eHealth implementation in Europe: a scoping review on legal, ethical, financial, and technological aspects

Background: The evolution of eHealth development has shifted from standalone tools to comprehensive digital health environments, fostering data exchange among diverse stakeholders and systems. Nevertheless, existing research and implementation frameworks have primarily emphasized technological and organizational aspects of eHealth implementation, overlooking the intricate legal, ethical, and financial considerations. It is essential to discover what legal, ethical, financial, and technological challenges should be considered to ensure successful and sustainable implementation of eHealth.Objective: This review aims to provide insights into barriers and facilitators of legal, ethical, financial, and technological aspects for successful implementation of complex eHealth technologies, which impacts multiple levels and multiple stakeholders.Methods: A scoping review was conducted by querying PubMed, Scopus, Web of Science, and ACM Digital Library (2018–2023) for studies describing the implementation process of eHealth technologies that facilitate data exchange. Studies solely reporting clinical outcomes or conducted outside Europe were excluded. Two independent reviewers selected the studies. A conceptual framework was constructed through axial and inductive coding, extracting data from literature on legal, ethical, financial, and technological aspects of eHealth implementation. This framework guided systematic extraction and interpretation.Results: The search resulted in 7.308 studies that were screened for eligibility, of which 35 (0.48%) were included. Legal barriers revolve around data confidentiality and security, necessitating clear regulatory guidelines. Ethical barriers span consent, responsibility, liability, and validation complexities, necessitating robust frameworks. Financial barriers stem from inadequate funding, requiring (commercial) partnerships and business models. Technological issues include interoperability, integration, and malfunctioning, necessitating strategies for enhancing data reliability, improving accessibility, and aligning eHealth technology with existing systems for smoother integration.Conclusions: This research highlights the multifaceted nature of eHealth implementation, encompassing legal, ethical, financial, and technological considerations. Collaborative stakeholder engagement is paramount for effective decision-making and aligns with the transition from standalone eHealth tools to integrated digital health environments. Identifying suitable stakeholders and recognizing their stakes and values enriches implementation strategies with expertise and guidance across all aspects. Future research should explore the timing of these considerations and practical solutions for regulatory compliance, funding, navigation of responsibility and liability, and business models for reimbursement strategies

Optical skin assessment based on spectral reflectance estimation and Monte Carlo simulation

Optical non-contact measurements in general, and chromophore concentration estimation in particular, have been identified to be useful tools for skin assessment. Spectral estimation using a low cost hand held device has not been studied adequately as a basis for skin assessment. Spectral measurements on the one hand, which require bulky, expensive and complex devices and direct channel approaches on the other hand, which operate with simple optical devices have been considered and applied for skin assessment. In this study, we analyse the capabilities of spectral estimation for skin assessment in form of chromophore concentration estimation using a prototypical low cost optical non-contact device. A spectral estimation work flow is implemented and combined with pre-simulated Monte Carlo spectra to use estimated spectra based on conventional image sensors for chromophore concentrations estimation and obtain health metrics. To evaluate the proposed approach, we performed a series of occlusion experiments and examined the capabilities of the proposed process. Additionally, the method has been applied to more general skin assessment tasks. The proposed process provides a more general representation in form of a spectral image cube which can be used for more advanced analysis and the comparisons show good agreement with expectations and conventional skin assessment methods. Utilising spectral estimation in conjunction with Monte Carlo simulation could lead to low cost, easy to use, hand held and multifunctional optical skin assessment with the possibility to improve skin assessment and the diagnosis of diseases

Laser induced explosive vapor and cavitation resulting in effective irrigation of the root canal, part 1: a visualization study

Background and Objectives: Limited information exists regarding the induction of explosive vapor and cavitation bubbles in an endodontic rinsing solution. It is also not clear whether a fiber has to be moved in the irrigation solution or can be kept stationary. No information is available on safe power settings for the use of cavitation in the root canal. This study investigates the fluid movements and the mechanism of action caused by an Er,Cr:YSGG laser in a transparent root model. Material and Methods: Glass models with an artificial root canal (15 rum long, with a 0.06 taper and apical diameter of 400 pm) were used for visualization and registration with a high-speed imaging technique (resolution in the microsecond range) of the creation of explosive vapor bubbles with an Er,Cr:YSGG laser at pulse energies of 75, 125, and 250 mJ at 20 Hz using a 200 mu m fiber (Z2 Endolase). Fluid movement was investigated by means of dyes and visualization of the explosive vapor bubbles, and as a function of pulse energy and distance of the fiber tip to the apex. Results: The recordings in the glass model show the creation of expanding and imploding vapor bubbles with secondary cavitation effects. Dye is flushed out of the canal and replaced by surrounding fluid. It seems not necessary to move the fiber close to the apex. Conclusion: Imaging suggests that the working mechanism of an Er,Cr:YSGG laser in root canal treatment in an irrigation solution can be attributed to cavitation effects inducing high-speed fluid motion into and out the canal. Lasers Surg. Med. 41:514-519, 2009. (C) 2009 Wiley-Liss, Inc

Laser induced explosive vapor and cavitation resulting in effective irrigation of the root canal, part 2: evaluation of the efficacy

Background and Objectives: Limited information exists regarding the efficacy of laser activated irrigation (LAI) on removal of root canal debris. This study compares the efficacy of LAI for removal of debris in root canals as compared to conventional irrigation (CI) and passive ultrasonic irrigation (PUI). Materials and Methods: A splitted tooth model was constructed with straight roots prepared to a 0.06 taper and an apical diameter of ISO 40. A vertical groove was cut in the canal wall at 2-6 mm to the end of the canal in one halve of the root canal wall and filled with dentinal debris. In group 1 root canals were irrigated with 2.5% NaOCl by hand (20 seconds) with the needle 1 mm short from the apical stop, in group 2 NaOCl was ultrasonically activated (20 seconds) with an Irrisafe tip 1 mm short from the apical stop, and in group 3 NaOCl was activated with an Er,Cr:YSGG laser (Z2 Endolase tip -200 mu m fiber, four times for 5 seconds, 75 mJ, 20 Hz, stationary at 5 mm from the apical stop). The remaining quantity of dentin debris in the groove was evaluated using a scoring system. Results: LAI resulted in significantly less debris than PUI (P <0.005) and CI (P <0.0005). PUI also showed significantly less debris than CI (P <0.005). Conclusion: Under the conditions of this study LAI is statistically significantly more effective in removing artificially placed dentin debris in a root canal as PUI and CI. Lasers Surg. Med. 41:520-523, 2009. (C) 2009 Wiley-Liss, Inc

Comparison of the temperature accuracy between smart phone based and high-end thermal cameras using a temperature gradient phantom

Recently, low cost smart phone based thermal cameras are being considered to be used in a clinical setting for monitoring physiological temperature responses such as: body temperature change, local inflammations, perfusion changes or (burn) wound healing. These thermal cameras contain uncooled micro-bolometers with an internal calibration check and have a temperature resolution of 0.1 degree. For clinical applications a fast quality measurement before use is required (absolute temperature check) and quality control (stability, repeatability, absolute temperature, absolute temperature differences) should be performed regularly. Therefore, a calibrated temperature phantom has been developed based on thermistor heating on both ends of a black coated metal strip to create a controllable temperature gradient from room temperature 26 °C up to 100 °C. The absolute temperatures on the strip are determined with software controlled 5 PT-1000 sensors using lookup tables. In this study 3 FLIR-ONE cameras and one high end camera were checked with this temperature phantom. The results show a relative good agreement between both low-cost and high-end camera's and the phantom temperature gradient, with temperature differences of 1 degree up to 6 degrees between the camera's and the phantom. The measurements were repeated as to absolute temperature and temperature stability over the sensor area. Both low-cost and high-end thermal cameras measured relative temperature changes with high accuracy and absolute temperatures with constant deviations. Low-cost smart phone based thermal cameras can be a good alternative to high-end thermal cameras for routine clinical measurements, appropriate to the research question, providing regular calibration checks for quality control