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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: BACKGROUND: Video-games are becoming a common tool to guide patients through rehabilitation because of their power of motivating and engaging their users. Video-games may also be integrated into an infrastructure that allows patients, discharged from the hospital, to continue intensive rehabilitation at home under remote monitoring by the hospital itself, as suggested by the recently funded Rewire project. OBJECTIVE: Goal of this work is to describe a novel low cost platform, based on video-games,…targeted to neglect rehabilitation. METHODS: The patient is guided to explore his neglected hemispace by a set of specifically designed games that ask him to reach targets, with an increasing level of difficulties. Visual and auditory cues helped the patient in the task and are progressively removed. A controlled randomization of scenarios, targets and distractors, a balanced reward system and music played in the background, all contribute to make rehabilitation more attractive, thus enabling intensive prolonged treatment. RESULTS: Results from our first patient, who underwent rehabilitation for half an hour, for five days a week for one month, showed on one side a very positive attitude of the patient towards the platform for the whole period, on the other side a significant improvement was obtained. Importantly, this amelioration was confirmed at a follow up evaluation five months after the last rehabilitation session and generalized to everyday life activities. CONCLUSIONS: Such a system could well be integrated into a home based rehabilitation system.
Keywords: Adaptive video-games, neglect rehabilitation, video processing, monitoring, space exploration, mirror images, body scheme
Abstract: BACKGROUND: Currently, in developing countries, there is considerable interest in using mobile phones as job-aids for community health workers (CHWs) to improve the care they provide. However, acceptance of new technologies can be inhibited if the workload imposed is perceived as excessive compared to existing methods. OBJECTIVE: To compare perceived workload of CHWs using clinical care guidelines presented on mobile phones versus using conventional paper-based guidelines. METHODS: Validated clinical practice guidelines were…developed as Interactive Structured Rich-Medical guidelines (ISRMGs) on Windows Mobile 6.5 mobile phones. A prospective randomized controlled study was performed in Colombia in which 50 CHWs used the ISRMGs, and paper-based materials with the same information, in a cross-over design to diagnose and treat 15 matched pairs of medical cases presented on Human Patient simulators. The NASA Task Load Index, a validated measure of perceived workload, was administered and results compared by means of a mixed model analysis. RESULTS: When using the ISRMGs on mobile phones the health workers reported statistically significant decreases in mental demand, frustration, and overall workload as compared to using paper-based job-aids. CONCLUSIONS: Use of ISRMGs on mobile phones by community health workers in developing countries has the potential to decrease their perceived workload, fatigue, and enhance their ability to provide better care for more patients.
Keywords: Mobile health, mHealth, clinical practice guidelines, community health workers, rich media, persuasive technology
Abstract: BACKGROUND: U.S. healthcare costs consistently outpace inflation, causing growing problems of affordability. This trend cannot be sustained indefinitely. OBJECTIVE: The purpose of this study is to use supply-chain tools for macro-level examination of the U.S. healthcare as a business system and identify options and best use practices. METHOD: We compare the important and successful U.S. food industry to the essential but problematic U.S. healthcare industry. Supply chain strategies leading to food business…operations success are examined and healthcare applications suggested. We emphasize "total cost of ownership" which includes all costs incurred by all stakeholders of U.S. healthcare, including maintenance and cleanup, not just the initial purchase price. RESULTS: U.S. hospitals and clinics can use supply chain strategies in a total cost of ownership framework to reduce healthcare costs while maintaining patient care quality. Supply chain strategies of resource pooling, mass customization, centralized logistics, specialization, postponement and continuous improvement that have been successfully used in the U.S. food industry should be more widely applied to the U.S. healthcare industry. New and growing areas of telemedicine and medical tourism should be included in the supply chain analysis of U.S. healthcare. Valid statistical analysis of results in all areas of U.S. healthcare is an important part of the process. CONCLUSIONS: U.S. healthcare industry problems are systematic operational and supply chain problems rather than problems with workforce or technology. Examination of the U.S. healthcare industry through a supply chain framework should lead to significant operational improvement in both prevention and treatment of acute and chronic ailments. A rational and unemotional reorganization of the U.S. healthcare system operations, using supply chain strategies, should help reduce healthcare costs while maintaining quality and increasing accessibility.
Keywords: Supply chain management, total cost of ownership, supply chain strategies, systems thinking, U.S. healthcare, cost drivers, telemedicine/telehealth, medical tourism
Abstract: INTRODUCTION: Midshaft clavicle fractures comprise up to 15% of all adult upper extremity fractures and account for 76% of all clavicle fractures. The treatment of choice remains controversial. The aim of our retrospective study was to compare the outcome of the surgical and conservative procedure in a trauma care unit (single center study). MATERIAL and METHODS: In a cohort of 151 (mean age 36,1y/male 115/female 36) cases, between 2005 and 2009, 70 patients (46.4%) were treated…conservatively (mean age 40.8y) and 81 (53.6%) underwent either surgical treatment with a locking compression plate (n=73/mean age 40.3y) or an intramedullary nail system (n=8, mean age 27.1y). Mean follow up was 15 months. Nine patients (5.9%) were lost to follow-up, due to poor compliance. The clinical outcome was assessed by the Disability of Arm, Shoulder and Hand (DASH) score and the Constant shoulder score. RESULTS: The average DASH score was 7.3 and the Constant score measured 91.7 in the surgical group. The conservative group achieved a DASH score of 11.1 and a Constant score of 88.1. The clinical scores showed a significant superiority for the benefit of the surgical treatment for the DASH (p=0.037) and Constant score (p=0.036). Totally nine patients had a non-union in the conservative group and six a hardware failure in the surgical group which were revised. DISCUSSION: The treatment options for midshaft clavicle fractures have to be discussed carefully for each patient with regard to the non-union risk, function, cosmesis and revision surgery. CONCLUSION: Both therapeutic modalities demonstrated comparable efficacy. For active and younger patients we would favour a surgical treatment due to the short time of rehabilitation, the return to sport activities and the high non-union rate after conservative treatment.
Keywords: Clavicle fracture, treatment, non union, outcome
Abstract: BACKGROUND: Many short stems for total hip arthroplasty have been introduced by the manufacturers only during the last decade. One of them is the Nanos short stem (Smith and Nephew, Marl, Germany). The development of short stems was aimed at preserving bone and soft tissue by utilizing a minimally invasive approach, thus allowing a quick return to an active life. It was purpose of this study to evaluate the radiological changes after using this device.…METHODS: We present the radiological results of 202 cementless THAs which were performed in 172 patients using the Nanos stem. Radiological evaluation was performed using standing anterior-posterior (AP) and lateral radiographs of the proximal femur preoperatively, postoperatively and during the follow up. We analyzed the preoperative and postoperativ CCD angle, the subsisdence, preoperative and postoperative offset, osteolysis, bone resorption, increased density, neocortex and periarthricular ossifications. RESULTS: One stem had to be revised due to subsidence four days after implantation. Two cups (BiconPlus, Smith and Nephew, Marl, Germany) had to be revised during the time of follow up due to an aseptic cup loosening. Two stems showed radiolucent lines at the implant-bone-interface at the last follow-up. An increase of bone density could be detected in 18 hips (8.9%). 14 hips showed periarticular ossifications. Measurable subsidence was detected in a total of four stems (1.9%). The preoperative neck-shaft-angle angle was 133.8 ± 4.4° (range: 118.5–146.2) and the neck-shaft-angle angle at the time of follow up was 134.6 ± 4.3° (range: 123.3–147; P< 0.05). The preoperative and postoperative offset changed from 109.3 ± 11.9 mm (range: 80.9–131.6) to 109.7 ± 12.3 mm (range: 79.7–155.6; P< 0.05). CONCLUSION: In summary, this study shows that a correct anatomical reconstruction is possible with a device of this design. The outcome is comparable to that of other short stems. Further studies should be performed in a prospective and randomized design to evaluate the advantage of such a device with a higher level of evidence.
Keywords: Short hip stem, Nanos, total hip arthrosplasty, radiology
Abstract: BACKGROUND: Robotics-assisted treadmill exercise (RATE) with focus on motor recovery has become popular in early post-stroke rehabilitation but low endurance for exercise is highly prevalent in these individuals. This study aimed to develop an exercise testing method using robotics-assisted treadmill exercise to evaluate aerobic capacity after severe stroke. METHODS: Constant load testing (CLT) based on body weight support (BWS) control, and incremental exercise testing (IET) based on guidance force (GF) control were implemented during RATE.…Analyses focussed on step change, step response kinetics, and peak performance parameters of oxygen uptake. RESULTS: Three subjects with severe motor impairment 16–23 days post-stroke were included. CLT yielded reasonable step change values in oxygen uptake, whereas response kinetics of oxygen uptake showed low goodness of fit. Peak performance parameters were not obtained during IET. CONCLUSION: Exercise testing in post-stroke individuals with severe motor impairments using a BWS control strategy for CLT is deemed feasible and safe. Our approach yielded reasonable results regarding cardiovascular performance parameters. IET based on GF control does not provoke peak cardiovascular performance due to uncoordinated walking patterns. GF control needs further development to optimally demand active participation during RATE. The findings warrant further research regarding the evaluation of exercise capacity after severe stroke.
Keywords: Stroke, exercise testing, severe motor impairment, aerobic capacity, robotics-assisted treadmill exercise
Abstract: Growth and growth enhancing policies are among the top priorities of the EU policy agenda to overcome mounting budgetary, economic and societal challenges, e.g. demographic change. The Europe 2020 strategy aims to coordinate and support actions at European, national and regional level to enhance smart, sustainable and inclusive growth. By developing the European Innovation Partnership for active and healthy ageing, the Commission aimed at fostering innovation as a way of reaching the goal of increasing Healthy…Life Years (HLY) by 2 years on average across the EU Member States. The goal is a triple win for Europe: better health and independent living for elderly citizens, sustainable health systems and a competitive market of innovative products responding to elderly needs. eHealth plays an important role in reaching this objectives. The EIP policy aims to bring together stakeholders to remove barriers for the uptake of eHealth innovation and growth of eHealth markets, developing or rolling out sustainable business models of eHealth and telemedicine, exploring innovative funding mechanisms, e.g. PPPs, improving interoperability and ending market fragmentation. To improve interoperability between electronic health systems and maximise social and economic benefits of eHealth is also the main objective of the new eHealth Network (Directive 2001/24/EU) – a voluntary network of national authorities responsible for eHealth, which all EU Member states have joined.
Keywords: eHealth, growth, innovation, active and healthy ageing, interoperability, sustainable health systems
Abstract: This paper examined the long-term effects of the use of telecare (e-Health) on the residents of Nishi-aizu Town, Fukushima, Japan, between 2002 and 2010. We compared medical expenditure and days of treatment between telecare users (treatment group) and non-users (control group) based on receipt data obtained from the National Health Insurance, which is operated by the government. In previous studies, we used receipt data obtained for the years 2002 to 2006; this study expands the analysis…period four more years with respect to respondents who were included in previous analyses. Ninety users and 118 non-users were included in both analyses. Using rigorous statistical methods, including system generalized method of moments (GMM), this paper demonstrates that telecare users require fewer days of treatment and lower medical expenditure than non-users with respect to the chronic diseases of stroke, hypertension, heart failure, and diabetes. To date, there have been no publications examining the long-term economic effects of the use of telemedicine, so the current study presents a new facet to the research in this field.
Keywords: Telecare, medical expenditure, days of treatment, system GMM, chronic diseases, peripheral device
Abstract: This paper aims to discuss the economics of biobanking. Among the critical issues in evaluating potential ROI for creation of a bio-bank are: scale (e.g. local, national, international), centralized versus virtual/distributed, degree of sample annotation/QC procedures, targeted end-users and uses, types of samples, potential characterization, both of samples and annotations. The paper presents a review on cost models for an economic analysis of biobanking for different steps: data collection (e.g. biospecimens in…different types of sites, storage, transport and distribution, information management for the different types of information (e.g. biological information such as cell, gene, and protein)). It also provides additional concepts to process biospecimens from laboratory to clinical practice and will help to identify how changing paradigms in translational medicine affect the economic modeling.