Expert review of medical devices
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Expert Rev Med Devices · Feb 2019
ReviewAdvanced methods of spinal stimulation in the treatment of chronic pain: pulse trains, waveforms, frequencies, targets, and feedback loops.
Spinal cord stimulation has emerged as a state-of-the-art evidence-based treatment for chronic neuropathic pain and mixed nociceptive-neuropathic pain. In recent years, several newer devices and treatment algorithms have provided unique and effective ways of treating chronic pain by spinal cord stimulation. In a previous review, the authors commented on the 5-year forecast for high frequency and Burst waveforms, as the only two paresthesia independent SCS strategies. Over the last 5 years, there has been considerable addition to the outcome data related to these modalities. Additionally, new treatment algorithms and modalities for spinal cord stimulation have emerged. In this review, the authors provide an up to date summary of these modalities of treatment, indications, and evidence on all different modalities and programming paradigms that are available today. ⋯ The evidence to support outcomes of spinal cord stimulation has evolved considerably since our last review in 2014. New targets, frequencies and pulse trains, and feedback appear to have advanced the efficacy of spinal cord stimulation. Future developments aim to continue to refine patient selection and maintenance of patients in therapy.
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Expert Rev Med Devices · Feb 2019
ReviewWearable sensors to improve detection of patient deterioration.
Monitoring a patient's vital signs forms a basic component of care, enabling the identification of deteriorating patients and increasing the likelihood of improving patient outcomes. Several paper-based track and trigger warning scores have been developed to allow clinical evaluation of a patient and guidance on escalation protocols and frequency of monitoring. However, evidence suggests that patient deterioration on hospital wards is still missed, and that patients are still falling through the safety net. ⋯ A review of the literature was performed. Expert commentary: Findings suggest that several sensor designs are available with the potential to improve patient safety for both hospital patients and those at home. Larger clinical trials are required to ensure both diagnostic accuracy and usability.
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Expert Rev Med Devices · Dec 2018
ReviewDeveloping an optimized strategy with transcranial direct current stimulation to enhance the endogenous pain control system in fibromyalgia.
Fibromyalgia affects more than 5 million people in the United States and has a detrimental impact on individuals' quality of life. Current pharmacological treatments provide limited benefits to relieve the pain of fibromyalgia, along with a risk of adverse effects; a scenario that explains the increasing interest for multimodal approaches. A tailored strategy to focus on this dysfunctional endogenous pain inhibitory system is transcranial direct current stimulation (tDCS) of the primary motor cortex. ⋯ Also, we reviewed the neural control of different pathways that integrate the endogenous pain inhibitory system, as well as the effects of tDCS and aerobic exercise both alone and combined. In addition, potential neurophysiological assessments are addressed: conditioned pain modulation, temporal slow pain summation, transcranial magnetic stimulation, and electroencephalography in the context of fibromyalgia. Expert commentary: By understanding the neural mechanisms underlying pain processing and potential optimized interventions in fibromyalgia with higher accuracy, the field has an evident potential of advancement in the direction of new neuromarkers and tailored therapies.
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Expert Rev Med Devices · Nov 2018
Lung volume reduction with endobronchial valves in patients with emphysema.
Bronchoscopic lung volume reduction with endobronchial valves is a recently acknowledged treatment option in patients with severe emphysema and absence of interlobar collateral ventilation. In endobronchial valve treatment, implantation of one-way valves leads to deflation of a hyperinflated lung lobe. Multiple studies showed significant improvements in lung function, exercise capacity, and quality of life in this patient subgroup which often did not have any remaining treatment options. ⋯ Development of advanced diagnostic imaging methods will result in a better patient and target selection and improved outcomes. Furthermore, optimizing the device and the procedure might be an important focus in future developments to enhance outcomes and reduce adverse events.
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Expert Rev Med Devices · Aug 2018
ReviewCurrent devices used for the monitoring of injection pressure during peripheral nerve blocks.
Peripheral nerve blocks are generally safe. However, there is a small but real associated risk of needle-related complications such as nerve injury. Nerve injury has been associated with high pressure injections in animals, and some data supports the use of monitors to limit injection pressure during these procedures. ⋯ While each of the reviewed methods has its advantages and drawbacks, all of the means of injection pressure monitoring are relatively simple and inexpensive to perform. More outcomes data are required to demonstrate a reduction in injury with their use.