Technology and health care : official journal of the European Society for Engineering and Medicine
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Technol Health Care · Jan 2012
Impact of enterococcus on immunocompetent and immunosuppressed patients with perforation of the small or large bowel.
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. ⋯ 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.
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Technol Health Care · Jan 2012
ReviewOn the efficiency of FES cycling: a framework and systematic review.
Research and development in the art of cycling using functional electrical stimulation (FES) of the paralysed leg muscles has been going on for around thirty years. A range of physiological benefits has been observed in clinical studies but an outstanding problem with FES-cycling is that efficiency and power output are very low. The present work had the following aims: (i) to provide a tutorial introduction to a novel framework and methods of estimation of metabolic efficiency using example data sets, and to propose benchmark measures for evaluating FES-cycling performance; (ii) to systematically review the literature pertaining specifically to the metabolic efficiency of FES-cycling, to analyse the observations and possible explanations for the low efficiency, and to pose hypotheses for future studies which aim to improve performance. ⋯ Performance assessments should be carried out at a well-defined operating point, i.e. under conditions of well controlled work rate and cadence, because these variables have a strong effect on energy expenditure. Future work should focus on the two main factors which affect FES-cycling performance, namely: (i) unfavourable biomechanics, i.e. crude recruitment of muscle groups, non-optimal timing of muscle activation, and lack of synergistic and antagonistic joint control; (ii) non-physiological recruitment of muscle fibres, i.e. mixed recruitment of fibres of different type and deterministic constant-frequency stimulation. We hypothesise that the following areas may bring better FES-cycling performance: (i) study of alternative stimulation strategies for muscle activation including irregular stimulation patterns (e.g. doublets, triplets, stochastic patterns) and variable frequency stimulation trains, where it appears that increasing frequency over time may be profitable; (ii) study of better timing parameters for the stimulated muscle groups, and addition of more muscle groups: this path may be approached using EMG studies and constrained numerical optimisation employing dynamic models; (iii) development of optimal stimulation protocols for muscle reconditioning and FES-cycle training.
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Technol Health Care · Jan 2012
ReviewPrevention and diagnosis of retained foreign bodies through the years: past, present, and future technologies.
Post operative retained foreign bodies are a rare but recalcitrant problem. We detail reports of interventions over the last two centuries and review the most current interventions using automated data identity capture and computer aided detection. This was one of earliest areas in which multidisciplinary collaboration was achieved in patient safety. This multidisciplinary collaboration was unique because most other initiatives had been internal: among the disciplines working in the OR i.e. surgeons, nurses and anesthesiologists; this collaboration, to achieve optimal patient safety at that point in time was between surgeons and radiologists to ensure a lack of post operative retained foreign bodies.
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Technol Health Care · Jan 2012
What do patients know about their low back pain? An analysis of the quality of information available on the Internet.
Previous surveys showed a poor quality of the web sites providing health information about low back pain. However, the rapid and continuous evolution of the Internet content may question the current validity of those investigations. The present study is aimed to quantitatively assess the quality of the Internet information about low back pain retrieved with the most commonly employed search engines. ⋯ News web sites were well designed and easy to use, but lacked in validity. The average quality of the hits retrieved by the most commonly employed search engines could be defined as satisfactory and favorably comparable with previous investigations. Awareness of the user about checking the quality of the information remains of concern.
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Technol Health Care · Jan 2012
ReviewMerits and capabilities of helicopter emergency medical service (HEMS) in traumatized patients.
Since the introduction of helicopter emergency medical service (HEMS) into the civilian rescue system, there is an ongoing discussion on its potential benefits in terms of time- and cost-effectiveness as well as clinical outcome improvement. Currently, the use of HEMS seems to provide a survival benefit in traumatized patients due to several aspects compared to ground emergency medical service (GEMS). ⋯ However, these aspects should be considered carefully as specific circumstances referring to rescue teams, on-scene management as well as preclinical durations, triaging of trauma patients and subsequent treatment at different hospitals have to be attended. In the present review current aspects of HEMS compared to GEMS are discussed.