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Being able to monitor the heart activity of patients during their daily life in a reliable, comfortable and affordable way is one main goal of the personalized medicine. Current wearable solutions lack either on the wearing comfort, the quality and type of the data provided or the price of the device. This paper shows the development of a Textile Sensor Platform (TSP) in the form of an electrocardiogram (ECG)-measuring T-shirt that is able to transmit the ECG signal to a smartphone. The development process includes the selection of the materials, the design of the textile electrodes taking into consideration their electrical characteristics and ergonomy, the integration of the electrodes on the garment and their connection with the embedded electronic part. The TSP is able to transmit a real-time streaming of the ECG-signal to an Android smartphone through Bluetooth Low Energy (BLE). Initial results show a good electrical quality in the textile electrodes and promising results in the capture and transmission of the ECG signal. This is still a working- progress and it is the result of an interdisciplinary master project between the School of Informatics and the School of Textiles & Design of the Reutlingen University.
The amount of image data has been rising exponentially over the last decades due to numerous trends like social networks, smartphones, automotive, biology, medicine and robotics. Traditionally, file systems are used as storage. Although they are easy to use and can handle large data volumes, they are suboptimal for efficient sequential image processing due to the limitation of data organisation on single images. Database systems and especially column-stores support more stuctured storage and access methods on the raw data level for entiere series.
In this paper we propose definitions of various layouts for an efficient storage of raw image data and metadata in a column store. These schemes are designed to improve the runtime behaviour of image processing operations. We present a tool called column-store Image Processing Toolbox (cIPT) allowing to easily combine the data layouts and operations for different image processing scenarios.
The experimental evaluation of a classification task on a real world image dataset indicates a performance increase of up to 15x on a column store compared to a traditional row-store (PostgreSQL) while the space consumption is reduced 7x. With these results cIPT provides the basis for a future mature database feature.
Analysis of multicellular patterns is required to understand tissue organizational processes. By using a multi-scale object oriented image processing method, the spatial information of cells can be extracted automatically. Instead of manual segmentation or indirect measurements, such as general distribution of contrast or flow, the orientation and distribution of individual cells is extracted for quantitative analysis. Relevant objects are identified by feature queries and no low-level knowledge of image processing is required.
Continuous monitoring of individual vital parameters can provide information for the assessment of one’s health and indications of medical problems in the context of personalized medicine. Correlations between parameters and health issues are to be evaluated. As one project in this topic area, a telemedicine platform is implemented to gather data of outpatients via wearables and accumulate them for physicians and researchers to review. This work extracts requirements, draws use case scenarios, and shows the current system architecture consisting of a patient application, a physician application with a web server, and a backend server application. In further work, the prototype will assist to develop a vendor-free and open monitoring solution. A conclusion on functionality and usability will be evaluated in an imminent first study.
The implementation of a web based portal QA solution will lead to a high acceptance of the staff as the usage of commonly known standard software (e.g. web browser) allows intuitive handling. In the daily use a significant simplification of the workflow and Performance enhancement can be achieved by easy access to the check documents. As the data is now saved in a database it can easily be processed and long-term trends can be displayed. Therefore possible errors can be detected much easier and earlier. By the usage of time stamps and user authentication procedures and user responsibilities are comprehensibly documented. As the software is browser based, integration into an existing software Environment is not critical. As only technical QA data is processed, no further data security measures are necessary. A certification as a medical product is not required.
Mobile monitoring of outpatients during cancer therapy becomes possible through technological advancements. This study leveraged a new remote patient monitoring app for in-between systemic therapy sessions. Patients’ evaluation showed that the handling is feasible. Clinical implementation must consider an adaptive development cycle for reliable operations.
Background
Although teledermatology has been proven internationally to be an effective and safe addition to the care of patients in primary care, there are few pilot projects implementing teledermatology in routine outpatient care in Germany. The aim of this cluster randomized controlled trial was to evaluate whether referrals to dermatologists are reduced by implementing a store-and-forward teleconsultation system in general practitioner practices.
Methods
Eight counties were cluster randomized to the intervention and control conditions. During the 1-year intervention period between July 2018 and June 2019, 46 general practitioner practices in the 4 intervention counties implemented a store-and-forward teledermatology system with Patient Data Management System interoperability. It allowed practice teams to initiate teleconsultations for patients with dermatologic complaints. In the four control counties, treatment as usual was performed. As primary outcome, number of referrals was calculated from routine health care data. Poisson regression was used to compare referral rates between the intervention practices and 342 control practices.
Results
The primary analysis revealed no significant difference in referral rates (relative risk = 1.02; 95% confidence interval = 0.911–1.141; p = .74). Secondary analyses accounting for sociodemographic and practice characteristics but omitting county pairing resulted in significant differences of referral rates between intervention practices and control practices. Matched county pair, general practitioner age, patient age, and patient sex distribution in the practices were significantly related to referral rates.
Conclusions
While a store-and-forward teleconsultation system was successfully implemented in the German primary health care setting, the intervention's effect was superimposed by regional factors. Such regional factors should be considered in future teledermatology research.
Background: Internationally, teledermatology has proven to be a viable alternative to conventional physical referrals. Travel cost and referral times are reduced while patient safety is preserved. Especially patients from rural areas benefit from this healthcare innovation. Despite these established facts and positive experiences from EU neighboring countries like the Netherlands or the United Kingdom, Germany has not yet implemented store-and-forward teledermatology in routine care.
Methods: The TeleDerm study will implement and evaluate store-and-forward teledermatology in 50 general practitioner (GP) practices as an alternative to conventional referrals. TeleDerm aims to confirm that the possibility of store-and-forward teledermatology in GP practices is going to lead to a 15% (n = 260) reduction in referrals in the intervention arm. The study uses a cluster-randomized controlled trial design. Randomization is planned for the cluster “county”. The main observational unit is the GP practice. Poisson distribution of referrals is assumed. The evaluation of secondary outcomes like acceptance, enablers and barriers uses a mixed methods design with questionnaires and interviews.
Discussion: Due to the heterogeneity of GP practice organization, patient management software, information technology service providers, GP personal technical affinity and training, we expect several challenges in implementing teledermatology in German GP routine care. Therefore, we plan to recruit 30% more GPs than required by the power calculation. The implementation design and accompanying evaluation is expected to deliver vital insights into the specifics of implementing telemedicine in German routine care.
Integrating tools and applications into a clinically useful system for individual continuous health data surveillance requires an architecture considering all relevant medical and technical conditions. Therefore, the requirements of an integrated system including a health app to collect and monitor sensor data to support personalized medicine are analyzed. The structure and behavior of the system are defined regarding the specific health use cases and scenarios. A vendor-independent architecture, which enables the collection of vital data from arbitrary wearables using a smartphone, is presented. The data is centrally managed and processed by attending physicians. The modular architecture allows the system to extend to new scenarios, data formats, etc. A prototypical implementation of the system shows the feasibility of the approach.
A clinically useful system for individual continuous health data monitoring needs an architecture that takes into account all relevant medical and technical conditions. The requirements for a health app to support such a system are collected, and a vendor independent architecture is designed that allows the collection of vital data from arbitrary wearables using a smartphone. A prototypical implementation for the main scenario shows the feasibility of the approach.