Clinical Engineering

An experimental analysis was carried out to evaluate the effects induced by a membrane oxygenator on the pressure exerted by a roller pump in a hydraulic circuit for extracorporeal circulation (ECC). The research was conducted with two catheter pressure transducers whose signals were gathered by means of an automatic data acquisition system. The tests were carried out using a blood substitute (Emagel"') that shows density and viscosity values similar to those of the hemodiluted blood. An overall examination of the obtained results, with a circuit simulating an ECC system used in the operating room, allows a quantification of the noticeable reduction in amplitude and bandwidth of the pressure wave, measured in the aortic arch of the patient. A membrane oxygenator seriously limits any effort, in ECC, to reproduce a physiological wave in order to have a correct blood perfusion.

The Infusion Pump (IP) is a Medical-Hospital Equipment (MHE) that is used to regulate the passage of liquids that will be infused into the patient due to the positive pressure generated by the pump. There are three main types of failure causes that can occur in MHE: human error, technology failure, and external phenomena. At the Maternidade Escola Januário Cicco (MEJC), located at Natal, RN, most of the maintenance events in the IPs came from de lack of information from the professionals who handled the equipment, as well as from human error. The present study describes the training in IPs to the medical staff (nurses, nursing technician, and physician), elaborated and performed during the curriculum internship of one of the authors and aims to compare the number of maintenance calls in IPs before and after training to assess the impact of training. For this, the occurrence numbers were obtained before and after training, and a comparison was made between the results. There was a drop of more than 70% in the number of internal maintenance services, showing that the training is very important within the hospital environment.

Resumen-El sistema de salud moderno confía en los dispositivos y equipos médicos para brindar mayor calidad y mejor servicio a los pacientes. El cuidado proporcionado por los entes prestadores de servicios de salud, como clínicas y hospitales, depende de esta tecnología, mejorar y optimizar los servicios de atención y tratamiento de la salud de los pacientes. Por lo anterior, es muy importante contar con una persona capacitada que pueda proporcionar con eficacia un plan para la adquisición, mantenimiento y reemplazo de estos equipos médicos, y además, que esté en condiciones de optimizar la relación costo/beneficio en la institución. El ingeniero clínico es aquella persona capaz de desarrollar el plan de adquisición que beneficiará, no sólo a la institución prestadora de servicios de salud, sino también al paciente y al personal médico. Este artículo busca brindar, tanto al personal administrativo como al clínico, unas pautas básicas sobre el proceso de adquisición de la tecnología biomédica.

"The clinical bacteria of multi-drug resistant to some antibiotics are
considered a common problem in the world wide. Alternative
antibacterial strategies are urgently needed, and thus this situation
has led to a re-evaluation of the therapeutic use of ancient
remedies, such as plants and plant-based products, including
Nigella sativa (N. sativa). This study aimed to evaluate the
antibacterial activity of Yemeni N. sativa oil against some Clinical
Bacterial Isolates (CBI) and Control Strains of Bacteria (CSB) in
comparison with Augmentin® (Amoxicillin and Clavulanic Acid).
This study was carried out in Sana’a city during the period of one
year from May 2012 to April 2013. The antibacterial activity of oil
with different concentrations was determined by using disc agar
diffusion technique against CBI (Staphylococcus aureus and
Pseudomonas aeruginosa) and CSB (Staphylococcus aureus
ATCC25619, Pseudomonas aeruginosa ATCC29737), also the
Minimum Inhibition Concentration (MIC) of oil extract was
determined. The results indicated that, the highest significant
antibacterial activity was at the maximum concentration of the oil
against Staphylococcus aureus and Pseudomonas aeruginosa in
comparison with Augmentin ® discs (p < 0.05) respectively. This
study observed that, there was strong positive correlation between
the diameter zone (DZ-mm) and oil concentrations (%). In
addition, the DZ (mm) of the oil for CSB was higher than CBI.
Also the oil activity was found to be more effective against
Staphylococcus aureus than Pseudomonas aeruginosa. On the
other hand, the MIC of the oil against CBI were ranged between ≥
0.5% and 4%. Whereas, the CSB particularly Staphylococcus
aureus were sensitive to low concentrations of oil. It could be
concluded that, the oil had high antibacterial effect against CSB
and CBI with high concentration and more effective than
Augmentin® discs."

Background With many medical equipment in hospitals coming in direct contact with healthcare workers, patients, technicians, cleaners and sometimes care givers, it is important to pay close attention to their capacity in harboring potentially harmful pathogens. The goal of this study was to assess the role that medical equipment may potentially play in hospital acquired infections in four public health facilities in Uganda. Methods A cross-sectional study was conducted from December 2017 to January 2018 in four public health facilities in Uganda. Each piece of equipment from the neonatal department, imaging department or operating theatre were swabbed at three distinct points: a location in contact with the patient, a location in contact with the user, and a remote location unlikely to be contacted by either the patient or the user. The swabs were analyzed for bacterial growth using standard microbiological methods. Seventeen bacterial isolates were randomly selected and tested for ...

Background With many medical equipment in hospitals coming in direct contact with healthcare workers, patients, technicians, cleaners and sometimes care givers, it is important to pay close attention to their capacity in harboring potentially harmful pathogens. The goal of this study was to assess the role that medical equipment may potentially play in hospital acquired infections in four public health facilities in Uganda. Methods A cross-sectional study was conducted from December 2017 to January 2018 in four public health facilities in Uganda. Each piece of equipment from the neonatal department, imaging department or operating theatre were swabbed at three distinct points: a location in contact with the patient, a location in contact with the user, and a remote location unlikely to be contacted by either the patient or the user. The swabs were analyzed for bacterial growth using standard microbiological methods. Seventeen bacterial isolates were randomly selected and tested for ...

Backgrounds and Objective: Advancements in technology have led to great strides in research and innovation that have improved healthcare provision around the world. However, the majority of the technology available is underutilized in Sub-Saharan Africa. In addition, the ever-increasing sophistication and cost of medical equipment means that access and proper use is limited in low-and middle-income countries (LMICs). There is, however, a general paucity of well-documented evidence for the utilization of medical equipment in LMICs. Therefore, this study evaluates the current availability and utilization of medical equipment in tertiary hospitals and research facilities in Uganda and provides baseline information to clinical/biomedical engineers, innovators, managers, and policymakers. Material and Methods: The study evaluated the equipment currently used in 9 purposively selected public tertiary hospitals and 5 research laboratories representing different regions of Uganda. Data were collected by personnel specialized in biomedical engineering utilizing a mixed-method approach that involved inventory taking and surveys directed to the health workers in the designated health facilities. Results: The hospitals contributed 1995 (85%) pieces of medical equipment while the research laboratories contributed 343 (15%) pieces amounting to 2338 pieces of equipment involved in the study. On average, 34% of the medical equipment in the health facilities was faulty, and 85.6% lacked manuals. Discussion and conclusion: Although innovative solutions and donated equipment address the immediate and long-term goals of resource-constrained settings, our study demonstrated several issues around existing medical devices, and these need immediate attention.

A simple mathematical model has been developed to identify and prioritize medical equipment in need of replacement. The model contains a total of ten attributes addressing four primary replacement issues: equipment service and support; equipment function; cost benefits; and clinical efficacy. Sensitivity to incomplete or subjective data is significantly reduced through the use of a •yes•no ft (0, 1) scoring scheme. Decision.making validity does not appear to be compromised with such a technique. When tested on a sample of 146 medical devices in five different categories. the model recommended that two devices be replaced within the existing fiscal year and eight in the following year, and that fifteen devices be placed in an advisory category. The model's recommendations appear to be compatible with existing subjective criteria.

Establishing causal relations between random variables from observational data is perhaps the most important challenge in today's science. In remote sensing and geosciences this is of special relevance to better understand the Earth's system and the complex interactions between the governing processes. In this paper, we focus on observational causal inference, thus we try to estimate the correct direction of causation using a finite set of empirical data. In addition, we focus on the more complex bivariate scenario that requires strong assumptions and no conditional independence tests can be used. In particular, we explore the framework of (non-deterministic) additive noise models, which relies on the principle of independence between the cause and the generating mechanism. A practical algorithmic instantiation of such principle only requires 1) two regression models in the forward and backward directions, and 2) the estimation of statistical independence between the obtained residuals and the observations. The direction leading to more independent residuals is decided to be the cause. We instead propose a criterion that uses the sensitivity (derivative) of the dependence estimator, the sensitivity criterion allows to identify samples most affecting the dependence measure, and hence the criterion is robust to spurious detections. We illustrate performance in a collection of 28 geoscience causal inference problems, in a database of radiative transfer models simulations and machine learning emulators in vegetation parameter modeling involving 182 problems, and in assessing the impact of different regression models in a carbon cycle problem. The criterion achieves stateof-the-art detection rates in all cases, it is generally robust to noise sources and distortions. The presented approach confirms the validity in observational bi-variate problems in the Earth sciences.

This paper presents the results of a survey about technovigilance carried out in 21 clinical institutions from the southwest of Colombia. It also provides an analysis of how these programs take into account different risk management methodologies in order to create awareness of the importance of patient safety in all members of the staff and improve the quality of the health services provided.

Hospitals outsource several activities of the service support in order to focus on the core healthcare production as maintenance service. Recently, faced to the sophistication and the costs of medical equipment that continue to escalate, governments have implemented new reforms to control costs and improve the efficiency and the quality. Hospitals become interested in minimizing the total operational cost, by optimizing healthcare production planning and their support activities. Reorganizing the medical equipment maintenance service becomes a priority for the hospital managers to reduce the cost and the dependency on external parties while ensuring that the medical devices are safe, accurate, and operating at the required level of performance. In this article, we propose an efficient procedure to take the appropriate decisions for medical equipment maintenance such as the selection of maintenance strategy, the insourcing/outsourcing, and the selection of contracts_ type and content. A practical application of this procedure in the Tunisian context is considered. Nevertheless, our procedure is general and can be tailored to hospitals in both developed and developing countries. Modern medical devices and equipment have become very complex and sophisticated and are expected to operate under stringent environments. Hospitals must ensure that their critical medical devices are safe, accurate, reliable and operating at the required level of performance. 1 According to Khalaf, 2 the greatest problem for many developing countries is not the lack of equipment, but rather that 50% and sometimes up to 75% of the equipment supplied is not operative. As cited by the Centre for Biomedical Engineering and Hospital Maintenance, 3 the main purpose of a biomedical maintenance service is to ensure patient and user safety by maintaining an optimal performance for all biomedical devices. The complexity and the cost of biomedical maintenance have risen sharply in the last few decades. In fact, a maintenance activity is of different types: & Corrective maintenance: This activity is performed after detecting a failure and intended to return the medical device to an operational state. 4 According to Rahman and Chattopadhyay, 5 the strategy of running the equipment until failure does not require any extra labor or a special budget to be applied. Yet, the random downtime and the overuse of the labor to repair the equipment can be costly. & Preventive maintenance: This activity is performed at predetermined intervals or according to prescribed criteria and intended to reduce the probability of failure or the degradation of medical equipment. 6 Preventive maintenance is considered to be potentially effective according to Gits 7 when the equipment suffers from wear-out phenomenon; that is, it has an increasing failure rate. We distinguish 2 categories of preventive maintenance activities: Time-based maintenance (TBM): In this category, the equipment is periodically checked and maintained. This activity can reduce the failure rate of equipment. However, it requires specific resources such as budget and labor to be implemented. 6 Condition-based maintenance (CBM): It requires regular assessment of the system condition during operation. For this category, we need special sensors to measure the prediction variables. 5 Moreover, a statistical model is required to relate the measured variables to the equipment (state) health, for example, equipment remaining useful life.

The rate of male breast cancer has increased in recent years, due to the deficiency of preventive examinations (male mammography). Besides, since male breasts are generally smaller than female breasts, it is essential to monitor the doses received by male breasts, as well as those received by close, healthy and critical organs in order to assess the plan used in this kind of treatment. To do this, the distribution of doses in male breasts was simulated and assessed, based on the procedures adopted in the treatment of female breasts, when submitted to a radiation beam from a linear accelerator. The Alderson Rando phantom was used and the relevant absorbed doses were measured by TLD-100 thermoluminescent dosimeters distributed throughout the volume of interest. The results of the treatment planning were compared with the results obtained by TLDs. A difference of up to 8.5%, in comparison with the planned dose, as well as a 6% relative standard deviation was found.

The healthcare industry is the largest industry in the US, and costs are growing rapidly. There is also an increase in waste, medical errors and patient injuries. One central problem is that hospitals have compartmentalized and disaggregated business models in which clinical specialists duplicate information. An international project called Integrating the Healthcare Enterprise (IHE) is underway to develop consistent information enterprise architectures for hospitals. The Operating Room (OR) is one of the most complex parts of the hospital, involving many other departments like laboratory, radiology, pathology, pharmacy, anesthesiology and billing, so a formal IHE design for the OR has not yet begun. This current research describes a collaborative workflow model for the OR using Event-Driven Process Chains, a popular and successful process reengineering tool used in ERP systems engineering.

Editor's Summary intervention in cancer. the iKnife technology is ready for widespread use in the operating room to improve the accuracy of surgical histology, with low rates of false-positive and false-negative readouts. This first-in-human demonstration shows that 81 patients. These spectra, when matched against the previously created database, confirmed the results of normal samples surgical smoke for mass spectrometric analysis. More than 800 spectra were acquired with the iKnife from To adapt this technology for use in vivo, during surgery, the authors created the ''intelligent knife'' (iKnife), which metastatic tumors ex vivo.

Spinal fusion is typically performed for treatment of a variety of problems such as fractured vertebrae, and correction of spinal curvature deformities (e.g. scoliosis), Transpedicular spinal fusion is a particular type of spinal fusion that involves the use of large screws (pedicle screws) to fix a corrective structure to the spine. As illustrated in , these screws are attached to the pedicle.

To determine the maturity of a profession one must have knowledge of the individual attributes of the practitioners of that profession and the universal strength of unique skills among them. We have conducted an international survey of Clinical Engineering (CE) professionals associated with the management of technological tools developed for and deployed within the healthcare delivery system. The survey targeted participants who are practicing engineering tasks related to the safe and efficient management of technology used in the delivery of healthcare services. The participants, consisted of cohort of individuals whose contact information was collected from attendees at previous clinical and biomedical engineering events including: (1) presentation at congresses/regional meetings, (2) serving on international technical committees or task forces, (3) attending virtual clinical engineering events, or (4) subscribing to the Global Clinical Engineering Journal. The purpose of the surv...

Background With many medical equipment in hospitals coming in direct contact with healthcare workers, patients, technicians, cleaners and sometimes care givers, it is important to pay close attention to their capacity in harboring potentially harmful pathogens. The goal of this study was to assess the role that medical equipment may potentially play in hospital acquired infections in four public health facilities in Uganda. Methods A cross-sectional study was conducted from December 2017 to January 2018 in four public health facilities in Uganda. Each piece of equipment from the neonatal department, imaging department or operating theatre were swabbed at three distinct points: a location in contact with the patient, a location in contact with the user, and a remote location unlikely to be contacted by either the patient or the user. The swabs were analyzed for bacterial growth using standard microbiological methods. Seventeen bacterial isolates were randomly selected and tested for ...

An Algorithm For Microprocessor-Based QRS Detection OMAR ESCALONA, BS GIANFRANCO PASSARIELLO, IE, M.Eng. FERNANDO MORA, IE, MS Departamento de Electrónica y Circuitos, Universidad Simon Bolivar, Caracas, Venezuela Qns detection is fundamental ...

En este trabajo se presentan los resultados obtenidos tras analizar la información recolectada en once instituciones prestadoras de servicios de salud (IPS) en la ciudad de Cali y municipios aledaños, sobre tres elementos clave para la buena práctica de la Ingeniería Clínica: adquisición de tecnología, gestión de mantenimiento y formación del personal. Se realizó una comparación entre las prácticas actuales de IC en las IPS encuestadas y las prácticas propuestas en la literatura existente. Se propone además una serie de aspectos a tomar en cuenta con miras a mejorar el desempeño de los departamentos de IC tanto en la ciudad como en el país.

This study aimed to test a protocol of measurements based on Biophotogrammetry to Analysis of Respiratory Mechanics (BARM) in healthy children. Seventeen normal spirometric children (six male and 11 female) were tested. Their performed maneuvers of forced inspiratory vital capacity were recorded in the supine position. The images were acquired by a digital camera, laterally placed to the trunk. Surface markers allowed that the files, exported to CorelDraw® software, were processed by irregular trapezoids paths. Compartments were defined in the thoracic (TX), abdominal (AB) and the chest wall (CW). They were defined at the end of an inspiration and expiration, both maximum, controlled by a digital spirometer. The result showed that the measured areas at the inspiratory and expiratory periods were statistically different (p<0.05). It reflects the mobility of CW and compartments. In conclusion, the proposed method can identify the breathing pattern of the measured subject using images in two dimensions (2D).

Background With many medical equipment in hospitals coming in direct contact with healthcare workers, patients, technicians, cleaners and sometimes care givers, it is important to pay close attention to their capacity in harboring potentially harmful pathogens. The goal of this study was to assess the role that medical equipment may potentially play in hospital acquired infections in four public health facilities in Uganda. Methods A cross-sectional study was conducted from December 2017 to January 2018 in four public health facilities in Uganda. Each piece of equipment from the neonatal department, imaging department or operating theatre were swabbed at three distinct points: a location in contact with the patient, a location in contact with the user, and a remote location unlikely to be contacted by either the patient or the user. The swabs were analyzed for bacterial growth using standard microbiological methods. Seventeen bacterial isolates were randomly selected and tested for ...

Backgrounds and Objective: Advancements in technology have led to great strides in research and innovation that have improved healthcare provision around the world. However, the majority of the technology available is underutilized in Sub-Saharan Africa. In addition, the ever-increasing sophistication and cost of medical equipment means that access and proper use is limited in low- and middle-income countries (LMICs). There is, however, a general paucity of well-documented evidence for the utilization of medical equipment in LMICs. Therefore, this study evaluates the current availability and utilization of medical equipment in tertiary hospitals and research facilities in Uganda and provides baseline information to clinical/biomedical engineers, innovators, managers, and policymakers.Material and Methods: The study evaluated the equipment currently used in 9 purposively selected public tertiary hospitals and 5 research laboratories representing different regions of Uganda. Data were...

To perform spectral analysis of noise generated by equipments and activities in a level III neonatal intensive care unit (NICU) and measure the real time sequential hourly noise levels over a 15 day period. Noise generated in the NICU by individual equipments and activities were recorded with a digital spectral sound analyzer to perform spectral analysis over 0.5 - 8 KHz. Sequential hourly noise level measurements in all the rooms of the NICU were done for 15 days using a digital sound pressure level meter . Independent sample t test and one way ANOVA were used to examine the statistical significance of the results. The study has a 90 % power to detect at least 4 dB differences from the recommended maximum of 50 dB with 95 % confidence. The mean noise levels in the ventilator room and stable room were 19.99 dB (A) sound pressure level (SPL) and 11.81 dB (A) SPL higher than the maximum recommended of 50 dB (A) respectively ( p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The equipments generated 19.11 dB SPL higher than the recommended norms in 1 - 8 KHz spectrum. The activities generated 21.49 dB SPL higher than the recommended norms in 1 - 8 KHz spectrum ( p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The ventilator and nebulisers produced excess noise of 8.5 dB SPL at the 0.5 KHz spectrum. Noise level in the NICU is unacceptably high .Spectral analysis of equipment and activity noise have shown noise predominantly in the 1 - 8 KHz spectrum. These levels warrant immediate implementation of noise reduction protocols as a standard of care in the NICU.

Introduction: On an annual basis, the total number of obstetrics and gynecological, urological, and colorectal surgeries amount to just over 3 million (Rothrock, 2014). These surgeries face a 6% risk of experiencing intraoperative complications such as bladder and ureteral lacerations. To remedy such complications safely and effectively, surgeons need adequate access to the site of injury, which is usually achieved by repositioning the patient between supine and lithotomy. We report the design and development of a permanent Operating Room (OR) table attachment that transitions patients intraoperatively between supine and lithotomy. Our approach was compared to that with Yellofin stirrups (Allen Medical, 2017), the current gold standard for lithotomy repositioning.