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Muscle dysfunction and muscle atrophy are common complications resulting from Chronic Obstructive Pulmonary Disease (COPD). The evaluation of the peripheral muscles can be carried out through the assessment of their structural components from ultrasound images or their functional components through isometric and isotonic strength tests. This evaluation, performed mainly on the quadriceps muscle, is not only of great interest for diagnosis, prognosis and monitoring of COPD, but also for the evaluation of the benefits of therapeutic interventions. In this work, bioimpedance spectroscopy technology is proposed as a low-cost and easy-to-use alternative for the evaluation of peripheral muscles, becoming a feasible alternative to ultrasound images and strength tests for their application in routine clinical practice. For this purpose, a laboratory prototype of a bioimpedance device has been adapted to perform segmental measurements in the quadriceps region. The validation results obtained in a pseudo-randomized study in patients with COPD in a controlled clinical environment which involved 33 volunteers confirm the correlation and correspondence of the bioimpedance parameters with respect to the structural and functional parameters of the quadriceps muscle, making it possible to propose a set of prediction equations. The main contribution of this manuscript is the discovery of a linear relationship between quadriceps muscle properties and the bioimpedance Cole model parameters, reaching a correlation of 0.69 and an average error of less than 0.2 cm regarding the thickness of the quadriceps estimations from ultrasound images, and a correlation of 0.77 and an average error of 3.9 kg regarding the isometric strength of the quadriceps muscle.
Assuntos
Impedância Elétrica , Doença Pulmonar Obstrutiva Crônica , Humanos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Masculino , Músculo Quadríceps/fisiopatologia , Músculo Quadríceps/diagnóstico por imagem , Músculo Quadríceps/fisiologia , Pessoa de Meia-Idade , Idoso , Feminino , Espectroscopia Dielétrica/métodos , Espectroscopia Dielétrica/instrumentação , Força Muscular/fisiologia , Músculo Esquelético/fisiopatologia , Músculo Esquelético/diagnóstico por imagemRESUMO
Body Sensor Networks (BSN) have emerged as a particularization of Wireless Sensor Networks (WSN) in the context of body monitoring environments, closely linked to healthcare applications. These networks are made up of smart biomedical sensors that allow the monitoring of physiological parameters and serve as the basis for e-Health applications. This Special Issue collects some of the latest developments in the field of BSN related to new developments in biomedical sensor technologies, the design and experimental characterization of on-body/in-body antennas and new communication protocols for BSN, including some review studies.
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Monitorização Fisiológica/instrumentação , Telemedicina , Dispositivos Eletrônicos Vestíveis , Tecnologia sem Fio , Tecnologia Biomédica , Redes de Comunicação de Computadores , HumanosRESUMO
Non-oncologic chronic pain is a common high-morbidity impairment worldwide and acknowledged as a condition with significant incidence on quality of life. Pain intensity is largely perceived as a subjective experience, what makes challenging its objective measurement. However, the physiological traces of pain make possible its correlation with vital signs, such as heart rate variability, skin conductance, electromyogram, etc., or health performance metrics derived from daily activity monitoring or facial expressions, which can be acquired with diverse sensor technologies and multisensory approaches. As the assessment and management of pain are essential issues for a wide range of clinical disorders and treatments, this paper reviews different sensor-based approaches applied to the objective evaluation of non-oncological chronic pain. The space of available technologies and resources aimed at pain assessment represent a diversified set of alternatives that can be exploited to address the multidimensional nature of pain.
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Dor Crônica/fisiopatologia , Fisiologia/métodos , Algoritmos , Frequência Cardíaca/fisiologia , Humanos , Medição da Dor , Escala Visual AnalógicaRESUMO
This work addresses the design and experimental characterization of on-body antennas, which play an essential role within Body Sensor Networks. Four antenna designs were selected from a set of eighteen antenna choices and finally implemented for both passive and active measurements. The issues raised during the process of this work (requirements study, technology selection, development and optimization of antennas, impedance matching, unbalanced to balanced transformation, passive and active characterization, off-body and on-body configurations, etc.) were studied and solved, driving a methodology for the characterization of on-body antennas, including transceiver effects. Despite the influence of the body, the antennas showed appropriate results for an in-door environment. Another novelty is the proposal and validation of a phantom to emulate human experimentation. The differences between experimental and simulated results highlight a set of circumstances to be taken into account during the design process of an on-body antenna: more comprehensive simulation schemes to take into account the hardware effects and a custom design process that considers the application for which the device will be used, as well as the effects that can be caused by the human body.
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The purpose of this work is to describe a first approach to a smart bioimpedance spectroscopy device for its application to the estimation of body composition. The proposed device is capable of carrying out bioimpedance measurements in multiple configurable frequencies, processing the data to obtain the modulus and the bioimpedance phase in each of the frequencies, and transmitting the processed information wirelessly. Another novelty of this work is a new algorithm for the identification of Cole model parameters, which is the basis of body composition estimation through bioimpedance spectroscopy analysis. Against other proposals, the main advantages of the proposed method are its robustness against parasitic effects by employing an extended version of Cole model with phase delay and three dispersions, its simplicity and low computational load. The results obtained in a validation study with respiratory patients show the accuracy and feasibility of the proposed technology for bioimpedance measurements. The precision and validity of the algorithm was also proven in a validation study with peritoneal dialysis patients. The proposed method was the most accurate compared with other existing algorithms. Moreover, in those cases affected by parasitic effects the proposed algorithm provided better approximations to the bioimpedance values than a reference device.
Assuntos
Composição Corporal , Monitorização Fisiológica/métodos , Algoritmos , Antropometria , Estatura , Índice de Massa Corporal , Peso Corporal , Espectroscopia Dielétrica , Impedância Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , SoftwareRESUMO
In this paper, a first approach to the design of a portable device for non-contact monitoring of respiratory rate by capacitive sensing is presented. The sensing system is integrated into a smart vest for an untethered, low-cost and comfortable breathing monitoring of Chronic Obstructive Pulmonary Disease (COPD) patients during the rest period between respiratory rehabilitation exercises at home. To provide an extensible solution to the remote monitoring using this sensor and other devices, the design and preliminary development of an e-Health platform based on the Internet of Medical Things (IoMT) paradigm is also presented. In order to validate the proposed solution, two quasi-experimental studies have been developed, comparing the estimations with respect to the golden standard. In a first study with healthy subjects, the mean value of the respiratory rate error, the standard deviation of the error and the correlation coefficient were 0.01 breaths per minute (bpm), 0.97 bpm and 0.995 (p < 0.00001), respectively. In a second study with COPD patients, the values were −0.14 bpm, 0.28 bpm and 0.9988 (p < 0.0000001), respectively. The results for the rest period show the technical and functional feasibility of the prototype and serve as a preliminary validation of the device for respiratory rate monitoring of patients with COPD.
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Capacitância Elétrica , Monitorização Fisiológica/instrumentação , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Taxa Respiratória , Dispositivos Eletrônicos Vestíveis , Adulto , Feminino , Humanos , Internet , MasculinoRESUMO
BACKGROUND: The term 'Patient Empowerment' (PE) is a growing concept so in popularity as in application covering situations where citizens are encouraged to take an active role in the management of their own health. This concept is serving as engine power for increasing the quality of health systems, but a question is still unanswered, 'how PE will be effectively achieved?' Beyond psychological implications, empowerment of patients in daily practice relies on technology and the way it is used. Unfortunately, the heterogeneity of approaches and technologies makes difficult to have a global vision of how PE is being performed. OBJECTIVE: To clarify how technology is being applied for enhancing patient empowerment as well as to identify current (and future) trends and milestones in this issue. SEARCH STRATEGY: Searches for relevant English language articles using Medline, Scopus, ACM Digital Library, Springer Link, EBSCO host and ScienceDirect databases from the year 2000 until October 2012 were conducted. Among others, a selection criterion was to review articles including terms 'patient' and 'empowerment' in title, abstract or as keywords. MAIN RESULTS AND CONCLUSIONS: Results state that practical approaches to empower patients vary in scope, aim and technology. Health literacy of patients, remote access to health services, and self-care mechanisms are the most valued ways to accomplish PE. Current technology already allows establishing the first steps in the road ahead, but a change of attitude by all stakeholders (i.e. professionals, patients, policy makers, etc.) is required.
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Sistemas de Informação , Participação do Paciente , Humanos , Educação de Pacientes como AssuntoRESUMO
Objetive: .Although transcranial direct current stimulation constitutes a non-invasive neuromodulation technique with promising results in a great variety of applications, its clinical implementation is compromised by the high inter-subject variability reported. This study aims to analyze the inter-subject variability in electric fields (E-fields) over regions of the cortical motor network under two electrode montages: the classical C3Fp2 and an alternative P3F3, which confines more the E-field over this region.Approach.Computational models of the head of 98 healthy subjects were developed to simulate the E-field under both montages. E-field parameters such as magnitude, focality and orientation were calculated over three regions of interest (ROI): M1S1, supplementary motor area (SMA) and preSMA. The role of anatomical characteristics as a source of inter-subject variability on E-field parameters and individualized stimulation intensity were addressed using linear mixed-effect models.Main results.P3F3 showed a more confined E-field distribution over M1S1 than C3Fp2; the latter elicited higher E-fields over supplementary motor areas. Both montages showed high inter-subject variability, especially for the normal component over C3Fp2. Skin, bone and CSF ROI volumes showed a negative association with E-field magnitude irrespective of montage. Grey matter volume and montage were the main sources of variability for focality. The curvature of gyri was found to be significantly associated with the variability of normal E-fields.Significance.Computational modeling proves useful in the assessment of E-field variability. Our simulations predict significant differences in E-field magnitude and focality for C3Fp2 and P3F3. However, anatomical characteristics were also found to be significant sources of E-field variability irrespective of electrode montage. The normal E-field component better captured the individual variability and low rate of responder subjects observed in experimental studies.
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Eletrodos , Córtex Motor , Estimulação Transcraniana por Corrente Contínua , Humanos , Córtex Motor/fisiologia , Masculino , Adulto , Feminino , Adulto JovemRESUMO
Renal transplantation is the treatment of choice for patients suffering from chronic renal disease, one of the leading causes of death worldwide. Among the biological barriers that may increase the risk of acute renal graft rejection is the presence of human leukocyte antigen (HLA) incompatibilities between donor and recipient. This work presents a comparative study of the influence of HLA incompatibilities on renal transplantation survival in the Andalusian (South of Spain) and United States (US) population. The main objective is to analyse the extent to which results about the influence of different factors on renal graft survival can be generalised to different populations. The Kaplan-Meier estimator and the Cox model have been used to identify and quantify the impact on the survival probability of HLA incompatibilities, both in isolation and in conjunction with other factors associated with the donor and recipient. According to the results obtained, HLA incompatibilities considered in isolation have negligible impact on renal survival in the Andalusian population and a moderate impact in the US population. Grouping by HLA score presents some similarities for both populations, while the sum of all HLA scores (aHLA) only has an impact on the US population. Finally, the graft survival probability of the two populations differs when aHLA is considered in conjunction with blood type. The results suggest that the disparities in the renal graft survival probability between the two populations under study are due not only to biological and transplantation-associated factors, but also to social-health factors and ethnic heterogeneity between populations.
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In health systems, there has been an emergence of new types of data and new technologies that allow continuously monitoring the status of the patients and make easy the achievement of real time information. The storage of all the acquired information makes possible to identify trends in medical data by means of new Clinical Decision Support subsystems. Current knowledge management solutions are specific, proprietary and closed and can not perform real-time analysis to improve the patient's diagnosis or treatment. There are neither solutions that integrate the large amount of heterogeneous information that nowadays are available in health environments. To overcome these objections, this paper proposes a new approach to design a data management system in a telehealthcare system with specific real-time constraints on knowledge acquisition and generation. It is a preliminary study and presents the main features of the system architecture and a preview of the technological solution implemented.
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Inteligência Artificial , Sistemas de Gerenciamento de Base de Dados , Sistemas de Apoio a Decisões Clínicas , Telemedicina , Telemetria , Humanos , Nefropatias/terapia , Sistemas Automatizados de Assistência Junto ao Leito , Software , Interface Usuário-ComputadorRESUMO
A critical issue in healthcare informatics is to facilitate the integration and interoperability of applications. This goal can be achieved through an open architecture based on a middleware independent from specific applications; useful for working with existing systems, as well as for the integration of new systems. Several standard organizations are making efforts toward this target. This work is based on the EN 12967-1,2,3, developed by CEN, that follows the ODP (Open Distributed Processing) methodology, providing a specification of distributed systems based on the definition of five viewpoints. However, only the three upper viewpoints are used to produce EN 12967, the two lower viewpoints should be considered in the implementation context. We are using Semantic Grid for lower views and Semantic Web and Web Services for the definition of the upper views. We analyze benefits of using these methods and technologies and expose methodology for the development of this semantic healthcare middleware observing European Standards.
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Inteligência Artificial , Sistemas de Informação , Internet , Semântica , Integração de Sistemas , Europa (Continente) , Humanos , SoftwareRESUMO
Intrabody Communication (IBC) uses the human body tissues as transmission media for electrical signals to interconnect personal health devices in wireless body area networks. The main goal of this work is to conduct a computational analysis covering some bioelectric issues that still have not been fully explained, such as the modeling of skin-electrode impedance, the differences associated with the use of constant voltage, or current excitation modes, or the influence on attenuation of the subject's anthropometrical and bioelectric properties. With this aim, a computational finite element model has been developed, allowing the IBC channel attenuation as well as the electric field and current density through arm tissues to be computed as a function of these parameters. As a conclusion, this parametric analysis has in turn permitted us to disclose some knowledge about the causes and effects of the above-mentioned issues, thus, explaining and complementing previous results reported in the literature.
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Impedância Elétrica , Resposta Galvânica da Pele/fisiologia , Modelos Biológicos , Telemetria/métodos , Anisotropia , Braço/fisiologia , Desenho de Equipamento , Análise de Elementos Finitos , Humanos , Masculino , Telemetria/instrumentaçãoRESUMO
Despite first written references to permanent developmental stuttering occurred more than 2500 years ago, the mechanisms underlying this disorder are still unknown. This paper briefly reviews stuttering causal hypothesis and treatments, and presents the requirements that a new stuttering therapeutic device should verify. As a result of the analysis, an adaptive altered auditory feedback device based on a multimodal intelligent monitor, within the framework of a knowledge-based telehealthcare system, is presented. The subsequent discussion, based partly on the successful outcomes of a similar intelligent monitor, suggests that this novel device is feasible and could help to fill the gap between research and clinic.
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Biorretroalimentação Psicológica/instrumentação , Retroalimentação , Gagueira/terapia , Telemedicina , Biorretroalimentação Psicológica/métodos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Fonoterapia , Gagueira/etiologiaRESUMO
OBJECTIVES: Several important problems in the majority of countries are challenging the centralized and overburdened current model of healthcare. Telehealthcare is presented as a new paradigm that offers high expectations to solve this picture. In this paper we present the major outcomes of the viability study of a novel personalized telehealthcare system for nephrology (NEFROTEL). METHODS: The study evaluates the accuracy and quality of the knowledge generated by two key processing layers, namely, sensor layer and patient physiological image (PPI) layer, in an independent way, thanks to its modular design. The first one was defined by a personalized falling detection monitor, on account of the consequences of falls in chronic renal patients. The second one was analyzed by means of a PPI's prototype based on a urea compartmental pharmacokinetic model. The experimental study of the falling detector monitor has been more extensive than the other because the latter has already been addressed in other works. RESULTS: The outcomes show, firstly, the capability of the PPIs to provide integrated and correlated physiological knowledge adapted to each patient, and secondly, demonstrate the reliability of the impact detection function of the adaptive human movement monitor compliant with the NEFROTEL paradigm. CONCLUSIONS: The study confirms that NEFROTEL is able to provide knowledge concerning a patient in a manner that cannot be accomplished by the ordinary healthcare model at the present time.
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Atenção à Saúde/organização & administração , Falência Renal Crônica/terapia , Nefrologia/métodos , Telemedicina , Idoso , Idoso de 80 Anos ou mais , Atenção à Saúde/normas , Estudos de Viabilidade , Feminino , Humanos , Falência Renal Crônica/economia , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Equipe de Assistência ao Paciente , Diálise RenalRESUMO
Several studies point out the paradox that classic telemedicine by which doctor interacts remotely with patients in real-time is disappearing despite it has not been widely adopted yet. Many cues indicate that health information technologies will be finally adopted because of the growth in health expenditure and the emerging healthcare challenges. Notwithstanding, a detailed analysis of the referred concern has led us to propose a shift in the paradigm of telemedicine systems. This paper presents the major methodological issues of the information model of a novel telehealthcare system for nephrology (Nefrotel) which supports the cited shift in the paradigm. With this objective, we first revise the technological requirements of the database of Nefrotel, and second analyze the current scenario of health information model standards. Our study has shown that it is possible to ensure the compliance and evolution of Nefrotel with information model standards, maximizing its interoperability.
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Redes de Comunicação de Computadores/organização & administração , Sistemas Inteligentes , Nefrologia , Integração de Sistemas , Telemedicina , Simulação por Computador , Bases de Dados Factuais , Humanos , Bases de ConhecimentoRESUMO
BACKGROUND: M2M (Machine-to-Machine) communications represent one of the main pillars of the new paradigm of the Internet of Things (IoT), and is making possible new opportunities for the eHealth business. Nevertheless, the large number of M2M protocols currently available hinders the election of a suitable solution that satisfies the requirements that can demand eHealth applications. OBJECTIVES: In the first place, to develop a tool that provides a benchmarking analysis in order to objectively select among the most relevant M2M protocols for eHealth solutions. In the second place, to validate the tool with a particular use case: the respiratory rehabilitation. METHODS: A software tool, called Distributed Computing Framework (DFC), has been designed and developed to execute the benchmarking tests and facilitate the deployment in environments with a large number of machines, with independence of the protocol and performance metrics selected. RESULTS: DDS, MQTT, CoAP, JMS, AMQP and XMPP protocols were evaluated considering different specific performance metrics, including CPU usage, memory usage, bandwidth consumption, latency and jitter. The results obtained allowed to validate a case of use: respiratory rehabilitation of chronic obstructive pulmonary disease (COPD) patients in two scenarios with different types of requirement: Home-Based and Ambulatory. CONCLUSIONS: The results of the benchmark comparison can guide eHealth developers in the choice of M2M technologies. In this regard, the framework presented is a simple and powerful tool for the deployment of benchmark tests under specific environments and conditions.
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Benchmarking , Internet , Doenças Respiratórias/reabilitação , HumanosRESUMO
In this paper, a burn color image segmentation and classification system is proposed. The aim of the system is to separate burn wounds from healthy skin, and to distinguish among the different types of burns (burn depths). Digital color photographs are used as inputs to the system. The system is based on color and texture information, since these are the characteristics observed by physicians in order to form a diagnosis. A perceptually uniform color space (L*u*v*) was used, since Euclidean distances calculated in this space correspond to perceptual color differences. After the burn is segmented, a set of color and texture features is calculated that serves as the input to a Fuzzy-ARTMAP neural network. The neural network classifies burns into three types of burn depths: superficial dermal, deep dermal, and full thickness. Clinical effectiveness of the method was demonstrated on 62 clinical burn wound images, yielding an average classification success rate of 82%.
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Inteligência Artificial , Queimaduras/classificação , Queimaduras/patologia , Cor , Colorimetria/métodos , Interpretação de Imagem Assistida por Computador/métodos , Reconhecimento Automatizado de Padrão/métodos , Algoritmos , Estudos de Viabilidade , Lógica Fuzzy , Humanos , Aumento da Imagem/métodos , Armazenamento e Recuperação da Informação/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
In this paper, a computer assisted diagnosis (CAD) tool for the classification of burns into their depths is proposed. The aim of the system is to separate burn wounds from healthy skin, and to distinguish among the different types of burns (burn depths) by means of digital photographs. It is intended to be used as an aid to diagnosis in local medical centres, where there is a lack of specialists. Another potential use of the system is as an educational tool. The system is based on the analysis of digital photographs. It extracts from those images colour and texture information, as these are the characteristics observed by physicians in order to form a diagnosis. Clinical effectiveness of the method was demonstrated on 35 clinical burn wound images, yielding an average classification success rate of 88% compared to expert classified images.
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Queimaduras/diagnóstico , Diagnóstico por Computador/métodos , Índices de Gravidade do Trauma , Algoritmos , Queimaduras/classificação , Queimaduras/patologia , Cor , Humanos , Processamento de Imagem Assistida por Computador/métodos , Reconhecimento Automatizado de Padrão , Fotografação/métodosRESUMO
Several important problems in the majority of industrialized countries have challenged the centralized and overburdened current model of healthcare. Telehealthcare systems are presented as a new paradigm, offering high expectations to provide effective solutions to this picture. With this paper we present a new methodological approach for telehealthcare systems that pursues the generation of clinical and physiological knowledge of the patient in a real time and personalized manner. This approach is based on a computational component, identified as patient physiological image (PPI), which is responsible for generating an image of the state of the patient and therapy devices. Three key issues of the proposed methodological approach are evaluated. With the objective to validate the capability of the PPI to determine the internal state of a patient, a digital simulation experiment over the mathematical model of a PPI is done. Numerical results are compared to those obtained by a validated mathematical model. Secondly, a laboratory prototype of a novel human physical activity monitor that follows the designed methodological approach will be tested, in order to evaluate the trade-off between processing capacity, portability, and cost-efficiency and power consumption, which are necessary to assure its compliance with the methodology. As a third key issue, the capability of our methodology to integrate physiological information belonging to different scales is analyzed. This is done by means of a case study related to the integration of the regulation of water function of AQP2 channels (genomic, proteomic and cellular levels) into a kidney collecting duct epithelium mathematical model of a PPI. The analysis and preliminary evaluation of the proposed telehealthcare methodological approach, featured by an advanced personalization of health assistance, have been satisfactory.
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Proteômica , Telemedicina , Atenção à Saúde , Humanos , Modelos Teóricos , Monitorização Fisiológica , Integração de SistemasRESUMO
SIGNIFICANCE: The need for increasingly energy-efficient and miniaturized bio-devices for ubiquitous health monitoring has paved the way for considerable advances in the investigation of techniques such as intrabody communication (IBC), which uses human tissues as a transmission medium. However, IBC still poses technical challenges regarding the measurement of the actual gain through the human body. The heterogeneity of experimental setups and conditions used together with the inherent uncertainty caused by the human body make the measurement process even more difficult. GOAL: The objective of this study, focused on galvanic coupling IBC, is to study the influence of different measurement equipments and conditions on the IBC channel. METHODS: Different experimental setups have been proposed in order to analyze key issues such as grounding, load resistance, type of measurement device and effect of cables. In order to avoid the uncertainty caused by the human body, an IBC electric circuit phantom mimicking both human bioimpedance and gain has been designed. Given the low-frequency operation of galvanic coupling, a frequency range between 10 kHz and 1 MHz has been selected. RESULTS: The correspondence between simulated and experimental results obtained with the electric phantom have allowed us to discriminate the effects caused by the measurement equipment. CONCLUSION: This study has helped us obtain useful considerations about optimal setups for galvanic-type IBC as well as to identify some of the main causes of discrepancy in the literature.