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ISSN 0928-7329 (P)
Impact Factor 2023: 1.6
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 infection caused by the SARS-CoV-2 (COVID-19) pandemic is a threat to human lives. An early and accurate diagnosis is necessary for treatment. OBJECTIVE: The study presents an efficient classification methodology for precise identification of infection caused by COVID-19 using CT and X-ray images. METHODS: The depthwise separable convolution-based model of MobileNet V2 was exploited for feature extraction. The features of infection were supplied to the SVM classifier for training which produced accurate classification results. RESULT: The accuracies for CT and X-ray images are 99.42% and 98.54% respectively. The…MCC score was used to avoid any mislead caused by accuracy and F1 score as it is more mathematically balanced metric. The MCC scores obtained for CT and X-ray were 0.9852 and 0.9657, respectively. The Youden’s index showed a significant improvement of more than 2% for both imaging techniques. CONCLUSION: The proposed transfer learning-based approach obtained the best results for all evaluation metrics and produced reliable results for the accurate identification of COVID-19 symptoms. This study can help in reducing the time in diagnosis of the infection.
Keywords: Transfer learning, COVID-19, MobileNet V2, deep learning
Abstract: BACKGROUND: The COVID-19 pandemic broke out in 2019 and rapidly spread across the globe. Most of the severe and dead cases are middle-aged and elderly patients with chronic systemic diseases. OBJECTIVE: This study aimed to assess the association between fasting blood glucose (FPG) and body mass index (BMI) levels in patients with coronavirus disease 2019 (COVID-19) under different conditions. METHODS: Experimental-related information (age, gender, BMI, and FPG on the second day of admission) from 86 COVID-19 cases (47 males and 39 females) with an average age of (39 ± 17)…years was collected in April and November 2020. These cases were divided into three groups according to the most severe classification of each case determined by the clinical early warning indicators of severe-critically illness, the degree of progression, and the treatment plan shown in the diagnosis and treatment plan of COVID-19 pneumonia. Statistical models were used to analyze the differences in the levels of FPG and BMI, age, and gender among the three groups. RESULTS: 1. Experimental group: 21 patients with asymptomatic or and mild symptoms (group A), 45 patients with common non-progression (group B), and 20 patients with common progression and severe symptoms (group C). 2. The age differences among the three groups were statistically significant and elderly patients had a higher risk of severe disease (t = 4.1404, 3.3933, 9.2123, P = 0.0001, 0.0012, 0.0000). There was a higher proportion of females than males in the normal progression and severe disease cases (χ 2 = 5.512, P = 0.019). 3. The level of FPG was significantly higher in group C than in group A (t = 3.1655, P = 0.0030) and B (t = 2.0212, P = 0.0475). The number of diabetes or IFG in group C was significantly higher than in group A (χ 2 = 5.979, P = 0.014) and group B (χ 2 = 6.088, P = 0.014). 4. BMI was significantly higher in group C than in groups A (t = 3.8839, P = 0.0004) and B (t = 3.8188, P = 0.0003). The number of overweight or obese patients in group C was significantly higher than in groups A (χ 2 = 8.838, P = 0.003) and B (χ 2 = 10.794, P = 0.001). 5. Patients’ age, gender, and FPG were independent risk factors for COVID-19 disease progression (β = 0.380, 0.191, 0.186; P = 0.000, 0.034, 0.045). CONCLUSION: The levels of FPG and BMI were significantly increased in the population with common progressive and severe COVID-19. FPG and age are independent risk factors for the progression of COVID-19.
Keywords: COVID-19, fasting plasma glucose, body mass index, diabetes
Abstract: BACKGROUND: Coronavirus disease 2019 (COVID-19) is a deadly viral infection spreading rapidly around the world since its outbreak in 2019. In the worst case a patient’s organ may fail leading to death. Therefore, early diagnosis is crucial to provide patients with adequate and effective treatment. OBJECTIVE: This paper aims to build machine learning prediction models to automatically diagnose COVID-19 severity with clinical and computed tomography (CT) radiomics features. METHOD: P-V-Net was used to segment the lung parenchyma and then radiomics was used to extract CT radiomics features from the segmented lung parenchyma regions.…Over-sampling, under-sampling, and a combination of over- and under-sampling methods were used to solve the data imbalance problem. RandomForest was used to screen out the optimal number of features. Eight different machine learning classification algorithms were used to analyze the data. RESULTS: The experimental results showed that the COVID-19 mild-severe prediction model trained with clinical and CT radiomics features had the best prediction results. The accuracy of the GBDT classifier was 0.931, the ROUAUC 0.942, and the AUCPRC 0.694, which indicated it was better than other classifiers. CONCLUSION: This study can help clinicians identify patients at risk of severe COVID-19 deterioration early on and provide some treatment for these patients as soon as possible. It can also assist physicians in prognostic efficacy assessment and decision making.
Abstract: BACKGROUND: Medical devices (MDs) represent the backbone of the modern healthcare system. Considering their importance in daily medical practice, the process of manufacturing, marketing and usage has to be regulated at all levels. Harmonized evidence-based conformity assessment of MDs during PMS relying on traceability of medical device measurements can contribute to higher reliability of MD performance and consequently to higher reliability of diagnosis and treatments. OBJECTIVE: This paper discusses issues within MD post-market surveillance (PMS) mechanisms in order to set a path to harmonization of MD PMS. METHODS: Medline (1980–2021), EBSCO (1991–2021), and…PubMed (1980–2021) as well as national and international legislation and standard databases along with reference lists of eligible articles and guidelines of relevant regulatory authorities such as the European Commission and the Food and Drug Administration were searched for relevant information. Journal articles that contain information regarding PMS methodologies concerning stand-alone medical devices and relevant national and international legislation, standards and guidelines concerning the topic were included in the review. RESULTS: The search strategy resulted in 2282 papers. Out of those only 24 articles satisfied the eligibility criteria and were finally included in the review. Papers were grouped per categories: medical device registry, medical device adverse event reporting, and medical device performance evaluation. In addition to journal articles, national and international legislation, standards, and guidelines were reviewed to assess the state of PMS in different regions of the world. CONCLUSION: Although the regulatory framework prescribes PMS of medical devices, the process itself is not harmonized with international standards. Particularly, conformity assessment of MDs, as an important part of PMS, is not measured and managed in a traceable, evidence-based manner. The lack of harmonization within PMS results in an environment of increased adverse events involving MDs and overall mistrust in medical device diagnosis and treatment results.
Keywords: Medical device, post-market surveillance, conformity assessment, performance inspection, standardization
Abstract: BACKGROUND: Digital phenotyping has been defined as the moment-by-moment assessment of an illness state through digital means, promising objective, quantifiable data on psychiatric patients’ conditions, and could potentially improve diagnosis and management of mental illness. As it is a rapidly growing field, it is to be expected that new literature is being published frequently. OBJECTIVE: We conducted this scoping review to assess the current state of literature on digital phenotyping and offer some discussion on the current trends and future direction of this area of research. METHODS: We searched four databases, PubMed, Ovid…MEDLINE, PsycINFO and Web of Science, from inception to August 25 th , 2021. We included studies written in English that 1) investigated or applied their findings to diagnose psychiatric disorders and 2) utilized passive sensing for management or diagnosis. Protocols were excluded. A narrative synthesis approach was used, due to the heterogeneity and variability in outcomes and outcome types reported. RESULTS: Of 10506 unique records identified, we included a total of 107 articles. The number of published studies has increased over tenfold from 2 in 2014 to 28 in 2020, illustrating the field’s rapid growth. However, a significant proportion of these (49% of all studies and 87% of primary studies) were proof of concept, pilot or correlational studies examining digital phenotyping’s potential. Most (62%) of the primary studies published evaluated individuals with depression (21%), BD (18%) and SZ (23%) (Appendix 1). CONCLUSION: There is promise shown in certain domains of data and their clinical relevance, which have yet to be fully elucidated. A consensus has yet to be reached on the best methods of data collection and processing, and more multidisciplinary collaboration between physicians and other fields is needed to unlock the full potential of digital phenotyping and allow for statistically powerful clinical trials to prove clinical utility.
Keywords: Digital phenotyping, digital sensing, psychiatry, scoping review, artificial intelligence, machine learning, mobile health
Abstract: BACKGROUND: Ultrasound-guided needle placement has revolutionized the thoracic paravertebral block technique and can be applied in thoracoscopic surgery. OBJECTIVE: This study investigated the median effective volume (EV 50 ) of an ultrasound-guided single shot of 0.3% ropivacaine used as a thoracic paravertebral nerve block for the radical thoracoscopic resection of lung cancer. METHODS: A total of 27 patients who received a single shot of ultrasound-guided thoracic paravertebral nerve block and underwent radical thoracoscopic resection of lung cancer were enrolled in this study between February 10 and August 13, 2018. All…patients were rated as ASA grades I or II. Using ultrasound as a guide, the block needle was gradually pushed through the lateral costotransverse ligaments to the thoracic paravertebral space by the in-plane technique. After confirming the absence of blood or cerebrospinal fluid, 1–2 ml of 0.3% ropivacaine hydrochloride was injected to confirm that the position of the needle was appropriate, and a pre-determined volume of 0.3% ropivacaine hydrochloride was then administered to the patients. Sensory testing by pinprick was performed every 5 minutes for 30 minutes following the thoracic paravertebral block injection to identify the time segments during which the loss of sensation to the pinprick and its blocking effect occurred. RESULTS: All patients completed the study and 14 (51.8%) had a successful block. CONCLUSION: The EV 50 of 0.3% ropivacaine was 18.46 ml (95% CI 17.09–19.95 ml) and the EV 95 was 20.89 ml.
Keywords: Median effective volume, sequential trial, thoracic paravertebral nerve block, ultrasound-guided, thoracoscopic radical surgery
Abstract: BACKGROUND: Lower respiratory tract infection (LRTI) is a clinical multi-infectious disease caused by viral, bacterial, and other microbial infections. OBJECTIVE: The present study aims to explore the therapeutic effects of high-flow nasal cannula (HFNC) oxygen therapy and its influence on the serum levels of inflammatory factors in senior patients with LRTI. METHODS: In this randomized controlled trial, 84 senior patients with LRTI were enrolled between March 2017 and December 2019 and divided into the observation group and the control group according to the random number table method, with 42 cases in each group.…Conventional nasal cannula (CNC) oxygen therapy was conducted in the control group and HFNC was conducted in the observation group. After 3 days of treatment, sputum properties, sputum volume, sputum viscosity, and sputum crust formation were recorded to determine the clinical efficacy. ELISA was performed to detect the serum levels of tumor necrosis factor alpha (TNF-α ) and interlukein (IL)-8 before and after treatment. RESULTS: The total efficacy in the observation group was 92.86%, which was higher than in the control group (73.81%) (P < 0.05). Three days after treatment, the percentage of grade I sputum in the observation group (73.81%) was higher than in the control group (40.48%). Moreover, the percentage of grade II sputum (23.81%), the percentage of grade III sputum (2.38%), together with the sputum crust formation rate in the observation group (4.76%) were all lower than in the control group (45.24, 14.28, and 26.19%, respectively) (P < 0.05). Three days after treatment, the levels of IL-8 (0.21 ± 0.03 pg/L) and TNF-α (1.27 ± 0.14 ng/L) in the observation group were lower than in the control group (0.30 ± 0.04 pg/L, and 1.49 ± 0.18 ng/L) (t = 6.525, 11.665, 6.252, respectively; P < 0.05). CONCLUSION: The application of HFNC in senior patients with LRTI could improve respiratory humidification, reduce the number of sputum aspirations, and improve anti-inflammatory effects. It is worthy of application in elderly patients with LRTI.
Abstract: BACKGROUND: Arteriosclerosis is one of the diseases that endanger human health. There is a large amount of information in pulse wave signals to reflect the degree of arteriosclerosis. OBJECTIVE: The degree of arteriosclerosis is assessed by analyzing pulse wave signal and calculating multi-scale entropy values. METHODS: A method based on the multiscale cross-approximate entropy of the pulse wave of the human finger is proposed to assess the degree of arteriosclerosis. A total of 86 subjects were divided into three groups. The data of 1000 pulse cycles were selected in the experiment, and the…multiscale cross-approximate entropy was calculated for the climb time and pulse wave peak interval. Independent sample t -test analysis gives the small-scale cross-approximate entropy of the two time series of climb time and pulse wave peak interval as p < 0.001 in Groups 1 and 2. The large-scale cross-approximate entropy of the two time series of climb time and pulse wave peak interval is p < 0.017 in Groups 2 and 3. RESULTS: Using the proposed algorithm, the results showed that the small-scale cross-approximate entropy of climb time and pulse wave peak interval could reflect the degree of arteriosclerosis in the human body from the perspective of autonomic nerve function. The large-scale cross-approximate entropy of climb time and pulse wave peak interval confirmed the effect of diabetes on the degree of arteriosclerosis. CONCLUSIONS: The results demonstrate the multiscale cross-approximate entropy is a comprehensive index to evaluate the degree of human arteriosclerosis.
Abstract: BACKGROUND: Navigation portable applications have largely grown during the last years. However, the majority of them works just for outdoor positioning and routing, due to their architecture based upon Global Positioning System signals. Real-Time Positioning System intended to provide position estimation inside buildings is known as Indoor Positioning System (IPS). OBJECTIVE: This paper presents an IPS implemented as a mobile application that can guide patients and visitors throughout a healthcare premise. METHODS: The proposed system exploits the geolocation capabilities offered by existing navigation frameworks for determining and displaying the user’s position. A hybrid…mobile application architecture has been adopted because it allows to deploy the code to multiple platforms, simplifying maintenance and upgrading. RESULTS: The developed application features two different working modes for on-site and off-site navigation, which offer both the possibility of actual navigation within the hospital, or planning a route from a list of available starting points to the desired target, without being within the navigable area. Tests have been conducted to evaluate the performance and the accuracy of the system. CONCLUSION: The proposed application aims to overcome the limitations of Global Navigation Satellite System by using magnetic fingerprinting in combination with sensor fusion simultaneously. This prevents to rely on a single technology, reducing possible system failures and increasing the scalability.
Keywords: Indoor Positioning System, RTLS, wayfinding, sensor fusion, health care
Abstract: BACKGROUND: Patient-individualised anatomic alignment in total knee arthroplasty (TKA) requires exact positioning of the tibial and femoral components. Patient-specific instrumentation (PSI) may be advantageous for implantation. However, the role of PSI in the instrumentation of such knee designs has not been investigated. OBJECTIVE: The aim of this study was to investigate the accuracy of a PSI system designed for patient-individualised anatomic alignment. METHODS: Fifty-four patients from a single centre were consecutively enrolled in this study. Patient-specific femoral and tibial cutting guides were manufactured using 3D models from computed tomography (CT) scans. All patients…received an anatomic TKA implant design through an extension gap first technique. Postoperative radiography was taken, and implant component alignment and leg alignment were compared to the preoperative planning. RESULTS: Thirty-four patients were evaluable. Mean differences between planned angles values obtained from CT scans and the measured radiographic values were small and not significantly different from zero. CONCLUSIONS: Implantation of an anatomic knee design that allows individual component alignment using PSI is feasible. The percentage of component misalignment in the coronal plane was remarkably low. Whether this leads to clinical benefits requires further verification.
Keywords: Total knee arthroplasty, patient-specific instrumentation, anatomic alignment, surgical technique