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.

A versatile multicomponent assembly via β-cyclodextrin host-guest chemistry on graphene for biomedical applications

A multi-component nanosystem based on graphene and comprising individual cyclodextrins at its surface is assembled, creating hybrid structures enabling new and important functionalities: optical imaging, drug storage, and cell targeting for medical diagnosis and treatment. These nanohybrids are part of a universal system of interchangeable units, capable of mutilple functionalities. The surface components, made of individual β-cyclodextrin molecules, are the "hosts" for functional units, which may be used as imaging agents, for anti-cancer drug delivery, and as tumor-specific ligands. Specifically, individual β-cyclodextrin (β-CD), with a known capability to host various molecules, is considered a module unit that is assembled onto graphene nanosheet (GNS). The cyclodextrin-functionalized graphene nanosheet (GNS/β-CD) enables "host-guest" chemistry between the nanohybrid and functional "payloads". The structure, composition, and morphology of the graphene nanosheet hybrid have been investigated. The nanohybrid, GNS/β-CD, is highly dispersive in various physiological solutions, reflecting the high biostability of cyclodextrin. Regarding the host capability, the nanohybrid is fully capable of selectively accommodating various biological and functional agents in a controlled fashion, including the antivirus drug amantadine, fluorescent dye [5(6)-carboxyfluorescein], and Arg-Gly-Asp (RGD) peptide-targeting ligands assisted by an adamantine linker. The loading ratio of 5(6)-carboxyfluorescein is as high as 110% with a drug concentration of 0.45 mg mL(-1). The cyclic RGD-functionalized nanohybrid exhibits remarkable targeting for HeLa cells.

A plastic surgeon's guide to applying smartphone technology in patient care

BACKGROUND

The vast array of information technology available to plastic surgeons continues to expand. With the recent introduction of smartphone application ("app") technology to the market, the potential for incorporating both social media and app technology into daily practice exists.

OBJECTIVES

The authors describe and evaluate the smartphone applications most pertinent to plastic surgery.

METHODS

Smartphone apps from all available markets were analyzed for various factors, including popularity among general consumers, ease of use, and functionality. Using various advertising guidelines from plastic surgery societies as well as the US Food and Drug Administration, each app's content was further analyzed within the context of ethical obligations.

RESULTS

The apps with the highest number of ratings were those offering the option to upload photos and morph each photo according to the user's own preference. The title of apps also appears to play a role in popularity. A majority of apps demonstrated the same features available on websites.

CONCLUSIONS

The applicability of social media marketing via smartphone apps has the potential to change future patient-surgeon interactions by offering more personalized and user-friendly encounters. The role of smartphone apps is important to the future of plastic surgery as long as plastic surgeons maintain an active role in the development of these apps to ensure their value.

Porous low modulus Ti40Nb compacts with electrodeposited hydroxyapatite coating for biomedical applications

Porous ß-type non-toxic Ti40Nb alloy was prepared by compaction of mechanically alloyed powder mixed with NaCl or Mg particles as space-holder material. The compacts with porosity of 36-80% demonstrated a very low Young's modulus of ~1.5-3 GPa and compression strength of ~10-35 MPa, which is suitable for potential implant material application. Porous samples were electrochemically covered with hydroxyapatite. The influence of the deposition time and of the electrolyte concentrations on the morphology of the hydroxyapatite coating was studied. It is demonstrated that a homogenous coating of hydroxyapatite crystals with different shape and size can be obtained on the surface of the porous samples.

The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review

BACKGROUND

Mobile technologies could be a powerful media for providing individual level support to health care consumers. We conducted a systematic review to assess the effectiveness of mobile technology interventions delivered to health care consumers.

METHODS AND FINDINGS

We searched for all controlled trials of mobile technology-based health interventions delivered to health care consumers using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990-Sept 2010). Two authors extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and used random effects meta-analysis. We identified 75 trials. Fifty-nine trials investigated the use of mobile technologies to improve disease management and 26 trials investigated their use to change health behaviours. Nearly all trials were conducted in high-income countries. Four trials had a low risk of bias. Two trials of disease management had low risk of bias; in one, antiretroviral (ART) adherence, use of text messages reduced high viral load (>400 copies), with a relative risk (RR) of 0.85 (95% CI 0.72-0.99), but no statistically significant benefit on mortality (RR 0.79 [95% CI 0.47-1.32]). In a second, a PDA based intervention increased scores for perceived self care agency in lung transplant patients. Two trials of health behaviour management had low risk of bias. The pooled effect of text messaging smoking cessation support on biochemically verified smoking cessation was (RR 2.16 [95% CI 1.77-2.62]). Interventions for other conditions showed suggestive benefits in some cases, but the results were not consistent. No evidence of publication bias was demonstrated on visual or statistical examination of the funnel plots for either disease management or health behaviours. To address the limitation of the older search, we also reviewed more recent literature.

CONCLUSIONS

Text messaging interventions increased adherence to ART and smoking cessation and should be considered for inclusion in services. Although there is suggestive evidence of benefit in some other areas, high quality adequately powered trials of optimised interventions are required to evaluate effects on objective outcomes.

Evaluation of a 433 MHz band body sensor network for biomedical applications

Body sensor networks (BSN) are an important research topic due to various advantages over conventional measurement equipment. One main advantage is the feasibility to deploy a BSN system for 24/7 health monitoring applications. The requirements for such an application are miniaturization of the network nodes and the use of wireless data transmission technologies to ensure wearability and ease of use. Therefore, the reliability of such a system depends on the quality of the wireless data transmission. At present, most BSNs use ZigBee or other IEEE 802.15.4 based transmission technologies. Here, we evaluated the performance of a wireless transmission system of a novel BSN for biomedical applications in the 433MHz ISM band, called Integrated Posture and Activity NEtwork by Medit Aachen (IPANEMA) BSN. The 433MHz ISM band is used mostly by implanted sensors and thus allows easy integration of such into the BSN. Multiple measurement scenarios have been assessed, including varying antenna orientations, transmission distances and the number of network participants. The mean packet loss rate (PLR) was 0.63% for a single slave, which is comparable to IEEE 802.15.4 BSNs in the proximity of Bluetooth or WiFi networks. Secondly, an enhanced version is evaluated during on-body measurements with five slaves. The mean PLR results show a comparable good performance for measurements on a treadmill (2.5%), an outdoor track (3.4%) and in a climate chamber (1.5%).

Reducing healthcare disparities with a technology mediated solution

As healthcare costs in the US continue to rise exponentially it becomes a strategic imperative to examine all areas of healthcare delivery and identify those which are currently inefficient and ineffective and identify ways to find superior solutions that support a healthcare value proposition of excellence in access quality and value. Moreover, given the current emphasis on identifying meaningful use of technology it becomes possible to develop appropriate technology solutions that not only comply with this requirement but also facilitate superior healthcare delivery to ensue. This is such the case with improving access to language services in healthcare or more specifically the development of a real time on-line technology mediated solution to support limited English proficiency patients as the following discussed.

[Tumor, metastasis and what's in between]

Cancer is a major factor of morbidity and mortality worldwide. Over 90% of cancer-related deaths are due to metastatic disease. Observations made more than 140 years ago described cancer cells from solid tumors in the bloodstream. yet, the significance of these circulating and disseminated cells and their contribution to the generation of metastasis remained a mystery. Recently, substantial technological advances have enabled the detection and isolation of circulating tumor cells from the peripheral blood. Currently, this technology allows quantitative analysis of circulating cancer cell content and permits a view of the genetic and phenotypic changes in this accessible population. In the future, researchers hope to use circulating tumor cells as a powerful tool for early detection, prognosis, tumor response assessment and even for treatment selection. The discovery of cancer cells in the bloodstream holds many promises in the study, diagnosis and treatment of cancer, but, at the same time, raises difficult questions regarding the identity of these cells, their contribution to the process of metastasis and their ability to aid medical decisions. This review aims to introduce the topic of circulating tumor cells to the Israeli medical community and encourage active participation in basic and translational research in this field. We believe this field holds great potential for promoting the practice of surgical oncology, tumor surveillance and clinical oncology.

Assessing the added value of health technologies: reconciling different perspectives

Providing universal access to innovative, high-cost technologies leads to tensions in today's health care systems. The tension becomes particularly evident in the context of scarce resources, where the risk of taking contentious coverage decisions increases rapidly. To ensure economic sustainability, the payers of health care think that the benefits from the use of the new technologies need to be commensurate with the costs. Therefore, many jurisdictions have programs of health technology assessment, which often results in restrictions of access to care, either through complete refusal to reimburse the technology or its restriction of use to only a subset of the eligible patient population. However, manufacturers feel that they should be adequately rewarded for their innovations and require sufficient funds to invest in further research. Finally, patients perceive these technologies to have added benefits, and so they are concerned when they are denied access. If sustainable access to health care is to be maintained in the future, approaches are needed to reconcile these different perspectives. This article explores the approaches, in both methods and policy, to help bring about this reconciliation. These include rethinking the notion of social value (on the part of payers), aligning manufacturers' research more closely with societal objectives, and increasing patient participation in health technology assessment.

A wideband scalar network analyzer for biomedical dehydration measurements

This paper presents a wideband microwave approach towards biomedical dehydration monitoring. The introduced concept is verified via invasive measurements on several blood samples. A microwave measurement circuit, based of a two-port scalar vector network analyzer is presented. The circuit operates between 5GHz and 20GHz using a planar permittivity sensor. Measurements of all subcomponents are shown together with measurements of a Water-NaCl-Glycerol solution.

[The social hygienic assessment of significance of diseases under organization of ambulatory polyclinic care]

The article presents the results of analysis of appealability of adult population of Omsk to municipal polyclinic on the subject of diseases. The coefficients of relative importance of different classes of diseases to determine the groups af their significance were calculated on the basis of integrated evaluation of common and primary morbidity and diseases of patients under dispensarization monitoring. The established character of formation of flows of appealabiliy of population on the subject of diseases is a basic one to determine demand in medical technologies and planning of activities of ambulatory polyclinic section of health care.

The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis

BACKGROUND

Mobile health interventions could have beneficial effects on health care delivery processes. We aimed to conduct a systematic review of controlled trials of mobile technology interventions to improve health care delivery processes.

METHODS AND FINDINGS

We searched for all controlled trials of mobile technology based health interventions using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990-Sept 2010). Two authors independently extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and we used random effects meta-analysis to give pooled estimates. We identified 42 trials. None of the trials had low risk of bias. Seven trials of health care provider support reported 25 outcomes regarding appropriate disease management, of which 11 showed statistically significant benefits. One trial reported a statistically significant improvement in nurse/surgeon communication using mobile phones. Two trials reported statistically significant reductions in correct diagnoses using mobile technology photos compared to gold standard. The pooled effect on appointment attendance using text message (short message service or SMS) reminders versus no reminder was increased, with a relative risk (RR) of 1.06 (95% CI 1.05-1.07, I(2) = 6%). The pooled effects on the number of cancelled appointments was not significantly increased RR 1.08 (95% CI 0.89-1.30). There was no difference in attendance using SMS reminders versus other reminders (RR 0.98, 95% CI 0.94-1.02, respectively). To address the limitation of the older search, we also reviewed more recent literature.

CONCLUSIONS

The results for health care provider support interventions on diagnosis and management outcomes are generally consistent with modest benefits. Trials using mobile technology-based photos reported reductions in correct diagnoses when compared to the gold standard. SMS appointment reminders have modest benefits and may be appropriate for implementation. High quality trials measuring clinical outcomes are needed. Please see later in the article for the Editors' Summary.

The COST Action on cyberbullying: developing an international network

The COST Action IS0801 on cyberbullying had the aim of a) sharing of developing expertise in knowledge base and measurement techniques across researchers, b) sharing of input from outside the research community; specifically, from legal experts as well as from mobile phone companies and internet service providers c) sharing of already nationally published guidelines, and recommended coping strategies, including positive uses of new technologies, and d) increasing awareness of the issue, as well as of the outcomes of the Action. Besides the conferences and Training schools organised, the Action has fostered or facilitated a considerable number of grant applications, publications as well as other outreach activities, and has established a fruitful international network.

The use of social media in healthcare: organizational, clinical, and patient perspectives

The purpose of this review paper is to explore the impacts of social media on healthcare organizations, clinicians, and patients. This study found that healthcare organizations, clinicians and patients can benefit from the use of social media. For healthcare organizations, social media can be used primarily for community engagement activities such as fundraising, customer service and support, the provision of news and information, patient education, and advertising new services. The study also found that the most widely used social media venues for physicians were online communities where physicians can read news articles, listen to experts, research new medical developments, network, and communicate with colleagues regarding patient issues. Patients can benefit from the use of social media through education, obtaining information, networking, performing research, receiving support, goal setting, and tracking personal progress. Future research should further examine other financial, technological, informational, ethical, legal, and privacy issues surrounding the use of social media in healthcare.

[Contemporary medical technologies in diagnosis and evaluating risk of occupational diseases]

Laboratory tests in occupational medicine get more importance and are used in clinical practice for diagnosis and evaluating the treatment efficiency, as well as for assessing risk of occupational, occupationally mediated diseases and more advanced forms of noninfectional diseases, to reveal early manifestations of diseases in workers exposed to hazardous work conditions. The article covers contemporary molecular technologies to diagnose and evaluate risk of occupational diseases, that are used nowadays in FSBI "RIOH" RAMS.

Biotechnological approaches to the treatment of aspermatogenic men

Aspermatogenesis is a severe impairment of spermatogenesis in which germ cells are completely lacking or present in an immature form, which results in sterility in approximately 25% of patients. Because assisted reproduction techniques require mature germ cells, biotechnology is a valuable tool for rescuing fertility while maintaining biological fatherhood. However, this process involves, for instance, the differentiation of preexisting immature germ cells or the production/derivation of sperm from somatic cells. This review critically addresses four potential techniques: sperm derivation in vitro, germ stem cell transplantation, xenologous systems, and haploidization. Sperm derivation in vitro is already feasible in fish and mammals through organ culture or 3D systems, and it is very useful in conditions of germ cell arrest or in type II Sertoli-cell-only syndrome. Patients afflicted by type I Sertoli-cell-only syndrome could also benefit from gamete derivation from induced pluripotent stem cells of somatic origin, and human haploid-like cells have already been obtained by using this novel methodology. In the absence of alternative strategies to generate sperm in vitro, in germ cells transplantation fertility is restored by placing donor cells in the recipient germ-cell-free seminiferous epithelium, which has proven effective in conditions of spermatogonial arrest. Grafting also provides an approach for ex-vivo generation of mature sperm, particularly using prepubertal testis tissue. Although less feasible, haploidization is an option for creating gametes based on biological cloning technology. In conclusion, the aforementioned promising techniques remain largely experimental and still require extensive research, which should address, among other concerns, ethical and biosafety issues, such as gamete epigenetic status, ploidy, and chromatin integrity.

New-generation radiofrequency technology

Radiofrequency (RF) technology has become a standard treatment in aesthetic medicine with many indications due to its versatility, efficacy, and safety. It is used worldwide for cellulite reduction; acne scar revision; and treatment of hypertrophic scars and keloids, rosacea, and inflammatory acne in all skin types. However, the most common indication for RF technology is the nonablative tightening of tissue to improve skin laxity and reduce wrinkles. Radiofrequency devices are classified as unipolar, bipolar, or multipolar depending on the number of electrodes used. Additional modalities include fractional RF; sublative RF; phase-controlled RF; and combination RF therapies that apply light, massage, or pulsed electromagnetic fields (PEMFs). This article reviews studies and case series on these devices. Radiofrequency technology for aesthetic medicine has seen rapid advancements since it was used for skin tightening in 2003. Future developments will continue to keep RF technology at the forefront of the dermatologist's armamentarium for skin tightening and rejuvenation.

Design of the optocoupler applied to medical lighting systems

A new type of optocoupler applied to medical lighting system is proposed, and the principle, Etendue and design process is introduced. With the help of Tracrpro, modeling and simulation of the optocoupler is conducted and the parameters are optimized. Analysis of factors affecting the energy coupling efficiency is done. With a view towards the development of Ultra High Brightness Light Emitting Diodes (UHB-LEDs), which play an important role a new sources of lighting in various biomedical devices, including those used in diagnosis and treatment, a series of simulations are executed and a variety of solutions are achieved. According to simulation results, the design target of coupling efficiency is achieved and the optical uniformity is also significantly improved. According to the result of theoretical analysis, verification experiments are designed and simulation results are verified. The optocoupler, which has simple structure, compact size and low cost, is suitable for applications in the field of low-cost medical domain.

Microdermabrasion: molecular mechanisms unraveled, part 1

Microdermabrasion (MDA) remains a common in-office procedure for many dermatologic practices.The procedure offers minimal downtime with a low incidence of side effects, making it a relatively desirable option for skin rejuvenation. Investigators have identified many of the molecular mechanisms behind this technology in an attempt to optimize clinical results. In particular, activation of the wound healing response plays a key role in the remodeling of post-MDA treated skin, although this response varies based on the type of MDA employed.While many studies discuss the clinical applications of MDA and their relation to histologic changes found after treatment, few address the basic science behind the technology.Our review covers progress made in the last 10 years of research, with an emphasis on the molecular mechanisms.

Microdermabrasion: molecular mechanisms unraveled, part 2

Microdermabrasion (MDA) remains a common in-office procedure for many dermatologic practices. The procedure offers minimal downtime with a low incidence of side effects, making it a relatively desirable option for skin rejuvenation. Investigators have identified many of the molecular mechanisms behind this technology in an attempt to optimize clinical results. In particular, activation of the wound healing response plays a key role in the remodeling of post-MDA treated skin, although this response varies based on the type of MDA employed. In addition, advances in MDA technology offer new and promising ways to enhance transcutaneous penetration of active ingredients to improve clinical outcomes. Our review addresses innovative applications of MDA in the last 10 years of research.

Prospects and applications of nanobiotechnology: a medical perspective

BACKGROUND

Nanobiotechnology is the application of nanotechnology in biological fields. Nanotechnology is a multidisciplinary field that currently recruits approach, technology and facility available in conventional as well as advanced avenues of engineering, physics, chemistry and biology.

METHOD

A comprehensive review of the literature on the principles, limitations, challenges, improvements and applications of nanotechnology in medical science was performed.

RESULTS

Nanobiotechnology has multitude of potentials for advancing medical science thereby improving health care practices around the world. Many novel nanoparticles and nanodevices are expected to be used, with an enormous positive impact on human health. While true clinical applications of nanotechnology are still practically inexistent, a significant number of promising medical projects are in an advanced experimental stage. Implementation of nanotechnology in medicine and physiology means that mechanisms and devices are so technically designed that they can interact with sub-cellular (i.e. molecular) levels of the body with a high degree of specificity. Thus therapeutic efficacy can be achieved to maximum with minimal side effects by means of the targeted cell or tissue-specific clinical intervention.

CONCLUSION

More detailed research and careful clinical trials are still required to introduce diverse components of nanobiotechnology in random clinical applications with success. Ethical and moral concerns also need to be addressed in parallel with the new developments.

Financial risk-sharing in updating the National List of Health Services in Israel: stakeholders' perceived interests

OBJECTIVES

Risk-sharing is being considered by many health care systems to address the financial risk associated with the adoption of new technologies. We explored major stakeholders' views toward the potential implementation of a financial risk-sharing mechanism regarding budget-impact estimates for adding new technologies to the Israeli National List of Health Services. According to our proposed scheme, health plans will be partially compensated by technology sponsors if the actual use of a technology is substantially higher than what was projected and health plans will refund the government for budgets that were not fully utilized.

METHODS

By using a semi-structured protocol, we interviewed major stakeholders involved in the process of updating the National List of Health Services (N = 31). We inquired into participants' views toward our proposed risk-sharing mechanism, whether the proposed scheme would achieve its purpose, its feasibility of implementation, and their opinion on the other stakeholders' incentives.

RESULTS

Participants' considerations were classified into four main areas: financial, administrative/managerial, impact on patients' health, and influence on public image. Most participants agreed that the conceptual risk-sharing scheme will improve the accuracy of early budget estimates and were in favor of the proposed scheme, although Ministry of Finance officials tended to object to it.

CONCLUSIONS

The successful implementation of risk-sharing schemes depends mainly on their perception as a win-win situation by all stakeholders. The perception exposed by our participants that risk-sharing can be a tool for improving the accuracy of early budget-impact estimates and the challenges pointed by them are relevant to other health care systems also and should be considered when implementing similar schemes.

CMOS low current measurement system for biomedical applications

We present a micro-chip implementation of a low current measurement system for biomedical applications using capacitive feedback that exhibits 190 fA of RMS noise in a 1 kHz bandwidth. The sampling rate is selectable up to 100 kHz. When measuring the amplifier noise with a 10 GΩ resistor and a 47 pF capacitor at the input, typical of cell membrane capacitance in DNA and patch clamp experiments, the measured RMS noise was 2.44 pA on a 50 pA signal in a 10 kHz bandwidth. Two channels were implemented on 630 × 440 μm² using a 0.5-μm 3-metal 2-poly CMOS process. Each channel consumes 1.5 mW of power from a 3.3 V supply. We measured the characteristics of an artificial lipid bilayer similar to the ones used in DNA sequencing experiments via nanopores.

Overview: HTM professionals and electronic health records

Revolutionary changes in healthcare delivery systems are impacting every facet of healthcare itself, including clinical engineering. While basic equipment services will always be needed, more time and human resources must be dedicated to emerging markets within health IT as a part of a large delivery team. Now is the time to initiate the changes necessary to promote the evolution of health IT.

Spintronic platforms for biomedical applications

Since the fundamental discovery of the giant magnetoresistance many spintronic devices have been developed and implemented in our daily life (e.g. information storage and automotive industry). Lately, advances in the sensors technology (higher sensitivity, smaller size) have potentiated other applications, namely in the biological area, leading to the emergence of novel biomedical platforms. In particular the investigation of spintronics and its application to the development of magnetoresistive (MR) biomolecular and biomedical platforms are giving rise to a new class of biomedical diagnostic devices, suitable for bench top bioassays as well as point-of-care and point-of-use devices. Herein, integrated spintronic biochip platforms for diagnostic and cytometric applications, hybrid systems incorporating magnetoresistive sensors applied to neuroelectronic studies and biomedical imaging, namely magneto-encephalography and magneto-cardiography, are reviewed. Also lab-on-a-chip MR-based platforms to perform biological studies at the single molecule level are discussed. Overall the potential and main characteristics of such MR-based biomedical devices, comparing to the existing technologies while giving particular examples of targeted applications, are addressed.

Pyrolytic carbon coating for cytocompatibility of titanium oxide nanoparticles: a promising candidate for medical applications

Nanoparticles for biomedical use must be cytocompatible with the biological environment that they are exposed to. Current research has focused on the surface functionalization of nanoparticles by using proteins, polymers, thiols and other organic compounds. Here we show that inorganic nanoparticles such as titanium oxide can be coated by pyrolytic carbon (PyC) and that the coating has cytocompatible properties. Pyrolization and condensation of methane formed a thin layer of pyrolytic carbon on the titanium oxide core. The formation of the PyC shell retards coalescence and sintering of the ceramic phase. Our MTT assay shows that the PyC-coated particles are cytocompatible at employed doses.

How places matter: telecare technologies and the changing spatial dimensions of healthcare

Dominant discourses on telecare technologies often celebrate the erasure of distance and place. This paper provides a critical intervention into these discourses by investigating how spaces still matter, despite the move from physical to virtual encounters between healthcare professionals and patients. I argue that science and technology studies (STS) research on telecare, as well as other technologies, can be enriched by including a focus on place to understand the dynamic interactions between people and things. Adopting insights of human geographers, I show how places in which technologies are used affect how technologies enable or constrain human actions and identities. Whereas some spaces may facilitate the incorporation of technologies, others may resist technologies. A focus on how places matter is important for understanding how telecare technologies reorder and redefine healthcare. Although other healthcare technologies are also important actors in transforming healthcare, telecare technologies do this in a very specific way: they redefine the spatial dimensions of healthcare. To capture and further explore this changing spatial configuration of healthcare, I introduce the notion of technogeography of care. This concept provides a useful heuristic to study how places matter in healthcare. Although telecare technologies introduce virtual encounters between healthcare providers and patients, the use of telecare devices still largely depends on locally grounded, situated care acts. Based on interviews with users of several cardiac telecare applications, including healthcare professionals and patients in Germany and The Netherlands, the paper shows how patients' homes and public spaces are important for shaping the implementation and use of telecare technologies, and vice versa. Last, but not least, telecare devices are implicated as well. The paper emphasizes the place-dependency of the use and meaning of technical devices by showing how the same technological device can do and mean different things in different places.

A literature overview and comparison of driving impairing condition assessment approaches by health enabling technologies

Due to demographic change, more elderly people have the need to preserve and support mobility by car despite age-related functional limitations. Since accidents by the elderly are primarily caused by age related limitations, and not by careless or irresponsible behavior, it may be beneficial to detect driving impairing conditions. The presented review gives an overview of technologies to detect driving impairing conditions like drowsiness and stress or excessive demand. A comparison of the approaches to detect these conditions suggests that a combination of approaches is the most feasible method. However, there are still few systems that focus on the elderly.