Extending remote patient monitoring with mobile real time clinical decision support

Large scale implementation of telemedicine services such as telemonitoring and teletreatment will generate huge amounts of clinical data. Even small amounts of data from continuous patient monitoring cannot be scrutinised in real time and round the clock by health professionals. In future huge volumes of such data will have to be routinely screened by intelligent software systems. We investigate how to make m-health systems for ambulatory care more intelligent by applying a Decision Support approach in the analysis and interpretation of biosignal data and to support adherence to evidence-based best practice such as is expressed in treatment protocols and clinical practice guidelines. The resulting Clinical Decision Support Systems must be able to accept and interpret real time streaming biosignals and context data as well as the patient’s (relatively less dynamic) clinical and administrative data. In this position paper we describe the telemonitoring/teletreatment system developed at the University of Twente, based on Body Area Network (BAN) technology, and present our vision of how BAN-based telemedicine services can be enhanced by incorporating mobile real time Clinical Decision Support. We believe that the main innovative aspects of the vision relate to the implementation of decision support on a mobile platform; incorporation of real time input and analysis of streaming\ud biosignals into the inferencing process; implementation of decision support in a distributed system; and the consequent challenges such as maintenance of consistency of knowledge, state and beliefs across a distributed environment

Unintended and accidental medical radiation exposures in radiology: guidelines on investigation and prevention

This paper sets out guidelines for managing radiation exposure incidents involving patients in diagnostic and interventional radiology. The work is based on collation of experiences from representatives of international and national organizations for radiologists, medical physicists, radiographers, regulators, and equipment manufacturers, derived from an International Atomic Energy Agency Technical Meeting. More serious overexposures can result in skin doses high enough to produce tissue reactions, in interventional procedures and computed tomography, most notably from perfusion studies. A major factor involved has been deficiencies in training of staff in operation of equipment and optimization techniques. The use of checklists and time outs before procedures commence, and dose alerts when critical levels are reached during procedures can provide safeguards to reduce risks of these effects occurring. However, unintended and accidental overexposures resulting in relatively small additional doses can take place in any diagnostic or interventional X-ray procedure and it is important to learn from errors that occur, as these may lead to increased risks of stochastic effects. Such events may involve the wrong examinations, procedural errors, or equipment faults. Guidance is given on prevention, investigation and dose calculation for radiology exposure incidents within healthcare facilities. Responsibilities should be clearly set out in formal policies, and procedures should be in place to ensure that root causes are identified and deficiencies addressed. When an overexposure of a patient or an unintended exposure of a foetus occurs, the foetal, organ, skin and/or effective dose may be estimated from exposure data. When doses are very low, generic values for the examination may be sufficient, but a full assessment of doses to all exposed organs and tissues may sometimes be required. The use of general terminology to describe risks from stochastic effects is recommended rather than calculation of numerical values, as these are misleading when applied to individuals

An Inpatient Rehabilitation Interprofessional Care Pathway for Traumatic Hip Fracture: A Pilot Quality Improvement Project

Background: Each year over 300,000 older adults are hospitalized for hip fracture. The impact of the cost of hip fracture on the US health care system is estimated to be as high as $9 billion, with the typical cost of a hip fracture episode around$30,000. Formalized pathways have been developed and successfully utilized for many patient presentations, including hip fracture, in the acute setting. Although this research is important to the comprehensive care of the elderly hip fracture patient, very little research exists that outlines evidence-based best-practice for patients in the post-acute recovery period. Purpose: The primary aim of this project was to develop an evidence-based, comprehensive, coordinated, and interprofessional care pathway for hip fracture patients in the acute rehabilitation setting to improve the percentage of patients discharging to community settings by 20% from current baseline by the end of the pilot period. Methods: The design of this project was an observational cohort study. Descriptive statistics will be used to compare intervention groups to controls, including frequencies and distributions. Results: The hip fracture tool itself had inconclusive results, the impacts of the effects on team work and enhanced coordination of the care team was realized through reducing institutionalized days for hip fracture patients in acute rehabilitation

No longer diseases of the wealthy : prevalence and health-seeking for self-reported chronic conditions among urban poor in Southern India

Background: The burden of chronic conditions is high in low-and middle-income countries and poses a significant challenge to already weak healthcare delivery systems in these countries. Studies investigating chronic conditions among the urban poor remain few and focused on specific chronic conditions rather than providing overall profile of chronic conditions in a given community, which is critical for planning and managing services within local health systems. We aimed to assess the prevalence and health-seeking behaviour for self-reported chronic conditions in a poor neighbourhood of a metropolitan city in India. Methods: We conducted a house-to-house survey covering 9299 households (44514 individuals) using a structured questionnaire. We relied on self-report by respondents to assess presence of any chronic conditions, including diabetes and hypertension. Multivariable logistic regression was used to analyse the prevalence and health-seeking behaviour for self-reported chronic conditions in general as well as for diabetes and hypertension in particular. The predictor variables included age, sex, income, religion, household poverty status, presence of comorbid chronic conditions, and tiers in the local health care system. Results: Overall, the prevalence of self-reported chronic conditions was 13.8% (95% CI = 13.4, 14.2) among adults, with hypertension (10%) and diabetes (6.4%) being the most commonly reported conditions. Older people and women were more likely to report chronic conditions. We found reversal of socioeconomic gradient with people living below the poverty line at significantly greater odds of reporting chronic conditions than people living above the poverty line (OR = 3, 95% CI = 1.5, 5.8). Private healthcare providers managed over 80% of patients. A majority of patients were managed at the clinic/health centre level (42.9%), followed by the referral hospital (38.9%) and the super-specialty hospital (18.2%) level. An increase in income was positively associated with the use of private facilities. However, elderly people, people below the poverty line, and those seeking care from hospitals were more likely to use government services. Conclusions: Our findings provide further evidence of the urgent need to improve care for chronic conditions for urban poor, with a preferential focus on improving service delivery in government health facilities

Medical Staff Services Quality to Patients Satisfaction Based on SERVQUAL Dimensions

Hospital service quality was a degree of discrepancy between patients\u27 perceptions and their expectations about hospitals services. Service quality which was provided by medical staff emphasizes the actual hospital service process. In the hospital, patients\u27 satisfaction could be widely used to determine hospital service quality. The purpose of this study was to analyze the influence of medical staff services quality on patients satisfaction based on SERVQUAL dimensions. This study used an analytic observational design with cross-sectional approach. There were 314 respondents taken from inpatients hospital admission using simple random sampling. Based on regression analysis results, five dimensions of health services quality affect patients\u27 level of satisfaction and obtained the equation of Y = 0.026 + 0.226X1 + 0.332X2 + 0.1X3 + 0.075X4 + 0.235X5, this explained that patients\u27 satisfaction was affected by all dimensions of health service quality (RATER) simultaneously. However, different values will be obtained if all dimensions were measured separately, range from 10% to 33.2%. It could be concluded that patients\u27 satisfaction were influenced by the quality of medical staff services through its five components: reliability, assurance, tangible, empathy and responsiveness

Infrastructure coverage of the ural federal district regions: assessment metodology and diagnostic results

The article examines the infrastructure as one of the essential elements in the economic system. The authors consider the development stages of this concept in the scientific community and provide the opinions of a number of researchers as to the role and place of the infrastructure in the economic system. The article provides a brief genesis of approaches to describing the infrastructure and conferring its functions on individual branches. The authors emphasize the higher importance of infrastructure coverage with the economy transition to machine production. Two key methodological approaches are identified to describe the substance and content of the infrastructure: industrial and functional. The authors offer their methodology of assessing the infrastructure coverage of regional-level territories. The methodology is based on identifying a combination of specific indicators the values of which can be used to evaluate the development level of individual infrastructure elements. The indicative analysis being the basis of the methodological apparatus helps make a judgment of any phenomenon by comparing the current observed values with the previously adopted threshold levels. Such comparison makes it possible to classify the observations by the «norm—pre-crisis—crisis» scale. An essential advantage of this method is the possibility of standardizing the indicators, or, in other words, bringing them to one comparable conditional value. Thus, you can get estimates for individual blocks of indicators and a complex assessment for the whole set in general. The authors have identified four main infrastructure elements: transport, communications, public utility services and healthcare. The methodology includes 21 indicators all together. The test estimates based on the authors’ methodology revealed the defects in the development of the Ural regions` infrastructure. The article provides a brief analysis of the obtained data with identifying individual indicators and areas.The research has been supported by the Russian Science Foundation (Project № 14-18-00574)

A method for identifying communication breakdowns in user-interfaces

Businesses are increasingly communicating with their customers via web-based interfaces. However, users are experiencing a lack of guidance and support in the communication of these often complex services. This paper proposes a method for identifying where and why there is a breakdown in communication between the interface and the user. In creating the method, the importance and value of having such a method are considered and discussed, particularly for communication rich interfaces. The method is developed based on the results from user trials with a mortgage application interface using the existing evaluation method. Although the results from piloting the method suggest that it is useful for identifying communication breakdowns within the user-interfaces, more work is required before a definitive method can be produced. As a result of this study it appears that communication breakdowns are related either to the information within an interface or to the process