Biomedical Instrumentation and Technology最新文献

{"title":"Lint Fiber-Associated Medical Complications Following Invasive Procedures.","authors":"Wava Truscott","doi":"10.2345/0899-8205-57.s1.5","DOIUrl":"10.2345/0899-8205-57.s1.5","url":null,"abstract":"","PeriodicalId":35656,"journal":{"name":"Biomedical Instrumentation and Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10508855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9421993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Characteristics Associated With Higher Rates of Monitor Alarms.","authors":"Halley Ruppel, Spandana Makeneni, Irit R Rasooly, Daria F Ferro, Christopher P Bonafide","doi":"10.2345/0899-8205-57.4.171","DOIUrl":"10.2345/0899-8205-57.4.171","url":null,"abstract":"<p><p><b><i>Background:</i></b> Continuous physiologic monitoring commonly is used in pediatric medical-surgical (med-surg) units and is associated with high alarm burden for clinicians. Characteristics of pediatric patients generating high rates of alarms on med-surg units are not known. <b><i>Objective:</i></b> To describe the demographic and clinical characteristics of pediatric med-surg patients associated with high rates of clinical alarms. <b><i>Methods:</i></b> We conducted a cross-sectional, single-site, retrospective study using existing clinical and alarm data from a children's hospital. Continuously monitored patients from med-surg units who had available alarm data were included. Negative binomial regression models were used to test the association between patient characteristics and the rate of clinical alarms per continuously monitored hour. <b><i>Results:</i></b> Our final sample consisted of 1,569 patients with a total of 38,501 continuously monitored hours generating 265,432 clinical alarms. Peripheral oxygen saturation (SpO₂) low alarms accounted for 57.5% of alarms. Patients with medical complexity averaged 11% fewer alarms per hour than those without medical complexity (<i>P</i> < 0.01). Patients older than 5 years had up to 30% fewer alarms per hour than those who were younger than 5 years (<i>P</i> < 0.01). Patients using supplemental oxygen averaged 39% more alarms per hour compared with patients who had no supplemental oxygen use (<i>P</i> < 0.01). Patients at high risk for deterioration averaged 19% more alarms per hour than patients who were not high risk (<i>P</i> = 0.01). <b><i>Conclusion:</i></b> SpO₂ alarms were the most common type of alarm in this study. The results highlight patient populations in pediatric medical-surgical units that may be high yield for interventions to reduce alarms. Most physiologic monitor alarms in pediatric medical-surgical (med-surg) units are not informative and likely could be safely eliminated to reduce noise and alarm fatigue.¹^-³ However, identifying and sustaining successful alarm-reduction strategies is a challenge. Research shows that 25% of patients in pediatric med-surg units produce almost three-quarters of all alarms.⁴ These patients are a potential high-yield target for alarm-reduction strategies; however, we are not aware of studies describing characteristics of pediatric patients generating high rates of alarms. The patient populations seen on pediatric med-surg units are diverse. Children of all ages are cared for on these units, with diagnoses ranging from acute respiratory infections, to management of chronic conditions, and to psychiatric conditions. Not all patients on pediatric med-surg units have physiologic parameters continuously monitored,⁴ but among those who do, understanding patient characteristics associated with high rates of alarms may help clinicians, healthcare technology managemen","PeriodicalId":35656,"journal":{"name":"Biomedical Instrumentation and Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10764059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139088870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chemical Changes Over Time Associated with Protein Drying.","authors":"Allan Kimble, Christopher Ratanski, Terra A Kremer","doi":"10.2345/0899-8205-57.2.52","DOIUrl":"10.2345/0899-8205-57.2.52","url":null,"abstract":"<p><p>Upon drying, physical changes of the characteristics of proteins are observed by coagulation, but the nature and chronology of these changes have not been well studied. Coagulation changes the structure of protein from liquid to a solid or a thicker liquid by heat, mechanical action, or acids. Changes may have implications regarding the cleanability of reusable medical devices; therefore, an understanding of the chemical phenomena associated with drying of proteins is essential to ensuring adequate cleaning and mitigation of retained surgical soils. Using a high-performance gel permeation chromatography analysis with right-angle light-scattering detector at 90°, it was demonstrated that as soils dry, the molecular weight distribution changes. From the experimental evidence, the molecular weight distribution trends over time with drying to higher values. This is interpreted as a combination of oligomerization, degradation, and entanglement. As water is removed through evaporation, the distance between proteins decreases and their interactions increase. Albumin will polymerize into higher-molecular-weight oligomers, decreasing its solubility. Mucin, commonly found in the gastrointestinal tract to prevent infection, will degrade in the presence of enzymes releasing low-molecular-weight polysaccharides and leaving behind a peptide chain. The research described in this article investigated this chemical change.</p>","PeriodicalId":35656,"journal":{"name":"Biomedical Instrumentation and Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10512996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10032635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technological Intervention to Improve Alarm Management in Acute Care Telemetry Units.","authors":"Cora R Lehet, Julie A Lopez, Robert J Frank, Maria Cvach","doi":"10.2345/0899-8205-57.2.67","DOIUrl":"10.2345/0899-8205-57.2.67","url":null,"abstract":"<p><p><b><i>Background:</i></b> Telemetry monitoring is intended to improve patient safety and reduce harm. However, excessive monitor alarms may have the undesired effect of staff ignoring, silencing, or delaying a response due to alarm fatigue. Outlier patients, or those patients who are responsible for generating the most monitor alarms, contribute to excessive monitor alarms. <b><i>Methods:</i></b> Daily alarm data reports at a large academic medical center indicated that one or two patient outliers generated the most alarms daily. A technological intervention aimed at reminding registered nurses (RNs) to adjust alarm thresholds for patients who triggered excessive alarms was implemented. The notification was sent to the assigned RN's mobile phone when a patient exceeded the unit's seven-day average of alarms per day by greater than 400%. <b><i>Results:</i></b> A reduction in average alarm duration was observed across the four acute care telemetry units (<i>P</i> < 0.001), with an overall decrease of 8.07 seconds in the postintervention versus preintervention period. However, alarm frequency increased significantly (<i>χ</i>²₃ = 34.83, <i>P</i> < 0.001). <b><i>Conclusion:</i></b> Implementing a technological intervention to notify RNs to adjust alarm parameters may reduce alarm duration. Reducing alarm duration may improve RN telemetry management, alarm fatigue, and awareness. More research is needed to support this conclusion, as well as to determine the cause of the observed increase in alarm frequency.</p>","PeriodicalId":35656,"journal":{"name":"Biomedical Instrumentation and Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10512988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10032638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cleaning Challenges: Can Extended Soil Dry Times Be Reversed?","authors":"Julie Hoover, Mary Ann Drosnock, Christopher Carfaro, Terra A Kremer","doi":"10.2345/0899-8205-57.2.44","DOIUrl":"10.2345/0899-8205-57.2.44","url":null,"abstract":"<p><p><b><i>Background:</i></b> Cleaning is essential to ensuring the safe processing of reusable medical devices, and most manufacturers' instructions for use (IFUs) specify that clinical soil should not be allowed to dry on devices. If soil is allowed to dry, the cleaning challenge could be increased due to change in soil solubility. As a result, an additional step could be needed to reverse the chemical changes and return a device to a state where cleaning instructions are appropriate. <b><i>Methods:</i></b> Using a solubility test method and surrogate medical devices, the experiment described in this article challenged eight remediation conditions to which a reusable medical device might be exposed if soil is dried on a device. These conditions included soaking with water or neutral pH, enzymatic, or alkaline detergent cleaning agents, as well as conditioning with an enzymatic humectant foam spray. <b><i>Results:</i></b> The results demonstrated that only the alkaline cleaning agent was able to solubilize the extensively dried soil as effectively as the control, with a 15-minute soak being as effective as a 60-minute soak. <b><i>Discussion:</i></b> Although opinions vary, the overall data demonstrating the risk and chemical changes that occur when soil dries on medical devices are limited. Further, in cases in which soil is allowed to dry on devices for an extended time outside of the guidance from leading practices and manufacturers' IFUs, what additional steps or processes may be necessary to ensure that cleaning can be effective? <b><i>Conclusion:</i></b> This experiment demonstrated the effectiveness of a soaking step with an alkaline cleaning agent as an additional step if soil is dried on reusable medical devices, thus reversing the effect of an extended soil dry time.</p>","PeriodicalId":35656,"journal":{"name":"Biomedical Instrumentation and Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10508861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9698012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cleanability of Metal Surface Finishes Found in Medical Devices and the Environment of Care.","authors":"Jesiska Tandy,&nbsp;Kathy Hanhquynh Le,&nbsp;Garrett Michael Deane,&nbsp;Steven Joseph Burns","doi":"10.2345/1943-5967-56.2.29","DOIUrl":"https://doi.org/10.2345/1943-5967-56.2.29","url":null,"abstract":"<p><p>The surface finish of reusable medical devices often is a consideration during design, with attention paid to utility, aesthetics, and cost. To study the cleanability of metal surfaces of varying roughness and finish, soil made of bovine blood and egg yolk was placed on nickel alloy surface of varying average roughness (Ra) values (nominal values of 2-500 μin) and finishes (lapped, ground, milled, profiled, and shape turned). A commercially available wipe consisting of quaternary ammonium compound and less than 20% alcohol was applied for a total of eight wipe cycles to remove the soil. The wipe was applied in both horizontal and vertical directions. Evaluation methods for cleanliness include visual inspection and adenosine triphosphate (ATP) measurement. Rougher surfaces above nominal Ra of 250 were found to have higher ATP readings when wiped in both horizontal and vertical directions. In addition, different surface finishes have different cleanabilities despite similar nominal Ra. To ensure optimal cleaning, surfaces should be cleaned in multiple directions. In the future, similar studies will be coupled with efficacy studies and surfaces made with other materials will be investigated.</p>","PeriodicalId":35656,"journal":{"name":"Biomedical Instrumentation and Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9767432/pdf/i1943-5967-56-2-29.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9228491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Signaling Patient Oxygen Desaturation with Enhanced Pulse Oximetry Tones.","authors":"Penelope M Sanderson,&nbsp;Robert G Loeb,&nbsp;Helen Liley,&nbsp;David Liu,&nbsp;Estrella Paterson,&nbsp;Kelly Hinckfuss,&nbsp;Jelena Zestic","doi":"10.2345/0899-8205-56.2.46","DOIUrl":"https://doi.org/10.2345/0899-8205-56.2.46","url":null,"abstract":"<p><p>Manufacturers could improve the pulse tones emitted by pulse oximeters to support more accurate identification of a patient's peripheral oxygen saturation (SpO2) range. In this article, we outline the strengths and limitations of the variable-pitch tone that represents SpO2 of each detected pulse, and we argue that enhancements to the tone to demarcate clinically relevant ranges are feasible and desirable. The variable-pitch tone is an appreciated and trusted feature of the pulse oximeter's user interface. However, studies show that it supports relative judgments of SpO2 trends over time and is less effective at supporting absolute judgments about the SpO2 number or conveying when SpO2 moves into clinically important ranges. We outline recent studies that tested whether acoustic enhancements to the current tone could convey clinically important ranges more directly, without necessarily using auditory alarms. The studies cover the use of enhanced variable-pitch pulse oximeter tones for neonatal and adult use. Compared with current tones, the characteristics of the enhanced tones represent improvements that are both clinically relevant and statistically significant. We outline the benefits of enhanced tones, as well as discuss constraints of which developers of enhanced tones should be aware if enhancements are to be successful.</p>","PeriodicalId":35656,"journal":{"name":"Biomedical Instrumentation and Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9767428/pdf/i1943-5967-56-2-46.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9587263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aluminum Leaching from Fluid Warmers: Regulatory Deferral to Clinicians' Decision.","authors":"Marko Oydanich,&nbsp;Rotem Naftalovich,&nbsp;Patrick J Discepola,&nbsp;Jim Doran,&nbsp;Faraz A Chaudhry,&nbsp;Daniel J Eloy","doi":"10.2345/1943-5967-56.2.37","DOIUrl":"https://doi.org/10.2345/1943-5967-56.2.37","url":null,"abstract":"<p><p>Fluid-warming systems are crucial in surgical and trauma settings because of their key role in preventing or treating hypothermia and enabling proper resuscitation of blood products that are stored cold. Recently, several manufacturers have issued warnings of the possibility of aluminum leaching from their fluid warmers and cautioned about the potential for aluminum toxicity in patients who underwent fluid resuscitation with these devices. Studies suggest that one of the main factors affecting aluminum leaching in this setting is the coating of the aluminum plate itself. Coating, often with a biocompatible material, appears to reduce aluminum leaching by 100- to 200-fold compared with an uncoated plate. Nonetheless, leaching with the coating is still at a level exceeding U.S. regulations. A few aluminum-free warming systems are available on the market, but these are not carried by all providers and some clinicians may be less familiar with their use. Medical device manufacturers will likely design future warming systems with less potential for aluminum blood contact. In the meantime, the risk of inadequate resuscitation, consequent to the proper fluid warmer no longer being available, is contrasted with the risk of potential toxicity. In the situation described here, the regulators deferred the ultimate decision of which fluid warmer to use in a given situation to the risk-benefit decision of the clinician.</p>","PeriodicalId":35656,"journal":{"name":"Biomedical Instrumentation and Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9767429/pdf/i1943-5967-56-2-37.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9413565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detecting Unusual Intravenous Infusion Alerting Patterns with Machine Learning Algorithms.","authors":"Marian Obuseh,&nbsp;Denny Yu,&nbsp;Poching DeLaurentis","doi":"10.2345/0899-8205-56.2.58","DOIUrl":"https://doi.org/10.2345/0899-8205-56.2.58","url":null,"abstract":"<p><strong>Objective: </strong>To detect unusual infusion alerting patterns using machine learning (ML) algorithms as a first step to advance safer inpatient intravenous administration of high-alert medications.</p><p><strong>Materials and methods: </strong>We used one year of detailed propofol infusion data from a hospital. Interpretable and clinically relevant variables were feature engineered, and data points were aggregated per calendar day. A univariate (maximum times-limit) moving range (mr) control chart was used to simulate clinicians' common approach to identifying unusual infusion alerting patterns. Three different unsupervised multivariate ML-based anomaly detection algorithms (Local Outlier Factor, Isolation Forest, and k-Nearest Neighbors) were used for the same purpose. Results from the control chart and ML algorithms were compared.</p><p><strong>Results: </strong>The propofol data had 3,300 infusion alerts, 92% of which were generated during the day shift and seven of which had a times-limit greater than 10. The mr-chart identified 15 alert pattern anomalies. Different thresholds were set to include the top 15 anomalies from each ML algorithm. A total of 31 unique ML anomalies were grouped and ranked by agreeability. All algorithms agreed on 10% of the anomalies, and at least two algorithms agreed on 36%. Each algorithm detected one specific anomaly that the mr-chart did not detect. The anomaly represented a day with 71 propofol alerts (half of which were overridden) generated at an average rate of 1.06 per infusion, whereas the moving alert rate for the week was 0.35 per infusion.</p><p><strong>Discussion: </strong>These findings show that ML-based algorithms are more robust than control charts in detecting unusual alerting patterns. However, we recommend using a combination of algorithms, as multiple algorithms serve a benchmarking function and allow researchers to focus on data points with the highest algorithm agreeability.</p><p><strong>Conclusion: </strong>Unsupervised ML algorithms can assist clinicians in identifying unusual alert patterns as a first step toward achieving safer infusion practices.</p>","PeriodicalId":35656,"journal":{"name":"Biomedical Instrumentation and Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9767430/pdf/i1943-5967-56-2-58.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9702011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CMMS Database Migration in Clinical Engineering: Penn Medicine's Experience.","authors":"Richard Panichelli","doi":"10.2345/1943-5967-56.2.41","DOIUrl":"https://doi.org/10.2345/1943-5967-56.2.41","url":null,"abstract":"<p><p>Database migration involves the transferring of data from one system to another system and typically is associated with information systems, database administration, relational databases, analytics, and business intelligence. Database migration requires careful planning and poses many challenges related to data assessment and cleansing, migration, testing, and managing risks throughout the project. This article describes the database migration activities associated with Penn Medicine's initiative to insource the clinical engineering department at Princeton Health into the health system's corporate information services department. Achieving established milestones throughout the project was pivotal to its successful execution. Defining key goals and making business decisions that would positively affect and support the migration also was imperative. Moreover, the experience described here highlights multiple stages of a computerized maintenance management system (CMMS) database migration project, conveys the importance of building internal and external relationships, and addresses additional ways to improve on future migration projects.</p>","PeriodicalId":35656,"journal":{"name":"Biomedical Instrumentation and Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9767431/pdf/i1943-5967-56-2-41.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9413566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}