In-patient deterioration is a global phenomena and timely recognition and action improves outcome. Intensive care facilities are scarce and expensive and therefore patient care must be optimal. A retrospective health record analysis was used for this study. The findings indicated that nursing personnel do not recognize patient deterioration timeuously. However, the implementation of an outreach team and clinical markers training program improved the recognition of patient deterioration in general wards with three hours and 40 minutes. It is recommended to implement a comprehensive hospital program that addresses the basic knowledge and skills of general ward personnel to observe, recognize, assess and intervene to patients with clinical deterioration. Together with an extensive training program, a basic physiological parameters guideline to activate a team of experts to the bedside, such as an Outreach team, assist nursing personnel to recognize and manage those patients timeuously and ensure treatment in an appropriate level of care. / Health Studies / M. A. (Health studies)

A Úlcera por Pressão (UP) é uma lesão na pele e em tecidos subjacentes causada pela prolongada exposição de regiões do corpo à pressão. O surgimento de UPs impacta diretamente na qualidade de vida de pacientes acamados, já que são feridas dolorosas, e levam à um aumento no tempo de internação para que seja feito o seu tratamento. Abordagens que utilizam software para monitorar automaticamente pacientes acamados vem sendo propostas para apoiar a prevenção de UP\'s. Por meio de uma revisão sistemática, pode-se identificar o estado da arte de tais abordagens, que são baseadas principalmente em sensores instalados sobre o colchão para identificar pontos de pressão. Para realização do monitoramento por essas abordagens, há necessidade do contato do equipamento com o corpo do paciente. Por conta disso, questões como conforto e a higienização ou troca do equipamento, quando um novo paciente precisa ser monitorado devem ser levadas em consideração. Neste trabalho, foi desenvolvido um sistema para apoio à prevenção de úlcera por pressão (SAPU) que realiza o monitoramento de movimentações e posição de decúbito de uma maneira alternativa às abordagens existentes. São recuperados dados de posição e imagens de profundidade do sensor de movimentos Kinect, que são utilizados por métodos de estimativa de movimentação e posição de decúbito propostos neste trabalho. Assim, não se faz necessário o contato direto do paciente com o equipamento de monitoramento. Além disso, o sistema provê, aos profissionais da saúde, indicadores de movimentação por regiões do corpo, que é uma informação que não é provida por outras abordagens existentes. Um experimento preliminar foi realizado com três participantes, que foram instruídos a realizar uma série de movimentações e troca de posição para avaliação dos métodos de estimativa da posição de decúbito e movimentação utilizados pelo SAPU. Os resultados, apesar de preliminares, dão indícios da viabilidade de sua aplicação para monitoramento de pacientes acamados. / Pressure ulcer (PU) is a lesion on the skin and underlying tissues caused by prolonged exposure of body regions to pressure. PU directly impacts bedridden patients\' quality of life since they are painful and may lead to a prolonged period of hospital internment in order to be treated. Approaches that use software to automatically monitor bedridden patients have been proposed to support pressure ulcer prevention. Through a systematic review, we identified the state of art of these approaches that are mainly based on sensors installed on a mattress to identify pressure points. Since the patient is in contact with the monitoring equipment, issues like comfort and the equipment hygiene or replacement when a new patient is monitored need to be considered. In this paper, we present a system to support pressure ulcer prevention (SAPU) that automatically monitors the patient\'s movements and decubitus positions in an alternative way. Position data and depth images are obtained from the Kinect motion sensor and used by methods we proposed to estimate movement and decubitus positions without any contact of the monitoring equipment with the patient. The system also provides movements indicators by body regions that is an information not given by other approaches. A preliminary experiment have been carried out with three participants that performed a sequence of movements and assumed different decubitus positions so that we could evaluate the methods to estimate the decubitus positions and movements detection that are used by SAPU. Even though the results are preliminary, they provide evidence that these methods can be applied in order to monitor patient\'s movements and decubitus positions.

A Úlcera por Pressão (UP) é uma lesão na pele e em tecidos subjacentes causada pela prolongada exposição de regiões do corpo à pressão. O surgimento de UPs impacta diretamente na qualidade de vida de pacientes acamados, já que são feridas dolorosas, e levam à um aumento no tempo de internação para que seja feito o seu tratamento. Abordagens que utilizam software para monitorar automaticamente pacientes acamados vem sendo propostas para apoiar a prevenção de UP\'s. Por meio de uma revisão sistemática, pode-se identificar o estado da arte de tais abordagens, que são baseadas principalmente em sensores instalados sobre o colchão para identificar pontos de pressão. Para realização do monitoramento por essas abordagens, há necessidade do contato do equipamento com o corpo do paciente. Por conta disso, questões como conforto e a higienização ou troca do equipamento, quando um novo paciente precisa ser monitorado devem ser levadas em consideração. Neste trabalho, foi desenvolvido um sistema para apoio à prevenção de úlcera por pressão (SAPU) que realiza o monitoramento de movimentações e posição de decúbito de uma maneira alternativa às abordagens existentes. São recuperados dados de posição e imagens de profundidade do sensor de movimentos Kinect, que são utilizados por métodos de estimativa de movimentação e posição de decúbito propostos neste trabalho. Assim, não se faz necessário o contato direto do paciente com o equipamento de monitoramento. Além disso, o sistema provê, aos profissionais da saúde, indicadores de movimentação por regiões do corpo, que é uma informação que não é provida por outras abordagens existentes. Um experimento preliminar foi realizado com três participantes, que foram instruídos a realizar uma série de movimentações e troca de posição para avaliação dos métodos de estimativa da posição de decúbito e movimentação utilizados pelo SAPU. Os resultados, apesar de preliminares, dão indícios da viabilidade de sua aplicação para monitoramento de pacientes acamados. / Pressure ulcer (PU) is a lesion on the skin and underlying tissues caused by prolonged exposure of body regions to pressure. PU directly impacts bedridden patients\' quality of life since they are painful and may lead to a prolonged period of hospital internment in order to be treated. Approaches that use software to automatically monitor bedridden patients have been proposed to support pressure ulcer prevention. Through a systematic review, we identified the state of art of these approaches that are mainly based on sensors installed on a mattress to identify pressure points. Since the patient is in contact with the monitoring equipment, issues like comfort and the equipment hygiene or replacement when a new patient is monitored need to be considered. In this paper, we present a system to support pressure ulcer prevention (SAPU) that automatically monitors the patient\'s movements and decubitus positions in an alternative way. Position data and depth images are obtained from the Kinect motion sensor and used by methods we proposed to estimate movement and decubitus positions without any contact of the monitoring equipment with the patient. The system also provides movements indicators by body regions that is an information not given by other approaches. A preliminary experiment have been carried out with three participants that performed a sequence of movements and assumed different decubitus positions so that we could evaluate the methods to estimate the decubitus positions and movements detection that are used by SAPU. Even though the results are preliminary, they provide evidence that these methods can be applied in order to monitor patient\'s movements and decubitus positions.

[Truncated abstract] Physical healthcare uses a suite of tools for measuring response to treatment. However, reliable systems of regular patient monitoring are rare in mental healthcare. Mental health services often measure a treatment response from pre- to post- therapy, yet measurement between those occasions is less common. This omission is problematic since arguably there is a need for an alarm system in psychotherapy (Andrews & Page, 2005). A substantial minority of patients do not experience reliable change following treatment, and a small proportion deteriorates (Hansen, Lambert, & Forman, 2002; Newnham, Harwood, & Page, 2007). Without monitoring, it is not always possible to know which patients are progressing poorly. Since the publication of Howard and colleagues' (1996) proposal that patient progress be monitored routinely during therapy and the results fed back to clinicians to direct treatment, this monitoring regime has garnered attention in the United States and Europe (Lambert, 2007; Lutz, et al., 2006). Findings in outpatient psychotherapy have demonstrated that providing real-time feedback on patient progress to clinicians and patients significantly improves clinical outcomes for those patients demonstrating a negative response to treatment (Harmon et al., 2007; Lambert et al., 2001; Lambert et al., 2002). What is not yet apparent is how these processes would generalize to inpatient and day patient (i.e. patients attending hospital for a whole day of treatment) psychiatric care. Inpatients often present with greater severity and are treated in an intensive setting. ... Deviations from this expected pattern would highlight possible differences between inpatient and outpatient care. To develop an appropriate system for monitoring patient progress, it was important to first define clinically significant recovery in inpatient psychiatric care, and provide criteria for clinicians to judge outcome in routine practice (Newnham, Harwood, & Page, 2007). Second, a quick and easy-to-administer system of progress monitoring and real-time feedback was developed to enhance treatment decision making (Newnham, Hooke, & Page, 2009). Third, the system was evaluated to determine clinical effectiveness. Using the World Health Organization’s Wellbeing Index, a program for monitoring patient progress and providing feedback to clinicians and patients was established at Western Australia's largest private psychiatric service. The sample consisted of 1308 consecutive inpatients and day patients whose primary diagnoses were predominantly depressive (67.7%) and anxiety (25.9%) disorders. Feedback to patients and clinicians was effective in reducing depressive symptoms (F (1,649) = 6.29, p<.05) for those patients at risk of poor outcome, but not effective in improving wellbeing (F (1,569) = 1.14, p>.05). The findings support the use of progress monitoring and feedback in psychiatric care to improve symptom outcomes, but raise questions about changes in wellbeing during psychotherapy. The effectiveness study was conducted as a historical cohort trial, consistent with quality improvement efforts, and replication with a randomized controlled design is warranted. Feedback of progress information appears to be an important process within psychotherapy, and further investigation of the means by which clinicians and patients use that information is necessary.

Compliance to strict home exercise programs is understood to be a mainstay of post-surgical flexor tendon rehabilitation. Therapists recognise the potential of poor compliance (overuse or under-use of prescribed exercise) and spontaneous movements during rehabilitation. Some therapists may suggest that compliance to specific exercise regimens and control of spontaneous or general movements are fundamentally important in optimising the rehabilitation outcomes and minimising the potential of adverse events. Yet there is little objective data to document the actual levels of exercise or spontaneous finger movement performed outside the clinical setting. The purpose of this study was to document both diary and instrumented methods of reporting finger movement during a 48hr period. Following surgical repair of the flexor tendon, subjects attending a private hand therapy clinic provided consent and reported subjective diary (n=16) data of sets and repetitions of exercise for up to 6 weeks post-operatively. Nine subjects also had instrumented data logged on 3 occasions during the first 6 weeks of rehabilitation and were not fully aware of the purpose of the instrumentation. All subjects were instructed to perform 10 passive followed by 10 active exercises every waking hour, for the first 6 weeks and were assessed on range of motion, DASH, pain and strength. Results demonstrated that patients reported, via their diaries, that they are on average 80% compliant. Parallel data logger information suggests that this figure is more likely to reflect 50% compliance. A significant (p< .05) increase in spontaneous movements in the last 2 weeks of the 6 week assessment period was detected. No significant correlation between patient's level of compliance or spontaneous movement and their outcome were detected.

In-patient deterioration is a global phenomena and timely recognition and action improves outcome. Intensive care facilities are scarce and expensive and therefore patient care must be optimal. A retrospective health record analysis was used for this study. The findings indicated that nursing personnel do not recognize patient deterioration timeuously. However, the implementation of an outreach team and clinical markers training program improved the recognition of patient deterioration in general wards with three hours and 40 minutes. It is recommended to implement a comprehensive hospital program that addresses the basic knowledge and skills of general ward personnel to observe, recognize, assess and intervene to patients with clinical deterioration. Together with an extensive training program, a basic physiological parameters guideline to activate a team of experts to the bedside, such as an Outreach team, assist nursing personnel to recognize and manage those patients timeuously and ensure treatment in an appropriate level of care. / Health Studies / M. A. (Health studies)

Made available in DSpace on 2014-12-17T14:55:18Z (GMT). No. of bitstreams: 1 ViniciusSVS_TESE.pdf: 2375594 bytes, checksum: e3d85d405a408eb605711ffd55dbe760 (MD5) Previous issue date: 2014-03-17 / The monitoring of patients performed in hospitals is usually done either in a manual or semiautomated way, where the members of the healthcare team must constantly visit the patients to ascertain the health condition in which they are. The adoption of this procedure, however, compromises the quality of the monitoring conducted since the shortage of physical and human resources in hospitals tends to overwhelm members of the healthcare team, preventing them from moving to patients with adequate frequency. Given this, many existing works in the literature specify alternatives aimed at improving this monitoring through the use of wireless networks. In these works, the network is only intended for data traffic generated by medical sensors and there is no possibility of it being allocated for the transmission of data from applications present in existing user stations in the hospital. However, in the case of hospital automation environments, this aspect is a negative point, considering that the data generated in such applications can be directly related to the patient monitoring conducted. Thus, this thesis defines Wi-Bio as a communication protocol aimed at the establishment of IEEE 802.11 networks for patient monitoring, capable of enabling the harmonious coexistence among the traffic generated by medical sensors and user stations. The formal specification and verification of Wi-Bio were made through the design and analysis of Petri net models. Its validation was performed through simulations with the Network Simulator 2 (NS2) tool. The simulations of NS2 were designed to portray a real patient monitoring environment corresponding to a floor of the nursing wards sector of the University Hospital Onofre Lopes (HUOL), located at Natal, Rio Grande do Norte. Moreover, in order to verify the feasibility of Wi-Bio in terms of wireless networks standards prevailing in the market, the testing scenario was also simulated under a perspective in which the network elements used the HCCA access mechanism described in the IEEE 802.11e amendment. The results confirmed the validity of the designed Petri nets and showed that Wi-Bio, in addition to presenting a superior performance compared to HCCA on most items analyzed, was also able to promote efficient integration between the data generated by medical sensors and user applications on the same wireless network / O monitoramento de pacientes realizado nos hospitais normalmente ? feito de forma manual ou semi-automatizada, em que os membros da equipe de sa?de precisam constantemente se deslocar at? os pacientes para verificarem o estado de sa?de em que eles se encontram. A ado??o desse procedimento, todavia, compromete a qualidade do monitoramento realizado, uma vez que a escassez de recursos f?sicos e humanos nos hospitais tende a sobrecarregar os membros da equipe de sa?de e assim impedir que os mesmos se desloquem aos pacientes com a freq??ncia adequada. Diante disso, diversos trabalhos existentes na literatura especificam alternativas voltadas ? melhoria desse monitoramento mediante o uso de redes sem fio. Nesses trabalhos, a rede ? destinada apenas ao tr?fego de dados gerados por sensores m?dicos e n?o existe a possibilidade da mesma ser alocada para o envio de informa??es oriundas de aplica??es presentes nas esta??es de usu?rio existentes no hospital. Todavia, em se tratando de ambientes de automa??o hospitalar, esse aspecto constitui-se em um ponto negativo, haja vista que os dados gerados nessas aplica??es podem estar diretamente relacionados ao monitoramento de pacientes realizado. Desse modo, esta tese define o Wi-Bio como sendo um protocolo de comunica??o voltado ao estabelecimento de redes de monitoramento de pacientes IEEE 802.11 capazes de permitir a conviv?ncia harmoniosa entre os tr?fegos gerados por sensores m?dicos e esta??es de usu?rio. A especifica??o e verifica??o formal do Wi-Bio foram feitas mediante o projeto e an?lise de modelos em redes de Petri e sua valida??o foi realizada atrav?s simula??es efetuadas na ferramenta Network Simulator 2 (NS2). As simula??es realizadas no NS2 foram projetadas para retratarem um ambiente real de monitoramento de pacientes correspondente a um andar do setor de enfermarias do Hospital Universit?rio Onofre Lopes (HUOL), localizado na cidade de Natal/RN. Al?m disso, no intuito de verificar a viabilidade do Wi-Bio quanto aos padr?es de redes sem fio vigentes no mercado, o cen?rio de testes tamb?m foi simulado sob uma perspectiva em que os elementos da rede utilizavam o mecanismo de acesso HCCA descrito na emenda IEEE 802.11e. Os resultados obtidos atestaram a validade das redes de Petri projetadas e mostraram que o Wi-Bio, al?m de apresentar um desempenho superior ao do HCCA na maioria dos quesitos analisados, tamb?m se mostrou capaz de promover uma integra??o eficiente entre os dados gerados por sensores m?dicos e aplica??es de usu?rio sob a mesma rede sem fio

Submitted by Ana Caroline Costa (ana_caroline212@hotmail.com) on 2018-11-30T19:09:50Z No. of bitstreams: 2 Dissertação - Hugo de Almeida Ribeiro - 2018.pdf: 2177519 bytes, checksum: fb8741d8762fdd3e58e586442025299e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-12-03T13:16:23Z (GMT) No. of bitstreams: 2 Dissertação - Hugo de Almeida Ribeiro - 2018.pdf: 2177519 bytes, checksum: fb8741d8762fdd3e58e586442025299e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-12-03T13:16:23Z (GMT). No. of bitstreams: 2 Dissertação - Hugo de Almeida Ribeiro - 2018.pdf: 2177519 bytes, checksum: fb8741d8762fdd3e58e586442025299e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-11-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Healthcare demand is expected to surpass healthcare offer in the next years, encumbering the healthcare system. In one side we have an increase in life expectancy, and therefore the occurrence of chronic diseases, while on the other side we have a shortage of healthcare professionals. Remote patient monitoring systems can be used to continuously keep track of a person health status. When integrated to social networking services, we can build a carer network around the patient. This network is composed of formal (healthcare professionals) and informal carers (family and friends). Information regarding the patient health status can be disseminated within the carer network. Then the remote patient monitoring system may instruct informal carers to assist the patient before recommending formal care. Thus reducing the demands over the healthcare system. There are research initiatives on health information dissemination using social networking. But these initiatives are isolated. This dissertation aims to propose a domain model and an architectural model for remote patient monitoring systems that integrate social networking services unifying concepts found in state-of-the-art literature. The proposed solution is based on three sub-domains: remote patient monitoring systems, enable continuous health status monitoring; social networking services, allow actors to show interest in monitoring other actors health status; and event notification systems, distribute health information among actors. An skeletal system was built to validate the proposal. This skeletal systems consists on modifying an existing system to satisfy restrictions imposed by the proposed models and an usage scenario. / Espera-se que nos próximos anos a demanda por cuidados de saúde supere a oferta, debilitando o sistema de saúde. Os aumentos da expectativa de vida e da ocorrência de doenças crônicas vão de encontro a falta de profissionais de saúde. Sistemas de monitoramento remoto de pacientes podem ser usados para acompanhar continuamente o estado de saúde de uma pessoa. Quando integrados a serviços de redes sociais, uma rede de cuidadores pode ser formada ao redor do paciente. Esta rede é composta por cuidadores formais (profissionais de saúde) e informais (familiares e amigos). Informação a respeito do estado de saúde do paciente pode ser disseminada na rede de cuidadores. Dessa forma, o sistema de monitoramento remoto pode instruir cuidadores informais a auxiliar o paciente antes de recomendar cuidado profissional, reduzindo, portanto, as demandas sobre o sistema de saúde. Existem esforços de pesquisa de soluções que permitam a disseminação de informação de saúde usando abordagem de redes sociais. No entanto, essas pesquisas encontram-se isoladas. Este trabalho tem como objetivo propor um modelo de domínio e um modelo arquitetural que integrem serviços de rede social para disseminar informação de um paciente para sua rede de cuidadores, unificando os conceitos presentes na literatura. A solução apresentada baseia-se em três subdomínios: sistemas de monitoramento remoto de pacientes, os quais permitem o acompanhamento contínuo do estado de saúde dos pacientes; serviços de redes sociais, que possibilitam que os atores do sistema informem ter interesse em acompanhar o estado de saúde de outros atores; e sistemas de notificação de eventos, que distribuem as informações de saúde entre os atores. A validação foi realizada por meio de esqueleto de sistema, consistindo na modificação de um sistema existente, satisfazendo às restrições dos modelos propostos e atendendo a um cenário de uso.

Every year in the UK, tens of thousands of hospital patients suffer adverse events, such as un-planned transfers to Intensive Therapy Units or unexpected cardiac arrests. Studies have shown that in a large majority of cases, significant physiological abnormalities can be observed within the 24-hour period preceding such events. Such warning signs may go unnoticed, if they occur between observations by the nursing staff, or are simply not identified as such. Timely detection of these warning signs and appropriate escalation schemes have been shown to improve both patient outcomes and the use of hospital resources, most notably by reducing patients’ length of stay. Automated real-time early-warning systems appear to be cost-efficient answers to the need for continuous vital-sign monitoring. Traditionally, a limitation of such systems has been their sensitivity to noisy and artefactual measurements, resulting in false-alert rates that made them unusable in practice, or earned them the mistrust of clinical staff. Tarassenko et al. (2005) and Hann (2008) proposed a novelty detection approach to the problem of continuous vital-sign monitoring, which, in a clinical trial, was shown to yield clinically acceptable false alert rates. In this approach, an observation is compared to a data fusion model, and its “normality” assessed by comparing a chosen statistic to a pre-set threshold. The method, while informed by large amounts of training data, has a number of heuristic aspects. This thesis proposes a principled approach to multivariate novelty detection in stochastic time- series, where novelty scores have a probabilistic interpretation, and are explicitly linked to the starting assumptions made. Our approach stems from the observation that novelty detection using complex multivariate, multimodal generative models is generally an ill-defined problem when attempted in the data space. In situations where “novel” is equivalent to “improbable with respect to a probability distribution ”, formulating the problem in a univariate probability space allows us to use classical results of univariate statistical theory. Specifically, we propose a multivariate extension to extreme value theory and, more generally, order statistics, suitable for performing novelty detection in time-series generated from a multivariate, possibly multimodal model. All the methods introduced in this thesis are applied to a vital-sign monitoring problem and compared to the existing method of choice. We show that it is possible to outperform the existing method while retaining a probabilistic interpretation. In addition to their application to novelty detection for vital-sign monitoring, contributions in this thesis to existing extreme value theory and order statistics are also valid in the broader context of data-modelling, and may be useful for analysing data from other complex systems.

First part of this thesis presents the design, validation, and implementation of an Orthogonal Frequency Division Multiplexing (OFDM) transmitter and receiver on a Cyclone II FPGA chip using DSP builder and Quartus II high level design tools. The resources in terms of logical elements (LE) including combinational functions and logic registers allocated by the model have been investigated and addressed. The result shows that implementing the basic OFDM transceiver allocates about 14% (equivalent to 6% at transmitter and 8% at receiver) of the available LE resources on an Altera Cyclone II EP2C35F672C6 FPGA chip, largely taken up by the FFT, IFFT and soft decision encoder. Secondly, a new wavelet-based OFDM system based on FDPP-DA based channel estimation is proposed as a reliable ECG Patient Monitoring System, a Personal Wireless telemedicine application. The system performance for different wavelet mothers has been investigated. The effects of AWGN and multipath Rayleigh fading channels have also been studied in the analysis. The performances of FDPP-DA and HDPP-DA-based channel estimations are compared based on both DFT-based OFDM and wavelet-based OFDM systems. The system model was studied using MATLAB software in which the average BER was addressed for randomized data. The main error differences that reflect the quality of the received ECG signals between the reconstructed and original ECG signals are established. Finally a DA-based architecture for 1-D iDWT/DWT based on an OFDM model is implemented for an ECG-PMS wireless telemedicine application. In the portable wireless body transmitter unit at the patient site, a fully Serial-DA-based scheme for iDWT is realized to support higher hardware utilization and lower power consumption; whereas a fully Parallel-DA-based scheme for DWT is applied at the base unit of the hospital site to support a higher throughput. It should be noted that the behavioural level of HDL models of the proposed system was developed and implemented to confirm its correctness in simulation. Then, after the simulation process the design models were synthesised and implemented for the target FPGA to confirm their validation.