Browsing by Author "Dey, Roopam"

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    Open Access
    Assessing user feedback and clinical outcomes when using a novel sleeve attachment device providing reduced activation force and a built in dose counter for pressurised metered dosage inhalers
    (2023) Mapondela, Kassim; Levin, Michael; Dey, Roopam
    Background: Activating pressurised metered dose inhalers (pMDI) is often challenging for children. Easy Squeezy (ES), is a novel sleeve attachment device that reduces this activation force by from 46N to 12.6N and monitors the remaining doses using its built-in counter. Objectives: The primary objective of this study was to examine the usability and patient experience of the ES sleeve attachment device in the paediatric patient population and, to assess clinical outcomes (lung function, asthma control and quality of life) when using a novel sleeve attachment device for pressurised metered dose inhalers (pMDI) compared to using pMDI without the novel sleeve attachment. Methods: The usability cross-sectional study included 40 participants between the ages of 5 to 10 years, half of whom had prior experience in using a pMDI. Participants and their parents recorded their responses on the ease of use, perceptions and satisfaction with using the pMDI alone and the pMDI with the ES. The longitudinal cohort clinical study included 55 asthmatic children between the age of 5 and 12 years randomised into two groups. One group used ES for 6 weeks while the other group used pMDI. After 6 weeks the participants crossed over to the other group. Lung function test parameters were measured before randomisation and after each 6 weeks of device use. Quality of life information (PAQLQ) and child asthma control test (C-ACT) were measured after each period of device use. Results: The participants and their parents preferred ES to pMDI alone and felt happier using the ES device (100% in experienced vs 95% in inexperienced). They felt it was easier for them to activate the pMDI using ES. They expressed that the built-in counter in ES will make it easier to keep track of the doses. There was no significant difference in the baseline lung function between the groups in the clinical study. ES group had significantly lower percentage difference between pre- and post-bronchodilator FEV1 ( -6.5±15.7; FEV1/FVC: 2.5±7.5) vs (FEV1: 3.5±14.6; difference in FEV1: 3.4±13.8; FEV1/FVC: -2.6±7.4). Although no significant differences were observed in PAQLQ scores between the groups, more patients in the ES group had improvement of PAQLQ than the group using pMDI alone. Total C-ACT scores were significantly higher for the ES group. Conclusion: The Easy Squeezy device improves patient satisfaction and asthma control and may improve users' quality of life. Key words: Keywords: Pressured metered dose inhaler, children, Easy Squeezy, quality of life, lung function, asthma, asthma control.
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    Open Access
    Design and Development Towards a Novel Prosthesis for Total Shoulder Arthroplasty to Reduce Aseptic Glenoid Loosening
    (2018) Dey, Roopam; Sivarasu, Sudesh; Roche, Stephen
    Total shoulder arthroplasty (TSA) is the most common surgical solution, that helps in restoring the structural and functional integrity of a diseased glenohumeral (GH) joint with intact rotator-cuff. A 300% increase in the usage of TSA has been observed since 2007, along with 2.5% increase in revision rate. Aseptic glenoid loosening accounts for 37% of postsurgical failures in TSA. Eccentric loading of the prosthetic glenoid cup, leading to the “rocking horse” effect, is one of the prevalent causes of aseptic glenoid loosening. Current anatomical total shoulder prosthesis (ATSP) geometry does not consider all the GH morphometric features, for example the elliptical shape of the humeral head. Moreover, the morphometric studies leading to the initial ATSP design did not consider the GH morphology of any sub-Saharan population. Hence, there exists a gap in understanding of the implications of certain morphometric features on the functionality of a post-TSA GH joint. This thesis had two primary aims to address this gap in knowledge. Firstly, to study the GH morphometric variations between cohorts representing native European (Swiss) and native sub-Saharan (South African) populations. Secondly, to develop anatomically inspired ATSP design concepts and test them using biomechanical and finite element (FE) models, insilico, under standardised testing protocols. The morphometric analysis suggested that an average Swiss humeral head radius of curvature was larger (P<0.05) than the average South African humeral head. By comparing the biological head sizes, across both the populations, with the dimensions of the commercially available humeral heads, it can be inferred that suitable humeral prostheses are currently not available for individuals with head sizes >28mm or <19mm. Considering both the populations, the inherent shape of an average humeral head was found to be elliptical. The thickest region of the head was found to lie in the posterior region and not at the geometric center. Hertzian contact theory was applied to calculate the GH stresses produced by symmetric and asymmetric elliptical heads. Higher concentric stresses (P<0.001), within the acceptable limit for polyethylene, were observed to be imparted by the asymmetric heads. Population-specific musculoskeletal models were developed to study the post-TSA kinematic variation. When an identical range of motion (RoM) was performed by these models, population-specific variation in muscle moment arms was observed. The novel glenoid designs were not found to alter the post-surgical kinematics. FE models of the biradial, compartmental and pear-shaped glenoid implant designs were subjected to compressive and shear loading according to the American Society for Testing and Materials (ASTM). Using the bi-radial the glenoid cup, with thickened posterior-superior surface, anatomically relevant force distribution patterns could be replicated. Compartmentalising the glenoid prosthesis into concentric and eccentric regions with the gaps, proved to be highly beneficial. When compared to a commercially available glenoid prosthesis, the compartmental prosthesis was able to contain the GH forces to the concentric region for longer, delaying the eccentric loading and therefore potentially reducing the “rocking horse” effect. In the light of the above observations, two conclusions can be drawn from this thesis. Firstly, it would be beneficial if population-specific ATSP were made available for natives of certain geographic locations. Secondly, glenoid prosthesis designs could be compartmentalised to contain the GH joint forces within the concentric regions of the cup which might aid in the reduction of post-TSA complications.
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    Development of a Solution Method to Promote Proper Bandaging Techniques for Transfemoral Amputees
    (2021) Lalla, Bhaveen; Sivarasu, Sudesh; Dey, Roopam
    Post-operative care for lower limb amputees focuses on reducing swelling and promoting healing of the residual limb. Healing and desired residual limb maturation is necessary to achieve a conical shape suitable for prosthesis integration. Elastic bandaging is applied to the residual limb to achieve this conical shape. Bandaging requires skill and frequent reapplication. In many cases, the amputee is unable to bandage the residual limb effectively following surgery and professional assistance may not be readily available, increasing the risk of permanent damage due to improper bandaging. Transfemoral amputees are often confined to a wheelchair and spend the most time without a prosthesis fitted compared to any other lower limb amputee. An effective method in achieving the optimum residual limb shape, while promoting proper bandaging is therefore required. The aim of this study was to develop a solution method to assist transfemoral amputees with proper bandaging to achieve a shorter healing period and promote faster prosthesis integration through residual limb re-shaping. An overall solution method comprising of three sub-systems was designed to instruct bandaging. This included the development of a bandaging template, a mobile application and an elastic bandage dispenser. A printable bandaging template generated by a Python script based on the measurements of the patient's residual limb circumferences was developed to instruct bandaging. Development of a mobile application allowed for the design of an interface to control the dispensing device and instruct bandaging steps. The developed Bandage Utility Dispenser (BUD) transmits unrolled bandage length measurements to the mobile application using Bluetooth, to meet the target bandage lengths. Target bandage lengths are calculated by a second Python script to recommend sufficient bandage lengths. Target bandage lengths are expected to apply adequate pressure, while covering the exposed area of the residual limb for the current bandaging step. Testing occurred on an anatomically correct residual limb model (ACM) and five constructed models (CM) assembled by altering proximal and distal ACM circumferential measurements in increments of 5 cm. Measurement and pressure testing were performed after successfully validating the use of the CMs using a Bland-Altman analysis on the ACM and a CM of equal dimensions. Measurement testing utilised a chi-square goodness of fit test to compare observed and expected bandage length measurements for each model. Results for all models indicated that observed and expected measurements did not differ significantly. Pressure testing was performed by measuring the pressure application along the perimeter of the models with assembled pressure pads. Readings were analysed using a one sample t-test to compare differences between sample means and the recommended pressure application from literature. Testing results indicated that pressure application for five of the six models were in an acceptable range. Future recommendations have been established to potentially improve design, functionality and testing of the current iteration of the BUD solution method.