Future of Smart Cardiovascular Implants

Cardiovascular disease remains the leading cause of death in Western society. Recent technological advances have opened the opportunity of developing new and innovative smart stent devices that have advanced electrical properties that can improve diagnosis and even treatment of previously intractable conditions, such as central line access failure, atherosclerosis and reporting on vascular grafts for renal dialysis. Here we review the latest advances in the field of cardiovascular medical implants, providing a broad overview of the application of their use in the context of cardiovascular disease rather than an in-depth analysis of the current state of the art. We cover their powering, communication and the challenges faced in their fabrication. We focus specifically on those devices required to maintain vascular access such as ones used to treat arterial disease, a major source of heart attacks and strokes. We look forward to advances in these technologies in the future and their implementation to improve the human condition.

A Review of Implant Communication Technology in WBAN: Progress and Challenges

Over the past six decades, there has been tremendous progress made in the field of medical implant communications. A comprehensive review of the progress, current state of the art, and future direction is presented in this paper. Implanted medical devices (IMDs) are designed mainly for the purpose of diagnostic, therapeutic, and assistive applications in heathcare, active living, and sports technology. The primary target of IMDs' design revolves around reliable communications, sustainable power sources, and a high degree of miniaturization while maintaining biocompatibility to surrounding tissues adhering to the human safety limits set by appropriate guidelines. The role of the Internet of Things and intelligent data analysis in implant device networks as future research is presented in this paper. Finally, in addition to reviewing the state of the art, a novel intuitive lower bound on implant size is presented.

Wearable technology for cardiology: An update and framework for the future

The field of cardiology has long used wearable medical devices to monitor heart rate and rhythm. The past decade has seen the emergence of many new wearable devices, including several that have been widely adopted by both physicians and consumers. In this review, we discuss existing and forthcoming devices designed to measure activity, heart rate, heart rhythm, and thoracic fluid. We also offer several frameworks to classify and better understand wearable devices, such that we may weigh their potential benefit in improving healthcare with the many challenges that must be addressed to reap these benefits.

[Active cardiac implantable electronic devices: What is possible in ambulatory health care in 2017?]

Telemonitoring (TM) features are implemented in nearly all cardiac implantable electronic devices (CIEDs) that have recently been released to the market. In combination with pacemakers, defibrillators and systems for cardiac resynchronization it is a safe and efficient method for routine technical aftercare of the devices as well as for monitoring heart failure and arrhythmias. Using TM has the potential to optimize patient care with regard to economic, clinical and safety aspects. Despite the good availability of existing data and clear recommendations of the responsible scientific societies, it is often seen as an isolated solution which is not fully integrated into standard care, although it has its own EBM number for implantable cardioverter-defibrillators and cardiac resynchronization therapy systems. The reasons are not only the unsatisfactory reimbursement of costs, different IT structures and the borders between clinics and medical practices, but also acceptance problems of physicians and legal aspects. The compensation of cardiac pacemakers and 'event recorders' is unsolved. TM provides the prospect for optimal and cross-sectoral patient care. Furthermore it has the potential to become the standard method for the care for patients with a CIED.

Long-term blood glucose monitoring with implanted telemetry device in conscious and stress-free cynomolgus monkeys

AIMS

Continuous blood glucose monitoring, especially long-term and remote, in diabetic patients or research is very challenging. Nonhuman primate (NHP) is an excellent model for metabolic research, because NHPs can naturally develop Type 2 diabetes mellitus (T2DM) similarly to humans. This study was to investigate blood glucose changes in conscious, moving-free cynomolgus monkeys (Macaca fascicularis) during circadian, meal, stress and drug exposure.

MATERIALS AND METHODS

Blood glucose, body temperature and physical activities were continuously and simultaneously recorded by implanted HD-XG telemetry device for up to 10 weeks.

RESULTS AND DISCUSSION

Blood glucose circadian changes in normoglycemic monkeys significantly differed from that in diabetic animals. Postprandial glucose increase was more obvious after afternoon feeding. Moving a monkey from its housing cage to monkey chair increased blood glucose by 30% in both normoglycemic and diabetic monkeys. Such increase in blood glucose declined to the pre-procedure level in 30 min in normoglycemic animals and >2 h in diabetic monkeys. Oral gavage procedure alone caused hyperglycemia in both normoglycemic and diabetic monkeys. Intravenous injection with the stress hormones, angiotensin II (2 μg/kg) or norepinephrine (0.4 μg/kg), also increased blood glucose level by 30%. The glucose levels measured by the telemetry system correlated significantly well with glucometer readings during glucose tolerance tests (ivGTT or oGTT), insulin tolerance test (ITT), graded glucose infusion (GGI) and clamp.

CONCLUSION

Our data demonstrate that the real-time telemetry method is reliable for monitoring blood glucose remotely and continuously in conscious, stress-free, and moving-free NHPs with the advantages highly valuable to diabetes research and drug discovery.

Current rare indications and future directions for implantable loop recorders

The scope of application for implantable loop recorders has shifted away from the evaluation of unclear palpitations and syncope episodes to more complex conditions. This article focuses on rare indications of growing importance such as rhythm monitoring after ablation of atrial fibrillation or after cryptogenic stroke. Furthermore, forthcoming applications in various clinical settings are described, e. g., arrhythmia detection after myocardial infarction, after catheter-based valve interventions, in heart failure, and in cardiomyopathies. Enhancement of the capabilities of implantable loop recorders could broaden their fields of use.

Wireless Medical Telemetry Service Is Changing, Not Going Away

The Wireless Medical Telemetry Service (WMTS) was established in 1999 by the Federal Communications Commission (FCC) to protect the use of licensed medical telemetry for physiological and fetal monitoring. The WMTS space has three frequency bands: 608-614 MHz (over-the-air [OTA] television channel 37), 1,395-1,400 MHz, and 1,427-1,432 MHz. This article addresses the recent FCC rule affecting the OTA channel 37 WMTS band. We also will address the potential impact on WMTS use in the hospital, the potential risks, and what hospitals need to do to mitigate those risks.

[Connected home, monitoring and improved care]

New technologies offer a new approach to healthcare management that benefits the patient, especially at home: better living spaces, improved safety and preservation of communication. Professionals concerned and family caregivers should be trained in these new technologies to discover and explore everyday their possibilities and uses.

Correlations between first documented cardiac rhythms and preceding telemetry in patients with code blue events

BACKGROUND

Among in-hospital cardiac arrest (IHCA) patients, the first cardiac rhythm documented on resuscitation records (FDR) is often used as a surrogate for arrest etiology. Although the FDR generally represents the electrical activity at the time of cardiopulmonary resuscitation initiation, it may not be the ideal rhythm to infer the arrest etiology. We hypothesized that a rhythm present earlier-at the time of the code blue call-would frequently differ from the FDR, because the FDR might represent the later stage of a progressive cardiopulmonary process.

OBJECTIVE

To evaluate agreement between FDR and telemetry rhythm at the time of code blue call.

DESIGN

Cross-sectional study.

SETTING

A 750-bed adult tertiary care hospital and a 240-bed adult inner city community hospital.

PATIENTS

Adult general ward patients monitored on the hospital's telemetry system during the 2 minutes prior to a code blue call for IHCA.

INTERVENTION

None.

MEASUREMENTS

Agreement between FDR and telemetry rhythm.

RESULTS

Among 69 IHCAs, agreement between FDR and telemetry was 65% (kappa = 0.37). Among 17 events with FDRs of ventricular tachyarrhythmia (VTA), telemetry showed VTA in 12 (71%) and other organized rhythms in 5 (29%). Among 12 events with first documented rhythms of asystole, telemetry showed asystole in 3 (25%), VTA in 1 (8%), and other organized rhythms in 8 (67%).

CONCLUSIONS

The FDR had only fair agreement with the telemetry rhythm at the time of code blue call. The telemetry rhythm may be a useful adjunct to the FDR when investigating arrest etiology.

Wireless devices incite 'medical spring'

A new breed of medical technology is emerging to make diagnosis and treatment more targeted, effective and efficient. How can hospitals harness all that potential?

The era of micro and nano systems in the biomedical area: bridging the research and innovation gap

The area of Micro and Nano systems (MNS) focuses on heterogeneous integration of technologies (e.g. electronics, mechanics and biotechnology) and implementation of multiple functionalities (e.g. sensing, processing, communication, energy and actuation) into small systems. A significant amount of MNS activities targets development and testing of systems enabling biomedicine and personal health solutions. Convergence of micro-nano-bio and Information & communication technologies is being leading to enabling innovative solutions e.g. for in-vitro testing and in vivo interaction with the human body for early diagnosis and minimally invasive therapy. Of particular interest are smart wearable systems such as smart textiles aiming at the full integration of sensors/actuators, energy sources, processing and communication within the clothes to enable non-invasive personal health, lifestyle, safety and emergency applications. The paper presents on going major R&D activities on micro-nano-bio systems (MNBS) and wearable systems for pHealth under the European Union R&D Programs, Information and Communication Technologies (ICT) priority; it also identifies gaps and discusses key challenges for the future.

[Facing the challenges of ubiquitous computing in the health care sector]

The steady progress of microelectronics, communications and information technology will enable the realisation of the vision for "ubiquitous computing" where the Internet extends into the real world embracing everyday objects. The necessary technical basis is already in place. Due to their diminishing size, constantly falling price and declining energy consumption, processors, communications modules and sensors are being increasingly integrated into everyday objects today. This development is opening up huge opportunities for both the economy and individuals. In the present paper we discuss possible applications, but also technical, social and economic barriers to a wide-spread use of ubiquitous computing in the health care sector.

The future is mobile and wireless

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

From computers to ubiquitous computing by 2010: health care

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

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

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

Applications of medical informatics in allergy/immunology

OBJECTIVE

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

DATA SOURCES

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

STUDY SELECTION

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

RESULTS

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

CONCLUSIONS

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

Home Monitoring: what can we expect in the future?

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

Wireless capsule endoscopy: from diagnostic devices to multipurpose robotic systems

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

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

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

Cardiac rhythm management: the shape of things to come

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

SUMMARY

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

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

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

Electroactive Polymer-Based Devices for e-Textiles in Biomedicine

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

Organic Field Effect Transistors for Textile Applications

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

[The technical possibilities in telemonitoring of physiological parameters]

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

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

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