Studies in health technology and informatics
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Stud Health Technol Inform · Jan 2008
Concepts on the pathogenesis of adolescent idiopathic scoliosis. Bone growth and mass, vertebral column, spinal cord, brain, skull, extra-spinal left-right skeletal length asymmetries, disproportions and molecular pathogenesis.
There is no generally accepted scientific theory for the causes of adolescent idiopathic scoliosis (AIS). Encouraging advances thought to be related to AIS pathogenesis have recently been made in several fields including anthropometry of bone growth, bone mass, spinal growth modulation, extra-spinal left-right skeletal length asymmetries and disproportions, magnetic resonance imaging of vertebral column, spinal cord, brain, skull, and molecular pathogenesis. These advances are leading to the evaluation of new treatments including attempts at minimally invasive surgery on the spine and peri-apical ribs. ⋯ From these concepts, a collective model for AIS pathogenesis is formulated. The central concept of this model includes the body schema of the neural systems, widely-studied in adults, that control normal posture and coordinated movements with frames of reference in the posterior parietal cortex. The escalator concept has implications for the normal development of upright posture, and the evolution in humans of neural control, the trunk and unique bipedal gait.
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Cross-border activities in health care in the European single market are increasing. Many of these cross-border developments are related to e-Health. E-Health describes the application of information and communication technologies across the whole range of functions that affect the health care sector. ⋯ More and clear guidelines on the reimbursement criteria for telemedicine and on liability would also be very useful. Guidance at the European level can be given as to the criteria that (tele-) health sessions will have to comply with for reimbursement purposes, since it is still unclear when e-Health sessions will be reimbursed. It is clear that the existing European legal framework is not finished yet and that more specific European rules are needed.
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Stud Health Technol Inform · Jan 2008
The last challenges and barriers to the development of telemedicine programs.
Over the past several decades the concept of telemedicine has evolved to be more commonplace with many unique applications. These applications have been made possible by overcoming challenges and barriers that have been present for most of telemedicine's development. The application of telemedicine continues to undergo growth and scrutiny. ⋯ Future generations of telemedicine users will look back at this period as one of transition. The first 30 years or so of telemedicine implementation were fraught with barriers and challenges. The next 30 years will see and entirely different paradigm of practicing medicine, including consumerism and smart systems.
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Stud Health Technol Inform · Jan 2008
Intensive care telemedicine: evaluating a model for proactive remote monitoring and intervention in the critical care setting.
Historically, telemedicine has focused on the application of traditional physician-to-patient (and physician-to-physician) interactions enhanced by two-way video and audio capability. This "one-on-one" interaction via a telemedicine link can dramatically extend a physician's or other caregiver's geographic range and availability. However, this same telemedicine model is most often implemented "on-demand" for a specified time-limited encounter. ⋯ Multiple challenges remain before remote ICU systems become more broadly accepted and applied. These include cost of implementation of the system, resistance to the system by ICU physicians and nurses, and integration of data systems and clinical information into the remote electronic ICU model. In this chapter, we will provide background information on error reduction theory and the role of the remote ICU model, review current data supporting use of the remote ICU system, address the current obstacles to effective implementation, and look to the future of the field for solutions to these challenges.
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Stud Health Technol Inform · Jan 2008
An artificial neural network derived trauma outcome prediction score as an aid to triage for non-clinicians.
In mass casualty events Emergency Medical Service Providers (EMS) choose treatment at Scene or a "scoop and run" approach. The latter requires clinically trained personnel at the reception site to triage patients. Current methodology based on Revised Trauma Score (tRTS) requires use of Glasgow Coma Scale, a method reliant on experience and clinical knowledge. ⋯ Models performed well in predicting mortality compared to standard outcome predictors. Possible additional variables such as gender or ethnicity might improve the Neural Network predictive ability. Pulse appears an essential variable not recorded by the NTDB.