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ABSTRACT In this poster, we describe partial findings from a larger study that explored the co-first and co-corresponding author phenomenon in two biomedical research areas, pharmacy and anesthesia. The top 10 journals in the two areas by the five-year impact factor as listed in 2013 JCR were used for the paper sources. A total of 17802 pharmacy papers and 35801 anesthesia papers were included in the analyses. Each paper was manually examined to identify the co-first and co-corresponding author papers. In this poster, we will show the distributions of the paper numbers and percentages of the co-first and co-corresponding papers over twenty years (1995-2014), the distributions of author numbers sharing the co-first and co-corresponding authorship, and the combinations and distributions of the authors' byline positions. [ABSTRACT FROM AUTHOR]

Anaesthesiologists have a variety of services with a variety of customers or patients. Still, most of the science is only on the basis of the assessment and the literature on certain objective results, such as nausea and vomiting, pain, hemodynamic. However, after undergoing anaesthesia, patient satisfaction has not been paid more attention and has not been comprehensively studied. It is very different from other industries, where customer satisfaction is the main point of activity in their activities. This paper attempts to provide an understanding of the literature on patient satisfaction with anaesthesia services in patients who have received anaesthesia service, where this literature has been collected from various related sources. This research is designed using a qualitative approach through literature study. Reviews of patient satisfaction with anaesthesia services were carried out by reading and analysing 30 peer-reviewed journal articles and summarised in two tables, namely journal articles and publisher distribution and article categories based on their subject. This study's findings are that patient satisfaction is a complex and multi-dimensional concept, which is influenced by several variables such as previous anaesthesia experience, techniques used, duration of procedures, respect for privacy, and communication. In conclusion, patient satisfaction with anaesthesia services can increase or decrease. Several factors can influence this, and these factors can be properly handled by creating awareness about the importance of customer satisfaction in service and conducting training to improve it in people who work in an anaesthetic environment, including anaesthetists. [ABSTRACT FROM AUTHOR]

The process of administrating anaesthesia into the patient's body is very crucial during any surgery. The intravenous method of anesthetic drug delivery is widely used in comparison to inhale as they provide steady maintenance and recovery rate is faster. The anaesthetist administers a regulated dosage of anaesthesia to the patient which depends on the essential body functioning parameters such as heart rate, depth of anaesthesia, body temperature etc. Conventionally anaesthesia is administered manually which may lead to anesthetic complications due to inappropriate dosing. To reduce the chances of anaesthesia complications, a system has been proposed which automatically regulates the anaesthesia dosage. The objective of this work is to design and develop a prototype device for assisted intravenous anaesthesia delivery system that would help to administer anaesthesia as per the specific requirement of the patients undergoing surgeries. The prototype device has an embedded PID based control algorithm that help anaesthesiologist to calculate and regulate dosage of the drug at various stages of the surgery. To ensure highest safety for the patients, various sensors have also been integrated into the device that simultaneously track critical parameters like Bi-spectral Index, temperature, pulse oximetry and cardiography and in case of deviations generate alarm for immediate corrective action. [ABSTRACT FROM AUTHOR]

This paper focuses on the impact of the current turf battle between certified registered nurse anesthetists (CRNAs) and anesthesiologists (MDAs). After reviewing the history between the two occupations and the current turf battle, this paper presents survey data to explore the workplace interactions of CRNAs and their professional identity. CRNAs are the sole anesthesia providers of approximately two-thirds of the nation's rural hospital anesthesia care (Blumenreich 2004, 2000; Bettin 2001; Fallacaro and Ruiz-Law 2004). The ability of many rural hospitals to provide anesthesia services is dependent on CRNAs. Results are compared for those practicing in rural locations to those practicing in urban locations. The impact of the turf battle, as well as current changes in the health care system, such as changing workforce supply and technological developments on interactions with other health care workers and patients are presented. There are some significant rural-urban differences in professional identity and interpersonal relations in the workplace. CRNAs practicing in rural areas are less negatively impacted by the turf battle and feel more positive about technological developments in anesthesia than those CRNAs practicing in urban areas. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

Failure to secure the airway with an endotracheal tube in a timely manner on induction of anaesthesia can lead to serious complications, including death. Equipment design and selection can often contribute to procedure success or failure, although current equipment does not always provide optimum solutions. Most anaesthetists consider endotracheal tube introducers (bougies) essential equipment; however, there are many different types available, with little relative performance data to inform choice. To date, no performance assessment system exists that is capable of assessing the shape retention properties of bougies. This paper discusses the design development process of the Shape Retention Testing System (SRTS) that utilises motion detection, object tracking and image processing to assess the relative performance of bougie introducers. [ABSTRACT FROM AUTHOR]

Many operations within the UK do not require general anaesthesia, and are instead carried out under sedation. A doctor normally provides this, and as the patient is not in control, they may be either under or over-sedated due to a misjudgement of patient anxiety. One solution would be to allow the patients to directly control their own sedation level. This paper presents an invention for innovation (i4i) project developing such a Patient Maintained Propofol Sedation Device (PMPSD). Due to the health risks associated with under and over-sedation, the anaesthetists' interface takes on an added importance to ensure they can oversee the process and intervene when needed. Through the project, a unique opportunity has arisen where anaesthetists have been involved throughout the interface design process, contributing to the development and testing of a prototype. We present this prototype, highlight its key features and how it differs from existing sedation pump interface systems. As the project continues, the interface will be used as part of a clinical trial at Nottingham University Hospitals NHS Trust involving 80 orthopaedic patients throughout the rest of 2018 and into 2019. [ABSTRACT FROM AUTHOR]

This paper presents a new procedure to find the impact of the time-delay (TD) of the patient and instrumentations such as bispectral index (BIS) monitor on closed-loop control of depth of anaesthesia during surgery. In the current work, the TD is estimated using Smith Predictive control technique. The method is validated with measured BIS signals in simulation. The results showed that the proposed procedure improves the performance of the closed-loop system for reference tracking and overall stability, and the proposed method has less overshoot, shorter settling time and is more robust to disturbances. [ABSTRACT FROM PUBLISHER]

Manual or open-loop administration does not take into account patient's individual dose or dose-response relationship; hence they represent sub-optimal solutions for optimizing individual drug titration. This may lead to under-or over- sedation, increasing the time on mechanical ventilation, the length of intensive care unit (ICU) stay and mortality. Model based predictive control can mitigate with this problem, improving the efficiency of drug delivery and patient safety. A multiple-input single-output (MISO) patient model is identified and validated in this paper. The inputs are two drugs commonly used for general anesthesia, propofol and remifentanil, and the output is the Bispectral Index (BIS). Wavelet time-frequency analysis was used to filter the measured signals. The parameters of the interaction model which relates the effect-site concentrations of these drugs to BIS are identified based on least-squares algorithm, using data from real-life clinical tests. [ABSTRACT FROM PUBLISHER]

Methods for developing touchless user interfaces are still under investigation. Promising approaches to come up with usable gestures combine two phases: First, gestures are elicited from users by asking them to demonstrate gestures for given tasks or dialogs. Afterwards a gesture set is extracted and tested with users in a subsequent evaluation phase. The steps within the two phases may differ due to different challenges to overcome, like the gesture extraction. This paper reports on the methods and results of those two phases in the context of interactions with a medical information system during anesthesia induction. [ABSTRACT FROM AUTHOR]

Bispectral index (BIS) is a popular technology widely used in hospitals to monitor depth of patients' anesthesia during surgeries. Maintaining a proper, steady state of the patient's BIS level is critical for patient safety. In this paper an autoregressive moving average model is implemented on patient BIS data for the prognosis of the depth of anesthesia. This prognosis will enable anesthesiologists to make adjustments to the anesthetics prior to a shift in the BIS for the purpose of maintaining steady state BIS. This proposed method will alleviate the current demand for anesthesiologists to make their own predictions during surgery based on past experiences. [ABSTRACT FROM PUBLISHER]

Regional anesthesia is preferred to global anesthesia when applicable due to its safety, low cost and patient preference. Successful regional anesthesia depends upon precise location of the peripheral nerve or nerve plexus. Locating peripheral nerves is usually done using nerve stimulation which is considered by many to be the current ‘gold standard’. In order to generate a nerve impulse by electrical means, a threshold stimulus of current must be applied to the nerve “rheobase”. The technique depends on stimulating muscular twitching at a close distance to the nerve without actually touching it. In this paper, a design for ucontrnller-based nerve locator is introduced. The current delivered to the nerve is maintained constant in the proposed design for a wide range of load impedances. The device is tested and used to locate the nerves in the limbs of the animal. Moreover, the device tested successfully against IEC safety standards and compared to prior arts. The comparison is based on five characteristics which are waveform, current intensity, impulse duration, maximum load and functionality. Based on that rules the proposed design is able to achieve reasonably high scores that put it on the second place among 22 available nerve stimulators. [ABSTRACT FROM PUBLISHER]

In a previous paper we showed how the continual reachability set can be numerically computed using efficient maximal reachability tools. The resulting set is in general arbitrarily shaped and in practice possibly non-convex. Here, we present a fixed-complexity piecewise ellipsoidal under-approximation of the continual reachability set computed using ellipsoidal techniques. This provides a simple approximation of an otherwise relatively complicated set that can be used when a closed-form representation is needed. We demonstrate the results on a problem of control of anesthesia. [ABSTRACT FROM PUBLISHER]

This paper focuses on multistability theory for discontinuous dynamical systems having a set of multiple isolated equilibria and/or a continuum of equilibria. Multistability is the property whereby the solutions of a dynamical system can alternate between two or more mutually exclusive Lyapunov stable and convergent equilibrium states under asymptotically slowly changing inputs or system parameters. In this paper, we extend the definition and theory of multistability to discontinuous autonomous dynamical systems. In particular, nontangency Lyapunov-based tests for multistability of discontinuous systems with Filippov solutions are established. The results are then applied to excitatory and inhibitory biological neuronal networks to explain the underlying mechanism of action for anesthesia and consciousness from a multistable dynamical system perspective, thereby providing a theoretical foundation for general anesthesia using the network properties of the brain. [ABSTRACT FROM PUBLISHER]

Using a macro level analysis and the countervailing powers framework, this paper presents a case study of an allied health occupation, certified registered nurse anesthetists (CRNAs), that succeeded in winning the right of independent practice in some US states, despite strong opposition from anesthesiologists, their physician counterparts. Two countervailing powers are examined—technology and the political-economic context. The findings demonstrate that the development of a systematic body of knowledge, which is crucial for professional power, can undermine that power, when the knowledge can be embodied in equipment and practice guidelines, as is happening in anesthesia. The alignment of this countervailing power with government initiatives to reduce health care costs opened a window for CRNAs to become independent practitioners. [ABSTRACT FROM AUTHOR]

Controlling the level of anaesthesia is important for improving the success rate of surgeries and for reducing the risks to which operated patients are exposed. This paper proposes a nonlinear H-infinity approach to optimal control of the level of anaesthesia. The dynamic model of the anaesthesia, which describes the concentration of the anaesthetic drug in different parts of the body, is subjected to linearization at local operating points. These are defined at each iteration of the control algorithm and consist of the present value of the system's state vector and of the last control input that was exerted on it. For this linearization Taylor series expansion is performed and the system's Jacobian matrices are computed. For the linearized model an H-infinity controller is designed. The feedback control gains are found by solving at each iteration of the control algorithm an algebraic Riccati equation. The modelling errors due to this approximate linearization are considered as disturbances which are compensated by the robustness of the control loop. The stability of the control loop is confirmed through Lyapunov analysis. [ABSTRACT FROM AUTHOR]

Use of anesthesia and the cold environment of an operating room inhibits thermoregulation in a patient body causing perioperative hypothermia. In the worst case, this situation may cause death. Maintaining normothermia is thus a key requirement during the perioperative period. In today's state-of-the-art, normothermia is maintained through a number of manual techniques, such as monitoring and controlling the temperature of the warming blankets, fluid warmers, and air conditioning system in the operating room. Since each patient illustrates different response to stimuli, a one-size-fits-all approach to maintaining normothermia is not the right approach. This paper presents ongoing work an autonomous, closed-loop control solution to maintain patient normothermia during perioperative periods. [ABSTRACT FROM PUBLISHER]

With the increasing demand for health care, hospitals are looking for ways to optimize their care processes in order to increase efficiency, while guaranteeing the quality of the care. Process modeling is a crucial step for process improvement, since it provides a process model that can be analyzed and optimized. Process mining is a recent promising methodology to discover process models based on data from event logs. However, early applications of process mining to health care has produced overly complex models, which have been attributed to the complexity of the health care domain. In this paper, we argue that existing process mining methods fail to identify good process models, even for well-defined clinical processes. We identify a number of reasons for this shortcoming and discuss a few directions for extending process mining methods in order to make them more suitable for the clinical domain. [ABSTRACT FROM PUBLISHER]

This paper suggests an extension of an existing, clinically evaluated, closed-loop drug delivery system for hypnotic depth control using propofol. The extension introduces closed-loop administration of the analgesic drug remifentanil, thus forming a multiple input-single output (MISO) control system. Remifentanil acts and is metabolized at a significantly faster time scale than propofol. Direct control of analgesia is hindered by the current absence of a reliable real-time nociception monitor. However, several hypnotic depth monitors respond to nociception. Sudden changes in the measured hypnotic depth are frequently caused by changes in noxious stimulation. The novelty of this work lies in increasing the disturbance rejection bandwidth of the control system for hypnotic depth by directing the high frequency content of its control error to a remifentanil controller. Such a mid-ranging control system was implemented and tuned based on 23 patient models obtained from a previous clinical study and its performance is demonstrated through a simulation study. [ABSTRACT FROM PUBLISHER]

With the advances in biochemistry, molecular biology, and neurochemistry there has been impressive progress in understanding the molecular properties of anesthetic agents. However, there has been little focus on how the molecular properties of anesthetic agents lead to the observed macroscopic property that defines the anesthetic state, that is, lack of responsiveness to noxious stimuli. In this paper, we develop a mean field synaptic firing rate cortical neuronal model and demonstrate how the induction of general anesthesia can be explained using multistability; the property whereby the solutions of a dynamical system exhibit multiple attracting equilibria under asymptotically slowly changing inputs or system parameters. In particular, we demonstrate multistability in the mean when the system initial conditions or the system coefficients of the neuronal connectivity matrix are random variables. Uncertainty in the system coefficients is captured by representing system uncertain parameters by a multiplicative white noise model wherein stochastic integration is interpreted in the sense of Itô. Modeling a priori system parameter uncertainty using a multiplicative white noise model is motivated by means of the Maximum Entropy Principle of Jaynes and statistical analysis. [ABSTRACT FROM PUBLISHER]

A closed-loop adaptive controller for propofol and remifentanil administration using BIS measurements is proposed in this paper. The controller design relies on a reduced MISO Wiener model for the depth of anesthesia. The exact linearization of this minimal Wiener structure using the model continuous-time parameter estimates calculated online by an extended Kalman filter is a key point in the design. A linear quadratic gaussian controller is developed for the exactly linearized system. Good results were obtained when the robustness of the proposed controller was assessed with respect to inter and intrapatient variability through Monte Carlo simulations on a database of 500 patients. [ABSTRACT FROM PUBLISHER]

Epidural anesthesia procedures are performed in approximately 75 percent of all childbirths in the United States; however, failure rates for these procedures are as high as 40 percent across all cases and 70 percent in the obese population. Due to the limitations associated with X-ray-based fluoroscopy, including exposure to ionizing radiation and lack of portability, the standard of care is to perform epidurals using palpation - i.e. without medical imaging. High-quality 3D imaging of spinal bone surfaces, obtained using a portable ultrasound device, could potentially overcome these challenges and offer physicians a safe imaging tool to increase success rates. A 4-channel handheld ultrasound system with custom 0.95 cm diameter piston transducers focused at 5 cm were designed and fabricated. The system was then used to image an excised lumbar spine in a water bath over a mechanically scanned 90 mm × 50 mm 2D plane. Positional information regarding the surface of the lumbar spine bone at each point across the 2D plane was estimated in MATLAB by detecting the position of maximum envelope-detected signal above the noise level. 3D topographical images were rendered and qualitatively compared to photographs of the actual spine. Additionally, 3D printed models of anatomically accurate lumbar vertebrae were fabricated and embedded in a graphite gelatin phantom. Imaging was conducted with a mechanically scanned 5 MHz piston transducer, 3D images were formed, and the correlation between the known surfaces and ultrasound estimated surfaces was computed. Images of the excised spine using the handheld ultrasound system yielded excellent correlation to optical images. Automated measurements (performed in MATLAB) of spinous process and epidural gap dimensions across the axis of the spine were within 0.5 mm of the actual dimensions. 3D images of the printed spine model produced a 0.88 correlation coefficient between estimated and true spine surface locations. Results in this paper demonstrate the feasibility of a handheld ultrasound device for low-cost, safe, and portable imaging of spinal bone anatomy in 3D, which possesses the potential for improving the success rates of epidural anesthesia procedures. [ABSTRACT FROM PUBLISHER]

This paper introduces a simplified linear interaction model between two drugs, namely Propofol and Remifentanil, which will be used in a model based predictive control algorithm for (nonlinear) automatic induction and regulation of DOA. Depth of anesthesia (DOA) is evaluated by means of the Bispectral index (BIS). The simulation tests are performed on a set of 24 virtually generated realistic patient models. The results are promising and the performance of the controller shows a high-efficiency, optimal dosage of the two drugs in order to achieve the desired BIS reference. [ABSTRACT FROM PUBLISHER]

In the clinical practice the concerns about the administration of hypnotics and analgesics for minimally invasive diagnostics and therapeutic procedures have enormously increased in the past years. The automatic detection of changes in the signals used to evaluate the depth of anesthesia is hence of foremost importance in order to decide how to adapt the doses of hypnotics and analgesics that should be administered to patients. The aim of this work is to online detect drifts in the referred depth of anesthesia signals of patients undergoing general anesthesia. The performance of the proposed method is illustrated using BIS records previously collected from patients subject to abdominal surgery. The results show that the drifts detected by the proposed method are in accordance with the actions of the clinicians in terms of times where a change in the hypnotic or analgesic rates had occurred. This detection was performed under the presence of noise and sensor faults. The presented algorithm was also online validated. The results encourage the inclusion of the proposed algorithm in a decision support system based on depth of anesthesia signals. [ABSTRACT FROM PUBLISHER]

Introduction & Objectives: High-Intensity Focused Ultrasound (HIFU) has been shown to be a successful treatment for localised prostate cancer (PC). Here we have explored the effectiveness of the HIFU treatment for hormone-resistant prostate cancer (HRPC). December 2009; all of them showed treatment failure following hormone ablation. The median time before hormone-resistance was 20 (3-48) months. In the group with localised PC: number of patients 237, Gleason score ≤7, stage T1-2N0M0, age 69 (60-89) years, mean PSA before treatment 40,0 (5,8-92,9) ng/ml, mean prostate volume - 39,3 (28-92) cc; in the group with locally advanced PC: number of patients 104, Gleason score ≤9, stage T2-3N0M0, age 72 (52-83) years, PSA before treatment 30,3 (20,1-60) ng/ml, mean prostate volume - 41,2 (25-198) cc. HIFU was delivered under spinal anesthesia using the Ablatherm HIFU device (EDAP, France). Pre HIFU transurethral resection of the prostate (TURP) was performed for all patients. Mean follow-up time 18 months (3- 30). Results: The median PSA level 12 months after HIFU treatment was 0,04 (0-2,24) ng/ml - localised PC, and for locally advanced disease - 0,05 (0-48,4) ng/ml, at 18 months after HIFU treatment this was 0,2 (0,02-2,0) ng/ml for localised PC, and for locally advanced disease 0,18 (0,04-7,45) ng/ml. Patients with localised PC has 4,5% recurrence, those with locally advanced PC 20%. Kaplan-Meir analyses of the total group indicated that the risk of recurrence after 1 year follow-up was 10%, the risk of recurrence was 19% after 2 years of follow-up. Conclusions: Our initial experience shows that ultrasound ablation is safe, minimally invasive and effective as a treatment for localised and locally advanced hormone-resistant prostate cancer. [ABSTRACT FROM AUTHOR]

This study aims at exploring the opportunities of Business Process Management (BPM) to design a workflow of information along the patient treatment process at the Operating Room (OR). It also includes optimization processes and supporting Information Systems (IS) development in the Anesthesia Department for Cardiac Surgery at "Hospital Arrábida" in Oporto (Hospital da Arrábida 2010). None hospital or health system today is immune from concerns regarding quality of patient care, bottom-line performance, increasing regulations, and staffing shortages. Physicians are constantly being pressured to increase efficiency while reducing costs in order to provide patient satisfaction on healthcare services. New technologies and organizing trends like voluntary practice guidelines, financial incentives, case management programs, social-technical issues, clinical restrictions have had variable success in controlling costs associated with physician's clinical decision-making (Kuhn et al. 2007). The OR is probably the most complex location in any hospital and critical care areas are more demanding with regard to costs and resources (Grover 2006). Every minute and every day decisions are taken that affect the clinical outcomes and costs of treatments. According to a Harvard study report, surgery is the fastest growing and most resource-intensive area of the hospital (Butler 2005). On average, the surgical environment accounts for more than 50% of a hospital's total budget and 95% of the costs associated with clinical decisions are taken near the patient (Grover 2006). At critical areas it is possible to automatically capture up to 80% of data from medical devices/nurse documentation from a patient (Butler 2005). It is also recognized that there is a discrepancy between the potential and the actual usage of IT in healthcare (Kuhn et al. 2007; Lenz and Manfres 2005). To cope with this challenge hospitals should be more process-oriented and business-focused (Grover 2006). The next generation of clinical IS will distribute automatically the Right Work to the Right User at the Right Time across patients and users (Eder and Haumann 2007). [ABSTRACT FROM AUTHOR]

The article presents a study which examines the impact of premedication and general anesthesia on tear production in clinically normal dogs. For the study, researchers analyzed twenty dogs of different ages, breeds and genders. They found a significant decline in tear production ten minutes following premedication from the mean base-line value. They concluded that premedication and general anesthesia lessen tear production in dogs.