dedicated ground ambulance for neonatal emergency transport service. This study demonstrated that it is not possible simply to adapt the currently dedicated ambulance for mobile intensive care and resuscitation services (actual type C European Community) in a modern dedicated NETS ambulance; it is of paramount importance suggesting to European Community to introduce a further ambulance type, to be identified type D, strictly reserved to neonatal transport activities.


Asunto(s)
Ambulancias/normas , Diseño de Equipo/normas , Europa (Continente) , Humanos , Recién Nacido , Italia
9.
Artículo en Inglés | MEDLINE | ID: mdl-31416115

RESUMEN

The design of electronic cigarette (EC) atomizing units has evolved since their introduction over 10 years ago. The purpose of this study was to evaluate atomizer design in ECs sold between 2011-2017. Atomizers from 34 brands representing three generations of ECs were dissected and photographed using a stereoscopic microscope. Five distinct atomizer design categories were identified in first generation products (cig-a-like/cartomizer) and three categories were found in the third generation. Atomizers in most cig-a-like ECs contained a filament, thick wire, wire joints, air-tube, wick, sheath, and fibers, while some later models lacked some of these components. Over time design changes included an increase in atomizer size; removal of solder joints between wires; removal of Polyfil fibers; and removal of the microprocessor from Vuse. In second and third generation ECs, the reservoirs and batteries were larger, and the atomizing units generally lacked a thick wire, fibers, and sheath. These data contribute to an understanding of atomizer design and show that there is no single design for ECs, which are continually evolving. The design of the atomizer is particularly important as it affects the performance of ECs and what transfers into the aerosol.


Asunto(s)
Aerosoles/normas , Sistemas Electrónicos de Liberación de Nicotina/normas , Diseño de Equipo/normas , Diseño de Equipo/tendencias , Nebulizadores y Vaporizadores/normas , Nebulizadores y Vaporizadores/tendencias , Predicción
10.
Cancer Radiother ; 23(6-7): 625-629, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31447346

RESUMEN

Recent technological developments in linear accelerators (linacs) and their imaging systems have made it possible to routinely perform stereotactic radiotherapy (SRT) treatments. To ensure the security and quality of the treatments, national and international recommendations have been written. This review focuses on the recommendations of the report 91 of the International Commission on Radiation Units (ICRU) on stereotactic treatments with small photon beams and proposes to answer the question of the eligibility of the commercially available accelerators for the treatment of extra-cranial SRT (SBRT). The ICRU 91 report outlines important features needed to respect the constraints, which are high intensity photon beam, integrated image-guidance, high mechanical accuracy of the linac, multileaf collimator with reduced leaf width, bundled motion management and bundled 6 Dimensional "robotic" couch tabletop. Most of the contemporary linacs meet these recommendations, in particular, stereotactic dedicated linacs, or modern gantry-based linacs equipped with 3 dimensional cone-beam CT imaging and 2D-stereoscopic planar imaging. Commercially available ring-based linacs have some limitations: they offer only coplanar treatments, and couch movements are limited to translations and, some have limited imaging equipment and no ability to manage intrafraction motion. However, for performing SBRT, non-coplanar irradiations are not mandatory, contrarily to intracranial stereotactic irradiations. Furthermore, patients' rotations can be corrected, thanks to real-time adaptive radiotherapy available on MRI-linacs. Finally, significant improvements are expected in the short term to compensate the weaknesses of the current devices.


Asunto(s)
Adhesión a Directriz , Agencias Internacionales/normas , Neoplasias/radioterapia , Aceleradores de Partículas/normas , Radiocirugia/instrumentación , Diseño de Equipo/normas , Humanos , Inmovilización/instrumentación , Fotones/uso terapéutico , Garantía de la Calidad de Atención de Salud , Radiocirugia/métodos , Radiocirugia/normas , Radioterapia Guiada por Imagen/normas
11.
Nurs Child Young People ; 31(3): 38-46, 2019 May 09.
Artículo en Inglés | MEDLINE | ID: mdl-31468865

RESUMEN

Research and advances in technology have enabled children and young people with life-limiting conditions to live longer. To maintain their well-being and quality of life many of these children usually require some form of intravenous access for treatment. Children's nurses should have the skills and training to ensure they are competent to practise using totally implanted central venous access devices such as portacaths (ports). This article addresses the care and management of these ports in children and the wide variation in practice that exists in the UK, and makes recommendations for practice.


Asunto(s)
Dispositivos de Acceso Vascular/tendencias , Administración Intravenosa/instrumentación , Adolescente , Niño , Niños con Discapacidad/rehabilitación , Niños con Discapacidad/estadística & datos numéricos , Diseño de Equipo/normas , Humanos , Calidad de Vida/psicología , Reino Unido , Dispositivos de Acceso Vascular/efectos adversos
12.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(4): 307-309, 2019 Jul 30.
Artículo en Chino | MEDLINE | ID: mdl-31460729

RESUMEN

This capacitive venous transfusion alertor is based on rise time of RC circuit and input capture function of timer in the microcontroller. The measure element of alertor is integrated with circuit board, it has the advantages of simple structure and low cost. Combined with narrow band intent of things(NB-IoT) technology to upload data, it can reduce the workload of medical personnel and caregivers, avoid unnecessary trouble and danger.


Asunto(s)
Algoritmos , Transfusión Sanguínea , Sistemas Microelectromecánicos , Transfusión Sanguínea/instrumentación , Transfusión Sanguínea/normas , Diseño de Equipo/normas , Sistemas Microelectromecánicos/normas
13.
Medicina (Kaunas) ; 55(8)2019 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-31366186

RESUMEN

Background and objectives: Medical devices such as catheters are used on a large scale to treat heart and cardiovascular diseases. Unfortunately, they present some important drawbacks (structure failure, calcifications, infections, thrombosis, etc.), with the main side effects occurring due to adhesion and proliferation of bacteria and living cells on the surface of the implanted devices. The aim of this work is to modify the surface of polyvinyl chloride (PVC), an affordable biocompatible material, in order to reduce these aforementioned side effects. Materials and Methods: The surface of PVC was modified by depositing a thin layer also of PVC that incorporates an active substance, dicoumarol (a well-known anticoagulant), by spin coating process. The modified surfaces were analyzed by Fourier-transform infrared (FT-IR) microscopy, Fourier-transform infrared (FT-IR) spectroscopy, Ultraviolet-visible spectroscopy (UV-VIS), and Scanning electron microscopy (SEM) in order to determine the surface morphology and behavior. The samples were tested for Gram-positive (S. aureus ATCC 25923) and Gram-negative (P. aeruginosa ATCC 27853) standard strains from American Type Culture Collection (ATCC). Results: The material obtained had a smooth surface with a uniform distribution of dicoumarol, which is released depending on the deposition parameters. The concentration of dicoumarol at the surface of the material and also the release rate is important for the applications for which the surface modification was designed. PVC modified using the proposed method showed a good ability to prevent salt deposition and decreased the protein adhesion, and the resistance to bacterial adherence was improved compared with standard PVC.


Asunto(s)
Dicumarol/uso terapéutico , Cloruro de Polivinilo/efectos adversos , Materiales Biocompatibles , Catéteres/efectos adversos , Catéteres/microbiología , Catéteres/normas , Dicumarol/normas , Diseño de Equipo/métodos , Diseño de Equipo/normas , Humanos , Cloruro de Polivinilo/normas , Cloruro de Polivinilo/uso terapéutico
14.
BMJ ; 366: l4230, 2019 07 02.
Artículo en Inglés | MEDLINE | ID: mdl-31266745

RESUMEN

The studyFawsitt C, Thom H, Hunt L. Choice of prosthetic implant combinations in total hip replacement: cost-effectiveness analysis using UK and Swedish hip joint registries data. Value Health 2019;22:303-12.This study was funded by the NIHR Research for Patient Benefit Programme (project number PB-PG-0613-31032).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000771/a-traditional-hip-implant-is-as-effective-as-more-expensive-newer-types-for-older-people.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Diseño de Equipo , Prótesis de Cadera , Complicaciones Posoperatorias , Reoperación , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/métodos , Cerámica/uso terapéutico , Análisis Costo-Beneficio , Diseño de Equipo/métodos , Diseño de Equipo/normas , Femenino , Prótesis de Cadera/clasificación , Prótesis de Cadera/normas , Humanos , Masculino , Prótesis Articulares de Metal sobre Metal , Osteoartritis de la Cadera/cirugía , Polietileno/uso terapéutico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Falla de Prótesis/efectos adversos , Reoperación/métodos , Reoperación/estadística & datos numéricos , Reino Unido
15.
Work ; 63(3): 415-426, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31256108

RESUMEN

BACKGROUND: Non-automated tool handles transmit a large magnitude of vibration to operators' hands, causing discomfort and pain. Therefore, the need for a better handle design is a matter of prime concern to overcome musculoskeletal disorders such as hand-arm vibration syndrome. OBJECTIVE: This study aimed to examine the influence of handle shapes in reducing the transmission of hand-arm vibration. METHODS: Seven different handles were designed and fabricated using 3D printing technology at the SSN College of Engineering, with consideration for the anatomical shape of the hand. The frequency-weighted Root Mean Square (RMS) values of the vibration levels transmitted were recorded at the wrist of twelve subjects, unaffected by musculoskeletal disorders. Subjective ratings of vibration and comfort perception were measured using the Borg Scale of Perceived Exertion. RESULTS: The total vibration value (ahv) of each of the six novel prototype handles (B-G) was compared to that of the reference handle denoted handle-A. The vibration reductions for handles B to G respectively were 0.542 m/s2 (14.59%), 0.481 m/s2 (12.95%), 0.351 m/s2 (9.45%), 0.270 m/s2 (7.27%), 0.407 m/s2 (10.96%) and 0.192 m/s2 (5.17%). CONCLUSIONS: A significant level of vibration reduction was achieved by the prototype handles. Qualitative feedback from the study subjects suggests that they were not aware of the levels of vibration being transmitted to the hand with each handle.


Asunto(s)
Diseño de Equipo/normas , Síndrome por Vibración de la Mano y el Brazo/complicaciones , Dolor/clasificación , Adulto , Síndrome por Vibración de la Mano y el Brazo/psicología , Humanos , Masculino , Dolor/psicología
16.
Emerg Med J ; 36(8): 456-458, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31217181

RESUMEN

INTRODUCTION: Recent terror attacks and assassinations involving highly toxic chemical weapons have stressed the importance of sufficient respiratory protection of medical first responders and receivers. As full-face respirators cause perceptual-motor impairment, they not only impair vision but also significantly reduce speech intelligibility. The recent introduction of electronic voice projection units (VPUs), attached to a respirator, may improve communication while wearing personal respiratory protection. OBJECTIVE: To determine the influence of currently used respirators and VPUs on medical communication and speech intelligibility. METHODS: 37 trauma anaesthetists carried out an evaluation exercise of six different respirators and VPUs including one control. Participants had to listen to audio clips of a variety of sentences dealing with scenarios of emergency triage and medical history taking. RESULTS: In the questionnaire, operators stated that speech intelligibility of the Avon C50 respirator scored the highest (mean 3.9, ±SD 1.0) and that the Respirex Powered Respiratory Protective Suit (PRPS) NHS-suit scored lowest (1.6, 0.9). Regarding loudness the C50 plus the Avon VPU scored highest (4.1, 0.7), followed by the Draeger FPS-7000-com-plus (3.4, 1.0) and the Respirex PRPS NHS-suit scored lowest (2.3, 0.8). CONCLUSIONS: We found that the Avon C50 is the preferred model among the tested respirators. In our model, electronic voice projection modules improved loudness but not speech intelligibility. The Respirex PRPS NHS-suit was rated significantly less favourably in respect of medical communication and speech intelligibility.


Asunto(s)
Comunicación , Socorristas/estadística & datos numéricos , Diseño de Equipo/normas , Sustancias Peligrosas/efectos adversos , Ventiladores Mecánicos/efectos adversos , Diseño de Equipo/estadística & datos numéricos , Diseño de Equipo/tendencias , Humanos , Inteligibilidad del Habla , Encuestas y Cuestionarios , Evaluación de la Tecnología Biomédica/métodos , Evaluación de la Tecnología Biomédica/estadística & datos numéricos , Reino Unido , Ventiladores Mecánicos/estadística & datos numéricos , Ventiladores Mecánicos/tendencias , Calidad de la Voz
17.
Anaesthesia ; 74(11): 1406-1415, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31161650

RESUMEN

Modern mechanical ventilator technologies broadly consist of digitally-controlled electronic devices and analogue systems driven by compressed gas sources. Drawbacks such as high cost, complex maintenance and the need for cumbersome sources of compressed driving gas hinder adoption in pre-hospital and low-resource environments. We describe the evaluation and testing of a simple, low-cost alternative ventilator that uses a novel pressure-sensing approach and control algorithm. This is designed to provide portable positive-pressure mechanical ventilation at a reduced cost, while autonomously monitoring patient condition and important safety parameters. A prototype ventilator was constructed and evaluated using an anaesthetic test-lung as a patient surrogate. Using a modifiable test-lung and digital pressure sensor, we investigated ventilation pressure waveform circuit leak detection, and compliance and resistance change detection. During intermittent positive-pressure ventilation to the test-lung, the prototype system showed acceptable pressure waveform parameters: all simulated circuit leaks ≥ 6 mm2 in size were detected; compliance changes were detected between 10 ml.cmH2 O-1 , 20 ml.cmH2 O-1 and 50 ml.cmH2 O-1 ; and resistance changes were detected across the available simulated range. These results show this prototype technology has the potential to provide safe emergency ventilation without the use of any complex digital sensors or software while its construction and design enables significant reductions in cost and complexity. The study suggests further work is now justified in progressing the technology to clinical trials.


Asunto(s)
Diseño de Equipo/métodos , Respiración Artificial/instrumentación , Ventiladores Mecánicos/economía , Diseño de Equipo/economía , Diseño de Equipo/normas , Humanos , Respiración Artificial/economía , Ventiladores Mecánicos/normas
18.
J Tissue Viability ; 28(3): 125-132, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31174961

RESUMEN

AIM: Prolonged mechanical loading on soft tissues adjacent to bony prominences can lead to pressure ulcers. The presence of moisture at the skin interface will lower the tolerance to load. Absorbent pads manage moisture in individuals with incontinence, although their role in maintaining skin health is unknown. The present study investigated the effects of moist incontinence pads on skin physiology after periods of mechanical loading. MATERIAL AND METHODS: Twelve healthy participants were recruited to evaluate a single incontinence pad design under three moisture conditions: 0% (dry), 50% and 100% fluid capacity. For each pad condition, pressure (9 kPa) or pressure in combination with shear (3 N) was applied to the sacrum, followed by a period of off-loading. Measures included trans-epidermal water loss (TEWL) and inflammatory biomarkers sampled at the skin interface. RESULTS: Results revealed no change in TEWL in the loaded dry pad condition. By contrast, when the pads contained moisture, significant increases in TEWL were observed. These increases were reversed during off-loading. Inflammatory biomarkers, specifically IL-1α/total protein ratio, were up-regulated during dry pad loading, which recovered during off-loading. Loaded moist pads caused a significant increase in biomarkers, which remained elevated throughout the test period. CONCLUSION: The study revealed a marked compromise to stratum corneum integrity when the skin was exposed to moist incontinence pads in combination with mechanical loads. These physiological changes were largely reversed during off-loading. Incontinence pads provided some protection in the dry state, although more research is required to determine optimal clinical guidance for their use.


Asunto(s)
Humedad/efectos adversos , Pañales para la Incontinencia/normas , Piel/lesiones , Adulto , Biomarcadores/análisis , Biomarcadores/sangre , Inglaterra , Diseño de Equipo/normas , Femenino , Voluntarios Sanos/estadística & datos numéricos , Humanos , Humedad/prevención & control , Inflamación/sangre , Inflamación/diagnóstico , Interleucina-1alfa/análisis , Interleucina-1alfa/sangre , Masculino , Persona de Mediana Edad , Presión/efectos adversos , Úlcera por Presión/fisiopatología , Úlcera por Presión/prevención & control , Proteínas/análisis , Piel/irrigación sanguínea , Piel/fisiopatología , Cuidados de la Piel/métodos
19.
Artículo en Inglés | MEDLINE | ID: mdl-31234466

RESUMEN

European Directives 2002/44/EC and 2003/10/EC establish the exposure limit values for preventing operators' risks to vibration and noise transmitted by machines. Few studies studied noise and vibration of agricultural backpack powered machines (as mist blowers and blowers), but nobody critically studied them. This work analyzed the field back vibration, hand-arm vibration (HAV), and noise transmitted to ten operators by eight blowers and mist blowers. Unweighted and weighted vibration were analyzed, using the standards ISO 2631-1 (back), and ISO 5349-1 and ISO/TR 18570 (hand-arm system). The noise was evaluated by recording the acoustic pressure level at the operators' ears using the ISO 9612. With the ISO 2631-1, the vibration to the operators' back was low (0.38 ms-2), but the unweighted vibration measured along y and z-axes (not used by the ISO 2631-1) were high (>11 ms-2). HAV were also low when using the ISO 5349-1 (the highest value was 2.51 ms-2 in mist blowers), but high with the ISO/TR 18570 for the onset of vibration white finger (1446 ms-1.5 in blowers). Noise levels were always high: more than 100 dB(A), excluding the blower with the exhaust inside the blower hose. This last machine had noise levels lower than 86 dB(A), but its specific feature could increase environmental pollution.


Asunto(s)
Diseño de Equipo/normas , Ruido , Exposición Profesional/normas , Vibración , Agricultura/instrumentación , Unión Europea , Exposición Profesional/análisis
20.
Cardiovasc Intervent Radiol ; 42(8): 1168-1174, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31076839

RESUMEN

BACKGROUND AND PURPOSE: Precise stent deployment is important for successful treatment of intracranial aneurysms by stent-assisted coiling (SAC). We evaluated the accuracy of virtual stents generated using commercial stent planning software by comparing the length of virtual and actually deployed intracranial laser cut stents on three-dimensional digital subtraction angiography (3D-DSA) images. METHODS: We retrospectively analyzed the data of 75 consecutive cases of intracranial wide-necked aneurysms treated with the SAC technique using laser cut stents. Based on 3D-DSA images acquired by C-arm CT, stent sizing and placement were intraoperatively simulated by a commercial software application. The difference in length of the stents was estimated by measuring proximal discrepancies between the end points of the virtual and actually deployed stents on fused pre-procedural and post-procedural 3D-DSA images. Discrepancies between distal stent end points were manually minimized. The Kruskal-Wallis test was applied to test whether stent location, type, and length had an effect on difference in length between virtual and real stent. RESULTS: The median difference in length between virtual and real stents was 1.58 mm with interquartile range 1.12-2.12 mm. There was no evidence for an effect of stent location (p = 0.23), stent type (p = 0.33), or stent length (p = 0.53) on difference in length between virtual and real stents. CONCLUSIONS: Stent planning software allows 3D simulation of laser cut stents overlain on 3D-DSA images of vessels and may thus be useful for stent selection and deployment of laser cut stents during stent-assisted coiling of intracranial aneurysms.


Asunto(s)
Embolización Terapéutica/instrumentación , Diseño de Equipo/normas , Aneurisma Intracraneal/terapia , Stents/normas , Angiografía de Substracción Digital/métodos , Angiografía Cerebral/métodos , Angiografía por Tomografía Computarizada/métodos , Embolización Terapéutica/métodos , Femenino , Humanos , Imagenología Tridimensional/métodos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios Retrospectivos , Resultado del Tratamiento
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