Design and additive manufacturing of a patient specific polymer thumb splint concept

Traditionally, upper limb splints often fall short of being optimal with respect fit and patient expectations, resulting in a lack of use and no treatment of the underlying condition. In this study we address several current limitations and examine the feasibility of using 3D optical scanning, Computer Aided Design (CAD) and low cost 3D printing as a tool to create more ergonomic and efficacious splints for patients suffering from compromised musculature or trauma of the thumb. Optical scanning allows for a non-invasive and rapid means to reproduce the surface topology of a person's hand and this data was used as the template for the device design. We explore the use of CAD to create a more aesthetically pleasing and functional splint, enhancing both comfort and potential moisture release. Finally, we demonstrate that low cost polymer printing can allow for rapid design evaluation and production of a final, usable device

PhysicTV - Motion-based physical rehabilitation games for the Google-TV

O termo PhysicTV é composto por dois termos distintos. O primeiro (Physic - Físico) refere-se ao aspeto físico associado ao objetivo da plataforma e o segundo (TV - Televisão) refere-se ao aspeto tecnológico uma vez que os jogos a desenvolver vão ser jogados numa televisão.Enquanto plataforma, o PhysicTV contém duas tecnologias principais: XtionPRO e GoogleTV. Os principais objetivos deste projeto são a integração entre essas tecnologias e o desenvolvimento de jogos eletrónicos que possam ser utilizados para efeitos de reabilitação. O primeiro desses objetivos constituirá uma vertente inovadora e o segundo vai permitir ao fisioterapeuta uma ligeira mudança nas sessões com os seus pacientes, tornando-as mais dinâmicas e mantendo os pacientes mais motivados aquando da realização de exercícios. Com o XtionPRO e os seus sensores de movimento, é possível ao utilizador interagir com o sistema através dos movimentos dos braços, permitindo-lhe realizar exercícios e ir melhorando durante as sessões.PhysicTV as a concept is composed of two distinct terms. The first (Physic) relates to the physical aspect associated with the platform and the second (TV) relates to the technological component of the project since the games to developed will be played on a television screen.As a platform, PhysicTV contains two main technologies: XtionPRO and GoogleTV. The main goals of this project are the successful integration between those two technologies and the development of electronic games that can be used for rehabilitation purposes. The first goal will guarantee an inovative side and the second will allow the physioterapist to change a bit the sessions with his patients, making those sessions more dynamic and keeping the patients more motivated when doing the exercises. With the XtionPRO, that has motion sensors, it is possible for the user to interact with the system with arm movements, allowing him/her to do physical exercises and consequently keep improving during the sessions

Investigating practice variation in a changing primary care. A multilevel perspective on The Skaraborg Primary Care Database

Background and Aims: Differences in the clinical care of patients have been explained through the concept of practice variation, that is, the occurrence of established local medical procedures that varies between geographic areas. The primary measures introduced to eliminate undesirable differences in medical care are the introduction of medical guidelines and economical incentives that rewards the desired behaviour. Practice variation in primary care can be seen on different hierarchically organised levels (e.g. patient, physician, health care center (HCC)) and Multilevel Regression analysis techniques (MLRA) offer a suitable tool to analyse these kinds of data. Data extracted from computerised medical records are ideal for studying practice variation as they often comprise information from several levels. In the region of Skaraborg in Sweden a new database, the Skaraborg Primary care database (SPCD), comprising information extracted form the computerised medical records of all public health care centres has recently been established. The overall aims of this thesis were to examine the usefulness and quality of the SPCD database for research and to study practice variation in some important areas such as diagnosis registration, laboratory analysis ordering and prescriptions. Furthermore, the influence of changes in the economic incentives on physician’s clinical behaviour was investigated. Material and Methods: In all studies data from the SPCD comprising data on individual patients from all public health care centres was used. The registration of diagnoses in the SPCD was validated by comparing the occurrence of recorded diagnosis in the diagnosis register of the database with the free text part of the patient medical records for a randomly selected sample of patients. Multilevel logistic regression analysis was used to investigate practice variation in prescribing and laboratory test ordering, focusing on measures of both frequency and variance. The effects of changes in economic incentives for diagnosis coding and prescribing were examined by comparing multilevel analysis results before and after implementation of the economic incentives. Results and Conclusions: The frequency of registration of ICD codes varied between diagnoses but also between physicians and HCCs. Different diagnoses need to be validated separately. The occurrence of practice variation was demonstrated both in laboratory test ordering where the physician level was the most important level and in prescribing where physician and HCC levels were equally important in explaining the observed variation. A positive effect in adherence to prescribing guidelines was demonstrated after the introduction of a decentralised drug budget. The introduction of a strong economic incentive for ICD coding showed the expected rise in coding rates and decline in variation, directly affecting the diagnoses register of the research database. Changes in the healthcare process will have a direct impact on the research database. Knowledge about the local health care processes is essential when interpreting database data. The SPCD seems as a good complement to previously established databases and quality registers, offering new possibilities when studying primary care

Watch your back : exploration of the practical usability of a visual feedback apparatus for patients with chronic non-specific low back pain

Background : An effective treatment of chronic lumbar back pain is still one of the challenges in physiotherapy. So far, numerous treatment methods exist, but the use of real time visual feedback is one of the newer therapeutic approaches. Its implementation possibilities, however, should be investigated further by more research. Objective : Therefore, the aim of this bachelor thesis is to develop a video-supported system for visual feedback and to test its usability. Procedure : As 85 percent of chronic back pain in the lumbar spine is not due to structural pathologies, this patient population was targeted. Based on the current literature, the clinical picture was presented in a use case. A prototype of a device for a video transmission of the back was developed and tested on a patient with chronic nonspecific lumbar back pain. Result : The system was evaluated using the system usability scale and reached a value of 77.5 out of 100, which represents a good usability. Conclusion : By means of technical adjustments to avoid a delay in transmission and by an exact positioning of the monitor, an improvement of the usability can be achieved. Further research is required to evaluate the developed system for its efficacy in the treatment of chronic lumbar back pain.Darstellung des Themas : Chronische lumbale Rückenschmerzen erfolgreich zu therapieren gehört nach wie vor zu den Herausforderungen in der Physiotherapie. Zahlreiche Behandlungsmethoden existieren, der Einsatz von visuellem Echtzeit-Feedback gehört jedoch zu einem neueren Therapieansatz, dessen Implementierungsmöglichkeiten aber noch durch weitere Forschung genauer untersucht werden sollte. Ziel : Daher ist es das Ziel dieser Bachelorthesis, ein videogestütztes System für visuelles Feedback zu entwickeln und dieses hinsichtlich dessen Anwendbarkeit zu überprüfen. Vorgehen : Da 85 Prozent der chronischen Rückenschmerzen in der Lendenwirbelsäule nicht auf strukturelle Pathologien zurückzuführen sind, wurde der Fokus auf diese Patientenpopulation gelegt. Anhand der aktuellen Literatur wurde das klinische Bild in Form eines Use Case dargestellt, der Prototyp eines Apparates zur Videoübertragung des Rückens entwickelt, und an einem Patienten mit chronischen unspezifischen lumbalen Rückenschmerzen getestet. Ergebnis : Das System wurde mit der System Usability Scale überprüft, und erreichte 77,5 von 100 Punkten, was einer guten praktischen Anwendbarkeit entspricht. Schlussfolgerung : Anhand technischer Anpassungen zur Vermeidung einer zeitlichen Verzögerung bei der Übertragung und durch eine exakte Positionierung des Monitors könnte eine Verbesserung der praktischen Anwendbarkeit erreicht werden. Weitere Forschung ist erforderlich, um das entwickelte System auf seine Wirksamkeit bei der Behandlung chronischer lumbaler Rückenschmerzen hin zu untersuchen

Proceedings30th European Symposium on Clinical PharmacyIntegrating Pharmaceutical Care into Practice10 - 13 October 2001, Antwerp, Belgium

http://dx.doi.org/10.1023/A:101740901402

Strategic destigmatisation in market entry – case analysis of online communication in the pelvic health market

Stress urinary incontinence (SUI) is a stigmatising medical and social problem suffered in silence by millions of people globally. The worldwide market for adult incontinence protection is larger than the mobile phone market in the United Kingdom, which means that this consumer group has significant purchasing power. Companies planning to enter the market with exercise products for pelvic floor muscles face barriers to entry related to the stigma of incontinence. This thesis shows how three companies, which have entered the market in recent years strategically use stigma related multimodal discourse, and especially stigma removal (destigmatisation) in their public online communication. New destigmatising discursive practices such as devictimisation, empowerment, anonymisation and medicalisation were discovered. Rationalisation, scientification and conformisation were recognized, in line with previous studies’ findings. Devictimisation, empowerment and anonymisation were targeted to relieve the client stigma. Medicalisation is used in a new context for raising awareness about the incontinence problem and building legitimacy for the products. A combination of the stigma removal practises was used for product differentiation and positioning. Destigmatisation was used also for risk management purposes; to affect client purchasing behaviour by highlighting positive and minimising negative risk factors. A stigmatising discursive practice such as shaming was actively used by one company to attack a competitor. Anonymising was intended to be used for destigmatising clients yet it could be interpreted as maintaining a stigma related to female body. This thesis expands the research of stigmatised markets into a new industry and adds to the theory of strategies for entering them. It develops the dimensions of strategy by taking into consideration the hidden stakeholder communication as well as the active stigmatisation aspects. It builds upon the research by empirically revealing a “sleeper” strategy -previously theorised but not proven. For managerial implications this thesis brings out the systemic nature of the stigma related challenges in strategy formulation, as well as the criticality of consistent implementation of the entry plans in stigmatized markets. Future research proposals include exploring the interface between corporate social responsibility and business ethics, and further exploring a customer’s role in stigmatised markets. An interesting research topic would be to attempt to quantify the role of for-profit companies in contributing to a positive affect in treating the root causes of SUI

A Conversational Agent in mHealth for Self-Management of Parkinson’s Disease

Nos dias que correm vivemos rodeados de tecnologia, onde os “smartphones” preenchem um espaço muito importante nas nossas vidas. O uso de serviços móveis pelos “smartphones” no âmbito da saúde tem sido cada vez mais próspero, com um uso acessível por parte de todos. Com os avanços ao nível de inteligência artificial, especialmente no que toca à criação de sistemas inteligentes que comuniquem de forma natural com os humanos, torna-se possível criar agentes de conversação adequados para uma interação pessoa-máquina com distintos objetivos. Um dos objetivos que o projeto ONParkinson tem é o de aumentar a adesão terapêutica por parte das pessoas com doença de Parkinson. Sendo que a execução recorrente de exercício físico é essencial na gestão dos sintomas da doença de Parkinson. Por isso, existe a necessidade de interagir, educar e motivar os pacientes com doença de Parkinson para uma maior adesão aos exercícios terapêuticos. Este trabalho propõe uma solução, no âmbito do projeto ONParkinson, que envolve a criaçãao de um agente de conversação com unidades de conhecimento mais focadas nos exercicios terapêuticos e com unidades que visam motivar e manter a pessoa com doença de Parkinson motivada para a realização de exercícios terapêuticos. A avaliação da solução envolve fisioterapeutas e pessoas com doença de Parkinson. O plano de avaliação estabelece o estudo do desempenho técnico, da experiência do utilizador e da investigação na área da Saúde. Grande parte do conjunto dos pacientes com doença de Parkinson tem uma idade avançada, o que poderia levar a uma maior resistência ao uso das novas tecnologias. No entanto, os valores obtidos nos indicadores referentes à perspetiva de utilidade, facilidade de uso e satisfação da utilização demonstram um bom nível de usabilidade da solução proposta. Como a investigação de eficácia clínica ainda não foi conduzida, não é possível concluir a efiácia da solução proposta no aumento da adesão terapêutica por parte dos pacientes com doença de Parkinson.Nowadays, we live surrounded by technology, where smartphones fill a very important space in our lives. The use of mobile services by smartphones in the health sector has been increasingly prosperous, with accessible use by everyone. With advances in artificial intelligence methodologies, regarding the creation of intelligent systems that communicate naturally with humans, it is possible to create conversational agents for person-machine interaction with different objectives. One of the goals of the ONParkinson project is to increase therapeutic adherence by people with Parkinson’s disease. The recurrent execution of physical exercise is essential in the management of the symptoms of Parkinson’s disease. Therefore, there is a need to interact, educate and motivate patients with Parkinson’s disease for greater adherence to therapeutic exercises. This work proposes a solution, within the scope of the ONParkinson project, which involves the creation of a conversation agent with units of knowledge more focused on therapeutic exercises and with units aiming to motivate and keep the person with Parkinson’s disease motivated to perform therapeutic exercises. The evaluation of the solution involves physical therapists and patients with Parkinson’s disease. The evaluation plan establishes the study of technical performance, the study of user experience and Health research study. A large part of the set of patients with Parkinson’s disease is of advanced age, which could lead to greater resistance to the use of new technologies. However, the values obtained in the indicators referring to the perception of usefulness, ease of use and interaction satisfaction demonstrate a good level of usability of the proposed solution. As the investigation of clinical efficacy has not yet been conducted, it is not possible to conclude the effectiveness of the proposed solution in increasing therapeutic adherence by patients with Parkinson’s disease

Enhanced Living Environments

This open access book was prepared as a Final Publication of the COST Action IC1303 “Algorithms, Architectures and Platforms for Enhanced Living Environments (AAPELE)”. The concept of Enhanced Living Environments (ELE) refers to the area of Ambient Assisted Living (AAL) that is more related with Information and Communication Technologies (ICT). Effective ELE solutions require appropriate ICT algorithms, architectures, platforms, and systems, having in view the advance of science and technology in this area and the development of new and innovative solutions that can provide improvements in the quality of life for people in their homes and can reduce the financial burden on the budgets of the healthcare providers. The aim of this book is to become a state-of-the-art reference, discussing progress made, as well as prompting future directions on theories, practices, standards, and strategies related to the ELE area. The book contains 12 chapters and can serve as a valuable reference for undergraduate students, post-graduate students, educators, faculty members, researchers, engineers, medical doctors, healthcare organizations, insurance companies, and research strategists working in this area

Lateral versus posterior approach to shoulder injection in patients with subacromial impingement syndrome: A mixed methods study

Objectives: To determine the effectiveness of lateral approach to subacromial injection compared to posterior approach for the treatment of subacromial impingement syndrome (SAIS); and to establish the experiences of SAIS patients receiving these injections associated with better clinical outcomes. Design: This study used a mixed methods approach that combines a pragmatic randomised control trial to investigate which injection approach is better and a semi-structured qualitative interview to investigate the experiences of SAIS patients receiving these injections. Settings: Out-patients community musculoskeletal service Sample: 80 patients with SAIS for the randomised control study and 20 participants for the semi-structured qualitative interview. Interventions: The Intervention group received a single subacromial injection with a 21-gauge Green needle with a 40 mg/ml of Kenalog and a 4 ml 1% of Lidocaine through a lateral approach. The Control group received an identical treatment except that the location was by a posterior approach. Outcome measures: Difference in improvements in the overall patient reported outcome measures (PROMs) and shoulder pain and disability index score (SPADI) at 8 and 12 weeks follow-up between the two groups. Results: A moderate but statistically and clinically significant difference in improvement in day-time pain (mean change score) occurred in favour of the lateral group (mean = 3.7) compared with the posterior group (mean = 2.3) between week 0 to 8 (1.4 points [95% CI 0.3 to 2.6, p = 0.018]). However, there were no statistically significant differences between the groups in night-time pain, shoulder function and SPADI scores. There was a statistically and clinically significant difference (p = 0.001) within the groups for all clinical outcomes between week 0 to 8 and between week 0 and 12. This was confirmed by participants from the semi-structured interviews which were conducted 12 weeks after the injection. Conclusion: There were no real significant differences in the treatments; however, both forms of treatment were associated with significant improvement in shoulder pain, function and disability. This was confirmed by participants from the semi-structured interviews, who felt that they improved not only because of the effect of the cortisone injection, but also because of other factors such as education about their treatment, exercise information, the experience and skills of the injecting clinicians, access to treatment as well as good customer service