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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: Diabetes is rapidly growing in prevalence worldwide. The number of people with diabetes was 171 million in 2000 and will grow to 366 million by 2030. One reason for this is a growing elderly population, but younger people are increasingly likely to develop diabetes due to an increase in mean weight and a decrease in exercise. The increasing resources needed to modify lifestyle and appropriately manage diabetes are a worldwide healthcare burden. Promising solutions arise among others from wireless technologies and mobile solutions. In this paper, the needs for information, change in lifestyle, health monitoring, and management of medication and…complications in diabetes are analysed. They form a basis for following review of available wireless solutions for managing diabetes. Finally, future prospects of mobile management of diabetes are discussed.
Abstract: To assess bone healing and investigate the influence of different pharmaceutics (e.g. growth factors) on bone stiffness and strength in-vivo, new quantitative methods are necessary. Therefore, a new manual and motorized stiffness meter to quantify bone regeneration in a model of distraction osteogenesis were compared. The design, equipment, and improvements of the measurement devices are described. Furthermore, their difference in precision and accuracy in comparison to tests from a material testing system, used as "gold standard", were evaluated. Both devices were able to assess regenerate stiffness: the accuracy ranged between ± 9% for the manual and ±5% for the motorized…version for stiffness data over 0.1 Nm/°; precision between ± 3.8% for the manual and ± 3.2% for the motorized device. In summary, the two stiffness measurement devices described in this study have the power to monitor the beginning of bone healing and therefore predict the load bearing capacity of regenerating bone. The motorized version showed advantages over the manual device when investigating and monitoring the stiffness of bone during a consolidation period: (1) better accuracy in both stiffness below and above 0.1 Nm/°, (2) a better precision in the stiffness range of interest, (3) easier handling, and (4) standardisation of the measurement process using the stepper motor and definition of the maximums of torque, angulation and rotation speed.
Abstract: Studies suggest benefits from correcting anaemia in heart failure using a combination of erythropoiesis-stimulating agents (ESAs) and intravenous iron. We set out to investigate the number of older patients who would require treatment of anaemia in a large teaching hospital in the United Kingdom and the cost implications. The prevalence of anaemia and chronic kidney disease (CKD) in patients 65 years and older with systolic dysfunction attending the local heart failure clinic was determined. The projected numbers of patients in our health district who would meet published kidney disease guidelines for treatment of anaemia was then estimated. The costs of…treatment with combination ESAs and IV iron were calculated for these patients based on the treatment costs for renal anaemia in our local renal unit. Sensitivity analysis for different thresholds of haemoglobin and eGFR was performed. In our study of 86 heart failure patients, mean age 81 years, 34% have anaemia and 73% have stage III CKD with estimated glomerular filtration rate < 60 ml/min/1.73 cm2 . At the haemoglobin threshold value of ≤ 11.0 g/dl for treatment of anaemia in heart failure patients with stage III CKD, 1031 elderly heart failure patients in our health district (total population 424,654) would require treatment with IV iron and erythropoietin, at a cost of £2.7 million per annum. The estimated cost of treating anaemia in elderly patients with heart failure using ESAs and IV iron is substantial and its cost effectiveness is unknown.
Abstract: Balance is a complex motor skill and it is frequently disturbed among stroke survivors. Rehabilitation experts are still facing challenges in achieving good stability. The primary aim of this study was to determine the effect of a wobble board exercise program on static and dynamic balance of hemiplegic subjects. Seventeen (17) stroke survivors were randomly selected into two groups. The subjects in the experimental group were trained on wobble board for six weeks while the control group received only the baseline treatment programs. The modified version of the timed balance test was used to assess balance while the foursquare step…test was used to assess dynamic balance. Descriptive statistics and Analysis of variance (ANOVA) were used to analyze the data obtained. The result showed that there was significant difference in the static balance (eye closed) (F=7.49, P< 0.05) and dynamic balance (F3.20, P< 0.05) between the groups but there was no significant difference in static balance (eye opened) (F= 1.75, P> 0.05). The study concluded that wobble board exercise improved both static (eye closed) and dynamic balance of stroke survivor used in this study.
Abstract: Background: Finite element (FE) simulations of mechanical tissue loading help provide insight into internal tissue stress and strain distribution. Thus, better understanding of pressure sore aetiology and pressure sore prophylaxis can be acquired. Indispensable in the simulation process is adequate mechanical description of interacting soft tissue and body support materials. Sufficient verification of employed material parameters is required. Method of approach: Gluteal soft tissue material parameters, previously derived from experimental tissue indentation of a geometrically limited buttock sub-domain are shown to be suitable in simulating complex deformation of the entire buttocks. In the context of parameter verification,…defined tissue loading via a soft foam material specimen was performed. Making use of magnetic resonance imaging (MRI), the scenario was scanned to gain tissue displacement information. Anatomical surface data was reconstructed and an FE-model of the experimental situation was generated and simulated. MR-image information was compared with simulation results. Results: Deformation of gluteal skin/fat and passive muscle tissue and support material under loading was in good agreement with the corresponding MR-image data. Visual accordance was found for deformed skin boundary as well as for internal fat-muscle tissue boundaries by superimposing experimental and numerical output. In addition, section surface boundaries of the MR-images and the FE-model of skin/fat and muscle at the deformed state were discretized and sufficient sample points were provided. A correlation factor of R2 =0.998 for skin/fat deformation was derived, comparing simulation with MRI output. Conclusion: Reliability of employed tissue material parameters for use in realistic loading scenarios at finite strains including complex tissue and bone anatomy, non-linear tissue support material, multiple tissue types and contact interactions is shown.
Keywords: Pressure sores, human gluteal soft tissue, FE-simulation, tissue material parameters
Abstract: Controversy exists in the literature regarding the most appropriate treatment for anterior cruciate ligament (ACL) ruptures in the skeletally immature patient. To study the histological and biomechanical stages following ACL reconstruction during growth, it is necessary to establish an equivalent model to replicate the situation of an immature skeleton. In the present study we evaluated a large animal model of ACL reconstruction during growth using skeletally immature sheep. In contrast to existing models we did not intend to provoke growth disturbances. Instead, we identified those criteria known to be essential to prevent growth disturbances in the human situation…and transformed them into an animal model. Applying those criteria to skeletally immature sheep at an age of four months, we performed a fully transphyseal ACL reconstruction of their right knee. The contralateral knee served as a control. The sheep were then sacrificed 3, 6, 12 and 24 weeks after surgery. This animal model is described in detail in the present manuscript. Basic science data are presented in order to 1) make it easier for other research groups to study ACL reconstruction during growth using our model and 2) to improve this model by modifying the one or other detail of the proposed technique. Using this model, remaining open questions concerning ACL reconstruction during growth can be addressed in future studies.
Keywords: ACL reconstruction, growth, animal model
Abstract: In this paper, we report a procedure for making a patient specific Fasciaform Mold for a Formaldehyde Fasciaform Grafting Tympanoplasty procedure based on Computer Tomography (CT) of the patient's temporal bone. Three dimensional ear canal models were first reconstructed from the CT scans of patients. The models were then used by CNC (Computer Numeric Control) machines for making stainless steel molds as well as rapid prototyping machines for producing acrylic based polymer molds. Both a stainless steel mold and a pair of plastic acrylic molds were produced for Formaldehyde Fasciaform Grafting Tympanoplasty. The procedure is found to be feasible in…producing a patient specific fasciaform mold within a reasonable time.