Author：admin Release Time：April 29, 2011 Category：Technology & Engineering
Conventional assessment during surgical procedures or in critical care comprises monitoring of heart rate, arterial blood pressure and urinary output, with or without catheter-base measurement of Central Venous Pressure (CVP). The decision to use cardiac output monitoring in addition (or occasionally as substitute) to conventional assessment is a clinical judgment, usually taken by an anesthetist or intensivist.
However, it is currently accepted that management of cardiac output fluid balance and haemodynamic status are the key factors in improving outcomes for high- risk surgery and the care of critically ill patients.
The fundamental technical requirement of haemodynamic monitoring is accurate cardiac output determination.
A range of devices using different techniques are available for cardiac output monitoring. There is no defining method for assessing cardiac output and no method can be regarded as a gold standard. However, the determination of cardiac output by the pulmonary artery cardiac catheter is usually considered as the most reliable.
For a system to be clinically useful it must be able to maintain accuracy of cardiac output determination in a variety of situations, for example in situations where cardiac output varies overtime. An ideal system will respond to dynamic changes quickly and accurately.
A Short Description of Some Systems for Monitoring Cardiac Output
1. Pulmonary arterial catheterization: the tip of the catheter which includesa temperature sensor, is positioned in a branch of the pulmonary artery. Cold saline is administered in discrete pulses through the catheter, and the resulting temperature changes are recorded. The cardiac output is calculated from the analysis of the temperature changes. By a different approach, a thermal element on the tip emits heat in an on-off sequence – and the resulting pulmonary artery temperature changes are measured. The cardiac output is calculated by using the relation of the output signal to the input signal.
2. Pulse control analysis: the fluctuations in arterial pressure are used to assess vascular flow. A variety of models exist to predict cardiac output based on measured pulse pressure waveforms.
3. Flick’s principle: based on the measurement of arterial and venous carbon dioxide concentration. Using this principle, cardiac output can be easily derived for intubated patients.
4. Electrical bioempedance and bioreactance: when the electrical current paths through the thorax (or the whole body) electric bioimpedance or bioreactance can be measured. Vascular blood flow affects the electrical parametes of the body. Based on such variations, the cardiac output can be calculated.
5. Thoracic Doppler: if an ultrasound, continuous wave Doppler transducer is positioned on the outside of the chest wall. The function of the heart valves can be monitored. By using the analysis of the acquired information, it is possible to derive the cardiac output.
6. Esophageal Doppler: ultrasound Doppler flow measurement can be performed in the descending aorta, using a probe positioned in the patient’s esophagus. Cardiac output is derived from measured aortic blood flow velocity. Aortic cross – sectional area is estimated and cardiac output is calculated by assuming a constant partition between descending and ascending blood supply.
Equipment in Clinical Use
All types of cardiac output monitors are in clinical use. The transesophageal aortic monitor is currently used more, as it features good stability and reliable monitoring capability. It is considered to be a minimally-invasive device and is well tolerated by adult patients. The bioimpedance/ bioreactance monitors are being seen more frequently in hospitals. They are non- invasive and simple to use.
(From:http://www.medwow.com/articles/haemodynamic-monitoring/haemodynamic-monitoring-principles/)
Author：admin Release Time：April 28, 2011 Category：Technology & Engineering
BiomedBuddy is nothing short of a revolution in medical equipment maintenance. In a time of rising health care costs, shrinking budgets, and the expansion of medicine across the globe, BiomedBuddy puts you in control of your medical equipment by providing support and documentation allowing hospitals to service their own equipment. The main idea behind the site is a collaborative training base, one that gives members access to video and written tutorials instructing on the maintenance and repair of many types of medical equipment. Members are also allowed and encouraged to submit their own training videos. For many hospitals, the cost of service contracts and repair work is far greater than the cost of the equipment, causing a sinkhole of cash flow every time a minor adjustment is needed. By accessing this site, hospital staff will have confidence in repairing and maintaining their equipment in house. In addition to the monetary savings, hospitals will find themselves with a more highly trained staff, more control over their equipment and the timeliness of service, and more predictable budgetary requirements for the service and maintenance of equipment. They will also be part of a larger community working to build self sufficiency within the medical community through the sharing of knowledge, lowering health care costs and improving productivity of in house staff.
But BiomedBuddy will do more than provide a more efficient and cost- effective alternative. For some hospitals, it is the only means through which to repair secondhand equipment and acquire reliable parts. As hospitals sell off old equipment, which do not generally come with the high-cost service plans with which they were initially sold, the buyers must gamble on whether it will be useful to them or not. Rarely is secondhand equipment sold in perfect condition, so the buying hospital must generally accept and work around any deficiencies. This may be due to the lack of funds to contract a repairman, or simply to the lack of access to one. When DIY is the only option, BiomedBuddy ensures that hospitals have the opportunity to use equipment to their fullest, and safest, capacity. Many hospitals in second and third world countries must rely on used equipment and parts, and many times buy multiple quantities of the same equipment in the hopes that one will do a decent job. With the skills gained from BiomedBuddy, these hospitals will be better able to utilize used equipment.
BiomedBuddydoes not stop at information sharing, however. It will also serve as an online marketplace for new and used medical equipment. Currently, BiomedBuddy offers any used part for the STAGO unit, testing each part on a working unit to ensure you receive a reliable part. They also have a consignment program where hospitals can sell their used or unwanted parts. The growth of the BiomedBuddy community will create a reliable and comprehensive one stop shop for medical parts and tools. This type of access makes in house repair and maintenance even simpler.
How does it work? BiomedBuddy.com operates on a system called Drupal – an open source content management platform. Because Drupal was created to handle the organization of large amounts of content, it is the perfect web solution for a site that will constantly be updated with user submitted information – tutorials, trainings, parts for sale, etc. Drupal contains built in functionality for e-commerce, submission and download of files, peer-to-peer networking, and collaborative authoring environments (think Wikipedia). These attributes allow BiomedBuddy.com to provide the large amount of content and flexibility needed for such an undertaking, and also ensure it’s sustainability throughout the inevitable growth and expansion of the site.
Why contribute? It is easy to see how the site will be useful to hospitals across the globe, but it is important that the site has contributors. In addition to member contributions, which will no doubt remain a large part of the BiomedBuddy library, we are seeking out Field Service Engineers, hospital BMET’s, Adobe Programmers, Flash Programmers, WEB Designers and other companies to assist us in making “Medical Service Training Programs”.In return for their assistance, they will get a share of the profits. Also, once a training program is completed, there is no work, only updating.Most of the work can be done at home and the pay-out lasts as long as the program is cost effective to maintain on the site.All information will of course be kept confidential.
It is free to join and to contribute to BiomedBuddy, giving users a hassle-free solution to meet their biomedical needs. For some, it will be the solution needed to offer reliable and affordable healthcare where there currently is none. For all, it will offer the freedom totruly be in control of their medical technology.
(From:http://www.medwow.com/articles/medical-software/biomedbuddy/)
Author：admin Release Time：April 27, 2011 Category：Business & Market
The Global Oncology Health Network has been in the business of de-installing all imaging modalities of medial equipment, for the past fifteen years. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scanners, Linear Accelerators, Simulators and Rad rooms.
In 1996 I began my journey in the De-installation, crating and transportation service. We have been servicing clients nationally and internationally. Working with clinics like St Louis University Hospital, Tenet, HMA, Clarian Health, The Doctors Hospital Nationally, to name a few. In addition, internationally servicing clients in China, Russia and South America.
The greatest challenge of all, however, is not with the systems being de-installed, but with the coordination and communications with hospital staff. The real key is to remove equipment without disturbing the patients or staff. Aside from keeping the noise level at a minimum, the process requires adequate ventilation, cleanliness and safe removal from facility to dock. It has to be like you’re not even there.
Here are some tips on hiring a vendor for your next De-install.
The 10 steps to the de-installation process:
1. Be sure to select a company with a proven track record of success. Get three references and call them, see how well the project went with them. Were they 100% satisfied, on budget and made the deadline you set up?
2. Give the vendor a laundry list on the equipment make, model and condition. Is it being recycled for scrap or will it be delivered and installed in other facilities. If its scrap, just make sure they follow FDA guidelines in disposal of the elements. If being crated and installed, than get quotes on de-installing, crating, shipping and installed at new facility. Turnkey is what most clinics or hospitals look for.
3. Make sure the hospital is protected from liability in case of an accident. Typically, the hospital is named as an added insured. Up to 2 million in liability is standard.
4. It’s very important to assign a project manager, who will follow the project and implement, purchase orders, project assistance with electrician and maintenance. Your staff doesn’t like surprises when the de-install crew is there and needs power locked out, or water shut off. Also have security aware of their arrival and have badges ready. The director of the department and staff needs to be informed of the activity in clinic and how you will interact with them and the safety of patient and staff looked after.
5. Lock out the power and water if applicable and begin de-installing in the room. The vender should keep noise to a minimum and not be running back and forth during business hours.
6. A sticky mat at the door will help eliminate dust and debris from getting in the halls. Don’t let the vender torch anything, unless a fire permit is given. If smoke is involved or excessive dust accruing, a Hepa filter with a charcoal filter will help with odor and air quality.
7. Have an exit route outlined for the removal of the elements through hallway to dock. Protect the floor with Masonite, if rolling equipment over 1000 lbs or more, to protect floor tiles. Always be sure to remove most items after busy or business hours, for a safe departure.
8. A staging area is recommended, if the elements can’t be loaded right away. Usually loading is not a problem at night or early mornings before or after main hospital deliveries. Please check with the dock supervisor on his schedule and your project removal dates vender is recommending.
9. When the vendor is planning on loading, please have the dock supervisor remove any unnecessary equipment or containers on dock, so they have plenty of room to move around safely.
10. Sweep the room of any screws, nuts or dust left behind. After you’re ready to roll, ask the project manager if he or she is 100% happy with your job. This is important to you, as well as the vendor, as he is only known by his last successful job.
As hospitals continue to add wings to their facilities and make the transition from analog to digital equipment, there is a greater need for The Global Oncology Health Network, than ever before.
(From:http://www.medwow.com/articles/maintenance-installation/imaging-de-installs-without-interruption-of-patient-or-staff/)
Author：admin Release Time：April 26, 2011 Category：Business & Market
A linear accelerator is the device used for high-energy x-radiation treatments to patients diagnosed with cancer. It is very large and heavy apparatus, with highly sophisticated technologies driven by dedicated software.
The linear accelerator is located in a room with lead and concrete walls, so that the high-energy x-rays are shielded. The accelerator only gives off radiation when it is actually turned on; therefore the risk of accidental exposure is extremely low. The linear accelerator is used to treat all parts and organs of the body. It delivers a uniform dose of high-energy x-ray to the region of the patient’s tumor. These x-rays can destroy the cancer cells, while sparing the surrounding normal tissue. The linear accelerator uses microwave technology to accelerate electrons which collide with a target, and as a result of the collisions, high-energy x-rays are produced and directed to the patient’s tumor. The x-rays are shaped by a multileaf collimator [think of a camera iris] that is incorporated into the head of the machine as they exit the machine to conform to the shape of the patient’s tumor. The beam exits the accelerator through the accelerator “head” which is supported by a movable vertical arm. This assembly is called a gantry, which rotates around the patient. The rotation allows the radiation to enter the patient‘s body through a continuously changing area of skin. The skin is more sensitive to radiation than the inner structures of the body. The patient lies on a moveable treatment couch and lasers are used to make sure the patient is correctly positioned. The treatment couch can move in many directions including: up, down, right, left, in and out. Radiation can be delivered to the tumor from any angle, by rotating the gantry and moving the treatment couch.
A radiation oncologist prescribes the appropriate treatment. Imaging is done to insure the beam position doesn’t vary from the treatment plan. A medical radiation physicist and the medical dosimetrist determine how to deliver the prescribed dose and calculate the amount of time it will take the accelerator to deliver that dose.
Each morning before any patients are treated, the radiation therapist performs checks on the machine to ensure that it is working properly, using a piece of equipment called a “tracker” to make sure that the radiation intensity is uniform across the beam. In addition, the radiation physicist makes more detailed weekly and monthly checks of the linear accelerator. Radiation therapists operate the linear accelerator and give patients their daily radiation treatments. Internal checking systems prevent the machine from turning on until all the prescribed treatment requirements are perfect. During treatment the radiation therapist continuously watches the patient through a closed-circuit television monitor. The patient can speak to the therapist, if needed, by microphone.
Manufacturers are continuously designing improvements to the hardware and software with the goal of higher dosages to the tumor, while shielding the adjacent tissue.
Radiation treatments incorporating the newest technologies continue to extend the lives of thousands of cancer survivors
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