Virtual implantation of Derivo Embolization Devices using PreSize Neurovascular software: Accuracy evaluation and size selection comparison study.

BACKGROUND: Evaluating the deployed length of flow diverting stents (FDs) to select the optimal device size remains a challenging, yet crucial, task in aneurysm treatment. This study reports on the accuracy of PreSize Neurovascular (Oxford Heartbeat Ltd), a visualization and simulation software for FD intervention planning, in predicting FD deployed length, and on its impact on device size selection. METHODS: Imaging data from consecutive patients treated with Derivo Embolization Device (Acandis GmbH) were collected from University Medical Center Hamburg-Eppendorf and retrospectively analyzed. Accuracy evaluation: prediction accuracy was calculated by comparing deployed FD lengths measured from imaging data and simulated by PreSize. Size selection comparison: two Interventional Neuroradiologists (INR1, INR2), blinded to the devices deployed, used PreSize to select the optimal device size (diameter and length). Their choices were compared against the deployed devices selected by conventional planning. RESULTS: Among 98 implanted devices, PreSize predicted deployed FD length with a mean accuracy of 94.54% (95% confidence interval [93.72%, 95.35%]). Among 98 aneurysm cases, PreSize-informed device lengths were significantly shorter (Wilcoxon signed-rank test, INR1: W = 394, P < .001, INR2: W = 305, P < .001) by 4.13 and 4.18 mm on average, and up to 20 and 25 mm, for INR1 and INR2, respectively, than the conventionally selected FDs. In 32% of cases, PreSize-informed devices resulted in fewer vessel bends covered by the FD while achieving sufficient aneurysm coverage. CONCLUSIONS: PreSize retrospectively predicted deployed FD lengths with high accuracy. Moreover, INRs in this study were more inclined to select shorter stent length in the simulation than they would have done conventionally.

A Comprehensive Overview of IoT-Based Federated Learning: Focusing on Client Selection Methods.

The integration of the Internet of Things (IoT) with machine learning (ML) is revolutionizing how services and applications impact our daily lives. In traditional ML methods, data are collected and processed centrally. However, modern IoT networks face challenges in implementing this approach due to their vast amount of data and privacy concerns. To overcome these issues, federated learning (FL) has emerged as a solution. FL allows ML methods to achieve collaborative training by transferring model parameters instead of client data. One of the significant challenges of federated learning is that IoT devices as clients usually have different computation and communication capacities in a dynamic environment. At the same time, their network availability is unstable, and their data quality varies. To achieve high-quality federated learning and handle these challenges, designing the proper client selection process and methods are essential, which involves selecting suitable clients from the candidates. This study presents a comprehensive systematic literature review (SLR) that focuses on the challenges of client selection (CS) in the context of federated learning (FL). The objective of this SLR is to facilitate future research and development of CS methods in FL. Additionally, a detailed and in-depth overview of the CS process is provided, encompassing its abstract implementation and essential characteristics. This comprehensive presentation enables the application of CS in diverse domains. Furthermore, various CS methods are thoroughly categorized and explained based on their key characteristics and their ability to address specific challenges. This categorization offers valuable insights into the current state of the literature while also providing a roadmap for prospective investigations in this area of research.

DES Selection for Left Main and Coronary Bifurcation Stenting.

Coronary bifurcation lesions present a challenging lesion subset regarding procedural complexity and worse patient outcomes as compared to simple lesions. Drug eluting stents (DES), as the current standard of care for percutaneous myocardial revascularization, have tubular design and uniform diameter, and therefore, need to be subjected to a standardized set of procedural modifications, to optimally fit and reconstruct underlying bifurcation anatomy. Since contemporary DES have various design platforms, with diverse mechanical properties, we must be aware of the device's favorable characteristics and limitations, to ensure maximal procedural safety and success. This is especially true for bifurcation lesion stenting, during which device integrity will often be eventually tested by undergoing specific procedural steps, such as proximal balloon optimization, kissing-balloon inflations, or even intentional stent crushing. In this review we address the design characteristics of contemporary DES, their bifurcation-specific experimental testing data, and reported clinical results, in an attempt to provide relevant information and help in device selection for bifurcation stenting procedures.

Impact of Stenting on PDA Length, Curvature, and Pulsatile Deformations Based on CT Assessment.

Background: We sought to investigate the impact of stenting on native patent ductus arteriosus (PDA) length, curvature, and pulsatile deformations in patients with ductal-dependent pulmonary circulations. Methods: Patients with PDA stents who received contrast-enhanced 3-dimensional computed tomography with a view of the PDA, thoracic aorta, and pulmonary arteries were retrospectively included in this study. Geometric models of the prestented and poststented PDA were constructed from the computed tomography images, and PDA arclength, curvature, and pulsatile deformations were quantified. Results: A total of 12 patients with cyanotic congenital heart disease were included, 10 of whom received 1 stent in the PDA and 2 received multiple overlapping stents. From prestenting to poststenting, the PDA shortened by 26 ± 18% (P = .004) and decreased in mean and peak curvature by 60 ± 21% and 68 ± 15%, respectively (both P < .001). Pulsatile deformations varied highly for the native PDA, stented PDA, and stents themselves. Conclusions: The shortening and straightening of the PDA after stenting are significant and substantial, and their quantitative characterization will enable interventionalists to select stent lengths that span the entire PDA without encroaching on the aortic or pulmonary artery, which could cause hemodynamic interference, stent kink, and fatigue. Pulsatile PDA deformations can be used to design and evaluate devices tailored to congenital heart disease in neonates.

Sex-Specific Considerations in Degenerative Aortic Stenosis for Female-Tailored Transfemoral Aortic Valve Implantation Management.

The impact of sex on pathophysiological processes, clinical presentation, treatment options, as well as outcomes of degenerative aortic stenosis remain poorly understood. Female patients are well represented in transfemoral aortic valve implantation (TAVI) trials and appear to derive favorable outcomes with TAVI. However, higher incidences of major bleeding, vascular complications, and stroke have been reported in women following TAVI. The anatomical characteristics and pathophysiological features of aortic stenosis in women might guide a tailored planning of the percutaneous approach. We highlight whether a sex-based TAVI management strategy might impact on clinical outcomes. This review aimed to evaluate the impact of sex from diagnosis to treatment of degenerative aortic stenosis, discussing the latest evidence on epidemiology, pathophysiology, clinical presentation, therapeutic options, and outcomes. Furthermore, we focused on technical sex-oriented considerations in TAVI including the preprocedural screening, device selection, implantation strategy, and postprocedural management.

A Systematic Review of Published Algorithms for Selecting an Inhaled Delivery System in Chronic Obstructive Pulmonary Disease.

Rationale: Medication for treatment of chronic obstructive pulmonary disease (COPD) is available in many different delivery systems; however, national and international guidelines do not provide recommendations on how to select the optimal system for an individual patient. Objectives: To perform a systematic review of published algorithms for inhaler selection in outpatients with COPD. Methods: PubMed, EMBASE, PsycINFO, Cochrane, and Google Scholar were searched for articles on inhaler selection published between January 1, 1990, and March 10, 2021. The results were reviewed for articles containing an algorithm for inhaler selection. The quality of publications containing an algorithm was assessed using the Joanna Briggs Institute's System for the Unified Management, Assessment and Review of Information text and opinion critical appraisal checklist. Individual steps recommended in the algorithms and the order in which they were considered were extracted independently by the two authors using the Joanna Briggs Institute's text and opinion data extraction tool. Textual syntheses and a table of factors included were used to appraise and compare algorithms. Results: The search identified 1,016 publications. After removing duplicate studies (n = 409), 607 abstracts were examined. Nine different algorithms or hierarchical recommendations for device selection were identified. All nine publications were considered of good quality. Most algorithms contain only a few decision steps. There were significant differences between the algorithms. None of the algorithms have been validated. Three domains for factors included in the algorithms were identified: patient factors, device attributes, and healthcare professional (HCP) factors. Patient factors were considered most frequently (19 times) compared with device attributes (10 times) and HCP factors (7 times). Five specific attributes/factors with at least three rankings in different algorithms were identified as key factors for device selection: ability to perform the required inspiratory maneuver and handle device correctly, sufficient inspiratory flow for dry powder inhalers, availability of molecule(s) in the device, and continuity of device. Conclusions: Although the algorithms generally provide step-by-step approaches based on a literature review and/or the experiences of the different authors, none were developed using item generation/reduction methodology or included input from patients with COPD. However, the review identified key factors that should be considered by HCPs when selecting therapy. Registration: PROSPERO (CRD42021244475).

Comprehensive Audiological Management of Hearing Loss in Children, Including Mild and Unilateral Hearing Loss.

Management of hearing loss in infants and young children has evolved rapidly with the formation of universal newborn hearing screening and early intervention programs. This review describes the management process for children with hearing loss, including determining candidacy for amplification, selection of amplification devices, electroacoustic verification, and outcomes validation. The importance of a coordinated, evidence-based approach can help to ensure the best communication outcomes for children with hearing loss.

UK Vessel Health and Preservation (VHP) Framework: a commentary on the updated VHP 2020.

BACKGROUND: In 2016, a UK vessel health and preservation (VHP) framework was developed to support healthcare staff to select the most appropriate vascular access device for patients requiring intravenous therapy. The VHP framework was based on available evidence and expert consensus. The VHP was based on available evidence and expert consensus. DEVELOPMENT OF THE VHP 2020 FRAMEWORK: A multidisciplinary team reviewed the original UK VHP framework and considered new published evidence, national and international guidelines and expert opinion. A literature search was performed using Cinahl and Medline, incorporating a variety of terms linked to vascular access devices, assessment and selection. Articles published in and after 2014 in English were included. Twelve articles were found to be relevant including three evidence-based guidelines, two randomised control trials and one systematic review. FINDINGS: Three main studies provided the evidence for the update: the MAGIC study that assessed the appropriateness of peripherally inserted central catheters in patients; a study that utilised the 'A-DIVA scale' to predict the likelihood of difficult venous access; and a study that incorporated an 'I-DECIDED tool' for peripheral intravenous catheter assessment and decision-making for device removal. In addition, published guidelines provided evidence that the original advice on appropriate osmolarity of medicines for peripheral administration needed updating. CONCLUSION: The 2020 UK VHP framework reflects latest evidence-based research and guidelines, providing healthcare staff updated guidance to assist in maintaining good practice in vascular access assessment and device selection and patient safety.

Human-Centered Design Strategies for Device Selection in mHealth Programs: Development of a Novel Framework and Case Study.

BACKGROUND: Despite the increasing use of remote measurement technologies (RMT) such as wearables or biosensors in health care programs, challenges associated with selecting and implementing these technologies persist. Many health care programs that use RMT rely on commercially available, "off-the-shelf" devices to collect patient data. However, validation of these devices is sparse, the technology landscape is constantly changing, relative benefits between device options are often unclear, and research on patient and health care provider preferences is often lacking. OBJECTIVE: To address these common challenges, we propose a novel device selection framework extrapolated from human-centered design principles, which are commonly used in de novo digital health product design. We then present a case study in which we used the framework to identify, test, select, and implement off-the-shelf devices for the Remote Assessment of Disease and Relapse-Central Nervous System (RADAR-CNS) consortium, a research program using RMT to study central nervous system disease progression. METHODS: The RADAR-CNS device selection framework describes a human-centered approach to device selection for mobile health programs. The framework guides study designers through stakeholder engagement, technology landscaping, rapid proof of concept testing, and creative problem solving to develop device selection criteria and a robust implementation strategy. It also describes a method for considering compromises when tensions between stakeholder needs occur. RESULTS: The framework successfully guided device selection for the RADAR-CNS study on relapse in multiple sclerosis. In the initial stage, we engaged a multidisciplinary team of patients, health care professionals, researchers, and technologists to identify our primary device-related goals. We desired regular home-based measurements of gait, balance, fatigue, heart rate, and sleep over the course of the study. However, devices and measurement methods had to be user friendly, secure, and able to produce high quality data. In the second stage, we iteratively refined our strategy and selected devices based on technological and regulatory constraints, user feedback, and research goals. At several points, we used this method to devise compromises that addressed conflicting stakeholder needs. We then implemented a feedback mechanism into the study to gather lessons about devices to improve future versions of the RADAR-CNS program. CONCLUSIONS: The RADAR device selection framework provides a structured yet flexible approach to device selection for health care programs and can be used to systematically approach complex decisions that require teams to consider patient experiences alongside scientific priorities and logistical, technical, or regulatory constraints.

Establishment of relationships between native and inhalation device specific spirometric parameters as a step towards patient tailored inhalation device selection.

INTRODUCTION: Drug emission from DPIs is dependent on the inspiratory flow parameters through them, which are not directly measured by standard spirometry. Their estimation based on native spirometric data could help in choosing the appropriate device and optimizing the drug deposition. OBJECTIVES: The aim of this study was to survey patient preferences and to find correlations between breathing parameters of COPD patients through DPI devices and their baseline spirometric data, age, gender, disease severity and anthropometric characteristics. Another objective was to establish relationships between peak inspiratory flows (PIFdev) through Breezhaler®, Genuair® and Turbuhaler® inhalers and their determinants. METHODS: Breathing parameters of 49 patients with previously diagnosed COPD and currently using one of the above inhalers were recorded by normal spirometry and while inhaling through the selected DPIs. Statistical analysis of the measured data was completed. All specific data are provided as (mean ±â€¯standard deviation). RESULTS: More than 60% of the patients stated that their current device is the easiest to use. The means of the measured PIFdev values were 91.4 L/min, 77.1 L/min and 77.5 L/min for Breezhaler®, Genuair®, and Turbuhaler®, respectively. PIFdev values were significantly higher for males than for females, but differences upon age, BMI and disease severity group were not significant (at p = 0.05). Peak inspiratory flows through the inhalers (PIFdev) correlated best with their native spirometric counterparts (PIF) and linear PIFdev-PIF relationships could be determined (Breezhaler®: r = 0.60, p = 0.002, Genuair®: r = 0.55, p = 0.001, Turbuhaler®: r = 0.57, p = 0.002). Physical background of the deduced equations was also provided. CONCLUSIONS: Present correlations may be used to assess the success of inhalation of COPD patients through the studied devices and to choose the appropriate device for each patient. As a consequence, the amount of the drug emitted by the device can be optimized, the deposition efficiency within the lungs increased and the related therapeutic effect improved.

Individualizing the selection of long-acting bronchodilator therapy for patients with COPD: considerations in primary care.

Chronic obstructive pulmonary disease (COPD) is a common condition encountered in primary care settings. COPD remains the third leading cause of death in the United States and carries a significant burden to both patients and the healthcare system. COPD is a chronic, progressive, irreversible lung disease associated with high morbidity and mortality. Proper assessment and diagnosis requires spirometry which is currently underutilized in primary care. Management is focused on adequate symptom control, improving quality of breathing and quality of life, and preventing exacerbations and hospitalizations. However, many patients are not receiving long-acting bronchodilator maintenance therapy as recommended in current clinical guidelines. Even when patients receive appropriate therapy, real-world issues such as a patient's health literacy, physical and cognitive limitations, and therapy nonadherence limit the effectiveness of prescribed inhaled medications. Primary care providers are well situated to ensure that prescribed therapies and long-term management goals are matched to the individual needs of patients with COPD.

Development of the UK Vessel Health and Preservation (VHP) framework: a multi-organisational collaborative.

Vascular access is an important part of many patient care management plans but has some unwanted risks. Previous work published by Moureau et al. (2012) inspired a working group led by the UK Infection Prevention Society (IPS) to produce a vessel health and preservation (VHP) framework. This was with the intention of producing a resource for frontline staff to be able to assess and select the best vascular access device to meet the individual patient's needs and to preserve veins for future use. The working group produced a framework that used available evidence, expert opinion and some small scale testing of the components of the framework. The work so far has received positive feedback but further work is required to formally evaluate the VHP framework in clinical practice to measure both staff knowledge and patient outcomes.

Differential Medical Aerosol Device and Interface Selection in Patients during Spontaneous, Conventional Mechanical and Noninvasive Ventilation.

Many aerosol delivery devices are available on the market that have different features, characteristics, and operating requirements that need to be considered for the effective treatment of patients with pulmonary diseases. Device selection in aerosol medicine is largely patient dependent. Since there is no aerosol device that suits all patient populations, device selection and successful integration of the prescribed aerosol device to patients is essential. This article explores key issues in differential device selection in spontaneously breathing adults with or without artificial airways, as well as critically ill patients receiving invasive and noninvasive ventilation, with discussion of considerations for integration of aerosol devices to each of these patient populations.