Design and Evaluation of a Technological Platform for Monitoring Patients with Dementia: Unifying Requirements from Mexican Day Centers.

The monitoring of patients with dementia who receive comprehensive care in day centers allows formal caregivers to make better decisions and provide better care to patients. For instance, cognitive and physical therapies can be tailored based on the current stage of disease progression. In the context of day centers of the Mexican Federation of Alzheimer, this work aims to design and evaluate Alzaid, a technological platform for assisting formal caregivers in monitoring patients with dementia. Alzaid was devised using a participatory design methodology that consisted in eliciting and validating requirements from 22 and 9 participants, respectively, which were unified to guide the construction of a high-fidelity prototype evaluated by 14 participants. The participants were formal caregivers, medical staff, and management. This work contributes a high-fidelity prototype of a technological platform for assisting formal caregivers in monitoring patients with dementia considering restrictions and requirements of four Mexican day centers. In general, the participants perceived the prototype as quite likely to be useful, usable, and relevant in the job of monitoring patients with dementia (p-value < 0.05). By evaluating and designing Alzaid that unifies requirements for monitoring patients of four day centers, this work is the first effort towards a standard monitoring process of patients with dementia in the context of the Mexican Federation of Alzheimer.

Design and evaluation of a dashboard to support the comprehension of the progression of patients with dementia in day centers.

BACKGROUND AND OBJECTIVE: In day centers, people with dementia are assigned to specific groups to receive care according to the progression of the disease. This article presents the design and evaluation of a dashboard aimed at facilitating the comprehension of the progression of people with dementia to support decision-making of healthcare professionals (HCPs) when determining patient-group assignment. MATERIALS AND METHOD: A participatory design methodology was followed to build the dashboard. The grounded theory methodology was utilized to identify requirements. A total of 8 HCPs participated in the design and evaluation of a low-fidelity prototype. The perceived usefulness and perceived ease of use of the high-fidelity prototype was evaluated by 15 HCPs (from several day centers) and 38 psychology students utilizing a questionnaire based on the technology acceptance model. RESULTS: HCPs perceived the dashboard as extremely likely to be useful (Mdn=6.5 out of 7) and quite likely to be usable (Mdn=6 out of 7). Psychology students perceived the dashboard as quite likely to be useful and usable (both with Mdn=6). CONCLUSIONS: Making use of a participatory design helped foster in HCPs a sense of ownership of the dashboard, thus facilitating its acceptance. The creation of low-fidelity and high-fidelity prototypes led to identifying valuable, timely, and specific feedback at different stages of the development process as well as to establishing a set of lessons learned for the development of dashboards in the healthcare domain.

A comparative case study of 2D, 3D and immersive-virtual-reality applications for healthcare education.

BACKGROUND AND OBJECTIVE: The workings of medical educational tools are implemented using a myriad of approaches ranging from presenting static content to immersing students in gamified virtual-reality environments. The objective of this paper is to explore whether and how different approaches for designing medical educational tools affect students' learning performance. MATERIALS AND METHODS: Four versions of an educational tool for the study of clinical cases were implemented: a 2D version, a gamified 2D version, a gamified 3D version, and a gamified immersive-virtual-reality version. All complying with the same functional requirements. Each version was used and evaluated by an independent group of students. The participants (n = 78) evaluated the applications regarding usefulness, usability, and gamification. Afterward, the students took an exam to assess the retention of information on the clinical cases presented. RESULTS: One-sample Wilcoxon signed-rank tests confirmed that the participants perceived that it was at least quite likely that gamification helped improved their learning. In addition, based on the participants' perception, the gamification of the immersive-virtual-reality version helped the most to improve their learning performance in comparison with the gamified 2D and 3D versions. CONCLUSIONS: Regardless of whether different versions of a medical educational tool (complying with the same functional requirements) are perceived as equally useful and usable, the design approach (either 2D, 3D, or immersive-virtual-reality with or without gamification) affects students' retention of information on clinical cases.

Design and evaluation of a mobile application for monitoring patients with Alzheimer's disease: A day center case study.

BACKGROUND AND OBJECTIVE: This paper presents Alzheed, a mobile application for monitoring patients with Alzheimer's disease at day centers as well as a set of design recommendations for the development of healthcare mobile applications. The Alzheed project was conducted at Day Center "Dorita de Ojeda" that is focused on the care of patients with Alzheimer's disease. MATERIALS AND METHODS: A software design methodology based on participatory design was employed for the design of Alzheed. This methodology is both iterative and incremental and consists of two main iterative stages: evaluation of low-fidelity prototypes and evaluation of high-fidelity prototypes. Low-fidelity prototypes were evaluated by 11 day center's healthcare professionals (involved in the design of Alzheed), whereas high-fidelity prototypes were evaluated using a questionnaire based on the technology acceptance model (TAM) by the same healthcare professionals plus 30 senior psychology undergraduate students uninvolved in the design of Alzheed. RESULTS: Healthcare professional participants perceived Alzheed as extremely likely to be useful and extremely likely to be usable, whereas senior psychology undergraduate students perceived Alzheed as quite likely to be useful and quite likely to be usable. Particularly, the median and mode of the TAM questionnaire were 7 (extremely likely) for healthcare professionals and 6 (quite likely) for psychology students (for both constructs: perceived usefulness and perceived ease of use). One-sample Wilcoxon signed-rank tests were performed to confirm the significance of the median for each construct. CONCLUSIONS: From the experience of designing Alzheed, it can be concluded that co-designing with healthcare professionals leads to (i) fostering group endorsement, which prevents resistance to change and (ii) helps to meet the needs of both healthcare professionals and patients, guaranteeing the usefulness of the application. In addition, evaluation of mobile healthcare applications by users involved and uninvolved in the application's design process helps to improve the ease of use of the application.

Tibial tunnel widening associated with anterior cruciate ligament reconstruction using autogenous hamstrings: A comparison between antero-medial portal and transtibial techniques. / Valoración de la apertura del túnel tibial tras la reconstrucción del ligamento cruzado anterior empleando isquiotibiales autógenos: Estudio comparativo entre la técnica de portal anteromedial y la técnica transtibial convencional.

OBJECTIVE: Evaluate the enlargement effect of the tibial tunnel emergence of 2 different of anterior cruciate ligament reconstruction techniques: antero-medial portal (AMP) vs. transtibial (TT) technique. METHODS: A prospective, randomized controlled study was performed in 36 consecutive patients who underwent anterior cruciate ligament reconstruction with autologous hamstring tendon grafts employing the AMP and conventional TT techniques. Lateral and antero-posterior radiographs were obtained for each patient at 6 weeks and 12 months postoperatively. The sclerotic margins of the tibial tunnels were measured at the widest dimension of the tunnel as well as the diameter of the tibial emergence and were compared with the initially drilled tunnel size after correction for radiographic magnification. Statistical analysis was performed to compare the 2 groups by use of the independent-samples t test, with significance set at .05. RESULTS: The mean percentage increase in the diameter of tibial tunnel emergence at 6 weeks after surgery was 8.1%±2.9 for the PAM technique and 21.20%±11.87 for the TT technique on the anteroposterior x-ray view. However, the mean percentage increase in the diameter of the tibial tunnel emergence on the lateral view was 7.1%±4.72 for the medial portal technique and 17.64%±11.48 for the transtibial technique. This difference was statistically significant on both anteroposterior and lateral views. CONCLUSIONS: The diameter of the tibial tunnel emergence for hamstring autologous anterior cruciate ligament reconstructions was significantly lower for the medial portal technique when compared with the conventional TT technique.

[Myths and evidence on the use of botulinum toxin: neuropharmacology and dystonia]. / Mitos y evidencias en el empleo de la toxina botulinica: neurofarmacologia y distonias.

INTRODUCTION: Botulinum toxin type A (BTA) is a bacterial endotoxin, whose therapeutic use has had a dramatic impact on different neurological disorders, such as dystonia and spasticity. AIM: To analyze and summarize different questions about the use of BTA in our clinical practice. DEVELOPMENT: A group of experts in neurology developed a list of topics related with the use of BTA. Two groups were considered: neuropharmacology and dystonia. A literature search at PubMed, mainly for English language articles published up to June 2016 was performed. The manuscript was structured as a questionnaire that includes those questions that, according to the panel opinion, could generate more controversy or doubt. The initial draft was reviewed by the expert panel members to allow modifications, and after subsequent revisions for achieving the highest degree of consensus, the final text was then validated. Different questions about diverse aspects of neuropharmacology, such as mechanism of action, bioequivalence of the different preparations, immunogenicity, etc. were included. Regarding dystonia, the document included questions about methods of evaluation, cervical dystonia, blepharospasm, etc. CONCLUSION: This review does not pretend to be a guide, but rather a tool for continuous training of residents and specialists in neurology, about different specific areas of the management of BTA.

TITLE: Mitos y evidencias en el empleo de la toxina botulinica: neurofarmacologia y distonias.Introduccion. La toxina botulinica de tipo A (TBA) ha supuesto una verdadera revolucion terapeutica en neurologia, y en la actualidad es el tratamiento rutinario en las distonias focales y la espasticidad. Objetivo. Plantear, revisar y responder cuestiones controvertidas en relacion con la neurofarmacologia de la TBA y su uso en las distonias en la practica clinica habitual. Desarrollo. Un grupo de expertos en trastornos del movimiento reviso una lista de temas controvertidos relacionados con la farmacologia de la TBA y su uso en las distonias. Revisamos la bibliografia e incluimos articulos relevantes especialmente en ingles, pero tambien, si su importancia lo merece, en castellano y en frances, hasta junio de 2016. El documento se estructuro como un cuestionario que incluyo las preguntas que podrian generar mayor controversia o duda. El borrador inicial del documento fue revisado por los miembros del panel y se realizaron las modificaciones necesarias hasta alcanzar el mayor grado de consenso. Incluimos preguntas sobre diferentes aspectos de la neurofarmacologia, especialmente el mecanismo de accion, la bioequivalencia de los diferentes preparados y la inmunogenicidad. En relacion con el subapartado de las distonias, se incluyeron aspectos sobre la evaluacion y el tratamiento de las distonias focales. Conclusiones. Esta revision no pretende ser una guia, sino una herramienta practica destinada a neurologos y medicos internos residentes interesados en esta area, dentro de diferentes ambitos especificos del manejo de la TBA.

[Cemented total knee replacement: comparative study between the use or not of tourniquet on the inmediate results]. / Artroplastía total cementada de rodilla: comparación entre el uso o no de isquemia en el resultado postoperatorio inmediato.

Comparison of immediate postoperative results of patients undergoing cemented total knee arthroplasty with and without ischemia. Observational, cross-sectional, retrospective, analytical, single-center study that included 180 patients who underwent total knee arthroplasty from 2011 to 2014: 120 without ischemia, 60 with ischemia. Mean age was 70 years with SD ± 7. Criteria to assess the immediate postoperative results include intraoperative bleeding, hemoglobin differential and pain. Exclusion criteria comprised patients being treated at a pain clinic, those on anticoagulants, with a history of bleeding disorders, psychiatric conditions, kidney failure or those intolerant to NSAIDs. In total knee arthroplasty without ischemia there is better pain control (p = 0.026). The hemoglobin differential and intraoperative bleeding were less with ischemia (p = 0.008). 32.8% of patients required blood transfusion, but no statistically significant relationship was established with the use or non-use of ischemia (p = 0.301). The most commonly reported pain was within a VAS of 0-3; 62.2% of cases reported mild pain. Mean hemoglobin differential was 3.7 with SD ± 1.3 with a range from 0 to 7.4. Patients in whom no ischemia was used during the surgical procedure experienced less pain. There was less bleeding and hemoglobin differential with the use of ischemia. However, this did not result in a statistically significant difference in the need for blood transfusion. The use of ischemia with caution and according to the surgeons preference is recommended.

Comparar el resultado postoperatorio inmediato en el paciente sometido a artroplastía total cementada de rodilla con y sin el uso de isquemia. Estudio observacional, transversal, retrospectivo, analítico y unicéntrico. 180 pacientes operados de artroplastía total cementada de rodilla: 120 sin isquemia, 60 con isquemia, de 2011 a 2014, edad promedio 70 años con DE ± 7 años, se comparará el sangrado operatorio, diferencial de hemoglobina y dolor como criterios de resultado postoperatorio inmediato. Se excluyeron pacientes de clínica de dolor, manejo con anticoagulantes, coagulopatía previa, patología siquiátrica, insuficientes renales o con intolerancia a AINEs. En artroplastía total cementada de rodilla sin isquemia se presenta mejor control del dolor (p = 0.026). El diferencial de hemoglobina y sangrado operatorio es menor cuando está asociado al uso de isquemia (p = .008). Se requirió transfusión sanguínea en 32.8%, sin establecer una relación entre el uso o exclusión de isquemia con relevancia estadística (p = 0.301). El dolor referido más común se encuentra entre 0 y 3 de EVA correspondiente a dolor leve en 62.2% de los casos. El diferencial de hemoglobina promedio se reporta en 3.7 con desviación estándar de ± 1.3 en un rango de 0 a 7.4. Existe menor dolor postoperatorio en el paciente al que no se aplica isquemia durante el procedimiento quirúrgico; hay menor sangrado y diferencial de hemoglobina con el uso de isquemia; sin embargo, esto no representa estadísticamente una diferencia en la necesidad de transfusión sanguínea. Se recomienda utilizar con cautela la isquemia y su uso queda a elección del cirujano.

Algorithm for phase extraction from a set of interferograms with arbitrary phase shifts.

The generalized analytical quadrature filter from a set of interferograms with arbitrary phase shifts is obtained. Both symmetrical and non symmetrical algorithms for any order are reported. The analytic expression is obtained through the convolution of a set of two-frame algorithms and expressed in terms of the combinatorial theory. Finally, the solution is applied to obtain several generalized tunable quadrature filters.

Two-frame algorithm to design quadrature filters in phase shifting interferometry.

The main purpose of this paper is to present a method to design tunable quadrature filters in phase shifting interferometry. From a general tunable two-frame algorithm introduced, a set of individual filters corresponding to each quadrature conditions of the filter is obtained. Then, through a convolution algorithm of this set of filters the desired symmetric quadrature filter is recovered. Finally, the method is applied to obtain several tunable filters, like four and five-frame algorithms.

Avulsión aislada de bíceps femoral distal. Resultados en tres casos / Isolated avulsion of the distal femoral biceps. Results in three cases

Introducción: Analizar la avulsión aislada del tendón del bíceps femoral distal, una lesión poco frecuente, en tres futbolistas de primera división nacional. Material y métodos: Tres jugadores de fútbol profesionales de primera división española, presentaron una avulsión aislada del tendón del m. bíceps femoral distal durante la práctica deportiva con diferentes mecanismos de producción que fueron intervenidos mediante reinserción anatómica del tendón del m. bíceps en la cabeza de peroné siguiendo un protocolo rehabilitador específico. Efectuamos un control isocinético a los 3, 6 y 12 meses de la intervención. Resultados: La valoración clínica fue satisfactoria en todos los casos, el rango de movilidad articular final de la rodilla fue completo y la recuperación de fuerza y resistencia muscular completa fue confirmada con el estudio isocinético seriado. Los pacientes se incorporaron a su actividad deportiva a pleno rendimiento en un tiempo medio de 14 semanas. Conclusiones: En deportistas de alto nivel, la reparación quirúrgica mediante la reinserción bicipital en la cabeza de peroné, restablece la anatomía y la función normal de la rodilla (AU)

Introduction: An analysis is made of an infrequent lesion, isolated avulsion of the distal femoral biceps tendon, in three elite category (league first division) soccer players. Material and methods: Three professional soccer players of the Spanish national league (first division) presented isolated avulsion of the distal femoral biceps tendon, produced by different mechanisms during sports activity. The injuries were treated by anatomical reinsertion of the biceps tendon in the fibular head, with the application of a specific rehabilitation protocol. Isokinetic controls were made 3, 6 and 12 months after the operation. Results: The clinical results were satisfactory. The end mobility range of the knee was complete in all cases, and full recovery of muscle strength and resistance was confirmed by the serial isokinetic tests. The patients were able to fully return to their sports activity after an average of 14 weeks. Conclusions: In elite athletes, surgical recovery through reinsertion of the biceps muscle in the fibular head restores the normal anatomy and function of the knee (AU)

Reinserción de la avulsión distal del músculo biceps braquial con técnica de Endobutton® / Endobutton-assisted repair of distal biceps brachii tendon ruptures

Objetivo: analizar los resultados del tratamiento quirúrgico de las avulsiones distales del bíceps con técnica de Endobutton ® y presentar detalles técnicos que simplifican la cirugía.Pacientes y metodologá: utilizamos el implante Endobutton ® para reanclar 8 avulsiones distales del tendón del bíceps. Todos los pacientes eran varones y la edad media de 42 años (rango de 35 a 56 años).La movilidad completa se permitió a la semana de la cirugía. El seguimiento mínimo fue de 12 meses.Resultados: Todos los pacientes estaban satisfechos conel resultado final. La movilidad media fue de 3 a 140º,con 80º de supinación y 75º de pronación. Todos los pacientes recuperaron su nivel de actividad previo a la lesión. No tuvimos ninguna complicación neurológica ni sinostosis radio-cubital.Conclusiones: la reparación de las roturas del bíceps distal con técnica de Endobutton es una técnica sencilla y segura. La fuerte fijación inicial permite una rehabilitación postoperatoria agresiva que mejora los resultados de movilidad y fuerza

Objective: the purpose of this study was to analyze theresults of EndoButton- assisted repair of distal biceps tendon ruptures and present technical tips that simplify the technique.Patients and methods: we used the Endobutton™ to repair8 distal biceps avulsions. All patients were male, average age was 42 (range 35-56). Full range of motion astolerated was allowed one week after surgery. The minimumfollow up was 12 months All patients were satisfied with their final result. Average range of motion was 3 to 140º with 80º supination and 75º pronation. All patients returned to their pre-injury activity level. There were no neural injuries and no radio-ulnar synostosis.Conclusion: the repair of distal biceps tendon ruptureusing the Endobutton™ is a simple and safe technique.The strong fixation allows aggressive postoperative rehabilitation and provides excellent results both in motion and strength

[Brain stem involvement in eclampsia and HELLP syndrome]. / Afectación del tronco cerebral en la eclampsia y síndrome HELLP.

INTRODUCTION: Nowadays, eclampsia is a rare complication of pregnancy and the puerperium. However, it is still one of the main causes of maternal morbi-mortality. Systemic findings in eclampsia may sometimes include association with microangiopathic hemolytic anaemia, raised liver enzymes and thrombocytopenia. This clinical combination constitutes the HELLP syndrome (Hemolysis Elevated Liver enzymes Low Platelets). The commonest neurological findings in eclampsia are headache, visual alterations, convulsions and stupor or coma. The presence of clinical symptoms and signs due to brainstem disorders is unusual. CLINICAL CASE: We present the case of a thirty year old woman with eclampsia and associated HELLP syndrome, which briefly affected the brain stem. The patient showed progressive general and neurological improvement. Three months afterwards she still had paresia of the sixth right cranial nerve, due to what was presumed to be a right paramedian infarct of the pons. CONCLUSION: We consider it important not to forget this exceptional association so that suitable treatment may be given to such patients since prognosis is not invariably bad.

[Postoperative complications in a case of iatrogenic hypothyroidism induced by diet drugs]. / Complicaciones postoperatorias de un hipotiroidismo iatrógeno no detectado inducido por fármacos adelgazantes.

Oral thyroid preparations, which were first administered in 1892 to treat myxedema, are the oldest effective endocrine medications. Since thyroxin became available, such drugs have been dispensed without a physician's prescription and have come to be mistakenly referred to as "diet pills". Self-prescription of such products can cause changes in thyroid function, with systemic repercussions. We report the case of a woman who took thyroid extracts, among other diet drugs to enhance weight loss without medical supervision. The patient failed to report taking such drugs during the preanesthetic visit. Interrupting therapy several days before surgery produced a state of hypothyroidism that led to marked postoperative hemodynamic changes necessitating transfer to the intensive care unit.

[Deficiency, disability and handicap in multiple sclerosis: a population-based study in Valladolid]. / Deficiencia, discapacidad y minusvalía en la esclerosis múltiple: un estudio de base poblacional en Valladolid.

INTRODUCTION: Apart from impairment there is hardly any other assessment of the repercussions of multiple sclerosis (MS) in population studies. OBJECTIVE: To analyze the functional state of en epidemiological series of patients in the Valladolid health district. MATERIAL AND METHODS: A descriptive transversal study of a geographically defined population base. During a period of three months and complementing a prevalence study, were assessed, by means of the Minimal Record of Disability, impairment, disability and handicap in a series of 51 patients (33 women and 18 men) with clinically defined MS, who lived in the area on 1 March 1997. RESULTS: There was a primarily progressive evolution in 21.6% of the patients, and secondarily progressive in 11.8%. Average follow-up time was 9.1 years (range 1-41) and average age of onset 27.8 years (range 14.7-51.0). The distribution of scores on the Expanded Disability Status Scale was bimodal (average and interquartile range: 3.0 (1.5-5.0). 80.4% of the patients continued to be ambulatory. 21.5% had frequent urinary incontinence or required a long-term urinary catheter. Less than 20% needed help with day to day activities. 78% of the patients complained of some degree of fatigue, and 51% had difficulties with social relationships. 59.4% of the patients had full-time jobs and 70.6% had no financial problems. CONCLUSIONS: The study shows that the functional state of persons with MS is better than was thought, and that assessment of the consequences of this illness should include disability and handicap profiles.

[Predominance of urban suicides over rural suicides in Spain]. / Predominio del suicidio urbano sobre el rural en España.

INTRODUCTION: The different occurrence of Suicide depending on the rural/urban environment, as well as the interaction of this variable with others such as sex and age has given rise to a large quantity of investigations over the world. It was necessary to carry out in Spain an updated study of these characteristics. OBJECTIVE AND METHODS: Our purpose is to work with the raw data referred to suicide in the two last Spanish Census years. 4,619 records of suicide are requested and obtained from the Spanish National Statistics Institute registered in the years 1981 and 1991. Adjusted rates by rural/urban environment, sex and age are established and compared to each other. RESULTS AND CONCLUSIONS: Suicide rate in Spain is always higher in the cities that in the country, no matter be sex or the age group. However, there appears to be no continuous relationship between Suicide and the environment variable, since the large cities seem to confer a certain prevention. On the other hand, the feminine urban suicidal behaviour is becoming quantitatively more and more similar to those of men.