Communication architecture for AAL. Supporting patient care by health care providers in AAL-enhanced living quarters.

INTRODUCTION: This article is part of the Focus Theme of Methods of Information in Medicine on "Using Data from Ambient Assisted Living and Smart Homes in Electronic Health Records". BACKGROUND: Concepts of Ambient Assisted Living (AAL) support a long-term health monitoring and further medical and other services for multi-morbid patients with chronic diseases. In Germany many AAL and telemedical applications exist. Synergy effects by common agreements for essential application components and standards are not achieved. OBJECTIVES: It is necessary to define a communication architecture which is based on common definitions of communication scenarios, application components and communication standards. METHODS: The development of a communication architecture requires different steps. To gain a reference model for the problem area different AAL and telemedicine projects were compared and relevant data elements were generalized. The derived reference model defines standardized communication links. RESULTS: As a result the authors present an approach towards a reference architecture for AAL-communication. The focus of the architecture lays on the communication layer. The necessary application components are identified and a communication based on standards and their extensions is highlighted. CONCLUSION: The exchange of patient individual events supported by an event classification model, raw and aggregated data from the personal home area over a telemedicine center to health care providers is possible.

[Laxative abuse, plasma potassium levels and chronic interstitial nephritis due to phenacetin abuse (author's transl)]. / Laxantienabusus, Plasma-Kalium und chronische interstitielle Nephritis durch Phenacetinabusus

In 154 patients with phenacetin nephropathy and in 26 patients with phenacetin abuse but without nephropathy a laxative abuse was observed in 3.2% and 15.4%, hypokalemia (3.5 maequ/l or less) in 9.1% and 3.9, respectively. The mean plasma potassium concentration was normal in both groups (4.45 and 4.22 maequ/l, respectively). These data do not support the recently proposed hypothesis that the simultaneous abuse of laxatives contributes to the development of analgesic nephropathy, and that the absence of laxative intake might explain the lack of renal damage in some phenacetin abusers. Although it cannot be excluded that long-standing potassium deficiency in consequence of an abuse of laxatives or diuretics exerts an additional nephrotoxic effect in some cases, this mechanism seems not to be involved in the majority of patients with phenacetin nephropathy.