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Technology and Health Care is intended to serve as a forum for the presentation of original articles and technical notes, observing rigorous scientific standards. Furthermore, upon invitation, reviews, tutorials, discussion papers and minisymposia are featured.
The following types of contributions and areas are considered:
1. Original articles:
Technology development in medicine: New concepts, procedures and devices associated with the use of technology in medical research and clinical practice are presented to a readership with a widespread background in engineering and/or medicine.
Significance of medical technology and informatics for healthcare: The appropriateness, efficacy and usefulness deriving from the application of engineering methods, devices and informatics in medicine and with respect to public health are discussed.
2. Technical notes:
Short communications on novel technical developments with relevance for clinical medicine.
3. Reviews and tutorials (upon invitation only):
Tutorial and educational articles for persons with a primarily medical background on principles of engineering with particular significance for biomedical applications and vice versa are presented.
4. Minisymposia (upon invitation only):
Under the leadership of a Special Editor, controversial issues relating to healthcare are highlighted and discussed by various authors.
Abstract: Despite recent advances in treatment of severe injured patients, e.g. due to damage control orthopaedics, multi organ dysfunction syndrome (MODS) and sepsis are major complications in daily practice. During one year 94 patients were prospectively collected. Inclusion criteria: ISS ⩾ 16, age 18–60 y, primary admission to our level-1 trauma center, survival > 48 hours after trauma. The development of MODS and sepsis were observed and different groups were formed (+/-). Demographic data revealed no significant…differences between the subgroups. Comparing groups +MODS and −MODS significant differences on admission day were observed, when PCT showed first on day 2 after trauma differences. Regarding the development of sepsis PCT was advantageous to IL-6 showing significant higher plasma levels in group +sepsis from the first day after trauma. Serum levels of IL-6 and PCT could be useful in early identification of high risk patients to develop posttraumatic MODS. For sepsis PCT is the better prognostic factor.
Abstract: Study design: The current study involves a cadaveric specimen with navigated pedicle screw placement using conventional reference markers and isocentric 3D fluoroscopy and also minimally invasive reference marker use with a flat panel 3D scanner. Objective: To test the feasibility of a novel minimally invasive reference marker system for navigated pedicle screw placement in combination the use of a new imaging modality i.e. flat panel 3D imaging. Summary of background data: A major limiting factor of…navigated pedicle screw placement is the requirement for intraosseous fixation of reference markers. This usually necessitates an open approach to the spinous process. To address this issue, the current authors have developed a minimally-invasive fixation device for spinal reference marker fixation. Methods: A fresh-frozen cadaver with no history of spinal injury or deformity was positioned prone on a radiolucent table. L3 and L4 vertebrae were randomly selected for conventional pedicle screw insertion while T5 and T6 were selected for the percutaneous technique. A flat detector 3D C-arm (Ziehm vision FD 3D; Ziehm, Nuremberg, Germany) was used to evaluate the position of the pedicle screws at the vertebral levels targeted in the study. Results: All screws placed within the lumbar spine involved conventional reference markers. The average depth deviation was 0.73 mm and the average axis deviation was 1.67 mm. Within the thoracic spine, the minimally-invasive marker fixation devices were used. The average depth deviation was 0.85 mm and the average axis deviation was 1.75 mm. In both cases, the plan and navigation were performed satisfactorily. The Y-jaw clamp for minimally-invasive reference fixation seemed to provide stable and robust fixation of the markers, requiring only two small incisions. Conclusions: The minimally invasive reference marker system produced results which were comparable to the conventional intra-osseous markers while the flat detector-based navigation was shown to be easier to use and faster than isocentric Iso-3D techonology.
Abstract: The purpose of this prospective randomized comparative biomechanical study on six pairs of human cadaveric forearms was to study the mechanism of implant loosening and loss of lunate positioning and to discern whether primary stability following staple arthrodesis differs from plate fixation. Six wrists were randomly assigned to either group such that one wrist of each pair was fixed via titanium staples and the other via a mini-titanium plate with oblique screw. Under fluoroscopic guidance, passive…extension and flexion of each wrist was performed using a spring balance. Traction force increased by 5 N at each step, ranging from 0 N to a maximum of 100 N. Fixation using a plate and oblique screw demonstrated greater flexibility than staple fixation. Loosening of the implant and/or the lunate occurred earlier following staple fixation in all pairs. Osteolytic rims around the staple limbs within the lunate occurred in all wrists. These were observed to be an early sign of implant loosening and fusion failure. The current investigators conclude that radiolunate fusion via miniplate and oblique screw is superior to staple fixation in terms of primary stability which is consistent with the radiological results of comparable clinical trails.
Keywords: Radiolunate arthrodesis, wrist biomechanics, implant loosening, cadaveric study
Abstract: Introduction: In a complete dislocation of the talus, the talus is stripped of all its ligament connections in the triple articulated ankle joint. This case report describes the treatment and the 3-year follow-up of a complete dislocation of the talus with the use of intraoperative 3D imaging. Patients and methods: The 19-year-old patient was involved as a driver in a car accident. After the radiological diagnosis of a complete talus dislocation, an emergency operation was performed due to the…critical soft tissue condition. The ISO-C3D fluoroscope from the company Siemens (Erlangen, Germany) was utilized for reduction control. Results: Follow-up evaluations were completed three years after the treatment, the patient had no complaints. Discussion: Since these types of serious injuries are always combined with severe soft tissue damage, the main goals of this treatment have to be debridement and minimized iatrogenic surgical damage. By using intraoperative 3D imaging, immediate reduction control is available, so that revision operations can be avoided. Conclusion: Complete dislocation of the talus is an extremely rare injury, which may cause serious complications. A fast and careful reduction, whether open or closed, should be the goal of treatment. Successful reduction can be determined intraoperatively with the use of 3D imaging.
Keywords: Complete dislocation, talus, 3D fluoroscopy, imaging, CAS
Abstract: Background: The reorientation of the acetabular component in total hip replacement is currently carried out under consideration of the safe zone, respecting the best possible range of motion and is influenced by wear debris of different bearings. Is the prefered orientation a reconstruction of the native anatomy and are there sex-specific differences? Methods: On the basis of 168 CT datasets (72 women, 96 men) 336 native hip joints were analysed. The abduction and anteversion of the…acetabulum as well as the location of the hip center were detected. As a reference the anterior pelvic plane was used. Results: The 144 female hip joints showed a mean abduction of 53.0° (SD 6.14°) and an anteversion of 24.63° (SD 6.61°). The 192 male hip joints showed an abduction of 53.58° (SD 6.68°) and an anteversion of 21.31° (SD 6.17°). Significant differences were observed on comparison between the sexes in relation to the anteversion and the location of the hip center. Likewise, there was a significant correlation between the position of the hip center and the degree of anteversion. Conclusions: In total hip arthroplasty a reconstruction of the native acetabular orientation is not possible, gender specific characteristics should be considered.
Keywords: Native acetabular orientation, anteversion, abduction, localization of hip center, gender differences
Abstract: Healthcare delivery in the rural developing world is limited by a severe shortage of health workers as well as profound communicative and geographic barriers. Understaffed hospitals are forced to provide care for patients that reside at a great distance from the institutions themselves, sometimes more than 100 miles away. Community health workers (CHWs), volunteers from local villages, have been integral in bridging this patient-physician gap, but still lose enormous of amounts of time in transit between…hospital and village. We report the results of a retrospective mobile health (mHealth) pilot at St. Gabriel's Hospital in Malawi designed to eliminate many of these trips in favor of communication via text messages. A group of 75 CHWs were supplied with cell phones and trained to utilize the network for a variety of usage cases, including patient adherence reporting, appointment reminders, and physician queries. At the end of the pilot, the hospital saved approximately 2,048 hours of worker time, $2,750 on net ($3,000 in fuel savings minus $250 in operational costs), and doubled the capacity of the tuberculosis treatment program (up to 200 patients). We conclude that mHealth interventions can provide cost-effective solutions to communication barriers in the setting of rural hospitals in the developing world.
Keywords: Mobile health (mHealth), cell phones, text messaging, SMS, FrontlineSMS, Malawi, St. Gabriel's, community health workers (CHWs), tuberculosis, HIV, patient adherence monitoring, communication barriers, hospital efficiency, brain drain
Abstract: Background and purpose: Various algorithms are available for the analysis of diffusion tensor (DTI) images. Many of these stand alone software packages require time-intensive user interactions not yet suited for routine clinical application Here, we demonstrate the use of the 'Analysis of Functional NeuroImages' (AFNI) software package, a standard for the analysis of functional magnetic resonance images (fMRI), to automatically align clinical DTI images onto the ICBM DTI81 atlas potentially enabling the combined…presentation of fMRI and DTI results. Methods: Fractional anisotropy (FA) maps from seven patients diagnosed with video/EEG defined complex partial seizures were retrospectively analyzed. Affine transformations parameters for seven different cost functions provided by the 3dAllineate software tool were calculated. Alignment quality and variations of the transformation parameters were assessed. Results: Best alignment between the FA maps for each subject and the ICBM DTI81 atlas was achieved with cost functions utilizing the cost ratio (CR) (symmetrized* CR, symmetrized+ CR and unsymmetrized CR). Symmetrized* CR performed slightly better, in particular for lateral white matter structures. Relatively small variations in the transformation parameters emphasize the robustness of the transformations. Conclusions: Good alignment of FA maps to the ICBM DTI81 white matter atlas can be achieved using an automated affine transformation with software tools provided by AFNI potentially enabling the combined presentation of fMRI and DTI information. This procedure maybe readily be applied in clinical practice.
Keywords: Diffusion tensor imaging, international consortium of brain mapping, voxel-based analysis, magnetic resonance imaging