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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: Both osteomyelitis and prosthetic joint infection can be treated surgically with the use of antibiotic loaded bone grafts, as part of local antimicrobial therapy. OBJECTIVE: The purpose of the study was to evaluate and to report on a novel, biodegradable, long-acting (4–6 weeks) antibiotic-impregnated bone graft (AIBG). A novel drug delivery system, containing vancomycin, was utilized in a rabbit osteomyelitis model in order to evaluate the antimicrobial efficacy of the antibiotic bone graft. METHODS: Forty adult New Zealand rabbits were used. The animals were randomized into three Groups: healthy animals without osteomyelitis,…where AIBG was used to fill a defect (Group I); osteomyelitis caused with a methicillin-resistant S.aureus strain (MRSA) treated with AIBG (Group II); osteomyelitis caused with MRSA and treated with bone grafts without local antibiotics (Group III). At six weeks post-operation, the animals were sacrificed and histological, laboratory and radiologic evaluations were performed. RESULTS: Of the 24 operated rabbits, osteomyelitis was confirmed in 18 animals. In groups with osteomyelitis, only minor radiological changes were observed on day 21 post-op. Radiographs taken on day 42 post-op showed radiological signs of chronic osteomyelitis in Group III, whereas in Group II, bone healing was observed. Bacterial cultures taken on day 42 post-op revealed the original MRSA strain in Group III, whereas no bacteria were detected in Group II. Histological examinations showed the presence of macrophage cells which slowly break down the DDS matrix. The presence of DDS did not inhibit re-ossification. CONCLUSIONS: The drug delivery system was effective against MRSA-induced osteomyelitis without negative effect on osteointegration. This biodegradable technology has the potential to be a powerful tool in fighting bone infections.
Keywords: Local antibiotic therapy, drug delivery system, biodegradable, bone infection, experimental osteomyelitis
Abstract: BACKGROUND: The quality of upper extremity (UE) function can be evaluated by measuring the kinematic parameters of patient movements. OBJECTIVE: This investigation focused on finding the angles and angular velocity amplitudes of UE motions in healthy participants to compare with the experimental results of patients with a UE disability who are trying to recover previous movement conditions. METHODS: The UE motions of 23 healthy adult volunteers were tested using a three-dimensional motion capture system and measuring hand segment motions. A simplified 7 degrees of freedom (DOF) human arm kinematic model created within MATLAB and…used to process the experimental data. RESULTS: The interpersonal CV (coefficients of variability) of left-side motions showed that the lowest CV of linear velocity amplitudes was at elbow flexion (4.2%), but the highest was at wrist extension (48.3%). The lowest and highest CV of angular velocity amplitudes were 19.6% and 55.7%, during shoulder adduction and wrist extension, respectively. CONCLUSIONS: High interpersonal CV may restrict the direct comparison of kinematic parameters of UE in different healthy and disabled persons.
Keywords: Upper extremity, objective evaluation, motion capture system, biomechanics, kinematic human hand model
Abstract: BACKGROUND: Spinal fusion surgery has become one of the most common spinal procedures during the recent years. Searching for an optimum structural stability of the vertebral interspace, surgical implants which can be inserted via a posterior lumbar interbody fusion (PLIF) approach have been enhanced recently. OBJECTIVE: Evaluation of safety and efficacy of a novel PLIF polyetheretherketone (PEEK) interbody cage (TWIST) with an impactionless insertion technique. METHODS: Surgical outcome in 15 patients treated with the new system were observed preoperatively, one and three years after surgery using the Oswestry Disability Index (ODI), a Visual…Analogue Scale (VAS) for pain and radiological outcome analysis of fusion success. RESULTS: Fifteen patients (7 female, 8 male) were included in the test series. After three years ODI and VAS were significantly improved. The pain intensity was reduced by more than 75% after one year and after 3 years, pain intensity was about 60% below the initial situation. The Oswestry values (ODI) improved significantly in all patients after 3 years. The fusion evaluation showed a fusion success in 87% of the patients. CONCLUSION: The clinical and radiological results of this first series give a positive standing and important information on the efficacy and safety over 3 years. The follow-up checks with imaging techniques showed that the fusions were very successful and functional outcome as well as pain reduction were increased.
Abstract: INTRODUCTION: The use of reverse shoulder arthroplasty (RSA) has increased dramatically over the last two decades, with many surgeons now indicating RSA for the acute management of displaced proximal humerus fractures (PHF) in the elderly. RSA relies on adequate deltoid muscle function to obtain a good outcome, yet no literature to date exists which discusses preoperative assessment of deltoid structure prior to RSA. The purpose of this study was to assess for preoperative fatty deltoid-degeneration in patients with displaced PHF. MATERIALS AND METHODS: We reviewed the axial CT scans of 100 consecutive patients with a displaced…PHF. Fatty degeneration within each of the three deltoid-heads was graded at three levels, according to Goutallier and colleagues. Fractures were classified according to Neer. RESULTS: Seventy-nine percent of the patients were female, 75% showed 3 or 4 parts fractures. The average cross-sectional area of the posterior deltoid was greatest-representing 37%, 40% and 42% of total area at each level, respectively. Severe fatty degeneration (Stages 3 and 4) was observed in the posterior deltoid only (26%). Absence of fatty degeneration (Stage 0) was observed in < 25% of cases. The Inter-Observer-Reliability for the continuous variables proved to be high. CONCLUSION: Preoperative deltoid fatty degeneration is common in displaced PHF in the elderly. Because CT is commonly obtained to assess fracture morphology and for preoperative planning purposes, it is an ideal tool to assess the deltoid additionally. Future studies are warranted to determine whether preoperative fatty infiltration of the deltoid correlates with mid and long term functional outcomes when RSA is used acutely to manage a PHF. LEVEL OF EVIDENCE: Level IV-consecutive case series.
Abstract: Technological advances in prosthetics have attracted the curiosity of researchers in monitoring design and developments of the sockets to sustain maximum pressure without any soft tissue damage, skin breakdown, and painful sores. Numerous studies have been reported in the area of pressure measurement at the limb/socket interface, though, the relation between amputee’s physiological parameters and the pressure developed at the limb/socket interface is still not studied. Therefore, the purpose of this work is to investigate the effects of patient-specific physiological parameters viz. height, weight, and stump length on the pressure development at the transtibial prosthetic limb/socket interface. Initially, the pressure…values at the limb/socket interface were clinically measured during stance and walking conditions for different patients using strain gauges placed at critical locations of the stump. The measured maximum pressure data related to patient’s physiological parameters was used to develop an artificial neural network (ANN) model. The effects of physiological parameters on the pressure development at the limb/socket interface were examined using the ANN model. The analyzed results indicated that the weight and stump length significantly affects the maximum pressure values. The outcomes of this work could be an important platform for the design and development of patient-specific prosthetic socket which can endure the maximum pressure conditions at stance and ambulation conditions.
Abstract: BACKGROUND: Core stabilization plays an important role in the regulation of postural stability. To overcome shortcomings associated with pain and severe core instability during conventional core stabilization tests, we recently developed the dynamic neuromuscular stabilization-based heel sliding (DNS-HS) test. OBJECTIVE: The purpose of this study was to establish the criterion validity and test-retest reliability of the novel DNS-HS test. METHOD: Twenty young adults with core instability completed both the bilateral straight leg lowering test (BSLLT) and DNS-HS test for the criterion validity study and repeated the DNS-HS test for the test-retest reliability study.…Criterion validity was determined by comparing hip joint angle data that were obtained from BSLLT and DNS-HS measures. The test-retest reliability was determined by comparing hip joint angle data. RESULTS: Criterion validity was (ICC 2 , 3 ) = 0.700 (p < 0.05), suggesting a good relationship between the two core stability measures. Test-retest reliability was (ICC 3 , 3 ) = 0.953 (p < 0.05), indicating excellent consistency between the repeated DNS-HS measurements. CONCLUSIONS: Criterion validity data demonstrated a good relationship between the gold standard BSLLT and DNS-HS core stability measures. Test-retest reliability data suggests that DNS-HS core stability was a reliable test for core stability. Clinically, the DNS-HS test is useful to objectively quantify core instability and allow early detection and evaluation.
Abstract: BACKGROUND: Plain radiography, 2-dimensional (2D) magnetic resonance imaging (MRI), and computed tomography (CT) do not precisely display morphology and acetabular coverage in developmental dysplasia of the hip or pincer-type femoroacetabular impingement. Pelvic position and pelvic tilt affect assessment of the acetabular parameters, leading to misinterpretation. OBJECTIVE: We tested a 3-dimensional (3D) CT evaluation script to calculate the crossover sign (COS), acetabular coverage and morphology. METHODS: To test the method, we constructed a phantom pelvic model, in which the acetabulum was mounted at different coverages of the femoral head, and simulated a COS and…the acetabular morphology. Additionally we examined the reliability and objectivity of this method in ten patients with CT scans of the pelvis for conditions unrelated to hip disorders. RESULTS: We obtained an average accuracy of the 3D CT evaluation script of - 0.37 ∘ (range - 3.84 to 3.88; SD ± 1.43) for morphology, and 0.002% (range - 7.28% to 6.90%; SD ± 1.60%) for coverage of the femoral head. Significant correlation between the expected and calculated COS (p = 0.01) was found. CONCLUSIONS: Our 3D CT evaluation script permits precise evaluation of the acetabular coverage profile, the presence or absence of a COS and acetabular morphology, independent of patient positioning or pelvic tilt.
Keywords: Acetabular coverage profile, crossover sign, 3D computed tomography
Abstract: This paper is the last of a series of five methodological contributions in the field of stated preference studies for disease econometric models. It proposes several advances to integrate in the predictive model new variables on effects of computerization of medical records in clinical practice, adoption of new drug therapies and effect of different types of variables to control physicians’ attributes such as the type of visit disposition (with a variable on the referral process). Different stages of propagation of IT in clinical practice are analyzed for the type of information computerized in the medical records. Results of a clustering…analysis on medical practices and the statistical results on the predictive disease models are presented on a diabetes type II analytical data set from the US National Medical Ambulatory Care Survey. The three new independent variables on ebilling, clusters of medical practices with different level of IT confirms previous results with a reduction of drug utilization with e billing and higher drug utilization for the more computerized group of practices. Drug utilization is also much lower when a physician requests a referral. Patient economics and its effects at the point of visit are clearly modified with the diffusion of IT.
Keywords: Innovativeness, patient economics, clinical choices sets, IT in medical practice, clustering
Abstract: Anatomical reduction and rigid fixation of acetabular posterior wall fractures extending to the acetabular roof proves challenging because of the big bony fragment and muscular obstruction to accessing this region. This report describes a novel reconstructive technique in a patient with an acetabular posterior wall fracture involving the acetabular roof. Both the standard Kocher-Langenbeck approach and a greater trochanter osteotomy technique were used. Following anatomical reduction, a dual arc-shaped reconstruction plate technique was employed to achieve rigid fixation. The patient recovered with satisfactory function at the injured hip. We recommend this dual arc-shaped reconstruction plate technique for the treatment of…acetabular posterior wall fractures extending to the acetabular roof in clinical practice.
Keywords: Acetabular fractures, posterior wall, two arc-shaped plates
Abstract: Dysphagic patients usually have a variety of clinical problems such as malnutrition, significant weight loss, and aspiration pneumonia. Dysphagia is a complication commonly caused by strokes, and surface electromyography (sEMG) provides a simple, non-radioactive, and non-invasive method to measure the patterns of muscle activity during swallowing, allowing clinicians to describe the physiology of swallowing behavior. Most previous studies have described swallowing behavior in terms of amplitude and duration. However, there is no objective and precise approach available for the evaluation of swallowing coordination. In order to evaluate swallowing coordination more precisely, a wireless and wearable monitoring device for dysphagia evaluation…was designed for the present study in order to measure four muscle groups simultaneously during swallowing. In this context, the variations of the cross-correlation coefficients were defined as the discoordination index, a metric which can effectively reflect the differences between the surface EMG patterns of the bilateral muscle groups. The experimental results of this study show that the discoordination indices for dysphagic patients are significantly larger than those for healthy subjects and that these discoordination indices can be used as an effective means of evaluating the coordination between bilateral swallowing muscles.
Keywords: Surface electromyography, dysphasia evaluation, medical device, swallowing