-
The British Journal of Radiology Nov 2023Short-term or long-term CVCs are now considered the standard of practice for the administration of chemotherapy, fluid therapy, antibiotic therapy, and parenteral... (Review)
Review
Short-term or long-term CVCs are now considered the standard of practice for the administration of chemotherapy, fluid therapy, antibiotic therapy, and parenteral nutrition. Central venous access catheters are broadly divided into tunneled or non-tunneled catheters. Tunneled catheters can be further subdivided into totally implanted and totally not implanted devices. Device selection generally depends on various factors such as availability of peripheral veins, expected duration of therapy, and desired flow rate. Ultrasound-guided access is the safest technique for central venous access compared to the landmark technique and departments should strive to for a 100% ultrasound guided access. This review gives a basic overview of the differences of CVC catheters including PICCs, Hickman-catheters and port-catheters along with the criteria for CVC selection. It will also describe technical tips on placement of CVCs. Finally, it aims to highlight complications which are associated with CVC placement and options to treat or prevent them.
Topics: Humans; Central Venous Catheters; Catheterization, Central Venous; Anti-Bacterial Agents; Catheterization, Peripheral
PubMed: 37191031
DOI: 10.1259/bjr.20220894 -
The Science of the Total Environment Jun 2023Despite advances in medicine and innovations in many underpinning fields including disease prevention and control, the Spaulding classification system, originally... (Review)
Review
A review of Spaulding's classification system for effective cleaning, disinfection and sterilization of reusable medical devices: Viewed through a modern-day lens that will inform and enable future sustainability.
Despite advances in medicine and innovations in many underpinning fields including disease prevention and control, the Spaulding classification system, originally proposed in 1957, remains widely used for defining the disinfection and sterilization of contaminated re-usable medical devices and surgical instruments. Screening PubMed and Scopus databases using a PRISMA guiding framework generated 272 relevant publications that were used in this review. Findings revealed that there is a need to evolve how medical devices are designed, and processed by cleaning, disinfection (and/or sterilization) to mitigate patient risks, including acquiring an infection. This Spaulding Classification remains in use as it is logical, easily applied and understood by users (microbiologists, epidemiologists, manufacturers, industry) and by regulators. However, substantial changes have occurred over the past 65 years that challenge interpretation and application of this system that includes inter alia emergence of new pathogens (viruses, mycobacteria, protozoa, fungi), a greater understanding of innate and adaptive microbial tolerance to disinfection, toxicity risks, increased number of vulnerable patients and associated patient procedures, and greater complexity in design and use of medical devices. Common cited examples include endoscopes that enable non- or minimal invasive procedures but are highly sophisticated with various types of materials (polymers, electronic components etc), long narrow channels, right angle and heat-sensitive components and various accessories (e.g., values) that can be contaminated with high levels of microbial bioburden and patient tissues after use. Contaminated flexible duodenoscopes have been a source of several significant infection outbreaks, where at least 9 reported cases were caused by multidrug resistant organisms [MDROs] with no obvious breach in processing detected. Despite this, there is evidence of the lack of attention to cleaning and maintenance of these devices and associated equipment. Over the last few decades there is increasing genomic evidence of innate and adaptive resistance to chemical disinfectant methods along with adaptive tolerance to environmental stresses. To reduce these risks, it has been proposed to elevate classification of higher-risk flexible endoscopes (such as duodenoscopes) from semi-critical [contact with mucous membrane and intact skin] to critical use [contact with sterile tissue and blood] that entails a transition to using low-temperature sterilization modalities instead of routinely using high-level disinfection; thus, increasing the margin of safety for endoscope processing. This timely review addresses important issues surrounding use of the Spaulding classification system to meet modern-day needs. It specifically addresses the need for automated, robust cleaning and drying methods combined with using real-time monitoring of device processing. There is a need to understand entire end-to-end processing of devices instead of adopting silo approaches that in the future will be informed by artificial intelligence and deep-learning/machine learning. For example, combinational solutions that address the formation of complex biofilms that harbour pathogenic and opportunistic microorganisms on the surfaces of processed devices. Emerging trends are addressed including future sustainability for the medical devices sector that can be enabled via a new Quintuple Helix Hub approach that combines academia, industry, healthcare, regulators, and society to unlock real world solutions.
Topics: Humans; Artificial Intelligence; Cross Infection; Disinfectants; Disinfection; Endoscopes; Equipment Contamination
PubMed: 36963674
DOI: 10.1016/j.scitotenv.2023.162976 -
European Heart Journal Feb 2024The role of cardiac implantable electronic device (CIED)-related tricuspid regurgitation (TR) is increasingly recognized as an independent clinical entity. Hence,... (Review)
Review
The role of cardiac implantable electronic device (CIED)-related tricuspid regurgitation (TR) is increasingly recognized as an independent clinical entity. Hence, interventional TR treatment options continuously evolve, surgical risk assessment and peri-operative care improve the management of CIED-related TR, and the role of lead extraction is of high interest. Furthermore, novel surgical and interventional tricuspid valve treatment options are increasingly applied to patients suffering from TR associated with or related to CIEDs. This multidisciplinary review article developed with electrophysiologists, interventional cardiologists, imaging specialists, and cardiac surgeons aims to give an overview of the mechanisms of disease, diagnostics, and proposes treatment algorithms of patients suffering from TR associated with CIED lead(s) or leadless pacemakers.
Topics: Humans; Pacemaker, Artificial; Defibrillators, Implantable; Tricuspid Valve; Tricuspid Valve Insufficiency; Rheumatic Heart Disease; Retrospective Studies
PubMed: 38096587
DOI: 10.1093/eurheartj/ehad783 -
Physiological Measurement Nov 2023Photoplethysmography is a key sensing technology which is used in wearable devices such as smartwatches and fitness trackers. Currently, photoplethysmography sensors are... (Review)
Review
Photoplethysmography is a key sensing technology which is used in wearable devices such as smartwatches and fitness trackers. Currently, photoplethysmography sensors are used to monitor physiological parameters including heart rate and heart rhythm, and to track activities like sleep and exercise. Yet, wearable photoplethysmography has potential to provide much more information on health and wellbeing, which could inform clinical decision making. This Roadmap outlines directions for research and development to realise the full potential of wearable photoplethysmography. Experts discuss key topics within the areas of sensor design, signal processing, clinical applications, and research directions. Their perspectives provide valuable guidance to researchers developing wearable photoplethysmography technology.
Topics: Photoplethysmography; Wearable Electronic Devices; Fitness Trackers; Signal Processing, Computer-Assisted; Heart Rate
PubMed: 37494945
DOI: 10.1088/1361-6579/acead2 -
Journal of Diabetes Science and... Nov 2023Diabetes management and treatment requires the use of many devices that frequently must puncture the skin, creating a risk of unintentional retention in the body as a... (Review)
Review
BACKGROUND
Diabetes management and treatment requires the use of many devices that frequently must puncture the skin, creating a risk of unintentional retention in the body as a retained diabetes device. In this article, we reviewed case studies about retained diabetes devices and presented analyses of the success rate of current imaging techniques in identifying retained devices and the success rate of device removal.
METHODS
PubMed and Google Scholar were searched for articles about retained diabetes devices. Relevant articles that included sufficient details about discovery and removal of the device were included. The success rate of identification and the success rate of removal of retained devices were both calculated as percentages.
RESULTS
Sixteen case studies of retained diabetes devices were identified. These devices included parts of continuous glucose monitors and infusion sets, a lancet, and various types of needles for insulin injection. Each case is presented with details about the year of publication, the retained diabetes device, the company that produced the device, the age and gender of the patient, the type of diabetes that the patient had, the location of the device, the reason for initial discovery of the retained device, the process of locating the device, the success rate for removal of the device, and the removal procedure of the device. Analysis revealed a 100% success rate for the use of imaging technology including X-rays and computed tomography to identify a retained diabetes device. The patients with retained diabetes devices had a 62.5% success rate for eventual removal of the device.
CONCLUSIONS
With the increasing use of injected, inserted, and implanted diabetes wearables for digital health, it is likely that some of the devices will detach, break apart, or otherwise become retained in the body. It is important to be aware of available technologies to identify retained diabetes devices so that it will be possible in most cases to surgically remove these devices if they detach or become retained.
Topics: Humans; Diabetes Mellitus, Type 1; Insulin; Skin; Needles; Tomography, X-Ray Computed
PubMed: 35787699
DOI: 10.1177/19322968221105895 -
Indian Journal of Dermatology,... 2023Procedural dermatology includes invasive conventional dermatologic surgeries which involve significant use of knife and suture, minimally invasive procedures and... (Review)
Review
Procedural dermatology includes invasive conventional dermatologic surgeries which involve significant use of knife and suture, minimally invasive procedures and device-based procedures. Device-based procedures are the easiest to learn and are less prone to human errors due to automation but can lead to monotony, while conventional surgeries require significant skill, craftsmanship and interest. There has been a recent shift in the approach to procedural dermatology as a therapeutic option with complementary and combination models replacing the conventional hierarchical model in which procedures were last in the step-ladder approach. The demand for both conventional dermatologic surgeries and minimally invasive cosmetic procedures is increasing. Unfortunately, this demand has not been met with adequate supply. Consequently, the number of trained professionals with expertise in these procedures is very limited; they are far outnumbered by unqualified practitioners. A limited number of dermatologic surgeons practicing conventional surgeries has resulted in huge waiting lists for vitiligo surgeries, inappropriate excisions for skin cancers and poor cosmetic outcomes of excisions without proper knowledge of flaps and grafts. Increasingly procedures are being performed by inadequately trained personnel, resulting in complications. There is also an absence of good quality research on the subject of procedural dermatology, which has resulted in a lack of standardisation of various procedures and knowledge about the efficacy of various drug-procedure and procedure-procedure combinations. An increasing variety of gimmicky but costly procedures are being offered to the public without much evidence of efficacy. Individual institutional and broad policy directives are needed to address these issues. Special emphasis is required on formal hands-on procedural dermatology training during residency and beyond it.
Topics: Humans; Dermatology; Surgical Flaps; Internship and Residency; Surgeons
PubMed: 36688880
DOI: 10.25259/IJDVL_322_2022 -
Nature Communications Nov 2023Bioresorbable bioelectronics, with their natural degradation properties, hold significant potential to eliminate the need for surgical removal. Despite notable...
Bioresorbable bioelectronics, with their natural degradation properties, hold significant potential to eliminate the need for surgical removal. Despite notable achievements, two major challenges hinder their practical application in medical settings. First, they necessitate sustainable energy solutions with biodegradable components via biosafe powering mechanisms. More importantly, reliability in their function is undermined by unpredictable device lifetimes due to the complex polymer degradation kinetics. Here, we propose an on-demand bioresorbable neurostimulator to address these issues, thus allowing for clinical operations to be manipulated using biosafe ultrasound sources. Our ultrasound-mediated transient mechanism enables (1) electrical stimulation through transcutaneous ultrasound-driven triboelectricity and (2) rapid device elimination using high-intensity ultrasound without adverse health effects. Furthermore, we perform neurophysiological analyses to show that our neurostimulator provides therapeutic benefits for both compression peripheral nerve injury and hereditary peripheral neuropathy. We anticipate that the on-demand bioresorbable neurostimulator will prove useful in the development of medical implants to treat peripheral neuropathy.
Topics: Humans; Absorbable Implants; Reproducibility of Results; Peripheral Nerve Injuries; Physics; Electric Stimulation
PubMed: 37951985
DOI: 10.1038/s41467-023-42791-5 -
Frontiers in Cellular and Infection... 2023Healthcare settings have dramatically advanced the latest medical devices, such as urinary catheters (UC) for infection, prevention, and control (IPC). The continuous or... (Review)
Review
Healthcare settings have dramatically advanced the latest medical devices, such as urinary catheters (UC) for infection, prevention, and control (IPC). The continuous or intermittent flow of a warm and conducive (urine) medium in the medical device, the urinary catheter, promotes the formation of biofilms and encrustations, thereby leading to the incidence of CAUTI. Additionally, the absence of an innate immune host response in and around the lumen of the catheter reduces microbial phagocytosis and drug action. Hence, the review comprehensively overviews the challenges posed by CAUTI and associated risks in patients' morbidity and mortality. Also, detailed, up-to-date information on the various strategies that blended/tailored the surface properties of UC to have anti-fouling, biocidal, and anti-adhesive properties to provide an outlook on how they can be better managed with futuristic solutions.
Topics: Humans; Biofilms; Catheter-Related Infections; Catheters; Incidence; Urinary Tract Infections
PubMed: 37560318
DOI: 10.3389/fcimb.2023.1134433 -
Brazilian Journal of Cardiovascular... Oct 2023
Topics: Humans; Heart-Assist Devices; Brazil; Heart Failure
PubMed: 37801429
DOI: 10.21470/1678-9741-2023-0074 -
Journal of Electrocardiology 2024An elderly man with severe chronic obstructive pulmonary disease and a history of complete heart block with pacemaker placement was found to have pacemaker lead...
An elderly man with severe chronic obstructive pulmonary disease and a history of complete heart block with pacemaker placement was found to have pacemaker lead infection and required device extraction. He had a standard dual chamber pacemaker in place, however the ECG obtained showed paced QRS complexes with presence of R wave in lead V1 and QS in lead I suggestive of left ventricular pacing. Additional imaging with CT scan obtained for confirmation revealed that the heart was displaced to the left posterior hemithorax secondary to pulmonary disease. Due to significant posterolateral rotation of the heart, a right ventricular paced rhythm can demonstrate Q/S waves in the lateral leads (I, aVL, V5-6) and R waves in the right precordial leads (V1-3). This can be misdiagnosed as a left ventricular paced rhythm.
Topics: Male; Humans; Aged; Cardiac Resynchronization Therapy; Electrocardiography; Heart Ventricles; Pacemaker, Artificial; Tomography, X-Ray Computed; Cardiac Pacing, Artificial
PubMed: 38118295
DOI: 10.1016/j.jelectrocard.2023.11.013