scholarly journals Non-bronchoscopic Bronchoalveolar Lavage as a Refinement for Safely Obtaining High-quality Samples from Macaques

2020 ◽  
Vol 70 (6) ◽  
pp. 520-525
Author(s):  
Cassandra R Moats ◽  
Kurt T Randall ◽  
Tonya M Swanson ◽  
Hugh B Crank ◽  
Kimberly M Armantrout ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Vital Signs ◽  
Cost Effective ◽  
Average Procedure ◽  
Procedure Time ◽  
Safe Alternative ◽  
Volume Yield ◽  
Procedural Complications ◽  
Lower Airways ◽  
Average Procedure Time

Nonbronchoscopic bronchoalveolar lavage (NB-BAL) is a minimally invasive diagnostic and research tool used to sample the cells of lower airways and alveoli without using a bronchoscope. Our study compared NB-BAL and bronchoscopic bronchoalveolar lavage (B-BAL) in terms of costs, cell yields, and the number of post-procedural complications in macaques. We also analyzed procedure times, BAL fluid volume yields, and vital signs in a subset of animals that underwent NB-BAL. Compared with the B-BAL technique, NB-BAL was less expensive to perform, with fewer complications, fewer animals requiring temporary or permanent cessation of BALs, and higher cell yields per mL of recovered saline. The average procedure time for NB-BAL was 6.8 ± 1.6 min, and the average NB-BAL lavage volume yield was 76 ± 9%. We found no significant differences in respiration rate before, during, or after NB-BAL but did find significant differences in heart rate and oxygen saturation (SpO2). This study demonstrates that NB-BAL is a simple, cost-effective, and safe alternative to B-BAL that results in higher cell yields per mL, improved animal welfare, and fewer missed time points, and thus constitutes a refinement over the B-BAL in macaques.

scholarly journals Merger Control in Hungary

2021 ◽  
Vol 66 (2) ◽  
pp. 252-274
Author(s):  
Csaba Balázs Rigó ◽  
András Tóth ◽  
András Bodócsi ◽  
Judit Buránszki ◽  
Attila Dudra
Keyword(s):  
Data Processing ◽  
Full Scale ◽  
Time Limit ◽  
Political Transition ◽  
Merger Control ◽  
The Political ◽  
Competition Authority ◽  
Average Procedure ◽  
Procedure Time ◽  
Average Procedure Time

The present study presents the findings of the most comprehensive research that has ever been conducted in relation to the 30-year-old Hungarian merger authorisation process that has been in place since the political transition in Hungary. The aim of the research is, in particular, to present to the wider professional public the development of the authorisation process for mergers (or concentrations) in Hungary, which started in the last decade, and the resulting public value returns that have been achieved. The most important results to emerge from the research are that – compared to 2010 data – the average procedure time for full-scale merger proceedings in 2020 was reduced by 62%, and the administrative time limit for simplified cases decreased by 82.5%. Furthermore, the research revealed that today one-third of the Hungarian Competition Authority’s market interventions in connection with mergers take a verbal/informal form. This study was conducted using the methodology of data processing and analysing that are at the disposal of the Hungarian Competition Authority.

scholarly journals Applicability of Endobronchial Ultrasound and Virtual Bronchoscopic Navigation Combined with Rapid On-Site Evaluation in Diagnosing Peripheral Lung Lesions

2021 ◽  
Author(s):  
Jia-Chao Qi ◽  
Liping Liao ◽  
Zhiwei Zhao ◽  
HuiXue Zeng ◽  
Tiezhu Wang ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Endobronchial Ultrasound ◽  
Average Procedure ◽  
Procedure Time ◽  
Significant Difference ◽  
Positive Rate ◽  
Site Evaluation ◽  
Medical University ◽  
The Impact ◽  
Average Procedure Time

Abstract Background To investigate the value of endobronchial ultrasound (EBUS) and virtual bronchoscopic navigation (VBN) combined with rapid on-site evaluation (ROSE) in diagnosing peripheral pulmonary lesions (PPLs). Methods Between January 1st 2019 to September 1st 2021, EBUS and VBN examination were performed in 250 consecutive patients with PPLs who were admitted to Zhangzhou Affiliated Hospital of Fujian Medical University (Fujian, China). Finally, 198 eligible patients were randomly divided into ROSE group (100 cases) and non-ROSE group (98 cases). The diagnostic yield of brushing and biopsy, the complications, the procedure time, the diagnosis time and expense during diagnosis were analyzed. Results In the ROSE group, the positive rate of EBUS brushing and biopsy were 68%, 84%, repectively. The average procedure time and diagnosis time were 18.6 ± 6.8 min, 3.84 ± 4.28 days, repectively, and the average expense was 4093.15 ± 4494.67 yuan. In the controls, the positive rate of brushing and biopsy were 44%, 74%, repectively. The average procedure time and diagnosis time were 15.4 ± 5.7 min, 6.46 ± 3.66 days, repectively. And the average expense during diagnosis was 6420.28 ± 4541.33 yuan. There was significant difference in the positive rate of EBUS brushing and biopsy, diagnosis time and expense during diagnosis between both groups. And no significant difference was observed in the complications and the procedure time. Additionally, the impact of ROSE on diagnostic yield in right upper lobe and the size of lesion ≤2 cm in diameter was significant. Conclusion In combination with ROSE, EBUS could significantly improve the positive rate of diagnosing PPLs, shorten diagnosis time and reduce expense during diagnosis. ROSE will be of great importance in the diagnosis of PPLs and medical resource.

scholarly journals Non-directed bronchial lavage is a safe method for sampling the respiratory tract in critically ill patient

2018 ◽  
Vol 20 (3) ◽  
pp. 237-241
Author(s):  
BV Bonvento ◽  
JA Rooney ◽  
MO Columb ◽  
BA McGrath ◽  
AM Bentley ◽  
...  
Keyword(s):  
Intensive Care ◽  
Bronchoalveolar Lavage ◽  
Vital Signs ◽  
Service Evaluation ◽  
Ventilator Associated Pneumonia ◽  
Safe Procedure ◽  
Procedure Time ◽  
Time Points ◽  
Post Procedure ◽  
Significant Difference

Ventilated patients are at risk of acquiring ventilator-associated pneumonia. Various techniques are available for diagnosing ventilator-associated pneumonia including bronchoalveolar lavage, protected specimen brush and non-directed bronchoalveolar lavage. There is a paucity of evidence regarding the safety profile of these techniques, particularly non-directed bronchoalveolar lavage. This service evaluation aimed to establish whether non-directed bronchoalveolar lavage is a safe procedure. A prospective service evaluation of non-directed bronchoalveolar lavage on our adult intensive care unit was undertaken by a senior physiotherapist trained into carrying out the procedure, measuring pre- and post-procedure vital signs including heart rate (HR), tidal volume (VT), systolic blood pressure (SBP) and pulse oximetry (SpO2). Eighty-five episodes in 41 patients were included in the evaluation. There was a statistically significant difference between pre- and immediately post-procedure recordings for all vital signs measure. HR (min-1), means (SD) 87.1 (16.4), 91.5 (16.5), 87.5 (15.9), 87.7 (15.7) respectively pre, immediately, 5 min after and 30 min after procedure ( P < 0.01). SBP mmHg, means (SD) 133.9 (26.1), 142.1 (25.6), 136.9 (25.3), 134.8 (23.4) pre, immediately, 5 min and 30 min after procedure ( P < 0.01). VT mL, median (range) 0.523 (0.118–1.180), 0.512 (0.131–1.05), 0.519 (0.104–0.95), 0.534 (0.110–1.080) each pre, immediately, 5 min and 30 min post procedure ( P < 0.05). SpO2 %, median (range) 98 (89–100), 100 (96–100), 98 (92–100), 97 (90–100) again each pre-, immediately post, 5 and 30 min post-procedure time-points ( P < 0.0001). The statistically significant difference was not detected between pre-, 5 or 30 min post-procedure time-points. None of the changes observed were clinically significant and no untoward events happened to any of the subjects included. Non-directed bronchoalveolar lavage is a safe and inexpensive procedure that can be carried out easily in an intensive care setting by a trained physiotherapist, avoiding the need for invasive bronchoscopy.

Three-Dimensional Printed Targeting Device for Scaphoid Fracture Fixation

Hand ◽  
2020 ◽  
pp. 155894472090650 ◽  
Author(s):  
Matthew C. DeWolf ◽  
Alexander Hartov ◽  
Thomas A. Fortney ◽  
Lance G. Warhold
Keyword(s):  
Radiation Exposure ◽  
Guide Wire ◽  
Scaphoid Fracture ◽  
Kirschner Wire ◽  
Three Dimensional ◽  
Average Procedure ◽  
Procedure Time ◽  
Intraoperative Radiation ◽  
Freehand Technique ◽  
Average Procedure Time

Background: Percutaneous guide wire insertion for scaphoid screw fixation can be challenging and often requires multiple attempts with significant radiation exposure to the surgical team. A 3-dimensional (3D) printed targeting device has the potential to reduce procedure time and intraoperative radiation exposure. Methods: Our targeting device protocol included a preprocedure computed tomography (CT) scan of a casted cadaver wrist, followed by 3D printing of a customized targeting guide. In a comparison trial, seven orthopedic surgery residents performed percutaneous scaphoid guide wire insertion on different cadaver specimens by both freehand technique and using our targeting device. Radiation exposure and procedure times were compared. All specimens underwent postprocedure CT to assess Kirschner wire (K-wire) accuracy, determined by central third placement. Pre- and postprocedure CT scans from the targeting device group were co-registered to compare planned and actual K-wire trajectories. Results: Using the freehand technique, mean fluoroscopy time was 120 seconds (standard deviation: ±53 seconds) generating 2.45 milligray of radiation. Average procedure time was 21 minutes with a mean of 6.4 (range: 3-9) insertion attempts. A single insertion attempt was made using the targeting device with an average procedure time of 30 seconds and no fluoroscopy exposure. Four K-wires were placed within the central scaphoid in both groups. Using the targeting device, average linear deviation from the planned trajectory was 2.1 mm, while the maximum linear deviation was 3.75 mm. Conclusion: When compared to freehand scaphoid guide wire insertion, our targeting device provides similar accuracy while significantly reducing intraoperative radiation exposure and procedure time.

scholarly journals Longitudinal remotely mentored self-performed lung ultrasound surveillance of paucisymptomatic Covid-19 patients at risk of disease progression

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Andrew W. Kirkpatrick ◽  
Jessica L. McKee ◽  
John M. Conly
Keyword(s):  
At Risk ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Human Life ◽  
Vital Signs ◽  
Home Monitoring ◽  
Cost Effective ◽  
Care Providers ◽  
Vital Signs Monitoring ◽  
Ultrasound Probes

AbstractCOVID-19 has impacted human life globally and threatens to overwhelm health-care resources. Infection rates are rapidly rising almost everywhere, and new approaches are required to both prevent transmission, but to also monitor and rescue infected and at-risk patients from severe complications. Point-of-care lung ultrasound has received intense attention as a cost-effective technology that can aid early diagnosis, triage, and longitudinal follow-up of lung health. Detecting pleural abnormalities in previously healthy lungs reveal the beginning of lung inflammation eventually requiring mechanical ventilation with sensitivities superior to chest radiographs or oxygen saturation monitoring. Using a paradigm first developed for space-medicine known as Remotely Telementored Self-Performed Ultrasound (RTSPUS), motivated patients with portable smartphone support ultrasound probes can be guided completely remotely by a remote lung imaging expert to longitudinally follow the health of their own lungs. Ultrasound probes can be couriered or even delivered by drone and can be easily sterilized or dedicated to one or a commonly exposed cohort of individuals. Using medical outreach supported by remote vital signs monitoring and lung ultrasound health surveillance would allow clinicians to follow and virtually lay hands upon many at-risk paucisymptomatic patients. Our initial experiences with such patients are presented, and we believe present a paradigm for an evolution in rich home-monitoring of the many patients expected to become infected and who threaten to overwhelm resources if they must all be assessed in person by at-risk care providers.

scholarly journals Wedged Sensor in Distress? Lessons Learned from Troubleshooting Dampened Transmitted PA Waveforms of CardioMEMS Device

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Robby Singh ◽  
Santo Scarfone ◽  
Marcel Zughaib
Keyword(s):  
Heart Failure ◽  
Rare Complication ◽  
Cost Effective ◽  
Lessons Learned ◽  
Pressure Monitoring ◽  
Readmission Rates ◽  
Inaccurate Data ◽  
Device Placement ◽  
Procedural Complications ◽  
Repeat Angiography

Introduction. Cardiovascular disease is a leading cause of morbidity and mortality with heart failure constituting a large portion of this spectrum. Heart failure patients have 90-day readmission rates of nearly 41% associated with a high expense. Numerous strategies to reduce readmissions have been attempted with the CardioMEMS pulmonary artery pressure monitoring system as one of the more successful ones. As this device becomes used more frequently, it is important to recognize procedural complications. We present of a rare complication where a patient underwent successful device placement and was subsequently found to have dampened waveforms which were due to device migration. Case Report. A 79-year-old male underwent successful CardioMEMS placement due to recurrent heart failure hospitalizations. 6 months later, the transmitted waveforms appeared dampened, and repeat angiography revealed a device that had migrated. Rather than abandoning the device, it was recalibrated and continued to transmit data and helped manage the patient’s heart failure. Conclusion. CardioMEMS is a cost-effective tool to help reduce heart failure hospitalizations. Device migration is a rare complication and can lead to inaccurate data. However, as seen in this case, the device can be successfully recalibrated and can continue to be utilized to help reduce heart failure admissions.

scholarly journals Noninvasive Continuous Monitoring of Vital Signs With Wearables: Fit for Medical Use?

2020 ◽  
Vol 15 (1) ◽  
pp. 34-43 ◽  
Author(s):  
Malte Jacobsen ◽  
Till A. Dembek ◽  
Guido Kobbe ◽  
Peter W. Gaidzik ◽  
Lutz Heinemann
Keyword(s):  
Continuous Monitoring ◽  
Literature Search ◽  
Vital Signs ◽  
Cost Effective ◽  
Motion Sensors ◽  
Wearable Computer ◽  
Randomized Controlled ◽  
Medical Context ◽  
General Physical ◽  
Digital Biomarkers

Background: Wearables (= wearable computer) enable continuous and noninvasive monitoring of a range of vital signs. Mobile and cost-effective devices, combined with powerful data analysis tools, open new dimensions in assessing body functions (“digital biomarkers”). Methods: To answer the question whether wearables are ready for use in the medical context, a PubMed literature search and analysis for their clinical-scientific use using publications from the years 2008 to 2018 was performed. Results: A total of 79 out of 314 search hits were publications on clinical trials with wearables, of which 16 were randomized controlled trials. Motion sensors were most frequently used to measure defined movements, movement disorders, or general physical activity. Approximately 20% of the studies used sensors to detect cardiovascular parameters. As for the sensor location, the wrist was chosen in most studies (22.8%). Conclusion: Wearables can be used in a precisely defined medical context, when taking into account complex influencing factors.

scholarly journals An Optimized System for Interventional Magnetic Resonance Imaging-Guided Stereotactic Surgery: Preliminary Evaluation of Targeting Accuracy

2011 ◽  
Vol 70 (suppl_1) ◽  
pp. ons95-ons103 ◽  
Author(s):  
Paul S. Larson ◽  
Philip A. Starr ◽  
Geoffrey Bates ◽  
Lisa Tansey ◽  
R. Mark Richardson ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
First Generation ◽  
Average Error ◽  
Procedure Time ◽  
Resonance Imaging ◽  
Radial Error ◽  
Average Procedure Time ◽  
Targeting Accuracy ◽  
Deep Brain

Abstract BACKGROUND: Deep brain stimulation electrode placement with interventional magnetic resonance imaging (MRI) has previously been reported using a commercially available skull-mounted aiming device (Medtronic Nexframe MR) and native MRI scanner software. This first-generation method has technical limitations that are inherent to the hardware and software used. A novel system (SurgiVision ClearPoint) consisting of an aiming device (SMARTFrame) and software has been developed specifically for interventional MRI, including deep brain stimulation. OBJECTIVE: To report a series of phantom and cadaver tests performed to determine the capability, preliminary accuracy, and workflow of the system. METHODS: Eighteen experiments using a water phantom were used to determine the predictive accuracy of the software. Sixteen experiments using a gelatin-filled skull phantom were used to determine targeting accuracy of the aiming device. Six procedures in 3 cadaver heads were performed to compare the workflow and accuracy of ClearPoint with Nexframe MR. RESULTS: Software prediction experiments showed an average error of 0.9 ± 0.5 mm in magnitude in pitch and roll (mean pitch error, −0.2 ± 0.7 mm; mean roll error, 0.2 ± 0.7 mm) and an average error of 0.7 ± 0.3 mm in X-Y translation with a slight anterior (0.5 ± 0.3 mm) and lateral (0.4 ± 0.3 mm) bias. Targeting accuracy experiments showed an average radial error of 0.5 ± 0.3 mm. Cadaver experiments showed a radial error of 0.2 ± 0.1 mm with the ClearPoint system (average procedure time, 88 ± 14 minutes) vs 0.6 ± 0.2 mm with the Nexframe MR (average procedure time, 92 ± 12 minutes). CONCLUSION: This novel system provides the submillimetric accuracy required for stereotactic interventions, including deep brain stimulation placement. It also overcomes technical limitations inherent in the first-generation interventional MRI system.

Evaluating telemedicine systems and services

2005 ◽  
Vol 11 (4) ◽  
pp. 167-177 ◽  
Author(s):  
Paul Taylor
Keyword(s):  
Cost Effective ◽  
Appropriate Technology ◽  
Sufficient Evidence ◽  
Safe Alternative ◽  
Telemedicine Service ◽  
Common Structure ◽  
Wide Range ◽  
Cost Effective Alternative ◽  
New Community ◽  
Clinical Conditions

The evaluation of telemedicine involves attempts to answer a wide range of questions involved in making decisions about safety, about practicality and about utility. Roughly speaking, if we wish to provide a telemedicine service we should first establish that it is safe, next that it is practical and finally that it is worthwhile. In establishing safety, most laboratory studies of telemedicine have a common structure, and consist of the following steps: (1) selection of cases; (2) interpretation; (3) comparison with a gold standard; (4) statistical analyses. Most of the studies to establish the practicality of telemedicine have been carried out as demonstrations, to show that a proposed application can be implemented in a chosen setting. In terms of utility, telemedicine has been used to improve the efficiency of an existing service or to make an existing service available to a new community. One of the difficulties is that the vendors of relatively expensive telemedicine systems and services disseminate much of the information on the topic. We have to focus not on the glamorous technology but on the underlying issue of how the participants in health care (patients, general practitioners, specialists) can communicate more effectively, using the range of technological options open to them. Ensuring that the most appropriate technology is used in the most effective way should be the primary aim of telemedicine research. There is now sufficient evidence for us to be confident that telemedicine is a safe alternative to conventional care in a variety of situations and for a number of clinical conditions. Reliable evidence that it is a practical and cost-effective alternative is, at the time of writing, harder to find.

scholarly journals Is suture ligation of cystic duct in laparoscopic cholecystectomy a safe alternative to clipping? Our experience in a rural centre

2019 ◽  
Vol 6 (10) ◽  
pp. 3715
Author(s):  
K. R. Manoj Prabu ◽  
Dhinesh Balaji ◽  
Vishwanath M. Pai
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Cystic Duct ◽  
Operating Time ◽  
Cost Effective ◽  
Safe Alternative ◽  
Suture Ligation ◽  
Medical College ◽  
The Mean ◽  
Mean Time

Background: Laparoscopic cholecystectomy is one of the most common surgeries performed nowadays. It remains an enigma regarding efficacy, safety and postoperative complications for using suture ligation for ligating cystic duct in laparoscopic cholecystectomy. The aim of the present study was to study the efficacy of ligating the cystic duct with sutures in laparoscopic cholecystectomy.Methods: This prospective study was performed between June 2018 and April 2019 in Saveetha Medical College and Hospital, in a rural center, Kanchipuram, India. All the patients included consented for the study. Patients who underwent subtotal cholecystectomy were excluded from the study.Results: The study included 70 patients who underwent laparoscopic cholecystectomy in a single unit. All cases were operated by a single surgeon. Of the 70 patients, the Cystic duct (CD) was simply ligated in 55 patients with CD <5 mm in diameter. The CD in 15 of those patients had to be divided and sutured in continuity for wide CD (>5 mm). The mean time for ligation of cystic duct was 5 min. Similarly, the mean time for ligation of cystic artery was 1.50 min. The mean operative time was 50 mins. There were no postoperative complications, such as bile leakage.Conclusions: SL of the CD is a very safe and secure alternative to the application of metal clips. It can be used in dilated CD, readily available and very cost effective and the complications of clips are avoided. The only disadvantage is that it needs expertise to perform and subsequently increasing the operating time. This technique is recommended in all laparoscopic cholecystectomies, especially in difficult cases.

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