Clinical Engineering Research Articles

Clinical engineers’ services and physicians’ orders

Clinical engineers’ services and physicians’ orders

Defibrillation deactivation state and activation status in patients with implantable cardioverter-defibrillators at the end of life

Abstract Background Implantable cardioverter-defibrillators (ICDs) are effective in preventing sudden cardiac death due to lethal arrhythmias. Defibrillation is also known to cause physical and emotional distress to patients, and guidelines on palliative care for cardiovascular disease recommend that when patients with ICDs reach the end of life, the benefits and burdens of ICDs should be fully explained to patients and a policy regarding the cessation of defibrillation discussed. However, there are few reports on the treatment status and defibrillation deactivation in patients with ICDs in the terminal phase. Aim To investigate defibrillation activation and defibrillation deactivation in terminally ill patients with ICDs. Results Death was confirmed in 146 patients in the medical record, and a DNAR policy was decided in 46 patients. The decision to deactivate defibrillation was informed to 24 patients (16%), and 15 patients (10%) were deactivated (11 patients in terminal heart failure and 4 patients in others). Four of the nine patients (6%) who did not deactivate defibrillation had a shock before death.Of the 22 patients (14 cardiovascular deaths and 8 others) who were not explained about the deactivation of defibrillation, 4 had shock activation before death.Of the 24 patients who received explanation about defibrillation deactivation, 6 (25%) had the policy decided by the patient and family, and 18 (75%) had the policy decided by the family because the patient's will could not be confirmed due to deterioration of end-stage condition. Discussion This study showed that defibrillation was deactivated in only 10% of Japanese patients with end-stage ICDs.ICD patients do not always reach the end of life due to heart failure. It is important for physicians, clinical engineers, and device nurses involved in device care to provide information and to confirm the wishes of patients and their families regarding the deactivation of defibrillation so that they can be supported in their decision-making regarding defibrillation no matter under what circumstances they reach the end of life. Conclusion Discussion of ICD deactivation in palliative care is needed to reduce the risk of painful shock and distress at the end of life.

Optimizing EHR Data

Electronic health records (EHRs) contribute to quality-of-care delivery directly. With a comprehensive and effective use of EHR data, healthcare providers can create precise, personalized treatment plans and seamlessly communicate across departments. By optimizing the data in a health system, clinical engineers can improve these processes and, subsequently, patient flow. This article combines case studies and existing research to explore the challenges and opportunities in current EHR data systems, how evolving artificial intelligence tools can be used to improve data utilization, and the importance of interoperability.

Flow analysis and fabrication of micro scale controlled surfaces by ultrashort pulse laser for microfluidic device applications

Microfluidics finds a wide range of industrial applications mainly in fields such as biomedical, clinical, electrical, and thermal engineering. Microchannels are the building blocks of most microfluidic devices. Thus, it becomes evident to understand the properties and the effect of the surfaces on the outcomes of devices. In this study, the effect of the shape of microchannels and the roughness elements on the flow is evaluated. Microchannels with three cross-sections and roughness elements of three different geometries are considered. The effect of varying Reynolds numbers on the flow parameters such as Friction factor, Nusselt number, Poiseuille number, pressure drop and surface temperature at the base of the substrate is studied. It is observed that rough microchannels and rectangular roughness elements showed a higher Nusselt number than smooth microchannels. The rough microchannels with triangular roughness elements showed higher friction factors. The surface temperature is higher for the smooth microchannels with triangular roughness elements. Furthermore, to demonstrate the manufacturability of microfluidic channels with controlled surfaces and to validate the preliminary results of the numerical simulations, the ultrashort pulse laser micromachining technique is used to fabricate the microchannels with structures on Polymethyl Methacrylate (PMMA) material.

Excerpts from the May-June 2024 issue of ACCE News, the official newsletter of the American College of Clinical Engineering

Excerpts from the May-June 2024 issue of ACCE News, the official newsletter of the American College of Clinical Engineering

Crothall Healthcare Clinical Engineering Information Technology at the University of Cincinnati Health

This article highlights the critical role of Crothall Healthcare’s clinical engineering information technology (CEIT) department in ensuring cybersecurity and efficiency in healthcare facilities focusing on its partnership with UCHealth in Cincinnati, Ohio. It underscores the importance of cybersecurity in healthcare, outlines CEIT’s responsibilities, and addresses the multifaceted challenges they encounter. CEIT’s work is essential in safeguarding patient safety and healthcare data integrity in an increasingly technology-driven healthcare landscape.

Clinical engineering units and their role in the organizational structure of the healthcare system.

Clinical engineering units and their role in the organizational structure of the healthcare system.

Analysis of Responses of GPT-4V to the Japanese National Clinical Engineer Licensing Examination.

Chat Generative Pretrained Transformer (ChatGPT; OpenAI) is a state-of-the-art large language model that can simulate human-like conversations based on user input. We evaluated the performance of GPT-4V in the Japanese National Clinical Engineer Licensing Examination using 2,155 questions from 2012 to 2023. The average correct answer rate for all questions was 86.0%. In particular, clinical medicine, basic medicine, medical materials, biological properties, and mechanical engineering achieved a correct response rate of ≥ 90%. Conversely, medical device safety management, electrical and electronic engineering, and extracorporeal circulation obtained low correct answer rates ranging from 64.8% to 76.5%. The correct answer rates for questions that included figures/tables, required numerical calculation, figure/table ∩ calculation, and knowledge of Japanese Industrial Standards were 55.2%, 85.8%, 64.2% and 31.0%, respectively. The reason for the low correct answer rates is that ChatGPT lacked recognition of the images and knowledge of standards and laws. This study concludes that careful attention is required when using ChatGPT because several of its explanations lack the correct description.

Perfusionist education in Japan: A survey of challenges and current status.

This study aimed to examine the educational challenges faced by perfusionists in Japan. Although Japan has over 400 cardiovascular surgery centers, it performs fewer surgeries than by countries such as Germany and the United States. We focused on challenges related to varying caseloads and working conditions. We conducted an online survey containing 24 questions using Google Forms from January to June 2022, targeting perfusionists in Japan. The 24-question survey spanned various educational topics and was approved by the Morinomiya University of Medical Sciences Ethics Committee. Responses were received from 129 perfusionists across 77 institutions. Approximately 70% of these centers managed less than 200 cardiopulmonary bypass (CPB) cases per year, with a similar proportion of perfusionists handling under 50 CPB cases annually. Challenges in Japanese perfusionist education include enhancing communication and troubleshooting skills and the need for instructors with a broad teaching experience. This study emphasizes the significant differences in caseload and work environments for perfusionists among Japanese institutions. Perfusionists, who often work in clinical engineering, have various responsibilities. These findings highlight the need for improved communication, problem-solving skills, and the implementation of modern teaching technologies. Additionally, this study highlights the complexities of training Japanese perfusionists and underscores the need for more practical, technology-driven educational methods. Addressing these issues is crucial for improving Japan's healthcare standards and could influence global perfusionist education.

Transforming Hypertension Diagnosis and Management in The Era of Artificial Intelligence: A 2023 National Heart, Lung, and Blood Institute (NHLBI) Workshop Report.

Hypertension is among the most important risk factors for cardiovascular disease, chronic kidney disease, and dementia. The artificial intelligence (AI) field is advancing quickly, and there has been little discussion on how AI could be leveraged for improving the diagnosis and management of hypertension. AI technologies, including machine learning tools, could alter the way we diagnose and manage hypertension, with potential impacts for improving individual and population health. The development of successful AI tools in public health and health care systems requires diverse types of expertise with collaborative relationships between clinicians, engineers, and data scientists. Unbiased data sources, management, and analyses remain a foundational challenge. From a diagnostic standpoint, machine learning tools may improve the measurement of blood pressure and be useful in the prediction of incident hypertension. To advance the management of hypertension, machine learning tools may be useful to find personalized treatments for patients using analytics to predict response to antihypertension medications and the risk for hypertension-related complications. However, there are real-world implementation challenges to using AI tools in hypertension. Herein, we summarize key findings from a diverse group of stakeholders who participated in a workshop held by the National Heart, Lung, and Blood Institute in March 2023. Workshop participants presented information on communication gaps between clinical medicine, data science, and engineering in health care; novel approaches to estimating BP, hypertension risk, and BP control; and real-world implementation challenges and issues.

A teaching model for biomedical imaging informatics

IntroductionRadiology played a leading role in the transformation of medicine to a digital environment. To ensure the smooth operation and managing workflow in a digital imaging environment, dedicated, well-trained individuals are needed. The objective of this study was to develop a teaching and learning model for imaging informatics. MethodsQuantitative and qualitative data were collected through a literature review and three structured questionnaires. Results from literature and questionnaires informed the Delphi statements. Three Delphi rounds with medical informatics and higher education experts were completed – all data contributed to developing the teaching and learning model. ResultsLiterature provided the frame of reference related to regulation and inclusions in the model. Six summated imaging informatics themes with categories that included topics, teaching, learning and assessment as well as project management, and clinical engineering were included in the first Delphi questionnaire. The three-round Delphi resulted in consensus achieved for 142 of the 184 statements and the stability of 37 statements. The model created aligns with the context, goals, content, learning experiences and assessment that lead to holistic student development. ConclusionFeedback from a variety of sources assisted the development of the teaching model for image informatics. The model can be regarded as having a broad scope but also depth since expert refinement strengthened the final inclusions. The flexible, holistic nature of this model addresses not only the educational impediments associated with curriculum development but additionally catalyses a pragmatic approach to implementation and operationalisation thereof. Implications for practiceThe developed teaching and learning model could serve to improve the training of radiographers and IT specialists to become certified imaging informatics professionals. This model may be incorporated to assist the integration of all systems – to improve quality and service.

Health professionals involved in diabetic foot and their tasks in a country without podiatrists: From a Japanese Nationwide Survey.

Although there are no podiatrists in 85% of countries worldwide, how diabetic foot is managed in those countries is still unknown. We sought to identify the health professionals involved in diabetic foot and their tasks in Japan, where no podiatrists exist. This cross-sectional study used the Japanese Nationwide Survey on Foot Ulcer Management dataset, consisting of 249 medical doctors and 680 allied health professionals. The types of health professionals involved in the diabetic foot were identified, and the tasks performed by each professional were compared within subgroups (medical doctors and allied health professionals). We found that the primary medical doctors involved in diabetic foot care in Japan were plastic surgeons (33.5%), dermatologists (21%), cardiovascular/vascular surgeons (15.2%), and cardiologists (12.1%). Nurses were the main allied health professionals (80%), and the rest consisted of prosthetists/orthotists (7.6%), physical/occupational therapists (5.9%), and clinical engineering technologists (3.6%). Medical doctors performed tasks related to their specialties significantly more than others (p < 0.001); however, they also engaged in tasks outside of their specialty, such as plastic surgeons performing preventive foot care (72%). Among allied health professionals, clinical engineering technologists performed more vascular assessments (p < 0.001), and half were engaged in wound management, preventive foot care, and self-foot care education. In conclusion, the type and proportion of health professionals in our study differed from those in countries with podiatrists, and many performed tasks outside their specialties. This is the first nationwide cross-sectional study of diabetic foot care in a country without podiatrists and is unique in examining multiple specialists/professionals in one study.

Following are excerpts from the March-April 2024 issue of ACCE News, the official newsletter of the American College of Clinical Engineering

Following are excerpts from the March-April 2024 issue of ACCE News, the official newsletter of the American College of Clinical Engineering

Barriers to conservative kidney management for Japanese healthcare professionals involved in the treatment of end-stage renal disease.

Conservative kidney management (CKM) is a treatment alternative for patients with end-stage kidney disease (ESKD). Despite the increasing population of elderly dialysis patients in Japan, CKM is not as readily available compared with that in North America and Europe. Therefore, it is important to clarify the barriers to CKM in Japan. We interviewed 11 experts to explore their beliefs and issues regarding CKM. Based on the interviews, we categorized the CKM barriers into eight categories and created a 24-item questionnaire. A questionnaire survey was conducted among 112 medical professionals involved in ESKD management. To investigate the types of barriers, we conducted an exploratory factor analysis using the questionnaire results. Responses were obtained from 53 (47.3%) of 112 subjects (18 doctors, 29 nurses, 6 clinical engineers), with 94.3% considering CKM as a treatment option for ESKD. Factor analysis categorized the questions into the following: (1) Lack of palliative care experience, (2) Ethics and responsibility, (3) Patient's problem, (4) Dialog with patients and families, and (5) Lack of support system. Regarding barriers to CKM, "lack of experience in palliative care" and "lack of support system" scored the highest, and "ethics and responsibility" scored the lowest. Barriers to CKM may be classified into five factors, with "lack of experience in palliative care" and "lack of support system" being the important barriers to overcome. Additionally, most healthcare professionals consider CKM as the fourth option for renal replacement therapy.

Enhancing Osteogenic Differentiation of Dental Pulp Stem Cells with Covalently Bonded All‐Carbon Scaffolds

AbstractThe regeneration of bone tissue is a complex process requiring innovative biomaterials with enhanced osteogenic properties to facilitate successful tissue engineering. Herein, a 3D bionic scaffold comprised of covalently bound graphene/carbon nanotube monoliths are present (3DGp/CNTs) exhibiting long‐range ordered porous characteristics, showcasing promising attributes for bone tissue applications. The lightweight, all‐carbon scaffolds not only demonstrate excellent mechanical performance in the hydrated state but also mimic the structural and functional features of the extracellular matrix, actively promoting cellular adhesion, proliferation, and differentiation. Significantly, the osteogenic differentiation of dental pulp stem cells (DPSCs) is observed, as evidenced by the upregulation of RUNX2, OSX, BSP, ALP, OPN, and OCN expression. This notable outcome can be attributed to the synergistic effect of 3DGp/CNTs, which create a conducive microenvironment for DPSCs and promote osteogenic differentiation by activating the BMP pathway. This observation elucidates the mechanism through which 3DGp/CNTs induce DPSC mineralization. The combination of these advantages, along with its straightforward and cost‐effective preparation technique, positions 3DGp/CNTs as a promising candidate for dental clinical engineering.

The Use of Business Intelligence Software to Monitor Key Performance Indicators (KPIs) for the Evaluation of a Computerized Maintenance Management System (CMMS)

The increasing use of electromedical equipment in hospital care services necessitates effective management of complex devices often unsupported by existing control systems. This paper focuses on developing a pool of evaluation indices for the Clinical Engineering Department (CED) of the ASST Grande Ospedale Metropolitano Niguarda in Milano (Italy), aiming to enhance awareness of the economic value, assess operational units, and optimize maintenance processes. Leveraging business intelligence, this study identifies 18 key performance indicators (KPIs) across logistics, technical, and equipment management categories. An interactive dashboard, implemented using Power BI, facilitates dynamic analysis and visualization of these KPIs, providing insights into the maintenance efficiency and obsolescence of medical devices. It offers a comprehensive framework for ongoing monitoring and decision-making. The results showcase the potential of the developed KPIs and dashboard to enhance operational insights and guide improvements in the healthcare facility’s maintenance processes.

Research and Development in Biomedical Prosthetics

In this report the sole data is based on innovation and development in biomedical prosthetics field. The current technology used for prosthetic includes 3D printing, device implants, digital design tools and more. There are several types of biomedical engineering, such as tissue, genetic, neural and stem cells, as well as chemical and clinical engineering for health care. Many electronic and magnetic method uses sensors in equipment such as Computed Tomography (CT) scans, Magnetic Resonance Imaging (MRI) scans, Electroencephalography (EEG). The notation of the idea is using sensors in body supporting equipment’s or an attachment as prosthetics with the incorporation of AI that could get results in movement or functioning in any nonfunctioning body part as desired.

3D printing traceability in healthcare using 3Diamond software

Background3D printing is one of the fastest-growing technologies in medicine, but it is essential to have a system for 3D printing documentation that is accessible for not only clinical engineers and surgeons, but also quality managers and data-privacy officers in hospitals. Dedicated software such as product lifecycle management (PLM) software could enable comprehensive management and traceability of all data relevant to 3D printing tasks in a hospital and would highly beneficial. Therefore, customizable software called 3Diamond was developed for 3D printing in medicine. MethodsThe software development process involved several stages, including setting specifications based on end-user requirements, design, implementation, and testing. In order to ensure the software's long-term success and smooth operation, critical phases were also considered, such as deployment and maintenance. ResultsThe developed software provides immediate and complete traceability of all preparations and controls, as well as management of reports, orders, stock, and post-operative follow-up of tasks related to 3D printing in a hospital. Based on user requirements, software testing is provided automatically with each release. The software was implemented in a natural clinical environment with a developed 3D printing center. ConclusionAlthough 3D printing has potential for innovation in the medical profession, it is nevertheless subject to regulations. Even though there are exemptions for patient-specific products, the effects of their local legal implementations related to 3D printing cannot be fully overseen. To this end, 3Diamond provides a robust system for 3D printing documentation that is accessible to different personnel in hospitals.

Transforming evidence-based clinical guidelines into implementable clinical decision support services: the CAREPATH study for multimorbidity management.

The CAREPATH Project aims to develop a patient-centered integrated care platform tailored to older adults with multimorbidity, including mild cognitive impairment (MCI) or mild dementia. Our goal is to empower multidisciplinary care teams to craft personalized holistic care plans while adhering to evidence-based guidelines. This necessitates the creation of clear specifications for clinical decision support (CDS) services, consolidating guidance from multiple evidence-based clinical guidelines. Thus, a co-creation approach involving both clinical and technical experts is essential. This paper outlines a robust methodology for generating implementable specifications for CDS services to automate clinical guidelines. We have established a co-creation framework to facilitate collaborative exploration of clinical guidelines between clinical experts and software engineers. We have proposed an open, repeatable, and traceable method for translating evidence-based guideline narratives into implementable specifications of CDS services. Our approach, based on international standards such as CDS-Hooks and HL7 FHIR, enhances interoperability and potential adoption of CDS services across diverse healthcare systems. This methodology has been followed to create implementable specifications for 65 CDS services, automating CAREPATH consensus guideline consolidating guidance from 25 selected evidence-based guidelines. A total of 296 CDS rules have been formally defined, with input parameters defined as clinical concepts bound to FHIR resources and international code systems. Outputs include 346 well-defined CDS Cards, offering clear guidance for care plan activities and goal suggestions. These specifications have led to the implementation of 65 CDS services integrated into the CAREPATH Adaptive Integrated Care Platform. Our methodology offers a systematic, replicable process for generating CDS specifications, ensuring consistency and reliability across implementation. By fostering collaboration between clinical expertise and technical proficiency, we enhance the quality and relevance of generated specifications. Clear traceability enables stakeholders to track the development process and ensure adherence to guideline recommendations.

Examining the Relation of Transformational Leadership in Clinical Engineering on the Performance of Medical Equipment: A Neural Network Approach

In the realm of healthcare administration, heightened expectations can lead to stress, therefore impacting working conditions. Specifically, studies on leadership styles have provided a valuable understanding of the factors that hinder performance, particularly in relation to the implementation of transactional leadership. Despite its crucial significance, there is a dearth of research on the management styles employed in clinical engineering. This study examines the impact of leadership styles on the functioning of medical equipment. We assess leadership styles and the performance of medical equipment from the perspective of end-users using a cross-sectional survey and questionnaires that consider many significant criteria. A neural network model is employed to classify the leadership styles exhibited by the Clinical Engineering Department (CED) and to analyze the correlation between these styles and the equipment’s performance. The results suggest a significant correlation between the leadership styles of those in charge of CED and the functioning of medical equipment. A strong and favorable correlation exists between transformative leadership and equipment performance (r = 0.856**, P = 0.000). The data suggests that transformative leadership is highly significant, with a mean score of 3.07 ± 0.817.