Pulse Oximeter

Masimo (NASDAQ: MASI) announced today that a new study published in this month's issue of the European peer-reviewed journal Acta Paediatrica demonstrates that pulse oximetry makes a critical difference in neonatal resuscitation both in terms of reliability and speed of measurements.  In comparing the measurement response times of three different pulse oximetry technologies, researchers found that the Masimo Radical-7™ pulse oximeter with Masimo SET® Measure-Through Motion and Low Perfusion technology displayed reliable oxygen saturation (SpO2) measurements three to four times faster than competing pulse oximeters.

In comparing the measurement response times of three different pulse oximetry technologies, researchers found that the Masimo Radical-7™ pulse oximeter with Masimo SET® Measure-Through Motion and Low Perfusion technology displayed reliable oxygen saturation (SpO2) measurements three to four times faster than competing pulse oximeters. 2 measurement was recorded post-ductally (one sensor placed on each foot) once an adequate pulse rate signal was displayed. Results showed that "the pulse oximeter with Masimo SET provided the fastest response time."
 

Despite numerous advances to improve newborn care, oxygen is still used liberally during newborn resuscitation—unnecessarily exposing many newborns to potentially damaging hyperoxia.  Although pulse oximetry is an important clinical tool for evaluating a patient's oxygenation status and guiding resuscitation, measurement failure rates due to motion artifact and low perfusion can be high—leading to inaccurate readings, failure to report readings, or freezing of displayed values. As a result, the time to obtain a reliable oxygen saturation reading during newborn resuscitation in the delivery room and during NICU care is a critically important consideration when choosing a pulse oximetry technology.  This is the first prospective observational study to compare pulse oximetry technology performance in detail during newborn resuscitation under unstable critical conditions.

The study was conducted at two health care centers in Barranquilla, Colombia (Clinica del Mar and Medicina Alta Complejidad S.A.) on 32 newborns (median gestational age of 32 weeks) receiving resuscitation as standard of care either in the delivery room or in the Neonatal Intensive Care Unit (NICU). Using the Masimo LNOP® sensor with the Radical-7, the E630 sensor with the Ohmeda Biox 3700, and the OxiMax Max-N sensor for the Nellcor N395, the time to a reliable SpO

In the first comparison of 17 infants, the median response time to obtain a reliable measurement for the Masimo Radical-7 was 20.2±6 (with a range of 18-26 seconds) versus 74.2±12 (with a range of 38-98 seconds) for the Ohmeda Biox 3700. 

In the second comparison of 15 infants, the median response time for the Masimo Radical-7 was 20.9±4 (with a range of 19-28 seconds) versus 67.3±21 (with a range of 40-90 seconds) for the Nellcor N-395.

Finding that "there are significant differences in the response of pulse oximeters during neonatal resuscitation," researchers concluded that "the speed and reliability of the Masimo SET technology can be of help for clinicians to more accurately adjust the fraction of inspired oxygen during newborn resuscitations, thus preventing or minimizing damage secondary to unnecessary exposure of oxygen and hyperoxemia and to wide fluctuations in oxygen levels." 

The 'gold standard' Measure-Through Motion and Low Perfusion performance of Masimo SET® has been shown in over 100 independent clinical studies to provide the most accurate and trustworthy measurements—even under the most challenging clinical conditions, including patient motion and low perfusion. 

Source: Masimo Corporation

Corneal Cross-linking Illumination System

Crosslinking with riboflavin and UV-A light has proven to be a first-line treatment for people with corneal ectasia disorders such as keratoconus, and pellucid marginal degeneration and corneal weakness (ectasia) after LASIK.

Photo-polymerisation with the use of ultra-violet light is the most promising technique to achieve cross-linking in connective tissue. Photo-polymerisation is activated by means of a non-toxic and soluble photomediator together with a wavelength of 365 nm UV-A light source.

Fig 1, shows corneal crosslinking strengthens bonds in the stroma of the cornea, which is the layer from which tissue is removed during LASIK surgery

Fig 2, shows UV-X in use for eye treatment.

Homogeneous UV-A irradiation of the corneal is an important factor for a safe treatment procedure.Thus a homogeneous illumination of the cornea with a patented beam and optics is essential - the IROC UV-X. UV-X was developed by an experience team of researchers in collaboration with the inventors of the procedure, Prof Theo Seiler and Prof Eberhard Spoerl. It is designed with a special focus on both safety and effectivity of the procedure, embodying the cutting-edge knowledge in the field of corneal cross-linking.

Fig 3, shows Scanning Electron microscopy image of the homogenizing micro-structure used in the UV-X.

Pictures of the UV-X treatment versus the LED techniques are shown below:

Fig 4, shows UV-A versus direct LED irradiation

Fig 5, shows compensation of the corneal curvature using UV-X.

Fig 6, shows comparison of the treatment distance with reference to intensity-damage threshold.

Fig 7, shows an optical design according to Koehler's reduces the radiant exposure to retina.

Once patients have received crosslinking, in most cases their corneal shape will either remain stable or actually improve. This can provide patients with improved visual acuity and improved ability to wear contact lenses.

 Some surgeons have also reported reasonable results in improving the stability of the cornea in people who have undergone radial keratotomy, an incisional refractive procedure from the 1980s and 1990s. Crosslinking appears to work best for those who are experiencing daily fluctuations in their vision.

People who are considering vision correction procedures such as LASIK also might eventually be pre-treated with corneal crosslinking to strengthen the eye's surface before undergoing an excimer laser ablation that reshapes the cornea.

Source:  http://www.allaboutvision.com/conditions/corneal-crosslinking.htm

Fibroscan an alternative to liver biopsy

Fibroscan technique is a concept developed and produced by Echosens.

The FibroScan technique is used to quantify hepatic fibrosis in a totally non-invasive and painless manner, with no contra-indications for the patient. It is basically an ultrasound scanning system assessing liver scarring, termed fibroisis. Here the wave generated by the ultrasound transducer is propagated down to amd through the liver in which the velocity of the wave is measured. The speed of the wave reflects the degree of fibrosis and correlates with the stiffness of the liver. A higher degree of fibrosis correlates to higher stiffness of the liver. Fibroscan uses Kilopascals as the unit of measurement. The measurement is a median score of at least 10 readings. In viral hepatitis, a score of less than 7 means no or insignificant liver fibrosis. A score  of more than 12.5 KPa is severe fibrosis or cirrhosis and the results between this suggest moderate fibrosis.

Does FibroScan Accurately Assess Liver Fibrosis?

 Vibration-controlled transient elastography (VCTE) with FibroScan can provide an accurate assessment of liver fibrosis in patients with chronic viral hepatitis, but operator-related and patient-related factors affect measurements.
(Report 2 articles published in the April issue of Clinical Gastroenterology and Hepatology.) The lowest levels of variation occur in patients with no or early-stage fibrosis, or when the procedure is performed by a single experienced operator, the studies show.

It is important to determine the level of fibrosis in patients with chronic liver diseases, including nonalcoholic steatohepatitis (NASH), to evaluate disease progression. Until recently, liver disease progression could only be monitored by collection of biopsies and histologic analyses. However, liver biopsies provide information about only a small part of the liver, and are uncomfortable and even dangerous for patients.

VCTE with FibroScan (Echosens; Paris, France) transmits a vibration at low frequency to induce an elastic shear wave; the velocity of the wave propagation can be measured and directly relates to the tissue stiffness. VCTE acquires information from about 100-fold more sample tissue than a liver biopsy. Furthermore, the procedure is rapid, noninvasive, and can be performed at the bedside, providing the physician with immediate information for patients. Findings from VCTE are generally considered to be reproducible.

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.

Reference: http://journalsblog.gastro.org/does-fibroscan-accurately-assess-liver-fibrosis/

Wireless Vital Signs Monitoring

The process of manually charting patient's blood pressure, pulse rate, respiration rate, SpO2 are laborious and tedious. It also opened up for error in charting for each patient where the charting error could be onto a wrong patient's record or vital signs were not timely charted accordingly. Using RFID-enabled technology on-line vital signs monitoring is an approach towards minimising some of these errors and help manage the process in a better way.

 

Source: www.cadi.com.sg

Here we can utilize an electronic bridge that serves as a medical device interface with direct connection to non-invasive blood pressure devices, SpO2, etc via RS232 serial port and wirelessly uploading the data onto the central clinical charting system or a dedicated Vital Signs Dashboard. The electronic bridge makes use of the WLAN 802.11 b/g, ISM band radio technology. It receives the vital signs data through the RS232 port and upload the data to the central clinical charting system . Each patient's record is recognised by the barcode of the patient's wrist which is entered into the system by a barcode scanner. Nurses can observe and make assessments of the patients before uploading data onto the central clinical charting system. Uploading of the patients' vital signs measurements can also be done automatically with the system or at user-defined intervals. Hospital clinical staff will be able to view the patient's vital signs through its wed-based system. The ultimate aim of the system is the relieve nurses from the menial tasks but on the other hand provide accurate data capturing of the patients vital signs.

Robotics Surgery

Have you heard of Robotics Surgery? Well this is not new! Surgeon nowadays uses robotic arm to perform surgical procedures! 


The use of robotics minimally invasive techniques minimize the physical and emotional impact of surgery on patients. Robotically-assisted MIS represents a third generation of surgery, one which builds upon the advances to open surgery introduced by MIS. Robotic technology takes surgery beyond the limits of the human hand, introducing precise, versatile instrument movement combined with three-dimensional visualization of the operative site. With minimally invasive surgery, the goal is to accomplish internal repair while leaving the body surface as natural as it was prior to surgery. Many procedures require only several days in the hospital and promote reduced recovery time. Patients can often get back to their normal routines more quickly.

What are the benefits of using such a device where in the past they rely solely on their pair of hands to do the magic?
The reasons as follows:

• minimally invasive
• minimize the physical and emotional impact of surgery on patients
• it takes surgery beyond the limits of the human hand, introducing precise, versatile instrument movement combined with three-dimensional visualization of the operative site.
• accomplish internal repair while leaving the body surface as natural as it was prior to surgery.
• promote reduced recovery time where patients can often get back to their normal routines more quickly. 

Source: http://www.davincisurgery.com/

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.
 
Source: http://www.davincisurgery.com/