Background
The manufacturing of any standard mechanical ventilator cannot rapidly be upscaled to several thousand units per week, largely due to supply chain limitations. The aim of this study was to design, verify and perform a pre-clinical evaluation of a mechanical ventilator based on components not required for standard ventilators, and that met the specifications provided by the Medicines and Healthcare Products Regulatory Agency (MHRA) for rapidly-manufactured ventilator systems (RMVS).
Methods
The design utilises closed-loop negative feedback control, with real-time monitoring and alarms. Using a standard test lung, we determined the difference between delivered and target tidal volume (VT) at respiratory rates between 20 and 29 breaths per minute, and the ventilator's ability to deliver consistent VT during continuous operation for >14 days (RMVS specification). Additionally, four anaesthetised domestic pigs (3 male-1 female) were studied before and after lung injury to provide evidence of the ventilator's functionality, and ability to support spontaneous breathing.
Findings
Continuous operation lasted 23 days, when the greatest difference between delivered and target VT was 10% at inspiratory flow rates
>
825 mL/s. In the pre-clinical evaluation, the VT difference was -1 (-90 to 88) mL [mean (LoA)], and positive end-expiratory pressure (PEEP) difference was -2 (-8 to 4) cmH
2
O. VT delivery being triggered by pressures below PEEP demonstrated spontaneous ventilation support.
Interpretation
The mechanical ventilator presented meets the MHRA therapy standards for RMVS and, being based on largely available components, can be manufactured at scale.
Funding
Work supported by Wellcome/EPSRC Centre for Medical Engineering,King’s Together Fund and Oxford University.
Background: The UK is home to 13 million menopausal women. The aim of this study was to determine the views of GPs on their levels of confidence and comfort when advising or treating menopausal women and assess the need for further training. Method: An anonymous online questionnaire was sent out to GPs working within the NHS across the UK between January 2021 and March 2021. The questionnaire was circulated via GP e-mail lists, Facebook, and LinkedIn, and included an option for respondents to volunteer for a semi-structured interview. Results: The questionnaire had 173 responses. 52% of GPs indicated that they were not offered enough support to be able to advise and treat women with menopausal symptoms appropriately. 77.5% of GPs expressed that there is a need to improve training provided on menopause in medical school and GP training. 60.7% of GPs felt comfortable managing menopausal women and offering them management options. 22.5% of the respondents felt that the NICE guidelines are easy and clear guidance for clinical practice. Five GPs were further interviewed, and the analysis of the responses showed the perceived need by the GPs for improvements in medical training regarding menopause. Conclusion: There is a need for better support and medical training for GPs to help them advice and treat women with menopausal symptoms. This is key for ensuring that every woman in the UK feels supported in their journey during the menopausal transition and is offered evidence-based advice to help them make informed decisions.
We are presenting a case of 4-years-old previously healthy male with coma, severe acute hepatitis and multiorgan failure in presence of Influenza infection. Literature review highlighted an immune-mediated pathophysiology for such presentations so the child underwent a trial of plasmapheresis which resulted in a rapid clinical improvement and child was discharge in his baseline neurologic status by day 14.
There has been limited review of the reported deployment of infusion pumps in low- and lower-middle-income countries. This paper aims to identify the current distribution of infusion pumps in low- and lower-middle-income countries (LLMICs) used to treat neonates. A rapid review was conducted using material sourced from ProQuest, Pubmed, Web of Science, and IEEE Xplore. Twenty-six search results met the inclusion criteria. Within these, 41 neonatal healthcare facilities were discussed with 17 of the facilities having infusion pumps available, 13 limited access, and 11 none. Infusion pump use remains limited in Sub-Saharan Africa so efforts should be made to deploy specialist neonatal care improvement packages, potentially including infusion pumps designed for LLMICs. The effects of COVID-19, to neonatal care LLMICs, should be accessed to ensure progress has not regressed. These proposals aim to aid in the continued improvement of neonatal care globally and reduce newborn mortalities.
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