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At least 73 records · Page 4Linked to original sources
PubMed2004

[Virtual MR endoscopy of the ventricles prior to neurosurgical interventional endoscopy -- evaluation of different presentation techniques].

PURPOSE: In the past, virtual endoscopies have been performed for planning of endoscopic interventions or for diagnostic purposes in various organ systems with increasing frequency. This study evaluates the ability of virtual ventricular endoscopy to depict anatomical structures and the use for planning of real endoscopy. MATERIALS AND METHODS: In a prospective study, 4 volunteers and 8 patients were examined with MRI. In 3 of the patients endoscopy was performed by our neurosurgeons thereafter. The calculation of the virtual endoscopy was based on 1 mm sagittal T2-weighted images. Comparison of surface rendering and volume rendering was made by means of video sequencing of individual views, and these were compared with the intraoperative endoscopic videos concerning the depictability of anatomical landmarks. RESULTS: The reconstructions using volume rendering were more significant and easier to calculate than those based on surface rendering. Virtual endoscopy in the transparent mode allowed visualization of hazardous structures outside the ventricular system such as the basilar artery tip. Transparent 3D images of the ventricles gave a good overview on the depicted structures and enabled a better orientation during the virtual camera flight than surface rendered views. CONCLUSION: MR-based virtual endoscopy of the ventricular system can be obtained on the basis of surface- and volume-rendered views of sagittal T2-weighted thin sections. Preoperative utilization of this method simplifies the planning of endoscopy by visualization of anatomical structures.

Brain Diseases↗
PubMedDate not supplied

Benefits of a virtual play rehabilitation environment for children with cerebral palsy on perceptions of self-efficacy: a pilot study.

This paper presents the results of a clinical trial of a virtual reality play-based intervention. The results of three single case studies are presented. The virtual reality intervention used the Mandala Gesture Xtreme technology. It was applied to three school-aged children with cerebral palsy. A pre-test-post-test design was used. The relevant outcome of interest was self-efficacy as measured with the Canadian Occupational Performance Measure (COPM). Group scores on the COPM indicated clinically significant changes in self-efficacy for all children. Two of the participants demonstrated the greatest changes in both perceived performance abilities and satisfaction with performance with respect to task specific domain areas. Qualitative comments from the participants revealed a high degree of motivation, interest, pleasure, and opportunity for engagement in play, activities not previously engaged in. Overall, this pilot study suggests the viability of a virtual reality play-based intervention as part of the rehabilitation process for children with cerebral palsy. These results form the basis of a larger scale randomized clinical trial.

Cerebral Palsy↗
PubMed2025

Implementation of a Face-To-Face Vs Virtual Peer-Integrated Collaborative Care Intervention for Mental Health Treatment of Physical Trauma Survivors: A Qualitative Study of Lessons from the COVID-19 Pandemic.

OBJECTIVE: We assessed the impact of the COVID-19 pandemic on the implementation of a peer-integrated enhancement of integrated clinical care intervention to address the mental health needs of 450 patients undergoing treatment for a physical injury. METHODS: Qualitative data were collected by 7 clinician investigators of a randomized controlled trial acting as participant observers in a trauma care setting of a major U.S. metropolitan hospital and analyzed in collaboration with an external mixed methods specialist. RESULTS: The pandemic created or exacerbated several implementation barriers, including increased risk of infection, homelessness, hospitalizations and comorbid conditions such as fentanyl overdoses that increased demand on emergency department and Trauma Center services, imposition of safety measures to reduce risk of infection in clinical settings, transition from face-to-face to virtual interactions with study patients, shortages of specialty mental health providers, suspension of recruitment of patients into the study, scheduling calls with patients, and an increased workload for the study clinical interventionists. Peer specialists perceived the transition to virtual interactions with patients reduced their effectiveness; however, this was not reflected in assessments of patient satisfaction with services received and may have inadvertently increased adoption by Trauma Center staff. Reduction in reach of the intervention to target population was temporary. CONCLUSIONS: The COVID-19 pandemic exacerbated existing barriers and created new barriers to successfully implementing evidence-based practices in trauma care settings, resulting in an attenuation of their effectiveness. However, the shift from face-to-face to virtual services delivery may have actually led to improved implementation outcomes. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03569878. Registered June 15, 2018.

Humans↗
PubMed1994

Government intervention in cardiovascular disease--help or hindrance? A Swedish viewpoint.

In Sweden the government owns, operates, and finances nearly all health care; therefore, intervention by the government is virtually total. Until recently, government intervention in cardiovascular disease was mainly by allocation of resources through budgets to different hospital departments, based on the advice of expert groups. However, this form of intervention has become ineffective over the last few years as economic conditions have deteriorated and health care spending ceased to grow. Instead, interventions aimed at containing costs and improving the efficiency of health care have now been implemented. The important question in government intervention in health care is whether it will be compatible with clinical and therapeutic freedom and with continued progress in medical research. In the future regulations must be developed with a greater knowledge about the interaction between economic and medical factors in health care in order to provide clinical and therapeutic freedom whilst allowing continued progress in medical research.

Aged↗
PubMed2001

A new virtual reality approach for planning of cardiac interventions.

A novel approach to three-dimensional (3D) visualization of high quality, respiratory compensated cardiac magnetic resonance (MR) data is presented with the purpose of assisting the cardiovascular surgeon and the invasive cardiologist in the pre-operative planning. Developments included: (1) optimization of 3D, MR scan protocols; (2) dedicated segmentation software; (3) optimization of model generation algorithms; (4) interactive, virtual reality visualization. The approach is based on a tool for interactive, real-time visualization of 3D cardiac MR datasets in the form of 3D heart models displayed on virtual reality equipment. This allows the cardiac surgeon and the cardiologist to examine the model as if they were actually holding it in their hands. To secure relevant examination of all details related to cardiac morphology, the model can be re-scaled and the viewpoint can be set to any point inside the heart. Finally, the original, raw MR images can be examined on line as textures in cut-planes through the heart models.

Cardiovascular Diseases↗
PubMed2001

Limits of fetal viability and its enhancement.

According to Websters Encyclopedic Unabridged Dictionary of the English Language, viable of a fetus it means having reached such a stage of development as to be capable of living, under normal conditions, outside the uterus. Viability exists as a function of biomedical and technological capacities, which are different in different parts of the world. As a consequence, there is, at the present time, no worldwide, uniform gestational age that defines viability. Viability is not an intrinsic property of the fetus because viability should be understood in terms of both biological and technological factors. It is only in virtue of both factors that a viable fetus can exist ex utero and thus later achieve independent moral status. Moreover, these two factors do not exist as a function of the autonomy of the pregnant woman. When a fetus is viable, that is, when it is of sufficient maturity so that it can survive into the neonatal period and later achieve independent moral status given the availability of the requisite technological support, and when it is presented to the physician, the fetus is a patient. In the United States viability presently occurs at approximately 24 weeks of gestational age (Chervenak, L.B. McCullough; Textbook of Perinatal Medicine, 1998). In Portugal, the mortality increase significantly with GA<25 weeks. At 25 weeks mortality was 44.4% and at 26 weeks was 24.4% (I. Macedo et al. Matemidade Dr. Alfredo da Costa, Lisbon, 2000). In Poland during last years we observe also a very significant decrease of perinatal mortality. There are several aspects of fetal viability: ethical, social, psychological and medical. Ethical aspects There is a compelling conceptual and clinical reason to reject Primum non nocere as the primary principle of perinatal ethics; virtually all medical interventions involve unavoidable risks of harm, for example, amniocentesis. If Primum non nocere were to be made the primary principle of perinatal ethics, virtually all of perinatal medicine would be unethical. Social aspects Greatly increased advances in perinatal medicine lead on one hand to a high quality of care expected and demanded by both the health care professionals and patients, but on the other hand the resources available for responding to the expectations and demands are becoming increasingly stretched. Even in the high-income countries, the available resources are scarce in relation to these demands a high quality of care expected and demanded by both the health care professionals and patients, but on the other hand the resources available for responding to the expectations and demands are becoming increasingly stretched. Medical aspects During the preconceptional period the most important actions are: family planning, education, analysis of previous obstetrical miscarriages and prevention of congenital malformations (folic acid). Pregnancy presents several problems, which can significantly influence fetal viability. Proper management of these problems can improve perinatal outcome. Among others prevention of prematurity is the most important goal of contemporary perinatal medicine. Enhancement of fetal viability There are several possibilities to enhance fetal viability. The most important are: organization of perinatal care, introduction of new technologies to perinatal medicine, intensive fetal therapy and early detection of fetal distress. Three levels system of perinatal care, transport in utero, introduction and promotion of new methods, continues education of staff are characteristic for the modern organization of perinatal medicine. Echocardiography, Color Doppler Energy, 3D sonography, prenatal diagnosis (cordocentesis, analysis of fetal cells in maternal blood,.), fetal pulse oximetry, mathematical analysis of the signal are the methods which should be used at the highest level of perinatal care. Today, the prospect of survival is only about 1 in 10 at 23 weeks, and if the child lives it is more likely to be handicapped that not. At 24 weeks the chance of a normal survivor is about 50%, and after this the odds are in favor of a normal survivor. Considering this data, intensive care should be an optional choice for fetuses at 23 and 24 weeks of gestation and should be offered to every fetus at 25 weeks or more.

Ethics, Medical↗
PubMed2026

The role of simulator immersion on learning and transfer of decision-making skill in sport.

Virtual reality has become popular in sport and other domains because it can immerse the user within a sporting context and solve logistical problems for additional off-field training. There is limited evidence, however, of whether immersion is crucial for learning and transfer. This study compared training of decision-making skill between 360-degree video virtual reality (360VR) and two-dimensional video. Twenty-eight Australian Rules Football players were randomly assigned to one of three training groups: 360VR, two-dimensional video, and control. Across four weeks, participants in the training groups were exposed to decision-making scenarios consisting of visual, contextual and auditory cues. Performance was assessed pre- and post-training with virtual reality and field-based decision-making tests. Results indicated that the two-dimensional video training group showed significantly superior decision-making in the field-based transfer test compared to 360VR and control groups post intervention. There was also indication that two-dimensional video training was superior to the control post intervention in the virtual reality test. Findings indicate that immersion created in virtual reality is not an underpinning mechanism for learning and transfer, rather the use of perceptual information is crucial. 360VR may facilitate uptake through engagement, but two-dimensional video is adequate for learning and transfer of decision-making to the field.

Humans↗
PubMed2003

A virtual reality environment for evaluation of a daily living skill in brain injury rehabilitation: reliability and validity.

OBJECTIVE: To establish the stability and validity of information collected in a virtual reality environment from persons with traumatic brain injury (TBI). DESIGN: Prospective correlation design to examine 3-week test-retest results for equivalence reliability between computer-simulated and natural environments. SETTING: A residential rehabilitation center for brain injury. PARTICIPANTS: Fifty-four consecutive patients with TBI who received comprehensive rehabilitation services and who were at different stages of recovery. INTERVENTION: An immersive virtual kitchen was developed in which a meal preparation task involving multiple steps was performed. The subjects completed meal preparation both in a virtual reality kitchen and an actual kitchen twice over a 3-week period. MAIN OUTCOME MEASURES: Time and errors on task completion using virtual reality assessment, actual kitchen performance (analogous to the virtual reality environment), occupational therapy (OT) evaluation, and neuropsychologic tests. RESULTS: The stability of performance using the simulated virtual environment was estimated with intraclass correlation coefficients (ICCs). The ICC value for total performance, based on all steps involved in the meal preparation task, was.76 (P<.01). The construct validity of the simulated environment was examined by correlating performance in the virtual environment with that in the actual kitchen (r=.63, P<.01), the OT evaluation (r=.30, P=.05 for meal preparation; r=.40, P=.01 for cognitive subskills), and neuropsychologic tests (r=.56, P<.01 for the full-scale intelligence quotient [IQ]; r=.40, P<.01 for the verbal IQ; r=.56, P<.01 for the performance IQ). Finally, a multiple regression analysis revealed that the virtual reality environment test was a good predictor for the actual assessment kitchen (beta=.35, P=.01). CONCLUSION: The virtual reality system showed adequate reliability and validity as a method of assessment in persons with brain injury.

Adolescent↗
PubMed2006

Virtual histology and color flow intravascular ultrasound in peripheral interventions.

The quality and interpretation of intravascular ultrasound (IVUS) imaging has been revolutionized in recent years by two new and major advances: virtual histology and color flow IVUS. Virtual histology intravascular ultrasound (VHIVUS) is a catheter-based technology where IVUS is generated from the transducer on the catheter tip and the reflected signals from the artery wall produce a color-coded map of the arterial disease. Different histological constituents of the plaque produce different reflected signals and these are assigned different colors (dark green, fibrous; yellow/green, fibrofatty; white, calcified; red, necrotic lipid core plaque). This color-coded map assists the interventionalist in understanding more fully how the lesion will behave at the moment of treatment, whether it will resist complete stent deployment or be liable to embolization. Originally introduced for coronary interventions, VHIVUS is now being applied to peripheral situations. Because it provides a detailed and close-proximity view of plaque, its potential to improve the safety and efficacy of carotid endoluminal repair is stimulating substantial interest. Similarly, color flow IVUS provides greater understanding for the operator of blood flow, and the interface between the vessel wall and the blood stream, lumen size, and success of treatment. Color flow IVUS does not use the Doppler effect, but creates real-time images that resemble color flow Doppler ultrasound. These two technological advances in IVUS have greatly improved the ability of the endovascular specialist to understand the arterial disease they are treating and to assess the completion of treatment.

Blood Vessel Prosthesis Implantation↗
PubMed1996

Efficacy of interventions designed to inhibit the progression of coronary atherosclerosis.

This paper reviews the design and results of published randomized coronary angiographic trials and estimates treatment effect sizes for these trials to clearly demonstrate that antiatherosclerosis interventions are effective in inhibiting the progression of coronary artery disease (CAD). Furthermore, these interventions show differential treatment benefit on particular lesion populations defined by initial lesion severity. The efficacy of such interventions have been virtually unstudied in diabetic populations. Ancillary analyses of these trials implicate certain risk factors for the continued progression of CAD assessed by coronary angiography; although standard lipids such as total cholesterol and LDL-cholesterol are important risk factors, recent evidence suggests that triglycride-rich lipoproteins are also important contributors to progression of CAD, both in treated and untreated trial subjects. Recent reports demonstrating an association between progression of coronary disease assessed by coronary angiography and the risk of clinical events provide critical validation for the use of serial coronary angiography as a surrogate endpoint measure in controlled clinical trials. Finally, the advent of noninvasive ultrasonographic measures of carotid intima-media thickness may provide an important avenue for future testing of antiatherosclerosis interventions.

Carotid Arteries↗
PubMed2000

Health care in the 21st century: evidence-based medicine, patient preference-based quality, and cost effectiveness.

The combination of evidence-based medicine, patient-based preferences using utility analysis, and econometric modeling yields a model to evaluate the incremental cost effectiveness of health care interventions. This methodology allows a comparison of the cost effectiveness of virtually all health care interventions and incorporates the patient voice to provide an information system that can improve the quality of health care and simultaneously reduce costs. It has been estimated that such an information system could save more than $90 billion per year of the annual $1.3 trillion health care bill in the United States.

Cost-Benefit Analysis↗
PubMed1986

Laser photocoagulation in the palliation of colorectal malignancies.

Besides surgical intervention, there are virtually no palliative treatment modalities available for bleeding and/or obstructing colorectal malignancy. The usefulness and safety of laser photocoagulation was prospectively investigated in 63 patients with colorectal cancer. The merits were evaluated in the treatment of obstruction (16 patients), bleeding (32 patients), and combined hemorrhage and obstruction (15 patients). Luminal patency could be restored in 15 (94%), hemostasis was achieved in 28 (88%), and treatment was effective in 13 (87%) patients with bleeding and obstructing tumors. In the 56 evaluable and initially responding patients, no beneficial long-term results were achieved in six patients, as major complications of (re)stenosis, necessitating colostomy, occurred in three, posttreatment hemorrhage with need for blood transfusion in two, and a pararectal abscess formation was seen in one patient. Except probably for this pararectal abscess, there was no treatment-related death. Transient stenosis and laser-induced bleeding, as minor complications present in 12 (19%), responded favorably upon reinstitution of laser photocoagulation. The beneficial effect of laser photocoagulation was, in general, evident after 2 to 3 sessions. Forty-six patients could be discharged from the hospital and their treatment could be continued in the outpatient clinic. Further hospital admission could be avoided in 39. Laser treatment for palliation of obstructing and/or bleeding colorectal cancer proved to be an efficacious, safe, and rapidly effective therapy. Laser photocoagulation can be considered as a valuable alternative to aggressive surgical intervention in the absence of other conservative treatment modalities in palliation.

Aged↗
PubMed2002

[Clinical aspects of a virtual operating room for the prediction of operative interventions in some disease of the middle ear].

Clinical aspects of creating a software system for simulation and prediction of operative interventions and hearing function changes are considered. The system will make simulation and prediction transparent and convenient for the user. The technical challenge is to create mediation languages which enforce rigorous mathematical computation while supporting intuitive behaviour. The prevalent textual interface of command lines and pull-down menus is replaced by physical behaviour within an environment. The system is based on new possibilities of computer-integrated environments for problem solving such as virtual environments and it will be presented in a form of a virtual operating room. The following aspects are taken into consideration: a model of the middle ear, database for existing methods of operative interventions, x-ray and computed tomography imaging of the temporal bone, determination and localization of otosclerosis foci, modeling and determination of acoustic parameters for transplantation materials, simulation and prognosis of potential complications.

Ear, Middle↗
PubMed2005

Applying intravascular ultrasound to optimize the placement of coronary drug-eluting stents.

Intravascular ultrasound (IVUS) has provided in the last 2 decades major insights into the pathophysiology of coronary artery disease, and the mechanisms of action of percutaneous revascularization devices, helping the widespread adoption of coronary stents. The introduction of drug-eluting stents (DES) has recently lead to a revolution in the field of interventional cardiology, by virtually eliminating restenosis in selected low-risk lesions and significantly reducing both restenosis and repeat revascularizations in higher risk lesions. At the moment, the role of IVUS in the DES era is not well defined. Clinical studies utilizing IVUS in DES implantation used this technology mainly to evaluate the endpoint of intimal hyperplasia and to study the problem of incomplete apposition. On a theoretical basis, a method able to better evaluate optimal placement of a local drug delivery system should have a high rationale. Despite this sound preamble, no specific investigation has been conducted to evaluate the clinical need and possible advantage of routine IVUS for DES implantation and uncertainty is still present. A major hindrance lays in the low incidence of restenosis in most randomized trials enrolling few selected lesions per patient, as this fact enlarges the number of patients who need to be treated to demonstrate a benefit and casts doubts on the cost effectiveness of a more expensive and time consuming approach. The situation is bound to change when more complex patients and lesions are being treated, a setting associated with a higher event rate even when DES are used. While waiting for a prospective study addressing such issue, we can only rely on indirect evidence to justify and support the usage of IVUS in complex clinical settings with implantation of DES.

Coronary Artery Disease↗
PubMed2026

Toward AI Virtual Cells for Hepatology: Representation, Generation, Dynamics, and Intervention in Single-Cell Models.

``Single-cell and spatial atlases describe the healthy and diseased liver at high resolution, including lobular hepatocyte zonation, fibrotic macrophage-stellate niches, cholangiocyte reactions, immune remodeling, and hepatocellular carcinoma ecosystems. These maps show where cell states occur but do not, by themselves, predict whether liver injury will progress or how the liver will respond to an untested drug, toxicant, or genetic perturbation. In this review, we organize current approaches toward an AI Virtual Cell (AIVC) for the liver into three complementary modeling routes. Generative models represent cell states, dynamics and transport models infer state transitions, and pretrained or foundation models test whether learned representations transfer across donors, etiologies, disease stages, and platforms. Perturbation-response prediction serves as a cross-cutting assessment of whether these layers can predict responses to untested genetic, chemical, inflammatory, or metabolic interventions. Available evidence can be categorized as direct liver validation, liver-included benchmarks, general single-cell evidence, and conceptual applications. Published models demonstrate individual components, including atlas integration, inferred trajectories, transferable representations, and retrospective response programs. However, these models do not constitute a prospectively validated liver simulator. At minimum, evaluation should include donor-, etiology-, stage-, platform-, and perturbation-level hold-outs. Model performance should be reported using response direction, recovery of differentially expressed genes and rare states, and calibrated uncertainty. Claims about tissue- or function-level prediction additionally require independent spatial, histologic, metabolic, and functional readouts. Near-term use should prioritize experiment selection and hypothesis generation, whereas clinical decision support remains a longer-term objective.

AI Virtual Cell↗
PubMed1987

Dermatomyositis presenting with Ludwig's angina.

An interesting case of a patient with dermatomyositis and a superimposed Ludwig's angina is presented. Dermatomyositis is a disease that is poorly understood and has many presenting characteristics similar to facial cellulitis and infection. In the present case the rapid progression of the clinical course necessitated prompt intervention. It was virtually impossible to differentiate between signs of dermatomyositis and an infectious process. No clear cause of the facial swelling was determined, but it was presumably from an ulcerative lesion in the floor of the mouth.

Bacterial Infections↗
PubMedDate not supplied

The moral domain of the medical record: the routine ethics evaluation.

The structure, content, and orientation of the contemporary medical record inadequately reflect the appropriate influence of patients' rights and bioethics on health care. Most tellingly, the medical chart reveals a remarkable absence of attention to medical ethics, except in the case of crisis management. But medical ethics informs both crisis decision-making and virtually all clinical interventions. Indeed, clinical care embodies a complex array of choices influenced by individual and cultural values, themselves reflecting religious beliefs, personal histories, psychologies, and social mores. But the typical medical chart, which records clinical descriptions, analyses, and rationales for treatment, rarely identifies or accounts for this value-laden dimension of care and thus both over-simplifies and distorts the depiction of a patient's illness and its treatment. To better reflect the complex moral domain of clinical care, and assist in organizing its complex structure, a systematic procedure is proposed here to evaluate the ethical status of every patient: As a routine part of the clinical evaluation, in a designated Ethical Concerns section of the medical record, an "ethics work-up' is designed to serve as a moral 'diagnostic' analogous to its scientific counterpart. Adapted to the needs of individual patients, such evaluations should identify ethical problems, coordinate related data, resources, and opinion, and define the rationale for choices made and actions pursued. In establishing improved integration of the 'epistemologies' of care and the 'ethics' of care, the goals of a more humane, patient-centered medicine may be better met.

Boston↗