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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: Noninvasive ventilation is increasingly used in newborns, but intubation and mechanical ventilation remain important lifesaving tools for neonatal intensive care. New lung-protective mechanical ventilation technologies were developed in the last few decades and are now commercially available. Nevertheless, a recent survey (van Kaam et al. J Pediatr 2010) reported that time-cycled pressure-limited ventilation is the most common mode in neonatal ventilation and that newer ventilation modes are rarely used. The aim of this survey was to provide an overview of modern ventilation strategies based on available clinical studies. These new ventilation strategies can improve numerous physiological variables, but there is…little information about the associated risks and long-term outcomes. We suggest that additional randomized controlled trials of these new ventilation strategies are needed before any definitive recommendations can be given.
Keywords: Mechanical ventilation, synchronized mechanical ventilation, high frequency ventilation, proportional assist ventilation, infants
Abstract: We used the Recursive Least Squares algorithm and a predictor filter to automatically identify the start and stop times of 6 simple nursing activities. The dataset included continuous acceleration recordings obtained with a single accelerometer sensor attached to the backs of 8 nurses. The algorithm requires no training. It identifies the start and stop time of each activity when at least 2 of 3 axes show significant acceleration changes not more than a second apart. The overall accuracy of the algorithm for a total of 96 start and stop events was 86.46% ± 12.55%. The accuracy was higher than 91%…for 5 out of 8 subjects. The algorithm also indicated the onset of subcomponents of nursing activities for the majority of the subjects. The results of this study suggest that the presented algorithm may be useful in identifying transition points of human activities recorded with accelerometers.
Keywords: Infection control, hand hygiene, accelerometer, nursing activities, transition points, recursive least squares, adaptive segmentation
Abstract: Objectives: A robotic system has been used in tens of thousands of minimally invasive prostate cancer treatment surgeries worldwide. The aim of the paper is to evaluate the effectiveness of the robotic surgery versus traditional surgery for the treatment of early prostate cancer in Italy. Methods: Since this study is an observational study, we have no control over the treatment assignment. However, the treated (patient who undergo robotic assisted laparoscopic prostatectomy (RALP)) and control groups (patient who undergo open radical prostatectomy (ORP)) may differ significantly prior to treatment in ways that may affect the outcomes under study.…In order to avoid erroneous conclusions we have dealt with the problem of significant group differences by using a propensity score matching procedure. Results: The average age at radical prostatectomy for the two groups was similar. 97% of patients have bladder neck sparing during the open prostatectomy versus 77% of patients who belong to RALP group. RALP group presents higher urinary continence and lower blood loss rate with respect to ORP group (86,3% versus 65.6% and 9% versus 31.1% respectively). Among patients who underwent ORP 20.4% were spared nerves versus 4.5% of patients who were treated with RALP. The body mass and self-assessed health for the two groups were similar. In the logistic regression model used for the calculation of Propensity Score, bladder neck sparing and the size of the tumor were significant and presented a negative coefficient. Older age, advanced stage of the tumor, and linfonodal involvement negatively affect the likelihood of robotic technology. From our empirical analysis it arises that the robot technique does not significantly affect the hospital stay, blood loss nor the variables about post-intervention quality of life (urinary continence and self-assessed health). Conclusions: The robotic system does not seem to present major efficacy with respect to open radical prostatectomy. In particular our findings do not support any significant differences in quality of life, blood loss, hospital stay, and urinary incontinence in patients operated with robot-assisted surgery versus open retropubic radical prostatectomy.
Keywords: Robot-assisted surgery, open radical prostatectomy, SAH, propensity score matching
Abstract: The growth of health information technology, the focus on patient safety and an increased degree of regulatory involvement in the practice of medicine have all transformed the way practitioners provide care. This paper reviews some of the recognized benefits of these advances, while outlining some of the challenges for providers at the bedside, utilizing a case study involving a hypothetical obstetric patient. The way external factors, such as information technology and regulatory requirements, influence the daily practice of medicine, should be carefully considered as the profession evolves. Integration and streamlining processes should remain a guiding principle to ensure patient…safety and assist with workflow.
Abstract: This paper discusses the application of an adaptive technology platform to evaluate clinical pathways, clinical strategies and their application to early genetic testing in Europe. It results from a collaboration between Professor Christine Huttin, who created a technology startup called endepusresearchinc (www.endepusresearchinc-com) in Cambridge USA and Dr Michael Liebman, Managing Director of Strategic Medicine, Inc.(www.strategicmedicine.com) positioned in the translational medicine space with technologies to model disease processes and experience in early genetic testing for breast cancer. Diagnostics was identified as a potential area for application of economic and business models using ENDEPUSresearchinc statistical methods combining implicit and explicit financial information…for prospective payment systems in various types of health care financing systems. The new economics resulting from such platforms challenges the constrained environment for public, private laboratories and partnerships, the restrictions imposed by governmental agencies, alliances between stakeholders such as the medical profession and laboratories: such early technologies are clearly identified as a key benefit to the system over time but a major challenge for short term returns.
Keywords: Early genetic testing, breast cancer, translational medicine, adaptive technology
Abstract: Magnetic Resonance Imaging (MRI) has established itself as a major imaging modality in life science research and clinical practice. It is characterized by high spatial resolution, high soft tissue contrast, non-invasiveness, and universal applicability in terms of orientation and location of imaging areas. The procedure allows furthermore the investigation of physiological and pathophysiological processes, in particular in combination with Magnetic Resonance Spectroscopy (MRS). MR methodology is not exhausted, new procedures and areas of application develop widely in life science and medicine. This article is limited to basic physical aspects.
Keywords: Magnetic resonance imaging, magnetic resonance spectroscopy, diagnostic imaging