Analytic Hierarchy Process to Define the Most Important Factors and Related Technologies for Empowering Elderly People in Taking an Active Role in their Health.

Successful management of health conditions in older population is determined by strategic involvement of a professional team of careers and by empowering patients and their caregivers to take over a central role and responsibility in the daily management of condition. Identifying, structuring and ranking the most important needs related to these aspects could pave the way for improved strategies in designing systems and technological solutions supporting user empowerment. This paper presents the preliminary results of a study aiming to elicit these needs. Healthcare professionals, working together in the European and Innovation Partnership on Active and Healthy Ageing (EIP-AHA) initiative, have defined a set of needs and factors that have been organized in two hierarchies around the concepts of patient activation and proactive and prepared care team, defined in the Chronic Care Model. The two hierarchies have been mapped, by a team of experts in computer science, with technologies and solutions that could facilitate the achievement of the identified needs.

Building Bridges for Innovation in Ageing: Synergies between Action Groups of the EIP on AHA.

The Strategic Implementation Plan of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) proposed six Action Groups. After almost three years of activity, many achievements have been obtained through commitments or collaborative work of the Action Groups. However, they have often worked in silos and, consequently, synergies between Action Groups have been proposed to strengthen the triple win of the EIP on AHA. The paper presents the methodology and current status of the Task Force on EIP on AHA synergies. Synergies are in line with the Action Groups' new Renovated Action Plan (2016-2018) to ensure that their future objectives are coherent and fully connected. The outcomes and impact of synergies are using the Monitoring and Assessment Framework for the EIP on AHA (MAFEIP). Eight proposals for synergies have been approved by the Task Force: Five cross-cutting synergies which can be used for all current and future synergies as they consider overarching domains (appropriate polypharmacy, citizen empowerment, teaching and coaching on AHA, deployment of synergies to EU regions, Responsible Research and Innovation), and three cross-cutting synergies focussing on current Action Group activities (falls, frailty, integrated care and chronic respiratory diseases).

Comparative assessment of glucose prediction models for patients with type 1 diabetes mellitus applying sensors for glucose and physical activity monitoring.

The present work presents the comparative assessment of four glucose prediction models for patients with type 1 diabetes mellitus (T1DM) using data from sensors monitoring blood glucose concentration. The four models are based on a feedforward neural network (FNN), a self-organizing map (SOM), a neuro-fuzzy network with wavelets as activation functions (WFNN), and a linear regression model (LRM), respectively. For the development and evaluation of the models, data from 10 patients with T1DM for a 6-day observation period have been used. The models' predictive performance is evaluated considering a 30-, 60- and 120-min prediction horizon, using both mathematical and clinical criteria. Furthermore, the addition of input data from sensors monitoring physical activity is considered and its effect on the models' predictive performance is investigated. The continuous glucose-error grid analysis indicates that the models' predictive performance benefits mainly in the hypoglycemic range when additional information related to physical activity is fed into the models. The obtained results demonstrate the superiority of SOM over FNN, WFNN, and LRM with SOM leading to better predictive performance in terms of both mathematical and clinical evaluation criteria.

Telehygiene system for preventive chronopharmacology in space.

A remote computerized health care (telehygiene) system for space travel includes monitoring devices and pharmaceuticals aimed at the optimization of health and the environment. Early risk indicators are provided by dynamic characteristics of rhythms of several frequencies describing variation inside the physiologic range. These rhythm characteristics, assessed as one goes, can be updated and compacted as data accumulate by the use of chronobiologic software that resolves anticipated components of lower and lower frequency, thus providing summaries of data at intervals of differing length. At any time, harbingers of risk, including characteristics of circannual rhythms, can be retrieved in an instant. On their basis, early preventive action can be instituted for risk lowering and for delivery of timed treatment when needed. Preventive or curative health care in space and terrestrial spin-offs are the more effective the more of the chronome (time-structure) is resolved.

Effect of amiodarone on ventricular fibrillation and defibrillation thresholds in the canine heart under normal and ischemic conditions.

The main goal of this project was to study the effect of amiodarone upon ventricular fibrillation and defibrillation thresholds (VFT and VDT) in the canine heart under normal and ischemic conditions. Both parameters were assessed in 11 dogs, each experiment consisting of three consecutive phases: (a) control, which resulted in VFT = 27.9 (S.D. = 15.5) and VDT = 43.9 (S.D. = 4.5); (b) drug, with VFT = 63.5 (S.D. = 32.8) and VDT = 57.8 (S.D. = 11.3), and (c) coronary occlusion, with VFT = 44.7 (S.D. = 21.6) and VDT = 57.1 (S.D. = 11.0). These values are overall means scaled to ventricular weight (microA/g for VFT and mA/g for VDT). Both VFT and VDT in (b) and (c) were, on the average, greater than in (a) and these differences were statistically significant (P less than 0.01, paired t-test). The animals were kept normothermic (37.3 degrees C, S.D. = 0.6) within normal values for the acid-base state. We concluded that amiodarone increased the VFT significantly. Similarly, it increased VDT. However, although the latter change was statistically significant, we believe it would not be important from a physiological or clinical point of view.

Multimedia telehomecare system using standard TV set.

Nowadays, there are a very large number of patients that need specific health support at home. The deployment of broadband communication networks is making feasible the provision of home care services with a proper quality of service. This paper presents a telehomecare multimedia platform that runs over integrated services digital network and internet protocol using videoconferencing standards H.320 and H.323, and standard TV set for patient interaction. This platform allows online remote monitoring: ECG, heart sound, blood pressure. Usability, affordability, and interoperability were considered for the design and development of its hardware and software components. A first evaluation of technical and usability aspects were carried forward with 52 patients of a private clinic and 10 students in the University. Results show a high rate (mean = 4.33, standard deviation--SD = 1.63 in a five-points Likert scale) in the global perception of users on the quality of images, voice, and feeling of virtual presence.

A telemedicine system for remote cooperative medical imaging diagnosis.

Telemedicine is changing the classical form of health care delivery, by providing efficient solutions to an increasing number of new situations: here we consider those which require some type of computer-supported cooperative work (CSCW) between health care professionals located in different clinical sites. This paper presents the design and development of a telemedicine system for remote computer-supported cooperative medical imaging diagnosis. The main and novel component of our system is a new CSCW distributed architecture, comprised by a collaborative toolkit to add audioconferencing, telepointing, window sharing, user's coordination and application synchronization facilities, either to existing or new medical imaging diagnosis applications. In comparison with existing CSCW products, mainly based on centralized architectures, our distributed toolkit is specially designed for telemedicine applications: to allow different levels of sharing between participants, to improve user feedback in highly interactive user interfaces, and to optimize the required communication bandwidth in order to implement a telemedicine CSCW application on almost any telecommunication network. This telemedicine CSCW system has been applied to build a cooperative medical imaging diagnosis application, in which two doctors, located in different hospitals, need to achieve a cooperative diagnosis on haemodynamic studies using cardiac angiography images. The design of the graphical user interface for this kind of telemedicine CSCW systems, a critical component which conforms any telemedicine application, is also addressed with a new methodological approach, to assure the system usability and final user acceptance. The telemedicine cardiac angiography pilot has been implemented, tested and evaluated within the Research Project 'FEST-Framework for European Services in Telemedicine' funded by EU AIM Programme.

Integration of telemedicine into emergency medical services.

We developed an integrated model of telemedicine services in emergency medical care. The architecture was designed to support pre-hospital management. The experimental work was carried out with the collaboration of the emergency medical services (EMS) in Madrid. Two different study populations were defined: a control population using conventional EMS protocols and a population using the telemedicine system. The telemedicine system was based on a telepresence service; electrocardiograms and images were transmitted from the ambulance to the health emergency coordination centre. The cost of dealing with 100 patients using telemedicine was C6030 less than the cost of conventional care. The response times using telemedicine were significantly lower.

Transmission trials with a support system for the treatment of cardiac arrest outside hospital.

A mobile electrocardiogram (ECG) transmission system was developed which could transmit single-lead ECG data via GSM mobile telephony. Ambulance transmission trials comprised a total of 72 communications, of which 94% were successful. The system was able to redial up to a predetermined number of times until the GSM call was re-established (during the trials this value was set to five). The average number of GSM call tries was 1.3 per connection. The mean time required to establish a connection was 45 s; the minimum was 34 s, when only one attempt was needed to establish a GSM call. The average duration of ECG transmission between communication breakdowns was 5 min 12 s. When a link breakdown occurred, the user had to wait for an average of only 42 s to continue monitoring the signal.

Modelling home televisiting services using systems dynamic theory.

A quantitative model was developed to study the provision of a home televisiting service. Systems dynamic theory was used to describe the relationships between quality of care, accessibility and cost-effectiveness. Input information was gathered from the telemedicine literature, as well as from over 75 sessions of a televisiting service provided by the Severo Ochoa Hospital to 18 housebound patients from three different medical specialties. The model allowed the Severo Ochoa Hospital to estimate the equipment needed to support increased medical contacts for intensive cardiac and other patients.

Patient satisfaction with a home televisiting service based on interactive television over a cable network.

Experience shows that high-quality audiovisual contact between remote health carers and patients facilitates a telemedicine service. However, the lack of broadband communication to the home usually prevents domestic televisiting. Deployment of cable networks in Spain has allowed the implementation of a home televisiting service designed for patients with chronic diseases. In a trial, 15 patients received televisits by three specialists and three nurses from the Severo Ochoa Hospital in Madrid. Five patients suffered from chronic pain, five were from the nephrology unit and five had been treated at the intensive-care unit after acute myocardial infarction. Each patient participated in three televisiting sessions, two provided by a specialist and the other by a nurse. The average length of a televisit was 12 min (range 5-21 min). The patients expressed their satisfaction with the service.

A home telecare management system.

The increasing tendency to discharge chronic patients from hospital, as well as the growing expectation of improved quality of life for elderly and disabled people at home, was the original motivation for the development of a home telecare management system. The system allows a service centre to perform remote monitoring of biological signals and other data via the public telephone network, as well as to manage different emergency situations arising at home. The system is part of the FU-funded EPIC project (European Prototype for Integrated Care). It was tested in Belfast (Northern Ireland) and is currently being installed in Torre del Mar (Spain). This paper describes the system design and preliminary evaluation. The results indicate that the system operators find it highly acceptable in terms of efficiency, effectiveness, helpfulness, control and learnability. Integration of home telecare data with community-care information systems is essential if data captured at home are to be incorporated into the care process effectively.

An assistive home care environment for people with special needs.

We have developed a system for supporting people with special needs. It allows remote monitoring of electrocardiographic and other signals together with multimode environmental control. The multimodal approach allows users with disabilities to interact more with the home environment. Telemedicine devices were integrated into the system to provide a link to health services. The system provided support for the independent living of people with special needs. The pilot site was a rehabilitation service attached to the National Paraplegic Hospital of Toledo, Spain. During the six-week trial period, the system did not fail, nor was any unauthorized access reported. Twelve people with special needs and three staff evaluated aspects of the system on a scale from 0 to 9, on which higher scores indicated a positive assessment. The mean score for efficiency was 7.8, for satisfaction 8, for helpfulness 7.4, for controllability 7.2 and for learnability 8.

Theoretical efficiency of a televisiting service for home care support.

We have made a theoretical study of the potential for televisiting. All journeys made by the home care support team in an area of Madrid were reviewed to study the possibility of using televisiting. During the year 2000 the team provided an average of seven home visits a day. The home visits took 30 min on average, and the journey time was 30 min for urban areas and 45 min in the suburbs. We estimated that two of each day s visits could be carried out by telemedicine, with a mean duration of 15 min each. A model was used to calculate the resource demands and the potential cost-savings of televisiting compared with traditional home care. Using televisiting, 62% more suburban oncology patients could be managed and a cost reduction of euro;6 per visit could be achieved after 10 weeks.

Using cable television networks for interactive home telemedicine services.

Most recent cable television network infrastructures can be used to deliver broadband interactive telemedicine services to the home. These facilities allow the provision of social and health services like medical televisiting for elderly, disabled and chronically ill patients; health tele-education; and teleconsultation on demand. Large numbers of patients could benefit from these services. There is also the increasing European tendency to offer customized home-care services. These applications are being developed and validated by a pilot project in Madrid as part of the ATTRACT project of the European Commission. The long-term aim is to develop broadband applications on a large scale to support low-cost interactive home telemedicine services for both patients and institutions.

A telemedicine model for integrating point-of-care testing into a distributed health-care environment.

Centralized testing demands costly laboratories, which are inefficient and may provide poor services. Recent advances make it feasible to move clinical testing nearer to patients and the requesting physicians, thus reducing the time to treatment. Internet technologies can be used to create a virtual laboratory information system in a distributed health-care environment. This allows clinical testing to be transferred to a cooperative scheme of several point-of-care testing (POCT) nodes. Two pilot virtual laboratories were established, one in Italy (AUSL Modena) and one in Greece (Athens Medical Centre). They were constructed on a three-layer model to allow both technical and clinical verification. Different POCT devices were connected. The pilot sites produced good preliminary results in relation to user acceptance, efficiency, convenience and costs. Decentralized laboratories can be expected to become cost-effective.

User satisfaction with home telecare based on broadband communication.

Home telecare services based on broadband communication were established in five locations in Europe. Two different types of telecare unit were developed: one based on a PC or set-top box containing a videoconferencing codec and another on off-the-shelf videoconferencing units. The participants in the project were 13 medical staff, 135 patients and 88 people informally caring for the patients. Questionnaires were used to evaluate user satisfaction with eight telecare services. Almost all participants rated the usability of the system as good or excellent. A total of 105 telecare sessions were scored by the medical staff. Overall, the quality of audio and video communication was judged satisfactory. For the patients and carers, the perceived quality of communication was also satisfactory and did not vary significantly between sites. The medical staff were reasonably satisfied with how the service supported them in their work. Except for the item about being able to support patients in a critical situation, medical staff agreed that an improved quality of health services was offered through telecare. All participants agreed that personal information was treated confidentially and that there was little risk in using the telecare services. The medical staff trusted the assessments they could make remotely while using the telecare system. Although the findings cannot be generalized due to the small number of telecare sessions and the relatively short duration of the experiment, the results encourage further research.

[Bardet-Biedl syndrome: subclinical renal disorders in 2 siblings]. / Síndrome de Bardet-Biedl: alteraciones renales subclínicas en dos hermanos.

Two siblings with Bardet-Biedl's syndrome are studied, in whom renal structural and functional disorders were observed, with reduction in the ability to concentrate urine in both cases and decrease of creatinine clearance in the second case. The study of the hypophyseal function was normal.

"AmI for health: chronic disease management".

Several students of Bioengineering complain about the excess of theoretical classes and the difficulty to assimilate the subject taught. This work presents a strategy to mix theory and practice when teaching, thus motivating students to engage in their studies.

A mobile feedback system for integrated E-health platforms to improve self-care and compliance of diabetes mellitus patients.

Exploiting the full potential of telemedical systems means using platform based solutions: data are recovered from biomedical sensors, hospital information systems, care-givers, as well as patients themselves, and are processed and redistributed in an either centralized or, more probably, decentralized way. The integration of all these different devices, and interfaces, as well as the automated analysis and representation of all the pieces of information are current key challenges in telemedicine. Mobile phone technology has just begun to offer great opportunities of using this diverse information for guiding, warning, and educating patients, thus increasing their autonomy and adherence to their prescriptions. However, most of these existing mobile solutions are not based on platform systems and therefore represent limited, isolated applications. This article depicts how telemedical systems, based on integrated health data platforms, can maximize prescription adherence in chronic patients through mobile feedback. The application described here has been developed in an EU-funded R&D project called METABO, dedicated to patients with type 1 or type 2 Diabetes Mellitus.