Unobtrusive, Continuous LIDAR-Based Measurement of Gait Characteristics at Home.

This paper describes a novel approach to the unobtrusive assessment of a subset of gait characteristics using a light detection and ranging (LIDAR) device. The developed device is poised to enable unobtrusive, nearly continuous monitoring and inference of patients' gait characteristics to assess physical and cognitive states. The device provides a rapidly sampled signal representing the distance of a participant's body from the LIDAR device. The densely sampled distance estimation is processed by custom algorithms that can potentially be used to estimate various gait characteristics such as step size, cadence, double support, and even step-size symmetry.Clinical Relevance- Since gait is a complex behavior that requires seamless cooperation of multiple systems, including sensation, perception, muscular synergies, and even cognition. Subtle changes in gait may, therefore, indicate issues with physical and mental functionality. In addition to the walking speed, the gait monitoring results can provide inferences about the physical and cognitive states of the unobtrusively monitored individuals using their own data as a baseline.

Unobtrusive computer monitoring of sensory-motor function.

Cognitive assessments and the early detection of dementia are an important component of clinical care. In this paper we describe an approach to continuous monitoring of sensory-motor function that corresponds to standard tests of cognitive function, but measured more frequently and in a natural home environment. The approach is based on monitoring human-computer interactions using standard devices such as keyboard and pointing devices.

The impact of a community-wide self-care information project on self-care and medical care utilization.

This study assesses the effects of the Healthwise Communities Project (HCP) on use of self-care resources and health care utilization. The intervention included the distribution of the Healthwise Handbook, the provision of a telephone advice line, and a Web site. All of these products use a symptom-based approach and are aimed at a general population. A quasi-experimental design was used with two comparison communities. Measurements over time assessed the effects of the HCP while controlling for secular trends. Survey and utilization data are used to assess the effect of the intervention. Findings indicate that the community intervention increased the use of self-care resources. Users believe that these products help them make better decisions regarding when to seek care and how to self-treat problems. Most believe that using the self-care resources saved them from seeking unnecessary care. The findings from the utilization data provide some evidence to support this conclusion.

Techniques for identifying the applicability of new information management technologies in the clinical setting: an example focusing on handheld computers.

This article describes techniques and strategies used to judge the potential applicability of new information management technologies in the clinical setting and to develop specific design recommendations for new features and services. We focus on a project carried out to identify the potential uses of handheld computers (i.e., the Palm Pilot or a small WinCE-based device) in the ambulatory practice setting. We found that the potential for a robust handheld computing device to positively affect the outpatient ambulatory clinical setting is enormous, and that the information derived from the exploratory research project is useful in creating specific design recommendations for further development.

Prevalence and predictors of the use of self-care resources.

Health care reform goals are to reduce costs and increase access while maintaining quality of care. A potentially effective avenue for achieving these difficult goals is to activate the untapped potential of consumers in managing their own health care. This study focuses on three Northwest communities and examines the prevalence of the use of self-care resources and the correlates of use. A random sample of households was surveyed using a mail-out questionnaire. The findings indicated that the use of self-care resources was high in the three community populations. Consulting a self-care book was the most commonly used resource, followed by telephone advice nurses. Communities do vary in their level of self-care resource use. Understanding this variability may help communities to expand the use of such resources and lessen the demand for formal health care services. Suggestions for future studies are discussed.

Health care providers and purchasers and evaluation of interactive health communication applications. Science Panel on Interactive Communication and Health.

Health care providers and purchasers of health services have an opportunity to improve patient care and potentially save costs through the wise purchase of interactive health communication applications for patients and employees. Purchasing decisions based on evaluation and evidence should drive the design and development of new systems. The cycle of evaluation includes a needs assessment before system development, usability testing during development, and studies of use and outcomes in natural settings. This type of evidence is critical to our understanding of how best to provide health information and decision assistance to patients, employees, and others.

Advances in health information technology for patients.

Patients now have access to a wide variety of health-related educational material via computers and other sources. To ensure quality, security, and data integrity, it is likely that these databases of patient health information will become part of the information that HIM professionals manage and coordinate for patient use in the clinical setting. This article describes the health information resources available to patients.

The use of multimedia in the informed consent process.

OBJECTIVE: The goal of the project was to create recommendations and design specifications for a multimedia tool to enhance the informed consent process for clinical trials. The authors focused on the needs of patients with potential cognitive impairment. DESIGN: The authors first performed a needs assessment using focus groups and interviews with health care researchers, institutional review board members, and three groups of patients (who had depression, breast cancer, or schizophrenia). Their feedback was incorporated into the design of a prototype multimedia tool. The design included general modules with information about clinical trials and informed consent as well as trial-specific modules. The authors then used the resulting prototype multimedia tool for informed consent in follow-up focus groups and interviews to obtain feedback on the feasibility and potential effectiveness of using such a tool routinely for clinical trials. RESULTS: The authors showed that it was feasible to adapt a structured multimedia informed consent system to a specific clinical trial and to incorporate techniques to improve the understandability of informed consent content. Patients generally felt the prototype system was useful and could replace the paper document. They felt using the system would be less stressful, because they would have a greater sense of control and could proceed at their own pace. They liked the hierarchic and modular approach to providing information and felt that the use of video made information more understandable. Researchers and institutional review board members also found the system to be valuable in these ways but had concerns about how to review the system for potential biases in presentation and about the legal issues associated with replacing the paper document.

Physician and plan effects on satisfaction of Medicaid managed care patients with their health care and providers.

As many Medicaid patients move into managed care, it is important that physicians competing to serve these patients understand the factors that lead to patient satisfaction. This study uses survey data from 7,313 Oregon Medicaid managed care patients to create a model describing how provider effects and health plan effects relate to patients' satisfaction with their medical care and provider. Path analysis was used to test the explanatory power and strength of relationships in the model. Perceived technical and interpersonal physician quality and health plan rating were most strongly linked with these patients' satisfaction with their care and provider.

A QRS detection algorithm.

In this article we present the choices that the designers of any QRS detector must make and explain the constraints we adopted. We outline the signal processing that precedes and the beat analysis that follows QRS detection in our single-channel, arrhythmia-monitoring algorithm and then expound the QRS detection algorithm in detail. Finally, we present the results of a QRS detector performance evaluation and comment on their importance. This article can be read to three depths: the text affords an overview of QRS detection for on-patient, ambulatory arrhythmia analysis; the commented pseudocode documents the logic of our QRS detector; and the pseudocode "footnotes" supply technical detail.

Cutaneous monitoring of systemic PCO2 on patients in the respiratory intensive care unit being weaned from the ventilator.

A procedure for measuring the partial pressure of CO2 in equilibrium with the epidermis was developed at Hewlett--Packard Laboratories. It consists of determining by infra-red absorption techniques the concentration of CO2 inside a small (50 microliter) chamber applied hermetically over and around an epidermal window (2.25 cm2) stripped of its stratum corneum or horny layer. We have applied the procedure to 25 patients in the Respiratory Intensive Care Unit at Stanford Hospital. Only patients scheduled for weaning from the ventilator were selected for the study. The epidermal windows were on the medial aspect of the forearm and were monitored for 3--6 h. Arterial blood samples were periodically withdrawn from the catheterized radial artery and were analysed by conventional means for subsequent comparison with the cutaneous measurements which were recorded in real time at the rate of one a minute. The range of arterial PCO2 values that were measured varied from 3.33 to 9.30 kPa (25 to 70 mmHg) and correlated well with the corresponding cutaneous PCO2 values that were typically higher than the arterial values by 0.7 kPa (5.2 mmHg) with a standard deviation of 0.2 kPa (1.5 mmHg). Some recordings of cutaneous PCO2 are shown and discussed.