The electronic medical record (EMR) is now nearly ubiquitous in the USA. This article will review the EMR system with respect to goals, utilization, advantages compared with hand written records, as well as problems and/or disadvantages of the EMR system.

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Esophageal cancer with liver metastasis is rare and when diagnosed is usually advanced and surgical management is contraindicated. The most common sites of distant hematogenous metastases in esophageal cancer cases are the liver, lungs, and bones. Here, we present a rare case of esophageal carcinoma presenting with cystic metastases to the liver.

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Advancements in technology have always had major impacts on medicine. Increased use of smartphone and related software applications has created a new era in clinical data exchange among patients and clinicians. Teledentistry is a combination of telecommunications and dentistry, involving the exchange of clinical information and images over remote distances for dental consultation and treatment planning. It has the potential to address many of the problems related to access, cost efficiency and quality of dental care. Through teleconsultation with specialists in larger communities, a dentist in a nearby community can provide access to specialty care for their patients easily. Teledentistry can extend care to underserved patient populations, such as those in rural areas, at a reasonable cost. This review article aims to emphasize the importance of teledentistry in various specialties of dentistry and its role in serving the underserved population.

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Background and Objectives: Cloud-based mHealth services have the potential to make quality healthcare available in remote locations in the world. A practical deployment will involve medicolegal issues involving physicians and patients in different within and across countries. However, the first step is to evaluate such a cloud-based mHealth (MyOnlineClinic). This study aimed to understand and find out the factors that influence the end-user intention to use this new technology in Australia. Materials and Methods: We surveyed 167 end-users in 2015 and performed a Structural Equation Model analysis using Smart PLS to identify the intention to use the system among the participants. Results: The study revealed that the Unified Theory of Acceptance and Use of Technology construct, particularly facilitating condition (FC) (β = 0.355, P = 0.002), has yielded a significant influence on the behavioral intention to use MyOnlineClinic. However, the relationships between performance expectancy and behavioral intention (β = 0.162, P = 0.141), effort expectancy and behavioral intention (β = −0.004, P = 0.971), and social influences and behavioral intention (β = 0.164, P = 0.100) were insignificant. Further, age showed moderating effect on these variables. The majority of the respondents agreed or strongly agreed that technological issues such as sound (92.2%), video qualities (88.6%), and interaction with doctor (89.8%) are good. Conclusion: The end-users’ intentions to use MyOnlineClinic system were particularly influenced by FCs such as hardware, software, and the information technology knowledge/familiarity of users. These factors may get further accentuated when these systems are deployed across countries with different languages, technological infrastructures, and medicolegal environments. Therefore, cloud-based mHealth would help in removing some barriers, such as differences in software versions and interoperability problems of systems at physician and patient ends.

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Schwannoma, also called neurilemmoma, is a benign peripheral nerve sheath tumor. Most common locations are flexor surfaces of the extremities, neck, mediastinum, retroperitoneum, posterior spinal roots, and cerebellopontine angle. Pleural schwannomas are extremely rare neoplasms of the thoracic cavity. To the best of our knowledge, till date, <20 cases have been reported. Herein, we report a case of primary benign pleural schwannoma in an elderly 60-year-old female in whom the pleural mass was discovered incidentally on computed tomography chest. The patient was subjected to left posterolateral thoracotomy; pleural mass was resected which showed histopathological and immunohistochemical features of schwannoma.

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Automatic processing large amount of microscopic images is important for medical and biological studies. Deep learning has demonstrated better performance than traditional machine learning methods for processing massive quantities of images; therefore, it has attracted increasing attention from the research and industry fields. This paper summarizes the latest progress of deep learning methods in biological microscopic image processing, including image classification, object detection, and image segmentation. Compared to the traditional machine learning methods, deep neural networks achieved better accuracy without tedious feature selection procedure. Obstacles of the biological image analysis with deep learning methods include limited training set and imperfect image quality. Viable solutions to these obstacles are discussed at the end of the paper. With this survey, we hope to provide a reference for the researchers conducting biological microscopic image processing.

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Background and Objectives: Lung cancer is the commonest cancer killer in the western world. Many patients have lung cancers first identified on chest radiograph (CXR). Potentially curable cancers are often missed on CXR. This study quantified the incidence of cases of lung cancer which were initially overlooked and studied the causes of delayed diagnosis. Materials and Methods: All consecutive patients discussed during a 3-month period at the local lung cancer multidisciplinary meeting (MDM) were identified. All imaging within two years prior to diagnosis of lung cancer were reviewed with its report. Any CXR examination which failed to raise the potential for lung cancer was blindly reviewed by four consultant chest radiologists. Results: 189 patients were identified from the MDM over three months. 38,049 CXRs were carried out in the trust over the same period. Of the 189 patients, 58 had previous CXRs within 2 years reported as normal. On review 27 (47%) showed an abnormality in the region of the lung subsequently shown to have cancer. 70% of lesions were central, obscured by the heart, diaphragm, clavicles or mediastinum. Conclusions: This study shows that 1 in 1,409 CXRs reported as normal harbours a visible lung cancer on retrospective review. In this group 14% of patients with lung cancer could potentially have been diagnosed earlier. Of those that had previous CXRs, 47% had abnormal CXRs reported as normal. This study qualifies the rate of missed lung cancer on CXR in clinical practice and highlights where on CXR cancers are missed.

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Wearable technologies designed to deliver benefits to health and well-being through the use of digital applications are becoming increasingly ubiquitous. This article focuses on the use of wearable technologies which track user lifestyle behaviors and seek to provide tools for better personal health management. It provides an evidence of general positive health outcomes from previous research and provides a detailed analysis of the functionalities and strategic approaches of three different wearable devices which have been used continuously and simultaneously by the lead author for over 18 months. Based on the experience of long-term use of these devices, the article draws some conclusions about their usage and future development strategies.

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With the rapid development of the internet and information technologies, coupled with a variety of digital media, the digital technology has become a conventional method of health education for the general public and has the potential to influence health behaviors. Our aim was to conduct a review of how digital technology projects have been used in the health education and health promotion, as well as the disadvantages and barriers in the process.

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Background and Objectives: Aging society is a social health issue that digital gaming solutions can address by enabling both infrastructures as advanced environments for care and patients as active people in their aging. Cost-effective patient management may be emphasized thanks to the communication protocols that allow remote monitoring and intervention by medical professionals. Services for elderly depend on their behavior and lifestyle toward personal health management. Digital games could increase seniors' engagement and motivation. However, a few studies have looked at the acceptance of digital games by the elderly. The study here presented aims to evaluate the feasibility of a gaming rehabilitation platform. Materials and Methods: In Singapore, fifty elderly practiced 30-min sessions and evaluated their experience with a new tool based on game scenarios for rehabilitation. Results: Results are discussed in the light of Davis' Technology Acceptance Model, highlighting mainly a good perceived usefulness of the service. Conclusions: This preliminary study is encouraging the spread of digital medical games for old patients.

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The pursuit of digital biomarkers wherein signal outputs from biosensors are collated to inform health-care decisions continues to evolve at a rapid pace. In the field of neurodegenerative disorders, a goal is to augment subjective patient-reported inputs with patient-independent verifiable data that can be used to recommend interventive measures. For example, in the case of Alzheimer's disease, such tools might preselect patients in the presymptomatic and prodromal phases for definitive positron emission tomographic analysis, allowing accurate staging of disease and providing a reference point for subsequent therapeutic and other measures. Selection of appropriate and meaningful digital biomarkers to pursue, however, requires deep understanding of the disease state and its ecological relationship to the instrumental activities of daily living scale. Similar opportunities and challenges exist in a number of other chronic disease states including Parkinson's, Huntington's, and Duchenne's disease, multiple sclerosis, and cardiovascular disease. This review will highlight progress in device technology, the need for holistic approaches for data inputs, and regulatory pathways for adoption. The review focuses on published work from the period 2012–2017 derived from online searches of the most widely used abstracting portals.

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Digital imaging and communication in medicine (DICOM) is a standard that specifies a nonproprietary data exchange protocol, which was developed by the American College of Radiology and the National Electrical Manufacturers Association. It has now become the uncontested standard for the exchange and management of biomedical images. Here, we hope to highlight the significance of DICOM in digital imaging and to illustrate its indispensable role in digital imaging in the future.

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Cone beam computed tomography (CBCT) is a developing imaging technique designed to provide relatively low-dose high-spatial-resolution visualization of high-contrast structures in the head and neck and other anatomic areas. It is a vital content of a dental patient's record. A literature review demonstrated that CBCT has been utilized for oral diagnosis, oral and maxillofacial surgery, endodontics, implantology, orthodontics; temporomandibular joint dysfunction, periodontics, and restorative and forensic dentistry. Recently, higher emphasis has been placed on the CBCT expertise, the three-dimensional (3D) images, and virtual models. This literature review showed that the different indications for CBCT are governed by the needs of the specific dental discipline and the type of procedure performed.

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Objective: The aim was to evaluate diagnostic accuracy of 640 slice computed tomography angiography (640-CTCA) in diagnosis of coronary artery stenosis. Materials and Methods: Selective coronary angiography (SCA) and 640 slice CTCA were performed in 120 patients with suspected coronary artery disease (CAD) (78 male, 42 female, aged from 36 to 79 years old, with an average of 58.23 years). Various post-processing reconstructions of coronary arteries and branches, such as volumetric imaging, multi-planar reconstruction, curved planar reconstruction, maximum intensity projection were used. The coronary segments, with statistical evaluations combined with its diameter ≥1.5 mm were collected to analyze the diagnosis accuracy of 640-CTCA on coronary artery stenosis, with SCA as the reference standard. Results: About 96.91% (1535/1584) of coronary artery segments were evaluable arteries, and the sensitivity, specificity, positive and negative predictive value of 640-CTCA for detecting coronary artery stenosis were 93.44%, 99.59%, 95.00% and 99.45% respectively. 3.09% (49/1584) of coronary artery segments could not be evaluated due to motion artifact in 21 segments, calcification in 18 segments and poor display of lumen in 10 segments. There were no significant differences in the diagnostic accuracy of coronary artery stenosis between 640-CTCA and SCA. Conclusion: 640-CTCA has a higher accuracy and specificity, which is a reliable tool in the screening of CAD, coronary surgery, preoperative evaluation and the postoperative follow-up.

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Objective: The aim was to explore image quality and radiation dose in patients with different heart rates in 640-slice volume computed tomography (CT) coronary angiography by using tube voltage of 100 kV. Materials and Methods: The 220 consecutive patients clinically suspected or confirmed of coronary artery disease were divided into three groups: 67 cases in 1 beat group (heart rate <65 bpm); 134 cases in 2 beats group (65 bpm ≤heart rate <80 bpm); 19 cases in 3 beats group (heart rate >80 bpm). When scanning was completed, the best phase for coronary arteries would be chosen. Various postprocessing reconstructions of coronary arteries and branches, such as volume reconstruction (VR), maximum density projection, multiplanar reconstruction, curved surface reconstruction, were used. We classified image quality and made statistical analysis according to 4-grades method. We also compared scalability of coronary arterial segments and radiation doses between the groups. Results: There were no significant differences in the scalability of coronary arterial segments between the groups. Effective radiation doses of the three groups were (2.5±0.8) mSv, (8.4±3.1) mSv and (11.2±3.8)mSv. The radiation doses between the groups showed statistical difference (P < 0.05). Conclusion: 640-slice volume CT can be adapted to changes during heart rate, and ensure the image quality under the condition of 100 kV, and radiation doses were significantly reduced in patients with heart rate <65 bpm.

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The simulation of clinical situations with the acquisition of fine motor skills is an essential component of the dental students' learning experience. The traditional approach to dental skills training has drawbacks in terms of cost, availability, lack of real-world cases, with the restraints of time, clinical supervision, and the funding of raw materials such as real and plastic teeth. The introduction of dental haptics opens the door to a more realistic clinical experience which can be free from the previous constraints. The performance of the students should be reviewed invaluably by pinpointing exactly where mistakes may have been made and directed learning should be allowed. Also, haptics offers the possibility of unlimited training hours by which students can gain skills without demands on manpower and resources. This paper provides a comprehensive review of literature on haptics for training of periodontal procedures.

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Objective: To assess prevalence, usage pattern, and risk of internet addiction (IA) among undergraduate students of a health institution from Delhi. Materials and Methods: A cross-sectional descriptive study was carried out during March-April 2015 using 20-item Young's IA test, a Likert scale-based interview schedule with scores ranging from 0 to 100 points with a higher score indicating greater internet dependency. Background variables included sociodemographic details, general health practices, self-assessment of mental health status, inter-personal relation (family/friends), personality type, and global satisfaction in life. The scoring pattern was analyzed in the form of low risk (score ≤49 points) and high risk (score ≥50 points) for IA. The proportion, Chi-square test, adjusted, and un-adjusted odds ratio (OR) (95% confidence interval) were computed using regression analysis. Results: Out of 202, 40.6% were MBBS students, followed by 35.6% from nursing, and 23.8% from medical lab technology stream; 68.3% were females; the mean age was 20.3 ± 1.4 years; and 61.9% were residing in hostels. It was observed that 44 (21.8%) and 22 (10.9%) students had ever consumed alcohol and smoked, respectively, while only 42 (20.8%) were engaged in physical activity (≥30 min) during most (≥5) of the days of the week. Based on self-assessment, 33 (16.3%) were globally dissatisfied and 88 (43.6%) reported themselves to be introverts. The majority of students were using internet for educational purpose (98%), entertainment (95.0%), accessing social sites (92.5%), checking E-mails (76.2%), and pornographic websites (45%). With regard to IA, 171 (84.7%) were at low risk (score ≤49) and 31 (15.4%) were at high risk (score ≥50). Male students (P = 0.001), ever consumed alcohol (P = 0.003), ever smoker (P = 0.02), and regular physical activity (P = 0.04) were found to be significantly associated with a high risk of IA based on Chi-square test, but none were found significant at higher levels of analyses (adjusted OR). No significant association of IA was found with mental status, global satisfaction, inter-personal relationship, or personality type. Conclusion: A large majority (84.7%) of students in our study are found to be at low risk of internet addiction.

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Objective: Biomedical data processing generally requires the secure stepwise transfer of sensitive personal information across multiple parties. Mediating such operations using distributed secure digital ledgers, i.e., blockchains, is investigated in this article. Materials and Methods: The bitmark property rights blockchain was used to simulate the process of assessing individuals for enrollment to specific clinical trials. In the scenario presented, a sponsor publishes a recruitment call for a clinical trial and patients signal their willingness to participate in the trial through blockchain transactions. The blockchain creates and maintains digital references of the medical data assets of prospective study participants as well as digital property certificates for assigning access rights to corresponding medical data assets. Trial matching services review the patient blockchain records and recommend study participants that are likely to meet the enrollment criteria of recruiting clinical trials. Digital certificates assign transient access rights to the data assets of the prospective study participants. These certificates are transferred to pertinent matching services and sponsors, allowing these organizations to examine the candidacy of each prospective study participant. Results: The trial matching simulation demonstrates that property rights blockchains can implement complicated multiparty interactions, such as those associated with medical data exchange, without supplemental peer-to-peer communications. Conclusions: Blockchain-based data marketplaces of the type described, when coupled with data-controlled virtual infrastructure environments (i.e., Medical Data Trusts), provide a viable model for managing the transfer, provenance, and processing of individual health information.

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Background and Objectives: Stroke is a leading cause of long-term disability. Rehabilitation involving repetitive, high-intensity, and task-specific exercise is the pathway to restore motor skills. Robotic assistive devices such as Gloreha are increasingly being used in upper limb rehabilitation. The aim of this study is to explore the efficacy of robotic therapy for upper limb rehabilitation using robotic glove (Gloreha) in patients with stroke. Materials and Methods: The patients affected by stroke who were admitted to our rehabilitation unit were studied. Patients were exposed to Gloreha device rehabilitation (30 min/die), physiotherapy (1,5 hours/die), and occupational therapy (30 min/die). We measured the impairment in motor function and muscle tone using the modified Ashworth scale (MAS), the activities of daily living functional independence measure (FIM), and the finger dexterity Nine-Hole Peg test (NHPT). Results: Twelve patients (mean age = 64.5 years; male/female: 8:4) were admitted at the rehabilitation training. We found statistically significant differences between admission and discharged in terms of functional recovery using the FIM scale (pre/M = 88.33; post/M = 117.25,P = 0.01); hand training showed a better outcome using the NHPT (pre/M = 51.8; post/M = 36.33, P = 0.01). No significant changes were observed in terms of spasticity with the MAS (pre/M = 1.25; post/M = 1.08;P > 0.05). Conclusions: Rehabilitation with robotic glove (Gloreha) can positively promote functional recovery of arm function in a patient with stroke.

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