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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 AND OBJECTIVE: Although careful clinical examination and medical history are the most important steps towards a diagnostic separation between different tremors, the electro-physiological analysis of the tremor using accelerometry and electromyography (EMG) of the affected limbs are promising tools. METHODS: A soft-decision wavelet-based decomposition technique is applied with 8 decomposition stages to estimate the power spectral density of accelerometer and surface EMG signals (sEMG) sampled at 800 Hz. A discrimination factor between physiological tremor (PH) and pathological tremor, namely, essential tremor (ET) and the tremor caused by Parkinson’s disease (PD), is obtained by summing the…power entropy in band 6 (B6: 7.8125–9.375 Hz) and band 11 (B11: 15.625–17.1875 Hz). RESULTS: A discrimination accuracy of 93.87% is obtained between the PH group and the ET & PD group using a voting between three results obtained from the accelerometer signal and two sEMG signals. CONCLUSION: Biomedical signal processing techniques based on high resolution wavelet spectral analysis of accelerometer and sEMG signals are implemented to efficiently perform classification between physiological tremor and pathological tremor.
Abstract: BACKGROUND: Flutter is a device used in removing excess lung secretions. The conventional flutter lacks a biofeedback component to facilitate optimal use by the patients. OBJECTIVE: The current research aims to compare the effects of biofeedback flutter devices with the conventional flutter in managing the symptoms of patients with chronic obstructive pulmonary diseases. METHODS: One hundred and sixty-eight participants were randomly allocated into four groups: Group A (conventional), Group B (visual biofeedback), Group C (auditory biofeedback) and Group D (visual and auditory biofeedback). All groups were treated five days for 20 minutes. Outcome…measures included wet sputum weight [during intervention (T1) and 1 hour after intervention (T2)], oxygen saturation and dyspnea score (before and after intervention) on all days. RESULTS: The wet sputum expectorated (T2) by Group B was significantly higher than Group A (P < 0.001), Group C (P < 0.001) and Group D (P < 0.05). The dyspnea score for Group B (P < 0.05), Group C (P < 0.05) and Group D (P < 0.05) was significantly lower than Group A. The post-intervention oxygen saturation level was higher in Group D followed by Groups B, C and A. CONCLUSION: The use of biofeedback flutter is effective in the removal of secretion, reducing dyspnea and improving oxygen saturation when compared to conventional flutter.
Abstract: BACKGROUND: Today, hospital rankings are based not only on basic clinical indicators, but even on quality service indicators such as patient waiting times. Improving these indicators is a very important issue for hospital management, so finding a solution to achieve it in a simple and effective way is one of the greatest goals. OBJECTIVES: The aim of this article is to evaluate the use of a discrete event simulation model to improve healthcare processes and reduce waiting time of patients and hospital costs. METHODS: The case study proposed in this paper is the…reorganization of non-clinical front office operation for the patients (i.e. booking of exams, delivering medical reports, etc.) of the Careggi University Hospital of Florence, to optimize the utilization of the human resources and to improve performances of the process. RESULTS: The development and validation of the model was made according to an analysis of real processes and data, pre and post implementation of model outcomes. The new organization shows a decrease of waiting times from an average value of 10 minutes and 37 seconds to 5 minutes and 57 seconds (- 44%). CONCLUSIONS: This paper shows that discrete event simulation could be a precise, cost-limited tool to optimize hospital processes and performance.
Keywords: Discrete event simulation, healthcare, optimization, front office, lean thinking
Abstract: BACKGROUND: Over the past 20 years, magnetic resonance receiving coil technology has developed rapidly. The traditional, commercial knee joint coil has a fixed mechanical structure. To meet the imaging needs of most patients, it is necessary to ensure that the mechanical geometry of the coil is as large as possible. Therefore, different quality images can be obtained by filling coefficients under loads of knees of different sizes. Lufkin et al. [1 ] have demonstrated that the signal-to-noise ratio (SNR) of coil imaging is directly proportional to its filling coefficient, which is S / N ≈…Q L * η . Thus, the pursuit of an optimal coil filling coefficient is an important way to improve the coil imaging quality. OBJECTIVE: This study combines wearable concepts and coil development techniques and applies flexible and elastic materials to coil designs. METHODS: We used an elastic material instead of the traditional fixed mechanical structure to develop a 1.5T 5-channel knee joint receiving coil that can be attached to knee joints of different sizes within a certain range, allowing the coil to achieve a maximum filling coefficient under the loads of knees of different sizes. RESULTS: Compared to commercial 8-channel knee coils, the phantom test and clinical knee joint imaging demonstrated that the SNR of the developed coil increased by four times in the shallow layer and two times in the deep layer, under different load conditions. CONCLUSION: This high SNR performance demonstrates potential for the realization of high resolution and fast imaging sequences in knee imaging.
Keywords: Magnetic resonance, wearable, coil, SNR, filling coefficient
Abstract: BACKGROUND: Fetal heart activity adds significant information about the status of the fetus health. Early diagnosis of issues in the heart before delivery allows early intervention and significantly improves the treatment. OBJECTIVE: This paper presents a new adaptive filtering algorithm for fetal electrocardiogram (FECG) extraction from the maternal abdominal signal, known in literature as abdominal electrocardiogram (AECG) signal. Fetal QRS complex waves will be identified and extracted accurately for fetal health care and monitoring purposes. METHODS: We use discrete wavelet transform recursive inverse (DWT-RI) adaptive filtering algorithm for this objective. Thoracic maternal electrocardiogram…(MECG) is used as a reference in the proposed algorithm and FECG components are extracted from AECG signal after suppressing the MECG projections. The proposed algorithm is compared to other typical adaptive filtering algorithms, least mean squares (LMS), recursive least squares (RLS), and recursive inverse (RI). RESULTS: Fetal QRS waveforms successful identification and extraction from AECG signal is evaluated objectively and visually and compared to other algorithms. We validated the proposed algorithm using both synthetic data and real clinical data. CONCLUSIONS: The proposed algorithm is capable of extracting fetal QRS waveforms successfully from AECG and outperforms other adaptive filtering algorithms in terms of accuracy and positive predictivity.
Abstract: BACKGROUND: Walking is a basic human activity and many orthopedic diseases can manifest with gait abnormalities. However, the muscle activation intervals of lower limbs are not clear. OBJECTIVE: The aim of this study was to explore the contraction patterns of lower limb muscles by analyzing activation intervals using surface electromyography (SEMG) during walking. METHODS: Four muscles including the tibialis anterior (TA), lateral gastrocnemius (LG), medial gastrocnemius (MG), and rectus femoris (RF) of bilateral lower extremity of 92 healthy subjects were selected for SEMG measurements. The number of activations (activation intervals) and the…point of the highest root mean square (RMS) EMG signal in the percentage of the gait cycle (GC) were used to analyze muscle activities. RESULTS: The majority of TA and RF showed two activation intervals and both gastrocnemius parts three activation intervals during walking. The point of the highest RMS EMG signal in the percentage of the GC for TA, LG, MG and RF are 5%, 41%, 40%, and 8%, respectively. The activation intervals were mostly affected by age, height, different genders and bilateral limbs. CONCLUSION: This study identified the different activation intervals (four for each muscle) and the proportion of healthy adults in which they occurred during the normal gait cycle. These different activation intervals provided a new insight to evaluate the function of nerves and muscles. In addition, the activation interval and RMS peak time proposed in this study can be used as new parameters for gait analysis.
Keywords: Surface electrography, activation intervals, peak time, gait cycle, walking
Abstract: BACKGROUND: The rupture of syndesmotic ligaments is treated with a screw fixation as the gold standard. An alternative is the stabilization with a TightRope ® . A couple of studies investigated the different clinical outcome and some even looked at the stability in the joint, but none of them examined the occurring pressure after fixation. OBJECTIVE: Is there a difference in pressure inside the distal tibiofibular joint between a screw fixation and a TightRope ® ? Does the contact area differ in these two treatment options? METHODS:…This biomechanical study aimed to investigate the differences in fixation of the injured syndesmotic ligaments by using a fixation with one quadricortical screw versus singular TightRope ® both implanted 1 cm above the joint. By using 12 adult lower leg cadaveric specimens and pressure recording sensor, we recorded the pressure across the distal tibiofibular joint. Additionally we measured the contact surface area across the joint. RESULTS: The mean of the pressure across the distal tibiofibular joint from the start of the insertion of the fixation device to the complete fixation was 0.05 Pascal for the TightRope ® and 0.1 for the screw (P = 0.016). The mean of the maximum pressure across the joint (after completion of fixation and releasing the reduction clamp) was 1.750 mega Pascal with the screw fixation and 0.540 mega Pascal with TightRope ® (P = 0.008). The mean of the measured contact area of the distal tibiofibular joint after fixation was 250 mm 2 in the TightRope ® group and of 355 mm 2 in the screw fixation (P = 0.123). CONCLUSIONS: The screw fixation is stronger and provides a larger surface contact area, which leads us to the conclusion that it provides a better stability in the joint. While previous clinical studies did not show significant clinical difference between the two methods of fixation, the biomechanical construct varied. Long term clinical studies are required to establish whether this biomechanical distinction will contribute to various clinical outcomes.
Abstract: BACKGROUND AND OBJECTIVE: Musculature affected during spondylodesis surgery may benefit and recover faster if supported by spine orthosis postoperatively. METHODS: This prospective study included 50 consecutive patients undergoing one- or two-level spondylodesis. The intervention group received a lumbar spine orthosis (n = 23), while the control group remained without orthosis (n = 27). Patients were assessed for pain (Visual Analogue Scale, VAS), Oswestry Disability index (ODI) as well as the use of analgesics. RESULTS: Patients wearing an orthosis postoperatively reported a higher degree…of subjective stability. However, both intervention as well as control group did not show any significant differences for each of the follow-up points regarding VAS, ODI or the use of analgesics. CONCLUSION: Wearing an orthosis has neither impact on subjective pain, the need for analgesics nor for postoperative functionality. However, patients reported that they profited from wearing the orthosis by feeling more stable, thereby nicely improving their postoperative mobility. Thus, novel patient reported outcome measures have to be developed to assess these features in future studies.
Abstract: BACKGROUND: In recent years, there has been an increasing interest in developing in-shoe foot plantar pressure systems. Although such devices are not novel, devising insole devices for gait analysis is still an important issue. OBJECTIVE: The goal of this study is to develop a new portable system for plantar pressure distribution measurement based on a three-axis accelerometer. METHODS: The portable system includes: PJRC Teensy 3.6 microcontroller with 32-bit ARM Cortex-M4 microprocessor with a clock speed of 180 MHz; HC-11 radio modules (transmitter and receiver); a battery; a fixing band; pressure sensors; MPU-9150 inertial navigation…module; and FFC tape. The pressure insole is leather-based and consists of seven layers. It is divided into 16 areas and the outcome of the system is data concerning plantar pressure distribution under foot during gait. The system was tested on 22 healthy volunteer subjects, and the data was compared with a commercially available system: Medilogic. RESULT: The SNR value for the proposed sensor is 28.27 dB. For a range of pressure of 30–100 N, the sensitivity is 0.0066 V/N while the linearity error is 0.05. The difference in plantar pressure from both the portable plantar pressure system and Medilogic is not statistically significant. CONCLUSION: The proposed system could be recommended for research applications both inside and outside of a typical gait laboratory.
Keywords: Pressure sensors, gait, insole, accelerometer, portable system