Automobility Transfer Device
Team: Anne Zeng, Katelyn Greene, Giang Ha
Client: Dr. Janice Schwartz, MD, Professor of Medicine, Bioengineering and Therapeutic Sciences at UCSF, Research Scientist at Jewish Home of San Francisco (JHSF)
Problem: Older adults are prone to injury when entering and exiting vehicles.
Needs Statement: A device capable of handling loads the lower extremities typically experience through vehicle ingress and egress provides the user with stability needed for a comfortable and safe vehicle transfer.
Maintaining mobility is paramount to active aging and is inherently tied to overall health and quality of life of older adults. Recent surveys and national data reveal that automobile travel is the most significant mode of transportation for older adults. Standard automobiles, however, do not accommodate users of limited mobility due to inconvenient seat heights, lack of adequate handholds, and insufficient interior space to facilitate a safe and comfortable experience for older adults. In particular, older adults are prone to significant injury as they get into and out of a vehicle. This high prevalence of injury during vehicle ingress and egress motivated the need for a safe and comfortable assistive device to help older adults with this process.
Population: Older adults who are cognitively intact and physically able to operate mobility assistance devices.
Outcome: Reduce the usage of lower extremities for older adults entering and exiting vehicles.
Increasing Freedom-of-Movement of ICU Patients
Team: Tanay Nandgaonkar, Tra Tran, Victor Tieu
Client: Dr. Arash Afshinnik , Director of Neuro-critical Care at UCSF Fresno
Assistant Clinical Professor, Department of Neurologic Surgery, Division of Neurology, UC San Francisco Fresno
Problem: Tangling and detachment of wires connecting various devices and adapters to a portable attachment for the central monitor in the patient unit are cumbersome.
Needs Statement: A method to increase freedom-of-movement in neurological ICU patients in rehabilitation or approaching step-down in order to improve ICU discharge times.
Vital sign monitoring is a crucial aspect of critical patient care in the hospital intensive care unit (ICU). Unfortunately, uninterrupted vital sign monitoring remains a major challenge in critical patient care using the current standard-of-care devices and physical setup. Detachment of devices by patient grabbing and pulling—often during periods of delirium or agitation—may compel healthcare providers to use physical and chemical restraints that can increase the risk of harm and injury or, in the case of sedation, reduce responsiveness to stimuli that can be indicative of underlying neurological problems. This especially impacts patients in the neurological ICU who are undergoing rehabilitation or approaching step-down: the basic procedure in evaluating these patients is to tell the patient to get up from their bed and sit down on a chair by their side. The combination of EKG, pulse oximeter, blood pressure cuffs, IV tubings, power cords, temperature probes, and sometimes urinary catheters makes it extremely difficult for the patient move about.
Population: Neurological ICU patients.
Outcome: Increase freedom-of-movement in neurological ICU patients in rehabilitation, or approaching step-down, in order to improve ICU discharge times.
Monitoring Impending Respiratory Failure in an Outpatient Setting
Team: Justin Choe, Andrew Hild, Dhruv Kothari, Anisha Kumar
Client: Dr. George Su, MD, Assistant Professor of Pulmonology and Critical Care Medicine at UCSF and SFGH
Problem: Outpatients have limited access to options that can accurately assess their level of respiratory compromise and impending respiratory failure without extreme inconvenience and expense.
Needs Statement: A method to predict impending type II respiratory failure in outpatients with COPD to reduce the rate of respiratory related outpatient mortality.
The process of respiration occurs primarily within the lungs and involves numerous steps that serve to promote gas exchange. Chronic respiratory disorders are a group of diseases affecting the airways and other associated structures of the lungs. These generally lead to impaired respiration and physiological stress, potentially culminating in a life-threatening condition. As such, a method to monitor respiratory function in an outpatient setting is a crucial clinical need that would be of utmost importance to the well-being of patients suffering from these disorders. In particular, the ability to alert patients of impending respiratory failure has the potential to greatly increase both a patient’s understanding of his or her condition and improve his or her quality of life.
Population: Outpatients with Chronic Obstructive Pulmonary Disorder (COPD) who suffer from type II respiratory failure.
Outcome: To reduce the occurrence of outpatient related respiratory mortality due to an inability to determine the potential for respiratory failure.
Pain Monitoring in Extra-Clinical Settings
Team: Tyler Davis, Alison Long, Botao Peng
Clients: Dr. Christine Ritchie, MD, Professor in Clinical Translational Research and Aging at UCSF Nicole Thompson, Clinical Research Coordinator, UCSF Geriatrics
Problem: Pain intensity is difficult to accurately and frequently measure, and often relies on digital technology that is convoluted and challenging to use for some patient types.
Needs Statement: A device that accurately gauges pain intensity in older adults with multiple chronic conditions, in order to improve the clinical prescription of pain medication.
Older adults with multiple chronic conditions are typically excluded from research studies as these conditions can be complicating factors in clinical trials. Patients with chronic pain also have less motivation to participate in experimental studies, and older patients have limitations in dexterity, vision, and cognitive function that lower their clinical trial candidacy. Prior to this project, Dr. Ritchie launched the Cognitive-activity Assessment in Response to Rx Intervention (CARRI) project, which attempts to engage chronic pain patients with technology for a real-time assessment of pain, cognition, function, and medication use. Although the system allows for a comprehensive investigation into the effects of pain medication, it has many shortcomings. Perhaps the largest drawback of the system is the time it requires from the patient; the three cognitive tests take up to an hour each day to complete, on top of the time required to make multiple pain and medication inputs.
Population: Older patients, with multiple chronic conditions such as heart disease, arthritis, and liver conditions, who often have lower dexterity and visual capabilities than other patient types and a limited familiarity with digital technology.
Outcome: Allow clinicians to see correlations between medication intake and pain levels throughout the day, and make adjustments to medication prescriptions accordingly, in order to reduce drug side effects and provide patients with better pain management.
Quantitative Assessment of Degree and Spatial Extent of Pain Nerve Block
Team: Darya Fadavi, Jeffrey Feng, Noreen Wauford
Client: Dr. Matthew Haight, DO, Anesthesiologist at UCSF
Problem: Measuring the degree and spatial extent of pain nerve block quantitatively and precisely.
Needs Statement: To measure the degree and spatial extent of pain nerve block both quantitatively and precisely in post-operative thoracic and abdominal adult surgical patients who have been given an epidural for their anesthetic administration.
Currently, there is no direct method of quantifying pain; in clinical practice, patients are most commonly asked to verbally rate their pain on a numeric scale. Several issues and limitations arise from qualitative methods of assessment as they are highly subjective, relying on self-reports of pain from conscious and cooperative patients. Anesthetic treatments, which are largely determined by these responses, vary widely in efficacy as a result. Overall, the current methods increase the amount of time needed by clinicians and nurses to monitor individual patients and the risk of complications, resulting in longer hospital stays. The capability of quantifying the measurement of pain, both by degree/extent and physical region, is fundamentally important as it significantly improves over current methods of pain measurement that are not precise due to their subjective nature.
Population: Post-op thoracic and abdominal adult surgical patients with epidurals.
Outcome: Lower complication rates in postoperative patients.
Screening for Autonomic Nervous System Dysfunction
Team: Maxine Arnush, Priya Bhattacharjee, Joshua Chen, Richard Xu
Client: Dr. Parvin Azizi, MD, Pediatric Neurologist, UCSF Fresno
Problem: Pediatric patients cannot be diagnosed with Autonomic Nervous System dysfunction because there are no available tools.
Needs Statement: A method to screen for ANS dysfunction in symptomatic pediatric patients who have been referred to a neurologist in order to reduce cases of misdiagnosis and improve treatment outcomes.
In the short-term, undiagnosed Autonomic Nervous System (ANS) disorder correlates to physical limitation and disability, physiological and behavioral worsening, and an inability to navigate society without potential risk of symptomatic flare-ups. Current diagnostic tools require a relatively high level of patient compliance, can often be physically restraining, and require precise directions to be followed on the part of the patient. There is a plethora of misdiagnoses of ANS dysfunction that can be attributed to the lack of screening tools available to pediatric neurology teams. In addition, children require a more sensitive method of diagnosis since their disease states are less progressed than those of adult patients. Currently, there is no available hardware or medical device that can effectively, sensitively, and quickly diagnose ANS dysfunction in a child-friendly way.
Population: Pediatric patients referred to a neurologist, 7-8 years of age.
Outcome: Reducing misdiagnosis, leading to a reduction in social implications as well as an impact in the clinical space for other neurologists.
Tremor Detection for Parkinson’s Patients
Team: Ashlee Horn, Jeff Hsiao, Katherine Spack, Alex Takahashi
Client: Dr. Cong Zhi Zhao, MD, Neurologist, UCSF Fresno
Problem: Parkinson’s symptoms and drug usage aren’t tracked accurately, resulting in a significant amount of time being taken to find a stable drug regimen.
Needs Statement: A tool to accurately record patients’ symptoms which delays the determination of a stable drug regimen by a neurologist. This solution simplifies symptom monitoring, enabling neurologists to quickly identify an effective treatment regimen for the patient.
Parkinson’s disease is the second most common neurodegenerative disease and affects 10 million people across the globe. Symptoms are particularly debilitating physically and emotionally; these include tremors, slowness, instability, fatigue, depression, and anxiety. On top of this, patients follow a strict daily drug regimen of up to twenty pills per day. Treatment plans are individualized to maximize the drug effectiveness while minimizing adverse reactions. As the disease progresses, treatment plans have to be adjusted. This process takes between three to six months due to factors including low patient compliance, subjective data, and inaccurate symptom logging. Often, patients do not have any records of whether or not they were experiencing symptoms, and can only give general, non-detailed information of their progression since their last visit. Caretakers will occasionally misreport the symptoms of the patient by either minimizing or exaggerating the impact Parkinson’s has on the patient’s daily lives. As it stands, the technology used to track symptoms and drug usage is inconvenient.
Population: Parkinson’s patients with tremor symptoms adjusting drug regimens.
Outcome: Reduce the amount of time for patients to attain a stable drug regimen.
Vital Sign Monitoring in Low Resource Settings
Team: Aran Bahl, Matt Chan, Karthik Prasad, Sara Sampson
Client: Dr. Richard Wang, MD, Clinical Fellow in Pulmonary Medicine at UCSF
Dr. George Su, MD, Associate Professor at UCSF
Problem: Infrequent vital sign monitoring due to low staff to patient ratios. Non-functional, non-intuitive, and/or missing equipment.
Needs Statement: A low cost device to frequently monitor vital signs in developing countries.
High mortality rates in low resource area hospitals, such as those in sub-Saharan Africa, have been linked to infrequent vital sign monitoring of admitted medical patients. More often than not, vital signs in low resource settings can be recorded as infrequently as once per day to once every few days, as compared to U.S. hospitals where it is normal to measure vital signs every few hours or even continuously. Even at this rate, it is uncommon for nurses to thoroughly chart the vital sign trends of each patient, which is essential for detecting gradual changes in temperature (T), heart rate (HR), respiratory rate (RR), or blood pressure (BP), all of which can be indicators of more serious complications. The major reason for this infrequency in recording and tracking fundamental vital signs can be attributed to the lack of available resources in some healthcare centers. In the developing world, an estimated 60-80% of all lives lost are linked to sepsis. Major indicators of sepsis include changes in core temperature, HR, and RR. These warning signs, if left untreated, can lead to severe sepsis, septic shock, or even death.
Population: Moderately unstable or infectious patients patients at risk for sepsis.
Outcome: Decrease in the mortality rates related to septic shock.