Medical equipment classification: method and decision-making support based on paraconsistent annotated logic

As technology evolves, the role of medical equipment in the healthcare system, as well as technology management, becomes more important. Although the existence of large databases containing management information is currently common, extracting useful information from them is still difficult. A useful tool for identification of frequently failing equipment, which increases maintenance cost and downtime, would be the classification according to the corrective maintenance data. Nevertheless, establishment of classes may create inconsistencies, since an item may be close to two classes by the same extent. Paraconsistent logic might help solve this problem, as it allows the existence of inconsistent (contradictory) information without trivialization. In this paper, a methodology for medical equipment classification based on the ABC analysis of corrective maintenance data is presented, and complemented with a paraconsistent annotated logic analysis, which may enable the decision maker to take into consideration alerts created by the identification of inconsistencies and indeterminacies in the classification.     

Characteristics of educational software use in 106 clinical laboratories

The University of Washington, Seattle, has developed educational software for clinical laboratories. We used a 32-question survey to study software implementation. Of 106 clinical laboratories (response rate, 60%) that purchased the software and completed the survey, 89 laboratories (84%) that reported using the software formed the basis for the study. The most common software users were laboratory personnel, followed by medical technologist or medical laboratory technician students, residents, and medical students; the mean (SD) number of personnel categories using the software per laboratory was 1.8 (0.8). The most common reasons for use were initial instruction, cross-training, and competency assessment. The most frequent setting for software use was an area where laboratory testing occurred, followed by a dedicated training location, a location chosen by the employee, a classroom, and a distance learning mode. On a scale of 1 (poor) to 5 (excellent), the average satisfaction rating as an instructional tool was 4.4 and as a competency assessment tool, 4.2. Compared with laboratories in hospitals with 400 beds or fewer, laboratories in hospitals with more than 400 beds used the software for more categories of users (P = .008), had a higher proportion of laboratories using it for residents (P = .003), and had a higher proportion of laboratories with dedicated training areas (P = .02).     

A quality improvement study for medical devices usage in an acute healthcare setting

Abstract

The objectives of this study were, for a large NHS Trust, to (1) Implement a medical devices training information system which connects the medical equipment inventory to the electronic staff record. (2) Monitor the changes in safety-related practice in the Trust after implementation (3) Examine the association between training compliance and Trust-wide adverse incident data for high risk medical devices. (4) Identify possible gaps in training course content from adverse incident data. A new system was made available, showing medical devices training records for staff in each location. Relevant staff members were trained on how to set up courses, record training, adjust training requirements and view reports. Training practice, compliance and adverse incidents for high-risk equipment were monitored over 30?months after implementation. Trends and changes in training practice were analysed. The Trust now has monitoring information on medical devices training available that had previously been absent. Training compliance increased from 23% to 59%. The frequency and severity of adverse incidents remained relatively constant throughout and was not associated with the increased uptake of training Trust-wide. Training gaps were identified. A Trust-wide system for recording medical devices training has provided training assurance. After implementation changes in practice with training have been identified. It was not possible to show a direct association between increased training compliance and reduced medical device-related incidents Trust-wide. There were specific training courses where changes in content could increase the safe use of medical devices.     

Risks associated with diagnostic devices.

Therapeutic medical devices alter patients' physiological functions. Diagnostic devices are for information gathering, manipulation, and display. Despite this difference in purpose, both types of medical equipment have potential risks associated with their use that must be recognized and subjected to the principles of risk management. For diagnostic equipment, special concerns include direct side effects, clinical misinterpretation of results, malperformance, obvious non-function, and inherent limitations. The role of clinical engineering in diagnostic risk management must be consistent with its general obligations in equipment acquisition, training, maintenance, and hazard identification. Since sharp lines of distinction often cannot be drawn between equipment, operator, and clinical issues, clinical engineering has the opportunity and responsibility to extend its contributions into an integrated systems approach to medical device safety and effectiveness.     

Evaluating the potential and problems of three-dimensional computed tomography measurements of arterial stenosis

Volume visualization is gaining widespread acceptance in medical applications. As its use increases, the issue of accuracy becomes critical. There have been very few studies examining the accuracy of volume rendering techniques. We studied the accuracy of hardware-assisted volume rendering for measurement of arterial stenosis in computed tomography (CT) data. The results of our study reveal that accurate measurements can be made from volume rendered CT data. However, error is present (absolute average error from 5.1% to 13.6%) and there is some variability, even for experts (standard deviation ranged from 4.8% to 15%). The evidence suggests that the choice of volume rendering (transfer function) parameters greatly affects the accuracy of the results. Accurate transfer function parameter selection is a fiddicult problem. Parameters that produce realistic images often provide inaccurate measurements. As the use of volume visualization grows and more inexperienced users begin using these tools for medical diagnosis and staging, new guidelines, aids, and techniques must be developed to ensure reliable, accurate visualization results.     

Caring for children in isolated small hospitals--problems and solutions?

A high priority for most parents is to have ready access to paediatric medical services, particularly when their child becomes ill. A difficult balance is therefore sometimes required between the provision of these services in a small local hospital where the throughput of work (and hence opportunities for education and training) will be limited, and the disadvantages of distance and delay where there is geographical isolation from such services. It is also important that doctors have the opportunity to gain experience in the range of environments in which they may work after completion of their training, whether in primary or secondary care. We report an innovative initiative to sustain a local inpatient paediatric service and to enhance the provision of education and training for doctors through development of a training network and rotation. We also highlight issues arising from this, in particular the implications for adequate availability of support from career grade paediatric staff.     

Technical note: new connecting devices for potential equalization

Two types of new equipotential connecting devices have been developed for the medical electrical equipment. The features of each type include lower contact resistance, firm connection between socket and pin and a high level of safety. The results of testing a third type of connector (developed earlier) are included. They have individual features which users can select according to their particular purposes of use. The new devices will contribute to improved safety of the medical electrical equipment.     

The association between students' research involvement in medical school and their postgraduate medical activities

The authors examined the impact of students' research involvement during medical school on their postresidency medical activities. The three medical schools involved--The Pennsylvania State University College of Medicine (PSU), The University of Connecticut School of Medicine (UCONN), and The University of Massachusetts Medical School (UMASS)--have nearly indistinguishable applicant, matriculant, and curriculum profiles. However, at PSU a research project is a curriculum requirement for students who did not do medical research prior to entering medical school. Questionnaires were sent to all graduates from the classes of 1980, 1981, and 1982. A total of 567 graduates completed the questionnaires, an overall response rate of approximately 76%. Medical school research experience was reported by 83% (183) of the PSU graduates, 34% (52) of the UCONN graduates, and 28% (54) of the UMASS graduates. When compared on a school-by-school basis, the graduates from the three schools did not differ with respect to residency specialty training, fellowship training, academic appointments, career practice choices, or postgraduate research involvement. However, when all the graduates studied were examined as a single group, medical school research experience was found to be strongly associated with postgraduate research involvement.     

Work organisation,work environment and the use of medical equipment: A survey study of the impact on quality and safety

In a study of hospital staff's perceived quality of care and worry, related to the use of medical equipment, a systems approach was used. This included training and user aspects on the equipment, environmental ergonomics, work organisation and psychosocial work conditions. In a survey study, 543 hospital staff members from seven departments with various degrees of equipment utilisation participated. By means of factor analysis, factors which were important to perceived quality of care and worry were determined. Adaptation of equipment and environment and training on the use of equipment were shown to be important. However, several organisational and psychosocial factors turned out to have a still greater impact. In the assessment of healthcare technologies which include medical equipment a holistic systems approach is therefore advocated.     

In-house development of test equipment for quality control and training. Case study: a prototype ECG simulator-tester

The support services for biomedical technology address a variety of technical and administrative issues, concerning the safe and efficient operation of medical equipment over the period of its intended use and the training of hospital personnel in issues concerning safety and quality. Clinical Engineering Departments undertake the responsibility of developing and operating training programs in medical equipment utilisation apart from the traditional role of training and supervising technicians involved in testing, calibration and preventive/corrective maintenance of electromedical equipment. In view of the above, the Institute of Biomedical Technology and the Centre of Biomedical Engineering collaborated for the design and development of a prototype digital ECG and arrhythmia simulator. In the absence of internationally accepted inspection protocols for ECG simulators, the verification phase of the project involved mainly the inspection of the device's conformity to its initial technical specifications. The results demonstrated that this tester, due to simplicity in construction and easiness of use could be a practical, reliable and economical solution for electrocardiograph and ECG monitor testing and waveform recognition training.     

In-house development of test equipment for quality control and training. Case study: a prototype ECG simulator-tester

The support services for biomedical technology address a variety of technical and administrative issues, concerning the safe and efficient operation of medical equipment over the period of its intended use and the training of hospital personnel in issues concerning safety and quality. Clinical Engineering Departments undertake the responsibility of developing and operating training programs in medical equipment utilisation apart from the traditional role of training and supervising technicians involved in testing, calibration and preventive/corrective maintenance of electromedical equipment. In view of the above, the Institute of Biomedical Technology and the Centre of Biomedical Engineering collaborated for the design and development of a prototype digital ECG and arrhythmia simulator. In the absence of internationally accepted inspection protocols for ECG simulators, the verification phase of the project involved mainly the inspection of the device's conformity to its initial technical specifications. The results demonstrated that this tester. due to simplicity in construction and easiness of use could be a practical, reliable and economical solution for electrocardiograph and ECG monitor testing and waveform recognition training.     

Evidence-based approach to the maintenance of laboratory and medical equipment in resource-poor settings

Much of the laboratory and medical equipment in resource-poor settings is out-of-service. The most commonly cited reasons are (1) a lack of spare parts and (2) a lack of highly trained technicians. However, there is little data to support these hypotheses, or to generate evidence-based solutions to the problem. We studied 2,849 equipment-repair requests (of which 2,529 were out-of-service medical equipment) from 60 resource-poor hospitals located in 11 nations in Africa, Europe, Asia, and Central America. Each piece of equipment was analyzed by an engineer or an engineering student and a repair was attempted using only locally available materials. If the piece was placed back into service, we assumed that the engineer’s problem analysis was correct. A total of 1,821 pieces of medical equipment were placed back into service, or 72%, without requiring the use of imported spare parts. Of those pieces repaired, 1,704 were sufficiently documented to determine what knowledge was required to place the equipment back into service. We found that six domains of knowledge were required to accomplish 99% of the repairs: electrical (18%), mechanical (18%), power supply (14%), plumbing (19%), motors (5%), and installation or user training (25%). A further analysis of the domains shows that 66% of the out-of-service equipment was placed back into service using only 107 skills covering basic knowledge in each domain; far less knowledge than that required of a biomedical engineer or biomedical engineering technician. We conclude that a great majority of laboratory and medical equipment can be put back into service without importing spare parts and using only basic knowledge. Capacity building in resource-poor settings should first focus on a limited set of knowledge; a body of knowledge that we call the biomedical technician’s assistant (BTA). This data set suggests that a supported BTA could place 66% of the out-of-service laboratory and medical equipment in their hospital back into service.     

Diagnostic equipment outside the laboratory.

A questionnaire was circulated to clinical biochemistry laboratories in the North West Thames region of the United Kingdom requesting information on extralaboratory equipment. Data on the types and numbers of instruments in use, their relationship with the laboratory, and quality assurance procedures were obtained. Laboratories were prepared to maintain equipment over which they had no responsibility for purchase, training of users, or use. The quality assurance of these instruments gave even greater cause for concern. Although internal quality control procedures were performed on many of the instruments, laboratories were involved in only a minority of these procedures. Quality control procedures and training of users were undertaken on site in less than 50% of blood gas analysers and bilirubin meters and in less than 25% of glucose meters. External quality assessment procedures were non-existent for all of the instruments in use with the exception of glucose stick meters in two laboratories.     

Medical equipment libraries: implementation,experience and user satisfaction

Abstract

The hospital-wide pooling and sharing of certain types of medical equipment can lead to both significant improvements in patient safety and financial advantages when compared with a department or ward-level equipment ownership system. In September 2003, a Medical Equipment Loan Service (MELS) was established, focusing initially on infusion pumps. The aims and expected benefits included; improving availability of equipment for both patients and clinical users, managing and reducing clinical risk, reducing equipment diversity, improving equipment management and reducing the overall cost of equipment provision. A user survey was carried out in 2005 and repeated in 2011. The results showed wide and continued satisfaction with the service. The process and difficulties of establishing the service and its development to include additional types of equipment are described. The benefits of managing medical equipment which is in widespread general use, through a MELS as part of a Clinical Engineering Department, are presented.     

A new way to integrate clinically relevant technology into small-group teaching.

Medical educators need to teach learners to efficiently access the best available evidence at the point of care and apply it in a patient-centered manner. As information becomes more readily available via the Internet and handheld computers, strategies to use these tools as part of the educational process become more important. New teaching skills are needed when attempting to seamlessly introduce technology into small-group settings in the midst of blending old and new teaching methods. The authors' development of a conceptual model known as "e-microskills" at the University of Connecticut School of Medicine in 2002 has facilitated the smooth integration of technology into teaching. This model's cornerstone is direct empowerment of learners during small-group sessions to perform observed searches for the best medical evidence on the Internet and with handheld computer resources. This is done in the context of a mnemonic, PEARL: (1) Choose a "Preplanned search intervention"; (2) allow learners to "Execute the search," thus committing themselves; (3) "Allow learners to teach other learners" about their search process; (4) "Review the quality of evidence" for the information found; and (5) discuss "Lessons of the search." Additional features of this teaching model include ground rules for teaching with technology that optimizes teaching time by reducing anticipated obstacles. The rules add structure in an otherwise impromptu setting thus maximizing the teachable moment. While "e-microskills" are described here within the context of a third-year family medicine clerkship, they can easily be adapted to other small-group teaching settings.     

Medical device development,from technical design to integrated product development

Abstract

The development process of medical devices (MDs) implies the integration of knowledge and skills from the fields of medicine and engineering. Such an integration is difficult because of lack of communication, mismatch of priorities and work-style differences among those fields. Besides, MD development has particularities that make the product development process (PDP) even more complex such as high level of regulations, concurrent technologies application as well as different end users requirements. In addition, these MDs are classified according to the level of risk they offer to users – low, medium and high – what makes their development project very complex in practice depending on the risk associated. For the specific case of SMEs in the broad mechanical and electronic area that develop physical MD with low and medium-risk levels, PDP models in place have proved to be not well fit to the reality they face. This research objective is to synthesise a PDP model for SMEs in the specific medical sector, by incorporating the best practices of the engineering area and particularities of the medical area. The methodology used was an extensive bibliographic analysis and field research conducted towards SMEs in the MD industry.     

Videobasierte Lehre der Pathologie

Modern computer technology provides students with easier access to learning materials. Basic knowledge of pathological findings in organs is essential in medical education. We have produced didactic videos for teaching pathology in a clinical context in addition to regular lectures at the university. Didactic material includes macroscopic and histological findings, as well as cartoons explaining pathophysiology and clinical links. Videos can be downloaded in mv4 format as podcasts to a local hard disk or to an iPhone or iPod via iTunes University and are designed to improve classical medical literature. Analysis over 3 years of server traffic and subjective impressions by the students revealed regular use and high acceptance by users. Didactic material in clinical pathology can be successfully integrated in videos to complement lectures and practical training. Modern teaching methods in pathology make the specialty more understandable and therefore more attractive for students.     

数字化影像信息系统在医院的移动应用

目的：构建全套完整无线数字化影像信息系统，使各科医务人员能够操作该系统在整个医院范围内安全、快速、简便的进行医疗应用。材料和方法：基于医院现有GE Centricity PACS／RIS的企业级架构和WEB技术向临床发布影像的应用，以多台戴尔PowerEdge服务器分别用作PACS服务器、RIS服务器、HIS服务器和PACS—web服务器。网络连接设备使用戴尔Powerconnect交换机和TP—LINK无线宽带路由器。用户终端移动设备使用戴尔Latitude笔记本电脑。首先依托医院现有的有线网络构架，选择具有代表性的科室，如放射科、神经外科、神经内科、预防保健科、质控科，并将无线宽带路由器通过双绞线连接至以太网接口，设置无线宽带路由器指定IP地址、子网掩码，设置路由器工作模式，MAC地址过滤、SSID并且禁用SSID广播、频道和加密属性。建立起集中控制式无线网络。在用户终端设置无线适配器，设置为与路由器相同的SSID、频道和加密属性。测试终端移动设备和服务器之间的连接，并且交给最终用户使用。结果：用户使用终端移动设备进行医疗工作日常操作移动性便携性明显优于原系统。而医疗软什的使用与原系统相同，无须另外培训。神经外科和神经内科的临床医生可以手持终端移动设备在患者床前边查房边做病程记录，并且同时通过浏览器基于IHE规范要求优先调阅关键帧影像，通过TruRez增量传输技术降低对无线网络带宽的要求，以web浏览的形式快速从GE Centricity PACS—web服务器实时渊用患者的影像资料。预防保健科和质控科通过HIS和RIS查询进行疾病分类、例数统计，快速生成报表，进行传染病监控和质罱控制。放射科医生需要经常从PACS服务器调用大量的DICOM格式文件，由于无线宽带路由器的带宽为54M，是原有线网络100M带宽的一半，调用时间有所延长。结论：使用医用无线网络系统的通信交流方式较传统方式更加迅速便捷。各种医务人员使用终端移动设备可以在医疗机构内任意漫游、高速传输影像、报告、病历以及其他电子文档。当影像浏览信息极大丰富时（如扩展对心电信息、电生理、超声、病理等信息），正确的操作者可以在正确的时间、安全的获得正确的、完善的临床诊断应用需要的综合诊断信息。对操作者而言简单明了，能够在所有医疗通信系统中使用而无需考虑制造商的因素。