Jaydeep Unni, Ph.D.
Sr. Project Manager, Robert Bosch Healthcare Systems, Palo Alto, CA
Remote Patient Monitoring – Challenges and Opportunities
Remote Patient Monitoring (RPM) is gaining importance and acceptance with rising number of chronic disease conditions and with increase in the aging population. As instances of Heart diseases, Diabetes etc are increasing the demand for these technologies are increasing. RPM devices typically collect patient vital sign data and in some case also patient responses to health related questions. Thus collected data is then transmitted through various modalities (wireless/Bluetooth/cellular) to Hospitals/Doctor’s office for clinical evaluation. With these solutions Doctors are able to access patient’s vital data ‘any time any where’ thus enabling them to intervene on a timely and effective manner. For older adult population chronic disease management, post-acute care management and safety monitoring are areas were RPM finds application. That said, there are significant challenges in adoption of Remote Patient Monitoring including patient willingness and compliance for adoption, affordability, availability of simpler/smarter technology to mention a few. But experts contend that if implemented correctly Remote Patient Monitoring can contain healthcare expenditure by reducing avoidable hospitalization while greatly improving quality of care.
Sharmila Mande, Ph.D.
Principal Scientist and Head, Bio Sciences R&D, TCS Innovation Labs, Pune
Gut microbiome and health: Moving towards the new era of translational medicine
The microbes inhabiting our body outnumber our own cells by a factor of 10. The genomes of these microbes, called the ‘second genome’ are therefore expected to have great influence on our health and well being. The emerging field of metagenomics is rapidly becoming the method of choice for studying the microbial community (called microbiomes) present in various parts of the human body. Recent studies have implicated the role of gut microbiomes in several diseases and disorders. Studies have indicated gut microbiome’s role in nutrient absorption, immuno-modulation motor-response, and other key physiological processes. However, our understanding of the role of gut microbiota in malnutrition is currently incomplete. Exploration of these aspects are likely to help in understanding the microbial basis for several physiological disorders associated with malnutrition (eg, increased susceptibility to diarrhoeal pathogens) and may finally aid in devising appropriate probiotic strategies addressing this menace. A metagenomic approach was employed for analysing the differences between gut microbial communities obtained from malnourished and healthy children. Results of the analysis using TCS’ ‘Metagenomic Analysis Platform’ were discussed in detail during my talk.
Srisairam Achuthan, Ph.D.
Senior Scientific Programmer, Research Informatics Division, Department of Information Sciences, City of Hope, CA, USA
Applying Machine learning for Automated Identification of Patient Cohorts
Srisairam Achuthan, Mike Chang, Ajay Shah, Joyce Niland
Patient cohorts for a clinical study are typically identified based on specific selection criteria. In most cases considerable time and effort are spent in finding the most relevant criteria that could potentially lead to a successful study. For complex diseases, this process can be more difficult and error prone since relevant features may not be easily identifiable. Additionally, the information captured in clinical notes is in non-coded text format. Our goal is to discover patterns within the coded and non-coded fields and thereby reveal complex relationships between clinical characteristics across different patients that would be difficult to accomplish manually. Towards this, we have applied machine learning techniques such as artificial neural networks and decision trees to determine patients sharing similar characteristics from available medical records. For this proof of concept study, we used coded and non-coded (i.e., clinical notes) patient data from a clinical database. Coded clinical information such as diagnoses, labs, medications and demographics recorded within the database were pooled together with non-coded information from clinical notes including, smoking status, life style (active / inactive) status derived from clinical notes. The non-coded textual information was identified and interpreted using a Natural Language Processing (NLP) tool I2E from Linguamatics.
H S M Kort, J-W J Lammers, S N W Vorrink, T Troosters
Introduction
Chronic Obstructive Pulmonary Disease (COPD) is a disabling airway disease with variable extrapulmonary effects that may contribute to disease severity in individual patients (Rabe et al. 2007). The world health organization predicts that COPD will become the third leading cause of death worldwide by 2030. Patients with COPD demonstrate reduced levels of spontaneous daily physical activity (DPA) compared with healthy controls (Pitta et al. 2005). This results in a higher risk of hospital admission and shorter survival (Pitta et al. 2006). Pulmonary rehabilitation can help to improve the DPA level, however, obtained benefits decline after 1–2 years (Foglio et al. 2007).
Purpose
In order to maintain DPA in COPD patients after rehabilitation, we developed a mobile phone application. This application measures DPA as steps per day, measured by the accelerometer of the smartphone, and shows the information to the patient via the display of the mobile phone. A physiotherapist can monitor the patient via a secure website where DPA measurements are visible for all patients. Here, DPA goals can be adjusted and text messages sent.
Method
Three pilot studies were performed with healthy students and COPD patients to test the application for usability, user friendliness and reliability with questionnaires and focus groups. Subjects also wore a validated accelerometer. For the Randomized Controlled Trial (RCT) 140 COPD patients will be recruited in Dutch physiotherapy practises. They will be randomised in an intervention group that receives the smartphone for 6 months and a control group. Measurements include lungfunction, dyspnea, and exercise capacity and are held at 0, 3, 6 and 12 months.
Results and Discussion
The application was found to be useful, easy to learn and use. Subjects had no problems with health care professionals seeing information on their physical activity performance. They do find it important to be able to determine who can see the information. Correlations between the accelerometer and the measurements on DPA of the smartphone for steps per hour were 0.69 and 0.70 for pilot studies 1 (students) and 2 (COPD patients) respectively. The version of the application in pilot study 3 contained an error, which made correlations with the accelerometer unusable. The RCT study is now being executed.
Arathy R and Binoy B Nair
PC based heart sound monitoring system
Heart diseases caused by disorders of the heart and blood vessels, are world’s largest killers. Early detection and monitoring of heart abnormalities is essential for diagnosis and effective treatment of heart diseases. Severalmethodologies are used for screening and diagnosing heart diseases. They are auscultation, electrocardiogram (ECG), echo-cardiogram, ultrasound etc. The effectiveness and applicability of all these diagnostic methods are highly dependent on the equipment cost and size as well as skill of the physician. This paper presents the design and development of a low cost portable wireless/tubeless digital stethoscope which can be used by the physician for monitoring the patient from a distance. The stethoscope system interfaces to a PC and is also capable of analyzing the heart sounds and identifying abnormalities in the heart sound and its classification. Storage of heart sound for later analysis is also possible.This advanced functionality increases the physician’s diagnostic capability, and such a PCG is not still available in most hospitals. Acoustic stethoscope can be changed into a digital stethoscope by inserting an electric capacity microphone into its diaphragm (Wang, Chen and Samjin, 2009).