[High-tech medical care in surgical endocrinology]

The number of patients with endocrine system diseases increases annually. Widespread introduction of screening programs and improvement of laboratory and instrumental diagnostic is one of the most important causes for this. Treatment of patients with endocrine system diseases within the high-tech medical care leads to perform the unique surgical interventions. It increases survival and patients' life quality.

Digital signal processing by virtual instrumentation of a MEMS magnetic field sensor for biomedical applications

We present a signal processing system with virtual instrumentation of a MEMS sensor to detect magnetic flux density for biomedical applications. This system consists of a magnetic field sensor, electronic components implemented on a printed circuit board (PCB), a data acquisition (DAQ) card, and a virtual instrument. It allows the development of a semi-portable prototype with the capacity to filter small electromagnetic interference signals through digital signal processing. The virtual instrument includes an algorithm to implement different configurations of infinite impulse response (IIR) filters. The PCB contains a precision instrumentation amplifier, a demodulator, a low-pass filter (LPF) and a buffer with operational amplifier. The proposed prototype is used for real-time non-invasive monitoring of magnetic flux density in the thoracic cage of rats. The response of the rat respiratory magnetogram displays a similar behavior as the rat electromyogram (EMG).

Micro HTA as a tool for clinical governance: the experience of the Breast Unit in "Santa Maria" Terni Hospital

The last decade has witnessed the affirmation of the paradigm Health Technology Assessment (HTA) as a tool for government innovation technology in health care. As is known, this is an approach of evaluation oriented policy making that, in addition to provide for the disclosure of its results, it is proposed to consider simultaneously the clinical, economic, organizational, ethical and social issues arising from the introduction or disposal of a health technology, understood in the broadest sense of the term. In order to reconstruct a realistic picture of its level of implementation we have reproduced a micro HTA which served to assess the Harmonic Focus® device usefulness in breast surgery.

How technology in care at home affects patient self-care and self-management: a scoping review

The use of technology in care at home has potential benefits such as improved quality of care. This includes greater focus on the patients’ role in managing their health and increased patient involvement in the care process. The objective of this scoping review is to analyse the existing evidence for effects of technology in home-based care on patients’ self-care and self-management. Using suitable search terms we searched the databases of Pubmed, Embase, Cochrane Library, Cinahl, Picarta and NIVEL dating from 2002 to 2012. Thirty-three studies (six review studies and twenty-seven individual studies) were selected. Effects were extracted from each study and were classified. In almost all the studies, the concepts self-care and self-management are not clearly defined or operationalized. Therefore, based on a meta-analysis, we made a new classification of outcome measures, with hierarchical levels: (1) competence (2) illness-management (3) independence (social participation, autonomy). In general, patient outcomes appear to be positive or promising, but most studies were pilot studies. We did not find strong evidence that technology in care at home has (a positive) effect on patient self-care and self-management according to the above classification. Future research is needed to clarify how technology can be used to maximize its benefits.

A case of successful interaction between cells derived from human ovarian follicular liquid and gelatin cryogel for biotech and medical applications

Significant research efforts have been undertaken in the last decade to develop specific cell-based therapies and, in particular, adult multipotent mesenchymal stem cells (MSCs) hold great promise toward such regenerative strategies. Bio-materials have been widely used in reconstructive bone surgery to heal critical-size bone defects due to trauma, tumor resection, and tissue degeneration. In particular, gelatin cryogel scaffolds are promising new biomaterials owing to their biocompatibility. There is an increasing demand for MSC-based regenerative approaches in the musculoskeletal system. Combining stem cells with biomaterial scaffolds provides a promising strategy for tissue engineering. Our previous studies showed the possibility to obtain MSCs from the human ovarian follicular liquid (FL) that is usually wasted during in vitro fertilization (IVF). In this study, we tested the ability of these FL cells to grow on gelatin cryogel in comparison with MSCs derived from human bone marrow. Samples and controls were analyzed with confocal and scanning electron microscopes. Results demonstrated that FL cells could grow on the biomaterial not only on the top but also in the layers below till 60 µm of deepness. Data suggested that the observed cells were mesenchymal since positive for vimentin and CD-44, typical MSC markers. Successful growth of putative MSCs derived from follicular liquid on 3D gelatin cryogel opens potential developments in biotech and medical applications.

Bridging the gap between the technological singularity and mainstream medicine: highlighting a course on technology and the future of medicine

The "technological singularity" is defined as that putative point in time forecasted to occur in the mid twenty-first century when machines will become smarter than humans, leading humans and machines to merge. It is hypothesized that this event will have a profound influence on medicine and population health. This work describes a new course on Technology and the Future of Medicine developed by a diverse, multi-disciplinary group of faculty members at a Canadian university. The course began as a continuous professional learning course and was later established as a recognized graduate course. We describe the philosophy of the course, the barriers encountered in course development, and some of the idiosyncratic solutions that were developed to overcome these, including the use of YouTube audience retention analytics. We hope that this report might provide a useful template for other institutions attempting to set up similar programs.

Mesoporous silica with fibrous morphology: a multifunctional core-shell platform for biomedical applications

Multifunctional mesoporous silica nanocomposites are attractive carriers for targeted drug delivery in nanomedicine. Although promising developments have been made in the fabrication of multifunctional mesoporous silica nanocomposites, the design and mass production of novel multifunctional carriers are still challenging. This paper reports the facile one-pot fabrication of a multifunctional inorganic composite composed of superparamagnetic Fe3O4 nanoparticles and coated dye-functionalized mesoporous silica with a high specific surface area. The resulting composite particles had a tunable particle size, special open pore channels with high specific surface area, which is quite favorable for drug loading and release properties, as well as luminescent and superparamagnetic properties suitable for targeted drug delivery and tracking. This composite exhibited low toxicity, suggesting potential biomedical applications.

A low-frequency versatile wireless power transfer technology for biomedical implants

Implantable biomedical sensors and actuators are highly desired in modern medicine. In many cases, the implant's electrical power source profoundly determines its overall size and performance . The inductively coupled coil pair operating at the radio-frequency (RF) has been the primary method for wirelessly delivering electrical power to implants for the last three decades . Recent designs significantly improve the power delivery efficiency by optimizing the operating frequency, coil size and coil distance . However, RF radiation hazard and tissue absorption are the concerns in the RF wireless power transfer technology (RF-WPTT) , . Also, it requires an accurate impedance matching network that is sensitive to operating environments between the receiving coil and the load for efficient power delivery . In this paper, a novel low-frequency wireless power transfer technology (LF-WPTT) using rotating rare-earth permanent magnets is demonstrated. The LF-WPTT is able to deliver 2.967 W power at  ∼ 180 Hz to an 117.1 Ω resistor over 1 cm distance with 50% overall efficiency. Because of the low operating frequency, RF radiation hazard and tissue absorption are largely avoided, and the power delivery efficiency from the receiving coil to the load is independent of the operating environment. Also, there is little power loss observed in the LF-WPTT when the receiving coil is enclosed by non-magnetic implant-grade stainless steel.

Recombinant thrombomodulin of different domains for pharmaceutical, biomedical, and cell transplantation applications

Thrombomodulin (TM) is a membrane glycoprotein mainly expressed by vascular endothelial cells and is involved in many physiological and pathological processes, such as coagulation, inflammation, cancer development, and embryogenesis. Human TM consists of 557 amino acids divided into five distinct domains: N-terminal lectin-like domain (designated as TMD1); six epidermal growth factor (EGF)-like domain (TMD2); Ser/Thr-rich domain (TMD3); transmembrane domain (TMD4); and cytoplasmic tail domain (TMD5). The different domains are responsible for different biological functions of TM. In the past decades, various domains of TM have been cloned and expressed for TM structural and functional study. Further, recombinant TMs of different domains show promising antithrombotic and anti-inflammatory activity in both rodents and primates and a recombinant soluble TM has been approved for therapeutic application. This review highlights recombinant TMs of diverse structures and their biological functions, as well as the complex interactions of TM with factors involved in the related biological processes. Particularly, recent advances in exploring recombinant TM of different domains for pharmaceutical, biomedical, and cell transplantation applications are summarized.

Validation of electronic systems to collect patient-reported outcome (PRO) data-recommendations for clinical trial teams: report of the ISPOR ePRO systems validation good research practices task force

Outcomes research literature has many examples of high-quality, reliable patient-reported outcome (PRO) data entered directly by electronic means, ePRO, compared to data entered from original results on paper. Clinical trial managers are increasingly using ePRO data collection for PRO-based end points. Regulatory review dictates the rules to follow with ePRO data collection for medical label claims. A critical component for regulatory compliance is evidence of the validation of these electronic data collection systems. Validation of electronic systems is a process versus a focused activity that finishes at a single point in time. Eight steps need to be described and undertaken to qualify the validation of the data collection software in its target environment: requirements definition, design, coding, testing, tracing, user acceptance testing, installation and configuration, and decommissioning. These elements are consistent with recent regulatory guidance for systems validation. This report was written to explain how the validation process works for sponsors, trial teams, and other users of electronic data collection devices responsible for verifying the quality of the data entered into relational databases from such devices. It is a guide on the requirements and documentation needed from a data collection systems provider to demonstrate systems validation. It is a practical source of information for study teams to ensure that ePRO providers are using system validation and implementation processes that will ensure the systems and services: operate reliably when in practical use; produce accurate and complete data and data files; support management control and comply with any existing regulations. Furthermore, this short report will increase user understanding of the requirements for a technology review leading to more informed and balanced recommendations or decisions on electronic data collection methods.

Probability elicitation to inform early health economic evaluations of new medical technologies: a case study in heart failure disease management

OBJECTIVES

Early estimates of the commercial headroom available to a new medical device can assist producers of health technology in making appropriate product investment decisions. The purpose of this study was to illustrate how this quantity can be captured probabilistically by combining probability elicitation with early health economic modeling. The technology considered was a novel point-of-care testing device in heart failure disease management.

METHODS

First, we developed a continuous-time Markov model to represent the patients' disease progression under the current care setting. Next, we identified the model parameters that are likely to change after the introduction of the new device and interviewed three cardiologists to capture the probability distributions of these parameters. Finally, we obtained the probability distribution of the commercial headroom available per measurement by propagating the uncertainty in the model inputs to uncertainty in modeled outcomes.

RESULTS

For a willingness-to-pay value of €10,000 per life-year, the median headroom available per measurement was €1.64 (interquartile range €0.05-€3.16) when the measurement frequency was assumed to be daily. In the subsequently conducted sensitivity analysis, this median value increased to a maximum of €57.70 for different combinations of the willingness-to-pay threshold and the measurement frequency.

CONCLUSIONS

Probability elicitation can successfully be combined with early health economic modeling to obtain the probability distribution of the headroom available to a new medical technology. Subsequently feeding this distribution into a product investment evaluation method enables stakeholders to make more informed decisions regarding to which markets a currently available product prototype should be targeted.

Space-confined fabrication of silver nanodendrites and their enhanced SERS activity

Here we report a controllable method based on electrodeposition to fabricate Ag nanodendrites (NDs) on a microwell patterned electrode. The microwell patterns on the ITO electrode are fabricated via the microcontact printing technique. By varying the microwell size and electrodeposition time, the morphology of metal deposits on the microwell patterned ITO electrode can be tuned from boulders to dendrites. At the edge of the microwells, the current density was strengthened, which incurs rapid nucleation. The nucleus develops into dendrites because of Mullins-Sekerka instability. However, only boulders were observed at the center of microwells. By reducing the size of the microwells, only NDs were fabricated due to the edge effect. On the basis of understanding the underlying mechanism for dendritic growth in a confined space, our method is used for fabricating other noble metal (Au, Pt) nanodendrites. The controllable synthesis of Au and Pt NDs indicates the universality of this method. Compared with Ag film obtained from electron beam evaporation, the as-prepared Ag NDs exhibit highly enhanced surface-enhanced Raman scattering (SERS) sensitivity when they are used to detect rhodamine 6G (R6G). This approach provides a very controllable, reliable and general way for space-confined fabricating the noble metal nanodendrite arrays which show great promise in catalysis, sensing, biomedicine, electronic and magnetic devices.

[The development of dispensarization of population in presents conditions]

The article considers the development of dispensarization of population, including new tasks, possible obstacles in the content of this work and approaches to overcome them.

All nations depend on the global knowledge pool--analysis of country of origin of studies used for health technology assessments in Germany

Background

Health Technology Assessments (HTAs) are used to inform decision-making and their usefulness depends on the quality and relevance of research and specific studies for health-policy decisions. Little is known about the country of origin of studies used for HTAs.

Objective

To investigate which countries have made the largest contributions to inform health policy decisions through studies included in HTAs in Germany.

Methods

The country of origin was extracted from all studies included in HTAs of the German Institute for Quality and Efficiency in Health Care, (IQWiG), published from 2/2006 to 9/2010. Studies were ranked according to the total number of studies per country, adjusted for population size, gross domestic product (GDP), and total health expenditure.

Results

1087 studies were included in 54 HTA reports. Studies were assigned to 45 countries. Most of the studies (27%) originated from the United States (USA), 18% were multinational, followed by 7% from the United Kingdom (UK) and 5% from Germany. Nordic countries led the ranking when adjusting for population size/million (ranks 1-3,6,9/45 countries), GDP/billion US$ (1,2,5,9,14/45), or health expenditure/billion US$ (1,3,5,12,13/45). The relative contribution of the UK was stable in the analyses when adjusted for population size (7/45), GDP (7/45), and health expenditure (9/45), whereas the USA (13, 18, and 30/45) and Germany (17, 19, and 21/45) dropped in the ranking.

Conclusions

More than half of the studies relevant for evidence-informed decision-making in Germany originated from the USA, followed by multinational research and the UK. Only 5% of the studies originated from Germany. According to our findings, there appears to be some discrepancy between the use of globally generated evidence and the contribution to the knowledge pool by individual countries.

Considerations for an institution for evaluation of diabetes technology devices to improve their quality in the European Union

All medical devices used for self-monitoring of blood glucose (BG), insulin injection, continuous subcutaneous insulin infusion, and continuous glucose monitoring in the European Union (EU) must have a Communauté Européenne (CE) mark. However, the approval process for obtaining this mark is different from that used by the European Medicines Agency in the EU for drugs or by the Food and Drug Administration in the United States for such medical and in vitro diagnostic devices. The notified bodies involved in the CE mark process perform this evaluation in cooperation with the manufacturers. They have only limited diabetes know-how; they have to handle all kinds of medical devices. There are devices for therapy on the market in the EU (i.e., they have market approval) that do not fulfill quality requirements, as indicated, for example, in the international norm ISO 15197 for BG test systems. Evaluation of the performance of such systems is usually provided by the manufacturers. What is missing in the EU is an independent institution that performs regular and critical evaluation of the quality of devices used for diabetes therapy before and also after their market approval. The work of such an institution would focus on BG test systems (these represent two-thirds of the market of medical devices for diabetes treatment) but would also evaluate the performance of other devices. It has to be clarified what legal framework is required for such an institution and how it can be financed; probably this can be done in a shared manner by the manufacturers of such devices and the health insurance companies. Positive evaluation results should be a prerequisite prior to any reimbursement for such devices.

Fe-Pd based ferromagnetic shape memory actuators for medical applications: Biocompatibility, effect of surface roughness and protein coatings

Ferromagnetic shape memory (FMSM) alloys constitute an exciting new class of smart materials that can yield magnetically switchable strains of several percent at constant temperatures and frequencies from quasi-static up to some kilohertz. In addition to their FMSM properties, these alloys can still be operated as conventional shape memory materials and also exhibit related superelasticity, which are both important features for use in medical devices. In this study, extensive in vitro assessments demonstrate for the first time that vapor-deposited single crystalline Fe(70)Pd(30) thin films and roughness graded polycrystalline splats of the same stoichiometry exhibit excellent biocompatibility and even bioactivity in contact with different cell types-a prerequisite for medical applications. The present study shows that fibroblast and epithelial cell lines, as well as primary osteoblast cells, proliferate well on Fe-Pd. The number of focal contacts, important for strong tissue bonding, can be improved with different binding agents from the extracellular matrix. However, even without coating, there is clear evidence that cells on Fe-Pd substrates behave similarly to control experiments. Additionally, cytotoxic effects of polycrystalline surfaces with various roughness profiles can be excluded, giving another tunable parameter for applying Fe-Pd magnetically switchable membranes in, e.g., stents and valves.