Technology and Health Care - Volume 22, issue 1

Authors: Priyaa, Sneha | Murthy, Shruti | Sharan, Swati | Mohan, Krishna | Joshi, Ashish

Article Type: Research Article

Abstract: Background: Information and Communication Technologies (ICTs) in health is not merely about technology but a means to reach various optimal outcomes across the entire health system. Objective: The objective of this pilot study is to assess the perceptions of receiving health messages through SMS among individuals living in rural Indian settings. Methods: A convenient sample of 100 individuals aged 18 years and above and living in rural settings of Kuthampakkam village in Chennai, a Southern part of India were enrolled during September 2013. Individuals having the mobile phone and agreeing to participate were enrolled in …the study. Individuals with physical and mental challenges or involved in other clinical trials were excluded from the study. Information was gathered on the variables including socio-demographics, individual familiarity with use of technology, mobile phone usage and the perceptions of using SMS for obtaining health information. Information was gathered using a series of quantitative assessments. Descriptive analysis was performed to report means and standard deviations for the continuous variables and frequency analysis was reported for the categorical variables. Analysis of variance (ANOVA) was used to compare the means of the various continuous variables as compared to the chi-square analysis that was performed to compare the frequency distribution for the categorical variables. All analysis was performed using SAS v9.1. Results: A convenient sample of 100 rural individuals was enrolled. The average age of the study participants was 34 years (SD=17), with more than half of them being males (54%; n=54), and 47% (n=47) of them had education less than high school. Results showed that more than half of the individuals had no computers either at home (61%; n=61) or work (68%; n=68). 100% of them had mobile phones in their household. Text messaging was common in more than half of the study participants. Results showed that the majority of the study participants agreed that receiving calls on the mobile phones for receiving health messages would be the most preferred method. Results showed that the individuals in the age group of 21–40 years, males, with some college education, and in the income category of 50,000–1,00,000 were most likely to obtain SMS based health messages. Conclusions: ICT based health programs need to be established so that the audience receives the optimal technological platform program necessary to obtain health messages. This also suggests that future research is needed to determine the population that would actually adopt the use of SMS based health interventions rather than using SMS as a tool for delivery of health information to all. Show more

Keywords: SMS, mobile phone, health messages, practice, mobile health

DOI: 10.3233/THC-130766

Citation: Technology and Health Care, vol. 22, no. 1, pp. 1-11, 2014

Authors: Balan, J.A. Alex Rajju | Rajan, S. Edward

Article Type: Research Article

Abstract: Background: Volumes of medical images are rapidly generated in medical field and to manage them effectively has become a great challenge. This paper studies the development of innovative medical image retrieval based on texture features and accuracy. Objective: The objective of the paper is to analyze the image retrieval based on diagnosis of healthcare management systems. Methods: This paper traces the development of innovative medical image retrieval to estimate both the image texture features and accuracy. The texture features of medical images are extracted using MDCT and multi SVM. Both the theoretical approach and …the simulation results revealed interesting observations and they were corroborated using MDCT coefficients and SVM methodology. Results: All attempts to extract the data about the image in response to the query has been computed successfully and perfect image retrieval performance has been obtained. Experimental results on a database of 100 trademark medical images show that an integrated texture feature representation results in 98% of the images being retrieved using MDCT and multi SVM. Conclusion: Thus we have studied a multiclassification technique based on SVM which is prior suitable for medical images. The results show the retrieval accuracy of 98%, 99% for different sets of medical images with respect to the class of image. Show more

Keywords: Medical image retrieval, MDCT, multi SVM, CBIR

DOI: 10.3233/THC-130767

Citation: Technology and Health Care, vol. 22, no. 1, pp. 13-25, 2014

Authors: Hsieh, W.-M. | Chen, C.-C. | Wang, S.-C. | Tan, S.-Y. | Hwang, Y.-S. | Chen, S.-C. | Lai, J.-S. | Chen, Y.-L.

Article Type: Research Article

Abstract: Background: Daily life movements require balance ability. Good balance control is closely related to body stability and its development. Therefore, balance training is necessary for any age group. Objective: This study proposes the combination of Kinect and virtual reality to build an information platform of interactive scenarios, for practice and evaluation of balance ability. Real-time monitoring of SpO2 , pulse rate, velocity and reaction time during the training process is presented for the training activities of elderly physical function. Methods: Based on the indicators of balance ability, this information platform sets out various training activities to …improve balance ability, making the supposedly tedious process fun and vivid and leading to much better training results. Results: The data (SpO2 , pulse rate, velocity, reaction time) collected from this platform can be sorted and analysed, and the results used to evaluate the performance of balance training, and referenced for follow-up planning in the future. The real-time pulse rate and SpO2 measurement information indicating the training activities for the elderly to maintain physical function has a positive significance. A noninvasive and unconstrained real-time method to detect the pulse rate and SpO2 during exercises is presented. The results of balance assessment scale testing of BBS and TUG for the experimental group show that effective balance really improved. The difference between the experimental group and the control group was achieved by using paired t-test. The data were analysed by the descriptive statistics on significant level of P < 0.01. Conclusions: From the training results of the participants, we know that the information platform developed for enhancing balance ability is in line with practical needs. Furthermore, the fun and interesting game-like exercises it introduces are very helpful in improving balance ability, and certainly in preventing falls. Show more

Keywords: Balance, fall, Kinect, virtual reality, information platform

DOI: 10.3233/THC-130769

Citation: Technology and Health Care, vol. 22, no. 1, pp. 27-36, 2014

Authors: Gill, Sarah-Louise | O'Neill, Hugh | McCoy, Ryan J. | Logeswaran, Suhanniya | O'Brien, Fiona | Stanton, Alice | Kelly, Helena | Duffy, Garry P.

Article Type: Research Article

Abstract: Background: Cardiovascular diseases (CVD) account for 36% of deaths in Europe and the United States. Gene therapy can act as a therapeutic modality for the treatment of CVD. The use of microRNA mimetics may be advantageous as they regulate important processes in health and pathology. A major hurdle for using miRNA therapies relates to site specific delivery and sufficient cellular uptake of material to achieve efficacy Objective: To assess the feasibility of ultrasound responsive microbubble mediated delivery of miR mimics to cardiomyocytes. Methods: Liposome/microbubble formulations were added to HL-1 cardiomyocytes in the presence/absence of ultrasound (US). …Transfection efficacy and functionality was assessed using epifluorescent microscopy, flow cytometry and qRT-PCR. DNA Quantification post-ultrasound mediated transfection of HL-1s using microbubbles was quantified. The capability of miR-133 microbubble formulations to suppress hypertrophy were measured by quantifying changes in cell size. Results: Ultrasound mediated microbubble formulations enhanced intracellular delivery of miR mimics in cardiomyocytes. Both complexed/encapsulated miR-microbubble formulations delivered functional miR mimics and showed no adverse effect on cardiomyocyte viability. Furthermore, ultrasound mediated microbubble transfection of miR-133 mimics reversed cardiomyocyte hypertrophy in an in-vitro model. Conclusions: This novel delivery method has the potential for further development as a targeted delivery strategy for miR therapeutics to the heart. Show more

Keywords: microRNA, heart failure, microbubbles, ultrasound, cardiomyocytes

DOI: 10.3233/THC-130772

Citation: Technology and Health Care, vol. 22, no. 1, pp. 37-51, 2014

Authors: Panigrahi, Atman | Sohani, Shardul | Amadi, Chioma | Joshi, Ashish

Article Type: Research Article

Abstract: Introduction: Chronic obstructive pulmonary disease (COPD) is a pulmonary disease characterized by airflow limitation that is not fully reversible. It is projected to be the third leading cause of death worldwide by 2020. The objective of the study was to examine the impact of music on psychological and physiological outcomes among individuals with COPD. Methods: The scientific databases PubMed, google scholar and EBSCO were used to search for relevant articles published during a period of 01/01/2005 to 12/31/2012. The search terms “Music and COPD”, “Music and Emphysema”, “Singing and COPD”, “Singing and Emphysema” , “music improves COPD” …and “singing therapy on COPD”, were used either in single or in combination. The inclusion criteria included studies having an experimental study design, were written in English and were conducted among individuals age 18 years and above. Studies that focused on the healthy population or had a disease other than COPD were excluded. Studies where music therapy was not the primary intervention and were systematic reviews were also excluded from the final analysis. Variables analyzed included year of publication, study location, study setting, target audience, study design, sample size, study duration, intervention and its components and the outcomes including physiological and psychological were assessed. Results: A total of 7 papers that met the inclusion criteria were included in the final analysis. Studies included various music interventions such as singing, listening and playing music. Forty percent of the studies were performed in US. More than half of the studies (70%, n=5) had a randomized control study design and were performed in a hospital setting. The duration of the studies varied from 6 weeks to 21 months. The sample size in these studies varied from 7 to 72. Music showed improvement in the psychological outcomes such as quality of life, dyspnea and anxiety and mixed results in the improvement of physiological outcomes such as FEV, FVC, and breathing control among individuals living with COPD. Discussion: More research of a longer duration and with a larger sample size is needed to examine the impact of music interventions on clinical, functional, psychological and physiological outcomes among COPD individuals. Show more

DOI: 10.3233/THC-130773

Citation: Technology and Health Care, vol. 22, no. 1, pp. 53-61, 2014

Authors: Pombo, Nuno | Araújo, Pedro | Viana, Joaquim | da Costa, Manuel Dias

Article Type: Research Article

Abstract: Background: For economic reasons, i.e., to reduce costs of in-hospital patient accommodations, constant pressure has been applied in recent years to increase the percentage of ambulatory surgeries. Effective control of post-operative pain after ambulatory surgery is challenging to all health professionals. Computerised systems are being implemented more frequently for remote patient monitoring, including during the at-home post-operative period. Objective: This study evaluates the feasibility of delivering a computerised system, developed in-house, for remote pain monitoring. It evaluates the user-friendliness of the system and the extent of patient compliance. Finally, a comparative assessment of the system is made …with respect to the quality of pain treatment in ambulatory surgery. Methods: The participants included 32 adults, aged 18–75, randomly assigned to a control group or to a computerised treatment group. The primary treatment outcome was measured by pain intensity ratings (0–10 NRS) reported several times per day during a five-day monitoring period, using an electronic pain diary combined with a web-based personal health record. Results and conclusions: The findings demonstrated the feasibility and suitability of the proposed system for pain management. Its handling was user-friendly, without requiring advanced skill or prior experience. In addition, the results showed that the guidance of health care professionals is essential to patients' satisfaction and positive experience with the system. There were no significant group differences with respect to improvements in the quality of pain treatment; however, this can be explained by the low pain scores registered in both groups, related to the type of surgical interventions recruited and the degrees of pain that are easily treated. To evaluate the benefits from a patient-centred perspective, studies of major ambulatory surgeries or of patients in chronic pain, including oncologic and non-oncologic pain resistant to treatment, are necessary. Show more

Keywords: Remote monitoring, electronic pain diary, post-operative, acute pain, clinical decision support system, controlled trial

DOI: 10.3233/THC-130774

Citation: Technology and Health Care, vol. 22, no. 1, pp. 63-75, 2014

Authors: Kumar, Ajit | Maskara, Sanjeev | Chiang, I.-Jen

Article Type: Research Article

Abstract: Background: In 2012, almost half-million foreigners (2.3% of the total population) from 160 countries were estimated to live in Taiwan. In 2010, approximately eighty-seven percent of the population expressed high satisfaction in the national health care system of Taiwan. However, satisfaction level among foreign residents towards the Taiwanese health care system has not been clearly documented in the literature. Objective: In this study, we assessed satisfaction level among foreign residents for receiving healthcare facility in Taiwanese hospital. In addition, the study came out with some potential solutions to improve health care received by them. Methods: …Human-Centered Design (HCD) approach was deployed, which included three phases: observation, pattern recognition, and ideation and delivery. Each phase involved various steps. Techniques, such as ethnography, interview, discussion, and survey were used in accomplishing various steps within each phase. Four participants and two facilitators from Taiwan took part in the study. Results: The study revealed various stories, insights, and themes about the health care received by the foreigners in Taiwan. In addition, some potential solutions and immediate available opportunities were recommended to improve their health care. Conclusions: The results provided a deeper understanding into the satisfaction level among foreign residents in Taiwan. For instance, this study pointed out the need to improve English proficiency of hospital's administrative staffs because a lack of English language proficiencies was found to be a major barrier in delivering quality health care to foreign residents. Therefore, adoption of various training modalities, such as English training using mobile device based games, role-play, and hospital's workflow depiction using English posters were recommended. Show more

Keywords: Human-centered design, health care, satisfaction, Taiwan

DOI: 10.3233/THC-130775

Citation: Technology and Health Care, vol. 22, no. 1, pp. 77-90, 2014

Authors: Zamarrón, Carlos | Lado, María J. | Teijeiro, Tomas | Morete, Emilio | Vila, Xose A. | Lamas, Paulo Felix

Article Type: Research Article

Abstract: Background: Chronic obstructive pulmonary disease (COPD) patients present functional and structural changes of the respiratory system that have a profound influence on cardiac autonomic dysfunction. Objetive: To analyse heart rate variability in COPD patients under stable condition and during acute exacerbation episodes (AECOPD). Methods: Twenty three severe COPD male patients, 69.6 ± 7.3 years, in stable condition were followed up for two years. Home visits were carried out by a nurse every month, and home or hospital visits were arranged on demand. Every three months an ECG, oxygen saturation and spirometric recording was obtained …for each patient. If the patient presented AECOPD compatible clinical data the same measurements were performed before any change of treatment. Spectral parameters of heart rate variability in time and frequency domains were obtained from ECG. The time evolution of power in low frequency (LF) and high frequency (HF) bands were obtained from the spectrogram. In addition, we calculated the LF/HF ratio and total heart rate variability power (POW). Results: We analysed 154 patient-visit records during the follow up, pertaining to 23 patients and 8 controls; 19 of the patients had experienced at least one AECOPD. Stable COPD patients had higher HF values than control subjects. No significant differences were found in LF, LF/HF ratio or POW variables. AECOPD patients had higher LF, HF and POW than the stable COPD and control groups. Conclusion: AECOPD patients exhibited signs of increased autonomic activity compared with stable COPD. Show more

Keywords: Chronic obstructive pulmonary disease, heart rate variability, home care program, autonomic dysfunction

DOI: 10.3233/THC-140777

Citation: Technology and Health Care, vol. 22, no. 1, pp. 91-98, 2014

Authors: Tseng, Ming-Hseng | Wu, Hui-Ching

Article Type: Research Article

Abstract: Background: Drug is an important part of disease treatment, but medication errors happen frequently and have significant clinical and financial consequences. The prevalence of prescription medication use among the ambulatory adult population increases with advancing age. Because of the global aging society, outpatients need to improve medication safety more than inpatients. Objective: The elderly with multiple chronic conditions face the complex task of medication management. To reduce the medication errors for the elder outpatients with chronic diseases, a cloud medication safety supporting system is designed, demonstrated and evaluated. Methods: The proposed system is composed …of a three-tier architecture: the front-end tier, the mobile tier and the cloud tier. The mobile tier will host the personalized medication safety supporting application on Android platforms that provides some primary functions including reminders for medication, assistance with pill-dispensing, recording of medications, position of medications and notices of forgotten medications for elderly outpatients. Finally, the hybrid technology acceptance model is employed to understand the intention and satisfaction level of the potential users to use this mobile medication safety support application system. Results: The result of the system acceptance testing indicates that this developed system, implementing patient-centered services, is highly accepted by the elderly. Conclusion: This proposed M-health system could assist elderly outpatients' homecare in preventing medication errors and improving their medication safety. Show more

Keywords: Medication safety, QR code, health information technology, aged care, homecare informatics, M-health

DOI: 10.3233/THC-140778

Citation: Technology and Health Care, vol. 22, no. 1, pp. 99-113, 2014

Authors: Panzica, Martin | Suero, Eduardo M. | Omar, Mohamed | Bretin, Philipp | Krettek, Christian | Citak, Musa

Article Type: Research Article

Abstract: Background: Articular fracture reduction control remains a challenge even with the development of computer-assisted surgery. The Kyphoplasty procedure has shown advantages in treating vertebral fractures. One case report showed successful reduction of acetabular fractures using Kyphoplasty. Objective: This study examines the efficacy of this method in reducing depressed tibial plateau fractures. Methods: An insertion sleeve for the Kyphon balloon that could be calibrated by the navigation system was designed. A total of 30 test series in synthetic bone cubes were performed using fracture instruments of 2.5 mm, 5 mm and 15 mm diameter, respectively, creating three …different depression fracture depths (mean 1.87 mm, 4.2 mm and 1.72 mm, respectively). The Kyphon balloon was used to attempt reduction of each fracture. The same setup was used for testing in five cadaveric tibia specimens. Results: After reduction, there was a remaining depression depth mean in the synthetic bone of 0.27 mm for the 2.5 mm instrument; 2.1 mm for the 5 mm instrument; and 1.72 mm for the 15 mm instrument. We could not adequately reduce depression fractures in cadaveric testing. Conclusions: The Kyphon balloon was accurately placed with the aid of navigation. The depth was the decisive factor in the reduction of the fracture and not the diameter. In cadavers, depression fractures greater than 5~mm depth could not be reduced with our setup. Show more

Keywords: Navigation, tibial plateau fracture, kyphon, ISO C-3D, CAS

DOI: 10.3233/THC-130765

Citation: Technology and Health Care, vol. 22, no. 1, pp. 115-121, 2014

Authors: Schneider, Marco M. | Kendoff, Daniel | O'Loughlin, Padhraig F. | Hessling, Carola | Gehrke, Thorsten | Citak, Mustafa

Article Type: Research Article

Abstract: Background: Autologous transfusion has become a cost-efficient and useful option in the treatment of patients with high blood loss following major orthopaedic surgery. However, the effectiveness of autologous transfusion in total joint replacement remains controversial. Objective: The current study analyzed the efficacy of autologous transfusion with washed shed blood (WSB) in primary total knee and total hip arthroplasty (TKA, THA). Methods: Between January 2011 and December 2011, patients being treated with a primary TKA (n=162) and/or THA (n=227) and who met the inclusion criteria were recruited to the study in consecutive fashion. …Results: The patient age, BMI and ASA scores showed no statistically significant correlation to the degree of blood loss, quantity of autotransfusion necessary or Hb differential in TKA patients. The use of an autologous transfusion system in TKA and THA is not correlated statistically to a reduction in the amount of allogenic or autologous transfusion. Conclusions: The use of the autotransfusion system does not correlate significantly with the amount of allogenic transfusion in TKA and THA in the current authors' patient cohort. Age, BMI and ASA score appeared not to exert significant influence on the total amount of autotransfusion or Hb difference. Show more

Keywords: Autotransfusion system, allogenic blood transfusions, total hip arthroplasty, total knee arthroplasty, effectivness

DOI: 10.3233/THC-130770

Citation: Technology and Health Care, vol. 22, no. 1, pp. 123-128, 2014

Authors: Muenzberg, M. | Stretz, C. | Baur, W. | Stangl, R. | Merschin, D.

Article Type: Research Article

Abstract: Background: Controversy exists on whether gender-specific anatomic differences in the human knee have to be taken into account by gender-specific design in total knee replacement (TKR). We evaluated total knees that were implanted in both genders. Objective: This paper will describe the influence of gender on the outcome after a unisex total knee arthroplasty. Methods: 52 total knee prostheses (mobile bearing Brehm Precision Knee®, BPK) were implanted in 48 patients (16 male, 32 female, 4 bilateral). Median follow-up was 15 months. HSS score, KSS score, ROM, VAS, and radiologic axis were used as outcome measures. We …also obtained preoperative scores of these parameters, creating difference parameters respectively. All surgeries were performed by a single surgeon. Results: No significant difference could be determined between genders for postoperative parameters and difference between preoperative and postoperative parameters between both groups. Women scored higher on HSS score preoperatively and postoperatively with 50.0 and 91.0 points versus 47.0 and 88.0 points in the male group. On KSS score, the female group scored higher preoperatively and postoperatively as well, with 79.0 and 174.0 points versus the male group with 74.0 and 168.0. Conclusion: As the results obtained with this unisex prosthesis system were not statistically significant when compared for gender, we conclude the BPK currently addresses gender-specific anatomic differences sufficiently. Show more

Keywords: Arthroplasty, gender, female, male, TKA

DOI: 10.3233/THC-130771

Citation: Technology and Health Care, vol. 22, no. 1, pp. 129-136, 2014

Authors: Chen, C.-C. | Chen, W.-L. | Chen, B.-N. | Shih, Y.-Y. | Lai, J.-S. | Chen, Y.-L.

Article Type: Research Article

Abstract: Background: A mouse is an important communication interface between a human and a computer, but it is still difficult to use for the elderly or disabled. Objective: To develop a low-cost computer mouse auxiliary tool. Methods: The principal structure of the low-cost mouse auxiliary tool is the IR (infrared ray) array module and the Wii icon sensor module, which combine with reflective tape and the SQL Server database. Results: This has several benefits including cheap hardware cost, fluent control, prompt response, adaptive adjustment and portability. Also, it carries the game module with the …function of training and evaluation; to the trainee, it is really helpful to upgrade the sensitivity of consciousness/sense and the centralization of attention. The intervention phase/maintenance phase, with regard to clicking accuracy and use of time, p value (p< 0.05) reach the level of significance. Conclusions: The development of the low cost adaptive computer mouse auxiliary tool was completed during the study and was also verified as having the characteristics of low cost, easy operation and the adaptability. To patients with physical disabilities, if they have independent control action parts of their limbs, the mouse auxiliary tool is suitable for them to use, i.e. the user only needs to paste the reflective tape by the independent control action parts of the body to operate the mouse auxiliary tool. Show more

Keywords: IR array, reflective tape, auxiliary tool, database

DOI: 10.3233/THC-130768

Citation: Technology and Health Care, vol. 22, no. 1, pp. 137-145, 2014

Authors: Johansson, Annette M. | Söderberg, Siv | Lindberg, Inger

Article Type: Research Article

Abstract: Background: Accessibility to specialized health care is important for residents in rural areas. Videoconsultation can provide increased accessibility to health care. Before implementation of new technologies, it is important to study residents' views. Objective: This study describes views of residents of rural areas on accessibility to specialist care and the use of videoconsultation as tool to increase accessibility. Method: A questionnaire was distributed via the primary health care centres in rural areas of northern Sweden. Data was analysed with both quantitative and qualitative methods. Results: The quantitative analysis revealed three main …areas: savings in time, environmental damage and cost of not having to travel were important; security of information must be coupled with increased availability of specialist care; responses depended on an individual's specific health care needs. The open-ended answers resulted into two categories: 1) experiences related to availability of specialist care and 2) views on participating in VC. Conclusion: Despite the fact that rural residents considered the distance as important factor in access to care, there was uncertainty regarding videoconsultation as solution. Although respondents were familiar with different types of communication technologies, they probably hesitated because they did not have information on what videoconsultation would mean to them. Show more

Keywords: Primary health care, technology, video consultation, rural areas, implementation, questionnaire, quantitative, qualitative content analysis

DOI: 10.3233/THC-140776

Citation: Technology and Health Care, vol. 22, no. 1, pp. 147-155, 2014