An ANT+ Protocol Based Health Care System

In remote health care Body Area Networks (BAN) are very popular but demand low energy consumption due to very constrained resources. For it several protocols, such as ZigBee, BlueTooth, WiFi etc, have been proposed but non has delivered the optimum results. These systems also demand vast interoperability among devices. Recently a propriety protocol ANT+ provides such features and strengthens the goals for Internet of Things (IOT). The authors describe a software architecture which flexibly integrates ANT+ protocol enabled sensors to deliver health care services. The approach is validated on a health care application that integrates heart rate, cadence, distance, foot steps and environmental temperature sensors. Described architecture is modular, flexible, scalable and possess several features

FEATURE SELECTION APPLIED TO THE TIME-FREQUENCY REPRESENTATION OF MUSCLE NEAR-INFRARED SPECTROSCOPY (NIRS) SIGNALS: CHARACTERIZATION OF DIABETIC OXYGENATION PATTERNS

Diabetic patients might present peripheral microcirculation impairment and might benefit from physical training. Thirty-nine diabetic patients underwent the monitoring of the tibialis anterior muscle oxygenation during a series of voluntary ankle flexo-extensions by near-infrared spectroscopy (NIRS). NIRS signals were acquired before and after training protocols. Sixteen control subjects were tested with the same protocol. Time-frequency distributions of the Cohen's class were used to process the NIRS signals relative to the concentration changes of oxygenated and reduced hemoglobin. A total of 24 variables were measured for each subject and the most discriminative were selected by using four feature selection algorithms: QuickReduct, Genetic Rough-Set Attribute Reduction, Ant Rough-Set Attribute Reduction, and traditional ANOVA. Artificial neural networks were used to validate the discriminative power of the selected features. Results showed that different algorithms extracted different sets of variables, but all the combinations were discriminative. The best classification accuracy was about 70%. The oxygenation variables were selected when comparing controls to diabetic patients or diabetic patients before and after training. This preliminary study showed the importance of feature selection techniques in NIRS assessment of diabetic peripheral vascular impairmen

A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties.

BackgroundThe U.S. Centers for Medicare and Medicaid Services established the Electronic Health Record (EHR) Incentive Program in 2009 to stimulate the adoption of EHRs. One component of the program requires eligible providers to implement clinical decision support (CDS) interventions that can improve performance on one or more quality measures pre-selected for each specialty. Because the unique decision-making challenges and existing HIT capabilities vary widely across specialties, the development of meaningful objectives for CDS within such programs must be supported by deliberative analysis.DesignWe developed a conceptual framework and protocol that combines evidence review with expert opinion to elicit clinically meaningful objectives for CDS directly from specialists. The framework links objectives for CDS to specialty-specific performance gaps while ensuring that a workable set of CDS opportunities are available to providers to address each performance gap. Performance gaps may include those with well-established quality measures but also priorities identified by specialists based on their clinical experience. Moreover, objectives are not constrained to performance gaps with existing CDS technologies, but rather may include those for which CDS tools might reasonably be expected to be developed in the near term, for example, by the beginning of Stage 3 of the EHR Incentive program. The protocol uses a modified Delphi expert panel process to elicit and prioritize CDS meaningful use objectives. Experts first rate the importance of performance gaps, beginning with a candidate list generated through an environmental scan and supplemented through nominations by panelists. For the highest priority performance gaps, panelists then rate the extent to which existing or future CDS interventions, characterized jointly as "CDS opportunities," might impact each performance gap and the extent to which each CDS opportunity is compatible with specialists' clinical workflows. The protocol was tested by expert panels representing four clinical specialties: oncology, orthopedic surgery, interventional cardiology, and pediatrics

Distance Aware Relaying Energy-efficient: DARE to Monitor Patients in Multi-hop Body Area Sensor Networks

In recent years, interests in the applications of Wireless Body Area Sensor Network (WBASN) is noticeably developed. WBASN is playing a significant role to get the real time and precise data with reduced level of energy consumption. It comprises of tiny, lightweight and energy restricted sensors, placed in/on the human body, to monitor any ambiguity in body organs and measure various biomedical parameters. In this study, a protocol named Distance Aware Relaying Energy-efficient (DARE) to monitor patients in multi-hop Body Area Sensor Networks (BASNs) is proposed. The protocol operates by investigating the ward of a hospital comprising of eight patients, under different topologies by positioning the sink at different locations or making it static or mobile. Seven sensors are attached to each patient, measuring different parameters of Electrocardiogram (ECG), pulse rate, heart rate, temperature level, glucose level, toxins level and motion. To reduce the energy consumption, these sensors communicate with the sink via an on-body relay, affixed on the chest of each patient. The body relay possesses higher energy resources as compared to the body sensors as, they perform aggregation and relaying of data to the sink node. A comparison is also conducted conducted with another protocol of BAN named, Mobility-supporting Adaptive Threshold-based Thermal-aware Energy-efficient Multi-hop ProTocol (M-ATTEMPT). The simulation results show that, the proposed protocol achieves increased network lifetime and efficiently reduces the energy consumption, in relative to M-ATTEMPT protocol.Comment: IEEE 8th International Conference on Broadband and Wireless Computing, Communication and Applications (BWCCA'13), Compiegne, Franc

A falls prevention programme to improve quality of life, physical function and falls efficacy in older people receiving home help services: study protocol for a randomised controlled trial

BACKGROUND: Falls and fall-related injuries in older adults are associated with great burdens, both for the individuals, the health care system and the society. Previous research has shown evidence for the efficiency of exercise as falls prevention. An understudied group are older adults receiving home help services, and the effect of a falls prevention programme on health-related quality of life is unclear. The primary aim of this randomised controlled trial is to examine the effect of a falls prevention programme on quality of life, physical function and falls efficacy in older adults receiving home help services. A secondary aim is to explore the mediating factors between falls prevention and health-related quality of life. METHODS: The study is a single-blinded randomised controlled trial. Participants are older adults, aged 67 or older, receiving home help services, who are able to walk with or without walking aids, who have experienced at least one fall during the last 12 months and who have a Mini Mental State Examination of 23 or above. The intervention group receives a programme, based on the Otago Exercise Programme, lasting 12 weeks including home visits and motivational telephone calls. The control group receives usual care. The primary outcome is health-related quality of life (SF-36). Secondary outcomes are leg strength, balance, walking speed, walking habits, activities of daily living, nutritional status and falls efficacy. All measurements are performed at baseline, following intervention at 3 months and at 6 months' follow-up. Sample size, based on the primary outcome, is set to 150 participants randomised into the two arms, including an estimated 15-20% drop out. Participants are recruited from six municipalities in Norway. DISCUSSION: This trial will generate new knowledge on the effects of an exercise falls prevention programme among older fallers receiving home help services. This knowledge will be useful for clinicians, for health managers in the primary health care service and for policy makers

Written information for patients (or parents of child patients) to reduce the use of antibiotics for acute upper respiratory tract infections in primary care

BackgroundAcute upper respiratory tract infections (URTIs) are frequently managed in primary care settings. Although many are viral, and there is an increasing problem with antibiotic resistance, antibiotics continue to be prescribed for URTIs. Written patient information may be a simple way to reduce antibiotic use for acute URTIs. ObjectivesTo assess if written information for patients (or parents of child patients) reduces the use of antibiotics for acute URTIs in primary care. Search methodsWe searched CENTRAL, MEDLINE, Embase, CINAHL, LILACS, Web of Science, clinical trials.gov, and the World Health Organization (WHO) trials registry up to July 2016 without language or publication restrictions. Selection criteriaWe included randomised controlled trials (RCTs) involving patients (or parents of child patients) with acute URTIs, that compared written patient information delivered immediately before or during prescribing, with no information. RCTs needed to have measured our primary outcome (antibiotic use) to be included. Data collection and analysisTwo review authors screened studies, extracted data, and assessed study quality. We could not meta-analyse included studies due to significant methodological and statistical heterogeneity; we summarised the data narratively. Main resultsTwo RCTs met our inclusion criteria, involving a total of 827 participants. Both studies only recruited children with acute URTIs (adults were not involved in either study): 558 children from 61 general practices in England and Wales; and 269 primary care doctors who provided data on 33,792 patient-doctor consultations in Kentucky, USA. The UK study had a high risk of bias due to lack of blinding and the US cluster-randomised study had a high risk of bias because the methods to allocate participants to treatment groups was not clear, and there was evidence of baseline imbalance. In both studies, clinicians provided written information to parents of child patients during primary care consultations: one trained general practitioners (GPs) to discuss an eight-page booklet with parents; the other conducted a factorial trial with two comparison groups (written information compared to usual care and written information plus prescribing feedback to clinicians compared to prescribing feedback alone). Doctors in the written information arms received 25 copies of two-page government-sponsored pamphlets to distribute to parents. Compared to usual care, we found moderate quality evidence (one study) that written information significantly reduced the number of antibiotics used by patients (RR 0.53, 95% CI 0.35 to 0.80; absolute risk reduction (ARR) 20% (22% versus 42%)) and had no significant effect on reconsultation rates (RR 0.79, 95% CI 0.47 to 1.32), or parent satisfaction with consultation (RR 0.95, 95% CI 0.87 to 1.03). Low quality evidence (two studies) demonstrated that written information also reduced antibiotics prescribed by clinicians (RR 0.47, 95% CI 0.28 to 0.78; ARR 21% (20% versus 41%); and RR 0.84, 95% CI 0.81 to 0.86; 9% ARR (45% versus 54%)). Neither study measured resolution of symptoms, patient knowledge about antibiotics for acute URTIs, or complications for this comparison. Compared to prescribing feedback, we found low quality evidence that written information plus prescribing feedback significantly increased the number of antibiotics prescribed by clinicians (RR 1.13, 95% CI 1.09 to 1.17; absolute risk increase 6% (50% versus 44%)). Neither study measured reconsultation rate, resolution of symptoms, patient knowledge about antibiotics for acute URTIs, patient satisfaction with consultation or complications for this comparison. Authors' conclusionsCompared to usual care, moderate quality evidence from one study showed that trained GPs providing written information to parents of children with acute URTIs in primary care can reduce the number of antibiotics used by patients without any negative impact on reconsultation rates or parental satisfaction with consultation. Low quality evidence from two studies shows that, compared to usual care, GPs prescribe fewer antibiotics for acute URTIs but prescribe more antibiotics when written information is provided alongside prescribing feedback (compared to prescribing feedback alone). There was no evidence addressing resolution of patients' symptoms, patient knowledge about antibiotics for acute URTIs, or frequency of complications. To fill evidence gaps, future studies should consider testing written information on antibiotic use for adults with acute URTIs in high- and low-income settings provided without clinician training and presented in different formats (such as electronic). Future study designs should endeavour to ensure blinded outcome assessors. Study aims should include measurement of the effect of written information on the number of antibiotics used by patients and prescribed by clinicians, patient satisfaction, reconsultation, patients' knowledge about antibiotics, resolution of symptoms, and complications.</p