Technology and Health Care - Volume 24, issue 6

Authors: Kratz, Thomas | Simon, Christina | Fendrich, Volker | Schneider, Ralph | Wulf, Hinnerk | Kratz, Caroline | Efe, Turgay | Schüttler, Karl F. | Zoremba, Martin

Article Type: Research Article

Abstract: BACKGROUND: Goal directed fluid management in major abdominal surgery has shown to reduce perioperative complications. The approach aims to optimize the intravascular fluid volume by use of minimally invasive devices which calculate flow-directed variables such as stroke volume (SV) and stroke volume variation (SVV). OBJECTIVE: We aimed to show the feasibility of routinely implementing this type of hemodynamic monitoring during pancreatic surgery, and to evaluate its effects in terms of perioperative fluid management and postoperative outcomes. METHODS: All patients undergoing pancreatic surgery at a university hospital during two successive 12 months periods were …included in this retrospective cohort analysis. Twelve months after the implementation of a standard operating procedure for a goal directed therapy (GDT, N = 45) using a pulse contour automated hemodynamic device were compared with a similar period before its use (control, N = 31) regarding mortality, length of hospital and ICU stay, postoperative complications and the use of fluids and vasopressors. RESULTS: Overall, 76 patients were analysed. Significantly less crystalloids were used in the GDT group. Patients receiving GDT showed significantly fewer severe complications (insufficiency of intestinal anastomosis: 0 vs. 5 (P = 0.0053) and renal failure: 0 vs. 4 (P = 0.0133). Mortality for pancreatic surgery was 1 vs. 3 patients, (P = 0.142), and length of stay (LOS) in the intensive care unit (ICU) was 4.38 ± 3.63 vs. 6.87 ± 10.02 (P= 0.0964) days. Use of blood products was significantly less within the GDT group. CONCLUSIONS: Implementation of a SOP for a GDT in the daily routine using flow-related parameters is feasible and is associated with better outcomes in pancreatic surgery. Show more

Keywords: Goal directed therapy, major abdominal surgery, pancreatic surgery, pluse-contour-automated-analysis, fluid therapy

DOI: 10.3233/THC-161237

Citation: Technology and Health Care, vol. 24, no. 6, pp. 899-907, 2016

Authors: Zens, Martin | Goldschmidtboeing, Frank | Wagner, Ferdinand | Reising, Kilian | Südkamp, Norbert P. | Woias, Peter

Article Type: Research Article

Abstract: BACKGROUND: Several different surgical techniques are used in the treatment of olecranon fractures. Tension band wiring is one of the most preferred options by surgeons worldwide. The concept of this technique is to transform a tensile force into a compression force that adjoins two surfaces of a fractured bone. Currently, little is known about the resulting compression force within a fracture. OBJECTIVE: Sensor devices are needed that directly transduce the compression force into a measurement quality. This allows the comparison of different surgical techniques. Ideally the sensor devices ought to be placed in the gap between …the fractured segments. METHODS: The design, development and characterization of miniaturized pressure sensors fabricated entirely from polydimethylsiloxane (PDMS) for a placement within a fracture is presented. The pressure sensors presented in this work are tested, calibrated and used in an experimental in vitro study. RESULTS: The pressure sensors are highly sensitive with an accuracy of approximately 3 kPa. A flexible fabrication process for various possible applications is described. The first in vitro study shows that using a single-twist or double-twist technique in tension band wiring of the olecranon has no significant effect on the resulting compression forces. CONCLUSIONS: The in vitro study shows the feasibility of the proposed measurement technique and the results of a first exemplary study. Show more

Keywords: Polydimethylsiloxane (PDMS), pressure sensor, tension band wiring, compression force

DOI: 10.3233/THC-161243

Citation: Technology and Health Care, vol. 24, no. 6, pp. 909-917, 2016

Authors: Bredow, J. | Beyer, F. | Oppermann, J. | Kraus, B. | Meyer, C. | Stein, G. | Eysel, P. | Koy, T.

Article Type: Research Article

Abstract: BACKGROUND: Goal of this study is to present an easily reproducible and reliable measurement to evaluate accuracy of screw placement in cervical spine. METHODS: Accuracy of cervical screw position was assessed in 52 patients treated with 163 screws. Each patient receiving pedicle, transarticular C1/2, lateral mass, or laminar screws and postoperative CT scan was included. Placement position was categorized in 5 grades: Grade 1 is ideal with pedicle wall perforation < 1 mm, grade 2 < 2 mm, grade 3 < 3 mm, and grade 4 < 4 mm. Grade 5 > 4 mm and/or obstruction …of transverse foramen by more than half a screw diameter. Intraclass correlation coefficient (ICC) values were assessed for inter- and intraobserver reliability. RESULTS: The mode of individual evaluations was calculated to assign a single value to each screw. This yielded 89 grade 1 (54.6%), 48 grade 2 (29.4%), 14 grade 3 (8.6%), 3 grade 4 (1.8%), and 9 grade 5 (5.5%) screws. Intraobserver reliability ICC was 0.966 and 0.959 for measurements. Interobserver reliability ICC was 0.938. CONCLUSION: This study introduces a reliable classification of cervical spine instrumentation with various screw types. This should enable the use of a uniform and reproducible, and thus comparable classification for screw position in cervical spine. Show more

Keywords: Classification, screw placement accuracy, cervical spine, spondylodesis

DOI: 10.3233/THC-161246

Citation: Technology and Health Care, vol. 24, no. 6, pp. 919-925, 2016

Authors: Wimmer, M.D. | Ploeger, M.M. | Friedrich, M.J. | Bornemann, R. | Roessler, P.P. | Gravius, S. | Randau, T.M.

Article Type: Research Article

Abstract: BACKGROUND: When deciding upon the best treatment strategy in revision arthroplasty, it is absolutely crucial to use the best possible preoperative detection whether a periprosthetic joint infection (PJI) is present or not. New molecular markers investigated in serum samples and synovial fluid can help to improve the preoperative diagnosis. In 2001, a novel IL-6 lateral flow immunoassay testing device was introduced which has never been tested in synovial fluid so far. OBJECTIVE: For our study we investigated whether the test can be used safely, feasibly and time effectively with synovial fluid gathered from potentially infected THAs …or TKAs and whether the already published cutoff for IL-6 in synovial fluid predicting a PJI can be reproduced using the QuickLine IL-6 immunoassay. METHODS: After ethic approval and within the scope of a prospective controlled trial we investigated 26 patients (m = 9, 34.6%; f= 17, 65.4%) with n = 13 (50%) potentially infected total hip arthroplasties (THAs) and n = 13 (50%) suspected PJIs of total knee arthroplasties (TKAs). Sterile aspirated synovial fluid was examined for total leukocyte count and cell differentiation by a blood count analyzer in body fluid mode as well as for IL-6 (Immulite, Siemens Medical Solutions Diagnostics GmbH, Eschborn, Germany). Another part of the joint aspirate was tested using the QuickLine IL-6 Test by Milenia Biotec (Milenia Biotec, Gießen, Germany). RESULTS: The mean concentration of IL-6 as determined from our reference laboratory testing (Siemens Immulight) for aseptic cases was 1,219 pg/mL (SD 1,369 pg/mL, min 134 pg/mL-max 4,214 pg/mL). The mean IL-6 concentration measured via the IL-6 QuickLine for aseptic cases was 410 pg/mL (SD 371 pg/mL, min 100 pg/mL-max 1562 pg/mL). The test showed no false negative or false positive results in the cases tested. In six patients, PJI was considered proven. The QuickLine Test indicated IL 6 concentrations > 10,000 pg/mL in these cases without further quantification above this maximum detection threshold. Results from the QuickLine Test and the laboratory tests were matched and a non-linear best fit curve (log-log-curve) was applied. The subsequent Spearman correlation showed a correlation coefficient of r = 0.92 (95% CI 0.81-0.97) which corresponds to a two-tailed p-value of < 0.0001, respectively. As a primary finding we were able to show that the Milenia QuickLine IL-6 Test can be used safely, feasibly and time effectively with synovial fluid gathered intraoperatively from potentially infected THAs or TKAs. The test as provided worked well in 84.6% of the samples tested and failed only due to very viscous synovial fluid. As a secondary result we found that the previously published cut-off for IL-6 in synovial fluid predicting a PJI with a sensitivity of 46.88% and a specificity of 97.62% can be reproduced using the QuickLine IL-6 immunoassay. CONCLUSION: Taking the limitations of the low sample size as a given this relatively simple point of care (POC) assay showed promising results in our pilot trial and may help diagnosing PJI. It may help physicians and surgeons to choose the best and least invasive treatment strategy for patients presenting with painful arthroplasty. Show more

Keywords: Prosthetic joint infections, total hip arthroplasty, retrograde forceps, diagnosis

DOI: 10.3233/THC-161247

Citation: Technology and Health Care, vol. 24, no. 6, pp. 927-932, 2016

Authors: Kim, Seonho | So, Wi-Young

Article Type: Research Article

Abstract: The purpose of this study was to examine the secular trends in weight status and weight-related behaviors in adolescents in Korea from 2006 to 2013. Using a repeated cross-sectional design, we analyzed raw data from the 2006 and 2013 Korea Youth Risk Behavior Web-based Survey, which included 69,500 adolescents in 2006 and 70,354 adolescents in 2013. Subjects were 12- to 18-year-old boys and girls from the first grade of middle school through the third grade of high school. The data was collected by using an anonymous self-administered online survey. From 2006 to 2013, the prevalence of obesity increased by 0.7 …(percent point; %p) (p < 0.001) in boys and 1.0%p (p < 0.001) in girls. At the same time, the prevalence of obesity increased by 1.0%p (p < 0.001) in middle-school students and decreased by 0.7%p (p < 0.001) in high-school students. Healthy, unhealthy, and extreme weight-control behaviors decreased in all adolescents (all p < 0.001). Obesity and unhealthy weight control behaviors in Korean adolescents remain major public concerns, and programs to encourage healthy weight control behaviors are required. Show more

Keywords: Adolescents, obesity, weight control behaviors

DOI: 10.3233/THC-161252

Citation: Technology and Health Care, vol. 24, no. 6, pp. 933-941, 2016

Authors: Stephan, Karl. D. | McLean, Robert J.C. | DeLeon, Gian | Melnikov, Vadim

Article Type: Research Article

Abstract: OBJECTIVE: We investigate the effect of feed-gas humidity on the oxidative properties of an atmospheric-pressure plasma jet using nitrogen gas. BACKGROUND: Plasma jets operating at atmospheric pressure are finding uses in medical and biological settings for sterilization and other applications involving oxidative stress applied to organisms. Most jets use noble gases, but some researchers use less expensive nitrogen gas. The feed-gas water content (humidity) has been found to influence the performance of noble-gas plasma jets, but has not yet been systematically investigated for jets using nitrogen gas. METHOD: Low-humidity and high-humidity feed gases …were used in a nitrogen plasma jet, and the oxidation effect of the jet was measured quantitatively using a chemical dosimeter known as FBX (ferrous sulfate-benzoic acid-xylenol orange). RESULTS: The plasma jet using high humidity was found to have about ten times the oxidation effect of the low-humidity jet, as measured by comparison with the addition of measured amounts of hydrogen peroxide to the FBX dosimeter. CONCLUSIONS: Atmospheric-pressure plasma jets using nitrogen as a feed gas have a greater oxidizing effect with a high level of humidity added to the feed gas. Show more

Keywords: Plasma, plasma jet, humidity, nitrogen plasma jet, sterilization

DOI: 10.3233/THC-161226

Citation: Technology and Health Care, vol. 24, no. 6, pp. 943-948, 2016

Authors: Afzal, Uzma | Mahmood, Tariq | Anwar, Masood | Shaikh, Zubair

Article Type: Research Article

Abstract: BACKGROUND: Configuration of complex Laboratory Developed Tests (LDTs) is a time-consuming and complicated task, potentially leading to inconsistent LDTs in which features constraints remain unresolved and important features could remain unselected. OBJECTIVE: Our objective is to address these issues by presenting an automated, health informatics solution which autonomously optimizes feature selection in complex LDTs through Particle Swarm Optimization (PSO). The optimization goal is to minimize inconsistencies and configuration time, and maximize the number of selected features. METHODS: We implemented our technology …in a local, secondary-care hospital in Pakistan which configures LDT for a local epidemic disease. First, a list of inconsistent LDT configurations is generated. This is used to initially estimate optimal PSO parameters, which are then used for optimization process. RESULTS: Results show that PSO is able to minimize 91% inconsistencies between 9 and 11 seconds. The number of selected critical features also increases by 100% in the optimized LDT configuration. CONCLUSIONS: We present a novel and the first application of computational optimization to solve LDT configuration issues. Show more

Keywords: Laboratory developed test, health informatics, inconsistencies, particle swarm optimization

DOI: 10.3233/THC-161227

Citation: Technology and Health Care, vol. 24, no. 6, pp. 949-956, 2016

Authors: von Engelhardt, Lars Victor | El Tabbakh, Mohammed Roshdy | Engers, Rainer | Lahner, Matthias | Jerosch, Jörg

Article Type: Case Report

Abstract: BACKGROUND: Osteoid osteoma is an osteoblastic benign bone tumor usually affecting young adolescents. Intra-articular lesions are not common; usually the diagnosis is delayed. A lot of studies report difficulties and complications in the management of osteoid osteoma of the hip joint using imaging guided techniques or open surgical procedures. Only few published cases have described that it can be treated precisely using hip arthroscopy. Additionally, the use of hip arthroscopy to apply the Chondrofiller® , an acellular collagen matrix for the management of articular cartilage defects of the hip joint, has not yet been described. CASE …PRESENTATION: This report presents an osteoid osteoma of the femoral neck. A 20-year-old female professional basketball player presented with pain in the left groin since more than 12 months. On magnetic resonance and computed tomography imaging, an osteoid osteoma was suggested. The lesion was successfully removed using arthroscopy. During surgery, a concomitant grade 4 cartilage lesion on the femoral head was detected. For the treatment of this severe defect we used the Chondrofiller® , which is a new acellular collagen implant for auto-regeneration of articular cartilage. This matrix was filled into the prepared and dried defect using CO2 arthroscopy. After the hardening of the matrix the surgery was finished. The patient was pain free shortly after the operation and returned to sports within 16 weeks. Return to high-performance sports 8 months after surgery was without of any sign of complaints. CONCLUSIONS: This article demonstrates that hip arthroscopy is a valuable tool for biopsy and excision of intra-articular osteoid osteoma affecting the hip joint, as well as for addressing other concomitant pathologies such as a severe synovitis or cartilage defects. CO2 arthroscopy provided good conditions for the drying and filling of the cartilage defect with the Chondrofiller® . Show more

Keywords: Hip arthroscopy, osteoid osteoma, cartilage defect, cartilage matrix, hip joint, CO2 arthroscopy

DOI: 10.3233/THC-161223

Citation: Technology and Health Care, vol. 24, no. 6, pp. 957-964, 2016

Authors: Leite, Fernando Ochoa | Cochat, Catarina | Salgado, Henrique | da Costa, Mariana Pinto | Queirós, Marta | Campos, Olga | Carvalho, Paulo

Article Type: Case Report

Abstract: INTRODUCTION: Doctor-patient communication is essential to the establishment of a therapeutic relationship and to the clinical improvement of the patient. Medical Interpreter Services (MIS) allow the doctors to communicate with patients that do not speak the same language of the clinical staff. However, MIS are not always available and when that happens it is of the upmost importance to find alternatives. OBJECTIVES AND METHODS: Presentation of a clinical case in which Google Translate^© (GT^©) was used as a translation tool to communicate with a patient. Discussion of the utility and validity of GT^© as a …translation tool in Medicine. A Pubmed search for articles concerning the use of technological innovations as translation tools was performed using the key words: GT^©, language barriers, foreign language, and communication barriers. RESULTS: In the reported clinical case, GT^© allowed the translation and the establishment of communication with a foreign patient. The Pubmed search found two articles concerning the use and validity of GT^© as a translation tool in Medicine. CONCLUSIONS: GT^© is the most readily available and free initial mode of communication between a doctor and a patient when language is a barrier. Nonetheless, GT^© should not be trusted for important medical communications unless all avenues to find a human translator have been exhausted, and the procedure is clinically urgent. Show more

Keywords: Medical translation, Google Translate^©, communication

DOI: 10.3233/THC-161241

Citation: Technology and Health Care, vol. 24, no. 6, pp. 965-968, 2016

Authors: Masoni, Marco | Guelfi, Maria Renza | Gensini, Gian Franco

Article Type: Short Communication

Abstract: Illegal activities prosecutable by law in the real life can be committed on the internet alike. In the healthcare domain, we refer mainly to selling of illegal and counterfeit drugs, exchange of pedo-pornographic material and marketing of stolen medical records. These illegal activities are made easier by recent developments of the Internet that medical community must be aware of: darknet and bitcoin. The first allows anonymous surfing and the last anonymous financial transactions. After discussing which healthcare areas are affected by these technological developments of the Internet and the deriving consequences, then the Authors express their opinion …on what actions can be taken to protect internet community. Show more

Keywords: Darknet, TOR, bitcoin, regulation, drugs trade, anonymity, pedo-pornography, medical records

DOI: 10.3233/THC-161244

Citation: Technology and Health Care, vol. 24, no. 6, pp. 969-972, 2016