The Use of Telemedicine Access to Schools to Facilitate Expert Assessment of Children with Asthma

Research has shown that access to an asthma specialist improves asthma outcomes. We hypothesized that we could improve access to expert asthma care through a telemedicine link between an asthma specialist and a school-based asthma program. We conducted a prospective cohort study in 3 urban schools to ascertain the feasibility of using an asthma-focused telemedicine solution. Each subject was seen by an asthma expert at 0, 8, and 32 weeks. The assessment and recommendations for care were sent to the primary care physician (PCP) and parents were told to contact their physician for follow-up care. Eighty three subjects participated in the study. Subjects experienced improvement (P < .05) in family social activities and the number of asthma attacks. Ninety four percent of subjects rated the program as good or excellent. This study demonstrates the feasibility and acceptance of a school-based asthma program using a telemedicine link to an asthma specialist

Monitorização de sinais fisiológicos: projeto de um eletrocardiógrafo wireless

Nos últimos anos tem-se visto a aplicação crescente das tecnologias da comunicação na área da saúde. Tendo em conta esta tendência surgiu a ideia de aplicar estas mesmas tecnologias para desenvolver uma Rede de Sensores Wireless baseada num eletrocardiógrafo aliado a um protocolo wireless. A aplicabilidade desta rede passar por diversas aplicações como a monitorização de pacientes a partir de suas casas ou para desportistas recolherem dados das suas atividades desportivas com a finalidade de melhorar as suas performances. O sinal ECG, o sinal originado pelo coração, é captado à superfície da pele. O circuito proposto constituído por cinco módulos com as suas funções específicas, sendo eles: um módulo de pré-amplificação diferencial, um módulo do circuito de referência da perna direita, um módulo de filtro passa-alto e um módulo conjunto de um filtro passa-baixo e um amplificador de ganho elevado. De seguida o sinal analógico é convertido para digital, através do ADC12 presente no microprocessador da Texas Instruments CC430F6137, e enviado através de uma antena de rádio-frequência fazendo uso do protocolo wireless da Texas Instruments, o SimpliciTI, desta forma espera-se adquirir e visualizar o sinal de ECG. Neste trabalho o sinal de ECG poderá então ser visualizado no monitor do computador recorrendo ao Access Point C1111 para receber os dados e utilizando o programa Processing para os demonstrar. O sistema proposto seria ainda constituído por outro módulo que baseado no eZ430-Chronos, mas não chegou a ser desenvolvido. Como resultados finais, conseguiu-se efetuar corretamente a aquisição digital de dados e a transmissão destes. No entanto o circuito de tratamento do sinal, não f sinal analógico de forma correta.In the last years, we have seen an increase in the application of telecommunications technologies in the healthcare area. Following this trend, came up the idea of applying these same technologies to develop a wireless sensor network based on a electrocardiograph allied with a wireless protocol. This network could then be used to monitoring patients at their home or to sportsmen could collect data of their physical activities to enhance their performances. The ECG signal is originated by the heart and captured at the skin’s surface. The proposed system is formed by five modules each one with specific functions, they are: a differential amplification module, a driven right leg circuit module, a high-pass filter and a low-pass filter combined with a high gain amplifier module. The analog signal e digitalized through the ADC12, located in the Texas Instruments microprocessor CC430F6137, and is sent through an RF antenna using the wireless Texas Instruments protocol, the SimpliciTI, with that we hope to acquire and visualize the ECG signal. In this paper, the ECG signal will be visualized in a computer’s monitor using the C1111 Access Point to receive the data and using the Processing software to show them. The proposed system was constituted by a third module based in the eZ430-Chronos but was not developed in this paper. The final results we were able to make the data’s digital acquisition and transmition. However the circuit responsible for the signal treatment was not able to acquire the analog signal correctly

Telehealthcare for asthma

BACKGROUND: Healthcare systems internationally need to consider new models of care to cater for the increasing numbers of people with asthma. Telehealthcare interventions are increasingly being seen by policymakers as a potential means of delivering asthma care. We defined telehealthcare as being healthcare delivered from a distance, facilitated electronically and involving the exchange of information through the personalised interaction between a healthcare professional using their skills and judgement and the patient providing information. OBJECTIVES: To assess the effectiveness of telehealthcare interventions in people with asthma. SEARCH METHODS: We searched in the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO; this was supplemented by handsearching of respiratory journals. We also searched registers of ongoing and unpublished trials. SELECTION CRITERIA: We selected completed randomised controlled trials of telehealthcare initiatives aiming to improve asthma care. DATA COLLECTION AND ANALYSIS: Two review authors independently appraised studies for inclusion and extracted data and performed meta‐analyses. We analysed dichotomous variables to produce an odds ratio (OR) and continuous variables to produce a mean difference. MAIN RESULTS: We included 21 trials in this review. The 21 included studies investigated a range of technologies aiming to support the provision of care from a distance. These included: telephone (n = 9); video‐conferencing (n = 2); Internet (n = 2); other networked communications (n = 6); text Short Messaging Service (n = 1); or a combination of text and Internet (n = 1). Meta‐analysis showed that these interventions did not result in clinically important improvements in asthma quality of life (minimum clinically important difference = 0.5): mean difference in Juniper's Asthma Quality of Life Questionnaire (AQLQ) 0.08 (95% CI 0.01 to 0.16). Telehealthcare for asthma resulted in a non‐significant increase in the odds of emergency department visits over a 12‐month period: OR 1.16 (95% CI 0.52 to 2.58). There was, however, a significant reduction in hospitalisations over a 12‐month period: OR 0.21 (95% CI 0.07 to 0.61), the effect being most marked in people with more severe asthma managed predominantly in secondary care settings. AUTHORS' CONCLUSIONS: Telehealthcare interventions are unlikely to result in clinically relevant improvements in health outcomes in those with relatively mild asthma, but they may have a role in those with more severe disease who are at high risk of hospital admission. Further trials evaluating the effectiveness and cost‐effectiveness of a range of telehealthcare interventions are needed

Clinical foundations and information architecture for the implementation of a federated health record service

Clinical care increasingly requires healthcare professionals to access patient record information that may be distributed across multiple sites, held in a variety of paper and electronic formats, and represented as mixtures of narrative, structured, coded and multi-media entries. A longitudinal person-centred electronic health record (EHR) is a much-anticipated solution to this problem, but its realisation is proving to be a long and complex journey. This Thesis explores the history and evolution of clinical information systems, and establishes a set of clinical and ethico-legal requirements for a generic EHR server. A federation approach (FHR) to harmonising distributed heterogeneous electronic clinical databases is advocated as the basis for meeting these requirements. A set of information models and middleware services, needed to implement a Federated Health Record server, are then described, thereby supporting access by clinical applications to a distributed set of feeder systems holding patient record information. The overall information architecture thus defined provides a generic means of combining such feeder system data to create a virtual electronic health record. Active collaboration in a wide range of clinical contexts, across the whole of Europe, has been central to the evolution of the approach taken. A federated health record server based on this architecture has been implemented by the author and colleagues and deployed in a live clinical environment in the Department of Cardiovascular Medicine at the Whittington Hospital in North London. This implementation experience has fed back into the conceptual development of the approach and has provided "proof-of-concept" verification of its completeness and practical utility. This research has benefited from collaboration with a wide range of healthcare sites, informatics organisations and industry across Europe though several EU Health Telematics projects: GEHR, Synapses, EHCR-SupA, SynEx, Medicate and 6WINIT. The information models published here have been placed in the public domain and have substantially contributed to two generations of CEN health informatics standards, including CEN TC/251 ENV 13606

Evaluación clínica, económica y de satisfacción de una red asistencial de asma. Estrategia coordinada y multidisciplinar entre atención primaria y neumología.

510 p.Estudio observacional de cohortes prospectivo, cuasi-experimental, multicéntrico, con un tamaño muestral de 400 pacientes asmáticos de cupos de Atención Primaria. Se evalúa el impacto clínico, económico y de satisfacción tras una intervención denominada ¿Red Asistencial de Asma¿ y basada en una estrategia colaborativa y multidisciplinar entre Atención Primaria y Neumología, fomentando la implementación de la GEMA (Guía Española de Manejo para el Asma), gracias también al soporte de las Tecnologías de la Información y la Comunicación.De este modo, la Red Asistencial de Asma va en coherencia con la gestión por procesos incentivada por Osakidetza, evita el sobrediagnóstico de asma y fomenta el diagnóstico de asma con prueba concluyente, la adecuación del tratamiento, la calidad de la nomenclatura diagnóstica y la educación e implantación de medidas de control del paciente asmático en Atención Primaria, además de objetivarse un manejo más frecuente de las agudizaciones a nivel de Atención Primaria y menor a nivel hospitalario, con el consecuente ahorro de recursos económicos, predominantemente por costes directos sanitarios y costes indirectos. Todo ello corrobora la facilitación de la implementación de la guía clínica nacional GEMA en Atención Primaria gracias a la Red Asistencial de Asma, que demuestra, asimismo, la consecución de los indicadores promovidos por la propia GEMA. Del mismo modo, el proyecto mejora la satisfacción tanto de los pacientes asmáticos como de los profesionales sanitarios, quienes recomiendan su implantación en Osakidetza. Finalmente, el programa aumenta la calidad de vida tanto específica como genérica y se trata de una estrategia claramente coste-efectiva desde la perspectiva tanto del sistema sanitario como social, por lo que podría extenderse su implantación a un ámbito mayor