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At least 55 records · Page 3Linked to original sources
PubMed2003

[Value of navigation and robot-guided surgery in total knee arthroplasty].

Up to now robotics play a minor role in orthopedic surgery because the financing and daily costs of these devices overburden the budgets of normal hospitals. The technical demands are time consuming and pose an additional cost factor. The trauma to the patients in the opinion of some authors is considerable. Nevertheless, robotics play an important role in the further development of orthopedic surgery because improvements in technology will lead to a better operative outcome for the patients. Navigation devices have been developed in the last few years in different centers. From the medical point of view, it is important that navigation systems support surgeons in the analysis of all questions concerning alignment. This pertains not only to rotation analyses of the femur and tibia components but also to analyses of the cinematic gap in flexion and extension. The handling of soft tissues has an important influence on the postoperative function of the knee. It is also a medical issue that the navigation systems should be open, i.e., that different designs of implants could be implanted with one navigation device. There are some systems which offer this quality. Improvements in technology are necessary especially in rotation analyses of the lower limb.

Arthroplasty, Replacement, Knee↗
PubMedDate not supplied

Medicare Part D: an overview of its practical and clinical impact.

The Medicare Part D outpatient prescription drug benefit will transform American health care delivery. In addition to increasing access to medicines, it will have a profound impact on physicians and drug developers. Senior citizens and other Medicare recipients will be forced to come to terms with a complex benefit structure and to make difficult choices. Physicians will have to help their patients navigate the new benefit as well as adjust their practices to deal with multiple formularies with different coverage policies. Medicare is creating a framework for collecting evidence, both from studies of comparative efficacy of drugs and from automated tracking of outcomes.

Aged↗
PubMed2006

Evolving trends in medical care-coordination for patients with HIV and AIDS.

HIV/AIDS is a condition characterized by a variety of medical and social needs that affect individuals over time. System-level problems of access, rising costs of care, and varying quality of HIV/AIDS care in addition to the individual barriers to care such as stigma, perceived discrimination, competing needs, and co-morbid conditions have highlighted the importance of using comprehensive approaches to care delivery. Several types of services have been proposed to improve care coordination for various diseases, including case management, community health workers, promotoras, and patient navigators. In this paper, we will review the characteristics of care coordination interventions for persons with HIV and the findings in the literature about their association with HIV health outcomes. We will conclude with a discussion of the implications and important areas for further investigations on this topic.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Visualization of flow patterns distal to aortic valve prostheses in humans using a fast approach for cine 3D velocity mapping.

The fluid dynamic performance of mechanical heart valves differs from normal valves and thus is considered related to late clinical complications in patients. Since flow patterns evolving around heart valves are complex in space and time, flow visualization based on time-resolved 3D velocity data might add important information regarding the performance of specific valve designs in vivo. However, previous cine 3D techniques for three-directional phase-contrast velocity mapping suffer from long scan duration and therefore might hamper assessment in patients. A hybrid 3D phase-contrast sequence combining segmented k-space acquisition with short EPI readout trains is presented with its validation in vitro. The technique was applied to study flow patterns downstream from a bileaflet aortic prosthesis in six patients. Navigator echoes were incorporated for respiratory motion compensation. Before flow visualization, spurious phase errors due to concomitant gradient fields and eddy currents were corrected. Flow visualization was based on particle paths and animated velocity vector plots. Dedicated algorithms for particle path integration were implemented to account for the considerable motion of the ascending aorta during the cardiac cycle. A distinct flow pattern reflecting the valve design was observed closest to the valve during early flow acceleration. Reverse flow occurred adjacent to high velocity jets and above the hinge housings. Later in systole, flow became confined to the central vessel area and reverse flow along the inner aortic curvature developed. Further downstream from the valve, flow patterns varied considerably among patients, indicating the impact of varying aortic anatomy in vivo. It is concluded that MR velocity mapping is a potential tool for studying 3D flow patterns evolving around heart valve prostheses in humans. J. Magn. Reson. Imaging 2001;13:690-698.

Aged↗
PubMed2003

Avatars in clinical psychology: a framework for the clinical use of virtual humans.

Early applications of virtual reality (VR) technology in psychological assessment, treatment, and research have yielded promising results. In particular, an increasing number of studies analyze the unique features of the experience made by patients during their exposure to virtual environments. However, the majority of these studies explore how patients navigate in the virtual spaces and interact with virtual objects. Only a few of them investigate the features of inhabited virtual environments, where real people and autonomous virtual humans are able to interact and to cooperate. In particular, there is a lack of discussion of the role that such autonomous virtual humans could have in VR-aided psychotherapy. The main goal of this paper is to identify a framework for future research in this area. Three levels of analysis are identified. The purpose of the first two levels is the identification of the key "physical" features (e.g., appearance, structure) and "internal" characteristics (e.g., behavior, degree of autonomy, perceptual capabilities) needed by an effective simulation. The third level is concerned with the evaluation of the interaction characteristics required for a successful relationship between the patient and the virtual human.

Behavior Therapy↗
PubMed2001

Community-based cancer screening for underserved women: design and baseline findings from the Breast and Cervical Cancer Intervention Study.

BACKGROUND: Underutilization of breast and cervical cancer screening has been observed in many ethnic groups and underserved populations. Effective community-based interventions are needed to eliminate disparities in screening rates and thus to improve prospects for survival. METHODS: The Breast and Cervical Cancer Intervention Study was a controlled trial of three interventions in the San Francisco Bay Area from 1993 to 1996: (1) community-based lay health worker outreach; (2) clinic-based provider training and reminder system; and (3) patient navigator for follow-up of abnormal screening results. Study design and a description of the interventions are reported along with baseline results of a household survey conducted in four languages among 1599 women, aged 40-75. RESULTS: Seventy-six percent of women ages 40 and over had had at least one mammogram, and most had had a clinical breast examination (88%) and Pap smear (89%). Rates were significantly lower for non-English-speaking Latinas and Chinese women (56 and 32%, respectively, for mammography), and maintenance screening (three mammograms in the past 5 years) varied from 7% (non-English-speaking Chinese) to 53% (Blacks). Pap smear screening in the past 3 years was low among non-English-speaking Latinas (72%) and markedly lower among non-English-speaking Chinese women (24%). The strongest predictors of screening behavior were having private health insurance and frequent use of medical services. Having a regular clinic and speaking English were also important. Race/ethnicity, education, household income, and employment status were, overall, not significant predictors of screening behavior. CONCLUSIONS: These baseline results support the importance of cancer screening interventions targeted to persons of foreign origin, particularly those less acculturated.

Adult↗
PubMed2006

Creating alliances to improve cancer prevention and detection among urban medically underserved minority groups. The East Harlem Partnership for Cancer Awareness.

The East Harlem Partnership for Cancer Awareness (EHPCA) was formed in 1999 to reduce disparities in cancer screening and prevention among medically underserved minorities residing in a large urban community (East Harlem, New York City) by increasing awareness of cancer risk, prevention, and treatment, and promoting greater participation in breast, cervical, colorectal, and prostate cancer screening and early detection. The Partnership augments a 20-year collaboration between an academic medical center, a public hospital, and 2 community health centers. Needs assessments were conducted to inform program development. Cancer education, outreach, and screening programs were developed based on the PRECEED-PROCEED model for health education and health promotion programming. Needs assessments revealed that although the majority of the population (86%) was insured and had a source of primary care, cancer screening guidelines for breast, cervical, prostate, and colorectal cancers were not being followed. Outreach strategies, targeted curricula, educational sessions, and screening programs have been developed and implemented to improve knowledge levels and increase screening participation. The EHPCA is a model of a successful partnership among the public and private sectors to reduce disparities in cancer screening and prevention in a diverse, medically underserved, urban minority community. Future efforts to reduce cancer screening disparities in this population will include patient navigation and improved access to standard-of-care screening such as colonoscopy. Cancer 2006. (c) 2006 American Cancer Society.

Black or African American↗
PubMed2005

Preliminary investigation of respiratory self-gating for free-breathing segmented cine MRI.

Segmented cine MRI generally requires breath-holding, which can be problematic for many patients. Navigator echo techniques, particularly successful for free-breathing coronary MRA, are incompatible with the acquisition strategies and SSFP pulse sequences commonly used for cine MRI. The purpose of this work is to introduce a new self-gating technique deriving respiratory gating information directly from the raw imaging data acquired for segmented cine MRI. The respiratory self-gating technique uses interleaved radial k-space sampling to provide low-resolution images in real time during the free-breathing acquisition that are compared to target expiration images. Only the raw data-producing images with high correlation to the target images are included in the final high-resolution reconstruction. The self-gating technique produced cine series with no significant differences in quantitative image sharpness to series produced using comparable breath-held techniques. Because of the difficulties associated with breath-holding, the respiratory self-gating technique represents an important practical advance for cardiac MRI. , Inc.

Algorithms↗
PubMed2005

Determinants of cancer disparities: barriers to cancer screening, diagnosis, and treatment.

There is a critical disconnect between what we discover and what we deliver to all Americans in the form of prevention, screening, detection, diagnosis, and treatment of cancer. We must identify and eliminate all barriers that prevent the benefits of research from reaching all people. Such barriers may be experienced at any point along the continuum of prevention, screening, diagnosis and treatment, and palliative care. In communities of low socioeconomic status, patient navigation has proved to be an effective intervention in promoting such timely diagnosis and treatment when applied at the point of abnormal finding. Geographic areas with excess cancer mortality should be delineated and targeted with an intense approach to providing culturally relevant education, appropriate access to screening diagnosis and treatment, and improved support systems, including navigation.

Culture↗
PubMed2001

Exploiting genetic alterations to design novel therapies for cancer.

In the 3 decades since the signing of the National Cancer Act, there has been tremendous progress in the elucidation of the molecular underpinnings of cancer. Molecular genetic studies have been particularly insightful, revealing genetic rearrangements, such as chromosomal translocations, which may be the seminal event leading to deregulated cell growth for many childhood and adult cancers. These findings have led to new diagnostic and prognostic tools but have been slow to be translated into new therapeutic modalities. This article reviews a variety of methods now under development to exploit genetic changes in cancer to develop specific anticancer agents using gene therapy, viral therapy, and immunotherapy approaches. As many of these strategies inevitably enter the clinic, it will be imperative for health care professionals to be familiar with these novel approaches as they help patients navigate the likely broad array of treatment options.

Adenoviruses, Human↗
PubMed2006

Obesity: a problem of darwinian proportions?

Obesity has been described as an abnormality arising from the evolution of man, who becomes fat during the time of perpetual plenty. From the perspective of "Darwinian Medicine," if famine is avoided, obesity will prevail. Problems regarding obesity arise within many disciplines, including socioeconomic environments, the educational system, science, law, and government. This article will discuss various ethical aspects of several disciplines regarding obesity, with a focus on scientific inquiry. We will discuss this within the categories: (1) chronic kidney disease predialysis, (2) dialysis, and (3) renal transplantation. This article aims to help nephrologists and their patients navigate through the ethical aspects of obesity and chronic kidney disease.

Bariatrics↗
PubMedDate not supplied

Case management in public health screening programs: the experience of the national breast and cervical cancer early detection program.

This article describes a large public health screening program's early experience in adding case management as a formal program component. The results demonstrate that state and tribal programs participating in the National Breast and Cervical Cancer Early Detection Program have implemented a variety of organizational models for case management of women with abnormal screening results. Programs have different approaches to staffing and reimbursement of case management services, yet most programs have implemented a "patient navigator" or "medical" model of case management service delivery. Although a number of challenges were identified, a clear and positive finding is that case managers are playing an integral role in the transition between a cancer diagnosis through the program and enrollment in Medicaid for treatment services through the National Breast and Cervical Cancer Prevention and Treatment Act of 2000.

Breast Neoplasms↗
PubMed2005

Walking forward: the South Dakota Native American project.

BACKGROUND: The "Walking Forward" program is a scientific collaborative program between Rapid City Regional Hospital, the University of Wisconsin, the Mayo Clinic, and partnerships with the American Indian community in western South Dakota-3 reservations and 1 urban population. The purpose is to increase participation of health disparities populations on National Cancer Institute clinical trials as part of the Cancer Disparities Research Partnership program. Clinical practice suggests that Native American cancer patients present with more advanced stages of cancer and hence have lower cure rates and higher treatment-related morbidities. It is hypothesized that a conventional course of cancer treatment lasting 6 to 8 weeks may be a barrier. METHODS: Innovative clinical trials have been developed to shorten the course of treatment. A molecular predisposition to treatment side effects is also explored. These clinical endeavors will be performed in conjunction with a patient navigator research program. RESULTS AND CONCLUSIONS: Research metrics include analysis of process, clinical trials participation, treatment outcome, and assessment of access to cancer care at an early stage of disease.

Breast Neoplasms↗
PubMed2006

Community-based participatory research increases cervical cancer screening among Vietnamese-Americans.

Using community-based participatory research methods, a community-research coalition in Santa Clara County, California (SCC) conducted a quasi-experimental, controlled trial to increase Pap test receipt and to build community capacity among Vietnamese-American women. From 1999 to 2004, the Coalition planned and implemented an Action Plan with six components: multimedia campaign, lay health worker outreach, Vietnamese Pap clinic with patient navigation, registry and reminder system, continuing medical education for Vietnamese physicians, and restoring a Breast and Cervical Cancer Control Program site. Components were evaluated individually. Community-wide, cross-sectional telephone surveys of Vietnamese women in SCC (intervention community) and Harris County, Texas (comparison community) measured overall project impact. Receipt and currency of Pap tests increased significantly in the intervention compared with the comparison community. Community involvement, system changes, community and research capacity building, dissemination of results, and program sustainability were also demonstrated. Community-based participatory research is feasible and effective in Vietnamese-American communities.

Adolescent↗
PubMed2003

Feasibility and safety of pulmonary vein isolation using a new mapping and navigation system in patients with refractory atrial fibrillation.

BACKGROUND: Ostial pulmonary vein (PV) isolation by radiofrequency (RF) catheter ablation can cure patients with atrial fibrillation (AF); however, this procedure carries the risk of PV stenosis. The aim of this study was to assess the feasibility of a new mapping and navigation technique using a multipolar basket catheter (BC) for PV isolation in patients with refractory AF and to analyze its safety with regard to PV stenosis at long-term follow-up. METHODS AND RESULTS: We studied 55 patients (mean age, 53+/-11 years; 40 male) with drug-refractory AF (paroxysmal, n=37; persistent, n=18). A 64-pole BC was placed transseptally into each of the accessible PVs. By use of a nonfluoroscopic navigation system, the ablation catheter was guided to the BC electrodes at the PV ostium, with earliest activation during sinus rhythm. RF was delivered by use of maximum settings of temperature at 50 degrees C and power at 30 W. The end point of the procedure was the complete elimination of all distal and fragmented ostial PV potentials. Of 165 targeted veins, 163 were successfully isolated with a mean RF duration of 720+/-301 seconds per vein. At 1-year follow-up, 62% of the patients were in sinus rhythm without antiarrhythmic drugs. Contrast-enhanced magnetic resonance angiography revealed 2 PV stenoses of >25% out of 165 treated vessels. CONCLUSIONS: The use of a multipolar BC allowed effective and safe PV isolation by combining 3D mapping and navigation. At 1-year follow-up, 62% of the patients were in sinus rhythm without antiarrhythmic drugs, and the incidence of relevant diameter reduction of the treated PVs was 1.2%.

Atrial Fibrillation↗
PubMed2007

Neuroendovascular magnetic navigation: clinical experience in ten patients.

INTRODUCTION: The magnetic navigation system consists of an externally generated magnetic field that is used to control and steer a magnetically tipped microguidewire. The goal of this study was to demonstrate that the use of the magnetic navigation system and its magnetic microguidewire is feasible and safe in all types of neuroendovascular procedures. METHODS: A magnetic navigation system is an interventional workstation that combines a biplanar fluoroscopy system with a computer-controlled magnetic field generator to provide both visualization and control of a magnetically activated endovascular microguidewire. Ten consecutive patients underwent a variety of neuroendovascular procedures using the magnetic guidance system and magnetic microguidewire. All patients presented with a neurovascular disease that was suitable for endovascular treatment. Multiple different devices and embolic agents were used. RESULTS: Of the ten patients, three were male and seven female. Their mean age was 53.9 years. The predominant neurovascular condition was the presence of intracranial aneurysm (nine patients). One patient had a left mandibular arteriovenous malformation. All treatments were successfully performed on the magnetic navigation system suite. The magnetic navigation system and the magnetic microguidewire allowed safe and accurate endovascular navigation allowing placement of the microcatheters in the desired location. There were no neurological complications or death in our series. CONCLUSION: The use of the magnetic navigation system and the magnetic microguidewire in the endovascular treatment of patients with neurovascular diseases is feasible and safe.

Adult↗
PubMed1989

A vitreoretinal service.

Many serious disorders that threaten eyesight can now be treated with vitreoretinal surgery. As there was no regional facility for this treatment a service was developed to provide it. Among the first 100 patients treated over half had diabetic vitreoretinal disease. The remainder had ocular trauma (15), non-diabetic vasculopathy (10), rhegmatogenous retinal detachment (10), and miscellaneous disorders including diagnostic procedures (14). Sight was improved in most cases, 27 diabetic and 21 non-diabetic patients regaining navigating vision. Few patients were made worse: one only of the 49 non-diabetic patients and 12 of the 51 diabetic patients, and none whose vision was better than the ability to count fingers before operation. The many indications for this procedure, the size of the population that could benefit (an estimated minimum of 3800 operations per year in the United Kingdom in patients with diabetes alone), and the great potential benefit of the procedure all suggest the need for regional services. These would be cost effective in preventing blindness.

Adolescent↗