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Sher, Malvina, Stephanie Freudenberger, Stephanie Auriemmo, Patricia Tufaro, Hope Hunter, Maureen Marren y Philip Chang. "832 Trends for Treatment of Complex Hand Burns in the Acute Setting". Journal of Burn Care & Research 41, Supplement_1 (marzo de 2020): S254. http://dx.doi.org/10.1093/jbcr/iraa024.405.
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Abstract Introduction Complex hand burns require special consideration of therapy practices within the acute setting. Deep hand burns, their associated injuries, and the sequelae of healing can cause significant dysfunction. The purpose of this study was to examine current practices in the inpatient treatment of complex hand burns in order to identify potential trends that may guide clinical practice for edema management, anti-deformity positioning, and range of motion (ROM). Methods A confidential internet survey was sent to burn therapists in this country from the American Burn Association (ABA) Occupational and Physical Therapy (OT/PT) Special Interest Group list. One therapist from each burn center was asked to complete the survey. Results There were 41 respondents representing 33% of burn centers. The majority of respondents were occupational therapists (78%) from burn centers with 500 or less annual admissions (76%) and more than 16 years of experience treating burn patients (68%). Burn therapists most commonly measure composite (57%) and isolated (51%) joint passive/active ROM, followed by measuring distance from fingertip to distal palmar crease (43%). With questionable or confirmed tendon involvement, the majority (68%) of OT/PTs performed isolated joint techniques, with active ROM the most common at 38%. Therapists initiate edema management, other than elevation, within 24 hours (44%) from the patient’s admission. The most prevalent edema management practice is active exercise (94%) compared to other more aggressive practices such as self-adherent wrap (50%). Anti-deformity orthotics are initiated within 24 hours (44%) and are the most common means of post-graft immobilization (41%). For hand stiffness, 53% of therapists utilize casting. For stiff proximal interphalangeal (PIP) joints, joint mobilization (45%) and thermal modality with ROM exercises (32%) were viewed as the most effective interventions, surpassing orthotics and casting. While 88% of centers utilize an interdisciplinary approach to care for the hand, 59% view the hand as a surgical priority. Percutaneous pins are utilized for joint stability, most frequently in PIP joints (62%) and remained 2–3 weeks on average (45%). Conclusions The survey highlights trends directed towards a more conservative management of complex hand burns related to edema management, anti-deformity positioning, and ROM. There is less of a clear consensus among burn therapists on how to approach complicated hand injuries that involve exposed/injured tendons or stiff joints. Interdisciplinary rounds can be utilized to promote communication regarding more aggressive means of therapy intervention in order to improve patient outcomes related to the hand. Applicability of Research to Practice Present current trends in the inpatient treatment of complex hand burns.
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Natarajan, Sriram y Aura Ganz. "SURGNET: An Integrated Surgical Data Transmission System for Telesurgery". International Journal of Telemedicine and Applications 2009 (2009): 1–9. http://dx.doi.org/10.1155/2009/435849.
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Remote surgery information requires quick and reliable transmission between the surgeon and the patient site. However, the networks that interconnect the surgeon and patient sites are usually time varying and lossy which can cause packet loss and delay jitter. In this paper we propose SURGNET, a telesurgery system for which we developed the architecture, algorithms and implemented it on a testbed. The algorithms include adaptive packet prediction and buffer time adjustment techniques which reduce the negative effects caused by the lossy and time varying networks. To evaluate the proposed SURGNET system, at the therapist site, we implemented a therapist panel which controls the force feedback device movements and provides image analysis functionality. At the patient site we controlled a virtual reality applet built in Matlab. The varying network conditions were emulated using NISTNet emulator. Our results show that even for severe packet loss and variable delay jitter, the proposed integrated synchronization techniques significantly improve SURGNET performance.
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Hansson, Anders, Ann Svensson, Britt Hedman Ahlström, Lena G. Larsson, Berit Forsman y Pia Alsén. "Flawed communications: Health professionals’ experience of collaboration in the care of frail elderly patients". Scandinavian Journal of Public Health 46, n.º 7 (12 de julio de 2017): 680–89. http://dx.doi.org/10.1177/1403494817716001.
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Aims: Frail elderly patients who have multiple illnesses do not fare well in modern health care systems, mainly due to a lack of care planning and flawed communication between health professionals in different care organisations. This is especially noticeable when patients are discharged from hospital. The aim of this study was to explore health care professionals’ experience of obstacles and opportunities for collaboration. Methods: Health professionals were invited to participate in three focus groups, each consisting of a hospital physician, a primary care physician, a hospital nurse, a primary care nurse, a municipal home care nurse or an assistant officer, a physical or occupational therapist and a patient or a family member representative. These individual people were then asked to discuss the obstacles and opportunities for communication between themselves and with the patients and their relatives when presented with the case report of a fictitious patient. Content analysis was used to identify categories. Results: Several obstacles were identified for effective communication and care planning: insufficient communication with patients and relatives; delayed collaboration between care-givers; the lack of an adequate responsible person for care planning; and resources not being distributed according to the actual needs of patients. The absence of an overarching responsibility for the patient, beyond organisational borders, was a recurring theme. These obstacles could also be seen as opportunities. Conclusions: Obstacles for collaboration were found on three levels: societal, organisational and individual. As health care professionals are well aware of the problems and also see solutions, management for health care should support employees’ own initiatives for changes that are of benefit in the care of frail elderly patients with multiple illnesses.
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Mbonihankuye, Scholas, Athanase Nkunzimana y Ange Ndagijimana. "Healthcare Data Security Technology: HIPAA Compliance". Wireless Communications and Mobile Computing 2019 (17 de octubre de 2019): 1–7. http://dx.doi.org/10.1155/2019/1927495.
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Information technology (IT) plays an increasingly important and prominent role in the health sector. Data security is more important than ever to the healthcare industry and in world in general. The number of data breaches compromising confidential healthcare data is on the rise. For data security, cloud computing is very useful for securing data. Due to data storage issue, there is a need to use the electronic communication, and a number of methods have been developed for data security technology. Health Insurance Portability and Accountability Act (HIPAA) is one of the methods that can help in healthcare research. On stored database of patient in hospital or clinic, we can develop a conservational and analytical method so as to keep the medical records of the patients in a well-preserved and adequate environment. The method includes the improvement of working possibilities by delivering all the details necessary for the patient. All the information must be identified clearly. The protection of the privacy of the patients and the security of their information are the most imperative obstacles to obtain their intakes when considering the adoption of useful health data in the electronic field of healthcare industries.
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Lupu, Robert Gabriel, Danut Constantin Irimia, Florina Ungureanu, Marian Silviu Poboroniuc y Alin Moldoveanu. "BCI and FES Based Therapy for Stroke Rehabilitation Using VR Facilities". Wireless Communications and Mobile Computing 2018 (2018): 1–8. http://dx.doi.org/10.1155/2018/4798359.
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In recent years, the assistive technologies and stroke rehabilitation methods have been empowered by the use of virtual reality environments and the facilities offered by brain computer interface systems and functional electrical stimulators. In this paper, a therapy system for stroke rehabilitation based on these revolutionary techniques is presented. Using a virtual reality Oculus Rift device, the proposed system ushers the patient in a virtual scenario where a virtual therapist coordinates the exercises aimed at restoring brain function. The electrical stimulator helps the patient to perform rehabilitation exercises and the brain computer interface system and an electrooculography device are used to determine if the exercises are executed properly. Laboratory tests on healthy people led to system validation from technical point of view. The clinical tests are in progress, but the preliminary results of the clinical tests have highlighted the good satisfaction degree of patients, the quick accommodation with the proposed therapy, and rapid progress for each user rehabilitation.
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Roberts, Lisa y Sally J. Bucksey. "Communicating With Patients: What Happens in Practice?" Physical Therapy 87, n.º 5 (1 de mayo de 2007): 586–94. http://dx.doi.org/10.2522/ptj.20060077.
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Background and Purpose Communication is the most important aspect of practice that health care professionals have to master. The purpose of this study was to measure the content and prevalence of verbal and nonverbal communications between physical therapists and patients with back pain. Subjects Seven physical therapists and 21 patients with back pain participated in this study. Methods The first interaction following the initial assessment was recorded with a video camera. The outcome measures were the Medical Communications Behavior System (verbal communication) and frequencies of nonverbal behaviors (affirmative head nodding, smiling, eye gaze, forward leaning, and touch). Semistructured interviews were undertaken with the physical therapists to determine the perceived influence of the video camera. Results A total of 2,055 verbal statements were made. Physical therapists spent approximately twice as much time talking as patients, with content behaviors (such as taking history and giving advice) comprising 52% of verbal communications. The most prevalent nonverbal behaviors were touch by physical therapists (54%) and eye gaze by patients (84%). Discussion and Conclusion The prevalence and content of communication can be measured with video analysis and validated tools. Communication is an extremely important but underexplored dimension of the patient-therapist relationship, and the methods described here could provide a useful model for further research and reflective practice.
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Freebury, D. Ray. "The Therapeutic Alliance: A Psychoanalytic Perspective*". Canadian Journal of Psychiatry 34, n.º 8 (noviembre de 1989): 772–74. http://dx.doi.org/10.1177/070674378903400805.
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Psychoanalysis has long distinguished between the transference neurosis and that part of the communication between therapist and patient which depends upon a relatively intact part of the patient's ego. It has been proposed that it is this capacity of the patient that sustains the difficult work of dealing with communications which are the consequence of transference, and which often threaten the viability of the treatment. This quality has been referred to variously as the unobjectionable positive transference, rational transference, mature transference, therapeutic alliance and working alliance. The ever broadening scope of Psychoanalysis, along with our greater knowledge of early childhood development, has enhanced our understanding of the many influences affecting the treatment alliances. Newer views of the transference, which stress the significance of the therapists' contributions to the therapeutic dyad, make it clear that the therapeutic alliance can no longer be explained as some simple, reality based, conflict free, motivating force. It involves, rather, a complex interaction of several factors, to each of which one must add the therapists' reciprocal reactions. Psychotherapy outcome research will need to take all of these factors into consideration.
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Rodomonti, Martina, Eleonora Fiorenza, Francesco Gazzillo y Nino Dazzi. "Progress in Psychotherapy: The Perspective of Control-Mastery Theory". Psychodynamic Psychiatry 49, n.º 1 (marzo de 2021): 131–59. http://dx.doi.org/10.1521/pdps.2021.49.1.131.
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In the classical psychoanalytic tradition, the patient is seen as unconsciously governed by forces that are at odds with the healing process. But over the years, the concept of resistance against change has been subjected to modifications, and the patient's contribution to the therapeutic relationship has come to be seen as more oriented to a conscious and unconscious collaboration with the clinician. This article aims to explore a new way of understanding how progress in psychotherapy is achieved and to reframe the therapeutic relationship from the point of view of Control-Mastery Theory (CMT). According to CMT, people are motivated to achieve adaptive goals, to master their traumas, and to feel better; to this purpose, patients unconsciously assume proactive roles in the therapeutic process. Indeed, they work during therapy to disprove their pathogenic beliefs, testing them in the therapeutic relationship, and helping the therapist through coaching behaviors, attitudes, and communications aimed at providing helpful information to understand the components of their own unconscious plan.
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Abdulrahman, Amal y Deborah Richards. "In Search of Embodied Conversational and Explainable Agents for Health Behaviour Change and Adherence". Multimodal Technologies and Interaction 5, n.º 9 (18 de septiembre de 2021): 56. http://dx.doi.org/10.3390/mti5090056.
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Conversational agents offer promise to provide an alternative to costly and scarce access to human health providers. Particularly in the context of adherence to treatment advice and health behavior change, they can provide an ongoing coaching role to motivate and keep the health consumer on track. Due to the recognized importance of face-to-face communication and establishment of a therapist-patient working alliance as the biggest single predictor of adherence, our review focuses on embodied conversational agents (ECAs) and their use in health and well-being interventions. The article also introduces ECAs who provide explanations of their recommendations, known as explainable agents (XAs), as a way to build trust and enhance the working alliance towards improved behavior change. Of particular promise, is work in which XAs are able to engage in conversation to learn about their user and personalize their recommendations based on their knowledge of the user and then tailor their explanations to the beliefs and goals of the user to increase relevancy and motivation and address possible barriers to increase intention to perform the healthy behavior.
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Perri, Damiano, Martina Fortunelli, Marco Simonetti, Riccardo Magni, Jessica Carloni y Osvaldo Gervasi. "Rapid Prototyping of Virtual Reality Cognitive Exercises in a Tele-Rehabilitation Context". Electronics 10, n.º 4 (13 de febrero de 2021): 457. http://dx.doi.org/10.3390/electronics10040457.
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In recent years, the need to contain healthcare costs due to the growing public debt of many countries, combined with the need to reduce costly travel by patients unable to move autonomously, have captured the attention of public administrators towards tele-rehabilitation. This trend has been consolidated overwhelmingly following the Covid-19 pandemic, which has made it precarious, difficult and even dangerous for patients to access hospital facilities. We present an approach based on the rapid prototyping of virtual reality, cognitive tele-rehabilitation exercises, which reinforce the group of exercises available in the Nu!reha platform. Patients who experienced injury or pathology need to practice continuous training in order to recover functional abilities, and the therapist needs to monitor the outcomes of such practices. The group of new exercises based on the rapid prototyping approach, become crucial especially in this pandemic period. The Virtual Reality exercises are designed on Unity 3D to empower the therapist to set up personalized exercises in an easy way, enabling the patient to receive personalized stimuli, which are essential for a positive outcome in the practice. Furthermore, the reaction speed of the system is of fundamental importance, as the temporal evolution of the scene must proceed parallel to the patient’s movements, to ensure an effective and efficient therapeutic response. So, we optimized the virtual reality application in order to make the loading phase and the startup phase as fast as possible and we have tested the results obtained with many devices: in particular computers and smartphones with different operating systems and hardware. The implemented method powers up the Nu!Reha system®, a collection of tele-rehabilitation services that helps patients to recover cognitive and functional capabilities.
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Favorskaya, M. N. y E. I. Savchina. "DIGITAL WATERMARKING OF 3D MEDICAL VISUAL OBJECTS". ISPRS - International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences XLII-2/W12 (9 de mayo de 2019): 61–67. http://dx.doi.org/10.5194/isprs-archives-xlii-2-w12-61-2019.
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<p><strong>Abstract.</strong> At present, medical equipment provides often 3D models of scanning organs instead of ordinary 2D images. This concept is supported by Digital Imaging and COmmunications in Medicine (DICOM) standard available for telemedicine. This means that the confidential information under transmission ought to be protected by special techniques, particularly digital watermarking scheme instead of textual informative files represented, for example, on CD disks. We propose a multilevel protection, for which a fragile watermark is the first level of protection. The Region Of Interest (ROI) watermark and textual watermarks with information about patient and study (the last ones can be combines as a single textual watermark) form the second level of protection. Encryption of the ROI and textual watermarks using Arnold’s transform is the third level of protection. In the case of 3D models, we find the ROI in each of 2D sliced images, apply the digital wavelet transform or digital shearlet transform (depending on the volume of watermarks) for the ROI and textual watermarks embedding, and embed a fragile watermark using digital Hadamard transform. The main task is to find the relevant regions for embedding. To this and, we develop the original algorithm for selecting relevant regions. The obtained results confirm the robustness of our approach for rotation, scaling, translation, and JPEG attacks.</p>
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Dubey, Ajay, Jeff Bernard, Bret Heintz, Kyle Antes, Stacy Hartman, Bernard Taylor, Brennan Scott Cheek, Jeffrey Limmer, Lalan S. Wilfong y John Russell Hoverman. "Creating a radiation oncology oriented safety culture within a large oncology practice: Lessons learned." Journal of Clinical Oncology 35, n.º 8_suppl (10 de marzo de 2017): 85. http://dx.doi.org/10.1200/jco.2017.35.8_suppl.85.
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85 Background: Texas Oncology (TXO) is a dedicated oncology practice consisting of more than 400 physicians and 57 radiation oncologists at 52 sites of service. In order to enhance communications of the rad onc team, establish accountability by using metrics, and engage continuous improvement, we initiated a program to establish regional quality committees in each radiation oncology practice site. Methods: In 2015, the TXO leadership approved the formation of Regional Quality Committees (RQC) at each site. The key members of each RQC include a Physician Chair, a Physicist Co-Chair, Chief Therapist, Radiation Safety Officer, Dosimetrist, and Nurse. Meeting frequency was recommended monthly, but quarterly meetings were required. Meeting documentation reporting was required including a formal agenda, minutes for items discussed, and listing of attendees. Metrics with regard to RQC activities were reported and recorded beginning in 2016. The 2016 Action plan for the RQC at each site included documentation of timeout procedure, regular chart rounds, new patient conference, as well as a mortality and morbidity conference. Results: See table. Conclusions: Within 3 calendar quarters, a functional RQC was established in all 52 radiation oncology practice sites within TXO. Compliance with the action plan was high with regard to action items not requiring multiple physician participants (RQC committee, timeout, chart rounds, CQI projects, performance metrics). Compliance was lower in activities that required multiple physician participation. Verbal feedback was positive regarding the RQC program. Respecting time demands of physicians, education, and communication were identified as key success factors in the RQC program. [Table: see text]
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Griffiths, Frances E., Xavier Armoiry, Helen Atherton, Carol Bryce, Abigail Buckle, Jonathan AK Cave, Rachel Court et al. "The role of digital communication in patient–clinician communication for NHS providers of specialist clinical services for young people [the Long-term conditions Young people Networked Communication (LYNC) study]: a mixed-methods study". Health Services and Delivery Research 6, n.º 9 (febrero de 2018): 1–270. http://dx.doi.org/10.3310/hsdr06090.
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BackgroundYoung people (aged 16–24 years) with long-term health conditions tend to disengage from health services, resulting in poor health outcomes. They are prolific users of digital communications. Innovative UK NHS clinicians use digital communication with these young people. The NHS plans to use digital communication with patients more widely.ObjectivesTo explore how health-care engagement can be improved using digital clinical communication (DCC); understand effects, impacts, costs and necessary safeguards; and provide critical analysis of its use, monitoring and evaluation.DesignObservational mixed-methods case studies; systematic scoping literature reviews; assessment of patient-reported outcome measures (PROMs); public and patient involvement; and consensus development through focus groups.SettingTwenty NHS specialist clinical teams from across England and Wales, providing care for 13 different long-term physical or mental health conditions.ParticipantsOne hundred and sixty-five young people aged 16–24 years living with a long-term health condition; 13 parents; 173 clinical team members; and 16 information governance specialists.InterventionsClinical teams and young people variously used mobile phone calls, text messages, e-mail and voice over internet protocol.Main outcome measuresEmpirical work – thematic and ethical analysis of qualitative data; annual direct costs; did not attend, accident and emergency attendance and hospital admission rates plus clinic-specific clinical outcomes. Scoping reviews–patient, health professional and service delivery outcomes and technical problems. PROMs: scale validity, relevance and credibility.Data sourcesObservation, interview, structured survey, routinely collected data, focus groups and peer-reviewed publications.ResultsDigital communication enables access for young people to the right clinician when it makes a difference for managing their health condition. This is valued as additional to traditional clinic appointments. This access challenges the nature and boundaries of therapeutic relationships, but can improve them, increase patient empowerment and enhance activation. Risks include increased dependence on clinicians, inadvertent disclosure of confidential information and communication failures, but clinicians and young people mitigate these risks. Workload increases and the main cost is staff time. Clinical teams had not evaluated the impact of their intervention and analysis of routinely collected data did not identify any impact. There are no currently used generic outcome measures, but the Patient Activation Measure and the Physicians’ Humanistic Behaviours Questionnaire are promising. Scoping reviews suggest DCC is acceptable to young people, but with no clear evidence of benefit except for mental health.LimitationsQualitative data were mostly from clinician enthusiasts. No interviews were achieved with young people who do not attend clinics. Clinicians struggled to estimate workload. Only eight full sets of routine data were available.ConclusionsTimely DCC is perceived as making a difference to health care and health outcomes for young people with long-term conditions, but this is not supported by evidence that measures health outcomes. Such communication is challenging and costly to provide, but valued by young people.Future workFuture development should distinguish digital communication replacing traditional clinic appointments and additional timely communication. Evaluation is needed that uses relevant generic outcomes.Study registrationTwo of the reviews in this study are registered as PROSPERO CRD42016035467 and CRD42016038792.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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"A Steganographic Apps-based Patient‟s Information Encryption-Decryption". International Journal of Recent Technology and Engineering 8, n.º 2S6 (16 de septiembre de 2019): 909–12. http://dx.doi.org/10.35940/ijrte.b1169.0782s619.
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A steganographic apps-based patient’s information communication system has been designed, developed and implemented in Java programming language that can hide patient confidential data in an image. The Playfair cipher encryption-decryption technique with a set of keywords has been used in this transaction system. For this, the patient’s information is first encrypted with the Playfair encryption technique and produces the cipher text that are embedded with an image in a hidden format and then the image is sent to the destination. In the receiving end, the encrypted hidden information is extracted and retrieve the information by using the reverse process. The process has been applied on several patient’s information and steganographic images and found the results successfully. This proposed steganographic process is a higher layer of security methods in the communications and can be applied where high security is needed.
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Schore, Allan N. "The Interpersonal Neurobiology of Intersubjectivity". Frontiers in Psychology 12 (20 de abril de 2021). http://dx.doi.org/10.3389/fpsyg.2021.648616.
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In 1975, Colwyn Trevarthen first presented his groundbreaking explorations into the early origins of human intersubjectivity. His influential model dictates that, during intimate and playful spontaneous face-to-face protoconversations, the emotions of both the 2–3-month-old infant and mother are nonverbally communicated, perceived, mutually regulated, and intersubjectively shared. This primordial basic interpersonal interaction is expressed in synchronized rhythmic-turn-taking transactions that promote the intercoordination and awareness of positive brain states in both. In this work, I offer an interpersonal neurobiological model of Trevarthen’s intersubjective protoconversations as rapid, reciprocal, bidirectional visual-facial, auditory-prosodic, and tactile-gestural right brain-to-right brain implicit nonverbal communications between the psychobiologically attuned mother and the developing infant. These co-constructed positive emotional interactions facilitate the experience-dependent maturation of the infant’s right brain, which is in an early critical period of growth. I then address the central role of interpersonal synchrony in intersubjectivity, expressed in a mutual alignment or coupling between the minds and bodies of the mother and infant in face-to-face protoconversations, as well as how these right brain-to-right brain emotional transmissions generate bioenergetic positively charged interbrain synchrony within the dyad. Following this, I offer recent brain laterality research on the essential functions of the right temporoparietal junction, a central node of the social brain, in face-to-face nonverbal communications. In the next section, I describe the ongoing development of the protoconversation over the 1st year and beyond, and the co-creation of a fundamental energy-dependent, growth-promoting social emotional matrix that facilitates the emergence of the highly adaptive human functions of mutual play and mutual love. In the final section, I discuss the clinical applications of this interpersonal neurobiological model of intersubjectivity, which has a long history in the psychotherapy literature. Toward that end, I offer very recent paradigm-shifting hyperscanning research that simultaneously measures both the patient and therapist during a psychotherapeutic interaction. Using the Trevarthen’s two-person intersubjective model, this research demonstrates changes in both brains of the therapeutic dyad and the critical role of nonverbal communications in an emotionally-focused psychotherapy session. These studies specifically document interbrain synchronization between the right temporoparietal junction of the patient and the right temporoparietal junction of the clinician, a right brain-to-right brain nonverbal communication system in the co-constructed therapeutic alliance. Lastly, I discuss the relationship between the affect communicating functions of the intersubjective motivational system and the affect regulating functions of the attachment motivational system.