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Nejadshafiee M, Nekoei-Moghadam M, Bahaadinbeigy K, Khankeh H, Sheikhbardsiri H. Providing telenursing care for victims: a simulated study for introducing of possibility nursing interventions in disasters. BMC Med Inform Decis Mak 2022; 22:54. [PMID: 35236344 PMCID: PMC8889514 DOI: 10.1186/s12911-022-01792-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Uncertainty occurrence of disasters requires special attention and a shortage of health care specialists is a challenge for health care systems; therefore, the use of telenursing care during a disaster is an appropriate way to provide care. This study aimed to investigate telenursing operational possibilities in disasters. Methods A cross-sectional study was performed by implementing a functional exercise (Drill) for the possibility of nursing interventions in the response phase to disasters at Kerman University of Medical Sciences in 2021. Two evaluators examined and scored the possibility of providing telenursing care using a researcher-made checklist and we surveyed Inter-rater agreement between two evaluators by Cohen's kappa coefficient. Data were analyzed using descriptive tests and SPSS 20 software. Results Findings showed that implementation of telenursing care would be helpful in future disasters. The scores received from assessment of the evaluation checklist for this simulated exercise program by the first evaluator was 83.25 and for the second evaluator was 72.00. The results of the study showed that the mean score of the possibility of telenursing in disasters was at a high level 77.50. Thus, the quality of the telenursing care in simulated conditions was satisfactory. Conclusion Today, disaster management is almost impossible without using new technologies. This study found that due to the lack of specialized nursing staff in the deprived areas affected by disasters, the most important way to provide health care for a large group of the population is to develop effective health services so that everyone can use these services equally and fairly.
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Affiliation(s)
| | - Mahmoud Nekoei-Moghadam
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamidreza Khankeh
- Department of Educational and Rehabilitation Psychology, Leipzig University, Leipzig, Germany
| | - Hojjat Sheikhbardsiri
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Hayden EM, Davis C, Clark S, Joshi AU, Krupinski EA, Naik N, Ward MJ, Zachrison KS, Olsen E, Chang BP, Burner E, Yadav K, Greenwald PW, Chandra S. Telehealth in emergency medicine: A consensus conference to map the intersection of telehealth and emergency medicine. Acad Emerg Med 2021; 28:1452-1474. [PMID: 34245649 PMCID: PMC11150898 DOI: 10.1111/acem.14330] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Telehealth has the potential to significantly change the specialty of emergency medicine (EM) and has rapidly expanded in EM during the COVID pandemic; however, it is unclear how EM should intersect with telehealth. The field lacks a unified research agenda with priorities for scientific questions on telehealth in EM. METHODS Through the 2020 Society for Academic Emergency Medicine's annual consensus conference, experts in EM and telehealth created a research agenda for the topic. The multiyear process used a modified Delphi technique to develop research questions related to telehealth in EM. Research questions were excluded from the final research agenda if they did not meet a threshold of at least 80% of votes indicating "important" or "very important." RESULTS Round 1 of voting included 94 research questions, expanded to 103 questions in round 2 and refined to 36 questions for the final vote. Consensus occurred with a final set of 24 important research questions spanning five breakout group topics. Each breakout group domain was represented in the final set of questions. Examples of the questions include: "Among underserved populations, what are mechanisms by which disparities in emergency care delivery may be exacerbated or ameliorated by telehealth" (health care access) and "In what situations should the quality and safety of telehealth be compared to in-person care and in what situations should it be compared to no care" (quality and safety). CONCLUSION The primary finding from the process was the breadth of gaps in the evidence for telehealth in EM and telehealth in general. Our consensus process identified priority research questions for the use of and evaluation of telehealth in EM to fill the current knowledge gaps. Support should be provided to answer the research questions to guide the evidenced-based development of telehealth in EM.
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Affiliation(s)
- Emily M Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Davis
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Aditi U Joshi
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Neel Naik
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Erica Olsen
- Department of Emergency Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Elizabeth Burner
- Department of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Kabir Yadav
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Peter W Greenwald
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Shruti Chandra
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Haleem A, Javaid M, Singh RP, Suman R. Telemedicine for healthcare: Capabilities, features, barriers, and applications. SENSORS INTERNATIONAL 2021; 2:100117. [PMID: 34806053 PMCID: PMC8590973 DOI: 10.1016/j.sintl.2021.100117] [Citation(s) in RCA: 135] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022] Open
Abstract
Regular hospital visits can be expensive, particularly in rural areas, due to travel costs. In the era of the Covid-19 Pandemic, where physical interaction becomes risky, people prefer telemedicine. Fortunately, medical visits can be reduced when telemedicine services are used through video conferencing or other virtual technologies. Thus, telemedicine saves both the patient's and the health care provider time and the cost of the treatment. Furthermore, due to its fast and advantageous characteristics, it can streamline the workflow of hospitals and clinics. This disruptive technology would make it easier to monitor discharged patients and manage their recovery. As a result, it is sufficient to state that telemedicine can create a win-win situation. This paper aims to explore the significant capabilities, features with treatment workflow, and barriers to the adoption of telemedicine in Healthcare. The paper identifies seventeen significant applications of telemedicine in Healthcare. Telemedicine is described as a medical practitioner to diagnose and treat patients in a remote area. Using health apps for scheduled follow-up visits makes doctors and patients more effective and improves the probability of follow-up, reducing missing appointments and optimising patient outcomes. Patients should have an accurate medical history and show the doctor any prominent rashes, bruises, or other signs that need attention through the excellent quality audio-video system. Further, practitioners need file management and a payment gateway system. Telemedicine technologies allow patients and doctors both to review the treatment process. However, this technology supplements physical consultation and is in no way a substitute for a physical consultation. Today this technology is a safe choice for patients who cannot go to the doctor or sit at home, especially during a pandemic.
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Affiliation(s)
- Abid Haleem
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Mohd Javaid
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Ravi Pratap Singh
- Department of Industrial and Production Engineering, Dr B R Ambedkar National Institute of Technology, Jalandhar, Punjab, India
| | - Rajiv Suman
- Department of Industrial & Production Engineering, G.B. Pant University of Agriculture & Technology, Pantnagar, Uttarakhand, India
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Kyriacou E, Antoniou Z, Hadjichristofi G, Fragkos P, Kronis C, Theodosiou T, Constantinou R. Operating an eHealth System for Prehospital and Emergency Health Care Support in Light of Covid-19. Front Digit Health 2021; 3:654234. [PMID: 34713128 PMCID: PMC8521915 DOI: 10.3389/fdgth.2021.654234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/29/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: The support of prehospital and emergency call handling and the impact of Covid-19 is discussed throughout this study. The initial purpose was to create an electronic system (eEmergency system) in order to support, improve, and help the procedure of handling emergency calls. This system was expanded to facilitate needed operation changes for Covid-19. Materials and Methods: An effort to reform the procedures followed for emergency call handling and Ambulance dispatch started on the Island of Cyprus in 2016; along that direction, a central call centre was created. The electronic system presented in this work was designed for this call centre and the new organization of the ambulance services. The main features are the support for ambulance fleet handling, the support for emergency call evaluation and triage procedure, and the improvement of communication between the call centre and the ambulance vehicles. This system started regular operation at the end of 2018. One year later, when Covid-19 period started, we expanded it with the addition of several new features in order to support the handling of patients infected with the new virus. Results: This system has handled 112,414 cases during the last 25 months out of which 4,254 were Covid-19 cases. These cases include the transfer of patients from their house to the reference hospital, or the transfer of critical patients from the reference hospital to another hospital with an intensive care unit or transfer of patients from one hospital to another one for other reasons, like the number of admissions. Conclusion: The main purpose of this study was to create an electronic system (eEmergency system) in order to support, improve, and help the procedure of handling emergency calls. The main components and the architecture of this system are outlined in this paper. This system is being successfully used for 25 months and has been a useful tool from the beginning of the pandemic period of Covid-19.
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Affiliation(s)
- Efthyvoulos Kyriacou
- Department of Electrical and Computer Engineering and Informatics, Cyprus University of Technology, Limassol, Cyprus
| | - Zinonas Antoniou
- eHealth Lab, Department of Computer Science, University of Cyprus, Nicosia, Cyprus
| | - George Hadjichristofi
- Department of Computer Science and Engineering, European University Cyprus, Nicosia, Cyprus
| | - Prokopios Fragkos
- eHealth Lab, Department of Electrical and Computer Engineering and Informatics, Frederick University, Limassol, Cyprus
| | - Chris Kronis
- eHealth Lab, Department of Electrical and Computer Engineering and Informatics, Frederick University, Limassol, Cyprus
| | - Theodosis Theodosiou
- Ambulance Department, State Health Services Organization, Ministry of Health, Nicosia, Cyprus
| | - Riana Constantinou
- Ambulance Department, State Health Services Organization, Ministry of Health, Nicosia, Cyprus
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5
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Wearable, Multimodal, Biosignal Acquisition System for Potential Critical and Emergency Applications. Emerg Med Int 2021; 2021:9954669. [PMID: 34221510 PMCID: PMC8213464 DOI: 10.1155/2021/9954669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023] Open
Abstract
For emergency or intensive-care units (ICUs), patients with unclear consciousness or unstable hemodynamics often require aggressive monitoring by multiple monitors. Complicated pipelines or lines increase the burden on patients and inconvenience for medical personnel. Currently, many commercial devices provide related functionalities. However, most devices measure only one biological signal, which can increase the budget for users and cause difficulty in remote integration. In this study, we develop a wearable device that integrates electrocardiography (ECG), electroencephalography (EEG), and blood oxygen machines for medical applications with the hope that it can be applied in the future. We develop an integrated multiple-biosignal recording system based on a modular design. The developed system monitors and records EEG, ECG, and peripheral oxygen saturation (SpO2) signals for health purposes simultaneously in a single setting. We use a logic level converter to connect the developed EEG module (BR8), ECG module, and SpO2 module to a microcontroller (Arduino). The modular data are then smoothly encoded and decoded through consistent overhead byte stuffing (COBS). This developed system has passed simulation tests and exhibited proper functioning of all modules and subsystems. In the future, the functionalities of the proposed system can be expanded with additional modules to support various emergency or ICU applications.
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6
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Shah NM, Kaltsakas G. Telemedicine in the management of patients with chronic respiratory failure. Breathe (Sheff) 2021; 17:210008. [PMID: 34295411 PMCID: PMC8291909 DOI: 10.1183/20734735.0008-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/12/2021] [Indexed: 12/20/2022] Open
Abstract
Patients with chronic respiratory failure are often required to attend multiple hospital appointments, which may be difficult due to their physical disabilities and the amount of equipment they are required to bring. Their caregivers often struggle with the lack of immediate care available when the patient suffers difficulties at home. Telemedicine is an opportunity to bridge the gap between home and healthcare professionals by allowing the healthcare team to reach into patients' homes to provide more frequent support. The evidence for the use of telemedicine in patients with chronic respiratory failure remains equivocal. Although the uptake of telemedicine has been slow, the SARS-CoV-2 pandemic has resulted in the rapid dissemination of telemedicine to allow the delivery of care to vulnerable patients while reducing the need for their attendance in hospital. Logistical and legal challenges to the delivery of telemedicine remain, but the pandemic may serve as a driver to ameliorate these challenges and facilitate wider use of this technology to improve the experience of patients with chronic respiratory failure. Educational aims To provide an overview of the rationale for delivering care via telemedicine for patients with chronic respiratory failure.To provide the evidence base for establishing a telemedicine service.To highlight the potential opportunities and challenges in delivering a telemedicine service for patients with chronic respiratory failure.
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Affiliation(s)
- Neeraj M Shah
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Georgios Kaltsakas
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
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7
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Ullah SMA, Islam MM, Mahmud S, Nooruddin S, Raju SMTU, Haque MR. Scalable Telehealth Services to Combat Novel Coronavirus (COVID-19) Pandemic. ACTA ACUST UNITED AC 2021; 2:18. [PMID: 33426530 PMCID: PMC7786340 DOI: 10.1007/s42979-020-00401-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/18/2020] [Indexed: 01/14/2023]
Abstract
An ongoing pandemic, the novel coronavirus disease 2019 (COVID-19) is threatening the nations of the world regardless of health infrastructure conditions. In the age of digital electronic information and telecommunication technology, scalable telehealth services are gaining immense importance by helping to maintain social distances while providing necessary healthcare services. This paper aims to review the various types of scalable telehealth services used to support patients infected by COVID-19 and other diseases during this pandemic. Recently published research papers collected from various sources such as Google Scholar, ResearchGate, PubMed, Scopus, and IEEE Xplore databases using the terms "Telehealth", "Coronavirus", "Scalable" and "COVID-19" are reviewed. The input data and relevant reports for the analysis and assessment of the various aspects of telehealth technology in the COVID-19 pandemic are taken from official websites. We described the available telehealth systems based on their communication media such as mobile networks, social media, and software based models throughout the review. A comparative analysis among the reviewed systems along with necessary challenges and possible future directions are also drawn for the proper selection of affordable technologies. The usage of scalable telehealth systems improves the quality of the healthcare system and also reduces the infection rate while keeping both patients and doctors safe during the pandemic.
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Affiliation(s)
- Shah Muhammad Azmat Ullah
- Department of Electronics and Communication Engineering, Khulna University of Engineering & Technology, Khulna, 9203 Bangladesh
| | - Md Milon Islam
- Department of Computer Science and Engineering, Khulna University of Engineering & Technology, Khulna, 9203 Bangladesh
| | - Saifuddin Mahmud
- Advanced Telerobotics Research Lab, Department of Computer Science, Kent State University, Kent, Ohio USA
| | - Sheikh Nooruddin
- Department of Computer Science and Engineering, Khulna University of Engineering & Technology, Khulna, 9203 Bangladesh
| | - S M Taslim Uddin Raju
- Department of Computer Science and Engineering, Khulna University of Engineering & Technology, Khulna, 9203 Bangladesh
| | - Md Rezwanul Haque
- Department of Computer Science and Engineering, Khulna University of Engineering & Technology, Khulna, 9203 Bangladesh
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Mumtaz N, Saqulain G, Mumtaz N. COVID-19 Rehab Fright Management. Pak J Med Sci 2020; 37:277-282. [PMID: 33437291 PMCID: PMC7794137 DOI: 10.12669/pjms.37.1.3187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Being diagnosed as positive for SARS-2 CoV RNA on PCR generates anxiety and stress as well as depression due to the prospects of being isolated. With genetically varied forms of virus on the rise the widely adopted manner to protect oneself is social distancing. This is frightening for rehabilitation professionals who at times are exposed at close quarters to the patients as rehabilitation is essential. Data in this backdrop is lacking, as this is a recent and ongoing pandemic. As such the current study was conducted with an attempt to review and highlight the causes of fright among rehabilitation professionals and possible management options in the wake of current pandemic of COVID-19 in the perspective of Pakistan. For this purpose literature was searched from major electronic databases including PubMed, Google, Google Scholar and Web-of-science, with keywords "Covid-19, mental health, telehealth, telemedicine, tele-rehabilitation and combination of words". Eighty English, full text articles were studied out of which 36 were used for the literature review. With this literature review we conclude that COVID-19 has resulted in fear of contracting and transmitting this disease among health professionals and can be reduced and managed by provision of tele-rehabilitation and telehealth facilities. Patients emerging from prolonged mechanical ventilations require extensive rehabilitation to restore routine body functions. The role of the otolaryngologist and speech language pathologist (SLP) is formal and direct to ensure appropriate and timely long term intervention and rehabilitation to ensure that these individuals re-enter mainstream activities.
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Affiliation(s)
- Nazia Mumtaz
- Dr. Nazia Mumtaz, PhD (Rehabilitation Sciences) Head of Department of Speech Language Pathology, Faculty of Rehab & Allied Health Sciences, Riphah International University, Islamabad
| | - Ghulam Saqulain
- Dr. Ghulam Saqulain, F.C.P.S (Otorhinolaryngology) Head of Department of Otolaryngology Department of ENT, Capital Hospital, Islamabad
| | - Nadir Mumtaz
- Mr. Nadir Mumtaz, LLB Former DG Research, FBR Islamabad
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9
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Electronic Health Information Systems to Improve Disease Diagnosis and Management at Point-of-Care in Low and Middle Income Countries: A Narrative Review. Diagnostics (Basel) 2020; 10:diagnostics10050327. [PMID: 32443856 PMCID: PMC7277945 DOI: 10.3390/diagnostics10050327] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/23/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022] Open
Abstract
The purpose of an electronic health information system (EHIS) is to support health care workers in providing health care services to an individual client and to enable data exchange among service providers. The demand to explore the use of EHIS for diagnosis and management of communicable and non-communicable diseases has increased dramatically due to the volume of patient data and the need to retain patients in care. In addition, the advent of Coronavirus disease 2019 (COVID-19) pandemic in high disease burdened low and middle income countries (LMICs) has increased the need for robust EHIS to enable efficient surveillance of the pandemic. EHIS has potential to enable efficient delivery of disease diagnostics services at point-of-care (POC) and reduce medical errors. This review provides an overview of literature on EHIS's with a focus on describing the key components of EHIS and presenting evidence on enablers and barriers to implementation of EHISs in LMICs. With guidance from the presented evidence, we proposed EHIS key stakeholders' roles and responsibilities to ensure efficient utility of EHIS for disease diagnosis and management at POC in LMICs.
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10
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Dietrich D, Dekova R, Davy S, Fahrni G, Geissbühler A. Applications of Space Technologies to Global Health: Scoping Review. J Med Internet Res 2018; 20:e230. [PMID: 29950289 PMCID: PMC6041558 DOI: 10.2196/jmir.9458] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/21/2018] [Accepted: 04/22/2018] [Indexed: 12/27/2022] Open
Abstract
Background Space technology has an impact on many domains of activity on earth, including in the field of global health. With the recent adoption of the United Nations’ Sustainable Development Goals that highlight the need for strengthening partnerships in different domains, it is useful to better characterize the relationship between space technology and global health. Objective The aim of this study was to identify the applications of space technologies to global health, the key stakeholders in the field, as well as gaps and challenges. Methods We used a scoping review methodology, including a literature review and the involvement of stakeholders, via a brief self-administered, open-response questionnaire. A distinct search on several search engines was conducted for each of the four key technological domains that were previously identified by the UN Office for Outer Space Affairs’ Expert Group on Space and Global Health (Domain A: remote sensing; Domain B: global navigation satellite systems; Domain C: satellite communication; and Domain D: human space flight). Themes in which space technologies are of benefit to global health were extracted. Key stakeholders, as well as gaps, challenges, and perspectives were identified. Results A total of 222 sources were included for Domain A, 82 sources for Domain B, 144 sources for Domain C, and 31 sources for Domain D. A total of 3 questionnaires out of 16 sent were answered. Global navigation satellite systems and geographic information systems are used for the study and forecasting of communicable and noncommunicable diseases; satellite communication and global navigation satellite systems for disaster response; satellite communication for telemedicine and tele-education; and global navigation satellite systems for autonomy improvement, access to health care, as well as for safe and efficient transportation. Various health research and technologies developed for inhabited space flights have been adapted for terrestrial use. Conclusions Although numerous examples of space technology applications to global health exist, improved awareness, training, and collaboration of the research community is needed.
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Affiliation(s)
- Damien Dietrich
- Hopitaux Universitaires de Genève, eHealth and Telemedicine Division, Geneva, Switzerland
| | - Ralitza Dekova
- Hopitaux Universitaires de Genève, eHealth and Telemedicine Division, Geneva, Switzerland
| | - Stephan Davy
- Hopitaux Universitaires de Genève, eHealth and Telemedicine Division, Geneva, Switzerland
| | - Guillaume Fahrni
- Hopitaux Universitaires de Genève, eHealth and Telemedicine Division, Geneva, Switzerland
| | - Antoine Geissbühler
- Hopitaux Universitaires de Genève, eHealth and Telemedicine Division, Geneva, Switzerland
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Tan TH, Gochoo M, Chen YF, Hu JJ, Chiang JY, Chang CS, Lee MH, Hsu YN, Hsu JC. Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation. SENSORS 2017; 17:s17010202. [PMID: 28117724 PMCID: PMC5298775 DOI: 10.3390/s17010202] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/04/2017] [Accepted: 01/17/2017] [Indexed: 11/16/2022]
Abstract
This study presents a new ubiquitous emergency medical service system (UEMS) that consists of a ubiquitous tele-diagnosis interface and a traffic guiding subsystem. The UEMS addresses unresolved issues of emergency medical services by managing the sensor wires for eliminating inconvenience for both patients and paramedics in an ambulance, providing ubiquitous accessibility of patients' biosignals in remote areas where the ambulance cannot arrive directly, and offering availability of real-time traffic information which can make the ambulance reach the destination within the shortest time. In the proposed system, patient's biosignals and real-time video, acquired by wireless biosensors and a webcam, can be simultaneously transmitted to an emergency room for pre-hospital treatment via WiMax/3.5 G networks. Performances of WiMax and 3.5 G, in terms of initialization time, data rate, and average end-to-end delay are evaluated and compared. A driver can choose the route of the shortest time among the suggested routes by Google Maps after inspecting the current traffic conditions based on real-time CCTV camera streams and traffic information. The destination address can be inputted vocally for easiness and safety in driving. A series of field test results validates the feasibility of the proposed system for application in real-life scenarios.
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Affiliation(s)
- Tan-Hsu Tan
- Department of Electrical Engineering, National Taipei University of Technology, Taipei 10608, Taiwan.
| | - Munkhjargal Gochoo
- Department of Electrical Engineering, National Taipei University of Technology, Taipei 10608, Taiwan.
| | - Yung-Fu Chen
- Department of Dental Technology and Materials Science, Central Taiwan University of Science and Technology, Taichung City 40601, Taiwan.
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan.
| | - Jin-Jia Hu
- Department of Electrical Engineering, National Taipei University of Technology, Taipei 10608, Taiwan.
| | - John Y Chiang
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan.
| | - Ching-Su Chang
- Department of Data & Broadband Maintenance Center, Chunghwa Telecom Hsinchu Business Group, Hsinchu City 300, Taiwan.
| | - Ming-Huei Lee
- Department of Urology, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung 42055, Taiwan.
| | - Yung-Nian Hsu
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung 403, Taiwan.
| | - Jiin-Chyr Hsu
- Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City 242-13, Taiwan.
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12
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Tsirmpas C, Kouris I, Anastasiou A, Giokas K, Iliopoulou D, Koutsouris D. An Internet of Things platform architecture for supporting ambient assisted living environments. Technol Health Care 2016; 25:391-401. [PMID: 27886016 DOI: 10.3233/thc-161270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Internet of Things (IoT) is the logical further development of today's Internet, enabling a huge amount of devices to communicate, compute, sense and act. IoT sensors placed in Ambient Assisted Living (AAL) environments, enable the context awareness and allow the support of the elderly in their daily routines, ultimately allowing an independent and safe lifestyle. The vast amount of data that are generated and exchanged between the IoT nodes require innovative context modeling approaches that go beyond currently used models. Current paper presents and evaluates an open interoperable platform architecture in order to utilize the technical characteristics of IoT and handle the large amount of generated data, as a solution to the technical requirements of AAL applications.
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13
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Kyriacou E, Nicolaidou I, Hadjichristofi G, Kyprianou S, Christou S, Constantinou R. Health and rescue services management system during a crisis event. Healthc Technol Lett 2016; 3:205-211. [PMID: 27733928 DOI: 10.1049/htl.2016.0040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 11/20/2022] Open
Abstract
Τhe performance of rescuers and personnel handling major emergencies or crisis events can be significantly improved through continuous training and through technology support. The work done in order to create a system has been discussed which can support both resources and victims during a crisis or major emergency event. More specifically, the system supports real-time management of firefighter teams, rescue teams, health services, and victims during a major disaster. It can be deployed in an ad hoc manner in the disaster area, as a stand-alone infrastructure (using its own telecommunications and power). It mainly consists of a control station, which is installed in the area command centre, the firefighters units, the rescuers units, the ambulance vehicles units, and the telemedicine units that can be used in order to support victim handling at the casualties clearing station. The system has been tested and improved through continuous communication with experts and through professional exercises; the results and conclusions are presented.
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Affiliation(s)
- Efthyvoulos Kyriacou
- Department of Computer Science and Engineering , Frederick University , Limassol 3080 , Cyprus
| | - Iolie Nicolaidou
- Department of Communication and Internet Studies , Cyprus University of Technology , Limassol , Cyprus
| | - George Hadjichristofi
- Department of Computer Science and Engineering , Frederick University , Limassol 3080 , Cyprus
| | - Stelios Kyprianou
- Department of Computer Science and Engineering , Frederick University , Limassol 3080 , Cyprus
| | - Synesios Christou
- Department of Computer Science and Engineering , Frederick University , Limassol 3080 , Cyprus
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Xiong H, Tao J, Chen Y. A Robust and Anonymous Two Factor Authentication and Key Agreement Protocol for Telecare Medicine Information Systems. J Med Syst 2016; 40:228. [PMID: 27628729 DOI: 10.1007/s10916-016-0590-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/04/2016] [Indexed: 11/28/2022]
Abstract
Nowadays people can get many services including health-care services from distributed information systems remotely via public network. By considering that these systems are built on public network, they are vulnerable to many malicious attacks. Hence it is necessary to introduce an effective mechanism to protect both users and severs. Recently many two-factor authentication schemes have been proposed to achieve this goal. In 2016, Li et al. demonstrated that Lee et al.'s scheme was not satisfactory to be deployed in practice because of its security weaknesses and then proposed a security enhanced scheme to overcome these drawbacks. In this paper, we analyze Li et al.'s scheme is still not satisfactory to be applied in telecare medicine information systems (TMIS) because it fails to withstand off-line dictionary attack and known session-specific temporary information attack. Moreover, their scheme cannot provide card revocation services for lost smart card. In order to solve these security problems, we propose an improved scheme. Then we analyze our scheme by using BAN-logic model and compare the improved scheme with related schemes to prove that our scheme is advantageous to be applied in practice.
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Affiliation(s)
- Hu Xiong
- School of Information and Software Engineering, University of Electronic Science and Technology of China & State Key Laboratory of Cryptology, P.O. Box 5159, Beijing, 100878, China.
| | - Junyi Tao
- School of Information and Software Engineering, University of Electronic Science and Technology of China, P.O. Box 5159, Beijing, 100878, China
| | - Yanan Chen
- The MOE key Laboratory for Transportation Complex Systems Theory and Technology School of Traffic and Transportation, Beijing Jiaotong University, Beijing, 100044, People's Republic of China
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Otis MJD, Ayena JC, Tremblay LE, Fortin PE, Ménélas BAJ. Use of an Enactive Insole for Reducing the Risk of Falling on Different Types of Soil Using Vibrotactile Cueing for the Elderly. PLoS One 2016; 11:e0162107. [PMID: 27603211 PMCID: PMC5014342 DOI: 10.1371/journal.pone.0162107] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 08/17/2016] [Indexed: 11/18/2022] Open
Abstract
Background Our daily activities imply displacements on various types of soil. For persons with gait disorder or losing functional autonomy, walking on some types of soil could be challenging because of the risk of falling it represents. Methods In this paper, we present, in a first part, the use of an enactive shoe for an automatic differentiation of several types of soil. In a second part, using a second improved prototype (an enactive insole), twelve participants with Parkinson’s disease (PD) and nine age-matched controls have performed the Timed Up and Go (TUG) test on six types of soil with and without cueing. The frequency of the cueing was set at 10% above the cadence computed at the lower risk of falling (walking over the concrete). Depending on the cadence computed at the lower risk, the enactive insole activates a vibrotactile cueing aiming to improve gait and balance control. Finally, a risk index is computed using gait parameters in relation to given type of soil. Results The frequency analysis of the heel strike vibration allows the differentiation of various types of soil. The risk computed is associated to an appropriate rhythmic cueing in order to improve balance and gait impairment. The results show that a vibrotactile cueing could help to reduce the risk of falling. Conclusions Firstly, this paper demonstrates the feasibility of reducing the risk of falling while walking on different types of soil using vibrotactile cueing. We found a significant difference and a significant decrease in the computed risks of falling for most of types of soil especially for deformable soils which can lead to fall. Secondly, heel strike provides an approximation of the impulse response of the soil that can be analyzed with time and frequency-domain modeling. From these analyses, an index is computed enabling differentiation the types of soil.
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Affiliation(s)
- Martin J. -D. Otis
- Department of Applied Sciences, University of Quebec at Chicoutimi (UQAC), REPARTI centre, Chicoutimi, Quebec, Canada
| | - Johannes C. Ayena
- Department of Applied Sciences, University of Quebec at Chicoutimi (UQAC), REPARTI centre, Chicoutimi, Quebec, Canada
- * E-mail:
| | - Louis E. Tremblay
- Department of Health Sciences, University of Quebec at Chicoutimi, Chicoutimi, Quebec, Canada
| | - Pascal E. Fortin
- Department of Electrical Engineering and Computer at the Center for intelligent machine, McGill University, Montreal, Quebec, Canada
| | - Bob-Antoine J. Ménélas
- Department of Mathematics and Computer Sciences, University of Quebec at Chicoutimi, Chicoutimi, Quebec, Canada
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Abstract
Because of an ageing population and a relative lack of professionals, the German health system is under great pressure. In rural regions in particular, anesthesiology is also affected - nursing staff, anesthetists, intensive care physicians, and emergency physicians often have to be supported by freelancers from other regions and from abroad - at least periodically. In addition to the increasing number of treatments, the potential quality of therapy is also increasing owing to progress in medical research. Against this background the need for resources is increasing to ensure the optimal quality of treatment. This applies to all clinical disciplines, including all sections of anesthesiology - especially in economically underdeveloped regions where highly qualified experts are lacking. In various cases it is not the physical attendance or manual skills of experts that is primarily requested on-site, but rather their medical expertise and experience. Therefore, telemedicine systems are suitable for closing these gaps very effectively and efficiently. In the various anesthesiological sub-sections the number of scientific papers published to date varies. For anesthesia and pain therapy only a few telemedical applications or concepts have been reported in the literature. However, in tele-intensive care medicine and tele-emergency medicine several national and international research projects have successfully been carried out, leading to established routine systems in some cases.
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Cho H, Lee JH. A Study on the Optimal Positions of ECG Electrodes in a Garment for the Design of ECG-Monitoring Clothing for Male. J Med Syst 2015; 39:95. [PMID: 26254250 DOI: 10.1007/s10916-015-0279-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 06/01/2015] [Indexed: 12/14/2022]
Abstract
Smart clothing is a sort of wearable device used for ubiquitous health monitoring. It provides comfort and efficiency in vital sign measurements and has been studied and developed in various types of monitoring platforms such as T-shirt and sports bra. However, despite these previous approaches, smart clothing for electrocardiography (ECG) monitoring has encountered a serious shortcoming relevant to motion artifacts caused by wearer movement. In effect, motion artifacts are one of the major problems in practical implementation of most wearable health-monitoring devices. In the ECG measurements collected by a garment, motion artifacts are usually caused by improper location of the electrode, leading to lack of contact between the electrode and skin with body motion. The aim of this study was to suggest a design for ECG-monitoring clothing contributing to reduction of motion artifacts. Based on the clothing science theory, it was assumed in this study that the stability of the electrode in a dynamic state differed depending on the electrode location in an ECG-monitoring garment. Founded on this assumption, effects of 56 electrode positions were determined by sectioning the surface of the garment into grids with 6 cm intervals in the front and back of the bodice. In order to determine the optimal locations of the ECG electrodes from the 56 positions, ECG measurements were collected from 10 participants at every electrode position in the garment while the wearer was in motion. The electrode locations indicating both an ECG measurement rate higher than 80.0 % and a large amplitude during motion were selected as the optimal electrode locations. The results of this analysis show four electrode locations with consistently higher ECG measurement rates and larger amplitudes amongst the 56 locations. These four locations were abstracted to be least affected by wearer movement in this research. Based on this result, a design of the garment-formed ECG monitoring platform reflecting the optimal positions of the electrode was suggested.
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Affiliation(s)
- Hakyung Cho
- BLACKYAK Co. Ltd., Seoul, Republic of Korea,
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Thelen S, Czaplik M, Meisen P, Schilberg D, Jeschke S. Using off-the-Shelf Medical Devices for Biomedical Signal Monitoring in a Telemedicine System for Emergency Medical Services. IEEE J Biomed Health Inform 2015; 19:117-23. [DOI: 10.1109/jbhi.2014.2361775] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ajami S, Lamoochi P. Use of telemedicine in disaster and remote places. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2014; 3:26. [PMID: 25013819 PMCID: PMC4089116 DOI: 10.4103/2277-9531.131886] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
One of the methods, especially those living in remote areas or have crashed and does not have access to specialists is telemedicine. Telemedicine describes the use of medical information exchanged from one site to another via electronic communications to improve patients' health status and care. Travel and wait times between the initial consultations with the patient's own general practitioner and referral to specialist can be reduced and specialists have successfully provided remote triage and treatment consults of victims via the robot. The robot proved to be a useful means to extend resources and provide expert consulting if specialists were unable to physically be at the site. In fact, the telemedicine system is providing health care services for individuals who are not available because of geographical and environmental conditions. The aim of this study was to identify telemedicine applications in disaster, and proposed use of this technology in areas where the shortage of specialists in remote areas in disasters. This study was un-systematic (narrative) review. The literature was searched for using of telemedicine in disaster and remote places with the help of libraries, conference proceedings, data bank, and also search engines available at Google, Google scholar. In our searches, we employed the following keywords and their combinations: telemedicine, remote place, earthquake, disaster, war, and telecommunication in the searching areas of title, keyword, abstract, and full text. In this study, more than 85 articles and reports were collected and 26 of them were selected based on their relevancy. This literature review helps define the concept of "components and usages of the Telemedicine in disaster" as the new technology in the present age.
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Affiliation(s)
- Sima Ajami
- Department of Health Information Technology, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Lamoochi
- School of Medical Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Reisner AT, Khitrov MY, Chen L, Blood A, Wilkins K, Doyle W, Wilcox S, Denison T, Reifman J. Development and validation of a portable platform for deploying decision-support algorithms in prehospital settings. Appl Clin Inform 2013; 4:392-402. [PMID: 24155791 DOI: 10.4338/aci-2013-04-ra-0023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 08/13/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Advanced decision-support capabilities for prehospital trauma care may prove effective at improving patient care. Such functionality would be possible if an analysis platform were connected to a transport vital-signs monitor. In practice, there are technical challenges to implementing such a system. Not only must each individual component be reliable, but, in addition, the connectivity between components must be reliable. OBJECTIVE We describe the development, validation, and deployment of the Automated Processing of Physiologic Registry for Assessment of Injury Severity (APPRAISE) platform, intended to serve as a test bed to help evaluate the performance of decision-support algorithms in a prehospital environment. METHODS We describe the hardware selected and the software implemented, and the procedures used for laboratory and field testing. RESULTS The APPRAISE platform met performance goals in both laboratory testing (using a vital-sign data simulator) and initial field testing. After its field testing, the platform has been in use on Boston MedFlight air ambulances since February of 2010. CONCLUSION These experiences may prove informative to other technology developers and to healthcare stakeholders seeking to invest in connected electronic systems for prehospital as well as in-hospital use. Our experiences illustrate two sets of important questions: are the individual components reliable (e.g., physical integrity, power, core functionality, and end-user interaction) and is the connectivity between components reliable (e.g., communication protocols and the metadata necessary for data interpretation)? While all potential operational issues cannot be fully anticipated and eliminated during development, thoughtful design and phased testing steps can reduce, if not eliminate, technical surprises.
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Ma JL, Cui YL, Dong MC. An effective low-complexity multi-vital-signs compression technique for embedded-link e-home healthcare. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:1177-1181. [PMID: 24109903 DOI: 10.1109/embc.2013.6609716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Transplanting the existing e-home healthcare system to source-limited embedded-link device for home-use health monitoring, intelligent medical diagnosis and wireless transmission is attractive. Yet, constrains of portable storage, computing and transmission promote the need of data compression for such applications. Existing compression techniques are mostly desktop-computer-based and computation-consuming, making them unsuitable for mobile device. To tackle such a bottleneck problem, this paper addresses an effective low-complexity multi-vital-signs compression technique based on orthogonal polynomial decomposition (OPD) algorithm using Hermite functions. The technique is proposed and operated on the designated healthcare system with optimized parameters. Validated and tested with cardiovascular disease (CVD) diagnosis based on sphygmogram both experimentally and clinically, the proposed technique achieves comparable good performance with distortion less than 2% and compression ratio up to 6, and preserves significant pathological features of multi-vital-signs for clinical diagnosis. The proposed technique is highly robust even for freaky and pathological signals. In addition, the compressed results reflecting morphological features can be directly adapted to the subsequent medical analysis without further decompression.
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Developing an active emergency medical service system based on WiMAX technology. J Med Syst 2011; 36:3177-93. [PMID: 22109672 DOI: 10.1007/s10916-011-9809-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 11/09/2011] [Indexed: 10/15/2022]
Abstract
The population structure has changed with the aging of population. In the present, elders account for 10.63% of the domestic population and the percentage is still gradually climbing. In other words, the demand for emergency services among elders in home environment is expected to grow in the future. In order to improve the efficiency and quality of emergency care, information technology should be effectively utilized to integrate medical systems and facilities, strengthen human-centered operation designs, and maximize the overall performance. The improvement in the quality and survival rate of emergency care is an important basis for better life and health of all people. Through integrated application of medical information systems and information communication technology, this study proposes a WiMAX-based emergency care system addressing the public demands for convenience, speed, safety, and human-centered operation of emergency care. This system consists of a healthcare service center, emergency medical service hospitals, and emergency ambulances. Using the wireless transmission capability of WiMAX, patients' physiological data can be transmitted from medical measurement facilities to the emergency room and emergency room doctors can provide immediate online instructions on emergency treatment via video and audio transmission. WiMAX technology enables the establishment of active emergency medical services.
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Transtelephonic electrocardiographic transmission in the preparticipation screening of athletes. Int J Telemed Appl 2011:217909. [PMID: 18369413 PMCID: PMC2275315 DOI: 10.1155/2008/217909] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 10/03/2007] [Indexed: 11/23/2022] Open
Abstract
Transtelephonic electrocardiographic transmission (TET) is the most widespread form of telecardiology since it enables clinicians to assess patients at a distance. The purpose of this study was to assess the efficacy and effectiveness of TET either by fixed telephone line (POTS) or by mobile phone in the preparticipation screening of young athletes. A total of 506 players, aged 20.5 ± 6.2 years, from 23 soccer clubs in the prefecture of Thessaloniki, Greece, were physically examined in their playfields by a general practitioner (GP) and had their ECG recorded. In 142 cases, and on the judgment of the GP, the ECG was transmitted via POTS and/or global system for mobile communications (GSM) to a specialised medical centre where it was evaluated by a cardiologist. The mean total time for recording, storing, and transmitting the ECG was four minutes per subject. It was found that the success rate for transmission at first attempt was similar for both fixed and mobile networks, that is, 93% and 91%, respectively. The failure rate in the GSM network was correlated to the reception level at the site of transmission. Only in about half (n = 74) of the transmitted ECGs did the cardiologist confirm “abnormal” findings, although in 16, they were considered to be clinically insignificant. Consequently, 58 athletes were referred for further medical examination. Our results indicate that TET (either by fixed telephone line or by mobile phone) can ensure valid, reliable, and objective measurements, and significantly contribute to the application of medical screening in a great number of athletes. Therefore, it is recommended as an alternative diagnostic tool for the preparticipation screening of athletes living in remote areas.
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Mougiakakou SG, Kyriacou E, Perakis K, Papadopoulos H, Androulidakis A, Konnis G, Tranfaglia R, Pecchia L, Bracale U, Pattichis C, Koutsouris D. A feasibility study for the provision of electronic healthcare tools and services in areas of Greece, Cyprus and Italy. Biomed Eng Online 2011; 10:49. [PMID: 21649924 PMCID: PMC3127994 DOI: 10.1186/1475-925x-10-49] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 06/07/2011] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Through this paper, we present the initial steps for the creation of an integrated platform for the provision of a series of eHealth tools and services to both citizens and travelers in isolated areas of the southeast Mediterranean, and on board ships travelling across it. The platform was created through an INTERREG IIIB ARCHIMED project called INTERMED. METHODS The support of primary healthcare, home care and the continuous education of physicians are the three major issues that the proposed platform is trying to facilitate. The proposed system is based on state-of-the-art telemedicine systems and is able to provide the following healthcare services: i) Telecollaboration and teleconsultation services between remotely located healthcare providers, ii) telemedicine services in emergencies, iii) home telecare services for "at risk" citizens such as the elderly and patients with chronic diseases, and iv) eLearning services for the continuous training through seminars of both healthcare personnel (physicians, nurses etc) and persons supporting "at risk" citizens.These systems support data transmission over simple phone lines, internet connections, integrated services digital network/digital subscriber lines, satellite links, mobile networks (GPRS/3G), and wireless local area networks. The data corresponds, among others, to voice, vital biosignals, still medical images, video, and data used by eLearning applications. The proposed platform comprises several systems, each supporting different services. These were integrated using a common data storage and exchange scheme in order to achieve system interoperability in terms of software, language and national characteristics. RESULTS The platform has been installed and evaluated in different rural and urban sites in Greece, Cyprus and Italy. The evaluation was mainly related to technical issues and user satisfaction. The selected sites are, among others, rural health centers, ambulances, homes of "at-risk" citizens, and a ferry. CONCLUSIONS The results proved the functionality and utilization of the platform in various rural places in Greece, Cyprus and Italy. However, further actions are needed to enable the local healthcare systems and the different population groups to be familiarized with, and use in their everyday lives, mature technological solutions for the provision of healthcare services.
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Affiliation(s)
- Stavroula G Mougiakakou
- Institute of Communication and Computer Systems, National Technical University of Athens, Athens, Greece
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital - Inselspital - University of Bern, Bern, Switzerland
| | - Efthyvoulos Kyriacou
- Department of Computer Science, University of Cyprus, Cyprus
- Department of Computer Science and Engineering, Frederick University, Lemesos, Cyprus
| | - Kostas Perakis
- Institute of Communication and Computer Systems, National Technical University of Athens, Athens, Greece
| | | | - Aggelos Androulidakis
- Institute of Communication and Computer Systems, National Technical University of Athens, Athens, Greece
| | - Georgios Konnis
- Institute of Communication and Computer Systems, National Technical University of Athens, Athens, Greece
| | - Riccardo Tranfaglia
- Department of Biomedical, Electronic and Telecommunication Engineering, University of Naples Federico II, Naples, Italy
| | - Leandro Pecchia
- Department of Biomedical, Electronic and Telecommunication Engineering, University of Naples Federico II, Naples, Italy
| | - Umberto Bracale
- Department of General, Vascular and Thoracic Surgery, University of Naples Federico II, Naples, Italy
| | | | - Dimitrios Koutsouris
- Institute of Communication and Computer Systems, National Technical University of Athens, Athens, Greece
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Kyriacou E, Constantinides P, Pattichis CS, Pattichis MS, Panayides A. eEmergency health care information systems. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2011; 2011:2501-2504. [PMID: 22254849 DOI: 10.1109/iembs.2011.6090693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In this paper we provide an overview of the way that information and communication technologies have been used for emergency healthcare support. The paper provides a literature review of case studies exploring information systems for monitoring signals, images, medical videos, as well as information protocols used during emergency health care support, and describes future trends. We anticipate that eEmergency systems can significantly improve the delivery of healthcare during emergency cases. However, the monitoring and evaluation of these systems and especially their use in daily practice still remains a goal to be achieved.
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Affiliation(s)
- E Kyriacou
- Department of ComputerScience and Engineering, Frederick University Cyprus, Lemesos, Cyprus.
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Kyriacou EC, Pattichis CS, Pattichis MS. An overview of recent health care support systems for eEmergency and mHealth applications. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2009:1246-9. [PMID: 19964506 DOI: 10.1109/iembs.2009.5333913] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Advances in mobile communications and medical technologies facilitate the development of emerging mobile systems and applications for healthcare. The objective of this paper is to provide an overview and the current status of mobile health care systems (mHealth) and their applications for Emergency healthcare support (eEmergency). Our paper reports on journal papers that use wireless, emergency telemedicine systems that appeared since 2000. The majority of the applications are focused on the transmission of crucial biosignals (mainly ECG) for the support of heart-related healthcare. A limited number of new studies were focused on supporting emergency healthcare for trauma by facilitating both 2D image or video transmission (eg: ultrasound). Alternatively, new studies have focused on integrated systems for specialized emergency scenaria such as stroke. This paper is an extension of work previously published by our group [1].
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Affiliation(s)
- E C Kyriacou
- Department of Computer Science and Engineering, Frederick University Cyrus, Lemesos, Cyprus.
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Chudácek V, Georgoulas G, Lhotská L, Stylios C, Petrík M, Cepek M. Examining cross-database global training to evaluate five different methods for ventricular beat classification. Physiol Meas 2009; 30:661-77. [PMID: 19525571 DOI: 10.1088/0967-3334/30/7/010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The detection of ventricular beats in the holter recording is a task of great importance since it can direct clinicians toward the parts of the electrocardiogram record that might be crucial for determining the final diagnosis. Although there already exists a fair amount of research work dealing with ventricular beat detection in holter recordings, the vast majority uses a local training approach, which is highly disputable from the point of view of any practical-real-life-application. In this paper, we compare five well-known methods: a classical decision tree approach and its variant with fuzzy rules, a self-organizing map clustering method with template matching for classification, a back-propagation neural network and a support vector machine classifier, all examined using the same global cross-database approach for training and testing. For this task two databases were used-the MIT-BIH database and the AHA database. Both databases are required for testing any newly developed algorithms for holter beat classification that is going to be deployed in the EU market. According to cross-database global training, when the classifier is trained with the beats from the records of one database then the records from the other database are used for testing. The results of all the methods are compared and evaluated using the measures of sensitivity and specificity. The support vector machine classifier is the best classifier from the five we tested, achieving an average sensitivity of 87.20% and an average specificity of 91.57%, which outperforms nearly all the published algorithms when applied in the context of a similar global training approach.
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Affiliation(s)
- V Chudácek
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Czech Republic.
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Hong S, Kim S, Kim J, Lim D, Jung S, Kim D, Yoo SK. Portable emergency telemedicine system over wireless broadband and 3G networks. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2009:1250-1253. [PMID: 19964507 DOI: 10.1109/iembs.2009.5333914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The telemedicine system aims at monitoring patients remotely without limit in time and space. However the existing telemedicine systems exchange medical information simply in a specified location. Due to increasing speed in processing data and expanding bandwidth of wireless networks, it is possible to perform telemedicine services on personal digital assistants (PDA). In this paper, a telemedicine system on PDA was developed using wideband mobile networks such as Wi-Fi, HSDPA, and WiBro for high speed bandwidths. This system enables to utilize and exchange variety and reliable patient information of video, biosignals, chatting messages, and triage data. By measuring bandwidths of individual data of the system over wireless networks, and evaluating the performance of this system using PDA, we demonstrated the feasibility of the designed portable emergency telemedicine system.
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Affiliation(s)
- SungHye Hong
- Brain Korea 21 Project for Medical Science, Univ. of Yonsei, Seoul, Korea.
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Hsu CM, Wang WS, Luo CH. The power-efficient biomedical acquisition system by variable-resolution sigma-delta modulator. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2008; 2007:3152-5. [PMID: 18002664 DOI: 10.1109/iembs.2007.4352998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A novel biomedical acquisition system which can adjust its resolution by the condition of signal is presented in this paper. The resolution of sigma-delta modulator in proposed system can be automatically varied by switching its architecture and sampling rate that can acquire accurate date without additional power consumption. The modulator in this system reaches specifications from 10-bit to 16-bit resolution and consumes power from 48microW to 360microW. In the electrocardiogram and electroculogram acquisition by proposed system, it can save more than 40% and 73% power consumption comparing with the conventional acquisition system.
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Affiliation(s)
- Chen-Ming Hsu
- Department of Electrical Engineering, National Cheng Kung University, Tainan, Taiwan, 701
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30
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Nageba E, Fayn J, Rubel P. A generic task-driven multi-agent telemedicine system. ACTA ACUST UNITED AC 2008; 2007:3733-6. [PMID: 18002809 DOI: 10.1109/iembs.2007.4353143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Pervasive Telemedicine is an emerging research discipline, which focuses on the development and the application of ubiquitous computing technology for healthcare purposes. However, the current telemedicine systems lack to be self adaptable to handle different types of data such as vital biosignals, images, video and textual data. In addition, they do not use the full capabilities of the computing devices on which they run. Unfortunately, the existing telemedicine systems do not pay enough attention to the quality level of their offered services nor offer adequate resources management for meeting bandwidth and end-to-end communication delays. In this paper we propose an information and communication architecture of a generic telemedicine system based on a knowledge base and intelligent agents interacting each with the other in a synergetic way to perform several medical tasks for a high level of quality of service (QoS). The medical assistance to skiers and high mountains resorts residents will be used in particular as an example of applicability scenario and models personalization.
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Affiliation(s)
- Ebrahim Nageba
- Methodologies of Information Processing, Cardiology research group, INSA de Lyon, INSERM ERM107 MTIC, Université de Lyon, BRON, F-69677, France.
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31
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Kyriacou E, Pattichis C, Pattichis M, Jossif A, Paraskeva L, Konstantinides A, Vogiatzis D. An m-Health monitoring system for children with suspected arrhythmias. ACTA ACUST UNITED AC 2007; 2007:1794-7. [PMID: 18002326 DOI: 10.1109/iembs.2007.4352660] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Advances in wireless communications and networking technologies as well as computer and medical technologies, enable the development of small size, power efficient and more reliable medical multi-parameter recording systems, which can be used for continuous monitoring of patients. Through this paper we present the basic architecture and initial development steps of an m-Health monitoring system that will be used in order to monitor children with suspected cardiac arrhythmias. The proposed system will be based on sensor networks, in order to monitor a subject while being in a predefined area like his/her house; while a module based on PDAs and wearable ECG recorders will be used in order to extent the coverage outside the patient's house. The system will be based on a variable sampling rate to conserve power for the possible arrhythmia episode. The system design has been completed, the hardware specifications have been decided and currently the system is going through the development phase.
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Affiliation(s)
- E Kyriacou
- Dep. of Computer Science, University of Cyprus, Dep. of Comp. Science and Engineering, Frederick Insitute of Technology, Cyprus.
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32
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Vouyioukas D, Maglogiannis I, Pasias V. Pervasive E-health services using the DVB-RCS communication technology. J Med Syst 2007; 31:237-46. [PMID: 17685147 DOI: 10.1007/s10916-007-9061-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Two-way satellite broadband communication technologies, such as the Digital Video Broadcasting with Return Channel via Satellite (DVB-RCS) technology, endeavour to offer attractive wide-area broadband connectivity for telemedicine applications, taking into consideration the available data rates, Quality of Service (QoS) provision, survivability, flexibility and operational costs, even in remote areas and isolated regions where the terrestrial technologies suffer. This paper describes a wide-area tele-medicine platform, specially suited for homecare services, based on the DVB-RCS and Wi-Fi communication technologies. The presented platform combines medical data acquisition and transfer, patient remote monitoring and teleconference services. Possible operational scenarios concerning this platform and experimental results regarding tele-monitoring, videoconference and medical data transfer are also provided and discussed in the paper.
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Affiliation(s)
- Demosthenes Vouyioukas
- Department of Information and Communication Systems Engineering, University of the Aegean, Karlovassi, 83200 Samos, Greece.
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33
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Chu Y, Ganz A. A mobile teletrauma system for rural trauma care. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2004:3282-5. [PMID: 17270982 DOI: 10.1109/iembs.2004.1403923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
This paper introduces a cost-effective, portable teletrauma system that assists the health care centers in providing pre-hospital trauma care to rural population. Simultaneous transmission of a patient's video, medical images, and ECG signals, which is required throughout the prehospital procedure, is demonstrated over commercially available, low-bandwidth, wireless cellular data service using transmission technologies such as CDMA. Moreover, the physician can remotely control the information sent from the patient side. Such a technology will allow a trauma specialist to be virtually present at the remote location and participate in pre-hospital care, which improves the quality of trauma care and can potentially reduce mortality and morbidity.
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Affiliation(s)
- Yuechun Chu
- Multimedia Networks Laboratory, ECE Department University of Massachusetts, Amherst 01003, MA, USA.
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Mandellos GJ, Lymperopoulos DK, Koukias MN, Tzes A, Lazarou N, Vagianos C. A novel mobile telemedicine system for ambulance transport. Design and evaluation. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2004:3080-3. [PMID: 17270929 DOI: 10.1109/iembs.2004.1403870] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
It is generally accepted that early and specialized pre-hospital patient treatment improves outcome in terms of mortality and morbidity, in emergency cases. The focus of this paper is to present the implementation and the evaluation of an ambulance located telemedicine system for pre-hospital patient treatment The primary emphasis is on the vital sign transmission from the accident site or the moving ambulance to the consultation site, using the GSM mobile telephony network. There, the experts evaluate the patient data, decides about the treatment protocol and provide directions to the ambulance's medical staff concerning on the patient handling until the arrival to the hospital.
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Affiliation(s)
- G J Mandellos
- Dept. of Electr. Eng. & Comput. Technol., Patras Univ., Greece
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Abstract
PURPOSE OF REVIEW Effective communication is essential to patient safety. Although radio pagers have been the cornerstone of medical communication, new devices such as cellular telephones, personal digital assistants (PDAs), and laptop or tablet computers can help anesthesiologists to get information quickly and reliably. Anesthesiologists can use these devices to speak with colleagues, access the medical record, or help a colleague in another location without having to leave a patient's side. Recent advances in communication technology offer anesthesiologists new ways to improve patient care. RECENT FINDINGS Anesthesiologists rely on a wide variety of information to make decisions, including vital signs, laboratory values, and entries in the medical record. Devices such as PDAs and computers with wireless networking can be used to access this information. Mobile telephones can be used to get help or ask for advice, and are more efficient than radio pagers. Voice over Internet protocol is a new technology that allows voice conversations to be routed over computer networks. It is widely believed that wireless devices can cause life-threatening interference with medical devices. The actual risk is very low, and is offset by a significant reduction in medical errors that results from more efficient communication. SUMMARY Using common technology like cellular telephones and wireless networks is a simple, cost-effective way to improve patient care.
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Affiliation(s)
- Keith J Ruskin
- Anesthesiology, Yale University School of Medicine, New Haven, Connecticut 06880, USA.
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36
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Halín N, Junnila M, Loula P, Aarnio P. The LifeShirt system for wireless patient monitoring in the operating room. J Telemed Telecare 2006; 11 Suppl 2:S41-3. [PMID: 16375793 DOI: 10.1258/135763305775124623] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We examined the functionality and reliability of a wearable physiological monitoring system (LifeShirt) during normal daily activities and in a hospital operating room (OR) environment. The garment collects physiological data such as oxygen saturation, and stores them in a recorder from which it can be read afterwards. Ten normal subjects wore the shirt continuously for 8 h per day. Feedback from the testers was quite positive, although the collected data varied in quality. Ten hospital patients also wore the shirt during endoscopy. The data collected during the hospital stay were qualitatively adequate. Measuring respiratory function caused the biggest problems. The study showed that intelligent garment technology could be used in an OR environment for patient monitoring, albeit not in realtime. It may also be useful in home follow-up.
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Affiliation(s)
- Nina Halín
- Tampere University of Technology, Pori, Finland.
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38
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Maglogiannis IG, Karpouzis K, Wallace M. Image and Signal Processing for Networked E-Health Applications. ACTA ACUST UNITED AC 2006. [DOI: 10.2200/s00015ed1v01y200602bme002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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39
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Scilingo EP, Gemignani A, Paradiso R, Taccini N, Ghelarducci B, De Rossi D. Performance evaluation of sensing fabrics for monitoring physiological and biomechanical variables. ACTA ACUST UNITED AC 2005; 9:345-52. [PMID: 16167688 DOI: 10.1109/titb.2005.854506] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the last few years, the smart textile area has become increasingly widespread, leading to developments in new wearable sensing systems. Truly wearable instrumented garments capable of recording behavioral and vital signals are crucial for several fields of application. Here we report on results of a careful characterization of the performance of innovative fabric sensors and electrodes able to acquire vital biomechanical and physiological signals, respectively. The sensing function of the fabric sensors relies upon newly developed strain sensors, based on rubber-carbon-coated threads, and mainly depends on the weaving topology, and the composition and deposition process of the conducting rubber-carbon mixture. Fabric sensors are used to acquire the respitrace (RT) and movement sensors (MS). Sensing features of electrodes, instead rely upon metal-based conductive threads, which are instrumental in detecting bioelectrical signals, such as electrocardiogram (ECG) and electromyogram (EMG). Fabric sensors have been tested during some specific tasks of breathing and movement activity, and results have been compared with the responses of a commercial piezoelectric sensor and an electrogoniometer, respectively. The performance of fabric electrodes has been investigated and compared with standard clinical electrodes.
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40
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Koos R, Sinha AM, Stellbrink C. Home Monitoring in an ICD patient with incessant ventricular tachycardia. ACTA ACUST UNITED AC 2005; 94:461-4. [PMID: 15997347 DOI: 10.1007/s00392-005-0244-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2004] [Accepted: 01/28/2005] [Indexed: 11/24/2022]
Abstract
Due to the increasing number of patients and complexity of modern tachycardia devices, efficient therapy surveillance as offered by Home Monitoring (HM) is of increasing importance. We report of an ICD patient with incessant ventricular tachycardia, in whom immediate arrhythmia transmission by HM permitted hospitalization and change of medication without time delay.
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Affiliation(s)
- R Koos
- Medizinische Klinik I der RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany.
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41
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Abstract
This paper introduces a cost-effective portable teletrauma system that assists health-care centers in providing prehospital trauma care. Simultaneous transmission of a patient's video, medical images, and electrocardiogram signals, which is required throughout the prehospital procedure, is demonstrated over commercially available 3G wireless cellular data service. Moreover, the physician can remotely control the information sent from the patient side. Such a technology will allow a trauma specialist to be virtually present at the remote location and participate in prehospital care, which improves the quality of trauma care and can potentially reduce mortality and morbidity. To alleviate the limited and fluctuant bandwidth barriers of the wireless cellular link, the system adapts to network conditions through media transformations, data prioritization, and application-level congestion control methods. Experimental evaluation of the system prototype over real network conditions, transmitting different media types between the trauma patient and hospital unit, is encouraging. The teletrauma system reported in this paper is the first of its kind and it provides a basis for future enhancements.
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Affiliation(s)
- Yuechun Chu
- Multimedia Networks Laboratory, Department of Electrical and Computer Engineering, University of Massachusetts, Amherst, MA 01003, USA.
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