No description available.

Tout professionnel de la santé est sujet devant un patient à une incertitude inhérente à la pratique médicale. Dans le cas d'incident médical lors d'un trajet aérien, cette incertitude comporte trois sources additionnelles : (1) variabilité des conditions aéronautiques, (2) variabilité individuelle des conditions du patient, (3) variabilité individuelle des compétences de l'intervenant. Aujourd'hui les incidents médicaux dans l'avion sont estimés à 350 par jour dans le monde et lorsqu'ils surviennent, ils sont pris en charge dans 95% des cas par des professionnels de la santé passagers qui se portent volontaires. C'est souvent pour eux une première expérience. La principale raison de la réticence des professionnels de la santé à répondre à l'appel du commandant est la nécessité d'improviser; ayant à établir un diagnostic et évaluer la gravité de l'état du patient dans des conditions difficiles. A part l'assistance à distance par télémédecine l'intervenant, souvent seul face à ses doutes et son incertitude, ne dispose d'aucune autre aide à bord. Par ailleurs l'aviation civile dispose de systèmes de retour d'expérience (RETEX) pour gérer la complexité de tels processus. Des politiques de recueil et d'analyse des événements sont mises en place à l'échelle internationale, par exemple ECCAIRS (European Co-ordination Centre for Accident and Incident Reporting Systems) et ASRS (Aviation Safety Reporting System).Dans ce travail de thèse, nous proposons tout d'abord une formalisation sémantique basée sur les ontologies pour préciser conceptuellement le vocabulaire des incidents médicaux se produisant durant les vols commerciaux. Ensuite, nous mettons en œuvre un processus d'extraction des connaissances à partir des données (bases existantes) pour identifier les structures caractéristiques (patterns) des différents groupes d'incidents majeurs. Enfin, nous proposons une architecture de Système d'Aide à la Décision Médicale (SADM) qui intègre la gestion des incertitudes présentes tant sur les données récoltées que les niveaux de compétences des professionnels médicaux intervenants. / There is an inherent risk in the practice of medicine that can affect the conditions of medical activities (diagnostic or therapeutic purposes). The management of uncertainty is also an integral part of decision-making processes in the medical field. In the case of a medical incident during an air travel, this uncertainty includes three additional sources: (1) variability of the aeronautical conditions, (2) individual variability of the patient's conditions, (3) individual variability of the intervener's skills. Presently, medical incidents in the plane are estimated worldwide at 350 per day and when they occur, they are handled in 95 \% of cases by health professionals who are passengers. It is often for them a first experience. The main reason for the reluctance of health professionals to respond to the aircraft captain's call is the need to improvise; having to make a diagnosis and assess the severity of the patient's condition under difficult conditions. Apart from telemedicine with remote assistance, the intervener, often alone in the face of his doubts and uncertainty, has no other decision aid tool on board. Civil aviation also has feedback systems to manage the complexity of such processes. Event collection and analysis policies are put in place internationally, for example ECCAIRS (European Co-ordination Center for Accident and Incident Reporting Systems) and ASRS (Aviation Safety Reporting System). In this work, we first propose a semantic formalization based on ontologies to clarify conceptually the vocabulary of medical incidents occurring during commercial flights. Then, we implement a knowledge extraction process from the data available on existing databases to identify the patterns of the different groups of incidents. Finally, we propose a Clinical Decision Support System (CDSS) architecture that integrates the management of the uncertainties present on both the collected data and the skill levels of the medical professionals involved.

Objectives: Dental Monitoring® (“DM,” Dental Monitoring, Paris, France), is a cloud-based software that allows orthodontists to track patients’ treatment remotely. The purpose of this study was to investigate the accuracy of the software in making linear measurements. Methods: Patients took intraoral photographs using the DM application, immediately followed by impressions for plaster models. Intercanine and intermolar width and arch depth measurements were made by DM and compared to measurements made on the plaster models. Data was analyzed using two one-sided t-tests for equivalence with equivalence bounds of +/-0.5mm. Significance level was set at 0.05. Results: Thirty sets of measurements were compared. The intercanine and intermolar measurement differences were on average 0.17mm and -0.02mm, respectively, and were deemed equivalent. The arch depth measurements had an average difference of -0.54mm and were deemed not equivalent. Conclusion: The monitoring software seems to provide an accurate assessment of linear tooth movements.

Virtual Reality (VR) is a highly evolving domain and is used in anincreasing number of areas in today's society. Among the technologiesassociated with VR and especially mobile VR, is hand tracking and handgesture recognition. Telemedicine is one of the elds where VR is startingto thrive, and so the concept of adding the use of hand gestures came to bein order to explore the possibilities that can come from it. This researchis conducted with the development of a prototype application that usessome of the most emerging technologies. Manomotion's hand trackingand hand gesture recognition algorithms, and Photon's servers and developerkit, which makes multi-user applications achievable, allowed theconceptual idea of the prototype to become reality. In order to test itsusability and how potential users perceive it, a user study with 24 participantswas made, 8 of which were either studying or working in themedical eld. Additional expert meetings and observations from the userstudy also contributed to ndings that helped show how hand gesturescan aect a doctor consultation in Telemedicine. Findings showed thatthe participants thought of the proposed system as a less costly and timesaving solution, and that they felt immersed in the VR. The hand gestureswere accepted and understood. The participants did not have dicultieson learning or executing them, and had control of the prototype environment.In addition, the data showed that participants considered it to beusable in the medical eld in the future.

Abstract Older adults with complex memory problems benefit when they have the opportunity to consult with a specialist for a comprehensive cognitive assessment. Specialists such as geriatricians, psychogeriatricians or neurologists often work in major cities or large metropolitan towns. Travelling to see a specialist either alone or with a carer is complicated for an older person because of medical issues or disability. The use of videoconferencing may provide a way to link a specialist with a patient without the need for the patient, or the specialist, to travel long distances. Two literature reviews were carried out. The initial review identified studies of the diagnosis of cognition via telemedicine. Thirty-two studies were identified which assessed cognition via telephone or video conference. The focus of the study was either the administration of a standardised cognitive assessment tool (n=30) or an unstructured comprehensive cognitive assessment interview (all via video conference) (n=2). The sample sizes were small but the levels of agreement were high, suggesting that further work in this area may identify that diagnosis of dementia via video conference is reliable. There has been limited work in the area of diagnostic agreement when a specialist is assessing a patient for the first time via video conference, even less work in the area of mental health assessment of older people. The second literature review identified 19 studies of diagnostic agreement using video conference with a sample size of 20 or more. The fields of research were: Dermatology (n=10); Mental Health (n=4); Minor Injuries (n=2); Neurology (n=2); and Rheumatology (n=1). Of the four studies in the area of mental health, one focused on the diagnosis of dementia with the publication of a protocol for assessing Alzheimer’s disease (AD) via video conference. The review highlighted that diagnosis via video conference in other medical fields had been shown to be reliable but that limited work was evident regarding the reliability of diagnosing dementia via video conference. A range of statistical analyses have been used to measure agreement in studies of diagnosis via VC. Overall Proportional Agreement (Po) and Cohen’s kappa (K) are the two most common calculations. There was little uniformity of reporting in the studies identified in the literature review. The variation in reporting made it difficult to compare results or provide data for a meta-analysis of similar studies. Consideration of the methods for analysing diagnostic agreement was undertaken using the approaches identified in the literature review as a starting point. The aim of this research was to identify if a diagnosis of the presence of dementia in an older adult by a specialist is reliable when the assessment interview occurs via video conference. A pilot study was carried out prior to the implementation of a National Health and Medical Research Council (NHMRC) funded multi-site project to test inter-rater agreement for the diagnosis of dementia and subsidiary questions. The candidate is a Chief Investigator (CI) on the NHMRC project grant and participated in writing the grant submission. A pilot study was completed for the purpose of refining the research protocol and establishing preliminary data for the calculation of sample size. A geriatrician carried out a cognitive assessment via video conference with the patient and the carer. The doctor had access to the patient’s chart and the results of a battery of standardised cognitive assessments administered face-to-face (FTF) by the clinic nurse earlier in the day. A second interview was carried out, face-to-face, by a second doctor on the same day. Inter-rater reliability was assessed between doctors. To place the level of agreement in context, inter-rater reliability between paired face-to-face assessments was also measured. Forty-two participants were divided into two groups: paired face-to-face assessments (FF, n=22) or paired video conference and face-to-face assessments (FV/VF, n=20). Twenty-two participants were male. Their average age was 70 years (SD=11.1, Range 50-90). The mean Standardised Mini-Mental State Examination (SMMSE) score was 23.93 (SD=5.42, Range 8-30)[1]. The outcome of agreement was measured using PO and Cohen’s K. FF group (PO=0.636; K=0.430, p=0.005) and the FV/VF group (PO=0.650; K=0.650, p=0.004) showed similar levels of agreement. The main study was a non-inferiority, prospective cohort study following a similar format as the pilot. Patients were randomised to two groups. The first group participated in two interviews; one via VC, the other was face-to-face (FV/VF). The second group was subjected to dual face-to-face assessments (FF). The video conference interview consisted of real-time video conference with the doctor interacting with both the carer and the patient. A battery of standardised assessments, a medical history, imaging and blood tests were prepared before hand and available to the doctor for use in the interview. One hundred and fifty-five participants were divided into two groups: paired face-to-face assessments (FF, n=73) or paired video conference and face-to-face assessments (FV or VF, n=82). Seventy-five of the participants were male. The average age was 76-years (SD=9, Range 54-95). The mean SMMSE was 23.8 (SD=4.4, Range 8-30). Overall proportional agreement (Po) and Weighted K were calculated as a measure of agreement for the presence of dementia. The FF group (Po=0.740; K=0.57, p<0.0001) and the FV/VF group (Po=0.780; K=0.64, p<0.0001) showed similar levels of agreement. Using the same study cohort, additional data were collected to identify the significance of the physical examination (PE) for diagnosing dementia. One of two doctors was allocated the task of completing a physical examination of the patient following initial assessment interview and after the diagnosis decisions had been recorded. Following the physical examination a second record of diagnosis decisions were recorded by the same doctor. The doctor was asked to identify if the diagnosis, formulation, treating options or additional investigations had altered as a result of the in-person physical examination. The physical examination supported clarity of the diagnosis particularly if a vascular element was involved. This dissertation provides evidence of the reliability of a diagnosis of dementia obtained via video conference. Furthermore, the work detailed in this dissertation represents the largest international study on assessing diagnostic accuracy of cognition and makes a significant contribution to the work in telemedicine in the area of mental health. This dissertation provides generalisations that can impact the use of video conference for diagnosis across a range of specialities, with the ultimate goal of improving access to specialist advice for people living in rural areas.

<p>Technology of today makes it possible to change the way traditional healthcare is conducted. As the population grows older, and the elderly is becoming an increasing part of the whole population, the need for cost efficient and personalised care increases. By implementing home healthcare IT projects, it is possible for more patients to be treated at home with sustained quality of care.</p><p>This thesis documents the work of a master’s degree project carried out during the autumn of 2005. The project is part of a research project within the Department of Biomedical Engineering at Linköping University. The project aims at developing a data model for storing medical data. The model should be general and easy to expand. This model is intended to be used within a larger system allowing a patient to measure medical data from a remote location.</p>

<p>Designing computer systems that effectively support the user is the major goal within human-computer interaction. To achieve this, we must understand and master several tasks. This process must initially deal with the question of knowing what to develop and later, with the question of knowing how to design and develop the system. This view might seem off-target at first, since it does not explicitly mention the goals or functions of the system. However, more often than not, there is no objective goal to aim for that can be formally specified and used as a target criterion that will signal when we have designed an appropriate system. Instead, there is a large set of vague goals – some of which may last through the entire project and some that will not. It is therefore somewhat confounding that most of the current methods of systems development require that these goals are explicitly laid out, in order to steer development. </p><p>For researchers in Human-Computer Interaction, the existence of many varying – and possibly conflicting goals – presents is a great challenge. The constructive main focus on producing usable systems is a matter of understanding this complex situation and knowing how to proceed from there.</p><p>There are many existing approaches that can be used to carry out this complex development process. This thesis presents one approach, based on the notion that the elements that constitute a successful system are also a part of the solution. </p><p>This thesis presents this approach as it is applied to the development of systems for computer-supported work in health care. The projected solution suggests that we need to focus more intently on active user involvement in iterative development that is significantly long-term. The traditional, rather narrow circle of focus that encompasses design, development and evaluation is not sufficient.</p>

“Telemedicine” denotes medicine at a distance using telecommunications and information technologies. The aim of the thesis is to reveal determinants and outcomes of telemedicine diffusion—that is, the spread of telemedicine in time and space. Telemedicine is examined both at the national level and in a regional case study. At the national level, quantitative methodology is utilized to analyze the emergence of health care facilities using telemedicine to receive medical assistance. The regional case study examines the diffusion and outcomes of telemedicine networks in Northern Sweden based on non-quantitative data sources. The first telemedicine applications in Sweden emerged between hospitals in southern Sweden in the 1970s. It was in the 1990s, however, that the practice of telemedicine took off on a larger scale. By the year 2000, the number of remote sites was quite evenly distributed across the country and between specialist and primary care facilities. In northern Sweden, telemedicine was first implemented in the mid-1980s, and is now carried out in all counties in the region. The telemedicine networks in northern Sweden primarily concern teleradiology, general telemedicine, and telepathology. Commonly, telemedicine is carried out within counties in hierarchical hub and spoke-type networks connecting specialist and primary care facilities. The study shows that existing telemedicine facilitates its further diffusion at the regional level, but shows a lack of the obvious neighborhood effect that could be expected in light of many previous diffusion studies and geographical diffusion theory. The health care system in Sweden is characterized by a high degree of regional autonomy. Contacts between medical staff, and thus dissemination of information and opinions concerning telemedicine, are therefore likely to be more prevalent within than between the regional health care organizations. The health care organizations are also decision-making bodies with different telemedicine policies. In addition, already implemented telemedicine programs tend to expand within the health care organization in which they originated. Although no traditional neighborhood effect to speak of can be noticed in Swedish telemedicine diffusion, distance matters in the diffusion process in a quite different respect. The study shows that health care facilities located far from more specialized care are especially likely to adopt telemedicine. Another local factor, facility size, is also positively correlated with telemedicine diffusion. This correlation between facility size and telemedicine adoption, as well as the circumstance that the diffusion process started with, and has progressed the furthest in, specialist care, suggest that the diffusion of telemedicine exhibits hierarchical characteristics. The development of telemedicine technology significantly influences the rate of telemedicine diffusion. In a simulation of the diffusion process, it is shown that—given that computers and information technology continue to develop according to the present trend—there will be a significant increase in the number of primary care facilities functioning as remote telemedicine sites during the first decade of the 21st century. / digitalisering@umu

Technology of today makes it possible to change the way traditional healthcare is conducted. As the population grows older, and the elderly is becoming an increasing part of the whole population, the need for cost efficient and personalised care increases. By implementing home healthcare IT projects, it is possible for more patients to be treated at home with sustained quality of care. This thesis documents the work of a master’s degree project carried out during the autumn of 2005. The project is part of a research project within the Department of Biomedical Engineering at Linköping University. The project aims at developing a data model for storing medical data. The model should be general and easy to expand. This model is intended to be used within a larger system allowing a patient to measure medical data from a remote location.

Στόχος της παρούσας διπλωματικής εργασίας είναι η ανάλυση και μελέτη της χρήσης του βίντεο και κατά συνέπεια της ιατρικής εικόνας στην ιατρική και ειδικότερα στην τηλεϊατρική και των τρόπων με τον οποίο επεξεργάζεται και συμπιέζεται η πληροφορία αυτή για να γίνει αποδοτικότερη για τις ισχύουσες συνθήκες. / Target of this essay is the analysis and study of the use of the video and medical images in medicine and telemedicine in particular