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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 purpose of this article was to evaluate the different techniques of operative treatment of primary synovial chondromatosis (PSC) of the hip. We performed a systematic review of literature of PSC and also present one case report about arthroscopic treatment of PSC. Our study compares both established operative procedures, open versus arthroscopic surgery, and shows each advantages and complications. One hundred and forty-seven publications were found in a PubMed literature review searching the terms: "synovial chondromatosis",…"synovial osteochondromatosis", "synovial metaplasia" and "hip". All included studies were divided into open surgery or arthroscopic surgery concerning the therapeutic strategy and the corresponding results. We could find a total number of 3 reviews about PSC of the hip relating to operative procedures. One patient presented to our outpatient clinic with PSC. After other pathologies causing hip pain were excluded, the patient underwent hip arthroscopy with excision of the loose bodies and partial synovectomy. Diagnosis of PSC was confirmed by histopathology. The patient was examined before and one year after surgery with the Visual Analogue Scale (VAS) and the Hip Outcome Score (HOS ADL). Resecting PSC by hip arthroscopy is a minor surgical, but demanding procedure with minimal risks, even useful in the treatment of elderly patients with moderate osteoarthritis.
Keywords: PSC, primary synovial chondromatosis, hip arthroscopy, open hip surgery, surgical hip dislocation, review of literature
Abstract: As the number of aged people is rapidly growing, the need for health and living care of aged people living alone becomes imperative. The telecare systems are able to provide flexible services for older people suffering from chronic diseases, but are largely user group oriented. However, it is common in elderly to show symptoms of a combination of (chronic) diseases. Moreover, elderly are totally dependent on a third person as they are unable to perform a…number of basic functions at home. They also feel cutt off from the social fabric. Old people living in remote places typically use telephone that dials a social alarm control center or mobile social alarm systems and monitoring systems. This study examines the existing solutions related to elderly assistance and proposes an advanced solution based on web technology for the self-management of health and independent living of elderly.
Keywords: Integrated care, health, independent living, elderly, web services, sensors, self-management
Abstract: BACKGROUND: Despite potential applications for improving health services using GPS technology, little is known about ethical concerns, acceptability, and logistical barriers for their use, particularly among marginalized groups. OBJECTIVES: We garnered the insights of people who inject drug (PWID) in San Francisco on these topics. METHODS: PWID were enrolled through street-outreach (n=20) and an ongoing study (n=4) for 4 focus group discussions. Participants also completed a self-administered questionnaire on demographic characteristics and their numbers and…types of interactions with other PWID. RESULTS: Median age was 30.5 years, majorities were male (83.3%) and white (68.2%). Most interacted with other PWID for eating meals and purchasing drugs over the last week; fewer reported interactions such as sexual contact, drug treatment, or work. Participants identified several concerns about carrying GPS devices, including what authorities might do with the data, that other PWID and dealers may suspect them as informants, and adherence to carrying and use. Most felt concerns were surmountable with detailed informed consent on the purpose of the study and practical ways to carry, charge, and hide devices. CONCLUSIONS: PWID felt data collection on their movements and social interactions with other PWID using GPS can be acceptable with addressing specific concerns. The technology is now in hand to greatly expand the ability to monitor health conditions with respect to the environment and improve the location of prevention, care, and treatment facilities to serve hard to reach, mobile, and hidden populations.
Keywords: GPS technology, data collection, acceptability, people who inject drugs
Abstract: Microcalcification clusters appear as groups of small, bright particles with arbitrary shapes on mammographic images. They are the earliest sign of breast carcinomas and their detection is the key for improving breast cancer prognosis. But due to the low contrast of microcalcifications and same properties as noise, it is difficult to detect microcalcification. This work is devoted to developing a system for the detection of microcalcification in digital mammograms. After removing noise from mammogram using the…Discrete Wavelet Transformation (DWT), we first selected the region of interest (ROI) in order to demarcate the breast region on a mammogram. Segmenting region of interest represents one of the most important stages of mammogram processing procedure. The proposed segmentation method is based on a filtering using the Sobel filter. This process will identify the significant pixels, that belong to edges of microcalcifications. Microcalcifications were detected by increasing the contrast of the images obtained by applying Sobel operator. In order to confirm the effectiveness of this microcalcification segmentation method, the Support Vector Machine (SVM) and k-Nearest Neighborhood (k-NN) algorithm are employed for the classification task using cross-validation technique.
Abstract: BACKGROUND: The analysis of non-linear respiratory system mechanics under the dynamic conditions of controlled mechanical ventilation is affected by systemic disturbances of the respiratory signals. Cardio-pulmonary coupling induces cardiogenic oscillations to the respiratory signals, which appear prominently in the second half of expiration. OBJECTIVE: We hypothesized that breathing phase-selective filtering of expiratory data improves the analysis of respiratory system mechanics. METHODS: We retrospectively analyzed data from a multicenter-study (28 patients with injured…lungs, under volume-controlled ventilation) and from two additional studies (3 lung healthy patients and 3 with injured lungs, under pressure-controlled ventilation). Data streams were recorded at different levels of positive end-expiratory pressure. Using the gliding-SLICE method, intratidal dynamic respiratory mechanics were analyzed with and without low-pass filtering of expiratory or inspiratory data separately. The quality of data analysis was derived from the coefficient of determination (R^2 ). RESULTS: Without filtering, R^2 lay below 0.995 for 87 of 280 investigated data streams. In 68 cases expiration-selective low-pass filtering improved the quality of analysis to R^2 ⩾ 0.995. In contrast, inspiration-selective filtering did not improve R^2 . CONCLUSIONS: The selective filtering of expiration data eliminates negative side-effects of cardiogenic oscillations thus leading to a significant improvement of the analysis of dynamic respiratory system mechanics.
Abstract: BACKGROUND: This paper reports the development of standard techniques for technology evaluation in hospital carried out at the Florence Teaching Hospital Careggi (AOUC), where, as a complex system, the technological evaluation is a strategic and essential element for the maintenance of high-quality clinical activity and maximization of available resources. OBJECTIVE: The aim of this paper has been the development of a system of economically sustainable models for the implementation of HTA and HS analyses in…the hospital environment as well as presenting, in addition to a valid scientific resilience, the methodological and temporary flexibility to satisfy needs of hospital decision-makers. METHODS: The evaluation models call for 3 main phases: an initial analysis of the in-hospital request, a collection of data, and finally a draft of a specific, easily usable set of reports. RESULTS: Three standardized and tested models of evaluation were developed, which, in relation to the objective of the request and schedule of the assignment, provide for the production of a speedy report (1-week), an intermediate report (1-month), or a extensive report typical of classical studies of hospital based HTA (1-year). It is then related to the evaluation model of the IORT (Intra-Operative Radiation Therapy) technology. DISCUSSIONS AND CONCLUSION: The developed models have permitted the construction, using personnel and laboratories within the hospital, of an evaluation system reliable and responsive to the HOSPITAL's temporary needs based on the HS and HTA analyses in the hospital environment. Regarding the applicable case of IORT, this has shown how in-hospital requests have been satisfied in the preset time: although it establishes expected improvements on the social effect and weight of the illness and reveals a high territorial strategic relevance, the introduction of IORT in the hospital presents some criticalities on the impact on the healthcare organization and the necessity of specific training of medical technologist personnel.
Keywords: Horizon scanning, health technology assessment, hospital based, IORT
Abstract: BACKGROUND: Bone cutting is a well-known surgical procedure in orthopaedics and dentistry for fracture treatment and reconstruction. Common complications associated with the process are mechanical damage linked with excessive levels of penetration force. Larger forces may produce minor cracks in bone which may seriously affect strength of fixation and may delay the healing process. OBJECTIVE: This paper investigates cracking behavior in the microstructure of cortical bone in cutting using experimental…and numerical techniques. METHODS: Experiments were performed on cortical bone to study the mechanics of crack propagation and evaluate the extent of crack with the drilling force and amount of penetration. Finite element (FE) simulations were performed to visualize the extension and arrest of the cracks in bone microstructure. RESULTS: The length of crack was found to be strongly influenced by the drilling force and amount of drill penetration. Osteon were seen to deflect the cracks at their boundaries. Crack propagation in bone microstructure was observed to depend on anatomical direction. Numerical simulations predicted the direction of crack propagation and found osteon boundaries to act as barrier to the cracks. CONCLUSIONS: Lower drilling force may be used in cutting the bone to avoid cracks in the bone tissue. A detailed FE model based on fracture data of cortical bone is to be produced to simulate cracking of bone microstructure.
Keywords: Orthopedics, bone drilling, finite element simulation, crack, drilling force, micro-CT, scanning electron microscopy
Abstract: BACKGROUND: Hemiplegia can cause accidental falls, as the patients place their arms in front of their chests or next to the hips when they walk. This is due to limitations in the ability to swing their arms during walking. OBJECTIVE: This study proposes a functional electrical stimulator approach in order to improve the foot drop and abnormal movement of the upper limbs during walking. The goal of this study is to verify the feasibility…of improving the foot drop and arm swing problems of hemiplegic patients using electrical stimulators in a clinical trial. METHODS: The present study utilizes a functional electrical stimulator found on the market. The stimulator is controlling the gait and arm swing of the patient while the patient is walking. It can help him or her restore regular gait cycles and arm swings. The FES device can also train the patient to walk safely and regain control of his or her arm swing. After the four-week training, the subjects had to walk 10 meters without the FES system. The step length, step time, and joint goniograms were recorded in order to determine whether there was any improvement. RESULTS: After the four-week training was concluded, the three post-stroke patients showed an improvement in arm swing angle when walking. The improvement was found to be 7.16% in the first patient, 43.06% in the second, and 54.66% in the third. These results are all statistically significant. The t-test had a p-value 0.012 (p< 0.05), which demonstrated that the method used in the present study had the potential to significantly improve the arm swing of post-stroke patients. CONCLUSIONS: The present study showed that a traditional foot drop functional electrical stimulator providing stimulation also to the patient's upper limbs, while being triggered by a foot switch under his or her heel, can help the patient to swing the arms and reduce the foot drop. The method has significant effect on traditional foot drop therapy. The subjects' high degree of acceptance and willingness to commit to long-term use showed that the method is indeed worthy of further research.
Keywords: Functional electrical stimulation, gait analysis, drop foot, hemiplegia, goniometter
Abstract: PURPOSE: There is a paucity of data on effects of motor-level stimulation using Transcutaneous Electrical Nerve Stimulator (TENS) on ipsilateral quadriceps femoris group of muscles. The effect is also unknown on the untrained contralateral quadriceps femoris. The primary purpose of this study was to determine the effect of TENS on quadriceps muscle strength at the stimulated ipsilateral and un-stimulated contra-lateral extremities. METHODS: Participants were 50 apparently healthy undergraduate. They were recruited using sample of…convenience. The right quadriceps group of muscles were stimulated for 15 minutes twice a week for 8 weeks using motor-level stimulation parameters (frequency of 85 Hz and pulse width of 100 microseconds) while the left lower limbs (control) were not stimulated. The right and left quadriceps muscle strengths were quantified using tensiometer; at onset and after 8 weeks. The data were analysed using the descriptive and inferential statistics (paired t-test and ANOVA). Alpha level was set at 0.05. RESULTS: The initial and final left strengths of the un-stimulated quadriceps muscles were 311.46 ± 58.84N and 395.60 ± 100.71N at onset and after 8 weeks respectively. After 8 weeks the un-stimulated left quadriceps strength was significantly greater than the initial value (t=−7.63, p < 0.001). Similarly, the initial and final right quadriceps strength (stimulated limb) were 351.51 ± 117.68N and 471.31 ± 112.19N; at onset and after 8 weeks respectively. The post stimulation strength of the right quadriceps was also significantly higher than the pre-intervention strength (t=−10.25, p < 0.001). However, the increment in quadriceps strength between right and left extremities after 8 weeks was insignificant (t =−1.35, p=0.18). There was also significant increase in the girth of the right quadriceps (t= −6.08, p=0.001) after 8 weeks. CONCLUSION: We concluded that there were increments in both strength and muscle size of the stimulated right quadriceps using motor level stimulation parameters of TENS modality. The un-stimulated contralateral quadriceps strength also increased after 8 weeks. This implied that there was cross-training effect at the contralateral quadriceps group of muscles.
Keywords: Quadriceps muscle, strength, cross-training, motor level stimulation TENS
Abstract: BACKGROUND: Despite technical improvements, aseptic loosening after total knee arthroplasty (TKA) remains a frequent complication. A one-stage revision arthroplasty is the most common therapeutic pathway. OBJECTIVE: The aim of this study was to evaluate the diagnostic value of bone scintigraphy in detecting aseptic loosening after TKA. METHODS: We retrospectively identified 46 cases of one-stage revision TKA performed between January 2011 and December 2012. In each case a bone scintigraphy was performed at least one year after the primary…TKA and 3.2 ± 2.2 month prior to revision arthroplasty. Additionally, we evaluated the rate of satisfaction and pain level 16.2 ± 5.4 months after one-stage revision arthroplasty. RESULTS: Bone scintigraphy indicated aseptic loosening in 28 cases. Intraoperative aseptic loosening was verified in 34 cases. Bone scintigraphy had a sensitivity of 0.76 and a specificity of 0.83 in detecting aseptic loosening. The positive predictive value was 0.93, and the negative predictive value 0.56. At follow-up consultation, 35 patients were very satisfied or satisfied, and 31 patients had no pain or occasional pain. CONCLUSIONS: Bone scintigraphy is a helpful tool in detecting aseptic loosening after TKA. Nevertheless, the results from bone scintigraphy should be compared with clinical findings and patients' disorders.
Keywords: Aseptic loosening, one-stage revision arthroplasty, total knee arthroplasty