Study on the Comparison of Three Typical Gas Flow Standards for Calibrating Low Gas Flowmeter

A gas flowmeter for measuring low flow rate has been widely used in the field of medical, health, environmental protection, energy industry, aerospace, etc. To against Covid-2019, the requirement on the low flow rate has been increasing dramatically. At present, the typical standard devices for calibrating low gas flowmeter mainly include standard bell provers of gas flow, standard piston provers of low gas flow and standard laminar of low gas flow. Different measuring principles are adopted among these typical standard devices. To ensure the consistency of these typical standard devices, a comparison test is performed. The standard devices used in the comparison are of the same accuracy grade, with an extended uncertainty of 0.2%(k=2). The piston-type gas flow calibrator of grade 1.0 is selected as the transfer standard, and three flow points with high flow rate, medium flow rate and low flow rate are selected for test. The consistency of measurement results is evaluated by normalized deviation En. The comparison results are acceptable which show that three typical standard devices are accurate and reliable. © FLOMEKO 2022.All rights reserved

Impact of Time-Motion Patient Flow Analysis on the Productivity of an Endoscopy Unit in a Large Safety-Net Health Center

Introduction: The COVID-19 pandemic disrupted health care delivery, particularly for high-volume procedural areas. To improve productivity in the Los Angeles County 1 University of Southern California Medical Center (LAC + USC) Endoscopy Unit, we initiated an iterative rapid cycle quality improvement process to identify inefficiencies and implement changes to our workflow. Method(s): A time-motion analysis of patient flow through the LAC + USC Endoscopy Unit was used to construct a time-tracked flow sheet to track individual patients as they moved through the Unit. Data were collected weekly over 3 9-10 week phases, and intervening plan-do-study-act (PDSA) cycles were conducted to direct interventions for subsequent phases. Following phase 1 (9/1/21 to 11/9/21) we implemented targeted interventions at the start of phase 2 (12/1/21 to 2/1/22) and phase 3 (3/15/22 to 5/31/22). Phase 2 was focused on our anesthesia supported endoscopy room which requires greater resource coordination. Metrics were compared to published benchmarks. Linear regression was used to compare outcome parameters for the lean process flow improvement project. Result(s): Our phase 1 analysis showed operational delays in room turnover time for all procedures and pre-operative assessment and first-case on time start percentage for procedures supported by anesthesia, when compared to published benchmarks (Table 1). In phase 2 we implemented an intervention of combining pre-anesthesia visits with endoscopy teaching visits for patients designated to have anesthesia support. This significantly improved both turnover time and throughput for the anesthesia room (Table 1). In phase 3 we initiated a policy of preparing the first patient of the day in the procedure room which dramatically increased first-case on time start percentage. We further streamlined inter-procedure processes by simultaneously consenting, placingmonitoring equipment and documenting in the time between procedures, leading to a greater than 20% increase in total procedure volume (Table 1). Procedure throughput for the anesthesia supported procedure room increased from 4.5 to 7 to 9 procedures per room per day for phases 1, 2, and 3 respectively (Table 1). EndoscopyUnit staffing remained unchanged throughout the study period. Conclusion(s): Time-motion analysis of patient flow may be used to perform targeted interventions with significant improvements in Endoscopy Unit efficiency. This may be achieved without costly interventions such as hiring additional support staff or faculty. (Table Presented).

Identifying candidates for one-night stay robot assisted simple prostatectomy: Single center analysis

Introduction & Objectives: Since COVID-19 global pandemic started, increasing importance was given to same-day discharge (SDD) protocols to minimize viral exposure, reducing healthcare costs without compromising patients' safety. While SDD protocols have been applied for robotic radical prostatectomy, literature is still lacking studies evaluating the feasibility of meeting SSD criteria for patients who underwent RASP. Our aim was to evaluate the feasibility and safety of hospital discharge 24h after surgery. Our secondary endpoint was to assess predictors of successful discharge on 1st postoperative day (POD). Material(s) and Method(s): Patients with allergy to local anesthetics, those scheduled for concomitant surgical procedures and those with severe comorbidities (ASA score 3-4) were excluded from the analysis. Outcomes of this study were: Postoperative Hb drop, 30-day post-surgical readmission, any post-discharge complication, postoperative, time to flatus and consequent regular diet restoration, PSA, flowmetry parameters and validated questionnaires. The SDD criteria included: stable postoperative hemoglobin and vital signs, tolerance of clear liquids, pain control with oral medications and no perioperative complications requiring a prolonged hospitalization (Clavien >1). Result(s): Demographics and baseline values of 63 consecutive patients were reported in Table 1. Perioperative outcomes were shown in table 2. No perioperative complications were reported, median DELTAHb was 2.2 mg/dl, vital signs were stable for every patient. Overall, 55 (87%) patients passed flatus within 24 hours from surgery, and regular diet was restored;7 patients (11%) needed opioids for pain control. Two thirds of patients (n=42, 67%) met the criteria for SDD. At logistic regression analysis, patient's age was the only independent predictor of one night stay (OR 0.89;95% CI 0.80 - 0.98 p=0.02;Table 3). Patients younger than 60 met 24 hours discharge criteria in 90%, while those older than 70 in 50% of cases. Conclusion(s): In a selected cohort of patients with negligible comorbidities profile, discharge within 24h from RASP seems a safe and feasible option in 67% of cases. Patient' age was the only predictor of successful 1 night stay after RASP in our series. [Table presented]Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Intermediate respirtory care unit patient flow analysis during the covid-19 pandemic

The IRCU of our hospital has increased its activity in the COVID-19 pandemic. The respiratory isolation condition has been an organizational challenge and has had a huge impact in the patient flow. Our IRCU has 3 subunits: nonCOVID (8 beds), COVID (up to 24 beds in open stay) and non-tested (8 beds). We have analysed the hospital activity register from November 2020 to April 2021, analysing the patient flow. For COVID IRCU admission criteria, a positive PCR with FiO2 > 0.50 with SatO2 <95%, RR > 25 and PaO2/FiO2 <250. We had 685 admissions: 52% in the COVID IRCU (average stay 6.82 days), 27.6% in the non-tested IRCU (AS 3.94 d) and 26.4% in the non-COVID IRCU (AS 6.32 d). A total of 43% admissions of the COVID-IRCU came from the Infectious Diseases Unit (IDU), 43.5% from the ED/other hospitals, and 1.12% from the ICU. Of the overall of COVID-IRCU, 29% required admission to the ICU and the mortality rate (MR) was 15.16%. A total of 40.7% admissions of non-COVID IRCU, ED 45.7%, and 13.6% the ICU. Of 6.4% patients required admission to the ICU (MR 6.4%). A total of 61.4% admissions of the non-tested IRCU, ED and 22.2% required admission to the ICU, with a 13.2% MR. The pandemic has highlighted the importance of the IRCU, reducing admissions and ICU stay. Our IRCU, maintains optimal respiratory isolation conditions in the non-tested IRCU, maintaining the normal activity in the non-COVID IRCU.

Measured Air Flow Leakage in Facemask Usage.

The importance of wearing a facemask during a pandemic has been widely discussed, and a number of studies have been undertaken to provide evidence of a reduced infectious virus dose because of wearing facemasks. Here, one aspect that has received little attention is the fraction of breathing flow that is not filtered because it passes as leak flow between the mask and face. Its reduction would be beneficial in reducing the dose response. The results of the present study include the filter material pressure loss parameters, pressure distributions under masks, and the fraction of breathing flow leaked versus steady breathing flow in the range of 5 to 30 L min-1, for two commonly used facemasks mounted on mannequins, in the usual 'casual' way and in a 'tight' way by means of three different fitters placed over the mask to improve the seals. For the 'casual' mount, leaks were high: 83% to 99% for both masks at both exhalation and inhalation flows. For the 'tight' mount with different fitters, the masks showed different lower levels in the range of 18 to 66% of leakage, which, for exhalation, were nearly independent of flow rate, while for inhalation, were decreasing with increasing rates of respiration flows, probably because suction improved the sealing. In practice, masks are worn in a 'casual' mount, which would imply that nearly all contagious viruses found in aerosols small enough to follow air streams would be exhaled to and inhaled from the ambient air.

Urology Referral of Non-neurogenic Male Lower Urinary Tract Symptoms during Covid-19 Pandemic from Primary Health Care Center. Steps Can Make Difference

Introduction:Waiting times for prostate assessment and diagnosis in suspected BPH are exceptionally long(1). Deficient referral data considerably affect triage decision and patients' waiting list. Aim(s): To assess quality of male LUTS referrals. Material(s) and Method(s): A retrospective study included urgent (within 2 weeks) and routine (within 4 weeks) electronic male LUTS referrals for (patients >= 40 years(2)) to Urology clinic in AlWakra Hospital during (June 2021-February 2022) from Primary Health Care (PHC). Exclusion: Covid-19 positive, frank hematuria, fever, UTI, suspected malignancy, known urethral stricture, urinary retention or catheter/JJ stent in situ. Next available Urology clinic slot and LUTS referral data were analyzed. All cases were electronically registered (quality control). Result(s): Next available Urology clinic first visit (on February 2022) for (9 staff, 11 clinics weekly) is (mean 251 days). LUTS referrals: 57 patients, age (40-86) years, urgent 24/57 (42%) and routine 33/57 (58%) referrals. Analysis showed documented: urinalysis in 16/57, renal function tests in 24/57, US KUB results in 8/57, PSA result (no documented counseling/request justification) in 22/57, and (flowmetry and voiding diary) in 1/57 referrals. All without documented digital rectal examination (DRE) or IPSS score. Conclusion(s): Standardized non-neurogenic male LUTS (referral template), encouraging IPSS, flowmetry and voiding diary use in PHC, and electronic registry use will optimize Urology clinic utilization. Covid- 19 restrictions/Telemedicine consultations should not prevent DRE assessment. PHC physicians' education about indications for urgent LUTS referral and PSA request guidelines is essential. Copyright © 2022 European Association of Urology. Published by Elsevier B.V.

Flowmeter based on capillary tubes trough 3D stereolithography fabrication for test mechanical ventilation equipment

Mechanical ventilators and high-flow machines are medical devices with important measuring instruments for monitoring patients with respiratory failure. The most common monitoring parameters are lung proximal pressure, inspiratory flow, expiratory flow, inspiratory oxygen fraction, etc. The present work delves into the design, fabrication, and experimental measurement of a proximal flow sensor based on the theory of capillary tubes and stereolithography. The design was carried out in Inventor Professional 2020 software and then the computational study by CFD ANSYS to compare the dynamic pressure states of the geometric measurement points. The manufacturing was carried out using SLA 3D printing technology on an ANYCUBIC FHOTON MONO X.The fabricated FM SLA prototype has radially positioned latex tubing lines to achieve differential pressure measurement at two points separated by capillary tubes. These hoses are connected to a developmental embedded system based on a HONEYWELL 001PG7A5 differential pressure sensor and Arduino Uno Microcontroller. Finally, experimental tests of the Flow Meter Stereolithography (FM SLA) protype measurements were performed with flow rates from 0 to 44.5 lpm in 1 lpm increments. From the collected data we have an R2: 0.9983 in quadratic polynomial approximation with the actual measurement data. © 2022 IEEE.

ASAIO 2022 Annual Meeting Abstracts

The proceedings contain 226 papers. The topics discussed include: identification of biomarkers sensitive to pulsatile and continuous flow for identification of promising continuous flow VAD modulation protocols to mitigate non-surgical bleeding events;comprehensive machine learning analysis of pre-implantation risk factors for right heart failure after LVAD implantation;combining VA-ECMO And Impella (EC-Pella) before reperfusion mitigates left ventricular loading and injury due to VA-ECMO in acute myocardial infarction;platelet function at the intersection of the COVID-19 'cytokine storm' and mechanical circulatory support;a dialysate free portable artificial kidney device;durable right heart mechanical support system: a multi-day proof-of-concept study in pulmonary hypertension sheep;a dual-action nitric oxide-releasing slippery surface coating for extracorporeal organ support: first evaluation at clinically relevant blood flow rate for partial lung support;cannula add-on for pressure and flow measurement in VADs;and comparison of interlaboratory CFD simulations of the FDA benchmark blood pump model.

AN OPERATIONS MANAGEMENT APPROACH TO A CRITICAL ENDOSCOPIC BACKLOG

Background: The COVID-19 pandemic introduced unprecedented disruptions to healthcare delivery, particularly for ambulatory services such as gastrointestinal endoscopy. At the peak of the pandemic in our region between December 2020 to February 2021, ambulatory endoscopy services were suspended at the Los Angeles County + University of Southern California Medical Center (LAC+USC). While endoscopy services resumed in March 2021, the operational challenges introduced by COVID-19 led to a mounting backlog of patients awaiting endoscopic procedures reaching 1,035 by June 2021. As part of our solution to this crisis, we used the principles of operations management to perform a process flow analysis to identify inefficiencies and develop targeted interventions to enhance the operational performance of our endoscopy unit. Methods: A time-motion analysis of patient flow through the LAC+USC Endoscopy Unit was used to construct a comprehensive time-tracked flow sheet to track individual patients as they moved through the unit from check-in to discharge on random dates over a 6-week period (Figure 1). Simultaneously, a qualitative stakeholder survey on perceived operational inefficiencies was distributed to all faculty, staff, and fellows in the endoscopy unit. At the end of 6 weeks, collected data were compared to both published benchmarks and stakeholder survey responses, and inefficiencies identified for intervention. Results: Data were collected for 214 procedures (179 moderate sedation, 35 monitored anesthesia care) in the endoscopy unit. When compared to established benchmarks, we found operational delays in 1) check-in to procedure start time, 2) room turnover time, and 3) first-case on-time start percentage (Table 1). Results from the stakeholder survey aligned with these data. Targeted interventions (Table 1) developed by a multi-disciplinary group of faculty, nursing staff, and trainees from both Gastroenterology and Anesthesiology departments were then implemented, including 1) preparation of the first patient of the day in the procedure room, 2) pre-operative clinic visits for all patients designated to require anesthesia during endoscopy, 3) implementation of a brief-operative note and 4) a time study to encourage first-case on-time start. In combination with maneuvers to streamline the pre-procedure process, this resulted in a reduction of the backlog to 430 by November 2021. Conclusion: Granular analysis of data tracking process flow times through the LAC+USC Endoscopy Unit aligned with stakeholder perceptions regarding operational inefficiencies. The combination of objective and subjective data allowed us to rapidly implement targeted interventions to increase the throughput of the endoscopy unit and address the backlog of endoscopy procedures caused by the COVID-19 pandemic. (Figure Presented) (Table Presented)

COVID-19 outbreak investigation in a hospital using computational flow analysis

Introduction: Over the last two years, the COVID-19 has caused unprecedented disruption worldwide. Healthcare workers (HCW), particular those working in hospitals have been the most affected from increased risk of contracting COVID-19 from hospital environment and patient care. Although various efforts have been taken by the hospital to reduce the risk, however, outbreaks still continue to occur. This case study reports on an outbreak investigation using computation flow analysis to investigate an outbreak in a non-COVID-19 ward. Material and Methods: This is a case report of an outbreak that occurs in a non-COVID-19 ward in a teaching hospital in Malaysia. The outbreak investigation was conducted, which includes contact tracing, risk assessment, walk-through survey, airflow measurements and computational flow analysis (CFA). Results: The outbreak occurred in one of the five bedded cubicles in a non-COVID-19 ward. The index case was a patient that was admitted for non-COVID-19 related medical conditions. The index case subsequently transmitted the disease to three patients and one HCW. On initial assessment, the HCW was not considered to have acquired COVID-19 from the index case, as the HCW have no unprotected contact with the index case. However, after the walk-through survey assessment, it was noted that airflow may be a contributing factor. An airflow measurement and CFA was conducted and reviewed the possibility route of transmission. Conclusion: The use of airflow assessment and CFA should be considered in a respiratory diseases outbreak investigation.

A blueprint for well-designed, high-performing cloth masks that can outperform a 3-layered surgical mask

Introduction: During COVID-19, due to the worldwide shortages of medical masks, homemade cloth masks became a mainstay of the pandemic. The CDC and WHO recommend the use of homemade cloth masks. However, there is insufficient evidence on the performance: respiratory droplet blocking ability, water-resistant capacity, breathability, and washability of commonly used fabrics to design high-performing cloth masks that can outperform medical masks. Material and Methods: We conducted a series of experiments on aerosol blocking (using healthy volunteers sneeze, image-based flow measurement technique), water-resistant, breathability, and washability to evaluate all dimensions of protection of 17 different commonly available fabrics and their layered combinations. Results: The research provides a blueprint for the optimal design of a high-performing cloth mask that can outperform a 3-layered surgical mask. A minimum of 3 layers is recommended to provide the performance of surgical masks. A combination of cotton/linen for the inner layer, blends for the middle–layer, and polyester/nylon for the outer–layer. The average thread count (threads contained in one square inch) should be greater than 200, and the porosity (percent of pores in a fabric) should be less than 2 %. Increasing the number of layers increases the droplet blocking efficiency by approximately 20 times per additional fabric layer. Machine washing at 60 °C did not affect the performance of cloth masks. Conclusions: These results and visualizations can assist people in preparing effective homemade cloth masks during the ongoing COVID-19 pandemic and future epidemics.

Assessment of Respiratory System Resistance during High-Frequency Oscillatory Ventilation Based on In Vitro Experiment

High-frequency oscillatory ventilation (HFOV) is a type of mechanical ventilation with a protective potential characterized by a small tidal volume. Unfortunately, HFOV has limited monitoring of ventilation parameters and mechanical parameters of the respiratory system, which makes it difficult to adjust the continuous distension pressure (CDP) according to the individual patient’s airway status. Airway resistance Raw is one of the important parameters describing the mechanics of the respiratory system. The aim of the presented study was to verify in vitro whether the resistance of the respiratory system Rrs can be reliably determined during HFOV to evaluate Raw in pediatric and adult patients. An experiment was performed with a 3100B high-frequency oscillator, a physical model of the respiratory system, and a pressure and flow measurement system. The physical model with different combinations of resistance and compliance was ventilated during the experiment. The resistance Rrs was calculated from the impedance of the physical model, which was determined from the spectral density of the pressure at airway opening and the spectral cross-density of the gas flow and pressure at airway opening. Rrs of the model increased with an added resistor and did not change significantly with a change in compliance. The method is feasible for monitoring respiratory system resistance during HFOV and has the potential to optimize CDP settings during HFOV in clinical practice.