Geoff Appelboom

Smart wearable body sensors for patient self-assessment and monitoring

BackgroundInnovations in mobile and electronic healthcare are revolutionizing the involvement of both doctors and patients in the modern healthcare system by extending the capabilities of physiological monitoring devices. Despite significant progress within the monitoring device industry, the widespread integration of this technology into medical practice remains limited. The purpose of this review is to summarize the developments and clinical utility of smart wearable body sensors.MethodsWe reviewed the literature for connected device, sensor, trackers, telemonitoring, wireless technology and real time home tracking devices and their application for clinicians.ResultsSmart wearable sensors are effective and reliable for preventative methods in many different facets of medicine such as, cardiopulmonary, vascular, endocrine, neurological function and rehabilitation medicine. These sensors have also been shown to be accurate and useful for perioperative monitoring and rehabilitation medicine.ConclusionAlthough these devices have been shown to be accurate and have clinical utility, they continue to be underutilized in the healthcare industry. Incorporating smart wearable sensors into routine care of patients could augment physician-patient relationships, increase the autonomy and involvement of patients in regards to their healthcare and will provide for novel remote monitoring techniques which will revolutionize healthcare management and spending.

The promise of wearable activity sensors to define patient recovery

The recent emergence of mobile health--the use of mobile telecommunication and wireless devices to improve health outcomes, services, and research--has inspired a patient-centric approach to monitor health metrics. Sensors embedded in wearable devices are utilized to acquire greater self-knowledge by tracking basic parameters such as blood pressure, heart rate, and body temperature as well as data related to exercise, diet, and psychological state. To that end, recent studies on utilizing wireless fitness activity trackers to monitor and promote functional recovery in patients suggest that collecting up-to-date performance data could help patients regain functional independence and help hospitals determine the appropriate length of stay for a patient. This manuscript examines existing functional assessment scales, discusses the use of activity tracking sensors in evaluating functional independence, and explores the growing application of wireless technology in measuring and promoting functional recovery.

Hematoma volume as the major determinant of outcomes after intracerebral hemorrhage

Intracerebral hemorrhage (ICH) is a leading cause of morbidity and mortality, greatly linked to hematoma volume. Understanding the characteristics and size of hematoma is integral to evaluating severity and prognosis after ICH. Examination of the literature suggests that markers for hematoma size vary, but the key range between 20-30 mL is most widely used as the cut-off for classification of hematoma volume. The role of hematoma volume in episodes of hematoma expansion and re-bleeding further impact outcomes, with increased growth associated with larger hematoma volume. Additionally, many commonly used predictors of ICH outcomes are directly related to hematoma volume, implicating it as an important variable when determining outcomes. In conclusion, hematoma volume is likely the most significant determinant of outcomes in intracerebral hemorrhage.

The quantified patient: a patient participatory culture.

Abstract The Quantified Self Movement, which aims to improve various aspects of life and health through recording and reviewing daily activities and biometrics, is a new and upcoming practice of self monitoring that holds much promise. Now, the most underutilized resource in ambulatory health care, the patient, can participate like never before, and the patient’s Quantified Self can be directly monitored and remotely accessed by health care professionals.

Motion Sensors to Assess and Monitor Medical and Surgical Management of Parkinson Disease

Patients with Parkinson disease (PD) often suffer from a resting tremor, bradykinesia, rigidity, postural instability, and gait difficulty. Determining a patients candidacy for deep-brain stimulation (DBS) surgery and tracking their clinical response postoperatively requires that the frequency, duration, and severity of these symptoms be characterized in detail. Conventional means of assessing these symptoms, however, rely heavily on patient self-reporting, which often fails to provide the necessary level of detail. Wearable accelerometers are a novel tool that can detect and objectively characterize these movement abnormalities in both the clinical setting and the patients home environment. In this article, we review the role of accelerometers in surgical candidate selection, recording and predicting falls, recording and predicting freezing of gait, evaluating surgical outcomes, and evaluating postoperative recovery and in altering DBS settings. Although accelerometry has yet to make it into the mainstream clinic, there is great promise for this technology in monitoring Parkinson patients.

The role of age in intracerebral hemorrhages

We aimed to identify the role of age in intracerebral hemorrhage (ICH), as well as characterize the most commonly used age cut off points in the literature, with the hope of understanding and guiding treatment. Strokes are one of the leading causes of death in the USA, and ICH is the deadliest type. Age is a strong risk factor, but it also affects the body in numerous ways, including changes to the cardiovascular and central nervous systems that interplay with the multiple risk factors for ICH. Understanding the role of age in risk and outcomes of ICH can guide treatment and future clinical trials. A current review of the literature suggests that the age cut offs for increased rates of mortality and morbidity vary from 60-80 years of age, with the most common age cut offs being at 65 or 70 years of age. In addition to age as a determinant of ICH outcomes, age has its own effects on the maturing body in terms of changes in physiology, while also increasing the risk of multiple chronic health conditions and comorbidities, including hypertension, diabetes, and anticoagulant treatment for atrial fibrillation, all of which contribute to the pathology of ICH. The interaction of these chronic conditions, changes in physiology, age, and ICH is evident. However, the exact mechanism and extent of the impacts remains unclear. The ambiguity of these connections may be further obscured by individual patient preferences, and there are limitations in the literature which guides the current recommendations for aging patients.

Aquaporin-4 gene variant independently associated with oedema after intracerebral haemorrhage

Abstract Introduction: Aquaporin-4 (AQP4) is the prominent water-channel protein in the brain playing a critical role in controlling cell water content. After intracerebral haemorrhage (ICH), perihematomal oedema (PHE) formation leads to a rapid increase in intracranial pressure (ICP) after the initial bleed. We sought to investigate the effect of a common genomic variant in the AQP4 gene on PHE formation after ICH. Methods: We reviewed the literature and identified a candidate polymorphism in AQP4 genes previously reported in Genome Wide Association Studies (GWAS). Between February 2009 and March 2011, 128 patients consented to genetic testing and were genotyped for single nucleotide polymorphism (SNP) on the AQP4 gene. Genomic DNA was extracted from buccal swabs using MasterAmp extraction kits (Epicentre, Madison, WI, USA). DNA extracted from buffy coats of whole blood samples was amplified via PCR. Linear regression with log-transformed ICH + PHE volume as the response variable was used to determine the association of SNP controlled for admission variables age, GCS, infratentorial location, hypertension, systolic blood pressure (SBP), blood urea nitrogen (BUN), glucose and alkaline phosphatase. Results: Nine of 128 patients had the minor allele for SNP rs1058427. Presence of the minor allele was significant in the model (P = 0.021), and associated with an increase of 88% in ICH + PHE volume (β = 0.632, exp(β) = 1.88) after controlling for admission variables. The only other significant variables included in the model was GCS (P < 0.001). Conclusion: The establishment of an independent association between rs1054827 and ICH + PHE volume provides evidence implicating the AQP4 gene in haematoma and oedema formation after ICH. Further investigation is needed to characterise this link.

Motion Sensors to Assess and Monitor Medical and Surgical Management ofParkinsonâÂÂs Disease

Patients with Parkinson’s Disease (PD) often suffer from a resting tremor, bradykinesia, rigidity, postural instability and gait difficulty. Determining a patient’s candidacy for Deep-Brain Stimulation (DBS) surgery and tracking their clinical response postoperatively requires that the frequency, duration, and severity of these symptoms be characterized in detail. Conventional means of assessing these symptoms, however, rely heavily on patient selfreporting, which often fails to provide the necessary level of detail. Wearable accelerometers are a novel tool that can detect and objectively characterize these movement abnormalities both in the clinical setting as well as in the patient’s home environment. In this article, we review the role of accelerometers in surgical candidate selection, recording and predicting falls, recording and predicting freezing of gait, evaluating surgical outcomes, and evaluating postoperative recovery and in altering DBS settings. While accelerometry has yet to make it into the mainstream clinic, there is great promise for this technology in monitoring Parkinson’s patients.

Patient engagement in clinical research through mobile technology

Rapid innovation and the adoption of mobile, cellular and digital technologies are dramatically changing the face of the global healthcare industry. With the ubiquity of mobile devices in today’s society, the impact of wireless technology in healthcare is multifaceted – promoting patient engagement, information sharing, and enhancing communication with providers. Perhaps most significant in wireless technology use in health is patient engagement. Patient engagement is defined as the active participation and actions patients take to reap the greatest benefits from the healthcare services and providers with whom they interact [1]. With the advent of mHealth, mobile and electronic health information technology that emphasizes shared decision-making and personal responsibility [2], mobile applications and devices are becoming well suited for use in chronic illnesses where patterns of health change may be gradual and subtle, but also often the best means of long-term management. As the application of the quantified self, a movement aiming to improve health and self through daily self-monitoring and recording [3], takes roots in the era of mobile health, the role of patient engagement and clinical research through mobile technology will blossom. Researchers and patients have been increasingly engaged by the advent of wearable monitoring devices and the scope offered by these. Personal devices available for health and fitness maintenance and monitoring are changing the face of fitness in today’s society, engaging participants daily [4], and forming a platform for the launch of new clinical research projects. Extension of wearable monitoring devices for health applications in clinical research is now a growing sector. With this technology, a plethora of medical parameters can be measured, monitored and recorded remotely by the patient himself, physicians, or third party researchers [2]. Building patient registries to accelerate clinical research is now potentially faster and more feasible. Additionally, the patient can become his or her own researcher, actively participating in self-experimentation with monitoring and tracking of behavior, lifestyle and health changes. Conversely, patients can engage in larger scale clinical trials, seeking to gain active participation in clinical trials with more patient-centered feedback as patient empowerment and engagement in his or her healthcare and clinical research develops [5]. With growth in this area of data collection, increasing development of this software and device technology, and expanding use by the population and patients, the wealth of information available is immense. Health researchers are increasingly able to access and analyze electronic health data, insurance claims and other kinds of traditional health information; however, they are largely restricted from the growing mounds of health and fitness data, courtesy of these personal fitness bands, devices and mobile applications. Perhaps tapping into this vast sea of data is the future of clinical research in areas of fitness, behavioral change, health monitoring and chronic illness management, Patient engagement in clinical research through mobile technology

Meta-analysis of Telemonitoring to Improve HbA1c Levels: Promises for Stroke Survivors

Background: Diabetes mellitus predisposes to ischemic stroke, a major cause of death in this population, and worsens the post-stroke prognosis. Monitoring glycemic control is useful not only in the primary prevention of stroke in diabetics, but also in the rehabilitation from and secondary prevention of stroke. In an often functionally and neurocognitively impaired population, however, poor compliance to treatment regimens is a major problem. Digital, wireless telemonitoring glucometers offer a solution to the compliance issue—not only do they give patients a dynamic experience of their own glycemic control via digital monitors, but many also have an integrated alert system with healthcare providers and more real-time feedback than traditional self-monitoring methods. Objective: To evaluate effectiveness of telemonitoring technologies in improving long-term glycemic control. Methods: A search on www.clinicaltrials.gov on November 2013, using keywords “telemonitoring” (n=103), “selfcare device” (n=50), and “self management device” (n=210), revealed trials investigating a range of chronic disease including heart disease, diabetes, COPD, asthma, and hypertension. Some of the cardiac-oriented trials utilized varying outcome measurements. Therefore, we only selected published diabetes trials comparing HbA1c levels of a group receiving standard of care to a group receiving a telemonitoring intervention. Using a random effects model of mean difference, a meta-analysis was conducted on five trials that measured differences in HbA1c levels between the two groups at six months follow-up. Results: Five clinical trials were identified. Four of the five studies showed a greater reduction in HbA1c in the intervention group compared to controls at 6 months, although only one was statistically significant. There was considerable heterogeneity between studies (I2= 69.5%, p=0.02). The random effects model estimated the aggregate effect size for mean difference in reduction of HbA1c levels in the treatment group vs. control to be 0.08% [-0.12- 0.28%], which was not statistically significant (p=0.42). Conclusions: The varying results may be due to specific factors in the trials that contributed to their large heterogeneity. Although there is great potential to use telemonitoring in stroke patients, further trials are needed to support its role in improving diabetes management in this population. Nonetheless, in the future telemonitoring may substantially help patients at risk of ischemic stroke and those who require close glucose monitoring.