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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: The non-image-forming effects of luminous radiation on people with intellectual disabilities or dementia received attention from researchers. Such studies, however, have generally been conducted using disparate methodologies which precludes generalization and reproducibility. OBJECTIVE: The aim of this study was to determine the practical applicability of measurement devices for studies investigating non-image-forming effects of luminous radiation, specifically for people with intellectual disabilities or dementia. METHODS: In three experiments, ten cognitive impaired people and thirty-nine unaffected subjects participated by wearing one or more portable devices. Six devices were assessed in total. Measurement…data was accompanied with user experiences obtained from questionnaires, interviews and observations in order to assess the devices on practical and comfort issues. RESULTS: On average, the devices worn by the cognitive impaired subjects were not experienced as annoying or irritating. No significant differences are found between genders and for one of the portable devices significantly less annoyance was reported by the cognitive impaired participants compared to the unaffected group of participants. INNOVATIVE SOLUTION: The three phases of the research process in towards measuring personal luminous exposures are: selection of the most suitable portable device, application of the assessment method, and the application of the device in the (pilot) study. CONCLUSIONS: However, the findings of this study suggest that inaccuracies potentially caused by practical and comfort issues associated with the portable devices need to be considered.
Abstract: PURPOSE: To develop a mobile application (app) for oral cancer screening. METHODS: The app was developed using Android system version 4.4.2, with JAVA language. Information concerning sociodemographic data and risk factors for oral cancer development, e.g., tobacco and alcohol use, sun exposure and other contributing factors, such as unprotected oral sex, oral pain and denture use, were included. We surveyed a population at high risk for oral cancer development and then evaluated the sensitivity/specificity/accuracy and predictive values of clinical oral diagnosis between two blinded trained examiners, who used movies and data from the app, and…in loco oral examination as gold-standard. RESULTS: A total of 55 individuals at high risk for oral cancer development were surveyed. Of these, 31% presented homogeneous/heterogeneous white lesions with potential of malignancy. The clinical diagnoses performed by the two examiners using videos were found to have sensitivity of 82%-100% (average 91%), specificity of 81%-100% (average 90.5%), and accuracy of 87.27%-95.54% (average 90.90%), as compared with the gold-standard. The Kappa agreement value between the gold-standard and the examiner with the best agreement was 0.597. CONCLUSION: Mobile apps including videos and data collection interfaces could be an interesting alternative in oral cancer research development.
Keywords: Oral cancer, health informatics, health public policy
Abstract: BACKGROUND: Myocardial revascularization by coronary artery bypass grafting (CABG) is an effective measure for reducing symptoms and mortality in patients with unstable or severe coronary artery disease (CAD). Autonomic function can be estimated non-invasively using heart rate variability (HRV). HRV of patients undergoing CABG is investigated before and after CABG using a soft-decision wavelet based spectral analysis. OBJECTIVE: The main purpose of this work is to evaluate non-invasively HRV in patients undergoing CABG before operation; and to monitor the status of patients through HRV investigation on day 6 and day 30 after the CABG operation.…The study intends to contribute scientific value to understanding the effect of CABG on the cardiovascular autonomic function and surgical outcome. METHODS: The soft-decision wavelet-based technique is used in this work in order to measure the power spectral density of the three main bands (VLF, LF, and HF) of HRV in 24 patients undergoing CABG operation, before the operation (Group 1: G1), and 6 days after operation (Group 2: G2) and 30 days after operation (Group 3: G3). The data is obtained from Sultan Qaboos University hospital in Oman. RESULTS: The HF power increases in 22 out of 24 patients in G2 compared to G1. While the LF power decreases in 21 out of 24 patients in G2 compared to G1. Comparing G3 to G1 the LF power decreases in 20 patients. The sum of the VLF and LF power is reduced in G2 in all 24 subjects compared to G1, and in 19 subjects in G3 compared to G1. CONCLUSIONS: The power spectral density of the HF shows increase in patients recorded on day 6 after operation compared to patients before the operation. The LF shows a decrease in G2 compared to G1. The results of G3 after 30 days of operation still show an increase of the HF power and a decrease in the LF power in most of the patients compared to their values before operation.
Abstract: Body circumference is a known health-related factor. This cross-sectional study aimed to investigate the associations of relative lower body circumferences with metabolic syndrome (MetS) and arterial stiffness (AS) in 684 men aged > 40 (mean, 54.6 ± 8.5) years. Participants were measured for waist, thigh, and calf circumferences; underwent blood tests and blood pressure measurements to detect MetS; and received brachial ankle pulse wave velocity measurements to measure AS. The waist-to-thigh, waist-to-calf, and thigh-to-calf circumferences were calculated and classified into quartiles. Age-adjusted multiple logistic regression models were used to assess the associations between the circumference ratios and AS vs.…non-AS and MetS vs. non-MetS (systolic and diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol, and fasting plasma glucose). The mean body mass index was 24.9 ± 2.8 kg/m2 ; the mean waist, thigh, and calf circumferences were 87.4 ± 7.6, 53.8 ± 4.2, and 36.4 ± 2.7 cm, respectively. Compared to the lowest quartiles, participants in waist-to-thigh circumference quartiles 3 (odds ratio [OR] = 3.195, 95% confidence interval [CI] = 1.825-5.594, p < 0.001) and 4 (OR = 4.755, 95% CI = 2.715-8.325, p < 0.001), and participants in waist-to-calf circumference quartiles 2 (OR = 2.511, 95% CI = 1.397-4.511, p = 0.002), 3 (OR = 3.929, 95% CI = 2.076-7.435, p < 0.001), and 4 (OR = 5.298, 95% CI = 2.847-9.858, p < 0.001) had significantly greater risks of MetS; participants in waist-to-calf circumference quartile 4 (OR = 2.481, 95% CI = 1.477-4.167, p < 0.001) and participants in waist-to-calf circumference quartile 4 (OR = 1.763, 95% CI = 1.088-2.856, p = 0.021) had a significantly greater risk of AS, indicating that age-adjusted relative lower body circumferences associate with MetS and AS. Large thigh and calf circumferences may indicate reduced risks for cardiovascular disease.
Keywords: Arterial stiffness, body circumference, metabolic syndrome
Abstract: BACKGROUND: Speech synthesis models have been considered as viable tools for performance evaluation of cochlear stimulation algorithms, due to the difficulties of clinical tests. OBJECTIVE: The present study has developed a tool that can be used before any audio signal reconstruction algorithm, which shows more conformity with the electrophysiological parameters of the patient in evaluation of the cochlear implant stimulation algorithms. METHODS: In this method, excitable nerve fiber characteristics such as stimulation threshold and effective refractory period have been considered in the signal pre-reconstruction process. This algorithm subsumes the user's biological parameters (e.g.,…the manner of distribution of the remaining intact nerve fibers) as well as the stimulation signal parameters (e.g., stimulation rate, pulse width, amplitude of stimulation, the distance between stimulation electrode and fibers) in the signal pre-reconstruction. RESULTS: Effect of changes in these parameters can be observed by the number of excited fibers, which is directly related to the signal intensity and pitch frequency perceived by the user. The obtained results from simulations are in accordance with previous clinical findings. Also, the ability of the proposed tool can be seen by the correspondence between the results obtained from the proposed model and the amplitude growth functions of the cochlear implant users. CONCLUSIONS: This paper has introduced a tool for signal reconstruction from electrical stimulation so that a more comprehensive criterion for examination of the stimulating algorithms in cochlear implant can be achieved.
Abstract: The medical device industry has grown rapidly and incessantly over the past century. The sophistication and complexity of the designed instrumentation is nowadays rising and, with it, has also increased the need to develop some better, more effective and efficient maintenance processes, as part of the safety and performance requirements. This paper presents the results of performance tests conducted on 50 mechanical ventilators and 50 infant incubators used in various public healthcare institutions. Testing was conducted in accordance to safety and performance requirements stated in relevant international standards, directives and legal metrology policies. Testing of output parameters for mechanical ventilators…was performed in 4 measuring points while testing of output parameters for infant incubators was performed in 7 measuring points for each infant incubator. As performance criteria, relative error of output parameters for mechanical ventilators and absolute error of output parameters for infant incubators was calculated. The ranges of permissible error, for both groups of devices, are regulated by the Rules on Metrological and Technical Requirements published in the Official Gazette of Bosnia and Herzegovina No. 75/14, which are defined based on international recommendations, standards and guidelines. All ventilators and incubators were tested by etalons calibrated in an ISO 17025 accredited laboratory, which provides compliance to international standards for all measured parameters. The results show that 30% of the tested medical devices are not operating properly and should be serviced, recalibrated and/or removed from daily application.
Abstract: BACKGROUND: The goal of this work is to develop a digital version of a standard cognitive assessment, the Trail Making Test (TMT), and assess its utility. OBJECTIVE: This paper introduces a novel digital version of the TMT and introduces a machine learning based approach to assess its capabilities. METHODS: Using digital Trail Making Test (dTMT) data collected from (N = 54) older adult participants as feature sets, we use machine learning techniques to analyze the utility of the dTMT and evaluate the insights provided by the digital features. RESULTS: Predicted…TMT scores correlate well with clinical digital test scores (r = 0.98) and paper time to completion scores (r = 0.65). Predicted TICS exhibited a small correlation with clinically derived TICS scores (r = 0.12 Part A, r = 0.10 Part B). Predicted FAB scores exhibited a small correlation with clinically derived FAB scores (r = 0.13 Part A, r = 0.29 for Part B). Digitally derived features were also used to predict diagnosis (AUC of 0.65). CONCLUSION: Our findings indicate that the dTMT is capable of measuring the same aspects of cognition as the paper-based TMT. Furthermore, the dTMT's additional data may be able to help monitor other cognitive processes not captured by the paper-based TMT alone.
Keywords: Computerized cognitive assessment, design and validation, machine learning, mobile application, Trail Making Test
Abstract: It is thought that the critical brain dynamics in sleep is modulated during frequent periods of wakefulness. This paper utilizes the capacity of EEG based scaling analysis to quantify sleep fragmentation in patients with obstructive sleep apnea. The scale-free (fractal) behavior refers to a state where no characteristic scale dominates the dynamics of the underlying process which is evident as long range correlations in a time series. Here, Multiscaling (multifractal) spectrum is utilized to quantify the disturbed dynamic of an OSA brain with fragmented sleep. The whole night multichannel sleep EEG recordings of 18 subjects were employed to compute and…quantify variable power-law long-range correlations and singularity spectra. Based on this characteristic, a new marker for sleep fragmentation named ``scaling based sleep fragmentation'' was introduced. This measure takes into account the sleep run length and stage transition quality within a fuzzy inference system to improve decisions made on sleep fragmentation. The proposed index was implemented, validated with sleepiness parameters and compared to some common indexes including sleep fragmentation index, arousal index, sleep diversity index, and sleep efficiency index. Correlations were almost significant suggesting that the sleep characterizing measure, based on singularity spectra range, could properly detect fragmentations and quantify their rate. This method can be an alternative for quantifying the sleep fragmentation in clinical practice after being approved experimentally. Control of sleep fragmentation and, subsequently, suppression of excessive daytime sleepiness will be a promising outlook of this kind of researches.
Abstract: BACKGROUND: Intraocular Pressure (IOP) is defined as the pressure of aqueous in the eye. It has been reported that the normal range of IOP should be within the 10-20 mmHg with an average of 15.50 mmHg among the ophthalmologists. Keratoconus is an anti-inflammatory eye disorder that debilitated cornea unable to reserve the normal structure contrary to the IOP in the eye. Consequently, the cornea would bulge outward and invoke a conical shape following by distorted vision. In addition, it is known that any alterations in the structure and composition of the lens and cornea would exceed a change of…the eye ball as well as the mechanical and optical properties of the eye. OBJECTIVE: Understanding the precise alteration of the eye components' stresses and deformations due to different IOPs could help elucidate etiology and pathogenesis to develop treatments not only for keratoconus but also for other diseases of the eye. METHODS: In this study, at three different IOPs, including 10, 20, and 30 mmHg the stresses and deformations of the human eye components were quantified using a Three-Dimensional (3D) computational Fluid-Structure Interaction (FSI) model of the human eye. RESULTS: The results revealed the highest amount of von Mises stress in the bulged region of the cornea with 245 kPa at the IOP of 30 mmHg. The lens was also showed the von Mises stress of 19.38 kPa at the IOPs of 30 mmHg. In addition, by increasing the IOP from 10 to 30 mmHg, the radius of curvature in the cornea and lens was increased accordingly. In contrast, the sclera indicated its highest stress at the IOP of 10 mmHg due to over pressure phenomenon. The variation of IOP illustrated a little influence in the amount of stress as well as the resultant displacement of the optic nerve. CONCLUSION: These results can be used for understanding the amount of stresses and deformations in the human eye components due to different IOPs as well as for clarifying significant role of IOP on the radius of curvature of the cornea and the lens.
Keywords: Human eye, Intraocular Pressure, keratoconus, fluid-structure interaction, stresses and deformations
Abstract: Evaluating the biomechanical and performance factors of the knee joint during golf swing can provide objective and quantitative information about improving the performance and development of efficient physical training, as the legs are important for achieving an efficient swing and maximum speed of the club head in golf. In the present study, kinematic movements of the knee joint were identified during the downswing by using 3-dimensional motion analysis, and isokinetic strength was measured with driver and 5-iron clubs in 15 professional (PRO) golfers and 10 amateur (AMA) golfers. Results showed that PRO golfers had a narrower minimal angle between the…thigh and lower leg in the trail knee than the AMA golfers, regardless of the club used, and the angular velocity of the lead knee was faster during the downswing with a 5-iron club in the AMA golfers than in the PRO golfers. The PRO and AMA golfers had a wider minimal angle between the thigh and lower leg, smaller total range of movement, and slower angular velocity of the trail knee when swinging a 5-iron club than when swinging a driver club. These results are expected to provide useful information to prevent golf-related injuries that usually arise in the knee joint and help improve the golf performance of amateur golfers.
Keywords: Downswing, golf, knee joint, isokinetic strength, kinematic movement
Abstract: OBJECTIVE: To establish a three-dimensional finite element model of the human chest for engineering research on individual protection. METHOD: Computed tomography (CT) scanning data were used for three-dimensional reconstruction with the medical image reconstruction software Mimics. The finite element method (FEM) preprocessing software ANSYS ICEM CFD was used for cell mesh generation, and the relevant material behavior parameters of all of the model's parts were specified. The finite element model was constructed with the FEM software, and the model availability was verified based on previous cadaver experimental data. RESULTS: A finite element model…approximating the anatomical structure of the human chest was established, and the model's simulation results conformed to the results of the cadaver experiment overall. CONCLUSION: Segment data of the human body and specialized software can be utilized for FEM model reconstruction to satisfy the need for numerical analysis of shocks to the human chest in engineering research on body mechanics.
Keywords: Human chest, finite element model, availability check
Abstract: BACKGROUND: Sacroiliac joint (SIJ) syndrome can cause various symptoms and may also be one reason for persistent low back pain, especially in patients with prior spinal fusions. If conservative treatments fail to improve symptoms, arthrodesis surgery can be considered. Minimally invasive approaches have emerged recently providing a good alternative to conventional methods. A novel triangular implant system (iFuse) can achieve an arthrodesis of the SIJ without the use of additional screws or bone material. OBJECTIVE: Aim of the present study was an evaluation of short-term safety and efficacy of the implant system. METHODS:…Twenty-four patients were included in the study and treated with the iFuse system. In addition to demographic data, pain intensity (visual analogue scale) and functional impairment (Oswestry-disability index) were assessed prior to surgery and 1 month, 3 months, 6 months, 12 months and 24 months thereafter. During surgery and the follow up period all adverse events were documented and the correct implant position was controlled via plain radiographs. RESULTS: VAS scores and ODI improved significantly directly after surgery from 84.3 ± 9.2 mm to 40.7 ± 9.2 mm and from 76.8 ± 9.2% to 40.7 ± 9.2 % (p < 0.001). The ODI improved further to 31 ± 5.4% after 24 months whereas the VAS improved until the 3 months examination and ten stayed constant between 27.7 mm and 26.5 mm to 27 ± 6.6 mm at 24 months. No adverse events, intraoperative complications, implant malpositioning or loosening could be recorded at any time. CONCLUSIONS: The iFuse system is an effective and safe treatment for minimally invasive surgical arthrodesis of the SIJ. Pain and functional impairment can be significantly improved. However, in addition to this case series, further controlled studies are necessary, particularly in terms of a previous spinal fusion history.
Abstract: INTRODUCTION: PMMA-augmentation of pedicle screws strengthens the bone-screw-interface reducing cut-out risk. Injection of fluid cement bears a higher risk of extravasation, with difficulty of application because of inconsistent viscosity and limited injection time. OBJECTIVE: To test a new method of cement augmentation of pedicle screws using radiofrequency-activated PMMA, which is suspected to be easier to apply and have less extravasations. METHODS: Twenty-seven fresh-frozen human cadaver lumbar spines were divided into 18 osteoporotic (BMD ≤ 0.8 g/cm2 ) and 9 non-osteoporotic (BMD > 0.8 g/cm2 ) vertebral bodies. Bipedicular cannulated pedicle screws were implanted…into the vertebral bodies; right screws were augmented with ultra-high viscosity PMMA, whereas un-cemented left pedicle screws served as negative controls. Cement distribution was controlled with fluoroscopy and CT scans. Axial pullout forces of the screws were measured with a material testing machine, and results were analyzed statistically. RESULTS: Fluoroscopy and CT scans showed that in all cases an adequately big cement depot with homogenous form and no signs of extravasation was injected. Pullout forces showed significant differences (p < 0.001) between the augmented and non-augmented pedicle screws for bone densities below 0.8 g/cm2 (661.9 N ± 439) and over 0.8 g/cm2 (744.9 N ± 415). CONCLUSIONS: Pullout-forces were significantly increased in osteoporotic as well as in non-osteoporotic vertebral bodies without a significant difference between these groups using this standardized, simple procedure with increased control and less complications like extravasation.
Abstract: INTRODUCTION: Due to spinal instability and compressive neurologic deficits surgical management is sometimes necessary in patients with metastatic spinal lesions. However, in some cases open surgery is not possible and minimally invasive procedures, like cryoablation, are needed. The aim of the current study was to investigate whether a miniature cryoprobe provides adequate tissue cooling in vertebrae and to evaluate the direct impact of cryosurgery on vertebral body stability. MATERIALS AND METHODS: Twelve thoracic vertebral bodies were harvested from fresh cadavers. After documenting bone density cryoablation was performed in six vertebral bodies according to a standardized…procedure. Afterwards temperature inside the vertebral body and maximum breaking force were measured in the control and experimental groups. RESULTS: Required temperature of -50° was reached in all areas. There was a significant correlation between maximum breaking force and measured bone density (p= 0.001). Mean breaking force within the experimental group was 5047 N (SD = 2955 N) compared to 4458 N (SD = 2554 N) in the control group. There were no observable differences in maximum breaking force between both groups. CONCLUSION: Miniature cryoprobe can deliver adequate tissue cooling to -50°C in vertebral bodies. The procedure does not seem to influence breaking force of the treated bones in-vitro . Therefore, using miniature probes cryosurgery may provide a valuable alternative to conventional surgical resection of neoplastic diseases as well as of benign locally aggressive bone tumors.
Keywords: Cryoablation, miniature cryoprobes, metastatic spinal lesion, breaking force
Abstract: This paper discusses what can ensure the performance of judgment studies with an information design that integrates economics of medical systems, in the context of digitalization of healthcare. It is part of a series of 5 methodological papers on statistical procedures and problems to implement judgment research designs and decision models, especially to address cost of care, and ways to measure conversation on cost of care between physicians and patients, with unstructured data such as economic narratives to complement billing and financial information (e.g. cost cognitive cues in conjoint or reversed conjoint designs). The paper discusses how congruence of tasks…can increase the reliability of data. It uses some results of two Meta reviews of judgment studies in different fields of applications: psychology, business, medical sciences and education. It compares tests for congruence in judgment studies and efficiency tests in econometric studies.
Keywords: Judgment studies, decision models, congruence of clinical tasks, cost sharing research
Abstract: There have been rapid advances in technologies over the past decade and virtual reality technology is an area which is increasingly utilized as a healthcare intervention in many disciplines including that of Medicine, Surgery and Psychiatry. In Psychiatry, most of the current interventions involving the usage of virtual reality technology is limited to its application for anxiety disorders. With the advances in technology, Internet addiction and Internet gaming disorders are increasingly prevalent. To date, these disorders are still being treated using conventional psychotherapy methods such as cognitive behavioural therapy. However, there is an increasing number of research combining various other…therapies alongside with cognitive behavioural therapy, as an attempt possibly to reduce the drop-out rates and to make such interventions more relevant to the targeted group of addicts, who are mostly adolescents. To date, there has been a prior study done in Korea that has demonstrated the comparable efficacy of virtual reality therapy with that of cognitive behavioural therapy. However, the intervention requires the usage of specialized screens and devices. It is thus the objective of the current article to highlight how smartphone applications could be designed and be utilized for immersive virtual reality treatment, alongside low cost wearables.
Keywords: M-Health, smartphones, virtual reality therapy, internet addiction, internet gaming disorder
Abstract: Smartphones and their accompanying applications are currently widely utilized in various healthcare interventions. Prior to the deployment of these tools for healthcare intervention, typically, proof of concept feasibility studies, as well as randomized trials are conducted to determine that these tools are efficacious prior to their actual implementation. In the field of psychiatry, most of the current interventions seek to compare smartphone based intervention against conventional care. There remains a paucity of research evaluating different forms of interventions using a single smartphone application. In the field of nutrition, there has been recent pioneering research demonstrating how a multi-phasic randomized controlled…trial could be conducted using a single smartphone application. Despite the innovativeness of the previous smartphone conceptualization, there remains a paucity of technical information underlying the conceptualization that would support a multi-phasic interventional trial. It is thus the aim of the current technical note to share insights into an innovative server design that would enable the delivery of multi-phasic trials.
Keywords: M-health, smartphones, randomized interventional, trials, server design
Abstract: BACKGROUND: Women with breast cancer undergoing chemotherapy experience a variety of physical and psychosocial symptoms, which have negative effect on women's quality of life and psychological well-being. Although M-health technologies provides innovative and easily accessible option to provide psychosocial support, mobile phone based interventions remain limited for these women in China. OBJECTIVE: To develop a new mobile application to offer information as well as social and emotional support to women with breast cancer undergoing chemotherapy to promote their self-efficacy and social support, thus improving symptom management strategies. METHODS: Basing on previous theoretical framework…which incorporated Bandura's self-efficacy theory and the social exchange theory, a new mobile application, called Breast Cancer e-Support Program (BCS) was designed, with the content and functionality being validated by the expert panel and women with breast cancer. RESULTS: BCS App program has four modules: 1) Learning forum; 2) Discussion forum; 3) Ask-the-Expert forum; and 4) Personal Stories forum. BCS program can be applied on both android mobile phones and iPhones to reach more women. CONCLUSIONS: This is the first of its kind developed in China for women with breast cancer undergoing chemotherapy. A randomized controlled trial is undertaking to test the effectiveness of BCS program.
Keywords: M-health, mobile phone, application, breast cancer, chemotherapy, symptom management