Wireless communication interface for EEG/PSG Holter monitor

Communication interfaces for medical devices are normally wired. For long-term monitoring applications, wired devices limit patient mobility. In this paper a wireless communication interface for an EEG/PSG Holter monitor is presented. Selection of broadcasting band, communication standard, available hardware, and connection algorithm to use are discussed before making a choice. Results of experimental tests carried out on the prototype demonstrate the functionality of the implemented interface.     

A special-purpose computer for on-line statistical analysis of the heart rate

At present electronic instruments, in particular measuring devices, are widely used in hospitals. However, the usage of information processing systems is mainly limited to academic hospitals because of the costs, the need of skilled staff, etc. In this paper a relatively simple special purpose computer is described for the on-line generation of the tachogram, histogram, and joint interval distribution of a continuously updated series of RR intervals. Moreover mean value and variance of this series are calculated. This instrument has been in clinical use in a nonacademic hospital for one year and has proven to be a useful aid in patient monitoring. Some suggestions for improvement are discussed.     

Smart wearable systems: Current status and future challenges

ObjectiveExtensive efforts have been made in both academia and industry in the research and development of smart wearable systems (SWS) for health monitoring (HM). Primarily influenced by skyrocketing healthcare costs and supported by recent technological advances in micro- and nanotechnologies, miniaturisation of sensors, and smart fabrics, the continuous advances in SWS will progressively change the landscape of healthcare by allowing individual management and continuous monitoring of a patient's health status. Consisting of various components and devices, ranging from sensors and actuators to multimedia devices, these systems support complex healthcare applications and enable low-cost wearable, non-invasive alternatives for continuous 24-h monitoring of health, activity, mobility, and mental status, both indoors and outdoors. Our objective has been to examine the current research in wearable to serve as references for researchers and provide perspectives for future research.MethodsHerein, we review the current research and development of and the challenges facing SWS for HM, focusing on multi-parameter physiological sensor systems and activity and mobility measurement system designs that reliably measure mobility or vital signs and integrate real-time decision support processing for disease prevention, symptom detection, and diagnosis. For this literature review, we have chosen specific selection criteria to include papers in which wearable systems or devices are covered.ResultsWe describe the state of the art in SWS and provide a survey of recent implementations of wearable health-care systems. We describe current issues, challenges, and prospects of SWS.ConclusionWe conclude by identifying the future challenges facing SWS for HM.     

危重监护与输液控制诊疗一体化系统一基于CAN总线的监护输液基站

目的：在重症监护患者的治疗过程中,病人病情复杂而多变,若不及时处理往往会危及到病人生命,根据病人病情变化来实时控制输液也显得越来越重要。传统的输液系统仅具备开环输液控制功能。无法根据病人的实时生理状况自动调节输液,需要医生手动操作。为此我们将生理参数监护和输液控制有机结合起来。提出“危重监护与输液控制诊疗一体化系统”,实现输液的闭环控制,提高ICU输液治疗质量。本文介绍该系统的基于CAN总线的监护输液基站。方法：监护输液基站系统由监护板卡、平板电脑、CAN通讯接Ll卡三部分组成。监护板卡负责采集病人的实时生理信息,平板电脑负责处理该信息并根据其变化控制输液参数,CAN通讯接口卡负责与输液设备进行通讯,将平板电脑的控制命令下传并接受输液设备的运行状态等反馈信息,从而实现简单闭环输液控制。此外,监护输液基站还可以通过wi-Fi无线局域网与中央服务器连接,实现基站与服务器的信息同步。结果：该系统不仅能协调多台输液设备同时工作。还可以根据病人的实时生理数据变化来完成简单闭环输液控制,与服务器同步的数据准确无误。结论：该系统将生理监护和输液治疗两部分有机结合,实现了输液的简单闭环控制,还具有稳定性高、抗干扰能力强等特点,给ICU医务工作者对工作提供了便利,同时也对重症患者的监护和治疗具有相当重要的意义。     

The think aloud method: a guide to user interface design

OBJECTIVES: Clinical use of computer systems has been hampered by their poorly designed user interfaces. The objective of this study was to design a user interface for a pediatric oncologists' computerized patient record with great consideration of their working behavior and of human computer interfacing principles so as to contribute to oncologists' efficiency and satisfaction in interaction with the system. METHODS: The think aloud method was used in combination with video recording to get a deep understanding of the way in which four pediatric oncologists searched through the paper-based patient record in preparing a patient visit. Protocol and video analyses was used to develop a cognitive task model reflecting pediatric oncologists' task behavior. This model was input for a prototype user interface, which was subsequently evaluated by eight other pediatric oncologists. RESULTS: The resulting computerized medical record system proved to meet pediatric oncologists' information needs and task behavior patterns. The design of the user interface minimized pediatric oncologists' work load and was highly efficient in supporting the pediatric oncologists in preparing their patient visits. The pediatric oncologists were very much satisfied with the computer system. CONCLUSIONS: It is argued that early involvement of cognitive engineering methods in the system design process may be of great help in designing systems that fully support health care professionals' work practices. The think aloud method, if applied under prescribed conditions, is a valuable information source of human task-behavior and as such a useful technique for requirements analysis in designing clinical computer systems.     

Blood pressure measurements taken by patients are similar to home and ambulatory blood pressure measurements

OBJECTIVE: To compare blood pressure measurements taken at home by physicians, nurses, and patients with office blood pressure measurement , ambulatory blood pressure monitoring and home blood pressure measurement. METHODS: A total of 44 patients seen by a home care program were studied. Protocol 1 a) blood pressure was measured by the patient, a physician and a nurse during a regular home visit (Home1); b) home blood pressure measurement was measured for 4 days (HBPM1); c) office blood pressure measurement was measured by a physician, a nurse, and the patient; and by 24-hour ambulatory blood pressure monitoring. Protocol 2 blood pressure was measured by the patient, a physician, and a nurse during a special home visit in the presence of a physician and a nurse only (Home2); and b) home blood pressure measurement was taken for the second time (HBPM2). Echocardiography, guided by a two-dimensional echocardiograph, was performed. RESULTS: Protocol 1: a) office blood pressure measurement and Home1 were significantly higher than ambulatory blood pressure monitoring, except for systolic and diastolic office blood pressure measurement taken by the patient or a family member, systolic blood pressure taken by a nurse, and diastolic blood pressure taken by a physician. b) ambulatory blood pressure monitoring and HBPM1 were similar. Protocol 2: a) HBPM2 and Home2 were similar. b) Home2 was significantly lower than Home1, except for diastolic blood pressure taken by a nurse or the patient. There were significant relationships between: a) diastolic blood pressure measured by the patient and the thickness of the interventricular septum, posterior wall, and left ventricular mass; and b) ambulatory and HBPM2 diastolic and systolic blood pressure taken by a physician (home2) and left ventricular mass. Therefore, the data indicate that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic values relative to "office measurement." CONCLUSION: This study showed that the measurement most similar to home blood pressure measurement and ambulatory blood pressure monitoring was blood pressure measured by the patient, and that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic value relative to "office measurements".     

基于TCP/IP协议的多床位远程监护系统的设计

目的：建立一个基于TCP/IP协议的多床位远程生理参数监护系统,对常年卧床的老龄患者进行生理参数的实时监测,为家庭、社区及基层医疗机构提供远程监护和及时的医疗救护。方法：在医用护理床上加入生理参数监护模块,床边配置平板电脑作为上位机和人机交互界面,上位机与监护模块之间通过RS232串口通信,构成独立的床边监护终端。利用网络交换设备将多个床边监护终端与中心监护基站相连结,分别开发客户端和服务器端程序,采用基于TCP/IP的客户端/服务端Socket网络通信协议实现生理参数数据传输与远程监护控制。并在中心监护基站上利用数据库同步技术,设计了可查询病史的电子病历。结果：各床边监护终端既可独立工作,又可接入网络,与中心监护基站建立起C/S模式的多参数生理监护局域网系统。结论：系统可以根据实际需要灵活配置,利用现有的电脑和网络设备就可以实现生理信息实时传输与远程控制,适应当前新的医学模式。不但可以实现疾病院前早期预防、早期诊断,同时可以有效降低医疗成本,提高医护人员工作效率。     

Preventing medical errors in point-of-care testing: security, validation, safeguards, and connectivity.

OBJECTIVES: o prevent medical errors, improve user performance, and enhance the quality, safety, and connectivity (bidirectional communication) of point-of-care testing. PARTICIPANTS: Group A included 37 multidisciplinary experts in point-of-care testing programs in critical care and other hospital disciplines. Group B included 175 professional point-of-care managers, specialists, clinicians, and researchers. The total number of participants equaled 212. EVIDENCE: This study followed a systems approach. Expert specifications for prevention of medical errors were incorporated into the designs of security, validation, performance, and emergency systems. Additional safeguards need to be implemented through instrument software options and point-of-care coordinators. Connectivity will be facilitated by standards that eliminate deficiencies in instrument communication and device compatibility. Assessment of control features on handheld, portable, and transportable point-of-care instruments shows that current error reduction features lag behind needs. CONCENSUS PROCESS: Step 1: United States national survey and collation of group A expert requirements for security, validation, and performance. Step 2: Design of parallel systems for these functions. Step 3: Written critique and improvement of the error-prevention systems during 4 successive presentations to group B participants over 9 months until system designs stabilized into final consensus form. CONCLUSIONS: The consensus process produced 6 conclusions for preventing medical errors in point-of-care testing: (1) adopt operator certification and validation in point-of-care testing programs; (2) implement security, validation, performance, and emergency systems on existing and new devices; (3) require flexible, user-defined error-prevention system options on instruments as a prerequisite to federal licensing of new diagnostic tests and devices; (4) integrate connectivity standards for bidirectional information exchange; (5) preserve fast therapeutic turnaround time of point-of-care test results; and (6) monitor invalid use, operator competence, quality compliance, and other performance improvement indices to reduce errors, thereby focusing on patient outcomes.(Arch Pathol Lab Med. 2001;1307-1315)     

Patient safety, potential adverse drug events, and medical device design: a human factors engineering approach

Adverse drug events are the single leading threat to patient safety. Human factors engineering has been repeatedly proposed, but largely untested, as the key to improving patient safety. The value of this approach was investigated in the context of a commercially available patient-controlled analgesia device that has been linked with several alleged patient injuries and deaths. Several reports have stated that errors in programming drug concentration were made during these adverse drug events. A simulation of the commercially available interface was compared experimentally with a simulated prototype of a new interface designed according to a human factors process. Professional nurses, averaging over 5 years of clinical experience with the commercially available interface and only minimal experience with the new interface, programmed both interfaces. The new interface eliminated drug concentration errors, whereas the simulated commercially available interface did not. Also, the new interface led to significantly fewer total errors and faster performance. These findings may have broad implications for the design, regulation, and procurement of biomedical devices, products, or systems that improve patient safety in clinical settings.     

Computers in imaging and health care: Now and in the future

Early picture archiving and communication systems (PACS) were characterized by the use of very expensive hardware devices, cumbersome display stations, duplication of database content, lack of interfaces to other clinical information systems, and immaturity in their understanding of the folder manager concepts and workflow reengineering. They were implemented historically at large academic medical centers by biomedical engineers and imaging informaticists. PACS were nonstandard, home-grown projects with mixed clinical acceptance. However, they clearly showed the great potential for PACS and filmless medical imaging. Filmless radiology is a reality today. The advent of efficient softcopy display of images provides a means for dealing with the ever-increasing number of studies and number of images per study. Computer power has increased, and archival storage cost has decreased to the extent that the economics of PACS is justifiable with respect to film. Network bandwidths have increased to allow large studies of many megabytes to arrive at display stations within seconds of examination completion. PACS vendors have recognized the need for efficient workflow and have built systems with intelligence in the management of patient data. Close integration with the hospital information system (HIS)-radiology information system (RIS) is critical for system functionality. Successful implementation of PACS requires integration or interoperation with hospital and radiology information systems. Besides the economic advantages, secure rapid access to all clinical information on patients, including imaging studies, anytime and anywhere, enhances the quality of patient care, although it is difficult to quantify. Medical image management systems are maturing, providing access outside of the radiology department to images and clinical information throughout the hospital or the enterprise via the Internet. Small and medium-sized community hospitals, private practices, and outpatient centers in rural areas will begin realizing the benefits of PACS already realized by the large tertiary care academic medical centers and research institutions. Hand-held devices and the Worldwide Web are going to change the way people communicate and do business. The impact on health care will be huge, including radiology. Computer-aided diagnosis, decision support tools, virtual imaging, and guidance systems will transform our practice as value-added applications utilizing the technologies pushed by PACS development efforts. Outcomes data and the electronic medical record (EMR) will drive our interactions with referring physicians and we expect the radiologist to become the informaticist, a new version of the medical management consultant.     

Input of treatment planning data via a video frame grabber

Video frame grabbers are powerful devices which perform rapid conversion of video images into digital format for subsequent computer processing. Recently, the cost of these devices has become competitive with sonic and magnetic digitizing tablets commonly used in radiation therapy treatment planning. Frame grabbers, plus all associated hardware/software can be interfaced to a variety of personal or microcomputers, and allow input of irregular treatment field and patient contour data into standard treatment planning systems. Such a system is described, which offers advantages of speed, accuracy, and resolution as compared to more conventional digitizing systems.     

A data base approach to laboratory computerization

The Regenstrief Clinical Laboratory System (RCLS) has been operational since 1975 at Wishard Memorial Hospital in Indianapolis, Indiana. The clinician support, use of a true data base management system, and the user interfaces distinguish this system from many commercially available laboratory systems. Physician reports include laboratory, clinical (e.g., physical examination), pharmacy, and radiology data in a single, compact flow sheet. The system can search patient medical records for conditions that may require corrective action and inform physicians of the reasons these actions should be considered. The RCLS data base and its flexible data retrieval capabilities provide a variety of effective technics for monitoring laboratory utilization. The site-specific modifications required to transport this system do not require reprogramming. Important laboratory support features include highly "user friendly" design, multiple specimen numbering sequences, large amounts of free text, reports that can be tailored by non-programmer personnel, CAP accounting statistics, online instrument interfaces, and extensive online instructional facilities.     

穿戴式生物传感系统的研究新进展

穿戴式生物传感系统是近年发展起来的一种新型生命参数动态监测系统。该系统通常由无线的小型传感器、手持单元和专家系统构成。其中,穿戴式生物传感器和数据分析处理部分是生物传感系统中的两大技术。其研究发展分基础和应用两方面。在未来的发展中,穿戴式生物传感器将与多学科相结合并向小型化、智能化方向发展。     

XML-based application interface services--a method to enhance integrability of disease specific systems

Disease specific systems usually offer excellent functionality for the management of the covered diseases. But the restriction to a certain disease often hampers their wide spread use since they are not optimised for clinical workflow. The Giessener Tumordokumentationssystem (GTDS) is a disease specific system that is not only designed for the use in tumour registries but also to support clinical care. In order to integrate it into hospital information systems, we implemented standard communication interfaces. However, interfaces are not satisfactory since they do not consider aspects of the normal workflow of a clinical user. Therefore, we developed a strategy that should ease the access to the system in the environment of existing systems. From the technical point of view, XML with its capabilities to represent even complex data in a rather simple way helped to implement this strategy. We use XML to communicate with API-like services and created a WWW environment to demonstrate the access to these services. Since HTML based access itself is a means to integrate systems, we intend to expand this environment to an appropriate region based means to improve the communication with registries. Another application using the services is the transfer of data between two registries with common patients.     

Decision support at home (DSatHOME) - system architectures and requirements

ABSTRACT: BACKGROUND: Demographic change with its consequences of an aging society and an increase in the demand for care in the home environment has triggered intensive research activities in sensor devices and smart home technologies. While many advanced technologies are already available, there is still a lack of decision support systems (DSS) for the interpretation of data generated in home environments. The aim of the research for this paper is to present the stateof- the-art in DSS for these data, to define characteristic properties of such systems, and to define the requirements for successful home care DSS implementations. METHODS: A literature review was performed along with the analysis of cross-references. Characteristic properties are proposed and requirements are derived from the available body of literature. RESULTS: 79 papers were identified and analyzed, of which 20 describe implementations of decision components. Most authors mention server-based decision support components, but only few papers provide details about the system architecture or the knowledge base. A list of requirements derived from the analysis is presented. Among the primary drawbacks of current systems are the missing integration of DSS in current health information system architectures including interfaces, the missing agreement among developers with regard to the formalization and customization of medical knowledge and a lack of intelligent algorithms to interpret data from multiple sources including clinical application systems. CONCLUSIONS: Future research needs to address these issues in order to provide useful information - and not only large amounts of data - for both the patient and the caregiver. Furthermore, there is a need for outcome studies allowing for identifying successful implementation concepts.     

Methotrexate in Rheumatoid Arthritis

When a patient taking methotrexate should have a liver biopsy to assess for liver damage is a difficult and critical question for rheumatologists. It is not cost effective nor medically necessary to perform biopsies on all patients after a specific dose of methotrexate has been reached, nor after they have been treated for a definite length of time. Clinicians should take into account a patient's possible pre-existing factors (hepatitis, diabetes, obesity, past and present alcohol consumption), concomitant medications, intercurrent illnesses and serial laboratory evaluations when assessing the need for a biopsy in an individual patient being treated with methotrexate.     

非DICOM设备标准化的实现技术

我国的现有医疗影像设备的接口种类繁杂,只是部分较先进的设备才具有标准数字接口.为了将这些设备接入PACS,需要将从现有设备中获取的图像转换为DICOM3 0格式,并赋予其DICOM标准中的某种角色,以利于实现PACS等网络的建设.本文提出了一种实现DICOM标准化的可行技术.