Made available in DSpace on 2014-12-17T14:54:59Z (GMT). No. of bitstreams: 1 CeciliaRML_TESE.pdf: 2405004 bytes, checksum: b79db46caa488d92a5933e45e80ca647 (MD5) Previous issue date: 2011-06-10 / The area of the hospital automation has been the subject a lot of research, addressing relevant issues which can be automated, such as: management and control (electronic medical records, scheduling appointments, hospitalization, among others); communication (tracking patients, staff and materials), development of medical, hospital and laboratory equipment; monitoring (patients, staff and materials); and aid to medical diagnosis (according to each speciality). This thesis presents an architecture for a patient monitoring and alert systems. This architecture is based on intelligent systems techniques and is applied in hospital automation, specifically in the Intensive Care Unit (ICU) for the patient monitoring in hospital environment. The main goal of this architecture is to transform the multiparameter monitor data into useful information, through the knowledge of specialists and normal parameters of vital signs based on fuzzy logic that allows to extract information about the clinical condition of ICU patients and give a pre-diagnosis. Finally, alerts are dispatched to medical professionals in case any abnormality is found during monitoring. After the validation of the architecture, the fuzzy logic inferences were applied to the trainning and validation of an Artificial Neural Network for classification of the cases that were validated a priori with the fuzzy system / A ?rea da automa??o hospitalar tem sido alvo de muitas pesquisas, abordando problemas pertinentes que podem ser automatizados, como: gerenciamento e controle (prontu?rio eletr?nico, marca??o de consulta, internamento, entre outros); comunica??o (rastreamento de pacientes, materiais e funcion?rios); desenvolvimento de equipamentos m?dicos, hospitalares e laboratoriais; monitoramento (pacientes, materiais e funcion?rios); e aux?lio ao diagn?stico m?dico (de acordo com cada especialidade). Esta tese de doutorado apresenta uma Arquitetura de um Sistema Inteligente de Monitoramento e Envio de Alertas de Pacientes (SIMAp). A arquitetura est? baseada em t?cnicas de sistemas inteligentes e aplicada na automa??o hospitalar, mais especificamente em Unidade de Terapia Intensiva (UTI) para monitoramento de pacientes. O objetivo do SIMAp ? a transforma??o dos dados do monitor multiparam?trico em informa??es, por meio do conhecimento dos especialistas e dos par?metros de normalidade dos sinais vitais de pacientes, utilizando l?gica fuzzy na extra??o das informa??es a respeito do quadro cl?nico de pacientes internados em UTI. Por fim, alertas s?o gerados e podem ser enviados para a equipe m?dica, caso seja encontrada alguma anormalidade no monitoramento. Ap?s a valida??o da arquitetura, as infer?ncias oriundas do modelo fuzzy foram aplicadas no treinamento e valida??o de uma RNA para a classifica??o das situa??es previstas no modelo, resultando no pr?-diagn?sticos

Made available in DSpace on 2014-12-17T14:55:46Z (GMT). No. of bitstreams: 1 BrunoGA_DISSERT.pdf: 1765683 bytes, checksum: 36a019ab0774ddb05d83c6ceb1679e89 (MD5) Previous issue date: 2010-08-10 / Hospital Automation is an area that is constantly growing. The emergency of new technologies and hardware is transforming the processes more efficient. Nevertheless, some of the hospital processes are still being performed manually, such as monitoring of patients that is considered critical because it involves human lives. One of the factors that should be taken into account during a monitoring is the agility to detect any abnormality in vital signs of patients, as well as warning of this anomaly to the medical team involved. So, this master's thesis aims to develop an architecture to automate this process of monitoring and reporting of possible alert to a professional, so that emergency care can be done effectively. The computing mobile was used to improve the communication by distributing messages between a central located into the hospital and the mobile carried by the duty / A Automa??o Hospitalar consiste numa ?rea que est? em constante crescimento. Os processos envolvidos est?o sendo informatizados e automatizados cada vez mais com o surgimento de novas tecnologias e novos hardwares. Apesar disso, muitos dos processos envolvidos ainda est?o sendo realizados de forma manual, como ? o caso do monitoramento de pacientes, considerado um processo cr?tico por estar envolvido com vidas humanas. Um dos fatores que deve ser levado em conta durante um monitoramento ? a agilidade na detec??o de alguma anomalia nos sinais vitais de pacientes, assim como o aviso desta anomalia ? equipe m?dica envolvida. Visando isto, o presente trabalho de mestrado visa apresentar uma arquitetura para automatizar este processo de monitoramento e comunica??o de poss?veis alertas a um profissional da ?rea, para que o atendimento de urg?ncias possa ser feito de forma eficaz. Foi utilizada a computa??o m?vel e distribu?da para a comunica??o e envio de mensagens entre uma central localizada no hospital, e o dispositivo m?vel portado pelo plantonista

Computers network in the hospital environments are central topics of discussion on the use of systems applied to health care to ensure data capture of vital signs. This study aims at analyzing the data capture model of the proposed sensor node, using the Modbus protocol communication standard in the acquisition of multi-parametric information of biological signs of patients. The research was conducted with experimental purpose to characterize the ModBus protocol in the RS485 serial network. It was also performed a systematic review to support the choice of the data model and serial communication standard in wired networks. Thus, a sensor node prototype (PIC18F26K20) was built to capture body temperature and heart rate in the wired communication network in which the protocols CAN and ModBUS were tested. The data from the sensor nodes were subjected to capture tests and sending the data to the central node, and displayed on portable platform (Smartphones). It was also observed the bandwidth characteristics and quality of the obtained data. The systematic review showed a trend in the use of the CAN protocol as wired communication standard for HealthCare activities, the application used in the experiment presented limitations. However, after the experiment using the ModBus protocol, this was adequate and easy to implement applications in the hospital environment, having a low-cost platform as a solution to that area. / Redes de computadores em ambientes hospitalares são temas centrais de discussão sobre a utilização de sistemas aplicados à atividade em saúde que garantam a captura dos dados de sinais vitais. O presente trabalho teve como objetivo analisar o modelo de captura dos dados do nodo sensor proposto, utilizando o padrão de comunicação do protocolo ModBUS na aquisição de informações multiparamétricas de sinais biológicos de pacientes. A pesquisa foi desenvolvida com propósito experimental para a caracterização do protocolo ModBUS sob a rede serial RS485. Foi realizada, ainda, uma revisão sistemática para subsidiar a escolha do modelo de dados e do padrão de comunicação serial em redes cabeadas. Para tanto, foi construído um protótipo de nodo sensor (PIC18F26K20) para captura de temperatura corporal e frequência cardíaca na comunicação da rede com fio na qual os protocolos CANbus e ModBUS foram testados. Os dados dos nodos sensores foram submetidos a testes de captura e envio dos dados ao nodo central, e exibidos em plataforma portáteis (Smartphones). Foram, ainda, observadas as características de largura de banda e qualidade dos dados obtidos. A revisão sistemática demonstrou uma tendência na utilização do protocolo CANbus como padrão de comunicação cabeado para as atividades HealthCare, a aplicação utilizada no experimento apresentou limitações. No entanto, após experimento utilizando o protocolo ModBus, este mostrou-se adequado e de fácil implementação em aplicações na área hospitalar, tendo uma plataforma de baixo custo como solução para a referida área.

Serious illness in childhood is a rare occurrence, but accounts for 20% of childhood deaths. Early recognition and treatment of serious illness is vital if the child is to recover without long-term disability. It is known that vital signs such as heart rate, respiratory rate, temperature, and oxygen saturation can be used to identify children who are at high risk of serious illness. This thesis presents research into the development of a vital signs monitor, designed for use in the initial assessment of unwell children at their first point of contact with a medical practitioner. Child-friendly monitoring techniques are used to obtain vital signs, which can then be combined using data fusion techniques to assist clinicians in identifying children with serious illness. Existing normal ranges for heart rate and respiratory rate in childhood vary considerably, and do not appear to be based on clinical evidence. This thesis presents a systematic meta-analysis of heart rate and respiratory rate from birth to 18 years of age, providing evidence-based curves which can be used to assess the degree of abnormality in these important vital signs. Respiratory rate is particularly difficult to measure in children, but is known to be predictive of serious illness. Current methods of automated measurement can be distressing, or are time-consuming to apply. This thesis therefore presents a novel method for estimating the respiratory rate from an optical finger sensor, the pulse oximeter, which is routinely used in clinical practice. Information from multiple vital signs can be used to identify children at risk of serious illness. A number of data fusion techniques were tested on data collected from children attending primary and emergency care, and shown to outperform equivalent existing scoring systems when used to identify those with more serious illness.

<p>Тешка траума се може дефинисати на неколико различитих начина. Најчешће коришћена дефиниција укључује коришћење Injury Severity Score ( ISS скор). Ако је вредност ISS скор &gt;15, ради се о тешкој трауми. Траума је временски осетљиво стање, због тога је за збрињавање тешко повређених пацијената неопходна добра сарадња различитих нивоа здравствене заштите и здравствених стручњака различитих специјалности. У претходних неколико деценија, због сложенијег процеса лечења и великих трошкова, дошло је до потребе за што објективнијом проценом стања повређеног и исхода лечења. Циљ: Упоредити сензитивност и специфичност T-RTS скорa (Triage Revised Trauma Score), CRAMS скалe (Circulation, Respiration, Abdomen, Motor and Speech), МGAP скора (Mechanism, Glasgow coma scale, Age, and arterial Pressure) и GAP скора (Glasgow coma scale, Age, and arterial Pressure) примењених на прехоспиталном нивоу, проценити могућности прехоспитално примењених RTS, CRAMS, МGAP и GAP скорова у предикцији исхода лечења повређеног пацијента и утврдити значај појединачних фактора, одређиваних на прехоспиталном нивоу током иницијалног прегледa повређеног, за процену тежине повреде и предикцију исхода лечења повређеног. Истраживање је проспективног, опсервационог карактера. У истраживање су укључени пацијенти старији од 18 година, које су лекари Заводa за хитну медицинску помоћ Нови Сад (ЗЗХМП НС) и Службe хитне медицинске помоћи Дома здравља Бечеј (СХМП ДЗ Бечеј) збрињавали на терену након трауме, а потом их транспортовали у Ургентни центар Клиничког центра Војводине (УЦ КЦВ). На основу вредности ISS скора пацијенти су сврстани у једну од две групе: група А- пацијенти код којих је ISS скор након завршене дијагностике изнад 15- тешка траума и група Б -пацијенти код којих је након завршене дијагностике ISS скор &le;15- лака траума. У групи А је било 50, а у групи Б 257 пацијената. За граничне вредности скорова које означавају да траума није лака, највећу сензитивност у оцени тежине трауме је имао GAP скор 98,8%, а највећу специфичност MGAP скор 62%. У предвиђању исхода лечења, највећу сензитивност је имао RTS скор за предикцију 95,2%, а специфичност GAP скор и CRAMS скала 87,5%. MGAP скор, а пошто је у снажној корелацији са њим и GAP скор, мерени прехоспитално, су се издвојили као независни предиктор у оцени тежине трауме и предвиђању исхода лечења повређеног. Т- RTS скор и CRAMS скала су се издвојили као појединачни предиктори у оцени тежине трауме, али не и као независни предиктори. RTS скор за предикцију нема статистичку значајност у предвиђању исхода лечења повређеног, за разлику од CRAMS скале која има, али се није издвојила као независни предиктор исхода лечења. Осим наведених траума скорова, као независни предиктори у оцени тежине трауме издвојили су се: систолни крвни притисак, SaO2 у периферној крви мерена пулсном оксиметријом, повреда главе и врата и повреда грудног коша. За предвиђање исхода лечења повређеног само се SaO2 у периферној крви мерена пулсном оксиметријом издвојила као појединачни предиктор, али не и као независни предиктор исхода.</p> / <p>Teška trauma se može definisati na nekoliko različitih načina. Najčešće korišćena definicija uključuje korišćenje Injury Severity Score ( ISS skor). Ako je vrednost ISS skor &gt;15, radi se o teškoj traumi. Trauma je vremenski osetljivo stanje, zbog toga je za zbrinjavanje teško povređenih pacijenata neophodna dobra saradnja različitih nivoa zdravstvene zaštite i zdravstvenih stručnjaka različitih specijalnosti. U prethodnih nekoliko decenija, zbog složenijeg procesa lečenja i velikih troškova, došlo je do potrebe za što objektivnijom procenom stanja povređenog i ishoda lečenja. Cilj: Uporediti senzitivnost i specifičnost T-RTS skora (Triage Revised Trauma Score), CRAMS skale (Circulation, Respiration, Abdomen, Motor and Speech), MGAP skora (Mechanism, Glasgow coma scale, Age, and arterial Pressure) i GAP skora (Glasgow coma scale, Age, and arterial Pressure) primenjenih na prehospitalnom nivou, proceniti mogućnosti prehospitalno primenjenih RTS, CRAMS, MGAP i GAP skorova u predikciji ishoda lečenja povređenog pacijenta i utvrditi značaj pojedinačnih faktora, određivanih na prehospitalnom nivou tokom inicijalnog pregleda povređenog, za procenu težine povrede i predikciju ishoda lečenja povređenog. Istraživanje je prospektivnog, opservacionog karaktera. U istraživanje su uključeni pacijenti stariji od 18 godina, koje su lekari Zavoda za hitnu medicinsku pomoć Novi Sad (ZZHMP NS) i Službe hitne medicinske pomoći Doma zdravlja Bečej (SHMP DZ Bečej) zbrinjavali na terenu nakon traume, a potom ih transportovali u Urgentni centar Kliničkog centra Vojvodine (UC KCV). Na osnovu vrednosti ISS skora pacijenti su svrstani u jednu od dve grupe: grupa A- pacijenti kod kojih je ISS skor nakon završene dijagnostike iznad 15- teška trauma i grupa B -pacijenti kod kojih je nakon završene dijagnostike ISS skor &le;15- laka trauma. U grupi A je bilo 50, a u grupi B 257 pacijenata. Za granične vrednosti skorova koje označavaju da trauma nije laka, najveću senzitivnost u oceni težine traume je imao GAP skor 98,8%, a najveću specifičnost MGAP skor 62%. U predviđanju ishoda lečenja, najveću senzitivnost je imao RTS skor za predikciju 95,2%, a specifičnost GAP skor i CRAMS skala 87,5%. MGAP skor, a pošto je u snažnoj korelaciji sa njim i GAP skor, mereni prehospitalno, su se izdvojili kao nezavisni prediktor u oceni težine traume i predviđanju ishoda lečenja povređenog. T- RTS skor i CRAMS skala su se izdvojili kao pojedinačni prediktori u oceni težine traume, ali ne i kao nezavisni prediktori. RTS skor za predikciju nema statističku značajnost u predviđanju ishoda lečenja povređenog, za razliku od CRAMS skale koja ima, ali se nije izdvojila kao nezavisni prediktor ishoda lečenja. Osim navedenih trauma skorova, kao nezavisni prediktori u oceni težine traume izdvojili su se: sistolni krvni pritisak, SaO2 u perifernoj krvi merena pulsnom oksimetrijom, povreda glave i vrata i povreda grudnog koša. Za predviđanje ishoda lečenja povređenog samo se SaO2 u perifernoj krvi merena pulsnom oksimetrijom izdvojila kao pojedinačni prediktor, ali ne i kao nezavisni prediktor ishoda.</p> / <p>Severe trauma could be defined in several ways. The most commonly used definition includes Injury Severity Score (ISS) and severe trauma is determined if ISS &gt;15. Trauma management is a time sensitive issue and a coordination between different levels of health system and many specialists is vital in the treatment of severe trauma. In the last decades, a need for the objective evaluation of the severity of trauma and its outcome was perceived due to the complex management and treatment of trauma and its costs. Aim of the study: to compare the sensitivity and specificity between prehospital scores T-RTS (Revised Trauma Score), CRAMS (Circulation, Respiration, Abdomen, Motors, Speech), MGAP (Mechanism, Glasgow Coma Scale, Age, Arterial Pressure) and GAP (Glasgow Coma Scale, Age, Arterial Pressure), to assess the predictability of prehospital scores (RTS, CRAMS, MGAP and GAP) in the outcome of traumatized patients, to determine the significance of individual factors, initially determined during the prehospital evaluation, in evaluating the severity of trauma and the outcome of treatment. Patients enrolled into this prospective observational study were older than 18, prehospitally treated on the trauma site by the doctors of the Institute of the Emergency Medicine Novi Sad and Health Centre Bečej &ndash; Emergency Medical Service and afterward transported into the Emergency Centre Novi Sad. Based on ISS values, patients were divided into two groups: Group A &ndash; severe trauma (50 patients; ISS&gt;15) and Group B &ndash; mild trauma (257 patients; ISS&le;15). For the broder values of scores, determining the severity of trauma, GAP had the highest sensitivity (98%), while MGAP had the highest specificity (62%). RTS had the highest sensitivity in predicting the outcome (95.2%), while GAP and CRAMS had specificity of 87.5%. Prehospital MGAP score, in strong correlation with GAP, was singled out for its independent predictive value in determining the severity of trauma and its outcome. T-RTS and CRAMS stood out to be individual &ndash; but not independent &ndash; predictors in evaluating the severity of trauma. RTS was not statistically significant in predicting the outcome, in contrast with CRAMS. However, CRAMS was not singled out as an independent predictor of the outcome. In addition to the scores, independent predictors of the severity of trauma were: systolic blood pressure, arterial oxygen saturation (SaO2) by using the pulse oximeter, head, neck and thorax injuries. Only SaO2 proved to be a single &ndash; but not independent &ndash; predictor of the outcome.</p>

Blind source separation (BSS) aims at separating useful signal content from distortions. In the contactless acquisition of vital signs by means of the camera-based photoplethysmogram (cbPPG), BSS has evolved the most widely used approach to extract the cardiac pulse. Despite its frequent application, there is no consensus about the optimal usage of BSS and its general benefit. This contribution investigates the performance of BSS to enhance the cardiac pulse from cbPPGs in dependency to varying input data characteristics. The BSS input conditions are controlled by an automated spatial preselection routine of regions of interest. Input data of different characteristics (wavelength, dominant frequency, and signal quality) from 18 postoperative cardiovascular patients are processed with standard BSS techniques, namely principal component analysis (PCA) and independent component analysis (ICA). The effect of BSS is assessed by the spectral signal-tonoise ratio (SNR) of the cardiac pulse. The preselection of cbPPGs, appears beneficial providing higher SNR compared to standard cbPPGs. Both, PCA and ICA yielded better outcomes by using monochrome inputs (green wavelength) instead of inputs of different wavelengths. PCA outperforms ICA for more homogeneous input signals. Moreover, for high input SNR, the application of ICA using standard contrast is likely to decrease the SNR.

Hospital environments are ranked as one of the most stressful contemporary work environments for their employees, and this especially concerns nurses (Nejati et al. 2016). One of the core problems comprises the notion that the current technology adopted in hospitals does not support the mobile nature of medical work and the complex work environment, in which people and information are distributed (Bardram 2003). The employment of inadequate technology and the strenuous access to information results in a decrease in efficiency regarding the fulfilment of medical tasks, and puts a strain on the attention of the medical personnel. This thesis proposes a solution to the aforementioned problems through the design of ambient displays, that inform the medical personnel with the health statuses of patients whilst requiring minimal allocation of attention. The ambient displays concede a hierarchy of information, where the most essential information encompasses an overview of patients’ vital signs. Data regarding the vital signs are measured by biometric sensors and are embodied by shape-changing interfaces, of which the ambient displays consist. User-authentication permits the medical personnel to access a deeper layer within the hierarchy of information, entailing clinical data such as patient EMRs, after gesture-based interaction with the ambient display. The additional clinical information is retrieved on the user’s PDA, and can subsequently be viewed in more detail, or modified at any place within the hospital.In this thesis, prototypes of shape-changing interfaces were designed and evaluated in a hospital environment. The evaluation was focused on the interaction design and user-experience of the shape-changing interface, the capabilities of the ambient displays to inform users through peripheral awareness, as well as the remote communication between patient and healthcare professional through biometric data. The evaluations indicated that the required attention allocated for the acquisition of information from the shape-changing interface was minimal. The interaction with the ambient display, as well as with the PDA when accessing additional clinical data, was deemed intuitive, yet comprised a short learning curve. Furthermore, the evaluations in situ pointed out that for optimised communication through the ambient displays, an overview of the health statuses of approximately eight patients should be displayed, and placed in the corridors of the hospital ward.