Risks of emergency use authorizations for medical products during outbreak situations: a COVID-19 case study

Effect evaluation of new dressing URGOTULRANGE in the treatment of pressure injury

BACKGROUND

Pressure injury (PI) is a local injury of the skin and/or soft tissue located at the bone caused by medical or other equipment and is common in long-term bedridden patients.

OBJECTIVE

To investigate the clinical effect of Urgotul foam dressing in the treatment of stage 3 ∼ 4 PI and deep tissue PI.

METHODS

A total of 38 patients with stage 3 ∼ 4 PI and deep tissue PI admitted to Jinan Central Hospital from January 2016 to December 2018 were selected and randomly divided into a control group (dressing change plus silver ion cream dressing) and an observation group (dressing change plus Urgotul Absorb non-border foam dressing), with 19 cases in each group. After 4 weeks of treatment, the pain intensity during dressing change and the treatment efficacy for PI wounds were compared between the two groups.

RESULTS

There were no differences in gender (P= 0.740), age (P= 0.130), single wound area (P= 0.673), consultation department (P= 0.972), stage (P= 0.740), presence of undermining (P= 0.721), deep tissue PI (P= 0.721), and systemic antibiotic therapy (P= 1.000) between the two groups, which were comparable. The treatment effect of the observation group was better than that of the control group (P= 0.003), and the pain score of the observation group was lower than that of the control group (P< 0.001).

CONCLUSION

Urgotul Absorb non-border foam dressing has a good effect in the treatment of stage 3 ∼ 4 PI and deep tissue PI and can relieve patients' pain, and is thus worth promoting.

Application of a rehabilitation management strategy based on symptom management theory in postoperative functional exercises in patients with lower extremity arteriosclerosis obliterans

BACKGROUND

Lower extremity arteriosclerosis obliterans (ASO) is the most common occlusive disease of the peripheral blood vessels.

OBJECTIVE

To explore the application effect of symptom management-based rehabilitation strategy in postoperative functional exercises in patients with lower extremity ASO.

METHODS

The researchers selected 136 patients that underwent lower extremity ASO surgery for the first time in their department from January to September 2020. Patients were divided into a control group (n= 68) and an experimental group (n= 68). The control group implemented routine discharge rehabilitation education and continuous nursing. On this basis, the experimental group applied the symptom management theory to the rehabilitation management strategy to compare the degree of pain, the ankle-brachial index, self-care ability and quality of life between the two groups before and after the intervention.

RESULTS

Three months (P= 0.045) and six months (P=0.013) after discharge, the experimental group's degree of pain was significantly lower than that of the control group. At one month (P= 0.019), three months (P= 0.003) and six months (P= 0.000) after discharge, the experimental group recovered significantly better than the control group. At six months after discharge, the self-care ability, mood status and physical pain of the experimental group were significantly higher than in the control group (P< 0.05).

CONCLUSION

The rehabilitation management strategy, which is based on symptom management theory, can effectively improve the symptoms, quality of life and self-efficacy of ASO patients in continuous care. This nursing strategy is worthy of clinical promotion.

Adhesion measurement of living cells based on electrical impedance

BACKGROUND

Cells adherence provides specific information about physiology and pathology, the adhesion measurement between living cells and nanostructures can be measured by atomic force microscopy, but this detection technique is difficult to operate and costly. The adhesion height and effective contact area between cells and substrates are also the key factors affecting measurement value of the overall impedance. These factors change with structural parameters of the substrates, so the adhesion measurement between living cells and substrate can be indirectly reflected by the impedance value.

OBJECTIVE

To establish a mapping relationship between the impedance measurement and the adhesion measurement of living cells. The possibility of dynamic measurement of adhesion is realized by this method, and the experimental process is simplified.

METHODS

Laser interference technology was used to prepare nanoarray structures with different periods on the surface of silicon wafers for cells culture. Under the same experimental conditions, the impedance of living cells on the substrates of different cycle sizes were measured. The adhesion between cells and different substrates were analyzed by measuring impedance after the interaction between cells and substrate.

RESULTS

The adhesion of living cells on the substrates of different sizes be analyzed, and the mapping relationship between the impedance and the adhesion measurement was established. The results showed that, the larger the impedance value between cells and substrate, the larger the effective contact area and the smaller the gap between them.

CONCLUSION

The difference of adhesion height and effective adhesion area between living cells and substrates were obtained. This paper, a new method to measure the adhesion properties of living cells is presented, which provides theoretical basis for the related research.

Microleakage effect of in-office bleaching on two types of nanohybrid composites with or without surface sealer

BACKGROUND

Bleaching is a highly common method used nowadays to treat tooth discolouration because it is a significant cosmetic issue, particularly with anterior teeth, however bleaching itself results in microleakage.

OBJECTIVE

This study aims to evaluate the impact of in-office bleaching on class V restoration microleakage with type 1 and type 2 composite restorations.

METHODS

Three hundred and twenty healthy, caries-free removed human anterior teeth were used in this in-vitro study. All extracted teeth had their buccal and lingual surfaces uniformly prepped for class V cavities. The 120 removed teeth were divided into two groups, with Group 1 receiving Tetric N-Ceram nanohybrid composite restorations and Group 2 receiving 3 M Filtek Z350 XT nanohybrid composite restorations. Groups 1 and 2 were further broken into four more subgroups of four each. The restorations were sealed with a G-Coat Plus resin. The p-value was kept at 0.005 for the data analysis using the Chi-square and Fisher exact tests.

RESULTS

Allocating microleakage among 320 study models revealed that 141 (44.1%) study samples had no microleakage, whereas 20 (6.3%), 54 (16.9%), and 105 (32.8%) study samples had microleakage up to, between, and greater than two-thirds of cavity depth. With a statistically significant p-value of 0.001, no microleakage was discovered in 85 (53.1%) lingual surfaces with Tetric N-Ceram nanohybrid composite restoration and 56 (35%) buccal surfaces with 3M Filtek Z350 XT nanohybrid composite restoration. 19.1% of samples of N-Ceram that were sealed and not bleached had no microleakage, according to analysis of microleakage across several groups. With a p-value of 0.001, the distribution of microleakage among various clusters was statistically notable.

CONCLUSION

According to the findings of the study, hydrogen peroxide bleaching has an enhanced impact on micro escape during dye dispersion. Both with and without bleaching, resin coating can be utilised to minimise marginal microleakage.

Research on contactless intelligent medication pickup mode selection based on a hospital in China under COVID-19

BACKGROUND

During an outbreak such as COVID-19, hospital staff needs to be in close contact with all types of patients visiting the hospital and the risk of cross-infection is extremely high. Payment and medication pickup is a mandatory part of a patient's hospital visit, with direct contact between healthcare workers and patients, and long waiting times in the hospital area, which can easily lead to the spread of disease infection.

OBJECTIVE

This paper designed the prototype of a contactless smart medicine cabinet based on RFID technology and optimized the patient consultation and medication pickup process to address these problems.

METHODS

We conducted a 50-day field observation of patients for consultation and medication pickup at the First Hospital in H city, Jiangsu Province, China, and randomly timed 1600 sets of data from Surgery (ophthalmology) and Internal patients, then we designed the prototype of a contactless smart medicine cabinet based on RFID technology, optimized the patient consultation and medication pickup process, comparing the traditional and intelligent models using AnyLogic.

RESULTS

The results show that this contactless medicine cabinet was able to reduce the time taken by patients in consultation and medicine pickup by 18.74 minutes, increasing the overall efficiency of the consultation by 32.20%. The simulation revealed that this contactless intelligent medication pickup model was able to reduce the time taken by patients in consultation and medicine pickup, increasing the overall efficiency of the consultation, effectively reducing the frequency of contact between healthcare workers and patients, and reducing the risk of disease infection.

CONCLUSION

The proposed technical model provides a new idea to solve the problems of long queues, low efficiency and high risk of infection for patients to consult and get medicine during epidemics. Especially within hospitals it has important theoretical and practical implications for epidemic prevention and control as well as future hospital management.

Study on the therapeutic effects and prognosis evaluation of non-invasive ventilation in patients with chronic obstructive pulmonary disease with lung cancer

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory complication among the elderly, and its severity can escalate to respiratory failure as the disease progresses.

OBJECTIVE

To evaluate the application value of non-invasive ventilation in the clinical treatment of patients with COPD and lung cancer. This study assesses its therapeutic effects and its impact on patients' quality of life (QoL) as measured by the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale.

METHODS

A retrospective analysis was conducted on clinical data from 102 patients with COPD and lung cancer. Patients were divided into two groups: the control group (n= 48), who received conventional treatment, and the observation group (n= 54), who received non-invasive positive pressure ventilation (NIPPV) in addition to conventional treatment. Relevant indicators of curative effect, including blood gas indices, incidence of dyspnoea, improvements in mental health and appetite, and FACT-L QoL scores, were analysed at 2 weeks, 1 month, and 6 months post-treatment.

RESULTS

At 2 weeks post-treatment, the observation group who had used NIPPV showed significant improvements in blood gas indices, dyspnoea, mental state and self-care ability compared with the control group (p< 0.05). At 1 month, these benefits persisted and included improved maintenance of body weight (p< 0.05). By 6 months, the observation group had a lower incidence of pulmonary encephalopathy (p< 0.05), and QoL, as measured by the FACT-L scale, improved significantly in the observation group but declined in the control group (p< 0.05).

CONCLUSION

NIPPV demonstrates significant efficacy in treating COPD patients with lung cancer, particularly in enhancing curative effects and improving patients' QoL.

Long term remineralizing effect of casein phosphopeptide amorphous calcium phosphate in white spot lesions: A systematic review and meta-analysis

BACKGROUND

White spot lesions (WSLs) appear as white, opaque areas on the teeth and are caused by a demineralization of the enamel.

OBJECTIVE

The purpose of this systematic review and meta-analysis was to determine whether casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has beneficial effects on WSLs and provides remineralizing benefits that are superior to those of placebo or no treatment.

METHODS

Following a thorough analysis of the literature across major online sources, 103 papers - 54 of which underwent in-depth evaluation - were found. We used inclusion and exclusion criteria to choose research articles that were appropriate for our review.

RESULTS

10 papers met this review's requirements and were subsequently included. As compared to the controls, CPP-ACP demonstrated increased efficacy in treatment of WSLs in terms of remineralisation and other parameters which included microhardness tests and enamel surface roughness. The forest plots present the results of meta-analyses comparing the effect of CPP-ACP versus control/other agents on white spot lesions (WSLs). In terms of odds ratios (OR), CPP-ACP showed a small increase in the odds of WSLs compared to control/other agents. In-vitro studies showed no significant difference in relative risk (RR) between CPP-ACP and control/other agents. Randomized control trials indicated a small increase in the risk of WSLs with CPP-ACP treatment, but the overall effect was not statistically significant.

CONCLUSION

There was evidence to support the use of CPP-ACP over other agents for WSL prevention or treatment, but further research is needed to confirm these findings.

Application of prone position ventilation in ventilation strategies for patients with COVID-19

BACKGROUND

Patients with coronavirus disease 2019 (COVID-19) have been shown to die mainly due to disease-induced acute respiratory distress syndrome (ARDS). Prone position ventilation (PPV) is an important ventilation strategy in the management of patients with ARDS.

OBJECTIVE

To investigate the application of PPV in ventilation strategies for patients with COVID-19.

METHODS

Three hundred patients with COVID-19 admitted to the Intensive Care Unit (ICU) of Shanxi Bethune Hospital from January 2020 to June 2021 were retrospectively collected. Based on body position and conscious state, all patients were divided into three groups: intubation prone position group (n= 110), awake prone position group (n= 90) and supine position group (n= 100); The acute physiology and chronic health evaluation II (APACHE-II) scores, blood gas indicators, complications and other relevant clinical indicators were compared among the three groups. One-way ANOVA was used to compare means between multiple groups for quantitative information that conformed to a normal distribution. Repeated measures ANOVA was used for repeated measures data. Component comparisons were made using the Kruskal-Wallis H rank sum test for non-normally distributed quantitative data.

RESULTS

One-way repeated-measures ANOVA main effect analysis showed different effects of different treatments on PaO2 in patients with COVID-19 (F treatment = 256.231, P< 0.05), with the order of awake prone position group > intubation prone position group > supine position group. The effects of the three different treatments on P/F in patients with COVID-19 (F treatment = 311.661, P< 0.05), with the order of awake prone position group > supine position group > intubation prone position group; Moreover, the three treatments had different effects on APACHE II scores in patients with COVID-19 (F treatment = 201.342, P< 0.05), with the order of intubation prone position group > supine position group > awake prone position group.

CONCLUSION

Intubation prone position and awake prone position can improve lung function to some extent in patients with COVID-19, and should be applied as early as possible in patients with COVID-19-induced ARDS.

Salivary microRNAs as innovative biomarkers for early diagnosis of oral diseases: a comparison of conventional cigarette smokers and tobacco heating system 2.2 users

BACKGROUND

MicroRNAs (miRNAs) are considered valid prognostic and diagnostic biomarkers. The different miRNA expression profiles in cancer cells compared to normal cells make them potential biomarkers used for the early diagnosis of oral diseases. Following exposure to cigarette smoking, miRNA altered profile expression is associated with resistance mechanisms against anticancer therapies. Cellular models showed a reduced human gingival epithelium alteration after exposure to THS2.2 and a lower pathogenicity than 3R4F CS. The aim of the study was to compare the expression of saliva miRNA profile of THS2.2 and 3R4F CS users compared to patients not exposed to the risk factor and to identify and study the modulation of miRNAs associated with the development of oral diseases. In particular, we will focus on the analysis of a group of miRNAs know to be involved in the development of smoking-related diseases.

METHODS

The study will be performed in 18 months and dentists and biochemists will be involved in the different phases. To perform the study, healthy volunteers, including smokers of THS2.2 or 3R4F CS, will be enrolled.

RESULTS

The samples will be collected from 3 experimental groups, each consisting of 30 subjects: group 1 (no smoking subjects), group 2 (subjects exposed to THS2.2), group 3 (subjects exposed to 3R4F CS). The collection of the saliva sample will be conducted in a standardized way. Following the collection, saliva will be processed.

CONCLUSIONS

Previous studies have suggested that miRNAs are prognostic biomarkers for various smoking-related diseases. Based on the post-transcriptional regulation of some mRNAs connected to different oral pathologies, we expect a specific miRNA-mRNA interaction, which could be a starting point for the development of new possible diagnostic, therapeutic and prognostic approaches.

The Role of Social Media in Communication and Learning at the Time of COVID-19 Lockdown-An Online Survey

This study aimed to assess orthodontic postgraduate students' use of social media during the COVID-19 lockdown. Ninety-four postgraduate students (67 master's students and 27 doctoral students) were enrolled in the study and asked to fill in an online questionnaire by answering questions regarding their use of social media during the COVID-19 lockdown. The frequency distributions and percentages were calculated using SPSS software. The results showed that 99% of the students used social media. The most frequently used type of social media was Facebook, 94%, followed by YouTube, 78%, and Instagram, 65%, while Twitter and Linkedin were used less, and no one used Blogger. About 63% of the students used elements of social media to learn more about orthodontics staging, biomechanics, and various approaches in managing orthodontic cases. About 56% of students tried uploading and downloading scientific papers, lectures, movies, presentations, and e-books from social media, while communication with professionals and searches about orthodontic products were reported in 47% of students' responses. On the other hand, 43% of the responses favored sharing orthodontic information and posts for teaching and discussion purposes. Generally, social media plays leading roles in the communication with, learning of, sharing of information with, and supervision of patients from a far during the COVID-19 lockdown.

A novel method for conformity assessment testing of mechanical ventilators for post-market surveillance purposes

BACKGROUND

Mechanical ventilators are medical devices used in intensive care units when patients are in need of mechanical aid to facilitate the process of breathing. As the function of breathing is the exchange of gases, the mechanical ventilator takes over that function while the patient is incapable to spontaneous breathing. As these devices are used to maintain the life of patents, their performance must be ensured and there cannot be significant deviations in the volumes and pressure of gases they introduce to the patient. The new Medical Device Regulation (MDR) defines medical device post-market surveillance (PMS) as performed by independent, third-party, notified bodies more strategically in hope to improve traceability of device performance. However, there is still an apparent gap in terms of standardised conformity assessment testing methods.

OBJECTIVE

This paper proposes a novel method for conformity assessment testing of mechanical ventilators for post-market surveillance purposes.

METHOD

The method was developed on the basis of metrology characteristics of mechanical ventilators and evaluation of their vital safety and performance parameters. In addition to the evaluation of essential safety and visual integrity of mechanical ventilators, their performance in terms of volume of oxygen delivered to the patient as well as the flow and pressure of the delivered gas is evaluated.

RESULTS

The developed method was validated between 2018 and 2021 in healthcare institutions of all levels. The results obtained during validation suggest that conformity assessment testing of mechanical ventilators as a method used during PMS contributes to significant improvement in devices' accuracy and reliability.

CONCLUSION

A standardized approach in conformity assessment testing of mechanical ventilators during PMS, besides increasing reliability of the devices, is the first step in digital transformation of management of these devices in healthcare institutions opening possibility for use of artificial intelligence.

A novel method for conformity assessment testing of patient monitors for post-market surveillance purposes

BACKGROUND

Patient monitors are medical devices used to monitor vital parameters such as heart rate, respiratory rate, blood pressure, blood oxygen saturation, and body temperature during inpatient treatment. As such, patient monitors provide physicians with information necessary to adjust the treatment as well as evaluate the overall status and recovery of the patient. Measurements made by intrinsic sensors of patient monitors must be compliant and provide reliable readings in order to ensure safety and optimal quality of care to the patients.

OBJECTIVE

This paper proposes a novel method for conformity assessment testing of patient monitors in healthcare institutions for post-market surveillance purposes.

METHOD

The method was developed on the basis of metrology characteristics of sensors used to monitor vital parameters observed by patient monitors and evaluation of their vital safety and performance parameters. In addition to the evaluation of essential safety and visual integrity of patient monitors, their performance in terms of accuracy of the readings is evaluated.

RESULTS

The developed method was validated between 2018 and 2021 in healthcare institutions of all levels. The results obtained during validation suggest that conformity assessment testing of patient monitors as a method used during PMS contributes to significant improvement in devices' accuracy and reliability.

CONCLUSION

A standardized approach in conformity assessment testing of patient monitors during PMS, besides increasing reliability of the devices, is the first step in digital transformation of management of these devices in healthcare institutions opening possibility for use of artificial intelligence.

A novel method for conformity assessment testing of dialysis machines for post-market surveillance purposes

BACKGROUND

Dialysis machines are used regularly in healthcare practice. They are classified as a type of medical device with moderate and high risk therefore significant requirements are placed on their safety and performance every time they are used on patients. The new Medical Device Regulation (MDR) defines medical device post-market surveillance (PMS) as performed by independent, third-party, notified bodies more strategically in hope to improve traceability of device performance. However, there is still an apparent gap in terms of standardised conformity assessment testing methods.

OBJECTIVE

This paper proposes a novel evidence-based method for conformity assessment testing of dialysis machines for post-market surveillance purposes.

METHOD

The novel method is developed according to the International Organisation of Legal Metrology (OIML) guidelines and is to be used for the purpose of conformity assessment testing of Dialysis machines with respect to their metrological characteristics during PMS.

RESULTS

The developed method was validated between 2018 and 2021 in healthcare institutions of all levels. The results obtained during validation suggest that conformity assessment testing of dialysis machines as a method used during PMS contributes to significant improvement in devices' accuracy and reliability.

CONCLUSION

A standardized approach in conformity assessment testing of dialysis machines during PMS, besides increasing reliability of the devices, is the first step in digital transformation of management of these devices in healthcare institutions opening possibility for use of artificial intelligence.

A novel method for conformity assessment testing of infusion and perfusion pumps for post-market surveillance purposes

BACKGROUND

Introduction of fluids, medicaments and nutrients into the human body during hospitalization is fundamental for treatment and healing of patients. Fluids are introduced by means of infusion pumps while nutrients and medicaments are introduced by perfusion pumps. It is of vital importance for these devices to deliver exact amounts of the aforementioned substances as significant deviations can result in severe patient harm. Therefore it is important to effectively monitor their performance and prevent failures.

OBJECTIVE

This paper proposes a novel method for conformity assessment testing of infusion and perfusion pumps for post-market surveillance purposes.

METHOD

The method was developed on the basis of metrology characteristics of the devices. In addition to the evaluation of essential safety and visual integrity of infusion and perfusion pumps, their performance in terms of delivered volumes was assessed and monitored.

RESULTS

The developed method was validated between 2018 and 2021 in healthcare institutions of all levels. The results obtained during validation suggest that conformity assessment testing of infusion and perfusion pumps as a method used during PMS contributes to significant improvement in devices' accuracy and reliability.

CONCLUSION

A standardized approach in conformity assessment testing of infusion and perfusion pumps during PMS, besides increasing reliability of the devices, is the first step in digital transformation of management of these devices in healthcare institutions opening possibility for use of artificial intelligence.

A novel method for conformity assessment testing of electrocardiographs for post-market surveillance purposes

BACKGROUND

Monitoring cardiac parameters is the fundamental aspect of every diagnostic process and is facilitated by electrocardiography (ECG) devices. This way, continuous state-of-the-art performance of ECG devices can be ensured. The new Medical Device Regulation (MDR) defines medical device post-market surveillance (PMS) as performed by independent, third-party, notified bodies more strategically in hope to improve traceability of device performance. However, there is still an apparent gap in terms of standardised conformity assessment testing methods.

OBJECTIVE

This paper proposes a novel method for conformity assessment testing of ECG devices for post-market surveillance purposes.

METHOD

The method was developed on the basis of International Organisation of Legal Metrology (OIML) guidelines and applied in healthcare institutions from 2018 to 2021.

RESULTS

The developed method was validated in healthcare institutions of all levels. The results obtained during validation suggest that conformity assessment testing of the ECG device as a method used during PMS contributes to significant improvement in devices' accuracy and reliability.

CONCLUSION

A standardized approach in conformity assessment testing of ECG devices during PMS, besides increasing reliability of the devices, is the first step in the digital transformation of the management of these devices in healthcare institutions opening possibility for use of artificial intelligence.

A novel method for conformity assessment testing of infant incubators for post-market surveillance purposes

BACKGROUND

Premature born infants or infants born sick require immediate medical attention and decreasing the stress imposed onto their body by the environment. Infant incubators provide an enclosed environment that can be controlled to fit the needs of the infant. As such, their performance must be consistent and without significant deviations. The only manner to ensure this is by post-market surveillance (PMS) focused on evaluation of both safety and performance. The new Medical Device Regulation (MDR) defines medical device post-market surveillance (PMS) as performed by independent, third-party, notified bodies more strategically in hope to improve traceability of device performance. However, there is still an apparent gap in terms of standardised conformity assessment testing methods.

OBJECTIVE

This paper proposes a novel method for conformity assessment testing of infant incubators for post-market surveillance purposes.

METHOD

The method was developed based on guidelines for devices providing measurements laid out by the International Organisation of Legal Metrology (OIML). The methodology was validated during a four year period in healthcare institutions of all levels.

RESULTS

The developed method was validated between 2018 and 2021 in healthcare institutions of all levels. The results obtained during validation suggest that conformity assessment testing of infant incubators as a method used during PMS contributes to significant improvement in devices' accuracy and reliability.

CONCLUSION

A standardized approach in conformity assessment testing of infant incubators during PMS, besides increasing reliability of the devices, is the first step in digital transformation of management of these devices in healthcare institutions opening possibility for use of artificial intelligence.

A novel method for conformity assessment testing of anaesthesia machines for post-market surveillance purposes

BACKGROUND

Anaesthesia machines, as moderate to high-risk medical devices intended for use on patients during surgical procedures must be safe and reliable with traceable performance every time they are used in healthcare practice. The new Medical Device Regulation (MDR) defines medical device post-market surveillance (PMS) as performed by independent, third-party, notified bodies more strategically in hope to improve traceability of device performance. However, there is still an apparent gap in terms of standardised conformity assessment testing methods.

OBJECTIVE

This paper proposes a novel evidence-based method for conformity assessment testing of anaesthesia machines for post-market surveillance purposes.

METHOD

The novel method is developed according to the International Organisation of Legal Metrology (OIML) guidelines and is to be used for the purpose of conformity assessment testing of anaesthesia machines with respect to their technical and metrological characteristics during PMS.

RESULTS

The developed method was validated between 2018 and 2021 in healthcare institutions of all levels. The results obtained during validation suggest that conformity assessment testing of anaesthesia machines as a method used during PMS contributes to significant improvement in devices' accuracy and reliability.

CONCLUSION

A standardized approach in conformity assessment testing of anaesthesia machines during PMS, besides increasing reliability of the devices, is the first step in digital transformation of management of these devices in healthcare institutions opening possibility for use of artificial intelligence.

A novel method for conformity assessment testing of defibrillators for post-market surveillance purposes

BACKGROUND

Defibrillators are medical devices (MDs) used in the most critical situations, hence their performance must be ensured at all times. This requires defibrillators to be subjected to regular performance assessments after they have been placed on the market. The new Medical Device Regulation (MDR) defines medical device post-market surveillance (PMS) as performed by independent, third-party, notified bodies more strategically in hope to improve traceability of device performance. However, there is still an apparent gap in terms of standardised conformity assessment testing methods.

OBJECTIVE

This paper proposes a novel evidence-based method for conformity assessment testing of defibrillators.

METHOD

The proposed method is developed in accordance with the International Organisation of Legal Metrology (OIML) guidelines and is intended to be used for conformity assessment testing of defibrillators for post-market surveillance purposes.

RESULTS

The developed method was validated from 2018 to 2021 in healthcare institutions of all levels. The results obtained during validation suggest that conformity assessment testing of defibrillators as a method used during PMS contributes to significant improvement in devices' accuracy and reliability.

CONCLUSION

A standardized approach in conformity assessment testing of defibrillators during PMS, besides increasing reliability of the devices, is the first step in the digital transformation of the management of these devices in healthcare institutions opening possibility for use of artificial intelligence.

A novel method for conformity assessment testing of therapeutic ultrasounds for post-market surveillance purposes

BACKGROUND

Therapeutic ultrasounds are medical devices used for treatment of conditions such muscle spasms, joint contractures or general muscle pain. Their function relies in the delivery of ultrasonic pulses that generate heat in tissue thus relieving the symptoms of aforementioned conditions. Accuracy of the delivered pulses directly affects the quality and effectiveness of the treatment and has to be ensured throughout the utilization of the therapeutic ultrasound in practice. The new Medical Device Regulation (MDR) defines medical device post-market surveillance (PMS) as performed by independent, third-party, notified bodies more strategically in hope to improve traceability of device performance. However, there is still an apparent gap in terms of standardised conformity assessment testing methods.

OBJECTIVE

This paper proposes a novel method for conformity assessment testing of therapeutic ultrasounds for post-market surveillance purposes.

METHOD

The method was developed based on metrology characteristics of therapeutic ultrasounds and includes visual, electrical safety and performance inspections of therapeutic ultrasounds to ensure that both safety and treatment reliability are achieved.

RESULTS

The developed method was validated between 2018 and 2021 in healthcare institutions of all levels. The results obtained during validation suggest that conformity assessment testing of therapeutic ultrasounds as a method used during PMS contributes to significant improvement in devices' accuracy and reliability.

CONCLUSION

A standardized approach in conformity assessment testing of therapeutic ultrasounds during PMS, besides increasing reliability of the devices, is the first step in digital transformation of management of these devices in healthcare institutions opening possibility for use of artificial intelligence.

Radix molaris is a hidden truth of mandibular first permanent molars: A descriptive- analytic study using cone beam computed tomography

BACKGROUND

Cone-beam computed tomography (CBCT) could be more beneficial in clinical situations that involve the determination of root canal morphology.

AIM

The aim of the study was to ascertain the prevalence of radix molaris (paramolaris-RP and entomolaris-RE) in a subpopulation of Saudi Arabia using CBCT.

METHOD

A total of 700 CBCT scans of mandibular permanent first molars were included in this study. All CBCT scans were interpreted by two trained dentists and an endodontist. Mandibular permanent first molars with fully developed roots and closed apices were only included. Computed Tomography scans were obtained from the dental college record. The anatomic characteristics which were checked included: the prevalence of radix molaris in both RE and RP and the prevalence of radix molaris according to the patient's gender and age. All CBCT images were processed and reconstructed using OnDemand3DTM imaging software.

RESULTS

Of the 700 patients included, 651 (93.0%) did not have radix molaris, 46 (6.6%) had radix entomolaris and 3 (0.4%) had radix paramolaris in the study group. There was no statistically significant difference between the genders and age in the incidence of RE and RP (P-value < 0.05).

CONCLUSION

The study showed that RE prevalence is more compared to RP in the first lower molars in the population studied. It is important to identify extra roots and associated canals to perform successful root canal treatment and avoid failure.

Long-term stability of over-the-counter cuffless blood pressure monitors: a proposal

Blood pressure is an important cardiovascular parameter. Currently, the cuff-based sphygmomanometer is a popular, reliable, measurement method, but blood pressure monitors without cuffs have become popular and are now available without a prescription. Blood pressure monitors must be approved by regulatory authorities. Current cuffless blood pressure (CL-BP) monitors are not suitable for at-home management and prevention of hypertension. This paper proposes simple criteria for over-the-counter CL-BP monitoring. First, the history of the sphygmomanometer and current standard blood pressure protocol are reviewed. The main components of CL-BP monitoring are accuracy during the resting condition, accuracy during dynamic blood pressure changes, and long-term stability. In this proposal we recommend intermittent measurement to ensure that active measurement accuracy mirrors resting condition accuracy. A new experimental protocol is proposed to maintain long-term stability. A medically approved automated sphygmomanometer was used as the standard device in this study. The long-term accuracy of the test device is based on the definition of propagation error, i.e., for an oscillometric automated sphygmomanometer (5 ± 8 mmHg) ± the error for the test device static accuracy (-0.12 ± 5.49 mmHg for systolic blood pressure and - 1.17 ± 5.06 mmHg for diastolic blood pressure). Thus, the long-term stabilities were - 3.38 ± 7.1 mmHg and - 1.38 ± 5.4 mmHg, which satisfied propagation error. Further research and discussion are necessary to create standards for use by manufacturers; such standards should be readily evaluated and ensure high-quality evidence.

Supplementary information

The online version contains supplementary material available at 10.1007/s12553-023-00726-6.

Clinical management and infection control protocols during the COVID-19 pandemic: An online survey

BACKGROUND

SARS-CoV-2 (COVID-19) is considered a highly infectious and life threatening disease.

OBJECTIVE

The present paper aims to evaluate various aspects of preventive measures and clinical management of the scheduled visits for orthodontic patients to the dental clinics during the outbreak of COVID-19, and to assess how orthodontists dealt with this challenge.

METHODS

Orthodontists in private and public clinics were invited to fill a questionnaire that addressed infection control protocols and concerns about clinical management of patients in the clinics during the pandemic. Frequncies and percentages of the responses were obtained and compared using Chi-square tests.

RESULTS

About 77% of those working in private clinics, and 63% of those working in private and governmental clinics performed room disinfection following each patient. In case of patients needing urgent management and have active infection, 56% of the participants provided care under high infection control measures; on the contrary, 64% provided symptomatic intervention including orthodontic wax, analgesics and sometimes mouthwash.

CONCLUSION

The COVID-19 pandemic has had a negative impact on the orthodontic treatments. All pre-cautionary measures have to be made available in the clinic in order to minimize the spread of viral infection with continuous dental health care training.

HTA-based modeling study of the process of medical transport tasks in high-speed health trains

BACKGROUND

High-speed health trains are important tools and guarantees in major accidents, epidemic pandemics, disasters, and warfare health care, and the health trains currently developed for common train platforms have more functional defects.

OBJECTIVE

The purpose of this study is to analyze the relationship between the medical transfer system and the medical system, and to obtain a better medical transfer train formation through the established model.

METHODS

Based on the case study of medical transport tools, this paper analyzes the components and interrelationships of the medical transport system and the medical system, and then analyzes the medical transport task process of the health train by using the hierarchical task analysis (HTA) method. Combined with the Chinese standard EMU, a medical transport task model of the high-speed health train is established. Through this model, the functional compartment unit of the high-speed health train and the marshaling scheme of the high-speed health train are obtained.

RESULTS

The expert system is used to evaluate the scheme. The results show that the train formation scheme formulated by the model in this paper is superior to other train formation schemes in three indicators, meeting the requirements of large medical transfer tasks.

CONCLUSION

The results of this study can improve the ability of on-site treatment of patients, and can provide a basis for the research and development of a high-speed health train, which has a certain practical application value.

The role of high-income countries in the establishment and development of modern critical care in low resource settings: A Slovenian model

BACKGROUND

Critical care medicine is a young branch of medicine, of which the development was much faster in High Income Countries (HICs) than in Low Resources Settings (LRS). Slovenia, as one of the successor states of former Yugoslavia, passed the process of transition and joined the European Union successfully. On the contrary, Bosnia and Herzegovina (B&H) went through the extremely difficult process of transition (four years of civil war), which left a deep scar to the healthcare system, including critical care medicine.

OBJECTIVE

To examine the impact of HICs on the development of critical care in LRS.

METHOD

This review examined the process of growing up the first modern Medical Intensive Care Unit (MICU) in the Republic of Srpska.

RESULTS

The five-year process of transferring critical care knowledge from Slovenia to the health care system of Republic of Srpska has contributed to the existence of modern and state of the art MICU with tremendous social effects.

CONCLUSION

The model of using the impact of HICs for improving critical care in LRS can be extrapolated to other similar settings.

Survivability, resilience and sustainability of supply chains: The COVID-19 pandemic

As a result of the COVID-19 pandemic, supply chains (SCs) have been exposed to their greatest disruption in recent memory. This unprecedented situation has given rise to the concept of SC survivability, which is based on the need to find a new temporary equilibrium allowing SCs to survive during extreme events. The purpose of this paper is to contribute to the conceptualization of SC survivability by providing some basic foundations for this new concept. Our analysis shows that dealing with SC survivability requires a larger scale than those adopted for the analysis of SC resilience. To solve this issue, we propose a new framework called "Human Needs Supply chains". This framework shows the interdependencies between SCs, society, and the environment and enables a shift from the classical SC's product-profit view to a holistic view centred on the satisfaction of basic human needs. Another contribution of this research is to highlight the links between SC survivability, SC resilience, and SC sustainability. We show that the classical resilience capacities (i.e., absorptive, adaptive, and restorative) are not enough to deal with extraordinary and long-term disruptions such as COVID-19, and we propose an adaptation of the SC resilience concept to integrate a survivability capacity. Building resilience with a survivability capacity will allow SCs to stay alive in a temporary non-viable equilibrium of sustainability during a large disruption and to recover to a viable equilibrium at the end of the crisis.

A real-time heart rate estimation framework based on a facial video while wearing a mask

BACKGROUND: The imaging photoplethysmography (iPPG) method is a non-invasive, non-contact measurement method that uses a camera to detect physiological indicators. On the other hand, wearing a mask has become essential today when COVID-19 is rampant, which has become a new challenge for heart rate (HR) estimation from facial videos recorded by a camera. OBJECTIVE: The aim is to propose an iPPG-based method that can accurately estimate HR with or without a mask. METHODS: First, the facial regions of interest (ROI) were divided into two sub-ROIs, and the original signal was obtained through spatial averaging with different weights according to the result of judging whether wearing a mask or not, and the CDF, which emphasizes the main component signal, was combined with the improved POS suitable for real-time HR estimation to obtain the noise-removed BVP signal. RESULTS: For self-collected data while wearing a mask, MAE, RMSE, and ACC were 1.09 bpm, 1.44 bpm, and 99.08%, respectively. CONCLUSION: Experimental results show that the proposed framework can estimate HR stably in real-time in both cases of wearing a mask or not. This study expands the application range of HR estimation based on facial videos and has very practical value in real-time HR estimation in daily life.

Post-market surveillance of medical devices: A review

BACKGROUND

Medical devices (MDs) represent the backbone of the modern healthcare system. Considering their importance in daily medical practice, the process of manufacturing, marketing and usage has to be regulated at all levels. Harmonized evidence-based conformity assessment of MDs during PMS relying on traceability of medical device measurements can contribute to higher reliability of MD performance and consequently to higher reliability of diagnosis and treatments.

OBJECTIVE

This paper discusses issues within MD post-market surveillance (PMS) mechanisms in order to set a path to harmonization of MD PMS.

METHODS

Medline (1980-2021), EBSCO (1991-2021), and PubMed (1980-2021) as well as national and international legislation and standard databases along with reference lists of eligible articles and guidelines of relevant regulatory authorities such as European Commission, Food and Drug Administration were searched for relevant information. Journal articles that contain information regarding PMS methodologies concerning stand-alone medical devices. National and international legislation, standards and guidelines concerning the topic.

RESULTS

The search strategy resulted in 2282 papers. Out of those only 24 articles satisfied the eligibility criteria and were finally included in the review. Papers were grouped per categories: medical device registry, medical device adverse event reporting, and medical device performance evaluation. In addition to journal articles, national and international legislation, standards, and guidelines were reviewed to assess the state of PMS in different regions of the world.

CONCLUSION

Although the regulatory framework prescribes PMS of medical devices, the process itself is not harmonized with international standards. Particularly, conformity assessment of MDs, as an important part of PMS, is not measured and managed in a traceable, evidence-based manner. The lack of harmonization within PMS results in an environment of increased adverse events involving MDs and overall mistrust in medical device diagnosis and treatment results.

Implementation of a Comprehensive Testing Protocol for a Rapidly Manufactured Mechanical Ventilator

Introduction

The COVID-19 pandemic highlighted that surges in critical care demand can overwhelm existing healthcare infrastructures, most evident in the acute shortage of mechanical ventilators across the globe. Despite efforts to encourage urgent authorization of newly developed emergency ventilators, the currently available testing protocols are not internationally accepted, standardized and none address testing in clinical settings. The aim of this study was to compile and perform a comprehensive clinical testing protocol for a newly developed emergency ventilator.

Methods

Using previously available guidance, we compiled a sequential testing protocol with a: 1. preclinical, 2. safety testing, 3. clinician usability test and 4. clinical stage involving respiratory failure patients. The protocol was then tested on the Luca ventilator, a mechanical ventilator capable of sophisticated ventilator settings rapidly developed specifically in response to the COVID-19 pandemic.

Results

During the pre-clinical/safety stages, the ventilator produced pressure and volume changes deemed acceptable by the Rapidly Manufactured Ventilator System guideline. Furthermore, our protocol allowed the identification of a number of issues that were easily resolved with minor software adjustments. Usability was excellent (overall System Usability Scale score = 90.5). Clinical testing revealed that a sampling frame of 15 critically ill patients was sufficiently powered to detect any significant, clinically relevant differences between the Luca ventilator and a standard ICU ventilator.

Conclusions

The ventilator was accurate, reliable, safe, and user-friendly. The implementation of a comprehensive, standardized pre-clinical/clinical testing protocol is feasible, potentially enabling the safe and timely emergency authorization of rapidly developed mechanical ventilators crucial in pandemic situations.

Performance Evaluation of Lateral Flow Assays for Coronavirus Disease-19 Serology

The coronavirus disease of 2019 (COVID-19) pandemic, caused by infection with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has undoubtedly resulted in significant morbidities, mortalities, and economic disruptions across the globe. Affordable and scalable tools to monitor the transmission dynamics of the SARS-CoV-2 virus and the longevity of induced antibodies will be paramount to monitor and control the pandemic as multiple waves continue to rage in many countries. Serologic assays detect humoral responses to the virus, to determine seroprevalence in target populations, or induction of antibodies at the individual level following either natural infection or vaccination. With multiple vaccines rolling out globally, serologic assays to detect anti-SARS-CoV-2 antibodies will be important tools to monitor the development of herd immunity. To address this need, serologic lateral flow assays (LFAs), which can be easily implemented for both population surveillance and home use, will be vital to monitor the evolution of the pandemic and inform containment measures. Such assays are particularly important for monitoring the transmission dynamics and durability of immunity generated by natural infections and vaccination, particularly in resource-limited settings. In this review, we discuss considerations for evaluating the accuracy of these LFAs, their suitability for different use cases, and implementation opportunities.

Is It Time to Call 'Code Blue' on Nursing Infrastructure? A Nurse's Perspective from the COVID-19 Front-line

The COVID-19 pandemic has highlighted the significance of every role within the interdisciplinary team and has exacerbated the challenges posed to every member. From the nursing perspective, many of these challenges were present before the pandemic but have become significantly larger problems that continue to demand global attention. This has provided an opportunity to critically evaluate and learn from the challenges the pandemic has both highlighted and created. We conclude that the nursing infrastructure requires a revolution in order to support, grow and retain nurses, who are vital to the delivery of high-quality healthcare.

Cost-effective vital signs monitoring system for COVID-19 patients in smart hospital

The lack of staffing during COVID-19 pandemic drives hospitals to expand their facilities in non-traditional settings to include centralized communication systems to monitor the vital signs of patients and predictive models to identify their health conditions. In this research, we have developed a microcontroller-based wireless vital signs monitoring system, which is able to measure the body temperature, heart rate, blood oxygen level, respiratory rate and Electrocardiogram of the patients. We managed to obtain a reliable but more affordable vital signs monitor with high mobility that can be implemented in large hospitals. The system satisfies the design considerations of medical centers in terms of size, cost, power consumption and simplicity in implementation. The developed system consists of a set of wearable sensor nodes, wireless communications infrastructure with multiple communications techniques to carry vital data from the patients to the management system that handles the patient’s medical data, and a graphical user interface with a control system that enables the hospital staff to observe the status of all the patients and take the appropriate actions. The system was implemented using 40 sensor nodes, 4 distribution points and one gateway covering a hospital area of approximately 2500 m². The system was tested and the measured percentage of lost packets is found to be less than 3.3% of those sent. During transmission, the current measured from the sensor node was 10.5 mA with a 3.3 V input voltage, which prolonged the operating time of the battery used.

Evaluation of serological lateral flow assays for severe acute respiratory syndrome coronavirus-2

BACKGROUND

COVID-19 has resulted in significant morbidity and mortality worldwide. Lateral flow assays can detect anti-Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) antibodies to monitor transmission. However, standardized evaluation of their accuracy and tools to aid in interpreting results are needed.

METHODS

We evaluated 20 IgG and IgM assays selected from available tests in April 2020. We evaluated the assays' performance using 56 pre-pandemic negative and 56 SARS-CoV-2-positive plasma samples, collected 10-40 days after symptom onset, confirmed by a molecular test and analyzed by an ultra-sensitive immunoassay. Finally, we developed a user-friendly web app to extrapolate the positive predictive values based on their accuracy and local prevalence.

RESULTS

Combined IgG + IgM sensitivities ranged from 33.9 to 94.6%, while combined specificities ranged from 92.6 to 100%. The highest sensitivities were detected in Lumiquick for IgG (98.2%), BioHit for both IgM (96.4%), and combined IgG + IgM sensitivity (94.6%). Furthermore, 11 LFAs and 8 LFAs showed perfect specificity for IgG and IgM, respectively, with 15 LFAs showing perfect combined IgG + IgM specificity. Lumiquick had the lowest estimated limit-of-detection (LOD) (0.1 μg/mL), followed by a similar LOD of 1.5 μg/mL for CareHealth, Cellex, KHB, and Vivachek.

CONCLUSION

We provide a public resource of the accuracy of select lateral flow assays with potential for home testing. The cost-effectiveness, scalable manufacturing process, and suitability for self-testing makes LFAs an attractive option for monitoring disease prevalence and assessing vaccine responsiveness. Our web tool provides an easy-to-use interface to demonstrate the impact of prevalence and test accuracy on the positive predictive values.

The ethics of shared Covid-19 risks: an epistemological framework for ethical health technology assessment of risk in vaccine supply chain infrastructures

This article addresses the topic of shared responsibilities in supply chains, with a specific focus on the application of the Internet of Things (IoT) in e-health environments, and Industry 4.0 issues-concerning data security, privacy, reliability and management, data mining and knowledge exchange as well as health prevention. In this article, we critically review methodologies and guidelines that have been proposed to approach these ethical aspects in digital supply chain settings. The emerging framework presents new findings on how digital technologies affect vaccine shared supply chain systems. Through epistemological analysis, the article derives new insights for transparency and accountability of supply chain cyber risk from Internet of Things systems. This research devises a framework for ethical awareness, assessment, transparency and accountability of the emerging cyber risk from integrating IoT technologies on shared Covid-19 healthcare supply chain infrastructure.

Telemedicine and e-Health research solutions in literature for combatting COVID-19: a systematic review

COVID-19 had led to severe clinical manifestations. In the current scenario, 98 794 942 people are infected, and it has responsible for 2 124 193 deaths around the world as reported by World Health Organization on 25 January 2021. Telemedicine has become a critical technology for providing medical care to patients by trying to reduce transmission of the virus among patients, families, and doctors. The economic consequences of coronavirus have affected the entire world and disrupted daily life in many countries. The development of telemedicine applications and eHealth services can significantly help to manage pandemic worldwide better. Consequently, the main objective of this paper is to present a systematic review of the implementation of telemedicine and e-health systems in the combat to COVID-19. The main contribution is to present a comprehensive description of the state of the art considering the domain areas, organizations, funding agencies, researcher units and authors involved. The results show that the United States and China have the most significant number of studies representing 42.11% and 31.58%, respectively. Furthermore, 35 different research units and 9 funding agencies are involved in the application of telemedicine systems to combat COVID-19.