Implementation of a Functional Pain Scale in an Adult Cancer Center

Background: Best practices include assessing functional status in addition to pain intensity in patients with cancer experiencing pain. The Defense and Veterans Pain Rating Scale (DVPRS) is an effective tool for assessing pain intensity and functional status in patients with cancer. Objective: To improve pain assessment among outpatient oncology patients in an adult cancer center by implementing the DVPRS and evaluating patient and nurse satisfaction with this tool. Methods: The Model for Healthcare Improvement was followed for the planning, implementation, and evaluation of this project. Nurses completed an online education module and self-assessment quiz before an in-person simulation checkoff demonstrated their correct use and documentation in the EHR of the DVPRS. Weekly audits of the electronic health record (EHR) for DVPRS use and documentation were done. Patient satisfaction was measured after each use of the DVPRS. Nurse satisfaction with the DVPRS was measured at the end of the 5-week pilot. Results: Ten of 12 (83%) nurses completed the DVPRS education and simulation check-off. The pilot was from February 13, 2023, to March 17, 2023. Documentation of DVPRS use was zero in the first two weeks. A midcycle assessment resulted in giving the nurses real-time reminders to use the DVPRS, and where and how to document its use in the EHR. Weeks three through five showed a steady increase in DVPRS use with 3 (15%), 5 (20%), and 8 (40%), respectively. Patient satisfaction was recorded by five patients in week 4 only with a mean score of 6.6 indicating a positive experience. In week five, nurse satisfaction was recorded by 7 (70%) nurses with a mean score of 3.62 indicating neutral/agreement with the DVPRS use. Conclusions: Adoption of the DVPRS to assess pain and functional status in this outpatient adult oncology center was limited. When the DVPRS was used, patients were satisfied. For the next cycle of change nurse buy-in should be evaluated and having APRNs and MDs assess patients’ pain using the DVPRS should be part of the process improvements

Analysis of induced electrical currents from magnetic field coupling inside implantable neurostimulator leads

<p>Abstract</p> <p>Background</p> <p>Over the last decade, the number of neurostimulator systems implanted in patients has been rapidly growing. Nearly 50, 000 neurostimulators are implanted worldwide annually. The most common type of implantable neurostimulators is indicated for pain relief. At the same time, commercial use of other electromagnetic technologies is expanding, making electromagnetic interference (EMI) of neurostimulator function an issue of concern. Typically reported sources of neurostimulator EMI include security systems, metal detectors and wireless equipment. When near such sources, patients with implanted neurostimulators have reported adverse events such as shock, pain, and increased stimulation. In recent <it>in vitro </it>studies, radio frequency identification (RFID) technology has been shown to inhibit the stimulation pulse of an implantable neurostimulator system during low frequency exposure at close distances. This could potentially be due to induced electrical currents inside the implantable neurostimulator leads that are caused by magnetic field coupling from the low frequency identification system.</p> <p>Methods</p> <p>To systematically address the concerns posed by EMI, we developed a test platform to assess the interference from coupled magnetic fields on implantable neurostimulator systems. To measure interference, we recorded the output of one implantable neurostimulator, programmed for best therapy threshold settings, when in close proximity to an operating low frequency RFID emitter. The output contained electrical potentials from the neurostimulator system and those induced by EMI from the RFID emitter. We also recorded the output of the same neurostimulator system programmed for best therapy threshold settings without RFID interference. Using the Spatially Extended Nonlinear Node (SENN) model, we compared threshold factors of spinal cord fiber excitation for both recorded outputs.</p> <p>Results</p> <p>The electric current induced by low frequency RFID emitter was not significant to have a noticeable effect on electrical stimulation.</p> <p>Conclusions</p> <p>We demonstrated a method for analyzing effects of coupled magnetic field interference on implantable neurostimulator system and its electrodes which could be used by device manufacturers during the design and testing phases of the development process.</p

Библиотека «александровцев»: от Александринского сиротского института до Александровского военного училища

.Статья посвящена истории создания и развития фундаментальной библиотеки Александровского военного училища, одного из престижных военно-учебных заведений русской армии. Показана роль книжного собрания училища в обучении и воспитании будущих офицеров

Библиотеки военно-фельдшерских школ

.В статье впервые рассматривается история создания библиотек для учителей и воспитателей, а также возрастных библиотек для воспитанников военно-фельдшерских школ, осуществлявших подготовку вспомогательного медицинского персонала для нужд военного ведомства. Показана роль Главного управления военно-учебных заведений по подготовке проектов основополагающих нормативно-правовых документов для военно-фельдшерских школ, среди которых особое значение для централизованного управления деятельностью школьными собраниями книг имела «Инструкция для содержания библиотек и учебных кабинетов в военно-фельдшерских школах». На примере Санкт-Петербургской военно-фельдшерской школы проанализирована роль школьной и возрастных библиотек в учебно-воспитательном процессе

Офицерская стрелковая школа и ее библиотека (середина XIX — начало XX в.)

The article presents the brief history of creation of the Officer Shooting School as the most important shooting and methodical center of the Russian army, and normative and legal basis for it and its libraries. There are analyzed the provisions “About the Officer Shooting School”, regulating operations of the military school and its library, as well as the printed “Catalogue of the Library Books of the Officer Shooting School” of 1901, composed by Captain N.L. Yunakov, the Head of the Teaching Department. There are described the special features of the use of books and periodicals from the library and the reading room by the permanent staff and non-permanent personnel. There is characterized the department of books bequeathed in 1889 to the School by its former first Chief in 1881—1889 His Majesty Retinue Major-General V.A. Villamov. There are identified the works prepared by the teaching staff of the school and published in there.В статье представлены краткая история создания Офицерской стрелковой школы как важнейшего стрелкового и методического центра русской армии, нормативно-правовая база для нее и библиотека при ней. Анализируются положения «Об Офицерской стрелковой школе», регламентирующие работу военно-учебного заведения и библиотеки, а также печатный «Каталог библиотеки Офицерской стрелковой школы» 1901 г., составленный правителем дел по учебной части капитаном Н.Л. Юнаковым. Показаны особенности пользования книгами и периодическими изданиями из библиотеки и читальной комнаты постоянным и переменным составом. Характеризуется отдел книг, завещанных в 1889 г. школе ее бывшим первым начальником в 1881—1889 гг. Свиты Его Величества генерал-майором В.А. Вилламовым. Выявлены труды, подготовленные преподавательским составом школы и изданные в ней

Библиотека Императорской Николаевской военной академии (1863-1917 гг.)

The article is devoted to the history of creation and development of the Universal Book Collection of the Imperial Nicholas Military Academy, justly called the «Sanctuary of Military Science»Статья посвящена истории создания и развития универсального книжного собрания Императорской Николаевской военной академии, которую по праву называли «Храмом военной науки»

Electromagnetic compatibility of implantable neurostimulators to RFID emitters

<p>Abstract</p> <p>Background</p> <p>The objective of this study is to investigate electromagnetic compatibility (EMC) of implantable neurostimulators with the emissions from radio frequency identification (RFID) emitters.</p> <p>Methods</p> <p>Six active implantable neurostimulators with lead systems were tested for susceptibility to electromagnetic fields generated by 22 RFID emitters. These medical devices have been approved for marketing in the U.S. for a number of intended uses that include: epilepsy, depression, incontinence, Parkinsonian tremor and pain relief. Each RFID emitter had one of the following carrier frequencies: 125 kHz, 134 kHz, 13.56 MHz, 433 MHz, 915 MHz and 2.45 GHz</p> <p>Results</p> <p>The test results showed the output of one of the implantable neurostimulators was inhibited by 134 kHz RFID emitter at separation distances of 10 cm or less. The output of the same implantable neurostimulator was also inhibited by another 134 kHz RFID emitter at separation distances of 10 cm or less and also showed inconsistent pulsing rate at a separation distance of 15 cm. Both effects occurred during and lasted through out the duration of the exposure.</p> <p>Conclusions</p> <p>The clinical significance of the effects was assessed by a clinician at the U.S. Food and Drug Administration. The effects were determined to be clinically significant only if they occurred for extended period of time. There were no observed effects from the other 5 implantable neurostimulators or during exposures from other RFID emitters.</p

ELECTROMAGNETIC COMPATIBILITY AND RENEWABLE POWER FOR IMPLANTABLE NEUROSTIMULATORS

Over the last decade, the number of implantable neurostimulator systems implanted in patients has been rapidly growing. Nearly 50,000 neurostimulators are implanted worldwide annually. The most common type of implantable neurostimulators is indicated for pain relief. At the same time, commercial use of other electromagnetic technologies is expanding, making electromagnetic interference neurostimulator function an issue of concern. The susceptibility of six active implantable neurostimulators with lead systems to an electromagnetic field generated by 22 radio frequency identification emitters was investigated. It was found that one implantable neurostimulation system was inhibiting the stimulation pulse during low frequency exposure at close distances. To systematically address the concerns posed by EMI, a test platform was developed to assess the interference from coupled magnetic fields on implantable neurostimulator systems. The lifetime of any active neurostimulator system heavily depends on its battery. Current technology has been able to provide solutions to power up such devices for up to five years. In fact, the latest research in this area showed that, on average, batteries last only three years. When an implantable battery needs to be replaced, a surgical procedure is required during this process. In addition, the current available implantable batteries contain potentially hazardous materials to human bodies and if leaked could cause potentially lethal complications. A system was developed that demonstrates a proof of concept based on cascaded concentration cells that can currently deliver 2 µW of power, capable of powering small scale implantable devices. Ideally, the system could replace or charge an existing battery based on concentration differences that already exist within the human body. The system has several advantages over the current implantable batteries and other proposed technologies. The most important advantage is the use of flexible, biocompatible materials. The system does not use toxic or nuclear materials and does not depend on energy sources outside of the human body or body movement. It does not heat body tissue, or require a cosmetic disadvantage. It makes use of renewable energy sources within the human body

Великий князь Михаил Павлович - устроитель библиотек в артиллерии, Инженерном корпусе и в военно-учебных заведениях (вторая четверть XIX в.)

N the basis of the archival materials and pre-revolutionary publications there is for the first time comprehensively studied the activities of the son of Emperor Paul I and Maria Feodorovna, Grand Duke Mikhail Pavlovich, being in the capacity of: General-Feldzeugmeister (1819-1849), Inspector General for Engineering (1825-1849), Director-General of Military Educational Institutions (1831-1849), where were laid the foundations of the centralized organization of the officer libraries in the Artillery, Corps of Engineers and in the Military Schools. Under Mikhail Pavlovich, as the Commander of the Guards Corps (1826-1849), the organized officer libraries in the Guards Corps have got its further development. There are presented and analyzed normative legal documents, having made the significant contribution to the history of military librarianship of the Russian Army. Some of them became the basis for the further development of “Statutes”, “Regulations” and “Instructions” of military libraries. There is given comparative characteristics and there are shown some organizational features of the artillery, engineers, combat engineer and regimental guard officer libraries, as well as book collections of the secondary military schools.В статье на основе архивных материалов и дореволюционных публикаций впервые комплексно рассматривается деятельность сына императора Павла I и Марии Федоровны великого князя Михаила Павловича на должностях: генерал-фельдцейхмейстера (1819-1849), генерал-инспектора по инженерной части (1825-1849), Главного начальника военно-учебных заведений (1831-1849), при которых были заложены основы централизованного устройства офицерских библиотек в артиллерии, Инженерном корпусе и в военно-учебных заведениях. При Михаиле Павловиче как командире Гвардейского корпуса (1826-1849) уже созданные офицерские библиотеки в войсках гвардии получили свое дальнейшее развитие. Приведены и проанализированы нормативно-правовые документы, внесшие значительный вклад в историю военно-библиотечного дела Русской армии. Некоторые из них стали основой для выработки последующих «Положений», «Уставов», «Инструкций» военных библиотек. Дана сравнительная характеристика и показаны некоторые особенности устройства артиллерийских, инженерных, саперных и полковых гвардейских офицерских библиотек, а также книжных собраний средних военно-учебных заведений