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Medical device implants for neuromodulation
Published in Ze Zhang, Mahmoud Rouabhia, Simon E. Moulton, Conductive Polymers, 2018
Current DBS neurostimulators utilize nonrechargeable battery technology, giving the devices a finite service life that varies according to the stimulation parameters, the number and polarity of electrode contacts, and the time period of stimulation during the day. For DBS of Parkinson’s disease, the typical stimulation parameters yield an estimated battery life of approximately 3.5 years. Surgical replacement is thus required every few years due to the battery life of the stimulator. Surgery has clear disadvantages, including the risk of infection, scarring, damage to connections, and cost of treatment. Externally rechargeable batteries are being developed, along with ways to increase the energy efficiency of the individual stimulus pulses generated by the IPG.
Surgery scheduling in the presence of operating room eligibility and dedicated surgeon: an adaptive composite dispatching method
Published in International Journal of Production Research, 2023
Shan Wang, Huiqiao Su, Guohua Wan, Liwei Zhong
The literature on surgery scheduling ranges from strategical level to operational level (May et al. 2011). This study is closely related to the studies at the operational level (see, e.g. Cardoen, Demeulemeester, and Beliën 2010; Guerriero and Guido 2011; Abdelrasol, Harraz, and Eltawil 2014; Samudra et al. 2016; Zhu et al. 2019, for detailed reviews). There are two types of surgery – elective surgery and emergency surgery. For elective surgery, practitioners can schedule them well in advance since the surgical information is available; while for emergency cases, scheduling must be done in an online fashion, i.e. the surgery is scheduled upon the patient's arrival. In practice, management normally reserves specific operating rooms or time slots for emergency surgery (please refer to Van Riet and Demeulemeester 2015; Kahraman and Topcu 2018; Duma and Aringhieri 2019; Jung et al. 2019, for more details). In the hospital with which we collaborate, several operating rooms are dedicated to emergency surgery, thus we focus on scheduling elective surgery in this study.
Cross-sectional changes of the distal carpal tunnel with simulated carpal bone rotation
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Carpal tunnel syndrome is a peripheral nerve entrapment syndrome affecting a large portion of the general (Atroshi et al. 1999) and working populations (Dale et al. 2013; Luckhaupt et al. 2013). The most common treatment for carpal tunnel syndrome is to undergo carpal tunnel release surgery, whereby pressure at the median nerve is relieved by transecting the transverse carpal ligament (TCL) (Badger et al. 2008; Rodner and Katarincic 2008). Regarding various patient outcome measurables, surgical treatment shows preferred results, as compared to those for therapeutic options such as splinting (Gerritsen et al. 2002), non-steroidal anti-inflammatory drugs (Jarvik et al. 2009) and steroid injections (Hui et al. 2005). Although surgery is more effective, the invasive nature of the procedure does present the risk of complications, albeit rare (Karl et al. 2016). Such risks are minimal with noninvasive physical therapeutics. These options, which can include splinting (Huisstede et al. 2010) and carpal bone mobilization (Huisstede et al. 2010), often involve force application at or near the radiocarpal or midcarpal joint. These force applications are likely to induce relative motion of the carpal bones.
Sacral neuromodulation for the treatment of overactive bladder: systematic review and future prospects
Published in Expert Review of Medical Devices, 2022
Sam Tilborghs, Stefan De Wachter
The introduction of the standardized electrode placement technique [84] was an important step that impacted real-world outcome by increasing intention to threat (ITT) results to such a level that from a cost-effective point of view, single-stage implants could be considered without the burden of the contemporary test phase. Without an obvious history that might interfere with normal bladder function, one-stage procedure could be potentially considered in (young) women with OAB wet, as they present with the highest SNM success rates. With patients being guaranteed SNM therapy, patients would not have the idea of ‘the need to qualify,’ leading to potentially more accurate voiding diary data and thus more reliable treatment results. By avoiding a second surgery, intra- and post-operative costs and complications could be reduced. An urgent need for optimizing cost-effectiveness of SNM therapy is needed. Neurostimulator replacement is the most important cost driver at a 15-year horizon, making technical improvements in battery life promising areas to progress. With greater cost-effectiveness, SNM therapy could be used earlier in the treatment algorithm, potentially leading for greater clinical success. With current MRI compatible SNM devices early implantation in diseases with known onset-like spinal cord injury could become more mainstream. Nevertheless, larger studies regarding success in neurogenic patients are necessary. More refined inclusion and exclusion criteria are warranted as prognostic factors are scarce. Prospective research in larger specific patient groups should be in the forefront of current research to be implemented into clinical practice.