Technology and Health Care - Volume 15, issue 3

Authors: Roback, Kerstin | Gäddlin, Per-Olof | Nelson, Nina | Persson, Jan

Article Type: Research Article

Abstract: Advances in biomedical engineering enable us to treat increasingly severe conditions. This implies an increased need for regulation and priority setting in healthcare, to ensure appropriate safety cautions and to avoid accelerating expenditures. This interview study investigates the mechanisms behind the adoption and use of medical devices through the subjective experiences of hospital staff working with devices for neonatal intensive care. The adoption was found to be primarily initiated by vendor activities, but professionals preferably sought information about functionality from close colleagues. Full integration of devices was sometimes not achieved, and even though the adopting units had good introduction routines, …there was no systematic follow-up of how adopted devices had been integrated in the work practices. Diffusion variations were, however, mainly found for temporarily tested devices and not for permanently available technologies. Three factors were found to be the major explanatory variables of the adoption of medical devices: (1) the subjective expected value of the device, (2) information and learning, and (3) the innovativeness of the adopting unit. Show more

Keywords: Diffusion, innovation, adoption, medical devices, neonatal intensive care, decision-making, healthcare management

DOI: 10.3233/THC-2007-15301

Citation: Technology and Health Care, vol. 15, no. 3, pp. 157-179, 2007

Authors: Cikajlo, Imre | Matjačsić, Zlatko

Article Type: Research Article

Abstract: The proposed approach offers few novelties in integration of objective assessment of postural responses when an unexpected perturbation is applied to the standing person into the existing rehabilitation therapy. The research apparatus was equipped with electrical actuators to provide unexpected perturbations (controllable and repeatable strength and duration) to the standing frame in eight directions during quiet standing in a fall-safe environment. During the perturbations ground reaction forces were recorded under each foot and the motion of center of pressure was derived to extract the postural response indicators in time and space domain. Seven neurologically intact subjects participated in normative set …up that was used to develop an algorithm for selective postural response characteristics analysis for each perturbation direction. The postural responses in two incomplete spinal cord injured persons and hemiparetic stroke patient were investigated and contrasted to the normative responses to test the proposed approach. The outcomes of the investigation showed expected distinctive direction-dependent postural responses characteristic for hemiparetic subjects. Our observations suggest that the approach may become effective in substantial quantitative multidirectional stabilometric evaluation of functional postural responses, especially when the effectiveness of the balance training rehabilitation program is in need for objective evaluation. Simultaneously the apparatus can be used also for the balance training and therefore become a training and assessment tool for clinical and home environment. Show more

Keywords: Postural response, clinical assessment, balance training, center of pressure, neurological rehabilitation

DOI: 10.3233/THC-2007-15302

Citation: Technology and Health Care, vol. 15, no. 3, pp. 181-193, 2007

Authors: Linder-Ganz, E. | Scheinowitz, M. | Yizhar, Z. | Margulies, S.S. | Gefen, A.

Article Type: Research Article

Abstract: The clinical practice for minimizing the risk of pressure sores (PS) is to relief pressures under bony prominences of immobilized patients by changing their postures frequently. The US Department of Health advises to relief sitting pressures at least every 1 hour, and every 15 minutes for individuals who are body-abled. Surprisingly, there is paucity of information in the literature concerning motion of healthy subjects during prolonged sitting, which can be compared with these recommendations. Considering that healthy individuals are able to sit for hours without suffering injuries, such information seems particularly important. Accordingly, our objective was to measure frequency of …postural changes and extent of motion during postural changes among healthy subjects who sit in a wheelchair (N=10), in order to provide information that is missing in the literature of PS biomechanics. Subjects were asked to sit comfortably for 90 minutes, during which their trunk's frontal and sagittal motions and sitting pressures were measured. We found that normals change their posture every 9 ± 6 minutes in the sagittal plane, and independently, every 6 ± 2 minutes in the frontal plane. Shoulders, thoracic-spine and lumbar-spine frontal plane motions were 8 ± 4°, 14 ± 7° and 15 ± 7°, respectively, and sagittal trunk-thigh movement was 10.3 ± 7°. The frequency of postural changes in normals, measured herein, was higher than frequencies reported in the literature for patients who suffered PS. This small study population therefore supports the hypothesis that prolonged immobilization contributes to PS onset. Show more

Keywords: Decubitus ulcer prevention, immobilization, posture, pressure sores, rehabilitation

DOI: 10.3233/THC-2007-15303

Citation: Technology and Health Care, vol. 15, no. 3, pp. 195-202, 2007

Authors: Melander-Wikman, A. | Jansson, M. | Hallberg, J. | Mörtberg, C. | Gard, G.

Article Type: Research Article

Abstract: An important factor for health is the possibility to be active and mobile. To make this possible various kinds of support are needed. Integrating geographical information systems technology and user experiences is important in the development of more user-friendly positioning devices. The Lighthouse Alarm and Locator trial aimed to test a new mobile alarm system with additional functionality such as positioning and monitoring of vital signs which can be used regardless of location (in hospital, at home). The system was tested by elderly persons from a pensioner organisation and home care personnel answered up on the alarms. After the tests …qualitative interviews were performed with the two groups. The results showed that their experiences of the new mobile alarm system could be described in three main categories: to be supervised, to feel safe and to be mobile. These categories formed a theme: Positioning – an ethical dilemma. The clients' mobility was perceived to increase. The personnel did not think that positioning was ethical but the clients (elderly) did. Show more

Keywords: Home care, mobility, positioning, safety alarm

DOI: 10.3233/THC-2007-15304

Citation: Technology and Health Care, vol. 15, no. 3, pp. 203-212, 2007

Authors: Uchiyama, Akinori | Nishimura, Masaji | Amata, Mitsuyuki | Mashimo, Takashi | Fujino, Yuji

Article Type: Research Article

Abstract: The aim of the study was to assess a new expiratory support (ES) system in resolving air trapping in the lungs during mechanical ventilation. The ES system consisted of a cylinder and two valves that were connected to the ventilatory circuit. The movements of them were synchronized with the ventilator. The cylinder aspirated gas during expiration. We compared the effects of the ES on air trapping between a narrower and an ordinary size endotracheal tube (ETT) (internal diameter (ID): 5 and 8 mm). In addition, we compared the effects of the ES on air trapping between normal and high airway …resistance of the lungs (5 and 20 cm H2 O/L/s). The ventilatory settings were as follows: volume controlled ventilation with constant inspiratory flow rate; tidal volume, 0.5 L; inspiratory time, 1.0 s; expiratory time, 1.0, 1.5, or 2.0 s; and PEEP, 0 cm H2 O. The ES normalized the end-expiratory alveolar pressure of the 5 mm ID ETT at a level similar to that of the 8 mm ID ETT. The ES also resolved the air trapping induced by the high airway resistance of the lungs. In conclusion, the ES system resolved the air trapping associated with a narrow endotracheal tube and high airway resistance of the lungs. Show more

Keywords: Mechanical ventilation, endotracheal tube, expiratory support, air trapping

DOI: 10.3233/THC-2007-15305

Citation: Technology and Health Care, vol. 15, no. 3, pp. 213-220, 2007

Authors: Kendoff, D. | Meller, R. | Citak, M. | Pearle, A. | Marquardt, S. | Krettek, C. | Hüfner, T.

Article Type: Research Article

Abstract: Restoration of rotational and translational stability is a goal of ACL reconstruction. Intraoperative instability measurements of AP translation and rotation are not well established clinically. We compared navigated measurements of tibial AP translation and rotation with mechanical measuring devices: the KT 1000 and a modified goniometer tool. Tests were repeated with intact and dissected ACLs, and measures of translation and rotation statistically compared. There was no significant difference in AP translation between navigation, 3.2 mm (range 1–6 mm) and the KT 1000, 4.8 mm (range, 4–7 mm) in our experimental set up (p>0.05). Tibial rotation revealed no significant difference, 0.12° …(range, 0°–1°) between navigation and goniometer (p>0.05). Total range of rotation was 4.2° (range, 2°–6°) in intact and 7.05° (range, 4°–9°) in dissected ACLs (p<0.05). Stability parameters in ACL navigation can be measured precisely under laboratory conditions and results are not significantly different from mechanical testing devices. Show more

DOI: 10.3233/THC-2007-15306

Citation: Technology and Health Care, vol. 15, no. 3, pp. 221-230, 2007