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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: Gastral nutrition in critically ill surgical patients can be difficult because of gastric paresis and a large number of patients fail to reach required caloric intake. Endoscopic or radiologic placement of nasointestinal tube is frequently performed with delay and may raise the risks for critical ill patients. Objective: Bedside placement of electromagnetically guided nasointestinal tube (EGNT) may reduce the risk of x-ray exposure, “time out of ward” and caloric deficit. Methods: All patients in a surgical intensive care unit with need of post-pyloric feeding tube placement were identified. Data were collected from Cortrak™-EGNT-System…and x-ray. An analysis of placement success rate, time for tube positioning and delay of enteral feeding when EGNT failed were performed. Results: 70 tubes were placed in 51 patients. After the first trial 79% were placed post-pyloric and 21% gastral. Successful postpyloric placement increased to 90% after the second trial. Placement failure occurred in 10% of all cases. In 3 patients jejunal placement was successful in modified anatomical situs after upper gastrointestinal surgery. After 20 min unsuccessful postpyloric placement, performance was stopped and declared as failure. X-ray findings correlated in 100% with Cortrak™ data. Time needed for placement varied from 1–20 min (mean 7,6 min). Conclusions: Bedside positioning of electromagnetically guided nasointestinal tube is safe and effective in critically ill surgical patients. Most placements succeed, even in patients after upper GI surgery. EGNT positioning is time saving and may enhance the caloric intake.
Abstract: Background: Recurrence of hepatocellular carcinoma (HCC) after surgical treatment is a common problem. It can be treated by radiofrequency ablation (RFA) or repeated hepatic resection (HR). This report compares both in a retrospective, single-institution database. Patients and methods: A prospectively collected database was retrospectively analyzed. RFA was performed under ultrasound control using two different monopolar devices. All kinds of access were used: open surgical (n=10), percutaneous (n=13) and laparoscopic (n=4). HR was performed using an ultrasound aspiration device. Indication for a particular treatment was allocated on a case-by-case basis; the final decision was often made intraoperatively.…Results: Survival after RFA (median 40 months) was similar compared to that after HR (48 months, p=0.641, logRank-test). Tumor-free survival was markedly impaired after RFA (15 vs. 29 months). This difference was however not significant (p=0.07, logRank-test). Both groups were different regarding occurrence of cirrhosis, maximal tumor size, time after initial diagnosis and duration of the procedure. Conclusion: In this non-randomized retrospective trial, survival and disease-free survival was not significantly different when compared between patients treated by RFA and HR. There was however a tendency towards a longer tumor-free survival in the resected patients.
Abstract: Background: Metabolic Syndrome (MetS) in India is a major contributor to the global increase in CVD. Lifestyle modification programs have been effective in reducing the burden of MetS. Objective: The Objective of our study was to evaluate the quality of MetS related health information on the internet in an Indian context. Methodology: We used a key term “metabolic syndrome” to retrieve websites from Google, Yahoo and Bing search engines by restricting pages from India during May 2012. Previously validated DISCERN tool was used by the three raters to assess 44 websites. All results have…been reported as p-values. Results: The most common topics that were covered in these websites included causes and risk factors of MetS (77.27%). On the contrary medication (13.64%), lab tests (11.36%), type of physical activities (6.82%), prognosis and regular check-ups (4.55%) were the least mentioned topics. The website category .org had higher average DISCERN scores as compared to others categories. Conclusion: Limited information was available related to treatment choices, warning signal and informed decision and hence the need exists for further research to develop evidence based health information portal for MetS in an Indian context.
Keywords: Evaluation, health information, internet, metabolic syndrome, quality
Abstract: Background: Very little is known about the perception of patients with alcohol use disorder (AUD) and comorbid depression about the usefulness of supportive text messages. Objective: To examine the perception of patients with AUD and comorbid depression about the usefulness of supportive text messages. Methods: Participants (n=26) with a DSM IV diagnosis of AUD and depression and completing an in-patient dual diagnosis treatment programme had twice daily supportive text messages delivered to their mobile phones for three months as part of a randomised trial. Participants were contacted at the end of the third month…to obtain their views regarding the usefulness of the supportive text messages using a semi-structured questionnaire. Results: Overall, 24 out of 26 patients were contactable for feedback (92% response rate). Eighteen (75%) patients reported that the text messages always or often reminded them to remain abstinent from alcohol. Again, 20 (83%) patients reported that the intervention had played a useful role in helping to improve their mental health, in particular, in serving as a motivation for recovery and in preventing relapse. Conclusions: Patients with AUD and depression perceive that supportive text messages help them to remain abstinent from alcohol and also improve upon their mental wellbeing.
Keywords: Depression, alcohol use disorder, supportive text messages, patients, perception
Abstract: Background: The introduction of a new technology in hospitals – Automated Dispensing Units (ADUs) – aims to contribute to more secure, safe, efficient and cost effective health services. Several studies highlight the beneficial effects of similar technologies as well as their cost-savings potential but there is little literature exploring nurses' perceptions and attitudes towards technology acceptance and the impact on technology use in a healthcare unit. Objective: This research aimed to explore nurses' perceptions and attitudes towards current technology use on their units and towards the introduction of ADU technology and use with nursing staff in two…different hospitals in South-East New-Brunswick, Canada. Methods: Semi-structured interviews were realized with the collaboration of nursing staff from two hospitals which were in urban and rural settings, prior to the introduction of ADUs in hospital wards. Results: Findings in this study highlight the fact that missing medications (i.e., doses not available in cart) are inherently related to the completion of nursing staff's medication distribution routine. Missing doses cause delays in medication delivery which may increase the occurrence of medication errors. Participants described current technology use as an intricate part of their routine. The latter is mainly utilized for patient monitoring and information retrieval. Overall, interview data indicated that ADU technology introduction is positively perceived by nursing staff particularly if the technology reduces missing doses events. Conclusions: Findings in this study underscore important concerns expressed by nursing staff regarding ADU technology integration into the current medication process and its impact on time management. Pre-implementation training and technical support were identified as important factors in facilitating technology acceptance and proper technology use.
Keywords: New technology, healthcare, medication distribution
Abstract: Background: A fundamental element of the social and safety function of a health structure is the need to guarantee continuity of clinical activity through the continuity of technology. Objective: This paper aims to design a Decision Support System (DSS) for medical technology evaluations based on the use of Key Performance Indicators (KPI) in order to provide a multi-disciplinary valuation of a technology in a health structure. Methods: The methodology used in planning the DSS followed the following key steps: the definition of relevant KPIs, the development of a database to calculate the KPIs, the…calculation of the defined KPIs and the resulting study report. Finally, the clinical and economic validation of the system was conducted though a case study of Business Continuity applied in the operating department of the Florence University Hospital AOU Careggi in Italy. Results: A web-based support system was designed for HTA in health structures. The case study enabled Business Continuity Management (BCM) to be implemented in a hospital department in relation to aspects of a single technology and the specific clinical process. Finally, an economic analysis of the procedure was carried out. Conclusions: The system is useful for decision makers in that it precisely defines which equipment to include in the BCM procedure, using a scale analysis of the specific clinical process in which the equipment is used. In addition, the economic analysis shows how the cost of the procedure is completely covered by the indirect costs which would result from the expenses incurred from a broken device, hence showing the complete auto-sustainability of the methodology.
Keywords: Hospital based technology assessment, healthcare continuity, business continuity management
Abstract: Background: Left ventricular myocytes are arranged in a complex three-dimensional mesh. Since all myocytes contract approximately to the same degree, mechanisms must exist to enable force transfer from each of these onto the framework as a whole, despite the transmural differences in deformation strain. This process has hitherto not been clarified in detail. Objective: To present a geometrical model that establishes a mechanical link between the three-dimensional architecture and the function of the left ventricular myocardium. Methods: The left ventricular equator was modeled as a cylindrical tube of deformable but incompressible material, composed of…virtual cardiomyocytes with known diastolic helical and transmural angles. By imposing reference circumferential, longitudinal, and torsional strains onto the model, we created a three-dimensional deformation field to calculate passive shortening of the myocyte surrogates. We tested two diastolic architectures: 1) a simple model with longitudinal myocyte surrogates in the endo- and epicardium, and circular ones in the midwall, and 2) a more accurate architecture, with progressive helical angle distribution varying from −60° in the epicardium to 60° in the endocardium, with or without torsion and transmural cardiomyocyte angulation. Results: The simple model caused great transmural unevenness in cardiomyocyte shortening; longitudinal surrogates shortened by 15% at all depths equal to the imposed longitudinal strain, whereas circular surrogates exhibited a maximum shortening of 23.0%. The accurate model exhibited a smooth transmural distribution of cardiomyocyte shortening, with a mean (range) of 17.0 (13.2–20.8)%. Torsion caused a shortening of 17.0 (15.2–18.9)% and transmural angulation caused a shortening of 15.2 (12.4–18.2)%. Combining the effects of transmural angulation and torsion caused a change of 15.2 (13.2–16.5)%. Conclusion: A continuous transmural distribution of the helical angle is obligatory for smooth shortening of the cardiomyocytes, but a combination of torsional and transmural angulation changes is necessary to execute systolic mural thickening whilst keeping shortening of the cardiomyocytes within its physiological range.
Abstract: Purpose: There are a number of factors responsible for the longevity of unicompartmental knee replacements (UKR). These include the magnitude of postoperative alignment and the type of material used. The effect of component design and material on postoperative alignment, however, has not been explored. Materials and methods: We retrospectively reviewed 89 patients who underwent UKR with robotic guidance. Patients were divided into two groups, according to whether they had received an all-polyethylene inlay component (Inlay group) or a metal-backed onlay component (Onlay group). We explored the magnitude of mechanical alignment correction obtained in both groups.…Results: Mean postoperative mechanical alignment was significantly closer to neutral in the Onlay group (mean=2.8°; 95% CI=2.4°, 3.2°) compared to the Inlay group (mean=3.9°; 95% CI=3.4°, 4.4°) (R2 =0.65; P=0.003), adjusting for gender, BMI, age, side and preoperative mechanical alignment (Fig. 2). Further exploration revealed that the thickness of the tibial polyethyelene insert had a significant effect on postoperative alignment when added to the model (R2 =0.68; P=0.01). Conclusion: Patients who received a metal-backed Onlay tibial component obtained better postoperative mechanical alignment compared to those who received all-polyethylene Inlay prostheses. The thicker overall construct of Onlay prostheses appears to be an important determinant of postoperative alignment. Considering their higher survivorship rates and improved postoperative mechanical alignment, Onlay prostheses should be the first option when performing medial UKR.
Abstract: Background: Asymptomatic bacterial colonisation of medical implants is increasingly recognised. The role of the often unusual bacteria is usually unknown however. Objective and methods: During a three-year period, patients presenting with clinically evident CIED lead endocarditis and/or pocket infections were included in a prospective database. Using 16s DNA analysis and sequencing, devices and pockets of consecutive patients with evident CIED infection were examined for the presence of bacterial species in addition to the ones grown in conventional culture in order to characterise their clinical role. Results: During the study 77 of a total of…409 consecutive operations involving the explantation of a CIED were performed for clinically evident infection. 71 were included in the study and conventional extended culture and 16s DNA analysis performed and compared. In 42.3% of the patients bacteria were identified by DNA analysis in addition to the culture of the supposedly causative organisms. Conclusion: DNA analysis is more sensitive than conventional culture of swabs in detecting any, or indeed multiple bacterial strains in CIED infection. This may in future influence treatment strategies as e.g. the cohabitation of different strains seems common and is not reflected by classical culture results. Spread of infection along the leads was clearly demonstrated and this strongly supports the recommendation of complete removal of all CIED components in every form of CIED infection. The more unusual bacteria demonstrated here do not appear to play a significant clinical role as suspected earlier.