Technology and Health Care - Volume 28, issue 2

Authors: Hayashi, Norio | Maruyama, Tomoko | Sato, Yusuke | Watanabe, Haruyuki | Ogura, Toshihiro | Ogura, Akio

Article Type: Research Article

Abstract: BACKGROUND: Applied research on artificial intelligence, mainly in deep learning, is widely performed. If medical images can be evaluated using artificial intelligence, this could substantially improve examination efficiency. OBJECTIVE: We investigated an evaluation system for medical images with different noise characteristics using a deep convolutional neural network. METHODS: Simulated computed tomography images are the targets of the system. We used an AlexNet trained with natural images for the deep convolutional neural network and a support vector machine for classification. Synthetic computed tomography images with circular and rectangular signal bodies at different levels of …contrast and added Gaussian noise were used for training and testing. RESULTS: Two transfer learning methods were tested: classification by a re-trained support vector machine using the AlexNet features, and a method that fine-tuned the deep convolutional neural network. Using the first method, all the test image noise levels could be classified correctly. The fine-tuning method achieved an accuracy rate of 92.6%. CONCLUSIONS: An image quality evaluation method using artificial intelligence will be useful for clinical images and different image quality indices in the future. Show more

Keywords: Classification, deep convolutional neural network (DCNN), noise, computed tomography (CT), phantom

DOI: 10.3233/THC-191718

Citation: Technology and Health Care, vol. 28, no. 2, pp. 113-120, 2020

Authors: Boatman, Fratina | Golden, Matthew | Jin, Jennifer | Kim, Yedarm | Law, Sidney | Lu, Annabel | Merriam, Natasha | Zola, Stuart

Article Type: Research Article

Abstract: BACKGROUND: There is growing evidence that assistive digital technology can enhance quality of life (QOL) for individuals with various forms of cognitive impairment, including dementia. OBJECTIVE: Assess whether the use of a visual mapping software program to manage activities of daily living would have a positive impact on QOL scores and on cognitive scores in a group of dementia residents in an adult living community. METHODS: We compared quality-of-life scores and cognitive function scores before and after using the assistive technology for three months. RESULTS: 1. QOL scores significantly improved …in the memory impaired residents, as measured by a self-report questionnaire. 2. Caregivers also reported significantly improved QOL scores in the residents, and the caregivers reported more improved scores than the residents did. 3. Net Promoter Scores for residents and caregivers showed that using visual maps was highly satisfying; they would continue using this technology. 4. Memory-impaired residents showed significantly improved scores in cognitive areas reflecting improved ability to focus and pay attention. CONCLUSIONS: In addition to the positive findings in QOL and cognition, assistive technologies applied to dementia care are easy to access, easy to use, have little risk of side effects, and are relatively low in cost. Show more

Keywords: Memory, mind mapping, hippocampus, neostriatum, declarative memory, procedural memory, habit memory

DOI: 10.3233/THC-191980

Citation: Technology and Health Care, vol. 28, no. 2, pp. 121-128, 2020

Authors: Alfieri, Fábio Marcon | da Silva Dias, Caren | dos Santos, Artur Cesar Aquino | Battistella, Linamara Rizzo

Article Type: Research Article

Abstract: BACKGROUND: Stroke combined with Diabetes Mellitus may cause sensibility and vascular alterations. OBJECTIVE: To determine whether sensitivity and plantar cutaneous temperature of clinically controlled patients with stroke and DM are different from those of patients with stroke only. METHODS: This is a cross-sectional case-control study. The volunteers were assessed for sensitivity by monofilament esthesiometry in their plantar region, and for temperature by infrared thermal imaging. The data was presented as means and standard deviations and comparisons were conducted with the Mann-Whitney statistical test, with statistical significance set at p < …0.05. RESULTS: Five cases and 11 controls were included according to the eligibility and pairing criteria. There were no discrepancies between the plegic and contralateral sides regarding temperature and sensibility of both cases and controls. However, in the control group, there was an observable tendency for different temperatures between the plegic and the contralateral sides, with p < 0.05 in most of the comparisons. CONCLUSIONS: There is no evidence that the cases and controls have different plantar sensibility nor different plantar temperature on their plegic and contralateral sides. However, significant temperature discrepancies between both plegic and contralateral sides were observed in the control group. Show more

Keywords: Stroke, cutaneous sensitivity, body temperature, evaluation, esthesiometry, thermography

DOI: 10.3233/THC-195660

Citation: Technology and Health Care, vol. 28, no. 2, pp. 129-134, 2020

Authors: Pyo, Seunghyeon | Cho, Kihun | Kwon, Suncheol | Lee, Donggeon | Song, Sunhae | Lee, Gyuchang

Article Type: Research Article

Abstract: OBJECTIVE: A high number of stroke survivors experience limitations in balance and gait abilities. Thus, an improvement in gait ability is an important goal in the rehabilitation of hemiplegic stroke survivors. This study aimed to investigate the effect of using the one-arm motorized walker, a hemi-walker developed to assist hemiplegic stroke survivors in gait training and activities of daily living, on the improvement in gait ability in hemiplegic stroke survivors. METHODS: Eleven hemiplegic stroke survivors who met the inclusion criteria were included. The participants were instructed to walk thrice using traditional walking aids on a gait …mat and then to walk thrice using the one-arm motorized walker. During each walk, spatiotemporal gait parameters, including velocity, cadence, step length, stride length, single support time, and double support time, were evaluated using a gait analysis system. RESULTS: Velocity and cadence significantly increased when the participants walked using the one-arm motorized walker compared to those who used traditional walking aids (p < 0.05), whereas double support time significantly decreased for both the more affected and less affected sides (p < 0.05). However, no significant difference was observed in terms of step length and single support time. CONCLUSION: The one-arm motorized walker may have a positive effect on the improvement of gait ability in hemiplegic stroke survivors. It can be an effective walking aid for hemiplegic stroke survivors who experience difficulties in independent walking. Show more

Keywords: One-arm motorized walker, hemiplegic stroke, gait analysis

DOI: 10.3233/THC-191595

Citation: Technology and Health Care, vol. 28, no. 2, pp. 135-142, 2020

Authors: Shimpi, Neel | McRoy, Susan | Zhao, Huimin | Wu, Min | Acharya, Amit

Article Type: Research Article

Abstract: BACKGROUND: Periodontitis (PD), a form of gum disease, is a major public health concern as it is globally prevalent and harms both individual quality of life and economic productivity. Global cost in lost productivity is estimated at US$54 billion annually. Moreover, current PD assessment applies only after the damage has already occurred. OBJECTIVE: This study proposes and tests a new PD risk assessment model applicable at point-of-care, using supervised machine learning methods. METHODS: We compare the performance of five algorithms using retrospective clinical data: Naïve Bayes (NB), Logistic Regression (LR), Support Vector Machine …(SVM), Artificial Neural Network (ANN), and Decision Tree (DT). RESULTS: DT and ANN demonstrated higher accuracy in classifying the patients with high or low PD risk as compared to NB, LR and SVM. The resultant model with DT showed a sensitivity of 87.08% (95% CI 84.12% to 89.76%) and specificity of 93.5% (95% CI 91% to 95.49%). CONCLUSIONS: A predictive model with high sensitivity and specificity to stratify individuals into low and high PD risk tiers was developed. Validation in other populations will inform translational value of this approach and its potential applicability as clinical decision support tool. Show more

Keywords: Data mining, decision support systems clinical, health information systems, periodontitis, electronic health records, risk assessment tools

DOI: 10.3233/THC-191642

Citation: Technology and Health Care, vol. 28, no. 2, pp. 143-154, 2020

Authors: Guo, Xitong | Wu, Xinghan | Li, Yan

Article Type: Research Article

Abstract: BACKGROUND: Quality control system is one of the hospital information systems. The adoption of quality control system increases the work efficiency; however, to some extent, it also increases the workload for physicians. OBJECTIVE: The purpose of this study is to investigate the impacts of the quality control system on quality of care (e.g., process and outcome performance). METHODS: Our study collected physicians’ behavior information from a large urban hospital in China. We constructed the fixed-effect model to examine the relationship between the quality control system adoption and quality of care. RESULTS: …Using the quality control system has a significant (p < 0.001) and negative effect on patients’ stay length in the hospital (process performance). Furthermore, using the quality control system has a significant (p < 0.001) and positive effect on the trends of cure rate in the hospital (outcome performance). The coefficient of the dependent variable from the patients’ stay length (process performance) is lower than the trends of cure rate (outcome performance). CONCLUSIONS: The controlling system can improve medical quality even though it limits physician behavior to some extent. The controlling system improves both the process performance and outcome performance, and it brings more benefits to outcome performance rather than process performance which means the reflection of the new technology may have more evident on outcome variables. Show more

Keywords: Quality control system, process quality, physician’s behavior change, hospital information system

DOI: 10.3233/THC-191596

Citation: Technology and Health Care, vol. 28, no. 2, pp. 155-163, 2020

Authors: Ali, Shahid | Sangi, Laila | Kumar, Naresh | Kumar, Bharat | Khurshid, Zohaib | Zafar, Muhammad S.

Article Type: Research Article

Abstract: BACKGROUND: The antibacterial properties are beneficial and desired for dental restorative composite materials. The incorporation of various antimicrobial agents into resin composites may compromise their physical and mechanical properties hence limiting their applications. OBJECTIVE: The aim of the current study is to evaluate the antibacterial activity and the hardness of microhybrid and flowable resin based composites (RBCs) modified using novel antimicrobial agent chitosan (CS). METHODS: The antibacterial activity of microhybrid and flowable RBCs modified with 0, 0.25, 0.5 and 1% w/w chitosan (CS) against Actinomyces viscous bacteria was explored using agar diffusion …test and direct contact methods. The hardness of control and experimental RBCs was determined by Vickers hardness (VH) tester. RESULTS: The results revealed that control and experimental flowable and microhybrid RBCs did not demonstrate growth inhibition zone in the lawn growth of Actinomyces viscous . The direct contact test revealed that colony forming unit (CFU) count of Actinomyces viscous was comparable among the experimental and control materials. The flowable RBCs containing 1% CS had significantly higher VH compared to control and other experimental flowable RBC groups. The microhybrid RBCs consisting of 0.50% CS exhibited significantly higher VH compared to experimental microhybrid RBC group containing 1% CS. Show more

DOI: 10.3233/THC-181568

Citation: Technology and Health Care, vol. 28, no. 2, pp. 165-173, 2020

Authors: Tatemoto, Tsuyoshi | Saitoh, Eiichi | Tanabe, Shigeo | Koyama, Soichiro | Kumazawa, Nobuhiro | Furuzawa, Shotaro | Kato, Tomoya | Yoshimuta, Hiroshi | Torii, Katsuhiko | Kiyono, Kei | Otaka, Yohei | Kanada, Yoshikiyo

Article Type: Research Article

Abstract: BACKGROUND: Falls during transfer to and from a wheelchair are associated with numerous problems. Factors responsible for difficulty in transferring include horizontal/vertical gaps between surfaces; obstacles, such as armrests; and complicated brake/footrests configurations before transferring. Moreover, controlling a wheelchair sufficiently close to the transfer surface within the confined home space is difficult. OBJECTIVE: We described the design of the novel Lateral Transfer Assist Robot (LTAR) for solving problems during transfer. Furthermore, the effectiveness and usability of the robot were preliminary examined in healthy adults. METHOD: The transfer problems and basic designs were …organized. The effectiveness of the prototype was measured by three-dimensional motion analysis and questionnaire. RESULTS: The prototype LTAR was developed. With just a push on a button, the footplate lowers to the floor and the seat and armrest lowers to the height of the seating surface to fill the gap between the surfaces. Using these features, users can transfer by simply shifting their buttocks sideways. Additionally, LTAR has omnidirectional wheels that help move it within a narrow space. The LTAR was confirmed to reduce the physical and subjective burden, except for maneuverability. CONCLUSION: The LTAR was found to be effective for home use and reducing burden of transfer. Show more

Keywords: Robotics, activities of daily living, falls, usability, wheeled mobility aids

DOI: 10.3233/THC-191762

Citation: Technology and Health Care, vol. 28, no. 2, pp. 175-183, 2020

Authors: Pieske, Oliver | Bauer, Maximilian | Schröder, Christian | Michaelis, Ina | Massen, Felix | Wallmichrath, Jens | Suero, Eduardo M. | Greiner, Axel

Article Type: Research Article

Abstract: BACKGROUND: Up to date there is no intramedullary, biodegradable osteosynthesis commercially available to treat non-comminuted midshaft fractures of small hollow bones applying not only a stable osteosynthesis but an additional axial compression to the fracture site. OBJECTIVE AND METHODS: Therefore we (1) designed different implant profiles and simulated the inner tension/volume using CAD. (2) Thereafter we manufactured a prototype with the best volume/tension-ratio using 70:30 poly-(L-lactide-co-D, L-lactide) (PLLA/PDLLA) and poly-ε -caprolactone (PCL) by injection moulding. Both materials are resorbable, licensed for medical use and show a slow degradation over at least one year. (3) …The implants were tested in a universal testing machine (Zwick/RoellZ010) using a 3-point-bending-setup. (4) We compared the implants with different types of commercially available Ti6Al4V 6-hole 2, 3 mm-plates including interlocking systems (Leibinger Set, Stryker) (each group n = 6) using a 4-point-bending-test-setup with artificial metacarpal bones (Sawbones ® ). RESULTS: The 3-point-bending-test-results showed that mean failure-force of PCL-tubes was 57.94 ± 4.28 N whereas the PLLA/PDLLA-tubes had an approximately four-fold higher value of 227.24 ± 1.87 N (p < 0.001). Additionally, the 4-point-bending-test-results showed that the maximum load of PLLA/PDLLA tubes (61.97 ± 3.58 N) was significantly higher than the strongest 6-hole metacarpal plate (22.81 ± 0.76 N) (p < 0.001). CONCLUSION: The study showed that the new type of biodegradable, intramedullary tension-osteosynthesis made of PLLA/PDLLA is even more stable than common plate osteosynthesis in a small-hallow-bone-model. Further in vivo investigation should be performed to evaluate the surgical technique and long-term healing process of the bone and biodegradation process of the implant. Show more

Keywords: Biodegradable, implant, osteosynthesis, intramedullary, hollow bone fracture

DOI: 10.3233/THC-191597

Citation: Technology and Health Care, vol. 28, no. 2, pp. 185-192, 2020

Authors: Eden, Lars | Frey, Sönke P. | Gilbert, Fabian | Jordan, Martin C. | Fenwick, Annabel | Meffert, Rainer H.

Article Type: Research Article

Abstract: BACKGROUND: Monteggia-like lesions are rare injuries. We retrospectively reviewed 40 consecutive patients with Monteggia-like lesions treated at a level I trauma center from 2009 to 2016. Clinical results were evaluated with a focus on the use of modern locking plates. OBJECTIVE AND METHODS: Twenty-eight patients had Bado type II fractures, 11 had Bado type I, and 1 had Bado type III. All patients were treated by plate fixation of the ulna with a locking compression plate or double mini-plates. Fixation or replacement was performed for radial head fractures. We characterized all fractures and recorded the range …of motion (ROM); 100-point visual analog scale (VAS) scores for pain and function; Disabilities of the Arm, Shoulder and Hand (DASH) score; and Mayo Elbow Performance Score (MEPS). A follow-up rate of 78% was reached at an average of 36 months (range, 12–95 months). RESULTS: Stable fixation without recurrent instability was accomplished. The average ROM for flexion reached 130 ∘ with an extension deficit of 13 ∘ . The sum of supination and pronation was 136 ∘ . The VAS scores for pain and function were 20 and 75, respectively. The average MEPS and DASH scores were 84 and 28, respectively. Bado type I fractures had better outcomes for all variables, especially forearm rotation (p < 0.05). The complication rate was 22.5% and revision rate was 17.5%. CONCLUSION: This fracture repair technique can safely achieve good and excellent outcomes in most cases and is partly superior to previously published techniques. However, Bado type II fractures still have a risk of poor results. Show more

Keywords: Proximal ulna, Monteggia fracture, Monteggia-like lesion, low-profile implants, elbow fracture, twin plates

DOI: 10.3233/THC-191812

Citation: Technology and Health Care, vol. 28, no. 2, pp. 193-201, 2020

Authors: Gao, Yu-Hang | Dong, Ning | Yang, Chen | Li, Shu-Qiang | Liu, Jian-Guo | Qi, Xin

Article Type: Research Article

Abstract: BACKGROUND: Few studies have investigated interleukin (IL)-33 as a potential proinflammtory cytokine in the joint cavity following subchondral fracture occurring during osteonecrosis of the femoral head (ONFH). OBJECTIVE: The aim of the present study was to investigate whether IL-33 and other proinflammtory cytokines, in addition to cartilage degeneration, were elevated in the joint cavity following subchondral fracture. METHODS: IL-33 levels were analyzed in the plasma, synovial fluid, and bone marrow aspirate, and the levels of IL-6, IL-17, IL-1β , tumor necrosis factor (TNF)-α , matrix metallopeptidase (MMP)-13, and carboxy-terminal …telopeptides of type II collagen (CTX-II) in synovial fluid were also quantitated to compare the levels of these proteins between stages II and III. Macro- and microscopic articular cartilage were evaluated and compared between stages II and III in the same patient. Moreover, immunohistochemical staining of MMP-13 and Col-II were examined. RESULTS: Of the 33 patients enrolled in the present study, 15 had hips in stage II and 18 had hips in stage III. IL-33 levels in all three sample types were significantly higher in stage III. Synovial fluid IL-6 and CTX-II levels were significantly higher in stage III. A clear step-off region in the weight-bearing area was macroscopically observed in the stage III femoral head. Microscopic evaluation showed symmetrical cartilage matrix deposition around the chondrocytes in the stage II articular cartilage, unlike that in stage III. Immunohistochemical staining of the stage III articular cartilage samples revealed positive MMP-13 staining in chondrocytes and decreased Col-II deposition in the matrix. CONCLUSIONS: The present study revealed elevated IL-33 and IL-6 levels and cartilage degeneration in stage III ONFH. Show more

Keywords: Osteonecrosis of the femoral head, cartilage degeneration, interleukin-33, interleukin-6

DOI: 10.3233/THC-191811

Citation: Technology and Health Care, vol. 28, no. 2, pp. 203-212, 2020

Authors: Perry, Omer | Wacht, Oren | Jaffe, Eli | Sinuany-Stern, Zilla | Bitan, Yuval

Article Type: Short Communication

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. Show more

Keywords: Emergency medical dispatcher, cardiac arrest, telephone cardiopulmonary resuscitation, video cardiopulmonary resuscitation, filming protocol

DOI: 10.3233/THC-192024

Citation: Technology and Health Care, vol. 28, no. 2, pp. 213-220, 2020

Authors: Shang, Haitao | Wu, Bolin | Liu, Zhao | Liu, Ying | Cheng, Wen

Article Type: Short Communication

Abstract: OBJECTIVE: The present study explored the efficiency of shear wave elastography (SWE) in diagnosing papillary thyroid microcarcinoma (PTMC). METHODS: This retrospective study constituted of 446 patients with 510 thyroid nodules. SWE values and ultrasound parameters of each nodule were used for comparison and analysis. RESULTS: The ultrasonography findings between malignant and benign nodules differed significantly (P < 0.05). The benign and PTMC nodule groups showed a remarkable difference in the stiffness, i.e., higher SWE values. CONCLUSION: SWE is useful in diagnosing micro thyroid nodules, and …the values were significantly correlated with tumor size and thyroid capsule invasion of PTMC. Show more

Keywords: Shear wave elastography, ultrasound, thyroid nodules, papillary thyroid microcarcinoma

DOI: 10.3233/THC-191895

Citation: Technology and Health Care, vol. 28, no. 2, pp. 221-226, 2020