WBSN based safe lifestyle: A case study of heartrate monitoring system

A Heart is the vital organ of the body. According to the “world health statistics, 2017” by WHO, about 460,000 people die due to fatal heart attacks every year. To reduce the death rate due to fatal heart attacks and malfunctioning of the cardiovascular system, this paper proposed a Wireless Body Sensor Network (WBSN) based, portable, easily affordable, miniatured, accurate “Heartrate Monitoring System (HMS)”. HMS can be used to regularly examine the cardiac condition at home or hospital to avoid or early detection of any serious condition. Heartrate Monitoring Algorithm (HMA) was designed to observe the spread heartbeat spectrum and worked at the backend of HMS. A case study was performed for forty healthy young subjects. Each subject data was computed for (sub) ̅-3S_

Supporting neonatal resuscitation in low-resource settings : Innovations and new strategies

Background: Lack of oxygen at birth, birth asphyxia, accounts annually for around 700 000 deaths. Heart rate is important in evaluating a neonate and effective positive pressure ventilation (PPV) may prevent neonatal deaths. Evaluating heart rate by auscultation may be inaccurate and standard face-mask ventilation (FMV) may be inadequate. NeoTap Life Support (NeoTapLS) is a free-of-charge smartphone app for heart rate recording designed for low-resource settings. The laryngeal mask airway (LMA) is a tube used as an alternative to a face mask. Both of these innovations may be task-shifted to midwives who are on the front-line of neonatal resuscitation in low-resource settings. This thesis reports on investigations into whether these innovations and new strategies can potentially increase adherence to guidelines and thereby reduce neonatal mortality and morbidity. Methods: Two observational studies and a clinical trial were conducted in Sweden and Uganda between 2014 and 2019. We investigated the accuracy and speed of heart rate assessment by NeoTapLS compared to a manikin, a metronome, pulse oximetry and electrocardiography, in simulations and in clinical use. A phase III open-label superiority randomized clinical trial, the NeoSupra Trial, compared LMA with face mask as a primary device for neonatal resuscitation carried out by midwives. The study involved neonates at ≥34 weeks of gestation and/or an expected birth weight of ≥2000 gram, thereby requiring PPV at birth. The primary outcome was a composite of 7-day mortality and moderate-to-severe hypoxic-ischemic encephalopathy, daily evaluated by Thompson scoring through Day 5. Results: Simulation studies showed a high correlation between measured and true values. In the manikin study, 93.5% of the auscultations and 86.3% of the palpations differed by ≤5 beats, mean acquisition time 14.9 vs. 16.3 s. In the metronome study, 77% differed by ≤10. In clinical assessment by doctors of neonates not needing PPV 88% differed by ≤10 and by midwives in neonates needing PPV 48% differed by ≤10, median acquisition time 5 vs. 2.7 s. NeoTapLS showed very good sensitivity and specificity in detecting heart rate <100 bpm. The NeoSupra Trial had a complete follow-up data of 99.2%; the primary outcome occurred in 27.4% in the LMA arm and 24.4% in the FMV arm (adjusted relative risk, 1.16; 95% confidence interval 0.90 to 1.51; P=0.26). Seven-day mortality was 21.7% in LMA and 18.4% in FMV (adjusted relative risk 1.21; 95% confidence interval, 0.90 to 1.63). The proportion of moderate-to-severe HIE was 11.2 vs. 10.1% (adjusted relative risk, 1.27; 95% confidence interval, 0.84 to 1.93). Intervention-related adverse events were few and similar between the arms. Conclusion: NeoTapLS is well adapted in the context it was used for swift and accurate heart rate recording by doctors. Clinical assessment by midwives was less accurate, suggesting that they may benefit from auscultation-focused training. LMA was safe in the hands of midwives but was not superior to a face mask in reducing early neonatal death and moderate-to-severe hypoxic-ischemic encephalopathy. It is suggested further investigations of these innovations and new strategies to explore the possibility of task-shifting its use to midwives in low-resource settings.Doktorgradsavhandlin

Telemedicine

Telemedicine is a rapidly evolving field as new technologies are implemented for example for the development of wireless sensors, quality data transmission. Using the Internet applications such as counseling, clinical consultation support and home care monitoring and management are more and more realized, which improves access to high level medical care in underserved areas. The 23 chapters of this book present manifold examples of telemedicine treating both theoretical and practical foundations and application scenarios

Sexual and Reproductive Health Rights and Information and Communications Technologies: A Policy Review and Case Study from South Africa

This report explores the intersection between sexual and reproductive health (SRH) and technological means of enhancing health. South Africa has a high teenage pregnancy rate. Almost a third of its girl teenagers report having been pregnant. The drivers of teenage pregnancy include uneven gender relations, poor access to health services and a lack of knowledge about sexual reproduction, contraception and poverty. Poverty and place of residence also affect pregnancy and health outcomes. Women and girls living in low-income residential areas have little or no access to comprehensive sexual and reproductive health services, including sexual, reproductive and maternal health. Women and girls located in rural, peri-urban and informal settlement contexts also experience technology deficits, including low levels of mobile phone ownership, poor network coverage, weak satellite signals and insufficient bandwidth. At present, very little research explores health within peri-urban contexts and the interconnections between poverty, place and health. At the same time, e- and m-health, and the information and communications technologies (ICT) that they rely on are frequently seen as a panacea to struggling health systems and as a means of meeting the health needs of women and girls in hard-to-reach places. Yet many complex factors are required for a successful m-health intervention. These include appropriate policy recognition from both the Department of Health and the Department of Communications; cooperation between the government and the private sector to bring together professional expertise (in health and technology); financial resources; awareness of women’s and girls’ sexual and reproductive health needs and rights; planning and provision of health information; consideration of ethical information and privacy; and awareness of the potential for such systems to generate savings and/or additional revenue. Using ICT (particularly mobile phones) to address the sexual and reproductive health needs of women and girls in hard-to-reach places is in its infancy. However, ICT and health offer enormous business potential and many mobile phone companies are exploring possible business models. This creates potential for the government and commercial companies to cooperate and develop new initiatives. This report is an exploration of this complex and emerging landscape which looks at relevant policies and current practice, asking: how are poor women’s and girls’ needs in rural and peri-urban conditions catered for through technological innovation in health?UK Department for International Developmen

COST EFFECTIVENESS AND SCALABILITY OF AN mHEALTH INTERVENTION TO IMPROVE PREGNANCY SURVEILLANCE AND CARE SEEKING IN RURAL BANGLADESH

Background: Proven health interventions, when implemented with high fidelity and adequate coverage, could save millions of maternal and newborn lives. In many low and middle-income countries, however, coverage levels of these interventions are still low. The mCARE program, implemented from 2011 to 2015 in Gaibandha district in Bangladesh, was implemented with the aim of developing and testing a mobile phone-based system to improve healthcare-seeking behaviors of pregnant women during and after their pregnancy through health worker-delivered automated and personally scheduled Short Message Service (SMS) and home visit reminders. Despite the growing recognition of the potential benefits of mobile health (mHealth) in improving knowledge, care seeking, and treatment adherence, little evidence exists on the value of mHealth for money or affordability in developing countries. Methods: Following established guidelines (e.g. CHEERS, ISPOR), we present analyses of the costs, consequences and affordability of the study drawn from a wide spectrum of datasets from the mCARE project including system-generated data on utilization, financial records from implementation and technical organizations, interviews with local experts and stakeholders, observations of service provision and exit interviews with 100 pregnant women in rural Bangladesh. Secondary data were also drawn from the literature and published national surveys. We used an ingredients-based approach to measure program costs by activity, and developed an Excel-based spreadsheet model to forecast program, provider and user costs and consequences for various alternatives and service delivery scenarios. The Lives Saved Tool (LiST) was used to model the number of lives saved and disability adjusted life years (DALYs) averted stemming from increases in coverage over time. We tested the robustness of the results though deterministic and probabilistic sensitivity analyses using Monte Carlo simulations. Finally, based on cost-effectiveness findings, we assessed the affordability of implementing the mCARE program using a budget impact analysis and cost-effectiveness affordability curves from the perspective of a budget holder. Results: At a cost of $12 per newborn death averted and$0.41 per DALY averted, the comprehensive mCARE program, which includes pregnancy surveillance and personally scheduled SMS and home visit reminders, is highly cost-effective from a program perspective, compared to a basic mCARE program, which does not include scheduled SMS and home visit reminders (Chapter 5). When delivered at scale over a 10-year analytic time horizon (2016 to 2025) and compared against a paper-based alternative, the comprehensive mCARE model costs $580,185 in the first year (2016) to start up and incrementally increases from$1,730,599 to $6,917,807 in the subsequent years (2017 to 2025) with incremental geographical expansion to another district each year. An estimated 19,682 total lives (including maternal, neonatal, and stillbirth) would be saved as a result, over a 10-year period. This corresponds to an incremental cost per DALY averted of$47 (Chapter 6). Assuming a willingness to fund $1,080 per DALY averted, based on the Bangladesh gross national income (GNI) per capita, the program has a 97$258,508 in the first year (2015) and $102,658 in subsequent years (2016 to 2020) – without adjusting for inflation and excluding overhead costs (Chapter 7). Above a budget threshold of$2.5 million, the program has a 93% probability of being cost-effective. Nationwide implementation of the comprehensive mCARE program would cost an estimated $47 million over the 2015-2020 period, comprising 0.9$5.4 billion) and 2.5% of public health expenditure ($1.9 billion). Conclusion: The results suggest that implementing the comprehensive mCARE program in Bangladesh may be cost-effective and affordable. Study findings are based on the primary data of 690 pregnant women; additional data are needed to verify forecasted costs and consequences of implementation at scale. Assumptions of the translation of changes in coverage for key maternal and newborn health services, including antenatal care, facility delivery and postnatal care, are dependent on supply side factors – relying on adequate human resources, supplies and commodities, and other inputs associated with quality of care, the measurement of which was beyond our scope. Even given these limitations, the study findings provide information that can help project the resources necessary to fund the program, and the consequences of potential variations of cost inputs at different levels of scale, which can be used to guide efforts of the government of Bangladesh to adopt, implement and sustain the mCARE program

Mathematical models for educational simulation of uterine contractions during labor

Tese de mestrado. Engenharia Biomédica. Faculdade de Engenharia. Universidade do Porto. 201

2022 - The Third Annual Fall Symposium of Student Scholars

The full program book from the Fall 2022 Symposium of Student Scholars, held on November 17, 2022. Includes abstracts from the presentations and posters.https://digitalcommons.kennesaw.edu/sssprograms/1026/thumbnail.jp

P14.01 An example of too much too soon? A review of caesarean sections performed in the first stage of labour in Kenya

Objective: Caesarean Section (CS) has potential short and long-term complications and is associated with excess maternal death. Decisions to perform (CS) are frequently made by inexperienced and unsupported non-specialist doctors, sometimes resulting in inappropriate decision-making and surgery. Our study assesses decision-making for CS in the first stage of labour in Kenya. Method: A panel of one UK and six Kenyan expert obstetricians reviewed clinical data extracted from 87 case-notes, that were randomly selected from a series obtained from seven referral hospitals in five Kenyan counties over six months in 2020. Following a preliminary review of the data and email discussion, an online panel was convened to discuss outstanding cases where consensus was yet to be reached. Agreement was reached by the panel in all but 5 cases. Results: In 41.3% cases, CS was considered appropriate, including 8% where CS was performed too late. The decision to delivery interval exceeded 2 h in 58.6% cases, including 16 cases of non-reassuring fetal status. In 10.3% it was considered that due to delay, further reassessment should have occurred. In 9.1% the CS was done too soon. There was insufficient information available to make a full assessment in 21.8% of cases. In 11.5% the CS was inappropriate. Conclusion: This review demonstrates that unnecessary caesarean sections are being performed, while some with appropriate indications are subject to delays. There is need for improved support for decision-making, coupled with improved record-keeping, improved quality of fetal monitoring during labour and more timely surgery when necessary

P14.02 An electronic behaviour diary: Monitoring the effects of advanced obstetric surgical skills training

Objective: Training should lead to improvements in the quality of clinical care delivery. It is essential to follow up participants after a training intervention to monitor changes in behaviour associated with adoption of lessons learned into clinical practice. We introduced an electronic diary to facilitate monitoring whilst minimising effort for participants. Method: An electronic diary was created using a freely available on-line platform. Following a training intervention on advanced obstetric surgical skills, obstetric residents from Kenya were invited to pilot completing the diary after their labour ward shifts. Entries were anonymised. Participants were asked to enumerate the times they utilised specific skills, or to state why they had been unable to do so, using tick box options. Reflections on skills used were entered using free comments. Results: All participants reported changed behaviours, for example, improved surgical knot-tying, safer needle handling, separate closure of uterine incision angles and techniques for delivery of the impacted fetal head. 6 reported conducting vaginal breech birth and 6 performed vacuum-assisted birth. All reported improvements in use of the safe surgical checklist, obtaining consent and respectful maternity care. 7 had participated in newborn resuscitation. Reflections suggested participants experienced improved levels of confidence and satisfaction when implementing new skills. Conclusion: This pilot study has demonstrated the feasibility of monitoring clinical behaviour change following training using an electronic platform. Monitoring the effect of training is essential to prove that training results in improvements to clinical practice. We plan to roll out this intervention following future training interventions

P04.41 Exploring reasons for and outcomes of second stage caesarean section and assisted vaginal birth in selected hospitals in Kenya

Objective: Obstetric vacuum devices for assisted vaginal birth (AVB) can avoid the need for unnecessary second-stage caesarean sections (SSCS), associated with increased morbidity and mortality. Despite emergency obstetric training since 2019, AVB was rarely performed. This study sought to better understand missed opportunities and reasons for non-performance of AVB in Kenya. Method: A mixed-methods design incorporated a review of randomly selected SSCS and AVB case notes, and key informant interviews with healthcare providers, from 8 purposively selected, high-volume hospitals in Kenya. The reviews were carried out by four experienced obstetricians (3 Kenyan, 1 British). The interviews were semi-structured and conducted online and analysed using a thematic approach. Results: Six AVB and 66 SSCS cases were reviewed. Nine percent of SSCS could have been AVB, and 58% reviewers were unable to determine appropriateness due to poor record keeping. Perinatal mortality was 9%, and 11% of infants and 9% of mothers experienced complications following SSCS. Twenty interviews, with obstetricians, midwives and medical officers, explored themes of previous experience, confidence, and adequacy of training relating to AVB. Reasons for non-performance included lack of equipment and staff. Conclusion: Increases in appropriate use of AVB could save the lives of infants and mothers and reduce ongoing morbidity. In order to achieve this, the varied reasons for non-performance of AVB need to be systematically addressed at local, regional and national levels