A New Device to Automate the Monitoring of Critical Patients’ Urine Output

Urine output (UO) is usually measured manually each hour in acutely ill patients. This task consumes a substantial amount of time. Furthermore, in the literature there is evidence that more frequent (minute-by-minute) UO measurement could impact clinical decision making and improve patient outcomes. However, it is not feasible to manually take minute-by-minute UO measurements. A device capable of automatically monitoring UO could save precious time of the healthcare staff and improve patient outcomes through a more precise and continuous monitoring of this parameter. This paper presents a device capable of automatically monitoring UO. It provides minute by minute measures and it can generate alarms that warn of deviations from therapeutic goals. It uses a capacitive sensor for the measurement of the UO collected within a rigid container. When the container is full, it automatically empties without requiring any internal or external power supply or any intervention by the nursing staff. In vitro tests have been conducted to verify the proper operation and accuracy in the measures of the device. These tests confirm the viability of the device to automate the monitoring of UO.

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ALK inhibitors, resistance development, clinical trials

Current Oncology ◽

10.3747/co.25.3760 ◽

2018 ◽

Vol 25 ◽

pp. 59 ◽

Cited By ~ 22

Author(s):

J.M. Rothenstein ◽

N. Chooback

Keyword(s):

Clinical Trials ◽

Patient Outcomes ◽

Clinical Decision Making ◽

Clinical Decision ◽

Current Treatment ◽

Resistance Development ◽

Ongoing Research ◽

Alk Positive ◽

Emergence Of Resistance ◽

Key Questions

The treatment of advanced non-small-cell lung cancer (nsclc) has undergone a paradigm shift since the early 2000s. The identification of molecular subtypes of the disease, based on oncogenic drivers, has led to the development of personalized medicine and the ability to deliver molecularly targeted therapies to patients. In the 10 years that have elapsed since the discovery of the ALK gene in a patient with nsclc, several active drugs have moved rapidly from bench to bedside, and multiple others are currently in clinical trials. Those developments have led to important improvements in patient outcomes, while simultaneously raising key questions about the optimal treatment for ALK-positive nsclc. The inevitable emergence of resistance to alk-directed therapy is central to ongoing research and daily clinical practice for affected patients. In the present review, we highlight the current treatment landscape, the available and emerging clinical trials, and the evolving clinical decision-making in ALK-positive nsclc, with a focus on Canadian practice.

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Establishment and Preclinical Application of Conditional Reprogramming Culture System for Laryngeal and Hypopharyngeal Carcinoma

10.21203/rs.3.rs-274002/v1 ◽

2021 ◽

Author(s):

Yanbo DONG ◽

Jian WANG ◽

Wei JI ◽

Mengzhu ZHENG ◽

Peng WANG ◽

...

Keyword(s):

Anticancer Drugs ◽

Drug Testing ◽

Clinical Decision Making ◽

Cell Model ◽

Clinical Decision ◽

Culture Technique ◽

Hypopharyngeal Carcinoma ◽

Molecular Characteristics ◽

Drug Responses

Abstract Purpose Management of laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC) remains highly challenging due to their anatomic location and highly variable therapeutic responses. We aim to establish a new in vitro model for LHSCC based on conditional reprogramming (CR), a novel cell-culture technique, and investigate its potential value on personalized cancer therapies. Methods Primary LHSCC cells were isolated from tumor specimens and cultured under CR conditions. The characteristics and malignant potential of cells were evaluated by histological staining, whole-exome sequencing and heterotransplantation. The responses of CR tumor cells to anticancer drugs and radiotherapy were tested using cell proliferation assay. CR cells could form xenografts and organoids, which were used for drug testing respectively. Clinical responses for certain patients were also compared with in vitro responses. Results A panel of 28 human LHSCC CR cells were established from 50 tumor tissues. They retain tumorigenic potential upon xenotransplantation and recapitulate molecular characteristics of LHSCC. Differential responses to anticancer drugs and radiotherapy were detected in vitro. CR cells can be transformed to xenograft and organoid, shared comparable drug responses. The clinical drug responses were consistent with in vitro drug responses. Conclusions The patient-derived CR cell model could promisingly be utilized in clinical decision-making and assist in the selection of personalized therapies for LHSCC.

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The Evolving Reduction of Vancomycin and Daptomycin Susceptibility in MRSA—Salvaging the Gold Standards with Combination Therapy

Antibiotics ◽

10.3390/antibiotics9110762 ◽

2020 ◽

Vol 9 (11) ◽

pp. 762

Author(s):

Taylor Morrisette ◽

Sara Alosaimy ◽

Jacinda C. Abdul-Mutakabbir ◽

Razieh Kebriaei ◽

Michael J. Rybak

Keyword(s):

Combination Therapy ◽

Patient Outcomes ◽

Treatment Option ◽

Standard Treatment ◽

Primary Treatment ◽

Alternative Approach ◽

Improve Patient ◽

Substantial Morbidity

Methicillin-resistant Staphylococcus aureus (MRSA) is associated with substantial morbidity and mortality. Vancomycin (VAN) has been used as the gold standard treatment for invasive MRSA infections for decades but, unfortunately, the reliance of VAN as the primary treatment option against these infections has led to a reduction in VAN susceptibility in MRSA isolates. Although daptomycin (DAP) is another common treatment option against invasive MRSA infections, it has been shown that the development of VAN resistance can lead to DAP nonsusceptibility. VAN or DAP backbone regimens in combination with other antibiotics has been advocated as an alternative approach to improve patient outcomes in VAN/DAP-susceptible infections, enhance outcomes in infections caused by isolates with reduced VAN/DAP susceptibility, and/or prevent the emergence of VAN/DAP resistance or further resistance. A peer-reviewed literature search was conducted using Medline, Google Scholar and PubMed databases. The primary purpose of this review is to describe the mechanisms and epidemiology of MRSA isolates with a reduction in VAN and/or DAP susceptibility, evaluate in vitro and in vivo literature describing combination therapy (CT) against MRSA isolates with reduced VAN and/or DAP susceptibility and describe studies involving the clinical outcomes of patients treated with CT against invasive MRSA infections.

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Dantrolene in the treatment of MDMA-related hyperpyrexia: a systematic review

CJEM ◽

10.1017/s1481803500012598 ◽

2010 ◽

Vol 12 (05) ◽

pp. 435-442 ◽

Cited By ~ 38

Author(s):

Brian E. Grunau ◽

Matthew O. Wiens ◽

Jeffrey R. Brubacher

Keyword(s):

Systematic Review ◽

Clinical Decision Making ◽

Case Reports ◽

Data Extraction ◽

Patient Characteristics ◽

Clinical Decision ◽

Poison Control ◽

Published Data ◽

Published Evidence

ABSTRACTObjective:The use of dantrolene in the treatment of hyperpyrexia related to MDMA (3,4-methylenedioxymethamphetamine) is controversial, with little data available to guide clinical decision-making. Although the treatment is recommended by several poison control centres, published data are primarily in the form of case reports and animal and in vitro experiments. We conducted a systematic review to investigate the published evidence regarding the safety and benefits of dantrolene for MDMA-related hyperpyrexia in humans.Data sources:A systematic search of Embase and MEDLINE was conducted from the earliest possible date to November 2008.Study selection:All human trials and case reports of MDMA-related hyperpyrexia were considered.Data extraction:Data were abstracted systematically and characteristics including use of dantrolene, adverse reactions attributed to dantrolene, peak temperature, complications from MDMA-related hyperpyrexia and survival were recorded.Data synthesis:Our search yielded 668 articles of which 53, reporting 71 cases of MDMA-induced hyperpyrexia, met our inclusion criteria. No clinical trials, randomized controlled trials, observational studies or meta-analyses were identified. Dantrolene was used in 26 cases. Patient characteristics were similar in the dantrolene and no dantrolene groups. The proportion of survivors was higher in the dantrolene group (21/26) than in the no dantrolene group (25/45). This difference was especially pronounced in those with extreme (≥ 42°C) and severe (≥ 40°C) fever, with a survival rate of 8 of 13 and 10 of 10, respectively, in the dantrolene group compared with 0 of 4 and 15 of 27 in the no dantrolene group. There were no reports of adverse events attributable to dantrolene with the exception of a possible association with an episode of transient hypoglycemia.Conclusion:Our systematic review suggests that dantrolene is safe for patients with MDMA-related hyperpyrexia. Dantrolene may also be associated with improved survival and reduced complications, especially in patients with extreme (≥ 42°C) or severe (≥ 40°C) hyperpyrexia, although this conclusion must be interpreted with caution given the risk of reporting or publication bias.

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THE VALUE OF IN VITRO DIAGNOSTIC TESTING IN THE PROVISION OF MEDICAL CARE TO ELDERLY PATIENTS WITH CARDIOVASCULAR DISEASES

Russian Clinical Laboratory Diagnostics ◽

10.18821/0869-2084-2020-65-3-191-196 ◽

2020 ◽

Vol 65 (3) ◽

pp. 191-196

Author(s):

A. S. Pushkin ◽

O. V. Lyang ◽

T. A. Ahmedov ◽

S. A. Rukavishnikova

Keyword(s):

Decision Making ◽

Medical Care ◽

Laboratory Tests ◽

Clinical Decision Making ◽

Diagnostic Testing ◽

Clinical Decision ◽

Initial Examination ◽

Attending Physicians ◽

The Impact

In vitro diagnostics are used at all stages of patient care. The aim of this study was to assess the impact of laboratory examination on clinical decision-making in providing medical care to patients with a cardiovascular profile. We also took into account the level of financing for the laboratory industry in the Russian Federation. We divided our study on three sequential steps: literature review, survey of clinicians and test-survey of clinicians. The share of costs for the laboratory tests in 2017 amounted to about 8% of the total funding for Russian health care. About 80% (70; 90) of the visits of the attending physicians are associated with the appointment of laboratory tests. Among patients who were prescribed any laboratory test - in 62.1% (95% CI 16.9-24.9) cases, the results of these tests influenced clinical decision making related to the initiation, modification or termination of any treatment. All visits of clinicians were divided by purpose: tests were prescribed in almost 100% (90; 100) cases during the initial examination, in 40% (20; 60) cases during repeated visits, and in 40% (15; 40) cases when patients were examined before discharge. In more than half of cases (57,4%; n=31), doctors correctly assumed about the about the share of financing of the laboratory industry. The majority of respondents considered the amount of expenses adequate and recommended to maintain the current level in the future. According to attending physicians, new laboratory markers should demonstrate additional information about clinical relevance to improve patient outcomes. Thus, in current economic realities, future laboratory tests should be financially maximally available and at the same time be clinically highly effective auxiliary instruments. It creates new challenges in finding laboratory biomarkers and putting them into clinical practice.

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Numerical Model to Predict Hemolysis and Transport in a Membrane-Based Microfluidic Device

10.1101/2020.06.15.152686 ◽

2020 ◽

Author(s):

Matthew D Poskus ◽

Thomas R Gaborski ◽

Steven W Day

Keyword(s):

Patient Outcomes ◽

Shear Stresses ◽

Device Performance ◽

Flow Rates ◽

Blood Damage ◽

Damage Models ◽

Conventional Hemodialysis ◽

Prototype Design ◽

Improve Patient

AbstractMicrofluidic devices may overcome the limitations of conventional hemodialysis and oxygenation technology to improve patient outcomes. Namely, the small form of this technology and parallel development of highly permeable membranes may facilitate the development of portable, low-volume, and efficient alternatives to conventional membrane-based equipment. However, the characteristically small dimensions of these devices may also inhibit transport and may also induce flow-mediated nonphysiologic shear stresses that may damage red blood cells (RBCs). In vitro testing is commonly used to quantify these phenomenon, but is costly and only characterizes bulk device performance. Here we developed a computational model that predicts the blood damage and solute transport for an abitrary microfluidic geometry. We challenged the predictiveness of the model with three geometric variants of a prototype design and validated hemolysis predictions with in vitro blood damge of prototype devices in a recirculating loop. We found that six of the nine tested damage models statistically agree with the experimental data for at least one geometric variant. Additionally, we found that one geometrical variant, the herringbone design, improved toxin (urea) transport to the dialysate by 38% in silico at the expense of a 50% increase in hemolysis. Our work demonstrates that computational modeling may supplement in vitro testing of prototype microdialyzer/micro-oxygenators to expedite the design optimization of these devices. Furthermore, the low device-induced blood damage measured in our study at physiologically relevant flow rates is promising for the future development of microfluidic dialyzers and oxygenators.

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Artificial intelligence in arthroplasty

Arthroplasty ◽

10.1186/s42836-021-00095-3 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Glen Purnomo ◽

Seng-Jin Yeo ◽

Ming Han Lincoln Liow

Keyword(s):

Artificial Intelligence ◽

Clinical Decision Making ◽

Recent Literature ◽

Improve Patient Care ◽

Clinical Decision ◽

Patient Specific ◽

Allocation Decision ◽

Medical Specialties ◽

Future Direction ◽

Improve Patient

AbstractArtificial intelligence (AI) is altering the world of medicine. Given the rapid advances in technology, computers are now able to learn and improve, imitating humanoid cognitive function. AI applications currently exist in various medical specialties, some of which are already in clinical use. This review presents the potential uses and limitations of AI in arthroplasty to provide a better understanding of the existing technology and future direction of this field.Recent literature demonstrates that the utilization of AI in the field of arthroplasty has the potential to improve patient care through better diagnosis, screening, planning, monitoring, and prediction. The implementation of AI technology will enable arthroplasty surgeons to provide patient-specific management in clinical decision making, preoperative health optimization, resource allocation, decision support, and early intervention. While this technology presents a variety of exciting opportunities, it also has several limitations and challenges that need to be overcome to ensure its safety and effectiveness.

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Feasibility study of in vitro drug sensitivity assay of advanced non-small cell lung adenocarcinomas

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2019-000505 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000505

Author(s):

Emoke Papp ◽

Anita Steib ◽

Elhusseiny MM Abdelwahab ◽

Judit Meggyes-Rapp ◽

Laszlo Jakab ◽

...

Keyword(s):

Clinical Decision Making ◽

Therapy Response ◽

Clinical Decision ◽

Response To Therapy ◽

Solid Tumours ◽

Chemosensitivity Test ◽

Pleural Effusions ◽

In Vitro Chemosensitivity ◽

Lung Adenocarcinomas

Background Despite improved screening techniques, diagnosis of lung cancer is often late and its prognosis is poor. In the present study, in vitro chemosensitivity of solid tumours and pleural effusions of lung adenocarcinomas were analysed and compared with clinical drug response.Methods Tumour cells were isolated from resected solid tumours or pleural effusions, and cryopreserved. Three-dimensional (3D) tissue aggregate cultures were set up when the oncoteam reached therapy decision for individual patients. The aggregates were then treated with the selected drug or drug combination and in vitro chemosensitivity was tested individually measuring ATP levels. The clinical response to therapy was assessed by standard clinical evaluation over an 18 months period.Results Based on the data, the in vitro chemosensitivity test results correlate well with clinical treatment response.Conclusions Such tests if implemented into the clinical decision making process might allow the selection of an even more individualised chemotherapy protocol which could lead to better therapy response.

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New Device for Intrinsic Hand Muscle Strength Measurement: An Alternative to Strain Gauge Handheld Dynamometer

Evaluation & the Health Professions ◽

10.1177/0163278717727568 ◽

2017 ◽

Vol 42 (1) ◽

pp. 103-113 ◽

Cited By ~ 1

Author(s):

Jagannathan Madhanagopal ◽

Om Prakash Singh ◽

Vikram Mohan ◽

Kathiresan V. Sathasivam ◽

Abdul Hafidz Omar ◽

...

Keyword(s):

Muscle Strength ◽

Clinical Decision Making ◽

Force Measurement ◽

Interobserver Reliability ◽

Clinical Decision ◽

Strength Measurement ◽

New Device ◽

Intrinsic Hand Muscle ◽

Hand Muscle ◽

Accuracy And Repeatability

An accurate measurement of intrinsic hand muscle strength (IHMS) is required by clinicians for effective clinical decision-making, diagnosis of certain diseases, and evaluation of the outcome of treatment. In practice, the clinicians use Intrins-o-meter and Rotterdam Intrinsic Hand Myometer for IHMS measurement. These are quite bulky, expensive, and possess poor interobserver reliability (37–52%) and sensitivity. The purpose of this study was to develop an alternative lightweight, accurate, cost-effective force measurement device with a simple electronic circuit and test its suitability for IHMS measurement. The device was constructed with ketjenblack/deproteinized natural rubber sensor, 1-MΩ potential divider, and Arduino Uno through the custom-written software. Then, the device was calibrated and tested for accuracy and repeatability within the force range of finger muscles (100 N). The 95% limit of agreement in accuracy from −1.95 N to 2.06 N for 10 to 100 N applied load and repeatability coefficient of ±1.91 N or 6.2% was achieved. Furthermore, the expenditure for the device construction was around US$ 53. For a practical demonstration, the device was tested among 16 participants for isometric strength measurement of the ulnar abductor and dorsal interossei. The results revealed that the performance of the device was suitable for IHMS measurement.

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02 The role of feedback and follow up in ambulance services: a qualitative interview study

Emergency Medicine Journal ◽

10.1136/emermed-2020-999abs.2 ◽

2020 ◽

Vol 37 (10) ◽

pp. e2.2-e3

Author(s):

Caitlin Wilson ◽

Gillian Janes ◽

Rebecca Lawton ◽

Anne-Marie Howell ◽

Jonathan Benn

Keyword(s):

Professional Development ◽

Patient Safety ◽

Clinical Decision Making ◽

Improve Patient Safety ◽

Clinical Decision ◽

Feedback Seeking ◽

Professional Behaviour ◽

Current Feedback ◽

Staff Wellbeing ◽

Improve Patient

BackgroundInternational studies have shown that the feedback that ambulance staff receive lacks structure, relevance, credibility and routine implementation (Cash, 2017; Morrison, 2017). Research from psychology and implementation science suggests that feedback can change professional behaviour, improve clinical outcomes and positively influence staff mental health (Ivers, 2012; Michie and Williams, 2003). The aim of this study was to explore the experience of ambulance staff regarding current feedback provision and their views on how feedback impacts on patient safety, staff wellbeing and professional development.MethodsA qualitative study conducted as part of a wider study of work-related wellbeing in ambulance staff. 25 semi-structured interviews with prehospital staff in a clinical role from a UK ambulance service sampled using theoretical sampling. Theoretically-informed thematic analysis using psychological theory linked to the self-motives framework for feedback-seeking behaviour.ResultsStudy participants viewed current feedback provision as inadequate and consistently expressed a desire for increased feedback. Participants raised concerns that inadequate feedback could negatively impact on patient safety by preventing learning from mistakes. Enhancing feedback provision was suggested to improve patient safety by supporting professional development and clinical decision-making, through facilitating reflection, knowledge acquisition and professional behaviour change. Similarly, participants thought that enhanced feedback could improve staff wellbeing by enabling closure and encouraging intra-professional dialogue and peer-support. The self-motives framework was useful in interpreting personal and professional motivators for feedback-seeking behaviour within the data.ConclusionsIn accordance with previous research in this area, this study highlights prehospital clinicians’ strong desire for feedback. Furthermore, it suggests that enhancing prehospital feedback could improve patient safety by enriching clinical decision-making and supporting professional development, as well as promote staff wellbeing. Findings from this initial study will be used to guide a PhD programme to address this evidence gap.

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