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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: Pagers are the most commonly used method of communications in American hospitals. However, its financial cost and efficiency is unknown. OBJECTIVE: To evaluate the efficiency of conventional hospital pagers and to estimate the financial cost of time wasted by the use of these pagers. METHODS: We conducted a survey among 100 clinicians, nurses and pharmacists in our community teaching hospital, estimating the time spent in the process of sending and responding to pages and the financial equivalent of this time, and evaluating the potential advantages of hospital-based wireless telephones…compared with traditional pagers. RESULTS: A total of 70 clinicians completed the survey for a response rate of 70%. The average time spent per daytime shift in using the paging system was between 48 and 66 minutes for physicians, 120 minutes for nurses and 165 minutes for pharmacists. The financial cost of time lost for a single medical ward for one month was estimated to be $2,732-$17,250, depending on the case scenario. CONCLUSIONS: Our study suggests that the traditional paging system is an inefficient means of communication between clinicians and hospital staff and that a switch to direct phone calls might be far more cost-effective. Similar considerations probably apply to most hospitals that still use traditional pagers.
Abstract: BACKGROUND: Many studies have been conducted that highlight the prevalence of misdiagnoses within the medical profession and the statistically poor diagnostic accuracy rates associated with junior clinicians. OBJECTIVE: There is evidence that crowdsourcing and multiple medical opinions can improve the veracity of a diagnosis. This paper proposes a cloud based prototype that makes use of interactive web technologies along with the concepts of crowdsourcing and e-learning to improve diagnostic accuracy rates amongst junior doctors. METHODS: Existing approaches in this field are analysed to identify potential gaps and opportunities. Sample representations…of both junior and senior clinicians are surveyed to establish the feasibility of adopting collaborative diagnostics. It is theorised that the prototype developed in this work will harness the experience and knowledge of expert clinicians. RESULTS: The prototype is a fully responsive web-based and feature-rich interactive system that has been developed using the latest Internet technologies. It has been evaluated using usability tests and a one month long trial involving a sample of end-users. CONCLUSIONS: Crowdsourcing is an innovative process in its infancy but the results being produced indicate a promising future for its use within medicine. The results offer an inclination that the prototype's usage could be attributed to improved diagnostic ability. However the findings need to be replicated in larger, independent samples.
Keywords: Collaborative diagnosis, crowdsourcing, e-learning, medical education, medical informatics, human computer interaction
Abstract: OBJECTIVE: We evaluated the use of NiTi rotary and stainless steel endodontic instruments for canal shaping by undergraduate students. We also assessed the quality of root canal preparation as well as the occurrence of iatrogenic events during instrumentation. METHODS: In total, 30 third-year dental students attending Taibah University Dental College prepared 180 simulated canals in resin blocks with NiTi rotary instruments and stainless steel hand files. Superimposed images were prepared to measure the removal of material at different levels from apical termination using the GSA image analysis software. Preparation time, procedural accidents, and canal shape…after preparation were analyzed using χ 2 and t-tests. The statistical significance level was set at P < 0.05. RESULTS: There were significant differences in preparation time between NiTi instruments and stainless steel files; the former was associated with shorter preparation time, less ledge formation (1.1% vs. 14.4%), and greater instrument fracture (5.56% vs. 1.1%). These results indicate that NiTi rotary instruments result in better canal geometry and cause less canal transportation. CONCLUSIONS: Manual instrumentation using stainless steel files is safer than rotary instrumentation for inexperienced students. Intensive preclinical training is a prerequisite for using NiTi rotary instruments. These results prompted us to reconsider theoretical and practical coursework when teaching endodontics.
Abstract: BACKGROUND: Bar-code technology, used for verification of patients and their medication, could prevent medication errors in clinical practice. OBJECTIVE: Retrospective analysis of electronically stored medical error reports was conducted in a university hospital. METHODS: The number of reported medication errors of injected drugs, including wrong drug administration and administration to the wrong patient, was compared before and after implementation of the bar-code verification system for inpatient care. RESULTS: A total of 2867 error reports associated with injection drugs were extracted. Wrong patient errors decreased significantly after implementation of the…bar-code verification system (17.4/year vs. 4.5/year, p< 0.05), although wrong drug errors did not decrease sufficiently (24.2/year vs. 20.3/year). The source of medication errors due to wrong drugs was drug preparation in hospital wards. CONCLUSION: Bar-code medication administration is effective for prevention of wrong patient errors. However, ordinary bar-code verification systems are limited in their ability to prevent incorrect drug preparation in hospital wards.
Abstract: BACKGROUND: There is little research exploring training effects of engaging in active video gaming activities. OBJECTIVES: This study sought to determine the cardiovascular and metabolic responses, changes in flexibility and exercise adherence to an aerobic dance exercise programme using the XBOX Kinect over a 6 week training period. METHODS: Training was conducted using the Just Dance 4 disc on the XBOX Kinect 360. Participants attended five, 30 minute sessions per week for the first two weeks, four 45 minute sessions per week for the next two weeks and three 60 minute sessions…per week for the last two weeks. Outcomes assessed included flexibility, body mass index (BMI), percentage body fat, maximal oxygen consumption (VO2max ), resting and post exercise blood pressure, heart rate and blood lactate levels. RESULTS: There were significant improvements in flexibility, maximal oxygen consumption and resting heart rate. There were no significant changes in BMI, percentage body fat or blood lactate levels. Nine (37.5%) participants continued to engage in this form of exercise at least 3-days per week over the 3-month post intervention follow-up period. CONCLUSION: Engaging in dancing using dance videogames can lead to improved cardiovascular conditioning and flexibility in sedentary female university students.
Abstract: OBJECTIVE: The current retrospective case-control study examines the prognostic value of radiologic parameters for long-term clinical outcome assessment after a calcaneus fracture. METHODS: In the authors' trauma department 262 adult patients with an isolated calcaneus fracture were treated from 1995 to 2005. Using conventional x-ray and computed tomography imaging. the calcaneal fractures were classified according to Sanders system. In addition, Boehler's and Gissane's angles were measured before and after therapy and the Larsen stage of subtalar arthrosis was determined. After a mean follow-up interval of 9.5 years, 44 patients were available for clinical and radiological…assessment. RESULTS: At the time of trauma the average age of the study group was 52 (range, 29-79) years. Thirty-seven patients were treated operatively and seven conservatively. Patients with a negative Boehler's angle, upon admission, exhibited significantly worse results using four of the five clinical scoring systems than patients with a preserved or slight reduced Boehler's angle. Operative treatment in patients whose Boehler's angle was elevated to normal range or beyond exhibited %worse better results than patients with an over-correction of Boehler's angle. In 11 cases, two primary and nine secondary subtalar arthrodeses were performed. The degree of subtalar arthrosis as per Larsen was increased 2.54 ± 1.14 in the course of hospital admission, arthrodesis and/or follow up examination. The results show no significant difference between operative and conservative treatment. CONCLUSIONS: Boehler's angle at time of admission appears to be a valuable prognosticator for functional long-term results after calcaneus fracture. An operative over-correction of a reduced Boehler's angle should be avoided.
Abstract: BACKGROUND: The objective of this study was to investigate how treatment strategies in the same treatment affected the canine's initial displacement and the stress in periodontal ligament using three-dimensional finite element analysis. And to find out the way to design an effective treatment plan. METHODS: Based on computed tomography images of the teeth and their supporting tissues, solid models were used to build finite element models. Three treatment plans of three different transparent tooth correction therapies finite element-analyses were operated. RESULTS: The canine's initial displacement and stresses' distribution in periodontal ligament were…obtained. CONCLUSIONS: For rotation movement, the canine should rotate along tooth long axis, and not combine with other kinds of tooth movement as possible. For translation movement, the combination of translation and inclination movement is helpful for the treatment.
Keywords: Finite element method, initial movement, center of rotation, stress, movement combination
Abstract: BACKGROUND: The advent of international medical travel has resulted in many patients travelling abroad to seek medical attention at foreign institutions. However, it is not known whether long-haul flights further increase the risk of VTE in patients who are to receive a joint replacement. OBJECTIVES: We performed this retrospective cohort study to analyze if patients with preoperative air travel with a flight time more than four hours are at higher risk for VTE development following total knee or total hip athroplasty (THA) compared to patients without preoperative travel. METHODS: Between January 2007…and December 2012, 245 patients were treated with either a primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) with preoperative air travel with a flight time more than 4 hours at our institution. One-hundred fifty five patients (n= 87 THA and n= 68 TKA) out of 245 patients met the inclusion and exclusion criteria and were included in this study. A total of 187 patients (n= 92 THA and n= 95 TKA) without bus, air or car travel longer than 30 minutes met the inclusion and exclusion criteria and were included in this study as controls. RESULTS: Patients with preoperative air travel were not at higher risk for VTE development compared to patients without preoperative air travel following TKA (HR = 0.95; 95%CI = 0.14-6.52). Gender (HR = 0.41; 95%CI = 0.05-3.56) and age (HR = 3.77; 95%CI = 0.63-22.37) did not influence the VTE development in TKA patients. CONCLUSIONS: Our study results show that preoperative air travel do not further increase the risk of VTE after TKA and THA.
Keywords: Deep vein thrombosis, air travel, long-haul flight, total knee arthroplasty, total hip arthroplasty
Abstract: BACKGROUND: Adequate pain management is essential for preventing hemodynamic instability which can affect the perfusion of vital organs during the perioperative period, particularly in geriatric patients. For hip arthroplasty, peripheral nerve block is frequently used, limiting the adverse effects of opioid and non-opioid analgesics. OBJECTIVE: The aim was to survey the impact of a supplementary single shot femoral nerve block (FNB) on hemodynamic stability and pain level. METHODS: After registration at German Clinical Trial Register (DRKS-ID): DRKS00000752. and Ethics Committee approval (University Hospital of Marburg), 80 patients who underwent elective hip surgery…were included. Half of them were randomly assigned to receive a FNB followed by general anesthesia; a control group received only general anesthesia as standard procedure (STD). Blood pressure and heart rate were measured and recorded every five minutes during surgery and stay at the postanesthesia care unit (PACU). RESULTS: Fifty-two patients were included for statistical analysis. The FNB group had significantly lower systolic blood pressures during and after surgery and lower diastolic blood pressure postoperatively, heart rate, as well as opioid and non-steroidal anti-inflammatory consumption. CONCLUSIONS: Femoral nerve block improved perioperative hemodynamic stability mostly likely attributable to an overall reduced sympathico adrenergic tone.
Keywords: Femoral nerve block, hip arthroplasty, hemodynamic control, postoperative analgesics
Abstract: BACKGROUND: Measuring subtalar joint (STJ) motion is accompanied by complications due to the oblique STJ axis which results in triplanar pronation and supination. OBJECTIVE: We developed a pronator and supinator testing apparatus whose axis was aligned with Inman's STJ axis. The purpose of this study was to assess day-to-day reliability of active STJ range of motion (ROM) measurements and to compare the results with those of a rearfoot goniometer. METHODS: Active pronation, supination and total STJ ROM measurements were administered to 12 men (mean age: 23.8 years) and 12 women (mean age:…22.3 years) at two separate test sessions. Intraclass correlations (ICC), limits of agreement (LoA) and minimum detectable change (MDC) were calculated. RESULTS: Except for pronation ROM in men, the STJ goniometer revealed substantial (ICC > 0.8) reliability in all conditions. Relative MDCs and LoAs were below 15% and 10%, respectively. Significantly higher total ROM (P< 0.05) was found for women compared to men when using the STJ goniometer. The rearfoot goniometer showed high reliability (ICCs > 0.7) but underestimated STJ ROM in average of 37%. CONCLUSIONS: Both goniometric methods showed high day-to-day reliability. However, when using the rearfoot goniometer, researchers have to consider whether the level of underestimation of STJ motion is acceptable in the context of the planned investigation.
Keywords: Range of motion, subtalar joint axis, pronation, supination, intraclass correlations, limits of agreement, minimum detectable change