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Diane R M Somlo, Nelson P Repenning, Abeel A Mangi
BACKGROUND: Contemporary reimbursement systems allow hospitals to maintain profitability by offering procedural services. However, increasing procedural volume can be met with structural inefficiencies that in turn cause delays, worse patient outcomes, and increased cost. METHODS: A multidisciplinary team assessed operations and outcomes at the Heart and Vascular Center at Yale New Haven Hospital, a tertiary academic medical center. Data were analyzed retrospectively to assess delays in transferring patients between care environments, patient outcomes, and cost...
June 13, 2018: Annals of Thoracic Surgery
Ansar Z Vance, Daniel A Leung, Timothy W Clark
Pedal access has become an indispensable technique for endovascular therapy of complex lower extremity peripheral vascular disease. From an option as a single access in a patient lacking traditional access approaches to a critical maneuver in combined antegrade-retrograde approaches during the treatment of complex chronic total occlusions, pedal access is an essential tool for any endovascular physician treating peripheral arterial disease. Anticipatory planning is critical in the successful utilization of pedal access...
June 14, 2018: Journal of Cardiovascular Surgery
Carsten W Israel
Transient loss of consciousness represents one of the most frequent reasons for patients to present in the emergency room. Already at the very beginning, the diagnostic work-up is faced with fundamental questions: (1) Was it really a loss of consciousness? (2) Which department (neurology, cardiology, or others) should check the patient? (3) Is an in-hospital diagnostic work-up required? These questions can be answered from a meticulous patient history which needs to be adjusted to the individual case but also has to systematically go through a list of questions...
June 2018: Herzschrittmachertherapie & Elektrophysiologie
Qi Zeng, Qingyan Wang, Jianfeng Jason Zheng, Wolfgang Kainz, Ji Chen
A typical cochlear implant system under Magnetic Resonance Imaging (MRI) procedures may couple with the radio frequency (RF) electromagnetic field (EMF) and results in an intensified electric field at the lead tip. As a result, the RF energy deposited in human tissues around the lead tip may induce heating and cause tissue damage concerns. The purpose of this work is to evaluate the RF-EMF-induced heating for cochlear implant system in 1.5T MRI coil and highlight the factors that have significant effects on the heating...
June 12, 2018: Physics in Medicine and Biology
Anand Kumar Mishra, Francesca Tramacere, Roberto Guarino, Nicola Maria Pugno, Barbara Mazzolai
Plants use many strategies to move efficiently in soil, such as growth from the tip, tropic movements, and morphological changes. In this paper, we propose a method to translate morphological features of Zea mays roots into a new design of soft robots that will be able to move in soil. The method relies on image processing and curve fitting techniques to extract the profile of Z. mays primary root. We implemented an analytic translation of the root profile in a 3D model (CAD) to fabricate root-like probes by means of 3D printing technology...
2018: PloS One
Wei Peng, Xiaowei Tang, Xiangsheng Fu
A 53-year-old man presented with nausea and dysemesia underwent gastroscopy, which revealed a submucosal tumor arising from the esophagus at 25 cm from the incisors, approximately 3.0×3.0 cm in size. Endoscopic ultrasound showed that the lesion originated from the muscularis propria (Figure 1). Submucosal tunneling endoscopic resection [1] was carried out under general anesthesia using a videoendoscope equipped with near-focus function (EVIS-HQ290, Olympus Medical Systems Co. Ltd., Tokyo, Japan) with a transparent cap (D-201-10704, Olympus) attached to the tip...
June 5, 2018: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
Michael W Rowley, Myunghan Choi, Steve Chen, Kevin Hirsch, Anil B Seetharam
BACKGROUND AND AIMS: Hepatic encephalopathy (HE) is a common complication of elective transjugular intrahepatic portosystemic shunt (TIPS) placement and is often successfully medically managed. Risk factors for refractory hepatic encephalopathy (RHE) necessitating revision of TIPS are not well defined. We evaluated the incidence, predictors, and outcomes of post-TIPS RHE necessitating TIPS revision. METHODS: In a retrospective cohort study of 174 consecutive patients undergoing elective TIPS placement (2010-2015), we evaluated the incidence of post-TIPS RHE...
June 5, 2018: Cardiovascular and Interventional Radiology
Yan-Bin Liu, Yin Wang, Zi-Qiang Chen, Jun Li, Wei Chen, Chuan-Feng Wang, Qiang Fu
BACKGROUND: The use of percutaneous endoscopic lumbar discectomy (PELD) is increasing in the treatment of lumbar disc herniations (LDH). Nerve and vessel injury may happen during the establishment of the transforaminal working channel. Also, there is usually exposure to intraop radiation when the C-arm is used to help establish the location of the transforaminal working channel. OBJECTIVE: To evaluate the accuracy and safety of the volume navigation technique for guiding transforaminal puncture in cadaver and clinical patient treatment...
May 2018: Pain Physician
Neerja Bharti, Suryabrata Chattopadhyay, Navneet Singla, Indu Bala, Yatindra K Batra, Jaimanti Bakshi
BACKGROUND: The management of glossopharyngeal neuralgia due to oropharyngeal carcinoma is particularly difficult because of rich innervations of the area, erosive nature of neoplasm and dynamic pain evoked by the functional movements like swallowing and chewing. Few case reports have shown the efficacy of pulsed radiofrequency (PRF) treatment in primary and secondary glossopharyngeal neuralgia in non-cancer patients. However, the efficacy of PRF ablation of the glossopharyngeal nerve in oral cancer patients is not known...
May 2018: Pain Physician
Gavin Hazell, Leanne E Fisher, W Andrew Murray, Angela H Nobbs, Bo Su
Infections resulting from bacterial biofilm formation on the surface of medical devices are challenging to treat and can cause significant patient morbidity. Recently, it has become apparent that regulation of surface nanotopography can render surfaces bactericidal. In this study, poly(ethylene terephthalate) nanocone arrays are generated through a polystyrene nanosphere-mask colloidal lithographic process. It is shown that modification of the mask diameter leads to a direct modification of centre-to-centre spacing between nanocones...
May 28, 2018: Journal of Colloid and Interface Science
Marie E Murray, Jamie C Barner, Nathan D Pope, Mark D Comfort
OBJECTIVE: To determine how implementing a systematic medication therapy management (MTM) process impacted MTM completion rates. METHODS: This process improvement pilot included 4 grocery store-based community pharmacy sites. Site staff were trained on a systematic process to integrate OutcomesMTM opportunities into pharmacy workflow. Technicians prepared MTM paperwork, including a standardized comprehensive medication review (CMR) worksheet, which pharmacists used to deliver the service at the counsel window...
January 1, 2018: Journal of Pharmacy Practice
Ikumi Sugiyama, Kenzo Kudo, Yasuyuki Sadzuka
 Cancer chemotherapy-induced stomatitis may spread throughout a patient's entire oral cavity and decrease the patient's QOL. The therapy for stomatitis at Iwate Medical University Hospital (IMUH) includes dental treatment before chemotherapy, in addition to oral rinses or cryotherapy as a preventative measure. However, in our survey of doctors and nurses, the responses of patients "satisfied" with the present approach for stomatitis treatment reached only 5.1%. Therefore, we attempted treatment using an indomethacin spray, prepared as a hospital preparation, with pre-approval of the ethics committee and based on a previous report of its positive effect on patients at another hospital...
2018: Yakugaku Zasshi: Journal of the Pharmaceutical Society of Japan
Iris De Falco, Costanza Culmone, Arianna Menciassi, Jenny Dankelman, John J van den Dobbelsteen
Needles are advanced tools commonly used in minimally invasive medical procedures. The accurate manoeuvrability of flexible needles through soft tissues is strongly determined by variations in tissue stiffness, which affects the needle-tissue interaction and thus causes needle deflection. This work presents a variable stiffness mechanism for percutaneous needles capable of compensating for variations in tissue stiffness and undesirable trajectory changes. It is composed of compliant segments and rigid plates alternately connected in series and longitudinally crossed by four cables...
June 4, 2018: Medical & Biological Engineering & Computing
Anthony J Cornel, Yoosook Lee, António Paulo Gouveia Almeida, Todd Johnson, Joel Mouatcho, Marietjie Venter, Christiaan de Jager, Leo Braack
BACKGROUND: A century of studies have described particular aspects of relatively few mosquito species in southern Africa, mostly those species involved with disease transmission, specifically malaria and arboviruses. Patterns of community composition such as mosquito abundance and species diversity are often useful measures for medical entomologists to guide broader insights and projections regarding disease dynamics and potential introduction, spread or maintenance of globally spreading pathogens...
June 1, 2018: Parasites & Vectors
Golafsoun Ameri, Daniel Bainbridge, Terry M Peters, Elvis C S Chen
Complications in ultrasound-guided central line insertions are associated with the expertise level of the operator. However, a lack of standards for teaching, training and evaluation of ultrasound guidance results in various levels of competency during training. To address such shortcomings, there has been a paradigm shift in medical education toward competency-based training, promoting the use of simulators and quantitative skills assessment. It is therefore necessary to develop reliable quantitative metrics to establish standards for the attainment and maintenance of competence...
May 29, 2018: Ultrasound in Medicine & Biology
Paul Mignon, Philippe Poignet, Jocelyne Troccaz
Robotic control of needle bending aims at increasing the precision of percutaneous procedures. Ultrasound feedback is preferable for its clinical ease of use, cost and compactness but raises needle detection issues. In this paper, we propose a complete system dedicated to robotized guidance of a flexible needle under 3D ultrasound imaging. This system includes a medical robot dedicated to transperineal needle positioning and insertion, a rapid path planning for needle steering using bevel-tip needle natural curvature in tissue, and an ultrasound-based automatic needle detection algorithm...
May 29, 2018: Annals of Biomedical Engineering
J Randall Curtis, Lois Downey, Anthony L Back, Elizabeth L Nielsen, Sudiptho Paul, Alexandria Z Lahdya, Patsy D Treece, Priscilla Armstrong, Ronald Peck, Ruth A Engelberg
Importance: Clinician communication about goals of care is associated with improved patient outcomes and reduced intensity of end-of-life care, but it is unclear whether interventions can improve this communication. Objective: To evaluate the efficacy of a patient-specific preconversation communication-priming intervention (Jumpstart-Tips) targeting both patients and clinicians and designed to increase goals-of-care conversations compared with usual care. Design, Setting, Participants: Multicenter cluster-randomized trial in outpatient clinics with physicians or nurse practitioners and patients with serious illness...
May 26, 2018: JAMA Internal Medicine
Marianne Brodmann, Eric Thérasse, Andrew Benko, Louis-Philippe Riel, Steven Dion, Philippe Généreux, Martin Brouillette
BACKGROUND: The aim of this study was to examine the safety and efficacy of the SoundBite™ Crossing System for the recanalization of infrainguinal chronic total occlusion (CTO) lesions. CTOs are frequent among patients with severe claudication or critical limb ischemia. Failure to recanalize CTOs remains common and is associated with poor prognosis. The SoundBite™ Crossing System (SoundBite Medical Solutions Inc., Montreal, Canada) is a newly developed device that uses a 0.018-inch wire (SoundBite™ Active Wire) to deliver acoustic shock waves to the distal tip of a steerable guidewire to facilitate directed penetration of the proximal cap and crossing of the occlusion...
May 23, 2018: Journal of Cardiovascular Surgery
Luis A Velosa-Moncada, Luz Antonio Aguilera-Cortés, Max A González-Palacios, Jean-Pierre Raskin, Agustin L Herrera-May
Primary tumors of patients can release circulating tumor cells (CTCs) to flow inside of their blood. The CTCs have different mechanical properties in comparison with red and white blood cells, and their detection may be employed to study the efficiency of medical treatments against cancer. We present the design of a novel MEMS microgripper with rotatory electrostatic comb-drive actuators for mechanical properties characterization of cells. The microgripper has a compact structural configuration of four polysilicon layers and a simple performance that control the opening and closing displacements of the microgripper tips...
May 22, 2018: Sensors
Chia-Chang Huang, Hui-Chi Hsu, Ling-Yu Yang, Chen-Huan Chen, Ying-Ying Yang, Ching-Chih Chang, Chiao-Lin Chuang, Wei-Shin Lee, Fa-Yauh Lee, Shinn-Jang Hwang
BACKGROUND: Failure to transfer procedural skills learned in a laboratory to the bedside is commonly due to a lack of peer support/stimulation. A digital platform (Facebook) allows new clinical clerks to share experiences and tips that help augment their procedural skills in a peer-assisted learning/teaching method. This study aims to investigate the effectiveness of the innovation of using the digital platform to support the transfer of laboratory-trained procedural skills in the clinical units...
May 17, 2018: Journal of the Chinese Medical Association: JCMA
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