Improved Treatment of Postpartum Hemorrhage: Design, Development, and Bench-Top Validation of a Reusable Intrauterine Tamponade Device for Low-Resource Settings

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Katherine Hu ◽  
Maya M. Lapinski ◽  
Gavin Mischler ◽  
Robert H. Allen ◽  
Amir Manbachi ◽  
...  
Keyword(s):  
Postpartum Hemorrhage ◽  
Low Cost ◽  
Clinical Settings ◽  
Design Development ◽  
Low Resource Settings ◽  
Low Resource ◽  
Effective Interventions ◽  
Target Pressure ◽  
The Mean ◽  
Uterine Balloon Tamponade

Abstract Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, and effective interventions for addressing PPH are urgently needed. Uterine balloon tamponade (UBT) is a technique to control PPH. Commercially available UBT devices are expensive and frequently require imaging technology to ensure placement. Condom-catheter uterine tamponade (C-UBT) is a technique appropriate for low-resource settings. Testing of the C-UBT is needed to better understand and optimize this technique for use in a variety of clinical settings including low-resource contexts. We describe here the design, development, and bench-top validation of a reusable C-UBT device optimized for low-resource settings. The device was tested in three differently sized uterine models using a variety of condom balloon configurations. Intrauterine wall pressure application was measured to evaluate the device capacity to apply pressure of at least 90 mmHg, estimating the mean arterial pressure within the uterine vasculature. Bench-top experimental validation of pressure exerted in uterine models demonstrated the device's capability of reaching hemostatic pressure in uterine volumes ranging from 170 to 1740 mL. Device adaptability and versatility were shown through its ability to reach the target pressure of 90 mmHg in different uterine sizes by varying balloon parameters, including condom thickness and condom configuration. The results of this study show the potential of a low-cost, reusable C-UBT device optimized to treat PPH in a variety of clinical settings, including low-resource contexts.

scholarly journals Evaluation of a continuous neonatal temperature monitor for low-resource settings: a device feasibility pilot study

2020 ◽  
Vol 4 (1) ◽  
pp. e000655
Author(s):  
Sonia E. Sosa Saenz ◽  
Mary Kate Hardy ◽  
Megan Heenan ◽  
Z. Maria Oden ◽  
Rebecca Richards-Kortum ◽  
...  
Keyword(s):  
Clinical Evaluation ◽  
Low Cost ◽  
Low Resource Settings ◽  
Low Resource ◽  
Patient Monitor ◽  
Link Type ◽  
Temperature Monitor ◽  
The Mean ◽  
Neonatal Ward ◽  
Continuous Temperature

ObjectiveEvaluate a novel continuous temperature monitor in a low-resource neonatal ward.DesignWe developed a low-cost continuous neonatal temperature monitor (NTM) for use in low-resource settings. Accuracy of NTM was initially assessed in the laboratory. Clinical evaluation then was performed in a neonatal ward in a central hospital in Malawi; eligible neonates (<1 week of age) were recruited for continuous temperature monitoring with NTM and a Philips Intellivue MP30 Patient Monitor.Interventions and outcome measuresThe temperature probes of NTM and the reference patient monitor were attached to the infant’s abdomen, and core temperature was continuously recorded for up to 3 hours. Axillary temperatures were taken every hour. We compared temperatures measured using NTM, the patient monitor and the axillary thermometer.ResultsLaboratory temperature measurements obtained with NTM were within 0.059°C (range: −0.035°C to 0.195°C) of a reference thermometer. A total of 39 patients were recruited to participate in the clinical evaluation of NTM; data from four patients were excluded due to faulty hardware connections. The mean difference in measured temperatures between the NTM and the Intellivue MP30 was −0.04°C (95% CI −0.52°C to 0.44°C).ConclusionNTM meets ISO 80601-2-56 standards for accuracy and is an appropriate, low-cost continuous temperature monitor for neonatal wards in low-resource settings.Trial registration numbersNCT03965312 and NCT03866122.

Comparison of Papanicolaou Test With Visual Detection Tests in Screening for Cervical Cancer and Developing the Optimal Strategy for Low Resource Settings

2010 ◽  
Vol 20 (5) ◽  
pp. 862-868 ◽  
Author(s):  
Pakhee Aggarwal ◽  
Swaraj Batra ◽  
Gauri Gandhi ◽  
Vijay Zutshi
Keyword(s):  
Cervical Cancer ◽  
Predictive Value ◽  
Visual Inspection ◽  
Visual Detection ◽  
Alternative Methods ◽  
Papanicolaou Test ◽  
Low Resource Settings ◽  
Low Resource ◽  
The Mean ◽  
Sensitivity Specificity

Objectives:To compare the sensitivity, specificity, positive and negative predictive values, and accuracy of Papanicolaou test with visual inspection with acetic acid (VIA)/VIA using magnification devices (VIAM) and develop the best strategy for screening in low resource settings.Materials and Methods:This is a prospective cross-sectional study on 408 symptomatic multiparous women in the reproductive age group, sequentially using the Papanicolaou test, the VIA, and the VIAM for screening. Women with a positive screening test underwent guided biopsy and endocervical curettage. The site of biopsy was recorded. Histopathological findings were taken as the "gold" standard in comparing the methods.Results:The mean (SD) age was 32.3 (6.8) years (range, 15-49 years), whereas the mean (SD) parity was 2.9 (1.2) (range, 1-9). Abnormal cytological findings were detected in 2.9% patients, whereas the remaining smears were negative for any intraepithelial lesion or malignancy. A total of 113 cases were screened positive by one/all methods. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the Papanicolaou test, the VIA, and the VIAM were 24, 98, 42, 96, and 94%; 95, 78, 19, 99, and 79%; and 95, 78, 19, 99, and 79%, respectively, for high-grade lesions.Conclusions:The Papanicolaou test had low sensitivity but high specificity, whereas visual detection methods had a high sensitivity in addition to being cheaper. Alternative methods of screening such as VIA/VIAM can be a valuable alternative to the Papanicolaou test for cervical cancer screening in low resource settings. Visual inspection using magnification devices may be of benefit over VIA in doubtful cases.

scholarly journals O Papel da Ocitocina na Profilaxia da Hemorragia Pós-Parto em Locais com Recursos Limitados

2021 ◽  
Vol 34 (13) ◽  
Author(s):  
Inês Ferreira ◽  
Ana Reynolds
Keyword(s):  
Postpartum Hemorrhage ◽  
Healthcare Professionals ◽  
Cultural Barriers ◽  
Low Resource Settings ◽  
Low Resource ◽  
Widespread Access ◽  
Political Economic ◽  
Demand For Health ◽  
Cultural Constraints

Introduction: Postpartum hemorrhage remains one of the leading causes of maternal death globally. Oxytocin is the uterotonic agent of choice for the prophylaxis of this complication. However, its use in low-resource settings is associated with clinical, political, economic and cultural constraints. The goal of this article is to describe the use of oxytocin for postpartum hemorrhage prophylaxis in low-resource settings.Material and Methods: A literature review on the topic was carried out, and 24 articles were included.Results: The information was organized into seven sections: the evaluation of the efficacy of oxytocin compared to other uterotonics, the use of oxytocin in home births, the training of healthcare professionals, the quality of the available oxytocin, the new formulations, the risks associated with the use of uterotonic and the adopted health policies.Discussion: Despite the progress achieved widespread access to oxytocin for postpartum hemorrhage prophylaxis in low-resource settings is less than desirable. The main difficulties encountered were the shortage of skilled healthcare professionals for oxytocin administration, deficiencies concerning the quality of the drug and the inadequacy of available clinical guidelines.Conclusion: In order to reduce maternal mortality caused by postpartum hemorrhage in low-resource settings, it is essential to improve the knowledge of healthcare professionals, to implement good practices on the use of uterotonics, to optimize resource management and to overcome cultural barriers that prevent the demand for health services.

scholarly journals Applying heat and humidity using stove boiled water for decontamination of N95 respirators in low resource settings

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0255338
Author(s):  
Siddharth Doshi ◽  
Samhita P. Banavar ◽  
Eliott Flaum ◽  
Surendra Kulkarni ◽  
Ulhas Vaidya ◽  
...  
Keyword(s):  
Large Scale ◽  
Low Cost ◽  
Low Resource Settings ◽  
Low Resource ◽  
Surgical Masks ◽  
Temperature And Humidity ◽  
Similar Temperature ◽  
N95 Respirators ◽  
Electricity Access ◽  
Uv C

Global shortages of N95 respirators have led to an urgent need of N95 decontamination and reuse methods that are scientifically validated and available world-wide. Although several large scale decontamination methods have been proposed (hydrogen peroxide vapor, UV-C); many of them are not applicable in remote and low-resource settings. Heat with humidity has been demonstrated as a promising decontamination approach, but care must be taken when implementing this method at a grassroots level. Here we present a simple, scalable method to provide controlled humidity and temperature for individual N95 respirators which is easily applicable in low-resource settings. N95 respirators were subjected to moist heat (>50% relative humidity, 65–80°C temperature) for over 30 minutes by placing them in a sealed container immersed in water that had been brought to a rolling boil and removed from heat, and then allowing the containers to sit for over 45 minutes. Filtration efficiency of 0.3–4.99 μm incense particles remained above 97% after 5 treatment cycles across all particle size sub-ranges. This method was then repeated at a higher ambient temperature and humidity in Mumbai, using standard utensils commonly found in South Asia. Similar temperature and humidity profiles were achieved with no degradation in filtration efficiencies after 6 cycles. Higher temperatures (>70°C) and longer treatment times (>40 minutes) were obtained by insulating the outer vessel. We also showed that the same method can be applied for the decontamination of surgical masks. This simple yet reliable method can be performed even without electricity access using any heat source to boil water, from open-flame stoves to solar heating, and provides a low-cost route for N95 decontamination globally applicable in resource-constrained settings.

scholarly journals Low-Cost, Accessible Fabrication Methods for Microfluidics Research in Low-Resource Settings

Micromachines ◽  
2018 ◽  
Vol 9 (9) ◽  
pp. 461 ◽  
Author(s):  
Hoang-Tuan Nguyen ◽  
Ha Thach ◽  
Emmanuel Roy ◽  
Khon Huynh ◽  
Cecile Perrault
Keyword(s):  
Developing Countries ◽  
Scientific Community ◽  
Low Cost ◽  
Microfluidic Devices ◽  
Research Community ◽  
Access To Healthcare ◽  
Healthcare Industry ◽  
Low Resource Settings ◽  
Limited Access ◽  
Low Resource

Microfluidics are expected to revolutionize the healthcare industry especially in developing countries since it would bring portable, easy-to-use, self-contained diagnostic devices to places with limited access to healthcare. To date, however, microfluidics has not yet been able to live up to these expectations. One non-negligible factor can be attributed to inaccessible prototyping methods for researchers in low-resource settings who are unable to afford expensive equipment and/or obtain critical reagents and, therefore, unable to engage and contribute to microfluidics research. In this paper, we present methods to create microfluidic devices that reduce initial costs from hundreds of thousands of dollars to about $6000 by using readily accessible consumables and inexpensive equipment. By including the scientific community most embedded and aware of the requirements of healthcare in developing countries, microfluidics will be able to increase its reach in the research community and be better informed to provide relevant solutions to global healthcare challenges.

A Low-Resource Oxygen Blender Prototype for Use in Modified Bubble CPAP Circuits

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Jared Floersch ◽  
Elsa Hauschildt ◽  
Adam Keester ◽  
Samuel Poganski ◽  
Kiet Tran ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Low Cost ◽  
World Health ◽  
Pure Oxygen ◽  
Hypodermic Needle ◽  
Low Resource Settings ◽  
Low Resource ◽  
Tract Infections

Abstract Continuous positive airway pressure (CPAP) is a method of respiratory support used around the world to treat children with lower respiratory tract infections (LRTI) (WHO, 2016, Oxygen Therapy for Children, World Health Organization, Geneva, Switzerland, Report). Bubble continuous positive airway pressure (bCPAP) is an effective form of CPAP that is currently used in both high- and low-resource countries. Low-cost, modified bCPAP devices have been designed as an ideal form of CPAP in low-resource areas (Bjorklund, A. R., Mpora, B. O., Steiner, M. E., Fischer, G., Davey, C. S., and Slusher, T. M., 2018, “Use of a Modified Bubble Continuous Positive Airway Pressure (bCPAP) Device for Children in Respiratory Distress in Low- and Middle-Income Countries: A Safety Study,” Paediatr. Int. Child Health, 39(3), pp. 1–8). However, patients in low-resource settings undergoing bCPAP treatment are often given pure oxygen, which has been linked to retinopathy of prematurity, cardiovascular complications, and patient mortality (Rodgers, J. L., Iyer, D., Rodgers, L. E., Vanthenapalli, S., and Panguluri, S. K., 2019, “Impact of Hyperoxia on Cardiac Pathophysiology,” J. Cell. Physiol., 234(8), pp. 1–9; Ramgopal, S., Dezfulian, C., Hickey, R. W., Au, A. K., Venkataraman, S., Clark, R. S. B., and Horvat, C. M., 2019, “Association of Severe Hyperoxemia Events and Mortality Among Patients Admitted to a Pediatric Intensive Care Unit,” JAMA Network Open, 2(8), p. e199812). This problem is typically avoided by using commercial oxygen blenders, which can titrate down the concentration of oxygen delivered to the minimum needed; however, these blenders can cost nearly 1000 USD and are almost always unavailable in low-resource settings. The lack of available low-cost oxygen blenders compatible with modified bCPAP circuits creates a barrier for low-resource hospitals to be able to provide blended oxygen to patients. There is a need for a low-cost oxygen blender for use in low-resource settings. We propose a passive oxygen blender that operates via entrainment of atmospheric air. The device can easily be assembled in low-resource areas using a 22 gauge hypodermic needle, two 3 cc syringes, tape or super glue, and the materials required for bCPAP—for approximately 1.40 USD per device. The blender has not been clinically tested yet, but can achieve oxygen concentrations as low as 60% with bCPAP levels of 5 cm H2O (490 Pa) when used in a standard bCPAP circuit without a patient.

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