A three stage ontology-driven solution to provide personalized care to chronic patients at home.

PURPOSE: The goal of this work is to contribute to personalized clinical management in home-based telemonitoring scenarios by developing an ontology-driven solution that enables a wide range of remote chronic patients to be monitored at home. METHODS: Through three stages, the challenges of integration and management were met through the ontology development and evaluation. The first stage dealt with the ontology design and implementation. The second stage dealt with the ontology application study in order to specifically address personalization issues. For both stages, interviews and working sessions were planned with clinicians. Clinical guidelines and MDs (medical device) interoperability were taken into account as well during these stages. Finally the third stage dealt with a software prototype implementation. RESULTS: An ontology was developed as an outcome of the first stage. The structure, based on the autonomic computing paradigm, provides a clear and simple manner to automate and integrate the data management procedure. During the second stage, the application of the ontology was studied to monitor patients with different and multiple morbidities. After this task, the ontology design was successfully adjusted to provide useful personalized medical care. In the third and final stage, a proof-of-concept on the software required to remote monitor patients by means of the ontology-based solution was developed and evaluated. CONCLUSIONS: Our proposed ontology provides an understandable and simple solution to address integration and personalized care challenges in home-based telemonitoring scenarios. Furthermore, our three-stage approach contributes to enhance the understanding, re-usability and transferability of our solution.

A clinical distortion index for compressed echocardiogram evaluation: recommendations for Xvid codec.

This paper introduces a new clinical distortion index able to measure the decrease in diagnostic content in compressed echocardiograms. It is calculated using cardiologists' answers to a clinical testbed composed of two types of tests: one blind and the other semi-blind. This index may be used to compare clinical performance among video codecs from a clinical perspective. It can also be used to classify compression rates into useful and useless ranges, thus providing recommendations for echocardiogram compression. A study carried out in order to illustrate its use with Xvid video codec is also presented. The results obtained showed that, for 2D and M modes, the transmission rate should be at least 768 kbit s(-1) and for color Doppler mode and pulsed/continuous Doppler, 256 kbit s(-1).

Acute pancreatitis promotes the generation of two different exosome populations.

Exosomes are small extracellular vesicles that act as intercellular messengers. Previous studies revealed that, during acute pancreatitis, circulating exosomes could reach the alveolar compartment and activate macrophages. However, proteomic analysis suggested that the most likely origin of these exosomes could be the liver instead of the pancreas. The present study aimed to characterize the exosomes released by pancreas to pancreatitis-associated ascitic fluid (PAAF) as well as those circulating in plasma in an experimental model of taurocholate-induced acute pancreatitis in rats. We provide evidence that during acute pancreatitis two different populations of exosomes are generated with relevant differences in cell distribution, protein and microRNA content as well as different implications in their physiological effects. During pancreatitis plasma exosomes, but not PAAF exosomes, are enriched in the inflammatory miR-155 and show low levels of miR-21 and miR-122. Mass spectrometry-based proteomic analysis showed that PAAF exosomes contains 10-30 fold higher loading of histones and ribosomal proteins compared to plasma exosomes. Finally, plasma exosomes have higher pro-inflammatory activity on macrophages than PAAF exosomes. These results confirm the generation of two different populations of exosomes during acute pancreatitis. Deep understanding of their specific functions will be necessary to use them as therapeutic targets at different stages of the disease.

[Renal cysts communicating with the excretory duct]. / Quistes renales comunicantes con la vía excretora.

The paper reports 2 cases of cystic-pyelocalyceal communication one secondary to traumatism and the other one infection-induced, demonstrating the possibilities of using etiological diagnosis in these communications, and the therapy to be followed. Endoscopic manipulation is usually enough to allow correct diagnosis as well as treatment.

A methodological approach for designing a usable ontology-based GUI in healthcare.

This paper presents a methodological approach to the design and evaluation of an interface for an ontology-based system used for designing care plans for monitoring patients at home. In order to define the care plans, physicians need a tool for creating instances of the ontology and configuring some rules. Our purpose is to develop an interface to allow clinicians to interact with the ontology. Although ontology-driven applications do not necessarily present the ontology in the user interface, it is our hypothesis that showing selected parts of the ontology in a "usable" way could enhance clinician's understanding and make easier the definition of the care plans. Based on prototyping and iterative testing, this methodology combines visualization techniques and usability methods. Preliminary results obtained after a formative evaluation indicate the effectiveness of suggested combination.

SPIHT-based echocardiogram compression: clinical evaluation and recommendations of use.

This paper describes an echocardiogram coding method that takes into account the visualization modes in order to compress efficiently the echocardiogram, a methodology to evaluate compressed echocardiograms and the evaluation of the compression method using the proposed evaluation methodology. The compression method takes advantage of the particular characteristics of each visualization mode and uses different compression techniques for each mode to compress efficiently the echocardiogram. A complete evaluation has been designed in order to recommend a minimum transmission rate for each operation mode that guarantees sufficient clinical quality. The evaluation of the echocaradiograms compressed with the proposed method has been carried out. The recommended transmission rates have been established as the following: 200 kbps for the 2D and the color Doppler modes, and 40 kbps for the M and the pulsed/continuous Doppler modes. These rates, especially the latter, are very low compared to previous results. These recommendations are valid for all devices and images compressed with the proposed method. The evaluation process can be applied to any compression method.

Lessons learned after a three-year store and forward teledermatology experience using internet: Strengths and limitations.

PURPOSE: This paper presents a three-year teledermatology evaluation experience. The aim is to explain the methodology followed, present the evaluation results, discuss critically the issues that emerged during the experience and report the main lessons learned. METHODS: A complete design and evaluation methodology was conducted to fully address significant issues arising from other previous teledermatology experiences. First, system-design requirements and image quality issues were studied. Then, a detailed clinical concordance study was undertaken to determine the accuracy of diagnoses made using teledermatology in order to assess different dermatological clinics. Finally, an impact study on the health system was performed. Furthermore, clinical, technical, social and alignment outcomes were analyzed during the study and at the end of it, in order to understand how emerging factors affected the final setup of the teledermatology system. RESULTS: The most important results reported in this study can be summarized as follows. (1) A complete web-based environment for teledermatology support was developed as a result of a dynamic evaluation process with clinical personnel. (2) A total of 120 teleconsultations (82 pediatric and 28 adult) were made during the clinical concordance study. Concordance analysis was carried out for each dermatological disease group. High concordance rates were found in pediatrics for inflammatory dermatoses (76%) and also for adults (75%) with infections and infestations. (3) Physicians were satisfied with the teledermatology system but the time dedicated to consultation in primary care was a limiting factor (19min for each teleconsultation). (4) An extensive discussion about the successful and the limiting aspects of the teledermatology experience revealed the reasons behind the final decision not to proceed with its implementation. It was considered not to be aligned with Health Care Organization (HCO) strategy and consequently did not achieve high-level support for its long-term implementation. CONCLUSIONS: A high degree of diagnostic accuracy both for pediatric and adult consultations was achieved using the teledermatology system with affordable technical requirements. Its usefulness for filtering dermatological referrals was also demonstrated in the study. Nevertheless, other factors such as the reorganization required for the physicians' time schedule, remuneration issues, absence of EHR (electronic health record) integration and lack of interaction with the HCO were important limiting factors. This led to the conclusion that under the evaluation conditions long-term set-up was not possible. It was also concluded that HCO participation would have been essential for both the evaluation study and the long-term set-up of the system.

Setting up a telemedicine service for remote real-time video-EEG consultation in La Rioja (Spain).

PURPOSE: The purpose of this paper is to report and discuss a successful experience in the setting up of a telemedicine solution for remote video-electroencephalography consultation (tele-EEG) in La Rioja, Spain. The setup has been implemented between a primary hospital situated in Calahorra (Calahorra Hospital Foundation, FHC) and a secondary hospital in Logroño (San Pedro Hospital, HSP), the capital city of the region of La Rioja. METHODS: During the twelve first months of the setting-up a detailed evaluation study was performed. During this period we evaluated the technical aspects of the setup and also demonstrated the clinical viability of the system. The impact on hospital organization and the impact on patients regarding the improvement in their quality of life, as well as their financial savings, were also evaluated. RESULTS: During these twelve months a total of 259 consultations were conducted through the telemedicine system. The clinical viability study was completely successful, and technical problems were detected only during the first months of setting-up. Regarding patients' preferences (177 completed an opinion questionnaire), 99% expressed a high degree of satisfaction with the telemedicine service. They also remarked that they preferred the telemedicine service to previous methods for the EEG test, on the grounds that it provided a significant improvement in access to specialized medical care and important financial savings in terms of travel (around 30€ per visit) and of time (approximately 2h) invested in consultations. CONCLUSIONS: After one year of evaluation, we concluded that the tele-EEG system had been successfully introduced into the clinical routine. As a matter of fact, the success of the telemedicine system has led to its widespread use and it has now replaced the conventional EEG service for FHC patients almost completely.

Experience of a real-time tele-EEG service.

This paper reports an experience in the setting-up and evaluation of a telemedicine solution to provide an electroencephalography service between a secondary hospital placed in Calahorra (Calahorra Hospital Foundation, FHC) and a tertiary hospital placed in Logroño (San Pedro Hospital, HSP) both in La Rioja, Spain. We have evaluated technical and clinical aspects of the tele-EEG (electroencephalography) service as well as the impact over patients, health staff and hospital organization for 6 months. During this period, there have been performed a total of 116 clinical consultations. With reference to patients' opinion, 98% of them stated to be satisfied with the new tele-EEG system and 75% of them preferred it rather than the conventional one, due to they reduce traveling expenses and the total invested time in the EEG test. This new service has been also very appreciated by medical staff, who assure thanks to the tele-EEG service the access for patients to this type of clinical test is improved.