Bone Age Practices in Infants and Older Children among Practicing Radiologists in Pakistan: Developing World Perspective.

Objective To investigate which bone age assessment techniques are utilized by radiologists in Pakistan to determine skeletal age in three defined age groups: less than one year, one to three years and three to 18 years. We also assessed the perceived confidence in skeletal age assessments made by respondents using their chosen bone age assessment technique, within each defined age group. Materials and methods A cross-sectional survey was conducted among 147 practicing radiologists in Pakistan. A pre-validated survey form was adopted from a similar study conducted amongst members of the Society for Pediatric Radiology. The survey collected demographic information, choice of bone age assessment technique in each age group and confidence of bone age assessments in each age group. Results The hand-wrist method of Greulich and Pyle was used by 87.5% of respondents when assessing bone age in infants (less than one year), followed by Gilsanz-Ratib hand bone age method (7.3%). In children aged one to three years, Greulich and Pyle method was chosen by 85.7% of respondents, followed by Gilsanz-Ratib hand bone age method (6.1%) and the Hoerr, Pyle, Francis' Radiographic Atlas of Skeletal Development of the Foot and Ankle (3.1%). In children, older than three years, the Greulich and Pyle technique was used by 83.7% of respondents. This was followed by Gilsanz-Ratib hand bone age method (5.8%) and the Hoerr, Pyle, Francis' Radiographic Atlas of Skeletal Development of the Foot and Ankle (3.8%). 26.4% were "very confident" in bone age assessments conducted among infants. In children aged one to three years, 38.1% were "very confident". In children, greater than three years, 48.6% were "very confident" in their chosen technique. Conclusion Greulich and Pyle is the dominant method for bone age assessments in all age groups, however, confidence in its application among infants and young children is low. It is recommended that clear recommendations be developed for bone age assessments in this age group alongside incorporation of indigenous standards of bone age assessments based on a representative sample of healthy native children.

An Open Platform for Seamless Sensor Support in Healthcare for the Internet of Things.

Population aging and increasing pressure on health systems are two issues that demand solutions. Involving and empowering citizens as active managers of their health represents a desirable shift from the current culture mainly focused on treatment of disease, to one also focused on continuous health management and well-being. Current developments in technological areas such as the Internet of Things (IoT), lead to new technological solutions that can aid this shift in the healthcare sector. This study presents the design, development, implementation and evaluation of a platform called Common Recognition and Identification Platform (CRIP), a part of the CareStore project, which aims at supporting caregivers and citizens to manage health routines in a seamless way. Specifically, the CRIP offers sensor-based support for seamless identification of users and health devices. A set of initial requirements was defined with a focus on usability limitations and current sensor technologies. The CRIP was designed and implemented using several technologies that enable seamless integration and interaction of sensors and people, namely Near Field Communication and fingerprint biometrics for identification and authentication, Bluetooth for communication with health devices and web services for wider integration with other platforms. Two CRIP prototypes were implemented and evaluated in laboratory during a period of eight months. The evaluations consisted of identifying users and devices, as well as seamlessly configure and acquire vital data from the last. Also, the entire Carestore platform was deployed in a nursing home where its usability was evaluated with caregivers. The evaluations helped assess that seamless identification of users and seamless configuration and communication with health devices is feasible and can help enable the IoT on healthcare applications. Therefore, the CRIP and similar platforms could be transformed into a valuable enabling technology for secure and reliable IoT deployments on the healthcare sector.

Ambient assisted living healthcare frameworks, platforms, standards, and quality attributes.

Ambient Assisted Living (AAL) is an emerging multi-disciplinary field aiming at exploiting information and communication technologies in personal healthcare and telehealth systems for countering the effects of growing elderly population. AAL systems are developed for personalized, adaptive, and anticipatory requirements, necessitating high quality-of-service to achieve interoperability, usability, security, and accuracy. The aim of this paper is to provide a comprehensive review of the AAL field with a focus on healthcare frameworks, platforms, standards, and quality attributes. To achieve this, we conducted a literature survey of state-of-the-art AAL frameworks, systems and platforms to identify the essential aspects of AAL systems and investigate the critical issues from the design, technology, quality-of-service, and user experience perspectives. In addition, we conducted an email-based survey for collecting usage data and current status of contemporary AAL systems. We found that most AAL systems are confined to a limited set of features ignoring many of the essential AAL system aspects. Standards and technologies are used in a limited and isolated manner, while quality attributes are often addressed insufficiently. In conclusion, we found that more inter-organizational collaboration, user-centered studies, increased standardization efforts, and a focus on open systems is needed to achieve more interoperable and synergetic AAL solutions.

Patient communication in radiology: current status of breaking bad news among radiologists and radiology trainees in Pakistan.

Breaking bad news can be an intimidating task for any physician. The aim of this study was to record the practices of breaking bad news to the patients by Pakistani radiologists and trainees. The radiologists and trainees attending the 26th National Radiological Conference in October 2010 in Karachi, Pakistan, were surveyed. The response rate was 76%. The respondents included residents (51%), private practicing radiologists (28%), academic radiologists (13%), and other trainees (8%). Most of the academic radiologists communicated with their patients. The daily frequency of breaking bad news by residents was noted, which was highest in the public teaching hospitals (71%). For severe abnormalities such as malignancy, 50% residents, 55% of the academic radiologists and 74% of the private practicing radiologists were very uncomfortable in disclosure of results. Differences in frequency of communication with patients were noticed with both different training levels, and different settings of practice in a developing country.

Ultrasound biosafety during pregnancy: what do operators know in the developing world?: national survey findings from pakistan.

OBJECTIVES: The purpose of this study was to evaluate the knowledge and attitudes of ultrasound users toward safety aspects during routine obstetric examinations. METHODS: A self-administered questionnaire was given to all registered participants of the 10th Annual International Radiological Conference in Karachi, Pakistan. RESULTS: A total of 306 participants completed the questionnaire (response rate, 70%), including 170 consultant radiologists (55%), 90 radiology residents (30%), 31 sonographers (10%), and 15 others (5%). The mean sonography experience of the end users ± SD was 5.1 ± 5 years. Around half of the participants (45.5%) reported that there should be limitations on the use of ultrasound during low-risk pregnancy. Overall, safety knowledge was inadequate among the participants. However, those who were concerned about limitations on the use of ultrasound during pregnancy were 2.5 times more likely to be familiar with the mechanical index (P < .001) and 1.8 times more likely to be familiar with the thermal index (P < .001). CONCLUSIONS: Increased training for professionals on safety issues of ultrasound procedures during pregnancy is needed. Furthermore, the concept of the absolute safety of ultrasound procedures without knowledge of safety parameters such as the mechanical and thermal indices needs to be changed, and more clarity is required when defining parameters under which the procedures can be safely performed.

Situs ambiguous.

The case of a female child is described who presented with recurrent respiratory infections and "recurrent right subphrenic abscess." Detailed radiological work-up identified situs ambiguous abdominis with bronchiectasis, duodenal malrotation, umbilical hernia and spina bifida.