Caracterización de la gestión del mantenimiento de equipo biomédico en servicios de urgencia de clínicas y hospitales de Medellín en el período 2008-2009

La gestión de mantenimiento es una herramienta de gran impacto que apoya al personal de Ingeniería en el desarrollo, control y dirección de programas de mantenimiento para el equipo médico. Objetivo: caracterizar la gestión de mantenimiento en servicios de urgencia de clínicas y hospitales del área metropolitana de Medellín en el período 2008-2009. Materiales y métodos: se realizó una encuesta a jefes y técnicos de mantenimiento en once entidades prestadoras de servicios de salud, clasificadas en tercer nivel y pertenecientes a la red de salud del municipio de Medellín. Resultados: entre las instituciones encuestadas se encontró que la causa de falla más común en los equipos del servicio de urgencia es el mal manejo de los equipos (75%) por partede los operarios y que 70% del mantenimiento es realizado por personal con experiencia en el área (tecnólogos en mantenimiento de equipo biomédico e ingenieros biomédicos). En las once instituciones públicas y privadas encuestadas se halló que solo se contaban con cronogramas de mantenimiento y/o con información desactualizada concerniente a las hojas de vida de los equipos, planes de mantenimiento o adquisición y baja de equipos. Conclusión: el estudio muestra la existencia de debilidades en ciertos puntos de la gestión, incluyendo mala organización, poca disponibilidad de repuestos originales y falta de capacitación en el personal que maneja los equipos.

Uma comparação entre os custos atuais, custos por pacote e reembolso hospitalar para o procedimento de revascularização miocárdica

In Brazil, the supplemental healthcare system is going through a transition period from the traditional Fee-for-service reimbursement system to the Package reimbursement system, similar to the American model known as the Diagnoses Related Groups (DRG) system. Although the Package concept is nothing new to the hospital environment, it is still seldom used since this system calls for a level of control and analytical knowledge of hospital costs that are poorly developed in Brazilian institutions. This study focuses on determining how much the reimbursement for a Myocardial Revascularization Package actually covers of the current costs for patients submitted to this procedure. A prospective analysis method for determining the cost per patient has been developed and 13 patients were individually followed-up during all their hospitalization period. The expenses with intensive care unit and in-patient clinical care, as well as the type of admittance - whether elective or emergency - were determined for each patient. Additionally, all the resources and materials for the surgical procedure were included, comprising specialized personnel, surgical fees, procedures and tests, biomedical equipment, and all the materials and medication used during the hospital stay. Based on this data, the current total costs were calculated and compared to the reimbursement for the Package previously agreed upon by the institution and the healthcare carriers. The study found an average cost of BR$ 8,826 for a Myocardial Revascularization surgical procedure, while the respective reimbursement for the Package is of BR$ 7,476. Therefore, the reimbursement does not cover the current costs of the procedure.

Development of an AMR-ACB Array for Gastrointestinal Motility Studies

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Development of an AMR-ACB Array for Gastrointestinal Motility Studies

The association between anisotropic magnetoresistive (AMR) sensor and AC biosusceptometry (ACB) to evaluate gastrointestinal motility is presented. The AMR-ACB system was successfully characterized in a bench-top study, and in vivo results were compared with those obtained by means of simultaneous manometry. Both AMR-ACB and manometry techniques presented high temporal cross correlation between the two periodicals signals (R = 0.9 +/- 0.1; P < 0.05). The contraction frequencies using AMR-ACB were 73.9 +/- 7.6 mHz and using manometry were 73.8 +/- 7.9 mHz during the baseline (r = 98, p < 0.05). The amplitude of contraction using AMR-ACB was 396 +/- 108 mu T.s and using manometry were 540 +/- 198 mmHg.s during the baseline. The amplitudes of signals for AMR-ACB and manometric recordings were similarly increased to 86.4% and 89.3% by neostigmine, and also decreased to 27.2% and 21.4% by hyoscine butylbromide in all animals, respectively. The AMR-ACB array is nonexpensive, portable, and has high-spatiotemporal resolution to provide helpful information about gastrointestinal tract.

Tailoring magnetic field gradient design to magnet cryostat geometry

Eddy currents induced within a magnetic resonance imaging (MRI) cryostat bore during pulsing of gradient coils can be applied constructively together with the gradient currents that generate them, to obtain good quality gradient uniformities within a specified imaging volume over time. This can be achieved by simultaneously optimizing the spatial distribution and temporal pre-emphasis of the gradient coil current, to account for the spatial and temporal variation of the secondary magnetic fields due to the induced eddy currents. This method allows the tailored design of gradient coil/magnet configurations and consequent engineering trade-offs. To compute the transient eddy currents within a realistic cryostat vessel, a low-frequency finite-difference time-domain (FDTD) method using total-field scattered-field (TFSF) scheme has been performed and validated

Neurosurgical Needs and Assets Assessment of Public Hospitals in Uganda: An Eevaluation of Mulago Hospital to Inform Neurosurgical Program Planning at Mbarara

Background: Since 2007, there has been an ongoing collaboration between Duke University and Mulago National Referral Hospital (NRH) in Kampala, Uganda to increase surgical capacity. This program is prepared to expand to other sites within Uganda to improve neurosurgery outside of Kampala as well. This study assessed the existing progress at Mulago NRH and the neurosurgical needs and assets at two potential sites for expansion. Methods: Three public hospitals were visited to assess needs and assets: Mulago NRH, Mbarara Regional Referral Hospital (RRH), and Gulu RRH. At each site, a surgical capacity tool was administered and healthcare workers were interviewed about perceived needs and assets. A total of 39 interviews were conducted between the three sites. Thematic analysis of the interviews was conducted to identify the reported needs and assets at each hospital. Results: Some improvements are needed to the Duke-Mulago Collaboration model prior to expansion; minor changes to the neurosurgery residency program as well as the method for supply donation and training provided during neurosurgery camps need to examined. Neurosurgery can be implemented at Mbarara RRH currently but the hospital needs a biomedical equipment technician on staff immediately. Gulu RRH is not well positioned for Neurosurgery until there is a CT Scanner somewhere in the Northern Region of Uganda or at the hospital. Conclusions: Neurosurgery is already present in Uganda on a small scale and needs rapid expansion to meet patient needs. This progression is possible with prudent allocation of resources on strategic equipment purchases, human resources including clinical staff and biomedical staff, and changes to the supply chain management system.

Sistema colaborativo para monitoramento remoto de equipamentos biomédicos para a videolaparoscopia através do framework web-engineering e o padrão MVC sistema vera-3C

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Tecnologia, Departamento de Engenharia Mecânica, 2015.

Development of an equipment to detect and quantify muscular spasticity

Dissertação para obtenção do Grau de Mestre em Engenharia Biomédica

Research lines in Hyperthermia at the Bioinstrumentation Laboratory of the Centre for Biomedical Technology

The Bioinstrumentation Laboratory belongs to the Centre for Biomedical Technology (CTB) of the Technical University of Madrid and its main objective is to provide the scientific community with devices and techniques for the characterization of micro and nanostructures and consequently finding their best biomedical applications. Hyperthermia (greek word for “overheating”) is defined as the phenomenon that occurs when a body is exposed to an energy generating source that can produce a rise in temperature (42-45ºC) for a given time [1]. Specifically, the aim of the hyperthermia methods used in The Bioinstrumentation Laboratory is the development of thermal therapies, some of these using different kinds of nanoparticles, to kill cancer cells and reduce the damage on healthy tissues. The optical hyperthermia is based on noble metal nanoparticles and laser irradiation. This kind of nanoparticles has an immense potential associated to the development of therapies for cancer on account of their Surface Plasmon Resonance (SPR) enhanced light scattering and absorption. In a short period of time, the absorbed light is converted into localized heat, so we can take advantage of these characteristics to heat up tumor cells in order to obtain the cellular death [2]. In this case, the laboratory has an optical hyperthermia device based on a continuous wave laser used to kill glioblastoma cell lines (1321N1) in the presence of gold nanorods (Figure 1a). The wavelength of the laser light is 808 nm because the penetration of the light in the tissue is deeper in the Near Infrared Region. The first optical hyperthermia results show that the laser irradiation produces cellular death in the experimental samples of glioblastoma cell lines using gold nanorods but is not able to decrease the cellular viability of cancer cells in samples without the suitable nanorods (Figure 1b) [3]. The generation of magnetic hyperthermia is performed through changes of the magnetic induction in magnetic nanoparticles (MNPs) that are embedded in viscous medium. The Figure 2 shows a schematic design of the AC induction hyperthermia device in magnetic fluids. The equipment has been manufactured at The Bioinstrumentation Laboratory. The first block implies two steps: the signal selection with frequency manipulation option from 9 KHz to 2MHz, and a linear output up to 1500W. The second block is where magnetic field is generated ( 5mm, 10 turns). Finally, the third block is a software control where the user can establish initial parameters, and also shows the temperature response of MNPs due to the magnetic field applied [4-8]. The Bioinstrumentation Laboratory in collaboration with the Mexican company MRI-DT have recently implemented a new research line on Nuclear Magnetic Resonance Hyperthermia, which is sustained on the patent US 7,423,429B2 owned by this company. This investigation is based on the use of clinical MRI equipment not only for diagnosis but for therapy [9]. This idea consists of two main facts: Magnetic Resonance Imaging can cause focal heating [10], and the differentiation in resonant frequency between healthy and cancer cells [11]. To produce only heating in cancer cells when the whole body is irradiated, it is necessary to determine the specific resonant frequency of the target, using the information contained in the spectra of the area of interest. Then, special RF pulse sequence is applied to produce fast excitation and relaxation mechanism that generates temperature increase of the tumor, causing cellular death or metabolism malfunction that stops cellular division

Cardiorespiratory monitoring equipment interferes with whole body impedance measurements

Bioelectrical impedance measurements are widely used for the study of body composition. Commonly measurements are made at 50 kHz to estimate total body water or at low frequencies (< 10 kHz) to estimate extracellular fluid volume. These measurements can be obtained as single measurements at discrete frequencies, or as fitted data interpolated from plots of measurements made at multiple frequencies. This study compared single frequency and multiple frequency (MF) measurements taken in the intensive care environment. MF bioimpedance (4-1000 kHz) was measured on an adult with and without cardiorespiratory monitoring, and on babies in the neonatal intensive care unit. Measurements obtained at individual frequencies were plotted against frequency and examined for the presence of outlying points. Fitted data for measurements obtained at 5 kHz and 50 kHz with and without cardiorespiratory monitoring were compared. Significant artefacts were detected in measurements at approximately 50 kHz and at integral divisions of this frequency as a result of interference from cardiorespiratory monitors. Single frequency measurements taken at these frequencies may be subject to errors that would be difficult to detect without the aid of information obtained from MF measurements.

Evaluation of gastrointestinal motility in awake rats: a learning exercise for undergraduate biomedical students

Souza MA, Souza MH, Palheta RC Jr, Cruz PR, Medeiros BA, Rola FH, Magalhaes PJ, Troncon LE, Santos AA. Evaluation of gastrointestinal motility in awake rats: a learning exercise for undergraduate biomedical students. Adv Physiol Educ 33: 343-348, 2009; doi: 10.1152/advan.90176.2008.-Current medical curricula devote scarce time for practical activities on digestive physiology, despite frequent misconceptions about dyspepsia and dysmotility phenomena. Thus, we designed a hands-on activity followed by a small-group discussion on gut motility. Male awake rats were randomly submitted to insulin, control, or hypertonic protocols. Insulin and control rats were gavage fed with 5% glucose solution, whereas hypertonic-fed rats were gavage fed with 50% glucose solution. Insulin treatment was performed 30 min before a meal. All meals (1.5 ml) contained an equal mass of phenol red dye. After 10, 15, or 20 min of meal gavage, rats were euthanized. Each subset consisted of six to eight rats. Dye recovery in the stomach and proximal, middle, and distal small intestine was measured by spectrophotometry, a safe and reliable method that can be performed by minimally trained students. In a separate group of rats, we used the same protocols except that the test meal contained (99m)Tc as a marker. Compared with control, the hypertonic meal delayed gastric emptying and gastrointestinal transit, whereas insulinic hypoglycemia accelerated them. The session helped engage our undergraduate students in observing and analyzing gut motor behavior. In conclusion, the fractional dye retention test can be used as a teaching tool to strengthen the understanding of basic physiopathological features of gastrointestinal motility.

Stimuli-responsive magnetic particles for biomedical applications

In recent years, magnetic nanoparticles have been studied due to their potential applications as magnetic carriers in biomedical area. These materials have been increasingly exploited as efficient delivery vectors, leading to opportunities of use as magnetic resonance imaging (MRI) agents, mediators of hyperthermia cancer treatment and in targeted therapies. Much attention has been also focused on ""smart"" polymers, which are able to respond to environmental changes, such as changes in the temperature and pH. In this context, this article reviews the state-of-the art in stimuli-responsive magnetic systems for biomedical applications. The paper describes different types of stimuli-sensitive systems, mainly temperature- and pH sensitive polymers, the combination of this characteristic with magnetic properties and, finally, it gives an account of their preparation methods. The article also discusses the main in vivo biomedical applications of such materials. A survey of the recent literature on various stimuli-responsive magnetic gels in biomedical applications is also included. (C) 2010 Elsevier B.V. All rights reserved.

Noise reduction in biomedical speech signal processing based on time and frequency Kalman filtering combined with spectral subtraction

The goal of this paper is to study and propose a new technique for noise reduction used during the reconstruction of speech signals, particularly for biomedical applications. The proposed method is based on Kalman filtering in the time domain combined with spectral subtraction. Comparison with discrete Kalman filter in the frequency domain shows better performance of the proposed technique. The performance is evaluated by using the segmental signal-to-noise ratio and the Itakura-Saito`s distance. Results have shown that Kalman`s filter in time combined with spectral subtraction is more robust and efficient, improving the Itakura-Saito`s distance by up to four times. (C) 2007 Elsevier Ltd. All rights reserved.

Risk-based decision making method for maintenance policy selection of thermal power plant equipment

This study presents a decision-making method for maintenance policy selection of power plants equipment. The method is based on risk analysis concepts. The method first step consists in identifying critical equipment both for power plant operational performance and availability based on risk concepts. The second step involves the proposal of a potential maintenance policy that could be applied to critical equipment in order to increase its availability. The costs associated with each potential maintenance policy must be estimated, including the maintenance costs and the cost of failure that measures the critical equipment failure consequences for the power plant operation. Once the failure probabilities and the costs of failures are estimated, a decision-making procedure is applied to select the best maintenance policy. The decision criterion is to minimize the equipment cost of failure, considering the costs and likelihood of occurrence of failure scenarios. The method is applied to the analysis of a lubrication oil system used in gas turbines journal bearings. The turbine has more than 150 MW nominal output, installed in an open cycle thermoelectric power plant. A design modification with the installation of a redundant oil pump is proposed for lubricating oil system availability improvement. (C) 2009 Elsevier Ltd. All rights reserved.