nebulizer project matthew lawrence brockman daniel puthenpurayil george nathan joseph hankins...
TRANSCRIPT
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Nebulizer ProjectMatthew Lawrence BrockmanDaniel Puthenpurayil George
Nathan Joseph HankinsMarissa Kathleen McHugh
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OutlineI. What’s a Nebulizer, Needs Assessment & Scope of Work - MatthewII. Our Design – MatthewIII. In-Country Implementation – NathanIV. In-Country Training – MarissaV. Issues Encountered – DanielVI. Evaluation/Feedback – NathanVII. Cost Analysis – DanielVIII. Testing and Results – MatthewIX. Sustainability and Ownership – MatthewX. Entrepreneurial – Nathan
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What’s a NebulizerCompressor, filter, tubing, cup, mask
Compressor not a medical device, simply supplies air
Cup aerosolizes water with medication
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Needs Assessment: Respiratory Problem
Causes
Environmental effectsDesert climateDrynessWindDusty air/Dust stormsAllergenic trees
Garbage and vegetation burned near homes
Indoor cooking firesCockroach infestations
Factors contributing to high prevalence of respiratory problems:
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Needs Assessment: Nebulizer Availability
Problems receiving nebulizer treatment:
Limited availability at local clinicsoOnly 1-2 nebulizersoWalking distanceoClosed on weekendsoOpen 7AM to Noono Frequent power outagesoDays designated for non-respiratory problems
High cost (about $100) compared to salary
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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 problemso Larry and Angie Overholt
Needs Assessment: o Large portion of the population suffers from asthmao Environmental causeso Low availability of nebulizers
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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
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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
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In-Country Implementation: Week 1
Day Date Tasks Completed
Monday
5/5/2014
- 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
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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
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In-Country Implementation: Week 1Day Date Tasks Completed
Thursday 5/8/2014
- 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)
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In-Country Implementation: Week 1
Day Date Tasks Completed
Friday 5/9/2014
- 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
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In-Country Implementation: Week 1
Day Date Tasks Completed
Saturday 5/10/2014
- Provided free treatments, demonstrated the method, and handed out manuals outside
pharmacy (met teacher)- Worked on Poster design for Public Health
Departments
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In-Country Implementation: Week 2
Day Date Tasks Completed
Monday 5/12/2014
- Introduced Method, Treated Patients, and Trained Nurses/Doctor/Patients at
Dr. Girón’s Private Clinic (donated nebulizer, committed to getting more
data)- Printed and Laminated More Manuals
- Updated Treatment Forms
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In-Country Implementation: Week 2Day Date Tasks Completed
Tuesday 5/13/2014
- 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
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In-Country Implementation: Week 2Day 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)
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In-Country Implementation: Week 2Day Date Tasks Completed
Thursday 5/15/2014
- 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)
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The training process involved:Demonstration of assembly and
operationExplanation of evaluation formsReview and distribution of manualDistribution of posters
In-Country Training
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Constructed a user manual1. Instructions for assembly2. List of materials including pictures,
prices, and store names3. Directions for usage and sanitation4. Reservoir recommendations5. Troubleshooting
In-Country Training
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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. Giron’s clinic, and at Farma City.
In-Country Training
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All places visited followed the same basic pattern
Trained doctor(s) and nurses
Trained asthma and non-asthma patients and parents
In-Country Training
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Taught nurses how to use peak flow meters
Taught nurses how to complete the pre/post evaluation forms
In-Country Training
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Issues EncounteredTransportation 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
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Evaluation/FeedbackCheap; 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
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Evaluation/FeedbackPeople 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
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R&D Cost Pre-TripDate Source Material Purchased Quantity Individual Price Cost Shipping
2/12/2014 mil lersgarden.com In line Universal Gas Filters Fuel filter 1/4" 5/6 5 1.80$ 9.00$ 3.00$ 2/15/2014 justnebul izers .com Air Filters For Omron CompAir Nebulizer Systems 10 1.39$ 13.90$ 6.95$ 2/18/2014 Target Schwinn- Bike pump 1 17.29$ 17.29$ -$ 2/27/2014 Lowes Brass hose barb adaptor (1/8" ID x 1/4: MIP) 2 3.58$ 7.16$ -$ 2/27/2014 Lowes Brass hose barb adaptor (3/16" ID x 1/4: MIP) 2 3.88$ 7.76$ -$ 2/27/2014 Lowes Brass tee pipe (1/4" PIP) 1 7.47$ 7.47$ -$ 2/27/2014 Lowes Pressure gauge 1 9.98$ 9.98$ -$ 3/13/2014 Target Basketball 1 10.99$ 10.99$ -$ 3/20/2014 Walmart Bell-Bike pump 1 9.96$ 9.96$ -$ 3/20/2014 Target Basketball 1 10.99$ 10.99$ -$ 3/20/2014 Target Schwinn hand pump 1 24.59$ 24.59$ -$ 3/20/2014 Target Size 4 Soccer Ball 2 9.99$ 19.98$ -$ 3/25/2014 Dick's Sporting GoodsSize 5 Soccer Ball 1 24.99$ 24.99$ -$ 3/25/2014 Dick's Sporting GoodsSize 5 Soccer Ball 2 15.99$ 31.98$ -$ 3/25/2014 Dick's Sporting GoodsInflation Needles 4 2.49$ 9.96$ -$ 3/28/2014 Medicomp Nebulizer Filter 4mm M 50 3.23$ 161.56$ 13.44$
Subtotals 377.56$ 23.39$ Total Cost 400.95$
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R&D Cost During TripDate Supplier Item
Payment, Dollars
Payment, Lempira
8-May-14Comercial El Balon de Oro balls $ 36.59 L. 750.00
7-May-14 Super Torrillo pumps $ 44.44 L. 911.006-May-14 La Colonia balls $ 6.46 L. 132.457-May-14 Farmacias Kielsa parts $ 8.29 L. 170.008-May-14 Super Torrillo pumps and balls $ 21.85 L. 448.00
7-May-14Copy Centro Douglas copying $ 10.98 L. 225.00
7-May-14 Global Cyber copying $ 14.63 L. 300.00
8-May-14Copy Centro Douglas copying $ 5.85 L. 120.00
8-May-14 Global Cyber copying $ 1.95 L. 40.00
10-May-14Copy Centro Douglas copying $ 4.88 L. 100.00
10-May-14 Global Cyber copying $ 1.22 L. 25.008-May-14 Global Cyber copying $ 23.56 L. 483.00
14-May-14 Global Cyber copying $ 2.93 L. 60.0014-May-14 Global Cyber copying $ 9.76 L. 200.0012-May-14 Global Cyber copying $ 14.54 L. 298.0015-May-14 Global Cyber copying $ 1.22 L. 25.00
15-May-14Copy Centro Douglas copying $ 6.10 L. 125.00
15-May-14Farmacia de los Pobres Masks $ 8.78 L. 180.00
15-May-14 Farmacia Familiar Masks $ 3.17 L. 65.005-May-14 Farmacias Kielsa masks $ 17.80 L. 365.00
5-May-14Comercial El Balon de Oro balls $ 6.10 L. 125.00
5-May-14 Auto Partes Dimer $ 0.98 L. 20.007-May-14 Motorepuestos filters $ 2.24 L. 46.005-May-14 Super Torrillo pump and needles $ 18.24 L. 374.009-May-14 DeTodo balls and pumps $ 23.06 L. 472.65
10-May-14Copy Centro Douglas copying $ 3.02 L. 62.00
Total Cost 298.64$ 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 400.95$ During Trip 298.64$ Total 699.59$
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Per Nebulizer Cost – United StatesUsing a size 5 soccer ball and the cheapest of
the other materials, one nebulizer cost the team approximately $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$ Size 5 Soccer Ball 15.99$ Needle 0.83$ Nebulizer tubing, cup, and mask set 1.99$ Total Cost 30.57$
In line Universal Gas Filters Fuel filter 1/4" 5/6 1.80$ Bell-Bike pump 9.96$ Nebulizer tubing, cup, and mask set 1.99$ Total cost 13.75$
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Per Nebulizer Cost – Honduras
Cost with reservoir: $16.73
Cost without reservoir: $9.17
Hondurans can likely get these items for a lower price – One person commented they could get a soccer ball for L. 80.00
Motorcycle Fuel Filter L. 20.00 0.98$ Schwinn- Bike pump L. 125.00 6.10$ Size 5 Soccer Ball L. 150.00 7.32$ Needle L. 5.00 0.24$ Nebulizer tubing, cup, and mask set L. 43.00 2.10$ Total Cost L. 343.00 16.73$
Motorcycle Fuel Filter L. 20.00 0.98$ Schwinn- Bike pump L. 125.00 6.10$ Nebulizer tubing, cup, and mask set L. 43.00 2.10$ Total cost L. 188.00 9.17$
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In-Country Testing Regimen
Assess situation
Pre-treatment baseline measurementsQualitative testingQuantitative testing
Post-treatment evaluationQualitative analysisQuantitative analysis
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Pre and Post-Treatment Qualitative Testing
List observations related to breathing (Is patient coughing, wheezing, gasping for air, etc.)
Doctor/Nurse observations or comments
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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
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Post-Treatment Quantitative Analysis
Have patient blow into peak flow meter three times, take maximumApply Equation 1 to find percent increase
Ask patient to rate difficulty of breathing from uno to diez, uno being perfect lung functionReport difference
Equation 1
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Testing: ResultsTreated 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
p-value was 0.413
We therefore fail to reject the null hypothesis that the two means are the same
Little data so far
Before AfterPercentIncrease
100 250 150%150 200 33%
92%Average
Medical Nebulizer
Before AfterPercentIncrease
125 160 28%100 220 120%
70 120 71%120 170 42%
50 80 60%110 150 36%190 245 29%
90 150 67%100 150 50%
60 150 150%100 200 100%
60 150 150%75%Average
Home-Made Nebulizer
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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
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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
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Sustainability and Ownership
Cambridge teacher will continue to spread the idea
Posters and manuals at health departments
Dr. Giron will make and distribute nebulizers
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Entrepreneurial Opportunities
Demand exists
Product: Nebulizer kit and manual
End user: Asthma patients
Costumer: Philanthropic or Social EnterpriseNon-profits such as NGOsSocial entrepreneur
Dr. GirónRoger HenriquezCarlos Ferrera
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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.
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AcknowledgementsRoger Dzwonczyk
Mariantonieta Gutierrez
Angie Overholt and the entire WGM team
Anna K Young
Kathy Stone
Duane Hart
Nationwide Children’s Hospital