Effect of deploying biomedical equipment technician on the functionality of medical equipment in the government hospitals of rural Nepal.

BACKGROUND: Medical equipment plays a crucial role in the provision of quality healthcare services, despite this more than 50% of equipment in developing countries are non-functioning due to a lack of appropriate human resources to maintain. To address this problem some government hospitals of Nepal have deployed a mid-level technical cadre called 'Biomedical Equipment Technician' (BMET). This study aims to evaluate the effectiveness of deploying a BMET on the functionality of medical equipment in government hospitals of rural Nepal. METHODS: We used a mixed-methods approach with a comparative research design. A comprehensive range of 2189 pieces of medical equipment at 22 hospitals with and without BMET were observed to assess their functional status. Medical equipment were stratified into 6 categories based on department and T tests were conducted. We collected qualitative data from 9 BMETs, 22 medical superintendents, and 22 health staff using semi-structured interviews and focus-group discussions. Thematic content analysis was conducted to explore how the BMET's work was perceived. FINDINGS: The quantity of non-functional devices in hospitals without BMETs was double that of hospitals with BMETs (14% and 7% respectively, p < 0.005). Results were similar across all departments including General (16% versus 3%, p = 0.056), Lab (15% versus 7%, p < 0.005) and Operation Theater (14% versus 5%, p < 0.005). Hospitals with BMETs had fewer overall non-functional devices requiring simple or advanced repair compared to hospitals without BMETs [3% versus 7% (p < 0.005) simple; 4% versus 6% (p < 0.005) advanced]. In our qualitative analysis, we found that BMETs were highly appreciated by hospital staff. Hospital workers perceived that having a BMET on staff, rather than twice-yearly visits from central-level maintenance technicians, is an effective way to keep medical equipment functional. However, without a favorable working environment, the BMET alone cannot perform optimally. CONCLUSIONS: Having a BMET at a rural government hospital has a substantial positive effect on the functional status of medical devices at the hospital. BMETs should be deployed at all rural hospitals to increase the functionality of medical devices, thereby improving the working environment and quality of health services provided.

Calidad de las imágenes, la lectura y el servicio de mamografía en cuatro centros de imagenología de Manizales, Colombia / Image quality, reading, and mammography service in four diagnostic imaging centers in Manizales, Colombia

Resumen | Introducción. La calidad de la mamografía está directamente relacionada con la capacidad para detectar anormalidades y, por ello, es necesario el control de calidad en los centros de imágenes diagnósticas. Objetivo. Evaluar la calidad de la imagen, la lectura y el servicio de mamografía de algunos centros de imágenes diagnósticas en Manizales, Colombia. Materiales y métodos. Cuatro centros participaron de forma voluntaria y bajo acuerdos de confidencialidad en el estudio. De las 520 mujeres atendidas en ellos, a 318 se les hicieron mamografías. A partir de una inspección visual del servicio, se evaluaron la infraestructura, la tecnología y el personal de la unidad. Un radiólogo experto en lectura e interpretación clínica de imágenes mamarias evaluó la calidad de la imagen y la de su lectura. El análisis estadístico se hizo utilizando un anova y determinando el índice kappa y el porcentaje de desacuerdo. Resultados. Se encontró falta de calidad de las imágenes obtenidas, principalmente, por presencia de artificios en el 75 % de ellas, e identificación y rotulación deficientes; además, en la toma de la proyección oblicua medio-lateral, se encontró falta de visualización del ángulo inframamario. El grado de concordancia en el reporte BI-RADS fue bajo en los cuatro centros, con diferencias importantes en el informe y la descripción de los hallazgos. Conclusión. Los centros de imágenes diagnósticas evaluados están habilitados para el funcionamiento, pero se encontraron deficiencias importantes en la calidad de las imágenes y en su lectura, lo que pone de manifiesto la necesidad de establecer estándares de calidad y mejorar los aspectos que se puedan mejorar.

Abstract | Introduction: Mammography quality is directly related to the ability to detect an abnormality and, therefore, quality control is necessary for diagnostic imaging centers. Objective: To evaluate image quality, reading, and mammography service in some diagnostic imaging centers in Manizales, Colombia. Materials and methods: Four diagnostic imaging centers participated voluntarily in the study under confidentiality agreements. Out of 520 women attending the centers, 318 had a mammography. The infrastructure, technology, and human resources of each unit were evaluated based on visual inspections. A radiologist expert in reading and clinical interpretation of mammary images evaluated the quality of the image and the reading. We made the statistical analysis using anova, the kappa index, and the percentage of disagreement. Results: We found images of diminished quality mainly due to the presence of artifacts in 75 % of those evaluated, as well as non-compliance with identification criteria and image labeling. There were difficulties in taking the lateral median oblique projection given the absence of the inframammary. The level of agreement in the BI-RADS reporting was low in the four centers with important differences in the report and description of findings. Conclusion: The city's diagnostic centers under evaluation are authorized for their operation. However, there are important deficiencies in image quality and reading, which highlights the need to seek quality standards starting from those aspects that can be improved upon.

Deployment of a New CRRT/PIRRT Device during the COVID-19 Pandemic Emergency: Organizational Challenges and Implementation Results.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic led to increased demand nationwide for dialysis equipment, including supplies and machines. To meet the demand in our institution, our surge plan included rapid mobilization of a novel continuous renal replacement treatment (CRRT) machine named SAMI. The SAMI is a push-pull filtration enhanced dialysis machine that can conjugate extremely high single-pass solute removal efficiency with very precise fluid balance control. MATERIAL AND METHODS: Machine assembly was conducted on-site by local biomedical engineers with remote assistance by the vendor. One 3-h virtual training session of 3 dialysis nurses was conducted before SAMI deployment. The SAMI was deployed in prolonged intermittent replacement therapy (PIRRT) mode to maximize patients covered per machine per day. Live on-demand vendor support was provided to troubleshoot any issues for the first few cases. After 4 weeks of the SAMI implementation, data on treatments with the SAMI were collected, and a questionnaire was provided to the nurse trainees to assess device usability. RESULTS: On-site installation of the SAMI was accomplished with remote assistance. Delivery of remote training was successfully achieved. 23 PIRRT treatments were conducted in 10 patients. 7/10 of patients had CO-VID-19. The median PIRRT dose was 50 mL/kg/h (IQR [interquartile range] 44 - 62 mL/kg/h), and duration of the treatment was 8 h (IQR 6.3 - 8 h). Solute control was adequate. The user response was favorable to the set of usability questions involving user interface, on-screen instructions, machine setup, troubleshooting, and the ease of moving the machine. CONCLUSION: Assembly of the SAMI and training of nurses remotely are possible when access to vendor employees is restricted during states of emergency. The successful deployment of the SAMI in our institution during the pandemic with only 3-h virtual training supports that operating the SAMI is simple and safe.

WebPalestra: Jardins Terapêuticos

Estratégias para implantação, definições, limitações de tratos culturais e noções de cultivo de plantas medicinais, metabolismo de síntese de princípios ativos das plantas medicinais, cuidados no armazenamento e na aquisição do plantas medicinais. Plantas medicinais como fonte de renda, programa de Vitória.

Time-Driven Activity-Based Costing Comparison of Stereotactic Radiosurgery to Multiple Brain Lesions Using Single-Isocenter Versus Multiple-Isocenter Technique.

PURPOSE: Stereotactic radiosurgery (SRS) historically has been used to treat multiple brain lesions using a multiple-isocenter technique-frequently associated with significant complexity in treatment planning and long treatment times. Recently, given innovations in planning algorithms, patients with multiple brain lesions may now be treated with a single-isocenter technique using fewer total arcs and less time spent during image guidance (though with stricter image guided radiation therapy tolerances). This study used time-driven activity-based costing to determine the difference in cost to a provider for delivering SRS to multiple brain lesions using single-isocenter versus multiple-isocenter techniques. METHODS AND MATERIALS: Process maps, consisting of discrete steps, were created for each phase of the SRS care cycle and were based on interviews with department personnel. Actual treatment times (including image guidance) were extracted from treatment record and verify software. Additional sources of data to determine costs included salary/benefit data of personnel and average list price/maintenance costs for equipment. RESULTS: Data were collected for 22 patients who underwent single-isocenter SRS (mean lesions treated, 5.2; mean treatment time, 30.2 minutes) and 51 patients who underwent multiple-isocenter SRS (mean lesions treated, 4.4; mean treatment time, 75.2 minutes). Treatment time for multiple-isocenter SRS varied substantially with increasing number of lesions (11.8 minutes/lesion; P < .001), but to a much lesser degree in single-isocenter SRS (1.8 minutes/lesion; P = .029). The resulting cost savings from single-isocenter SRS based on number of lesions treated ranged from $296 to $3878 for 2 to 10 lesions treated. The 2-mm planning treatment volume margin used with single-isocenter SRS resulted in a mean 43% increase of total volume treated compared with a 1-mm planning treatment volume expansion. CONCLUSIONS: In a comparison of time-driven activity-based costing assessment of single-isocenter versus multiple-isocenter SRS for multiple brain lesions, single-isocenter SRS appears to save time and resources for as few as 2 lesions, with incremental benefits for additional lesions treated.

Medical Waste-Sorting and Management Practices in Five Hospitals in Ghana.

Hospital waste management in Ghana faces the risk of cross-contamination from the lack of thorough sorting of the waste at the points of generation, codisposal of hazardous and nonhazardous waste types, and use of open-fire pits and substandard incinerators for burning infectious waste. This has increased the potential for the spread of infections and chemical pollutants. A cross-sectional study was conducted in five hospitals in Ghana to assess behavioral patterns on waste sorting and the effectiveness of hospital waste management in Ghana. A total of 250 questionnaires were distributed purposively to some staff of the five hospitals to assess workers' perceptions on medical waste sorting and handling. Additionally, focused group discussions and transect walks were adopted to examine the current collection, storage, treatment, and disposal methods used in the health facilities. Chi-square analyses showed significant differences in waste-sorting behavior based only on occupation (p < 0.0001, n=180) and not on gender, education, or experience in the health sector. Even though contaminated sharps were separated into brown safety boxes, color coding for other infectious waste containers was inconsistent across the health facilities. The study revealed that incineration is still the modal method of treatment in Ghanaian hospitals and therefore new approaches such as an engineering approach were required to minimize its environmental effects. It is recommended that periodic in-service training workshops be held for healthcare staff on the right source-segregation of medical waste, in order to facilitate the effective and safe handling, transport, treatment, and disposal of waste from health facilities.

Avaliação dos riscos à saúde dos trabalhadores de Enfermagem do pronto socorro de um hospital universitário / Evaluation of health risks for nursing workers in the emergency department of a university hospital

Objetivo: Identificar o conhecimento dos dos trabalhadores de Enfermagem do pronto socorro de um hospital universitário acerca dos riscos laborais a que estão submetidos. Método: Estudo exploratório sob a abordagem quantitativa, onde aplicou-se um questionário para 137 profissionais de Enfermagem (48 enfermeiros, 37 técnicos de enfermagem e 52 auxiliares de enfermagem) do Pronto Socorro de um Hospital Universitário. Resultados: Os sujeitos do estudo são predominantemente do sexo feminino (70,8%), na faixa etária de 26 a 35 anos (43,1%), com até cinco anos de trabalho no pronto socorro (81,6%) e atuando no turno noturno (41,6%). Dos riscos, os mais apontados foram os biológicos como bactérias, vírus, sangue, e secreções, pelas três categorias profissionais. Seguiram-se os riscos físicos com material perfuro cortante, manutenção precária e ruídos; os químicos medicamentos, poeira e desinfetantes; e os ergonômicos levantar e sustentar pacientes e andar muito pelo setor. Conclusão: Os profissionais reconhecem o principal risco envolvido em sua prática assistencial como sendo biológico. Esses resultados são importantes para nortear ações na gestão que visem ações preventivas. (AU)

Objective: To identify the health risks of nursing workers in the emergency department of a university hospital. Method: Exploratory study with quantitative approach, using a questionnaire applied in 137 nursing workers (48 nurses, 37 nursing technicians and 52 nursing assistants) from the Emergency Room of an university hospital center. Results: The sample consisted of predominantly female (70.8%), ages 26 to 35 years old (43.1%), with up to five years of work in the emergency room (81.6%) and working in the night shift (41.6%). The main risk cited by all professionals was Biological, exemplified by bacteria, viruses, blood, and secretions. Others risks were also remembered, such as the Physical ones: use of sharp-perforating material, poor maintenance of the environment and noise; Chemical risks described as contact with medical drugs, dust and disinfectants; and the Ergonomic ones, like to raise and to support patients and walk around the sector a lot. Conclusion: Nursing Professionals recognize the main risk involved in their daily practice as being biological. These results are important to guide further preventive actions. (AU)

Objetivo: identificar los riesgos para la salud de los trabajadores de enfermería en el departamento de emergencias de un hospital universitario. Método: estudio exploratório con enfoque cuantitativo, desarrollado a partir de un cuestionario para 137 profesionales de enfermería (48 enfermeras, 37 técnicas de enfermería y 52 auxiliares de enfermería) de la sala de emergencias de uno hospital universitario. Resultados: Los sujetos del estudio son predominantemente mujeres (70.8%), de 26 a 35 años (43.1%), con hasta cinco años de trabajo en la sala de emergencias (81.6%) y trabajando en el turno nocturno (41,6%). De los riesgos, los más destacados fueron los Biologicos, como bacterias, virus, sangre y secreciones, por las tres categorías profesionales. A seguir fueran los riesgos Fisicos con lo material perforante, mala conservación del área física y ruido; los Quimicos con las drogas químicas, polvo y desinfectantes; y los Ergonómicos com la movilizacion y apoyo a los pacientes y se muever mucho por el sector. Conclusión: Los profesionales reconocen que el principal riesgo involucrado en su práctica de cuidado es biológico. Estos resultados son importantes para guiar las acciones de gestión dirigidas a acciones preventivas (AU)

[General Troubleshooting and Preventive Maintenance of the Digestive Electron Microscope System].

OBJECTIVE: Improve the integrity of the digestive electron microscope equipment and reduce the cost of equipment failure maintenance. METHODS: By studying the composition and function of the digestive electron microscope system and analyzing the causes of common faults, a targeted preventive maintenance plan is developed, equipment users are graded, and a training system is established. RESULTS: The user of the device can skillfully analyze the cause of the malfunction and timely deal with the sudden failure of the diagnosis and treatment, thereby reduce the risk of diagnosis and treatment and the investment in hospital maintenance. CONCLUSIONS: Through the analysis and processing of the digestive electron microscope system, point detection leakage, grading training, preventive maintenance can significantly improve the equipment integrity rate, reduce the risk of clinical diagnosis and treatment, effectively reduce the number of equipment failures, and reduce maintenance costs.

Characterization of the adult patients' falling incidents in a university hospital. / Caracterização dos incidentes de quedas de pacientes adultos internados em um hospital universitário.

OBJECTIVE: To evaluate the occurrences and to characterize the falling incidents of adult patients hospitalized in clinical and surgical units of a university hospital in the southern region of the country, in the period from 2011 to 2014. METHOD: Descriptive, cross-sectional and retrospective study, carried out from December 2016 to December 2017. The sample consisted of 1112 reports, covering all hospitalized patients who were notified with falls occurring in the studied period. Data were analyzed using descriptive and analytical statistics. RESULTS: Female and elderly patients were predominant in the sample, in which 69.4% of the incidents did not present any damage. The occurrence of falls was significantly higher at night. Limitation to walking and being unaccompanied were the most prevalent factors in the patient's conditions before the fall. CONCLUSION: The fall is a multifactorial event that requires periodic evaluation of the risk factors by the team to plan their prevention.

Use of Systems Engineering to Design a Hospital Command Center.

BACKGROUND: In hospitals and health systems across the country, patient flow bottlenecks delay care delivery-emergency department boarding and operating room exit holds are familiar examples. In other industries, such as oil, gas, and air traffic control, command centers proactively manage flow through complex systems. METHODS: A systems engineering approach was used to analyze and maximize existing capacity in one health system, which led to the creation of the Judy Reitz Capacity Command Center. This article describes the key elements of this novel health system command center, which include strategic colocation of teams, automated visual displays of real-time data providing a global view, predictive analytics, standard work and rules-based protocols, and a clear chain of command and guiding tenets. Preliminary data are also shared. RESULTS: With proactive capacity management, subcycle times decreased and allowed the health system's flagship hospital to increase occupancy from 85% to 92% while decreasing patient delays. CONCLUSION: The command center was built with three primary goals-reducing emergency department boarding, eliminating operating room holds, and facilitating transfers in from outside facilities-but the command center infrastructure has the potential to improve hospital operations in many other areas.

Caracterização dos incidentes de quedas de pacientes adultos internados em um hospital universitário / Caracterización de los incidentes de caídas de pacientes adultos internados en un hospital universitario / Characterization of the adult patients' falling incidents in a university hospital

Resumo OBJETIVO Avaliar as notificações e caracterizar os incidentes de quedas dos pacientes adultos internados em unidades clínicas e cirúrgicas de um hospital universitário na região sul do país, no período de 2011 a 2014. MÉTODO Estudo descritivo, transversal e retrospectivo, realizado no período de dezembro de 2016 a dezembro de 2017. A amostra foi de 1112 notificações, abrangendo todos os pacientes internados que foram notificados com ocorrência de quedas no período estudado. Os dados foram analisados por meio de estatística descritiva e analítica. RESULTADOS Foram predominantes na amostra os pacientes do sexo feminino e idosos, onde 69,4% dos incidentes não apresentaram dano. A ocorrência de quedas foi significativamente maior no período noturno. Limitação para deambular e estar desacompanhado foram os fatores mais prevalentes nas condições do paciente antes da queda. CONCLUSÃO Queda é um evento multifatorial que necessita avaliação periódica dos fatores de risco pela equipe para planejar sua prevenção.

Resumen OBJETIVO Evaluar las notificaciones y caracterizar los incidentes de caídas de los pacientes adultos internados en unidades clínicas y quirúrgicas de un hospital universitario en la región sur del país, en el período 2011 a 2014. MÉTODO Estudio descriptivo, transversal y retrospectivo, realizado en el período de diciembre de 2016 a diciembre de 2017. La muestra fue de 1112 notificaciones, abarcando a todos los pacientes internados que fueron notificados con ocurrencia de caídas en el periodo estudado. Los datos fueron analizados por medio de estadística descriptiva y analítica. RESULTADOS: Fueron predominantes en la muestra los pacientes del sexo femenino y ancianos, donde el 69,4% de los incidentes no presentaron daño. La ocurrencia de caídas fue significativamente mayor en el período nocturno. La limitación para deambular y estar desatendido fueron los factores más prevalentes en las condiciones del paciente antes de la caída. CONCLUSIÓN La caída es un evento multifactorial que necesita evaluación periódica de los factores de riesgo por el equipo para planificar su prevención.

Abstract OBJECTIVE To evaluate the occurrences and to characterize the falling incidents of adult patients hospitalized in clinical and surgical units of a university hospital in the southern region of the country, in the period from 2011 to 2014. METHOD Descriptive, cross-sectional and retrospective study, carried out from December 2016 to December 2017. The sample consisted of 1112 reports, covering all hospitalized patients who were notified with falls occurring in the studied period. Data were analyzed using descriptive and analytical statistics. RESULTS Female and elderly patients were predominant in the sample, in which 69.4% of the incidents did not present any damage. The occurrence of falls was significantly higher at night. Limitation to walking and being unaccompanied were the most prevalent factors in the patient's conditions before the fall. CONCLUSION The fall is a multifactorial event that requires periodic evaluation of the risk factors by the team to plan their prevention.

General Troubleshooting and Preventive Maintenance of the Digestive Electron Microscope System / 中国医疗器械杂志

OBJECTIVE@#Improve the integrity of the digestive electron microscope equipment and reduce the cost of equipment failure maintenance.@*METHODS@#By studying the composition and function of the digestive electron microscope system and analyzing the causes of common faults, a targeted preventive maintenance plan is developed, equipment users are graded, and a training system is established.@*RESULTS@#The user of the device can skillfully analyze the cause of the malfunction and timely deal with the sudden failure of the diagnosis and treatment, thereby reduce the risk of diagnosis and treatment and the investment in hospital maintenance.@*CONCLUSIONS@#Through the analysis and processing of the digestive electron microscope system, point detection leakage, grading training, preventive maintenance can significantly improve the equipment integrity rate, reduce the risk of clinical diagnosis and treatment, effectively reduce the number of equipment failures, and reduce maintenance costs.

High rate treatment of hospital wastewater using activated sludge process induced by high-frequency ultrasound.

The biomass concentration of conventional activated sludge (CAS) process due to low sludge sedimentation in clarifiers is limited to 3000 mg/L. In this study, high-frequency ultrasound wave (1.8 MHz) was applied to enhance the CAS process performance using high Mixed Liquor Suspended Solid (MLSS) concentration. The study conducted using a pilot scale CAS bioreactor (with and without ultrasound) and their performance for treating a hospital wastewater were compared. Experimental conditions were designed based on a Central Composite Design (CCD). The sets of data analyzed, modeled and optimized using Response Surface Methodology (RSM). The effect of MLSS concentration 3000-8000 mg/L and hydraulic retention time (HRT) 2-8 h are considered as operating variables to investigate on process responses. The obtained results showed that high-frequency ultrasound was significantly decreased the sludge volume index (SVI) 50% and effluent turbidity about 88.5% at high MLSS. Also, observed that COD removal of both systems was nearly similar, as the maximum COD removal for sonicated and non-sonicated systems were 92 and 92.5% respectively. However, this study demonstrates that the ultrasound irradiation has not had any negative effect on the microbial activity.

"I Help Them Navigate the Organization": Recognizing the Contributions of Non-Clinical Professionals to Person-Centered Approaches in Assisted Living.

The current study explored the contribution of non-clinical professionals, such as housekeepers and maintenance mechanics, in promoting person-centered care (PCC) for older adults residing in assisted living. Semi-structured face-to-face interviews with staff (n = 8), concierge (n = 2), maintenance mechanics (n = 2), housekeepers (n = 3), and an administrative assistant (n = 1) from an assisted living organization were conducted. Interviews were audiorecorded, transcribed, and reviewed for accuracy. The comments from the staff were coded based on prior PCC themes (i.e., promoting decision making, meaningful living, pleasurable living, and personhood). Results show that non-clinical staff play an important role in facilitating PCC in their everyday tasks with residents. A new sub-theme was added regarding how non-clinical staff help residents in assisted living navigate the organization. Findings suggest that all tasks, no matter how routine, can be performed in a person-centered manner, contributing to the quality of life of older adults in assisted living. The authors recommend including all staff who have direct contact with residents in person-centered education and training efforts as they support the PCC goals of an organization. [Journal of Gerontological Nursing, 44(2), 9-13.].

Ingeniería para los Hospitales Públicos: el caso de la Ingeniería Biomédica / Engineering for Public Hospitals

El texto trata de la inversión en equipamientos biomédicos en los últimos diez años, para desentrañar otra visión de la ingeniería biomédica en el hospital público. Para ello, discute la innovación y el desarrollo en hospitales públicos, la incorporación de la tecnología a nivel local y el papel de la gestión de la ingeniería.