Search results for: patient specific implants

Authors: Scott M. Black, Craig Maclean, Pauline Hall Barrientos, Konstantinos Ritos, Asimina Kazakidi

Abstract:

Aortic aneurysms and dissections are leading causes of death in cardiovascular disease. Both inevitably lead to hemodynamic instability without surgical intervention in the form of vascular stent-graft deployment. An accurate description of the aortic geometry and blood flow in patient-specific cases is vital for treatment planning and long-term success of such grafts, as they must generate physiological branch perfusion and in-stent hemodynamics. The aim of this study was to create patient-specific computational fluid dynamics (CFD) models through a multi-modality, multi-dimensional approach with boundary condition optimization to predict branch flow rates and in-stent hemodynamics in custom stent-graft configurations. Three-dimensional (3D) thoracoabdominal aortae were reconstructed from four-dimensional flow-magnetic resonance imaging (4D Flow-MRI) and computed tomography (CT) medical images. The former employed a novel approach to generate and enhance vessel lumen contrast via through-plane velocity at discrete, user defined cardiac time steps post-hoc. To produce patient-specific boundary conditions (BCs), the aortic geometry was reduced to a one-dimensional (1D) model. Thereafter, a zero-dimensional (0D) 3-Element Windkessel model (3EWM) was coupled to each terminal branch to represent the distal vasculature. In this coupled 0D-1D model, the 3EWM parameters were optimized to yield branch flow waveforms which are representative of the 4D Flow-MRI-derived in-vivo data. Thereafter, a 0D-3D CFD model was created, utilizing the optimized 3EWM BCs and a 4D Flow-MRI-obtained inlet velocity profile. A sensitivity analysis on the effects of stent-graft configuration and BC parameters was then undertaken using multiple stent-graft configurations and a range of distal vasculature conditions. 4D Flow-MRI granted unparalleled visualization of blood flow throughout the cardiac cycle in both the pre- and postsurgical states. Segmentation and reconstruction of healthy and stented regions from retrospective 4D Flow-MRI images also generated 3D models with geometries which were successfully validated against their CT-derived counterparts. 0D-1D coupling efficiently captured branch flow and pressure waveforms, while 0D-3D models also enabled 3D flow visualization and quantification of clinically relevant hemodynamic parameters for in-stent thrombosis and graft limb occlusion. It was apparent that changes in 3EWM BC parameters had a pronounced effect on perfusion distribution and near-wall hemodynamics. Results show that the 3EWM parameters could be iteratively changed to simulate a range of graft limb diameters and distal vasculature conditions for a given stent-graft to determine the optimal configuration prior to surgery. To conclude, this study outlined a methodology to aid in the prediction post-surgical branch perfusion and in-stent hemodynamics in patient specific cases for the implementation of custom stent-grafts.

Keywords: 4D flow-MRI, computational fluid dynamics, vascular stent-grafts, windkessel

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Authors: Yonathan Audhitya Suthihono, Ratih Dyah Kusumastuti

Abstract:

The radiology department in a tertiary referral hospital faces service operation challenges such as huge and various patient arrival, which can increase the probability of patient queuing. During the COVID-19 pandemic, it is mandatory to apply social distancing protocol in the radiology department. A strategy to prevent the accumulation of patients at one spot would be required. The aim of this study is to identify an alternative solution which can reduce the patient’s waiting time in radiology department. Discrete event simulation (DES) is used for this study by constructing several improvement scenarios with Arena simulation software. Statistical analysis is used to test the validity of the base case scenario model and to investigate the performance of the improvement scenarios. The result of this study shows that the selected scenario is able to reduce patient waiting time significantly, which leads to more efficient services in a radiology department, be able to serve patients more effectively, and thus increase patient satisfaction. The result of the simulation can be used by the hospital management to improve the operational performance of the radiology department.

Keywords: discrete event simulation, hospital management patient queuing model, radiology department services

Procedia PDF Downloads 106

Authors: Badino Manuel, Farias Maria Alejandra

Abstract:

Telemedicine (TM) has the potential to develop efficient and cost-effective means for delivering quality health care services and outcomes, showing equal or, in some cases, better results than in-person treatment. To analyze patient satisfaction with the use of TM becomes relevant because this can affect the results of treatment and the adherence to it. The aim is to assess patient satisfaction with telemedicine for treating substance-related disorders in a mental health service in Córdoba, Argentina. A descriptive cross-sectional study was conducted among patients with substance-related disorders (N=115). A patient satisfaction survey was conducted from December 2021 to March 2022. For a total of 115 participants, 59,1% were male, 38,3% were female and 2,6% non-binary. In relation to educational status, 40% finished university, 39,1% high school, and 20,9 % only primary school. Regarding age, 4,3 % were young, 92,2% were adults, and 3,5% were elderly. Regarding TM treatment, 95,7% reported being satisfied. Furthermore, 85,2% of users declared that they would continueTM treatment, and 14,8% said that they would not resume TM treatment. To conclude, high levels of patient satisfaction contributes to the continuity of TM modality.

Keywords: telemedicine, mental health, substance-related disorders, patient satisfaction

Procedia PDF Downloads 100

Authors: Zuzana Durajova, Natasa Diatkova, Shreya Bhardwaj

Abstract:

This paper introduces the project START, its activities, goals, evaluation and final results. Over the past few decades, the legal discourse surrounding mental health has resulted in improvement in patient rights (in Netherlands, etc.), the appointment of Ombudspersons for psychiatric patients (in Austria, Sweden) and facilitating the participation of patients in decision-making processes. Czech legislation already recognizes the position of “patient’s advocate” as a person of trust. However, this instrument is not very widely known and rarely used in practice. In the pilot study of the project, legal training for patient advocacy is provided to persons with experience with mental health problems/psychiatric hospitalization chosen from a Czech-based NGO. These persons (patient advocates) visit patients in involuntary hospitalization in one closed ward in the chosen psychiatric institution. During visits, the patient advocates inform patients about their legal standing, their procedural rights and also offer them individual support in contacting their counsel, family members etc. To understand the effect of the intervention, qualitative interviews and participant observations are conducted with the patients, advocates, the hospital management and staff and other identifiable stakeholders, such as government officials responsible for mental health care reform. The interviews are held before, during and after the intervention (support from patient advocates in hospitals). Given the ethical quandaries arising from using psychiatric wards as a field setting, we assume a participatory approach to ensure respect for patient boundaries and dignity. Through this project, we seek to establish a profession of patient advocates based on professional standards.

Keywords: patient advocacy, involuntary hospitalization, Czech Republic, patient Rights, professionalization

Procedia PDF Downloads 182

Authors: Ya-Hui Wang

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Lower speech therapy rate of tracheostomized patient was noted in comparison with previous researches. This study is aim to shed light on the referral status of speech therapy in those patients in Taiwan. This study developed an analysis for the size and key characteristics of the population of tracheostomized in-patient in the Taiwan. Method: We analyzed National Healthcare Insurance data (The Collaboration Center of Health Information Application, CCHIA) from Jan 1 2010 to Dec 31 2010. Result: over ages 3, number of tracheostomized in-patient is directly proportional to age. A high service loading was observed in North region in comparison with other regions. Only 4.87% of the tracheostomized in-patients were referred for speech therapy, and 1.9% for swallow examination, 2.5% for communication evaluation.

Keywords: refer, speech therapy, training, rehabilitation

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Authors: Hsin-Yi Huang

Abstract:

This study mainly discussed the disease-induced and surgery-induced physical, psychological, and spiritual issues faced by a patient who suffered from emphysema and respiratory failure and had underwent a right-lung transplantation surgery. Nursing care was provided from May 21 to May 29. Based on the observations, interviews, physical examinations, and evaluations that were carried out using Roy’s adaptation model, the following nursing issues were identified: risk of infection, lack of knowledge, and anxiety. Active care was provided and a good nursing relationship with the patient and the patient’s family was established. The four strategies of Bandura’s self-efficacy theory (self-transcendence, vicarious experience, verbal persuasion, and biofeedback) were employed. Instructions for the appropriate rehabilitation exercises were given, immunosuppressant concentration was monitored, and special measures were taken to prevent infection. The patient was encouraged to express feelings and was provided with sufficient information to alleviate anxiety. With assistance from nursing personnel and the medical team, the patient was successfully discharged from the hospital and thereafter embarked on the path of postoperative recovery. The patient learned about the importance of home self-care and regular follow-up outpatient visits, and patient management was implemented for discharge preparation services. This nursing case study may serve as a reference to nurses managing similar cases in future.

Keywords: anxiety, lung transplantation, Roy's adaptation model, self-efficacy theory

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Authors: Bela Siska Afrida, Wisnu Barlianto, Desy Wulandari, Ery Olivianto

Abstract:

Background: Allergic asthma, caused by IgE-mediated allergic reactions, remains a global health issue with high morbidity and mortality rates. Immunotherapy is the only etiology-based approach to treating asthma, but no standard biomarkers have been established to evaluate the therapy’s effectiveness. This study aims to determine the correlation between the ratios of serum levels of HDM-specific IgE/total IgE and Asthma Control Test (ACT) score as a biomarker of the response to immunotherapy in pediatric allergic asthma patients. Patient and Methods: This retrospective cohort study involved 26 pediatric allergic asthma patients who underwent HDM-specific subcutaneous immunotherapy for 14 weeks at the Pediatric Allergy Immunology Outpatient Clinic at Saiful Anwar General Hospital, Malang. Serum levels of HDM-Specific IgE and Total IgE were measured before and after immunotherapy using Chemiluminescence Immunoassay and Enzyme-linked Immunosorbent Assay (ELISA) method. Changes in asthma control were assessed using the ACT score. The Wilcoxon Signed Ranked Test and Spearman correlation test were used for data analysis. Results: There were 14 boys and 12 girls with a mean age of 6.48 ± 2.54 years. The study showed a significant decrease in serum HMD-specific levels before immunotherapy [9.88 ± 5.74 kuA/L] compared to those of 14 weeks after immunotherapy [4.51 ± 3.98 kuA/L], p = 0.000. Serum Total IgE levels significant decrease before immunotherapy [207.6 ± 120.8IU/ml] compared to those of 14 weeks after immunotherapy [109.83 ± 189.39 IU/mL], p = 0.000. The ratios of serum HDM-specific IgE/total IgE levels significant decrease before immunotherapy [0.063 ± 0.05] compared to those of 14 weeks after immunotherapy [0.041 ± 0.039], p = 0.012. There was also a significant increase in ACT scores before and after immunotherapy (each 15.5 ± 1.79 and 20.96 ± 2.049, p = 0.000). The correlation test showed a weak negative correlation between the ratios of HDM-specific IgE/total IgE levels and ACT score (p = 0.034 and r = -0.29). Conclusion: In conclusion, this study showed that a decrease in HDM-specific IgE levels, total IgE levels, and HDM-specific IgE/total IgE ratios, and an increase in ACT score, was observed after 14 weeks of HDM-specific subcutaneous immunotherapy. The weak negative correlation between the HDM-specific IgE/total IgE ratio and the ACT score suggests that this ratio can serve as a potential biomarker of the effectiveness of immunotherapy in treating pediatric allergic asthma patients.

Keywords: HDM-specific IgE/total IgE ratio, ACT score, immunotherapy, allergic asthma

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Authors: Saimir Heta, Kers Kapaj, Rialda Xhizdari, Ilma Robo

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Despite the existence of different dental specialties, the dentist-patient relationship is unique, in the very fact that the treatment is performed by one doctor and the patient identifies the malpractice presented as part of that doctor's practice; this is in complete contrast to cases of medical treatments where the patient can be presented to a team of doctors, to treat a specific pathology. The rules of dental ethics are almost the same as the rules of medical ethics. The appearance of dental malpractice affects exactly this two-party relationship, created on the basis of professionalism, without deviations in this direction, between the dentist and the patient, but with very narrow individual boundaries, compared to cases of medical malpractice. Main text: Malpractice can have different reasons for its appearance, starting from professional negligence, but also from the lack of professional knowledge of the dentist who undertakes the dental treatment. It should always be seen in perspective that we are not talking about the individual - the dentist who goes to work with the intention of harming their patients. Malpractice can also be a consequence of the impossibility, for anatomical or physiological reasons of the tooth under dental treatment, to realize the predetermined dental treatment plan. On the other hand, the dentist himself is an individual who can be affected by health conditions, or have vices that affect the systemic health of the dentist as an individual, which in these conditions can cause malpractice. So, depending on the reason that led to the appearance of malpractice, the method of treatment from a legal point of view also varies, for the dentist who committed the malpractice, evaluating the latter if the malpractice came under the conditions of applying the rules of dental ethics. Conclusions: The deviation from the predetermined dental plan is the minimum sign of malpractice and the latter should not be definitively related only to cases of difficult dental treatments. The identification of the reason for the appearance of malpractice is the initial element, which makes the difference in the way of its treatment, from a legal point of view, and the involvement of the dentist in the assessment of the malpractice committed, must be based on the legislation in force, which must be said to have their specific changes in different states. Malpractice should be referred to, or included in the lectures or in the continuing education of professionals, because it serves as a method of obtaining professional experience in order not to repeat the same thing several times, by different professionals.

Keywords: dental ethics, malpractice, negligence, legal basis, continuing education, dental treatments

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Authors: Ritesh Verma, Manisha Rathi, Chand Singh Dhull, Sumit Sachdeva, Jitender Phogat

Abstract:

Temporal trabeculectomy with the Ologen implant was done in a 66-year-old lady with uveitic glaucoma. Serial IOP measurement was done to assess the efficacy of ologen implant in uveitic glaucoma. The patient had an IOP of 4mmhg day 1 postoperatively and Ologen implant was in place with a well-formed bleb. On follow up patient had an IOP of 14mmhg and unaided visual acuity of 6/12 on day 10 postoperatively. After 12 weeks of Trabeculectomy with Ologen implant, the IOP of the patient was 14 mmHg, the vision was 6/6 with -1.25 DS and -1.25 DC at 90 degrees. Trabeculectomy performed in patients with uveitic glaucoma has a higher chance of failure due to increased inflammation and fibrosis. Trabeculectomy with ologen implant done in a patient of uveitic glaucoma provides excellent postoperative results and the patient has a well-controlled IOP even after 56 weeks of surgery and a best corrected visual acuity of 6/6. Trabeculectomy with the ologen implant is superior to other surgeries in cases of secondary glaucoma with increased inflammation.

Keywords: glaucoma surgery, ologen implant, temporal trabeculectomy, uveitic glaucoma

Procedia PDF Downloads 194

Authors: Obe Olumide Olayinka, Victor Balanica, Eugen Neagoe

Abstract:

The effects of hypertension are often lethal thus its early detection and prevention is very important for everybody. In this paper, a neural network (NN) model was developed and trained based on a dataset of hypertension causative parameters in order to forecast the likelihood of occurrence of hypertension in patients. Our research goal was to analyze the potential of the presented NN to predict, for a period of time, the risk of hypertension or the risk of developing this disease for patients that are or not currently hypertensive. The results of the analysis for a given patient can support doctors in taking pro-active measures for averting the occurrence of hypertension such as recommendations regarding the patient behavior in order to lower his hypertension risk. Moreover, the paper envisages a set of three example scenarios in order to determine the age when the patient becomes hypertensive, i.e. determine the threshold for hypertensive age, to analyze what happens if the threshold hypertensive age is set to a certain age and the weight of the patient if being varied, and, to set the ideal weight for the patient and analyze what happens with the threshold of hypertensive age.

Keywords: neural network, hypertension, data set, training set, supervised learning

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Authors: R. Litt, A. Kana, K. House

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The primary aim of this patient-related experience questionnaire was to gain a better understanding of our patients' experience as inpatients when they undergo orthognathic surgery. The secondary aim of this study was to identify ways in which we can improve the orthognathic inpatient experience and to share this with other units. All patients who received orthognathic surgery at an NHS hospital - Bristol Royal Infirmary, England, over the course of 6 months were asked to complete a questionnaire regarding their care. This data was then analysed and compared to the same questionnaire given to patients treated in a private hospital where orthognathic surgery was completed. All treatment was completed by the same surgeon. The design of the questions took into account NICE (National Institute for Health and Care Excellence) guidance on improving the experience of patient care. Particularly taking into account patients' essential requirements of care, for example, assessing and managing pain, ensuring adequate and appropriate nutrition, and ensuring the patients' personal needs are regularly reviewed and addressed. Overall the patient-related experience after orthognathic surgery was comparable in both the NHS and private hospitals. However, the questionnaire highlighted aspects of inpatient care after orthognathic surgery that can easily be improved in order to provide our patients with the best possible care.

Keywords: orthognathic surgery, patient feedback, jaw surgery, inpatient experience

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Authors: Grace Omowunmi Soyebi

Abstract:

A computerized medical record system is a collection of medical information about a person that is stored on a computer. One principal problem of most hospitals in rural areas is using the file management system for keeping records. A lot of time is wasted when a patient visits the hospital, probably in an emergency, and the nurse or attendant has to search through voluminous files before the patient's file can be retrieved, this may cause an unexpected to happen to the patient. This Data Mining application is to be designed using a Structured System Analysis and design method which will help in a well-articulated analysis of the existing file management system, feasibility study, and proper documentation of the Design and Implementation of a Computerized medical record system. This Computerized system will replace the file management system and help to quickly retrieve a patient's record with increased data security, access clinical records for decision-making, and reduce the time range at which a patient gets attended to.

Keywords: programming, computing, data, innovation

Procedia PDF Downloads 111

Authors: Sarah Atalla, Shubham Gupta, Kim Alipio, Tanya Maric

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Background: Chelsea and Westminster Hospital have introduced the Birmingham Symptom Specific Obstetric Triage System (BSOTS) for patients who present acutely to the Maternity Assessment Suite (MAS) to prioritise care by urgency. The primary objective was to evaluate whether BSOTS was used appropriately to assess patients (defined as a 90% threshold). The secondary objective was to assess whether patients were seen within their designated triaged timeframe (defined as a 90% threshold). Methodology: MAS records were retrospectively reviewed for a randomly selected one-week period of data from 2020 (21/09/2020 - 27/09/2020). 189 patients presented to MAS during this time. Data were collected on the presenting complaint, time of attendance (divided into four time categories), and triage colour code for the urgency of a review by a doctor (red: immediately, orange: within 15 minutes, yellow: within 1 hour, green: within 4 hours). The number of triage waiting times that were breached and the outcome of the attendance was noted. Results: 49% of patients presenting to MAS during this time period were triaged, which therefore did not meet the 90% target. 67% of patients who were triaged were seen within their allocated timeframe as designated by their triage colour code, which therefore did not meet the 90% target. The most frequent reason for patient attendance was reduced fetal movements (30.5% of attendances). The busiest time of day (when most patients presented) was between 06:01-12:00, and this was also when the highest number of patients were not triaged (26 patients or 54% of patients presenting in this time category). The most used triage category (59%) was the green colour code (to be seen by a doctor within 4 hours), followed by orange (24%), yellow (14%), and red (3%). 45% of triaged patients were admitted, whilst 55% were discharged. 62% of patients allocated to the green triage category were discharged, as compared to 56% of yellow category patients, 27% of orange category patients, and 50% of red category patients. The time of patient presentation to the hospital was also associated with the level of urgency and outcome. Patients presenting from 12:01 to 18:00 were more likely to be discharged (72% discharged) compared to 00:01-06:00 where only 12.5% of patients were discharged. Conclusion: The triage system for assessing the urgency of acutely presenting obstetric patients is only being effectively utilised for 49% of patients. There is potential for enhancing the employment of the triage system to enable further efficiency and boost the promotion of patient safety. It is noted that MAS was busiest at 06:01 - 12:00 when there was also the highest number of non-triaged patients – this highlights some areas where we can improve, including higher levels of staffing, better use of BSOTS to triage patients, and patient education.

Keywords: birmingham, BSOTS, maternal, obstetric, pregnancy, specific, symptom, triage

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Authors: Fernanda A. Vechietti, Natália O. B. Muniz, Laura C. Treccani, Kurosch. Rezwan, Luis Alberto dos Santos

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CoCr alloys are widely used in prosthetic implants due to their excellent mechanical properties, such as good tensile strength, elastic modulus and wear resistance. Their biocompatibility and lack of corrosion are also prominent features of this alloy. One of the most effective and simple ways to protect metal’s surfaces are treatments, such as electrochemical oxidation by passivation, which is used as a protect release of metallic ions. Another useful treatment is the electropolishing, which is used to reduce the carbide concentration and protrusion at the implanted surface. Electropolishing is a cheap and effective method for treatment of implants, which generally has complex geometries. The purpose of this study is surface modification of the alloy CoCr(ASTM F90-09) by different methods: polishing, electro polishing, passivation and heat treatment for application as biomaterials. The modification of the surface was studied and characterized by SEM, profilometry, wettability and compared to the surface of the samples untreated. The heat treatment and of passivation increased roughness (0.477 µm and 0.825 µm) the samples in relation the sample electropolished and polished(0.131 µm and 0.274 µm) and were observed the improve wettability’s with the increase the roughness.

Keywords: biomaterial, CoCr, surface treatment, heat treatment, roughness

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Authors: Murtadha Kareem, Oliver Faust

Abstract:

Wearable biosensor systems can be designed and developed for health monitoring. There is much interest in both scientific and industrial communities established since 2007. Fundamentally, the cost of healthcare has increased dramatically and the world population is aging. That creates the need to harvest technological improvements with small bio-sensing devices, wireless-communication, microelectronics and smart textiles, that leads to non-stop developments of wearable sensor based systems. There has been a significant demand to monitor patient's health status while the patient leaves the hospital in his/her personal environment. To address this need, there are numerous system prototypes which has been launched in the medical market recently, the aim of that is to provide real time information feedback about patient's health status, either to the patient himself/herself or direct to the supervising medical centre station, while being capable to give a notification for the patient in case of possible imminent health threatening conditions. Furthermore, wearable health monitoring systems comprise new techniques to address the problem of managing and monitoring chronic heart diseases for elderly people. Wearable sensor systems for health monitoring include various types of miniature sensors, either wearable or implantable. To be specific, our proposed system able to measure essential physiological parameter, such as heart rate signal which could be transmitted through Bluetooth to the cloud server in order to store, process, analysis and visualise the data acquisition. The acquired measurements are connected through internet of things to a central node, for instance an android smart phone or tablet used for visualising the collected information on application or transmit it to a medical centre.

Keywords: Wearable sensor, Heart rate, Internet of things, Chronic heart disease

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Authors: Ian McCulloh, Andrew Placona, Darren Stewart, Daniel Gause, Kevin Kiernan, Morgan Stuart, Christopher Zinner, Laura Cartwright

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An estimated 22-25% of viable deceased donor kidneys are discarded every year in the US, while waitlisted candidates are dying every day. As many as 85% of transplanted organs are refused at least once for a patient that scored higher on the match list. There are hundreds of clinical variables involved in making a clinical transplant decision and there is rarely an ideal match. Decision makers exhibit an optimism bias where they may refuse an organ offer assuming a better match is imminent. We propose a semi-parametric Cox proportional hazard model, augmented by an accelerated failure time model based on patient specific suitable organ supply and demand to estimate a time-to-next-offer. Performance is assessed with Cox-Snell residuals and decision curve analysis, demonstrating improved decision support for up to a 5-year outlook. Providing clinical decision makers with quantitative evidence of likely patient outcomes (e.g., time to next offer and the mortality associated with waiting) may improve decisions and reduce optimism bias, thus reducing discarded organs and matching more patients on the waitlist.

Keywords: decision science, KDPI, optimism bias, organ transplant

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Authors: Hacer Y. Teke, Sultan Pehlivan, Mustafa Karapırlı, Asude Gökmen, Sait Özsoy

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The case is here presented of a patient with DMD with electrocardiograph findings within normal limits who underwent spinal surgery then developed the rarely seen complication of cardiac tamponade which resulted in death. A 17-year old male with DMD was admitted to hospital for spinal surgery. Due to a postoperative drop in hemoglobin, blood transfusion was administered to the patient, no complication developed and he was discharged on the third day. Four days after discharge, the patient worsened at home and an ambulance was called. Before the nearest hospital was reached, the patient died in the ambulance. An autopsy was performed. A fatal but rarely seen complication of Acute Myocardial Infarction (AMI) is myocardial rupture. 85% of ruptures occur in the first week of AMI but just as they can be seen on the day of the infarct, they can also be seen 2 weeks later. The case presented here had infarction findings related to different times and in different areas.

Keywords: duchenne muscular dystrophy, myocardial infarction, myocardial rupture, anesthesia

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Authors: Hafsa Qabool, Rashna Sukhia, Mubassar Fida

Abstract:

Introduction: Success of orthodontic mechanotherapy is highly dependent upon patient cooperation and compliance throughout the duration of treatment. This study was conducted to assess the cooperation and compliance of adult orthodontic patients during the leveling and alignment, space closure/molar correction, and finishing stages of tooth movement. Materials and Methods: Patient cooperation and compliance among three stages of orthodontic treatment were assessed using the Orthodontic Patient Cooperation Scale (OPCS) and Clinical Compliance Evaluation (CCE) form. A sample size of 38 was calculated for each stage of treatment; therefore, 114 subjects were included in the study. Shapiro-Wilk test identified that the data were normally distributed. One way ANOVA was used to evaluate the percentage cooperation and compliance among the three stages. Pair-wise comparisons between the three stages were performed using Post-hoc Tukey. Results: Statistically significant difference was seen for scores of patient compliance using CCE (p = 0.01); however, the results of the OPCS showed a non-significant difference for patient cooperation (p = 0.16) among the three stages of treatment. Post-hoc analysis showed significant differences (p = 0.01) in patient cooperation and compliance between space closure and the finishing stage. Highly significant (p < 0.001) decline in oral hygiene was found with the progression of orthodontic treatment. Conclusions: Improvement in the cooperation and compliance levels for adult orthodontic patients was observed during space closure & molar correction stage, which then showed a decline as treatment progressed. Oral hygiene was progressively compromised as orthodontic treatment progressed.

Keywords: patient compliance, adult orthodontics, orthodontic motivation, orthodontic patient adherence

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Authors: S. Woźniak, J. Rybka, T. Paszkowski, P. Milart

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A 30-year-old patient, who was pregnant for her second 9 weeks, was admitted to the hospital due to a suspected incomplete miscarriage. A fetal egg was found in the uterine cavity near the mouth of the fallopian tube. The patient was qualified for dilatation and curettage. The histopathological examination revealed fragments of the trophoblast. Two months later, the patient was re-admitted to the hospital due to vaginal bleeding and elevated levels of beta-hCG. Additional tests were performed. An intramural pregnancy was suspected. The patient was qualified for embolization of the uterine arteries and then treatment with methotrexate. Three weeks later, during a routine gynecological examination, a detached tumor 4 cm in diameter was found in the vagina. The material was sent for histopathological examination, which showed the presence of trophoblastic cells.

Keywords: ectopic pregnancy, intramural pregnancy, uterine artery embolization, methotrexate

Procedia PDF Downloads 91

Authors: Grace Omowunmi Soyebi

Abstract:

A computerized medical record system is a collection of medical information about a person that is stored on a computer. One principal problem of most hospitals in rural areas is using the file management system for keeping records. A lot of time is wasted when a patient visits the hospital, probably in an emergency, and the nurse or attendant has to search through voluminous files before the patient's file can be retrieved; this may cause an unexpected to happen to the patient. This data mining application is to be designed using a structured system analysis and design method which will help in a well-articulated analysis of the existing file management system, feasibility study, and proper documentation of the design and implementation of a computerized medical record system. This computerized system will replace the file management system and help to quickly retrieve a patient's record with increased data security, access clinical records for decision-making, and reduce the time range at which a patient gets attended to.

Keywords: programming, data, software development, innovation

Procedia PDF Downloads 72

Authors: Xing Wang, Lin Feng, Lingling E., Hongchen Liu

Abstract:

In patients with type 2 diabetes mellitus (DM) there is poorer quality osseointegration than in non-diabetic (n-DM) patients, and the success of dental implants is less. Recent studies have demonstrated that insulin could stimulate bone cells to produce and accelerate implant osseointegration in DM patients.This raised the question whether insulin could provide local bone anabolic effects in non-diabetic patients. In this study,48 SD rats were divided into four groups randomly: DM group, DM+insulin group, n-DM group, n-DM + insulin group. All rats were implanted the titanium implant near the epiphyseal end of tibia, then the DM + insulin and n-DM + insulin group received twice-daily subcutaneous injections of insulin (10U/day).Two,four and eight weeks after implantation, rats were killed in batches. Histomorphometry and immunohistochemistry were used to evaluate bone formation and osseointegration. The amount of newly formed bone, Implant–bone contact and the expression of OCN,RUNX2 in the DM+insulin, n-DM and n-DM+insulin group were significantly more than in the DM group (p<0.05). Compared with the n-DM group,the Implant–bone contact and expression of OCN,RUNX2 were significantly increased in n-DM+insulin group (p< 0.05). Taken together,these observations provide evidence that insulin has the potential to increase bone formation and osseointegration around implant not only in diabetic subjects but also in non-diabetic subject.

Keywords: insulin, diabetes mellitus, osseointegration, dental implants

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Authors: Saimir Heta, Ilma Robo, Dhimiter Papakozma, Eduart Kapaj, Vera Ostreni

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Introduction: The biocompatible materials applied to the implant surfaces are the target of recent literature studies. Methodologies: Modification of implant surfaces in different ways such as application of additional ions, surface microstructure change, surface or laser ultrasound alteration, or application of various substances such as recombinant proteins are among the most affected by articles published in the literature. The study is of review type with the main aim of finding the different ways that the mesenchymal cell reaction to these materials is, according to the literature, in the same percentage positive to the osteointegration process. Results: It is emphasized in the literature that implant success as a key evaluation key has more to implement implant treatment protocol ranging from dental health amenity and subsequent of the choice of implant type depending on the alveolar shape of the ridge level. Conclusions: Osteointegration is a procedure that should initially be physiologically independent of the type of implant pile material. With this physiological process, it can not "boast" for implant success or implantation depending on the brand of the selected implant, as the breadth of synthetic or natural materials that promote osteointegration is relatively large.

Keywords: mesenchymal cells, implants, review, biocompatible materials

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Authors: Esra Bora, Alper Omeroglu, Zeynep Pelin Polat, Oguzhan Kara, Fatih Akdogan, Sema Ucak Basat

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Hyponatremia is one of the most encountered electrolyte imbalance among all medical fields. It has a wide range of symptoms as well as complications from fatigue to loss of consciousness. Although a lot of factors can cause low sodium levels in serum, combining specific medications can lead to severe hyponatremia in a rapid onset which can cause high mortality and morbidity. The objective of this case report was to underline that prescribing specific medications disregarding their side effects can cause this common electrolyte imbalance but in a more severe manner. In this case report, we present a 46-year-old male patient with a serum sodium level of 104 mEq/L who consumed hydrochlorothiazide for hypertension and was under treatment with selective serotonin reuptake inhibitors (SSRIs) for major depression. The patient had tonic-clonic seizures at the second hour of the treatment and intubation was needed due to loss of consciousness and hypoxia. After proper replacement of sodium with hypertonic solutions in intensive care unit for nine days, extubation indicated. Even in healthy young males, hyponatremia due to two separately prescribed medications can lead life-threatening hyponatremia. Physicians should be aware of the side effects of diuretics, especially hydrochlorothiazides and SSRIs and their combinations.

Keywords: diuretics, hydrochlorothiazide, hyponatremia, SSRI

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Authors: Maria L. McLeod

Abstract:

This study examines the ways in which cancer patient narratives are portrayed and framed on the websites of three leading U.S. cancer care centers –The University of Texas MD Anderson Cancer Center in Houston, Memorial Sloan Kettering Cancer Center in New York, and Seattle Cancer Care Alliance. Thirty patient stories, ten from each cancer center website blog, were analyzed using qualitative and quantitative textual analysis of unstructured data, documenting repeated use of specific metaphors and tropes while charting common themes and other elements of story structure and content. Patient narratives were coded using grounded theory as the basis for conducting emergent qualitative research. As part of a systematic, inductive approach to collecting and analyzing data, recurrent and unique themes were examined and compared in terms of positive and negative framing, patient agency, and institutional praise. All three of these cancer care centers are teaching hospitals with university affiliations, that emphasizes an evidence-based scientific approach to treatment that utilizes the latest research and cutting-edge techniques and technology. Thus, the use of anecdotal evidence presented in patient narratives could be perceived as being in conflict with this evidence-based model, as the patient stories are not an accurate representation of scientific outcomes related to developing cancer, cancer reoccurrence, or cancer outcomes. The representative patient narratives tend to exclude or downplay adverse responses to treatment, survival rates, integrative and/or complementary cancer treatments, cancer prevention and causes, and barriers to treatment, such as the limitation of insurance plans, costs of treatment, and/or other issues related to access, potentially contributing to false narratives and inaccurate notions of cancer prevention, cancer care treatment and the potential for a cure. Both quantitative and qualitative findings demonstrate that cancer patient stories featured on the blogsites of the nation’s top cancer care centers deemphasize patient agency and, instead, emphasize deference and gratitude toward the institutions where the featured patients received treatment. Along these lines, language choices reflect positive framing of the cancer experience. Accompanying portrait photos of healthy appearing subjects as well as positive-framed headlines, subheads, and pull quotes function similarly, reflecting hopeful, transformative experiences and outcomes over hardship and suffering. Although patient narratives include real, factual scientific details and descriptions of actual events, the stories lack references to more negative realities of cancer diagnosis and treatment. Instead, they emphasize the triumph of survival by which the cancer care center, in the savior/hero role, enables the patient’s success, represented as a cathartic medical journey.

Keywords: cancer framing, cancer stories, medical gaze, patient narratives

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Authors: Yasir Karabacak

Abstract:

Objective: The aim of periodontal therapy is to control and eliminate inflammation in order halt disease progression. The initial periodontal therapy (IPT) including scaling and root planing (SRP) can control periodontal disease in most cases of periodontitis; also maintaining good oral hygiene by the patient is fundamental. The aim of this case report is to present IPT and to present 3-month follow-up results in a patient with periodontitis. Materials and Methods IPT of a 63-year-old non-smoker male with generalized periodontitis is presented. The patient had no history of systemic disease. The intraoral examination reveals marked gingival inflammation as well as plaque accumulation and significant calculus deposits. On radiographic examination, severe bone loss was evident. The patient was diagnosed with generalized advanced periodontitis. Initial periodontal therapy including oral hygiene instructions and quadrant-based SRP under local anesthesia was performed using hand and ultrasonic instruments. No antibiotics were prescribed. The patient was recalled 4 weeks after IPT. Results Favorable clinical improvement was obtained. Gingival inflammation was resolved significantly. A reduction of the mean probing depth from 2.4 mm at baseline to 1.9 mm was observed. The patient presented with a good standard of oral hygiene. The plaque scores decreased from 54.0% at baseline to 17.0%. In addition, the percentage of sites with bleeding on probing decreased from 80.0% at baseline to 44.0%. The patient was scheduled for maintenance therapy every three months. Conclusion: The level of oral hygiene has a great impact on periodontal treatment outcome and supports periodontal therapy properly.

Keywords: initial periodontal, therapy and follow-up in a periodontitis, patient, a case report

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Authors: Deepak Singh

Abstract:

AI technology is rapidly being integrated into the healthcare system, bringing many ethical and social implications. This literature review examines the various aspects of this phenomenon, focusing on the ethical considerations of using AI in healthcare, such as how it might affect patient autonomy, privacy, and doctor-patient relationships. Furthermore, the review considers the potential social implications of AI in Healthcare, such as the potential for automation to reduce the availability of healthcare jobs and the potential to widen existing health inequalities. The literature suggests potential benefits and drawbacks to using AI in healthcare, and it is essential to consider the ethical and social implications before implementation. It is concluded that more research is needed to understand the full implications of using AI in healthcare and that ethical regulations must be in place to ensure patient safety and the technology's responsible use.

Keywords: AI, healthcare, telemedicine, telehealth, ethics, security, privacy, patient, rights, safety

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Authors: Sujata Chaturvedi, Ishita Pant, Deepak Kumar Jha, Vinod Kumar Singh Gautam, Chandra Bhushan Tripathi

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Objective: To describe clinical, histopathological and immunohistochemical profile of glioblastoma in patients and to correlate these findings with patient survival. Material and methods: 30 cases of histopathologically diagnosed glioblastomas were included in this study. These cases were analysed in detail for certain clinical and histopathological parameters. Immunohistochemical staining for p53, epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), mouse double minute 2 homolog (MDM2) and Ki67 was done and scores were calculated. Results of these findings were correlated with patient survival. Results: A retrospective analysis of the histopathology records and clinical case files was done in 30 cases of glioblastoma (WHO grade IV). The mean age of presentation was 50.6 years with a male predilection. The most common involved site was the frontal lobe. Amongst the clinical parameters, age of the patient and extent of surgical resection showed a significant correlation with the patient survival. Histopathological parameters showed no significant correlation with the patient survival, while amongst the immunohistochemical parameters expression of MDM2 showed a significant correlation with the patient survival. Conclusion: In this study incorporating clinical, histopathological and basic panel of immunohistochemistry, age of the patient, extent of the surgical resection and expression of MDM2 showed significant correlation with the patient survival.

Keywords: glioblastoma, p53, EGFR, VEGF, MDM2, Ki67

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Authors: Ying Li, Rui Hu, Shizhen Chen, Xin Zhou, Yunhuang Yang

Abstract:

Prostate cancer is one of the leading causes of cancer-related death among men. Prostate-specific antigen (PSA), a specific product of prostatic epithelial cells, is an important indicator of prostate cancer. Though PSA is not a specific serum biomarker for the screening of prostate cancer, it is recognized as an indicator for prostate cancer recurrence and response to therapy for patient’s post-prostatectomy. Since radical prostatectomy eliminates the source of PSA production, serum PSA levels fall below 50 pg/mL, and may be below the detection limit of clinical immunoassays (current clinical immunoassay lower limit of detection is around 10 pg/mL). Many clinical studies have shown that intervention at low PSA levels was able to improve patient outcomes significantly. Therefore, ultra-sensitive and precise assays that can accurately quantify extremely low levels of PSA (below 1-10 pg/mL) will facilitate the assessment of patients for the possibility of early adjuvant or salvage treatment. Currently, the commercially available ultra-sensitive ELISA kit (not used clinically) can only reach a detection limit of 3-10 pg/mL. Other platforms developed by different research groups could achieve a detection limit as low as 0.33 pg/mL, but they relied on sophisticated instruments to get the final readout. Herein we report a microfluidic platform for point-of-care (POC) detection of PSA with a detection limit of 0.5 pg/mL and without the assistance of any equipment. This platform is based on a previously reported volumetric-bar-chart chip (V-Chip), which applies platinum nanoparticles (PtNPs) as the ELISA probe to convert the biomarker concentration to the volume of oxygen gas that further pushes the red ink to form a visualized bar-chart. The length of each bar is used to quantify the biomarker concentration of each sample. We devised a long reading channel V-Chip (LV-Chip) in this work to achieve a wide detection window. In addition, LV-Chip employed a unique enzyme-free ELISA probe that enriched PtNPs significantly and owned 500-fold enhanced catalytic ability over that of previous V-Chip, resulting in a significantly improved detection limit. LV-Chip is able to complete a PSA assay for five samples in 20 min. The device was applied to detect PSA in 50 patient serum samples, and the on-chip results demonstrated good correlation with conventional immunoassay. In addition, the PSA levels in finger-prick whole blood samples from healthy volunteers were successfully measured on the device. This completely stand-alone LV-Chip platform enables convenient POC testing for patient follow-up in the physician’s office and is also useful in resource-constrained settings.

Keywords: point-of-care detection, microfluidics, PSA, ultra-sensitive

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Authors: Rizka Aisha Rahmi Hariadi, Chao Ou-Yang, Han-Cheng Wang, Rajesri Govindaraju

Abstract:

As the increasing of medical check-up popularity, there are a huge number of medical check-up data stored in database and have not been useful. These data actually can be very useful for future strategic planning if we mine it correctly. In other side, a lot of patients come with unpredictable coming and also limited available facilities make medical check-up service offered by hospital not maximal. To solve that problem, this study used those medical check-up data to predict patient re-coming. Sequential pattern mining (SPM) and association rules method were chosen because these methods are suitable for predicting patient re-coming using sequential data. First, based on patient personal information the data was grouped into … groups then discriminant analysis was done to check significant of the grouping. Second, for each group some frequent patterns were generated using SPM method. Third, based on frequent patterns of each group, pairs of variable can be extracted using association rules to get general pattern of re-coming patient. Last, discussion and conclusion was done to give some implications of the results.

Keywords: patient re-coming, medical check-up, health examination, data mining, sequential pattern mining, association rules, discriminant analysis

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Authors: Regina R. Gunawan, Indwiani Astuti, H. Raden Danarto

Abstract:

Cancer is the leading cause of death worldwide. Cancer is caused by mutations that alter the function of normal human genes and give rise to cancer genes. MicroRNA (miRNA) is a small non-coding RNA that regulates the gen through complementary bond towards mRNA target and cause mRNA degradation. miRNA works by either promoting or suppressing cell proliferation. miRNA level expression in cancer may offer another value of miRNA as a biomarker in cancer diagnostic. miRNA-21 is believed to have a role in carcinogenesis by enhancing proliferation, anti-apoptosis, cell cycle progression and invasion of tumor cells. Hsa-miR-21-5p marker has been identified in Prostate Cancer (PCa) and Benign Prostatic Hyperplasia (BPH) patient’s urine. This research planned to explore the diagnostic performance of miR-21 to differentiate PCa and BPH patients. In this study, urine samples were collected from 20 PCa patients and 20 BPH patients. miR-21 relative expression against the reference gene was analyzed and compared between the two. miRNA expression was analyzed using the comparative quantification method to find the fold change. miR-21 validity in identifying PCa patients was performed by quantifying the sensitivity and specificity with the contingency table. miR-21 relative expression against miR-16 in PCa patient and in BPH patient has 12,98 differences in fold change. From a contingency table of Cq expression of miR-21 in identifying PCa patients from BPH patient, Cq miR-21 has 100% sensitivity and 75% specificity. miR-21 relative expression can be used in discriminating PCa from BPH by using a urine sample. Furthermore, the expression of miR-21 has higher sensitivity compared to PSA (Prostate specific antigen), therefore miR-21 has a high potential to be analyzed and developed more.

Keywords: benign prostate hyperplasia, biomarker, miRNA-21, prostate cancer

Procedia PDF Downloads 142