A lthough left ventricular assist devices (LVADs) improve survival and quality of life in carefully selected patient populations, the risks associated with the operation and the necessary lifestyle changes make the decision to undergo LVAD implant a monumental one. [1][2][3][4][5][6] The informed consent process, guided by the ethical principle of autonomy, calls for comprehension of the benefits and risks of the offered therapy and available alternatives. 7 Medical decision making around LVAD therapy, for both bridge-to-transplant (BTT) and destination therapy (DT), is improved if eligible patients and their caregivers are empowered to understand this complex treatment decision. [8][9][10][11][12][13] The process of patient and caregiver education on complex medical therapies is an area of active development. Consultation by healthcare professionals is important, but opinions can vary between individuals and specialties, and discussions are often limited by time.14 Several forms of educational materials are available to patients. Not surprisingly, the accuracy, quality, and usefulness of such patient-oriented materials is varied and has been criticized when used in medical decisions for other diseases. [15][16][17][18] Although all formats of educational materials have potential value, formal decision aids seem to be particularly useful in preintervention education through their explicit goals of conveying to patients that they have a choice, providing details on practical alternatives and helping patients clarify their values. [19][20][21][22][23] As the use of LVADs continues to increase, so does the availability of LVAD-related educational materials. 24 Patients and families of those with severe heart failure are using these resources to educate themselves on LVAD therapy, which may in the end have an effect on medical decision making. However, the scope and quality of these materials has not been Background-Left ventricular assist devices (LVADs) are being used with increasing frequency to treat severe heart failure.Patients seek out informational resources when considering implantation. The primary study objective was to characterize the scope and quality of available LVAD educational materials. Methods and Results-In July 2013, we performed a cross-sectional search of Internet, print, and multimedia resources available to patients considering LVAD. Written materials <10 sentences, videos <2 minutes, and materials clearly directed to healthcare professionals were excluded. Seventy-seven materials met inclusion criteria. Potential benefits of LVAD therapy were discussed in all (n=77), whereas less often mentioned were risks (n=43), lifestyle considerations (n=29), surgical details (n=26), caregiver information (n=9), and hospice or palliative care (n=2 Methods Search StrategyTo identify existing educational resources written for a patient considering LVAD therapy, we used several targeted Internet searches and a survey of mechanical circulatory support coordinators. Two research librarians assisted in deve...
Objective To understand mechanical circulatory support (MCS) coordinators’ perspectives related to destination therapy left ventricular assist devices (DT LVAD) decision making Background MCS coordinators are central to the team that interacts with patients considering DT LVAD, and are well positioned to comment upon the pre-implantation process. Methods From August 2012–January 2013, MCS coordinators were recruited to participate in semi-structured, in-depth interviews. Established qualitative approaches were used to analyze and interpret data. Results Eighteen MCS coordinators from 18 programs were interviewed. We found diversity in coordinators’ roles and high programmatic variability in how DT LVAD decisions are approached. Despite these differences, three themes were consistently recommended: 1) DT LVAD is a major patient-centered decision: “you’re your best advocate…this may not be the best choice for you”; 2) this decision benefits from an iterative, multidisciplinary process: “It is not a one-time conversation”; and 3) this process involves a tension between conveying enough detail about the process yet not overwhelming patients: “It’s sometimes hard to walk that line to not scare them but not paint a rainbow and butterflies picture.” Conclusions MCS coordinators endorsed a shared decision-making process that starts early, uses non-biased educational materials, and involves a multidisciplinary team sensitive to the tension between conveying enough detail about the therapy yet not overwhelming patients.
Particulate number count is an important consideration for engine developers due to changes in emissions legislation. Changes are driven by an increasing body of evidence that particulate number, particularly smaller particles, have a deleterious effect on human health. This article presents the results of an investigation into the key factors influencing particulate number emissions measurement repeatability during dynamometer-based testing of a gasoline direct-injection engine. At the outset of this work, a review of literature summarises some of the current discussion concerning particulate formation, evolution and measurement to identify the key factors that influence these three things. Having established what these factors are a number of engine experiments are undertaken to determine how sensitive particulate number measurements are to change in these factors and therefore how great an influence they are on measurement repeatability in engine experiments of a similar type. The investigation highlights a number of important results, showing that particular regard ought to be given to the pre-conditioning of engine internal surfaces which begins when the engine is started. In addition, the effect of coolant temperature (including the dynamics of the control system) is observed and highlighted as another key source of variation as is intake air temperature.
A novel sensorless speed estimation algorithm for use with direct online three-phase induction motors is proposed. Speed information is extracted from the motor current spectrum by tracking the frequency of key components, which vary as a function of motor rotational speed. An important advantage of this technique is that the speed estimation algorithm is independent of motor mechanical and electrical parameters. The algorithm operates via estimating rotor bar number, which is in turn used to determine rotational speed via rotor bar pass frequency detection including a sanity check on estimated speed via comparison with a linear speed estimate based on rated nameplate data. Experimental results are included for a range of three-phase induction motors including motors carrying faults (bearing, rotor, stator and air-gap eccentricity). The results demonstrate the robustness of the algorithm to motors operating with a variety of faults and thus the potential for use of the algorithm in induction motor fault detection and diagnosis applications.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.