A telemedicine distributed system for cooperative medical diagnosis

Procceedings of: Eighteenth Annual Symposium on Computer Aplications in Medical Care, november 5-9, 1994, Washington, USA. Edited by Judy G. OzboltTelemedicine is changing the classicalform of health care delivery, dramatically increasing the number of new applications in which some type of distributed synchronous cooperation between health care professionals is required. This paper presents the design and development ofa telemedicine distributed system for cooperative medical diagnosis based on two new approaches: 1) a distributed layered architecture specially designed to add synchronous computer supported cooperative workfeatures either to new or existing medical applications; 2) the definition of a methodological procedure to design graphical user interfaces for telemedicine cooperative working scenarios. The cooperative work is supported by a collaborative toolkit that provides telepointing, window sharing, coordination and synchronization. Finally, we have implemented and installed the telemedicine system in clinical practice between two hospitals, providing teleconferencing facilities for cooperative decision support in haemodynamics studies. This specific implementation and a preliminary evaluation were accomplished under the Research Project FEST "Framework for European Services in Telemedicine" funded by the EU AIM Programme.This work is supported in part by EU - AIM FEST project no. A-201 1, and by grants CICYT TEMA TIC 92-1288-PB and TELEMEDICINA TIC 93-1279-E.Publicad

Laparoscopic Video Analysis for Training and Image Guided Surgery

Automatic analysis of Minimally Invasive Surgical video has the potential to drive new solutions for alleviating needs of safe and reproducible training programs, objective and transparent evaluation systems and navigation tools to assist surgeons and improve patient safety. Surgical video is an always available source of information, which can be used without any additional intrusive hardware in the operating room. This paper is focused on surgical video analysis methods and techniques. It describes authors' contributions in two key aspects, the 3D reconstruction of the surgical field and the segmentation and tracking of tools and organs based on laparoscopic video images. Results are given to illustrate the potential of this field of research, like the calculi of the 3D position and orientation of a tool from its 2D image, or the translation of a preoperative resection plan into a hepatectomy surgical procedure using the shading information of the image. Research efforts are required to further develop these technologies in order to harness all the valuable information available in any video-based surgery

Capacidad de aprendizaje y responsabilidad: validación del proceso de evaluación en una asignatura del grado de farmacia y percepción de los estudiantes sobre su capacidad de aprender a aprender

Se exponen los resultados de la validación del proceso de evaluación mediante rúbrica de las Prácticas de una asignatura del Grado de Farmacia para desarrollar la competencia Capacidad de Aprendizaje y Responsabilidad, demostrándose la cohesión entre las puntuaciones de profesores y la autoevaluación de alumnos. La percepción de estos estudiantes respecto al desarrollo de su capacidad de Aprender a Aprender se recoge mediante un cuestionario cerrado. La mayoría piensa que se aprende de los errores

Community projects based on Art & Health: A collaboration between the Faculty of Fine Arts at the Complutense University of Madrid and Madrid city council's Madrid Salud Service

In 2011 the Faculty of Fine Arts at the Complutense University of Madrid, and Madrid City Council's Health Promotion and Prevention Service (Madrid Salud Service) signed a collaboration agreement for developing joint projects and activities. This mutual collaboration agreement has generated an extremely active working network, in which university students supported by health service professionals plus Faculty academics and researchers have designed, and developed, community projects based on art and health with a number of groups (children, adolescents, women at risk, people with diversity, etc.). Across all these projects, both artistic creativity and art education have worked as mediators to offer significant experiences in promoting health. These arts programs (painting, drawing, photography, textiles, dialogues, and art appreciation) have been designed and developed by students for these communities and groups. These community projects based on art and health emphasise the capacity for commitment and collaboration of the groups and communities involved. Students and participants create together and in an atmosphere of trust, with awareness of their abilities and of the importance of art as a tool for changing their realities, in other words, as a tool for social transformation

Identifying multimorbidity profiles associated with COVID-19 severity in chronic patients using network analysis in the PRECOVID Study; 35181720

A major risk factor of COVID-19 severity is the patient''s health status at the time of the infection. Numerous studies focused on specific chronic diseases and identified conditions, mainly cardiovascular ones, associated with poor prognosis. However, chronic diseases tend to cluster into patterns, each with its particular repercussions on the clinical outcome of infected patients. Network analysis in our population revealed that not all cardiovascular patterns have the same risk of COVID-19 hospitalization or mortality and that this risk depends on the pattern of multimorbidity, besides age and sex. We evidenced that negative outcomes were strongly related to patterns in which diabetes and obesity stood out in older women and men, respectively. In younger adults, anxiety was another disease that increased the risk of severity, most notably when combined with menstrual disorders in women or atopic dermatitis in men. These results have relevant implications for organizational, preventive, and clinical actions to help meet the needs of COVID-19 patients. © 2022, The Author(s)

Chronic diseases associated with increased likelihood of hospitalization and mortality in 68, 913 COVID-19 confirmed cases in Spain: A population-based cohort study

Background Clinical outcomes among COVID-19 patients vary greatly with age and underlying comorbidities. We aimed to determine the demographic and clinical factors, particularly baseline chronic conditions, associated with an increased risk of severity in COVID-19 patients from a population-based perspective and using data from electronic health records (EHR). Methods Retrospective, observational study in an open cohort analyzing all 68, 913 individuals (mean age 44.4 years, 53.2% women) with SARS-CoV-2 infection between 15 June and 19 December 2020 using exhaustive electronic health registries. Patients were followed for 30 days from inclusion or until the date of death within that period. We performed multivariate logistic regression to analyze the association between each chronic disease and severe infection, based on hospitalization and all-cause mortality. Results 5885 (8.5%) individuals showed severe infection and old age was the most influencing factor. Congestive heart failure (odds ratio -OR- men: 1.28, OR women: 1.39), diabetes (1.37, 1.24), chronic renal failure (1.31, 1.22) and obesity (1.21, 1.26) increased the likelihood of severe infection in both sexes. Chronic skin ulcers (1.32), acute cerebrovascular disease (1.34), chronic obstructive pulmonary disease (1.21), urinary incontinence (1.17) and neoplasms (1.26) in men, and infertility (1.87), obstructive sleep apnea (1.43), hepatic steatosis (1.43), rheumatoid arthritis (1.39) and menstrual disorders (1.18) in women were also associated with more severe outcomes. Conclusions Age and specific cardiovascular and metabolic diseases increased the risk of severe SARSCoV-2 infections in men and women, whereas the effects of certain comorbidities are sex specific. Future studies in different settings are encouraged to analyze which profiles of chronic patients are at higher risk of poor prognosis and should therefore be the targets of prevention and shielding strategies. © 2021 Gimeno-Miguel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

A Methodological Approach for Implementing an Integrated Multimorbidity Care Model: Results from the Pre-Implementation Stage of Joint Action CHRODIS-PLUS

Patients with multimorbidity (defined as the co-occurrence of multiple chronic diseases) frequently experience fragmented care, which increases the risk of negative outcomes. A recently proposed Integrated Multimorbidity Care Model aims to overcome many issues related to fragmented care. In the context of Joint Action CHRODIS-PLUS, an implementation methodology was developed for the care model, which is being piloted in five sites. We aim to (1) explain the methodology used to implement the care model and (2) describe how the pilot sites have adapted and applied the proposed methodology. The model is being implemented in Spain (Andalusia and Aragon), Lithuania (Vilnius and Kaunas), and Italy (Rome). Local implementation working groups at each site adapted the model to local needs, goals, and resources using the same methodological steps: (1) Scope analysis; (2) situation analysis-"strengths, weaknesses, opportunities, threats" (SWOT) analysis; (3) development and improvement of implementation methodology; and (4) final development of an action plan. This common implementation strategy shows how care models can be adapted according to local and regional specificities. Analysis of the common key outcome indicators at the post-implementation phase will help to demonstrate the clinical effectiveness, as well as highlight any difficulties in adapting a common Integrated Multimorbidity Care Model in different countries and clinical settings

Utilidad de un sistema de seguimiento óptico de instrumental en cirugía laparoscópica para evaluación de destrezas motoras

En este trabajo se estudia la utilidad de un sistema de evaluación de destrezas quirúrgicas basado en el análisis de los movimientos del instrumental laparoscópico. Método: El sistema consta de un simulador físico laparoscópico y un sistema de seguimiento y evaluación de habilidades técnicas quirúrgicas. En el estudio han participado 6 cirujanos con experiencia intermedia (entre 1 y 50 intervenciones laparoscópicas) y 5 cirujanos expertos (más de 50 intervenciones laparoscópicas), todos ellos con la mano derecha como dominante. Cada sujeto realizó 3 repeticiones de una tarea de corte con la mano derecha en tejido sintético, una disección de la serosa gástrica y una sutura en la disección realizada. Para cada ejercicio se analizaron los parámetros de tiempo, distancia recorrida, velocidad, aceleración y suavidad de movimientos para los instrumentos de ambas manos. Resultados: En la tarea de corte, los cirujanos expertos muestran menor aceleración (p = 0,014) y mayor suavidad en los movimientos (p = 0,023) en el uso de la tijera. Respecto a la actividad de disección, los cirujanos expertos requieren menos tiempo (p = 0,006) y recorren menos distancia con ambos instrumentos (p = 0,006 para disector y p = 0,01 para tijera). En la tarea de sutura, los cirujanos expertos presentan menor tiempo de ejecución que los cirujanos de nivel intermedio (p = 0,037) y recorren menos distancia con el disector (p = 0,041). Conclusiones: El sistema de evaluación se mostró útil en las tareas de corte, disección y sutura, y constituye un progreso en el desarrollo de sistemas avanzados de entrenamiento y evaluación de destrezas quirúrgicas laparoscópicas

Baseline chronic comorbidity and mortality in laboratory-confirmed COVID-19 cases: Results from the PRECOVID study in Spain

We aimed to analyze baseline socio-demographic and clinical factors associated with an increased likelihood of mortality in men and women with coronavirus disease (COVID-19). We conducted a retrospective cohort study (PRECOVID Study) on all 4412 individuals with laboratory-confirmed COVID-19 in Aragon, Spain, and followed them for at least 30 days from cohort entry. We described the socio-demographic and clinical characteristics of all patients of the cohort. Age-adjusted logistic regressions models were performed to analyze the likelihood of mortality based on demographic and clinical variables. All analyses were stratified by sex. Old age, specific diseases such as diabetes, acute myocardial infarction, or congestive heart failure, and dispensation of drugs like vasodilators, antipsychotics, and potassium-sparing agents were associated with an increased likelihood of mortality. Our findings suggest that specific comorbidities, mainly of cardiovascular nature, and medications at the time of infection could explain around one quarter of the mortality in COVID-19 disease, and that women and men probably share similar but not identical risk factors. Nonetheless, the great part of mortality seems to be explained by other patient-and/or health-system-related factors. More research is needed in this field to provide the necessary evidence for the development of early identification strategies for patients at higher risk of adverse outcomes