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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: Methods and tools were developed and designed to give assistance when creating and maintaining decision support systems in which the knowledge part is represented as rules written according to the Arden Syntax. Methods have also been designed and developed to support the process of adding decision support systems to clinical systems.
Keywords: Arden Syntax, Decision Support, System Development
Abstract: Both a prototype medical record system and a protocol information system are presented. Both systems are used for research purposes. The philosophy behind the medical record system is that the system should provide both freedom of vocabulary and freedom of level of detail. The freedom of vocabulary is guaranteed by allowing free text entry. Freedom of level of detail is obtained by structuring the medical record in a hierarchical way and to allow the physician to enter data at the level of detail that suits him best. The protocol information system supports the physician in managing the patient. It guides…the user through the protocol and allows him to obtain background information about the protocol. Both flowcharts and images are included. After each session a summary of the steps taken can be printed. A first evaluation indicates that physicians like to use the system and learn from it.
Keywords: Medical record system, Protocol, Information system, Structuring free text
Abstract: This article constitutes an introduction to the basic tools necessary to understand Systems Ergonomics applied to the development of clinical systems. A basic description of clinical patient care in the system ergonomics language is provided, and the current situation found in hospital information management is criticized from an ergonomic point of view. We have laid out a model of the information flow in the clinical environment, which breaks the complex process of patient care in clearly defined elements: the Clinical Information Process Units. Presented here as an example of the application of Systems Ergonomics to the clinical working processes, the…Clinical Information Process Units constitute the central element in the system ergonomic model of the information flow in the clinical environment.
Keywords: Ergonomics, System engineering, Data management, High dependency environment
Abstract: The considerable additional ventilatory work needed to overcome the resistance of the endotracheal tube (ETT) is flow-dependent. In spontaneously breathing intubated patients this additional ventilatory work is therefore dependent on the flow pattern and cannot be adequately compensated for by support with a constant pressure. We propose a method to fully compensate for the ETT resistance during inspiration and expiration by regulating tracheal pressure (Ptrach ),Ptrach is calculated at a rate of 500 Hz by measurement of flow and pressure at the outer end of the ETT and from coefficients describing the flow-dependent ETT resistance. The calculated tracheal pressure…is fed into a modified demand-flow ventilator which can then control tracheal pressure to a target value (Ptrach,targ ). Tracheal pressure can either be kept constant (automatic tube compensation, ATC), or changed in any chosen fashion. We tested our system on a laboratory lung model simulating a spontaneously breathing patient. Even under the simulation of extreme conditions the maximum deviation of Ptrach from Ptrach,targ was smaller than 2.5 mbar. We evaluated our system in 10 spontaneously breathing intubated patients breathing at ATC with or without volume proportional pressure support (VPPS) by measuring Ptrach . The mean maximum deviation of Ptrach from Ptrach,targ was 2.9 mbar. The rms-deviation was 1.1 mbar (inspiration and expiration considered) and 1.7 mbar (inspiration alone). The accuracy of the control of Ptrach is thus comparable to the control of airway pressure afforded by the unmodified demand-flow ventilator.
Abstract: Medical Technology and Research are discussed here from the particular viewpoint of a university engineering department active in a specific area of biomedical engineering research (biomechanics and rehabilitation engineering) and in charge of a postgraduate programme in Biomedical and Clinical Engineering. Hence the focus of this paper is on medical technology. Medical technology is discussed within two distinct – but interrelated – contexts: health care practice on the one hand (1) and medical research on the other hand (2). European cooperation in Biomedical Engineering research is reviewed, together with the relevant EC programmes (3). Finally, our own conclusions are added…to those of the EC-IRDAC report (4).
Keywords: Medical technology, Health care practice, Medical research