ABSTRACT
Background: Digital health technologies are poised to revolutionise the healthcare industry by improving accessibility to services and patient outcomes. The novel coronavirus disease-19 (COVID-19) pandemic has presented unprecedented challenges for the delivery of allied healthcare and has catalysed rapid adoption of telehealth. As such, allied healthcare consumers and providers stand to benefit from the capabilities of the digital health movement, ultimately justifying a scoping review of current and emerging technologies. Objective: To provide decision makers with up-to-date information on the allied health applications of new and emerging digital health technologies; their evidence of efficacy, scope of use, and limitations. Methods: A scoping review of the literature was conducted, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. To synthesise original research, MEDLINE, CINAHL, and EMBASE databases were searched from 2010 to June 2020 and reference lists were examined for randomised control trials analysing the efficacy of these technologies in allied health applications. Results: A total of 14 articles were included with a focus on common musculoskeletal conditions managed by allied health service providers. Studies were selected for data extraction after abstract and full-text screening by three independent reviewers. The results of this review indicate that telehealth technology effectively monitors and progresses patient care, while mobile health applications provide remote support and enable data collection. Conclusion: Emerging trends suggest that digital technologies serve as promising adjuncts to allied healthcare. Further research is warranted regarding the safety and efficacy of digital health technologies in this context.
ABSTRACT
Within recent years brachytherapy of the prostate has become a treatment of choice. The treatment can be dated back up to the beginning of the twentieth century. It is interesting that the urological routes have never been explored directly by authors of articles and textbooks in the field of radiology and radiooncology.
Subject(s)
Brachytherapy/history , Medical Oncology/history , Prostatic Neoplasms/history , Prostatic Neoplasms/radiotherapy , Urology/history , History, 19th Century , History, 20th Century , Humans , MaleABSTRACT
The Didusch Center for Urologic History encompasses a rich and varied collection of drawings, photographs, and instruments of historical importance to urology, many displayed in the urological exhibits during the American Urological Association (AUA) conventions. The Center also houses a library devoted to urological and early medical texts and the AUA archives and is the institution of research in all fields of urologic history in the USA. The museum collection features most of Didusch's original drawings, as well as an impressive instrument collection acquired primarily through donations by urologists. The original William P. Didusch Museum (now known as the William P. Didusch Center for Urologic History) was originally housed in the AUA's Baltimore City headquarters building. Upon the association's move to Linthicum, MD in 2003, the museum has evolved into the William P. Didusch Center for Urologic History and taken on new tasks and responsibilities that include the topic of research in urologic history.
Subject(s)
Academies and Institutes/organization & administration , Information Dissemination/methods , Societies, Medical/organization & administration , Urology/history , Urology/organization & administration , History, 15th Century , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 21st Century , History, Ancient , History, Medieval , United StatesABSTRACT
Collections from medical societies which are not connected with a university or another public institution cannot be legitimized on the basis of the argument of conserving historical heritage. Even the museum itself with its many tasks and classical site of scientific communication comes into public view and becomes a topic of scientific interest.
Subject(s)
Interdisciplinary Communication , Museums , Science/organization & administration , Societies, Medical/organization & administration , Urology/organization & administration , GermanyABSTRACT
PURPOSE: Max Brödel (1870-1941) is known as one of the major medical illustrators of the turn of the last century. Some important aspects of his biography and his influence on illustration in the specialty of urology are discussed. MATERIALS AND METHODS: The German artist Brödel was invited to The Johns Hopkins Hospital, Baltimore in 1894 and soon became a well-known illustrator in gynecology. He introduced new innovative art media, such as his carbon dust and stipple board technique to reproduce vivid tissue, while developing an instructive and didactic manner of medical illustration. He is also known as an anatomist and scientist, mainly for his description of an avascular area of the kidney (Brödel's bloodless line) and an improved method of nephropexy using a suture that he designed. RESULTS: In 1911 Max Brödel became head of the first Department of Art as Applied to Medicine, establishing the profession of medical illustration. In addition to some work for Hugh Hampton Young, his most important influence on urology was through his student William P. Didusch, who was a medical illustrator at the Brady Urological Institute in Baltimore for more than 40 years. CONCLUSIONS: Brödel changed the appearance of medical illustration at the beginning of the 20th century and improved its role in medical literature. Max Brödel should be referred to as the man who put art into medicine.
Subject(s)
Medical Illustration/history , Germany , History, 19th Century , History, 20th Century , Humans , Male , Maryland , Urology/historySubject(s)
Museums/history , Societies, Medical/history , Urology/history , History, 20th Century , United StatesABSTRACT
Duplex ultrasound is used commonly to evaluate vascular function in impotent men. There is evidence, however, that some men with normal vascular function may have falsely abnormal duplex ultrasound results because of suppression of response to pharmacological stimulation due to anxiety. We performed a prospective blinded study of 40 impotent men comparing duplex ultrasound to a formal nocturnal penile tumescence evaluation. Duplex ultrasound was done with a standard 10 MHz. color Doppler unit after intracorporeal pharmacological stimulation. Nocturnal penile tumescence was performed at a sleep laboratory, and included measurements of penile circumference, axial rigidity, arterial pulsations, and direct patient and observer evaluation of erections. Of 40 men 20 had an abnormal duplex ultrasound result (maximum arterial velocity less than 30 cm. per second), including 9 who had normal nocturnal penile tumescence with at least 1 rigid erection (greater than 550 gm. axial rigidity) lasting at least 5 minutes. All 9 men had evidence of psychogenic dysfunction on history and personality inventory, and only 1 had evidence of vascular disease. Of the other 11 patients with abnormal duplex ultrasound and nocturnal penile tumescence findings, only 2 had evidence of psychogenic impotence and 9 had evidence of vascular disease. In these 11 men there were significant correlations between maximum arterial velocity on duplex ultrasound, and maximum rigidity and arterial pulsations on nocturnal penile tumescence. Of 40 patients 20 had a normal duplex ultrasound finding (maximum velocity greater than 30 cm. per second). Nine of these patients had a normal nocturnal penile tumescence test, of whom 5 had evidence of psychogenic impotence and only 1 had evidence of vascular disease. Eleven men with normal duplex ultrasound had an abnormal nocturnal penile tumescence test, including only 2 with any evidence of psychogenic impotence, while 9 had vascular disease and 1 had a history of neurological disease. Based on this study 9 of 14 men (64%) with a normal nocturnal penile tumescence test and other evidence of psychogenic impotence had abnormal duplex ultrasound. Therefore, an abnormal duplex ultrasound study should be interpreted cautiously if there is evidence of psychogenic impotence. In men with vasculogenic impotence there is an excellent correlation and cross-validation between maximum velocity on duplex ultrasound, and axial rigidity and arterial pulsations on nocturnal penile tumescence.
Subject(s)
Erectile Dysfunction/diagnostic imaging , Penile Erection , Penis/diagnostic imaging , Adult , Aged , Blood Flow Velocity , Erectile Dysfunction/etiology , Erectile Dysfunction/physiopathology , Humans , Male , Middle Aged , Penis/physiopathology , Prospective Studies , Sleep , UltrasonographyABSTRACT
Evaluation of male erectile function ideally should include measurement of axial rigidity expressed as grams force required to produce penile buckling. An axial rigidity more than 550 gm. is generally considered adequate for vaginal penetration. Unfortunately, this test cannot be done frequently and may disrupt sleep. An alternative method of determining rigidity is to use the RigiScan,* which makes repetitive measurements of radial rigidity at the base and tip of the penis expressed as per cent of normal maximum. Previous studies have demonstrated a positive correlation between axial and radial rigidity measurements but they have not been compared in patients with a wide range of erectile function. We performed a prospective study in a consecutive series of patients presenting with impotence comparing axial rigidity measured with a tonometer and radial rigidity measured by RigiScan. Erectile rigidity also was evaluated by a trained, blinded observer. Overall, RigiScan base and tip radial rigidity correlated well with axial rigidity (p < 0.002) and observer ratings (p < 0.003); axial rigidity similarly correlated well with observer ratings (p < 0.0001). However, when RigiScan base and tip radial rigidity exceeded 60% of maximum, there was a poor correlation with axial rigidity and observer ratings (p > 0.1). In this range, the RigiScan failed to discriminate axial rigidities between 450 and 900 gm. buckling force; however, axial rigidity in this same range again correlated well with observer ratings (p < 0.0001). Since an axial rigidity of more than 550 gm. is considered adequate for vaginal penetration, the RigiScan may not be able to detect mild abnormalities in erectile function. Further study is in progress to evaluate the significance of these findings but presently a RigiScan measurement of radial rigidity in excess of 60% of maximum should be interpreted cautiously and not necessarily regarded as normal. In this range further measurements of axial rigidity or observer ratings of rigidity may be necessary to establish the diagnosis.
Subject(s)
Erectile Dysfunction/physiopathology , Penile Erection/physiology , Humans , Male , Monitoring, Physiologic/instrumentation , Prospective StudiesABSTRACT
We performed a double-blind, crossover study using objective measurements to compare maximum rigidity and duration of erections with papaverine hydrochloride in combination with phentolamine mesylate and/or prostaglandin E1. The rationale for the protocol was to combine a smooth muscle relaxant (papaverine) with either or both vasodilating agents (phentolamine and prostaglandin E1) commonly used for injection therapy. The 7 volunteer patients with organic impotence documented by abnormal nocturnal penile tumescence testing were injected with 0.5 to 1.0 ml. papaverine (30 mg./ml.) in combination with phentolamine (0.5 mg./ml.) and/or prostaglandin E1 (5 micrograms./ml.). Each patient received 2 injections on each of 2 testing dates; injection 2 was given after tumescence resulting from injection 1 had subsided completely. The medications were given in a randomized, counterbalanced order following double-blind procedures. Patients evaluated the erections subjectively. In addition, the RigiScan device was used to measure maximum rigidity and duration of erections. All patients observed increased duration of erections with both combinations containing prostaglandin E1. Analysis of RigiScan measurements showed no statistically significant differences for maximum rigidity (p greater than 0.1) but significantly greater duration of erections with papaverine plus prostaglandin E1, and papaverine plus phentolamine plus prostaglandin E1 compared to papaverine plus phentolamine (p less than 0.001). There was no statistical difference in rigidity or duration of erections between papaverine plus prostaglandin E1 and papaverine plus phentolamine plus prostaglandin E1. No patient reported significant penile pain with any of the injections. We conclude that the combination of papaverine and prostaglandin E1 produces erections of longer duration than papaverine plus phentolamine and that no additional benefit is gained by adding phentolamine to a combination of papaverine and prostaglandin E1. Further studies are in progress to define optimal dose response curves for papaverine and prostaglandin E1 as individual agents and in combination.
Subject(s)
Alprostadil/therapeutic use , Erectile Dysfunction/drug therapy , Papaverine/therapeutic use , Penile Erection/drug effects , Phentolamine/therapeutic use , Double-Blind Method , Drug Therapy, Combination , Humans , Male , Prospective Studies , Time FactorsABSTRACT
A new inflatable penile prosthesis is described. The operative approaches, infrapubic and scrotal, are discussed and compared. The results of 56 successive implants are presented. The simplicity of the device which combines the usual intra-abdominal reservoir and the scrotal pump into a scrotal "resipump" is discussed. The device has shown a good performance and is a valuable addition to the varieties of penile implants.
Subject(s)
Erectile Dysfunction/surgery , Penile Prosthesis , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Prosthesis DesignABSTRACT
Technical complications requiring frequent surgical revision of the most commonly used penile component prosthesis have led to the development of a new inflatable device that has been implanted in 202 patients. This hydraulic device provides excellent functional qualities; no connector separations, aneurysms, or ruptures have been encountered in these patients. Reoperations became necessary in 8 per cent of these patients. Cosmetic and functional results are good, and patient acceptance has been excellent.
Subject(s)
Penis/surgery , Prostheses and Implants , Erectile Dysfunction/surgery , Follow-Up Studies , Humans , Male , Prostheses and Implants/adverse effects , ReoperationABSTRACT
We present our experience with the new Mentor inflatable penile prosthesis for the treatment of organic impotence. Technical complications requiring frequent revision of the most commonly used inflatable prosthesis have led to the development of a new device, which we have used in 116 patients. This hydraulic device provides excellent functional qualities. No connector separations, aneurysms or ruptures have been encountered. Reoperations became necessary in 10.5 per cent of the patients. Cosmetic and functional results were good, and patient acceptance has been excellent.
Subject(s)
Erectile Dysfunction/therapy , Penis , Prostheses and Implants , Follow-Up Studies , Humans , Male , Prosthesis Design , ReoperationSubject(s)
Cryptorchidism , Abdomen , Cryptorchidism/diagnosis , Cryptorchidism/surgery , Diagnosis, Differential , Humans , Inguinal Canal , Male , Methods , Testis/surgeryABSTRACT
Congenital anorchism is a rare condition. Bilateral impa-pable undescended testes are relatively common by comparison. Surgical exploration has been regarded as the final arbiter between anorchism and bilateral cryptorchism. Exploration has not proved completely reliable in making this differentiation. Endocrine studies, particularly the human chorionic gonadotropin (HCG) stimulation test together with measurements of basal plasma gonadotropins, can reliably exclude "functioning" testicular tissue. Eleven fully evaluated and operated cases support this contention. In the specific clinical setting of a normal phenotypic male child with a 46XY karyotype and no müllerian structures palpable on rectal examination, nonfunctioning testes on endocrine testing means congenital anorchism and surgical confirmation is unnecessary. In contradistinction, a positive HCG test would appear to mandate through and extensive surgical exploration.
Subject(s)
Cryptorchidism/diagnosis , Testis/abnormalities , Child , Child, Preschool , Chorionic Gonadotropin , Diagnosis, Differential , Follicle Stimulating Hormone/blood , Functional Laterality , Gonadotropin-Releasing Hormone , Humans , Luteinizing Hormone/blood , Male , Palpation , Phenotype , Testosterone/bloodABSTRACT
A Wilms' tumor, completely filling the collecting system of a kidney, led to nonfunction of the involved kidney. Histologic examination proved absence of renal vein involvement. Review of our case material and discussions with other centers showed that this unusual presentation has been seen elsewhere.
