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Current Robotics Reports 2021With the rapid growth and development of robotic technology, its implementation in medical fields has also been significantly increasing, with the transition from the... (Review)
Review
PURPOSE OF REVIEW
With the rapid growth and development of robotic technology, its implementation in medical fields has also been significantly increasing, with the transition from the period of mainly using surgical robots to the era with combinations of multiple types of robots. Therefore, this paper introduces the newest robotic systems and technology applied in operating rooms as well as their architectures for integration.
RECENT FINDINGS
Besides surgical robots, other types of robotic devices and machines such as diagnostic and treatment devices with robotic operating tables, robotic microscopes, and assistant robots for surgeons emerge one after another, improving the quality of surgery from different aspects. With the increasing number and type of robots, their integration platforms are also proposed and being spread.
SUMMARY
This review paper presents state-of-the-art robot-related technology in the operating room. Robotic platforms and robot components which appeared in the last decade are described. In addition, system architectures for the integration of robots as well as other devices in operating rooms are also introduced and compared.
PubMed: 34977594
DOI: 10.1007/s43154-021-00055-4 -
Sensors (Basel, Switzerland) Mar 2022The main purpose of this paper is to introduce a new concept, named "one4all" in the realm of SCADA (Supervisory Control and Data Acquisition) systems, used by a...
The main purpose of this paper is to introduce a new concept, named "one4all" in the realm of SCADA (Supervisory Control and Data Acquisition) systems, used by a regional company (particularly a water supplying company) for managing the different views of its users. As a secondary purpose, the paper presents an integration of such an SCADA system with a GIS (Geographical Information System) system. All the regional water supply companies in Romania manage water and wastewater networks, many sensors and actuators, dozens of water pump plants, several water treatment and wastewater plants, tanks and many hydrophores in different parts of their operating range. Due to the wide geographical operating range, an SCADA system needs to be put in place, but the management of such a system in a traditional way is hard to implement, especially when the human resource is low. The methodology presented in this paper, involving adding helper tables and dynamic template windows within an SCADA tool ("one4all" tool), will show how efficiently the human resource can be used. Additionally, the paper shows that companies as described above, can use a single SCADA system that generates different views for all the managed sub regions instead of different systems for every sub region. Implementing only one SCADA system built with the concept "one4all" in mind, and integrating it with a GIS system that is built on the same principle, represents a new approach that will bring value to any organization willing to adopt it. The concept of "one4all", implemented as a software tool for an SCADA system, is a new concept that will help any developer to easily build applications that generate different views for different users based on their permissions and their operating range. Finally, the paper presents some examples of the same concept, implemented in a different vertical (GIS) and programming language, thus presenting that a "one4all" concept is viable and helpful, bringing value to the information technology industry.
Topics: Geographic Information Systems; Humans; Romania; Software; Water Supply
PubMed: 35336586
DOI: 10.3390/s22062415 -
The Cochrane Database of Systematic... Apr 2019Rapid and accurate detection of stroke by paramedics or other emergency clinicians at the time of first contact is crucial for timely initiation of appropriate...
BACKGROUND
Rapid and accurate detection of stroke by paramedics or other emergency clinicians at the time of first contact is crucial for timely initiation of appropriate treatment. Several stroke recognition scales have been developed to support the initial triage. However, their accuracy remains uncertain and there is no agreement which of the scales perform better.
OBJECTIVES
To systematically identify and review the evidence pertaining to the test accuracy of validated stroke recognition scales, as used in a prehospital or emergency room (ER) setting to screen people suspected of having stroke.
SEARCH METHODS
We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid) and the Science Citation Index to 30 January 2018. We handsearched the reference lists of all included studies and other relevant publications and contacted experts in the field to identify additional studies or unpublished data.
SELECTION CRITERIA
We included studies evaluating the accuracy of stroke recognition scales used in a prehospital or ER setting to identify stroke and transient Ischemic attack (TIA) in people suspected of stroke. The scales had to be applied to actual people and the results compared to a final diagnosis of stroke or TIA. We excluded studies that applied scales to patient records; enrolled only screen-positive participants and without complete 2 × 2 data.
DATA COLLECTION AND ANALYSIS
Two review authors independently conducted a two-stage screening of all publications identified by the searches, extracted data and assessed the methodologic quality of the included studies using a tailored version of QUADAS-2. A third review author acted as an arbiter. We recalculated study-level sensitivity and specificity with 95% confidence intervals (CI), and presented them in forest plots and in the receiver operating characteristics (ROC) space. When a sufficient number of studies reported the accuracy of the test in the same setting (prehospital or ER) and the level of heterogeneity was relatively low, we pooled the results using the bivariate random-effects model. We plotted the results in the summary ROC (SROC) space presenting an estimate point (mean sensitivity and specificity) with 95% CI and prediction regions. Because of the small number of studies, we did not conduct meta-regression to investigate between-study heterogeneity and the relative accuracy of the scales. Instead, we summarized the results in tables and diagrams, and presented our findings narratively.
MAIN RESULTS
We selected 23 studies for inclusion (22 journal articles and one conference abstract). We evaluated the following scales: Cincinnati Prehospital Stroke Scale (CPSS; 11 studies), Recognition of Stroke in the Emergency Room (ROSIER; eight studies), Face Arm Speech Time (FAST; five studies), Los Angeles Prehospital Stroke Scale (LAPSS; five studies), Melbourne Ambulance Stroke Scale (MASS; three studies), Ontario Prehospital Stroke Screening Tool (OPSST; one study), Medic Prehospital Assessment for Code Stroke (MedPACS; one study) and PreHospital Ambulance Stroke Test (PreHAST; one study). Nine studies compared the accuracy of two or more scales. We considered 12 studies at high risk of bias and one with applicability concerns in the patient selection domain; 14 at unclear risk of bias and one with applicability concerns in the reference standard domain; and the risk of bias in the flow and timing domain was high in one study and unclear in another 16.We pooled the results from five studies evaluating ROSIER in the ER and five studies evaluating LAPSS in a prehospital setting. The studies included in the meta-analysis of ROSIER were of relatively good methodologic quality and produced a summary sensitivity of 0.88 (95% CI 0.84 to 0.91), with the prediction interval ranging from approximately 0.75 to 0.95. This means that the test will miss on average 12% of people with stroke/TIA which, depending on the circumstances, could range from 5% to 25%. We could not obtain a reliable summary estimate of specificity due to extreme heterogeneity in study-level results. The summary sensitivity of LAPSS was 0.83 (95% CI 0.75 to 0.89) and summary specificity 0.93 (95% CI 0.88 to 0.96). However, we were uncertain in the validity of these results as four of the studies were at high and one at uncertain risk of bias. We did not report summary estimates for the rest of the scales, as the number of studies per test per setting was small, the risk of bias was high or uncertain, the results were highly heterogenous, or a combination of these.Studies comparing two or more scales in the same participants reported that ROSIER and FAST had similar accuracy when used in the ER. In the field, CPSS was more sensitive than MedPACS and LAPSS, but had similar sensitivity to that of MASS; and MASS was more sensitive than LAPSS. In contrast, MASS, ROSIER and MedPACS were more specific than CPSS; and the difference in the specificities of MASS and LAPSS was not statistically significant.
AUTHORS' CONCLUSIONS
In the field, CPSS had consistently the highest sensitivity and, therefore, should be preferred to other scales. Further evidence is needed to determine its absolute accuracy and whether alternatives scales, such as MASS and ROSIER, which might have comparable sensitivity but higher specificity, should be used instead, to achieve better overall accuracy. In the ER, ROSIER should be the test of choice, as it was evaluated in more studies than FAST and showed consistently high sensitivity. In a cohort of 100 people of whom 62 have stroke/TIA, the test will miss on average seven people with stroke/TIA (ranging from three to 16). We were unable to obtain an estimate of its summary specificity. Because of the small number of studies per test per setting, high risk of bias, substantial differences in study characteristics and large between-study heterogeneity, these findings should be treated as provisional hypotheses that need further verification in better-designed studies.
Topics: Humans; Ischemic Attack, Transient; Mass Screening; Randomized Controlled Trials as Topic; Severity of Illness Index; Stroke
PubMed: 30964558
DOI: 10.1002/14651858.CD011427.pub2 -
Plastic and Reconstructive Surgery.... Jan 2022Residents can achieve distinction by discerning which areas of achievement are worth additional focus at each stage in training. Our survey examines the perspectives of...
BACKGROUND
Residents can achieve distinction by discerning which areas of achievement are worth additional focus at each stage in training. Our survey examines the perspectives of faculty members affiliated with Accreditation Council for Graduation Medical Education-accredited plastic surgery residency programs regarding qualities indicative of resident excellence.
METHODS
A survey including Likert scales and rank-ordering was distributed to plastic surgery program directors and faculty with the intent to assess perspectives regarding resident excellence at each stage of training. Responses were analyzed using marginal homogeneity tests and summary tables.
RESULTS
In total, 90 respondents completed the survey. An estimated 94.5% believe it is possible for residents to achieve excellence at any stage of clinical training, and 87.7% report their definition of excellence differs by training level. Top three metrics indicative of resident excellence for interns and junior residents were preparation for operative cases, bedside manner, and personality. For seniors: preparation for operative cases, leadership capability, and bedside manner. For chief residents: preparation for operative cases, leadership capability, and technical operative expertise.
CONCLUSIONS
A resident who displays excellence inspires mentorship, which can propel future career success. Faculty agree excellence can be achieved by residents of any stage, although the qualities that define this evolve by training year. Preparation for operative cases is considered a critical component of resident performance at all levels. Bedside manner and personality are ways intern and junior level residents excel, whereas leadership ability and technical expertise in the operating room become significant in senior and chief trainees.
PubMed: 35070602
DOI: 10.1097/GOX.0000000000004061 -
Scandinavian Journal of Trauma,... Sep 2018The hybrid emergency room (hybrid ER) system was first established in 2011 in Japan. It is defined as an integrated system including an ER, emergency computed tomography... (Review)
Review
The hybrid emergency room (hybrid ER) system was first established in 2011 in Japan. It is defined as an integrated system including an ER, emergency computed tomography (CT) and interventional radiology (IVR) rooms, and operating rooms. Severe trauma patients can undergo emergency CT examinations and therapies (surgeries) without being transferred. The hybrid ER system is attracting attention because trauma resuscitation using this system has been reported to potentially improve the mortality rate in severe trauma patients. In August 2017, we established a new table-rotated-type hybrid ER to facilitate surgical functions. Herein, we introduce a new table-rotated-type hybrid ER consisting of an IVR-CT-operating room system and discuss its efficiency and feasibility for trauma resuscitation, including surgery and IVR. This system includes four new concepts: (1) to secure a wide working space during trauma resuscitation by reconsidering the arrangement of the C-arm, (2) ensure an air-conditioned operating room in the hybrid ER, (3) adopt an operating table but not interventional radiology table, and (4) prepare a trauma bay with three additional beds for multiple victims. This hybrid ER system also adopted the rotated-type table to secure a wide working space during the resuscitation phase. The C-arm was located away from the patients and placed on the wall opposite to the CT gantry, in contrast to that in previous systems. If patients needed an emergency IVR, the table was just rotated, and the IVR could be conducted immediately. This improvement can secure a wide working space in the hybrid ER. Moreover, the patient table was also a surgical operating table, and the hybrid ER system had an air-conditioned operating room (class 10,000). In the anticipation of many trauma patients being transported to the ER, a new trauma bay with three additional beds next to the hybrid ER was established, which also had an air-conditioned operating room. This new rotated-type hybrid ER system facilitates efficient surgical functions during trauma resuscitation and can secure a wide working space for the medical team to immediately perform resuscitative procedures and IVRs without delay.
Topics: Emergency Service, Hospital; Equipment Design; Humans; Japan; Operating Rooms; Operating Tables; Resuscitation
PubMed: 30223859
DOI: 10.1186/s13049-018-0532-z -
Scientific Reports May 2022This paper aims to promote a quantum framework that analyzes Industry 4.0 cyber-physical systems more efficiently than traditional simulations used to represent...
This paper aims to promote a quantum framework that analyzes Industry 4.0 cyber-physical systems more efficiently than traditional simulations used to represent integrated systems. The paper proposes a novel configuration of distributed quantum circuits in multilayered complex networks that enable the evaluation of industrial value creation chains. In particular, two different mechanisms for the integration of information between circuits operating at different layers are proposed, where their behavior is analyzed and compared with the classical conditional probability tables linked to the Bayesian networks. With the proposed method, both linear and nonlinear behaviors become possible while the complexity remains bounded. Applications in the case of Industry 4.0 are discussed when a component's health is under consideration, where the effect of integration between different quantum cyber-physical digital twin models appears as a relevant implication.
PubMed: 35562377
DOI: 10.1038/s41598-022-11691-x -
Nanoscale Research Letters Apr 2021Nanobiosensors are convenient, practical, and sensitive analyzers that detect chemical and biological agents and convert the results into meaningful data between a... (Review)
Review
Nanobiosensors are convenient, practical, and sensitive analyzers that detect chemical and biological agents and convert the results into meaningful data between a biologically active molecule and a recognition element immobilized on the surface of the signal transducer by a physicochemical detector. Due to their fast, accurate and reliable operating characteristics, nanobiosensors are widely used in clinical and nonclinical applications, bedside testing, medical textile industry, environmental monitoring, food safety, etc. They play an important role in such critical applications. Therefore, the design of the biosensing interface is essential in determining the performance of the nanobiosensor. The unique chemical and physical properties of nanomaterials have paved the way for new and improved sensing devices in biosensors. The growing demand for devices with improved sensing and selectivity capability, short response time, lower limit of detection, and low cost causes novel investigations on nanobiomaterials to be used as biosensor scaffolds. Among all other nanomaterials, studies on developing nanobiosensors based on metal oxide nanostructures, graphene and its derivatives, carbon nanotubes, and the widespread use of these nanomaterials as a hybrid structure have recently attracted attention. Nanohybrid structures created by combining these nanostructures will directly meet the future biosensors' needs with their high electrocatalytic activities. This review addressed the recent developments on these nanomaterials and their derivatives, and their use as biosensor scaffolds. We reviewed these popular nanomaterials by evaluating them with comparative studies, tables, and charts.
PubMed: 33877478
DOI: 10.1186/s11671-021-03519-w -
Annals of Translational Medicine Jun 2020Barn-integrated operating rooms have been used in an effort to save space and improve operating room efficiency during orthopedic surgeries. This study aimed to...
BACKGROUND
Barn-integrated operating rooms have been used in an effort to save space and improve operating room efficiency during orthopedic surgeries. This study aimed to investigate the feasibility of performing several thoracic surgeries in a barn-integrated operating room simultaneously.
METHODS
Both numerical simulation and field measurement approaches were applied to evaluate the performance of the ventilation system for the barn-integrated operating room. Computational fluid dynamics (CFD) method was applied to simulate airflow velocity field and particle concentration field. On-site test of airflow velocities were measured with a thermal anemometer. Bacteria-carrying particle (BCP) deposition and distribution was estimated using passive air sampling (PAS) and active air sampling (AAS) methods during mock surgeries.
RESULTS
The airflow distribution and concentration contours showed the barn-integrated operating room to be highly effective in controlling the concentration of airborne bacteria in the operating fields. The airflow and bacteria count met the current standard of GB50333-2013 Specifications, and there was no evidence of air mixing between cabins.
CONCLUSIONS
A barn-integrated operating room with several ultraclean operating tables in a single room would be a viable proposition for general thoracic surgeries in the future. As well as achieving a satisfactory level of contamination control, such an approach would reduce operating costs.
PubMed: 32647684
DOI: 10.21037/atm-20-4349 -
Medicine Jun 2018Weaning failure is common in mechanically ventilated patients. Whether ultrasound can predict weaning outcome remains controversial. This meta-analysis was performed to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Weaning failure is common in mechanically ventilated patients. Whether ultrasound can predict weaning outcome remains controversial. This meta-analysis was performed to assess the accuracy of diaphragmatic ultrasonography for predicting reintubation within 48 hours of extubation.
METHODS
Literature search was performed in PubMed, Embase, and Cochrane Library to identify all the relevant papers, published in English up to July 16, 2017. Eligible studies were included if data were in adequate details to rebuild 2 × 2 contingency tables. Methodological quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) in Review Manager 5.3. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve were pooled using the fixed or random effects model, meanwhile, the heterogeneity was evaluated using Cochran Q test and I statistics in Meta-DiSc 1.4. Publication bias was assessed using Deeks funnel plot in Stata 12.0.
RESULTS
Thirteen studies with 742 subjects were included in this meta-analysis. The pooled sensitivities for diaphragm excursion (DE) and diaphragm thickness fraction (DTF) were 0.786 and 0.893, and the pooled specificities were 0.711 and 0.796, respectively. The area under curve (AUC) for DE and DTF were 0.8590 and 0.8381. The DORs for DE and DTF were 10.623 and 32.521. No publication bias was observed among these studies.
CONCLUSIONS
Diaphragmatic ultrasonography is a promising tool for predicting reintubation within 48 hours of extubation. However, due to heterogeneities among the included studies, large-scale studies are warranted to confirm our findings.
Topics: Airway Extubation; Diaphragm; Female; Humans; Intubation, Intratracheal; Male; Predictive Value of Tests; ROC Curve; Sensitivity and Specificity; Ultrasonography; Ventilator Weaning
PubMed: 29851847
DOI: 10.1097/MD.0000000000010968 -
Journal of Tissue Engineering 2021The aim of this review is to provide a systematic design guideline to users, particularly engineers interested in developing and deploying lung models, and biologists... (Review)
Review
The aim of this review is to provide a systematic design guideline to users, particularly engineers interested in developing and deploying lung models, and biologists seeking to identify a suitable platform for conducting in vitro experiments involving pulmonary cells or tissues. We first discuss the state of the art on lung in vitro models, describing the most simplistic and traditional ones. Then, we analyze in further detail the more complex dynamic engineered systems that either provide mechanical cues, or allow for more predictive exposure studies, or in some cases even both. This is followed by a dedicated section on microchips of the lung. Lastly, we present a critical discussion of the different characteristics of each type of system and the criteria which may help researchers select the most appropriate technology according to their specific requirements. Readers are encouraged to refer to the tables accompanying the different sections where comprehensive and quantitative information on the operating parameters and performance of the different systems reported in the literature is provided.
PubMed: 33996022
DOI: 10.1177/20417314211008696