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A Study of Measurement Performance Evaluation for Toilet Systems with an Uroflowmeter in Hospital Facility

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A Study of Measurement Performance Evaluation for Toilet Systems with an Uroflowmeter in Hospital Facility CIBW062 Symposium 2013 A study of measurement performance evaluation for toilet systems with an uroflowmeter in hospital facility H. Yamasaki(1)，M.Otsuka(2) [email protected] [email protected] 1. TOTO Ltd., Japan 2. College of Architecture and Environmental Design, Kanto-gakuin Univ., Japan. Abstract The voided volume of urine or the uroflowmetry of the patients are routinely examined in urology department of healthcare facilities in order to diagnose urinary system diseases or manage systemic metabolism. Conventional uroscopy has several problems. Patients often suffer mental anguish with a sense of shame on ground that they discharge their urine and leave it in the public eye at inspection rooms. Nurses have heavy workload with the preparation of urine sampling or disposal after clinical examination. Medical doctors may run a risk of occurrence of hospital infection unless the urine is properly disposed. Toilet with an uroflowmeter is evaluated in hospital facility in this study. We demonstrated the effectiveness of the calibration system in experimenting on the drainage load before and after the completion. As results, the toilet system can measure the characteristics of urine of the patients precisely during their usual defecation under within ±200Pa of the jurisdiction pressure fluctuation in loop ventilation method of SHASE-S206. We designed and developed the first reliable toilet system with an uroflowmeter to measure the voided volume of urine or the uroflowmetry in the world. It is found that the toilet in actual healthcare facilities can solve most problems of conventional uroscopy according to our availability for hundreds of clinical uses. The toilet system as medical equipment saved the load of the nurses and brought comfort to the patients. Keywords Drainage system, Toilet, Uroflowmeter, Drainage load, Pressure fluctuation 599 CIBW062 Symposium 2013 1 Introduction The number of elderly people increases rapidly in Japan shown in Fig.11). The death rate of prostate cancer of geriatric condition will increase in near future. In the medical institution, they have to measure the voided volume of urine or the urine flow rate not only for diagnosis of their urinary diseases but also for control of systemic metabolism, so the workload of nurses may increase with more opportunities of handling urine than before. Patients often suffer mental anguish with a sense of shame on ground that they discharge their urine and leave it in the public eye at inspection room2). Medical doctors may run a risk of the occurrence of hospital infection unless the urine is properly disposed. We have developed the world's first toilet systems with an uroflowmeter to solve several clear and present problems in the examination of the voided volume of urine or the uroflowmetry in hospital facilities. This device released the patients from a sense of shame, nurses from slavery labour, and medical doctors from unsanitary environment or the risks of hospital infection. This report is the summary of the equipment configuration of the toilet systems and its clinical evaluation results. ( Year's Old) 80 60 Man Woman 40 20 0 120 80 40 0 0 40 80 120 ( Million People) ( Million People) Figure 1 - Population pyramid of Japan 2 Problems of measurement of the voided volume and the flow rate Generally, the urinalysis means the qualitative and/or quantitative analysis of the specified substances in urine of patients such as glucose, protein, and occult blood. In medical institution, the physical indexes of urine are routinely measured. The voided volume of urine, the urine flow rate and the urine flow rate waveform are important to allow the diagnosis of several diseases and to control their systemic metabolism. There are several problems in measuring the physical index summarized in Table 1. 600 CIBW062 Symposium 2013 Table 1 Problems of measurement the characteristics of urine Patient Nurse Medical doctor Measurement “The load of the “A filth room is dirty. “By wrong data, the urine urine collection is big There might be the result of voided and it is difficult. nosocomial infection. measurements are not volume I feel the mental pain A smell occurs.” reliable.” such as the sense of shame.” Measurement “I cannot urinate as “Because sterilizing of “I am worried about the urine usual because of the urine receiving the influence of the flow rate pressure,” container is laborious , mental status of the I do not want to patient on the perform examination measurement.” many times. ” 3 Overview of the toilet systems with an uroflowmeter Fig.2 shows system block diagram of the toilet systems with an uroflowmeter. The toilet adjusts its water level to the control point under trap ware by watering after the toilet ejects some water of the bowl by means of its water nozzle control of rim and jet in flushing. The pressure fluctuation of the water level of toilet bowl is cancelled by calibration of the pressure in drain pipe measured simultaneous with pressure sensor. The toilet system determines the voided volume of urine and the urine flow rate with the corrected water level of the toilet bowl pressure and its calibration curve of water level and the water in its toilet bowl. The calibration curve is made each toilet system in test-drive in installation3),4). From Civil Qater Water Level Addjusting Units Printer Rim Duct Jet Duct Tank Unit Control Unit Stage Measurement Unit Operation And Drainage Pressure Sensor Indication Department Water Level Sensor Junction To In-Hospital LAN Department Figure 2 - System block diagram of the toilet systems with an uroflowmeter 601 CIBW062 Symposium 2013 Patients can start and stop a urine flow particular measurement and flush by the operation and display unit. In addition, medical personnel can operate various setting such as data retention period and choice of measurement items by it. Fig.3 shows an example of a system configuration diagram that links with the medical institution. The personal computer in nurse station can link with the existing systems of healthcare facility by dedicated tabulation software. Patients are generally authenticated by the individual bar code described in their tag list in Japan. The toilet system has an option to recognize each patient by the bar code without contact. The personal identification device患者バーコード読取りによる of the non-contact using非接触の個人認証 reading of the bar code of the list tag. Measurement Measurement 測定結果result 測定結果 Measurement result 測定結果 result 患者情報Patient 患者情報Patient information information Nursing Support 尿流量測定装置Toilet Systems With Exclusive尿流量管理くん Software Joint Ownership An Uroflowmeter. 共有フォルダFolder 看護支援システムSystem フロースカイ （専用集計ソフト） Figure 3 - One case of the system that planned cooperation with the medical institution 4 Installation and Usage 4.1 Installation The toilet system needs water supply, drainage and 100V of power supply. It is installed like a western-style water closet with floor drain in an exactly similar way. 4.2 Attention in installation The toilet system has to be installed the following steps to measure urine characteristics. 4.2.1 Configuration of calibration curve Western-style stool water closet is manufactured with lower dimensional accuracy than general machine parts. So the calibration curve of water level and volume of bowl must be made individually with several constant drain levels of bowl by metering pump after filled to trap ware. 4.2.2 Configuration of initial water level for measurement This toilet is watered over water level of the trap ware in a different manner of general toilet stools. 602 CIBW062 Symposium 2013 4.3 usage Fig.4 shows a setting example and a schematic view of the usage. The measurement start button is shared with a personal identification button to determine the result of each patient. The patients need only press the button after using the toilet normally. Measurement start button (Shared A Personal Identification Button) Urination Measurement End Button Flushing Button Figure 4 - A setting example and a schematic view of the usage 5 The effect of drainage pressure fluctuation on the measured result 5.1 Method of confirmation 5.1.1 Evaluation method Test equipment, effluent load method and measurement method of Otsuka et al.5),6) are adopted. 5.1.2 Confirmation of the validity of the measurement results The measured voided volume of urine Wu and maximum urine flow rate qumax by the toilet system needs less than ±10% of fluctuation range under the influence of the pressure fluctuation of effluent load to establish a correct diagnosis according to the result of our previous experiments. The suitable pressure range to get right Wu and qumax was found over -200Pa and under +400Pa. In contrast, the urine flow curve Qu (t) is required to preserve the characteristics of each symptom, so Qu (t) need have the similar waveforms after effluent loads. We determined the suitable pressure fluctuation mathematically. Further, the similarity of urine flow curves was determined by nine urological physicians using the Qu(t) with/without the effect of drain pressure. 603 CIBW062 Symposium 2013 5.2 Required range of drain pressure fluctuation The positive and negative pressure of drain pipe caused by an increase of effluent load alters Qu(t) and leads to worsening of the correlativity. Fig. 5 shows the relationship between the correlation coefficient r and Pmin, Pmax. The correlation coefficient r is over 0.82 with good coincidence of Qu(t) as far as the pressure fluctuation between ±200Pa. It was suggested that the strains of Qu(t) mislead the clinical judgment out of this range. The experiment showed that Q(t) is more susceptible to the effect of pressure fluctuation of drain pipe than Wu and qumax. The toilet system which measures simultaneously important urinary characteristic value of Wu, qumax, Q(t) must be connected to drainage systems with smaller pressure fluctuation under ±200Pa than ones specified in SHASE-S 2187) .
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