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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: Patients with LSS tend to adopt a flexed lumbar posture and trunk position, particularly when stepping over an obstacle, as this activity alters the biomechanical demands placed on the trunk and lower extremities. OBJECTIVE: To investigate the effects of lumbar spinal stenosis (LSS) on patients’ trunk and lower-extremity kinematics, and on activities involving the gluteus medius (GMed) and vastus lateralis (VL). METHODS: All participants (9 older adult patients with LSS and 11 control subjects) were required to negotiate an obstacle while walking. Trunk and lower-extremity kinematic data and GMed and VL activities…were recorded using a synchronized 3D motion capture system and surface electromyography. RESULTS: The thoracic (12.01 ∘ ± 8.82 ∘ and 16.45 ∘ ± 10.80 ∘ ) and spinal (9.92 ∘ ± 14.03 ∘ and 5.99 ∘ ± 15.94 ∘ ) flexion angles of the leading and trailing swing limbs were higher, and the pelvic anterior tilting angle (2.37 ∘ ± 7.76 ∘ and 10.38 ∘ ± 8.07 ∘ ) was lower in the LSS group than in the control group (p < 0.05). With the exception of toe-off and normalized GMed activities in the contralateral leading limb (p > 0.05), all GMed (256.73 ± 112.22%, 174.00 ± 75.79%, and 270.57 ± 114.45%, respectively) and VL (208.98 ± 124.81%, 182.97 ± 93.23%, 283.91 ± 154.71%, and 394.42 ± 108.94%, respectively) activities of the contralateral leading and trailing swing limb (heel-strike and toe-off normalized activities) were significantly higher in the LSS group than in the control group (p < 0.05). CONCLUSIONS: Patients with LSS exhibited trunk-flexed postures when stepping over an obstacle, and these trunk alignments placed higher demands on the GMed and VL activities normalized by double-limb support during joint loading in the single-leg stance. These findings support clinical recommendations for regulating the physical activity of obstacle negotiation that may be beneficial in the management of patients with LSS.
Abstract: BACKGROUND: Many previous research studies have demonstrated that investing in health information technology (IT) in a hospital setting has potential benefits, including eliminating duplicate or unnecessary tests and adverse drug events, conserving healthcare provider time and effort by making information more readily available, and reducing cost by increasing efficiency or productivity metrics. However, the effect of health IT on uncompensated care has not been reported yet. OBJECTIVE: The objective of this study was to examine the effect of health IT investment on uncompensated care provided by hospitals. METHODS: The general linear model (GLM) with log…link and normal distribution was used to estimate the association between health IT spending and the provision of uncompensated care using Texas American Hospital Association (AHA) data from 2004 to 2010. RESULTS: The total health IT investment was significantly and negatively associated with the provision of uncompensated care. When health IT investment was increased by 10%, the provision of uncompensated care was reduced by 2.7%. Health IT investment was also significantly and negatively associated with bad debt. When health IT investment was increased by 10%, bad debt was decreased by 3.2%. CONCLUSION: Health IT investment was negatively associated with the provision of uncompensated care. This means that health IT could reduce administrative burden and improve efficiency of tracking patient insurance status and billings.
Keywords: Uncompensated care, charity care, bad debt, health information technology
Abstract: BACKGROUND: The World Wide Web has become a huge repository of knowledge in many domains, including health problems and remedy. An intelligent system, having the capability of mining the relevant information from the web, can provide instant guidance in our basic health problems. OBJECTIVE: The first objective is to convert the free-form long user query into a structured summary. The second objective is to provide an advice for a health query posed by a user. The suggestion can be in the form of names of medicines and related information or a warning to indicate that the…situation is a medical emergency. METHODS: First, a set of template information is extracted from the user question. A search query is formed to retrieve relevant pages from a set of trusted websites. The retrieved pages are processed in various levels to extract the remedy and related information. RESULTS AND CONCLUSION: The system is tested using a set of real questions collected from various relevant websites. The system generated suggestions are evaluated by experts. Evaluation results show that the system provides relevant results in 92.92% cases.
Keywords: E-health, online remedy finding, medical informatics applications, health information management, natural language processing
Abstract: OBJECTIVE: This study aims to explore whether positive end-expiratory pressure (PEEP) guided by esophageal pressure is better than the acute respiratory distress syndrome network (ARDSNet) during the treatment of traumatic acute respiratory distress syndrome (ARDS) patients. SUGGESTIONS: The use of the oxygenation method of inhaled oxygen concentration titration PEEP is suggested. METHODS: This study takes traumatic ARDS patients as the research object. The data of 23 patients were included in this study. The patients were randomly divided into two groups: the esophageal pressure titration PEEP group (n =…12), and the ARDSNet (PEEP-FiO 2 table) titration PEEP group (n = 11). All patients were given mechanical ventilation, and changes in oxygenation index, respiratory mechanics, hemodynamics and inflammatory reaction index were recorded when titrating the best PEEP with the two methods on the current day of grouping and after grouping for 24, 48 and 72 hours. RESULTS: The PEEP titration value in the esophageal pressure group was 12 ± 4 cm H 2 O, and this value was significantly higher than the PEEP titration value in the ARDSNet group (8 ± 3 cm H 2 O) (P < 0.05). The end-expiratory transpulmonary pressure of titrating the best PEEP with the esophageal pressure method and ARDSNet method is 0.5 ± 0.7 cm H 2 O vs. - 1.1 ± 3.3 cm H 2 O (P < 0.05). When titrating the best PEEP with the esophageal pressure method, lung tissue compliance, end-expiratory transpulmonary pressure and the oxygenation index are higher than those obtained through the ARDSNet method (P < 0.05). (2) In the esophageal pressure group, with the extension of treatment time, high-sensitivity C reactive protein (hs-CRP) and procalcitonin (PCT) exhibited a trend of significant decrease (P < 0.05). In the ARDSNet group, with the extension of treatment time, PCT also exhibited a significant decrease (P < 0.05), while the decrease in hs-CRP was not significant (P > 0.05). After comparing these two treatment groups at each monitoring time point, we found that the difference in hs-CRP and PCT was not statistically significant (P > 0.05). During the 72-hour treatment of interleukin-6 (IL-6) and interleukin-8 (IL-8), we found that these two were significantly lower in the esophageal pressure group than in the ARDSNet group (P < 0.05). CONCLUSIONS: The PEEP selection of mechanical ventilation of patients with traumatic ARDS guided by transpulmonary pressure and calculated by measuring intrapleural pressure can realize the individual adjustment of PEEP, identify ARDS patients benefiting from high PEEP, and provide a PEEP setting that can better meet the needs of traumatic patients.
Abstract: BACKGROUND: The diversity of the results of different hormone replacement therapy (HRT) protocols and the fuzziness of the conclusions have caused problems in routine clinical practice. OBJECTIVE: To develop an intelligent decision-making system for HRT specifically is appropriate as we use the abbrevation HRT in the background section in menopausal women in order to assist physicians. METHODS: This study consisted of 179 peri- and post-menopausal patients who were admitted to Hacettepe University Hospital (between 1996 and 2001) with various menopausal complaints. Database variables used in this study were age, height, weight, menopause duration, clinical…condition, HRT duration, and the laboratory test results. Our newly developed multiple-centered fuzzy clustering (MCFC) algorithm was applied to the medical data set to differentiate patient groups. Finally, a hybrid intelligent decision-making system was developed by combining knowledge-based algorithms and the MCFC algorithm results. RESULTS: We have used Fuzzy C-means, K-means, Hard C-means, similarity based clustering, and MCFC algorithms on the medical data set and have determined that the MCFC algorithm is the most appropriate algorithm for our medical model. We have defined 5 clusters and 16 cluster centers. A diagnostic phrase was assigned to each cluster center by the physician and these clusters together with knowledge-based algorithms were used for the decision-making system. CONCLUSIONS: We have developed a computerized hybrid decision-making system recommending HRT to peri- and post-menopausal women in order to assist and protect physicians.
Keywords: Menopause, hormone replacement therapy, neural networks, intelligent diagnostic systems
Abstract: BACKGROUND: Passenger comfort is affected by many factors. Patient comfort is even more specific due to its mental and physical health condition. OBJECTIVE: Developing a system for monitoring patient transport conditions with the comfort level classification, which is affected by the patient parameters. METHODS: Smartphone with the developed Android application was installed in an EMS to monitor patient transport between medical institutions. As a result, 10 calculated parameters are generated in addition to the GPS data and the subjective comfort level. Three classifiers are used to classify the transportation. At the end, the…adjustment of classified comfort levels is performed based on the patient’s medical condition, age and gender. RESULTS: Modified SVM classifier provided the best overall classification results with the precision of 90.8%. Furthermore, a model that represents patient sensitivity to transport vibration, based on the patient’s medical condition, is proposed and the final classification results are presented. CONCLUSIONS: The Android application is mobile, simple to install and use. According to the obtained results, SVM and Naive Bayes classifier gave satisfying results while KNN should be avoided. The developed model takes transport comfort and the patient’s medical condition into consideration, so it is suitable for the patient transport comfort classification.
Abstract: BACKGROUND: Conventional radiography (CR) is the imaging method of choice in monitoring bone remodelling and other stability parameters after total hip arthroplasty (THA). Quantitative roentgen- or computed-tomography-based methods to determine bone density are prone to metal artifacts and often very costly, which is why they are not used as standard in a clinical setting. Since subjective assessment of bone remodelling in CR also has a certain susceptibility to errors, semi-quantitative methods have been developed to help approximate periprosthetic bone density development via CR to open up an additional tool for documentation of radiographic THA follow-up. OBJECTIVE:…Proof-of-principle of a newly designed imaging-software-aided method to measure relative bone density around the femoral stem in a series of conventional radiographs following THA. METHODS: Eighty-six patients with hip modular tapered, fluted titanium stems were selected from the clinical database and series of baseline and postoperative follow-up radiographs were obtained after 24 and 48 weeks. Relative bone densities were measured per Gruen zones G1-7 with the use of an open-source image analysis package (ImageJ) by means of greyscale histograms. In addition, subjective evaluation of selected cases was performed by three independent, blinded orthopedic surgeons. Besides descriptive and nonparametric analyses, intra-class correlation (ICC) was performed and objective and subjective results were compared by linear regression analysis. RESULTS: Two individual cases are presented as a proof-of-principle. Increase or decrease of bone density could be measured correctly over time in each case. In a collective analysis there were no significant differences in mean relative bone densities between groups after 24 and 48 weeks, although a positive tendency was visible towards increased bone formation over time. Individual analyses by Gruen zones revealed that some zones, namely the proximal ones (e.g. G6), exhibit a broader scattering than others over time. This could be explained by the design of the evaluated tapered revision stem that achieves distal fixation and allows for proximal micromotion. Correlation analysis with subjective ratings (inter-rater reliability ICC = 0.71) showed a positive correlation with objective results, suggesting a feasibility of the method for clinical use. CONCLUSIONS: In conclusion the presented method is an easy and accessible tool to quantify relative bone density changes during THA follow-up. It shows a positive correlation to established subjective assessment of bone remodelling and may therefore serve as a quantitative supplement in clinical documentation.
Keywords: Relative bone density, software, histogram, greyscale, revision hip arthroplasty
Abstract: BACKGROUND: Although there are several different kinds of fixation techniques for the sacroiliac fracture-dislocation, the treatment remains a challenge for orthopedic surgeons. OBJECTIVE: The purpose of this study was to compare the stability of sacroiliac fracture-dislocation fixed with two iliosacral (IS) screws, tension band plate (TBP), and minimally invasive adjustable plate (MIAP). METHODS: Five human cadavers (L4-pelvic-femora) were used to compare biomechanical stability. The pubic symphysis separation and left sacroiliac dislocation were created. The symphysis pubis was stabilized with a five-hole plate. The sacroiliac joint dislocation fracture was fixed with three kinds of…internal fixation in a randomized design. The specimens were fastened in a biomechanical machine with a cycle vertical load. Displacements of the whole specimen and shifts in the fracture gap were recorded. RESULTS: Under different vertical loads, the shifts in the fracture gap and the displacements of the pelvis fixed with MIAP were similar to those in fractures fixed with two IS screws. However, the shifts in the fracture gap and the displacements of the pelvis fixed with MIAP were significantly smaller than those fixed with TBP. CONCLUSIONS: The stability of the sacroiliac joint dislocation fixed with MIAP was similar to that of dislocation fixed with two IS screws, and MIAP performed better than the TBP under vertical load.
Abstract: The ways in which patient care is organized, managed and delivered are changing dramatically. As these changes continue to unfold, the organizational arrangements within which they take place – the production process – need to be redesigned. Redesign is always challenging, as peoples’ routines, habits and expectations are frequently disrupted, and need to be modified or replaced by new ones. However, it should be a priority, as the need for change is only going to increase over time.
Keywords: Coordination of care, delivery of care, managerial behaviors, organization of work