Face Of Patient Research Articles

Contamination of multiuse eyedrop bottles by exhaled air from patients wearing face masks during the COVID-19 pandemic: Schlieren imaging analysis.

To determine whether mask-induced redirected exhaled air through the superior mask gap contacts multiuse eyedrop bottles during drop administration and the efficacy of interventions to reduce such exposure. Academic ophthalmology center. Interventional analysis. Schlieren airflow imaging was taken of an examinee wearing frequently used face masks and enacting common clinical scenarios-with and without manual occlusion of the superior mask gap and/or neck extension-and maximum visible vertical breath plume height was quantified. Bottle height during eyedrop administration was measured for 4 ophthalmologists during instillation to 8 eyes of 4 subjects. Breath plume height (mean ± SD 275.5 ± 16.3 mm) was significantly greater than mean bottle height (13.9 ± 4.7 mm; P < .01). Plume height was reduced with manual mask occlusion vs without (P < .01) and was also lower than mean bottle height with manual mask occlusion (P < .01) but not in the absence of occlusion (P < .01). Neck extension alone did not adequately redirect liberated breath to prevent contact with a bottle. Exhaled air liberated from commonly worn patient face masks was able to contact multiuse eyedrop bottles during eyedrop administration. These findings have important patient safety implications during the coronavirus disease 2019 pandemic and with other respiratory pathogens because these multiuse bottles could potentially serve as vectors of disease. Occlusion of the superior mask gap significantly reduces breath contamination and should be strongly considered by eyecare providers during drop administration in eye clinics.

Automatic detection of basal cell carcinoma by hyperspectral imaging.

The purpose of this study was to test the ability of hyperspectral imaging (HSI) combined with unsupervised anomaly detectors to automatically differentiate basal cell carcinoma (BCC) from normal skin. Hyperspectral images of the face of a female patient with a BCC of the lower lip were acquired using a visible/near-infrared HSI system and two anomaly detection algorithms (Reed-Xiaoli and Reed-Xiaoli/Uniform Target hybrid anomaly detectors) were used to detect pathological tissue from normal skin. The results revealed that the receiver operating characteristic curve of the Reed-Xiaoli/Uniform Target hybrid detector was higher than that of the Reed-Xiaoli detector in the range of false positive rates between 0 and 0.8. The area under curve values were good (0.7074 and 0.8607, respectively) with Reed-Xiaoli/Uniform Target hybrid detector performing better. In conclusion, HSI combined with either of two anomaly detectors can play a promising role in the automated screening of BCC.

Impact of patient face mask use on endophthalmitis after intravitreal anti-VEGF injections

ObjectiveTo compare the incidence of endophthalmitis after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections with and without patient face masking. DesignTwo-centre retrospective cohort study ParticipantsPatients receiving a total of 28 501 injections (period 1 before masking: n = 13 863; period 2 after masking: n = 14 638) MethodsPeriods before and after implementation of patient masking were compared: period 1 (July–December 2019) and period 2 (July–December 2020). All patients requiring treatment for endophthalmitis following intravitreal anti-VEGF injections were reviewed. Endophthalmitis risks were compared. Statistical simulations were run to determine the number of injections or endophthalmitis cases required to detect a statistically significant difference between both periods. ResultsFive patients (0.036%) had endophthalmitis in period 1 compared with 7 patients (0.048%) in period 2. Odds ratio, 95% confidence interval, for risk of patient masking was 1.326, 0.421–4.179 (p = 0.63). Three patients (0.022%) in period 1 had culture-positive endophthalmitis compared with 2 patients (0.014%) in period 2. Risk of patient masking for culture-positive endophthalmitis was 0.631, 0.105–3.779 (p = 0.61). Assuming similar rates of endophthalmitis, 476,806 injections in both groups would be required to detect a significant difference. Alternatively, assuming that masking would increase endophthalmitis risk in period 2, a significant difference would require twice as many cases (n = 15, 0.102%) for a risk of 2.843, 1.033–7.825 (p = 0.043). ConclusionsThe implementation of patient masking in clinical practice did not significantly alter the rate of endophthalmitis following intravitreal anti-VEGF injections.

A Theory of Social Agency for Human-Robot Interaction.

Motivated by inconsistent, underspecified, or otherwise problematic theories and usages of social agency in the HRI literature, and leveraging philosophical work on moral agency, we present a theory of social agency wherein a social agent (a thing with social agency) is any agent capable of social action at some level of abstraction. Like previous theorists, we conceptualize agency as determined by the criteria of interactivity, autonomy, and adaptability. We use the concept of face from politeness theory to define social action as any action that threatens or affirms the face of a social patient. With these definitions in mind, we specify and examine the levels of abstraction most relevant to HRI research, compare notions of social agency and the surrounding concepts at each, and suggest new conventions for discussing social agency in our field.

B-PO03-186 MONITORING ATRIAL FIBRILLATION PATIENTS USING ACTIVE CONTACTLESS VIDEOPLESTHYMOGRAPHY IMPLEMENTED ON A PERSONAL TABLET

Early detection of subclinical AF can help prevent significant complications such as embolic stroke, heart failure, and AF-related hospitalizations. We evaluated the performance of a facial pulsation detection video technology called videoplethysmography (VPG) to detect the presence of AF using a monitoring method that does not require a dedicated sensor and/or cumbersome recording procedures. We enrolled patients with AF undergoing either cardioversion or ablation therapy. Patients were asked to collect two 25-sec video recordings daily using a smart tablet loaded with the VPG technology. Early recurrence of AF during the 15-day follow-up period was based on continuous ECG recording (14-day patch monitor). ECGs were manually annotated for the presence of AF episodes lasting >15-sec in duration. The VPG algorithm measured pulse irregularity and was designed to minimize false positive detections. Development and validation were performed on independent datasets (½ split without a subject in common). We report the specificity, sensitivity, and accuracy of the video-based method to detect early recurrence of AF during the follow-up period. The motion of the patient's face was tracked, but no feedback was provided to the subjects during the measurement. We enrolled 112 patients (age: 65∓9 years, 81 men) over an 18 month period. Five subjects did not collect any quality data while 107 patients collected 7∓5 minutes of data on average at home (min:30sec, max: 25min) over 12∓3 days (min:1.5, max:14.7 days). Thirty subjects (28%) experienced at least one 15-sec AF episode post-procedure. The sensitivity and specificity of the AF detection algorithm based on a total duration of 7 min. of video recordings, over 12 days were 33% and 95% in the validation dataset (accuracy: 74%). Less than one-minute daily monitoring using a contactless VPG method can detect AF in one-third of patients experiencing an early recurrence of AF with a 5% false-positive rate. The sensitivity of the VPG method is expected to increase with a larger number of daily VPG recordings.

Handling Errors in the Use of Inhalation Devices: Inhalation Technique Skills and Knowledge in Pediatric Nurses.

Children suffering from bronchial diseases need assistance from nurses in the use of inhalation devices. We aimed to assess nurses' skills and knowledge concerning drug administration with inhalation devices in hospitalized pediatric patients. An expert panel defined medication errors in drug administration with inhalation devices in children. We monitored 241 inhalation procedures to investigate nurses' inhalation technique skills. Twenty-nine nurses completed a questionnaire to assess nurses' knowledge. Skills: In 93 of 241 (39%) inhalation procedures, the mask/mouthpiece did not fit airtight. In none of the 11 inhalations administering a glucocorticoid, the patient's mouth was thoroughly cleaned afterward. Knowledge: Ten of 29 nurses (34%) thought a distance between mask and the patient's face was acceptable. Only 16 of 29 (55%) knew that it is necessary to thoroughly clean the patient's mouth after the inhalation of budesonide. We found that education on inhalation procedures including practical training is required to increase patient safety.

IMPORTANCE OF CAD/CAM TECHNOLOGIES IN ECTOPROSTHETICS OF THE MAXILLOFACIAL AREA (LITERATURE REVIEW)

Relevance. In patients suffering from defects in the organs of the maxillofacial region, often the most acute problem is not so much the problem of dysfunction, but rather unsatisfactory aesthetics. The loss of a particular organ of the maxillofacial region leads in many cases to become the cause of persistent disorders on the part of psychoemotional problems [1–3]. In the modern world, the face is the main "visiting card" of a person, most attracting attention from the people around him. The presence of one or another defect in the maxillofacial region forms a number of psychological problems in the patient, causing a feeling of shame from his inferior appearance. Materials and methods. The literature analysis of the applied methods of ectoprosthetics in the maxillofacial region was carried out. Results and discussion . Comparing the traditional and computer methods of making facial epitheses, one should note a common similarity – the laboriousness of the process, which requires an excellent understanding of the anatomy of the maxillofacial region, fluency in computer software. Having analyzed a large amount of foreign literature, I would like to emphasize that the success of the performed ectoprosthetics largely depends on a clear and complete visualization of the clinical picture as a whole, without focusing on a specific organ. This is the key condition for creating a harmonious aesthetics of the face and the entire appearance of the patient after the treatment as a whole. The restored harmonious appearance of the patient's face will allow for faster adaptation in society. Currently, it is not possible to unambiguously determine the best method. A decrease in the speed of production and the optional availability of medical education, according to a number of authors [4, 5, 16, 18, 19], are the motive for the choice and widespread introduction of CAD/CAM technologies, while some scientists [28] doubt their effectiveness. However, it is worth remembering that the result of the treatment is important for the patient, not the method itself, and only this is the result of his final assessment.

IMPORTANCE OF CAD/CAM TECHNOLOGIES IN ECTOPROSTHETICS OF THE MAXILLOFACIAL AREA (LITERATURE REVIEW)

Relevance. In patients suffering from defects in the organs of the maxillofacial region, often the most acute problem is not so much the problem of dysfunction, but rather unsatisfactory aesthetics. The loss of a particular organ of the maxillofacial region leads in many cases to become the cause of persistent disorders on the part of psychoemotional problems [1–3]. In the modern world, the face is the main "visiting card" of a person, most attracting attention from the people around him. The presence of one or another defect in the maxillofacial region forms a number of psychological problems in the patient, causing a feeling of shame from his inferior appearance. Materials and methods. The literature analysis of the applied methods of ectoprosthetics in the maxillofacial region was carried out. Results and discussion . Comparing the traditional and computer methods of making facial epitheses, one should note a common similarity – the laboriousness of the process, which requires an excellent understanding of the anatomy of the maxillofacial region, fluency in computer software. Having analyzed a large amount of foreign literature, I would like to emphasize that the success of the performed ectoprosthetics largely depends on a clear and complete visualization of the clinical picture as a whole, without focusing on a specific organ. This is the key condition for creating a harmonious aesthetics of the face and the entire appearance of the patient after the treatment as a whole. The restored harmonious appearance of the patient's face will allow for faster adaptation in society. Currently, it is not possible to unambiguously determine the best method. A decrease in the speed of production and the optional availability of medical education, according to a number of authors [4, 5, 16, 18, 19], are the motive for the choice and widespread introduction of CAD/CAM technologies, while some scientists [28] doubt their effectiveness. However, it is worth remembering that the result of the treatment is important for the patient, not the method itself, and only this is the result of his final assessment.

Deviation from Clinical Routines Can Reveal Sources of Device Design Vulnerability

The ability to adequately ventilate a patient is critical and sometimes a challenge in the emergency, intensive care, and anesthesiology settings. Commonly, initial ventilation is achieved through the use of a face mask in conjunction with a bag that is manually squeezed by the clinician to generate positive pressure and flow of air or oxygen through the patient's airway. Large or small erroneous openings in the breathing circuit can lead to leaks that compromise ventilation ability. Standard procedure in anesthesiology is to check the circuit apparatus and oxygen delivery system prior to every case. Because the face mask itself is not a piece of equipment that is associated with a source of leak, some common anesthesia machine designs are constructed such that the circuit is tested without the mask component. We present an example of a leak that resulted from complete failure of the face mask due to a tiny tear in its cuff by the patient's sharp teeth edges. This subsequently prevented formation of a seal between the face mask and the patient's face and rendered the device incapable of generating the positive pressure it is designed to deliver. This instance depicts the broader lesson that deviation from clinical routines can reveal unappreciated sources of vulnerability in device design.

Real-time imaging of airflow patterns and impact of infection control measures in ophthalmic practice: a pandemic perspective.

To analyze exhaled airflow patterns in a clinical scenario and the impact of infection control practices and room air circulation in context of the COVID-19 pandemic. Raghudeep Eye Hospital, India. Experimental study. Ten patients attending ophthalmic outpatient clinic (OPD) and operating room (OR) were included. Using Schlieren imaging, exhaled airflow patterns were documented with/without an N95 mask or face shield during respiratory activities. Recordings were performed with and without room air conditioning turned on. Exhaled airflow patterns in OPD and OR when using vs not using these infection control measures and the impact of room air circulation on these were compared. Five patients each in OPD and OR were included. There was a forward stream of exhaled air from the patient's mouth/nose during all respiratory activities. An N95 mask dampened its intensity and forward transmission. Taping the mask around the nasal bridge further reduced airflow leakage. A mechanical barrier in front of the patient's face blocked forward propagation of the exhaled airflow. Turning on a forceful and direct draft of air over the surgeon's working area dampened and diverted the exhaled airflow away from the surgeons' breathing area. This effect was particularly pronounced in the OR, with the overhead laminar airflow. Using high force airflow with the draft facing downward can dampen and divert the exhaled airflow away from healthcare providers. Using masks/mechanical barriers and taping the mask reduces potential dissemination of aerosols and, thereby, human and surface contamination.

Deviation from Clinical Routines Can Reveal Sources of Device Design Vulnerability.

The ability to adequately ventilate a patient is critical and sometimes a challenge in the emergency, intensive care, and anesthesiology settings. Commonly, initial ventilation is achieved through the use of a face mask in conjunction with a bag that is manually squeezed by the clinician to generate positive pressure and flow of air or oxygen through the patient's airway. Large or small erroneous openings in the breathing circuit can lead to leaks that compromise ventilation ability. Standard procedure in anesthesiology is to check the circuit apparatus and oxygen delivery system prior to every case. Because the face mask itself is not a piece of equipment that is associated with a source of leak, some common anesthesia machine designs are constructed such that the circuit is tested without the mask component. We present an example of a leak that resulted from complete failure of the face mask due to a tiny tear in its cuff by the patient's sharp teeth edges. This subsequently prevented formation of a seal between the face mask and the patient's face and rendered the device incapable of generating the positive pressure it is designed to deliver. This instance depicts the broader lesson that deviation from clinical routines can reveal unappreciated sources of vulnerability in device design.

The Influence of Universal Face Mask Use on Endophthalmitis Risk after Intravitreal Anti–Vascular Endothelial Growth Factor Injections

PurposeRoutine use of face masks for patients and physicians during intravitreal anti–vascular endothelial growth factor (VEGF) injections has increased with the emergence of the coronavirus disease 2019 pandemic. This study evaluates the impact of universal face mask use on rates and outcomes of post-injection endophthalmitis (PIE).DesignRetrospective, multicenter, comparative cohort study.ParticipantsEyes receiving intravitreal anti-VEGF injections from October 1, 2019, to July 31, 2020, at 12 centers.MethodsCases were divided into a “no face mask” group if no face masks were worn by the physician or patient during intravitreal injections or a “universal face mask” group if face masks were worn by the physician, ancillary staff, and patient during intravitreal injections.Main Outcome MeasuresRate of endophthalmitis, microbial spectrum, and visual acuity (VA).ResultsOf 505 968 intravitreal injections administered in 110 547 eyes, 85 of 294 514 (0.0289%; 1 in 3464 injections) cases of presumed endophthalmitis occurred in the “no face mask” group, and 45 of 211 454 (0.0213%; 1 in 4699) cases occurred in the “universal face mask” group (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.51–1.18; P = 0.097). In the “no face mask” group, there were 27 cases (0.0092%; 1 in 10 908 injections) of culture-positive endophthalmitis compared with 9 cases (0.004%; 1 in 23 494) in the “universal face mask” group (OR, 0.46; 95% CI, 0.22–0.99; P = 0.041). Three cases of oral flora–associated endophthalmitis occurred in the “no face mask” group (0.001%; 1 in 98 171 injections) compared with 1 (0.0005%; 1 in 211 454) in the “universal face mask” group (P = 0.645). Patients presented a mean (range) 4.9 (1–30) days after the causative injection, and mean logarithm of the minimum angle of resolution (logMAR) VA at endophthalmitis presentation was 2.04 (~20/2200) for “no face mask” group compared with 1.65 (~20/900) for the “universal face mask” group (P = 0.022), although no difference was observed 3 months after treatment (P = 0.764).ConclusionsIn a large, multicenter, retrospective study, physician and patient face mask use during intravitreal anti-VEGF injections did not alter the risk of presumed acute-onset bacterial endophthalmitis, but there was a reduced rate of culture-positive endophthalmitis. Three months after presentation, there was no difference in VA between the groups.

Custom-made 3D printed masks for children using non-invasive ventilation: a comparison of 3D scanning technologies and specifications for future clinical service use, guided by patient and professional experience

Non-invasive ventilation (NIV) is assisted mechanical ventilation delivered via a facemask for people with chronic conditions that affect breathing. Mass-produced masks are available for both the adult and paediatric markets but masks that fit well are difficult to find for children who are small or have asymmetrical facial features. A good fit between the mask and the patient's face to minimise unintentional air leakage is essential to deliver the treatment effectively. We present an innovative use of 3D assessment and manufacturing technologies to deliver novel custom-made facemasks for children for whom a well-fitting standard mask is not available. This paper aims to describe the processes undertaken to investigate and compare currently available technologies for 3D scanning children and to explore the design of a system for creating custom-made paediatric NIV masks within the NHS. The paper therefore considers not only the quality and accuracy of the data, but also other factors such as the time and ease of process. Searches for all currently available scanning technologies were made. Photogrammetry image stitch using a smartphone and a digital camera, and two structured light scanners were selected and compared in the laboratory, in discussion with user groups, and in adult volunteers. Using the processes described, it became apparent that the optimal 3D scanning system for this purpose was the handheld structured light scanner. This option offered both superior accuracy and convenience and was more cost effective.

A Guide to Doppler Ultrasound Analysis of the Face in Cosmetic Medicine. Part 1: Standard Positions.

Interest in Doppler ultrasound (DUS) analysis of the face has grown in cosmetic medicine, in particular for injectable fillers. When dealing with complications, DUS has the advantage of easily visualizing the filler and identifying the problem in relation to the patient's anatomy. When working with hyaluronic acid filler, ultrasound-guided injections with hyaluronidase can precisely target the problem. In addition, DUS can be used to study the anatomy of a patient, specifically to prevent intravascular injections. We predict that in a few years' time DUS will become standard equipment in the offices of cosmetic doctors. We discuss the basics of ultrasound imaging of different tissues with the concomitant terminology. With the use of 7 basic DUS probe positions, key anatomic reference points can be easily found. From these, all relevant anatomic structures in the face can be observed and analyzed. With some practice, physicians will ultimately be able to acquire a complete 3-dimensional mental image of a patient's face.

Efficacy of Platelet Rich Plasma in Treatment of Acne Scars

History: Scarring is a typical consequence of acne vulgaris; acne scarring frequently takes place on the face leading to psychological trauma and social impairment, particularly nowadays when a self-confident appearance is very necessary with all those cosmetic methods. The aim of the work is to estimate the effectiveness of plasma-rich platelet injection in atrophic scar patients. Methods: PRP injection was compared to the left side of the same patient's face for the therapy of acne scars by 2 sessions – one month apart. The research includes 20 participants, and follow-up photographs (pre- and post-treatment) before 1 month after the last session. The evaluation was carried out with the use of the qualitative and quantitative scar method. Results & Conclusion: major improvements have been made on the right side (PRP side).

MorphFace: A Hybrid Morphable Face for a Robopatient

Physicians use pain expressions shown in a patient's face to regulate their palpation methods during physical examination. Training to interpret patients’ facial expressions with different genders and ethnicities still remains a challenge, taking novices a long time to learn through experience. This letter presents MorphFace: a controllable 3D physical-virtual hybrid face to represent pain expressions of patients from different ethnicity-gender backgrounds. It is also an intermediate step to expose trainee physicians to the gender and ethnic diversity of patients. We extracted four principal components from the Chicago Face Database to design a four degrees of freedom (DoF) physical face controlled via tendons to span <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$\sim\!85\%$</tex-math></inline-formula> of facial variations among gender and ethnicity. Details such as skin colour, skin texture, and facial expressions are synthesized by a virtual model and projected onto the 3D physical face via a front-mounted LED projector to obtain a hybrid controllable patient face simulator. A user study revealed that certain differences in ethnicity between the observer and the MorphFace lead to different perceived pain intensity for the same pain level rendered by the MorphFace. This highlights the value of having MorphFace as a controllable hybrid simulator to quantify perceptual differences during physician training.

Confidentiality and Conflicts of Interest: An Assessment of Twitter Posts in Gastrointestinal Endoscopy.

To evaluate compliance with confidentiality and conflicts of interest (COI) in tweets sharing gastrointestinal (GI) endoscopy videos/images. Physicians' tweets containing GI endoscopy videos/images were assessed for confidentiality and COI compliance. Identifiable details in tweets included procedure date (17.9%), date of birth (0.8%), and patient's face visible (0.5%). Ninety-five tweets (10%) mentioned the name/brand of a medical device. Of the 19 posted by US physicians, 7 came from physicians who had received payments from the device manufacturer. None of these physicians disclosed relevant COI. GI endoscopy tweets describing clinical cases or procedures may insufficiently address issues of confidentiality and COI.

Fractional erbium: YSGG laser compared to the combination of fractional erbium: YSGG laser and topical autologous platelet-rich plasma for treatment of atrophic acne scars: a case report

Background: Acne scar is the most common complication in acne that occurs in about 49% of acne individuals. Fractional resurfacing lasers such as CO2 laser and erbium-doped yttrium aluminum garnet (Er: YAG) have been widely used for acne scar treatment and give satisfying results have complications such as pain, hyperpigmentation, infection, prolonged erythema, and scarring. Fractional erbium: yttrium scandium gallium garnet (Er: YSGG) laser solves previous laser techniques' disadvantages. It has an ideal wavelength of 2790 nm, which balances the epidermis layer's vaporization and thermal damage in the dermis's superficial layer. Platelet Rich Plasma (PRP) is an autologous concentration of human platelets in a small plasma volume that secreted various growth factors that can speed up the scar healing process.Case report: A-24 years old male student came with a chief complaint of acne scars on his face four years before the examination. The patient's condition is classified as moderate-severe acne scarring based on Goodman and Baron's criteria (qualitative global acne scarring system). Acne scars treatment plan was single fractional erbium: YSGG laser for the left side of the face and combined fractional Er: YSGG laser with topical autologous PRP on the right side. This procedure was performed in 2 sessions with an interval of 4 weeks, the final evaluation at 12 weeks after the first procedure. Clinical improvement of acne scars was assessed using qualitative and quantitative scales based on Goodman and Baron's, patient and observer scar assessment scale (POSAS), quartile grading scale, and patient satisfaction level.Conclusion: In the final evaluation, there was an improvement on the entire grading scale on the right side of the face (Er: YSGG laser + PRP) and the face's left side (Er: YSGG laser only). Post-treatment erythema was found on both sides of the patient's face but disappeared within three days on the face's right side and five days on the face's left side.

FDA Reminder: Metal Hazards in Patient Face Masks During MRI Examinations

Biomedical Safety & Standards: March 01, 2021 - Volume 51 - Issue 4 - p 25-26 doi: 10.1097/01.BMSAS.0000734700.43820.3a

Pyoderma Gangrenosum of the Chest Wall in a Male Patient with Ulcerative Colitis

Ulcerative colitis, an inflammatory bowel disease, often exhibits extra-intestinal manifestations including various dermatological problems. Pyoderma gangrenosum (PG) is a painful ulcerative cutaneous disorder characterized by the development of rapidly enlarging nodules. The lesion may become aggravated when ulcerative colitis is active, and it commonly affects the extensor surfaces of the lower extremities but rarely the upper extremities, face, periauricular area, anterior chest, back, or buttocks. We encountered a rare case of PG of the chest wall near the left breast, on the face and pretibial area of a male patient with ulcerative colitis. He had not undergone breast surgery and had no history of trauma. The lesion and symptoms were successfully treated by steroid and mesalazine; there was no need for surgery or more potent drugs.