Biomedical Technology

Nitinol (Nickel Titanium Naval Ordinance Laboratory), an alloy containing an almost equal mixture of nickel and titanium, was invented in the late 1960s. For many years, it was considered a ''solution in search of a problem.'' It has generated interest in the medical device world only in the past decade, when it became a key component of several revolutionary medical devices including vascular stents, tools, and grafts.

BACKGROUND AND RELATED WORK Department of Veterans Affairs  Polytrauma Centers The signature injuries of soldiers returning from Afghanistan and Iraq are polytrauma and TBI [5-6]. In the majority of Department of Veterans Affairs (VA) clinical cases, polytrauma and TBI are caused by blast injuries from improvised explosive devices, although TBI also results from noncombat events such as motor vehicle accidents. Polytrauma is defined as injuries to two or more body systems from one event. An extreme example would be injuries that simultaneously result in limb amputation, TBI, burns, deafness, and blindness, with long-term physical and cognitive impairments and functional disabilities.

Physicians are currently presented with very difficult ethical issues regarding who receives what level of medical care and for how long. A meaningful response to these perplexing issues necessitates a collaboration of doctors with others steeped in religious and ethical traditions. This paper addresses the complicated issue of the rationing of health care, and this issue is then addressed by responses from representatives of the religious community. This symposium took place at the New York Hospital--Cornell Medical Center in March 1991.

To establish the relative effectiveness and cost of providing a home-based exercise programme versus home-based exercise supplemented with an 8-week class-based exercise programme. The trial was a pragmatic, single-blind randomised clinical trial accompanied by a full economic evaluation. Patients were randomly allocated to either home-based exercise or home exercise supplemented with class exercise programmes. A total of 214 patients, meeting the American College of Rheumatology's classification of knee osteoarthritis, were selected from referrals from the primary and secondary care settings. Both groups were given a home exercise programme aimed at increasing lower limb strength, and endurance, and improving balance. The supplemented group also attended 8 weeks of twice-weekly knee classes run by a physiotherapist. Classes represented typical knee class provision in the UK. Assessments of locomotor function, using a timed score of three locomotor activities, walking pain and s...

Telemedicine is used more and more frequently worldwide. It is increasingly popular in North America, Australia, South Africa, as well as the Scandinavian countries. However, it is not commonly used in Hungary despite various attempts, which is presumably due to earlier dismissive governmental attitude. In this paper the authors analyze ethical, legal and financial aspects of telemedicine from the viewpoints of physicians and patients, too. The results indicate that it cannot be clearly decided whether telemedicine is worth to apply at present. Further, introduction of telemedicine should be based on experience gained in local application. Orv. Hetil., 2013, 154, 1167–1171.

Health technology forecasting is designed to provide reliable predictions about costs, utilization, diffusion, and other market realities before the technologies enter routine clinical use. In this article we address three questions central to forecasting's usefulness: Are early forecasts sufficiently accurate to help providers acquire the most promising technology and payers to set effective coverage policies? What variables contribute to inaccurate forecasts? How can forecasters manage the variables to improve accuracy? We analyzed forecasts published between 2007 and 2010 by the ECRI Institute on four technologies: single-room proton beam radiation therapy for various cancers; digital breast tomosynthesis imaging technology for breast cancer screening; transcatheter aortic valve replacement for serious heart valve disease; and minimally invasive robot-assisted surgery for various cancers. We then examined revised ECRI forecasts published in 2013 (digital breast tomosynthesis)...

Military operations, mass casualty events, and remote work sites present unique challenges to providers of immediate medical care, who may lack the necessary skills for optimal clinical management. Moreover, the number of patients in these scenarios may overwhelm available health care resources. Recent applications of closed-loop control (CLC) techniques to critical care medicine may offer possible solutions for such environments. Here, feedback of a monitored variable or group of variables is used to control the state or output of a dynamic system. Some potential advantages of CLC in patient management include limiting task saturation when there is simultaneous demand for cognitive and active clinical intervention, improving quality of care through optimization of the titration of medications, conserving limited consumable supplies, preventing secondary insults in traumatic brain injury, shortening the duration of mechanical ventilation, and achieving appropriate goal-directed resuscitation. The uses of CLC systems in critical care medicine have been increasingly explored across a wide range of therapeutic modalities. This review will provide an overview of control system theory as applied to critical care medicine that must be considered in the design of autonomous CLC systems, and introduce a number of clinical applications under development in the context of deployment of such applications to austere environments.

To ensure rapid access to new potentially beneficial health technologies, obtain best value for money, and ensure affordability, healthcare payers are adopting a range of innovative reimbursement approaches that may be called Managed Entry Agreements (MEAs). The Health Technology Assessment International (HTAi) Policy Forum sought to identify why MEAs might be used, issues associated with implementation and develop principles for their use. A 2-day deliberative workshop discussed key papers, members' experiences, and collectively addressed four policy questions that resulted in this study. MEAs are used to give access to new technologies where traditional reimbursement is deemed inappropriate. Three different forms of MEAs have been identified: management of budget impact, management of uncertainty relating to clinical and/or cost-effectiveness, and management of utilization to optimize performance. The rationale for using these approaches and their advantages and disadvantages ...

There have been calls in recent years for greater public involvement in health technology assessment (HTA). Yet the concept of public involvement is poorly articulated and little attention has been paid to the context of HTA agencies. This article investigates how public involvement is conceptualized in the HTA agency environment. Using qualitative concept analysis methods, we reviewed the HTA literature and the websites of HTA agencies and conducted semi-structured interviews with informants in Canada, Denmark, and the United Kingdom. Our analysis reveals that HTA agencies' role as bridges or boundary organizations situated at the frontier of research and policymaking causes the agencies to struggle with the idea of public involvement. The HTA community is concerned with conceptualizing public involvement in such a way as to meet scientific and methodological standards without neglecting its responsibilities to healthcare policymakers. We offer a conceptual tool for analyzing the nature of public involvement across agencies, characterizing different domains, levels of involvement, and types of publics.

Typhoid fever is a systemic infection caused by the bacterium Salmonella enterica subspecies enterica serotype typhi, a foremost public health predicament in developing countries. This study investigated hepatotoxicological changes associated with Salmonella typhi infection in Wistar rats and the potential of ethanol root extract of Millettia aboensis (EREMA) to reverse these changes. 51 animals were divided into six groups: group 1 was normal control with no treatment but were given feed and water ad libitum, group 2 was infected with Salmonella typhi without treatment (negative control), group 3, 4 and 5 were Salmonella typhi infected and treated with 100mg/kg, 200mg/kg and 400mg/kg of the extract respectively, and group 6 was infected and treated with 7.14mg/kg of ciprofloxacin. The animals were inoculated with a single infectious dose of Salmonella typhi bacterium (2.0 x 10 8 cfu/ml) and were subsequently treated with the graded doses of the extract and 7.14mg/kg of ciprofloxacin for a period of fifteen days. The rats were humanely sacrificed using diethyl ether anesthesia and blood samples taken for liver function investigation including [aspartate aminotransferase (AST) alanine aminotransferase (ALT), alkaline phosphatase (ALP), total bilirubin (TB), Albumin, conjugate bilirubin (CB) and total protein (TP)] and liver harvested and processed for histological assessment. Inoculation with S. typhi caused significant increase in all the liver function parameters and different degrees of damages to the liver cells. These were all reversed on treatment with ethanol root extract of Millettia aboensis. Thus the extract exhibited both anti-Salmonella typhi as well as hepato-curative potentials on the Kuffer cells.

Objective: To investigate stakeholder involvement by Health Technology Assessment Organisations (HTAOs) in France, Spain, England and Wales, Germany, Sweden, and The Netherlands and to examine whether this involvement depends on (i) the administrative tradition and the relevant conception of the relationship between state and society (contractarian and corporative vs. organic), (ii) the general structure of the healthcare system (HCS) (Bismarckian vs. Beveridgian system), and (iii) the role of Health Technology Assessment (HTA) and HTAOs in the HCS. Methods: Given the exploratory nature of the study, we considered interviews based on semi-structured questionnaires the most appropriate data-gathering technique. The interviews were administered to 16 key personnel in the HTAOs concerned. We have also carried out a literature review on HTAOs and stakeholders (1999-2011) using PubMed, Ebsco, JSTOR and Wiley Science. Results: In contractarian and (to a lesser extent) Bismarckian models, stakeholders are more involved. The administrative tradition and the HCS appear less important when the HTA is binding and used for regulatory purposes. In such situations, stakeholders are more intensively involved because their participation provides an opportunity for HTAOs to achieve consensus and legitimacy in advance. Conclusions: Despite the limitations of the research (we did not conduct multiple interviews for each HTAO, and key informants were not always available) and its exploratory nature, we can conclude that models of stakeholders involvement cannot easily be transferred from one country to another due to the importance of national administrative traditions and the characteristics of HCSs.

Public procurement is generally an important sector of the economy and, in most countries, is controlled by the introduction of regulatory and policy mechanisms. In the Greek healthcare sector, recent legislation redefined centralized procurement through the reestablishment of a state Health Procurement Committee (EPY), with an aim to formulate a plan to reduce procurement costs of medical devices and pharmaceuticals, improve payment time, make uniform medical requests, transfer redundant materials from one hospital to another and improve management of expired products. The efforts described in this paper began in early 2010, under the co-ordination of the Ministry of Health (MoH) and with the collaboration of senior staff from the International Monetary Fund (IMF), the European Commission (EC) and the European Central Bank (ECB). The procurement practices and policies set forth by EPY and the first measurable outcomes, in terms of cost savings, resulting from these policies are presented. The importance of these measures is discussed in light of the worst economic crisis faced by Greece since the restoration of democracy in 1974, as a result of both the world financial crisis and uncontrolled government spending.

Diffusion of innovation Thailand UTAUT model a b s t r a c t Background: One of the most important factors for the success of health information technology (IT) implementation is users' acceptance and use of that technology. Thailand has implemented the national universal healthcare program and has been restructuring the country's health IT system to support it. However, there is no national data available regarding the acceptance and use of health IT in many healthcare facilities, including community health centers (CHCs). This study employed a modified Unified Theory of Acceptance and Use of Technology (UTAUT) structural model, to understand factors that influence health IT adoption in community health centers in Thailand and to validate this extant IT adoption model in a developing country health care context.

The coexistence of technology and caring is best exemplified in nursing. The theory of Technological Competency as Caring in Nursing illuminates this coexistence as the essence of technology in health care premised on machine technologies as a generic concept of objects or things that are mechanical, organic, and electronic. With its timely development these technologies are continually imbued with artificial general intelligence. As such, the ultimate expression of machine technologies in nursing turns out to be autonomous robots (ARs) with future potentials of functions comparable to human persons. While theory-based nursing practice is essential to nursing care practice, quality human care, particularly with technologies assuming indispensable practice process mechanisms is critical. Some practice-based questions informing ARs and human person engagements in nursing care practice include, "Will ARs which are imbued with artificial intelligence replace nurses in their practice?" "What contributions to quality human health care will autonomous and artificially intelligent robots provide?" While these questions may reflect far-reaching ramifications of technologies in health care, it must also be acknowledged that these technologies are fundamental to the delivery of quality human health care now, and in the future.

The acquisition of a range of diverse clinical skills is a central feature of the pre-registration nursing curriculum. Prior to exposure to clinical practice, it is essential that learners have the opportunity to practise and develop such skills in a safe and controlled environment under the direction and supervision of clinical experts. However, the competing demands of the HE nursing curriculum coupled with an increased number of learners have resulted in a reduced emphasis on traditional apprenticeship learning. This paper presents an alternative model for clinical skills teaching that draws upon the principles of cognitive apprenticeship [Collins, A., Brown, J.S., Newman, S., 1989. Cognitive Apprenticeship: teaching the crafts of reading, writing and mathematics. In: Resnick, L.B. (Ed.) Knowing. Learning and Instruction: Essays in Honor of Robert Glaser. Lawrence Erlbaum Associates, New Jersey, pp. 453-494] and situated cognition within a technologically rich and authentic learning environment. It will show how high quality DVD materials illustrating clinical skills performed by expert practitioners have been produced and used in conjunction with CCTV and digital recording technologies to support learning within a pedagogic framework appropriate to skills acquisition. It is argued that this model not only better prepares the student for the time they will spend in the practice setting, but also lays the foundation for the development of a clinically competent practitioner with the requisite physical and cognitive skills who is fit for purpose [UKCC, 1999. Fitness for Practice: The UKCC Commission for Nursing and Midwifery Education. United Kingdom Central Council for Nursing Midwifery and Health Visiting, London].

Physics in therapy is as diverse as it is substantial. In this review, we highlight the role of physics-occasionally transitioning into engineering-through discussion of several established and emerging treatments. We specifi cally address minimal access surgery, ultrasound, photonics, and interventional MRI, identifying areas in which complementarity is being exploited. We also discuss some of the fundamental physical principles involved in the application of each treatment to medical practice.

The field of biomaterials has become a vital area, as these materials can enhance the quality and longevity of human life. Metallic materials are often used as biomaterials to replace structural components of the human body. Stainless steels, cobalt-chromium alloys, commercially pure titanium and its alloys are typical metallic biomaterials that are being used for implant devices. Stainless steels have been widely used as biomaterials because of their very low cost as compared to other metallic materials, good mechanical and corrosion resistant properties and adequate biocompatibility. However, the adverse effects of nickel ions being released into the human body have promoted the development of "nickel-free nitrogen containing austenitic stainless steels" for medical applications. Nitrogen not only replaces nickel for austenitic structure stability but also much improves steel properties. Here we review the harmful effects associated with nickel and emphatically the advantages of nitrogen in stainless steel, as well as the development of nickel-free nitrogen containing stainless steels for medical applications. By combining the benefits of stable austenitic structure, high strength, better corrosion and wear resistance and superior biocompatibility in comparison to the currently used austenitic stainless steel (e.g. 316L), the newly developed nickel-free high nitrogen austenitic stainless steel is a reliable substitute for the conventionally used medical stainless steels.

The discovery of DNA paternity tests has stirred a debate concerning the definition of paternity and whether the grounds for such a definition are legal or biological. According to the classical rules of Islamic law, paternity is established and negated on the basis of a valid marriage. Modern biomedical technology raises the question of whether paternity tests can be the sole basis for paternity, even independently of marriage. Although on the surface this technology seems to challenge the authority of Islamic law in this area, the paper argues that classical Islamic rulings pertaining to paternity issues continue to hold higher authority even in cases of conflict with modern technology-based alternatives. Through closer analysis, the paper traces the emergence of a differentiation in the function of DNA tests between identity and paternity verification. While the former is accepted without reservation, the latter is approved only when it does not violate the rulings of Islamic law.

The purpose of this article is to present a taxonomy for telemedicine. The field has markedly grown, with an increasing number of applications, a variety of technologies, and newly introduced terminology. A taxonomy would serve to bring conceptual clarity to this burgeoning set of alternatives to in-person healthcare delivery. The article starts with a brief discussion of the importance of taxonomy as an information management strategy to improve knowledge sharing, facilitate research and policy initiatives, and provide some guidance for the orderly development of telemedicine. We provide a conceptual context for the proliferation of related concepts, such as telehealth, e-health, and m-health, as well as a classification of the content of these concepts. Our main concern is to develop an explicit taxonomy of telemedicine and to demonstrate how it can be used to provide definitive information about the true effects of telemedicine in terms of cost, quality, and access. Taxonomy development and refinement is an iterative process. If this initial attempt at classification proves useful, subject matter experts could enhance the development and proliferation of telemedicine by testing, revising, and verifying this taxonomy.

The presence of reactive primary amines in the backbone structure of chitosan, enables the derivatisation with different functional groups and thereby improving and expanding its properties, such as solubility and mucoadhesiveness, for biomedical applications. Such derivatives can be exploited with good results in a number of biomedical areas, including enhancement of nucleic acid transfection in gene therapy, as well as many other applications aiming to maximize drug delivery and aiding tissue engineering. The aim of this review is to provide an up to date overview of the methods used for derivatizing the chitosan with amino acids and to discuss the characteristics and potential biomedical application of the different amino acid derivatized chitosans described in the literature.

Recent days Computer-aided design and image processing techniques are one of the most emerging useful tools for analysis of models in various medical, industrial and research areas. In medical field for the diagnosis of various diseases in vivo techniques including biochemical test, enzymatic tests are needed for continuous monitoring of patients. These diagnosis procedures are time consuming and inconvenient for patients. Therefore Computer assisted designing and image processing techniques are most promising non invasive tools for faster diagnosis and useful tool for designing of biomedical implants. In this paper portal vein was segmented from patient’s Liver computed tomography (CT) image by dedicated software. A Liver’s CT image of 38 year old Indian male patient’s was collected and by using imaged based software MIMICS (Materialise’s Interactive Medical Image Control System, Belgium) 3D model of HPV (hepatic portal vein) was obtained and Solid Work Professional (Dassault Systems Solid Works Corporation, USA) software was used for designing of normal portal vein’s 3D model and various portal vein diseased models including minor right portal vein thrombosis ( 19-20% reduction in medial region of vein), severe right portal vein thrombosis (20-22% reduction in medial and distal region of vein), minor left portal vein thrombosis (19-20% reduction in medial region of vein, severe right portal vein
thrombosis(20-22% reduction in medial and distal region of vein), left aneurysm (150-200 % increase of medial region).These models can be used for designing for implants and analysis of portal vein’s disorder like portal thrombosis, and portal aneurysm which are main cause of portal hypertension and also useful for surgeon for planning surgery and also helpful for understanding of portal vein hemodynamic (pressure, velocity, wall shear force)

The paper reports on a symposium on sports helmets and presents a synthesis of information and opinion from a range of presenters and disciplines. A review of the literature shows that helmets play an important role in head injury prevention and control. Helmets have been shown to be very effi cacious and effective in a range of sports and in preventing specifi c head injury risks, especially moderate to severe head injury. The symposium emphasised the importance of helmet standards and the need for further development. There are calls for helmets that address the needs of competitive (elite) athletes separate to helmets for recreational athletes. Defi ciencies in the evidence base for head injury risks and helmet efficacy and effectiveness were identifi ed in some sports. Issues in designing helmets that are suitable to prevent severe head injuries and concussion were discussed and explained from biomechanical and engineering perspectives. The need to evaluate helmet performance in oblique impacts and incorporate this into standards was covered in a number of presentations. There are emerging opportunities with in-helmet technology to improve impact performance or to measure impact exposure. In-helmet technology as it matures may provide critical information on the severity of the impact, the location of the injured athlete, for example, snowboarder, and assist in the retrieval and immediate, as well as the long-term medical management of the athlete. It was identifi ed that athletes, families and sports organisations can benefi t from access to information on helmet performance. The importance of selecting the appropriate-sized helmet and ensuring that the helmet and visor were adjusted and restrained optimally was emphasised. The translation pathway from the science to new and better helmets is the development of appropriate helmet standards and the requirement for only helmets to be used that are certifi ed to those standards.

Resumen-El sistema de salud moderno confía en los dispositivos y equipos médicos para brindar mayor calidad y mejor servicio a los pacientes. El cuidado proporcionado por los entes prestadores de servicios de salud, como clínicas y hospitales, depende de esta tecnología, mejorar y optimizar los servicios de atención y tratamiento de la salud de los pacientes. Por lo anterior, es muy importante contar con una persona capacitada que pueda proporcionar con eficacia un plan para la adquisición, mantenimiento y reemplazo de estos equipos médicos, y además, que esté en condiciones de optimizar la relación costo/beneficio en la institución. El ingeniero clínico es aquella persona capaz de desarrollar el plan de adquisición que beneficiará, no sólo a la institución prestadora de servicios de salud, sino también al paciente y al personal médico. Este artículo busca brindar, tanto al personal administrativo como al clínico, unas pautas básicas sobre el proceso de adquisición de la tecnología biomédica.

The pediatric complex chronic conditions (CCC) classification system, developed in 2000, requires revision to accommodate the International Classification of Disease 10th Revision (ICD-10). To update the CCC classification system, we incorporated ICD-9 diagnostic codes that had been either omitted or incorrectly specified in the original system, and then translated between ICD-9 and ICD-10 using General Equivalence Mappings (GEMs). We further reviewed all codes in the ICD-9 and ICD-10 systems to include both diagnostic and procedural codes indicative of technology dependence or organ transplantation. We applied the provisional CCC version 2 (v2) system to death certificate information and 2 databases of health utilization, reviewed the resulting CCC classifications, and corrected any misclassifications. Finally, we evaluated performance of the CCC v2 system by assessing: 1) the stability of the system between ICD-9 and ICD-10 codes using data which included both ICD-9 codes and ICD-...