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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: Osteonecrosis of the femoral head is a more progressive disease for which many patients will eventually require total hip arthroplasty. With the advent of improved metal-on-metal prostheses, total hip resurfacing arthroplasty has emerged as a viable treatment option. However, it remains controversial whether this procedure should be used in patients with osteonecrosis when the femoral resurfacing component is implanted onto non-vital bone. In this study the bone mineral density (BMD) of osteonecrotic femoral heads were compared with the BMD of osteoarthrotic femoral heads. The purpose of this study was to analyse the differences between these two groups to gather information…that may be useful in predicting the outcome of total hip resurfacing arthroplasty in cases of severe osteonecrosis of the femoral head. The femoral heads were classified according to the ARCO classification using MRI. For DEXA analysis the femoral heads were subdivided into three regions: the cranial femoral head (R1), the caudal femoral head (R2), and the proximal femoral neck (R3). In R3, BMD in osteonecrotic femoral heads was significantly lower than in those with osteoarthrosis and in R2 it was significantly higher. It can be assumed that a higher BMD in the caudal femoral head (R2) is caused by a "reactive interface" that occurred in this region especially in ARCO IV femoral heads. This fact, the lower BMD in the proximal femoral neck (R3) and the individual expansion of the osteonecrotic region should be considered when planning resurfacing arthroplasty for femoral head necrosis.
Keywords: Osteonecrosis, femoral head, ARCO, total hip resurfacing arthroplasty
Abstract: Aims: The rough estimation of the education and the self-confidence of nurses, both students and professionals, regarding deep venous catheterization in adult patients, the evaluation of the change in self-confidence of one team of students who were trained with a simulator on deep venous catheterization and the correlation of their self-confidence with their performance recorded by the simulator. Material and methods: Seventy-six nurses and one hundred twenty-four undergraduate students participated in the study. Fourty-four University students took part in a two-day educational seminar and were trained on subclavian and femoral vein paracentesis with a simulator and an anatomical…model. Three questionnaires were filled in by the participants: one from nurses, one from students of Technological institutions, while the University students filled in the previous questionnaire before their attendance of the seminar, and another questionnaire after having attended it. Results/Discussion: Impressive results in improving the participants’ self-confidence were recorded. However, the weak correlation of their self-confidence with the score automatically provided by the simulator after each user’s training obligates us to be particularly cautious about the ability of the users to repeat the action successfully in a clinical environment. Conclusion: Educational courses and simulators are useful educational tools that are likely to shorten but in no case can efface the early phase of the learning curve in clinical setting, substituting the clinical training of inexperienced users.
Keywords: Deep venous catheterization, self-confidence, simulators, DEX system, Vancouver model
Abstract: Different reimbursement schemes for health care providers have been developed worldwide. They have evolved over time and have been influenced by politics, costs, patient needs and technological progress. Different methods in the valuation of technologies and their reflection in outpatient reimbursement schemes are analyzed. Using Magnetic Resonance Imaging (MRI) as an example, five different reimbursement schemes from four countries are compared according to defined performance criteria. Major differences in the structure and valuation of internationally used reimbursement schemes are presented; Prices for Neurocranium MRI scans vary from €98 to €462 and large discrepancies can even be found within the same…country. There are politically driven reimbursement schemes like the German Gebührenordnung für ‘A’rzte, while others such as the Swiss TARMED are primarily based on actual costs.
Keywords: Valuation, payment, technologies, Magnetic Resonance Imaging, reimbursement schemes
Abstract: Arterial tonometry is a non-invasive technique for continuous registration of arterial pressure waveforms. This study aims to assess tonometric blood pressure recording (TBP) as an alternative for invasive long-term bedside monitoring. A prospective study was set up where patients undergoing neurosurgical intervention were subjected to both invasive (IBP) and non-invasive (TBP) blood pressure monitoring during the entire procedure. A single-element tonometric pressure transducer was used to better investigate different inherent error sources of TBP measurement. A total of 5.7 hours of combined IBP and TBP were recorded from three patients. Although TBP performed fairly well as an alternative for IBP…in steady state scenarios and some short-term variations, it could not detect relevant long-term pressure variations at all times. These findings are discussed in comparison to existing work. Physiological alterations at the site of TBP measurement are highlighted as a potentially important source of artifacts. It is concluded that at this point arterial tonometry remains not enough understood for long-term use during a delicate operative procedure. Physiological changes at the TBP measurement site deserve further investigation before tonometry technology is to be considered as an non-invasive alternative for long-term clinical monitoring.
Abstract: Objective: The present meta-analysis illustrates relevant information about hip replacement in young patients that has been published during the past 3 decades. Material and methods: Based on a MedLine literature review a total of 95 studies were evaluated. Parameters for evaluation of study quality and outcome were implant survival rates (ISR), number of patients, indications, follow-up, surgical approaches and number of surgeons. Results: Most studies consider patient numbers <50. In 33 studies one implant system was applied compared to 65 studies in which more than one system was used. Most studies include different surgical approaches. 20%…of all studies contained neither the number of surgeons, nor the type of surgical approach. The overall ISR could be evaluated in 67 studies. Sufficient data about the ISR of stem and/or sockets were available in 50 papers. Conclusions: Most published studies analyzed inhomogeneous study populations; study variables vary as do the implants used for treatment.