Learning to use a rear-mounted power assist for manual wheelchairs

Abstract

Objectives: 1) To investigate how much training manual wheelchair users perceive is required to learn to use a rear-mounted power assist safely and confidently. 2) To evaluate how the power assist affected wheelchair users’ ability to negotiate a standardized obstacle course, wheelchair skills capacity and wheelchair mobility confidence.

Method: This study used a pre- versus post-test intervention design. Outcome measures included a standardized obstacle course, and modified versions of the Wheelchair Skills Test 4.2 (WST) and the Wheelchair Confidence Measure.

Results: The 11 participants felt safe and confident using the power assist within one to two training sessions. However, some potential safety concerns were noted. Participants performed two obstacle course tasks significantly more quickly with the power assist.

Conclusions: Participants felt safe using the device with limited training and the device facilitated some mobility task performance. Further research is needed to understand the outcomes of long-term, community use.

• Implications for Rehabilitation

• Most experienced wheelchair users wanted only one or two training sessions with a new rear mounted power assist device; however, some safety concerns were noted.

• The device did not appear to affect user’s confidence.

• The device enabled users to perform some mobility tasks more quickly and allowed some users to perform some mobility tasks they were unable to perform in their regular MWC.

     

A parallel robot to assist vitreoretinal surgery

Purpose  

This paper describes the development and evaluation of a parallel prototype robot for vitreoretinal surgery where physiological hand tremor limits performance.     

Proportional assist ventilation and neurally adjusted ventilatory assist

Patient-ventilator synchrony is a common problem with all patients actively triggering the mechanical ventilator. In many cases synchrony can be improved by vigilant adjustments by the managing clinician. However, in most institutions clinicians are not able to spend the time necessary to ensure synchrony in all patients. Proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) were both developed to improve patient-ventilator synchrony by proportionally unloading ventilatory effort and turning control of the ventilatory pattern over to the patient. This paper discusses PAV's and NAVA's theory of operation, general process of application, and the supporting literature.     

飞秒激光辅助白内障超声乳化手术配合及手术室管理技巧

目的探讨飞秒激光辅助白内障超声乳化手术的配合及手术室管理技巧。方法选取我院进行飞秒激光辅助白内障超声乳化手术的患者59例59只眼,由同一主刀医生完成手术,同一巡回护士配合手术。结果术后患者视力均达到1.0,无严重并发症发生,对手术室护理工作满意。结论飞秒激光辅助白内障超声乳化手术是当前比较尖端的眼科白内障技术,手术效果好,相比传统超声乳化手术增加激光手术环节,需要手术室眼科护士的积极配合,调整激光参数,优化手术流程,与医生共同完成手术。     

Using a cartographic model to assist medical diagnoses

Objective

The main goal of the CHUB (cartographic human body) model is to introduce a cartographic approach that can assist the analysis, visualization and diagnosis of medical images and related data.

Method

A cartographic model is proposed as a reference framework for the development of computer systems and applications. This model accommodates subtle spatial features of these data that may facilitate diagnosis. Medical images and related data are structured into different “human-referenced” information layers. Algebraic map operations are used to combine these layers and achieve greater insights into the information content.

Results

Two case studies were considered to evaluate and validate the model: hydrokinetic therapy and the diagnosis of knee osteoarthritis. A prototype based on the CHUB model was implemented and two different approaches were performed to test and evaluate it. Full acceptance of the model was achieved by clinicians who used the CHUB system.

Conclusion

A cartographic model provides a feasible means for analyzing and visualizing medical image and related data. CHUB is a suitable model that may be used as a common framework for systems, applications and/or support tools that analyze and visualize medical images and related data (for example, in disease diagnosis).     

Mathematical methods to assist with hospital operation and planning

Within health Operational Research, the use of 'computer package' methods such as simulation and system dynamics is becoming so prevalent that it feels somewhat old hat to use analytical methods to develop explicit mathematical formulae or even to explore the mathematical structure of problems. This paper will discuss the use of such 'back of the envelope' analysis illustrating its usefulness. It will be shown that not only does this approach yield considerable insight, but also that it can give rise to powerful and practical solution methods. Examples of this will be discussed in relation to issues such as bed needs estimation, admissions and facilities planning. The author is Director of the Clinical Operational Research Unit (CORU) which was established in 1983, receiving core funding from the UK Department of Health. The concept of a full time university-based research unit dedicated to applying expertise in Operational Research (OR) to problems in health care provides a relatively rare research resource. Yet, the scope for such research, applied to an increasing range of health care activity, is enormous. Issues such as treatment evaluation, performance measures, clinical governance, evidence based medicine and health service delivery are all amenable to OR. Further, OR often provides an immensely cost effective alternative to traditional methods of clinical research based on randomised controlled trials or large scale epidemiological studies. The nature of OR, and one of its main strengths, is that it encompasses a wide range of analytical and scientific methods. Mathematical modeling, statistics, computer-based methods, trial design and analysis all contribute to health OR and, under both of its Directors since 1983, a conscious effort has been made within CORU to foster a diversity of research methodologies. Particular emphasis is put on developing new mathematical methods and computer software. This is somewhat at odds with what seems to be a growing trend in health OR towards researchers specialising in just one or two areas of methodology; thus Tom does queueing theory, Dick does simulation and Harry does System Dynamics. Of course there are exceptions, but for whatever reason, the trend towards specialisation seems real. In this paper, benefits of a more diverse approach to health OR is advocated, particularly the use of 'back of envelope' mathematical methods as an alternative to the use of proprietary software packages. Three case studies are described to illustrate this approach.     

Biventricular assist devices

Ventricular assistance and its effect on the human body are described in this article. Nursing care based on the physiology of device influence and prevention of complications is also discussed.     

Ventricular assist system

Despite the recent remarkable advances in the medical treatment for severe end-stage heart failure, we still need a more powerful therapy to save patients presenting with cardiogenic shock or progressive cardiac deterioration. The implantation of ventricular assist system (VAS) is one of the available strategies in such patients and it has been used as a bridge to recovery or a bridge to transplantation. Because of the severe shortage of brain -dead donors, the role of VAS is now expanding into an alternative to transplantation, which is called a destination therapy. This review summarizes the current application and the future direction of VAS therapy for end -stage heart failure in Japan.     

Ventilatory assist therapy

NPPV has been shown to improve arterial blood gas values, prevent symptoms resulting from alveolar hypoventilation, and decrease hospitalization in patients with chronic respiratory failure with COPD. Regarding acute exacerbation of COPD, the utility of NPPV has been established so NPPV will be regarded first-line therapy as ventilatory assist therapy. On the other hand, with respect to chronic stable COPD, the utility of NPPV isn' t established yet. However NPPV cases have been increasing rapidly in these years, as new home respiratory care technique. From now on, we have to evaluate the objective utility of NPPV from the standpoint of evidence.     

Strategies to assist prevention of burnout in nursing staff

This article explores strategies that nurses can use to protect themselves from burnout. The literature emphasises the need for organisational reform to prevent burnout. In the absence of organisational change the use of problem-focused strategies and emotion-focused strategies, such as reflection, may offer some protection against burnout. There is evidence that improving nurses' wellbeing results in better patient care.     

Cardiac assist devices as a bridge to cardiac transplant

The number of heart transplants being performed in the United States over the last decade has increased significantly. The supply of human donor hearts has not kept up with the demand. This situation has led to the development of means to support patient's cardiac function until a human donor heart can be obtained. Methods to support the patient include use of ventricular assist devices and the total artificial heart. Integration of caring and technology in patients receiving cardiac assist devices (CADs) provides a challenge for critical care nurses. Nursing care of the patient with a CAD involves identification and prevention of complications, familiarization with new technology, and development of a caring environment.