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At least 145 records · Page 8Linked to original sources
PubMed2002

Thoracoscopic excision for ectopic mediastinal parathyroid tumor.

Ectopic parathyroid adenoma or hyperplasia in the mediastinum are seen in a percentage of patients with hyperparathyroidism and have generally been treated by conventional open surgery. However, due to recent improvements in the ability of diagnostic imaging such as 99mTc-methoxyisobutylisonitrile (MIBI) scintigraphy to identify these lesions, we have been obtaining favorable results from thoracoscopic excision of mediastinal parathyroid tumors. In thoracoscopic surgery, three to four trocars were inserted between the fourth and seventh ribs from a lateral approach. Based on diagnostic imaging, tumors were identified and excised by the shortest possible route. Surgery time for four consecutive patients ranged from 50 to 140 min, and hemorrhage volumes were small. No intra- or postoperative complications were observed, and the postoperative course for these patients has been uneventful. Analgesia was required only a few times for each patient. In the most recent patient, radioisotope-navigated thoracoscopic excision was performed using 99mTc-MIBI. When thoracoscopic excision was combined with radioisotope navigation, tumor identification took less time, cutting the surgery time in half and ultimately placing less stress on the patient.

Adult↗
PubMed2005

Cognitive ergonomics in virtual environments: development of an intuitive and appropriate input device for navigating in a virtual maze.

For patients suffering from mild cognitive impairments, the navigation through a virtual maze should be as intuitive and efficient as possible in order to minimize cognitive and physical strain. This paper discusses the appropriateness of interaction devices for being used for easy navigation tasks. Information gained from human centered evaluation was used to develop an intuitive and ergonomic interaction device. Two experiments examined the usability of tracked interaction devices. Usability problems with the devices are discussed. The findings from the experiments were translated into general design guidance, in addition to specific recommendations. A new device was designed on the basis of these recommendations and its usability was evaluated in a second experiment. The results were used to develop a lightweight interaction device for navigation in the virtual maze.

Cognition Disorders↗
PubMed2005

Interdisciplinary collaboration: the heart and soul of health care.

In a health care system in which patient complexity, outcome indicators, and informed families are representative of current reality, an interdisciplinary approach to care is crucial to successful navigation of a patient's experience in the ICU. To guide practitioners toward favorable patient progression, a thorough understanding of interdisciplinary collaboration is necessary. This article focuses on definitions of, benefits of, and barriers to interdisciplinary collaboration and provides practical solutions for implementation.

Attitude of Health Personnel↗
PubMedDate not supplied

[Methods of resolution for haptic assistance during catheterization].

During catheterization navigation within the patient is mainly dependent on a live x-ray image on the screen. Although methods for 3D visualisation and remote navigation of the catheter are discussed and tested still precise positioning is merely the result of intense training and a high skill and level of training of the performing surgeon. This article refers to a system which can be considered as an add-on for existing procedures of catheterization. It compromises of a miniaturised force sensor located at the tip of guide-wires whose prototype is shown here. The measured forces will be presented to the surgeon amplified by an external actuator described in this article. As a result a haptic perception of the forces between the tip of the guide-wire and the vessels walls will be available and enable the surgeon to gain an impression which is comparable to palpation of living vessels from the inside

Catheterization↗
PubMed2003

Coronary artery imaging with real-time navigator three-dimensional turbo-field-echo MR coronary angiography: initial experience.

PURPOSE: To examine the value of a commercially available three-dimensional (3D) real-time navigator magnetic resonance (MR) coronary angiographic examination for detection of significant coronary artery stenoses, with conventional coronary angiography as the standard of reference. MATERIALS AND METHODS: Twenty-one patients underwent 3D navigator MR coronary angiography immediately before catheterization. Two observers independently graded image quality on a scale from 1 (unreadable) to 5 (excellent), quantified coronary artery visualization, and evaluated the presence of significant (ie, >50% narrowing) stenoses. kappa statistics were used to assess interobserver agreement, and receiver operating characteristic (ROC) analysis was used to assess stenosis detection. RESULTS: For two of 21 patients, MR coronary angiogram quality was insufficient for analysis (mean score < 2). For the remaining 19 patients, the mean image quality scores assigned by observers 1 and 2 were 3.3 +/- 1.0 (SD) and 3.2 +/- 0.9, respectively. A mean of 71% of all coronary artery segments were visible at MR coronary angiography, and there was 91% agreement between the observers (kappa = 0.78). Observers 1 and 2 detected significant stenoses (n = 29) at MR coronary angiography with sensitivities of 44.4% and 55.5%, respectively; specificities of 95.1% and 83.7%, respectively; and 80% agreement (kappa = 0.35). Areas under the ROC curve were 0.817 and 0.795 for observers 1 and 2, respectively. CONCLUSION: Large portions of the coronary arteries can be visualized with MR coronary angiography. Imaging results are not consistently reliable, however. The examination is premature for routine clinical assessment of significant coronary artery stenosis owing to low sensitivity and large observer variability.

Adult↗
PubMed2006

The influence of computed tomography motion artifacts on computer-assisted surgery.

PURPOSE: Motion artifacts can significantly deteriorate the precision of a computer-assisted surgical intervention because they destroy the isometric representation of tomographic pictures. In the context of a study, the influence of typical motion artifacts on the precision of markerless laser registration in image-guided oral and maxillofacial surgery was analyzed, and quality factors for evaluation of the isometry of a computed tomography (CT) dataset were determined. PATIENTS AND METHODS: Twenty patients underwent markerless registration, the precision being determined by means of intraoral evaluation markers. Then the 20 CT datasets were used for simulation of a typical motion artifact. The precision of the overlay of the dataset was checked again on the navigation workstation, in absence of the patient. The navigation system used was the Surgical Segment Navigator SSN++ (University of Heidelberg, Heidelberg, Germany). RESULTS: The motion artifacts reduced the average patient registration from 1 to 4 mm. Quality factors for the isometry of a CT dataset were: the volume enclosed between the soft tissue mantles of the preoperative CT dataset and the intraoperative laser scan dataset, as well as the orientation of the normal vectors on the 3-dimensional reconstruction of the CT dataset. CONCLUSION: The isometry of a CT dataset should always be checked before performance of a computer assisted surgical intervention because anisometric datasets result in inaccurate patient registration and navigation.

Artifacts↗
PubMed2003

The new navigation in EHRs: enabling teamwork of professionals and patients.

After development of a state of the art electronic health record, which is accessible via the internet and belongs to a patient, who can manage access to it, the methods of introducing it into routine use in the environment of children's oncology is the theme of this paper. The new navigation in an EHR intends a shared use for the patient, relatives, and different HCPs. The laboratory devices were equipped with an HL7-interface to send messages to the HIS. These messages are combined in documents according to the CDA and sent to the EHR. In a similar way referral letters are uploaded directly from the HIS. Several information resources are used to enlighten the patient and help to enable him to become a member of a team for collaborative care. The varying roles of patient and HCPs lead to some very interesting questions, which have to be answered by a following study.

Germany↗
PubMed2003

Neuroendoscopy based on computer assisted adjustment of the endoscope holder in the laboratory.

OBJECTIVE: We present our initial clinical experience with a novel technique of frameless stereotactic neuroendoscopy using a neuronavigation system, a specially designed aiming device (endoscope holder/targeting device) combined with a vacuum-mouthpiece based head holder. Due to the reproducibility of patient immobilization in the fixation system, the endoscope holder can be adjusted in the laboratory in the absence of the patient. METHODS: An individual vacuum-mouthpiece was fabricated. The patients were scanned with an external reference frame attached to this mouthpiece and the images were transferred to the neuronavigation system. Determination of the path, mouthpiece-based registration and adjustment of the targeting device were performed the day before surgery in the absence of the patient. In the OR the patient was repositioned and the endoscope was introduced through the preadjusted aiming device to the precalculated depth. RESULTS: The novel technique was successfully used for frameless endoscopic navigation in five patients. Three endoscopic third ventriculostomies in adults, one endoscopic septostomy due to unilateral hydrocephalus in an adult female patient and one endoscopic ventriculo-cysto cisternostomy in a 20-month-old girl with a suprasellar arachnoid cyst, were performed with excellent clinical results and without technical complications. CONCLUSION: Our initial experience indicates that frameless stereotaxy, in combination with a relocatable head holder and a special targeting device, allows for precise and preplanned advancement of the neuroendoscope, reducing or even eliminating intraoperative registration and endoscope trajectory adjustments, thus substantially reducing OR time. Due to the non-invasive but rigid immobilization method, neuronavigation can also be performed in children under 2 years of age.

Adult↗
PubMed2026

Unacknowledged Burdens and Clinical Assets of BIPOC Genetic Counseling Students: Qualitative Evidence to Inform Supervision.

As the genetic counseling profession works to diversify its predominantly white workforce, understanding the experiences of Black, Indigenous, and People of Color (BIPOC) students is central to equity efforts. While BIPOC students bring invaluable cultural and linguistic diversity that improves patient care, they often navigate clinical training environments that lack diversity and psychological safety. This article draws on data from a longitudinal constructivist qualitative study to examine how racial and ethnic concordance (or lack thereof) with patients and clinical supervisors influenced the clinical training, professional development, and well-being of BIPOC genetic counseling students. Semi-structured interviews were conducted with 25 BIPOC genetic counseling students in the United States and Canada. Interviews were recorded using Zoom.us, transcribed using Rev.com, and analyzed in NVivo using reflexive thematic analysis. The analysis led to the construction of three themes: (1)Shared identity with patients is a clinical advantage: Participants leveraged their cultural and linguistic intuition to establish trust and rapport with patients; (2) Identity navigation involves cognitive and emotional labor: Participants shouldered an unacknowledged burden in managing stereotype threat, overcoming feelings of exclusion, and educating supervisors; and (3) Racial/ethnic identity shapes supervisory dynamics: Participants described BIPOC supervisors as providing identity-affirming support, while some white supervisors avoided discussions about identity or committed microaggressions. These results suggest that BIPOC genetic counseling students have clinical assets rooted in biculturalism, yet carry a burden that often goes unacknowledged of managing power imbalances and pressure to assimilate in predominantly white clinical supervision spaces. To promote equitable training, programs should implement supervisor training on culturally responsive identity broaching, establish independent, transparent mechanisms for students to report biases they encounter in clinic, and expand mentorship networks to provide additional support.

Humans↗
PubMed2003

Total knee arthroplasty implanted with and without kinematic navigation.

Between September 2000 and February 2002 we inserted 120 total knee arthroplasties. In 60 patients we used the standard technique, and in 60 patients we used the OrthoPilot navigation system. Postoperatively all patients had standing long radiographs of the lower extremity from the hip joint to the ankle. We considered the ideal value of the anatomic lateral tibiofemoral angle (LTFA) to be 174 degrees. In the standard group the mean value of LTFA was 174.9 degrees and in the navigation group 174.3 degrees. A deviation between 0 degrees and 2 degrees from the ideal value was seen in 42 cases in the standard group and in 53 cases in the navigation group. In the standard group 18 cases had a deviation of more than 2.1 degrees, whereas there were only seven cases in the navigation group with a deviation exceeding 2.1 degrees. There were no complications related to the use of the navigation system. The system affords a possibility to place femoral and tibial components precisely with less axis deviation than with the conventional technique.

Aged↗
PubMed2002

Adherence to HIV drug therapy.

Antiretroviral therapy has dramatically improved the prognosis for many patients with HIV infection. For many patients who can navigate combinations of drugs and time their doses precisely, these drug regimens typically slow the progression of the disease and lengthen survival. But because these drug regimens are very complex, adherence--the degree to which patients follow medical advice in taking the prescribed drugs--is now a major determinant of HIV treatment success. This Issue Brief summarizes recent work on the effect of adherence on short-term outcomes, and the ability of providers to predict and estimate their patients' adherence to therapy.

Antiretroviral Therapy, Highly Active↗
PubMed1997

Image-guided endoscopic ENT surgery.

Intraoperative three-dimensional (3D) "navigation" has significantly improved patient safety during operative procedures on the paranasal sinuses and the frontal skull base. The ISG Viewing Wand (ISG Technologies, Mississauga, Ontario, Canada) is now used routinely for such procedures in our hospital at the present time. Current use with our radiological and intraoperative protocols has demonstrated a clinical accuracy of 1-2 mm. Initial experience with the ARTMA Virtual Patient (ARTMA Biomedical, Vienna, Austria) has allowed endoscopic 3D navigation by using augmented reality techniques and has been found to be very promising. We present our experience with these systems and discuss the impact of these unique techniques on computer-assisted surgery (CAS) in otorhinolaryngology and head and neck surgery.

Adult↗
PubMed1998

Hypertextual navigation operationalizing generic clinical practice guidelines for patient-specific therapeutic decisions.

Despite the proliferation of implemented clinical practice guidelines, there is still little evidence of physicians compliance to formal standards. The ONCODOC project proposes a framework for elaborating generic decision support guidelines in a document-based paradigm with a knowledge-based approach. It has been first applied to assist clinicians in the treatment of breast cancer patients. Therapeutic expertise has been encoded as a decision tree. The decision process is driven by the clinician who interactively browses a hypertext version of the decision tree. During the navigation, he incrementally assigns values to decision parameters on the basis of his free interpretation of his patient's condition and thus builds a clinical context leading to patient-specific therapeutic recommendations. These guidelines are distributed on a hospital intranet and are evaluated at the point of care in an oncology department.

Breast Neoplasms↗
PubMed2003

Stereotactic single-dose radiotherapy of stage I non-small-cell lung cancer (NSCLC).

PURPOSE: The treatment of early-stage lung cancers is a primary domain of thoracic surgery, leading to persuasive results. In patients with medical contraindications, radiotherapy is an alternative, although with considerably worse outcome. Radiotherapy is associated with the risk of severe acute side effects and a permanent decrease of lung function. By the introduction of an extracranial stereotactic treatment technique, the amount of normal tissue in the high-dose region can be reduced, allowing the performance of single-dose treatment with high, biologically effective doses. METHODS AND MATERIALS: Between October 1998 and May 2001, 10 patients with histologically confirmed Stage I non-small-cell lung cancer were treated with stereotactic single-dose radiotherapy. A self-developed stereotactic frame was used for patient positioning and navigation. Total doses applied ranged from 19 to 26 Gy. After treatment, regular CT-based follow-up was performed. RESULTS: During a median follow-up period of 14.9 months, the tumors in 8 of 10 patients were locally controlled. The actuarial overall survival was 80% and 64%, respectively, 12 and 24 months after therapy. Actuarial local recurrence-free survival reached 88.9% and 71.1%, respectively. Therapy-related perifocal normal-tissue reaction occurred in 70% of all treated patients, although no major clinical symptoms were seen. In 5 patients, systemic metastases were found during follow-up; 1 patient developed suspect mediastinal lymph nodes. CONCLUSION: Stereotactic single-fraction radiotherapy is a feasible, safe, and effective procedure for the treatment of Stage I non-small-cell lung cancer. It promises high local control with a reduced overall treatment time. However, further investigation in a larger patient collective with extended follow-up is necessary.

Adenocarcinoma↗
PubMed2001

[Advances in the diagnosis of tumours by imaging methods (possibilities of three-dimensional imaging and application to volumetric resections of brain tumours with evaluation in virtual reality and subsequent stereotactically navigated demarcation].

Oncological problems are so varied that it is very difficult to record all advances in different diagnostic branches in a comprehensive manner. In the first part the authors focus attention on an example of the possible use of imaging examination methods in conjunction with different types of three-dimensional imaging used in their hospital. The second part is devoted to volumetric resections of brain tumours with navigated demarcation. In 17 patients the authors used the PC working station equipped with navigation software STEREOPLAN PLUS for planning volumetric resection of different brain tumours in virtual reality. The demarcation proper of the brain tumour size during surgery was implemented by means of a stereotactic apparatus ZAMORANO-DUJOVNY and a pointer in the field of the microscope. The accuracy of navigation of the whole system for demarcation of the tumourous affection was +/- 1 mm. The intervention was supplemented by functional examination by means of surface electrodes during partial awakening of the patient for mapping the functional areas of the cerebral cortex. The result was resection of relatively precise volumes of tumourous tissue with the possibility of maximum preservation in particular of motor but also other functions of the CNS.

Adult↗
PubMedDate not supplied

Use of personal digital assistants for retrieval of medical images and data on high-resolution flat panel displays.

For its new acute care hospital, the University of California at Los Angeles is evaluating innovative technology involving high-resolution flat panel display devices configured as "network appliances" that can be wall mounted for use in the retrieval and display of medical images and data. Physicians and healthcare providers can log on with wireless handheld computers, which can serve as an identification device as well as a navigational tool for selecting patient records and data. These data are displayed and manipulated on the flat panel display without the need for a keyboard or mouse. A prototype was developed with commercially available image display software, which was modified to allow the remote control of software functions from a handheld device through an infrared communication port. The system also allows navigation through the patient data in a World Wide Web-based electronic patient record. This prototype illustrates the evolution of radiologic facilities toward "shareable" high-quality display devices that allow more convenient and cost-effective access to medical images and related data in complex clinical environments, resulting in a paradigm shift in data navigation and accessibility.

Computers, Handheld↗
PubMed1997

Application of a three-dimensional intraoperative navigational system in craniofacial surgery.

Recent advances in imaging technology have prompted the development of new instrumentation that permits direct interactive visualization of image data in the operating room. The ISG Viewing Wand (ISG Technologies, Mississauga, Ontario, Canada) is a frameless stereotactic system that combines three-dimensional computer-assisted imaging with a hand-guided, position-sensing, articulated arm. In this article we describe the use of the ISG Viewing Wand as a three-dimensional intraoperative navigational system in craniofacial surgery and review our initial clinical experience in 17 patients. The wand was used as an aid in the correction of craniofacial asymmetry in 12 patients and as a navigational device assisting in craniofacial skeletal resection in 5 patients. By orienting the surgeon to his exact location throughout the procedure, the ISG Viewing Wand was found to be useful in defining intraorbital anatomy, in determining ocular globe position, and in delineating tumor margins. Excellent anatomical spatial correlation was obtained, and the probe tip position was within 2 mm of its actual position in all cases. Use of the system added minimal additional time, and overall no adverse effects were attributed to use of the wand.

Analog-Digital Conversion↗