Technology and Health Care - Volume 20, issue 1

Authors: Galen, Sujay | Wiggins, Laura | McWilliam, Robert | Granat, Malcolm

Article Type: Research Article

Abstract: Background: Among the ambulant population of children with spastic cerebral palsy (CP), dynamic equinus is one of the most common form of gait deviation that is encountered. Objective: To investigate the combined effects of Functional Electrical Stimulation (FES) and Botulinum Toxin A (BTXA) therapy in children with spastic CP, and to demonstrate the feasibility of this combination therapy. Methods: A single-subject design with repeated measures was adopted. Eight children (six males, two females; mean age 7 y 9 mo, SD 1 y 5 mo; range 7 y to 11 y) diagnosed with hemiplegic (n=6) …or diplegic (n=2) spastic CP completed the study. Each subject participated in the study for twenty weeks. This period consisted of baseline (one week), BTXA phase (three weeks), first FES phase (four weeks), first control phase (four weeks), second FES phase (four weeks) and second control phase (four weeks). Subjects were assessed at the end of each phase. The ankle angle at the end of swing phase was selected as the primary outcome measure. The secondary outcome measure recorded was the foot contact pattern. Results: There was an increase in ankle dorsiflexion at the end of the combined intervention in most subjects (n=6), accompanied by an improvement in foot contact pattern. Conclusions: This pilot study demonstrated that it is feasible to combine BTXA therapy with FES in ambulant children with spastic CP. Show more

Keywords: Functional electrical stimulation, botulium toxin a therapy, cerebral palsy, dynamic equinus

DOI: 10.3233/THC-2011-0648

Citation: Technology and Health Care, vol. 20, no. 1, pp. 1-9, 2012

Authors: van Hoof, J. | Westerlaken, A.C. | Aarts, M.P.J. | Wouters, E.J.M. | Schoutens, A.M.C. | Sinoo, M.M. | Aries, M.B.C.

Article Type: Research Article

Abstract: Light therapy is increasingly administered and studied as a non-pharmacologic treatment for a variety of health-related problems, including treatment of people with dementia. Light therapy comes in a variety of ways, ranging from being exposed to daylight, to being exposed to light emitted by light boxes and ambient bright light. Light therapy is an area in medicine where medical sciences meet the realms of physics, engineering and technology. Therefore, it is paramount that attention is paid in the methodology of studies to the technical aspects in their full breadth. This paper provides an extensive introduction for non-technical researchers on how …to describe and adjust their methodology when involved in lighting therapy research. A specific focus in this manuscript is on ambient bright light, as it is an emerging field within the domain of light therapy. The paper deals with how to (i) describe the lighting equipment, (ii) describe the light measurements, (iii) describe the building and interaction with daylight. Moreover, attention is paid to the uncertainty in standards and guidelines regarding light and lighting for older adults. Show more

Keywords: Methodology, colour temperature, lighting, ambient bright light, illuminance, dementia

DOI: 10.3233/THC-2011-0650

Citation: Technology and Health Care, vol. 20, no. 1, pp. 11-23, 2012

Authors: Greiner, K. Allen | Geana, Mugur V. | Epp, Aaron | Watson, Angela | Filippi, Melissa | Daley, Christine Makosky | Engelman, Kimberly K. | James, Aimee S. | Campbell, Marci

Article Type: Research Article

Abstract: Objective: The aim of this exploratory study was to assess factors deemed by patients as “important” as they planned and considered undergoing colorectal cancer (CRC) screening, and to use this data to design a computer-delivered intervention to promote screening. Methods: Fifty participants 50 years or older, not up-to-date with current recommended CRC screening guidelines, were recruited from a primary care clinic. A semi-structured interview focused on aspects of preparing for colorectal cancer screening was administered; after transcription, researchers used triangulation and consensus to identify relevant themes and concepts. Results: Four main themes were identified …that dealt with issues important for both FOBT and colonoscopy planning: personal concerns, reminders, communication with healthcare providers and obtaining test results. FOBT specific themes included: sample collection and return. For colonoscopy screening, themes included: scheduling, intervention questions, colonoscopy preparation, and transportation. These can be classified as barrier, process and accessory themes. The developed computer-administered implementation intentions algorithm addressed all the identified concerns in a planned and sequential manner, in order to facilitate planning for CRC screening. Conclusions: The results of this study suggest that appropriate reminders, explanations of procedures, and patient understanding of temporary life disruptions, help patients develop and accept a detailed screening plan. Show more

Keywords: Colorectal cancer screening, FOBT, colonoscopy, implementation intentions, computer intervention, underserved populations

DOI: 10.3233/THC-2011-0653

Citation: Technology and Health Care, vol. 20, no. 1, pp. 25-35, 2012

Authors: Kaffarnik, Magnus Friedrich | Urban, Max | Hopt, Ulrich Theodor | Utzolino, Stefan

Article Type: Research Article

Abstract: Introduction and methods: The role of enterococcus in intraabdominal infection remains controversial. A retrospective study of 473 patients with bowel perforation was conducted to assess the impact of enterococci on outcome of patients with perforation of the small and large bowel. Results: The overall mean age was 61.4 with a gender ratio of 60/40 (m/f). We detected enterococci in 54% of all patients. In the group of enterococci-positive patients, we found Enterococcus faecalis (E. faecalis) in over 70% and Enterococcus faecium (E. faecium) in over 50%. Those in whom we detected enterococci (Pos) had a higher 90-day …mortality rate than patients who were enterococci negative (Neg) (29.7%/19.4%, P 0.007). Morbidity, length of stay in intensive care unit (ICU-LOS) and length of stay in hospital (hospital-LOS) were significantly higher in the Pos group. The subgroup of Pos who received specific antimicrobial therapy against these species (Pos-treated) had a higher 90-day mortality rate than the subgroup without specific therapy (Pos-not treated) (35.5%/23.3%, P 0.04). The Pos-not treated group had higher morbidity, ICU-LOS and hospital-LOS than the Neg group. The mortality rate, ICU-LOS and hospital-LOS of immunosuppressed patients (12%) were significantly higher compared with patients not on immunosuppression with similar morbidity. We found a higher rate of E. faecium than in other studies (55.1%). However, we observed no difference in mortality and morbidity between patients infected with E. faecalis and E. faecium. In multivariate analysis, detection of enterococci did not influence mortality. Significant risk factors were age, immunosuppression, specific antimicrobial therapy and anastomotic leakage. Conclusion: Enterococci seem to play a minor role in uncomplicated intraabdominal infections. Our results suggest that enterococci play a role in the severity of postoperative complications. In particular, detection of enterococci in patients with anastomotic leakage are suggested to be an indicator of severe illness. We found significantly higher rates of E. faecium than described before, but no significant differences in clinical outcome between E. faecalis and E. faecium. When empirical therapy against enterococci is recommended, E. faecalis and E. faecium should both be covered. Show more

Keywords: Enterococcus, bowel perforation, immunosuppression, postoperative complications

DOI: 10.3233/THC-2011-0654

Citation: Technology and Health Care, vol. 20, no. 1, pp. 37-48, 2012

Authors: Mommsen, Philipp | Bradt, Nikolas | Zeckey, Christian | Andruszkow, Hagen | Petri, Max | Frink, Michael | Hildebrand, Frank | Krettek, Christian | Probst, Christian

Article Type: Research Article

Abstract: Background: In consideration of rising cost pressure in the German health care system, the usefulness of helicopter emergency medical service (HEMS) in terms of time- and cost-effectiveness is controversially discussed. The aim of the present study was to investigate whether HEMS is associated with significantly decreased arrival and transportation times compared to ground EMS. Methods: In a retrospective study, we evaluated 1,548 primary emergency missions for time sensitive diagnoses (multiple trauma, traumatic brain and burn injury, heart-attack, stroke, and pediatric emergency) performed by a German HEMS using the medical database, NADIN, of the German Air Rescue Service. …Arrival and transportation times were compared to calculated ground EMS times. Results: HEMS showed significantly reduced arrival times at the scene in case of heart-attack, stroke and pediatric emergencies. In contrast, HEMS and ground EMS showed comparable arrival times in patients with multiple trauma, traumatic brain and burn injury due to an increased flight distance. HEMS showed a significantly decreased transportation time to the closest centre capable of specialist care in all diagnosis groups (p < 0.001). Conclusions: The results of the present study indicate the time-effectiveness of German air ambulance services with significantly decreased transportation times. Show more

Keywords: Emergency medical service, air rescue, ground ambulance, mission times, time sensitive diagnosis

DOI: 10.3233/THC-2011-0655

Citation: Technology and Health Care, vol. 20, no. 1, pp. 49-56, 2012

Authors: Hawi, Nael | Liodakis, Emmanouil | O'Loughlin, Padhraig F. | Kabbani, Abdul-Rahman | Stüber, Volker | Petri, Max | Stübig, Timo | Krettek, Christian | Citak, Musa

Article Type: Research Article

Abstract: Rotational malalignment following intramedullary nailing is a well-recognised problem. The threshold for clinically relevant malrotation has been established to be in the region of 15° whereas the incidence of significant malrotation following femoral nailing ranges from 22 to 43 percent. Many studies have been performed to address this issue with the major challenge acknowledged to be intraoperative control of femoral anteversion. In the current study, the investigators developed and analysed a novel method to estimate the femoral antetorsion based on computed tomography (CT) data. They hypothesized that this method would be intra-operatively feasible and repeatable without further radiation. …CT scans (n=166) of femoral neck fractures performed between 2005 and 2010 were evaluated. Twenty patients had a femoral neck fracture and thus were excluded. Every femoral neck was measured according the method described by Jend et al. and the current authors. In contrast to the Jend method, the current authors described femoral antetorsion as the angle between the ventral cortex of the femoral neck and the posterior condylar line. To determine this angle, the axial cuts from computed tomography data were studied. In order to maximise measurement consistencty among cases, the axial cut which displayed the intertrochanteric crest was selected. Mean femoral antetorsion is 12.15°± 10.04° according to Jend et al. In comparison, a mean angle of 12.61°± 11.16° was demonstrated in the current study. The absolute difference in measuring the femoral neck angle when these different methods are compared was 4.44°. Statistically, there is no significant difference between the mean results for femoral antetorsion. The advantage of the method proposed in the current study, is the opportunity to enter the ventral femoral cortex during the surgical procedure without disturbing the process of femoral nailing. Thus, the surgeon can avail of continuous control of femoral rotation intra-operatively. Show more

Keywords: Femoral antetorsion, rotational malalignment, femoral shaft fractures, intramedullary nailing

DOI: 10.3233/THC-2011-0651

Citation: Technology and Health Care, vol. 20, no. 1, pp. 57-63, 2012

Authors: Hawi, Nael | Haentjes, Jonas | Suero, Eduardo M. | Liodakis, Emmanouil | Krettek, Christian | Stübig, Timo | Hüfner, Tobias | Citak, Musa

Article Type: Research Article

Abstract: Femoral malrotation is a common complication after internal fixation of a femoral shaft fracture. The only valid, objective monitoring method is computer tomography-assisted torsion measurement between the proximal and distal femur; unfortunately, this can only be carried out postoperatively. A difference of 15° compared to the contralateral femur is seen as an indication for revision. With the development of computer-assisted surgery, new possibilities for performing torsion control and correction intraoperatively has been introduced. These methods also allow for navigation-assisted definition of the optimal incision site, intramedullary access, femoral nail and interlocking. The main problem lies in the extra time of …surgery, which is due to performing all the steps of the surgery navigated. The solution for this problem is “hybrid navigation”, in which the surgeon can select the steps he needs from the navigation system, depending on his experience or surgical technique. Show more

Keywords: Femur shaft fracture, antetorsion, fracture reduction, internal fixation, CAS, computer navigation

DOI: 10.3233/THC-2011-0652

Citation: Technology and Health Care, vol. 20, no. 1, pp. 65-71, 2012