Dialys ersätter njurens funktion att rena blodet och att återställa kroppens elektrolytbalans. En viktig del inom dialys är vattenreningen och kvalitén på vattnet. För att avgöra kvalitén så används bakterieodling som metod och nackdelen med detta är det tar en lång tid att få provsvar. Genom att mäta konduktivitet i samband med konceptet A0 så kan antalet provtagningar sänkas och fördelen med detta är att det sparar både tid och pengar. En existerande mjukvara har utvecklats i ett tidigare projekt och syftet med detta examensarbete är att förbättra prestanda och användarvänligheten i den existerande mjukvara och samt utveckla en modul som genererar loggfiler som i ett senare skede kan göras kompatibelt med andra vattenrenare. Det objektorienterade kodspråket C# används som utvecklingsmiljö och arbetet utfördes på Centrum för medicinsk teknik och strålningsfysik – Forsknings- och utvecklingsavdelningen (CMTS-MTFoU) på Norrlandsuniversitetssjukhus. En modul som skapar loggfiler i ett liknande format som Aquaboss loggfilerna utvecklades separat från övervakningsmjukvaran. Implementering i övervakningsmjukvaran skedde genom att modifiera källkoden för grafen så blev den kompatibel med de skapade loggarna. Det resulterade i en fungerande och förbättrad version av övervakningsmjukvaran i både prestanda och användarvänlighet. Mjukvaran är dock fortfarande i teststadiet och måste genomgå ytterligare förbättringar för att kunna med största säkerhet användas i region Västerbotten. Den största förändringen är att en ytterligare graf utvecklades som plottar värdena från de skapade loggarna som ska i ett senare skede ska kunna ersättas eller vidareutvecklas så att värden från andra vattenrenare ska bli kompatibla med grafen. / If a patient has a kidney failure a hemodialysis machine recreates the kidneys function to clean the blood and stabilize the body’s electrolyte balance. One of the important aspects of a dialysis-machine is the water purification process and the water quality. To determine the water quality, two measurements related to disinfection are in consideration, the concept of A0 and conductivity. The purpose of this work is to improve on the existing software that monitors the disinfection effect and the conductivity in various ways that includes performance and user friendliness also, to develop a separate module that generates logfiles with randomized values in reasonable intervals that can be read through a graph and at a later stage improved upon to be used by different water purifiers then from Aquaboss. The overall goal is that the monitor software will be implemented and used throughout the region of Västerbotten. C# with Microsoft Visual Studios 2019 was used during the development process and the work was conducted at CMTS-MT-FoU at Norrland university hospital, Umeå. The priority was creating a logfile generator separate from the monitor software and replicating the real logfiles in a text format. Thereafter implementing this module into the monitor software, itself. The processing of the logfiles with data stretching back to the last two years takes around 10-14 seconds to complete and freezes the user interface (UI). To improve this, all the logic that does the processing was put on a separate thread. A progress bar was added with a constant animation to give a visual indication that and ends when the processing phase is finished. This resulted in an improved version of the existing monitoring software in terms of performance and user friendliness in the graphical interface. The point of the logfile generator is to be replaced in a later stage by values or logfiles from a water purifier of different kinds then what is right now currently used in the developed monitor software (Aquaboss).

Ever since 1968, when the method of flexible bronchoscope was created, the specific method of reusable instruments has been the name of the game. The idea of having the best possible equipment for usage seemed like the most optimal solution for the growing general market that is bronchoscopy. Over the past few years, that narrative has drastically changed, with a rapidly growing market for disposable instruments. Why now and what the benefits are for using disposable over reusable bronchoscopes are common enquiries that are being delved into. This study is aimed to analyse the pros and cons of the different methods, as well as understanding the cost effectiveness. Questions such as, “during a year long period, what method is the cheapest”, “what kind of materials go into a bronchoscope, are their differences” and “what is the most preferred method by relevant personnel” are questions that have been examined. To find these answers, relevant personnel at Swedishhospitals were interviewed, and thorough research was conducted through published articles. The results, pointed towards the fact that it depends on how often the bronchoscope is being used. A smaller hospital that uses a bronchoscope three times a year will benefit from using a disposable bronchoscope from a cost-effective perspective. While a bigger hospital that uses a bronchoscope more than 1000 times a year, will benefit from using a reusable bronchoscope from a cost-effective perspective. If you however take the rate of infections of 2.8% from using a reusable bronchoscope into account, the disposable instrument is the optimal solution. This will work parallel with the potential risk of costs from a fault diagnosis, which increases with the worse camera that the disposable bronchoscope provides. As of today there is no simple answer to which solution is the better one both economically and environmentally. What hospitals should do is make calculations and balance the options against each other and find the best solution for their hospital according to their needs and possibilities.

No description available.

Användandet av 3D-skrivare har ökat inom sjukvården, och möjliggjort utskrift av anatomiska modeller. Karolinska Universitetssjukhuset i Solna planerar att starta ett 3D-laboratorium, med möjlighet till egen produktion av anatomiska modeller. För detta behövs kunskap kring vilka riktlinjer som ska följas, samt möjlighet till kvalitetssäkring av skrivare. I detta arbete undersöks regelverken kring 3D-printing, och ett kvalitetssäkringsobjekt för framtida kvalitetssäkring tas fram. Regelverket för medicintekniska produkter undersöktes bland dokument från EU, USA, och Australien. Tolkningen av EU:s publikationer görs via kontakt med Läkemedelsverket och Socialstyrelsen. Södertälje Sjukhus, jurister, samt professorer vid Stockholms Universitet och Kungliga Tekniska Högskolan kontaktas också med frågor kring riktlinjer. Resultatet visar på ett vagt och subjektivt tolkat regelverk inom EU, där 3D-printade anatomiska modeller kan tolkas som specialanpassade- eller egentillverkade produkter. Kvalitetssäkringsobjektet tas fram med grund i 13 kriterier. De kriterier som i detta arbete ej visar skillnad mellan utskrivna modeller, däribland negativa vinklar, spiral (form), kantighet och ömtålighet spiral, kan bytas ut eller specificeras på annat sätt. Kriterier som minsta hålbredd, kvalitetssäkringsobjektets bottenarea, släthet, självsprickor, spiral (kvalitet) och sprickor (hål) visade på kvalitetsskillnader hos utskrifterna. / Utveckling av 3D-laboratorium på Karolinska Universitetssjukhuset

No description available.

Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Case Report - A case is described of central oxygen pipeline failure that occurred at a large academic hospital and its subsequent implications for managing the situation. Literature review - The literature review undertaken focused on the current state of affairs with regards to anaesthetic staff's knowledge of and preparedness for the management implications of central oxygen pipeline failure. The events I describe below demonstrate a significant deficiency in the staff’s understanding of and training for the crisis, which should be remedied to improve patient safety. Specific measures are suggested in the literature to prevent such incidents and guidelines are available to manage central oxygen pipeline failure. These are reviewed in this study. Recommendations - This study attempts to bring together the most critical aspects that need to be addressed to safely manage similar future incidents. Prevention should include measures to implement clearly stated disaster management plans and increased awareness with regards to the medical gas pipeline system (MGPS), simulation training, efficient alarm systems, personally conducted routine evaluations of equipment and emergency backup systems by anaesthesiologists and effective communication between hospital staff. Careful planning and successful coordination during maintenance and modification of the medical gas pipeline system, using piston-type or air-driven, rather than oxygen-driven, ventilators and optimal design of the hospital bulk oxygen system can contribute to reduce risks. In the event of central oxygen pipeline failure a specific sequence of actions should be taken by the anaesthesiologist and a clear institutional operational policy is described. / AFRIKAANSE OPSOMMING: Gevalsbeskrywing - 'n Geval van sentrale suurstoftoevoerversaking, wat plaasgevind het by 'n groot opleidingshospitaal, word bespreek. Daar word ook gekyk na die praktiese gevolge met betrekking tot die hantering van die situasie. Literatuurstudie - 'n Literatuurstudie is aangepak met die doel om te fokus op die huidige toedrag van sake betreffende narkosepersoneel se kennis en paraatheid in die hantering van sentrale suurstoftoevoerversaking. 'n Wesenlike gebrek aan begrip en opleiding aangaande hierdie onderwerp is geïdentifiseer – areas wat, met die nodige aandag, verbeter kan word ten einde die welstand van pasiënte te verseker. Spesifieke voorkomende maatreëls en hanteringsriglyne word voorgestel deur die literatuur en word gevolglik hersien in hierdie studie. Aanbevelings - Hierdie studie poog om kernaspekte aan te raak ten einde soortgelyke toekomstige voorvalle veilig en optimaal te kan hanteer. Voorkomende maatreëls behels onder meer die daarstelling van duidelik verstaanbare noodplanne, verbeterde bewustheid aangaande die mediese gaspypsisteem, simulasie-opleiding, doeltreffende alarmstelsels, effektiewe kommunikasie tussen hospitaalpersoneel, sowel as narkotiseurs wat self roetine-evaluasies van hul narkosetoebehore en -noodtoerusting uitvoer. Noukeurige beplanning en neweskikking tydens herstelwerk of werk aan die mediese gaspypsisteem, die gebruik van suierventilators (of dan lugaangedrewe in plaas van suurstofaangedrewe ventilators) en die optimale uitleg van 'n hospitaal se suurstoftoevoer, kan bydra om die risiko's te beperk. In die geval van sentrale suurstoftoevoerversaking behoort die narkotiseur stapsgewyse aksie te neem. 'n Duidelike institusionele noodbeleid word ook omskryf.

Atualmente existe uma gama considerável de procedimentos assistenciais de saúde os quais, seja por cultura, ou por exigências legais, só podem ser realizados com aporte tecnológico. Logo reduzir o tempo de parada de um equipamento médico está diretamente associado à viabilização da assistência necessária ao paciente. Em outras palavras, prestar uma manutenção otimizada representa qualidade na prestação de serviço da unidade assistencial de saúde, podendo em alguns casos, até, evitar a morte do paciente. Para isso é muito importante que os defeitos sejam reconhecidos e tratados adequadamente, não se esquecendo da otimização dos recursos financeiros. Com base nesta premissa, este trabalho propõe estabelecer uma relação dos tipos de defeitos apresentados pelos equipamentos com sua ocorrência, utilizando para tal o método de Pareto, fornecendo uma ferramenta de análise de grande utilidade na estruturação de grupos de manutenção corretiva de um serviço de engenharia clínica. Assim foram tomados como amostra quatro tipos de equipamentos que são eletrocardiógrafos, monitores cardíacos, unidades eletrocirúrgicas e incubadoras neonatais; caracterizando a existência de defeitos que podem ser classificados em baixa, média e alta complexidade de resolução, o que reflete na necessidade de ferramentas gerais ou específicas ao reparo e do nível de qualificação da equipe técnica, além do universo de componentes, partes e peças envolvidas com cada etapa de manutenção. Foram qualificados e quantificados defeitos para cada tipo de equipamentos acima, onde se constatou que nos equipamentos médico-hospitalares estudados, a maioria das paradas requisitou intervenções simples, de baixa complexidade. Ou seja, poucos defeitos foram responsáveis por muitas ordens de serviço e que o corpo técnico de manutenção pode esperar e se programar para atuar em cada um deles de acordo com o gráfico de Pareto. Desta forma o serviço de engenharia clínica pode ser direcionado para as necessidades prioritárias do estabelecimento assistencial de saúde, sendo capaz de produzir resultados com melhor custo-benefício. / At the present time there is a considerable range of assistential procedures for the health area, whether by culture or by legal demand they can only happen with technological support. Therefore, to reduce the halt time of a medical equipment is directly associated with feasibility of assistance needed by the patient. In other words, to provide optimized maintenance represents quality in the service provided in health assistential unit, in some cases it can even avoid the death of a patient. In order to accomplish the issue discussed above, it is important to recognize the defects and mend them adequately, however, the optimization of financial resources cannot be forgotten. Based on that premise, this work proposes the establishment of a relation between the kind of defects presented by equipments and its occcurrence, using the Pareto\'s method to accomplish this goal, providing a research tool of great utility in the structure of corrective maintenance groups of a service in clinic engineering. Therefore four kinds of equipment were taken as samples; they are: electrocardiograph, cardiac monitor, electrossurgical units and neo-natal incubator. Once portray ting the existence of defects, which can be classified in low, medium or high complexity of resolution, they can reflect on the necessity of using general or specific tools for mending the equipment and the level of qualification of the technical staff. Moreover, the universe of components, parts and tools involved with each stage of maintenance. For each of the equipment mentioned above the defects were quantified and qualified, within this procedure the medical equipment that was studied, the majority of halt required just simple interventions of low complexity. Therefore, few defects were responsible for many service request forms and the maintenance technical staff could wait and prepare to perform according to Pareto\'s graphic. As a result, the service of clinic engineering can be drawn into the main necessities of the assistant health establishment, being capable of presenting results with the lowest cost-benefit.

Orientador: José Roberto Fioretto / Banca: Eduardo Mekitariam filho / Banca: Marcelo Braciela Brandão / Banca: Mário ferreira Carpi / Banca: Regina Grigoli César / Resumo: Comparar os efeitos agudos do óxido nítrico inalatório (Noi) sobre a oxigenação durante ventilação oscilatória de alta frequência (VAF) e ventilação mecânica convencional (VMC) em crianças com insuficiência respiratória hipoxêmica aguda (IRHA). Crianças com IRHA, com idade entre 1 mês e 14 anos, em VMC com pressão expiratória final positiva (PEEP) maior ou igual a 10cmH2O foram aleatorizadas para VMC (GVMC, n=14) ou VAF (GVAF, n=14), em estudo randomizado e cruzado. Foram registrados índices de oxigenação e variáveis hemodinâmicas à inclusão (Tind), 1 hora após iniciar VMC (T0) e a cada 4h (T4...T24). A relação PaO2/FiO2 aumentou significantemente depois de 4 horas comparada com a inclusão em ambos os grupos [(GVMC- Tind: 111,95 ± 37 < T4h: 143,88 ± 47,5mmHg, p<0,05; GVAF- Tind: 123,76 ± 33 < T4h: 194,61 ± 62,42mmHg, p<0,05)], sem diferença estatística entre eles. Em T8h, a relação PaO2/FiO2 foi maior no GVAF comparado com GVMC (GVAF: 227,9 ± 80,7 > GVMC: 171,21 ± 52,9mmHg, p < 0,05). A FiO2 pode ser reduzida após 4h no GVAF ( GVAF- T4h: 0,53 ± 0,09 < Tind: 0,64 ± 0,2; P < 0,05), mas somente após 8 horas no GVMC. Comparando os grupos em T8h, observou-se que a diminuição da FiO2 foi maior para o GVAF (GVAF: 0,47 ± 0,06 < GVMC: 0,58 ± 0,1; p < 0,05). Tanto a VAF como VMC, associadas com a administração precoce de NOi, melhoram a oxigenação. A VAF possibilita redução da FiO2 e aumento da relação PaO2/FiO2 mais precoces quando comparada com VMC, em 8h. Entretanto, ao final de 24h de observação, não houve diferença significante na melhora clínica devido a aplicação da VAF associada com NOi quando comparada com VMC associada com o gás. Nossos resultados precisam ser confirmados por uma base mais ampla de casos em estudo randomizado / Abstract: To compare the acute oxygenation effects of high-frequency oscillatory ventilation (HFOV) plus inhaled nitric oxide (iNO) with conventional mechanical ventilation (CMV) plus iNO in acute hypoxemic respiratory failure (AHRF) children. Children with AHRF, aged between 1 month and 14 years under CMV with PEEP ≥ 10 cmH2O were randomly assigned to CMV (CMVG, n = 14) or HFOV (HFVG, n = 14) in a crossover design. Oxygenation indexes and hemodynamic variables were recorded at enrollment (Tind), 1 hr after CMV start (T0) and then every 4 hr (T4h, etc.). PaO2/FiO2 significantly increased after 4 hr compared to enrollment in both groups [(CMVG -Tind: 111.95 ± 37 < T4h: 143.88 ± 47.5 mmHg, p < 0.05; HFVG-Tind: 123.76 ± 33 < T4h:194.61± 62.42 mmHg, p < 0.05)] without statistical differences between groups. At T8h, PaO2/FiO2 was greater for HFVG compared with CMVG (HFVG: 227.9 ± 80.7 > CMVG: 171.21 ± 52.9 mmHg, p < 0.05). FiO2 could be significantly reduced after 4 hr for HFVG (HFVG-T4h: 0.53 ± 0.09 < Tind: 0.64 ± 0.2; P < 0.05) but only after 8 hr for CMVG. Comparing groups at T8h, it was observed that FiO2 decrease was greater for HFVG (HFVG: 0.47 ± 0.06 < CMVG: 0.58 ± 0.1; p < 0.05). CBoth ventilatory techniques with iNO improve oxygenation. HFOV causes earlier FiO2 reduction and increased PaO2/FiO2 ratio compared to CMV at 8 hr. However, at the end of the protocol, there was no significant difference and no clinical improvement derived from the application of both ventilatory strategies with iNO. It is not possible to say what would have happened if a different conventional ventilatory mode had been used, given the fact that our study has a limited number of patients included in each group / Doutor

The medical equipment market is very competitive in Taiwan, the equipment suppliers in response to the multiplex market changing, and to satisfy with the hospitals about demands of equipment and costs of control, we adopt the cooperative way, buildoperate- transfer (BOT) for specific equipment in some hospitals. ¡´The equipment suppliers may participate in the management of non-medical behavior to achieve mutual benefit and win-win situation with the hospital. ¡´ This study is case study research, according to the experiences of management over past several years I collect data from the objects of 6 BOT cases in each 6 hospital. By data classification and statistical analysis, found the characteristics and differences in each case that the equipment suppliers can proposed the more precise investment appraisal in the future. ¡´ This research found that medical equipment, the number of patients, examination items, the proportion between hospital and the equipment supplier, hospital¡¦s location, and the payment points from NHI are causing hospitals and equipment suppliers having a large gap between revenue and are affecting the survival of medical suppliers. ¡´ According to the results, in order to providing more accurate diagnosis to doctors and improving patient's medical quality, this study suggested that the hospitals and the equipment suppliers should develop a set of medical equipment about BOT investment appraisal system. To achieve the aspect that a three-way win for the patient, hospital and equipment supplier.

Since Taiwan implemented national health insurance, the advanced medical equipment companies began to enter the Taiwan market, driven by the rise of medical equipment industry. But with the degree of national health insurance payment system limitations and changes, such as: Global Budget, DRG (Diagnosis-Related Group), resulting in market competition. How to be successful business development, the medical equipment suppliers have to think about it and find the solutions. Medical device marketing channel is a very important part , especially , under the environmental situation of the development of innovative products is not easy, as well as NHI price reduction , so the channel strategy to optimize all the more were necessary up. The purpose of this study is to explore the medical equipment business channel business development decision-making factors and decision-making method. In this study, using the literatures of medical equipment industrial property, business model, channel management, relationship Marketing and the key factors ¡K.etc, to construct a number of dimensions of "the critical factor of medical equipment operation and development ". In addition to conduct expert interviews with some executives of the medical equipment suppliers, access decision factors and decision-making methods into the questionnaire of interview, as well as analyze the correlation between decision factors and decision-making . The results could be a reference of decision making for medical equipment industry. The findings are as follows: 1. Supplies will based on Company size, financial capacity and lack of core parts to select distributors, the selection of channel pattern will consider the complementary of each other. Some core advantages, as the channel management of resources, can improve market penetration and market share. 2. Financial strategy usually results in considering the growth of the financial strategy or cost control, will affect the choice of channel type. Growth strategy will be direct , cost-control strategies will be authorized . 3. Product professional level will be considered together with the ability of distributors, and distributors of professional competence will affect the extent of authorization from suppliers. 4. Brand awareness and product profitability are channel management resources for suppliers. 5. Distributor professional ability and risk-taking ability have to match product attributes and customer attributes. 6. Suppliers¡¦ resources have to integrate a good channel relationship models to improve efficiency and benefits.