Transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) repair of inguinal hernia

Both the transabdominal preperitoneal and the totally extraperitoneal repair of inguinal hernia have gained wide popularity throughout the surgical community. Recent guidelines issued by the International Endohernia Society noticed the lack of high-quality comparative evidence between endoscopic and laparoscopic inguinal hernia repair. In view of the wide dissemination of minimally invasive techniques for inguinal hernia repair and the high prevalence of this surgical disease, evaluation of currently available high quality comparative evidence of contemporary modalities is essential. A systematic review and meta-analysis of randomized trials, quasi-randomized studies and prospective non-randomized studies comparing the transabdominal with the preperitoneal approach of inguinal hernia repair was undertaken, with the objective to evaluate the outcomes of the two techniques, as expressed by the incidence of recurrence, operative morbidity and chronic pain. The electronic databases of the National Library of Medicine, Excerpta Medica and the Cochrane Central Register of Controlled Trials were searched. No language restrictions were applied, and abstracts of articles in other than the English language were translated. The Medical Subject Headings (MeSH terms) “laparoscopy”, “endoscopy” and “inguinal hernia”, and the terms “TAPP”, “preperitoneal”, “properitoneal”, “TEP”, “totally extraperitoneal”, “total extraperitoneal” were used. A total number of 18 articles (10 randomized and 8 prospective case-control studies) were included in the analysis. The selected studies were published in the English language. The cumulative study population consisted of 1288 patients with a total of 1303 hernia defects. Our meta-analytical model demonstrated similar recurrence rates for the preperitoneal (1.4 %) and the transabdominal approach (3.5%), with a trend in favor of the TEP repair. The incidence of intraoperative complications was similar for the laparoscopic and the preperitoneal approach (3.6% vs. 2.0%, respectively). Postoperative in-hospital morbidity was similar for TAPP and TEP (11.2% vs. 7.3%), with no evidence of between-study heterogeneity and no evidence of publication bias. No significant differences between the TAPP and the TEP repair were demonstrated with regard to operative time (73.0 versus 70.9 minutes, respectively), whereas significant heterogeneity existed among studies. Postoperative pain as expressed by the visual analogue scoring system was similar between TAPP and TEP (2.4 vs. 2.2), although heterogeneity and publication bias were evident. Furthermore, no significant differences in terms of long-term pain or sensory deficits were found between the two treatment arms. A trend in favor of the transabdominal approach could not be statistically confirmed (6.1% vs. 9.1%). Current data suggest similar results for laparoscopic and endoscopic inguinal hernia repair with regard to patient-oriented outcomes. A trend toward higher recurrence rates with the TAPP repair must not be disregarded, and may suggest modification of technical details, in order to provide long-term outcomes to the patients. Discrete differences between the transabdominal and the preperitoneal repair render transition from one technique to another rather not justified according to current data. High-quality randomized trials with a longer-term follow-up are considered essential, in order to further assess the relative effectiveness of the two procedures in the prevention of hernia recurrence

Advanced observation and telemetry heart system utilizing wearable ECG device and a Cloud platform

Short lived chest pain episodes of post PCI patients represent the most common clinical scenario treated in the Accidents and Emergency Room. Continuous ECG monitoring could substantially diminish such hospital admissions and related ambulance calls. Delivering community based, easy-To-handle, easy to wear, real time electrocardiography systems is still a quest, despite the existence of electronic electrocardiography systems for several decades. The PATRIOT system serves this challenge via a 12-channel, easy to wear, easy to carry, mobile linked, miniaturized automatic ECG device and a Cloud platform. The system may deliver high quality electrocardiograms of a patient to medical personnel either on the spot or remotely both in a synchronous or asynchronous mode, enhancing autonomy, mobility, quality of life and safety of recently treated coronary artery disease patients

Design and evaluation of a person-centric heart monitoring system over fog computing infrastructure

Heart disease and stroke are becoming the leading cause of death worldwide. Electrocardiography monitoring devices (ECG) are the only tool that helps physicians diagnose cardiac abnormalities. Although the design of ECGs has followed closely the electronics miniaturization evolution over the years, existing wearable ECG have limited accuracy and rely on external resources to analyze the signal and evaluate heart activity. In this paper, we work towards empowering the wearable device with processing capabilities to locally analyze the signal and identify abnormal behavior. The ability to differentiate between normal and abnormal heart activity significantly reduces (a) the need to store the signals, (b) the data transmitted to the cloud and (c) the overall power consumption. Based on this concept, the HEART platform is presented that combines wearable embedded devices, mobile edge devices, and cloud services to provide on-the-spot, reliable, accurate and instant monitoring of the heart. The performance of the system is evaluated concerning the accuracy of detecting abnormal events and the power consumption of the wearable device. Results indicate that a very high percentage of success can be achieved in terms of event detection ratio and the device being operative up to a several days without the need for a recharge

On the Deployment of Healthcare Applications over Fog Computing Infrastructure

Fog computing is considered as the most promising enhancement of the traditional cloud computing paradigm in order to handle potential issues introduced by the emerging Interned of Things (IoT) framework at the network edge. The heterogeneous nature, the extensive distribution and the hefty number of deployed IoT nodes will disrupt existing functional models, creating confusion. However, IoT will facilitate the rise of new applications, with automated healthcare monitoring platforms being amongst them. This paper presents the pillars of design for such applications, along with the evaluation of a working prototype that collects ECG traces from a tailor-made device and utilizes the patient's smartphone as a Fog gateway for securely sharing them to other authorized entities. This prototype will allow patients to share information to their physicians, monitor their health status independently and notify the authorities rapidly in emergency situations. Historical data will also be available for further analysis, towards identifying patterns that may improve medical diagnoses in the foreseeable future

Effects of multimedia computer-assisted instruction (MCAI) on academic achievement in physical education of Greek primary students

Computer technology has become an integral part of physical education, yet there have been few studies exploring the use of multimedia technology in the instruction of Physical Education. The purpose of this study was to investigate if Computer Assisted Instruction (CAI) in Physical Education is functional in the school environment. An interactive multimedia CD-ROM program was developed, especially for the needs of the study, titled «The tree of Health». This intervention trial involved 12 fifth- and sixthgrade classes (N = 248 students), randomized into 3 groups: Multimedia Computer Assisted Instruction, Traditional Approach to teaching (TA), and Control. Students were tested using pre and post-tests that measured knowledge of «Health related fitness» subjects. The experiment lasted 12 class hours, two classes per week over six weeks. The results of an analysis of covariance indicated that there was a significant increase in achievement post-test for the (MCAI) group when compared to either the (TA) or control groups, F(1, 238) = 13.486, p < .0167; F(1, 238) = 53.872, p < .0167. These results indicate that this new educational tool is an effective way to introduce health-related physical education programs for young students in typical classroom settings.Computer technology has become an integral part of physical education, yet there have been few studies exploring the use of multimedia technology in the instruction of Physical Education. The purpose of this study was to investigate if Computer Assisted Instruction (CAI) in Physical Education is functional in the school environment. An interactive multimedia CD-ROM program was developed, especially for the needs of the study, titled «The tree of Health». This intervention trial involved 12 fifth- and sixthgrade classes (N = 248 students), randomized into 3 groups: Multimedia Computer Assisted Instruction, Traditional Approach to teaching (TA), and Control. Students were tested using pre and post-tests that measured knowledge of «Health related fitness» subjects. The experiment lasted 12 class hours, two classes per week over six weeks. The results of an analysis of covariance indicated that there was a significant increase in achievement post-test for the (MCAI) group when compared to either the (TA) or control groups, F(1, 238) = 13.486, p < .0167; F(1, 238) = 53.872, p < .0167. These results indicate that this new educational tool is an effective way to introduce health-related physical education programs for young students in typical classroom settings

Effects of multimedia computer-assisted instruction (MCAI) on academic achievement in physical education of Greek primary students

Computer technology has become an integral part of physical education, yet there have been few studies exploring the use of multimedia technology in the instruction of Physical Education. The purpose of this study was to investigate if Computer Assisted Instruction (CAI) in Physical Education is functional in the school environment. An interactive multimedia CD-ROM program was developed, especially for the needs of the study, titled «The tree of Health». This intervention trial involved 12 fifth- and sixthgrade classes (N = 248 students), randomized into 3 groups: Multimedia Computer Assisted Instruction, Traditional Approach to teaching (TA), and Control. Students were tested using pre and post-tests that measured knowledge of «Health related fitness» subjects. The experiment lasted 12 class hours, two classes per week over six weeks. The results of an analysis of covariance indicated that there was a significant increase in achievement post-test for the (MCAI) group when compared to either the (TA) or control groups, F(1, 238) = 13.486, p < .0167; F(1, 238) = 53.872, p < .0167. These results indicate that this new educational tool is an effective way to introduce health-related physical education programs for young students in typical classroom settings.Computer technology has become an integral part of physical education, yet there have been few studies exploring the use of multimedia technology in the instruction of Physical Education. The purpose of this study was to investigate if Computer Assisted Instruction (CAI) in Physical Education is functional in the school environment. An interactive multimedia CD-ROM program was developed, especially for the needs of the study, titled «The tree of Health». This intervention trial involved 12 fifth- and sixthgrade classes (N = 248 students), randomized into 3 groups: Multimedia Computer Assisted Instruction, Traditional Approach to teaching (TA), and Control. Students were tested using pre and post-tests that measured knowledge of «Health related fitness» subjects. The experiment lasted 12 class hours, two classes per week over six weeks. The results of an analysis of covariance indicated that there was a significant increase in achievement post-test for the (MCAI) group when compared to either the (TA) or control groups, F(1, 238) = 13.486, p < .0167; F(1, 238) = 53.872, p < .0167. These results indicate that this new educational tool is an effective way to introduce health-related physical education programs for young students in typical classroom settings