Feasibility Evaluation of Commercially Available Video Conferencing Devices to Technically Direct Untrained Nonmedical Personnel to Perform a Rapid Trauma Ultrasound Examination.

Introduction: Point-of-care ultrasound (POCUS) is a rapidly expanding discipline that has proven to be a valuable modality in the hospital setting. Recent evidence has demonstrated the utility of commercially available video conferencing technologies, namely, FaceTime (Apple Inc, Cupertino, CA, USA) and Google Glass (Google Inc, Mountain View, CA, USA), to allow an expert POCUS examiner to remotely guide a novice medical professional. However, few studies have evaluated the ability to use these teleultrasound technologies to guide a nonmedical novice to perform an acute care POCUS examination for cardiac, pulmonary, and abdominal assessments. Additionally, few studies have shown the ability of a POCUS-trained cardiac anesthesiologist to perform the role of an expert instructor. This study sought to evaluate the ability of a POCUS-trained anesthesiologist to remotely guide a nonmedically trained participant to perform an acute care POCUS examination. Methods: A total of 21 nonmedically trained undergraduate students who had no prior ultrasound experience were recruited to perform a three-part ultrasound examination on a standardized patient with the guidance of a remote expert who was a POCUS-trained cardiac anesthesiologist. The examination included the following acute care POCUS topics: (1) cardiac function via parasternal long/short axis views, (2) pneumothorax assessment via pleural sliding exam via anterior lung views, and (3) abdominal free fluid exam via right upper quadrant abdominal view. Each examiner was given a handout with static images of probe placement and actual ultrasound images for the three views. After a brief 8 min tutorial on the teleultrasound technologies, a connection was established with the expert, and they were guided through the acute care POCUS exam. Each view was deemed to be complete when the expert sonographer was satisfied with the obtained image or if the expert sonographer determined that the image could not be obtained after 5 min. Image quality was scored on a previously validated 0 to 4 grading scale. The entire session was recorded, and the image quality was scored during the exam by the remote expert instructor as well as by a separate POCUS-trained, blinded expert anesthesiologist. Results: A total of 21 subjects completed the study. The average total time for the exam was 8.5 min (standard deviation = 4.6). A comparison between the live expert examiner and the blinded postexam reviewer showed a 100% agreement between image interpretations. A review of the exams rated as three or higher demonstrated that 87% of abdominal, 90% of cardiac, and 95% of pulmonary exams achieved this level of image quality. A satisfaction survey of the novice users demonstrated higher ease of following commands for the cardiac and pulmonary exams compared to the abdominal exam. Conclusions: The results from this pilot study demonstrate that nonmedically trained individuals can be guided to complete a relevant ultrasound examination within a short period. Further evaluation of using telemedicine technologies to promote POCUS should be evaluated

A Review of Wireless Body Area Networks for Medical Applications

Recent advances in Micro-Electro-Mechanical Systems (MEMS) technology, integrated circuits, and wireless communication have allowed the realization of Wireless Body Area Networks (WBANs). WBANs promise unobtrusive ambulatory health monitoring for a long period of time and provide real-time updates of the patient's status to the physician. They are widely used for ubiquitous healthcare, entertainment, and military applications. This paper reviews the key aspects of WBANs for numerous applications. We present a WBAN infrastructure that provides solutions to on-demand, emergency, and normal traffic. We further discuss in-body antenna design and low-power MAC protocol for WBAN. In addition, we briefly outline some of the WBAN applications with examples. Our discussion realizes a need for new power-efficient solutions towards in-body and on-body sensor networks.Comment: 7 pages, 7 figures, and 3 tables. In V3, the manuscript is converted to LaTe

Advanced observation and telemetry heart system utilizing wearable ECG device and a Cloud platform

Short lived chest pain episodes of post PCI patients represent the most common clinical scenario treated in the Accidents and Emergency Room. Continuous ECG monitoring could substantially diminish such hospital admissions and related ambulance calls. Delivering community based, easy-To-handle, easy to wear, real time electrocardiography systems is still a quest, despite the existence of electronic electrocardiography systems for several decades. The PATRIOT system serves this challenge via a 12-channel, easy to wear, easy to carry, mobile linked, miniaturized automatic ECG device and a Cloud platform. The system may deliver high quality electrocardiograms of a patient to medical personnel either on the spot or remotely both in a synchronous or asynchronous mode, enhancing autonomy, mobility, quality of life and safety of recently treated coronary artery disease patients

Wireless Medical Sensor Networks: Design Requirements and Enabling Technologies

This article analyzes wireless communication protocols that could be used in healthcare environments (e.g., hospitals and small clinics) to transfer real-time medical information obtained from noninvasive sensors. For this purpose the features of the three currently most widely used protocols—namely, Bluetooth® (IEEE 802.15.1), ZigBee (IEEE 802.15.4), and Wi-Fi (IEEE 802.11)—are evaluated and compared. The important features under consideration include data bandwidth, frequency band, maximum transmission distance, encryption and authentication methods, power consumption, and current applications. In addition, an overview of network requirements with respect to medical sensor features, patient safety and patient data privacy, quality of service, and interoperability between other sensors is briefly presented. Sensor power consumption is also discussed because it is considered one of the main obstacles for wider adoption of wireless networks in medical applications. The outcome of this assessment will be a useful tool in the hands of biomedical engineering researchers. It will provide parameters to select the most effective combination of protocols to implement a specific wireless network of noninvasive medical sensors to monitor patients remotely in the hospital or at home

Wireless body sensor networks for health-monitoring applications

This is an author-created, un-copyedited version of an article accepted for publication in Physiological Measurement. The publisher is not responsible for any errors or omissions in this version of the manuscript or any version derived from it. The Version of Record is available online at http://dx.doi.org/10.1088/0967-3334/29/11/R01

Ubiquitous Computing for Remote Cardiac Patient Monitoring: A Survey

New wireless technologies, such as wireless LAN and sensor networks, for telecardiology purposes give new possibilities for monitoring vital parameters with wearable biomedical sensors, and give patients the freedom to be mobile and still be under continuous monitoring and thereby better quality of patient care. This paper will detail the architecture and quality-of-service (QoS) characteristics in integrated wireless telecardiology platforms. It will also discuss the current promising hardware/software platforms for wireless cardiac monitoring. The design methodology and challenges are provided for realistic implementation

Real time telemedical health care systems with wearable sensors

The time between detection and response to chronic diseases could go a long way in saving lives. The current trend in health monitoring systems is to move from the hospital centered device to eventually portable personal devices. Hence,Telemedical health care involves the remote delivery of medical care service to either out-of-hospital or admitted patients through wireless network and computer information technology. This paper systematically reviews the most recent works in telemedical health care system to propose a more efficient model. The focus is more on wearable sensors and devices with most attention given to cardiovascular patients in recent times. The huge literature available reflects the size of activity and attention given to telemedicine. The reviewed works are published within the last five years. Furthermore, the proposed systems are compared in terms of their connectivity, targeted application, type of sensor used, etc. Our study reveals Telemedicine to be a profound field with researchers from multidisciplinary sectors. However, there are still many gaps that need to be filled before maturity. Factors such as efficient wireless transmission, cyber data security, sensor design and integration, device miniaturization and intelligent algorithm for multi parameter data fusion require further considerations

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

Photoplethysmography based remote health monitoring system

One of the world's most leading killer diseases is the cardiovascular disease, which accounts for 16.7 million deaths annually. Out of the total population in the world, about 22 million people run the risk of sudden heart failure. However, saving the lives of cardiac patients can be improved by the emergency monitoring so that the initiation of treatment can be taken up within the crucial hour. The acquired signals by pulse oximetry provide significant information about the heart-rate, arterial blood oxygenation, blood pressure and respiratory-rate. Telemedicine provides a great impact in the emergency monitoring of patients located in remote nonclinical environments. A home cardiac telemedicine emergency system based on photoplethysmography has been developed. The acquired signals are processed, transmitted and stored in a local PC. Finally, the data are sent to the remote terminal located at the hospital through internet. The diagnoses are done by specialists from the reading and action can be immediately taken in emergency cases