Development of a system for telemonitoring of respiration parameters for patients with Obstructive Sleep Apnea.

Obstructive Sleep Apnea is a chronic sleep disorder affecting a large number of the global population. Telemonitoring has been successfully evaluated as an alternative method to traditional care. This paper identifies drawbacks of the current telemonitoring approaches and presents a universal wireless system for continuous monitoring of basic respiration parameters. The proposed system monitors four parameters, namely respiratory flow, airway pressure, Carbon Dioxide (CO2) and Oxygen (O2) gas concentrations. Data are wirelessly transmitted to a computer which acts as a web server. The system will allow remote evaluation of home ventilation support efficiency and the application of custom algorithms for decision support and respiration event detection.

Adapting the design of Anesthesia Information Management Systems to innovations depicted in Industrial Property documents.

The purpose of this paper is to present the design and the current development status of an Anesthesia Information Management System (AIMS). For this system, the physical and technical advances, depicted in relevant, recently published Industrial Property documents, have been taken into account. Additional innovative sensors create further data-load to be managed. Novel wireless data-transmission modes demand eventually compliance to further proper standards, so that interoperability between AIMS and the existing Hospital Information Systems is being sustained. We attempted to define, the state-of-the-art concerning the functions, the design-prerequisites and the relevant standards and of an "emerging" AIMS that is combining hardware innovation, real-time data acquisition, processing and displaying and lastly enabling the necessary interoperability with the other components of the existing Hospital Information Systems. Finally, we report based on this approach, about the design and implementation status, of our "real-world" system under development and discuss the multifarious obstacles encountered during this still on-going project.

Development of a low-cost wireless monitoring system supporting the continuity of medical care of the patient at home.

The fusion of Biomedical Technology, Informatics and Medical Decision-making into the modern Clinical Decision Support Systems (CDSS), as well as the population ageing and the escalation of hospital costs are the driving forces for adopting decentralized systems of health care provision. One of the main problems arising with decentralized health care provision, such as Home Care, is the discontinuity of medical care. This discontinuity appears not only in medical data transfer, but also in the quality of medical supervision. In order to accommodate for the lack of sufficient medical supervision in Home-Care environment, we have developed low-cost prototype solution for monitoring basic physiological parameters. The implemented architecture is employing wearable biomedical signal acquisition modules, utilizing "off the shelf" technologies in order to minimize cost. These modules transmit the acquired vital signs through a wireless link to a laptop computer. A web application allows continuous quasi real-time supervision of patient's biosignals from any PC equipped with a web browser and appropriate authorization codes.

Locating of the required key-variables to be employed in a ventilation management decision support system.

The aim of the paper is to identify the key physiological variables and ventilator settings involved in ventilation management, and required for an appropriate Clinical Decision Support System (CDSS). Based on the results of a questionnaire designed for the purpose of the research, 70 hours of physiological and ventilation data were recorded. Recorded data were classified by clinicians into three major lung pathologies and were further statistically analyzed for identifying strong relationships between monitored and controlled ventilator parameters. Correlation analysis was evaluated by Intensive Care Unit (ICU) clinicians. Based on the evaluators' majority voting the number and type of participating variables in a CDSS was drastically decreased. The number and type of monitored variables ranged from a single one to six, depending on the patient's lung pathology, and the controlled ventilator setting. Evaluation results were successfully applied to Neural Network models for providing suggestions on Tidal Volume and the Fraction of inspired Oxygen.

Ensuring the continuity of care of cardiorespiratory diseases at home. Monitoring equipment and medical data exchange over semantically annotated web services.

OBJECTIVES: A significant portion of care related to cardiorespiratory diseases is provided at home, usually but not exclusively, after the discharge of a patient from hospital. It is the purpose of the present study to present the technical means which we have developed, in order to support the adaptation of the continuity of care of cardiorespiratory diseases at home. METHODS: We have developed an integrated system that includes: first, a prototype laptop-based portable monitoring system that comprises low-cost commercially available components, which enable the periodical or continuous monitoring of vital signs at home; second, software supporting medical decision-making related to tachycardia and ventricular fibrillation, as well as fuzzy-rules-based software supporting home-ventilation optimization; third, a typical continuity of care record (CCR) adapted to support also the creation of a homecare plan; and finally, a prototype ontology, based upon the HL7 clinical document architecture (CDA), serving as basis for the development of semantically annotated web services that allow for the exchange and retrieval of homecare information. RESULTS: The flexible design and the adaptable data-exchange mechanism of the developed system result in a useful and standard-compliant tool, for cardiorespiratory disease-related homecare. CONCLUSIONS: The ongoing laboratory testing of the system shows that it is able to contribute to an effective and low-cost package solution, supporting patient supervision and treatment. Furthermore, semantic web technologies prove to be the perfect solution for both the conceptualization of a continuity of care data exchange procedure and for the integration of the structured medical data.

A neuro-fuzzy controller for the estimation of tidal volume and respiration frequency ventilator settings for COPD patients ventilated in control mode.

Patients with chronic obstructive pulmonary disease (COPD) are characterized by increased work of breathing (WOB) and ventilatory muscle dysfunction. Mechanical ventilation is applied to unload the WOB; rest respiratory muscles decrease arterial partial pressure of carbon dioxide (PaCO2) and treat hypoxemia. Since patients' needs are not static, ventilator settings have to be adjusted regularly. The aim of the present study was the development and evaluation of a neuro-fuzzy controller, that utilizes non-invasively acquired parameters for the determination of the appropriate tidal volume (VT) and respiration frequency (RR) ventilator settings for COPD patients. Forty three (43) hours of non-invasively monitored physiology parameters and ventilator settings, from four (4) different COPD patients ventilated in control mode, were collected in two (2) General Hospitals in Greece. Recorded data were randomly allocated into two sets, namely training set (60%) and evaluation set (40%). A neuro-fuzzy controller was developed and trained, by employing the training set. The controller utilizes non-invasively measured parameters, namely oxygen saturation (SpO2), lung compliance (C) and resistance (R), Peak Inspiratory pressure (PIP) and Plateau pressure (Pplateau), for predicting appropriate VT and RR settings. The developed neuro-fuzzy controller was tested against evaluation set. The Mean Square Error of the tidal volume and the respiration rate was 0.222 ml/Kgr and 1.21 breaths per minute (bpm) respectively.

An integrated system supporting training in medical and administrative decision making in the emergency department.

The aim of the present project was the development of an integrated computer-based system supporting training in medical and administrative decision making in the Emergency Department. The system comprises of, first, a module supporting on-line acquaintance with Emergency Medical Guidelines, second, a vital-signs monitoring and processing module, and finally an administrative module organizing the most relevant facts about a patient's health status in compliance with the ASTM E2369-0 Standard Specification for Continuity of Care Record, in order to be employed after discharge from the Emergency Care to a hospital ward or to homecare.

Extending the use of DRGs to estimate mean Home-Care cost by employing an adapted ASTM E2369-05 Continuity of Care Record.

The purpose of this study is the presentation of a system appropriate to be used upon the transition of a patient, from hospital to homecare. The developed system is based upon the creation of a structured subset of data, complying with the ASTM E2369-0 Standard Specification for Continuity of Care Record, concerning the most relevant facts about a patient's healthcare, organized and transportable, in order to be employed during the post-discharge homecare period. The system allows for the extension of the use of DRGs to estimate mean Home-Care cost, taking advantage of the planning and the optimal documentation of the provided homecare.

Estimation of the DRGs related mean surgical treatment cost for 535 patients in Greece by employing custom-made software.

The purpose of the present study was the development of a Medical Procedure Resources-Allocation and Cost-Capturing Software for the Estimation of the Mean DRGs associated Treatment Cost and its initial implementation in the specific context of the Surgery Department.

Upgrading undergraduate biomedical engineering laboratory training.

This paper presents the upgrading of biomedical engineering laboratory training at the Department of Medical Instrumentation Technology of the Technological Educational Institution of Athens (TEI-A), taking place in the framework of the "Upgrading of Undergraduate Curricula of TEI-A" project. The educational material of selected specialized laboratory sectors is totally renewed, and new sectors are introduced, so that student-centered learning is promoted utilizing advanced computer-enhanced educational environments. The current implementation status is presented for the laboratories dealing with biosignal acquisition, medical data digital processing and, more extensively, computer networks applications in medicine, where a training application simulating a Radiology Department computer network was developed. Benefits of the use of a balanced training approach, combining hands-on experience with computer simulations, are discussed.

Literacy and hemispheric specialization for language: dichotic listening in young functionally illiterate men.

The functional cerebral organization of young men who were defined as illiterate was studied by testing their dichotic listening for language stimuli. These functionally illiterate men showed greater right ear advantage for language stimuli than 50 educated subjects, a pattern already observed with completely illiterate persons of both sexes. This finding is consistent with the view that mastering written codes for language might be one of the most relevant parameters in hemispheric specialization when language is studied.

Neuropsychological consequences of the exposure of a group of telephonists to unusual auditory stimuli.

A group of 144 right-handed telephone operators reported a number of psychosomatic complaints after long-lasting unusual presentation of auditory stimuli to their left ears during working hours. The main finding of the study of their hemisphere organisation for verbal stimuli, as measured by dichotic listening to pairs of digits, is that the group displayed a clear shift of the right-ear preference to the left and differed significantly from the control group of 40 persons. The finding was verified by a follow-up study conducted eight years later.

Hemispheric specialization for language in the congenitally blind: the influence of the Braille system.

The functional cerebral organization of two groups of congenitally blind persons of different age and schooling was studied by testing their dichotic listening to pairs of digits. The younger congenitally blind group showed a comparable level of performance to their control counterparts; however, older subjects shifted their initial right ear advantage to an increased left ear performance as they progressed in the mastery of the Braille system. As this system is founded on spatial strategies, we can conclude that this shift is related to the activation of some right hemispheric linguistic mechanisms.