Expert Operators Research Articles

Effect of different sealing caps on the backflow of short-term dialysis catheters: A bench study.

Needle-free connectors (NFCs) are recommended as closure systems for peripheral and central vascular catheters to reduce needlestick injuries and infections, while potentially reducing blood reflux. However, their performance in short-term dialysis catheters has never been evaluated. The aim of this study was to evaluate the backflow associated with two NFCs (Neutron™ and Tego™) compared to the standard closure. In this bench study, the physiological blood pressure of the superior vena cava was simulated. Expert operators performed three sealing sequences for each combination of connector and lumens of the catheter, with and without closing the clamp. After that, the backflow was measured in millimeters using a high-precision digital caliper. No combination of caps, lumens, or clamping sequences eliminated the backflow. No differences were observed between standard caps and NFCs in both lumens, apart from the Tego™/No clamp combination in the proximal lumen that showed higher backflow (standard cap 15 [11; 17] mm vs Tego™ 23 [19; 25] mm, p < 0.001). Clamping reduced backflow in both the proximal (13 [11; 17] mm vs 20 [13; 25] mm) and distal lumens (12 [11; 16] mm vs 14 [12; 17] mm). No differences were found between standard caps and NFCs in the distal lumen, regardless of clamping. Proximal lumen consistently exhibited larger backflow (14 [12; 22] mm) compared to distal lumens (13 [11; 17] mm, p = 0.005). NFCs do not seem to introduce any advantage on backflow reduction as compared to a standard cap combined with lumen and clamping. Our data suggest that clamping should become standard practice when NFCs are used in the management of short-term dialysis catheters.

An Unusual Cause of Failure of Fiberoptic Intubation due to Continuous Suctioning: A Case Report

ABSTRACTFlexible fiberoptic intubation is the gold standard technique during difficult airway management. Failure of fiberoptic intubation could be due to patient factors, equipment factors, and operator expertise. We present a case where fiberoptic intubation was unsuccessful because of equipment error following continuous suction pressure application.

Percutaneous Kidney Biopsy: A Valuable Diagnostic Tool

Percutaneous kidney biopsy is a valuable diagnostic tool for the pathological evaluation of renal diseases, particularly glomerular disorders. It is crucial for guiding treatment decisions when clinical and laboratory findings are uncertain. Since its introduction in the mid-20th century, percutaneous kidney biopsy has evolved from an initial blind approach, associated with higher complication rates, to advanced methods using real-time ultrasound or computed tomography guidance and spring-loaded biopsy needles. These advancements have significantly improved tissue sampling accuracy and minimized complications, establishing percutaneous kidney biopsy as a relatively safe diagnostic procedure. Despite these improvements, the invasive nature of the procedure emphasizes the importance of careful patient selection and operator expertise. Nephrologists, as the primary operators and performers of kidney biopsy, play a pivotal role in ensuring timely and appropriate patient care.

Perception of Dental Interns About Intracanal Fracture of Endodontic Instruments in the Central Region of Saudi Arabia: A Cross-Sectional Study

ABSTRACT Objective: This study assessed the perceptions among dental interns regarding intracanal fracture of endodontic instruments. Methodology: This cross-sectional observational study was performed among 206 dental interns working in Saudi Arabia. A validated questionnaire encompassing 15 close-ended questions was used. The questionnaire consisted of two components: the first component (Section I) gathered demographic details, and the second part (Section II) examined the causes of EFS during root canal treatment. A Pearson’s Chi-square test was applied to determine the association of perceptions of EFS during endodontic procedures between male and female interns. Results: The study findings showed that out of 206 dental interns, 107 (51.9%) were males and 99 (48.1%) were females. The perceptions regarding intracanal instrument fracture revealed that hand files (71 (34.5%)) were less likely to break than rotary files (132 (64.1%)). Around 152 (73.8%) respondents said that stainless steel was the most frequently broken alloy. Moreover, there was a significant relationship between gender and the belief that operator expertise plays a role in preventing instrument fracture. Conclusion: This study concluded that dental interns were aware of factors contributing to file separation during endodontic treatment. They believed fractures were more common in the apical third of posterior teeth, preferred Nickel Titanium for instruments, and thought hand files were less prone to fracture than rotary files.

B-Guide System: Improving the Predictability of Complete-Arch Implant and Prosthetic Placement Using Fixed Prosthesis Guides.

Computer-aided implant placement (CAIP) offers improved accuracy and reduced invasiveness. However, traditional static CAIP (sCAIP) protocols for complete-arch restorations often involve multiple guides and clinical steps, increasing the risk of soft tissue trauma and procedural complexity. This article introduces the B-guide technique, which integrates implant placement and interim prosthesis delivery into a single device to simplify the procedure and minimize tissue damage. The B-guide combines the implant osteotomy and placement guide with an abutment placement and prosthesis pick-up mechanism. The guide remains in place post-implantation, allowing immediate prosthesis conversion. A 55-year-old female patient underwent complete-arch rehabilitation using the B-guide, enabling immediate implant placement and loading. The B-guide minimized soft tissue trauma and eliminated the need for multiple guides, significantly reducing treatment complexity and time. The B-guide simplifies procedures and improves predictability compared with traditional systems by integrating prosthetic adaptation and implant placement, reducing cumulative errors. However, its success is heavily reliant on the operator's expertise, especially in preoperative planning and design. By integrating implant and prosthesis placement into a single guide, the B-guide reduces surgical complexity, minimizes trauma, and enhances prosthetic outcomes, improving clinical efficiency.

Artificial intelligence integration in healthcare: perspectives and trends in a survey of U.S. health system leaders

BackgroundThe healthcare sector is rapidly integrating artificial intelligence-derived predictive models (AIDPM) to enhance clinical decision support, operational efficiency, and patient experiences. However, research on management strategies for AIDPM acquisition, deployment, and governance remains limited. This study examines changes in AIDPM integration and governance since 2021, with a particular focus on large language models and health equity considerations.ResultsOur survey of health system leaders achieved a 49% response rate (32/65). While 84% of institutions reported using AIDPM in clinical practice, only 53% had established dedicated teams for these models. Compared to 2021, there was a significant increase in representation from experts in clinical informatics, operations, and quality improvement on AIDPM teams. Most organizations (41%) primarily purchased AIDPM from external vendors. Support for integrating large language models into healthcare practices was unanimous among respondents. The principal obstacles to AIDPM adoption included regulatory concerns, data security, workflow integration, and clinician acceptance. A large majority (72%) of respondents supported government regulation of AI in healthcare. While 76% of organizations reported having a team member dedicated to health equity, ethicists and diversity leaders were underrepresented on AIDPM teams (18%). Organizations reported various efforts to promote health equity, but involvement of frontline clinicians in AIDPM development and its impact on health equity was significantly less common.ConclusionsClinical adoption of AIDPM faces challenges due to the absence of established best practices. Health system leaders strongly support federal regulations for AI in healthcare. These regulations could provide quality and safety standards. The study highlights the need for developing evaluation guidelines, especially for large language models. It also reveals a lack of uniform involvement of frontline clinicians and equity experts in AIDPM governance. Their involvement could increase adoption and trust of these new AI tools. Future research should assess healthcare systems' adherence to emerging regulations and best practice frameworks. This research should emphasize patient safety and health equity. These findings underscore the urgent need for a comprehensive roadmap. This roadmap would guide the responsible implementation of AIDPM in healthcare settings.

HaptiScan: A Haptically-Enabled Robotic Ultrasound System for Remote Medical Diagnostics

Medical ultrasound is a widely used diagnostic imaging modality that provides real-time imaging at a relatively low cost. However, its widespread application is hindered by the need for expert operation, particularly in remote regional areas where trained sonographers are scarce. This paper presents the development of HaptiScan, a state-of-the-art telerobotic ultrasound system equipped with haptic feedback. The system utilizes a commercially available robotic manipulator, the UR5 robot from Universal Robots, integrated with a force/torque sensor and the Phantom Omni haptic device. This configuration enables skilled sonographers to remotely conduct ultrasound procedures via an internet connection, addressing both the geographic and ergonomic limitations faced in traditional sonography. Key innovative features of the system include real-time force feedback, ensuring that sonographers can precisely control the ultrasound probe from a remote location. The system is further enhanced by safety measures such as over-force sensing, patient discomfort monitoring, and emergency stop mechanisms. Quantitative indicators of the system’s performance include successful teleoperation over long distances with time delays, as demonstrated in simulations. These simulations validate the system’s control methodologies, showing stable performance with force feedback under varying time delays and distances. Additionally, the UR5 manipulator’s precision, kinematic, and dynamic models are mathematically formulated to optimize teleoperation. The results highlight the effectiveness of the proposed system in overcoming the technical challenges of remote ultrasound procedures, offering a viable solution for real-world telemedicine applications.

Clinical utility of echocardiography in internal medicine: a narrative review

Echocardiography has emerged as an invaluable tool in internal medicine, providing real-time, non-invasive evaluation of cardiac structure and function. Its clinical utility spans a wide range of applications, including the diagnosis and management of heart failure, valvular heart diseases, and cardiomyopathies, as well as systemic conditions like sepsis and chronic kidney disease. The ability to perform bedside echocardiography has made it particularly useful in critical care settings, allowing for rapid assessment of cardiac function in hemodynamically unstable patients. Echocardiography also plays a key role in guiding therapeutic interventions, from fluid management to valvular repair and replacement procedures. Despite its many advantages, echocardiography is not without limitations. Image quality may be compromised in patients with obesity, lung disease, or prior thoracic surgery, necessitating alternative imaging modalities like cardiac magnetic resonance imaging or computed tomography. Operator expertise is another critical factor influencing diagnostic accuracy, underscoring the importance of proper training. Recent advancements, including artificial intelligence integration and portable devices, are expected to further expand the role of echocardiography, making it more accessible in diverse clinical settings. This narrative review highlights the broad clinical utility of echocardiography in internal medicine, its challenges, and the future directions that promise to enhance its role in patient care.

Are virtual harm reduction interventions right for everyone?: A qualitative study of the appropriateness of overdose response hotlines and applications for different subgroups of people who use substances

IntroductionOverdose response hotlines and apps are novel virtual harm reduction technologies that allow remote monitoring of individuals while they use substances (especially if they use alone) through electronic means. The authors explored partner perspectives to determine which groups of people who use substances (PWUS) these services would be most appropriate for, with the aim of better informing service providers on how to target their use to maximize benefit for clients. MethodsThe study conducted 64 semi-structured interviews with participants from a variety of backgrounds (individuals with lived or living experience of substance use, lay persons, health care providers, harm reduction workers, and operational experts). All information from interviews was kept confidential, de-identified, and stored on a secure server. Inductive thematic analysis identified major themes and subthemes. Two evaluators coded transcripts using Dedoose software. Once initial coding was complete, transcript coders selected quotes and shared them with a consulting project manager to cross-validate themes. The study conducted interviews until thematic saturation across all participants was reached based on the consensus of the two evaluators and the primary investigator. ResultsOverall, the study determined that overdose response hotlines and apps would potentially have at least some utility for any PWUS. However, some were found to have a varying level of appropriateness for specific subgroups of PWUS. There were 11 different subgroups identified in this study and of these subgroups, the majority were identified as groups for whom virtual harm reduction services would be appropriate interventions. ConclusionsOverdose response hotlines and apps are helpful and potentially life-saving adjunctive options which may be more appropriate for some subgroups of PWUS than others. These results may help service providers to target groups with the most potential to benefit.

Deep learning approaches for automated classification of neonatal lung ultrasound with assessment of human-to-AI interrater agreement

Neonatal respiratory disorders pose significant challenges in clinical settings, often requiring rapid and accurate diagnostic solutions for effective management. Lung ultrasound (LUS) has emerged as a promising tool to evaluate respiratory conditions in neonates. This evaluation is mainly based on the interpretation of visual patterns (horizontal artifacts, vertical artifacts, and consolidations). Automated interpretation of these patterns can assist clinicians in their evaluations. However, developing AI-based solutions for this purpose is challenging, primarily due to the lack of annotated data and inherent subjectivity in expert interpretations. This study aims to propose an automated solution for the reliable interpretation of patterns in LUS videos of newborns. We employed two distinct strategies. The first strategy is a frame-to-video-level approach that computes frame-level predictions from deep learning (DL) models trained from scratch (F2V-TS) along with fine-tuning pre-trained models (F2V-FT) followed by aggregation of those predictions for video-level evaluation. The second strategy is a direct video classification approach (DV) for evaluating LUS data. To evaluate our methods, we used LUS data from 34 neonatal patients comprising of 70 exams with annotations provided by three expert human operators (3HOs). Results show that within the frame-to-video-level approach, F2V-FT achieved the best performance with an accuracy of 77% showing moderate agreement with the 3HOs. while the direct video classification approach resulted in an accuracy of 72%, showing substantial agreement with the 3HOs, our proposed study lays down the foundation for reliable AI-based solutions for newborn LUS data evaluation.

Roles of Quiet in Health Care Organizations.

This anecdote of one regional academic health network's reputational demise suggests what might be learned about tendencies of undervaluing chaplaincy expertise, peace, and quiet in the everyday operations of professional caregiving.

A road map to manual segmentation of cerebral structures.

Manual segmentation is an essential tool in the researcher's technical arsenal. It is a frequent practice necessary for image analysis in many protocols, especially in neuroimaging and comparative brain anatomy. In the framework of emergence of studies focusing on alternative animal models, manual segmentation procedures play a critical role. Nevertheless, this critical task is often assigned to students, a process that, unfortunately, tends to be time-consuming and repetitive. Well-conducted and well-described segmentation procedures can potentially guide novice and even expert operators and enhance research works' internal and external validity, making it possible to harmonize studies and facilitate data sharing. Furthermore, recent advances in neuroimaging, such as exvivo imaging or ultra-high-field MRI, enable new acquisition modalities and the identification of minute structures that are barely visible with typical approaches. In this context of increasingly detailed and multimodal brain studies, reflecting on methodology is relevant and necessary. Because it is crucial to implement good practices in manual segmentation per se but also in the description of the segmentation procedures in research papers, we propose a general roadmap for optimizing the technique, its process and the reporting of manual segmentation. For each of them, the relevant elements of the literature have been collected and cited. The article is accompanied by a checklist that the reader can use to verify that the critical steps are being followed.

The prognostic value of contrast stress echocardiography in a real-world population of symptomatic patients without known coronary artery disease

Abstract Background Coronary artery disease (CAD) is the leading cause of mortality and morbidity worldwide. In addition to diagnosis, non-invasive tests may also provide prognostic information useful in the risk stratification and management of CAD patients. Stress echocardiography (SE) is an accurate, non-invasive method for the detection of obstructive CAD. However, in real-world clinical practice the test performance may vary among different centres, depending on availability, local protocols, and operator expertise. Purpose To evaluate the prognostic value of contrast SE in a real-world population of symptomatic patients without known CAD. Methods This was a cohort follow-up study of patients without known CAD and symptoms of atypical chest pain, unexplained dyspnoea or palpitations who were referred to the echocardiography lab of a tertiary hospital for SE between January 2020 and December 2021. Patients with resting regional wall motion abnormalities were excluded. All patients underwent treadmill exercise stress echocardiography (ESE) or dobutamine stress echocardiography (DSE) if unable to exercise. Contrast agents were used in almost all patients (99%). The study population was followed-up for at least 2 years after SE by phone and/or electronic hospital records. Cardiac outcome was defined as anatomically or functionally significant stenosis on angiography, revascularization, acute coronary syndrome (ACS), or cardiac-related death. Results The study comprised 266 patients (mean age 58±12 years, 63% male) who underwent either ESE (58%) or DSE (42%). The patients' details are reported in Table 1. The most common indication for the exam was atypical chest pain, with a prevalence of 73%. SE exams were positive for inducible ischaemia in 14 (5%) patients. Symptoms during the exam were present in 3 (21%) patients with positive SE and 4 patients (2%) with negative SE (p=0.004). No serious complications (sustained ventricular tachycardia, myocardial infarction, or death) were recorded. During the follow-up (median 30, IQR 23–38 months), 264 patients (99%) were successfully contacted. Cardiac outcome occurred in 10 patients. Among 14 patients with positive SE, 8 underwent revascularization due to significant coronary artery stenosis. Among 250 patients with negative SE, 1 underwent revascularization due to significant coronary artery stenosis and 1 presented with ACS 13 months after the test (both patients underwent DSE). Negative predictive value was 99% over a median follow-up of 30 months, corresponding to an annualized event rate of 0.32% per year. A positive SE was significantly associated with cardiac outcome (log-rank test p&amp;lt;0.0001, Figure 1). Conclusion Contrast SE carries significant prognostic implications in symptomatic patients without known CAD. A positive test is strongly associated with the need for revascularization, while a normal test result has an excellent negative predictive value regarding cardiovascular morbidity and mortality.Figure 1

2.F. Scientific session: Challenges in healthcare architectures

Abstract The Workshop titled “Challenges in healthcare architectures” - proposed and developed by the three EUPHA Section: Urban Public Health (URB), Public Mental Health (MEN) and Environmental Health (ENV) - is aimed to foster the dialogue between designers (architects and urban planners), Public Health experts (operators, professionals and epidemiologists), general/sanitary Directors of healthcare facilities and medical staff, to establish a multidisciplinary approach for understanding together how to create and manage the healthcare facilities of the future. According to the main Conference topic “Sailing the waves of European public health: exploring a sea of innovation”, the workshop mainly addresses both the “Health care services and systems” and the “Health workforce, practice and training” EPH24 conference topics. The Workshops purpose is to explore the concept for the hospital of the future, that should be resilient to changes and capable of protecting different users’ health and tackle the transforming social, economic, environmental and epidemiological needs of the context in which they are located. As in many other spheres and economic activities, the pandemic accelerated the processes of innovation and digitization that had somehow already been activated. The healthcare issue, the use of smart devices for a dialogue between the healthcare professionals and the pervasive use of apps to monitor certain health parameters, are just some of the megatrends that were being observed and which have now necessarily entered into everyday life. In the same way, the hospital, which in the face of this gradual process of dematerialization and relocation of ‘softer’ clinical-diagnostic activities, reaffirms itself as a center of the highest specialty for the treatment and care of acute patients, for high-level clinical and experimental re-search, for diagnostics and more complex operations. At the same time, and finally, the hospital is inserted in a territorial healthcare facilities network, that should be planned, designed, and managed. The workshop program includes inputs which they argue current experiences, emerging practices and scientific outcomes related to the hospital design, planning and management sphere, coming from four different European countries. From designing to managing practices, in “Hospital Design and planning in the line of Foresight of Health Needs” and in “Sustainability in the Next Generation Hospital”. From digitalization in national resilience experiences, in “Digital Health Spaces in the City of Lisbon. The Role of Digitalization in linking Boundaryless Hospitals and Smart Health Cities” to novel approaches for specific disease, in “Building bridges: mobile mental health care units in four European countries”. Key messages • Explore the “hospital of the future” concept, resilient to changes, capable of protecting users’ health, and to tackle the transforming social, economic, environmental and epidemiological needs. • Establish a multidisciplinary and territorial approach, for understanding together how to create and manage the healthcare network of the future.

8.F. Scientific session: Promoting Public Health with healthy smart buildings

Abstract The Workshop titled “Promoting Public Health with healthy smart buildings” - proposed and developed by the three EUPHA Section: Urban Public Health (URB), Public Mental Health (MEN) and Environmental Health (ENV) - is aimed to foster the dialogue between designers (architects and urban planners), Public Health experts (operators, professionals and epidemiologists), policy/decision makers and buildings’ users, to establish a multidisciplinary approach for understanding together how to create and manage healthy living indoor environments (both housing and complex constructions/public buildings). According to the main Conference topic “Sailing the waves of European public health: exploring a sea of innovation”, the workshop mainly addresses both the “Climate emergency/Environment and health/Urban health” and the “Mental health” EPH24 conference topics. The workshop purpose is to explore the effects of the housing conditions, according to “umbrella” exposure of the quality of the buildings, stressing topics like emissions, qualities, functional features, accessibility, supportive, Indoor Environmental Quality, Indoor Air Quality, and health implications on users’ well-being. In fact, time spent at home and in the indoor environment increased due to the COVID-19 experience, and social-sanitary emergencies are expected to grow due to the urbanization phenomenon. Thus, the role of the physical environment in which we live, study, and work, has become of crucial importance, as the literature has recently highlighted. The workshop program includes inputs which they argue current experiences, emerging practices and scientific outcomes related to the healthy Buildings, coming from four different European countries. From Sustainable Development Goals, in “Healthy air for healthy minds”, to Indoor Environmental Quality implications, in “How to promote health in indoor living and working spaces: quali-quantitative analysis to evaluate the indoor air quality through users’ perception and low-cost sensors”. From experience-based works related to specific functions, in “Leveraging digital platforms to improve Public Health in hospital smart buildings”, to other specific public buildings’ experiences, in “Novi Sad cultural stations as healthy buildings for wellbeing concept”. Key messages • explore the relationship between housing conditions, Indoor Environmental Quality, and the implications on users’ well-being, like “umbrella” exposure of the quality of the buildings. • establish a multidisciplinary approach for understanding together how to create and manage healthy living indoor environments, at private and public scale.

Combined ARNI and SGLT2i impacts on peak tricuspid regurgitant velocity and echocardiographic probability of pulmonary hypertension

Abstract Background In heart failure with reduced ejection fraction (HFrEF), the development of pulmonary hypertension (PH) is associated with poor prognosis. Recent medical advancements have substantially improved both survival rates and HF hospitalization. However, the impact of combining angiotensin receptor neprilysin inhibitor (ARNI) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) on peak tricuspid regurgitant velocity (TRV) and PH echocardiographic probability remains unexplored. Purpose We aimed to evaluate the effect of ARNI alone versus ARNI combined with SGLT2i on peak TRV and PH probability in a real-life population of outpatients with HFrEF. Methods This was an observational monocentric study including patients treated with either ARNI alone or with SGLT2i on top of ARNI. Echocardiographic examinations were performed by fully accredited operators and all parameters were analysed offline by expert operators blinded to clinical data. We performed echocardiographic evaluation in all patients before initiating treatment and at 12 months follow-up. We excluded patients who discontinued ARNI within 6 months of introduction and those who did not complete at least 6 months of follow-up with both drugs. Results 80 HFrEF patients were included, 41 receiving ARNI+SGLT2i and 39 receiving ARNI alone. Baseline mean peak TRV was similar between the two groups (280±44 cm/s and 259±48 cm/s respectively, p=0.09). At follow-up, mean peak TRV was 232±32 cm/s in ARNI+SGLT2i group and 258±45 cm/s in ARNI alone group (p=0.02). The decrease in peak TRV was significant in ARNI+SGLT2i group, p=0.0004 (Table). At baseline the echocardiographic probability of PH was comparable between both groups, p=0.53 (Figure). Nevertheless, during follow-up, the proportion of patients with high probability of PH decreased in the ARNI+SGLT2i group (from 22% to 2%), while in the ARNI alone group it did not change (Figure). Conclusions In HFrEF the combination of ARNI+SGLT2i demonstrates high effectiveness in TRV reduction, downgrading PH probability class. In our population, this evidence is primarily driven by the decrease TRV. These results may suggest the positive effect of SGLT2i on pulmonary vascular remodelling and right heart hemodynamic worth of full investigation in further studies aimed at targeting left-sided PH and its prevention strategies.

Modeling the operational and labor costs of autonomous robotaxi services

Autonomous vehicle (AV) companies are rolling out driverless taxi-type services in cities around the world, promising to enhance road safety, promote equity, and foster environmental sustainability while simultaneously threatening the jobs of current taxi and ride-hailing drivers. The potential impacts of these “robotaxi” services hinge upon not only whether AV technology becomes sufficiently performant, but also whether AV services become economically competitive. In this study, we develop ground-up cost models for a traditional taxi and a robotaxi service to compare their relative competitiveness. We draw on direct observations of commercially available robotaxi services, semi-structured interviews with AV operational and regulatory experts (N = 27), and archival documents to include the most detailed accounting of frontline robotaxi labor roles to date. We find that labor remains a significant cost for existing robotaxi services but that robotaxi operating costs are still lower than those of traditional taxi services. Ultimately, utilization rates and annual mileage will serve as the most influential factors for robotaxi competitiveness. Finally, if jobs shift from traditional taxi to robotaxi services, the total number of frontline jobs could decrease by between 57% and 76%, but the distribution of worker wages would shift higher. Transportation planners, researchers, and policymakers should continue accounting for labor costs in an AV future, as these costs will influence where AV deployment and job losses are (and are not) likely to occur, and should proactively investigate alternative career paths for potentially displaced frontline workers. Robotaxi costs are highly sensitive to lower labor ratios (i.e., fewer vehicles per worker), but firms reach economies of scale relatively quickly. Robotaxi firms should weigh marginal labor cost reductions against impacts to passengers and workers.

A high-fidelity personalised 3d printed simulator for the left atrial appendage occlusion procedure

Purpose This study aims to develop a realistic 3D printing-based simulator for the training and planning of the left atrial appendage occlusion (LAAO) to be used in the cath lab. Design/methodology/approach Starting from a pre-operative computed tomography dataset of a patient already treated with LAAO, the model was obtained, consisting in the right and left heart, opportunely assembled to replicate the position and orientation of the patient's anatomy while lying on the cath lab table. Different 3D printing techniques and materials were used to mimic the interaction between the cardiac tissue and the clinical instrumentation. The simulator was tested in the cath lab under proper image guidance by three LAAO expert operators. The clinicians were required to assign a score in terms of realism to each material used to fabricate the fossa ovalis and the LAA. Findings The simulated interventions were successfully performed by the operators, who were able to navigate in the system and release the occluder device as during a real procedure. The intraoperative images acquired during the simulations were highly comparable with data from a real intervention, with a mean percentage difference below 10%. Originality/value This study demonstrated the feasibility of the proposed simulator to faithfully replicate the LAAO procedure and its potentiality to be used for multiple purposes, including the training of the young clinicians, the evaluation of the most complicated cases and the design of novel occluder devices, in a fully realistic setting.

Fire management in the disaster prevention and mitigation division of lad luang municipality, phra pradaeng district, samut prakan province

This article aims to study the management of problems, obstacles, and suggest guidelines for the development of fire management in Lat Luang Municipality's public disaster prevention and relief work. Phra Pradaeng District Samut Prakan Province, sample group used in this study The total population was determined to be a sample of 50 people and a sample of 15 people was used to collect qualitative data. The researcher used quantitative and qualitative research processes. and collected data using questionnaires and in-depth interviews. The results of the research found that 1) Fire management of disaster prevention and relief work in Lat Luang Municipality. Phra Pradaeng District Samut Prakan Province as a whole is at a good level. 2) Guidelines for developing fire management of disaster prevention and relief work in Lat Luang Municipality. Phra Pradaeng District Samut Prakan Province: There should be a situation commander with specific knowledge and expertise in direct disaster prevention and relief operations. Including creating awareness for the people to be aware and participate in fire prevention in the community. Promote participation and integration of all sectors in management, including the public and private sectors, the public, volunteer foundations and training centers. And there should be sufficient budget support for all sectors to participate in sustainable disaster prevention and relief.

A simple method to identify implant sites in totally edentulous arches: a pilot study with thermo-printed templates used with cone beam computed tomography.

All dental implants must be placed following radiological, clinical and aesthetic indications in compliance with prosthetic principles avoiding iatrogenic damage to patients. In implantology, among the key choices, to obtain predictable results, it is essential to establish (by cone beam computed tomography [CBCT]) the sites where to insert the implants; these sites must be identified, during the surgical phase, in the oral cavity. Surgical guides represent a valid aid especially in complex cases that require multiple implants. For some clinical conditions, expert operators choose the free hand technique during which identifying the chosen implant sites on CBCT in the oral cavity is more difficult. This experimental study is based on the use of thermo-molded mask as an alternative to surgical guides when the freehand technique is adopted in totally edentulous patients. These innovative masks, containing radiopaque references, are initially worn by patients during the execution of the CBCT, and later during surgery to identify the implant sites in the oral cavity. The procedure described proved to be very useful and able to increase the precision of the freehand technique even if it does not provide information on the inclination of the implants. The metal references help clinical identification of the implant site. Our thermo-molded masks, in particular clinical conditions, could represent a valid and economical alternative to the classic surgical guide. The described procedure does not increase costs for the patient and significantly increases the precision in inserting the implants during free-hand techniques.