The future is mobile and wireless

Demand for mobile and wireless diagnostic and therapy devices is increasing and microsystems technology is helping to meet that demand.

From computers to ubiquitous computing by 2010: health care

Over the past decade, miniaturization and cost reduction in semiconductors have led to computers smaller in size than a pinhead with powerful processing abilities that are affordable enough to be disposable. Similar advances in wireless communication, sensor design and energy storage have meant that the concept of a truly pervasive 'wireless sensor network', used to monitor environments and objects within them, has become a reality. The need for a wireless sensor network designed specifically for human body monitoring has led to the development of wireless 'body sensor network' (BSN) platforms composed of tiny integrated microsensors with on-board processing and wireless data transfer capability. The ubiquitous computing abilities of BSNs offer the prospect of continuous monitoring of human health in any environment, be it home, hospital, outdoors or the workplace. This pervasive technology comes at a time when Western world health care costs have sharply risen, reflected by increasing expenditure on health care as a proportion of gross domestic product over the last 20 years. Drivers of this rise include an ageing post 'baby boom' population, higher incidence of chronic disease and the need for earlier diagnosis. This paper outlines the role of pervasive health care technologies in providing more efficient health care.

New frontiers in home telemonitoring. It's already here. Where are you?

Home-monitoring technology is a somewhat rare example of highly effective healthcare information technology that patients "get." Clinical and IT professionals throughout the United States and Europe demonstrate that patients quickly understand and grow to value telemonitoring as a tool to take charge of their own health. Healthcare providers involved with home telemonitoring programs report significant direct and indirect benefits for all stakeholders, as well as a number of lessons learned when working with patients, clinical and medical staff, healthcare administrators and board members and third-party payors. Despite decades of successes, health telemonitoring technologies are still relatively untapped. However, new technologies are reaching the marketplace. Demographic and regulatory shifts are pushing stakeholders toward a new frontier in telemonitoring. Based on their own experiences and an extensive literature review, the authors conclude: the new frontier of home telemedicine is here. Where are you?

Applications of medical informatics in allergy/immunology

OBJECTIVE

To provide a general overview of informatics and its interface with allergy/immunology.

DATA SOURCES

The PubMed interface to MEDLINE was searched with the keywords asthma, allergy, or immunology together with the keywords informatics, bioinformatics, and information technology to retrieve the articles relevant to this review.

STUDY SELECTION

The authors' knowledge of the field was used to include sources of information other than those obtained through the MEDLINE search.

RESULTS

A survey of informatics, with emphasis on the relevance to allergy, asthma, and immunology, is presented.

CONCLUSIONS

Several innovative informatics approaches have significant potential to improve health care on diverse fronts. Newer methods of information representation are poised to facilitate the impact of cutting-edge research on clinical practice.

Home Monitoring: what can we expect in the future?

The Home Monitoring of implanted cardiac rhythm management devices developed by Biotronik (Berlin, Germany) is a new useful tool for monitoring patients. Home Monitoring provides access to technical and clinical data, allowing almost continuous patient surveillance. The implanted defibrillators and pacemakers transmit encrypted messages, which are automatically analyzed in the Home Monitoring Service Center and sent to the physician. The expected benefit of this kind of data transmission is an improvement in patient follow-up and early detection of changes in the rhythmologic state of the patient. However, these new tools raise several questions, which will require an answer in the nearest future. These questions focus on safety and economic aspects, and on the liability of the physician and the manufacturer. Technological improvement is also expected.

Wireless capsule endoscopy: from diagnostic devices to multipurpose robotic systems

In the recent past, the introduction of miniaturised image sensors with low power consumption, based on complementary metal oxide semiconductor (CMOS) technology, has allowed the realisation of an ingestible wireless capsule for the visualisation of the small intestine mucosa. The device has received approval from Food and Drug Administration and has gained momentum since it has been more successful than traditional techniques in the diagnosis of small intestine disorders. In 2004 an esophagus specific capsule was launched, while a solution for colon is still under development. However, present solutions suffer from several limitations: they move passively by exploiting peristalsis, are not able to stop intentionally for a prolonged diagnosis, they receive power from an internal battery with short length, and their usage is restricted to one organ, either small bowel or esophagus. However the steady progresses in many branches of engineering, including microelectromechanical systems (MEMS), are envisaged to affect the performances of capsular endoscopy. The near future foreshadows capsules able to pass actively through the whole gastrointestinal tract, to retrieve views from all organs and to perform drug delivery and tissue sampling. In the long term, the advent of robotics could lead to autonomous medical platforms, equipped with the most advanced solutions in terms of MEMS for therapy and diagnosis of the digestive tract. In this review, we discuss the state of the art of wireless capsule endoscopy (WCE): after a description on the current status, we present the most promising solutions.

The future of military medicine has not arrived yet, but we can see it from here

Throughout history, military medical personnel have provided care for their comrades in arms, often at the expense of their own lives. For many centuries, these medical personnel have applied the highest available level of knowledge and technology to the care of their patients. This paper discusses the current state of the technological art for the care of combat casualties, and discusses some of the newest technology solutions currently being developed for the provision of field medical care. The ongoing efforts of the Defense Advanced Research Projects Agency (DARPA), the U.S. Army Medical Research and Materiel Command (MRMC), and the U.S. Army Telemedicine and Advanced Technology Research Center (TATRC) are highlighted.

Cardiac rhythm management: the shape of things to come

PURPOSE OF REVIEW

The aim of this article is to forecast a major imminent change in the clinical practice of cardiac rhythm management, which is argued to be remote patient monitoring, its potential benefits to clinical practitioners and its barriers to widespread diffusion.

RECENT FINDINGS

All four major manufacturers of cardiac rhythm management devices have recently introduced varying types of systems that allow remote patient monitoring. These remote patient monitoring systems promise more efficient patient management in today's clinical setting of rapidly growing numbers of patients with increasingly heterogeneous etiology, varying indications and comorbidities. The major differences between current systems are related to the degree of patient involvement in remote patient monitoring and limits on patient mobility. Other important factors that influence the value of remote patient monitoring are the degree to which remote follow-up would completely fulfill the requirements of an in-office follow-up and the inclusion of sensors that enable the prediction of major clinical events such as heart failure decompensation with a high degree of accuracy.

SUMMARY

Even if the different remote patient monitoring systems currently available offer several clinical benefits such as early detection of cardiac events and complications, reduced follow-up costs and increased safety, the full potential of such systems requires the possibility to easily transfer relevant patient data to common patient databases that are linked to hospital information systems or electronic patient records. Only then will it be possible to gain a complete picture of patient conditions. This will require the development of common protocols for data communication and may involve issues of patient data ownership and integrity.

Flexible technologies and smart clothing for citizen medicine, home healthcare, and disease prevention

Improvement of the quality and efficiency of healthcare in medicine, both at home and in hospital, is becoming more and more important for patients and society at large. As many technologies (micro technologies, telecommunication, low-power design, new textiles, and flexible sensors) are now available, new user-friendly devices can be developed to enhance the comfort and security of the patient. As clothes and textiles are in direct contact with about 90% of the skin surface, smart sensors and smart clothes with noninvasive sensors are an attractive solution for home-based and ambulatory health monitoring. Moreover, wearable devices or smart homes with exosensors are also potential solutions. All these systems can provide a safe and comfortable environment for home healthcare, illness prevention, and citizen medicine.

Electroactive Polymer-Based Devices for e-Textiles in Biomedicine

This paper describes the early conception and latest developments of electroactive polymer (EAP)-based sensors, actuators, electronic components, and power sources, implemented as wearable devices for smart electronic textiles (e-textiles). Such textiles, functioning as multifunctional wearable human interfaces, are today considered relevant promoters of progress and useful tools in several biomedical fields, such as biomonitoring, rehabilitation, and telemedicine. After a brief outline on ongoing research and the first products on e-textiles under commercial development, this paper presents the most highly performing EAP-based devices developed by our lab and other research groups for sensing, actuation, electronics, and energy generation/storage, with reference to their already demonstrated or potential applicability to electronic textiles.

Organic Field Effect Transistors for Textile Applications

In this paper, several issues concerning the development of textiles endowed with electronic functions will be discussed. In particular, issues concerning materials, structures, electronic models, and the mechanical constraints due to textile technologies will be detailed. The idea starts from an already developed organic field-effect transistor that is realized on a flexible film that can be applied, after the assembly, on whatever kind of substrate, in particular, on textiles. This could pave the way to a variety of applications aimed to conjugate the favorable mechanical properties of textiles with the electronic functions of transistors. Furthermore, a possible perspective for the developments of organic sensors based on this structure are described.

[The technical possibilities in telemonitoring of physiological parameters]

For decades, telemonitoring of vital parameters has been a recurring topic among experts. Because of its lack of economical advantages it has not established itself as a standard up to now. Thanks to novel wireless communication technologies such as Bluetooth or Zigbee, the enormous technological progress in mobile communication via GSM, GPRS, as well as UMTS and various radical medical changes within disease management programs, currently very promising new potentials for telemonitoring are appearing. This article summarizes the current technological developments, discusses their advantages and drawbacks, and deduces scenarios and technical requirements for future system architectures.

[Support of prevention medicine techniques with the help of telemedical monitoring]

Prevention medicine should not be limited to regular preventive diagnosis in a prevention center. Expecially for patients with a known increased risk a mobile telemonitoring would be benefitial. This telemonitoring continuously measures certain vital parameters, detects negative changes or even acute risks with an inbuilt intelligence (smart sensor) and sends alarm messages to the prevention center. This paper presents firsts products already available on the market, analyses weaknesses and draws a scenario of a future telemedical system for preventive purposes. One focus is the development of mobile hubs, that provide the communication with the mobile sensors and that at the same time allow a tracking or positioning of the patient.