Data Exchange Standards in Teleophthalmology: Current and Future Developments.

BACKGROUND: Teleophthalmology services are considered capable of supporting screening, early diagnosis, and monitoring of leading causes of blindness on a global scale. Therefore, standards and best practices are needed to seamlessly exchange medical ocular images and related data among relevant stakeholders with maximum interoperability. OBJECTIVES: This paper provides an overview of current standards in the field of store-and-forward teleophthalmology data exchange and further developments in this area. METHODS: A literature review was conducted for healthcare standards with a focus on data exchange in ophthalmology. RESULTS: IHE, HL7 FHIR, DICOM, and clinical terminologies are considered the most important standards, providing distinct concepts, solutions, and guidelines for ophthalmology. CONCLUSION: Available standards provide the necessary base for teleophthalmology on technical and semantic interoperability, but practical use is limited due to missing process interoperability resulting in proprietary interfaces of vendors and rejection by ophthalmologists. Further investigations should analyze processual needs on ophthalmology data exchange standards.

Endoluminal endosurgery: rivet application in flexible endoscopy.

BACKGROUND: Endoluminal endoscopy could be significantly enhanced by adequate approaches to wound closure. Current solutions are basically confined to clip applications. OBJECTIVE: A new approach to sewing in flexible endoscopy is achieved with an endoluminal rivet system. This system allows the application of several ligatures without withdrawing the rivet application device to reload. For this purpose, a pilot experimental study of the device was conducted, which obtained a tissue approximation and avoided the difficult process of knot tying. DESIGN: Pilot experimental study. SETTING: The rivet application was tested through a 1.8-mm working channel of the endoscope in laboratory and postmortem animal tissues. It consists of a flexible anchor at the front and a lockable bracket at the rear. Both edges of a defect of the GI wall can be aligned and compressed, thus leading to wound closure. INTERVENTIONS: Test samples were evaluated in postmortem gastric tissue by using flexible gastroscopes. The feasibility of applying a series of rivets with 1 instrument to close transmural lacerations of the stomach was demonstrated. Further tests were performed to determine the forces to penetrate the gastric wall. MAIN OUTCOME MEASUREMENTS: Tissue closure, rivet degradation. RESULTS: The penetration force can be brought down to less than 0.57 N by using a magnesium tip. The sharp tip of the rivet, which could potentially lacerate healthy tissue after implantation, is degraded in the stomach within the first few hours because of rapid corrosion. LIMITATIONS: Lack of in vivo feasibility data. CONCLUSIONS: Endoluminal wound closure through common gastroscopes and colonoscopes is possible. Further in vivo data are required for the rivet system.