Miguel Cadena Méndez

Analysis of the Medical Imaging Services at Three Hospitals of the Mexican National Health System

We present a study on the quality of operation and the characteristics of the medical imaging equipment in three specialty hospitals of the Mexican Health System. Six month residencies were carried out in order to better understand the problems and internal functioning of the three imaging departments. The kinds of equipment, the types of equipment failures and the internal operation of these services were analyzed. The results allow us to identify four factors that are linked to faults in the quality of the health care delivered to patients. The first factor is equipment obsolescence; the second is related to deficient preventive maintenance procedures and problems associated the supervising of external service providers. The third factor is derived from the equipment’s (over) workload, which is indirectly tied to the age of the imaging modalities and the fourth factor is misuse of the equipment. The solutions to these problems include the modernization of the equipment and a better supervision by the clinical engineering department of all the processes involving the medical imaging services in each hospital. In addition to this, a special effort of the continuing education of personnel associated with medical imaging at all levels should be carried out.

Analysis of the impact of medical technology assessment subjects on BME Curricula

This paper presents and analyzes the factors that have arisen on the implementation of the medical technology assessment and management courses, and the academic methodologies used to deal with them. Five courses that cover topics as Technology Management, Health Economics, Quality Assessment, Innovation and Entrepreneurship were designed as electives for BME curriculum and have been taught for the last two years. The activities carried out within the courses are described and their impact on the comprehension of the course contents are presented. Also, several elements and factors pertaining to the teaching-learning process are discussed. Future perspectives for the students that follow this sub-specialty branch of the BME curriculum are presented.

Critical assessment and outlook for the 50 biomedical engineering undergraduate programs in mexico

Biomedical Engineering (BME) has been taught in Mexico at the undergraduate level for over forty years. The rationale for the introduction of this profession was to help manage and maintain the growing technological infrastructure in the health care system during the seventies. Owing to this, it is not surprising that early versions of the BME curricula were oriented towards clinical engineering and medical instrumentation. In the last decade the number of programs has grown from three in the seventies and eighties to fifty at present. This work is the result of the analysis of the BME programs in all the institutions that offer this degree in Mexico. Three main issues were studied: the curricula, the sub-disciplines that were emphasized in the programs and the job market. Results have shown a striking resemblance in most of the programs, which are mostly dedicated to teaching aspects of medical instrumentation and clinical engineering. These results reflect an agreement with the requirements of the job market, but since most job offerings are for low-paying positions in sales, service and hospital maintenance, we question the wisdom of stressing these sub-specialties at research universities, where faculties and research labs offer a wide variety of options. An analysis of work at these centers shows that most of the results are publications, so the need to emphasize translational research and partnerships with industry are suggested.

Imaging Facilities for Basic Medical Units: A Case in the State of Guerrero, Mexico

This work presents the methodology to design a small imaging unit in a small regional hospital that takes into account the real imaging needs in the region regardless of current administrative guidelines. The situation of the imaging facilities in Mexico’s states is studied and compared with other countries, and a project plan is designed for the specific state (Guerrero) where the clinic is to be located. The proposal includes the acquisition of a basic suite of modalities that include an ultrasound system, a mammography unit, and a conventional X-ray system in addition to a CT system that is not available anywhere within the state. The system should be primarily digital and should incorporate a simple picture archiving and communications system that can be the basis of a future telemedicine unit. The conclusion of this study also proposes changes in the segmented and pyramidal structure of the Mexican health system in order to provide higher quality care at the lower level, to reduce bottlenecks, and to provide higher quality health care near the patient’s home.

Knowledge network for medical technology management in Mexico

OBJECTIVES The role of biomedical engineers (BMEs) has changed widely over the years, from managing a group of technicians to the planning of large installations and the management of medical technology countrywide. As the technology has advanced, the competence of BMEs has been challenged because it is no longer possible to be an expert in every component of the technology involved in running a hospital. Our approach has been to form a network of professionals that are experts in different fields related to medical technology, where work is coordinated to provide high quality services at the planning and execution stages of projects related to medical technology. METHODS A study of the procedures involved in the procurement of medical technology has been carried out over the years. These experiences have been compared with several case studies where the approach to problem solving in this area has been multidisciplinary. Planning and execution phases of projects involving medical technology management have been identified. RESULTS After several instances of collaboration among experts from different fields, a network for management of healthcare technology has been formed at our institution that incorporates the experience from different departments that were dealing separately with projects involving medical technology. CONCLUSIONS This network has led us to propose this approach to solve medical technology management projects, where the strengths of each subgroup complement each other. This structure will lead to a more integrated approach to healthcare technology management and will ensure higher quality solutions.

Biomedical Engineering curriculum at UAM-I: A critical review

The Biomedical Engineering (BME) curriculum at Universidad Autónoma Metropolitana (UAM) has undergone at least four major transformations since the founding of the BME undergraduate program in 1974. This work is a critical assessment of the curriculum from the point of view of its results as derived from an analysis of, among other resources, institutional databases on students, graduates and their academic performance. The results of the evaluation can help us define admission policies as well as reasonable limits on the maximum duration of undergraduate studies. Other results linked to the faculty composition and the social environment can be used to define a methodology for the evaluation of teaching and the implementation of mentoring and tutoring programs. Changes resulting from this evaluation may be the only way to assure and maintain leadership and recognition from the BME community.

Managing new directions for a 38 year old undergraduate BME program

The Biomedical Engineering curricula in general must reflect the state of the art in the technology related to medicine and health care, as students who graduate from these programs are directly related to the well-being of the patients, either through new devices and technologies being invented or through the application of their technical knowledge in the service industry. At present, there are more than 25 BME undergraduate programs in Mexico. Most of them are oriented towards the instrumentation and clinical engineering branches of the field, while a few others have strong components in signal analysis. The program at Universidad Autónoma Metropolitana (UAM) is one of the oldest and has been used as a reference by most other programs. Since UAM is one of the top three research universities in the country, it is well poised to incorporate its research directions into a more modern curriculum. This paper deals with the efforts that have been carried out in order to minimize the excessive influence of the electrical engineering subjects in the BME undergraduate curriculum and the approaches to reach consensus-based decisions to explore new directions related to emerging disciplines in medical technology and health care. After analysis of the current state, a discussion on future directions is presented.

Methodology for the design of a PACS in a small provincial hospital

This paper describes the design and implantation issues for a Picture Archiving and Communications System (PACS) in a 60-bed provincial hospital. Considerations such as the state of the imaging equipment, preventive maintenance, use and misuse of the equipment and the difficulties regarding migration to an all-digital imaging unit are discussed, as well as the criteria for the selection of the imaging modalities. Finally a design is proposed with four imaging modalities that use open-source database and display workstations. The system is currently under evaluation for possible reproduction in as many as 60 small clinics and hospitals throughout the country.

Metabolic Variability: ¿Noise or New Physiological Information?

The aim of this paper is to propose the measurement a new type of physiological variability. The premise is that there is embedded information in the form of short-term metabolic variability (MV) when the human gas exchange is measured using the mixing chamber and the breath by breath indirect calorimetry technique (ICT). This two measurement methods are compared to observe metabolic dynamics when subjects are subdue to physiological stimulus. Variances and low frequency power spectrums (0–0.5 Hz) are use to measure the MV activity. The hypothesis is proved measuring the MV in a population of 17 young volunteers subdue the clino-ortho maneuver. The test protocol was adapted using 30 minutes of data acquisition to include both mixing chamber and breath by breath ICT. Subjects were measured after 8 hours of fasting. The results showed a MV increment from 32.5 to 40 ml/min (p<0.01) for de VO2 standard deviation with none significance change for de the VCO2 using the mixing chamber ICT. Analogously the ICT breath by breath MV showed a total power spectrum change from 34.9 to 60 (ml/bth)2 for the VO2 and from 24 to 37 (ml/bth)2 for the VCO2 (p<0.05), mainly in the frequency region from 0.01 to 0.03 Hz. Therefore, it was concluded that breath by breath MV was approximately 3 times more relevant than the mixing chamber MV with the possibility to evidence metabolic control mechanism.

Caracterización de membranas hemodialíticas por microscopía de fuerza atómica

Recent development in the bio-medical engineering and use of the new type of nano-materials, requires different and rather more sophisticated analytical tools. The Atomic Force Microscopy (AFM) is one of the most sophisticated tools very often used for the surface morphology characterization. The pore size characterization and distribution on the surface of the dialysis (renal) membrane is of a special importance for qualitative and quantity evaluation of the hemodialyzer quality. In the present study, AFM has been used to characterize the surface pores of a hollow-fiber dialysis membrane (polysulfone). The inner and outer side of the fiber dialysis membrane, were subject of investigation (imaging). In order to understand the process of the hemodialyzer deactivations, membranes previously used in hospitals after a single use, 10th and 23rd times of use, were analyzed by AFM. The obtained AFM images revealed significant differences in the quality and characteristics of the surface conditions of the hemodialysis membranes, on the nanometric level. This study also clearly shows that AFM could be a powerful tool for evaluation of the hemodialysis membrane conditions.