Study design: Randomized controlled animal trial.Objectives: To analyze the early and late phase effects of platelet-rich plasma (PRP) injection into and around the damaged intervertebral disc using an animal model, and to evaluate the needle puncture technique in creating a degenerative disc model.Methods: The L4-L5 intervertebral disc of 18 adult Sprague-Dawley rats was injured with a 21-gauge needle. Animals received an immediate injection of PRP, or a delayed injection of PRP 2 weeks postinjury, or no further intervention (sham) (n = 6/group). Six uninjured controls were used. Magnetic resonance imaging (MRI) was performed for a control at time 0 and each group at 4 weeks postinjury, this allowed resolution of inflammation and an accurate assessment of healing. Specimens were collected from immediate PRP group at 2 and 4 weeks postinjury, and the delayed PRP group at 4 and 6 weeks postinjury. The sham and control specimens were collected at 2, 4, and 6 weeks postinjury. Each disc was sectioned and analyzed subjectively for overall structure, cellularity, and water content (utilizing MRI). Disc height was measured using descriptive statistics and one-way analysis of variance (ANOVA) with Tukey post hoc analysis. It was presumed both groups injected with PRP would have better outcomes than the sham group.Results: The sham group had clear degenerative changes with loss of organizational structure, empty space, fibrous tissue, and inflammatory cells, indicating needle puncture leads to degeneration. The PRP treated groups had fibers that were damaged with empty spaces and inflammatory cells. However, there was maintenance of the ring structure and the nucleus appeared to have a healthy central portion. Overall, both PRP - treated groups retained more normal morphologic features, contained fewer inflammatory cells, and had higher fluid content on MRI; however the effect was more pronounced in the immediate injection group. The disc height was significantly different in the sham and immediate injection group at the 4-week interval.Conclusions: This percutaneous needle puncture technique is an effective method for creating a degenerative disc model without posterior destabilization of the spine. The administration of PRP has a protective effect on damaged discs in the acute and delayed injection settings representing clinical treatment with PRP in the early versus late stages of the degenerative process. It appears that earlier intervention in the disease process would be more beneficial than PRP treatment of already severely degenerated discs.

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Background An alternative mode of interaction with navigation systems for open liver surgery was requested. Surgeons who use such systems are impeded by having to constantly switch between viewing the navigation system screen and the patient during an operation. Methods To this end, an auditory display system for open liver surgery is introduced with support for guiding the tracked instrument towards and remaining on a predefined resection line. In order to evaluate the method, a clinically orientated user study with 12 surgeons was conducted.Results Qualitative results from the user study show that the proposed auditory display is recognized as a useful addition to the current visual mode of interaction. A statistical analysis revealed that participants spent less time looking on the screen (10 % versus 96 %). Accuracy for resection guidance was significantly improved when using auditory display as an additional information channel (0.6 mm versus 1.4 mm), however, the overall time for the resection task was shorter without auditory display (47 sec versus 24 sec). Conclusions By reducing dependence on the visual modality during resection guidance, the auditory display is well suited to become integrated in navigation systems for liver surgery.

Purpose During medical needle placement using image-guided navigation systems, the clinician must concentrate on a screen. To reduce the clinician’s visual reliance on the screen, this work proposes an auditory feedback method as a stand-alone method or to support visual feedback for placing the navigated medical instrument, in this case a needle. Methods An auditory synthesis model using pitch comparison and stereo panning parameter mapping was developed to augment or replace visual feedback for navigated needle placement. In contrast to existing approaches which augment but still require a visual display, this method allows view-free needle placement. An evaluation with 12 novice participants compared both auditory and combined audiovisual feedback against existing visual methods. Results Using combined audiovisual display, participants show similar task completion times and report similar subjective workload and accuracy while viewing the screen less compared to using the conventional visual method. The auditory feedback leads to higher task completion times and subjective workload compared to both combined and visual feedback. Conclusion Audiovisual feedback shows promising results and establish a basis for applying auditory feedback as a supplement to visual information to other navigated interventions, especially those for which viewing a patient is beneficial or necessary.

An integrated telehealth network that linked three hospitals, a federally qualified health care clinic with six sites, a county dental clinic, and patient homes was developed and implemented using both private and federal funding. The goal of the network was to deliver 10 different medical, dental, and behavioral health services to a rural community. The network served patients from nine different counties and two states. Outcomes from the disease management programs for congestive heart failure and diabetes, as well as crisis telehealth and teledental health, were reported. Results for the diabetes disease management program increased the number of diabetics who brought their blood sugar under control. Additionally, based on hospital days per patient per year with and without intervention, and the cost of intervention by telehealth, it was projected that the national cost of care for CHF hospitalizations could be reduced from 8 billion dollars to 4.2 billion dollars. This telehealth network can serve as a model for integrating health services in each county of the state. Once each county had an integrated telehealth network, the county networks could be linked to provide regional services and coordination on a statewide basis.

A psychoacoustically motivated sonification design to guide clinicians in two-dimensional space is presented, e.g., to navigate a scalpel towards a target resection trajectory, ablation needle towards a preplanned insertion point, or drill towards a target burrhole for craniotomy. Navigation is achieved by mapping spatial dimensions to audio synthesis parameters that affect the magnitude of different perceptual sound qualities. Orthogonal spatial dimensions are mapped to orthogonal auditory qualities. In a preliminary laboratory study, non-expert users successfully identified the target field out of 16 possible fields in 41% of all trials. The correct cardinal direction was identified in 84% of the trials. Based on both findings and further psychoacoustic considerations, the mapping range is optimized, and an implementation of an additional depth dimension is discussed

Purpose This article investigates the current state of the art of the use of auditory display in image-guided medical interventions. Auditory display is a means of conveying information using sound, and we review the use of this approach to support navigated interventions. We discuss the benefits and drawbacks of published systems and outline directions for future investigation. Methods We undertook a review of scientific articles on the topic of auditory rendering in image-guided intervention. This includes methods for avoidance of risk structures and instrument placement and manipulation. The review did not include auditory display for status monitoring, for instance in anesthesia. Results We identified 13 publications in the course of the search. Most of the literature (62%) investigates the use of auditory display to convey distance of a tracked instrument to an object using proximity or safety margins. The remainder discuss continuous guidance for navigated instrument placement. Four of the articles present clinical evaluations, 9 present laboratory evaluations, and 3 present informal evaluation (3 present both laboratory and clinical evaluations). Conclusion Auditory display is a growing field that has been largely neglected in research in image-guided intervention. Despite benefits of auditory displays reported in both the reviewed literature and non-medical fields, adoption in medicine has been slow. Future challenges include increasing interdisciplinary cooperation with auditory display investigators to develop more meaningful auditory display designs and comprehensive evaluations which target the benefits and drawbacks of auditory display in image guidance.

The aim of this study was to follow up a sample of physicians who began core medical training (CMT) in 2009. This paper examines the long-term validity of CMT and GP selection methods in predicting performance in the Membership of Royal College of Physicians (MRCP(UK)) examinations. We performed a longitudinal study, examining the extent to which the GP and CMT selection methods (T1) predict performance in the MRCP(UK) examinations (T2). A total of 2,569 applicants from 2008-09 who completed CMT and GP selection methods were included in the study. Looking at MRCP(UK) part 1, part 2 written and PACES scores, both CMT and GP selection methods show evidence of predictive validity for the outcome variables, and hierarchical regressions show the GP methods add signifi cant value to the CMT selection process. CMT selection methods predict performance in important outcomes and have good evidence of validity; the GP methods may have an additional role alongside the CMT selection methods . KEYWORDS : Assessment , CMT , core medical training , CT1 , interviews , machine-marked tests , selection , validity IntroductionIn the UK, up to 3,000 junior doctors apply annually to core medical training (CMT), through a nationally coordinated process, to train as physicians.1 To ensure that individuals selected for training will become competent in practice, selection assessments must be valid, fair and legally defensible. In particular, establishing the predictive validity of a selection method is central to understanding the extent to which a method can predict applicants' future performance.3 This ABSTRACTThe predictive validity of a situational judgement test, a clinical problem solving test and the core medical training selection methods for performance in specialty training ensures that selection methods identify the best person for the role.To date, there has been no published evidence of the longerterm, predictive validity of the CMT selection process. However, a 2009 study explored the GP machine-marked tests (MMTs) for shortlisting into CMT . 4 Patterson et al included two invigilated MMTs: 1 a clinical problem solving test (CPS), designed to measure applicants' ability to apply clinical knowledge in a relevant context and make clinical decisions in practice 2 a situational judgement test (SJT), where applicants were presented with text-based scenarios of professional dilemmas they may encounter at work and asked to identify an appropriate response from a list of alternatives.This 2009 study demonstrated that the GP MMTs were reliable and predictive of subsequent performance in CMT selection interviews, suggesting that the MMTs may be a useful selection methodology for CMT in the UK. However, to date no validation work has been conducted to further substantiate these findings, even though the 2009 paper suggested that future research studies should explore the prediction of longerterm outcomes, including progression during training.This study expands on Patterson and colleagues' 2009 research by following up the same samp...