Use of mobile applications in hand therapy

IntroductionMobile devices can be incorporated into therapy as an engaging alternative to traditional therapy options. The use of mobile devices and smartphone applications can enhance the quality of care provided by health care professionals.PurposeTo find mobile apps that can be incorporated into hand therapy practice.MethodsHand therapy evaluation, interventions, proprioception, laterality, and home exercise program applications can be incorporated into practice. Patient education can also be provided via the use of mobile applications.ConclusionSmartphone applications can be a valuable intervention and impact performance in individuals with impaired hand function. Smartphone applications offer a client-centered, and potentially motivating, activity option that can be utilized to aid the hand therapist.     

Utility of routine postoperative visit after appendectomy and cholecystectomy with evaluation of mobile technology access in an urban safety net population

Background

The value of routine postoperative visits after general surgery remains unclear. The objective of this study was to evaluate the utility of routine postoperative visits after appendectomy and cholecystectomy and to determine access to mobile technology as an alternative platform for follow-up.

Methods

Retrospective review of 219 appendectomies and 200 cholecystectomies performed at a safety net hospital. One patient underwent both surgeries. Patient demographics, duration of clinic visit, and need for additional imaging, tests or readmissions were recorded. Access to mobile technology was surveyed by a validated questionnaire.

Results

Of 418 patients, 84% percent completed a postoperative visit. At follow-up, 58 patients (14%) required 70 interventions, including staple removal (16, 23%), suture removal (4, 6%), drain removal (8, 11%), additional follow-up (20, 28%), medication action (16, 21%), additional imaging (3, 4%), and readmission (1, 1%). Occupational paperwork (62) and nonsurgical clinic referrals (28) were also performed. Average check-in to check-out time was 100 ± 54 min per patient. One intervention was performed for every 7.8 h of time in the clinic. Additionally, 88% of the surveyed population reported access to cell phone technology, and 69% of patients <40 y had smartphone access.

Conclusions

Routine in-person follow-up after surgery consumes significant time and resources for patients and healthcare systems but has little impact on patient care. Most of the work done in the clinic is administrative and could be completed using mobile technology, which is pervasive in our population.     

针灸治疗脑瘫患儿语言障碍的分析

目的：探讨针灸治疗脑瘫患儿语言障碍的研究进展。方法选择2013年1~12月我院收治的脑瘫患儿30例,将这30例患儿随机分成两组,每组15例患儿,分别命名为治疗组和对照组,对照组的15例患儿采取常规语言训练,治疗组的15例患者在采取常规语言训练的基础上,进行针灸治疗,观察两组患儿的临床治疗效果。结果治疗组临床治疗的总有效率为96.8%。对照组临床治疗的总有效率为77.4%。治疗组患儿临床治疗的总有效率明显的高于对照组。两组总有效率比较,差异有统计学意义（P＜0.05）。结论针灸治疗脑瘫患儿的语言障碍具有良好的效果,该种方法值得临床推广。     

Language barriers in Hispanic patients: relation to upper-extremity disability

BackgroundAlthough upper-extremity disability has been shown to correlate highly with various psychosocial aspects of illness (e.g., self-efficacy, depression, kinesiophobia, and pain catastrophizing), the role of language in musculoskeletal health status is less certain. In an English-speaking outpatient hand surgery office setting, we sought to determine (1) whether a patient’s primary native language (English or Spanish) is an independent predictor of upper-extremity disability and (2) whether there are any differences in the contribution of measures of psychological distress to disability between native English- and Spanish-speaking patients.MethodsA total of 122 patients (61 native English speakers and 61 Spanish speakers) presenting to an orthopaedic hand clinic completed sociodemographic information and three Patient-Reported Outcomes Measurement Information System (PROMIS)-based computerized adaptive testing questionnaires: PROMIS Pain Interference, PROMIS Depression, and PROMIS Upper-Extremity Physical Function. Bivariate and multivariable linear regression modeling were performed.ResultsSpanish-speaking patients reported greater upper-extremity disability, pain interference, and symptoms of depression than English-speaking patients. After adjusting for sociodemographic covariates and measures of psychological distress using multivariable regression modeling, the patient’s primary language was not retained as an independent predictor of disability. PROMIS Depression showed a medium correlation (r = −0.35; p < 0.001) with disability in English-speaking patients, while the correlation was large (r = −0.52; p < 0.001) in Spanish-speaking patients. PROMIS Pain Interference had a large correlation with disability in both patient cohorts (Spanish-speaking: r = −0.66; p < 0.001; English-speaking: r = −0.77; p < 0.001). The length of time since immigration to the USA did not correlate with disability among Spanish speakers.ConclusionPrimary language has less influence on symptom intensity and magnitude of disability than psychological distress and ineffective coping strategies. Interventions to optimize mood and to reduce pain interference should be considered in patients of all nationalities.Type of study/level of evidence: Prognostic II.     

Perceived barriers to mammography among underserved women in a Breast Health Center Outreach Program

Background

To investigate perceived barriers to mammography among underserved women, we asked participants in the Siteman Cancer Center Mammography Outreach Registry–developed in 2006 to evaluate mobile mammography's effectiveness among the underserved–why they believed women did not get mammograms.

Methods

The responses of approximately 9,000 registrants were analyzed using multivariable logistic regression. We report adjusted odds ratios (OR) and 95% confidence intervals (CI) significant at 2-tailed P values less than .05.

Results

Fears of cost (40%), mammogram-related pain (13%), and bad news (13%) were the most commonly reported barriers. Having insurance was associated with not perceiving cost as a barrier (OR .44, 95% CI .40 to .49), but with perceiving fear of both mammogram-related pain (OR 1.39, 95% CI 1.21 to 1.60) and receiving bad news (OR 1.38, 95% CI 1.19 to 1.60) as barriers.

Conclusion

Despite free services, underserved women continue to report experiential and psychological obstacles to mammography, suggesting the need for more targeted education and outreach in this population.     

Using your voice: speech recognition technology in medicine and surgery

Data entry and control of equipment are existing applications of speech recognition technology in medicine and surgery. Specialized dictation tasks, such as radiographic reporting, are feasible using isolated speech, speaker dependent, large vocabulary devices. General dictation will be possible using an automatic dictation device. Vocabulary size varies from a few to many thousand words, but most data entry, command, and control applications require 200 words or less, whereas specialized dictation tasks require about 1000 words and general dictation for a given user requires on the order of 10,000 words.     

Use of language mapping to aid in resection of gliomas in eloquent brain regions

Studies looking at resection in high-grade gliomas have had mixed results. The authors briefly review the literature regarding the value of the extent of resection. They proceed to the preoperative and intraoperative tools available to the neurosurgeon to distinguish eloquent from noneloquent language cortex and fibers, including the emerging roles of functional magnetic resonance imaging diffusion tensor imaging tractography and direct cortical/subcortical stimulation in the surgical management of tumors in eloquent areas. Finally, the authors evaluate the postoperative course of these patients and the effect of language deficits on their quality of life.     

Implementing an intravenous insulin protocol in your practice: practical advice to overcome clinical, administrative, and financial barriers

Diabetes mellitus is the fourth most common comorbid condition among hospitalized patients, and 30% of patients undergoing open-heart surgery have diabetes. The link between hyperglycemia and poor outcome has been well described, and large clinical trials have shown that aggressive control of blood glucose with an insulin infusion can improve these outcomes. The barriers to implementing an insulin infusion protocol are numerous, despite the fact that doing so is paramount to clinical success. Barriers include safety concerns, such as fear of hypoglycemia, insufficient nursing staff to patient ratios, lack of administrative and physician support, various system and procedural issues, and resistance to change. Key steps to overcome the barriers include building support with multidisciplinary champions, involving key staff, educating staff, and administrators of the clinical and economic benefits of improving glycemic control, setting realistic goals, selecting a validated insulin infusion protocol, and internally marketing the success of the protocol.     

The digital divide in adoption and use of mobile health technology among caregivers of pediatric surgery patients

Purpose

The purpose of this study was to identify mobile Health (mHealth) technology utilization among caregivers of pediatric surgery patients.

Gesell在基层医院语言发育迟缓儿童中的应用

目的：探讨 Gesell 在基层医院语言发育迟缓儿童中应用效果。方法随机选取我院2007年1月～2012年12月在儿科门诊就诊的2～3岁语言发育迟缓儿童,共计52例。采用 Gesell 婴幼儿发育量表,对每个儿童进行发育评估。按运动能、应物能、语言能、应人能4个能区,将研究对象的评估结果统计对比。结果52例儿童的 Gesell 发育评估结果：按运动能、应物能、语言能、应人能4个能区,将研究对象的评估结果统计。3岁以下语言发育迟缓儿童 Gesell 检查,动作和应物能区平均 DQ 尚在正常范围内,而语言及应人能区平均 DQ 落后于正常;语言能发育落后（12.1±4.8）月,发育异常52例（100.00%）。结论 Gesell 在基层医院语言发育迟缓儿童中应用效果显著,Gesell 中应物能是小儿对外界刺激的分析和综合的能力,是预示智慧潜力的主要基础。可通过日常适应其发育水平的语言训练并定期随访即可,对于应物 DQ 低于正常的患儿,需至专门的康复治疗科室治疗。     

The language of evidence based medicine: Answers to common questions?

Evidence based medicine (EBM) is an expanding field that combines clinical intuition with the best available evidence in clinical decision making. The shift to evidence based rationale encourages educating future physicians to formulate appropriate research questions and develop critical appraisal skills that are needed to practice EBM.This article identifies areas where clinicians may struggle with epidemiological terminology when critically appraising the literature. A review of the relevant terminology encountered in studies that focus on therapy, harm, diagnosis and prognosis can be beneficial to the clinician and are explained within this article.     

Using information technology to improve quality in the OR

This article summarizes the current state of technology as it pertains to quality in the operating room, ties the current state back to its evolutionary pathway to understand how the current capabilities and their limitations came to pass, and elucidates how the overlay of information technology (IT) as a wrapper around current monitoring and device technology provides a significant advance in the ability of anesthesiologists to use technology to improve quality along many axes. The authors posit that IT will enable all the information about patients, perioperative systems, system capacity, and readiness to follow a development trajectory of increasing usefulness.     

Bad words: why language counts in our work with bariatric patients

Language is powerful. Our words convey our impressions, attitudes, and worldview. Language not only reflects, but also shapes, the way that we think. In the field of bariatric-metabolic surgery, it is critical for clinicians to choose our language thoughtfully. In this paper, we demonstrate the importance of language choices in our clinical work and our professional communications; explore the potential pitfalls of words and phrases commonly used in the field of obesity; and encourage the use of more productive language choices in our communications with patients and professional colleagues, both within and outside of our field.     

A comparative study of the role of shoes,arch supports,and navicular cookies in the management of symptomatic mobile flat feet in children

Summary A clinical and radiological study in 50 children with symptomatic mobile flat feet treated with varying combinations of shoes, custom-made arch supports, and pads over a period of four years is presented. It was concluded that children with symptomatic mobile flat feet should be fitted initially with laced high top shoes containing a steel shank and firm counter. A custom-made navicular pad should be added if adequate symptomatic relief is not obtained from the recommended shoes. Navicular cookies were found to be ineffective.

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Résumé Les résultats d'une étude clinique et radiologique de pieds plats réductibles chez l'enfant sont présentés.Dans cette série, 50 enfants suivis pendant 4 ans ont été traités en combinant de façon variée les chaussures, les semelles orthopédiques et les contreforts.Les auteurs concluent que l'enfant présentant un pied plat réductible sera bien soutenu au début par le port de bottines lacées, armées d'une empeigne en acier et de contrefort solide.Un contrefort scaphoïdien fait sur mesure doit être ajouté, si le tableau douloureux n'est pas amendé par les souliers préconisés.Les pelotes scaphoïdiennes paraissent être inefficaces.

     

Vertebral bone mineral density of the elderly in the urban community by mobile DXA

The present paper describes a population survey of bone mineral density (BMD) on the third lumbar vertebra (L3) using dual X-ray absorptiometry fixed in a van (mobile DXA) with lateral projection. Subjects were 387 persons aged 65 to 84 years living in Koganei City, a western suburb of Tokyo. This is the baseline survey of the 10-year project “Longitudinal Interdisciplinary Study on Aging” supported by Tokyo Metropolitan Institute of Gerontology (TMIG-LISA). As for the pattern of age-related BMD calculated in the range-of-interest (ROI) being set in the center of vertebral body to eliminate the posterior segment of vertebra and/or secondary hyperostotic changes with aging, the mean BMD of L3 declined in females from 0.514±0.121g/cm² (mean±standard deviation) in age-group 65–69 to 0.377±0.137 g/cm² in age-group 80–84. In males, it showed a decrease from 0.731±0.155 in 65–69 to 0.613±0.158 in 75–79 but a slight (insignificant) increase at age-group 80–84. There were significant differences of mean BMD between males and females in each age-group and in average. BMD was significantly associated with age (negatively) and body mass index (positively) in the multiple regression analysis.     

Clinical validation of an artificial intelligence-enabled wound imaging mobile application in diabetic foot ulcers

There is a lifetime risk of 15% to 25% of development of diabetic foot ulcers (DFUs) in patients with diabetes mellitus. DFUs need to be followed up on and assessed for development of complications and/or resolution, which was traditionally performed using manual measurement. Our study aims to compare the intra- and inter-rater reliability of an artificial intelligence-enabled wound imaging mobile application (CARES4WOUNDS [C4W] system, Tetsuyu, Singapore) with traditional measurement. This is a prospective cross-sectional study on 28 patients with DFUs from June 2020 to January 2021. The main wound parameters assessed were length and width. For traditional manual measurement, area was calculated by overlaying traced wound on graphical paper. Intra- and inter-rater reliability was analysed using intra-class correlation statistics. A value of <0.5, 0.5–0.75, 0.75–0.9, and >0.9 indicates poor, moderate, good, and excellent reliability, respectively. Seventy-five wound episodes from 28 patients were collected and a total of 547 wound images were analysed in this study. The median wound area during the first clinic consultation and all wound episodes was 3.75 cm² (interquartile range [IQR] 1.40–16.50) and 3.10 cm² (IQR 0.60–14.84), respectively. There is excellent intra-rater reliability of C4W on three different image captures of the same wound (intra-rater reliability ranging 0.933–0.994). There is also excellent inter-rater reliability between three C4W devices for length (0.947), width (0.923), and area (0.965). Good inter-rater reliability for length, width, and area (range 0.825–0.934) was obtained between wound nurse measurement and each of the C4W devices. In conclusion, we obtained good inter-rater and intra-rater reliability of C4W measurements against traditional wound measurement. The C4W is a useful adjunct in monitoring DFU wound progress.     

Strategies to overcome therapeutic resistance in renal cell carcinoma

Background

Renal cell cancer (RCC) is a prevalent and lethal disease. At time of diagnosis, most patients present with localized disease. For these patients, the standard of care includes nephrectomy with close monitoring thereafter. While many patients will be cured, 5-year recurrence rates range from 30% to 60%. Furthermore, nearly one-third of patients present with metastatic disease at time of diagnosis. Metastatic disease is rarely curable and typically lethal. Cytotoxic chemotherapy and radiation alone are incapable of controlling the disease. Extensive effort was expended in the development of cytokine therapies but response rates remain low. Newer agents targeting angiogenesis and mTOR signaling emerged in the 2000s and revolutionized patient care. While these agents improve progression free survival, the development of resistance is nearly universal. A new era of immunotherapy is now emerging, led by the checkpoint inhibitors. However, therapeutic resistance remains a complex issue that is likely to persist.