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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: OBJECTIVES: The anisotropic natures of dental tissues result in variable properties from one point to the other within the same tooth. The aim of this study was to analyze deciduous incisors enamel and dentin for elastic modulus and hardness. In addition, retained deciduous incisors were assessed to compare properties with exfoliated teeth. METHODS: Deciduous mandibular incisors either exfoliated at physiological age or retained were included in this study. Samples were prepared by dissecting teeth in…transverse sections and surfaces under investigation were prepared and polished for nanoindentation. Nanoindentation was performed at multiple sites using Hysitron [TI 725 Ubi] testing instrument. Data analysis was performed using SPSS software (version 20) to calculate absolute hardness and elastic modulus. The statistical significance was calculated using the t-test. RESULTS: The hardness of human deciduous incisor varies between 0.01–7 GPa. The highest value of hardness was observed for the incisal edge (5.09 ± 0.64 GPa) followed by mid-surface enamel and cervical enamel. The hardness of mantle dentin was (0.56 ± 0.19 GPa) and the inner dentin was (0.34 ± 0.12 GPa). CONCLUSIONS: The average hardness of primary teeth enamel is lower than permanent teeth enamel. The hardness of retained teeth enamel is greater than exfoliated teeth however lower than permanent teeth enamel of the equivalent region.
Abstract: BACKGROUND: Since the increase of the number of technological aids in the operating room (OR), equipment-related incidents have come to be a common kind of adverse events. This underlines the importance of adequate equipment management to improve the safety in the OR. OBJECTIVE: A system was developed to monitor the safety status (periodic maintenance and registered malfunctions) of OR devices and to facilitate the notification of malfunctions. The objective was to assess whether the system is…suitable for use in an busy OR setting and to analyse its effect on the notification of malfunctions. METHODS: The system checks automatically the safety status of OR devices through constant communication with the technical facility management system, informs the OR staff real-time and facilitates notification of malfunctions. The system was tested for a pilot period of six months in four ORs of a Dutch teaching hospital and 17 users were interviewed on the usability of the system. RESULTS: The users provided positive feedback on the usability. For 86.6% of total time, the localisation of OR devices was accurate. 62 malfunctions of OR devices were reported, an increase of 12 notifications compared to the previous year. CONCLUSIONS: The safety status system was suitable for an OR complex, both from a usability and technical point of view, and an increase of reported malfunctions was observed. The system eases monitoring the safety status of equipment and is a promising tool to improve the safety related to OR devices.
Abstract: BACKGROUND: Hip fracture in the elderly is a serious problem, and solutions to prevent falls are needed. OBJECTIVE: This study focused on elucidating data critical to fall prevention by evaluating ambulatory function, and we achieved this by developing a plantar pressure measurement device to determine gait function. METHODS: Our device enables measurement of gait function in the unrestrained state by transmitting wireless data. In this study, we applied the device to field experiments involving 98…subjects (39 healthy individuals, 44 elderly non-fallers, and 15 elderly fallers). Gait features were determined by measuring the pressure values and foot contact patterns used as gait function parameters in previous studies. RESULTS: In particular, decreased peak pressure values were noted at heel strike and toe off during walking in elderly fallers compared with elderly non-fallers. In addition, compared with healthy subjects, elderly fallers also showed extension of the double support phase, and differences in individual gait pattern features were observed between the groups. CONCLUSIONS: Experiments confirmed that our device can be used to obtain the gait features of a diverse group of elderly individuals. Moreover, our device enables objective and quantitative evaluation of gait function and thus may be useful for evaluating gait function in the elderly.
Abstract: BACKGROUND: A commercial breakthrough of point-of-care testing (POCT) and self-tests for laypersons (direct-to-consumer applications, DTC) is anticipated based on the advancements in the development of lab-on-a-chip system (LOC) technology. OBJECTIVE: The aim of this study was to investigate risks and benefits of LOC based diagnostic devices for healthcare and private self-testers. METHODS: Interviews with 22 developers/researchers of LOC technology and 10 technology assessment experts were conducted about the (a) need for, (b) benefits, and…(c) risks of LOCs for healthcare and as DTC applications. A qualitative content analysis was conducted. RESULTS: Need for LOCs were seen mainly for healthcare, but not as DTC applications for fatal diseases. While benefits were seen mainly for healthcare and partially for DTC applications (e.g. faster diagnostics, more favourable diagnostics, POCT), risks were emphasised especially for DTC applications and less frequently for healthcare (e.g. various technical challenges, misinterpretation of test results, quality/reliability requirements). CONCLUSIONS: Medical expertise is the key imperative for the application of LOC based portable diagnostic devices in healthcare and particularly for self-testing. LOCs have to be designed to be easily operated and interpreted by self-testers. For healthcare, LOCs are envisaged to be a promising emerging technology with various benefits.
Keywords: Risk, lab-on-a-chip system and LOC, self-test, direct-to-consumer application, healthcare
Abstract: BACKGROUND: Electroencephalogram (EEG) is an important tool for clinical diagnosis of brain-related disorders and problems. However, it is corrupted by various biological artifacts, of which ECG is one among them that reduces the clinical importance of EEG especially for epileptic patients and patients with short neck. OBJECTIVE: To remove the ECG artifact from the measured EEG signal using an evolutionary computing approach based on the concept of Hybrid Adaptive Neuro-Fuzzy Inference System, which…helps the Neurologists in the diagnosis and follow-up of encephalopathy. METHODS: The proposed hybrid learning methods are ANFIS-MA and ANFIS-GA, which uses Memetic Algorithm (MA) and Genetic algorithm (GA) for tuning the antecedent and consequent part of the ANFIS structure individually. The performances of the proposed methods are compared with that of ANFIS and adaptive Recursive Least Squares (RLS) filtering algorithm. RESULTS: The proposed methods are experimentally validated by applying it to the simulated data sets, subjected to non-linearity condition and real polysomonograph data sets. Performance metrics such as sensitivity, specificity and accuracy of the proposed method ANFIS-MA, in terms of correction rate are found to be 93.8%, 100% and 99% respectively, which is better than current state-of-the-art approaches. CONCLUSIONS: The evaluation process used and demonstrated effectiveness of the proposed method proves that ANFIS-MA is more effective in suppressing ECG artifacts from the corrupted EEG signals than ANFIS-GA, ANFIS and RLS algorithm.
Abstract: BACKGROUND: The usage of Smartphones and smartphone applications in the recent decade has indeed become more prevalent. Previous research has highlighted the lack of critical appraisal of new applications. In addition, previous research has highlighted a method of using just the Internet Browser and a text editor to create an application, but this does not eliminate the challenges faced by clinicians. In addition, even though there has been a high rate of smartphone applications usage and…acceptance, it is common knowledge that it would cost clinicians as well as their centers a lot to develop smartphone applications that could be catered to their needs, and help them in their daily educational needs. OBJCETIVE: The objectives of the current research are thus to highlight a cost-effective methodology of development of interactive education smartphone applications, and also to determine whether medical students are receptive towards having smartphone applications and their perspectives with regards to the contents within. METHODOLOGY: In this study, we will elaborate how the Mastering Psychiatry Online Portal and web-based mobile application were developed using HTML5 as the core programming language. The online portal and web-based application was launched in July 2012 and usage data were obtained. Subsequently, a native application was developed, as it was funded by an educational grant and students are recruited after their end of posting clinical examination to fill up a survey questionnaire relating to perspectives. RESULTS: Our initial analytical results showed that since inception to date, for the online portal, there have been a total of 15,803 views, with a total of 2,109 copies of the online textbook being downloaded. As for the online videos, 5,895 viewers have watched the training videos from the start till the end. 722 users have accessed the mobile textbook application. A total of 185 students participated in the perspective survey, with the majority having positive perspectives about the implementation of a smartphone application in psychiatry. CONCLUSIONS: This is one of the few studies that describe how an educational application could be developed using a simple and cost effective methodology and this study has also demonstrated students' perspectives towards Smartphone in psychiatric education. Our methods might apply to future research involving the use of technology in education.
Abstract: BACKGROUND: In recent times there has been a significant change in lifestyle in many parts of the world, with most people experiencing a more sedentary existence combined with an abundance of food. This has resulted in the modern epidemic of obesity and consequent hyperinsulinemia – situations which in women may precipitate expression of fertility problems; effective methods to evaluate the fertility status are required. Ultrasonographic imaging is an effective, easy to use, safe, and readily available…noninvasive means to evaluate fertility potential. OBJECTIVE: Manual recognition of the follicles in terms of area measurement and counting the number of follicles is laborious; often fatigue may lead to error-prone conclusions. The paper attempts an automated classification of the ovaries based on the biomarking done by the physician. Also, biomarked data correlates with the hormones values such as androgen, testosterone and leutinizing hormone. METHODS: Despeckled images are segmented by improved active contour with split-Bregman optimization. The features are extracted from images using geometric and intensity method. The significant features selected by particle swarm optimization and dimension reduction by principal component analysis and classification by probabilistic neural network. RESULTS: Proposed probabilistic neural network achieves maximum efficiency of 97% compared to SVM 92% and RBF 88%. CONCLUSIONS: The results obtained show that using a very large number of features combined with a feature selection approach allows us to achieve high classification rates.
Keywords: Polycystic ovary syndrome, particle swarm optimization, principal component analysis, support vector machine, probabilistic neural network
Abstract: BACKGROUND: Analysis of liver tissue in normal and abnormal conditions is essential for disease research, medical device design and treatment planning. Currently cirrhosis and malignancies of liver are among the major causes of mortality, worldwide. OBJECTIVE: The objective of this work is to design an efficient capacitive sensor using Finite Element Methods (FEM), for diagnosis of cirrhotic and malignant liver. METHODS: In this work, 3D geometric FEM models (N=120) of normal, cirrhotic and malignant liver were generated…using Comsol 3.5a. A set of 'E' shaped metallic plates, each with a dimension of 1 × 1 × 1 mm were modeled and mounted on the developed liver models. Four different bio-compatible metals namely Gold, Silver, Palladium and Platinum were used for analysis. Further, the observed capacitance values were converted into voltage using a De Sauty's bridge circuit implemented using Proteus 8. Finally, the statistical significance of the results was analyzed using the ANOVA test. RESULTS: Results demonstrate that the observed voltages show significant variations between different liver pathologies. The developed sensor characteristic was found to be linear and the sensitivity of the sensor was found to be high when platinum electrodes were used. The diagnostic ability of the developed sensors for the adopted biocompatible metals was found to be highly statistically significant (P < 0.001). CONCLUSIONS: The proposed sensor design is compact with small dimensions and can be placed in contact with the human liver using endoscopic techniques. Hence, the developed sensor may provide a minimally invasive technique for liver diagnosis. This study appears to be of high clinical relevance since modelling of normal and abnormal liver, as well as design of suitable sensors for identification of liver abnormalities is required for improving the present diagnostic techniques.
Abstract: BACKGROUND: The distal radius keeps heading the list of commonly fractured bones. Although little is known about the frequency and localization of accompanying fractures as well as their influence on the total course of in-patient treatment. OBJECTIVE: This study is supposed to show the influence of concomitant fractures. These fractures should be identified as risk factors for a prolonged stay to improve the in hospital treatment. METHODS: We retrospectively reviewed 721 patients with distal radius…fracture. Frequency and localization of concomitant fractures, AO-type, patient age as well as duration of in-hospital treatment were analyzed. RESULTS: Out of 721 patients 124 (17.2%) had one or more concomitant fractures (CF). The most common CF were proximal femur fractures, pelvic ring fractures and humerus fractures. Compared to patients without CF, these patients showed a significant increase in duration of post operative hospital stay (5.2 vs. 12.5 days, p=0.0001). CONCLUSIONS: Patients presenting a concomitant fracture should be thoroughly cared for by their physicians and therapists. Especially an early and focused mobilization and a well-timed relocation for further medical treatment are important to reduce avoidable treatment days in the acute care hospital.
Abstract: BACKGROUND: Healthy sleep can be characterized by several stages: wake, light, SWS, and REM sleep. The clinical experts find that the breath of subjects is different in these sleep stages, but such observation is lacking data supporting, The statistical research about investigating breathing patterns during sleep process will be helpful for the sleep and breathing domain. OBJECTIVE: The objective of the paper is to statistically analyze the respiratory characteristics during different sleep…stages. METHODS: Firstly, we calculated the mean value and standard deviation of respiratory rates of these stages, in which the respiratory rates were obtained by the autocorrelation method. Then the detrended fluctuation analysis (DFA) algorithm was applied to analyze long-range correlation of respiratory rates of sleep stages. RESULTS: The mean and standard deviation of respiratory rates are wake: 16.62 ± 2.43 cycles per minute (CPM), light: 15.15 ± 1.53 CPM, SWS: 15.06 ± 0.96 CPM and REM: 16.37 ± 2.03 CPM, respectively. The scaling exponent applied by detrended fluctuation analysis (DFA) algorithm reached about 0.7 for each stage. CONCLUSION: Results of the mean and standard deviation of respiratory rates show that different sleep stages lead to different autonomic regulations of breathing and exhibit different respiratory rates and fluctuations. And the DFA results demonstrate that respiratory rates are all long-range correlated in these stages although they lead to different fluctuation.