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Background: (1) The "Systematic Review Support" system has a high degree of perceived usability., Background: (2)  Its use facilitates the exclusion of duplicate references and the selection of studies., Background: (3)  Remote and synchronous usability testing made research possible during the pandemic., Background: (4)  Combining usability techniques made it possible to identify the necessary adjustments., Background: (5)  The method used expanded the test's capacity in a real context of use., to evaluate the usability of the "Systematic Review Support" computer system., methodological study involving 21 students who evaluated the computer system in a remote and synchronous usability test. Two activities were carried out, containing 21 tasks simulating the initial steps of a review study, proposals for eliminating duplicate references, selecting studies and resolving disagreements between evaluators. At the end, participants answered the System Usability Scale questionnaire. The measures used were: completion rate with assistance (effectiveness) and time to complete the task (efficiency). The data was described in a table using the mean, standard deviation, minimum and maximum values., in a total of 21 tasks, the participants had an assisted completion rate of 9% and an average time of 55.1 minutes (the expected time being 60 minutes). The average score provided by the System Usability Scale instrument was 82.4 (considering a score from 0 to 100), median 85; minimum value 35 and maximum 97.5., the computer system has the effectiveness and efficiency parameters required of a computer review tool. It has a usability score of 82.4 on a scale of 0 to 100 assessed by the System Usability Scale instrument. The version presented incorporates the adjustments identified in the test in use.

ABSTRACT Video games with virtual interaction have been successfully used in physical therapy programs, although there is a lack of knowledge regarding evidence involving clinical results. This study aimed to evaluate learning and some parameters of the center of pressure (COP) displacement of a Nintendo Wii Fit task in hemiplegic and healthy subjects immediately after a rehabilitation training program and after a 3-month washout period. Twenty subjects being 10 hemiplegic and 10 healthy performed three assessments over different periods; Pre, Post and 3-months after rehabilitation training. Participants were positioned on the Wii Balance Board(r). The game task performed (Ski Slalom(r) game) involved mediolateral movements. During the task's execution, the Wii Balance Board(r) was placed on a force plate (AMTI OR-6, USA). As such, COP data displacement could be collected during the game. After the training, the hemiplegic subjects showed no change in COP sway pattern and this condition persisted after three months. However, both groups improved their time performance to finish the task after training and maintained the improvement in performance after 3-months. COP displacement of hemiplegic subjects did not change after training, healthy subjects were able to reduce their mediolateral and anteroposterior COP displacement.

O crescente número de usuários de internet desencadeou um aumento na busca dos serviços de farmácias virtuais brasileiras. Com o objetivo de avaliar a validade das informações divulgadas nesses sites, realizou-se estudo descritivo com 18 farmácias virtuais quanto aos aspectos legais, acessibilidade, fontes de informação e propagandas de medicamentos. Verificou-se que 15 não possuíam autorização de funcionamento da Agência Nacional de Vigilância Sanitária; 17 não tinham o nome do farmacêutico responsável pelo funcionamento; 17 comercializavam medicamentos sem registro, especialmente fitoterápicos, e não dispunham de informações sobre reações adversas a medicamentos e nem exibiam alertas e recomendações sanitárias determinadas por essa Agência. Como o controle sanitário e o comércio de medicamentos nas farmácias virtuais brasileiras ainda não estão regulamentados pelos órgãos governamentais competentes, essas falhas encontradas nos sites podem colocar em risco a saúde de seus usuários.The growing number of Internet users brought forth an increase in the search for Brazilian online pharmacy services. Aiming at evaluating the validity of information disseminated in these websites, a descriptive study was carried out in 18 virtual pharmacies concerning legal aspects, accessibility, sources of information and drug advertisings. It was found 15 pharmacies did not have authorization of the Brazilian National Health Surveillance Agency; the manager pharmaceutical officer's name could not be found in 17 of them; 17 pharmacies marketed drugs with no registration, especially herbal medicines, and did not show either information on adverse drug reactions or this agency's alerts and health recommendations. Since health control and drug commerce in Brazilian online pharmacies have not been yet regulated by proper government agencies, these gaps found in the sites can pose risk to the users' health.

Objective: to evaluate usability of the Meu PICC (My PICC) app for follow-up of outpatients using peripherally inserted central catheters through the validated System Usability Scale instrument., Method: a cross-sectional study that applied the System Usability Scale to 30 patients using peripherally inserted central catheters, ten nurses and eight Information and Communication Technology professionals to assess usability of the app., Results: a statistical difference was observed between age and usability (p=0.006), as well as a negative correlation between app use time and usability (p=0.002). As per the System Usability Scale adjectival classification, 40.0% and 33.3% of the patients considered the app as the best possible to be imagined and as excellent, respectively. In relation to the nurses, 70.0% considered the app as the best possible to be imagined and 20.0% as excellent; of the Information and Communication Technology professionals, 50.0% considered the app as the best possible to be imagined and the other 50.0%, as excellent., Conclusion: the usability assessment showed that patients, nurses and ICT professionals considered the app useful for monitoring patients using PICCs and evaluated it as appropriate, evaluating it as the best possible to be imagined or as excellent. These results corroborate use of the Meu PICC app in the monitoring of outpatient use of PICCs.

Objective: To provide an overview of the meaning and types of virtual reality (VR) system, its current applications in the field of urology and future implications., Synthesis of the Evidence: The concept of VR involves the generation of computer environments with which a user can interact directly. Urology technologies and surgical practices are constantly evolving and RV simulation has become an important complement in urologist training curricula, taking into account not only simulations in surgical techniques, but also in non-surgical techniques such as communication and decision making. VR approaches for image-guided surgery have demonstrated potential in the field of urology by supporting guidance for various disorders. An increasing number of pre and intraoperative imaging modalities have been used to create detailed surgical route maps. The tracing of these surgical roadmaps with the surgical vision of real life has been produced in different ways (electromagnetic, acoustic, optical ...), recommending the combination of several approaches to provide a superior result. One of the disadvantages of navigation systems is soft tissue deformations, requiring confirmatory images. Although early studies report that navigation surgeries provide results equal to or greater than conventional approaches, most of the work has been done in relatively small groups of patients, thus requiring studies with larger sample sizes., Conclusions: The development of VR offers urologists many opportunities, with surgical simulation being one of its most important applications today. Likewise, the first clinical studies have demonstrated the potential of augmented reality (2D and 3D models) to improve surgical accuracy, describing different navigation systems for different urological surgical interventions.

Introduction: Spinal cord injury is a complex and life-disrupting condition. The functional recovery of the upper limb has been considered as an important objective in tetraplegia because it improves significantly the quality of living in these patients. Virtual reality is a new emerging tool of rehabilitation in spinal cord injured patients., Aim: To carry out a systematic review about the information about the application of these systems in spinal cord injury in the rehabilitation of the upper limb., Patients and Methods: This review includes clinical trials dated until April 2018, which investigate the functional recovery of the upper limb through virtual reality systems in patients with complete or incomplete tetraplegia. The following databases were used to search for those clinical trials: Scopus, Web of Science, PubMed, Medline Complete, Science Direct, CINHAL and Brain., Results: Five articles were selected for this review, including randomized clinical trials and clinical trials. The main results show a good tendency on the functional recovery with the combination of virtual reality systems and conventional therapy., Conclusions: The main limitations and the low quality of the studies show the necessity of further investigations with this new tool of rehabilitation. However, the incorporation of virtual reality systems as a rehabilitation supplement might be a beneficial tool on the functional recovery in spinal cord injury.

Objective: To recommend metrics to qualify software production and to propose guidelines for the CAPES quadrennial evaluation of the Post-Graduation Programs of Medicine III about this issue. Method: Identification of the development process quality features, of the product attributes and of the software use, determined by Brazilian Association of Technical Standards (ABNT), International Organization Standardization (ISO) and International Electrotechnical (IEC), important in the perspective of the CAPES Medicine III Area correlate users, basing the creation proposal of metrics aiming to be used on four-year evaluation of Medicine III. Results: The in use software quality perception by the user results from the provided effectiveness, productivity, security and satisfaction that originate from its characteristics of functionality, reliability, usability, efficiency, maintainability and portability (in use metrics quality). This perception depends on the specific use scenario. Conclusion: The software metrics should be included in the intellectual production of the program, considering the system behavior measurements results obtained by users' performance evaluation through out the favorable responses punctuation sum for the six in use metrics quality (27 sub-items, 0 to 2 points each) and for quality perception proof (four items, 0 to 10 points each). It will be considered as very good (VG) 85 to 94 points; good (G) 75 to 84 points; regular (R) 65 to 74 points; weak (W) 55 to 64 points; poor (P)

Objective: To identify the relationship between the characteristics of students, their learning environment, their occupation, and the virtual objects for self-regulated learning. In addition, to establish connections with participant's observation. Important aspects for the training of health professionals., Methods: A qualitative study was applied to students who participated in the Education and Occupational Therapy subject. Two tools were used: virtual Objects Questionnaire for the educational field learning and Participant Observation. The first instrument was piloted and reviewed by experts., Results: The study reported similar demographic data and background of similar education in relation to: origin, access to the computer and exclusivity to study; as well as the development of secondary education studies in Bogotá and in private institutions. In the learning environments, there is a tendency to show that they agree with the program of the subject in fulfillment of explicit objectives chosen for the study in 75 % and implicit in 60 %. With regards to the occupation, it was found that the virtual object allowed to deepen on the subject that the students developed and put into practice previous knowledge on communication technologies. The Participant Observation tool found particularities in the elements of motivation, efficacy and self-regulated learning., Conclusions: The implementation of the Virtual Learning Objects favor the students' motivation, self-regulated learning and their appropriation of concepts and knowledge related to the subject; therefore, it is proposed as a learning strategy.

Objectives: To evaluate the utility of virtual cystoscopy (VC) performed with CT urography in patients being studied under gross hematuria or patients being followed-up after a previous bladder cancer and compare the results with those obtained with gold standard technique (optical cystoscopy)., Methods: Retrospective study of 117 patients who were referred for VC by the Urology Department between May 2014 and May 2015. Those patients presented with gross hematuria or they were previously treated patients from bladder cancer being followed up. These patients were evaluated with MDCT and virtual cystoscopy after distending the bladder with air. The results were compared with those obtained with optical cystoscopy which was performed no more than a week after., Results: The global sensitivity and specificity of VC were 81,8 and 92,1%. Aditional findings detected in CT urography were an aortic dissection, urinary lithiasis and colonic metastasis., Conclusion: VC seems an useful technique in the diagnosis and follow-up for bladder cancer with a good correlation with OC. The main limitations are the impossibility of biopsy during the procedure and the detection of erythematous lesions. Collateral findings can be detected performed with CT urography although the high radiation exposure does not recommend their combined use., (Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

The ARIA initiative was started during a World Health Organization workshop in 1999. The initial goals were to propose a new classification for allergic rhinitis, to promote the concept of multi-morbidity in asthma and rhinitis and to develop guidelines with stakeholders for world-wide use. ARIA is now focused on the implementation of emerging technologies for individualized and predictive medicine. MASK: MACVIA-Aria Sentinel Network uses mobile technology to develop care pathways that enable management by a multidisciplinary group or by patients themselves. An App for iOS and Android uses a visual analogue scale to assess symptom control and work productivity, as well as a clinical decision support system; it is associated with an interoperable tablet for health professionals. The escalation strategy uses recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of ARIA's new approach is to provide an active and healthy life to people affected by rhinitis, regardless of age, gender or socioeconomic status, in order to reduce social and health inequalities caused by the disease.

Introduction and Objectives: Pathologic intimal thickening (PIT) has been considered a benign plaque phenotype. We report plaque phenotypic changes in a baseline/follow-up intravascular ultrasound-based virtual histology study., Methods: A total of 61 patients with stable coronary artery disease were analyzed from the HEAVEN trial (89 patients randomized between routine statin therapy vs atorvastatin 80mg and ezetimibe 10mg) with serial intravascular ultrasound imaging of nonculprit vessels. We compared changes in 693 baseline and follow-up 5-mm long segments in a novel risk score, Liverpool Active Plaque Score (LAPS), plaque parameters, and plaque composition., Results: The PIT showed the highest increase of risk score and, with fibrous plaque, also the LAPS. Necrotic core (NC) abutting to the lumen increased in PIT (22 ± 51.7; P = .0001) and in fibrous plaque (17.9 ± 42.6; P = .004) but decreased in thin cap fibroatheroma (TCFA) (⿿15.14 ± 52.2; P = .001). The PIT was the most likely of all nonthin cap fibroatheroma plaque types to transform into TCFA at follow-up (11% of all TCFA found during follow-up and 35.9% of newly-developed TCFA), but showed (together with fibrous plaque) the lowest stability during lipid-lowering therapy (24.7% of PIT remained PIT and 24.5% of fibrous plaque remained fibrous plaque)., Conclusions: Over the 1-year follow-up, PIT was the most dynamic of the plaque phenotypes and was associated with an increase of risk score and LAPS (together with fibrous plaque), NC percentage (together with fibrous plaque) and NC abutting to the lumen, despite a small reduction of plaque volume during lipid-lowering therapy. The PIT was the main source for new TCFA segments., (Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Virtual reality (VR) is used in the field of rehabilitation/physical therapy to improve patients' functional abilities. The last 5 years have yielded numerous publications on the use of VR in patients with neurological disease which aim to establish whether this therapeutic resource contributes to the recovery of motor function., Development: The following databases were reviewed: Cochrane Original, Joanna Briggs Connect, Medline/Pubmed, Cinahl, Scopus, Isi Web of Science, and Sport-Discus. We included articles published in the last 5 years in English and/or Spanish, focusing on using RV to improve motor function in patients with stroke. From this pool, we selected 4 systematic reviews and 21 controlled and/or randomised trials. Most studies focused on increasing motor function in the upper limbs, and/or improving performance of activities of daily living. An additional article examines use of the same technique to increase motor function in the lower limb and/or improve walking and static-dynamic balance., Discussion and Conclusions: Strong scientific evidence supports the beneficial effects of VR on upper limb motor recovery in stroke patients. Further studies are needed to fully determine which changes are generated in cortical reorganisation, what type of VR system is the most appropriate, whether benefits are maintained in the long term, and which frequencies and intensities of treatment are the most suitable., (Copyright © 2015 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The high variability of sinonasal anatomy requires the best knowledge of its three-dimensional (3D) conformation to perform surgery more safely and efficiently. The aim of the study was to validate the utility of Osirix® and stereolithography in improving endoscopic sinonasal surgery planning., Methods: Osirix® was used as a viewer and Digital Imaging and Communications in Medicine (DICOM) 3D imaging manager to improve planning for 114 sinonasal endoscopic operations with polyposis (86) and chronic rhinosinusitis (CRS) (28). Stereolithography rapid prototyping was used for 7 frontoethmoidal mucoceles., Results: Using Osirix® and stereolithography, a greater number of anatomical structures were identified and this was done faster, with a statistically-significant clinical-radiological correlation (P<.01) compared with 2D CT plates. With a share of more than 75% of surgery performed by residents, surgical time was reduced by 38±12.3min in CRS and 42±27.9 in sinonasal polyposis. The fourth-year residents reached 100% surgical competence in critical surgical milestones with 16 surgeries (CI 12-19)., Conclusions: The systematic use of Osirix® for visualisation and treatment of 3D sinonasal images from DICOM data files, along with the surgical team's ability to manipulate them as virtual reality, allows surgeons to perform endoscopic sinonasal surgery with greater confidence and in less time than using 2D images. Residents also achieve surgical competence faster, more safely and with fewer complications. This beneficial impact is increased when the surgical team has stereolithography rapid prototyping in more complex cases., (Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.)

Introduction: The aging population and the growing use of technology are two realities of modern society. Developing tools to support medication self-management to polymedicated elderly may contribute to increase their safety., Objective: To know how patients polymedicated and older than 64 years manage dose their medication and assessment the utility of two medication self-management applications, specifically analyzing management systems, medication errors and positive and improvable aspects of each of the tools presented., Patients and Methods: Seven focal groups with 59 patients from associations and health departments were conducted. In such meetings, they received the applications and they were encouraged to use it. Then, a several group questions were asked them about their health status, how they managed their medication and their assessment about the applications., Results: Most participants reported to use memory strategies to take correctly their medication. They assessed positively the applications although some of them showed resistance to incorporate it in their daily routine. The simple interface and ease of use were the characteristics of the applications most appreciated by patients., Conclusions: Is possible to foster among elderly patients the use of technological tools to support the proper administration of medications with purpose is to decrease errors and increase safety. When designing health applications is necessary to take into account the preferences of those who are targeted., (Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.)

The importance of optical or conventional colonoscopy in diagnosing colon disease is undisputed. In this context, optical colonoscopy is the gold standard against which other techniques must be validated. Apart from enabling direct inspection of the colonic mucosa, optical colonoscopy enables biopsies and techniques to treat and prevent colorectal cancer. Virtual colonoscopy or CT colonography has been validated in multicenter studies; virtual colonoscopy is as sensitive as optical colonoscopy for the detection of polyps and colon cancer. It is currently the only valid alternative to optical colonoscopy. Its role in patients with medium or high risk of colon cancer is in the process of being defined as multidisciplinary teams gain experience. This article aims to discuss the usefulness of virtual colonoscopy in different clinical situations, emphasizing the situations in which there is enough scientific evidence, and to discuss the controversies surrounding its possible use for population-based screening., (Copyright © 2013 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: The limitations in performing functional activities in children and adolescents with cerebral palsy are important. The use of virtual reality systems is a new treatment approach that reinforces task-oriented motor learning. The purpose of this guide is to study the impact of the use of virtual reality systems in the improvement and acquisition of functional skills, and to evaluate the scientific evidence to determine the strength of recommendation of such interventions., Development: All available full-text articles, regardless of their methodology, were included. The following data bases were consulted: PubMed (Medline), PEDro, EMBASE (OVID-Elsevier), Cochrane Library, Medline (OVID), CINAHL, ISI Web Knowledge. An assessment was made of methodological quality, the level of scientific evidence, and the strength of recommendations using the tools: Critical Review Form - Quantitative Studies and the Guidelines for Critical Review Form - Quantitative Studies and U.S. Preventive Services Task Force. Finally, we included 13 articles and 97 participants were recruited. We obtained significant improvements in outcome measures that assessed postural control and balance, upper limb function, the selective joint control, and gait., Conclusions: The guide has some limitations: the limited number of patients enrolled, clinical diversity and age range, as well as the methodological quality of existing trials. Virtual reality is a promising tool in the treatment of children with cerebral palsy. There is strong scientific evidence of an acceptable recommendation for the use of virtual reality systems in the treatment of cerebral palsy., (Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.)

In recent decades, the traditional teaching model of gastrointestinal endoscopy has been based on the teacher-student tutorial method based on theoretical models. Today, simulators have the advantages of virtual reality. The handling apparatus is similar to that used in clinical practice; it is safe, which allows unlimited use, cost-effective for institutions and with superior performance over other training models. Besides, biological simulators are a viable, accessible and affordable tool to simulate gastrointestinal lesions, allowing training in endoscopy with a high degree of similarity in the endoscopic appearance. In this review, we analyze both models, showing its advantages for the training of the endoscopist of the times.

Background and Objective: Patients with type 1 diabetes (T1DM) treated with continuous subcutaneous insulin infusion (CSII) have available several specific features of these devices. The aim of this study was to evaluate the relationship between real use of them and the degree of glycemic control in patients using this therapy., Patients and Methods: Forty-four T1DM patients on CSII therapy with or without real-time continuous glucose monitoring (CGM) were included. Data from 14 consecutive days were retrospectively collected using the therapy management software CareLink Personal/Pro(®) and HbA1c measurement performed at that period. The relationship between the frequency of usie of specific features of insulin pumps (non-sensor augmented or sensor-augmented) and glycemic control was analyzed., Results: Mean HbA1c in the group was 7.5 ± .8%. Mean daily number of boluses administered was 5.1 ± 1.8, with 75.4% of them being bolus wizards (BW). Daily number of boluses was significantly greater in patients with HbA1c <7.5% than in those with HbA1c>7.5% (5.3 ± 1.6 vs. 4.3 ± 1.6, P=.056). There was a trend to greater use of BW in patients with better control (82.8 ± 21.4% vs. 69.9 ± 29.1%, P=.106). HbA1c was lower in patients using CGM (n=8) as compared to those not using sensor-augmented pumps (7.6 ± .8 vs 7.1 ± .7, P=.067), but the difference was not statistically significant., Conclusions: More frequent use of BW appears to be associated to better metabolic control in patients with T1DM using pump therapy. In standard clinical practice, augmentation of insulin pump with CGM may be associated to improved glycemic control., (Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.)

Executive functions include a wide range of self regulatory functions that allow control, organization and coordination of other cognitive functions, emotional responses and behaviours. The traditional approach to evaluate these functions, by means of paper and pencil neuropsychological tests, shows a greater than expected performance within the normal range for patients whose daily life difficulties would predict an inferior performance. These discrepancies suggest that classical neuropsychological tests may not adequately reproduce the complexity and dynamic nature of real life situations. Latest developments in the field of virtual reality offer interesting options for the neuropsychological assessment of many cognitive processes. Virtual reality reproduces three-dimensional environments with which the patient interacts in a dynamic way, with a sense of immersion in the environment similar to the presence and exposure to a real environment. Furthermore, the presentation of these stimuli, as well as distractors and other variables, may be controlled in a systematic way. Moreover, more consistent and precise answers may be obtained, and an in-depth analysis of them is possible. The present review shows current problems in neuropsychological evaluation of executive functions and latest advances in the consecution of higher preciseness and validity of the evaluation by means of new technologies and virtual reality, with special mention to some developments performed in Spain.

Background: The changes in recent decades in the training of medical student seem to agree that the educational model for professional skills is most appropriate. The virtual simulator translates skills acquired the operating room, in the Faculty of Medicine of the University of Colima noticed the need to prepare the students of pregrade transferring surgical trainees' skills in basic laparoscopic activities that require a simple cognitive effort., Objective: The hypothesis in this study was to evaluate the acquisition of skills in laparoscopic simulator in students of pregrade., Methods: Educational research, analytical comparison, which was conducted within the activities of the program of Problem Based Learning in the program of Education and Surgical Technique, Faculty of Medicine of the University of Colima., Results: All participants in the simulator achieved a significantly better during the task one after three repetitions (p= 0.001). The evaluation of final students calcification, we observed significant differences in means being lower during the initial assessment (8.60 ± 0.76) compared to the end (8.96 ± 0.58) p= 0.001., Conclusions: The acquisition of skills in the simulator is longer but at the end is better than the acquisition of skills from the traditional method, showing that leads to the acquisition of skills that promote the transfer of skills to the surgical environment.

Background: The high number of computer workers wearing contact lenses raises the question whether the sum of these two risk factors for eye health may cause a worsening of Computer Vision Syndrome. The aim of this review is to synthesize the knowledge about ocular and visual alterations related with computer use in contact lens wearers., Methods: International review of scientific papers (2003-2013) in Spanish and English, using Scoping Review method, in Medline through PubMed and in Scopus., Results: The initial search provided 114 references, after applying inclusion/exclusion criteria six of them were included. All of them reveal that symptoms when using computer are more prevalent in contact lens wearers, with values of symptoms presentation prevalence ranging from 95.0% to 16.9% in wearers and from 57.5% to 9.9% in non-wearers, and four times more likely to develop dry eye [OR: 4.07 (95% CI: 3.52 to 4.71)]., Conclusion: Computer workers suffer more ocular and visual disturbances if they also are contact lens users, but studies are few and non conclusive. Likewise, further research regarding contact lens type and their conditions of use, both in symptoms and tear quality and ocular surface are needed. Silicone hydrogel lenses are associated with more comfort.

Objective: To analyze the effect of modal computer-based alerts on the concomitant prescription of valproic acid (VPA) and meropenem., Material and Method: Analytical intervention study conducted in a tertiary hospital for eleven months. Hospitalized patients with a diagnosis of epilepsy and treated with VPA and meropenem in concomitant therapy were included. In the computerized prescription order entry software an automatic non-modal alert was reconverted to a modal one. This was triggered when the physician introduced VPA and meropenem together in the same prescription. To measure the effect of this alert the prescription habits were compared with a previous period in which the alert was not modal., Results: Modal computer-based alert modified the prescription habit by reducing the number of patients with concomitant treatment from 13 to 4 (P=.046). However, it was notable that the number of requests for VPA serum levels decreased, and the average number of concomitant days of treatment rose from 4.7 to 8.75 in those patients in which none of the drugs was suspended., Conclusions: The implementation of modal computer-based alerts reduces patient exposure to concomitant treatment with meropenem and VPA., (Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.)

Objectives: To evaluate satisfaction and short-term impact on metabolic control of diabetes monitoring through the DiabeTIC website., Patients and Methods: A prospective, uncontrolled intervention study was conducted in 32 patients aged 29.7±9.7 years (65% female) incorporated to the telemedicine platform DiabeTIC between March and September 2012. All patients completed a satisfaction questionnaire in the first month, and impact on metabolic control was evaluated at three and six months., Results: In the satisfaction survey conducted in the first month of follow-up, the following mean scores (0-10) were obtained: overall impression with the platform: 8.6±1.8; ease of use: 8.1±1.5; intuitive navigation: 6.7±3.0; value of measurements: 9.1±1.1; importance of the platform in diabetes management: 9.5±0.9; sense of security: 9.5±0.8; value of the library: 9.4±1.1; value of messages: 9.1±1.4, and recommendation to use the platform: 9.4±0.9. Glycosilated hemoglobin concentrations significantly improved at six months as compared to study start (7.0±0.8 versus 8.1±1.9; p=0.007). Nine patients were discharged from DiabeTIC before completing six months of follow-up., Conclusions: Patients with diabetes monitored through the DiabeTIC website report a high degree of satisfaction, showing improved metabolic control at short-term follow-up., (Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.)

Objective: To evaluate the efficacy of a gravity-supported, computer-enhanced device (Armeo® Spring) for upper limb rehabilitation in chronic stroke patients., Material and Methods: We included 23 chronic hemiparetic patients (chronicity: 328 ± 90.8 days; distribution: 17 men and 6 women) aged 54.6 ± 9.5 years, who had sustained ischaemic stroke (n=12) or haemorrhagic stroke (n=11). All patients completed 36 one-hour sessions using the Armeo® Spring system. Arm movement was assessed at the beginning and end of the treatment programme and once more 4 months later. Main outcome measurements covered structure, activity, and function, as per the International Classification of Functioning, Disability and Health: Modified Ashworth Scale, Motricity Index (MI), Fugl-Meyer Assessment Scale (FM), Motor Assessment Scale (MAS), Manual Function Test (MFT), and Wolf Motor Function Test (WMFT)., Results: Repeated measures ANOVA showed significant improvement (time effect) for all function scales (P<.01 for FM and MI) and activity scales (P<.01 for MAS, MFT and WMFT-ability, and P<.05 WMFT-time) without significant changes in muscle tone. The post-hoc analysis (Bonferroni) showed different evolutionary patterns for function and activity measurements, and clear benefits related to Armeo® Spring training, especially on activity scales., Conclusions: Armeo® Spring is an effective tool for rehabilitating the affected arm in patients with hemiparesis secondary to ictus, even in the chronic stage., (Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.)

Objective: To study effectiveness of and satisfaction with a virtual reality-based balance rehabilitation system (BioTrak) for patients with acquired brain injury (ABI)., Material and Methods: Ten patients with chronic hemiparesis (chronicity>6 months) following an ABI completed a 20-session programme using the balance reaching-task module of the BioTrak system. All patients were assessed at baseline, at the end of treatment, and one month later with the Berg Balance Scale (BBS), the Tinetti Performance-Oriented Mobility Assessment (POMA), and the computerised posturography tool NedSVE/IBV. The posturography study included analysis of sensory indexes, limits of stability, and rhythmic weight shift. The usability study was conducted using an ad hoc questionnaire., Results: Repeated measures ANOVA showed a significant improvement in BBS (P<.01), TBS (P<.01), vestibular index (P<.05), and anterior-posterior weight shift (P<.05); a trend in the same direction was also found for medial lateral weight shift (P=.059). The post-hoc analysis revealed significant improvement between the initial and final assessments for BBS, POMA and anterior-posterior weight shift control; gains remained a month after completing the programme. The system showed a high degree of usability in terms of presence, immersion and user-friendliness, and there was a significant absence of adverse effects., Conclusion: Our results confirm the utility of virtual reality systems for balance rehabilitation in this population. Usability data suggest that BioTrak could be adapted for use in multiple rehabilitation settings by a high number of patients., (Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.)

Introduction: The Fundamentals of Laparoscopic Surgery program is an educational program developed by the Society of American Gastrointestinal Endoscopic Surgeons, which includes a handson skills training component, a cognitive component, and an assessment component for laparoscopic surgery. Its main objective is to provide surgical residents and practicing surgeons with the opportunity to learn fundamental skills and obtain the theoretical knowledge required to perform laparoscopic surgery, guaranteeing a better performance in the operating room, and thus, improving patient security., Objective: The purpose of this study was to evaluate the effectiveness of telesimulation for teaching the Fundamentals of Laparosopic Surgery program in Colombia., Materials and Methods: Twenty participants (ten general surgeons and ten general surgery residents) in two cities in Colombia participated in eight weekly telesimulation sessions. Fundamentals of Laparoscopic Surgery scores were obtained for each participant before the telesimulation sessions (pre-test scores) and after telesimulation training was completed (post-test scores)., Results: Using scoring parameters developed by the Society of American Gastrointestinal Endoscopic Surgeons, we found a significant improvement between pre-test and post-test scores. All the participants passed the skills component of the course., Conclusion: This study evidences the effectiveness of telesimulation to improve the laparoscopic skills of the participants who had no previous knowledge of the Fundamentals of Laparoscopic Surgery program, which guaranteed obtaining the necessary score for approving the practical component of the program.

When designing a custom-made dental restoration, using a digital workflow represents an important advance over mechanical tools such as facebows or mechanical articulators. When using virtual scanning procedures, there is a direct transfer from the patient to the articulator. This paper presents a novel methodology to design custom-made restorations. This new approach permits the transfer of all data directly from the patient to the virtual articulator, always taking into account the kinematics of the mandible. Rapid further developments can be expected in the near future.

Purpose: The uveal melanoma is the most common primary intraocular tumour in adults. The objective of this work is to show how a computerised database has been formed with specific applications, for clinical and research use, to an extensive group of patients diagnosed with uveal melanoma., Method: For the design of the database a selection of categories, attributes and values was created based on the classifications and parameters given by various authors of articles which have had great relevance in the field of uveal melanoma in recent years., Results: The database has over 250 patient entries with specific information on their clinical history, diagnosis, treatment and progress. It enables us to search any parameter of the entry and make quick and simple statistical studies of them., Conclusion: The database models have been transformed into a basic tool for clinical practice, as they are an efficient way of storing, compiling and selective searching of information. When creating a database it is very important to define a common strategy and the use of a standard language., (Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.)

This study was conducted to evaluate the moderating role of self-guided training in the relationship between task conflict and team innovation in synchronic computer-mediated communication (SCMC) teams. For this purpose, a laboratory study was carried out in which 26 teams were assigned to the training condition and 24 to the control condition. Results confirmed that SCMC teams develop a negative relationship between task conflict and innovation, but also revealed that self-guided training may slow these counterproductive effects down. Our study provides new evidence of the linear relationship between task conflict and team innovation in SCMC teams, extending previous research findings obtained in face-to-face teams to virtual context and suggest that self-guided training can be useful for virtual team innovation.

BCI (Brain-Computer Interface) is a system that allows interaction between the human brain and a computer. It is based on analyzing electroencephalographic signals (EEG) and processing them to generate control commands. The study analyzed the possible influence of psychological variables, such as the imaginative kinesthetic capacity and anxiety, in relation to performance in a BCI. All participants (4 male and 19 female students) completed the questionnaires and carried out a session of BCI to control their EEG signals in a virtual setting of a car along a straight road. The group was divided into two subgroups according to their EEG signals or differential responses obtained in the left-right discrimination. Study results showed no significant differences in cognitive variables of imagination or in anxiety. By comparing the degree of participants' BCI control, a new quantitative parameter for comparing performances and making decisions in signal processing was found. The findings, the ongoing research process to refine the control of a BCI, and the interaction of psychological and computer procedures are discussed.

In recent years, image techniques have transformed the diagnosis in Medicine. Nevertheless, they are, by now, far from a widespread clinic and surgical use. Beyond the simple picture inspection, DICOM digital files can be explored by using image analysis/processing techniques in a better way. In practice, clinicians and surgeons usually are limited to 'see' pictures delivered by Radiology. However, image analysis/processing techniques allow the 'client' (neurologist or neuro-surgeon) to accomplish interactive image visualizations, multiplanar or 3D rendering, measurements, pathway visualizations, etc. All these tasks, offer a great advantage in diagnosis, surgical planning, teaching and investigation. This paper revise the fundaments of image analysis techniques in order to emphasize their utility, and to widespread its utilization not in the server (Radiological Department) but, principally, in the client side. Some examples of cranio-spinal pathologies are presented aiming to these objectives.

This article analyzes the possibility of using social networks for teaching and learning telemedicine. The Telemedicine Laboratory is presented as a case study that offers a learning model supported by the development of a social network in a higher education environment. We performed a qualitative research study through an anonymous survey and participant observation. The results show that the Telemedicine Laboratory allows the generation of new knowledge from a holistic approach to reality, through communication and information technology, supported by the development of a social network. The presence of "invited experts" in the teaching and learning process and the linking of this process to problematic situations that members can "recognize" and perceive as true for their domain increase motivation and constitute success factors in the learning and teaching process., (Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.)

Introduction: Due to the poor agreement between endoscopy and histology, the gastric biopsy continues being the gold standard for the diagnosis of atrophic chronic gastritis. The Virtual chromoendoscopy system allows better observation of the gastric mucosa., Objective: Evaluate the agreement between the Kimura-Takemoto ´s endoscopic system classification and the histological system of OLGA (Operative for Link Assessment Gastritis), as well as to evaluate the application of the virtual chromoendoscopy., Methodology: A prospective and longitudinal study of cohorts, 138 patients was include, using endoscopic system of atrophy by Kimura and Takemoto (K-T), with conventional optical and with the use of seventh filter of virtual chromoendoscopy ,then comparing with the histological findings of the OLGA pathology system, also were determinated injuries associated with respect to stage OLGA., Results: The kappa index of agreement between conventional endoscopy and the system OLGA was 0.859 and with the system of virtual chromoendoscopy was 0.822, the preneoplasic and neoplastic gastric lesions were associate to stages III and IV of atrophy., Conclusions: The endoscopic and histological correlation with both systems isvery good, with or without the use of virtual chromoendoscopy., Keywords: chronic atrophic gastritis, virtual chromoendoscopy, olga system, , kimuratakemoto system.

Microscopy has been constantly evolving since the end of the Twentieth Century, with the introduction of new resources which have improved its practice. For example, the use of the virtual microscope has reached a high level of maturity; it is a synergy among disciplines such as pathology, histology, medical informatics and image analysis. This technology has moved forward many paradigms in research, diagnosis, education and medical training. The virtual microscopy systems require the digitalization of a physical slide, using motorized microscopes, pre and post image processing, compression, transmission and visualization. This article provides an extensive analysis of each of these processes. The main characteristics of virtual microscopy are presented as well as the impact of these systems in image interpretation and in diagnostic activities.

The amount of published information and its continuing growth can no longer be managed by an individual searcher. One of today's great challenges for the academic researcher and clinician is to find a relevant scientific article using bibliographic search strategies. We aimed to design and build a Virtual Room of Gastroenterology (VRG) generating real-time automated search strategies and producing bibliographic and full text search results. These results update and complement with the latest evidence the Clinical Guideline Program of the World Gastroenterology Organisation. The HTML driven interface provides a series of pre-formulated MeSH based search strategies for each Aula. For each topic between 10 and 20 specific terms, qualifiers and subheadings are identified. The functionality of the VRG is based on the PubMed's characteristic that allows a search strategy to be captured as a web address. The VRG is available in Spanish and English, and the access is free. There are 28 rooms currently available. All together these rooms provide an advanced bibliographic access using more than 900 pre-programmed MeSH driven strategies. In a further very recent development some of the topics of VRG now allow cascade based searches. These searches look at resource sensitive options and possible ethnic difference per topic. The VRG allows significant reductions in time required to design and carry out complex bibliographic searches in the areas of gastroenterology, hepatology and endoscopy. The system updates automatically in real-time thus ensuring the currency of the results.

Introduction: Virtual reality allows the user to interact with elements within a simulated scene. In recent times we have been witness to the introduction of virtual reality-based devices as one of the most significant novelties in neurorehabilitation., Aim: To review the clinical applications of the developments based on virtual reality for the neurorehabilitation treatment of the motor aspects of the most frequent disabling processes with a neurological origin., Development: A review was carried out of the Medline, Physiotherapy Evidence Database, Ovid and Cochrane Library databases up until April 2009. This was completed with a web search using Google. No clinical trial conducted on its effectiveness has been found to date. The information that was collected is based on the description of the various prototypes produced by the different groups involved in their development. In most cases they are clinical trials conducted with a small number of patients, which have focused more on testing the validity of the device and checking whether it works correctly than on attempting to prove its clinical effectiveness. Although most of the clinical applications refer to patients with stroke, there were also several applications for patients with spinal cord injuries, multiple sclerosis, Parkinson's disease or balance disorders., Conclusions: Virtual reality is a novel tool with a promising future in neurorehabilitation. Further studies are needed to demonstrate its clinical effectiveness as compared to the traditional techniques.

R is a GNU statistical and programming environment with very high graphical capabilities. It is very powerful for research purposes, but it is also an exceptional tool for teaching. R is composed of more than 1400 packages that allow using it for simple statistics and applying the most complex and most recent formal models. Using graphical interfaces like the Rcommander package, permits working in user-friendly environments which are similar to the graphical environment used by SPSS. This last characteristic allows non-statisticians to overcome the obstacle of accessibility, and it makes R the best tool for teaching. Is there anything better? Open, free, affordable, accessible and always on the cutting edge.

At the present time the development of computers allows access to some three-dimensional models (3D) of physiological or pathological human situations obtained from patients with different medical or surgical problems. These models have a wide variety of applications: knowledge of the pathogenic mechanisms, help in diagnosis, planning of surgical strategies, training of surgical residents, teaching of medicine and surgery, design of devices and materials for use in medical and surgical practice or even distance interventions. Our objective is to design a 3D model of the inguinal region with the purpose of improving knowledge of the pathogenic mechanisms of inguinal hernia, the planning of surgical strategies and the teaching of the surgery of these hernias. They can also be used study the mechanical response of biomaterials into the abdominal wall.

Reflectance confocal microscopy is a noninvasive tool that allows skin cells and structure to be imaged in real time. The technique has been used to assess benign and malignant lesions and has shown great potential in basic research and clinical dermatology. As might be expected, it also has great potential in longitudinal clinical studies and in the evaluation of dynamic processes such as those that occur after exposure to UV radiation or during the tumor response to noninvasive therapy. This article briefly describes the fundamental aspects and basic principles of reflectance confocal microscopy and discusses its clinical applications essentially in the management of cutaneous tumors. We also consider the limitations of the technique associated with the optical properties of the skin, with instrumentation, and with interpretation of the images.

Introduction: A brain-computer interface (BCI) is based on the analysis of the electroencephalographic (EEG) signals recorded during certain mental activities, to control an external device. Main users are people with severe neuromuscular disorders, like amyotrophic lateral sclerosis. One of the most important problems to control a BCI is the need of providing suitable training, helping subjects to get some control of the EEG signals., Aim: To carry out a study of possible effects of the use of specific mental tasks during the first phase of the training period., Subjects and Methods: Eighteen healthy untrained subjects took part in the experiment. A group of subjects were trained to discriminate between two motor imagery tasks (imagination of right and left hand movements). Another group were trained to discriminate between a motor imagery task (imagination of right hand movements) and mental relaxation. Objective and subjective measures based on questionnaires were taken., Results: Some subjects do not achieved EEG control, but subjects at the second group showed a greater facility to control a BCI., Conclusion: Training protocols should not be randomly chosen; they must be adapted to the subject to be effective. Sometimes it is necessary to increase the number of sessions without feedback before submitting a subject to a session with feedback, and a correct choice of the mental tasks is very important. Mental tasks which are easy to discriminate improve classification result and produce better satisfaction to the subject.