基于无线技术的远程病人监护系统

基于无线通信的远程病人监护系统是现代通信技术在医疗领域的最新应用，已经引起越来越多人们的关注。根据监护目的、对象及应用领域的不同对远程监护系统进行了分类，并提出了基于无线传感器网络的远程监护体系结构，最后对基于无线个人域网（wireless personal areanetwork，wPAN）标准的无线通信技术进行概述。该系统可以应用于家庭、社区及医院的远程医疗健康监护，并可以根据需求进行扩展和升级。     

3G双处理器远程心电实时监护系统的研制

目的:详细介绍基于3G双处理器远程心电实时监护系统总体设计框架,以及各个具体功能模块的设计方法。方法:综合运用3G技术、网络技术、多媒体技术等技术,以高性能TMS302VC5402芯片为核心,专用数字信号处理器BSP15处理多媒体信息,3G通信模块HC25来实现。结果:基于3G双处理器的远程心电实时监护系统可以实时接收ECG数据并进行在线自动分析、波形显示,一旦检测到病变心电信号或可疑的心电信号时,给以预警和提示;医患可以通过远程双向音视频等技术在远离医疗设施的环境中实现急救处理。结论:本系统的实现可以帮助医生实时、全面地、无地域限制地获取病人心电信息,适合于监护具有长期带病与突然发病特点的冠心病人。3G的引入更进一步加强了信息传递的实时性与便利性。     

远程会诊系统中生理信号实时采集传输系统的设计与实现

目的:研究远程会诊系统中人体生理信号的实时采集与传输,用于对患者进行实时远程物理检查,辅助远程诊断。方法:应用传感器获取生理信号,用LabWindows/CVI编程,实现远程会诊中心音、呼吸音和脉搏的实时采集和传输。结果:远程会诊专家能够实时对远程患者进行心音、呼吸音和脉搏等物理检查,并将诊断结果实时反馈给患者。结论:在现有的网络条件下,系统可以很好的实现生理信号的实时采集与传输,具有较强的实用性。     

基于Windows phone 8的慢性病健康监护软件设计与实现

目的:研究针对慢性病患者的健康监护系统中的移动终端,实现接收便携式监护仪采集的生理参数并进行管理和上传。方法:该客户端基于Windows phone 8,使用蓝牙连接便携监护仪,实时显示生理数据;使用文件方式存储和管理监护历史数据;使用Windows phone 8后台传输功能将监护数据上传至服务器。结果:开发了基于Windows phone 8的手机客户端,实现了对监护仪生理参数的接收、处理、显示、存储和上传,同时具备医患互动、预约挂号、一键报警、健康网站浏览、设置等功能。结论:该终端作为移动监护仪与服务器的桥梁,实现了对患者的远程监护,具备丰富的周边功能,可提供一种全新的诊疗体验。     

基于微信公众平台的移动血压监护系统的设计

针对传统的血压监护系统用户网络体验性差的问题,基于微信公众平台和嵌入式技术设计出一种智能移动血压监护系统。该系统的智能移动监护终端搭载PIC32MX微控制器,移植运行嵌入式Linux系统,可采集用户的心电、脉搏数据,并通过Internet将数据上传至接入微信的中心服务器,在微信中心服务器中利用脉搏波传播时间（PWTT）计算出实时的血压值。用户可以添加本系统的微信公众号,使用微信客户端查询监护结果。结果表明,该系统能够实现无袖带式连续血压测量,能够实现远程血压监护的功能,对慢性病的管理与治疗有重要意义。     

基于J2ME的多参数智能手机监护界面的设计

目的:本文采用J2ME技术设计一种穿戴式多参数智能手机监护界面.方法:系统在Wireless Toolkit模拟环境下进行了仿真实验,并结合穿戴式检测技术和GPRS技术实现多生理参数的远程监护.结果:系统可以实时检测心电、心率、血压、体温以及血氧饱和度,具有数据分析、异常报警等功能.最后将参数传至智能手持设备,并能与医疗服务中心站建立远程通信.结论:实验结果表明系统具有移植性强、简单易用、响应速度快等优点.本系统有望实现3G时代下的重大医疗应用并为远程医疗的进一步研究提供基础.     

基于云端的远程随身电子听诊系统

目的:提出基于云端的远程随身电子听诊系统。方法:通过ARM处理器对听诊信号进行预处理、编码存储,并通过WIFI网络把WAV文件格式封装的数据发送至云端服务器。服务器接收到的音频数据将在WEB上展示,并提供在线播放和波形展示功能。结果:在保留传统听诊器功能的同时,本系统实现了听诊信息的数字化和信息储存,以便与历史病情信息进行比较。通过听诊信号图形化展示,也可以更直观地对疾病进行诊断。结论:相较于传统听诊器,本系统既可用于实时听诊,也可用于离线听诊,提高了听诊的灵活性,对突发性疾病以及病患的远程监护有一定的优势。     

穿戴式心电监护模块的微型化研究

基于硬件软件化的设计理念,研究适用于移动心电监护的微型化技术,最终设计出微型化心电监护模块。模块由微型化预处理电路及单片机组成,其中传统电路的部分功能由单片机完成,从而实现模块的微型化;通过短距离ZigBee或远距离GPRS无线通信,将异常心电数据发送至社区医疗工作站,实现心电异常的实时预警。系统成功预警的室性扑动、窦性停搏等严重心电异常。实际应用效果表明,系统体积小、应用灵活方便,以低成本实现了心电异常患者享受远程移动监护的服务,符合低成本健康医疗模式转变的趋势。     

基于移动智能终端的单通道胎儿心电监护系统

目的 设计基于移动智能终端的单通道胎儿心电监护系统,以实现扩展卡尔曼滤波(extended Kalman filtering,EKF)和奇异值分解(singular value decomposition,SVD)相结合的单通道胎儿心电提取算法,实时获取高信噪比的胎儿心电信号,完成胎心监护的远程移动医疗.方法 利用STM32单片机控制24位采样芯片ADS1298,对单通道的孕妇腹部信号进行采集,并将采集后的数据经蓝牙传送给移动智能终端,在基于Android的移动智能终端上实现EKF和SVD相结合的单通道胎儿心电提取算法,完成对胎儿心电的实时提取、显示、存储与分析,计算心律变异率,实现对整个监护系统进行控制等功能.结果 测试结果表明,该系统可从单通道孕妇腹部信号中准确提取出胎儿心电信号,准确度为95.60％,阳性预测率为98.71％,系统工作稳定,连续处理5个胎心周期的数据用时约为70μs,小于一个母体心动周期(约0.8 s)的时间,适于临床对胎儿心电的实时监护.结论 该系统实时性强、准确率高、工作稳定、操作简单、便于携带,实现了对胎心监护的可穿戴式远程移动医疗,适合社区医院和家庭使用.     

远程多生理参数实时监测云服务平台的构建与分析

针对现有的多生理参数实时监测系统中,由于终端用户数量增加和上传数据加大所导致的服务后台数据一致性无法保证、生理参数存储与处理能力不足、实时性较差以及数据利用率低等问题,提出了基于云计算的多生理参数监测后台数据集群存储与并行处理新模式。通过对监测系统云平台的基础设施即服务层资源虚拟化、平台即服务层实时计算平台的构建、软件即服务层数据流的接收与分析,以及多生理参数流传输通路瓶颈问题等方面的研究,实现了生理信息大数据量的实时传输、存储与集群处理,并可利用批处理对患者的历史数据实现纵向分析。仿真测试结果表明:基于云平台的远程多生理参数监测系统在集群数据处理时间和负载平衡方面,比传统的服务器模式具有明显的优势。该平台解决了传统远程医疗服务中数据周转时间长、实时分析算法误差较大和架构拓展困难等问题,为多生理参数无线监测以专业的"穿戴式无线传感+移动终端无线传输+云计算服务"模式走向家庭健康监测提供了技术支撑。     

The Lighthouse Alarm and Locator trial - a pilot study.

An important factor for health is the possibility to be active and mobile. To make this possible various kinds of support are needed. Integrating geographical information systems technology and user experiences is important in the development of more user-friendly positioning devices. The Lighthouse Alarm and Locator trial aimed to test a new mobile alarm system with additional functionality such as positioning and monitoring of vital signs which can be used regardless of location (in hospital, at home). The system was tested by elderly persons from a pensioner organisation and home care personnel answered up on the alarms. After the tests qualitative interviews were performed with the two groups. The results showed that their experiences of the new mobile alarm system could be described in three main categories: to be supervised, to feel safe and to be mobile. These categories formed a theme: Positioning - an ethical dilemma. The clients' mobility was perceived to increase. The personnel did not think that positioning was ethical but the clients (elderly) did.     

A Mobile and Ubiquitous Approach for Supporting Frailty Assessment in Elderly People

Background

Frailty is a health condition related to aging and dependence. A reduction in or delay of the frailty state can improve the quality of life of the elderly. However, providing frailty assessments can be difficult because many factors must be taken into account. Usually, measurement of these factors is performed in a noncentralized manner. Additionally, the lack of quantitative methods for analysis makes it impossible for the diagnosis to be as complete or as objective as it should be.

Objective

To develop a centralized mobile system to conduct elderly frailty assessments in an accurate and objective way using mobile phone capabilities.

Methods

The diagnosis of frailty includes two fundamental aspects: the analysis of gait activity as the main predictor of functional disorders, and the study of a set of frailty risk factors from patient records. Thus, our system has several stages including gathering information about gait using accelerometer-enabled mobile devices, collecting values of frailty factors, performing analysis through similarity comparisons with previous data, and displaying the results for frailty on the mobile devices in a formalized way.

Results

We developed a general mechanism to assess the frailty state of a group of elders by using mobile devices as supporting tools. In collaboration with geriatricians, two studies were carried out on a group of 20 elderly patients (10 men and 10 women), previously selected from a nursing home. Frailty risk factors for each patient were collected at three different times over the period of a year. In the first study, data from the group of patients were used to determine the frailty state of a new incoming patient. The results were valuable for determining the degree of frailty of a specific patient in relation to other patients in an elderly population. The most representative similarity degrees were between 73.4% and 71.6% considering 61 frailty factors from 64 patient instances. Additionally, from the provided results, a physician could group the elders by their degree of similarity influencing their care and treatment. In the second study, the same mobile tool was used to analyze the frailty syndrome from a nutritional viewpoint on 10 patients of the initial group during 1 year. Data were acquired at three different times, corresponding to three assessments: initial, spontaneous, and after protein supplementation. The subsequent analysis revealed a general deterioration of the subset of elders from the initial assessment to the spontaneous assessment and also an improvement of biochemical and anthropometric parameters in men and women from the spontaneous assessment to the assessment after the administration of a protein supplement.

Conclusions

The problem of creating a general frailty index is still unsolved. However, in recent years, there has been an increase in the amount of research on this subject. Our studies took advantage of mobile device features (accelerometer sensors, wireless communication capabilities, and processing capacities among others) to develop a new method that achieves an objective assessment of frailty based on similarity results for an elderly population, providing an essential support for physicians.     

Using mobile phones in healthcare management for the elderly

The increasing average life expectancy is simultaneously increasing the incidence of chronic diseases and the number of healthy elderly people, consequently leading to an increased demand for healthcare management methods that do not involve hospital visits. The development of health management services involving mobile phones will change the focus of medical services from hospital visits and treatments to managing the health decisions made by individuals in their daily lives. However, the elderly may experience specific difficulties in adapting to constantly evolving services.This study reviews various health-related devices such as mobile phones that are available for providing healthcare to the elderly, and the different ways of using them. As the use of mobile phone increases, it is expected that elderly mobile phone users will also be able to regularly check their health status at any time and place.The issues of an ageing population pertain to the entire society rather than only to the elderly, which make mobile-phone-based medical informatics as a health management service a worthy goal.     

Information access at the point of care: what can we learn for designing a mobile CPR system?

OBJECTIVES: Hospitals have started to migrate their paper-based records to computerized patient records (CPR). The majority of today's CPR systems are stationary, which means that physicians use a clinical workstation to access CPR information. But health care professionals need to request and enter information at different locations, for example, on their daily ward round. This suggests the use of mobile computers, enabling an ubiquitous access to needed data. Different studies show that health care professionals are reluctant to use poorly designed mobile CPR systems, as the work at the point of care is very time-pressured and hectic. To design a system with high acceptance, it is essential to obtain empirical insight into the work practices and context in which the mobile CPR system will be used. METHOD: We investigated the physicians' work with the patient record during their daily round. With the help of a compact notation method, the physicians' interaction with the information system was recorded in real time. Fourteen physicians from three different departments (internal medicine, surgery, and geriatrics) of a middle-sized Swiss hospital participated in our study. RESULTS: Physicians have clear access preferences when they interact with the patient record during their daily round. There exists a clear profile of access frequencies and patterns, respectively. As an example, approximately 50% of all patient record accesses concern information about medications, vital signs and lab test results. DISCUSSION/CONCLUSION: A CPR system which is designed to reflect the access frequencies and patterns should improve the efficiency of data entry and retrieval and thus result in a system with high acceptance among physicians in the demanding environment during hospital rounds.     

Mobile mammography: assessment of self-referral in reaching medically underserved women

BACKGROUND: Mobile mammography can be useful in reaching medically underserved women. However, it is not known whether self-referral for mobile mammography is the best approach for reaching the most vulnerable populations. OBJECTIVES: 1) To describe the community outreach patterns of a county-sponsored mobile mammography unit, 2) To characterize the follow-up patterns for women with abnormal screening mammograms, and 3) to identify reasons why women screened on mobile units seek follow-up care outside of the safety-net system. METHODS: We prospectively followed women aged > or = 40 years who received mobile mammograms using electronic records and medical chart review, and surveyed women who had no evidence of diagnostic follow-up. We also reviewed administrative records to determine outreach patterns of the mobile mammography units. RESULTS: Seventy-five percent of mobile visits were with community-based organizations or community health centers. At least one quarter of women chose to follow-up outside of the safety-net for evaluation of abnormal screening mammograms. Of these, nearly 40% reported having insurance or a private physician as the primary reason for having diagnostic evaluation outside of the public hospital system. CONCLUSIONS: Despite serving primarily community-based facilities, self-referral for mobile mammography may not optimally target medically underserved women most in need of breast cancer screening.     

glUCModel: A monitoring and modeling system for chronic diseases applied to diabetes

Chronic patients must carry out a rigorous control of diverse factors in their lives. Diet, sport activity, medical analysis or blood glucose levels are some of them. This is a hard task, because some of these controls are performed very often, for instance some diabetics measure their glucose levels several times every day, or patients with chronic renal disease, a progressive loss in renal function, should strictly control their blood pressure and diet. In order to facilitate this task to both the patient and the physician, we have developed a web application for chronic diseases control which we have particularized to diabetes. This system, called glUCModel, improves the communication and interaction between patients and doctors, and eventually the quality of life of the former. Through a web application, patients can upload their personal and medical data, which are stored in a centralized database. In this way, doctors can consult this information and have a better control over patient records. glUCModel also presents three novelties in the disease management: a recommender system, an e-learning course and a module for automatic generation of glucose levels model. The recommender system uses Case Based Reasoning. It provides automatic recommendations to the patient, based on the recorded data and physician preferences, to improve their habits and knowledge about the disease. The e-learning course provides patients a space to consult information about the illness, and also to assess their own knowledge about the disease. Blood glucose levels are modeled by means of evolutionary computation, allowing to predict glucose levels using particular features of each patient. glUCModel was developed as a system where a web layer allows the access of the users from any device connected to the Internet, like desktop computers, tablets or mobile phones.     

Mobile phone-based telemonitoring for heart failure management: a randomized controlled trial

Background

Previous trials of telemonitoring for heart failure management have reported inconsistent results, largely due to diverse intervention and study designs. Mobile phones are becoming ubiquitous and economical, but the feasibility and efficacy of a mobile phone-based telemonitoring system have not been determined.

Objective

The objective of this trial was to investigate the effects of a mobile phone-based telemonitoring system on heart failure management and outcomes.

Methods

One hundred patients were recruited from a heart function clinic and randomized into telemonitoring and control groups. The telemonitoring group (N = 50) took daily weight and blood pressure readings and weekly single-lead ECGs, and answered daily symptom questions on a mobile phone over 6 months. Readings were automatically transmitted wirelessly to the mobile phone and then to data servers. Instructions were sent to the patients’ mobile phones and alerts to a cardiologist’s mobile phone as required.

Results

Baseline questionnaires were completed and returned by 94 patients, and 84 patients returned post-study questionnaires. About 70% of telemonitoring patients completed at least 80% of their possible daily readings. The change in quality of life from baseline to post-study, as measured with the Minnesota Living with Heart Failure Questionnaire, was significantly greater for the telemonitoring group compared to the control group (P = .05). A between-group analysis also found greater post-study self-care maintenance (measured with the Self-Care of Heart Failure Index) for the telemonitoring group (P = .03). Brain natriuretic peptide (BNP) levels, self-care management, and left ventricular ejection fraction (LVEF) improved significantly for both groups from baseline to post-study, but did not show a between-group difference. However, a subgroup within-group analysis using the data from the 63 patients who had attended the heart function clinic for more than 6 months revealed the telemonitoring group had significant improvements from baseline to post-study in BNP (decreased by 150 pg/mL, P = .02), LVEF (increased by 7.4%, P = .005) and self-care maintenance (increased by 7 points, P = .05) and management (increased by 14 points, P = .03), while the control group did not. No differences were found between the telemonitoring and control groups in terms of hospitalization, mortality, or emergency department visits, but the trial was underpowered to detect differences in these metrics.

Conclusions

Our findings provide evidence of improved quality of life through improved self-care and clinical management from a mobile phone-based telemonitoring system. The use of the mobile phone-based system had high adherence and was feasible for patients, including the elderly and those with no experience with mobile phones.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00778986","term_id":"NCT00778986"}}NCT00778986     

基于MSP430及安卓系统的老年人生理信息监护系统

目的：随着老龄化的不断加剧,老年人的监护需求量也在不断的增加,为了解决相应的老年人监护问题,介绍了一种基于MSP430单片机和安卓系统结合的老年人生理信息采集监护系统的工作原理。方法：以MSP430为核心,配以血氧、体温等传感器模块对老年人生理信息进行采集,利用传感器技术与嵌入式技术相结合。设计了生理信息采集终端。设计中采用了跌倒检测,在老年人出现跌倒时,能够及时通知监护人员,防止出现救治不及时的情况,同时还利用蓝牙通信,将采集的信息上传到基于Android系统的智能手机终端。利用Android系统上传数据到服务器,为老年人建立生理监护系统。结果：对设计进行了实验测试．经试验表明系统能够正常的进行数据采集,体温测量数据误差在±0．3℃,血氧饱和度的测量在正常范围95％-98％之间,跌倒检测很准确的检测到了跌倒状况,满足测试的标准,达到了设计的预期效果。结论：该系统能够很好的实现老年人的生理信息监护．对老年人的血氧、体温进行了很好的监测．在老年人出现跌倒时能够及时的进行报警,得到救治,具有良好的扩展性和广泛的应用前景。     

A Mobile Phone Integrated Health Care Delivery System of Medical Images

With the growing computing capability of mobile phones, a handy mobile controller is developed for accessing the picture archiving and communication system (PACS) to enhance image management for clinicians with nearly no restriction in time and location using various wireless communication modes. The PACS is an integrated system for the distribution and archival of medical images that are acquired by different imaging modalities such as CT (computed tomography) scanners, CR (computed radiography) units, DR (digital radiography) units, US (ultrasonography) scanners, and MR (magnetic resonance) scanners. The mobile controller allows image management of the PACS including display, worklisting, query and retrieval of medical images in DICOM format. In this mobile system, a server program is developed in a PACS Web server which serves as an interface for client programs in the mobile phone and the enterprise PACS for image distribution in hospitals. The application processing is performed on the server side to reduce computational loading in the mobile device. The communication method of mobile phones can be adapted to multiple wireless environments in Hong Kong. This allows greater feasibility to accommodate the rapidly changing communication technology. No complicated computer hardware or software is necessary. Using a mobile phone embedded with the mobile controller client program, this system would serve as a tool for heath care and medical professionals to improve the efficiency of the health care services by speedy delivery of image information. This is particularly important in case of urgent consultation, and it allows health care workers better use of the time for patient care.     

Georeferenced and secure mobile health system for large scale data collection in primary care

IntroductionMobile health consists in applying mobile devices and communication capabilities for expanding the coverage and improving the effectiveness of health care programs. The technology is particularly promising for developing countries, in which health authorities can take advantage of the flourishing mobile market to provide adequate health care to underprivileged communities, especially primary care. In Brazil, the Primary Care Information System (SIAB) receives primary health care data from all regions of the country, creating a rich database for health-related action planning. Family Health Teams (FHTs) collect this data in periodic visits to families enrolled in governmental programs, following an acquisition procedure that involves filling in paper forms. This procedure compromises the quality of the data provided to health care authorities and slows down the decision-making process.ObjectivesTo develop a mobile system (GeoHealth) that should address and overcome the aforementioned problems and deploy the proposed solution in a wide underprivileged metropolitan area of a major city in Brazil.MethodsThe proposed solution comprises three main components: (a) an Application Server, with a database containing family health conditions; and two clients, (b) a Web Browser running visualization tools for management tasks, and (c) a data-gathering device (smartphone) to register and to georeference the family health data. A data security framework was designed to ensure the security of data, which was stored locally and transmitted over public networks.ResultsThe system was successfully deployed at six primary care units in the city of Sao Paulo, where a total of 28,324 families/96,061 inhabitants are regularly followed up by government health policies. The health conditions observed from the population covered were: diabetes in 3.40%, hypertension (age >40) in 23.87% and tuberculosis in 0.06%. This estimated prevalence has enabled FHTs to set clinical appointments proactively, with the aim of confirming or detecting cases of non-communicable diseases more efficiently, based on real-time information.ConclusionThe proposed system has the potential to improve the efficiency of primary care data collection and analysis. In terms of direct costs, it can be considered a low-cost solution, with an estimated additional monthly cost of U$ 0.040 per inhabitant of the region covered, or approximately U$ 0.106 per person, considering only those currently enrolled in the system.