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A High-Speed, Light Weight Hardware Architecture for H.264- Compatible Compression on an FPGA
No full textVideo compression is a technique that reduces and removes spatial and temporal redundancy of video data, resulting in a reduction in transmission time and communication bandwidth across a network and efficient storage. H.264, a widely adopted video compression standard, is the result of collaborative efforts between the ISO (International Organization for Standardization) Moving Picture Experts Group (MPEG) and the ITU (International Telecommunication Union) Video Coding Experts Group (VCEG). H.264 uses an array of algorithms for coding digital video to achieve better compression efficiency compared to previous standards. However, this efficiency increase comes at the cost of higher computational complexity for H.264 encoders. This thesis design and implement an H.264-compatible intra-frame video encoder on FPGA. The encoding algorithms, like intra prediction, transform, quantization, and entropy coding, are initially implemented and tested in MATLAB. Later, these algorithms are translated into VHDL language and evaluated through timing simulations vi in Vivado. The FPGA implementation is then tested using various input pixel sizes and video resolutions across multiple FPGA devices. The encoder supports all video resolutions and frame rates
A Quality Improvement Initiative: A Patient Education Video for Enhancing Postoperative Pain Management
No full textBackground/Purpose: The current opioid epidemic remains as one of the most severe public health crises in history. The perioperative setting is often where an initial exposure to opioids occurs, not only as a key component of an anesthetic, but in the form of prescriptions for the management of postoperative pain. A prior DNP project was developed to minimize patient exposure to opioids during select sinus surgery procedures with the use of an opioid sparing anesthesia outline. The results of the initial project identified that key modifications were needed to not only improve the outline itself, but also highlighted a knowledge gap in patient education regarding opioid use and postoperative pain management. With the goal to address this knowledge gap, the purpose of this DNP project was to 1) amend and update the opioid sparing anesthesia outline; 2) evaluate adherence to the outline by anesthesia providers; 3) retrospectively assess the outcomes of patients who received an opioid sparing anesthetic; and 4) develop a preoperative patient education video and evaluate its impact on patient knowledge and understanding of safe opioid use and postoperative pain management.
Methods: A preoperative patient education video was developed by the multidisciplinary team. The video was scripted, formatted, and recorded by the project team in a role-play setting between patient and provider. The comprehensive application to the IRB was submitted in the summer of 2022, but due to newly mandated IRB processes in obtaining consent, it prevented carrying out the project as planned. Therefore, a new methodology was developed and included the physician member of the project team providing the patient education video in her office and via a QR code emailed to applicable patients who were scheduled for surgery. Patients were asked to complete a questionnaire specific to the video during their two-week postoperative visit. The questionnaire is formatted to determine the efficacy of the video in enhancing patient knowledge about safe postoperative pain management techniques. Comparisons of patient knowledge before and after viewing the video will be assessed.
Results: The patient education video was provided to patients in the physician’s office when scheduled for specific sinus surgery procedures from March 2023 until July 2023. The anticipated sample size (n=20-25) for patient evaluation of the video will be based upon the surgeon scheduling sinus surgeries during this same time frame.
Discussion/Conclusion: This study aims to investigate the efficacy of a patient education video on the understanding of postoperative pain management, opioid use, and the safe storage and disposal of opioids, with the purpose to allow patients to become stakeholders in their health and make more informed decisions about their postoperative pain management
Evaluation of a COVID-19 Surgical Scheduling Guideline using the Appraisal of Guidelines for Research and Evaluation AGREE II Instrument
No full textIntroduction/Background Since the beginning of the SARS-COVID-19 pandemic in February 2020, the operating room and surgical care has undergone vast change. At its start, COVID-19 infection caused many elective surgeries to be canceled, operating room schedules to be altered, and inquiries of how healthcare should change in order to continue providing the best care during unprecedented circumstances. Hospital administration, healthcare workers, and patients began searching for valid information to guide best practice. COVID-19 has been found to severely affect the physiology of the circulatory and pulmonary systems of patients. With new discovery of pathophysiologic consequences of COVID-19 infection, the need for well-founded guidelines to assist clinicians in managing surgical and anesthetic care is realized. Guidelines surrounding the treatment of surgical patients infected with COVID-19 were formed during a time of crisis when evidence was limited and instability in healthcare delivery occupied much of healthcare team efforts. This period of uncertainty, paired with the volume of patients infected with COVID-19, may have contributed to the development of unclear guidelines as well as inconsistencies in following established guidelines that were meant to direct surgical and anesthesia care during times of peak infection of the COVID-19 pandemic.
Method: The main purpose of this Doctor of Nursing Practice (DNP) final project was to evaluate a clinical practice guideline (CPG) designed to be used by anesthesia providers to guide timing of surgery for patients diagnosed with COVID-19 in a major midwestern hospital in Michigan. The surgical scheduling guideline was evaluated for overall quality, development, and reporting using the AGREE II instrument and following instructions from AGREE Enterprise. The quality improvement methodology for this project followed the Agency for Healthcare Research and Quality’s “Plan-Do-Study-Act'' model for testing an implemented change. The appraisal team consisted of four appraisers that examined the CPG guideline. All items within the AGREE II instrument were given a score on a Likert scale ranging between 1-7 (strongly disagree = 1 and strongly agree = 7). Quality scores corresponding to six domains of the AGREE II instrument were calculated in addition to a compilation of the overall quality of guideline scores.
Results The guideline received low appraisal scores for the domain categories contained in the AGREE II instrument. All quality scores for the six appraised domains were low except for Domain 4: Clarity of Presentation (65.28%). In addition, the guideline received an overall low guideline quality rating of 25%. Although all domain scores and the final appraisal score were low, three out of four appraisers would recommend the guideline for use with modifications.
Discussion Large contributors of poor appraisal scores were the lack of available supporting evidence and explicit language needed for continual use and improvement. In developing future practice guidelines that will assist in upholding the delivery of safe surgical and anesthesia care even during an unprecedented crisis such as the COVID-19 pandemic, it is essential to include source materials to lend transparency for clinician use. Additionally, guidelines intended to influence patient care outcomes should include explicit evidence and language that states the desired outcomes. Additions such as these would better ensure the assessed guideline would contribute to positive change in patient care
Metabolic and Physiological Differences Between Knee Crutch Ambulation and Normal Gait: A Case Study
No full textThe knee crutch was originally developed in 1999 by the company iWalkFree as an assistive aid for individuals with below-the-knee injuries (iWALKFree). Although it has been over 20 years since the knee crutch was first commercialized, there have been very few studies published on how it affects the user. In addition, most studies concerning the knee crutch only describe the biomechanical and EMG data, instead of physiological and metabolic data. This two-participant case study research employed a portable gas analysis instrument to understand the minute ventilation (VE), oxygen (O2) consumption, and heart rate differences between walking with a knee crutch and walking with no assistive device. Upon comparing the results of this study to previous research, it was determined that the knee crutch allows greater efficiency than using other assistive devices such as traditional crutches and the knee scooter, indicated by lesser metabolic and physiologic stress
