ABSTRACT
BACKGROUND AND AIMS: The number of patients requiring home dialysis in Japan is increasing due to COVID-19 and the aging of the population. Home haemodialysis has been performed in Japan since the 1960s. However, as of March 2019, there were 720 home haemodialysis patients in Japan, which is only 0.2% of the total number of dialysis patients. The possible causes are as follows. The number of home haemodialysis patients has not increased markedly due to safety concerns as home haemodialysis patients perform dialysis at home, and the out-ofpocket costs are high. In addition, patients and caregivers must be able to manage themselves, and the burden on both patients and caregivers is heavy. Therefore, the Ministry of Health, Labour and Welfare (Japan) has advocated the need for home patients to share information with medical institutions to improve their quality of life, including COVID-19 measures. We have built a system to support home dialysis patients. Here, we have added an exercise therapy function to this system to encourage patients to continue exercising. METHOD: The items recorded/displayed in the patient's home peritoneal dialysis support system included records such as time, blood pressure, blood glucose level, urine volume, meal content, replacement start time, dialysate/plasma ratio, drainage volume, injection volume, water content and water removal and drainage. These inputs were entered via drop-down menus and displayed visually in graphs or by uploading images. The medical staff could see photographs of the affected areas and of meals entered by the patient. Patients could also share their opinions and treatment schedules with the medical staff at the medical institution. In addition, when exercising, the patients used an ergometer that allowed them to sit or lie down. The developed system incorporates records of the patient's exercises. Data were captured directly from the ergometer into the developed system in CSV format and could also be entered manually via drop-down menus. RESULTS: Using the developed system, we were able to enter and view patients' vital data and display photographs showing the color and volume of the drainage pack. By viewing these photographs, the medical staff could confirm the photographs of the affected areas, the color of the packs and the contents of the patients' meals. In addition, displaying the patient's vital records in a graph allowed for visual evaluation over time, which was useful when giving advice to patients. Using the two-way communication function, patients were also able to share their opinions and treatment schedules with the medical staff of the medical institution. Patients can now consult with medical staff, making their homes more like part of the hospital and giving them greater peace of mind. Figure 1 shows an example of the display of the developed system. Figure 2 shows an example of the patient's pedaling exercise results input from the ergometer. The amount of pedal movement performed by the patient was conserved through the dynamo and used to charge mobile devices. This allows the patient to charge their mobile devices while exercising, thus encouraging them to continue exercising. CONCLUSION: We have developed a support system for home haemodialysis patients that allows the input and display of patients' vital records and consultation with medical staff online. We have added a function to the system to encourage home haemodialysis patients to continue exercising. By using the developed system, patients can now perform home dialysis, including continuous exercise safely and with peace of mind, and healthcare professionals can access all medical information of patients, including changes over time. (Figure Presented).
ABSTRACT
BACKGROUND AND AIMS: COVID-19 and the aging of the Japanese population are increasing the number of people requiring peritoneal dialysis at home. However, the rate of computer system utilization among the elderly is low in Japan, and the Ministry of Health, Labour and Welfare (MHLW) of Japan is currently considering permission for telemedicine. Therefore, home care support systems for home peritoneal dialysis patients are not sufficient, and even if a patient desires home medical care it may not be possible. The MHLW emphasized the need for home care patients to share information with medical institutions and improve quality of life (QOL), including COVID-19 measures. Therefore, we have built a system that allows home-based peritoneal dialysis patients and medical institutions to share medical information and provide home-based care with peace of mind. Here, we also discuss evaluation of the developed system. METHOD: A system for sharing medical information was developed in the PHP programming language on a personal computer system using Microsoft Azure cloud services, including databases and a social networking service (SNS). In the developed system, medical information, affected area, and photographs of meal contents for each patient can be uploaded and visually confirmed. The patient's vital records can also be visually confirmed on a graph. In addition, it is possible for patients to share opinions and treatment schedules with the medical staff of medical institutions. The developed system was evaluated by 12 simulated patients consisting of one woman and four men in their 20s, two men in their 30s, one woman and one man in their 40s, and one woman and two men in their 50s. The evaluation items were task achievement and Web usability evaluation scale (WUS). The characteristics of each age group were analyzed according to the WUS. The medical information in this system was shared using SNS, which could only be accessed by invitation. RESULTS: The information exchange system allowed the medical staff at the institute to receive and respond to the opinions of patients. In addition, medical staff were able to share important patient data. Figure 1 shows an example of the developed system displayed on the patient side (a) and on the medical staff side (b) at the institute. The patient filled in each item and uploaded photographs if necessary. The medical staff at the institute were able to view the medical information and uploaded photographs of each patient. One subject required a manual to operate the system, but the task completion rate was 100%. The system developed in this study could also be used by patients in age groups unfamiliar with personal computers. With the continued adoption of Internet access, the developed system built using a web application framework has been well received by patients. The WUS evaluation results are shown in Fig. 2. Subjects in their 20s showed the greatest increase in overall judgment of 4.0 in the 5-point WUS. The item showing differences between age groups was 'display.' The standard deviation of 'useful' was small, about 3.5 for all age groups. Using the system a second time was easier for the users than the first time. In addition, clinical evaluations showed that use of this system allowed home-based patients to be treated in the same way as those in hospital. CONCLUSION: When using the system developed in this study, there was no relationship between age group and task achievement. The overall result of the 5-point WUS was very high (4.0). The system developed here can be recommended for use by home patients. The patient was able to receive almost the same treatment as in the hospital while at home. As a result, the system developed here can be used for treatment of peritoneal dialysis patients at home.
ABSTRACT
BACKGROUND AND AIMS: As it is necessary to refrain from going out due to the COVID-19 pandemic, a system that allows dialysis patients to be treated at a remote location or at home, i.e., a home care support system, is required. Information and communications technology (ICT) used for these purposes is widely applied in various medical fields. Using ICT has the advantage of allowing the sharing of patients' electronic patient records (EPR) among medical staff, but increases the risk of copyright infringement and privacy leaks during archiving and transmission. We have developed a home care support system for peritoneal dialysis patients using information hiding technology consisting of both digital watermarking technology for copyright protection and steganography technology for communication security when treating patients at home using ICT. In addition, we evaluated the developed system. METHOD: The system for sharing medical information was developed in the PHP programming language on a personal computer system using Microsoft Azure cloud services. Figure 1 shows an explanation of the digital watermarking technology and steganography technology used in the developed system. 1. Digital watermarking technology The patient's data, such as EPR data, facility name, etc., were hidden in the region of non-interest (RONI) of the patient's chest CT image series and stored in a database. 2. Steganography technology We call scene photos 'cover pictures.' Medical information (CT images, etc.) was hidden in the cover picture. In this study, the cover picture containing the medical information was designated as a Stego image. A body CT image series (16-bit, 512×512, 100 slices) was used to verify the steganography technique. These CT images were compressed using 7-Zip and then saved in a folder, which was then embedded in the cover photo. The Stego image was then sent from the patient's home to the medical institution via the home care support system. RESULTS: We investigated the hash value, peak signal-to-noise ratio (PSNR), and structural similarity (SSIM) of the image series (Fig. 2). If the structure of the image or photograph was exactly the same, the SSIMshows a value of 1. If the PSNR is ≥40 dB, the image quality can be maintained without affecting diagnosis. If part of the ROI is changed during transmission, the hash value decoded from the received Stego image will be different from that before transmission. For Stego images containing watermarked or hidden CT images with 4000 words embedded, SSIM and PSNR were ≥0.99 dB and 65.3 dB, respectively. If the medical information was embedded in a low bit plane, such as a 1-bit or 2-bit plane, the radiologist could not identify the embedded information. When our technology was applied, there were no changes in the capacity of CT images or Stego images before and after embedding. Therefore, it was not possible to tell that medical information was embedded due to changes in capacity. CONCLUSION: Using ICT, we have built a home care support system that can conceal medical information by combining digital watermarking technology and steganography technology to ensure the copyright of images and to ensure privacy and secure transmission of EPR and CT images. Using the developed system, daily medical information of dialysis patients could be transmitted safely to the institute, and the medical staff could share the information safely. Both techniques can be applied to all digital image information, and is not just limited to CT images.