From Wearable Sensors to Smart Implants--Toward Pervasive and Personalized Healthcare.

OBJECTIVE: This paper discusses the evolution of pervasive healthcare from its inception for activity recognition using wearable sensors to the future of sensing implant deployment and data processing. METHODS: We provide an overview of some of the past milestones and recent developments, categorized into different generations of pervasive sensing applications for health monitoring. This is followed by a review on recent technological advances that have allowed unobtrusive continuous sensing combined with diverse technologies to reshape the clinical workflow for both acute and chronic disease management. We discuss the opportunities of pervasive health monitoring through data linkages with other health informatics systems including the mining of health records, clinical trial databases, multiomics data integration, and social media. CONCLUSION: Technical advances have supported the evolution of the pervasive health paradigm toward preventative, predictive, personalized, and participatory medicine. SIGNIFICANCE: The sensing technologies discussed in this paper and their future evolution will play a key role in realizing the goal of sustainable healthcare systems.

Trends in ambulatory self-report: the role of momentary experience in psychosomatic medicine.

In this article, we review the differences between momentary, retrospective, and trait self-report techniques and discuss the unique role that ambulatory reports of momentary experience play in psychosomatic medicine. After a brief historical review of self-report techniques, we discuss the latest perspective that links ambulatory self-reports to a qualitatively different conscious self-the "experiencing self"--which is functionally and neuroanatomically different from the "remembering" and "believing" selves measured through retrospective and trait questionnaires. The experiencing self functions to navigate current environments and is relatively more tied to the salience network and corporeal information from the body that regulates autonomic processes. As evidence, we review research showing that experiences measured through ambulatory assessment have stronger associations with cardiovascular reactivity, cortisol response, immune system function, and threat/reward biomarkers compared with memories or beliefs. By contrast, memories and beliefs play important roles in decision making and long-term planning, but they are less tied to bodily processes and more tied to default/long-term memory networks, which minimizes their sensitivity for certain research questions. We conclude with specific recommendations for using self-report questionnaires in psychosomatic medicine and suggest that intensive ambulatory assessment of experiences may provide greater sensitivity for connecting psychological with biologic processes.

Autotransfusión en emergencias extrahospitalarias / Autotransfusion in extrahospitalary emergencies

La autotransfusión es una técnica conocida desde hace tiempo que consiste básicamente en la recuperación y transfusión al propio paciente de sangre autóloga. En el medio hospitalario se usa frecuentemente en sangrados intra operatorios o postquirúrgicos en intervenciones ortopédicas, cardiacas y vasculares. En Medicina de Urgencias se ha empleado principalmente en conflictos bélicos en casos de hemotórax o hemoperitoneos cuantiosos, recogiendo la sangre de estas cavidades corporales y reinfundiéndola, en pacientes en situación de hipovolemia crítica. Pensamos que es una técnica valiosa que adaptada a nuestro medio y en el contexto de una indicación cuidadosa en medicina de emergencia extrahospitalaria puede ser de enorme utilidad. Hay equipos comerciales relativamente sencillos para realizar esta técnica con eficacia y seguridad. Nosotros, ante la dificultad de acceso real que hoy día tenemos a estos sistemas proponemos un sistema de recogida y reinfusión sencillo partiendo de materiales básicos que podría permitirnos realizar una autotransfusión extrahospitalaria a la espera de contar con medios estándar más adecuados (AU)

Autotransfusion is a long-known technique basically comprising recovery from the patient and later transfusion to the same patient of autologous blood. In the hospitalary environment it is often used in intra or postoperative bleeding in orthopaedic, cardiac and vascular surgery. In the context of emergency medicine it has been used mainly in war in cases of severe haemothorax or haemoperitoneum, recovering the blood from these body cavities and reinfusing it to patients in critical hypovolaemia situations. We consider it to be a valuable technique which might be highly useful in the context of extrahospitalary emergencies, if adapted to our own environment and in the context of a careful indication. Thre are relatively simple commerciallyavailale kits for carrying out this technique with efficacy and safety. Considering the real difficulties in acceding to such kits we are at present faced with, we propose a simple recovery and reinfusion system based on basic material which might allow us to carry out extrahospitalary autotransfusion while awaiting the availability of more adequate standard equipment (AU)