Holistic interaction model for peoble living with a chronic disease

Ambient Intelligence (AmI) allows the intelligent and natural interaction between the context and individuals. This paradigm will facilitate user support through novel medical protocol design for chronic disease treatment, based on the healthy lifestyle promotion. Cardiovascular Diseases (CVD) account for 45% of all deaths in the western world according to the 2004 World Health Organization statistic report. Heart Failure (HF), CVD’s primary paradigm, mainly affects people older than 65. The European MyHeart Project’s mission is to empower citizens to fight CVD by leading a preventative lifestyle and allowing early diagnosis. This Thesis aims to model the patient interaction based on contexts and the implementation of this model into a Heart Failure Management integrated product. Heart Failure Management daily monitors vital body signals, using wearable and mobile technologies, to continuously assess this chronic disease. The methodology applied herein has involved stakeholders in an iterative process. The Thesis proposed the holistic Patient Interaction Model (hPIM) which comprises three contexts: 1) the Patient Context which defines for instance, the human factors or the patient personal routine. Besides, the Patient Context includes all sensors around the patient which play important role since they allow an implicit interaction without specific patient input. 2) Around this first context, the Medical Context comprises also the services which provide the patients with a remote monitoring assessment. This context groups all medical professionals. And 3) Social and Business Context appears around all. This context states the social and clinical rules that must be taken into account. With this holistic approach all actors are studied to enhance as well the human-human interaction. The hPIM is adapted to a particular target group: people who suffer from heart failure. The solution goals are defined by reviewing existing similar solutions working together with technical and medical experts, and researchers. This multidisciplinary team stated the initial hypothesis for the system. The generic user (“persona”) of HFM is Carlos Gómez, 72 years old. He is retired and has heart failure. His awareness of his heart condition leads him to be proactive in his health. He can use an electronic device following an intuitive system. He requires no special needs regarding accessibility (e.g. blind people). His chief goals are selfassurance and self-confidence when performing his daily routine. He must feel unperturbed and lose his fear of a sudden death. He also aims to control his own health evolution by self-managing his health. He wishes to live normally, thus making it crucial to give him a system that is non-intrusive that invisible public view while under treatment. Namely, the system must adapt to his daily routine. In the HFM context, the end users are prompted to follow a daily routine consisting of a set of activities (i.e. symptoms questionnaires, measurements using wearable garments and portable devices). The vital signs assessed are ECG, heart rate, and respiration. The portable devices are a blood pressure cuff for systolic and diastolic blood pressure and weight scale. All devices and garments have communication capability (i.e. Bluetooth). Moreover, the user can perform a light exercise of 5-6 minutes, several days a week to improve their health. This routine varies for every patient but must follow some rules for medical reason (e.g. blood pressure must be taken every morning). The routine can be personalized for each patient despite the light constraints. There were two scenarios detected within the system: indoors and outdoors. The former contains a set of measurements, using the wearable garments and portable devices at home. The user answers two questionnaires defined by the medical team. The later contains an exercise scenario (e.g. a short walk) that promotes a healthy lifestyle and improves cardiovascular capability. The professional checks the status of all patients via portal. Adaptation to personal routines is the most important user requirement. Specifically, each user will have a different daily health schedule according to particular health status, preferences, mental status and recommended medical protocol. Furthermore, the user application must be intuitive, user-friendly, and must allow natural interaction. A PDA with a touch-screen allows these requirements. Adaptability to user preferences and routines within HFM is achieved via dynamic workflow execution (which depends on the context information). First, we defined taxonomy: a session is a day using HFM, a day is divided in contexts (morning, exercise, evening, and night). Each context comprises a set of activities requiring user participation at the same temporary term (i.e. a task or activity is the measurement of blood pressure). These carefully designed systems play an important role in motivating people to adopt healthier lifestyles by using technical solutions. These solutions allow patient self-management of their chronic condition. The evaluation aims to validate the model, feasibility, efficiency, user experience, and acceptance of the implementation on heart failure patients. The validation performed along the complete life cycle demonstrated that the holistic model represents the reality. Moreover it represents the combination of knowledge of all stakeholders and is a reference for future models and implementations. La Inteligencia Ambiental (AmI) permite la interacción inteligente y natural entre el contexto y los individuos. Este nuevo paradigma ayudará a los pacientes a gestionar su propia enfermedad de acuerdo a los protocolos médicos correspondientes, mejorando su estilo de vida. En el mundo, especialmente en los países más desarrollados, las enfermedades cardiovasculares (ECVs) se han convertido en la principal causa de muerte. En España, en el año 2001, de las 360.931 defunciones registradas, el 34.9% se produjeron por ECV, convirtiéndose en la primera causa de defunción. En el resto de países desarrollados las cifras son bastante similares. La presente tesis doctoral tiene como objeto principal modelar la interacción de usuarios basada en información contextual. Se aplica el modelo a un caso de uso: pacientes con insuficiencia cardiaca que monitorizan diariamente su salud fuera del ámbito hospitalario, gracias al uso de sensores wearable y tecnologías móviles. La metodología aplicada se basa en el diseño participativo, involucrando a los distintos actores en un proceso iterativo. El modelo holístico de interacción del paciente (en inglés, the holistic Patient Interaction Model, hPIM) se organiza en tres contextos que definen las variables, actores y sistemas involucrados. El contexto del paciente agrupa los factores humanos y la rutina personal. Los sensores y dispositivos de interacción también son variables de este contexto de paciente. El contexto médico agrupa a los profesionales y los servicios de gestión de la enfermedad cerrando el lazo, ajustando los protocolos personales de manera remonta. El contexto social y político define las reglas que rigen la prestación de salud en un determinado país o región. El modelo hPIM se aplica a un grupo particular para definir todas las vistas del modelo: los pacientes con insuficiencia cardiaca. Las soluciones se definen revisando la literatura y contando con la involucración de un equipo multidisciplinar formado por psicólogos, médicos, pacientes, técnicos y expertos en la gestión de la salud. La persona genérica se llama Carlos Gómez, tiene 72 años, padece insuficiencia cardiaca y esté retirado. Está preocupado por su estado de salud. Es capaz de manejar dispositivos electrónicos sencillos y entre sus objetivos se encuentra el ser capaz de auto-gestionar su condición crónica, por lo que necesita una interacción adaptada a sus necesidades. En el escenario modelado, los pacientes siguen una rutina diaria en la cual realizan una serie de actividades para gestionar su enfermedad (por ejemplo, medirse la tensión arterial o contestar un cuestionario de síntomas). Las señales vitales medidas son el electrocardiograma y la respiración. También se mide el peso y la presión arterial con dispositivos portátiles médicos. Todos los aparatos de medida se comunican con Bluetooth de manera automática con la PDA. El paciente realiza si está recomendado por el médico y de acuerdo al contexto actual un ejercicio de cinco o seis minutos. La rutina de tratamiento varía de un paciente a otro de acuerdo a su tratamiento personal y su rutina diaria. Se contemplan entonces dos escenarios, uno interior para las medidas en el hogar y otro exterior para el paseo como ejercicio cuando proceda. Los profesionales médicos comprueban la evolución de sus pacientes a través de un portal web con acceso restringido. La aplicación de los pacientes debe estar adaptada a su tratamiento médico y su rutina personal. Además, la interacción debe ser intuitiva, “user-fiendly” y natural en el sentido de que se pueda utilizar sin ayudas especiales. Por ellos, la estación de paciente está implementada en una PDA con pantalla táctil. La adaptación a las rutinas personales se consigue mediante la implementación de flujos de trabajo (workflows) dinámicos en una máquina de estados que ejecuta las tareas o actividades (p.e. la medida del peso) de acuerdo al protocolo personalizado y a la condición de contexto actual. Para ellos se han definido los siguientes términos, para conseguir esa modularidad y adaptabilidad dinámica: una “sesión” se corresponde con un día de uso del sistema. La sesión se compone de “contextos” que agrupan en intervalos temporales y con ciertas condiciones una serie de “actividades”. Las actividades son las tareas individuales que deben realizar los pacientes. Estos sistemas diseñados con diseño participativo centrados y orientados a los pacientes constituyen un pilar fundamental en la promoción de estilos de vida saludables en la sociedad del futuro. Permitirán a los pacientes a tener un mejor control sobre su condición crónica. La evaluación del modelo, así como la eficiencia, experiencia de paciente y la aceptación de la solución tecnológica se ha realizado a lo largo del ciclo de vida de la investigación involucrando a todos los actores que forman parte de la realidad de la gestión extra-hospitalaria de pacientes crónicos, en concreto con insuficiencia cardiaca. Esta validación ha demostrado la viabilidad del modelo y los beneficios de su uso a la hora de diseñar soluciones tecnológicas

Heart Failure Monitoring System Based on Wearable and Information Technologies

In Europe, Cardiovascular Diseases (CVD) are the leading source of death, causing 45% of all deceases. Besides, Heart Failure, the paradigm of CVD, mainly affects people older than 65. In the current aging society, the European MyHeart Project was created, whose mission is to empower citizens to fight CVD by leading a preventive lifestyle and being able to be diagnosed at an early stage. This paper presents the development of a Heart Failure Management System, based on daily monitoring of Vital Body Signals, with wearable and mobile technologies, for the continuous assessment of this chronic disease. The System makes use of the latest technologies for monitoring heart condition, both with wearable garments (e.g. for measuring ECG and Respiration); and portable devices (such as Weight Scale and Blood Pressure Cuff) both with Bluetooth capabilitie

Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS3). MOMA and Maccabi Healthcare Services (Israel). Case Study Report

MOMA is a care model based on a multidisciplinary 24/7 advanced technology call centre for treatment of various chronic diseases. It was established in 2012 by Maccabi Healthcare Services in cooperation with the Gertner Institute. Maccabi Healthcare Services is one of the four authorised health funds providing universal healthcare services in Israel. The MOMA initiative was designed as a technological tool to improve the integration of different services such as long-term care, pharmacy, homecare and hospital care, in coordination with the patient’s primary care physician and other community-based resources. MOMA addresses the needs of chronically ill patients, which Maccabi Healthcare Services considered as patients who should receive special care instead of standard care.JRC.J.3-Information Societ

Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS3).Veterans Health Administration (USA). Case Study Report

The Veterans Health Administration (VHA) is an agency of the United States Department of Veterans’ Affairs (this Department that has the 3rd largest budget among departments of the US administration). The medical assistance program implemented by the VHA is the largest integrated care system in the US (consisting of 150 medical centres and nearly 1,700 facilities comprising community-based outpatient clinics, community living centres, Veterans’ Centres and domiciliary assistance). It provides comprehensive care to almost 9 million veterans every year. The VHA is centrally administered and fully integrated; its services are funded and provided by the federal government. Therefore the VHA works both as a provider and payer, a rather unusual feature in the US health care structure. In fact, VHA is the only truly national health care system in the US, with hospitals or other facilities in every state and major metropolitan area of the country, as well as in Puerto Rico, the Virgin Islands, Guam, American Samoa and the Philippines. The VHA network is divided into 23 Veterans Integrated Service Networks, or VISNs, i.e. regional systems of care working together to better meet local health care needs and provide greater access to care.JRC.J.3-Information Societ

Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS3). Diabmemory (Austria). Case Study Report

In 2010, the Austrian Social Insurance Institution for Railways and Mining Industry (Versicherungsanstalt für Eisenbahnen und Bergbau, VAEB) started a proof-of-concept diabetes telemonitoring project called DiabMemory, as part of a wider programme called "Health Dialogue" (“Gesundheitsdialog”). DiabMemory allows diabetes patients to track health parameters using a mobile phone and share this data with their General Practitioner (GP). After being diagnosed with type 1 or 2 diabetes in primary or secondary care, patients insured by VAEB are given the opportunity to stay for a period of one to three weeks at a special rehabilitation facility in Breitenstein (Lower Austria) to receive education on all aspects relevant to their health and medical conditions like nutrition, physical activity, and psychological aspects. If they decide to join the programme, they receive the equipment and training on how to use the DiabMemory system and how to integrate it into their everyday lives. After their stay in Breitenstein, participants are able to use DiabMemory without further help. A web-based application allows health professionals responsible for therapy management within the Health Dialogue programme to access patient data and adjust therapy plans when needed. Moreover, they can provide users with motivational messages and feedback can be sent directly to the patient’s mobile.JRC.J.3-Information Societ

Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS3). Integrated care programme for older in- and out-patients University Hospital of Getafe (Spain). Case Study Report

For more than 20 years the Geriatrics Service of the University Hospital of Getafe (Hospital Universitario de Getafe – HUG) has been offering integrated care programmes for older in- and out-patients. These services provide continuous, progressive and coordinated attention to patients at high risk of functional decline, institutionalisation, and hospitalisation, at home or in residential care settings. The objective is to offer the most appropriate care according to the changing needs of the patients. The programme is twofold: for people admitted to the hospital, the care teams responsible for the different phases of the treatment are coordinated through periodic meetings (both physical and remote, the latter to coordinate care with other hospitals) and coordinate with the team in primary care before discharge; for patients who are at home or in residential care facilities, the programme includes follow-up of the patient directly, or in close collaboration with primary care and social care agents when needed.JRC.J.3-Information Societ

Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS3). Renewing Health Carinthia (Austria). Case Study Report

Renewing Health is a European project (February 2010-December 2013), partly funded by the European Union under the ICT Policy Support Programme, part of the Competitiveness and Innovation framework Programme (CIP), with a total budget of €14 million and European co-financing of €7 million. The project aimed to implement health-related ICT services through large-scale real-life test beds for the validation and subsequent evaluation of innovative eHealth services, using a patient-centred approach and a rigorous common assessment methodology. This case study focuses on the Austrian Partner of the project: the Carinthia region and, more precisely, KABEG (Krankenanstalten Betriebsgesellschaft), the hospital management company in the region. In RENEWING HEALTH, KABEG integrated a set of telemonitoring solutions into their existing systems for two target groups - patients suffering from Diabetes Mellitus Type II and patients suffering from COPD – in order to carry out two pilots to test the effects of the resulting system.JRC.J.3-Information Societ

Implicit, Explicit, and Structural Barriers and Facilitators for Information and Communication Technology Access in Older Adults

Older adults’ usage of information and communication technology (ICT) is challenged or facilitated by perception of usefulness, technology design, gender, social class, and other unspoken and political elements. However, studies on the use of ICT by older adults have traditionally focused on explicit interactions (e.g., usability). The article then analyzes how symbolic, institutional, and material elements enable or hinder older adults from using ICT. Our ethnographic methodology includes several techniques with Spanish older adults: 15 semi-structured interviews, participant observation in nine ICT classes, online participant observation on WhatsApp and Jitsi for 3 months, and nine phone interviews due to COVID-19. The qualitative data were analyzed through Situational Analysis. We find that the elements hindering or facilitating ICT practice are implicit-symbolic (children’s surveillance, paternalism, fear, optimism, low self-esteem, and contradictory speech-act), explicit-material (affordances, physical limitations, and motivations), and structural-political (management, the pandemic, teaching, and media skepticism). Furthermore, unprivileged identities hampered the ICT practices: female gender, blue-collar jobs, illiteracy, and elementary education. However, being motivated to use ICT prevailed over having unprivileged identities. The study concludes that society and researchers should perceive older adults as operative with technologies and examine beyond explicit elements. We urge exploration of how older adults’ social identities and how situatedness affects ICT practice. Concerning explicit elements, Spanish authorities should improve and adapt ICT facilities at public senior centers and older adults’ homes, and ICT courses should foster tablet and smartphone training over computers

A systematic mapping study on integration proposals of the personas technique in agile methodologies

Agile development processes are increasing their consideration of usability by integrating various user‐centered design techniques throughout development. One such technique is Personas, which proposes the creation of fictitious users with real preferences to drive application design. Since applying this technique conflicts with the time constraints of agile development, Personas has been adapted over the years. Our objective is to determine the adoption level and type of integration, as well as to propose improvements to the Personas technique for agile development. A systematic mapping study was performed, retrieving 28 articles grouped by agile methodology type. We found some common integration strategies regardless of the specific agile approach, along with some frequent problems, mainly related to Persona modelling and context representation. Based on these limitations, we propose an adaptation to the technique in order to reduce the creation time for a preliminary persona. The number of publications dealing with Personas and agile development is increasing, which reveals a growing interest in the application of this technique to develop usable agile softwareThis research was funded by the Spanish Ministry of Science, Innovation and Universities research grant PGC2018-097265-B-I00, MASSIVE project (RTI2018-095255-B-I00) and by EIT-Health, grant number 19091 (POSITIVE project). This research was also supported by the Madrid Region R&D programme (project FORTE, P2018/TCS-4314

Поліваріантність ефектів біоактивної води Нафтуся на вегетативну реактивність, їх ендокринний і імунний супровід та можливість прогнозування

Выявлены разнонаправленные изменения (а также отсутствие оных) в результате питьевой монотерапии биоактивной водой Нафтуся вегетативной реактивности у женщин детородного возраста с хронической гинекологически-эндокринной патологией. Прослежены сопутствующие изменения ряда эндокринных и иммунных показателей. Доказана возможность надежного прогнозирования (точность - 92%) типа эффекта по 30 исходным показателям, отобранным методом дискриминантного анализа.Are revealed various changes (and also absence these) as a result of drinking monotherapy by bioactive water Naftussya of vegetative reactivity at the women of reproductive age with chronic ginecological and endocrine pathology. Are investigated accompanying changes of line of endocrine and immune parameters. The opportunity of reliable forecasting (accuracy - 92 %) such as effect on 30 initial parameters selected method of discriminant analysis is proved