Studies in health technology and informatics
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Stud Health Technol Inform · Jan 2008
From guidelines to careflows: modelling and supporting complex clinical processes.
Research on computer interpretable clinical guidelines has largely focused on individual points of care rather than processes of care. Whether we consider simple aids like clinical alerts and reminders or more sophisticated data interpretation and decision-making, guideline developers tend to focus on specific tasks rather than processes like care plans and pathways which are extended in time. ⋯ We also briefly discuss the distinct theoretical frameworks which have grown up around them, notably Petri nets for workflow modelling and mathematical logics for guidelines. We conclude that these offer complementary views of clinical processes and that a key research challenge is find a way of unifying them.
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Stud Health Technol Inform · Jan 2008
Treatment of early adolescent idiopathic scoliosis using the SpineCor System.
The purpose of this prospective observational study was to evaluate the effectiveness of the Dynamic SpineCor System for adolescent idiopathic scoliosis in accordance with the standardized outcome criteria proposed by the Scoliosis Research Society Committee on Bracing and Nonoperative Management. The SpineCor System is the first and only truly dynamic brace, which provides a progressive correction of Idiopathic Scoliosis from 15 degrees Cobb angle and above. The new therapeutic approach is based on a new concept upon the etiology and pathogenesis of idiopathic scoliosis; a pathology of the neuro-musculoskeletal system in growth and maturation. ⋯ Eight mature patients out of 298 (2.7%) required surgery within 2 years of follow-up beyond skeletal maturity. The conclusion drawn from these findings is that the SpineCor brace is effective for the treatment of adolescent idiopathic scoliosis. Moreover, positive outcomes are maintained after 2 years because 151 (93.2%) of 162 patients stabilized or corrected their end of bracing Cobb angle up to 2 years after bracing.
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Stud Health Technol Inform · Jan 2008
Comparative StudyBiomechanical characterisation of osteosyntheses for proximal femur fractures: helical blade versus screw.
Proximal femur fractures are of main concern for elderly and especially osteoporotic patients. Despite advanced implant modifications and surgical techniques, serious mechanical complication rates between 4-18% are found in conventional osteosyntheses of proximal femur fractures. Clinical complications such as the rotation of the femoral head and the cut-out phenomenon of the fracture fixation bolt are often diagnosed during post-operative treatments. ⋯ The helical blade showed a significant higher torque for the rotation of the femoral head compared to the screw system. The pull-out forces of the blade were substantially lower than of the comparative screw. Taken together the helical blade showed a higher potential of rotational stability, but after a rotation the lower pull-out forces demonstrate a higher degree of damage to the femoral head.
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Stud Health Technol Inform · Jan 2008
Computer-assisted Cobb angle measurement on posteroanterior radiographs.
The Cobb angle method is the gold standard to assess severity of scoliosis. A computer-aided method was developed to provide a semi-automatic Cobb angle measurement during a scoliosis clinic. This study was to evaluate the reliability and accuracy of the developed method. ⋯ For each curve type, the inter-method, inter-observer, and intra-observer variability were analyzed by Intraclass correlation coefficients (ICC[2,1]). The ICC values were higher than 0.90 in all these types. The developed method was reliable to measure the Cobb angle and was not dependent on the curve type.
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Stud Health Technol Inform · Jan 2008
Comparative StudySagittal alignment correction of the thoracolumbar junction in idiopathic scoliosis by in situ bending technique.
A long thoracolumbar sagittal rectitude is sometimes present in adolescent idiopathic scoliosis. The purpose of this study was to identify typical patterns, by comparing frontal plane deformities and vertebral rotation leading to this rectitude. Surgical thoracolumbar alignment correction by three-dimensional in situ bending of rods was then analyzed. ⋯ In situ bending realizes a stepwise correction of the three-dimensional deformity at different levels. An accurate preoperative analysis is mandatory to achieve an adequate sagittal balance, frontal curve correction and vertebral derotation simultaneously. The determined patterns of thoracolumbar rectitude are helpful to plan surgical correction accurately.