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Patients who fail to maintain adequate respiration by themselves may need long-term mechanical ventilation (LTMV) for shorter or longer periods. Recent Norwegian data suggests considerable regional differences in the indication for initiation of LTMV. Norwegian Knowledge Centre for the Health Services has prepared three consecutive reports about LTMV. This is the third report in the series in which we review the effects of LTMV for patients with cystic fibrosis or COPD. The report overview two systematic reviews - one about the effect of LTMV for patients with cystic fibrosis and one about LTMV for patients with stable COPD. Current evidence does not suggest that LTMV is associated with improved survival or reduced need for hospitalisation in patient with stable COPD, but the quality of the evidence is too low to allow firm conclusions. LTMV probably have little or no effect on arterial blood gas values among patients with stable COPD. We need more evidence before concluding how LTMV affect sleep efficiency and quality of life in patients with stable COPD, and whether the effect of LTMV among patients with stable COPD is affected by the time selected for initiation of therapy. We need more evidence before concluding about the effectiveness of LTMV on survival, hospitalisation, sleep efficiency and quality of life in patients with cystic fibrosis.
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Patients who fail to maintain adequate respiration may need long-term mechanical ventilation (LTMV) in shorter or longer periods. Patients using LTMV constitute a heterogeneous group with respect to age, diagnoses and disease progression. Norwegian data suggests considerable regional differences in the use of LTMV. Commission The Norwegian Directorate of Health recently prepared new guidelines for the use of LTMV outside hospitals. The Norwegian Knowledge Centre for Health Services was commissioned to prepare a systematic review on the efficacy of LTMV. This is the first of three reviews, and here we summarize evidence on the effectiveness of LTMV for patients with neuromuscular disorders and for patients with central respiratory failure. Main results1. LTMV may be associated with some degree of life extension and improved quality of life for patients with amyotrophic lateral sclerosis, at least for patients with good bulbar function. The quality of evidence is low, and it is not possible to draw firm conclusions about the real effect.2. LTMV can be associated with life extension among hypoventilated patients with Duchenne muscular dystrophy, but the quality of evidence is low, and it is not possible to draw firm conclusions about the real effect.3. Across patients with various neuromuscular diagnoses, it seems that LTMV may be associated with fewer hospital admissions, and that invasive LTMV is associated with greater risk of complications and hospitalization than non-invasive LTMV. The quality of evidence is low, and we can not draw firm conclusions about the real effect.4. For some diagnoses, for example central respiratory failure, we were not able to identify any research fulfilling our inclusion criteria.
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This chapter explores the interrelationships between embodied knowledge and assistive technology. Its primary focus is on interwar developments to respiratory technologies in Britain, but explores more broadly the extent to which consideration of users and user involvement has featured in the design of various technologies to facilitate breathing. The chapter uses under-utilised primary sources from the National Archives and the Royal Institution to examine mechanical respirators such as the Bragg-Paul Pulsator, then develop this user-focused framework to consider the later rise of ambulatory oxygen for home use. Considering how users have mattered in respiratory assistive technology highlights the problems with prosthetic designs which fail to consider the full social worlds of the user. Understanding these problems necessitates awareness of the longer history of their development and the longer-term problems inherent to ownership of the air. This relates to the politics of nationalised healthcare because ambulatory oxygen was outsourced from NHS pharmacy control in 2006. The chapter therefore concludes with a discussion of how standardised technology currently affects diverse users' ability to engage with assistive technologies.
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Patients who fail to maintain adequate respiration may need long-term mechanical ventilation (LTMV) in shorter or longer periods. Patients using LTMV constitute a heterogeneous group with respect to age, diagnoses and disease progression. Norwegian data suggests considerable regional differences in the use of LTMV. Commission The Norwegian Directorate of Health recently prepared new guidelines for the use of LTMV outside hospitals. The Norwegian Knowledge Centre for Health Services was commissioned to prepare a systematic review on the efficacy of LTMV. This is the first of three reviews, and here we summarize evidence on the effectiveness of LTMV for patients with neuromuscular disorders and for patients with central respiratory failure. Main results1. LTMV may be associated with some degree of life extension and improved quality of life for patients with amyotrophic lateral sclerosis, at least for patients with good bulbar function. The quality of evidence is low, and it is not possible to draw firm conclusions about the real effect.2. LTMV can be associated with life extension among hypoventilated patients with Duchenne muscular dystrophy, but the quality of evidence is low, and it is not possible to draw firm conclusions about the real effect.3. Across patients with various neuromuscular diagnoses, it seems that LTMV may be associated with fewer hospital admissions, and that invasive LTMV is associated with greater risk of complications and hospitalization than non-invasive LTMV. The quality of evidence is low, and we can not draw firm conclusions about the real effect.4. For some diagnoses, for example central respiratory failure, we were not able to identify any research fulfilling our inclusion criteria.
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Patients who fail to maintain adequate respiration by themselves may need long-term mechanical ventilation (LTMV) for shorter or longer periods. Recent Norwegian data suggests considerable regional differences in the indication for initiation of LTMV. Norwegian Knowledge Centre for the Health Services has prepared three consecutive reports about LTMV. This is the third report in the series in which we review the effects of LTMV for patients with cystic fibrosis or COPD. The report overview two systematic reviews - one about the effect of LTMV for patients with cystic fibrosis and one about LTMV for patients with stable COPD. Current evidence does not suggest that LTMV is associated with improved survival or reduced need for hospitalisation in patient with stable COPD, but the quality of the evidence is too low to allow firm conclusions. LTMV probably have little or no effect on arterial blood gas values among patients with stable COPD. We need more evidence before concluding how LTMV affect sleep efficiency and quality of life in patients with stable COPD, and whether the effect of LTMV among patients with stable COPD is affected by the time selected for initiation of therapy. We need more evidence before concluding about the effectiveness of LTMV on survival, hospitalisation, sleep efficiency and quality of life in patients with cystic fibrosis.
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This chapter explores the interrelationships between embodied knowledge and assistive technology. Its primary focus is on interwar developments to respiratory technologies in Britain, but explores more broadly the extent to which consideration of users and user involvement has featured in the design of various technologies to facilitate breathing. The chapter uses under-utilised primary sources from the National Archives and the Royal Institution to examine mechanical respirators such as the Bragg-Paul Pulsator, then develop this user-focused framework to consider the later rise of ambulatory oxygen for home use. Considering how users have mattered in respiratory assistive technology highlights the problems with prosthetic designs which fail to consider the full social worlds of the user. Understanding these problems necessitates awareness of the longer history of their development and the longer-term problems inherent to ownership of the air. This relates to the politics of nationalised healthcare because ambulatory oxygen was outsourced from NHS pharmacy control in 2006. The chapter therefore concludes with a discussion of how standardised technology currently affects diverse users' ability to engage with assistive technologies.
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Construction --- Industrial hygiene --- Medical equipment --- Construction --- Industrial hygiene --- Medical equipment
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The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not.
Robotics. --- Automation --- Machine theory --- Medical equipment & techniques
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