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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: Bone drilling is a common surgical procedure in orthopedics, dental and neurosurgeries. In conventional bone drilling process, the surgeon exerts a considerable amount of pressure to penetrate the drill into the bone tissue. Controlled penetration of drill in the bone is necessary for safe and efficient drilling. Objective: Development of a validated Finite Element (FE) model of cortical bone drilling. Methods: Drilling experiments were conducted on bovine cortical bone. The FE model of the bone drilling was based on mechanical properties obtained from literature data and additionally conducted microindentation tests on the cortical bone.…Results: The magnitude of stress in bone was found to decrease exponentially away from the lips of the drill in simulations. Feed rate was found to be the main influential factor affecting the force and torque in the numerical simulations and experiments. The drilling thrust force and torque were found to be unaffected by the drilling speed in numerical simulations. Simulated forces and torques were compared with experimental results for similar drilling conditions and were found in good agreement. Conclusions: FE schemes may be successfully applied to model complex kinematics of bone drilling process.
Keywords: Bone drilling, finite element method, orthopedics, thrust force, drilling torque
Abstract: Background: Self-management of hypertension by controlling Blood Pressure (BP) through technology-based interventions can effectively reduce the burden of high BP, which affects one out of every three adults in the United States. Objective: The primary aim of this study is to explore the role of technology enabled interventions to improve or enhance self-management among individuals with hypertension. Methods: We conducted a systematic review of the literature published between July 2008 and June 2013 on the MEDLINE database (via PubMed interface) during July 2013. The search words were “hypertension” and “primary care” in combination with each of…the terms of “technology", “internet”, “computer” and “cell phone”. Our inclusion criteria consisted of: (a) Randomized Controlled Trials (RCTs) (b) conducted on human subjects; (c) technology-based interventions (d) to improve self-management (e) of hypertension and if the (f) final results of the study were published in the study. Our exclusion criteria included (a) management of other conditions and (b) literature reviews. Results: The initial search resulted in 108 results. After applying the inclusion and exclusion criteria, a total of 12 studies were analyzed. Various technologies implemented in the studies included internet-based telemonitoring and education, telephone-based telemonitoring and education, internet-based education, telemedicine via videoconferencing, telehealth kiosks and automated modem device. Some studies also involved a physician intervention, in addition to patient intervention. The outcomes of proportion of subjects with BP control and change in mean SBP and DBP were better for the group of subjects who received combined physician and patient interventions. Conclusion: Interventions to improve BP control for self-management of hypertension should be aimed at both physicians as well as the patients. More interventions should utilize the JNC-7 guidelines and cost-effectiveness of the intervention should also be assessed.
Abstract: Background: Strategic vibration of musculotendinous regions of a limb elicits illusionary sensations of movement. As a rehabilitation technique, this ‘kinesthetic illusion’ has demonstrated beneficial results for numerous sensory-motor disorders. However, literature shows little consistency in the vibration parameters or body positioning used, and their effects have yet to be comprehensively investigated. Objective: To characterize the effects of the vibration amplitude, frequency, and limb position on the kinesthetic illusion. Methods: Movement illusions were induced in 12 participants’ biceps and triceps. The effect of amplitude (0.1 to 0.5 mm), frequency (70 to 110 Hz), and two limb positions…were quantified on the strength of illusion (SOI), range of motion (ROM) and velocity. Results: Amplitude significantly affected the illusionary SOI, ROM and velocity in the biceps and triceps (p < 0.05). Increasing amplitude resulted in an increase of all three output variables. Limb position showed an effect on illusionary velocity in the biceps as well as ROM and velocity in the triceps (p < 0.05). Frequency demonstrated no statistical effect. Conclusions: Amplitude demonstrated the most profound impact on the kinesthetic illusion in the experimental ranges tested. This work may help guide clinicians and researchers in selecting appropriate vibratory parameters and body positions to consistently elicit and manipulate the kinesthetic illusion.
Keywords: Kinesthetic illusion, vibration illusion, movement illusion, factorial design
Abstract: Background: Continued and frequent use of the affected arm can result in increased function after stroke. However, long-term access to therapy is often limited, and home exercise compliance is low. While rehabilitation gaming is becoming increasingly prevalent, concerns about therapeutic method, safety, and usability for independent home use remain largely unaddressed. Objective: The following paper presents usability evaluation of a game based home therapy program called Home Arm Movement Stroke Training Environment (HAMSTER), which is focused on retraining normal arm kinematics and preventing compensation strategies that limit recovery. Methods: Kinect games were created with special consideration…for the stroke population and retraining normal movement kinematics. Ten individuals with stroke evaluated the games in focused interviews and one individual with chronic stroke completed one month of independent HAMSTER use in the home. Results: The focused interviews showed the need for motivational upper extremity home interventions. Usability evaluation showed the ability for individuals with stroke to interact with the kinematics focused Kinect games after a short exposure time. The single participant evaluation of home use showed good compliance and improvement on all of the clinical outcome measures after the one month of HAMSTER use. Conclusions: These positive results merit further evaluation of kinematic-focused home gaming interventions like HAMSTER to reduce the use of compensation strategies during home exercise and provide a supplement to conventional care to improve exercise compliance and upper extremity function after stroke.
Abstract: Background: The size of medical datasets is usually very large, which directly affects the computational cost of the data mining process. Instance selection is a data preprocessing step in the knowledge discovery process, which can be employed to reduce storage requirements while also maintaining the mining quality. This process aims to filter out outliers (or noisy data) from a given (training) dataset. However, when the dataset is very large in size, more time is required to accomplish the instance selection task. Objective: In this paper, we introduce an efficient data preprocessing approach (EDP), which is composed of two…steps. The first step is based on training a model over a small amount of training data after preforming instance selection. The model is then used to identify the rest of the large amount of training data. Methods: Experiments are conducted based on two medical datasets for breast cancer and protein homology prediction problems that contain over 100000 data samples. In addition, three well-known instance selection algorithms are used, IB3, DROP3, and genetic algorithms. On the other hand, three popular classification techniques are used to construct the learning models for comparison, namely the CART decision tree, k-nearest neighbor (k-NN), and support vector machine (SVM). Results: The results show that our proposed approach not only reduces the computational cost by nearly a factor of two or three over three other state-of-the-art algorithms, but also maintains the final classification accuracy. Conclusions: To perform instance selection over large scale medical datasets, it requires a large computational cost to directly execute existing instance selection algorithms. Our proposed EDP approach solves this problem by training a learning model to recognize good and noisy data. To consider both computational complexity and final classification accuracy, the proposed EDP has been demonstrated its efficiency and effectiveness in the large scale instance selection problem.
Keywords: Data preprocessing, instance selection, medical data mining, breast cancer, protein homology
Abstract: Background: There is a high prevalence of metabolic syndrome in Western societies, and it is therefore an example of chronic disease whose follow-up could be enhanced by telemedicine. Objective: The objective of this study was to assess the effectiveness of a telemedicine programme for the follow-up and control of patients with metabolic syndrome in a primary-care setting. Methods: Semi-experimental study in which 82 patients with metabolic syndrome were included in a telemedicine programme and compared to 82 patients routinely followed up at health-care facilities. The programme consisted of the teletransmission of analytical parameters via the PITES…technological platform for chronic and dependent patients. Other study variables were lifestyle, treatment compliance, perceived health status and satisfaction with the programme. Results: Follow-up showed that 68 patients (82.9%) continued in the programme after 6 months and 45 (54.9%) after one year, with a mean stay of 39.7 weeks. Comparison of the parameters obtained for the telemedicine and control-group patients indicated that the former registered significantly lower mean values for systolic blood pressure (125.5 ± 10.6 SD vs. 136.7 ± 12.0 SD), diastolic blood pressure (81.0 ± 6.3 SD vs. 84.0 ± 6.8 SD), total cholesterol (177.4 ± 34.5 SD vs. 202.4 ± 31.7 SD) and cLDL (106.0 ± 28.1 SD vs. 121.3 ± 30.6 SD). By the end of follow-up, the health status scores of the patients monitored by telemedicine had risen significantly (69.2 vs. 64.2; p = 0.04), and 86.6% stated that they were satisfied. Conclusions: Telemedicine allows for better control of some of the defining parameters of metabolic syndrome than is achieved by routine clinical practice. Teletransmission is viable and satisfactory, and constitutes a novel contribution to the clinical management of these patients.
Keywords: Metabolic syndrome, telemedicine, primary health care
Abstract: Background: Isocentric three-dimensional C-arms allow for more effective intraoperative fracture reduction control compared to two-dimensional imaging techniques. However, thir design is not appropriate for shoulder scanning. Objective: To assess the feasibility of using a newer generation variable isocentric flat detector 3D C-arm for intraoperative glenohumeral and acromioclavicular joint assessment and to compare the accuracy of its intraoperative 3D imaging technology to a standard two-dimensional (2D) flat detector fluoroscope. Methods: Five whole-body human cadavers were used (ten shoulders). Native shoulder scans were obtained. A glenohumeral arthrotomy was performed and several injuries and procedures were simulated. Five independent…orthopaedic surgeons reviewed each scan and filled out a questionnaire assessing the quality of the images using a visual analog scale (VAS) and a points scoring system. Results: The examiners rated the 3D images as very-good-to-excellent according to the established parameters: image quality; visualization of the corticalis and the spongiosa; delineation of the joint surface; presence of artifacts; and clinical assessment capability. This high quality of the images led to a higher interobserver reliability for 3D images compared to 2D images. Conclusions: Variable isocentric 3D C-arm technology is feasible for intraoperative assessment of shoulder procedures. Assessment of 3D images in shoulder procedures showed better interexaminer reliability in this experiment compared to 2D images. With the aid of intraoperative 3D shoulder imaging, intraoperative 3D C-arm navigation could help improve accuracy in the clinical setting.
Keywords: 3D C-arm, shoulder imaging, shoulder surgery, shoulder trauma
Abstract: Background: Parkinson's disease (PD) is a neurodegenerative disease that predominantly alters patients' motor performance. Reduced step length and inability of step are important symptoms associated with PD. Assessing patients' motor state monitoring step length helps to detect periods in which patients suffer lack of medication effect. Objective: Evaluate the adaption of existing step length estimation methods based on accelerometer sensors to a new position on left lateral side of waist in 28 PD patients. Methods: In this paper, a user-friendly position, the lateral side of the waist, is selected to place a tri-axial accelerometer. A newly…developed step detection algorithm – Sliding Window Averaging Technique (SWAT) is evaluated in detecting steps using signals from this location. The detected steps are then used to estimate step length using four proposed correction factors for Zijlstra's, Gonzalez's and Weinberg's methods that were originally developed for the signals from lower back. Result: Results obtained from 28 PD patients are discussed and the effects of calibrating in each motor state are compared. A generic correction factor is also proposed and compared with the best method to use instead of individual calibration. Despite variable gait speed and different motor state, SWAT achieved overall accuracy of 96.76% in step detection. Among the different step length estimators, the Zijlstra method performs better with multiplying individual correction factors that consider left and right step length separately providing average error of 0.033 m. Conclusions: Zijlstra's method with individual correction factor that considers left and right step length separately and obtained from during ON state of a PD patients provide most accurate estimation among the others. As training session is during ON state, data from induced OFF state to train the methods are not required. A generic correction factor is also proposed to apply with Zijlstra's method to avoid individual calibration process.
Keywords: Parkinson's disease, gait properties, accelerometers, signal processing
Abstract: Background: Gait impairment seems to be a risk factor for falls and mortality. Because gait change cannot be determined easily with classical clinical tests, some authors have suggested that it might be useful to use a gait-analysis system among elderly community-dwelling people. Objective: The main objective of the present study was to determine the predictive value of a quantitative evaluation of the gait characteristics in nursing home residents for the occurrence of falls and death performed using a tri-axial accelerometer (Locométrix®). Material and methods: One hundred elderly nursing home residents (80 women and 20 men, mean…age 86.4 ± 6.04 years) were included in this study with the aim to follow them for 2 years. Deaths and falls were systematically recorded. A quantitative evaluation of a 10-second walk was performed with a tri-axial accelerometer (Locometrix®). Demographic data (i.e age, sex, body mass index) and clinical data (i.e. fall risk evaluated by the Tinetti test) were also recorded. Results: During the two years of follow-up, 27 patients died. After adjustment on all potential confounding variables, only body mass index was significantly associated with the risk of mortality with an odds ratio of 0.86 (95% CI: 0.77–0.96, p = 0.04). At the end of the study period, 440 falls had occurred (mean: 4.44 ± 6.79 falls per patient) but no single factors were independently associated with fall incidence. Conclusion: Our results show that a quantitative gait analysis performed using a tri-axial accelerometer is not predictive of long-term falls and mortality among nursing home residents.
Keywords: Mortality, falls, risk factors, nursing home
Abstract: Background: In cartilage repair, scaffold-assisted single-step techniques are used to improve the cartilage regeneration. Nevertheless, the fixation of cartilage implants represents a challenge in orthopaedics, particularly in the moist conditions that pertain during arthroscopic surgery. Within the animal kingdom a broad range of species has developed working solutions to intermittent adhesion under challenging conditions. Using a top-down approach we identified promising mechanisms for biomimetic transfer. Objective: The tree-frog adhesive system served as a test case to analyze the adhesion capacity of a polyglycolic acid (PGA) scaffold with and without a structural modification in a bovine articular cartilage defect…model. Methods: To this end, PGA implants were modified with a simplified foot-pad structure and evaluated on femoral articular bovine cartilage lesions. Non-structured PGA scaffolds were used as control. Both implants were pressed on 20 mm × 20 mm full-thickness femoral cartilage defects using a dynamometer. Results: The structured scaffolds showed a higher adhesion capacity on the cartilage defect than the non-structured original scaffolds. Conclusions: The results suggest that the adhesion ability can be increased by means of biomimetic structured surfaces without the need of additional chemical treatment and thus significantly facilitate primary fixation procedures.