Pain detection with bioimpedance methodology from 3-dimensional exploration of nociception in a postoperative observational trial

Although the measurement of dielectric properties of the skin is a long-known tool for assessing the changes caused by nociception, the frequency modulated response has not been considered yet. However, for a rigorous characterization of the biological tissue during noxious stimulation, the bioimpedance needs to be analyzed over time as well as over frequency. The 3-dimensional analysis of nociception, including bioimpedance, time, and frequency changes, is provided by ANSPEC-PRO device. The objective of this observational trial is the validation of the new pain monitor, named as ANSPEC-PRO. After ethics committee approval and informed consent, 26 patients were monitored during the postoperative recovery period: 13 patients with the in-house developed prototype ANSPEC-PRO and 13 with the commercial device MEDSTORM. At every 7 min, the pain intensity was measured using the index of Anspec-pro or Medstorm and the 0-10 numeric rating scale (NRS), pre-surgery for 14 min and post-anesthesia for 140 min. Non-significant differences were reported for specificity-sensitivity analysis between ANSPEC-PRO (AUC = 0.49) and MEDSTORM (AUC = 0.52) measured indexes. A statistically significant positive linear relationship was observed between Anspec-pro index and NRS (r(2) = 0.15, p < 0.01). Hence, we have obtained a validation of the prototype Anspec-pro which performs equally well as the commercial device under similar conditions

Robot Autonomy for Surgery

Autonomous surgery involves having surgical tasks performed by a robot operating under its own will, with partial or no human involvement. There are several important advantages of automation in surgery, which include increasing precision of care due to sub-millimeter robot control, real-time utilization of biosignals for interventional care, improvements to surgical efficiency and execution, and computer-aided guidance under various medical imaging and sensing modalities. While these methods may displace some tasks of surgical teams and individual surgeons, they also present new capabilities in interventions that are too difficult or go beyond the skills of a human. In this chapter, we provide an overview of robot autonomy in commercial use and in research, and present some of the challenges faced in developing autonomous surgical robots

Business Process Redesign in the Perioperative Process: A Case Perspective for Digital Transformation

This case study investigates business process redesign within the perioperative process as a method to achieve digital transformation. Specific perioperative sub-processes are targeted for re-design and digitalization, which yield improvement. Based on a 184-month longitudinal study of a large 1,157 registered-bed academic medical center, the observed effects are viewed through a lens of information technology (IT) impact on core capabilities and core strategy to yield a digital transformation framework that supports patient-centric improvement across perioperative sub-processes. This research identifies existing limitations, potential capabilities, and subsequent contextual understanding to minimize perioperative process complexity, target opportunity for improvement, and ultimately yield improved capabilities. Dynamic technological activities of analysis, evaluation, and synthesis applied to specific perioperative patient-centric data collected within integrated hospital information systems yield the organizational resource for process management and control. Conclusions include theoretical and practical implications as well as study limitations

Eliminating Central Line Infections and Spreading Success at High-Performing Hospitals

Synthesizes lessons in preventing central line-associated bloodstream infections, including the importance of evidence-based protocols, dedicated teams to oversee central line insertions, participation in collaboratives, and monitoring of infection rates

Vigilance of Certified Registered Nurse Anesthetists

Vigilance of certified registered nurse anesthetists (CRNAs) is an integral component of the care they provide patients under general anesthetic. the practice of CRNas is important as the official seal of the American Association of Nurse Anesthetists (AANA). on the seal, Morpheus, the god of dreams, is shown holding the Lamp of Learning, by the light of which he keeps vigil (Hirter & Van Nest, 1995). as the patients remain unconscious under general anesthesia, CRNas remain the patients\u27 eyes and ears remains responsive to their needs. the CRNa must remain attentive to the patient\u27s needs by continuously monitoring the patient in the operating room and constantly communicating with the operating room staff. Complete focus must be maintained to avoid any mishaps or adverse events. in essence, CRNas must remain focused and vigilant when caring for their patients. the importance of vigilance is essential and undeniable for optimal patient outcomes, but the process has yet to be defined and understood. Fourteen CRNas participated in phone interviews in this study. CRNas practicing in both hospital and ambulatory settings were included. Through data analysis, using constant comparison, a model emerged that explained vigilance in the CRNa process. the core category was Using Senses, and the model had seven subcategories. the categories below reflected stages in the process model. the process begins with the CRNA\u27s care of the patient (Being Alert). This is when the CRNa assumes care of the patient, maintains a high level of alertness, and does not get mentally fatigued. Being alert allows the CRNa to be ready to care for their patients. When CRNas are alert, they are attentive and engaged (Being Attentive and Engaged) in watching over their patients. This allows the CRNa to be constantly aware and pay attention to their patients. Being attentive and engaged allows the CRNa to be focused (Focusing) on every aspect of patient care. Unfortunately, the operating room is a dynamic environment, where distractions, such as music, conversation, and technology can distract clinicians from being engaged in the care of their patients. These distractions can, but do not always, occur. When they do occur, the CRNa redirects their attention and begins to focus, which allows CRNas to use their senses to look, listen, and feel (Looking, Listening, and Touching). Using the senses of looking, listening, and feeling, the CRNa can pick up on events or look for cues that can help continue or improve care by anticipating changes at random intervals during the case. by using their senses and picking up on cues, the CRNa knows what is going on with the patient (Know What Is Happening). the findings of this study have implications for nurse administrators. This theory will be informative and helpful for hospital administrators, as they may want to implement a policy similar to that which the aviation industry developed for pilots reporting for duty. in regards to nursing research, the Institute of Medicine ([IOM], 2003) has used the phenomena of vigilance and surveillance interchangeably, but the processes are not interchangeable. There is a distinction between these two concepts. This study provides a link between the two phenomena. Vigilance is a link to the process of surveillance and studying it will help the researcher expound upon the previous surveillance research in nursing