BACKGROUND: Activities of daily living (ADL) are essential for independence and personal well-being, reflecting an individual\'s functional status. Impairment in executing these tasks can limit autonomy and negatively affect quality of life. The assessment of physical function during ADL is crucial for the prevention and rehabilitation of movement limitations. Still, its traditional evaluation based on subjective observation has limitations in precision and objectivity.
OBJECTIVE: The primary objective of this study is to use innovative technology, specifically wearable inertial sensors combined with artificial intelligence techniques, to objectively and accurately evaluate human performance in ADL. It is proposed to overcome the limitations of traditional methods by implementing systems that allow dynamic and noninvasive monitoring of movements during daily activities. The approach seeks to provide an effective tool for the early detection of dysfunctions and the personalization of treatment and rehabilitation plans, thus promoting an improvement in the quality of life of individuals.
METHODS: To monitor movements, wearable inertial sensors were developed, which include accelerometers and triaxial gyroscopes. The developed sensors were used to create a proprietary database with 6 movements related to the shoulder and 3 related to the back. We registered 53,165 activity records in the database (consisting of accelerometer and gyroscope measurements), which were reduced to 52,600 after processing to remove null or abnormal values. Finally, 4 deep learning (DL) models were created by combining various processing layers to explore different approaches in ADL recognition.
RESULTS: The results revealed high performance of the 4 proposed models, with levels of accuracy, precision, recall, and F1-score ranging between 95% and 97% for all classes and an average loss of 0.10. These results indicate the great capacity of the models to accurately identify a variety of activities, with a good balance between precision and recall. Both the convolutional and bidirectional approaches achieved slightly superior results, although the bidirectional model reached convergence in a smaller number of epochs.
CONCLUSIONS: The DL models implemented have demonstrated solid performance, indicating an effective ability to identify and classify various daily activities related to the shoulder and lumbar region. These results were achieved with minimal sensorization-being noninvasive and practically imperceptible to the user-which does not affect their daily routine and promotes acceptance and adherence to continuous monitoring, thus improving the reliability of the data collected. This research has the potential to have a significant impact on the clinical evaluation and rehabilitation of patients with movement limitations, by providing an objective and advanced tool to detect key movement patterns and joint dysfunctions.

A precise radiotherapy plan is crucial to ensure accurate segmentation of glioblastomas (GBMs) for radiation therapy. However, the traditional manual segmentation process is labor-intensive and heavily reliant on the experience of radiation oncologists. In this retrospective study, a novel auto-segmentation method is proposed to address these problems. To assess the method\'s applicability across diverse scenarios, we conducted its development and evaluation using a cohort of 148 eligible patients drawn from four multicenter datasets and retrospective data collection including noncontrast CT, multisequence MRI scans, and corresponding medical records. All patients were diagnosed with histologically confirmed high-grade glioma (HGG). A deep learning-based method (PKMI-Net) for automatically segmenting gross tumor volume (GTV) and clinical target volumes (CTV1 and CTV2) of GBMs was proposed by leveraging prior knowledge from multimodal imaging. The proposed PKMI-Net demonstrated high accuracy in segmenting, respectively, GTV, CTV1, and CTV2 in an 11-patient test set, achieving Dice similarity coefficients (DSC) of 0.94, 0.95, and 0.92; 95% Hausdorff distances (HD95) of 2.07, 1.18, and 3.95 mm; average surface distances (ASD) of 0.69, 0.39, and 1.17 mm; and relative volume differences (RVD) of 5.50%, 9.68%, and 3.97%. Moreover, the vast majority of GTV, CTV1, and CTV2 produced by PKMI-Net are clinically acceptable and require no revision for clinical practice. In our multicenter evaluation, the PKMI-Net exhibited consistent and robust generalizability across the various datasets, demonstrating its effectiveness in automatically segmenting GBMs. The proposed method using prior knowledge in multimodal imaging can improve the contouring accuracy of GBMs, which holds the potential to improve the quality and efficiency of GBMs\' radiotherapy.

OBJECTIVE: Isokinetic knee extensor strength is poorly evaluated in geriatric day hospitals (GDHs), despite its potential functional significance compared to grip strength. This study aimed to investigate age-related effects on absolute and relative isokinetic knee extensor peak torque (KEPT) data in community-dwelling older GDH patients.
METHODS: A total of 472 French GDH patients (179 men and 293 women, aged 75-94 years) participated in this study. Absolute and relative KEPT were measured at six distinct angular velocities between 0.52 and 3.14 rad/s. In addition, comfortable gait speed and grip strength were assessed. Participants were stratified by sex and age using 5-year intervals. One-way ANOVAs were used to examine age-related effects on KEPT values. Multiple linear regression models were employed to investigate the associations between gait speed and both mean KEPT values and grip strength, with separate models conducted on absolute and relative values.
RESULTS: The recruited GDH patients presented lower absolute and relative KEPT values in comparison with established reference values for healthy community-dwelling older individuals, with men being consistently stronger than women. Notably, there was a significant decline in both absolute and relative KEPT values beyond the age of 85 for both sexes. Importantly, the multiple linear regression analyses conducted revealed a significant positive relationship between gait speed and mean KEPT values, surpassing the association with grip strength.
CONCLUSIONS: These findings underscore the clinical importance of assessing isokinetic knee extensor strength in community-dwelling older GDH patients, particularly for tailoring personalized physical activity interventions.

暂无摘要。

OBJECTIVE: To investigate the potential of virtual contrast-enhanced MRI (VCE-MRI) for gross-tumor-volume (GTV) delineation of nasopharyngeal carcinoma (NPC) using multi-institutional data.
METHODS: This study retrospectively retrieved T1-weighted (T1w), T2-weighted (T2w) MRI, gadolinium-based contrast-enhanced MRI (CE-MRI) and planning CT of 348 biopsy-proven NPC patients from three oncology centers. A multimodality-guided synergistic neural network (MMgSN-Net) was trained using 288 patients to leverage complementary features in T1w and T2w MRI for VCE-MRI synthesis, which was independently evaluated using 60 patients. Three board-certified radiation oncologists and two medical physicists participated in clinical evaluations in three aspects: image quality assessment of the synthetic VCE-MRI, VCE-MRI in assisting target volume delineation, and effectiveness of VCE-MRI-based contours in treatment planning. The image quality assessment includes distinguishability between VCE-MRI and CE-MRI, clarity of tumor-to-normal tissue interface and veracity of contrast enhancement in tumor invasion risk areas. Primary tumor delineation and treatment planning were manually performed by radiation oncologists and medical physicists, respectively.
RESULTS: The mean accuracy to distinguish VCE-MRI from CE-MRI was 31.67%; no significant difference was observed in the clarity of tumor-to-normal tissue interface between VCE-MRI and CE-MRI; for the veracity of contrast enhancement in tumor invasion risk areas, an accuracy of 85.8% was obtained. The image quality assessment results suggest that the image quality of VCE-MRI is highly similar to real CE-MRI. The mean dosimetric difference of planning target volumes were less than 1Gy.
CONCLUSIONS: The VCE-MRI is highly promising to replace the use of gadolinium-based CE-MRI in tumor delineation of NPC patients.

UNASSIGNED: Dega osteotomy is becoming more widely used for the treatment of developmental dysplasia of the hip (DDH).
UNASSIGNED: A thorough description of this procedure is needed as many of the technical aspects are not fully defined. Moreover, more follow-up series are also needed to evaluate its outcomes.
UNASSIGNED: In this study, we gave a detailed anatomic description for this procedure and also presented our experience as a retrospective radiographic and case-note study. We examined the clinical and radiographic records of 44 patients (48 hips) with varying degrees of DDH.
UNASSIGNED: The average age of the patients was 2 months and 7 months while the average follow up period was 41 months. Clinical and radiographic assessment including CT with 3D reconstruction to examine the anatomic characteristics of the osteotomy were undertaken. We found that concentric reduction was achieved in 93.7% with excellent clinical and radiographic outcomes. Only 3 cases needed revision of the Dega osteotomy. The re-operation rate was 12.5%. CT scan revealed that the arcuate line was crossed by the osteotomy in the majority of cases. In 20.7% of cases, a bone cut that was intended to be a Dega osteotomy was found to have been inadvertently implemented as another osteotomy variant. However, this bore no significant effect on the outcome.
UNASSIGNED: We found that a well-implemented Dega osteotomy is a reliable tool to cope with the acetabular changes in DDH.

Despite the importance of communication, radiology departments often depend on communication tools that were not created for the unique needs of imaging workflows, leading to frequent radiologist interruptions. The objective of this study was test the hypothesis that a novel asynchronous communication tool for the imaging workflow (RadConnect) reduces the daily average number of synchronous (in-person, telephone) communication requests for radiologists. We conducted a before-after study. Before adoption of RadConnect, technologists used three conventional communication methods to consult radiologists (in-person, telephone, general-purpose enterprise chat (GPEC)). After adoption, participants used RadConnect as a fourth method. Technologists manually recorded every radiologist consult request related to neuro and thorax CT scans in the 40 days before and 40 days after RadConnect adoption. Telephone traffic volume to section beepers was obtained from the hospital telephone system for the same period. The value and usability experiences were collected through an electronic survey and structured interviews. RadConnect adoption resulted in 53% reduction of synchronous (in-person, telephone) consult requests: from 6.1 ± 4.2 per day to 2.9 ± 2.9 (P < 0.001). There was 77% decrease (P < 0.001) in telephone volume to the neuro and thorax beepers, while no significant volume change was noted to the abdomen beeper (control group). Survey responses (46% response rate) and interviews confirmed the positive impact of RadConnect on interruptions. RadConnect significantly reduced radiologists\' telephone interruptions. Study participants valued the role-based interaction and prioritized worklist overview in the survey and interviews. Findings from this study will contribute to a more focused work environment.

BACKGROUND: For a long time, chronic pruritus was considered difficult to treat. Modern therapy options and detailed guidelines have created new opportunities for patients to improve their quality of life. However, due to the complexity of the disease, the need for multimodal treatment remains.
OBJECTIVE: This article aims to investigate whether dermatological rehabilitation offers additional benefits to those affected and whether it should therefore be part of the treatment concept for chronic pruritus.
METHODS: After introduction of the pruritus program of a rehabilitation clinic, a prospective study is presented that focuses on the patient-relevant benefits of therapy. It used standardized questionnaires to record pruritus intensity, the presence of depression, anxiety, itch-related limitations, and quality of life in patients with chronic pruritus before and after rehabilitation.
RESULTS: Of the patients surveyed, 91.7% achieved a patient-relevant benefit through rehabilitation. Pruritus intensity, depression, anxiety, itch-related limitations, and restrictions on quality of life decreased significantly. Almost half of all participating patients had been initially diagnosed more than 10 years ago.
CONCLUSIONS: Dermatological rehabilitation with a multimodal concept for the treatment of chronic pruritus can help affected patients and should be part of the therapy concept. This should be done as early as possible before the disease progresses over a long period of time and makes treatment more difficult.
UNASSIGNED: HINTERGRUND: Chronischer Pruritus galt lange Zeit als schwer therapierbar. Durch moderne Therapieoptionen und eine ausführliche Leitlinie wurden für die Patienten neue Möglichkeiten geschaffen, ihre Lebensqualität zu verbessern. Es bleibt allerdings durch die Komplexität der Erkrankung die Notwendigkeit einer multimodalen Behandlung.
UNASSIGNED: In diesem Beitrag soll untersucht werden, ob eine dermatologische Rehabilitation den Betroffenen einen zusätzlichen Nutzen bietet und somit ein Bestandteil im Therapiekonzept des chronischen Pruritus sein sollte.
METHODS: Nach einem Einblick in das Pruritus-Programm einer Rehabilitationsklinik folgt die Vorstellung einer prospektiven Studie, die den patientenrelevanten Nutzen der Therapie in den Mittelpunkt rückt. Diese erfasste anhand von standardisierten Fragebögen die Pruritusintensität, das Vorliegen von Depression, Angst, Pruritus-bezogene Einschränkungen und Lebensqualität bei Patienten mit chronischem Pruritus vor und nach der Rehabilitation.
UNASSIGNED: Es erreichten 91,7 % der befragten Patienten durch die Rehabilitation einen patientenrelevanten Nutzen. Die Scores für die Pruritusintensität, das Vorliegen von Depression, Angst, Pruritus-bezogenen Einschränkungen und Einschränkungen der Lebensqualität sanken signifikant. Fast die Hälfte aller teilnehmenden Patienten hatte zuvor einen mehr als 10 Jahre dauernden Krankheitsverlauf.
UNASSIGNED: Eine dermatologische Rehabilitation mit einem multimodalen Konzept zur Therapie des chronischen Pruritus kann den betroffenen Patienten helfen und sollte beim Erstellen eines Therapiekonzeptes einen festen Stellenwert haben. Dies soll möglichst frühzeitig geschehen, noch bevor sich die Erkrankung durch einen langen Verlauf aggraviert und dadurch die Therapie erschwert.

暂无摘要。

Entrustable professional activities (EPAs) are the tasks or responsibilities which can be entrusted to a learner competent in that task to allow for unsupervised practice. The concept of EPAs is well documented in medical education literature, but only recently in nursing education. A paucity of literature exists on the application of an EPA framework specifically in nurse anesthesia. Based on the successful application of EPAs in competency-based medical and nursing education, we are of the opinion that this framework may also be utilized in the transition to competency-based education for nurse anesthesia learners. Many certified registered nurse anesthetists clinical preceptors lack training in competency-based education and teaching. The concept of EPAs may assist clinical preceptors in the translation of competencies and performance evaluation of learners. EPAs are defined for the nurse anesthesia clinical education setting. Examples of EPAs specific to nurse anesthesia include anesthesia machine checks, intubation, invasive line placement, regional anesthesia blocks, and preoperative assessment. Criteria of EPAs, barriers to use, and concrete examples are provided. Deliberate use of the EPA framework by clinical preceptors may lead to a more effective evaluation of the learner, thus resulting in purposeful progression to competence.