Certainty Modeling of a Decision Support System for Mobile Monitoring of Exercise-induced Respiratory Conditions

Mobile health systems in recent times, have notably improved the healthcare sector by empowering patients to actively participate in their health, and by facilitating access to healthcare professionals. Effective operation of these mobile systems nonetheless, requires high level of intelligence and expertise implemented in the form of decision support systems (DSS). However, common challenges in the implementation include generalization and reliability, due to the dynamics and incompleteness of information presented to the inference models. In this paper, we advance the use of ad hoc mobile decision support system to monitor and detect triggers and early symptoms of respiratory distress provoked by strenuous physical exertion. The focus is on the application of certainty theory to model inexact reasoning by the mobile monitoring system. The aim is to develop a mobile tool to assist patients in managing their conditions, and to provide objective clinical data to aid physicians in the screening, diagnosis, and treatment of the respiratory ailments. We present the proposed model architecture and then describe an application scenario in a clinical setting. We also show implementation of an aspect of the system that enables patients in the self-management of their conditions

KALwEN: a new practical and interoperable key management scheme for body sensor networks

Key management is the pillar of a security architecture. Body sensor networks (BSNs) pose several challenges–some inherited from wireless sensor networks (WSNs), some unique to themselves–that require a new key management scheme to be tailor-made. The challenge is taken on, and the result is KALwEN, a new parameterized key management scheme that combines the best-suited cryptographic techniques in a seamless framework. KALwEN is user-friendly in the sense that it requires no expert knowledge of a user, and instead only requires a user to follow a simple set of instructions when bootstrapping or extending a network. One of KALwEN's key features is that it allows sensor devices from different manufacturers, which expectedly do not have any pre-shared secret, to establish secure communications with each other. KALwEN is decentralized, such that it does not rely on the availability of a local processing unit (LPU). KALwEN supports secure global broadcast, local broadcast, and local (neighbor-to-neighbor) unicast, while preserving past key secrecy and future key secrecy (FKS). The fact that the cryptographic protocols of KALwEN have been formally verified also makes a convincing case. With both formal verification and experimental evaluation, our results should appeal to theorists and practitioners alike

Clinical Decision Support Systems (CDSS) for preventive management of COPD patients

Background The use of information and communication technologies to manage chronic diseases allows the application of integrated care pathways, and the optimization and standardization of care processes. Decision support tools can assist in the adherence to best-practice medicine in critical decision points during the execution of a care pathway. Objectives The objectives are to design, develop, and assess a clinical decision support system (CDSS) offering a suite of services for the early detection and assessment of chronic obstructive pulmonary disease (COPD), which can be easily integrated into a healthcare providers' work-flow. Methods The software architecture model for the CDSS, interoperable clinical-knowledge representation, and inference engine were designed and implemented to form a base CDSS framework. The CDSS functionalities were iteratively developed through requirement-adjustment/development/validation cycles using enterprise-grade software-engineering methodologies and technologies. Within each cycle, clinical-knowledge acquisition was performed by a health-informatics engineer and a clinical-expert team. Results A suite of decision-support web services for (i) COPD early detection and diagnosis, (ii) spirometry quality-control support, (iii) patient stratification, was deployed in a secured environment on-line. The CDSS diagnostic performance was assessed using a validation set of 323 cases with 90% specificity, and 96% sensitivity. Web services were integrated in existing health information system platforms. Conclusions Specialized decision support can be offered as a complementary service to existing policies of integrated care for chronic-disease management. The CDSS was able to issue recommendations that have a high degree of accuracy to support COPD case-finding. Integration into healthcare providers' work-flow can be achieved seamlessly through the use of a modular design and service-oriented architecture that connect to existing health information systems

Ambient-aware continuous care through semantic context dissemination

Background: The ultimate ambient-intelligent care room contains numerous sensors and devices to monitor the patient, sense and adjust the environment and support the staff. This sensor-based approach results in a large amount of data, which can be processed by current and future applications, e. g., task management and alerting systems. Today, nurses are responsible for coordinating all these applications and supplied information, which reduces the added value and slows down the adoption rate. The aim of the presented research is the design of a pervasive and scalable framework that is able to optimize continuous care processes by intelligently reasoning on the large amount of heterogeneous care data. Methods: The developed Ontology-based Care Platform (OCarePlatform) consists of modular components that perform a specific reasoning task. Consequently, they can easily be replicated and distributed. Complex reasoning is achieved by combining the results of different components. To ensure that the components only receive information, which is of interest to them at that time, they are able to dynamically generate and register filter rules with a Semantic Communication Bus (SCB). This SCB semantically filters all the heterogeneous care data according to the registered rules by using a continuous care ontology. The SCB can be distributed and a cache can be employed to ensure scalability. Results: A prototype implementation is presented consisting of a new-generation nurse call system supported by a localization and a home automation component. The amount of data that is filtered and the performance of the SCB are evaluated by testing the prototype in a living lab. The delay introduced by processing the filter rules is negligible when 10 or fewer rules are registered. Conclusions: The OCarePlatform allows disseminating relevant care data for the different applications and additionally supports composing complex applications from a set of smaller independent components. This way, the platform significantly reduces the amount of information that needs to be processed by the nurses. The delay resulting from processing the filter rules is linear in the amount of rules. Distributed deployment of the SCB and using a cache allows further improvement of these performance results

Discrete separation of patients’ profiles for chronical obstructive pulmonary disease context-aware healthcare efficient systems

According to the Public Health Agency of Canada (PHAC), the symptoms of chronic obstructive pulmonary disease (COPD) are shortness of breath, coughing, and sputum production. Many studies estimate that COPD will become the third-leading cause of death worldwide by 2030 (WHO, 2008). Pervasive healthcare systems cover healthcare issues, including chronic diseases; they help patients to manage their own health information and healthcare services at any time and in any place. We developed a COPD healthcare system based on a combination of the parameters of patients. The main goal is to avoid the severe phases of the disease by monitoring them. This combination of risk factors provides in total 600 profiles from data, with 88.5% accuracy. However, many studies have focused on and shown the issues of the effectiveness and accuracy of these systems. The problem is to apply a new classification model to detect the severe phases of the disease early. Therefore, instead of working on COPD parameters, we design and validate a profile-based classification model of patients. This model will facilitate the building of a rule-based framework. In addition, the accuracy of our extended COPD system is improved using the classification and separation of patients’ profiles

The Ethical Implications of Personal Health Monitoring

Personal Health Monitoring (PHM) uses electronic devices which monitor and record health-related data outside a hospital, usually within the home. This paper examines the ethical issues raised by PHM. Eight themes describing the ethical implications of PHM are identified through a review of 68 academic articles concerning PHM. The identified themes include privacy, autonomy, obtrusiveness and visibility, stigma and identity, medicalisation, social isolation, delivery of care, and safety and technological need. The issues around each of these are discussed. The system / lifeworld perspective of Habermas is applied to develop an understanding of the role of PHMs as mediators of communication between the institutional and the domestic environment. Furthermore, links are established between the ethical issues to demonstrate that the ethics of PHM involves a complex network of ethical interactions. The paper extends the discussion of the critical effect PHMs have on the patient’s identity and concludes that a holistic understanding of the ethical issues surrounding PHMs will help both researchers and practitioners in developing effective PHM implementations