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At least 91 records · Page 5Linked to original sources

PubMed2002

Multimedia telehomecare system using standard TV set.

Nowadays, there are a very large number of patients that need specific health support at home. The deployment of broadband communication networks is making feasible the provision of home care services with a proper quality of service. This paper presents a telehomecare multimedia platform that runs over integrated services digital network and internet protocol using videoconferencing standards H.320 and H.323, and standard TV set for patient interaction. This platform allows online remote monitoring: ECG, heart sound, blood pressure. Usability, affordability, and interoperability were considered for the design and development of its hardware and software components. A first evaluation of technical and usability aspects were carried forward with 52 patients of a private clinic and 10 students in the University. Results show a high rate (mean = 4.33, standard deviation--SD = 1.63 in a five-points Likert scale) in the global perception of users on the quality of images, voice, and feeling of virtual presence.

Computer Communication Networks↗

PubMed1999

The potential impact of home telecare on clinical practice.

Home telecare, in which the health status of patients at home is monitored remotely, has the potential to improve care and reduce costs. Its widespread implementation would require fundamental changes in the healthcare system.

Activities of Daily Living↗

PubMed2002

Shared virtual environments for telerehabilitation.

Current VR telerehabilitation systems use offline remote monitoring from the clinic and patient-therapist videoconferencing. Such "store and forward" and video-based systems cannot implement medical services involving patient therapist direct interaction. Real-time telerehabilitation applications (including remote therapy) can be developed using a shared Virtual Environment (VE) architecture. We developed a two-user shared VE for hand telerehabilitation. Each site has a telerehabilitation workstation with a videocamera and a Rutgers Master II (RMII) force feedback glove. Each user can control a virtual hand and interact hapticly with virtual objects. Simulated physical interactions between therapist and patient are implemented using hand force feedback. The therapist's graphic interface contains several virtual panels, which allow control over the rehabilitation process. These controls start a videoconferencing session, collect patient data, or apply therapy. Several experimental telerehabilitation scenarios were successfully tested on a LAN. A Web-based approach to "real-time" patient telemonitoring--the monitoring portal for hand telerehabilitation--was also developed. The therapist interface is implemented as a Java3D applet that monitors patient hand movement. The monitoring portal gives real-time performance on off-the-shelf desktop workstations.

Computer Simulation↗

PubMed2002

Wireless and Web-based medical monitoring in the home.

A remote medical monitoring system is described, which continuously monitors patients' state of health. The system uses the services provided by intranets and the Internet to allow remote supervision of patients, who may be domiciled in their own home. A hardware/software prototype system has been constructed to demonstrate the use of non-invasive and minimally intrusive sensors attached to patients. Continuous real-time data is acquired, stored and processed. A wireless system or wires connect these monitor devices to the World Wide Web and, on request, information is delivered to authorized medical staff via a web browser or Wireless Application Protocol-enabled mobile telephones. Medical staff may examine real-time data or graphical information and make comparisons with historical data. Parameters may be set to select and control the data acquisition devices. The potential exists for augmentation of patient health by development of novel sensors and low-power electronic circuitry, and this research continues.

Aged↗

PubMed2005

Development of implantable devices for continuous ambulatory monitoring of central hemodynamic values in heart failure patients.

BACKGROUND: Care and management of patients with congestive heart failure (CHF) is a major health-care challenge. The value of acute hemodynamic data in assessing heart failure has been questioned in some studies, while more intensive hemodynamic monitoring has been reported to improve patient care in others. A series of patient studies are reported here that were conducted to identify device requirements and verify the feasibility of continuous hemodynamic monitoring in CHF patients and devices for remote transfer and use of these data. METHODS AND RESULTS: The results of four separate studies in 68 CHF patients who received systems for chronic hemodynamic monitoring between 1992 and the present are reviewed. One early study was with five patients followed for 7-16 months and another study was with nine patients followed for 4-22 months. A third study included 21 patients followed up to 39 months, and the fourth study included 32 patients implanted in 1998-99 with many of them still in follow-up. These studies support the technical feasibility of implanted devices and the external instrumentation required to transfer and manage the collected data. They also support the long-term stability and accuracy of these systems. Three additional acute studies conducted with 30 patients and chronic data from 53 of the 68 patients with the implanted systems are presented that support the feature included in the newer monitors--the ability to reliably estimate pulmonary artery diastolic pressures from the right ventricular pressure signal. CONCLUSIONS: Development of implantable technology to measure several hemodynamic variables in ambulatory CHF patients is feasible. External instrumentation needed to remotely acquire data from the implanted devices has been verified. The potential to eliminate the uncertainties associated with the use of acute, invasive hemodynamics and the ability to evaluate long-term ambulatory hemodynamic patterns is provided. These findings set the stage for determining the potential clinical value of these systems in impacting the care of chronic CHF patients.

Electrocardiography, Ambulatory↗

PubMed2004

Remote monitoring of implantable cardioverter defibrillators: a prospective analysis.

A prospective study evaluating the functionality and ease of use of the Medtronic CareLink Network, "CareLink," was conducted at ten investigational sites. This internet-based remote monitoring service allows clinicians to remotely manage their patients' implantable cardioverter defibrillators (ICDs) and chronic diseases. The network is comprised of a patient monitor, a secure server, and clinician and patient websites. Under clinician direction, patients interrogated their ICDs at home, and transmitted data to secure servers via a standard telephone line. Comprehensive device data and a 10-second presenting rhythm electrogram were captured by the monitor and available for access and review on the clinician website. The information could also be printed using a standard desktop computer with internet access. During this study, patients were asked to transmit device data twice, at least 7 days apart, as scheduled by the clinic. Monitor functionality was assessed, and ease of using the system components was evaluated via questionnaires completed by patients and clinicians following each data transmission and review. Fifty-nine patients (64 +/- 14 years, range 22-85 years) completed 119 transmissions with only 14 calls to the study support center. Clinician review of data transmissions revealed several clinically significant findings, including silent AF discovery, assessment of antiarrhythmic drug efficacy in a previously diagnosed AF patient, previously unobserved atrial undersensing, and ventricular tachycardia. ICD patients found the monitor easy to use. Clinicians were pleased with the performance of the network and the quality of the web-accessed data, and found it comparable to an in-office device interrogation. CareLink is a practical tool for routine device management and may allow timely identification of clinically important issues.

Adult↗

PubMed2005

Arthritis in Canada: what do we know and what should we know?

Doctors' visits for inflammatory arthritis reportedly represent only 6% of the overall visit rates for all arthritis and related conditions (163 per 1000), with about 40% of these patients seeing a specialist. Data from provincial drug plan databases show that although the proportion of the population aged 65 years and older with prescriptions for disease modifying antirheumatic drugs increased to 1% in 2000, this is only half the expected prevalence of rheumatoid arthritis in this age group. There are large provincial variations. Despite data on the efficacy and importance of treatment of early inflammatory arthritis, research is lacking on: the experience of arthritis, decision-making about seeking medical care, and factors affecting access to, and payment for, treatment, including drugs and rehabilitation; primary care decision-making about referral and treatment; organizational aspects of specialist care and access to drugs; and new ways of delivering services to reach patients in underserviced or remote areas. Monitoring the population impact of arthritis, including economic costs, is a priority for research, as are epidemiological studies on risk factors.

Aged↗

PubMedDate not supplied

Modular design of microcomputer-based medical instruments.

A modular design approach is effective for developing compact microcomputer-based medical instruments. Each instrument consists of two modules: a microcomputer instrument module that provides data conversion and computing functions and a characteristic module that does analog signal conditioning and includes all interfaces to the environment. The five instruments summarized here are: (a) a portable, battery-operated arrhythmia monitor for ambulatory patients; (b) a physician's computer for remote telephone communication with the portable monitor; (c) a battery-powered arrhythmia monitor/recorder for the operating room; (d) a portable, battery-operated biofeedback device for speech therapy; and (e) a neuromuscular blockade monitor for the operating room.

Computers↗

PubMed2003

Tsukuba remote monitoring system for continuous-flow artificial heart.

In order to make long-term medical treatment with the use of an artificial heart effective, we developed the Tsukuba remote monitoring system, which enables medical staff to manage the physiological condition of patients and the driving condition of the artificial heart at anytime from a remote place. This remote monitoring system has three functions: first, a remote monitoring function, which enables medical staff to monitor measured data from a remote place anytime by using not only a personal computer but also a cellular phone; second, an analyzing function, which estimates the unmeasured physiological behavior in the body based on a mathematical physiological model; and third, a warning function, which detects physiological problems and malfunction of the artificial heart by applying the if-then rule and sends a warning message to the medical staff. As a result of applying this system to animal experiments, we have confirmed the effectiveness of the proposed system.

Animals↗

PubMed1987

TRAM: a new concept in transport monitoring.

A new monitoring system has been designed to eliminate the need to interrupt monitoring to transport critically ill patients. The key innovation of the system is a self-contained multiparameter signal acquisition and processing module that contains a battery-backed microprocessor and retains monitor setup information when moved from one monitor to another. The module functions in Marquette Series 7010 surgical monitors and bedside monitors and in the new Marquette Transport Remote Acquisition Monitor (TRAM). Lines connecting the patient to the module remain connected. The TRAM module provides continuous, integrated multiparameter monitoring during transport. Monitored parameters include up to four simultaneous ECG leads, two invasive blood pressures, pulse rate, cardiac output and two temperatures (in place of cardiac output).

Computer Systems↗

PubMed2005

Private volunteer medical organizations: how effective are they?

Religious and other secular organizations have been involved with medical missionary work in sub-Saharan Africa for centuries, especially in remote provinces and villages. In times past, most of these countries were under the control of foreign powers. Private volunteer organizations operated within a structured environment, which, perhaps, facilitated their mission and their ability to review and evaluate their effectiveness because of the tight control the colonial powers maintained over every facet of native life. However, the transition from colonialism to independence has resulted in a different environment in which healthcare is fragmented and a low priority in most countries because of financial constraints. The lack of standardization, vintage laboratory equipment, a manual medical record system, lack of a subsidized transportation system, infrequent postal service and the absence of phone systems in the remote provinces and villages make treatment and tracking of patients, monitoring therapy and measuring outcomes/results difficult. Therefore, judging the effectiveness of an initiative in remote district hospitals and village clinics can be difficult. This manuscript addresses some of these issues and provides solutions to some that have been effective for one organization.

Africa South of the Sahara↗

PubMed2004

Point-of-care monitoring of anticoagulant therapy by rural community pharmacists: description of successful outcomes.

Warfarin is a recognised high-risk drug for adverse events. Patients from rural and remote regions are at increased risk of these events because of problems of access to health care providers and services, and there is some reluctance to prescribe warfarin to patients in rural areas because of the difficulties in monitoring anticoagulated patients. The availability of portable international normalised ratio (INR) monitors is particularly attractive in rural or remote settings because of the lack of access to pathology services. Pharmacists and other health professionals in rural areas are ideally placed to assist general practitioners in the management of their anticoagulated patients through the use of portable INR monitors. The present article describes three cases of successful outcomes of pharmacist-assisted anticoagulation monitoring in the rural setting. Innovative service delivery models like these are needed to meet the needs of the increasing number of rural Australians requiring warfarin therapy.

Anticoagulants↗

PubMed2000

Telemedicinal virtual reality for cognitive rehabilitation.

Cognitive rehabilitation and assessment of cognitively impaired patients has traditionally been performed using paper and pencil psychometeric tests. These tests are becoming increasingly dated and do not involve real world tasks. This paper describes a virtual reality kitchen designed to help patients relearn important daily living skills. Some important issues concerning virtual reality and the disabled are discussed. Additionally we describe the development of a prototype networked system to enable a doctor to monitor remotely the rehabilitation of a group of patients.

Activities of Daily Living↗

PubMed2005

Monitoring a remote phototherapy unit via telemedicine.

BACKGROUND: The delivery of effective phototherapy to patients with psoriasis living in areas devoid of dermatologists is difficult. Telemedicine has proven useful in the delivery of health care in such locations. OBJECTIVE: This evidence-based study sought to investigate the use of telemedicine in the monitoring of phototherapy of psoriasis patients located in a Nova Scotia region with no dermatologist. METHODS: Psoriatic patients were reviewed six months before and after protocols and monitoring were instituted. First, charts of 23 patient treated with phototherapy were reviewed from the Aberdeen Hospital in New Glasgow. Patients were either self-referred or referred by a family physician and occasionally a dermatologist. Treatments were not monitored by a specialist. Second, a group of 33 patients receiving treatment were supervised via telemedicine by a dermatologist 250 km away in Halifax. RESULTS: During the study period, treatment time decreased from 140 to 37 days. In the monitored group, 40% more patients were clear of psoriasis at time of discharge. The number of patients with side effects decreased. The number of self-and family practice-referred patients dropped; the clinic became a referral center for dermatologists. CONCLUSION: Telemedicine provided an excellent way to monitor patients receiving phototherapy in an area without a dermatologist. Overall, patient care improved: More patients were treated effectively with better outcomes and fewer side effects.

Adult↗

PubMed2002

A telemedicine system to support a new model for care of chronically ill patients.

We have developed a new model for the care of chronically ill patients, based on home care supported by remote monitoring technology and telemedicine. The variables monitored included non-invasive blood pressure, blood oxygen saturation, threelead electrocardiogram, spirometry (including flow-volume curve) and respiratory rate. The telemedicine system consisted of a home-based patient unit and a management centre that received information from the home units. The chronic care management centre was installed in two hospitals, in Spain (Barcelona) and Belgium (Leuven). We expect this to result in significant cost-savings and a better quality of care.

Chronic Disease↗

PubMed1999

PC-based telerehabilitation system with force feedback.

A PC-based orthopedic rehabilitation system was developed for use at home, while allowing for remote monitoring from the clinic. The home rehabilitation station has a Pentium II PC with graphics accelerator, Polhemus tracker, and a novel Multipurpose Haptic Control Interface with its own Pentium board. This interface is used to sample patient's hand positions and to provide resistive forces using the Rutgers Master II (RMII) glove. A library of virtual rehabilitation routines was developed using WorldToolKit software. At the present time, it consists of two physical therapy exercises (DigiKey and Ball) and two functional rehabilitation exercises (Peg Board test and Ball game). All VR exercises allow automatic and transparent patient data collection into an Oracle database. A remote Pentium II PC is connected with the home-based PC over the Internet and an additional video-conferencing connection. The remote computer running Oracle server is used to maintain the patient database, monitor progress and change exercise level of difficulty. This allows for timely patient progress monitoring and repeat evaluations over time from the Clinic. The system will soon start clinical trails at Stanford Medical School, with progress being monitored remotely from Rutgers University. Other rehabilitation haptic interfaces under development include devices for elbow, and knee rehabilitation connected to the Multipurpose Haptic Control Interface.

Computer Graphics↗

PubMed1997

Reduction in the incidence of carbon monoxide exposures in humans undergoing general anesthesia.

BACKGROUND: Carbon monoxide forms via reaction of isoflurane, enflurane, and desflurane with dried CO2 absorbents. The authors hypothesize that interventions by nonphysician support personnel to decrease absorbent drying will decrease the exposure rate of patients to carbon monoxide from anesthetic breakdown. METHODS: In the control group, all anesthetizing personnel were made aware of the factors enabling CO generation from anesthetic breakdown, and prevention techniques were left to the anesthetizing personnel. After data collection was complete, the following interventions were initiated to reduce absorbent drying: Anesthesia technicians and housekeeping personnel were instructed to turn off all anesthesia machines after the last case of the day in each room, and the CO2 absorbent was changed each morning if fresh gas was found flowing. Baralyme was used in all phases of this study. RESULTS: Five cases of intraoperative carbon monoxide exposure occurred among 1,085 (0.46%) first cases in the control group. Postintervention, patient carbon monoxide exposures decreased (P < 0.05), with one exposure among 1,961 (0.051%) first cases in the main operating room. Two exposures among 68 (2.9%) first cases occurred in remote locations (P < 0.001) versus main operating room. Predisposing factors for absorbent drying include the prolonged use of anesthesia machines for monitored anesthesia care, inappropriate drying techniques for expiratory flowmeters, understaffing of support personnel, and anesthesia in remote locations. CONCLUSIONS: These interventions reduced patient exposure to carbon monoxide. Monitoring for carbon monoxide exposures during general anesthesia may be necessary to recognize and end patient exposures that occur despite preventative measures.

Adsorption↗

PubMed2004

Mobile patient monitoring based on impedance-loaded SAW-sensors.

A remotely requestable, passive, short-range sensor network for measuring small voltages is presented. The sensor system is able to simultaneously monitor six small voltages in millivolt-range, and it can be used for Holter-electrocardiogram (ECG) and other biopotential monitoring, or in industrial applications. The sensors are based on a surface acoustic wave (SAW) delay line with voltage-dependent, impedance loading on a reflector interdigital transducer (IDT). The load circuit impedance is varied by the capacitance of the voltage-controlled varactor. High resolution is achieved by developing a MOS-capacitor with a thin oxide, low flat-band voltage, and zero-voltage capacitance in the space-charge region, as well as a high-Q-microcoil by thick metal electroplating. Simultaneous monitoring of multiple potentials is realized by time-division-multiplexing of different sensor signals.

Acoustics↗