THE EFFECT OF MODERATE VERSUS DEEP SEDATION ON THE SATISFACTION AND LENGTH OF STAY OF PATIENTS UNDERGOING COLONOSCOPY IN A LEBANESE SPECIALIZED ENDOSCOPY CENTER

Colonoscopy is one of the most common screening procedure to detect colorectal cancer. Sedation during colonoscopy decreases anxiety, discomfort, minimizes risks, and promotes the overall satisfaction of the patient. It’s a challenge for nurses to adopt a sedation regimen taking into consideration traditional and modern techniques and methods. Purpose: To compare moderate and deep sedation effects on satisfaction, length of stay, and overall experience of patients undergoing colonoscopy. Methods: A quasi-experimental research was conducted among 149 patients who responded to the Iowa Satisfaction with Anesthesia Scale after been consented pre-procedure. Results: Statistically significant differences were demonstrated for almost most items of Iowa satisfaction with the anesthesia scale, in addition to the clear difference between the post-procedure stay duration and time to have had their vitals baselined again. Conclusion: Deep sedation using Propofol was much more effective in enhancing patient satisfaction and reducing the length of stay and procedure duration substantially, thus contributing to a higher quality of care and improved performance of the endoscopy units

Sensorelemente aus leitfähigem Silikon für einen nachgiebigen Greifer

Das Ziel dieses Beitrages ist die Grundlagen zu schaffen, die erlauben sollen das leitfähige Silikon Powersil 466 A/B VP [1] als Sensorelemente zu verwenden. Deshalb werden Untersuchungen der Eigenschaften des leitfähigen Silikons in Abhängigkeit von verschiedenen Belastungen durchgeführt. Die Sensorelemente ändern unter der Einwirkung von Belastungen ihre elektrischen Eigenschaften. Dieser Beitrag präsentiert eine Anwendung dieses Materials als Sensorelemente für einen neuen nachgiebigen Greifer. Die Sensorelemente dieses Greifers haben zwei Funktionen; sie sind Teile der Greiferstruktur und sie geben grobe Information über den Greifprozess. Die Herstellungstechnologie des sensorisierten Greifers und die experimentellen Messungen werden in diesem Beitrag erläutert.The target of this paper is to create the foundation that allows using the conductive silicone rubber Powersil 466 A/B VP as sensor elements. Therefore, several investigations of electrical conductive silicone rubber characteristics in depending on different loads are carried out. The conductive silicone rubber changes its electrical properties under the loads. This paper presents an application for this material as sensor elements for a new compliant gripper. The sensor elements of this gripper have two functions; they are parts of the gripper structure and they give rough information about the gripping process. The production process of the sensorized gripper and the experimental measurements is discussed in this paper

Compliant mechanism with hydraulic activation used for implants and medical instruments

The hydraulic actuation of cochlear implant is considered in this research. The deformation behavior of the compliant mechanism by hydraulic actuation is of interest to facilitate the insertion of the implant or the instrument used in the non-linear access paths to the target area, and to avoid any damage, which could occur during the surgical procedure. The described implant is a hydraulically actuated compliant structure with a symmetric internal hollow core and with a non-stretchable thin fibre embedded in the wall. Under inner pressure of 6 bar, the structure is bended, thus the insertion will facilitate during the operation. With the help of the simulations, a specific geometry of the compliant structure is determined for the target deformation executed by hydraulic actuation. In this paper a Finite Element (FE) model and an analytical model is demonstrated for simulation the deformation behavior of the fibre The maximum difference between both model results for simulated fibre curves is about 0.5 mm. This is 1.6% of the entire length of the implant

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Einsatz funktioneller Materialien zur Realisierung inhärenter Sensorik bei elastischen Strukturen

Sensorisierung der technischen Systeme hat in vielen Forschungsbereichen der Robotik zunehmend an Bedeutung gewonnen. Insbesondere für Mensch-Maschine-Schnittstellen sind sensorisierte und nachgiebige Systeme von Interesse. Die Nachgiebigkeit eines Systems kann zum Beispiel durch die Materialeigenschaften sowie durch die geometrische Gestaltung gewährleistet werden. In der vorliegenden Arbeit wird eine Möglichkeit zur Sensorisierung nachgiebiger Systeme, die für den Bereich der Robotik von Interesse sind, beschrieben. Dafür wird ein elektrisch leitfähiger Silikonkautschuk eingesetzt. Der Vorteil der Anwendung des leitfähigen Silikonkautschuks ist, dass die Nachgiebigkeit solcher Systeme weiterhin erhalten bleibt bzw. sich verbessert. Unter Nutzung experimenteller Untersuchungen von den leitfähigen Silikonkautschuken ELASTOSIL R 570/50 MH C1 und POWERSIL® 466 A/B VP konnte das elektrische Verhalten dieser Materialien unter den mechanischen Beanspruchungen charakterisiert werden. Die Einsatzmöglichkeiten des leitfähigen Silikonkautschuks als Sensorelemente werden am Beispiel von drei nachgiebigen Systemen aufgezeigt. Die hier verwendeten Sensorelemente beruhen auf dem Prinzip der elektrischen Widerstandsänderung unter den mechanischen Beanspruchungen. Das erste System ist eine taktile Struktur und hat eine einfache Gestalt. Mit dem ersten System wird die Anwendbarkeit von dem Material ELASTOSIL R 570/50 MH C1 als Sensorelement aufgezeigt. Verschiedene Tests werden an der taktilen Struktur zur Ermittlung der Kontaktstellen durchgeführt. Die Messergebnisse werden dargestellt und diskutiert. Bei dem zweiten System handelt es sich um einen nachgiebigen Greifer. Der Greifer kann sich an verschiedene Objekte beim Greifvorgang anpassen. Des Weiteren können durch die inhärente nachgiebige Sensorik Informationen über das gegriffene Objekt beim Greifvorgang geliefert werden. Im letzten Teil der Arbeit wird das dritte System, eine nachgiebige Gelenkverbindung mit inhärenter Sensorik, diskutiert. Die Sensorelemente des Systems können dank der Materialeigenschaften des Silikonkautschuks zusätzlich die Funktionen einer Feder und eines Dämpfers übernehmen. Dies ermöglicht einen kompakten Aufbau des Systems mit einer Steuerungsmöglichkeit der Drehrichtung mithilfe der gelieferten Sensorsignale bei einem Kollisionsfall.Sensorization of technical systems has become increasingly important in many research fields of robotics. The sensorized and compliant systems are especially of interest for human-machine interfaces. The compliance of a system can be, for example, achieved by the material properties as well as by the geometrical design. In the presented thesis, a possibility of the sensorization of compliant systems is described, that are of interest for robotics. In order to do this, an electrical conductive silicone rubber is used. The advantage of this material is that the compliance of the system remains available or can be even improved. Based on experimental investigations of the conductive silicone rubber ELASTOSIL R 570/50 MH C1 and POWERSIL® 466 A/B VP, the electrical behavior of these materials could be characterized in dependence on the mechanical loads. The application possibilities of the conductive silicone rubber as sensor elements are shown by using the examples of three compliant systems. The sensor elements made of the conductive silicone rubber are based on the principle of the change in the electrical resistance under the mechanical loads. The first system is a tactile structure with a simple design. By using the first system, the applicability of the material ELASTOSIL R 570/50 MH C1 as a sensor element is shown. Several tests are performed on the tactile structure to determine the contact points. The measurement results are presented and discussed. The second system is a compliant gripper. This gripper can accommodate to different grasped objects during the gripping process. Furthermore, information about the grasped object can be provided by the inherent compliant sensor elements during the gripping process. In the last part of this thesis, the third system is discussed, which is a compliant joining structure with embedded sensor elements. Thanks to the material properties of the silicone rubber, the sensor elements of the system can additionally take the tasks of a spring and a damper. This allows a compact construction of the system and a control possibility of the rotation direction with the help of the sensor signals, which will be provided during the collision

Tunable bandpass filter with wide out-of-band rejection

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