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Le Bourlout Y, Ehnholm G, Nieminen HJ. Multi-modal transducer-waveguide construct coupled to a medical needle. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 154:3388-3396. [PMID: 37991464 DOI: 10.1121/10.0022326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 10/16/2023] [Indexed: 11/23/2023]
Abstract
Annually, more than 16 × 109 medical needles are consumed worldwide. However, the functions of the medical needle are still limited mainly to cutting and delivering material to or from a target site. Ultrasound combined with a hypodermic needle could add value to many medical applications, for example, by reducing the penetration force needed during the intervention, adding precision by limiting the needle deflection upon insertion into soft tissues, and even improving tissue collection in fine-needle biopsy applications. In this study, we develop a waveguide construct able to operate a longitudinal-flexural conversion of a wave when transmitted from a Langevin transducer to a conventional medical needle, while maintaining high electric-to-acoustic power efficiency. The optimization of the waveguide structure was realized in silico using the finite element method followed by prototyping the construct and characterizing it experimentally. The experiments conducted at low electrical power consumption (under 5 W) show a 30 kHz flexural needle tip displacement up to 200 μm and 73% electric-to-acoustic power efficiency. This, associated with a small sized transducer, could facilitate the design of ultrasonic medical needles, enabling portability, batterization, and improved electrical safety, for applications such as biopsy, drug and gene delivery, and minimally invasive interventions.
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Affiliation(s)
- Yohann Le Bourlout
- Medical Ultrasonics Laboratory (MEDUSA), Department of Neuroscience and Biomedical Engineering, Aalto University, Rakentajanaukio 2, Espoo, 02150, Finland
| | - Gösta Ehnholm
- Medical Ultrasonics Laboratory (MEDUSA), Department of Neuroscience and Biomedical Engineering, Aalto University, Rakentajanaukio 2, Espoo, 02150, Finland
| | - Heikki J Nieminen
- Medical Ultrasonics Laboratory (MEDUSA), Department of Neuroscience and Biomedical Engineering, Aalto University, Rakentajanaukio 2, Espoo, 02150, Finland
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Boulias C, Ismail F, Phadke CP, Bagg S, Bureau I, Charest S, Chen R, Cheng A, Ethans K, Fink M, Finlayson H, Gulasingam S, Guo M, Haziza M, Hosseini H, Khan O, Lang M, Lapp T, Leckey R, Li Pi Shan R, Liem N, Lo A, Mason M, McNeil S, McVeigh S, Miller T, Mills PB, Naud P, O'Connell C, Petitclerc M, Prevost J, Reebye R, Richardson D, Satkunam L, Sharma S, Short C, Sirois G, Unarket M, Wein T, Wilkins K, Winston P. A Delphi-Based Consensus Statement on the Management of Anticoagulated Patients With Botulinum Toxin for Limb Spasticity. Arch Phys Med Rehabil 2018; 99:2183-2189. [PMID: 29803825 DOI: 10.1016/j.apmr.2018.04.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/19/2018] [Accepted: 04/22/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To create a consensus statement on the considerations for treatment of anticoagulated patients with botulinum toxin A (BoNTA) intramuscular injections for limb spasticity. DESIGN We used the Delphi method. SETTING A multiquestion electronic survey. PARTICIPANTS Canadian physicians (N=39) who use BoNTA injections for spasticity management in their practice. INTERVENTIONS After the survey was sent, there were e-mail discussions to facilitate an understanding of the issues underlying the responses. Consensus for each question was reached when agreement level was ≥75%. MAIN OUTCOME MEASURES Not applicable. RESULTS When injecting BoNTA in anticoagulated patients: (1) BoNTA injections should not be withheld regardless of muscles injected; (2) a 25G or smaller size needle should be used when injecting into the deep leg compartment muscles; (3) international normalized ratio (INR) level should be ≤3.5 when injecting the deep leg compartment muscles; (4) if there are clinical concerns such as history of a fluctuating INR, recent bleeding, excessive or new bruising, then an INR value on the day of injection with point-of-care testing or within the preceding 2-3 days should be taken into consideration when injecting deep compartment muscles; (5) the concern regarding bleeding when using direct oral anticoagulants (DOACs) should be the same as with warfarin (when INR is in the therapeutic range); (6) the dose and scheduling of DOACs should not be altered for the purpose of minimizing the risk of bleeding prior to BoNTA injections. CONCLUSIONS These consensus statements provide a framework for physicians to consider when injecting BoNTA for spasticity in anticoagulated patients. These consensus statements are not strict guidelines or decision-making steps, but rather an effort to generate common understanding in the absence of evidence in the literature.
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Affiliation(s)
- Chris Boulias
- West Park Healthcare Centre, Toronto, Ontario, Canada; Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada.
| | - Farooq Ismail
- West Park Healthcare Centre, Toronto, Ontario, Canada; Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Chetan P Phadke
- West Park Healthcare Centre, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Graduate Program in Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Stephen Bagg
- Providence Care Hospital and School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Isabelle Bureau
- Centre for Integrated Health and Social Service (CISSS) for Chaudière-Appalaches Region, Hôtel-Dieu de Lévis, Lévis, Québec, Canada
| | - Stephane Charest
- Spasticity Clinic, H Mauricie Center of Quebec, Trois-Rivières, Québec, Canada
| | - Robert Chen
- University Health Network, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Albert Cheng
- Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada; Providence Healthcare, Toronto, Ontario, Canada
| | - Karen Ethans
- Winnipeg Health Sciences Centre and Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Milo Fink
- Wascana Rehabilitation Centre and University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Heather Finlayson
- GF Strong Rehabilitation Center and Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sivakumar Gulasingam
- Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Meiqi Guo
- Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Muriel Haziza
- Physiatry Clinic, CDN Institute of Rehabilitation, Montreal, Québec, Canada
| | | | - Omar Khan
- Regional Rehabilitation Centre, Hamilton, Ontario, Canada; Hotel Dieu Shaver, St. Catharines, Ontario, Canada
| | | | - Timothy Lapp
- Muskoka Algonquin Health Care and Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Robert Leckey
- Stan Cassidy Centre, Fredericton, New Brunswick, Canada; Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rodney Li Pi Shan
- Foothills Medical Centre, Calgary, Alberta, Canada; University of Calgary, Calgary, Alberta, Canada
| | - Nathania Liem
- Hôtel-Dieu Grace Healthcare, Windsor, Ontario, Canada
| | - Alexander Lo
- University Health Network, Toronto, Ontario, Canada
| | | | - Stephen McNeil
- Foothills Medical Centre, Calgary, Alberta, Canada; University of Calgary, Calgary, Alberta, Canada
| | - Sonja McVeigh
- Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Rehabilitation Centre, Halifax, Nova Scotia, Canada
| | - Thomas Miller
- St. Joseph's Health Care London, Western University, London, Ontario, Canada
| | - Patricia B Mills
- GF Strong Rehabilitation Center and Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pierre Naud
- Capital Health Complex, Quebec City, Québec, Canada
| | - Colleen O'Connell
- Stan Cassidy Centre, Fredericton, New Brunswick, Canada; Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Julie Prevost
- Saint-Jérôme Regional Hospital, Saint-Jérôme, Québec, Canada
| | - Rajiv Reebye
- GF Strong Rehabilitation Center and Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Denyse Richardson
- Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Lalith Satkunam
- Glenrose Rehabilitation Hospital and Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
| | - Satyendra Sharma
- University Health Network, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Christine Short
- Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Rehabilitation Centre, Halifax, Nova Scotia, Canada
| | - Genevieve Sirois
- Quebec of Institute of Rehabilitation and Physical Impairment and Laval University, Québec City, Québec, Canada
| | - Milan Unarket
- Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Theodore Wein
- Montreal General Hospital and McGill University, Montreal, Québec, Canada
| | | | - Paul Winston
- CBI Health Centre, Victoria, British Columbia, Canada
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Mouser A, Uettwiller-Geiger D, Plokhoy E, Berube J, Ahuja AJ, Stankovic AK. Evaluation of Pain and Specimen Quality by Use of a Novel 25-Gauge Blood Collection Set With Ultra-Thin Wall Cannula and 5-Bevel Tip Design. J Appl Lab Med 2017; 2:201-210. [PMID: 32630975 DOI: 10.1373/jalm.2017.023564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/05/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Phlebotomy has significant impact on overall patient satisfaction. Smaller gauge needles, such as a 25 gauge, may lessen patient discomfort but increase hemolysis and tube-filling times. Our studies evaluated the effect of a 5-bevel, 25-gauge blood collection set (BCS) with ultra-thin wall cannula [BD Vacutainer® UltraTouch™ Push Button BCS (UltraTouch)] on patient pain and anxiety compared with two 3-bevel, thin-wall, 23-gauge BCSs [BD Vacutainer® Safety-Lok™ (Safety-Lok) and Greiner Bio-One Vacuette® (Vacuette)]. Our studies also evaluated the 25-gauge UltraTouch for sample quality and tube filling compared with the 3-bevel, thin-wall, 23-gauge BD Vacutainer Push Button BCS. METHODS We conducted 2 studies with 214 subjects to compare pain and anxiety regarding future phlebotomy with the 3 aforementioned devices. Another study with 52 subjects assessed hemolysis in specimens collected with the UltraTouch and Push Button BCS; bench testing evaluated tube-filling times with these devices. A questionnaire captured pain upon needle insertion, overall pain, and anxiety regarding future phlebotomy. Hemolysis was evaluated visually, by Hemolysis Index and hemolysis-sensitive indicators potassium (K) and lactate dehydrogenase (LDH). RESULTS A statistically significant decrease was noted for overall pain with UltraTouch compared with Vacuette and with insertion pain compared with Safety-Lok. There was no significant difference in anxiety regarding future phlebotomy. No increase was observed in Hemolysis Index, K or LDH. Tube-filling times were comparable for each device. CONCLUSIONS The 25-gauge UltraTouch provided less overall pain compared with the 23-gauge Vacuette, less pain upon needle insertion than the 23-gauge Safety-Lok, and no compromise in specimen quality or flow rate.
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Affiliation(s)
- Amy Mouser
- BD Life Sciences-Preanalytical Systems, Franklin Lakes, NJ
| | | | | | - Julie Berube
- BD Life Sciences-Preanalytical Systems, Franklin Lakes, NJ
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Sezgin B, Ozel B, Bulam H, Guney K, Tuncer S, Cenetoglu S. The Effect of Microneedle Thickness on Pain During Minimally Invasive Facial Procedures: A Clinical Study. Aesthet Surg J 2014; 34:757-65. [PMID: 24787992 DOI: 10.1177/1090820x14532941] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Minimally invasive procedures are becoming increasingly popular because they require minimal downtime and are effective for achieving a more youthful appearance. The choice of needle for minimally invasive procedures can be a major factor in the patient's comfort level, which in turn affects the physician's comfort level. OBJECTIVES In this comparative study, the authors assessed levels of pain and bruising after participants were injected with 30-gauge or 33-gauge (G) microneedles, which are commonly used for minimally invasive injection procedures. METHODS Twenty healthy volunteers were recruited for this prospective study. Eight injection points (4 on each side of the face) were determined for each patient. All participants received injections of saline with both microneedles in a randomized, blinded fashion. Levels of pain and bruising were assessed and analyzed for significance. RESULTS The highest level of pain was in the malar region, and the lowest level was in the glabella. Although all pain scores were lower for the 33-G microneedle, the difference was significant only for the forehead. Because most minimally invasive procedures require multiple injections during the same sitting, the overall procedure was evaluated as well. Assessment of the multiple-injection process demonstrated a significant difference in pain level, favoring the 33-G needle. Although the difference in bruising was not statistically significant between the 2 needles, the degree of bruising was lower with the 33-G needle. CONCLUSIONS For procedures that involve multiple injections to the face (such as mesotherapy and injection of botulinum toxin A), thinner needles result in less pain, making the overall experience more comfortable for the patient and the physician. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Billur Sezgin
- Dr Sezgin is an Attending Physician in the Department of Plastic, Reconstructive and Aesthetic Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Bora Ozel
- Drs Ozel and Guney are residents, Dr Tuncer is an Associate Professor, and Dr Cenetoglu is a Professor and the Department Head, in the Department of Plastic, Reconstructive and Aesthetic Surgery, Gazi University Hospital, Ankara, Turkey
| | - Hakan Bulam
- Dr Bulam is an Attending Physician in the Department of Plastic, Reconstructive and Aesthetic Surgery, Numune Research and Training Hospital, Ankara, Turkey
| | - Kirdar Guney
- Drs Ozel and Guney are residents, Dr Tuncer is an Associate Professor, and Dr Cenetoglu is a Professor and the Department Head, in the Department of Plastic, Reconstructive and Aesthetic Surgery, Gazi University Hospital, Ankara, Turkey
| | - Serhan Tuncer
- Drs Ozel and Guney are residents, Dr Tuncer is an Associate Professor, and Dr Cenetoglu is a Professor and the Department Head, in the Department of Plastic, Reconstructive and Aesthetic Surgery, Gazi University Hospital, Ankara, Turkey
| | - Seyhan Cenetoglu
- Drs Ozel and Guney are residents, Dr Tuncer is an Associate Professor, and Dr Cenetoglu is a Professor and the Department Head, in the Department of Plastic, Reconstructive and Aesthetic Surgery, Gazi University Hospital, Ankara, Turkey
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