Automated Home Oxygen Delivery for Patients with COPD and Respiratory Failure: A New Approach

Long-term oxygen therapy (LTOT) has become standard care for the treatment of patients with chronic obstructive pulmonary disease (COPD) and other severe hypoxemic lung diseases. The use of new portable O-2 concentrators (POC) in LTOT is being expanded. However, the issue of oxygen titration is not always properly addressed, since POCs rely on proper use by patients. The robustness of algorithms and the limited reliability of current oximetry sensors are hindering the effectiveness of new approaches to closed-loop POCs based on the feedback of blood oxygen saturation. In this study, a novel intelligent portable oxygen concentrator (iPOC) is described. The presented iPOC is capable of adjusting the O-2 flow automatically by real-time classifying the intensity of a patient's physical activity (PA). It was designed with a group of patients with COPD and stable chronic respiratory failure. The technical pilot test showed a weighted accuracy of 91.1% in updating the O-2 flow automatically according to medical prescriptions, and a general improvement in oxygenation compared to conventional POCs. In addition, the usability achieved was high, which indicated a significant degree of user satisfaction. This iPOC may have important benefits, including improved oxygenation, increased compliance with therapy recommendations, and the promotion of PA

Effect of inspiratory pressure support on exercise performance in patients with chronic obstructive pulmonary disease

Title: Effect of inspiratory pressure support on exercise performance in patients with chronic obstructive pulmonary disease. Purpose: This study examined the effects of a non-invasive ventilator on submaximal and maximal exercise performance in patients with chronic obstructive pulmonary disease (COPD). Methods: Fourteen men (66.0 ± 7.4yr) and six women (59.0 ± 7.4yr) with a diagnosis of COPD, a forced expiratory volume! (FEVi) <40%, and the ability to tolerate 12 cmH20 of pressure on a non- invasive ventilator performed two maximal exercise tests on a cycle ergometer, with and without ventilatory assistance prior to exercise. Blood samples, respiratory metabolic measures, heart rate and rating of perceived exertion (RPE) were obtained throughout each exercise test. Results: Peak work rate (W), total exercise time, and respiratory rate were higher (p<0.05) when exercise was preceded by ventilatory support compared to no support. There was no difference in peak oxygen uptake (V02), carbon dioxide (VC02,), heart rate (HR), minute ventilation (VE), tidal volume (VT), blood lactate or RPE between the two experimental conditions. A total of 12 subjects completed at least 5 stages of the exercise protocol, and their physiological response during exercise with NIV and without NIV were compared. RPE was significantly lower during the first 3 min in the NIV condition than the no NIV condition. Circulating levels of blood lactate were lower (p<0.01) during stage 3 in the NIV than the than no NIV condition. There was no difference in RR, VT, HR, %HR, VE, V 0 2and %V02 between the two experimental conditions during sub maximal exercise. Conclusions: Application of non-invasive ventilatory support prior to exercise improves maximal exercise performance, but has no effect on cardio-metabolic response during submaximal exercise in patients with COPD

Telemedicine provides new treatment possibilities in COPD care

Chronic Obstructive Pulmonary Disease (COPD) is a chronic, progressive lung disease. COPD has a high impact on quality of life, large social consequences, a progressive course and it cannot be cured. Physiotherapy, increasing physical participation in daily activities, and early detection and treatment of exacerbations are important elements in current COPD disease management. Home-exercise programmes and self-management of exacerbations are effective new treatment methods. When these programmes are offered as a telemedicine application, they could contribute to a reduction in labour and costs. This paper describes a number of telemedicine applications designed for implementation in COPD care: 1) remote monitoring of physical activity and symptoms; 2) coaching and feedback in daily life to gain an active lifestyle; 3) a web portal for online exercising, self-management of exacerbations and communication between professionals and patient and; 4) serious gaming. For each application we share the motivation, design, and (future) evaluations with the target group: COPD patients. The designed applications are in general positively received by patients and professionals and seem to be able to improve the patient’s well-being. Further development and further scaling of these technologies in everyday care would be an important next step

Evaluating the impact of physical activity apps and wearables: interdisciplinary review

Background: Although many smartphone apps and wearables have been designed to improve physical activity, their rapidly evolving nature and complexity present challenges for evaluating their impact. Traditional methodologies, such as randomized controlled trials (RCTs), can be slow. To keep pace with rapid technological development, evaluations of mobile health technologies must be efficient. Rapid alternative research designs have been proposed, and efficient in-app data collection methods, including in-device sensors and device-generated logs, are available. Along with effectiveness, it is important to measure engagement (ie, users’ interaction and usage behavior) and acceptability (ie, users’ subjective perceptions and experiences) to help explain how and why apps and wearables work. Objectives: This study aimed to (1) explore the extent to which evaluations of physical activity apps and wearables: employ rapid research designs; assess engagement, acceptability, as well as effectiveness; use efficient data collection methods; and (2) describe which dimensions of engagement and acceptability are assessed. Method: An interdisciplinary scoping review using 8 databases from health and computing sciences. Included studies measured physical activity, and evaluated physical activity apps or wearables that provided sensor-based feedback. Results were analyzed using descriptive numerical summaries, chi-square testing, and qualitative thematic analysis. Results: A total of 1829 abstracts were screened, and 858 articles read in full. Of 111 included studies, 61 (55.0%) were published between 2015 and 2017. Most (55.0%, 61/111) were RCTs, and only 2 studies (1.8%) used rapid research designs: 1 single-case design and 1 multiphase optimization strategy. Other research designs included 23 (22.5%) repeated measures designs, 11 (9.9%) nonrandomized group designs, 10 (9.0%) case studies, and 4 (3.6%) observational studies. Less than one-third of the studies (32.0%, 35/111) investigated effectiveness, engagement, and acceptability together. To measure physical activity, most studies (90.1%, 101/111) employed sensors (either in-device [67.6%, 75/111] or external [23.4%, 26/111]). RCTs were more likely to employ external sensors (accelerometers: P=.005). Studies that assessed engagement (52.3%, 58/111) mostly used device-generated logs (91%, 53/58) to measure the frequency, depth, and length of engagement. Studies that assessed acceptability (57.7%, 64/111) most often used questionnaires (64%, 42/64) and/or qualitative methods (53%, 34/64) to explore appreciation, perceived effectiveness and usefulness, satisfaction, intention to continue use, and social acceptability. Some studies (14.4%, 16/111) assessed dimensions more closely related to usability (ie, burden of sensor wear and use, interface complexity, and perceived technical performance). Conclusions: The rapid increase of research into the impact of physical activity apps and wearables means that evaluation guidelines are urgently needed to promote efficiency through the use of rapid research designs, in-device sensors and user-logs to assess effectiveness, engagement, and acceptability. Screening articles was time-consuming because reporting across health and computing sciences lacked standardization. Reporting guidelines are therefore needed to facilitate the synthesis of evidence across disciplines

Holistic System Design for Distributed National eHealth Services

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Wearable and BAN Sensors for Physical Rehabilitation and eHealth Architectures

The demographic shift of the population towards an increase in the number of elderly citizens, together with the sedentary lifestyle we are adopting, is reflected in the increasingly debilitated physical health of the population. The resulting physical impairments require rehabilitation therapies which may be assisted by the use of wearable sensors or body area network sensors (BANs). The use of novel technology for medical therapies can also contribute to reducing the costs in healthcare systems and decrease patient overflow in medical centers. Sensors are the primary enablers of any wearable medical device, with a central role in eHealth architectures. The accuracy of the acquired data depends on the sensors; hence, when considering wearable and BAN sensing integration, they must be proven to be accurate and reliable solutions. This book is a collection of works focusing on the current state-of-the-art of BANs and wearable sensing devices for physical rehabilitation of impaired or debilitated citizens. The manuscripts that compose this book report on the advances in the research related to different sensing technologies (optical or electronic) and body area network sensors (BANs), their design and implementation, advanced signal processing techniques, and the application of these technologies in areas such as physical rehabilitation, robotics, medical diagnostics, and therapy

Mobile Health Technologies

Mobile Health Technologies, also known as mHealth technologies, have emerged, amongst healthcare providers, as the ultimate Technologies-of-Choice for the 21st century in delivering not only transformative change in healthcare delivery, but also critical health information to different communities of practice in integrated healthcare information systems. mHealth technologies nurture seamless platforms and pragmatic tools for managing pertinent health information across the continuum of different healthcare providers. mHealth technologies commonly utilize mobile medical devices, monitoring and wireless devices, and/or telemedicine in healthcare delivery and health research. Today, mHealth technologies provide opportunities to record and monitor conditions of patients with chronic diseases such as asthma, Chronic Obstructive Pulmonary Diseases (COPD) and diabetes mellitus. The intent of this book is to enlighten readers about the theories and applications of mHealth technologies in the healthcare domain

Assistive Technology and Biomechatronics Engineering

This Special Issue will focus on assistive technology (AT) to address biomechanical and control of movement issues in individuals with impaired health, whether as a result of disability, disease, or injury. All over the world, technologies are developed that make human life richer and more comfortable. However, there are people who are not able to benefit from these technologies. Research can include development of new assistive technology to promote more effective movement, the use of existing technology to assess and treat movement disorders, the use and effectiveness of virtual rehabilitation, or theoretical issues, such as modeling, which underlie the biomechanics or motor control of movement disorders. This Special Issue will also cover Internet of Things (IoT) sensing technology and nursing care robot applications that can be applied to new assistive technologies. IoT includes data, more specifically gathering them efficiently and using them to enable intelligence, control, and new applications