Validation of the Algorithm for Bio-signal Data in Home-health Management Systems / 대한의료정보학회지

OBJECTIVE: The purpose of this study was to verify the algorithm on bio-signals for a home-health management system. METHODS: A methodological study was done to verify the blood pressure and blood sugar algorithm to deliver tailored patient information. The verifying process was as follows: Step 1; development of the algorithm through a literature review, Step 2; programming the algorithm using Microsoft SQL Server 2005 and Visual Studio 2005, Step 3; Reviewing of the algorithm by examining results from the home-health management system and experts' evaluation Step 4; evaluating the agreement of the algorithm by comparison between results from the home-health management system and intended results using bio-signal data set, and completion of the algorithm. RESULTS: Discordance rate between results from the home-health management system and intended results for blood pressure and blood sugar were 5.72% and 2.04%, respectively. Also, discordance rate between results from the home-health management system and experts' evaluation of blood pressure and blood sugar were 30.38% and 20.41%, respectively. All discordance were revised until all the researchers reached agreement. CONCLUSION: The home-health management system with an accurate algorithm on bio-signals can contribute to promote clients' health and reduce the cost of medical services.

A New Communication Device Using the Anal Sphincter

OBJECTIVE: The purpose of this study was to invent a new communication device by utilizing the function of anal sphincter muscles that was another residual motor function to the last in amyotrophic lateral sclerosis (ALS) patients. METHOD: We designed a sensor which worked by changing intensity of the contraction and was enable severely paralyzed patients to communicate by means of self-regulation of the anal sphincter contraction. This device made sentences through combination of selected Korean letters deprived from sphincter contractions. RESULTS: This device was composed of three parts. Anal sensor: the head part of the sensor regulated by sphincters was located in the rectum, signal processing module: the raw signal from the sensor was boosted up and set up on the baseline voltage equal to threshold by threshold detector, and device program: the icon mode which was composed of routine questions and requested to their care-givers. And in user-writing mode, patients could choose syllable elements using the sensor operating by sphincter. CONCLUSION: This system was designed for advanced ALS patients with only the available function of sphincter muscles and could give them another new option in selecting communication devices.

Needs Assesment of Potential Users for Tele-health Surveillance System / 대한의료정보학회지

OBJECTIVE: This study was undertaken to assess the potential users' needs for a tele-health surveillance system and to develop a program that reflects the clients' needs. METHODS: A descriptive study was conducted using interviews with a questionnaire during home visitations. Four hundred subjects from residences two affluent areas of Korea were selected by convenience sampling. RESULTS: Through the tele-health surveillance system, they wanted to manage diseases such as heart disease(23.0%), cancers(20.5%) and endocrine diseases(17.5%). The highest score for areas of the tele-health surveillance system was cancer screening. The most highly preferred reporting system was immediate reporting of the screening results by a personal digital assistant with a tailored health management system that reflects their own bio-signals. CONCLUSION: Potential users want to manage their health in disease prevention and health promotion as well as treating diseases. These aspects should be considered in the development and utilization of a tele-health surveillance system.

Wireless Ausculate Educational System / 대한의료정보학회지

This research is about embodiment of system to support auscultation education more effectively. Cardiac sound data that is stored to PC made many learner deliver by wireless system. For this system we developed a special radio transmitter receiver and a program to manage and remake data. Because of selecting radio system, there is no limitation of establishment and education place. also through web server database and update of data are available. For this reason we can add cardiac sound data newly in education. In case of utilizing existent electron stethoscope in auscultation education, the biggest demerit is that do not deliver sense of sound of actuality stethoscope properly. But radio receiving apparatus that we developed is no difference with sense of sound of cardiac through actuality stethoscope and did so that heighten effect of auscultation education.

Wireless Ausculate Educational System / 대한의료정보학회지

This research is about embodiment of system to support auscultation education more effectively. Cardiac sound data that is stored to PC made many learner deliver by wireless system. For this system we developed a special radio transmitter receiver and a program to manage and remake data. Because of selecting radio system, there is no limitation of establishment and education place. also through web server database and update of data are available. For this reason we can add cardiac sound data newly in education. In case of utilizing existent electron stethoscope in auscultation education, the biggest demerit is that do not deliver sense of sound of actuality stethoscope properly. But radio receiving apparatus that we developed is no difference with sense of sound of cardiac through actuality stethoscope and did so that heighten effect of auscultation education.

The Heart Sound Data Analysis, Management System using the Wireless Stethoscope / 대한의료정보학회지

This paper is about the system using a wireless stethoscope to analysis the FFT and the time-frequency for a heart sound and to manage the collected data for a web-based system. We reformed a wireless stethoscope, connected to PC interface and added the analysis function. In result, we combined merits of an existed wireless system to be convenient for measuring the heart sound and to be available for many listener to ausculate the heart sound simultaneously, and an existed wired system to supply the various analysis functions. The heart sounds data was made into the database to search or refer to the patient data. It is possible to search and refer by the web-browser to the recorded heart sound file, the analyzed file by FFT and the STFT time-frequency method.

Development of Integrated ECG Management System based Web with CORBA / 대한의료정보학회지

In these days, computing environment turns to web environment and a lot of hospitals build information system. A medical services through the web provide patients and doctors with convenience and help experts to communicate with each other. Initially, web provided static text information, but nowadays needs of interactivity between client and server is increasing. In order to diagnose heart diseases, we use 12 channel ECG, stress ECG, holter ECG, etc. These data are a lot of correlation with each other but there are little system managed them with integration. To enhance management efficiency and share medical information, it is necessary to develop integrated ECG management system based the web. In this paper, we use common object request broker architecture(CQRBA) to implement the system. The CORBA is to apply object oriented concept to web. We can implement application easily and reduce costs to maintain and repay because server objects and client objects exist independently. We developed a System to integrate these data using network and to raise management efficiency. we focus on the performance of object web and the implementation of ECG management system based on the web.

The Patient Monitoring Information ARS. Call System / 대한의료정보학회지

This study is to develop a system which offers the auto-response and the auto-call about the patient monitoring information of the heart rate, NIBP, SpO2 and overall status from a patient monitor to registered users. After detecting a dial tone by a developed ARS and confirming a registered user, this system offers the information of a required patient by ARS voice. If a user registered to an auto-calling service, this system can offer a patient monitoring information automatically and periodically for a user' s setting to a user' s hand-phone or beeper by the voice or the number. Additionally, when the patient' s emergency situation to happen, this system calls the emergency state to an registered user' s hand-phone or beeper by the voice or the number. All of the information of patient monitoring is managed by the SQL database system for easy to the data extraction and the service of the statistical information effectively.

Analysis of the Left Ventricular Contractile Reserve Using End-systolic Pressure-Volume Relation (ESPVR) in Idiopathic Dilated Cardiomyopathy: Its Correlation with Pathologic Findings

BACKGROUND: Left ventricular (LV) end-systolic pressure volume relation (ESPVR) is considered as a load independent contractile index. However, its application in human beings has been limited by the difficulty in the accurate real time measurement of the LV volume changes. With introduction of the echocardiographic automatated edge detection method, on-line generation of multiple LV pressure volume-loops has become possible to assess ESPVR. This study was performed to investigate the correlation of the degree of myocardial damages with myocardial contractility and contractile reserve assessed by ESPVR as a surrogate of contractility index. METHODS: Studies were attempted in ten patients with idiopathic dilated cardiomyopathy. Baseline two-dimensional and Doppler echocardiography, cardiac catheterization for hemodynamic assessment and endomyocardial biopsy were performed. Generation of multiple LV pressure-volume loops during occlusion and release of the inferior vena cava by a balloon catheter was performed using the volume signals from the echocardiographic automatated edge detection method and the pressure signals from a 5F fluid-filled lumen catheter. ESPVR was measured at the baseline and after 3 minutes of dobutamin infusion (10 microgram/Kg/min). RESULTS: No correlation was observed between the degree of myocyte hypertrophy change or interstitial fibrosis and the two-dimensional echocardiographic or hemodynamic data. However, restrictive LV filling pattern was more common in the patients with severe degree of myocyte hypertrophy change. Myocardial contractility and contractile reserve were also significantly reduced in this patient group. The degree of interstitial fibrosis did not affect myocardial contractility or contractile reserve in this particular patient group. CONCLUSION: Assessment of ESPVR using the echocardiographic automatated edge detection method was feasible in the patients with idiopathic dilated cardiomyopathy. The degree of myocardial hypertrophy change was prominent in the patients with reduced contractility and contractile reserve.

Assessment of Left Atrial Function Using Instantaneous Pressure-Volume Relations in Mitral Stenosis before and after Percutaneous Mitral Balloon Valvuloplasty

BACKGROUND: The left atrium functions as a reservoir for blood stored during ventricular systole, a conduit for pulmonary venous flow during ventricular diastole, and as a pump augmenting left ventricular filling during atrial systole. Cardiac angiography and Doppler echocardiography have been used in the assessment of atrial function. These measurements are, however, quite sensitive to ventricular and atrial loading conditions. Instantaneous pressure-volume relations of the left atrium have been described by a time-varying elastance model in the isolated left atrium and intact circulation in animal models. The mitral stenosis can be characterized hemodynamically as increased afterload of the left atrium. Percutaneous mitral balloon valvuloplasty, which results in a dramatic increase in the mitral orifice area in patients with mitral stenosis, is a well-suited clinical model for physiological assessment of the left atrial function in response to acute change of the left atrial afterload. The purpose of this study was 1) to evaluate the feasibility of the left atrial pressure-volume loop using automatic boundary detection method, 2) to obtain the left atrial pressure-volume loop in patients with mitral stenosis and to compare with that of normal controls, and 3) to assess the changes of the left atrial wall tesion and stroke work after percutaneous mitral balloon valvuloplasty in patients with mitral stenosis using the left atrial pressure-volume relations. METHODS: Twelve patients had simultaneous measurements of left atrial pressure and left atrial volume using trasseptal catheterization and two-dimensional echocardiography with automatic boundary detection technology. The left atrial pressure-volume was constructed by a computer workstation interfaced with an ultrasound system. Left atrial volumetric parameters, areas of A and V loops, and peak wall tension were measured and compared before and after percutaneous mitral balloon valvuloplasty. RESULTS: 1) The left atrial pressure-volume loop could be obtained without complications in the control group as well as in patients with mitral stenosis. 2) The left atrial peak wall tension and A and V loop areas were significantly increased in mitral stenosis compared to the control group. 3) Left atrial maximal volume, minimal volume and volume before active atrial contraction were significantly increased in mitral stenosis compared to control group. 4) Left atrial ejection fraction and left atrial active emptying fraction were significantly reduced in mitral stenosis. Left atrial passive emptying fraction was slightly reduced in mitral stenosis compared to control group without statistical significance. 5) Left atrial peak wall tension and A loop area were significantly reduced after percutaneous mitral balloon valvuloplasty. 6) There were no significant changes in left atrial maximal volume, minimal volume, volume before active atrial contraction, total volume change, passive emptying volume, active emptying volume, passive emptying fraction, active emptying fraction, V loop area and left atrial ejection fraction after percutaneous mitral balloon valvuloplasty. CONCLUSION: The left atrial stroke work and peak wall tension can be assessed quantitatively using left atrial pressure-volume relations in patients with mitral stenosis and those are significantly reduced after percutaneous mitral balloon valvuloplasty. The analysis of left atrial pressure-volume loop is a potentially useful means in the assessment of left atrial function.