SeizeIT: SEIZURE victims are no longer leashed

Seizure considered to be one of the severe and most common type of neurological disorders. Despite the availability of numerous anti-seizure drugs, it is often difficult to control the disease completely and effectively. Lack of close supervision and failure in providing urgent medical care during and after seizure episodes, leads to serious injuries or even death. On the other hand, Use of wireless sensor networks in everyday applications have rapidly increased due to decreased technology costs and improved product reliability. Therefore developing a wearable device to monitor seizure may complete the anamnesis, help medical staff in diagnosing and acute treatment while preventing seizure related accidents. There are number of seizure detection systems available in the market. Still their performance is far from perfect. This paper explores an application of biomedical wireless sensor networks, which attempts to monitor patients in a completely non-invasive and non-intrusive manner. It describes a wearable device together with seizure prediction and alerting system, which is designed to address some issues with seizure detection systems in the market. Its functional block diagram and operating modes are detailed. Possible application areas of the device are also discusse

Development of a Knowledge Base for smart screening of language disorders in primary care

Monitoring of neuro-evolutive development from birth until the age of six is a decisive factor in a child's quality of life. Early detection of development disorders in early childhood can facilitate necessary diagnosis and/or treatment. Primary-care pediatricians play a key role in early detection of development alterations as they can undertake the preventive and therapeutic actions necessary in the interest of a child's optimal development. The focus of this research paper is the construction of a Knowledge Base for smart screening aimed to assist pediatricians in processes of early referral in language disorders. The proposed model provides health professionals with a decision-making tool that supports referral processes. In this way, essential diagnostic and/or therapeutic actions are triggered for a comprehensive individual development. The resulting system was developed on the basis of an analysis and verification of 21 cases of children with language disorders

GSA: A Framework for Rapid Prototyping of Smart Alarm Systems

We describe the Generic Smart Alarm, an architectural framework for the development of decision support modules for a variety of clinical applications. The need to quickly process patient vital signs and detect patient health events arises in many clinical scenarios, from clinical decision support to tele-health systems to home-care applications. The events detected during monitoring can be used as caregiver alarms, as triggers for further downstream processing or logging, or as discrete inputs to decision support systems or physiological closed-loop applications. We believe that all of these scenarios are similar, and share a common framework of design. In attempting to solve a particular instance of the problem, that of device alarm fatigue due to numerous false alarms, we devised a modular system based around this framework. This modular design allows us to easily customize the framework to address the specific needs of the various applications, and at the same time enables us to perform checking of consistency of the system. In the paper we discuss potential specific clinical applications of a generic smart alarm framework, present the proposed architecture of such a framework, and motivate the benefits of a generic framework for the development of new smart alarm or clinical decision support systems

The clinical use and indications for head computed tomography scans in paediatric ambulatory care (short stay ward and medical emergencies) at a children’s hospital over a one-year period, 1st January-31st December 2013

Background: Computed tomography (CT) imaging is an indispensable tool in the management of acute paediatric illness. It offers quick answers, allowing timely lifesaving decision-making. Clinical evidence is required to maximise its benefits against radiation-exposure risks to patients and cost to the healthcare system. Aims: The study aimed to retrospectively investigate clinical presentation and indications of head CT at a tertiary paediatric hospital. Methods: Records of children presenting with acute illness to the medical emergency unit, excluding trauma, of Red Cross War Memorial Children’s Hospital, Cape Town, over one year (2013) were retrospectively reviewed. Participants were included if they underwent head CT scan within 24 hours of presentation. Clinical data were extracted from records and CT findings reported by a paediatric radiologist. Results: Inclusion criteria were met by 311 patients; 188 (60.5%) were boys. The median age was 39.2 (IQR 12.6-84.0) months. Commonest indications were seizures (n=169;54.3%), reduced level of consciousness (n=140;45.0%), headache (n=74;23.8%) and suspected ventriculoperitoneal shunt (VPS) malfunction (n=61;19.7%). In 217 (69.8%) patients CT showed no adverse findings. In the 94 (30.2%) patients in whom CT abnormalities were detected, the predominant findings were hydrocephalus (n=54;57.4%) and cerebral oedema (n=29;30.9%). Abnormal CT findings were commoner in patients with nausea or vomiting (n=21;9.3%, p=0.05) papilloedema (n=3;1.3%, p=0.015) and long tract signs (n=23;10.2%, p=0.02). Forty-seven patients (15.1%) required surgical intervention after CT of which 40 (85.1%) needed a ventricular drainage procedure. A larger proportion of patients with VPS (25/62;40.3%) required surgical intervention compared to patients without VPS (22/249;8.8%, p <0.001) Conclusion: Most children presenting with acute illness (excluding trauma) and undergoing emergency head CT have normal findings. Patients with ventriculoperitoneal shunts constituted a large proportion of patients requiring intervention after CT. Considerations should be made to use clinical presentation to select patients most likely to benefit from CT

The clinical use and indications for head computed tomography scans in paediatric ambulatory care (short stay ward and medical emergencies) at a children’s hospital over a one-year period, 1st January-31st December 2013

Background: Computed tomography (CT) imaging is an indispensable tool in the management of acute paediatric illness. It offers quick answers, allowing timely lifesaving decision-making. Clinical evidence is required to maximise its benefits against radiation-exposure risks to patients and cost to the healthcare system. Aims: The study aimed to retrospectively investigate clinical presentation and indications of head CT at a tertiary paediatric hospital. Methods: Records of children presenting with acute illness to the medical emergency unit, excluding trauma, of Red Cross War Memorial Children’s Hospital, Cape Town, over one year (2013) were retrospectively reviewed. Participants were included if they underwent head CT scan within 24 hours of presentation. Clinical data were extracted from records and CT findings reported by a paediatric radiologist. Results: Inclusion criteria were met by 311 patients; 188 (60.5%) were boys. The median age was 39.2 (IQR 12.6-84.0) months. Commonest indications were seizures (n=169;54.3%), reduced level of consciousness (n=140;45.0%), headache (n=74;23.8%) and suspected ventriculoperitoneal shunt (VPS) malfunction (n=61;19.7%). In 217 (69.8%) patients CT showed no adverse findings. In the 94 (30.2%) patients in whom CT abnormalities were detected, the predominant findings were hydrocephalus (n=54;57.4%) and cerebral oedema (n=29;30.9%). Abnormal CT findings were commoner in patients with nausea or vomiting (n=21;9.3%, p=0.05) papilloedema (n=3;1.3%, p=0.015) and long tract signs (n=23;10.2%, p=0.02). Forty-seven patients (15.1%) required surgical intervention after CT of which 40 (85.1%) needed a ventricular drainage procedure. A larger proportion of patients with VPS (25/62;40.3%) required surgical intervention compared to patients without VPS (22/249;8.8%, p <0.001) Conclusion: Most children presenting with acute illness (excluding trauma) and undergoing emergency head CT have normal findings. Patients with ventriculoperitoneal shunts constituted a large proportion of patients requiring intervention after CT. Considerations should be made to use clinical presentation to select patients most likely to benefit from CT

Status epilepticuksen hoidon viiveet : vaikutus ennusteeseen

Status epilepticus (SE), i.e. prolonged epileptic seizure, is a life-threatening medical emergency, which is associated with high mortality and morbidity. International guidelines suggest early and efficient treatment. Thus, long duration of SE is one of the main predictors of poor prognosis and the only prognostic factor that can be affected by shortening the delays in the treatment. However, studies on delays, implementation of treatment guidelines and the effect of delays on outcome are scarce. The aim of this thesis was to systematically investigate delays in the treatment of SE and factors related to the delays along the whole treatment chain. We also aimed at clarifying the effect of delays on the outcome and at identifying the significant delays related to outcome in order to propose evidence-based targets for streamlining the SE treatment protocol. The material of this retrospective study consists of 82 consecutive SE patients treated in a tertiary hospital emergency department over two years. Delays, patient characteristics and parameters related to treatment chain were identified and their relations, correlations and effects were investigated. The results of this thesis reveal that the delays in the treatment of SE are unacceptably long and exceed markedly the suggested time frames in the guidelines. Fulfilment of the suggested SE treatment algorithm is frequently hampered by failing recognition of SE at onset, also by professionals, which may increase the delays in consecutive parts of the treatment chain. Delays seem to be more significant determinants of SE duration than previously established outcome predictors. Additionally, various long delays in the treatment (second- and third-stage medication, diagnostic and tertiary hospital delays) increase the risk of mortality and poor functional outcome at hospital discharge and since the predictive cut-off point of these delays lies under 2,5 hours, the focus of protocol streamlining should be in the pre-hospital phase of the treatment. However, none of the delays are independent risk factors for poor outcome, which reflects the dynamism of SE, but also demonstrates that every step of the treatment chain needs to be optimized. In conclusion, we propose that generation of simplified criteria for suspicion of an imminent SE and streamlining pre-hospital treatment chain are advocated. We suggest amendments to the protocol, such as triaging suspected SE patients with highest priority, recruiting physician-based EMS units upon primary alarm, administration of second-stage medication out-of-hospital and transportation of SE patients exclusively to hospitals with neurological expertise. Also improvement of diagnostic possibilities on emergency site should be considered.Status epilepticus (SE), eli pitkittynyt epileptinen kohtaus, on hengenvaarallinen hätätila, johon tehokkaastikin hoidettuna liittyy kuolleisuutta ja sairastavuutta. Kohtauksen pitkä kesto on yksi merkittävimmistä huonoon ennusteeseen liittyvistä tekijöistä. Kansainväliset hoitosuositukset suosittavat nopeaa ja tehokasta hoitoa SE:n lopettamiseksi. Tutkimustieto hoidon viiveistä, hoitosuositusten toteutumisesta ja näiden vaikutuksista ennusteeseen on kuitenkin erittäin vähäistä. Väitöstutkimuksen tavoitteena oli selvittää status epilepticuksen hoitoon liittyviä viiveitä ja viiveisiin vaikuttavia tekijöitä hoitoketjun eri vaiheissa. Lisäksi tavoitteena oli tutkia viiveiden vaikutusta SE-potilaiden ennusteeseen ja tunnistaa sen kannalta merkittävimmät viiveet ja tekijät, jotta hoitoketjun toiminnan tehostaminen tulevaisuudessa olisi mahdollista. Tavoitteiden saavuttamiseksi tarkasteltiin Helsingin Yliopistollisen Keskussairaalan päivystyksessä kahden vuoden aikana hoidettujen aikuisten SE-potilaiden asiakirjamerkinnät. Tutkimustulosten perusteella viiveet status epilepticuksen hoidossa ovat pitkiä ja ylittävät kestoltaan selvästi kansainvälisten hoitosuositusten viiterajat. Hoidon viiveet näyttävät vaikuttavan SE:n kestoon enemmän kuin muut aiemmin tunnistetut ennustetekijät. Lääkehoitoihin, diagnostiikkaan ja hoitopaikan valintaan liittyvillä viiveillä on merkittävä vaikutus SE-potilaiden kuolleisuuteen ja toipumisennusteeseen: mitä lyhyemmät viiveet, sitä parempi ennuste akuuttivaiheen sairaalahoidon päättyessä. Useat eri viiveet, erityisesti hoitoketjun alkupäässä, vaikuttavat merkittävästi ennusteeseen, mikä korostaa hoitoketjun jokaisen vaiheen mahdollisimman hyvän onnistumisen tärkeyttä ennusteen parantamiseksi. Status epilepticuksen hoidon viiveet eivät tutkimuksen perusteella olleet hyväksyttävällä tasolla ja niiden lyhentämiseksi tulisi pyrkiä hoitoketjun virtaviivaistamiseen. Epäiltäessä potilaalla SE:tä lääkäriyksikön tai koulutetun hoitoyksikön hälyttäminen olisi suositeltavaa heti ensivaiheessa, jotta viiveiden lyhentämiseksi kaikki olennaiset lääkkeet ja hoitotoimenpiteet olisi mahdollista toteuttaa jo ennen sairaalaan saapumista. Erityisesti toisen linjan lääkehoidon annostelun mahdollistaminen ensihoidossa olisi suositeltavaa. SE-potilaat tulisi kuljettaa jatkohoitoon sellaiseen sairaalaan, jossa neurologinen erityisosaaminen ja riittävät diagnostiset tutkimusmahdollisuudet ovat ympärivuorokautisessa käytössä

Pediatric Seizures: Access and Utilization of Specialty Care and Mental Health Care

Epilepsy is the leading neurological disorder among children, and requires specialized health care (Zack & Kobau, 2015). However, many patients with seizures do not receive appropriate specialized care (Begley et al., 2009; Burneo et al., 2009). This study examined the impact of health insurance type on access to and use of specialty care and mental health care among pediatric patients, ages 3-17, whose parents reported that they had experienced at least one seizure in the last year. This study was a secondary analysis of data collected in the 2011 (n = 77) and 2016 (n = 87) National Health Survey and investigated whether having private, public, or no insurance affected these children’s access to and utilization of specialty and mental health care. It was hypothesized that children with private insurance would have greater access to and utilization of both types of care. Whether severity of mental health symptoms among these children affected mental health care was also investigated, with the hypothesis that those with more severe symptoms would have less access and utilization. Changes in the relationship between insurance type and mental health care over time were also investigated, with the hypothesis that the disparity in access to and utilization of mental health care among participants who had private vs. public health insurance would be larger in 2011 than in 2016. Contrary to these hypotheses, there were no significant differences in access to and use of specialty care and mental health care across insurance types (public, private, and non-insured). Mental health severity was significantly associated with participants’ access and use of mental health care, but the relationship was positive, not negative as hypothesized. There were no significant differences between 2011 and 2016 in participants’ access to and use of mental health care. Insurance type, symptom severity, and changes related to Affordable Care Act implementation may only be a small factor in disparities of care affecting pediatric seizure patients

Deployment and validation of a smart system for screening of language disorders in primary care

Neuro-evolutive development from birth until the age of six years is a decisive factor in a child?s quality of life. Early detection of development disorders in early childhood can facilitate necessary diagnosis and/or treatment. Primary-care pediatricians play a key role in its detection as they can undertake the preventive and therapeutic actions requested to promote a child?s optimal development. However, the lack of time and little specific knowledge at primary-care avoid to applying continuous early-detection anomalies procedures. This research paper focuses on the deployment and evaluation of a smart system that enhances the screening of language disorders in primary care. Pediatricians get support to proceed with early referral of language disorders. The proposed model provides them with a decision-support tool for referral actions to trigger essential diagnostic and/or therapeutic actions for a comprehensive individual development. The research was conducted by starting from a sample of 60 cases of children with language disorders. Validation was carried out through two complementary steps: first, by including a team of seven experts from the fields of neonatology, pediatrics, neurology and language therapy, and, second, through the evaluation of 21 more previously diagnosed cases. The results obtained show that therapist positively accepted the system proposal in 18 cases (86%) and suggested system redesign for single referral to a speech therapist in three remaining cases