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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: Optical navigation of needles < 1 mm diameter remains a challenging task. Bending of these tools is the limiting factor. Objective: To use a conventional optical navigation system for interventional fine needle procedures. Materials and methods: A novel custom-made device was constructed to guide the needle in the direction of the planned trajectory. Accuracy of this device was analyzed with two setups (A = ballistic gelatin; B = used pork meat). For both setups, a Plexiglas cube with integrated Plexiglas reference arrays was used. Metal targets of 1 mm diameter were placed in the center.…Images were acquired using a 3D fluoroscope connected to a conventional optical navigation system. After trajectory planning, ten navigated injections were performed freehand and with the linear bearing device for each setup. A 3D scan was performed to measure the distance between contrast medium and metal target after each injection. Results: Freehand navigation with a needle of 0.9 mm in diameter was not accurate with either setup (Setup A: mean 33.4 mm; range, 3-63 mm; Setup B: mean 40.1 mm; range, 12-75 mm). Linear bearing navigation was significant more precisely (Setup A: mean 0.7 mm; range, 0-0.75 mm; Setup B: mean 0.29 mm, range 0-1.3 mm) than freehand navigation. Conclusion: The linear bearing device reduced all bending. Optical fine needle navigation was accomplished with precision comparable to electromagnetic navigation. This device may provide useful for minimally-invasive clinical applications. Follow-up studies should compare electromagnetic and optical navigation systems in the same setup.
Abstract: Managing bipolar disorder is an important health issue that can strongly affect the patient's quality of life during occurrences of depressive or manic episodes and is therefore a growing burden to healthcare systems. A widely practised method of monitoring the course of the disorder is by mood and general mental health questionnaires, which are nowadays often implemented on mobile electronic devices. Detecting changes to daily routine and behaviour is of crucial importance as they can be symptomatic of an ongoing episode, or in the case of an external cause, may trigger such an episode. Current mobile phones and…geospatial technology provide a means of monitoring aspects of daily routine and lifestyle which may be valuable in facilitating self-management of the condition. This manuscript introduces a methodology for analysing data obtained from a simple wearable system based on a mid-range mobile phone, along with trial results from a control group of three participants with no history of Bipolar Disorder. It is suggested that such an approach offers an unobtrusive, acceptable and low cost means of monitoring bipolar disorder patients that could significantly improve their care.
Keywords: Bipolar disorder, significant location discovery, pervasive monitoring, mobile psychiatry, Bluetooth encounters
Abstract: Objective: (i) to compare cardiopulmonary performance parameters obtained from incremental exercise tests (IETs) performed using a robotics-assisted treadmill and an arm crank ergometer; (ii) to investigate test-retest reliability during both modes of exercise. Design: Each participant performed two IETs to the limit of tolerance on both a robotics-assisted treadmill and an arm crank ergometer. Setting: A Spinal Injuries Unit in the United Kingdom. Participants: 10 people with an incomplete spinal cord injury (SCI). Interventions: Not applicable. Main Outcome Measures: Peak oxygen uptake (V̇O2peak ), the gas exchange threshold (GET), peak…heart rate (HRpeak ) and peak lactate (Lactatepeak ) were obtained for each mode of assessment. The mean responses and test-retest reliability of the main outcome measures were determined and compared between modes of assessment. Results: V̇O2peak was 16% higher (p= 0.016) and the V̇O2 at the GET was 40% higher (p =0.007) during the robotics-assisted treadmill exercise (RATE) IET. There was a trend for HRpeak to be higher during arm crank ergometry (ACE) (p=0.058). Lactatepeak was 46% higher (p=0.006) during the ACE IET. During robotics-assisted exercise, the test-retest reliability was very high for V̇O2peak (r=0.95), high for the GET (r=0.75) and HRpeak (r=0.88), and moderate for Lactatepeak (r=0.58). For ACE, the test-retest reliability was very high for V̇O2peak (r=0.93), high for HRpeak (r =0.81) and Lactatepeak (r=0.78), and low for the GET (r=0.16). Conclusions: The results suggest that, when compared with ACE, RATE can be a highly effective stressor of the cardiopulmonary system, and may be a more appropriate mode of assessment to determine and monitor cardiopulmonary fitness in people with incomplete SCI.
Abstract: Purulent exudate is one of the clinical signs of decubitus ulcers; and it is indicative of infection. The greatest challenge is the decreasing sensitivity of infective micro-organisms to antibiotics. There appears to be paucity of data on the effect of Ultraviolet radiation on wound exudates and appearance. The main purpose of this study was to determine the effect of ultraviolet radiation (Type B) on wound exudates and appearance of decubitus ulcers. Ten (10) bed-ridden subjects with ascertained bilateral sore from unrelieved pressure in their lower extremities consented to participate in the study. The decubitus ulcers were treated with traditional saline-wet-to-moist…(WM) wound dressing. The decubitus ulcers on the left lower extremities were the experimental limbs and were exposed to ultraviolet radiation as adjunct while the right lower limbs served as control and received only the saline-wet-to-moist (WM) wound dressing. The frequency of treatment was 3 times per week for 6 weeks. The type of exudates produced, amount of exudates, wound appearance and depth description were scored on a 5-point likert scale. The data was analyzed using descriptive statistics and non-parametric inferential statistics (Kruska-Wallis test). The result of the Kruskal Wallis test showed that there was significant improvement in the type of exudates produced by the decubitus ulcers of the experimental (left) limbs (X2 = 33.71, p < 0.00) when compared with the control limbs. Similarly, there was significant reduction in the amount of exudates produced by the decubitus ulcers of the experimental limbs (X2 = 30.58, p < 0.00) when compared with that of the control. Also, there was significant improvement in the appearance of the decubitus ulcers (X2 = 33.01, p< 0.00) and depth description of the experimental (left) limbs compared to that of the control (right). This study concluded that Ultraviolet radiation (Type B) can significantly improve the appearance of decubitus ulcers. Also, it can significantly reduce the amount of purulent exudates and can hasten skin replacement of decubitus ulcers.
Abstract: Objectives: Technology overlapping is a phenomenon based on the availability of different technologies to treat the same morbidity in the same patient group. The aim of this study was to explore the cost-effectiveness of technology overlapping in a case study on colorectal cancer (CRC), and describe an approach to investigate the phenomena and to propose adequate interventions. Methods: A Semi-Markov model, based on a cohort of 10,000 people undergoing a CRC diagnostic test, was developed to simulate the overlapping phenomena and compare it with hypothetical scenarios where only one diagnostic tool is available. Deterministic sensitivity analyses were conducted…on parameters with the greatest uncertainty. Results: The results of the Semi-Markov model indicated that technology overlapping is not cost-effective. Conclusions: This study is a first attempt to address the significance of technology overlapping. The Semi-Markov model demonstrated that technology overlapping is the least cost-effective arm, so alternate health care policies must be investigated.
Abstract: The optimal forearm boom should facilitate dynamic investigation of the wrist and approaches for wrist arthroscopy. It should be safely fixed at the operating table without any contact with the patient. It must be compatible with the arm of any patient and should be sterilisable. Repositioning of distal radius fractures, fluoroscopy and insertion of Kirschner-wires should not be restricted. According to these criteria the current investigators designed a new forearm boom which was subsequently used in 19 wrist arthroscopies and 9 distal radius fracture fixations. Twenty-eight patients with heights between 150 and 205 cm and forearm lengths between 17.5 to…37 cm were treated. Preoperatively, wrist motion was tested in those 19 wrists, that underwent wrist arthroscopy, before and after fixation by the forearm boom and any restriction due to usage of the novel device was found. The new forearm boom satisfied all of the criteria cited above. Therefore the current authors believe the new forearm boom may be valuable for the indications mentioned.
Abstract: Introduction: Intramedullary nailing has become the gold standard in the treatment of femoral shaft fractures. This procedure involves the placement of distal interlocking bolts using the freehand technique. Accurate placement of distal interlocks can be a challenging task, especially in inexperienced hands. Misplacement of distal interlocking bolts can lead to iatrogenic fracture, instability of the bone-implant construct, or even malalignment of the extremity. Repeated drilling attempts increase radiation exposure and can cause additional bony and soft tissue trauma. We hypothesize that robot-guided placement of distal interlocks is more accurate, precise, and efficient than the freehand technique. Methods:…A custom-designed drill guide was mounted onto the arm of an industrial robot. We developed a special device to secure a generic block (Synbone, Malans, Switzerland) into which an intramedullary nail could be inserted in a standardized way. A metric scale allowed later measurements of the drillings. Digital images were taken from each side of the block for analysis of the drilling trajectories. The fluoroscope was adjusted to obtain perfect circles of the distal interlocking holes. The number of images necessary to achieve this was recorded. The axis was recognized automatically by using the differences in contrast between the matrix of the generic bone and the implant (intramedullary nail). The drill trajectories were then computed. The robot with the mounted drill-guide automatically moved onto the calculated trajectory. The surgeon then executed the drilling. We performed 40 robot assisted drillings in generic blocks. Freehand drilling served as our control group. Results: Analysis of the digital images revealed a mean deviation of 0.94 mm and 2.7° off the ideal trajectory using robotic assistance. In 100% of the cases (n=40), the distal locking hole was hit. A mean of 8.8 images was acquired. After manual drilling, 92.5% of the distal interlocks were hit. A mean deviation of 3.66 mm and 10.36° was measured. A mean of 23.4 fluoroscopic images were needed. The differences between the two methods were statistically significant. Conclusion: Robot-guided drilling increases the accuracy and precision of distal interlocking while reducing irradiation. Considering economical and logistical aspects, this application should be integrated with robot-guided fracture reduction.
Abstract: Introduction: The accuracy of preoperative planning of the size of total knee arthroplasty (TKA) in literature is only 50%. A problem of conventional radiographic planning with prothesis templates is varying enlargement of the radiographs. Digital planning and analysis of lower leg geometry revealed improved reliability compared to conventional techniques. The aim of the study was to evaluate the accuracy of digital planning of TKA with special planning software and calibrated radiographs and its interobserver reliability. Methods: In a prospective study the sizes of 30 TKA were planned with special software by a senior and a junior surgeon…independently. For calibration a 30 mm reference ball on the radiographs was used. The planning was compared with the intraoperative chosen size of the TKA. Results: The correlation of the planned femoral component with the chosen size was 87% for the senior and 77% for the junior surgeon. The planning of the tibial component revealed a correlation for the senior surgeon in 90% and for the junior surgeon in 87%. Both component was planned correctly in 77% by the senior and in 63% by the junior surgeon. In 50% the planning of both surgeons matched completely the used prosthesis sizes. The linear κ coefficient of Cohen revealed a good agreement (0.65) and a high interobserver reliability. Discussion: Planning TKA with special planning software with digital, calibrated radiographs is more accurate compared to previous conventional planning. The senior surgeons planning of both component sizes matched in 77% the correct size. Clinical experience improves the accuracy of preoperative planning.
Keywords: Total knee arthroplasty, digital planning software, accuracy of planning, interobserver reliability
Abstract: Background: Precise identification of bony landmarks by use of pointer based navigation systems is influenced by thickness of soft tissue. Ultrasound-based navigation systems try to overcome the problems of positional deviation associated with soft tissue. The aim of the study was to investigate the influence of the BMI and the thickness of the soft tissue on the post-operative cup position and accuracy in the application of an ultrasound-based (US CAOS) and a pointer-based navigation system (P CAOS). Methods: 82 patients received a hip replacement in minimally invasive surgery in two cohorts: US CAOS group: using ultrasound navigation…(n = 39) and P CAOS group: using a pointer-based navigation (n = 43). Results: There was a significant difference in anteversion and anteversion error between the groups. In addition, we observed a significant correlation between the thickness of the presymphysial soft tissue and the anteversion error in both groups. We also detected a significant correlation between the anteversion error and the BMI in both groups. However, the absolute error in anteversion with increasing thickness of the soft tissue layer was slighter in the ultrasound-based group compared to pointer-based navigation. Conclusions: The accuracy of the ultrasound-based and pointer-based navigation systems are influenced by the BMI and the thickness of the soft tissue layer above the symphysis. However, ultrasound-based navigation seems to have advantages with thicker soft tissue layers, as seen in overweight and obese patients.
Keywords: Ultrasound-based navigation, pointer-based navigation, acetabular cup orientation, accuracy
Abstract: Healthcare is one of the largest and fast growing industries in the U.S. The U.S Bureau of Labor Statistics stated that it provided 14.3 million jobs for wage and salary workers in 2008 and it is estimated that 3.2 million new wage and salary jobs will be generated between 2008 and 2018 . Unfortunately, that is only an estimate. Advancements and emerging technologies are more prevalent these days which could affect the amount of jobs that exist. One such technology is TeleHealth. I will look at the future of technology and the affect it might have by replacing human jobs…with machines; will technology create additional jobs, or take jobs away. My objective is to explore the area of TeleHealth in depth through published research articles to support my theory, if technology expands and become more advanced then it will eventually replace humans in their jobs in the health care industry as well as create new jobs in different areas of the field.
Keywords: TeleHealth, remote monitoring, E-visit, E-Consult, technology and jobs, robotics, health care