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Sökning: hsv:(MEDICIN OCH HÄLSOVETENSKAP) hsv:(Klinisk medicin) hsv:(Allmänmedicin) > Teknik

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1.
  • Ahlander, Britt-Marie, 1954- (författare)
  • Magnetic Resonance Imaging of the Heart : Image quality, measurement accuracy and patient experience
  • 2016
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Non-invasive diagnostic imaging of atherosclerotic coronary artery disease (CAD) is frequently carried out with cardiovascular magnetic resonance imaging (CMR) or myocardial perfusion single photon emission computed tomography (MPS). CMR is the gold standard for the evaluation of scar after myocardial infarction and MPS the clinical gold standard for ischemia. Magnetic Resonance Imaging (MRI) is at times difficult for patients and may induce anxiety while patient experience of MPS is largely unknown.Aims: To evaluate image quality in CMR with respect to the sequences employed, the influence of atrial fibrillation, myocardial perfusion and the impact of patient information. Further, to study patient experience in relation to MRI with the goal of improving the care of these patients.Method: Four study designs have been used. In paper I, experimental cross-over, paper (II) experimental controlled clinical trial, paper (III) psychometric crosssectional study and paper (IV) prospective intervention study. A total of 475 patients ≥ 18 years with primarily cardiac problems (I-IV) except for those referred for MRI of the spine (III) were included in the four studies.Result: In patients (n=20) with atrial fibrillation, a single shot steady state free precession (SS-SSFP) sequence showed significantly better image quality than the standard segmented inversion recovery fast gradient echo (IR-FGRE) sequence (I). In first-pass perfusion imaging the gradient echo-echo planar imaging sequence (GREEPI) (n=30) had lower signal-to-noise and contrast–to-noise ratios than the steady state free precession sequence (SSFP) (n=30) but displayed a higher correlation with the MPS results, evaluated both qualitatively and quantitatively (II). The MRIAnxiety Questionnaire (MRI-AQ) was validated on patients, referred for MRI of either the spine (n=193) or the heart (n=54). The final instrument had 15 items divided in two factors regarding Anxiety and Relaxation. The instrument was found to have satisfactory psychometric properties (III). Patients who prior CMR viewed an information video scored significantly (lower) better in the factor Relaxation, than those who received standard information. Patients who underwent MPS scored lower on both factors, Anxiety and Relaxation. The extra video information had no effect on CMR image quality (IV).Conclusion: Single shot imaging in atrial fibrillation produced images with less artefact than a segmented sequence. In first-pass perfusion imaging, the sequence GRE-EPI was superior to SSFP. A questionnaire depicting anxiety during MRI showed that video information prior to imaging helped patients relax but did not result in an improvement in image quality.
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2.
  • Ortiz Catalan, Max Jair, 1982, et al. (författare)
  • Self-Contained Neuromusculoskeletal Arm Prostheses
  • 2020
  • Ingår i: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 382:18, s. 1732-1738
  • Tidskriftsartikel (refereegranskat)abstract
    • After transhumeral amputation, four patients had implantation of a self-contained, osseointegrated prosthesis with a neuromusculoskeletal interface that allowed intuitive control of the prosthetic hand and arm over 3 to 7 years. A video shows use of the prostheses in daily life. We report the use of a bone-anchored, self-contained robotic arm with both sensory and motor components over 3 to 7 years in four patients after transhumeral amputation. The implant allowed for bidirectional communication between a prosthetic hand and electrodes implanted in the nerves and muscles of the upper arm and was anchored to the humerus through osseointegration, the process in which bone cells attach to an artificial surface without formation of fibrous tissue. Use of the device did not require formal training and depended on the intuitive intent of the user to activate movement and sensory feedback from the prosthesis. Daily use resulted in increasing sensory acuity and effectiveness in work and other activities of daily life. (Funded by the Promobilia Foundation and others.)
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3.
  • Lendaro, Eva, 1989, et al. (författare)
  • Phantom motor execution as a treatment for phantom limb pain: Protocol of an international, double-blind, randomised controlled clinical trial
  • 2018
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055 .- 2044-6055. ; 8:7
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction Phantom limb pain (PLP) is a chronic condition that can greatly diminish quality of life. Control over the phantom limb and exercise of such control have been hypothesised to reverse maladaptive brain changes correlated to PLP. Preliminary investigations have shown that decoding motor volition using myoelectric pattern recognition, while providing real-time feedback via virtual and augmented reality (VR-AR), facilitates phantom motor execution (PME) and reduces PLP. Here we present the study protocol for an international (seven countries), multicentre (nine clinics), double-blind, randomised controlled clinical trial to assess the effectiveness of PME in alleviating PLP. Methods and analysis Sixty-seven subjects suffering from PLP in upper or lower limbs are randomly assigned to PME or phantom motor imagery (PMI) interventions. Subjects allocated to either treatment receive 15 interventions and are exposed to the same VR-AR environments using the same device. The only difference between interventions is whether phantom movements are actually performed (PME) or just imagined (PMI). Complete evaluations are conducted at baseline and at intervention completion, as well as 1, 3 and 6 months later using an intention-to-treat (ITT) approach. Changes in PLP measured using the Pain Rating Index between the first and last session are the primary measure of efficacy. Secondary outcomes include: Frequency, duration, quality of pain, intrusion of pain in activities of daily living and sleep, disability associated to pain, pain self-efficacy, frequency of depressed mood, presence of catastrophising thinking, health-related quality of life and clinically significant change as patient's own impression. Follow-up interviews are conducted up to 6 months after the treatment. Ethics and dissemination The study is performed in agreement with the Declaration of Helsinki and under approval by the governing ethical committees of each participating clinic. The results will be published according to the Consolidated Standards of Reporting Trials guidelines in a peer-reviewed journal.
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4.
  • Lang, Victoria Ashley, 1994, et al. (författare)
  • Mathematical and Computational Models for Pain: A Systematic Review
  • 2021
  • Ingår i: Pain Medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 22:12, s. 2806-2817
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. There is no single prevailing theory of pain that explains its origin, qualities, and alleviation. Although many studies have investigated various molecular targets for pain management, few have attempted to examine the etiology or working mechanisms of pain through mathematical or computational model development. In this systematic review, we identified and classified mathematical and computational models for characterizing pain. Methods. The databases queried were Science Direct and PubMed, yielding 560 articles published prior to January 1st, 2020. After screening for inclusion of mathematical or computational models of pain, 31 articles were deemed relevant. Results. Most of the reviewed articles utilized classification algorithms to categorize pain and no-pain conditions. We found the literature heavily focused on the application of existing models or machine learning algorithms to identify the presence or absence of pain, rather than to explore features of pain that may be used for diagnostics and treatment. Conclusions. Although understudied, the development of mathematical models may augment the current understanding of pain by providing directions for testable hypotheses of its underlying mechanisms. Additional focus is needed on developing models that seek to understand the underlying mechanisms of pain, as this could potentially lead to major breakthroughs in its treatment.
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6.
  • Blease, Charlotte, et al. (författare)
  • Computerization and the future of primary care : a survey of general practitioners in the UK
  • 2018
  • Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:12
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectiveTo describe the opinions of British general practitioners regarding the potential of future technology to replace key tasks carried out in primary care.DesignCross sectional online survey.Participants1,474 registered GPs in the United Kingdom.Main outcome measuresInvestigators measured GPs’ opinions about the likelihood that future technology will be able to fully replace–not merely aid–the average GP in performing six primary care tasks; in addition, if GPs considered replacement for a particular task likely, the survey measured opinions about how many years from now this technological capacity might emerge.ResultsA total of 720 (49%) responded to the survey. Most GPs believed it unlikely that technology will ever be able to fully replace physicians when it comes to diagnosing patients (489, 68%), referring patients to other specialists (444, 61%), formulating personalized treatment plans (441, 61%), and delivering empathic care (680, 94%). GPs were not in agreement about prognostics: one in two participants (380, 53%) considered it likely that technology will be fully capable of replacing physicians in performing this task, nearly half (187, 49%) of whom believed that the technological capacity will arise in the next ten years. Against these findings, the majority of GPs (578, 80%) believed it likely that future technology will be able to fully replace humans to undertake documentation; among them 261 (79%) estimated that the technological wherewithal would emerge during the next ten years. In general, age and gender were not correlated with opinions; nor was reported burnout and job satisfaction or whether GPs worked full time or part time.ConclusionsThe majority of UK GPs in this survey were skeptical about the potential for future technology to perform most primary care tasks as well as or better than humans. However, respondents were optimistic that in the near future technology would have the capacity to fully replace GPs’ in undertaking administrative duties related to patient documentation.
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7.
  • Fhager, Andreas, 1976, et al. (författare)
  • Simulation Study of a Haemorrhagic Stroke Detector and Its Performance
  • 2019
  • Ingår i: 13th European Conference on Antennas and Propagation, EuCAP 2019.
  • Konferensbidrag (refereegranskat)abstract
    • Intracranial bleedings caused by stroke or head trauma is a serious condition that need immediate medical care and interventions. Pre-hospital detection and diagnosis would constitute a major breakthrough in streamlining the care and in reducing the time from incidence to start of treatment. In this paper we present a numerical simulation study to investigate the detection capability of a machine learning algorithm and its performance when diagnosing patients with intracranial bleedings from healthy subjects, for example hemorrhagic stroke patients from healthy persons. The specific goal is to study the training phase of the classifier and how parameters, such as number of antennas, number of training samples, noise, etc. affect the ability to detect bleedings with different volumes. The detection performance is evaluated in a cross-validation scheme.
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8.
  • Geijer, Håkan, 1961-, et al. (författare)
  • Temperature measurements with a temporal scanner : systematic review and meta-analysis
  • 2016
  • Ingår i: BMJ Open. - London, United Kingdom : BMJ Group. - 2044-6055. ; 6:3
  • Forskningsöversikt (refereegranskat)abstract
    • Objectives: Systematic review and meta-analysis on the diagnostic accuracy of temporal artery thermometers (TAT).Design: Systematic review and meta-analysis. The index test consisted of temperature measurement with TAT. The reference test consisted of an estimation of core temperature.Participants: Clinical patients as well as healthy participants, with or without fever.Interventions: Literature search in PubMed, Embase, Cinahl and Web of Science. Three reviewers selected articles for full-text reading after which a further selection was made. Risk of bias was assessed with QUADAS-2. Pooled difference and limits of agreement (LoA) were estimated with an inverse variance weighted approach. Subgroup and sensitivity analyses were performed. Sensitivity and specificity were estimated using hierarchical models. Quality of evidence was assessed according to the GRADE system.Primary and secondary outcome measures: The primary outcome was measurement accuracy expressed as mean difference ±95% LoA. A secondary outcome was sensitivity and specificity to detect fever. If tympanic thermometers were assessed in the same population as TAT, these results were recorded as well.Results: 37 articles comprising 5026 participants were selected. Pooled difference was -0.19°C (95% LoA -1.16 to 0.77°C), with moderate quality of evidence. Pooled sensitivity was 0.72 (95% CI 0.61 to 0.81) with a specificity of 0.94 (95% CI 0.87 to 0.97). The subgroup analysis revealed a trend towards underestimation of the temperature for febrile patients. There was a large heterogeneity among included studies with wide LoA which reduced the quality of evidence.Conclusions: TAT is not sufficiently accurate to replace one of the reference methods such as rectal, bladder or more invasive temperature measurement methods. The results are, however, similar to those with tympanic thermometers, both in our meta-analysis and when compared with others. Thus, it seems that TAT could replace tympanic thermometers with the caveat that both methods are inaccurate.Trial registration number: CRD42014008832.
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9.
  • Gross, James, Professor, 1975- (författare)
  • Towards an Internet of Reality
  • 2021
  • Ingår i: 2021 IEEE 32Nd Annual International Symposium On Personal, Indoor And Mobile Radio Communications (PIMRC). - : Institute of Electrical and Electronics Engineers (IEEE).
  • Konferensbidrag (refereegranskat)abstract
    • Driven by standardization and commercialization, digital infrastructures evolve in waves. Over the last few years, a particular focus has been on realizing ultra-reliable low-latency wireless communications (URLLC), anticipated mostly for rather specific use cases in industrial automation. Even though initial such systems finally exist today - with future network releases advancing URLLC capabilities even more - the broad market impact to date is low. We argue in this paper that an essential missing component for corresponding dependable applications like closed-loop control or human-in-the-loop are nearby compute capabilities provided within the infrastructure, aka edge computing capabilities. Only in conjunction can such future infrastructures support dependable applications to a full extent. Nevertheless, this also leads to unique challenges which will be central to the evolution of networked infrastructures during the current decade. Out of this evolution of networked infrastructures, we finally argue that a new type of networked application class will emerge, resembling the representation of various aspects of reality in the infrastructure at any point in time. We dub this development the Internet of Reality, and discuss further challenges in this context.
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10.
  • Gunnarsson, Ronny K, 1955, et al. (författare)
  • Effect of promoting current local research activities on large monitors on the population's interest in health-related research: a randomised controlled trial.
  • 2019
  • Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 9:8
  • Tidskriftsartikel (refereegranskat)abstract
    • The objectives of this study were threefold: to estimate people's interest in health-related research, to understand to what extent people appreciate being actively informed about current local health-related research and to investigate whether their interest can be influenced by advertising local current health-related research using large TV monitors.Randomised controlled trial using a stepped wedge design.The emergency department waiting room at two public hospitals in northern Queensland, Australia.Waiting patients and their accompanying friends and relatives in the emergency department waiting room not requiring immediate medical attention.A TV monitor advertising local current health-related research.OR for the effect of intervention on changing the interest in health-related research compared with a control group while adjusting for gender, age and socioeconomic standard.The intervention significantly increased the short-term interest in health-related research with an OR of 1.3 (1.1-1.7, p=0.0063). We also noted that being female and being older was correlated to a higher interest in health-related research CONCLUSIONS: This study found that proactive information significantly increased the general populations' interest in health-related research. There are reasonable set up costs involved but the costs for maintaining the system were very low. Hence, it seems reasonable that research-active organisations should give much higher priority to this type of activity.ACTRN12617001085369.
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