Technical Performance of Continuous Pressure Insufflators Versus Traditional Insufflators in the Presence of Leaks During Laparoscopic Surgery

2021 ◽  
pp. 155335062110072
Author(s):  
Silvana Perretta ◽  
Andrea Spota ◽  
Bernard Dallemagne
Keyword(s):  
Laparoscopic Surgery ◽  
Pressure Difference ◽  
Absolute Difference ◽  
Absolute Pressure ◽  
Swine Model ◽  
Pressure Setting ◽  
Technical Performance ◽  
Delivery Performance ◽  
Significant Performance ◽  
Clinically Significant

Background. New insufflators have been developed to manage leaks emanating from the working cavity during laparoscopic surgery. Little data have been published to show the performance of these insufflators. This study evaluates the performance of 2 modern continuous pressure insufflators in various leak conditions. Methods. Performance of a new continuous pressure insufflator, EVA15 (Palliare, Galway, Ireland), was compared with that of a continuous pressure insufflator, Airseal intelligent Flow System (iFS) (CONMED, Utica, NY), and a traditional intermittent pressure insufflator, Endoflator 40 (KARL STORZ, Tuttlingen, Germany). Six different leak scenarios were created in a swine model to create different dynamic leak profiles of between 5 and 15 L/min. Pressure deviation from setting was measured for each insufflator tested. The following were calculated: (a) mean absolute difference of measured insufflation pressure vs. the insufflator pressure setting for the 50 second measurement period (MAD) and (b) standard deviation of the absolute differences (SD). Results. The average mean absolute pressure difference between the EVA15 and Airseal is .27 mmHg. However, the average mean absolute pressure difference between the EVA15 and Endoflator 40 is 2.62 mmHg. Conclusions. Continuous pressure insufflators provide superior pressure delivery performance in leak situations when compared against a traditional intermittent pressure insufflator. No clinically significant performance difference was observed when comparing the EVA15 and Airseal iFS insufflators in the tested leak situations.

scholarly journals Analysis of Health Insurance Big Data for Early Detection of Disabilities: Algorithm Development and Validation (Preprint)

2020 ◽  
Author(s):  
Seung-Hyun Jeong ◽  
Tae Rim Lee ◽  
Jung Bae Kang ◽  
Mun-Taek Choi
Keyword(s):  
Big Data ◽  
Health Insurance ◽  
Early Detection ◽  
Developmental Delays ◽  
Brain Lesion ◽  
Detection Model ◽  
Clinical Diagnoses ◽  
Significant Performance ◽  
Clinically Significant ◽  
Age Range

BACKGROUND Early detection of childhood developmental delays is very important for the treatment of disabilities. OBJECTIVE To investigate the possibility of detecting childhood developmental delays leading to disabilities before clinical registration by analyzing big data from a health insurance database. METHODS In this study, the data from children, individuals aged up to 13 years (n=2412), from the Sample Cohort 2.0 DB of the Korea National Health Insurance Service were organized by age range. Using 6 categories (having no disability, having a physical disability, having a brain lesion, having a visual impairment, having a hearing impairment, and having other conditions), features were selected in the order of importance with a tree-based model. We used multiple classification algorithms to find the best model for each age range. The earliest age range with clinically significant performance showed the age at which conditions can be detected early. RESULTS The disability detection model showed that it was possible to detect disabilities with significant accuracy even at the age of 4 years, about a year earlier than the mean diagnostic age of 4.99 years. CONCLUSIONS Using big data analysis, we discovered the possibility of detecting disabilities earlier than clinical diagnoses, which would allow us to take appropriate action to prevent disabilities.

In-phase rejection requirements for measuring respiratory input impedance

1984 ◽  
Vol 56 (3) ◽  
pp. 804-809 ◽  
Author(s):  
R. Peslin ◽  
P. Jardin ◽  
C. Duvivier ◽  
P. Begin
Keyword(s):  
Pressure Difference ◽  
Input Impedance ◽  
Pressure Transducer ◽  
Absolute Pressure ◽  
Impedance Measurements ◽  
Differential Pressure Transducer ◽  
Rejection Ratio ◽  
Respiratory Flow ◽  
In Series ◽  
The Subject

Respiratory flow is commonly obtained by measuring the pressure difference across a pneumotachograph. When respiratory input impedance is studied, that pressure difference may be very small with respect to the absolute pressure swings inside the pneumotachograph. Then the in-phase rejection of the differential pressure transducer is expected to markedly influence the accuracy of the data. The problem was investigated by computer simulation and by measurements on a mechanical analog of the respiratory system made of a resistance, an inertance, and a compliance arranged in series. Both studies demonstrated that comparatively small differences in the volumes of the chambers or in the lengths or diameters of the connecting tubes led to artifactual frequency dependence of resistance and serious misestimation of compliance and inertance. Errors were larger when the resistance of the pneumotachograph was smaller and the impedance of the subject larger. In practice, with usual pneumotachographs accurate impedance measurements require using the most symmetrical transducers presently available (common-mode rejection ratio of about 70 dB at 30 Hz).

scholarly journals Point-of-care versus central testing of hemoglobin during large volume blood transfusion

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Justin Herman ◽  
Brian Park ◽  
Bharat Awsare ◽  
Frances West ◽  
Denine Crittendon ◽  
...  
Keyword(s):  
Massive Transfusion ◽  
Clinical Laboratory ◽  
Complete Blood Count ◽  
Point Of Care ◽  
Tertiary Care ◽  
Absolute Difference ◽  
Care Hospital ◽  
Specific Patient ◽  
Paired Samples ◽  
Clinically Significant

Abstract Background Point-of-care (POC) hemoglobin testing has the potential to revolutionize massive transfusion strategies. No prior studies have compared POC and central laboratory testing of hemoglobin in patients undergoing massive transfusions. Methods We retrospectively compared the results of our point-of-care hemoglobin test (EPOC®) to our core laboratory complete blood count (CBC) hemoglobin test (Sysmex XE-5000™) in patients undergoing massive transfusion protocols (MTP) for hemorrhage. One hundred seventy paired samples from 90 patients for whom MTP was activated were collected at a single, tertiary care hospital between 10/2011 and 10/2017. Patients had both an EPOC® and CBC hemoglobin performed within 30 min of each other during the MTP. We assessed the accuracy of EPOC® hemoglobin testing using two variables: interchangeability and clinically significant differences from the CBC. The Clinical Laboratory Improvement Amendments (CLIA) proficiency testing criteria defined interchangeability for measurements. Clinically significant differences between the tests were defined by an expert panel. We examined whether these relationships changed as a function of the hemoglobin measured by the EPOC® and specific patient characteristics. Results Fifty one percent (86 of 170) of paired samples’ hemoglobin results had an absolute difference of ≤7 and 73% (124 of 170) fell within ±1 g/dL of each other. The mean difference between EPOC® and CBC hemoglobin had a bias of − 0.268 g/dL (p = 0.002). When the EPOC® hemoglobin was < 7 g/dL, 30% of the hemoglobin values were within ±7, and 57% were within ±1 g/dL. When the measured EPOC® hemoglobin was ≥7 g/dL, 55% of the EPOC® and CBC hemoglobin values were within ±7, and 76% were within ±1 g/dL. EPOC® and CBC hemoglobin values that were within ±1 g/dL varied by patient population: 77% for cardiac surgery, 58% for general surgery, and 72% for non-surgical patients. Conclusions The EPOC® device had minor negative bias, was not interchangeable with the CBC hemoglobin, and was less reliable when the EPOC® value was < 7 g/dL. Clinicians must consider speed versus accuracy, and should check a CBC within 30 min as confirmation when the EPOC® hemoglobin is < 7 g/dL until further prospective trials are performed in this population.

Single-Session Baseline Virtual Reality Simulator Scores Predict Technical Performance for Laparoscopic Colectomy: A Study in the Swine Model

2014 ◽  
Vol 71 (6) ◽  
pp. 883-891 ◽  
Author(s):  
Sergio Eduardo Alonso Araujo ◽  
Victor E. Seid ◽  
Alexandre B. Bertoncini ◽  
Lucas A. Horcel ◽  
Sergio C. Nahas ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Laparoscopic Colectomy ◽  
Swine Model ◽  
Virtual Reality Simulator ◽  
Single Session ◽  
Technical Performance

Unilateral and bilateral electroconvulsive therapy: what informs Scottish psychiatrists' choices?

2009 ◽  
Vol 33 (3) ◽  
pp. 95-98 ◽  
Author(s):  
Kevin A. Brown
Keyword(s):  
Electroconvulsive Therapy ◽  
Response Rate ◽  
Remission Rate ◽  
Postal Questionnaire ◽  
Absolute Difference ◽  
Clinical Implications ◽  
Remission Rates ◽  
The Difference ◽  
Clinically Significant

Aims and MethodA postal questionnaire was sent to Scottish consultant psychiatrists asking about their attitudes towards unilateral and bilateral electroconvulsive therapy (ECT), and the difference in effectiveness between the two ECT types that they considered clinically significant.ResultsThe response rate was 61%. of those that responded, 62% were prescribers of ECT and most (79%) favoured bilateral ECT over unilateral ECT. the outcome that they were most concerned with was remission rate: 97% believe that an absolute difference of more than 5% in remission rate would make the difference in effectiveness between the two types of ECT clinically important.Clinical ImplicationsFuture investigators should focus on comparative remission rates of bilateral and unilateral ECT.

Obtaining Time-Varying Pulsatile Gas Flow Rates With the Help of Dynamic Pressure Difference and Other Measurements for an Orifice-Plate Meter

2013 ◽  
Vol 135 (4) ◽  
Author(s):  
A. Narain ◽  
N. Ajotikar ◽  
M. T. Kivisalu ◽  
A. F. Rice ◽  
M. Zhao ◽  
...  
Keyword(s):  
Mass Flow Rate ◽  
Mass Flow ◽  
Flow Rate ◽  
Pressure Difference ◽  
Dynamic Pressure ◽  
Orifice Plate ◽  
Absolute Pressure ◽  
Time Varying ◽  
Flow Rates ◽  
The Mean

Use of a conventional orifice-plate meter is typically restricted to measurements of steady flow rates. For any gas flowing within a duct in a pulsatile manner (i.e., large amplitude mass flow rate fluctuations relative to its steady-in-the-mean value), this paper proposes a new and effective approach for obtaining its time-varying mass flow rate at a specified cross section of an orifice meter. The approach requires time-varying (dynamic) pressure difference measurements across an orifice-plate meter, time-averaged mass flow rate measurements from a separate device (e.g., Coriolis meter), and a dynamic absolute pressure measurement. Steady-in-the-mean turbulent gas flows (Reynolds number ≫2300) with low mean Mach numbers (<0.2) exhibit effectively constant densities over long time-durations and are often made pulsatile by the presence of rotary or oscillatory devices that drive the flow (compressors, pumps, pulsators, etc.). In these pulsatile flows, both flow rate and pressure-difference fluctuation amplitudes at or near the device driver frequency (or its harmonics) are large relative to their steady mean values. The time-varying flow rate values are often affected by transient compressibility effects associated with acoustic waves. If fast Fourier transforms of the absolute pressure and pressure-difference measurements indicate that the predominant frequency is characterized by fp, then the acoustic effects lead to a nonnegligible rate of change of stored mass (associated with density changes) over short time durations (∼ 1/fP) and modest volumes of interest. As a result, for the same steady mean mass flow rate, the time variations (that resolve these density changes over short durations) of mass flow rates associated with pulsatile (and turbulent) gas flows are often different at different cross sections of the orifice meter (or duct). Together with the experimental measurements concurrently obtained from the three recommended devices, a suitable computational approach (as proposed and presented here) is a requirement for effectively converting the experimental information on time-varying pressure and pressure-difference values into the desired dynamic mass flow rate values. The mean mass flow rate measurement assists in eliminating variations in its predictions that arise from the use of turbulent flow simulation capabilities. Two independent verification approaches establish that the proposed measurement approach works well.

scholarly journals Analysis of Health Insurance Big Data for Early Detection of Disabilities: Algorithm Development and Validation

10.2196/19679 ◽  
2020 ◽  
Vol 8 (11) ◽  
pp. e19679
Author(s):  
Seung-Hyun Jeong ◽  
Tae Rim Lee ◽  
Jung Bae Kang ◽  
Mun-Taek Choi
Keyword(s):  
Big Data ◽  
Health Insurance ◽  
Early Detection ◽  
Developmental Delays ◽  
Brain Lesion ◽  
Detection Model ◽  
Clinical Diagnoses ◽  
Significant Performance ◽  
Clinically Significant ◽  
Age Range

Background Early detection of childhood developmental delays is very important for the treatment of disabilities. Objective To investigate the possibility of detecting childhood developmental delays leading to disabilities before clinical registration by analyzing big data from a health insurance database. Methods In this study, the data from children, individuals aged up to 13 years (n=2412), from the Sample Cohort 2.0 DB of the Korea National Health Insurance Service were organized by age range. Using 6 categories (having no disability, having a physical disability, having a brain lesion, having a visual impairment, having a hearing impairment, and having other conditions), features were selected in the order of importance with a tree-based model. We used multiple classification algorithms to find the best model for each age range. The earliest age range with clinically significant performance showed the age at which conditions can be detected early. Results The disability detection model showed that it was possible to detect disabilities with significant accuracy even at the age of 4 years, about a year earlier than the mean diagnostic age of 4.99 years. Conclusions Using big data analysis, we discovered the possibility of detecting disabilities earlier than clinical diagnoses, which would allow us to take appropriate action to prevent disabilities.

scholarly journals DEXAMETHASONE AND POSTOPERATIVE ANALGESIA

2018 ◽  
Vol 12 (3) ◽  
pp. 148-154
Author(s):  
Alexei M. Ovechkin ◽  
M. E Politov
Keyword(s):  
Laparoscopic Surgery ◽  
Side Effects ◽  
Peripheral Nerve ◽  
Motor Block ◽  
Standard Dose ◽  
Single Administration ◽  
Duration Of Action ◽  
Promising Area ◽  
Clinically Significant ◽  
Area Of Application

The review contains the analysis of analgesic and opioid-saving action of dexamethasone in its systemic administration. These effects are most evident in the preventive administration of the drug 1.5-2 hours before surgery. The most promising area of application of dexamethasone as a component of anesthetic support is laparoscopic surgery. In the orthopedic clinic, the use of dexamethasone can increase the duration of action of peripheral nerve blockades and plexuses (both sensory and motor block), while perineural administration (addition to the local anesthetics) has no advantages over intravenous injection. Single administration of a standard dose of dexamethasone (8 mg) is not accompanied by the occurrence of clinically significant side effects.

Improved Ease of Use Designs for Rapid Heart Cooling

2012 ◽  
Vol 6 (3) ◽  
Author(s):  
Thomas L. Merrill ◽  
Denise R. Merrill ◽  
Jennifer E. Akers
Keyword(s):  
Pressure Difference ◽  
Cooling System ◽  
Cooling Capacity ◽  
Heart Tissue ◽  
Ease Of Use ◽  
Swine Model ◽  
Animal Testing ◽  
Attack Model ◽  
External Cooling ◽  
Cooling Design

Mild hypothermia has been shown to reduce heart tissue damage resulting from acute myocardial infarction (AMI). In previous work we developed a trilumen cooling catheter to deliver cooled blood rapidly to the heart during emergency angioplasty. This paper describes two alternative designs that seek to maintain tissue cooling capability and improve “ease of use.” The first design was an autoperfusion design that uses the natural pressure difference between the aorta and the coronary arteries to move blood through the trilumen catheter. The second design used an external cooling system, where blood was cooled externally before being pumped to the heart through a commercially available guide catheter. Heat transfer and pressure drop analyses were performed on each design. Both designs were fabricated and tested in both in vitro and in vivo settings. The autoperfusion design did not meet a cooling capacity target of 20 W. Animal tests, using swine with healthy hearts, showed that the available pressure difference to move blood through the trilumen catheter was approximately 5–10 mmHg. This differential pressure was too low to motivate sufficient blood flow rates and achieve the required cooling capacity. The external cooling system, however, had sufficient cooling capacity and reasonable scalability. Cooling capacity values varied from 14 to 56 W over a flow range of 30–90 ml/min. 20 W and 30 W were achieved at 38 ml/min and 50 ml/min, respectively. Animal testing showed that a cooling capacity of 30 W delivered to the left anterior descending (LAD) and left circumflex arteries (LCX) of a healthy 70 kg swine can reduce heart tissue temperatures rapidly, approximately 3 °C in 5 min in some locations. Core temperatures dropped by less than 0.5 °C during this cooling period. An autoperfusion design was unable to meet the target cooling capacity of 20 W. An external cooling design met the target cooling capacity, providing rapid (1 °C/min) localized heart tissue cooling in a large swine model. Future animal testing work, involving a heart attack model, will investigate if this external cooling design can save heart tissue.

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