Securing future healthcare environments in a post-COVID-19 world: moving from frameworks to prototypes

The deployment of Internet of Things platforms as well as the use of mobile and wireless technologies to support healthcare environments have enormous potential to transform healthcare. This has also led to a desire to make eHealth and mHealth part of national healthcare systems. The COVID-19 pandemic has accelerated the requirement to do this in order to reduce the number of patients needing to attend hospitals and General Practitioner surgeries. This direction however has resulted in a renewed need to look at security of future healthcare platforms including information and data security as well as network and cyber-physical security. There have been security frameworks that were developed to address such issues. However, it is necessary to develop a security framework with a combination of security mechanisms that can be used to provide all the essential security requirements for healthcare systems. In addition, there is now a need to move from frameworks to prototypes which is the focus of this paper. Several security frameworks for eHealth and mHealth are first examined. This leads to a new reference model from which an implementation framework is developed using new mechanisms such as Capabilities, Secure Remote Procedure Calls and a Service Management Framework. The prototype is then evaluated against practical security requirements

Development and evaluation of a photometric fibre-optic sensor for monitoring abdominal organ photoplethysmographs and blood oxygen saturation

A two wavelength photometric fibre-optic reflectance sensor was developed for assessing abdominal organ perfusion. In vitro tests showed that reliable photoplethysmographic (PPG) signals and blood oxygen saturation (SpO2) values were recorded when the separation between emitting and receiving fibres was at 3mm and the emitting current was between 20mA-40mA. In a clinical study, good quality PPG signals were obtained from the small and large bowel of a patient undergoing laparotomy. Abdominal organ SpO2 were in good agreement with those obtained from a commercial device. These observations suggest that the fibre-optic sensor may be suitable for monitoring abdominal organ perfusion

A new fibre optic pulse oximeter probe for monitoring splanchnic organ arterial blood oxygen saturation

A new, continuous method of monitoring splanchnic organ oxygen saturation (SpO2) would make the early detection of inadequate tissue oxygenation feasible, reducing the risk of hypoperfusion, severe ischaemia, and, ultimately, death. In an attempt to provide such a device, a new fibre optic based reflectance pulse oximeter probe and processing system were developed followed by an in vivo evaluation of the technology on seventeen patients undergoing elective laparotomy. Photoplethysmographic (PPG) signals of good quality and high signal-to-noise ratio were obtained from the small bowel, large bowel, liver and stomach. Simultaneous peripheral PPG signals from the finger were also obtained for comparison purposes. Analysis of the amplitudes of all acquired PPG signals indicated much larger amplitudes for those signals obtained from splanchnic organs than those obtained from the finger. Estimated SpO2 values for splanchnic organs showed good agreement with those obtained from the finger fibre optic probe and those obtained from a commercial device. These preliminary results suggest that a miniaturized ‘indwelling’ fibre optic sensor may be a suitable method for pre-operative and post-operative evaluation of splanchnic organ SpO2 and their health

Preliminary assessment of abdominal organ perfusion utilizing a fiber optic photoplethysmographic sensor

In an attempt to overcome the limitations of current techniques for monitoring abdominal organ perfusion, a prototype reflectance fiber optic photoplethysmographic (PPG) sensor and processing system was evaluated on seventeen anaesthetized patients undergoing laparotomy. Good quality PPG signals were obtained from the large bowel, small bowel, liver and stomach. Simultaneous PPG signals from the finger were also obtained for comparison purposes using an identical fiber optic sensor. Analysis of the mean ac and dc PPG amplitudes of all acquired signals indicated larger amplitudes for those signals obtained from abdominal organs than those obtained from the finger. Mean estimated blood oxygen saturation (SpO2) values from all abdominal sites showed good agreement with those obtained from the finger using both the finger fiber optic sensor and a commercial finger pulse oximeter. Furthermore, a Bland and Altman between-method-differences analysis on the estimated SpO2 data suggests that a fiber optic abdominal sensor may be a suitable method for the evaluation of abdominal organ perfusion

An in vivo investigation of photoplethysmographic signals and preliminary pulse oximetry estimation from the bowel using a new fiberoptic sensor

BACKGROUND: The continuous monitoring of splanchnic organ oxygen saturation could make the early detection of inadequate tissue oxygenation feasible, reducing the risk of hypoperfusion, severe ischemia, multiple organ failure, and, ultimately, death. Current methods for assessing splanchnic perfusion have not been widely accepted for use in the clinical care environment. In an attempt to overcome the limitations of the current techniques, a new fiberoptic photoplethysmographic (PPG)/pulse oximetry sensor was developed as a means of assessing splanchnic organ perfusion during surgery in humans. METHODS: A new fiberoptic splanchnic pulse oximeter and an optically identical fiberoptic finger pulse oximeter have been developed. Simultaneous PPG signals and preliminary estimates of arterial oxygen saturation from the bowel (small and large) and finger were obtained in 17 patients (3 men and 14 women) undergoing open laparotomy. RESULTS: Good quality PPG signals were obtained from the small and large bowel and from the finger in all patients (lower 95% confidence limit for the proportion was 0.64). Comparisons of blood oxygen saturation values acquired when using the splanchnic and the finger fiberoptic sensors and a commercial finger pulse oximeter indicated that there was no statistically significant difference between them (all P > 0.454). A Bland and Altman plot of the difference between blood oxygen saturation values from the bowel fiberoptic pulse oximeter and the fiberoptic finger pulse oximeter against their mean showed that the limits of agreement between the 2 pulse oximeters were −3.8% and 4.2% for small bowel measurements, and −3.4% and 4.3% for large bowel measurements. The 95% prediction interval for the difference between the 2 devices was between −4.2% and 4.7%. CONCLUSION: This study demonstrated that good quality PPG signals can be obtained from the bowel using a new fiberoptic sensor. Further evaluation is required to determine whether fiberoptic pulse oximetry of the bowel may provide a suitable method for monitoring splanchnic perfusion

In-Vivo Evaluation of a Fiber-Optic Splanchnic Photoplethysmographic Sensor during Open Laparotomy

There is a need for a reliable and continuous monitoring of abdominal organ oxygen saturation (SpO2). Splanchnic ischemia may ultimately lead to cellular hypoxia and necrosis and may well contribute to the development of multiple organ failures and increased mortality. A new prototype reflectance fiber optic photoplethysmographic sensor and signal processing system was evaluated on six anaesthetized patients undergoing elective laparotomy. PPG signals were obtained from various organs, including large and small bowel, liver, and stomach. The normalized amplitudes of the splanchnic PPG signals were in good agreement with those obtained from the periphery using an identical fiber optic sensor. Furthermore, average SpO2 values were in good agreement and showed correlation with those obtained from a commercial system. These preliminary results suggest that a miniaturized `indwelling' fiber optic sensor may be a suitable method for pre-operative and post-operative evaluation of splanchnic organ SpO2 and their health

A New Fibre Optic Pulse Oximeter Probe for Monitoring Splanchnic Organ Arterial Blood Oxygen Saturation

a new continuous method of monitoring splanchnic organ oxygen saturation (SpO2) would make the early detection of inadequate tissue oxygenation feasible, reducing the risk of hypoperfusion, severe ischaemia, and, ultimately, death. In an attempt to provide such a device, a new fiber optic based reflectance pulse oximeter probe and processing system were developed followed by an in vivo evaluation of the technology on seventeen patients undergoing elective laparotomy. Photoplethysmographic (PPG) signals of good quality were obtained from the small bowel, large bowel, liver and stomach. Simultaneous peripheral PPG signals from the finger were also obtained for comparison purposes. Analysis of the amplitudes of all acquired PPG signals indicated much larger amplitudes for those signals obtained from splanchnic organs than those obtained from the periphery. Estimated SpO2 values for splanchnic organs showed good agreement with those obtained from the peripheral fibre optic probe and those obtained from a commercial device. These preliminary results suggest that a miniaturized ‘indwelling’ fibre optic sensor may be a suitable method for pre-operative and post-operative evaluation of splanchnic organ SpO2 and their health