Transcript Powerpoint
Nebulizer Project
Matthew Lawrence Brockman Daniel Puthenpurayil George Nathan Joseph Hankins Marissa Kathleen McHugh 1
Outline
I. What’s a Nebulizer, Needs Assessment & Scope of Work Matthew II. Our Design – Matthew III. In-Country Implementation – Nathan IV. In-Country Training – Marissa V. Issues Encountered – Daniel VI. Evaluation/Feedback – Nathan VII. Cost Analysis – Daniel VIII. Testing and Results – Matthew IX. Sustainability and Ownership – Matthew X. Entrepreneurial – Nathan 2
What’s a Nebulizer
Compressor, filter, tubing, cup, mask Compressor not a medical device, simply supplies air Cup aerosolizes water with medication 3
Needs Assessment: Respiratory Problem Causes
Factors contributing to high prevalence of respiratory problems: Environmental effects Desert climate Dryness Wind Dusty air/Dust storms Allergenic trees Garbage and vegetation burned near homes Indoor cooking fires Cockroach infestations 4
Needs Assessment: Nebulizer Availability
Problems receiving nebulizer treatment: Limited availability at local clinics o Only 1-2 nebulizers o Walking distance o Closed on weekends o Open 7AM to Noon o Frequent power outages o Days designated for non-respiratory problems High cost (about $100) compared to salary 5
Scope of Work and Needs Assessment
Problem Statement: Deliver a simple, home-made nebulizer and an instruction manual Costumer: o Resistants of Choluteca, Honduras who suffer from respiratory problems o Larry and Angie Overholt Needs Assessment: o Large portion of the population suffers from asthma o o Environmental causes Low availability of nebulizers 6
Our Design
Filter filters to about 10 micrometers, car or motorcycle fuel filters will work similarly Bike pump acts as compressor This project uses actual nebulizer cup, mask, and tubing Soccer ball filters out the duty cycle of the pump as a capacitive element 7
In-Country Implementation
The team’s main goals were as follows: Source local parts Treat and take data in health departments and villages Train people in health departments and villages on how to build and use Distribute manuals on operation and creation of device Donate a nebulizer to each village Gain local feedback 8
In-Country Implementation: Week 1
Day Date
Monday 5/5/201 4
Tasks Completed
- Sourced Parts Locally - Tested/Troubleshot Local Parts - Worked on Manual Tuesday 5/6/2014 - Worked on Manual - Reassessed Schedule and Desired Statistical Method to be Used - Tested/Troubleshot Local Parts 9
In-Country Implementation: Week 1
Day Date
Wednesday 5/7/2014
Tasks Completed
- Finalized Manual/Made Copies Introduced Both Methods, Treated, and Trained Local Woman, Erma (donated nebulizer) Introduced Both Methods and Trained Nurses/Doctor at Choluteca Health Department 10
In-Country Implementation: Week 1
Day Date
Thursday 5/8/2014 -
Tasks Completed
Introduced Both Methods, Treated Patient, and Trained Nurses/Nursing Students/Doctor at Namasigue Health Department (donated nebulizer, health department had no electricity) Purchased Additional Parts Introduced Both Methods, Treated Children, and Trained Women’s Guild of Siete de Mayo (donated nebulizer) 11
In-Country Implementation: Week 1
Day
Friday
Date
5/9/2014
Tasks Completed
Introduced Method and Trained Nurses/Patients at Choluteca Health Department (donated nebulizer) Lined up Visits to Private Clinic, Hospital, and Pharmacy Prepared for Pharmacy Advertising 12
In-Country Implementation: Week 1
Day
Saturday
Date
5/10/2014
Tasks Completed
Provided free treatments, demonstrated the method, and handed out manuals outside pharmacy (met teacher) Worked on Poster design for Public Health Departments 13
In-Country Implementation: Week 2
Day
Monday
Date
5/12/2014
Tasks Completed
Introduced Method, Treated Patients, and Trained Nurses/Doctor/Patients at Dr. Gir ó n’s Private Clinic (donated nebulizer, committed to getting more data) Printed and Laminated More Manuals Updated Treatment Forms 14
In-Country Implementation: Week 2
Day
Tuesday
Date
5/13/2014
Tasks Completed
Introduced Method and Trained Nurses/Doctor in Namasigue Health Department (presented poster) Treated Infant Successfully with Only Saline Discussed Entrepreneurship Opportunities Introduced Method and Trained Women in Siete de Mayo 15
In-Country Implementation: Week 2
Day Date Tasks Completed
Wednesday 5/14/2014 Visited Choluteca Health Department (presented poster) Interviewed by Local News TV Station, TeleVida63 Searched and Found Teacher of Cambridge Bilingual School we Met on the Street Saturday and Presented for His Class (donated nebulizer) 16
In-Country Implementation: Week 2
17
In-Country Implementation: Week 2
Day
Thursday
Date
5/15/2014
Tasks Completed
Introduced Method and Trained Nurses/Patients/Doctors at the Choluteca Hospital’s Nebulization Clinic, Emergency Room, and Pediatric Ward (donated laminated manual) Introduced Method and Trained Entire Waiting Area of Hospital (ran out of manuals) Returned to Dr. Girón’s office and were able to record results of 2 patients using an electrical nebulizer Introduced Method, Treated, and Trained 2 Women of La Bonanza (donated one nebulizer) 18
In-Country Training
The training process involved: Demonstration of assembly and operation Explanation of evaluation forms Review and distribution of manual Distribution of posters 19
In-Country Training
Constructed a user manual 1.
Instructions for assembly 2.
List of materials including pictures, prices, and store names 3.
Directions for usage and sanitation 4.
Reservoir recommendations 5.
Troubleshooting 20
In-Country Training
Distributed laminated, color copies to public health departments and Dr. Giron’s clinic, the women’s group in Siete de Mayo, and Mr. Carlos from Cambridge.
Distributed black/white copies to woman in Choluteca, woman in La Bonanza, public health departments, Dr. G iron’s clinic, and at Farma City.
21
In-Country Training
All places visited followed the same basic pattern Trained doctor(s) and nurses Trained asthma and non-asthma patients and parents 22
In-Country Training
Taught nurses how to use peak flow meters Taught nurses how to complete the pre/post evaluation forms 23
Issues Encountered
Transportation dependability Quality of Honduran materials and healthcare Given “North American Prices” – Prices also varied Quantity and age of patients Language Barrier – Quality of our instruction may have varied Creation of the manuals – Far walk to print 24
Evaluation/Feedback
Cheap; most who need cannot afford electric nebulizer (L1,800), ours cost L343 Generally preferred reservoir design General public eager to learn (passed out over 100 manuals) “Our country needs this” A few people were hesitant at first – required additional explanation 25
Evaluation/Feedback
People were often excited by the design and would tell others - Cambridge teacher had told students and staff members including the security guard Doctor at Namasigue said it was a useful design because often patients are without electricity 26
R&D Cost Pre-Trip
Date Source Material Purchased 2/12/2014 mi l l ers ga rden.com
2/15/2014 jus tnebul i zers .com
2/18/2014 Ta rget 2/27/2014 Lowes 2/27/2014 Lowes 2/27/2014 Lowes 2/27/2014 Lowes 3/13/2014 Ta rget In line Universal Gas Filters Fuel filter 1/4" 5/6 Air Filters For Omron CompAir Nebulizer Systems Schwinn- Bike pump Brass hose barb adaptor (1/8" ID x 1/4: MIP) Brass hose barb adaptor (3/16" ID x 1/4: MIP) Brass tee pipe (1/4" PIP) Pressure gauge Basketball 3/20/2014 Wa l ma rt 3/20/2014 Ta rget 3/20/2014 Ta rget 3/20/2014 Ta rget Bell-Bike pump Basketball Schwinn hand pump Size 4 Soccer Ball 3/25/2014 Di ck's Sporting Goods Size 5 Soccer Ball 3/25/2014 Di ck's Sporting Goods Size 5 Soccer Ball 3/25/2014 Di ck's Sporting Goods Inflation Needles 3/28/2014 Medi comp Nebulizer Filter 4mm M
Subtotals Total Cost
Quantity Individual Price Cost 5 10 1 2 2 1 1 1 1 1 1 2 1 2 4 50 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 1.80
1.39
17.29
3.58
3.88
7.47
9.98
10.99
9.96
10.99
24.59
9.99
24.99
15.99
2.49
3.23
$ 9.00
$ 13.90
$ 17.29
$ 7.16
$ 7.76
$ 7.47
$ 9.98
$ 10.99
$ 9.96
$ 10.99
$ 24.59
$ 19.98
$ 24.99
$ 31.98
$ 9.96
$ 161.56
$ 377.56
$ 400.95
Shipping $ 3.00
$ 6.95
$ $ $ $ $ $ $ $ $ $ $ $ $ $ 13.44
$ 23.39
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R&D Cost During Trip
Payment, Date Supplier Item Payment, Dollars Lempira
8-May-14 7-May-14 6-May-14 7-May-14 8-May-14 7-May-14 7-May-14 Comercial El Balon de Oro Super Torrillo La Colonia Farmacias Kielsa Super Torrillo Copy Centro Douglas Global Cyber 8-May-14 8-May-14 Copy Centro Douglas Global Cyber Copy Centro 10-May-14 Douglas 10-May-14 Global Cyber 8-May-14 Global Cyber 14-May-14 Global Cyber 14-May-14 Global Cyber 12-May-14 Global Cyber 15-May-14 Global Cyber Copy Centro 15-May-14 Douglas 15-May-14 Farmacia de los Pobres 15-May-14 Farmacia Familiar 5-May-14 Farmacias Kielsa Comercial El Balon 5-May-14 de Oro 5-May-14 Auto Partes Dimer 7-May-14 Motorepuestos 5-May-14 Super Torrillo 9-May-14 DeTodo 10-May-14 Copy Centro Douglas
Total Cost
balls pumps balls parts pumps and balls copying copying copying copying copying copying copying copying copying copying copying copying Masks Masks masks balls filters pump and needles balls and pumps copying $ 36.59 $ 44.44 $ 6.46 $ 8.29 $ 21.85 $ 10.98 $ 14.63 $ 5.85 $ 1.95 $ 4.88 $ 1.22 $ 23.56 $ 2.93 $ 9.76 $ 14.54 $ 1.22 $ 6.10 $ 8.78 $ 3.17 $ 17.80 $ 6.10 $ 0.98 $ 2.24 $ 18.24 $ 23.06 $ 3.02
$ 298.64
L. 750.00
L. 911.00
L. 132.45
L. 170.00
L. 448.00
L. 225.00
L. 300.00
L. 120.00
L. 40.00
L. 100.00
L. 25.00
L. 483.00
L. 60.00
L. 200.00
L. 298.00
L. 25.00
L. 125.00
L. 180.00
L. 65.00
L. 365.00
L. 125.00
L. 20.00
L. 46.00
L. 374.00
L. 472.65
L. 62.00
L. 6,122.10
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Total R&D Cost
Mostly from purchasing balls and prototyping materials Large purchase of the filters to donate Pre-Trip During Trip Total $ 400.95
$ 298.64
$ 699.59
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Per Nebulizer Cost – United States
Using a size 5 soccer ball and the cheapest of the other materials, one nebulizer cost the team approximately
$30.57
In line Universal Gas Filters Fuel filter 1/4" 5/6 Bell-Bike pump Size 5 Soccer Ball Needle Nebulizer tubing, cup, and mask set
Total Cost
$ 1.80
$ 9.96
$ 15.99
$ 0.83
$ 1.99
$ 30.57
Without a reservoir, the nebulizer cost approximately
$13.75
In line Universal Gas Filters Fuel filter 1/4" 5/6 $ 1.80
Bell-Bike pump $ 9.96
Nebulizer tubing, cup, and mask set
Total cost
$ 1.99
$ 13.75
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Per Nebulizer Cost – Honduras
Cost with reservoir:
$16.73
Motorcycle Fuel Filter Schwinn- Bike pump Size 5 Soccer Ball Needle Nebulizer tubing, cup, and mask set
Total Cost
Cost without reservoir:
$9.17
L. 20.00
L. 125.00
L. 150.00
L. 5.00
L. 43.00
L. 343.00
$ 0.98
$ 6.10
$ 7.32
$ 0.24
$ 2.10
$ 16.73
Motorcycle Fuel Filter Schwinn- Bike pump Nebulizer tubing, cup, and mask set
Total cost
L. 20.00
L. 125.00
L. 43.00
L. 188.00
$ 0.98
$ 6.10
$ 2.10
$ 9.17
Hondurans can likely get these items for a lower price – One person commented they could get a soccer ball for L. 80.00
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In-Country Testing Regimen
Assess situation Pre-treatment baseline measurements Qualitative testing Quantitative testing Post-treatment evaluation Qualitative analysis Quantitative analysis 32
Pre and Post-Treatment Qualitative Testing
List observations related to breathing (Is patient coughing, wheezing, gasping for air, etc.) Doctor/Nurse observations or comments 33
Pre and Post-Treatment Quantitative Testing
Have patient blow into peak flow meter three times, take maximum Ask patient to rate difficulty of breathing from
uno
to
diez
,
uno
being perfect lung function 34
Post-Treatment Quantitative Analysis
Have patient blow into peak flow meter three times, take maximum Apply Equation 1 to find percent increase Ask patient to rate difficulty of breathing from
uno
to
diez
,
uno
being perfect lung function Report difference
Equation 1
Post − Pre × 100% Pre 35
Testing: Results
Treated 14 patients while in country: yielded 8 numerical data points Honduran Nurse at the private clinic collected 2 control data points and 4 more data points using our nebulizer The power of the test will be low, will hopefully increase as our contacts continue to take data Alpha level of 0.05 (medically standard) Null Hypothesis: The average percent increase in peak flow for the medical nebulizer is the same as the average increase in peak flow for the home made nebulizer.
Alternative Hypothesis: The average percent increase in peak flow for the medical nebulizer is greater than the average increase in peak flow for the home made nebulizer.
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Testing and Results
Medical Nebulizer Home-Made Nebulizer Percent Percent Before After Before After 125 100 70 120 50 110 190 90 100 60 100 60
Average
160 220 120 170 80 150 245 150 150 150 200 150 Increase 28% 120% 71% 42% 60% 36% 29% 67% 50% 150% 100% 150%
75%
100 150
Average
p-value was 0.413
250 200 Increase 150% 33%
92%
We therefore fail to reject the null hypothesis that the two means are the same Little data so far 37
Observational Results
Treatment had qualitative success Stopped bronchospasms in one patient Patients reported less or no difficulty breathing post treatment Some children fell asleep while using the nebulizer 38
Sustainability and Ownership
Made from locally available parts for low cost: sustainable supply of nebulizer Ownership: instructions for constructing Trained variety of individuals Targeted individuals/groups who are most likely to continue using the device and teach others – parents 39
Sustainability and Ownership
Cambridge teacher will continue to spread the idea Posters and manuals at health departments Dr. Giron will make and distribute nebulizers 40
Entrepreneurial Opportunities
Demand exists Product: Nebulizer kit and manual End user: Asthma patients Costumer: Philanthropic or Social Enterprise Non-profits such as NGOs Social entrepreneur Dr. Girón Roger Henriquez Carlos Ferrera 41
Conclusions
This was a reasonably successful pilot study There is a need for this project in the developing world Well-perceived and culturally acceptable device Future studies should collect more data Failed to reject the null hypothesis that this method is as effective as the medical nebulizer.
42
Acknowledgements
Roger Dzwonczyk Mariantonieta Gutierrez Angie Overholt and the entire WGM team Anna K Young Kathy Stone Duane Hart Nationwide Children’s Hospital 43
Questions?
44