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González Del Castillo J, Martín-Delgado MC, Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, Bouza E. Lessons from COVID-19 for future disasters: an opinion paper. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2022; 35:444-454. [PMID: 35754203 PMCID: PMC9548069 DOI: 10.37201/req/058.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/15/2022]
Abstract
A "Pandemic/Disaster Law" is needed to condense and organize the current dispersed and multiple legislation. The State must exercise a single power and command appropriate to each situation, with national validity. The production of plans for the use of land and real estate as potential centers for health care, shelter or refuge is recommended. There should be specific disaster plans at least for Primary Health Care, Hospitals and Socio-sanitary Centers. The guarantee of the maintenance of communication and supply routes is essential, as well as the guarantee of the autochthonous production of basic goods. The pandemic has highlighted the need to redefine the training plans for physicians who, in their different specialties, have to undertake reforms that allow a more versatile and transversal training. National research must have plans to be able to respond quickly to questions posed by the various crises, using all the nation's resources and in particular, all the data and capabilities of the health sector. Contingency plans must consider ethical aspects, and meet the needs of patients and families with a humanized approach. In circumstances of catastrophe, conflicts increase and require a bioethical response that allows the best decisions to be made, with the utmost respect for people's values. Rapid, efficient and truthful communication systems must be contained in a special project for this sector in critic circumstances. Finally, we believe that the creation of National Coordination Centers for major disasters and Public Health can contribute to better face the crises of the future.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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Khonsari RH, Oranger M, François PM, Mendoza-Ruiz A, Leroux K, Boussaid G, Prieur D, Hodge JP, Belle A, Midler V, Morelot-Panzini C, Patout M, Gonzalez-Bermejo J. Quality versus emergency: How good were ventilation fittings produced by additive manufacturing to address shortages during the COVID19 pandemic? PLoS One 2022; 17:e0263808. [PMID: 35446853 PMCID: PMC9022824 DOI: 10.1371/journal.pone.0263808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/29/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The coronavirus disease pandemic (COVID-19) increased the risk of shortage in intensive care devices, including fittings with intentional leaks. 3D-printing has been used worldwide to produce missing devices. Here we provide key elements towards better quality control of 3D-printed ventilation fittings in a context of sanitary crisis. MATERIAL AND METHODS Five 3D-printed designs were assessed for non-intentional (junctional and parietal) and intentional leaks: 4 fittings 3D-printed in-house using FDeposition Modelling (FDM), 1 FDM 3D-printed fitting provided by an independent maker, and 2 fittings 3D-printed in-house using Polyjet technology. Five industrial models were included as controls. Two values of wall thickness and the use of coating were tested for in-house FDM-printed devices. RESULTS Industrial and Polyjet-printed fittings had no parietal and junctional leaks, and satisfactory intentional leaks. In-house FDM-printed fittings had constant parietal leaks without coating, but this post-treatment method was efficient in controlling parietal sealing, even in devices with thinner walls (0.7 mm vs 2.3 mm). Nevertheless, the use of coating systematically induced absent or insufficient intentional leaks. Junctional leaks were constant with FDM-printed fittings but could be controlled using rubber junctions rather than usual rigid junctions. The properties of Polyjet-printed and FDM-printed fittings were stable over a period of 18 months. CONCLUSIONS 3D-printing is a valid technology to produce ventilation devices but requires care in the choice of printing methods, raw materials, and post-treatment procedures. Even in a context of sanitary crisis, devices produced outside hospitals should be used only after professional quality control, with precise data available on printing protocols. The mechanical properties of ventilation devices are crucial for efficient ventilation, avoiding rebreathing of CO2, and preventing the dispersion of viral particles that can contaminate health professionals. Specific norms are still required to formalise quality control procedures for ventilation fittings, with the rise of 3D-printing initiatives and the perspective of new pandemics.
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Affiliation(s)
- Roman Hossein Khonsari
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker - Enfants Malades, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
- Délégation Inter-Départementale pour le Développement de la Fabrication Additive (DIDDFA), Direction générale, Assistance Publique – Hôpitaux de Paris, Paris, France
- * E-mail:
| | - Mathilde Oranger
- Service de Réhabilitation Respiratoire (Département R3S), Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Sorbonne Université, Paris, France
| | | | | | | | - Ghilas Boussaid
- Service de Réhabilitation Respiratoire (Département R3S), Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Delphine Prieur
- Délégation Inter-Départementale pour le Développement de la Fabrication Additive (DIDDFA), Direction générale, Assistance Publique – Hôpitaux de Paris, Paris, France
| | | | - Antoine Belle
- Service de Pneumologie, Centre Hospitalier Intercommunal de Compiègne-Noyon, Compiègne, France
| | - Vincent Midler
- Département de la Maîtrise d’Ouvrage et de la Politique Technique – DEFIP, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Capucine Morelot-Panzini
- Faculté de Médecine, Sorbonne Université, Paris, France
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Paris, France
| | - Maxime Patout
- Faculté de Médecine, Sorbonne Université, Paris, France
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Paris, France
- Service des Pathologies du Sommeil (Département R3S), Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Jésus Gonzalez-Bermejo
- Service de Réhabilitation Respiratoire (Département R3S), Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Sorbonne Université, Paris, France
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Paris, France
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Vallatos A, Maguire JM, Pilavakis N, Cerniauskas G, Sturtivant A, Speakman AJ, Gourlay S, Inglis S, McCall G, Davie A, Boyd M, Tavares AAS, Doherty C, Roberts S, Aitken P, Mason M, Cummings S, Mullen A, Paterson G, Proudfoot M, Brady S, Kesterton S, Queen F, Fletcher S, Sherlock A, Dunn KE. Adaptive Manufacturing for Healthcare During the COVID-19 Emergency and Beyond. FRONTIERS IN MEDICAL TECHNOLOGY 2021; 3:702526. [PMID: 35047941 PMCID: PMC8757720 DOI: 10.3389/fmedt.2021.702526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/06/2021] [Indexed: 01/25/2023] Open
Abstract
During the COVID-19 pandemic, global health services have faced unprecedented demands. Many key workers in health and social care have experienced crippling shortages of personal protective equipment, and clinical engineers in hospitals have been severely stretched due to insufficient supplies of medical devices and equipment. Many engineers who normally work in other sectors have been redeployed to address the crisis, and they have rapidly improvised solutions to some of the challenges that emerged, using a combination of low-tech and cutting-edge methods. Much publicity has been given to efforts to design new ventilator systems and the production of 3D-printed face shields, but many other devices and systems have been developed or explored. This paper presents a description of efforts to reverse engineer or redesign critical parts, specifically a manifold for an anaesthesia station, a leak port, plasticware for COVID-19 testing, and a syringe pump lock box. The insights obtained from these projects were used to develop a product lifecycle management system based on Aras Innovator, which could with further work be deployed to facilitate future rapid response manufacturing of bespoke hardware for healthcare. The lessons learned could inform plans to exploit distributed manufacturing to secure back-up supply chains for future emergency situations. If applied generally, the concept of distributed manufacturing could give rise to "21st century cottage industries" or "nanofactories," where high-tech goods are produced locally in small batches.
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Affiliation(s)
- Antoine Vallatos
- Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, United Kingdom
| | - James M. Maguire
- School of Engineering, University of Edinburgh, Edinburgh, United Kingdom
| | - Nikolas Pilavakis
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | | | - Steve Gourlay
- School of Engineering, University of Edinburgh, Edinburgh, United Kingdom
| | - Scott Inglis
- Department of Medical Physics, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Graham McCall
- AESSiS - Advanced Engineering Solutions, London, United Kingdom
| | - Andrew Davie
- Department of Medical Physics, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Mike Boyd
- uCreate Studio, Main Library, University of Edinburgh, George Square, Edinburgh, United Kingdom
| | - Adriana A. S. Tavares
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science and Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Connor Doherty
- Department of Medical Physics, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Sharen Roberts
- Department of Medical Physics, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Paul Aitken
- School of Engineering, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark Mason
- School of Engineering, University of Edinburgh, Edinburgh, United Kingdom
| | - Scott Cummings
- School of Engineering, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew Mullen
- School of Engineering, University of Edinburgh, Edinburgh, United Kingdom
| | - Gordon Paterson
- School of Engineering, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthew Proudfoot
- School of Engineering, University of Edinburgh, Edinburgh, United Kingdom
| | - Sean Brady
- School of Engineering, University of Edinburgh, Edinburgh, United Kingdom
| | - Steven Kesterton
- Department of Medical Physics, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Fraser Queen
- Lomond Process Engineering, Glasgow, United Kingdom
| | | | - Andrew Sherlock
- School of Engineering, University of Edinburgh, Edinburgh, United Kingdom
- Shapespace, Edinburgh, United Kingdom
| | - Katherine E. Dunn
- School of Engineering, University of Edinburgh, Edinburgh, United Kingdom
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