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Healthcare, Volume 2, Issue 1 (March 2014), Pages 1-149

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Editorial

Jump to: Research, Review

Open AccessEditorial Acknowledgement to Reviewers of Healthcare in 2013
Healthcare 2014, 2(1), 123-124; doi:10.3390/healthcare2010123
Received: 27 February 2014 / Accepted: 27 February 2014 / Published: 27 February 2014
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Abstract The editors of Healthcare would like to express their sincere gratitude to the following reviewers for assessing manuscripts in 2013. [...] Full article

Research

Jump to: Editorial, Review

Open AccessArticle Atypical Presentation of Herpes Zoster Duplex Bilateralis in a Renal Transplanted Patient
Healthcare 2014, 2(1), 20-26; doi:10.3390/healthcare2010020
Received: 21 October 2013 / Revised: 24 November 2013 / Accepted: 25 November 2013 / Published: 20 December 2013
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Abstract
Viral infections in renal transplant patients are an important cause of morbidity and mortality. In most cases, the clinical presentation of herpes zoster allows the diagnosis to be made only by history and physical examination. However, patients who are immunosuppressed may have [...] Read more.
Viral infections in renal transplant patients are an important cause of morbidity and mortality. In most cases, the clinical presentation of herpes zoster allows the diagnosis to be made only by history and physical examination. However, patients who are immunosuppressed may have uncommon presentations, and require a high index of suspicion and additional diagnostic testing for proper management. We report a rare presentation of herpes zoster duplex bilateralis involving symmetrical dermatomes over the lower limbs occurring in a woman with a recent history of renal transplantation. The skin lesions were also atypical representing a diagnostic challenge. This infection should be part of differential diagnosis of cutaneous manifestations in organ transplant recipients. Full article
Open AccessArticle Living with a Gastric Band: A Qualitative Study
Healthcare 2014, 2(1), 47-59; doi:10.3390/healthcare2010047
Received: 13 November 2013 / Revised: 31 December 2013 / Accepted: 6 January 2014 / Published: 13 January 2014
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Abstract
Gastric banding is an established and effective form of weightloss surgery. Semi-structured interviews explored the experiences of gastric banding of twenty purposively recruited patients one year after surgery. Data was analysed using thematic analysis. Results: Three themes emerged. They included ‘Exercising choice’ [...] Read more.
Gastric banding is an established and effective form of weightloss surgery. Semi-structured interviews explored the experiences of gastric banding of twenty purposively recruited patients one year after surgery. Data was analysed using thematic analysis. Results: Three themes emerged. They included ‘Exercising choice’ (restriction by the band was counterbalanced by new food-related choices.); ‘Rediscovering life’ (improved health, physical ability and energy enabled the patients to re-discover life.) and ‘Goals achieved with no regrets’ (patients had nearly achieved their self-set goals.) Conclusion: Beyond achieving weight loss and improved health, the participants had improved quality of life as defined by patients. Knowledge about this active process informs the care of these patients. Full article
(This article belongs to the Special Issue The Burden of Obesity in Health Care)
Open AccessArticle Development and Validation of a Questionnaire to Measure Serious and Common Quality of Life Issues for Patients Experiencing Small Bowel Obstructions
Healthcare 2014, 2(1), 139-149; doi:10.3390/healthcare2010139
Received: 23 December 2013 / Revised: 11 February 2014 / Accepted: 21 February 2014 / Published: 7 March 2014
Cited by 1 | PDF Full-text (121 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
A validated questionnaire to assess the impact of small bowel obstructions (SBO) on patients’ quality of life was developed and validated. The questionnaire included measurements for the impact on the patients’ quality of life in respect to diet, pain, gastrointestinal symptoms and [...] Read more.
A validated questionnaire to assess the impact of small bowel obstructions (SBO) on patients’ quality of life was developed and validated. The questionnaire included measurements for the impact on the patients’ quality of life in respect to diet, pain, gastrointestinal symptoms and daily life. The questionnaire was validated using 149 normal subjects. Chronbach alpha was 0.86. Test retest reliability was evaluated with 72 normal subjects, the correlation coefficient was 0.93. Discriminate validity was determined to be significant using the normal subject questionnaires and 10 questionnaires from subjects with recurrent SBO. Normative and level of impact for each measured domain were established using one standard deviation from the mean in the normal population and clinical relevance. This questionnaire is a valid and reliable instrument to measure the impact of SBO on a patient’s quality of life related to recurrent SBOs; therefore establishing a mechanism to monitor and quantify changes in quality of life over time. Full article
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Review

Jump to: Editorial, Research

Open AccessReview Malignant Melanoma
Healthcare 2014, 2(1), 1-19; doi:10.3390/healthcare2010001
Received: 27 August 2013 / Revised: 12 November 2013 / Accepted: 22 November 2013 / Published: 20 December 2013
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Abstract
Melanomas are a major cause of premature death from cancer. The gradual decrease in rates of morbidity and mortality has occurred as a result of public health campaigns and improved rates of early diagnosis. Survival of melanoma has increased to over 90%. [...] Read more.
Melanomas are a major cause of premature death from cancer. The gradual decrease in rates of morbidity and mortality has occurred as a result of public health campaigns and improved rates of early diagnosis. Survival of melanoma has increased to over 90%. Management of melanoma involves a number of components: excision, tumor staging, re-excision with negative margins, adjuvant therapies (chemo, radiation or surgery), treatment of stage IV disease, follow-up examination for metastasis, lifestyle modification and counseling. Sentinel lymph node status is an important prognostic factor for survival in patients with a melanoma >1 mm. However, sentinel lymph node biopsies have received partial support due to the limited data regarding the survival advantage of complete lymph node dissection when a micrometastasis is detected in the lymph nodes. Functional mutations in the mitogen-activated pathways are commonly detected in melanomas and these influence the growth control. Therapies that target these pathways are rapidly emerging, and are being shown to increase survival rates in patients. Access to these newer agents can be gained by participation in clinical trials after referral to a multidisciplinary team for staging and re-excision of the scar. Full article
Open AccessReview Modeling Melanoma In Vitro and In Vivo
Healthcare 2014, 2(1), 27-46; doi:10.3390/healthcare2010027
Received: 12 November 2013 / Revised: 7 December 2013 / Accepted: 10 December 2013 / Published: 23 December 2013
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Abstract
The behavior of melanoma cells has traditionally been studied in vitro in two-dimensional cell culture with cells adhering to plastic dishes. However, in order to mimic the three-dimensional architecture of a melanoma, as well as its interactions with the tumor microenvironment, there [...] Read more.
The behavior of melanoma cells has traditionally been studied in vitro in two-dimensional cell culture with cells adhering to plastic dishes. However, in order to mimic the three-dimensional architecture of a melanoma, as well as its interactions with the tumor microenvironment, there has been the need for more physiologically relevant models. This has been achieved by designing 3D in vitro models of melanoma, such as melanoma spheroids embedded in extracellular matrix or organotypic skin reconstructs. In vivo melanoma models have typically relied on the growth of tumor xenografts in immunocompromised mice. Several genetically engineered mouse models have now been developed which allow the generation of spontaneous melanoma. Melanoma models have also been established in other species such as zebrafish, which are more conducive to imaging and high throughput studies. We will discuss these models as well as novel techniques that are relevant to the study of the molecular mechanisms underlying melanoma progression. Full article
(This article belongs to the Special Issue Melanoma and Neoplasms of Skin)
Figures

Open AccessReview Established and Emerging Biomarkers in Cutaneous Malignant Melanoma
Healthcare 2014, 2(1), 60-73; doi:10.3390/healthcare2010060
Received: 27 September 2013 / Revised: 4 December 2013 / Accepted: 7 January 2014 / Published: 14 January 2014
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Abstract
In an era of personalized medicine, disease specific biomarkers play an increasing role in the stratification of high-risk patient groups. Cutaneous malignant melanoma is the most deadly form of skin cancer with an ever-increasing global incidence, especially in patients under 35-years of [...] Read more.
In an era of personalized medicine, disease specific biomarkers play an increasing role in the stratification of high-risk patient groups. Cutaneous malignant melanoma is the most deadly form of skin cancer with an ever-increasing global incidence, especially in patients under 35-years of age. Despite the excellent prognosis for patients diagnosed with early stage disease, metastatic disease still carries significant overall mortality. Biomarkers aim not only to identify high-risk patients, but also to provide potential therapeutic targets for differing patient subgroups. Furthermore, accessibility to tissue samples from a range of disease stages in malignant melanoma, unlike most other solid tissue tumours, provides the unique opportunity to explore the biology of tumour progression that may be relevant in the biology of cancer as a whole. Over the past decade, there have been major advances in targeted therapies, providing new avenues and hope to patients with this devastating disease. This review will focus on most up to date histological, serological and molecular biomarkers in malignant melanoma. Full article
(This article belongs to the Special Issue Melanoma and Neoplasms of Skin)
Open AccessReview Standards and Guidelines in Telemedicine and Telehealth
Healthcare 2014, 2(1), 74-93; doi:10.3390/healthcare2010074
Received: 10 December 2013 / Revised: 14 January 2014 / Accepted: 7 February 2014 / Published: 12 February 2014
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Abstract
The development of guidelines and standards for telemedicine is an important and valuable process to help insure effective and safe delivery of quality healthcare. Some organizations, such as the American Telemedicine Association (ATA), have made the development of standards and guidelines a [...] Read more.
The development of guidelines and standards for telemedicine is an important and valuable process to help insure effective and safe delivery of quality healthcare. Some organizations, such as the American Telemedicine Association (ATA), have made the development of standards and guidelines a priority. The practice guidelines developed so far have been well received by the telemedicine community and are being adopted in numerous practices, as well as being used in research to support the practice and growth of telemedicine. Studies that utilize published guidelines not only help bring them into greater public awareness, but they also provide evidence needed to validate existing guidelines and guide the revision of future versions. Telemedicine will continue to grow and be adopted by more healthcare practitioners and patients in a wide variety of forms not just in the traditional clinical environments, and practice guidelines will be a key factor in fostering this growth. Creation of guidelines is important to payers and regulators as well as increasingly they are adopting and integrating them into regulations and policies. This paper will review some of the recent ATA efforts in developing telemedicine practice guidelines, review the role of research in guidelines development, review data regarding their use, and discuss some of areas where guidelines are still needed. Full article
Open AccessReview Human Factors and Human-Computer Considerations in Teleradiology and Telepathology
Healthcare 2014, 2(1), 94-114; doi:10.3390/healthcare2010094
Received: 6 January 2014 / Revised: 31 January 2014 / Accepted: 7 February 2014 / Published: 19 February 2014
Cited by 3 | PDF Full-text (287 KB) | HTML Full-text | XML Full-text
Abstract
Radiology and pathology are unique among other clinical specialties that incorporate telemedicine technologies into clinical practice, as, for the most part in traditional practice, there are few or no direct patient encounters. The majority of teleradiology and telepathology involves viewing images, which [...] Read more.
Radiology and pathology are unique among other clinical specialties that incorporate telemedicine technologies into clinical practice, as, for the most part in traditional practice, there are few or no direct patient encounters. The majority of teleradiology and telepathology involves viewing images, which is exactly what occurs without the “tele” component. The images used are generally quite large, require dedicated displays and software for viewing, and present challenges to the clinician who must navigate through the presented data to render a diagnostic decision or interpretation. This digital viewing environment is very different from the more traditional reading environment (i.e., film and microscopy), necessitating a new look at how to optimize reading environments and address human factors issues. This paper will review some of the key components that need to be optimized for effective and efficient practice of teleradiology and telepathology using traditional workstations as well as some of the newer mobile viewing applications. Full article
Open AccessReview Telemedicine Workplace Environments: Designing for Success
Healthcare 2014, 2(1), 115-122; doi:10.3390/healthcare2010115
Received: 10 December 2013 / Revised: 13 February 2014 / Accepted: 17 February 2014 / Published: 24 February 2014
Cited by 1 | PDF Full-text (85 KB) | HTML Full-text | XML Full-text
Abstract
When designing a facility for telemedicine, there are several things to consider from a human factors point of view, as well as from a practicality point of view. Although the future practice of telemedicine is likely to be more of a mobile-based [...] Read more.
When designing a facility for telemedicine, there are several things to consider from a human factors point of view, as well as from a practicality point of view. Although the future practice of telemedicine is likely to be more of a mobile-based practice and centered more in the home than it is now, it is still very important to consider ways to optimize the design of clinic-based telemedicine facilities. This is true on both ends of a consultation—where the patient is and where the consultant is. On the patient side, the first thing to realize is that most telemedicine clinics are not going to be newly designed and built. In all likelihood they will be existing rooms converted to telemedicine clinic rooms. Quite often the former room will not even have been used for clinical purposes, but may have simply been a storage area cleared out for telemedicine use. Therefore, design is often a challenge but there are a few basic principles that can be followed to create a workable clinical space. This paper will review some of the basic human factors principles to take into account when designing a working telemedicine environment. Full article
Open AccessReview Melanoma of the Hand: Current Practice and New Frontiers
Healthcare 2014, 2(1), 125-138; doi:10.3390/healthcare2010125
Received: 30 September 2013 / Revised: 4 February 2014 / Accepted: 17 February 2014 / Published: 6 March 2014
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Abstract
Melanoma of the hand represents a complicated clinical entity. Anatomic features of the hand create challenges in successful management of melanoma not encountered elsewhere in the body. The objectives of this article are to outline current standards for managing melanoma of the [...] Read more.
Melanoma of the hand represents a complicated clinical entity. Anatomic features of the hand create challenges in successful management of melanoma not encountered elsewhere in the body. The objectives of this article are to outline current standards for managing melanoma of the hand including diagnosis, surgical, and chemotherapeutic management. Particular emphasis will be placed on currently debated topics of the role of sentinel lymph node biopsy, the role of Mohs micrographic surgery, tissue sparing management of subungual melanoma, and the consideration of melanoma of the hand as a distinct entity based on clinical and molecular studies. Full article
(This article belongs to the Special Issue Melanoma and Neoplasms of Skin)

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