Devices and Data Workflow in COPD Wearable Remote Patient Monitoring: A Systematic Review

Background: With global increase in Chronic Obstructive Pulmonary Disease (COPD) prevalence and mortality rates, and socioeconomical burden continuing to rise, current disease management strategies appear inadequate, paving the way for technological solutions, namely remote patient monitoring (RPM), adoption considering its acute disease events management benefit. One RPM’s category stands out, wearable devices, due to its availability and apparent ease of use. Objectives: To assess the current market and interventional solutions regarding wearable devices in the remote monitoring of COPD patients through a systematic review design from a device composition, data workflow, and collected parameters description standpoint. Methods: A systematic review was conducted to identify wearable device trends in this population through the development of a comprehensive search strategy, searching beyond the mainstream databases, and aggregating diverse information found regarding the same device. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed, and quality appraisal of identified studies was performed using the Critical Appraisal Skills Programme (CASP) quality appraisal checklists. Results: The review resulted on the identification of 1590 references, of which a final 79 were included. 56 wearable devices were analysed, with the slight majority belonging to the wellness devices class. Substantial device heterogeneity was identified regarding device composition type and wearing location, and data workflow regarding 4 considered components. Clinical monitoring devices are starting to gain relevance in the market and slightly over a third, aim to assist COPD patients and healthcare professionals in exacerbation prediction. Compliance with validated recommendations is still lacking, with no devices assessing the totality of recommended vital signs. Conclusions: The identified heterogeneity, despite expected considering the relative novelty of wearable devices, alerts for the need to regulate the development and research of these technologies, specially from a structural and data collection and transmission standpoints.Introdução: Com o aumento global das taxas de prevalência e mortalidade da Doença Pulmonar Obstrutiva Crónica (DPOC) e o seu impacto socioeconómico, as atuais estratégias de gestão da doença parecem inadequadas, abrindo caminho para soluções tecnológicas, nomeadamente para a adoção da monitorização remota, tendo em conta o seu benefício na gestão de exacerbações de doenças crónicas. Dentro destaca-se uma categoria, os dispositivos wearable, pela sua disponibilidade e aparente facilidade de uso. Objetivos: Avaliar as soluções existentes, tanto no mercado, como na área de investigação, relativas a dispositivos wearable utilizados na monitorização remota de pacientes com DPOC através de uma revisão sistemática, do ponto de vista da composição do dispositivo, fluxo de dados e descrição dos parâmetros coletados. Métodos: Uma revisão sistemática foi realizada para identificar tendências destes dispositivos, através do desenvolvimento de uma estratégia de pesquisa abrangente, procurando pesquisar para além das databases convencionais e agregar diversas informações encontradas sobre o mesmo dispositivo. Para tal, foram seguidas as diretrizes PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), e a avaliação da qualidade dos estudos identificados foi realizada utilizando a ferramenta CASP (Critical Appraisal Skills Programme). Resultados: A revisão resultou na identificação de 1590 referências, das quais 79 foram incluídas. Foram analisados 56 dispositivos wearable, com a ligeira maioria a pertencer à classe de dispositivos de wellness. Foi identificada heterogeneidade substancial nos dispositivos em relação à sua composição, local de uso e ao fluxo de dados em relação a 4 componentes considerados. Os dispositivos de monitorização clínica já evidenciam alguma relevância no mercado e, pouco mais de um terço, visam auxiliar pacientes com DPOC e profissionais de saúde na previsão de exacerbações. Ainda assim, é notória a falta do cumprimento das recomendações validadas, não estando disponíveis dispositivos que avaliem a totalidade dos sinais vitais recomendados. Conclusão: A heterogeneidade identificada, apesar de esperada face à relativa novidade dos dispositivos wearable, alerta para a necessidade de regulamentação do desenvolvimento e investigação destas tecnologias, especialmente do ponto de vista estrutural e de recolha e transmissão de dados

Advanced sensors technology survey

This project assesses the state-of-the-art in advanced or 'smart' sensors technology for NASA Life Sciences research applications with an emphasis on those sensors with potential applications on the space station freedom (SSF). The objectives are: (1) to conduct literature reviews on relevant advanced sensor technology; (2) to interview various scientists and engineers in industry, academia, and government who are knowledgeable on this topic; (3) to provide viewpoints and opinions regarding the potential applications of this technology on the SSF; and (4) to provide summary charts of relevant technologies and centers where these technologies are being developed

Continuous monitoring of vital parameters for clinically valid assessment of human health status

Tese de mestrado integrado, Engenharia Biomédica e Biofísica (Sinais e Imagens Médicas) Universidade de Lisboa, Faculdade de Ciências, 2019The lack of devices suitable for acquiring accurate and reliable measures of patients' physiolog-ical signals in a remote and continuous manner together with the advances in data acquisition technol-ogies during the last decades, have led to the emergence of wearable devices for healthcare. Wearable devices enable remote, continuous and long-term health monitoring in unattended setting. In this con-text, the Swiss Federal Laboratories for Material Science and Technology (Empa) developed a wearable system for long-term electrocardiogram measurements, referred to as textile belt. It consists of a chest strap with two embroidered textile electrodes. The validity of Empa’s system for electrocardiogram monitoring has been proven in a clinical setting. This work aimed to assess the validity of the textile belt for electrocardiogram monitoring in a home setting and to supplement the existing system with sensors for respiratory monitoring. Another objective was to evaluate the suitability of the same weara-ble, as a multi-sensor system, for activity monitoring. A study involving 12 patients (10 males and 2 females, interquartile range for age of 48–59 years and for body mass indexes of 28.0–35.5 kg.m-2) with suspected sleep apnoea was carried out. Overnight electrocardiogram was measured in a total of 28 nights. The quality of recorded signals was assessed using signal-to-noise ratio, artefacts detection and Poincaré plots. Study data were compared to data from the same subjects, acquired in the clinical setting. For respiratory monitoring, optical fibre-based sensors of different geometries were integrated into the textile belt. Signal processing algorithms for breathing rate and tidal volume estimation based on respiratory signals acquired by the sensors were developed. Pilot studies were conducted to compare the different approaches for respiratory monitoring. The quality of respiratory signals was determined based on signal segments “sinusoidality”, evaluated through the calculation of the cross-correlation between signal segments and segment-specific reference waves. A method for accelerometry-based lying position recognition was proposed, and the proof of concept of activity intensity classification through the combination of subjects’ inertial acceleration, heart rate and breathing rate data, was presented. Finally, a study with three participants (1 male and 2 females, aged 21 ± 2 years, body mass index of 20.3 ± 1.5 kg.m-2) was conducted to assess the validity of the textile belt for respiratory and activity monitoring. Electrocardiogram signals acquired by the textile belt in the home setting were found to have better quality than the data acquired by the same device in the clinical setting. Although a higher artefact percentage was found for the textile belt, signal-to-noise ratio of electrocardiogram signals recorded by the textile belt in the home setting was similar to that of signals acquired by the gel electrodes in the clinical setting. A good agreement was found between the RR-intervals derived from signals recorded in home and clinical settings. Besides, for artefact percentages greater than 3%, visual assessment of Poincaré plots proved to be effective for the determination of the primary source of artefacts (noise or ectopic beats). Acceleration data allowed posture recognition (i.e. lying or standing/sitting, lying position) with an accuracy of 91% and positive predictive value of 80%. Lastly, preliminary results of physical activity intensity classification yielded high accuracy, showing the potential of the proposed method. The textile belt proved to be appropriate for long-term, remote and continuous monitoring of subjects’ physical and physiological parameters. It can monitor not only electrocardiogram, but also breathing rate, body posture and physical activity intensity, having the potential to be used as tool for disease prediction and diagnose support.Contexto: A falta de dispositivos adequados para a monitorização de sinais fisiológicos de um modo remoto e contínuo, juntamente com avanços tecnológicos na área de aquisição de dados nas últimas décadas, levaram ao surgimento de wearable devices, i.e. dispositivos vestíveis, no sector da saúde. Wearable devices possibilitam a monitorização do estado de saúde, de uma forma remota, contínua e de longa duração. Quando feito em ambiente domiciliar, este tipo de monitorização (i.e. contínua, remota e de longa duração) tem várias vantagens: diminui a pressão posta sobre o sistema de saúde, reduz despesas associadas ao internamento e acelera a resposta a emergências, permitindo deteção precoce e prevenção de condições crónicas. Neste contexto, a Empa, Laboratórios Federais Suíços de Ciência e Tecnologia de Materiais, desenvolveu um sistema vestível para a monitorização de eletrocardiograma de longa duração. Este sistema consiste num cinto peitoral com dois elétrodos têxteis integrados. Os elétrodos têxteis são feitos de fio de polietileno tereftalato revestido com prata e uma ultrafina camada de titânio no topo. De modo a garantir a aquisição de sinais de alta qualidade, o cinto tem nele integrado um reservatório de água que liberta vapor de água para humidificar os elétrodos. Este reservatório per-mite a monitorização contínua de eletrocardiograma por 5 a 10 dias, sem necessitar de recarga. A vali-dade do cinto para a monitorização de eletrocardiograma em ambiente clínico já foi provada. Objetivo: Este trabalho teve por objetivo avaliar a validade do cinto para a monitorização de eletrocar-diograma em ambiente domiciliar e complementar o sistema existente com sensores para monitorização respiratória. Um outro objetivo foi analisar a adequação do cinto, como um sistema multisensor, para monitorização da atividade física. Métodos: Um estudo com 12 pacientes com suspeita de apneia do sono (10 homens e 2 mulheres, am-plitude interquartil de 48–59 anos para a idade e de 28.0–35.5 kg.m-2 para o índice de massa corporal) foi conduzido para avaliar a qualidade do sinal de eletrocardiograma medido em ambiente domiciliar. O sinal de eletrocardiograma dos pacientes foi monitorizado continuamente, num total de 28 noites. A qualidade dos sinais adquiridos foi analisada através do cálculo da razão sinal-ruído; da deteção de ar-tefactos, i.e., intervalos RR com um valor inviável de um ponto de vista fisiológico; e de gráficos de Poincaré, um método de análise não linear da distribuição dos intervalos RR registados. Os dados ad-quiridos neste estudo foram comparados com dados dos mesmos pacientes, adquiridos em ambiente hospitalar. Para a monitorização respiratória, sensores feitos de fibra óptica foram integrados no cinto. Al-gorítmicos para a estimar a frequência respiratória e o volume corrente dos sujeitos tendo por base o sinal medido pelas fibras ópticas foram desenvolvidos neste trabalho. As diferentes abordagens foram comparadas através de estudos piloto. Diferentes métodos para avaliação da qualidade do sinal adquirido foram sugeridos. Um método de reconhecimento da postura corporal através do cálculo de ângulos de orientação com base na aceleração medida foi proposto. A prova de conceito da determinação da intensidade da atividade física pela combinação de informações relativas á aceleração inercial e frequências cardíaca e respiratória dos sujeitos, é também apresentada neste trabalho. Um estudo foi conduzido para avaliar a validade do cinto para monitorização da respiração e da atividade física. O estudo contou com 10 parti-cipantes, dos quais 3 vestiram o cinto para monitorização da respiração (1 homem e 2 mulheres, idade 21 ± 2 anos, índice de massa corporal 20.3 ± 1.5 kg.m-2). Resultados: O estudo feito com pacientes com suspeita de apneia do sono revelou que os sinais eletro-cardiográficos adquiridos pelo cinto em ambiente domiciliar foram de melhor qualidade que os sinais adquiridos pelo mesmo dispositivo em ambiente hospitalar. Uma percentagem de artefacto de 2.87% ±4.14% foi observada para os dados adquiridos pelos elétrodos comummente usados em ambiente hospi-talar, 7.49% ± 10.76% para os dados adquiridos pelo cinto em ambiente domiciliar e 9.66% ± 14.65% para os dados adquiridos pelo cinto em ambiente hospitalar. Embora tenham tido uma maior percenta-gem de artefacto, a razão sinal-ruído dos sinais eletrocardiográficos adquiridos pelo cinto em ambiente domiciliar foi semelhante á dos sinais adquiridos pelos elétrodos de gel em ambiente hospitalar. Resul-tados sugerem uma boa concordância entre os intervalos RR calculados com base nos eletrocardiogra-mas registados em ambientes hospitalar e domiciliar. Além disso, para sinais com percentagem de arte-facto superior a 3%, a avaliação visual dos gráficos de Poincaré provou ser um bom método para a determinação da fonte primária de artefactos (batimentos irregulares ou ruído). A monitorização da aceleração dos sujeitos permitiu o reconhecimento da postura corporal (isto é, deitado ou sentado/em pé) com uma exatidão de 91% e valor preditivo positivo de 80%. Por fim, a classificação da intensidade da atividade física baseado na aceleração inercial e frequências cardíaca e respiratória revelou elevada exatidão, mostrando o potencial desta técnica. Conclusão: O cinto desenvolvido pela Empa provou ser apropriado para monitorização de longa-dura-ção de variáveis físicas e fisiológicos, de uma forma remota e contínua. O cinto permite não só monito-rizar eletrocardiograma, mas também frequência respiratória, postura corporal e intensidade da atividade física. Outros estudos devem ser conduzidos para corroborar os resultados e conclusões deste trabalho. Outros sensores poderão ser integrados no cinto de modo a possibilitar a monitorização de outras vari-áveis fisiológicas de relevância clínica. Este sistema tem o potencial de ser usado como uma ferramenta para predição de doenças e apoio ao diagnóstico

Every sign of life

Thesis (Ph. D.)--Massachusetts Institute of Technology, School of Architecture and Planning, Program in Media Arts and Sciences, 2003.MIT Institute Archives copy: pages 151-[182] bound in reverse order.Includes bibliographical references (p. 142-150).Every Sign of Life introduces an approach to and motivational schema for personal health monitoring. It is an exploration of how to make information collected by personal health-monitoring devices fun and engaging, and consequently more useful to the non-specialist. In contrast to the common methodology of adding game elements to established biofeedback systems, the Every Sign of Life approach is to design and build games that use biosensor information to effect the game environment. This work tests the hypothesis that fun (the joy of learning, achieving, competing, etc.) is a way to achieve the goal of self-efficacy; to induce people to take care of their own health by altering their habits and lifestyles. One result is a basic architecture for personal health-monitoring systems that has led to an approach to the design of sensor peripherals and wearable computer components called "Extremity Computing." This approach is used to redefine biosensor monitoring from periodic to continuous (ultimately saving data over a lifetime). Another result is an approach to adding implicit biofeedback to computer games. This has led to a new genre of games called "Bio-Analytical Games" that straddles the boundary between sports and computer games. A series of studies of how to present health information to children and adults have demonstrated the ability of consumers to use bioinformatics without involving professionals.by Vadim Gerasimov.Ph.D

Smart Sensors for Healthcare and Medical Applications

This book focuses on new sensing technologies, measurement techniques, and their applications in medicine and healthcare. Specifically, the book briefly describes the potential of smart sensors in the aforementioned applications, collecting 24 articles selected and published in the Special Issue “Smart Sensors for Healthcare and Medical Applications”. We proposed this topic, being aware of the pivotal role that smart sensors can play in the improvement of healthcare services in both acute and chronic conditions as well as in prevention for a healthy life and active aging. The articles selected in this book cover a variety of topics related to the design, validation, and application of smart sensors to healthcare

Minimally invasive clinical monitoring and data transference in cardiac patients

'Wet' electrodes used in electrocardiography (ECG), are applied to the surface of the skin to record cardiac activity. Over time, water-based electrolytic gels between the electrodes and skin dehydrate, reducing signal quality. Microneedle-electrodes negate the need for conductive gels and potentially improve signal fidelity by circumventing the stratum corneum and contacting the underlying conductive epidermal layers. This thesis aimed to assess the wearability and functionality of microneedle-electrodes in cardiac signal acquisition. Epoxy, 500μm-length microneedles were applied to excised skin models to assess insertion performance. Increasing downward application force increased microneedle penetration efficiency from 79%±8.20 (5N) to 87%±13.32 (15N). The microneedle application technique also had an impact on penetration efficiency, with impact insertion (93%±5.75) proving more effective than manual downward force (71%±22.01). Metallised versions of the epoxy microneedles were integrated into a commercial electrode and compared to conventional wet electrodes in human volunteers. Wet electrodes recorded higher quality signals than microneedle-electrodes in healthy human participants (1.6dB difference between the electrode types). This clinical data informed the development of an in vitro laboratory skin model to assess the influence of microneedle-electrode parameters on a simulated ECG signal. Increasing microneedle length from 500μm (25.2dB±3.25) to 600μm (24.3dB±2.31) did not result in a sustained improvement in signal quality (p>0.05). Bespoke second-generation microneedle-electrodes were manufactured allowing an improved signal quality to be maintained over the recording period (17.3dB±2.11 compared to 15.0dB±1.97 for wet electrodes; p>0.05) in the laboratory model. Human participant studies assessed their wearability and functionality. At rest, the metallised epoxy (23.2dB±5.79) and bespoke (22.5dB±7.57) microneedle-electrode performance was comparable to wet electrodes (24.9dB±6.44) (p>0.05). Under active conditions, the signal-to-noise ratio declined for all electrodes and ECG traces highlighted increased motion artifacts. Participants preferred wet electrodes and highlighted seven key wearability themes. Further optimisation of microneedle-electrodes for ECG monitoring is therefore, warranted

Telemedicine and its application in telemedicine management

Telemedicine can be defined as the extensive depiction of providing medical and healthcare services by using telecommunications structures. Information Technology (IT) which covers controlling, interactive media, pattern recognition, knowledge management, image and signal processing: have empowered an extensive array of telemedicine applications to be supported. The joined consequence of the expansion of the global population and maturing populace in most advanced countries offersascent to an increasing interest on the public health system. The effect on public health systems in various nations were further empowered by a change in the lifestyle and environmental contamination which further increases the demand for health systems. This is obvious from the pattern of perpetual ailments and complication arising from obesity-related conditions which attack youthful individuals over the previous decade. Currently, the financial prosperity which blesses the present generation is a result of the diligent work done by our fore fathers and the rapacious exploitation of the natural resources that will eventually cause various issues to the upcoming generation. Therefore, we should seize the responsibility of caring for the elderly who tirelessly sacrificed their time for the betterment of the current generation. Nevertheless, we are attempting to upgrade medicinal technology to enhance our well-being, and to furnish a supportable healthcare system for the upcoming era. Telemedicine is poised as a means of fulfilling our obligations to the adolescents and the elderly