Glossary of medical devices and procedures: abbreviations, acronyms, and definitions

Balloon expandable coronary stent materials: a systematic review focused on clinical success

Balloon expandable coronary stenting has revolutionized the field of interventional cardiology as a potential, minimally invasive modality for treating coronary artery disease. Even though stenting is successful compared to angioplasty (that leaves no stent in place), still there are many associated clinical complications. Bare metal stents are associated with in-stent restenosis caused mostly by neointimal hyperplasia, whereas success of drug-eluting stents comes at the expense of late-stent thrombosis and neoatherosclerosis. Even though innovative and promising, clinical trials with bioabsorbable stents reported thrombosis and a rapid pace of degradation without performing scaffolding action in several instances. It should be noted that a vast majority of these stents are based on a metallic platform which still holds the potential to mitigate major cardiovascular events and reduced economic burden to patients, alongside continuous improvement in stent technology and antiplatelet regimes. Hence, a systematic review was conducted following PRISMA guidelines to assess the clinically relevant material properties for a metallic stent material. From a materials perspective, the major causes identified for clinical failure of stents are inferior mechanical properties and blood-material interaction-related complications at the stent surface. In addition to these, the stent material should possess increased radiopacity for improved visibility and lower magnetic susceptibility values for artefact reduction. Moreover, the review provides an overview of future scope of percutaneous coronary interventional strategy. Most importantly, this review highlights the need for an interdisciplinary approach by clinicians, biomaterial scientists, and interventional cardiologists to collaborate in mitigating the impediments associated with cardiovascular stents for alleviating sufferings of millions of people worldwide.

Graphical abstract

Integrating Wikipedia Articles and Images into an Information Resource for Radiology Patients

Wikipedia-an open-access online encyclopedia-contains a large number of medically relevant articles and images that may help supplement glossaries of radiology terms. We sought to determine the extent to which concepts from a large online radiology glossary developed as part of the Patient-Oriented Radiology Reporter (PORTER) initiative could be mapped to relevant Wikipedia web pages and images using automated or semi-automated approaches. The glossary included 4090 concepts with their definitions; the concept's preferred name and lexical variants, such as plurals, adjectival forms, synonyms, and abbreviations, yielded a total of 13,030 terms. Of the 4090 concepts, 3063 (74.9%) had a corresponding English-language Wikipedia page identified by automated search with subsequent manual review. We applied the MediaWiki application programming interface (API) to generate web-service calls to identify the images from each concept's corresponding Wikipedia page; three reviewers selected relevant images to associate with the glossary's concepts. Licensing terms for the images were reviewed. For 800 randomly sampled concepts that had associated Wikipedia pages, 362 distinct images were identified from the MediaWiki library and matched to 404 concepts (51%). Three images (1%) had unspecified licensing terms; the rest were in the public domain or available via a Creative Commons license. Wikipedia and the MediaWiki library offer a large collection of medical articles and images that can be incorporated into an online lay-language glossary of radiology terms though a semi-automated approach.

PORTER: a Prototype System for Patient-Oriented Radiology Reporting

To empower patients to participate in their medical care and decision-making, effective communication is critical. In radiology, the clinical report is the primary medium of communication. Although radiologists historically have authored reports with the referring provider as the intended reader, patients increasingly access the reports through portals to electronic health record systems. We developed a system named PORTER (Patient-Oriented Radiology Reporter) to augment radiology reports with lay-language definitions. Our IRB-approved, HIPAA-compliant study protocol analyzed 100 knee MRI reports from an academic medical center to identify the most commonly utilized terms. A glossary of 313 terms was constructed to include definitions of the terms and, where available, links to reference sources and public-domain images. Flesch-Kincaid readability scores were computed to assure that definitions were readable at or below 10th-grade reading level. The system provided an interactive web site to view outpatient knee MRI exams. After logging in with their exam ID number and date of birth, patients viewed their report annotated with definitions from the glossary. Applicable images were displayed when the user's mouse hovered over a glossary term. This patient-oriented system can help empower patients to better understand their radiology results.

Management of the fractured edentulous atrophic mandible

BACKGROUND

Fractures of the atrophic and edentulous (toothless) mandible (lower jaw) are fairly common in elderly people. Atrophy and weakening tend to occur as a result of reduced vascularity and decreased blood flow. Treatment options for reduction and fixation include closed and open techniques, with the degree of atrophy having a significant influence on the type of treatment. Many methods have been proposed for treating fractures of the atrophic mandible but there is still some uncertainty as to which method has the most successful outcomes.

OBJECTIVES

The objective of this review was to provide reliable evidence regarding the effectiveness of any interventions either open or closed that can be used in the management of fractured edentulous atrophic mandibles.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 4); MEDLINE from 1966 and EMBASE from 1980, both to 30th January 2006. Last search was done in January 2006.

SELECTION CRITERIA

Randomised controlled trials involving people over 55 years of age with fractures in the symphysis, parasymphysis, body, angle, ramus, condyle, and coronoid process of atrophic edentulous mandibles in which the fracture was a result of trauma, implant insertion or due to pathological fracture. Any studies that compared methods of management (open or closed reduction or fixation) were to be included.

DATA COLLECTION AND ANALYSIS

Screening of eligible studies was conducted in duplicate and independently by two review authors. Results were to be expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors.

MAIN RESULTS

No eligible randomised controlled trials were identified.

AUTHORS' CONCLUSIONS

This review illustrates that there is currently inadequate evidence for the effectiveness of a single approach, either open or closed, in the management of fractured atrophic edentulous mandibles and that until high level evidence is available treatment decisions should continue to be based on clinician's prior experience. This absence of evidence may in part reflect a certain lack of clarity and the apparent diversity and lack of reliability in some of the traditional and normative predictors of successful outcomes.

Fracture Fixation

The basic goal of fracture fixation is to stabilize the fractured bone, to enable fast healing of the injured bone, and to return early mobility and full function of the injured extremity. Fractures can be treated conservatively or with external and internal fixation. Conservative fracture treatment consists of closed reduction to restore the bone alignment. Subsequent stabilization is then achieved with traction or external splinting by slings, splints, or casts. Braces are used to limit range of motion of a joint. External fixators provide fracture fixation based on the principle of splinting. There are three basic types of external fixators: standard uniplanar fixator, ring fixator, and hybrid fixator. The numerous devices used for internal fixation are roughly divided into a few major categories: wires, pins and screws, plates, and intramedullary nails or rods. Staples and clamps are also used occasionally for osteotomy or fracture fixation. Autogenous bone grafts, allografts, and bone graft substitutes are frequently used for the treatment of bone defects of various causes. For infected fractures as well as for treatment of bone infections, antibiotic beads are frequently used.

Joint arthroplasties and prostheses

Joint arthroplasty is the most frequently performed orthopedic procedure after fracture fixation. The major indications for any joint replacement are degenerative joint disease, inflammatory arthropathy, avascular necrosis, and complicated fractures. The major contraindications for any joint arthroplasty are systemic and joint infection and a neuropathic joint. The interpretation of radiographs in cases of joint arthroplasty is a significant part of many radiology practices, and correct recognition of the prosthetic devices and their complications by the radiologist is important. The article reviews the most common types of joint arthroplasties and prostheses of the upper and lower extremities and discusses the most frequent complications associated with their placement.