scholarly journals A Review of Pneumatic Actuators Used for the Design of Medical Simulators and Medical Tools

2019 ◽  
Vol 3 (3) ◽  
pp. 47 ◽  
Author(s):  
Thibault Sénac ◽  
Arnaud Lelevé ◽  
Richard Moreau ◽  
Cyril Novales ◽  
Laurence Nouaille ◽  
...  
Keyword(s):  
Joint Venture ◽  
Low Cost ◽  
Objective Assessment ◽  
Variable Stiffness ◽  
Medical Specialty ◽  
Needle Insertion ◽  
Epidural Needle ◽  
Body Parts ◽  
Pneumatic Actuation ◽  
Assisted Delivery

Simulators have been traditionally used for centuries during medical gestures training. Nowadays, mechatronic technologies have opened the way to more evolved solutions enabling objective assessment and dedicated pedagogic scenarios. Trainees can now practice in virtual environments representing various kind of patient and body parts including physio-pathologies issues. Gestures, to be mastered, vary according to each medical specialty (e.g., ultrasound probe orientations, or forceps installation during assisted delivery). Hence, medical students need kinesthetic feedback in order to significantly improve their learning capabilities. Gesture simulators require haptic devices with variable stiffness actuators. Existing solutions do not always fit the requirements because of their significant size. Contrary to electric actuators, pneumatic technology is low-cost, available off-the-shelf and offers a better mass–power ratio. However, it presents two main drawbacks: nonlinear dynamics and need for a compressed air supply. During the last decade, we have developed several haptic solutions based on pneumatic actuation (e.g., birth simulator, epidural needle insertion simulator) and, recently, in a joint venture with Prisme laboratory, a pneumatic probe master device for remote ultrasonography. This paper recalls literature scientific approaches on pneumatic actuation developed in the medical context and illustrated with the aforementioned applications to highlight the benefits.

scholarly journals Changes in Gaze Behavior during the Learning of the Epidural Technique with a Simulator in Anesthesia Novices (Preprint)

2020 ◽  
Author(s):  
Emanuele Capogna ◽  
Francesco Salvi ◽  
Lorena Delvino ◽  
Andrea Di Giacinto ◽  
Angelica Del Vecchio ◽  
...  
Keyword(s):  
Eye Tracking ◽  
Assessment Tool ◽  
Objective Assessment ◽  
Needle Insertion ◽  
Epidural Block ◽  
Epidural Needle ◽  
Eye Tracker ◽  
Gaze Behavior ◽  
Before And After ◽  
Potential Applications

BACKGROUND Current literature demonstrates the ability of eye tracking to provide reliable quantitative data as an objective assessment tool, with potential applications to medical and surgical training to improve performance. OBJECTIVE The aim of this study was to evaluate the changes in gaze behavior in anesthesia novice trainees when performing a simulated epidural technique before and after a hands-on training on the epidural simulator. METHODS We enrolled 48 novice trainees who had never previously performed an epidural block. After a standardized learning module, each trainee practiced the epidural procedure on the epidural simulator while wearing a pair of eye tracking glasses (Tobii Pro Glasses 50 Hz wearable wireless eye tracker). After this baseline recording, each trainee spent two hours practicing with the epidural simulator and afterwards once again performed the eye tracking epidural procedure. Eye tracking metrics and epidural learning (duration of the procedure and number of attempts) before and after the simulated practice were recorded. RESULTS The duration of the epidural procedure was shorter and the number of epidural attempts reduced after the tutorial. Before the tutorial, during needle insertion. the eye tracking metrics showed more visit counts of shorter duration and after the tutorial less visit counts (P=.05) but of longer duration (P=.03). A significant correlation was observed between the number of epidural needle insertions (additional attempts) and the number (OR=2.02 (0.23-1.27; P=.008)) and duration (OR=0.65 (-0.93-0.02; P=.05)) of visits. CONCLUSIONS In novice anesthesia trainees who had never previously performed an epidural block, we observed significant changes in gaze behavior associated with increased performance during the initial phase of epidural technique learning with a simulator. These results may create a prototype for future studies on eye tracking technique as a teaching and evaluating tool in simulation. CLINICALTRIAL Not necessary

The Conversion Conundrum: The State and Federal Response to Hospitals’ Changes in Charitable Status

1997 ◽  
Vol 23 (2-3) ◽  
pp. 221-250
Author(s):  
Lawrence E. Singer
Keyword(s):  
Joint Venture ◽  
Low Cost ◽  
State Level ◽  
The State ◽  
Nonprofit Hospitals ◽  
For Profit ◽  
Tax Exempt ◽  
Federal Response ◽  
Profit Status ◽  
Hospital Conversions

The pressures encountered by hospitals in the current era of reimbursement declines and stiffened competition are well known. As the “ultimate” payors—primarily employers and government—aggressively continue to seek low cost care, the response of the hospital industry has been to move toward consolidation and efficiency-enhancing mechanisms.Increasingly, nonprofit, tax-exempt hospitals have come to believe that they are at a significant disadvantage vis-á-vis their for-profit brethren in their ability to attract the capital needed to compete in the market. A growing trend among nonprofit hospitals, therefore, is to sell to or enter into a joint venture with a proprietary organization, or alternatively to convert to for-profit status. In 1995, fifty-eight nonprofit hospitals became for-profit; hospital conversions to for-profit status in 1996 are projected to outstrip the pace established the prior year.The conversion trend has not gone unnoticed at the state level. Recently, several states have proposed or enacted laws regulating sales and conversions of nonprofit hospitals, and many more states are contemplating such legislation.

Epidural needle insertion

2018 ◽  
Vol 67 (12) ◽  
pp. 922-930 ◽  
Author(s):  
H. Bomberg ◽  
N. Paquet ◽  
A. Huth ◽  
S. Wagenpfeil ◽  
P. Kessler ◽  
...  
Keyword(s):  
Needle Insertion ◽  
Epidural Needle

scholarly journals EMLA Cream Prior to Insertion of Elective Epidurals

1995 ◽  
Vol 23 (3) ◽  
pp. 339-341 ◽  
Author(s):  
J. A. Elson ◽  
M. J. Paech
Keyword(s):  
Elective Caesarean Section ◽  
Needle Insertion ◽  
Patient Comfort ◽  
Epidural Needle ◽  
Double Blind Study ◽  
Double Blind ◽  
Emla Cream ◽  
Skin Infiltration ◽  
Group A ◽  
Group B

A randomized double-blind study was conducted in 83 women scheduled for elective caesarean section to determine the efficacy of EMLA and lignocaine infiltration for epidural insertion. The patients were randomly allocated to one of three groups: Group A (EM/LIG) received EMLA and intradermal and subdermal 1% lignocaine infiltration, Group B (EM/SAL) EMLA and saline while Group C (PL/LIG) received placebo cream and 1% lignocaine. Assessments using a 100 mm pain score were performed on skin infiltration and after subsequent insertion of a 16 gauge Tuohy needle into the supraspinous ligament. Skin changes under the applied cream and nursing rating of patients’ response were also noted. Statistical analyses were performed using Kruskal-Wallis and Fisher's Exact Tests. Groups were comparable for age, weight, parity and EMLA application time (interquartile range 105-150 minutes) There were significantly higher pain scores for skin infiltration in Group C (PL/LIG) (P<0.01) and for epidural needle insertion in Group B (EM/SAL) (P<0.05). We concluded that in this patient population, the application of EMLA cream for at least 90 minutes plus 1% lignocaine infiltration optimized patient comfort for epidural insertion.

Real-time Ultrasound-Guided Lumbar Epidural with Transverse Interlaminar View: Evaluation of an In-Plane Technique

Pain Medicine ◽  
2019 ◽  
Vol 20 (9) ◽  
pp. 1750-1755 ◽  
Author(s):  
Hesham Elsharkawy ◽  
Wael Saasouh ◽  
Rovnat Babazade ◽  
Loran Mounir Soliman ◽  
Jean-Louis Horn ◽  
...  
Keyword(s):  
Success Rate ◽  
Real Time ◽  
Epidural Anesthesia ◽  
Needle Insertion ◽  
Adult Patients ◽  
Epidural Needle ◽  
Anatomical Landmarks ◽  
Care Hospital ◽  
Open Prostatectomy ◽  
Ultrasound Guided

Abstract Objective The anatomical landmarks method is currently the most widely used technique for epidural needle insertion and is faced with multiple difficulties in certain patient populations. Real-time ultrasound guidance has been recently used to aid in epidural needle insertion, with promising results. Our aim was to test the feasibility, success rate, and satisfaction associated with a novel real-time ultrasound-guided lumbar epidural needle insertion in the transverse interlaminar view. Design Prospective descriptive trial on a novel approach. Setting Operating room and preoperative holding area at a tertiary care hospital. Subjects Adult patients presenting for elective open prostatectomy and planned for surgical epidural anesthesia. Methods Consented adult patients aged 30–80 years scheduled for open prostatectomy under epidural anesthesia were enrolled. Exclusion criteria included allergy to local anesthetics, infection at the needle insertion site, coagulopathy, and patient refusal. A curvilinear low-frequency (2–5 MHz) ultrasound probe and echogenic 17-G Tuohy needles were used by one of three attending anesthesiologists. Feasibility of epidural insertion was defined as a 90% success rate within 10 minutes. Results Twenty-two patients were enrolled into the trial, 14 (63.6%) of whom found the process to be satisfactory or very satisfactory. The median time to perform the block was around 4.5 minutes, with an estimated success rate of 95%. No complications related to the epidural block were observed over the 48 hours after the procedure. Conclusions We demonstrate the feasibility of a novel real-time ultrasound-guided epidural with transverse interlaminar view.

Strategic merge: a gain or a gamble – the case of Telco China

2019 ◽  
Vol 9 (2) ◽  
pp. 1-23
Author(s):  
Wing Sun Li
Keyword(s):  
Undergraduate Students ◽  
Business Performance ◽  
Joint Venture ◽  
Low Cost ◽  
Emerging Market ◽  
High Tech ◽  
Competitive Strategies ◽  
Content Type ◽  
Differentiation Strategy ◽  
Academic Level

Learning outcomes By reviewing the case study, readers are expected to understand the constraints of competitive strategies in a shifting environmental landscape; the difficulties of foreign companies to sustain in an emerging market with government interventions; the subtlety of joint venture (JV) formation by partners with very divergent background, priority and agenda; evaluation of behavioural orientations of partnership and JV operational arrangements as determinants of a successful JV strategy. Case overview/synopsis High-tech companies can enjoy super profits from their products when only a few competitors can compete with them technologically. However, these companies also nurture a high-cost operational culture that sets a constraint for their further growth when superiority of the technology can no longer be maintained. High-tech companies may reposition their businesses with a strategic shift from differentiation strategy to cost focus strategy. The attendant shift as well as synchronization problem in an organization may require a larger effort to revamp. This case describes a global telecom infrastructure company with successful business performance in China in her early establishment with a pre-emptive technological edge. Mitigation of technological superiority and the rise of local competitors have forced the Company to opt for a cooperative strategy with a local player in the establishment of a low-cost joint venture. Does the new joint venture facilitate the strategic shift or just create an illusion of cooperation? Complexity academic level Undergraduate students and post graduate students taking strategic management course. Supplementary materials Teaching Notes are available for educators only. Please contact your library to gain login details or email [email protected] to request teaching notes. Subject code CSS 11: Strategy.

scholarly journals Exposure to impacts across a competitive rugby season impairs balance and neuromuscular function in female rugby athletes

2020 ◽  
Vol 6 (1) ◽  
pp. e000740
Author(s):  
Stephanie E Black ◽  
Bruno Follmer ◽  
Rinaldo André Mezzarane ◽  
Gregory E P Pearcey ◽  
Yao Sun ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Low Cost ◽  
Objective Assessment ◽  
Assessment Tools ◽  
Neurological Deficits ◽  
Normative Values ◽  
Balance Performance ◽  
Head Impacts ◽  
Unstable Surface ◽  
Balance Board

ObjectivesWe used objective assessment tools to detect subtle neurological deficits that accompany repetitive and mild head impacts in contact sport across a season.MethodsFemale participants (n=13, 21±1.8 years old; 167.6±6.7 cm; 72.8±6.1 kg) completed assessments pre and post the varsity rugby season. A commercial balance board was used to assess static balance and response to dynamic postural challenge. Spinal cord excitability via the soleus H-reflex was assessed in both legs. Video analysis was used to identify head impact exposures.ResultsA total of 172 potential concussive events were verified across 11 athletes (15.6±11; 95% CI: 6.5 to 19.8). Balance performance was worse at post-season for total centre of pressure which increased by 26% in the double stance on a stable surface (t(12)=-2.33; p=0.03; d=0.6) and by 140% in the tandem stance on a foam surface (t(12)=-3.43; p<0.01; d=0.9). Despite that, dynamic postural performance was improved after the season (p<0.01). Spinal cord excitability in rugby athletes did not change across the season but deviated from normative values at baseline.ConclusionQuantitative measures revealed that exposure to impacts across a competitive rugby season impair balance in two specific stances in female rugby athletes. Tandem-leg stance on an unstable surface and double-leg stance on firm surface are useful assessment conditions when performed over a low-cost balance board, even without clinically diagnosed concussion.

Sign in / Sign up

Export Citation Format

Share Document