Short description of the terms of maintenance.
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Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 179 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 252 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
\n'}],latestNews:[{slug:"stanford-university-identifies-top-2-scientists-over-1-000-are-intechopen-authors-and-editors-20210122",title:"Stanford University Identifies Top 2% Scientists, Over 1,000 are IntechOpen Authors and Editors"},{slug:"intechopen-authors-included-in-the-highly-cited-researchers-list-for-2020-20210121",title:"IntechOpen Authors Included in the Highly Cited Researchers List for 2020"},{slug:"intechopen-maintains-position-as-the-world-s-largest-oa-book-publisher-20201218",title:"IntechOpen Maintains Position as the World’s Largest OA Book Publisher"},{slug:"all-intechopen-books-available-on-perlego-20201215",title:"All IntechOpen Books Available on Perlego"},{slug:"oiv-awards-recognizes-intechopen-s-editors-20201127",title:"OIV Awards Recognizes IntechOpen's Editors"},{slug:"intechopen-joins-crossref-s-initiative-for-open-abstracts-i4oa-to-boost-the-discovery-of-research-20201005",title:"IntechOpen joins Crossref's Initiative for Open Abstracts (I4OA) to Boost the Discovery of Research"},{slug:"intechopen-hits-milestone-5-000-open-access-books-published-20200908",title:"IntechOpen hits milestone: 5,000 Open Access books published!"},{slug:"intechopen-books-hosted-on-the-mathworks-book-program-20200819",title:"IntechOpen Books Hosted on the MathWorks Book Program"}]},book:{item:{type:"book",id:"3245",leadTitle:null,fullTitle:"A Comprehensive Survey of International Soybean Research - Genetics, Physiology, Agronomy and Nitrogen Relationships",title:"A Comprehensive Survey of International Soybean Research",subtitle:"Genetics, Physiology, Agronomy and Nitrogen Relationships",reviewType:"peer-reviewed",abstract:"Soybean is the most important oilseed and livestock feed crop in the world. These dual uses are attributed to the crop's high protein content (nearly 40% of seed weight) and oil content (approximately 20%); characteristics that are not rivaled by any other agronomic crop. Across the 10-year period from 2001 to 2010, world soybean production increased from 168 to 258 million metric tons (54% increase). Against the backdrop of soybean's striking ascendancy is increased research interest in the crop throughout the world. Information in this book presents a comprehensive view of research efforts in genetics, plant physiology, agronomy, agricultural economics, and nitrogen relationships that will benefit soybean stakeholders and scientists throughout the world. We hope you enjoy the book.",isbn:null,printIsbn:"978-953-51-0876-4",pdfIsbn:"978-953-51-4259-1",doi:"10.5772/45867",price:159,priceEur:175,priceUsd:205,slug:"a-comprehensive-survey-of-international-soybean-research-genetics-physiology-agronomy-and-nitrogen-relationships",numberOfPages:626,isOpenForSubmission:!1,isInWos:1,hash:"3df988c24d0849fa18b82a63f62ad860",bookSignature:"James E. Board",publishedDate:"January 2nd 2013",coverURL:"https://cdn.intechopen.com/books/images_new/3245.jpg",numberOfDownloads:62638,numberOfWosCitations:37,numberOfCrossrefCitations:58,numberOfDimensionsCitations:183,hasAltmetrics:1,numberOfTotalCitations:278,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 28th 2012",dateEndSecondStepPublish:"March 20th 2012",dateEndThirdStepPublish:"June 16th 2012",dateEndFourthStepPublish:"July 16th 2012",dateEndFifthStepPublish:"October 15th 2012",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,8,9",editedByType:"Edited by",kuFlag:!1,editors:[{id:"28828",title:"Prof.",name:"James",middleName:null,surname:"Board",slug:"james-board",fullName:"James Board",profilePictureURL:"https://mts.intechopen.com/storage/users/28828/images/3420_n.jpg",biography:"James Board is a Professor of Agronomy in the School of Plant, Environmental, and Soil Sciences in the Louisiana State University Agricultural Center in Baton Rouge, Louisiana, USA. He obtained a Ph.D. in plant physiology from the University of California at Davis in 1978, and shortly thereafter assumed his current position. He has been working on soybean production and physiology at this institution for the last 32 years and has also taught crop ecological/physiological classes across this period. Dr. Board has authored 61 refereed journal articles related to planting dates, row spacings, plant population, defoliation, stress physiology, growth dynamics, and yield component formation",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"328",title:"Food Technology",slug:"agricultural-and-biological-sciences-bromatology-food-technology"}],chapters:[{id:"41170",title:"A Proteomics Approach to Study Soybean and Its Symbiont Bradyrhizobium japonicum –A Review",doi:"10.5772/53728",slug:"a-proteomics-approach-to-study-soybean-and-its-symbiont-bradyrhizobium-japonicum-a-review",totalDownloads:2467,totalCrossrefCites:4,totalDimensionsCites:9,signatures:"Sowmyalakshmi Subramanian and Donald L. 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"878",title:"Phytochemicals",subtitle:"A Global Perspective of Their Role in Nutrition and Health",isOpenForSubmission:!1,hash:"ec77671f63975ef2d16192897deb6835",slug:"phytochemicals-a-global-perspective-of-their-role-in-nutrition-and-health",bookSignature:"Venketeshwer Rao",coverURL:"https://cdn.intechopen.com/books/images_new/878.jpg",editedByType:"Edited by",editors:[{id:"82663",title:"Dr.",name:"Venketeshwer",surname:"Rao",slug:"venketeshwer-rao",fullName:"Venketeshwer Rao"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4816",title:"Face Recognition",subtitle:null,isOpenForSubmission:!1,hash:"146063b5359146b7718ea86bad47c8eb",slug:"face_recognition",bookSignature:"Kresimir Delac and Mislav Grgic",coverURL:"https://cdn.intechopen.com/books/images_new/4816.jpg",editedByType:"Edited by",editors:[{id:"528",title:"Dr.",name:"Kresimir",surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"65296",title:"Stem Borers of Cereal Crops in Africa and Their Management",doi:"10.5772/intechopen.83719",slug:"stem-borers-of-cereal-crops-in-africa-and-their-management",body:'Stem borers constitute the most widely distributed and injurious group of insect pests of cereal crops. They are commonly known to be one of the limiting factors of cereal production worldwide. They are present in field throughout the crop growing stage from seedling to maturity. The stem borers found on cereal crops in Africa are mainly lepidopterans and dipterans. Cereal crops such as rice, sorghum, maize, sugarcane and pearl millet suffer from the attack of stem borers. The larval stage constitutes the most damaging developmental stage of the pest. They are concealed inside the stem where they feed on the internal cavity of the plant making them very difficult to control. Stem borers cause severe damage on plant stems particularly the destruction of the central leaves (dead-heart) and the drying of the panicle (white head). Their attack leads to significant yield losses. According to [1], the most serious pests of cereal crops in Africa include stem borers. The severity of damage depends not only on the species and density of the pest but also on the phenology stage of the crops. Yield losses of about 10 and 100% due to stem borer have been recorded in rice fields [2].
To control these pests, various strategies have been practiced. These include cultural practices, host plant resistance, habitat management, biocontrol and the use of synthetic pesticides. Each management method has some advantages and limitation regarding its impact on environment, human health and its economic costs and sustainability. Nowadays, the integrated management, combining two or several of these management methods appears to be the most effective and sustainable option. This chapter comprises two main sections. The first section gives an overview of the main stem borers and their host range in Africa and the second section describes the various management options used to control stem borers and discusses the advantage and limitation of each method while exploring option of combining multiple methods to sustainably mitigate the effect of the stem borer on stakeholder farmers in Africa. This chapter will support the current research on the sustainable management of stem borers attacking cereal crops and will contribute to increase their productivity in Africa.
Several stem borers species have been reported to cause severe damage on various cereals crop in Africa.
The maize stalkborer, Busseola fusca (Lepidoptera: Noctuidae) is reported to be of economic importance for maize and sorghum [3] while maintaining its population on some alternative hosts. The spotted stem borer, Chilo partellus (Lepidoptera: Pyralidae) is considered to be one of the devastating stem borer of sorghum and maize [4, 5] and also makes severe damage on rice in some African countries (Togola, unpublished data). The African striped rice borer, Chilo zacconius Bleszynski (Lepidoptera: Pyralidae) is among the major rice stem borer species occurring in the humid forest and savanna zones according to Akinsola [6]. The host range comprises cultivated rice, wild rice, Oryza longistaminata, Panicum sp., and Paspalum scrobiculatum but it has been found also on maize [7]. Other host plants include Pennisetum spp., Rottboellia cochinchinensis (Loureiro) W.D. Clayton, Saccharum officinarum L and Sorghum arundinaceum (Desv.) Stapf. [6, 8, 9]. The pink Stem Borer Sesamia calamistis (Noctuidae) is generally less important than Busseola fusca and Chilo partellus as a pest of cereal crops in Africa but may be locally abundant. It attacks sorghum, maize, rice and sugarcane as main host. It can be found also on wheat and pearl millet.as secondary crop host and at less extend on wild grass such as Pennisetum purpureum, Setaria sp., Rottboellia exaltata and Cyperus distans as alternative host [10, 11]. The millet stem borer Coniesta ignefusalis Hampson (Lepidoptera: Pyralidae) is an important pest of pearl millet (Pennisetum glaucum (L.) especially in West Africa [12]. The damage caused by C. ignefusalis is estimated to 15 and 100% of crop losses annually, depending on location and season [13]. The last generation enters diapause at the beginning of the dry season and stay for 6 months the time the next growing season comes. The sugarcane stem borer Eldana saccharina (Pyralidae) is a stem borer of cereal crops in Africa with particular economically importance on sugarcane. In the past E. saccharina appeared to be of very little important pest in Africa, except on sugarcane. But it has recently increased in importance on other crops such as maize, and sorghum in several African countries [14]. Also it can attack rice. Its hosts among wild grasses are Panicum maximum, Cyperus papyrus [15], Sorghum halepense, S. verticilliflorum and Pennisetum purpureum. The white rice borer Maliarpha separatella Ragonot (Lepidoptera: Pyralidae) is an important stem-borer of rice in West Africa [16]. The larva bores into the stem from the lowest internode where it feeds on the internal tissue preventing the nutrient to rise up until the panicle. The damage caused by this stem borer is said to be unique among rice stem borers because it rarely causes deadhearts or whiteheads [7]. The symptoms of M. separatella damage are similar to that of the sheath rot caused by a fungus pathogen Sarocladium oryzae. The stem of the infested plant becomes weakened, the panicles incompletely exerted from the flag leaf and the grains incompletely filled with brown coloration. M. separatella is more severe in low land, irrigated and floated rice. It also attacks the wild rices Oryza longistaminata and Oryza punctata [17]. It was also reported on some wild grasses such as Andropogon tectorum and Echinochloa holubii [18]. The rice yellow stem borer Scirpophaga spp (Lepidoptera: Pyralidae) are among the minor rice stem borers in Africa. Several species of Scirpophaga exist but the most dominant in Africa is S. melanoclista Meyrick [7]. The stalk-eyed fly Diopsis spp. (Diptera: Diopsidae) is a serious pest of rice in Africa. The two main species commonly found in rice in Africa are Diopsis thoracica Westwood and Diopsis apicalis Westwood [7]. Diopsid can be found in all rice ecological zones but preferentially in humid and shady lowland [19, 20, 21] and also in irrigated rice fields [7]. Damage from Diopsid larvae is similar to the primary damage made by Lepidopteran larvae resulting to the death of the central leaf of rice plant (deadheart). Feeding by the larvae significantly reduces the tiller density, the effective panicles, the grains weight and the total yield [7] and increases the number of immature panicles. The damage level increases according to Diopsis density. In endemic area 60% of the tillers can be infested [22]. Finally the African rice gall midge (AfRGM), Orseolia oryzivora Harris and Gagné (Diptera: Cecidomyiidae) is an indigenous dipteran borer of rice that was first reported from southern Sudan in 1947 [23, 24]. The pest is now spread in more than 20 African countries where severe yield losses have been reported. The damage converted the shoot meristem into a gall. The infested plant is no longer able to develop into a floral meristem and then the reproductive potential of the plant is severely compromised [23]. Larval feeding causes severe damage to rice during the vegetative stages (seedling to panicle initiation). Heavy yield losses of 45–80% in farmers’ rice crops have been recorded in some fields [25, 26].
A clear knowledge of these stem borer species and their host crop are of key importance for a sustainable management action.
Because of the nature of the habitat of stem borers (internal shelter), their management requires some specific control measures and actions. Various strategies exist for managing stem borers’ population and damage in cereals crops. These include cultural practices, host plant resistance, biocontrol and use of synthetic pesticides.
Cultural practices are considered as classic pest control methods. This method consist of manipulating the cropping systems in order (1) to avoid the meeting of crop susceptible stage with pest highest density or (2) to improve the crop growing condition or (3) to make the environment unfavorable for pest proliferation. The cultural practices have the advantage to be easy to implement with less cost. They are more convenient for smallholder farmers in developing countries [27]. Preventives cultural practices comprise a wide range of agronomic practices. These tactics need to be undertaken as first line defense measures to prevent high infestation of stem borers in cereals fields. Among the most effectives cultural practices in controlling stem borers there is cereals intercropping or strip cropping with non-host crops such as cowpea, soybeans and groundnut. Also the choice of appropriate date for planting cereals crops allows the crops to escape to critical period where the pest pressure is high [28]. The sol fertilization and field hygiene are cultural practices that reinforce the plant vigor and increase its defense system. [29, 30] demonstrated that zinc fertilization and potassium fertilization significantly decrease stem borers population in rice and increase paddy yield. Other practice such as destruction of crop residues (burning, plowing or disking) appears to be an effective cultural tactic for limiting the number of diapausing larva of stem borer. [31] demonstrated that plowing and disking crop residues destroyed 24% of the stem borers’ population on sorghum and 19% of maize stem borers. Similarly, [32] reported that the destruction of sugarcane residue after harvest significantly reduced the infestation of subsequent crops by Eldana saccharina. Burning of crop residues was also reported to be effective against Chilo spp. and Busseola fusca as well [15]. Burning or composting old stalks before the onset of the rains is effective against B. fusca [13]. The management of the maize stalkborer B. fusca includes intercropping maize with non-hosts crops like cassava and cowpea or with a repellent plant such as silver leaf desmodium (Desmodium uncinatum) [33]. Others cultural practices such as destruction of alternatives host plants or ratoons, synchronized plantings, crop rotations, high cropping density, use of trap crops, good irrigation and good fertilization are good cultural tactics against the insect pests in general and stem borers in particular [27]. The use of trap crops or intercropping upland NERICA rice and maize have also been suggested as an effective method for controlling M. separatella in rice ecosystems in Nigeria [26]. Practices such as irrigation, planting density and dates of planting were all found to be effective as well important factors for consideration [17, 34]. According to [24], the management of the African rice gall midge take into account early and synchronized planting as rice fields planted early are less likely suffer serious damage than those planted late. Also destruction of alternative host plants such as rice ratoons, volunteers and Oryza longistaminata as well as the use of moderate levels of fertilizer (e.g. 60 kg/ha) prevent the build-up of AfRGM population. The same author highlighted the importance of plant spacing as close spacing provides a suitable micro-environment for the survival of the exposed life stages of AfRGM. Cleaning of the rice field especially the destruction of the wild rice are good cultural practice for managing the African striped rice borer, C. zacconius. The ‘push-pull’ method based on the intercropping of Desmodium with millet was report to effectively act as a repellent that ‘pushes’ the millet stem borer C. ignefusalis away from the millet [35]. The most useful advantage of the cultural practices is that they are compatible to all pest control measures. They represent an important component of the integrated pest management of the stems borers. The main disadvantage of the cultural practices is that they need to be continuous and collective process from field preparation to harvest. A good cultural practices field can get infested if the surrounding farmers do not apply same or no management option.
Plant resistance is the genetically inherited qualities that confer the plant ability to ward off or withstand pest attacks or recover from injury due to a pest [36, 37]. This method is the most farmer-friendly pest control option that can significantly reduce stem borer damage when supplemented with other options such as cultural or biological measures. It is most attractive as the use of insecticides is largely beyond the means of the small farmer. Considerable progress has been made in screening and breeding for host plant resistance to cereals’ stem borers but only limited number of varieties have shown good level of resistance. Wiseman [38] showed that the resistant cultivar should be the base from which integrated pest management strategies arise. Rana et al. [39] reported that antibiotic property in sorghum plays more role in plant resistance to stem borer than ovipositional non-preference. Some plant biophysical characters such as stem hardness, leaf hairiness are important in plant resistance to stem borers. Sorghum varieties having these traits are rejected by the moths for oviposition. Pearl millet varieties such as Zongo was reported to be moderately resistant to Coniesta ignefusalis [40]. According to [41], hairiness of leaves and leaf sheaths were partly responsible for the differences in genotypic vulnerability to C. ignefusalis. Also they reported that plants with trichomes were not preferred by this pest for oviposition. [42] reported good level of resistance in the sweet sorghums BR 501, BR 504, and BR 505 to the sugarcane borer Eldana saccharina. [20], found good source of resistance to diopsids among upland NERCA varieties. Also, they reported that rice varieties having ability to produce new tillers to compensate the infested stems can tolerate the damage by diopsid. So far no improved rice variety was identified to be resistant to O. oryzivora attack but some tolerance was noted in Oryza glaberrima and also in some improved released rice varieties in Nigeria such as Cisadane and FARO 51 [24]. Despite limited achievement on varietal resistance to stem borer, this option remain a promising IPM component. Recent advances in biotechnology can increase the prospects of generating resistance materials and accelerate the transfer of gene for improving new genotypes.
Biological control is the manipulation of natural enemies with the aim to maintain pest population below the economic injury level (EIL). Several organisms such as insects, fungus, virus and bacteria can be used as biocontrol agents [13, 43]. Insects based organisms acting as natural enemies are either predators (using the host as food) or parasitoids (laying their eggs in the host). Most of these insects belong to hymenoptera or diptera orders [27]. Biocontrol appears to be one of the most effective and environment friendly management option of stem borers. Indeed, stem borer’s population and damage can be regulated by sustaining the action of natural enemies. This can be done through a good habitat management to favor the buildup of the population of natural enemies (spiders, wasps, ladybirds, etc.) or through mass rearing and field release of specific parasitoids to control target pest species. The success of the release of several parasitoids was reported in managing cereals stem borers in Africa. Two natural enemies of the maize stalkborer (B. fusca) are the larval parasitoids Cotesia sesamiae and Bracon sesamiae [31, 44]. Parasitoids such as Tetrastichus atriclavus, Apanteles sesamiae, and Pediobius furvus have been reported by [13] to be most important parasites of B. fusca. Similarly Cotesia flavipes and Xanthopimpla stemmator was reported to effectively control the spotted stem borer C. partellus [4]. The parasitoids Cotesia sesamiae, Xanthopimpla stemmator, Trichogramma spp, etc. are cited as good biocontrol agent against the pink Stem Borer Sesamia calamistis (Togola, unpublished data). The biological control of the cereal stem borers is mainly based on habitat management to sustain natural enemies including various parasitoids wasp. [45] found that that the contribution of egg parasitism is more important in controlling lepidopteran stem borers than parasitism of larvae and pupae. The African rice gall midge (AfRGM) is attacked by two parasitoids such as Platygaster diplosisae (Hymenoptera: Platygastridae) and Aprostocetus procerae (Hymenoptera: Eulophidae) that can decrease the population of the pest below the economic injury threshold in rice-production systems [25]. Several insects species such as Cyrtorhinus viridis (Heteroptera: Miridae), Conocephalus longipennis (Orthoptera: Tettigoniidae) and Anaxipha longipennis (Orthoptera: Gryllidae) are predators of AfRGM [24]. The effectiveness and sustainability of the biological control methods depends on the availability of the biocontrol agent at suitable density. Practices such as habitat management or avoiding the use of wide spectrum chemicals can contribute to increase the carry-over of population of natural enemies and maintain the pest population below a critical level. The main constraints of the biocontrol measures are the difficulty to find the specific biocontrol agents for targeted pest species, the complexity of the mass rearing and the complication to be explained by extension workers and to be implemented by farmers.
Chemical control, despite all the danger and environmental hazard, remains an important option to consider in situation where the pest population is already established. Also it can be used as IPM component to supplement varietal resistance or cultural practices. Chemical control can be achieved by applications of granules or dusts to the leaf whorl early in crop growth to kill early larval instars of E. saccharina [10]. Controlling M separatella using chemical insecticides is effective but not widely practiced because of the high costs involved [46]. As for O. oryzivora, chemical control can be envisaged in conditions of high infestation of rice field. In all cases, choice of selective systemic insecticides is needed to avoid adverse effects on non-target organisms and biodiversity.
The individual control methods discussed above have their limitations and none often is sufficient to adequately control stem borer outbreaks. Hence, the integrated pest management (IPM), also known as integrated pest control (IPC) appears to be the most appropriate option for managing these pests. IPM requires the combination of several compatible and complementary practices with the aim to maintain pest populations below the economic injury level (EIL) while reducing the use of high hazardous pesticides and sustaining the action of natural enemies. Several studies have reported the success of IPM in the management of cereals’ stem borers. [25] reported that varietal resistance/tolerance, cultural practices and biological control are important components of integrated management of rice stem borers. Similarly [24] found that the effective control of the African Rice Gall Midge relies on the combination of cultural practices, habitat management and moderate use of insecticide chemical. Kega [47] demonstrated that the use of resistant rice cultivars and entomopathogenic nematodes is a viable method to control M. separatella. Nwanze and Mueller [48] indicated that host plant resistance and cultural practices should be major components in the integrated management of sorghum stem borers. According to [49] an increase of yield can be obtained when sorghum varieties with tolerance or moderate resistance to stem borer are coupled with need-based application of pesticides. Youm et al. [41] suggested options such as early planting, destruction of crop residues and use pheromone bait traps for successful management of the millet stem borer C. ignefusalis. According to the conclusion from an international workshop organized by the International Institute for Semi-Arid Tropics, cultural methods and host plant resistance should be considered as the major components of the integrated management of cereals’ stem borers [50]. However these practices need to be reinforced with other measures such as biological control and if necessary the use of selective systemic chemical . It is important to quote that integrated stem borer management is likely to be severely constrained by the limited capability of farmers to implement several options . For this reason it is highly important that the IPM takes into account the community farming systems and know-how.
The stem borers represent a group of insects of economic importance to cereal crops in Africa. Because of the nature of their attacks and the complexity of their biology, the success of the management options will depends on the integration of various strategies ranging from cultural practices to host plant resistance, biological control and moderate use of systemic chemical when necessary. The cultural practices and host plant resistance remains the major component of the IPM of cereal’s stem borers. They can be reinforced by the biological and chemical control. The cultural practices involve farmers’ engagement and cooperation. As for varietal resistance, more research action is needed to identify or develop varieties that tolerate the stem borers attack. Regarding the deployment of chemical and biocontrol options, more intensive action from extension service is need to increase the capacity of farmers so that they can engage appropriate action to limit yield losses in cereal and increase their incomes.
Within the large and modern hospitals, an increasingly common problem is the efficient management of the maintenance of the medical equipment, the quality of the assistance and the profitability. If effective management of medical equipment maintenance is to be applied, the management structure should apply appropriate planning, management and implementation processes. This is essential for providing quality health services while saving resources. Medical equipment management includes inspection and preventive and corrective maintenance operations [1].
\nThe efficient management of maintenance and repair work must be planned and implemented using appropriate maintenance strategies to keep the devices safe and functional in accordance with the basic functional specifications. In addition to the high initial investments, medical equipment requires continuous and costly maintenance during its useful life. The issue of maintenance is the main point of discussion of the management of medical devices. Studies have shown that the most frequent cause of stopping of medical equipment is poor maintenance, planning and management. To solve this problem, it is necessary to establish and regulate an adequate system for the proper maintenance and use of medical equipment. Perfect maintenance is the equation of performance, risk, resources and costs to achieve this goal [2, 3].
\nThe first maintenance policies developed consist of interventions on equipment, which run until it stops accidentally (breakdown) in place due to wear or because of defects. The intervention is considered satisfactory as long as the equipment/system is operating at a minimum acceptable level (reactive maintenance). The development and increase of the complexity of medical equipment and devices have led to modernizing and updating maintenance techniques and policies. Depending on the costs related to the spare parts and materials, respectively to the losses due to the time spent in repair, several types of maintenance policies have been developed [4].
\nDue to the way the health services are organized, the technical staff in the health units should not only perform maintenance and repair work but also be actively involved in the acquisition and management of the equipment. For example, they can plan equipment services and manage stocks; they can provide technical consultancy for procurement and can develop technical cost estimates. I can also make budget forecasts regarding the maintenance costs of medical equipment.
\nIn providing high-quality health services, medical equipment plays an essential role, because when the equipment is not used or properly maintained human damage can occur. In many situations, noncalibration, modification or repair of medical equipment by unqualified personnel can result in injury to the patient or loss of medical record. Preuse testing, preventative maintenance, malfunction reports (and incident reports) and repair procedures are just a few of the necessary actions prior to performing the medical act, to avoid injury caused by the use of medical equipment.
\nEven if the medical equipment used in the hospital is purchased, rented or borrowed, the commitment to safety is an essential element of any process related to the use of medical equipment. Proper maintenance and proper use of medical equipment ensures maximum efficiency and increased availability of equipment, at optimal costs and under satisfactory conditions of quality, safety and environmental protection [5].
\nIn order to make the process of maintenance of the medical equipment more efficient, it is necessary to consider the use of a maintenance program of the equipment that takes into account its characteristics and the defects that appear to the medical equipment. The application of such a program of maintenance of medical equipment could be effective in applying correct maintenance strategies for the management of the older technological devices and the new high-tech devices, due to their different characteristics.
\nMaintenance was long considered as a subordinate function, entailing an inevitable waste of money. There was a tendency to lump it together with troubleshooting and repairing machinery that was subject to wear and obsolescence. However, hospitals today are realizing that maintenance is not merely a ‘partner’ in medical services: it is an indispensable requirement for quality medical services [6]. Its relation with equipment performance is a question of integrated strategy at senior management level. As such, the maintenance function becomes a management responsibility.
\nThe structure that determines the goals and objectives of maintaining medical equipment is very important. If the goals and objectives are progressive, then the maintenance structure is recognized as a contributor to the hospital’s foundation line, and thus, variations can be used on some of the more conventional organizational structures.
\nObjectives of maintenance management: the more specific objectives of maintenance management are as follows [7]:
To optimize the reliability of equipment and infrastructure
To ensure that equipment and infrastructure are always in good condition
To carry out prompt emergency repair of equipment and infrastructure so as to secure the best possible availability for medical use
To improve operational safety
To train medical personnel in specific maintenance skills
To advise on the acquisition, installation and operation of medical devices
To ensure medical environmental protection
Within the clinical engineering department of any hospital, a crucial aspect of the activities is the activity of maintenance and preventive maintenance of the medical equipment, because it involves significant human and financial resources. Therefore, the optimization of the use of the resources available in the clinical engineering departments is done by evaluating the efficiency of the preventive maintenance programs of the medical equipment [8].
\nForms of maintenance:
\nMaintenance has three major forms:
Design-out maintenance
Preventive maintenance, which includes systematic (periodic) maintenance and condition-based maintenance
Corrective maintenance
These are illustrated in Figure 1.
\nThe forms of maintenance.
Maintenance can also be divided into planned and unplanned maintenance (or scheduled and unscheduled) (Figure 2). The following chart highlights the relation to the previous chart.
\nPlanned and unplanned forms of maintenance.
\nTable 1 briefly explains the terms used in the two charts.
\nMaintenance | \nMaintenance is the function whose objective is to ensure the fullest availability of production equipment, utilities and related facilities at optimal cost and under satisfactory conditions of quality, safety and protection of the environment. | \n
Design-out maintenance | \nThis is also known as plant improvement maintenance, and its object is to improve the operation, reliability or capacity of the equipment in place. This sort of work usually involves studies, construction, installation, start-up and tuning. | \n
Preventive maintenance | \nThe principle of preventive maintenance is anticipation. It is put into practice in two forms: systematic (periodic) maintenance and condition-based maintenance. | \n
Corrective maintenance | \nThis is also called breakdown maintenance, palliative or curative maintenance. This form of maintenance consists of the following: \n
| \n
Systematic maintenance | \nThis consists of servicing equipment at regular intervals, either according to a time schedule or on the basis of predetermined units of use (hours of operation or distance traveled). The aim is to detect failure or premature wear and to correct this before a breakdown occurs. The servicing schedule is usually based on manufacturers’ forecasts, revised and adjusted according to experience of previous servicing; this information is recorded in the machine’s file. This type of maintenance is also called periodic maintenance. | \n
Condition-based maintenance | \nThis type of maintenance of the medical equipment is easy to apply because it does not require the disassembly of the equipment, the same technique based on the inspection by listening to the equipment involved. Predictive maintenance requires continuous observation of equipment to detect possible faults or to monitor its condition. | \n
Planned maintenance | \nThis is maintenance that is known to be necessary sufficiently in advance for normal planning and preparation procedures to be followed. | \n
Unplanned maintenance | \nThis is maintenance that is not carried out regularly as the need for it is not predictable; it is sometimes called unscheduled maintenance. | \n
Short description of the terms of maintenance.
The seven forms of maintenance distinguished above are the main types currently used in practice. Although preventive and predictive maintenance strategies differ in many ways, a maintenance program comprising both strategies yielded positive results. The maintenance strategy evaluation demonstrated that strategies based on performance verification and safety testing results and the manufacturers’ recommendations led to a significant reduction in equipment failures and a significant increase in corrective maintenance.
\nAn efficient strategy in the correct application of the maintenance of medical devices consists of the use of a maintenance strategy for older devices and another strategy for high-tech devices. We must keep in mind that older medical devices to which only corrective maintenance has been applied cannot be included in preventive maintenance strategies, such as new high-tech devices. Maintenance costs would increase greatly if we also reported old devices in the maintenance process [9, 10].
\nThe access today is put on performance verification and safety testing in the use of medical equipment, which leads to a change in the maintenance strategies of the devices without necessarily taking into account the manufacturer’s recommendations. Also, the decision-making in the management of medical equipment should be based on all the results of medical equipment malfunctions and the existence of a detailed history for each medical device.
\nPerformance measurement is a key management tool. In terms of maintenance management, an essential issue is to ensure that the planned and executed maintenance activities have given the expected results. Efficient use of indicators can facilitate this fact. Such an indicator, represented by key performance indicators (Kpi) is able to evaluate important aspects of the maintenance function. To this end, it has been shown that the measurement of maintenance performance is dominated by delay indicators (equipment, maintenance costs and safety performance).
\nThe reduced use of the peak indicators in the maintenance process can also be observed. The obtained results did not show direct correlations between the maintenance objectives pursued and the Kpi used. Subsequent analyzes revealed that only a small part of the companies involved have a high percentage of decisions and changes caused by the use of Kpi and only a few are satisfied with their performance measurement systems. By analyzing the correlation, a strong positive linear relationship was identified between the degree of satisfaction and the changes/decisions of the process that are triggered by the use of Kpi, the people least satisfied with the least decisions and changes triggered by the use of Kpi. These observations indicate some inefficiency of performance measurement systems in improving driving performance [11].
\nThe components of a system, such as pumps, electric or hydraulic motors, transmission systems, etc. as integral parts of it, must operate at optimal parameters to ensure that the overall performance of the device is achieved. Addressing the maintenance problems and establishing the procedures and the maintenance strategy for equipment must therefore take into account both monitoring and diagnosing at the level of each component, but also the influence of the system variables. Most of the time, the cause of a defect is found in the variations of the process parameters, and a nonintegrative approach to monitoring and diagnosing the system can lead to inefficient actions. Thus, in addition to the most popular techniques of monitoring and diagnosis (vibration monitoring, thermography and tribology), other parameters of a system such as flow rates, voltages, currents, temperatures, etc. must be considered.
\nIn systems equipped with computer control or semiautomatic control, most of these parameters are purchased and used in the command and control process. Their type and number vary from system to system, but the algorithm for applying the monitoring and diagnostic procedure is similar. The collection of these parameters, together with the application of the traditional technologies of predictive maintenance, will provide all the necessary data for the analysis of the state and the performances of the system [12].
\nSince a large part of the equipment used in the medical field belongs to the category of electromechanical systems, the analysis of the maintenance technologies will focus on these, from the simplest (examples: electric motor-pump type drive systems) to complex devices.
\nIt should be kept in mind that, in any system, the maintenance program will focus on its critical components. A critical component is defined as the element directly involved in the proper functioning of the device, on which the entire system depends, its efficiency and, last but not least, the quality of the product.
\nSome of the technologies for monitoring and diagnosing the state of a system are set out in the following. Vibration analysis is one of the most widely used detection methods to diagnose defects in electromechanical systems. This method measures the vibrations of the system, usually with an accelerometer, and then examines the frequency spectrum generated to identify significant frequencies from the point of view of the state of the equipment. Certain frequencies are typical of the system in normal operation. Changing the amplitude of certain harmonics, for example, can mean the presence of a defect. The data can be collected periodically, using a portable system, or continuously, by installing a continuous monitoring system. A major advantage is that the measurements are fast and noninvasive, and the functioning of the tested system is not disturbed [13].
\nAnother key parameter that can provide information about one’s status of equipment/system is temperature. This is an important indicator of the mechanical, electrical or load conditions applied to a component. Thermography is a predictive maintenance technique that uses instruments that can monitor infrared energy emission to determine operating conditions.
\nInfrared scanning is recommended as a regular maintenance procedure in many situations, extracting solid results as quickly as possible and without interrupting process flow, a key benefit to the industry, regardless of the age of the equipment. As an advantage of scanning a large area in a very short time, the ease with which data can be stored and processed for further analysis of images, the high mobility of the thermography camera that can be positioned at any time and place, the thermographic evaluation that is done uninterrupted and equipment inspection staff who are out of danger are emphasized.
\nLubrication fluid analysis can be used to determine mechanical wear, lubrication or fluid condition. The presence of metallic particles in the lubricating fluid suggests the existence of a wear, their analysis providing information on the part subjected to wear. For fluid analysis, it uses complex equipment, which is why this method is not so often used in practice.
\nThis strategy prioritizes the training of technicians to maintain an optimal number of actions, very important for essential medical equipment frequently used in medical institutions.
\nPrioritization of medical equipment maintenance should be performed for each new type of device during the inspection received when the device is added to the inventory. The device will then be assigned a test frequency. Subsequently, the maintenance history of the device will be monitored to evaluate the effectiveness of the maintenance program.
\nThe end point of providing an organizational tool to the biomedical or clinical engineer would ensure the safe and efficient performance of medical equipment. The system must be evaluated on criteria such as:
Data management for medical devices, manufacturers and suppliers
Acquisition conditions
Implementation and management of quality and safety protocols and procedures, including necessary documentation and data
Carrying out corrective maintenance activities
Routine procedure planning, such as acceptance testing, preventive maintenance, quality and safety inspections
Management and monitoring of training provided by manufacturers or technical staff including biomedical engineer or clinical engineer [14]
The risk assessment was divided into four main areas: clinical function, failure avoidance probability, history of incidents and regulatory or manufacturer requirements. Devices would be evaluated on the aforementioned criteria and be assigned a score. The values would be added and a cumulative score is given for each device type. The total score would act as a quantifiable indicator for the maintenance policy. A total score of 12 or more would indicate a semiannual testing, a score between 9 and 11 would require annual testing, whereas a score of 8 or less would suggest a lesser necessity for annual testing, either biannual or no schedule, depending on clinical use. The end result would be an increase in the cost-effectiveness of the test program, less equipment downtime leading to improved patient care and a higher financial return to direct patient care activities.
\nTo illustrate the applicability of risk assessment criteria, we evaluated two types of devices extensively used in healthcare: the defibrillator and the enteral feeding pump. Defibrillators are devices that correct or prevent arrhythmias (e.g., ventricular fibrillation and ventricular tachycardia) by sending an electrical impulse to the heart. External defibrillators, in particular, send high electrical impulses through the thoracic wall, stopping the independent action of the individual myofibers, so that the intrinsic pacemaker can take over. A set charge, between 0 and 360 J, is generated and delivered through paddles or disposable electrodes through the chest wall to the heart, determining a global contraction. Most defibrillators include an electrocardiograph to monitor the patient’s rhythm, while others even include the pacer function. The clinical use is typically for emergency heart pacing such as severe bradycardia, asystole, pacemaker failure or ventricular fibrillation.
\nFor this particular type of device, the assessment should include electrical safety evaluation—ground wire resistance, chassis and lead leakage—and inspection of parameters’ performance, which includes measuring the energy output of the defibrillator throughout its range. This would include determining the value output at the lowest, midlevel and highest settings. The range of error should be with 15% of the set energy level (for 360 J, the output should be ranging from 206 to 414 J). Other performance tests would be determining the output levels at maximum setting for 10 charge cycles. The final output should still be within 15% of the recommended setting and charge time should not exceed 15 seconds. The appraisal for functional assessment frequency would be twice a year (Table 2) [15].
\nCriteria | \nRisk | \nScore | \n
---|---|---|
Clinical function | \n\n | \n |
No patient contact | \n1 | \n\n |
Device may make contact with the patient who is noncritical | \n2 | \n\n |
Device is used for patient diagnosis or direct monitoring | \n3 | \n\n |
Device is used to deliver direct treatment to the patient | \n4 | \n\n |
Device is used for a life support | \n5 | \n5 | \n
Problem avoidance probability | \n\n | \n |
Maintenance would not impact reliability of the device | \n1 | \n\n |
Common device failure modes are unpredictable | \n2 | \n\n |
Common device failure is predictable and can be avoided by preventive maintenance | \n3 | \n\n |
Specific regulatory requirements dictate preventive maintenance or testing | \n4 | \n4 | \n
Incident history | \n\n | \n |
No history | \n1 | \n\n |
A significant history of incidents exists | \n2 | \n2 | \n
Manufacturers/regulatory requirements for specific schedules | \n\n | \n |
No requirements | \n1 | \n\n |
There are requirements for testing | \n2 | \n2 | \n
Total | \n\n | 13 | \n
Times per year tested | \n2(hight level) | \n
Sample risk assessment for defibrillator.
Enteral feeding pumps are used in patients who have gastrointestinal complications and who cannot consume adequate nutrients for certain reasons. The feeding solutions are transmitted to the patient through temporary feeding tubes or surgically implanted. These pumps can precisely control the flow of liquid supply solutions that are administered entirely through the digestive tract. These pumps are based on a pump mechanism such as a rotary peristaltic pump, a linear peristaltic pump or a volumetric pump. Most pumps record the dose frequency, dose settings and volume infused into memory. Audible and visual alarms alert the user to flow changes or malfunctions.
\nThe quantity of volume delivered must be within 10% of the established volume. Thus, for a set volume of 10 ml, the measured volume must be between 9 and 11 ml. The measured occlusion pressure must be within 1 psi of the pump occlusion pressure. For an occlusion pressure of 20 psi, the measured pressure must be between 19 and 21 psi. The recommended frequency of the functional test is annually (Table 3).
\nCriteria | \nRisk | \nScore | \n
---|---|---|
Clinical function | \n\n | \n |
No patient contact | \n1 | \n\n |
Device is in contact with the patient who is not critical | \n2 | \n\n |
Device is used for patient diagnosis or direct monitoring | \n3 | \n\n |
Device is used to deliver direct treatment to the patient | \n4 | \n4 | \n
Device is used for a life support | \n5 | \n\n |
Problem avoidance probability | \n\n | \n |
Maintenance would not impact reliability of the device | \n1 | \n\n |
Common device failure modes are unpredictable | \n2 | \n2 | \n
Common device failure is predictable and can be avoided by preventive maintenance | \n3 | \n\n |
Specific regulatory requirements dictate preventive maintenance or testing | \n4 | \n\n |
Incident history | \n\n | \n |
No history | \n1 | \n1 | \n
A significant history of incidents exists | \n2 | \n\n |
Manufacturers/regulatory requirements for specific schedules | \n\n | \n |
No requirements | \n1 | \n1 | \n
There are requirements for testing | \n2 | \n\n |
Total | \n\n | 8 | \n
Times per year tested | \n1(normal) | \n
Sample risk assessment for enteral feeding pump.
Before returning the equipment to medical personnel, it must be ensured that it has been adjusted to the original specific settings. Make sure that the volume of the audible alarms is loud enough to be heard under normal operating conditions [15].
\nMaintenance costs represent a large part of total cost functioning of health systems. Depending on the specifics of each device, the costs of maintenance can represent from 15 to 60% of the value of the expenses. For the situation in which the equipment works in safe conditions until a certain level of wear or a defect in the initial state has been established, we discuss about preventive and predictive maintenance. In such cases, the equipment will be stopped at an early date, and the repair will only be done where needed. This type of maintenance allows the early detection, localization and identification of the defect or the worn part, as well as the calculation of the operating life in safe conditions of the device. The activity of preventive and predictive type makes possible the planning of the stop, the preparation of the intervention team, the provision of the necessary spare parts and respectively the minimization of the parking time for repair [16].
\nPredictive maintenance represents a superior qualitative leap in a modern maintenance system, regardless of the domain or the specific production, because it offers all the information needed for the following:
Early detection of the defects
Location
Diagnosis of defects
Calculation of the operating life in safe conditions of the medical equipment
The common premise from which the predictive maintenance starts is that the periodic or continuous monitoring of the mechanical, electrical or other indicators of the functioning of the systems or processes can provide the data necessary to ensure the maximum interval between the repair and maintenance works, respectively, to minimize the cost of interruptions of maintenance. Unplanned maintenance can be the cause of possible failures, sometimes major. However, predictive maintenance is more than that. It is in fact the means of improving and increasing the productivity, product quality and overall efficiency of the systems in question. Predictive maintenance is actually a philosophy or attitude that, based on operating conditions, allows the optimization of the entire medical system. A comprehensive management of predictive maintenance uses the best methods to obtain the operating parameters of the component subsystems of a medical system, on the basis of which it will schedule maintenance and repair activities. Including predictive maintenance in the general maintenance program optimizes the availability of devices and equipment and greatly reduces maintenance costs. By using the records of the entire care of historical repair components and maintained maintenance, we can make a mathematical prediction model for the entire world.
\nClassifications of different types of failures and the establishment of policies for analysis involve three different levels: system level, failure peak and component level. Results analyzed can be set for a model for optimizing maintenance/inspection.
\nIt is considered a continuous process so that it can be put into operation or rejected (scrap). The way of monitoring the functionality is as follows: first, check each product; continue checking until the consecutive k linear products are reached (full inspection). From this point, the inspection of the equipment is no longer deterministic, “piece by piece”; they will be chosen randomly, independently of the other, with probability α. Continue random monitoring (partially verified) until a defect is discovered, and then revert to previous monitoring and so on. Suppose the probability of a product being defective is q. It is understood that if a problem is found, the item is removed temporarily or permanently.
\nAverage of all relevant product cycle is equal to:
\nIt can be shown that the proportion of undetected defective items is given by:
\nAnother model that offers good results when used in this field is known as “replacing a durable good.” This is based on the assumption, for example, that the service life of the equipment is represented by a continuous random variable with the distribution function H and the density h and that a policy to replace the good says that it will happen if it has a major failure or if it is still in operation, it is acceptable to reach a certain “age,” say the T years. We assume that the price of similar new equipment is C1, and when the equipment fails, we seriously consider a C2 amount, corresponding to the provision of the equipment.
\nThe average length of a life cycle of equipment can be expressed as:
\nDepending on the distribution of H, which is usually uniform (0, T0), where T0 is a standard period, depending on the case, for example 10 years and costs C1 and C2, one can estimate the value of T, which will reduce to a minimum the cost of having an older, optimizing device. As in the field of health care, failure prevention is more effective than focusing on remedying them. Repairs are almost always expensive, requiring overspecialized personnel and often expensive parts. However, corrective maintenance is a permanent component of medical technology management.
\nCorrective maintenance allows a device to maintain its full performance of functions, through effective interventions at the time of a problem. However, this action must be well planned, because it acts not only on the level of symptoms, but also on the level of finding and solving the cause of the defect itself.
\nUsers and technical staff have the obligation to maintain medical equipment at a level of safety as high as possible, compared to other types of usual equipment. Most complex medical equipment works, for example, in the intensive care unit. They have an electrical connection that in certain situations of first defect can create injuries or even death of the patient by electric shock. Patients connected to such medical equipment are not able to respond to dangerous conditions or pain. Other types of medical equipment work to support life, and a problem, sometimes even minor in some respects, can lead to the death of the patient when the equipment is used incorrectly or is poorly maintained. The life cycle of medical equipment, from the point of view of media technology management, comprises 4 stages and 9 themes according to current standards (Figure 3) [17, 18, 19, 20].
\nLife cycle of the medical equipment.
An important stage in the life of medical equipment is that of maintenance and repairs that involve certain assumptions and challenges.
\nSome assumptions are as follows:
Maintenance culture exists and is respected by the technicians, users and other staff.
Technical staff are present, trained and know how to maintain and repair the equipment.
Preventive maintenance schedules exist and they are performed regularly.
Technicians have access to spare parts, on stock in the hospital or ordered in and spare parts are delivered within 24 hours if necessary.
Technicians have access to and know how to use test equipment to calibrate and test medical equipment.
A maintenance system of medical equipment should be considered as a simple system with inputs/outputs. Inputs to the system are data of defective equipment, materials and spare parts, consumables, data and information on its use, local and global policies and procedures. The result is reliable and well-configured medical equipment that can be achieved only by efficient planning of maintenance and service. The system to be functional has a set of rules that must be implemented. These activities include planning, scheduling, executing and controlling.
\nThe control is performed having as objective the organization and functioning of the maintenance system. The objectives coincide with the organization’s objectives and include equipment availability, costs and quality. An important role is played by the feedback that is used to improve the performance of the medical system/equipment [21].
\nThe existence of an effective maintenance control system improves the reliability of the equipment and increases its service life without having unscheduled shutdowns. Maintenance control contains a set of activities, tools and procedures used to coordinate and allocate maintenance resources, including those for specialized personnel, to achieve the objectives of the system, including the following:
Work control
Quality control and processes
Cost control
An essential element of maintenance control is the work order system used for planning, executing and controlling maintenance work. The work order system consists of the necessary documents and the well-defined workflow process. The documents provide means for planning and collecting the information needed to monitor and report maintenance work.
\nCurrently, the process of controlling the maintenance of medical equipment involves four stages:
Concrete and coherent setting of objectives and standards: the control process begins with planning; the objectives and performance standards to be pursued are established. Performance objectives must be clear results that must be achieved.
Methods of measuring effective performance: the purpose is to accurately determine the results of performance (output standards) and/or performance efforts (input standards). Quantification must be accurate to identify significant differences between what was actually achieved and what was originally planned at the beginning of the process [22, 23].
An important role is played by the comparison of the results obtained following the measurements with imposed objectives and standards. This stage is expressed by the control equation: Need for action = Desired performance − Actual performance. Sometimes, a comparison with data from the history of equipment use, data collected from the medical device file, can be taken into account for an evaluation of current performance. Or you can use a relative comparison that tracks the performance of other equipment in the same model, meeting the same standard, used by people with similar training. In comparison, maintenance standards are scientifically established by methods such as time and motion studies. Preventive maintenance routines, for example, are measured in terms of expected time in each routine performed, depending on operating hours or time intervals.
Carrying out corrective actions: the last step in the control process is to take all necessary measures to correct problems, nonconformities or improvements. Effective management is one that pays attention to situations that show the greatest need for correction. It saves time, energy and other valuable resources, focusing on critical and priority areas. Maintenance managers must pay special attention to two types of situations: a problematic situation in which the real performance is below the imposed standard and a second situation, of opportunity, in which the real performance is above the standard.
The oldest and most common maintenance and repair strategy is “fix it when it breaks.” The appeal of this approach is that no analysis or planning is required. The problems with this approach include the occurrence of unscheduled downtime at times that may be inconvenient, perhaps preventing accomplishment of committed production schedules. These problems provide motivation to perform maintenance and repair before the problem arises. The simplest approach is to perform maintenance and repair at preestablished intervals, defined in terms of elapsed or operating hours. This strategy can provide relatively high equipment reliability, but it tends to do so at excessive cost (higher scheduled downtimes) [24]. A further problem with time-based approaches is that failures are assumed to occur at specific intervals. The only way to minimize both maintenance and repair costs and probability of failure is to perform ongoing assessment of machine health and ongoing prediction of future failures based on current health and operating and maintenance history [25, 26, 27].
\nThis is the motivation for prognostics: minimize repair and maintenance costs and associated operational disruptions, while also minimizing risk of unscheduled downtime. Preventive maintenance is the strategy organized to perform maintenance at predetermined intervals to reduce the probability of failure or performance degradation. It can be classified into constant interval, age-based or imperfect maintenance:
Constant interval maintenance: as the name suggests, it is done at fixed intervals (in addition to any maintenance prompted by failure that is performed when it manifests). Intervals are selected to balance high risk of failure with long intervals and high preventive maintenance costs with short intervals.
Age-based maintenance: in this strategy, preventive maintenance at fixed intervals is carried out only after the system has reached a specific age.
Imperfect maintenance: in the above to be restored to its original condition after a preventive maintenance. However, it may be the case that the condition of the system is in between good (original) and bad (failure). This is the premise of imperfect maintenance strategies, which take into consideration the uncertainty of the current state of the equipment while scheduling future activities [28, 29].
Providing quality medical services involves correct and efficient resource management and planning. An important element in achieving this is a balance between costs involved in the investment of new equipment and its maintenance. Proper use and proper maintenance of medical equipment must be supported by a clear policy in the field, technical guidance and practical tools for maintaining the functional parameters of media equipment. By using functional medical equipment, it will be possible to significantly improve the quality of the medical act and the efficiency of such a service. Consistent management practices in this area will help increase efficiency in the field of health.
\nAn analysis of the maintenance of medical equipment is made to assess the lifespan of that equipment, which can be extended or shortened depending on the actions taken. Equipment maintenance is crucial for its lifespan. If maintenance periods are not met, on time and on a regular basis, medical equipment will be damaged to the point where it will cost more to repair than to replace. If no decisions are made at all in the maintenance of medical equipment, it will degrade irreparably. The importance of maintenance activities consists in the efficient management of the equipment; this task requires extensive information about the medical device. Thus, it is necessary to know the history of the equipment, how it has been exploited in the past, to say if the situation is improving and to learn from previous situations.
\nFinally, records provide staff with valuable technical information and evidence that they can use when they need arguments or need help or additional resources. The maintenance of the database system helps to keep track of repair services and other actions for optimal operation of medical equipment.
\nThe authors declare no conflict of interest.
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