ABSTRACT
Problem and Motivation. Medical device remote control technologies can enable remote experts to contribute to patient care during tele-critical care during public health emergencies like COVID-19 to address the shortage of local clinical expertise. The benefit of such technologies may be further amplified if one remote-control application can operate multiple interoperable medical devices (e.g. multiple types of ventilators or IV pumps) to support the typical diversity of deployed medical devices in one institution. However, due to the variation in capabilities of different makes/models of the same device type, this unified remote control capability requires the standardization of the data interfaces of similar devices to provide sufficient information about these devices to enable safe remote control. Method(s): Medical Device Interface Data Sheets (MDIDS) [1] can provide a useful tool for documenting current and future device interface requirements and capabilities. We examined several clinical use scenarios where externally controllable infusion pumps are used to support tele-critical care, based on which we generalized an MDIDS for remotely controllable infusion pumps. To validate this generic MDIDS, we cross-checked it with the capabilities of several externally controllable infusion pumps: the NeuroWave Accupump, Eitan Medical Sapphire, and the BD Alaris GH. Result(s): During the development of the generic remotely controllerable infusion pump MDIDS, we were able to identify the common and specific data elements that different infusion pumps need to provide at their data interfaces, considering the great diversity in these devices related to infusion mechanism, infusion programming methods, device alarms and alerts, and system settings. The resulting MDIDS includes over 100 data elements, many of which are essential for safety, including those common across different pump types (e.g., maximum settable infusion rate, occlusion alarm) and those specific to certain pump types (e.g., syringe size for syringe pumps). We developed the generic MDIDS as the theoretical basis and developed an application in our OpenICE open-source interoperability research platform [2] to remotely control the above three infusion pumps either via serial communication (representing controlling the infusion pump at a distance limited by a physical wired connection inside or outside the patient room) or across the Internet using the web extension service of OpenICE (representing situations where remote experts have no physical access to the patient). Conclusion. MDIDS for externally controllable medical devices can provide a solid basis to improve the safety and interoperability of medical device remote control technologies in the tele-critical care context. They can also benefit the research, development, and testing of physiological closed-loop control systems. We applied the MDIDS methodology to infusion pumps and ventilators to support the integration of these devices to the U.S. Army Telemedicine & Advanced Technology Research Center (TATRC) National Emergency Tele-Critical Care System.
ABSTRACT
Background The prevalence of children living with life limiting conditions is increasing. These children often require tertiary palliative care input for management of symptoms: specialist palliative care teams develop individual symptom management plans and/or syringe driver plans (SMP/SDP) to guide management of pain and distressing symptoms. There is no national guidance on how and when such plans should be used and their implementation varies across the country. Objectives Identify the development and use of SMP/SDP in management of symptoms in children referred to a tertiary palliative care service with particular attention medications used at the end of life (EoL). Methods Seven month (February-August 2020) prospective, comparative study of all children referred to a tertiary palliative care service including: recording of all referrals with number of SMP/SDP written type and number of medications prescribed in the SMP/SDP and used by the patient at the EoL. Results 102 patients were referred to the tertiary palliative care service. 87 SMPs were written for a total of 58 patients. 43 patients had a SMP/SDP at the EoL. Median medications included in a SMP was 13 (range 3-32) with 2 medications (range 0-14) used at EoL. Median number prescribed in SDPs was 6 (range 2-10) with 2 drugs used at EoL (range 0-7). The most common medications prescribed and used were opiates and midazolam. The most common symptoms were pain, breathlessness nausea vomiting and constipation. Conclusions SMPs/SDPs are written for a significant number of patients referred to palliative care. Often only a few drugs from the SMP/SDP were required at the end of life particularly opiates and midazolam. Further study is needed to understand the purpose use and impact of SMP/SDP on symptom control particularly at the EoL. Of note this project took place during the coronavirus pandemic, and hence bears repeating when circumstance change.
ABSTRACT
The importance of measurement quality cannot be over emphasized in medical applications, as one is dealing with life issues and the wellbeing of society, from oncology to new-borns, and more recently to patients of the COVID-19 pandemic. In all these dire situations, the accuracy of fluid delivered according to a prescribed dose can be critical. Microflow applications are growing in importance for a wide variety of scientific fields, namely drug development and administration, Organ-on-a-Chip, or bioanalysis, but accurate and reliable measurements are a tough challenge in micro-to-femto flow operating ranges, from 2.78 × 10-4 mL/s down to 2.78 × 10-7 mL/s (1000 µL/h down to 1 µL/h). Several sources of error have been established such as the mass measurement, the fluid evaporation dependent on the gravimetric methodology implemented, the tube adsorption and the repeatability, believed to be closely related to the operating mode of the stepper motor and drive screw pitch of a syringe pump. In addition, the difficulty in dealing with microflow applications extends to the evaluation of measurement uncertainty which will qualify the quality of measurement. This is due to the conditions entailed when measuring very small values, close to zero, of a quantity such as the flow rate which is inherently positive. Alternative methods able to handle these features were developed and implemented, and their suitability will be discussed.