Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.297
Filtrar
1.
Medicine (Baltimore) ; 99(9): e19331, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118765

RESUMO

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.


Assuntos
Cartilagem Cricoide/cirurgia , Agulhas/efeitos adversos , Traqueia/lesões , Animais , Estudos Cross-Over , Modelos Animais de Doenças , Desenho de Equipamento/métodos , Desenho de Equipamento/normas , Agulhas/tendências , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Suínos/lesões , Ensino
2.
Medicine (Baltimore) ; 99(9): e19393, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118791

RESUMO

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.


Assuntos
Desenho de Equipamento/normas , Insuficiência Cardíaca/cirurgia , Coração Auxiliar/normas , Resultado do Tratamento , Insuficiência Cardíaca/fisiopatologia , Coração Auxiliar/tendências , Humanos , Razão de Chances , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos
3.
AAPS PharmSciTech ; 20(8): 329, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31676991

RESUMO

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.


Assuntos
Sistemas de Liberação de Medicamentos/métodos , Inaladores de Pó Seco/métodos , Desenho de Equipamento/métodos , Hidrodinâmica , Administração por Inalação , Aerossóis , Criança , Sistemas de Liberação de Medicamentos/normas , Inaladores de Pó Seco/normas , Desenho de Equipamento/normas , Humanos , Tamanho da Partícula , Pós
4.
Nat Rev Urol ; 16(11): 675-689, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31548731

RESUMO

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.


Assuntos
Desenho de Equipamento , Prolapso de Órgão Pélvico/cirurgia , Polipropilenos , Telas Cirúrgicas , Incontinência Urinária por Estresse/cirurgia , Desenho de Equipamento/normas , Feminino , Humanos , Vagina
5.
J Pediatr Orthop B ; 28(6): 564-571, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31503104

RESUMO

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.


Assuntos
Articulação do Tornozelo/diagnóstico por imagem , Pé Torto Equinovaro/diagnóstico por imagem , Desenho de Equipamento/normas , Órtoses do Pé , Pé/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Braquetes/normas , Criança , Pré-Escolar , Pé Torto Equinovaro/terapia , Estudos Transversais , Feminino , Órtoses do Pé/normas , Humanos , Lactente , Masculino , Projetos Piloto
6.
Ital J Pediatr ; 45(1): 97, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391074

RESUMO

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.


Assuntos
Ambulâncias/normas , Desenho de Equipamento/normas , Europa (Continente) , Humanos , Recém-Nascido , Itália
7.
Artigo em Inglês | MEDLINE | ID: mdl-31416115

RESUMO

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.


Assuntos
Aerossóis/normas , Sistemas Eletrônicos de Liberação de Nicotina/normas , Desenho de Equipamento/normas , Desenho de Equipamento/tendências , Nebulizadores e Vaporizadores/normas , Nebulizadores e Vaporizadores/tendências , Previsões
8.
Medicina (Kaunas) ; 55(8)2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31366186

RESUMO

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.


Assuntos
Dicumarol/uso terapêutico , Cloreto de Polivinila/efeitos adversos , Materiais Biocompatíveis , Cateteres/efeitos adversos , Cateteres/microbiologia , Cateteres/normas , Dicumarol/normas , Desenho de Equipamento/métodos , Desenho de Equipamento/normas , Humanos , Cloreto de Polivinila/normas , Cloreto de Polivinila/uso terapêutico
9.
Cancer Radiother ; 23(6-7): 625-629, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31447346

RESUMO

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.


Assuntos
Fidelidade a Diretrizes , Agências Internacionais/normas , Neoplasias/radioterapia , Aceleradores de Partículas/normas , Radiocirurgia/instrumentação , Desenho de Equipamento/normas , Humanos , Imobilização/instrumentação , Fótons/uso terapêutico , Garantia da Qualidade dos Cuidados de Saúde , Radiocirurgia/métodos , Radiocirurgia/normas , Radioterapia Guiada por Imagem/normas
10.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(4): 307-309, 2019 Jul 30.
Artigo em Chinês | MEDLINE | ID: mdl-31460729

RESUMO

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.


Assuntos
Algoritmos , Transfusão de Sangue , Sistemas Microeletromecânicos , Transfusão de Sangue/instrumentação , Transfusão de Sangue/normas , Desenho de Equipamento/normas , Sistemas Microeletromecânicos/normas
11.
Nurs Child Young People ; 31(3): 38-46, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31468865

RESUMO

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.


Assuntos
Dispositivos de Acesso Vascular/tendências , Administração Intravenosa/instrumentação , Adolescente , Criança , Crianças com Deficiência/reabilitação , Crianças com Deficiência/estatística & dados numéricos , Desenho de Equipamento/normas , Humanos , Qualidade de Vida/psicologia , Reino Unido , Dispositivos de Acesso Vascular/efeitos adversos
12.
BMJ ; 366: l4230, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266745

RESUMO

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.


Assuntos
Artroplastia de Quadril , Desenho de Equipamento , Prótese de Quadril , Complicações Pós-Operatórias , Reoperação , Idoso , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Cerâmica/uso terapêutico , Análise Custo-Benefício , Desenho de Equipamento/métodos , Desenho de Equipamento/normas , Feminino , Prótese de Quadril/classificação , Prótese de Quadril/normas , Humanos , Masculino , Próteses Articulares Metal-Metal , Osteoartrite do Quadril/cirurgia , Polietileno/uso terapêutico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Falha de Prótese/efeitos adversos , Reoperação/métodos , Reoperação/estatística & dados numéricos , Reino Unido
13.
Work ; 63(3): 415-426, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256108

RESUMO

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.


Assuntos
Desenho de Equipamento/normas , Síndrome da Vibração do Segmento Mão-Braço/complicações , Dor/classificação , Adulto , Síndrome da Vibração do Segmento Mão-Braço/psicologia , Humanos , Masculino , Dor/psicologia
14.
Artigo em Inglês | MEDLINE | ID: mdl-31234466

RESUMO

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.


Assuntos
Desenho de Equipamento/normas , Ruído , Exposição Ocupacional/normas , Vibração , Agricultura/instrumentação , União Europeia , Exposição Ocupacional/análise
15.
Emerg Med J ; 36(8): 456-458, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31217181

RESUMO

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.


Assuntos
Comunicação , Socorristas/estatística & dados numéricos , Desenho de Equipamento/normas , Substâncias Perigosas/efeitos adversos , Ventiladores Mecânicos/efeitos adversos , Desenho de Equipamento/estatística & dados numéricos , Desenho de Equipamento/tendências , Humanos , Inteligibilidade da Fala , Inquéritos e Questionários , Avaliação da Tecnologia Biomédica/métodos , Avaliação da Tecnologia Biomédica/estatística & dados numéricos , Reino Unido , Ventiladores Mecânicos/estatística & dados numéricos , Ventiladores Mecânicos/tendências , Qualidade da Voz
16.
Anaesthesia ; 74(11): 1406-1415, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31161650

RESUMO

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.


Assuntos
Desenho de Equipamento/métodos , Respiração Artificial/instrumentação , Ventiladores Mecânicos/economia , Desenho de Equipamento/economia , Desenho de Equipamento/normas , Humanos , Respiração Artificial/economia , Ventiladores Mecânicos/normas
17.
J Tissue Viability ; 28(3): 125-132, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31174961

RESUMO

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.


Assuntos
Umidade/efeitos adversos , Tampões Absorventes para a Incontinência Urinária/normas , Pele/lesões , Adulto , Biomarcadores/análise , Biomarcadores/sangue , Inglaterra , Desenho de Equipamento/normas , Feminino , Voluntários Saudáveis/estatística & dados numéricos , Humanos , Umidade/prevenção & controle , Inflamação/sangue , Inflamação/diagnóstico , Interleucina-1alfa/análise , Interleucina-1alfa/sangue , Masculino , Pessoa de Meia-Idade , Pressão/efeitos adversos , Lesão por Pressão/fisiopatologia , Lesão por Pressão/prevenção & controle , Proteínas/análise , Pele/irrigação sanguínea , Pele/fisiopatologia , Higiene da Pele/métodos
18.
Cardiovasc Intervent Radiol ; 42(8): 1168-1174, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31076839

RESUMO

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.


Assuntos
Embolização Terapêutica/instrumentação , Desenho de Equipamento/normas , Aneurisma Intracraniano/terapia , Stents/normas , Angiografia Digital/métodos , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada/métodos , Embolização Terapêutica/métodos , Feminino , Humanos , Imagem Tridimensional/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
19.
JMIR Mhealth Uhealth ; 7(5): e12293, 2019 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-31140439

RESUMO

BACKGROUND: To our knowledge, few studies have examined the use of wearable sensing devices to effectively integrate information communication technologies and apply them to health care issues (particularly those pertaining to posture correction). OBJECTIVE: A novel system for posture correction involving the application of wearable sensing technology was developed in this study. The system was created with the aim of preventing the unconscious development of bad postures (as well as potential spinal diseases over the long term). METHODS: The newly developed system consists of a combination of 3 subsystems, namely, a smart necklace, notebook computer, and smartphone. The notebook computer is enabled to use a depth camera to read the relevant data, to identify the skeletal structure and joint reference points of a user, and to compute calculations relating to those reference points, after which the computer then sends signals to the smart necklace to enable calibration of the smart necklace's standard values (base values for posture assessment). The gravitational acceleration data of the user are collected and analyzed by a microprocessor unit-6050 sensor housed in the smart necklace when the smart necklace is worn, with those data being used by the smart necklace to determine the user's body posture. When poor posture is detected by the smart necklace, the smart necklace sends the user's smartphone a reminder to correct his or her posture; a mobile app that was also developed as part of the study allows the smart necklace to transmit such messages to the smartphone. RESULTS: The system effectively enables a user to monitor and correct his or her own posture, which in turn will assist the user in preventing spine-related diseases and, consequently, in living a healthier life. CONCLUSIONS: The proposed system makes it possible for (1) the user to self-correct his or her posture without resorting to the use of heavy, thick, or uncomfortable corrective clothing; (2) the smart necklace's standard values to be quickly calibrated via the use of posture imaging; and (3) the need for complex wiring to be eliminated through the effective application of the Internet of Things as well as by implementing wireless communication between the smart necklace, notebook computer, and smartphone.


Assuntos
Postura , Dispositivos Eletrônicos Vestíveis/tendências , Acelerometria/instrumentação , Desenho de Equipamento/métodos , Desenho de Equipamento/normas , Desenho de Equipamento/estatística & dados numéricos , Humanos , Smartphone/tendências , Doenças da Coluna Vertebral/prevenção & controle , Dispositivos Eletrônicos Vestíveis/estatística & dados numéricos , Tecnologia sem Fio/instrumentação
20.
BMC Anesthesiol ; 19(1): 87, 2019 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138143

RESUMO

BACKGROUND: Patient monitoring is critical for perioperative patient safety as anesthesiologists routinely make crucial therapeutic decisions from the information displayed on patient monitors. Previous research has shown that today's patient monitoring has room for improvement in areas such as information overload and alarm fatigue. The rationale of this study was to learn more about the problems anesthesiologists face in patient monitoring and to derive improvement suggestions for next-generation patient monitors. METHODS: We conducted a two-center qualitative/quantitative study. Initially, we interviewed 120 anesthesiologists (physicians and nurses) about the topic: common problems with patient monitoring in your daily work. Through deductive and inductive coding, we identified major topics and sub themes from the interviews. In a second step, a field survey, a separate group of 25 anesthesiologists rated their agree- or disagreement with central statements created for all identified major topics. RESULTS: We identified the following six main topics: 1. "Alarms," 2. "Artifacts," 3. "Software," 4. "Hardware," 5. "Human Factors," 6. "System Factors," and 17 sub themes. The central statements rated for the major topics were: 1. "problems with alarm settings complicate patient monitoring." (56% agreed) 2. "artifacts complicate the assessment of the situation." (64% agreed) 3. "information overload makes it difficult to get an overview quickly." (56% agreed) 4. "problems with cables complicate working with patient monitors." (92% agreed) 5. "factors related to human performance lead to critical information not being perceived." (88% agreed) 6. "Switching between monitors from different manufacturers is difficult." (88% agreed). The ratings of all statements differed significantly from neutral (all p < 0.03). CONCLUSION: This study provides an overview of the problems anesthesiologists face in patient monitoring. Some of the issues, to our knowledge, were not previously identified as common problems in patient monitoring, e.g., hardware problems (e.g., cable entanglement and worn connectors), human factor aspects (e.g., fatigue and distractions), and systemic factor aspects (e.g., insufficient standardization between manufacturers). An ideal monitor should transfer the relevant patient monitoring information as efficiently as possible, prevent false positive alarms, and use technologies designed to improve the problems in patient monitoring.


Assuntos
Anestesiologistas/normas , Atitude do Pessoal de Saúde , Desenho de Equipamento/normas , Monitorização Intraoperatória/normas , Enfermeiras Anestesistas/normas , Qualidade da Assistência à Saúde/normas , Anestesiologistas/psicologia , Desenho de Equipamento/métodos , Desenho de Equipamento/psicologia , Feminino , Humanos , Masculino , Monitorização Intraoperatória/métodos , Monitorização Intraoperatória/psicologia , Inquéritos e Questionários
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA