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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: Introduction: The aim of the study was to investigate the role of the intra-operative three-dimensional imaging in the tibial plateau fractures with complex depressions. Material and methods: Thirty tibial plateau fracture patients with complex depression were treated with the use of intra-operative three-dimensional imaging (Arcadis 3D). The image quality as well as the clinical benefit was evaluated. Results: In total 74 plates were used in these 30 patients. Six Kirschner wires and 50 screws were used…outside the plate as raft technique in 4 and 21 patients. The additional critical imaging information which was unachievable in plain fluoroscopy was gain in 12 patients. Four patients among these 12 patients were revised because of the depression. Two patients were revised due to the misplacement of screws. Conclusion: The intra-operative three-dimensional imaging (Arcadis) is necessary when the two-dimensional fluoroscopy was unsatisfactory in the depressed tibial plateau fracture.
Abstract: Competence in performing endoscopy requires a considerable amount of hands-on practice for a physician to master. In an effort to reduce the involvement of patients in the training process, simulation has become an important part of endoscopic training. This paper presents a low-cost training and evaluation system for upper endoscopy that serves as an additional or alternative tool, particularly for entry-level gastroenterology fellows. The protocol of making a customized mechanical training model that provides…realistic visual appearances of the upper GI tract was created. The materials and methods used in the fabrication are outlined step-by-step in this report. A software application associated with the mechanical model was also developed to provide help for trainee during practice, evaluate the performance automatically upon completion of the training tasks, and record the performance and results in a database for review or further analysis by the trainee or instructor. Our software provides trainee with an interactive training experience. A survey obtained from sixteen gastroenterologists shows a promising feasibility of using the developed system. The developed low-cost upper endoscopy simulator can provide both training and evaluation functions with substantially low investment.
Keywords: Upper endoscopy, training simulator, fellow evaluation, endoscopic image classification, support vector machines
Abstract: After total knee replacement the persistence of pain represents a significant problem. In this study, a novel knee arthroplasty (Aequos G1 knee arthroplasty) is investigated that was designed to replicate main features of human knee morphology to reduce the periodically occurring pain after knee replacement. Previous work showed theoretically that this arthroplasty design may reconstruct the four-bar linkage mechanism as it occurs in human knee by contriving a convex lateral tibial compartment and a sagittal offset…of the centre of the medial and lateral femur condyles – inducing a roll-back mechanism as it exists in human. The aim of this study was to determine whether this potential roll-back mechanism can be confirmed by in-vivo measurements. This retrospective study showed that the patellar tendon angle decreases during flexion of 0.21° per degree of flexion on average in the 16 knees studied. This amount is similar to physiological knee kinematics and in contrast to existing results in the literature after implantation of conventional total knee replacements which lack physiological knee kinematics. The results suggest that physiological motion after implantation of the Aequos G1 knee arthroplasty occurs during loaded motion up to approximately 45° knee flexion.
Abstract: Introduction: The importance of the vitality of a nonunion is crucial for the planning of the reconstructive procedure. Purpose of the present study is to analyze the role of single photon emission computed tomography (SPECT) in diagnosing and planning the treatment of atrophic nonunions in the upper and lower extremity. Patients and Methods: This study examined retrospectively the SPECT/CT scans of 10 patients (mean age = 44.5 ± 16.5 years, 9 males/1 female,…4 tibia/4 femur/1 radius/1 fibula) who underwent surgical exploration for suspected avital pseudarthrosis. Surgical and histopathological findings were compared with the radiologists' findings to assess the sensitivity and specificity of SPECT in diagnosing avital nonunions. The average interval from the osteosynthesis until their SPECT scan was 18 months. All surgical findings have been documented electronically in the hospital computer system. Results of the radiologist's reading were then compared with surgical exploration and histopathological findings and specifity and sensitivity was calculated. Results: There were 4 vital and 6 nonvital pseudarthroses. SPECT scans identified all the vital pseudarthroses and 3 of the 6 nonvital pseudarthroses. The sensitivity of SPECT in diagnosing non-vital atrophic nonunions is 50% and the specifity 100%. Conclusions: SPECT/CT scan is a test with a low sensitivity but good specificity that excludes infection and confirms nonviability of the nonunion site. However, we shall wait for larger pool of research results in order to incorporate this test in routine clinical use.
Abstract: Since heparin has been in use as an anticoagulant during vascular surgery and medical problems such as DVT or pulmonary embolism, there has been no consensus as to the best method of monitoring its effect on anticoagulation. In this study we used Sonoclot Analyzer to detect hemostasis changes resulting from heparin administration. The study involved 16 randomly selected male patients undergoing peripheral reconstructive surgery. Blood samples were drawn and analyzed in the operating room on the…Sonoclot Coagulation and Platelet Function Analyzer. Results showed that patients respond to heparin differently. The Sonoclot monitors the hemodynamics of blood using four variables: SonACT (activated clotting time) time, rate, peak, and contraction rate. Heparin has three effective on the Sonoclot Signature; prolonged ACT result, lower clot rate, and reduction in clot retraction. The SonACT time is the time for first fibrin to form. Prolong this time indicates the presence of anticoagulation. The Sonoclot Analyzer results confirm that it is a reliable and sensitive device for monitoring heparinization levels.
Abstract: Purpose: This study was initiated to integrate information and enterprise-wide healthcare delivery system issues specifically within an inpatient retail pharmacy operation in a U.S. community hospital. Methodology: Six Sigma tools were used to examine the effects to an inpatient retail pharmacy service process. Some of the tools used include service blueprints, cause-effect diagram, gap analysis derived from customer and employee surveys, mistake proofing was applied in various business situations and results were analyzed to…identify and propose process improvements and integration. Findings: The research indicates that the Six Sigma tools in this discussion are very applicable and quite effective in helping to streamline and integrate the pharmacy process flow. Additionally, gap analysis derived from two different surveys was used to estimate the primary areas of focus to increase customer and employee satisfaction. The results of this analysis were useful in initiating discussions of how to effectively narrow these service gaps. Contribution: This retail pharmaceutical service study serves as a framework for the process that should occur for successful process improvement tool evaluation and implementation. Pharmaceutical Service operations in the U.S. that use this integration framework must tailor it to their individual situations to maximize their chances for success.
Keywords: Six Sigma, process integration, pharmacy process flow, GAP analysis, service blueprinting, enterprise information integration