In addition to the advantages for patients and physicians, the progression of digitalization will also have economic implications for healthcare systems in toto worldwide. The integration of digital ...innovations enables healthcare institutions to transform their current activities and processes and to create a new form of patient care.
Using digital applications process optimization can be achieved by increased efficiency and therefore a reduction in costs in the healthcare system. Improved processes can in turn achieve an increase in quality in the treatment of patients. Simultaneously, a duplication of investigations can be avoided through digital interfaces and the communication among the healthcare professions involved can be improved, which would result in a conservation of resources. Finally, these influences can lead to more precision in medicine, acceleration of healing processes and represent an advantage for all parties involved.
Economic redistribution due to digitalization of medicine will become increasingly apparent in the future. Ethical considerations as well as data protection will be important topics. At the same time investments and digital innovations must be sponsored by the government and industry. Scientific studies are necessary to secure the evidence of new methods for practice in orthopedics and trauma surgery.
In the context of the COVID-19 pandemic, video consultations have gained importance in orthopaedic and traumatological departments. In current literature, different adaptations of classic joint and ...functional examinations have been described for the virtual examination.
A systematic review of current literature on adaptations for the virtual joint and functional examination in orthopaedics and trauma surgery was performed over PubMed (January 2010 to April 2021). The identified examination methods were then summarised systematically according to body region and pathology. Each examination was then described in detail and depicted in an exemplary picture.
In total 17 articles were identified and included in the analysis. Most of the examinations employed classical examination methods which were adapted so that they could be performed by the patient independently. Everyday items were described as supporting tools. In five publications, orthopaedic examinations performed in video consultations were compared to the classical examination. Results of functional examinations showed less agreement with results of classical orthopaedic examinations when compared to inspection and ROM-testing.
Current literature offers a substantial repertoire of examination options that can be used in the orthopaedic and traumatological video consultation. The reported examinations are mostly oriented to classical orthopaedic examinations. In future digital examinations have to be validated and possibly further adapted in future.
We propose a new metric called hubbedness to describe traffic flow in modern optical networks. We compare theoretical savings of point-to-multipoint vs point-to-point transceivers and find ...significant savings for a wide variety of traffic patterns when optical transceivers of sufficiently high data rates are available.
Zusammenfassung
Einleitung
Das Fortschreiten der Digitalisierung wird neben Vorteilen für Patienten und Ärzte auch ökonomische Implikationen für das Gesundheitswesen in toto weltweit haben. Die ...Integration digitaler Innovationen ermöglicht es Gesundheitsunternehmen, ihre bisherigen Aktivitäten und Prozesse zu transformieren und eine neue Form der Patientenversorgung zu schaffen.
Wichtige ökonomische Themenfelder der Digitalisierung
Mithilfe digitaler Anwendungen können eine Prozessoptimierung durch Effizienzsteigerung und damit eine Kostensenkung im Gesundheitswesen erreicht werden. Verbesserte Prozesse können wiederum eine Qualitätssteigerung bei der Behandlung von Patienten erreichen. Gleichzeitig kann durch digitale Schnittstellen eine Doppelung von Untersuchungen vermieden und die Kommunikation unter beteiligten Gesundheitsprofessionen verbessert werden, was eine Ressourcenschonung zur Folge hätte. Letztlich können diese Einflüsse zu einer Präzisierung der Medizin führen, Heilungsabläufe beschleunigen und für alle Beteiligten einen Vorteil darstellen.
Ausblick
Ökonomische Umverteilungen durch die Digitalisierung der Medizin werden sich erst in der Zukunft klar zeigen. Ethische Überlegungen und auch der Datenschutz werden wichtige Themen sein. Gleichzeitig müssen Investitionen und digitale Innovationen von staatlicher und unternehmerischer Seite gefördert werden. Wissenschaftliche Studien können auch in der Orthopädie und Unfallchirurgie helfen, die nötige Evidenz neuer Methoden für die Praxis zu sichern.
Chronic rejection is the most common cause of graft loss in renal transplantation. The pathomechanisms underlying chronic rejection are poorly understood, and no treatment has yet successfully been ...established. We hypothesized that, in analogy to models of reduced renal mass, the administration of a selective endothelin (ET) A receptor antagonist could improve the course of chronic rejection in renal allografts.
Experiments were performed in the Fisher-to-Lewis rat model of chronic rejection. Lewis-->Lewis isografts served as controls. Animals were treated with either the oral selective ET-A receptor antagonist LU135252 (50 mg/kg/day) or vehicle. Animal survival, blood pressure, creatinine clearance, proteinuria, and urinary ET excretion were investigated for 24 weeks. Kidneys were removed for light microscopical evaluation, determination of ET mRNA expression and tissue protein concentration, and immunohistochemical assessment of cell surface markers.
Rats with chronic rejection showed an increase in renal ET mRNA synthesis and ET protein content. Treatment with LU135252 resulted in a significant improvement in survival after 24 weeks (0.92 vs. 0.38, P<0.01 by log-rank test). Creatinine clearance was higher in animals treated with the selective ET-A receptor antagonist (P<0.05). LU135252 had no influence on blood pressure and proteinuria. Selective ET-A blockade was associated with significantly less morphological changes and a significant reduction of expression of cell surface markers for macrophages (ED1), T cells (R73), and MHC II (F17-23-2).
The renal ET-A system plays an important role in the pathomechanisms underlying chronic renal allograft rejection, because the treatment with a selective ET-A receptor antagonist dramatically improves the course of chronic renal failure after allograft transplantation. These results offer a novel therapeutical option for treatment of chronic renal allograft rejection, for which so far no therapy is known.
A markedly increased expression of endothelin (ET)-1 has been observed in renal allografts with chronic rejection, one of the most common causes of kidney graft loss. In this study we investigated ...the effect of treatment with a combined ET-A/B-receptor antagonist on the course of chronic renal allograft rejection. Experiments were performed in the Fisher-to-Lewis rat model of chronic rejection. Lewis-to-Lewis isografts and uninephrectomized Lewis rats served as controls. Animals were treated with either the oral combined ET-A/B-receptor antagonist LU224332 (20 mg/kg/day) or vehicle. Animal survival, blood pressure, creatinine clearance, proteinuria, and urinary ET excretion were investigated for 24 weeks. Kidneys were removed for light-microscopic evaluation and immunohistochemical assessment of cell-surface markers. Treatment with LU224332 did not improve survival after 24 weeks (0.47 vs. 0.38; p > 0.05 by log-rank test), nor did it have an influence on blood pressure, creatinine clearance, or proteinuria. Combined ET-A/B-receptor blockade was associated with a reduction of expression of cell-surface markers for macrophages (EDI), T-cells (R73), and major histocompatibility complex (MHC) II (F17-23-2), but did not lead to an improvement of histologic changes of chronic allograft rejection. Our data show that blocking both ET-A- and -B receptors, in opposition to a previously published beneficial effect of selective ET-A blockade, does not prevent the progression of chronic renal allograft rejection and does not prolong survival in this model. Functional integrity of the ET-B receptor therefore seems to play an important role in the nephroprotection provided by selective ET-A-receptor antagonists in chronic renal allograft nephropathy.
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