Technology and Health Care - Volume 28, issue 6

Authors: Iyengar, M. Sriram | Pinzon, Oscar E. | Campbell, Ron R.

Article Type: Research Article

Abstract: BACKGROUND: The design of Patient Management and Information Systems during outbreaks of highly infectious diseases in low resource environments poses special challenges. Such systems necessitate special functional and design requirements to support patient care under austere conditions. A primary concern is to minimize spread of the disease to caregivers and non-infected individuals. Patient management in these conditions requires the design and development of systems customized for complex patient and caregiver workflows. OBJECTIVE: Design and develop a Patient Management and Information System for healthcare facilities on the frontlines of outbreaks of highly infectious diseases in low resource …environments. METHODS: A team composed of clinicians with experience in Ebola care in affected areas of Africa and informaticians developed detailed hardware, software and functionality requirements. These were translated into hardware designs, software architectures, screen and interface designs and implemented using Common Off-The-Shelf hardware. An experimental app development system was used to develop mHealth software modules. RESULTS: The system was developed and implemented as a proof of concept. Acceptance testing showed that the system met functionality requirements. CONCLUSION: Useful Patient Management and Information systems can be developed and implemented for frontline use in low-resource environments during outbreaks of highly infectious diseases. Show more

Keywords: Ebola, patient management, mHealth, app, outbreak, low-resource, highly infectious disease

DOI: 10.3233/THC-192100

Citation: Technology and Health Care, vol. 28, no. 6, pp. 697-709, 2020

Authors: Tian, Fang | Chen, Li-Ping | Yuan, Gang | Zhang, Ai-Min | Jiang, Yu | Li, Shuang

Article Type: Research Article

Abstract: OBJECTIVE: To investigate the differences of tumor necrosis factor-α (TNF-α ), interleukin-6 (IL-6) and galectin-3 concentrations in lobar pneumonia and bronchopneumonia induced by mycoplasma pneumoniae (MP) in children and to explore these related factors predicting the severity of MP. METHODS: A total of 148 children with mycoplasma pneumoniae pneumonia (MPP) and 32 healthy controls were analyzed from March 2017 to August 2018 in our province. Clinical information was collected from the hospitalized MP patients. The 148 patients with MPP were divided into two groups: lobar pneumonia group and bronchial pneumonia group. …The 32 healthy children were considered the control group. The concentrations of TNF-α , IL-6 and Gal-3 were examined in the serum of 148 children patients with MPP and 32 healthy children by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA). RESULTS: The TNF-α , IL-6 and Gal-3 levels were obviously higher in both the lobar pneumonia and bronchial pneumonia groups, compared to those in the control group. Furthermore, these levels were significantly higher in the lobar pneumonia group, compared to the bronchial pneumonia group. After treatment, the levels of TNF-α , IL-6 and Gal-3 totally descended during the recovery period. CONCLUSION: There are differences in serum TNF-α , IL-6 and Gal-3 concentrations in lobar pneumonia and bronchial pneumonia caused by MP in children. In general, the TNF-α , IL-6 and Gal-3 levels were significantly higher in the lobar pneumonia group, when compared to the bronchial pneumonia group. This was because most lobar pneumonia cases are much more serious than bronchial pneumonia. Moreover, it has been proven that TNF-α , IL-6 and Gal-3 may play an important role in the pathogenesis development of MPP. At the same time, these are important issues in diagnosing MPP. Show more

Keywords: Mycoplasma pneumonia, lobar pneumonia, bronchial pneumonia, tumor necrosis facto-alpha, TNF-α, interleukin-6, IL-6, galctin-3, Gal-3

DOI: 10.3233/THC-192011

Citation: Technology and Health Care, vol. 28, no. 6, pp. 711-719, 2020

Authors: Fröschen, Frank Sebastian | Walter, Sebastian Gottfried | Randau, Thomas Martin | Gravius, Nadine | Gravius, Sascha | Hischebeth, Gunnar Thorben Rembert

Article Type: Research Article

Abstract: BACKGROUND: To date only scanty data exist regarding the effect of failed debridement, antibiotics, irrigation and retention of the prostheses (DAIR) and negative pressure wound therapy (NPWT) on the outcome of a subsequent exchange arthroplasty. OBJECTIVE: The objective of this study was to determine the success rate of a two- or multi-stage procedure after initial failed DAIR/NPWT in patients with an acute periprosthetic joint infection (PJI) and to evaluate the influence of possible risk factors for treatment failure. METHODS: Nineteen consecutive patients with a persisting PJI and ongoing NPWT after treatment of an …acute PJI with DAIR of the hip or knee joint from October 2010 to June 2017 were included. All patients were treated according to a structured treatment algorithm after referral to our hospital. The endpoint was a successful reimplantation with absence of signs of infection two years after replantation (“replantation group”) or treatment failure (“treatment failure group”) in terms of a permanent girdlestone arthroplasty, fistula, amputation or death. A risk factor analysis was performed between the two groups. RESULTS: Explantation was performed in 15 cases, amputation in one case, and DAIR/establishment of a fistula in three cases. The treatment success rate after reimplantation in terms of “definitively free of infection” two years after surgery according to Laffer was 36.85% (seven out of 19 patients). Statistical analysis revealed the number of surgeries until wound consolidation (p = 0.007), number of detected bacterial strains (p = 0.041), a polymicrobial PJI (p = 0.041) and detection of a difficult-to-treat organism (p = 0.005) as factors associated with treatment failure. After failed DAIR/NPWT we could detect a significant higher number of different bacterial strains (p = 0.001). CONCLUSIONS: The treatment success rate after failed DAIR and NPWT with 36% is low and associated with a high treatment failure rate (permanent girdlestone arthroplasty, fistula or amputation, death). Thus, the definition of risk factors is crucial. We found that the number of revisions until wound consolidation, a polymicrobial PJI and detection of a difficult-to-treat organisms were risk factors for treatment failure. Furthermore, after failed DAIR/NPWT we could detect a significant higher number of different bacterial strains, with a possible adverse effect on a consecutive exchange. Show more

Keywords: Revision total joint arthroplasty, PJI, NPWT, reimplantation, multi-stage revision, risk factor

DOI: 10.3233/THC-192095

Citation: Technology and Health Care, vol. 28, no. 6, pp. 721-731, 2020

Authors: Jung, Jihye | Choi, Wonjae | Lee, Seungwon

Article Type: Research Article

Abstract: BACKGROUND: Symmetry of gait is an important component of rehabilitation in stroke patients. Insufficient weight-bearing causes gait asymmetry. OBJECTIVE: This study aimed to identify the immediate effects of sufficient weight-bearing on the forefoot during the stance phase using visual feedback. METHODS: Twenty-seven individuals with stroke enrolled in this study. All patients were evaluated for gait parameters with and without visual feedback. Visual feedback was provided through a smart application and a beam projector screen that showed a weight shift as a change in color. Spatiotemporal gait parameters were evaluated, resulting in values for …a calculated symmetry index, in addition to heel % and toe % temporal values. RESULTS: Velocity and cadence were significantly decreased when visual feedback was provided (p < 0.05). Spatiotemporal parameters, except for bilateral step length, swing time of affected side, and single-limb support of less affected side, showed significant improvement (p < 0.05). The gait pattern of subjects was more symmetrical with visual feedback compared to non-visual feedback (p < 0.05). The toe-on time significantly improved on the affected side with visual feedback (p < 0.05). CONCLUSION: This study suggests that visual feedback aids in the improvement of gait symmetry, forefoot weight-bearing on the affected side, and spatiotemporal parameters. Show more

Keywords: Biofeedback, gait, weight-bearing, stroke

DOI: 10.3233/THC-192016

Citation: Technology and Health Care, vol. 28, no. 6, pp. 733-741, 2020