Content uploaded by N. Maglaveras
Author content
All content in this area was uploaded by N. Maglaveras on Mar 26, 2016
Content may be subject to copyright.
A preview of the PDF is not available
A Personalized Framework for Medication Treatment Management in Chronic Care
Abstract and Figures
The ongoing efforts toward continuity of care and the recent advances in information and communication technologies have led to a number of successful personal health systems for the management of chronic care. These systems are mostly focused on monitoring efficiently the patient's medical status at home. This paper aims at extending home care services delivery by introducing a novel framework for monitoring the patient's condition and safety with respect to the medication treatment administered. For this purpose, considering a body area network (BAN) with advanced sensors and a mobile base unit as the central communication hub from the one side, and the clinical environment from the other side, an architecture was developed, offering monitoring patterns definition for the detection of possible adverse drug events and the assessment of medication response, supported by mechanisms enabling bidirectional communication between the BAN and the clinical site. Particular emphasis was given on communication and information flow aspects that have been addressed by defining/adopting appropriate formal information structures as well as the service-oriented architecture paradigm. The proposed framework is illustrated via an application scenario concerning hypertension management.
Figures - uploaded by N. Maglaveras
Author content
All figure content in this area was uploaded by N. Maglaveras
Content may be subject to copyright.
... A utilização de u-Health no suporte ao cuidado de DCNT pode ser realizado na assistência às atividades de autogerenciamento (MAMYKINA et al., 2008;MATTILA et al., 2008), na oferta de meios para comunicação entre paciente e cuidadores (MAMYKINA et al., 2008), no monitoramento de condições de saúde em tempo real (ROSSO et al., 2010;KOUTKIAS et al., 2010;GIULI, 2011) ou também através do envio de mensagens aos responsáveis médicos em casos onde o paciente encontra-se em situação de risco. Esta seção apresenta cinco trabalhos que concentram-se no uso de u-Health para suporte às atividades de cuidado de DCNT. ...
... A ontologia é um componente básico para o modelo, uma vez que ela representa o conhecimento a respeito do domínio de cuidado de DCNT, de forma que os componentes de software compartilhem o mesmo entendimento sobre os conceitos expressos nessa representação de conhecimento. A ontologia do U'Ductor foi inspirada pelos modelos de conhecimento apresentados por Koutkias et-al (KOUTKIAS et al., 2010) e Paganelli e Giuli (PAGANELLI; GIULI, 2011), tendo sido utilizada principalmente como modelo de mensagens para comunição entre nodos, middleware e módulos executáveis. ...
... Devido a arquitetura utilizada pelo modelo, é possível encontrar recursos de auxílio de acordo com a localização do paciente. Nesse modelo, o paciente tem liberdade para buscar recursos de auxílio a qualquer momento e qualquer local, não ficando restrito ao suporte oferecido pela organização de saúde (MAMYKINA et al., 2008;ROSSO et al., 2010;KOUTKIAS et al., 2010;GIULI, 2011), ou ao auxílio de contatos conhecidos (MATTILA et al., 2008). ...
De acordo com a Organização Mundial de Saúde, doenças cardíacas, doenças respiratórias crônicas, câncer e diabetes são as doenças crônicas não transmissíveis mais comuns, assim como uma das principais causas da mortalidade no mundo. Nesses casos é necessário mais do que o engajamento do paciente no auxílio ao cuidado destas doenças. O apoio da comunidade e das organizações de saúde também é desejável. Estes devem apoiar os pacientes em suas atividades de autogerenciamento, fazendo-os sentirem-se confiantes e motivados. A computação ubíqua dá condições para ajudar os pacientes de doenças crônicas na gestão de suas atividades, oferecendo-lhes apoio a qualquer hora, em qualquer lugar. O presente trabalho apresenta o U’Ductor, um modelo para cuidado ubíquo de doenças crônicas não transmissíveis, cujo objetivo é facilitar a integração entre pacientes e recursos da comunidade e organizações de saúde. O U’Ductor dá um passo a frente em relação aos trabalhos estudados ao integrar pacientes, membros da comunidade e organizações de saúde, e recursos da comunidade e organizações de saúde. Tais características não foram exploradas nos trabalhos estudados da maneira como é feita no U’Ductor. Um protótipo do modelo foi avaliado por pacientes crônicos que deram pareceres positivos em relação a sua aplicabilidade nas atividades de cuidado de doenças crônicas não transmissíveis.
... We fund two studies that included monitoring vital signs, and patient treatment process as the underlying factors for their frameworks. 26 Based on the results of our review anticipated outcomes reported by the studies were widely varied. Where some studies considered more than four outcomes such as extending home care telehealth service, personalised medication treatment and personalisation of healthcare, 19 others reported only two outcomes. ...
... 9 19 20 22 24 A broad range of factors and anticipated outcomes were identified by the reviewed studies as components of conceptual frameworks. Factors reported by Koutkias et al 26 were related to patient's treatment procedure, in terms of medication response and patient safety. 26 Villarreal et al 27 referred to factors as creating modules and communication tools between each of the measuring devices and the mobile phone. ...
... Factors reported by Koutkias et al 26 were related to patient's treatment procedure, in terms of medication response and patient safety. 26 Villarreal et al 27 referred to factors as creating modules and communication tools between each of the measuring devices and the mobile phone. 27 The framework proposed by Salisbury et al 22 addressed four key factors including engagement of patients and health professionals, effective chronic disease management (including subcomponents of self-management, optimisation of treatment, care coordination), partnership between providers, and patient social and health system context.Dhillon et al 24 discussed about the system that was web based, has a Facebook-like plug-in Beentjes 2015 23 Estimating the added value of e-health will be possible because it is controlled by the standard Illness Management and Recovery (IMR) programme. ...
Background:
Monitoring and evaluations of digital health (DH) solutions for the management of chronic diseases are quite heterogeneous and evidences around evaluating frameworks are inconsistent. An evidenced-based framework is needed to inform the evaluation process and rationale of such interventions. We aimed to explore the nature, extent and components of existing DH frameworks for chronic diseases.
Methods:
This review was conducted based on the five steps of Arksey and O'Malley's scoping review methodology. Out of 172 studies identified from, PubMed, Embase and Web of Science, 11 met our inclusion criteria. The reviewed studies developed DH frameworks for chronic diseases and published between 2010 and 2018.
Results:
According to WHO guidelines for monitoring and evaluation of DH interventions, we identified seven Conceptual frameworks, two Results frameworks, one Logical framework and one Theory of change. The frameworks developed for providing interventions such as self-management, achieving personal goals and reducing relapse for cardiovascular disease, diabetes, chronic obstructive pulmonary disease and severe mental health. A few studies reported evaluation of the frameworks using randomised clinical trials (n=3) and feasibility testing via Likert scale survey (n=2). A wide range of outcomes were reported including access to care, cost-effectiveness, behavioural outcomes, patient-provider communications, technology acceptance and user experience.
Conclusion:
There is a lack of evidence on the application of consistent DH frameworks. Future research should address the use of evidence-based frameworks into the research design, monitoring and evaluation process. This review explores the nature of DH frameworks for the management of chronic diseases and provides examples to guide monitoring and evaluation of interventions.
... A utilização de u-Health no suporte à educação pode ser realizado na assistência às atividades de autogerenciamento de DCNT [Mamykina et al. 2008, Mattila et al. 2008], na oferta de meios para comunicação entre paciente e cuidadores [Mamykina et al. 2008], no monitoramento de condiçõ es de saú de em tempo real [Rosso et al. 2010, Koutkias et al. 2010, Paganelli and Giuli 2011 ou também através do envio de mensagens aos responsáveis médicos em casos onde o paciente encontra-se em situação de risco. Esta seção apresenta três trabalhos que concentram-se no uso de u-Health para suporte as atividades de gerenciamento de DCNT. ...
... Em [Koutkias et al. 2010], os autores propõ em um framework cujo objetivo é utilizar os dados coletados através de sensores de monitoramento, para identificar como o paciente reage aos medicamentos prescritos e efeitos adversos que podem ser causados por eles. O framework conceitual é uma ontologia criada para descrever os aspectos relacionados ao domínio de monitoramento de efeitos de uso de medicamento. ...
... O UDuctor é um modelo de suporte ubíquo ao gerenciamento de DCNT que concentrase em preencher a lacuna apresentada em outros trabalhos com relação ao suporte à educação, sendo esta uma característica citada nas documentaçõ es sobre o modelos de cuidados crô nicos. O modelo complementa os trabalhos estudados [Mattila et al. 2008, Koutkias et al. 2010, Paganelli and Giuli 2011, ao adicionar o suporte a integração entre pacientes e recursos da comunidade e organizaçõ es de saú de. ...
O artigo propõe o uso do UDuctor, um modelo para cuidado ubíquo de doenças crônicas não transmissíveis (DCNT), para fornecer suporte à educação de pessoas com DCNT através do autogerenciamento. Este suporte é fornecido pelo uso de computação ubíqua através do uso de smartphones e in-ternet. A avaliação de suporte à educação foi realizada por dez pessoas através de um questionário composto por cinco perguntas.
... 3) Non-measurable medical context information: which are symptoms that are difficult to be measured such as: headache, vomiting, sleepiness, and dizziness. Despite their measuring difficulties, they should be considered along with the measurable context in the healthcare context [9], [14]. ...
... 4) Medications context information: provide the current medications given for a patient as it affects the readings of patient"s vital signs [9], [14], [15]. Thus, healthcare givers evaluate the patient"s response to take the appropriate medical decisions [9]. ...
... 3) Non-measurable medical context information: which are symptoms that are difficult to be measured such as: headache, vomiting, sleepiness, and dizziness. Despite their measuring difficulties, they should be considered along with the measurable context in the healthcare context [9], [14]. 4) Medications context information: provide the current medications given for a patient as it affects the readings of patient"s vital signs [9], [14], [15]. ...
... Despite their measuring difficulties, they should be considered along with the measurable context in the healthcare context [9], [14]. 4) Medications context information: provide the current medications given for a patient as it affects the readings of patient"s vital signs [9], [14], [15]. Thus, healthcare givers evaluate the patient"s response to take the appropriate medical decisions [9]. ...
During the treatment process, medical institutes collect context information about their patients and store it in their healthcare systems. The collected information describes the measurable, risk, or medication information and used to improve the performance of the institutes healthcare systems by allowing diverse knowledge about patients. Being said that some other information is needed as they influence patients' life style such as education and income as the high level of education or income reflected positively to the patient's life, and probably resulting in reducing likelihood disease or incidence of infectious diseases. In this paper, a new type of healthcare context information (Social Context) is proposed to address this need. It can be divided into four main categories: related people, behavior, income and education of the patient. We believe that the new proposed context information should be considered in the designing process of the context-aware medical informatics systems beside to the well-known context information.
... In healthcare intuitions, medication errors' percentage is 56% for ordering, 34% for administration, 6% for transcribing, and 4% for dispensing [5]. While statistical data of hospitals show that computerized data is utilized in most healthcare institutions, the Institute of Medicine (IOM) records that there is an occurrence of many medication errors during the clinical process [6]. Hospital monitoring and management systems can be a solution to efficiently speed up data flow in hospitals, reduce errors and im-prove the inventory control of high risk or expensive medications [7]. ...
The enhancement of patient safety and the improvement of medical care services remain one the main concerns of the World Health Organization. Thus, given the healthcare critical impact on patients, there is a growing need for high-risk and expensive medicine management. For this purpose, we propose an innovative system prototype for the reduction of medication error possibility from prescription, validation to its preparation. We present a Radio Frequency IDentification monitoring system for hospital and pharmacy using digital signature. Our designed system is constituted of RFID readers, ESP8266 modules, and tags to ensure an automated medication management and a good inventory control.
... The importance of sustained support over extended periods of time is particularly important for patients, especially for rehabilitation, chronic diseases, or other conditions such as those affecting cancer survivors. In these situations, patients are often left at home, expected to continue their lives and activities, while dealing with potential complications and issues inherent to their health conditions [27]. To support them effectively in this delicate phase, healthcare providers need to have a sufficient understanding of the individual pathways of each patient, as well as the potential risks and courses of action [19]. ...
Patients are often required to follow a medical treatment after discharge, e.g., for a chronic condition, rehabilitation after surgery, or for cancer survivor therapies. The need to adapt to new lifestyles, medication, and treatment routines, can produce an individual burden to the patient, who is often at home without the full support of healthcare professionals. Although technological solutions –in the form of mobile apps and wearables– have been proposed to mitigate these issues, it is essential to consider individual characteristics, preferences, and the context of a patient in order to offer personalized and effective support. The specific events and circumstances linked to an individual profile can be abstracted as a patient trajectory, which can contribute to a better understanding of the patient, her needs, and the most appropriate personalized support. Although patient trajectories have been studied for different illnesses and conditions, it remains challenging to effectively use them as the basis for data analytics methodologies in decentralized eHealth systems. In this work, we present a novel approach based on the multi-agent paradigm, considering patient trajectories as the cornerstone of a methodology for modelling eHealth support systems. In this design, semantic representations of individual treatment pathways are used in order to exchange patient-relevant information, potentially fed to AI systems for prediction and classification tasks. This paper describes the major challenges in this scope, as well as the design principles of the proposed agent-based architecture, including an example of its use through a case scenario for cancer survivors support.
... Existing MPMSs differ in terms of the types and number of features that they support. MPMSs collect and monitor patients' vital signs, such as blood pressure and body temperature, and observe their physical activities, such as walking and running [45]. MPMSs can use environmental sensors to provide surrounding environmental conditions, such as room temperature, humidity, lighting level and location, to patients [30]. ...
This paper presents comprehensive insights into mobile patient monitoring systems (MPMSs) from evaluation and benchmarking aspects on the basis of two critical directions. The current evaluation criteria of MPMSs based on the architectural components of MPMSs and possible solutions are discussed. This review highlights four serious issues, namely, multiple evaluation criteria, criterion importance, unmeasurable criteria and data variation, in MPMS benchmarking. Multicriteria decision-making (MCDM) analysis techniques are proposed as effective solutions to solve these issues from a methodological aspect. This methodological aspect involves a framework for benchmarking MPMSs on the basis of MCDM to rank available MPMSs and select a suitable one. The benchmarking framework is discussed in four steps. Firstly, pre-processing and identification procedures are presented. Secondly, the procedure of weight calculation based on the best–worst method (BWM) is described. Thirdly, the development of a benchmark framework by using the VIKOR method is introduced. Lastly, the proposed framework is validated.
The internet of things (IoT) and deep learning are emerging technologies in diverse research fields, including the provision of IT services in medical domains. In the COVID-19 era, intelligent medication behavior monitoring systems for stable patient monitoring are further required, because many patients cannot easily visit hospitals. Several previous studies made use of wearable devices to detect medication behaviors of patients. However, the wearable devices cause inconvenience while equipping the devices. In addition, they suffer from inconsistency problems due to errors of measured values. We devise a medication behavior monitoring system that uses the IoT and deep learning to avoid sensing errors and improve user experiences by effectively detecting various activities of patients. Based on the real-time operation of our proposed IoT device, the proposed solution processes captured images of patents via OpenPose to check medication situations. The proposed system identifies medication status on time by using a human activity recognition scheme and provides various notifications to patients' mobile devices. To support reliable communication between our system and doctors, we employ MQTT protocol with periodic data transmissions. Thus, the measured information of patient's medication status is transmitted to the doctors so that they can periodically perform remote treatments. Experimental results show that all medication behaviors are accurately detected and notified to the doctor efficiently, improving the accuracy of monitoring the patient's medication behavior.
The development of pervasive healthcare systems consists of applying ubiquitous computing in the healthcare context. The systems developed in this research field have the goals of offering better healthcare services, promoting the well-being of the people, and assisting healthcare professionals in their tasks. The aim of the chapter is to give an overview of the main research efforts in the area of pervasive healthcare systems and to identify which are the main research challenges in this topic of research. Furthermore, the authors review the current state of the art for these kinds of systems with respect to some of the research challenges identified. In particular, the authors focus on contributions done regarding interoperability, scalability, and security of these systems.
Rules play an increasingly important role in a variety of Semantic Web applications as well as in traditional IT systems. As a universal medium for publishing information, the Web is envisioned to become the place for publishing, distributing, and exchanging rule-based knowledge. Realizing the importance and the promise of this vision, W3C has created the Rule Interchange Format Working Group (RIF WG) and chartered it to develop an interchange format for rules in alignment with the existing standards in the Semantic Web architecture stack.
However, creating a generally accepted interchange format is by no means a trivial task. First, there are different understandings of what a “rule” is. Researchers and practitioners distinguish between deduction rules, normative rules, production rules, reactive rules, etc. Second, even within the same category of rules, systems use different (often incompatible) semantics and syntaxes. Third, existing Semantic Web standards, such as RDF and OWL, show incompatibilities with many kinds of rule languages at a conceptual level.
This article discusses the role that different kinds of rule languages and systems play on the Web, illustrates the problems and opportunities in exchanging rules through a standardized format, and provides a snapshot of the current work of the W3C RIF WG.
Semantic Web technologies such as RDF are usually incorporated in the infrastructure of desktop and web applications and can
currently not be entirely deployed on mobile devices. Therefore, the unique opportunities and novel features the Semantic
Web offers are not amenable in mobile application scenarios, in which context and context-awareness is essential. In this
thesis, we propose a context-sensitive Semantic Web framework for mobile devices by which contextual data can be processed
semantically and integrated with data sets and services from other communities. Mobile devices augmented with those capabilities
can operate autonomously and independent in different environments.
‘ The current care systems cannot do the job. Trying harder will not work. If we want safer, higher-quality care, we will need to have redesigned systems of care, including the use of information technology to support clinical and administrative processes.’
This comprehensive text explains the principles and practice of Web services and relates all concepts to practical examples and emerging standards. Its discussions include: Ontologies Semantic web technologies Peer-to-peer service discovery Service selection Web structure and link analysis Distributed transactions Process modelling Consistency management. The application of these technologies is clearly explained within the context of planning, negotiation, contracts, compliance, privacy, and network policies. The presentation of the intellectual underpinnings of Web services draws from several key disciplines such as databases, distributed computing, artificial intelligence, and multi-agent systems for techniques and formalisms. Ideas from these disciplines are united in the context of Web services and service-based applications. Featuring an accompanying website and teacher's manual that includes a complete set of transparencies for lectures, copies of open-source software for exercises and working implementations, and resources to conduct course projects, this book makes an excellent graduate textbook. It will also prove an invaluable reference and training tool for practitioners.
From the Publisher:
In October 2000, the US National Institute of Standards and Technology selected the block cipher Rijndael as the Advanced Encryption Standard (AES). AES is expected to gradually replace the present Data Encryption Standard (DES) as the most widely applied data encryption technology.|This book by the designers of the block cipher presents Rijndael from scratch. The underlying mathematics and the wide trail strategy as the basic design idea are explained in detail and the basics of differential and linear cryptanalysis are reworked. Subsequent chapters review all known attacks against the Rijndael structure and deal with implementation and optimization issues. Finally, other ciphers related to Rijndael are presented.|This volume is THE authoritative guide to the Rijndael algorithm and AES. Professionals, researchers, and students active or interested in data encryption will find it a valuable source of information and reference.
Abstract With an increasingly mobile,society and,the worldwide deployment of mobile and wireless networks, the wireless infrastructure can support many,current and emerging,healthcare applications. This could fulfill the vision of “Pervasive Healthcare” or healthcare to anyone, anytime, and anywhere by removing locational, time and other restraints while increasing both the coverage and the quality. In this paper, we present applications and require- ments of pervasive healthcare, wireless networking solutions and several important research problems. The pervasive healthcare applications include pervasive health monitoring, intelligent emergency management system, pervasive health- care data access, and ubiquitous mobile telemedicine. One major application in pervasive healthcare, termed compre- hensive health monitoring is presented in significant details using wireless networking solutions of wireless LANs, ad hoc wireless networks, and, cellular/GSM/3G infrastructure- orientednetworks.Manyinterestingchallengesofcomprehen- sive wireless health monitoring, including context-awareness, reliability, and, autonomous and adaptable operation are also presented along with several high-level solutions. Several interesting research problems,have,been,identified and presented for future research. Keywords,mobile and wirelessnetworks.pervasive
To give a brief, introductory overview of current developments and trends in miniaturized medical sensors which will be informative to non-specialists in the field.
Summary of the different types of wearable and implantable sensors with examples of current state-of-the-art devices and systems used in medical applications.
After more than a decade of intensive research and development around the world, miniaturized medical sensors are becoming commercially available, allowing increasingly rapid collection of large-scale medical data and its wireless transmission to health care centers. However, most sensor systems are not yet in routine use and still restricted to specialized sites, undergoing validation trials, mostly within research laboratories.
Challenges to routine adoption of medical sensor systems often arise from a combination of lack of awareness of the technology among many medical practitioners, technological limitations of the device systems (artifacts and noise resulting from problems in garment fit or device implantation), and open issues of evaluation and validation for the very broad scope of conditions in home-care and ambient environments over which medical sensors need to operate for routine, reliable, practical use.
The decision to receive palliative care at home brings with it the complexity of managing a medication regime. Effective symptom control is often directly linked to medication management and relies on access to medications at all times. In home-based palliative care practice, polypropylene syringes of medications may be drawn up and left in clients' domestic refrigerators for subcutaneous administration by carers to provide immediate relief for symptoms such as pain and nausea. However, although there has been some discussion in the literature about the need for ready access to medications for symptom control of clients receiving care in the community, the feasibility of this practice has received scant attention. The aim of this article is to present the carers' experiences of administering medications in this manner.
Semistructured interviews with 14 carers, who were administering medication in a home-based palliative care setting, were analyzed using qualitative methods to develop meaning units and themes.
Interviews revealed that this practice was highly valued. The carers willingly assumed the responsibility of medication administration, as it allowed the clients to remain at home where they desired to be. They could provide immediate symptom relief, which was of utmost importance to both the client and carer. The carers were empowered in their caring role, being able to participate in the care provided, rather than standing on the sidelines as helpless observers. Carers acknowledged the security and ethical issues associated with the presence of certain medications in the home and valued the 24-h telephone support that was available to them. After clients had died, the carers reflected on their involvement in care and felt a sense of pride and achievement from administering medications in this way because they had been able to care for their loved ones at home and fulfill their wish to die there.
These interviews confirm the feasibility of this practice, which is a component of quality end-of-life care.