Positive end-expiratory pressure and surfactant administration mode influence function in ex-vivo premature sheep lungs.

AIM: Respiratory distress syndrome often necessitates endotracheal surfactant administration in extremely preterm infants. Our study aimed to explore a multi-modal simulation tool for investigating treatment strategies in ex vivo sheep lungs during spontaneous breathing. METHODS: An electromechanical lung simulator (xPULM) mimicking spontaneous breathing was coupled with a non-aerated premature sheep lung, replicating a premature respiratory system. Changes in tidal volume for different positive end-expiratory pressure (PEEP) levels prior to and after either bolus or nebulised surfactant administration were compared. RESULTS: In two preterm sheep lungs, we observed a progressive decline in tidal volume with increasing PEEP levels prior to surfactant delivery from 0.30 ± 0.01 mL at zero PEEP to 0.04 ± 0.01 mL at 15 cmH2O PEEP. Our measurements showed that both bolus (p < 0.05) and nebulised (p < 0.05) surfactant administration resulted in a significant increase in tidal volume, with no significant difference (p = 0.71) between the two methods. CONCLUSION: The experimental setup demonstrated the feasibility of xPULM for investigating the effectiveness of different PEEP levels and modes of surfactant administration with respect to tidal volume in premature sheep lungs. The lack of adequate lung water resorption in our model warrants further investigations.

Extended Reality Solutions in Medical Context and Educational Approaches.

The healthcare sector is growing in importance as people continue to age and pandemics complicate the boundary conditions of such systems. The number of innovative approaches to solve singular tasks and problems in this area is only slowly increasing. This is particularly evident when looking at medical technology planning, medical training and process simulation. In this paper a concept for versatile digital improvements to these problems by using state of the art development methods of Virtual Reality (VR) and Augmented Reality (AR) are presented. The programming and design of the software is done with the help of Unity Engine, which provides an open interface for docking with the developed framework for future work. The solutions were tested under domain specific environments and have shown good results and positive feedback.

Immersive Spatial Planning in Healthcare: Developing a Pipeline to Automatically Convert Computer Aided DesignData to Virtual Reality.

Equipping rooms used for medical purposes, like e.g., intensive care units, is an expensive and time-consuming task. In order to avoid extensive subsequent adjustments due to inappropriate layout visualization or geometric conditions difficult to identify in 2D plans, it is of utmost importance to provide an optimal planning environment to future users such as physicians and nurses. In this paper we present the concept of a fully automatized pipeline, which is designed to visualize computer aided design (CAD) data using virtual reality (VR). The immersive VR experience results in improvement of efficiency in the decision-making process during the planning phase due to better spatial imagination. The pipeline was successfully tested with CAD data from existing Intensive Care Units. The results indicate that the pipeline can be a valuable tool in the field of spatial planning in healthcare, due to simple usage and fast conversion of CAD data. The next step will be the development of a plugin for CAD tools to allow for interactions with the CAD models in Virtual Reality, which is not yet possible without manual intervention.

Experimental Evaluation of Dry Powder Inhalers during Inhalation and Exhalation Using a Model of the Human Respiratory System (xPULM™).

Dry powder inhalers are used by a large number of patients worldwide to treat respiratory diseases. The objective of this work is to experimentally investigate changes in aerosol particle diameter and particle number concentration of pharmaceutical aerosols generated by four dry powder inhalers under realistic inhalation and exhalation conditions. To simulate patients undergoing inhalation therapy, the active respiratory system model (xPULM™) was used. A mechanical upper airway model was developed, manufactured, and introduced as a part of the xPULM™ to represent the human upper respiratory tract with high fidelity. Integration of optical aerosol spectrometry technique into the setup allowed for evaluation of pharmaceutical aerosols. The results show that there is a significant difference (p < 0.05) in mean particle diameter between inhaled and exhaled particles with the majority of the particles depositing in the lung, while particles with the size of (>0.5 µm) are least influenced by deposition mechanisms. The fraction of exhaled particles ranges from 2.13% (HandiHaler®) over 2.94% (BreezHaler®), and 6.22% (Turbohaler®) to 10.24% (Ellipta®). These values are comparable to previously published studies. Furthermore, the mechanical upper airway model increases the resistance of the overall system and acts as a filter for larger particles (>3 µm). In conclusion, the xPULM™ active respiratory system model is a viable option for studying interactions of pharmaceutical aerosols and the respiratory tract regarding applicable deposition mechanisms. The model strives to support the reduction of animal experimentation in aerosol research and provides an alternative to experiments with human subjects.

Electro-mechanical Lung Simulator Using Polymer and Organic Human Lung Equivalents for Realistic Breathing Simulation.

Simulation models in respiratory research are increasingly used for medical product development and testing, especially because in-vivo models are coupled with a high degree of complexity and ethical concerns. This work introduces a respiratory simulation system, which is bridging the gap between the complex, real anatomical environment and the safe, cost-effective simulation methods. The presented electro-mechanical lung simulator, xPULM, combines in-silico, ex-vivo and mechanical respiratory approaches by realistically replicating an actively breathing human lung. The reproducibility of sinusoidal breathing simulations with xPULM was verified for selected breathing frequencies (10-18 bpm) and tidal volumes (400-600 ml) physiologically occurring during human breathing at rest. Human lung anatomy was modelled using latex bags and primed porcine lungs. High reproducibility of flow and pressure characteristics was shown by evaluating breathing cycles (nTotal = 3273) with highest standard deviation |3σ| for both, simplified lung equivalents ([Formula: see text] = 23.98 ± 1.04 l/min, µP = -0.78 ± 0.63 hPa) and primed porcine lungs ([Formula: see text] = 18.87 ± 2.49 l/min, µP = -21.13 ± 1.47 hPa). The adaptability of the breathing simulation parameters, coupled with the use of porcine lungs salvaged from a slaughterhouse process, represents an advancement towards anatomically and physiologically realistic modelling of human respiration.

Changes of particle deposition caused by different breathing patterns during active lung simulation.

Aerosols are an integral part of everyday life and as such are inhaled under various conditions and circumstances. These may vary based on the health and activity status of an individual. The aim of this work is to analyse the particle deposition mechanisms during the simulation of three different breathing patterns using an aerosol representing the PM1 fraction of fine particles. The active electro-mechanical lung simulator xPULM is utilized as a driving force and is combined with a non-invasive direct reading optical aerosol measurement system. Results show differences between the number of deposited particles for the three breathing patterns and for the three typical size ranges of airborne particles. Overall, the presented approach demonstrates the possibility of determining the changes of aerosol uptake based on different breathing patterns using the electro-mechanical lung simulator and laboratory produced aerosols. Further measurement cycles must be performed in order to validate the found interactions and to characterize the major influencing parameters.

Development of a Multidisciplinary and Telemedicine Focused System Database.

BACKGROUND: Tele-rehabilitation at home is one of the promising approaches in increasing rehabilitative success and simultaneously decreasing the financial burden on the healthcare system. OBJECTIVES: Novel and mostly mobile devices are already in use, but shall be used in the future to a higher extent for allowing at home rehabilitation processes at a high quality level. The combination of exercises, assessments and available equipment is the basic objective of the presented database. METHODS: The database has been structured in order to allow easy-to-use and fast access for the three main user groups. Therapists - looking for exercise and equipment combinations - patients - rechecking their tasks for home exercises - and manufacturers - entering their equipment for specific use cases. RESULTS: The database has been evaluated by a proof of concept study and shows a high degree of applicability for the field of rehabilitative medicine. Currently it contains 110 exercises/assessments and 111 equipment/systems. CONCLUSION: Foundations of presented database are already established in the rehabilitative field of application, but can and will be enhanced in its functionality to be usable for a higher variety of medical fields and specifications.

Development of a virtual lab for practical eLearning in eHealth.

In recent years an ongoing development in educational offers for professionals working in the field of eHealth has been observed. This education is increasingly offered in the form of eLearning courses. Furthermore, it can be seen that simulations are a valuable part to support the knowledge transfer. Based on the knowledge profiles defined for eHealth courses a virtual lab should be developed. For this purpose, a subset of skills and a use case is determined. After searching and evaluating appropriate simulating and testing tools six tools were chosen to implement the use case practically. Within an UML use case diagram the interaction between the tools and the user is represented. Initially tests have shown good results of the tools' feasibility. After an extensive testing phase the tools should be integrated in the eHealth eLearning courses.

Development of Knowledge Profiles for International eHealth eLearning Courses.

Professionals working in the multidisciplinary field of eHealth vary in their educational background. However, knowledge in the areas of medicine, engineering and management is required to fulfil the tasks associated with eHealth sufficiently. Based on the results of an analysis of national and international educational offers a survey gathering user requirements for the development of knowledge profiles in eHealth was conducted (n=75) by professionals and students. During a workshop the first results were presented and discussed together with the network partners and the attendees. The resulting knowledge profiles contain knowledge areas of all three thematic content categories including fundamentals of medical terminology, standards and interoperability and usability as well as basics of all three content categories. The knowledge profiles are currently applied in a master's degree programme at the UAS Technikum Wien and will be developed further.

Applicability of IHE/Continua components for PHR systems: learning from experiences.

Capturing personal health data using smartphones, PCs or other devices, and the reuse of the data in personal health records (PHR) is becoming more and more attractive for modern health-conscious populations. This paper analyses interoperability specifications targeting standards-based communication of computer systems and personal health devices (e.g. blood pressure monitor) in healthcare from initiatives like Integrating the Healthcare Enterprise (IHE) and Continua Health Alliance driven by industry and healthcare professionals. Furthermore it identifies certain contradictions and gaps in the specifications and suggests possible solutions. Despite these shortcomings, the specifications allow fully functional implementations of PHR systems. Henceforth, both big business and small and medium-sized enterprises (SMEs) can actively contribute to the widespread use of large-scale interoperable PHR systems.

Bedside patient data viewer using RFID and e-Ink technology.

In the daily routine of hospitals, which work with paper based medical records, the staff has to find the appropriate patient file if it needs information about the patient. With the introduction of ELGA the Austrian hospitals have to use specific standards for their clinical documentation. These structured documents can be used to feed an e-Ink reader with information about every patient in a hospital. Combined with RFID and security measures, the clinical staff is supported during the patient file searching process. The developed experimental setup of the Bedside Patient Data Viewer demonstrates a prototype of such a system. An Amazon Kindle Paperwhite is used to display processed data, supplied by a Raspberry Pi with an attached RFID module for identification purposes. Results show that such a system can be implemented, however a lot of organizational and technical issues remain to be solved.

LUMOR: an app for standardized control and monitoring of a porcine lung and its nutrient cycle.

The outcome of the EU-funded project ElBik has been the lung simulator 'iLung', which imitates an actively breathing human lung with a porcine lung. In order to keep the explanted lung in a nearly physiological state during transportation from the slaughterhouse to the ventilation laboratory the tissue needs to be nourished and temperature controlled. The Project AlveoPic designs a mobile transport vehicle implementing an ISO/IEEE 11073-20601 compliant communication interface for the exchange of the physical parameters, alert messages and setpoint-values. An appropriate 11073 domain information model is designed and limitations of the defined services and attributes are identified. For monitoring purposes the Android App LUMOR is implemented providing a user with an easy-to-handle GUI. It was found, that alert capabilities and remote set features are not well supported in ISO/IEEE 11073-20601 at the moment and possible workarounds are discussed.

Certification programs for eHealth--status quo.

The skills of the workforce are a core factor for the quality of healthcare systems. On top of the basic education, postgraduate training is an important factor for continuously maintaining as well as improving the workforce qualification level. Advanced training often provides certification of the acquired skills. This paper analyses the status quo of international certification programs in the sector of eHealth (EU, US, Global). It uses available literature and observations from international educational expert's workgroups. It identifies gaps regarding certifications in eHealth and suggests steps for solutions. Despite little attention to legal and financial eHealth related content in certification programs in the EU as well as a low degree of harmonization of international certifications in general, there are strong activities especially in the international scope towards personal certification programs in eHealth. Major changes are to be expected within the coming years.

Education for eHealth--a status analysis.

eHealth is not only a growing market, but also an important factor for new healthcare systems. National and European initiatives implicitly demand a higher level of knowledge in the areas of healthcare, engineering and management. As part of the eLearning4eHealth project an initial web based study was performed concentrating on European and global eHealth related educational programs. The results show that eHealth related courses do not evenly exist for the identified professions. 43% of the offered programs are focused on the engineering sector, whereas only 21% are available for the management sector. In order to offer compatible and comparable state of knowledge in the identified fields of profession and knowledge, further educational programs may be necessary. Despite the found shortcomings, results have shown that international activities have started in order to close the gaps and improve the quality of knowledge in the interdisciplinary field of eHealth.