Clinical validation of the CHRONIOUS wearable system in patients with chronic disease

Web Health Monitoring Survey: A New Approach to Enhance the Effectiveness of Telemedicine Systems

BACKGROUND

Aging of the European population and interest in a healthy population in western countries have contributed to an increase in the number of health surveys, where the role of survey design, data collection, and data analysis methodology is clear and recognized by the whole scientific community. Survey methodology has had to couple with the challenges deriving from data collection through information and communications technology (ICT). Telemedicine systems have not used patients as a source of information, often limiting them to collecting only biometric data. A more effective telemonitoring system would be able to collect objective and subjective data (biometric parameters and symptoms reported by the patients themselves), and to control the quality of subjective data collected: this goal be achieved only by using and merging competencies from both survey methodology and health research.

OBJECTIVE

The objective of our study was to propose new metrics to control the quality of data, along with the well-known indicators of survey methodology. Web questionnaires administered daily to a group of patients for an extended length of time are a Web health monitoring survey (WHMS) in a telemedicine system.

METHODS

We calculated indicators based on paradata collected during a WHMS study involving 12 patients, who signed in to the website daily for 2 months.

RESULTS

The patients' involvement was very high: the patients' response rate ranged between 1.00 and 0.82, with an outlier of 0.65. Item nonresponse rate was very low, ranging between 0.0% and 7.4%. We propose adherence to the chosen time to connect to the website as a measure of involvement and cooperation by the patients: the difference from the median time ranged between 11 and 24 minutes, demonstrating very good cooperation and involvement from all patients. To measure habituation to the questionnaire, we also compared nonresponse rates to the items between the first and the second month of the study, and found no significant difference. We computed the time to complete the questionnaire both as a measure of possible burden for patient, and to detect the risk of automatic responses. Neither of these hypothesis was confirmed, and differences in time to completion seemed to depend on health conditions. Focus groups with patients confirmed their appreciation for this "new" active role in a telemonitoring system.

CONCLUSIONS

The main and innovative aspect of our proposal is the use of a Web questionnaire to virtually recreate a checkup visit, integrating subjective (patient's information) with objective data (biometric information). Our results, although preliminary and if need of further study, appear promising in proposing more effective telemedicine systems. Survey methodology could have an effective role in this growing field of research and applications.

Multiobjective optimization-based design of wearable electrocardiogram monitoring systems

Nowadays, the use of Wearable User Interfaces has been extensively growing in medical monitoring applications. However, production and manufacture of prototypes without automation tools may lead to non viable results since it is often common to find an optimization problem where several variables are in conflict with each other. Thus, it is necessary to design a strategy for balancing the variables and constraints, systematizing the design in order to reduce the risks that are present when it is exclusively guided by the intuition of the developer. This paper proposes a framework for designing wearable ECG monitoring systems using multi-objective optimization. The main contributions of this work are the model to automate the design process, including a mathematical expression relating the principal variables that make up the criteria of functionality and wearability. We also introduce a novel yardstick for deciding the location of electrodes, based on reducing interference from ECG by maximizing the electrode-skin contact.