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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: The aim of this study is to describe the process of staff and patient adoption and compliance of a real-time locating system (RTLS) across two health care settings and present lessons learned. While previous work has examined the technological feasibility of tracking staff and patients in a health care setting in real-time, these studies have not described the critical adoption issues that must be overcome for deployment. The ability to track and monitor individual staff and…patients presents new opportunities for improving workflow, patient health and reducing health care costs. A RTLS is introduced in both a long-term care and a polytrauma transitional rehabilitation program (PTRP) in a Veterans Hospital to track staff and patient locations and five lessons learned are presented from our experiences and responses to emergent technological, work-related and social barriers to adoption. We conclude that successful tracking in a health care environment requires time and careful consideration of existing work, policies and stakeholder needs which directly impact the efficacy of the technology.
Keywords: Radio frequency identification device (RFID), real time systems, patient compliance, patient adherence, nursing staff, staff workload
Abstract: BACKGROUND: Intravascular ultrasound (IVUS) is an invasive imaging modality that provides high resolution cross-sectional images permitting detailed evaluation of the lumen, outer vessel wall and plaque morphology and evaluation of its composition. Over the last years several methodologies have been proposed which allow automated processing of the IVUS data and reliable segmentation of the regions of interest or characterization of the type of the plaque. OBJECTIVE: In this paper we present a novel methodology…for the automated identification of different plaque components in grayscale IVUS images. METHODS: The proposed method is based on a hybrid approach that incorporates both image processing techniques and classification algorithms and allows classification of the plaque into three different categories: Hard Calcified, Hard-Non Calcified and Soft plaque. Annotations by two experts on 8 IVUS examinations were used to train and test our method. RESULTS: The combination of an automatic thresholding technique and active contours coupled with a Random Forest classifier provided reliable results with an overall classification accuracy of 86.14%. CONCLUSIONS: The proposed method can accurately detect the plaque using grayscale IVUS images and can be used to assess plaque composition for both clinical and research purposes.
Keywords: Atherosclerotic plaque, classification, feature extraction, active contours, automatic thresholding
Abstract: BACKGROUND: Socially assistive robotics for elderly care is a growing field. However, although robotics has the potential to support elderly in daily tasks by offering specific services, the development of usable interfaces is still a challenge. Since several factors such as age or disease-related changes in perceptual or cognitive abilities and familiarity with computer technologies influence technology use they must be considered when designing interfaces for these users. OBJECTIVE: This paper presents findings from usability…testing of two different services provided by a social assistive robot intended for elderly with cognitive impairment: a grocery shopping list and an agenda application. The main goal of this study is to identify the usability problems of the robot interface for target end-users as well as to isolate the human factors that affect the use of the technology by elderly. METHODS: Socio-demographic characteristics and computer experience were examined as factors that could have an influence on task performance. A group of 11 elderly persons with Mild Cognitive Impairment and a group of 11 cognitively healthy elderly individuals took part in this study. Performance measures (task completion time and number of errors) were collected. RESULTS: Cognitive profile, age and computer experience were found to impact task performance. Participants with cognitive impairment achieved the tasks committing more errors than cognitively healthy elderly. Instead younger participants and those with previous computer experience were faster at completing the tasks confirming previous findings in the literature. CONCLUSIONS: The overall results suggested that interfaces and contents of the services assessed were usable by older adults with cognitive impairment. However, some usability problems were identified and should be addressed to better meet the needs and capacities of target end-users.
Abstract: BACKGROUND: C-reactive protein (CRP) point-of-care testing (POCT) can be a valuable tool for decision making in primary care. Very few studies have illustrated the utilization of CRP POCT. OBJECTIVE: To conduct a systematic review on the use of CRP POCT in primary care settings and to examine its feasibility and acceptability in an outpatient primary care setting. METHODS: The search was conducted via PubMed. Final articles in the systematic review met inclusion and exclusion criteria. For the feasibility…and acceptability analysis, a convenience sample of 20 adult subjects was enrolled and CRP POCT was conducted. RESULTS: Antibiotic prescription was the most predominant outcome assessed, and antibiotic prescription reduction was the most common finding of CRP POCT effectiveness testing. CONCLUSION: CRP POCT can be used to detect inflammation and can reduce antibiotic prescription in primary care. It is a satisfactory procedure that should be available in the primary care setting.
Keywords: CRP, point of care, adults, children primary care, antibiotics
Abstract: BACKGROUND: With an ever increasing number of biological models available on the internet, a standardized modelling framework is required to allow information to be accessed and visualized. OBJECTIVE: In this paper we propose a novel Extensible Markup Language (XML) based format called ART-ML that aims at supporting the interoperability and the reuse of models of geometry, blood flow, plaque progression and stent modelling, exported by any cardiovascular disease modelling software. ART-ML has been developed and…tested using ARTool. ARTool is a platform for the automatic processing of various image modalities of coronary and carotid arteries. METHODS: The images and their content are fused to develop morphological models of the arteries in 3D representations. All the above described procedures integrate disparate data formats, protocols and tools. ART-ML proposes a representation way, expanding ARTool, for interpretability of the individual resources, creating a standard unified model for the description of data and, consequently, a format for their exchange and representation that is machine independent. More specifically, ARTool platform incorporates efficient algorithms which are able to perform blood flow simulations and atherosclerotic plaque evolution modelling. Integration of data layers between different modules within ARTool are based upon the interchange of information included in the ART-ML model repository. ART-ML provides a markup representation that enables the representation and management of embedded models within the cardiovascular disease modelling platform, the storage and interchange of well-defined information. RESULTS: The corresponding ART-ML model incorporates all relevant information regarding geometry, blood flow, plaque progression and stent modelling procedures. All created models are stored in a model repository database which is accessible to the research community using efficient web interfaces, enabling the interoperability of any cardiovascular disease modelling software models. CONCLUSIONS: ART-ML can be used as a reference ML model in multiscale simulations of plaque formation and progression, incorporating all scales of the biological processes.
Keywords: Cardiovascular diseases, modelling, atherosclerosis, extensible markup language
Abstract: BACKGROUND: An amount of 70,000 minor/major amputees are annually performed for different reasons such as tumor, trauma, perivascular diseases or diabetic ulcera yearly in Germany. Over the course of time a lot of patients get problems with their stump, which leads to an incompatible prosthetic treatment and immobilisation. OBJECTIVE: Handicapped patients are often characterized by a long history of pain. The fact that they often had comorbidities as diabetes, vascular diseases or other metabolic affection,…leads to the situation that no other differential diagnoses are taken into account. PATIENTS AND METHODS: We present a case of a 62 year old patient with a history of burning pain with punctum maximum at the dorso-medial part of the distal femur stump 40 years after a traumatic above-knee amputation. He had sought different medical consultations and had a lot of modifications on his prosthesis shaft with partial benefit. The clinical examination confirmed the suspected diagnosis of a stump neuroma from the sciatic nerve, which has been verified in the MRI. Concerning the symptoms and the increasing immobilisation caused by the burning pain, we indicated a surgical revision which includes a resection from the neuroma and a local flap graft correction. RESULTS: Postoperatively he described a complete pain relief. After 6 weeks under weight bearing mobilisation he was 100% free of pain in his new custom-made shaft prosthesis and could mobilised under full bearing. CONCLUSION: We conclude that neurinoma needs to be considered in handicapped patients with such symptomatology and has to be surgically revised, even if that decision especially for handicapped patients is often difficult for the surgeon.
Abstract: BACKGROUND: Adhesive capsulitis (AC) is characterized by a limited active and passive motion. Although the exact pathology remains unknown, a number of contributing factors are discussed. OBJECTIVE: AC has probably been caused by the Re-PUVA therapy (PUVA irradiation plus acitretin) of a cutaneous T-cell lymphoma, type mycosis fungoides. Acitretin belongs to the group of retinoids and is often used in cornification disorders. METHODS: After non-successful initial conservative therapy with intraarticular steroid injections and physical…therapy, a significant improvement of shoulder joint mobility was finally achieved by an arthroscopic juxtaglenoid capsulotomy and adhesiolysis. RESULTS: A therapy with acitretin should be considered as a possible trigger of AC. CONCLUSIONS: Patient's medication should be checked carefully on possible triggers of AC. The athroscopic adhesiolysis is an effective method for a frustrating conservative treatment of AC.
Abstract: BACKGROUND AND OBJECTIVE: The gastrointestinal tract is a primary district of the living organism that shows a complex configuration in terms of biological tissues and structural conformation. The investigation of tissues mechanical functionality in healthy and degenerative conditions is mandatory to plan and design innovative diagnostic and surgical procedures. The aim of this work is to provide some tools for the mechanical analysis of gastrointestinal structures. METHODS: Computational methods allow for evaluating tissues…behaviour and interaction phenomena between biomedical devices, prosthetic elements and tissues themselves. The approach envisages a strong integration of expertise from different areas, proceeding from medicine to bioengineering, computational and experimental biomechanics, bio-robotics and materials science. The development of computational models of gastrointestinal structures requires data from histological analysis and mechanical testing, together with engineering and mathematical skills for the definition of constitutive formulations and numerical procedures. RESULTS AND CONCLUSION: An outline of the computational mechanics approach to the investigation of the gastrointestinal tissues and structures response is reported. A general formulation is presented together with specific applications to oesophageal and colonic tissues. Preliminary results from the numerical analysis of interaction phenomena between colonoscopy devices and tissues are also proposed to address to aspects that allow for an evaluation of feasibility and reliability of the proposed approach.