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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: Previous studies revealed evidence that induced hypothermia attenuates ischemic organ injuries after severe trauma. In the present study, the effect of hypothermia on liver damage was investigated in a porcine long term model of multi-system injury, consisting of blunt chest trauma, penetrating abdominal trauma, musculoskeletal injury, and hemorrhagic shock METHODS: In 30 pigs, a standardized polytrauma including blunt chest trauma, penetrating abdominal trauma, musculoskeletal injury, and hemorrhagic shock of 45% of total blood volume was induced. Following trauma, hypothermia of 33 ∘ C was induced for 12 h and intensive care treatment…was evaluated for 48 h. As outcome parameters, we assessed liver function and serum transaminase levels as well as a histopathological analysis of tissue samples. A further 10 animals served as controls. RESULTS: Serum transaminase levels were increased at the end of the observation period following hypothermia without reaching statistical significance compared to normothermic groups. Liver function was preserved (p ⩽ 0.05) after the rewarming period in hypothermic animals but showed no difference at the end of the observation period. In H&E staining, cell death was slightly increased hypothermic animals and caspase-3 staining displayed tendency towards more apoptosis in hypothermic group as well. CONCLUSIONS: Induction of hypothermia could not significantly improve hepatic damage during the first 48 h following major trauma. Further studies focusing on multi-organ failure including a longer observation period are required to illuminate the impact of hypothermia on hepatic function in multiple trauma patients.
Abstract: There are so many beauty salons in Metropolis who provide services to women exclusively [1 ]. These beauty salons depend mostly on electricity for their services to customers, without it there is no effective means of operation [2 ]. These beauty salons are definitely leading to women empowerment. The beauty salons are run by the women for women. Since they fall under the category of micro and small enterprises, these salons may avail so many financial and non- financial advantages from the Government of India. They also provide employment opportunities to the women employees. The development of such beauty salons…rests on the clients’ satisfaction on the provision of their services. Hence it is essential to measure the clients attitude towards the services offered by the beauty salons, especially electro therapy facial, laser skin whitening and laser hair removal treatments, which are coming under micro current treatment as a cosmetic tool.
Keywords: Electro therapy, micro current treatment, laser treatment, facial therapy
Abstract: BACKGROUND: Flow recirculation occurs in eccentric coronary stenosis, which can lead to adverse outcome. The complex local geodesic patterns of eccentric stenosis are critical factors in determining the flow characteristics in post-stenotic flow. OBJECTIVE: The main objective of this study is to relate the relationship between the detailed morphological parameters in eccentric coronary stenosis and the post-stenotic flow characteristics. METHODS: Several idealized eccentric coronary stenosis models with variable morphological parameters are created to conduct a series of computational fluid dynamics analysis. The impact of four specific lesion morphological parameters, eccentricity index (EI), diameter stenosis (DS), stenosis…length (SL) and shape of lesion, are investigated. RESULTS: When EI is small (< 0.33), the length of recirculation zones would increase as EI increase; while when EI is large (> 0.33), it would decreased as EI increase; Larger magnitude of retrograde flow occurs in models with smaller EIs. Both the recirculation zone length and maximum shear rate increase significantly as DS increases. Increase of SL will lead to increase of recirculation zone length. Higher maximum shear rate and larger recirculation zone are observed in models with sharper stenosis shape. CONCLUSIONS: Except DS, the detailed geometry patterns (EI, SL and shape of the stenosis) also have great impact on post-stenotic flow behaviors in eccentric coronary stenosis.
Abstract: BACKGROUND: Piercings are placed at different body sites often invisible to medical staff. They may cause additional injuries in trauma and emergency surgery by electro-cautery. OBJECTIVE: To clarify whether electrosurgery will have a direct damaging effect to the skin around a pierced skin area. METHODS: Metallic piercings were fixed at defined distances from the neutral and active electrode on abdominal pig skin. The distance of the active electrode was reduced by 5 mm increments to 0. The respective increases in temperature were determined with a thermal camera. A macroscopic and histological analysis of the area around…the piercing to detect thermal damage was carried out. RESULTS: Significant increases in temperature and visible changes in the tissue around the piercing only occurred when the active electrode was in direct contact with the piercing (increase of 47.3 ∘ C). Electro-cautery in distance of 5 to 10 mm to the piercing showed only temperature increases of less than 5 ∘ C. CONCLUSIONS: If metallic piercings are not directly touched by the active electrode and the distance is more than 5–10 mm, no clinically relevant effect is created on the tissue in direct proximity to the piercings by electro-cautery. In an emergency surgery situation, a piercing not fixed in direct proximity to the surgical field may likely be ignored.
Keywords: Electrosurgery, body piercing, body jewelry, burn injury
Abstract: BACKGROUND AND OBJECTIVES: Categorization of the casualties in accordance with medical care priorities is crucial in a military environment. Automation of the triage process is still a challenging task. The goal of the paper is to propose a novel algorithm for automation of medical emergency protocol in the military environment by the creation of classifiers that can provide accurate prioritization of injured soldier cases. It is a part of a complex military telemedicine system that provides continuous monitoring of soldiers’ vital data gathered on-site using an unobtrusive set of sensors. METHODS: After pre-processing the collected raw…physiological data and eliminating the outliers using Naïve Bayesian Classifier, the system is capable of calculating the risk level and categorizing the victims based on Markov Decision Process. The NBC has been trained with a dataset that has contained labels and 6 features. Training set has held 8000 randomly chosen samples. Twenty percent of the determined dataset has been used for the validation set. RESULTS: For algorithm verification, several evaluation scenarios have been created. In each scenario, randomly generated vital sign data describing the hypothetical health condition of soldiers was contemporarily assessed by the system as well as by 50 experienced military medical physicians. CONCLUSION: The obtained correlation result of the proposed algorithm and medical physicians’ classifications is strong evidence that the system can be implemented in warfare emergency medicine.
Keywords: Triage, emergency care systems, efficiency, first responders, military
Abstract: BACKGROUND: Hybrid simulation can be developed with mannequins of any fidelity and tabletop simulators with a standardized patient to create a complex, high-level learning activity. OBJECTIVE: The aim of this study is to analyze the effects of a hybrid simulation technique used with nursing students in a scenario about the emergency setting. METHODS: This one-group pre-test post-test model quasi-experimental study was carried out with 39 students in Ankara, Turkey, from October 2014 to July 2015. RESULTS: Nearly all participants reported that the simulation improved their critical thinking, decision-making skills, and…self-confidence before the clinical activity and that they felt as though they were real nurses during the activity (94.7%, 97.3%, 84.2%, and 92.1%, respectively). CONCLUSION: The results of this study support the integration of hybrid simulation experiences throughout the nursing curriculum, as evidenced by positive responses from students through the simulation evaluation questionnaire.
Abstract: BACKGROUND: The aging-related disease and associated neurodegenerative complications, such as cognitive impairment, has received increasing attention. OBJECTIVE: The aim of this study was to show changes in cognitive behavior and molecular related the synaptic plasticity in aged-induced cognitive deficits rats. METHODS: We used novel object recognition testing and morphological staining as well as western blot to detect changes in cognitive behavior and molecular related the synaptic plasticity. RESULTS: The morphological changes of synaptic structure and number on hippocampal neurons and learning and memory deficits were shown during natural aging. Moreover,…learning and memory improvement was associated with alterations of hippocampal synaptic plasticity-related proteins, such as SNAP-25, synaptophysin, snapsoin-1 and so on, which distributes to cognitive decline in natural aging. CONCLUSIONS: Our study provides more behavior and molecular evidence on relationship of cognitive deficits and aging.
Abstract: The most appropriate organizational software is always a real challenge for managers, especially, the IT directors. The illustration of the term “enterprise software selection”, is to purchase, create, or order a software that; first, is best adapted to require of the organization; and second, has suitable price and technical support. Specifying selection criteria and ranking them, is the primary prerequisite for this action. This article provides a method to evaluate, rank, and compare the available enterprise software for choosing the apt one. The prior mentioned method is constituted of three-stage processes. First, the method identifies the organizational requires and assesses…them. Second, it selects the best method throughout three possibilities; indoor-production, buying software, and ordering special software for the native use. Third, the method evaluates, compares and ranks the alternative software. The third process uses different methods of multi attribute decision making (MADM), and compares the consequent results. Based on different characteristics of the problem; several methods had been tested, namely, Analytic Hierarchy Process (AHP), Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS), Elimination and Choice Expressing Reality (ELECTURE), and easy weight method. After all, we propose the most practical method for same problems.
Keywords: Software selection criteria, multi-attribute decision-making (MADM), buying model, buy vs. make, organizational buying behavior (OBB), hospital management system
Abstract: BACKGROUND: Scientific management methods are urgently needed to balance the demand and supply of heath care services in Chinese hospitals. Operating theatre is the bottleneck and costliest department. Therefore, the surgery scheduling is crucial to hospital management. OBJECTIVE: To increase the utilization and reduce the cost of operating theatre, and to improve surgeons’ satisfaction in the meantime, a practical surgery scheduling which could assign the operating room (OR) and surgeon for the surgery and sequence surgeries in each OR was provided for hospital managers. METHODS: Surgery durations were predicted by fitting the distributions.…A two-step mixed integer programming model considering surgery duration uncertainty was proposed, and sample average approximation (SAA) method was applied to solve the model. RESULTS: Durations of various surgeries were log-normal distributed respectively. Numerical experiments showed the model and method could get good solutions with different sample sizes. CONCLUSIONS: Real-life constraints and duration uncertainty were considered in the study, and the model was also very applicable in practice. Average overtime of each OR was reducing and tending to be stable with the number of surgeons increasing, which is a discipline for OR management.
Keywords: OR scheduling, surgeon assignment, stochastic programming, sample average approximation
Abstract: BACKGROUND: Low vitamin D is a major risk factor for osteoporotic fractures. Evidence also suggests correlation between deficiency and musculoskeletal pain. OBJECTIVE: Non-interventional study in patients undergoing spine surgery to investigate links between vitamin D levels and clinical features. METHODS: 25-OH vitamin D levels were assessed in two cohorts: Cohort 1 (vertebral fractures; VF) and Cohort 2 (other spinal issues; excluding VF). Lab values as well as painDETECT questionnaires, VAS and Oswestry Disability Index (ODI) were recorded. Follow-up visits were conducted a few days and 6 weeks postoperatively. RESULTS: One…hundred and nine patients were enrolled. Mean VAS measured 72 mm in Cohort 1 and 55 mm in Cohort 2. Mean vitamin D concentrations were 16.8 ± 11 ng/ml in Cohort 1 and 18.3 ± 11 ng/ml in Cohort 2. VAS and ODI significantly correlated with vitamin D levels. Median painDETECT scores were 9 in Cohort 1 and 16 in Cohort 2. Six weeks postoperatively mean VAS was 31.4 ± 28 mm in Cohort 1 and 23.3 ± 21 mm in Cohort 2. Median painDETECT scores were 5 in both cohorts. CONCLUSION: Interactions are apparent between neuropathic pain and vitamin D serum levels. Consequently, vitamin D should be monitored in all patients requiring spinal surgery.
Abstract: OBJECTIVE: This retrospective study compared the efficacy of combined percutaneous ozone injection and percutaneous discectomyto percutaneous ozone injection alone for the treatment of cervical disc herniation. METHODS: Patients with cervical disc herniation who were enrolled in our hospital from October 2010 to June 2015 were divided into two groups: 1) treated with percutaneous ozone injection alone (control; n = 19); and 2) those treated with combined ozone injection and percutaneous microdiscectomy (combined treatment; n = 28). The efficacy of the combined treatment was evaluated relative to…the control by visual analogue scale (VAS) and the modified Macnab standard. Effective treatment was defined as excellent or good, and ineffective as fair or poor. RESULTS: No major complications occurred in either group. For the control group, the VAS scores dropped from 6.75 ± 2.34 before surgery to 2.78 ± 1.85 immediately after surgery, and to 4.18 ± 1.46 during the follow-ups. For patients who received the combined treatment, the VAS scores were 7.12 ± 2.03 before surgery, 3.86 ± 2.87 immediately after surgery, and 3.27 ± 1.53 during the follow-ups. At the 6-month follow-up, 73.7% (14 from 19 patients) in the control group and 89.2% (25 from 28 patients) in the treatment group were judged to have received effective treatment. Difference in efficacy between two groups of treatment was statistically significant (P = 0.033). CONCLUSION: The rate of effective treatment in patients who received combined percutaneous microdiscectomy and ozone injection was higher than that of patients who received ozone injection alone. Combination of percutaneous microdiscectomy and ozone injection might be an effective method to treat patients with cervical disk hernia.
Abstract: BACKGROUND: The distal radius fracture is one of the common clinical fractures. At present, there are no reports regarding application of the finite element method in studying the mechanism of Colles fracture and the biomechanical behavior when using splint fixation. OBJECTIVE: To explore the mechanism of Colles fracture and the biomechanical behavior when using different fixed splints. METHODS: Based on the CT scanning images of forearm for a young female volunteer, by using model construction technology combined with RPOE and ANSYS software, a 3-D distal radius fracture forearm finite element model with a…real shape and bioactive materials is built. The material tests are performed to obtain the mechanical properties of the paper-based splint, the willow splint and the anatomical splint. The numerical results are compared with the experimental results to verify the correctness of the presented model. Based on the verified model, the stress distribution of different tissues are analyzed. Finally, the clinical tests are performed to observe and verify that the anatomical splint is the best fit for human body. RESULTS: Using the three kinds of splints, the transferred bone stress focus on the distal radius and ulna, which is helpful to maintain the stability of fracture. Also the stress is accumulated in the distal radius which may be attributed to flexion position. Such stress distribution may be helpful to maintain the ulnar declination. By comparing the simulation results with the experimental observations, the anatomical splint has the best fitting to the limb, which can effectively avoid the local compression. CONCLUSION: The anatomical splint is the most effective for fixing and curing the fracture. The presented model can provide theoretical basis and technical guide for further investigating mechanism of distal radius fracture and clinical application of anatomical splint.
Abstract: We examine, from a medical-legal perspective, the pro and cons of the information technology procedures that the Italian Institute of Social Security (INPS ) has implemented to manage the provision of social disability assistance , meaning that separate from the payment of pension contributions, being welfare , anchored to an administrative requirement by way of the compulsory payment of a minimum social security contribution.
Keywords: Social security, civil disability, Italian Law, INPS
Abstract: Impingement, tibial erosions, and “painful hardware” caused by a lag screw used for malleolar fracture stabilization are rare occurrences. We report a case of a symptomatic lag screw, used to fix a distal fibular fracture, that impinged on the distal tibial and causing symptoms. Awareness of the condition and early diagnosis based on thoughtful review of CT images are key to symptom alleviation. A review of the published data on the complication of “painful hardware” following ankle fracture fixation is also presented.
Keywords: Lag screw, ankle fracture fixation, painful hardware, symptomatic lag screw, computed tomography
Abstract: Doctors usually require patients’ medical records before medical examinations. Nevertheless, obtaining such records may take time. Hence, Near Field Communication (NFC) could be used to store and send medical records between doctors and patients. Another issue is that there could be a threat such as, Man In The Middle Attack and eavesdropping, thus, a security method is required to secure the data. Furthermore, the information regarding the key and initialisation vector in NFC cannot be sent using one data package, hence, the data transmission should be done several times. Therefore, the initialisation vector that changed in each transmission is implemented,…and the key utilised is based on the component agreed by both parties. This study aims at applying the cryptography process that does disturb and hinder the speed of data transmission. The result demonstrated that the data transmitted could be secured and the encryption process did not hinder data exchange. Also, different number of characters in plaintexts required different amount of time for encryption and decryption. It could be affected by the specifications of the devices used and the processes happening in the devices.
Keywords: Near Field Communication, electronic medical record, advanced encryption standard, medical record
Abstract: BACKGROUND: Current methods for tracking the progress of people with obesity towards a weight loss goal appear simple and potentially misleading. A technique to quantify change in body shape whilst visualising areas of the body where weight loss occurs would be advantageous, and has the potential to be used as a motivational tool. Three-dimensional (3D) surface-imaging would serve as a good basis for such a technique, however current systems are prohibitively expensive. OBJECTIVE: Highlight the use of a cheaper alternative 3D surface-imaging system for volumetric measurement in people with obesity. METHODS: A recently…developed low-cost 3D surface-imaging system was used, having previously being validated in a healthy population. A total of 61 people with obesity, enrolled on a weight-loss programme, were surface-imaged using the system. RESULTS: The findings suggest the low-cost system can obtain 3D surface-images of an obese human body, from which numerical parameters could be calculated and further analysis conducted. CONCLUSIONS: Further studies will focus on the validity and reliability of such analyses and the potential of the system to be considered as a long-term instalment in primary healthcare settings as a weight loss aid.
Keywords: 3D Surface-imaging, anthropometry, obesity, volume
Abstract: A flexible piezoelectric thin film sensor has been proposed recently in several studies for detection of muscle movements. The objective of this study was to investigate the ability of this sensor to assess skeletal muscle performance and fatigue under isokinetic contractions. Simultaneous noninvasive measurements of muscles activity were done using surface electromyography (EMG) electrodes and two thin film piezoelectric sensors. Measurements were taken from the biceps during slow and fast elbow flexion with and without strong grip, during different weight lifting and from the gastrocnemius during treadmill marching at speeds of 4 and of 10 kph. The results shows correlation…between the onset of EMG and the piezoelectric sensors (Piezo) signals during muscle contraction. Increasing contraction intensity increase significantly both EMG and Piezo signals. Higher contractions velocity increased Piezo signal. Opposite linear relation was found between the average maximal EMG envelope amplitudes and the average maximal Piezo peaks with increasing loads. The significant decrease in the maximal Piezo peaks with time of all 3 subjects during elbow flexion while holding weight suggests the ability of piezoelectric thin film sensor to track muscle fatigue during isokinetic contractions.
Abstract: BACKGROUND: Wireless physiological signal monitoring system designing with secured data communication in the health care system is an important and dynamic process. OBJECTIVE: We propose a signal monitoring system using NI myRIO connected with the wireless body sensor network through multi-channel signal acquisition method. Based on the server side validation of the signal, the data connected to the local server is updated in the cloud. The Internet of Things (IoT) architecture is used to get the mobility and fast access of patient data to healthcare service providers. METHODS: This research work proposes a…novel architecture for wireless physiological signal monitoring system using ubiquitous healthcare services by virtual Internet of Things. RESULTS: We showed an improvement in method of access and real time dynamic monitoring of physiological signal of this remote monitoring system using virtual Internet of Things approach. This remote monitoring and access system is evaluated in conventional value. This proposed system is envisioned to modern smart health care system by high utility and user friendly in clinical applications. CONCLUSION: We claim that the proposed scheme significantly improves the accuracy of the remote monitoring system compared to the other wireless communication methods in clinical system.
Keywords: e-Health care network, physiological wireless body sensor, ubiquitous computing, virtual Internet of Things, wireless remote monitoring system
Abstract: Low-cost biosensors combined with low-cost portable devices can be very useful in time critical situations of mass casualties, when fast triage procedure must be attained. A methodology that uses ECG to derive the vital parameters (heart rate and respiratory rate) needed for the triage procedure is presented and it is aimed to leverage affordable low-cost equipment that can be easily utilized by urgent medical units or even volunteers in events of considerable number of injured civilians. The methodology relies on selected well-known and published algorithms for heart rate and respiratory rate derivation from a given ECG signal. It consists of…methods for R-wave detection, kurtosis computation, smoothing, and finding peaks. The proposed approach is shown to offer a good trade-off between the accurate measurement of the parameters and their fast derivation. It has been evaluated by using a publicly available database. Its robustness is measured in terms of accuracy estimation, showing a sensitivity of 0.87 for heart rate and 0.74 for respiratory rate, a sensitivity of 0.76 considering the triage process and an average-case execution time of 0.02 seconds, making it suitable for real-time applications.