Patient-Telemonitoring After Revascularization Procedures in the Lower Extremities

Multidisciplinary cooperation of participating healthcare professionals, use of common standards in diagnostics, and clinical pathways in the treatment of vascular patients should provide for a higher-quality clinical practice. Using telemedicine, a more efficient way of obtaining specialist treatment is achievable. However, its introduction may raise safety and security issues, which originate from its enabling information technology. In this chapter, a model of patient-telemonitoring after revascularization procedures in the lower extremities is presented. A protocol for proper authentication and authorization to access medical equipment and patient medical records has been introduced. The associated clinical study has shown that most post-operative follow-up examinations can successfully be performed by trained nurses. Hence, improvements to healthcare logistics, mainly due to shortening waiting times for specialist treatment and the reduction of follow-up examinations on the secondary healthcare level, can be achieved using telemedicine.

A Qualitative Study Exploring Barriers and Facilitators to Establishing Nurse-led, Multidisciplinary Psychological Care for Trauma Patients: Experiences From Doctors and Nurses

BackgroundTrauma patients are often in a state of psychological stress, experiencing helplessness, sadness, frustration, irritation, avoidance, irritability and other adverse emotions. Doctors and nurses are at the forefront of caring trauma patients and they play a crucial role in psychological supports and mental health care. However, few qualitative studies had based on the framework of the Theory of Planned Behavior (TPB) to explore the experiences in providing psychological care for trauma patients. We examined attitudinal, normative, and control beliefs underpinning medical staffs’ decisions to perform psychological care.MethodA qualitative study of in-depth semi-structured interviews was conducted among 14 doctors and nurses engaging in trauma care. The participants came from six tertiary hospitals in Chongqing, China. Data analysis was performed using the approach of Colaizzi. According to the framework of TPB, the researchers identified and summarized the themes.ResultsImportant advantages (mutual trust, patients' adherence and recovery), disadvantages (workload, short-term ineffective, practice unconfidently), referents (supportive: managers, patients, kinsfolk, nursing culture; unsupportive: some colleagues and patients), barriers (insufficient time or energy, resources situations), and facilitators (access to psychologist, training/education, reminders) were identified. Some demands, such as training diversity, multidisciplinary cooperation and families' support, reflected by doctors and nurses were important for them to carry out psychological care.ConclusionAccording to the TPB, this article explored the internal and external promotion and hindrance factors that affecting the intentions and behaviors of doctors and nurses in implementing psychological care for trauma patients. We also focused on the experience and demands of health professionals in conducting psychological care, which could provide references for managers to formulate corresponding psychological care procedures and norms.

Role of Home-Modification Training for Care Managers

With the aging of society, the long-term care insurance system -which includes home modifications to continue living at home- was established in 2000. However, the quality of home modifications has been persistent issue, and effective training is expected to conclusively solve this problem. To this end, the purpose of this study is to clarify the rational for training care managers who plan home modifications. A survey comprising two sets of questionnaires was conducted; one set encompassed is all 62municipalities in Tokyo, whereas the other involved care manager who participated in training program. The results of the first questionnaire showed that, out of 62 municipalities, 9 (14.5%) provided training on home modification, of which 8 (88.9%) provided training on administrative procedures. In one municipality that provided training on practical aspects of home modification, we provide questionnaires to 59 care managers participating in the training. -Lectures on administrative procedures, physical conditions of invalids, and reading drawings were conducted by administrative staff, occupational therapists, and architects, respectively. Afterwards, the participants attended a planning workshop. According to the questionnaire conducted after the workshop, 80.4% of the participants could understand home modifications in the system, 85.5% understood how to modify homes based on the occupants’ symptoms and physical conditions, 81.6% could interpret drawings, 90.2% could plan modifications, and 81.6% found the training useful. These findings indicate that the training of care managers has indeed been effective in actual practice. Improving the quality of home modifications through multidisciplinary cooperation is significant in maintaining home life.

Rheumatic Manifestations and Diseases From Immune Checkpoint Inhibitors in Cancer Immunotherapy

Immune checkpoint inhibitors (ICIs), which can enhance antitumor immunity and inhibit cancer growth, have revolutionized the treatment of multiple cancers and dramatically decreased mortality. However, treatment with ICIs is directly associated with immune-related adverse events (irAEs) because of inflammation in off-target organs and autoimmunity resulting from non-specific immune activation. These irAEs can cause rheumatic diseases and manifestations such as inflammatory arthritis, polymyalgia rheumatica, myositis, vasculitis, Sicca and Sjogen's syndrome, and systemic lupus erythematosus. Early diagnosis and treatment of these adverse events will improve outcomes and quality of life for cancer patients. The treatment of rheumatic diseases induced by ICIs requires multidisciplinary cooperation among physicians. Furthermore, the underlying mechanisms are not fully understood and it is difficult to predict and evaluate these side effects precisely. In this review, we summarize available studies and findings about rheumatic irAEs, focusing mainly on the clinical manifestations, epidemiology, possible mechanisms, and guiding principles for treating these irAEs.

The Effects of Preterm Birth on Musculoskeletal Health-Related Disorders

Preterm birth is associated with various diseases and conditions which demand multidisciplinary medical care. Approximately 10% of all neonates are born prematurely with an increasing survival rate in almost all Western countries. This ongoing, yet desirable trend is creating new challenges for sufficient medical treatment regimens, which should be upheld throughout the patients’ lives. Orthopedic surgeons are focused on musculoskeletal disorders and the improvement of patients’ ability to cope with the challenges of everyday life. The most common conditions associated with preterm birth are cerebral palsy and a dysregulation of the calcium/phosphorus metabolism, which may lead to fractures. These diseases may vary greatly in their organic manifestation and clinical presentation. This demands multidisciplinary cooperation and parental support. Clinical management is aimed on the early enhancement of a patient’s physical, as well as neurological condition, and to prevent the development of secondary musculoskeletal disorders. In this article, we give an overview of the current literature on the most common musculoskeletal disorders associated with preterm birth and critically discuss state of the art diagnostic standards and treatment algorithms.

Severe Anaphylaxis in Pregnancy: A Systematic Review of Clinical Presentation to Determine Outcomes

Anaphylactic reactions during pregnancy can range from subjective cutaneous symptoms to anaphylaxis and lethal anaphylactic shock. The fetal and maternal outcomes are unpredictable. This study is the first systematic review of the clinical presentation of severe anaphylaxis in pregnancy as defined by the World Allergy Organization to determine maternal and fetal outcomes. We searched PubMed, the Web of Science, and Scopus databases for articles published between 1 January 1985 and 15 April 2021 using the following terms (((anaphylactic shock) AND (pregnancy)) OR ((anaphylaxis) AND (pregnancy))). In 42 studies involving 47 patients, 36.17% of patients were 31–35 years old, and 74.47% of cases occurred peripartum, mostly during cesarean section. Accurate diagnosis with valid and reliable outcome measures was reported for 71.74% of cases. Twenty-two allergens were identified: antibiotics (penicillins and cephalosporins), anesthetic drugs (suxamethonium, mepivacaine), latex, oxytocin, sodium and sucrose iron, laminaria, misoprostol, rubber from Foley catheter, oral phytomenadione, ranitidine, chamomile, and ant sting. Two cases of maternal death related to latex and intravenous iron sucrose, and six infants with neurological disease were reported, mostly related to antibiotics. This review of the currently available literature shows that favorable outcomes are attainable with a high degree of observation, multidisciplinary cooperation, and rapid treatment.

High-rise Building Integrated with Solar Chimney and Bioenergy

In dense mega cities, high-rise buildings huge energy consumption on mechanical ventilation and overheat produced by the air conditioners are among big challenges for the sustainable building development and green city construction. Solar chimney is proved to be an efficient method to promote natural ventilation for buildings. Different types of solar chimney are presented with a high-rise building layout example. Solar chimney geometry and environment basic data is suggested to be evaluated to optimize the Solar chimney’s natural ventilation. In addition, aiming as well a clean and sustainable environment, bio-energy can be adopted in buildings by integrating with algae-fluid window and wall system. Different materials of radiation absorber can be studied and integrated with solar chimney. An outline of research on solar chimney integrated with bio-energy for high-rise building is given in this paper. In order to succeed, close multidisciplinary cooperation is necessary for the project which involves at least architecture, thermal physics, air dynamics, materials science and biology. Experiment conditions and potential risk should be discussed beforehand.

Decentralized Enterprise Risk Management Issues under Rapidly Changing Environments

Under the growing complexity of manufacturing processes, supply chains, markets and stakeholder expectations, enterprise risk management (ERM) has become an extremely important, probably yet still underdeveloped, management function. Enterprise risk management theory and practice should keep pace with the changes of rapidly changing environments, through new, more adaptive approaches. The article presents some of the results of a longitudinal survey at Eastern-European manufacturing organizations made on risk management techniques. The goal of the research was the study of risk management techniques under rapidly changing environments in highly standardized industries (pharmaceutical and automotive). The research was focused on the role of human resources in handling technology-related/operational risks and to what extent a decentralized risk management is present. Multidisciplinary cooperation, the selection of the teams, communication and the decision making within the team was analysed. During our research few common risk analysis routines were identified at the studied organizations. Through an interview-based qualitative survey, possible weaknesses of common risk identification techniques were identified. The article presents three risk evaluation methods with the same features. The answers provided during the interviews indicate that risk assessment techniques are mostly centralized (coordinated by a single person/unit), linear (based on If-Then construct) and rigid, definitively not suitable when quick changes are in the organization environment.

FUSION AND EVALUATION OF 3D DATA AND EXCAVATION DOCUMENTS FOR COMPARISON OF ORIGINAL AND DIGITAL COPY IN THE CASE OF A MEGALITHIC TOMB

This contribution shows the preliminary results of the multidisciplinary cooperation of archaeological, technical and heritage issues using the example of the megalithic tomb Kleinenkneten II. The tomb was excavated in the 1930s, but big parts of the documentation have unfortunately been destroyed. Furthermore, some ancient interpretations need to be objectively reviewed. More than 500 historical image data visually document the historical excavation situation. In addition, the current situation was recorded in 3D using modern methods. Geodetic products, such as orthophotos, can be derived from modern data and compared with old plans. Also, a point cloud was calculated from historical images, which can be compared with the current situation. The combination of modern and historical data enables new archaeological interpretations. From a museum perspective, strategies for the construction of authentic value of the 3D model is considered, as well as its communication to the public.