Personalizable AI platform for universal access to research and diagnosis in digital pathology.

BACKGROUND AND MOTIVATION: Digital pathology has been evolving over the last years, proposing significant workflow advantages that have fostered its adoption in professional environments. Patient clinical and image data are readily available in remote data banks that can be consumed efficiently over standard communication technologies. The appearance of new imaging techniques and advanced artificial intelligence algorithms has significantly reduced the burden on medical professionals by speeding up the screening process. Despite these advancements, the usage of digital pathology in professional environments has been slowed down by poor interoperability between services resulting from a lack of standard interfaces and integrative solutions. This work addresses this issue by proposing a cloud-based digital pathology platform built on standard and open interfaces. METHODS: The work proposes and describes a vendor-neutral platform that provides interfaces for managing digital slides, and medical reports, and integrating digital image analysis services compatible with existing standards. The solution integrates the open-source plugin-based Dicoogle PACS for interoperability and extensibility, which grants the proposed solution great feature customization. RESULTS: The solution was developed in collaboration with iPATH research project partners, including the validation by medical pathologists. The result is a pure Web collaborative framework that supports both research and production environments. A total of 566 digital slides from different pathologies were successfully uploaded to the platform. Using the integration interfaces, a mitosis detection algorithm was successfully installed into the platform, and it was trained with 2400 annotations collected from breast carcinoma images. CONCLUSION: Interoperability is a key factor when discussing digital pathology solutions, as it facilitates their integration into existing institutions' information systems. Moreover, it improves data sharing and integration of third-party services such as image analysis services, which have become relevant in today's digital pathology workflow. The proposed solution fully embraces the DICOM standard for digital pathology, presenting an interoperable cloud-based solution that provides great feature customization thanks to its extensible architecture.

Carpal Tunnel Anthropometrics Using Acrylic Casts: A Cadaveric Study With Implications for Carpal Tunnel Release.

BACKGROUND: Abundant literature exists on the morphology of the carpal tunnel. Despite this, the shape of the carpal tunnel has been reported erratically, and most studies did not attempt to correlate findings with measurements taken from cadavers. The objective of this study was to perform a morphological analysis, determine the shape and mean dimensions of the carpal tunnel, determine the level of the narrowest area of the tunnel, and establish a set of values capable of serving as a reference for carpal tunnel release. METHODS: The carpal tunnels of 20 fresh cadaveric hands were dissected, and acrylic casts were created and measured using industrial computed tomography. RESULTS: Of the 20 casts, 19 were shaped like elliptic cylinders, with little variation in their measurements along the length. The location of the narrowest section of the carpal tunnel is very different among casts, and the length of the roof of the carpal tunnel ranged from 21.26 to 29.86 mm. CONCLUSIONS: The most common shape of the carpal tunnel is an elliptic cylinder. Because of the unpredictability of the location of the narrowest area of the carpal tunnel, carpal tunnel release must continue through all extension of its roof. We advise that the release should rarely be extended distally more than 30 mm from the distal palmar wrist crease, which corresponds, in most cases, to the middle of the pisiform.

Dicoogle Open Source: The Establishment of a New Paradigm in Medical Imaging.

The rapid and continuous growth of data volume and its heterogeneity has become one of the most noticeable trends in healthcare, namely in medical imaging. This evolution led to the deployment of specialized information systems supported by the DICOM standard that enables the interoperability of distinct components, including imaging modalities, repositories, and visualization workstations. However, the complexity of these ecosystems leads to challenging learning curves and makes it time-consuming to mock and apply new ideas. Dicoogle is an extensible medical imaging archive server that emerges as a tool to overcome those challenges. Its extensible architecture allows the fast development of new advanced features or extends existent ones. It is currently a fundamental enabling technology in collaborative and telehealthcare environments, including research projects, screening programs, and teleradiology services. The framework is supported by a Learning Pack that includes a description of the web programmatic interface, a software development kit, documentation, and implementation samples. This article gives an in-depth view of the Dicoogle ecosystem, state-of-the-art contributions, and community impact. It starts by presenting an overview of its architectural concept, highlights some of the most representative research backed up by Dicoogle, some remarks obtained from its use in teaching, and worldwide usage statistics of the software. Finally, the positioning of Dicoogle in the medical imaging software field is discussed through comparison with other well-known solutions.

Intra-Query Parallelism for a Scalable and Responsive Web-Based Digital Pathology Viewer.

Computational systems are successfully used in distinct areas of health. However, the use of digital imaging in pathology is taking its first steps when compared with the radiology sector. For instance, inter-institutional web platforms interoperable with various scanners through standard communications are very rare. This is due to the fact that the technology is only now being mature enough to meet the major challenges of this sector in terms of data storage and data access for efficient visualization of images with several gigabytes. The remote access to those images proves to be a challenge in an open and heterogeneous environment. This paper proposes a scalable and efficient architecture for storing and dynamic data retrieval on distributed large-scale systems. The adopted methodology relies on intra-query parallelism to retrieve a large number of image segments in a scalable distributed environment.

Role-Based Architecture for Secure Management of Telepathology Sessions.

Digital pathology is the computer technology that allows the management of the information generated by the whole-slide scanners from a microscopic slide, encompassing the virtual microscopy. This paper proposes and describes the architecture of a secure collaborative platform that integrates a web pathology viewer with role-based access control. The proposed architecture is ensured by a shared medical repository that serves web pathology viewer with the medical images, using the DICOM standard. The system offers collaborative work session management tools as the managing of users, sessions, access control to sessions, and many others. Furthermore, the use cases related to telepathology and e-learning are presented.

Automedicação: comportamento de um grupo de estudantes de saúde no ensino superior / Self-medication: behavior of a group of health students in higher education

Introduction: In developed countries, self-medication has become a common practice, especially where over-the-counter medication is possible. Self-medication is considered one of the main public health problems. Aim: To characterize the profile of a group of students in health higher education, in relation to self-medication during their academic career. Methods: Cross-sectional descriptive exploratory study, framed in the quantitative paradigm. 285 students from the Nursing Degree and Physiotherapy Degree courses, a stratified sample, from a private Higher School of Health in northern Portugal, participated. A structured questionnaire was used to gather the necessary information for the study, the data collection period was from October to December 2017. Data analysis was performed using the Statistical Package for Social Sciences (SPSS - version 24), using descriptive statistics techniques (univariate and bivariate). Results and Discussion: Participated predominantly female students, with an average age of 21 years. They resort to self-medication, and on their own initiative. The most commonly used drugs were analgesics and anti-inflammatory drugs, which were consumed for short periods. The results obtained with the study are in line with others developed in the area. Conclusions: Students self-medicate and base their decision making with knowledge in pharmacology. These results are important for the population where the study was conducted. It is suggested to approach non-pharmacological interventions to treat pain cause that stood out for self-medication

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Nível de e-literacia em saúde em alunos do ensino secundário privado / Level of e-literacy in health in private secondary school students

Introduction: e-literacy in health is related to the use of Internet or other electronic means related to the dissemination or visualization of information about health and / or health services. Objectives: To describe the level of e-literacy in health, in a group of students of a private high school, in the North of Portugal; to relate the level of e-literacy in health with sociodemographic data; to relate the level of e-literacy in health with the contextual variables of the students. Method: Descriptive, correlational and transversal quantitative study. 102 students from the science and technology course of a private high school in the north of Portugal participated. A questionnaire was applied consisting of 3 groups: group I sociodemographic variables; group II consisted of contextual variables and group III constituted by the "eHEALS - eHealth Literacy Scale" scale. Results: Students presented positive levels of e-Literacy in health. They know how to use the Internet to find health information and recognize its usefulness and importance, but did not have confidence in the information obtained when making deci-sions on health. Conclusion: Students present positive levels of e-literacy in health but need guidance to the sources of consultation in order to rely on the information accessed for health project management

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Abordagem na sala de emergência: dotação adequada de recursos de enfermagem / Emergency room approach: safe nursing staffing / Enfoque en la sala de urgencias: dotación adecuada de los recursos de enfermería

Enquadramento: O prognóstico da pessoa em situação crítica na sala de emergência depende da eficácia da atuação da equipa que a assiste. Objetivos: Perceber e justificar a necessidade de alocar um enfermeiro que tenha como função a abordagem em exclusivo a clientes da sala de emergência num hospital da região de Lisboa e Vale do Tejo com um serviço de urgência polivalente. Metodologia: Estudo retrospetivo, descritivo, exploratório, quantitativo. 3185 clientes críticos, recolha de informação por grelha de observação. Análise estatística foi realizada com o software IBM SPSS Statistics, versão 25.0. Recorreu-se ao teste de Kruskal-Wallis e Qui-quadrado. Resultados: No ano de 2017, na sala de emergência admitiram-se em média 9 clientes por dia, os cuidados diretos prestados exigiram em média 45,4 minutos, 65% foram admitidos na unidade de internamento médico-cirúrgico do serviço de urgência ou na área de observação clínica do mesmo serviço. Conclusão: Emerge a necessidade de garantir dotação adequada aquando da prestação de cuidados à pessoa em situação crítica, sendo necessário um enfermeiro para funções exclusivas à sala de emergência.

Background: The prognosis of the critically ill person in the emergency room depends on the effective performance of the health team in operation. Objectives: To understand and justify the need to allocate a nurse who works exclusively in the assistance to patients in the emergency room of a hospital in the Great Lisbon and Tagus Valley region with multipurpose emergency service. Methodology: Retrospective, descriptive, exploratory, and quantitative study, with a sample of 3185 critically ill patients. Data collection through observation grid. Statistical analysis was performed using the IBM SPSS Statistics software, version 25.0. The Kruskal-Wallis test and chi-square test were used. Results: In 2017, an average of 9 patients per day were admitted in the emergency room. The direct care delivered lasted, on average, 45.4 minutes, 65% were admitted to the surgical admission unit service or the area of clinical observation of the emergency department. Conclusion: It is crucial to ensure safe staffing in care delivery to the critically ill person, being necessary a nurse working exclusively in the emergency room.

Marco contextual: El pronóstico de la persona en una situación crítica en la sala de urgencias depende de la eficacia del equipo que la asiste. Objetivos: Comprender y justificar la necesidad de asignar un enfermero cuya función sea atender exclusivamente a los pacientes de la sala de urgencias de un hospital de la región de Lisboa y Valle del Tajo con un servicio de urgencias polivalente. Metodología: Estudio retrospectivo, descriptivo, exploratorio y cuantitativo. 3185 pacientes críticos, recopilación de información mediante una parilla de observación. El análisis estadístico se realizó con el programa IBM SPSS Statistics, versión 25.0. Se utilizó la prueba de Kruskal-Wallis y la de ji al cuadrado. Resultados: En 2017, se admitió una media de 9 pacientes por día en la sala de urgencias, la atención directa prestada exigió un promedio de 45,4 minutos, el 65% fue admitido en la unidad de internamiento médico-quirúrgico del servicio de urgencias o en el área de observación clínica del mismo servicio. Conclusión: Es necesario garantizar una dotación adecuada cuando se atiende a la persona en una situación crítica, y es necesario un enfermero para las funciones exclusivas de la sala de urgencias.

Cardiac rehabilitation program and health literacy levels: A cross-sectional, descriptive study.

In Portugal, cardiovascular diseases stand out among the main causes of morbidity, disability, and mortality, with an expectation of growth up to the year 2025. A descriptive, exploratory study was carried out with patients in a cardiac rehabilitation program from an institution in the northern region of Portugal; 103 participants were randomly selected for the study. The data collection took place from February to April 2017. The majority of respondents presented a low level of literacy (inadequate and problematic). The profiles of the participants were characterized by the predominance of married males, with a mean age of 69 years. The participants considered doctors and nurses as the professionals who contribute the most to the increase of their health literacy. These health professionals have the opportunity and the responsibility to increase the health literacy levels of patients. It is known that low levels of health literacy are a problem throughout the European Union. Portugal's general population reflects this reality, and this study contributed to the conclusion that cardiac rehabilitation patients also present worrying levels of health literacy.