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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: We studied the anatomic positioning of the femoral tunnel during simulated anterior cruciate ligament reconstruction using an anteromedial portal approach in cadaveric models. METHODS: In thirty cadaveric human knee specimens, simulation of an arthroscopic anterior cruciate ligament reconstruction was performed and the femoral tunnel was drilled using an anteromedial portal. A Kirschner wire was passed into the tunnel and radiographs were obtained. These radiographs were then evaluated in the coronal and sagittal planes. Angles between the axis of the femoral tunnel and the joint line in the coronal plane (alpha, α )…or the femoral long axis in the sagittal plane (beta, β ) were calculated for each specimen. The external aperture of the femoral tunnel was defined as the point of exit of the Kirschner wire from the lateral femoral cortex. This was evaluated relative to a prescribed rectangle and coordinate axis, with the radiographic quadrant method of Bernard, to assess the accuracy of femoral tunnel placement. RESULTS: The mean α in the coronal plane was 48.53 ∘ , the mean β in the sagittal plane was 32.23 ∘ . All of the femoral tunnel external apertures were located outside of the rectangle CONCLUSION: We evaluated the positioning of the femoral tunnel and the external aperture of the femoral tunnel with the anteromedial portal technique. This study provides a reference standard to assess accurately femoral tunnel positioning on postoperative radiographs.
Abstract: BACKGROUND: Kyphoplasty is a proven minimally invasive procedure for the treatment of patients with osteoporotic fractures. By augmentation of fractured vertebral body, however, a very large portion of the intervertebral structures will be destroyed. With the help of a new device (Vertect Jack Device), the erection of the vertebral body will be carried out more gentle. OBJECTIVE: In the present study, the new method should be clinically tested for efficacy and safety for the first time. As a comparison results of previous treatments with kyphoplasty were used. METHODS: For Vertect Jack Device study…patients with painful vertebral fractures were selected in which conservative treatment had not yielded sufficient results. For comparison random data from the records of patients who had been treated with kyphoplasty were selected. The Vertect Jack Device was placed under the central fractures and then erected. After having restorted the vertebral height the device was removed and cement injected. Clinical and radiological examinations were carried out before and after 1,3, and 6 months. RESULTS: In the Vertect Jack Device Group the data of 40 patients were evaluated. For group 2 (kyphoplasty) 50 patients were selected. There was a significant difference in the duration of the surgery (Group 1: 27.4, Group 2: 45.9 minutes). A significant difference of 20 mm with regard to the reduction of VAS scores (0–100 mm pain intensity) was detected. Under the application of the Vertect Jack Device an average increase of 3.1 mm of vertebral height was achieved. In group 2, the erection averaged 0.4 mm. A correlation between the postoperative change of vertebral body height and VAS scores could not be detected in both groups. CONCLUSIONS: The comparative analysis of this study shows that promising results can be achieved with the augmentation of vertebral fractures with the Vertect Jack Device. When compared with kyphoplasty, advantages show in terms of targeted and thus more gentle application possibility and better pain relief over a period of 6 months after surgery. Further study results should help to demonstrate the efficacy and tolerability of the new method.
Keywords: Vertect Jack Device, vertebral augmentation, kyphoplasty
Abstract: BACKGROUND: Pressure injuries are an important health care issue. This problem is even more evident with patients with neurological conditions. OBJECTIVE: This study aims to develop an analytical tool to predict the magnitude of the maximum stresses developed at the wheelchair cushion-patient contact area. METHOD: Newton’s polynomial interpolation method was applied in order to obtain correlations between the maximum stress developed and the weight of the patient and the maximum pressure and body mass index (BMI) of the participants. For this study it was recruited five able-bodies and nine patients with spinal cord injury.…RESULTS: The agreement between the computed stress values and those measured with the able-bodied group is excellent, but in the patients within the spinal cord injury group, the concordance is poor. The correlations were applied in data from Crawford’s study, and predictions of pressures show lack of agreement. CONCLUSIONS: Correlation between the weight of a person and the maximum stress developed by him or her while sitting for extended periods of time has been demonstrated. The lack of agreement between estimated and measured values in spinal cord injuries and Crawford’s data can be mainly attributed to some sort of neurological status.
Keywords: Prediction of pressure injuries, numerical analysis, wheelchair cushions
Abstract: BACKGROUND: Vertebral compression fractures (VCF) change the natural spinal alignment and inevitably lead to a decreased quality of life. OBJECTIVE: The aim of the study was to evaluate changes in pulmonary function after VCF were treated by radiofrequency kyphoplasty (RF-TVA). METHODS: Twenty-five patients were treated with RF-TVA and analyzed in 3 subgroups taking into account the spinal location of the VCF. Pain as measured by visual analogue scale (VAS), Oswestry-Disability-Index (ODI), vertebral height, forced expiratory volume in 1 second (FEV 1 ), and peak expiratory flow (PEF) were assessed before,…directly after and 30 days after RF-TVA. RESULTS: The mean vertebral height was improved in all subgroups, with a minor reduction from one to 30 days postoperatively. The mean VAS and ODI significantly decreased in the main and upper diaphragm groups from baseline to the follow-up after 30 days. Patients treated below the main diaphragm region showed a significant improvement of ODI and a clear trend to significant improvements of VAS. PEF and FEV 1 were significantly improved in the main diaphragm group. FEV 1 also increased significantly in the upper diaphragm group with a clear trend to significance in the lower diaphragm group. CONCLUSIONS: Results indicate that RF-TVA may improve pulmonary function especially in cases where fractures are located in the main spinal region of the diaphragm.
Abstract: BACKGROUND: The influence of various musculoskeletal disorders has been evaluated using different kinetic and kinematic parameters. But the efficiency of walking can be evaluated by measuring the effort of the subject, or by other words the energy that is required to walk. OBJECTIVE: The aim of this study was to identify mechanical energy differences between the normal and pathological groups. Four groups of 15 healthy subjects, 13 Parkinson subjects, 4 osteoarthritis subjects, and 4 ACL reconstructed subjects have participated in this study. The motions of foot, shank and thigh were recorded using a three dimensional motion…analysis system. The kinetic, potential and total mechanical energy of each segment was calculated using 3D markers positions and anthropometric measurements. RESULTS: Maximum value and sample entropy of energies was compared between the normal and abnormal subjects. Maximum value of potential energy of OA subjects was lower than the normal subjects. Furthermore, sample entropy of mechanical energy for Parkinson subjects was low in comparison to the normal subjects while sample entropy of mechanical energy for the ACL subjects was higher than that of the normal subjects. CONCLUSION: Findings of this study suggested that the subjects with different abilities show different mechanical energy during walking.
Abstract: BACKGROUND: Treadmills are used frequently in rehabilitation enabling neurologically impaired subjects to train walking while being assisted by therapists. Numerous studies compared walking on treadmill and overground for unperturbed but not also perturbed conditions. OBJECTIVE: The objective of this study was to compare stepping responses (step length, step width and step time) during overground and treadmill walking in a group of healthy subjects where balance assessment robots applied perturbing pushes to the subject’s pelvis in sagittal and frontal planes. METHODS: During walking in both balance assessment robots (overground and treadmill-based) with applied perturbations…the stepping responses of a group of seven healthy subjects were assessed with a motion tracking camera. RESULTS: The results show high degree of similarity of stepping responses between overground and treadmill walking for all perturbation directions. Both devices reproduced similar experimental conditions with relatively small standard deviations in the unperturbed walking as well as in perturbed walking. CONCLUSIONS: Based on these results we may conclude that stepping responses following perturbations can be studied on an instrumented treadmill where ground reaction forces can be readily assessed which is not the case during perturbed overground walking.
Abstract: National recommendations in Sweden recommend a safety distance of 3 meter (m) between mobile phones and medical-electrical (ME) equipment in hospitals. A questionnaire was used to investigate how often mobile phones were reported to interfere with ME products in clinical practice across Sweden. The results confirmed that ME equipment can be affected by mobile phone use but, the risk of the patient’s outcome being affected were minimal; no cases were identified which led to injury or death. In conclusion, the results support recommendations for a general safety distance of 0.5 m between mobile phones and ME…equipment in care environments.
Keywords: Medical devices, cellular phone, mobile phone, patient safety, safety distance
Abstract: PURPOSE: To assess the attitude to and perception of transvaginal sonography (TVS) among Nigerian women of mixed educational status in order to ascertain factors that may prevent them from submitting to TVS when recommended. METHODS: A Cross-sectional survey was adopted for the study. Subjects were enrolled from one missionary, one government and eight private hospitals. The instruments for data collection were visual analogue scale (VAS), to ascertain patients’ pain/discomfort experience, and a researcher-developed semi-structured questionnaire. The level of pain/discomfort on the VAS was categorized into four on a scale of 100. The categories were: 0–5 (no pain), 6–40…(mild pain), 41–74 (moderate pain), and 75–100 (severe pain). RESULTS: The majority (50.6%) of the respondents who attained secondary education had positive attitude to TVS. The majority majority of the respondents (63.1%) preferred female sonographers. A majority of the respondents (54.1%) perceived TVS as not embarrassing, 78% did not consider it stressful, 96.9% reported that the sonographers were professional, 46.7% felt that a chaperon was needed, 98.4% reported there was enough privacy and 84.7% reported they needed prior information. Most of the respondents (82%) were willing to consent to TVS in future, 90.5% reported no pain, 8.6% reported mild pain/discomfort and 0.9% reported moderate pain. CONCLUSIONS: Majority of our respondents had a positive attitude to TVS and were willing to consent to TVS in future, hence it was acceptable to them. It was however observed that acceptability increased with increasing education.
Abstract: Publications describing the diagnosis and treatment of anterior dislocation of the sacroiliac joint are scarce. We report the case a 19-year-old female at 8 weeks’ gestation who presented with anterior fracture dislocation of the right sacroiliac joint, posterior fracture dislocation of the left sacroiliac joint (crescent fracture), and incomplete abortion resulting from high energy trauma. Orthopedic surgery involved standard anterior sacroiliac joint plating using an ilioinguinal approach combined with a modified Stoppa approach. Three attempts at complete abortion failed. Complete abortion was eventually achieved by dilatation and curettage two weeks after orthopedic surgery. Our findings reveal a need to improve…techniques for diagnosis and treatment of anterior fracture dislocation of the sacroiliac joint, so greater attention can be paid to the rapid and effective management of associated comorbidities, and those resulting from the initial trauma.
Abstract: BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has developed rapidly and becomes a significant treatment for emergency. Current blood pumps for ECMO have different disadvantages. OBJECTIVE: To design a pulsatile DC electromagnetic blood pump for ECMO. METHODS: The design is presented with a driving principle which the rectilinear reciprocation of a magnet inside energized solenoids is implemented, and with a structure of solenoids with compensation coils. Furthermore, a prototype was constructed and the performance indexes of it were measured with the experimental evaluations, where the acceleration experiment was performed without any loads, and the flows…were measured in the ranges of preload and afterload are 5 to 30 mmHg and 50 to 80 mmHg respectively when the frequency of the motion is 80 beats per minute. RESULTS: The electromagnetic force is greater than 1.4 N when the DC reaches 2.7 A and the flow of the prototype is greater than 3.0 L/min except the differences between the preload and the afterload are greater than or equal to 70 mmHg. CONCLUSIONS: The design of the blood pump for ECMO meets the theoretical and clinical requirements.
Keywords: Pulsatile blood pump, DC electromagnet, solenoid with compensation coils
Abstract: A smart electrocardiogram (ECG) garment system was designed for continuous, non-invasive and comfortable ECG monitoring, which mainly consists of four components: Conductive textile electrode, garment, flexible printed circuit board (FPCB)-based ECG processing module and android application program. Conductive textile electrode and FPCB-based ECG processing module (6.8 g, 55 mm × 53 mm × 5 mm) are identified as two key techniques to improve the system’s comfort and flexibility. Preliminary experimental results verified that the textile electrodes with circle shape, 40 mm size in diameter, and 5 mm thickness sponge are best suited for the long-term…ECG monitoring application. The tests on the whole system confirmed that the designed smart garment can obtain long-term ECG recordings with high signal quality.