Guenter Schreier

The Internet of Things for Ambient Assisted Living

The Internet of Things (IoT) is the logical further development of today’s Internet. Technological advancements lead to smart objects being capable of identifying, locating, sensing and connecting and thus leading to new forms of communication between people and things and things themselves. Ambient Assisted Living (AAL) encompasses technical systems to support elderly people in their daily routine to allow an independent and safe lifestyle as long as possible. Keep In Touch (KIT) uses smart objects and technologies (Near Field Communication and Radio Frequency Identification) to facilitate telemonitoring processes. Closed Loop Healthcare Services take use of KIT technology and are capable of processing relevant data and establishing communication channels between elderly people and their environment and different groups of care-givers (physicians, relatives, mobile care providers). The combination of KIT technology (smart objects) and Closed Loop Healthcare Services results in an applied IoT infrastructure for AAL scenarios. Already applied IoT and AAL applications in telemonitoring and medication intake compliance projects show that these applications are useful and accepted by the elderly and that the developed infrastructure enables a new form of communication between people and people, people-to-people (P2P) communication. The personal communication between elderly people, their environment and relevant groups of care givers is an important aspect in AAL. Through the combination of KIT and Closed Loop Healthcare, a central AAL paradigm can be realized through the IoT, where the elderly live in their homes with smart objects, thus smart homes, communicating to the outside world in an intelligent and goal-orientated manner.

Effect of Home-Based Telemonitoring Using Mobile Phone Technology on the Outcome of Heart Failure Patients After an Episode of Acute Decompensation: Randomized Controlled Trial

Background Telemonitoring of patients with chronic heart failure (CHF) is an emerging concept to detect early warning signs of impending acute decompensation in order to prevent hospitalization. Objective The goal of the MOBIle TELemonitoring in Heart Failure Patients Study (MOBITEL) was to evaluate the impact of home-based telemonitoring using Internet and mobile phone technology on the outcome of heart failure patients after an episode of acute decompensation. Methods Patients were randomly allocated to pharmacological treatment (control group) or to pharmacological treatment with telemedical surveillance for 6 months (tele group). Patients randomized into the tele group were equipped with mobile phone–based patient terminals for data acquisition and data transmission to the monitoring center. Study physicians had continuous access to the data via a secure Web portal. If transmitted values went outside individually adjustable borders, study physicians were sent an email alert. Primary endpoint was hospitalization for worsening CHF or death from cardiovascular cause. Results The study was stopped after randomization of 120 patients (85 male, 35 female); median age was 66 years (IQR 62-72). The control group comprised 54 patients (39 male, 15 female) with a median age of 67 years (IQR 61-72), and the tele group included 54 patients (40 male, 14 female) with a median age of 65 years (IQR 62-72). There was no significant difference between groups with regard to baseline characteristics. Twelve tele group patients were unable to begin data transmission due to the inability of these patients to properly operate the mobile phone (“never beginners”). Four patients did not finish the study due to personal reasons. Intention-to-treat analysis at study end indicated that 18 control group patients (33%) reached the primary endpoint (1 death, 17 hospitalizations), compared with 11 tele group patients (17%, 0 deaths, 11 hospitalizations; relative risk reduction 50%, 95% CI 3-74%, P = .06). Per-protocol analysis revealed that 15% of tele group patients (0 deaths, 8 hospitalizations) reached the primary endpoint (relative risk reduction 54%, 95% CI 7-79%, P= .04). NYHA class improved by one class in tele group patients only (P< .001). Tele group patients who were hospitalized for worsening heart failure during the study had a significantly shorter length of stay (median 6.5 days, IQR 5.5-8.3) compared with control group patients (median 10.0 days, IQR 7.0-13.0; P= .04). The event rate of never beginners was not higher than the event rate of control group patients. Conclusions Telemonitoring using mobile phones as patient terminals has the potential to reduce frequency and duration of heart failure hospitalizations. Providing elderly patients with an adequate user interface for daily data acquisition remains a challenging component of such a concept.

Feasibility of a Mobile Phone–Based Data Service for Functional Insulin Treatment of Type 1 Diabetes Mellitus Patients

Background Patients with type 1 diabetes mellitus (DM1) have to be active participants in their treatment because they are inevitably responsible for their own day-to-day-care. Availability of mobile Internet access is advancing rapidly and mobile phones are now widely available at low cost. Thus, mobile phones have the potential to assist in daily diabetes management and to enable a telemedical interaction between patients and health care professionals. Objective The aim of the study was to evaluate the feasibility and user acceptance of a mobile phone–based data service to assist DM1 patients on intensive insulin treatment. Methods A software application called Diab-Memory (based on Java 2 Mobile Edition) has been developed to support patients when entering diabetes-related data with synchronization to the remote database at the monitoring center. The data were then processed to generate statistics and trends, which were provided for the patient and his/her health care professional via a Web portal. The system has been evaluated in the course of a clinical before-after pilot trial. Outcome measures focused on patients’ adherence to the therapy, availability of the monitoring system, and the effects on metabolic status. General user acceptance of the system was evaluated using a questionnaire. Results Ten patients (four female) with DM1 participated in the trial. Mean age was 36.6 years (± 11.0 years) and prestudy glycated hemoglobin (HbA1c) was 7.9% (± 1.1%). A total of 3850 log-ins were registered during the 3 months of the study. The total number of received datasets was 13003, which equates to an average of 14 transmitted parameters per patient per day. The service was well accepted by the patients (no dropouts), and data transmission via mobile phone was successful on the first attempt in 96.5% of cases. Upon completion of the study, a statistically significant improvement in metabolic control was observed (HbA1c: prestudy 7.9% ± 1.1% versus poststudy 7.5% ± 0.9%;P= .02). While there was a slight decrease in average blood glucose level (prestudy 141.8 mg/dL ± 22.5 mg/dL vs poststudy 141.2 mg/dL ± 23.1 mg/dL;P= .69), the difference was not statistically significant. Conclusion The results of the clinical pilot trial indicate that this proposed diabetes management system was well accepted by the patients and practical for daily usage. Thus, using the mobile phone as patient terminal seems to provide a ubiquitous, easy-to-use, and cost efficient solution for patient-centered data acquisition in the management of DM1. To confirm the promising results of the pilot trial further research has to be done to study long-term effects on glycemic control and cost-effectiveness.

Randomized trial of prophylactic granulocyte colony-stimulating factor during rapid COJEC induction in pediatric patients with high-risk neuroblastoma: The European HR-NBL1/SIOPEN study

PURPOSE To reduce the incidence of febrile neutropenia during rapid COJEC (cisplatin, vincristine, carboplatin, etoposide, and cyclophosphamide given in a rapid delivery schedule) induction. In the High-Risk Neuroblastoma-1 (HR-NBL1) trial, the International Society of Paediatric Oncology European Neuroblastoma Group (SIOPEN) randomly assigned patients to primary prophylactic (PP) versus symptom-triggered granulocyte colony-stimulating factor (GCSF; filgrastim). PATIENTS AND METHODS From May 2002 to November 2005, 239 patients in 16 countries were randomly assigned to receive or not receive PPGCSF. There were 144 boys with a median age of 3.1 years (range, 1 to 17 years) of whom 217 had International Neuroblastoma Staging System (INSS) stage 4 and 22 had stage 2 or 3 MYCN-amplified disease. The prophylactic arm received a single daily dose of 5 microg/kg GCSF, starting after each of the eight COJEC chemotherapy cycles and stopping 24 hours before the next cycle. Chemotherapy was administered every 10 days regardless of hematologic recovery, provided that infection was controlled. RESULTS The PPGCSF arm had significantly fewer febrile neutropenic episodes (P = .002), days with fever (P = .004), hospital days (P = .017), and antibiotic days (P = .001). Reported Common Toxicity Criteria (CTC) graded toxicity was also significantly reduced: infections per cycle (P = .002), fever (P < .001), severe leucopenia (P < .001), neutropenia (P < .001), mucositis (P = .002), nausea/vomiting (P = .045), and constipation (P = .008). Severe weight loss was reduced significantly by 50% (P = .013). Protocol compliance with the rapid induction schedule was also significantly better in the PPGCSF arm shown by shorter time to completion (P = .005). PPGCSF did not adversely affect response rates or success of peripheral-blood stem-cell harvest. CONCLUSION Following these results, PPG-GSF was advised for all patients on rapid COJEC induction.

A pilot study of mobile phone-based therapy for obese patients

Summary We conducted a pilot study to assess the feasibility of a web-based therapy management system with mobile phone access to support obese patients. A total of 25 patients participated in the study. The mean age of the patients was 48 years. The mean body mass index of the patients at recruitment was 35.6 kg/m2. The mean observation period was 70 days. A total of 361 successful data transmissions was performed — the mean number of transmissions per patient was 14. The total number of outgoing reminder messages was 123, corresponding to 4.9 reminder messages per patient. At the end of the study, there were significant reductions of 2.4 cm in abdominal girth (P < 0.001), 2.4 kg in bodyweight (P < 0.001) and 0.78 kg/m2 in body mass index (P < 0.001). In a questionnaire at the end of the study, the majority of the participants gave answers that indicated a positive attitude towards the system. The pilot study showed that mobile phones can be utilized as patient terminals for therapy in patients suffering from obesity.

Near Field Communication Technology as the Key for Data Acquisition in Clinical Research

Electronic data capture systems are utilized to collect, document, and process research data for clinical trials. Ideally, the workflow of collecting the data could be simplified by using mobile clients that enable for data acquisition at the point-of-care. Mobile phones provide a range of features to act as data acquisition unit for clinical trials. A novel approach towards an automated solution is the combination of mobile phones with Near Field Communication (NFC) technology. This technology enables for easy-to-use data acquisition just by touching items. The aim of this work has been to design and develop an additional path for clinical data acquisition based on mobile phones and NFC technology. The system was utilized in a pilot trial and evaluated regarding usability and feasibility for clinical application.

An automatic ECG processing algorithm to identify patients prone to paroxysmal atrial fibrillation

An algorithm to identify patients prone to paroxysmal atrial fibrillation (PAF) has been developed and evaluated using the PAF Prediction Challenge Database. The procedure is based on conventional electrocardiogram (ECG) signal pre-processing techniques for beat detection and classification, a correlation-based assessment of the P-wave morphology of both regular and premature heart beats of supraventricular origin, and a statistical test to calculate the PAF predictive parameter, i.e. the probability that a certain degree of P-wave variability is associated with potential triggers for PAF. This probability, finally, is used to differentiate between patients with and without PAF (screening) and to find out which of the two recordings of each patient immediately precedes the onset of PAF (prediction), respectively. The obtained diagnostic accuracies of 82% and 84%, respectively, indicate that this concept may be useful in terms of clinical PAF risk stratification.

A small-scale randomised controlled trial of home telemonitoring in patients with severe chronic obstructive pulmonary disease

Introduction This was a pilot study to examine the effects of home telemonitoring (TM) of patients with severe chronic obstructive pulmonary disease (COPD). Methods A randomised controlled 12-month trial of 42 patients with severe COPD was conducted. Home TM of oximetry, temperature, pulse, electrocardiogram, blood pressure, spirometry, and weight with telephone support and home visits was tested against a control group receiving only identical telephone support and home visits. Results The results suggest that TM had a reduction in COPD-related admissions, emergency department presentations, and hospital bed days. TM also seemed to increase the interval between COPD-related exacerbations requiring a hospital visit and prolonged the time to the first admission. The interval between hospital visits was significantly different between the study arms, while the other findings did not reach significance and only suggest a trend. There was a reduction in hospital admission costs. TM was adopted well by most patients and eventually, also by the nursing staff, though it did not seem to change patients’ psychological well-being. Discussion Ability to draw firm conclusions is limited due to the small sample size. However the trends of reducing hospital visits warrant a larger study of a similar design. When designing such a trial, one should consider the potential impact of the high quality of care already made available to this patient cohort.

Development of an electronic database for quality assurance of radiotherapy in the International Society of Paediatric Oncology (Europe) high risk neuroblastoma study.

Quality assurance of radiotherapy is an important determinant of outcome in some cancers. SIOPEN-R-NET developed a computerised remote data entry system for recording imaging and treatment parameters for its multimodality high risk neuroblastoma study. This will enable investigation of the relationship between radiotherapy quality and local control.

Initial experiences with a telemedicine framework for remote pacemaker follow-up

According to international guidelines implanted cardiac pacemakers (PM) have to be checked periodically to ensure that they are working correctly. To spare a significant number of patients the burden of traveling to specialized PM clinics a telemedicine framework has been developed prototypically. A mobile, personal digital assistant (PDA) based PM follow-up unit provides the caregiver at the point-of-care with the necessary infrastructure to perform a basic PM follow-up examination remotely. In case of detected malfunction of the PM the patient is ordered to the hospital for further examination. The system has been evaluated in a clinical pilot trial on 44 patients with a total of 23 different PM models from 8 different manufacturers. The initial results indicate the potential of the concept to work as an efficient, manufacturer independent screening method with the ultimate goal to increase the safety, quality and efficiency of PM therapy