Fractional order impedance models as rising tools for quantification of unconscious analgesia

This research focuses on modeling the diffusion process that occurs in the human body when an analgesic drug is taken up, by using fractional-order impedance models (FOIMs). We discuss the measurement of a suitable feedback signal that can be used in a model-based control strategy. With this knowledge an early dawn concept of a pain sensor is presented. The major challenges that are encountered during this development consist of identification of the patient model, validation of the pain sensor and validation of the effect of the analgesic drug

Monitoring Patient Safety in the Recovery Room

Respiratory depression is a serious complication after surgery. Early detection is a major patient safety concern for recovery room personnel as patients recover from anesthesia and experience pain. The opioids used for pain management may contribute to over-sedation effects and respiratory depression. Vital signs and pulse oximetry are standard postoperative monitoring procedures. End-tidal capnography and arterial blood gases may augment the standard-of-care procedures but may not be effective at detecting early respiratory depression. The purpose of this study was to generate baseline data trending patient safety variables and outcomes for postoperative patients using standard monitoring with standard-of-care plus transcutaneous capnography monitoring for CO2 levels. This study was guided by a retrospective, time series design with two study groups. A convenience sample of 800 patients from a large Midwestern hospital was assigned to postoperative recovery rooms equipped with standard monitoring (control group) or standard monitoring plus transcutaneous capnography (treatment group). The time series component refers to dependent measures collected at three points in time: admission to the recovery room and 30- and 60-minutes after admission. Dependent measures included respiratory rate, blood pressure, heart rate, oxygen saturation, pain score, Aldrete score, and opioid doses. Measures and time were treated as within subject factors. Data were analyzed by: group (treatment vs control), dependent measures, and time using multivariate analysis of variance. Aldrete score and opioid doses were treated as within-subject factors. Recovery time was assessed using an independent samples t-test. Trends in variables over time showed significant differences by groups. The transcutaneous capnography treatment group showed a shorter length of stay in the recovery room and overall reduction in opioid administration compared to the control group. Pain scores worsened for the treatment group over time. The transcutaneous capnography may improve management of opioids and patients’ level of consciousness but may have inadvertently heightened patients’ awareness of pain. Transcutaneous monitoring of recovery room patients may be beneficial in avoiding respiratory depression and improving patient safety and it has long-term implications for health care costs

Hybrid head cap for mouse brain studies

Abstract. In this thesis, I present a hybrid head cap in combination with non-invasive multi-channel Electroencephalogram (EEG) and Near-Infrared Spectroscopy (NIRS) to measure brainwaves on mice’s scalps. Laboratory animal research provides insights into multiple potential applications involving humans and other animals. An experimental framework that targets laboratory animals can lead to useful transnational research if it strongly reflects the actual application environment. The non-invasive head cap with three electrodes for EEG and two optodes for NIRS is suggested to measure brainwaves throughout the laboratory mice’s entire brain region without surgical procedures. The suggested hybrid head cap aims to ensure stability in vivo monitoring for mouse brain in a non-invasive way, similarly as the monitoring is performed for the human brain. The experimental part of the work to study the quality of the gathered EEG and fNIRS signals, and usability validation of the head cap, however, was not completed in the planned time frame of the thesis work

Acceptability, feasibility, and preliminary clinical usefulness of Bispectral index (BIS) monitoring in UK palliative care patients

Background Bispectral index (BIS) is a technology using electroencephalographic (EEG) readings to assess levels of consciousness in patients undergoing general anaesthesia in the operating room where it has been shown to improve patient care and outcomes. Few previous studies have investigated BIS use in palliative care patients receiving sedative medication and none of these have been conducted in the United Kingdom (UK). Aim To explore the acceptability, feasibility, and preliminary clinical usefulness of BIS monitoring in adult UK palliative care patients. Methods Three empirical studies were undertaken to meet the research aim: (1) a qualitative study exploring the perceptions of patients, current patient relatives, and bereaved relatives regarding the possible use of BIS in palliative care, (2) an exploratory study of BIS monitoring in adult hospice inpatients, and (3) a further qualitative study investigating patients', relatives', and hospice clinicians' direct experiences of BIS monitoring. Qualitative data were analysed using the framework method. Quantitative data were analysed using descriptive statistics, correlation coefficients, and the Wilcoxon signed-rank test. Results Ten palliative care patients, four current patient relatives, and eleven bereaved relatives participated in study (1). Forty hospice inpatients were monitored with BIS for study (2). Ten patients, two relatives, and ten clinicians participated in study (3). Findings suggest that conducting research with BIS in UK hospice inpatients is feasible and acceptable to key stakeholders. There was insufficient evidence to support the clinical usefulness of BIS monitoring in this population, probably due to a relatively small sample consisting of patients who were predominantly alert and responsive. Conclusion This research is the first to explore the use of BIS in the UK palliative care context. Findings from this work support the feasibility and acceptability of BIS as a research tool. Further research is needed to determine the clinical usefulness of BIS in palliative care

Perioperative Care

Perioperative care practices worldwide are in the midst of a seeing change with the implementation of multidisciplinary processes that improve surgical outcomes through (1) better patient education, engagement, and participation; (2) enhanced pre-operative, intra-operative, and post-operative care bundles; and (3) interactive audit programs that provide feedback to the surgical team. These improved outcomes include reductions in the frequency and severity of complications and improved throughput, which ultimately reduce operative stress. Practices in theatre as well as ward are becoming more collaborative and evidence-driven.This book is best utilized by perioperative care team members engaged in quality improvement, collaborative practice, and application of innovations in surgical care

Combating Alarm Fatigue: The Quest for More Accurate and Safer Clinical Monitoring Equipment

As the demand for health-care services continues to increase, clinically efficient and cost-effective patient monitoring takes on a critically important role. Key considerations inherent to this area of concern include patient safety, reliability, ease of use, and cost containment. Unfortunately, even the most modern patient monitoring systems carry significant drawbacks that limit their effectiveness and/or applicability. Major opportunities for improvement in both equipment design and monitor utilization have been identified, including the presence of excessive false and nuisance alarms. When poorly optimized, clinical alarm activity can affect patient safety and may have a negative impact on care providers, leading to inappropriate alarm response time due to the so-called alarm fatigue (AF). Ultimately, consequences of AF include missed alerts of clinical significance, with substantial risk for patient harm and potentially fatal outcomes. Targeted quality improvement initiatives and staff training, as well as the proactive incorporation of technological improvements, are the best approaches to address key barriers to the optimal utilization of clinical alarms, AF reduction, better patient care, and improved provider job satisfaction

Advancements and Breakthroughs in Ultrasound Imaging

Ultrasonic imaging is a powerful diagnostic tool available to medical practitioners, engineers and researchers today. Due to the relative safety, and the non-invasive nature, ultrasonic imaging has become one of the most rapidly advancing technologies. These rapid advances are directly related to the parallel advancements in electronics, computing, and transducer technology together with sophisticated signal processing techniques. This book focuses on state of the art developments in ultrasonic imaging applications and underlying technologies presented by leading practitioners and researchers from many parts of the world

Decoding Neural Signals with Computational Models: A Systematic Review of Invasive BMI

There are significant milestones in modern human's civilization in which mankind stepped into a different level of life with a new spectrum of possibilities and comfort. From fire-lighting technology and wheeled wagons to writing, electricity and the Internet, each one changed our lives dramatically. In this paper, we take a deep look into the invasive Brain Machine Interface (BMI), an ambitious and cutting-edge technology which has the potential to be another important milestone in human civilization. Not only beneficial for patients with severe medical conditions, the invasive BMI technology can significantly impact different technologies and almost every aspect of human's life. We review the biological and engineering concepts that underpin the implementation of BMI applications. There are various essential techniques that are necessary for making invasive BMI applications a reality. We review these through providing an analysis of (i) possible applications of invasive BMI technology, (ii) the methods and devices for detecting and decoding brain signals, as well as (iii) possible options for stimulating signals into human's brain. Finally, we discuss the challenges and opportunities of invasive BMI for further development in the area.Comment: 51 pages, 14 figures, review articl