Results of a Literature Review to Prepare Data Modelling in the Context of Kidney Transplant Rejection Diagnosis.

Due to demographic change the number of serious kidney diseases and thus required transplantations will increase. The increased demand for donor organs and a decreasing supply of these organs underline the necessity for effective early rejection diagnostic measures to improve the lifetime of transplants. Expert systems might improve rejection diagnostics but for the development of such systems data models are needed that encompass the relevant information to enable optimal data aggregation and evaluation. Results of a literature review concerning published data models and information systems concerned with kidney transplant rejection diagnostic lead to a set of data elements even if no papers could be identified that publish data models explicitly.

Information and communication technologies for promoting and sustaining quality of life, health and self-sufficiency in ageing societies--outcomes of the Lower Saxony Research Network Design of Environments for Ageing (GAL).

Many societies across the world are confronted with demographic changes, usually related to increased life expectancy and, often, relatively low birth rates. Information and communication technologies (ICT) may contribute to adequately support senior citizens in aging societies with respect to quality of life and quality and efficiency of health care processes. For investigating and for providing answers on whether new information and communication technologies can contribute to keeping, or even improving quality of life, health and self-sufficiency in ageing societies through new ways of living and new forms of care, the Lower Saxony Research Network Design of Environments for Ageing (GAL) had been established as a five years research project, running from 2008 to 2013. Ambient-assisted living (AAL) technologies in personal and home environments were especially important. In this article we report on the GAL project, and present some of its major outcomes after five years of research. We report on major challenges and lessons learned in running and organizing such a large, inter- and multidisciplinary project and discuss GAL in the context of related research projects. With respect to research outcomes, we have, for example, learned new knowledge about multimodal and speech-based human-machine-interaction mechanisms for persons with functional restrictions, and identified new methods and developed new algorithms for identifying activities of daily life and detecting acute events, particularly falls. A total of 79 apartments of senior citizens had been equipped with specific "GAL technology", providing new insights into the use of sensor data for smart homes. Major challenges we had to face were to deal constructively with GAL's highly inter- and multidisciplinary aspects, with respect to research into GAL's application scenarios, shifting from theory and lab experimentation to field tests, and the complexity of organizing and, in our view, successfully managing such a large project. Overall it can be stated that, from our point of view, the GAL research network has been run successfully and has achieved its major research objectives. Since we now know much more on how and where to use AAL technologies for new environments of living and new forms of care, a future focus for research can now be outlined for systematically planned studies, scientifically exploring the benefits of AAL technologies for senior citizens, in particular with respect to quality of life and the quality and efficiency of health care.

SIScaR-GPU: fast simulation and visualization of intraoperative scattered radiation to support radiation protection training.

Scattered radiation caused by the intraoperative use of mobile image intensifier systems (referred to as "C-arms") is the main source of radiation exposure for operating room personnel and surgeons. To keep this possibly harmful exposure at a minimum level, a deliberate use of radiation, knowledge about distribution of scattered radiation and appropriate behavior pattern are indispensable. Therefore in several countries knowledge concerning these aspects is taught in mandatory courses on radiation protection. Currently this teaching is typically based on non-interactive didactical methods (texts, pictures and videos). Because of the complexity of the knowledge field this restriction might lead to an insufficient understanding of the facts, an inappropriate behavior and therefore to an avoidable radiation exposure. This paper presents a new software module, which is able to simulate and visualize intraoperative radiation distribution and the resulting dose values for the attending persons within a few seconds (less than 30s). The developed components, which simulate the radiation transport using a graphics processing unit three times faster than comparable approaches, were integrated exemplarily in the computer based C-arm training system virtX. This extended training system improves the teaching through a prompt visual feedback on non-trivial scattered radiation facts in freely adoptable situations.

Health-enabling technologies for the elderly--an overview of services based on a literature review.

BACKGROUND: Services for the elderly based on health-enabling technologies promise to contribute significantly to the efficiency and effectiveness of future health care. Due to this promise, over the last years the scientific community has designed a complex variety of these valuable innovations. A systematic overview of the developed services would help to better understand their opportunities and limitations. OBJECTIVE: To obtain a systematic overview of services for the elderly based on health-enabling technologies and to identify archetypical service categories. METHODS: We conducted a literature review using PubMed and retrieved 1447 publications. We stepwise reduced this list to 27 key publications that describe typical service archetypes. RESULTS: We present six archetypical service categories, namely handling adverse conditions, assessing state of health, consultation and education, motivation and feedback, service ordering and social inclusion and describe their implementation in current research projects.

Increasing physical activity through health-enabling technologies: the project "being strong without violence".

Due to the increasing prevalence of adiposity in children numerous schools are introducing prevention programmes. Among these is "Gewaltlos Starksein" ("Being strong without violence"), a project of Hauptschule Sophienstraße Braunschweig, Germany (a general education secondary school for grades 5-10). This study aims to discover possible increases in activity through "Gewaltlos Starksein" where health-enabling technologies play a major role. A prospective intervention study with a span of 1.5 years was designed to measure this increase in activity. Partners in this study were Hauptschule Sophienstraße as the intervention group and Grund- und Hauptschule Pestalozzistraße as control group. Data collection was performed using a multi-sensor device, and questionnaires. Confirmatory data analysis of average metabolic equivalent (METs) yielded no significant results. Exploratory analysis showed interesting results, especially concerning the number of steps during leisure time. Descriptive analysis of questionnaires showed that all children enjoy physical activity. There were differences in sports team participation, open-air games and club affiliation. The study could not prove that the intervention "Gewaltlos Starksein" improves physical activity in children. However, the increased leisure activity step count indicates that "Gewaltlos Starksein" has positive effects on children's behaviour. This should be investigated in a further study in cooperation with psychologists.

The Lower Saxony research network design of environments for ageing: towards interdisciplinary research on information and communication technologies in ageing societies.

Worldwide, ageing societies are bringing challenges for independent living and healthcare. Health-enabling technologies for pervasive healthcare and sensor-enhanced health information systems offer new opportunities for care. In order to identify, implement and assess such new information and communication technologies (ICT) the 'Lower Saxony Research Network Design of Environments for Ageing' (GAL) has been launched in 2008 as interdisciplinary research project. In this publication, we inform about the goals and structure of GAL, including first outcomes, as well as to discuss the potentials and possible barriers of such highly interdisciplinary research projects in the field of health-enabling technologies for pervasive healthcare. Although GAL's high interdisciplinarity at the beginning slowed down the speed of research progress, we can now work on problems, which can hardly be solved by one or few disciplines alone. Interdisciplinary research projects on ICT in ageing societies are needed and recommended.

Health information systems for home telehealth services--a nomenclature for sensor-enhanced transinstitutional information system architectures.

Home telehealth services for elderly people promise to contribute to a more efficient health care in the future. Though isolated services at a patient's home might make sense for some applications, the full potential of home telehealth only arises through its integration into existing health information systems (HIS) and care processes. We know about traditional HIS architectures. However, so far no models exist, helping us to understand and describe the upcoming sensor-enhanced transinstitutional information system architectures for home telehealth services. To develop a nomenclature for sensor-enhanced transinstitutional health information system architectures. We conducted two systematic literature reviews, assessing typical services and users of home telehealth and key characteristics of transinstitutional health information system architectures. The information retrieved from both reviews was integrated to build the nomenclature sought after. We present a nomenclature of information and communication technology (ICT) architectures for home telehealth services. The developed dimensions provide an overview on typical users, services, operating organisations, information flow, geographical reach and architectural paradigms of sensor-enhanced transinstitutional health information systems. The developed nomenclature helps us to better understand the upcoming ICT architectures. However, we are still in need of further experiences with their application.

An approach to simulate and visualize intraoperative scattered radiation exposure to improve radiation protection training.

Intraoperative radiography based on mobile image intensifier systems (C-arms) is widely used during the treatment of trauma and emergency patients. These devices produce scattered radiation, potential hazardous for surgeon and operation room personal (ORP). The propagation and intensity of scattered radiation is not intuitive, is not perceivable by human senses and depends on many variables. At courses on radiation protection the knowledge of the behavior of scattered radiation and the modus operandi to minimize the radiation exposure should be taught to ORP and surgeons. Currently this can only be done theoretically using fixed pictures and precalculated videos. This paper presents an approach to interactively simulate and visualize scattered radiation with a computer based training system for mobile image intensifier systems. The simulation depicts radiation propagation and intensity for arbitrary C-arm adjustments and different irradiated materials. This teaching component focuses on improving the current radiation protection training with interactive visual and practical aspects.

Health-enabling technologies for pervasive health care: a pivotal field for future medical informatics research education?

Our societies are changing worldwide. Life expectancy has increased in many societies and this increase is often related to an increase in the relative amount of elderly persons. Health-enabling technologies are information and communication technologies for creating sustainable conditions for self-sufficient and self-determined lifestyles. Sensor-enhanced health information systems play a major role in this context. The question is discussed, whether health-enabling technologies for pervasive health care can be regarded as a pivotal field for future medical informatics research and education.

People's perceptions and expectations of assistive health-enabling technologies: an empirical study in Germany.

Demographic shifts and their consequences will lead to changes in the way health care is provided. Although assistive health-enabling technologies are regarded as one means to support these changes, they are minimally used, despite the maturity of the underlying technologies. This may partly be attributable to a disregard of users' needs and preferences. The aim of this article is to assess acceptance of health-enabling technologies with regard to their perceived usefulness, risks, and people's readiness to actually use them. Furthermore, we attempted to find out to whom individuals would entrust their health information, and what their basic fears are. We used a questionnaire presenting four exemplary technologies: emergency call systems, videophones, activity and health status monitoring. We conducted 147 face-to-face interviews and analyzed the results using descriptive statistics. Emergency call systems, health status and activity monitoring were rated as useful or very useful, videophones as hardly useful. Intrusion into one's privacy was the most prominent concern. Regarding fears in old age, people were mostly afraid of diseases and loss of independence. They would entrust their medical data to their physicians rather than relatives or caregivers. This study may contribute to systematic analyses of users' perceptions and preferences concerning assistive health-enabling technologies.

Sustainable ubiquitous home health care--architectural considerations and first practical experiences.

Despite the abundance of past home care projects and the maturity of the technologies used, there is no widespread dissemination as yet. The absence of accepted standards and thus interoperability and the inadequate integration into transinstitutional health information systems (tHIS) are perceived as key factors. Based on the respective literature and previous experiences in home care projects we propose an architectural model for home care as part of a transinstitutional health information system using the HL7 clinical document architecture (CDA) as well as the HL7 Arden Syntax for Medical Logic Systems. In two short case studies we describe the practical realization of the architecture as well as first experiences. Our work can be regarded as a first step towards an interoperable - and in our view sustainable - home care architecture based on a prominent document standard from the health information system domain.