256 research outputs found
The EU project “United4Health”: Results and experiences from automatic health status assessment in a Norwegian telemedicine trial system
Introduction Patients with chronic obstructive pulmonary disease require help in daily life situations to increase their individual perception of security, especially under worsened medical conditions. Unnecessary hospital (re-)admissions and home visits by doctors or nurses shall be avoided. This study evaluates the results from a two-year telemedicine field trial for automatic health status assessment based on remote monitoring and analysis of a long time series of vital signs data from patients at home over periods of weeks or months. Methods After discharge from hospital treatment for acute exacerbations, 94 patients were recruited for follow-up by the trial system. The system supported daily measurements of pulse and transdermal peripheral capillary oxygen saturation at patients' homes, a symptom-specific questionnaire, and provided nurses trained to use telemedicine ("telenurses") with an automatically generated health status overview of all monitored patients. A colour code (green/yellow/red) indicated whether the patient was stable or had a notable deterioration, while red alerts highlighted those in most urgent need of follow-up. The telenurses could manually overwrite the status level based on the patients' conditions observed through video consultation. Results Health status evaluation in 4970 telemonitor datasets were assessed retrospectively. The automatic health status determination (subgroup of 33 patients) showed green status at 46% of the days during a one-month monitoring period, 28% yellow status, and 19% red status (no data reported at 7% of the days). The telenurses manually downrated approximately 10% of the red or yellow alerts. Discussion The evaluation of the defined real-time health status assessment algorithms, which involve static rules with personally adapted elements, shows limitations to adapt long-term home monitoring with adequate interpretation of day-to-day changes in the patient's condition. Thus, due to the given sensitivity and specificity of such algorithms, it seems challenging to avoid false high alerts.acceptedVersionnivå
Strategic Intelligence Monitor on Personal Health Systems (SIMPHS): Report on Typology/Segmentation of the PHS Market
This market segmentation reports for Personal Health Systems (PHS) describes the methodological background and illustrates the principles of classification and typology regarding different fragments forming this market. It discusses different aspects of the market for PHS and highlights challenges towards a stringent and clear-cut typology or defining market segmentation. Based on these findings a preliminary hybrid typology and indications and insights are created in order to be used in the continuation of the SIMPHS project. It concludes with an annex containing examples and cases studies.JRC.DDG.J.4-Information Societ
Informatics for devices within telehealth systems for monitoring chronic diseases
Preliminary investigation at the beginning of this research showed that informatics on point-of-care (POC) devices was limited to basic data generation and processing.
This thesis is based on publications of several studies during the course of the research.
The aim of the research is to model and analyse information generation and exchange in telehealth systems and to identify and analyse the capabilities of these systems in managing chronic diseases which utilise point-of-care devices.
The objectives to meet the aim are as follows: (i) to review the state-of-the-art in informatics and decision support on point-of-care devices. (ii) to assess the current level of servitization of POC devices used within the home environment. (iii) to identify current models of information generation and exchange for POC devices using a telehealth perspective. (iv) to identify the capabilities of telehealth systems. (v) to evaluate key components of telehealth systems (i.e. POC devices and intermediate devices). (vi) to analyse the capabilities of telehealth systems as enablers to a healthcare policy.
The literature review showed that data transfer from devices is an important part of generating information. The implication of this is that future designs of devices should have efficient ways of transferring data to minimise the errors that may be introduced through manual data entry/transfer.
The full impact of a servitized model for point-of-care devices is possible within a telehealth system, since capabilities of interpreting data for the patient will be offered as a service (c.f. NHS Direct).
This research helped to deduce components of telehealth systems which are important in supporting informatics and decision making for actors of the system. These included actors and devices. Telehealth systems also help facilitate the exchange of data to help decision making to be faster for all actors concerned.
This research has shown that a large number of capability categories existed for the patients and health professionals. There were no capabilities related to the caregiver that had a direct impact on the patient and health professional. This was not surprising since the numbers of caregivers in current telehealth systems was low.
Two types of intermediate devices were identified in telehealth systems: generic and proprietary. Patients and caregivers used both types, while health professionals only used generic devices. However, there was a higher incidence of proprietary devices used by patients. Proprietary devices possess features to support patients better thus promoting their independence in managing their chronic condition.
This research developed a six-step methodology for working from government objectives to appropriate telehealth capability categories. This helped to determine objectives for which a telehealth system is suitable
Health monitoring system using pulse oximeter with remote alert
This A remote patient monitoring system is implemented
which is used for real time monitoring of various heath parameters
of a remotely based patient. Oxygen saturation and body
temperature are the two parameters calculated and transmitted via
a server to a remote client. The main purpose of this paper is to
present a remote Pulse Oximetry System for health monitoring
purposes. The framework lays on the idea that the vital health
signs, can be collected from the patient and passed to a processer,
where these signs will be processed, compared and monitored in
order to alert important personnel in the case of an emergency. The
blood oxygen saturation is the biometric sign which is monitored by
this device .The technique used in this work is called
“Photoplethysmography” which is based on the change in the
intensity of light transmitted through the tissue due to arterial blood
pulse. This technique converts the intensity of light into a voltage
signal which is used to calculate the oxygen saturation of the
patient. This is due to the fact that oxygenated blood has such
characteristics in absorbing the Red and Infrared wavelengths
which differs from the deoxygenated blood. Comparison of the two
absorptions produces an estimation of the oxygen saturation in the
patient’s blood
Clinical evaluation of a novel adaptive bolus calculator and safety system in Type 1 diabetes
Bolus calculators are considered state-of-the-art for insulin dosing decision support for people with Type 1 diabetes (T1D). However, they all lack the ability to automatically adapt in real-time to respond to an individual’s needs or changes in insulin sensitivity. A novel insulin recommender system based on artificial intelligence has been developed to provide personalised bolus advice, namely the Patient Empowerment through Predictive Personalised Decision Support (PEPPER) system. Besides adaptive bolus advice, the decision support system is coupled with a safety system which includes alarms, predictive glucose alerts, predictive low glucose suspend for insulin pump users, personalised carbohydrate recommendations and dynamic bolus insulin constraint.
This thesis outlines the clinical evaluation of the PEPPER system in adults with T1D on multiple daily injections (MDI) and insulin pump therapy. The hypothesis was that the PEPPER system is safe, feasible and effective for use in people with TID using MDI or pump therapy. Safety and feasibility of the safety system was initially evaluated in the first phase, with the second phase evaluating feasibility of the complete system (safety system and adaptive bolus advisor). Finally, the whole system was clinically evaluated in a randomised crossover trial with 58 participants.
No significant differences were observed for percentage times in range between the PEPPER and Control groups. For quality of life, participants reported higher perceived hypoglycaemia with the PEPPER system despite no objective difference in time spent in hypoglycaemia.
Overall, the studies demonstrated that the PEPPER system is safe and feasible for use when compared to conventional therapy (continuous glucose monitoring and standard bolus calculator). Further studies are required to confirm overall effectiveness.Open Acces
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
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
Informatics for devices within telehealth systems for monitoring chronic diseases
Preliminary investigation at the beginning of this research showed that informatics on point-of-care (POC) devices was limited to basic data generation and processing. This thesis is based on publications of several studies during the course of the research. The aim of the research is to model and analyse information generation and exchange in telehealth systems and to identify and analyse the capabilities of these systems in managing chronic diseases which utilise point-of-care devices. The objectives to meet the aim are as follows: (i) to review the state-of-the-art in informatics and decision support on point-of-care devices. (ii) to assess the current level of servitization of POC devices used within the home environment. (iii) to identify current models of information generation and exchange for POC devices using a telehealth perspective. (iv) to identify the capabilities of telehealth systems. (v) to evaluate key components of telehealth systems (i.e. POC devices and intermediate devices). (vi) to analyse the capabilities of telehealth systems as enablers to a healthcare policy. The literature review showed that data transfer from devices is an important part of generating information. The implication of this is that future designs of devices should have efficient ways of transferring data to minimise the errors that may be introduced through manual data entry/transfer. The full impact of a servitized model for point-of-care devices is possible within a telehealth system, since capabilities of interpreting data for the patient will be offered as a service (c.f. NHS Direct). This research helped to deduce components of telehealth systems which are important in supporting informatics and decision making for actors of the system. These included actors and devices. Telehealth systems also help facilitate the exchange of data to help decision making to be faster for all actors concerned. This research has shown that a large number of capability categories existed for the patients and health professionals. There were no capabilities related to the caregiver that had a direct impact on the patient and health professional. This was not surprising since the numbers of caregivers in current telehealth systems was low. Two types of intermediate devices were identified in telehealth systems: generic and proprietary. Patients and caregivers used both types, while health professionals only used generic devices. However, there was a higher incidence of proprietary devices used by patients. Proprietary devices possess features to support patients better thus promoting their independence in managing their chronic condition. This research developed a six-step methodology for working from government objectives to appropriate telehealth capability categories. This helped to determine objectives for which a telehealth system is suitable.EThOS - Electronic Theses Online ServiceGBUnited Kingdo
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