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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: With current advances in sensing technology, communication networks and software applications, the use of connected health technology within the home environment has become both more affordable and widespread. Nevertheless, the introduction of this new care paradigm has brought with it many challenges, with one of the most notable being assessing of the impact or otherwise of its usage. The assessment of efficiency, benefit and utility of such technology is recognised as still being in its infancy. Traditional evaluation protocols may fail to address the specific challenges associated with increased use of networks, databases and home deployments, in addition to the…multitude of factors influencing successful adoption. This article aims to delineate the required steps of connected health technology evaluations and move towards a common framework that can be used to support future evaluations. A series of recommendations are presented based on previous experience in the domain.
Abstract: It is becoming increasingly important to improve knowledge of physiotherapists about iontophoresis since it involves topical medications. There is need to ascertain that physiotherapists have adequate knowledge of the procedure. The primary aim of this study was to determine the opinion and knowledge level of Nigerian physiotherapists about iontophoresis. One hundred and twenty-three (123) physiotherapists were purposively selected. A structured self-administered questionnaire was used for this study. The data were analyzed using descriptive statistics. The result showed that 40 (33.3%) physiotherapists were using iontophoresis as a treatment technique for skin ulcer, hyperhidrosis, and arthritis. Sixty-six (53.7%) of all the respondents…chose galvanic (interrupted galvanic) current as the mode used for applying iontophoresis, 43 (35.0%) chose wrongly, faradic current as the current mode while 14 (11.3%) are ignorant of the correct current mode. The result showed variations in electrode placement for stimulation among physiotherapists- nerve root (12.2%), myotome (10.6%), trigger or acupuncture points (22.0%) while 12.2% indicated that they had no idea of appropriate electrodes placement. There was no significant difference in the mean percentage difference in the number of respondent who were correct in the type of current format being utilized for iontophoresis procedure and those who were wrong. Also, there was no significant difference in the mean percentage difference in the number of respondent who uses different methods of electrode placement. Most physiotherapists (62.6%) chose 1–15 minutes as the duration of application for iontophoresis while 31.7% chose their parameters based on patient's tolerance, experience and patient's condition. It was concluded that few physiotherapists in Nigeria have adequate knowledge about iontophoresis and very few are using iontophoresis as a treatment option.
Abstract: Robotics-assisted treadmill exercise has potential for cardiovascular rehabilitation of patients with miscellaneous neurological deficits. A novel approach is presented here which suggests using heart rate to define and control exercise intensity during robotics-assisted treadmill exercise. The work delineates the design and provides technical validation of the new method. A feedback structure in conjunction with a human-in-the-loop feedback for volitional control of mechanical work rate is proposed which provides automatic regulation of heart rate. A controller computes the target mechanical work rate based on target and actual heart rates. An analytical model-based method was used to design the controller.…The overall feedback design process is technically validated through a test series with different control tasks including square-wave tracking, disturbance rejection, ramp tracking and an open loop test. The feedback method and the heart rate control provide close to nominal performance for square-wave and ramp reference tracking tasks below and above the anaerobic threshold, which was estimated by the V-slope method. The controllers provide robust and stable performance as verified by calculation of the root mean square error of the tracked heart rate at different effort levels as well as with the disturbance test. Further work is required to evaluate the robustness of the approach across a group of subjects including neurological patients to show the potential for clinical implementation and to achieve a positive effect for the cardiovascular status of patients.
Abstract: Objective: To evaluate the usability of touchscreen mediated nutrition and feeding educational modules among low-income Latino immigrant parents. Methods: A cross-sectional study was performed March-August, 2010 in an outpatient pediatric setting among low-income Spanish-speaking parents of children < 3 years. Culturally-targeted educational modules focused on infant/toddler nutrition and feeding were delivered via touchscreen to participants in Spanish using a multimedia format including text, audio and pictures. Viewing of all modules lasted 25 minutes. Demographic and computer use data was collected. The outcomes assessed were perceived ease of use of the touchsreen and usefulness of the educational modules.…Results: The majority of the eighty participants reported rarely/never using a computer (64%; n=51) and 46% reported ⩽ 8th grade education. 92% of participants found the touchscreen ‘easy’/‘very easy’ to use. Nearly all users found the modules ‘useful’ (95%) and ‘easy’ to understand (96%). Higher educated individuals were more likely to find the touchscreen ‘very easy’ versus ‘easy’ to use (Odds Ratio=3.67, 95% CI:1.18–11.43) and the modules ‘very easy’ to understand (OR=3.99, 95% CI:1.37–11.62). Conclusions: Despite low computer experience levels, participants perceived touchscreens and the content presented as highly usable. Ongoing evaluation of providing targeted health education via touchscreens in this population is indicated.
Keywords: Health education, nutrition, Latino, technology, touchscreen computer, immigrant
Abstract: The appropriate maintenance of medical devices, including performance inspections and preventive maintenance, is fundamental in mitigating clinical risk caused by adverse events in health care. Although several models for managing and planning preventive maintenance have been developed, the problem is lacking in standard methodology and still presents an open challenge for today's health experts. This paper aims to provide and develop methodology together with support systems able to assist decision makers in constructing preventive maintenance and performance inspection plans, taking into account both the technical and economic needs of hospital clinical engineering departments. Interventions by decision…makers are of crucial importance within complex situations where large numbers, types of devices and different contractual situations are involved. SISMA system has achieved optimal results with minimum expense and maximum security for patients and technicians at the University Hospital of Florence where it has been applied in actual case studies.
Keywords: Technology in healthcare, clinical engineer, preventive maintenance, decision support system
Abstract: Background: The success of a tissue engineered construct is greatly influenced by the choice of scaffold material. Decellularized esophageal matrix is a promising material for esophageal tissue engineering. The aim of this study was to develop a decellularized ovine esophageal mucosa and to investigate the effect of decellularization on the appearance of the resulting tissue. Methods: Ovine esophagi were decellularized by combination of agitation, enzymatic digestion and treatment with 1 and 5% sodium dodecyl sulphate (SDS). Efficiency of decellularization was assessed by histological examination and DNA quantification. Finally, the effect of decellularization on tissue morphology was investigated…by scanning electron microscopy. Results: Decellularization resulted in a highly efficient removal of cells and DNA content. Electron microscopic investigation revealed a denuded, rough, undulating surface with preserved papillary structures. Individual papillae had a length of approximately 55 μm and were present at a density of 1332 μm/mm2 . Closer examination revealed a tightly packed sponge-like appearance with pores in the region of 300 nm. Numerous, intact collagen fibres were also visible. Conclusion: Ovine esophagus can be successfully decellularized through treatment with SDS. The resulting decellularized mucosal surface possesses a rough, 2D surface with a well preserved extracellular matrix. Such a material may be of advantage in tissue engineering of the esophagus. Characterisation of the papillary layer gives important insight into the suitability of decellularized esophageal mucosa for use in esophageal reconstruction and also provides morphological information which may help in the design of synthetic, biomimetic materials.
Abstract: The purpose of this prospective randomized comparative biomechanical study on four pairs of human cadaveric forearms was to discern whether primary stability following plate arthrodesis differs from the position of the screws. Four wrists were randomly assigned to either group such that one wrist of each pair was fixed via parallel screws and the other via an oblique screw crossing the radius and the lunate. Under fluoroscopic guidance, passive extension and flexion of each wrist was performed using a spring balance. Traction force increased by 5 N at each step, ranging from 0 N to a maximum of 100 N.…Fixation using a plate and oblique screw demonstrated lower recoverable deformation of the implant and a higher primary stability at the fusion site than parallel screws. The current investigators conclude that an oblique screw crossing radius and lunate increase primary stability which is consistent with the radiological results of comparable clinical trails.
Keywords: Radiolunate arthrodesis, wrist biomechanics, implant loosening, cadaveric study
Abstract: Observer error affects virtually all aspects of medicine. Our objective was to find a way to reduce it among clinical students. A minority need to be shown how to observe. A classroom exercise, repeated 6 times on separate days, using different simple objects, more than doubled the mean score on observation of visible properties of objects by a class of students in their first clinical year. Their corrected answer-slips were returned to the students at the next lecture 2 or 3 days later. Errors of omission and commission both decreased. Omission errors showed greater improvement but commission errors persisted in…the class. The increment in observation seemed to be retained 5 months after tuition. Attempts were made to make a universal proforma suitable for any observation. It increased mean class score by 33% in 1994. Reducing observer error may have an educational strand. strand.