Technology and Health Care - Volume 23, issue 4

Authors: Mitrasinovic, Stefan | Camacho, Elvis | Trivedi, Nirali | Logan, Julia | Campbell, Colson | Zilinyi, Robert | Lieber, Bryan | Bruce, Eliza | Taylor, Blake | Martineau, David | Dumont, Emmanuel L.P. | Appelboom, Geoff | Connolly Jr., E. Sander

Article Type: Research Article

Abstract: BACKGROUND: With the increased efforts to adopt health information technology in the healthcare field, many innovative devices have emerged to improve patient care, increase efficiency, and decrease healthcare costs. A recent addition is smart glasses: web-connected glasses that can present data onto the lenses and record images or videos through a front-facing camera. OBJECTIVE: In this article, we review the most salient uses of smart glasses in healthcare, while also denoting their limitations including practical capabilities and patient confidentiality. METHODS: Using keywords including, but not limited to, ``smart glasses'', ``healthcare'', …``evaluation'', ``privacy'', and ``development'', we conducted a search on Ovid-MEDLINE, PubMed, and Google Scholar. A total of 71 studies were included in this review. RESULTS: Smart glasses have been adopted into the healthcare setting with several useful applications including, hands-free photo and video documentation, telemedicine, Electronic Health Record retrieval and input, rapid diagnostic test analysis, education, and live broadcasting. CONCLUSIONS: In order for the device to gain acceptance by medical professionals, smart glasses will need to be tailored to fit the needs of medical and surgical sub-specialties. Future studies will need to qualitatively assess the benefits of smart glasses as an adjunct to the current health information technology infrastructure. Show more

Keywords: Smart glasses, google glass, epson moverio, Meta-Pro spaceglasses, telemedicine, augmented reality, heads-up-display, Electronic Health Records

DOI: 10.3233/THC-150910

Citation: Technology and Health Care, vol. 23, no. 4, pp. 381-401, 2015

Authors: Schüttler, Karl F. | Efe, Turgay

Article Type: Research Article

Abstract: BACKGROUND: Tissue engineering has provided the orthopedic surgeon with a vast portfolio of methods for replacement or regeneration of articular cartilage or meniscal tissue. On the one hand cell based techniques such as autologous chondrocyte transplantation (ACT) are a main focus of interest. On the other hand cell free techniques are rapidly evolving and gaining more interest. The European Union regulation of November 2007, demanding proof of efficacy in cases of autologous cell transplantation, additionally increased the interest in cell-free techniques [1]. OBJECTIVE: The aim of this review was to discuss the advantages and disadvantages …of cell-based and cell-free procedures and to summarize the clinical evidence for cell-free, tissue engineering procedures in orthopedic surgery for meniscal and cartilage defects. METHODS: A systematic review was performed searching for clinical human studies evaluating cell-free repair procedures for cartilage and meniscus defects. All human study reports with English or German language abstracts were included. RESULTS: The search revealed 82 studies of which only 12 met the inclusion criteria. Overall good clinical results for the use of cell-free meniscal and cartilage scaffolds were reported. CONCLUSION: With improved understanding of the healing process in cartilage- and meniscal-defects, acellular, off the shelf products might gain more importance. Show more

Keywords: Tissue engineering, cartilage, meniscus, cell-free, scaffold, repair

DOI: 10.3233/THC-150917

Citation: Technology and Health Care, vol. 23, no. 4, pp. 403-409, 2015

Authors: Zhang, Melvyn W.B. | Ho, Roger CM | Sockalingam, Sanjeev

Article Type: Research Article

Abstract: BACKGROUND: Delirium is a highly prevalent condition in the hospital settings, with prevalence rates ranging from 6% to 56%, based on previous studies. A recent review provides evidence for the need of practice tools at the point of care to increase impact and to improve patient outcomes related to delirium care. The major challenge is to help maintain the skill-sets required by clinicians and allied healthcare workers over time. There have been massive advancements in smartphone technologies, as well as several papers being published recently about how clinicians could be application developers. OBJECTIVE: The …following study will serve to illustrate how the authors made use of the latest advances in application creation technologies in designing a Delirium education application, containing protocols that are appropriate to their healthcare setting. The study in itself will serve as a pilot project aimed at implementing smartphone technologies in delirium education, to determine its feasibility as well as user's perspectives towards such an implementation. METHODOLOGY: The Delirium UHN Application was developed between the months of February 2013 to September 2014. Making use of the methodologies shared by Zhang MWB et al., the authors embarked on the development of the web-based and the native application. The web-based application was developed using HTML5 programming language and with the aid of an online application builder. Psychiatry residents and allied health professionals, at the University of Toronto were recruited to help evaluate the pilot web-based version of the application. RESULTS: Since the introduction of the web-based application during the delirium awareness week, there has been a total of 1165 unique access to the online web-based application. Of significance, there is a shift in the confidence levels of the participants with regards to the management of delirium after using the application. The majority of the participants (44.0%) reported being moderately comfortable with managing delirium prior to the usage of the application, but this changed after the implementation of the application, with 39.0% reporting being very confident and 44.0% being extremely confident about managing delirium after using the application. 69.0% of the participants also perceived the smartphone application to be of use to their clinical care for delirious patients. CONCLUSIONS: This study is one of the first to demonstrate the potential usage of smartphone innovations in delirium education. The current study demonstrated the added feasibility of smartphone applications, and demonstrated that users perceived that they are more abled with managing delirium after the usage of the smartphone application. Show more

Keywords: Technology, delirium, education, clinical, management, smartphone, mobile phones, applications, developmental methods

DOI: 10.3233/THC-150904

Citation: Technology and Health Care, vol. 23, no. 4, pp. 411-417, 2015

Authors: Azeez, Dhifaf | Gan, K.B. | Ali, M.A. Mohd | Ismail, M.S.

Article Type: Research Article

Abstract: BACKGROUND: Triage of patients in the emergency department is a complex task based on several uncertainties and ambiguous information. Triage must be implemented within two to five minutes to avoid potential fatality and increased waiting time. OBJECTIVE: An intelligent triage system has been proposed for use in a triage environment to reduce human error. METHODS: This system was developed based on the objective primary triage scale (OPTS) that is currently used in the Universiti Kebangsaan Malaysia Medical Center. Both primary and secondary triage models are required to develop this system. The primary …triage model has been reported previously; this work focused on secondary triage modelling using an ensemble random forest technique. The randomized resampling method was proposed to balance the data unbalance prior to model development. RESULTS: The results showed that the 300% resampling gave a low out-of-bag error of 0.02 compared to 0.37 without pre-processing. This model has a sensitivity and specificity of 0.98 and 0.89, respectively, for the unseen data. CONCLUSION: With this combination, the random forest reduces the variance, and the randomized resembling reduces the bias, leading to the reduced out-of-bag error. Show more

Keywords: Decision support system, emergency department, random forest, randomized resampling

DOI: 10.3233/THC-150907

Citation: Technology and Health Care, vol. 23, no. 4, pp. 419-428, 2015

Authors: Prabha, S. | Suganthi, S.S. | Sujatha, C.M.

Article Type: Research Article

Abstract: BACKGROUND: Breast thermography is a potential imaging method for the early detection of breast cancer. The pathological conditions can be determined by measuring temperature variations in the abnormal breast regions. Accurate delineation of breast tissues is reported as a challenging task due to inherent limitations of infrared images such as low contrast, low signal to noise ratio and absence of clear edges. OBJECTIVE: Segmentation technique is attempted to delineate the breast tissues by detecting proper lower breast boundaries and inframammary folds. Characteristic features are extracted to analyze the asymmetrical thermal variations in normal and abnormal …breast tissues. METHODS: An automated analysis of thermal variations of breast tissues is attempted using nonlinear adaptive level sets and Riesz transform. Breast thermal images are initially subjected to Stein's unbiased risk estimate based orthonormal wavelet denoising. These denoised images are enhanced using contrast-limited adaptive histogram equalization method. The breast tissues are then segmented using non-linear adaptive level set method. The phase map of enhanced image is integrated into the level set framework for final boundary estimation. The segmented results are validated against the corresponding ground truth images using overlap and regional similarity metrics. The segmented images are further processed with Riesz transform and structural texture features are derived from the transformed coefficients to analyze pathological conditions of breast tissues. RESULTS: Results show that the estimated average signal to noise ratio of denoised images and average sharpness of enhanced images are improved by 38% and 6% respectively. The interscale consideration adopted in the denoising algorithm is able to improve signal to noise ratio by preserving edges. The proposed segmentation framework could delineate the breast tissues with high degree of correlation (97%) between the segmented and ground truth areas. Also, the average segmentation accuracy and sensitivity are found to be 98%. Similarly, the maximum regional overlap between segmented and ground truth images obtained using volume similarity measure is observed to be 99%. Directionality as a feature, showed a considerable difference between normal and abnormal tissues which is found to be 11%. CONCLUSION: The proposed framework for breast thermal image analysis that is aided with necessary preprocessing is found to be useful in assisting the early diagnosis of breast abnormalities. Show more

Keywords: Breast thermography, level sets, segmentation, denoising, Riesz transform

DOI: 10.3233/THC-150915

Citation: Technology and Health Care, vol. 23, no. 4, pp. 429-442, 2015

Authors: Hwang, Dal-Yeon | Lee, Hwang-Jae | Lee, Gyu-Chang | Lee, Suk-Min

Article Type: Research Article

Abstract: BACKGROUND: Gait training is important for stroke rehabilitation, such as using the treadmill training with functional electrical stimulation (FES). OBJECTIVE: This study was to investigate the effects of the treadmill training with tilt sensor FES on the balance, gait, and muscle architecture of the tibialis anterior in stroke survivors. METHODS: The study was a randomized controlled trial. Thirty-four stroke survivors were recruited and screened eligibility criteria. Thirty-two participants were randomly allocated to two groups using random allocation software: Treadmill training with Tilt Sensor FES (TTSF) group (n= 16) and Treadmill training with …Placebo Tilt Sensor FES (TPTSF) group (n= 16). TTSF group performed gait training on treadmill with tilt sensor FES, and TPTSF group performed gait training on treadmill with placebo tilt sensor FES. Two participants were dropped during this study, and 30 participants were included at post-test. Balance and gait were measured using the timed up and go (TUG) test, berg balance scale (BBS), and 10 m walk test (10 mWT). Ultrasound imaging was used to measure the muscle architecture of the tibialis anterior. RESULTS: After intervention, there were significant improvements in the TUG, BBS, and 10 mWT compared to baseline in both groups (p< 0.05). At follow-up, the TUG, BBS, 10 mWT, and muscle architecture of tibialis anterior on the paretic side showed significant improvements in the TTSF group compared to TPTSF group (p< 0.05). CONCLUSIONS: The findings of this study suggest that TTSF can be an effective intervention for improving balance, gait ability, and muscle architecture of tibialis anterior of stroke survivors. Show more

Keywords: Stroke, ultrasound imaging, treadmill training, functional electrical stimulation

DOI: 10.3233/THC-150903

Citation: Technology and Health Care, vol. 23, no. 4, pp. 443-452, 2015

Authors: Hohloch, Lisa | Konstantinidis, Lukas | Wagner, Ferdinand C. | Strohm, Peter C. | Südkamp and, Norbert P. | Reising, Kilian

Article Type: Research Article

Abstract: BACKGROUND: Closed reduction and percutaneous pinning is regarded as the treatment of choice for unstable supracondylar humerus fractures, but there are cases in which the use of external fixation is preferable. OBJECTIVE: The aim of this study was to investigate whether the method of external fixation could be considered as a stable alternative to percutaneous pinning and whether there was a difference in stability between two different external fixator constructs. METHODS: Eighteen synthetic humeri were allocated to three groups of six bones each. The specimens of group 1 were fixed …by crossed pinning, those of group 2 by a new variation of an external fixator and the specimens of group 3 by an established variation of it. Osteotomy displacement was measured under static loading in internal and external rotation, as well as in extension and flexion. RESULTS: The external fixators proved to be significantly more stable than crossed pinning in sagittal loading. In internal rotation loading the new variation of the external fixator showed the best results. CONCLUSIONS: In case of fractures that can't be replaced by closed reduction the new variation of external fixator should be preferred to the established variation or open reduction and crossed pinning. Show more

Keywords: Supracondylar fracture, pediatric, biomechanical, crossed pinning, external fixator

DOI: 10.3233/THC-150905

Citation: Technology and Health Care, vol. 23, no. 4, pp. 453-461, 2015

Authors: Decker, Sebastian | Krämer, Manuel | Marten, Anna-Katharina | Pfeifer, Ronny | Wesling, Volker | Neunaber, Claudia | Hurschler, Christof | Krettek, Christian | Müller, Christian W.

Article Type: Research Article

Abstract: BACKGROUND: Inverse dynamization has recently been proposed for the treatment of tibia non-unions. Nickel-titanium (NiTi) shape memory alloys (SMAs) may provide an opportunity for contactless non-invasive alteration of the stiffness of an implant after surgery OBJECTIVE: The aim of this pilot study was to analyze the feasibility of the one way shape memory effect in a large animal as well as the feasibility of our ovine large animal fracture model. METHODS: A tibia osteotomy was performed in three sheep, followed by NiTi plate osteosynthesis in two cases and standard locking compression plate …(LCP) osteosynthesis in one sheep. Contactless induction heating was performed after 3 weeks in order to alter the stiffness of the NiTi plates. Euthanasia was followed by biomechanical analysis after 8 weeks. RESULTS: Successful change of configuration through contactless induction heating was shown in both SMA plates by image intensifier control. Although large differences in bending and torsional stiffness were observed between the operated and contralateral tibia, the sheep ambulated almost normally at six weeks post-operative. CONCLUSION: We were able to trigger the one way shape memory effect which non-invasively altered the stiffness of the plate osteosynthesis. Show more

Keywords: Sheep model, nickel-titanium, shape memory alloy, plate osteosynthesis, inverse dynamization, fracture repair

DOI: 10.3233/THC-150912

Citation: Technology and Health Care, vol. 23, no. 4, pp. 463-474, 2015

Authors: Springer, Shmuel

Article Type: Research Article

Abstract: BACKGROUND: Neuromuscular electrical stimulation (NMES) is commonly used in rehabilitation to restore movement to patients following orthopedic and neurological injuries. When applying NMES the goal is to induce the strongest contractions with minimal discomfort. OBJECTIVE: This study aimed to determine whether introducing an interphase interval (IPI) to 400 μ sec biphasic pulses during stimulation of the dorsiflexor muscles would have the same effect on force production and stimulation discomfort when stimulation was controlled by constant current (CC) or constant voltage (CV). METHODS: Eighteen healthy volunteers participated in the study. Each subject participated …in one session. Electrically induced contraction (EIC) forces and degree of discomfort were measured during stimulation of the ankle dorsiflexors with 0, 100 and 200 μ sec IPI settings with CC or CV. RESULTS: Compared to IPI = 0 μ sec, introduction of a 200 μ sec IPI increased force production with CC stimulation without increasing discomfort. No other enhancements in the EIC force compared to IPI = 0 μ sec were found between the IPIs with CC or CV. CONCLUSIONS: IPI may increase the effectiveness of biphasic pulse with CC, but not with CV stimulation. Show more

Keywords: Electrical stimulation, muscle force, constant current, constant voltage, inter-phase interva

DOI: 10.3233/THC-150913

Citation: Technology and Health Care, vol. 23, no. 4, pp. 475-483, 2015

Authors: Ozada, Neriman

Article Type: Research Article

Abstract: BACKGROUND: Biomechanics studies can help improve athletic performance. However, the biomechanics of knee joint ligament length changes and moment arms over six degrees of freedom (DOF) have yet to be established. OBJECTIVE: To construct a knee model to investigate the length and moment arm changes of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). METHOD: Six DOF joint modeling and analysis were performed using specialized modeling software. RESULTS: The length of all ligaments varied with …tibiofemoral flexion angle, contributed to joint motion, and restrained the joint in different positions. The ACL, MCL, and LCL lengths decreased, the PCL increased, the posterior tibial translation increased, the MCL moment arm increased, and the LCL moment arm decreased between 0° and 90°. The primary ligament restraints were the PCL (0° to 30°), MCL (30° to 60°), and PCL (60° to 90°). CONCLUSION: The restraining function of each ligament during motion can be modeled based on changes in ligament lengths during tibial translations and rotations during flexion. Understanding the correlations between ligament lengths and moment arm changes over a wide range of motion will help improve our understanding of joint kinematics and may be useful for the diagnosis and treatment of sports injury. Show more

Keywords: Biomechanics, anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, lateral collateral ligament

DOI: 10.3233/THC-150916

Citation: Technology and Health Care, vol. 23, no. 4, pp. 485-494, 2015

Authors: Koumpouros, Yiannis | Toulias, Thomas L. | Koumpouros, Nicholas

Article Type: Research Article

Abstract: BACKGROUND: The present research aims to identify the application of social media for marketing or communication purposes in healthcare. We studied the opinion of healthcare professionals, organizations and health consumers, trying to identify the current status, trends and beliefs. The research reveals that healthcare organizations have to move forward and engage with their customers. The health consumers are more mature than the health providers. The descriptive characteristics of the sample's responses collected during the survey are presented. OBJECTIVE: The current research tries to identify the application of social media for marketing or communication purposes …in healthcare in Greece. The scope of the paper is to investigate the status in Greece and compare it with other countries. METHODS: We studied the opinion of healthcare professionals, organizations and health consumers, trying to identify the current status, trends and beliefs. We formed adequate questionnaires which were distributed to the different target groups, while for statistical analysis we performed tests (in order to investigate the dependence between certain respondents' categories) as well as one-way ANOVA analysis for inference purposes. In this context, the results can depict the (average) behavior, as well as the homogeneity of the corresponding general population. RESULTS: The research conducted took into account the individualities of the Greek environment and revealed that both physicians and healthcare organizations have to move forward in order to engage with their customers. There is also a clear need to measure the effectiveness of any such media marketing effort. Most adopters are not yet-taking maximum advantage of the technology. Social networks are prevalent and several paradigms support their adoption for marketing purposes in the sensitive healthcare domain. Even though the expectations are ambitious, there is a lot of work to do in Greece in order to achieve the desired outcome. An important finding is that patients' attitudes are, in general, differentiated from those of healthcare professionals. Even though the results of the present paper can be generalized, according to the statistical analysis performed, further research would be warranted to cover all possible participants in the healthcare chain. It is clear that both physicians and healthcare organizations have to adopt social media marketing in their daily practice in order to meet the needs of their customers. The present paper advances the current state of knowledge, as there is not any prior study on this field in Greece. Show more

Keywords: Social media, marketing, health, Greece, social networks, social networking

DOI: 10.3233/THC-150918

Citation: Technology and Health Care, vol. 23, no. 4, pp. 495-507, 2015

Authors: Schiza, Eirini C. | Neokleous, Kleanthis C. | Petkov, Nikolai | Schizas, Christos N.

Article Type: Research Article

Abstract: BACKGROUND: Medical practice and patient-doctor relationship will continue improving while technology is integrated in our everyday life. In recent years the term eHealth landmarked a new era with improved health provider's skills and knowledge, and increased patient participation in medical care activities. OBJECTIVE: To show why the design and implementation of a healthcare system needs to follow a specific philosophy dictated by the level of eHealth maturity of a country and its citizens. METHODS: Based on the maturity level, an adaptable framework for implementing an Electronic Health System at national level is …derived, guided by the Patient Centered Philosophy as defined and introduced by the EU directives. Implementation prerequisites are analyzed together with guiding principles for identifying the maturity level of an organization or country. RESULTS: Cyprus being a small EU country, it can be used as pilot site for the whole Europe, was chosen for this study and its maturity level analysis is presented. Recommendations that determine general steps needed to prepare the ground for an adequate patient-centered national healthcare system are accompanied. CONCLUSION: The implementation of an integrated Electronic Health Record at National level, as a prerequisite for a patient-centered eHealth environment is evidently demonstrated. Show more

Keywords: Electronic Health Record (EHR), eHealth, Personalized Medicine, Patient-Centered Medicine

DOI: 10.3233/THC-150919

Citation: Technology and Health Care, vol. 23, no. 4, pp. 509-522, 2015

Authors: Chen, C.-C. | Chen, S.-C. | Shih, Y.-Y. | Chen, Y.-L.

Article Type: Research Article

Abstract: BACKGROUND: Needle-stick injuries accounts for a great proportion of all medical accidents in developing and undeveloped countries. The main cause of needle-stick accident injuries is the medical personnel's ``recovering'' the needle action after injection. OBJECTIVE: This study applies an electronic technique to the needling instrument for the purpose of automatically detaching the needle. The proposed method can effectively avoid needle-stick accident injury when ``recovering'' the needle. METHODS: The syringe needle auto-detaching device includes an abutment on which there is a turntable mechanism composed of a pedestal, a turn-table and a driving unit. …A photo interrupter on the pedestal detects the rotational angle of the turntable and controls the stepping motor through a control circuit. An optical sensor is located on the upper end of the sensing mechanism. When the syringe is inserted into the syringe plughole the exposed portion of the needle will be detected by the optical sensor. After the syringe is placed into the plughole, its needle will be detected by the sensor. At this time the needle will be detached from the syringe and automatically fall down into the needle collection box. RESULTS: The syringe needle auto-detaching device was fatigue tested for an extensive period of time (A group: 1000 times/day for 3 ml, B group: 1000 times/day for 5 ml, C group: 1000 times/day for 3 ml and 5 ml staggered, D group: 1000 times/day for 3 ml and 5 ml randomized). The needle and syringe detachment rates were 100% in all test groups. CONCLUSIONS: The syringe needle auto-detaching device developed in this study, in that the clinician performs only one step to dispose a needle. Six syringe needle sets can be managed sequence second by second. The proposed device without all of the risk factors of the traditional syringe needle detachment device. Show more

Keywords: Needle-stick, medical treatment, needling instrument, needle recovering

DOI: 10.3233/THC-150908

Citation: Technology and Health Care, vol. 23, no. 4, pp. 523-528, 2015

Article Type: Correction

DOI: 10.3233/THC-151030

Citation: Technology and Health Care, vol. 23, no. 4, pp. 529-529, 2015