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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: Internet has provided patients with a new source of variable medical information. Osteoporosis is a major public health concern and providing patients with accurate information regarding diseases and treatment is an essential component of medical care. The primary objective of this study was to assess the quality of Internet based nutrition information for osteoporosis patients. The search items “osteoporosis”, “diet”, “nutrition”, and “bone loss” were entered into the five most consulted search engines: Google, Yahoo, Bing, AOL and Lycos. The first 20 website matches generated by each search engine were 400 and grouped together by URL (uniform resource locators) suffix.…326 websites were excluded from the study as they had insufficient information, nonfunctioning links, websites not in English and duplicate websites. Of the remaining 74 sites, 64% were .Com sites followed by 18% .Org sites. .Org websites received the highest interface and content scores. Raters with healthcare and technical background rated the website interface and quality of content on the internet differently and this could be largely due to different training of the two raters and the manner in which they perceived the content. Health information websites should take into account the users' diverse backgrounds when presenting content to consumers.
Abstract: In this work various methods of parametric elastic models are compared, namely the classical snake, the gradient vector field snake (GVF snake) and the topology-adaptive snake (t-snake), as well as the method of self-affine mapping system as an alternative to elastic models. We also give a brief overview of the methods used. The self-affine mapping system is implemented using an adapting scheme and minimum distance as optimization criterion, which is more suitable for weak edges detection. All methods are applied to glaucomatic retinal images with the purpose of segmenting the optical disk. The methods are compared in terms of segmentation…accuracy and speed, as these are derived from cross-correlation coefficients between real and algorithm extracted contours and segmentation time, respectively. As a result, the method of self-affine mapping system presents adequate segmentation time and segmentation accuracy, and significant independence from initialization.
Abstract: Introduction: Objectively measuring the effect of primary care process interventions is very challenging. Real time location systems (RTLS) hold the potential to solve this problem. Methods: An outpatient clinic was outfitted with a RTLS based on active-RFID (radiofrequency identification). Staff and patients volunteered to wear RFID transponders which unobtrusively recorded time and location. Wearers were identified only by their role: Patient, MA, RN, MD. The clinical process intervention consisted of reorganizing how medical assistants were utilized from a ad hoc common pool of medical assistants to dedicated assignment of medical assistants. Process measures were recorded before, during…and after the intervention. Results: 230 unique patient encounters were recorded from October 2009–January 2010. Eight MDs, 7 MA and 6 RNs participated. Total flow time was significantly decreased while waiting room time was increased. Variance was significantly reduced for both total flow time and face time. In-room wait time and patient face time were decreased, though this did not reach statistical significance. Conclusion: Objectively measuring process change in primary care is feasible using RTLS. In this case the intervention resulted in the waiting room being used more effectively as a process buffer smoothing flow and potentially increasing clinic capacity.
Keywords: Primary care, RFID, Real-time location systems, process improvement, operations research
Abstract: Aim: The purpose of this study is to review current in-hospital based coding techniques and explore various means by which clinicians and HIM (Healthcare Information Management) staff members (which include Coding Technologist or "Coders") miss potential technical fee reimbursement due to poor dictation and/or lack of knowledge of the newer MS-DRG coding system in the U.S. Methods: An analysis of the 2008 implemented MS-DRG reimbursement system was conducted to compare it to the older DRG system in use prior. With the help of a practicing Cardiologist, five randomly selected inpatient charts were reviewed to identify whether or…not there was an opportunity to push deeper in to the patient diagnosis and treatment plan to determine if an opportunity existed to code each patient's diagnosis plan at a higher level due to poor documentation practices. Results: The review of five in-hospital patients charts seen by a Cardiologist, found that by correctly understanding the newer MS-DRG coding specifications and documenting patient diagnosis and comorbidities to appropriate reimbursement levels the hospital could have increased technical fee payments by about $50,000. Conclusions: By educating clinicians and HIM staff members to be rigorous in their dictation and interpretation of the patients MS-DRG diagnosis, comorbidities and treatment protocol, hospitals will be able to reclaim potentially millions of dollars annually. As more facilities adopt EMRs (electronic medical records), the introduction of "reminders" or drop down lists within an EMR could aid on the whole coding completeness, thereby increasing overall technical fee reimbursement levels while ensuring possibility of not overcharging accounts.
Keywords: MS-DRGs, reimbursement process, hospital payment, physician coding, informed decision making, best practices, medical diagnosis, centers for medicare and medicaid services (CMS), health insurance portability and accountability act (HIPPA)
Abstract: University students use mobile phones frequently. We previously showed that there was no association between mobile phone use and EMF health hazards among university students. As our previous study was based only on self-reported symptoms this double-blind study was designed to answer two basic questions. Firstly, are self-reported hypersensitive individuals capable of sensing whether there is a real/sham microwave exposure? Secondly, do hypersensitive patients show alterations in their biological parameters such as heart rate, respiration, and blood pressure during microwave exposure? The study consisted of a preliminary screening phase and two subsequent complementary phases. In the 1st phase, 700 students…were screened for EMF hypersensitivity. Fifty two participants were hypersensitive individuals but after applying the exclusion criteria only 28 students were invited to take part in the 2nd and 3rd phase of the study, but only 20 students (71.4%) declared their informed consent. In the 2nd phase, these self reported hypersensitive participants, were exposed/sham exposed to microwave radiation emitted from a mobile phone for 10 minutes and they were asked if they could sense the existence of microwave radiation. In the 3rd phase, all students were connected to ICU monitoring devices and their basic physiological parameters were recorded precisely. Among self-reported symptoms reported in our previous study, in this study only problem in concentration (P< 0.05) and low back pain (P< 0.05) were associated with mobile phone use. Furthermore, there was a significant association between the location of mobile phone during talk and the overall score of the severity of the symptoms (P< 0.001). When the participants were asked to report their perception about the real and sham exposures, only 5 students (25%) could discriminate the real exposure/sham exposure phases. This relative frequency can be only due to chance. In the 3rd phase all of the 20 participants were connected to intensive care unit monitors and the changes in their heart rate, respiration, and blood pressure during real/sham exposure were recorded. No statistically significant changes between the means of these parameters in real/sham exposure were observed. Our findings clearly confirm the results obtained inother provocative studies. These data also indicate the possible role of psychological factors in electromagnetic hypersensitivity.
Abstract: Technology management in healthcare must continually respond and adapt itself to new improvements in medical equipment. Multidisciplinary approaches which consider the interaction of different technologies, their use and user skills, are necessary in order to improve safety and quality. An easy and sustainable methodology is vital to Clinical Engineering (CE) services in healthcare organizations in order to define criteria regarding technology acquisition and replacement. This article underlines the critical aspects of technology management in hospitals by providing appropriate indicators for benchmarking CE services exclusively referring to the maintenance database from the CE department at the Careggi Hospital in Florence, Italy.
Keywords: Health technology management, clinical engineering, database analysis, support systems in healthcare
Abstract: In this work the retardation of Ehrlich tumor growth implanted in mice was studied by employing 4.5 Hz magnetic field. Eighty female Balb/c mice were used, twenty as normal group; the other sixty mice were inoculated with Ehrlich tumor, then they were divided equally into three groups namely A, B and C. Group A (control group) animals were not exposed to the magnetic field. The tumors in the thigh of the animals of group B were exposed to 4.5 Hz, 2 Gauss square wave magnetic field by using a small solenoid connected to a power square…wave generator. Group C animals were whole body exposed inside a large solenoid to 4.5 Hz, 2 Gauss square wave magnetic field. Both groups B and C were exposed for a period of 2 weeks at a rate 2 hours per day. Tumor volume, survival period, histological examination and dielectric relaxation of the tumor were measured to investigate the activity of the tumor of the exposed and the unexposed animals. The results indicated that exposing the tumor tissue to 4.5 Hz square wave magnetic field for 2 weeks at a rate 2 hours/day inhibited tumor growth and increased the survival period of the animals. However, group B showed more improvements than did group C. This was attributed to some distortions in the square waveform in the large solenoid (group C). By comparing data from current and previous work, it was concluded that the use of magnetic waves showed better results over previously published work using amplitude modulated electromagnetic waves with the same frequency.
Keywords: Extremely low frequency, Ehrlich tumor, magnetic field effects, magnetic field therapy, Tissue dielectrics
Abstract: Injuries of tendons and ligaments give rise to significant morbidity. Tissue engineering offers promising treatment concepts such as seeding a scaffold with human bone marrow stem cells (hBMSCs) to create high-quality tendon replacement tissue. HBMSCs are usually isolated and cultured prior to seeding. Studies evaluating if previous isolation is superior to seeding with bone marrow aspirates have not been published yet. The aim of this study was to compare these two seeding methods in terms of cell viability, proliferation and differentiation. HBMSCs were harvested from the iliac crest during routine trauma surgery. In group A the scaffold (human…achilles tendons) was seeded with bone marrow aspirates, while in group B hBMSCs were isolated, harvested and then seeded. Constructs were stimulated in perfusion bioreactors according to established protocols. Mean cell proliferation was significantly increased (p< 0.05) on tendons seeded with bone marrow aspirates. Cell viability, the concentration of alkaline phosphatase in the perfused media and the synthesis of procollagen – III – polypeptide (PIIIP) were not significantly different when comparing the two groups. The synthesis of procollagen-I-polypeptide (PIP) was significantly increased on tendons seeded with previously isolated hBMSCs p < 0.05). The results indicate that seeding a human tendon matrix scaffold with bone marrow aspirates may be equal to seeding with previously isolated hBMSCs. This new seeding method could facilitate and speed up the tissue engineering process.
Keywords: Tissue engineering, tendons, human bone marrow stem cells (hBMSCs), human tendon scaffold, cell proliferation, FGF-2 (fibroblast growth factor)
Abstract: The paper presents the background, main achievements and components of rehabilitation robotics in a simple way, using non-technical terms. The introductory part looks at the development of robotic approaches in the rehabilitation of neurological patients and outlines the principles of robotic device interactions with patients. There follows a section on virtual reality in rehabilitation. Hapticity and interaction between robot and human are presented in order to understand the added value of robotics that cannot be exploited in other devices. The importance of passive exercise and active tasks is then discussed using the results of various clinical trials, followed by the…place of upper and lower extremity robotic devices in rehabilitation practice. The closing section refers to the general importance of measurements in this area and stresses quantitative measurements as one of the advantages in using robotic devices.