ABSTRACT
During the United Kingdom's Covid-19 vaccination campaign, general practitioners (GPs) have held responsibility for vaccinating housebound patients. This presented them with a large, complex and unfamiliar logistical challenge, namely determining the most time-efficient route to visit multiple patients at their home address. In response to a lack of existing solutions tailored specifically to vaccination, and in light of overwhelming demand, Vaximap ( https://www.vaximap.org ) was created in January 2021 to automate the process of route planning. It is free of charge for all users and has been used to-date to plan vaccinations for over 470,000 patients. This article analyses usage data to estimate the time savings (3 work years) and financial savings (£110,000) the service has yielded for GP surgeries, thus demonstrating that it helped to accelerate the UK's Covid-19 vaccination campaign at critical moments.
ABSTRACT
BACKGROUND: The manufacturing of any standard mechanical ventilator cannot rapidly be upscaled to several thousand units per week, largely due to supply chain limitations. The aim of this study was to design, verify and perform a pre-clinical evaluation of a mechanical ventilator based on components not required for standard ventilators, and that met the specifications provided by the Medicines and Healthcare Products Regulatory Agency (MHRA) for rapidly-manufactured ventilator systems (RMVS). METHODS: The design utilises closed-loop negative feedback control, with real-time monitoring and alarms. Using a standard test lung, we determined the difference between delivered and target tidal volume (VT) at respiratory rates between 20 and 29 breaths per minute, and the ventilator's ability to deliver consistent VT during continuous operation for >14 days (RMVS specification). Additionally, four anaesthetised domestic pigs (3 male-1 female) were studied before and after lung injury to provide evidence of the ventilator's functionality, and ability to support spontaneous breathing. FINDINGS: Continuous operation lasted 23 days, when the greatest difference between delivered and target VT was 10% at inspiratory flow rates >825 mL/s. In the pre-clinical evaluation, the VT difference was -1 (-90 to 88) mL [mean (LoA)], and positive end-expiratory pressure (PEEP) difference was -2 (-8 to 4) cmH2O. VT delivery being triggered by pressures below PEEP demonstrated spontaneous ventilation support. INTERPRETATION: The mechanical ventilator presented meets the MHRA therapy standards for RMVS and, being based on largely available components, can be manufactured at scale. FUNDING: Work supported by Wellcome/EPSRC Centre for Medical Engineering,King's Together Fund and Oxford University.