A Concept of Mobile Support System for the Young Onset Dementia in Taiwan

Owing to the increasing population of young onset dementia all over the world. We designed a 6”-display Android mobile system for evaluating the potential patient of Dementia. A pilot test at experienced nursing members showed that they had strong willing of launching this design in their daily practical events.

Impact Analysis of the Interobserver Variability in CBCT-Based Soft-Tissue Matching using TCP/NTCP Models for Prostate Cancer Radiotherapy

Background: Prostate alignment is subject to interobserver variability in cone-beam CT (CBCT)-based soft-tissue matching. This study aims to analyze the impact of interobserver variability in CBCT-based soft-tissue matching for prostate cancer radiotherapy.Methods: Retrospective data, consisting of 156 CBCT images from twelve patients with intermediate- or high-risk prostate cancer were analyzed in this study. To simulate interobserver variability, couch shifts of 2 mm relative to the resulting patient position of prostate alignment were assumed as potential patient positions (27 possibilities). For each CBCT, the doses of the potential patient positions were recalculated using deformable image registration-based synthetic CT. The impact of the simulated interobserver variability was evaluated using tumor control probabilities (TCPs) and normal tissue complication probabilities (NTCPs).Results: No significant differences in TCPs were found between prostate alignment and potential patient positions (0.944 ± 0.003 vs 0.945 ± 0.003, P = 0.117). The average NTCPs of the rectum ranged from 5.16 (%) to 7.29 (%) among the potential patient positions and were highly influenced by the couch shift in anterior-posterior direction. In contrast, the average NTCPs of the bladder ranged from 0.75 (%) to 1.12 (%) among the potential patient positions and were relatively negligible.Conclusions: The NTCPs of the rectum, rather than the TCPs of the target, were highly influenced by the interobserver variability in CBCT-based soft-tissue matching. This study provides a theoretical explanation for daily CBCT-based image guidance and the prostate-rectum interface matching procedure.Trial registration: Not applicable.

Back to the Basics—Is Comfort Care the Same as Do Not Resuscitate? How Misinterpreting Code Status May Lead to Potential Patient Harm

Several research studies have shown that code status documentation is misinterpreted or incorrectly defined by a significant number of medical professionals. This misinterpretation among the medical team (i.e. equating Do Not Resuscitate (DNR) with comfort care measures only) may lead to false reporting, poor symptom management, and potentially adverse clinical outcomes. Most Hospice and Palliative Care providers are aware of these distinctions, however a shortage (and continued foreseen shortage) of Hospice and Palliative Care providers may mean these conversations and distinctions will fall to non-subspecialists, or providers of other medical specialties or degrees. The literature has demonstrated that these shortfalls and misinterpretations are present and constitute potential harm to our patients.

A novel approach to diagnose ADHD using virtual reality

Purpose The current golden standard for attention deficit hyperactivity disorder (ADHD) diagnosis is clinical diagnosis based on psychiatric interviews and psychological examinations. This is suboptimal, as clinicians are unable to view potential patients in multiple natural settings – a necessary condition for objective diagnosis. The purpose of this paper is to improve the objective diagnosis of ADHD by analyzing a quantified representation of the actions of potential patients in multiple natural environments. Design/methodology/approach The authors use both virtual reality (VR) and artificial intelligence (AI) to create an objective ADHD diagnostic test. Diagnostic and statistical manual of mental disorders, 5th Edition (DSM-5) and ADHD Rating Scale are used to create a rule-based system of quantifiable VR-observable actions. As a potential patient completes tasks within multiple VR scenes, certain actions trigger an increase in the severity measure of the corresponding ADHD symptom. The resulting severity measures are input to an AI model, which classifies the potential patient as having ADHD in the form inattention, hyperactivity-impulsivity, combined or neither. Findings The result of this study shows that VR-observed actions can be extracted as quantified data, and classification of this quantified data achieves near-perfect sensitivity and specificity with a 98.3% accuracy rate on a convolutional neural network model. Originality/value To the best of the authors’ knowledge, this is the first study to incorporate VR and AI into an objective DSM-5-based ADHD diagnostic test. By including stimulation to the visual, auditory and equilibrium senses and tracking movement and recording voice, we present a method to further the research of objective ADHD diagnosis.

Vedolizumab (Entyvio) in Crohn's disease

Vedolizumab is a biological medicine (biologic), marketed under the brand name Entyvio (Takeda), used to treat moderate-to-severe inflammatory bowel disease (IBD). This clinical review focuses primarily on the onset speed of vedolizumab in Crohn's disease. It consolidates research on the use of vedolizumab in IBD, including how the introduction of a formulation for subcutaneous injection has challenged IBD services to review the use of vedolizumab in Crohn's disease. It presents up-to-date information that addresses misconceptions among health professionals and patients that vedolizumab is slow to work in Crohn's disease. It explores why specialist IBD nurses might raise the availability of different biologics during patient consultations, as well as how to hold quality conversations on the topic and address potential patient misconceptions.

Comparison of biomechanical performance of single-level triangular and quadrilateral profile anterior cervical plates

The quadrilateral anterior cervical plate (ACP) is used extensively in anterior cervical discectomy and fusion (ACDF) to reconstruct the stability of the cervical spine and prevent cage subsidence. However, there have been no comparison studies on the biomechanical performance of quadrilateral ACP and triangular ACP. The objective of this study is to investigate the functional outcomes of quadrilateral ACP and triangular ACP usage in ACDF surgery. In this study, a finite element model of intact C1-C7 segments was established and verified. Additionally, two implant systems were built; one using triangle anterior cervical plates (TACP) and another using quadrilateral orion anterior cervical plate (QACP). Both models were then compared in terms of their postoperative biomechanical performance, under normal and excessive motion. Compared to QACP, the peak stress of the TACP screws and plates occurred at 359.2 MPa and 97.2 MPa respectively and were the highest during over extension exercises. Alternately, compared to TACP, the endplate peak stress and the cage displacement of QACP were the largest at over extension, with values of 7.5 MPa and 1.2 mm, respectively. Finally, the average stress ratio of bone grafts in TACP was relatively high at 31.6%. In terms of biomechanical performance, TACP can share the load more flexibly and reduce the risks of cage subsidence and slippage but the screws have high peak stress value, thereby increasing the risk of screw slippage and fracture. This disadvantage must be considered when designing a TACP based implant for a potential patient.

Pediatric Subspecialty Adoption of Telemedicine Amidst the COVID-19 Pandemic: An Early Descriptive Analysis

Telemedicine has rapidly expanded in many aspects of pediatric care as a result of the COVID-19 pandemic. However, little is known about what factors may make pediatric subspeciality care more apt to long-term adoption of telemedicine. To better delineate the potential patient, provider, and subspecialty factors which may influence subspecialty adoption of telemedicine, we reviewed our institutional experience. The top 36 pediatric subspecialties at Stanford Children's Health were classified into high telemedicine adopters, low telemedicine adopters, and telemedicine reverters. Distance from the patient's home, primary language, insurance type, institutional factors such as wait times, and subspecialty-specific clinical differences correlated with differing patterns of telemedicine adoption. With greater awareness of these factors, institutions and providers can better guide patients in determining which care may be best suited for telemedicine and develop sustainable long-term telemedicine programming.

Masking Between Reserved Alarm Sounds of the IEC 60601-1-8 International Medical Alarm Standard: A Systematic, Formal Analysis

Objective In this work, we systematically evaluated the reserved alarm sounds of the IEC 60601-1-8 international medical alarm standard to determine when and how they can be totally and partially masked. Background IEC 60601-1-8 gives engineers instruction for creating human-perceivable auditory medical alarms. This includes reserved alarm sounds: common types of alarms where each is a tonal melody. Even when this standard is honored, practitioners still fail to hear alarms, causing practitioner nonresponse and, thus, potential patient harm. Simultaneous masking, a condition where one or more alarms is imperceptible in the presence of other concurrently sounding alarms due to limitations of the human sensory system, is partially responsible for this. Methods In this research, we use automated proof techniques to determine if masking can occur in a modeled configuration of medical alarms. This allows us to determine when and how reserved alarm sound can mask other reserved alarms and to explore parameters to address discovered problems. Results We report the minimum number of other alarm sounds it takes to both totally and partially mask each of the high-, medium-, and low-priority alarm sounds from the standard. Conclusions Significant masking problems were found for both the total and partial masking of high-, medium-, and low-priority reserved alarm sounds. Application We show that discovered problems can be mitigated by setting alarm volumes to standard values based on priority level and by randomizing the timing of alarm tones.