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  Most popular articles (Since September 04, 2013)

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The electronic medical record in 2016: Advantages and disadvantages
Joseph S Alpert
April-June 2016, 2(2):48-51
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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The blockchain-based scientific study
Thomas F Heston
April-June 2017, 3(2):66-68
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3D printing: The cutting edge of digital medicine
Kerong Dai
October-December 2015, 1(2):51-53
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Cone beam computed tomography: A new vision in dentistry
Manas Gupta, Pankaj Mishra, Rahul Srivastava, Bhuvan Jyoti
July-September 2015, 1(1):7-16
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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The diagnostic evaluation of 640 slice computed tomography angiography in the diagnosis of coronary artery stenosis
Ziqiao Lei, Qing Fu, Heshui Shi, Haibo Xu, Ping Han, Jianming Yu
October-December 2015, 1(2):67-71
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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The consumerization of digital medicine
David John Wortley
October-December 2016, 2(4):135-139
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Application study of 640-slice computed tomography low dose coronary angiography
Ziqiao Lei, Ping Han, Haibo Xu, Jianming Yu
July-September 2015, 1(1):28-33
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 application of digital technology in community health education
Wen Ren, Conglin Huang, Ying Liu, Jingjing Ren
July-September 2015, 1(1):3-6
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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Esophageal carcinoma causing cystic metastases of liver
Reddy Ravikanth
July-September 2017, 3(3):145-146
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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Chest radiographs and the elusive lung cancer
Andrew E Walker, John T Murchison, Edwin Van Beek, Gillian Ritchie, Joanne Sharkey
July-September 2016, 2(3):120-126
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, health and well-being: Acase review
David Wortley, Ji-Young An, Claudio R Nigg
January-March 2017, 3(1):11-17
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 over18months. 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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Haptics: The science of touch in periodontics
Rashmi Khanna, Sapna Sharma, Monika Rana
October-December 2015, 1(2):58-62
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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Gamifying elderly care: Feasibility of a digital gaming solution for active aging
Antonio Ascolese, Jin Kiat, Lucia Pannese, Luca Morganti
October-December 2016, 2(4):157-162
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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Evolution of electronic gadgets and emergence of high-tech diseases
Kalaivani Annadurai, Geetha Mani, Raja Danasekaran
July-September 2015, 1(1):49-50
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Risk of internet addiction among undergraduate medical, nursing, and lab technology students of a health institution from Delhi, India
Anika Sulania, Sandeep Sachdeva, Nidhi Dwivedi
October-December 2015, 1(2):72-78
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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Using the Unified Theory of Acceptance and Use of Technology model to analyze cloud-based mHealth service for primary care
Fatema Khatun, Md. Jahir U Palas, Pradeep K Ray
April-June 2017, 3(2):69-75
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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A haptic device for wrist and elbow rehabilitation
Jun Jiang, Le Xie, Guojie Li
October-December 2015, 1(2):54-57
Interest in the devices for rehabilitation applications has been increasing. And the devices before have proved that they might assist in and quantify the rehabilitation for upper limb disability caused by stroke. This paper is to introduce rehabilitation application of a haptic device based on virtual reality technology, which is compact, portable, and modular. The focus here is a device with force feedback designed to provide five degrees of freedom, which are rotation, opposition, translation, pitch, and yaw. With five degrees of freedom above, the device can help individuals with arm weakness do their exercise and make patients achieve favorable rehabilitation efficacy during their upper limb rehabilitation.
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Delivering precision medicine: Personalization at scale
Steve Gardner
October-December 2016, 2(4):140-143
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Significance of digital imaging and communication in medicine in digital imaging
Manas Gupta, Neha Singh, Kriti Shrivastava, Pankaj Mishra
October-December 2015, 1(2):63-66
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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Analysis of artery occlusion caused by facial autologous fat injections
Xiangdong Qi, Jie Zhou, Limin Ma, Jianzeng Qin
July-September 2015, 1(1):39-42
Objective: To investigate the causes for retinal artery occlusion and cerebral infarction resulting from cosmetic facial autologous fat injections. Materials and Methods: Twenty-seven retrospective, noncomparative cases with artery occlusion caused by facial autologous fat injections were included. Injection sites, basic demographic information (age, sex, and laterality of the involved eyes), best-corrected visual acuities (BVCAs), fundus fluorescein angiography, optical coherence tomography findings, brain magnetic resonance imaging, and associated ocular and systemic manifestations were collected as study information. Twenty-seven cases were classified according to artery occlusion, which led to blindness and brain infarction, as relationship between blindness and brain infarction may provide clues to help us figure out the process of arterial blockage. Results: Of the 27 cases, 13 patients had ophthalmic artery occlusion (OAO), 6 had central retinal artery occlusion (CRAO), and 3 had branch retinal artery occlusion (BRAO). Injection sites were the glabellar area (9 cases), nasolabial area (5 cases), forehead area (4 cases), periocular area (2 cases), nose area and nasal area (2 cases), multiple places (2 cases), and other areas (3 cases). Injection at different injection sites may lead to blindness, which means that emboli went into the blood by different branches of the external carotid artery, and eventually blocked the ophthalmic artery and its branches. Concomitant brain infarction developed in 13 cases with retinal artery occlusion. The high probability of occurrence of cerebral infarction indicated that internal carotid artery could be a flow path of emboli. Conclusion: Cosmetic facial autologous fat injections may cause retinal artery occlusion. Under the pressure of injection, fat emboli go through the terminal artery of face into the ophthalmic artery counter currently. In some cases, retrograde arterial embolism also causes brain infarction. Middle cerebral artery occlusion is closely associated with OAO.
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Clinical and academic uses of smartphones among medical residents
Muhammad Haseeb, Mir T Altaf, Aneet Kour, Firdous Ahmed, Alamgir Jahan, Arpan Bijyal
July-September 2015, 1(1):34-38
Background and Objective: A smartphone is a cellular phone with an integrated computer that enables it to perform a wide array of tasks in addition to its primary purpose. Technological growth has been paralleled by a similar rise in the capabilities of modern day smartphones. And they have found their way into medical education as well as practice. iOS and Android based phones constitute the bulk of the smartphones. Together with their associated applications (apps), these devices have become an indispensable tool for the medical resident and practicing physician. The aim of this study is to make an objective assessment of the status of smartphones as a learning aid and practice tool among medical residents. Materials and Methods: The study was conducted on post-graduate trainees in the largest teaching hospital in Jammu province. The residents were approached in the hospital and requested to fill a pre-formulated questionnaire. 90 residents from different specialities were approached over a period of seven days. Results: 80% of the interviewees said they possessed a smartphone. The percentage was lower in first year trainees and highest in third year trainees. Android and iOS based phones were the devices most commonly used. 90% of those with smartphones said they used it for clinical or academic purposes in the hospital. Conclusion: A fairly large percentage of medical residents own smartphones. Most of them use these for clinical and academic purposes. Online resources and pre-installed apps are the two common resources accessed. There is a need for improving the credibility of online resources, and development of more medical apps for smartphones.
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Computer reconstruction of the cardiac skeleton and its application in locating heart valve planes
Ying Li, Wei Chen, Yonglin Chen, Kaijun Liu, Liwen Tan, Shaoxiang Zhang
January-March 2016, 2(1):22-29
Objective: To fully understand the original spatial position and three-dimensional (3D) anatomical morphology of cardiac skeleton (CS), and to quickly locate its position in patient-specific computed tomography angiography (CTA) images. Materials and Methods: First, we segmented and reconstructed 3D models of CS and its attached valves with Amira software, defined valve planes based on Chinese visible human 5 (CVH5), and then computed its geometric transformation matrix and applied them in locating the valve planes in patient-specific CTA images. Results: We reconstructed a 3D CS model based on CVH5 images which keep the original spatial position and its normal anatomical appearance. The 3D structures include aortic valve annulus (AVA), mitral valve annulus, tricuspid valve annulus, pulmonary valve annulus, and its attached valves. With the relative geometric transformation matrix, we quickly located the patient-specific valve planes that are vertical to each valve in CTA images. Conclusions: CVH5 dataset can be used in reconstructing the 3D model of CS, which is difficult for clinical images, such as CT, magnetic resonance imaging, and traditional anatomical method to achieve. Our method of 3D reconstruction presents more anatomical details than clinical images and keeps the original shape and position. We can define each valve plane on the CVH5 model and show its corresponding plane in patient-specific CTA images, which can be observed on each valve plane at the same time based on the consistent reference.
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Evolution of the digital biomarker ecosystem
Justin M Wright, Oliver B Regele, Lampros C Kourtis, Sean M Pszenny, Rhea Sirkar, Christopher Kovalchick, Graham Barry Jones
October-December 2017, 3(4):154-163
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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Increasing adherence in therapies and polypharmacy in Europe: EIP on AHA Action Group A1 activities toward integrated care information systems and self-management applications
Homer Papadopoulos, Anna Giardini, Elisio Costa, Alessandro Monaco, Alpana Mair, Clara Cena, Giuseppe Fico
October-December 2016, 2(4):144-148
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Academic use and attitude of the 1st year medical students toward smartphones in a North Indian city
Jyoti Rohilla, Ravi Rohilla, Aarti Rohilla, Kamal Singh
January-March 2016, 2(1):13-16
Objective: Smartphones have evolved from luxury to essential need items in general population nowadays. iOS by Apple, Android by Google, Windows by Microsoft and Blackberry account for the majority of smartphone operating system which are currently in use today. Materials and Methods: The present study was done among 350 students of medical, dental, nursing and physiotherapy streams to know the prevalence of smartphone use and attitude towards its use. Of the 350 students enrolled in the study, 257 completed the questionnaire with a response rate of 73.4%. Results: Out of 222, 198 had android devices, 13 had iPhones, and 11 had other operating systems including Windows and Blackberry. 191 (74.3%) of the subjects had a working email account. Conclusion: First year students have positive perception towards smartphone use and medical schools should encourage the use of medical applications among them. However, students and medical professionals should be cautious of the negative issues with smartphone use.
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