Technology and Health Care - Volume Pre-press, issue Pre-press
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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: Prolonged wheelchair sitting is known to lead to venous stasis and results in leg edema. OBJECTIVE: To clarify how a dynamic cushion affects leg edema in people with spinal cord injuries (SCI) evoked by wheelchair sitting, we measured the changes in leg volume induced during wheelchair sitting with a dynamic air cushion or a static cushion. METHODS: Seven wheelchair users with SCI participated in this study. Leg edema during wheelchair sitting was evaluated with strain gauge plethysmography (the gauge was placed 10 cm proximally from the medial malleolus). Following a period of…rest, the subjects sat on a reclining wheelchair containing a dynamic cushion for 15 min. Then, the protocol was repeated with a static cushion. The above two procedures were performed in a random order. These data were statistically compared between the two procedures. RESULTS: The change in leg volume observed during sitting on the dynamic cushion (- 0.02 ± 0.21 ml/100 ml) was smaller than that observed during sitting on the static cushion (0.18 ± 0.28 ml/100 ml) (P < 0.05). CONCLUSIONS: These results suggested that the dynamic air cushion relieved leg edema induced by wheelchair sitting in individuals with SCI.
Keywords: Wheelchair cushion, leg volume, spinal cord injury, plethysmography
Abstract: Due to the lack of typical clinical manifestations, the incomplete Kawasaki disease (KD) is easily misdiagnosed and missed. The sudden death risk in incomplete KD cases is similar to typical KD. In this study, we report a case of a 1-year-old boy who died suddenly without any warning after incomplete KD. The boy was admitted due to fever and a cough, with preliminary diagnosis of acute severe bronchial pneumonia, but no typical KD characteristics. After antibiotics and supportive treatment, the condition worsened. Finally, the boy died after the ineffective rescue. The pathology revealed that the boy suffered from incomplete KD.…From this case, we experience that, when infants or children have a long-lasting fever, the possibility of KD should not be ignored. In addition, when managing such patients, the frequency of heart ultrasound should be increased as appropriate.
Abstract: BACKGROUND: Video communications during cardiopulmonary resuscitation (CPR) can improve the quality of information exchange between a bystander performing CPR and an emergency medical dispatcher (EMD). OBJECTIVE: To improve chest compression effectiveness, a filming protocol instructing video camera placements around a patient was developed. This study measured whether the filming protocol increased chest compressions’ effectiveness. METHODS: A simulation study was conducted comparing CPR effectiveness under three conditions: telephone-instructed , video-instructed , and video-instructed with the filming protocol . Twenty-five emergency medical technicians acted as EMDsin the three conditions. A mannequin measured five factors that…determined the effectiveness of the chest compressions. RESULTS: Compared with telephone-instructed CPR, the filming protocol improved the proportion of time in which the bystander’s hands were in the correct position during chest compressions. Compared with video-instructed CPR, the filming protocol improved both the proportion of time in which the chest was fully released after each compression and the proportion of time in which the compressions were conducted with an appropriate rhythm. The depth and rate of compressions did not improve in the filming protocol condition. CONCLUSIONS: Video-instructed CPR with the filming protocol improves CPR effectiveness compared to telephone- and video-instructed CPR. Detailed implementation can improve new technology introduction.
Keywords: Emergency medical dispatcher, cardiac arrest, telephone cardiopulmonary resuscitation, video cardiopulmonary resuscitation, filming protocol
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: INTRODUCTION: 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. 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, the peak time, gait cycle, walking
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: Today, hospital rankings are based not only on basic clinical indicators, but even on quality service indicators such as patients’ 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: Blood vessels are constantly exposed to flow-induced stresses, and endothelial cells (ECs) respond to these stresses in various ways. OBJECTIVE: In order to facilitate endothelialization after endovascular implantation, cell behaviors around a metallic wire using a flow circulation system are observed. METHODS: A parallel flow chamber was designed to reproduce constant shear stresses (SSs) on cell surfaces and to examine the effects of a straight bare metal wire on cell monolayers. Cells were then exposed to flow for 24 h under SS conditions of 1, 2, and 3 Pa. Subsequently, cell distributions…were observed on the plate of the flow chamber and on the surface of the bare metal wire. Flow fields inside the flow chamber were analyzed using computational fluid dynamics under each SS condition. RESULTS: After 24 h, ECs on the bottom plate were concentrated toward the area of flow reattachment. The matching of higher cell density and CFD result suggests that flow-induced stimuli have an influence on EC distributions. CONCLUSION: Typical cell concentration occurs on dish plate along the vortexes, which produces large changes in SSs on cell layer.
Abstract: BACKGROUND: In neurorehabilitation, clinicians and managers are searching for new client-centred task-oriented applications which can be administered without extra costs and effort of therapists, and increase the client’s motivation. OBJECTIVE: To develop and evaluate a prototype of an intelligent activity-based client-centred training (i-ACT) system based on Microsoft Kinect ® . METHODS: Within an iterative user centred process, the i-ACT prototype was developed and necessary features were established for use in neurological settings. After the test trial with a high fidelity prototype, the value, usefulness, and credibility were evaluated.…RESULTS: Seven therapists participated in focus groups and 54 persons with neurological problems participated in test trials. A prototype was established based on the user’s experience. Results show that clients and therapists acknowledge the value and usefulness (clients 5.71/7; therapists 4.86/7), and credibility (clients 21.00/27; therapists 14.50/27) of i-ACT. CONCLUSIONS: Therapists want to be able to record an endless range of movements and activities which enables individualised exercise programs for persons with disabilities. For therapists it is important that the system provides feedback about the quality of movement and not only results. In future work, clinical trials will be performed towards feasibility and effectiveness of i-ACT in neurorehabilitation and other rehabilitation domains.
Abstract: BACKGROUND: There is a clear tendency towards cementless acetabular components in primary total hip arthroplasty. OBJECTIVE: The aim of this study was to assess the long term clinical and radiological outcome of titanium cementless acetabular cups when combined with a highly crosslinked polyethylene liner. METHODS: This study is a retrospective follow-up of 67 cups in 64 patients. Clinical outcomes were assessed using the Harris Hip Score. Radiolucent lines, osteolysis and loosening were assessed radiologically. Implant survival was determined using the Kaplan-Meier analysis. RESULTS: The average Harris Hip Score at follow-up…was 80.3 ± 14.5. Signs of osteolysis were observed in 7.1% of the radiographs. No aseptic loosening of the cup was reported. Survival of the cup with aseptic loosening as an endpoint was 100%. A comparison with 19 other studies using the same material combination demonstrated very similar results. All manufacturers with available studies have at least one report of 100% survivorship at 10-year follow-up for their titanium cup and highly crosslinked polyethylene acetabular component combination with aseptic loosening as an endpoint. CONCLUSIONS: The data suggests that the rate of aseptic loosening of a titanium cup combined with a highly-crosslinked polyethylene liner at 10-year follow-up could be as low as 0%.
Keywords: Hip arthroplasty, cementless, acetabulum, polyethylene, titanium