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Virtual percutaneous transluminal coronary angioplasty system for an educational support system.

With the increase of ischemic diseases of the circulatory system in Japan, the necessity for cardiovascular intervention continues to increase. However, because intervention operations have been developed only recently, the education system for the corresponding specialists in our country has not been established yet. In this study, an intervention educational support system using a virtual reality (VR) technique was developed. Of course, intervention includes percutaneous transluminal coronary angioplasty (PTCA). PTCA is an operation enlarging the stenosis of the coronary artery with a balloon through a guide catheter. The technique that lets the guide wire for the PTCA balloon cross the stenosis is one of the most difficult. A simulation system for the manipulation of a torque device for the PTCA guide wire was developed with this technology for VR. In virtual space, reconstitution of the 3-dimensional coronary artery with atherosclerosis was performed, and the virtual PTCA system was produced experimentally. An interesting system was produced experimentally as a system for the training of doctors studying to become interventional specialists. After the system was combined with an Expert system for treating ischemic heart diseases, its usefulness was steadily increased. With the development of more sophisticated VR methodology in the future, a PTCA training system without using a patient will be embodied.

Angioplasty, Balloon, Coronary↗

Matrix model of clinical psychology: applause or the sound of one hand clapping?

The matrix model as proposed by C.R. Snyder and T.R. Elliott (this issue, pp.1033-1054) is a welcome refocusing of clinical psychology for the 21st century. Yet, limitations to the model are that (a) it shifts attention to the target of interventions (i.e., "clients") and virtually ignores the function of the interventionist; (b) it might not be the best way to characterize "clients"; and (c) training might take longer than 5 years. Overall, it is a heuristic model; will it be accepted?

Curriculum↗

The 5 A day Virtual Classroom: an on-line strategy to promote healthful eating.

Communications technology can help stimulate youth to become involved in health promotion. This article reports on an innovative, Internet-based nutrition program that encouraged children to be advocates for policies that promote eating more fruits and vegetables, the 5 A Day Virtual Classroom. Through this program, students from across the United States discussed the recommendation of 5 A Day at the same time in a classroom without walls. In September 1997 children were asked, "If you were President Clinton, how would you get kids across the country to eat 5 A Day?" Based on content analysis of responses, this article suggests strategies that policymakers could use to encourage children to consume more fruits and vegetables. Approximately 2,600 students participated; 635 entries and 910 suggestions were received. The suggestion categories cited most often were mass media (19.8%), economic issues (15.4%), and social influence (13.8%). The most frequently mentioned specific ideas were to reward children for eating fruits and vegetables and to use presidential authority. Some regional, age, and gender patterns were found. Findings support the potential impact on health education of the 5 A Day Virtual Classroom and of interventions based on communications technology.

Child↗

Effectiveness and usability of artificial intelligence-powered assistive technologies in Supporting daily activities of children with cerebral palsy: a systematic review.

BACKGROUND: Cerebral Palsy (CP) is the main cause of motor disabilities in childhood, necessitating innovative approaches to rehabilitation and assistive technology (AT). Simultaneously, artificial intelligence (AI) is increasingly being integrated into devices to create more adaptive, personalized, and effective AT. This systematic review aimed to evaluate the effectiveness and usability of AI-powered assistive technologies designed to support daily activities and rehabilitation in children with CP. MATERIALS AND METHODS: Five databases, including Scopus, Web of Science, PubMed, Embase, and IEEE Xplore, were systematically searched, and 23 articles were included in the final analysis. Articles were identified, selected, and categorized into emerging thematic areas based on the primary function and application of the technology. RESULTS: Five key thematic topics were identified: 1) AI-driven motor rehabilitation and gait training for functional mobility; 2) intelligent assessment and monitoring systems for clinical decision support; 3) AI-supported communication, social interaction, and intention recognition tools; 4) gamified and virtual reality-based interventions to enhance engagement and usability; and 5) smart assistive systems supporting daily living and independent mobility. The findings demonstrate a strong trend toward the application of AI technologies in personalized, engaging, and data-driven interventions for children with CP. However, the field is predominantly in the proof-of-concept stage, with limitations including small sample sizes, lack of long-term clinical validation, challenges in user-centered design, and usability for children with CP. CONCLUSION: AI-powered assistive technologies hold significant potential for transforming the care of children with CP by enabling highly personalized and engaging interventions. To actualize this potential, future work must realize that practical application remains challenging owing to limited clinical validation, technological integration, and usability barriers for children with CP. Future research must prioritize user-centered design and multidisciplinary collaboration to ensure that AI and robotic advancements improve the usability and quality of life for children with CP.

Humans↗

Psychology over the Internet: On-Line Experiences.

The "International Symposium on Psychology over the Internet: On-Line Experiences" was held in Lima, Peru, July 2003, at the 29th InterAmerican Congress of Psychology. The main topic was the advantages and disadvantages of using this technology in the applied field of psychology. The Internet has been considered a new alternative for teaching-learning processes (virtual classroom); vocational assessment; counseling and orientation (virtual psychological consultation); and intervention focused on specific health-related problems. These experiences of on-line psychological services and their conclusions are briefly described herein.

Depression↗

Independent design and conduct of clinical trials.

Randomized clinical trials (RCTs) have justifiably become the cornerstone for the evaluation of virtually any kind of intervention: drugs, surgical or diagnostic procedures, behavioural modifications, health policies and even systems of care. This commentary focuses on two issues related to independence in clinical trials: first, the independence to ask important questions, and second, independence from bias in the conduct, analysis and reporting of trials, which can lead to misleading conclusions. The most frequent type of RCT are those evaluating therapies, and much of this commentary will be focused on issues relevant to such trials, although the principles apply generally.

Bias↗

AI-Driven Precision Medicine in Alzheimer's Disease: Drug Repurposing, Digital Therapeutics and Clinical Decision Support.

Alzheimer's Disease (AD) is a neurodegenerative disease that causes significant clinical, social, and economic burden worldwide. Despite improvements in understanding its multifaceted pathogenesis, current treatments are mostly symptomatic and ineffective across varied patient populations. To overcome these constraints, AI-driven precision medicine allows tailored risk assessment, treatment selection, and disease monitoring. This review covers AI's role in AD precision medicine, focusing on drug repurposing, digital therapies and clinical decision support systems. Machine and deep learning models are used to predict medication response, integrate heterogeneous data sources such as genomics, transcriptomics, neuroimaging and electronic health records, and uncover pharmacogenomic treatment success factors. The paper covers AIenabled precision pharmacology, including tailored dosing algorithms, adaptive therapeutic monitoring, and adverse drug reaction prediction. Bioinformatics-based target identification, network pharmacology, graphbased AI models, virtual screening, and real-world and clinical data validation are emphasized in AI-driven medication repurposing. AI-powered digital treatments like personalized cognitive training platforms, wearable- derived digital biomarkers, virtual and mixed reality interventions, adherence monitoring, and digital twins for therapy optimization have been discussed. AI-based clinical decision support systems are also thoroughly assessed for clinical value, accuracy, and explainability in disease subtyping, trajectory prediction, and risk stratification in preclinical and prodromal AD. Despite these promises, data heterogeneity, algorithmic bias, legal barriers, and privacy concerns exist. Federated learning enables safe multi-center collaboration and hybrid AI-human approaches, and it represents the future. AI's ability to alter AD care opens the door to precision medicine paradigms that use repurposed medications, digital tools and intelligent decision-making to improve patient outcomes.

Alzheimer’s disease↗

Knowledge of the adenomatous polyposis coli gene and its clinical application.

Familial adenomatous polyposis (FAP) is one of the most clearly defined and well understood of the inherited colorectal cancer syndromes. It is an autosomal dominant condition with high (> 90%) penetrance. Clinically, it is characterized by multiple (> 100) adenomatous polyps in the colon and rectum; variant features in addition to the colonic polyps may include polyps in the upper gastrointestinal tract and other extracolonic manifestations. Since the risk of colorectal cancer in untreated FAP is virtually 100%, screening and intervention for at-risk persons has consisted of annual colon examinations by endoscopy beginning around puberty. The objective of this regimen is early detection of colonic polyps in those who have FAP, followed by preventive colectomy. Because of recent findings that most cases of FAP are due to mutations of the adenomatous polyposis coli gene at chromosome 5q21, genetic testing will probably be incorporated as the first step in the management of individuals at risk for this condition, and screening regimens can be modified. Genetic counselling about the consequences of presymptomatic gene testing is an important component of this process.

Adenomatous Polyposis Coli↗

[Magnetic resonance imaging in the diagnosis of different forms of endometriosis].

The present paper examines the capacities of non-invasive MRI in the diagnosis of endometriosis. A standardized study algorithm is proposed, indications and methodology for MRI in different forms of endometriosis (EM) are specified. It is shown that in the diagnosis of different types of EM there are specific changes in the MR pattern of small pelvic organs, which allow one to make a differential diagnosis of this disease with a higher sensitivity (96%) and specificity (87%) as compared with ultrasound study. MRI makes it possible to assess the degree of invasion of endometrioid heterotopies into the wall of the intestine and cervix uteri with a high degree of accuracy and to judge the degree and extent of intestinal luminal narrowing. Diagnostic errors in solving these problems (as well as those associated with the detection of extragenital foci of EM in the small pelvis) are due first of all to movement artefacts a (respiration and intestinal motility) particularly in the presence of a significant adhesive process and/or after surgical intervention. MRI does not virtually yield false-negative conclusions in the diagnosis of different forms of genital endometriosis (less than 3%), which, in the authors' opinion, rather justifies some hyperdiagnosis (about 11%) made by this method in the diagnosis of endometriosis of the rectovaginal septum. MRI is a closing, specifying stage of instrumental diagnosis of not only EM, but also other small pelvic diseases.

Adult↗

Communication intervention for persons with severe and profound disabilities.

Traditionally, communication interventionists focused on teaching a beginning repertoire of communicative behavior, once learners with severe to profound disabilities had emitted intentional behavior. Increasingly, interventionists are recognizing that valuable opportunities may be lost if intervention does not begin at an earlier point. In part, intervention strategies at increasingly earlier points have resulted from a prevailing change from semantically-focused intervention logic to pragmatic, interaction-focused intervention logic. At the same time that intervention content has increasingly focused on pragmatics, there has been a wealth of information addressing the social functions served by repertoires of simple idiosyncratic (as well as socially unacceptable) behavior. The increasing availability of augmentative and alternative communicative options has provided an extensive array of motorically simple strategies to exert significant control and influence over one's environment. We have long since passed the need to demonstrate that persons with severe disabilities can be taught a repertoire of communicative functions. However, we have not been as successful in demonstrating that the communicative behavior taught is well maintained solely in the presence of natural maintaining contingencies. Nor have we adequately demonstrated that established repertoires are sufficiently generalized. Most recently, interventionists have begun to focus on more efficient strategies to use in the selection of the most critical teaching instances to teach a new communicative response. Additionally, interventionists are considering response efficiency as an important variable in determining the likelihood that a learner will choose to emit members of his or her communicative repertoire. There appears to be a consensus among those who currently serve individuals with severe disabilities that inclusion represents an attainable objective for students with even the most severe disabilities. Unfortunately, it is not clear that either special or regular educators are being adequately prepared to accomplish included placements. There remains a significant need to recognize those aspects of best practice which must be further explored in regular education settings. What once were considered best practice methods may not meet the test of social validity and be considered best practices in regular classrooms. The vast majority of intervention research has selected a fairly narrow communicative form or function to teach. Increasingly, information on maintenance and generalization is considered. However, often the periods sampled postacquisition are very modest. Among the plethora of available communication intervention curricula, there are virtually none that have taken a learner from a point of engaging in no intentional communicative behavior to the establishment of an effusive repertoire of communicative functions and corresponding vocabulary.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

Do we need a "virtual" program infrastructure for worksite and population health promotion efforts?

As the demand for Worksite Health Promotion heats up, it is becoming clear that the traditional models of programming that work well in worksites with large number of employees will not meet the needs of small and medium size employer organizations. Additionally, the large number of individuals who are served by health plans are also likely to require different types of Health Promotion interventions. In presenting the concept of a "virtual" set of interventions that form a "program infrastructure" this article seeks to bridge the gap between large employer programming strategies and small employer and health plan settings. A set of eleven interventions are described and recommended technical specifications are presented.

Health Promotion↗

Augmented reality visualization for CT-guided interventions: system description, feasibility, and initial evaluation in an abdominal phantom.

UNLABELLED: The purpose of this study was to evaluate the feasibility and performance of an augmented reality (AR) visualization prototype for virtual computed tomography (CT)-guided interventional procedures in a multimodality abdominal phantom. With the aid of AR guidance, three radiologists performed 30 attempts at targeting simulated liver lesions of different sizes (range, 5-15 mm) with a biopsy needle. The position of the needle tip relative to the lesion was verified by using ultrasonography and CT. With AR guidance, lesions were successfully targeted with the first needle pass in all cases. On the basis of these results, AR visualization for CT-guided intervention appears feasible and allows intuitive and accurate lesion targeting in a phantom. SUPPLEMENTAL MATERIAL: radiology.rsnajnls.org/cgi/content/full/2401040018/DC1

Abdomen↗

Virtual planning of hip operations and individual adaption of endoprostheses in orthopaedic surgery.

The introduction of virtual reality techniques in medicine opens up new possibilities for the planning of interventions. The presented software system for virtual operation planning in orthopaedic surgery (VIRTOPS) enables the virtual preoperative 3D planning and simulation of pelvis and hip operations. It is used to plan operations of bone tumours with endoprosthetic reconstruction of the hip based on multimodal image information. The operation and the endosprothetic reconstruction of the pelvis are simulated using virtual reality techniques. Stereoscopic visualisation techniques and 3D input devices support the 3D interaction with the virtual 3D models. The main task of the preoperative planning process is the individual design of an anatomically adaptable modular prosthesis. The placement and the design of the endoprosthesis are supported by different functions and visualisation techniques. The resulting 3D images and movies can be used for the documentation of the operation planning procedure, as well as, for the preoperative information of the patient.

Arthroplasty, Replacement, Hip↗

The effect among older persons of a general preventive visit on three health behaviors: smoking, excessive alcohol drinking, and sedentary lifestyle. The Medicare Preventive Services Research Team.

BACKGROUND: The U.S. Congress mandated evaluations, initiated in 1989, to determine whether extending Medicare benefits to include preventive services would improve health status, reduce costs of care, and improve health risk behaviors of beneficiaries. METHODS: The Johns Hopkins Medicare Preventive Services Demonstration was a randomized trial in which Medicare beneficiaries were assigned either to an intervention group that was offered yearly preventive visits for 2 years and optional counseling visits to their primary care provider or to a control group that received usual care. This report describes the effect of the intervention over a period of 2 years on smoking, problem alcohol use, and sedentary lifestyle. RESULTS: Differences were observed between the intervention and control groups in the extent to which changes occurred in smoking and problem alcohol use, but none of the differences was statistically significant. The proportion of smokers who quit was higher in the intervention group than in the control group (24.2 vs 17.9%, P = 0.09). However, a higher proportion of problem drinkers in the control group improved (67.1 vs 57.0%, P = 0.183). There was virtually no difference between the intervention and the control groups in the proportion with improvement in sedentary lifestyle. CONCLUSIONS: This study demonstrates the difficulty of bringing about health behavior change in older patients in the course of a yearly preventive visit for 2 years with their primary care physician when the visit encompasses screening and immunizations, as well as health behavior counseling directed by the physician. Further study is required to determine whether a more intense program of counseling for health behavior change among older persons by their primary care providers would be effective.

Aged↗

Impact of a mailed intervention on annual mammography and physician breast examinations among women at high risk of breast cancer.

Only a few studies have examined repeat annual mammography rates, and most studies find that such regularity is low, ranging from < 5% in the general population to between 14 and 20% of first-degree relatives. The present study tested the effectiveness of a mailed intervention designed to improve compliance with breast cancer screening guidelines among women at elevated familial risk. The study used a pretest-posttest control group design; 369 twin sisters of breast cancer cases were assigned alternately to an intervention or a control group on the basis of sequential registration numbers. The intervention consisted of written materials, an audiotape, and mailed reminders. The posttest was mailed 2.5 years after the intervention in order to provide adequate time to assess the regularity of screening. The intervention and control groups were virtually identical with respect to demographic and baseline screening characteristics. Of those who returned the follow-up questionnaire, annual physician breast examinations were 12.8% higher and annual mammograms were 10.3% higher in the intervention group than in the control group. The probability of annual screening with physician breast examination and mammography was higher in the intervention group, and the probability of annual mammography continued to be higher for women over age 52 years after controlling for baseline screening, year of diagnosis, education, and status of the twin. This result is consistent with improvements found in other studies. Women who did not return follow-up questionnaires were more likely to have had fewer physician breast examinations and mammograms and more likely to be in the intervention group than those who stayed in the study. Additionally, those who dropped out of the intervention arm perceived themselves to be less susceptible and perceived screening to be less effective than did those who dropped out of the control arm. Although the intervention caused many women to be screened more regularly, those who had not been screened in the past and those who held opinions that were not conducive to screening were more likely to drop out. This mailed intervention for high-risk women increased their rate of screening. Characteristics of women resistant to such programs have been identified; alternative strategies need to be developed to reach this small percentage of high-risk women who ignore their elevated susceptibility.

Adult↗

Psychotherapeutic intervention in angina: II. Implications for research and practice.

The second of a two-part series, this article draws on the clinical and research literature reviewed in the first article to formulate guidelines for research and clinical practice. In future research, the complex heterogeneity of coronary artery disease (CAD) must be recognized in more rigorous descriptive, comparative, and physiologic correlative studies of psychosocial etiology. Pseudoangina is largely unexamined by systematic study and therefore warrants research on several of its aspects. Similarly, systematic research on intervention in anginoid pain is virtually nonexistent and obviously warranted. Clinical guidelines include the emphasis of didactic, supportive approaches, detailed focus on several aspects of the pain, early and extended psychotherapeutic availability, recognition and treatment of underlying specific psychopathology, and somatic interventions aimed at presumed pathophysiologic mechanisms.

Angina Pectoris↗

Home telehealth improves clinical outcomes at lower cost for home healthcare.

Patient outcomes and cost were compared when home healthcare was delivered by telemedicine or by traditional means for patients receiving skilled nursing care at home. A randomized controlled trial was established using three groups. The first group, control group C, received traditional skilled nursing care at home. The second group, video intervention group V, received traditional skilled nursing care at home and virtual visits using videoconferencing technology. The third group, monitoring intervention group M, received traditional skilled nursing care at home, virtual visits using videoconferencing technology, and physiologic monitoring for their underlying chronic condition. Discharge to a higher level of care (hospital, nursing home) within 6 months of study participation was 42% for C subjects, 21% for V subjects, and 15% for M subjects. There was no difference in mortality between the groups. Morbidity, as evaluated by changes in the knowledge, behavior and status scales of the Omaha Assessment Tool, showed no differences between groups except for increased scores for activities of daily living at study discharge in the V and M groups. The average visit costs were $48.27 for face-to-face home visits, $22.11 for average virtual visits (video group), and $32.06 and $38.62 for average monitoring group visits for congestive heart failure and chronic obstructive pulmonary disease subjects, respectively. This study has demonstrated that virtual visits between a skilled home healthcare nurse and chronically ill patients at home can improve patient outcome at lower cost than traditional skilled face-to-face home healthcare visits.

Community Health Nursing↗

Virtual reality-based orthopedic telerehabilitation.

Rehabilitation interventions in remote areas are problematic because of distance and available resources. Orthopedic impairments acquired by individuals in remote areas can then lead to permanent disabilities/loss of function because of lack of appropriate rehabilitation. A system being developed by Rutgers and Stanford Universities provides therapy at the patient's home, with remote monitoring and periodic re-assessment. This telerehabilitation system uses virtual reality and haptic interfaces, and a pair of networked PCs. It is intended for rehabilitation of patients with hand, elbow, knee and ankle impairments. Data from the first patient treated with the telerehabilitation system is encouraging.

Exercise Therapy↗