A comprehensive survey of wearable and wireless ECG monitoring systems for older adults

Wearable health monitoring is an emerging technology for continuous monitoring of vital signs including the electrocardiogram (ECG). This signal is widely adopted to diagnose and assess major health risks and chronic cardiac diseases. This paper focuses on reviewing wearable ECG monitoring systems in the form of wireless, mobile and remote technologies related to older adults. Furthermore, the efficiency, user acceptability, strategies and recommendations on improving current ECG monitoring systems with an overview of the design and modelling are presented. In this paper, over 120 ECG monitoring systems were reviewed and classified into smart wearable, wireless, mobile ECG monitoring systems with related signal processing algorithms. The results of the review suggest that most research in wearable ECG monitoring systems focus on the older adults and this technology has been adopted in aged care facilitates. Moreover, it is shown that how mobile telemedicine systems have evolved and how advances in wearable wireless textile-based systems could ensure better quality of healthcare delivery. The main drawbacks of deployed ECG monitoring systems including imposed limitations on patients, short battery life, lack of user acceptability and medical professional’s feedback, and lack of security and privacy of essential data have been also discussed.     

Online self-management interventions for chronically ill patients: Cognitive impairment and technology issues

IntroductionAs the fraction of the population with chronic diseases continues to grow, methods and/or technologies must be found to help the chronically ill to take more responsibility to self-manage their illnesses. Internet based and/or mobile support for disease self-management interventions have often proved effective, but patients with chronic illnesses may have co-occurring cognitive impairment, making it more difficult for them to cope with technologies. Many older patients are also not familiar with technologies or they may have cognitive disabilities or dementia that reduce their ability to self-manage their healthcare. On-line solutions to the needs of chronically ill patients must be investigated and acted upon with care in an integrated manner, since resources invested in these solutions will be lost if patients do not adopt and continue to use them successfully.ObjectivesTo review the capabilities of online and mobile support for self-management of chronic illnesses, and the impacts that age and disease-related issues have on these interventions, including cognitive impairment and lack of access or familiarity with Internet or mobile technologies.MethodsThis study includes a review of the co-occurrence of cognitive impairment with chronic diseases, and discusses how cognitive impairment, dyadic caregiver patient support, patient efficacy with technology, and smart home technologies can impact the effectiveness and sustainability of online support for disease self-management.ResultsDisease self-management interventions (SMIs) using online patient centered support can often enable patients to manage their own chronic illnesses. However, our findings show that cognitive impairment often co-occurs in patients with chronic disease. This, along with age-related increases in multiple chronic illnesses and lack of technology efficacy, can be obstacles to Internet and mobile support for chronic disease self-management.ConclusionPatients with chronic diseases may have greater than expected difficulties in using Internet and mobile technologies for disease self-management, often due to cognitive impairment or unfamiliarity with technology. Approaches to dealing with such barriers include suitable integration of solutions involving patient–caregiver dyads, better design of online applications, careful attention to technology adoption and sustainability, and smart home technologies.     

脑卒中患者及家庭照料者生活满意度及其影响因素研究

目的：通过对脑卒中患者及其主要家庭照料者生活满意度的评估，了解其生活质量及有关影响因素，为临床心理干预、提高患者及其照料者生活质量提供依据。方法：调查对象为８９名脑卒中患者、８９名照料者以及１７８名正常对照组，采用生活质量综合自评问卷（ＧＱＯＬＩ）作为生活质量评定工具，病人组在常规住院治疗一个月后进行评定。结果：脑卒中患者与照料者的主观生活满意度均显著差于对照者；患者及照料者主观生活满意度下降的原因主要与自身客观生活状态、对生活的期望值及家庭成员的生活满意度有关。结论：作者据此提出在加强躯体药物治疗的基础上，临床心理干预应设法降低受试过高的生活期望值，提高生活满意度，以达到更满意的疗效。     

Online resources for family caregivers of cognitively competent patients: A review of user-driven reputable health website content on caregiver communication with health professionals

ObjectiveMost patients want their family involved in consultations and decisions, however some family caregivers report feeling overwhelmed and unsure of their role. As caregivers are increasingly looking to medical websites for guidance, this study aimed to review reputable web-resources available to inform family caregivers on how to be involved in medical consultations and decisions.MethodsGoogle searches were performed using lay search strings, to imitate how a cancer caregiver may locate information. Relevant webpages were included if they were directed at caregivers and from a reputable health organisation. Qualitative content analyses were performed on the included webpages.Results22 webpages were included and 8 were directed at caregivers of cancer patients. Six key categories of information were identified: preparing for consultations, helping during consultations, advocating for the patient, decision-making, communicating in hospital settings, and communicating with family and friends.ConclusionA range of online resources were found to guide family caregivers, particularly cancer caregivers, on involvement in consultations. However, few provided information to caregivers on complex situations such as treatment decision-making, advocating for patient’s needs, and communicating in a hospital setting.Practice implicationsClinicians can actively refer family caregivers to online resources that support caregiver communication in medical settings.     

Telecommunications technology as an aid to family caregivers of persons with dementia

OBJECTIVE: The aging of the population implies that an increased number of people are going to need some form of care or assistance. Caregiving poses a range of physical, emotional, and financial demands and often causes burden and stress for family members. This article describes how technology can be used to provide support to caregivers and increase the quality of life for both caregivers and care recipients. Preliminary data from an ongoing study of dementia caregivers is provided to demonstrate the feasibility of using technological interventions for this population. METHODS: The intervention involves a telecommunications system designed to augment a family therapy intervention by enhancing access to formal and informal support services. Specifically the system is intended to facilitate linkages between caregivers and other family members, friends, and other caregivers as well as to facilitate access to information on available resources. A total of 76 caregivers of dementia patients, including Cuban American and white American caregivers, received the telecommunications intervention. Data include real-time usage data and measures of usability at 6 months, 12 months, and 18 months after the initiation of the intervention. RESULTS: The data reported in this article are based on responses to the usability questionnaire at 6 months from a sample of 44 caregivers. Overall the results indicate that the system is easy to use and the caregivers find it valuable. The most common reason that the caregivers use the system is to communicate with other caregivers, especially those who are not nearby. The caregivers, especially the Cuban Americans, reported that the system facilitated their ability to communicate with family members and their therapist. The caregivers also indicated that they found participation in the "online discussion" groups to be very valuable and also found the "online resource guide"useful. CONCLUSIONS: The results demonstrate how current information and communication technologies can be used to help caregivers meet the challenges of caregiving and improve the quality of life for caregivers. The potential benefit of this type of technology for health care providers is also discussed.     

A Systematic Review of Healthcare Applications for Smartphones

ABSTRACT: BACKGROUND: Advanced mobile communications and portable computation are now combined in handheld devices called "smartphones", which are also capable of running third-party software. The number of smartphone users is growing rapidly, including among healthcare professionals. The purpose of this study was to classify smartphone-based healthcare technologies as discussed in academic literature according to their functionalities, and summarize articles in each category. METHODS: In April 2011, MEDLINE was searched to identify articles that discussed the design, development, evaluation, or use of smartphone-based software for healthcare professionals, medical or nursing students, or patients. A total of 55 articles discussing 83 applications were selected for this study from 2,894 articles initially obtained from the MEDLINE searches. RESULTS: A total of 83 applications were documented: 57 applications for healthcare professionals focusing on disease diagnosis (21), drug reference (6), medical calculators (8), literature search (6), clinical communication (3), Hospital Information System (HIS) client applications (4), medical training (2) and general healthcare applications (7); 11 applications for medical or nursing students focusing on medical education; and 15 applications for patients focusing on disease management with chronic illness (6), ENT-related (4), fall-related (3), and two other conditions (2). The disease diagnosis, drug reference, and medical calculator applications were reported as most useful by healthcare professionals and medical or nursing students. CONCLUSIONS: Many medical applications for smartphones have been developed and widely used by health professionals and patients. The use of smartphones is getting more attention in healthcare day by day. Medical applications make smartphones useful tools in the practice of evidence-based medicine at the point of care, in addition to their use in mobile clinical communication. Also, smartphones can play a very important role in patient education, disease self-management, and remote monitoring of patients.     

The current status of home medical treatment and its development in the future

In this aging society, life-style diseases, chronic diseases, and disorders related to aging comprise a considerable share of the diseases treated medically. The importance of home treatment has consequently increased. Compared to patients treated in the hospital, those treated at home usually cannot receive sufficient treatment at present, and may impose a burden of care on family members. However, the cost of treatment at home including medical expenses is generally smaller than that in the hospital. In addition, treatment at home has the advantage that patients can be treated and cared for without reservation by their family members in the dwelling where they have used to living their lives. In Japan, home treatment has been performed by general practitioners making home visits. In response to the increased and diversified needs of community residents, new types of home treatment have also been explored recently, and even clinics specialized in home treatment have been opened. Not only medical doctors but also various medical workers, such as nurses, pharmacists, and physical therapists participate in home treatment at present, and medical instruments and methods of telecommunication have been developed. These circumstances are expected to improve the quality of medical treatment at home. In particular, recent advances in techniques and deregulation have exceeded previous expectations as exemplified by the increased number of downsized mobile and portable medical instruments and by the development of devices that allow diagnostic imaging to be performed at home.     

无线网络和移动设备在医院信息系统中的应用

本文主要介绍了无线网络和移动设备在远程医疗、医生查房、临床护理方面所具备的独特优势。无线网络和移动设备的使用,可以提高医护人员的工作效率,降低工作成本,避免了重复工作或错误的发生。该新型医疗技术充分发挥医院信息系统的效能,有效提高了医疗质量、服务质量和运营效率,从而提高医院的综合竞争力。     

Palliative medicine--linkage of expert human care for the terminally ill and medical ethics

Palliative medicine is a new branch of medicine dealing with optimal quality of life and death, and is primarily a medical area of interest. Palliative care is a care provided by interdisciplinary palliative team. Let us remember that palliative care is a specific form of medical care for patients in the terminal phase of life. It is an approach to improve the quality of life of patients faced with fatal diseases, and of their families. Palliative care starts when classic methods of treatment have been exhausted, or when the symptoms of a malignant disease reach a level that the patient can hardly endure. It encompasses three areas: alleviating the symptoms, giving psycho-sociological support to patients and their caregivers, and dealing with ethical problems concerning the end of life. Particularly important is the ethics of palliative care, because it is focused on the aspects of care aimed at the patient and critical decision-making. The decisions made in palliative medicine require moral, legal and medical judgments. At the same time, one must strike a balance between clinical aspects of care and the patient's autonomy regarding his wishes, beliefs, and finally decisions about his own medical treatment. Ethical aspects of decision-making cannot be separated from clinical circumstances in the individual case, in the same way as medical decision-making cannot neglect the four (bio)ethical principles: beneficence, non-maleficence, autonomy of the person, and justice.     

我国宫颈癌患者配偶生活质量评价的研究现状

随着肿瘤治疗从单纯的“生物学”模式向“生物-心理-社会学”模式转变,治疗的目的已不仅是单纯的延长患者生存时限,如何在保证患者生存的同时提高其生活质量已变得同样重要。国内已有大量针对宫颈癌患者的生活质量的研究,同时,其照顾者的生活质量也开始得到多方面的关注,世界卫生组织将家庭照顾者及其需求定义为舒缓护理中的主要客观因素之一,美国及欧洲各国对患者照顾者的生活质量进行了广泛研究,而我国对宫颈癌患者配偶的生活质量研究相对较少、起步晚、发展慢。本文通过对我国宫颈癌患者其配偶生活质量评价的研究现状进行综述,研究其评价工具,探讨局限性,以期为临床护理干预提供指导,提高宫颈癌患者及配偶的生活质量。     

Emergency calls and need for emergency care in patients looked after by a palliative care team: Retrospective interview study with bereaved relatives

Background  

During the last stage of life, palliative care patients often experience episodes of respiratory distress, bleeding, pain or seizures. In such situations, caregivers may call emergency medical services leading to unwanted hospital admissions. The study aims to show the influence of our palliative care team to reducing emergency calls by cancer patients or their relatives during the last six month of life.     

A research agenda for ageing in China in the 21st century (2nd edition): Focusing on basic and translational research,long-term care,policy and social networks

One of the key issues facing public healthcare is the global trend of an increasingly ageing society which continues to present policy makers and caregivers with formidable healthcare and socio-economic challenges. Ageing is the primary contributor to a broad spectrum of chronic disorders all associated with a lower quality of life in the elderly. In 2019, the Chinese population constituted 18 % of the world population, with 164.5 million Chinese citizens aged 65 and above (65+), and 26 million aged 80 or above (80+). China has become an ageing society, and as it continues to age it will continue to exacerbate the burden borne by current family and public healthcare systems. Major healthcare challenges involved with caring for the elderly in China include the management of chronic non-communicable diseases (CNCDs), physical frailty, neurodegenerative diseases, cardiovascular diseases, with emerging challenges such as providing sufficient dental care, combating the rising prevalence of sexually transmitted diseases among nursing home communities, providing support for increased incidences of immune diseases, and the growing necessity to provide palliative care for the elderly. At the governmental level, it is necessary to make long-term strategic plans to respond to the pressures of an ageing society, especially to establish a nationwide, affordable, annual health check system to facilitate early diagnosis and provide access to affordable treatments. China has begun work on several activities to address these issues including the recent completion of the of the Ten-year Health-Care Reform project, the implementation of the Healthy China 2030 Action Plan, and the opening of the National Clinical Research Center for Geriatric Disorders. There are also societal challenges, namely the shift from an extended family system in which the younger provide home care for their elderly family members, to the current trend in which young people are increasingly migrating towards major cities for work, increasing reliance on nursing homes to compensate, especially following the outcomes of the ‘one child policy’ and the ‘empty-nest elderly’ phenomenon. At the individual level, it is important to provide avenues for people to seek and improve their own knowledge of health and disease, to encourage them to seek medical check-ups to prevent/manage illness, and to find ways to promote modifiable health-related behaviors (social activity, exercise, healthy diets, reasonable diet supplements) to enable healthier, happier, longer, and more productive lives in the elderly. Finally, at the technological or treatment level, there is a focus on modern technologies to counteract the negative effects of ageing. Researchers are striving to produce drugs that can mimic the effects of ‘exercising more, eating less’, while other anti-ageing molecules from molecular gerontologists could help to improve ‘healthspan’ in the elderly. Machine learning, ‘Big Data’, and other novel technologies can also be used to monitor disease patterns at the population level and may be used to inform policy design in the future. Collectively, synergies across disciplines on policies, geriatric care, drug development, personal awareness, the use of big data, machine learning and personalized medicine will transform China into a country that enables the most for its elderly, maximizing and celebrating their longevity in the coming decades. This is the 2nd edition of the review paper (Fang EF et al., Ageing Re. Rev. 2015).     

基于“互联网+”的移动医疗技术在慢性阻塞性肺病稳定期管理的应用及问题研究

随着互联网的发展,移动医疗技术也越来越成熟,在慢性阻塞性肺病稳定期管理的应用方面取得较大进展。通过该技术对于稳定期慢阻肺患者线上复诊、调整治疗等提供了方便,从而使患者提高对于自身疾病认识,持续监测自身健康,提高治疗疾病的依从性。本文综述了移动医疗技术在稳定期慢阻肺的应用现状,并对互联网移动医疗技术应用的局限性及发展方向进行探讨。     

Regulatory science of new technology: tendency of medical professionals’ interests on silicone breast implants

New technology related to artificial organs is most attractive for worldwide researchers. We believe they must contribute for the future patients against untreatable diseases. Regulatory science is a new science to establish ‘social acceptance’ of new technology into the clinical market as soon as possible. In the history of silicone breast implants, we could recognize risks many times; however, we missed such chances to prevent a subsequent crisis. We analyzed the trend of published literature related to silicone breast implants to review the medical professionals’ interests on such risks. This trend showed, despite issues of a social acceptance of silicone breast implants in a few countries, other countries’ medical professionals had no interest. Our hypothesis is ‘medical professionals face the government and do not have contributed to re-establish the social acceptance of new technologies for patients’. Any technology does not have the complete evidence of safety, efficacy and quality, despite regulatory authorities’ review and approval with clinical evidences. medical professionals need to conduct subsequently the epidemiological study, to take a meta-analysis periodically and to create/update the guidance for their patients under their professional ethics after the marketing of new technologies. We need to take seriously the ‘lesson learned’ from the history of silicone breast implants for all kind of new technologies existed in the present.     

Integrating diabetes self-management with the health goals of older adults: a qualitative exploration

OBJECTIVE: This study investigates the life and health goals of older adults with diabetes, and explores the factors that influence their diabetes self-management. METHODS: Qualitative in-depth interviews were conducted with 24 older adults with diabetes and other morbid conditions and/or their caregivers, when appropriate. RESULTS: Participants' provided a consistent set of responses when describing life and health goals. Participants described goals for longevity, better physical functioning, spending time with family, or maintaining independence. Diabetes discordant conditions, but not diabetes, were seen as barriers to life goals for participants with functional impairments. Functionally independent participants described additional health goals that related to diabetes self-management as diabetes was seen often a barrier to life goals. Caregivers, co-morbid conditions, denial and retirement were among the factors that influenced initiation of diabetes self-management. CONCLUSION: Participants endorsed health goals and diabetes self-management practices that they believed would help them accomplish their life goals. Functional capabilities and social support were key factors in the relationship between diabetes self-management and their broader goals. PRACTICE IMPLICATIONS: When planning diabetes treatments, clinicians, patients and caregivers should discuss the relationship between diabetes self-management and health and life goals as well as the affects of functional limitations and caregiver support.     

SARS and population health technology

The recent global outbreak of SARS (severe acute respiratory syndrome) provides an opportunity to study the use and impact of public health informatics and population health technology to detect and fight a global epidemic. Population health technology is the umbrella term for technology applications that have a population focus and the potential to improve public health. This includes the Internet, but also other technologies such as wireless devices, mobile phones, smart appliances, or smart homes. In the context of an outbreak or bioterrorism attack, such technologies may help to gather intelligence and detect diseases early, and communicate and exchange information electronically worldwide. Some of the technologies brought forward during the SARS epidemic may have been primarily motivated by marketing efforts, or were more directed towards reassuring people that "something is being done," ie, fighting an "epidemic of fear." To understand "fear epidemiology" is important because early warning systems monitoring data from a large number of people may not be able to discriminate between a biological epidemic and an epidemic of fear. The need for critical evaluation of all of these technologies is stressed.     

长沙市唐氏综合征患者经济负担及女性照护者心理与社会歧视评估

目的:对长沙市的唐氏综合征(Down syndrome,DS)疾病负担进行估算,从女性角度对DS患者主要照护者的心理负担及受社会歧视程度进行评估。方法:2020年3月,对居住在长沙地区且志愿参与的DS患者家庭进行深度访谈及问卷调查。DS的经济负担测算包括直接成本、间接成本和福利保障性收入。使用斯坦福心理幸福感(Psyc...     

A systematic review of interventions for family caregivers who care for patients with advanced cancer at home

ObjectiveTo examine the characteristics of interventions to support family caregivers of patients with advanced cancer.MethodsFive databases (CINAHL, Medline, PsycINFO, Web of Science, and the Cochrane Library) were searched for English language articles of intervention studies utilizing randomized controlled trials or quasi-experimental designs, reporting caregiver-related outcomes of interventions for family caregivers caring for patients with advanced cancer at home.ResultsA total of 11 studies met the inclusion criteria. Based on these studies, the types of interventions were categorized into psychosocial, educational, or both. The characteristics of interventions varied. Most interventions demonstrated statistically significant results of reducing psychological distress and caregiving burden and improving quality of life, self-efficacy, and competence for caregiving. However, there was inconsistency in the use of measures.ConclusionsMost studies showed positive effects of the interventions on caregiver-specific outcomes, yet direct comparisons of the effectiveness were limited. There is a lack of research aimed to support family caregivers’ physical health.Practice implicationsGiven caregivers’ needs to maintain their wellbeing and the positive effects of support for them, research examining long-term efficacy of interventions and measuring objective health outcomes with rigorous quality of studies is still needed for better outcomes for family caregivers of patients with advanced cancer.     

Applications of Light Emitting Diodes in Health Care

Light emitting diodes (LEDs) have become the main light sources for general lighting, due to their high lumen efficiency and long life time. Moreover, their high bandwidth and the availability of diverse wavelength contents ranging from ultraviolet to infrared empower them with great controllability in tuning brightness, pulse durations and spectra. These parameters are the essential ingredients of the applications in medical imaging and therapies. Despite the fast advances in both LED technologies and their applications, few reviews have been seen to link the controllable emission properties of LEDs to these applications. The objective of this paper is to bridge this gap by reviewing the main control techniques of LEDs that enable creating enhanced lighting patterns for imaging and generating effective photon doses for photobiomodulation. This paper also provides the basic mechanisms behind the effective LED therapies in treating cutaneous and neurological diseases. The emerging field of optogenetics is also discussed with a focus on the application of LEDs. The multidisciplinary topics reviewed in this paper can help the researchers in LEDs, imaging, light therapy and optogenetics better understand the basic principles in each other’s field; and hence to stimulate the application of LEDs in health care.     

癫(癎)患者服药依从性的影响因素分析

目的：分析癫痫患者服药依从性及其影响因素，探讨提高服药依从性的对策。方法：利用癫痫患者服药依从性调查问卷对确诊为癫痫的246例患者进行调查，以服药依从性好坏分成两组，比较其间各因素的差异，并对服药依从性的影响因素进行Logistic回归分析。结果：246例患者中依从性好组64例，占26％，依从性差组182例，占74％。两组在家庭经济状况、医疗费用支付方式、家长有无癫痫知识、总病程、服药种类、药物不良反应、社会支持之间比较差异存在显著意义（P〈0．05），在性别、年龄、职业、文化程度、生活事件、家族史、癫痫种类方面差异则无显著意义（P〉0．05）。Logistic回归分析结果，在a=0．05水平上进入回归方程的因素依次为家长有无癫痫知识、药物不良反应、医疗费用支付方式、家庭经济状况和社会支持。结论：癫痫患者服药依从性较差，受多种因素影响，应采取综合措施提高患者服药依从性，从而改善患者疗效和预后。