Acceptance of Digital Health Technologies in Palliative Care Patients.

Background: Digital health technologies have potential to transform palliative care (PC) services. The global aging population poses unique challenges for PC, which digital health technologies may help overcome. Evaluation of attitudes and perceptions combined with quantification of prior use habits favor an understanding of psychological barriers to PC patient acceptance of digital health technologies including artificial intelligence (AI). Objectives: We aimed to evaluate the attitudes and perceptions of PC patients regarding a broad range of digital health technologies used in their routine monitoring and treatment and identify barriers to use. Methods: We used a 39-item questionnaire to evaluate acceptance and use of smartphone-based electronic patient report outcome measures, wearables, AI, data privacy, and virtual reality (VR) in 29 female and male PC inpatients. Results: A majority of patients indicated an interest in (69.0%) and positive attitude toward (75.9%) digital health technologies. Nearly all (93.1%) patients believe that digital health technologies will become more important in medicine in the future. Most patients would consider using their smartphone (79.3%) or wearable (69.0%) more often for their health. The most feasible technologies were smartphones, wearables, and VR. Barriers to acceptance included unfamiliarity, data security, errors in data interpretation, and loss of personal interaction through AI. Conclusion: In this patient survey, acceptance of new technologies in a PC patient population was high, encouraging its use also at the end-of-life.

What is the Impact of a Spinal Fusion on Acetabular Implant Orientation in Functional Standing and Sitting Positions?

BACKGROUND: This study used EOS imaging of primary total hip arthroplasty (THA) patients, with and without predating spinal fusion, to investigate (1) the impact of spinal fusion on acetabular implant anteversion and inclination, and (2) whether more extensive spinal fusion (fusion starting above the thoracolumbar junction or extension of fusion to the sacrum) affects acetabular implant orientation differently than lumbar only spinal fusion. METHODS: Ninety-three patients had spinal fusion (case group), and 150 patients were without spinal fusion (controls). None of the patients experienced dislocation. The change in sacral slope (SS) and cup orientation from standing to sitting was measured. RESULTS: Mean SS change from the standing to sitting positions was -7.9°in the fusion group vs -18.4°in controls (P = .0001). Mean change in cup inclination from the standing to sitting positions was 4.9°in the fusion group vs 10.2°in controls (P = .0001). Mean change in cup anteversion from standing to sitting positions was 7.1°in the fusion group vs 12.1°in controls (P = .0001). For each additional level of spinal fusion, the change in SS from standing to sitting positions decreased by 1.6(95% confidence interval [CI], 2.2073-1.0741), the change in cup inclination decreased by 0.8(95% CI, 0.380-1.203), and the change in cup anteversion decreased by 0.9(95% CI, 0.518-1.352; P < .001 in all cases). CONCLUSION: Patients with spinal fusion demonstrated less adaptability of the lumbosacral junction. Longer spinal fusion or inclusion of the pelvis in the fusion critically impacts hip-spine biomechanics and significantly affects the ability to compensate in the standing-to-sitting transition.

Kinetics of lung macrophages monitored in vivo following particulate challenge in rabbits.

The ligand PK11195 binds specifically in macrophages. We have assessed the use of positron emission tomography (PET) of [(11)C]R-PK11195 to monitor macrophage disposition following particulate challenge to the lung. Repeated PET scanning was performed over 4 weeks following iv [(11)C]R-PK11195 in rabbits treated with 5-microm particles of either amorphous (aSiO(2)) or microcrystalline (xSiO(2)) silica instilled into right upper pulmonary lobes. aSiO(2) resulted in increased macrophages, few neutrophils, and no fibrosis, while xSiO(2) increased macrophages and neutrophils and caused fibrosis. After both stimuli, (11)C localized to the challenged area and correlated with macrophage numbers. Radioactive counts in challenged/control lung regions peaked at 4 days for aSiO(2) (2.88, n = 2) and 6 days for xSiO(2) (4.62, n = 2). The signal remained elevated throughout the study (aSiO(2), 2.33 +/- 0.77 SD, n = 14; xSiO(2), 3.99 +/- 1.29 SD, n = 9), as did macrophage accumulation. (11)C also localized to regions consistent with macrophage traffic through lymph ducts 6 days after aSiO(2) challenge, but not until 4 weeks after xSiO(2). Specific binding of R-PK11195 in macrophages was demonstrated by microautoradiography in lavage fluid from an inflamed rabbit knee-joint model. These data suggest that PET scanning after [(11)C]PK11195 provides a new noninvasive approach for the study of macrophage kinetics in the lung.