Advanced Medical Equipment Research Articles

Lack of Robust Laboratory Testing Infrastructure in Nigeria: A Promoter of Community Transmission Outcome of COVID 19 Virus Indicator

Background: An outbreak of unknown origin which broke out in China in December 2019 has become a global threat to human lives and economies. Coronavirus disease 2019 (COVID19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a pandemic by the World Health Organisation (WHO) due to its rapid global spread and concurrent of level devastation. Many countries are currently on lockdown to mitigate the spread while different treatment options have been proposed, but none has been approved by the appropriate authority. Currently, the disease has affected over 10 million people worldwide while claiming as many as 517,877 lives respectively. Aim: To evaluate the inadequate COVID-19 testing capacity in Nigeria, probable causes and how it can promote community transmission of the disease Methodology: Peer-reviewed published research articles containing information on COVID-19, the causative virus and other important details were systematically appraised and summarized. The reviewed studies comprise of cross-sectional and observational studies of wide range of outcome. Findings: COVID-19 which first broke out in Wuhan City of China has now spread to about 216 countries, causing fatalities in large numbers. It has been reported that individuals with increased risk of severe outcomes include the elderly and those with underlying health conditions. The incubation period of the disease ranges from 1-14 days, during which the disease can be transmitted by both symptomatic and asymptomatic patients. Patients manifest with symptoms such as fever, dry cough, dyspnoea, etc., while the major causes of death include multi-targeted organ failure, acute respiratory distress syndrome (ARDS), shock, etc. The disease can be diagnosed by the detection of the nucleic acid of SARS-CoV-2 in patient samples via real-time reverse-transcription polymerase chain reaction (rRT-PCR). Since there is currently no approved therapeutics or vaccine for the disease, early detection and management of symptoms represent the best way of helping patients to recover in good time. While many countries are responding by scaling up their testing capacities, Nigeria has struggled to scale up her testing capacity to a reasonable extent, though not really enough in capacity and robustness, considering the large population size to cover in the country, and this therefore, may pose huge amount of threat of increased community transmission of the disease in our neighbourhood, if not corrected in time Conclusion/recommendation: The leadership of Nigeria agency in-charge of disease control and prevention needs to scale up the testing capacity within the country, as soon as possible to reduce the risk of increased transmission of the disease, while reassuring the inhabitants of the hope and capacity of overcoming the outbreak. It is also very important that long-term development strategies be put in place to revamp the weak health care facilities in the country, with respect to provision of modern technological advanced medical equipment’s and the training of manpower to cover the already existing shortage of expertise in molecular diagnosis and research outcome

Deep Convolutional Neural Networks in Detecting Lung Mass From Chest X-Ray Images

There are more than one million cases of lung cancer per year in India alone. Early detection is vital in increasing the survival rate and decreasing treatment costs. This research is aimed at building a deep convolutional neural network which uses chest x-rays to identify lung mass, and then make a comparative study by tuning the hyperparameters. NIH Chest X-Ray Dataset containing more than 112,000 images were used for training and testing. The data was analysed and then fed to the neural network. Accuracy of over 96% was obtained in all the trials. A comparative study by varying the number of inputs and varying the number of hidden layers was carried out. The accuracies obtained were compared and was found that the accuracy increased with the increase in the number of hidden layers. A complete product was then ideated which when implemented would be a vital diagnostic tool and can be used in the remote locations of a country having just x-ray facilities and no other advanced medical equipment like CT.

Abstract 15875: Prediction of Intensive Care Unit Admission Among Patients Hospitalized for COVID-19: The Intermountain Coronavirus ICU Risk Model (CORONA-ICU)

Background: Treatment for COVID-19 has created surges in hospitalizations, intensive care unit (ICU) admissions, and the need for advanced medical therapy and equipment, including ventilators. Identifying patients early on who are at risk for more intensive hospital resource use and poor outcomes could result in shorter hospital stays, lower costs, and improved outcomes. Therefore, we created clinical risk scores (CORONA-ICU and -ICU+) to predict ICU admission among patients hospitalized for COVID-19. Methods: Intermountain Healthcare patients who tested positive for SARS-CoV-2 and were hospitalized between March 4, 2020 and June 8, 2020 were studied. Derivation of CORONA-ICU risk score models used weightings of commonly collected risk factors and medicines. The primary outcome was admission to the ICU during hospitalization, and secondary outcomes included death and ventilator use. Results: A total of 451 patients were hospitalized for a SARS-CoV-2 positive infection, and 191 (42.4%) required admission to the ICU. Patients admitted to the ICU were older (58.2 vs. 53.6 years), more often male (61.3% vs. 48.5%), and had higher rates of hyperlipidemia, hypertension, diabetes, and peripheral arterial disease. ICU patients more often took ACE inhibitors, beta-blockers, calcium channel blockers, diuretics, and statins. Table 1 shows variables that were evaluated and included in the CORONA-ICU risk prediction models. Models adding medications (CORONA-ICU+) improved risk-prediction. Though not created to predict death and ventilator use, these models did so with high accuracy (Table 2). Conclusion: The CORONA-ICU and -ICU+ models, composed of commonly collected risk factors without or with medications, were shown to be highly predictive of ICU admissions, death, and ventilator use. These models can be efficiently derived and effectively identify high-risk patients who require more careful observation and increased use of advanced medical therapies.

The concept of a portable isolated robotic medical module for evacuation of the sick and injured

Relevance. In our country, as part of the digitalization of healthcare, a number of organizational decisions have been made and are being implemented to optimize the medical evacuation of the sick and injured in emergency situations. The digital transformation of healthcare in order to address the issues of treatment correction, patient transportability and the feasibility of medical evacuation to the greatest degree is realized so far only in the form of telemedicine consultations. At the same time, the latest developments can already be applied, allowing the use of advanced information technologies, including artificial intelligence technologies, for each sick or injured during medical evacuation in the prehospital and hospital periods in the event of emergency response and during everyday work. One of such developments could be the creation of a portable isolated robotic medical module.Intention: To justify the concept of a portable, isolated robotic medical module for the medical evacuation of the sick and injured using advanced medical digital technologies.Methodology. Based on an analysis of the advanced medical equipment, medical materials, digital medical technologies, many years of comprehensive in-house experience in medical evacuation, an information and patent search was conducted for conceptual solutions to create a portable isolated robotic medical module (Module) for medical evacuation of the sick and injured in the daily life and emergency situations.Results and Discussion. A key solution to the problem is to implement the following original ideas. Firstly, it is the “block” principle of layout of the Module structure. In the first (upper) block, robotic diagnostic and medical equipment, control systems and telemetry communications are installed. If you need to work offline, the unit is protected from external influences. The second (middle) block is designed to accommodate a patient who receives medical care. The unit can be completely isolated from the external environment, a comfortable internal environment is created and elements of a video communication system are placed. The third (lower) block contains systems for patient’s life support and autonomic operation, and can be delivered on board the vehicle separately from the first and second blocks. The mass of the third block is not critical for the mass of theModule as a whole. Secondly, there is an idea of using special removable and replaceable shells to isolate the Module from adverse weather conditions. It is possible to use a removable cover made of protective materials. For the conditions of the Far North, these are heat-conserving materials, for the conditions of armed conflict - para-aramid fiber (Kevlar). Thirdly, ergonomic location of medical equipment above the patient provides convenient maintenance of equipment for medical manipulations. In this case, observation and treatment are not interrupted when moving the patient from one vehicle to another.Conclusion. Advanced digital medical technologies in the medical evacuation of the sick and injured within the concept of a portable, isolated, robotic medical module can significantly reduce risks and apply a patient-oriented approach during the medical evacuation of each patient. This makes a significant contribution to the development of medical evacuation and practical medicine.

Practical Experience of Establishing German Standard Level 1 Perinatal Center in Chongqing Health Care for Women and Children.

Germany, as a western developed country, has an advanced medical level, especially in the health care of very immature premature infants. We trace the medical history of perinatology to understand the development of perinatal centers in Germany. After analyzing the classification and function, hierarchical management and quality control systems of German perinatal centers, we established a German standard level 1 perinatal center in the Chongqing Health Center for Women and Children (CHCWC). During more than two years of practice, we changed concepts, continuously updated clinical knowledge and skills, developed a series of high-quality work processes and supervision systems and introduced advanced medical equipment. We believe that the experience of establishing a German standard level 1 perinatal center and perinatal center network in Chongqing is worthy of being promoted to the Chinese maternal and child health care system.

Operations research and health systems: A literature review

Todays, human health is in the best situation ever. The progress of vaccines, development of hospitals, new medicines, advanced medical equipment, and new treatments preventing death will place the health system indicators at its best state in all ages and centuries. In addition, healthcare is one of the biggest industries in developed and developing countries and is a service-oriented industry that is significant, high-quality, and safe in medical services. Healthcare has become one of the biggest sectors in terms of income and employment. Health care involves hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance, and medical equipment. Nowadays, the application of operations research in various fields, including health, is on increase. Although many issues face operations research in healthcare, such issues are not analytically different from the issues in other industries. Operations research, as a quantitative systemic method, can considerably solve the problems related to the health system. The present study aimed to evaluate the application of operations research models based on the research process in health systems including Markov decision-making processes (MDPs) and partially observable Markov decision process (POMDP), etc., and compare these methods with each other. The basis of this study was evaluating the publication of scientific studies on operations research models in the health systems.

Knowledge and intellectual capital in internationalizing SMEs, case study in technology-based health companies

PurposeInternational businesses play a significant role in the growth, innovation and survival of technology-based firms (TBFs). Creating new opportunities in international markets, using communication networks and confronting constraints on available resources have distinguished the internationalization of small and medium-sized enterprises (SMEs) and intensified the importance of knowledge acquisition and continuous learning. This study aimed to (1) configure (the types and sources of) and (2) measure the internationalization knowledge of TBFs, by focusing on a knowledge-intensive part of the health industry in an emerging country: Iranian advanced medical equipment companies.Design/methodology/approachFor this purpose, a qualitative approach was adopted to interview the leaders of eight TBFs exporting medical equipment. Obtained data were investigated using content analysis.FindingsAccording to the content analysis results for configuration, technological knowledge and market knowledge were mainly obtained through direct experience and vicarious learning; however, internationalization knowledge is not so established as the third major knowledge area to integrate technological with market knowledge in line with corporate strategies of an internationalizing firm. For measurement of knowledge assets of internationalizing firms as a prerequisite for continuous improvement, several intellectual capital indices were extracted, including human, structural and relational capital.Originality/valueThis research complements existing literature in internationalization knowledge configuration via deploying an "Intellectual capital" perspective. It could enhance efforts for improving the learning of internationalizing SMEs, especially in the developing countries.

Strategic purchasing in the market of advanced medical equipment: an applied model for developing countries

BackgroundPurchasing health services related to advanced medical equipment is merely based on the decision of the providers in Iran as a developing country in West Asia. This passive process makes health insurance organizations reimburse the bills retrospectively. This study aimed at developing a model for the strategic purchasing of high-tech medical services in Iranian health insurance organizations. MethodsThis was a mixed-method study consisting of a qualitative and a quantitative phase. In the qualitative phase, a scoping study was performed to identify the indicators and strategies of strategic purchasing of high-tech medical services in the world and then the primary model of strategic purchasing of high-tech medical services was developed for Iranian health insurance organizations by an expert panel. In the quantitative phase, the developed model was validated by the Delphi technique. ResultsNarrative analysis of the articles yielded six main dimensions and 36 sub-dimensions of strategic purchasing of high-tech medical services each of which was relevant to one of the five main questions of strategic purchasing. The main dimensions were the position of strategic purchasing in the health system, organization and management, position of internal and external stakeholders, health technology assessment, pricing, and indicators of contracting. ConclusionIn the present model, six applied dimensions were achieved for implementing strategic purchasing in Iranian Health Insurance Organization. The relationship of “stewardship and position of health system” and “Position of health stakeholders” which are responsible for all resource allocation and purchasing mechanism in the health system are emphasized. Simultaneously, the model emphasized “structure and management of the provider organizations” that is important for determining the real needs of the community and managing the correct medical demand.

Forty years review of upstream documents of the Islamic Republic of Iran's health sector on strategic purchasing of advanced-expensive medical equipment

PurposeAccording to the importance of strategic purchasing as an effective tool for resource allocation and service procurement, this study examines national laws, regulations and other related documents related to the strategic purchasing of health services related to the advanced medical equipment in Iran.Design/methodolgy/approachIt was a national qualitative document analysis conducted in 2019 applying content analysis approach. The four-step Scott method was used to include the documents in terms of authenticity, credibility, representation and meaningfulness. After retrieving the related documents, they were coded with the implicit and explicit approach. MAXQDA10 was used for content analysis.FindingsThe findings show that according to the framework of effective factors on the strategic purchasing of health services, seven main factors are determined as the main essential factors in purchasing advanced medical equipment. These factors consist of health care providers, health service buyers, purchaser and service provider contracts, payment mechanisms, organization and management evaluation of health technology including expensive medical equipment and technology-related.Research limitation/implicationThe study had some limitations as follows: the proposed method should be tested and its feasibility has to be investigated through appropriate tools for Iranian insurance companies and those with the similar settings.Practical implicationThe results of this study can shed more light for policy makers affiliated in Ministry of Health as the main service provider, Ministry of Welfare and the insurance agencies as the main purchasers of health services on paying attention to these seven main themes extracted from the upstream documents and laws and regulations of the Islamic Republic of Iran.Social implicationThe strategic purchasing of expensive high technology-based medical equipment is a necessity for Iranian public health insurance organizations that is emphasized in national documents in the way of implementing this necessity.Originality/valueThis study examines all the laws and regulations and all related documents in the strategic purchasing of health services related to advanced medical equipment, giving an analysis of the most important challenges and requirements of implementing strategic purchasing in the health services provision sector with expensive medical equipment.

Challenges of Continuous Nursing Education in Health Agencies

Background: Many factors effects on continuous nursing education, like environment of the study or teaching method, stimulation of employees to participate in the courses and participant’s satisfaction or outcome, so evaluating such unit is so vital and can strengthen weak points and this leads to better patient outcome and high rates of nurses job satisfaction. Aims: This study aims to evaluate continuous nursing education in three parts structure, process and outcome, and knowing factors affecting it. Methodology: Descriptive study design, data collected from three educational hospitals and eight primary health care centers,the approval to conduct the study was obtained from Training and Development Centre in Babylon Health institution, Ethical committee in the nursing college of Babylon and official permissions from Al-Hilla Teaching Hospital, Babylon Maternity and Children Teaching Hospital, Murjan Medical City and Al-Hilla health sectors 1 & 2. Structure and process data gathered by researcher from continuous nursing education unit manager by answering questionnaire which reviewed by (20) nursing experts, the outcome assessed by nurses who participated in continuous nursing education courses by answering the questionnaire by (250) nurse, convenient sampling. Results: The finding refers to several infrastructure weak points, low funds leads to decreased learning preparations like smart screens or advanced laboratories and medical equipment for training. The courses scheduling which set by health ministry are less than applied actually, and low focusing about nursing competencies in these courses, there wasn’t any coordination between health institutions and higher education to fill knowledge gaps or decrease subjects repetition for nurses, and few nurses takes courses out of their hospitals (abroad). High rates of participant nurses didn’t get money reward and most of them used participation certificate for promotion purposes, though, high rates of nurse’s satisfaction about continuous nursing education role, timing commitment, gaining knowledge and scientific materials provided. Conclusion: The purpose of this article was to describe our evaluation process. Continuous nursing education evaluation is central to the mission and integrity of nursing programs in preparing successful nurses, advanced practice nurses, leaders, and scholars. At a more immediate level, continuous nursing education evaluation is an integral component of continuous quality improvement and of significant benefit in planning and implementing intentional, data-driven, program changes. Putting continuous nursing education units in high priority in hospitals policies or primary health care centers in financial support will improve its performance and provide an appropriate environment, tools, hiring highly educated lecturers or participating in abroad of their governances or even country, for studying and learning new skills. Coordination with educational institutions will provide variety in teaching method and filling gaps in the learner knowledge chain, further studies in this field is required that focuses in Health ministry curriculum, separation of hospitals and primary health care centers, and about nurses that didn’t engaged in continuous nursing education courses.

Application of the DeepSense Deep Learning Framework to Determination of Activity Context from Smartphone Data

Current methods of assessing health are infrequent, costly, and require advanced medical equipment. 92% of US adults carry mobile phones, and 77% carry smartphones with advanced sensors (Smith, 2017). Smartphone apps are already being used to identify disease (e.g., skin cancer), but these apps require active participation by the user (e.g., uploading images). The goal of this research is to develop algorithms that enable continuous and real-time assessment of individuals by leveraging data that is passively and unobtrusively captured by cellphone sensors. Our first step to accomplish this is to identify the activity context in which the device is used as this affects the accuracy and reliability of sensor data for measuring and inferring a user’s health; data should be interpreted differently when the user is walking or running versus on a plane or bus. To do this, we use DeepSense, a deep learning approach to feature learning first developed by (Yao, Hu, Zhao, Zhang, & Abdelzaher, 2017). Here we present six experiments validating our model on: (1) a baseline implementation of DeepSense on the same data used by Yao et al., (2017) achieving a balanced accuracy (BA) of 95% over the six main contexts; (2) its ability to classify context using a different publically-available dataset (the ExtraSensory dataset) using the same 70/30 train/test split used by Vaizman et al. (2018), with a BA of 75%; (3) its ability to achieve improved classification when training on a single user, with a BA of 78%; (4) its ability to achieve accurate classification of a new user with a BA of 63%; (5) its improvement to 70% BA for new users when we considered phone placement to remove confounding information, and (6) its ability to accurately classify contexts over all 51 contexts collected by Vaizman et al, achieving a BA of 80% on 9 contexts, 75% on 12, and 70% on 17. We are now working to improve these results by adding other sensors available through smartphone data collection included in the ExtraSensory dataset (e.g., microphone). This will allow us to more accurately assess minor deviations in user behaviors that could indicate changes in health or injury status by accurately accounting for irrelevant, inaccurate, or misleading readings due to contextual effects that may confound interpretation.

Modelling and analysis of healthcare inventory management systems

The core competency of the healthcare system is to provide treatment and care to the patient. The prime focus has always been towards appointing specialized physicians, well-trained nurses and medical staffs, well-established infrastructure with advanced medical equipment, and good quality pharmacy items. But, of late, the focus is driven towards management side of healthcare systems which include proper capacity planning, optimal resource allocation, and utilization, effective and efficient inventory management, accurate demand forecasting, proper scheduling, etc. and may be dealt with a number of operations research tools and techniques. In this paper, a Markov decision process inventory model is developed for a hospital pharmacy considering the information of bed occupancy in the hospital. One of the major findings of this research is the significant reduction in the inventory level and total inventory cost of pharmacy items when the demand for the items is considered to be correlated with the number of beds of each type occupied by the patients in the healthcare system. It is observed that around 53.8% of inventory cost is reduced when the bed occupancy state is acute care, 63.9% when it is rehabilitative care, and 55.4% when long-term care. This may help and support the healthcare managers in better functioning of the overall healthcare system.

1.5mW,14.68V/µS-Low Power and High Speed Comparator Design for ADC Applications

Advanced medical equipments embedded with the sensors, analog to digital converters (ADC) and other equipment. Gain amplifier and the comparator are key blocks in ADCs improvement. Comparator is the key element in achieving a low offset and high slew ratein the ADCs, in addition power and speed optimizationdesigns are preferred. To achieve high speed and low power a modified architecture of a comparator is introduced. A 5V two stage comparator is designed to meet the specifications as, offset value <8.4mV, power dissipation <1.5mW and slew rate>14.68V/µS. Cadence Virtuoso tools and SCL 0.18 µm technology parameters are used for design. Designed comparator shows improved slew rate and power consumption in comparison with the existing comparators

Operation Method for Hybrid UPS with Energy Storage System Function

With the increasingly widespread use of modern communication systems, advanced medical equipment, advanced living facilities, and emergency systems requiring high-quality energy, there is an increasing need for reliable, efficient, and uninterrupted electricity supplies. Consequently, Uninterruptible Power Supplies (UPS) have recently experienced growing demand. However, because the stored energy of a UPS battery is only used in emergency situations, the battery utilization rate of a UPS is very low. Therefore, a hybrid UPS that integrates an Energy Storage System (ESS) with a UPS has recently been developed. Unlike the conventional UPS, this hybrid UPS can increase the battery utilization rate by using the stored energy of the battery when the grid is under normal operation. However, when a grid fault occurs, the hybrid UPS has to supply emergency power to critical loads. Therefore, transient voltage across the DC-link that could affect the power quality of critical loads can occur during mode transition. This paper proposes the operation method of a hybrid UPS with ESS function to minimize the transient voltage across the DC-link. PSCAD/EMTDC software is used to verify the validity of the proposed operation method.

Optical Correction of Keratoconus with a Scleral Gas-Permeable Lenses

The optical properties of the cornea are determined by its ability to refract and transmit light. Keratoconus changes cornea’s shape, the surface of the cornea becomes irregular, which leads to a violation of light refraction and the occurrence of optical aberrations. The progressing course of the disease and its late detection lead to a delayed start of therapeutic measures, which affects the prognosis of the disease progression and reduces the patient’s quality of life. The quality of visual functions depends on the stage of the process. There are 4 stages of keratoconus (according to M. Asler), each of which corresponds to certain changes in refraction and degree of deformation of the cornea. Early biomicroscopic signs are: “dilution” of the stroma (inhomogeneity of the cornea and a grayish tint in the zone of the developing apex), change in the shape of endothelial cells and clearly visible nerve endings due to longitudinal thickening. In the second stage of keratoconus, the biomicroscopic picture is complemented by the appearance of keratoconus lines (Vogt’s striae). The opacities of the Bowman’s membrane indicate the beginning of the scarring process and the transition of the disease to its third stage. The fourth stage of the disease is characterized by further development of stromal opacities and the occurrence of gross changes of the Descemet’s membrane. Advanced medical equipment for topographic mapping and measuring the cornea makes it much easier for ophthalmologists to diagnose keratoconus and choose more effective treatment methods: crosslinking or surgical treatment. Later it allows to stabilize keratoconus, but does not provide high visual acuity due to the induction of optical aberrations, including high order optical aberrations. Contact lens vision correction is the main way to correct the refractive error resulting from keratoconus. However, the use of corneal gas permeable or soft contact lenses cannot provide high quality vision, additionally causing discomfort associated with their excessive mobility. The use of scleral gas permeable contact lenses is the most effective method of optical correction of all stages of keratoconus and after keratoplasty.

Application Status and Development Trends of Medical Proton and Heavy Ion Accelerators

Cancer therapy with accelerated proton or heavy ion beam is the most advanced radiotherapy technology, which is recognized by the international community at present. It is of great practical significance to study the medical proton and heavy ion accelerators and the radiotherapy technology, in order to promote the development of the advanced medical radiotherapy equipments and improve the quality of life of cancer patients in China. After a brief overview of cancer therapy with proton and heavy ion beam, this paper summarized and analyzed the application status of medical proton accelerators and medical heavy ion accelerators at home and abroad, and finally put forward the future development trends of medical proton and heavy ion accelerators and the radiotherapy technology, it can provide a reference for the progress and development strategies of the advanced radiotherapy equipments in China.

An IoT architecture for preventive maintenance of medical devices in healthcare organizations

In recent years, hospitals have spent a significant amount on technologically advanced medical equipment to ensure not only the accuracy and reliability of medical devices, but also the required level of performance. Although medical devices have been revolutionized thanks to technology advancements, outdated maintenance strategies are still used in healthcare systems and services. Also, maintenance plans must often be developed for a mixture of advanced and obsolete technologies being used in medical devices. Therefore, most healthcare organizations have been facing the challenge of detecting equipment-related risks that would have been alleviated if effective integrity monitoring mechanisms were in place. Additionally, continuously growing volumes of large data streams, collected from sensors and actuators embedded into network-enabled sensors and microprocessors of medical equipment, require a scalable platform architecture to support the necessary storage and real-time processing of the data for device monitoring and maintenance. This paper investigates the issue of maintaining medical devices through an Internet-of-Things (IoT)-enabled autonomous integrity monitoring mechanism for those devices generating large-scale real-time data in healthcare organizations. The proposed architecture that includes an integrity monitoring framework and a data analytics module ensures the complete visibility into medical devices and provides a facility to predict possible failures before happening.

AI in the ICU: In the intensive care unit, artificial intelligence can keep watch

IN A HOSPITAL'S INTENSIVE CARE UNIT (ICU), the sickest patients receive round-the-clock care as they lie in beds with their bodies connected to a bevy of surrounding machines. This advanced medical equipment is designed to keep an ailing person alive. Intravenous fluids drip into the bloodstream, while mechanical ventilators push air into the lungs. Sensors attached to the body track heart rate, blood pressure, and other vital signs, while bedside monitors graph the data in undulating lines. When the machines record measurements that are outside of normal parameters, beeps and alarms ring out to alert the medical staff to potential problems. • While this scene is laden with high tech, the technology isn't being used to best advantage. Each machine is monitoring a discrete part of the body, but the machines aren't working in concert. The rich streams of data aren't being captured or analyzed. And it's impossible for the ICU team—critical-care physicians, nurses, respiratory therapists, pharmacists, and other specialists—to keep watch at every patient's bedside. • The ICU of the future will make far better use of its machines and the continuous streams of data they generate. Monitors won't work in isolation, but instead will pool their information to present a comprehensive picture of the patient's health to doctors. And that information will also flow to artificial intelligence (AI) systems, which will autonomously adjust equipment settings to keep the patient in optimal condition.

Factors affecting patient satisfaction with ecdemic medical care: a cross-sectional study in Nanchang, China.

PurposeThis study aimed to determine the factors that influence patient satisfaction with ecdemic medical care.Materials and methodsEight hundred and forty-four face-to-face interviews were conducted between October and November 2017 in two high-profile hospitals in Nanchang, China. Patient satisfaction was divided into lowest and highest satisfaction groups according the 80/20 rule. Demographic factors associated with patient satisfaction were identified by logistic regression models.ResultsRespondents’ main reasons for choosing a non-local hospital were “high level of medical treatment” (581/844), “good reputation of the hospital” (533/844), and “advanced medical equipment” (417/844). The top three items that dissatisfied the ecdemic patients were “long time to wait for treatment” (553/844), “complicated formalities” (307/844), and “poor overall service attitude” (288/844). Fewer female patients (adjusted odds ratio [AOR] =1.47, 95% confidence interval [CI] =1.03–2.11), patients with a family per-capita monthly income (FPMI) between 3,001 and 5,000 CNY (AOR =1.40, 95% CI =1.01–2.17), inpatients (AOR =1.46, 95% CI =1.01–2.13), and more patients with an FPMI >7,000 CNY (AOR =0.43, 95% CI =0.20–0.92) were detected in the lowest satisfaction group. Fewer patients with an associate’s or bachelor’s degree (AOR =2.40, 95% CI =1.37–4.20) and patients with an FPMI >7,000 CNY (AOR =3.02, 95% CI =1.10–8.33) were detected in the highest satisfaction group. Moreover, more inpatients (AOR =0.70, 95% CI =0.54–0.97) and those aged 46–65 years (AOR =0.63, 95% CI =0.33–0.98) were detected in the highest satisfaction group.ConclusionFindings suggested that managers of the medical facilities should note the importance of increasing their publicity through a rapidly developing media, as well as the necessity of creating a more patient-friendly medical care experience. Hospitals should also focus on the medical care experience of patients with relatively lower and higher income levels, male ecdemic patients, and ecdemic outpatients.

Dandy-Walker Syndrome in a Child at Rural Kelantan, Malaysia

Dandy-Walker syndrome is a rare congenital malformation of the brain that involves the cerebellum and the fourth ventricle. It is characterised by a classical triad of hydrocephalus, cystic dilatation of the fourth ventricle and complete or partial agenesis of the vermis. Majority of cases are diagnosed during neonatal or early infantile period. In this case report, a seven-year-old boy complained of recurrent headaches for the past one year. Physical examination was unremarkable. Examination of the fundus on the same day revealed bilateral papilloedema. His subsequent computed tomography scan of the brain done at a major district hospital demonstrated features in keeping with Dandy-Walker malformation. Our case highlighted the importance of embarking on a detailed and thorough approach when dealing with a child with chronic headache, especially in rural settings where advanced medical equipment is not readily available.