Geriatrics & e-Technology: a personalized follow-up of elderly residents in nursing homes to anticipate the decompensation of geriatric syndromes. Rationale for a first prospective study Ger-e-Tech

The objective of the GER-e-TEC project is to provide recorded personalized medical monitoring of residents in nursing homes using an intelligent telemedicine platform. It will assist healthcare staff by automatically processing the information from sensors and questionnaires to provide early detection and escalate alerts to enable health professionals, operating in retirement homes, to optimize patient care

Telehealth in the context of COVID-19: An analysis of male usage and perceptions in comparison to in-person healthcare

This item is only available electronically.Background: Telehealth facilitates the provision of healthcare at a distance using technology. The emergence of COVID-19 saw rapid telehealth adoption. Although preliminary research has begun to report on this transition, few studies have analysed how men have interacted with telehealth during the pandemic. Aim: To study the characteristics of older men’s (a) use of telehealth services, and (b) their perceptions of telehealth in comparison to in-person healthcare using Andersen's Behavioural Model of Health Services Use. Method: Data were sourced from the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study, which collected data on men’s demographic information, wellbeing, and healthcare utilisation during the pandemic. Results: Of the 731 male participants (M age= 69.5), 241 (33%) had used telehealth services since pandemic-related restrictions commenced in March 2020. Most men found telehealth services to be just as good (63%) as in-person services. Hierarchical logistic regressions found factors of need to be the only predictors of men’s use of telehealth services, and their perceptions of telehealth compared to in-person care. Men who used telehealth services were more likely to have chronic conditions (OR=1.44). Men who perceived telehealth services as just as good or better than in-person care were significantly more likely to have chronic conditions (OR=1.63), and significantly less likely to have clinically significant symptoms of depression (OR=0.32). Conclusion: Telehealth services are popular and useful for men with chronic conditions during the pandemic but may not be preferred by men with depression. The implications of these findings and future research recommendations are discussed.Thesis (B.PsychSc(Hons)) -- University of Adelaide, School of Psychology, 202

Intelligent Remote Monitoring and Management system for Type1 Diabetes

The work presented in this thesis focuses on developing a telemedicine system for better management of type1 diabetes in children and teenagers. The research and development of the system is motivated by the inadequate communication in the current system of management of the disease, which results in non-compliance of patients following the regimen. This non-compliance generally results in uncontrolled blood glucose levels, which can result in hypoglycaemia, hyperglycaemia and later life health complications. This further results in an increase in health care costs. In this context, the thesis presents a novel end-to-end, low cost telemedicine system, WithCare+, developed in close collaboration between the University of Sheffield (Electronics & Electrical Engineering) and Sheffield Children’s Hospital. The system was developed to address the challenges of implementing modern telemedicine in type 1 diabetic care with particular relevance to National Health Service children’s clinics in the United Kingdom, by adopting a holistic care driven approach (involving all stakeholders) based on specific key enabler technologies such as low cost and reconfigurable design. However, one of the major issues with current telemedicine system is non-compliance of the patients due to invasive procedure of the glucose measurement which could be clearly addressed by non-invasive method of glucose measurement. Hence, the thesis also makes a contribution towards non-invasive glucose measurement using Near Infrared spectroscopy in terms of addressing the calibration challenge; two methods are proposed to improve the calibration of the Near Infrared instrument. The first method combines locally weighted regression and partial least square regression and the second method combines digital band pass filtering with support vector regression. The efficacy of the proposed methods is validated in experiments carried out in a non-controlled environment and the results obtained demonstrate that the proposed methods improved the performance of the calibration model in comparison to traditional calibration techniques such as Principal Component Regression and Partial Least Squares regression

Επιδράσεις διαφορετικών προγραμμάτων άσκησης σε ασθενείς με χρόνια καρδιακή ανεπάρκεια

Εισαγωγή: Η αερόβια άσκηση, είτε σε συνεχόμενη είτε σε διαλειμματική μορφή, επιφέρει σημαντικά οφέλη σε ασθενείς με Χρόνια Καρδιακή Ανεπάρκεια (ΧΚΑ). Η προπόνηση με αντιστάσεις έχει επίσης αποδειχθεί ευεργετική στην ΧΚΑ. Ωστόσο, τα δεδομένα που αφορούν στον συνδυασμό αερόβιας άσκησης και προπόνησης με αντιστάσεις είναι περιορισμένα. Σκοπός της παρούσας μελέτης ήταν να διερευνήσει εάν η προσθήκη προπόνησης με αντιστάσεις σε ένα πρόγραμμα υψηλής έντασης διαλειμματικής άσκησης (ΥΕΔ) στα πλαίσια ενός προγράμματος καρδιακής αποκατάστασης θα είχε επιπρόσθετα οφέλη στην λειτουργική ικανότητα και στην ποιότητα ζωής σε ασθενείς με ΧΚΑ. Μέθοδος: Σαράντα τέσσερις ασθενείς (35 άντρες, κλάσμα εξώθησης <50%) συμμετείχαν στο πρόγραμμα καρδιακής αποκατάστασης και τυχαιοποιήθηκαν σε δύο ομάδες άσκησης. Την ομάδα υψηλής έντασης διαλειμματική άσκηση (ΥΕΔ) ή την ομάδα ΥΕΔ σε συνδυασμό με προπόνηση με αντιστάσεις (ΣΥΝ). Στην αρχή και μετά το πέρας του προγράμματος αποκατάστασης όλοι οι ασθενείς πραγματοποίησαν μέγιστη καρδιοαναπνευστική δοκιμασία κόπωσης (ΚΑΔΚ), τη δοκιμασία της 1 μέγιστης επανάληψης (1ΜΑΕ), τεστ μυϊκής αντοχής, υπέρηχο καρδιάς και το ερωτηματολόγιο Minnesota of Living with Heart Failure (MLWHFQ). Αποτελέσματα: Η πλειοψηφία των δεικτών της ΚΑΔΚ, το κλάσμα εξώθησης, η δοκιμασία 1ΜΕ, η δοκιμασία μυϊκής αντοχής και η ποιότητα ζωής βελτιώθηκαν μετά το πρόγραμμα καρδιακής αποκατάστασης σε κάθε ομάδα άσκησης (p < 0.05). Ωστόσο, η ομάδα ΣΥΝ παρουσίασε επιπρόσθετη βελτίωση στο τεστ των θωρακικών μυών καθώς και στην ισχύ στο αναερόβιο κατώφλι σε σύγκριση με την ομάδα ΥΕΔ. Συμπεράσματα: Ένα πρόγραμμα καρδιακής αποκατάστασης, που αποτελείται είτε από ΥΕΔ είτε από ΥΕΔ σε συνδυασμό με προπόνηση με αντιστάσεις, βελτιώνει την λειτουργική ικανότητα και την ποιότητα ζωής των ασθενών με ΧΚΑ. Ωστόσο, η προσθήκη μυϊκής ενδυνάμωσης σε ένα πρόγραμμα ΥΕΔ φαίνεται να επιφέρει επιπρόσθετα οφέλη στη μυϊκή δύναμη και αντοχή των θωρακικών μυών καθώς και στην ισχύ στο αναερόβιο κατώφλι.Background: Aerobic exercise, either continuous or high intensity interval training (HIIT), induces important benefits in chronic heart failure (CHF) patients. Resistance training has been also shown to be beneficial in CHF. However, data regarding combined aerobic exercise and muscle strength training is still limited. The aim of this study was to investigate whether adding strength training to a HIIT protocol within a cardiac rehabilitation (CR) program has a cumulative beneficial effect on the functional capacity (FC) and quality of life (QoL) in patients with CHF. Methods: Forty-four consecutive patients [35 males, ejection fraction (EF) <50%] with CHF under medication enrolled in a 36-session CR program and were randomized in two exercise groups; HIIT (HIIT group) or HIIT combined with strength training (COM group). All patients underwent baseline and endpoint outcome measures of a symptom-limited maximal cardiopulmonary exercise testing (CPET), 1 repetition maximum (1RM) test, muscular endurance test, echocardiography, and Minnesota Living with Heart Failure Questionnaire (MLWHFQ). Results: Most of the CPET indices, EF, 1RM test, muscular endurance and QoL were improved after the CR program in each exercise training group (p < 0.05). However, COM group demonstrated a further improvement in chest muscle testing and workload at anaerobic threshold (AT) compared to HIIT group. Conclusions: A CR program, consisted of either HIIT or HIIT combined with strength training, improves FC and QoL of patients with CHF. However, the addition of strength training to HIIT seems to have further beneficial effects on chest muscle strength and endurance, as well as workload at AT

Addressing data accuracy and information integrity in mHealth using ML

The aim of the study was finding a way in which Machine Learning can be applied in mHealth Solutions to detect inaccurate data that can potentially harm patients. The result was an algorithm that classified accurate and inaccurate data

Domiciliary monitoring to predict exacerbations of COPD

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a common, longterm condition that is usually caused by cigarette smoking. In addition to daily symptoms and limitation in activities, patients are prone to chest infections ('exacerbations'). These are a significant problem: unpleasant for patients, and sometimes severe enough to cause hospital admission and death. Reducing the impact of exacerbations is very important. Previous studies have shown that earlier treatment of exacerbations results in faster recovery, and reduced risk of hospital admission. Helping patients to better detect exacerbations early is therefore important. This PhD focuses on measuring overnight heart rate and oxygen saturation, which we hypothesised would provide the best chance of detecting COPD exacerbations earlier than changes in symptoms. // Aim: To evaluate the potential of monitoring physiological variables to provide earlier detection of exacerbations of COPD. // Methods: Firstly, a systematic review was conducted to assess the existing literature on predicting exacerbations of COPD by monitoring physiological variables. Next, two clinical tele-health datasets were accessed, from two different NHS services in London, to report the impact of false alarms on tele-health service, and to examine the feasibility of using downloadable data from home non-invasive ventilation to detect exacerbations resulting in hospitalisation. National and international surveys were conducted to explore the techniques that have been used by healthcare providers on how to customise tele-health alarm limits for each individual, and to explore healthcare providers’ perceptions of tele-health for COPD. These preliminary projects enabled me to formulate my research question and main PhD hypothesis, tested using a prospective randomised controlled trial. Patients were randomised into two groups (one measured physiology only in the morning versus overnight continuous measurement) and patients were monitored for up to six months or the first exacerbation, whichever was sooner. Patients’ acceptance of continuous overnight monitoring was assessed at the end of the study. // Results: Existing studies that used physiological variables were small and heterogeneous using different variables and different protocols. The majority of medical alarms received by tele-health teams are false. Most patients reported a positive acceptance of being monitored overnight. Continuous overnight monitoring identified changes at exacerbation earlier than once-daily monitoring, and earlier than symptoms. Changes in physiological variables were correlated with changes in symptoms during non-stable phases. There is widespread UK national and international use of tele-health monitoring physiological variables in COPD without sufficient evidence base. // Conclusion: Monitoring physiological parameters may be useful in assisting earlier detection of COPD exacerbations but further, robust studies are required to confirm this. A particular challenge is how to set alarm limits for individual patients given the heterogeneity inherent in COPD and COPD exacerbations