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: The transport of the inpatients to and from locations inside the hospital can vary in complexity depending on the patient location, status, and logistical needs. Most transport systems have not developed at the same speed as other medically related technologies. We conducted a pilot study of a new automated transport system for patients within the hospital. METHODS: Our innovative system was introduced in January 2020. We present a retrospective case review of all in-patient transport request during April 15, 2020 through May 30, 2020 at the Shaare Zedek Medical Center, Jerusalem, Israel. The system is…fully automated and works via smartphone and electronic medical record integration. Transfer requests are processed on the basis of priority, proximity, and availably. RESULTS: During the study period there were 15, 581 transfer requests. Mean times to hospital destinations ranged from 9:25 to 28:02 minutes. Overall, mean times were quicker for emergency and surgical services. Trip times by priority code were likely influence by unmeasured confounders. There were no reported patient identification adverse events. Peak requests occurred during 0900-1500, and at the beginning of the week. CONCLUSION: Our automated in-patient transfer system appears to be efficient, safe, well received, and capable of servicing our large tertiary care medical center. Future controlled studies are needed to assess efficacy, adverse events, and clinical outcomes.
Abstract: OBJECTIVE: This is a case study on the application of a piggy-back lens in the correction of severe keratoconus. METHODS: From the results of general eye examination, refractive state examination, and corneal morphology examination on the patient, it was determined that corneal protrusion and deformation of the right eye were obvious. The right eye was corrected using a piggy-back lens and the left eye with a rigid gas-permeable contact lens (RGPCL) alone. RESULTS: The right-eye lens fit well and the lens coverage was good. Both the static and dynamic fit results for the…left-eye lens were good. After wearing the glasses for one month, the patient attended a review and stated that the lenses were comfortable to wear. The patient’s vision was good after wearing the lenses. No obvious congestion was found in the conjunctiva under a slit lamp. The effects on both eyes of wearing RGPCLs were favorable. The corneal curvature reduced and the corneal thickness only changed to a small degree. CONCLUSION: For keratoconus patients, application of a piggy-back lens can improve corrected visual acuity, comfort levels, and safety, prolong the wearing time, and enhance the effect of orthokeratology.
Abstract: BACGROUND: Cervical stenoses are one of the main long-term consequences after conization of the uterine cervix. OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of a uterine cervix supporting device (Con-Cap TM ) in reducing uterine cervical stenosis after Loop Electrosurgical Excisional Procedure (LEEP). METHODS: We enrolled 112 patients who underwent LEEP between March 2017 to May 2019. Con-Cap TM was inserted into the uterine endocervical canal for 4 weeks after LEEP. Laboratory values and clinical symptoms were evaluated. The presence…of uterine cervical narrowing was determined at 2 weeks after removal of the Con-Cap TM . Data were analyzed using the two-sample t test and χ 2 test. RESULTS: A total of 78 women completed the 6-week study period. Thirty-four patients did not complete the study period. The diameter of the uterine cervical canal was significantly greater at postoperative 6 weeks than preoperatively (Hegar dilator No, 2.10 ± 0.56 vs. 3.21 ± 0.71, P < 0.01). The complications were acceptable. CONCLUSIONS: Con-Cap TM can be used to reduce uterine cervical stenosis safely and effectively after conization of uterine cervix.
Abstract: BACKGROUND: Walking like many other actions of a human is controlled by the brain through the nervous system. In fact, if a problem occurs in our brain, we cannot walk correctly. Therefore, the analysis of the coupling of brain activity and walking is very important especially in rehabilitation science. The complexity of movement paths is one of the factors that affect human walking. For instance, if we walk on a path that is more complex, our brain activity increases to adjust our movements. OBJECTIVE: This study for the first time analyzed the coupling of walking paths…and brain reaction from the information point of view. METHODS: We analyzed the Shannon entropy for electroencephalography (EEG) signals versus the walking paths in order to relate their information contents. RESULTS: According to the results, walking on a path that contains more information causes more information in EEG signals. A strong correlation (p = 0.9999) was observed between the information contents of EEG signals and walking paths. Our method of analysis can also be used to investigate the relation among other physiological signals of a human and walking paths, which has great benefits in rehabilitation science.
Keywords: Human brain, walking path, shannon entropy, information, EEG signals
Abstract: BACKGROUND: Digital complete dentures (CDs) by computer-aided designing and computer-aided manufacturing (CAD-CAM) techniques (milling and three-dimensional (3-D) printing) have been evaluated clinically and provided satisfactory results. But clinical studies assessing occlusal forces by digital dentures are lacking. OBJECTIVES: To compare the occlusal force parameters in complete dentures (CDs) fabricated by milling, 3-D printing and conventional techniques having 3 commonly used occlusal schemes, using computerized occlusal force analysis system (Tech-Scan III- T-Scan III). METHODS: A total of 45 CDs were fabricated for 5 patients. Nine sets of CDs were made for each patient and were…divided into 3 groups: Conventional CDs (CCD), Milled CDs (MCD), and 3-D printed CDs (3-DP CD). The CDs in each group were further divided into 3 sub-groups based on occlusion schemes – bilateral balanced (BBO), lingualized (LO) and mono plane (MP). Occlusal force analysis [percentage (%) of occlusal force applied on the right and left sides of the arch difference between them, centralization of forces and % of maximum occlusal/bite force] was done using computerized occlusal analysis system (T-Scan III) at the time of denture insertion. Univariate regression analysis and logistic regression analysis were performed (p < 0.05). RESULTS: The intergroup comparison of force distribution on right and left side in CDs fabricated by various techniques showed insignificant differences (p > 0.05) but statistically significant differences (p < 0.01) were found in Right – Left side force difference, maximum bite force % and centralization of forces. The maximum force difference on right and left side was observed CCD with MO (37.48 ± 1.03 N) and maximum occlusal-bite force % was observed for 3-DPCD with LO (95.40 ± 1.30 N). In comparison to 3-DP CD, the chances of centre of force out of ellipse (centralization of forces) was 3.36 and 2.15 times more in CCD and MCD techniques made CDs respectively. CONCLUSIONS: The occlusal parameters in CDs were affected by the fabrication techniques and occlusal schemes of CDs. The digital CDs retain adjusted occlusal schemes better and 3-DP CDs with BBO and LO occlusal schemes provided centralization of forces, better distribution and high maximum occlusal force % respectively.
Abstract: BACKGROUND: Fabrication of complete dentures by computer-aided designing and computer-aided manufacturing (CAD-CAM) techniques are now common. Subtractive and Additive are the two principal CAD-CAM techniques used for this purpose. However, studies that evaluated the occlusal forces by CDs manufactured by these techniques are lacking. OBJECTIVES: To compare the occlusal forces in complete dentures fabricated by additive, subtractive and conventional techniques with different occlusal schemes, using computerized occlusal force analysis system [Tech-Scan III (T-scan III)]. METHODS: Three groups (Gr) were made on the basis of techniques of fabrication of CDs: Conventional CDs (CCD), Subtractive…CDs (SCD), and Additive CDs (ACD). Each Group CDs were further divided into three sub groups based on occlusion schemes: bilateral balanced occlusion (BBO), lingualized occlusion (LO) and mono plane occlusion (MO). A total of 45 CDs were made: 15 in each group with 5 CDs of each occlusal scheme. For all samples, occlusal force analysis (percentage of occlusal force applied on the right and left sides of the arch, centralization of forces and percentage of maximum occlusal force) was done using computerized occlusal analysis system: T-scan III. Univariate regression analysis and logistic regression analysis were used to find the effects of the technique of fabrication and occlusion scheme over the occlusal forces (p < 0.05). RESULTS: The intergroup comparison revealed statistically significant differences (p < 0.01) in Right – Left side force difference, maximum bite force in CDs fabricated by various techniques and with different occlusion schemes. Though the effect of occlusion scheme was more than the technique of fabrication (according to effect size estimation). The maximum force difference between Right – Left side was observed in combination of CCD technique and MO scheme (36.88 ± 2.82 N). Furthermore, the maximum bite force was observed for SCD technique (89.14 ± 6.08 N) and LO scheme (92.17 ± 3.22 N). In comparison to ACD, the chances of centre of force out of ellipse was 2.53 time more in CCS and 0.75 times less in SCD techniques and in comparison to MO, the chances of out of ellipse was 0.298 times less in BBO and 0.396 times less in LO schemes, though these chances were not statistically significant (p > 0.05). CONCLUSIONS: The digital CDs fabricated by subtractive technique were proved to be superior to additive technique in terms of occlusal force analysis on tested parameters. However, further research is needed on patients to determine the exact superiority of one technique over the other.
Keywords: Digital dentures, T-scan, occlusal forces, milling, 3-D printing
Abstract: BACKGROUND: Doctors with various specializations and experience order brain computed tomography (CT) to rule out intracranial hemorrhage (ICH). Advanced artificial intelligence (AI) can discriminate subtypes of ICH with high accuracy. OBJECTIVE: The purpose of this study was to investigate the clinical usefulness of AI in ICH detection for doctors across a variety of specialties and backgrounds. METHODS: A total of 5702 patients’ brain CTs were used to develop a cascaded deep-learning-based automated segmentation algorithm (CDLA). A total of 38 doctors were recruited for testing and categorized into nine groups. Diagnostic time and accuracy were…evaluated for doctors with and without assistance from the CDLA. RESULTS: The CDLA in the validation set for differential diagnoses among a negative finding and five subtypes of ICH revealed an AUC of 0.966 (95% CI, 0.955–0.977). Specific doctor groups, such as interns, internal medicine, pediatrics, and emergency junior residents, showed significant improvement with assistance from the CDLA (p = 0.029). However, the CDLA did not show a reduction in the mean diagnostic time. CONCLUSIONS: Even though the CDLA may not reduce diagnostic time for ICH detection, unlike our expectation, it can play a role in improving diagnostic accuracy in specific doctor groups.
Keywords: Intracranial hemorrhages, diagnosis, artificial intelligence, deep learning, ROC curve
Abstract: BACKGROUND: Autofluorescence imaging technology has been utilized for preserving or identifying parathyroid glands (PTGs) during thyroid surgery. We developed a wireless PTGs detection device linked with smart glasses that allows for real-time video recording and screen switching according to the light source. OBJECTIVE: This study aimed to confirm the feasibility of the device and whether it would help preserve the PTG during the surgery. METHODS: This prospective study was conducted in 30 patients with 66 PTGs. The device’s agreement with the physician’s judgment was evaluated, and we determined how many PTGs were preserved from thyroidectomy.…RESULTS: The positive agreement rate for PTGs detection between the surgeon and device was 70.9%. Inadvertent parathyroidectomy was identified in surgical specimens of 6 patients (20%). No PTG was removed when it was confirmed by the device (0/39). Of the 27 glands not detected by the device, there was inadvertent removal of 6 PTGs. CONCLUSIONS: PTGs can be preserved successfully when the detection of them by the device is consistent with the surgeon’s discretion. A large-scale controlled study is necessary to demonstrate the practical effect of this device on hypoparathyroidism after thyroidectomy.
Abstract: BACKGROUND: Telemedicine is playing an increasingly more important role in disease diagnosis and treatment. The market of telemedicine application is continuously promoted, thus bringing some issues on telemedicine operations management. OBJECTIVE: We aimed to compare the teleconsultation scheduling performance of newly designed proactive strategy and existing static strategy and explore the decision-making under different conditions. METHODS: We developed a discrete-event simulation model based on practical investigation to describe the existing static scheduling strategy of teleconsultation. The static strategy model was verified by comparing it with the historical data. Then a new proactive strategy was…proposed, whose average waiting time, variance of waiting time and completed numbers were compared with the static strategy. RESULTS: The analysis indicated that the proactive strategy performed better than static under the current resource allocation. Furthermore, we explored the impact on the system of both strategies varying arrival rate and experts’ shift time. CONCLUSIONS: Under different shift times and arrival rates, the managers of telemedicine center should select different strategy. The experts’ shift time had a significant impact on all system performance indicators. Therefore, if managers wanted to improve the system performance to a greater extent, they needed to reduce the shift time as much as possible.