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Background and objectives: Currently the correct intrasurgical positioning and adjustment of mobile X-ray image intensifiers (C-arm) can be learned theoretically through the use of textbooks, the practical training with the device itself suffers from the lack of visual feedback, i.e. radiographs corresponding to the adjustment of the C-arm. This leads to the question, whether the training of correct operation and adjustment of a C-arm in different operation scenarios can be supported by a C-arm simulation system being part of a CBT system (Computer Based Training). Methods: In co-operation with physicians from accident surgery and radiology the computer-based training system virtX was developed. virtX confronts the user with different exercises of C-arm adjustment and evaluates their execution and the results. These tasks can be created with the help of an authoring tool and can be accomplished by the trainee in different modes: a pure virtual mode and a combined virtual-real mode. In the pure virtual mode the user controls the virtual C-arm in a virtual operating theatre via the graphic-interactive virtX user interface. In the virtual-real mode however the position and orientation of a real C-arm are detected and mapped onto the virtual C-arm. At any time during the completion of an exercise the user can produce a close-to-reality, virtual radiograph and can control all parameters, like the positions of the apertures, X-ray intensity, etc. virtX was used on a three-day course for OR personnel with 120 participants and evaluated using questionnaires.Results: 79 of the participants returned a questionnaire. The average age of the 62 female and 15 male participants (two n.s.) was 34 ± 9 years, their professional experience was 8.3 ± 7.6 years. 18 persons (23%) indicated to work occasionally with a C-arm, 61 (77%) worked regularly with it. Over 83% of the interviewed participants considered virtX a useful addition to the conventional C-arm training. With an acceptance of 91% of the participants the virtual radiography was judged particularly important for understanding C-arm functioning. With 84% acceptance the combined virtual-real mode also got a comparatively high rating. Conclusion: The evaluation results show a high degree of acceptance of the virtX system as a substantial enhancement of conventional C-arm training.

Background: INCA (Intelligent Control Assistant for Diabetes) is a project funded by the EU with the objective to improve diabetes therapy by creating a personal closed loop system interacting with telemedical remote control. Cost-benefit analyses of such systems are needed to decide on the introduction of telemedical systems such as the INCA system to routine care. Objective: To identify and apply suitable methods for a cost-benefit analysis from the perspective of the payor for health services (i.e. a health insurance company). Methods: For the cost analysis MOSAIK-M was used, a method and tool that supports health information systems analysis and design. Two MOSAIK-M models were created during the INCA project. Both, the “As is”-model of conventional insulin pump based diabetes care, and the “To be”-model of the INCA system were parameterised with cost values. With both models a period of one year was simulated to determine the yearly costs of diabetes management and treatment for a patient who does not suffer from diabetes related complications yet. The HbA1c-value was chosen as effectiveness parameter for diabetes therapy. To determine the probability of developing complications and their probable duration the Archimedes-Model was used. It was parameterised with selected HbA1c-values anticipating the effect of INCA. The simulation results in form of years of disease within a 30-years time frame were multiplied with corresponding treatment costs from the KoDiM study. Results: The yearly costs of conventional insulin pump treatment for a 19 year old diabetes type 1 patient with no complications are 5,907 euro (German health care system). Using the INCA system would raise the yearly costs by 7,348 euro. Almost all (98.53%) of the additional costs are generated by the continuous blood glucose measurement device. HbA1c-decreases from 7% (conventional treatment) to 6.5%, 6%, and 5.8 % would produce yearly savings (benefit) concerning the treatment of complications of 100.50 euro, 189.20 euro and 221.82 euro. Conclusions: The selected approach produces an estimation of a lower bound for cost savings. Further work is needed to improve the approximation and to include indirect and intangible costs. The INCA approach would be cost efficient from the chosen perspective, only if the costs of system operation were notably lowered. [ABSTRACT FROM AUTHOR]

Objectives: The economical need for efficient healthcare leads to cooperative shared care networks. A virtual electronic health record is required, which integrates patient related information but reflects the distributed infrastructure and restricts access only to those health professionals involved into the care process. Our work aims on specification and development of a system architecture fulfilling these requirements to be used in concrete regional pilot studies. Methods: Methodical analysis and specification have been performed in a healthcare network using the formal method and modelling tool MOSAIK-M. The complexity of the application field was reduced by focusing on the scenario of thyroid disease care, which still includes various interdisciplinary cooperation. Results: Result is an architecture for a secure distributed electronic health record for integrated care networks, specified in terms of a MOSAIK-M-based system model. The architecture proposes business processes, application services, and a sophisticated security concept, providing a platform for distributed document-based, patient-centred, and secure cooperation. A corresponding system prototype has been developed for pilot studies, using advanced application server technologies. The architecture combines a consolidated patient-centred document management with a decentralized system structure without needs for replication management. An eConsent-based approach assures, that access to the distributed health record remains under control of the patient. Conclusion: The proposed architecture replaces message-based communication approaches, because it implements a virtual health record providing complete and current information. Acceptance of the new communication services depends on compatibility with the clinical routine. Unique and cross-institutional identification of a patient is also a challenge, but will loose significance with establishing common patient cards. [ABSTRACT FROM AUTHOR]

Background: INCA (Intelligent Control Assistant for Diabetes) is a project funded by the EU with the objective to improve diabetes therapy by creating a personal closed loop system interacting with telemedical remote control. Cost-benefit analyses of such systems are needed to decide on the introduction of telemedical systems such as the INCA system to routine care., Objective: To identify and apply suitable methods for a cost-benefit analysis from the perspective of the payor for health services (i.e. a health insurance company)., Methods: For the cost analysis MOSAIK-M was used, a method and tool that supports health information systems analysis and design. Two MOSAIK-M models were created during the INCA project. Both, the "As is"-model of conventional insulin pump based diabetes care, and the "To be"-model of the INCA system were parameterised with cost values. With both models a period of one year was simulated to determine the yearly costs of diabetes management and treatment for a patient who does not suffer from diabetes related complications yet. The HbA1c-value was chosen as effectiveness parameter for diabetes therapy. To determine the probability of developing complications and their probable duration the Archimedes-Model was used. It was parameterised with selected HbA1c-values anticipating the effect of INCA. The simulation results in form of years of disease within a 30-years time frame were multiplied with corresponding treatment costs from the KoDiM study., Results: The yearly costs of conventional insulin pump treatment for a 19 year old diabetes type 1 patient with no complications are 5,907 euro (German health care system). Using the INCA system would raise the yearly costs by 7,348 euro. Almost all (98.53%) of the additional costs are generated by the continuous blood glucose measurement device. HbA1c-decreases from 7% (conventional treatment) to 6.5%, 6%, and 5.8 % would produce yearly savings (benefit) concerning the treatment of complications of 100.50 euro, 189.20 euro and 221.82 euro., Conclusions: The selected approach produces an estimation of a lower bound for cost savings. Further work is needed to improve the approximation and to include indirect and intangible costs. The INCA approach would be cost efficient from the chosen perspective, only if the costs of system operation were notably lowered.