Co-Design for People-Centred Care Digital Solutions: A Literature Review.

INTRODUCTION: The implementation of people-centred care requires strategies that respond to local conditions and contexts, with the participation of local stakeholders in collaborative approaches such as co-design. Within this framework, the authors performed a literature review to identify the most implemented practices in health and social care services for co-designing digital solutions. METHODS: The literature review was conducted following five steps: (i) Definition of the Keywords and their relations; (ii) Definition of the selection criteria; (iii) Search in PubMed; (iv) Selection of papers; and (v) Analysis of the selected papers. RESULTS: 20 papers addressed to co-design health digital solutions with stakeholders were analysed in terms of the activities implemented and participants involved. DISCUSSION: Previous studies using co-design methods for the deployment of health digital solutions employed a wide range of activities, most of them combining activities and/or mixed target groups. CONCLUSION: Co-design is the key to deliver people-centred care as it allows to involve stakeholders in the development of health digital solutions. Implementing one or more of the co-design methods identified in this literature review should be considered to better address the needs and specific projects and target groups.

Thermography for the differential diagnosis of vascular malformations.

Vascular malformations classification may pose a diagnostic challenge for physicians. In the early stages, they are diagnosed clinically mainly by visual inspection. For a deeper analysis, Doppler ultrasonography is the preferred technique to determine the haemodynamic behaviour of the anomaly. However, this imaging method is not always available and it requires trained operators to acquire and interpret the images. There is a lack of portable and user-friendly systems that may help physicians in the assessment of vascular malformations. We propose a new diagnostic procedure, more affordable and easier to use, based on a portable thermal camera. This technique provides information about temperature, which has been found to be correlated with the flow rate of the lesion. In our study, > 60 vascular malformations of previously diagnosed patients were analysed with a thermal camera to classify them into low-flow and high-flow malformations. The value was 1 for both sensitivity and specificity of this technique.

Development and viability of biofilms grown on experimental abutments mimicking dental implants: An in vivo model.

BACKGROUND: To determine whether an experimental abutment mimicking the macro- and microstructure of a dental implant is a suitable method for recovering biofilm, and to describe the features of biofilms formed around such abutments on healthy implants. MATERIAL AND METHODS: Experimental abutments were used in 15 patients without peri-implant diseases. After 14 days' absence of dental hygiene in this area, the abutments were retrieved and analyzed through confocal laser scanning microscopy and scanning electron microscopy. The biofilm formation on the surface of the first 5 abutments was determined by a fluorescence-staining method using SYTO9 nucleic acid stain. In order to study the biofilm's coverage and vitality, 10 additional abutments were assessed using live & dead bacterial viability. Descriptive and bivariate analyses of the data were performed. RESULTS: A global plaque coverage of the abutments was observed in all cases. The submucosal area of the abutment was mostly covered with biofilm (over 21%). Moreover, significant differences between supra- and subgingival locations were detected. CONCLUSIONS: This in vivo experimental model allows detailed observation of the extensive plaque growth found on exposed experimental abutments mimicking dental implants when hygiene measures are absent. The biofilm coverage is significantly higher in the supragingival zone than in the subgingival portion.

Aesthetic perception of single implants placed in the anterior zone. A cross-sectional study.

BACKGROUND: Several aesthetic indexes have been described to assess implant aesthetics. The aim of this study was to compare the aesthetic assessment made by dental professionals and students of single-tooth implants placed in the upper incisors. MATERIALS AND METHODS: A cross-sectional survey study using a subjective questionnaire to assess the aesthetics in 3 implant supported single-tooth cases in the anterior maxilla was performed. The interviewed subjects were divided into 4 groups: dentist with experience in implant treatment, dentists without experience in implants and 3rd and 5th year dental students. The questionnaire consisted of 2 visual analogue scales (VAS) to evaluate aesthetics, the pink esthetic score (PES), the white esthetic score (WES) and the simplified papilla index (PI). RESULTS: One-hundred dentists and one-hundred dental students filled the aesthetic assessment questionnaire. The results showed that the subjects were more critical than reference values, specially concerning prosthetic issues. The differences between groups were more obvious in the case with the best result. On the other hand, few differences were detected in the remaining cases. Regarding soft tissue and crown features, experienced dentists in implant dentistry were the most demanding. Cronbach's Alpha showed values ≥ 0,8 in the questionnaire in every case, which indicates an adequate reliability. CONCLUSIONS: Dentists and dental students have different opinions when assessing aesthetics of single tooth implant supported cases. Experience and area of expertise seem to influence the evaluation of aesthetics in the anterior region.

3D surgical planning in patients affected by lipodystrophy.

Lipodystrophy is a pathological condition characterized by the focal or general absence of adipose tissue. Surgeons reset the patient's surface contours using injectable materials to recreate a normal physical appearance. However, due to difficulties in preoperative planning and intraoperative assessment, about 15% of the surgical procedures involved are reinterventions to improve volume or symmetry. This increases the need for an available, efficient tool capable of providing the surgeon with a good estimation of the volumes to be injected before the intervention proper begins. This work describes a virtual reality-based application for the surgical planning of facial lipodystrophy correction (FLIC). The tool uses points selected interactively by the surgeon to compute a curve that delimits the surface area to be operated on. It then automatically computes an estimated natural reconstructed surface and the quantity of volume that needs to be implanted during the intervention. Experiments have been carried out in which the filling volumes estimated using FLIC and ZBrush software were compared with the real volumes injected by the surgeon. ICCs higher than 0.97 indicate that there were no significant differences between the respective measurements, thus validating the tool proposed in this paper.

Detección automatizada de microaneurismas mediante crecimiento de regiones y red neuronal Fuzzy Artmap / Automated detection of microaneurysms by using region growing and fuzzy artmap neural network

Objetivo: Comprobar si las modificaciones metodológicas de este nuevo algoritmo mejoran el resultado de otra estrategia presentada anteriormente. Métodos: Se realza y filtra la imagen negada del canal verde de la retinografía digital en color. Se aplica una umbralización multitolerancia para obtener puntos candidatos y en cada semilla se realiza un crecimiento de regiones por variación de intensidades. Se toman 15 características de cada región y entrenamos una red neuronal Fuzzy Artmap con 42 retinografías. Se aplica la red en el estudio de 11 retinografías del programa de detección precoz de retinopatía diabética, de buena calidad, con lesiones iniciales, obtenidas con el retinógrafo no midriático Topcon NW200. Resultados: Dos oftalmólogos experimentados detectan 52 microaneurismas en las 11 imágenes. El algoritmo detecta 39 microaneurismas y 3.752 regiones más, confirmando 38 microaneurismas y 135 falsos positivos. La sensibilidad ha mejorado respecto al algoritmo anterior del 60,53 al 73,08%. Los falsos positivos has disminuido de 41,8 por imagen a 12,27. Conclusiones: El nuevo algoritmo presenta indudables mejoras respecto al anterior, pero aún se puede perfeccionar, sobre todo en la determinación inicial de semillas(AU)

Objective: To assess whether the methodological changes of this new algorithm improves the results of a previously presented strategy. Methods: We enhance the image and filter out the green channel of the digital color retinography. Multitolerance thresholding was applied to obtain candidate points and make a seed growing region by varying intensities. We took 15 characteristics from each region to train a Fuzzy Artmap neural network using 42 retinal photographs. This network was then applied in the study of 11 good quality retinal photographs included in the diabetic retinopathy early detection screening program, with initial stages of retinopathy, obtained with the Topcon NW200 non-mydriatic retinal camera. Results: Two experienced ophthalmologists detected 52 microaneurysms in 11 images. The algorithm detected 39 microaneurysms and 3,752 more regions, confirming 38 microaneurysm and 135 false positives. The sensitivity is improved compared to the previous algorithm, from 60.53 to 73.08%. False positives have dropped from 41.8 to 12.27 per image. Conclusions: The new algorithm is better than the previous one, but there is still room for improvement, especially in the initial determination of seeds(AU)

[Automated detection of microaneurysms by using region growing and Fuzzy Artmap neural network]. / Detección automatizada de microaneurismas mediante crecimiento de regiones y red neuronal Fuzzy Artmap.

OBJECTIVE: To assess whether the methodological changes of this new algorithm improves the results of a previously presented strategy. METHODS: We enhance the image and filter out the green channel of the digital color retinography. Multitolerance thresholding was applied to obtain candidate points and make a seed growing region by varying intensities. We took 15 characteristics from each region to train a Fuzzy Artmap neural network using 42 retinal photographs. This network was then applied in the study of 11 good quality retinal photographs included in the diabetic retinopathy early detection screening program, with initial stages of retinopathy, obtained with the Topcon NW200 non-mydriatic retinal camera. RESULTS: Two experienced ophthalmologists detected 52 microaneurysms in 11 images. The algorithm detected 39 microaneurysms and 3,752 more regions, confirming 38 microaneurysm and 135 false positives. The sensitivity is improved compared to the previous algorithm, from 60.53 to 73.08%. False positives have dropped from 41.8 to 12.27 per image. CONCLUSIONS: The new algorithm is better than the previous one, but there is still room for improvement, especially in the initial determination of seeds.

EMPHYSEMA QUANTIFICATION IN A MULTI-SCANNER HRCT COHORT USING LOCAL INTENSITY DISTRIBUTIONS.

This article investigates the suitability of local intensity distributions to analyze six emphysema classes in 342 CT scans obtained from 16 sites hosting scanners by 3 vendors and a total of 9 specific models in subjects with Chronic Obstructive Pulmonary Disease (COPD). We propose using kernel density estimation to deal with the inherent sparsity of local intensity histograms obtained from scarcely populated regions of interest. We validate our approach by leave-one-subject-out classification experiments and full-lung analyses. We compare our results with recently published LBP texture-based methodology. We demonstrate the efficacy of using intensity information alone in multi-scanner cohorts, which is a simpler, more intuitive approach.

[Automatic detection of microaneurysms in colour fundus images]. / Detección automática de microaneurismas en retinografías.

PURPOSE: We present the development of a tool for the automatic detection of microaneurysms and its clinical evaluation. The intention of this tool is to facilitate the diagnosis of diabetic retinopathy in general screening programs. METHOD: The designed and developed tool consists of three stages of processing: 1) Obtaining of the basic image of eye with the retinal camera, inverted image on the green channel, and a high-pass filter of the image. This phase enhances the microaneurysms. 2) Detection of the candidates for microaneurysms, by means of an adaptive prediction filter and regions growth. 3) Selection, among the candidates, of whom microaneurysms must be considered to fulfil the criteria of circular shape, high intensity in the inverted green channel and contrasts with respect to the surrounding pixels. RESULTS: We selected to 20 retinal photographs of good quality and dimensions 600x600 pixels from patients with nonproliferative diabetic retinopathy. The ophthalmologists detected 297 microaneurysms in these images. The tool for automatic detection correctly located 252 microaneurysms, with a mean sensitivity of 89% and a false positives rate of 93%. CONCLUSIONS: The results obtained seem to indicate that the tool developed will be very useful for its potential use in screening programs in primary care centres. On the other hand, more work is needed on the algorithm to decrease the rate of false positives.

Detección automática de microaneurismas en retinografías / Automatic detection of microaneurysms in colour fundus images

Propósito: Presentamos el desarrollo de una herramienta para la detección automática de microaneurismas y su evaluación clínica. El propósito de esta herramienta es facilitar el diagnóstico de lesiones diabéticas en programas generales de detección.MétodoLa herramienta diseñada y desarrollada consta de tres etapas de procesamiento: 1) Obtención de la imagen de fondo de ojo con el retinógrafo, inversión del canal verde y filtrado paso de alta de la imagen. Esta fase realza los microaneurismas. 2) Detección de los candidatos a microaneurismas, mediante un filtrado de predicción adaptativo y un crecimiento de regiones. 3) Selección, de entre los candidatos, de los que deben considerarse microaneurismas por cumplir con los criterios de: forma circular, intensidad alta en el canal verde invertido y contraste respecto a los píxeles de alrededor.ResultadosSe seleccionaron 20 retinografías de buena calidad y dimensiones 600×600 píxeles de pacientes con retinopatía diabética no proliferante. Los oftalmólogos detectaron un total de 297 microaneurismas en estas imágenes. La herramienta de detección automática localizó adecuadamente 252 microaneurismas, con una sensibilidad media del 89% y una tasa de falsos positivos del 93%.ConclusionesLos resultados obtenidos parecen indicar que la herramienta desarrollada podría ser muy útil para su potencial utilización en programas de detección en los centros de asistencia primaria. Por otro lado, es necesario seguir trabajando en el algoritmo para disminuir la tasa de falsos positivos (AU)

Purpose: We present the development of a tool for the automatic detection of microaneurysms and its clinical evaluation. The intention of this tool is to facilitate the diagnosis of diabetic retinopathy in general screening programs.MethodThe designed and developed tool consists of three stages of processing: 1) Obtaining of the basic image of eye with the retinal camera, inverted image on the green channel, and a high-pass filter of the image. This phase enhances the microaneurysms. 2) Detection of the candidates for microaneurysms, by means of an adaptive prediction filter and regions growth. 3) Selection, among the candidates, of whom microaneurysms must be considered to fulfil the criteria of circular shape, high intensity in the inverted green channel and contrasts with respect to the surrounding pixels.ResultsWe selected to 20 retinal photographs of good quality and dimensions 600x600 pixels from patients with nonproliferative diabetic retinopathy. The ophthalmologists detected 297 microaneurysms in these images. The tool for automatic detection correctly located 252 microaneurysms, with a mean sensitivity of 89% and a false positives rate of 93%.ConclusionsThe results obtained seem to indicate that the tool developed will be very useful for its potential use in screening programs in primary care centres. On the other hand, more work is needed on the algorithm to decrease the rate of false positives (AU)

[Automatic detection of vessels in color fundus images]. / Detección automática de vasos en retinografías.

PURPOSE: The main purpose of the paper is to evaluate an automated method for blood vessels segmentation in color fundus images, due to its important role in the diagnosis of several pathologies such as diabetes. The final objective is to introduce the algorithm into a Computer Aided Diagnosis (CAD) tool that would be available in those local medical centers without specialists. METHOD: An automated method for blood vessels segmentation in color fundus images was implemented and tested. The algorithm starts with the extraction of vessel centerlines, which are used as guidelines for the subsequent vessel filling phase. The outputs of four directional differential operators are processed in order to select connected sets of candidate points to be further classified as centerline pixels using vessel derived features. The final segmentation is obtained using an iterative region growing method that integrates the contents of several binary images, resulting from vessel width dependent morphological filters. The method was evaluated using the images of two publicly available databases (STARE and DRIVE) and a database with 24 images. RESULTS: The algorithm outperforms other published algorithms and approximates the average accuracy of a human observer without a significant degradation of sensitivity and specificity. In addition, results have been subject to the experts' valuation that they think that retinal vessels remain represented with valuable accuracy on having analyzed the test's images. CONCLUSION: Due to the good segmentation results, the algorithm proposed could be implemented as part of a complete CAD tool in the local medical centers. This would reduce cost and diagnosis time.

Detección automática de vasos en retinografías / Automatic detection of vessels in color fundus images

Propósito: El propósito de este trabajo es la evaluación de un método automático para lasegmentación del árbol vascular en imágenes de retinografías, dado su importante papelen el diagnóstico de numerosas enfermedades, como la diabetes mellitus. El objetivo finales introducir el algoritmo en una herramienta de diagnóstico asistido por computadora(CAD, del inglés Computer Aided Diagnosis) que estaría disponible en los centros médicoslocales sin especialistas.Método: Se ha implementado y probado un método automático para la segmentación devasos. El algoritmo comienza con la extracción de las líneas centrales de los vasos, que seemplean como guías para la fase posterior de rellenado de vasos. Las salidas de 4 operadoresdireccionales se procesan para obtener conjuntos conexos de puntos candidatos que seclasificarán como píxeles pertenecientes a las líneas centrales mediante característicasderivadas de los vasos. La segmentación final se obtiene empleando un proceso iterativode crecimiento de regiones que integra los contenidos de varias imágenes binarias, resultadode aplicar determinados filtros morfológicos que dependen del ancho del vaso. Elmétodo se ha evaluado empleando las imágenes de 2 bases de datos públicas (STARE yDRIVE) y por una base de datos compuesta por 24 imágenes.Resultados: El algoritmo mejora otras soluciones y se aproxima en precisión a la obtenidapor un observador humano, sin por ello experimentar una degradación de la sensibilidady la especificidad. Asimismo, los resultados del algoritmo se han sometido a la valoraciónde expertos que consideran que los vasos quedan representados con apreciable exactitudal analizar las imágenes de prueba.Conclusión: Dados los buenos resultados obtenidos en la segmentación, el algoritmo propuestopodría implementarse e introducirse en una herramienta CAD disponible en los centrosmédicos locales. La reducción en coste y tiempo de exploración podría ser significativa(AU)

Purpose: The main purpose of the paper is to evaluate an automated method for bloodvessels segmentation in color fundus images, due to its important role in the diagnosis ofseveral pathologies such as diabetes. The final objective is to introduce the algorithm intoa Computer Aided Diagnosis (CAD) tool that would be available in those local medicalcenters without specialists.Method: An automated method for blood vessels segmentation in color fundus images wasimplemented and tested. The algorithm starts with the extraction of vessel centerlines,which are used as guidelines for the subsequent vessel filling phase. The outputs of fourdirectional differential operators are processed in order to select connected sets ofcandidate points to be further classified as centerline pixels using vessel derived features.The final segmentation is obtained using an iterative region growing method thatintegrates the contents of several binary images, resulting from vessel width dependentmorphological filters. The method was evaluated using the images of two publicly availabledatabases (STARE and DRIVE) and a database with 24 images.Results: The algorithm outperforms other published algorithms and approximates theaverage accuracy of a human observer without a significant degradation of sensitivity andspecificity. In addition, results have been subject to the experts’ valuation that they thinkthat retinal vessels remain represented with valuable accuracy on having analyzed thetest’s images.Conclusion: Due to the good segmentation results, the algorithm proposed could beimplemented as part of a complete CAD tool in the local medical centers. This wouldreduce cost and diagnosis time(AU)

The virtual reality tool VirSSPA in planning DIEP microsurgical breast reconstruction.

BACKGROUND: The significant variation in the vascular anatomy of the abdominal wall makes preoperative imaging essential when raising a DIEP (deep inferior epigastric artery perforator) flap due to the potential for maximizing operative success, reducing intraoperative error and minimizing operative complications. Variability in perforator anatomy makes DIEP flap surgery a suitable candidate for computer and virtual reality bio models. In this context, a study was undertaken to determine the feasibility of CTA-guided by VirSSPA application. VirSSPA is a virtual reality tool developed in our Hospital for surgical planning and training. This application allows surgeons to generate the three-dimensional (3D) model of the patient. OBJECTIVE: In this paper, we present a study about VirSSPA tool for virtual reality navigation in DIEP flap surgery and compare findings with operative measurements. METHODS: We recruited 12 consecutive patients planned for an elective DIEP flap for breast reconstruction. Each patient underwent preoperative imaging of the anterior abdominal wall vasculature with both conventional CTA and VirSSPA 3D reconstruction. Imaging findings were compared to operative findings. RESULTS: 3D reconstruction of the abdominal wall with VirSSPA demonstrated a significant good correlation with perforator location compared to operative findings, showing an average error rate of 0.228 cm (95% CI, 0.17-0.30). The Pearson product-moment correlation coefficient was found to be 0.99 (p = 0.01), reflecting an almost linear relationship between the two distances, intraoperative and the one measured in the 3D reconstruction. CONCLUSION: VirSSPA provides additional and potentially more accurate data over conventional CTA with regard to the site of the best perforators and its course through the muscle for DIEP micro-vascular surgery.

VirSSPA- a virtual reality tool for surgical planning workflow.

OBJECTIVE: A virtual reality tool, called VirSSPA, was developed to optimize the planning of surgical processes. METHODS: Segmentation algorithms for Computed Tomography (CT) images: a region growing procedure was used for soft tissues and a thresholding algorithm was implemented to segment bones. The algorithms operate semiautomati- cally since they only need seed selection with the mouse on each tissue segmented by the user. The novelty of the paper is the adaptation of an enhancement method based on histogram thresholding applied to CT images for surgical planning, which simplifies subsequent segmentation. A substantial improvement of the virtual reality tool VirSSPA was obtained with these algorithms. RESULTS: VirSSPA was used to optimize surgical planning, to decrease the time spent on surgical planning and to improve operative results. The success rate increases due to surgeons being able to see the exact extent of the patient's ailment. This tool can decrease operating room time, thus resulting in reduced costs. CONCLUSION: Virtual simulation was effective for optimizing surgical planning, which could, consequently, result in improved outcomes with reduced costs.

Digital imaging in remote diagnosis of burns.

Images are capable of giving an accurate representation of skin color and have been used extensively in teaching about and researching burn therapy. The advance from analogue to digital imaging allows the remote transmission of the clinical information contained in the digital image of a burn, using a suitable system. The large size of these image files reduces transmission speed and makes data compression desirable. Compression, by means of the JPEG algorithm, of up to 50 times the original size of 38 digital images of burns suffered by 22 consecutive patients did not lessen its great usefulness in determining the depth of burn injuries, according to a group of experts in burn care. The success rate was close to 90%, both for non-compressed images in original BMP format (mean size:1500 Kb) and for compressed images with a Q index of 50 (30 Kb files), when compared with the clinical diagnoses confirmed one week after the accident.