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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: A pilot study of 107 women aged 60–69 years recently suggested that the measurement of broadband ultrasound attenuation (BUA) provides a superior cost effective pre-screen referral method for bone mineral density (BMD) measurement by DXA (dual-energy X-ray absorptiometry) than can be achieved by clinical criteria (CC). The aim of this study was to compare the accuracy and cost effectiveness of BUA and clinical criteria in a younger cohort. 599 women aged 50–54 years (52.18 ± 1.35) had previously been measured by DXA at lumbar spine and right femoral neck, along with BUA measurement of the right calcaneus. Each subject had…also completed an extensive clinical and social questionnaire to ascertain those who would have met one or more of the six general clinical criteria adopted by our Centre. Each subject was classified by DXA using the WHO criteria as normal, osteopenic or osteoporotic, defined at lumbar spine or femoral neck. Sensitivity, specificity and accuracy were calculated for BUA and the clinical criteria, noting that analysis was undertaken with and without the oestrogen deficiency clinical criterion (CC1): “Any oestrogen deficient woman who would want to be treated or would want to continue treatment if found to be osteopenic or osteoporotic”. The accuracy for identifying osteoporotic subjects was 72.8% for BUA (at the point of matched sensitivity and specificity, 75 dB MHz−1 ), 30.7% for CC(1–6) and 64.3% for CC(2–6). When osteopenic subjects were incorporated, the accuracies were 63.8% for BUA (at the point of matched sensitivity and specificity, 82 dB MHz−1 ), 60.3% for CC(1–6) and 55.7% for CC(2–6). The minimum cost per osteoporotic subject correctly identified was £573.50 by DXA alone, £325 by BUA, £458 by CC(1–6) and £416 by CC(2–6). When osteopenic subjects were incorporated, the costs were £87, £83.50, £78 and £74, respectively. The overall cost, dependent upon the prevalence of osteoporosis (or osteopenia) within the population, more accurately indicates the feasibility of a population-based screening programme. For the identification of either osteoporotic or osteopenic subjects from the general population by DXA, the prevalence-compensated cost (cost per subject correctly identified multiplied by prevalence) is £45, irrespective of age cohort. If CC(2–6) were adopted for the identification of osteoporotic subjects alone, the prevalence-compensated cost would be £32 and £42 for the 50–54 and 60–69 aged cohorts, respectively. For BUA, the prevalence-compensated cost falls to £25 and £43 for the 50–54 and 60–69 aged cohorts, respectively. If osteoporotic or osteopenic subjects were to be identified in the 50–54 aged cohort, both CC(2–6) (£38) and BUA (£43) perform similarly to DXA alone. BUA appears to provide a valuable population pre-screen for the identification of osteoporotic subjects, less so for osteopenic. It is suggested that if both osteopenic and osteoporotic women are to be identified for clinical management incorporating DXA, then neither BUA nor clinical criteria are satisfactory referral methods. An unanswered question from this study, however, is whether ultrasound has an independent role in the assessment of fracture risk for perimenopausal women who do not have the benefit of referral for DXA.
Abstract: Hospital-wide information systems may provide economical solutions for communication processes or for documentation by means of centralized digital medical records. Within a large university hospital, however, there may be too many diverse subspecialties and too many special medical procedures to be supported comprehensively by a single database information system. A peripheral modular system has been tailored to the specific needs of a sleep disorder clinic as an adjunct to the main clinical information system. The client server application allows for automatic data acquisition by on-line devices and by a graphical user interface. It supports administrative tasks for patient management, specific…encounter interactions and data retrieval for research. Performance and acceptance of the system was assessed during clinical use, revealing positive response by the users, also with respect to significant time savings. Our experience suggests that the concept of peripheral database modules as “satellites” to a main clinical system provides flexibility in design and implementation of the specialized databases while providing access to data of more general relevance via the main database.
Abstract: We present a study of modelling and the first steps of an experiment of a smart room for hospitalised elderly people. The system aims at detecting falls and sicknesses, and implements four main functions: perception of patient and environment through sensors, reasoning from perceived events and patient clinical findings, action by way of alarm triggering and message passing to medical staff, and adaptation to various patient profiles, sensor layouts, house fixtures and architecture. It includes a physical multisensory device located in the patient’s room, and a multi-agent system for fall detection and alarm triggering. This system encompasses a perception agent,…and a reasoning agent. The latter has two complementary capacities implemented by sub-agents: deduction of type of alarm from incoming events, and knowledge induction from recorded events. The system has been tested with a few patients in real clinical situation, and the first experiment provides encouraging results which are described in a precise manner.
Abstract: Microaspiration enabled by high-volume-low-pressure cuffed endotracheal tubes is the most likely explanation for ventilator-associated pneumonia. To decontaminate the secretion at the proximal end of the cuff we developed a silver-coated endotracheal tube (SCET). In an in vitro model we investigated the efficacy of SCET to lower the bacterial load of secretion and aspirate. We developed a continuously contaminated and mechanically ventilated oropharynx–larynx–lung model to investigate the reduction of the bacterial count by SCET compared to controls. The model was continuously contaminated via the oropharynx–larynx with Pseudomonas aeruginosa ATCC 27853. During the investigation period of 50 hours the bacterial count of…oropharynx–larynx and lung was measured as colony-forming-units/ml. In addition, the characteristic curve of silver ion release of SCET was determined. SCET significantly reduced the bacterial count in oropharynx–larynx at all timepoints (p < 0.05 ). In lung the bacterial count was significantly lower beginning with the 36th hour of recording (p < 0.05 ). A reduction of greater than 2 log was found from 28 hours on in oropharynx–larynx and from 50 hours on in lung. The release of silver ions was very rapid and was described by a mono-exponential function with a time-constant τ of about 60 minutes and a saturation concentration of 200 ± 80 μ g/l. SCET showed a significant inhibition of growth of P. aeruginosa in the continuously contaminated and mechanically ventilated oropharynx–larynx–lung model. SCET by thus might be helpful in reducing ventilator-associated pneumonia.
Abstract: Study of the osmotic resistance to hypotonic medium of platelets has often been suggested as a global test to assess the viability of these cells in transfusion or to study modification during haematological pathologies. A number of authors have analysed the behaviour of platelets in hypotonic media by a variety of methods (cell count, determinations of substances released, morphology, etc.), but most studies are currently based on the so-called “Hypotonic Shock Response” test (HSR). In this study, the authors describe a new automated and reproducible apparatus, called fragilimeter, using slow dialysis to assess platelet osmotic resistance. The variations in…light transmission through a platelet suspension according to ionic strength are linked to the change in cellular volume and lysis and characterise the osmotic behaviour of the cells. The results revealed the good reproducibility and sensibility of the technique. This apparatus allows also the realisation of the “HSR” test.