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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: In recent years, there has been increased popularity for use of alternative treatment modalities for low back pain with limited investigation into whether they are effective in returning the worker to normal functionality. The objective of this study was to investigate the short-term impact on the restoration of the functional ability of common treatment modalities including physical therapy, acupuncture, chiropractic treatment, and massage therapy. A within subjects design was used that compared a baseline…assessment to three follow-up assessments: immediately following treatment, two days and seven days post treatment. Individuals suffering from low back pain were recruited from local clinics that specialize in one of the four treatment modalities. Twenty-four individuals who were suffering from low back pain and had started one of the treatment modalities were recruited into the study. Three-dimensional motions (ROM, velocity, and acceleration) during a standardized functional capacity protocol were measured prior to and during three follow-up periods. The results show the effectiveness of the treatments was dependent upon time and were predominantly in the non-sagittal motion planes (velocities and accelerations). Individual subjective pain levels also indicate all the treatment modalities were effective after the 1-week follow-up. Findings suggest those modalities primarily focused on the back musculature (acupuncture, massage, physical therapy) were more effective with respect to functional capacity restoration. The current results provide a quantitative evaluation, based upon trunk dynamics, of the effectiveness of these four treatment modalities.
Keywords: Chiropractic care, acupuncture, massage therapy, physical therapy
Abstract: Full thickness burns usually lead to a great loss of skin and physiological instability because human skin is not only the biggest organ of our body it is the most important protection barrier as well. As natural skin has only limited options to recover, there is a great need for the development of synthetic skin in order to save patients with these high total body surface area full-thickness burns. Many artificial skin substitutes have been developed…for this purpose so far. The benefits and harms of one substitute – Integra artificial skin® – are discussed in a critical literature review.
Abstract: High tibial osteotomy is a widely accepted treatment for unicompartmental osteoarthritis of the knee and other lower extremity deformities, particularly in young and active patients. However, it is generally recognized as a technically demanding procedure. The lack of intraoperative control of the mechanical axis of the affected limb often results in postoperative malalignments, which is one of the main reasons for poor long-term results. Moreover, inaccurate osteotomies, such as insufficient or excessive…bone cut, or incorrect orientation of the chisel or saw blade, have been observed. A computer assisted intraoperative planning and navigation system is therefore proposed in order to address these technical problems. During operation, fluoroscopic images are acquired and anatomical landmarks are digitized; a patient-specific coordinate system is established accordingly. After the three-dimensional measurement of the deformity and interactive planning of the osteotomy plane, the deformity is corrected under navigational guidance. The proposed system has been successfully introduced into the clinical practice of surgery after encouraging laboratory evaluations, with results affirming that it is safe and accurate.
Keywords: Computer assisted surgery, high tibial osteotomy, fluoroscopy, navigational guidance
Abstract: In this study we investigated safety-related usability issues of an advanced medical technology, a radiosurgery system. We were interested in which criteria are important for users when a system's usability and safety is to be improved. The data collection was based on interviews and observations at three different sites where the Leksell GammaKnife® is used. The analysis was qualitative. The main finding was that the user's identity or professional background has a significant impact…both on how he or she views his or her role in the clinical setting, and on how he or she defines what improvements are necessary and general safety issues. In fact, the opinion even of users experienced in safety-related problems was highly influenced by how they related to the technology and its development. None of the users actually considered Leksell GammaKnife as lacking in safety, instead, their assessment was directed towards potential future system improvements. Our findings suggest that the importance of user identity or professional background cannot be neglected during the development of advanced technology. They also suggest that the user feedback should always be related to user background and identity in order to understand how important different issues are for particular users.
Keywords: Usability, safety, user identity, GammaKnife surgery
Abstract: Introduction: Ultrasound studies evaluating bone tissue generally concentrate on two parameters – velocity and attenuation. This study aimed to determine whether ultrasound signal analysis techniques could provide additional information on the structural and mechanical characteristics of bone. Materials and methods: In vitro measurements were made on 26 left index fingers from human cadavers. Ultrasound measurements at the distal metaphysis and epiphysis; dual-energy X-ray absorptiometry of the whole phalanx; micro-computed tomography…at the distal quarter of the phalanx (that is, the distal epiphysis and metaphysis), and mechanical three-point bending tests were performed. Univariate and multivariate linear regression techniques were used to analyze the results. Results: The ultrasound parameters, speed of sound and ultrasound peak amplitude correlated significantly with the three micro-computed tomography measures used to describe the characteristics of mineralized material (r=0.69–0.79, p<0.05). Low frequency ultrasound correlated significantly with micro-computed tomography parameters describing inter-trabecular or marrow spaces (r=0.68–0.78, p<0.05). Comparison of ultrasound parameters with geometric characteristics showed that while speed of sound and ultrasound peak amplitude were related to the cortical area, moment of inertia, and mechanical load (r=0.57–0.83, p< 0.05), the amplitude of the fastest part of the ultrasound signal and full width at 80% maximum of the low frequency peak were related to the relative area of the medullary canal (r=0.40–0.43, p<0.05). Discussion: Quantitative ultrasound may provide information on structural, material and mechanical characteristics of bone to the same extent and even better than DXA Bone Mineral Density. These results have been obtained by a complete and exhaustive use of QUS technology in situ but under clinical conditions. The ultrasound parameters, correctly used and combined, seem to be effective tools for investigating bone tissue.
Abstract: Recent research works examine the potential employment of public-key cryptography schemes in e-health environments. In such systems, where a Public Key Infrastructure (PKI) is established beforehand, Attribute Certificates (ACs) and public key enabled protocols like TLS, can provide the appropriate mechanisms to effectively support authentication, authorization and confidentiality services. In other words, mutual trust and secure communications between all the stakeholders, namely physicians, patients and e-health service providers, can be successfully…established and maintained. Furthermore, as the recently introduced mobile devices with access to computer-based patient record systems are expanding, the need of physicians and nurses to interact increasingly with such systems arises. Considering public key infrastructure requirements for mobile online health networks, this paper discusses the potential use of Attribute Certificates (ACs) in an anticipated trust model. Typical trust interactions among doctors, patients and e-health providers are presented, indicating that resourceful security mechanisms and trust control can be obtained and implemented. The application of attribute certificates to support medical mobile service provision along with the utilization of the de-facto TLS protocol to offer competent confidentiality and authorization services is also presented and evaluated through experimentation, using both the 802.11 WLAN and General Packet Radio Service (GPRS) networks.
Keywords: Mobile health records, WLAN, GPRS, mobile healthcare environments, PKI, attribute certificates, TLS