emPATH is an open sourced mobile framework from UCSF. The framework is used to execute medical protocols on mobile devices. It originated from work done by Larry Suarez in the area of the autonomous management of distributed artifacts.
MEDICATION REMINDER AND HEALTHCARE – AN ANDROID APPLICATIONijmpict
This is an Android-based application in which an automatic alarm ringing system is implemented. It
focuses on doctor and patient interaction. Patients need not remember their medicine dosage timings as
they can set an alarm on their dosage timings. The alarm can be set for multiple medicines and timings
including date, time and medicine description. A notification will be sent to them through email or message
inside the system preferably chosen by the patients. They can search doctor disease wise. The patients will
get the contact details of doctors as per their availability. Also the users can see different articles related to
medical fields and health care tips. The system focuses on easy navigation and good user interface. Many
such Medical Reminder Systems have been developed where a new hardware is required but in our work
we have made an attempt to develop a system which is economical, time-saving and supports medication
adherence.
Patient-Generated Data for Cancer Treatment and ManagementTommy Snitz
Research poster created by myself and Matthew Villarreal while we were students of The University of Texas at Austin's Health Informatics and Health IT Program.
Looks into the benefits and challenges of using patient-generated data in cancer treatment and management
MEDICATION REMINDER AND HEALTHCARE – AN ANDROID APPLICATIONijmpict
This is an Android-based application in which an automatic alarm ringing system is implemented. It
focuses on doctor and patient interaction. Patients need not remember their medicine dosage timings as
they can set an alarm on their dosage timings. The alarm can be set for multiple medicines and timings
including date, time and medicine description. A notification will be sent to them through email or message
inside the system preferably chosen by the patients. They can search doctor disease wise. The patients will
get the contact details of doctors as per their availability. Also the users can see different articles related to
medical fields and health care tips. The system focuses on easy navigation and good user interface. Many
such Medical Reminder Systems have been developed where a new hardware is required but in our work
we have made an attempt to develop a system which is economical, time-saving and supports medication
adherence.
Patient-Generated Data for Cancer Treatment and ManagementTommy Snitz
Research poster created by myself and Matthew Villarreal while we were students of The University of Texas at Austin's Health Informatics and Health IT Program.
Looks into the benefits and challenges of using patient-generated data in cancer treatment and management
Karen Day, University of Auckland
Koray Atalag, University of Auckland
Denise Irvine, e3health
Bryan Houliston, Auckland University of Technology
(4/11/10, Illott, 1.45)
Yuri Quintana of BIDMC - November 11th Health Innovators Presentationmlkrgr
This is Yuri Quintana's presentation from November 11th's Health Innovators event "Leveraging Innovation to Improve Medication Adherence".
Please see more information about Health Innovators at http://www.healthinno.org.
Please visit http://www.bidmc.org/ to see more information about BIDMC
Mie2014 workshop: Gap Analysis of Personalized Health Services through Patien...Pei-Yun Sabrina Hsueh
Gap Analysis of Insight-Driven Personalized Health Services through Patient-Controlled Devices
Pei-Yun Sabrina HSUEH, , Michael MARSCHOLLEK, Yardena PERES, Stefan von CAVALLAR and Fernando J. MARTIN-SANCHEZ
IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
Hannover Medical School, Germany
IBM Research Lab in Haifa, Israel
IBM Research Lab in Melbourne, Australia
Melbourne Medical School, Australia
Mobile computing, wearable and embedded tech entail new and different styles of healthcare data processing, clinical and wellness decision support, and patient engagement schemes. This is especially important to the preventive and disease management scenarios that require better understanding of disease progression previously unable to achieve due to the lack of reliable means to capture granular patient-generated data in non-clinical settings. The new sources of data, when coupled with a framework to integrate analytical insights with feasible service models, enable reliable detection of inflection points, habit formation cycles and assessments of treatment efficacy. Research into data collection, recording, management and analysis of behavioral manisfestations and triggers will help address these challenges in areas spanning from simple fall detection to situations requiring complicated, multi-modal health monitoring such as Alzheimer’s progression and other adherence management cases. Leveraging recent advance in health devices and sensors as well as expertise in healthcare practice and informatics, the proposed workshop will help form a deeper understanding of requirements on patient-controlled devices to address unique healthcare challenges, identify care flow gaps and translate these findings to the design of platforms for patient-controlled devices and a portfolio of potential service models for preventive care and disease management.
Adoption of Integrated Healthcare Information System in Nairobi County: Kenya...Editor IJCATR
Health care information systems are aimed at facilitating the smooth running and interoperability of the health care
delivery processes to ensure efficiency and effectiveness; however, the complexity, heterogeneity and diversity of the health care
sector especially in Kenya poses serious challenges especially in relation to integration of the systems. There is a large disconnect
between the public and private health care delivery systems characterized by fragmentation of services, locally within hospitals
(among primary, secondary and tertiary health care settings) and across different health care centers. This research is aimed at
examining the adoption of integrated healthcare information system in Nairobi County; Kenyatta National Hospital represents the
public sector and The Mater Hospital the private sector. A sample size of 100 users on information system from the two hospitals
picked from the primary secondary and tertiary levels were selected and questionnaires administered to them. Data was analyzed
through descriptive statistics with the aid of SPSS. The results of the study indicated that there was a huge disparity between
healthcare information system adoption in the public and private sectors with the private sector’s adoption being at an advanced
stage. The major barriers to adoption including social political barriers, financial constraints and technical/technological barriers
also presented.
Eysenbach: eHealth: Transforming the dynamics of a complex health systemGunther Eysenbach
Keynote for the Australian 10th Annual Health Care Congress ( http://www.webcitation.org/5Vlz9j0HO ) in Sydney, 27th - 29th February 2008. Keynote contains a run-down of what ehealth is all about, and then focusses a fair bit on Personal Health Records (PHR 2.0) and Personal Health Applications. This is partly because the new Australian government under its new prime minister Kevin Rudd has set a couple of priorities for reforming health care, among them is "focussing on preventative health care and health promotion to help keep Australians healthy and out of hospital", which is a goal that can - in my opinion - be attained or at least greatly supported with Personal Health Records, or more specifically with what I call second generation PHRs or PHR 2.0. Contains screenshots of our Healthbook (TM) project, which was subsequently mentioned mentioned in the preliminary report of the 2020 Summit to the Prime Minister in Australia, see http://gunther-eysenbach.blogspot.com/search/label/healthbook
Karen Day, University of Auckland
Koray Atalag, University of Auckland
Denise Irvine, e3health
Bryan Houliston, Auckland University of Technology
(4/11/10, Illott, 1.45)
Yuri Quintana of BIDMC - November 11th Health Innovators Presentationmlkrgr
This is Yuri Quintana's presentation from November 11th's Health Innovators event "Leveraging Innovation to Improve Medication Adherence".
Please see more information about Health Innovators at http://www.healthinno.org.
Please visit http://www.bidmc.org/ to see more information about BIDMC
Mie2014 workshop: Gap Analysis of Personalized Health Services through Patien...Pei-Yun Sabrina Hsueh
Gap Analysis of Insight-Driven Personalized Health Services through Patient-Controlled Devices
Pei-Yun Sabrina HSUEH, , Michael MARSCHOLLEK, Yardena PERES, Stefan von CAVALLAR and Fernando J. MARTIN-SANCHEZ
IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
Hannover Medical School, Germany
IBM Research Lab in Haifa, Israel
IBM Research Lab in Melbourne, Australia
Melbourne Medical School, Australia
Mobile computing, wearable and embedded tech entail new and different styles of healthcare data processing, clinical and wellness decision support, and patient engagement schemes. This is especially important to the preventive and disease management scenarios that require better understanding of disease progression previously unable to achieve due to the lack of reliable means to capture granular patient-generated data in non-clinical settings. The new sources of data, when coupled with a framework to integrate analytical insights with feasible service models, enable reliable detection of inflection points, habit formation cycles and assessments of treatment efficacy. Research into data collection, recording, management and analysis of behavioral manisfestations and triggers will help address these challenges in areas spanning from simple fall detection to situations requiring complicated, multi-modal health monitoring such as Alzheimer’s progression and other adherence management cases. Leveraging recent advance in health devices and sensors as well as expertise in healthcare practice and informatics, the proposed workshop will help form a deeper understanding of requirements on patient-controlled devices to address unique healthcare challenges, identify care flow gaps and translate these findings to the design of platforms for patient-controlled devices and a portfolio of potential service models for preventive care and disease management.
Adoption of Integrated Healthcare Information System in Nairobi County: Kenya...Editor IJCATR
Health care information systems are aimed at facilitating the smooth running and interoperability of the health care
delivery processes to ensure efficiency and effectiveness; however, the complexity, heterogeneity and diversity of the health care
sector especially in Kenya poses serious challenges especially in relation to integration of the systems. There is a large disconnect
between the public and private health care delivery systems characterized by fragmentation of services, locally within hospitals
(among primary, secondary and tertiary health care settings) and across different health care centers. This research is aimed at
examining the adoption of integrated healthcare information system in Nairobi County; Kenyatta National Hospital represents the
public sector and The Mater Hospital the private sector. A sample size of 100 users on information system from the two hospitals
picked from the primary secondary and tertiary levels were selected and questionnaires administered to them. Data was analyzed
through descriptive statistics with the aid of SPSS. The results of the study indicated that there was a huge disparity between
healthcare information system adoption in the public and private sectors with the private sector’s adoption being at an advanced
stage. The major barriers to adoption including social political barriers, financial constraints and technical/technological barriers
also presented.
Eysenbach: eHealth: Transforming the dynamics of a complex health systemGunther Eysenbach
Keynote for the Australian 10th Annual Health Care Congress ( http://www.webcitation.org/5Vlz9j0HO ) in Sydney, 27th - 29th February 2008. Keynote contains a run-down of what ehealth is all about, and then focusses a fair bit on Personal Health Records (PHR 2.0) and Personal Health Applications. This is partly because the new Australian government under its new prime minister Kevin Rudd has set a couple of priorities for reforming health care, among them is "focussing on preventative health care and health promotion to help keep Australians healthy and out of hospital", which is a goal that can - in my opinion - be attained or at least greatly supported with Personal Health Records, or more specifically with what I call second generation PHRs or PHR 2.0. Contains screenshots of our Healthbook (TM) project, which was subsequently mentioned mentioned in the preliminary report of the 2020 Summit to the Prime Minister in Australia, see http://gunther-eysenbach.blogspot.com/search/label/healthbook
Sybase, back in 1995, was constructing an advanced workflow system based on agent technology. This system was presented to an invitation-only group of Powersoft customers at the 1995 Powersoft Users Group meeting at DisneyWorld. The group creating the solution was an advanced technology group formed when Sybase purchased Powersoft.
mHealth: Transforming Healthcare and Driving Business for Pharmaceutical Comp...Merqurio
Get exclusive access to our brand new Whitepaper "mHealth: Transforming Healthcare and Driving Business for Pharmaceutical Companies." Click here:
http://bit.ly/1x21JaM
It’s free.
10 Top Healthcare Application Development Trends You Need to Know in 2023.pdfTechinfofacts
The technology used in healthcare has advanced significantly over the past few years, healthcare application development trends and we can expect it to continue evolving well into the year 2023. Providing better healthcare services and improving patient outcomes is becoming increasingly imperative as artificial intelligence (AI) and the Internet of Things (IoT) take hold.
Over $50 billion is expected to be spent on healthcare apps by 2023. Healthcare will be impacted by mobile technology as it advances. Mobile apps will remain an important tool for improving healthcare delivery, providing more access to quality care for everyone.
Sting Stigma Eradication Application forms the lifetime of fighting Stigma related to HIV/AIDS in Kenya and other developing countries in Africa. However, through this project there is remarkable improvement in approach of dealing with people affected or infected by HIV. It is therefore a turning point to a long journey of fighting the diseases in the entire continent. The IT initiative has encouraged various organizations to develop systems to facilitate their day to day operations. SSEA incorporates various modules for automating service delivery and enhancing communication between the concerned parties and thus help in saving time and operations thus increasing efficiency. The purpose of this solution is to present the software engineering approach for development which focuses on the set of activities and associated results to develop a Sting Stigma Eradication Application meant to perform some of services delivery necessary for individuals affected by HIV/AIDS automatically at their comfort by use of widely used technology, mobile and web technology.
As the largest health care workforce group, nurses are well suit.docxbob8allen25075
As the largest health care workforce group, nurses are well suited to collaborate with other team members in the clinical work for an effective healthcare delivery (Matthys, Remmen, & Van Bogaert, 2017).
Collaboration is multidimensional and can occur in both face-to-face encounters and electronically for exchange of views and ideas. Collaboration is a planned or an unplanned engagement that takes place between individuals or teams of individuals, whether in-person or mediated by technology, where information is exchanged in some way (either explicitly, i.e. verbally or written, or implicitly, i.e. through shared understanding of gestures, emotions, etc.), and often occur across different roles (i.e. physician and nurse) to deliver patient care (Weir, 2011).
With reference to health informatics, a systematic review of literature, (Eikey, Reddy, & Kuziemsky, 2015), methods of collaborative work in health setting include telemedicine application, EMR, HER, EPR, CPOE, mobile technology, (PDAs, pagers, mobile phones), Web 2.0 applications, internet, online health communities, picture archives, and communication system, medicine dispensing devices and barcode systems, HIT and any other specific application. The authors further presented the "collaboration space model", to help researchers study collaboration and technology in healthcare.
In my healthcare setting, we use several health informatics methods such as pagers, mobile phones, communication system, medicine dispensing devices and barcode systems, but one that has been much applauded during this COVID 19 era is Telemedicine. I work in a psych/detox hospital.
We found telemedicine very relevant based on research results indicating that people with mental health problems are twice more likely to be frequent users of hospital emergency departments (Hunt, Weber, Showstack, Colby, & Callaham, 2006). The use of the emergency department for routine clinical care poses a huge strain on the health system because of the high cost of treatment, restricting use of the emergency department for admission of patients who really require admissions. This is also because of the associated complexity and pressure to admit patients for inpatient care (Institute of Medicine (U.S.), 2007).
Recent technological advancements have led to easy access to videoconferencing utilizing personal computers or tablets. A few research work has also been carried out using telemedicine. Patients are encouraged to check their vital signs using personal devices. Also, the introduction of asynchronous store-and-forward approaches enable clinicians review their patient without direct interaction. Also, telehomecare enables clinicians monitor their patients in their own homes (Yellowlees et al., 2010). Telepsychiatry aims to improve quality of care to patients and reduce costs in three ways: it will carry out assessment at a distance, the specialist will be able to provide emergency department doctors opinion on complex c.
A report on macro trends relating to health technology, produced in a one-day topic sprint by the members of KANT Berlin: Alper Çuğun, Chris Eidhof, Martin Spindler, Matt Patterson and Peter Bihr. (CC by)
To learn more about KANT Berlin and its members, please visit www.kantberlin.com
The Ultimate Guide to Healthcare App Development.pdfLucy Zeniffer
Planning to build a healthcare application? Here is your expert’s guide on steps to build a healthcare app, including types, features, and benefits of healthcare applications.
The future of healthcare: when mobile disappearsMatteo Penzo
In today’s digital world, mobile devices are the powerful bridges between a connected ecosystem of healthcare professionals, caregivers and patients. New developments in big data, wearable sensors and the application of social layers are shifting an industry that used to focus on curing diseases to one that emphasizes health and wellness. But the mass adoption of connected healthcare will only happen when solutions are designed to be intuitive and technologies are forgotten. The future of healthcare will happen when mobile disappears into the background, placing the patient in the center and in control of their lives.
A Review Role of Mobile Application for Medical Servicesijtsrd
"In advanced mobile communications and portable computation devices are now combined in handheld devices called “smart mobile phones, IPADs, Tablet PCâ€, which are also capable of running third party software. The number of smart mobile phones users is growing rapidly, including among healthcare professionals. The purpose of this study was to classify smart mobile phones based healthcare technologies as discussed in academic literature according to their functionalities, services and summarize articles in each category. Many medical applications for smart mobile phones have been developed and widely used by health professionals, doctors, consultant and patients. The use of smart phones is getting more attention in healthcare and medical services day by day. Medical service provider applications make smart mobile phones useful tools in the practice of evidence based medicine at the point of care, in addition to their use in mobile clinical communication with an correct references. Also, smart mobile phones can play a very important role in patient education, disease self management, and remote monitoring of patients. Miss. Naina S Thorat | Dr. R. V Kulkarni ""A Review- Role of Mobile Application for Medical Services"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Special Issue | Fostering Innovation, Integration and Inclusion Through Interdisciplinary Practices in Management , March 2019, URL: https://www.ijtsrd.com/papers/ijtsrd23060.pdf
Paper URL: https://www.ijtsrd.com/computer-science/programming-language/23060/a-review--role-of-mobile-application-for-medical-services/miss-naina-s-thorat"
Running head PATIENT MONITORING TECHNOLOGY1PATIENT MONITORI.docxtoltonkendal
Running head: PATIENT MONITORING TECHNOLOGY 1
PATIENT MONITORING TECHNOLOGY 2
Patient Monitoring Technology
Barbara C Hobby, BSN, RN
Chamberlain College of Nursing
NR512 Nursing Informatics
May, 2017
Abstract
Electronic Health Records advancements have been on the rise since the inception of information technology. One of the most recent technological developments in the healthcare industry is the patient monitoring technology. The article selected was titled “Data overload, access and affordability limit patient monitoring technology.” This paper seeks to investigate the rationale behind choosing the topic on patient monitoring technology, the impact of the technology on medical facilities, the advantages and disadvantages of using the technology, how informatics skills and knowledge were used in the process relevance to developing the impact of patient monitoring technology as well as futuristic recommendations for any physicians and manufacturers of the technology.
Patient Monitoring Technology
Advancements in the technology of Electronic Health Records have been on the rise since the inception of information technology. One of the most recent technological developments in the healthcare industry is patient monitoring technology. The article selected was titled “Data overload, access and affordability limit patient monitoring technology.” The rationale behind choosing this topic is to understand the importance of patient monitoring technology in healthcare today. As they are relatively new to the market, few books have been written about the various patient monitoring technologies available. This paper investigates their impact on the healthcare industry, the advantages, and disadvantages of their use, as well as any futuristic recommendations on the technology to healthcare practitioners (Mohammadzadeh & Sadfari, 2014). Even though most physicians are aware of the benefits associated with the use of patient monitoring technology, many shy away due to the numerous glitches in access, high costs associated with its use, and the threat of data overload.
Patient monitoring technology has a huge positive impact on the healthcare industry. The technology is used heavily for the remote tracking of major cardiovascular diseases, which cause close to 30% of the deaths in the world yearly. The diseases are triggered by various issues, including diabetes, high blood pressure, obesity, lack of exercise, smoking, as well as excessive consumption of alcohol (Darvish et al., 2014). Current patient monitoring technology is able to track the necessary healthcare metrics to determine if they are in danger, including cardiac output, blood pressure, amount of oxygen in the patient’s blood, body temperature, and heart activity. This technology has proven crucial for healthcare providers, as it helps them monitor the patients when they are out of their usual environment.
Even though the technology is more likely to have a positive i ...
Technology Acceptance Model for Mobile Health SystemsIOSR Journals
Abstract: The purpose of this paper is to explore the factors that influence health-related consumer’s
acceptance to use the mobile technology as a tool for receiving healthcare services. Based on technology
acceptance model (TAM), this paper provides a better understanding of antecedent of key acceptance constructs
(e.g. intention to use, perceived usefulness, perceived ease of use). The proposed research model and hypotheses
validated and tested with data collected from 302 Egyptians and Yemenis patients, health professionals, and
general health users. The results are analyzed using a number of statistical techniques including partial least
squares. The key findings obtaining from the results of the three surveyed stakeholders reveal that: (1) ninety
percent are indented to use mobile health services. (2) While intention to use has greatly influenced by
perceived usefulness, the impact of perceived ease of use varies. (3) Perceived value, perceived ease of use and
portability factors are significantly affect perceived usefulness. (4) Self-efficacy and technology anxiety have a
great impact on perceived ease of use. (5) The impact of the rest of the suggested factors ranged from medium,
low, and insignificant. The research made an in-depth exploration and examination of the factors that influence
user’s intention to use mobile health services focusing on technological, cultural, organizational, political, and
social aspects whereas most of the previous studies considered only one or two aspects together. The proposed
model can be applied to assess mobile health user’s acceptance, thereby help mobile health developers and
providers to develop better mobile health applications that meet the needs of the potential users.
Keywords: Intention to use, Mobile health, portability, Resistance to change, Technology anxiety, Technology
acceptance model
Technology is revolutionizing every industry, but
health care is especially seeing major
transformations that boost the quality of care,
provider efficiency, and patient convenience. The
impact of these four health care technology
advances is staggering.
Patient care decisions should be supported by timely clinical inform.docxssuser562afc1
Patient care decisions should be supported by timely clinical information, reflecting the best evidence possible (Institute of Medicine 2013). Present and future professional nurses must be able to use informatics and technology to facilitate critical decision-making for optimal patient outcomes (Massachusetts Department of Higher Education Nursing Initiative 2016). Nursing clinical informatics competencies involve the collection and use of patient data for analysis and dissemination. Nursing informatics with computer science was established to create innovative ways to provide quality care to our patients. Evidence based practice is a cornerstone to making NI better for the future. Without EBP there would be no such thing.
What I see for the future is that technology would be expanding at a faster rate. There would be less hands on and more robotics. What I mean by this is that robots would be administering meds at the bedside, documenting task, and even doing patient consults. I believe that this would be in the near future to come because it would cut the need for nursing staff in half and it would be cost effective for the company. The only thing that would be the downfall to this is that robots do not pose interpersonal skills so patient questions would go unanswered and in would block the communication to building a rapport. We have already advanced to telemedicine which in some cases can be beneficial to the patient being seen by the physician.
Another thing that would probably be good for the up and coming future would be if we could use the pyxis like we use Alexa and Siri. If we could give them voice commands where it could dispense patient medications that are due just by giving the first and last name of the patient would cut down on the time spent pulling meds. Instead of your taking 30mins to 1 hour pulling meds could just take about 15 to 20 mins. Modern technology is advancing so much that some of us cannot not keep up with the new demands of the workplace. In nursing we are always learning new things and we must continue to learn as we advance in our careers in order to be successful. New media offer new possibilities in teaching and learning. However, the appropriation of new knowledge and skills in dealing with technology, especially for older adults, is a critical challenge. This needs to be considered against the background of the digital divide. Which describes, among other things, the lack of information on the ability of older adults to use technology among those who have access to ICTs and new media in healthcare. In conclusion informatics will be changing for the better.
Reference
Institute of Medicine. (2013).
Core measurement needs for better care, better health, and lower costs: Counting what counts, workshop summary
. Washington, DC: National Academies Press. doi:10.17226/18333
Massachusetts Department of Higher Education Nursing Initiative. (2016).
Massachusetts nursing of the future nursing core comp.
1)Policies are written documents that mirror the administrat.docxteresehearn
1)
Policies are written documents that mirror the administrators of a particular organization. In this case, the organizations are healthcare organizations such as hospitals and clinics. With healthcare informatics becoming such a big part of healthcare organizations, policies are being made to keep patients and staff safe. Healthcare informatics policy is directed at making care more effective, improving public health, and proper collection and analyzation of data to guide evidence-based practice. Since policies are reflections of administrations, they can change based on the direction a healthcare organization is heading or what their focus may be (Hebda, Hunter, Czar, 2019). For example, if a hospital is having an increase in medication administration errors, then their policy may focus on scanning all patients and medications prior to administration.
One of the biggest concerns of healthcare informatics is the privacy and protection of important patient information and policies on informatics have been aimed at reducing the risk of the security of that information being breached. Hospitals have policies such as not putting patient identifiers in emails, logging out of electronic health records once leaving the patients room, education on phishing emails, creating firewalls, having backup storages for patient information, audit trails for and specialized access for private charts. There are also policies on the recovery and retrieval of healthcare information in case of unplanned disasters. The AMIA identified six key health informatics policies: patient empowerment, HIT safety, workforce education, data sharing, quality measurement, and public health (Simpson, 2012).
The impact these policies have made on informatics have been steps in the right direction due to the importance and protection they place on informatics. They allow us to safely use informatics for better patient outcomes. Telehealth is also fairly new has new policies arising too. For example, at our hospital we use telephysch medicine for psychiatric patients in the emergency department. One of our policies is that all of our psychiatric patients must be assessed by a telepsychiatrist and their recommendation must be upheld regarding 51/50 holds. Using telemedicine in place in person consultations at hospitals that do not have in house specialties improves patient care because it saves time and money for both the patient and hospital. It is especially effective for time sensitive cases such as patients with stroke like symptoms in deciding whether or not to use TPA because instead of having to wait for a neurologist to arrive, the neurologist is able to instantly assess the patient via computer video chat and receive expert consults.
References
Hebda, T., Hunter, K. M., & Czar, P. (2019). Handbook of informatics for nurses and healthcare professionals. NY, NY: Pearson.
Simpson RL. (2002). Nursing informatics. Issues in telemedicine: why is po.
Similar to emPATH Open Sourced Mobile Framework (20)
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
emPATH Open Sourced Mobile Framework
1. The emPATH Open Framework:
Supporting Evidence-Based Medicine on Mobile
Devices for Patient Care
Larry Suarez, Jeff Jorgenson, Tom Manley, Melwin Yen, and
Iana Simeonov
mHealth Group
University of California San Francisco, School of Medicine
SuarezL@medsch.ucsf.edu, JorgensonJ@medsch.ucsf.edu,
ManleyT@medsch.ucsf.edu, YenM@medsch.ucsf.edu, iana@calpoison.org
Abstract
Evidence-based Medicine (EBM) is an important endeavor within the medical
community. Unfortunately EBM has been slow to adoption due to a number of factors
including the lack of an infrastructure to construct and apply supporting care pathways
within the busy workflow of a care provider (Evans-Lacko, Jarrett, McCrone, &
Thornicroft, 2010). With the introduction of a major new delivery model in the form of
mobile devices, the question arises if the delivery model can accelerate the application
of EBM for patient care. Care pathways will migrate from the provider's workflow to the
patient's mobile device, alleviating already congested provider workflows. This migration
cannot be ignored because it is already happening with or without the medical
community. There are a large number of undisciplined mobile medical applications
already appearing on the market and reaching patients. But care pathways on mobile
devices may look quite different from care pathways executed by a practitioner. The
UCSF mHealth group in collaboration with University medical researchers has
developed a framework to support the application of EBM on mobile devices. The goal is
to enable mobile devices to be a disruptive new delivery model to help address some of
the major issues confronting the application of patient care through mobile devices.
Disruptive Delivery Model
Mobile devices such as the Apple iPhone provide new ways in which to deliver patient
care. Mobile devices are readily available to patients and are being used to collect
relevant medical data to enhance existing personalized care pathways. But a mobile
device is not merely a data collector. Mobile device features such as cameras, video
conferencing, and on-board sensors will continue to evolve at a tremendous pace.
Mobile device hardware is rivaling laptops in processor speed and data storage size.
Mobile devices are becoming sensor rich already including GPS and accelerometers,
and device-to-device communication will spawn new techniques to support patient
health (Vergados D., 2010). If mobile-based care pathways do not incorporate these
new capabilities then we believe the industry is missing an opportunity to change
medicine. A mobile device will be viewed as a medical "companion" to the patient and as
a medical assistant to the practitioner. Patients can now take control of their treatment
2. The emPATH Mobile Framework 2
UCSF mHealth Group 11/28/11
and still support close contact with their care provider. A mobile device provides
unmatched visibility into patient health-related events that are otherwise unavailable to
the practitioner. Mobile devices are being used to monitor patients, collect medical
encounters and events, analyze, and identify treatments in real-time (Varshney U.,
2007)(Kotz, Avancha, & Baxi, 2009)(Taylor, & Dajani, 2008), all in conjunction with
existing patient-provider face-to-face encounters. However, a mobile device can also be
viewed as yet another silo in the medical world where static and outdated data and
software is prevalent. Capturing remote data via a mobile device using an out-dated
clinical pathway is useless. The goal is to exploit the extremely real-time nature, unique
to mobile devices in order to realize highly effective real-time EBM solutions.
The mobile application characteristics required for supporting EBM on mobile devices
include:
Dynamic. The care pathways must be able to change in real-time to align with
patient experiences and progress (or lack). In addition, any metrics defined by
the care pathways and which drive data collection on the mobile device must be
dynamic. This area of research is known as "adaptive care management" and
"dynamic care pathways" (Altman, & Altman, 2010).
Personal. Each care pathway on a mobile device must be personalized. The
care pathway must use patient-specific data such as demographics to deliver the
pathway in the most appropriate way. Imagine how distinct a care pathway for a
teen is as compared to an elderly adult. Patients will not follow their care
pathways if the pathways are not personalized.
Relevant. Each patient may be at a different juncture within a particular illness.
If the care pathway does not address the unique issues relating to the stages of
the illness then the care pathway becomes irrelevant to the patient and
potentially dangerous.
Autonomous. Applications must be able to execute with as little human
intervention as necessary to support a clinical pathway. Current market mobile
applications typically require a great deal of human intervention to collect patient
data. Unless a patient can readily see the value of intrusions, they will have little
incentive to follow mobile-based treatment.
Sensor-based. Mobile medical applications will depend more and more on
external sensors or on-board sensors to derive data and hence affect their on-
board care pathways. Care pathways on mobile devices will increasingly depend
on sensors as part of patient treatment (Garg, Kim, Turaga, & Prabhakaran,
2010).
Goal-Driven. Most current market mobile applications are written based on
software requirements defined by care practitioners or software program
managers. However, effective mobile applications should be written based on
patient goals. This is the natural way practitioners manage their patients.
Practitioners typically define goals for their patients, such as increasing mobility,
reducing smoking, and reducing alcohol consumption. By constructing goal-
driven mobile applications, the underlying software can then change the care
pathway when goals change or current patient goals are unmet (Hurley, & Abidi,
2007).
3. The emPATH Mobile Framework 3
UCSF mHealth Group 11/28/11
The Connected (and Unrestrained) World
Technology has dramatically changed the way individuals communicate. Individuals
have greater access to information, data, and to one another, and near instantaneous
access to world events via Twitter, Facebook, and news feeds. This is typically referred
to as the "connected world" (Siemens, 2008). Mobile devices have accelerated this
change as individuals use mobile devices as their primary communication medium.
The medical arena has seen a dramatic increase in the use of medical applications on
mobile devices and vendors are rushing to take advantage of this recent euphoria
(Carey, 2011). Patients have access to the latest information concerning care
regiments, medications, support groups, and treatment research. However, the recent
advent of mobile medical applications is clouding the relationship between the patient
and their care providers. Patients may start to rely on mobile medical applications that
are not based on sound medical research and may conflict with current medical
practices, potentially exacerbating hidden patient illnesses such as depression. This
medical mobile application phenomenon is much like the effort by pharmaceuticals to
get between the patient and their care provider using advertisements for their new drugs
(Donohue, Cevasco, & Rosenthal, 2007). By taking advantage of the dynamic
communication that exists in our “connected world”, the mHealth group at UCSF is
creating frameworks and solutions that will help reduce the fracture between patients
and their care providers when using mobile devices and ensure that medical mobile
applications are based on solid research foundations.
Evidence-Based Medicine
Evidence-based Medicine (EBM) is simply defined as the integration of clinical
experiences, clinical expertise, patient values, patient experiences, and the latest best
practice research into the decision making process for patient care (Sackett, Rosenberg,
Gray, Haynes, & Richardson, 1996). The traditional means of describing patient care
processes is through care pathways (Every, Hochman, Becker, Kopecky, & Cannon,
2000). Care pathways consist of steps that either directs the patient in productive ways
(therapeutics) or requests information from the patient for analysis (diagnostics). Care
pathways that support EBM are moving from the clinic to the mobile device. Patients are
essentially carrying their care pathways with them and engaging the pathways as they
interact with their mobile devices. Care pathways become an integral part of a patient’s
life, all day every day, instead of beingrelegated solely to patient-provider face-to-face
encounters. Care pathways allow the practitioner to effectively manage their patients
outside the borders of the clinic. EBM is a continuous process as new information is
integrated into existing patient care pathways. Mobile devices allow care pathways to
take on new dimensions:
Increasingly adaptive. The ability of the care pathway to change in real-time
such as modifying patient medication dosages, adjusting medical devices worn
by the patient, and changing treatment regimes in reaction to illness episodes.
Increasingly personal. Care pathways on a mobile device can conform directly
to the patient. This includes changing how the mobile device interacts with the
patient based on demographics, patient beliefs, patient goals, current patient
health, and care provider goals.
4. The emPATH Mobile Framework 4
UCSF mHealth Group 11/28/11
Increasingly aware. Care pathways will incorporate greater amounts of
information from a patient's environment including GPS, data from body-worn
sensors, data from external wireless medical devices, and external data feeds.
This will allow the pathway to adjust treatment and effect patient behavior at the
most opportune time.
The emPATH Framework was designed to anticipate and support next generation care
pathways envisioned for mobile devices. Figure 1.1 shows the envisioned process flow
for supporting EBM on mobile devices.
Figure 1.1: EBM Process Flow
Care providers are integrating national health experiences into their own local
experiences to ensure the best possible outcome for their patients. The Athena Breast
Cancer project, a multi-institution national effort for addressing breast cancer in the
United States, identifies EBM as one of their cornerstone goals (Fernandez, 2009):
"...Use data and risk models to develop personalized, evidence-based
innovations in the diagnosis and treatment of breast cancer."
Technology advances such as sensors are contributing additional relevant information
that directly affects the care pathways that guide patients. For example, prescription
bottles will contain sensors that transmit dosage instructions that will appear within the
patient's mobile care pathways in real-time to ensure proper usage. Figure 1.2 shows
how the patient's environment will affect care pathways.
5. The emPATH Mobile Framework 5
UCSF mHealth Group 11/28/11
Figure 1.2: Patient Environment and Care Pathways
The Anatomy of Medical Mobile Applications
Medical applications for mobile devices have a general anatomy (components) which
include:
Engagement. Ability to engage the patient to ensure their participation.
Engagement solutions include gaming interfaces, rewards, personalization,
feedback, and encouragement.
Access. Ability to collect in real-time recent event data either through user input
(for example a survey) or autonomously through on-board or external sensors.
Classify. Ability to classify collected data and any existing on-board data and
determine the correct response based on the current patient care pathways
prescribed by a care provider.
Treatment. Execute the care pathway identified in component 3 (Classify).
UNICEF uses the corresponding process called ACT ("Assess", "Classify", "Treat") in
defining their care pathways for developing countries (UNICEF, 2005). The application
of the individual components may differ within individual mobile solutions but the
components can be readily identified. For example, the popular UCSF mobile application
"Pills vs. Candy" (Carter, 2011) uses gaming to engage the user, a survey to access the
data, a game score to classify the data, and feedback (total score) to treat the user. The
result is an individual that is aware of the issues/dangers concerning the physical
appearance of medications on the market. After taking the survey, an individual is able
to create in their own mind different techniques to help them identify medications.
Each of the components in the general anatomy should be based on medical research.
In other words, EBM can be applied to each component to ensure its effectiveness.
Mobile research at UCSF includes many of the components identified for mobile medical
applications. If the medical application is not engaging, the patient will not continue to
use the application, nullifying any effective EBM treatment. In addition, ineffective
6. The emPATH Mobile Framework 6
UCSF mHealth Group 11/28/11
engagement could trigger episodes in other hidden illnesses. If the application is
engaging but the treatment is not effective (not based on EBM) then the patient's efforts
would not be productive.
Mobile Device Care Pathways
The concept of care pathways on mobile devices is very attractive. The EBM care
pathways are intended to be living entities. The emPATH Framework allows care
pathways to exhibit what is referred to as self-star (self*) behavior. Pathways can self-
heal (prune), self-organize (change pathway ordering), self-generate (add new
pathways), and self-optimize (prune redundant pathway steps) (Devaraj, Gupta, Ko,
Thompson, Patel, & Nagda, 2005). The care pathways can change based on the goals
and constraints defined by the care provider or researcher. This dynamic behavior is
required to support a “connected world”. Otherwise the care pathways become silos,
static andstagnant, and eventually harmful to the patient.
The mHealth group and UCSF medical researchers are defining the structure of care
pathways to support self* behavior. Mobile-based care pathways are structured very
much like traditional care pathways but are augmented to support self* behavior. The
combination of a number of technologies are reflected in the care pathways including:
Workflow. Supports the physical requirements of dynamic care pathways. For
example, the ability to prune, augment, and re-order care pathways (Browne,
2005).
Agent-based systems. Supports the analytical requirements of dynamic care
pathways to determine where and when to prune, how to augment a care
pathway, and the most beneficial ordering of a care pathway (Isern, Sanchez, &
Moreno, 2007).
Web 3.0. Controls the internal structure of data within the mobile device, how it
is shared among the on-board software services and pathways, and how that
data is externalized to supporting research systems (Ciccarese, Ocana, Castro,
Das, & Clark, 2010).
The mHealth group uses a common process to construct EBM mobile applications. The
mHealth group has been able to deliver comprehensive mobile medical applications
within days of a researcher's request for an application. Figure 1.3 shows the general
development process. Care pathways are represented in XML (W3W 2008) on the
mobile device. This representation makes it easier to develop the pathway using
standard industry techniques such as the application of graph theory.
7. The emPATH Mobile Framework 7
UCSF mHealth Group 11/28/11
Figure 1.3: Care Pathway Generation for Mobile Devices
The emPATH Mobile Framework
The emPATH Mobile Framework provides a platform for researchers and software
developers to deliver dynamic care pathways in support of EBM on mobile devices.
The Framework and supporting care pathways resides entirely on the mobile device.
The Framework can be deployed as a hosted solution but the preferred mode is on-
board the mobile device for reasons including:
Easier for researchers to conduct quick trials without having to be tethered to a
hosted solution.
Supports situations where downtime due to lack of mobile device connectivity
would be detrimental to the patient (e.g., managing depression patients).
Institutions may not have control over the environment of the deployed solution.
The eventual hosting environment may not support chosen vendor hosting
components.
The traditional reasons for using a hosted solution do not readily apply for
medical applications.
Mobile applications for patient care typically require very unique interfaces for
patient engagement hence the rendering subsystem will typically reside on the
mobile device.
The UCSF mHealth group envisions the Framework to be used on small sensor
platforms in addition to its current use on cellular phones. The Framework has been
ported to function on Apple devices (iPhone, iPod, and iPad), Android-based devices,
and J2ME-based devices. Care pathways can be defined using any number of protocols
and representations including XML, RDF (W3W 2004), OWL (W3W 2007), Excel, and
proprietary solutions. Each care pathway is translated by the Framework into a canonical
form for processing.
8. The emPATH Mobile Framework 8
UCSF mHealth Group 11/28/11
The emPATH Framework comprises two frameworks: the Core Framework, which
contains features that are necessary to support mobile medical applications and the
EBM Framework, which directly supports dynamic care pathways. Figure 1.4 shows
both frameworks in addition to a Blackboard system (Nute, Potter, Cheng, Dass, &
Glende, 2005).
The Blackboard system supports connectivity between the services of the Core
Framework and the services of the EBM Framework. All services in the emPATH
Framework have access to the Blackboard system and can view real-time changes to
the Blackboard. The Blackboard system acts as a "chalk board" where services can
write items of interest that can trigger other services within the mobile application. For
example, a service monitoring patient temperature could write to the Blackboard that the
patient's temperature has exceeded a threshold. This could trigger care pathways or
other services in the application. The Blackboard is also where the patient's world model
is represented. The world model represents the world as envisioned by the patient
including their biases, their goals, and their current health state. The use of a blackboard
system to "decouple" services/care pathways allows new services and new care
pathways to be added, existing services/care pathways removed, and existing
services/care pathways updated in real-time with minimal impact on the mobile
application as a whole. In agent-based (AI system) terminology, the emPATH
Framework is a stigmergic system.
Figure 1.4: The emPATH Framework
The Core Framework
The Core Framework contains services that are available to all mobile medical
applications. These services are used to generate application features such as the
ability for a patient to interact directly with their care provider. The general architecture is
shown in Figure 1.5.
9. The emPATH Mobile Framework 9
UCSF mHealth Group 11/28/11
Figure 1.5: The Core Framework Architecture
The Core Framework contains a number of important features that are necessary to
support medical mobile applications including:
Alert System. The alert system can alert care providers and patients to issues
that require immediate attention. For example, if a patient’s heart rate exceeds a
defined threshold then an alert would be generated and sent to the care provider
and the patient.
Data Integration. Data integration is the ability of mobile applications to
exchange data with existing medical data systems. Data integration is an
important aspect of patient support that may involve multiple care providers.
Research systems can send and receive patient information in any number of
industry data formats such as HL7, Microsoft Excel spreadsheets, XML, and
RDF. The emPATH Framework can also send and receive patient data in any
number of network protocols such as web service calls, SOAP, HTTP, FTP, and
email.
Timers. The Core Framework supports multiple on-board timers to schedule
major patient regimen tasks such as when to take medication, when to create a
diary entry, and when to create a data entry. These timers are necessary to
ensure the patient follows specific care pathways created by their provider. The
Framework will notify the care provider if the patient does not accomplish a
specific scheduled task.
Data capture. The Framework supports data capture from a myriad of medical
devices including anticipated next generation devices. Data capture is one of the
most important aspects of any mobile medical solution.
Patient education. The Framework can provide focused patient information for
disease management, nutrition, and exercise recommendations. Patient
information is the cornerstone of any medical regimen.
Physician-Patient Communication. A care provider can communicate directly
with their patient in the form of “notes” or messages using the Apple Push
Notification system. The patient’s mobile device will vibrate and an indicator
10. The emPATH Mobile Framework 10
UCSF mHealth Group 11/28/11
will appear on the phone to tell the patient that a message has been received
from their care provider. Communication is also supported using the standard
mobile device capabilities such as email, text messaging, and cellular.
Remote Data Analysis. An embedded rule system supported by the
Framework can interpret patient monitoring data as it arrives to the mobile
device. The rule system will alert the care provider via email immediately if the
data exceeds normal thresholds or any other criteria defined by the care
provider. New threshold or analysis rules can be uploaded to the patient’s
mobile device in real-time.
Simulation Mode. The Framework can execute in a special “simulation mode”
in which the application will “play” a previous session to allow patients and
physicians to participate in “Human Computer Interaction” (HCI) studies. These
studies do not require medical monitoring devices freeing the participants to
concentrate on HCI issues.
Data Visualization. Ability to graphically display patient monitoring data on the
mobile device.
Real-time Update. Ability to upload to the patient’s mobile device in real-time
new information such as analysis rules, patient background information,
session details, event types, data types, and patient education material. This
can be done without patient participation.
The EBM Framework
The second framework, the EBM Framework, supports dynamic care pathways. The
Framework is designed to spur further research into the application of EBM on mobile
devices by allowing researchers or providers to introduce new components or replace
existing components of the Framework. The interfaces between each component are
well defined by the Framework. The general architecture of the EBM Framework is
shown in Figure 1.6. The red borders indicate well-defined interfaces that allow the
component to be enhanced or replaced. The EBM Framework also supports the
blackboard system. The major components of the EBM Framework includes:
Utterance Engine. The Utterance Engine is the "Watson" (Ferruci et al., 2010)
component of the EBM framework. Its task is to generate utterances
("interactions") to the rendering engine. The interactions (for example, "How are
you feeling today?" or "Please adjust the medical device as follows...") are
determined by on-board care pathways or generated by on-board analytical
software. There are no inherent restrictions as to the complexity of the Utterance
Engine or how the engine derives the utterances.
Rendering Engine. The Rendering Engine is responsible for rendering
utterances to the user. The rendering will differ depending on patient attributes
such as demographics, patient/provider goals, current patient health, and
environmental issues. Current on-going research is deriving the ontology or
language to be used between the Utterance Engine and the Rendering Engine.
For example, the Utterance Engine may use an ontology to request pain
information from the patient without a specific textual utterance. The Rendering
Engine will then render the information request using information from the on-
board PMR and the Blackboard system.
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On-board PMR. The EBM Framework supports an on-board Personal Medical
Record system. The system is designed to synchronize with external Electronic
Medical Record (EMR) systems such as EPIC. The on-board PMR is intended to
hold detailed personal health information beyond that of an external EMR
because the mobile device has direct access to the patient and the patient's
environment.
External Sensors. The EBM Framework supports the ability to receive data from
external sensors and to render that data appropriately. For example, a sensor
may be transmitting patient heart rate data in which the EBM Framework will
receive the data and post the information to the Blackboard system for
processing.
Events (Metrics). The EBM Framework supports the ability to store event data
in an encrypted on-board database system. In addition, the Framework allows
researchers to define in real-time which metrics are tracked and managed.
Figure 1.6: The EBM Framework Architecture
Care pathways can reference the blackboard system. For example, if a care pathway
defines a step to request patient information and that information already exists in the
PMR then that step will be skipped. Figure 1.7 shows a reference in the care pathway
XML to an entry in the Blackboard. The ACTIVE element in the XML implies that the
interaction (step) will be rendered only if the patient has cancer in the left breast.
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Figure 1.7: The emPATH Framework Blackboard
Conclusion
The emPATH Framework has been used in more than twenty mobile research projects
at UCSF including one NIH RO1 clinical trial. Mobile devices have proved to be an
outstanding delivery model for patient care. With the appropriate care pathways, the
mobile solutions have proved very effective in treating patients. Clinical trial data will
help evolve the Framework as new types of clinical pathways appear for mobile devices.
Current clinical pathways fall short of the potential of mobile devices. Pathways are
typically static in nature and require long cycles to augment. This is understandable
since the validity of a pathway is paramount. But researchers are starting to see the
potential of clinical pathways on mobile devices and are changing their approaches. The
mHealth Group is continually evolving the emPATH Framework to not only keep up with
the needs of the researchers but also to introduce new ways to construct care pathways.
Future Work
The mHealth Group is evolving the emPATH Framework in three ways:
Developing how the Framework interacts with rendering systems including those
providing rich interfaces, gaming systems, and avatar-based systems.
Improving the self* features of care pathways in order to provide more
intelligence in support of autonomous handling of care pathways.
Positioning the Framework to increasingly work with body sensor networks and
body-worn medical devices.
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