Antepartum Fetal Monitoring through a Wearable System and a Mobile Application

Prenatal monitoring of Fetal Heart Rate (FHR) is crucial for the prevention of fetal pathologies and unfavorable deliveries. However, the most commonly used Cardiotocographic exam can be performed only in hospital-like structures and requires the supervision of expert personnel. For this reason, a wearable system able to continuously monitor FHR would be a noticeable step towards a personalized and remote pregnancy care. Thanks to textile electrodes, miniaturized electronics, and smart devices like smartphones and tablets, we developed a wearable integrated system for everyday fetal monitoring during the last weeks of pregnancy. Pregnant women at home can use it without the need for any external support by clinicians. The transmission of FHR to a specialized medical center allows its remote analysis, exploiting advanced algorithms running on high-performance hardware able to obtain the best classification of the fetal condition. The system has been tested on a limited set of pregnant women whose fetal electrocardiogram recordings were acquired and classified, yielding an overall score for both accuracy and sensitivity over 90%. This novel approach can open a new perspective on the continuous monitoring of fetus development by enhancing the performance of regular examinations, making treatments really personalized, and reducing hospitalization or ambulatory visits. Keywords: tele-monitoring; wearable devices; fetal heart rate; telemedicin

Improving access to the health care system for disadvantaged groups with the help of private health insurance in Portugal

The world’s population is ageing, and so is the Portuguese population. (Instituto National de Estatistica, 2022c) With an aging population, it is especially important to make sure that people age healthily and do not become a greater burden on the system. This master thesis investigates the possibilities of supporting especially the disadvantaged, poor and old population with a private health insurance. The Portuguese market was analyzed to better understand the problem structure, and a benchmark analysis was performed to identify possible solutions. The result brought different solutions, which were investigated in more detail. The result shows that the problem can only be addressed by a combination of solutions. Attention has to be paid to the costs as well as to the revenue structure. The cost structure represents a larger solution potential, since more approaches were identified, and initiatives do already exist. More research needs to be done specifically on the revenue side. Especially with regards to legal regulations.A população mundial está a envelhecer, tal como a população portuguesa. (Instituto Nacional de Estatistica, 2022c) Com uma população envelhecida, é especialmente importante assegurar que as pessoas envelheçam saudavelmente e não se tornem um fardo maior para o sistema. Esta tese de mestrado investiga as possibilidades de apoiar especialmente a população desfavorecida, pobre e idosa com um seguro de saúde privado. O mercado português foi analisado para melhor compreender a estrutura do problema, e foi realizada uma análise de referência para identificar possíveis soluções. O resultado trouxe diferentes soluções, que foram investigadas com mais detalhe. O resultado mostra que o problema só pode ser abordado através de uma combinação de soluções. Há que prestar atenção aos custos, bem como à estrutura de receitas. A estrutura de custos representa um potencial de solução maior, uma vez que foram identificadas mais abordagens e que já existem iniciativas. Mais investigação tem de ser feita especificamente no lado das receitas. Especialmente no que diz respeito aos regulamentos legais

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

The telemedicine intervention in chronic disease management promises to involve patients in their own care, provides continuous monitoring by their healthcare providers, identifies early symptoms, and responds promptly to exacerbations in their illnesses. This review set out to establish the evidence from the available literature on the impact of telemedicine for the management of three chronic diseases: congestive heart failure, stroke, and chronic obstructive pulmonary disease. By design, the review focuses on a limited set of representative chronic diseases because of their current and increasing importance relative to their prevalence, associated morbidity, mortality, and cost. Furthermore, these three diseases are amenable to timely interventions and secondary prevention through telemonitoring. The preponderance of evidence from studies using rigorous research methods points to beneficial results from telemonitoring in its various manifestations, albeit with a few exceptions. Generally, the benefits include reductions in use of service: hospital admissions/re-admissions, length of hospital stay, and emergency department visits typically declined. It is important that there often were reductions in mortality. Few studies reported neutral or mixed findings.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140284/1/tmj.2014.9981.pd

Évaluation de l’impact des services en téléobstétrique du RUIS McGill offerts à une population de femmes inuites avec grossesse à risque élevé habitant sur la côte de la baie d’Hudson au Nunavik

L’accessibilité à des soins de santé pour une population habitant une région éloignée au Québec représente un défi de taille pour le Ministère de la santé et des services sociaux. Des solutions, telles que la télésanté, ont été présentées afin de pallier ce problème. Le RUIS McGill a ainsi développé un programme de téléobstétrique afin de desservir une population de femmes inuites à grossesse à risque élevé (GARE) habitant le Nunavik. L’objectif de ce mémoire fut de comprendre l’impact du service de téléobstétrique du RUIS McGill sur la santé des femmes et de leur nouveau-né ainsi que sur les coûts de santé et l’utilisation des services suite à son implantation au Centre de santé et de services sociaux Inuulitsivik sur la côte de la baie d’Hudson. Les femmes inuites à grossesse à risque élevé et leurs enfants de la région de la baie d’Hudson du Nunavik, éloignés des services obstétriques spécialisés, sont visés. Le service de téléobstétrique permet un accès aux obstétriciens du RUIS McGill localisés à Montréal. Un devis quasi-expérimental est utilisé pour examiner trois hypothèses portant sur l’état de santé des mères et des enfants, sur l’utilisation des services de santé et sur leurs coûts. Le service de téléobstétrique est devenu fonctionnel en 2006, offrant la possibilité de constituer une étude avant-après à deux groupes de femmes, soit celles ayant accouché avant 2006 (prétest) et celle ayant accouché après 2012 (post-test). La collecte de donnée se fit, dans son intégralité, par l’entremise des dossiers médicaux papier des participantes permettant l’analyse de 47 dossiers pour le prétest et de 81 dossiers pour le post-test. L’exécution d’analyse de covariance, de régression logistique et du test non paramétrique de Mann-Witney permit de conclure que le prétest et le post-test ne différent que sur deux variables, soient le poids à la naissance, plus faible dans le post-test et la pression artérielle de la mère à la naissance, plus élevée dans le post-test. Pour l’ensemble des autres variables portant sur les trois hypothèses à l’étude, les résultats de ce mémoire ne démontrent aucune différence significative entre les deux groupes démontrant ainsi qu’une même qualité de soins a été conservée suite à l’implantation du programme de téléobstétrique. Sur la base des résultats, ce mémoire recommande de revoir et modifier les objectifs du programme; de partager les bornes de communication de télésanté avec d’autres spécialités; d’entreprendre une évaluation du programme axée sur les coûts; de suivre rigoureusement l’utilisation du programme pour en maximiser l’efficacité et le potentiel; d’établir un tableau de bord; et d’entreprendre une étude évaluative comparative dans un service de téléobstétrique comparable.Health care accessibility to the population located in a remote region of Quebec represents a challenge for the Ministère de la santé et des services sociaux. Solution such as telemedicine has been used to mitigate this issue. Therefore RUIS McGill has developed a teleobstetric program helping Inuit women in Nunavik with their risky pregnancy. This thesis’s objective is to understand the impact of the RUIS McGill teleobstetric program on the mother and her new born health plus the cost and utilization of health services following its implementation in the Inuulitsivik Health & and Social Services Centre located on Hudson Bay Shore. Inuit women at high risk pregnancy and their children in the region of Nunavik's Hudson Bay, who are far away from specialist in obstetric, are targeted. The teleobstetric program provides access to the RUIS McGill obstetricians located in Montreal. A quasi- experimental design was used to examine three hypotheses about the mothers and their children health, the use of health services and their costs. The teleobstetric program became operational in 2006, providing the ability to be a before-after study with two groups of women, those who delivered before 2012 (pre-test) and those who delivered after 2006 (post-test). The data collection took place, in its entirety, through paper medical records of the participants allowing the analysis of 47 cases for the pre-test and 81 cases for the post-test. Variance and covariance’s analysis, logistical regression and the non-parametric Mann-Witney test has allowed to conclude that the pre-test and post-test are different for only two variables which is the weight at birth, lower in the post-test and for the blood pressure of the mother at birth, higher in the post-test. For all other variables based on the three hypothesis of this thesis, results show no significate difference between pre-test and post-test, illustrating that the same level of quality has been conserved after the implementation of the teleobstetric program. Based on results, this thesis recommends reviewing and modifying the program’s objectives; sharing telehealth communication terminals with other specialties; undertaking an assessment of the cost-based program; strictly monitor the use of the program to maximize efficiency and potential; establishing a dashboard; and undertaking a comparative evaluation study in a comparable teleobstetric service

Digital solutions for self-monitoring physical health and wellbeing during pregnancy

Perinatal disorders were among the top ten causes of global burden of disease in 2019. Better access to perinatal healthcare would help to reduce preventable morbidity. The increase in access to and use of smartphones presents a unique opportunity to transform and improve how women monitor their own health during pregnancy. This thesis aims to investigate the quality and usage of currently available pregnancy digital health tools for self-monitoring and to validate a newly developed, custom-built pregnancy self-monitoring tool. In Chapter 2, the most popular, commercially available pregnancy apps and their monitoring tools were evaluated for their quality by conducting a pregnancy app scoping review. In Chapters 3 and 4, pregnant women and healthcare professionals were surveyed and interviewed to better understand their usage of and attitudes towards digital health, as well as their thoughts about two hypothetical app features (a direct patient-to-healthcare professional communication tool and a novel body measurement tool). In Chapter 5, we test the performance of a first generation, custom-built body measurement tool (which we called BMT-1) by comparing the digital measurements extracted from photos taken on smartphones to physical measurements taken with measuring tape. The performance of BMT-1 was also assessed on a longitudinal set of digitally constructed pregnancy models. Collectively, the findings from Chapters 2, 3 and 4 provide evidence that there is both opportunity and scope for the development of new digital health tools to support and enhance the quality of care during pregnancy. The results from Chapter 5 indicate that BMT-1 successfully extracted body measurements from both photos and digitally constructed pregnancy models, though would require refinement before it could be launched. To finalise, in Chapter 6, I outline how these findings could help to guide the design, development and implementation of new pregnancy digital health tools

Cost-effectiveness of telemonitoring for high-risk pregnant women

Purpose Cost-minimization is a main topic in present-day health care. Clinicians are urged to keep hospital stays as short as possible, also in Obstetrics and Gynaecology Departments. At present stabilized high-risk pregnant women stay in hospital for the sole purpose of being monitored. Method In this retrospective study the cost-effectiveness of telemonitoring of such high-risk pregnant women was calculated by analyzing the data of 456 episodes originating from 415 patients of the Ghent University Hospital. Results and conclusions It was determined that telemonitoring made a cost-reduction of €145,822 per year possible. However, variables such as educational level, psychosocial situation, time–travel distance from home to the hospital, reimbursement system and actual clinical status were not included. Furthermore, the Belgian health authorities does not provide for a specific code to allow the billing of teleinterpretation of transmitted results