Development and validation of LoAD Calc, a mobile app for calculating the maximum safe single dose of local anesthetics (Preprint)

2020 ◽  
Author(s):  
Mélanie Suppan ◽  
Tal S. Beckmann ◽  
Cenan Gercekci ◽  
Thérèse Sigrist ◽  
Georges L. Savoldelli ◽  
...  
Keyword(s):  
Single Dose ◽  
Clinical Practice ◽  
Local Anesthetics ◽  
Design Thinking ◽  
Scientific Evidence ◽  
Ideal Body Weight ◽  
Mobile App ◽  
Systems Research ◽  
Continuous Feedback ◽  
Safe Dose

BACKGROUND Misuse of local anesthetics (LAs) can lead to life-threatening situations. Intravascular injection and administration of an inappropriately large dose are two of the most frequent reasons leading to systemic toxicity. Correct calculation of the maximum safe dose of LAs is therefore paramount in preventing such complications. Calculation can however turn out to be a real conundrum when considering all potentially relevant variables. Lack of specific literature and clear standards further complexifies this task. Moreover, doses used in clinical practice are often determined without prior calculation of the ideal body weight or adaptation to specific health conditions. Different solutions have already emerged to support anesthesiologists in LA dosage determination. They are seldom used in clinical practice as they require either access to a computer or specific documents to be at hand. Nowadays, most anesthesiologists are equipped with smartphone at work. A mobile app could therefore be an easy and practical solution for computing the maximum safe dose of LA. The few apps already created for this purpose often lack key elements, allowing invalid data to be entered and suggesting doses that might exceed the maximum safe dose. They mainly give the user general advice on how the computed dose should be further adapted or simply state that it should be used with caution. OBJECTIVE Our aim was to design an mHealth app for the calculation of the maximum safe single dose of LAs. METHODS A modified version of the Information Systems Research (ISR) framework, which adds design thinking modes to the original framework, was used to define and describe the development process. Using this modified framework, we aimed to design an mHealth app intended to be used by anesthesiologists. The app was enhanced through multiple iterations and developed with the aid of contextual observations and interviews, brainswarming sessions, prototyping and continuous feedback. RESULTS The modified ISR framework led us to engage with end-users and identify their needs at each step of the development. A review of the literature was performed to gather the scientific evidence regarding LA dose calculation. A search for already existing solutions allowed us to identify key features to embed or improve in our app. The design process led to the creation of two prototypes which underwent thorough testing by a sample of 8 anesthesiologists. Continuous feedback allowed for rapid identification and correction of problems and led to constant adaptation of the design. The final version of the app, LoAD Calc, was deployed on Apple and Android mobile test platforms and tested again by the same sample until deemed fit for release. CONCLUSIONS LoAD Calc, an mHealth app designed to allow easy, fast and safe computation of the maximum single dose of LAs, was successfully created using the modified ISR framework.

scholarly journals Development and Preliminary Validation of LoAD Calc, a Mobile App for Calculating the Maximum Safe Single Dose of Local Anesthetics

Healthcare ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 799
Author(s):  
Mélanie Suppan ◽  
Tal Sarah Beckmann ◽  
Cenan Gercekci ◽  
Thérèse Sigrist ◽  
Georges Louis Savoldelli ◽  
...  
Keyword(s):  
Local Anesthetics ◽  
Design Thinking ◽  
Mobile App ◽  
Systems Research ◽  
Information Systems Research ◽  
Preliminary Validation ◽  
Correct Calculation ◽  
Life Threatening ◽  
Continuous Feedback ◽  
Safe Dose

Local anesthetics systemic toxicity can lead to life-threatening situations. Correct calculation of the maximum safe dose is therefore paramount in preventing such complications. Different solutions have already emerged to support anesthesiologists but are seldom used in clinical practice as they require either access to a computer or specific documents to be at hand. A mobile app could provide an easy and practical solution; however, the few apps already created for this purpose often lack key elements, allowing invalid data to be entered and suggesting doses that might exceed the maximum safe dose. We describe the development of LoAD Calc, a mobile health (mHealth) app developed using a modified version of the Information Systems Research framework, which adds design thinking modes to the original framework. The app was enhanced through multiple iterations and developed with the aid of contextual observations and interviews, brainswarming sessions, prototyping, and continuous feedback. The design process led to the creation of two prototypes which underwent thorough testing by a sample of eight anesthesiologists. The final version of the app, LoAD Calc, was deployed on Apple and Android mobile test platforms and tested again by the same sample until deemed fit for release.

scholarly journals Development and validation of LoAD Calc, a mobile app for calculating the maximum safe single dose of local anesthetics (Preprint)

10.2196/26274 ◽  
2020 ◽  
Author(s):  
Mélanie Suppan ◽  
Tal S. Beckmann ◽  
Cenan Gercekci ◽  
Thérèse Sigrist ◽  
Georges L. Savoldelli ◽  
...  
Keyword(s):  
Single Dose ◽  
Local Anesthetics ◽  
Mobile App ◽  
Development And Validation

scholarly journals Comparing a Mobile Decision Support System Versus the Use of Printed Materials for the Implementation of an Evidence-Based Recommendation: Protocol for a Qualitative Evaluation (Preprint)

2018 ◽  
Author(s):  
Jhon Camacho ◽  
Ana María Medina Ch. ◽  
Zach Landis-Lewis ◽  
Gerald Douglas ◽  
Richard Boyce
Keyword(s):  
Clinical Practice ◽  
Decision Support ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Mobile App ◽  
Second Phase ◽  
Evidence Based ◽  
Clinical Algorithm ◽  
Qualitative Evidence ◽  
Printed Materials

BACKGROUND The distribution of printed materials is the most frequently used strategy to disseminate and implement clinical practice guidelines, although several studies have shown that the effectiveness of this approach is modest at best. Nevertheless, there is insufficient evidence to support the use of other strategies. Recent research has shown that the use of computerized decision support presents a promising approach to address some aspects of this problem. OBJECTIVE The aim of this study is to provide qualitative evidence on the potential effect of mobile decision support systems to facilitate the implementation of evidence-based recommendations included in clinical practice guidelines. METHODS We will conduct a qualitative study with two arms to compare the experience of primary care physicians while they try to implement an evidence-based recommendation in their clinical practice. In the first arm, we will provide participants with a printout of the guideline article containing the recommendation, while in the second arm, we will provide participants with a mobile app developed after formalizing the recommendation text into a clinical algorithm. Data will be collected using semistructured and open interviews to explore aspects of behavioral change and technology acceptance involved in the implementation process. The analysis will be comprised of two phases. During the first phase, we will conduct a template analysis to identify barriers and facilitators in each scenario. Then, during the second phase, we will contrast the findings from each arm to propose hypotheses about the potential impact of the system. RESULTS We have formalized the narrative in the recommendation into a clinical algorithm and have developed a mobile app. Data collection is expected to occur during 2018, with the first phase of analysis running in parallel. The second phase is scheduled to conclude in July 2019. CONCLUSIONS Our study will further the understanding of the role of mobile decision support systems in the implementation of clinical practice guidelines. Furthermore, we will provide qualitative evidence to aid decisions made by low- and middle-income countries’ ministries of health about investments in these technologies.

scholarly journals Single-Dose Toxicity Study on ML171, a Selective NOX1 Inhibitor, in Mice

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Se-Hyun Oh ◽  
Ji-Sun Ahn ◽  
Eun-Joo Oh ◽  
You-Jin Kim ◽  
Ju-Min Yook ◽  
...  
Keyword(s):  
Single Dose ◽  
Nicotinamide Adenine Dinucleotide Phosphate ◽  
Anterior Lobe ◽  
Negative Control ◽  
Icr Mice ◽  
Injection Dose ◽  
Good Laboratory ◽  
Males And Females ◽  
Isoform Selectivity ◽  
Safe Dose

Background. ML171 is a potent nicotinamide adenine dinucleotide phosphate oxidase (NOX) inhibitor with isoform selectivity only for NOX1. This study is aimed at investigating the safety of ML171 after a single intraperitoneal (IP) injection in mice. Methods. The toxicity of a single dose of ML171 was evaluated in 6-week-old Institute of Cancer Research (ICR) mice in a good laboratory practice (GLP) laboratory. Twenty-five mice of each sex were assigned to five groups: negative control, vehicle control, and 125, 250, and 500 mg/kg of ML171. All mice were acclimatized for one week before beginning the study. Mice received an IP injection of ML171 or vehicle. The general condition and mortality of the animals were observed. The mice were sacrificed to evaluate histopathology 14 days after the administration of ML171 or vehicle. Results. Bodyweights were not significantly different in any group. Three males and one female died due to ML171 administration in the 500 mg/kg dose group. Autopsies of the surviving mice did not reveal any significant abnormalities after the injection of 125 mg/kg of ML171. However, the anterior lobe edge of the liver was thickened and adhesions between the liver and adjacent organs were observed in mice treated with 250 or 500 mg/kg of ML171. In addition, hypertrophy of centrilobular hepatocytes and inflammatory cell infiltration were observed after injection of 250 and 500 mg/kg of ML171. Conclusion. Our results indicate that the lethal IP injection dose of ML171 is 500 mg/kg for both males and females. Mortality were not observed for lower doses of ML171. The safe dose of single IP ML171 in ICR mice was 250 mg/kg or less. Further studies are needed to confirm the safety of ML171 in the human body.

scholarly journals Planning Implementation Success of Syncope Clinical Practice Guidelines in the Emergency Department Using CFIR Framework

2021 ◽  
Author(s):  
Jing Li ◽  
Susan S. Smyth ◽  
Jessica Miller Clouser ◽  
Colleen A. McMullen ◽  
Vedant Gupta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Family Caregivers ◽  
Implementation Strategy ◽  
Care Pathway ◽  
Implementation Strategies ◽  
Mobile App ◽  
Care Plan ◽  
Local Context ◽  
Successful Implementation

Background and Objectives: Overuse and inappropriate use of testing and hospital admission are common in syncope evaluation and management. Though guidelines are available to optimize syncope care, study suggested that the current clinical guidelines have not significantly impacted resource utilization surrounding emergency department (ED) evaluation of syncope. Matching implementation strategies to barriers and facilitators and tailoring strategies to local context hold significant promise for a successful implementation of clinical practice guideline (CPG). Our team applied implementation science principles to develop a stakeholder-based implementation strategy. Methods and Materials: We partnered with patients, family caregivers, frontline clinicians and staff, and health system administrators at four health systems to conduct quantitative surveys and qualitative interviews for context assessment. The identification of implementation strategies was done by applying the CFIR-ERIC Implementation Strategy Matching Tool and soliciting stakeholders’ inputs. We then co-designed with patients and frontline teams, developed and tested specific strategies. Results: 114 clinicians completed surveys and 32 clinicians and stake-holders participated in interviews. Results from the surveys and interview indicated low awareness of syncope guidelines, and communication challenges with patients, lack of CPG protocol integration into ED workflows, and organizational process to change were recognized as major barriers. Thirty-one patients and their family caregivers participated in interviews and ex-pressed their expectations: clarity regarding their diagnosis, context surrounding care plan and diagnostic testing, and a desire to feel cared about. After identifying change methods to address those barriers, the multilevel, multicomponent implementation strategy, MISSION, included pa-tient educational materials, mentored implementation, academic detailing, Syncope Optimal Care Pathway and corresponding Mobile App, and Lean quality improvement methods. The pilot of MISSION demonstrated feasibility, acceptability and initial success on appropriate testing. Con-clusions: Effect multifaceted implementation strategies that target individuals, teams, and healthcare systems can be employed to plan successful implementation and promote adherence to syncope CPGs.

scholarly journals Qual o melhor anestésico local para meu paciente? Tabela das condições sistêmicas encontradas na clínica odontológica e a sua relação na escolha do sal anestésico e vasoconstritor

2020 ◽  
Author(s):  
Rodrigo Resende
Keyword(s):  
Clinical Practice ◽  
Literature Review ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Oral Surgery ◽  
Systemic Disease ◽  
Systemic Diseases ◽  
Dental Clinic ◽  
National Market ◽  
Dental Professionals

RESUMOO uso de soluções anestésicas é realizada quase que diariamente pelos profissionais de odontologia. Entretanto, os anestésicos locais disponíveis no mercado apresentam-se sob a forma de soluções com composições e concentrações variadas, tanto com relação ao sal anestésico, vasoconstritor e seu preservativo. Talvez, pela grande variedade de associações, possa surgir diversas dúvidas quanto à melhor escolha durante a prática clínica diária, principalmente quando o mesmo apresenta algum tipo de doença sistêmica. Com isso, o objetivo desse trabalho é realizar uma revisão de literatura das melhores indicações e possíveis contraindicações de soluções  anestésicas locais disponíveis no mercado nacional, relacionando com doenças sistêmicas que comumente são atendidas na clínica odontológica.Palavras – Chave: Odontologia; Anestésico local; Cirurgia oral. ABSTRACT The use of anesthetic solutions is performed almost daily by dental professionals. However, the local anesthetics available on the market come in the form of solutions with varying compositions and concentrations, both with respect to the anesthetic salt, vasoconstrictor and its preservative. Perhaps, due to the wide variety of associations, several doubts may arise regarding the best choice during daily clinical practice, especially when it presents some type of systemic disease. Thus, the objective of this work is to carry out a literature review of the best indications and possible contraindications for local anesthetic solutions available in the national market, relating to systemic diseases that are commonly seen in the dental clinic. Key words: Dentistry; Local anesthetic; Oral surgery.

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