Validity and reliability of remote dental screening by different oral health professionals using a store-and-forward telehealth model

Objective This study was conducted to evaluate the validity and reliability of intraoral photographic assessments by different members of a dental team as a means for dental screening in children.Methods The intraoral photographic records of 126 children (2 to 18 years old) were obtained from routine clinical records taken before dental treatment. Intraoral photographs were obtained using a DSLR camera and then uploaded to a cloud-based server using store-and-forward telehealth technology. Images were reviewed by an expert panel to formulate a benchmark screening baseline, to which the screeners' data were compared. The photographic assessments conducted by a mid-level dental practitioner (MLDP) and dentist, were compared to the benchmark expert panel assessment.Results The screeners' assessments by means of intraoral photography, when compared to the expert panel assessment had a sensitivity value of 82-89% and specificity value of 97%. The inter-examiner agreement between the expert panel assessment and photographic method (assessed by a dentist and MLDP), was almost perfect, with a kappa score ranging from 0.82 to 0.88. The mean DFT/dft score for the children as determined by the expert panel's review and photographic assessment ranging from 5.41 to 5.79, with mean scores between the two assessment methods not significantly different (P = 0.746).Conclusion Our results suggested that oral health professionals (other than dentists) have the potential to screen for caries from intraoral photographs with the same diagnostic accuracy and reliability as dentists. This strategy has implications for supporting the use of MLDPs such as dental therapists or hygienists to screen for oral disease using telehealth.

A mobile-health system to manage chronic obstructive pulmonary disease patients at home

Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality in Australia and globally, and leads to a substantial burden on healthcare services. Effective and timely management of patients with COPD has been essential to alleviate COPD exacerbation, improve the quality of life, and consequently reduce the economic burden. To achieve this, a mobile and internet technologies assisted home care model (M-COPD) was developed to assist clinicians to remotely monitor and manage COPD conditions and events. This paper will focus on the technical aspect of M-COPD system by describing its setup and discussing how the M-COPD could address the clinical needs in monitoring and managing COPD conditions of patients at home.

Working toward a portable tele-ophthalmic system for use in maximum-security prisons: a pilot study

The medical care of prisoners is a difficult and often costly process. Basic medical needs are serviced by prison medical officers. However, specialized care often means transport to specialist centers with the attendant cost and safety. We examined portable ophthalmic equipment in a prison environment to screen 11 prisoners who were scheduled for specialist ophthalmic assessment. Medical and ophthalmic histories were documented, visual acuity was tested, digital images were taken of the external eye and retina, and intraocular pressures taken. The data were sent via modem to a specialist ophthalmologist, and the reports were dictated via e-mail at the end of each session. Of the 11 patients who were scheduled to travel for ophthalmic assessment, only 2 were still required to travel to a specialist ophthalmic center. This pilot study showed that there were considerable cost savings to be made by this screening process with the attendant increase in community safety. The prototype equipment requires refinement by further experimentation, but showed the potential as an adjunct to current examination and assessment techniques when applied to a prison population.

Computer-assisted planimetry associated with Sturge-Weber syndrome

Photographs of the optic nerve head (optic disc) in the eye are used for the clinical assessment of the disease glaucoma. These images are usually subjectively assessed by a clinician. A case of Sturge-Weber Syndrome which includes glaucoma as a symptom, is presented here. Narrowing of the rim of the optic disc was measured using custom-made measurement software confirming glaucomatous progression. To maximize the information obtained from optic disc images, low cost software can assist with quantifying disc parameters aiding clinical interpretation.

Long-term real-time monitoring of adeno-associated virus-mediated gene expression in the rat retina

PURPOSE

Previous studies have demonstrated that adeno-associated virus (AAV) efficiently transduced retinal pigmented epithelial (RPE) cells. The goal of this study was to further evaluate and characterize transgene expression within the RPE cells over time in vivo.

METHODS

Adeno-associated virus-mediated gene transfer was monitored and quantified by retinal photography following subretinal injection of a recombinant AAV encoding the green fluorescent protein gene (rAAVCMV-gfp) into rat eyes. Retinal function of transduced rat eyes was measured by electroretinography.

RESULTS

The maximum level of transgene expression was reached at 8 weeks postinjection followed by a gradual decrease throughout the experimental period. Interestingly, it was observed that while gfp expression was stable in some RPE cells, gfp fluorescence completely disappeared in other cells over the duration of the experiment. The expression of AAV-mediated gfp in RPE cells did not alter the retinal function for over 1 year

CONCLUSIONS

These results confirm the importance of this direct visualization system to study vector transgene expression in vivo and support the use of AAV for diseases treatable by targeting RPE cells.

Comparison of optic disc image assessment methods when examining serial photographs for glaucomatous progression

AIM

To assess serial, simultaneous stereo optic disc images by four methods for glaucomatous progression.

METHODS

Using varying techniques, two ophthalmologists assessed serial optic disc images of 52 eyes from 27 patients with a mean duration between images of 18 months. The neuroretinal rim width was qualitatively assessed by four assessment methods and compared with quantitative rim measurements made using PC based software.

RESULTS

The highest sensitivity of 83% was achieved using computerised stereo chronoscopy.

CONCLUSION

Stereo chronoscopy improved the detection of subtle optic disc changes when compared with simpler assessment techniques.

Evaluation of adeno-associated virus-mediated gene transfer into the rat retina by clinical fluorescence photography

The purpose of this study was to evaluate recombinant adeno-associated virus (AAV) as an in vivo gene transfer vector for the retina and to explore the possibility of monitoring the expression of green fluorescent protein (GFP) using a noninvasive method. Rats were injected subretinally with rAAV-gfp or rAAV-lacZ. Strong expression of the reporter gene in a circular area surrounding the injection site was observed in retinal whole mounts and tissue sections. Higher magnification revealed that cells demonstrating high levels of green fluorescence were hexagonal in shape, indicating they were retinal pigment epithelium (RPE) cells. Histological observation of retinal sections demonstrated that recombinant AAV specifically transduced RPE cells. Ten animals were injected with rAAV-gfp for longitudinal studies and the fluorescence was monitored by retinal fluorescence photography. The GFP signal was detected in 100% of the animals as early as 2 weeks postinjection and remained present throughout the experimental period of 4 months. After 2 weeks, a gradual increase in the number of transduced cells occurred before reaching maximal levels of GFP expression at 8 weeks. This was followed by a small decrease over 4 weeks before reaching stable expression at 16 weeks. Our results demonstrated that rAAV efficiently transduces rat RPE cells and that retinal fluorescence photography is suitable for monitoring GFP expression. By using this noninvasive technique, we demonstrated that repetitive measurements of GFP expression in vivo in the rAAV-gfp-transduced retina are possible. This study demonstrated that retinal fluorescence photography is a potent tool for studying AAV-mediated gene delivery in the retina.

Optic disc topographic changes post-trabeculectomy visualized by anaglyphs

BACKGROUND

Publications on changes of optic disc topography usually illustrate their findings with two-dimensional images.

METHODS

With the introduction of computerized imaging, anaglyphs of stereo images can be produced for illustrations. Anaglyphs are viewed three-dimensionally with red-green spectacles that are included in refraction sets and are normally used to assess phoria. An anaglyph of progressive, glaucomatous progression is included to demonstrate the method, along with conventional colour images.

RESULTS

We present two cases of severely altered optic disc topography post-trabeculectomy and illustrate these cases with anaglyphs that can be viewed three-dimensionally.

CONCLUSION

Three-dimensional viewing of illustrations assists with the visualization, perception and interpretation of optic disc changes.

Prognostic factors in patients with metastatic (stage D2) prostate cancer: experience from the Scandinavian Prostatic Cancer Group Study-2

PURPOSE

Nuclear texture reflects the overall structures of the chromatin organization. We recently reported the principles and prognostic importance of image analysis of nuclei from metastatic prostate cancer. Immunohistochemical up regulation of the adhesion molecule sialyl Lewis(x) is also reported to be a prognostic parameter. Presently we analyzed statistically the prognostic impact of these 2 new parameters compared to well-known clinical parameters in metastatic prostate cancer.

MATERIALS AND METHODS

Prognostic factors, such as sedimentation rate, alkaline and acid phosphatases, hemoglobin, testosterone, performance status, pain due to metastasis, T category, histological grade and patient age, were included in a multivariate Cox proportional hazards regression analysis based on 262 patients from the Scandinavian Prostatic Cancer Group Study-2. Extent of bone lesions, deoxyribonucleic acid ploidy, texture analysis and sialyl Lewis(x) molecules based on subsets of these 262 patients were also analyzed in the same multivariate model.

RESULTS

This test identified chromatin texture as the most important factor (p < 0.001), followed by reaction of the oligosaccharide sialyl Lewis(x) (p < 0.01). Among the routine clinical and laboratory data, sedimentation rate, alkaline phosphatase and hemoglobin (p < 0.05) showed prognostic importance. Performance status, pain due to metastasis and extent of bone lesions showed prognostic value in the univariate analysis (p < 0.05).

CONCLUSIONS

These data indicate that computerized nuclear texture analysis as well as up regulation of sialyl Lewis(x) molecules may be new important prognostic factors in metastatic prostate cancer. Furthermore the prognostic importance of sedimentation rate, alkaline phosphatase and hemoglobin was confirmed.