Dejan Dinevski

Prospective Randomized Clinical Evaluation of Conventional Single-Bundle, Anatomic Single-Bundle, and Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction 281 Cases With 3- to 5-Year Follow-up

Background: Three different techniques of anterior cruciate ligament (ACL) reconstruction—conventional (transtibial) single bundle (CSB), anatomic single bundle (ASB), and anatomic double bundle (ADB)—have been described. Purpose: To determine if double-bundle reconstruction is needed to restore rotational stability or if anatomic placement of a single bundle can yield similar results. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: From December 2005 to December 2007, 320 patients were prospectively randomized into 3 groups: ADB, ASB, and CSB reconstruction. The average follow-up was 51.15 months (range, 39-63 months). At the final follow-up, 281 patients were available. In all groups, hamstring tendons were used with suspensory fixation on the femoral side and bioabsorbable interference screw fixation on the tibial side. The outcomes were evaluated by an independent blinded observer using the Lysholm score and subjective International Knee Documentation Committee (IKDC) form. The KT-1000 arthrometer was used to evaluate anteroposterior stability, and the pivot-shift test was used to determine rotational stability. Results: Anatomic single-bundle reconstruction resulted in better anteroposterior and rotational stability than CSB reconstruction (average side-to-side difference for anterior tibial translation was 1.6 mm in the ASB group vs 2.0 mm in the CSB group; P = .002). Negative pivot shift was 66.7% vs 41.7% (P = .003). In other parameters, the differences between groups were not statistically significant. The results of the ADB group were also superior to the ASB group for anteroposterior and rotational stability (average side-to-side difference for anterior tibial translation was 1.2 mm in the ADB group vs 1.6 mm in the ASB group; P = .002). Negative pivot shift was 93.1% vs 66.7%, respectively (P < .001), and range of motion was also significantly different (P = .005). The Lysholm score was 90.9, 91.8, and 93.0 in the CSB, ASB, and ADB groups, respectively. The difference was significant only when we compared ADB and CSB (P = .025). Subjective IKDC scores were 90.2, 90.6, and 92.1 in the CSB, ASB, and ADB groups, respectively. The difference was not significant. Conclusion: Anatomic double-bundle ACL reconstruction is significantly superior to conventional single-bundle ACL reconstruction and better than anatomic single-bundle reconstruction. Anatomic single-bundle reconstruction was superior to conventional single-bundle reconstruction. However, these differences are small and may not be clinically relevant.

Individualized anterior cruciate ligament surgery: a prospective study comparing anatomic single- and double-bundle reconstruction.

Background: Reconstruction of the anterior cruciate ligament (ACL) has become a commonly performed procedure. However, biomechanical studies have demonstrated that conventional single-bundle ACL reconstruction techniques are only successful in limiting anterior tibial translation but less effective for restoring rotatory laxity. Purpose: This study aimed to compare the results of single- and double-bundle ACL reconstruction using an anatomic technique, individualized based on the patient’s native ACL size. The authors hypothesized that there would be no difference between the results of anatomic single-bundle (ASB) and anatomic double-bundle (ADB) reconstruction when the surgical technique is individualized. Study Design: Cohort study; Level of evidence, 2. Methods: Depending on intraoperative measurements of the ACL insertion site size, patients were selected for either ASB (n = 32) or ADB (n = 69) ACL reconstruction. In all groups, hamstring tendons autograft was used with suspensory fixation on the femoral side and bioabsorbable interference screw fixation on the tibial side. The outcomes were evaluated by an independent blinded observer using the Lysholm score, subjective International Knee Documentation Committee (IKDC) form, KT-1000 arthrometer for anteroposterior stability, and pivot-shift test for rotational stability. The average follow-up was 30 months (range, 26-34 months). There were no statistically significant differences in the baseline demographics of the 2 groups. Results: There was no significant difference between the ADB and ASB groups for Lysholm score (93.9 vs 93.5), subjective IKDC score (93.3 vs 93.1), anterior tibial translation (1.5- vs 1.6-mm side-to-side difference), and pivot shift (92% vs 90% with negative pivot-shift examination). Conclusion: Anatomic double-bundle reconstruction is not superior to anatomic single-bundle reconstruction when an individualized ACL reconstruction technique is used.

The effect of platelet-derived growth factors on knee stability after anterior cruciate ligament reconstruction: a prospective randomized clinical study.

SummaryBACKGROUND: Arthroscopic reconstruction is a standard surgical procedure in cases of symptomatic knee instability due to rupture of the anterior cruciate ligament. Bone-tendon-bone and hamstring tendon grafts are both in use for anterior cruciate ligament reconstruction. There are no significant differences between the two types of graft in relation to function scores, but there is a difference in anteroposterior stability when measured on the KT-2000 arthrometer: knee joints after reconstruction with bone-tendon-bone autografts are more stable than those reconstructed with hamstring tendon autografts. PURPOSE: To improve knee stability after anterior cruciate ligament reconstruction with a hamstring graft and use of platelet-derived growth factors. BASIC PROCEDURE: Platelet-leukocyte gel was produced from platelet-leukocyte-rich plasma prepared from a unit of whole blood in an autologous platelet separator. The gel was applied locally, after hamstring graft placement. Fifty patients were included in the study: 25 in the platelet gel group, 25 in a control group. We evaluated anteroposterior knee stability with the KT-2000 arthrometer before surgery and at 3 and 6 months after surgery. MAIN FINDINGS: Patients treated with the gel demonstrated significantly better anteroposterior knee stability than patients in the control group. The calculated improvements in knee stability at 6 months were 1.3 ± 1.8 mm in the control group and 3.1 ± 2.5 mm in the platelet gel group (P = 0.011). PRINCIPAL CONCLUSION: Platelet-leukocyte gel, applied locally, can improve knee stability in surgery for reconstruction of the anterior cruciate ligament.

Open educational resources and lifelong learning

The role of open educational resources (OER) for the success and wide implementation of lifelong learning is investigated. Lifelong learning provision is based on the information technology and e-learning together with the emerging mobile learning technologies. Open source and open standards are the means of ldquoopenrdquo information technology support for learning processes. Basic idea, good examples, successful initiatives and development directions of the OER movement are presented in order to derive the development vision. Inevitability of innovative forms of teaching and learning for the success of OER is the most important concluding remark of the paper.

Biomedical question answering using semantic relations

BackgroundThe proliferation of the scientific literature in the field of biomedicine makes it difficult to keep abreast of current knowledge, even for domain experts. While general Web search engines and specialized information retrieval (IR) systems have made important strides in recent decades, the problem of accurate knowledge extraction from the biomedical literature is far from solved. Classical IR systems usually return a list of documents that have to be read by the user to extract relevant information. This tedious and time-consuming work can be lessened with automatic Question Answering (QA) systems, which aim to provide users with direct and precise answers to their questions. In this work we propose a novel methodology for QA based on semantic relations extracted from the biomedical literature.ResultsWe extracted semantic relations with the SemRep natural language processing system from 122,421,765 sentences, which came from 21,014,382 MEDLINE citations (i.e., the complete MEDLINE distribution up to the end of 2012). A total of 58,879,300 semantic relation instances were extracted and organized in a relational database. The QA process is implemented as a search in this database, which is accessed through a Web-based application, called SemBT (available at http://sembt.mf.uni-lj.si). We conducted an extensive evaluation of the proposed methodology in order to estimate the accuracy of extracting a particular semantic relation from a particular sentence. Evaluation was performed by 80 domain experts. In total 7,510 semantic relation instances belonging to 2,675 distinct relations were evaluated 12,083 times. The instances were evaluated as correct 8,228 times (68%).ConclusionsIn this work we propose an innovative methodology for biomedical QA. The system is implemented as a Web-based application that is able to provide precise answers to a wide range of questions. A typical question is answered within a few seconds. The tool has some extensions that make it especially useful for interpretation of DNA microarray results.

Adapted User-Centered Design: A Strategy for the Higher User Acceptance of Innovative e-Health Services

Being familiar with all the benefits of e-Health and the strategic plan for the Slovenian health sector’s informatization, Telekom Slovenia and the Faculty of Medicine from the University of Maribor, along with other partners, have initiated an e-Health project. The project group is developing various e-Health services that are based on modern ICT (information and communications technology) solutions and will be available on several screens. In order to meet the users’ needs and expectations and, consequently, achieve the high acceptance of e-Health services, the user-centered design (UCD) approach was employed in the e-Health project. However, during the research it was found that conventional UCD methods are not completely appropriate for older adults: the target population of the e-Health services. That is why the selected UCD methods were modified and adapted for older adults. The modified UCD methods used in the research study are presented in this paper. Using the results of the adapted UCD methods, a prototype for a service named MedReminder was developed. The prototype was evaluated by a group of 12 study participants. The study participants evaluated the MedReminder service as acceptable with a good potential for a high adoption rate among its target population, i.e., older adults.

E-health integration and interoperability based on open-source information technology

Th e fi rst relevant and frequently cited defi nition of Ehealth was published in 2001 [1]: “E-health is an emerging fi eld in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state of mind, a way of thinking, an attitude, and a commitment to networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology”. Although “E-health” is the generally accepted notation in the professional literature, the offi cial European bodies (Commission, Parliament, Council) use both “e-Health” and “eHealth”. In this introduction all three terms will be used intentionally in order to keep to the original notation when making references. Th e EU “offi cial” explanation of the term is presented on the European Commission (EC) Information Society portal [2]: “Th e term eHealth covers a range of technological areas. In the fast-moving world of ICT, diff erent names have been used for applications which are now seen as part of the eHealth fi eld. Th ese include medical informatics, telemedicine, health telematics, and ICTs for health”. Th e portal [2] also presents the wider point of view: “eHealth means Information and Communication Technologies tools and services for health. eHealth covers the interaction between patients and health-service providers, institution-to-institution transmission of data, or peer-topeer communication between patients and/or health professionals. Examples include health information networks, electronic health records, telemedicine services, wearable and portable systems which communicate, health portals, and many other ICT-based tools assisting disease prevention, diagnosis, treatment, health monitoring and lifestyle management. “eHealth systems provide patients with better information – on treatments, on their condition, and on improved standards of living – and make it simpler for healthcare professionals to access and share information, both general and patient-specifi c. Th e use of electronic patient records allows doctors to see much more of a person’s medical history than do paper fi les, which typically only include information on treatment in a single surgery or hospital. A patient’s condition can be monitored remotely, either freeing up a hospital bed which would have been required with previous monitoring equipment, or providing a better standard of care for the patient.” Th e EC Information Society provides in-depth information on the EU point of view. Th e “eHealth action plan, progress report 2005”, where the situation regarding eHealth development and application in EU member countries is investigated and the near future is envisioned, can be downloaded from the web page [2]. Th is paper aims to answer the following dilemma presented on the EC portal [2]: “Although ICTs have been revolutionising the healthcare sector in recent years, the EU has found that eff orts across the continent have been fragmented and could benefi t from improved cross-border coordination. eHealth tools and services have been widely introduced, but too often health authorities, hospitals, or doctors have chosen and implemented their own individual systems. If these systems are able to communicate with each other, the potential benefi ts they can bring to patients will increase signifi cantly.”

Evaluating Patients' Health Using a Hierarchical Multi-attribute Decision Model

Evaluation of a patients health status is an essential part of the healthcare process. For this purpose, Hendersons model of basic living activities (BLA) is often proposed as a set of criteria to be used in nursing. Despite its clarity and theoretical background, the model is only partially used in clinical practice. In this paper, we present the methodology for a hierarchical multi-attribute decision model to increase the practical efficiency of the BLA model. The result is a computerized model for the evaluation of a patients health status. This model was tested in clinical practice by 17 nurses in two health centres in Slovenia and a strengths, weaknesses, opportunities and threats (SWOT) analysis was carried out. The strengths included providing a holistic understanding of the nature and level of the nursing problems, enriching the documentation and reducing the possibility of overlooking something important. As a part of electronic documentation, this computerized model supports systematic patient data gathering and evaluation.

Using Literature-Based Discovery to Explain Adverse Drug Effects

We report on our research in using literature-based discovery (LBD) to provide pharmacological and/or pharmacogenomic explanations for reported adverse drug effects. The goal of LBD is to generate novel and potentially useful hypotheses by analyzing the scientific literature and optionally some additional resources. Our assumption is that drugs have effects on some genes or proteins and that these genes or proteins are associated with the observed adverse effects. Therefore, by using LBD we try to find genes or proteins that link the drugs with the reported adverse effects. These genes or proteins can be used to provide insight into the processes causing the adverse effects. Initial results show that our method has the potential to assist in explaining reported adverse drug effects.

Accuracy of intelligent medical systems

Intelligent medical systems are a special kind of medical software in general, and just as any medical software system they should make accurate presumptions. However, accuracy of intelligent medical systems is highly dependent on various factors such as: choosing an appropriate basic method (i.e. decision trees, neural networks), induction method (i.e. purity measures) and appropriate support methods (i.e. discretization, pruning, boosting). In this paper we present the results of extensive research of the above alternatives on 54 UCI databases and their influence on the accuracy of decision trees, which constitute one of the most desirable forms of intelligent medical systems. We also introduce new hybrid purity measures that on some databases outperform other purity measures. The results presented here show that the selection of the right purity measure with the proper discretization method and application of the boosting method can really make a difference in terms of higher accuracy of induced decision trees. Thereafter choosing the appropriate factors that can increase the accuracy of the induced decision tree is a very demanding and time-consuming task.