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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: This study, carried out at the Florence Teaching Hospital Careggi (AOUC), reports the technological evaluation, through the use of Health Technology Assessment (HTA), on the application of mitral clips in the treatment of mitral insufficiency. OBJECTIVE: The assessment, carried out by analyzing the clinical, technological, social, procedural, safety and economic elements, sought to answer the following research questions: Evaluation of the general technological status of the mitral clips in the treatment process of…mitral regurgitation, with particular reference to traditional methods; and contextualisation of the analyses within the hospital structure, by identifying criticality issues and improvements. METHODS: The methodology was based on the following steps: technological description; areas of evaluation and the selection of Key Performance Indicators; research of scientific facts and the collection of expert opinions; evaluation and reporting of findings. RESULTS: The results are based on an analysis which included a total of 50 indicators, effectively evaluating 86.5% of them, from the least from the clinical sector (80%) to the most in the areas of procedure, safety and social (100%). Traditional surgery (repair or valve replacement) still represents the gold standard for the treatment of mitral regurgitation due to its maturity both on a technological and clinical level. The minimally invasive procedures which use the mitral clips present interesting opportunities both on a social level (minimum stay in hospital and no post-operative rehabilitation) and clinical level, especially as an alternative to medication, even if they are still at an emergent level (the long-term results are unknown) and complex to use. From the clinical point of view they show some interesting findings related to immediate and post-operative mortality (none during the operation and a minor and equal amount 30 days and 12 months later in comparison to traditional methods) whilst economically, despite the fact that the cost of the device is greater than those used in traditional interventions, the cost-refund relationship does not show significant differences compared to the traditional types of treatment. CONCLUSION: The HTA evaluation of minimally invasive technologies that use clips for the treatment of mitral regurgitation shows, in the hospital setting, very interesting results, particularly for inoperable patients, where the clinical and social improvements are significant compared to pharmacological treatments, whilst for 'operable' patients, the traditional techniques are still the most appropriate.
Keywords: Health technology assessment, hospital based, mitral regurgitation, mitral clips
Abstract: BACKGROUND: Being well-informed and knowledgeable about their illnesses would be a great advantage to children with epilepsy (CWE). Subsequently, an effective education programme which could secure interest and simultaneously improve their awareness, knowledge and attitudes (AKA) is essential in enhancing well-being and health outcomes. OBJECTIVES: To describe the development of a new interactive animated epilepsy education programme (IAEEP) for children and to assess its feasibility, acceptability and practicality. METHODS: The IAEEP was…developed by an interdisciplinary group of neurologist, paediatrician, pharmacist, biomedical scientist and educators which was based on two established epilepsy education programmes: the educational programme for patients with epilepsy and their relatives (MOSES) and the modular educational program for children with epilepsy and their parents (FAMOSES). CWE from paediatric department of three general hospitals in Terengganu were initially introduced to the IAEEP and were requested to complete an evaluation form assessing its feasibility, acceptability and practicality. Descriptive statistics were employed for data analyses (SPSS 20.0). RESULTS: Sixteen CWE (median age=13.0; male=56.2%; Malay=81.2%; secondary school=56.2%) and their corresponding parents were recruited. Each CWE owned at least a computer/notebook/tablet (100%). The cost of distribution of IAEEP (in compact disc form) among CWE was estimated at about MYR 17.99/USD 5.90 per CWE. The average time required to interact with the programme was 22.8 minutes (SD=3.3, range 18–28 minutes). The programme was 100% acceptable and received full support from both CWE and their parents (100%). CONCLUSIONS: The favourable findings from this study add to the growing evidence suggesting that investment in interactive and animated education programme would be both feasible, well-received by patients and could be a potentially valuable approach to increase access and effectiveness of epilepsy care especially among CWE.
Keywords: Interactive animated epilepsy education programme, feasibility, acceptability, practicality, children
Abstract: BACKGROUND: Diabetic retinopathy is a microvascular complication of long-term diabetes and is the major cause for eyesight loss due to changes in blood vessels of the retina. Major vision loss due to diabetic retinopathy is highly preventable with regular screening and timely intervention at the earlier stages. Retinal blood vessel segmentation methods help to identify the successive stages of such sight threatening diseases like diabetes. OBJECTIVE: To develop and test a novel retinal imaging…method which segments the blood vessels automatically from retinal images, which helps the ophthalmologists in the diagnosis and follow-up of diabetic retinopathy. METHODS: This method segments each image pixel as vessel or nonvessel, which in turn, used for automatic recognition of the vasculature in retinal images. Retinal blood vessels were identified by means of a multilayer perceptron neural network, for which the inputs were derived from the Gabor and moment invariants-based features. Back propagation algorithm, which provides an efficient technique to change the weights in a feed forward network, is utilized in our method. RESULTS: Quantitative results of sensitivity, specificity and predictive values were obtained in our method and the measured accuracy of our segmentation algorithm was 95.3%, which is better than that presented by state-of-the-art approaches. CONCLUSIONS: The evaluation procedure used and the demonstrated effectiveness of our automated retinal imaging method proves itself as the most powerful tool to diagnose diabetic retinopathy in the earlier stages.
Abstract: BACKGROUND: People use upper limbs to conduct daily activities. When recovering from injuries, many patients neglect the importance of rehabilitation, which results in degraded function. OBJECTIVE: Rehabilitation after treatment of an injury is very important. This study proposes to improve and enhance the effectiveness of rehabilitation practice. METHODS: A patient record of the training process using the traditional rehabilitation hand gliding cart is produced by using a magnetic sensing element in the…panel, a servo host computer, and other devices. RESULTS: Clinical evidence shows that the training aids help significantly with the rehabilitation of patients with impaired upper limb function and reduce negative impacts from the disability in daily life and activities. CONCLUSIONS: This study has combined the gliding cart with reed switches, such that when the patient moves the cart, the movement tracks can be observed via the activated reed switches. The training data are collected and quantified for a better understanding of the recovery status of the patients. Each of the participating patients makes progress as expected.
Keywords: Rehabilitation, upper limb, magnetic sensor, gliding cart, reed switches
Abstract: BACKGROUND: An unintended bolus is delivered by the syringe pump if intravenous line occlusion is released in an inappropriate manner. OBJECTIVE: The aim of this study was to measure the amount of flushed fluid when an occlusion is inappropriately released and to assess the effect of different syringe pump settings (flow rate, alarm setting, size of syringe and syringe pump model) on the flushed amount. METHODS: After the stopcock was closed, infusions were started with different model…syringe pumps (Terufusion® TE312 and TE332S), different syringe sizes or at different alarm settings. After the occlusion alarm sounded, the occlusion was released and the amount of fluid emerging from the stopcock was measured. RESULTS: The bolus was significantly lower when the alarm was set at a low-pressure setting. The bolus was significantly lower with a 10-ml than a 50-ml syringe. A significant difference was seen only when a 50-ml syringe was used (TE312: 1.99 ± 0.16 ml vs. TE332S: 0.674 ± 0.116 ml, alarm High, p < 0.001). CONCLUSION: To minimize the amount of accidentally injected medication, a smaller syringe size and a low alarm setting are important. Using a syringe pump capable of reducing the inadvertently administered bolus may be helpful.
Keywords: Syringe pump, accidental flush, occluded intravenous line
Abstract: BACKGROUND: Normal "wear and tear" of bones during weight bearing activity creates microdamage that triggers bone to heal itself. OBJECTIVE: A controlled laboratory study was carried out to determine the effect of lithotripsy on bone apposition and resorption in osteopenic, hind-limb suspended, aged rats compared to age-matched controls allowed normal weight bearing (cage) activity. METHODS: First, we tested the feasibility of using a clinical lithotripsy device, designed for treatment of kidney stones, to create microdamage in bone.…In a second step, we tested the hypothesis that microdamage induced through lithotripsy treatment increases bone apposition in aged rats. In a third step, we exposed osteopenic, aged rats to lithotripsy to evaluate the effectiveness of lithotripsy in counteracting bone loss due to simulated disuse. RESULTS: Both in aged, weight bearing as well as aged, osteopenic rats, we showed that lithotripsy effectively increases the area of bone apposition along the periosteal and endosteal surfaces. While new bone apposition concentrates in areas of lithotripsy treatment in aged bone of weight bearing rats, new bone apposition extends beyond the immediate treatment site (to the contralateral limb) of osteopenic animals. Furthermore, bone resorption decreases in osteopenic (hindlimb suspended) and aged rat femora treated with lithotripsy, compared to baseline and hindlimb suspended controls. This decrease in resorption is not observed in the contralateral limb of osteopenic animals. CONCLUSION: Taken as a whole, lithotripsy may offer a viable treatment method for disuse osteopenia or osteoporosis, particularly for aging individuals or for those who are limited in their weight bearing activities.
Keywords: Aging, bone, osteopenia, lithotripsy, translational research
Abstract: BACKGROUND: Total hip arthroplasty (THA) is a safe and successful procedure for the treatment of osteoarthritis. One of the most common postoperative problems remains persistent hip pain. The arthroscopic evaluation of persistent hip pain following THA can be a valuable diagnostic tool in a select number of patients when carried out by experts in this technique. OBJECTIVE: Indication for arthroscopy was persistent pain after THA. Inclusion criteria were an absence of radiological loosening and a sterile…aspiration 6 weeks before arthroscopy. Hip joint function and pain were evaluated pre- and postoperatively using the visual analogue scale (VAS) and the Hip Outcome Score (HOS), which scored the activities of daily living (ADL), and a sports subscale. METHODS: 5 patients (3 female, 2 male) with an average age of 60.2 ± 4.27 years (range 51–72 years) were included in the study. Arthroscopy with biopsy, adhesiolysis and psoas tendon release was performed 21.0 ± 21.97 months (range 6–57 months) after primary hip replacement. RESULTS: Pathological findings were prosthetic joint infection (two cases), impingement between acetabular component and psoas tendon (two cases), adhesions of the periprosthetic tissue (one case). The patients achieved a significant improvement of the Hip Outcome Score (HOS), from an average of 45.6 ± 22.5 (range 14.0–63.1) to 76.5 ± 3.8 (range 41.0–89.4, P=0.016). Evaluation of the VAS showed a significant improvement from a preoperative value of 8.8 ± 0.5 to a postoperative value of 3.4 ± 1.0 (P=0.001). CONCLUSION: Hip arthroscopy provides a minimal-invasive tool for diagnosis and therapy. In cases of persistent pain after THA, standard diagnostic procedures should be utilised. Arthroscopy of a hip post-THA would be highly specialised. As a next step, arthroscopy helps the diagnosis and therapy of persistent pain after THA.
Keywords: Hip arthroscopy, total hip arthroplasty, persistent hip pain, periprosthetic hip infection
Abstract: BACKGROUND: Sedentary workers are most prone to work-related musculoskeletal disorders. OBJECTIVE: We report the case of a female sedentary worker with rounded shoulder posture (RSP) whose dominant upper back pain decreased after correction of her RSP with kinesiology taping. METHODS: We applied kinesiology taping around the patient's upper back and shoulder for 1 month (six times per week, each session lasting approximately 16 h) without any other interventions. RESULTS: After kinesiology taping, the RSP decreased…progressively and the dominant upper back pain gradually disappeared. The patient no longer complained of dominant upper back pain during desk work. CONCLUSION: We believe that kinesiology taping may be used to enable recovery from dominant upper back pain in female sedentary workers with RSP.
Abstract: Pantoea agglomerans is a rare isolate in orthopaedic patients. We describe the first case of an acute hip prosthetic joint infection (PJI) caused by Pantoea agglomerans. The microorganism was detected after sonication of the removed hip endoprosthesis.
Abstract: BACKGROUND: An extension deficit of the elbow joint can be caused by various pathologies such as arthroliths, posttraumatic scar tissues, synovitis, capsular fibrosis of the anterior joint compartment, osteophytes in the area of the olecranon fossa or osteochondral lesions (OCL). Arthroscopic treatment is a good therapeutic option for theses pathologies. OBJECTIVE: We performed a standardized elbow arthroscopy in the case of an 18-year old male roofer presented with an extension deficit of 5° which…had existed for several years. As physical activity, the patient performed boxing and BMX bicycle races. The patient had no history of any kind of previous elbow surgery, injury, inflammatory or metabolic rheumatic disease or haemophilia. METHODS: In the arthroscopic evaluation, we found a central OCL of the radial head with reactive capsular hypertrophy. The OCL was treated by microfracture with a chondropic. The clinical outcome was assessed by the Disability of Arm, Shoulder and Hand (DASH) score. RESULTS: The restoration of the elbow joints full range of the motion (ROM) was achieved by arthroscopic treatment and adhesiolysis. In the follow-up examination one year after arthroscopy, the patient was asymptomatic and the elbow joint could be moved freely. Evaluation of the DASH score showed an improvement from a preoperative score of 7.0 to a postoperative score of 2.6. CONCLUSIONS: Arthroscopy of the elbow is a good tool to treat OCL on the radial head. In cases of an extension deficit of the elbow, an OCL should be considered as a differential diagnosis.
Keywords: Elbow arthroscopy, extension deficit, osteochondral lesion, radial head